Myocardium conditioning using myocardial and parasympathetic stimulation

• US 7,689,286 B2
• Filed: 05/02/2006
• Issued: 03/30/2010
• Est. Priority Date: 05/02/2006
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Baynham, Tamara Colette, Spinelli, Julio C., Pastore, Joseph M., Kramer, Andrew P., Salo, Rodney W., Ross, Jeffrey
• Primary Examiner(s): Layno; Carl H
• Assistant Examiner(s): Dinga; Roland
• Application Number:
  US11/381,211
• Publication Number:
  US 20070260284A1
• Time in Patent Office: 1,428 Days
• Field of Search: 607/2, 607/4, 607/5, 607/9, 607/11, 607/14, 607/117, 600/509, 600/512, 600/515, 600/517
• US Class Current: 607/50
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• 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 1/37211 Means for communicating with stimulators
• CPC Class Codes: A61N 1/3956 Implantable devices for applying electric shocks to the heart, e.g. for cardioversion

Abstract

Various system embodiments comprise a neural stimulator, a pulse generator, and a controller. The neural stimulator is adapted to generate a neural stimulation signal. The pulse generator is adapted to generate a pacing signal to provide myocardium pacing. The controller is adapted to control the neural stimulator and the pulse generator to provide a cardioprotective conditioning therapy. The conditioning therapy includes neural stimulation to elicit a parasympathetic response and myocardium pacing. Other aspects and embodiments are provided herein.

Claims

1. A system, comprising:

means for providing cardioprotective therapy to treat heart disease through modulation of an Akt-mediated pathway,

wherein the means for providing cardioprotective therapy to treat heart disease includes both means for providing cardioprotective myocardial pacing therapy to modulate the Akt-mediated pathway, and means for providing cardioprotective neural stimulation therapy to elicit a parasympathetic response to modulate the Akt-mediated pathway,

wherein the means for providing cardioprotective myocardial pacing therapy includes means for delivering a programmed myocardial pacing sequence to modulate the Akt-mediated pathway, wherein the means for delivering the programmed myocardial pacing sequence includes means for initiating and timing a sequence of myocardial pacing pulses, wherein the programmed myocardial pacing sequence includes alternating pacing periods with a programmed pacing duration and non-pacing periods with a programmed non-pacing duration, wherein each pacing period in the programmed myocardial pacing sequence includes the timed sequence of myocardial pacing pulses delivered to a myocardium for the duration of each of the pacing periods and not delivering myocardial pacing pulses during each of the non-pacing periods.

2. The system of claim 1, wherein the means for providing cardioprotective therapy includes means for providing therapeutic postconditioning therapy after an ischemic event.

3. The system of claim 1, wherein the means for providing cardioprotective therapy includes means for providing prophylactic preconditioning therapy in anticipation of an ischemic event.

4. The system of claim 1, further comprising means for detecting an ischemia event, and means for providing the cardioprotective therapy in response to the detected ischemia event.

5. The system of claim 1, wherein the means for delivering the programmed myocardial pacing sequence includes:

means for initiating the pacing period;

means for, upon initiating the pacing period, delivering the timed sequence of myocardial pacing pulses for the programmed pacing duration; and

means for, upon completion of the pacing duration, initiating a subsequent pacing period after the programmed non-pacing duration.

6. The system of claim 1, wherein the means for providing cardioprotective pacing therapy includes means for integrating the cardioprotective neural stimulation therapy with the cardioprotective myocardial pacing therapy to provide the cardioprotective therapy.

7. The system of claim 1, wherein the means for providing cardioprotective therapy includes a neural stimulator and a pulse generator integrated into a single pulse generator circuit to provide the cardioprotective myocardial pacing therapy and the cardioprotective neural stimulation therapy.

8. The system of claim 1, wherein:

the means for providing cardioprotective therapy includes a neural stimulator to provide the cardioprotective neural stimulation therapy and a pulse generator to provide the cardioprotective myocardial pacing therapy; and

the neural stimulator is distinct from the pulse generator.

9. The system of claim 1, further comprising:

means for detecting an ischemia event;

means for automatically responding the to the detected ischemia event by providing a postconditioning cardioprotective therapy for the detected ischemia event, followed by a preconditioning cardioprotective therapy in anticipation of a subsequent ischemic event.

10. The system of claim 1, wherein the means for providing cardioprotective neural stimulation therapy to elicit a parasympathetic response includes means for transvascularly stimulating a vagus nerve from an internal jugular vein to elicit the parasympathetic response.

