Pacing therapy for diastolic heart failure
First Claim
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1. A cardiac pacing system comprising:
- a sensing circuit to sense at least one cardiac signal;
a pacing circuit to deliver pacing pulses;
an exertion level sensor;
a diastolic performance sensor to sense a signal indicative of a diastolic function that relates to how optimally the ventricles are filling with blood during diastole;
a signal processor adapted to receive and process the signal indicative of the diastolic function, the signal processor including a diastolic performance parameter generator to produce a diastolic performance parameter based on the signal indicative of the diastolic function;
a pacing controller coupled to the sensing circuit and the pacing circuit, the pacing controller being programmed to deliver paces with a rate-adaptive pacing mode based upon signals from the exertion level sensor wherein a rate-adaptive algorithm maps the exertion level signals to a modified pacing rate in accordance with a rate-response function;
wherein the pacing controller is programmed to determine if diastolic filling is compromised by comparing the diastolic performance parameter with a specified threshold value; and
wherein the pacing controller is further programmed to adjust one or more rate-adaptive pacing parameters that define the rate-response function if a comparison of the diastolic performance parameter with a specified threshold value indicates diastolic filling is compromised, wherein the one or more rate-adaptive pacing parameter are adjusted in a manner that tends to prevent increases in the modified pacing rate which compromise diastolic filling.
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Abstract
Described herein are methods and systems for delivering pacing therapy to HF patients who do not exhibit a reduced EF. Such patients do not have systolic dysfunction and generally do not benefit from established HF therapies that either augment contractile function or counteract conduction abnormalities. In one embodiment, a HF patient with a normal EF is tested for the adequacy of heart rate response during exercise. If the patient is found to be chronotropically incompetent, a rate-adaptive pacing mode is employed in order to improve functional capacity.
139 Citations
35 Claims
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1. A cardiac pacing system comprising:
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a sensing circuit to sense at least one cardiac signal; a pacing circuit to deliver pacing pulses; an exertion level sensor; a diastolic performance sensor to sense a signal indicative of a diastolic function that relates to how optimally the ventricles are filling with blood during diastole; a signal processor adapted to receive and process the signal indicative of the diastolic function, the signal processor including a diastolic performance parameter generator to produce a diastolic performance parameter based on the signal indicative of the diastolic function; a pacing controller coupled to the sensing circuit and the pacing circuit, the pacing controller being programmed to deliver paces with a rate-adaptive pacing mode based upon signals from the exertion level sensor wherein a rate-adaptive algorithm maps the exertion level signals to a modified pacing rate in accordance with a rate-response function; wherein the pacing controller is programmed to determine if diastolic filling is compromised by comparing the diastolic performance parameter with a specified threshold value; and wherein the pacing controller is further programmed to adjust one or more rate-adaptive pacing parameters that define the rate-response function if a comparison of the diastolic performance parameter with a specified threshold value indicates diastolic filling is compromised, wherein the one or more rate-adaptive pacing parameter are adjusted in a manner that tends to prevent increases in the modified pacing rate which compromise diastolic filling. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31)
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32. A method for treating a patient with diastolic heart failure, comprising:
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implanting a pacing system in the patient; programming the pacing system to deliver pacing therapy in a rate-adaptive mode wherein a rate-adaptive algorithm maps the exertion level signals to a modified pacing rate in accordance with a rate-response function; measuring a diastolic performance parameter during heart rate changes brought about by the rate-adaptive pacing therapy, wherein the diastolic performance parameter relates to how optimally the ventricles are filling with blood during diastole; determining if diastolic filling is compromised by comparing the diastolic performance parameter with a specified threshold value; and
,adjusting one or more rate-adaptive pacing parameters that define the rate-response function if a comparison of the diastolic performance parameter with a specified threshold value indicates diastolic filling is unduly compromised, wherein the one or more rate-adaptive pacing parameter are adjusted in a manner that tends to prevent increases in the modified pacing rate which compromise diastolic filling. - View Dependent Claims (33, 34, 35)
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Specification