# US 2019/0168007 A1 · Methods and systems for detecting atrial contraction timing fiducials and determining a cardiac interval from a ventricularly implanted leadless cardiac pacemaker > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 2019/0168007 A1 - Document ID: US20190168007A1 - Status: Published application - Kind: A1 - Application number: 16/200,048 - Filed: 2018-11-26 - Published: 2019-06-06 - Earliest claimed: 2017-12-01 - Assignees: Cardiac Pacemakers, Inc. - Applicants: Cardiac Pacemakers, Inc. - Inventors: Jeffrey E. Stahmann; Keith R. Maile; Krzysztof Z. Siejko; Allan Charles Shuros - Web page: https://patentgrep.com/patent/US20190168007A1 ## CPC - A61N 1/37512: {Pacemakers} - A61N 1/36167: {Timing, e.g. stimulation onset} - A61N 1/36564: {controlled by blood pressure} - A61N 1/36578: {controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone} - A61N 1/3706: {Pacemaker parameters (stimulation threshold A61N1/371)} - A61N 1/37205: {Microstimulators, e.g. implantable through a cannula} - A61N 1/3756: {Casings with electrodes thereon, e.g. leadless stimulators} - A61N 1/39622: {Pacing therapy} - A61B 5/686: {Permanently implanted devices, e.g. pacemakers, other stimulators, biochips (A61B5/6861 takes precedence)} - A61N 1/36585: {controlled by two or more physical parameters} - A61N 1/3682: {with a variable atrioventricular delay} - A61N 1/37252: {Details of algorithms or data aspects of communication system, e.g. handshaking, transmitting specific data or segmenting data} - A61N 1/3925: {Monitoring; Protecting} - A61N 1/3968: {Constructional arrangements, e.g. casings (A61N1/375 takes precedence)} - 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 A ventricularly implantable medical device that includes a sensing module that is configured to gather information during a cardiac cycle and to identify a cardiac interval based at least on part on the gathered information. Control circuitry in the implantable medical device is configured to deliver a ventricular pacing therapy to a patient's heart, wherein the ventricular pacing therapy is time dependent, at least in part, on the identified cardiac interval. ## Claims ### Claim 1 A leadless cardiac pacemaker (LCP) configured to sense cardiac activity and to deliver pacing therapy to a patient's heart, the LCP comprising: a housing; a first electrode secured relative to the housing and exposed to the environment outside of the housing; a second electrode secured relative to the housing and exposed to the environment outside of the housing; a sensing module responsive to the environment outside of the housing, the sensing module including one or more of a pressure measurement module and an acoustic measurement module, the sensing module configured to gather information suitable for identifying one or more timing fiducials associated a cardiac cycle of the patient's heart; a control module operatively coupled to the first electrode, the second electrode, and the sensing module, the control module is configured to: process information gathered by the sensing module to identify the one or more timing fiducials associated the cardiac cycle of the patient's heart; and deliver a pacing pulse to the patient's heart via the first electrode and the second electrode, wherein the pacing pulse is delivered at a time that is based, at least in part, on the identified one or more timing fiducials. ### Claim 2 (depends on 1) The LCP of claim 1, wherein the pacing pulse is delivered at a predetermined time after one of the one or more identified timing fiducials. ### Claim 3 (depends on 1) The LCP of claim 1, wherein the pacing pulse is delivered at a predetermined time after a predetermined one of the one or more identified timing fiducials. ### Claim 4 (depends on 3) The LCP of claim 3, wherein the predetermined time is dependent on which of the one or more identified timing fiducials is used as the predetermined one of the one or more identified timing fiducial. ### Claim 5 (depends on 1) The LCP of claim 1, wherein the sensing module comprises the pressure measurement module, and one of the one or more identified timing fiducials corresponds to a pressure event detected by the pressure measurement module resulting in a pressure timing fiducial, and wherein the predetermined one of the one or more identified timing fiducials is the pressure timing fiducial. ### Claim 6 (depends on 3) The LCP of claim 3, wherein the sensing module comprises the acoustic measurement module, and one of the one or more identified timing fiducials corresponds to an acoustic event detected by the acoustic measurement module resulting in an acoustic timing fiducial, and wherein the predetermined one of the one or more identified timing fiducials is the acoustic timing fiducial. ### Claim 7 (depends on 1) The LCP of claim 1, wherein the sensing module further comprises an electrogram measurement module. ### Claim 8 (depends on 7) The LCP of claim 7, wherein the control module is configured to process information gathered by two or more of the pressure measurement module, the acoustic measurement module and the electrogram measurement module, and to identify one or more timing fiducials associated the cardiac cycle of the patient's heart. ### Claim 9 (depends on 7) The LCP of claim 7, wherein the control module is configured to processes information gathered by two or more of the pressure