Cardiac resynchronization therapy utilizing P-wave sensing and dynamic anticipative left ventricular pacing
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Publication Number
US-9352159-B2
Publication Date
2016-05-31
Expiration Date
Abstract
A method for operating a pacemaker comprises the procedures of building a database of a cardiac cycle of a patient suffering from bundle branch block and artificially pacing a ventricle of the patient using the pacemaker according to anticipative atrioventricular (AV) delays in the database which are based on measured P-P intervals in the database.
Core Innovation
The invention relates to operating a subcutaneous pacemaker for a patient suffering from bundle branch block by building a database of a cardiac cycle that is explicitly based on time stamped entries of an onset of a P wave and a time duration of the P wave, and an onset of a QRS complex and a time duration of the QRS complex immediately following the P wave. The database is built using at least two subcutaneous sensors that sense the onset and time duration of the P wave and the onset and time duration of the QRS complex.
Atrioventricular (AV) delays corresponding to measured P-P intervals are determined for the cardiac cycle based on the time duration of the P wave and the onset of the QRS complex, and these AV delays are stored in the database. The pacemaker then artificially paces a first ventricle of the patient according to the AV delays in the database so as to enable native activation of a second ventricle not suffering from bundle branch block.
The timing is selected to anticipate a correct time during the cardiac cycle to pace the first ventricle to maximize a likelihood of simultaneous activation of the first ventricle and the second ventricle. The system uses a processor coupled to the subcutaneous sensors and a pacing electrode to provide pacing signals to the first ventricle according to the AV delays stored in the database.
Claims Coverage
Two independent claims are provided, one method claim and one apparatus claim. Both independent claims center on using subcutaneous sensors to build a time-stamped P-wave/QRS database, deriving AV delays from measured P-P intervals, and using those AV delays to pace a first ventricle to enable native activation of a second ventricle and to maximize a likelihood of simultaneous activation.
Database of time-stamped P-wave and QRS-complex features from subcutaneous sensors
building a database of a cardiac cycle of a patient suffering from bundle branch block, said database comprising time stamped entries indicating an onset of a P wave and a time duration of said P wave of said cardiac cycle and an onset of a QRS complex and a time duration of said QRS complex of said cardiac cycle immediately following said P wave, said database being built using at least two subcutaneous sensors for sensing said onset and said time duration of said P wave and said onset and said time duration of said QRS complex
AV delay determination from measured P-P intervals and database storage
determining atrioventricular (AV) delays of said cardiac cycle corresponding to measured P-P intervals of said cardiac cycle based on said time duration of said P wave and said onset of said QRS complex, said AV delays being stored in said database
Artificially pacing a first ventricle according to database AV delays to enable native activation of a second ventricle
artificially pacing a first ventricle of said patient suffering from bundle branch block using said pacemaker according to said AV delays in said database, thereby enabling native activation of a second ventricle of said patient not suffering from said bundle branch block and thereby also anticipating a correct time during said cardiac cycle to pace said first ventricle to maximize a likelihood of simultaneous activation of said first ventricle and said second ventricle
Subcutaneously positionable apparatus with subcutaneous P-wave/QRS sensing, database construction, and pacing electrode
Subcutaneously positionable apparatus for artificially pacing a heart of a patient suffering from bundle branch block, comprising: a power source; a processor, coupled with said power source; a plurality of subcutaneous sensors ... at least one ... for detecting P waves ... and at least another ... for detecting QRS complexes ...; and a pacing electrode ... for providing pacing signals to a first ventricle ...
Database includes time-stamped P-wave/QRS entries and AV delays corresponding to measured P-P intervals
wherein said plurality of subcutaneous sensors are used to construct a database of said cardiac cycle of said patient, said database being stored on said processor, said database comprising time stamped entries indicating an onset of said P waves and a time duration of said P waves ... and an onset of said QRS complexes and a time duration of said QRS complexes ... immediately following said P wave, said database further comprising atrioventricular (AV) delays of said cardiac cycle corresponding to measured P-P intervals of said cardiac cycle determined from said time duration of said P waves and said onset of said QRS complexes, said AV delays being stored in said database
Pacing a first ventricle according to stored AV delays to enable native activation of a second ventricle
and wherein said first ventricle is artificially paced by said pacing electrode according to said AV delays in said database, thereby enabling native activation of a second ventricle in said heart not suffering from said bundle branch block and thereby also anticipating a correct time during said cardiac cycle to pace said first ventricle to maximize a likelihood of simultaneous activation of said first ventricle and said second ventricle
Across both independent claims, the core claim coverage is the combination of subcutaneous P-wave and QRS detection used to construct a time-stamped cardiac-cycle database, derivation of AV delays from measured P-P intervals and storage of those AV delays, and artificial pacing of a first ventricle according to the stored AV delays to enable native activation of a second ventricle and to maximize a likelihood of simultaneous activation.
Stated Advantages
Enable native activation of a second ventricle in a heart not suffering from bundle branch block.
Anticipate a correct time during the cardiac cycle to pace the first ventricle.
Maximize a likelihood of simultaneous activation of the first ventricle and the second ventricle.
Documented Applications
No documented applications found
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