Blood volume redistribution therapy for heart failure

• US 9,526,893 B2
• Filed: 06/25/2013
• Issued: 12/27/2016
• Est. Priority Date: 07/27/2009
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Averina, Viktoria A., Hamann, Jason J., Ruble, Stephen, Shuros, Allan C.
• Primary Examiner(s): Levicky, William
• Assistant Examiner(s): Hankins, Lindsey G
• Application Number:
  US13/926,061
• Publication Number:
  US 20130289649A1
• Time in Patent Office: 1,281 Days
• US Class Current: 1/1
• CPC Class Codes: A61B 5/0537 Measuring body composition by impedance, e.g. tissue hydration or fat content
• CPC Class Codes: A61B 5/0538 invasively, e.g. using a catheter
• CPC Class Codes: A61B 5/0809 by impedance pneumography
• CPC Class Codes: A61B 5/4035 Evaluating the autonomic nervous system
• CPC Class Codes: A61B 5/4869 Determining body composition
• CPC Class Codes: A61N 1/3601 of respiratory organs
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters

Abstract

A first fluid status indicator of a pulmonary fluid status associated with pulmonary edema and a second fluid status indicator of a non-pulmonary fluid status can be used to provide an alert or to control a therapy for pulmonary edema. Additionally, intermittent cardiac blood volume redistribution therapy can be used to provide cardiac conditioning in heart failure patients.

Claims

1. A system, comprising:

a first fluid monitor configured to monitor fluid in a pulmonary region of a patient and provide a pulmonary fluid status;

a second fluid monitor configured to monitor fluid in a non-pulmonary region of the patient and provide a non-pulmonary fluid status;

a therapy delivery system configured to vasodilate vasculature in the non-pulmonary region;

a controller operably connected to the first and second fluid monitors and to the therapy delivery system, the controller configured to determine, using the pulmonary fluid status and the non-pulmonary fluid status, that an elevated fluid status is attributable to fluid distribution toward the pulmonary region rather than to an increase in total blood volume, and to control the therapy delivery system to deliver a therapy to vasodilate vasculature in the non-pulmonary region to redistribute fluid from the pulmonary region to the non-pulmonary region.

2. The system of claim 1, wherein the therapy delivery system is configured to deliver energy to an autonomic neural target.

3. The system of claim 1, wherein the therapy delivery system is configured to deliver spinal cord stimulation to vasodilate vasculature in the non-pulmonary region.

4. The system of claim 1, wherein the therapy delivery system is configured to deliver vagal nerve stimulation target to vasodilate vasculature in the non-pulmonary region.

5. The system of claim 1, wherein the therapy delivery system is configured to deliver neuromodulation to a celiac ganglion.

6. The system of claim 1, wherein the therapy delivery system is configured to deliver neuromodulation to a baroreceptor region.

7. The system of claim 1, wherein the therapy delivery system is configured to deliver neuromodulation to an adrenal nerve.

8. The system of claim 1, wherein the therapy delivery system is configured to deliver a first stimulation to locally vasodilate vasculature in a first location of the non-pulmonary region and deliver a second stimulation to locally vasoconstrict vasculature in a second location of the non-pulmonary region.

9. The system of claim 1, wherein at least one of the first fluid monitor or the second fluid monitor includes an impedance sensor.

10. The system of claim 1, wherein at least one of the first fluid monitor or the second fluid monitor includes an acoustic sensor or a pressure sensor.

11. A method, comprising:

monitoring fluid in a pulmonary region of a patient to provide a pulmonary fluid status;

monitoring fluid in a non-pulmonary region of the patient to provide a non-pulmonary fluid status, wherein monitoring fluid in the non-pulmonary region includes monitoring fluid in at least one of a splanchnic region or a leg region of the patient;

determining, using the pulmonary fluid status and the non-pulmonary fluid status, that an elevated pulmonary fluid status is attributable to fluid distribution toward the pulmonary region rather than to an increase in total blood volume;

delivering a therapy to vasodilate vasculature in the non-pulmonary region to redistribute fluid from the pulmonary region to the non-pulmonary region.

12. The method of claim 11, wherein delivering the therapy to vasodilate vasculature in the non-pulmonary region includes delivering energy to an autonomic neural target to vasodilate vasculature in the non-pulmonary region.

13. The method of claim 11, wherein delivering therapy to vasodilate vasculature in the non-pulmonary region includes delivering spinal cord stimulation to vasodilate vasculature in the non-pulmonary region.

14. The method of claim 11, wherein delivering therapy to vasodilate vascular beds in the non-pulmonary region includes vagal nerve stimulation target to vasodilate vasculature in the non-pulmonary region.

15. The method of claim 11, wherein delivering therapy to vasodilate vascular beds in the non-pulmonary region includes delivering neuromodulation to a celiac ganglion.

16. The method of claim 11, wherein delivering therapy to vasodilate vascular beds in the non-pulmonary region includes delivering baroreceptor stimulation.

17. The method of claim 11, wherein delivering therapy to vasodilate vascular beds in the non-pulmonary region includes delivering neuromodulation to an adrenal nerve.

18. The method of claim 11, wherein delivering a therapy to vasodilate vasculature in the non-pulmonary region includes delivering a first stimulation to locally vasodilate vasculature in a first location of the non-pulmonary region and delivering a second stimulation to locally vasoconstrict vasculature in a second location of the non-pulmonary region.

19. The method of claim 11, wherein at least one of monitoring fluid in the pulmonary region or monitoring fluid in the non-pulmonary region includes monitoring fluid using sensed impedance.

20. The method of claim 11, wherein at least one of monitoring fluid in the pulmonary region or monitoring fluid in the non-pulmonary region includes monitoring fluid using an acoustic sensor or a pressure sensor.