Methods And Systems For Controlling Blood Pressure By Controlling Atrial Pressure

• US 20150258342A1
• Filed: 03/25/2015
• Published: 09/17/2015
• Est. Priority Date: 12/21/2012
• Status: Active Grant

• Current Assignee: Backbeat Medical, LLC
• Original Assignee: Backbeat Medical, Inc.
• Inventors: Mika, Yuval, Sherman, Darren, Schwartz, Robert S., Van Tassel, Robert A., Burkhoff, Daniel
• Granted Patent: US 9,526,900 B2
• Time in Patent Office: Days
• US Class Current: 1/1
• CPC Class Codes: A61F 2/2412 with soft flexible valve members, e.g. tissue valves shaped like natural valves check valves with flexible valve members in general F16K15/14
• CPC Class Codes: A61F 2/2424 Ball valves
• CPC Class Codes: A61F 2250/0013 for adjusting fluid pressure
• CPC Class Codes: A61N 1/36117 for treating hypertension
• CPC Class Codes: A61N 1/36514 controlled by a physiological quantity other than heart potential, e.g. blood pressure controlled by two or more physical parameters A61N1/36585
• CPC Class Codes: A61N 1/36528 the parameter being measured by means of ultrasound
• CPC Class Codes: A61N 1/36564 controlled by blood pressure
• CPC Class Codes: A61N 1/36571 controlled by blood flow rate, e.g. blood velocity or cardiac output
• CPC Class Codes: A61N 1/36578 controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters
• CPC Class Codes: A61N 1/3682 with a variable atrioventricular delay
• CPC Class Codes: A61N 1/3684 for stimulating the heart at multiple sites of the ventricle or the atrium
• CPC Class Codes: A61N 1/36842 Multi-site stimulation in the same chamber
• CPC Class Codes: A61N 1/36843 Bi-ventricular stimulation

Abstract

Systems and methods for controlling blood pressure by controlling atrial pressure and atrial stretch are disclosed. In some embodiments, a stimulation circuit may be configured to deliver a stimulation pulse to at least one cardiac chamber of a heart of a patient, and at least one controller may be configured to execute delivery of one or more stimulation patterns of stimulation pulses to the at least one cardiac chamber, wherein at least one of the stimulation pulses stimulates the heart such that an atrial pressure resulting from atrial contraction of an atrium overlaps in time a passive pressure build-up of the atrium, such that an atrial pressure of the atrium resulting from the stimulation is a combination of the atrial pressure resulting from atrial contraction and the passive pressure build-up and is higher than an atrial pressure of the atrium would be without the stimulation, and such that the blood pressure of the patient is reduced.

Claims

1. A system for reducing blood pressure in a patient, the system comprising:

a stimulation circuit configured to deliver a stimulation pulse to at least one cardiac chamber of a heart of the patient; and

at least one controller configured to execute the delivery of one or more stimulation patterns of stimulation pulses to the at least one cardiac chamber,

wherein at least one of the stimulation pulses stimulates the heart such that an atrial pressure resulting from atrial contraction of an atrium overlaps in time a passive pressure build-up of the atrium, such that an atrial pressure of the atrium resulting from the stimulation is a combination of the atrial pressure resulting from atrial contraction and the passive pressure build-up and is higher than an atrial pressure of the atrium would be without the stimulation, and such that the blood pressure of the patient is reduced, and

wherein the one or more stimulation patterns comprise stimulating the heart such that atrial kick is reduced or prevented.

2. The system of claim 1, wherein the atrial pressure of the atrium resulting from the stimulation causes an increased atrial stretch of the atrium that reduces blood pressure through hormonal or neural pathways.

3. The system of claim 1, wherein the at least one of the stimulation pulses stimulates the heart such that a maximum of atrial pressure resulting from atrial contraction of an atrium overlaps in time a maximum passive pressure build-up of the atrium.

