System and method for utilizing brain state information to modulate cardiac therapy

• US 8,214,035 B2
• Filed: 04/27/2007
• Issued: 07/03/2012
• Est. Priority Date: 12/17/2004
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Giftakis, Jonathon E., Graves, Nina M., Werder, Jonathan C., Panken, Eric J.
• Primary Examiner(s): Lavert, Nicole F
• Application Number:
  US11/796,575
• Publication Number:
  US 20070260286A1
• Time in Patent Office: 1,894 Days
• Field of Search: 607/6, 607/9, 600/301
• US Class Current: 607/9
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• CPC Class Codes: A61B 5/318 Heart-related electrical modalities, e.g. electrocardiography [ECG]
• CPC Class Codes: A61B 5/369 Electroencephalography [EEG] devices for psychotechnics A61B5/16
• CPC Class Codes: A61B 5/4094 Diagnosing or monitoring seizure diseases, e.g. epilepsy
• CPC Class Codes: A61N 1/365 controlled by a physiological parameter, e.g. heart potential evoked response A61N1/371
• CPC Class Codes: A61N 1/37288 Communication to several implantable medical devices within one patient

Abstract

A system for regulating or modulating cardiac therapy using brain state information. The modulation may include suppressing standard, prescribed cardiac therapy for a period of time or it may involve modulating the type of cardiac therapy delivered In another embodiment, a system is provided for determining whether a cardiac event is categorized as neurologically matched, and, if so, modulating the therapeutic output to the heart.

Claims

1. A medical device system comprising:

a brain monitoring element for sensing activity of the brain and outputting a brain signal based upon the sensed activity of the brain;

a cardiac monitoring element for sensing activity of the heart and outputting a cardiac signal based upon the sensed activity of the heart;

a cardiac therapy module for providing therapeutic output to the heart; and

a processor in communication with the brain monitoring element, the cardiac monitoring element and the cardiac therapy module, the processor configured to;

receive the cardiac signal and detect a cardiac event in the cardiac signal;

activate the cardiac therapy module to provide the therapeutic output to the heart based on the detected cardiac event;

determine if the detected cardiac event is categorized as a neurologically matched cardiac event, a neurologically matched cardiac event comprising a cardiac event occurring within a specified time period of one or more neurological events; and

communicate to the cardiac therapy module to modulate the therapeutic output to the heart if the detected cardiac event is categorized as a neurologically matched cardiac event.

2. The system of claim 1 wherein a neurologically matched cardiac event comprises a cardiac event followed in time by a neurological event.

3. The system of claim 1 wherein the modulation of the therapeutic output to the heart comprises temporarily suspending cardiac therapy to the heart for a period of time and resuming cardiac therapy if the cardiac event is still present after the period of time.

4. The system of claim 3 wherein the cardiac therapy is temporarily suspended for a period of seconds.

5. The system of claim 1 wherein a neurologically matched cardiac event comprises a cardiac event having a predetermined degree of concordance to one or more neurological events.

6. The medical system according to claim 1 wherein if the detected cardiac event is of a specified nature, communicating to the therapy module to not modulate the therapeutic output to the heart, regardless of whether the detected cardiac event is a neurologically matched cardiac event.

7. The medical device system of claim 6 wherein the specified nature of the detected cardiac event is selected from the group consisting of bradycardia, asystole, tachycardia, wandering pacemaker, multifocal atrial tachycardia, atrial fibrillation, sinus pause, premature atrial contractions (PAC), ST segment elevation, ST segment depression, T-wave inversion QT interval prolongation, premature ventricular contractions (PVCs), AV-block (AVB) and bundle branch block (BBB).

8. The medical system according to claim 6 wherein the specified nature of the detected cardiac event is its duration that exceeds a predetermined threshold.

9. The medical system according to claim 6 wherein the specified nature of the detected cardiac event is its intensity that exceeds a predetermined threshold.

10. The system of claim 1 wherein the modulation of the therapeutic output to the heart comprises preventative pacing for a period of time.

