Fine resolution identification of a neural fulcrum for the treatment of chronic cardiac dysfunction
First Claim
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1. An implantable medical device (IMD) comprising:
- a neurostimulator coupled to an electrode assembly, said neurostimulator configured to deliver a stimulation signal to a patient; and
a control system configured to;
monitor a heart rate of a patient implanted with the IMD;
deliver to the patient a first set of stimulation signals at a first frequency, wherein said delivering comprises increasing the intensity parameter level for subsequent stimulation signals until bradycardia is detected;
detect whether a response to the stimulation signal having a first intensity parameter level below a second intensity parameter level at which bradycardia is detected is tachycardia or a transition heart rate response;
responsive to detecting that the response to the stimulation signal having the first intensity parameter level is tachycardia, deliver to the patient a second set of stimulation signals at a second frequency different than the first frequency, wherein said delivering the second set of stimulation signals comprises increasing the intensity parameter level for subsequent stimulation signals until bradycardia is detected; and
responsive to detecting that the response to the stimulation signal having the first intensity parameter level is the transition heart rate response, continue to deliver to the patient the stimulation signal having the first intensity parameter level.
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Abstract
Systems and methods are provided for delivering neurostimulation therapies to patients for treating chronic heart failure. A neural fulcrum zone is identified and ongoing neurostimulation therapy is delivered within the neural fulcrum zone. This neural fulcrum zone may be identified by monitoring a patient'"'"'s response to incrementally increased intensity settings at a first frequency. If the incremental intensity increases do not result in the identification of the neural fulcrum zone, the frequency may be changed to provide finer resolution identification of the neural fulcrum zone.
260 Citations
23 Claims
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1. An implantable medical device (IMD) comprising:
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a neurostimulator coupled to an electrode assembly, said neurostimulator configured to deliver a stimulation signal to a patient; and a control system configured to; monitor a heart rate of a patient implanted with the IMD; deliver to the patient a first set of stimulation signals at a first frequency, wherein said delivering comprises increasing the intensity parameter level for subsequent stimulation signals until bradycardia is detected; detect whether a response to the stimulation signal having a first intensity parameter level below a second intensity parameter level at which bradycardia is detected is tachycardia or a transition heart rate response; responsive to detecting that the response to the stimulation signal having the first intensity parameter level is tachycardia, deliver to the patient a second set of stimulation signals at a second frequency different than the first frequency, wherein said delivering the second set of stimulation signals comprises increasing the intensity parameter level for subsequent stimulation signals until bradycardia is detected; and responsive to detecting that the response to the stimulation signal having the first intensity parameter level is the transition heart rate response, continue to deliver to the patient the stimulation signal having the first intensity parameter level. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10)
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11. 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 at a plurality of intensity parameter levels, said method comprising:
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monitoring a heart rate of a patient implanted with the IMD; delivering to the patient a first set of stimulation signals at a first frequency, wherein said delivering comprises increasing the intensity parameter level for subsequent stimulation signals until bradycardia is detected; detecting whether a response to the stimulation signal having a first intensity parameter level below a second intensity parameter level at which bradycardia is detected is tachycardia or a transition heart rate response; responsive to detecting that the response to the stimulation signal having the first intensity parameter level is tachycardia, delivering to the patient a second set of stimulation signals at a second frequency different than the first frequency, wherein said delivering the second set of stimulation signals comprises increasing the intensity parameter level for subsequent stimulation signals until bradycardia is detected; and responsive to detecting that the response to the stimulation signal having the first intensity parameter level is the transition heart rate response, continue to deliver to the patient the stimulation signal having the first intensity parameter level. - View Dependent Claims (12, 13, 14, 15, 16, 17, 18, 19, 20)
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21. A neurostimulation system, comprising:
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an electrode assembly configured to deliver a stimulation signal to a patient; and an implantable medical device (IMD) comprising; a neurostimulator coupled to the electrode assembly, said neurostimulator configured to deliver the stimulation signal to the electrode assembly; and a control system configured to; monitor the heart rate of the patient implanted with the IMD; deliver to the electrode assembly a first set of stimulation signals at a first frequency, wherein said delivering comprises increasing the intensity parameter level for subsequent stimulation signals until bradycardia is detected; detect whether a response to the stimulation signal having a first intensity parameter level below a second intensity parameter level at which bradycardia is detected is tachycardia or a transition heart rate response; responsive to detecting that the response to the stimulation signal having the first intensity parameter level is tachycardia, deliver to the electrode assembly a second set of stimulation signals at a second frequency different than the first frequency, wherein said delivering the second set of stimulation signals comprises increasing the intensity parameter level for subsequent stimulation signals until bradycardia is detected; and responsive to detecting that the response to the stimulation signal having the first intensity parameter level is the transition heart rate response, continue to deliver to the patient the stimulation signal having the first intensity parameter level. - View Dependent Claims (22, 23)
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Specification