Pacing mode to reduce effects of orthostatic hypotension and syncope
First Claim
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1. An implantable cardiac rhythm management device, comprising:
- position sensing means for sensing a change in a patient'"'"'s position from a supine position to an upright position;
pressure sensing means for sensing when a patient'"'"'s blood pressure drops below a predefined threshold; and
therapy delivery means, responsive to the position sensing means and the pressure sensing means, for generating cardiac stimulating pulses at an increased rate effective to treat orthostatic hypotension when the patient moves from a supine position to an upright position and the patient'"'"'s blood pressure drops below the predefined threshold.
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Abstract
An implantable cardiac stimulation device is programmed to administer pacing therapy in response to a change in a patient'"'"'s position and a drop in blood pressure. The stimulation device is equipped with a position sensor to sense a position parameter indicative of when a patient changes from a supine position to an upright position and a pressure sensor to sense a pressure parameter indicative of a patient'"'"'s blood pressure. The device administers cardiac pacing therapy to the patient based on both the position parameter and the pressure parameter.
96 Citations
56 Claims
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1. An implantable cardiac rhythm management device, comprising:
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position sensing means for sensing a change in a patient'"'"'s position from a supine position to an upright position;
pressure sensing means for sensing when a patient'"'"'s blood pressure drops below a predefined threshold; and
therapy delivery means, responsive to the position sensing means and the pressure sensing means, for generating cardiac stimulating pulses at an increased rate effective to treat orthostatic hypotension when the patient moves from a supine position to an upright position and the patient'"'"'s blood pressure drops below the predefined threshold. - View Dependent Claims (2, 3, 4, 5)
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6. A cardiac stimulation device, comprising:
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position sensing means for sensing changes in a patient'"'"'s position;
pressure parameter sensing means for sensing a parameter indicative of a patient'"'"'s blood pressure, the pressure parameter sensing means detecting a drop in the patient'"'"'s blood pressure below a predefined threshold; and
therapy administration means, responsive to the position sensing means and the pressure parameter sensing means, for administering cardiac pacing therapy to the patient based on the changes in the patient'"'"'s position and the patient'"'"'s blood pressure dropping below the predefined threshold. - View Dependent Claims (7, 8, 9)
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10. A programmable cardiac stimulation device having a memory and a processor, the cardiac stimulation device being programmed to perform tasks comprising:
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administering pacing therapy to a patient when the patient experiences both (1) a change in position from a supine position to an upright position and (2) a drop in blood pressure below a predefined threshold; and
subsequently removing the pacing therapy in a systematic manner. - View Dependent Claims (11, 12, 43)
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13. A cardiac stimulation device comprising:
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a position sensor to sense a position parameter indicative of changes in a patient'"'"'s position;
a pressure sensor to sense a pressure parameter indicative of a patient'"'"'s blood pressure;
a processor operably coupled to the position sensor and the pressure sensor, the processor being configured to determine when to administer cardiac pacing therapy to the patient based on the position parameter and the pressure parameter, the processor being configured to monitor the pressure parameter during administration of the cardiac pacing therapy and to remove the cardiac pacing therapy in response to a change in the pressure parameter; and
a pacing generator configured to administer the cardiac pacing therapy as directed by the processor. - View Dependent Claims (14, 15, 16, 17, 18, 19, 20, 21, 22, 23)
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24. An implantable cardiac rhythm management device, comprising:
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position sensing means for sensing a change in a patient'"'"'s position;
pressure sensing means for sensing when a patient'"'"'s blood pressure drops below a predefined threshold; and
therapy delivery means for selectively administering pacing therapy to the patient based on the patient'"'"'s position and the patient'"'"'s blood pressure, and for monitoring the patient'"'"'s blood pressure during administration of the pacing therapy and for removing the pacing therapy in response to a change in the patient'"'"'s blood pressure. - View Dependent Claims (25, 26, 27)
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28. A method comprising:
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determining a position parameter indicative of a change in a patient'"'"'s position;
determining a pressure parameter indicative of a patient'"'"'s blood pressure; and
selectively administering pacing therapy to the patient based on the position parameter and the pressure parameter;
wherein the determining a pressure parameter comprises;
monitoring a patient'"'"'s blood pressure; and
detecting a drop in the patient'"'"'s blood pressure below a predefined threshold. - View Dependent Claims (29, 30, 31, 32, 33)
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34. A method comprising:
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determining a position parameter indicative of a change in a patient'"'"'s position;
determining a pressure parameter indicative of a patient'"'"'s blood pressure; and
selectively administering pacing therapy to the patient based on the position parameter and the pressure parameter;
wherein the determining a pressure parameter comprises;
monitoring a physiological parameter that can be correlated with a patient'"'"'s blood pressure; and
detecting a change in the physiological parameter that correlates to a drop in the patient'"'"'s blood pressure below a predefined threshold.
