System providing ventricular pacing and biventricular coordination
First Claim
1. A method of delivering biventricular coordination therapy, comprising:
- initiating an atrioventricular pacing delay for a first cardiac cycle relative to an atrial event paced or sensed using one or more atrial electrodes;
decreasing the atrioventricular pacing delay for a second cardiac cycle, occurring after the first cardiac cycle, if an intrinsic ventricular depolarization is sensed before expiration of the atrioventricular pacing delay for the first cardiac cycle;
computing the decreased atrioventricular pacing delay with a mathematical function using the previous atrioventricular pacing delay and the interval between the atrial event and the intrinsic ventricular depolarization during the first cardiac cycle; and
delivering the biventricular coordination therapy during the second cardiac cycle, using one or more right ventricular electrodes and one or more left ventricular electrodes separate from the one or more right ventricular electrodes, using the decreased atrioventricular pacing delay.
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Abstract
A cardiac rhythm management system includes techniques for computing an indicated pacing interval, AV delay, or other timing interval. In one embodiment, a variable indicated pacing interval is computed based at least in part on an underlying intrinsic heart rate. The indicated pacing interval is used to time the delivery of biventricular coordination therapy even when ventricular heart rates are irregular, such as in the presence of atrial fibrillation. In another embodiment, a variable filter indicated AV interval is computed based at least in part on an underlying intrinsic AV interval. The indicated AV interval is used to time the delivery of atrial tracking biventricular coordination therapy when atrial heart rhythms are not arrhythmic. Other indicated timing intervals may be similarly determined. The indicated pacing interval, AV delay, or other timing interval can also be used in combination with a sensor indicated rate indicator.
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Citations
76 Claims
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1. A method of delivering biventricular coordination therapy, comprising:
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initiating an atrioventricular pacing delay for a first cardiac cycle relative to an atrial event paced or sensed using one or more atrial electrodes; decreasing the atrioventricular pacing delay for a second cardiac cycle, occurring after the first cardiac cycle, if an intrinsic ventricular depolarization is sensed before expiration of the atrioventricular pacing delay for the first cardiac cycle; computing the decreased atrioventricular pacing delay with a mathematical function using the previous atrioventricular pacing delay and the interval between the atrial event and the intrinsic ventricular depolarization during the first cardiac cycle; and delivering the biventricular coordination therapy during the second cardiac cycle, using one or more right ventricular electrodes and one or more left ventricular electrodes separate from the one or more right ventricular electrodes, using the decreased atrioventricular pacing delay. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28)
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29. A method of delivering biventricular coordination therapy, comprising:
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initiating an atrioventricular pacing delay for a first cardiac cycle relative to an atrial event paced or sensed using one or more atrial electrodes; modifying the atrioventricular pacing delay for a second cardiac cycle, occurring after the first cardiac cycle, if an intrinsic ventricular depolarization is sensed before expiration of the atrioventricular pacing delay for the first cardiac cycle; computing the modified atrioventricular pacing delay with a mathematical function using the previous atrioventricular pacing delay and the interval between the atrial event and the intrinsic ventricular depolarization during the first cardiac cycle; and delivering the biventricular coordination therapy during the second cardiac cycle using one or more right ventricular electrodes and one or more left ventricular electrodes separate from the one or more right ventricular electrodes using the decreased atrioventricular pacing delay.
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30. A method of delivering biventricular coordination therapy, comprising:
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sensing an atrium using one or more atrial electrodes; sensing and pacing a right ventricle using one or more right ventricular electrodes; pacing a left ventricle using one or more left ventricular electrodes; initiating an atrioventricular pacing delay for a first cardiac cycle relative to an atrial event that is paced or sensed using the one or more atrial electrodes; sensing an intrinsic ventricular depolarization using the one or more right ventricular electrodes before expiration of the atrioventricular pacing delay; decreasing the atrioventricular pacing delay for a second cardiac cycle, occurring after the first cardiac cycle, after sensing the intrinsic ventricular depolarization using the one or more right ventricular electrodes; computing the decreased atrioventricular pacing delay with a mathematical function using the previous atrioventricular pacing delay and the interval between the atrial event and the intrinsic ventricular depolarization during the first cardiac cycle; and in the second cardiac cycle, pacing the right ventricle using the one or more right ventricular electrodes and pacing the left ventricle using the one or more left ventricular electrodes using the decreased atrioventricular pacing delay. - View Dependent Claims (31, 32)
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33. A biventricular coordination therapy device, comprising:
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one or more atrial electrodes for electrically coupling to an atrium; one or more right ventricular electrodes for electrically coupling to a right ventricle; one or more left ventricular electrodes for electrically coupling to a left ventricle; and a pulse generator coupled to the one or more atrial electrodes, the one or more right ventricular electrodes, and the one or more left ventricular electrodes, the pulse generator configured to initiate an atrioventricular pacing delay for a first cardiac cycle relative to an atrial event paced or sensed using the one or more atrial electrodes, decrease the atrioventricular pacing delay for a second cardiac cycle, occurring after the first cardiac cycle, if an intrinsic ventricular depolarization is sensed during the atrioventricular pacing delay for the first cardiac cycle, compute the decreased atrioventricular pacing delay with a mathematical function using the previous atrioventricular pacing delay and the interval between the atrial event and the intrinsic ventricular depolarization during the first cardiac cycle, and deliver the biventricular coordination therapy during the second cardiac cycle using the one or more right ventricular electrodes and the one or more left ventricular electrodes using the decreased atrioventricular pacing delay. - View Dependent Claims (34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62)
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63. A biventricular coordination therapy device, comprising:
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one or more atrial electrodes configured to implement at least one of sensing and pacing an atrium; one or more right ventricular electrodes configured to implement at least one of sensing and pacing a right ventricle; one or more left ventricular electrodes configured to implement at least one of sensing and pacing a left ventricle; and a pulse generator coupled to the one or more atrial electrodes, the one or more right ventricular electrodes, and the one or more left ventricular electrodes, the pulse generator configured to initiate an atrioventricular pacing delay for a first cardiac cycle relative to an atrial event paced or sensed using the one or more atrial electrodes, modify the atrioventricular pacing delay for a second cardiac cycle, occurring after the first cardiac cycle, if an intrinsic ventricular depolarization is sensed before expiration of the atrioventricular pacing delay for the first cardiac cycle, compute the decreased atrioventricular pacing delay with a mathematical function using the previous atrioventricular pacing delay and the interval between the atrial event and the intrinsic ventricular depolarization during the first cardiac cycle, and deliver a biventricular coordination therapy during the second cardiac cycle using the one or more right ventricular electrodes and the one or more left ventricular electrodes separate from the one or more right ventricular electrodes using the modified atrioventricular pacing delay.
