US5534016A
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US
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Dual chamber pacing system and method utilizing detection of ventricular fusion for adjustment of the atrial-ventricular delay as therapy for hypertrophic obstructive cardiomyopathy
Assignee: Vitatron Medical BV
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Filing: 1995-02-21
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Granted: 1996-07-09
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Expires: 2015-02-21
Abstract
Abstract A dual chamber pacemaker for providing ventricular pace pulses synchronized with atrial senses or paces, and having specific control for optimizing the AV escape interval and resultant AV delay for purposes of therapy for a patient with hypertrophic obstructive cardiomyopathy (HOCM). The pacemaker has an algorithm for varying the AV escape interval and detecting when the AV delay is lengthened to the point of evoking a fusion beat, thereby providing an accurate indication of a patient's underlying PR interval without significant loss of pacing capture. By monitoring T-wave detection and drop in amplitude of the evoked T-wave, an algorithm is enabled for optimizing the pacemaker AV delay within a range of values just less than the longest value for obtaining pre-excitation by the delivered pace pulse.
Inventors
- 👤 Willem Boute
Bibliographic Details
Application Number
—
Jurisdiction
US
Data Source
google_patents
Last Synchronized
2026-11-09 22:54
CPC Classifications
A; A61; A61N; A61N1/00; A61N1/18; A61N1/32; A61N1/36; A61N1/362; A61N1/3627; A61N1/365; A61N1/368; A61N1/3682
Claims Analysis
Total Claims: 22
Claim 1
Independent Claim
165 words
A dual chamber pacemaker system, having atrial sense means for sensing atrial signals from a patient, ventricular sense means for sensing ventricular signals from a patient, ventricular pace means for generating and delivering ventricular pace pulses to said patient's right ventricle, and sync control means for controlling said pace means to generate and deliver a ventricular pace pulse at a controlled AV escape interval following a sensed atrial signal, said sync control means having AV esc means for setting said AV escape interval, said AV esc means comprising: fusion means for detecting the occurrence of a fusion beat and the value AV fus of the AV escape interval corresponding to which a said fusion beat is detected, and program means for changing said AV escape interval so as to maintain said AV esc within a small range of values no greater than said value of AV fus , whereby pace pulses are delivered at an AV escape interval no greater than said AV fus .
Claim 2
Dependent Claim
165 words
A dual chamber pacemaker system, having atrial sense means for sensing atrial signals from a patient, ventricular sense means for sensing ventricular signals from a patient, ventricular pace means for generating and delivering ventricular pace pulses to said patient's right ventricle, and sync control means for controlling said pace means to generate and deliver a ventricular pace pulse at a controlled AV escape interval following a sensed atrial signal, said sync control means having AV esc means for setting said AV escape interval, said AV esc means comprising: fusion means for detecting the occurrence of a fusion beat and the value AV fus of the AV escape interval corresponding to which a said fusion beat is detected, and program means for changing said AV escape interval so as to maintain said AV esc within a small range of values no greater than said value of AV fus , whereby pace pulses are delivered at an AV escape interval no greater than said AV fus .
Claim 3
Dependent Claim
32 words
The pacemaker system as described in claim 1, wherein said program means has decrement means for decrementing said AV escape interval for the next ventricular pace pulse following a detected fusion beat.
Claim 4
Dependent Claim
30 words
The pacemaker system as described in claim 2, wherein said program means has means for increasing said AV escape interval by constant increments following a said next ventricular pace pulse.
Claim 5
Dependent Claim
53 words
The pacemaker system as described in claim 1, wherein said program means changes said AV escape interval so as to permit detection of a fusion beat without extending the AV escape interval to a value greater than AV fus , thereby avoiding a ventricular sense before timeout of a said AV escape interval.
