Method of optimizing mechanical heart rate during delivery of coupled or paired pacing

A method of operating a cardiac pacing device during coupled or paired pacing comprising:

• implementing an atrial-based pacing mode comprising sensing intrinsic atrial depolarizations and generating an atrial sense event signal in response thereto;
• providing atrial pacing pulses to the atrium of the heart at an atrial pacing rate, each atrial pacing pulse separated by an atrial escape interval corresponding to the atrial pacing rate, and restarting the atrial escape interval in response to an atrial sense event signal;
• sensing intrinsic ventricular depolarizations and generating a ventricular sense event signal in response thereto;
• and
• detecting the presence or absence of AV conduction;
• providing paired or coupled pacing pulses in the atrium at an atrial extra stimulus interval (AESI) timed from immediately preceding atrial pacing pulses and atrial sense event signals, respectively, sufficient to effect post-extra-systolic potentiation (PESP) of the atrium;
• and
• adjusting the atrial escape interval when the presence of AV conduction is detected and when the atrial pacing rate is below a target pacing rate to attempt to move the atrial pacing rate toward the target pacing rate.

A method of operating a cardiac pacing device during coupled or paired pacing comprising:

• implementing an atrial-based pacing mode comprising sensing intrinsic atrial depolarizations and generating an atrial sense event signal in response thereto;
• providing atrial pacing pulses to the atrium of the heart at an atrial pacing rate, each atrial pacing pulse separated by an atrial escape interval corresponding to the atrial pacing rate, and restarting the atrial escape interval in response to an atrial sense event signal;
• sensing intrinsic ventricular depolarizations and generating a ventricular sense event signal in response thereto;
• and
• detecting the presence or absence of AV conduction;
• providing paired or coupled pacing pulses in the atrium at an atrial extra stimulus interval (AESI) timed from immediately preceding atrial pacing pulses and atrial sense event signals, respectively, sufficient to effect post-extra-systolic potentiation (PESP) of the atrium;
• and
• switching to a dual-chamber pacing mode to provide ventricular pacing pulses to the ventricle of the heart at a minimum mechanical rate, each ventricular pacing pulse separated by a ventricular escape interval corresponding to the minimum mechanical rate, and restarting the ventricular escape interval in response to a ventricular sense event signal.