Permanently implantable system and method for detecting, diagnosing and treating congestive heart failure

• US 6,328,699 B1
• Filed: 01/11/2000
• Issued: 12/11/2001
• Est. Priority Date: 01/11/2000
• Status: Expired due to Term

• Current Assignee: Cedars-Sinai Medical Center (Cedars Sinai Health System)
• Original Assignee: Cedars-Sinai Medical Center (Cedars Sinai Health System)
• Inventors: Eigler, Neal L., Whiting, James S.
• Primary Examiner(s): Lacyk, John P.
• Assistant Examiner(s): Natnithithadha, Navin
• Application Number:
  US09/481,084
• Time in Patent Office: 700 Days
• Field of Search: 600/486, 600/485, 600/488, 600/508
• US Class Current: 600/486
• CPC Class Codes: A61B 2560/0209 adapted for power saving
• CPC Class Codes: A61B 5/0215 by means inserted into the body catheters A61M25/00
• CPC Class Codes: A61B 5/4839 combined with drug delivery
• CPC Class Codes: A61B 5/6882 Anchoring means
• 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

The invention provides improved apparatus and methods for treating congestive heart failure in a medical patient. The apparatus includes a pressure transducer permanently implantable within the left atrium of the patient'"'"'s heart and operable to generate electrical signals indicative of fluid pressures within the patient'"'"'s left atrium. The pressure transducer is connected to a flexible electrical lead, which is connected in turn to electrical circuitry, which in the preferred embodiment includes digital circuitry for processing electrical signals. The electrical circuitry processes the electrical signals from the pressure transducer and, based at least in part on those signals, generates a signal that indicates a desired therapeutic treatment for treating the patient'"'"'s condition. That signal is then communicated to the patient via a patient signaling device, following which the patient administers to him or herself the prescribed therapeutic treatment indicated by the signal.

Claims

1. Apparatus for treating congestive heart failure in a medical patient, the apparatus comprising:

a pressure transducer operable to generate a signal indicative of fluid pressure within the left atrium;

signal processing apparatus operable to generate a signal indicative of an appropriate therapeutic treatment based at least in part on the signal generated by the pressure transducer; and

a patient signaling device operable to communicate the signal indicative of the appropriate therapeutic treatment to the patient, wherein the patient signaling device is operable to generate at least two distinct signals distinguishable from one another by the patient, each said signal indicative of a different therapeutic treatment.

2. The apparatus of claim 1, further comprising an implantable flexible lead providing a signal connection between the pressure transducer and the signal processing apparatus.

3. The apparatus of claim 2, further comprising apparatus on the lead configured to anchor pressure transducer to the patient'"'"'s atrial septum.

4. The apparatus of claim 2, wherein the pressure transducer is located on the lead a predetermined distance away from a distal tip of the lead, wherein the distance is predetermined so that the pressure transducer will be positioned within the patient'"'"'s left atrium when the distal tip is positioned within a pulmonary vein connected to the patient'"'"'s left atrium.

5. The apparatus of claim 2, wherein the lead comprises a first lead component carrying apparatus configured to anchor the first lead component to the patient'"'"'s atrial septum and a second lead component carrying the pressure transducer, wherein the second lead component is implantable into the patient and fixable to the first lead component after the first lead component is implanted within the patient.

6. The apparatus of claim 3, wherein the apparatus on the lead configured to anchor the pressure transducer to the patient'"'"'s atrial septum comprises a helical screw configured for advancement into and fixation within the atrial septum.

7. The apparatus of claim 3, wherein the apparatus on the lead configured to anchor the pressure transducer to the patient'"'"'s atrial septum comprises at least one anchor deployable by spring force upon the withdrawal of a removable sheath to expose the anchor.

8. The apparatus of claim 1, wherein the signal processing apparatus is at least partially contained within a housing, the housing configured for permanent implantation within the patient'"'"'s body.

9. The apparatus of claim 1, further comprising apparatus configured to anchor the pressure transducer to the patient'"'"'s atrial septum.

10. The apparatus of claim 1, wherein the signal processing apparatus includes an analog-to-digital converter operable to convert analog signals from the pressure transducer to digital data reflective of the fluid pressure within the left atrium.

11. The apparatus of claim 1, wherein the signal processing apparatus includes digital memory for storing data reflective of pressures within the left atrium.

12. The apparatus of claim 11, further comprising apparatus configured to retrieve the data reflective of pressures within the left atrium from the digital memory.

13. The apparatus of claim 12, wherein the data retrieval apparatus includes a transceiver operable to transmit the data through the patient'"'"'s skin.

14. The apparatus of claim 1, wherein the signal processing apparatus is operable to receive modified programming with the signal processing apparatus implanted within the patient'"'"'s body.

15. The apparatus of claim 1, wherein the patient signaling device includes apparatus configured to produce an electrical shock perceptible by the patient.

16. The apparatus of claim 1, wherein the patient signaling device is operable to generate at least four distinct signals distinguishable from one another by the patient, each said signal indicative of a different therapeutic treatment.

