# US 10,864,377 B2 · Pacing mode switching in a ventricular pacemaker > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 10,864,377 B2 - Document ID: US10864377B2 - Status: Granted - Kind: B2 - Application number: 16/022,111 - Filed: 2018-06-28 - Published: 2018-12-20 - Granted: 2020-12-15 - Earliest claimed: 2016-12-01 - Assignees: Medtronic, Inc. - Applicants: Medtronic, Inc. - Inventors: Todd J. Sheldon; Yong K. Cho; Wade M. Demmer; Mark K. Erickson; Vincent E. Splett - Web page: https://patentgrep.com/patent/US10864377B2 ## CPC - A61N 1/36542: {controlled by body motion, e.g. acceleration} - A61N 1/3688: {configured for switching the pacing mode, e.g. from AAI to DDD} - A61N 1/3756: {Casings with electrodes thereon, e.g. leadless stimulators} - A61N 1/36507: {controlled by gradient or slope of the heart potential} - A61N 1/36535: {controlled by body position or posture} - A61N 1/36578: {controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone} - A61N 1/37217: {characterised by the communication link, e.g. acoustic or tactile} - 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 An intracardiac ventricular pacemaker is configured to operate in in a selected one of an atrial-tracking ventricular pacing mode and a non-atrial tracking ventricular pacing mode. A control circuit of the pacemaker determines at least one motion signal metric from the motion signal, compares the at least one motion signal metric to pacing mode switching criteria, and, responsive to the pacing mode switching criteria being satisfied, switches from the selected one of the non-atrial tracking pacing mode and the atrial tracking pacing mode to the other one of the non-atrial tracking pacing mode and the atrial tracking pacing mode for controlling ventricular pacing pulses delivered by the pacemaker. ## Claims ### Claim 1 An intracardiac ventricular pacemaker, comprising: a pulse generator configured to generate and deliver ventricular pacing pulses to a ventricle of a patient's heart via electrodes coupled to the pacemaker; a motion sensor configured to produce a motion signal; a control circuit coupled to the motion sensor and the pulse generator; and a housing implantable within a heart chamber and enclosing the pulse generator, the motion sensor and the control circuit; wherein the control circuit is configured to: detect atrial systolic events from the motion signal; operate in a selected one of an atrial-tracking ventricular pacing mode and a non-atrial tracking ventricular pacing mode, wherein operating in the atrial-tracking ventricular pacing mode comprises setting an atrioventricular pacing interval in response to detecting an atrial systolic event from the motion signal and controlling the pulse generator to deliver a ventricular pacing pulse in response to the atrioventricular pacing interval expiring; while operating in the selected one of the atrial-tracking ventricular pacing mode and the non-atrial tracking ventricular pacing mode, determine from the motion signal at least one motion signal metric; compare the at least one motion signal metric to pacing mode switching criteria; and responsive to the pacing mode switching criteria being satisfied, switch from the selected one of the non-atrial tracking ventricular pacing mode and the atrial-tracking ventricular pacing mode to the other one of the non-atrial tracking ventricular pacing mode and the atrial-tracking ventricular pacing mode. ### Claim 2 (depends on 1) The pacemaker of claim 1, wherein the control circuit is configured to determine the at least one motion signal metric by determining a patient physical activity metric. ### Claim 3 (depends on 1) The pacemaker of claim 1, wherein the control circuit is configured to determine the at least one motion signal metric by determining a patient posture from the motion signal. ### Claim 4 (depends on 1) The pacemaker of claim 1, further comprising a cardiac electrical signal sensing circuit enclosed by the housing and configured to sense intrinsic ventricular electrical events; wherein the control circuit is configured to: determine a ventricular event rate from a plurality of at least one of the sensed intrinsic ventricular events and the delivered ventricular pacing pulses; and establish a first switching threshold of the pacing mode switching criteria based on at least the ventricular event rate. ### Claim 5 (depends on 4) The pacemaker of claim 4, wherein the control circuit is further configured to: while operating in the atrial-tracking ventricular pacing mode, determine the motion signal metric by determining a sensor indicated pacing rate from the motion signal; compare the sensor indicated pacing rate to the first switching threshold; and switch from the atrial-tracking ventricular pacing mode to the non-atrial tracking ventricular pacing mode in response to at least the sensor indicated pacing rate being greater than the first switching threshold. ### Claim 6 (depends on 5) The pacemaker of claim 5, wherein the control circuit is further configured to: compare the sensor indicated pacing rate to a second switching threshold corresponding to an activities of daily living heart rate; and switch from the atrial-tracking ventricular pacing mode to the non-atrial tracking ventricular pacing mode in response to the sensor indicated pacing rate being greater than the second pacing mode switching threshold and greater