CLOSED LOOP NEURAL STIMULATION SYNCHRONIZED TO CARDIAC CYCLES

• US 20080021504A1
• Filed: 07/24/2006
• Published: 01/24/2008
• Est. Priority Date: 07/24/2006
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: McCabe, Aaron, Zhang, Yi, Sathaye, Alok S., Brooke, M. Jason, Libbus, Imad, Caparso, Anthony V., Haefner, Paul A.
• Granted Patent: US 7,873,413 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 1/36135 using physiological parameters
• CPC Class Codes: A61N 1/36139 with automatic adjustment
• CPC Class Codes: A61N 1/365 controlled by a physiological parameter, e.g. heart potential evoked response A61N1/371
• CPC Class Codes: A61N 1/36592 controlled by the heart rate variability
• CPC Class Codes: A61N 1/39622 Pacing therapy
• CPC Class Codes: A61N 1/3987 characterised by the timing or triggering of the shock

Abstract

Various aspects of the present subject matter relate to a method. According to various method embodiments, cardiac activity is detected, and neural stimulation is synchronized with a reference event in the detected cardiac activity. Neural stimulation is titrated based on a detected response to the neural stimulation. Other aspects and embodiments are provided herein.

Claims

1. A system, comprising:

a reference event detection circuit adapted to receive an input from a reference signal sensor and generate a synchronization control signal using a detected cardiac activity event;

a feedback detection circuit adapted to receive an input from a feedback sensor and generate a feedback control signal;

a stimulation control circuit adapted to generate a stimulation control signal, the stimulation control circuit including a synchronization circuit responsive to the synchronization control signal to time the stimulation control signal, the stimulation control circuit further including a therapy titration circuit responsive to the feedback control signal to adjust the stimulation control signal; and

a stimulation output circuit responsive to the stimulation control signal from the stimulation control circuit and adapted to generate a neural stimulation signal for use in stimulating at least one autonomic neural target.

2. The system of claim 1, wherein the autonomic neural target includes a neural target that affects heart rate.

3. The system of claim 1, wherein the autonomic neural target includes a neural target that affects a P-R interval, a neural target that affects blood pressure, a neural target that affects heart rate variability (HRV), a neural target that affects heart rate turbulence (HRT), a QT interval or atrial/ventricular refractory periods.

4. The system of claim 1, wherein the stimulation control circuit is adapted to generate the neural stimulation signal for use by at least one electrode in electrically stimulating the autonomic neural target.

5. The system of claim 1, wherein the stimulation control circuit is adapted to generate the neural stimulation signal for use by at least one transducer in stimulating the autonomic neural target using non-electrical stimulation energy.

6. The system of claim 1, wherein the stimulation control circuit includes an offset interval generator for use in offsetting the stimulation control signal from the synchronization control signal.

7. The system of claim 1, wherein the reference event detection circuit includes a P-wave detector.

8. The system of claim 1, wherein a sensor functions as the reference sensor and the feedback sensor.

9. The system of claim 1, wherein the feedback detection circuit is adapted to receive a contextual input and generate the feedback control signal using the contextual input and the sensor.

10. The system of claim 9, wherein the contextual input includes a posture sensor, an activity sensor, or both the posture sensor and the activity sensor.

11. The system of claim 9, wherein the contextual input includes a timer.

12. The system of claim 1, wherein the feedback sensor includes a cardiac data sensor.

13. The system of claim 12, wherein the cardiac data sensor includes a heart rate sensor.

14. The system of claim 12, wherein the cardiac data sensor includes a heart rate variability (HRV) sensor.

15. The system of claim 12, wherein the cardiac data sensor includes a heart rate turbulence (HRT) sensor.

16. The system of claim 12, wherein the cardiac data sensor includes a PR interval sensor.

17. The system of claim 12, wherein the cardiac data sensor includes a T-wave velocity sensor.

18. The system of claim 12, wherein the cardiac data sensor includes an action potential duration sensor.

19. The system of claim 1, wherein the feedback sensor includes a non-cardiac data sensor.

20. The system of claim 19, wherein the non-cardiac data sensor includes a respiration sensor.

21. The system of claim 19, wherein the non-cardiac data sensor includes a blood pressure sensor.

22. The system of claim 1, wherein the feedback sensor includes a sensor adapted to detect heart sounds.

23. A system, comprising:

a heart rate detector adapted to generate a synchronization control signal using a detected heart rate;

