Post long pause overdrive pacing in response to atrial tacharrhythmia episode

Abstract

This disclosure provides for methods and apparatus for preventing an early recurring atrial fibrillation and atrial flutter (AF) episode (herein “ERAF”). Some aspects of the foregoing involve commencing atrial overdrive pacing therapy delivery at an overdrive pacing rate upon detection of one of: (i) an AF episode and (ii) a relatively long pause between successive sensed P-waves during an AF episode. The AF episode typically has a cycle length interval of between about 100 ms and 300 ms, and the relatively long pause has a duration of between about 40 ms and 100 ms longer than the cycle length of the AF episode. Atrial overdrive pacing is delivered for a relatively short period of time after successful termination of the AF episode. Subsequently, the atrial pacing rate is rapidly decreased until either normal sinus rhythm or a lower programmed pacing rate is reached.

1 . A method of preventing an early recurring episode of atrial fibrillation or flutter (AF episode), comprising:
 detecting an ongoing AF episode;   sensing a relatively long pause during said ongoing AF episode;   initiating delivery of atrial overdrive pacing responsive to said sensed relatively long pause and continuing delivery until a termination of the ongoing AF episode occurs;   sustaining delivery of said atrial overdrive pacing subsequent to said termination; and   upon expiration of a relatively short post-AF termination time period rapidly reducing an atrial pacing rate until one of a normal sinus rhythm emerges and a lower programmed pacing rate is reached.   
     
     
         2 . A method according to  claim 1 , wherein the relatively short post-AF termination time period comprises between about ten seconds and about 30 minutes. 
     
     
         3 . A method according to  claim 1 , wherein the relatively short post-AF termination time period a programmable time period and said time period comprises between approximately one minute and less than about 60 minutes. 
     
     
         4 . A method according to  claim 1 , wherein rapidly reducing the rate comprises reducing the rate within less than about five seconds. 
     
     
         5 . A method according to  claim 1 , wherein rapidly reducing the rate comprises reducing the rate within less than about three seconds. 
     
     
         6 . A method according to  claim 1 , wherein rapidly reducing the rate comprises reducing the rate within less than about five cardiac cycles. 
     
     
         7 . A method according to  claim 1 , wherein rapidly reducing the rate comprises reducing the rate within less than about three cardiac cycles. 
     
     
         8 . A method according to  claim 1 , wherein delivering atrial overdrive pacing therapy to at least one of a left atria and a right atria comprises delivering the therapy via one of: a least one epicardial patch-type electrode, at least one electrode adapted to be disposed within an atrial chamber, at least one electrode adapted to be disposed within a portion of a cardiac vein. 
     
     
         9 . A computer readable medium adapted to execute stored executable instructions to prevent an early recurring episode of atrial fibrillation or flutter (AF episode), comprising:
 executable instructions for detecting an ongoing AF episode;   executable instructions for sensing a relatively long pause within said ongoing AF episode;   executable instructions for delivering atrial overdrive pacing therapy to at least one of a left atrium and a right atrium initiated responsive to sensing the sensed relatively long pause;   executable instructions for sustaining delivery of said atrial overdrive pacing until one of: a programmable duration expires, an on-going atrial tachycardia is sensed, a newly detected atrial tachycardia is declared; and   executable instructions for rapidly reducing an atrial pacing rate upon expiration of a relatively short post-AF termination time period until one of a normal sinus rhythm emerges and a lower programmed pacing rate is reached.   
     
     
         10 . A medium according to  claim 9 , wherein the relatively short post-AF termination time period comprises between about ten seconds and about 30 minutes. 
     
     
         11 . A medium according to  claim 9 , wherein the relatively short post-AF termination time period a programmable time period and said time period comprises between approximately one minute and less than about 60 minutes. 
     
     
         12 . A medium according to  claim 9 , wherein rapidly reducing the rate comprises reducing the rate within less than about five seconds. 
     
     
         13 . A medium according to  claim 9 , wherein rapidly reducing the rate comprises reducing the rate within less than about three seconds. 
     
     
         14 . A medium according to  claim 9 , wherein rapidly reducing the rate comprises reducing the rate within less than about five cardiac cycles. 
     
     
         15 . A medium according to  claim 9 , wherein rapidly reducing the rate comprises reducing the rate within less than about three cardiac cycles.