Electronic system to distinguish between sinus and nonsinus atrial depolarizations

Claim 2

An electronic system for pacing a heart that distinguishes between sinus and nonsinus atrial depolarizations and that does not stimulate ventricular depolarizations in response to nonsinus atrial depolarizations, comprising: an electric lead having first and second ends; at least two electrodes attached to the electric lead near the first end of the lead; a sensing circuit connected to the second end of the electric lead said sensing circuit for detecting voltage differences between one of the electrodes and an indifferent electrode and for detecting voltage differences between the two electrodes; a timing circuit connected to the sensing circuit said timing circuit for determining the time interval between the time a voltage difference is detected between one electrode and an indifferent electrode and the time a voltage difference is detected between the two electrodes; a logic circuit connected to the timing circuit said logic circuit for comparing the time intervals determined by the timing circuit to time intervals indicative of sinus atrial depolarizations; and ventricular stimulating circuit connected to the logic circuit said ventricular stimulating circuit that does not stimulate ventricular depolariation when the comparison made by the logic circuit indicates that the immediately preceding atrial depolarization was nonsinus.

Claim 3

The electronic system of Claim 1, wherein one of the electrodes is attached to the electric lead at the first end of the lead and the other electrode is attached to the electric lead at a point from 20 mm to 40 mm back from the first end of the lead.

Claim 4

The electronic system of Claim 1, wherein one of the electrodes is attached to the electric lead at the first end of the lead and the other electrode is attached to the lead at a point on the lead sufficiently removed from the first end of the lead so that when the first end of the lead is implanted into the right atrial appendage of a human heart, the other electrode is in the high right atrium.

Claim 5

The electronic system of Claim 1, wherein one of the electrodes is attached to the electric lead at the first end of the lead and the other electrode is attached to the lead at a point sufficiently removed from the first end of the electric lead so that when the first end of the electric lead is implanted into to the low septal right atrium of a human heart, the other electrode is in the high right atrium.

Claim 6

An electronic system for pacing a heart that distinguishes between sinus and nonsinus atrial depolarization and that does not stimulate ventricular depolarizations in response to nonsinus atrial depolarizations, comprising: an electric lead having first and second ends; at least two pairs of electrodes attached to the electric lead near the first end of the lead, the distance between the electrodes of each pair being less than the distance between the pairs of electrodes; a sensing circuit connected to the second end of the electric lead said sensing circuit for detecting voltage differences between the electrodes of each of the pairs of electrodes; a timing circuit connected to the sensing circuit said timing circuit for determining the time interval between the time a voltage difference is detected between the electrodes of one pair of electrodes and the time a voltage difference is detected between the electrodes of the other pair of electrodes; a logic circuit connected to the timing circuit said logic circuit for comparing the time interval determined by the timing circuit to the time interval indicative of sinus atrial depolarizations; and a ventricular stimulating circuit connected to the logic circuit said ventricular stimulating circuit that does not stimulate ventricular depolarizations when the comparison made by the logic circuit indicates that the immediately preceding atrial depolarization was nonsinus.

Claim 7

An electronic system for pacing a heart that distinguishes between sinus and nonsinus atrial depolarization and that does not stimulate ventricular depolarizations in response to nonsinus atrial depolarizations, comprising: an electric lead having first and second ends; at least two pairs of electrodes attached to the electric lead near the first end of the lead, the distance between the electrodes of each pair being less than the distance between the pairs of electrodes; a sensing circuit connected to the second end of the electric lead said sensing circuit for detecting voltage differences between the electrodes of each of the pairs of electrodes; a timing circuit connected to the sensing circuit said timing circuit for determining the time interval between the time a voltage difference is detected between the electrodes of one pair of electrodes and the time a voltage difference is detected between the electrodes of the other pair of electrodes; a logic circuit connected to the timing circuit said logic circuit for comparing the time interval determined by the timing circuit to the time interval indicative of sinus atrial depolarizations; and a ventricular stimulating circuit connected to the logic circuit said ventricular stimulating circuit that does not stimulate ventricular depolarizations when the comparison made by the logic circuit indicates that the immediately preceding atrial depolarization was nonsinus.

