System and method for dual-chamber pacing

• US 9,687,654 B2
• Filed: 04/23/2015
• Issued: 06/27/2017
• Est. Priority Date: 04/23/2015
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Sheldon, Todd J, Carney, James K, Greenhut, Saul E
• Primary Examiner(s): Wieland, Robert N
• Application Number:
  US14/694,279
• Publication Number:
  US 20160310733A1
• Time in Patent Office: 796 Days
• 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 1/365 controlled by a physiological parameter, e.g. heart potential evoked response A61N1/371
• 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 1/3712 Auto-capture, i.e. automatic adjustment of the stimulation threshold
• CPC Class Codes: A61N 1/3756 Casings with electrodes thereon, e.g. leadless stimulators

Abstract

An implantable medical device system including an atrial pacemaker and a ventricular pacemaker is configured to deliver dual chamber pacing in the presence of atrioventricular block. In response to detecting the AV block, the atrial pacemaker may establish a limited number of selectable pacing rates. The atrial pacemaker selects a rate from the limited number of selectable pacing rates and adjusts the atrial pacing rate to the selected rate. The ventricular pacemaker is configured to establish a ventricular pacing rate that is equivalent to the selected rate in response to detecting the AV block. Other examples are described herein.

Claims

1. A method for controlling cardiac pacing by an implantable medical device system comprising a first chamber pacemaker and a second chamber pacemaker, the method comprising:

selecting by a control module of the first chamber pacemaker a first chamber pacing rate from a first plurality of selectable pacing rates;

automatically detecting atrioventricular (AV) block;

in response to detecting the AV block, establishing a second plurality of selectable pacing rates comprising fewer selectable pacing rates than the first plurality of selectable pacing rates;

selecting a first rate from the second plurality of selectable pacing rates;

adjusting the first chamber pacing rate to the first rate;

delivering first pacing pulses to a first heart chamber at the selected first rate;

establishing a second chamber pacing rate that is equivalent to the first rate in response to detecting the AV block; and

delivering second pacing pulses to a second heart chamber at the second chamber pacing rate.

2. The method of claim 1, further comprising:

establishing a third plurality of selectable pacing rates by the second chamber pacemaker in response to detecting the AV block, wherein the third plurality of selectable pacing rates is equivalent to the second plurality of selectable pacing rates;

wherein selecting the first rate comprises determining by the first chamber pacemaker a first sensor indicated pacing rate and selecting the first rate to be greater than the first sensor indicated pacing rate; and

wherein establishing the second chamber pacing rate equivalent to the first rate comprises determining by the second chamber pacemaker a second sensor indicated pacing rate and selecting the first rate from the third plurality of pacing rate selections to be greater than the second sensor indicated pacing rate.

3. The method of claim 1, wherein selecting the first rate comprises:

determining a first chamber intrinsic heart rate;

determining a first sensor indicated pacing rate; and

selecting the first rate to be greater than a higher one of the first chamber intrinsic heart rate and the first sensor indicated pacing rate.

4. The method of claim 1, further comprising:

delivering a first portion of the first pacing pulses at the first rate and a first pulse output;

delivering a second portion of the first pacing pulses at the first rate and a second pulse output less than the first pulse output;

sensing the first portion of the first pacing pulses by the second chamber pacemaker;

determining the first rate from the sensed first portion of the first pacing pulses; and

establishing the second chamber pacing rate to be equivalent to the determined first rate.

5. The method of claim 4, further comprising:

delivering a first portion of the first pacing pulses at the first rate and a first pulse output;

delivering a second portion of the first pacing pulses at the first rate and a second pulse output less than the first pulse output;

sensing the first portion of the first pacing pulses by the second chamber pacemaker;

determining a first chamber pacing interval from the sensed first portion of the first pacing pulses; and

determining a difference in a first chamber pacemaker clock cycle frequency and a second chamber pacemaker clock cycle frequency in response to the determined first chamber pacing interval;

setting a second chamber pace interval corresponding to the established second chamber pacing rate; and

adjusting the second chamber pace interval by the determined difference.

6. The method of claim 1, further comprising:

delivering a first portion of the first pacing pulses at the first rate and a first pulse output;

delivering a second portion of the first pacing pulses at the first rate and a second pulse output less than the first pulse output;

sensing the first portion of the first pacing pulses by the second chamber pacemaker; and

establishing a phase of a second chamber pace interval of the first rate in response to the sensed first portion of the first pacing pulses.

