Dual-chamber implantable pacemaker having an adaptive av interval that

Abstract

A dual-chamber implantable pacemaker automatically adjusts its AV interval so that any ventricular stimulation pulses generated by the pacemaker at the conclusion of the pacemaker-defined AV interval occur at a time in the cardiac cycle that avoids fusion with the natural ventricular depolarization of a patient's heart. The AV interval is set using a search sequence that sets the AV interval value to be on one side or the other of the natural conduction time of the heart, and incrementally changes the AV interval value until it crosses over the natural conduction time interval. The cross-over point is manifest by the occurrence of an R-wave, where an R-wave had previously been absent, or the absence of an R-wave, where an R-wave had previously been present. A final AV interval value is then set as the AV interval value at the cross-over point, adjusted by appending an AV margin thereto. The search sequence is automatically invoked whenever a prescribed search time has elapsed, or whenever the sudden presence or absence of a sensed R-wave indicates a sufficient change in the natural conduction time so as to have crossed over with the existing AV interval. If the search sequence is invoked too frequently, it is automatically suspended for a prescribed suspension period.