than the first pacing mode switching threshold. ### Claim 7 (depends on 6) The pacemaker of claim 6, wherein the control circuit is further configured to: while operating in the non-atrial tracking ventricular pacing mode, determine the motion signal metric by determining the sensor indicated pacing rate; compare the sensor indicated pacing rate to the second pacing mode switching threshold; and switch back to the atrial-tracking ventricular pacing mode in response to the sensor indicated pacing rate being less than the second pacing mode switching threshold. ### Claim 8 (depends on 4) The pacemaker of claim 4, wherein the control circuit is configured to determine the ventricular event rate by determining a median ventricular event interval. ### Claim 9 (depends on 1) The pacemaker of claim 1, wherein the control circuit is configured to determine the at least one motion signal metric by processing the motion signal over a predetermined time segment. ### Claim 10 (depends on 1) The pacemaker of claim 1, wherein the control circuit is configured to: extend a ventricular pacing rate interval for at least one ventricular cycle; detect an atrial systolic event during the extended ventricular pacing rate interval; and determine if the pacing mode switching criteria are met in response to detecting the atrial systolic event. ### Claim 11 (depends on 10) The pacemaker of claim 10, wherein: the pacemaker further includes a sensing circuit for receiving a cardiac electrical signal via electrodes coupled to the pacemaker; the control circuit is further configured to: detect at least one of: a premature ventricular contraction from the cardiac electrical signal, a decreased patient physical activity from the motion signal, and a change in patient body posture from the motion signal; and extend the ventricular pacing rate interval in response to detecting at least one of the premature ventricular contraction, the decreased patient physical activity, and the change in patient posture. ### Claim 12 (depends on 10) The pacemaker of claim 10, wherein the control circuit is further configured to: determine a patient physical activity metric from the motion signal; and periodically extend the ventricular pacing rate interval at a frequency that is dependent on the patient physical activity metric. ### Claim 13 (depends on 1) The pacemaker of claim 1, wherein the control circuit is further configured to set the pacing mode switching criteria based on a patient condition determined from the motion signal. ### Claim 14 (depends on 1) The pacemaker of claim 1, wherein the control module is further configured to: switch from the atrial-tracking ventricular pacing mode to a first non-atrial tracking ventricular pacing mode for a temporary interval; and switch from the first non-atrial tracking ventricular pacing mode to a second non-atrial tracking ventricular pacing mode in response to the temporary interval expiring. ### Claim 15 (depends on 1) The pacemaker of claim 1, further comprising: at least one electrode carried by the housing and coupled to the pulse generator for delivering the ventricular pacing pulse in response to the atrioventricular pacing interval expiring. ### Claim 16 A method performed by an intracardiac ventricular pacemaker having a motion sensor configured to produce a motion signal, the method comprising: receiving the motion signal by a control circuit of the pacemaker detecting atrial systolic events from the motion signal; operating in a selected one of an atrial-tracking ventricular pacing mode and a non-atrial tracking ventricular pacing mode, wherein operating in the atrial-tracking ventricular pacing mode comprises setting an atrioventricular pacing interval in response to detecting an atrial systolic event from the motion signal and controlling a pulse generator of the pacemaker to deliver a ventricular pacing pulse in response to the atrioventricular pacing interval expiring; while operating in the selected one of the atrial-tracking ventricular pacing mode and the non-atrial tracking ventricular pacing mode, determining from the motion signal at least one motion signal metric; comparing the at least one motion signal metric to pacing mode switching criteria; and responsive to the pacing mode switching criteria being satisfied, switching from the selected one of the non-atrial tracking ventricular pacing mode and the atrial-tracking ventricular pacing mode to the other one of the non-atrial tracking ventricular pacing mode and the atrial-tracking ventricular pacing mode. ### Claim 17 (depends on 16) The method of claim 16, wherein determining the at least one motion signal metric comprises determining a patient physical activity metric. ### Claim 18 (depends on 16) The method of claim 16, wherein determining the at least one motion signal metric comprises determining a patient posture from the motion signal. ### Claim 19 (depends on 16) The method of claim 16, further comprising: receiving a cardiac electrical signal by a sensing circuit; sensing intrinsic ventricular electrical events from the cardiac electrical signal determining a ventricular event rate from a plurality of at least one of the sensed intrinsic ventricular events and delivered ventricular pacing pulses; and establishing a first switching threshold of the pacing mode switching criteria based on at least the ventricular event rate. ### Claim 