Multi-site cardiac stimulation device for controlling inter-chamber stimulation delay

• US 6,937,895 B1
• Filed: 08/14/2001
• Issued: 08/30/2005
• Est. Priority Date: 08/14/2001
• Status: Active Grant

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Inventors: Lu, Richard
• Primary Examiner(s): Jastrzab, Jeffrey R.
• Assistant Examiner(s): Oropeza, Frances P.
• Application Number:
  US09/930,725
• Time in Patent Office: 1,477 Days
• Field of Search: 600/373, 600/374, 600/393, 600/509, 600/515, 600/516, 600/518, 600/519, 600/521, 607/4, 607/5, 607/7, 607/9, 607/11, 607/14, 607/17, 607/28, 607/119, 607/122, 607/123
• US Class Current: 607/9
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/3682 with a variable atrioventricular delay
• CPC Class Codes: A61N 1/3684 for stimulating the heart at multiple sites of the ventricle or the atrium

Abstract

An implantable, multi-chamber cardiac stimulation device and method automatically adjust inter-chamber stimulation delays whenever stimulation rate is changed according to a patient'"'"'s metabolic need. Inter-chamber stimulation delays include inter-atrial delays, inter-ventricular delays, and atrio-ventricular delays. Inter-chamber stimulation delays are defined according to whether the event which triggers the start of the delay is an intrinsic sensed event or the delivery of a stimulation pulse. Adjustment to inter-chamber stimulation delays is made as a function of the stimulation rate changes. By providing automatically adjustable inter-chamber stimulation delays optimal synchronization of heart chamber contractions may be maintained at all stimulation rates.

Claims

1. A method of automatically adjusting inter-chamber delays for use in a multichamber cardiac stimulation device, comprising:

selectively adjusting a heart rate; and

in response to an adjustment of the heart rate, automatically adjusting an inter-chamber stimulation delay as a function of the heart rate;

wherein the inter-chamber stimulation delay is one of;

an inter-atrial delay, an inter-ventricular delay, or an atrio-ventricular delay between a left chamber and a right chamber.

2. The method of claim 1, wherein the step of selectively adjusting the heart rate includes causing a sensed event to trigger the automatic adjustment of the inter-chamber delay.

3. The method of claim 1, wherein the step of selectively adjusting the heart rate includes causing an algorithmic adjustment to trigger the automatic adjustment of the inter-chamber delay.

4. The method of claim 1, wherein the step of automatically adjusting the inter-chamber stimulation delay includes adjusting an inter-chamber delay between a right atrial sensed event and a left atrial stimulation pulse.

5. The method of claim 1, wherein the step of automatically adjusting the inter-chamber stimulation delay includes adjusting an inter-chamber delay between a right atrial stimulation pulse and a left atrial stimulation pulse.

6. The method of claim 1, wherein the step of automatically adjusting the inter-chamber stimulation delay includes adjusting an inter-chamber delay between a left atrial event and a left ventricular stimulation pulse.

7. The method of claim 1, wherein the step of automatically adjusting the inter-chamber stimulation delay includes adjusting an inter-chamber delay between a left atrial event and a right ventricular stimulation pulse.

8. The method of claim 1, wherein the step of automatically adjusting the inter-chamber stimulation delay includes adjusting an inter-chamber delay between a right atrial sensed event and a left ventricular stimulation pulse.

9. The method of claim 1, wherein the step of automatically adjusting the inter-chamber stimulation delay includes adjusting an inter-chamber delay between a right atrial stimulation pulse and a left ventricular stimulation pulse.

10. The method of claim 1, wherein the step of automatically adjusting the inter-chamber stimulation delay includes adjusting an inter-chamber delay between a left atrial sensed event and a right atrial stimulation pulse.

11. The method of claim 1, wherein the step of automatically adjusting the inter-chamber stimulation delay includes adjusting an inter-chamber delay between a left atrial stimulation pulse and a right atrial stimulation pulse.

12. The method of claim 1, wherein the step of automatically adjusting the inter-chamber stimulation delay includes adjusting an inter-chamber delay between a left atrial sensed event and a right ventricular stimulation pulse.

13. The method of claim 1, wherein the step of automatically adjusting the inter-chamber stimulation delay includes adjusting an inter-chamber delay between a left atrial stimulation pulse and a right ventricular stimulation pulse.

14. The method of claim 1, wherein the step of automatically adjusting the inter-chamber stimulation delay includes adjusting an inter-chamber delay between a right ventricular sensed event and a left ventricular stimulation pulse.

15. The method of claim 1, wherein the step of automatically adjusting the inter-chamber stimulation delay includes adjusting an inter-chamber delay between a right ventricular stimulation pulse and a left ventricular stimulation pulse.

16. The method of claim 1, wherein the step of automatically adjusting the inter-chamber stimulation delay includes adjusting an inter-chamber delay between a left ventricular sensed event and a right ventricular stimulation pulse.

17. The method of claim 1, wherein the step of automatically adjusting the inter-chamber stimulation delay includes adjusting an inter-chamber delay between a left ventricular stimulation pulse and a right ventricular stimulation pulse.

18. The method of claim 1, further including the step of delivering stimulation pulses to a heart chamber upon the expiration of an adjusted inter-chamber delay so that a desired synchronization of heart chamber contractions is maintained when a heart stimulation rate is changed.

