CN107480413B - Medical equipment for treating arrhythmia and atrioventricular interval searching method thereof - Google Patents
Medical equipment for treating arrhythmia and atrioventricular interval searching method thereof Download PDFInfo
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- CN107480413B CN107480413B CN201610399146.7A CN201610399146A CN107480413B CN 107480413 B CN107480413 B CN 107480413B CN 201610399146 A CN201610399146 A CN 201610399146A CN 107480413 B CN107480413 B CN 107480413B
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/362—Heart stimulators
- A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/362—Heart stimulators
- A61N1/37—Monitoring; Protecting
- A61N1/3702—Physiological parameters
Abstract
The invention provides a medical device for treating arrhythmia, which comprises a microprocessor and a digital/analog module connected with the microprocessor, wherein the microprocessor comprises a main control unit and a time control unit, the main control unit comprises an AV interval search control unit, the digital/analog module comprises a pacing control/generation unit and a sensing control/amplification unit, the main control unit is configured to set SAV/PAV to be an upper limit U L _ SAV/U L _ PAV, carries out AV interval search, and then shortens the AV interval from the upper limit to a new AV interval value more consistent with the instant condition of a patient according to the measured AV interval.
Description
Technical Field
The present invention relates generally to medical devices, and more particularly to a medical device for treating cardiac arrhythmias.
Background
The heart pacemaker is an electronic therapeutic apparatus implanted in a human body, and electric pulses powered by a battery are delivered by a pulse generator, and conducted by an electrode lead wire, the cardiac muscle contacted by an electrode is stimulated, so that the heart is excited and contracted, and the aim of treating heart dysfunction caused by certain arrhythmia is fulfilled.
It is important to reduce unnecessary ventricular pacing and encourage self-atrioventricular conduction in patients with dual chamber pacemakers, and to reduce the incidence of atrial fibrillation and heart failure in these patients, particularly those with reduced left ventricular function. Various techniques have been developed to achieve this, one is to apply new pacing "modes" such as ventricular pacing Management (MVP) or SafeR, and another is to extend the Paced Atrioventricular interval (PAVI) and the Sensed Atrioventricular interval (SAVI) to encourage more self-conduction and reduce ventricular pacing. In the latter technique, the pacemaker typically gradually extends the atrioventricular interval starting from the programmed PAVI/SAVI to a programmable incremental value (Δ AVI) of some degree to allow self-conduction. The ventricular pacing percentage (VP%) is monitored during this process to determine if a longer atrioventricular interval is required. If most heartbeats require pacing during the search, PAVI/SAVI will return to the initial setting.
However, current atrioventricular interval searching methods require a long time to search for the own Atrioventricular (AV) interval. And although the patient's own atrioventricular interval was searched, the patient's atrioventricular interval was not recorded. The result is that the characteristics of the patient's inter-atrioventricular changes are not clinically known, and only the same maximum atrioventricular deviation value is used for all patients.
Disclosure of Invention
The technical problem to be solved by the invention is to provide medical equipment for treating arrhythmia and an atrioventricular interval searching method thereof, which can search the AV interval of the medical equipment to achieve the physiological pacing target.
The present invention provides a medical device for treating arrhythmia, including a microprocessor and a digital/analog module connected with the microprocessor, the microprocessor includes a main control unit, a time control unit and a first data/information interaction interface, the main control unit includes an AV interval search control unit, the digital/analog module includes a pacing control/generation unit, a sensing control/amplification unit and a second data/information interaction interface, the time control unit includes a first timer and a second timer, the first data/information interaction interface is connected with the second data/information interaction interface for communication, the main control unit after detecting by implantation sets an initial value of SAV and PAV AS N _ SAV and N _ PAV respectively according to the type of atrial event, and after the waiting time set by the device is over, the main control unit starts the AV interval search interval, measures and stores AP-VS intervals in N cardiac cycles, AP-VP, AS-VP and R-R search interval, and AP-VP are set again, the number is equal to N _ VP, the number of APV search interval and AV interval is equal to N _ VP, and the last APV search interval is equal to N _ VP, the number of APV search interval, the APV search interval is set, the APV search interval is set to N _ VP and the last APV search interval, the APV search interval is set to N _ VP, the APV search interval, the APV-VP is set to be equal to N _ VP and the APV search interval, the APV search interval is set to be equal to the number of APV-VP, the APV search interval is set to be equal to the APV-VP and the APV search interval, the last APV search interval, the number of APV-VP is set to the APV search interval, the APV search interval is set to be equal to the APV search interval.
