Cardiac Stimulation Apparatus And Method For The Control Of Hypertension

• US 20160220824A1
• Filed: 04/07/2016
• Published: 08/04/2016
• Est. Priority Date: 02/12/2004
• Status: Active Grant

• Current Assignee: Backbeat Medical, LLC
• Original Assignee: Backbeat Medical, Inc.
• Inventors: Schwartz, Robert S., Van Tassel, Robert A.
• Granted Patent: US 10,232,183 B2
• Time in Patent Office: Days
• US Class Current: 1/1
• 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 1/36514 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 1/36564 controlled by blood pressure

Abstract

A method that electrically stimulates a heart muscle to alter the ejection profile of the heart, to control the mechanical function of the heart and reduce the observed blood pressure of the patient. The therapy may be invoked by an implantable blood pressure sensor associated with a pacemaker like device. In some cases, where a measured pretreatment blood pressure exceeds a treatment threshold, a patient'"'"'s heart may be stimulated with an electrical stimulus timed relative to the patient'"'"'s cardiac ejection cycle. This is done to cause dyssynchrony between at least two cardiac chambers or within a cardiac chamber, which alters the patient'"'"'s cardiac ejection profile from a pretreatment cardiac ejection profile. This has the effect of reducing the patient'"'"'s blood pressure from the measured pretreatment blood pressure.

Claims

1. A method, carried out with an implanted heart muscle stimulator associated with a heart of a patient, for treating a blood pressure disorder in the patient, the patient having a pretreatment systemic blood pressure corresponding to a pretreatment cardiac ejection profile and having an intrinsic temporal contraction sequence between an atrial chamber and a ventricular chamber of the heart, the method comprising:

stimulating the patient'"'"'s heart with an electrical stimulus timed relative to the patient'"'"'s cardiac ejection cycle to alter the intrinsic temporal contraction sequence between the atrial chamber and the ventricular chamber,

wherein altering the intrinsic temporal contraction sequence alters the patient'"'"'s cardiac ejection profile from the pretreatment cardiac ejection profile and reduces the patient'"'"'s systemic blood pressure from the pretreatment systemic blood pressure.

2. The method of claim 1, wherein the electrical stimulus elicits a contraction of the ventricular chamber substantially during contraction of the atrial chamber in the same cardiac cycle.

3. The method of claim 1, wherein the electrical stimulus provides a shorter delay between activation of the atrial chamber and activation of the ventricular chamber than a delay between activation of the atrial chamber and activation of the ventricular chamber in the intrinsic temporal contraction sequence.

4. The method of claim 1, wherein the electrical stimulus initiates contraction of the ventricular chamber before the start of contraction of the atrial chamber in the same cardiac cycle.

5. The method of claim 1, wherein the electrical stimulus causes a contraction of the atrial chamber and a contraction of the ventricular chamber that overlap in time in the same cardiac cycle.

6. The method of claim 5, wherein the electrical stimulus provides a shorter delay between activation of the atrial chamber and activation of the ventricular chamber than a delay between activation of the atrial chamber and activation of the ventricular chamber in the intrinsic temporal contraction sequence.

7. The method of claim 1, wherein stimulating the patient'"'"'s heart comprises sensing a contraction of one of the atrial chamber and the ventricular chamber and stimulating the other of the atrial chamber and the ventricular chamber with the electrical stimulus.

8. The method of claim 1, wherein stimulating the patient'"'"'s heart comprises sensing electrical activation of one of the atrial chamber and the ventricular chamber and stimulating the other of the atrial chamber and the ventricular chamber with the electrical stimulus.

9. The method of claim 1, wherein stimulating the patient'"'"'s heart comprises stimulating the atrial chamber and the ventricular chamber.

10. The method of claim 9, wherein stimulating the patient'"'"'s heart comprises stimulating the ventricular chamber before stimulating the atrial chamber.

11. The method of claim 1, wherein stimulating the patient'"'"'s heart comprises stimulating the patient'"'"'s heart on demand according to a blood pressure threshold.

12. The method of claim 11, further comprising monitoring the pretreatment systemic blood pressure of the patient using a sensor and invoking the stimulating when the sensor detects that the pretreatment systemic blood pressure is equal to or beyond the blood pressure threshold.

13. The method of claim 1, wherein stimulating the patient'"'"'s heart comprises applying a stimulation pattern having pattern parameters that change intermittently to prevent tachyphylaxis.

14. The method of claim 13, wherein the stimulation pattern is applied over a circadian period.

15. The method of claim 14, wherein the stimulation pattern is applied over the course of at least an hour of the circadian period.

16. The method of claim 13, wherein the stimulation pattern is applied over a chronic period.

17. The method of claim 1, wherein the electrical stimulus contracts the ventricular chamber such that a corresponding atrioventricular valve closes during or before contraction of the atrial chamber.

