System and method for determining optimal atrioventricular delay based on intrinsic conduction delays
First Claim
1. A method for determining an atrioventricular delay value for use in delivering cardiac pacing therapy to a heart of a patient in which an implantable cardiac stimulation device is implanted, the method comprising:
- determining an inter-atrial conduction delay for the patient;
determining an intrinsic atrioventricular conduction delay for the patient; and
determining an atrioventricular delay value for use in pacing based on the inter-atrial conduction delay and the intrinsic atrioventricular conduction delay;
wherein determining the inter-atrial conduction delay for the patient comprises;
determining a width of an electrical atrial event; and
deriving the inter-atrial conduction delay from the width of the atrial event;
wherein determining the width of the atrial event comprises;
inputting an atrial intracardiac electrogram (A-IEGM) signal derived from a lead implanted within the atria of the patient;
inputting a surface electrocardiogram (EKG) signal derived from leads mounted externally on the patient;
determining a value representative of the duration of an atrial event detected within the A-IEGM signal; and
adjusting the value based on a comparison of the A-IEGM signal and the EKG signal.
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Abstract
A system and method for estimating optimal atrioventricular delay values for use in pacing the ventricles. Both the intrinsic inter-atrial conduction delay and the intrinsic atrioventricular conduction delay are determined for the patient and then the preferred atrioventricular pacing delay is derived therefrom. By taking into account intrinsic inter-atrial delay along with intrinsic atrioventricular delay, a more reliable estimate of the true optimal atrioventricular delay values for the patient can be achieved than with techniques that only take into account intrinsic atrioventricular delay values. In one example, the technique uses intracardiac electrogram (IEGM) signals and surface electrocardiogram (EKG) signals and hence can be performed by an external programmer without requiring Doppler echocardiography or other cardiac performance monitoring techniques. In another example, wherein the implanted device is equipped with a coronary sinus lead, the technique uses only IEGM signals and hence can be performed by the device itself.
125 Citations
12 Claims
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1. A method for determining an atrioventricular delay value for use in delivering cardiac pacing therapy to a heart of a patient in which an implantable cardiac stimulation device is implanted, the method comprising:
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determining an inter-atrial conduction delay for the patient; determining an intrinsic atrioventricular conduction delay for the patient; and determining an atrioventricular delay value for use in pacing based on the inter-atrial conduction delay and the intrinsic atrioventricular conduction delay; wherein determining the inter-atrial conduction delay for the patient comprises; determining a width of an electrical atrial event; and deriving the inter-atrial conduction delay from the width of the atrial event; wherein determining the width of the atrial event comprises; inputting an atrial intracardiac electrogram (A-IEGM) signal derived from a lead implanted within the atria of the patient; inputting a surface electrocardiogram (EKG) signal derived from leads mounted externally on the patient; determining a value representative of the duration of an atrial event detected within the A-IEGM signal; and adjusting the value based on a comparison of the A-IEGM signal and the EKG signal.
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2. A method for determining an atrioventricular delay value for use in delivering cardiac pacing therapy to a heart of a patient in which an implantable cardiac stimulation device is implanted, the method comprising:
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determining an inter-atrial conduction delay for the patient; determining an intrinsic atrioventricular conduction delay for the patient; and determining an atrioventricular delay value for use in pacing based on the inter-atrial conduction delay and the intrinsic atrioventricular conduction delay; wherein determining the atrioventricular delay value based on the inter-atrial conduction delay and the intrinsic atrioventricular conduction delay comprises; determining a first candidate delay value (AS-VP1) based on the inter-atrial conduction delay in combination with the intrinsic atrioventricular delay derived from sensed atrial events; determining a second candidate delay value (AS-VP2) based on the inter-atrial conduction delay derived from sensed atrial events; and evaluating a AS-VP delay based on a comparison of AS-VP1 and AS-VP2. - View Dependent Claims (3, 4, 5, 6, 7, 8, 9)
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10. A method for determining an atrioventricular delay value for use in delivering cardiac pacing therapy to a heart of a patient in which an implantable cardiac stimulation device is implanted, the method comprising:
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determining an inter-atrial conduction delay for the patient; determining an intrinsic atrioventricular conduction delay for the patient; and determining an atrioventricular delay value for use in pacing based on the inter-atrial conduction delay and the intrinsic atrioventricular conduction delay; wherein determining atrioventricular pacing delay values based on the inter-atrial conduction delay and the intrinsic atrioventricular conduction delay comprises; determining a first candidate delay value (AP-VP1) based on the inter-atrial conduction delay in combination with the intrinsic atrioventricular delay derived from paced atrial events; determining a second candidate delay value (AP-VP2) based on the inter-atrial conduction delay derived from paced atrial events; and evaluating a AP-VP delay based on a comparison of AP-VP1 and AP-VP2. - View Dependent Claims (11)
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12. A method for determining an atrioventricular delay value for use in delivering cardiac pacing therapy to a heart of a patient in which an implantable cardiac stimulation device is implanted, the method comprising:
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determining an inter-atrial conduction delay for the patient; determining an intrinsic atrioventricular conduction delay for the patient; and determining an atrioventricular delay value for use in pacing based on the inter-atrial conduction delay and the intrinsic atrioventricular conduction delay; wherein determining an inter-atrial conduction delay for the patient comprises detecting the end of at least one atrial event in an atrial intracardiac electrogram (A-IEGM) signal by; detecting the onset of the atrial event in the A-IEGM signal; opening a detection window within the A-IEGM signal; setting positive and negative threshold values; identifying a last point in time within the detection window at which the A-IEGM signal falls outside the threshold values; and identifying the last point in time as being the end of the atrial event.
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Specification