Medtronic, Inc.

The Brigham and Women's Hospital, Inc.

Michael O Sweeney

Todd Jon Sheldon

Robert A Betzold

Paul A Belk

Douglas A Hettrick

Scott R Stanslaski

David Arthur Casavant

Thomas J Mullen

John Charles Stroebel

A system and method for cardiac resynchronization therapy ('CRT') in which a model of baseline cardiac electrical activity, such as a model of global baseline cardiac electrical activity derived from various surface electrocardiograph ('ECG') signals, is utilized to automatically adjust pacing control parameters of a cardiac implantable electrical device (&#x201c;CIED&#x201d;) are provided. The baseline model is compared to CRT response patterns using modified pacing control parameters in an iterative fashion, based on a patient-specific response pattern phenotype determination, until ventricular electrical asynchrony is minimized. The pacing control parameters resulting in the minimum ventricular electrical asynchrony are used to generate final control parameters for CRT.

System and method for automated adjustment of cardiac resynchronization therapy control parameters

A system and method for cardiac resynchronization therapy in which pacing control parameters are automatically adjusted by comparison of local electrograms acquired by a cardiac implantable electrical device with a model of cardiac electrical activity derived from surface-lead electrocardiograph measurements under baseline and paced conditions is provided. The adjusted pacing control parameters guarantee substantially maximum evidence of ventricular activation wavefront fusion while reducing the risk of compromising diastolic function. Atrioventricular intervals (AVIs] are measured and utilized to constrain the adjustment of pacing control parameters such that diastolic dysfunctions are not induced in the patient's heart.

A system and method for cardiac resynchronization therapy ('CRT'] in which a model of baseline cardiac electrical activity, such as a model of global baseline cardiac electrical activity derived from various surface electrocardiograph ('ECG') signals, is utilized to automatically adjust pacing control parameters of a cardiac implantable electrical device (&#x201c;CIED&#x201d;) are provided. The baseline model is modified with simulated pacing control parameters in an iterative fashion until ventricular electrical asynchrony is minimized. The simulated pacing control parameters resulting in the minimum ventricular electrical asynchrony are used to generate an updated model of ventricular activation, and this updated model is used to generate control parameters for the CIED using a QRS glyph morphological framework.

System and method for cardiac resynchronization therapy control parameter generation using ventricular activation simulation and surface ECG registration

An implantable medical device operates according to a ventricular pacing protocol (VPP) that precludes ventricular pacing in any cardiac cycle where a sensed ventricular event has occurred in the preceding cycle. The implantable medical device facilitates improved ventricular sensing, detection and classification.

System and method for providing improved atrial pacing based on physiological need

A medical device having a plurality of electrodes sensing cardiac signals, and a microprocessor operably coupled to the plurality of electrodes and configured to determine a cumulative atrioventricular interval (AVI) burden in response to the sensed cardiac signals, and to switch operation of the device between a minimal biventricular pacing (MBVP) mode and a conditional triple chamber pacing (CTCP) mode in response to the determined AVI burden.

System and method for conditional biventricular pacing

An implantable pacing system with single, double and triple chamber pacing capabilities, provided individually or in concert on a conditional or continuous basis depending upon ongoing analyses of atrial rhythm status, atrioventricular conduction status and ventricular rate. A mode is selected to reduce the occurrence of any ventricular pacing in favor of intrinsic atrioventricular and ventricular conduction. If excessively long PR intervals are occurring too frequently or atrioventricular conduction is unreliable or absent, the implantable pulse generator is operated in a conditional triple chamber pacing mode that provides atrial-synchronous biventricular pacing in every cardiac cycle for a period of time as necessary to restore and maintain AV synchrony, while minimizing ventricular asynchrony otherwise associated with monochamber RV pacing as in conventional dual chamber pacing systems. Similarly, biventricular pacing is provided in every cardiac cycle when ventricular rates are undesirably slow during atrial fibrillation, where AV synchronization is excluded.

An atrial based pacing protocol promotes intrinsic conduction. An entire cardiac cycle is monitored for ventricular activity and permitted to lapse with ventricular activity. Ventricular pacing is available in a cardiac cycle immediately subsequent to such a skipped beat. When monitoring for intrinsic ventricular events, an event is expected within a given window. If no such event is detected, the cardiac cycle is truncated, leading to a shorter cycle that is devoid of ventricular activity. The subsequent cycle has a high likelihood of a ventricular sensed event and a greater than normal AV interval is provided prior to pacing.

System and method for determining intrinsic AV interval timing

An implantable medical device includes cardiac pacing functions. In order to reduce ventricular pacing, various modes are employed that tolerate missed ventricular beats, provide backup pacing and maintain overall AV synchrony. Upon the occurrence of a PVC, A-A timing is modified so that resultant V-V intervals are appropriate and ventricular pacing is avoided.

System and method for ventricular interval smoothing following a premature ventricular contraction

An implantable medical device operates according to a ventricular pacing protocol (VPP) that precludes ventricular pacing in any cardiac cycle where a sensed ventricular event has occurred in the preceding cycle. Improved ventricular sensing, detection and classification is provided.

System and method for determining phsyiologic events during pacing mode operation

An atrial based pacing protocol promotes intrinsic conduction. An entire cardiac cycle is monitored for ventricular activity and permitted to lapse with ventricular activity. Ventricular pacing is available in a cardiac cycle immediately subsequent to such a skipped beat. When monitoring for intrinsic ventricular events, an event is expected within a given window. If no such event is detected, the cardiac cycle in truncated, leading to a shorter cycle that is devoid of ventricular activity. The subsequent cycle has a high likelihood of a ventricular sensed event and a greater than normal AV interval is provided prior to pacing.

System and method for promoting intrinsic conduction through atrial timing modification and calculation of timing parameters

A pacing protocol is provided that reduces or minimizes ventricular pacing in favor of intrinsic conduction. When operating in a mode that provides ventricular pacing, a series of conduction checks are performed to determine if intrinsic conduction has returned. These conduction checks occur according to a predetermined pattern that generally includes longer intervals between subsequent attempts. The AV interval provided for dual chamber based pacing is modulated and generally moves from a larger value to a nominal value as the interval between unsuccessful conduction checks increases.

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Chestnut Hill, MA, United States of America

Michael O Sweeney