4. The system of claim 1, wherein said at least one of the stimulation pulses comprises one of stimulating a ventricle of the heart and stimulating the atrium of the heart.

5. The system of claim 1, wherein said at least one of the stimulation pulses comprises stimulating a ventricle of the heart and the atrium.

6. The system of claim 5, wherein the one or more stimulation patterns comprise pacing the atrium and the ventricle at a substantially equal rate.

7. The system of claim 5, wherein the one or more stimulation patterns comprise pacing the atrium at a rate higher than a rate at which the ventricle is paced.

8. The system of claim 1, wherein said at least one of the stimulation pulses comprises stimulating the atrium of the heart such that the atrium contracts twice during a single cardiac cycle.

9. The system of claim 8, wherein said at least one of the stimulation pulses comprises stimulating the atrium twice during a single cardiac cycle.

10. The system of claim 8, wherein said at least one of the stimulation pulses comprises stimulating the atrium once during a single cardiac cycle.

11. The system of claim 1, wherein said at least one of the stimulation pulses comprises stimulating the atrium of the heart such that the atrium contracts only once during a single cardiac cycle.

12. The system of claim 1, wherein the one or more stimulation patterns comprise stimulating the heart at a plurality of heartbeats,

wherein at least some of the stimulation pulses stimulate the heart such that an atrial pressure resulting from atrial contraction of an atrium overlaps in time a passive pressure build-up of the atrium, such that an atrial pressure of the atrium resulting from the stimulation is a combination of the atrial pressure resulting from atrial contraction and the passive pressure build-up and is higher than an atrial pressure of the atrium would be without the stimulation, and

wherein at least some of the stimulation pulses are configured to reduce or prevent atrial kick.

13. The system of claim 1, wherein a stimulation pulse is provided such that in a single heartbeat both atrial kick is reduced or prevented and an atrial pressure resulting from atrial contraction of an atrium overlaps in time the passive pressure build-up of the atrium such that an atrial pressure of the atrium resulting from the stimulation is a combination of the atrial pressure resulting from atrial contraction and the passive pressure build-up and is higher than an atrial pressure of the atrium would be without the stimulation.

14. The system of claim 1, wherein the one or more stimulation patterns comprise at least one stimulation pulse set to have in a single heartbeat a first atrial contraction to commence when an atrioventricular valve is open and end after the atrioventricular valve is closed, and to elicit a second atrial contraction in which an atrial pressure resulting from atrial contraction of an atrium overlaps in time a passive pressure build-up of the atrium, such that an atrial pressure of the atrium resulting from the stimulation is a combination of the atrial pressure resulting from atrial contraction and the passive pressure build-up and is higher than an atrial pressure of the atrium would be without the stimulation.

15. The system of claim 14, wherein the first atrial contraction is sensed and the second atrial contraction is paced.

16. The system of claim 14, wherein the first atrial contraction and the second atrial contraction are paced.

17. The system of claim 13, wherein the one or more stimulation patterns comprise alternating between a plurality of stimulation patterns having a different ratio of:

first stimulation pulses that stimulate the heart such that an atrial pressure resulting from atrial contraction of an atrium overlaps in time a passive pressure build-up of the atrium, such that an atrial pressure of the atrium resulting from the stimulation is a combination of the atrial pressure resulting from atrial contraction and the passive pressure build-up and is higher than an atrial pressure of the atrium would be without the stimulation, and

second stimulation pulses that stimulate the heart such that atrial kick is reduced or prevented.

18. The system of claim 1, wherein the one or more stimulation patterns comprise alternating between a plurality of stimulation patterns having a different ratio of:

first stimulation pulses that stimulate the heart such that an atrial pressure resulting from atrial contraction of an atrium overlaps in time a passive pressure build-up of the atrium, such that an atrial pressure of the atrium resulting from the stimulation is a combination of the atrial pressure resulting from atrial contraction and the passive pressure build-up and is higher than an atrial pressure of the atrium would be without the stimulation, and

second stimulation pulses that do not provide an atrial pressure resulting from atrial contraction of an atrium that overlaps in time a passive pressure build-up of the atrium.

