Computer-implemented system and method for selecting therapy profiles of electrical stimulation of cervical vagus nerves for treatment of chronic cardiac dysfunction

• US 8,630,709 B2
• Filed: 12/07/2011
• Issued: 01/14/2014
• Est. Priority Date: 12/07/2011
• Status: Active Grant

• Current Assignee: LivaNova USA, Inc. (LivaNova Plc)
• Original Assignee: Cyberonics, Inc
• Inventors: Libbus, Imad, Amurthur, Badri, KenKnight, Bruce H.
• Primary Examiner(s): Koharski, Christopher D
• Assistant Examiner(s): CAREY, MICHAEL JAMES
• Application Number:
  US13/314,138
• Publication Number:
  US 20130158618A1
• Time in Patent Office: 769 Days
• Field of Search: 607/17, 607/9, 607/14, 607/45
• US Class Current: 607/17
• 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 1/37235 Aspects of the external programmer
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means

Abstract

A computer-implemented system and method for selecting therapy profiles of electrical stimulation of cervical vagus nerves for treatment of chronic cardiac dysfunction is provided. An external programmer includes a plurality of therapy profiles stored in memory. The therapy profiles include different sets of stimulation parameters that cooperatively define alternating cycles of stimuli application and stimuli inhibition for a neurostimulator that are tuned to both efferently activate the heart'"'"'s intrinsic nervous system and afferently activate the patient'"'"'s central reflexes. A programming wand is configured to provide the set of stimulation parameters chosen by the user to the neurostimulator through wireless telemetry. Finally, an implantable neurostimulator device includes a stimulation therapy lead terminated by helical electrodes and electrically coupled to the neurostimulator. The implantable neurostimulator is configured to therapeutically stimulate the cervical vagus nerve through the helical electrodes by triggering bi-directional action potentials as specified by the selected set of stimulation parameters.

Claims

1. A computer-implemented system for selecting therapy profiles of electrical stimulation of cervical vagus nerves for treatment of chronic cardiac dysfunction, comprising:

an external programmer, comprising;

a programming computer configured to execute using a processor program code that is stored in a recordable memory, comprising;

a plurality of therapy profiles stored in the recordable memory that each comprise different sets of stimulation parameters that cooperatively define alternating cycles of stimuli application and stimuli inhibition for a neurostimulator that are tuned to restore autonomic balance through continuously-cycling, intermittent and periodic electrical pulses simultaneously delivered at a periodic duty cycle in a range between 5% and 30%, at an intensity that avoids acute physiological side effects and with an unchanging cycle not triggered by physiological markers in a manner that results in creation and propagation (in both afferent and efferent directions) of action potentials within neuronal fibers comprising a cervical vagus nerve of a patient to both efferently activate the heart'"'"'s intrinsic nervous system and afferently activate the patient'"'"'s central reflexes; and

a user interface comprising input controls and a visual display and configured to display the therapy profiles to the patient and to select the set of stimulation parameters in the therapy profile chosen by the patient;

a programming wand interfaced to the programming computer and configured to provide the selected set of stimulation parameters to the neurostimulator through wireless telemetry; and

an implantable neurostimulator comprising a cervical vagus nerve stimulation therapy lead terminated by a pair of helical electrodes and electrically coupled to the neurostimulator, which is configured to therapeutically stimulate the patient'"'"'s cervical vagus nerve through the helical electrodes by creating and propagating the action potentials with a pulse generator as specified by the selected set of stimulation parameters stored in the recordable memory.

2. A system according to claim 1, wherein the programming computer further comprises:

a plurality of therapeutic levels stored in the recordable memory that each comprise a plurality of intensity settings for the set of stimulation parameters in each of the therapy profiles,

the user interface further configured to display the therapeutic levels to the user via the visual display and to modify the selected set of stimulation parameters based on the intensity setting in the therapeutic level chosen by the patient,

wherein the pulse generator is further configured to operate under the stimulation parameters stored in the recordable memory.

