Method and apparatus for temporarily varying a parameter in an implantable medical device

• US 7,133,718 B2
• Filed: 06/19/2003
• Issued: 11/07/2006
• Est. Priority Date: 06/19/2003
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Bakken, Earl E., Combs, William J., Markowitz, H. Toby, Bergman, Rebecca M.
• Primary Examiner(s): Pezzuto, Robert E.
• Assistant Examiner(s): DROESCH, KRISTEN L
• Application Number:
  US10/465,351
• Publication Number:
  US 20040260348A1
• Time in Patent Office: 1,237 Days
• Field of Search: None
• US Class Current: 607/9
• CPC Class Codes: A61N 1/365 controlled by a physiological parameter, e.g. heart potential evoked response A61N1/371
• CPC Class Codes: A61N 1/36592 controlled by the heart rate variability

Abstract

A method and apparatus for varying a parameter in an implantable medical device that includes a plurality of electrodes stimulating heart tissue and sensing cardiac signals, a timing and control device controlling the stimulation of heart tissue by the plurality of electrodes and measuring intervals between the sensed cardiac signals, a storage device storing the measured intervals, and a microprocessor. The microprocessor determines heart rate variability in response to the stored intervals, compares the determined heart rate variability to a predetermined target rate profile, adjusts the parameter from a first setting to a second setting different from the first setting in response to the comparing of the determined heart rate variability and the predetermined target rate profile, and adjusts the parameter from the second setting to a termination setting in response to a termination event or expiration of a first predetermined time period.

Claims

1. A method for temporarily varying a parameter in an implantable medical device, comprising:

determining heart rate variability;

comparing the determined heart rate variability to a predetermined target rate profile;

adjusting the parameter from a first setting to a second setting different from the first setting in response to the comparing of the determined heart rate variability and the predetermined target rate profile; and

adjusting the parameter from the second setting to a termination setting in response to expiration of a first predetermined time period.

2. The method of claim 1, further comprising determining whether to initiate a varying of a parameter in response to one of receipt of a patient activation and an internal indication of a predetermined time of day for initiating the varying of a parameter.

3. The method of claim 1, further comprising determining whether a varying of a parameter is appropriate in response to the comparing the determined heart rate variability to a predetermined target rate profile.

4. The method of claim 1, wherein determining heart rate variability includes generating a histogram of heart rates having a plurality of corresponding heart rate bins.

5. The method of claim 4, further comprising determining whether a varying of a parameter is appropriate in response to the comparing the determined heart rate variability to a predetermined target rate profile, wherein the varying of a parameter is determined to be appropriate in response to a percentage of time that heart rates are within one or more of the plurality of heart rate bins.

6. The method of claim 4, further comprising determining whether a varying of a parameter is appropriate in response to the comparing the determined heart rate variability to a predetermined target rate profile, wherein the varying of a parameter is determined to be appropriate in response to a number of beats within one or more of the plurality of heart rate bins.

7. The method of claim 1, further comprising determining whether a varying of a parameter is appropriate in response to the comparing the determined heart rate variability to a predetermined target rate profile, wherein the varying of a parameter is determined to be appropriate in response to change in heart rate variability being less than a predetermined value.

8. The method of claim 1, further comprising:

storing exercise time profiles corresponding to variations in the second setting; and

selecting a first exercise time profile from the stored exercise time profiles in response to the comparing the determined heart rate variability to a predetermined target rate profile.

9. The method of claim 8, wherein each of the stored exercise time profiles include an acceleration portion corresponding to adjusting the parameter from the first setting to the second setting, a steady-state portion corresponding to the first predetermined time period, and a deceleration portion corresponding to adjusting the parameter from the second setting to the termination setting.

10. The method of claim 9, wherein the first setting corresponds to a predetermined lower pacing rate and the second setting is greater than the predetermined lower pacing rate.

11. The method of claim 8, further comprising:

determining whether the predetermined target rate profile would be exceeded in response to the first exercise time profile; and

selecting a second exercise time profile from the stored exercise time profiles in response to the predetermined target profile being exceeded.

12. The method of claim 1, further comprising determining whether to adjust the parameter from the second setting to the termination setting prior to expiration of the first predetermined time period.