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35. A method of administering pacing therapy for orthostatic hypotension, comprising:
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detecting a change in a patient'"'"'s position from a supine position to an upright position;
detecting a drop in a patient'"'"'s blood pressure below a predefined threshold; and
adjusting a cardiac pacing rate from a first pacing rate to a second pacing rate effective to counteract effects of orthostatic hypotension in response to detection of the change in the patient'"'"'s position and the drop in the patient'"'"'s blood pressure. - View Dependent Claims (36, 37, 38, 39, 40, 41, 42)
monitoring positional data generated by a 3D accelerometer; and
detecting, from the positional data, the change from the supine position to the upright position.
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37. The method of claim 35, wherein the detecting a drop in the patient'"'"'s blood pressure comprises:
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directly sensing the patient'"'"'s blood pressure; and
ascertaining a drop in the patient'"'"'s blood pressure.
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38. The method of claim 35, wherein the detecting a drop in the patient'"'"'s blood pressure comprises:
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monitoring a physiological parameter that can be correlated with the patient'"'"'s blood pressure; and
ascertaining a change in the physiological parameter that correlates to a drop in the patient'"'"'s blood pressure.
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39. The method of claim 35, wherein the adjusting comprises increasing the cardiac pacing rate from the first pacing rate to the second pacing rate, which is higher than the first pacing rate.
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40. The method of claim 35, further comprising adjusting the cardiac pacing rate back toward the first pacing rate.
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41. The method of claim 35, further comprising adjusting the cardiac pacing rate back toward the first pacing rate after a predetermined amount of time.
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42. The method of claim 35, further comprising:
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detecting a rise in the patient'"'"'s blood pressure after said adjusting the cardiac pacing rate; and
in response, adjusting the cardiac pacing rate back toward the first pacing rate.
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44. A method of administering pacing therapy for vasovagal syncope, comprising:
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detecting a change in a patient'"'"'s position from a supine position to an upright position;
detecting a drop in the patient'"'"'s blood pressure below a predefined threshold; and
adjusting a cardiac pacing rate from a first pacing rate to a second pacing rate effective to counteract effects of vasovagal syncope in response to detection of the change in the patient'"'"'s position and a drop in the patient'"'"'s blood pressure below the predefined threshold. - View Dependent Claims (45, 46, 47, 48, 49, 50, 51)
detecting a rise in the patient'"'"'s blood pressure above another predefined threshold; and
in response, adjusting the cardiac pacing rate back toward the first pacing rate.
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51. One or more computer-readable media having computer-readable instructions thereon which, when executed by a programmable stimulation device, cause the stimulation device to execute the method of claim 44.
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52. A method comprising:
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increasing a pacing rate in a cardiac stimulation device from a first rate to a higher second rate when a patient experiences both (1) a change in position from a supine position to an upright position and (2) a drop in blood pressure below a predefined threshold; and
subsequently decreasing the pacing rate back toward the first rate. - View Dependent Claims (53, 54, 55)
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56. A method comprising:
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determining a position parameter indicative of a change in a patient'"'"'s position;
determining a pressure parameter indicative of a patient'"'"'s blood pressure;
selectively administering pacing therapy to the patient based on the position parameter and the pressure parameter;
monitoring the pressure parameter during administration of the pacing therapy;
systematically removing the pacing therapy in response to a change in the pressure parameter.
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Specification