Method and apparatus for delivering chronic and post-ischemia cardiac therapies
First Claim
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1. A system for pacing a heart having an ischemic region, the system comprising:
- an implantable medical device including;
a sensing circuit configured to sense one or more ischemia-indicating signals and one or more therapy-monitoring signals;
an ischemia detector coupled to the sensing circuit, the ischemic detector configured to detect an ischemic state indicative of an occurrence of an ischemic event from the one or more ischemia-indicating signals;
a therapy delivery device configured to deliver a chronic therapy and a post-ischemia therapy, the therapy delivery device including a pacing circuit configured to deliver pacing pulses to the heart during the chronic therapy and the post-ischemia therapy;
a therapy monitor coupled to the sensing circuit, the therapy monitor configured to produce one or more therapy-monitoring parameters using the one or more therapy-monitoring signals, the one or more therapy-monitoring parameters including at least one post-ischemia therapy-monitoring parameter indicative of effectiveness of the post-ischemia therapy and at least one chronic therapy-monitoring parameter indicative of effectiveness of the chronic therapy; and
a controller coupled to the ischemia detector, the therapy delivery device, and the therapy monitor, the controller including;
a post-ischemia therapy controller configured to initiate the delivery of the post-ischemia therapy in response to the occurrence of the ischemic event as indicated by the detected ischemic state and to adjust the delivery of the post-ischemia therapy using the detected ischemic state and the at least one post-ischemia therapy-monitoring parameter, the post-ischemic therapy controller including a post-ischemic pacing controller configured to adjust one or more regional pacing parameters of the post-ischemia pacing therapy to provide pre-excitation of the ischemic region to reduce stress and workload of the ischemic region in response to the occurrence of the ischemic event; and
a chronic therapy controller configured to adjust the delivery of the chronic therapy using the detected ischemic state and the at least one chronic therapy-monitoring parameter, the chronic therapy controller including a chronic pacing controller configured to adjust one or more global pacing parameters of the chronic therapy to reduce overall workload on the heart in response to the occurrence of the ischemic event.
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Abstract
An implantable cardiac rhythm management (CRM) device delivers a chronic therapy while detecting an ischemic state. When the ischemic state indicates the occurrence of an ischemic event, the implantable CRM device delivers a post-ischemia therapy. The post-ischemia therapy and the chronic therapy are adjusted using feedback control with the ischemic state and parameters indicative of the effectiveness of the post-ischemic therapy and the effectiveness of the chronic therapy as inputs.
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Citations
20 Claims
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1. A system for pacing a heart having an ischemic region, the system comprising:
an implantable medical device including; a sensing circuit configured to sense one or more ischemia-indicating signals and one or more therapy-monitoring signals; an ischemia detector coupled to the sensing circuit, the ischemic detector configured to detect an ischemic state indicative of an occurrence of an ischemic event from the one or more ischemia-indicating signals; a therapy delivery device configured to deliver a chronic therapy and a post-ischemia therapy, the therapy delivery device including a pacing circuit configured to deliver pacing pulses to the heart during the chronic therapy and the post-ischemia therapy; a therapy monitor coupled to the sensing circuit, the therapy monitor configured to produce one or more therapy-monitoring parameters using the one or more therapy-monitoring signals, the one or more therapy-monitoring parameters including at least one post-ischemia therapy-monitoring parameter indicative of effectiveness of the post-ischemia therapy and at least one chronic therapy-monitoring parameter indicative of effectiveness of the chronic therapy; and a controller coupled to the ischemia detector, the therapy delivery device, and the therapy monitor, the controller including; a post-ischemia therapy controller configured to initiate the delivery of the post-ischemia therapy in response to the occurrence of the ischemic event as indicated by the detected ischemic state and to adjust the delivery of the post-ischemia therapy using the detected ischemic state and the at least one post-ischemia therapy-monitoring parameter, the post-ischemic therapy controller including a post-ischemic pacing controller configured to adjust one or more regional pacing parameters of the post-ischemia pacing therapy to provide pre-excitation of the ischemic region to reduce stress and workload of the ischemic region in response to the occurrence of the ischemic event; and a chronic therapy controller configured to adjust the delivery of the chronic therapy using the detected ischemic state and the at least one chronic therapy-monitoring parameter, the chronic therapy controller including a chronic pacing controller configured to adjust one or more global pacing parameters of the chronic therapy to reduce overall workload on the heart in response to the occurrence of the ischemic event. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10)
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11. A method for pacing a heart having an ischemic region, the method comprising:
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delivering a chronic therapy including a chronic pacing therapy; sensing one or more ischemia-indicating signals and one or more therapy-monitoring signals; detecting an ischemic state indicative of an occurrence of an ischemic event from the one or more ischemia-indicating signals; initiating delivery of a post-ischemia therapy including a post-ischemia pacing therapy in response to the occurrence of the ischemic event as indicated by the detected ischemic state; producing one or more therapy-monitoring parameters from the one or more therapy-monitoring signals, the one or more therapy-monitoring parameters including at least one chronic therapy-monitoring parameter indicative of effectiveness of the chronic therapy and at least one post-ischemia therapy-monitoring parameter indicative of effectiveness of the post-ischemia therapy; and adjusting the delivery of the chronic therapy using the detected ischemic state and the at least one chronic therapy-monitoring parameter and the delivery of the post-ischemia therapy using the detected ischemic state and the at least one post-ischemia therapy-monitoring parameter, including adjusting one or more global pacing parameters of the chronic pacing therapy to reduce overall workload on the heart in response to the occurrence of the ischemic event and adjusting one or more regional pacing parameters of the post-ischemia pacing therapy to provide pre-excitation of the ischemic region to reduce stress and workload of the ischemic region in response to the occurrence of the ischemic event. - View Dependent Claims (12, 13, 14, 15, 16, 17, 18, 19, 20)
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Specification