System and method for utilizing brain state information to modulate cardiac therapy

• US 20070265677A1
• Filed: 04/27/2007
• Published: 11/15/2007
• Est. Priority Date: 12/17/2004
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Giftakis, Jonathon, Graves, Nina, Panken, Eric, Werder, Jonathan
• Granted Patent: US 8,209,019 B2
• Time in Patent Office: Days
• US Class Current: 607/45
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• 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 5/0245 by using sensing means generating electric signals, i.e. ECG signals
• CPC Class Codes: A61B 5/0816 Measuring devices for examining respiratory frequency measuring frequency of electric signals G01R23/00
• CPC Class Codes: A61B 5/1135 by monitoring thoracic expansion
• CPC Class Codes: A61B 5/318 Heart-related electrical modalities, e.g. electrocardiography [ECG]
• CPC Class Codes: A61B 5/369 Electroencephalography [EEG] devices for psychotechnics A61B5/16
• CPC Class Codes: A61B 5/4094 Diagnosing or monitoring seizure diseases, e.g. epilepsy
• CPC Class Codes: A61N 1/36064 Epilepsy
• CPC Class Codes: A61N 1/36082 Cognitive or psychiatric applications, e.g. dementia or Alzheimer's disease
• CPC Class Codes: A61N 1/3621 for treating or preventing abnormally high heart rate
• CPC Class Codes: A61N 1/365 controlled by a physiological parameter, e.g. heart potential evoked response A61N1/371
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters
• CPC Class Codes: A61N 1/37288 Communication to several implantable medical devices within one patient
• CPC Class Codes: A61N 1/3962 in combination with another heart therapy
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

A system for regulating or modulating cardiac therapy using brain state information. The modulation may include suppressing standard, prescribed cardiac therapy for a period of time or it may involve modulating the type of cardiac therapy delivered In another embodiment, a system is provided for determining whether a cardiac event is categorized as neurologically matched, and, if so, modulating the therapeutic output to the heart.

Claims

1. A medical device system comprising:

(a) a brain monitoring element for sensing activity in the brain and outputting a brain signal;

(b) a cardiac monitoring element for sensing activity in the heart and outputting a cardiac signal;

(c) a cardiac therapy module for providing therapeutic output to the heart; and

(d) a processor in communication with the brain monitoring element, the cardiac monitoring element and the cardiac therapy module, the processor configured to perform the following;

(i) simultaneously monitoring the brain signal and the cardiac signal;

(ii) detecting a cardiac event in the monitored cardiac signal;

(iii) activating the cardiac therapy module to provide the therapeutic output to the heart based on the detected cardiac event;

(iv) communicating to the cardiac therapy module to modulate the therapeutic output to the heart if a neurological event is detected in the monitored brain signal.

2. The system of claim 1 wherein the modulation of the therapeutic output to the heart comprises temporarily suspending cardiac therapy to the heart for a period of time and resuming cardiac therapy if the cardiac event is still present after the period of time.

3. The system of claim 2 wherein the period of time lasts for a period of seconds.

4. The system of claim 2 wherein the period of time lasts until the end of the detected neurological event

5. The system of claim 2 wherein the period of time lasts for a period of time after the conclusion of the detected neurological event.

6. The system of claim 2 wherein the period of time is programmable.

7. A medical system according to claim 1 wherein if a neurological event is not identified in the monitored brain signal, communicating to the therapy module to continue to deliver the therapeutic output to the heart.

8. A medical system according to claim 1 wherein if the detected cardiac event is of a specified nature, communicating to the therapy module to provide the therapeutic output to the heart, regardless of whether a neurological event is identified in the monitored brain signal.

9. The medical device system of claim 8 wherein the specified nature of the detected cardiac event is selected from the group consisting of bradycardia, asystole, tachycardia, wandering pacemaker, multifocal atrial tachycardia, atrial fibrillation, sinus pause, premature atrial contractions (PAC), ST segment elevation, ST segment depression, T-wave inversion, QT interval prolongation, premature ventricular contractions (PVCs), AV-block (AVB) and bundle branch block (BBB).

