US 5,540,727 AGranted

Method and apparatus to automatically optimize the pacing mode and pacing cycle parameters of a dual chamber pacemaker

AssigneeCardiac Pacemakers, Inc.

InventorsBruce A. Tockman, Julio C. Spinelli, Rodney W. Salo

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Abstract

A cardiac stimulating system incorporating a microprocessor-based controller is designed to automatically optimize both the pacing mode and one or more pacing cycle parameters in a way that results in optimization of a cardiac performance parameter, such as cardiac output. For each of a plurality of modes in which a DDD cardiac pacer can operate, a pacing parameter such as the AV interval of the pacer is incrementally adjusted and following that, an observation is made as to the effect of the adjustment on cardiac output. After the process has been repeated for all possible pacing modes, a determination is made to find the pacing mode and the AV interval or other pacing parameter that results in the maximum cardiac output or other optimal cardiac performance parameter. It is these pacing parameters that are then programmed into the microcontroller for causing the pacemaker to function in the desired mode and at the desired parameter values.

Claims9

Dependent claims

Apparatus for establishing an optimum pacing parameter value for an implantable, programmable, cardiac stimulating device, comprising:

(a) means for sensing respiratory activity of said patient;
(b) means for measuring at least one of a plurality of physiologic parameters and producing signals proportional to an average value of said at least one of said plurality of physiologic parameters over a predetermined time interval that includes an integral number of complete respiratory cycles;
(c) control means connected to said sensing means and said measuring means for incrementally changing a pacing parameter of said cardiac stimulating device by a predetermined increment value and storing said signals measured by said means for measuring associated with each incremental change of said pacing parameter until said pacing parameter reaches a predetermined limit, said control means being programmable to a plurality of pacing modes;
(d) means operatively coupled to said control means for comparing the signals stored to determine an optimum value thereof;
and
(e) means for sequentially selecting one of said plurality of pacing modes for said cardiac stimulating device, said measuring means, control means and comparing means being operative to determine one of a maximum and minimum value of said signals for each of said plurality of pacing modes;
and
(f) means for setting the pacing mode of said cardiac stimulator to the particular mode associated with said one of the maximum and minimum value of said stored signals for all of said plurality of pacing modes said pacing modes include pacing the atrium and pacing in one ventricle, pacing the atrium and pacing both ventricles, sensing the atrium and pacing one ventricle, sensing the atrium and pacing both ventricles, and pacing both atria.

5 more elements

A cardiac stimulating apparatus comprising:

(a) means for sensing atrial depolarization signals;
(b) means for stimulating at least one atrial chamber;
(c) means for sensing ventricular depolarization signals;
(d) means for stimulating at least one ventricular chamber;
(e) microprocessor control means coupled to said means for sensing atrial and ventricular depolarization signals, said means for stimulating at least one atrial chamber and said means for stimulating at least one ventricular chamber, said microprocessor control means including means for establishing an AV delay interval between a sensing of an atrial depolarization signal and the next subsequent stimulation of ventricular tissue;
(f) means operatively coupled to said microprocessor control means for sensing an average value of a physiologic parameter of the body during a predetermined time interval;
(g) means for periodically changing said AV delay interval and storing said average value of the physiologic parameter for each changed value of the AV delay interval by repeatedly incrementing an initial AV delay interval value until a predetermined maximum AV delay interval value is reached;
and
(h) means for setting the AV delay interval of the cardiac stimulating apparatus to a value producing a optimum average value of the physiologic parameter.

6 more elements

Dependencies are inferred from the claim text.

Facts

Application: 08/339,813Filed 15 Nov 1994
Granted: 30 Jul 1996
Term ends: Not estimatedThe source records don’t support an estimate.

Classification5 codes

A61N 1/36585
Controlled by a physiological parameter, e.g. heart potential: controlled by two or more physical parameters
A61N 1/3627
Heart stimulators: for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
A61N 1/3682
Comprising more than one electrode co-operating with different heart regions: with a variable atrioventricular delay
A61N 1/3688
Comprising more than one electrode co-operating with different heart regions: configured for switching the pacing mode, e.g. from AAI to DDD