Method and apparatus for cardiac protection pacing

• US 8,340,764 B2
• Filed: 02/17/2011
• Issued: 12/25/2012
• Est. Priority Date: 05/13/2005
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Baynham, Tamara Colette, Zhang, Yi, Pastore, Joseph M.
• Primary Examiner(s): Layno, Carl H.
• Assistant Examiner(s): MORALES, JON ERIC C
• Application Number:
  US13/029,631
• Publication Number:
  US 20110144709A1
• Time in Patent Office: 677 Days
• Field of Search: 607/9
• US Class Current: 607/9
• CPC Class Codes: A61N 1/3621 for treating or preventing abnormally high heart rate
• CPC Class Codes: A61N 1/36514 controlled by a physiological quantity other than heart potential, e.g. blood pressure controlled by two or more physical parameters A61N1/36585
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/36557 controlled by chemical substances in blood
• CPC Class Codes: A61N 1/36564 controlled by blood pressure
• CPC Class Codes: A61N 1/36578 controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters

Abstract

A pacing system delivers cardiac protection pacing to protect the heart from injuries associated with ischemic events. The pacing system detects an ischemic event and, in response, initiates one or more cardiac protection pacing sequences each including alternative pacing and non-pacing periods. In one embodiment, the pacing system initiates cardiac protection pacing sequences including at least one postconditioning sequence to protect the heart from a detected ischemic event and a plurality prophylactic preconditioning sequences to protect the heart from probable future ischemic events.

Claims

1. A method for delivering pacing pulses, the method comprising:

sensing one or more signals indicative of an ischemic event;

detecting the ischemic event from the one or more signals;

initiating one or more cardiac protection pacing sequences in response to the detection of the ischemic event, the one or more cardiac protection pacing sequences each including alternating pacing and non-pacing, periods, the pacing periods each having a pacing duration during which a plurality of pacing pulses is delivered, the nm-pacing periods each having a non-pacing duration during which no pacing pulse is delivered; and

delivering the plurality of pacing pulses during each of the pacing periods.

2. The method of claim 1, further comprising switching a pacing mode from a chronic pacing mode to a temporary pacing mode when one of the one or more cardiac protection pacing sequence is initiated and to switch the pacing mode from the temporary pacing mode to the chronic pacing mode when the one of the one or more cardiac protection pacing sequence is completed, the temporary pacing mode substantially different from the chronic pacing mode.

3. The method of claim 1, wherein the one or more cardiac protection pacing sequences comprises at least one postconditioning sequence, and further comprising initiating the at least one postconditioning sequence after an end of the ischemic event is detected.

4. The method of claim 3, wherein initiating the at least one postconditioning sequence comprises initiating the at least one postconditioning pacing sequence when a post-ischemia time interval expires, the post-ischemia time interval starting when the end of the ischemic event is detected and is up to approximately 10 minutes.

5. The method of claim 3, further comprising timing the at least one postconditioning sequence having a postconditioning sequence duration in a range of approximately 30 seconds to 1 hour and including alternating postconditioning pacing and non-pacing periods, the postconditioning pacing periods each having a postconditioning pacing duration in a range of approximately 5 seconds to 10 minutes during which the plurality of pacing pulses is delivered, the postconditioning non-pacing periods each having a postconditioning non-pacing duration in a range of approximately 5 seconds to 10 minutes during which no pacing pulse is delivered.

6. The method of claim 5, wherein the one or more cardiac protection pacing sequences further comprise a plurality of prophylactic preconditioning sequences, and further comprising initiating the prophylactic preconditioning sequences after the postconditioning sequence is completed.

7. The method of claim 6, wherein initiating the prophylactic preconditioning sequences comprises initiating the prophylactic preconditioning pacing sequences on a periodic basis using a predetermined period in a range of approximately 24 hours to 72 hours.

8. The method of claim 6, wherein initiating the prophylactic preconditioning sequences comprises initiating the prophylactic preconditioning pacing sequences in response to one or more preconditioning commands.

9. The method of claim 6, further comprising timing the plurality of prophylactic preconditioning pacing sequences each having a preconditioning sequence duration in a range of approximately 10 minutes to 1 hour and each including alternating preconditioning pacing and non-pacing periods, the preconditioning pacing periods each having a preconditioning pacing duration in a range of approximately 1 minute to 30 minutes during which the plurality of pacing pulses is delivered, the preconditioning non-pacing periods each having a preconditioning non-pacing duration in a range of approximately 1 minute to 30 minutes during which no pacing pulse is delivered.

10. The method of claim 1, further comprising:

detecting an arrhythmia; and

suspending the one or more cardiac protection pacing sequences when the arrhythmia is detected.

11. The method of claim 1, wherein sensing the one or more signals comprises sensing one or more cardiac signals, and detecting the ischemic event comprises detecting the ischemic event from the one or more cardiac signals.

12. The method of claim 11, wherein sensing the one or more cardiac signals comprises sensing surface biopotentials using multiple surface electrodes.

13. The method of claim 11, wherein sensing the one or more cardiac signals comprises sensing one or more subcutaneous electrocardiogram signals using subcutaneously implantable electrodes.

14. The method of claim 11, wherein sensing the one or more cardiac signals comprises sensing one or more electrogram signals using implantable endocardial or epicardial electrodes.

15. The method of claim 1, wherein sensing the one or more signals comprises sensing an impedance signal indicative of a cardiac impedance or transthoracic impedance, and detecting the ischemic event comprises detecting the ischemic event from the impedance signal.

16. The method of claim 1, wherein sensing the one or more signals comprises sensing a signal indicative of heart sounds, and detecting the ischemic event comprises detecting the ischemic event from the signal indicative of heart sounds.

17. The method of claim 1, wherein sensing the one or more signals comprises sensing a pressure signal indicative of a blood pressure, and detecting the ischemic event comprises detecting the ischemic event from the pressure signal.

18. The method of claim 1, wherein sensing the one or more signals comprises sensing an acceleration signal indicative of regional cardiac wall motion, and detecting the ischemic event comprises detecting the ischemic event from the acceleration signal.

19. The method of claim 1, wherein sensing the one or more signals comprises sensing a heart rate variability (HRV) signal indicative of an HRV parameter, and detecting the ischemic event comprises detecting the ischemic event from the HRV signal.

20. A method for operating an implantable medical device, the method comprising:

sensing one or more signals indicative of an ischemic event using the implantabie medical device;

detecting the ischemic event from the one or more signals using the implantable medical device;

initiating one or more cardiac protection pacing sequences in response to the detection of the ischemic event using the implantable medical device, the one or more cardiac protection pacing sequences each including alternating pacing and non-pacing periods, the pacing periods each having a pacing duration during which a plurality of pacing pulses is delivered, the non-pacing periods each having a non-pacing duration during which no pacing pulse is delivered; and

delivering the plurality of pacing pulses from the implantable medical device during each of the pacing periods.