19. The system of claim 1, wherein the at least one of the stimulation pulses comprises pacing at least one of the atrium of the heart and a ventricle of the heart such that a relative timing of excitation corresponds to an atrioventricular delay of approximately 2 ms.

20. The system of claim 1, wherein the at least one of the stimulation pulses comprises pacing at least one of the atrium of the heart and a ventricle of the heart such that a relative timing of excitation corresponds to an atrioventricular delay of between approximately 30 ms and approximately 0 ms.

21. A system for reducing blood pressure in a patient, the system comprising:

a stimulation circuit configured to deliver a stimulation pulse to at least one cardiac chamber of a heart of the patient; and

at least one controller configured to execute the delivery of one or more stimulation patterns of stimulation pulses to the at least one cardiac chamber,

wherein at least one of the stimulation pulses stimulates the heart such that an atrial pressure resulting from atrial contraction of an atrium overlaps in time a passive pressure build-up of the atrium, such that an atrial pressure of the atrium resulting from the stimulation is a combination of the atrial pressure resulting from atrial contraction and the passive pressure build-up and is higher than an atrial pressure of the atrium would be without the stimulation, and such that the blood pressure of the patient is reduced, and

wherein the one or more stimulation patterns comprise alternating between a plurality of stimulation patterns having a different ratio of;

first stimulation pulses that stimulate the heart such that an atrial pressure resulting from atrial contraction of an atrium overlaps in time a passive pressure build-up of the atrium, such that an atrial pressure of the atrium resulting from the stimulation is a combination of the atrial pressure resulting from atrial contraction and the passive pressure build-up and is higher than an atrial pressure of the atrium would be without the stimulation, and

second stimulation pulses that do not provide an atrial pressure resulting from atrial contraction of an atrium that overlaps in time a passive pressure build-up of the atrium.

22. The system of claim 21, wherein the atrial pressure of the atrium resulting from the stimulation causes an increased atrial stretch of the atrium that reduces blood pressure through hormonal or neural pathways.

23. The system of claim 21, wherein the at least one of the stimulation pulses stimulates the heart such that a maximum of atrial pressure resulting from atrial contraction of an atrium overlaps in time a maximum passive pressure build-up of the atrium.

24. The system of claim 21, wherein said at least one of the stimulation pulses comprises one of stimulating a ventricle of the heart and stimulating the atrium of the heart.

25. The system of claim 21, wherein said at least one of the stimulation pulses comprises stimulating a ventricle of the heart and the atrium.

26. The system of claim 25, wherein the one or more stimulation patterns comprise pacing the atrium and the ventricle at a substantially equal rate.

27. The system of claim 25, wherein the one or more stimulation patterns comprise pacing the atrium at a rate higher than a rate at which the ventricle is paced.

28. The system of claim 21, wherein said at least one of the stimulation pulses comprises stimulating the atrium of the heart such that the atrium contracts twice during a single cardiac cycle.

29. The system of claim 28, wherein said at least one of the stimulation pulses comprises stimulating the atrium twice during a single cardiac cycle.

30. The system of claim 28, wherein said at least one of the stimulation pulses comprises stimulating the atrium once during a single cardiac cycle.

31. The system of claim 21, wherein said at least one of the stimulation pulses comprises stimulating the atrium of the heart such that the atrium contracts only once during a single cardiac cycle.

32. The system of claim 21, wherein the one or more stimulation patterns comprise stimulating the heart such that atrial kick is reduced or prevented.

