Implantable stimulation device and method for determining atrial autocapture using PVC response

A programmer adapted for telemetric communication with a dual chamber cardiac stimulation device, the stimulation device adapted for delivering atrial and ventricular stimulation pulses to a heart, the programmer comprising:

• means for interrogating the stimulation device for obtaining and analyzing diagnostic data therefrom;
• means for displaying said diagnostic data;
• processor means for providing a command to the stimulation device to commence an atrial capture threshold test;
• means for analyzing said diagnostic data for determining an initial value for the atrial stimulation pulse amplitude, the analyzing means comprising means for estimating, based upon historical diagnostic data, the amplitude of the atrial stimulation pulse at which capture will be lost;
• means for setting the initial value for the atrial stimulation pulse amplitude;
• means for detecting loss of atrial capture, and
• means for recording an atrial capture threshold as being the atrial stimulation pulse amplitude below which capture is lost.

A programmer adapted for telemetric communication with a dual chamber cardiac stimulation device, the stimulation device adapted for delivering atrial and ventricular stimulation pulses to a heart, the programmer comprising:

• means for interrogating the stimulation device for obtaining and analyzing diagnostic data therefrom;
• means for displaying said diagnostic data;
• means for lengthening post ventricular atrial refractory period (PVARP) in the stimulation device;
• processor means for providing a command to the stimulation device to commence an atrial capture threshold test;
• means for detecting loss of atrial capture;
• and
• means for recording an atrial capture threshold as being the atrial stimulation pulse amplitude below which capture is lost.

A programmer adapted for telemetric communication with a dual chamber cardiac stimulation device, the stimulation device adapted for delivering atrial and ventricular stimulation pulses to a heart, the programmer comprising:

• means for interrogating the stimulation device for obtaining and analyzing diagnostic data therefrom;
• means for displaying said diagnostic data;
• processor means for providing a command to the stimulation device to commence an atrial capture threshold test;
• means for detecting loss of atrial capture;
• means for restoring PVARP to an initial value upon loss of capture;
• and
• means for recording an atrial capture threshold as being the atrial stimulation pulse amplitude below which capture is lost.

A programmer adapted for telemetric communication with a dual chamber cardiac stimulation device, the stimulation device adapted for delivering atrial and ventricular stimulation pulses to a heart, the programmer comprising:

• means for interrogating the stimulation device for obtaining and analyzing diagnostic data therefrom;
• means for displaying said diagnostic data;
• processor means for providing a command to the stimulation device to commence an atrial capture threshold test;
• means for detecting loss of atrial capture, the means for detecting loss of atrial capture comprising means for incrementally decreasing the atrial stimulation pulse amplitude until loss of atrial capture occurs;
• means for recording an atrial capture threshold as being the atrial stimulation pulse amplitude below which capture is lost;
• and
• means for delivering a backup atrial stimulation pulse concurrently with a ventricular stimulation pulse subsequent to loss of capture to minimize the possibility of a retrograde P-wave initiating a pacemaker mediated tachycardia.

A programmer adapted for telemetric communication with a dual chamber cardiac stimulation device, the stimulation device adapted for delivering atrial and ventricular stimulation pulses to a heart, the programmer comprising:

• means for interrogating the stimulation device for obtaining and analyzing diagnostic data therefrom;
• means for analyzing the diagnostic data in real-time to thereby minimize pauses and prevent unwanted rhythms from manual or automatic capture tests;
• means for displaying said diagnostic data;
• processor means for providing a command to the stimulation device to commence an atrial capture threshold test;
• means for detecting loss of atrial capture;
• and
• means for recording an atrial capture threshold as being the atrial stimulation pulse amplitude below which capture is lost.

A programmer adapted for telemetric communication with a cardiac stimulation device, the device adapted to deliver atrial and ventricular stimulation pulses to a patient's heart, the programmer configured to determine atrial capture threshold, the programmer comprising:

• a telemetry circuit adapted to provide a communication link with the stimulation device;
• a controller coupled to the telemetry circuit to send and receive diagnostic data and operational commands between the programmer and stimulation device;
• a processor configured to provide operational commands to the stimulation device to undertake operational functions including providing a command to commence an atrial capture threshold test;
• a monitor circuit adapted to monitor loss of capture;
• wherein the controller is further configured to cause the stimulation device to incrementally decrease atrial stimulation pulse amplitude until loss of capture occurs;
• and
• wherein the processor is further configured to cause the stimulation device, in response to loss of capture, to deliver a backup atrial stimulation pulse concurrently with a ventricular stimulation pulse to thereby minimize the possibility of a retrograde P-wave initiating a “pacemaker mediated tachycardia” (PMT);
• and
• a recording circuit coupled to the monitor circuit and adapted to record parametric data related to loss of capture.

A programmer adapted for telemetric communication with a cardiac stimulation device, the device adapted to deliver atrial and ventricular stimulation pulses to a patients heart, the programmer configured to determine atrial capture threshold, the programmer comprising:

• a telemetry circuit adapted to provide a communication link with the stimulation device;
• a controller coupled to the telemetry circuit to send and receive diagnostic data and operational commands between the programmer and stimulation device;
• a processor configured to provide operational commands to the stimulation device to undertake operational functions including providing a command to commence an atrial capture threshold test;
• a monitor circuit adapted to monitor loss of capture;
• wherein the processor is further configured and in response to loss of capture, to cause the stimulation device to initiate a premature ventricular contraction (PVC) response to thereby prevent a retrograde P-wave from initiating a PMT;
• and
• a recording circuit coupled to the monitor circuit and adapted to record parametric data related to loss of capture.

