Active implantable medical device with dual chamber pacing for the treatment of heart failure with preserved ejection fraction

Patent metadata

Field	Value
Publication number	US-9259581-B2
Application number	US-201414559793-A
Country	US
Kind code	B2
Filing date	Dec 3, 2014
Priority date	Dec 4, 2013
Publication date	Feb 16, 2016
Grant date	Feb 16, 2016

Abstract

An active implantable medical device provides atrial stimulation for resynchronization of the heart chambers. After a first cycle without stimulation, a premature left atrial stimulation is delivered with application of a short left inter-atrial delay, shorter than the sinus rhythm coupling interval. During the next cycle a non-premature left atrial stimulation is delivered, and the atrioventricular interval between the left atrial depolarization and the ventricular depolarization is evaluated and compared to its value in sinus rhythm to modify as necessary a parameter of the left atrial stimulation, such as the short left inter-atrial delay.

First claim

The invention claimed is:

1. An active implantable medical device, the device comprising digital processor circuits configured to:
sense ventricular depolarizations;
sense left atrial depolarizations;
deliver left atrial pacing pulses; and
control atrial stimulation of the left atrial pacing pulses, by applying a pacing pulse at a short left inter-atrial delay, shorter than the coupling interval of sinus rhythm according to a stimulation protocol, the stimulation protocol comprising:
after a first cardiac cycle without left atrial pacing, delivery of a premature left atrial stimulation pulse during a second immediately consecutive cardiac cycle, with application of a short left inter-atrial delay shorter than the coupling interval of sinus rhythm;
delivery of a non premature left-atrial stimulation pulse during a third cardiac cycle immediately subsequent to the second cardiac cycle, with application of a left inter-atrial delay corresponding to the coupling interval of sinus rhythm;

assess the atrioventricular interval between left atrial depolarization and ventricular depolarization during the second and third cardiac cycles, or the interventricular delay between two successive ventricular depolarizations;
compare the atrioventricular interval thus evaluated to the atrioventricular interval in sinus rhythm, or the interventricular delay thus assessed to the interventricular delay in sinus rhythm; and
control at least one parameter of the stimulation protocol according to the result of the comparison.

2. The device of claim 1 , wherein the parameter that is controlled depending on the result of the comparison, is the short left inter-atrial delay.

3. The device of claim 2 , wherein, if the atrioventricular interval increases above a given target value, or if the interventricular delay interval is less than the sinus rhythm coupling interval, the digital processor is further configured to:
reduce of a step change the short left inter-atrial delay; then
deliver a premature left atrial stimulation pulse during a subsequent cardiac cycle, with application of the short left inter-atrial delay reduced by one step.

4. The device of claim 3 , wherein, if the atrioventricular interval does not increase beyond the target value, and if the interventricular delay remains equal to the sinus rhythm coupling interval, the digital processor is further configured to:
increase by one variation step the short left inter-atrial delay; then
deliver a premature left atrial stimulation pulse during a subsequent cardiac cycle, with application of the short left inter-atrial delay increased by one step.

5. The device of claim 1 , further comprising a digital processor circuit configured to, on detection of a predetermined event:
inhibit any delivery of left atrial pacing pulse during at least during one cardiac cycle;
measure on at least one cardiac cycle the ventricular coupling interval; and
store this coupling ventricular interval as the sinus rhythm coupling interval for the determination of the short left inter-atrial and left inter-atrial delays corresponding to the sinus rhythm coupling interval in subsequent cycles.

6. The device of claim 5 , wherein the predetermined event is the expiry of a predetermined fixed time interval.

7. The device of claim 5 , wherein the predetermined event is the detection of the exceeding of a predetermined threshold by the variation of the atrio-ventricular delay and/or of the atrial coupling interval and/or of the interventricular delay.

8. The device of claim 2 , further comprising a digital processor circuit configured to:
collect right atrial depolarization; and
assess the variation, from one cardiac cycle to the following one(s), of the atrioventricular interval between the right atrial depolarization and the ventricular depolarization; and
if the variation thus assessed exceeds a predetermined threshold, reduce by one variation step the short left inter-atrial delay.

9. The device of claim 1 , wherein the device has no means for collecting and analyzing the endocardial acceleration.

10. A method for resynchronization of the contraction of the heart chambers, the method comprising:
sensing ventricular depolarizations;
sensing left atrial depolarizations; and
controlling atrial stimulation to prematurely selectively output the left atrial pacing pulses, by applying a pacing pulse at a short left inter-atrial delay, shorter than the coupling interval of sinus rhythm according to a stimulation protocol, the stimulation protocol comprising:
after a first cardiac cycle without left atrial pacing, delivery of a premature left atrial stimulation pulse during a second immediately consecutive cardiac cycle, with application of a short left inter-atrial delay shorter than the coupling interval of sinus rhythm;
delivery of a non-premature left-atrial stimulation pulse during a third cardiac cycle immediately subsequent to the second cardiac cycle, with application of a left inter-atrial delay corresponding to the coupling interval of sinus rhythm;

assessing the atrioventricular interval between left atrial depolarization and ventricular depolarization during the second and third cardiac cycles, or the interventricular delay between two successive ventricular depolarizations;
comparing the atrioventricular interval thus evaluated to the atrioventricular interval in sinus rhythm, or the interventricular delay thus assessed to the interventricular delay in sinus rhythm; and
controlling at least one parameter of the stimulation protocol according to the result of the comparison.

11. The method of claim 10 , wherein the controlled parameter is the short left inter-atrial delay.

12. The method of claim 11 , further comprising modifying the short left inter-atrial delay interval if the atrioventricular interval increases above a given target value, or if the interventricular delay interval is less than the sinus rhythm coupling interval by:
reducing of a step change the short left inter-atrial delay; then
delivering a premature left atrial stimulation pulse during a subsequent cardiac cycle, with application of the short left inter-atrial delay reduced by one step.

13. The method of claim 11 , further comprising modifying the short left inter-atrial delay interval if the atrioventricular interval does not increase beyond the target value, and if the interventricular delay remains equal to the sinus rhythm coupling interval by:
increasing by one variation step the short left inter-atrial delay; then
delivering a premature left atrial stimulation pulse during a subsequent cardiac cycle, with application of the short left inter-atrial delay increased by one step.

14. The method of claim 10 , further comprising:
detecting a predetermined event;
inhibiting any delivery of left atrial pacing pulse during at least during one cardiac cycle;
measuring on at least one cardiac cycle the ventricular coupling interval; and
storing this coupling ventricular interval as the sinus rhythm coupling interval for the determination of the short left inter-atrial and left inter-atrial delays corresponding to the sinus rhythm coupling interval in subsequent cycles.

15. The method of claim 14 , wherein the predetermined event is the expiry of a predetermined fixed timing interval.

16. The method of claim 14 , wherein the predetermined event is the detection of the exceeding of a predetermined threshold by the variation of the atrio-ventricular delay and/or of the atrial coupling interval and/or of the interventricular delay.

17. A method of providi

Assignees

• Sorin Crm Sas

Inventors

• Amblard Amel
• Limousin Marcel

Classifications

• A61N1/3627

  for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy · CPC title

• A61N1/368 Primary

  comprising more than one electrode co-operating with different heart regions {(A61N1/3622, A61N1/3627 take precedence)} · CPC title