Neural stimulation modulation based on monitored cardiovascular parameter

• US 8,442,640 B2
• Filed: 01/04/2010
• Issued: 05/14/2013
• Est. Priority Date: 12/24/2003
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Libbus, Imad
• Primary Examiner(s): Layno, Carl H
• Assistant Examiner(s): Sarcione, Jessica
• Application Number:
  US12/651,515
• Publication Number:
  US 20100106226A1
• Time in Patent Office: 1,226 Days
• Field of Search: 607/9, 607 17- 27, 607/44, 607/62
• US Class Current: 607/44
• CPC Class Codes: A61N 1/36053 adapted for vagal stimulation A61N1/36114 takes precedence
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/36117 for treating hypertension
• CPC Class Codes: A61N 1/36139 with automatic adjustment
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• 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 1/37235 Aspects of the external programmer

Abstract

An aspect relates to a system for providing baroreflex stimulation. An embodiment of the system comprises a heart rate monitor to sense a heart rate and provide a signal indicative of the heart rate, and a baroreflex stimulator. The stimulator includes a pulse generator to intermittently generate a stimulation signal to provide baroreflex stimulation for a baroreflex therapy, and further includes a modulator to adjust the stimulation signal based on the signal indicative of the heart rate such that the stimulation signal provides a desired baroreflex stimulation corresponding to a desired heart rate.

Claims

1. A method implemented by an implantable medical device, comprising:

generating a stimulation signal in a recurring succession of stimulation cycles and stimulating an autonomic neural target using the generated stimulation signal, wherein generating the stimulation signal includes generating the stimulation signal for a portion of each stimulation cycle and not generating the stimulation signal for another portion of each stimulation cycle, wherein stimulation of the autonomic neural target affects a cardiovascular parameter;

using a physiological sensor to obtain a first value for a cardiovascular feedback parameter corresponding to the portion of each cycle when the stimulation cycle is generated and a second value corresponding to the other portion of each cycle when the stimulation cycle is not generated;

determining a detected feedback change between the portions of the stimulation cycle, wherein determining the feedback change includes comparing the first value to the second value;

comparing the detected feedback change to a target change to provide a comparison result; and

adjusting the stimulation signal using the comparison result.

2. The method of claim 1, wherein adjusting the stimulation signal using the comparison result includes continuously adjusting the stimulation signal during the portion of each cycle when the stimulation cycle is generated until the detected feedback change reaches the target change.

3. The method of claim 1, wherein adjusting the stimulation signal using the comparison result includes making an adjustment in subsequent periods until the detected feedback change reaches the target change.

4. The method of claim 1, further comprising adjusting the target change using a circadian rhythm.

5. The method of claim 1, further comprising detecting an adverse event, and adjusting the target change in response to detecting the adverse event.

6. The method of claim 5, wherein the adverse event includes a ventricular fibrillation, and atrial fibrillation, a ventricular tachycardia or an atrial tachycardia.

7. The method of claim 5, wherein the adverse event includes dyspnea.

8. The method of claim 5, wherein the adverse event includes angina.

9. The method of claim 5, wherein the adverse event includes decompensation.

10. The method of claim 5, wherein the adverse event includes ischemia.

11. The method of claim 1, further comprising detecting activity, and adjusting the target change using the detected activity.

12. The method of claim 1, wherein stimulating the autonomic neural target using the generated stimulation signal includes providing efficacious stimulation to prevent remodeling of cardiac tissue or efficacious stimulation to reverse remodel cardiac tissue.

13. The method of claim 1, wherein the target change is a programmed target change.

14. The method of claim 1, wherein a programmed algorithm determines the target change.

15. The method of claim 1, wherein the at least one cardiovascular feedback parameter includes heart rate.

16. The method of claim 1, wherein the at least one cardiovascular feedback parameter includes blood pressure.

17. The method of claim 1, wherein the at least one cardiovascular feedback parameter includes respiration.

18. The method of claim 1, wherein the autonomic neural target includes a baroreflex target, wherein stimulating the baroreflex target induces a baroreflex response.

19. A system for providing neural stimulation, comprising:

a neural stimulator, including;

a pulse generator configured to chronically deliver an intermittent neural stimulation therapy, the pulse generator to generate a stimulation signal in a recurring succession of stimulation cycles to provide the intermittent neural stimulation where each stimulation cycle has a “

stimulation on”

portion and a “

stimulation off”

portion; and

a modulator to adjust the stimulation signal;

a cardiovascular parameter monitor configured to monitor a cardiovascular parameter and provide a first value indicative of the cardiovascular parameter during the “

stimulation on”

portion and a second value indicative of the cardiovascular parameter during the “

stimulation off”

portion; and

a comparator configured to compare the first and second values to provide a detected change for the cardiovascular parameter and to compare the detected change to a target change for the cardiovascular parameter to provide a therapy control signal, wherein the modulator uses the therapy control signal to adjust the stimulation signal in a manner to cause the detected change to reach the target change.

20. The system of claim 19, wherein adjusting the stimulation signal using the comparison result includes continuously adjusting the stimulation signal during the portion of each cycle when the stimulation cycle is generated until the detected feedback change reaches the target change.

21. The system of claim 19, wherein adjusting the stimulation signal using the comparison result includes making an adjustment in subsequent periods until the detected feedback change reaches the target change.

22. The system of claim 19, wherein the system is configured to adjust the target change using a circadian rhythm, or using detected activity, or in response to a detected adverse event.

23. The system of claim 19, wherein the system includes a programmed target change or a programmed algorithm to determine the target change.

24. The system of claim 19, wherein the cardiovascular parameter monitor is configured to monitor heart rate, blood pressure or respiration.