# US 11,027,137 B2 · Modulate pacing rate to increase the percentage of effective ventricular capture during atrial fibrillation > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 11,027,137 B2 - Document ID: US11027137B2 - Status: Granted - Kind: B2 - Application number: 16/152,078 - Filed: 2018-10-04 - Published: 2019-01-31 - Granted: 2021-06-08 - Earliest claimed: 2013-03-15 - Assignees: Medtronic, Inc. - Applicants: Medtronic, Inc. - Inventors: Richard M. T. Lu; Subham Ghosh; Robert W. Stadler - Web page: https://patentgrep.com/patent/US11027137B2 ## CPC - A61N 1/371: {Capture, i.e. successful stimulation} - A61B 5/361: Detecting fibrillation - A61N 1/3624: {occurring in the atrium, i.e. atrial tachycardia} - A61N 1/36842: {Multi-site stimulation in the same chamber} - A61N 1/37: Monitoring; Protecting - A61N 1/3716: {with reduction of residual polarisation effects} - A61N 1/3622: {comprising two or more electrodes co-operating with different heart regions} - A61N 1/3684: {for stimulating the heart at multiple sites of the ventricle or the atrium} - A61N 1/36843: {Bi-ventricular stimulation} - 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 The present disclosure pertains to cardiac pacing methods and systems, and, more particularly, to cardiac resynchronization therapy (CRT). In particular, the present disclosure pertains to determining whether a patient is experiencing atrial fibrillation (AF). If the patient is experiencing AF, the efficacy of CRT is determined. A signal is sensed in response to a ventricular pacing stimulus. Through signal processing, a number of features are parsed from the signal and a determination is made as to whether the ventricular pacing stimulus evoked a response from the ventricle. ## Claims ### Claim 1 An apparatus for determining whether ventricular pacing stimuli are capturing a paced ventricle during atrial fibrillation, comprising: processing means for determining whether a patient is experiencing atrial fibrillation; delivering means for delivering the ventricular pacing stimuli in response to determining the patient is in atrial fibrillation; sensing means for sensing signals in response to the ventricular pacing stimuli; processing means for determining whether the ventricular pacing stimuli are effectively capturing the paced ventricle over a series of the delivered ventricular pacing stimuli, the determination of whether the ventricular pacing are effectively capturing the paced ventricle comprising determining a number of consecutive ones of the series that effectively capture the paced ventricle; and modifying means for modifying a pacing rate during atrial fibrillation in response to the determination of effective capture by the ventricular pacing stimuli delivered during the series; wherein the modification to the pacing rate is based upon the determined number of consecutive ones of the series that effectively captured the paced ventricle. ### Claim 2 (depends on 1) The apparatus of claim 1 wherein the processing means for determining whether the ventricular pacing stimuli are capturing the paced ventricle is periodically performed to maximize battery life. ### Claim 3 (depends on 2) The apparatus of claim 2 wherein periodically determining whether the ventricular pacing stimuli are capturing the paced ventricle occurs solely during atrial fibrillation. ### Claim 4 (depends on 1) The apparatus of claim 1 wherein the ventricular pacing stimuli are left ventricular (LV) occurring at a LV tip electrode, and a monitoring vector is selected from one of a Lvtip-Rvcoil or a Lvtip-device case. ### Claim 5 (depends on 1) The apparatus of claim 1 wherein the ventricular pacing stimuli are LV pacing occurring at an LV ring, and a monitoring vector is selected from one of a LVring-Rvcoil or a LVring-device case. ### Claim 6 (depends on 1) The apparatus of claim 1 wherein the ventricular pacing stimuli are LV pacing occurring at a third LV electrode, and a monitoring vector is selected from one of the third LVelectrode-Rvcoil or third LVelectrode-device case. ### Claim 7 (depends on 1) The apparatus of claim 1 wherein the ventricular pacing stimuli are LV pacing occurring at a fourth LV electrode, and a monitoring vector is selected from one of the fourth