Apparatus for reversal of myocardial remodeling with pre-excitation
First Claim
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1. A cardiac pacing device, comprising:
- sensing and pulse generation circuitry for connecting to one or more sensing/pacing electrodes disposed in proximity to a stressed region of the myocardium;
an exertion level sensor;
a controller for controlling the delivery of pacing pulses;
wherein the controller is programmed to deliver pacing therapy to a first pacing site in a manner such that the stressed region of the myocardium is excited before other regions of the myocardium in order to subject the stressed region to less mechanical stress when the myocardium contracts;
wherein the controller is programmed to measure the patient'"'"'s exertion level with the exertion level sensor; and
,wherein the controller is programmed to alternate between a pulse output sequence that pre-excites the stressed region and a pulse output sequence that does not in accordance with the exertion level measurement such that pre-excitation of the stressed region is discontinued during periods of increased exertion.
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Abstract
An apparatus for reversing ventricular remodeling with electro-stimulatory therapy. A ventricle is paced by delivering one or more stimulatory pulses in a manner such that a stressed region of the myocardium is pre-excited relative to other regions in order to subject the stressed region to a lessened preload and afterload during systole. The unloading of the stressed myocardium over time effects reversal of undesirable ventricular remodeling.
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Citations
20 Claims
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1. A cardiac pacing device, comprising:
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sensing and pulse generation circuitry for connecting to one or more sensing/pacing electrodes disposed in proximity to a stressed region of the myocardium; an exertion level sensor; a controller for controlling the delivery of pacing pulses; wherein the controller is programmed to deliver pacing therapy to a first pacing site in a manner such that the stressed region of the myocardium is excited before other regions of the myocardium in order to subject the stressed region to less mechanical stress when the myocardium contracts; wherein the controller is programmed to measure the patient'"'"'s exertion level with the exertion level sensor; and
,wherein the controller is programmed to alternate between a pulse output sequence that pre-excites the stressed region and a pulse output sequence that does not in accordance with the exertion level measurement such that pre-excitation of the stressed region is discontinued during periods of increased exertion. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17)
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18. A system, comprising:
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an apparatus for identifying a stressed region of a patient'"'"'s myocardium; a pacing device with one or more electrodes including a pacing electrode for disposition at a first pacing site in proximity to the stressed region; wherein the pacing device is programmed to deliver pacing therapy to the first pacing site in a manner such that the stressed region of the myocardium is excited before other regions of the myocardium in order to subject the stressed region to less mechanical stress when the myocardium contracts; wherein the pacing device is programmed to measure the patient'"'"'s exertion level with an accelerometer or minute ventilation sensor; and
,wherein the pacing device is programmed to alternate between a pulse output sequence that pre-excites the stressed region and a pulse output sequence that does not in accordance with the exertion level measurement such that pre-excitation of the stressed region is discontinued during periods of increased exertion. - View Dependent Claims (19, 20)
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Specification