Apparatus and methods of optimizing atrioventricular pacing delay intervals

Patent metadata

Field	Value
Publication number	US-9597512-B2
Application number	US-201113084244-A
Country	US
Kind code	B2
Filing date	Apr 11, 2011
Priority date	Mar 13, 2008
Publication date	Mar 21, 2017
Grant date	Mar 21, 2017

Abstract

Methods for optimizing an atrioventricular (AV) pacing delay interval based upon ECG-based optimization such that an AV pacing delay interval value can be dynamically adjusted in an ambulatory subject. Ends of P-waves are determined. An operating atrioventricular interval is modified to maintain intervals between the determined ends of P-waves and beginnings of corresponding following QRS complexes above a predetermined certain value. The value may be between 30 and 60 milliseconds.

First claim

The invention claimed is:

1. A method of adjusting an operating atrio-ventricular (AV) interval in a pacing therapy delivery device, wherein the operating atrio-ventricular interval extends between delivery of an atrial pacing pulse and delivery of a following ventricular pacing pulse, comprising:
monitoring a cardiac activity signal;
detecting P-waves within the cardiac activity signal;
determining ends of the P-waves within the detected cardiac signal;
defining a minimum duration between the ends of the P-waves and beginnings of corresponding QRS complexes as a predetermined certain value; and
modifying the operating atrio-ventricular interval to maintain intervals between ends of P-waves and beginnings of corresponding QRS complexes above the predetermined certain value.

2. The method of claim 1 further comprising storing the modified atrio-ventricular interval.

3. The method of claim 2 wherein determining the end of the P-wave comprises measuring one of a slope of the P-wave, a threshold crossing of the P-wave, and a change in a polarity of the cardiac signal.

4. The method of claim 1 wherein the predetermined-certain value is 40 ms.

5. The method of claim 1 wherein the step of modifying includes increasing the operating atrio-ventricular interval.

6. The method of claim 1 further comprising operating the pacing delivery device in a bi-ventricular pacing mode at the operating atrio-ventricular interval.

7. The method of claim 1 further comprising:
measuring a duration of a previously detected P-wave;
measuring a duration of the P-wave;
comparing the duration of the P-wave to a measured duration of a previously detected P-wave; and
determining a cardiac status based on a result of the comparison.

8. The method of claim 1 further comprising:
measuring a duration of a previously detected QRS complex;
measuring a duration of the QRS complex;
comparing the duration of the QRS complex to a measured duration of a previously detected QRS complex; and
determining a cardiac status based on a result of the comparison.

9. The method of claim 1 further comprising:
measuring a heart rate; and
adjusting the operating atrio-ventricular interval if there is an increase in the monitored heart rate.

10. The method of claim 9 wherein adjusting the operating atrio-ventricular interval comprises modifying the operating atrio-ventricular interval by one ms for every one beat change in the measured heart rate.

11. The method of claim 1 wherein the predetermined certain value is 30-60 ms.

12. A method of claim 1 wherein determining ends of the P-waves within the detected cardiac signal comprises determining the ends of P-waves within one or more cardiac cycles and wherein modifying the operating atrio-ventricular interval comprises modifying the operating atrio-ventricular interval in cardiac cycles following the one or more cardiac cycle in which the ends of the P-waves were determined.

13. The method of claim 12 further comprising storing the modified atrio-ventricular interval.

14. The method of claim 13 wherein determining the end of the P-wave comprises measuring one of a slope of the P-wave, a threshold crossing of the P-wave, and a change in a polarity of the cardiac signal.

15. The method of claim 12 wherein the predetermined-certain value is 40 ms.

16. The method of claim 12 wherein the step of modifying includes increasing the operating atrio-ventricular interval.

17. The method of claim 12 further comprising operating the pacing delivery device in a bi-ventricular pacing mode at the operating atrio-ventricular interval.

18. The method of claim 12 further comprising:
measuring a heart rate; and
adjusting the operating atrio-ventricular interval if there is an increase in the monitored heart rate.

19. The method of claim 12 wherein the predetermined certain value is 30-60 ms.

Assignees

• Sambelashvili Aleksandre T
• Mullen Thomas J
• Medtronic Inc

Inventors

• Sambelashvili Aleksandre T
• Mullen Thomas J

Classifications

• A61N1/3627 Primary

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

• A61N1/3752

  Details of casing-lead connections · CPC title

• A61N1/3682

  with a variable atrioventricular delay · CPC title

• A61N1/3756

  Casings with electrodes thereon, e.g. leadless stimulators · CPC title

• A61N1/3684

  for stimulating the heart at multiple sites of the ventricle or the atrium · CPC title