18. A method, carried out with an implanted heart muscle stimulator associated with a heart of a patient, for treating a blood pressure disorder in the patient, the patient having a pretreatment systemic blood pressure corresponding to a pretreatment cardiac ejection profile and having an intrinsic contraction timing between at least two cardiac chambers, the method comprising:

stimulating the patient'"'"'s heart with an electrical stimulus timed relative to the patient'"'"'s cardiac ejection cycle to cause a dyssynchronous contraction timing between at least two cardiac chambers that varies from the intrinsic contraction timing;

wherein the dyssynchronous contraction timing between the at least two cardiac chambers alters the patient'"'"'s cardiac ejection profile from the pretreatment cardiac ejection profile and reduces the patient'"'"'s systemic blood pressure from the pretreatment systemic blood pressure.

19. The method of claim 18, wherein the dyssynchronous contraction timing comprises a contraction of a ventricular chamber substantially during contraction of an atrial chamber in the same cardiac cycle.

20. The method of claim 18, wherein the dyssynchronous contraction timing comprises a shorter delay between activation of the atrial chamber and activation of the ventricular chamber than a delay between activation of the atrial chamber and activation of the ventricular chamber in the intrinsic contraction timing.

21. The method of claim 18, wherein the dyssynchronous contraction timing comprises a contraction of a ventricular chamber before start of a contraction of an atrial chamber in the same cardiac cycle.

22. The method of claim 18, wherein the dyssynchronous contraction timing comprises a contraction of an atrial chamber and a contraction of a ventricular chamber that overlap in time in the same cardiac cycle.

23. The method of claim 22, wherein the dyssynchronous contraction timing comprises a shorter delay between activation of the atrial chamber and activation of the ventricular chamber than a delay between activation of the atrial chamber and activation of the ventricular chamber in the intrinsic contraction timing.

24. The method of claim 18, wherein stimulating the patient'"'"'s heart comprises sensing a contraction of one of the at least two cardiac chambers and stimulating the other of the at least two cardiac chambers with the electrical stimulus.

25. The method of claim 18, wherein stimulating the patient'"'"'s heart comprises sensing electrical activation of one of the at least two cardiac chambers and stimulating the other of the at least two cardiac chambers with the electrical stimulus.

26. The method of claim 18, wherein stimulating the patient'"'"'s heart comprises stimulating each of the at least two cardiac chambers.

27. The method of claim 26, wherein the at least two cardiac chambers comprise an atrial chamber and a ventricular chamber, and wherein stimulating the patient'"'"'s heart comprises stimulating the ventricular chamber before stimulating the atrial chamber.

28. The method of claim 18, wherein stimulating the patient'"'"'s heart comprises stimulating the patient'"'"'s heart on demand according to a blood pressure threshold.

29. The method of claim 28, further comprising monitoring the pretreatment systemic blood pressure of the patient using a sensor and invoking the stimulating when the sensor detects that the pretreatment systemic blood pressure is equal to or beyond the blood pressure threshold.

30. The method of claim 18, wherein stimulating the patient'"'"'s heart comprises applying a stimulation pattern having pattern parameters that change intermittently to prevent tachyphylaxis.

31. The method of claim 30, wherein the stimulation pattern is applied over a circadian period.

32. The method of claim 31, wherein the stimulation pattern is applied over the course of at least an hour of the circadian period.

33. The method of claim 30, wherein the stimulation pattern is applied over a chronic period.

34. The method of claim 18, wherein the electrical stimulus contracts a ventricular chamber such that a corresponding atrioventricular valve closes during or before contraction of an atrial chamber.

35. An implantable heart muscle stimulator apparatus for treating a blood pressure disorder in a patient, the patient having a pretreatment systemic blood pressure corresponding to a pretreatment cardiac ejection profile and having an intrinsic temporal contraction sequence between an atrial chamber and a ventricular chamber of the heart, the apparatus comprising:

at least one lead configured to be in electrical communication with a cardiac chamber of the patient'"'"'s heart; and

an electrical stimulation device in electrical communication with the at least one lead and programmed with logic to deliver through the at least one lead a stimulation pattern timed relative to the patient'"'"'s cardiac ejection cycle that alters the intrinsic temporal contraction sequence between the atrial chamber and the ventricular chamber such that the ventricular chamber contracts before or substantially during contraction of the atrial chamber in the same cardiac cycle, and causes, between the atrial chamber and the ventricular chamber, a dyssynchrony that alters the patient'"'"'s cardiac ejection profile from the pretreatment cardiac ejection profile and reduces the patient'"'"'s systemic blood pressure from the pretreatment systemic blood pressure.