42 results about "Ventricular stimulation" patented technology

A cardiac stimulation system and method delivers a left ventricle stimulator from a right ventricle lead system in the right ventricle chamber, into a right side of an interventricular septum at a first location, and transmuscularly from the first location to a second location along the left side of the septum. The left ventricle stimulator is affixed at the second location for transmuscular stimulation of the left ventricle conduction system. A biventricular stimulation system further includes a right ventricle stimulator also delivered by the right ventricle lead system to the first location along the right side of the septum for right ventricular stimulation. An energy source is coupled to the transmuscular stimulation system, i.e., a pacemaker, and / or defibrillator, or to enhance contractility, and may be coupled directly or via “leadless” system(s). Various highly beneficial particular arrangements of stimulators and leads are further described.

A heart stimulator has an atrial and ventricular pulse generator for producing atrial and ventricular stimulation pulses, an atrial sensor for sensing atrial signals and an evoked response detector for detecting the occurrence of incipient fusion beats from measured ventricular signals. A determination unit determines an incipient fusion AV-interval from the sensed atrial signals and the detected fusion beats, and a controller controls the pulse generator to deliver stimulation pulses at a controlled AV-interval which is shorter than the incipient fusion AV-interval. The evoked response detector includes an averaging unit which forms an average amplitude value of the measured ventricular signals during a predetermined time window of each cardiac cycle, and a comparator which compares the average value for each cardiac cycle with a predetermined limit criterion, and supplies the result of the comparison to the determination unit for determining a measured ventricular signal resulted from an incipient fusion beat or a completely stimulated capture.

A multi-chamber stimulation device and associated method reliably and automatically distinguish fusion from loss of capture during ventricular stimulation. The stimulation device provides immediate and accurate fusion detection when a loss of capture is suspected in the ventricles without delivering back-up stimulation pulses. To achieve this objective, the far-field signal present in the atrial channel is examined for evidence of a far-field R-wave whenever the ventricular channel detects a loss of capture. If a far-field R-wave is present, fusion is confirmed, and a far-field R-wave is absent, loss of capture is confirmed. Additionally, the stimulation device inhibits unnecessary back-up stimulation and threshold tests when fusion occurs, and provides appropriate adjustment of stimulation parameters based on confirmed fusion detection such that fusion re-occurrence is minimized.

The invention is directed to a heart stimulator for left-ventricular pacing comprising a left ventricular stimulation pulse generator connected or connectable to a single electrode lead for left ventricular stimulation having one or more electrodes for delivery of stimulation pulses to left ventricular myocardial heart tissue, said stimulation pulse generator being adapted to generate and deliver stimulation pulses of switchable polarity. The heart stimulator further comprises a control unit connected to the stimulation pulse generator for controlling the stimulation pulse generator and to trigger generation and delivery of stimulation pulses having a polarity controlled by said control unit, wherein the control unit is adapted to control said left ventricular stimulation pulse generator so as to deliver at least a pair of suprathreshold stimulation pulses of opposite polarity.

An implantable stimulation device delivers a stimulation pulse in the ventricular chamber of a patient's heart and automatically adjusts a post-ventricular atrial blanking period. The stimulation device generates a ventricular stimulation pulse to trigger an evoked response, in order to produce a ventricular far-field signal that follows a successfully captured ventricular stimulation pulse. The stimulation device further includes an atrial sense circuit that senses the ventricular far-field signal, and a control system that adaptively segments the post-ventricular atrial blanking period in a post-ventricular atrial blanking period (PVAB) which is fixed in duration, and a variable far-field interval (FFI) window. PVAB is initiated upon the delivery of the ventricular stimulation pulse, such that events sensed outside the segmented post-ventricular atrial blanking (SPVAB) period are presumed to be intrinsic atrial events, and events sensed within the far-field interval window are presumed to be far-field signals. The far-field interval window is preferably centered on a previously sensed far-field R-wave. If an intrinsic ventricular event is sensed, the stimulation device does not initiate the PVAB period but rather sets the FFI window.

An implantable cardiac stimulation device, such as a pacemaker, defibrillator and / or cardioverter, and an associated method that provide cardiac stimulation to at least two ventricular stimulation sites, within a single ventricle or across two ventricles. A high intrinsic atrial rate triggers a retrograde conduction detection routine when a high ventricular stimulation rate is sustained for a predetermined number of cycles during an atrial sensing mode. This routine interrupts concurrent stimulation, and alternates the stimulation output to the different ventricular sites.

