Pacemaker with detection of atrial activity without collection of atrial electrical activity

Patent metadata

Field	Value
Publication number	US-9884193-B2
Application number	US-201514922622-A
Country	US
Kind code	B2
Filing date	Oct 26, 2015
Priority date	Oct 27, 2014
Publication date	Feb 6, 2018
Grant date	Feb 6, 2018

Abstract

The invention relates to an active implantable pacemaker. The device analyzes a ventricular electrogram signal (EGM) and is able to recognize, in a search window, an EA4 component of endocardial acceleration (EA) associated with atrial activity. In the presence of atrioventricular conduction, the search window is determined based on the temporal position of the EA1 and/or EA2 components of the EA signal. In the absence of atrioventricular conduction, a delay is counted from a paced ventricular event and applied to mask the EA1 and/or EA2 components in the EA signal, and the window for research of the EA4 component follows the masking delay. In the presence of a confirmed EA4 component, an atrioventricular delay is applied, counted from the EA4 component, and in the opposite case a predetermined escape interval is applied, counted from the last stimulated ventricular event.

First claim

What is claimed is:

1. An active implantable medical device, such as a cardiac pacemaker, for stimulation, resynchronization and/or defibrillation, comprising:
an acceleration sensor adapted to deliver an endocardial acceleration (EA) signal, representative of cyclic contractions of a myocardium;
at least one electrode;
a pulse generator; and
a processor configured to:
analyze a ventricular electrogram (EGM) signal obtained using the at least one electrode to detect a plurality of cardiac events;
trigger ventricular stimulation via the at least one electrode and the pulse generator;
apply an atrioventricular delay (AVD); and
analyze the EA signal, wherein the analysis comprises recognizing and isolating in the EA signal an EA4 component corresponding to a fourth peak of an endocardial acceleration associated with an atrial activity, wherein the device does not collect an atrial EGM signal and wherein the processor is further configured to:
determine a search window for the EA4 component in the EA signal;
confirm the presence or absence of the EA4 component in the search window; and
apply stimulation including:
the AVD in the presence of a confirmed EA4 component; or
a predetermined escape interval in the absence of a confirmed EA4 component,

wherein the determination of the search window comprises:
analyzing the ventricular EGM to determine a presence or an absence of an atrioventricular conduction; and
a) in the presence of the atrioventricular conduction:
detecting a time of occurrence of a ventricular event from the ventricular EGM signal;
detecting in the EA signal an EA1 component and/or an EA2 component corresponding to a respective first peak and/or a second peak of endocardial acceleration associated with the ventricular event; and
determining the search window for the EA4 component depending on a temporal position of the detected EA1 and/or EA2 components, and

b) in the absence of the atrioventricular conduction:
applying a masking delay, determined by the analysis of the EA signal, of the EA1 and/or the EA2 components in the EA signal, where the delay begins at the EA1 component and ends after the EA2 component; and
setting the search window of the EA4 component for after the masking delay has ended.

2. The device of claim 1 , wherein the device is an intracardiac autonomous capsule comprising a tubular body provided at a distal end with an anchoring member capable of penetrating into a wall of a ventricle of a patient.

3. The device of claim 1 , wherein confirming the presence or absence of the EA4 component in the search window comprises assessing an overall energy level of the EA signal in the search window and comparing the overall energy level to a predetermined threshold.

4. The device of claim 1 , wherein confirming the presence or absence of the EA4 component in the search window comprises providing a morphological analysis of the EA signal, the morphological analysis comprising determining if the EA4 component is within a predetermined window of a local minima and/or a local maxima of the EA signal.

5. The device of claim 1 , wherein the processor is further configured to estimate an intrinsic rhythm of the patient in the absence of atrioventricular conduction, calculated based on a time interval separating a detection of two confirmed EA4 components for consecutive cardiac cycles.

6. The device of claim 5 , wherein the processor is further configured to calculate a ventricular pacing rate depending on a value of spontaneous rhythm calculated by an estimation of the intrinsic rhythm of the patient.

