Patent
Methods for operating a dual-chamber pacemaker to avoid triggering atrial fibrillation and perpetuation of repetitive ventriculo-atrial synchrony
| العنوان: | Methods for operating a dual-chamber pacemaker to avoid triggering atrial fibrillation and perpetuation of repetitive ventriculo-atrial synchrony |
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| Patent Number: | 11925,807 |
| تاريخ النشر: | March 12, 2024 |
| Appl. No: | 17/477396 |
| Application Filed: | September 16, 2021 |
| مستخلص: | Pacemaker-initiated atrial fibrillation during competitive atrial pacing is a common arrhythmia with potentially serious consequences The novel pacing method proposes a novel way to automatically detect and diagnose competitive atrial pacing, and to deliver an intervention via a pacing stimulus in the atrium simultaneously with delivering a pacing stimulus in the ventricle, and doing this after a longer waiting period. By doing this, potentially hazardous scenarios causing atrial fibrillation in competitive atrial pacing are avoided, while the rhythm regularity and the synchrony between the upper and lower chambers of the heart are maintained. At the same time, the vicious cycle of retrograde conduction from the ventricle to the atrium—the culprit of the problem—is terminated and not allowed to reoccur for several subsequent cardiac cycles, thereby preventing the extended propagation of repetitive non-reentrant ventriculo-atrial synchrony. |
| Inventors: | Orlov, Michael V (Brookline, MA, US) |
| Claim: | 1. A method for operating a dual chamber pacemaker configured for atrial and ventricular pacing, the method comprising the following steps: a. monitoring for: i. an onset of retrogradely conducted atrial electrical excitation recorded in post-ventricular atrial refractory period (PVARP), or ii. an increase in duration of time between retrograde atrial sense (AS) and atrial pace (AP) events over at least four successive cardiac cycles; or iii. a duration of time between retrograde atrial sense (AS) and atrial pace (AP) events is at or less than 30 percent of the present cardiac cycle duration; b. upon detection of either one of said events in step (a), extending an onset of atrial pacing stimulus by a predetermined interval, whereby avoiding atrial pacing during an atrial vulnerable period, c. regardless of the VA interval, initiating for the same cardiac cycle as in step (b) an onset of ventricular pacing stimulus to coincide with the onset of atrial pacing stimulus, whereby eliminating atrio-ventricular delay and blocking both atrio-ventricular and ventriculo-atrial electrical conduction allowing prevention of further occurrence of repetitive non-reentrant ventriculo-atrial synchrony (RNRVAS), and d. increasing the atrio-ventricular delay during at least 3 of the subsequent cardiac cycles after steps (b) and (c) from zero until reaching a physiologically acceptable value, while allowing for a change in heart rate, whereby interrupting onset or continuation of said retrogradely conducted atrial electrical excitation recorded in the PVARP as a cause of competitive atrial pacing and preventing an onset of atrial tachycardia or atrial fibrillation as a consequence thereof. |
| Claim: | 2. The method as in claim 1 , wherein steps (b) and (c) are repeated for a subsequent cardiac cycle prior to proceeding to step (d). |
| Claim: | 3. The method as in claim 1 , wherein steps (b) and (c) are repeated for two subsequent cardiac cycles prior to proceeding to step (d). |
| Claim: | 4. The method as in claim 1 , wherein step (d) is extended over at least 4 of the cardiac cycles subsequent to completion of step (c). |
| Claim: | 5. The method as in claim 1 , wherein step (d) is extended over at least 5 of the cardiac cycles subsequent to completion of step (c). |
| Claim: | 6. The method as in claim 1 , wherein step (d) is extended over at least 6 of the cardiac cycles subsequent to completion of step (c). |
| Claim: | 7. The method as in step (b) further comprising a step of temporary increasing the output of atrial stimulation above the output of the previous cardiac cycle. |
| Claim: | 8. The method as in claim 7 , wherein this temporary increase is removed once the normal rhythm is restored. |
| Claim: | 9. The method as in claim 7 , wherein the temporary increase in atrial stimulation output is at least 50% higher than in the prior cardiac cycle. |
| Claim: | 10. The method as in claim 1 , wherein in step (a) the duration of time between retrograde atrial sense (AS) and atrial pace (AP) events is at or less than 25 percent of the present cardiac cycle duration. |
| Claim: | 11. The method as in claim 1 , wherein in step (a) the duration of time between retrograde atrial sense (AS) and atrial pace (AP) events is at or less than 20 percent of the present cardiac cycle duration. |
| Claim: | 12. The method as in claim 1 , wherein in step (a) the duration of time between retrograde atrial sense (AS) and atrial pace (AP) events is at or less than 15 percent of the present cardiac cycle duration. |
| Patent References Cited: | 6498949 December 2002 Levine WO-2006065707 June 2006 |
| Other References: | Sharma PS et al. Repetitive nonreentran tventriculoatrial synchrony: An underrecognized cause of pacemaker-related arrhythmia. Heart Rhythm 2016;0;1-9. cited by applicant Alasti M et al. Pacemaker-mediated arrhythmias. J Arrhythmia 2018;1-8. cited by applicant Barold SS et al. Case report: complex arrhythmia induced by noncompetitive atrial pacing algorithm of DDDR pacemaker. J Interv Card Electrophysiol Dec. 2001;5(4):431-4. Abstract. cited by applicant Orlov MV et al. Is competitive atrial pacing a possible trigger for atrial fibrillation? Observations from the RATE registry. Heart Rhythm 2020, 1-7. cited by applicant |
| Primary Examiner: | Gedeon, Brian T |
| Attorney, Agent or Firm: | Leschinsky, Boris |
| رقم الانضمام: | edspgr.11925807 |
| قاعدة البيانات: | USPTO Patent Grants |
| الوصف غير متاح. |