SYSTEMS AND METHODS FOR SELECTIVE STIMULATION OF NERVE FIBERS IN CAROTID SINUS

• US 20150202444A1
• Filed: 01/14/2015
• Published: 07/23/2015
• Est. Priority Date: 01/17/2014
• Status: Abandoned Application

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Franke, Manfred, Shuros, Allan Charles, Mokelke, Eric A., Hincapie Ordonez, Juan Gabriel, Ternes, David J.
• Application Number:
  US14/597,112
• Publication Number:
  US 20150202444A1
• Time in Patent Office: Days
• US Class Current: 1/1
• CPC Class Codes: A61B 18/1206 Generators therefor
• CPC Class Codes: A61B 18/1477 Needle-like probes
• CPC Class Codes: A61B 18/20 using laser
• CPC Class Codes: A61B 2018/00577 Ablation
• CPC Class Codes: A61B 2018/00595 Cauterization
• CPC Class Codes: A61N 1/0551 Spinal or peripheral nerve electrodes
• CPC Class Codes: A61N 1/0558 Anchoring or fixation means therefor
• CPC Class Codes: A61N 1/36053 adapted for vagal stimulation A61N1/36114 takes precedence
• CPC Class Codes: A61N 1/36067 Movement disorders, e.g. tremor or Parkinson disease stimulating motor muscle A61N1/36003
• CPC Class Codes: A61N 1/36071 Pain
• CPC Class Codes: A61N 1/3611 Respiration control stimulating respiratory organs A61N1/3601
• CPC Class Codes: A61N 1/36117 for treating hypertension
• CPC Class Codes: A61N 1/36128 Control systems
• CPC Class Codes: A61N 1/36132 using patient feedback
• CPC Class Codes: A61N 1/36135 using physiological parameters
• CPC Class Codes: A61N 1/36171 Frequency
• CPC Class Codes: A61N 1/37205 Microstimulators, e.g. implantable through a cannula
• CPC Class Codes: A61N 1/37288 Communication to several implantable medical devices within one patient
• CPC Class Codes: A61N 1/3787 from an external energy source

Abstract

An example of a system may include at least one electrode for placement on tissue in a carotid sinus region and a stimulator. The stimulator may be configured to use the at least one electrode to deliver neural stimulation to a baroreceptor region or at least one nerve innervating the baroreceptor region in the carotid sinus region to elicit a baroreflex response, and to deliver a blocking stimulation to a carotid body or at least one nerve innervating the carotid body in the carotid sinus region to inhibit a chemoreceptor response, the stimulator configured to simultaneously deliver the neural stimulation and the blocking stimulation.

Claims

1. A system, comprising:

at least one electrode for placement on tissue in a carotid sinus region;

a stimulator configured to use the at least one electrode to deliver neural stimulation to a baroreceptor region or at least one nerve innervating the baroreceptor region in the carotid sinus region to elicit a baroreflex response, and to deliver a blocking stimulation to a carotid body or at least one nerve innervating the carotid body in the carotid sinus region to inhibit a chemoreceptor response, the stimulator configured to simultaneously deliver the neural stimulation and the blocking stimulation.

2. The system of claim 1 wherein the stimulator is configured to use a stimulation vector to deliver the blocking stimulation and to use the stimulation vector to deliver the neural stimulation.

3. The system of claim 1, wherein the at least one electrode includes an electrode for placement on or near a carotid body, and the stimulator is configured to use the electrode to both deliver the blocking stimulation and deliver the neural stimulation.

4. The system of claim 1, wherein the at least one electrode includes both a first electrode and a second electrode for placement on tissue in the carotid sinus region, and the stimulator is configured to use the first electrode to deliver neural stimulation to a baroreceptor region or a nerve innervating the baroreceptor region in the carotid sinus region to elicit a baroreflex response, and configured to use the second electrode to deliver a blocking stimulation to a carotid body or a nerve innervating the carotid body in the carotid sinus region to inhibit a chemoreceptor response, the stimulator configured to simultaneously deliver the neural stimulation and the blocking stimulation.

5. The system of claim 1, wherein the blocking stimulation includes a synaptic junction depletion block stimulation, the depletion block stimulation including a series of pulses at a depletion pulse frequency within a range between about 100 Hz to about 1 kHz.

6. The system of claim 5, further comprising a titration control module configured to adjust a frequency of the depletion block stimulation to discriminate between depletion of one neurotransmitter from depletion of another neurotransmitter.

7. The system of claim 1, wherein the blocking stimulation includes a kHz high frequency nerve block stimulation to prevent action potentials from propagating in axons, the kHz high frequency nerve block stimulation including a series of pulses at a frequency over 1 kHz.

8. The system of claim 1, wherein the neural stimulation includes a series of pulses at a frequency between 0.25 Hz to 50 Hz.

9. The system of claim 1, further comprising at least one physiologic response sensor operably connected to the controller, wherein the controller is configured to control the stimulator to apply a test stimulation to a test region within the carotid sinus region, and use the at least one physiologic response sensor to monitor a physiological response to the stimulation to determine if the test region is a carotid body or a nerve innervating the carotid body, or is a baroreceptor region or the nerve innervating the baroreceptor region.

10. The system of claim 9, wherein the at least one physiologic response sensor includes a sensor configured to sense a respiration parameter, and the controller is configured to use the sensed respiration parameter to determine if the test region is the carotid body.

11. The system of claim 10, wherein the sensor configured to sense the respiration parameter includes a transthoracic impedance sensor.

12. The system of claim 9, wherein the test stimulation to the test region includes a blocking stimulation to the carotid body.

13. The system of claim 1, wherein the at least one physiologic response sensor includes a sensor configured to sense a blood pressure or a sensor configured to sense heart rate, and the controller is configured to use the sensed blood pressure or the sensed heart rate to determine if the test region is the baroreceptor region or the carotid sinus nerve.

14. The system of claim 13, wherein the at least one physiologic response sensor includes an accelerometer, and the system is configured to use the accelerometer to detect heart rate from blood flow through a carotid artery.

15. The system of claim 14, wherein the system is configured to use the accelerometer to sense respiration.

16. The system of claim 1, further comprising a patch configured for implantation at the carotid sinus region, the patch to provide a substrate for the electrodes.

17. The system of claim 1, further comprising switches, under control of the controller, to connect the stimulator to:

a nerve block selection of electrodes for use in the nerve block stimulation;

or

a neural stimulation selection of electrodes for use in the neural stimulation.

18. The system of claim 17, wherein:

the stimulator includes a nerve block stimulator configured to deliver the blocking stimulation and a neural stimulator configured to deliver the neural stimulation; and

the switches are under control of the controller to connect the nerve block selection of electrodes to the nerve block stimulator, and to connect the neural stimulation selection of electrodes to the neural stimulator.

19. The system of claim 1, wherein:

the controller includes a titration control module configured for adjusting at least one parameter of the neural stimulation or at least one parameter of the blocking stimulation to capture desired axons.

20. A method, comprising:

delivering neural stimulation to a baroreceptor region in a carotid sinus region or at least one nerve innervating a baroreceptor region to elicit baroreflex response; and

delivering blocking stimulation to a carotid body in the carotid sinus region or at least one nerve innervating the carotid body to inhibit a chemoreflex response.