METHOD AND APPARATUS FOR INITIATING AND DELIVERING CARDIAC PROTECTION PACING

• US 20060287684A1
• Filed: 05/11/2006
• Published: 12/21/2006
• Est. Priority Date: 05/13/2005
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Baynham, Tamara Colette, Spinelli, Julio C., Prinzen, Frits W., Vanagt, Ward Y. R., Cornelussen, Richard N.
• Granted Patent: US 7,894,896 B2
• Time in Patent Office: Days
• US Class Current: 607/9
• CPC Class Codes: A61B 5/026 Measuring blood flow A61B3/1233, A61B3/1241 take precedence
• CPC Class Codes: A61N 1/3621 for treating or preventing abnormally high heart rate
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/36557 controlled by chemical substances in blood
• CPC Class Codes: A61N 1/36564 controlled by blood pressure
• CPC Class Codes: A61N 1/36578 controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone
• CPC Class Codes: A61N 1/36592 controlled by the heart rate variability
• CPC Class Codes: A61N 1/3702 Physiological parameters A61N1/365 takes precedence; evoked response A61N1/371

Abstract

A pacing system delivers cardiac protection pacing to protect the heart from injuries associated with ischemic events. The pacing system detects an ischemic event and, in response, initiates one or more cardiac protection pacing sequences each including alternative pacing and non-pacing periods. In one embodiment, the pacing system initiates a cardiac protection pacing sequence in response to the detection of the onset of an ischemic event, such that a pacing concurrent conditioning therapy is applied during the detected ischemic event.

Claims

1. A cardiac pacing system, comprising:

a sensing circuit to sense one or more signals indicative of an ischemic event;

an ischemia detector coupled to the sensing circuit, the ischemic detector adapted to detect an onset of the ischemic event from the one or more signals;

a pulse output circuit to deliver pacing pulses; and

a control circuit, coupled to the ischemia detector and the pulse output circuit, to control the delivery of the pacing pulses, the control circuit including;

a cardiac protection pacing sequence initiator adapted to initiate one or more cardiac protection pacing sequences in response to the detection of the onset of the ischemic event, the one or more cardiac protection pacing sequences each including alternating pacing and non-pacing periods, the pacing periods each having a pacing duration during which a plurality of the pacing pulses is delivered, the non-pacing periods each having a non-pacing duration during which none of the pacing pulses is delivered; and

a cardiac protection pacing timer adapted to time the one or more cardiac protection pacing sequences.

2. The system of claim 1, wherein the control circuit comprises a pacing mode switch adapted to switch a pacing mode from a chronic pacing mode to a temporary pacing mode when one of the one or more cardiac protection pacing sequence is initiated and to switch the pacing mode from the temporary pacing mode to the chronic pacing mode when the one of the one or more cardiac protection pacing sequence is completed, the temporary pacing mode being substantially different from the chronic pacing mode.

3. The system of claim 2, wherein the control circuit is adapted to detect an arrhythmia and to suspend the one or more cardiac protection pacing sequences in response to the detection of the arrhythmia.

4. The system of claim 1, further comprising:

an implantable medical device including at least the ischemia detector, the pulse output circuit, and the control circuit; and

an external system communicatively coupled to the implantable medical device.

5. The system of claim 4, wherein the ischemia detector is adapted to produce an ischemia alert signal indicative of the detection of the onset of the ischemic event, and the external system comprises:

an ischemia alert signal receiver to receive the ischemia alert signal from the implantable medical device; and

a presentation device configured to produce at least one of an alarm signal and a warning message when the ischemia alert signal is received.

6. The system of claim 5, wherein the cardiac protection pacing sequence initiator is adapted to initiate the one or more cardiac protection pacing sequences in response to the detection of the onset of the ischemic event and one or more commands, and wherein the external system further comprises a user input device adapted to receive the one or more commands.

