Pacing mode switching and rate response limit in a ventricular pacemaker
An intracardiac ventricular pacemaker having a motion sensor, a pulse generator and a control circuit coupled to the pulse generator and the motion sensor is configured to identify a ventricular systolic event, detect a ventricular passive filling event signal from the motion signal, and determine a time interval from the ventricular systolic event to the ventricular passive filling event. The pacemaker establishes a minimum pacing interval based on the time interval.
1. A medical device, comprising:
a pulse generator configured to deliver cardiac pacing pulses;
a motion sensor configured to produce a motion signal;
a sensing circuit configured to receive a cardiac electrical signal and sense R-waves from the cardiac electrical signal;
a control circuit coupled to the motion sensor, the sensing circuit, and the pulse generator, the control circuit configured to:
identify a ventricular systolic event as one of a ventricular pacing pulse delivered by the pulse generator or an R-wave sensed by the sensing circuit;
detect a ventricular passive filling event signal from the motion signal;
determine a time interval from the ventricular systolic event to the ventricular passive filling event; and
establish a minimum rate response pacing interval based on the time interval from the ventricular systolic event to the ventricular passive filling event, the minimum rate response pacing interval corresponding to a maximum pacing rate; and
a memory in communication with the control circuit and configured to store the minimum rate response pacing interval; and
the pulse generator is configured to deliver one or more pacing pulses at the maximum pacing rate.
2. The medical device of claim 1 , wherein:
the control circuit is further configured to:
determine a sensor indicated pacing rate interval; and
determine that the sensor indicated pacing rate interval is less than the minimum pacing interval;
the pulse generator is configured to deliver a pacing pulse at the minimum pacing interval corresponding to the maximum pacing rate in response to the sensor indicated pacing rate interval being less than the minimum pacing interval.
3. The medical device of claim 2 , wherein the control circuit is further configured to determine the sensor indicated pacing rate interval based on the motion signal.
4. The medical device of claim 3 , wherein:
the control circuit is further configured to switch from an atrial tracking pacing mode for controlling the pulse generator to deliver atrial synchronized pacing pulses to a non-atrial tracking pacing mode for controlling the pulse generator to deliver atrial asynchronous pacing pulses; and
the pulse generator is further configured to deliver ventricular pacing pulses in the non-atrial tracking pacing mode by delivering a pacing pulse at the sensor indicated pacing rate interval when the sensor indicated pacing rate interval is greater than the minimum pacing interval.
5. The medical device of claim 2 , wherein the control circuit is further configured to:
determine that pacing mode switching criteria are satisfied; and
determine the sensor indicated rate in response to the pacing mode switching criteria being satisfied.
6. The medical device of claim 1 , wherein:
the control circuit is further configured to:
detect an atrial systolic event from the motion signal,
set an atrioventricular pacing interval in response to detecting the atrial systolic event, and
the pulse generator is further configured to deliver at least one pacing pulse in an atrial tracking pacing mode by delivering the at least one pacing pulse upon expiration of the atrioventricular pacing interval; and
the control circuit is configured to determine the time interval from the ventricular systolic event to the ventricular passive filling event during the atrial tracking pacing mode.
7. The medical device of claim 1 , wherein the control circuit is configured to:
detect a resting stable heart rate; and
determine the time interval from the ventricular systolic event to the ventricular passive filling event during the resting stable heart rate.
8. The medical device of claim 1 , wherein the control circuit is configured to:
determine the time interval from the ventricular systolic event to the ventricular passive filling event for each of a plurality of heart rates;
extrapolate a corrected time interval from the ventricular systolic event to the ventricular passive filling event for a heart rate greater than the plurality of heart rates; and
establish the minimum pacing interval based on the corrected time interval.
9. The medical device of claim 1 , wherein the control circuit is further configured to determine the time interval from the ventricular systolic event to the ventricular passive filling event from the motion signal acquired over a plurality of cardiac cycles.