33. The system of claim 32, wherein the one or more stimulation patterns comprise stimulating the heart at a plurality of heartbeats,

wherein at least some of the stimulation pulses stimulate the heart such that an atrial pressure resulting from atrial contraction of an atrium overlaps in time a passive pressure build-up of the atrium, such that an atrial pressure of the atrium resulting from the stimulation is a combination of the atrial pressure resulting from atrial contraction and the passive pressure build-up and is higher than an atrial pressure of the atrium would be without the stimulation, and

wherein at least some of the stimulation pulses are configured to reduce or prevent atrial kick.

34. The system of claim 32, wherein a stimulation pulse is provided such that in a single heartbeat both atrial kick is reduced or prevented and an atrial pressure resulting from atrial contraction of an atrium overlaps in time the passive pressure build-up of the atrium such that an atrial pressure of the atrium resulting from the stimulation is a combination of the atrial pressure resulting from atrial contraction and the passive pressure build-up and is higher than an atrial pressure of the atrium would be without the stimulation.

35. The system of claim 21, wherein the one or more stimulation patterns comprise at least one stimulation pulse set to have in a single heartbeat a first atrial contraction to commence when an atrioventricular valve is open and end after the atrioventricular valve is closed, and to elicit a second atrial contraction in which an atrial pressure resulting from atrial contraction of an atrium overlaps in time a passive pressure build-up of the atrium, such that an atrial pressure of the atrium resulting from the stimulation is a combination of the atrial pressure resulting from atrial contraction and the passive pressure build-up and is higher than an atrial pressure of the atrium would be without the stimulation.

36. The system of claim 35, wherein the first atrial contraction is sensed and the second atrial contraction is paced.

37. The system of claim 35, wherein the first atrial contraction and the second atrial contraction are paced.

38. The system of claim 21, wherein the one or more stimulation patterns comprise at least one stimulation pulse set to have in a single heartbeat a first atrial contraction to commence when an atrioventricular valve is open and end before the atrioventricular valve is closed, and to elicit a second atrial contraction in which an atrial pressure resulting from atrial contraction of an atrium overlaps in time the passive pressure build-up of the atrium, such that an atrial pressure of the atrium resulting from the stimulation is a combination of the atrial pressure resulting from atrial contraction and the passive pressure build-up and is higher than an atrial pressure of the atrium would be without the stimulation.

39. The system of claim 21, wherein the at least one of the stimulation pulses comprises pacing at least one of the atrium of the heart and a ventricle of the heart such that a relative timing of excitation corresponds to an atrioventricular delay of approximately 2 ms.

40. The system of claim 21, wherein the at least one of the stimulation pulses comprises pacing at least one of the atrium of the heart and a ventricle of the heart such that a relative timing of excitation corresponds to an atrioventricular delay of between approximately 30 ms and approximately 0 ms.

41. A method, carried out with an implanted heart muscle stimulator associated with a heart of a patient, for reducing blood pressure of the patient, the method comprising:

stimulating the heart to provide an atrial pressure resulting from atrial contraction that overlaps in time a passive pressure build-up of the atrium, such that the overlapping atrial pressure resulting from the atrial contraction and passive pressure build-up elicits an atrial pressure that is a combination of the atrial pressure resulting from atrial contraction and the passive pressure build-up and is higher than an atrial pressure of the atrium would be without the stimulation, and such that the blood pressure of the patient is reduced; and

stimulating the atrium such that atrial kick is reduced or prevented.

42. The method of claim 41, wherein the atrial pressure of the atrium resulting from the stimulation of the heart causes an increased atrial stretch of the atrium that reduces blood pressure through hormonal or neuronal pathways.

43. The method of claim 41, wherein stimulating the heart comprises stimulating the heart such that a maximum of atrial pressure resulting from atrial contraction of an atrium overlaps in time a maximum passive pressure build-up of the atrium.

44. The method of claim 41, wherein stimulating the heart comprises one of stimulating the atrium of the heart and stimulating a ventricle of the heart.

