DEACTIVATION OF INTERMITTENT PACING THERAPY

• US 20090234401A1
• Filed: 03/17/2009
• Published: 09/17/2009
• Est. Priority Date: 03/17/2008
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Pastore, Joseph M., Stahmann, Jeffrey E., Shuros, Allan C., Arcot-Krishnamurthy, Shantha, Zielinski, John R.
• Granted Patent: US 8,483,826 B2
• Time in Patent Office: Days
• US Class Current: 607/4
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/368 comprising more than one electrode co-operating with different heart regions A61N1/3622, A61N1/3627 take precedence
• CPC Class Codes: A61N 1/3688 configured for switching the pacing mode, e.g. from AAI to DDD
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

This document discusses, among other things, an apparatus comprising an implantable cardiac depolarization sensing circuit, an electrical stimulation circuit, and a pacing mode controller. The pacing mode controller is configured to deliver pacing therapy according to a first pacing mode that is a normal operating mode, and to deliver pacing therapy according to second and third pacing modes. The second and third pacing modes increase mechanical stress on at least a particular portion of the ventricle as compared to the pacing therapy delivered during the first pacing mode. The pacing mode controller alternates between the second and third pacing modes when pacing is changed from the normal operating mode to a stress augmentation mode. The pacing mode controller suspends the change from the normal operating mode to the stress augmentation mode when a condition to prevent the change is detected.

Claims

1. An apparatus comprising:

at least one implantable cardiac depolarization sensing circuit configured to provide a sensed depolarization signal from a ventricle;

an electrical stimulation circuit configured to provide pacing electrical stimulation energy to at least one implantable electrode in the ventricle; and

a pacing mode controller communicatively coupled to the cardiac depolarization sensing circuit and the electrical stimulation circuit, wherein the pacing mode controller is configured to;

deliver pacing therapy according to a first mode, wherein the first mode is a normal operating mode;

deliver pacing therapy according to a second pacing mode, wherein the second pacing mode increases mechanical stress on at least a particular portion of the ventricle as compared to the pacing therapy delivered during the first pacing mode;

deliver pacing therapy according to a third pacing mode different from the second pacing mode, wherein the third pacing mode increases mechanical stress on at least a particular portion of the ventricle as compared to the pacing therapy delivered during the first pacing mode;

alternate between the second and third pacing modes when pacing is changed from the normal operating mode to a stress augmentation mode; and

suspend a change from the normal operating mode to the stress augmentation mode when a condition to prevent the change is detected.

2. The apparatus of claim 1, wherein the pacing mode controller is configured to retry the change to the stress augmentation mode after suspending the change from the normal operating mode.

3. The apparatus of claim 2, wherein the pacing mode controller includes a timer circuit, and wherein the pacing mode controller is configured to retry the change from the normal operating mode to the stress augmentation mode after a programmable time duration.

4. The apparatus of claim 2, wherein the pacing mode controller includes a counter circuit, and wherein the pacing mode controller is configured to retry the change from the normal operating mode to the stress augmentation mode for a programmable number of retry attempts before deactivating the stress augmentation mode.

5. The apparatus of claim 2, wherein the pacing mode controller is configured to retry the change from the normal operating mode to the stress augmentation mode when the condition to prevent the change is no longer detected.

6. The apparatus of claim 1, wherein the pacing mode controller is configured to suspend the change to the stress augmentation mode when delivering atrial tachyarrhythmia response pacing therapy in the first pacing mode.

7. The apparatus of claim 1, including:

an electrical high-energy shock stimulation circuit, communicatively coupled to the pacing mode controller, configured to provide at least one of cardioversion or defibrillation electrical stimulation energy to at least one implantable electrode; and

wherein the pacing mode controller is configured to suspend the change to the stress augmentation mode during delivery of the cardioversion or defibrillation electrical stimulation energy.

8. The apparatus of claim 1, including:

an electrical neural stimulation circuit, communicatively coupled to the pacing mode controller, configured to provide electrical neural stimulation energy to at least one implantable electrode; and

wherein the pacing mode controller is configured to suspend the change to the stress augmentation mode during delivery of the electrical neural stimulation energy.

9. The apparatus of claim 1, including:

a preventing condition detector, communicatively coupled to the pacing mode controller and the cardiac depolarization sensing circuit, configured to determine a heart rate using the sensed depolarization signal and to detect when the heart rate of a patient exceeds a heart rate threshold value; and

wherein the pacing mode controller is configured to suspend the change to the stress augmentation mode when the preventing condition detector detects the heart rate exceeds the heart rate threshold value.

10. The apparatus of claim 1, including:

an activity sensor circuit to produce an activity sensor signal representative of activity of a patient;

a preventing condition detector, communicatively coupled to the pacing mode controller and the activity sensor circuit, configured to detect from the activity sensor signal when an activity level of the patient exceeds an activity level threshold value; and

wherein the pacing mode controller is configured to suspend the change to the stress augmentation mode when the activity level of the patient exceeds the activity level threshold value.

11. The apparatus of claim 1, including:

a signal analyzer circuit communicatively coupled to the cardiac depolarization sensing circuit, wherein the signal analyzer circuit is configured to execute a scheduled measurement using the sensed depolarization signal; and

wherein the pacing mode controller is configured to suspend the change to the stress augmentation mode during the scheduled measurement.

12. The apparatus of claim 1, including:

a signal analyzer circuit communicatively coupled to the cardiac depolarization sensing circuit, wherein the signal analyzer circuit is configured to execute a diagnostic measurement using the sensed depolarization signal; and

wherein the pacing mode controller is configured to suspend the change to the stress augmentation mode during the diagnostic measurement.

