Cardiac stimulation apparatus and method for the control of hypertension

• US 9,320,903 B2
• Filed: 04/01/2013
• Issued: 04/26/2016
• Est. Priority Date: 02/12/2004
• Status: Active Grant

• Current Assignee: Backbeat Medical, LLC
• Original Assignee: Backbeat Medical, Inc.
• Inventors: Schwartz, Robert S., Van Tassel, Robert A.
• Primary Examiner(s): Heller, Tammie K
• Application Number:
  US13/854,283
• Publication Number:
  US 20140128934A1
• Time in Patent Office: 1,121 Days
• US Class Current: 1/1
• 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 1/36514 controlled by a physiological quantity other than heart potential, e.g. blood pressure controlled by two or more physical parameters A61N1/36585
• CPC Class Codes: A61N 1/36564 controlled by blood pressure

Abstract

A method that electrically stimulates a heart muscle to alter the ejection profile of the heart, to control the mechanical function of the heart and reduce the observed blood pressure of the patient. The therapy may be invoked by an implantable blood pressure sensor associated with a pacemaker like device. In some cases, where a measured pretreatment blood pressure exceeds a treatment threshold, a patient'"'"'s heart may be stimulated with an electrical stimulus timed relative to the patient'"'"'s cardiac ejection cycle. This is done to cause dyssynchrony between at least two cardiac chambers or within a cardiac chamber, which alters the patient'"'"'s cardiac ejection profile from a pretreatment cardiac ejection profile. This has the effect of reducing the patient'"'"'s blood pressure from the measured pretreatment blood pressure.

Claims

1. An implantable heart muscle stimulator device for treating a blood pressure disorder in a patient, the patient having a pretreatment systemic blood pressure corresponding to a pretreatment cardiac ejection profile, the device comprising:

at least one lead configured to be in electrical communication with a cardiac chamber of the patient'"'"'s heart; and

an electrical stimulator in electrical communication with the at least one lead and comprising a non-transitory computer-readable medium programmed to deliver through the at least one lead a stimulation pattern timed relative to the patient'"'"'s cardiac ejection cycle that alters a pretreatment contraction timing between at least two cardiac chambers, reduces atrioventricular delay in the patient'"'"'s cardiac election cycle, and causes, between the at least two cardiac chambers, a dyssynchrony that alters the patient'"'"'s cardiac ejection profile from the pretreatment cardiac ejection profile and reduces the patient'"'"'s systemic blood pressure from the pretreatment systemic blood pressure.

2. The device of claim 1, wherein the non-transitory computer-readable medium is incorporated into a pacemaker device.

3. The device of claim 1, wherein the electrical stimulator comprises a pacemaker device and wherein the non-transitory computer-readable medium is programmed with logic.

4. The device of claim 1, wherein the reduced atrioventricular delay changes the spatial contraction relations between an atrial chamber and a ventricular chamber.

5. The device of claim 1, wherein the reduced atrioventricular delay changes the temporal contraction relations between an atrial chamber and a ventricular chamber.

6. The device of claim 1, wherein the stimulation pattern comprises a pacing level stimulus that alters the patient'"'"'s cardiac ejection profile for an individual heartbeat.

7. The device of claim 1, wherein the non-transitory computer-readable medium is programmed to stimulate the patient'"'"'s heart on a beat-by-beat interval.

8. The device of claim 1, wherein the stimulation pattern comprises a pacing level stimulus that alters the patient'"'"'s cardiac ejection profile and is delivered intermittently.

9. The device of claim 1, wherein the stimulation pattern comprises a pacing level stimulus that alters the patient'"'"'s cardiac ejection profile, and wherein the stimulation pattern comprises pattern parameters that change intermittently to prevent tachyphylaxis.

10. The device of claim 1, wherein the non-transitory computer-readable medium is programmed to stimulate the patient'"'"'s heart at a pacing rate above sinus rhythm.

11. The device of claim 1, wherein the non-transitory computer-readable medium is programmed to stimulate the patient'"'"'s heart at a pacing rate within a range of approximately 70 to approximately 90 beats per minute.

12. The device of claim 1, further comprising a blood pressure sensor that communicates with the electrical stimulator and measures the patient'"'"'s pretreatment systemic blood pressure corresponding to a pretreatment cardiac ejection profile,

wherein the non-transitory computer readable medium is programmed to receive the blood pressure measurement from the blood pressure sensor, compare the measured pretreatment systemic blood pressure with a treatment threshold, and, when the measured pretreatment systemic blood pressure exceeds the treatment threshold, deliver the stimulation pattern timed relative to the patient'"'"'s cardiac ejection cycle.

13. The device of claim 1, wherein the non-transitory computer readable medium is programmed to deliver stimulations that reduce filling of a left ventricle of the patient'"'"'s heart.

14. The device of claim 1, wherein the non-transitory computer readable medium is programmed to stimulate a ventricle to dyssynchronously contract the ventricle substantially during contraction of a corresponding atrium.

