Source: http://www.google.com/patents/US20020183795?dq=5579430
Timestamp: 2017-08-22 12:23:03
Document Index: 74110054

Matched Legal Cases: ['art.\n30', 'art 8', 'art 8', 'art 8', 'art 8', 'art 8', 'art 8']

Patent US20020183795 - Method and system for ventricular fusion prevention - Google Patents
A method and system for ventricular fusion prevention is provided. It is determined whether an atrial sense occurred within a prior wait time and a scheduled ventricular pace is administered if no atrial sense occurred. If an atrial sense occurred and a ventricular sense follows within an additional...http://www.google.com/patents/US20020183795?utm_source=gb-gplus-sharePatent US20020183795 - Method and system for ventricular fusion prevention
Publication number US20020183795 A1
Application number US 09/844,070
Also published as US6654637
Publication number 09844070, 844070, US 2002/0183795 A1, US 2002/183795 A1, US 20020183795 A1, US 20020183795A1, US 2002183795 A1, US 2002183795A1, US-A1-20020183795, US-A1-2002183795, US2002/0183795A1, US2002/183795A1, US20020183795 A1, US20020183795A1, US2002183795 A1, US2002183795A1
Inventors Mattias Rouw, Peter Wohlgemuth
Original Assignee Mattias Rouw, Peter Wohlgemuth
Referenced by (43), Classifications (5), Legal Events (4)
Method and system for ventricular fusion prevention
US 20020183795 A1
1. A method for ventricular fusion prevention, comprising:
providing a value for wait time,
scheduling a ventricular pace;
determining whether an atrial sense occurred within a prior wait time;
administering the scheduled ventricular pace if no atrial sense occurred within the prior wait time;
awaiting either a ventricular sense or an additional wait time, if an atrial sense occurred within the prior wait time;
canceling the ventricular pace if the ventricular sense occurs; and
administering the scheduled ventricular pace if the additional wait time passes.
2. The method of claim 1, wherein the wait time is determined for an individual patient by testing.
providing a max AV interval;
incrementing a fusion beat counter if the ventricular pace is canceled; and
increasing the max AV interval if the fusion beat counter exceeds a predetermined value.
7. The method of claim 6, wherein the value of the fusion beat counter is determined for an individual patient by testing.
9. The method of claim 6, wherein the value of the fusion beat counter is selected from the ranges consisting of 1 to 20, 1 to 10, and 1 to 5.
11. The method of claim 6, wherein the value of the max AV interval is increased by an amount determined by the physician for an individual patient.
13. The method of claim 6, wherein the value of the max AV interval is increased to an amount determined by the physician for an individual patient.
means for providing a value for wait time,
means for scheduling a ventricular pace;
means for determining whether an atrial sense occurred within a prior wait time;
means for administering the scheduled ventricular pace if no atrial sense occurred within the prior wait time;
means for awaiting either a ventricular sense or an additional wait time, if an atrial sense occurred within the prior wait time;
means for canceling the ventricular pace if the ventricular sense occurs; and
means for administering the scheduled ventricular pace if the additional wait time passes.
16. The system of claim 15, wherein the wait time is determined for an individual patient by testing.
17. The system of claim 15, wherein the wait time is in the range of 0 to 30 ms.
18. The method of claim 15, wherein the wait time is selected from the ranges consisting of 10 ms to 30 ms, 20 ms to 30 ms, and 23 ms to 27 ms.
19. The method of claim 15, wherein the wait time is 25 ms.
means for providing a max AV interval;
means for incrementing a fusion beat counter if the ventricular pace is canceled; and
means for increasing the max AV interval if the fusion beat counter exceeds a predetermined value.
21. The system of claim 20, wherein the value of the fusion beat counter is determined for an individual patient by testing.
22. The system of claim 20, wherein the value of the fusion beat counter is from 1 to 20.
23. The method of claim 20, wherein the value of the fusion beat counter is selected from the ranges consisting of 1 to 20, 1 to 10, and 1 to 5.
24. The system of claim 20, wherein the value of the fusion beat counter is 3.
25. The system of claim 20, wherein the value of the max AV interval is increased by an amount determined by the physician for an individual patient.
26. The system of claim 20, wherein the value of the max AV interval is increased by 50 ms.
27. The system of claim 20, wherein the value of the max AV interval is increased to an amount determined by the physician for an individual patient.
