Systems and methods for controlling neurostimulation of acupuncture sites using an implantable cardiac rhythm management device

• US 8,682,450 B2
• Filed: 07/31/2012
• Issued: 03/25/2014
• Est. Priority Date: 07/31/2012
• Status: Active Grant

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories)
• Inventors: Min, Xiaoyi, Rosenberg, Stuart, Farazi, Taraneh Ghaffari, Fayram, Timothy A.
• Primary Examiner(s): Koharski, Christopher D
• Assistant Examiner(s): CAREY, MICHAEL JAMES
• Application Number:
  US13/563,417
• Publication Number:
  US 20140039238A1
• Time in Patent Office: 602 Days
• Field of Search: 600/548, 607/116
• US Class Current: 607/116
• CPC Class Codes: A61B 5/0215 by means inserted into the body catheters A61M25/00
• CPC Class Codes: A61B 5/0538 invasively, e.g. using a catheter
• CPC Class Codes: A61B 5/14532 for measuring glucose, e.g. by tissue impedance measurement
• CPC Class Codes: A61B 5/283 Invasive
• CPC Class Codes: A61B 5/4818 Sleep apnoea
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61F 7/00 Heating or cooling appliances for medical or therapeutic treatment of the human body heating or cooling means in connection with bedsteads or mattresses A47C21/00 ; massage, therapeutic baths A61H; hyperthermia using electric or magnetic fields or ultrasound A61N; electric heating elements H05B
• CPC Class Codes: A61H 2201/5002 Means for controlling a set of similar massage devices acting in sequence at different locations on a patient
• CPC Class Codes: A61H 2230/045 used as a control parameter for the apparatus
• CPC Class Codes: A61H 2230/305 used as a control parameter for the apparatus A61H2230/045 takes precedence
• CPC Class Codes: A61H 39/002 Using electric currents electrotherapy A61N1/32
• CPC Class Codes: A61H 39/06 Devices for heating or cooling such points within cell-life limits cauterisers, moxaburners, cryogenic apparatus A61B18/06; heating or cooling appliances for medical treatment of general areas of the human body A61F7/00
• 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 1/3621 for treating or preventing abnormally high heart rate
• 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 1/39622 Pacing therapy
• CPC Class Codes: A61N 1/39624 Pain reduction therapy
• CPC Class Codes: A61N 2/02 using magnetic fields produced by coils, including single turn loops or electromagnets A61N2/12 takes precedence

Abstract

Techniques are provided for use with an implantable cardiac rhythm management (CRMD) system equipped to deliver neurostimulation to acupuncture sites within anterior regions of the neck, thorax or abdomen of the patient. Parameters associated with the health of the patient are detected, such as parameters indicative of arrhythmia, heart failure and hypertension.

Claims

1. A method for use with an implantable medical system for implant within a patient where the implantable medical system is equipped for neurostimulation, the system comprising:

detecting, with the implantable medical system, a parameter representative of one of more of;

heart failure;

arrhythmia;

atrial tachycardia/atrial fibrillation (AT/AF) burden;

hypertension;

Cheyne-Stokes respiration (CSR) sleep apnea;

cardiac ischemia; and

angina; and

in response to the detected parameter, delivering neurostimulation, via the implantable medical system, to one or more acupuncture sites within anterior regions of one or more of the neck, thorax and abdomen of the patient;

wherein if the detected parameter includes parameters representative of hypertension, the acupuncture sites for delivery of the neurostimulation includes one or more of acupuncture sites P1 and P2;

and further wherein if the detected parameter includes parameters representative of at least one of CSR and sleep apnea, the acupunctures sites for delivery of the neurostimulation includes one or more of acupuncture sites L1 and L2.

2. The method of claim 1 wherein neurostimulation is delivered to acupuncture sites that include one of more of:

H1, H2+, H2−

, L1, L2, P1 and P2.

3. The method of claim 1 wherein the detected parameters are representative of heart failure and wherein the acupuncture sites for delivery of the neurostimulation include one or more of H1, H2+ and H2−

sites.

4. The method of claim 3 wherein the parameters representative of heart failure include one or more of:

impedance parameters;

evoked response (ER) parameters;

intracardiac electrogram (IEGM) conduction delay parameters;

cardiogenic impedance (Zc) conduction delay parameters;

left atrial (LA) pressure;

pulmonary artery (PA) pressure;

or right ventricular (RV) pressure.

