Methods and devices for implementing time of day pacing adjustments

• US 20060212080A1
• Filed: 03/17/2005
• Published: 09/21/2006
• Est. Priority Date: 03/17/2005
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Hartley, Jesse W., Lee, Kent, Ni, Quan, Baker, Kenneth L., Querimit, Michael A., Garg, Ankur, Tobacman, Kenneth I., Miklos, Corey J.
• Granted Patent: US 7,577,479 B2
• Time in Patent Office: Days
• US Class Current: 607/9
• CPC Class Codes: A61B 5/4812 Detecting sleep stages or cycles
• CPC Class Codes: A61B 5/4815 Sleep quality
• CPC Class Codes: A61N 1/368 comprising more than one electrode co-operating with different heart regions A61N1/3622, A61N1/3627 take precedence
• CPC Class Codes: A61N 1/3688 configured for switching the pacing mode, e.g. from AAI to DDD

Abstract

Methods and systems are directed to delivering cardiac pacing therapy to a patient. A pacing therapy associated with one or more pacing parameters is delivered. Alternate cardiac pacing therapies associated with one or more alternate pacing parameters are transitioned to, based on a sleep/wake cycle of the patient. Interactions between the pacing parameters of the pacing therapy and the alternate pacing parameters are resolved. Resolving pacing parameters may be based on analysis of lower rate limits and/or lower rate hysteresis, for example.

Claims

1. A method for delivering therapy to a patient, comprising:

delivering a cardiac pacing therapy associated with one or more pacing parameters;

transitioning to an alternate cardiac pacing therapy associated with one or more alternate pacing parameters, the transition based on a sleep/wake cycle of the patient; and

resolving interactions between the pacing parameters of the pacing therapy and the alternate pacing parameters.

2. The method of claim 1, wherein delivering the cardiac pacing therapy comprises delivering a rate adaptive pacing therapy.

3. The method of claim 1, wherein:

delivering the cardiac therapy comprises delivering the cardiac pacing therapy during a first portion of the patient'"'"'s sleep/wake cycle; and

transitioning to the alternate cardiac pacing therapy comprises transitioning to the alternate cardiac pacing therapy during a second portion of the patient'"'"'s sleep/wake cycle.

4. The method of claim 1, wherein transitioning to the alternate cardiac pacing therapy comprises:

detecting a change in a sleep/wake status of the patient; and

transitioning to the alternate cardiac pacing therapy based on the change in the patient'"'"'s sleep/wake status.

5. The method claim 1, wherein:

delivering the cardiac pacing therapy associated with the one or more pacing parameters comprises delivering the cardiac pacing therapy associated with a lower rate limit; and

transitioning to the alternate cardiac pacing therapy associated with the one or more alternate pacing parameters comprises transitioning to delivering the alternate cardiac pacing therapy associated with an alternate lower rate limit.

6. The method of claim 1, wherein resolving the interactions between the pacing parameters of the cardiac pacing therapy and the alternate pacing parameters comprises using an alternate lower rate limit associated with the alternate cardiac pacing therapy during the alternate pacing therapy if the alternate lower rate limit is below a lower rate limit associated with the cardiac pacing therapy.

7. The method of claim 6, wherein resolving the interactions comprises using a lower rate hysteresis if the alternate lower rate limit associated with the alternate cardiac pacing therapy is below the lower rate limit associated with the cardiac pacing therapy.

8. The method of claim 1, wherein resolving the interactions between the pacing parameters of the cardiac pacing therapy and the alternate pacing parameters comprises using a lower rate limit associated with the cardiac pacing therapy during the alternate cardiac pacing therapy if an alternate lower rate limit associated with the alternate cardiac pacing therapy is above the lower rate limit.

9. The method of claim 8, wherein resolving the interactions between the pacing parameters of the cardiac pacing therapy and the alternate pacing parameters comprises disabling a lower rate hysteresis if the alternate lower rate limit is above the lower rate limit.

10. The method of claim 1, wherein resolving the interactions between the pacing parameters of the cardiac pacing therapy and the alternate pacing parameters comprises arbitrating between therapy indications based on the pacing parameters and therapy indications based on the alternate pacing parameters.

11. The method of claim 10, wherein arbitrating between the therapy interactions comprises delivering a higher rate of a sensor indicated pacing rate based on a lower rate limit associated with the cardiac pacing therapy and an alternate lower rate limit associated with the alternate cardiac pacing therapy.

12. The method of claim 11, wherein the sensor indicated pacing rate is determined based on sensor rate hysteresis.

13. A cardiac rhythm management system, comprising:

one or more electrodes configured to electrically couple to a heart;

a pulse generator coupled to the one or more electrodes, the pulse generator configured to deliver pacing pulses to the heart;

circuitry configured to acquire information associated with a patient'"'"'s sleep/wake cycle; and

a therapy controller coupled to the pulse generator and the sleep/wake circuitry, the therapy controller configured to control transitions between a plurality of pacing therapies, including a pacing therapy associated with one or more pacing parameters and an alternate pacing therapy associated with one or more alternate pacing parameters, based on the patient'"'"'s sleep/wake cycle, the therapy controller further comprising an arbitration processor configured to resolve interactions between the pacing parameters of the pacing therapy and the alternate pacing parameters.

14. The system of claim 13, further comprising sensor circuitry coupled to the therapy unit, the sensor circuitry configured to develop a signal indicative of hemodynamic need, wherein at least one of the pacing therapy and the alternate pacing therapy is adapted based on the hemodynamic need.

15. The system of claim 13, wherein the therapy controller is configured to initiate a transition from the pacing therapy associated a first portion of the patient'"'"'s sleep/wake cycle to the alternate pacing therapy associated with a second portion of the patient'"'"'s sleep/wake cycle.

16. The system of claim 13, wherein:

the sleep/wake circuitry comprises a sleep detector configured to sense a change in a sleep/wake status of the patient; and

the therapy controller is configured to initiate a transition from the pacing therapy to the alternate pacing therapy based on the sensed change in the patient'"'"'s sleep/wake status.

17. The system of claim 13, wherein the arbitration processor is configured to select an alternate lower rate limit associated with the alternate pacing therapy to be used during the alternate pacing therapy if the alternate lower rate limit is below a lower rate limit associated with the pacing therapy, and to select the lower rate limit to be used during the alternate pacing therapy if the alternate lower rate limit is above the lower rate limit.

18. The system of claim 13, wherein at least one of the pacing therapies comprises a wake-time pacing therapy associated with a lower rate limit and at least one of the alternate pacing therapies comprises a sleep-time pacing therapy associated with an alternate lower rate limit.

19. The system of claim 13, wherein at least one of the plurality of pacing therapies comprises a therapy for treating for sleep disordered breathing.

20. A system for delivering therapy, to a patient, comprising:

a therapy unit configured to delivery a cardiac pacing therapy associated with one or more pacing parameters and an alternate pacing therapy associated with one or more alternate pacing parameters;

means for transitioning from the pacing therapy to the alternate cardiac pacing therapy based on a sleep/wake cycle of the patient; and

means for resolving interactions between the pacing parameters of the pacing therapy and the alternate pacing parameters.