Claim 8

The electronic system of Claim 5, wherein one pair of electrodes is positioned on the lead so that one of the electrodes of this pair is attached to the electric lead at the first end of the lead and the other pair of electrodes is attached to the lead at a point from 20 mm to 40 mm back from the first end of the lead.

Claim 9

The electronic system of Claim 5, wherein one pair of electrodes is positioned on the lead so that one of the electrodes of this pair is attached at the first end of the lead and the other pair of electrodes is attached to the lead at a point sufficiently removed from the first end of the lead so that when the first end of the lead is implanted into the low septal right atrium of a human heart, the other pair of electrodes is in the high right atrium.

Claim 10

Apparatus for distinguishing between sinus and non-sinus atrial depolarizations, comprising: an electric lead having first and second ends; at least two electrodes attached to the electric lead near the first end of the lead; detecting means connected to the second end of the electric lead for detecting voltage differences between one of the electrodes and an indifferent electrode and for detecting voltage differences between the two electrodes; and comparing means connected to the detecting means for comparing the time at which a voltage difference between one of the electrodes and an indifferent electrode is detected to the time at which a voltage difference between the two electrodes is detected.

Claim 11

Apparatus for distinguishing between sinus and non-sinus atrial depolarizations, comprising: an electric lead having first and second ends; at least two electrodes attached to the electric lead near the first end of the lead; detecting means connected to the second end of the electric lead for detecting voltage differences between one of the electrodes and an indifferent electrode and for detecting voltage differences between the two electrodes; and comparing means connected to the detecting means for comparing the time at which a voltage difference between one of the electrodes and an indifferent electrode is detected to the time at which a voltage difference between the two electrodes is detected.

Claim 12

The apparatus of Claim 8, wherein one electrode is attached to the electric lead at the first end of the lead and the other electrode is attached to the electric lead at a point from 20 mm to 40 mm back from the first end of the lead.

Claim 13

The apparatus of Claim 8, wherein one electrode is attached to the electric lead at the first end·-of the lead and the other electrode is attached to the lead at a point on the lead sufficiently removed from the first end of the lead so that when the first end of the lead is implanted into the right atrial appendage of a human heart, the other electrode is in the high right atrium.

Claim 14

The apparatus of Claim 8, wherein one electrode is attached to the electric lead at the first end of the lead and the other electrode is attached to the lead at a point sufficiently removed from the first end of the lead so that when the first end of the lead is implanted into the low septal right atrium of a human heart, the other electrode is in the high right atrium.

Claim 15

Apparatus for distinguishing between sinus and nonsinus atrial depolarizations, comprising: an electric lead having first and second ends; two pairs of electrodes attached to the electric lead near the first end of the lead, the distance between the electrodes of each pair being less than the distance between the pairs of electrodes; detecting means connected to the second end of the electric lead for detecting voltage differences between the electrodes of each pair of electrodes; and comparing means connected to the detecting means for comparing the time at which a voltage difference is detected between the electrodes of one pair of electrodes to the time at which a voltage difference is detected between the electrodes of the other pair of electrodes.

Claim 16

Apparatus for distinguishing between sinus and nonsinus atrial depolarizations, comprising: an electric lead having first and second ends; two pairs of electrodes attached to the electric lead near the first end of the lead, the distance between the electrodes of each pair being less than the distance between the pairs of electrodes; detecting means connected to the second end of the electric lead for detecting voltage differences between the electrodes of each pair of electrodes; and comparing means connected to the detecting means for comparing the time at which a voltage difference is detected between the electrodes of one pair of electrodes to the time at which a voltage difference is detected between the electrodes of the other pair of electrodes.

