Apparatus and methods for automatic determination of a fusion pacing pre-excitation interval
First Claim
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1. A method of determining a pre-excitation interval (PEI) for optimized delivery of a bi-ventricular, fusion-pacing therapy to a non-synchronous pair of ventricles, including delivery of a single ventricular pre-excitation pacing pulse to a relatively late activated ventricular chamber to promote mechanical synchrony between the late activated ventricular chamber and a relatively more rapid, intrinsically-conducting ventricular chamber, comprising:
- measuring an intrinsic atrio-ventricular delay interval for a first-to-depolarize ventricular (V1) chamber for at least one prior cardiac cycle;
delivering a pacing stimulus to the V1 chamber upon expiration of an atrio-ventricular (A-V) delay interval and sensing the resulting evoked depolarization in a last-to-depolarize ventricular (V2) chamber, wherein the AV delay interval is shorter than the intrinsic atrio-ventricular delay interval and wherein the; and
calculating a PEI using upon at least one of the following and based upon the relative temporal length of the interval between the V1 pacing stimulus delivery and the V2 sensing of the evoked depolarization;
PEI=k×
(V2p→
V1s) or PEI=k×
(V1p→
V2s) or PEI=k×
(V1s→
V2s), or PEI=k×
[(V1s→
V2s)−
(V2p→
V1s)], and wherein the value of the constant k is about zero-point-five (0.5).
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Abstract
Automated adjustment of a pre-excitation interval (PEI) used to deliver hemodynamically efficient fusion pacing therapy.
47 Citations
21 Claims
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1. A method of determining a pre-excitation interval (PEI) for optimized delivery of a bi-ventricular, fusion-pacing therapy to a non-synchronous pair of ventricles, including delivery of a single ventricular pre-excitation pacing pulse to a relatively late activated ventricular chamber to promote mechanical synchrony between the late activated ventricular chamber and a relatively more rapid, intrinsically-conducting ventricular chamber, comprising:
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measuring an intrinsic atrio-ventricular delay interval for a first-to-depolarize ventricular (V1) chamber for at least one prior cardiac cycle; delivering a pacing stimulus to the V1 chamber upon expiration of an atrio-ventricular (A-V) delay interval and sensing the resulting evoked depolarization in a last-to-depolarize ventricular (V2) chamber, wherein the AV delay interval is shorter than the intrinsic atrio-ventricular delay interval and wherein the; and calculating a PEI using upon at least one of the following and based upon the relative temporal length of the interval between the V1 pacing stimulus delivery and the V2 sensing of the evoked depolarization; PEI=k×
(V2p→
V1s) or PEI=k×
(V1p→
V2s) or PEI=k×
(V1s→
V2s), or PEI=k×
[(V1s→
V2s)−
(V2p→
V1s)], and wherein the value of the constant k is about zero-point-five (0.5). - View Dependent Claims (2, 3, 4)
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5. A method of determining the value of an operating pre-excitation interval (PEI) for optimized delivery of a bi-ventricular, fusion-pacing therapy to a non-synchronous pair of ventricles, including delivery of a single ventricular pre-excitation pacing pulse to a relatively late activated ventricular chamber to promote mechanical synchrony between the relatively late activated ventricular chamber and a relatively more rapid, intrinsically-conducting ventricular chamber, comprising:
- calculating a PEI value as a linear function of LVp-RVs and RVs-LVs wherein;
PEI=a*(RVs−
LVs)−
b*(LVp−
RVs)+c, where a, b and c are coefficients that can be determined from patient data. - View Dependent Claims (6, 7, 8, 9)
- calculating a PEI value as a linear function of LVp-RVs and RVs-LVs wherein;
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10. A method of determining a pre-excitation interval for optimized delivery of a bi-ventricular, fusion-pacing therapy to a non-synchronous pair of ventricles, including delivery of a single ventricular pre-excitation pacing pulse to a relatively late activated ventricular chamber to promote mechanical synchrony between the late activated ventricular chamber and a relatively more rapid, intrinsically-conducting ventricular chamber, comprising:
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measuring an intrinsic atrio-ventricular delay interval for one of the chambers for at least one cardiac cycle; delivering a pacing stimulus to the one of the chambers upon expiration of a first defined A-V delay shorter than the intrinsic atrio-ventricular delay interval and sensing the resulting evoked depolarization in the other of the chambers; and calculating a pre-excitation interval based upon length of the interval between the delivered pacing stimulus and the sensed evoked depolarization of wherein the pre-excitation interval equals a constant “
k”
times the interval between the delivered pacing stimulus and the sensed evoked depolarization and wherein k is about 0.5. - View Dependent Claims (11, 12, 13, 14, 15, 19, 20, 21)
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16. A method of determining a pre-excitation interval for optimized delivery of a bi-ventricular, fusion-pacing therapy to a non-synchronous pair of ventricles, including delivery of a single ventricular pre-excitation pacing pulse to a relatively late activated ventricular chamber to promote mechanical synchrony between the late activated ventricular chamber and a relatively more rapid, intrinsically-conducting ventricular chamber, comprising:
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measuring an intrinsic inter-ventricular delay interval between the chambers for at least one cardiac cycle; and calculating a pre-excitation interval based upon length of the measured intrinsic inter-ventricular delay interval wherein the pre-excitation interval equals a constant “
k”
times the interval between the delivered pacing stimulus and the sensed evoked depolarization and wherein k is about 0.5. - View Dependent Claims (17, 18)
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Specification