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64. A biventricular coordination therapy device, comprising:
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one or more atrial electrodes configured to sense an atrium; one or more right ventricular electrodes configured to sense and pace a right ventricle; one or more left ventricular electrodes configured to pace a left ventricle; and a pulse generator coupled to the one or more atrial electrodes, the one or more right ventricular electrodes, and the one or more left ventricular electrodes, the pulse generator configured to initiate an atrioventricular pacing delay for a first cardiac cycle relative to an atrial event paced or sensed using the one or more atrial electrodes, decrease the atrioventricular pacing delay for a second cardiac cycle, occurring after the first cardiac cycle, after sensing an intrinsic ventricular depolarization before expiration of the atrioventricular pacing delay for the first cardiac cycle, compute the decreased atrioventricular pacing delay with a mathematical function using the previous atrioventricular pacing delay and the interval between the atrial event and the intrinsic ventricular depolarization during the first cardiac cycle, and, during the second cardiac cycle, pace the right ventricle using the one or more right ventricular electrodes and pace the left ventricle using the one or more left ventricular electrodes using the decreased atrioventricular pacing delay. - View Dependent Claims (65, 66)
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67. A system for delivering biventricular coordination therapy to a patient, comprising:
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means for initiating an atrioventricular pacing delay for a first cardiac cycle relative to an atrial event paced or sensed using one or more atrial electrodes; means for decreasing the atrioventricular pacing delay for a second cardiac cycle, occurring after the first cardiac cycle, if an intrinsic ventricular depolarization is sensed before expiration of the atrioventricular pacing delay for the first cardiac cycle; means for computing the decreased atrioventricular pacing delay with a mathematical function using the previous atrioventricular pacing delay and the interval between the atrial event and the intrinsic ventricular depolarization during the first cardiac cycle; and means for delivering the biventricular coordination therapy during the second cardiac cycle, using one or more right ventricular electrodes and one or more left ventricular electrodes separate from the one or more right ventricular electrodes, using the decreased atrioventricular pacing delay. - View Dependent Claims (68, 69, 70, 71, 72, 73)
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74. A system for delivering biventricular coordination therapy, comprising:
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means for initiating an atrioventricular pacing delay for a first cardiac cycle relative to an atrial event paced or sensed using one or more atrial electrodes; means for modifying the atrioventricular pacing delay for a second cardiac cycle, occurring after the first cardiac cycle, if an intrinsic ventricular depolarization is sensed before expiration of the atrioventricular pacing delay for the first cardiac cycle; means for computing the modified atrioventricular pacing delay with a mathematical function using the previous atrioventricular pacing delay and the interval between the atrial event and the intrinsic ventricular depolarization during the first cardiac cycle; and means for delivering the biventricular coordination therapy during the second cardiac cycle using one or more right ventricular electrodes and one or more left ventricular electrodes separate from the one or more right ventricular electrodes using the decreased atrioventricular pacing delay.
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75. A system for delivering biventricular coordination therapy, comprising:
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means for sensing an atrium using one or more atrial electrodes; means for sensing and pacing a right ventricle using one or more right ventricular electrodes; means for pacing a left ventricle using one or more left ventricular electrodes; means for initiating an atrioventricular pacing delay for a first cardiac cycle relative to an atrial event that is paced or sensed using the one or more atrial electrodes; means for sensing an intrinsic ventricular depolarization using the one or more right ventricular electrodes before expiration of the atrioventricular pacing delay; means for decreasing the atrioventricular pacing delay for a second cardiac cycle, occurring after the first cardiac cycle, after sensing the intrinsic ventricular depolarization using the one or more right ventricular electrodes; means for computing the decreased atrioventricular delay with a mathematical function using the previous atrioventricular pacing delay and the interval between the atrial event and the intrinsic ventricular depolarization during the first cardiac cycle; and in the second cardiac cycle, means for pacing the right ventricle using the one or more right ventricular electrodes and pacing the left ventricle using the one or more left ventricular electrodes using the decreased atrioventricular pacing delay. - View Dependent Claims (76)
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Specification