Heart stimulating system for stimulating at least a ventricle of a heart including: stimulation pulse generator adapted to generate stimulation pulses and connected to a ventricular stimulation electrode for delivering stimulation pulses, atrial sensing stage connected to an electrode for picking up potentials inside an atrium and adapted to sense an excitation or contraction of atrial myocardium, ventricular sensing stage connected to an electrode for picking up potentials inside a ventricle and adapted to sense an excitation or contraction of ventricular myocardium, memory for AV-delay values, a control unit adapted to trigger said stimulation pulse generator to generate ventricular stimulation pulses timed based on AV-delay values stored in said memory and to acquire atrioventricular interval samples, and atrioventricular interval timing analyzing unit for receiving atrioventricular interval samples from said control unit and adapted to generate at least one histogram based on said atrioventricular interval samples and analyze said histograms.

A heart stimulator provides a reliable automatic capture threshold search feature. A stimulation pulse generator is connected to at least a ventricular stimulation electrode for delivering electric stimulation pulses to at least the ventricle of the heart. The stimulation pulses generated have a strength depending on a control signal. A sensing stage is connected to an electrode for picking up electric potentials inside at least said ventricle of a heart and a control unit connected to the sensing stage and to the stimulation pulse generator determines points of time for scheduling stimulation pulses, to trigger the stimulation pulse generator so as to deliver a stimulation pulse when scheduled and to put out control signals for controlling the strength of the stimulation pulse. The control unit is further adapted to perform a capture analysis which may take into account extraordinary events.

A dual-chamber cardiac pacemaker comprising an atrial detection unit which is adapted to detect electrical signals in the atrium of a heart as atrial sense events, a ventricular detection unit which is adapted to detect electrical signals of a ventricle of the heart as ventricular sense events, a stimulation unit which is adapted at least to trigger the delivery of electrical pulses to the ventricle as ventricular stimulation events, and a control unit which is connected to the atrial and the ventricular detection units and the stimulation unit and adapted to control triggering of the delivery of pulses in dependence on the atrial detection unit and the ventricular detection unit in such a way that pulse delivery to the ventricle is triggered after the expiry of an AV time after detection of an atrial sense or stimulation event if prior to expiry of the AV time no ventricular sense event is detected by the ventricular detection unit, wherein the control unit is further adapted to divide ventricular sense events into at least two categories of which a first category concerns ventricular sense events to be associated with natural stimulus conduction from the atrium to the ventricle while a second category concerns ventricular sense events to be associated with ventricular extrasystoles or premature ventricular contractions (PVC) and control of the cardiac pacemaker is differentiated in accordance with whether a ventricular sense event is or is not associated with the first category, characterized in that for the control of triggering of pulse delivery an AV monitoring interval is provided in such a way that the AV monitoring interval is triggered by each atrial sense event which is outside an atrial refractory time, wherein the cardiac pacemaker is adapted to associate ventricular events occurring within the AV monitoring interval to the first category.

Cardiac pacemaker, having at least one stimulation pulse generator to selectively generate stimulation pulses for delivery to an atrium or to an atrium and a ventricle of a heart in DDD mode, at least one sensing stage adapted to process electrical signals sensed by an atrial and ventricular sensing electrode to detect an atrial or ventricular event and to generate an atrial or ventricular sense signal upon event detection, a control unit connected to the generator and sensing stage and being adapted to trigger the generator in DDD mode, wherein the control unit is adapted to verify proper atrioventricular conduction and to switch from a regular (DDD) mode, wherein scheduled ventricular stimulation pulses having predetermined positive intensity is triggered unless inhibited to a ventricular pulse suppression mode (VPS mode) wherein no ventricular stimulation pulses or ventricular stimulation pulses of sub-threshold intensity are generated as long as proper atrioventricular conduction is verified.

