Method and apparatus for minimizing post-infarct ventricular remodeling

• US 20050288720A1
• Filed: 06/04/2004
• Published: 12/29/2005
• Est. Priority Date: 06/04/2004
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Spinelli, Julio C., Salo, Rodney W., Ross, Jeffrey
• Granted Patent: US 7,450,988 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

Abstract

A cardiac rhythm management device is configured to deliver pre-excitation pacing to one or more sites in proximity to an infarcted region of the ventricular myocardium. The pre-excitation pacing in conjunction with counterpulsation therapy serves to either prevent or minimize post-infarct remodeling.

Claims

1. A method for minimizing post-infarct ventricular remodeling, comprising:

delivering pacing pulses to one or more sites in proximity to an infarcted area in a ventricle, wherein the pacing pulses are delivered in a manner that pre-excites the site or sites in proximity to the infarcted area relative to other areas of the ventricle; and

,

delivering counterpulsation therapy to reduce afterload during ventricular systole.

2. The method of claim 1 wherein the counterpulsation therapy is intra-aortic balloon pumping.

3. The method of claim 1 wherein the counterpulsation therapy is external counterpulsation.

4. The method of claim 1 wherein the pacing pulses are delivered by an implantable device which controls the timing of the counterpulsation therapy via a telemetry link.

5. The method of claim 1 wherein paces are delivered to multiple sites in proximity to the infarcted area in an order defined by a specified pulse output sequence.

6. A method for alleviating ischemia in a ventricular region, comprising:

delivering pacing pulses to one or more sites in proximity to an ischemic region of a ventricle, wherein the pacing pulses are delivered in a manner that pre-excites the site or sites in proximity to the ischemic region relative to other areas of the ventricle; and

,

delivering counterpulsation therapy to reduce afterload during ventricular systole.

7. The method of claim 6 wherein the counterpulsation therapy is intra-aortic balloon pumping.

8. The method of claim 6 wherein the counterpulsation therapy is external counterpulsation.

9. The method of claim 6 wherein the pacing pulses are delivered by an implantable device which controls the timing of the counterpulsation therapy via a telemetry link.

10. The method of claim 6 wherein paces are delivered to multiple sites in proximity to the infarcted area in an order defined by a specified pulse output sequence.

11. A system for delivering therapy to reduce myocardial wall stress during systole, comprising:

an implantable cardiac rhythm management device having one or more sensing channels for sensing intrinsic cardiac activity, one or more pacing channels for delivering pacing pulses, a controller for controlling the delivery of pacing pulses in accordance with a pacing mode;

a counterpulsation device for reducing afterload during ventricular systole;

a telemetry link enabling communications between the counterpulsation device and the implantable device; and

,

wherein the controller of the implantable device is programmed to transmit signals via the telemetry link for controlling the operation of the counterpulsation device.

12. The system of claim 11 wherein the counterpulsation device is an intra-aortic balloon pump.

13. The system of claim 11 wherein the counterpulsation device is an external counterpulsation device.

14. The system of claim 11 wherein the telemetry link is an inductively coupled link.

15. The system of claim 11 wherein the telemetry link is a far-field RF link.

16. The system of claim 11 wherein the counterpulsation device further comprises one or more patient sensors for collecting physiological data which is transmitted to the implantable device via the telemetry link and used to modify the delivery of pre-excitation and/or counterpulsation therapy.

17. The system of claim 16 wherein the patient sensor is a blood pressure sensor.

18. The system of claim 11 wherein the implantable device further comprises an impedance sensor for detecting changes in wall motion and wall thickness in an area in proximity to the infarct and wherein the controller is programmed to modify the delivery of pre-excitation pacing and/or counterpulsation therapy in accordance therewith.

19. The system of claim 11 wherein the implantable device further comprises an acoustic sensor for sensing acoustic energy generated by the heart during a cardiac cycle and wherein the controller is programmed to modify the delivery of pre-excitation pacing and/or counterpulsation therapy in accordance therewith.

20. A cardiac rhythm management device, comprising:

one or more sensing channels for sensing intrinsic cardiac activity;

one or more pacing channels for delivering pacing pulses;

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

a telemetry unit; and

,

wherein the controller is programmed to send signals for controlling the operation of a counterpulsation therapy device.