Multi-site ventricular pacing therapy with parasympathetic stimulation
First Claim
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1. An implantable device for delivering cardiac function therapy to a patient, comprising:
- a plurality of pacing channels for delivering pacing pulses to multiple ventricular sites;
a parasympathetic stimulation channel for stimulating parasympathetic nerves innervating the heart;
a sensor for measuring cardiac output;
an exertion level sensor for measuring the patient'"'"'s exertion level;
a controller for controlling the delivery of pacing pulses to the multiple ventricular sites in accordance with a programmed pacing mode;
wherein the controller is programmed to deliver multi-site ventricular pacing therapy in conjunction with parasympathetic stimulation and wherein the controller is further programmed to deliver the multi-site ventricular pacing therapy with a pacing pulse output sequence that pre-excites at least one myocardial region relative to other regions for reducing ventricular wall stress;
wherein the controller is further programmed to deliver the multi-site ventricular pacing in accordance with a demand pacing mode that counteracts slowing of the heart rate by the parasympathetic stimulation so that no slowing of the heart rate occurs; and
,wherein the controller is programmed to compute a function that maps exertion levels to minimum cardiac output values considered to be adequate for a particular exertion level and is further programmed to cease the delivery of parasympathetic stimulation if a presently measured cardiac output is below the minimum cardiac output indicated as adequate by the computed function.
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Abstract
A method and device for delivering multi-site ventricular pacing therapy in conjunction with parasympathetic stimulation for reducing ventricular wall stress. Such reduction in ventricular wall stress is useful in reversing or preventing the ventricular remodeling which can occur in heart failure patients.
443 Citations
16 Claims
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1. An implantable device for delivering cardiac function therapy to a patient, comprising:
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a plurality of pacing channels for delivering pacing pulses to multiple ventricular sites; a parasympathetic stimulation channel for stimulating parasympathetic nerves innervating the heart; a sensor for measuring cardiac output; an exertion level sensor for measuring the patient'"'"'s exertion level; a controller for controlling the delivery of pacing pulses to the multiple ventricular sites in accordance with a programmed pacing mode; wherein the controller is programmed to deliver multi-site ventricular pacing therapy in conjunction with parasympathetic stimulation and wherein the controller is further programmed to deliver the multi-site ventricular pacing therapy with a pacing pulse output sequence that pre-excites at least one myocardial region relative to other regions for reducing ventricular wall stress; wherein the controller is further programmed to deliver the multi-site ventricular pacing in accordance with a demand pacing mode that counteracts slowing of the heart rate by the parasympathetic stimulation so that no slowing of the heart rate occurs; and
,wherein the controller is programmed to compute a function that maps exertion levels to minimum cardiac output values considered to be adequate for a particular exertion level and is further programmed to cease the delivery of parasympathetic stimulation if a presently measured cardiac output is below the minimum cardiac output indicated as adequate by the computed function. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8)
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9. A method for operating an implantable cardiac device in order to deliver therapy to a patient, comprising:
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stimulating parasympathetic nerves innervating the heart in order to reduce ventricular wall stress; delivering multi-site ventricular pacing therapy with a pacing pulse output sequence that pre-excites at least one myocardial region relative to other regions; delivering pacing pulses to multiple ventricular sites in accordance with a demand pacing mode that counteracts slowing of the heart rate by the parasympathetic stimulation so that no slowing of the heart rate occurs; measuring cardiac output; measuring the patient'"'"'s exertion level; and
,computing a function that maps exertion levels to minimum cardiac output values considered to be adequate for a particular exertion level and ceasing the delivery of parasympathetic stimulation if a presently measured cardiac output is below the minimum cardiac output indicated as adequate by the function. - View Dependent Claims (10, 11, 12, 13, 14, 15, 16)
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Specification