In an embodiment of the present invention, after setting the initial values of the SAV and PAV, the main control unit is further configured to send a signal to the time control unit, and control the first timer or the second timer to enter a timing mode, where the first timer corresponds to the SAV and the second timer corresponds to the PAV, and if the ventricular event VS sensed by the sensing control/amplification unit is not received by the main control unit during the interval between the SAV and the PAV, the main control unit sends a VP signal to the pacing control/generation unit.
In one embodiment of the present invention, in a new round of AV interval searching, if the SAV and PAV intervals expire and the master control unit has not received a VS sensed by the sensing control/amplification unit, the master control unit sends a VP signal to the pacing control/generation unit.
In one embodiment of the present invention, when the main control unit sets new SAV and PAV, first set SAV and PAV to AVS _ max + X, then compare the setting value with U L _ SAV and U L _ PAV, if SAV < U L _ SAV and PAV < U L _ PAV, the main control unit keeps the SAV and PAV set to the setting value unchanged, if SAV ≧ U L _ SAV and PAV ≧ U L _ PAV, the main control unit sets SAV and PAV to U L _ SAV and U L _ PAV, respectively.
In one embodiment of the present invention, after the main control unit keeps the SAV and PAV set to the set values unchanged, the main control unit continuously measures and stores AP-VS, AP-VP, AS-VS, AS-VP and R-R intervals until the number of VP in the latest N heartbeats is equal to or greater than M, sets SAV and PAV to U L _ SAV and PAV to U L _ PAV, starts a new round of AV interval search after waiting for a cardiac cycles, calculates whether the number of VP in the latest N cardiac cycles is equal to or greater than M in the new round of AV interval search, and if the number of VP in N cardiac cycles is equal to or greater than M, the main control unit resets SAV and PAV back to N _ SAV and N _ PAV, ends the AV search interval, and starts the new search again after the waiting time set by the apparatus ends.
In one embodiment of the present invention, the main control unit sets the SAV and the PAV to U L _ SAV and U L _ PAV, respectively, and then the main control unit starts a new round of AV interval search, and in the new round of AV interval search, the main control unit calculates whether the number of VP in the latest N cardiac cycles is more than or equal to M, if the number of VP in the N cardiac cycles is more than or equal to M, the main control unit resets the SAV and the PAV back to N _ SAV and N _ PAV, and the AV interval search is finished, and the new search is started again after the waiting time set by the device is finished.
In an embodiment of the present invention, the digital/analog module further includes a program control unit, and the external program controller exchanges data with the program control unit and generates a histogram of the a-V interval values corresponding to the heart rate and a time variation histogram of the R-R interval values between two queries.
The invention also provides an atrioventricular interval search method, which comprises the steps of starting an AV interval search after detection by implantation, setting initial values of SAV and PAV AS N _ SAV and N _ PAV respectively according to the category of atrial events, starting the AV interval search after waiting for A cardiac cycles, measuring and storing AP-VS, AP-VP, AS-VS, AS-VP and R-R intervals in the N cardiac cycles, waiting for B cardiac cycles if less than M cardiac cycles are VP in the last N cardiac cycles in the N _ SAV and N _ PAV states, measuring and storing AP-VS, AP-VP, AS-VS, AS-VP and R-R intervals in the B cardiac cycles, calculating the maximum A-VS interval (A-VS) AVS _ max, setting a new SAV interval and PAV interval, ending the interval search, if the N cardiac cycles are VP, AS-VS and R intervals in the N _ VP states, setting the maximum A-VS interval search interval max (A-VS) to be equal to 35max, setting a new SAV interval to be equal to VP and PAV interval after the last cardiac cycles, and starting the last APV interval search if the number of the last APV interval is equal to 35VP, the last cardiac cycles is equal to 35V interval, and the last cardiac cycles are set to be equal to an AV interval, and the number of the APV intervals, and the APV-VP is equal to an AV interval, and the last cardiac cycles, and the number of the APV-VP is set to be equal to an AV interval after the last cardiac cycles, and the last cardiac cycles, wherein the number of the APV is equal to 35M-VP, and the APV cycles, and the number of the APV cycles is set to be equal to an integer, and the number of the APV-VP, and the number of the APV cycles, and the APV cycles is set to be equal to an AV cycles, and the number of the last cardiac.
In one embodiment of the invention, after setting the initial values of the SAV and PAV, respectively, the SAV and PAV intervals are also clocked, and if no ventricular event VS is received within the SAV and PAV intervals, a VP signal is sent.
In one embodiment of the present invention, in a new round of AV interval searching, a VP signal is sent if the VS has not been received at the SAV and PAV interval expiration.