measurement module, the acoustic measurement module and the electrogram measurement module, and to fuse the information to identify one or more timing fiducials associated the cardiac cycle of the patient's heart. ### Claim 10 A leadless cardiac pacemaker (LCP) configured to sense cardiac activity and to deliver pacing therapy to a patient's heart, the LCP comprising: a housing; a first electrode secured relative to the housing and exposed to the environment outside of the housing; a second electrode secured relative to the housing and exposed to the environment outside of the housing; a sensing module responsive to the environment outside of the housing, the sensing module including one or more of a pressure measurement module and an acoustic measurement module, the sensing module configured to gather information suitable for determining one or more cardiac intervals associated with the patient's heart; a control module operatively coupled to the first electrode, the second electrode, and the sensing module, the control module is configured to: process information gathered by the sensing module to identify the one or more cardiac intervals associated with the patient's heart; and deliver a pacing pulse to the patient's heart via the first electrode and the second electrode, wherein the pacing pulse is delivered at a time that is based, at least in part, on the identified one or more cardiac intervals. ### Claim 11 (depends on 10) The LCP of claim 10, wherein the at least one of the one or more cardiac intervals is an atrioventricular interval, a ventricular to ventricular interval, or an atrial to atrial interval. ### Claim 12 (depends on 10) The LCP of claim 10, wherein the sensing module comprises the pressure measurement module, and a start of at least one of the one or more cardiac intervals begins at a pressure event detected by the pressure measurement module. ### Claim 13 (depends on 10) The LCP of claim 10, wherein the sensing module comprises the acoustic measurement module, and a start of at least one of the one or more cardiac intervals begins at an acoustic event detected by the acoustic measurement module. ### Claim 14 (depends on 10) The LCP of claim 10, wherein the sensing module further comprises an electrogram measurement module, and an end of at least one of the one or more cardiac intervals corresponds to an electrical event detected by the electrogram measurement module and/or a pacing pulse delivered to the patient's heart. ### Claim 15 (depends on 10) The LCP of claim 10, wherein the sensing module comprises the pressure measurement module, and an end of at least one of the one or more cardiac intervals corresponds to a pressure event detected by the pressure measurement module. ### Claim 16 (depends on 10) The LCP of claim 10, wherein the sensing module comprises the acoustic measurement module, and an end of at least one of the one or more cardiac intervals corresponds to an acoustic event detected by the acoustic measurement module. ### Claim 17 A leadless cardiac pacemaker (LCP) configured to sense cardiac activity and to deliver pacing therapy to a patient's heart, the LCP comprising: a housing; a first electrode secured relative to the housing and exposed to the environment outside of the housing; a second electrode secured relative to the housing and exposed to the environment outside of the housing; a sensing module responsive to the environment outside of the housing, the sensing module including two or more sensing modules each for detecting a different event type, the two or more sensing modules including an electrogram measurement module for detecting electrical event types, and one or more of a pressure measurement module for detecting pressure event types and an acoustic measurement module for detecting acoustic event types, the sensing module configured to gather information suitable for determining one or more cardiac intervals associated with the patient's heart; a control module operatively coupled to the first electrode, the second electrode, and the sensing module, the control module is configured to: process information gathered by the sensing module to identify the one or more cardiac intervals associated with the patient's heart, wherein at least one cardiac interval begins with a detected first event type and ends with a detected second event type that is different from the detected first event type; and deliver a pacing pulse to the patient's heart via the first electrode and the second electrode, wherein the pacing pulse is delivered at a time that is based, at least in part, on the identified one or more cardiac intervals. ### Claim 18 (depends on 17) The LCP of claim 17, wherein the control module delivers the pacing pulse a predetermined length of time after a start of the at least one cardiac interval or a predetermined length of time before an end of the at least one cardiac interval. ### Claim 19 (depends on 17) The LCP of claim 17, wherein the detected first event type is a pressure event type or an acoustic event type, and the detected second event type is an electrical event. ### Claim 20 (depends on 17) The LCP of claim 17, wherein the detected first event type is a pressure event type or an acoustic event type that is related to an atrial contraction, and the detected second event type is an electrical event type that is related to a ventricle contraction.