A pacemaker is operable in a tracking and a non-tracking mode and has an automatic mode switching function for switching the pacemaker into the non-tracking mode of operation in response to the detection of atrial tachycardia. A comparator compares an atrial interval, between detected atrial events, with a predetermined atrial tachycardia limit value and records a tachycardia indication if the interval is less than the atrial tachycardia limit value. The mode switching unit switches the mode of operation to the non-tracking mode if the number of recorded tachycardia indications reaches a predetermined tachycardia count limit. Intervals between other cardiac events detected by the atrial detector or a ventricular detector also are supplied to the comparator wherein they are compared with the atrial tachycardia limit value. The recorded number of tachycardia indications is reduced by one if at least one of these additional intervals, during a pacemaker interval between two consecutive ventricular stimulations or between two consecutive R-wave detections, is longer than the tachycardia limit value.

A dual chamber cardiac pacemaker has a pulse controller for delivering stimulation pulses to the ventricle of a heart, a ventricular sensor for sensing ventricular depolarization, and a unit for identifying a beginning of an A-V interval of the heart. The pulse controller causes a ventricular stimulation pulse to be generated at a predetermined energy level after the expiration of a predetermined A-V interval. The controller prolongs the A-V interval under certain circumstances. Upon the expiration of the prolonged A-V interval, the pulse controller causes the ventricular pulse generator to emit a ventricular stimulation pulse at a higher energy level than the predetermined energy level to evoke a response in the ventricle. This allows the intrinsic heart activity to be detected and utilized, while ensuring safe pacing, as well as successful and reliable stimulation and maintaining a low power consumption during normal operation.

Heart stimulating system for stimulating at least a ventricle of a heart including: stimulation pulse generator adapted to generate stimulation pulses and connected to a ventricular stimulation electrode for delivering stimulation pulses, atrial sensing stage connected to an electrode for picking up potentials inside an atrium and adapted to sense an excitation or contraction of atrial myocardium, ventricular sensing stage connected to an electrode for picking up potentials inside a ventricle and adapted to sense an excitation or contraction of ventricular myocardium, memory for AV-delay values, a control unit adapted to trigger said stimulation pulse generator to generate ventricular stimulation pulses timed based on AV-delay values stored in said memory and to acquire atrioventricular interval samples, and atrioventricular interval timing analyzing unit for receiving atrioventricular interval samples from said control unit and adapted to generate at least one histogram based on said atrioventricular interval samples and analyze said histograms.

An active implantable medical device including circuits for calculating an atrio ventricular delay (AVD) period. The device is able to detect the atrial and ventricular events; calculate an AVD and to start the AVD on detection of a spontaneous or paced atrial event. The device is able to deliver a low energy ventricular stimulation pulse at the expiration of the AVD in the absence of a detected spontaneous ventricular event. To calculate the AVD, the device uses an acceleration sensor to deliver an endocardiac acceleration (EA) signal representative of the movements produced by the contractions of the atrial cavity; and analyzes the EA signal to identify and isolate in the EA signal a component corresponding to the fourth peak of endocardiac acceleration (PEA4) associated to the atrial activity, and to calculate the AVD based on a parameter of this component.

A heart stimulator provides a reliable automatic capture threshold search feature. A stimulation pulse generator is connected to at least a ventricular stimulation electrode for delivering electric stimulation pulses to at least the ventricle of the heart. The stimulation pulses generated have a strength depending on a control signal. A sensing stage is connected to an electrode for picking up electric potentials inside at least said ventricle of a heart and a control unit connected to the sensing stage and to the stimulation pulse generator determines points of time for scheduling stimulation pulses, to trigger the stimulation pulse generator so as to deliver a stimulation pulse when scheduled and to put out control signals for controlling the strength of the stimulation pulse. The control unit is further adapted to perform a capture analysis which may take into account extraordinary events.

Certain embodiments of the present invention disclose an electrostimulator, in particular an atrial cardiac pacemaker, comprising electrode connections which are connected to a stimulation unit for the delivery of stimulation pulses by way of the electrode connections, and a stimulation control unit which is connected to the stimulation unit and adapted to trigger the delivery of stimulation pulses and to determine the strength of the stimulation pulses and for that purpose to deliver a stimulation control signal to the stimulation unit, and a detection unit which is connected to the stimulation control unit and at least indirectly to the electrode connections and adapted to evaluate electrical potentials at the electrode connections and to detect intrinsic (natural, spontaneous) events. The stimulation control unit is adapted to produce a far-field signal if the detection unit detects an intrinsic atrial event within a predetermined far-field coupling interval which begins after triggering of a ventricular stimulation pulse.

