# US 10,765,876 B2 · Method and apparatus for delivering anti-tachycardia pacing > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 10,765,876 B2 - Document ID: US10765876B2 - Status: Granted - Kind: B2 - Application number: 15/964,261 - Filed: 2018-04-27 - Published: 2019-10-31 - Granted: 2020-09-08 - Earliest claimed: 2018-04-27 - Assignees: Medtronic, Inc. - Applicants: Medtronic, Inc. - Inventors: Vladimir P. Nikolski - Web page: https://patentgrep.com/patent/US10765876B2 ## CPC - A61N 1/36507: {controlled by gradient or slope of the heart potential} - A61N 1/3987: {characterised by the timing or triggering of the shock} - A61B 5/341: Vectorcardiography [VCG] - A61B 5/352: Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval - A61B 5/355: Detecting T-waves - A61B 5/363: Detecting tachycardia or bradycardia - A61N 1/3925: {Monitoring; Protecting} - A61N 1/3956: {Implantable devices for applying electric shocks to the heart, e.g. for cardioversion} - A61N 1/3621: {for treating or preventing abnormally high heart rate} - A61N 1/36585: {controlled by two or more physical parameters} - A61N 1/3702: {Physiological parameters (A61N1/365 takes precedence; evoked response A61N1/371)} - A61N 1/39622: {Pacing therapy} - 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) - A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D) ## Abstract A medical device is configured to deliver anti-tachycardia pacing (ATP) in the presence of T-wave alternans. The device is configured to detect a ventricular tachyarrhythmia from a cardiac electrical signal received by the medical device. In response to the detected ventricular tachyarrhythmia, the device delivers a plurality of ATP pulses at alternating time intervals. The alternating time intervals comprise at least a first ATP time interval separating a first pair of the ATP pulses and a second ATP time interval different than the first ATP time interval. The second ATP time interval consecutively follows the first ATP time interval and separates a second pair of the ATP pulses. ## Claims ### Claim 1 A medical device comprising: a sensing circuit configured to receive a cardiac electrical signal from a patient's heart and sense R-waves and T-waves from the cardiac electrical signal; a therapy delivery circuit configured to generate and deliver anti-tachycardia pacing (ATP) pulses to the patient's heart via electrodes coupled to the therapy delivery circuit; a control circuit coupled to the sensing circuit and to the therapy delivery circuit and configured to: detect a ventricular tachyarrhythmia from the cardiac electrical signal received by the sensing circuit; responsive to the detected ventricular tachyarrhythmia, control the therapy delivery circuit to: deliver a plurality of ATP pulses at alternating ATP time intervals comprising at least a first ATP time interval separating a first pair of the plurality of the ATP pulses comprising a first ATP pulse and a second ATP pulse consecutively following the first ATP pulse at the first ATP time interval, a second ATP time interval separating a second pair of the plurality of ATP pulses comprising the second ATP pulse and a third ATP pulse consecutively following the second ATP pulse at the second ATP time interval, the second ATP time interval being different than the first ATP time interval and consecutively following the first ATP time interval, and a fourth ATP pulse consecutively following the third ATP pulse at the first ATP time interval. ### Claim 2 (depends on 1) The device of claim 1, wherein the control circuit is further configured to: set the first ATP time interval based on a time of a first one of the T-waves that is sensed by the sensing circuit; and control the therapy delivery circuit to deliver a second pulse of the first pair at the first ATP time interval following a first pulse of the first pair. ### Claim 3 (depends on 2) The device of claim 2, wherein the control circuit is further configured to set the first ATP time interval based on a time of the first one of the T-waves sensed by the sensing circuit that is consecutive with a leading pulse of the plurality of ATP pulses. ### Claim 4 (depends on 2) The device of claim 2, wherein: the sensing circuit is configured to sense the first one of the T-waves prior to the first pulse; and the control circuit is configured to: detect T-wave alternans from the cardiac electrical signal received by the sensing circuit prior to delivering the plurality of ATP pulses; determine a phase of the T-wave alternans in response to sensing the first one of the T-waves; and set the first ATP time interval based