Claim 17

The apparatus of Claim 12, wherein one pair of electrodes is positioned on the lead so that one of the electrodes of that pair of electrodes is attached to the electric lead at the first end of the lead and the other pair of electrodes is attached to the lead at a point from 20 mm to 40 mm back from the first end of the lead.

Claim 18

The apparatus of Claim 12, wherein one pair of electrodes is positioned on the lead so that one of the electrodes of that pair of electrodes is attached to the first end of the electric lead and the other pair of electrodes is attached to the lead at a point on the lead sufficiently removed from the first end of the lead so that when the first end of the lead is implanted in the low septal right atrium of a human heart, the other pair of electrodes is in the high right atrium.

Claim 19

Method of distinguishing between sinus and nonsinus atrial depolarizations, comprising: determining the direction of the electrical wave of atrial depolarization in a subject; and comparing the direction of the wave of atrial depolarization determined for the subject to the direction of the wave of atrial depolarization associated with sinus atrial depolarizations.

Claim 20

Method of distinguishing between sinus and nonsinus atrial depolarizations, comprising: determining the direction of the electrical wave of atrial depolarization in a subject; and comparing the direction of the wave of atrial depolarization determined for the subject to the direction of the wave of atrial depolarization associated with sinus atrial depolarizations.

Claim 21

The method of Claim 15 wherein the step of determining the direction of the electrical wave of atrial depolarization in a subject, comprises: obtaining an electric lead having first and second ends that has at least two electrodes attached near the first end of the lead; positioning the first end of the lead to detect electrical activity in the atrium of the subject; using detecting means connected to the second end of the lead to detect voltage differences between one of the electrodes and an indifferent electrode and between the two electrodes; and comparing the time at which a voltage difference is detected between one of the electrodes and an indifferent electrode to the time at which a voltage difference is detected between the two electrodes.

Claim 22

The method of Claim 16, wherein positioning the first end of the electric lead to detect electrical activity in the atrium of a subject, comprises: implanting the first end of the lead in the right atrial appendage of the subject.

Claim 23

The method of Claim 17, wherein the first end of the electric lead implanted into the right. atrial appendage has one electrode attached to the first end of the lead and the other electrode attached to the lead at a point from 20 mm to 40 mm back from the first end of the lead.

Claim 24

The method of Claim 17, wherein the first end of the electric lead implanted into the right atrial appendage has one electrode attached to the first end of the lead and the other electrode attached to the lead at a point sufficiently removed from the first end of the lead so that the other electrode is in the high right atrium.

Claim 25

The method of Claim 16, wherein positioning the first end of the electric lead to detect electrical activity in the atrium of a subject, comprises: implanting the first end of the lead in the low septal right atrium of the subject.

Claim 26

The method of Claim 20, wherein the first end of the electric lead implanted into the low septal right atrium has one electrode attached to the first end of the lead and the other electrode attached to the lead at a point sufficiently removed from the first end of the lead so that the other electrode is in the high right atrium.

Claim 27

The method of Claim 15, wherein the step of determining the direction of the electrical wave of atrial depolarization in a subject, comprises: obtaining an electrical lead having first and second ends that has at least two electrode pairs attached near the first end of the lead so that the distance between the electrodes of each pair is less than the distance between the pairs of electrodes; positioning the first end of the lead to detect electrical activity in the atrium of a subject; using detecting means connected to the second end of the lead to detect voltage differences between the electrodes of each pair of electrodes; and comparing the time at which a voltage difference is detected between the electrodes of one pair of electrodes to the time at which a voltage difference is detected between the electrodes of the other pair of electrodes to determine the direction of the electrical wave of atrial depolarization.

Claim 28

The method of Claim 22, wherein positioning the first end of the lead to detect electrical activity in the atrium of a subject, comprises: implanting the first end of the lead in the right atrial appendage of the subject.