3. A system according to claim 1, wherein the cervical vagus nerve stimulation therapy lead comprises a connector pin electrically connected to the helical electrodes by an insulated electrical lead body and the neurostimulator is powered by a primary battery and enclosed in a hermetically sealed housing, further comprising:

an electrical receptacle comprised on an outer surface of the housing into which the connector pin is securely and electrically connected; and

the pulse generator configured to deliver electrical therapeutic stimulation to the patient'"'"'s cervical vagus nerve.

4. A system according to claim 1, wherein the neurostimulator further comprises an integrated leadless heart rate sensor configured to sense the patient'"'"'s heart rate during the alternating cycles of stimuli application and stimuli inhibition and to record the sensed heart rate as data into the recordable memory.

5. A system according to claim 1, the neurostimulator further comprising:

a programmable switch configured to alter the creation and propagation of the action potentials by the pulse generator in response to a magnetic signal received from outside the housing; and

the pulse generator further configured to trigger different modes stored in a recordable memory further comprising;

a stimulation magnet mode configured to trigger the delivery of electrical therapeutic stimulation by the pulse generator for a fixed period of time in response to the magnetic signal; and

an inhibition magnet mode configured to suspend the delivery of the electrical therapeutic stimulation by the pulse generator for a fixed period of time in response to the magnetic signal.

6. A system according to claim 1, wherein the pulse generator is further configured to adjust output current, signal frequency, pulse width, signal ON time, and signal OFF time.

7. A computer-implemented method for selecting therapy profiles of electrical stimulation of cervical vagus nerves for treatment of chronic cardiac dysfunction, comprising:

storing a plurality of therapy profiles in a recordable memory of a programming computer, each therapy profile comprising different sets of stimulation parameters that cooperatively define alternating cycles of stimuli application and stimuli inhibition for a neurostimulator that are tuned to restore autonomic balance through continuously-cycling, intermittent and periodic electrical pulses simultaneously delivered at a periodic duty cycle in a range between 5% and 30%, at an intensity that avoids acute physiological side effects and with an unchanging cycle not triggered by physiological markers in both afferent and efferent directions of a cervical vagus nerve to both efferently activate the heart'"'"'s intrinsic nervous method and afferently activate the patient'"'"'s central reflexes;

displaying the therapy profiles to the patient and retrieving the set of stimulation parameters in the therapy profile selected by the patient; and

providing the selected set of stimulation parameters to the neurostimulator through wireless telemetry,

wherein the neurostimulator is configured to therapeutically stimulate a cervical vagus nerve of the patient through a pair of helical electrodes by creating and propagating the action potentials with the pulse generator as specified by the selected set of stimulation parameters stored in the recordable memory.

8. A method according to claim 7, further comprising:

storing a plurality of therapeutic levels in the recordable memory, each therapeutic level comprising a plurality of intensity settings for the set of stimulation parameters in each of the therapy profiles; and

displaying the therapeutic levels to the patient on the visual display and modifying the selected set of stimulation parameters based on the intensity setting in the therapeutic level chosen by the patient,

wherein the pulse generator is further configured to operate under the stimulation parameters stored in the recordable memory.

9. A method according to claim 7, wherein the cervical vagus nerve stimulation therapy lead comprises a connector pin electrically connected to the helical electrodes by an insulated electrical lead body and the neurostimulator is powered by a primary battery and enclosed in a hermetically sealed housing, further comprising an electrical receptacle comprised on an outer surface of the housing into which the connector pin is securely and electrically connected and the pulse generator configured to deliver electrical therapeutic stimulation to the patient'"'"'s cervical vagus nerve.

10. A method according to claim 7, wherein the neurostimulator further comprises an integrated leadless heart rate sensor configured to sense the patient'"'"'s heart rate during the alternating cycles of stimuli application and stimuli inhibition and to record the sensed heart rate as data into the recordable memory.

11. A method according to claim 7, the neurostimulator further comprising:

a programmable switch configured to alter the creation and propagation of the action potentials by the pulse generator in response to a magnetic signal received from outside the housing; and

the pulse generator further configured to trigger different modes stored in a recordable memory further comprising;

a stimulation magnet mode configured to trigger the delivery of electrical therapeutic stimulation by the pulse generator for a fixed period of time in response to the magnetic signal; and

an inhibition magnet mode configured to suspend the delivery of the electrical therapeutic stimulation by the pulse generator for a fixed period of time in response to the magnetic signal.