17. An apparatus according to claim 1, wherein the transducer is situated within the left atrium.

18. An apparatus according to claim 1, wherein the transducer is situated within a pulmonary vein.

19. An apparatus according to claim 1, wherein the transducer is situated within the left atrial appendage.

20. An apparatus according to claim 1, wherein the transducer is located in the septal wall.

21. An apparatus according to claim 1, wherein the transducer is situated at a location within the heart having a pressure that is at least nearly the same as the pressure in the left atrium.

22. An apparatus according to claim 1, wherein the transducer is situated at a location within the heart sufficient to generate a signal indicative of fluid pressure within the left atrium.

23. An apparatus according to claim 1, wherein the transducer is situated at a location outside the heart sufficient to generate a signal indicative of fluid pressure within the left atrium.

24. An apparatus according to claim 1, wherein the transducer is situated at a location relative to the heart sufficient to generate a signal indicative of fluid pressure within the left atrium.

25. An apparatus according to claim 1, wherein the transducer is associated with the heart in a manner that is sufficient to generate a signal indicative of fluid pressure within the left atrium.

26. An The apparatus of claim 1, further comprising a second sensor in addition to the pressure transducer, the second sensor operable to generate a second signal indicative of a second condition within the body of the patient, wherein the signal processing apparatus is operable to generate a signal indicative of an appropriate therapeutic treatment based at least in part on the second signal generated by the sound sensor.

27. The apparatus of claim 26, wherein the second sensor is a second pressure transducer.

28. The apparatus of claim 26, wherein the second sensor is an ECG electrode.

29. The apparatus of claim 26, wherein the second sensor is configured for implantation in the patient'"'"'s right atrium.

30. The apparatus of claim 26, wherein the second sensor is configured for implantation in a location inside the patient'"'"'s body outside the atria.

31. The apparatus of claim 1, wherein the patient signaling device includes a mechanical vibrator operable to produce a vibration perceptible by the patient.

32. The apparatus of claim 1, wherein the patient signaling device includes a transmitter operable to send information to a remote receiver.

33. The apparatus of claim 1, wherein the signal processing apparatus includes power management circuitry operable to deny power to at least some portions of the signal processing apparatus during periods of relative inactivity between periods of device operation.

34. The apparatus of claim 1, wherein the signal processing apparatus includes apparatus operable to compute mean left atrial pressures based on multiple individual signals generated by the pressure transducer.

35. The apparatus of claim 1, wherein the patient signaling device is operable to generate at least one signal indicative of an appropriate therapeutic treatment comprising a reduction in the normal dose of at least one medication taken by the patient.

36. The apparatus of claim 1, wherein the patient signal device generates signals in the form of predetermined sequences of individual signal pulses, the signal pulses being perceptible by the patient.

37. Apparatus for treating congestive heart failure in a medical patient, the apparatus comprising:

a pressure transducer operable to generate a signal indicative of fluid pressure within the left atrium;

signal processing apparatus operable to generate a signal indicative of an appropriate therapeutic treatment based at least in part on the signal generated by the pressure transducer; and

a patient signaling device operable to communicate the signal indicative of the

appropriate therapeutic treatment to the patient;

an implantable flexible lead providing a signal connection between the pressure transducer and the signal processing apparatus; and

apparatus on the lead configured to anchor the pressure transducer to the patient'"'"'s atrial septum comprising a helical screw configured for advancement into and fixation within the atrial septum.

38. Apparatus for treating congestive heart failure in a medical patient, the apparatus comprising:

a pressure transducer operable to generate a signal indicative of fluid pressure within the left atrium;

signal processing apparatus operable to generate a signal indicative of an appropriate therapeutic treatment based at least in part on the signal generated by the pressure transducer;

a patient signaling device operable to communicate the signal indicative of the appropriate therapeutic treatment to the patient;

an implantable flexible lead providing a signal connection between the pressure transducer and the signal processing apparatus; and

apparatus on the lead configured to anchor the pressure transducer to the patient'"'"'s atrial septum comprising at least one anchor deployable by spring force upon the withdrawal of a removable sheath to expose the anchor.

39. Apparatus for treating congestive heart failure in a medical patient, the apparatus comprising:

a pressure transducer operable to generate a signal indicative of fluid pressure within the left atrium;

signal processing apparatus operable to generate a signal indicative of an appropriate therapeutic treatment based at least in part on the signal generated by the pressure transducer;

a patient signaling device operable to communicate the signal indicative of the appropriate therapeutic treatment to the patient; and

an implantable flexible lead providing a signal connection between the pressure transducer and the signal processing apparatus, wherein the pressure transducer is located on the lead a predetermined distance away from a distal tip of the lead, wherein the distance is predetermined so that the pressure transducer will be positioned within the patient'"'"'s left atrium when the distal tip is positioned within a pulmonary vein connected to the patient'"'"'s left atrium.

