Systems and methods for reducing occurrences of atrial arrhythmias

• US 8,321,018 B2
• Filed: 02/14/2011
• Issued: 11/27/2012
• Est. Priority Date: 02/14/2011
• Status: Active Grant

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated), Cloud Packaging Equipment
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Inventors: Shkurovich, Sergio, Shelchuk, Anne M.
• Primary Examiner(s): MANUEL, GEORGE C
• Application Number:
  US13/027,174
• Publication Number:
  US 20120209345A1
• Time in Patent Office: 652 Days
• Field of Search: 607/23
• US Class Current: 607/23
• CPC Class Codes: A61B 2562/0247 Pressure sensors
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• CPC Class Codes: A61B 5/0215 by means inserted into the body catheters A61M25/00
• CPC Class Codes: A61B 5/053 Measuring electrical impedance or conductance of a portion of the body
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61B 5/6869 Heart
• CPC Class Codes: A61B 5/6876 Blood vessel
• CPC Class Codes: A61B 5/7275 Determining trends in physiological measurement data; Predicting development of a medical condition based on physiological measurements, e.g. determining a risk factor
• CPC Class Codes: A61N 1/3624 occurring in the atrium, i.e. atrial tachycardia
• CPC Class Codes: A61N 1/36564 controlled by blood pressure
• CPC Class Codes: A61N 1/3682 with a variable atrioventricular delay
• CPC Class Codes: A61N 1/3684 for stimulating the heart at multiple sites of the ventricle or the atrium
• CPC Class Codes: A61N 1/36842 Multi-site stimulation in the same chamber
• CPC Class Codes: A61N 1/36843 Bi-ventricular stimulation
• CPC Class Codes: G16H 20/30 relating to physical therapies or activities, e.g. physiotherapy, acupressure or exercising

Abstract

A method for reducing occurrences of atrial arrhythmias includes obtaining measures indicative of atrial pressure of a patient, and monitoring for a change in the measures indicative of atrial pressure that is indicative of an increased vulnerability to an atrial arrhythmia. In response to detecting the change in the measures indicative of atrial pressure that is indicative of the increased vulnerability to an atrial arrhythmia, pacing therapy that is adapted to reduce atrial pressure and thereby reduce vulnerability to an atrial arrhythmia is selectively delivered. Additionally, or alternatively, pacing therapy is adjusted to reduce atrial pressure and thereby reduce vulnerability to an atrial arrhythmia.

Claims

1. For use with an implantable system, a method for reducing occurrences of atrial arrhythmias, the method comprising:

(a) obtaining measures indicative of atrial pressure of a patient;

(b) monitoring for a change in the measures indicative of atrial pressure that is indicative of an increased vulnerability to an atrial arrhythmia wherein monitoring comprises monitoring atrial stretch based on the measures indicative of atrial pressure of the patient and detecting the increased vulnerability to an atrial arrhythmia when the monitored atrial stretch exceeds a corresponding threshold, or a change in the monitored atrial stretch exceeds a corresponding threshold; and

(c) in response to detecting the change in the measures indicative of atrial pressure that is indicative of the increased vulnerability to an atrial arrhythmia,

selectively delivering pacing therapy that is adapted to reduce atrial pressure and thereby reduce vulnerability to an atrial arrhythmia, and/or

adjusting pacing therapy to reduce atrial pressure and thereby reduce vulnerability to an atrial arrhythmia.

2. The method of claim 1, wherein detecting the increased vulnerability includes detecting that the monitored atrial stretch exceeds a corresponding threshold, or a change in the monitored atrial stretch exceeds a corresponding threshold, when one or more of the measures indicative of atrial pressure exceeds a corresponding threshold, or a change in the measures indicative of atrial pressure exceeds a corresponding threshold.

3. The method of claim 1, wherein step (b) includes detecting the increased vulnerability to an atrial arrhythmia when one or more of the measures indicative of atrial pressure exceeds a corresponding threshold, or a change in the measures indicative of atrial pressure exceeds a corresponding threshold.

4. The method of claim 1, wherein step (c) comprises selectively delivering pacing to overdrive the sinus rate, which reduces blood volume in the atria, and thereby reduces vulnerability to an atrial arrhythmia by reducing atrial stretch.

5. The method of claim 1, wherein step (c) comprises selectively delivering atrial overdrive pacing to reduce occurrences of ectopic atrial activity that might initiate an atrial arrhythmia, and thereby reduces vulnerability to an atrial arrhythmia.

6. The method of claim 1, further comprising:

once pacing therapy that is adapted to reduce atrial pressure is selectively initiated;

continue obtaining the measures indicative of atrial pressure of the patient; and

continue delivering the pacing therapy that is adapted to reduce atrial pressure until a further change in the measures indicative of atrial pressure is indicative of there no longer being an increased vulnerability to an atrial arrhythmia.