15. The device of claim 14, wherein the non-transitory computer-readable medium is programmed to stimulate the ventricle such that a corresponding atrioventricular valve closes during or before the contraction of the corresponding atrium.

16. The device of claim 1, wherein the non-transitory computer readable medium is programmed to stimulate a ventricle to dyssynchronously contract the ventricle before contraction of a corresponding atrium in the same cardiac cycle.

17. The device of claim 1, wherein the at least one lead comprises a first lead in electrical communication with a first cardiac chamber and a second lead in electrical communication with a second cardiac chamber, and

wherein the non-transitory computer readable medium is programmed to deliver the stimulation pattern through the first lead and the second lead to the first cardiac chamber and the second cardiac chamber, respectively, resulting in dyssynchrony between at least two cardiac chambers.

18. The device of claim 17, wherein the stimulation pattern dyssynchronously contracts a ventricle before or substantially during contraction of a corresponding atrium in the same cardiac cycle.

19. The device of claim 18, wherein the dyssynchronous contraction of the ventricle closes a corresponding atrioventricular valve during or before the contraction of the corresponding atrium.

20. The device of claim 1, wherein the at least one lead comprises a first lead in electrical communication with a first cardiac chamber and a second lead in electrical communication with a second cardiac chamber, and

wherein the non-transitory computer readable medium is programmed to receive data indicative of sensed natural activity of the first cardiac chamber and to deliver the stimulation pattern to the second cardiac chamber resulting in the dyssynchrony between at least two cardiac chambers.

21. The device of claim 20, wherein the stimulation pattern dyssynchronously contracts a ventricle before or substantially during contraction of a corresponding atrium in the same cardiac cycle.

22. The device of claim 21, wherein the dyssynchronous contraction of the ventricle closes a corresponding atrioventricular valve during or before the contraction of the corresponding atrium.

23. The device of claim 1, wherein the at least one lead comprises a first lead in electrical communication with a first cardiac chamber and a second lead in electrical communication with a second cardiac chamber, and

wherein the non-transitory computer readable medium is programmed to receive data indicative of sensed natural activity of the first cardiac chamber and to deliver the stimulation pattern to the first and second cardiac chambers resulting in the dyssynchrony between at least two cardiac chambers.

24. The device of claim 23, wherein the stimulation pattern dyssynchronously contracts a ventricle before or substantially during contraction of a corresponding atrium in the same cardiac cycle.

25. The device of claim 24, wherein the dyssynchronous contraction of the ventricle closes a corresponding atrioventricular valve during or before the contraction of the corresponding atrium.

26. The device of claim 1, further comprising at least one physiologic sensor in electrical communication with the electrical stimulator, wherein the physiologic sensor is configured to measure a physiologic parameter of the patient, and wherein the electrical stimulator is configured to adjust use of the stimulation pattern based on the measured physiologic parameter of the patient.

27. The device of claim 1, further comprising an activity sensor in electrical communication with the electrical stimulator, wherein the activity sensor is configured to measure an activity parameter of the patient, and wherein the electrical stimulator is configured to adjust use of the stimulation pattern based on the measured activity parameter of the patient.

28. The device of claim 1, wherein the electrical stimulator is configured to at least one of trigger and inhibit delivery of the stimulation pattern using, at least in part, information about a detected condition of the patient, and wherein the detected condition comprises at least one of a detected physiological condition and a detected activity condition.

29. An implantable heart muscle stimulator device for treating a blood pressure disorder in a patient, the patient having a pretreatment systemic blood pressure corresponding to a pretreatment cardiac ejection profile, the device comprising:

at least one lead configured to be in electrical communication with a cardiac chamber of the patient'"'"'s heart; and

an electrical stimulator in electrical communication with the at least one lead and comprising a non-transitory computer-readable medium programmed to deliver through the at least one lead a stimulation pattern timed relative to the patient'"'"'s cardiac ejection cycle that alters a pretreatment contraction timing between atrial and ventricular chambers, reduces atrioventricular delay in the patient'"'"'s cardiac election cycle, and causes, between the atrial and ventricular chambers, a dyssynchronous timing that alters the patient'"'"'s cardiac ejection profile from the pretreatment cardiac ejection profile and reduces the patient'"'"'s systemic blood pressure from the pretreatment systemic blood pressure.

30. The device of claim 29, wherein the non-transitory computer-readable medium is incorporated into a pacemaker device.

31. The device of claim 29, wherein the non-transitory computer readable medium is programmed to stimulate a ventricle to dyssynchronously contract the ventricle substantially during contraction of a corresponding atrium.

32. The device of claim 31, wherein the non-transitory computer-readable medium is programmed to stimulate the ventricle such that a corresponding atrioventricular valve closes during or before the contraction of the corresponding atrium.

33. The device of claim 29, wherein the non-transitory computer readable medium is programmed to stimulate a ventricle to dyssynchronously contract the ventricle before contraction of a corresponding atrium in the same cardiac cycle.