Post-extrasystolic potentiation stimulation with physiologic sensor feedback
First Claim
1. A cardiac pacemaker having escape interval timer means for generating a pace event signal at the time-out of an escape interval, natural heart depolarization sensing means for providing a sense event signal upon sensing a heart depolarization, means for resetting said escape interval timer means in response to pace and sense event signals, pulse generator means responsive to a pace event signal for generating a pacing pulse, and means for applying the packing pulse to a heart, further comprising means for selectively providing post-extrasystolic potentiation effects without undue cardiac stress comprising:
- means for causing said pulse generator means to provide a paired packing pulse a paired pulse interval after the occurrence of a pace event signal in order to induce a post-extrasystolic potentiation effect;
means for detecting a physiologic response resulting from said post-extrasystolic potentiation effect; and
means responsive to said detecting means for adjusting said selectively providing means to vary a parameter of said paired packing pulses accordingly.
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Accused Products
Abstract
A post-extrasystolic potentiation (PESP) cardiac pacing energy stimulator for applying paired and/or triggered pacing stimulation pulses to the right atrium and/or ventricle incorporating one or more sensors, such as a venous oxygen saturation, ventricular, atrial, or arterial blood pressure, or intracardiac or systemic blood flow sensor, and signal processing circuitry for controlling the frequency of or number of heart cycles between periodic delivery of triggered or paired pacing to induce PESP for the treatment of congestive heart failure or other cardiac dysfunctions. Preferably, a first sensor, e.g., a ventricular or arterial blood pressure or flow sensor, is employed to monitor the performance of the heart, and develop a cardiac performance index (CPI) and a second sensor, e.g., an oxygen saturation sensor positioned in the coronary sinus, is employed to monitor cardiac muscle stress and develop a cardiac stress index (CSI) to balance performance and stress. The PESP stimulator may be incorporated into a dual chamber (DDD) pacing system with or without physiologic rate control and with or without backup cardioversion/defibrillation therapy capabilities or in a separate, single purpose device. The PESP stimulator has particular application in atrial stimulation for augmenting filling of the ventricles.
586 Citations
28 Claims
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1. A cardiac pacemaker having escape interval timer means for generating a pace event signal at the time-out of an escape interval, natural heart depolarization sensing means for providing a sense event signal upon sensing a heart depolarization, means for resetting said escape interval timer means in response to pace and sense event signals, pulse generator means responsive to a pace event signal for generating a pacing pulse, and means for applying the packing pulse to a heart, further comprising means for selectively providing post-extrasystolic potentiation effects without undue cardiac stress comprising:
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means for causing said pulse generator means to provide a paired packing pulse a paired pulse interval after the occurrence of a pace event signal in order to induce a post-extrasystolic potentiation effect; means for detecting a physiologic response resulting from said post-extrasystolic potentiation effect; and means responsive to said detecting means for adjusting said selectively providing means to vary a parameter of said paired packing pulses accordingly. - View Dependent Claims (2, 3, 4, 5, 6)
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7. A method of operating a cardiac pacemaker to provide post-extrasystolic potentiation effect to augment filling of the ventricular chambers of the heart comprising:
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sensing atrial depolarizations; providing pacing pulses on demand to the atrium of the heart; providing paired and triggered packing pulses timed from immediately preceding packing pulses and sensed atrial depolarizations, respectively, sufficient to effect post-extra-systolic potentiation of the atrium while falling within the refractory period of the ventricle, whereby ventricular filling is augmented by the more vigorous contraction of the atrium; establishing a ratio of the application of said triggered and paired packing pulses in relation to a total number of packing pulses and sensed atrial depolarizations; detecting the level of cardiac stress induced by said post-extrasystolic potentiation; and adjusting the ratio to avoid undue cardiac stress. - View Dependent Claims (8, 9)
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10. A cardiac pacemaker for providing post-extrasystolic potentiation effect to augment filing of the ventricular chambers of the heart comprising:
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means for sensing atrial depolarizations; means for providing pacing pulses on demand to the atrium of the heart; means for providing paired and triggered pacing pulses timed from an immediately preceding pacing pulses and sensed atrial depolarizations, respectively, sufficient to effect post-extrasystolic potentiation of the atrium while falling within the refractory period of the ventricle, whereby ventricular filling is augmented by the more vigorous contraction of the atrium; means for establishing a ratio of the application of said triggered and paired stimulation pulses in relation to a total number of pacing pulses and sensed atrial depolarizations; means for detecting the level of cardiac stress induced by said post-extrasystolic potentiation; and means for adjusting said ratio to avoid undue cardiac stress. - View Dependent Claims (11, 12)
