Pressure sensing for feedback control of post-MI remodeling control pacing

• US 20070055317A1
• Filed: 09/06/2005
• Published: 03/08/2007
• Est. Priority Date: 09/06/2005
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Pastore, Joseph, Salo, Rodney, Hartley, Jesse, Kramer, Andrew, Stahmann, Jeffrey
• Granted Patent: US 7,877,140 B2
• Time in Patent Office: Days
• US Class Current: 607/23
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• 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 1/36564 controlled by blood pressure
• CPC Class Codes: A61N 1/3684 for stimulating the heart at multiple sites of the ventricle or the atrium
• CPC Class Codes: A61N 1/36842 Multi-site stimulation in the same chamber
• CPC Class Codes: A61N 1/36843 Bi-ventricular stimulation

Abstract

A method and device for delivering pre-excitation pacing to prevent or reduce cardiac remodeling following a myocardial infarction is described. The pre-excitation pacing is modulated in accordance with an intravascular pressure measurement in order to balance the beneficial effects of stress reduction with hemodynamic compromise.

Claims

1. An implantable device for delivering cardiac therapy to a patient, comprising:

one or more pacing channels for delivering pacing pulses to one or more ventricular sites;

a controller for controlling the delivery of pacing pulses to one or more ventricular sites during a cardiac cycle in accordance with a programmed pacing algorithm;

wherein the controller is programmed to deliver pre-excitation pacing which pre-excites a region of the ventricular myocardium so as to mechanically unload a region of the ventricular myocardium during systole;

a pressure sensor for acquiring a cardiovascular pressure measurement; and

,

wherein the controller is programmed to adjust the amount of pre-excitation pacing based upon the pressure measurement.

2. The device of claim 1 wherein the controller is programmed to adjust the amount of pre-excitation pacing by adjusting an AV delay used to deliver the pre-excitation pacing in an atrial tracking or AV sequential pacing mode.

3. The device of claim 1 wherein the controller is programmed to adjust the amount of pre-excitation pacing by adjusting a VV offset delay used to deliver the pre-excitation pacing to two or more ventricular sites.

4. The device of claim 1 wherein the controller is programmed to adjust the amount of pre-excitation pacing by adjusting a pacing configuration used to deliver the pre-excitation pacing.

5. The device of claim 1 wherein the controller is programmed to adjust the amount of pre-excitation pacing by decreasing the amount of pre-excitation pacing if the pressure measurement falls below a specified threshold value.

6. The device of claim 1 wherein the controller is programmed to adjust the amount of pre-excitation pacing by starting or stopping the delivery of pre-excitation pacing.

7. The device of claim 1 wherein the controller is further programmed to derive a cardiac function assessment from the pressure measurement and one or more other measured cardiac function parameters and adjust the amount of pre-excitation pacing based upon the cardiac function assessment.

8. The device of claim 7 further comprising:

an exertion level sensor; and

,

wherein the controller is programmed to derive the cardiac function assessment based upon the pressure measurement and the measured exertion level.

9. The device of claim 1 wherein the controller is programmed to trend pressure measurements in relation to the amount of pre-excitation pacing delivered in order to determine the effect of the pre-excitation pacing on cardiac function.

10. The device of claim 1 further comprising:

an stress reduction sensor; and

,

wherein the controller is programmed to derive the extent of regional unloading based upon the stress reduction sensor data and to adjust the amount of pre-excitation pacing based upon the extent of regional unloading and the cardiac function assessment.

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

delivering pre-excitation pacing pulses to one or more ventricular sites in a manner which pre-excites a region of the ventricular myocardium so as to mechanically unload a region of the ventricular myocardium during systole;

acquiring a cardiovascular pressure measurement; and

,

adjusting the amount of pre-excitation pacing based upon the pressure measurement.

12. The method of claim 11 further comprising adjusting the amount of pre-excitation pacing by adjusting an AV delay used to deliver the pre-excitation pacing in an atrial tracking or AV sequential pacing mode.

13. The method of claim 11 further comprising adjusting the amount of pre-excitation pacing by adjusting a VV offset delay used to deliver the pre-excitation pacing to two or more ventricular sites.

14. The method of claim 11 further comprising adjusting the amount of pre-excitation pacing by adjusting a pacing configuration used to deliver the pre-excitation pacing.

15. The method of claim 11 further comprising adjusting the amount of pre-excitation pacing by decreasing the amount of pre-excitation pacing if the pressure measurement falls below a specified threshold value.

16. The method of claim 11 further comprising adjusting the amount of pre-excitation pacing by starting or stopping the delivery of pre-excitation pacing.

17. The method of claim 11 further comprising deriving a cardiac function assessment from the pressure measurement and one or more other measured cardiac function parameters and adjusting the amount of pre-excitation pacing based upon the cardiac function assessment.

18. The method of claim 17 further comprising:

measuring an exertion level; and

,

deriving the cardiac function assessment based upon the pressure measurement and the measured exertion level.

19. The method of claim 11 wherein the controller is programmed to trend pressure measurements in relation to the amount of pre-excitation pacing delivered in order to determine the effect of the pre-excitation pacing on cardiac function.

20. The method of claim 11 further comprising:

acquiring stress reduction data; and

,

deriving the extent of regional unloading based upon the stress reduction data and adjusting the amount of pre-excitation pacing based upon the extent of regional unloading and the cardiac function assessment.