Determination of lower pacing rate limit
A lower pacing rate limit is utilized by pacing devices to initiate pacing in response to a patient's intrinsic rate being less than the lower pacing rate limit. Illustrative systems, devices, and methods may obtain rate modification information related to a patient such as physical characteristics, diagnostic parameters, pathologies, device characteristics of a pacing device implanted in the patient, and patient-reported information. The rate modification information may be used to determine lower pacing rate limit based thereon.
1 . A method comprising:
obtaining rate modification information comprising at least one physical characteristic of a patient utilizing a pacing device and at least one diagnostic parameter, the at least one diagnostic parameter comprising a nighttime heart rate;
receiving an upper bound, a lower bound, and a percentage of pacing threshold; and
determining a lower pacing rate limit for the pacing device based on the obtained rate modification information, the upper bound, the lower bound, and the percentage of pacing threshold, wherein the lower pacing rate limit is increased when a percentage of paced beats exceeds the percentage of pacing threshold and wherein the lower pacing rate limit is utilized by the pacing device to initiate pacing in response to the patient's intrinsic rate being less than the lower pacing rate limit.
2 . The method of claim 1 , wherein the at least one physical characteristic comprises one or more of height, sex, age, body mass index (BMI), body surface area, physical fitness level, and activity level.
3 . The method of claim 1 , wherein the rate modification information further comprises at least one pathology, wherein the at least one pathology comprises diastolic dysfunction/heart failure with preserved ejection fraction.
4 . The method of claim 1 , wherein the rate modification information further comprises at least one pathology, wherein the at least one pathology comprises one or more of systolic dysfunction, chronotropic incompetence, worsening heart failure, and comorbid disease.
5 . The method of claim 1 , wherein the at least one diagnostic parameter further comprises one or more of ventricular contractility, ventricular stiffness, pulse transit time, resting heart rate, arrhythmia burden, targeted pacing burden, heart rate recovery, impedance, fluid overload, edema, respiration rate, maximum heart rate, ejection fraction, left ventricular pressure, systemic blood pressure, pulmonary artery pressure, blood oxygenation, and presence or concentration of serum biomarkers.
6 . The method of claim 5 , wherein obtaining rate modification information comprising monitoring the at least one diagnostic parameter of the patient using the pacing device.
7 . The method of claim 1 , wherein the rate modification information further comprises at least one device configuration, wherein the at least one device configuration comprises one or more of ventricular pacing electrode location, atrial pacing electrode location, and type of pacing therapy.
8 . The method of claim 1 , wherein the rate modification information further comprises patient-reported information, wherein the patient-reported information comprises one or more of energy level, peripheral edema, desired activity performance, and pacing-related symptoms.
9 . The method of claim 1 , wherein the rate modification information further comprises patient-reported information, wherein the patient-reported information is obtained from a mobile computing device.
10 . The method of claim 1 , wherein the method further comprises configuring the pacing device with the lower pacing rate limit.
11 . The method of claim 1 , wherein obtaining rate modification information comprising obtaining the rate modification information from an electronic medical records system.
12 . The method of claim 1 , wherein determining a lower pacing rate limit for the pacing device based on the obtained rate modification information is performed by the pacing device.
13 . The method of claim 1 , wherein determining a lower pacing rate limit for the pacing device based on the obtained rate modification information is performed by a remote computing system communicatively coupled to the pacing device.
14 . A system comprising:
a computing apparatus comprising one or more processors and configured to:
obtain rate modification information comprising at least one physical characteristic of a patient utilizing a pacing device and at least one diagnostic parameter, the at least one diagnostic parameter comprising a nighttime heart rate;
receive an upper bound, a lower bound, and a percentage of pacing threshold; and
determine a lower pacing rate limit for the pacing device based on the obtained rate modification information, the upper bound, the lower bound, and the percentage of pacing threshold, wherein the lower pacing rate limit is increased when a percentage of paced beats exceeds the percentage of pacing threshold and wherein the lower pacing rate limit is utilized by the pacing device to initiate pacing in response to the patient's intrinsic rate being less than the lower pacing rate limit.
15 . The system of claim 14 , wherein the at least one physical characteristic comprises one or more of height, sex, age, body mass index (BMI), body surface area, physical fitness level, and activity level.
