# US 10,441,796 B2 · Multi-chamber intracardiac pacing system > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 10,441,796 B2 - Document ID: US10441796B2 - Status: Granted - Kind: B2 - Application number: 14/644,878 - Filed: 2015-03-11 - Published: 2016-01-21 - Granted: 2019-10-15 - Earliest claimed: 2015-03-11 - Assignees: Medtronic, Inc. - Applicants: Medtronic, Inc. - Inventors: Wade M Demmer; Todd J Sheldon; Saul E Greenhut; James D Reinke - Web page: https://patentgrep.com/patent/US10441796B2 ## CPC - A61B 5/363: Detecting tachycardia or bradycardia - A61B 5/318: Heart-related electrical modalities, e.g. electrocardiography [ECG] - A61B 5/686: {Permanently implanted devices, e.g. pacemakers, other stimulators, biochips (A61B5/6861 takes precedence)} - A61N 1/3622: {comprising two or more electrodes co-operating with different heart regions} - A61N 1/36592: {controlled by the heart rate variability} - A61N 1/3706: {Pacemaker parameters (stimulation threshold A61N1/371)} - A61N 1/3756: {Casings with electrodes thereon, e.g. leadless stimulators} - A61N 1/37205: {Microstimulators, e.g. implantable through a cannula} - A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D) - A61N: ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY (measurement of bioelectric currents A61B; surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body A61B18/00; anaesthetic apparatus in general A61M; incandescent lamps H01K; infrared radiators for heating H05B) ## Abstract The control module of a first pacemaker included in an implantable medical device system including the first pacemaker and a second pacemaker is configured to set a pacing escape interval in response to a far field pacing pulse sensed by the first pacemaker. The far field pacing pulse is a pacing pulse delivered by the second pacemaker. The pacing escape interval is allowed to continue without restarting the in response to a far field intrinsic event sensed by the first pacemaker during the pacing escape interval. The first pacemaker delivers a cardiac pacing pulse to the heart upon expiration of the pacing escape interval. ## Claims ### Claim 1 A medical device system, comprising a first implantable pacemaker comprising a housing and a pair of electrodes, the housing and the pair of electrodes configured to be implanted in a first heart chamber; and a second implantable pacemaker configured to be implanted in a second heart chamber different than the first heart chamber; the first implantable pacemaker further comprising: a first sensing module within the housing, the first sensing module configured to receive a cardiac electrical signal via the pair of electrodes and sense from the cardiac electrical signal near field intrinsic cardiac events occurring in the first heart chamber, far field intrinsic events occurring in the second heart chamber different than the first heart chamber, and far field pacing pulses, the far field pacing pulses being pacing pulses delivered in the second heart chamber by the second implantable pacemaker; a first pulse generator within the housing, the first pulse generator coupled to the pair electrodes for delivering a cardiac pacing pulse to the first heart chamber; and a first control module within the housing, the first control module configured to: set a first pacing escape interval in response to a far field pacing pulse sensed by the first sensing module; permit the first pacing escape interval to continue without restarting the first pacing escape interval in response to a far field intrinsic event sensed by the first sensing module during the first pacing escape interval; and control the pulse generator to deliver the cardiac pacing pulse to the first heart chamber upon expiration of the first pacing escape interval. ### Claim 2 (depends on 1) The system of claim 1, wherein the first control module is further configured to set a second pacing escape interval different than the first pacing escape interval in response to a far field intrinsic event sensed by the first sensing module outside the first pacing escape interval. ### Claim 3 (depends on 2) The system of claim 2, wherein the first control module is configured to: detect a tachycardia of the second heart chamber in response to the far-field intrinsic events sensed by the first sensing module; and disable setting the first and second escape intervals in response to detecting the tachycardia. ### Claim 4 (depends on 3) The system of claim 3, wherein the first control module is configured to detect the tachycardia by detecting a decrease in a rate of the far-field intrinsic events sensed by the first sensing module below a predetermined minimum rate. ### Claim 5 (depends on 3) The system of claim 3, wherein the first control module is configured to detect the tachycardia by detecting an increase of the far-field intrinsic events sensed by the first sensing module, the increase being above a predetermined pacing mode switch threshold. ### Claim 6 (depends on 2) The system of claim 2, wherein the first control module is further configured to: start an extended first pacing escape interval in response