Cardiac function management integrating cardiac contractility modulation

• US 8,712,520 B2
• Filed: 09/16/2009
• Issued: 04/29/2014
• Est. Priority Date: 09/16/2008
• Status: Expired due to Fees

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Stahmann, Jeffrey E.
• Primary Examiner(s): Koharski, Christopher D
• Assistant Examiner(s): VOORHEES, CATHERINE M
• Application Number:
  US12/561,128
• Publication Number:
  US 20100069977A1
• Time in Patent Office: 1,686 Days
• Field of Search: 607 4- 5, 607/9, 607/14, 607 17- 19, 607/25
• US Class Current: 607/9
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/36185 Selection of the electrode configuration
• 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 1/3686 configured for selecting the electrode configuration on a lead A61N1/3688 takes precedence
• CPC Class Codes: A61N 1/37 Monitoring; Protecting
• CPC Class Codes: A61N 1/3706 Pacemaker parameters stimulation threshold A61N1/371
• CPC Class Codes: A61N 1/3708 for power depletion
• CPC Class Codes: A61N 1/3712 Auto-capture, i.e. automatic adjustment of the stimulation threshold
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

An implantable cardiac rhythm/function management system integrates cardiac contractility modulation (CCM) and one or more other therapies, such as to preserve device safety, improve efficacy, enhance sensing and detection, or enhance therapy effectiveness and delivery. Examples of the one or more other therapies can include pacing, defibrillation/cardioversion, cardiac resynchronization therapy (CRT), or neurostimulation.

Claims

1. An apparatus comprising:

an implantable cardiac rhythm/function management device comprising;

a cardiac contractility modulation (CCM) therapy circuit configured to deliver a CCM therapy including a non-stimulatory electrical energy during a refractory period of the heart;

a tachyarrhythmia circuit, configured to perform a tachyarrhythmia function comprising;

detecting a tachyarrhythmia using an intrinsic cardiac signal morphology analysis circuit configured to compare an intrinsic cardiac signal morphology to a CCM morphology template or a non-CCM morphology template; and

delivering tachyarrhythmia therapy; and

a controller circuit, coupled to the CCM therapy circuit and the tachyarrhythmia circuit, the controller circuit configured to obtain or provide information about the CCM therapy and information about the tachyarrhythmia therapy, the controller circuit configured to adjust at least one of the CCM therapy or the tachyarrhythmia therapy using the information obtained by the controller circuit including information about whether the other of the CCM therapy or the tachyarrhythmia therapy is being delivered or has been scheduled to be delivered, wherein the controller is configured to adjust a morphology analysis using information from the CCM therapy circuit about whether a CCM condition is present, the controller being configured to direct the intrinsic cardiac signal morphology analysis circuit to compare;

an intrinsic cardiac signal morphology to the CCM morphology template if a CCM condition is present;

or

an intrinsic cardiac signal morphology to the non-CCM morphology template if a CCM condition is not present.

2. The apparatus of claim 1, wherein the tachyarrhythmia circuit comprises a shock therapy circuit configured to deliver shock therapy;

and

wherein the controller circuit is configured to isolate the CCM therapy circuit from the shock therapy circuit during shock therapy delivery.

3. The apparatus of claim, 1 wherein a CCM condition is deemed present if (a) the CCM therapy has been delivered within a specified preceding time period or (b) the CCM therapy is enabled.

4. The apparatus of claim, 1 wherein the controller is configured such that, when the CCM therapy is enabled, the controller circuit is configured to select the CCM morphology template obtained with the CCM therapy having been enabled.

5. The apparatus of claim 1, comprising a user interface configured to receive user-input information about at least one of the tachyarrhythmia function or the CCM therapy.

6. The apparatus of claim 2, wherein the controller circuit is configured to isolate the CCM therapy circuit from the shock therapy circuit during shock therapy delivery by re-routing shock energy away from the CCM therapy circuit.

7. The apparatus of claim 6, comprising a zener diode configured to re-route the shock energy away from the CCM therapy circuit during shock therapy delivery.

