Reverse hysteresis and mode switching for intermittent pacing therapy
First Claim
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1. A cardiac device, comprising:
- one or more sensing amplifiers for sensing electrical cardiac activity through one or more sensing channels;
one or more pulse generators for delivering pacing pulses to one or more myocardial sites through one or more pacing channels;
an exertion level sensor for measuring exertion level;
a controller programmed to operate the device in either a normal operating mode or an intermittent pacing therapy (IPT) mode;
wherein, in the IPT mode, the controller is programmed to deliver paces to the one or more myocardial sites using a pacing mode that results in some degree of dyssynchrony as compared with the normal operating mode;
wherein the controller is programmed to intermittently switch to the IPT mode that delivers ventricular pacing pulses with an escape interval initially set to a specified IPT value;
wherein the controller is programmed to switch to a non-atrial tracking IPT mode if the measured exertion level is below a specified value and switch to an atrial tracking IPT mode otherwise;
wherein, when operating in the IPT mode, the controller is further programmed to monitor for senses that inhibit the ventricular pacing pulses and, after a specified number of such senses have occurred, further shorten the escape interval from the IPT value; and
,wherein the controller is further programmed to continue operating in the IPT mode without shortening the escape interval if the escape interval has been shortened to a specified minimum limit value.
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Abstract
Cardioprotective pre-excitation pacing may be applied to stress or de-stress a particular myocardial region delivering of pacing pulses in a manner that causes a dyssynchronous contraction. Such dyssynchronous contractions are responsible for the desired cardioprotective effects of pre-excitation pacing. A method and device for applying reverse hysteresis and mode switching to the delivery of such cardioprotective pacing are described.
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Citations
18 Claims
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1. A cardiac device, comprising:
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one or more sensing amplifiers for sensing electrical cardiac activity through one or more sensing channels; one or more pulse generators for delivering pacing pulses to one or more myocardial sites through one or more pacing channels; an exertion level sensor for measuring exertion level; a controller programmed to operate the device in either a normal operating mode or an intermittent pacing therapy (IPT) mode; wherein, in the IPT mode, the controller is programmed to deliver paces to the one or more myocardial sites using a pacing mode that results in some degree of dyssynchrony as compared with the normal operating mode; wherein the controller is programmed to intermittently switch to the IPT mode that delivers ventricular pacing pulses with an escape interval initially set to a specified IPT value; wherein the controller is programmed to switch to a non-atrial tracking IPT mode if the measured exertion level is below a specified value and switch to an atrial tracking IPT mode otherwise; wherein, when operating in the IPT mode, the controller is further programmed to monitor for senses that inhibit the ventricular pacing pulses and, after a specified number of such senses have occurred, further shorten the escape interval from the IPT value; and
,wherein the controller is further programmed to continue operating in the IPT mode without shortening the escape interval if the escape interval has been shortened to a specified minimum limit value. - View Dependent Claims (2, 3, 4, 5, 6, 8, 9, 10)
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7. The device of claim l wherein the controller is programmed to measure one or more intrinsic cardiac intervals and set the value of the escape interval to an IPT value as a function of the intrinsic cardiac interval measurement.
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11. A method for operating a cardiac device, comprising:
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sensing electrical cardiac activity through one or more sensing channels; delivering pacing pulses to one or more myocardial sites through one or more pacing channels; measuring exertion level; operating the device in either a normal operating mode or an intermittent pacing therapy (IPT) mode; wherein, in the IPT mode, the paces are delivered to the one or more myocardial sites using a pacing mode that results in some degree of dyssynchrony as compared with the normal operating mode; in the IPT mode, delivering ventricular pacing pulses with an escape interval initially set to a specified IPT value; intermittently switching to the IPT mode; switching to a non-atrial tracking IPT mode if the measured exertion level below a specified value and switching to an atrial tracking IPT mode otherwise; when operating in the IPT mode, monitoring for senses that inhibit the ventricular pacing pulses and, after a specified number of such senses have occurred, further shortening the escape interval from the IPT value; and
,continuing operating in the IPT mode without shortening the escape interval if the escape interval has been shortened to a specified minimum limit value. - View Dependent Claims (12, 13, 14, 15, 16, 17, 18)
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Specification