Secure and efficacious therapy delivery for a pacing engine

Abstract

The above-described methods and apparatus are believed to be of particular benefit for patients suffering heart failure including cardiac dysfunction, chronic HF, and the like and all variants as described herein and including those known to those of skill in the art to which the invention is directed. It will understood that the present invention offers the possibility of monitoring and therapy of a wide variety of acute and chronic cardiac dysfunctions. The current invention provides systems and methods for delivering therapy for cardiac hemodynamic dysfunction via the innervated myocardial substrate receives one or more discrete pulses of electrical stimulation during the refractory period of said innervated myocardial substrate.

1 . A method of cardiac pacing, comprising:
 sensing depolarizations of an atrium and a ventricle of a patient's heart using an implantable cardiac pacemaker;   delivering atrial pacing pulses to the atrium of the patient's heart using the pacemaker; and   at a selected time Tx following a sensed depolarization of the ventricle resulting from a preceding conducted atrial depolarization, delivering an atrial coupled (ACP) atrial pacing pulse;   wherein Tx is selected such that an atrial depolarization resulting from the delivered ACP atrial pacing pulse is not conducted to the ventricle because the ventricle is in a refractory state.   
     
     
         2 . A method according to  claim 1 , wherein the preceding conducted atrial depolarization comprises a sensed atrial depolarization. 
     
     
         3 . A method according to  claim 2  further comprising delivering a pacing pulse to the ventricle following the sensed depolarization of the ventricle and wherein Tx is selected such that an atrial depolarization resulting from the delivered ACP atrial pacing pulse is not conducted to the ventricle because the ventricle is in a refractory state due to the delivered ventricular pacing pulse. 
     
     
         4 . . A method according to  claim 1 , wherein the conducted atrial depolarization comprises a paced atrial depolarization. 
     
     
         5 . A method according to  claim 4  further comprising delivering a pacing pulse to the ventricle following the sensed depolarization of the ventricle and wherein Tx is selected such that an atrial depolarization resulting from the delivered ACP atrial pacing pulse is not conducted to the ventricle because the ventricle is in a refractory state due to the delivered ventricular pacing pulse. 
     
     
         6 . An implantable cardiac pacemaker, comprising :
 means for sensing depolarizations of an atrium and a ventricle of a patient's heart;   means for delivering atrial pacing pulses to the atrium of the patient's heart; and   means for, at a selected time Tx following a sensed depolarization of the ventricle resulting from a preceding conducted atrial depolarization, delivering an atrial coupled (ACP) atrial pacing pulse;   wherein Tx is selected such that an atrial depolarization resulting from the delivered ACP atrial pacing pulse is not conducted to the ventricle because the ventricle is in a refractory state.   
     
     
         7 . A pacemaker according to  claim 6 , wherein the preceding conducted atrial depolarization comprises a sensed atrial depolarization. 
     
     
         8 . A pacemaker according to  claim 7  further comprising means for delivering a pacing pulse to the ventricle following the sensed depolarization of the ventricle and wherein Tx is selected such that an atrial depolarization resulting from the delivered ACP atrial pacing pulse is not conducted to the ventricle because the ventricle is in a refractory state due to the delivered ventricular pacing pulse. 
     
     
         9 . . A pacemaker according to  claim 6 , wherein the conducted atrial depolarization comprises a paced atrial depolarization. 
     
     
         10 . A pacemaker according to  claim 6  further comprising means for delivering a pacing pulse to the ventricle following the sensed depolarization of the ventricle and wherein Tx is selected such that an atrial depolarization resulting from the delivered ACP atrial pacing pulse is not conducted to the ventricle because the ventricle is in a refractory state due to the delivered ventricular pacing pulse.