Claim 6
Dependent Claim
144 words
A dual chamber pacemaker system, having atrial sense means for sensing atrial signals from a patient, ventricular sense means for sensing ventricular signals from a patient, ventricular pace means for generating and delivering ventricular pace pulses to said patient's right ventricle, and sync control means for controlling said pace means to generate and deliver a ventricular pace pulse at a controlled AV escape interval following a sensed atrial signal, said sync control means having AV esc means for setting said AV escape interval, said AV esc means comprising fusion means for detecting the occurrence of a fusion beat and the value AV fus of the AV escape interval corresponding to which a said fusion beat is detected, storing means for storing said value of AV fus and program means for changing said AV escape interval as a function of said stored AV fus value.
Claim 7
Dependent Claim
144 words
A dual chamber pacemaker system, having atrial sense means for sensing atrial signals from a patient, ventricular sense means for sensing ventricular signals from a patient, ventricular pace means for generating and delivering ventricular pace pulses to said patient's right ventricle, and sync control means for controlling said pace means to generate and deliver a ventricular pace pulse at a controlled AV escape interval following a sensed atrial signal, said sync control means having AV esc means for setting said AV escape interval, said AV esc means comprising fusion means for detecting the occurrence of a fusion beat and the value AV fus of the AV escape interval corresponding to which a said fusion beat is detected, storing means for storing said value of AV fus and program means for changing said AV escape interval as a function of said stored AV fus value.
Claim 8
Dependent Claim
44 words
The pacemaker system as described in claim 5 wherein said fusion means comprises detection means for detecting T-waves following delivery of ventricular pace pulses, and first determining means for determining a fusion beat when no T-wave is detected following a delivered ventricular pace pulse.
Claim 9
Dependent Claim
56 words
The pacemaker system as described in claim 5, wherein said fusion means comprises T-wave detection means for detecting a T-wave in response to a delivered ventricular pace pulse, amplitude means for determining the amplitude of a said detected T-wave, and second determining means for determining a fusion beat as a function of said detected T-wave amplitude.
Claim 10
Dependent Claim
52 words
The pacemaker system as described in claim 5, wherein said fusion means comprises T-wave sensing means for sensing T-waves following delivery of ventricular pace pulses, first means for determining the frequency of detected fusion beats, and wherein said program means adjusts said AV escape interval as a function of said determined frequency.
Claim 11
Dependent Claim
133 words
A dual chamber pacemaker having atrial sense means for sensing signals in a patient's atrium, ventricular sense means for sensing signals in said patient's ventricle, ventricular pace means for generating and delivering ventricular pace pulses to the patient's ventricle, and AV control means for controlling said pace means to generate and deliver a ventricular pace pulse at a controlled AV escape interval following a sensed atrial signal, comprising: monitoring means for monitoring at least one of said signals sensed in said patient's atrium and said patient's ventricle and detecting therefrom when a delivered pace pulse causes a fusion beat; fusion means for determining the AV escape interval AV fus corresponding to a detected fusion beat; and adjusting means for adjusting said AV escape interval to a value less than said AV fus .
Claim 12
Dependent Claim
133 words
A dual chamber pacemaker having atrial sense means for sensing signals in a patient's atrium, ventricular sense means for sensing signals in said patient's ventricle, ventricular pace means for generating and delivering ventricular pace pulses to the patient's ventricle, and AV control means for controlling said pace means to generate and deliver a ventricular pace pulse at a controlled AV escape interval following a sensed atrial signal, comprising: monitoring means for monitoring at least one of said signals sensed in said patient's atrium and said patient's ventricle and detecting therefrom when a delivered pace pulse causes a fusion beat; fusion means for determining the AV escape interval AV fus corresponding to a detected fusion beat; and adjusting means for adjusting said AV escape interval to a value less than said AV fus .
Claim 13
Dependent Claim
33 words
The dual chamber pacemaker a described in claim 9, wherein said monitoring means comprises means for monitoring T-wave amplitude, and evaluation means for evaluating when said T-wave amplitude indicates the occurrence of fusion.
Claim 14
Dependent Claim
33 words
The dual chamber pacemaker a described in claim 9, wherein said monitoring means comprises means for monitoring T-wave morphology, and evaluation means for evaluating when said T-wave morphology indicates the occurrence of fusion.