13. The method of claim 12, wherein the parameter is adjusted from the second setting to the termination setting prior to expiration of the first predetermined time period in response to one of a programming session, a magnet, a cardiac arrhythmia, spontaneous rate greater than the second setting, and rate response greater than the second setting.

14. The method of claim 1, wherein determining heart rate variability includes generating a histogram of heart rates having a plurality of corresponding heart rate bins, and further comprising, determining, prior to adjusting the parameter from the first setting to the second setting, whether a current generated histogram is consistent with a predetermined number of previously generated histograms.

15. The method of claim 9, further comprising:

determining whether the target rate profile has been reached;

repeating adjusting of the parameter from the first setting to the second setting and from the second setting to the termination setting in response to the target rate profile not being reached; and

updating one or more of the acceleration portion, the steady state portion and the deceleration portion in response to the target rate profile being reached.

16. The method of claim 1, wherein the termination setting corresponds to one of a spontaneous rate, a rate response rate, and the first setting.

17. The method of claim 8, further comprising;

storing information corresponding to the selected exercise time profile; and

outputting the stored information to an external device.

18. An implantable medical device, comprising:

a plurality of electrodes stimulating heart tissue and sensing cardiac signals;

a timing and control device controlling the stimulation of heart tissue by the plurality of electrodes and measuring intervals between the sensed cardiac signals;

a storage device storing the measured intervals; and

a microprocessor determining heart rate variability in response to the stored intervals, comparing the determined heart rate variability to a predetermined target rate profile, adjusting a parameter from a first setting to a second setting different from the first setting in response to the comparing of the determined heart rate variability and the predetermined target rate profile, and adjusting the parameter from the second setting to a termination setting in response to expiration of a first predetermined time period.

19. The device of claim 18, further comprising a patient activator generating a patient request for adjusting the parameter, wherein the timing and control device generates an indication of a programmed time of day for initiating the adjusting of the parameter, and the microprocessor initiates the adjusting of the parameter in response to receipt of one of the patient request from the patient activator and the indication of the programmed time of day from the timing and control unit.

20. The device of claim 18, wherein the microprocessor compares the determined heart rate variability to the predetermined target rate profile and determines the adjusting of the parameter is appropriate in response to the comparing of the determined heart rate variability to the predetermined target rate profile.

21. The device of claim 20, wherein the microprocessor generates a histogram of heart rates having a plurality of corresponding heart rate bins, and determines the adjusting of the parameter is appropriate in response to a percentage of time that heart rates are within one or more of the plurality of heart rate bins.

22. The device of claim 20, wherein the microprocessor generates a histogram of heart rates having a plurality of corresponding heart rate bins, and determines the adjusting of the parameter is appropriate in response to a number of beats within one or more of the plurality of heart rate bins.

23. The device of claim 18, wherein the microprocessor compares the determined heart rate variability to the predetermined target rate profile and determines the adjusting of the parameter is appropriate in response to change in heart rate variability being less than a predetermined value.

24. The device of claim 18, wherein the storage device stores exercise time profiles corresponding to variations in the second setting, and the microprocessor selects a first exercise time profile from the stored exercise time profiles in response to the comparison of the determined heart rate variability to the predetermined target rate profile.

25. The device of claim 24, wherein each of the stored exercise time profiles include an acceleration portion corresponding to adjusting the parameter from the first setting to the second setting, a steady-state portion corresponding to the second setting, and a deceleration portion corresponding to adjusting the parameter from the second setting to the termination setting.

26. The device of claim 25, wherein the first setting corresponds to a predetermined lower pacing rate and the second setting is greater than the predetermined lower pacing rate.

27. The device of claim 24, wherein the microprocessor determines whether the predetermined target rate profile would be exceeded in response to the first exercise time profile, and selects a second exercise time profile from the stored exercise time profiles in response to the predetermined target profile being exceeded.

28. The device of claim 18, wherein the microprocessor adjusts the parameter from the second setting to the termination setting, prior to expiration of the first predetermined time period, in response to detecting one of a programming session, a magnet, a cardiac arrhythmia, spontaneous rate greater than the second setting, and rate response greater than the second setting.

29. The device of claim 18, wherein the microprocessor generates a histogram of heart rates and determines, prior to adjusting the parameter from the first setting to the second setting, whether a current generated histogram is consistent with a predetermined number of previously generated histograms.

