# US 11,305,126 B2 · Atrial tracking in an intracardiac ventricular pacemaker

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- Number: US 11,305,126 B2
- Document ID: US11305126B2
- Status: Granted
- Kind: B2
- Application number: 16/720,030
- Filed: 2019-12-19
- Published: 2020-04-23
- Granted: 2022-04-19
- Earliest claimed: 2016-09-29
- Assignees: Medtronic, Inc.
- Applicants: Medtronic, Inc.
- Inventors: Vincent E. Splett; Todd J. Sheldon; Yong K. Cho; Wade M. Demmer; Mark K. Erickson
- Web page: https://patentgrep.com/patent/US11305126B2

## CPC

- A61N 1/36578: {controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone}
- A61N 1/36542: {controlled by body motion, e.g. acceleration}
- A61N 1/36585: {controlled by two or more physical parameters}
- A61N 1/3682: {with a variable atrioventricular delay}
- A61N 1/3684: {for stimulating the heart at multiple sites of the ventricle or the atrium}
- A61N 1/3756: {Casings with electrodes thereon, e.g. leadless stimulators}
- A61N 1/056: {Transvascular endocardial electrode systems}
- A61N 1/37205: {Microstimulators, e.g. implantable through a cannula}
- A61N 1/37512: {Pacemakers}
- 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 detect a ventricular diastolic event from a motion signal received by a pacemaker control circuit from a motion sensor. The control circuit starts an atrial refractory period having an expiration time set based on a time of the detection of the ventricular diastolic event. The control circuit detects an atrial systolic event from the motion signal after expiration of the atrial refractory period and controls a pulse generator of the pacemaker to deliver a pacing pulse to a ventricle of a patient's heart at a first atrioventricular pacing time interval after the atrial systolic event detection.

## Claims

### Claim 1

An implantable medical device, comprising:
a motion sensor configured to produce a motion signal; and
a control circuit coupled to the motion sensor and configured to:
determine a time interval corresponding to a ventricular event from the motion signal;
set an expiration time of an atrial refractory period based on the time interval;
detect an atrial event from the motion signal after the expiration time of the atrial refractory period; and
set an atrioventricular pacing interval in response to detecting the atrial event; and
a pulse generator configured to generate a pacing pulse at an expiration of the atrioventricular pacing interval.

### Claim 2 (depends on 1)

The device of claim 1, wherein the control circuit is further configured to:
determine the time interval corresponding to the ventricular event by detecting a ventricular event from the motion signal corresponding to ventricular diastole.

### Claim 3 (depends on 1)

The device of claim 1, wherein the control circuit is configured to:
determine the time interval corresponding to the ventricular event by determining a time interval corresponding to a passive ventricular filling event; and
set the expiration time of the atrial refractory period based on the time interval by setting the expiration time earlier than the passive ventricular filling event.

### Claim 4 (depends on 3)

The device of claim 3, wherein the control circuit is further configured to set the expiration time of the atrial refractory period to expire after an onset of ventricular diastole.

### Claim 5 (depends on 1)

The device of claim 1, further comprising a sensing circuit configured to sense a cardiac electrical signal;
wherein the control circuit is further configured to:
identify a ventricular electrical event, the ventricular electrical event being one of an R-wave of the sensed cardiac electrical signal, a T-wave of the sensed cardiac electrical signal, or a pacing pulse generated by the pulse generator; and
start the atrial refractory period in response to the identified ventricular electrical event.

### Claim 6 (depends on 1)

The device of claim 1, wherein: the control circuit is further configured to:
determine an atrial time interval associated with the detected atrial event;
detect a change in the atrial time interval; and
adjust the atrial refractory period in response to detecting the change in the atrial time interval.

### Claim 7 (depends on 1)

The device of claim 1, wherein the control circuit is further configured to:
detect a change in the time interval corresponding to the ventricular event; and
adjust the atrial refractory period in response to detecting the change in the time interval.

### Claim 8 (depends on 1)

The device of claim 1, further comprising:
a housing enclosing the pulse generator, the motion sensor and the control circuit; and
a cathode electrode and anode electrode carried by the housing and coupled to the pulse generator for delivering the generated pacing pulse.