40. Apparatus for treating congestive heart failure in a medical patient, the apparatus comprising:

a pressure transducer operable to generate a signal indicative of fluid pressure within the left atrium;

signal processing apparatus operable to generate a signal indicative of an appropriate therapeutic treatment based at least in part on the signal generated by the pressure transducer;

a patient signaling device operable to communicate the signal indicative of the appropriate therapeutic treatment to the patient;

an implantable flexible lead providing a signal connection between the pressure transducer and the signal processing apparatus, wherein the lead comprises a first lead component carrying apparatus configured to anchor the first lead component to the patient'"'"'s atrial septum and a second lead component carrying the pressure transducer, wherein the second lead component is implantable into the patient and fixable to the first lead component after the first lead component is implanted within the patient.

41. Apparatus for treating congestive heart failure in a medical patient, the apparatus comprising:

a pressure transducer operable to generate a signal indicative of fluid pressure within the left atrium;

signal processing apparatus operable to generate a signal indicative of an appropriate therapeutic treatment based at least in part on the signal generated by the pressure transducer;

a patient signaling device operable to communicate the signal indicative of the appropriate therapeutic treatment to the patient; and

a second sensor in addition to the pressure transducer, the second sensor operable to generate a second signal indicative of a second condition within the body of the patient, wherein the signal processing apparatus is operable to generate a signal indicative of an appropriate therapeutic treatment based at least in part on the second signal generated by the second sensor.

42. The apparatus of claim 41, wherein the second sensor is a second pressure transducer.

43. The apparatus of claim 41, wherein the second sensor is an ECG electrode.

44. The apparatus of claim 41, wherein the second sensor is configured for implantation in the patient'"'"'s right atrium.

45. The apparatus of claim 41, wherein the second sensor is configured for implantation in a location inside the patient'"'"'s body outside the atria.

46. Apparatus for treating congestive heart failure in a medical patient, the apparatus comprising:

a pressure transducer operable to generate a signal indicative of fluid pressure within the left atrium;

signal processing apparatus operable to generate a signal indicative of an appropriate therapeutic treatment based at least in part on the signal generated by the pressure transducer;

wherein the signal processing apparatus includes digital memory for storing data reflective of pressures within the left atrium;

a patient signaling device operable to communicate the signal indicative of the appropriate therapeutic treatment to the patient; and

apparatus configured to retrieve the data reflective of pressures within the left atrium from the digital memory, wherein the data retrieval apparatus includes a transceiver operable to transmit the data through the patient'"'"'s skin.

47. Apparatus for treating congestive heart failure in a medical patient, the apparatus comprising:

a pressure transducer operable to generate a signal indicative of fluid pressure within the left atrium;

signal processing apparatus operable to generate a signal indicative of an appropriate therapeutic treatment based at least in part on the signal generated by the pressure transducer; and

a patient signaling device operable to communicate the signal indicative of the appropriate therapeutic treatment to the patient, wherein the patient signaling device includes a mechanical vibrator operable to produce a vibration perceptible by the patient.

48. Apparatus for treating congestive heart failure in a medical patient, the apparatus comprising:

a pressure transducer operable to generate a signal indicative of fluid pressure within the left atrium;

signal processing apparatus operable to generate a signal indicative of an appropriate therapeutic treatment based at least in part on the signal generated by the pressure transducer; and

a patient signaling device operable to communicate the signal indicative of the appropriate therapeutic treatment to the patient, wherein the patient signaling device includes a transmitter operable to send information to a remote receiver.

49. Apparatus for treating congestive heart failure in a medical patient, the apparatus comprising:

a pressure transducer operable to generate a signal indicative of fluid pressure within the left atrium;

signal processing apparatus operable to generate a signal indicative of an appropriate therapeutic treatment based at least in part on the signal generated by the pressure transducer, wherein the signal processing apparatus includes power management circuitry operable to deny power to at least some portions of the signal processing apparatus during periods of relative inactivity between periods of device operation; and

a patient signaling device operable to communicate the signal indicative of the appropriate therapeutic treatment to the patient.

50. Apparatus for treating congestive heart failure in a medical patient, the apparatus comprising:

a pressure transducer operable to generate a signal indicative of fluid pressure within the left atrium;

signal processing apparatus operable to generate a signal indicative of an appropriate therapeutic treatment based at least in part on the signal generated by the pressure transducer, wherein the signal processing apparatus includes apparatus operable to compute mean left atrial pressures based on multiple individual signals generated by the pressure transducer; and

a patient signaling device operable to communicate the signal indicative of the appropriate therapeutic treatment to the patient.

51. Apparatus for treating congestive heart failure in a medical patient, the apparatus comprising:

a pressure transducer operable to generate a signal indicative of fluid pressure within the left atrium;

signal processing apparatus operable to generate a signal indicative of an appropriate therapeutic treatment based at least in part on the signal generated by the pressure transducer; and

a patient signaling device operable to communicate the signal indicative of the appropriate therapeutic treatment to the patient, wherein the patient signaling device is operable to generate at least one signal indicative of an appropriate therapeutic treatment comprising a reduction in the normal dose of at least one medication taken by the patient.

52. Apparatus for treating congestive heart failure in a medical patient, the apparatus comprising:

a pressure transducer operable to generate a signal indicative of fluid pressure within the left atrium;

signal processing apparatus operable to generate a signal indicative of an appropriate therapeutic treatment based at least in part on the signal generated by the pressure transducer; and

a patient signaling device operable to communicate the signal indicative of the appropriate therapeutic treatment to the patient, wherein the patient signal device generates signals in the form of predetermined sequences of individual signal pulses, the signal pulses being perceptible by the patient.