28. The system of claim 20, wherein the value of the max AV interval is increased to 220 ms.
29. The system of claim 15, further comprising means for applying an electrical pace to a mammalian heart.
30. The system of claim 15, further comprising means for storing data.
31. The system of claim 30, wherein the data storage means is selected from the group consisting of RAM and ROM.
32. The system of claim 15, further comprising means for storing program instructions.
33. The system of claim 32, wherein the program storage means is selected from the group consisting of RAM and ROM.
34. A computer usable medium storing computer readable program code having a program for ventricular fusion prevention, comprising:
computer readable program code that provides a value for wait time,
computer readable program code that schedules a ventricular pace;
computer readable program code that determines whether an atrial sense occurred within a prior wait time;
computer readable program code that administers the scheduled ventricular pace if no atrial sense occurred within the prior wait time;
computer readable program code that awaits either a ventricular sense or an additional wait time, if an atrial sense occurred within the prior wait time;
computer readable program code that cancels the ventricular pace if the ventricular sense occurs; and
computer readable program code that administers the scheduled ventricular pace if the additional wait time passes.
35. The program of claim 34, wherein the wait time is determined for an individual patient by testing.
36. The program of claim 34, wherein the wait time is in the range of 0 to 30 ms.
37. The method of claim 34, wherein the wait time is selected from the ranges consisting of 10 ms to 30 ms, 20 ms to 30 ms, and 23 ms to 27 ms.
38. The method of claim 34, wherein the wait time is 25 ms.
39. The program of claim 34, further comprising:
computer readable program code that provides a max AV interval;
computer readable program code that increments a fusion beat counter it the ventricular pace is canceled; and
computer readable program code that increases the max AV interval if the fusion beat counter exceeds a predetermined value.
40. The program of claim 39, wherein the value of the fusion beat counter is determined for an individual patient by testing.
41. The program of claim 39, wherein the value of the fusion beat counter is from 1 to 20.
42. The method of claim 39, wherein the value of the fusion beat counter is selected from the ranges consisting of 1 to 20, 1 to 10, and 1 to 5.
43. The program of claim 39, wherein the value of the fusion beat counter is 3.
44. The program of claim 39, wherein the value of the max AV interval is increased by an amount determined by the physician for an individual patient.
45. The program of claim 39, wherein the value of the max AV interval is increased by 50 ms.
46. The program of claim 39, wherein the value of the max AV interval is increased to an amount determined by the physician for an individual patient.
47. The program of claim 39, wherein the value of the max AV interval is increased to 220 ms.
Publication Date Inventor (s)
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Pat. No. 5,755,739 May 26, 1998 Sun et al.
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Pat. No. 4,825,870 May 02, 1989 Mann et al.
Pat. No. 4,365,639 Dec. 28, 1982 Goldreyer
FFRW Classification Jun. 00, 1999 Westendorp et al.
[0021]FIG. 1 is a schematic view of one embodiment of an implantable medical device in situ, made in accordance with the present invention;
[0022]FIG. 2 is another schematic view of an embodiment of the implantable medical device of FIG. 1, made in accordance with the present invention;
[0023]FIG. 3 is a block diagram illustrating components of an embodiment of the implantable medical device of FIG. 1, made in accordance with the present invention;
[0024]FIG. 4 is a schematic view of another embodiment of an implantable medical device, made in accordance with the present invention;
[0025]FIG. 5 is a block diagram illustrating components of an embodiment of the implantable medical device of FIG. 4, made in accordance with the present invention; and
[0026]FIG. 6 is a flow chart of a method for ventricular fusion prevention, in accordance with the present invention
[0027]FIGS. 7A & 7B show the time between the FFRW atrial sensing and the ventricular contraction for two cases.
[0028]FIG. 8 is a flow chart of another embodiment of a method for ventricular fusion prevention, in accordance with the present invention;.
[0030]FIG. 1 is a simplified schematic view of one embodiment of implantable medical device (“IMD”) 10 of the present invention. IMD 10 shown in FIG. 1 is a pacemaker comprising at least one of pacing and sensing leads 16 and 18 attached to hermetically sealed enclosure 14 and implanted near human or mammalian heart 8. Pacing and sensing leads 16 and 18 sense electrical signals attendant to the depolarization and re-polarization of the heart 8, and further provide pacing pulses for causing depolarization of cardiac tissue in the vicinity of the distal ends thereof. Leads 16 and 18 may have unipolar or bipolar electrodes disposed thereon, as is well known in the art. Examples of IMD 10 include implantable cardiac pacemakers disclosed in U.S. Pat. No. 5,158,078 to Bennett et al., U.S. Pat. No. 5,312,453 to Shelton et al. or U.S. Pat. No. 5,144,949 to Olson, all hereby incorporated by reference herein, each in its respective entirety.
[0031]FIG. 2 shows connector module 12 and hermetically sealed enclosure 14 of IMD 10 located in and near human or mammalian heart 8. Atrial and ventricular pacing leads 16 and 18 extend from connector header module 12 to the right atrium and ventricle, respectively, of heart 8. Atrial electrodes 20 and 21 disposed at the distal end of atrial pacing lead 16 are located in the right atrium. Ventricular electrodes 28 and 29 at the distal end of ventricular pacing lead 18 are located in the right ventricle.
