Sympathetic stimulation for improved myocardial relaxation
First Claim
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1. A device, comprising:
- neural stimulation circuitry for delivering electrostimulation pulses to one or more electrodes adapted for stimulating sympathetic nerves innervating the heart of a patient;
lusitropy sensing circuitry for measuring a lusitropy parameter during diastole wherein the lusitropy parameter is selected from a rate of ventricular pressure decrease, a rate of ventricular force decrease, or isovolumic relaxation time;
a controller programmed to compare the measured lusitropy parameter to a specified threshold in order to determine if diastolic relaxation is impaired and, when diastolic relaxation is impaired, enter a neural stimulation mode for operating the neural stimulation circuitry to deliver sympathetic stimulation to the heart; and
,cardiac sensing circuitry for connecting to one or more electrodes to sense cardiac electrical activity and wherein the controller is connected to the cardiac sensing circuitry and programmed to measure heart rate during delivery of sympathetic stimulation and to discontinue the neural stimulation mode when the heart rate increases above a specified safety threshold value.
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Abstract
Described are methods and devices for improving diastolic function with electrostimulation in heart failure patients who exhibit relatively normal systolic function. Such patients are characterized by impaired myocardial relaxation during diastole that prevents adequate filling of the ventricles during diastole to thereby reduce cardiac output. An implantable device is described for effecting strategic and periodic stimulation of the sympathetic nervous system to elicit myocardial adrenergic activation for improved myocardial relaxation.
22 Citations
18 Claims
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1. A device, comprising:
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neural stimulation circuitry for delivering electrostimulation pulses to one or more electrodes adapted for stimulating sympathetic nerves innervating the heart of a patient; lusitropy sensing circuitry for measuring a lusitropy parameter during diastole wherein the lusitropy parameter is selected from a rate of ventricular pressure decrease, a rate of ventricular force decrease, or isovolumic relaxation time; a controller programmed to compare the measured lusitropy parameter to a specified threshold in order to determine if diastolic relaxation is impaired and, when diastolic relaxation is impaired, enter a neural stimulation mode for operating the neural stimulation circuitry to deliver sympathetic stimulation to the heart; and
,cardiac sensing circuitry for connecting to one or more electrodes to sense cardiac electrical activity and wherein the controller is connected to the cardiac sensing circuitry and programmed to measure heart rate during delivery of sympathetic stimulation and to discontinue the neural stimulation mode when the heart rate increases above a specified safety threshold value. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9)
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10. A method for operating an implantable device in a patient, comprising:
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measuring a lusitropy parameter during diastole wherein the lusitropy parameter is selected from a rate of ventricular pressure decrease, a rate of ventricular force decrease, or an isovolumic relaxation time; comparing the measured lusitropy parameter to a specified threshold in order to determine if diastolic relaxation is impaired and, when diastolic relaxation is impaired, entering a neural stimulation mode to deliver electrostimulation pulses to one or more electrodes adapted for stimulating sympathetic nerves innervating the heart; and
,measuring heart rate during delivery of sympathetic stimulation and discontinuing the neural stimulation mode when the heart rate increases above a specified safety threshold value. - View Dependent Claims (11, 12, 13, 14, 15, 16, 17, 18)
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Specification