8. An apparatus comprising:

an implantable cardiac rhythm/function management device comprising;

a cardiac contractility modulation (CCM) therapy circuit configured to deliver a CCM therapy including a non-stimulatory electrical energy during a refractory period of the heart;

a tachyarrhythmia circuit, configured to perform a tachyarrhythmia function comprising;

detecting a tachyarrhythmia using an intrinsic cardiac signal morphology analysis circuit configured to compare an intrinsic cardiac signal morphology to a CCM morphology template or a non-CCM morphology template; and

delivering tachyarrhythmia therapy; and

a controller circuit, coupled to the CCM therapy circuit and the tachyarrhythmia circuit, the controller circuit configured to obtain or provide information about the CCM therapy and information about the tachyarrhythmia therapy, the controller circuit configured to adjust at least one of the CCM therapy or the tachyarrhythmia therapy using the information obtained by the controller circuit including information about whether the other of the CCM therapy or the tachyarrhythmia therapy is being delivered or has been scheduled to be delivered;

wherein the tachyarrhythmia circuit comprises a shock therapy circuit configured to deliver shock therapy; and

wherein the controller circuit is configured to isolate the CCM therapy circuit from shock therapy circuit during shock therapy delivery; and

wherein the controller circuit is configured to adjust a morphology analysis using information about whether a CCM condition is present;

wherein a CCM condition is deemed present if (a) CCM has been delivered within a specified preceding time period or (b) CCM is enabled; and

wherein the controller circuit is configured to select a morphology template based on whether a CCM condition is present, the controller being configured to direct the intrinsic cardiac signal morphology analysis circuit to compare;

an intrinsic cardiac signal morphology to the CCM morphology template if a CCM condition is present;

or

an intrinsic cardiac signal morphology to the non-CCM morphology template if a CCM condition is not present.

9. The apparatus of claim 8, wherein the controller circuit is configured to isolate the CCM therapy circuit from the shock therapy circuit during shock therapy delivery by turning on a zener diode to re-route shock energy away from the CCM therapy circuit.

10. A method comprising:

delivering a cardiac contractility modulation (CCM) therapy, wherein delivering the CCM therapy comprises delivering a non-stimulatory electrical energy during a refractory period of the heart;

performing a tachyarrhythmia function comprising;

detecting a tachyarrhythmia using an intrinsic cardiac signal morphology analysis circuit; and

delivering tachyarrhythmia therapy; and

obtaining or providing information about the CCM therapy and information about the tachyarrhythmia therapy, the information obtained or provided by a controller circuit,

adjusting at least one of the CCM therapy or the tachyarrhythmia therapy using the information obtained by the controller circuit including information about whether the other of the CCM therapy or the tachyarrhythmia therapy is being delivered or has been scheduled to be delivered, wherein adjusting at least one of the CCM therapy or the tachyarrhythmia therapy includes adjusting a morphology analysis using information from the CCM therapy circuit about whether a CCM condition is present, wherein detecting the tachyarrhythmia includes comparing;

an intrinsic cardiac signal morphology to a CCM morphology template if a CCM condition is present;

or

an intrinsic cardiac signal morphology to a non-CCM morphology template if a CCM condition is not present.

11. The method of claim 10, wherein delivering tachyarrhythmia therapy comprises delivering shock therapy;

and

wherein adjusting at least one of the CCM therapy or the tachyarrhythmia function comprises isolating CCM therapy delivery from shock therapy delivery.

12. The method of claim 10, wherein a CCM condition is deemed present if (a) the CCM therapy has been delivered within a specified preceding time period or (b) the CCM therapy is enabled.

13. The method of claim 10, comprising, when the CCM therapy is enabled, selecting the CCM morphology template obtained with the CCM therapy having been enabled.

14. The method of claim 10, comprising providing information about at least one of the tachyarrhythmia function or the CCM therapy to a user interface configured to receive user-input information.

15. The method of claim 11, wherein isolating CCM therapy delivery from shock therapy delivery includes turning on a zener diode to re-route shock energy away from a CCM therapy circuit.