7. The method of claim 1, further comprising:

determining a need to adjust the first chamber pacing rate from the first rate;

selecting a second rate from the second plurality of selectable pacing rates;

adjusting the first chamber pacing rate to the selected second rate; and

delivering third pacing pulses to the first heart chamber at the second rate.

8. The method of claim 7, further comprising:

scheduling a rate change interval;

adjusting the first chamber pacing rate to the selected second rate after the expiration of the rate change interval.

9. The method of claim 8, further comprising:

scheduling a rate change listening period by the second chamber pacemaker upon expiration of the rate change interval;

producing a rate change signal by the first chamber pacemaker after the expiration of the rate change interval;

detecting the rate change signal by the second chamber pacemaker during the rate change listening period;

determining the second rate by the second chamber pacemaker in response to the detected rate change signal;

adjusting the second chamber pacing rate to the determined second rate; and

delivering fourth pacing pulses to the second heart chamber at the second rate.

10. The method of claim 7, further comprising:

storing an electrical pulse code in a memory of each of the first chamber pacemaker and the second chamber pacemaker;

generating by the first chamber pacemaker at least one electrical pulse during a first chamber physiological refractory period to signal the selected second rate to the second chamber pacemaker according the electrical pulse code;

sensing the at least one electrical pulse;

determining the second rate by the second chamber pacemaker based on the sensed at least one electrical pulse and the stored electrical pulse code; and

adjusting the second chamber pacing rate to the determined second rate.

11. The method of claim 1, further comprising:

selecting different ones of the second plurality of pacing rates in response to changes in at least one of a sensed intrinsic rate and a sensor indicated pacing rate;

determining a frequency of selecting the different ones of the second plurality of pacing rates;

comparing the frequency to a change threshold; and

in response to the frequency meeting the change threshold, adjusting the second plurality of selectable pacing rates to a third plurality of selectable pacing rates, the third plurality of selectable pacing rates comprising a different number of selectable pacing rates than the second plurality of selectable pacing rates and the first plurality of selectable pacing rates.

12. An implantable medical device system, comprising:

a first chamber pacemaker comprising a first pacing pulse generator, a first sensing module and a first control module coupled to the first pacing pulse generator and the first sensing module; and

a second chamber pacemaker comprising a second pacing pulse generator, a second sensing module, and a second control module coupled to the second pulse generator and the second sensing module,

the first chamber pacemaker configured to;

select a first chamber pacing rate from a first plurality of selectable pacing rates;

detect atrioventricular (AV) block;

in response to detecting the AV block, establish a second plurality of selectable pacing rates comprising fewer selectable rates than the first plurality of selectable pacing rates;

select a first rate from the second plurality of selectable pacing rates;

adjust the first chamber pacing rate to the first rate; and

control the first chamber pulse generator to deliver first pacing pulses to a first heart chamber at the selected first rate;

the second control module configured to;

detect the AV block;

establish a second chamber pacing rate that is equivalent to the first rate in response to detecting the AV block; and

control the second pacing pulse generator to deliver second pacing pulses to a second heart chamber at the second chamber pacing rate.

13. The system of claim 12, wherein the first chamber pacemaker comprises a first sensor and the second chamber pacemaker comprises a second sensor, wherein:

the first control module is configured to select the first rate by determining a first sensor indicated pacing rate based on a signal from the first sensor and select the first rate to be greater than the first sensor indicated pacing rate; and

the second control module is configured to;

establish a third plurality of pacing rate selections in response to detecting AV block, the third plurality of pacing rate selections equivalent to the second plurality of pacing rate selections, and

establish the second chamber pacing rate equivalent to the first rate by determining a second sensor indicated pacing rate based on a signal from the second sensor and select the first rate from the third plurality of pacing rate selections, the selected first rate greater than the second sensor indicated pacing rate.

14. The system of claim 12, wherein:

the first chamber pacemaker comprises a rate response sensor;

the first chamber pacemaker configured to select the first rate by;

determining a first chamber intrinsic heart rate from signals received from the first sensing module;

determining a sensor indicated pacing rate in response to a signal from the rate response sensor; and

select the first rate to be greater than a higher one of the first chamber intrinsic heart rate and the sensor indicated pacing rate.

