US6144880A
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Cardiac pacing using adjustable atrio-ventricular delays
Assignee: Cardiac Pacemakers Inc
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Filing: 1998-05-08
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Granted: 2000-11-07
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Expires: 2018-05-08
Abstract
Abstract A pacing system for providing optimal hemodynamic cardiac function for parameters such as contractility (peak left ventricle pressure change during systole or LV+dp/dt), or stroke volume (aortic pulse pressure) using system for calculating atrio-ventricular delays for optimal timing of a ventricular pacing pulse. The system providing an option for near optimal pacing of multiple hemodynamic parameters. The system deriving the proper timing using electrical or mechanical events having a predictable relationship with an optimal ventricular pacing timing signal.
Inventors
- 👤 Jiang Ding
- 👤 Yinghong Yu
- 👤 Andrew P. Kramer
- 👤 Julio Spinelli
Bibliographic Details
Application Number
—
Jurisdiction
US
Data Source
google_patents
Last Synchronized
2026-10-28 14:45
CPC Classifications
E; E21; E21B; E21B17/00; E21B17/01; 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: 56
Claim 1
Independent Claim
139 words
A method, comprising: measuring an interval during a nonpaced systolic cycle between a first event and a second event, the first event related to an atrial contraction which is in a first predictable time-dependent relationship and the second event which is in a second predictable time-dependent relationship to a ventricular pacing signal optimally timed for maximum peak positive LV pressure change during systole, (LV+dp/dt); generating an atrio-ventricular delay (AVD c ) calculated from a predetermined mapping of a relationship of the interval to an optimal atrio-ventricular delay for maximum peak positive LV pressure change during systole, (LV+dp/dt); and delivering a pacing pulse to a ventricle with the generated atrio-ventricular delay (AVD c ); wherein AVD c provides an approximation of the optimal atrio-ventricular delay for pacing the ventricle to provide maximum peak positive LV pressure change during systole, (LVA+dp/dt).
Claim 2
Independent Claim
139 words
A method, comprising: measuring an interval during a nonpaced systolic cycle between a first event and a second event, the first event related to an atrial contraction which is in a first predictable time-dependent relationship and the second event which is in a second predictable time-dependent relationship to a ventricular pacing signal optimally timed for maximum peak positive LV pressure change during systole, (LV+dp/dt); generating an atrio-ventricular delay (AVD c ) calculated from a predetermined mapping of a relationship of the interval to an optimal atrio-ventricular delay for maximum peak positive LV pressure change during systole, (LV+dp/dt); and delivering a pacing pulse to a ventricle with the generated atrio-ventricular delay (AVD c ); wherein AVD c provides an approximation of the optimal atrio-ventricular delay for pacing the ventricle to provide maximum peak positive LV pressure change during systole, (LVA+dp/dt).
Claim 3
Dependent Claim
34 words
The method according to claim 1, wherein the first event is a P-wave, the second event is a beginning of a QRS complex (Q*), and the interval is between the P-wave and Q* (PQ*).
Claim 4
Dependent Claim
35 words
The method according to claim 2, where the predetermined mapping is a linear equation, and wherein AVD c is calculated from the linear equation, using a constant K1 and a constant K2: AVD c =K1(PQ*)-K2.
Claim 5
Dependent Claim
17 words
The method according to claim 3, wherein K1 is approximately 0.94 and K2 is approximately 55.7 milliseconds.
Claim 6
Dependent Claim
17 words
The method according to claim 3, wherein K1 is approximately 1.0 and K2 is approximately 67 milliseconds.
Claim 7
Dependent Claim
31 words
The method according to claim 3, wherein PQ* is measured using a programmable pulse generator having an electrode in a right atrium and an electrode sensing signals from a left ventricle.
Claim 8
Dependent Claim
25 words
The method according to claim 6, comprising detecting the P-wave when the P-wave reaches 20 percent of a maximum P-wave amplitude in the right atrium.
Claim 9
Dependent Claim
15 words
The method according to claim 6, further comprising detecting Q* using a low pass filter.
Claim 10
Dependent Claim
27 words
The method according to claim 8, comprising detecting Q* when a slope of a Q-wave reaches 2 percent of a maximum absolute value of the Q-wave slope.
Claim 11
Dependent Claim
13 words
The method according to claim 3, wherein PQ* is measured using surface EKG.
Claim 12
Dependent Claim
30 words
The method according to claim 1, wherein the first event is a P-wave, the second event is an R-wave (R), and the interval is between the P-wave and R (PR).
Claim 13
Dependent Claim
35 words
The method according to claim 11, where the predetermined mapping is a linear equation, and wherein AVD c is calculated from the linear equation, using a constant N1 and a constant N2: AVD c =N1(PR)-N2.
Claim 14
Dependent Claim
18 words
The method according to claim 12, wherein N 1 is approximately 0.82 and N2 is approximately 112 milliseconds.
Claim 15
Dependent Claim
18 words
The method according to claim 12, wherein N 1 is approximately 1.0 and N2 is approximately 159 milliseconds.