to a next far field pacing pulse event sensed by the first sensing module; determine a conduction time from the next far field pacing pulse event to a next near field intrinsic event sensed during the extended first pacing escape interval; compare the conduction time to a conduction time range; and responsive to the conduction time being within the conduction time range, set a back-up pacing interval in response to each one of a plurality of subsequent far field pacing pulse events, the back-up pacing interval being greater than the first pacing escape interval. ### Claim 7 (depends on 6) The system of claim 6, wherein the control module is further configured to: control the pulse generator to deliver a back-up pacing pulse to the first heart chamber upon expiration of the back-up pacing interval; and set the first pacing escape interval in response to a far field pacing pulse event sensed by the first sensing module after the back-up pacing pulse. ### Claim 8 (depends on 1) The system of claim 1, wherein the second implantable pacemaker comprises: a second housing; a second pair of electrodes, wherein the second housing and the second pair of electrodes are configured to be implanted in the second heart chamber; a second sensing module within the second housing, the second sensing module configured to receive a second cardiac electrical signal via the second pair of electrodes and sense from the second cardiac electrical signal second far field pacing pulse events that are first pacing pulses delivered in the first heart chamber by the first implantable pacemaker; a second pulse generator within the second housing, the second pulse generator coupled to the second pair of electrodes for delivering second cardiac pacing pulses to the second heart chamber; and a second control module within the second housing, the second control module configured to: set a first pacing pulse output for controlling the second cardiac pacing pulses that are delivered to the second heart chamber in response to not sensing the second far field pacing pulse events by the second sensing module; and set a second pacing pulse output for controlling the second cardiac pacing pulses that are delivered to the second heart chamber in response to sensing the second far field pacing pulse events by the second sensing module, the second pacing pulse output greater than the first pacing pulse output. ### Claim 9 (depends on 8) The system of claim 8, wherein the second control module is configured to: set the first pacing pulse output by setting a first pacing safety margin; and set the second pacing pulse output by setting a second pacing safety margin greater than the first pacing safety margin. ### Claim 10 (depends on 1) The system of claim 1, wherein: the first control module is configured to set a blanking interval in response to the far field pacing pulse, the blanking interval set to expire prior to an expected far field evoked response event; the first sensing module is configured to sense a far field evoked response following the blanking interval; and the first control module is configured to set the first pacing escape interval in response to the far field pacing pulse by starting the first pacing escape interval upon the far field evoked response sensed after the blanking interval. ### Claim 11 A method performed by an implantable medical device system including a first implantable pacemaker having a housing, the implantable medical device system further including a second implantable pacemaker, wherein the method comprises: sensing from a cardiac electrical signal received by a first sensing module within the housing of the first implantable pacemaker: near field intrinsic cardiac events occurring in a first heart chamber, far field intrinsic events occurring in a second heart chamber different than the first heart chamber, and far field pacing pulses, the far field pacing pulses being pacing pulses delivered in the second heart chamber by the second implantable pacemaker, wherein the housing of the first implantable pacemaker is configured to be implanted within the first heart chamber and the second implantable pacemaker is configured to be implanted within the second heart chamber; setting a first pacing escape interval in response to a far field pacing pulse sensed by the first sensing module; allowing the first pacing escape interval to continue without restarting the first pacing escape interval in response to a far field intrinsic event sensed by the first sensing module during the first pacing escape interval; and controlling a pulse generator within the housing of the first implantable pacemaker to deliver a cardiac pacing pulse to the first heart chamber upon expiration of the first pacing escape interval. ### Claim 12 (depends on 11) The method of claim 11, further comprising setting a second pacing escape interval different than the first pacing escape interval in response to a far field intrinsic event sensed by the first sensing module outside the first pacing escape interval. ### Claim 13 (depends on 12) The method of claim 12, further comprising: detecting