Addressing recurrent atrial fibrillation

• US 20040088010A1
• Filed: 10/31/2002
• Published: 05/06/2004
• Est. Priority Date: 10/31/2002
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Holzer, Stefan, Hettrick, Douglas A., Warman, Eduardo N., Ziegler, Paul D., Puererfellner, Helmut
• Granted Patent: US 7,127,292 B2
• Time in Patent Office: Days
• US Class Current: 607/5
• CPC Class Codes: A61N 1/395 for treating atrial fibrillation
• CPC Class Codes: A61N 1/3962 in combination with another heart therapy
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

The invention is directed to techniques for applying overdrive pacing to one or both atria following termination of an AF episode, to prevent a recurrent AF episode. An implantable medical device such as a pacemaker applies overdrive pacing according to overdrive pacing parameters, and sets the parameters as a function of the response of the patient to overdrive pacing. The parameters may be adjusted upward or downward, so that overdrive pacing may be applied effectively but not over-applied.

Claims

1. A method comprising:

applying overdrive pacing therapy to an atrium according to an overdrive pacing parameter following an episode of atrial fibrillation;

monitoring for an episode of recurrent atrial fibrillation; and

setting the overdrive pacing parameter as a function of the monitoring.

2. The method of claim 1, wherein the overdrive pacing parameter comprises at least one of an overdrive pacing rate, an overdrive pacing duration, and a waiting period preceding the overdrive pacing duration.

3. The method of claim 1, further comprising detecting a termination of the first episode of atrial fibrillation prior to applying the overdrive pacing therapy.

4. The method of claim 3, further comprising waiting for a waiting period between the termination of the first episode of atrial fibrillation and applying the overdrive pacing therapy.

5. The method of claim 1, further comprising:

administering a shock therapy to the atrium following a detection of the first episode of atrial fibrillation; and

applying the overdrive pacing therapy immediately after administering the shock therapy.

6. The method of claim 1, further comprising monitoring for the occurrence of an episode of recurrent atrial fibrillation while applying the overdrive pacing therapy.

7. The method of claim 6, further comprising:

applying the overdrive pacing therapy at an overdrive pacing rate;

detecting an episode of recurrent atrial fibrillation while applying the overdrive pacing therapy; and

increasing the overdrive pacing rate.

8. The method of claim 1, further comprising monitoring for the occurrence of an episode of recurrent atrial fibrillation in a monitoring period after applying the overdrive pacing therapy.

9. The method of claim 8, further comprising:

applying the overdrive pacing therapy for, an overdrive pacing duration;

detecting an episode of recurrent atrial fibrillation in the monitoring period; and

increasing the overdrive pacing duration.

10. The method of claim 1, further comprising:

applying the overdrive pacing therapy at an overdrive pacing rate for an overdrive pacing duration; and

decreasing at least one of the overdrive pacing rate and the overdrive pacing duration.

12. The medium of claim 1, wherein the overdrive pacing parameter comprises at least one of an overdrive pacing rate, an overdrive pacing duration, and a waiting period preceding the overdrive pacing duration.

11. A computer-readable medium comprising instructions for causing a programmable processor to:

apply overdrive pacing therapy to an atrium according to an overdrive pacing parameter following a first episode of atrial fibrillation;

monitor for an episode of recurrent atrial fibrillation; and

set the overdrive pacing parameter as a function of the monitoring.

13. The medium of claim 11, the instructions further causing the processor to detect a termination of the first episode of atrial fibrillation prior to applying the overdrive pacing therapy.

14. The medium of claim 13, the instructions further causing the processor to wait for a waiting period between the termination of the first episode of atrial fibrillation and applying the overdrive pacing therapy.

15. The medium of claim 11, the instructions further causing the processor to:

administer a shock therapy to the atrium following a detection of the first episode of atrial fibrillation; and

apply the overdrive pacing therapy immediately after administering the shock therapy.

16. The medium of claim 11, the instructions further causing the processor to monitor for the occurrence of an episode of recurrent atrial fibrillation while applying the overdrive pacing therapy.

17. The medium of claim 16, the instructions further causing the processor to:

apply the overdrive pacing therapy at an overdrive pacing rate;

detect an episode of recurrent atrial fibrillation while applying the overdrive pacing therapy; and

increase the overdrive pacing rate.

18. The medium of claim 11, the instructions further causing the processor to monitor for the occurrence of an episode of recurrent atrial fibrillation in a monitoring period after applying the overdrive pacing therapy.

19. The medium of claim 18, the instructions further causing the processor to:

apply the overdrive pacing therapy for an overdrive pacing duration;

detect an episode of recurrent atrial fibrillation in the monitoring period; and

increase the overdrive pacing duration.

20. The medium of claim 11, the instructions further causing the processor to:

apply the overdrive pacing therapy at an overdrive pacing rate for an overdrive pacing duration; and

decrease at least one of the overdrive pacing rate and the overdrive pacing duration.

21. An implantable medical device comprising:

at least one electrode disposed proximate to an atrium of a heart;

a pulse generator coupled to the electrode; and

a processor to control the pulse generator to deliver overdrive pacing therapy to the atrium via the electrode according to an overdrive pacing parameter following an episode of atrial fibrillation, monitor for an episode of recurrent atrial fibrillation, and set the overdrive pacing parameter as a function of the monitoring.

