Method and apparatus for safe and efficient delivery of cardiac stress augmentation pacing
First Claim
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1. A cardiac pacing system, comprising:
- a pacing output circuit adapted to deliver pacing pulses; and
a pacing control circuit coupled to the pacing output circuit and adapted to control the delivery of the pacing pulses, the pacing control circuit including;
a memory circuit storing a delivery schedule specifying timing for initiating stress augmentation pacing sessions each including a session duration during which the pacing pulses are delivered using pacing parameters selected to augment myocardial mechanical stress to a level effecting cardioprotection against myocardial injury or deterioration by increasing a degree of ventricular asynchrony;
wherein the delivery schedule is programmed to specify the stress augmentation pacing sessions to be delivered on a periodic basis at a session frequency between approximately 1 and 12 sessions each day and each including alternating non-pacing and pacing periods, the non-pacing periods each having a non-pacing duration during which no pacing pulse is timed to be delivered, the pacing periods each having a specified pacing duration during which a plurality of the pacing pulses is timed to be delivered using pacing parameters selected to augment myocardial mechanical stress to the level effecting cardioprotection against myocardial injury or deterioration;
an inhibitory signal input to receive an inhibitory signal indicative of detection of an event potentially reducing effectiveness of stress augmentation pacing during each of the stress augmentation pacing sessions; and
a stress augmentation pacing controller coupled to the memory circuit and the inhibitory signal input, the stress augmentation pacing controller programmed to initiate each of the stress augmentation pacing sessions according to the delivery schedule if the inhibitory signal is not present at a scheduled beginning of the each of the stress augmentation pacing sessions and modify the delivery schedule by rescheduling one or more of the stress augmentation pacing sessions if the inhibitory signal is present at the scheduled beginning of the each of the stress augmentation pacing sessions.
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Abstract
A cardiac pacing system controls the progression of a cardiac disorder such as heart failure by delivering cardiac stress augmentation pacing to create or augment regional stress in the heart according to a delivery schedule programmed for a patient. Various events associated with the patient'"'"'s conditions, activities, and other treatments may render the cardiac stress augmentation pacing risky or ineffective. The system detects such events before and during each cardiac stress augmentation pacing session and modifies the delivery schedule in response to the detection of each event to ensure patient safety and therapy efficiency.
226 Citations
21 Claims
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1. A cardiac pacing system, comprising:
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a pacing output circuit adapted to deliver pacing pulses; and a pacing control circuit coupled to the pacing output circuit and adapted to control the delivery of the pacing pulses, the pacing control circuit including; a memory circuit storing a delivery schedule specifying timing for initiating stress augmentation pacing sessions each including a session duration during which the pacing pulses are delivered using pacing parameters selected to augment myocardial mechanical stress to a level effecting cardioprotection against myocardial injury or deterioration by increasing a degree of ventricular asynchrony;
wherein the delivery schedule is programmed to specify the stress augmentation pacing sessions to be delivered on a periodic basis at a session frequency between approximately 1 and 12 sessions each day and each including alternating non-pacing and pacing periods, the non-pacing periods each having a non-pacing duration during which no pacing pulse is timed to be delivered, the pacing periods each having a specified pacing duration during which a plurality of the pacing pulses is timed to be delivered using pacing parameters selected to augment myocardial mechanical stress to the level effecting cardioprotection against myocardial injury or deterioration;
an inhibitory signal input to receive an inhibitory signal indicative of detection of an event potentially reducing effectiveness of stress augmentation pacing during each of the stress augmentation pacing sessions; anda stress augmentation pacing controller coupled to the memory circuit and the inhibitory signal input, the stress augmentation pacing controller programmed to initiate each of the stress augmentation pacing sessions according to the delivery schedule if the inhibitory signal is not present at a scheduled beginning of the each of the stress augmentation pacing sessions and modify the delivery schedule by rescheduling one or more of the stress augmentation pacing sessions if the inhibitory signal is present at the scheduled beginning of the each of the stress augmentation pacing sessions. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11)
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12. A method for operating a cardiac pacing system, comprising:
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determining whether an inhibitory signal is present before initiating each of stress augmentation pacing sessions according to a delivery schedule using an implantable medical device, the inhibitory signal indicative of detection of an event potentially reducing effectiveness of stress augmentation pacing during the each of stress augmentation pacing sessions, the stress augmentation pacing sessions each including a session duration during which pacing pulses are delivered from the implantable medical device using pacing parameters selected to augment myocardial mechanical stress to a level effecting cardioprotection against myocardial injury or deterioration by increasing a degree of ventricular asynchrony, the delivery schedule stored in the implantable medical device and specifying timing for initiating the stress augmentation pacing sessions;
timing the stress augmentation pacing sessions to be delivered on a periodic basis at a session frequency between approximately 1 and 12 sessions each day; and
timing the delivery of the pacing pulses during the each of the stress augmentation pacing sessions, including timing alternating non-pacing and pacing periods, the non-pacing periods each having a non-pacing duration during which no pacing pulse is timed to be delivered, the pacing periods each having a specified pacing duration during which a plurality of the pacing pulses is timed to be delivered using pacing parameters selected to augment rnyocardial mechanical stress to the level effecting cardioprotection against myocardial injury or deterioration;
initiatingthe each of the stress augmentation pacing sessions according to the delivery schedule using the implantable medical device if the inhibitory signal is not present; and modifying the delivery schedule by rescheduling one or more of the stress augmentation pacing sessions using the implantable medical device if the inhibitory signal is present. - View Dependent Claims (13, 14, 15, 16, 17, 18, 19, 20, 21)
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Specification