Neural stimulation system for reducing atrial proarrhythmia

• US 20070150011A1
• Filed: 12/28/2005
• Published: 06/28/2007
• Est. Priority Date: 12/28/2005
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Meyer, Scott, Sathaye, Alok
• Granted Patent: US 9,566,447 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 1/3624 occurring in the atrium, i.e. atrial tachycardia
• CPC Class Codes: A61N 1/3702 Physiological parameters A61N1/365 takes precedence; evoked response A61N1/371

Abstract

A system for reducing proarrhythmic effects of neural stimulation is provided. One aspect of this disclosure relates to an implantable medical device (IMD) for reducing proarrhythmic effects of neural stimulation. The IMD includes a neural stimulator adapted to deliver an electrical signal through at least one electrode to provide vagal stimulation. The IMD also includes a controller adapted to receive atrial arrhythmia vulnerability data and to control a therapeutic stimulator to limit atrial proarrhythmia using the atrial arrhythmia vulnerability data. The controller is further adapted to receive atrial arrhythmic history data and to control a therapeutic stimulator to limit atrial proarrhythmia using the atrial arrhythmic history data, according to various embodiments. According to one embodiment, the therapeutic stimulator includes the neural stimulator. The therapeutic stimulator includes a cardiac stimulator adapted to provide cardiac rhythm management therapy, according to various embodiments. Other aspects and embodiments are provided herein.

Claims

1. An implantable medical device, comprising:

means for delivering an electrical signal to provide vagal stimulation; and

means for controlling a therapeutic stimulator to limit atrial proarrhythmia using atrial arrhythmia vulnerability data.

2. The device of claim 1, wherein the vagal stimulation includes cardioprotective vagal stimulation.

3. The device of claim 1, wherein the controlling means is further adapted to receive atrial arrhythmic history data and to control a therapeutic stimulator to limit atrial proarrhythmia using the atrial arrhythmic history data.

4. The device of claim 1, wherein the therapeutic stimulator includes the neural stimulator.

5. The device of claim 1, wherein the therapeutic stimulator includes a cardiac stimulator adapted to provide cardiac rhythm management therapy.

6. The device of claim 2, wherein the controlling means is adapted to control the neural stimulator to limit therapy delivery to a specific time period.

7. The device of claim 6, the controlling means is adapted to control the neural stimulator to deliver therapy only when patient is awake.

8. The device of claim 6, wherein the controlling means is adapted to control the neural stimulator to deliver therapy only when patient is asleep.

9. The device of claim 4, wherein the controlling means is adapted to control the neural stimulator to reduce therapy delivery when one or more indicators of arrhythmic vulnerability are present.

10. The device of claim 4, wherein the controlling means is adapted to control the neural stimulator to reduce therapy delivery based on atrial arrhythmic history data.

11. The device of claim 9, wherein the indicator of arrhythmic vulnerability includes an increase in premature atrial complexes (PACs).

12. The device of claim 11, wherein the indicator of arrhythmic vulnerability includes an increase in PAC trains.

13. An implantable medical device, comprising:

a neural stimulator adapted to deliver an electrical signal to provide vagal stimulation;

a cardiac stimulator adapted to deliver an electrical signal to provide cardiac rhythm management therapy; and

a controller adapted to control the neural stimulator and the cardiac stimulator to limit atrial proarrhythmia using atrial arrhythmia vulnerability data.

14. The device of claim 13, wherein the vagal stimulation includes cardioprotective vagal stimulation.

15. The device of claim 13, wherein controller is further adapted to receive atrial arrhythmic history data and to control the neural stimulator and the cardiac stimulator to limit atrial proarrhythmia using the atrial arrhythmic history data.

16. The device of claim 13, wherein the controller is adapted to receive atrial arrhythmia vulnerability data from a sensor.

17. The device of claim 15, wherein the controller is adapted to access atrial arrhythmic history data from a memory within the implantable medical device.