15. The system of claim 12, wherein:

the first control module is configured to;

control the first pulse generator to deliver a first portion of the first pacing pulses at the first rate and a first pulse output; and

control the first pulse generator to deliver a second portion of the first pacing pulses at the first rate and a second pulse output less than the first pulse output; and

the second control module is configured to;

control the second sensing module to sense the first portion of the first pacing pulses;

determine the first rate from the sensed first portion of the first pacing pulses; and

establish the second chamber pacing rate to be equivalent to the determined first rate.

16. The system of claim 15, wherein:

the first control module is configured to;

control the first pulse generator to deliver a first portion of the first pacing pulses at the first rate and a first pulse output;

control the first pulse generator to deliver a second portion of the first pacing pulses at the first rate and a second pulse output less than the first pulse output;

the second control module is configured to;

control the second sensing module to sense the first portion of the first pacing pulses;

determine a first pacing interval from the sensed first portion of the first pacing pulses; and

determine a difference in a first clock cycle frequency of the first pacemaker and a second clock cycle frequency of the second pacemaker in response to the determined first pacing interval;

set a second pace interval corresponding to the established second chamber pacing rate; and

adjust the second pace interval by the determined difference.

17. The system of claim 12, wherein:

the first control module is further configured to;

control the first pulse generator to deliver a first portion of the first pacing pulses at the first rate and a first pulse output;

deliver a second portion of the first pacing pulses at the first rate and a second pulse output less than the first pulse output;

the second control module is further configured to;

control the second sensing module to sense the first portion of the first pacing pulses; and

establish a phase of a second chamber pace interval of the first rate in response to the sensed first portion of the first pacing pulses.

18. The system of claim 12, wherein the first control module is further configured to:

determine a need to adjust the first chamber pacing rate from the first rate;

select a second rate from the second plurality of selectable pacing rates;

adjust the first chamber pacing rate to the selected second rate; and

control the first pulse generator to deliver third pacing pulses to the first heart chamber at the second rate.

19. The system of claim 18, wherein the first control module is further configured to:

schedule a rate change interval;

adjust the first chamber pacing rate to the selected second rate after the expiration of the rate change interval.

20. The system of claim 19, wherein:

the first chamber pacemaker is configured to;

generate a rate change signal after the expiration of the rate change interval;

the second control module is configured to;

schedule a rate change listening period upon expiration of the rate change interval;

detect the rate change signal during the rate change listening period;

determine the second rate in response to the detected rate change signal;

adjust the second chamber pacing rate to the determined second rate; and

control the second pulse generator to deliver fourth pacing pulses to the second heart chamber at the second rate.

21. The system of claim 18, wherein:

each of the first chamber pacemaker and the second chamber pacemaker comprise a memory storing an electrical pulse code;

the first control module is configured to control the first pulse generator to generate at least one electrical pulse during a first chamber physiological refractory period to signal the selected second rate to the second chamber pacemaker according the electrical pulse code;

the second control module is configured to;

control the second sensing module to sense the at least one electrical pulse;

determine the second rate based on the sensed at least one electrical pulse and the stored electrical pulse code; and

adjust the second chamber pacing rate to the determined second rate.

22. The system of claim 12, wherein the first control module is further configured to:

select different ones of the second plurality of pacing rates in response to changes in at least one of a sensed intrinsic rate and a sensor indicated pacing rate;

determine a frequency of selecting the different ones of the second plurality of pacing rates;

compare the frequency to a change threshold; and

in response to the frequency meeting the change threshold, adjust the second plurality of selectable pacing rates to a third plurality of selectable pacing rates, the third plurality of selectable pacing rates comprising a different number of selectable pacing rates than the second plurality of selectable pacing rates and the first plurality of selectable pacing rates.

23. A non-transitory, computer-readable medium comprising a set of instructions which, when executed by an implantable medical device system comprising a first chamber pacemaker and a second chamber pacemaker, cause the system to:

select a first chamber pacing rate from a first plurality of selectable pacing rates;

detect atrioventricular (AV) block;

in response to detecting the AV block, establish a second plurality of selectable pacing rates comprising fewer selectable pacing rates than the first plurality of selectable pacing rates;

select a rate from the second plurality of selectable pacing rates;

adjust the first chamber pacing rate to the selected rate;

deliver first pacing pulses to a first heart chamber at the selected rate;

establish a second chamber pacing rate that is equivalent to the selected rate in response to detecting the AV block; and

deliver second pacing pulses to a second heart chamber at the second chamber pacing rate.