on the determined phase. ### Claim 5 (depends on 4) The device of claim 4, wherein the control circuit is further configured to: determine a first R-T time interval of a first phase of the detected T-wave alternans; determine a second R-T time interval of a second phase of the detected T-wave alternans; and establish the first ATP time interval and the second ATP time interval based on the first and second R-T time intervals. ### Claim 6 (depends on 2) The device of claim 2, wherein the second pair of pulses comprises the second pulse of the first pair and a third pulse of the plurality of ATP pulses, wherein: the sensing circuit is configured to sense a second one of the T-waves consecutive with the second pulse; and the control circuit is further configured to: set the second ATP time interval based on a time of the second one of the T-waves; and deliver the third pulse at the second ATP time interval following the second pulse of the first pair. ### Claim 7 (depends on 1) The device of claim 1, wherein the control circuit is further configured to: determine a cycle length of the ventricular tachyarrhythmia; set a base ATP interval based on the cycle length; adjust the base ATP interval to one of the first ATP time interval and the second ATP time interval in response to a timing of a first one of the T-waves sensed by the sensing circuit. ### Claim 8 (depends on 6) The device of claim 6, wherein adjusting the base ATP interval comprises: determining a T-wave time interval ending with the first one of the T-waves and starting with a first one of the R-waves sensed by the sensing circuit or a delivered one of the plurality of ATP pulses; and adjusting the base ATP interval to an interval longer than the T-wave time interval and shorter than the ventricular cycle length. ### Claim 9 (depends on 1) The device of claim 1, wherein the control circuit is further configured to: determine a cycle length of the ventricular tachyarrhythmia; set a coupling interval based on the cycle length; and control the therapy delivery circuit to: deliver a leading one of the plurality of ATP pulses at the coupling interval following a first one of the R-waves sensed by the sensing circuit; and deliver a second ATP pulse following the leading ATP pulse at the first ATP time interval, different than the coupling interval. ### Claim 10 (depends on 9) The device of claim 9, wherein the control circuit is further configured to control the therapy delivery circuit to deliver a third ATP pulse following the second ATP pulse at the second ATP time interval, wherein the second ATP time interval equals the coupling interval. ### Claim 11 (depends on 1) The device of claim 1, wherein the control circuit is further configured to: detect T-wave alternans from the cardiac electrical signal received by the sensing circuit prior to delivering the plurality of anti-tachycardia pacing pulses; determine a phase of the T-wave alternans in response to at least one of the T-waves sensed by the sensing circuit; wait for a first one of the R-waves sensed by the sensing circuit that leads a short phase of the T-wave alternans; and deliver a leading one of the plurality of ATP pulses after a coupling interval following the first one of the R-waves leading the short phase of the T-wave alternans. ### Claim 12 A method comprising: detecting a ventricular tachyarrhythmia from a cardiac electrical signal device of a patient's heart; responsive to detecting the ventricular tachyarrhythmia, delivering a plurality of anti-tachycardia pacing (ATP) pulses at alternating ATP time intervals comprising at least a first ATP time interval separating a first pair of the plurality of the ATP pulses comprising a first ATP pulse and a second ATP pulse consecutively following the first ATP pulse at the first ATP time interval, a second ATP time interval separating a second pair of the plurality of ATP pulses comprising the second ATP pulse and a third ATP pulse consecutively following the second ATP pulse at the second ATP time interval, the second ATP time interval being different than the first ATP time interval and consecutively following the first ATP time interval, and a fourth ATP pulse consecutively following the third ATP pulse at the first ATP time interval. ### Claim 13 (depends on 12) The method of claim 12, further comprising: setting the first ATP time interval based on a time of a first one of the sensed T-waves; and delivering a second pulse of the first pair at the first ATP time interval following a first pulse of the first pair. ### Claim 14 (depends on 13) The method of claim 13, further comprising