An active implantable medical device including circuits for calculating an atrio ventricular delay (AVD) period. The device is able to detect the atrial and ventricular events; calculate an AVD and to start the AVD on detection of a spontaneous or paced atrial event. The device is able to deliver a low energy ventricular stimulation pulse at the expiration of the AVD in the absence of a detected spontaneous ventricular event. To calculate the AVD, the device uses an acceleration sensor to deliver an endocardiac acceleration (EA) signal representative of the movements produced by the contractions of the atrial cavity; and analyzes the EA signal to identify and isolate in the EA signal a component corresponding to the fourth peak of endocardiac acceleration (PEA4) associated to the atrial activity, and to calculate the AVD based on a parameter of this component.

Adjusting the maximum ventricular stimulation frequency according to the hemodynamic state of the patient in an active implantable medical device. This device provides for limiting ventricular stimulation to a maximum frequency (Fmax), the rate of delivery of the stimulation pulses, measuring an intracardiac bio-impedance (Zn, Zn+1), and adjusting the maximum frequency according to the measured intracardiac bio-impedance. The adjusting process can include evaluating a parameter representative of the cardiac flow (dn, dn+1) utilizing the intracardiac signal of bio-impedance; controlling a predetermined variation (X %) of the frequency (f) of delivery of the stimulation pulses; evaluating the correlative variation (y %) of the cardiac flow; and adjusting the value of the maximum frequency (Fmax) according to the variation of the cardiac flow thus evaluated.

A heart stimulator provides for a more appropriate yet simple setting of the AV-delay. The heart stimulator comprises a stimulation pulse generator adapted to generate electric stimulation pulses and connected to a ventricular stimulation electrode for delivering electric stimulation pulses. A sensing stage connected to an electrode for picking up electric potentials inside a ventricle is adapted to sense an excitation or a contraction of a heart chamber. A memory is adapted to store parameters defining a Bezier function determining the relationship between AV-delay values and heart rate and a control unit connected to said memory, said sensing stage and to said stimulation pulse generator, is adapted to determine an actual AV-delay based on an actual intrinsic heart rate or an actual stimulation rate and a non-linear smoothing interpolation between said parameters stored in said memory.

An active implantable medical device comprising circuits for right ventricular, left ventricular, right atrial and eventually left atrial detection, as well as circuits for right and left ventricular stimulation. The device can operate in mode of resynchronization of the ventricular contractions, with an adjustable delay of inter-ventricular stimulation. It includes moreover: circuits for atrial stimulation; circuits able to operate the device in AAI mode with right atrial stimulation and right ventricular detection; circuits for detection of ventricular capture, to determine the detection or the loss of capture after a right ventricular stimulation and a left ventricular stimulation; and of the circuits for mode switching, able to control a switching of mode, from the mode of resynchronization towards AAI mode, in response to the detection of a loss of capture after a right ventricular stimulation or a left ventricular stimulation.

An implantable cardiac stimulation device, such as a pacemaker, defibrillator and / or cardioverter, and an associated method that provide cardiac stimulation to at least two ventricular stimulation sites, within a single ventricle or across two ventricles. A high intrinsic atrial rate triggers a retrograde conduction detection routine when a high ventricular stimulation rate is sustained for a predetermined number of cycles during an atrial sensing mode. This routine interrupts concurrent stimulation, and alternates the stimulation output to the different ventricular sites.

Implantable cardiac stimulator, with chamber stimulation unit connectable to left / right ventricular stimulation electrode to generate / deliver chamber stimulation pulses for stimulation of ventricle; ventricular sensing unit (VSU) to detect respective chamber contraction and deliver ventricular sensing signal when chamber contraction detected; optional atrial stimulation unit, connectable to atrial stimulation electrode to generate atrial stimulation pulses to stimulate atrium; atrial sensing unit, to detect atrial contraction, deliver atrial sensing signal indicating respective atrial event; tachycardia detection unit, connected to VSU to detect and categorize ventricular / supraventricular tachycardia; treatment control unit (TCU), triggers chamber stimulation unit to deliver antitachycardiac stimulation (ATP); analyzer unit, connected to atrial sensing unit and TCU. Analyzes atrial events from sensing unit before / during / after delivering antitachycardiac stimulation for atrial rhythm pattern during ventricular ATP by comparison atrial rhythm pattern immediately before ATP and to trigger TCU as function of ATP response signal representing comparison result for selection of the following antitachycardiac treatment.