In one embodiment of the present invention, when setting new SAV and PAV, firstly, both SAV and PAV are set to AVS _ max + X, then the new setting values are compared with U L _ SAV and U L _ PAV, if SAV < U L _ SAV and PAV < U L _ PAV, both SAV and PAV are set to AVS _ max + X, if SAV ≧ U L _ SAV, and PAV ≧ U L _ PAV, both SAV and PAV are set to SAV L _ SAV and PAV ═ U L _ PAV, respectively.
In one embodiment of the present invention, after setting both SAV and PAV to AVS _ max + X, AP-VS, AP-VP, AS-VS, AS-VP, and R-R intervals are also measured and stored continuously until the number of VP in the most recent N heartbeats is equal to or greater than M, if the number of VP in N cardiac cycles is equal to or greater than M, the main control unit resets SAV and PAV back to U L _ SAV and U L _ PAV, and the new search will start again after A cardiac cycles.
In one embodiment of the invention, after setting the SAV and the PAV to be U L _ SAV and U L _ PAV respectively, a new round of AV interval search is started, whether the number of VP in the latest N cardiac cycles is more than or equal to M or not is calculated in the new round of AV interval search, if the number of VP in the N cardiac cycles is more than or equal to M, the SAV and the PAV are reset to be N _ SAV and N _ PAV, the AV interval search is ended, and the new search is started again after the waiting time set by the equipment is ended.
In an embodiment of the present invention, the method further includes generating a histogram of AV interval values between two queries corresponding to the heart rate and a histogram of time variation corresponding to R-R interval values.
Compared with the prior art, the medical equipment and the atrioventricular interval searching method do not gradually increase the AV interval in the searching process, but directly set the SAV/PAV to the upper limit value of the programmable searching range. If there is significant Ventricular Sense (VS) on this AV interval, the pacemaker measures an atrial pacing AV interval (AP-V) and an atrial sense AV interval (AS-V), and then shortens the AV interval from the upper limit to a new AV interval value that is more consistent with the patient's immediate condition based on the measured AV interval.
Drawings
Fig. 1 is a block circuit diagram of a medical device for treating cardiac arrhythmia according to an embodiment of the present invention.
Fig. 2-3 are flow charts of the atrioventricular interval search method according to an embodiment of the present invention.
Detailed Description
In order to make the aforementioned objects, features and advantages of the present invention comprehensible, embodiments accompanied with figures are described in detail below.
In the following description, numerous specific details are set forth in order to provide a thorough understanding of the present invention, but the present invention may be practiced in other ways than those specifically described herein, and thus the present invention is not limited to the specific embodiments disclosed below.
Fig. 1 is a block circuit diagram of a medical device for treating cardiac arrhythmia according to an embodiment of the present invention. Referring to fig. 1, the medical apparatus 100 for treating arrhythmia of the present embodiment is a cardiac pacemaker, and includes a microprocessor 110 and a digital/analog module 120 connected to the microprocessor 110. The cardiac pacemaker searches for an Atrioventricular (AV) interval conduction of the patient to set the AV interval of the device, achieving the purpose of physiological pacing. Here, the selection and implementation of the microprocessor 110 are not limited. The digital/analog module 120 can sense external signals and output signals to the outside, and can perform data information interaction with the outside and the microprocessor 110.
The microprocessor 110 may include a main control unit 111, a time control unit 112, and a data/information interaction interface 113. The main control unit 111 may include an AV interval search control unit 111a and a data storage unit 111 b. The AV interval search control unit 111a is configured to control AV interval search initiation. The data storage unit 111b stores data generated during the operation of the microprocessor 110. The time control unit 112 has at least two timers, 3 timers are shown in the figure, namely a first timer 112a, a second timer 112b and a third timer 112 c.
Digital/analog module 120 may include a pacing control/generation unit 121, a sensing control/amplification unit 122, a programming unit 123, and a data/information interaction interface 124. The pacing control/generation unit 121 accepts a pacing request from the main control unit 111 and generates a signal of required intensity to be applied to the outside while assuming a small part of the control function. This part of the control functions differs according to differences in the objects to be acted upon, the strength, type, etc. of the signals. The sensing control/amplification unit 122 can capture and distinguish external real signals, such as cardiac signals, and inform the microprocessor 110 thereof, and can amplify the signals. The program control unit 123 can interact with the outside world, such as a user.
Here, the data/information interaction interface 124 is connected to the data/information interaction interface 113 to perform communication. The data/ information interaction interfaces 113 and 124 may be general I/O interfaces, and may also be serial or parallel data transmission modules. In this embodiment, the data/information interface 113 is capable of accepting sensed event information, issuing pacing event requests, serial data transactions, clock data transactions, and the like.
The main control unit 111 can receive and process the event occurrence message transmitted from the digital/analog module 120, and control the event to be occurred, etc. The main control unit 111 can selectively implement timing, time counting, and other time-related control functions by the time control unit 112. Accordingly, the time control unit 112 can capture and record the time of the event, and can control the accurate time of the event.
