Method and apparatus for using atrial discrimination algorithms to determine optimal pacing therapy and therapy timing

A cardiac pacing device for pacing a heart, comprising:

• a pacer configured to provide atrial pacing and ventricular pacing to the heart;
• an atrial activity sensor configured to sense atrial activity;
• a signal detector connected to the atrial activity sensor and configured to detect atrial depolarizations from the sensed atrial activity;
• and
• a processor connected to a memory, wherein the memory is configured to store instructions and the processor is configured to operate on the instructions, wherein the instructions stored in the memory include an atrial discrimination algorithm for distinguishing between fast atrial flutter at a first high rate and another atrial flutter at a second lower rate, wherein the processor is connected to the signal detector and to the pacer, and wherein the processor is configured to operate on the instructions in the memory to determine if the atrial activity is fast atrial flutter at the first high rate or the other atrial flutter at the second lower rate, and to control the pacer to provide ventricular pacing for the fast atrial flutter and to provide atrial pacing for the other atrial flutter.

A cardiac pacing device for pacing a heart, comprising:

• a pacer configured to provide atrial pacing and ventricular pacing to the heart;
• an atrial activity detector configured to detect atrial activity;
• and
• a processor connected to a memory, wherein the memory is configured to store instructions and the processor is configured to operate on the instructions, wherein the instructions stored in the memory include an atrial discrimination algorithm for distinguishing between fast atrial flutter at a first high rate and another atrial flutter at a second lower rate, wherein the atrial discrimination algorithm stored in the memory includes rate-based discrimination criteria, morphology-based discrimination criteria, or a multi-dimensional threshold function for comparison against a plurality of statistics calculated from the atrial activity signal, wherein the instructions stored in the memory include instructions, operable on by the processor, for providing ventricular pacing pulses at a pacing rate based on a detected atrial rate up to a maximum pacing rate, and instructions, operable on by the processor, for applying the atrial discrimination algorithm only if the detected atrial rate exceeds the maximum atrial tracking rate, wherein the processor is connected to the atrial activity detector and to the pacer, and wherein the processor is configured to operate on the instructions in the memory when a rate of detected atrial activity exceeds the maximum atrial tracking rate to determine if the atrial activity is fast atrial flutter at the first high rate or the other atrial flutter at the second lower rate, and to control the pacer to provide ventricular pacing for the fast atrial flutter and to provide atrial anti-tachycardia pacing for the other atrial flutter.