Responsive neurostimulation for the treatment of chronic cardiac dysfunction
First Claim
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1. A neurostimulation system, comprising:
- an implantable medical device (IMD), the IMD comprising;
an electrode assembly; and
a neurostimulator coupled to the electrode assembly, said neurostimulator adapted to deliver a stimulation signal to a patient in the patient'"'"'s neural fulcrum zone, said stimulation signal comprising an ON time period and an OFF time period; and
an external system, the external system comprising;
an external heart rate sensor configured to acquire a heart rate signal from the patient; and
an external control system communicatively coupled to the heart rate sensor, the external control system being programmed to;
monitor a baseline heart rate signal acquired by the external heart rate sensor during the OFF time periods of the stimulation signal;
monitor a heart rate response signal acquired by the external heart rate sensor during the ON time periods of the stimulation signal; and
in response to the monitored baseline signal and the monitored response signal, to cause the IMD to adjust one or more parameters of the stimulation signal to deliver the stimulation signal in the patient'"'"'s neural fulcrum zone, wherein the neural fulcrum zone corresponds to a stimulation intensity during which a transition heart rate response is detected, said transition heart rate response being between tachycardia and bradycardia and comprising a heart rate change of between about 0% and a decrease of 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. The implanted stimulation device includes a physiological sensor for monitoring the patient'"'"'s response to the neurostimulation therapy on an ambulatory basis over extended periods of time and a control system for adjusting stimulation parameters to maintain stimulation in the neural fulcrum zone based on detected changes in the physiological response to stimulation.
252 Citations
21 Claims
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1. A neurostimulation system, comprising:
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an implantable medical device (IMD), the IMD comprising; an electrode assembly; and a neurostimulator coupled to the electrode assembly, said neurostimulator adapted to deliver a stimulation signal to a patient in the patient'"'"'s neural fulcrum zone, said stimulation signal comprising an ON time period and an OFF time period; and an external system, the external system comprising; an external heart rate sensor configured to acquire a heart rate signal from the patient; and an external control system communicatively coupled to the heart rate sensor, the external control system being programmed to; monitor a baseline heart rate signal acquired by the external heart rate sensor during the OFF time periods of the stimulation signal; monitor a heart rate response signal acquired by the external heart rate sensor during the ON time periods of the stimulation signal; and in response to the monitored baseline signal and the monitored response signal, to cause the IMD to adjust one or more parameters of the stimulation signal to deliver the stimulation signal in the patient'"'"'s neural fulcrum zone, wherein the neural fulcrum zone corresponds to a stimulation intensity during which a transition heart rate response is detected, said transition heart rate response being between tachycardia and bradycardia and comprising a heart rate change of between about 0% and a decrease of about 5%. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11)
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12. A method of operating a neuromodulation system comprising an implantable medical device (IMD) and an external system, wherein the IMD comprises an electrode assembly and a neurostimulator coupled to the electrode assembly, and the external system comprises an external heart rate sensor and an external control system communicatively coupled to the heart rate sensor and the IMD, the method comprising:
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acquiring a heart rate signal from a patient using the external heart rate sensor; transmitting control signals from the external control system to the IMD to activate the neurostimulator to deliver a stimulation signal in the patient'"'"'s neural fulcrum zone, the stimulation signal comprising an ON time period and an OFF time period; monitoring with the external control system a baseline heart rate signal acquired by the external heart rate sensor during the OFF time periods of the stimulation signal; monitoring with the external control system a heart rate response signal acquired by the external heart rate sensor during the ON time periods of the stimulation signal; and in response to the monitored baseline signal and the monitored response signal, adjusting one or more parameters of the stimulation signal to deliver the stimulation signal in the patient'"'"'s neural fulcrum zone, wherein the neural fulcrum zone corresponds to a stimulation intensity during which a transition heart rate response is detected, said transition heart rate response being between tachycardia and bradycardia and comprising a heart rate change of between about 0% and a decrease of about 5%. - View Dependent Claims (13, 14, 15, 16, 17, 18, 19, 20, 21)
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Specification