Claim 29

The method of Claim 23, wherein the first end of the electrical lead implanted into the right atrial appendage has one of the electrodes of one pair of electrodes attached to the first end of the lead and the other pair of electrodes is positioned on the lead from 20 mm to 40 mm back from the first end of the lead.

Claim 30

The method of Claim 22, wherein positioning the first end of the lead to detect electrical activity in the atrium of a subject, comprises: implanting the first end of the lead in the low septal right atrium of the subject.

Claim 31

The method of Claim 25, wherein the first end of the electrical lead implanted into the low septal right atrium has one of the electrodes of one pair of electrodes attached to the first end of the lead and the second pair of electrodes is positioned on the lead sufficiently removed from the first end of the lead so that the other pair of electrodes is in the high right atrium.

Claim 32

Method of using a cardiac pacemaker to synchronize atrial activations and ventricular depolarizations, comprising: determining the direction of the electrical wave of atrial depolarization in a subject; comparing the direction of the wave of atrial depolarization determined for the subject to the direction of the wave of atrial depolarization associated with sinus atrial activation; and stimulating a ventricular depolarization only when the comparison made in the previous step indicates that the immediately preceding atrial depolarization was a spontaneous sinus or pacemaker stimulated sinus atrial depolarization.

Claim 33

Method of using a cardiac pacemaker to synchronize atrial activations and ventricular depolarizations, comprising: determining the direction of the electrical wave of atrial depolarization in a subject; comparing the direction of the wave of atrial depolarization determined for the subject to the direction of the wave of atrial depolarization associated with sinus atrial activation; and stimulating a ventricular depolarization only when the comparison made in the previous step indicates that the immediately preceding atrial depolarization was a spontaneous sinus or pacemaker stimulated sinus atrial depolarization.

Claim 34

Method of using a cardiac pacemaker to synchronize atrial activations and ventricular depolarizations comprising: obtaining an electric lead having first and second ends that has at least two electrodes attached near the first end of the lead; positioning the first end of the lead to detect electrical activity in the atrium of the subject; using a sensing circuit connected to the second end of the lead to detect voltage differences between one of the electrodes and an indifferent electrode and between the two electrodes; using a timing circuit connected to the sensing circuit to determine the temporal relationship of the time when a voltage difference is detected between one of the electrodes and an indifferent electrode and the time when a voltage difference is detected between the two electrodes; using a logic circuit connected to the timing circuit to compare the temporal relationship determined in the previous step to the temporal relationship indicative of sinus atrial depolarizations; and using a ventricular stimulating circuit connected to the logic circuit to stimulate ventricular depolarization only when the comparison made by the logic circuit indicates that the immediately preceding atrial contraction was a spontaneous sinus or pacemaker stimulated atrial depolarization.

Claim 35

Method of using a cardiac pacemaker to synchronize atrial activations and ventricular depolarizations comprising: obtaining an electric lead having first and second ends that has at least two electrodes attached near the first end of the lead; positioning the first end of the lead to detect electrical activity in the atrium of the subject; using a sensing circuit connected to the second end of the lead to detect voltage differences between one of the electrodes and an indifferent electrode and between the two electrodes; using a timing circuit connected to the sensing circuit to determine the temporal relationship of the time when a voltage difference is detected between one of the electrodes and an indifferent electrode and the time when a voltage difference is detected between the two electrodes; using a logic circuit connected to the timing circuit to compare the temporal relationship determined in the previous step to the temporal relationship indicative of sinus atrial depolarizations; and using a ventricular stimulating circuit connected to the logic circuit to stimulate ventricular depolarization only when the comparison made by the logic circuit indicates that the immediately preceding atrial contraction was a spontaneous sinus or pacemaker stimulated atrial depolarization.

Claim 36

The method of Claim 28 wherein, positioning the first end of the lead to detect electrical activity in the atrium of the subject, comprises: implanting the first end of the lead in the right atrial appendage.