11. The system of claim 10 wherein the preventative pacing comprises increased pacing rate and/or decreased pacing intensity.

12. The system of claim 11 wherein the modulation occurs for a period of seconds.

13. The system of claim 10 wherein the period of time is programmable.

14. The medical device system of claim 1 wherein the processor is further configured to

receive the brain signal and obtain information identifying one or more neurological events in the brain signal,

receive the cardiac signal and obtain information identifying one or more cardiac events in the cardiac signal, and

compare the brain signal to the cardiac signal, the comparing comprising determining a degree of expectancy between the one or more identified neurological events and the one or more identified cardiac events.

15. The medical device system of claim 14 wherein obtaining information identifying one or more neurological events in the brain signal comprises execution of a neurological event detection algorithm that outputs an indication that a neurological event is occurring or is not occurring based on an evaluation of the brain signal.

16. The medical device system of claim 1 further comprising a body implantable housing, the housing containing the therapy module and the processor.

17. The medical device system of claim 14 wherein the processor is further configured to obtain information categorizing each identified cardiac event as one of a first type neurologically matched cardiac event and a second type neurologically matched cardiac event.

18. The medical device system of claim 17 wherein the first type cardiac event is selected from the group consisting of bradycardia, asystole, tachyarrhythmia, atrial fibrillation, sinus pause, premature atrial contractions (PAC), ST segment elevation, ST segment depression, T-wave inversion, QT interval prolongation, premature ventricular contractions (PVCs), AV-block (AVB) and bundle branch block (BBB), and the second type cardiac event is different from the first type of cardiac event.

19. The medical device system of claim 17 wherein comparing the brain signal to the cardiac signal performed by the processor further comprises:

categorizing a first type cardiac event as a first type neurologically matched cardiac event when there is a neurological event within a specified time period after the first type cardiac event;

categorizing a second type cardiac event as second type neurologically matched cardiac event when there is a neurological event within a specified time period after the second type cardiac event; and

wherein the processor is further configured to communicate to the cardiac therapy module to modulate the therapeutic output to the heart if the detected cardiac event is categorized as a first type neurologically matched cardiac event but not as a second type neurologically matched cardiac event.

20. A method of providing cardiac therapy to the heart, the method comprising the steps of:

providing a brain monitoring element for sensing activity of the brain and outputting a brain signal based upon the sensed activity of the brain;

providing a cardiac monitoring element for sensing activity of the heart and outputting a cardiac signal based upon the sensed activity of the heart;

providing a cardiac therapy module for delivering therapeutic output to the heart; and

providing a processor in communication with the brain monitoring element, the cardiac monitoring element and the cardiac therapy module, the processor configured to;

receive the cardiac signal and detect a cardiac event in the cardiac signal;

activate the cardiac therapy module to provide the therapeutic output to the heart based on the detected cardiac event;

determine if the detected cardiac event is categorized as a neurologically matched cardiac event, a neurologically matched cardiac event comprising a cardiac event occurring within a specified time period of one or more neurological events; and

communicate to the cardiac therapy module to modulate the therapeutic output to the heart if the detected cardiac event is categorized as a neurologically matched cardiac event.

21. A medical device system comprising:

a brain monitoring element for sensing activity of the brain and outputting a brain signal based upon the sensed activity of the brain;

a cardiac monitoring element for sensing activity of the heart and outputting a cardiac signal based upon the sensed activity of the heart;

a cardiac therapy module for providing therapeutic output to the heart; and

a processor in communication with the brain monitoring element, the cardiac monitoring element and the cardiac therapy module, the processor configured to;

receive the cardiac signal and detect a cardiac event in the cardiac signal;

activate the cardiac therapy module to provide the therapeutic output to the heart based on the detected cardiac event;

determine if the detected cardiac event is categorized as a neurologically matched cardiac event, a neurologically matched cardiac event comprising a cardiac event occurring within a specified time period of one or more neurological events; and

communicate to the cardiac therapy module to deliver the therapeutic output to the heart if the detected cardiac event is categorized as a neurologically matched cardiac event.