Safety pacing in multi-site CRM devices

• US 7,630,765 B2
• Filed: 06/01/2006
• Issued: 12/08/2009
• Est. Priority Date: 12/26/2000
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Stahmann, Jeffrey E., Kramer, Andrew P., Calkins, Hugh
• Primary Examiner(s): Layno; Carl H
• Assistant Examiner(s): Wu; Eugene T
• Application Number:
  US11/421,660
• Publication Number:
  US 20060206156A1
• Time in Patent Office: 1,286 Days
• Field of Search: 607/9, 607/15, 607/17, 607/18, 607/25
• US Class Current: 607/9
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions
• 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 1/368 comprising more than one electrode co-operating with different heart regions A61N1/3622, A61N1/3627 take precedence
• CPC Class Codes: A61N 1/3684 for stimulating the heart at multiple sites of the ventricle or the atrium
• CPC Class Codes: A61N 1/36842 Multi-site stimulation in the same chamber
• CPC Class Codes: A61N 1/36843 Bi-ventricular stimulation

Abstract

Safety pacing in multi-site cardiac rhythm management (CRM) devices is provided. According to various method embodiments, a first cardiac signal from a first cardiac region and a second cardiac signal from a second cardiac region are sensed. The first cardiac region is paced to maintain at least a minimum cardiac rate, and the second cardiac region is paced to maintain at least the minimum cardiac rate when a pace in the first cardiac region is inhibited. Other aspects and embodiments are provided herein.

Claims

1. A method, comprising:

determining a cardiac rate;

providing pacing pulses to a first cardiac region to maintain the cardiac rate at least a minimum rate value;

starting a pace protection interval after a cardiac event in the first cardiac region;

inhibiting a pacing pulse to the first cardiac region during the pace protection interval; and

providing the pacing pulse to a second cardiac region at a safety interval timed from the inhibited pacing pulse to the first cardiac region.

2. The method of claim 1, including setting the safety interval timed from the inhibited pacing pulse in the range of zero (0.0) milliseconds to 300 milliseconds.

3. The method of claim 1, wherein providing the pacing pulse to the second cardiac region includes providing the pacing pulse to the second cardiac region after the pace protection interval.

4. The method of claim 1, including programming the pace protection interval in a range of 200 milliseconds to 500 milliseconds.

12. The method of claim 1, wherein pacing a second cardiac region to maintain at least the minimum cardiac rate when a pace in the first cardiac region is inhibited includes pacing the second cardiac region to maintain at least the minimum cardiac rate when a failure inhibits the pace in the first cardiac region.

13. The method of claim 1, wherein pacing a second cardiac region to maintain at least the minimum cardiac rate when a pace in the first cardiac region is inhibited includes pacing the second cardiac region to maintain at least the minimum cardiac rate when an algorithm inhibits pacing in the first cardiac region during a time interval following a cardiac event in the first cardiac region.

5. A method, comprising:

pacing a first cardiac region to maintain the cardiac rate at least a minimum rate value;

detecting a first cardiac event in the first cardiac region;

initiating a pace protection interval after the first cardiac event;

inhibiting pacing to the first cardiac region during the pace protection interval; and

pacing a second cardiac region to maintain the cardiac rate at least the minimum rate value in response to inhibiting pacing to the first cardiac region during the pace protection interval.

6. The method of claim 5, wherein pacing a second cardiac region includes:

initiating a safety interval after inhibiting a first pacing pulse to the first cardiac region; and

transmitting a second pacing pulse to the second cardiac region after the safety interval.

7. The method of claim 5, wherein pacing a second cardiac region includes:

detecting a first intrinsic cardiac event in the second cardiac region;

initiating a cardiac cycle escape time interval upon detecting the first intrinsic cardiac event; and

pacing the second cardiac region at the end of the cardiac cycle escape time interval when a subsequent second intrinsic cardiac event is not detected in the second cardiac region during the cardiac cycle escape time interval.

8. A method, comprising:

determining a cardiac rate from a second cardiac region;

providing pacing pulses to a first cardiac region to maintain the cardiac rate at least a minimum rate value;

identifying a paced cardiac event in the first cardiac region and the second cardiac region;

starting a pace protection interval after the paced cardiac event in the first cardiac region and a cardiac cycle escape time interval after the paced cardiac event in the second cardiac region;

inhibiting a pacing pulse to the first cardiac region during the pace protection interval; and

if a subsequent intrinsic cardiac event is not detected in the second cardiac region during the cardiac cycle escape time interval, delivering a pacing pulse to the second cardiac region at the end of the cardiac cycle escape time interval.

9. The method of claim 8, wherein the first cardiac region is a first ventricular chamber and the second cardiac region is a second ventricular chamber.

10. The method of claim 8, wherein the first cardiac region is a first atrial chamber and the second cardiac region is a second atrial chamber.

11. A method, comprising:

pacing a first cardiac region to maintain at least a minimum cardiac rate; and

pacing a second cardiac region to maintain at least the minimum cardiac rate when a pace in the first cardiac region is inhibited,

wherein pacing a first cardiac region includes pacing a first ventricular chamber, and pacing a second cardiac region includes pacing a second ventricular chamber.