10. A non-transitory, computer-readable medium storing a set of instructions, which, when executed by a control circuit of a medical device having a pulse generator for delivering cardiac pacing pulses and a motion sensor, cause the medical device to:
produce a motion signal by the motion sensor;
receive a cardiac electrical signal;
sense R-waves from the cardiac electrical signal;
identify a ventricular systolic event as one of a ventricular pacing pulse delivered by the pulse generator or a sensed R-wave;
detect a ventricular passive filling event signal from the motion signal;
determine a time interval from the ventricular systolic event to the ventricular passive filling event;
establish a minimum rate response pacing interval based on the time interval from the ventricular systolic event to the ventricular passive filling event, the minimum rate response pacing interval corresponding to a maximum pacing rate;
store the minimum rate response pacing interval; and
deliver one or more pacing pulses at the maximum pacing rate.
11. The non-transitory, computer-readable medium of claim 10 , further comprising instructions that cause the medical device to:
determine a sensor indicated pacing rate interval;
determine that the sensor indicated pacing rate interval is less than the minimum pacing interval; and
deliver a pacing pulse at the minimum pacing interval corresponding to the maximum pacing rate in response to the sensor indicated pacing rate interval being less than the minimum pacing interval.
12. The non-transitory, computer-readable medium of claim 11 , further comprising instructions that cause the medical device to determine the sensor indicated pacing rate interval based on the motion signal.
13. The non-transitory, computer-readable medium of claim 12 , further comprising instructions that cause the medical device to:
switch from an atrial tracking pacing mode for controlling the pulse generator to deliver atrial synchronized pacing pulses to a non-atrial tracking pacing mode for controlling the pulse generator to deliver atrial asynchronous pacing pulses; and
deliver ventricular pacing pulses by the pulse generator in the non-atrial tracking pacing mode by delivering a pacing pulse at the sensor indicated pacing rate interval when the sensor indicated pacing rate interval is greater than the minimum pacing interval.
14. The non-transitory, computer-readable medium of claim 11 , further comprising instructions that cause the medical device to:
determine that pacing mode switching criteria are satisfied; and
determine the sensor indicated rate in response to the pacing mode switching criteria being satisfied.
15. The non-transitory, computer-readable medium of claim 10 , further comprising instructions that cause the medical device to:
detect an atrial systolic event from the motion signal,
set an atrioventricular pacing interval in response to detecting the atrial systolic event,
deliver by the pulse generator at least one pacing pulse in an atrial tracking pacing mode by delivering the at least one pacing pulse upon expiration of the atrioventricular pacing interval; and
determine the time interval from the ventricular systolic event to the ventricular passive filling event during the atrial tracking pacing mode.
16. The non-transitory, computer-readable medium of claim 10 , further comprising instructions that cause the medical device to:
detect a resting stable heart rate; and
determine the time interval from the ventricular systolic event to the ventricular passive filling event during the resting stable heart rate.
17. The non-transitory, computer-readable medium of claim 10 , further comprising instructions that cause the medical device to:
determine the time interval from the ventricular systolic event to the ventricular passive filling event for each of a plurality of heart rates;
extrapolate a corrected time interval from the ventricular systolic event to the ventricular passive filling event for a heart rate greater than the plurality of heart rates; and
establish the minimum pacing interval based on the corrected time interval.
18. The non-transitory, computer-readable medium of claim 10 , further comprising instructions that cause the medical device to determine the time interval from the ventricular systolic event to the ventricular passive filling event from the motion signal acquired over a plurality of cardiac cycles.
19. A method, comprising:
producing a motion signal by a motion sensor;
sensing R-waves from a cardiac electrical signal;
identifying a ventricular systolic event as one of a ventricular pacing pulse or a sensed R-wave;
detecting a ventricular passive filling event signal from the motion signal;
determining a time interval from the ventricular systolic event to the ventricular passive filling event;
establishing a minimum rate response pacing interval based on the time interval from the ventricular systolic event to the ventricular passive filling event, the minimum rate response pacing interval corresponding to a maximum pacing rate; and
storing the minimum rate response pacing interval; and
delivering by a pulse generator that is responsive to the stored minimum rate response pacing interval one or more pacing pulses at the maximum pacing rate.