Claim 15
Dependent Claim
39 words
The dual chamber pacemaker as described in claim 9, wherein said adjusting means comprises means for determining the number of paced ventricular beats between fusion beats, and for adjusting said AV escape interval as a function of said number.
Claim 16
Dependent Claim
36 words
The dual chamber pacemaker as described in claim 9, wherein said adjusting means comprises program means for varying said AV escape interval within a range below AV fus and as a function of AV fus .
Claim 17
Dependent Claim
55 words
The dual chamber pacemaker as described in claim 9, wherein said adjusting means has means for decrementing said AV escape interval for at least the next pacemaker cycle following detecting that a delivered pace pulse has caused a fusion beat, and means for adjusting said decrement as a function of the determined AV fus .
Claim 18
Independent Claim
175 words
A method of therapy for treating a patient with HOCM, said method utilizing a dual chamber pacemaker having atrial sense means for sensing atrial signals form a patient, ventricular sense means for sensing ventricular signals from a patient, ventricular pace means for generating and delivering ventricular pace pulses to said patient's right ventricle, and sync control means for controlling said pace means to generate and deliver a ventricular pace pulse at a controlled AV escape interval following a sensed atrial signal, said sync control means having AV esc means for setting said AV escape interval, said method comprising: pacing said patient's right ventricle with an AV escape interval shorter than the patient's intrinsic PR conduction duration so as to provide complete capture with delivered pace pulses, detecting the occurrence of fusion beats by monitoring evoked T-waves and determining when the T-wave amplitude drops to a level indicative of a fusion, and following a said detected fusion beat adjusting said AV escape interval to a value less than the value which resulted in a fusion beat.
Claim 19
Independent Claim
175 words
A method of therapy for treating a patient with HOCM, said method utilizing a dual chamber pacemaker having atrial sense means for sensing atrial signals form a patient, ventricular sense means for sensing ventricular signals from a patient, ventricular pace means for generating and delivering ventricular pace pulses to said patient's right ventricle, and sync control means for controlling said pace means to generate and deliver a ventricular pace pulse at a controlled AV escape interval following a sensed atrial signal, said sync control means having AV esc means for setting said AV escape interval, said method comprising: pacing said patient's right ventricle with an AV escape interval shorter than the patient's intrinsic PR conduction duration so as to provide complete capture with delivered pace pulses, detecting the occurrence of fusion beats by monitoring evoked T-waves and determining when the T-wave amplitude drops to a level indicative of a fusion, and following a said detected fusion beat adjusting said AV escape interval to a value less than the value which resulted in a fusion beat.
Claim 20
Dependent Claim
29 words
The method in accordance with claim 15, comprising determining the frequency of evoked fusion beats, and thereafter adjusting said AV escape interval as a function of said detected frequency.
Claim 21
Dependent Claim
26 words
The method as described in claim 15, comprising detecting a fusion beat by sensing patient T-waves and monitoring at least one characteristic of said sensed T-waves.
Claim 22
Dependent Claim
34 words
The method as described in claim 15, comprising incrementing said AV escape interval during succeeding pacing cycles so that said AV escape interval is increased toward the value where the last fusion beat occurred.
References Cited (Backward Citations)
USPTO Annuity & Maintenance Windows
| Annuity Stage | Window Opens | Payment Deadline | Surcharge Period Until | Estimated Fee | Status |
|---|---|---|---|---|---|
| 3.5 Years (Year 4) | 1999-07-09 | 2000-01-08 | 2000-07-09 | $2000.00 | Window Closed / Lapsed |
| 7.5 Years (Year 8) | 2003-07-09 | 2004-01-08 | 2004-07-09 | $3760.00 | Window Closed / Lapsed |
| 11.5 Years (Year 12) | 2007-07-09 | 2008-01-08 | 2008-07-09 | $7700.00 | Window Closed / Lapsed |