13. The apparatus of claim 1, including:

an implantable impedance sensor circuit configured to provide a sensed cardiac impedance signal;

a signal analyzer circuit communicatively coupled to the impedance sensor circuit, wherein the signal analyzer circuit is configured to execute a diagnostic measurement using the cardiac impedance signal; and

wherein the pacing mode controller is configured to suspend the change to the stress augmentation mode during the diagnostic measurement.

14. The apparatus of claim 1, including:

a signal analyzer circuit communicatively coupled to the pacing mode controller and the cardiac depolarization sensing circuit, wherein the signal analyzer circuit is configured to detect, using the sensed depolarization signal, electrical energy applied by a second separate device as part of a diagnostic measurement; and

wherein the pacing mode controller is configured to suspend the change to the stress augmentation mode when the preventing condition detector detects the applied electrical energy.

15. The apparatus of claim 1, including:

a magnetic field sensor circuit communicatively coupled to the pacing mode controller, and

wherein the pacing mode controller is configured to suspend the change to the stress augmentation mode when the magnetic field sensor circuit detects a magnetic field.

16. The apparatus of claim 1, including:

a respiration sensor circuit configured to produce a respiration sensor signal representative of respiration of a patient;

a preventing condition detector communicatively coupled to the pacing mode controller and the respiration sensor circuit, wherein the preventing condition detector is configured to detect, using the respiration sensor signal, an episode of at least one of apnea, hypopnea, or hyperventilation; and

wherein the pacing mode controller is configured to suspend the change to the stress augmentation mode during the episode.

17. A method comprising:

delivering pacing therapy according to a first pacing mode using an implantable device, wherein the first pacing mode is a normal operating mode;

delivering pacing therapy according to a second pacing mode, wherein the second pacing mode increases mechanical stress on at least a particular portion of the ventricle as compared to the pacing therapy delivered during the first pacing mode;

delivering pacing therapy according to a third pacing mode different from the second pacing mode, wherein the third pacing mode increases mechanical stress on at least a particular portion of the ventricle as compared to the pacing therapy delivered during the first pacing mode;

alternating between the second and third pacing modes, when pacing is changed from the normal operating mode to a stress augmentation mode; and

suspending a change to the stress augmentation mode when a condition to prevent the change is present.

18. The method of claim 17, including retrying the change from the normal operating mode to the stress augmentation mode after suspending the change to the stress augmentation mode.

19. The method of claim 18, wherein retrying includes retrying the change from the normal operating mode to the stress augmentation mode after a programmable time duration.

20. The method of claim 18, wherein retrying includes retrying the change from the normal operating mode to the stress augmentation mode for a programmable number of retry attempts before deactivating the stress augmentation mode.

21. The method of claim 18, wherein retrying includes retrying the change from the normal operating mode to the stress augmentation mode after the implantable device determines the condition to prevent the change is no longer present.

22. The method of claim 17, wherein suspending a change to the stress augmentation mode includes suspending the change during delivery of a different higher priority therapy.

23. The method of claim 22, wherein the higher priority therapy includes at least one of:

delivering pacing therapy according to an atrial tachyarrhythmia response in the first pacing mode;

delivering defibrillation therapy;

delivering cardioversion therapy;

or

delivering neural stimulation therapy.

24. The method of claim 17, wherein suspending a change to the stress augmentation mode includes suspending the change to the stress augmentation mode when the implantable device detects a patient is exercising.

25. The method of claim 17, wherein suspending a change to the stress augmentation mode includes suspending a change to the stress augmentation mode until after a scheduled measurement is completed by the implantable device.

26. The method of claim 17, wherein suspending a change to the stress augmentation mode includes suspending the change when the implantable device determines a patient diagnostic measurement is being made.

27. The method of claim 17, wherein suspending a change to the stress augmentation mode includes suspending the change to the stress augmentation mode when the implantable device detects a presence of a magnetic field.

28. The method of claim 17, wherein suspending a change to the stress augmentation mode includes suspending the change to the stress augmentation mode when the implantable device detects an indication of at least one of:

apnea;

hypopnea;

or

hyperventilation.

29. A method comprising:

delivering pacing therapy according to a first pacing mode using an implantable device, wherein the first pacing mode is a normal operating mode;

determining if pacing according to a stress augmentation mode is scheduled, wherein the stress augmentation mode increases mechanical stress on at least a particular portion of the ventricle as compared to the pacing therapy delivered during the first pacing mode;

rescheduling a change to the stress augmentation mode when a condition to prevent the change is present;

otherwise,

delivering pacing therapy according to a second pacing mode while in the stress augmentation mode;

delivering pacing therapy according to a third pacing mode different from the second pacing mode while in the stress augmentation mode; and

alternating between the second and third pacing modes, when pacing is changed from the normal operating mode to the stress augmentation mode.

30. The method of claim 29, wherein rescheduling a change to the stress augmentation mode includes retrying includes retrying the change from the normal operating mode to the stress augmentation mode after a programmable time duration

31. The method of claim 29, wherein rescheduling a change to the stress augmentation mode includes retrying the change from the normal operating mode to the stress augmentation mode for a programmable number of retry attempts before deactivating the stress augmentation mode.

32. The method of claim 29, wherein rescheduling a change to the stress augmentation mode includes retrying the change from the normal operating mode to the stress augmentation mode after the implantable device determines the condition to prevent the change is no longer present.