System and method for decompensation detection and treatment based on patient hemodynamics
First Claim
1. A method of operating an implanted cardiac rhythm management system in a patient, the method comprising:
- applying an electrical stimulus to the patient'"'"'s heart at a first set of pacing parameters including a lower rate limit (LRL) setting;
acquiring a coronary venous pressure (CVP) signal from a pressure sensor implanted in a coronary vein of the patient;
calculating an average coronary venous end diastolic pressure (CV-EDP) value from the CVP signal;
monitoring the average CV-EDP value, such monitoring including detecting an increase in the average CV-EDP value above a threshold indicative of decompensation and subsequently detecting a reduction in the average CV-EDP value below the threshold indicative of termination of the decompensation; and
dynamically adjusting the LRL setting based on the average CV-EDP value by increasing the LRL setting in response to detecting the increase in the average CV-EDP value above the threshold and reducing the LRL setting in response to detecting the reduction in the average CV-EDP value below the threshold.
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Abstract
A system and method for detecting and treating symptoms of early decompensation utilizing a cardiac rhythm management. The system applies an electrical stimulus to the patient'"'"'s heart at a first set of pacing parameters including a lower rate limit (LRL) setting, and acquires a coronary venous pressure (CVP) signal from a pressure sensor implanted in a coronary vein of the patient. An average coronary venous end diastolic pressure (CV-EDP) value is calculated from the CVP signal. The system monitors the average CV-EDP value over a predetermined interval, and dynamically adjusts the LRL setting responsive to the detection of a first or a second predetermined event based on the average CV-EDP value.
72 Citations
15 Claims
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1. A method of operating an implanted cardiac rhythm management system in a patient, the method comprising:
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applying an electrical stimulus to the patient'"'"'s heart at a first set of pacing parameters including a lower rate limit (LRL) setting; acquiring a coronary venous pressure (CVP) signal from a pressure sensor implanted in a coronary vein of the patient; calculating an average coronary venous end diastolic pressure (CV-EDP) value from the CVP signal; monitoring the average CV-EDP value, such monitoring including detecting an increase in the average CV-EDP value above a threshold indicative of decompensation and subsequently detecting a reduction in the average CV-EDP value below the threshold indicative of termination of the decompensation; and dynamically adjusting the LRL setting based on the average CV-EDP value by increasing the LRL setting in response to detecting the increase in the average CV-EDP value above the threshold and reducing the LRL setting in response to detecting the reduction in the average CV-EDP value below the threshold. - View Dependent Claims (2, 3, 4, 5, 6)
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7. An implantable rate adaptive cardiac rhythm management system configured for applying pacing stimuli to a patient'"'"'s heart, the pacing stimuli defined by pacing parameters including a pacing rate and an LRL setting, the system comprising:
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a plurality of implantable medical electrical leads configured to sense cardiac electrical activity and to deliver the pacing stimuli, at least one of the leads being configured for chronic implantation within a coronary vein of the patient'"'"'s heart and including a pressure sensor configured to generate a coronary venous pressure (CVP) signal indicative of fluid pressure within the coronary vein; an implantable pulse generator operatively coupled to the leads configured to generate the pacing stimuli, the pulse generator including a control system configured to; acquire the CVP signal from the pressure sensor; calculate an average coronary venous end diastolic pressure (CV-EDP) value from the CVP signal; monitor the calculated average CV-EDP value, such monitoring including detecting an increase in the average CV-EDP value indicative of decompensation symptoms and detecting a reduction in the average CV-EDP value indicative of termination of the decompensation symptoms; and dynamically adjust the LRL setting based on the calculated average CV-EDP value by increasing the LRL setting in response to detecting the increase in the average CV-EDP value, maintaining the LRL setting at the increased setting for a prescribed time interval, and further increasing the LRL setting if the reduction in the average CV-EDP value is not detected during the prescribed time interval. - View Dependent Claims (8, 9, 10, 11)
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12. An implantable rate adaptive cardiac rhythm management system configured for applying pacing stimuli to a patient'"'"'s heart, the pacing stimuli defined by pacing parameters including a LRL setting, the system comprising:
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a pressure sensor configured for chronic implantation within a coronary vein of the patient'"'"'s heart to generate a coronary venous pressure (CVP) signal indicative of fluid pressure within the coronary vein; and an implantable pulse generator operatively coupled to the pressure sensor and configured to generate a pacing stimuli, the pulse generator including a control system configured to; acquire the CVP signal from the pressure sensor; calculate an average coronary venous end diastolic pressure (CV-EDP) value from the CVP signal; monitor the calculated average CV-EDP value, such monitoring including detecting an increase in the average CV-EDP value above a threshold indicative of decompensation symptoms and detecting a reduction in the average CV-EDP value below the threshold; and dynamically adjust the LRL setting based on the calculated average CV-EDP value by increasing the LRL setting in response to detecting the increase in the average CV-EDP value above the threshold and reducing the LRL setting in response to detecting the reduction in the average CV-EDP value below the threshold. - View Dependent Claims (13, 14, 15)
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Specification