Cardiopulmonary functional status assessment via heart rate response dectection by implantable cardiac device

• US 20060030892A1
• Filed: 08/09/2004
• Published: 02/09/2006
• Est. Priority Date: 08/09/2004
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Kadhiresan, Veerichetty, Baker, Lemont, Hopper, Donald, Fogoros, Richard
• Granted Patent: US 7,269,458 B2
• Time in Patent Office: Days
• US Class Current: 607/19
• CPC Class Codes: A61B 5/0205 Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition
• CPC Class Codes: A61N 1/365 controlled by a physiological parameter, e.g. heart potential evoked response A61N1/371
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/36542 controlled by body motion, e.g. acceleration
• CPC Class Codes: A61N 1/3702 Physiological parameters A61N1/365 takes precedence; evoked response A61N1/371

Abstract

An implantable cardiac device is configured and programmed to assess a patient'"'"'s cardiopulmonary function by evaluating the patient'"'"'s heart rate response. Such evaluation may be performed by computing a heart rate response slope, defined as the ratio of an incremental change in intrinsic heart rate to an incremental change in measured activity level. The heart rate response slope may then be compared with a normal range to assess the patient'"'"'s functional status.

Claims

1. A cardiac device, comprising:

one or more sensing channels for generating intra-cardiac electrogram signals;

a controller for detecting intrinsic cardiac activity and measuring an intrinsic heart rate from the electrogram signals;

an activity level sensor interfaced to the controller for measuring a parameter related to a patient'"'"'s level of physical activity; and

,

wherein the controller is programmed to monitor a patient'"'"'s cardiopulmonary functional status by constructing a historical record of activity level versus heart rate, referred to as a heart rate response profile.

2. The device of claim 1 wherein the heart rate response profile is a data structure containing a plurality of heart rates, each heart rate being associated with a discrete activity level.

3. The device of claim 2 wherein the heart rate response profile is updated by averaging a currently measured heart rate with the heart rate associated with an activity level corresponding to a currently measured activity level.

4. The device of claim 3 wherein the heart rate response profile is updated only if activity level measurements taken over the N second interval meet a predefined stability criterion.

5. The device of claim 1 wherein the controller is programmed to compute a heart rate response slope from the heart rate response profile, defined as the ratio of an incremental change in intrinsic rate to an incremental change in measured activity level.

6. The device of claim 5 wherein the controller is programmed to set an alarm flag if the heart rate response slope is not within a normal range as defined by upper and lower limit values.

7. The device of claim 6 further comprising:

a telemetry interface for communicating with a remote monitoring device; and

,

wherein the controller is programmed to send an alert message via the telemetry interface if an alarm flag is set.

8. The device of claim 6 further comprising:

a pacing channel for pacing a cardiac chamber, wherein the controller is programmed to control the delivery of pacing pulses in accordance with a programmed mode; and

,

wherein the controller is programmed to compute a maximum intrinsic heart rate parameter and switch to a rate-adaptive pacing mode if the heart rate response slope and maximum intrinsic heart rate parameters have decreased below predefined limit values.

9. The device of claim 8 wherein the controller is further programmed to calculate a response factor for rate-adaptive pacing based upon previously measured heart rates and activity levels.

10. The device of claim 1 wherein the controller is further programmed to compute a heart rate response parameter and to set an alarm flag if the heart rate response parameter is not within a normal range as defined by upper and lower limit values.

21. The device of claim 1 further comprising a posture sensor.

11. A method for operating a cardiac device, comprising:

generating intra-cardiac electrogram signals and measuring an intrinsic heart rate from the electrogram signals;

measuring a parameter related to a patient'"'"'s level of physical activity; and

,

monitoring a patient'"'"'s cardiopulmonary functional status by constructing a historical record of activity level versus heart rate, referred to as a heart rate response profile.

12. The method of claim 11 wherein the heart rate response profile is a data structure containing a plurality of heart rates, each heart rate being associated with a discrete activity level.

13. The method of claim 12 wherein the heart rate response profile is updated by averaging a currently measured heart rate with the heart rate associated with an activity level corresponding to a currently measured activity level.

14. The method of claim 13 wherein the heart rate response profile is updated only if activity level measurements taken over the N second interval meet a predefined stability criterion.

15. The method of claim 11 further comprising computing a heart rate response slope from the heart rate response profile, defined as the ratio of an incremental change in intrinsic rate to an incremental change in measured activity level.

16. The method of claim 15 further comprising setting an alarm flag if the heart rate response slope is not within a normal range as defined by upper and lower limit values.

17. The method of claim 16 further comprising send an alert message via a telemetry interface if an alarm flag is set.

18. The method of claim 16 further comprising:

pacing a cardiac chamber in accordance with a programmed mode; and

,

deriving a maximum intrinsic heart rate parameter and switching to a rate-adaptive pacing mode if the heart rate response slope and maximum intrinsic heart rate parameters have decreased below predefined limit values.

19. The method of claim 18 further comprising calculating a response factor for rate-adaptive pacing based upon previously measured heart rates and activity levels.

20. The method of claim 11 further comprising computing a heart rate response parameter and setting an alarm flag if the heart rate response parameter is not within a normal range as defined by upper and lower limit values.

22. The method of claim 11 further comprising collecting postural data and wherein the heart rate response profile includes the postural data.