PACEMAKER WITH DETECTION OF ATRIAL ACTIVITY WITHOUT COLLECTION OF ATRIAL ELECTRICAL ACTIVITY

摘要

The invention relates to an active implantable pacemaker. The device analyzes a ventricular electrogram signal (EGM) and is able to recognize, in a search window, an EA4 component of endocardial acceleration (EA) associated with atrial activity. In the presence of atrioventricular conduction, the search window is determined based on the temporal position of the EA1 and/or EA2 components of the EA signal. In the absence of atrioventricular conduction, a delay is counted from a paced ventricular event and applied to mask the EA1 and/or EA2 components in the EA signal, and the window for research of the EA4 component follows the masking delay. In the presence of a confirmed EA4 component, an atrioventricular delay is applied, counted from the EA4 component, and in the opposite case a predetermined escape interval is applied, counted from the last stimulated ventricular event.

主权项

1. An active implantable medical device, such as a cardiac pacemaker for stimulation,
resynchronization and/or defibrillation, comprising: an acceleration sensor adapted to deliver an endocardial acceleration (EA) signal, representative of the cyclic contractions of the myocardium; and a stimulation electrode; a processor configured to:
detect ventricular events by analysis of a ventricular electrogram (EGM) signal;trigger ventricular stimulation via the stimulation electrode;apply an atrioventricular delay (AVD), counted from an atrial event and at the end of which a ventricular pacing is delivered in the absence of detection of a spontaneous ventricular event; andanalyze the EA signal, wherein the analysis comprises recognizing and isolating in the EA signal an EA4 component corresponding to the fourth peak of endocardial acceleration associated with atrial activity, wherein the device does not collect an atrial EGM signal and wherein the processor is further configured to:
determine a search window of the EA4 component in the EA signal;confirm the presence or absence of an EA4 component in the search window; andapply to the ventricular stimulation means:
the AVD in the presence of a confirmed EA4 component; ora predetermined escape interval in the absence of a confirmed EA4 component, wherein the determination of the search window comprises:
a) in the presence of atrioventricular conduction:
detecting the time of occurrence of a ventricular event from the ventricular EGM signal;detecting in the EA signal EA1 and/or EA2 components corresponding to the respective first and/or second peaks of endocardial acceleration associated with the ventricular event; anddetermining the search window of the EA4 component depending on the temporal position of the detected EA1 and/or EA2 components, andb) in the absence of atrioventricular conduction:
applying a masking delay of the EA1 and/or EA2 components in the EA signal, counted from a paced ventricular event; anddetermining the search window of the EA4 component after the masking delay.