Multiple channel, sequential, cardiac pacing systems

A pacing method for improving the hemodynamic efficiency of a sick heart suffering from conduction delays in conducting spontaneous or evoked depolarizations originating in one of the right or left atrium to the other of the left or right atrium comprising the steps of:

• locating first and second right atrial pace/sense electrode in relation with the right atrium;
• locating first and second left atrial pace/sense electrodes in relation with the left atrium;
• sensing spontaneous and evoked cardiac depolarizations in the right atrium across said right atrial pace/sense electrodes and providing a right atrial sensed event signal;
• sensing spontaneous and evoked cardiac depolarizations in the left atrium across said left atrial pace/sense electrodes and providing a left atrial sensed event signal;
• timing an escape interval establishing a pacing rate and providing an escape interval pace trigger signal at the time out of the escape interval;
• restarting the timing of the escape interval in response to one of the right or left atrial sensed event signals;
• in response to the escape interval pace trigger signal, selectively triggering either right atrial pacing pulse output means coupled with said right atrial pace/sense electrodes to generate and deliver a right atrial pacing pulse to said right atrial pace/sense electrodes to evoke a right atrial depolarization or left atrial pacing pulse output means coupled with said left atrial pace/sense electrodes to generate and deliver a left atrial pacing pulse to said left atrial lead means to evoke a left atrial depolarization;
• timing a left atrial conduction delay window from a right atrial sensed event signal or from generation of a right atrial pacing pulse and providing a left atrial pace trigger signal at the expiration of the left atrial conduction delay window
• terminating the timing out of the left atrial conduction delay window in response to a left atrial sensed event signal;
• applying said left atrial pace trigger signal to said left atrial pacing pulse output means to trigger the generation and delivery of a left atrial pacing pulse to said left atrial lead means;
• timing a right atrial conduction delay window from a left atrial sensed event signal or from generation of a left atrial pacing pulse and providing a right atrial pace trigger signal at the expiration of the right atrial conduction delay window
• terminating the timing out of the right atrial conduction delay window in response to a right atrial sensed event signal;
• and
• applying said right atrial pace trigger signal to said right atrial pacing pulse output means to trigger the generation and delivery of a right atrial pacing pulse to said right atrial lead means;
• whereby an excessive conduction delay between a spontaneous or evoked depolarization in one of the right or left atrium and the conducted depolarization wave in the other of the left or right atrium is corrected by generation and delivery of a pacing pulse at the timing out of the conduction delay window.

A pacing method for improving the hemodynamic efficiency of a sick heart suffering from conduction delays in conducting spontaneous or evoked depolarizations originating in the right atrium to the left atrium comprising the steps of:

• locating first and second right atrial pace/sense electrode in relation with the right atrium;
• locating first and second left atrial pace/sense electrodes in relation with the left atrium;
• sensing spontaneous and evoked cardiac depolarizations in the right atrium across said right atrial pace/sense electrodes and providing a right atrial sensed event signal;
• sensing spontaneous and evoked cardiac depolarizations in the left atrium across said left atrial pace/sense electrodes and providing a left atrial sensed event signal;
• timing an escape interval establishing a pacing rate and providing an escape interval pace trigger signal at the time out of the escape interval;
• restarting the timing of the escape interval in response to the right atrial sensed event signals;
• in response to the escape interval pace trigger signal, triggering the right atrial pacing pulse output means coupled with said right atrial pace/sense electrodes to generate and deliver a right atrial pacing pulse to said right atrial pace/sense electrodes to evoke a right atrial depolarization;
• timing a left atrial conduction delay window from a right atrial sensed event signal or from generation of a right atrial pacing pulse and providing a left atrial pace trigger signal at the expiration of the left atrial conduction delay window
• terminating the timing out of the left atrial conduction delay window in response to a left atrial sensed event signal;
• and
• applying said left atrial pace trigger signal to said left atrial pacing pulse output means to trigger the generation and delivery of a left atrial pacing pulse to said left atrial lead means;
• whereby an excessive conduction delay between a spontaneous or evoked depolarization in the right atrium and the conducted depolarization wave in the left atrium is corrected by generation and delivery of a pacing pulse at the timing out of the conduction delay window.

A pacing system for improving the hemodynamic efficiency of a sick heart suffering from conduction delays in conducting spontaneous or evoked depolarizations originating in the right atrium to the left atrium comprising:

• right atrial lead means for locating first and second right atrial pace/sense electrode in relation with the right atrium;
• left atrial lead means for locating first and second left atrial pace/sense electrodes in relation with the left atrium;
• right heart sensing means for sensing spontaneous and evoked cardiac depolarizations in the right atrium across said right atrial pace/sense electrodes and providing a right atrial sensed event signal;
• left heart sensing means for sensing spontaneous and evoked cardiac depolarizations in the left atrium across said left atrial pace/sense electrodes and providing a left atrial sensed event signal;
• escape interval timing means for timing an escape interval establishing a pacing rate and providing an escape interval pace trigger signal at the time out of the escape interval;
• reset means for restarting the timing of the escape interval in response to the right atrial sensed event signals;
• right atrial pacing pulse output means coupled with said right atrial pace/sense electrodes responsive to the escape interval pace trigger signal for generating and delivering a right atrial pacing pulse to said right atrial pace/sense electrodes to evoke a right atrial depolarization;
• means for timing a left atrial conduction delay window from a right atrial sensed event signal or from generation of a right atrial pacing pulse and providing a left atrial pace trigger signal at the expiration of the left atrial conduction delay window;
• means for terminating the timing out of the left atrial conduction delay window in response to a left atrial sensed event signal;
• and
• left atrial pacing pulse output means coupled with said left atrial pace/sense electrodes and responsive to said left atrial pace trigger signal for generating and delivering a left atrial pacing pulse to said left atrial lead means;
• whereby an excessive conduction delay between a spontaneous or evoked depolarization in the right atrium and the conducted depolarization wave in the left atrium is corrected by generation and delivery of a pacing pulse at the timing out of the conduction delay window.