Implantable neurostimulator-implemented method for managing tachyarrhythmic risk during sleep through vagus nerve stimulation
First Claim
1. A method for managing tachyarrhythmic risk accompanying central sleep apnea through vagus nerve stimulation, comprising:
- providing an implantable neurostimulator comprising a pulse generator configured to deliver electrical therapeutic stimulation to a vagus nerve of a patient;
storing operating modes of the pulse generator in a recordable memory, the operating modes defining;
a maintenance dose of the electrical therapeutic stimulation; and
a boost dose of the electrical therapeutic stimulation comprising electrical pulses delivered at higher intensity than the maintenance dose;
delivering the maintenance dose to the vagus nerve via the pulse generator through an electrode electrically coupled to the pulse generator;
monitoring a physiological state of the patient via a sensor;
upon sensing a condition indicative of naturally-occurring bradycardia followed by a condition indicative of potential tachyarrhythmia, delivering the boost dose to the vagus nerve via the pulse generator through the electrode; and
progressively intensifying the electrical therapeutic stimulation as specified in the operating mode of the boost dose as the condition indicative of tachyarrhythmia continues.
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Abstract
A patient suffering from congestive heart failure is at increased risk of cardiac arrhythmogenesis during sleep, particularly if experiencing central sleep apnea as a co-morbidity. Low intensity peripheral neurostimulation therapies that target imbalance of the autonomic nervous system have been shown to improve clinical outcomes. Thus, bi-directional autonomic regulation therapy is delivered to the cervical vagus nerve at an intensity that is insufficient to elicit pathological or acute physiological side effects and without the requirement of an enabling physiological feature or triggering physiological marker. The patient'"'"'s physiology is monitored to identify periods of sleep. In one embodiment, upon sensing a condition indicative of tachyarrhythmia following a period of bradycardia, as naturally occurs during sleep, an enhanced “boost” dose of bi-directional neural stimulation intended to “break” the tachyarrhythmic condition is delivered. In a further embodiment, the boost dose is delivered upon sensing a physiological pattern indicative of Cheyne-Stokes respiration.
247 Citations
18 Claims
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1. A method for managing tachyarrhythmic risk accompanying central sleep apnea through vagus nerve stimulation, comprising:
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providing an implantable neurostimulator comprising a pulse generator configured to deliver electrical therapeutic stimulation to a vagus nerve of a patient; storing operating modes of the pulse generator in a recordable memory, the operating modes defining; a maintenance dose of the electrical therapeutic stimulation; and a boost dose of the electrical therapeutic stimulation comprising electrical pulses delivered at higher intensity than the maintenance dose; delivering the maintenance dose to the vagus nerve via the pulse generator through an electrode electrically coupled to the pulse generator; monitoring a physiological state of the patient via a sensor; upon sensing a condition indicative of naturally-occurring bradycardia followed by a condition indicative of potential tachyarrhythmia, delivering the boost dose to the vagus nerve via the pulse generator through the electrode; and progressively intensifying the electrical therapeutic stimulation as specified in the operating mode of the boost dose as the condition indicative of tachyarrhythmia continues. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10)
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11. An implantable neurostimulation system, comprising:
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a pulse generator configured to deliver electrical therapeutic stimulation to a vagus nerve of a patient via an electrode coupled to the implantable neurostimulation system; a recordable memory configured to store operating modes of the pulse generator, the operating modes defining; a maintenance dose of the electrical therapeutic stimulation; and a boost dose of the electrical therapeutic stimulation comprising electrical pulses delivered at higher intensity than the maintenance dose; wherein the pulse generator is configured to; deliver the maintenance dose to the vagus nerve via the pulse generator through the electrode; monitor a physiological state of the patient via a sensor; upon sensing a condition indicative of naturally-occurring bradycardia followed by a condition indicative of potential tachyarrhythmia, deliver the boost dose to the vagus nerve via the pulse generator through the electrode; and progressively intensify the electrical therapeutic stimulation as specified in the operating mode of the boost dose as the condition indicative of tachyarrhythmia continues. - View Dependent Claims (12, 13, 14, 15, 16, 17, 18)
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Specification