Neurostimulation in a neural fulcrum zone for the treatment of chronic cardiac dysfunction
First Claim
1. A method of operating an implantable medical device (IMD) comprising a neurostimulator coupled to an electrode assembly, the neurostimulator adapted to deliver a stimulation signal to a patient, the method comprising:
- activating the IMD to generate a plurality of stimulation signals, each stimulation signal of the plurality of stimulation signals having at least one parameter setting that is different as compared to a corresponding parameter setting of the other stimulation signals of the plurality of stimulation signals;
detecting a heart rate of the patient during the generation of the plurality of stimulation signals, wherein a tachycardia condition is detected with the tachycardia condition defined by a heart rate increase corresponding to a first subset of the plurality of stimulation signals and wherein a bradycardia condition is detected with the bradycardia condition defined by a heart rate reduction of greater than about 5% corresponding to a second subset of the plurality of stimulation signals; and
defining a neural fulcrum zone corresponding to a third subset of the plurality of stimulation signals during which a transition heart rate response is identifiable, the transition heart rate response being between a heart rate associated with the tachycardia condition and a heart rate associated with the bradycardia condition, the transition heart rate further comprising a heart rate reduction inclusively between about 0% and about 5%.
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Abstract
Systems and methods are provided for delivering neurostimulation therapies to patients for treating chronic heart failure. A neural fulcrum zone is identified and ongoing neurostimulation therapy is delivered within the neural fulcrum zone. This neural fulcrum zone corresponds to a combination of stimulation parameters at which autonomic engagement is achieved, while the tachycardia-inducing stimulation effects are offset by the bradycardia-inducing effects, thereby minimizing side effects such as significant heart rate changes while providing a therapeutic level of stimulation.
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Citations
27 Claims
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1. A method of operating an implantable medical device (IMD) comprising a neurostimulator coupled to an electrode assembly, the neurostimulator adapted to deliver a stimulation signal to a patient, the method comprising:
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activating the IMD to generate a plurality of stimulation signals, each stimulation signal of the plurality of stimulation signals having at least one parameter setting that is different as compared to a corresponding parameter setting of the other stimulation signals of the plurality of stimulation signals; detecting a heart rate of the patient during the generation of the plurality of stimulation signals, wherein a tachycardia condition is detected with the tachycardia condition defined by a heart rate increase corresponding to a first subset of the plurality of stimulation signals and wherein a bradycardia condition is detected with the bradycardia condition defined by a heart rate reduction of greater than about 5% corresponding to a second subset of the plurality of stimulation signals; and defining a neural fulcrum zone corresponding to a third subset of the plurality of stimulation signals during which a transition heart rate response is identifiable, the transition heart rate response being between a heart rate associated with the tachycardia condition and a heart rate associated with the bradycardia condition, the transition heart rate further comprising a heart rate reduction inclusively between about 0% and about 5%. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13)
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14. A method of identifying a set of parameter settings for an implantable medical device (IMD) for treating a chronic cardiac dysfunction condition of a patient, the method comprising:
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activating the IMD to generate a plurality of stimulation signals at a same frequency, each stimulation signal of the plurality of stimulation signals having at least one parameter setting that is different as compared to a corresponding parameter setting of the other stimulation signals of the plurality of stimulation signals; detecting a heart rate of the patient during the generation of the plurality of stimulation signals, wherein a tachycardia condition is detected with the tachycardia condition defined by a heart rate increase corresponding to a first subset of the plurality of stimulation signals and wherein a bradycardia condition is detected with the bradycardia condition defined by a heart rate reduction of greater than about 5% corresponding to a second subset of the plurality of stimulation signals; and defining a neural fulcrum zone corresponding to a third subset of the plurality of stimulation signals during which a transition heart rate response is identifiable, the transition heart rate response comprising a heart rate reduction inclusively between about 0% and about 5%.
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15. A neurostimulation system, comprising:
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an implantable medical device (IMD) comprising a neurostimulator coupled to an electrode assembly, the neurostimulator adapted to deliver a plurality of stimulation signals to a patient; and a control system programmed to; detect a heart rate of when the IMD generates the plurality of stimulation signals, each stimulation signal of the plurality of stimulation signals having at least one parameter setting that is different as compared to a corresponding parameter setting of the other stimulation signals of the plurality of stimulation signals; define a first subset of the plurality of stimulation signals during which a tachycardia condition of the patient is detected, the tachycardia condition defined by a heart rate increase; define a second subset of the plurality of stimulation signals during which a bradycardia condition of the patient is detected, the bradycardia condition defined by a heart rate decrease of greater than about 5%; and define a neural fulcrum zone corresponding to a third subset of the plurality of stimulation signals during which a transition heart rate response is identifiable, the transition heart rate response being between a heart rate associated with the tachycardia condition and a heart rate associated with the bradycardia condition, the transition heart rate response further comprising a heart rate decrease inclusively between about 0% and about 5%. - View Dependent Claims (16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27)
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Specification