In the main control unit 111, the AV interval search control unit 111a continuously records ventricular events for each cardiac cycle (i.e., heart beat), and determines whether to activate the AV interval search function according to the ratio of ventricular sensed events (VS) to ventricular paced events (VP) in the successive cardiac cycles. The data storage unit 112b may store atrial sense-ventricular sense (AS-VS), atrial pace-ventricular sense (AP-VS), atrial pace-ventricular pace (AP-VP), atrial sense-ventricular pace AS-VP, and R-R intervals measured by the main control unit 111.
The main control unit 111 sets the medical device 100 to operate in a dual chamber (DDD) operating mode, and after receiving an atrial sensed event signal or sending an atrial pacing signal, the main control unit 111 sets an atrioventricular interval (sensed atrioventricular interval SAV or paced atrioventricular interval PAV, both of which belong to AV intervals), and sends a signal to the time control unit 112, and makes the first timer 112a or the second timer 112b enter a timing mode, where the timed duration is the AV interval, which is used as a ventricular pacing interval after the atrial event, and is used to provide accurate time for the occurrence of the ventricular pacing event. After receiving a ventricular sensed event signal or sending a ventricular pacing signal, the main control unit 111 sets a ventricular atrial interval (VA interval) and sends a signal to the time control unit 112, so that the third timer 112c enters a timing mode, and the timed duration is the VA interval and is used as the next atrial pacing escape interval.
Upon receiving a signal from the sensing control/amplification unit 122 that an atrial event (AS) is sensed during the VA interval, the main control unit 111 sets the AV interval to the SAV interval, and sends a signal to the time control unit 112 to control the first timer 112a to enter the timing mode for the SAV interval.
If a signal that the sensing control/amplification unit 122 senses an atrial event internally is not received during the VA interval, the main control unit 111 transmits an Atrial Pacing (AP) signal to the pacing control/generation unit 121 to set the AV interval to the PAV interval and transmits a signal to the time control unit 112 to control the second timer 112b to enter a timing mode for the PAV interval.
Upon receiving a signal from the sense control/amplification unit 122 that a ventricular event is sensed during an interval of SAV or PAV, the main control unit 111 sends a message to the time control unit 112 to terminate the timing of the first timer 112a or the second timer 112 b.
After completing implant detection, the main control unit 111 initially sets the SAV and PAV intervals to N _ SAV and N _ PAV (N _ SAV and N _ PAV are programmable, N _ SAV ranges from 120-. The main control unit 111 will accordingly send a signal to the time control unit 112 to control the first timer 112a or 112b to enter the timing mode. The main control unit 111 sets the initial inter-SAV period value to N _ SAV, and sends a signal to the time control unit 112 to control the first timer 112a to enter the timing mode. The main control unit 111 sets the initial inter-PAV period value to N _ PAV and sends a signal to the time control unit 112 to control the second timer 112b to enter the timing mode.
AS described above, in the nominal value of the SAV/PAV interval, when receiving a ventricular event (VS) sensed by the sensing control/amplification unit 122, the main control unit 111 measures an AS-VS interval or an AP-VS interval and stores the measured AS-VS interval or AP-VS interval in the data storage unit 111 b; if the main control unit 111 does not receive the VS sensed by the sensing control/amplification unit 122 within the nominally valued SAV/PAV interval, the main control unit 111 transmits a signal for ventricular pacing to the pacing control/generation unit 121 and measures the AS-VP interval or the AP-VP interval and stores in the data storage unit 111 b. This is the AV interval measurement for one cardiac cycle.
After the wait time set by the master control unit 111 has expired, a search is performed for N (N positive integer and programmable, e.g., 8-64, nominal value of 16) cardiac cycles, then the master control unit 111 calculates the number of VP events in N cardiac cycles, if there are VP events in N cardiac cycles that are less than M/N (M/N programmable, range of M/N is e.g., 4/8-32/64, nominal value 8/16 in this embodiment), after waiting for B cardiac cycles, the master control unit 111 measures the AS-VS or AP-VS of each cardiac cycle and stores it in the data storage unit 111B, then the master control unit 111 calculates the largest AV-VS and master control-VS intervals AS-VS _ max and AP-VS _ max, and stores AS-VS _ max and AP-VS _ max, then the master control unit 111 sets the savv interval and PAV interval to maximum values AS-max + X and AP-VS _ max + X (X is a, range of 50, the search for AP-v interval is equal to AP-v _ interval, and stores the number of AP-v interval and AP-v interval is equal to AP-v _ v interval # v _ interval + VP _ max + AP + v _ interval + AP + v _ interval + v _ interval, and stores it is equal to AP _ v _ interval (AP _ v _ interval) and AP _ v _ interval) a + v _ interval + v _ interval + v _ interval, and AP _ v.