A programmer adapted for telemetric communication with a cardiac stimulation device, the device adapted to deliver atrial and ventricular stimulation pulses to a patients heart, the programmer configured to determine atrial capture threshold, the programmer comprising:

• a telemetry circuit adapted to provide a communication link with the stimulation device;
• a controller coupled to the telemetry circuit to send and receive diagnostic data and operational commands between the programmer and stimulation device;
• a processor configured to provide operational commands to the stimulation device to undertake operational functions including providing a command to commence an atrial capture threshold test;
• wherein the processor is configured to cause the stimulation device to lengthen the post ventricular atrial refractory period (PVARP) from an initial value to a first value prior to the atrial capture threshold test and restore PVARP to the initial value subsequent to such test;
• a monitor circuit adapted to monitor loss of capture;
• and
• a recording circuit coupled to the monitor circuit and adapted to record parametric data related to loss of capture.

A programmer adapted for telemetric communication with a cardiac stimulation device, the device adapted to deliver atrial and ventricular stimulation pulses to a patients heart, the programmer configured to determine atrial capture threshold, the programmer comprising:

• a telemetry circuit adapted to provide a communication link with the stimulation device;
• a controller coupled to the telemetry circuit to send and receive diagnostic data and operational commands between the programmer and stimulation device;
• a processor configured to provide operational commands to the stimulation device to undertake operational functions including providing a command to commence an atrial capture threshold test;
• wherein the processor is configured to cause the stimulation device to lengthen the atrial ventricular (AV) delay from an initial value prior to the atrial capture threshold test and restoring the AV delay to the initial value subsequent to such test;
• a monitor circuit adapted to monitor loss of capture;
• and
• a recording circuit coupled to the monitor circuit and adapted to record parametric data related to loss of capture.

A programmer adapted for telemetric communication with a cardiac stimulation device, the device adapted to deliver atrial and ventricular stimulation pulses to a patients heart, the programmer configured to determine atrial capture threshold, the programmer comprising:

• a telemetry circuit adapted to provide a communication link with the stimulation device;
• a controller coupled to the telemetry circuit to send and receive diagnostic data and operational commands between the programmer and stimulation device;
• an analyzer circuit coupled to the controller and adapted to analyze and process diagnostic data received from the stimulation device, in real-time;
• a processor configured to provide operational commands to the stimulation device to undertake operational functions including providing a command to commence an atrial capture threshold test;
• a monitor circuit adapted to monitor loss of capture;
• wherein the analyzer is further adapted to determine an estimated value for the atrial stimulation pulse amplitude based upon historical diagnostic data relating to the amplitude of the atrial stimulation pulse amplitude at which capture was lost and wherein the initial value of the atrial stimulation pulse amplitude is set incrementally greater than said estimated value;
• and
• a recording circuit coupled to the monitor circuit and adapted to record parametric data related to loss of capture.

A diagnostic system for determining atrial capture threshold comprising:

• a programmer adapted for telemetric communication with a cardiac stimulation device;
• a cardiac stimulation device adapted to deliver atrial and ventricular stimulation pulses upon command from the programmer;
• a communication link telemetrically joining the programmer and the stimulation device and adapted to provide transfer of operational commands and diagnostic data between the programmer and stimulation device, the programmer comprising:
• an analyzer circuit configured to analyze and process transferred diagnostic data in real-time;
• a processor configured to cause the stimulation device to commence an atrial capture threshold test while maintaining ventricular pulses at a level known to ensure capture in the ventricle;
• wherein the analyzer circuit is configured to estimate, from diagnostic data, an atrial stimulation pulse amplitude at which loss of capture would occur and wherein the initial amplitude of the atrial stimulation pulse is set incrementally greater than the estimated value;
• and
• a recording circuit coupled to the processor adapted to record the atrial capture threshold as being the atrial stimulation pulse amplitude below which capture is lost.

A programmer adapted for telemetric communication with a dual chamber cardiac stimulation device, the stimulation device adapted for delivering atrial and ventricular stimulation pulses to a heart, the programmer comprising:

• means for interrogating the stimulation device for obtaining and analyzing diagnostic data therefrom;
• means for displaying said diagnostic data;
• processor means for providing a command to the stimulation device to commence an atrial capture threshold test, the atrial capture threshold test comprising:
• means for detecting loss of atrial capture;
• means for recording an atrial capture threshold as being the atrial stimulation pulse amplitude below which capture is lost;
• and
• means for maintaining ventricular pulses at a level known to ensure capture in a ventricle of the heart.

A programmer adapted for telemetric communication with a cardiac stimulation device, the device adapted to deliver atrial and ventricular stimulation pulses to a patient's heart, the programmer configured to determine atrial capture threshold, the programmer comprising:

• a telemetry circuit adapted to provide a communication link with the stimulation device;
• a controller coupled to the telemetry circuit to send and receive diagnostic data and operational commands between the programmer and stimulation device;
• a processor configured to provide operational commands to the stimulation device to undertake operational functions including providing a command to commence an atrial capture threshold test, the atrial capture threshold test comprising:
• a monitor circuit adapted to monitor loss of capture;
• and
• a recording circuit coupled to the monitor circuit and adapted to record parametric data related to loss of capture;
• wherein the processor is configured to cause the stimulation device to maintain ventricular pulses at a level known to ensure capture of the ventricle.