16 . The system of claim 14 , wherein the rate modification information further comprises at least one pathology, wherein the at least one pathology comprises diastolic dysfunction/heart failure with preserved ejection fraction.
17 . The system of claim 14 , wherein the rate modification information further comprises at least one pathology, wherein the at least one pathology comprises one or more of systolic dysfunction, chronotropic incompetence, worsening heart failure, and comorbid disease.
18 . The system of claim 14 , wherein the at least one diagnostic parameter further comprises one or more of ventricular contractility, ventricular stiffness, pulse transit time, resting heart rate, arrhythmia burden, targeted pacing burden, heart rate recovery, impedance, fluid overload, edema, respiration rate, maximum heart rate, ejection fraction, left ventricular pressure, systemic blood pressure, pulmonary artery pressure, blood oxygenation, and presence or concentration of serum biomarkers.
19 . The system of claim 18 , wherein obtaining rate modification information comprising obtaining the at least one diagnostic parameter of the patient from the pacing device.
20 . The system of claim 14 , wherein the rate modification information further comprises at least one device configuration, wherein the at least one device configuration comprises one or more of ventricular pacing electrode location, atrial pacing electrode location, and type of pacing therapy.
21 . The system of claim 14 , wherein the rate modification information further comprises patient-reported information, wherein the patient-reported information comprises one or more of energy level, peripheral edema, desired activity performance, and pacing-related symptoms.
22 . The system of claim 14 , wherein the rate modification information further comprises patient-reported information, wherein the patient-reported information is obtained from a mobile computing device.
23 . The system of claim 14 , wherein the computing apparatus is further configured to configuring the pacing device with the lower pacing rate limit.
24 . The system of claim 14 , wherein obtaining rate modification information comprising obtaining the rate modification information from an electronic medical records system.
25 . An implantable medical device comprising:
one or more electrodes to deliver cardiac pacing therapy to and sense electrical activity from a patient's heart; and
a computing apparatus operably coupled the one or more electrodes and comprising one or more processors, the computing apparatus configured to:
monitor the patient's intrinsic heart rate using the one or more electrodes;
deliver pacing therapy to the patient's heart in response to the patient's intrinsic rate being less than a lower pacing rate limit;
obtain rate modification information comprising at least one physical characteristic of a patient utilizing a pacing device and at least one diagnostic parameter, the at least one diagnostic parameter comprising a nighttime heart rate;
receive an upper bound, a lower bound, and a percentage of pacing threshold; and
determine a lower pacing rate limit for the pacing device based on the obtained rate modification information, the upper bound, the lower bound, and the percentage of pacing threshold, wherein the lower pacing rate limit is increased when a percentage of paced beats exceeds the percentage of pacing threshold.
26 . The device of claim 25 , wherein the at least one physical characteristic comprises one or more of height, sex, age, body mass index (BMI), body surface area, physical fitness level, and activity level.
27 . The device of claim 25 , wherein the rate modification information further comprises at least one pathology, wherein the at least one pathology comprises diastolic dysfunction/heart failure with preserved ejection fraction.
28 . The device of claim 25 , wherein the rate modification information further comprises at least one pathology, wherein the at least one pathology comprises one or more of systolic dysfunction, chronotropic incompetence, worsening heart failure, and comorbid disease.
29 . The device of claim 25 , wherein the at least one diagnostic parameter further comprises one or more of ventricular contractility, ventricular stiffness, pulse transit time, resting heart rate, arrhythmia burden, targeted pacing burden, heart rate recovery, impedance, fluid overload, edema, respiration rate, maximum heart rate, ejection fraction, left ventricular pressure, systemic blood pressure, pulmonary artery pressure, blood oxygenation, and presence or concentration of serum biomarkers.
30 . The device of claim 29 , wherein obtaining rate modification information comprising monitoring the at least one diagnostic parameter of the patient using the one or more electrodes.
31 . The device of claim 25 , wherein the rate modification information further comprises at least one device configuration, wherein the at least one device configuration comprises one or more of ventricular pacing electrode location, atrial pacing electrode location, and type of pacing therapy.
32 . The device of claim 25 , wherein the rate modification information further comprises patient-reported information, wherein the patient-reported information comprises one or more of energy level, peripheral edema, desired activity performance, and pacing-related symptoms.
33 . The device of claim 25 , wherein the rate modification information further comprises patient-reported information, wherein the patient-reported information is obtained from a mobile computing device.