20 (depends on 19) The method of claim 19, further comprising: while operating in the atrial-tracking ventricular pacing mode, determining the motion signal metric by determining a sensor indicated pacing rate from the motion signal; comparing the sensor indicated pacing rate to the first switching threshold; and switching from the atrial-tracking ventricular pacing mode to the non-atrial tracking ventricular pacing mode in response to at least the sensor indicated pacing rate being greater than the first switching threshold. ### Claim 21 (depends on 20) The method of claim 20, further comprising: comparing the sensor indicated pacing rate to a second switching threshold corresponding to an activities of daily living heart rate; and switching from the atrial-tracking ventricular pacing mode to the non-atrial tracking ventricular pacing mode in response to the sensor indicated pacing rate being greater than the second pacing mode switching threshold and greater than the first pacing mode switching threshold. ### Claim 22 (depends on 21) The method of claim 21, further comprising: while operating in the non-atrial tracking ventricular pacing mode, determining the motion signal metric by determining the sensor indicated pacing rate; comparing the sensor indicated pacing rate to the second pacing mode switching threshold; and switching back to the atrial-tracking ventricular pacing mode in response to the sensor indicated pacing rate being less than the second pacing mode switching threshold. ### Claim 23 (depends on 19) The method of claim 19, further comprising determining the ventricular event rate by determining a median ventricular event interval. ### Claim 24 (depends on 16) The method of claim 16, wherein determining the at least one motion signal metric comprises processing the motion signal over a predetermined time segment. ### Claim 25 (depends on 16) The method of claim 16, further comprising: extending a ventricular pacing rate interval for at least one ventricular cycle; detecting an atrial systolic event during the extended ventricular pacing rate interval; and determining if the pacing mode switching criteria are met in response to detecting the atrial systolic event. ### Claim 26 (depends on 25) The method of claim 25, further comprising: detecting at least one of: a premature ventricular contraction from a cardiac electrical signal received by a sensing circuit of the pacemaker, a decreased patient physical activity from the motion signal, and a change in patient body posture from the motion signal; and extending the ventricular pacing rate interval in response to detecting at least one of the premature ventricular contraction, the decreased patient physical activity, and the change in patient posture. ### Claim 27 (depends on 25) The method of claim 25, further comprising: determining a patient physical activity metric from the motion signal; and periodically extending the ventricular pacing rate interval at a frequency that is dependent on the patient physical activity metric. ### Claim 28 (depends on 16) The method of claim 16, further comprising setting the pacing mode switching criteria based on a patient condition determined from the motion signal. ### Claim 29 (depends on 16) The method of claim 16, wherein in switching from the atrial-tracking ventricular pacing mode to the non-atrial tracking ventricular pacing mode comprises: switching from the atrial-tracking ventricular pacing mode to a first non-atrial tracking ventricular pacing mode for a temporary interval; and switching from the first non-atrial tracking ventricular pacing mode to a second non-atrial tracking ventricular pacing mode in response to the temporary interval expiring. ### Claim 30 (depends on 16) The method of claim 16, further comprising delivering the ventricular pacing pulse in response to the atrioventricular pacing interval expiring via at least one electrode carried by a housing that encloses the pulse generator, the motion sensor, and the control circuit of the pacemaker. ### Claim 31 A non-transitory, computer-readable medium storing a set of instructions, which, when executed by a control circuit of an intracardiac ventricular pacemaker having a motion sensor configured to produce a motion signal, cause the pacemaker to: detect atrial systolic events from the motion signal; operate in a selected one of an atrial-tracking ventricular pacing mode and a non-atrial tracking ventricular pacing mode, wherein operating in the atrial-tracking ventricular pacing mode comprises setting an atrioventricular pacing interval in response to detecting an atrial systolic event from the motion signal and controlling a pulse generator of the pacemaker to deliver a ventricular pacing pulse in response to the atrioventricular pacing interval expiring; while operating in the selected one of the atrial-tracking ventricular pacing mode and the non-atrial tracking ventricular pacing mode, determine from the motion signal at least one motion signal metric; compare the at least one motion signal metric to pacing mode switching criteria; and responsive to the pacing mode switching criteria being satisfied, switching from the selected one of the non-atrial tracking ventricular pacing mode and the atrial-tracking ventricular pacing mode to the other one of the non-atrial tracking ventricular pacing mode and the atrial-tracking ventricular pacing mode.