5. The method of claim 3 wherein the neurostimulation is delivered to achieve one or more of:

reverse modeling of the heart and mitigation of heart failure progression.

6. The method of claim 1 wherein the detected parameters are representative of arrhythmia and wherein the acupuncture sites for delivery of the neurostimulation include one or more of H1, H2+ and H2−

sites.

7. The method of claim 6 wherein the parameters representative of arrhythmia include one or more of:

AT parameters, AF parameters, ventricular fibrillation (VF) parameters, an AT/AF burden;

a premature atrial contraction (PAC) count;

a premature ventricular contraction (PVC) count;

a heart rate variability (HRV) value;

a heart rate turbulence (HRT) value;

a dispersion of conduction delays value; and

an antitachycardia pacing (ATP) success rate.

8. The method of claim 7 wherein the neurostimulation is delivered to achieve or more of:

prevention of an arrhythmia;

reduction of AT/AF burden; and

an improvement in ATP success rate.

9. The method of claim 1 wherein the parameters representative of hypertension include one or more of:

pulmonary artery pressure (PAP) values;

left atrial pressure (LAP) values; and

estimated PAP pressure derived from a maximum rate of change in right ventricular (RV) pressure (RV dP/dt max.)

10. The method of claim 1 wherein the neurostimulation is delivered to reduce hypertension.

11. The method of claim 1 wherein the parameters representative of at least one of CSR and sleep apnea include respiratory signals derived from impedance signals.

12. The method of claim 1 wherein the neurostimulation is delivered to achieve one or more of:

a reduction in CSR and a reduction in sleep apnea.

13. The method of claim 1 wherein the detected parameters are representative of one or more of cardiac ischemia and angina and wherein the acupuncture sites for delivery of the neurostimulation include one or more of the H1, H2+ and H2−

sites.

14. The method of claim 13 wherein the parameters representative of one or more of ischemia and angina include IEGM parameters.

15. The method of claim 13 wherein the neurostimulation is delivered to achieve one or more of:

a reduction in cardiac ischemia and a reduction in angina.

16. The method of claim 1 further including controlling the neurostimulation therapy in conjunction with delivery of therapeutic shocks.

17. The method of claim 16 wherein neurostimulation is controlled in to reduce shock pain using neurostimulation delivered at one or more of the H1, H2+ and H2−

acupuncture sites.

18. The method of claim 1 wherein the steps are performed by an implantable cardiac rhythm management device (CRMD) in conjunction within one or more implantable neurostimulation leads.

19. The method of claim 1 wherein the neurostimulation is delivered using one or more of:

a simultaneous stimulation pattern;

a sequential stimulation pattern;

or a combination of simultaneous and sequential stimulation patterns.

20. The method of claim 1 wherein the neurostimulation is delivered using one or more of:

electrical stimulation;

thermal stimulation; and

magnetic stimulation.

21. An implantable medical system for implant within a patient, the system comprising:

a neurostimulation lead system configured to deliver neurostimulation to one or more acupuncture sites within an anterior region of one or more of the neck, thorax and abdomen of the patient, the neurostimulation lead system including a percutaneous lead having three pairs of bipolar electrodes, with each pair at a different site;

a health parameter detection system operative to detect parameters representative of at least one of heart failure, arrhythmia, hypertension, diabetes and cardiac ischemia of the patient; and

a neurostimulation controller, operative in response to the detected parameter of the patient, to deliver neurostimulation to the one or more acupuncture sites using the neurostimulation lead system.

22. The implantable medical system of claim 21 wherein the implantable medical system includes a cardiac rhythm management device (CRMD) and wherein the health parameter detection system and the neurostimulation controller are components of the CRMD.

23. The system of claim 21 wherein the neurostimulation lead system includes two sternum (STN) leads with one implanted subcutaneously and the other implanted under the sternum.

24. The system of claim 21 wherein the neurostimulation lead system includes sternum (STN) leads implanted in pectoral regions of the patient.

25. The system of claim 21 wherein the neurostimulation lead system includes leads implanted in abdominal regions of the patient.

26. The system of claim 21 wherein the neurostimulation lead system includes surgical patches, the surgical patches being operable to generate paired current loops to induce magnetic field lines of force through selected stimulation sites for magnetic stimulation.