setting the first ATP time interval based on a time of the first one of the T-waves consecutive with a leading pulse of the plurality of ATP pulses. ### Claim 15 (depends on 13) The method of claim 13, further comprising: sensing the first one of the T-waves prior to the first pulse; detecting T-wave alternans from the cardiac electrical signal prior to delivering the plurality of ATP pulses; determining a phase of the T-wave alternans in response to sensing the first one of the T-waves prior to the first pulse; and setting the first ATP time interval based on the determined phase. ### Claim 16 (depends on 15) The method of claim 15, further comprising: determining a first R-T time interval of a first phase of the detected T-wave alternans; determining a second R-T time interval of a second phase of the detected T-wave alternans; and establishing the first ATP time interval and the second ATP time interval based on the first and second R-T time intervals. ### Claim 17 (depends on 13) The method of claim 13, wherein the second pair of pulses comprises the second pulse of the first pair and a third pulse of the plurality of ATP pulses, the method further comprising: sensing a second one of the sensed T-waves consecutive with the second pulse; setting the second ATP time interval based on a time of the second one of the sensed T-waves; and delivering the third pulse at the second ATP time interval following the second pulse of the first pair. ### Claim 18 (depends on 12) The method of claim 12, further comprising: determining a cycle length of the ventricular tachyarrhythmia; setting a base ATP interval based on the cycle length; adjusting the base ATP interval to one of the first ATP time interval and the second ATP time interval in response to a timing of a first one of the sensed T-waves. ### Claim 19 (depends on 18) The method of claim 18, wherein adjusting the base ATP interval comprises: determining a T-wave time interval ending with the first one of the sensed T-waves and starting with a first one of the sensed R-waves or a delivered one of the plurality of ATP pulses; and adjusting the base ATP interval to an interval longer than the T-wave time interval and shorter than the ventricular cycle length. ### Claim 20 (depends on 12) The method of claim 12, further comprising: determining a cycle length of the ventricular tachyarrhythmia; setting a coupling interval based on the cycle length; delivering a leading one of the plurality of ATP pulses at the coupling interval following a first one of the sensed R-waves; and delivering a second ATP pulse following the leading ATP pulse at the first ATP time interval, different than the coupling interval. ### Claim 21 (depends on 18) The method of claim 18, further comprising delivering a third ATP pulse following the second ATP pulse at the second ATP time interval, wherein the second ATP time interval equals the coupling interval. ### Claim 22 (depends on 12) The method of claim 12, further comprising: detecting T-wave alternans from the cardiac electrical signal prior to delivering the plurality of anti-tachycardia pacing pulses; determining a phase of the T-wave alternans in response to at least one of the sensed T-waves; waiting for a first one of the sensed R-waves that leads a short phase of the T-wave alternans; and delivering a leading one of the plurality of ATP pulses after a coupling interval following the first one of the sensed R-waves leading the short phase of the T-wave alternans. ### Claim 23 A non-transitory computer-readable medium storing a set of instructions which when executed by a control circuit of a medical device, cause the medical device to: detect a ventricular tachyarrhythmia from a cardiac electrical signal; responsive to the detected ventricular tachyarrhythmia, control a therapy delivery circuit of the medical device to deliver a plurality of anti-tachycardia pacing (ATP) pulses at alternating ATP time intervals comprising at least a first ATP time interval separating a first pair of the plurality of the ATP pulses comprising a first ATP pulse and a second ATP pulse consecutively following the first ATP pulse at the first ATP time interval, a second ATP time interval separating a second pair of the plurality of ATP pulses comprising the second ATP pulse and a third ATP pulse consecutively following the second ATP pulse at the second ATP time interval, the second ATP time interval being different than the first ATP time interval and consecutively following the first ATP time interval, and a fourth ATP pulse consecutively following the third ATP pulse at the first ATP time interval.