If the AS-VS _ max + X and the AP-VS _ max + X are both determined to be greater than or equal to U L _ SAV and U L _ PAV, the main control unit 111 sets the SAV interval and the PAV interval to be U L _ SAV and U L _ PAV, respectively, and sends signals to the time control unit 112, controls the first timer 112a or the second timer 112b to enter a timing mode, completes AV interval search, and then the main control unit 111 measures AP-VS, AP-VP, AS-VS, AS-VP, and R-R intervals during the period of time and stores the data in the data storage unit 111 b.
If there are more than or equal to M/N (M/N programmable, M/N ranges such AS 4/8-32/64, nominal value 8/16 in this embodiment) of N cardiac cycles, the main control unit 111 sets the SAV and PAV to U L _ SAV and U L _ SAV, U L _ SAV ═ N _ SAV + Δ, U L _ SAV ═ N _ SAV + Δ (programmable, range is 50-450 ms, nominal value is 350ms in this embodiment) and sends a signal to the time control unit 112, which controls the main control unit 112a or the main control unit 112B to enter the timed mode, if there are more than two consecutive N cardiac cycles after the main control unit 111B has started the timed interval, the main control unit 111 starts a new cycle of AV search, the interval of the AV search interval of the new cycle, the SAV 632 _ SAV and U L _ SAV search interval of the AP v search interval is equal to the timed interval of N + v _ SAV _ v _ interval, the AP _ interval of N _ SAV _ v _ interval, the AP _ interval search interval, the AP _ v _ interval search interval, and the AP _ v interval of N _ interval, the AP _ interval search interval, and the AP _ v interval, the AP _ interval search interval, and the AP _ v search interval are equal to the AP _ v interval, and the AP _ interval of the AP _ v _ interval, and the AP _ v _ interval, and the AP _ interval of the AP _ interval, and the AP _ interval are equal to the AP _ v _ interval, and the AP _ interval of the interval, and the AP _ v _ interval, and the interval of the AP _ v _ interval of the AP _ interval, and the AP _ v _ interval, respectively, the AP _ interval, the interval, and the AP _ interval, and the interval of the AP _ v _ interval of the AP _ v _ interval, the AP _ v _ interval are set, and the AP _ interval, and the AP _ v _ interval, and the AP _ interval, the AP _ interval are equal to the interval, and the AP _ v _ interval, and the AP _ interval are equal to the AP _ interval, and the AP _ v _ interval are set, respectively, and the AP _ v _.
After the device starts to operate, the main control unit 111 measures each AS _ VS, AP _ VS, AS _ VP and AP _ VP interval and R _ RV interval, the data are continuously stored in the data storage unit 111b of the main control unit 111, when the main control unit 111 receives information that the program control unit 123 calls the data, the main control unit 111 sends the data in the data storage unit 111b to the program control unit 123, the external program controller exchanges data with the program control unit 123 and generates two histograms, and AV-VS and AP-VS correspond to Heart Rate (HR) and AV-VS, AP-VS and HR correspond to time (24 hours).
FIG. 2 is a flow chart of a method of atrioventricular interval search in accordance with an embodiment of the present invention. Referring to fig. 2, the method comprises, from the perspective of the master control unit, the steps of:
first, the AV conduction status in the initial state is confirmed. About 30 minutes after implantation, after the device implanted in the patient has passed the implantation test at step 201, in step 202, the main control unit 111 sets the SAV interval (SAVI) and PAV interval (PAVI) according to the type of atrial event, with the initial values N _ SAVI and N _ PAVI (N _ SAVI and N _ PAVI are programmable, with nominal values of 150ms and 170ms), respectively, whereupon the main control unit 111 sends a signal to the time control unit 112, controlling the first timer 112a or 112b to enter a timing mode, during the nominal SAV/PAV interval, the main control unit 111 receives the ventricular sense event (VS) sensed by the sense control/amplification unit 122, if, during the SAV and PAV intervals, master control unit 111 does not receive a ventricular sense event sensed by sense control/amplification unit 122, the main control unit 111 sends a ventricular pacing signal to the pacing control/generation unit 122. The AV interval search control unit 111a then initiates an AV interval search. The main control unit 111 then measures the N cardiac cycles AP-VS, AP-VP, AS-VS, AS-VP and R-R interval at step 203 and stores these data in the data storage unit 111b at step 204.
