Fine resolution identification of a neural fulcrum 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, said neurostimulator adapted to deliver a stimulation signal at a plurality of intensity parameter levels at predefined increments, said method comprising:
- monitoring a heart rate of a patient implanted with the IMD;
delivering to the patient a first set of stimulation signals at a first frequency, wherein said delivering comprises incrementally increasing the intensity parameter level by the predefined increment for subsequent stimulation signals until bradycardia is detected;
detecting tachycardia or a transition heart rate response in response to the stimulation signal having a first intensity parameter level one predefined increment below a second intensity parameter level at which bradycardia is detected;
based on detecting tachycardia in response to the stimulation signal having the first intensity parameter level, delivering to the patient a second set of stimulation signals at a second frequency lower than the first frequency, wherein said delivering the second set of stimulation signals comprises incrementally increasing the intensity parameter level by the predefined increment for subsequent stimulation signals until bradycardia is detected; and
based on detecting the transition heart rate response in response to the stimulation signal having the first intensity parameter level, identifying the stimulation signal resulting in the transition heart rate response as corresponding to a neural fulcrum zone.
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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 may be identified by monitoring a patient'"'"'s response to incrementally increased intensity settings at a first frequency. If the incremental intensity increases do not result in the identification of the neural fulcrum zone, the frequency may be changed to provide finer resolution identification of the neural fulcrum zone.
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Citations
30 Claims
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1. A method of operating an implantable medical device (IMD) comprising a neurostimulator coupled to an electrode assembly, said neurostimulator adapted to deliver a stimulation signal at a plurality of intensity parameter levels at predefined increments, said method comprising:
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monitoring a heart rate of a patient implanted with the IMD; delivering to the patient a first set of stimulation signals at a first frequency, wherein said delivering comprises incrementally increasing the intensity parameter level by the predefined increment for subsequent stimulation signals until bradycardia is detected; detecting tachycardia or a transition heart rate response in response to the stimulation signal having a first intensity parameter level one predefined increment below a second intensity parameter level at which bradycardia is detected; based on detecting tachycardia in response to the stimulation signal having the first intensity parameter level, delivering to the patient a second set of stimulation signals at a second frequency lower than the first frequency, wherein said delivering the second set of stimulation signals comprises incrementally increasing the intensity parameter level by the predefined increment for subsequent stimulation signals until bradycardia is detected; and based on detecting the transition heart rate response in response to the stimulation signal having the first intensity parameter level, identifying the stimulation signal resulting in the transition heart rate response as corresponding to a neural fulcrum zone. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12)
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13. A method of operating an implantable medical device (IMD) comprising a neurostimulator coupled to an electrode assembly, said neurostimulator adapted to deliver a stimulation signal at a plurality of intensity parameter levels at predefined increments, said method comprising:
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monitoring a heart rate of a patient implanted with the IMD; delivering to the patient a first set of stimulation signals at a first frequency, wherein said delivering comprises incrementally increasing the intensity parameter level by the predefined increment for subsequent stimulation signals until either bradycardia or a transition heart rate response is detected; detecting tachycardia or a transition heart rate response in response to the stimulation signal having a first intensity parameter level one predefined increment below a second intensity parameter level at which bradycardia is detected; based on detecting tachycardia in response to the stimulation signal having the first intensity parameter level, delivering to the patient a second set of stimulation signals at a second frequency lower than the first frequency, wherein said delivering the second set of stimulation signals comprises incrementally increasing the intensity parameter level by the predefined increment until either bradycardia or a transition heart rate response is detected; and based on detecting the transition heart rate response in response to the stimulation signal having the first intensity parameter level, identifying the stimulation signal resulting in the transition heart rate response as corresponding to a neural fulcrum zone. - View Dependent Claims (14, 15, 16, 17, 18, 19, 20, 21, 22, 23)
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24. A neurostimulation system, comprising:
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an implantable medical device (IMD) comprising a neurostimulator coupled to an electrode assembly, said neurostimulator adapted to deliver a stimulation signal to a patient; and a control system programmed to; monitor a heart rate of a patient implanted with the IMD; activate the IMD to deliver to the patient a first set of stimulation signals at a first frequency, wherein said delivery comprises incrementally increasing the intensity parameter level by the predefined increment for subsequent stimulation signals until bradycardia is detected; detect tachycardia or a transition heart rate response in response to the stimulation signal having a first intensity parameter level one predefined increment below a second intensity parameter level at which bradycardia is detected; activate the IMD, based on detection of tachycardia in response to the stimulation signal having the first intensity parameter level, to deliver to the patient a second set of stimulation signals at a second frequency lower than the first frequency, wherein said delivery of the second set of stimulation signals comprises incrementally increasing the intensity parameter level by the predefined increment for subsequent stimulation signals until bradycardia is detected; and identify, based on the detection of the transition heart rate response in response to the stimulation signal having the first intensity parameter, the stimulation signal resulting in the transition heart rate response as corresponding to a neural fulcrum zone. - View Dependent Claims (25, 26, 27, 28, 29, 30)
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Specification