7. A cardiac pacing system, comprising:

a sensing circuit to sense one or more signals indicative of an ischemic event;

an ischemia detector, coupled to the sensing circuit, to detect an onset of the ischemic event from the one or more signals;

a pulse output circuit to deliver pacing pulses; and

a control circuit, coupled to the ischemia detector and the pulse output circuit, to control the delivery of the pacing pulses, the control circuit including;

a concurrent conditioning sequence initiator adapted to initiate a concurrent conditioning sequence when an ischemia time interval expires, the ischemia time interval starting when the onset of the ischemic event is detected, the concurrent conditioning sequence including alternating concurrent conditioning pacing and non-pacing periods, the concurrent conditioning pacing periods each having a concurrent conditioning pacing duration during which a plurality of the pacing pulses is delivered, the concurrent conditioning non-pacing periods each having a concurrent conditioning non-pacing duration during which none of the pacing pulses is delivered; and

a concurrent conditioning timer adapted to time the concurrent conditioning sequence.

8. The system of claim 7, wherein the control circuit comprises a pacing mode switch adapted to switch a pacing mode from a chronic pacing mode to a temporary pacing mode when concurrent conditioning sequence is initiated and to switch the pacing mode from the temporary pacing mode to the chronic pacing mode when the concurrent conditioning sequence is completed, the temporary pacing mode being substantially different from the chronic pacing mode.

9. The system of claim 8, wherein the control circuit is adapted to detect an arrhythmia and to suspend the concurrent conditioning sequence in response to the detection of the arrhythmia.

10. The system of claim 7, wherein the control circuit further comprises:

a preconditioning sequence initiator adapted to initiate a plurality of preconditioning sequences after the concurrent conditioning sequence is completed, the preconditioning sequences each including alternating preconditioning pacing and non-pacing periods, the preconditioning pacing periods each having a preconditioning pacing duration during which a plurality of the pacing pulses is delivered, the preconditioning non-pacing periods each having a preconditioning non-pacing duration during which none of the pacing pulses is delivered; and

a preconditioning timer adapted to time the preconditioning sequences.

11. The system of claim 10, wherein the preconditioning sequence initiator is adapted to initiate the preconditioning sequences on a periodic basis using a predetermined period.

12. A method for delivering pacing pulses, the method comprising:

sensing one or more signals indicative of an ischemic event;

detecting an onset of the ischemic event from the one or more signals;

initiating one or more cardiac protection pacing sequences in response to the detection of the onset of the ischemic event, the one or more cardiac protection pacing sequences each including alternating pacing and non-pacing periods, the pacing periods each having a pacing duration during which a plurality of pacing pulses is delivered, the non-pacing periods each having a non-pacing duration during which no pacing pulse is delivered; and

delivering the plurality of pacing pulses during each of the pacing periods.

13. The method of claim 12, further comprising switching a pacing mode from a chronic pacing mode to a temporary pacing mode when one of the one or more cardiac protection pacing sequence is initiated and to switch the pacing mode from the temporary pacing mode to the chronic pacing mode when the one of the one or more cardiac protection pacing sequence is completed, the temporary pacing mode substantially different from the chronic pacing mode.

14. The method of claim 12, wherein the one or more cardiac protection pacing sequences comprises at least one concurrent conditioning sequence, and further comprising initiating the at least one concurrent conditioning pacing sequence when an ischemia time interval expires.

15. The method of claim 14, further comprising starting the ischemia time interval when the onset of the ischemic event is detected.

16. The method of claim 15, further comprising programming the ischemia time interval to a time interval between approximately 15 minutes and 6 hours.

17. The method of claim 12, wherein the one or more cardiac protection pacing sequences comprises at least one concurrent conditioning sequence, and further comprising initiating the at least one concurrent conditioning sequence when the a concurrent conditioning command is received.

18. The method of claim 12, wherein the one or more cardiac protection pacing sequences comprise at least one concurrent conditioning sequence and a plurality of prophylactic preconditioning sequences, the prophylactic preconditioning sequences are initiated after the concurrent conditioning sequence is completed.

19. The method of claim 18, wherein initiating the prophylactic preconditioning sequences comprises initiating the prophylactic preconditioning pacing sequences on a periodic basis.

20. The method of claim 18, wherein initiating the prophylactic preconditioning sequences comprises initiating the prophylactic preconditioning pacing sequences in response to one or more preconditioning commands.

21. The method of claim 12, further comprising:

detecting an arrhythmia; and

suspending the one or more cardiac protection pacing sequences when the arrhythmia is detected.