Physiologic control of pacemaker rate using pre-ejection interval as the controlling parameter

摘要

A multi-pole pacing/sensing lead is used to measure the instantaneous impedance in the right ventricle of a patient's heart. The resulting impedance waveform is signal processed to obtain a measure of the time interval beginning with the occurrence of a paced beat or a spontaneous QRS complex (systole marker) and ending with the point where the impedance versus time signal crosses the zero axis in the positive direction following the paced or spontaneous QRS complex initiating the interval or some other predetermined point along the positive-going waveform. The resulting time interval is inversely proportional to the contractility of the heart and is found to decrease with exercise and the introduction of catecholamines. Thus, it can be used as a control parameter for a demand-type cardiac pacemaker. A means for obviating changes in pacing rate due to long-term drift in the impedance sensing circuitry is also disclosed.