Method and device for responding to the detection of ischemia in cardiac tissue
First Claim
1. A method of treating ischemia of a patient'"'"'s heart using an implantable cardiac stimulation device operating according to a set of prescribed adaptable pacing parameters including a pacing rate set as a function of the patient'"'"'s activity level up to a maximum sensor rate and an aggressiveness value specifying the rate of increase of the pacing rate per the increase in the patient'"'"'s activity level, wherein each of the parameters has an original value in the absence of ischemia, the method comprising the steps of:
- detecting the presence of ischemia in the patient'"'"'s heart; and
incrementally altering at least one of the prescribed adaptable pacing parameters of the cardiac stimulation device by a specified amount, initially from its respective original value, in response to detecting the presence of ischemia in the patient'"'"'s heart.
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Abstract
An apparatus and method for monitoring the patient'"'"'s heart for the presence of ischemia and altering the treatment delivered by an implantable cardiac stimulation device to minimize adverse ischemic effects, e.g., angina pectoris. Embodiments of the present invention are particularly beneficial when used with a rate responsive cardiac stimulation device. Typically, a rate responsive cardiac stimulation device increases its pacing rate (up to a maximum sensor rate) in response to increases in the patient'"'"'s activity level. The rate of this change is referred to in this patent as the aggressiveness of the rate responsiveness. However, in an ischemic state, the aggressiveness of the rate responsiveness may cause the heart to pace at a rate that exacerbates the ischemic effects. Accordingly, embodiments of the present invention alter the pacing regimen in one or more of the following ways. First, the maximum sensor rate is adaptively decremented in response to a detected ischemic state. Second, the aggressiveness of the rate responsiveness is adaptively decreased in response to a detected ischemic state. Third, the atrio-ventricular delay (AV) delay is adaptively extended in response to a detected ischemic state. Conversely, when an ischemic state is no longer detected, the adapted variable is incrementally returned toward its original value. Accordingly, ischemia can be minimized while still maintaining the rate responsive features of the implantable cardiac stimulation device.
78 Citations
32 Claims
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1. A method of treating ischemia of a patient'"'"'s heart using an implantable cardiac stimulation device operating according to a set of prescribed adaptable pacing parameters including a pacing rate set as a function of the patient'"'"'s activity level up to a maximum sensor rate and an aggressiveness value specifying the rate of increase of the pacing rate per the increase in the patient'"'"'s activity level, wherein each of the parameters has an original value in the absence of ischemia, the method comprising the steps of:
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detecting the presence of ischemia in the patient'"'"'s heart; and
incrementally altering at least one of the prescribed adaptable pacing parameters of the cardiac stimulation device by a specified amount, initially from its respective original value, in response to detecting the presence of ischemia in the patient'"'"'s heart. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 30, 31)
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12. An implantable cardiac stimulation device configured for stimulating a patient'"'"'s heart through at least one electrode implanted in electrical contact with selected cardiac tissue, the cardiac stimulation device comprising:
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at least one pulse generator configured for electrical coupling to the at least one electrode and configured to generate stimulation pulses at a pacing rate according to a set of prescribed adaptable pacing parameters, wherein each parameter has an original value in the absence of ischemia;
an ischemia detector configured for determining the presence of ischemia in at least a portion of the cardiac tissue;
a controller, coupled to the ischemia detector for periodically altering at least one of the prescribed adaptable pacing parameters of the cardiac stimulation device by a specified incremental amount, initially from its respective original value, in response to detecting the presence of ischemia by the ischemia detector.
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29. An implantable cardiac stimulation device configured for stimulating a patient'"'"'s heart through at least one electrode implanted in electrical contact with selected cardiac tissue, the cardiac stimulation device comprising:
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means for generating and delivering stimulation pulses to the at least one electrode according to a set of prescribed adaptable pacing parameters, wherein each pacing parameter has an original value in the absence of ischemia;
means for detecting the presence of ischemia in at least a portion of the cardiac tissue; and
means for periodically altering at least one of the prescribed adaptable pacing parameters of the cardiac stimulation device by a specified incremental amount, from its respective original value, in response to detecting the presence of ischemia by the ischemia detecting means.
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32. A method of treating ischemia of a patient'"'"'s heart using an implantable cardiac stimulation device operating according to a set of one or more prescribed adaptable pacing parameters including at least a pacing rate set as a function of the patient'"'"'s activity level up to a maximum sensor rate, wherein each of the parameters has an original value in the absence of ischemia, the method comprising the steps of:
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detecting the presence of ischemia in the patient'"'"'s heart;
determining the pacing rate when ischemia is detected;
altering the maximum sensor rate according to the pacing rate when ischemia is detected;
incrementally altering at least one of the prescribed adaptable pacing parameters of the cardiac stimulation device by a specified amount in response to continuing to detect the presence of ischemia in the patient'"'"'s heart.
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Specification