Method and system for determining a cardiac cycle pace time in accordance with metabolic demand in a leadless cardiac pacemaker system
A leadless cardiac pacemaker (LCP) is configured to sense cardiac activity and to pace a patient's heart and is disposable within a ventricle of the patient's heart. The LCP MAY include a housing, a first electrode and a second electrode that are secured relative to the housing and are spaced apart. A controller is disposed within the housing and is operably coupled to the first electrode and the second electrode such that the controller is capable of receiving, via the first electrode and the second electrode, electrical cardiac signals of the heart. The LCP may include a pressure sensor and/or an accelerometer. The controller may determine a pace time within a cardiac cycle based at least in part upon an indication of metabolic demand.
1. A leadless cardiac pacemaker (LCP) configured to sense cardiac activity and to pace a patient's heart, the LCP disposable within a ventricle of the patient's heart, the LCP comprising:
a housing;
a first electrode secured relative to the housing;
a second electrode secured relative to the housing, the second electrode spaced from the first electrode;
a controller disposed within the housing and operably coupled to the first electrode and the second electrode such that the controller is capable of receiving an electrical cardiac signal from the patient's heart via the first electrode and the second electrode;
a first sensor disposed relative to the housing and operably coupled to the controller, the controller configured to receive a first sensor signal from the first sensor, wherein the first sensor comprises an accelerometer and the first sensor signal is responsive to an atrial contraction of the patient's heart;
a second sensor disposed relative to the housing and operably coupled to the controller, the controller configured to receive a second sensor signal from the second sensor, wherein the second sensor comprises a pressure sensor and the second sensor signal is responsive to an atrial contraction of the patient's heart;
the controller configured to determine a ventricle pace time for delivering a ventricle pacing pulse to the ventricle of the patient's heart, the controller determining the ventricle pace time based at least in part on an indication of an atrial contraction event of the patient's heart and an indication of metabolic demand on the patient's heart, wherein the indication of an atrial contraction event is based primarily or exclusively on the received first signal if the indication of metabolic demand is below a metabolic demand threshold and is based primarily or exclusively on the received second signal if the indication of metabolic demand is above the metabolic demand threshold; and
the controller is configured to generate and deliver a ventricle pacing pulse at the ventricle pace time.
2. The LCP of claim 1 , wherein the indication of metabolic demand is based at least in part upon the received first sensor signal.
3. The LCP of claim 1 , wherein the indication of metabolic demand is based at least in part upon the received second sensor signal.
4. The LCP of claim 1 , wherein the indication of metabolic demand is based at least in part upon the received electrical cardiac signal.
5. The LCP of claim 1 , wherein the controller is configured to:
determine a posture of the patient based at least in part on an accelerometer signal from the accelerometer; and
determine the indication of metabolic demand based at least in part on the determined posture.
6. The LCP of claim 1 , wherein the controller is configured to:
determine an activity level of the patient based at least in part on an accelerometer signal from the accelerometer; and
determine the indication of metabolic demand based at least in part on the determined activity level.
7. The LCP of claim 1 , wherein the controller is configured to:
attempt to detect an A-wave via a pressure signal from the pressure sensor;
determine the ventricle pace time based at least in part on the A-wave when the A-wave is detected; and
determine the ventricle pace time based at least in part on one or more of a received pressure signal from the pressure sensor and/or a received accelerometer signal from the accelerometer other than the A-wave when the A-wave is not detected.
8. The LCP of claim 1 , wherein the controller is configured to:
determine the ventricle pace time based at least in part on an LV pressure parameter indicated in a pressure signal of the pressure sensor when the indication of metabolic demand is above the metabolic demand threshold; and
determine the ventricle pace time based at least in part on a heart sound indicated in the pressure signal of the pressure sensor and/or in an accelerometer signal of the accelerometer when the indication of metabolic demand is below the metabolic demand threshold.
9. The LCP of claim 1 , wherein the controller is configured to:
determine the ventricle pace time to achieve a higher change rate in LV pressure over time (dP/dt) when the indication of metabolic demand is above a relaxation threshold; and
determine the ventricle pace time to achieve a lower change rate in LV pressure over time (dP/dt) when the indication of metabolic demand is below the relaxation threshold.
10. The LCP of claim 1 , wherein the controller is configured to:
determine the ventricle pace time to achieve lower passive ventricular filling when the indication of metabolic demand is above a relaxation threshold; and
determine the ventricle pace time to achieve higher passive ventricular filling when the indication of metabolic demand is below a relaxation threshold.
11. The LCP of claim 1 , wherein the controller is configured to:
detect an S2 heart sound via the pressure sensor and/or the accelerometer;
detect an A-wave via the pressure sensor;
determine the ventricle pace time to achieve a smaller S2 to A-wave interval when the indication of metabolic demand exceeds a relaxation threshold; and
determine the ventricle pace time to achieve a larger S2 to A-wave interval when the indication of metabolic demand does not exceed the relaxation threshold.
12. The LCP of claim 1 , wherein controller is configured to:
detect an S2 heart sound via the pressure sensor and/or the accelerometer;
detect an S1 heart sound via the pressure sensor and/or the accelerometer;
determine the ventricle pace time to achieve a smaller S2 to S1 interval when the indication of metabolic demand exceeds a relaxation threshold; and
determine the ventricle pace time to achieve a larger S2 to S1 interval when the indication of metabolic demand does not exceed the relaxation threshold.
13. A leadless cardiac pacemaker (LCP) configured to sense cardiac activity and to pace a patient's heart, the LCP disposable within a ventricle of the patient's heart, the LCP comprising:
a housing;
a first electrode secured relative to the housing;
a second electrode secured relative to the housing, the second electrode spaced from the first electrode;
a controller disposed within the housing and operably coupled to the first electrode and the second electrode such that the controller is capable of receiving an electrical cardiac signal from the patient's heart via the first electrode and the second electrode;
a pressure sensor disposed relative to the housing and operably coupled to the controller, the controller configured to receive a pressure sensor signal from the pressure sensor, wherein the pressure sensor signal is responsive to an atrial contraction of the patient's heart;
an accelerometer disposed relative to the housing and operably coupled to the controller, the controller configured to receive an accelerometer signal from the accelerometer, wherein the accelerometer signal is responsive to an atrial contraction of the patient's heart;
the controller configured to determine a ventricle pace time for delivering a ventricle pacing pulse to the ventricle of the patient's heart, the controller determining the ventricle pace time based at least in part on an indication of an atrial contraction event of the patient's heart and an indication of a current posture of the patient, wherein the indication of an atrial contraction event is based primarily or exclusively on the received accelerometer signal if the indication of the posture of the patient is reclined, and is based primarily or exclusively on the received pressure signal if the indication of the posture of the patient is upright; and
the controller is configured to generate and deliver a ventricle pacing pulse at the ventricle pace time.
14. The LCP of claim 13 , wherein the controller is configured to determine the indication of the posture of the patient based at least in part on the accelerometer signal.
15. The LCP of claim 13 , wherein the controller is configured to:
determine the ventricle pace time based at least in part on an LV pressure parameter indicated in the pressure sensor signal when the indication of the posture of the patient is upright; and
determine the ventricle pace time based at least in part on a heart sound indicated in the pressure sensor signal and/or in the accelerometer signal when the indication of the posture of the patient is reclined.
16. The LCP of claim 13 , wherein the controller is configured to:
determine the ventricle pace time to achieve lower passive ventricular filling when the indication of the posture of the patient is upright; and
determine the ventricle pace time to achieve higher passive ventricular filling when the indication of the posture of the patient is reclined.