53. A method for treating congestive heart failure in a medical patient, the method comprising:

implanting a pressure transducer substantially permanently within the left atrium of the patient'"'"'s heart;

operating the pressure transducer to generate a signal indicative of fluid pressure within the left atrium;

communicating the signal indicative of the fluid pressure within the left atrium to signal processing apparatus;

operating the signal processing apparatus to generate a signal indicative of an appropriate therapeutic treatment, wherein operating the signal processing apparatus includes generating one of at least two distinct signals, each said signal indicative of a different therapeutic treatment; and

communicating the signal indicative of the appropriate therapeutic treatment to the patient.

54. The method of claim 53, and further comprising implanting at least a portion of the signal processing apparatus substantially permanently within the patient'"'"'s body.

55. The method of claim 53, and further comprising anchoring the pressure transducer to the patient'"'"'s atrial septum.

56. The method of claim 55, wherein implanting the signal processing apparatus within the patient'"'"'s body includes implanting the signal processing apparatus a subcutaneous pocket in the region of the patient'"'"'s shoulder.

57. The method of claim 55, wherein anchoring the pressure transducer to the patient'"'"'s atrial septum comprises advancing a helical screw into the patient'"'"'s atrial septum.

58. The method of claim 55, wherein anchoring the pressure transducer to the patient'"'"'s atrial septum comprises withdrawing a removable sheath to deploy at least one anchor by spring force to bear against the patient'"'"'s atrial septum.

59. The method of claim 53, and further comprising implanting the signal processing apparatus within the patient'"'"'s body.

60. The method of claim 53, wherein communicating the signal indicative of the appropriate therapeutic treatment includes generating an electrical shock perceptible by the patient.

61. The method of claim 53, wherein generating one of at least two distinct signals, each said signal indicative of a different therapeutic treatment, includes generating one of at least four distinct signals.

62. A apparatus according to claim 53, wherein the transducer is situated within the left atrium.

63. An apparatus according to claim 53, wherein the transducer is situated within a pulmonary vein.

64. An apparatus according to claim 53, wherein the transducer is situated within the left atrial appendage.

65. An apparatus according to claim 53, wherein the transducer is located in the septal wall.

66. An apparatus according to claim 53, wherein the transducer is situated at a location within the heart having a pressure that is at least nearly the same as the pressure in the left atrium.

67. An apparatus according to claim 53, wherein the transducer is situated within the heart.

68. An apparatus according to claim 53, wherein the transducer is situated outside of the heart.

69. An apparatus according to claim 53, wherein the transducer is associated with the heart in a manner that is sufficient to generate a signal indicative of fluid pressure within the left atrium.

70. A apparatus according to claim 53, wherein the transducer is situated within the left atrium.

71. The method of claim 53, wherein implanting a pressure transducer within the left atrium of the patient'"'"'s heart comprises:

approaching the left atrium through the right atrium;

penetrating the patient'"'"'s atrial septum; and

positioning the pressure transducer in side the patient'"'"'s left atrium.

72. The method of claim 71, and further comprising approaching the right atrium through the superior vena cava.

73. The method of claim 71, and further comprising approaching the right atrium through the inferior vena cava.

74. The method of claim 53, wherein implanting the pressure transducer substantially permanently within the left atrium of the patient'"'"'s heart includes advancing a flexible lead carrying the pressure transducer partially into a pulmonary vein connected to the left atrium while positioning the pressure transducer within the left atrium.

75. The method of claim 53, wherein implanting the pressure transducer substantially permanently within the left atrium of the patient'"'"'s heart includes:

advancing a first lead component carrying anchoring apparatus to the left atrium and deploying the anchoring apparatus to anchor the first lead component to the patient'"'"'s atrial septum; and

advancing a second lead component carrying a pressure transducer along the first lead component until the second lead component is in a position wherein the pressure transducer is positioned within the patient'"'"'s left atrium.

76. The method of claim 53, wherein communicating the signal indicative of the appropriate therapeutic treatment includes operating a mechanical vibrator to produce a vibration perceptible by the patient.

77. The method of claim 53, wherein communicating the signal indicative of the appropriate therapeutic treatment includes operating a transmitter to send information to a remote receiver.

78. The method of claim 53, further comprising operating power management circuitry to deny power to at least some portions of the signal processing apparatus during periods of relative inactivity between periods of active operation of those portions of the signal processing apparatus.

79. The method of claim 53, wherein operating the signal processing apparatus to generate a signal indicative of an appropriate therapeutic treatment includes computing mean left atrial pressures based on multiple individual signals generated by the pressure transducer.

80. The method of claim 53, wherein operating the signal processing apparatus to generate a signal indicative of an appropriate therapeutic treatment includes generating a signal indicative of an appropriate therapeutic treatment comprising a reduction in the normal dose of at least one medication taken by the patient.