7. The device of claim 5 , wherein the processor is further configured to calculate an escape interval according to the value of spontaneous rhythm calculated by the estimation of the intrinsic rhythm of the patient.

8. The device of claim 5 , wherein the processor is further configured to calculate the AVD in accordance with the value of spontaneous rhythm calculated by the estimation of the intrinsic rhythm of the patient.

9. The device of claim 5 , wherein the processor is further configured to calculate a duration of the search window based on the value of spontaneous rhythm calculated by the estimation of the intrinsic rhythm of the patient.

10. The device of claim 1 , wherein the at least one electrode comprises a stimulation electrode configured to trigger ventricular stimulation.

11. The device of claim 1 , wherein the at least one electrode comprises a detection electrode configured to obtain the ventricular EGM signal.

12. An active implantable medical device, comprising:
an acceleration sensor adapted to deliver an endocardial acceleration (EA) signal, representative of cyclic contractions of a myocardium;
at least one electrode;
a pulse generator; and
a processor configured to:
analyze a ventricular electrogram (EGM) signal obtained using the at least one electrode to detect a plurality of cardiac events;
trigger ventricular stimulation via the at least one electrode and the pulse generator;
apply an atrioventricular delay (AVD);
analyze the EA signal, wherein the analysis comprises recognizing and isolating in the EA signal an EA4 component corresponding to a fourth peak of an endocardial acceleration associated with an atrial activity, and wherein the processor is further configured to:
determine a search window for the EA4 component in the EA signal;
confirm the presence or absence of the EA4 component in the search window; and
apply stimulation including:
the AVD in the presence of a confirmed EA4 component; or
a predetermined escape interval in the absence of a confirmed EA4 component.

13. The device of claim 12 , wherein the at least one electrode comprises a stimulation electrode configured to trigger ventricular stimulation.

14. The device of claim 12 , wherein the at least one electrode comprises a detection electrode configured to obtain the ventricular EGM signal.

15. The device of claim 12 , wherein the processor is further configured to analyze the ventricular EGM signal to determine a presence or an absence of atrioventricular conduction.

16. The device of claim 14 , wherein in the presence of atrioventricular conduction, the processor is further configured to determine the search window for the EA4 component by:
detecting a time of occurrence of a ventricular event from the ventricular EGM signal;
detecting in the EA signal an EA1 and/or an EA2 components corresponding to a respective first and/or a second peaks of endocardial acceleration associated with the ventricular event; and
determining the search window for the EA4 component depending on a temporal position of the EA1 and/or the EA2 components.

17. The device of claim 14 , wherein in the absence of atrioventricular conduction, the processor is further configured to determine the search window for the EA4 component by:
applying a masking delay, determined by the analysis of the EA signal, of the EA1 and/or the EA2 components in the EA signal, where the delay beings at the EA1 component and ends after the EA2 component; and
setting the search window of the EA4 component for after the masking delay has ended.

18. The device of claim 14 , wherein the device is an intracardiac autonomous capsule comprising a tubular body provided at a distal end with an anchoring member capable of penetrating into a wall of a ventricle of a patient.

19. The device of claim 14 , wherein confirming the presence or absence of the EA4 component in the search window comprises assessing an overall energy

Assignees

• Sorin Crm Sas
• Univ Bretagne Occidentale
• Centre Hospitalier Regional Et Univ De Brest

Inventors

• Amblard Amel
• Dumont Jerome
• Renesto Fabrizio
• Mansourati Jacques

Classifications

• A61N1/37205

  Microstimulators, e.g. implantable through a cannula · CPC title

• A61N1/3682

  with a variable atrioventricular delay · CPC title

• A61N1/36507

  controlled by gradient or slope of the heart potential · CPC title

• A61B5/6869

  Heart · CPC title

• A61B5/1107 Primary

  Measuring contraction of parts of the body, e.g. organ or muscle · CPC title