22. The device of claim 21, further comprising sensing circuitry to detect the episode of atrial fibrillation and monitor for the episode of recurrent atrial fibrillation.

23. The device of claim 21, further comprising a telemetry unit to receive a threshold, wherein the processor computes a measure of episodes of atrial fibrillation in an evaluation period that are followed by recurrent episodes of atrial fibrillation, compares the measure to a threshold and sets an overdrive pacing parameter as a function of the comparison.

24. The device of claim 21, wherein the device operates in a plurality of pacing modes, and wherein the device selects a pacing mode as a function of a detected episode of atrial fibrillation.

25. A method comprising:

monitoring for episodes of atrial fibrillation in an evaluation period;

computing a measure of episodes of detected atrial fibrillation in the evaluation period that are followed by detected recurrent episodes of atrial fibrillation;

comparing the measure to a threshold; and

setting an overdrive pacing parameter as a function of the comparison.

26. The method of claim 25, wherein setting the overdrive pacing parameter comprises one of increasing and decreasing the overdrive pacing rate.

27. The method of claim 25, wherein setting the overdrive pacing parameter comprises one of increasing and decreasing the overdrive pacing duration.

28. The method of claim 25, wherein the threshold is a maximum threshold, and wherein setting the overdrive pacing parameter comprises increasing the overdrive pacing rate when the ratio of detected recurrent atrial fibrillation episodes to the total detected atrial fibrillation episodes is above the maximum threshold.

29. The method of claim 25, wherein setting the overdrive pacing parameter comprises one of increasing and decreasing the overdrive pacing duration.

30. A computer-readable medium comprising instructions for causing a programmable processor to:

monitor for episodes of atrial fibrillation in an evaluation period;

compute a measure of episodes of detected atrial fibrillation in the evaluation period that are followed by detected recurrent episodes of atrial fibrillation;

compare the measure to a threshold; and

set an overdrive pacing parameter as a function of the comparison.

31. The medium of claim 30, wherein the instruction cause the processor to set the overdrive pacing parameter comprises one of increasing and decreasing the overdrive pacing rate.

32. The medium of claim 30, wherein the instruction cause the processor to set the overdrive pacing parameter comprises one of increasing and decreasing the overdrive pacing duration.

33. The medium of claim 30, wherein the threshold is a maximum threshold, and wherein the instruction cause the processor to set the overdrive pacing parameter by increasing the overdrive pacing rate when the ratio of detected recurrent atrial fibrillation episodes to the total detected atrial fibrillation episodes is above the maximum threshold.

34. The medium of claim 30, wherein the instruction cause the processor to set an overdrive pacing parameter by one of increasing and decreasing the overdrive pacing duration.

35. An implantable medical device comprising:

at least one electrode disposed proximate to an atrium of a heart;

a pulse generator coupled to the electrode; and

a processor to control the pulse generator to deliver overdrive pacing therapy to the atrium via the electrode according to an overdrive pacing parameter following an episode of atrial fibrillation, monitor for episodes of atrial fibrillation in an evaluation period, compute a measure of episodes of detected atrial fibrillation in the evaluation period that are followed by detected recurrent episodes of atrial fibrillation, compare the measure to a threshold and set the overdrive pacing parameter as a function of the comparison.

36. The device of claim 35, further comprising sensing circuitry to detect at least one episode of atrial fibrillation and monitor for an episode of recurrent atrial fibrillation following the detected episode of atrial fibrillation.

37. The device of claim 35, further comprising a telemetry unit to receive the threshold.

38. The device of claim 35, wherein the device operates in a plurality of pacing modes, and wherein the device selects a pacing mode as a function of a detected episode of atrial fibrillation.

39. A method comprising:

detecting a fibrillation of an atrium of a heart;

delivering a shock therapy to the atrium;

immediately thereafter applying an overdrive pacing therapy to the atrium.

40. The method of claim 39, further comprising:

applying the overdrive pacing therapy according to an overdrive pacing parameter;

monitoring for an episode of recurrent atrial fibrillation; and

setting the overdrive pacing parameter as a function of the monitoring.

41. A computer-readable medium comprising instructions for causing a programmable processor to:

detect a fibrillation of an atrium of a heart;

deliver a shock therapy to the atrium;

immediately thereafter apply an overdrive pacing therapy to the atrium.

42. The medium of claim 41, the instructions further causing the processor to:

apply the overdrive pacing therapy according to an overdrive pacing parameter;

monitor for an episode of recurrent atrial fibrillation; and

set the overdrive pacing parameter as a function of the monitoring.

43. An implantable medical device comprising:

at least one electrode disposed proximate to an atrium of a heart;

a pulse generator coupled to the electrode; and

a processor to detect a fibrillation of the atrium, deliver a shock therapy to the atrium and immediately thereafter control the pulse generator to deliver overdrive pacing therapy to the atrium.

44. The device of claim 43, further comprising sensing circuitry to detect at least one episode of atrial fibrillation and monitor for an episode of recurrent atrial fibrillation following the detected episode of atrial fibrillation.