81. The method of claim 53, wherein communicating the signal indicative of the appropriate therapeutic treatment to the patient includes communicating to the patient at least one predetermined sequence comprising multiple individual signal pulses perceptible by the patient.

82. The method of claim 53, wherein operating wherein operating the signal processing apparatus to generate a signal indicative of an appropriate therapeutic treatment includes diagnosing a cause of worsening CHF.

113. The apparatus of claim 69, wherein the apparatus configured to anchor the indicator means to the patient'"'"'s atrial septum comprises a helical screw configured for advancement into and fixation within the atrial septum.

114. The apparatus of claim 69, wherein the apparatus on the lead configured to anchor the indicator means to the patient'"'"'s atrial septum comprises at least one anchor deployable by spring force upon the withdrawal of a removable sheath to expose the anchor.

123. The apparatus of claim 69, wherein the patient signaling device is operable to generate at least four distinct signals distinguishable from one another by the patient, each said signal indicative of a different therapeutic treatment.

83. A method for treating congestive heart failure in a medical patient, the method comprising:

implanting a pressure transducer substantially permanently within the left atrium of the patient'"'"'s heart, wherein implanting the pressure transducer within the left atrium of the patient'"'"'s heart comprises;

approaching the left atrium through the right atrium;

penetrating the patient'"'"'s atrial septum; and

positioning the pressure transducer in side the patient'"'"'s left atrium;

operating the pressure transducer to generate a signal indicative of fluid pressure within the left atrium;

communicating the signal indicative of the fluid pressure within the left atrium to signal processing apparatus;

operating the signal processing apparatus to generate a signal indicative of an appropriate therapeutic treatment; and

communicating the signal indicative of the appropriate therapeutic treatment to the patient.

84. The method of claim 83, and further comprising approaching the right atrium through the superior vena cava.

85. The method of claim 83, and further comprising approaching the right atrium through the inferior vena cava.

86. A method for treating congestive heart failure in a medical patient, the method comprising:

implanting a pressure transducer substantially permanently within the left atrium of the patient'"'"'s heart;

operating the pressure transducer to generate a signal indicative of fluid pressure within the left atrium;

communicating the signal indicative of the fluid pressure within the left atrium to signal processing apparatus;

operating the signal processing apparatus to generate a signal indicative of an appropriate therapeutic treatment;

communicating the signal indicative of the appropriate therapeutic treatment to the patient; and

anchoring the pressure transducer to the patient'"'"'s atrial septum, by advancing a helical screw into the patient'"'"'s atrial septum.

87. A method for treating congestive heart failure in a medical patient, the method comprising:

implanting a pressure transducer substantially permanently within the left atrium of the patient'"'"'s heart;

operating the pressure transducer to generate a signal indicative of fluid pressure within the left atrium;

communicating the signal indicative of the fluid pressure within the left atrium to signal processing apparatus;

operating the signal processing apparatus to generate a signal indicative of an appropriate therapeutic treatment;

communicating the signal indicative of the appropriate therapeutic treatment to the patient; and

withdrawing a removable sheath to deploy at least one anchor by spring force to bear against the patient'"'"'s atrial septum, thereby anchoring the pressure transducer to the patient'"'"'s atrial septum.

88. A method for treating congestive heart failure in a medical patient, the method comprising:

implanting a pressure transducer substantially permanently within the left atrium of the patient'"'"'s heart, wherein said implanting includes advancing a flexible lead carrying the pressure transducer partially into a pulmonary vein connected to the left atrium while positioning the pressure transducer within the left atrium;

operating the pressure transducer to generate a signal indicative of fluid pressure within the left atrium;

communicating the signal indicative of the fluid pressure within the left atrium to signal processing apparatus;

operating the signal processing apparatus to generate a signal indicative of an appropriate therapeutic treatment; and

communicating the signal indicative of the appropriate therapeutic treatment to the patient.

89. A method for treating congestive heart failure in a medical patient, the method comprising:

implanting a pressure transducer substantially permanently within the left atrium of the patient'"'"'s heart, wherein said implanting includes;

advancing a first lead component carrying anchoring apparatus to the left atrium and deploying the anchoring apparatus to anchor the first lead component to the patient'"'"'s atrial septum; and

advancing a second lead component carrying a pressure transducer along the first lead component until the second lead component is in a position wherein the pressure transducer is positioned within the patient'"'"'s left atrium;

operating the pressure transducer to generate a signal indicative of fluid pressure within the left atrium;

communicating the signal indicative of the fluid pressure within the left atrium to signal processing apparatus;

operating the signal processing apparatus to generate a signal indicative of an appropriate therapeutic treatment; and

communicating the signal indicative of the appropriate therapeutic treatment to the patient.

90. A method for treating congestive heart failure in a medical patient, the method comprising:

implanting a pressure transducer substantially permanently within the left atrium of the patient'"'"'s heart;

operating the pressure transducer to generate a signal indicative of fluid pressure within the left atrium;

communicating the signal indicative of the fluid pressure within the left atrium to signal processing apparatus;

operating the signal processing apparatus to generate a signal indicative of an appropriate therapeutic treatment; and

communicating the signal indicative of the appropriate therapeutic treatment to the patient, wherein said communicating includes operating a mechanical vibrator to produce a vibration perceptible by the patient.

