Electrogram morphology-based CRT optimization
First Claim
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1. A method for operating a cardiac rhythm management device in a patient, comprising:
- delivering paces to the left ventricle in accordance with a programmed pacing mode for pre-exciting the left ventricle, such that a left ventricular pace is delivered after a programmed AV delay interval with respect to an atrial event; and
,determining an optimum AV delay interval by;
recording an evoked response electrogram during a paced cardiac cycle with a short AV delay interval expected to be shorter than the patient'"'"'s intrinsic atrioventricular interval to ensure that paced excitation of both ventricles occurs before intrinsic activation;
incrementing the AV delay interval by a predetermined amount and recording an evoked response electrogram during a paced cardiac cycle with the incremented AV delay interval;
comparing the evoked response electrograms recorded with the incremented and short AV delay intervals;
continuing to increment the AV delay interval by the predetermined amount until the evoked response electrogram recorded with the incremented AV delay interval differs from the evoked response electrogram recorded with the short AV delay interval by a specified amount so as to indicate the occurrence of fusion beat that includes paced excitation of the left ventricle and intrinsic activation of the right ventricle; and
,determining the optimum AV delay interval as the incremented AV delay interval used when the fusion beat occurs.
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Abstract
A method and system for determining an optimum atrioventricular delay (AVD) interval and/or ventriculo-ventricular delay (VVD) intervals for delivering ventricular resynchronization pacing in an atrial tracking or atrial sequential pacing mode. Evoked response electrograms recorded at different AVD and VVD intervals are used to determine the extent of paced and intrinsic activation.
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Citations
30 Claims
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1. A method for operating a cardiac rhythm management device in a patient, comprising:
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delivering paces to the left ventricle in accordance with a programmed pacing mode for pre-exciting the left ventricle, such that a left ventricular pace is delivered after a programmed AV delay interval with respect to an atrial event; and
,determining an optimum AV delay interval by; recording an evoked response electrogram during a paced cardiac cycle with a short AV delay interval expected to be shorter than the patient'"'"'s intrinsic atrioventricular interval to ensure that paced excitation of both ventricles occurs before intrinsic activation; incrementing the AV delay interval by a predetermined amount and recording an evoked response electrogram during a paced cardiac cycle with the incremented AV delay interval; comparing the evoked response electrograms recorded with the incremented and short AV delay intervals; continuing to increment the AV delay interval by the predetermined amount until the evoked response electrogram recorded with the incremented AV delay interval differs from the evoked response electrogram recorded with the short AV delay interval by a specified amount so as to indicate the occurrence of fusion beat that includes paced excitation of the left ventricle and intrinsic activation of the right ventricle; and
,determining the optimum AV delay interval as the incremented AV delay interval used when the fusion beat occurs. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12)
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13. A cardiac rhythm management device, comprising:
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pacing channels through which paces may be delivered to both right and left ventricles; one or more sensing channels for generating an electrogram signal; a controller programmed to deliver paces to the left ventricle in accordance with a programmed pacing mode for pre-exciting the left ventricle such that the pace or paces are delivered after a programmed AV delay interval with respect to an atrial event; wherein the controller is programmed to determine an optimum AV delay interval by; recording an evoked response electrogram during a paced cardiac cycle with a short AV delay interval which is expected to be shorter than the patient'"'"'s intrinsic atrioventricular interval; incrementing the AV delay interval by a predetermined amount and recording an evoked response electrogram during a paced cardiac cycle with the incremented AV delay interval; comparing the evoked response electrograms recorded with the incremented and short AV delay intervals; continuing to increment the AV delay interval by the predetermined amount until the evoked response electrogram recorded with the incremented AV delay interval differs from the evoked response electrogram recorded with the short AV delay interval by a specified amount so as to indicate the occurrence of fusion beat that includes paced excitation of the left ventricle and intrinsic activation of the right ventricle; and
,determining the optimum AV delay interval as the incremented AV delay interval used when the fusion beat occurs. - View Dependent Claims (14, 15, 16, 17, 18, 19, 20, 21, 22, 23)
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24. A system, comprising:
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an implantable cardiac rhythm management device having pacing channels through which paces may be delivered to both right and left ventricles; a controller programmed to deliver paces to the left ventricle in accordance with a programmed pacing mode for pre-exciting the left ventricle such that the pace or paces are delivered after a programmed AV delay interval with respect to an atrial event; an external programmer in communication with the implantable device which is programmed to determine an optimum AV delay interval by; recording an evoked response electrogram during a paced cardiac cycle with a short AV delay interval expected to be shorter than the patient'"'"'s intrinsic atrioventricular interval; incrementing the AV delay interval by a predetermined amount and recording an evoked response electrogram during a paced cardiac cycle with the incremented AV delay interval; comparing the evoked response electrograms recorded with the incremented and short AV delay intervals; continuing to increment the AV delay interval by the predetermined amount until the evoked response electrogram recorded with the incremented AV delay interval differs from the evoked response electrogram recorded with the short AV delay interval by a specified amount so as to indicate the occurrence of fusion beat that includes paced excitation of the left ventricle and intrinsic activation of the right ventricle; and
,determining the optimum AV delay interval as the incremented AV delay interval used when the fusion beat occurs. - View Dependent Claims (25, 26, 27, 28, 29, 30)
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Specification