Claim 16
Dependent Claim
31 words
The method according to claim 11, wherein PR is measured using a programmable pulse generator having an electrode in a right atrium and an electrode sensing signals from a left ventricle.
Claim 17
Dependent Claim
25 words
The method according to claim 15, comprising detecting the P-wave when the P-wave reaches 20 percent of a maximum P-wave amplitude in the right atrium.
Claim 18
Dependent Claim
15 words
The method according to claim 15, comprising detecting R at a peak of the R-wave.
Claim 19
Dependent Claim
41 words
The method according to claim 1, wherein the first event is a P-wave, the second event is a signal (Y) from a micromanometer signaling an onset of ventricular pressure during systole, and the interval is between the P-wave and Y (PY).
Claim 20
Dependent Claim
35 words
The method according to claim 18, where the predetermined mapping is a linear equation, and wherein AVD c is calculated from the linear equation, using a constant M1 and a constant M2: AVD c =M1(PY)-M2.
Claim 21
Dependent Claim
17 words
The method according to claim 19, wherein M1 is approximately 0.96 and M2 is approximately 139 milliseconds.
Claim 22
Dependent Claim
17 words
The method according to claim 19, wherein M1 is approximately 1.0 and M2 is approximately 150 milliseconds.
Claim 23
Dependent Claim
29 words
The method according to claim 18, wherein PY is measured using a programmable pulse generator having an electrode in a right atrium and the micromanometer in a left ventricle.
Claim 24
Dependent Claim
25 words
The method according to claim 22, comprising detecting the P-wave when the P-wave reaches 20 percent of a maximum P-wave amplitude in the right atrium.
Claim 25
Dependent Claim
32 words
The method according to claim 1, wherein the first event is a P-wave, the second event is a signal (Y) from a cardiac phonogram signaling an onset of ventricular pressure during systole.
Claim 26
Dependent Claim
31 words
The method according to claim 1, wherein the first event is a P-wave, the second event is a signal (Y) from an accelerometer signalling an onset of ventricular pressure during systole.
Claim 27
Dependent Claim
32 words
The method according to claim 1, wherein the first event is a P-wave, the second event is a signal (Y) from a Doppler recording signalling an onset of ventricular pressure during systole.
Claim 28
Dependent Claim
32 words
The method according to claim 1, wherein the first event is a P-wave, the second event is a signal (Y) from a echo imager signalling an onset of ventricular pressure during systole.
Claim 29
Independent Claim
142 words
An apparatus, comprising: a programmable pulse generator transmitting ventricular pacing pulses with an atrio-ventricular delay (AVD c ) calculated from an interval measured during a nonpaced systolic cycle by the programmable pulse generator between a first event and a second event, the first event related to an atrial contraction which is in a first predictable time-dependent relationship and the second event which is in a second predictable time-dependent relationship to a ventricular pacing signal optimally timed for maximum peak positive LV pressure change during systole, (LV+dp/dt) wherein the AVD c is calculated by the programmable pulse generator from a predetermined mapping of a relationship of the interval to an optimal atrio-ventricular delay for maximum peak positive LV pressure change during systole, (LV+dp/dt) and wherein AVD c provides an approximation of the optimal atrio-ventricular delay for pacing the ventricle to provide maximum LV+dp/dt.
Claim 30
Independent Claim
142 words
An apparatus, comprising: a programmable pulse generator transmitting ventricular pacing pulses with an atrio-ventricular delay (AVD c ) calculated from an interval measured during a nonpaced systolic cycle by the programmable pulse generator between a first event and a second event, the first event related to an atrial contraction which is in a first predictable time-dependent relationship and the second event which is in a second predictable time-dependent relationship to a ventricular pacing signal optimally timed for maximum peak positive LV pressure change during systole, (LV+dp/dt) wherein the AVD c is calculated by the programmable pulse generator from a predetermined mapping of a relationship of the interval to an optimal atrio-ventricular delay for maximum peak positive LV pressure change during systole, (LV+dp/dt) and wherein AVD c provides an approximation of the optimal atrio-ventricular delay for pacing the ventricle to provide maximum LV+dp/dt.
Claim 31
Dependent Claim
34 words
The apparatus according to claim 28, wherein the first event is a P-wave, the second event is a beginning of a QRS complex (Q*), and the interval is between the P-wave and Q* (PQ*).
Claim 32
Dependent Claim
35 words
The apparatus according to claim 29, where the predetermined mapping is a linear equation, and wherein AVD c is calculated from the linear equation, using a constant K1 and a constant K2: AVD c =K1(PQ*)-K2.
Claim 33
Dependent Claim
17 words
The apparatus according to claim 30, wherein K1 is approximately 0.94 and K2 is approximately 55.7 milliseconds.
Claim 34
Dependent Claim
17 words
The apparatus according to claim 30, wherein K1 is approximately 1.0 and K2 is approximately 67 milliseconds.
Claim 35
Dependent Claim
48 words
The apparatus according to claim 30, wherein PQ* is measured using the programmable pulse generator, wherein the pulse generator further comprises a first electrode adapted for a right atrium and a second electrode adapted for a left ventricle, wherein PQ* is measured using said first and second electrodes.
