Pacemaker with improved hysteresis

Abstract

An implantable pacemaker system is provided with a conditional hysteresis feature, whereby a hysteresis value is added to the pacing escape interval only when the prior spontaneous rate corresponded to a rate below the top of a predetermined hysteresis band. This feature limits the lengthening of the escape interval when there are sudden drops in the natural rate thereby avoiding excessive changes in rate. In a preferred embodiment, the pacemaker defines a hysteresis band around a given pacing rate, e.g., lower rate limit, the band having an upper hysteresis limit and a lower hysteresis limit. No hysteresis lengthening of the escape interval is utilized for spontaneous heartbeats having rates above the upper hysteresis limit; for spontaneous heartbeats having rates between the lower rate limit and the upper hysteresis limit, an escape interval is set to have a value corresponding to a rate between the pacing limit and the lower rate limit of the hysteresis band which is, e.g., 0-30 bpm below the lower rate limit; and for a sensed spontaneous rate below the lower rate limit, a hysteresis escape interval corresponding to the lower hysteresis limit is established. In the preferred embodiment, sensed heartbeats having a prior rate between the lower rate limit and the upper hysteresis limit cause an escape interval which is lengthened beyond the LRL escape interval by an amount which varies linearly with the differential between the upper hysteresis rate limit and the spontaneous rate.