Preferred ADI/R: a permanent pacing mode to eliminate ventricular pacing while maintaining backup support

Patent metadata

Field	Value
Publication number	US-9375579-B2
Application number	US-201113154761-A
Country	US
Kind code	B2
Filing date	Jun 7, 2011
Priority date	Sep 17, 2002
Publication date	Jun 28, 2016
Grant date	Jun 28, 2016

Abstract

A preferred atrial-based pacing method and apparatus is provided using an intelligent cardiac pacing system to having the ability to continue atrial-based pacing as long as relatively reliable AV conduction is present. In the event that such relatively reliable AV conduction is not present, mode switching to a DDD/R or a DDI/R pacing mode while continually biased to mode switch back to atrial-based pacing. The standard or relatively reliable AV conduction may be changed either automatically or manually. This increases pacing that utilizes natural AV conduction however possible so as to gain all the benefits of cardiac contractile properties resulting therefrom, while tolerating the occasional missed ventricular depolarization (i.e., non-conducted P-wave). In the event where relatively reliable AV conduction is not present, the pacing mode is switched to a DDD/R mode while detecting a return of the relatively reliable AV conduction (and resulting mode switch to preferred atrial based pacing).

First claim

The invention claimed is:

1. A method of promoting an atrial-based pacing modality, comprising the steps of:
pacing an atrial chamber of a heart pursuant to an atrial-based pacing modality;
detecting a ventricular response from the pacing; and
based on a predetermined criteria, determining whether a relatively reliable AV conduction condition exists:
if the relatively reliable conduction condition is present, continuing the atrial-based pacing modality, and
if the relatively reliable conduction condition is not present, switching to a dual-chamber pacing modality;
in the event that the ventricular response is a PVC, switching the pacing modality to a dual-chamber pacing modality for at least one cardiac cycle or for a predetermined period of time;
determining a number of pacing modality switches that have occurred during the predetermined period of time; and
in the event that the number of pacing modality switches exceeds a predetermined threshold number, then continuing the dual-chamber pacing modality without performing a step of determining whether relatively reliable AV conduction condition is present and discontinuing the pacing modality switching, and
in the event that the number of mode switches do not exceed the predetermined threshold number, then repeatedly performing the step of detecting whether relatively reliable AV conduction condition is present.

2. A method according to claim 1 , further comprising the following step:
determining whether a relatively reliable AV conduction condition is present and if present, mode switching back to the atrial-based pacing modality and if not present, mode switching to one of: a DDD/R pacing mode, a DDD pacing mode, a DDI/R pacing mode, a DDI pacing mode.

3. A method according to claim 1 further comprising the step of repeatedly performing the step of determining whether the relatively reliable AV conduction condition is present.

4. A method according to claim 1 , further comprising the following steps: subsequent to a delivery of a defibrillation therapy, continuing the dual-chamber pacing mode for the predetermined period of time.

5. A method according to claim 1 , further comprising the steps of:
detecting an atrial tachyarrhythmia; and
mode switching to a one of: a DDI/R pacing mode, a DDI pacing mode, a DDD pacing mode, a DDD/R pacing mode.

6. A method of promoting an atrial-based pacing modality, comprising the steps of:
pacing an atrial chamber of a heart pursuant to an atrial-based pacing modality;
detecting a ventricular response from the pacing; and
based on a predetermined criteria, determining whether a relatively reliable AV conduction condition exists:
if the relatively reliable conduction condition is present, continuing the atrial-based pacing modality,
if the relatively reliable conduction condition is not present, switching to a dual-chamber pacing modality;
in the event that the ventricular response is a PVC, switching the pacing modality to a dual-chamber pacing modality for at least one cardiac cycle or for a predetermined period of time;
determining whether a relatively reliable AV conduction condition is present and if present, mode switching back to the atrial-based pacing modality and if not present, mode switching to one of: a DDD/R pacing mode, a DDD pacing mode, a DDI/R pacing mode, a DDI pacing mode; and
determining a number of mode switches that have occurred during the predetermined period of time; and
in the event that the number of mode switches exceeds a predetermined threshold number, then continuing the dual-chamber pacing mode without performing a step of determining whether relatively reliable AV conduction is present and discontinuing the mode switching, and
in the event that the number of mode switches do not exceed the predetermined threshold number, then repeatedly performing the step of determining whether the relatively reliable AV conduction condition is present.

7. A non-transitory computer readable medium having computer-executable instructions for performing a method of programming pacing cycles based on a preferred ADI/R mode in a medical device, the method comprising:
implementing an atrial-based pacing mode, wherein said pacing mode comprises at least a one of: an ADI/R pacing mode, an ADI pacing mode, an AAI/R pacing mode, and an AAI pacing mode;
detecting whether a relatively reliable AV conduction condition is present;
switching to a dual-chamber pacing mode in the event that the relatively reliable AV conduction is not detected;
detecting whether the relatively reliable AV conduction condition is present and if present, then mode switching to a one of: the ADI/R pacing mode, the ADI pacing mode, the AAI/R pacing mode, the AAI pacing mode, and if not present, continuing the dual-chamber pacing mode;
repeating the attempting step; and further comprising the step of:
ceasing performing the step of repeating the attempting step in the event that more than a predetermined number of the attempting steps do not detect that the relatively reliable AV conduction condition is present;
determining a number of mode switches that have occurred during a predetermined period of time; and
in the event that the number of mode switches exceeds a predetermined threshold number, then continuing the dual-chamber pacing mode without performing a step of detecting whether relatively reliable AV conduction condition is present and discontinuing the mode switching, and
in the event that the number of mode switches do not exceed the predetermined threshold number, then repeatedly performing the step of detecting whether relatively reliable AV conduction condition is present.

8. A method according to claim 6 , further comprising the following steps: subsequent to a delivery of a defibrillation therapy, continuing the dual-chamber pacing mode for the predetermined period of time.

9. A method according to claim 6 , further comprising the steps of:
detecting an atrial tachyarrhythmia; and
mode switching to a one of: a DDI/R pacing mode, a DDI pacing mode, a DDD pacing mode, a DDD/R pacing mode.

10. A method according to claim 7 further comprising the step of repeatedly performing the step of determining whether the relatively reliable AV conduction condition is present.

11. A method according to claim 7 , further comprising the following steps: subsequent to a delivery of a defibrillation therapy, continuing the dual-chamber pacing mode for the predetermined period of time.

12. A method according to claim 7 , further comprising the steps of: detecting an atrial tachyarrhythmia; and
mode switching to a one of: a DDI/R pacing mode, a DDI pacing mode, a DDD pacing mode, a DDD/R pacing mode.

Assignees

• Casavant David A
• Belk Paul
• Mullen Thomas J
• Stroebel John C
• Medtronic Inc

Inventors

• Casavant David A
• Belk Paul
• Mullen Thomas J
• Stroebel John C

Classifications

• A61N1/3688

  configured for switching the pacing mode, e.g. from AAI to DDD · CPC title

• A61N1/368 Primary

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

• A61N1/3682

  with a variable atrioventricular delay · CPC title