14. A method, comprising:

pacing a first cardiac region to maintain at least a minimum cardiac rate; and

pacing a second cardiac region to maintain at least the minimum cardiac rate when a pace in the first cardiac region is inhibited,

wherein pacing a first cardiac region includes pacing a first atrial chamber, and pacing a second cardiac region includes pacing a second atrial chamber.

15. The method of claim 14, wherein pacing a second cardiac region to maintain at least the minimum cardiac rate when a pace in the first cardiac region is inhibited includes pacing the second cardiac region to maintain at least the minimum cardiac rate when a failure inhibits the pace in the first cardiac region.

16. The method of claim 14, wherein pacing a second cardiac region to maintain at least the minimum cardiac rate when a pace in the first cardiac region is inhibited includes pacing the second cardiac region to maintain at least the minimum cardiac rate when an algorithm inhibits pacing in the first cardiac region during a time interval following a cardiac event in the first cardiac region.

17. A method, comprising:

pacing a first cardiac region to maintain at least a minimum cardiac rate; and

pacing a second cardiac region to maintain at least the minimum cardiac rate when a pace in the first cardiac region is inhibited,

wherein both of the first and second cardiac regions are located in a single cardiac chamber.

18. The method of claim 17, wherein pacing a second cardiac region to maintain at least the minimum cardiac rate when a pace in the first cardiac region is inhibited includes pacing the second cardiac region to maintain at least the minimum cardiac rate when a failure inhibits the pace in the first cardiac region.

19. The method of claim 17, wherein pacing a second cardiac region to maintain at least the minimum cardiac rate when a pace in the first cardiac region is inhibited includes pacing the second cardiac region to maintain at least the minimum cardiac rate when an algorithm inhibits pacing in the first cardiac region during a time interval following a cardiac event in the first cardiac region.

20. An apparatus, comprising:

means for pacing a first cardiac region to maintain at least a minimum cardiac rate;

means for detecting a cardiac event at the first cardiac region;

means for inhibiting pacing to the first cardiac region during a pace protection interval after the cardiac event; and

means for pacing a second cardiac region to maintain the cardiac rate at least the minimum rate when the means for pacing the first cardiac region is inhibited.

21. The apparatus of claim 20, wherein the means for pacing a second cardiac region to maintain the cardiac rate includes means for pacing the second cardiac region based on a cardiac cycle escape time interval from a detected second cardiac signal.

22. The apparatus of claim 20, wherein the means for pacing a second cardiac region to maintain the cardiac rate includes means for pacing the second cardiac region based on a safety time interval from the inhibited pacing pulse at the first cardiac region.

23. The apparatus of claim 20, wherein the means for inhibiting pacing to the first cardiac region during a pace protection interval after the cardiac event and the means for pacing a second cardiac region includes a pace protection circuit to communicate with at least one cardiac signal sensor and with a pace output circuit, the at least one cardiac signal sensor to sense the cardiac event, the pace output circuit to selectively pace the first cardiac region and the second cardiac region, and the pace protection circuit to provide the pace protection interval after the cardiac event to inhibit pacing by the pace output circuit to the first cardiac region during the pace protection interval, and to signal the pace output circuit to pace the second cardiac region when pacing to the first cardiac region is inhibited.

24. An apparatus, comprising:

an input to receive a sensor signal;

a cardiac signal analyzer to communicate with the input to determine a cardiac rate;

an output to communicate with the analyzer to pace at least one of a first cardiac region or a second cardiac region to maintain the cardiac rate at a minimum value; and

a pace protection circuit connected to the output to inhibit pacing to the first cardiac region during a pace protection interval and to pace the second cardiac region to maintain the cardiac rate during the pace protection interval.

25. The apparatus of claim 24, wherein the pace protection interval ranges from 200 milliseconds to 500 milliseconds.

26. The apparatus of claim 24, wherein the analyzer is adapted to determine a cardiac escape interval and the pace protection circuit is adapted to send the pacing signal to the second cardiac region after a cardiac cycle escape time interval from a detected second cardiac signal.

27. The apparatus of claim 24, wherein the analyzer is adapted to determine a cardiac escape interval and the pace protection circuit is adapted to send the pacing signal to the second cardiac region after a safety time interval from the inhibited pacing pulse at the first cardiac region.

28. An apparatus, comprising:

a signal generator;

a first electrode adapted for connection to the signal generator;

a second electrode adapted for connection to the signal generator; and

where the signal generator includes;

a cardiac signal analyzer adapted to determine a cardiac rate from a signal sensed using the first electrode or adapted to determine a cardiac rate from a signal sensed using the second electrode;

a pacing output adapted to provide pacing pulses to the first electrode to maintain a cardiac rate at least a minimum rate value; and

a pace protection circuit adapted to start a pace protection interval after a cardiac event and to inhibit pacing pulses from the pacing output to a first cardiac chamber during the pace protection interval, and provide a pacing pulse from the pacing output to the second electrode at a safety interval timed from the inhibited pacing pulse to the first cardiac chamber.

29. The apparatus of claim 28, wherein the safety interval is programmed in the range of zero (0.0) milliseconds to 300 milliseconds.

30. The apparatus of claim 28, wherein the pace protection circuit provides the pacing pulse to the second cardiac region after the pace protection interval.

31. The apparatus of claim 28, wherein the pace protection interval is programmable in a range of 200 milliseconds to 500 milliseconds.