Baroreflex modulation with carotid sinus nerve stimulation for the treatment of heart failure
First Claim
1. A system for coordinating the stimulation of nerves for controlling the level of neurohormonal activation in a living body having a heart subject to potential or actual pathologic stress levels comprising:
- an implantable pulse generator with a microprocessor and memory adapted and disposed to run a plurality of processes,a sensor for sensing SVO2 in the body, and a sensor for determining pressure in a ventricle of the heart of the body, both said sensors adapted and disposed to provide readings to said microprocessor for use by said processes,a bradycardia pacer control process included within said pulse generator for pacing the heart when a condition of bradycardia is present so as to prevent insufficient heart rate by said heart,at least one stimulation electrode connected to effectively deliver electrical stimulation to a baroreceptor nerve site,an adjustment process for monitoring heart rate and estimating PVR from said SVO2 and pressure so as to determine appropriate modifications to the stimulation output to said stimulation electrode, andmeans for making said modifications.
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Accused Products
Abstract
A system and method for stimulating the baroreflex arc based on levels of indicators from the body includes a pacemaker for bradycardia support pacing should the indicators show the need for support pacing. Other indicators and a process take advantage of an assumed relationship between peripheral vascular resistance and pulmonary resistance to determine the level of nerve stimulation required. This level is adjusted or optimized based on its interaction with heart activity and changes in the other indicators. These other indicators are readily available to the implanted device and allow for a process to make an estimate of pulmonary vascular resistance, from which SVR is also estimated. The value determined for SVR is the primary value used to determine the level of nerve stimulation absent indicators for the need to provide bradicardia pacing. The pacemaker can be rate responsive, as can the process for determining the level of nerve stimulation to be delivered. Several different lead configurations are described.
823 Citations
21 Claims
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1. A system for coordinating the stimulation of nerves for controlling the level of neurohormonal activation in a living body having a heart subject to potential or actual pathologic stress levels comprising:
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an implantable pulse generator with a microprocessor and memory adapted and disposed to run a plurality of processes, a sensor for sensing SVO2 in the body, and a sensor for determining pressure in a ventricle of the heart of the body, both said sensors adapted and disposed to provide readings to said microprocessor for use by said processes, a bradycardia pacer control process included within said pulse generator for pacing the heart when a condition of bradycardia is present so as to prevent insufficient heart rate by said heart, at least one stimulation electrode connected to effectively deliver electrical stimulation to a baroreceptor nerve site, an adjustment process for monitoring heart rate and estimating PVR from said SVO2 and pressure so as to determine appropriate modifications to the stimulation output to said stimulation electrode, and means for making said modifications. - View Dependent Claims (2, 3, 4, 5, 6)
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7. A system for coordinating the stimulation of nerves for controlling the level of neurohormonal activation in a living body having a heart subject to potential or actual pathologic stress levels comprising:
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an implantable pulse generator with a microprocessor and memory adapted and disposed to run a plurality of processes, a sensor for sensing and measuring the value of an indicator of SVR in said body, adapted and disposed to provide readings to said microprocessor for use by said processes, a bradycardia pacer control process included within said pulse generator for pacing the heart when a condition of bradycardia is present so as to prevent insufficient heart rate by said heart, at least one stimulation electrode connected to effectively deliver electrical stimulation output to a baroreceptor nerve site, a process for monitoring heart rate and estimating SVR from said sensor in order to modify said stimulation output. - View Dependent Claims (8, 9, 10, 11, 12, 13, 14, 15, 16, 17)
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18. A method of automatically optimizing the cardiovascular responsiveness of a patient for the patient'"'"'s condition through controlled application of electrical stimulation of nerves emanating from baroreceptors of said patient comprising:
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providing electrical stimulation to said nerves of sufficient intensity and duration so as to reduce neurohormonal activation and induce peripheral blood vessel dilation and a drop in heart rate, determining the responsiveness of the patient'"'"'s body to said stimulation by sensing a feedback parameter of patient'"'"'s responsiveness indicating altered cardiovascular function; and adjusting said electrical stimulation provided to the nerves based on said feedback and an optimization algorithm until the patient'"'"'s cardiovascular system is optimized for his/her condition, sensing activity of said patient using an activity sensor, and if said activity sensor indicates periods of activity, suspending or lowering intensity of said electrical stimulation until a period of time after the sensed activity has ceased. - View Dependent Claims (19, 20)
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21. A method of controlled application of electrical stimulation of nerves emanating from baroreceptors of said patient comprising:
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providing electrical stimulation to said nerves of sufficient intensity and duration so as to reduce neurohormonal activation and induce peripheral blood vessel dilation and a drop in heart rate, sensing activity of said patient using an activity sensor, and if said activity sensor indicates periods of activity, suspending or lowering intensity of said electrical stimulation until a period of time after the sensed activity has ceased.
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Specification