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13. A method of operating a cardiac pacemaker for providing stimulating pulses to a patient'"'"'s heart comprising the steps of:
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sensing naturally occurring heart signals and generating a sense event signal; generating pacing stimulating pulses at a minimum pacing rate, by providing each pacing pulse separated by an escape interval corresponding to the pacing rate; restarting the escape interval in response to a sense event signal; measuring a physiological parameter; comparing said measured parameter to predetermined criteria; and if said measured physiological parameter meets said criteria, generating a further pacing pulse coupled to preceding packing pulse and sense events after a coupling interval shorter than said escape interval to induce post-extrasystolic potentiation. - View Dependent Claims (14, 15, 16)
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17. An atrial-ventricular cardiac pacemaker for providing atrial and ventricular stimulating pulses to the patient'"'"'s atrium and ventricle at a predetermined rate and atrial-ventricular synchronous relationship in the absence of naturally occurring atrial and ventricular sense events comprising:
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atrial sensing means for sensing naturally occurring atrial heart signals and generating an atrial sense event signal in response thereto; ventricular sensing means for sensing naturally occurring ventricular heart signals and generating a ventricular sense event signal in response thereto; atrial pulse generating means for generating atrial stimulating pulses at a minimum atrial packing rate, including atrial timing means for providing each atrial stimulating pulse separated by an atrial escape interval corresponding to a pacing rate, and reset means responsive to an atrial sense event signal for resetting said atrial timing means and restarting the atrial escape interval; ventricular pulse generator means for generate ventricular stimulating pulses at a minimum pacing rate, including ventricular timing means for providing each ventricular stimulating pulse separated by a ventricular escape interval corresponding to the ventricular pacing rate, and reset means responsive to a ventricular sense event signal for resetting said ventricular timing means and restarting the ventricular escape interval; means for measuring physiological parameters indicative of the level of myocardial requirements for blood oxygen and the level of myocardial effort and for providing a sensor output signal in response thereto; and means responsive to said sensor output signal for periodically and selectively causing said atrial and ventricular pulse generator means to provide a coupled stimulating pulses at predetermined time intervals following preceding atrial and ventricular sense and pace events to induce post-extrasystolic potentiation. - View Dependent Claims (18)
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19. A cardiac pacemaker having escape interval timer means for generating a pace event signal at the time-out of an escape interval, sensing means for providing a sense event signal upon sensing a heart depolarization, means for resetting said escape interval timer means in response to said pace and sense event signals, pulse generator means responsive to pace event signals for generating pacing pulses, and means for applying said pacing pulses to a heart, further comprising means for selectively providing post-extrasystolic potentiation effects without undue cardiac stress comprising:
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means for causing said pulse generator means to provide triggered pacing pulses a triggered pulse interval after the occurrence of said sense event signals in order to induce a post-extrasystolic potentiation effect; means for detecting a physiologic response resulting from said post-extrasystolic potentiation effect; and means responsive to said detecting means for adjusting said selectively providing means to vary a parameter of said triggered pacing pulses accordingly. - View Dependent Claims (20, 21, 22, 23)
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24. A cardiac pacemaker having escape interval timer means for generating a pace event signal at the time-out of an escape interval, sensing means for providing a sense event signal upon sensing a heart depolarization, means for resetting said escape interval timer means in response to said pace and sense event signals, pulse generator means responsive to a pace event signal for generating a pacing pulse, and means for applying the pacing pulse to a heart, further comprising means for selectively providing post-extrasystolic potentiation effects without undue cardiac stress comprising:
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means for causing said pulse generator means to provide a post-extrasystolic potentiation inducing packing pulse a coupled pulse interval after the occurrence of a sense event signal in order to induce a post-extrasystolic potentiation effect; means for detecting a physiologic response resulting from said post-extrasystolic potentiation effect; and means responsive to said detecting means for adjusting said selectively providing means to vary a parameter of said post-extrasystolic potentiation inducing pacing pulses pacing pulses accordingly. - View Dependent Claims (25, 26, 27, 28)
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Specification