Apparatus and method for reversal of myocardial remodeling with electrical stimulation

• US 20020161410A1
• Filed: 04/27/2001
• Published: 10/31/2002
• Est. Priority Date: 04/27/2001
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Spinelli, Julio C., Kramer, Andrew P., KenKnight, Bruce H., Salo, Rodney W.
• Granted Patent: US 6,628,988 B2
• Time in Patent Office: Days
• US Class Current: 607/9
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/365 controlled by a physiological parameter, e.g. heart potential evoked response A61N1/371
• CPC Class Codes: A61N 1/36542 controlled by body motion, e.g. acceleration
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters
• CPC Class Codes: A61N 1/368 comprising more than one electrode co-operating with different heart regions A61N1/3622, A61N1/3627 take precedence

Abstract

An apparatus and method for reversing ventricular remodeling with electro-stimulatory therapy. A ventricle is paced by delivering one or more stimulatory pulses in a manner such that a stressed region of the myocardium is pre-excited relative to other regions in order to subject the stressed region to a lessened preload and afterload during systole. The unloading of the stressed myocardium over time effects reversal of undesirable ventricular remodeling.

Claims

1. A method for cardiac pacing, comprising:

delivering a stimulatory pulse to a ventricular pacing site in response to sensed cardiac activity and lapsed time intervals in accordance with a programmed pacing mode; and

,

wherein the pacing site is selected such that a stressed region of the ventricular myocardium is pre-excited relative to other regions in order to unload the stressed region and effect reversal of ventricular remodeling.

2. The method of claim 1 wherein a plurality of stimulating/sensing electrodes are disposed in the ventricles, and further comprising:

pacing the ventricles during a cardiac cycle by outputting multiple pulses to the electrodes in a specified pulse output sequence; and

,

wherein the pulse output sequence is specified such that the stressed region of the ventricular myocardium is excited before other regions.

3. The method of claim 2 wherein the plurality of stimulating/sensing electrodes are disposed in a single ventricle.

4. The method of claim 2 wherein a stimulating/sensing electrode is disposed in both the left and right ventricles with right and left ventricular stimulatory pulses delivered in accordance with a specified interventricular delay interval, and further wherein the interventricular delay interval is specified so as to excite the stressed region of the myocardium first.

5. The method of claim 1 wherein the stimulatory pulse delivered to the stressed region is triggered by an atrial sense or pace.

6. The method of claim 2 further comprising adjusting the pulse output sequence in accordance with measurements of conduction delays that reflect regional variations in myocardial mass.

7. The method of claim 2 further comprising adjusting the pulse output sequence in accordance with thoracic impedance measurements that reflect regional variations in myocardial mass.

8. The method of claim 2 further comprising adjusting the pulse output sequence in accordance with thoracic impedance measurements that reflect variations in contraction sequence.

9. The method of claim 2 further comprising adjusting the pulse output sequence in accordance with activity level measurements reflective of metabolic demand so that the pulse output sequence is alternated between one designed to produce hemodynamically more effective contractions when metabolic needs of the body are great to one designed for remodeling reversal when metabolic needs are less.

10. The method of claim 1 wherein the stimulatory pulse delivered to the stressed region is triggered by a ventricular sense or pace.

11. A cardiac rhythm management device, comprising:

one or more ventricular sensing channels for sensing ventricular depolarizations and generating ventricular sense signals in accordance therewith;

a plurality of stimulatory channels for delivering stimulation to one or more ventricular pacing sites;

a controller for controlling the delivery of stimulatory pulses in accordance with a programmed pacing mode; and

,

wherein the controller is programmed to pace one or more pacing sites during a cardiac cycle by delivering pulses in a specified pulse output sequence such that a stressed region of the ventricular myocardium is excited before other regions.

12. The device of claim 11 wherein the stimulatory channels include a plurality of stimulating/sensing electrodes disposed in a single ventricle.

13. The device of claim 11 wherein the stimulatory channels include a stimulating/sensing electrode disposed in both the left and right ventricles, and wherein the controller is programmed to deliver right and left ventricular stimulatory pulses in accordance with a specified interventricular delay interval, with the interventricular delay interval specified so as to excite a stressed region of the myocardium before other regions of the myocardium.

14. The device of claim 11 wherein the pulse output sequence is specified in accordance with regional measurements of myocardial mass so that stressed regions are excited first during a paced cardiac cycle.

15. The device of claim 11 wherein the controller is programmed to adjust the pulse output sequence in accordance with measurements of conduction delays that reflect regional variations in myocardial mass.

16. The device of claim 11 further comprising a thoracic impedance sensor and wherein the controller is programmed to adjust the pulse output sequence in accordance with impedance measurements that reflect regional variations in myocardial mass.

17. The device of claim 11 further comprising an exertion level sensor and wherein the controller is programmed to adjust the pulse output sequence in accordance with activity level measurements reflective of metabolic demand so that the pulse output sequence is alternated between one designed to produce hemodynamically more effective contractions when metabolic needs of the body are great to one designed for remodeling reversal when metabolic needs are less.

18. The device of claim 11 further comprising a thoracic impedance sensor and wherein the controller is programmed to adjust the pulse output sequence in accordance with impedance measurements that reflect variations in contraction sequence.