# US 12,708,780 B2 · Determination of lower pacing rate limit > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 12,708,780 B2 - Document ID: US12708780B2 - Status: Granted - Kind: B2 - Application number: 18/138,686 - Filed: 2023-04-24 - Published: 2023-11-02 - Granted: 2026-08-18 - Earliest claimed: 2022-04-29 - Assignees: Medtronic, Inc. - Applicants: Medtronic, Inc. - Inventors: Matthew J. Hoffman; Troy E. Jackson; Markus Meyer - Web page: https://patentgrep.com/patent/US12708780B2 ## CPC - A61N 1/36592: {controlled by the heart rate variability} - A61N 1/3627: {for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy} - A61N 1/37235: {Aspects of the external programmer} - 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 A lower pacing rate limit is utilized by pacing devices to initiate pacing in response to a patient's intrinsic rate being less than the lower pacing rate limit. Illustrative systems, devices, and methods may obtain rate modification information related to a patient such as physical characteristics, diagnostic parameters, pathologies, device characteristics of a pacing device implanted in the patient, and patient-reported information. The rate modification information may be used to determine lower pacing rate limit based thereon. ## Claims ### Claim 1 A method comprising: obtaining rate modification information comprising at least one physical characteristic of a patient utilizing a pacing device and at least one diagnostic parameter, the at least one diagnostic parameter comprising a nighttime heart rate; receiving an upper bound, a lower bound, and a percentage of pacing threshold; and determining a lower pacing rate limit for the pacing device based on the obtained rate modification information, the upper bound, the lower bound, and the percentage of pacing threshold, wherein the lower pacing rate limit is increased when a percentage of paced beats exceeds the percentage of pacing threshold and wherein the lower pacing rate limit is utilized by the pacing device to initiate pacing in response to the patient's intrinsic rate being less than the lower pacing rate limit. ### Claim 2 (depends on 1) The method of claim 1, wherein the at least one physical characteristic comprises one or more of height, sex, age, body mass index (BMI), body surface area, physical fitness level, and activity level. ### Claim 3 (depends on 1) The method of claim 1, wherein the rate modification information further comprises at least one pathology, wherein the at least one pathology comprises diastolic dysfunction/heart failure with preserved ejection fraction. ### Claim 4 (depends on 1) The method of claim 1, wherein the rate modification information further comprises at least one pathology, wherein the at least one pathology comprises one or more of systolic dysfunction, chronotropic incompetence, worsening heart failure, and comorbid disease. ### Claim 5 (depends on 1) The method of claim 1, wherein the at least one diagnostic parameter further comprises one or more of ventricular contractility, ventricular stiffness, pulse transit time, resting heart rate, arrhythmia burden, targeted pacing burden, heart rate recovery, impedance, fluid overload, edema, respiration rate, maximum heart rate, ejection fraction, left ventricular pressure, systemic blood pressure, pulmonary artery pressure, blood oxygenation, and presence or concentration of serum biomarkers. ### Claim 6 (depends on 5) The method of claim 5, wherein obtaining rate modification information comprising monitoring the at least one diagnostic parameter of the patient using the pacing device. ### Claim 7 (depends on 1) The method of claim 1, wherein the rate modification information further comprises at least one device configuration, wherein the at least one device configuration comprises one or more of ventricular pacing electrode location, atrial pacing electrode location, and type of pacing therapy. ### Claim 8 (depends on 1) The method of claim 1, wherein the rate modification information further comprises patient-reported information, wherein the patient-reported information comprises one or more of energy level, peripheral edema, desired activity performance, and pacing-related symptoms. ### Claim 9 (depends on 1) The method of claim 1, wherein the rate modification information further comprises patient-reported information, wherein the patient-reported information is obtained from a mobile computing device. ### Claim 10 (depends on 1) The method of claim 1, wherein the method further comprises configuring the pacing device with the lower pacing rate limit. ### Claim 11 (depends on 1) The method of claim 1, wherein obtaining rate modification information comprising obtaining the rate modification information from an electronic medical records system. ### Claim 12 (depends on 1) The method of claim 1, wherein determining a lower pacing rate limit for the pacing device based on the obtained rate modification information is performed by the pacing device. ### Claim 13 (depends on 1) The method of claim 1, wherein determining a lower pacing rate limit for the pacing device based on the obtained rate modification information is performed by a remote computing system communicatively coupled to the pacing device. ### Claim 14 A system comprising: a computing apparatus comprising one or more processors and configured to: obtain rate modification information comprising at least one physical characteristic of a patient utilizing a pacing device and at least one diagnostic parameter, the at least one diagnostic parameter comprising a nighttime heart rate; receive an upper bound, a lower bound, and a percentage of pacing threshold; and determine a lower pacing rate limit for the pacing device based on the obtained rate modification information, the upper bound, the lower bound, and the percentage of pacing threshold, wherein the lower pacing rate limit is increased when a percentage of paced beats exceeds the percentage of pacing threshold and wherein the lower pacing rate limit is utilized by the pacing device to initiate pacing in response to the patient's intrinsic rate being less than the lower pacing rate limit. ### Claim 15 (depends