CARDIAC FUNCTION MANAGEMENT INTEGRATING CARDIAC CONTRACTILITY MODULATION

• US 20100069980A1
• Filed: 09/16/2009
• Published: 03/18/2010
• Est. Priority Date: 09/16/2008
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Stahmann, Jeffrey E.
• Granted Patent: US 8,634,910 B2
• Time in Patent Office: Days
• US Class Current: 607/5
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/36185 Selection of the electrode configuration
• 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 1/3686 configured for selecting the electrode configuration on a lead A61N1/3688 takes precedence
• CPC Class Codes: A61N 1/37 Monitoring; Protecting
• CPC Class Codes: A61N 1/3706 Pacemaker parameters stimulation threshold A61N1/371
• CPC Class Codes: A61N 1/3708 for power depletion
• CPC Class Codes: A61N 1/3712 Auto-capture, i.e. automatic adjustment of the stimulation threshold
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

An implantable cardiac rhythm/function management system integrates cardiac contractility modulation (CCM) and one or more other therapies, such as to preserve device safety, improve efficacy, enhance sensing and detection, or enhance therapy effectiveness and delivery. Examples of the one or more other therapies can include pacing, defibrillation/cardioversion, cardiac resynchronization therapy (CRT), or neurostimulation.

Claims

1. An implantable cardiac rhythm/function management device comprising:

a cardiac contractility modulation (CCM) therapy circuit configured to deliver a non-stimulatory electrical energy during a refractory period of the heart;

a non-CCM cardiac therapy circuit configured to deliver non-CCM therapy; and

a controller circuit, coupled to the CCM therapy circuit and the non-CCM therapy circuit, the controller circuit configured to adjust at least one of a CCM therapy or a non-CCM therapy using information about the other of the CCM therapy or the non-CCM therapy.

2. The device of claim 1, wherein the controller circuit is configured to defer CCM therapy until at least one of:

(1) a recharge pulse is competed;

(2) a cardiac arrhythmia assessment is completed;

(3) a neural stimulation is completed;

or (4) a defibrillation shock is completed.

3. The device of claim 1, wherein the non-CCM therapy circuit comprises an electrostimulation therapy circuit;

wherein the controller circuit is configured to adjust an electrostimulation energy using information about whether a CCM condition is present; and

wherein the controller is configured to determine whether a CCM condition is present and to determine a CCM condition to be present when (a) CCM has been delivered within a specified preceding time period or (b) CCM is enabled.

4. The device of claim 3, wherein the controller is configured to determine a electrostimulation threshold energy when at least one CCM condition is present;

and

wherein the controller is configured to deliver the electrostimulation therapy at or above the electrostimulation threshold energy when at least one CCM condition is determined to be present.

5. The device of claim 3, wherein the controller is configured to determine a electrostimulation threshold energy when at least one CCM condition is present;

and

wherein the controller is configured to deliver the electrostimulation therapy at a specified energy derived from the electrostimulation threshold energy when no CCM condition is determined to be present.

6. The device of claim 3, wherein the controller is configured to determine a electrostimulation threshold energy when no CCM condition is present;

and

wherein the controller is configured to deliver the electrostimulation therapy at a specified energy derived from the electrostimulation threshold energy when at least one CCM condition is determined to be present.

7. The device of claim 3, wherein the controller is configured to determine a electrostimulation threshold energy when no CCM condition is present;

and

wherein the controller is configured to deliver the electrostimulation therapy at or above the electrostimulation threshold energy when no CCM condition is determined to be present.

8. The device of claim 1, wherein the non-CCM therapy circuit comprises an electrostimulation therapy circuit;

wherein the controller circuit is configured to coordinate delivery of CCM therapy with at least one of issuing a recharge pulse or configuring a coupling capacitor; and

wherein the controller circuit is configured to inhibit concurrent delivery of CCM therapy and the recharge pulse to the same location.

9. The device of claim 8, wherein the controller circuit is configured to trigger delivery of CCM, then trigger issuing a recharge pulse, before then triggering delivery of an electrostimulation during the same cardiac cycle.

10. The device of claim 8, wherein the controller circuit is configured to trigger issuing a recharge before discharging a CCM residual charge.

11. The device of claim 8, wherein the controller circuit is configured to trigger delivery of CCM, then to configure a coupling capacitor, before then triggering delivery of an electrostimulation.

12. The device of claim 8, wherein the controller circuit is configured to trigger delivering an electrostimulation, then trigger delivering a CCM, before then triggering a recharge to discharge electrostimulation and CCM residual charge.

13. The device of claim 8, wherein the controller circuit is configured to trigger delivering an electrostimulation, then configuring a coupling capacitor for delivering CCM, then trigger delivering the CCM, before then triggering a recharge to discharge electrostimulation and CCM residual charge.

14. The device of claim 8, wherein the controller is configured to configure the coupling capacitor such that a residual CCM energy upon a coupling capacitor is additive to energy delivered during an electrostimulation.

15. The device of claim 1, wherein the non-CCM therapy circuit comprises at least one of an autothreshold or autocapture circuit;

and

wherein the controller circuit is configured to use information about whether CCM is enabled and whether at least one of autocapture or autothreshold is enabled to do at least one of the following;

(1) suspend CCM during autothreshold or autocapture;

(2) perform autothreshold or autocapture when CCM is inactive;

or (3) assign non-conflicting electrode configurations to the CCM and at least one of the autothreshold or autocapture.

16. The device of claim 1, wherein the non-CCM therapy circuit comprises at least one of an autothreshold or autocapture circuit;

and

wherein the controller circuit is configured to;

(1) detect a change in an electrostimulation capture threshold energy; and

(2) adjust CCM therapy using information about the change in the electrostimulation capture threshold energy.

17. The device of claim 1, wherein the non-CCM therapy circuit comprises a ventricular potential sensing circuit;

wherein the ventricular potential sensing circuit is configured to sense at least one of an evoked potential or an intrinsic potential; and

wherein the controller circuit is configured to;

(1) detect a change in ventricular potential, the change in ventricular potential including at least one of a change in a magnitude, timing, or morphology of a ventricular potential; and

(2) adjust CCM therapy using information about a change in ventricular potential.

18. The device of claim 1, wherein the non-CCM therapy circuit comprises at least one of a pacing or defibrillation threshold determination circuit;

and

wherein the controller circuit is configured to control CCM therapy during at least one of pacing or defibrillation threshold testing.

19. The device of claim 1, wherein the non-CCM therapy circuit comprises an intrinsic cardiac signal sensing circuit;

and

wherein the controller circuit is configured to coordinate CCM therapy delivery and intrinsic heart signal sensing by adjusting at least one of;

CCM energy, CCM delivery timing, CCM delivery location, or CCM electrode configuration, differently based on whether a preceding beat was a paced beat or a sensed beat.

20. The device of claim 1, wherein the non-CCM therapy circuit comprises an intrinsic cardiac signal sensing circuit;

and

wherein the controller circuit is configured to coordinate CCM therapy delivery and intrinsic heart signal sensing by adjusting at least one of;

CCM energy, CCM delivery timing, CCM delivery location, or CCM electrode configuration, differently based on which cardiac chamber is paced.