Automatic determination of chronotropic incompetence using atrial pacing at rest
First Claim
1. An apparatus comprising:
- an implantable cardiac signal sensing circuit configured to provide an electrical cardiac signal representative of cardiac activity of a subject;
an implantable therapy circuit configured to deliver electrical pacing stimulation energy to a heart of a subject; and
a controller circuit, communicatively coupled to the cardiac signal sensing circuit and the therapy circuit, including a chronotropic incompetence detection circuit configured to;
initiate pacing of an atrium of the subject at a rate higher than a device-indicated rate or a sensed intrinsic rate;
monitor a time interval between a paced event in the atrium and a sensed intrinsic event in the ventricle (paced AV interval);
initiate an increase in the pacing rate while continuing the monitoring of the paced AV interval;
calculate a change in paced AV intervals between a highest paced rate used in the monitoring and a lowest paced rate used in the monitoring;
indicate that the paced AV intervals are evidence of chronotropic incompetence when the calculated change in the paced AV intervals exceeds a specified threshold AV interval change value; and
provide an indication of chronotropic incompetence to a user or process.
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Accused Products
Abstract
An apparatus comprises an implantable cardiac signal sensing circuit that provides an electrical cardiac signal representative of cardiac activity of a subject, an implantable therapy circuit that delivers electrical pacing stimulation energy to a heart of a subject, and a controller circuit. The controller circuit includes a chronotropic incompetence detection circuit that initiates pacing of an atrium of the subject at a rate higher than a device-indicated rate or a sensed intrinsic rate, monitor the AV interval, initiates an increase in the pacing rate while continuing the monitoring of the AV interval, calculates a change in AV intervals between a highest paced rate used in the monitoring and a lowest paced rate used in the monitoring, and indicates that the AV intervals are evidence of chronotropic incompetence when the calculated change in the AV intervals exceeds a specified threshold AV interval change value.
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Citations
20 Claims
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1. An apparatus comprising:
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an implantable cardiac signal sensing circuit configured to provide an electrical cardiac signal representative of cardiac activity of a subject; an implantable therapy circuit configured to deliver electrical pacing stimulation energy to a heart of a subject; and a controller circuit, communicatively coupled to the cardiac signal sensing circuit and the therapy circuit, including a chronotropic incompetence detection circuit configured to; initiate pacing of an atrium of the subject at a rate higher than a device-indicated rate or a sensed intrinsic rate; monitor a time interval between a paced event in the atrium and a sensed intrinsic event in the ventricle (paced AV interval); initiate an increase in the pacing rate while continuing the monitoring of the paced AV interval; calculate a change in paced AV intervals between a highest paced rate used in the monitoring and a lowest paced rate used in the monitoring; indicate that the paced AV intervals are evidence of chronotropic incompetence when the calculated change in the paced AV intervals exceeds a specified threshold AV interval change value; and provide an indication of chronotropic incompetence to a user or process. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17)
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18. A method comprising:
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pacing an atrium of the subject with an implantable medical device (IMD) while monitoring with the IMD a time interval between a paced event in the atrium and a sensed intrinsic event in the ventricle (paced AV interval), wherein the paced rate is higher than a device-indicated rate or sensed intrinsic rate; increasing the pacing rate while continuing the monitoring of the paced AV interval; calculating with the MID a change in paced AV intervals between a highest paced rate used in the monitoring and a lowest paced rate used in the monitoring; determining with the IMD that the paced AV intervals are evidence of chronotropic incompetence when the calculated change in the paced AV intervals exceeds a specified threshold AV interval change value; and providing an indication of chronotropic incompetence to a user or process. - View Dependent Claims (19, 20)
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Specification