12. A method according to claim 7, wherein the pulse generator is further configured to adjust output current, signal frequency, pulse width, signal ON time, and signal OFF time.

13. An implantable device for treatment of chronic cardiac dysfunction using select therapy profiles, comprising:

a cervical vagus nerve stimulation therapy lead, comprising;

a pair of helical electrodes configured to conform to an outer diameter of a cervical vagus nerve sheath of a patient; and

a set of connector pins electrically connected to the helical electrodes by an insulated electrical lead body; and

a neurostimulator powered by a primary battery and enclosed in a hermetically sealed housing, further comprising;

an electrical receptacle comprised on an outer surface of the housing into which the connector pins are securely and electrically coupled;

a recordable memory into which a therapy profile has been stored by an external programmer, the therapy profile comprising a set of stimulation parameters that cooperatively define alternating cycles of stimuli application and stimuli inhibition that are tuned to restore autonomic balance through continuously-cycling, intermittent and periodic electrical pulses simultaneously delivered at a periodic duty cycle in a range between 5% and 30%, at an intensity that avoids acute physiological side effects and with an unchanging cycle not triggered by physiological markers in a manner that results in creation and propagation (in both afferent and efferent directions) of action potentials within neuronal fibers comprising a cervical vagus nerve to both efferently activate the heart'"'"'s intrinsic nervous method and afferently activate the patient'"'"'s central reflexes; and

a pulse generator configured to therapeutically stimulate the patient'"'"'s cervical vagus nerve through the helical electrodes based on the set of stimulation parameters in the therapy profile stored in the recordable memory.

14. An implantable device according to claim 13, further comprising:

an integrated leadless heart rate sensor configured to sense the patient'"'"'s heart rate in response to the electrical therapeutic stimulation, wherein the pulse generator further configured to alter the creation and propagation of the action potentials in response to the sensed heart rate,

wherein the pulse generator is further configured to suspend the creation and propagation of the action potentials for a fixed period of time in response to the sensed heart rate, as sensed by the leadless heart rate sensors, falling below a lower bound of acceptable heart rates defined in the set of stimulation parameters, after which the creation and propagation of the action potentials resumes.

15. An implantable device according to claim 14, wherein the lower bound of the acceptable heart rates is expressed as at least one of a ratio, a percentile, a function, and discrete independent values with respect to the sensed heart rate, as sensed by the leadless heart rate sensors.

16. An implantable device according to claim 14, further comprising:

an integrated leadless heart rate sensor configured to sense the patient'"'"'s heart rate and to alter the creation and propagation of the action potentials in response to the sensed heart rate,

wherein the pulse generator is further configured to gradually down titrate the creation and propagation of the action potentials in response to the sensed heart rate, as sensed by the leadless heart rate sensors, falling below a lower bound of the acceptable heart rates defined in the set of stimulation parameters.

17. An implantable device according to claim 16, wherein the pulse generator is further configured to suspend the creation and propagation of the action potentials for a fixed period of time and gradually up titrate the creation and propagation of the action potentials after the down titration.

18. An implantable device according to claim 14, further comprising:

an integrated leadless heart rate sensor configured to sense the patient'"'"'s heart rate in response to the electrical therapeutic stimulation, wherein the pulse generator is further configured to alter the creation and propagation of the action potentials in response to the sensed heart rate,

wherein the pulse generator is further configured to gradually up titrate the creation and propagation of the action potentials in response to the sensed heart rate, as sensed by the leadless heart rate sensors, rising above an upper bound of the acceptable heart rates defined in the set of stimulation parameters.

19. An implantable device according to claim 18, wherein the upper bound of the acceptable heart rates is expressed as at least one of a ratio, a percentile, a function, and discrete independent values with respect to the sensed heart rate, as sensed by the leadless heart rate sensors.

20. An implantable device according to claim 13, wherein the pulse generator is further configured to adjust output current, signal frequency, pulse width, signal ON time, and signal OFF time.