In the N _ SAVI/N _ PAVI state, if it is determined in step 205 that less than M (M is a positive integer) cardiac cycles in the last N cardiac cycles are ventricular pacing signals, step 210 waits again for B cardiac cycles, then in step 211 the main control unit 111 measures the AS-VS or AP-VS interval for each cardiac cycle and stores it in the data storage unit 111B, the main control unit 111 calculates in step 212 the maximum AV-VS and AP-VS intervals AS-VS _ max and AP-VS _ max and stores them, in step 213 the main control unit 111 sets the SAV interval and PAV interval to maximum values AS-VS _ max + X and AP-VS _ max + X, respectively (X can be programmed to range from 50 to 450ms, nominal value is 50ms), and compares it with the current U34 _ SAV and U L _ PAV, if the AS-VS + X and AP-VS intervals are both 50ms, nominal value is 50ms, and the AP-VS interval is equal to the current U L _ SAV interval, and if it is equal to the AS _ VS interval is equal to the last V interval, step 112, step 213, the AS _ VS interval is found to be equal to the last AV interval, step 112, the AS _ VS interval is found to be equal to step 112, the step 217 and the step 213, the step 220, the step 213, the step 220, the step of sending back to the step of sending a control unit detects the AS-VS interval and the AS-VS interval is found to a timer control unit detects the last AV interval, and the step 112a step 213, and a step of sending a step 112a, and a step of sending a step 112 a.
Referring back to step 205, if it is determined that M (M is a positive integer) or more cardiac cycles in the last N cardiac cycles are ventricular pacing signals, the main control unit 111 sets the SAV and PAV to U L _ SAV and U L _ PAV in step 206, after waiting a cardiac cycles in step 207, the AV interval search control unit 111a starts a new round of AV interval search, the SAV and PAV intervals are U L _ SAV and U L _ PAVI, respectively, the main control unit 111 measures the AP-VS, AP-VP, AS-VS, AS-VP and R-R intervals during the period and stores these data in the data storage unit 111B in step 208, the main control unit 111 determines whether the number of AV interval search signals in the last N cardiac cycles is equal to or more than M, if the number of ventricular pacing signals in N cardiac cycles is equal to or more than M, the main control unit 111 returns to step 202 sets the SAV and PAV intervals to N _ SAV and N _ VP search, stores the number of AV interval search signals in the last N-VP search interval in step 209, and calculates the last N-VP search time after the step 211, the AV interval search is finished, and the step 211, the last N-VP search is finished, and the AV interval is calculated AS-VP after the step 209, the last step 211, the last AV interval is calculated.
When the programmer inquires the device 100, the main control unit 111 receives the information that the programmer 123 calls the data, and the main control unit 111 sends the data in the data storage unit 111b until the time of the last programmer inquiry to the programmer 123, wherein the data comprise the measurement of each AS _ VS interval, AP _ VS interval, AS _ VP interval, AP _ VP interval and V _ V interval by the main control unit 111. The external programmer exchanges data with the programming unit 123 and generates a histogram of the a-V interval values corresponding to the heart rate and a time variation histogram of the R-R interval values between two queries. The physician can observe the patient's heart rate distribution between visits, the AV interval corresponding to the heart rate, and the patient's heart rate status over different time periods.
In the medical device and the method for searching for an interatrial interval according to the above embodiments of the present invention, the AV interval is not gradually increased during the search, but the SAV/PAV is directly set to the upper limit value of the programmable search range. If there is significant Ventricular Sense (VS) on this AV interval, the pacemaker measures an atrial pacing AV interval (AP-V) and an atrial sense AV interval (AS-V), and then shortens the AV interval from the upper limit to a new AV interval value that is more consistent with the patient's immediate condition based on the measured AV interval. A histogram of AV intervals and corresponding heart rates is stored in the device for the user to use as a reference for setting future upper limits, while also knowing the relationship between HR and PR intervals. Embodiments of the present invention are more personalized than conventional approaches, and extending the search range directly to the upper limit initially may make the search faster and thus reduce Ventricular Pacing (VP) more quickly. The histogram of the AV interval corresponding to the heart rate and the two corresponding times is new, and the application of this information to guide future programming will make the programming more personalized and the setting of the parameters more appropriate for each patient.
Although the present invention has been described with reference to the present specific embodiments, it will be appreciated by those skilled in the art that the above embodiments are merely illustrative of the present invention, and various equivalent changes and substitutions may be made without departing from the spirit of the invention, and therefore, it is intended that all changes and modifications to the above embodiments within the spirit and scope of the present invention be covered by the appended claims.