45. The method of claim 44, further comprising pacing the atrium and the ventricle at a substantially equal rate.

46. The method of claim 44, further comprising pacing the atrium at a rate higher than a rate at which the ventricle is paced.

47. The method of claim 41, further comprising stimulating the atrium such that the atrium contracts twice during a single cardiac cycle.

48. The method of claim 47, further comprising stimulating the atrium twice during a single cardiac cycle.

49. The method of claim 47, further comprising stimulating the atrium once during a single cardiac cycle.

50. The method of claim 41, further comprising stimulating the atrium such that the atrium contracts only once during a single cardiac cycle.

51. The method of claim 41, wherein stimulating the heart comprises delivering stimulation pulses to the heart at a plurality of heartbeats,

wherein at least some of the stimulation pulses stimulate the heart such that an atrial pressure resulting from atrial contraction of an atrium overlaps in time a passive pressure build-up of the atrium, such that an atrial pressure of the atrium resulting from the stimulation is a combination of the atrial pressure resulting from atrial contraction and the passive pressure build-up and is higher than an atrial pressure of the atrium would be without the stimulation, and

wherein at least some of the stimulation pulses are configured to reduce or prevent atrial kick.

52. The method of claim 41, wherein a stimulation pulse is provided such that in a single heartbeat both atrial kick is reduced or prevented and an atrial pressure resulting from atrial contraction of an atrium overlaps in time the passive pressure build-up of the atrium such that an atrial pressure of the atrium resulting from the stimulation is a combination of the atrial pressure resulting from atrial contraction and the passive pressure build-up and is higher than an atrial pressure of the atrium would be without the stimulation.

53. The method of claim 41, wherein stimulating the heart comprises delivering at least one stimulation pulse set to have in a single heartbeat a first atrial contraction to commence when an atrioventricular valve is open and end after the atrioventricular valve is closed, and to elicit a second atrial contraction in which an atrial pressure resulting from atrial contraction of an atrium overlaps in time a passive pressure build-up of the atrium, such that an atrial pressure of the atrium resulting from the stimulation is a combination of the atrial pressure resulting from atrial contraction and the passive pressure build-up and is higher than an atrial pressure of the atrium would be without the stimulation.

54. The method of claim 53, wherein the first atrial contraction is sensed and the second atrial contraction is paced.

55. The method of claim 53, wherein the first atrial contraction and the second atrial contraction are paced.

56. The method of claim 41, further comprising alternating between a plurality of stimulation patterns having a different ratio of:

first stimulation pulses that stimulate the heart such that an atrial pressure resulting from atrial contraction of an atrium overlaps in time a passive pressure build-up of the atrium, such that an atrial pressure of the atrium resulting from the stimulation is a combination of the atrial pressure resulting from atrial contraction and the passive pressure build-up and is higher than an atrial pressure of the atrium would be without the stimulation, and

second stimulation pulses that stimulate the atrium such that atrial kick is reduced or prevented.

57. The method of claim 41, further comprising alternating between a plurality of stimulation patterns having a different ratio of:

first stimulation pulses that stimulate the heart such that an atrial pressure resulting from atrial contraction of an atrium overlaps in time a passive pressure build-up of the atrium, such that an atrial pressure of the atrium resulting from the stimulation is a combination of the atrial pressure resulting from atrial contraction and the passive pressure build-up and is higher than an atrial pressure of the atrium would be without the stimulation, and

second stimulation pulses that do not provide an atrial pressure resulting from atrial contraction of an atrium that overlaps in time a passive pressure build-up of the atrium.

58. The method of claim 41, further comprising pacing at least one of the atrium of the heart and a ventricle of the heart such that a relative timing of excitation corresponds to an atrioventricular delay of approximately 2 ms.

59. The method of claim 41, further comprising pacing at least one of the atrium of the heart and a ventricle of the heart such that a relative timing of excitation corresponds to an atrioventricular delay of between approximately 30 ms and approximately 0 ms.