7. The method of claim 1, further comprising:

once pacing therapy that is adapted to reduce atrial pressure is selectively initiated;

continue obtaining the measures indicative of atrial pressure of the patient while delivering the pacing therapy that is adapted to reduce atrial pressure; and

using the measures indicative of atrial pressure as feedback to adjust pacing parameters associated with the pacing therapy and/or to switch to a different type of pacing therapy until a further change in the measures indicative of atrial pressure is indicative of there no longer being an increased vulnerability to an atrial arrhythmia.

8. The method of claim 1, wherein the measures indicative of atrial pressure obtained at step (a) are selected from the group consisting of:

(a.1) measures of left atrial pressure obtained from a pressure sensor implanted in the left atrium;

(a.2) measures of right atrial pressure obtained from a pressure sensor implanted in the right atrium;

(a.3) measures of pulmonary artery pressure that correlate with atrial pressure obtained from a pressure sensor implanted in the pulmonary artery;

(a.4) measures of right ventricular pressure that correlate with atrial pressure obtained from a pressure sensor implanted in the right ventricle; and

(a.5) measures of left ventricular pressure that correlate with atrial pressure obtained from a pressure sensor implanted in the left ventricle.

9. For use with an implantable system, a method for reducing occurrences of atrial arrhythmias, the method comprising:

(a) obtaining measures indicative of atrial pressure of a patient;

(b) monitoring for a change in the measures indicative of atrial pressure that is indicative of an increased vulnerability to an atrial arrhythmia; and

(c) in response to detecting the change in the measures indicative of atrial pressure that is indicative of the increased vulnerability to an atrial arrhythmia,

selectively delivering pacing therapy that is adapted to reduce atrial pressure and thereby reduce vulnerability to an atrial arrhythmia, and/or

adjusting pacing therapy to reduce atrial pressure and thereby reduce vulnerability to an atrial arrhythmia;

wherein step (c) comprises adjusting at least one of atrio-ventricular (AV) delay and interventricular (VV) delay, to increase the filling time in the ventricles, which reduces blood in the atria by increasing a volume of blood being moved out of the atria, and thereby reduces vulnerability to an atrial arrhythmia by reducing atrial stretch.

10. For use with an implantable system, a method for reducing occurrences of atrial arrhythmias, the method comprising:

(a) obtaining measures indicative of atrial pressure of a patient;

(b) monitoring for a change in the measures indicative of atrial pressure that is indicative of an increased vulnerability to an atrial arrhythmia; and

(c) in response to detecting the change in the measures indicative of atrial pressure that is indicative of the increased vulnerability to an atrial arrhythmia,

selectively delivering pacing therapy that is adapted to reduce atrial pressure and thereby reduce vulnerability to an atrial arrhythmia, and/or

adjusting pacing therapy to reduce atrial pressure and thereby reduce vulnerability to an atrial arrhythmia;

wherein step (c) comprises adjusting timing between pacing at different locations within at least one of the ventricles during delivery of multisite ventricular pacing, to increase the filling time in the ventricles, which reduces blood in the atria by increasing a volume of blood being moved out of the atria, and thereby reduces vulnerability to an atrial arrhythmia by reducing atrial stretch.

11. For use with an implantable system, a method for reducing occurrences of atrial arrhythmias, the method comprising:

(a) obtaining measures indicative of atrial stretch of a patient;

(b) monitoring for a change in the measures indicative of atrial stretch that is indicative of an increased vulnerability to an atrial arrhythmia; and

(c) in response to detecting the change in the measures indicative of atrial stretch that is indicative of the increased vulnerability to an atrial arrhythmia,

selectively delivering pacing therapy that is adapted to reduce atrial stretch and thereby reduce vulnerability to an atrial arrhythmia, and/or

adjusting pacing therapy to reduce atrial stretch and thereby reduce vulnerability to an atrial arrhythmia.

12. The method of claim 11, wherein:

step (a) includes obtaining measures indicative of atrial pressure of a patient, wherein the greater the measures indicative of atrial pressure the greater the atrial stretch; and

step (b) includes detecting the increased vulnerability to an atrial arrhythmia when at least one of the obtained measures indicative of atrial pressure exceeds a threshold, or a change in the measures indicative of atrial stretch exceeds a threshold.

13. An implantable system for reducing occurrences of atrial arrhythmias, comprising:

a sensor configured to obtain measures indicative of atrial pressure of a patient;

a monitor configured to monitor for a change in the measures indicative of atrial pressure that is indicative of an increased vulnerability to an atrial arrhythmia, wherein the monitor is adapted to monitor atrial stretch based on the measures indicative of atrial pressure of the patient, and detect the increased vulnerability to an atrial arrhythmia when the monitored atrial stretch exceeds a corresponding threshold, or a change in the monitored atrial stretch exceeds a corresponding threshold; and

a controller configured to control pacing therapy;

wherein in response to the monitor detecting the change in the measures indicative of atrial pressure that is indicative of an increased vulnerability to an atrial arrhythmia, the controller is configured to

selectively deliver pacing therapy that is adapted to reduce atrial pressure and thereby reduce vulnerability to an atrial arrhythmia, and/or

adjust pacing therapy to reduce atrial pressure and thereby reduce vulnerability to an atrial arrhythmia.

