# US 2019/0168008 A1 · Methods and systems for detecting atrial contraction timing fiducials within a search window from a ventricularly implanted leadless cardiac pacemaker

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- Number: US 2019/0168008 A1
- Document ID: US20190168008A1
- Status: Published application
- Kind: A1
- Application number: 16/204,982
- Filed: 2018-11-29
- Published: 2019-06-06
- Earliest claimed: 2017-12-01
- Assignees: Cardiac Pacemakers, Inc.
- Applicants: Cardiac Pacemakers, Inc.
- Inventors: Keith R. Maile; Jeffrey E. Stahmann; Michael J. Kane; Benjamin J. Haasl; Krzysztof Z. Siejko; Allan Charles Shuros; William J. Linder; Brendan Early Koop
- Web page: https://patentgrep.com/patent/US20190168008A1

## CPC

- A61N 1/37512: {Pacemakers}
- A61N 1/36167: {Timing, e.g. stimulation onset}
- A61N 1/36507: {controlled by gradient or slope of the heart potential}
- A61N 1/36542: {controlled by body motion, e.g. acceleration}
- 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 1/3756: {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 identify a search window of time within a cardiac cycle to search for an atrial artifact. Control circuitry in the ventricular 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 an atrial event identified in the search window of time.

## Claims

### Claim 1

A leadless cardiac pacemaker (LCP) configured to sense cardiac activity and to deliver pacing therapy to a ventricle of 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 secured relative to the housing and responsive to the environment outside of the housing, the sensing module including at least two of a pressure measurement module, an acoustic measurement module, an acceleration measurement module, and an electrogram measurement module;
a control module operatively coupled to the first electrode, the second electrode, and the sensing module, the control module is configured to:
identify a window of time during each of one or more cardiac cycles, wherein the window of time has a duration that is less than an entire cardiac cycle;
process information gathered during the window of time by at least one of the two or more measurement modules to identify an atrial event of the patient's heart during a cardiac cycle; and
deliver a ventricular pacing pulse to the patient's heart via the first electrode and the second electrode, wherein the ventricular pacing pulse is delivered at a time that is based, at least in part, on the identified atrial event.

### Claim 2 (depends on 1)

The LCP of claim 1, wherein the sensing module includes a pressure measurement module and at least one of an acoustic measurement module, an acceleration measurement module, and an electrogram measurement module.

### Claim 3 (depends on 2)

The LCP of claim 2, wherein the control module is configured to process information gathered during the window of time by the pressure measurement module to identify an atrial event of the patient's heart during the cardiac cycle.

### Claim 4 (depends on 1)

The LCP of claim 1, wherein the control module is configured to move the window of time to search for the atrial event.

### Claim 5 (depends on 1)

The LCP of claim 1, wherein the control module is configured to change the duration of the window of time to search for the atrial event.

### Claim 6 (depends on 1)

The LCP of claim 1, wherein the identified window is established relative a ventricular event.

### Claim 7 (depends on 1)

The LCP of claim 1, wherein the control module is configured to:
use signal averaging of signals gathered during each of a plurality of consecutive cardiac cycles from at least one of the pressure measurement module, the acoustic measurement module, the acceleration measurement module, and the electrogram measurement module;
identify the window of time based on the signal averaging; and
use the identified window of time during one or more subsequent cardiac cycles to identify the atrial event of the patient's heart during each of the one or more subsequent cardiac cycles.

### Claim 8 (depends on 1)

The LCP of claim 1, wherein the control module processes information gathered during the window of time by at least two of the two or more measurement modules to identify an atrial event of the patient's heart during the cardiac cycle, and wherein the information gathered by each of the at least two of the two or more measurement modules is weighted differently.

### Claim 9 (depends on 1)

The LCP of claim 1, wherein the control module dynamically selects which of the at least one of the two or more measurement modules are used to gather information from during the window of time.

### Claim 10 (depends on 1)

The LCP of claim 1, wherein the control module dynamically selects which of the at least one of the two or more measurement modules are used to gather information from during the window of time based at least in part on a detected signal to noise ratio for each of two or more of the measurement modules.

### Claim 11 (depends on 1)

The LCP of claim 1, wherein the control module dynamically selects which of the at least one of the two or more measurement modules are used to gather information from during the window of time based at least in part on a detected signal to noise ratio for each of two or more of the measurement modules and a predetermined priority.

### Claim 12 (depends on 11)

The LCP of claim 11, wherein a p-wave detecting atrial activation by the electrogram measurement module has a higher priority than a pressure signal detecting an atrial kick by the pressure measurement module.

### Claim 13 (depends on 1)

The LCP of claim 1, wherein when the control module is identifying an atrial event, the control module is configured to change to a VOO pacing mode.

### Claim 14 (depends on 1)

The LCP of claim 1, wherein the control module is configured to deliver a ventricular pacing therapy at an altered pacing rate in response to a failure to detect the atrial event.

### Claim 15 (depends on 1)

The LCP of claim 1, wherein the atrial event is at least one of a p-wave, a-wave, S4 heart sound, cardiac tissue vibration, tricuspid valve position, and an atrial induced pressure pulse.

### Claim 16

A leadless cardiac pacemaker (LCP) configured to sense cardiac activity and to deliver ventricle 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 disposed within the housing, the sensing module including at least two measurement modules and configured to sense signals caused by an atrium contraction;
a control module operatively coupled to the first electrode, the second electrode, and the sensing module, the control module is configured to:
identify a search window for identifying an atrial event;
process one or more of the signals gathered during the search window from at least one of the at least two measurement modules to identify the atrial event; and
deliver a ventricular pacing pulse to the patient's ventricle via the first electrode and the second electrode, the timing of which is based, at least in part, on the identified atrial event.

### Claim 17 (depends on 16)

The LCP of claim 16, wherein the search window is established relative a ventricular event.

### Claim 18 (depends on 16)

The LCP of claim 16, wherein the sensing module includes a pressure measurement module and at least one of an acoustic measurement module, an acceleration measurement module, and an electrogram measurement module.

### Claim 19

A leadless cardiac pacemaker (LCP) configured to sense cardiac activity and to deliver pacing therapy to a ventricle of 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 disposed within the housing and configured to obtain data regarding an atrium contraction from within the ventricle;
a control module operatively coupled to the first electrode, the second electrode, and the sensing module, the control module is configured to:
establish a search window;
identify an atrial event using data gathered during the search window by the sensing module;
deliver a ventricular pacing pulse to the patient's ventricle via the first electrode and the second electrode, the timing of which is based, at least in part, on the identified atrial event.

### Claim 20 (depends on 19)

The LCP of claim 19, wherein the search window is established based on a detected ventricle event.