Hysteresis activation of accelerated pacing
First Claim
Patent Images
1. An implantable medical device compromising:
- a sensing arrangement to sense electrical cardiac signals;
a pulse generator to deliver stimulation pulses to a heart; and
a control arrangement, responsive to the sensing arrangement, to respond to an intrinsic heart rate decreasing below a first hysteresis rate by directing the pulse generator to deliver stimulation pulses at an accelerated rate greater than a programmed lower rate for a programmed duration, decreasing the rate of delivery after the proqrammed duration, and directing the pulse generator to deliver additional stimulation pulses at the accelerated rate if the intrinsic heart rate does not increase to a level at or above the first rate, wherein the control arrangement is further configured to select the accelerated rate as the greater of a fixed rate and art average heart rate over a period immediately before decrease of the intrinsic heart rate below the hysteresis rate.
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Abstract
An improved pacemaker has a hysteresis feature that activates accelerated pacing during periods of sinus arrest and/or extreme bradycardia. When the patient'"'"'s intrinsic heart rate drops below a hysteresis rate, the pacemaker reverts to a programmable accelerated rate or to the average cardiac rate. Accelerated pacing is delivered for a programmable period of time, after which the pacing rate is gradually reduced toward a lower rate. If a desirable intrinsic rate is not attained after the pacing rate is reduced to the lower rate, the intervention cycle repeats.
89 Citations
36 Claims
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1. An implantable medical device compromising:
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a sensing arrangement to sense electrical cardiac signals;
a pulse generator to deliver stimulation pulses to a heart; and
a control arrangement, responsive to the sensing arrangement, to respond to an intrinsic heart rate decreasing below a first hysteresis rate by directing the pulse generator to deliver stimulation pulses at an accelerated rate greater than a programmed lower rate for a programmed duration, decreasing the rate of delivery after the proqrammed duration, and directing the pulse generator to deliver additional stimulation pulses at the accelerated rate if the intrinsic heart rate does not increase to a level at or above the first rate, wherein the control arrangement is further configured to select the accelerated rate as the greater of a fixed rate and art average heart rate over a period immediately before decrease of the intrinsic heart rate below the hysteresis rate. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12)
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13. An implantable medical device system comprising:
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a sensing arrangement to sense electrical cardiac signals;
a pulse generator to deliver stimulation pulses to a heart;
at least one pacing lead, coupled to the pulse generator and configured to deliver the stimulation pulses to a chamber of the heart; and
a control arrangement responsive to the sensing arrangement and configured to respond to an intrinsic heart rate decreasing below a hysteresis rate by directing the pulse generator to deliver stimulation pulses to the heart at an accelerated rate greater than a programmed lower rate for a programmed duration, decreasing the rate of delivery after the programmed duration, and repeating directing the pulse generator to deliver stimulation pulses at the accelerated rate unless the intrinsic heart rate is recovered, wherein the control arrangement is further configured to select the accelerated rate as the greater of a fixed rate and an average heart rate over a period immediately before decrease of the intrinsic heart rate below the hysteresis rate. - View Dependent Claims (14, 15, 16, 17, 18, 19, 20, 21, 22, 23)
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24. A method of cardiac pacing comprising:
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detecting an intrinsic heart rate;
when the intrinsic heart rate decreases below a hysteresis rate, delivering stimulation pulses to a heart at an accelerated rate greater than a programmed lower rate for a programmed duration;
decreasing the rate of delivery after the programmed duration; and
repeating delivering stimulation pulses at the accelerated rate unless the intrinsic heart rate is recovered, further comprising selecting the accelerated rate as the greater of a fixed rate and an average heart rate over a period immediately before decrease of the intrinsic heart rate below the hysteresis rate. - View Dependent Claims (25, 26, 27, 28, 29, 30)
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31. A method of cardiac pacing comprising:
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defining a hysteresis rate lower than a programmed lower rate and an accelerated rate greater than the programmed lower rate;
when an intrinsic heart rate decreases below the hysteresis rate, delivering stimulation pulses to a heart at the accelerated rate for a programmed duration;
decreasing the rate of delivery after the programmed duration at a programmed rate of deceleration; and
ceasing delivery of stimulation pulses when the intrinsic heart rate returns to a normal rate, further comprising selecting the accelerated rate as the greater of a fixed rate and an average heart rate over a period immediately before decrease of the intrinsic heart rate below the hysteresis rate.
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32. A method of manufacturing an implantable medical device comprising:
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providing a sensing arrangement to sense electrical cardiac signals;
providing a pulse generator to deliver stimulation pulses to a heart;
coupling a control arrangement to the sensing arrangement; and
programming the control arrangement to respond to an intrinsic heart rate decreasing below a hysteresis rate by directing the pulse generator to deliver stimulation pulses to the heart at an accelerated rate greater than a programmed lower rate for a programmed duration decreasing the rate of delivery after the programmed duration, and repeating directing the pulse generator to deliver stimulation pulses at the accelerated rate unless the intrinsic heart rate is recovered, further comprising programming the control arrangement to select the accelerated rate as the greater of a fixed rate and an average heart rate over a period immediately before decrease of the intrinsic heart rate below the hysteresis rate. - View Dependent Claims (33, 34, 35, 36)
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Specification