11. The system of claim 1, wherein the means for providing cardioprotective neural stimulation therapy to elicit a parasympathetic response includes means for stimulating a vagus nerve using a nerve cuff to elicit the parasympathetic response.

12. The system of claim 1, wherein the sequence of alternating pacing and non-pacing periods includes a regular interval between pacing periods.

13. The system of claim 1, wherein the means for providing cardioprotective neural stimulation therapy includes means for inhibiting sympathetic nerve traffic.

14. The system of claim 1, wherein the means for providing cardioprotective neural stimulation therapy includes means for stimulating parasympathetic nerve traffic.

15. The system of claim 1, wherein the system includes:

means for providing at least two pacing modes for pacing myocardial tissue, wherein one of the at least two pacing modes includes the cardioprotective myocardial pacing therapy; and

means for interrupting another one of the at least two pacing modes to deliver the cardioprotective myocardial pacing therapy.

16. A method, comprising:

providing cardioprotective therapy to treat heart disease through modulation of an Akt-mediated pathway,

wherein providing cardioprotective therapy to treat heart disease includes both providing cardioprotective myocardial pacing therapy to modulate the Akt-mediated pathway, and providing cardioprotective neural stimulation therapy to elicit a parasympathetic response to modulate the Akt-mediate pathway,

wherein providing cardioprotective myocardial pacing therapy includes delivering a programmed myocardial pacing sequence to modulate the Akt-mediated pathway, wherein delivering the programmed myocardial pacing sequence includes initiating and timing a sequence of myocardial pacing pulses, wherein the programmed myocardial pacing sequence includes alternating pacing periods with a programmed pacing duration and non-pacing periods with a programmed non-pacing duration, wherein each pacing period in the programmed myocardial pacing sequence includes the timed sequence of myocardial pacing pulses delivered to a myocardium for the duration of each of the pacing periods in the programmed myocardial pacing sequence and not delivering myocardial pacing pulses during each of the a non-pacing periods in the programmed myocardial pacing sequence.

17. The method of claim 16, wherein providing cardioprotective therapy includes providing therapeutic postconditioning therapy after an ischemic event.

18. The method of claim 16, wherein providing cardioprotective therapy includes providing prophylactic preconditioning therapy in anticipation of an ischemic event.

19. The method of claim 16, further comprising detecting an ischemia event, and providing the cardioprotective therapy in response to the detected ischemia event.

20. The method of claim 16, wherein providing cardioprotective neural stimulation therapy includes providing vagus nerve stimulation.

21. The method of claim 16, wherein providing cardioprotective neural stimulation therapy includes providing neural stimulation to a vagus nerve branch.

22. The method of claim 16, wherein providing cardioprotective neural stimulation therapy includes providing neural stimulation to a cardiac fat pad.

23. The method of claim 16, wherein providing cardioprotective neural stimulation therapy includes providing neural stimulation therapy to stimulate parasympathetic nerve traffic.

24. The method of claim 16, wherein providing cardioprotective neural stimulation therapy includes providing neural stimulation therapy to inhibit sympathetic nerve traffic.

25. The method of claim 16, wherein providing cardioprotective transvascularly stimulating a vagus nerve from an internal jugular vein.

26. The method of claim 16, wherein delivering the programmed myocardial pacing sequence includes:

initiating the pacing period;

upon initiating the pacing period, delivering the timed sequence of myocardial pacing pulses for the programmed pacing duration; and

upon completion of the pacing duration, initiating a subsequent pacing period after the programmed non-pacing duration.

27. The method of claim 16, wherein providing cardioprotective pacing therapy includes integrating the cardioprotective neural stimulation therapy with the cardioprotective myocardial pacing therapy to provide the cardioprotective neural stimulation only during the pacing periods.

28. The method of claim 16, wherein providing cardioprotective therapy includes integrating the cardioprotective neural stimulation therapy with the cardioprotective myocardial pacing therapy to provide the cardioprotective neural stimulation only during the non-pacing periods.

29. The method of claim 16, further comprising:

detecting an ischemia event; and

automatically responding the to the detected ischemia event by providing a postconditioning cardioprotective therapy for the detected ischemia event, followed by a preconditioning cardioprotective therapy in anticipation of a subsequent ischemic event.

30. The method of claim 16, wherein the method includes:

providing at least two pacing modes for pacing myocardial tissue, wherein one of the at least two pacing modes includes the cardioprotective myocardial pacing therapy; and

interrupting another one of the at least two pacing modes to deliver the cardioprotective myocardial pacing therapy.