a feedback detection circuit adapted to receive an input from a cardiac data sensor and generate a feedback control signal using detected cardiac data;

a stimulation control circuit adapted to generate a stimulation control signal, the stimulation control circuit including a synchronization circuit responsive to the synchronization control signal to time the stimulation control signal, the stimulation control circuit further including a therapy titration circuit responsive to the feedback control signal to adjust the stimulation control signal; and

a stimulation output circuit responsive to the stimulation control signal from the stimulation control circuit and adapted to generate a neural stimulation signal for use in stimulating at least one autonomic neural target.

24. The system of claim 23, wherein the cardiac data includes an ECG signal.

25. The system of claim 23, wherein the cardiac data includes heart rate.

26. The system of claim 25, wherein the therapy titration circuit is responsive to the feedback control signal to adjust the stimulation control signal to maintain a desired heart rate.

27. The system of claim 25, wherein the therapy titration circuit is responsive to the feedback control signal to adjust the stimulation control signal to change a desired heart rate.

28. The system of claim 23, further comprising at least one non-intracardiac electrode for use in detecting the heart rate.

29. The system of claim 23, further comprising at least one intracardiac electrode for use in detecting the heart rate.

30. The system of claim 23, wherein the feedback detection circuit is adapted to receive a contextual input and generate the feedback control signal using the contextual input and the detected cardiac data.

31. A system, comprising:

means for detecting cardiac activity;

means for synchronizing neural stimulation with a reference event in the detected cardiac activity; and

means for titrating neural stimulation based on a detected response to the neural stimulation.

32. The system of claim 31, wherein the means for titrating neural stimulation based on a detected response to the neural stimulation includes means for titrating neural stimulation based on a detected cardiac response to the neural stimulation.

33. The system of claim 31, wherein the means for titrating neural stimulation based on a detected response to the neural stimulation includes means for titrating neural stimulation based a detected non-cardiac response to the neural stimulation.

34. The system of claim 31, wherein the detected cardiac response to the neural stimulation includes the detected cardiac activity that includes the reference event.

35. A method, comprising:

detecting cardiac activity;

synchronizing neural stimulation with a reference event in the detected cardiac activity; and

titrating neural stimulation based on a detected response to the neural stimulation.

36. The method of claim 35, wherein the detected response to the neural stimulation includes a detected cardiac response to the neural stimulation.

37. The method of claim 36, wherein the detected cardiac response to the neural stimulation includes heart rate.

38. The method of claim 36, wherein the detected cardiac response to the neural stimulation includes a detected heart rate variability (HRV), a detected heart rate turbulence (HRT), a detected PR interval, a detected T-wave velocity, a detected heart sound morphology, or a detected action potential duration.

39. The method of claim 36, wherein the detected cardiac response includes detected cardiac activity that includes the reference event.

40. The method of claim 35, wherein the detected response to the neural stimulation includes a detected non-cardiac response to the neural stimulation.

41. The method of claim 40, wherein the detected non-cardiac response to the neural stimulation includes a detected hemodynamic parameter or a detected respiration parameter.

42. The method of claim 35, wherein synchronizing neural stimulation with the reference event in the detected cardiac activity includes synchronizing neural stimulation using a detected P-wave.

43. The method of claim 35, wherein titrating neural stimulation based on the detected cardiac activity includes changing a feature of a stimulation signal.

44. The method of claim 43, wherein changing the feature of the stimulation signal includes changing an amplitude of the stimulation signal, changing a frequency of the stimulation signal, changing a pulse duration of the stimulation signal, changing a waveform of the stimulation signal, or changing a stimulation vector.

45. The method of claim 35, wherein detecting cardiac activity includes detecting a heart rate.

46. The method of claim 35, wherein detecting cardiac activity includes sensing an ECG signal.

47. The method of claim 35, wherein titrating neural stimulation based on the detected cardiac activity includes determining if a steady heart rate is not being maintained, and adjusting the neural stimulation to maintain the steady heart rate.

48. The method of claim 35, wherein titrating neural stimulation based on the detected cardiac activity includes determining if a heart rate is to be changed, and adjusting the neural stimulation to change the heart rate.