Neurostimulation titration utilizing T-wave alternans
First Claim
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1. A method of operating an implantable medical device (IMD) comprising a neurostimulator coupled to an electrode assembly, said neurostimulator adapted to deliver a stimulation signal to a patient, said method comprising:
- monitoring an electrocardiogram (ECG) of the patient to determine a baseline for the patient either prior to implantation or in a post-implant period before initiation stimulation by the IMD, wherein the baseline comprises one or more of a baseline T-wave alternans (TWA), a baseline heart rate turbulence slope (TS), or a baseline heart rate turbulence onset (TO);
activating the IMD to deliver to the patient a plurality of stimulation signals at increasing stimulation intensities, causing a change from the baseline, until a target threshold is detected, wherein the target threshold comprises one or more of a target TWA threshold, a target heart rate TS threshold, or a target heart rate TO threshold; and
activating the IMD to deliver a therapeutic level of stimulation corresponding to the stimulation intensity at which the target threshold was detected.
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Abstract
Systems and methods are provided for delivering neurostimulation therapies to patients. A titration process is used to gradually increase the stimulation intensity to a desired therapeutic level until a target T-wave alternans change from a baseline T-wave alternans is achieved.
254 Citations
25 Claims
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1. A method of operating an implantable medical device (IMD) comprising a neurostimulator coupled to an electrode assembly, said neurostimulator adapted to deliver a stimulation signal to a patient, said method comprising:
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monitoring an electrocardiogram (ECG) of the patient to determine a baseline for the patient either prior to implantation or in a post-implant period before initiation stimulation by the IMD, wherein the baseline comprises one or more of a baseline T-wave alternans (TWA), a baseline heart rate turbulence slope (TS), or a baseline heart rate turbulence onset (TO); activating the IMD to deliver to the patient a plurality of stimulation signals at increasing stimulation intensities, causing a change from the baseline, until a target threshold is detected, wherein the target threshold comprises one or more of a target TWA threshold, a target heart rate TS threshold, or a target heart rate TO threshold; and activating the IMD to deliver a therapeutic level of stimulation corresponding to the stimulation intensity at which the target threshold was detected. - View Dependent Claims (2, 3, 4, 5, 6, 7)
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8. A method of operating an implantable medical device (IMD) comprising a neurostimulator coupled to an electrode assembly, said neurostimulator adapted to deliver a stimulation signal to a patient, said method comprising:
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monitoring an electrocardiogram (ECG) of the patient to determine a baseline for the patient either prior to implantation or in a post-implant period before initiation stimulation by the IMD, wherein the baseline comprises one or more of a baseline T-wave alternans (TWA), a baseline heart rate turbulence slope (TS), or a baseline heart rate turbulence onset (TO); activating the IMD to deliver to the patient a plurality of stimulation signals at increasing stimulation intensities until a target change from the baseline is observed, wherein the target change comprises one or more of a target TWA change, a target heart rate TS change, or a target heart rate TO change; and identifying a neural fulcrum zone corresponding to the stimulation intensity during which the target change from the baseline was observed. - View Dependent Claims (9, 10, 11, 12, 13, 14)
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15. A method of operating an implantable medical device (IMD) comprising a neurostimulator coupled to an electrode assembly, said neurostimulator adapted to deliver a stimulation signal to a patient, said method comprising:
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computationally determining a baseline cardiac magnitude value for the patient either prior to implantation or in a post-implant period before initiation stimulation by the IMD, wherein the baseline cardiac magnitude value comprises one or more of a T-wave alternans (TWA) magnitude value, a heart rate turbulence slope (TS) magnitude value, or a heart rate turbulence onset (TO) magnitude value; computationally determining a current cardiac magnitude value for the patient, wherein the current cardiac magnitude value comprises one or more of a T-wave alternans (TWA) magnitude value, a heart rate turbulence slope (TS) magnitude value, or a heart rate turbulence onset (TO) magnitude value; activating the IMD to deliver to the patient a plurality of stimulation signals at increasing stimulation intensities, causing a change from the baseline, until the current cardiac magnitude value reaches to a target cardiac magnitude, wherein the target magnitude comprises one or more of a TWA target magnitude, a heart rate TS target magnitude, or a heart rate TO target magnitude; and activating the IMD to deliver a therapeutic level of stimulation corresponding to the stimulation intensity during which the current cardiac magnitude value reached the target cardiac magnitude. - View Dependent Claims (16, 17)
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18. A neurostimulation system, comprising:
an implantable medical device (IMD) comprising; an electrode assembly; a neurostimulator coupled to the electrode assembly, wherein the neurostimulator is adapted to deliver a stimulation signal to a patient; an electrocardiogram (ECG) sensor; and a control system programmed to; monitor the ECG of the patient using the ECG sensor to determine a baseline for the patient either prior to implantation or in a post-implant period before initiation stimulation by the IMD, wherein the baseline comprises one or more of a baseline T-wave alternans (TWA), a baseline heart rate turbulence slope (TS), or a baseline heart rate turbulence onset (TO); activate the IMD to deliver to the patient a plurality of stimulation signals at increasing stimulation intensities, causing a change from the baseline, until a target threshold is detected, wherein the target threshold comprises one or more of a target TWA threshold, a target heart rate TS threshold, or a target heart rate TO threshold; and activate the IMD to deliver a therapeutic level of stimulation corresponding to the stimulation intensity at which the target threshold was detected. - View Dependent Claims (19, 20, 21, 22, 23, 24)
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25. A neurostimulation system, comprising:
an implantable medical device (IMD) comprising; an electrode assembly; a neurostimulator coupled to the electrode assembly, wherein the neurostimulator is adapted to deliver a stimulation signal to a patient; an electrocardiogram (ECG) sensor; and a control system programmed to; activate the IMD to deliver to the patient a plurality of stimulation signals; monitor the ECG of the patient using the ECG sensor; determine a baseline cardiac magnitude value for the patient either prior to implantation or in a post-implant period before initiation stimulation by the IMD, wherein the baseline cardiac magnitude value comprises one or more of a T-wave alternans (TWA) magnitude value, a heart rate turbulence slope (TS) magnitude value, or a heart rate turbulence onset (TO) magnitude value; determine a current cardiac magnitude value based on the monitored ECG, wherein the current cardiac magnitude value comprises one or more of a TWA magnitude value, a heart rate TS magnitude value, or a heart rate TO magnitude value; activate the IMD to deliver to the patient a plurality of stimulation signals at increasing stimulation intensities, causing a change from the baseline, until the current cardiac magnitude value reaches to a target cardiac magnitude, wherein the target magnitude comprises one or more of a TWA target magnitude, a heart rate TS target magnitude, or a heart rate TO target magnitude; and activate the IMD to deliver a therapeutic level of stimulation corresponding to the stimulation intensity during which the current cardiac magnitude value reached the target cardiac magnitude.
Specification