Cardiac resynchronization therapy for improved hemodynamics based on disordered breathing detection

• US 20070118180A1
• Filed: 11/18/2005
• Published: 05/24/2007
• Est. Priority Date: 11/18/2005
• Status: Abandoned Application

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Lee, Kent, Ni, Quan, Hartley, Jesse, E. Stahmann, Jeffrey, Daum, Douglas
• Application Number:
  US11/282,963
• Publication Number:
  US 20070118180A1
• Time in Patent Office: Days
• US Class Current: 607/17
• CPC Class Codes: A61B 5/02 Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
• CPC Class Codes: A61B 5/08 Detecting, measuring or recording devices for evaluating the respiratory organs A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/366 Detecting abnormal QRS complex, e.g. widening
• CPC Class Codes: A61B 5/4818 Sleep apnoea
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61B 5/6846 specially adapted to be brought in contact with an internal body part, i.e. invasive
• 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

Abstract

The presence of disordered breathing is detected using an implantable medical device. A cardiac condition is detected that is indicative of the patient'"'"'s cardiac status. Based on the presence of disordered breathing and the cardiac condition, the patient is identified as suitable for a cardiac resynchronization therapy.

Claims

1. A method, comprising:

detecting presence of disordered breathing using an implantable medical device;

detecting a cardiac condition indicative of the patient'"'"'s cardiac status; and

identifying the patient as suitable for a cardiac resynchronization therapy based on the presence of disordered breathing and the cardiac condition.

2. The method of claim 1, further comprising delivering at least one of a cardiac pacing therapy other than a cardiac resynchronization therapy, a cardiac shock therapy, and a cardiac neurostimulation therapy.

3. The method of claim 1, wherein detecting the presence of disordered breathing comprises detecting at least one of obstructive sleep apnea, central sleep apnea, hypopnea, orthopnea, paroxysmal nocturnal dyspnea, and Cheyne-Stokes respiration.

4. The method of claim 1, comprising enabling the implantable medical device to perform the cardiac resynchronization therapy based on identifying the patient as suitable for the cardiac resynchronization therapy.

5. The method of claim 1, wherein the implantable medical device comprises a pulse generator and electrodes that are configured for cardiac resynchronization therapy delivery.

6. The method of claim 1, wherein detecting the cardiac condition comprises detecting a ventricular dysynchrony in the patient'"'"'s heart via an implantable or patient-external sensing arrangement.

7. The method of claim 1, wherein detecting the cardiac condition comprises detecting left ventricular systolic dysfunction via an implantable or patient-external sensing arrangement.

8. The method of claim 1, wherein detecting the cardiac condition comprises detecting a left ventricular systolic dysfunction comprising a left ventricular ejection fraction value less than a predetermined limit.

9. The method of claim 1, wherein detecting the cardiac condition comprises determining that a QRS complex pulse width of a cardiac cycle exceeds a predetermined limit.

10. The method of claim 1, wherein detecting the cardiac condition comprises detecting a ventricular wall motion asynchrony that exceeds a predetermined limit.

11. The method of claim 1, comprising one or more of initiating, terminating, adjusting, or optimizing the cardiac resynchronization therapy in response to detecting the presence of disordered breathing and the cardiac condition.

12. The method of claim 1, wherein detecting the presence of disordered breathing is used to trigger an alert using a patient-external device.

13. The method of claim 1, wherein detecting the presence of disordered breathing comprises detecting an apnea/hypopnea index greater than a predetermined limit.

14. The method of claim 1, comprising enabling the implantable medical device to perform a first cardiac resynchronization therapy in response to detecting obstructive sleep apnea, and enabling the implantable medical device to perform a second cardiac resynchronization therapy after detecting central sleep apnea.

15. The method of claim 2, comprising adjusting an atrioventricular delay based on the detected disordered breathing.

16. The method of claim 1, wherein the cardiac resynchronization therapy comprises selecting a cardiac stimulation vector based on the detected disordered breathing.

17. An implantable medical device, comprising:

a housing configured for implantation in a patient;

a lead system comprising an electrode arrangement and coupled to the housing; and

a processor provided in the housing and coupled to the lead system, the processor configured to detect presence of disordered breathing, detect a cardiac condition indicative of the patient'"'"'s cardiac status, and identify the patient as suitable for a cardiac resynchronization therapy based on the presence of disordered breathing and the cardiac condition.

18. The device of claim 17, wherein implantable medical device comprises a pulse generator coupled to the processor and configured to deliver at least one of a cardiac pacing therapy other than a cardiac resynchronization therapy, a cardiac shock therapy, and a cardiac neurostimulation therapy.

19. The device of claim 18, wherein the processor is configured to enable the pulse generator to perform the cardiac resynchronization therapy based on identifying the patient as suitable for the cardiac resynchronization therapy.

20. The device of claim 18, wherein the processor is configured to adjust an atrioventricular delay based on the detected disordered breathing.

21. The device of claim 17, wherein the processor is configured to detect at least one of obstructive sleep apnea, central sleep apnea, hypopnea, orthopnea, paroxysmal nocturnal dyspnea, and Cheyne-Stokes respiration.

22. The device of claim 17, further comprising one or both of an implantable sensor arrangement and a patient-external sensor arrangement coupled to the implantable medical device, the processor configured to detect a ventricular dysynchrony in the patient'"'"'s heart via the one or both of the implantable or patient-external sensing arrangement.

23. The device of claim 17, wherein the processor is coupled to communication circuitry configured to facilitate wireless communication between the processor and a patient-external device or system.

24. The device of claim 23, wherein patient-external device or system is configured to generate a clinician alert to initiate, terminate, adjust, or optimize the cardiac resynchronization therapy.

25. The device of claim 17, wherein the implantable medical device comprises transthoracic impedance measuring circuitry coupled to the processor and configured to detect patient breathing.

26. An implantable medical device, comprising:

means for detecting presence of disordered breathing from within a patient;

means for detecting a cardiac condition indicative of the patient'"'"'s cardiac status; and

means for identifying the patient as suitable for a cardiac resynchronization therapy based on the presence of disordered breathing and the cardiac condition.

27. The device of claim 26, comprising means for alerting a clinician that the patient is suitable for the cardiac resynchronization therapy.