LVelectrode-Rvcoil or fourth LVelectrode-device case. ### Claim 8 (depends on 1) The apparatus of claim 1 wherein determining whether a ventricular pacing stimuli are effectively capturing a paced ventricle occurs during normal device pace timing operation. ### Claim 9 (depends on 1) The apparatus of claim 1 wherein a duty cycle mode is employed when determining whether effective ventricular capture is occurring during AF. ### Claim 10 (depends on 1) The apparatus of claim 1 further comprising means for determining whether a ventricular event is a paced ventricular event. ### Claim 11 (depends on 10) The apparatus of claim 10 further comprising means for acquiring an EGM in response to determining a ventricular event is a paced ventricular event. ### Claim 12 (depends on 1) The apparatus of claim 1 wherein the ventricular pacing stimuli are delivered during one of biventricular pacing, multisite left ventricular pacing and fusion pacing. ### Claim 13 A method for determining whether ventricular pacing stimuli are capturing a paced ventricle during atrial fibrillation, comprising: determining whether a patient is experiencing atrial fibrillation; delivering the ventricular pacing stimuli in response to determining the patient is in atrial fibrillation; sensing signals in response to the ventricular pacing stimuli; determining whether the ventricular pacing stimuli are effectively capturing the paced ventricle over a series of the delivered ventricular pacing stimuli, the determination of whether the ventricular pacing are effectively capturing the paced ventricle comprising determining a number of consecutive ones of the series that effectively capture the paced ventricle; and modifying a pacing rate during atrial fibrillation in response to the determination of effective capture by the ventricular pacing stimuli delivered during the series; wherein the modification to the pacing rate is based upon the determined number of consecutive ones of the series that effectively captured the paced ventricle. ### Claim 14 (depends on 13) The method of claim 13 wherein determining whether the ventricular pacing stimuli are capturing the paced ventricle is periodically performed to maximize battery life. ### Claim 15 (depends on 14) The method of claim 14 wherein periodically determining whether the ventricular pacing stimuli are effectively capturing the paced ventricle occurs solely during atrial fibrillation. ### Claim 16 (depends on 13) The method of claim 13 wherein the ventricular pacing stimuli are left ventricular (LV) pacing occurring at a LV tip electrode, and a monitoring vector is selected from one of a Lvtip-Rvcoil or a Lvtip-device case. ### Claim 17 (depends on 13) The method of claim 13 wherein LV the ventricular pacing stimuli are pacing is occurring at an LV ring, and a monitoring vector is selected from one of a LVring-Rvcoil or a LVring-device case. ### Claim 18 (depends on 13) The method of claim 13 wherein the ventricular pacing stimuli are LV pacing occurring at a third LV electrode, and a monitoring vector is selected from one of the third LVelectrode-Rvcoil or third LVelectrode-device case. ### Claim 19 (depends on 13) The method of claim 13 wherein the ventricular pacing stimuli are LV pacing is occurring at a fourth LV electrode, and a monitoring vector is selected from one of the fourth LVelectrode-Rvcoil or fourth LVelectrode-device case. ### Claim 20 (depends on 13) The method of claim 13 wherein determining whether a ventricular pacing stimuli are effectively capturing a paced ventricle occurs during normal device pace timing operation. ### Claim 21 (depends on 13) The method of claim 13 wherein a duty cycle mode is employed when determining whether effective ventricular capture is occurring during AF. ### Claim 22 (depends on 13) The method of claim 13 further comprising determining whether a ventricular event is a paced ventricular event. ### Claim 23 (depends on 22) The method of claim 22 further comprising acquiring an EGM in response to determining a ventricular event is a paced ventricular event. ### Claim 24 (depends on 13) The method of claim 13 wherein the ventricular pacing stimuli are delivered during one of biventricular pacing, multisite left ventricular pacing and fusion pacing.