30. The device of claim 25, wherein the microprocessor determines whether the target rate profile has been reached, repeats adjusting of the parameter from the first setting to the second setting and from the second setting to the termination setting in response to the target rate profile not being reached, and updates one or more of the acceleration portion, the steady state portion, and the deceleration portion in response to the target rate profile being reached.

31. The device of claim 18, wherein the termination setting corresponds to one of a spontaneous rate, a rate response rate, and the first setting.

32. The device of claim 24, further comprising an output device outputting information corresponding to the selected exercise time profiles.

33. An implantable medical device, comprising:

means for determining heart rate variability;

means for comparing the determined heart rate variability to a predetermined target rate profile;

means for adjusting a parameter from a first setting to a second setting different from the first setting in response to the comparing of the determined heart rate variability and the predetermined target rate profile; and

means for adjusting the parameter from the second setting to a termination setting in response to expiration of a first predetermined time period.

34. A computer readable medium having computer executable instructions for performing a method comprising:

determining heart rate variability;

comparing the determined heart rate variability to a predetermined target rate profile;

adjusting the parameter from a first setting to a second setting different from the first setting in response to the comparing of the determined heart rate variability and the predetermined target rate profile; and

adjusting the parameter from the second setting to a termination setting in response to expiration of a first predetermined time period.

35. An implantable medical device, comprising:

means for stimulating heart tissue and sensing cardiac signals;

means for controlling timing of the stimulation of heart tissue and measuring intervals between the sensed cardiac signals;

means for determining heart rate variability in response to the intervals;

means for comparing the determined heart rate variability to a predetermined target rate profile;

means for adjusting a parameter from a first setting to a second setting different from the first setting in response to the comparing of the determined heart rate variability and the predetermined target rate profile, and adjusting the parameter from the second setting to a termination setting in response to expiration of a first predetermined time period;

means for selecting a first exercise time profile from stored exercise time profiles in response to the comparison of the determined heart rate variability to the predetermined target rate profile, each of the stored exercise time profiles including an acceleration portion corresponding to adjusting the parameter from the first setting to the second setting, a steady-state portion corresponding to the first predetermined time period, and a deceleration portion corresponding to adjusting the parameter from the second setting to the termination setting, wherein the adjusting means adjusts the parameter from the second setting to the termination setting, prior to expiration of the first predetermined time period, in response to detecting one of a programming session, a magnet, a cardiac arrhythmia, spontaneous rate greater than the second setting, and rate response greater than the second setting.

36. The device of claim 35, further comprising means for generating a patient request for adjusting the parameter, wherein the controlling means generates an indication of a programmed time of day for initiating the adjusting of the parameter, and the adjusting means initiates adjusting of the parameter in response to one of the patient request and the indication of the programmed time of day for initiating the adjusting of the parameter.

37. The device of claim 36, wherein the determining means generates a histogram of heart rates having a plurality of corresponding heart rate bins, and determines the adjusting of the parameter is appropriate in response to a percentage of time that heart rates are within one or more of the plurality of heart rate bins.

38. The device of claim 35, wherein the determining means generates a histogram of heart rates having a plurality of corresponding heart rate bins, and determines the adjusting of the parameter is appropriate in response to a number of beats within one or more of the plurality of heart rate bins.

39. The device of claim 35, wherein the first setting corresponds to a predetermined lower pacing rate and the second setting is greater than the predetermined lower pacing rate.

40. The device of claim 35, wherein the comparing means determines whether the predetermined target rate profile would be exceeded in response to the first exercise time profile, and selects a second exercise time profile from the stored exercise time profiles in response to the predetermined target profile being exceeded.

41. The device of claim 35, wherein the determining means generates a histogram of heart rates and determines, prior to the adjusting of the parameter from the first setting to the second setting, whether a current generated histogram is consistent with a predetermined number of previously generated histograms.

42. The device of claim 35, wherein the comparing means determines whether the target rate profile has been reached, and the adjusting means repeats adjusting of the parameter from the first setting to the second setting and from the second setting to the termination setting in response to the target rate profile not being reached, and updates one or more of the acceleration portion, the steady state portion and the deceleration portion in response to the target rate profile being reached.

43. The device of claim 35, wherein the termination setting corresponds to one of a spontaneous rate, a rate response rate, and the first setting.

44. The device of claim 37, further comprising means for outputting information corresponding to the selected exercise time profiles.