Method and apparatus for preventing cardiac arrhythmias with endovascular stimulation

• US 20030181951A1
• Filed: 03/25/2002
• Published: 09/25/2003
• Est. Priority Date: 03/25/2002
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Cates, Adam W.
• Granted Patent: US 7,123,959 B2
• Time in Patent Office: Days
• US Class Current: 607/9
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/3962 in combination with another heart therapy
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

Certain cardiac arrhythmias can be prevented by appropriate electrical stimulation of autonomic nerves innervating the heart. An implantable cardiac rhythm management device is configured to deliver such stimulation when an autonomic imbalance is predicted to be present via an endovascular electrode. Autonomic imbalance may be predicted to be present based upon circadian rhythms, detected heart rates, or detected heart rate variability.

Claims

1. An implantable cardiac rhythm management device, comprising:

a ventricular sensing channel;

an autonomic stimulation channel including a pulse generator and a stimulation electrode adapted for endovascular disposition adjacent sympathetic or parasympathetic nerves innervating the heart; and

,

a controller for causing the delivery of autonomic stimulation pulses for stimulating sympathetic or parasympathetic nerves when an autonomic imbalance reflecting increased sympathetic or parasympathetic activity is predicted to be present.

2. The device of claim 1 wherein autonomic imbalance is predicted to be present by measurement of heart rate via the ventricular sensing channel.

3. The device of claim 1 wherein the autonomic stimulation channel includes a bipolar stimulation electrode incorporated into a lead adapted for intravenous insertion.

4. The device of claim 1 further comprising a cardioversion/defibrillation shocking channel that includes a shock pulse generator and a shock lead, and wherein the autonomic stimulation channel includes a bipolar stimulation electrode incorporated into the shock lead.

5. The device of claim 1 wherein the pulse generator delivers autonomic stimulation in the form of a pulse train.

6. The device of claim 5 wherein the pulse train is at a frequency of between 5 and 50 Hz.

7. The device of claim 1 wherein the controller is programmed to monitor heart rate via the ventricular sensing channel and to detect increased sympathetic activity when one or more time intervals between successive ventricular senses (i.e., RR intervals) falls below a specified minimum threshold value.

8. The device of claim 7 wherein increased sympathetic activity is detected when an average of RR intervals taken over a specified period of time falls below a specified minimum threshold value.

9. The device of claim 1 wherein the controller is programmed to monitor heart rate via the ventricular sensing channel and to detect increased sympathetic activity based upon the variability of the measured heart rate.

10. The device of claim 1 wherein the controller is programmed to deliver parasympathetic stimulation at periodic time intervals when increased sympathetic activity is predicted to be present based upon circadian rhythms.

11. A method for reducing the likelihood of cardiac arrhythmias, comprising:

delivering electrical stimulation to parasympathetic nerves innervating the heart when increased sympathetic activity is predicted to be present; and

,

wherein the parasympathetic stimulation is delivered via a bipolar electrode incorporated into an intravenous lead disposed in the vena cava.

12. The method of claim 11 wherein increased sympathetic activity is predicted to be present by measurement of heart rate via the ventricular sensing channel.

13. The method of claim 11 wherein the parasympathetic stimulation is delivered at periodic time intervals when increased sympathetic activity is predicted to be present based upon circadian rhythms.

14. The method of claim 11 further comprising delivering the parasympathetic stimulation via a bipolar stimulation electrode incorporated into a shock lead normally used for delivering cardioversion/defibrillation shocks.

15. The method of claim 11 further comprising delivering the parasympathetic stimulation in the form of a pulse train.

16. The method of claim 15 wherein the pulse train is at a frequency of between 5 and 50 Hz.

17. The method of claim 11 further comprising monitoring heart rate and detecting increased sympathetic activity when one or more time intervals between successive ventricular senses (i.e., RR intervals) falls below a specified minimum threshold value.

18. The method of claim 17 wherein increased sympathetic activity is detected when an average of RR intervals taken over a specified period of time falls below a specified minimum threshold value.

19. The method of claim 11 further comprising measuring heart rate and detecting increased sympathetic activity based upon the variability of the measured heart rate.

20. A method for reducing the likelihood of cardiac arrhythmias, comprising:

delivering electrical stimulation to sympathetic nerves innervating the heart when increased parasympathetic activity is predicted to be present; and

,

wherein the sympathetic stimulation is delivered via a bipolar electrode incorporated into an intravenous lead disposed in the vena cava.