### Claim 9

A method performed by an implantable medical device, comprising:
producing a motion signal by a motion sensor;
determining a time interval corresponding to a ventricular event from the motion signal;
setting an expiration time of an atrial refractory period based on the time interval;
detecting an atrial event from the motion signal after the expiration time of the atrial refractory period;
setting an atrioventricular pacing interval in response to detecting the atrial event; and
generating a pacing pulse at an expiration of the atrioventricular pacing interval.

### Claim 10 (depends on 9)

The method of claim 9, wherein determining the time interval corresponding to the ventricular event comprises detecting a ventricular event from the motion signal corresponding to ventricular diastole.

### Claim 11 (depends on 9)

The method of claim 9, further comprising:
determining the time interval corresponding to the ventricular event by determining a time interval corresponding to a passive ventricular filling event; and
setting the expiration time of the atrial refractory period based on the time interval by setting the expiration time earlier than the passive ventricular filling event.

### Claim 12 (depends on 11)

The method of claim 11, comprising setting the expiration time of the atrial refractory period after an onset of ventricular diastole.

### Claim 13 (depends on 9)

The method of claim 9, further comprising:
sensing a cardiac electrical signal;
identifying a ventricular electrical event, the ventricular electrical event being one of an R-wave of the sensed cardiac electrical signal, a T-wave of the sensed cardiac electrical signal, or a pacing pulse generated by the pulse generator; and
starting the atrial refractory period in response to identifying the ventricular electrical event.

### Claim 14 (depends on 9)

The method of claim 9, further comprising:
determining an atrial time interval associated with the detected atrial event;
detecting a change in the atrial time interval; and
adjusting the atrial refractory period in response to detecting the change in the atrial time interval.

### Claim 15 (depends on 9)

The method of claim 9, further comprising:
detecting a change in the time interval corresponding to the ventricular event; and
adjusting the atrial refractory period in response to detecting the change in the time interval.

### Claim 16

A non-transitory computer-readable medium storing a set of instructions which when executed by a control circuit of an implantable medical device having a motion sensor, cause the device to:
produce a motion signal by the motion sensor;
determine a time interval corresponding to a ventricular event from the motion signal;
set an expiration time of an atrial refractory period based on the time interval;
detect an atrial event from the motion signal after the expiration time of the atrial refractory period;
set an atrioventricular pacing interval in response to detecting the atrial event; and
generate a pacing pulse at an expiration of the atrioventricular pacing interval.

### Claim 17 (depends on 16)

The non-transitory computer-readable medium of claim 16, further comprising instructions which cause the device to determine the time interval corresponding to the ventricular event by detecting a ventricular event from the motion signal corresponding to ventricular diastole.

### Claim 18 (depends on 16)

The non-transitory computer-readable medium of claim 16, further comprising instructions which cause the device to:
determine the time interval corresponding to the ventricular event by determining a time interval corresponding to a passive ventricular filling event; and
set the expiration time of the atrial refractory period based on the time interval by setting the expiration time earlier than the passive ventricular filling event.

### Claim 19 (depends on 18)

The non-transitory computer-readable medium of claim 18, further comprising instructions which cause the device to set the expiration time of the atrial refractory period after an onset of ventricular diastole.

### Claim 20 (depends on 16)

The non-transitory computer-readable medium of claim 16, further comprising instructions which cause the device to:
sense a cardiac electrical signal;
identify a ventricular electrical event, the ventricular electrical event being one of an R-wave of the sensed cardiac electrical signal, a T-wave of the sensed cardiac electrical signal, or a pacing pulse generated by the pulse generator; and
start the atrial refractory period in response to identifying the ventricular electrical event.

### Claim 21 (depends on 16)

The non-transitory computer-readable medium of claim 16, further comprising instructions which cause the device to:
determine an atrial time interval associated with the detected atrial event;
detect a change in the atrial time interval; and
adjust the atrial refractory period in response to detecting the change in the atrial time interval.

### Claim 22 (depends on 16)

The non-transitory computer-readable medium of claim 16, further comprising instructions which cause the device to:
detect a change in the time interval corresponding to the ventricular event; and
adjust the atrial refractory period in response to detecting the change in the time interval.