Claim 37

The method of Claim 29 wherein, the first end of the electrical lead implanted into the right atrial appendage has one electrode attached to the first end of the lead and the other electrode attached to the lead at a point from 20 mm to 40 mm back from the first end of the lead.

Claim 38

The method of claim 29. wherein the first end of the electrical lead implanted into the right atrial appendage has one electrode attached to the first end of the lead and the other electrode attached to the lead at a point sufficiently removed from the first end of the lead so that the other electrode is in the high right atrium.

Claim 39

The method of Claim 28, wherein positioning the first end of the lead to detect electrical activity in the atrium of the subject, comprises: implanting the first end of the lead in the low septal right atrium.

Claim 40

The method of Claim 32, wherein the first end of the electrical lead implanted into the low septal right atrium has one electrode attached to the first end of the lead and the other electrode attached to the lead at a point sufficiently removed from the first end of the lead so that the other electrode is in the high right atrium.

Claim 41

Method of using a cardiac pacemaker to synchronize sinus atrial depolarizations and ventricular depolarizations, comprising: obtaining an electrical lead having first and second ends that has at least two pairs of electrodes attached near the first end of the lead; positioning the first end of the lead to detect electrical activity in the atrium of the subject; using a sensing circuit connected to the second end of the lead to detect voltage differences between the electrodes of one pair of electrodes and between the electrodes of the other pair of electrodes; using a timing circuit connected to the sensing circuit to determine the temporal relationship of the time when a voltage difference is detected between the electrodes of one pair of electrodes and the time when a voltage difference is detected between the electrodes of the other pair of electrodes; using a logic circuit connected to the timing circuit to compare the temporal relationship determined in the previous step to the temporal relationship indicative of sinus atrial depolarizations; and using a ventricular stimulating circuit connected to the logic circuit to stimulate ventricular depolarizations only when the comparison made by the logic circuit indicates that the immediately preceding atrial contraction was a spontaneous sinus or pacemaker stimulated atrial depolarization.

Claim 42

Method of using a cardiac pacemaker to synchronize sinus atrial depolarizations and ventricular depolarizations, comprising: obtaining an electrical lead having first and second ends that has at least two pairs of electrodes attached near the first end of the lead; positioning the first end of the lead to detect electrical activity in the atrium of the subject; using a sensing circuit connected to the second end of the lead to detect voltage differences between the electrodes of one pair of electrodes and between the electrodes of the other pair of electrodes; using a timing circuit connected to the sensing circuit to determine the temporal relationship of the time when a voltage difference is detected between the electrodes of one pair of electrodes and the time when a voltage difference is detected between the electrodes of the other pair of electrodes; using a logic circuit connected to the timing circuit to compare the temporal relationship determined in the previous step to the temporal relationship indicative of sinus atrial depolarizations; and using a ventricular stimulating circuit connected to the logic circuit to stimulate ventricular depolarizations only when the comparison made by the logic circuit indicates that the immediately preceding atrial contraction was a spontaneous sinus or pacemaker stimulated atrial depolarization.

Claim 43

The method of Claim 34, wherein positioning the first end of the lead to detect electrical activity in the atrium of the subject, comprises: implanting the first end of the lead in the right atrial appendage.

Claim 44

The method of Claim 35, wherein the first end of the electric lead implanted into the right atrial appendage has one of the electrodes of one pair of electrodes attached to the first end of the lead and the other pair of electrodes is attached to the lead at a point from 20 mm to 40 mm back from the first end of the lead.

Claim 45

The method of Claim 34, wherein positioning the first end of the lead to detect electrical activity in the atrium of the subject, comprises: implanting the first end of the lead in the low septal right atrium.

Claim 46

The method of Claim 37, wherein the first end of the electrical lead implanted into the low septal right atrium has one of the electrodes of one pair of electrodes attached to the electric lead at the first end of the lead and the other pair of electrodes is attached to the lead at a point sufficiently removed from the first end of the lead so that the other pair of electrodes is in the high right atrium.