18. An implantable medical device, comprising:

a neural stimulator adapted to deliver an electrical signal to provide vagal stimulation;

a sensing circuit adapted to be connected to at least one sensor, the at least one sensor adapted to monitor atrial activity to measure atrial arrhythmia vulnerability; and

a controller adapted to receive measured data from the sensing circuit and to control the neural stimulator to limit atrial proarrhythmia using the measured data.

19. The device of claim 18, wherein the vagal stimulation includes cardioprotective vagal stimulation.

20. The device of claim 18, wherein controller is further adapted to receive atrial arrhythmic history data and to control the neural stimulator to limit atrial proarrhythmia using the atrial arrhythmic history data.

21. The device of claim 18, wherein the at least one sensor is adapted to actively measure atrial electrophysiology parameters.

22. The device of claim 21, wherein the controller is adapted to control the neural stimulator to limit atrial proarrhythmia based on the atrial electrophysiology parameters.

23. The device of claim 19, wherein the atrial electrophysiology parameters include unipolar electrogram areas.

24. The device of claim 19, wherein the atrial electrophysiology parameters include atrial effective refractory periods (AERP).

25. A system, comprising:

at least one neural stimulation lead having a proximal portion and a distal portion;

a plurality of electrodes along the distal portion of the at least one lead; and

an implantable medical device coupled to the proximal portion of the at least one lead, the implantable device including;

a neural stimulator adapted to deliver an electrical signal through at least one electrode to provide cardioprotective vagal stimulation; and

a controller adapted to receive atrial arrhythmia vulnerability data and to control the neural stimulator to limit atrial proarrhythmia using the atrial arrhythmia vulnerability data.

26. The system of claim 25, wherein the at least one lead includes a transvascular lead.

27. The system of claim 25, wherein the implantable medical device includes a cardiac rhythm management device.

28. A system, comprising:

an implanted neural stimulator adapted to deliver an electrical signal through at least one electrode to provide cardioprotective vagal stimulation; and

an external monitoring device wirelessly coupled to the stimulator, the device including;

a monitoring module adapted to monitor atrial activity to measure atrial vulnerability; and

a controller module adapted to receive atrial arrhythmia vulnerability data and to control the neural stimulator to limit atrial proarrhythmia using the atrial arrhythmia vulnerability data.

29. The system of claim 28, wherein the external monitoring device includes a personal computer.

30. The system of claim 28, wherein the external monitoring device includes an advanced patient management (APM) system.

31. A method, comprising:

applying neural stimulation therapy to deliver cardioprotective vagal stimulation;

monitoring atrial activity to detect changes related to the application of neural stimulation therapy; and

titrating the applied therapy to reduce atrial proarrhythmia in response to the detected changes in atrial activity.

32. The method of claim 31, further comprising:

receiving atrial arrhythmic history data and titrating the applied therapy to reduce atrial proarrhythmia using the atrial arrhythmic history data.

33. The method of claim 31, wherein monitoring atrial activity includes monitoring atrial arrhythmia activity using implanted cardiac leads.

34. The method of claim 31, wherein monitoring atrial activity includes monitoring atrial arrhythmia activity using subcutaneous wireless electrocardiogram (ECG) measurements.

35. A method, comprising:

applying neural stimulation therapy to deliver cardioprotective vagal stimulation; and

applying cardiac rhythm management strategies to reduce atrial proarrhythmia from the neural stimulation therapy.

36. The method of claim 35, further comprising:

monitoring atrial activity to detect changes related to the application of neural stimulation therapy; and

wherein applying cardiac rhythm management strategies include applying cardiac rhythm management strategies for preventing atrial arrhythmia in response to the detected changes in atrial activity.

37. The method of claim 36, wherein applying cardiac rhythm management strategies includes applying atrial overdrive pacing.

38. The method of claim 36, wherein applying cardiac rhythm management strategies includes applying atrial anti-tachy pacing.

39. The method of claim 36, wherein applying cardiac rhythm management strategies includes automatically engaging algorithms for preventing paroxysmal atrial fibrillation.

40. The method of claim 36, wherein applying cardiac rhythm management strategies includes applying atrial overdrive pacing if prior atrial tachycardia events have been detected.