Baroreflex stimulation synchronized to circadian rhythm

• US 8,818,513 B2
• Filed: 03/01/2012
• Issued: 08/26/2014
• Est. Priority Date: 12/24/2003
• Status: Expired due to Fees

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Libbus, Imad
• Primary Examiner(s): Heller, Tammie K
• Application Number:
  US13/410,013
• Publication Number:
  US 20120165888A1
• Time in Patent Office: 908 Days
• Field of Search: 607/23, 607/44
• US Class Current: 607/44
• CPC Class Codes: A61N 1/3601 of respiratory organs
• 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 1/3614 based on impedance measurement
• CPC Class Codes: A61N 1/36564 controlled by blood pressure

Abstract

An embodiment of a baroreflex stimulator comprises a pulse generator to provide a baroreflex stimulation signal through an electrode, and a modulator to modulate the baroreflex stimulation signal based on a circadian rhythm template. According to an embodiment of a method for operating an implantable medical device, comprising a baroreflex stimulation therapy is applied at a stimulation intensity using a baroreflex stimulator in the implantable medical device, and the baroreflex stimulation therapy is modulated based on a circadian rhythm template stored within the implantable medical device. Modulating the baroreflex stimulation therapy includes using the circadian rhythm template to change the stimulation intensity to mimic natural blood pressure fluctuations during the day.

Claims

1. An implantable medical system for treating a patient, the system comprising:

a pulse generator configured to generate stimulation for a baroreflex therapy;

a sensor configured to sense a physiologic parameter for monitoring a physiological response to the baroreflex therapy, wherein the pulse generator is configured to use the monitored physiological response to control generation of the stimulation for the baroreflex therapy to achieve a target physiological response to the baroreflex therapy;

a circadian rhythm template storage with a circadian rhythm template stored therein, wherein the template reflects natural fluctuations throughout a day in the physiologic parameter; and

a modulator configured to use the circadian rhythm template to change the target physiological response to the baroreflex stimulation therapy to mimic the natural fluctuations in the physiologic parameter of the patient throughout the day.

2. The system of claim 1, wherein the sensor configured to sense a physiologic parameter for monitoring a physiological response to the baroreflex therapy is configured to sense a blood pressure of the patient.

3. The system of claim 1, wherein the sensor configured to sense a physiologic parameter for monitoring a physiological response to the baroreflex therapy is configured to sense a heart rate of the patient.

4. The system of claim 1, wherein the sensor configured to sense a physiologic parameter for monitoring a physiological response to the baroreflex therapy is configured to sense automatic nervous system activity of the patient.

5. The system of claim 1, wherein the sensor configured to sense a physiologic parameter for monitoring a physiological response to the baroreflex therapy is configured to sense a respiration of the patient.

6. The system of claim 1, wherein the circadian rhythm template reflects natural fluctuations throughout the day in a parameter selected from a group of parameters consisting of:

a blood pressure parameter, a respiration parameter, a heart rate parameter, and an automatic nervous system activity parameter.

7. The system of claim 1, wherein the system is configured to deliver the stimulation to a neural stimulation site selected from the group of neural stimulation sites consisting of:

a vagus nerve, a carotid sinus baroreceptor region, and a carotid sinus nerve.

8. The system of claim 1, wherein the system is configured to detect and respond to an adverse event, and modulate the response to the adverse event using the circadian rhythm template.

9. The system of claim 1, wherein the system is configured to control cardiac output using the circadian rhythm template.

10. The system of claim 1, wherein the system includes an implantable neural stimulator and an implantable cardiac rhythm management (CRM) device, wherein the neural stimulator includes the pulse generator and the CRM device includes the sensor.

11. A method for delivering a baroreflex therapy, the method comprising:

sensing a physiologic parameter for monitoring a physiological response to the baroreflex therapy;

stimulating a neural stimulation target, based on the monitored physiological response, to achieve a target physiological response to the baroreflex therapy; and

modulating the target physiological response to the baroreflex therapy, based on a circadian rhythm template that reflects natural fluctuations throughout a day in the physiologic parameter, to change the target physiological response to the baroreflex stimulation therapy to mimic the natural fluctuations in the physiologic parameter of the patient throughout the day.

12. The method of claim 11, wherein sensing a physiologic parameter for monitoring a physiological response to the baroreflex therapy comprises sensing a blood pressure of the patient.

13. The method of claim 11, wherein sensing a physiologic parameter for monitoring a physiological response to the baroreflex therapy comprises sensing a heart rate of the patient.

14. The method of claim 11, wherein sensing a physiologic parameter for monitoring a physiological response to the baroreflex therapy comprises sensing automatic nervous system activity of the patient.

15. The method of claim 11, wherein sensing a physiologic parameter for monitoring a physiological response to the baroreflex therapy comprises sensing a respiration of the patient.

16. The method of claim 11, wherein the circadian rhythm template reflects natural fluctuations throughout the day in a parameter selected from a group of parameters consisting of:

a blood pressure parameter, a respiration parameter, a heart rate parameter, and an automatic nervous system activity parameter.

17. The method of claim 11, wherein stimulating a neural stimulation target includes stimulating a vagus nerve.

18. The method of claim 11, wherein stimulating a neural stimulation target includes stimulating a baroreceptor region.

19. The method of claim 18, wherein the baroreceptor region includes a carotid sinus baroreceptor region.

20. The method of claim 11, wherein stimulating a neural stimulation target includes stimulating a carotid sinus nerve.

21. The method of claim 11, further comprising:

detecting and responding to an adverse event; and

modulating the response to the adverse event using the circadian rhythm template.

22. The method of claim 11, further comprising controlling cardiac output using the circadian rhythm template.

23. The method of claim 11, wherein sensing the physiologic parameter includes using an implantable cardiac rhythm management (CRM) device to sense the physiologic parameter.