19. A multichamber cardiac stimulation device for automatically adjusting inter-chamber delays, comprising:

a pulse generator that selectively generates stimulation pulses;

a lead, connected to the pulse generator, that delivers the stimulation pulses to one or more cardiac chambers;

a sensor that senses cardiac activity and generates sense signals;

control circuitry that is responsive to the sense signals to adjust a heart rate;

a timing circuit, responsive to an adjustment of the heart rate, to automatically adjust an inter-chamber stimulation delay as a function of the heart rate;

wherein the inter-chamber stimulation delay is one of;

an inter-atrial delay, an inter-ventricular delay, or an atrio-ventricular delay between a left chamber and a right chamber.

20. The stimulation device of claim 19, wherein the heart rate change is triggered by a sensed event.

21. The stimulation device of claim 19, wherein the heart rate change is triggered by a stimulation pulse.

22. The stimulation device of claim 19, wherein an inter-chamber delay is a delay between at least one of:

a right atrial sensed event and a left atrial stimulation pulse;

a right atrial stimulation pulse and a left at atrial stimulation pulse;

a right atrial sensed event and a left ventricular stimulation pulse;

a right atrial stimulation pulse and a left ventricular stimulation pulse;

a left atrial sensed event and a right atrial stimulation pulse;

a left atrial stimulation pulse and a right atrial stimulation pulse;

a left atrial sensed event and a right ventricular stimulation pulse;

a left atrial stimulation pulse and a right ventricular stimulation pulse;

a right ventricular sensed event and a left ventricular stimulation pulse;

a right ventricular stimulation pulse and a left ventricular stimulation pulse;

a left ventricular sensed event and a right ventricular stimulation pulse; and

a left ventricular stimulation pulse and a right ventricular stimulation pulse.

23. The stimulation device of claim 19, wherein the timing circuit automatically adjusts the inter-chamber stimulation delay as a linear function of the heart rate.

24. The stimulation device of claim 19, wherein the timing circuit automatically adjusts the inter-chamber stimulation delay as a predetermined percentage of the heart rate.

25. A multichamber cardiac stimulation device for automatically adjusting inter-chamber delays, comprising:

means for selectively adjusting a heart rate; and

means, responsive to an adjustment in the heart rate, for automatically adjusting an inter-chamber stimulation delay as a function of the heart rate;

wherein the inter-chamber stimulation delay is one of;

an inter-atrial delay, an inter-ventricular delay, or an atrio-ventricular delay between a left chamber and a right chamber.

26. The stimulation device of claim 25, wherein the heart rate change is triggered by a sensed event.

27. The stimulation device of claim 25, wherein the heart rate change is triggered by a stimulation pulse.

28. The stimulation device of claim 25, wherein an inter-chamber delay is a delay between:

a right atrial sensed event and a left atrial stimulation pulse;

a right atrial stimulation pulse and a left atrial stimulation pulse;

a right atrial sensed event and a right ventricular stimulation pulse;

a right atrial stimulation pulse and a right ventricular stimulation pulse;

a right atrial sensed event and a left ventricular stimulation pulse;

a right atrial stimulation pulse and a left ventricular stimulation pulse;

a left atrial sensed event and a right atrial stimulation pulse;

a left atrial stimulation pulse and a right atrial stimulation pulse;

a left atrial sensed event and a right ventricular stimulation pulse;

a left atrial stimulation pulse and a right ventricular stimulation pulse;

a right ventricular sensed event and a left ventricular stimulation pulse;

a right ventricular stimulation pulse and a left ventricular stimulation pulse;

a left ventricular sensed event and a right ventricular stimulation pulse;

or

a left ventricular stimulation pulse and a right ventricular stimulation pulse.

29. A multichamber cardiac stimulation device comprising:

a pulse generator that selectively generates stimulation pulses;

a lead, connected to the pulse generator, that delivers the stimulation pulses to one or more cardiac chambers;

a control circuit that is programmed with one or more pacing algorithms to control a heart rate; and

a timing circuit that is responsive to a change in the heart rate to automatically adjust an inter-chamber stimulation delay as a function of the heart rate change;

wherein the inter-chamber stimulation delay is one of;

an inter-atrial delay, an inter-ventricular delay, or an atrio-ventricular delay between a left chamber and a right chamber.

30. The device of claim 29, wherein the one or more pacing algorithms comprise an overdrive pacing algorithm, a vasovagal response algorithm, and an orthostatic compensation pacing algorithm.

31. The stimulation device of claim 29, wherein the inter-chamber delay is a delay between at least one of:

a right atrial sensed event and a left atrial stimulation pulse;

a right atrial stimulation pulse and a left atrial stimulation pulse;

a right atrial sensed event and a right ventricular stimulation pulse;

a right atrial stimulation pulse and a right ventricular stimulation pulse;

a right atrial sensed event and a left ventricular stimulation pulse;

a right atrial stimulation pulse and a left ventricular stimulation pulse;

a left atrial sensed event and a right atrial stimulation pulse;

a left atrial stimulation pulse and a right atrial stimulation pulse;

a left atrial sensed event and a right ventricular stimulation pulse;

a left atrial stimulation pulse and a right ventricular stimulation pulse;

a right ventricular sensed event and a left ventricular stimulation pulse;

a right ventricular stimulation pulse and a left ventricular stimulation pulse;

a left ventricular sensed event and a right ventricular stimulation pulse; and

a left ventricular stimulation pulse and a right ventricular stimulation pulse.

32. The stimulation device of claim 29, wherein the timing circuit automatically adjusts the inter-chamber stimulation delay as a linear function of the heart rate.

33. The stimulation device of claim 29, wherein the timing circuit automatically adjusts the inter-chamber stimulation delay as a predetermined percentage of the heart rate.