Neural stimulation system for cardiac fat pads

• US 20060206159A1
• Filed: 03/11/2005
• Published: 09/14/2006
• Est. Priority Date: 03/11/2005
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Moffitt, Julia, Libbus, Imad
• Granted Patent: US 7,769,446 B2
• Time in Patent Office: Days
• US Class Current: 607/37
• CPC Class Codes: A61N 1/0551 Spinal or peripheral nerve electrodes
• CPC Class Codes: A61N 1/056 Transvascular endocardial electrode systems
• CPC Class Codes: A61N 1/0587 Epicardial electrode systems; Endocardial electrodes piercing the pericardium
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/36135 using physiological parameters
• CPC Class Codes: A61N 1/36514 controlled by a physiological quantity other than heart potential, e.g. blood pressure controlled by two or more physical parameters A61N1/36585
• CPC Class Codes: A61N 1/3962 in combination with another heart therapy
• CPC Class Codes: A61N 1/3987 characterised by the timing or triggering of the shock

Abstract

Various aspects relate to a device which, in various embodiments, comprises a header, a neural stimulator, a detector and a controller. The header includes at least one port to connect to at least one lead, and includes first and second channels for use to provide neural stimulation to first and second neural stimulation sites for a heart. The controller is connected to the detector and the neural stimulator to selectively deliver a therapy based on the feedback signal. A first therapy signal is delivered to the first neural stimulation site to selectively control contractility and a second therapy signal is delivered to the second neural stimulation site to selectively control one of a sinus rate and an AV conduction. Other aspects and embodiments are provided herein.

Claims

1. An implantable medical device, comprising:

a header including at least one port to connect to at least one lead, including;

a first channel to connect to a first lead electrode for use to provide neural stimulation to a first neural stimulation site for a heart; and

a second channel to connect to a second lead electrode for use to provide neural stimulation to a second neural stimulation site for the heart; and

a neural stimulator connected to the first channel to selectively apply neural stimulation to the first neural stimulation site for the heart, and connected to the second channel to selectively apply neural stimulation to the second neural stimulation site for the heart;

a detector connected to the header to receive at least one sensed signal indicative of at least one sensed physiological parameter, the detector to generate at least one feedback signal based on the at least one sensed signal;

a controller connected to the detector and to the neural stimulator to selectively deliver a neural stimulation therapy based on the feedback signal, the neural stimulation therapy to deliver a first therapy signal through the first channel to the first neural stimulation site for the heart to selectively control contractility for the heart, and a second therapy signal through the second channel to the second neural stimulation site for the heart to selectively control one of a sinus rate and an AV conduction for the heart.

2. The device of claim 1, wherein:

the first neural stimulation site for the heart includes an SVC-AO cardiac fat pad located proximate to a junction between a superior vena cava and an aorta; and

the second neural stimulation site for the heart includes a cardiac fat pad selected from a group of fat pads consisting of;

a PV cardiac fat pad associated with an sinoatrial (SA) node, the PV cardiac fat pad being located proximate to a junction between a right atrium and right pulmonary vein; and

an IVC-LA cardiac fat pad associated with an atrioventricular (AV) node, the IVC-LA cardiac fat pad being located proximate to a junction between an inferior vena cava and a left atrium.

3. The device of claim 1, wherein the at least one lead includes at least one epicardial lead to provide epicardial neural stimulation to a cardiac fat pad, and the neural stimulator is adapted to epicardially stimulate the cardiac fat pad using the at least one epicardial lead.

4. The device of claim 1, wherein the at least one lead includes at least one intravascularly-fed lead adapted to be positioned into vascular proximate to a cardiac fat pad to transvascularly provide neural stimulation to the cardiac fat pad, and the neural stimulator is adapted to transvascularly stimulate the cardiac fat pad using the intravascularly-fed lead.

5. The device of claim 1, wherein

the header includes a third channel to connect to a third lead electrode for use to provide neural stimulation to a third neural stimulation site for the heart, and the neural stimulator is connected to the third channel to selectively apply neural stimulation to the third neural stimulation site for the heart, the neural stimulation therapy to deliver a third therapy signal through the third channel to the third neural stimulation site for the heart, one of the second therapy signal and the third therapy signal being adapted to selectively control one of the sinus rate and the AV conduction for the heart and the other of the second therapy signal and the third therapy signal being adapted to selectively control the other of the sinus rate and the AV conduction for the heart.

6. The device of claim 5, wherein:

the first neural stimulation site for the heart includes an SVC-AO cardiac fat pad located proximate to a junction between a superior vena cava and an aorta;

the second neural stimulation site for the heart includes a PV cardiac fat pad associated with an sinoatrial (SA) node, the PV cardiac fat pad being located proximate to a junction between a right atrium and right pulmonary veins; and

the third neural stimulation site for the heart includes an IVC-LA cardiac fat pad associated with an atrioventricular (AV) node, the IVC-LA cardiac fat pad being located proximate to a junction between an inferior vena cava and a left atrium.

7. The device of claim 6, wherein the at least one lead includes:

a first epicardial lead with the first lead electrode positioned to epicardially stimulate the SVC-AO cardiac fat pad;

a second epicardial lead with the second lead electrode positioned to epicardially stimulate the PV cardiac fat pad; and

a third epicardial lead with the third lead electrode positioned to epicardially stimulate the IVC-LA cardiac fat pad.