10. A medical system according to claim 8 wherein the specified nature of the detected cardiac event is its duration that exceeds a predetermined threshold.

11. A medical system according to claim 8 wherein the specified nature of the detected cardiac event is its intensity that exceeds a predetermined threshold.

13. The system of claim 1 wherein the modulation of the therapeutic output to the heart comprises preventative pacing for a period of time.

14. The system of claim 13 wherein the preventative pacing comprises decreasing pacing pulse widths for a period of time, and, if the cardiac event is still present after the period of time, increasing the pacing pulse widths.

15. The system of claim 14 wherein the period of time is a period of seconds.

16. The system of claim 14 wherein the period of time lasts until the end of the detected neurological event.

17. The system of claim 14 wherein the period of time lasts for a period of time after the conclusion of the detected neurological event.

18. The system of claim 13 wherein the preventative pacing comprises decreasing pacing pulse amplitude for a period of time, and, if the cardiac event is still present after the period of time, increasing the pacing pulse amplitude.

19. The system of claim 18 wherein the period of time is a period of seconds.

20. The system of claim 18 wherein the period of time lasts until the end of the detected neurological event.

21. The system of claim 18 wherein the period of time lasts for a period of time after the conclusion of the detected neurological event.

22. The system of claim 13 wherein the preventative pacing comprises decreasing pacing pulse frequency for a period of time, and, if the cardiac event is still present after the period of time, increasing the pacing pulse frequency.

23. The system of claim 22 wherein the period of time is a period of seconds.

24. The system of claim 22 wherein the period of time lasts until the end of the detected neurological event.

25. The system of claim 22 wherein the period of time lasts for a period of time after the conclusion of the detected neurological event.

26. The system of claim 13 wherein the preventative pacing comprises decreasing pacing pulse charge density for a period of time, and, if the cardiac event is still present after the period of time, increasing the pacing pulse charge density.

27. The system of claim 26 wherein the period of time is a period of seconds.

28. The system of claim 26 wherein the period of time lasts until the end of the detected neurological event.

29. The system of claim 26 wherein the period of time lasts for a period of time after the conclusion of the detected neurological event.

30. The system of claim 13 wherein the period of time is programmable.

31. The system of claim 1 wherein the modulation of the therapeutic output to the heart comprising defibrillation therapy.

32. The system of claim 13 wherein the defibrillation therapy comprises using a low defibrillation shock energy for a period of time, and, if the cardiac event is still present after the period of time, increasing the defibrillation shock energy.

33. The system of claim 32 wherein the period of time is a period of seconds.

34. The system of claim 32 wherein the period of time lasts until the end of the detected neurological event.

35. The system of claim 31 wherein the period of time lasts for a period of time after the conclusion of the detected neurological event.

36. The medical device system of claim 1 wherein the therapeutic output is provided through the cardiac monitoring element.

37. The medical device system of claim 1 wherein monitoring the brain signal comprises execution of a neurological event detection algorithm that outputs an indication that a neurological event is occurring or is not occurring based on an evaluation of the brain signal.

38. The medical device of claim 1 further comprising a body implantable housing, the housing containing the therapy module and the processor.

12. A method of providing cardiac therapy to a heart, the method comprising the steps of:

(a) providing a brain monitoring element for sensing activity in the brain and outputting a brain signal;

(b) providing a cardiac monitoring element for sensing activity in the heart and outputting a cardiac signal;

(c) providing a cardiac therapy module for delivering therapeutic output to the heart; and

(d) providing processor in communication with the brain monitoring element, the cardiac monitoring element and the cardiac therapy module, the processor configured to perform the following steps;

(i) simultaneously monitoring the brain signal and the cardiac signal;

(ii) detecting a cardiac event in the monitored cardiac signal;

(iii) activating the cardiac therapy module to provide the therapeutic output to the heart based on the detected cardiac event;

(iv) communicating to the cardiac therapy module to modulate the therapeutic output to the heart if a neurological event is detected in the monitored brain signal.