91. A method for treating congestive heart failure in a medical patient, the method comprising:

implanting a pressure transducer substantially permanently within the left atrium of the patient'"'"'s heart;

operating the pressure transducer to generate a signal indicative of fluid pressure within the left atrium;

communicating the signal indicative of the fluid pressure within the left atrium to signal processing apparatus;

operating the signal processing apparatus to generate a signal indicative of an appropriate therapeutic treatment; and

communicating the signal indicative of the appropriate therapeutic treatment to the patient, wherein said communicating includes operating a transmitter to send information to a remote receiver.

92. A method for treating congestive heart failure in a medical patient, the method comprising:

implanting a pressure transducer substantially permanently within the left atrium of the patient'"'"'s heart;

operating the pressure transducer to generate a signal indicative of fluid pressure within the left atrium;

communicating the signal indicative of the fluid pressure within the left atrium to signal processing apparatus;

operating the signal processing apparatus to generate a signal indicative of an appropriate therapeutic treatment;

communicating the signal indicative of the appropriate therapeutic treatment to the patient; and

operating power management circuitry to deny power to at least some portions of the signal processing apparatus during periods of relative inactivity between periods of active operation of those portions of the signal processing apparatus.

93. A method for treating congestive heart failure in a medical patient, the method comprising:

implanting a pressure transducer substantially permanently within the left atrium of the patient'"'"'s heart;

operating the pressure transducer to generate a signal indicative of fluid pressure within the left atrium;

communicating the signal indicative of the fluid pressure within the left atrium to signal processing apparatus;

operating the signal processing apparatus to generate a signal indicative of an appropriate therapeutic treatment, wherein said operating includes computing mean left atrial pressures based on multiple individual signals generated by the pressure transducer; and

communicating the signal indicative of the appropriate therapeutic treatment to the patient.

94. A method for treating congestive heart failure in a medical patient, the method comprising:

implanting a pressure transducer substantially permanently within the left atrium of the patient'"'"'s heart;

operating the pressure transducer to generate a signal indicative of fluid pressure within the left atrium;

communicating the signal indicative of the fluid pressure within the left atrium to signal processing apparatus;

operating the signal processing apparatus to generate a signal indicative of an appropriate therapeutic treatment, wherein said operating includes generating a signal indicative of an appropriate therapeutic treatment comprising a reduction in the normal dose of at least one medication taken by the patient; and

communicating the signal indicative of the appropriate therapeutic treatment to the patient.

95. A method for treating congestive heart failure in a medical patient, the method comprising:

implanting a pressure transducer substantially permanently within the left atrium of the patient'"'"'s heart;

operating the pressure transducer to generate a signal indicative of fluid pressure within the left atrium;

communicating the signal indicative of the fluid pressure within the left atrium to signal processing apparatus;

operating the signal processing apparatus to generate a signal indicative of an appropriate therapeutic treatment; and

communicating the signal indicative of the appropriate therapeutic treatment to the patient, wherein communicating the signal includes communicating to the patient at least one predetermined sequence comprising multiple individual signal pulses perceptible by the patient.

96. A method for treating congestive heart failure in a medical patient, the method comprising:

implanting a pressure transducer substantially permanently within the left atrium of the patient'"'"'s heart;

operating the pressure transducer to generate a signal indicative of fluid pressure within the left atrium;

communicating the signal indicative of the fluid pressure within the left atrium to signal processing apparatus;

operating the signal processing apparatus to generate a signal indicative of an appropriate therapeutic treatment, wherein operating the signal processing apparatus includes diagnosing a cause of worsening CHF; and

communicating the signal indicative of the appropriate therapeutic treatment to the patient.

97. Apparatus for treating congestive heart failure in a medical patient, the apparatus comprising:

indicator means for generating a signal indicative of fluid pressure within the left atrium;

signal processing apparatus operable to generate a signal indicative of an appropriate therapeutic treatment based at least in part on the signal generated by the indicator means; and

a patient signaling device operable to communicate the signal indicative of the appropriate therapeutic treatment to the patient, wherein the patient signaling device is operable to generate at least two distinct signals distinguishable from one another by the patient, each said signal indicative of a different therapeutic treatment.

98. An apparatus according to claim 97, wherein the indicator means is a pressure transducer.

99. A apparatus according to claim 97, wherein the indicator means is situated within the left atrium.

100. An apparatus according to claim 97, wherein the indicator means is situated within a pulmonary vein.

101. An apparatus according to claim 97, wherein the indicator means is situated within the left atrial appendage.

102. An apparatus according to claim 97, wherein the indicator means is located in the septal wall.

103. An apparatus according to claim 97, wherein the indicator means is situated at a location within the heart having a pressure that is at least nearly the same as the pressure in the left atrium.

104. An apparatus according to claim 97, wherein the indicator means is situated at a location within the heart sufficient to generate a signal indicative of fluid pressure within the left atrium.

