System and method for decompensation detection and treatment based on patient hemodynamics

• US 8,423,140 B2
• Filed: 05/26/2010
• Issued: 04/16/2013
• Est. Priority Date: 06/01/2009
• Status: Expired due to Fees

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Maskara, Barun, Liu, Lili, Alvarez, Guy, Meyer, Scott A.
• Primary Examiner(s): DIETRICH, JOSEPH M
• Application Number:
  US12/787,630
• Publication Number:
  US 20100305649A1
• Time in Patent Office: 1,056 Days
• Field of Search: 607/9, 607/11, 607/17
• US Class Current: 607/9
• CPC Class Codes: A61N 1/36564 controlled by blood pressure

Abstract

A system and method for detecting and treating symptoms of early decompensation utilizing a cardiac rhythm management. The system applies an electrical stimulus to the patient'"'"'s heart at a first set of pacing parameters including a lower rate limit (LRL) setting, and acquires a coronary venous pressure (CVP) signal from a pressure sensor implanted in a coronary vein of the patient. An average coronary venous end diastolic pressure (CV-EDP) value is calculated from the CVP signal. The system monitors the average CV-EDP value over a predetermined interval, and dynamically adjusts the LRL setting responsive to the detection of a first or a second predetermined event based on the average CV-EDP value.

Claims

1. A method of operating an implanted cardiac rhythm management system in a patient, the method comprising:

applying an electrical stimulus to the patient'"'"'s heart at a first set of pacing parameters including an LRL setting;

acquiring a CVP signal from a pressure sensor implanted in a coronary vein of the patient;

calculating a baseline CV-EDP value from the CVP signal corresponding to a first interval;

monitoring average CV-EDP values over a predetermined time interval subsequent to the first interval;

comparing each of average CV-EDP values to the baseline CV-EDP value;

determining a difference (Δ

CV-EDP) between at least one of the average CV-EDP values and the baseline average CV-EDP value

automatically increasing the LRL setting in response to said difference (Δ

CV-EDP) between at least one of the average CV-EDP values and the baseline average CV-EDP value exceeding a predetermined threshold; and

subsequently automatically reducing the LRL setting upon detecting a predetermined event.

2. The method of claim 1 wherein the predetermined event includes the Δ

CV-EDP returning to below the predetermined threshold.

3. The method of claim 1 wherein the predetermined event is an expiration of a predetermined time period for applying the electrical stimulus at the increased LRL setting.

4. The method of claim 1 wherein the baseline CV-EDP value is a rolling average CV-EDP value over a plurality of cardiac cycles or a predetermined time interval.

5. The method of claim 1 further comprising recalculating the baseline CV-EDP value after reducing the LRL setting upon detecting the predetermined event.

6. The method of claim 1 wherein the predetermined threshold is a programmed percentage change in any of the plurality of average CV-EDP values relative to the baseline CV-EDP value.

7. The method of claim 1 monitoring average CV-EDP values includes generating a CVP waveform based on the CVP signal and calculating an average CV-EDP value over a predetermined interval based on the CVP waveform.

8. The method of claim 1 wherein the automatically increasing the LRL setting includes maintaining the LRL setting at the increased setting for a prescribed time interval.

9. The method of claim 8 further comprising increasing the LRL if the predetermined event is not detected after the prescribed time interval.

10. The method of claim 9 further comprising increasing the LRL up to a prescribed maximum LRL if the predetermined event is not detected after the prescribed time interval.