Method for elimination of ventricular pro-arrhythmic effect caused by atrial therapy

• US 7,536,224 B2
• Filed: 04/30/2003
• Issued: 05/19/2009
• Est. Priority Date: 04/30/2003
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Gillberg, Jeffrey M., Brown, Mark L., Ritscher, David E.
• Primary Examiner(s): EVANISKO, GEORGE ROBERT
• Application Number:
  US10/426,765
• Publication Number:
  US 20040220624A1
• Time in Patent Office: 2,211 Days
• Field of Search: 607 5- 14, 607/119, 607/4
• US Class Current: 607/14
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions

Abstract

A system and method are provided for controlling atrial anti-tachycardia pacing (ATP) delivery based on detection of ventricular pro-arrhythmia during or immediately after atrial ATP. Ventricular pro-arrhythmia is detected based on one or more criteria relating to pro-arrhythmic changes including, but not limited to, ventricular rate changes, R-wave morphology changes, and/or 1:1 or nearly 1:1 atrial-ventricular conduction patterns persisting at high ventricular rates. Upon detecting ventricular pro-arrhythmia, a current atrial ATP sequence is aborted. Atrial ATP therapies may subsequently be temporarily or permanently disabled.

Claims

1. An implantable medical device, comprising:

a therapy delivery circuit to generate a therapy;

a sensing circuit to receive cardiac signals;

a plurality of electrodes coupled to the sensing circuit and the therapy delivery circuit sensing cardiac signals and delivering the therapy; and

control circuitry coupled to the therapy delivery circuit and the sensing circuit, the control circuitry configured to receive cardiac signals from the sensing circuit, determine a need for delivering the therapy, initiate the therapy within a first chamber of a heart in response to the determined need, detect pro-arrhythmia in a second chamber of the heart different from the first chamber in response to the cardiac signals, the detected pro-arrhythmia occurring in the second chamber in response to the delivered therapy in the first chamber, and to control the therapy delivery in the first chamber in response to the pro-arrhythmia being detected in the second chamber, wherein the therapy corresponds to atrial pacing and the control circuitry detects ventricular pro-arrhythmia and terminates the therapy delivery in response to the ventricular pro-arrhythmia being detected, and wherein the control circuitry is further configured to detect an approximately 1;

1 conduction pattern between the atrium and ventricles of the heart in response to the sensed cardiac signals, wherein the ventricular pro-arrhythmia is detected in response to detecting the approximately 1;

1 conduction pattern.

2. The device of claim 1, further comprising a telemetry circuit to receive an external input, wherein the control circuitry determines the need for delivering the therapy and initiates the therapy in response to receipt of the external input.

3. The device of claim 1, wherein the control circuitry is further configured to determine one of a ventricular rate, an R-wave morphology, and an atrial-ventricular conduction pattern in response to the cardiac signals and wherein the ventricular pro-arrhythmia is detected in response to changes in one of the ventricular rate, R-wave morphology, and atrial-ventricular conduction patterns.

4. The device of claim 1, wherein the sensed cardiac signals comprise signals sensed subsequent to the therapy delivery and the control circuitry detects the pro-arrhythmia in response to the sensed cardiac signals sensed subsequent to the therapy delivery.

5. The device of claim 1, wherein the plurality of electrodes include leadless electrodes.

6. The device of claim 1, further comprising a storage device storing ventricular pro-arrhythmia detections associated with the delivered therapy.

7. The device of claim 1, wherein the control circuitry determines when the ventricular pro-arrhythmia is no longer detected and re-initiates the therapy in response to ventricular pro-arrhythmia no longer being detected.

8. An implantable medical device, comprising:

a therapy delivery circuit to generate a therapy;

a sensing circuit to receive cardiac signals;

a plurality of electrodes coupled to the sensing circuit and the therapy delivery circuit sensing cardiac signals and delivering the therapy; and

control circuitry coupled to the therapy delivery circuit and the sensing circuit, the control circuitry configured to receive cardiac signals from the sensing circuit, determine a need for delivering the therapy, initiate the therapy within a first chamber of a heart in response to the determined need, detect pro-arrhythmia in a second chamber of the heart different from the first chamber in response to the cardiac signals, the detected pro-arrhythmia occurring in the second chamber in response to the delivered therapy in the first chamber, and to control the therapy delivery in the first chamber in response to the pro-arrhythmia being detected in the second chamber, wherein the sensed cardiac signals comprise signals sensed before initiating therapy delivery and subsequent to initiating therapy delivery,

wherein the control circuitry determines a reference metric associated with the sensed cardiac signals sensed before initiating therapy delivery, determines a metric associated with the sensed cardiac signals sensed subsequent to initiating therapy delivery, wherein the pro-arrhythmia is detected in response to the metric associated with sensed cardiac signals sensed subsequent to initiating therapy delivery being substantially different than the reference metric.

9. An implantable medical device, comprising:

a therapy delivery circuit to generate a therapy;

a sensing circuit to receive cardiac signals;

a plurality of electrodes coupled to the sensing circuit and the therapy delivery circuit sensing cardiac signals and delivering the therapy;

control circuitry coupled to the therapy delivery circuit and the sensing circuit, the control circuitry configured to receive cardiac signals from the sensing circuit, determine a need for delivering the therapy, initiate the therapy within a first chamber of a heart in response to the determined need, detect pro-arrhythmia in a second chamber of the heart different from the first chamber in response to the cardiac signals, the detected pro-arrhythmia occurring in the second chamber in response to the delivered therapy in the first chamber, and to control the therapy delivery in the first chamber in response to the pro-arrhythmia being detected in the second chamber; and

a storage device storing ventricular pro-arrhythmia detections associated with the delivered therapy, wherein the therapy is an anti-tachycardia pacing therapy and corresponds to atrial pacing, and the control circuitry detects ventricular pro-arrhythmia and terminates the therapy delivery in response to the ventricular pro-arrhythmia being detected, and further comprising a counter to count a number of times the therapy is terminated, wherein the control circuitry is further configured for permanently disabling the therapy when the counter reaches a permanent disable value.