a tachycardia of the second heart chamber in response to the far-field intrinsic events sensed by the first sensing module; and disabling setting the first and second escape intervals in response to detecting the tachycardia. ### Claim 14 (depends on 13) The method of claim 13, wherein detecting the tachycardia comprises detecting a decrease in a rate of the far-field intrinsic events sensed by the first sensing module below a predetermined minimum rate. ### Claim 15 (depends on 13) The method of claim 13, wherein detecting the tachycardia comprises detecting an increase of the far-field intrinsic events sensed by the first sensing module above a predetermined pacing mode switch threshold. ### Claim 16 (depends on 12) The method of claim 12, further comprising: starting an extended first pacing escape interval in response to a next far field pacing pulse event sensed by the first sensing module; determining a conduction time from the next far field pacing pulse event to a next near field intrinsic event sensed during the extended first pacing escape interval; comparing the conduction time to a conduction time range; and responsive to the conduction time being within the conduction time range, setting a back-up pacing interval in response to each one of a plurality of subsequent far field pacing pulse events, the back-up pacing interval being greater than the first pacing escape interval. ### Claim 17 (depends on 16) The method of claim 16, further comprising: controlling the pulse generator to deliver a back-up pacing pulse to the first heart chamber upon expiration of the back-up pacing interval; and setting the first pacing escape interval in response to a far field pacing pulse event sensed by the first sensing module after the back-up pacing pulse. ### Claim 18 (depends on 11) The method of claim 11, further comprising: sensing, from a second cardiac electrical signal received by a second sensing module within a second housing of the second implantable pacemaker, second far field pacing pulse events that are pacing pulses delivered in the first heart chamber by the first implantable pacemaker, wherein the second housing of the second implantable pacemaker is configured to be implanted within the second heart chamber; setting a first pacing pulse output for controlling second cardiac pacing pulses that are delivered to the second heart chamber, the first pacing pulse output set in response to not sensing the second far field pacing pulse events by the second sensing module; and setting a second pacing pulse output for controlling the second cardiac pacing pulses that are delivered to the second heart chamber, the second pacing pulse output set in response to sensing the second far field pacing pulse events by the second sensing module, the second pacing pulse output greater than the first pacing pulse output. ### Claim 19 (depends on 18) The method of claim 18, further comprising: setting the first pacing pulse output by setting a first pacing safety margin; and setting the second pacing pulse output by setting a second pacing safety margin greater than the first pacing safety margin. ### Claim 20 (depends on 11) The method of claim 11, wherein setting the first pacing escape interval in response to the far field pacing pulse comprises: setting a blanking interval in response to the far field pacing pulse, the blanking interval set to expire prior to an expected far field evoked response event; sensing a far field evoked response following the blanking interval; and starting the first pacing escape interval upon sensing the far field evoked response after the blanking interval. ### Claim 21 A non-transitory, computer-readable storage medium storing a set of instructions that, when executed by a control module within a housing of a first implantable pacemaker of a medical device system including the first implantable pacemaker and a second implantable pacemaker, cause the system to: sense from a cardiac electrical signal received by a first sensing module of the first implantable pacemaker near field intrinsic cardiac events occurring in a first heart chamber, far field intrinsic events occurring in a second heart chamber different than the first heart chamber, and far field pacing pulses, the far field pacing pulses being pacing pulses delivered in the second heart chamber by the second implantable pacemaker, wherein the housing of the first implantable pacemaker is configured to be implanted within the first heart chamber and the second implantable pacemaker is configured to be implanted within the second heart chamber; setting a first pacing escape interval in response to a far field pacing pulse sensed by the first sensing module; allowing the first pacing escape interval to continue without restarting the first pacing escape interval in response to a far field intrinsic event sensed by the sensing module during the first pacing escape interval; and controlling a pulse generator within the housing of the first implantable pacemaker to deliver a cardiac pacing pulse to the first heart chamber upon expiration of the first pacing escape interval.