Vagal stimulation for improving cardiac function in heart failure or CHF patients

• US 20040199210A1
• Filed: 06/11/2003
• Published: 10/07/2004
• Est. Priority Date: 06/12/2002
• Status: Active Grant

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Inventors: Shelchuk, Anne M.
• Granted Patent: US 7,277,761 B2
• Time in Patent Office: Days
• US Class Current: 607/17
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy

Abstract

Exemplary methods for decreasing workload, maintaining or increasing cardiac output and/or achieving a desirable autonomic balance by stimulating one or more parasympathetic nerves. Various exemplary methods include delivering one or more stimulation pulses postinspiration and/or based at least in part on detection of one or more cardiac event. Other methods and/or devices are also disclosed.

Claims

1. A method comprising:

detecting a need for increased cardiac output; and

responsive to detecting the need for increased cardiac output, stimulating a parasympathetic nerve to increase vagal tone and increase end diastolic volume.

2. The method of claim 1, wherein the detecting comprises sensing a pressure.

3. The method of claim 1, wherein the stimulating occurs postinspiration only.

4. The method of claim 1, wherein detection of a cardiac event initiates the stimulating.

5. The method of claim 1, further comprising synchronizing the stimulating to one or more events in a cardiac cycle.

6. The method of claim 1, wherein the stimulation halts after a set period of time.

7. The method of claim 1, further comprising halting the stimulating and implementing a diagnostic algorithm after the halting.

8. The method of claim 7, further comprising comparing results of the diagnostic algorithm after the halting to results prior acquired prior to the stimulating.

9. A method comprising:

detecting a need to increase stroke volume;

responsive to the detecting, stimulating a parasympathetic nerve according to one or more stimulation parameters to increase vagal tone and increase end diastolic volume;

determining whether adequate AV conduction exists; and

responsive to the determining, adjusting one or more of the one or more stimulation parameters.

10. The method of claim 9, further comprising determining whether stroke volume increased.

11. The method of claim 10, further comprising adjusting one or more of the one or more stimulation parameters in response to an inadequate increase in stoke volume.

12. The method of claim 9, wherein the detecting comprises detecting a need to increase cardiac output.

13. The method of claim 9, wherein the detecting comprises detecting a need to reduce workload.

14. The method of claim 9, wherein the detecting comprises detecting a need to reduce sympathetic tone or to increase parasympathetic tone.

15. The method of claim 9, wherein the stimulating occurs postinspiration only.

16. The method of claim 9, wherein detection of a cardiac event initiates the stimulating.

17. A method comprising:

detecting an increase in sympathetic tone;

responsive to the detecting, stimulating a parasympathetic nerve according to one or more stimulation parameters;

determining whether adequate AV conduction exists; and

responsive to the determining, implementing ventricular pacing if inadequate AV conduction exists.

18. The method of claim 17, further comprising determining whether a decrease occurred in sympathetic tone.

19. The method of claim 18, further comprising adjusting one or more of the one or more stimulation parameters in response to an inadequate decrease in sympathetic tone.

20. The method of claim 17, wherein the stimulating occurs postinspiration only.

21. The method of claim 17, wherein detection of a cardiac event initiates the stimulating.

22. A method comprising:

detecting a heart rate above a threshold rate;

stimulating a parasympathetic nerve to increase vagal tone; and

pacing one or more chambers of the heart at a rate less than the threshold rate.

23. The method of claim 22, further comprising synchronizing the stimulating with one or more events in a cardiac cycle.

24. An apparatus comprising:

means for detecting a need for increased cardiac output; and

means for stimulating a parasympathetic nerve, responsive to the detecting, to increase vagal tone and to increase end diastolic volume.

25. The apparatus of claim 24, wherein the means for detecting comprises one or more sensors.

26. The apparatus of claim 24, wherein the means for stimulating a parasympathetic nerve comprises an electrode positionable proximate to the parasympathetic nerve.

27. An apparatus comprising:

means for detecting a need to increase stroke volume;

means for stimulating a parasympathetic nerve, responsive to the detecting, according to one or more stimulation parameters to increase vagal tone and thereby to increase end diastolic volume;

means for determining whether adequate AV conduction exists; and

means adjusting one or more of the one or more stimulation parameters responsive to the determining.

28. An apparatus comprising:

means for detecting an increase in sympathetic tone;

means for stimulating a parasympathetic nerve according to one or more stimulation parameters;

means for determining whether adequate AV conduction exists; and

means for implementing ventricular pacing if inadequate AV conduction exists.