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 pacing therapy in accordance with a programmed pacing mode for pre-exciting one of the ventricles relative to the other ventricle, such that a pace to the pre-excited ventricle 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 pre-excited ventricle and intrinsic activation of the other 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.
97 Citations
20 Claims
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1. A method for operating a cardiac rhythm management device in a patient, comprising:
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delivering pacing therapy in accordance with a programmed pacing mode for pre-exciting one of the ventricles relative to the other ventricle, such that a pace to the pre-excited ventricle 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 pre-excited ventricle and intrinsic activation of the other 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)
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11. A cardiac rhythm management device, comprising:
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one or more pulse generators for delivering paces via pacing channels to both right and left ventricles; one or more sensing amplifiers for receiving an electrogram signal; a controller programmed to deliver pacing therapy in accordance with a programmed pacing mode for pre-exciting one of the ventricles relative to the other ventricle, such that a pace to the pre-excited ventricle is 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 pre-excited ventricle and intrinsic activation of the other ventricle; and
,determining the optimum AV delay interval as the incremented AV delay interval used when the fusion beat occurs. - View Dependent Claims (12, 13, 14, 15, 16, 17, 18, 19, 20)
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Specification