14. The system of claim 13, wherein the sensor is arrangeable at a site selected from the group consisting of:

the left atrium to obtain measures of left atrial pressure;

the right atrium to obtain measures of right atrial pressure;

the pulmonary artery to obtain measures of pulmonary artery pressure that correlate with atrial pressure;

the right ventricle to obtain measures of right ventricular pressure that correlate with atrial pressure; and

the left ventricle to obtain measures of left ventricular pressure that correlate with atrial pressure.

15. An implantable system for reducing occurrences of atrial arrhythmias, comprising:

a sensor configured to obtain measures indicative of atrial pressure of a patient;

a monitor configured to monitor for a change in the measures indicative of atrial pressure that is indicative of an increased vulnerability to an atrial arrhythmia; and

a controller configured to control pacing therapy;

wherein in response to the monitor detecting the change in the measures indicative of atrial pressure that is indicative of an increased vulnerability to an atrial arrhythmia, the controller is configured to selectively deliver pacing therapy that is adapted to reduce atrial pressure and thereby reduce vulnerability to an atrial arrhythmia, and/or adjust pacing therapy to reduce atrial pressure and thereby reduce vulnerability to an atrial arrhythmia;

wherein in response to the monitor detecting the change in the measures indicative of atrial pressure that is indicative of an increased vulnerability to an atrial arrhythmia, the controller is configured to;

selectively deliver pacing to overdrive the sinus rate, which reduces blood volume in the atria, and thereby reduces vulnerability to an atrial arrhythmia by reducing atrial stretch;

adjust at least one of atrio-ventricular (AV) delay and interventricular (VV) delay, to increase the filling time in the ventricles, which reduces blood in the atria by increasing a volume of blood being moved out of the atria, and thereby reduces vulnerability to an atrial arrhythmia by reducing atrial stretch;

adjust timing between pacing at different locations within at least one of the ventricles during delivery of multisite ventricular pacing, to increase the filling time in the ventricles, which reduces blood in the atria by increasing a volume of blood being moved out of the atria, and thereby reduces vulnerability to an atrial arrhythmia by reducing atrial stretch; and

/or

selectively deliver atrial overdrive pacing to reduce occurrences of ectopic atrial activity that might initiate an atrial arrhythmia, and thereby reduces vulnerability to an atrial arrhythmia.

16. An implantable system for reducing occurrences of atrial arrhythmias, comprising:

a sensor configured to obtain measures indicative of atrial stretch of a patient;

a monitor configured to monitor for a change in the measures indicative of atrial stretch that is indicative of an increased vulnerability to an atrial arrhythmia; and

a controller configured to control pacing therapy;

wherein in response to the monitor detecting the change in the measures indicative of atrial stretch that is indicative of an increased vulnerability to an atrial arrhythmia, the controller is configured to

selectively deliver pacing therapy that is adapted to reduce atrial pressure and thereby reduce vulnerability to an atrial arrhythmia, and/or

adjust pacing therapy to reduce atrial pressure and thereby reduce vulnerability to an atrial arrhythmia.

17. The system of claim 16, wherein:

the measures indicative of atrial stretch include measures indicative of atrial pressure of a patient, wherein the greater the measures indicative of atrial pressure the greater the atrial stretch; and

the monitor is configured to detect the increased vulnerability to an atrial arrhythmia when at least one of the obtained measures indicative of atrial pressure exceeds a threshold, or a change in the measures indicative of atrial stretch exceeds a threshold.

18. The system of claim 16, wherein the sensor is a pressure sensor arrangeable at a site selected from the group consisting of:

the left atrium to obtain measures of left atrial pressure;

the right atrium to obtain measures of right atrial pressure;

the pulmonary artery to obtain measures of pulmonary artery pressure that correlate with atrial pressure;

the right ventricle to obtain measures of right ventricular pressure that correlate with atrial pressure; and

the left ventricle to obtain measures of left ventricular pressure that correlate with atrial pressure.

19. The system of claim 16, wherein in response to the monitor detecting the change in the measures indicative of atrial stretch that is indicative of an increased vulnerability to an atrial arrhythmia, the controller is configured to:

selectively deliver pacing to overdrive the sinus rate, which reduces blood volume in the atria, and thereby reduces vulnerability to an atrial arrhythmia by reducing atrial stretch;

adjust at least one of atrio-ventricular (AV) delay and interventricular (VV) delay, to increase the filling time in the ventricles, which reduces blood in the atria by increasing a volume of blood being moved out of the atria, and thereby reduces vulnerability to an atrial arrhythmia by reducing atrial stretch;

adjust timing between pacing at different locations within at least one of the ventricles during delivery of multisite ventricular pacing, to increase the filling time in the ventricles, which reduces blood in the atria by increasing a volume of blood being moved out of the atria, and thereby reduces vulnerability to an atrial arrhythmia by reducing atrial stretch; and

/or

selectively deliver atrial overdrive pacing to reduce occurrences of ectopic atrial activity that might initiate an atrial arrhythmia, and thereby reduces vulnerability to an atrial arrhythmia.