8. The device of claim 6, wherein the at least one lead includes:

a first intravascularly-fed lead with the first lead electrode adapted to be positioned to transvascularly stimulate the SVC-AO cardiac fat pad;

a second intravascularly-fed lead with the second lead electrode adapted to be positioned to transvascularly stimulate the PV cardiac fat pad; and

a third intravascularly-fed lead with the third lead electrode adapted to be positioned to transvascularly stimulate the IVC-LA cardiac fat pad.

9. The device of claim 8, wherein the first intravascularly-fed lead is adapted to be fed into a right pulmonary artery.

10. The device of claim 8, wherein the first intravascularly-fed lead is adapted to be fed into the superior vena cava.

11. The device of claim 8, wherein the second intravascularly-fed lead is adapted to be fed into a right pulmonary artery.

12. The device of claim 8, wherein the second intravascularly-fed lead is adapted to be fed into the right pulmonary vein.

13. The device of claim 8, wherein the third intravascularly-fed lead is adapted to be fed into the inferior vena cava.

14. The device of claim 8, wherein the third intravascularly-fed lead is adapted to be fed into a coronary sinus.

15. The device of claim 8, wherein the third intravascularly-fed lead is adapted to be fed into the left atrium.

16. The device of claim 6, wherein the at least one lead includes:

a first intravascularly-fed lead with the first lead electrode adapted to be fed into a first vessel and through a wall of the first vessel to position proximate the SVC-AO cardiac fat pad;

a second intravascularly-fed lead with the second lead electrode adapted to be fed into a second vessel and through a wall of the second vessel to position proximate the PV cardiac fat pad; and

a third intravascularly-fed lead with the third lead electrode adapted to be fed into a third vessel and through a wall of the third vessel to position proximate the IVC-LA cardiac fat pad.

17. The device of claim 1, wherein the at least one sensed signal is indicative of a cardiac rate.

18. The device of claim 1, wherein the at least one sensed signal is indicative of a cardiac rhythm.

19. The device of claim 1, wherein the at least one sensed signal is indicative of cardiac contractility.

20. The device of claim 1, wherein the at least one sensed signal is indicative of blood pressure.

21. The device of claim 1, wherein the at least one sensed signal is indicative of sensed nerve traffic representing at least one of sympathetic nerve traffic and parasympathetic nerve traffic.

22. An implantable medical device, comprising:

means for providing a feedback signal indicative of at least one physiological signal; and

means for providing a neural stimulation therapy responsive to the feedback signal, including;

means for stimulating a first neural stimulation site for a heart to selectively control contractility for the heart; and

means for stimulating a second neural stimulation site for the heart to selectively control one of an sinus rate and an AV conduction for the heart.

23. The device of claim 22, wherein:

the means for stimulating the second neural stimulation site for the heart includes means for selectively stimulating the second neural stimulation site to control the sinus rate; and

the means for providing the neural stimulation therapy includes means for stimulating a third neural stimulation site for the heart to control the AV conduction.

24. The device of claim 23, wherein:

the first neural stimulation site includes an SVC-AO cardiac fat pad located proximate to a junction between a superior vena cava and an aorta; and

the second neural stimulation site includes a PV cardiac fat pad associated with an sinoatrial (SA) node, the PV cardiac fat pad being located proximate to a junction between a right atrium and right pulmonary veins; and

the third neural stimulation site includes an IVC-LA cardiac fat pad associated with an atrioventricular (AV) node, the IVC-LA cardiac fat pad being located proximate to a junction between an inferior vena cava and a left atrium.

25. The device of claim 23, wherein the means for providing the neural stimulation therapy responsive to the feedback signal includes means for pacing the heart using the means for selectively stimulating the second neural stimulation site to control the sinus rate and using the means for stimulating a third neural stimulation site for the heart to control the AV conduction.

26. The device of claim 22, wherein the means for providing the feedback signal includes means for providing a feedback signal indicative of a sinus rate.

27. The device of claim 22, wherein the means for providing the feedback signal includes means for providing a feedback signal indicative of AV conduction.

28. The device of claim 22, wherein the means for providing the feedback signal includes means for providing a feedback signal indicative of cardiac contractility.

29. A method, comprising:

providing a feedback signal indicative of at least one physiological signal; and

providing a neural stimulation therapy responsive to the feedback signal, including;

stimulating an SVC-AO cardiac fat pad to selectively control contractility for the heart, the SVC-AO fat pad being located proximate to a junction between a superior vena cava and an aorta; and

stimulating a PV cardiac fat pad associated with an sinoatrial (SA) node to selectively control a sinus rate, the PV cardiac fat pad being located proximate to a junction between a right atrium and right pulmonary veins; and

stimulating an IVC-LA cardiac fat pad associated with an atrioventricular (AV) node to selectively control AV conduction, the IVC-LA cardiac fat pad being located proximate to a junction between an inferior vena cava and a left atrium.

30. The method of claim 29, wherein providing a neural stimulation therapy includes using an epicardial lead to epicardially stimulate at least one the cardiac fat pads.

31. The method of claim 29, wherein providing a neural stimulation therapy includes using an intravascularly-fed lead to transvascularly stimulate at least one the cardiac fat pads.

32. The method of claim 29, wherein providing a feedback signal includes providing a feedback signal indicative of a sinus rate, and AV conduction, and cardiac contractility.