System and method for promoting intrinsic conduction through atrial timing modification and calculation of timing parameters
First Claim
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1. A method comprising:
- operating an implantable medical device according to a ventricular pacing protocol (VPP) wherein ventricular pacing is precluded in a given cardiac cycle where a ventricular event occurred in a cardiac cycle immediately prior to the given cardiac cycle;
establishing an A-A interval;
initiating a first AV interval timer at the initiation of the given cardiac cycle;
sensing for ventricular events;
scheduling an early atrial pacing pulse at an accelerated atrial interval (AP(E)) prior to the termination of the A-A interval if no ventricular event is sensed within the duration of the AV interval timer, wherein the interval from an immediately preceding atrial event (A) to the AP(E) (A-AP(E)) is ≧
the AV interval timer, is ≦
a lower rate interval (LRI), and the AP(E) is selected to lead to a likely ventricular event (Target VS) at a predetermined time; and
canceling the early atrial pacing pulse and reverting to the A-A interval if a ventricular event is sensed prior to the early atrial pacing pulse.
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Abstract
An atrial based pacing protocol promotes intrinsic conduction. An entire cardiac cycle is monitored for ventricular activity and permitted to lapse with ventricular activity. Ventricular pacing is available in a cardiac cycle immediately subsequent to such a skipped beat. When monitoring for intrinsic ventricular events, an event is expected within a given window. If no such event is detected, the cardiac cycle in truncated, leading to a shorter cycle that is devoid of ventricular activity. The subsequent cycle has a high likelihood of a ventricular sensed event and a greater than normal AV interval is provided prior to pacing.
110 Citations
16 Claims
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1. A method comprising:
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operating an implantable medical device according to a ventricular pacing protocol (VPP) wherein ventricular pacing is precluded in a given cardiac cycle where a ventricular event occurred in a cardiac cycle immediately prior to the given cardiac cycle; establishing an A-A interval; initiating a first AV interval timer at the initiation of the given cardiac cycle; sensing for ventricular events; scheduling an early atrial pacing pulse at an accelerated atrial interval (AP(E)) prior to the termination of the A-A interval if no ventricular event is sensed within the duration of the AV interval timer, wherein the interval from an immediately preceding atrial event (A) to the AP(E) (A-AP(E)) is ≧
the AV interval timer, is ≦
a lower rate interval (LRI), and the AP(E) is selected to lead to a likely ventricular event (Target VS) at a predetermined time; andcanceling the early atrial pacing pulse and reverting to the A-A interval if a ventricular event is sensed prior to the early atrial pacing pulse. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8)
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9. A method comprising:
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operating an implantable medical device according to a ventricular pacing protocol (VPP) wherein ventricular pacing is precluded in a given cardiac cycle where a ventricular event occurred in a cardiac cycle immediately prior to the given cardiac cycle; establishing an A-A interval; initiating a first AV interval timer at the initiation of the given cardiac cycle; sensing for ventricular events; scheduling an early atrial pacing pulse at an accelerated atrial interval (AP(E)) prior to the termination of the A-A interval if no ventricular event is sensed within the duration of the AV interval timer, wherein the interval from an immediately preceding atrial event (A) to the AP(E) (A-AP(E)) is ≧
the AV interval timer, is ≦
a lower rate interval (LRI), and the AP(E) is selected to lead to a likely ventricular event (Target VS) at a predetermined time;initiating a paced atrio-ventricular (PAV) interval upon delivery of the early atrial pace; and delivering a ventricular pace at the expiration of the PAV interval timer unless inhibited by a sensed ventricular event, wherein the PAV≧
AP(E)Target VS. - View Dependent Claims (10)
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11. A method comprising:
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operating an implantable medical device according to a ventricular pacing protocol (VPP) wherein ventricular pacing is precluded in a given cardiac cycle where a ventricular event occurred in a cardiac cycle immediately prior to the given cardiac cycle; establishing an A-A interval; initiating a first AV interval timer at the initiation of the given cardiac cycle; sensing for ventricular events; scheduling an early atrial pacing pulse at an accelerated atrial interval (AP(E)) prior to the termination of the A-A interval if no ventricular event is sensed within the duration of the AV interval timer, wherein the interval from an immediately preceding atrial event (A) to the AP(E) (A-AP(E)) is ≧
the AV interval timer, is ≦
a lower rate interval (LRI), and the AP(E) is selected to lead to a likely ventricular event (Target VS) at a predetermined time; andcomparing the A-AP(E) interval to data recorded in the memory of the IMD and only implement the A-AP(E) interval if the data indicates successful intrinsic conduction has previously occurred at the atrial rate resulting from the A-AP(E) interval.
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12. An implantable medical device comprising:
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means for operating an implantable medical device (IMD) according to a ventricular pacing protocol (VPP) wherein ventricular pacing is precluded in a given cardiac cycle wherein a ventricular event occurred in a cardiac cycle immediately subsequent to the given cardiac cycle; means for establishing an A-A interval; means for initiating a first AV interval timer at the initiation of the given cardiac cycle; means for sensing for ventricular events; means for scheduling an early atrial pacing (AP(E) pulse prior to the termination of the A-A interval if no ventricular event is sensed within the duration of the AV interval timer, wherein the interval from an immediately preceding atrial event (A) to the AP(E) (A-AP(E)) is ≧
the AV interval timer, is ≦
a lower rate interval (LRI), and the AP(E) is selected to lead to a likely ventricular event (Target VS) at a predetermined time; andmeans for canceling the atrial pacing pulse and reverting to the A-A interval if a ventricular event is sensed prior to the atrial pacing pulse.
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13. An implantable medical device comprising:
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means for operating an implantable medical device (IMD) according to a ventricular pacing protocol (VPP) wherein ventricular pacing is precluded in a given cardiac cycle wherein a ventricular event occurred in a cardiac cycle immediately subsequent to the given cardiac cycle; means for establishing an A-A interval; means for initiating a first AV interval timer at the initiation of the given cardiac cycle; means for sensing for ventricular events; means for scheduling an early atrial pacing (AP(E) pulse prior to the termination of the A-A interval if no ventricular event is sensed within the duration of the AV interval timer, wherein the interval from an immediately preceding atrial event (A) to the AP(E) (A-AP(E)) is ≧
the AV interval timer, is ≦
a lower rate interval (LRI), and the AP(E) is selected to lead to a likely ventricular event (Target VS) at a predetermined time; andmeans for initiating a paced atrio-ventricular (PAV) interval timer upon delivery of the early atrial pace; means for delivering a ventricular pace at the expiration of the PAV interval timer unless inhibited by a sensed ventricular event, wherein the PAV≧
AP(E)Target VS. - View Dependent Claims (14, 15, 16)
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Specification