on 14) The system of claim 14, wherein the at least one physical characteristic comprises one or more of height, sex, age, body mass index (BMI), body surface area, physical fitness level, and activity level. ### Claim 16 (depends on 14) The system of claim 14, wherein the rate modification information further comprises at least one pathology, wherein the at least one pathology comprises diastolic dysfunction/heart failure with preserved ejection fraction. ### Claim 17 (depends on 14) The system of claim 14, wherein the rate modification information further comprises at least one pathology, wherein the at least one pathology comprises one or more of systolic dysfunction, chronotropic incompetence, worsening heart failure, and comorbid disease. ### Claim 18 (depends on 14) The system of claim 14, wherein the at least one diagnostic parameter further comprises one or more of ventricular contractility, ventricular stiffness, pulse transit time, resting heart rate, arrhythmia burden, targeted pacing burden, heart rate recovery, impedance, fluid overload, edema, respiration rate, maximum heart rate, ejection fraction, left ventricular pressure, systemic blood pressure, pulmonary artery pressure, blood oxygenation, and presence or concentration of serum biomarkers. ### Claim 19 (depends on 18) The system of claim 18, wherein obtaining rate modification information comprising obtaining the at least one diagnostic parameter of the patient from the pacing device. ### Claim 20 (depends on 14) The system of claim 14, wherein the rate modification information further comprises at least one device configuration, wherein the at least one device configuration comprises one or more of ventricular pacing electrode location, atrial pacing electrode location, and type of pacing therapy. ### Claim 21 (depends on 14) The system of claim 14, wherein the rate modification information further comprises patient-reported information, wherein the patient-reported information comprises one or more of energy level, peripheral edema, desired activity performance, and pacing-related symptoms. ### Claim 22 (depends on 14) The system of claim 14, wherein the rate modification information further comprises patient-reported information, wherein the patient-reported information is obtained from a mobile computing device. ### Claim 23 (depends on 14) The system of claim 14, wherein the computing apparatus is further configured to configuring the pacing device with the lower pacing rate limit. ### Claim 24 (depends on 14) The system of claim 14, wherein obtaining rate modification information comprising obtaining the rate modification information from an electronic medical records system. ### Claim 25 An implantable medical device comprising: one or more electrodes to deliver cardiac pacing therapy to and sense electrical activity from a patient's heart; and a computing apparatus operably coupled the one or more electrodes and comprising one or more processors, the computing apparatus configured to: monitor the patient's intrinsic heart rate using the one or more electrodes; deliver pacing therapy to the patient's heart in response to the patient's intrinsic rate being less than a lower pacing rate limit; obtain rate modification information comprising at least one physical characteristic of a patient utilizing a pacing device and at least one diagnostic parameter, the at least one diagnostic parameter comprising a nighttime heart rate; receive an upper bound, a lower bound, and a percentage of pacing threshold; and determine a lower pacing rate limit for the pacing device based on the obtained rate modification information, the upper bound, the lower bound, and the percentage of pacing threshold, wherein the lower pacing rate limit is increased when a percentage of paced beats exceeds the percentage of pacing threshold. ### Claim 26 (depends on 25) The device of claim 25, wherein the at least one physical characteristic comprises one or more of height, sex, age, body mass index (BMI), body surface area, physical fitness level, and activity level. ### Claim 27 (depends on 25) The device of claim 25, wherein the rate modification information further comprises at least one pathology, wherein the at least one pathology comprises diastolic dysfunction/heart failure with preserved ejection fraction. ### Claim 28 (depends on 25) The device of claim 25, wherein the rate modification information further comprises at least one pathology, wherein the at least one pathology comprises one or more of systolic dysfunction, chronotropic incompetence, worsening heart failure, and comorbid disease. ### Claim 29 (depends on 25) The device of claim 25, wherein the at least one diagnostic parameter further comprises one or more of ventricular contractility, ventricular stiffness, pulse transit time, resting heart rate, arrhythmia burden, targeted pacing burden, heart rate recovery, impedance, fluid overload, edema, respiration rate, maximum heart rate, ejection fraction, left ventricular pressure, systemic blood pressure, pulmonary artery pressure, blood oxygenation, and presence or concentration of serum biomarkers. ### Claim 30 (depends on 29) The device of claim 29, wherein obtaining rate modification information comprising monitoring the at least one diagnostic parameter of the patient using the one or more electrodes. ### Claim 31 (depends on 25) The device of claim 25, wherein the rate modification information further comprises at least one device configuration, wherein the at least one device configuration comprises one or more of ventricular pacing electrode location, atrial pacing electrode location, and type of pacing therapy. ### Claim 32 (depends on 25) The device of claim 25, wherein the rate modification information further comprises patient-reported information, wherein the patient-reported information comprises one or more of energy level, peripheral edema, desired activity performance, and pacing-related symptoms. ### Claim 33 (depends on 25) The device of claim 25, wherein the rate modification information further comprises patient-reported information, wherein the patient-reported information is obtained from a mobile computing device.