105. An apparatus according to claim 97, wherein the indicator means is situated at a location outside the heart sufficient to generate a signal indicative of fluid pressure within the left atrium.

106. An apparatus according to claim 97, wherein the indicator means is situated at a location relative to the heart sufficient to generate a signal indicative of fluid pressure within the left atrium.

107. An apparatus according to claim 97, wherein the indicator means is associated with the heart in a manner that is sufficient to generate a signal indicative of fluid pressure within the left atrium.

108. The apparatus of claim 97, further comprising an implantable flexible lead providing a signal connection between the indicator means and the signal processing apparatus.

109. The apparatus of claim 108, further comprising apparatus configured to anchor the indicator means to the patient'"'"'s atrial septum.

110. The apparatus of claim 108, wherein the indicator means is located on the lead a predetermined distance away from a distal tip of the lead, wherein the distance is predetermined so that the indicator means will be positioned within the patient'"'"'s left atrium when the distal tip is positioned within a pulmonary vein connected to the patient'"'"'s left atrium.

111. The apparatus of claim 108, wherein the lead comprises a first lead component carrying apparatus configured to anchor the first lead component to the patient'"'"'s atrial septum and a second lead component carrying the indicator means, wherein the second lead component is implantable into the patient and fixable to the first 5 lead component after the first lead component is implanted within the patient.

112. The apparatus of claim 109, further comprising apparatus on the lead configured to anchor the indicator means to the patient'"'"'s atrial septum.

115. The apparatus of claim 97, wherein the signal processing apparatus is at least partially contained within a housing, the housing configured for permanent implantation within the patient'"'"'s body.

116. The apparatus of claim 97, wherein the signal processing apparatus includes an analog-to-digital converter operable to convert analog signals from the indicator means to digital data reflective of the fluid pressure within the left atrium.

117. The apparatus of claim 97, wherein the signal processing apparatus includes digital memory for storing data reflective of pressures within the left atrium.

118. The apparatus of claim 117, further comprising apparatus configured to retrieve the data reflective of pressures within the left atrium from the digital memory.

119. The apparatus of claim 118, wherein the data retrieval apparatus includes a transceiver operable to transmit the data through the patient'"'"'s skin.

120. The apparatus of claim 97, wherein the signal processing apparatus is operable to receive modified programming with the signal processing apparatus implanted within the patient'"'"'s body.

121. The apparatus of claim 97, wherein the patient signaling device includes a mechanical vibrator operable to produce a vibration perceptible by the patient.

122. The apparatus of claim 97, wherein the patient signaling device includes apparatus configured to produce an electrical shock perceptible by the patient.

124. The apparatus of claim 97, wherein the patient signal device generates signals in the form of predetermined sequences of individual signal pulses, the signal pulses being perceptible by the patient.

125. The apparatus of claim 97, further comprising a second sensor in addition to the indicator means, the second sensor operable to generate a second signal indicative of a second condition within the body of the patient, wherein the signal processing apparatus is operable to generate a signal indicative of an appropriate therapeutic treatment based at least in part on the second signal generated by the second sends.

126. The apparatus of claim 97, wherein the patient signaling device includes a transmitter operable to send information to remote receiver.

127. The apparatus of claim 97, wherein the signal processing apparatus includes power management circuitry operable to deny power to at least some portions of the signal processing apparatus during periods of relative inactivity between periods of device operation.

128. The apparatus of claim 97, wherein the signal processing apparatus includes apparatus operable to compute mean left atrial pressures based on multiple individual signals generated by the indicator means.

129. The apparatus of claim 97, wherein the patient signaling device is operable to generate at least one signal indicative of an appropriate therapeutic treatment comprising a reduction in the normal dose of at least one medication taken by the patient.

130. Apparatus for treating congestive heart failure in a medical patient, the apparatus comprising:

indicator means for generating a signal indicative of fluid pressure within the left atrium;

signal processing apparatus operable to generate a signal indicative of an appropriate therapeutic treatment based at least in part on the signal generated by the indicator means; and

a patient signaling device operable to communicate the signal indicative of the appropriate therapeutic treatment to the patient;

an implantable flexible lead providing a signal connection between the indicator means and the signal processing apparatus; and

apparatus configured to anchor the indicator means to the patient'"'"'s atrial septum, wherein the apparatus comprises a helical screw configured for advancement into and fixation within the atrial septum.

131. Apparatus for treating congestive heart failure in a medical patient, the apparatus comprising:

indicator means for generating a signal indicative of fluid pressure within the left atrium;

signal processing apparatus operable to generate a signal indicative of an appropriate therapeutic treatment based at least in part on the signal generated by the indicator means; and

a patient signaling device operable to communicate the signal indicative of the appropriate therapeutic treatment to the patient;

an implantable flexible lead providing a signal connection between the indicator means and the signal processing apparatus; and

apparatus configured to anchor the indicator means to the patient'"'"'s atrial septum, wherein the apparatus comprises at least one anchor deployable by spring force upon the withdrawal of a removable sheath to expose the anchor.