Claims (14)
1. A medical device for treating cardiac arrhythmias, comprising a microprocessor and a digital/analog module connected to the microprocessor, wherein:
the microprocessor comprises a main control unit, a time control unit and a first data/information interaction interface, wherein the main control unit comprises an AV interval search control unit, the digital/analog module comprises a pacing control/generation unit, a sensing control/amplification unit and a second data/information interaction interface, the time control unit comprises a first timer and a second timer, and the first data/information interaction interface is connected with the second data/information interaction interface for communication;
after the detection of the implant, the master control unit is configured to set the initial values of SAV and PAV to N _ SAV and N _ PAV, respectively, and after the waiting time set by the device has ended, to cause the AV interval search control unit to initiate an AV interval search, to measure and store AP-VS, AP-VP, AS-VS, AS-VP and R-R intervals in N cardiac cycles, to calculate the largest A-VS interval S _ max if there are less than M cardiac cycles in the last N cardiac cycles, to wait for B cardiac cycles, to measure and store AP-VS, AP-VP, AS-VS, AS-VP and R-R intervals in the B cardiac cycles, to calculate the largest A-VS interval S _ max, to set the new SAV and PAV intervals, which ends if there are more than or equal to M cardiac cycles, to set the SAV interval search for N-VP and PAV intervals, to continue the AV interval search for N-VP, to calculate the largest AV interval S _ max, to continue the AV interval search for N-VS, to start the N-VP interval S _ VP and the N-VP interval, to search for N-VP interval S-VP, to finish, to calculate the largest AV interval S _ MP interval S _ VP and PAV interval S _ VP, to continue the number, to calculate the AV interval S _ MP interval S _ max, to calculate the AV interval S _ VP and the AV interval N _ VP to be equal to less than N-VP interval, to finish, to calculate the number, to finish, to continue to calculate the number, to calculate the AV interval, to finish after the number of the AV interval, to finish, to calculate the AV interval, to calculate the number of the AV interval S-VP and the APV interval S-VP to finish, to calculate the AV interval S-VP to finish, to finish the number of the AV interval S-VP to finish, to finish N _ VP to finish, to finish the AV interval to set the number of the AV interval to finish the AV interval, to finish the;
where AV is an atrioventricular interval, SAV is a sensed atrioventricular interval, PAV is a paced atrioventricular interval, VS is a ventricular event, VP is a ventricular pacing event, AS-VS is atrial sensing-ventricular sensing, AP-VS is atrial pacing-ventricular sensing, AP-VP is atrial pacing-ventricular pacing, AS-VP is atrial sensing-ventricular pacing, and R-R is a ventricular interval.
2. The medical apparatus for treating arrhythmia according to claim 1, wherein the main control unit, after setting the initial values of SAV and PAV, respectively, is further configured to send a signal to the timing control unit to control the first timer or the second timer to enter a timing mode, the first timer corresponding to SAV and the second timer corresponding to PAV, and the main control unit sends a VP signal to the pacing control/generation unit if the ventricular event VS sensed by the sensing control/amplification unit is not received within the interval of SAV and PAV.
3. The medical device of claim 1, wherein in a new round of the search for the AV interval, the master control unit sends a VP signal to the pacing control/generation unit if the VS sensed by the sensing control/amplification unit has not been received by the master control unit upon expiration of the SAV and PAV intervals.
4. The medical apparatus of claim 1, wherein the main control unit sets new SAV and PAV by first setting both SAV and PAV to AVS _ max + X, where X is a programmable time value, and then comparing SAV with U L _ SAV and PAV with U L _ PAV, if SAV < U L _ SAV and PAV < U L _ PAV, the main control unit keeps SAV and PAV set to AVS _ max + X unchanged, and if SAV ≧ U L _ SAV and PAV ≧ U L _ PAV, the main control unit sets SAV and PAV to U L _ SAV and U L _ PAV, respectively.
5. The medical device of claim 4, wherein the main control unit continuously measures and stores the AP-VS, AP-VP, AS-VS, AS-VP, and R-R intervals until the number of VPs in the last N heartbeats is equal to or greater than M, and sets the SAV and PAV to SAV = U L _ SAV and PAV = U L _ PAV, and initiates a new round of AV interval search after waiting a cardiac cycles, and wherein the main control unit calculates whether the number of VPs in the last N cardiac cycles is equal to or greater than M during the new round of AV interval search, and if the number of VPs in the N cardiac cycles is equal to or greater than M, the main control unit resets the SAV and PAV back to N _ SAV and N _ PAV, and the new round of AV interval search ends and the new search will begin again after the wait time set by the device ends.
6. The medical device of claim 4, wherein the main control unit sets the SAV and PAV to U L SAV and U L PAV, respectively, and initiates a new round of AV interval search, wherein in the new round of AV interval search, the main control unit determines whether the number of VP in the most recent N cardiac cycles is equal to or greater than M, and if the number of VP in the N cardiac cycles is equal to or greater than M, the main control unit resets the SAV and PAV back to N SAV and N PAV, and the AV interval search ends and the new search restarts after the wait time set by the device ends.
