Method and apparatus for treating diastolic heart failure

• US 20070203522A1
• Filed: 02/28/2006
• Published: 08/30/2007
• Est. Priority Date: 02/28/2006
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Hettrick, Douglas, Euler, David, Mulligan, Lawrence
• Granted Patent: US 7,792,581 B2
• Time in Patent Office: Days
• US Class Current: 607/9
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy

Abstract

Methods and systems for treating patients with diastolic heart failure (DHF) are disclosed which include slowing a patient'"'"'s heart rate below its intrinsic rate, and controlling the rate using cardiac pacing therapy to improve LV filling and cardiac output. In certain embodiments, a pacing treatment rate may be determined by adjusting an adaptive rate by an amount determined by evaluating one or more patient parameters.

Claims

1. A method of treating a patient with diastolic heart failure (DHF), the method comprising:

causing the patient'"'"'s base heart rate to decrease below an intrinsic rate; and

delivering cardiac pacing therapy at a treatment rate, R_T, wherein R_T is determined by adjusting an adaptive rate, R₀, by a rate adjustment, R_A, to thereby improve cardiac output.

2. The method of claim 1 wherein the rate adjustment, R_A, is a function of one or more monitored patient parameters.

3. The method of claim 1 wherein the adaptive rate, R₀, is derived from an activity sensor.

4. The method of claim 1 wherein the adaptive rate, R₀, is derived from a physiologic sensor.

5. The method of claim 1 wherein R_A is a function of R₀.

6. The method of claim 1 wherein applying the rate adjustment, R_A, is triggered when a monitored patient parameter crosses a predetermined threshold.

7. The method of claim 1 wherein R_T is determined by subtracting R_A from R₀.

8. A computer-readable medium programmed with instructions for performing a method of treating diastolic heart failure (DHF) in a patient with an implantable medical device (IMD), the medium comprising instructions for causing a programmable processor to:

deliver cardiac pacing therapy at a treatment rate, R_T,

wherein R_T is determined by adjusting an adaptive rate, R₀, by a rate adjustment, R_A, to thereby improve cardiac output, and

wherein R_A is a function of one or more monitored patient parameters.

9. The medium of claim 8 further comprising instructions to deliver at least one of coupled and paired pacing stimuli to cause post extra-systolic potentiation (PESP) to thereby lower a patient'"'"'s base heart rate.

10. The medium of claim 8 further comprising instructions to derive R₀ from an activity sensor.

11. The medium of claim 8 further comprising instructions to determine R_A as a function of R₀.

12. The medium of claim 8 further comprising instructions to trigger adjusting R_T by applying R_A to R₀ when at least one of R_T, R₀, and R_A crosses a predetermined threshold.

13. The medium of claim 8 further comprising instructions to trigger adjusting R_T by applying R_A to R₀ when a monitored patient parameter crosses a predetermined threshold.

14. The medium of claim 13 further comprising instructions to classify a plurality of monitored patient parameters into at least two tiers of parameters based on time to acquire the parameter.

15. The medium of claim 14 further comprising instructions to classify the at least two tiers of parameters into a first tier and a second tier of monitored patient parameters, the first tier including patient parameters that can be acquired within about 5 to 10 seconds, the second tier including patient parameters that can be acquired within about 10 to 60 seconds.

16. The medium of claim 15 wherein the first tier of patient parameters includes hemodynamic pressure, and wherein the second tier of patient parameters includes oxygen saturation.

17. The medium of claim 15 further comprising instructions to classify a third tier of monitored patient parameters, the third tier including patient parameters that can be acquired within about 1 to 10 minutes.

18. The medium of claim 15 further comprising instructions to determine R_A as a logical function of the first and second tiers of monitored patient parameters.

19. The medium of claim 8 further comprising instructions to determine R_T by subtracting R_A from R₀.

20. A medical device system for treating diastolic heart failure (DHF) comprising:

an implantable medical device (IMD) and leads adapted to deliver cardiac pacing therapy to a patient;

at least one sensor capable of generating a signal representative of a monitored patient parameter and providing the signal to the IMD; and

a processor adapted to cause the IMD to deliver cardiac pacing therapy at a treatment rate, R_T,

wherein R_T is determined by adjusting an adaptive rate, R₀, by a rate adjustment, R_A, to thereby improve cardiac output, and

wherein R_A is a function of one or more monitored patient parameters.