METHOD AND APPARATUS FOR PREVENTING CARDIAC ARRHYTHMIAS WITH ENDOVASCULAR STIMULATION

• US 20070129763A1
• Filed: 10/16/2006
• Published: 06/07/2007
• Est. Priority Date: 03/25/2002
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Cates, Adam
• Granted Patent: US 8,792,979 B2
• Time in Patent Office: Days
• US Class Current: 607/9
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/3962 in combination with another heart therapy
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

Certain cardiac arrhythmias can be prevented by appropriate electrical stimulation of autonomic nerves innervating the heart. An implantable cardiac rhythm management device is configured to deliver such stimulation when an autonomic imbalance is predicted to be present via an endovascular electrode. Autonomic imbalance may be predicted to be present based upon circadian rhythms, detected heart rates, or detected heart rate variability.

Claims

1. An implantable device, comprising:

a sympathetic stimulation channel for electrically stimulating sympathetic nerves innervating the heart of a patient;

a sensing channel for sensing a physiological variable reflective of autonomic balance;

a controller programmed to detect autonomic imbalance in the patient; and

,

wherein the controller is further programmed to cause the delivery of stimulation pulses through the sympathetic stimulation channel when increased parasympathetic activity is detected.

2. The device of claim 1 further comprising:

a parasympathetic stimulation channel for electrically stimulating parasympathetic nerves innervating the heart; and

,

wherein the controller is further programmed to cause the delivery of stimulation pulses through the parasympathetic stimulation channel when increased sympathetic activity is detected.

3. The device of claim 2 wherein the sympathetic and parasympathetic stimulation channels include:

a pulse generator; and

,

stimulation electrodes adapted for endovascular disposition adjacent sympathetic and parasympathetic nerves innervating the heart.

4. The device of claim 1 wherein the sensing channel is a cardiac sensing channel and the physiological variable reflective of autonomic balance is heart rate.

5. The device of claim 4 wherein the controller is programmed to detect autonomic imbalance based on the time intervals between successive ventricular senses.

6. The device of claim 4 wherein the controller is programmed to detect autonomic imbalance based on an average of RR intervals taken over a specified period of time.

7. The device of claim 4 wherein the controller is programmed to detect autonomic imbalance based upon the variability of the measured heart rate.

8. The device of claim 7 wherein the controller is programmed to compute a ratio of low frequency variation to high frequency variation of heart rate in order to detect autonomic imbalance.

9. The device of claim 8 wherein the controller is programmed to analyze a RR interval signal to determine its energies in defined high and low frequency bands and determine a ratio between a low frequency (LF) band with signal power ranging from 0.04 to 0.15 Hz and a high frequency band (HF) with signal power ranging from 0.15 to 0.40 Hz to detect autonomic imbalance.

10. The device of claim 1 wherein the controller is programmed to predict autonomic imbalance based upon circadian rhythms.

11. A method, comprising:

sensing a physiological variable reflective of autonomic balance;

detecting autonomic imbalance in the patient; and

,

delivering stimulation pulses through a sympathetic stimulation channel for electrically stimulating sympathetic nerves innervating the heart of a patient when increased parasympathetic activity is detected.

12. The method of claim 11 further comprising delivering stimulation pulses through a parasympathetic stimulation channel for electrically stimulating parasympathetic nerves innervating the heart when increased sympathetic activity is detected.

13. The method of claim 12 further comprising endovascularly disposing stimulation electrodes for delivering stimulation pulses adjacent sympathetic and parasympathetic nerves innervating the heart.

14. The method of claim 11 wherein the physiological variable reflective of autonomic balance is heart rate.

15. The method of claim 14 further comprising detecting autonomic imbalance based on the time intervals between successive ventricular senses.

16. The method of claim 14 further comprising detecting autonomic imbalance based on an average of RR intervals taken over a specified period of time.

17. The method of claim 14 further comprising detecting autonomic imbalance based upon the variability of the measured heart rate.

18. The method of claim 17 further comprising computing a ratio of low frequency variation to high frequency variation of heart rate in order to detect autonomic imbalance.

19. The method of claim 18 further comprising analyzing a RR interval signal to determine its energies in defined high and low frequency bands and determine a ratio between a low frequency (LF) band with signal power ranging from 0.04 to 0.15 Hz and a high frequency band (HF) with signal power ranging from 0.15 to 0.40 Hz to detect autonomic imbalance.

20. The method of claim 11 further comprising predicting autonomic imbalance based upon circadian rhythms.