BAROREFLEX STIMULATION SYSTEM TO REDUCE HYPERTENSION

• US 20100076511A1
• Filed: 11/30/2009
• Published: 03/25/2010
• Est. Priority Date: 12/24/2003
• Status: Active Grant

• Current Assignee: Avram Scheiner, Imad Libbus, Ronald W. Heil Jr
• Original Assignee: Avram Scheiner, Imad Libbus, Ronald W. Heil Jr
• Inventors: Scheiner, Avram, Libbus, Imad, Heil, Ronald W. JR.
• Granted Patent: US 8,195,289 B2
• Time in Patent Office: Days
• US Class Current: 607/9
• CPC Class Codes: A61N 1/36117 for treating hypertension
• 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 1/36564 controlled by blood pressure

Abstract

Various aspects of the present subject matter provide an implantable medical device. In various embodiments, the device comprises a pulse generator, a lead, a sensor, and a controller. The pulse generator generates a baroreflex stimulation signal as part of a baroreflex therapy. The lead is adapted to be electrically connected to the pulse generator and to be intravascularly fed into a heart. The lead includes an electrode to be positioned in or proximate to the heart to deliver the baroreflex signal to a baroreceptor region in or proximate to the heart. The sensor senses a physiological parameter regarding an efficacy of the baroreflex therapy and provides a signal indicative of the efficacy. The controller is connected to the pulse generator to control the baroreflex stimulation signal and to the sensor to receive the signal indicative of the efficacy of the baroreflex therapy. Other aspects are provided herein.

Claims

1. An implantable medical device for pacing a heart and for delivering neural stimulation from a pulmonary artery to an autonomic neural pathway, comprising:

a neural stimulation generator to generate a neural stimulation signal;

a cardiac stimulation generator to generate a cardiac pacing signal;

a lead configured to be electrically connected to the neural stimulation generator and the cardiac stimulation generator, wherein the lead includes a neural stimulation electrode and a cardiac pacing electrode, wherein the lead is configured to be intravascularly fed into the heart through a right ventricle and a pulmonary valve into the pulmonary artery to operationally position the neural stimulation electrode in the pulmonary artery proximate to the autonomic neural pathway for use in delivering neural stimulation to stimulate the autonomic neural pathway, and to operationally position the cardiac stimulation electrode for use in delivering the cardiac pacing signal to capture the heart; and

a controller connected to the neural stimulation generator to control the neural stimulation signal and connected to the cardiac stimulation generator to control the cardiac pacing signal.

2. The device of claim 1, wherein the neural stimulation electrode is positioned in the pulmonary artery proximate to a ligamentum arteriosum.

3. The device of claim 1, further comprising sensing circuitry to sense intrinsic signals indicative of refractories, the sensing circuitry being connected to the controller.

4. The device of claim 1, wherein the neural stimulation electrode is positioned proximate to a baroreflex target.

5. The device of claim 4, wherein the controller is configured to provide a baroreflex therapy, and to deliver the neural stimulation signal to the baroreflex target as part of the baroreflex therapy.

6. The device of claim 5, wherein the baroreflex target includes sensory nerve endings sensitive to pressure in a pulmonary artery, and wherein the baroreflex therapy provided by the controller inhibits sympathetic activity to elicit a desired baroreflex effect that reduces coronary vascular resistance and increases blood flow.

7. The device of claim 1, wherein the controller is configured to determine an appropriate time to deliver the neural stimulation signal.

8. The device of claim 1, further comprising a blood pressure sensor for sensing systemic blood pressure, wherein the controller is configured to use systemic blood pressure as feedback to control the neural stimulation signal.

9. The device of claim 1, further comprising a respiration sensor for sensing respiration, wherein the controller is configured to use respiration as feedback to control the neural stimulation signal.

10. The device of claim 1, wherein the controller is configured to determine a refractory period of a cardiac cycle, and to enable the neural stimulation only during the refractory period of the cardiac cycle.

11. The device of claim 10, wherein the controller is configured to use the cardiac electrode to sense cardiac activity to determine the refractory period.

12. The device of claim 1, wherein the device is configured to stimulate an afferent nerve trunk or a baroreceptor to stimulate the autonomic neural pathway.

13. The device of claim 1, wherein the controller is configured to increase a pacing rate for pacing the heart if neural stimulation is being delivered.

14. A method for pacing a heart and providing an autonomic neural stimulation therapy from a pulmonary artery to an autonomic neural target, comprising:

applying the autonomic neural stimulation therapy, including electrically stimulating the autonomic neural target using a lead intravascularly fed through a portion of a heart and into the pulmonary artery; and

pacing the heart using the lead.

15. The method of claim 14, further comprising sensing blood pressure and using sensed blood pressure as feedback for controlling the autonomic neural stimulation therapy.

16. The method of claim 14, further comprising sensing respiration and using sensed respiration as feedback for controlling the autonomic neural stimulation therapy.

17. The method of claim 14, wherein electrically stimulating the autonomic neural target includes electrically stimulating a target near a ligamentum arteriosum.

18. The method of claim 14, further comprising determining a refractory period of a cardiac cycle and enabling the autonomic neural stimulation therapy only during the refractory period.

19. The method of claim 18, wherein determining the refractory period includes using the cardiac electrode to sense the refractory period.

20. The method of claim 14, wherein applying the autonomic neural stimulation therapy includes applying a baroreflex therapy.

21. The method of claim 14, further comprising feeding the lead through the heart into the pulmonary artery to position a cardiac electrode in the heart and to position a neural stimulation electrode in the pulmonary artery.

22. The method of claim 14, further comprising increasing a pacing rate for pacing the heart if applying the neural stimulation therapy.

23. A method for providing a autonomic neural stimulation therapy from a pulmonary artery to an autonomic neural target, comprising:

applying the autonomic neural stimulation therapy, including electrically stimulating the autonomic neural target using a neural stimulation electrode on a lead intravascularly fed through a portion of a heart and into the pulmonary artery; and

sensing cardiac activity using a cardiac electrode on the lead,

wherein the lead is configured to position the neural stimulation electrode in the pulmonary artery and to position the cardiac electrode in the heart.

24. The method of claim 23, wherein sensing cardiac activity includes using the cardiac electrode to detect a refractory, the method further comprising enabling the autonomic neural stimulation therapy during the refractory.

25. The method of claim 23, further comprising sensing an adverse event using the cardiac electrode, the method further comprising adjusting the autonomic neural stimulation in response to detecting the adverse event.