7. The medical device of claim 1, wherein the digital/analog module further comprises a programmable unit, and wherein the external programmer exchanges data with the programmable unit and generates a histogram of a-V interval values versus heart rate and a time-varying histogram of R-R interval values versus heart rate between queries.
8. An atrioventricular interval search method comprising the steps of:
initiating an AV interval search after passing implant detection;
setting the initial values of SAV and PAV to be N _ SAV and N _ PAV respectively according to the category of the atrial event;
after waiting for A cardiac cycles, starting AV interval search, measuring and storing AP-VS, AP-VP, AS-VS, AS-VP and R-R intervals in N cardiac cycles;
if in the N _ SAV state and the N _ PAV state, less than M cardiac cycles in the last N cardiac cycles are VP, waiting for B cardiac cycles, measuring and storing AP-VS, AP-VP, AS-VS, AS-VP and R-R intervals in the B cardiac cycles, calculating the maximum A-VS interval max (A-VS) AVS _ max, setting new SAV and PAV, and finishing the AV interval search;
if in the N _ SAV state and the N _ PAV state, more than or equal to M of the latest N cardiac cycles are VP, respectively setting SAV and PAV as SAV = U L _ SAV and PAV = U L _ PAV, wherein U L _ SAV = N _ SAV +, U L _ PAV = N _ PAV +, (is a programmable time value);
after A cardiac cycles, starting a new round of AV interval search;
calculating whether the number of the VPs in the latest N cardiac cycles is more than or equal to M, if the number of the VPs in the N cardiac cycles is more than or equal to M, resetting the SAV and the PAV to be N _ SAV and N _ PAV respectively, ending the AV interval search, and starting the new search again after the waiting time set by the equipment is ended;
if the number of the VPs in the N cardiac cycles is less than M, continuously waiting for the B cardiac cycles, measuring AP-VS, AP-VP, AS-VS, AS-VP and R-R intervals in the B cardiac cycles, calculating the maximum A-VS interval AVS _ max, finishing the AV interval search, and setting new SAV and PAV, wherein A, N, M and B are positive integers;
where AV is an atrioventricular interval, SAV is a sensed atrioventricular interval, PAV is a paced atrioventricular, VS is a ventricular event, VP is a ventricular paced event, AS-VS is atrial sense-ventricular sense, AP-VS is atrial pace-ventricular sense, AP-VP is atrial pace-ventricular pace, AS-VP is atrial sense-ventricular pace, and R-R is a ventricular interval.
9. The atrioventricular interval search method as claimed in claim 8, wherein after setting the initial values of SAV and PAV, respectively, the SAV and PAV intervals are also clocked, and a VP signal is sent if no ventricular event VS is received within the SAV and PAV intervals.
10. The atrioventricular interval search method as claimed in claim 8, wherein in a new round of AV interval search, a VP signal is sent if no VS has been received at the expiration of the SAV and PAV intervals.
11. The atrioventricular interval search method as claimed in claim 8, wherein when setting new SAV and PAV, first setting both SAV and PAV to AVS _ max + X, X being a programmable time value, then comparing SAV with U L _ SAV, PAV with U L _ PAV, if SAV < U L _ SAV and PAV < U L _ PAV, then setting both SAV and PAV to AVS _ max + X, if SAV ≧ U L _ SAV, PAV ≧ U L _ PAV, then setting SAV and PAV to SAV = U L _ SAV, PAV = U L _ PAV, respectively.
12. The atrioventricular interval search method AS claimed in claim 11, wherein after setting both SAV and PAV to AVS max + X, AP-VS, AP-VP, AS-VS, AS-VP and R-R intervals are also measured and stored continuously until the number of VP in the most recent N heartbeats is equal to or greater than M, and if the number of VP in N cardiac cycles is equal to or greater than M, the main control unit resets SAV and PAV back to U L SAV and U L PAV, and a new search will start again after a cardiac cycles.
13. The atrioventricular interval search method as claimed in claim 11, wherein after setting SAV and PAV to U L SAV and U L PAV, respectively, a new round of AV interval search is started, and in the new round of AV interval search, whether the number of VP in the most recent N cardiac cycles is equal to or greater than M is calculated, and if the number of VP in N cardiac cycles is equal to or greater than M, SAV and PAV are reset back to N SAV and N PAV, and the AV interval search is ended and the new search is started again after the waiting time set by the device is ended.
14. The atrioventricular interval search method as claimed in claim 8, further comprising generating a histogram of AV interval values corresponding to heart rate and a histogram of time variation corresponding to R-R interval values between queries.
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