US 6,477,415 B1 · AV synchronous cardiac pacing system delivering multi-site ventricular pacing triggered by a ventricular sense event during the AV delay

Abstract

A pacing system for selectively sensing spontaneous ventricular cardiac depolarizations at first and second spaced apart ventricular sites during the time-out of an AV delay and delivering pace pulses to the spaced apart ventricular sites in a triggered pacing mode. The first and second ventricular sites are preferably right ventricular (RV) and left ventricular (LV) pace/sense electrode sites, and RV event and LV event signals are sensed at the RV and LV pace/sense electrodes. A V-A pacing escape interval and a ventricular refractory period, a trigger pace window, an upper rate interval and further post-event time periods are started upon a RV or LV sense event or a first ventricular pace pulse delivered upon time-out of the AV delay. A triggered ventricular pace pulse or pulses is delivered to one or both of the RV and LV pace/sense electrode sites upon detecting an RV sense event or LV sense event during the AV delay. In one triggered pacing mode, a RV or LV pace pulse is delivered upon a RV or LV sense event during the AV delay to one of the RV or LV pace/sense electrode sites. In another triggered pacing mode, a triggered pace pulse is delivered to the other one of the RV or LV pace/sense electrode sites after a triggered pacing delay timed from a non-refractory RV or LV sense event occurring during the AV delay. In still another triggered pacing mode, a first pace pulse is delivered upon a RV or LV sense event, the triggered pacing delay is timed out, and a second pace pulse is delivered to the other one of the RV or LV pace/sense electrode sites after time-out of the triggered pacing delay. Triggered ventricular pacing is disabled during the V-A escape interval. Such a system could be employed in pacemakers that are part of a cardio defibrillator system if desired.

Claims10

Dependent claims

In a multi-site, AV sequential, cardiac pacemaker, a method of selectively sensing spontaneous ventricular cardiac depolarizations at spaced apart ventricular sites and delivering pace pulses to the spaced apart ventricular sites for improving the hemodynamic efficiency of a sick heart suffering from conduction delays in conducting spontaneous or evoked depolarizations through the ventricles that compromise cardiac output, wherein said method comprises the steps of:

sensing spontaneous atrial depolarizations and providing atrial sense event signals;
timing out an AV delay from the atrial sense event signals;
sensing spontaneous cardiac depolarizations at a first ventricular site and providing first ventricular sense event signals;
sensing spontaneous cardiac depolarizations at a second ventricular site and providing second ventricular sense event signals;
upon provision of a first or second ventricular sense event signal during the timing out of the AV delay, delivering a ventricular pace pulse to a predetermined one of the first and second ventricular sites without delay;
upon time-out of the AV delay, delivering a ventricular pace pulse to a predetermined one of the first and second ventricular sites;
and
timing out a V-A escape interval establishing a pacing rate from a selected one of the first and second ventricular sense event signals provided during the AV delay and during the time-out of the V-A escape interval,
whereby triggered ventricular pacing is only provided to at least one of the first and second ventricular sites only when a first or second ventricular sense event signal is provided during time-out of the AV delay.

6 more elements

In a multi-site cardiac pacemaker, a pacing system for selectively sensing spontaneous ventricular cardiac depolarizations at spaced apart ventricular sites and delivering pace pulses to the spaced apart ventricular sites for improving the hemodynamic efficiency of a sick heart suffering from conduction delays in conducting spontaneous or evoked depolarizations through the ventricles that compromise cardiac output, wherein said pacemaker further comprises:

an atrial pace/sense lead adapted to be advanced into relation with an atrial chamber to situate an atrial pace/sense electrode in or adjacent to the atrial chamber;
ventricular pace/sense lead means for situating a first ventricular pace/sense electrode at a first ventricular site and a second ventricular pace/sense electrode at a second ventricular site spaced from said first ventricular site;
and
a pace pulse generator coupled to said atrial pace/sense lead and said ventricular pace/sense lead means comprising:
an atrial sense amplifier coupled to said atrial pace/sense electrode for sensing spontaneous atrial depolarizations and providing atrial sense event signals;
an AV delay timer for timing out an AV delay from the atrial sense event signals;
a first ventricular sense amplifier coupled to said first ventricular pace/sense electrode for sensing spontaneous cardiac depolarizations at the first ventricular site and providing first ventricular sense event signals;
a second ventricular sense amplifier coupled to said second ventricular electrode for sensing spontaneous cardiac depolarizations at the second ventricular site and providing second ventricular sense event signals;
an escape interval timer for timing out a V-A escape interval establishing a pacing rate from one of the first and second ventricular sense event signals occurring during the time-out of the AV delay or the V-A escape interval;
ventricular trigger pacing means coupled to said ventricular pace/sense lead means and operable in response to provision of a first or second ventricular sense event signal during the time-out of the AV delay for delivering a ventricular pace pulse to a predetermined one of said first and second pace/sense electrodes at said first and second ventricular sites without delay;
and
V-A escape interval restarting means operable in response to provision of a first or second ventricular sense event signal during the time-out of the V-A escape interval for terminating and restarting the V-A escape interval,
whereby triggered ventricular pacing is provided to at least one of the first and second ventricular sites only when a first or second ventricular sense event signal is provided during time-out of the AV delay.

10 more elements

Dependencies are inferred from the claim text.

AV synchronous cardiac pacing system delivering multi-site ventricular pacing triggered by a ventricular sense event during the AV delay

Life of this patent

AV synchronous cardiac pacing system delivering multi-site ventricular pacing triggered by a ventricular sense event during the AV delay

Life of this patent

Abstract

Claims10