Claim 36
Dependent Claim
26 words
The apparatus according to claim 33, wherein the P-wave is identified when the P-wave reaches 20 percent of a maximum P-wave amplitude in the right atrium.
Claim 37
Dependent Claim
19 words
The apparatus according to claim 33, comprising a low pass filter coupled to the second electrode for detecting Q*.
Claim 38
Dependent Claim
28 words
The apparatus according to claim 35, wherein Q* is detected when a slope of a Q-wave reaches 2 percent of a maximum absolute value of the Q-wave slope.
Claim 39
Dependent Claim
20 words
The apparatus according to claim 30, wherein PQ* used to create the predetermined mapping is measured using a surface EKG.
Claim 40
Dependent Claim
33 words
The apparatus according to claim 28, wherein the first event is a P-wave, the second event is a peak of an R-wave (R), and the interval is between the P-wave and R (PR).
Claim 41
Dependent Claim
35 words
The apparatus according to claim 38, where the predetermined mapping is a linear equation, and wherein AVD c is calculated from the linear equation, using a constant N1 and a constant N2: AVD c =N1(PR)-N2.
Claim 42
Dependent Claim
17 words
The apparatus according to claim 39, wherein N1 is approximately 0.82 and N2 is approximately 112 milliseconds.
Claim 43
Dependent Claim
17 words
The apparatus according to claim 39, wherein N1 is approximately 1.0 and N2 is approximately 159 milliseconds.
Claim 44
Dependent Claim
48 words
The apparatus according to claim 39, wherein PR is measured using the programmable pulse generator, wherein the pulse generator further comprises a first electrode adapted for a right atrium and a second electrode adapted for a left ventricle, wherein PR is measured using said first and second electrodes.
Claim 45
Dependent Claim
26 words
The apparatus according to claim 42, wherein the P-wave is identified when the P-wave reaches 20 percent of a maximum P-wave amplitude in the right atrium.
Claim 46
Dependent Claim
16 words
The apparatus according to claim 42, wherein R is identified at a peak of the R-wave.
Claim 47
Dependent Claim
50 words
The apparatus according to claim 28, including a micromanometer adapted to produce a signal (Y), wherein the first event is a P-wave, the second event is the signal (Y) from the micromanometer signaling an onset of ventricular pressure during systole, and the interval is between the P-wave and Y (PY).
Claim 48
Dependent Claim
35 words
The apparatus according to claim 45, where the predetermined mapping is a linear equation, and wherein AVD c is calculated from the linear equation, using a constant M1 and a constant M2: AVD c =M1(PY)-M2.
Claim 49
Dependent Claim
17 words
The apparatus according to claim 46, wherein M1 is approximately 0.96 and M2 is approximately 139 milliseconds.
Claim 50
Dependent Claim
17 words
The apparatus according to claim 46, wherein M1 is approximately 1.0 and M2 is approximately 150 milliseconds.
Claim 51
Dependent Claim
46 words
The apparatus according to claim 45, wherein PY is measured using the programmable pulse generator, wherein the pulse generator further comprises an electrode adapted for a right atrium and the micromanometer adapted for a left ventricle, wherein PY is measured using the electrode and the micromanometer.
Claim 52
Dependent Claim
25 words
The apparatus according to claim 49, wherein the P-wave is identified when P-wave reaches 20 percent of a maximum P-wave amplitude in the right atrium.
Claim 53
Dependent Claim
42 words
The apparatus according to claim 28, including a cardiac phonogram adapted to produce a signal (Y), wherein the first event is a P-wave, the second event is the signal (Y) from the cardiac phonogram signalling an onset of ventricular pressure during systole.
Claim 54
Dependent Claim
40 words
The apparatus according to claim 28, including an accelerometer adapted to produce a signal (Y), wherein the first event is a P-wave, the second event is the signal (Y) from the accelerometer signalling an onset of ventricular pressure during systole.
Claim 55
Dependent Claim
42 words
The apparatus according to claim 28, including a Doppler recording adapted to produce a signal (Y), wherein the first event is a P-wave, the second event is the signal (Y) from the Doppler recording signalling an onset of ventricular pressure during systole.
Claim 56
Dependent Claim
42 words
The apparatus according to claim 28, including a echo imager adapted to produce a signal (Y), wherein the first event is a P-wave, the second event is the signal (Y) from the echo imager signalling an onset of ventricular pressure during systole.
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USPTO Annuity & Maintenance Windows
| Annuity Stage | Window Opens | Payment Deadline | Surcharge Period Until | Estimated Fee | Status |
|---|---|---|---|---|---|
| 3.5 Years (Year 4) | 2003-11-07 | 2004-05-08 | 2004-11-07 | $2000.00 | Window Closed / Lapsed |
| 7.5 Years (Year 8) | 2007-11-07 | 2008-05-08 | 2008-11-07 | $3760.00 | Window Closed / Lapsed |
| 11.5 Years (Year 12) | 2011-11-07 | 2012-05-08 | 2012-11-07 | $7700.00 | Window Closed / Lapsed |