132. Apparatus for treating congestive heart failure in a medical patient, the apparatus comprising:

indicator means for generating a signal indicative of fluid pressure within the left atrium, wherein the indicator means is located on the lead a predetermined distance away from a distal tip of the lead, wherein the distance is predetermined so that the indicator means will be positioned within the patient'"'"'s left atrium when the distal tip is positioned within a pulmonary vein connected to the patient'"'"'s left atrium;

signal processing apparatus operable to generate a signal indicative of an appropriate therapeutic treatment based at least in part on the signal generated by the indicator means; and

a patient signaling device operable to communicate the signal indicative of the appropriate therapeutic treatment to the patient;

an implantable flexible lead providing a signal connection between the indicator means and the signal processing apparatus.

133. Apparatus for treating congestive heart failure in a medical patient, the apparatus comprising:

indicator means for generating a signal indicative of fluid pressure within the left atrium;

signal processing apparatus operable to generate a signal indicative of an appropriate therapeutic treatment based at least in part on the signal generated by the indicator means; and

a patient signaling device operable to communicate the signal indicative of the appropriate therapeutic treatment to the patient; and

an implantable flexible lead providing a signal connection between the indicator means and the signal processing apparatus, wherein the lead comprises a first lead component carrying apparatus configured to anchor the first lead component to the patient'"'"'s atrial septum and a second lead component carrying the indicator means, wherein the second lead component is implantable into the patient and fixable to the first lead component after the first lead component is implanted within the patient.

134. Apparatus for treating congestive heart failure in a medical patient, the apparatus comprising:

indicator means for generating a signal indicative of fluid pressure within the left atrium;

signal processing apparatus operable to generate a signal indicative of an appropriate therapeutic treatment based at least in part on the signal generated by the indicator means; and

a patient signaling device operable to communicate the signal indicative of the appropriate therapeutic treatment to the patient; and

a second sensor in addition to the indicator means, the second sensor operable to generate a second signal indicative of a second condition within the body of the patient, wherein the signal processing apparatus is operable to generate a signal indicative of an appropriate therapeutic treatment based at least in part on the second signal generated by the second sensor.

135. The apparatus of claim 134, wherein the second sensor is a pressure transducer.

136. The apparatus of claim 134, wherein the second sensor is an ECG electrode.

137. The apparatus of claim 134, wherein the second sensor is configured for implantation in the patient'"'"'s right atrium.

138. The apparatus of claim 134, wherein the second sensor is configured for implantation in a location inside the patient'"'"'s body outside the atria.

139. Apparatus for treating congestive heart failure in a medical patient, the apparatus comprising:

indicator means for generating a signal indicative of fluid pressure within the left atrium;

signal processing apparatus operable to generate a signal indicative of an appropriate therapeutic treatment based at least in part on the signal generated by the indicator means, wherein the signal processing apparatus includes digital memory for storing data reflective of pressures within the left atrium;

a patient signaling device operable to communicate the signal indicative of the appropriate therapeutic treatment to the patient;

apparatus configured to retrieve the data reflective of pressures within the left atrium from the digital memory; and

wherein the data retrieval apparatus includes a transceiver operable to transmit the data through the patient'"'"'s skin.

140. Apparatus for treating congestive heart failure in a medical patient, the apparatus comprising:

indicator means for generating a signal indicative of fluid pressure within the left atrium;

signal processing apparatus operable to generate a signal indicative of an appropriate therapeutic treatment based at least in part on the signal generated by the indicator means; and

a patient signaling device operable to communicate the signal indicative of the appropriate therapeutic treatment to the patient;

wherein the patient signaling device includes a transmitter operable to send information to a remote receiver.

141. Apparatus for treating congestive heart failure in a medical patient, the apparatus comprising:

indicator means for generating a signal indicative of fluid pressure within the left atrium;

signal processing apparatus operable to generate a signal indicative of an appropriate therapeutic treatment based at least in part on the signal generated by the indicator means, wherein the signal processing apparatus includes power management circuitry operable to deny power to at least some portions of the signal processing apparatus during periods of relative inactivity between periods of device operation; and

a patient signaling device operable to communicate the signal indicative of the appropriate therapeutic treatment to the patient.

142. Apparatus for treating congestive heart failure in a medical patient, the apparatus comprising:

indicator means for generating a signal indicative of fluid pressure within the left atrium;

signal processing apparatus operable to generate a signal indicative of an appropriate therapeutic treatment based at least in part on the signal generated by the indicator means, wherein the signal processing apparatus includes apparatus operable to compute mean left atrial pressures based on multiple individual signals generated by the indicator means; and

a patient signaling device operable to communicate the signal indicative of the appropriate therapeutic treatment to the patient.

143. Apparatus for treating congestive heart failure in a medical patient, the apparatus comprising:

indicator means for generating a signal indicative of fluid pressure within the left atrium;

signal processing apparatus operable to generate a signal indicative of an appropriate therapeutic treatment based at least in part on the signal generated by the indicator means, wherein the patient signaling device is operable to generate at least one signal indicative of an appropriate therapeutic treatment comprising a reduction in the normal dose of at least one medication taken by the patient; and

a patient signaling device operable to communicate the signal indicative of the appropriate therapeutic treatment to the patient.