[0044]FIGS. 4 and 5 illustrate one embodiment of IMD 10 and a corresponding lead set of the present invention, where IMD 10 is a PCD. In FIG. 4, the ventricular lead takes the form of leads disclosed in U.S. Pat. Nos. 5,099,838 and 5,314,430 to Bardy, and includes an elongated insulative lead body 1 carrying three concentric coiled conductors separated from one another by tubular insulative sheaths. Located adjacent the distal end of lead 1 are ring electrode 2, extendable helix electrode 3 mounted retractably within insulative electrode head 4 and elongated coil electrode 5. Each of the electrodes is coupled to one of the coiled conductors within lead body 1. Electrodes 2 and 3 are employed for cardiac pacing and for sensing ventricular depolarizations. At the proximal end of the lead is bifurcated connector 6 which carries three electrical connectors, each coupled to one of the coiled conductors. Defibrillation electrode 5 may be fabricated from platinum, platinum alloy or other materials known to be usable in implantable defibrillation electrodes and may be about 5 cm in length.
IMD 10 is provided with an electrode system. If the electrode configuration of FIG. 4 is employed, the correspondence to the illustrated electrodes is as follows. Electrode 25 in FIG. 5 includes the uninsulated portion of the housing of PCD 10. Electrodes 25,15, 21 and 5 are coupled to high voltage output circuit 27, which includes high voltage switches controlled by CV/defib control logic 29 via control bus 31. Switches disposed within circuit 27 determine which electrodes are employed and which electrodes are coupled to the positive and negative terminals of the capacitor bank (which includes capacitors 33 and 35) during delivery of defibrillation pulses.
Detection of atrial or ventricular tachyarrhythmias, as employed in the present invention, may correspond to tachyarrhythmia detection algorithms known in the art. For example, the presence of an atrial or ventricular tachyarrhythmia may be confirmed by detecting a sustained series of short R-R or P-P intervals of an average rate indicative of tachyarrhythmia or an unbroken series of short R-R or P-P intervals. The suddenness of onset of the detected high rates, the stability of the high rates, and a number of other factors known in the art may also be measured at this time. Appropriate ventricular tachyarrhythmia detection methodologies measuring such factors are described in U.S. Pat. No. 4,726,380 issued to Vollmann, U.S. Pat. No. 4,880,005 issued to Pless et al. and U.S. Pat. No. 4,830,006 issued to Haluska et al., all incorporated by reference herein, each in its respective entirety. An additional set of tachycardia recognition methodologies is disclosed in the article “Onset and Stability for Ventricular Tachyarrhythmia Detection in an Implantable Pacer-Cardioverter-Defibrillator” by Olson et al., published in Computers in Cardiology, Oct. 7-10, 1986, IEEE Computer Society Press, pp. 167-170, also incorporated by reference herein in its entirety. Atrial fibrillation detection methodologies are disclosed in Published PCT Application Serial No. US92/02829, Publication No. WO92/18198, by Adams et al., and in the article “Automatic Tachycardia Recognition”, by Arzbaecher et al., published in PACE, May-June, 1984, pp. 541-547, both of which are incorporated by reference herein in their entireties.
[0065]FIG. 6 shows a flow chart of a method for ventricular fusion prevention in accordance with the present invention. An IMD 10 disposed within mammalian heart 8 is programmed to avoid ventricular fusion by using atrial activity to determine if an intrinsic ventricular pulse should be expected. Typically, the atrial activity is a Far Field R-wave (FFRW).
[0070]FIGS. 7A & 7B show the time between the FFRW atrial sensing and the ventricular contraction for two cases. The normal right atrial lead in FIG. 7A first detects a P-wave from an atrial contraction. The normal right atrial lead next detects a FFRW. In 22 ms, the normal ventricular lead detects the ventricular contraction. Similarly, the coronary sinus lead in FIG. 7B first detects a P-wave from an atrial contraction. The coronary sinus lead next detects a FFRW. In 40 ms, the normal ventricular lead detects the ventricular contraction. These cases illustrate that a fusion beat can be avoided by delaying a scheduled ventricular pace if atrial activity occurred within the prior wait time to see if a ventricular contraction occurs within the following wait time.
[0078]FIG. 8 shows a flow chart of a method for ventricular fusion prevention in accordance with the present invention. An IMD 10 disposed within mammalian heart 8 is programmed to avoid ventricular fusion by using atrial activity to determine if an intrinsic ventricular pulse should be expected. Typically, the atrial activity is a Far Field R-wave (FFRW).
US7412286 * Aug 29, 2003 Aug 12, 2008 Biotronik Gmbh & Co. Kg Biatrial triple-chamber cardiac pacemaker with multi-conditional inhibition of second atrial stimulation
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