The invention is directed to a heart stimulator for left-ventricular pacing comprising a left ventricular stimulation pulse generator connected or connectable to a single electrode lead for left ventricular stimulation having one or more electrodes for delivery of stimulation pulses to left ventricular myocardial heart tissue, said stimulation pulse generator being adapted to generate and deliver stimulation pulses of switchable polarity. The heart stimulator further comprises a control unit connected to the stimulation pulse generator for controlling the stimulation pulse generator and to trigger generation and delivery of stimulation pulses having a polarity controlled by said control unit, wherein the control unit is adapted to control said left ventricular stimulation pulse generator so as to deliver at least a pair of suprathreshold stimulation pulses of opposite polarity.

A heart stimulator for biventricular pacing comprises at least one stimulation pulse generator connected or connectable to a right ventricular or atrial stimulation electrode lead and a left ventricular or atrial electrode lead, respectively. The heart stimulator is adapted to generate right chamber stimulation pulses for a right atrium or ventricle and left chamber stimulation pulses for a left ventricle or atrium. A high rate protection unit connected to said stimulation pulse generator is adapted to trigger, upon any right or left chamber stimulation pulse, a protection time window having a predetermined duration in time and comprising an early part immediately followed by a late part. The protection unit is further adapted to only allow atrial or ventricular stimulation pulses in said early part of said protection time window and to suppress any atrial or ventricular stimulation pulse in said late part.

Implantable cardiac stimulator, with chamber stimulation unit connectable to left / right ventricular stimulation electrode to generate / deliver chamber stimulation pulses for stimulation of ventricle; ventricular sensing unit (VSU) to detect respective chamber contraction and deliver ventricular sensing signal when chamber contraction detected; optional atrial stimulation unit, connectable to atrial stimulation electrode to generate atrial stimulation pulses to stimulate atrium; atrial sensing unit, to detect atrial contraction, deliver atrial sensing signal indicating respective atrial event; tachycardia detection unit, connected to VSU to detect and categorize ventricular / supraventricular tachycardia; treatment control unit (TCU), triggers chamber stimulation unit to deliver antitachycardiac stimulation (ATP); analyzer unit, connected to atrial sensing unit and TCU. Analyzes atrial events from sensing unit before / during / after delivering antitachycardiac stimulation for atrial rhythm pattern during ventricular ATP by comparison atrial rhythm pattern immediately before ATP and to trigger TCU as function of ATP response signal representing comparison result for selection of the following antitachycardiac treatment.

An implantable cardiac stimulator having an at least partially electrically conductive housing, a ventricular stimulation unit connectable to left ventricular or right ventricular stimulation electrode and designed to generate ventricular stimulation pulses for stimulation of heart ventricle, having terminal for right ventricular defibrillation electrode. Has far-field electrogram detection unit (FFEDU) and stimulation success detecting unit (SSDU), of which FFEDU has first input connected to the terminal for right ventricular defibrillation electrode and second input connected to housing. FFEDU detects far-field electrocardiogram based on electric potentials applied to inputs and deliver these potentials to SSDU. SSDU has electrogram input and signal input receives a far-field electrogram generated by FFEDU and receives stimulation signal that represents a ventricular stimulation pulse generated and delivered by ventricular stimulation unit and analyzes section of received far-field electrogram immediately following delivery of ventricular stimulation impulse to determine whether it represents an effective or ineffective ventricular stimulation.

An implantable medical device including a control unit, at least a right ventricular sensing unit and / or a right atrial sensing unit, wherein the right ventricular sensing unit is connected or can be connected to a right ventricular stimulation electrode lead having at least one electrode pole and a stimulation unit that is connected or can be connected to a multipolar left ventricular stimulation electrode lead having a plurality of electrode poles. The control unit is adapted to determine right atrioventricular conduction state and to cause selection of one of the plurality of electrode poles of the multipolar left ventricular stimulation electrode lead depending a respective determined right atrioventricular conduction state.

In a device and method in a dual chamber pacing system operating in an atrial synchronized mode, the cardiac stimulator is connectable to a lead arrangement arranged for sensing atrial electrical and mechanical activity. Upon detection of an atrial arrhythmia based on either of sensed atrial mechanical activity, atrial electrical activity, or a combination thereof, a mode switch from an atrial synchronized ventricle stimulating mode to a non-atrial synchronized mode is triggered.