Cardiac resynchronization therapy for improved hemodynamics based on disordered breathing detection

• US 9,931,074 B2
• Filed: 08/10/2016
• Issued: 04/03/2018
• Est. Priority Date: 11/18/2005
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Ni, Quan, Daum, Douglas R., Stahmann, Jeffrey E., Lee, Kent, Hartley, Jesse W.
• Primary Examiner(s): MALAMUD, DEBORAH LESLIE
• Application Number:
  US15/233,369
• Publication Number:
  US 20160345897A1
• Time in Patent Office: 601 Days
• Field of Search: None
• CPC Class Codes: A61B 5/02 Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
• CPC Class Codes: A61B 5/08 Detecting, measuring or recording devices for evaluating the respiratory organs A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/366 Detecting abnormal QRS complex, e.g. widening
• CPC Class Codes: A61B 5/4818 Sleep apnoea
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61B 5/6846 specially adapted to be brought in contact with an internal body part, i.e. invasive
• 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 1/36521 the parameter being derived from measurement of an electrical impedance

Abstract

The presence of disordered breathing is detected using an implantable medical device. A cardiac condition is detected that is indicative of the patient'"'"'s cardiac status. Based on the presence of disordered breathing and the cardiac condition, the patient is identified as suitable for a cardiac resynchronization therapy.

Claims

1. An implantable medical device, comprising:

a housing configured for implantation in a patient; and

a processor provided in the housing and configured to;

detect presence of sleep disordered breathing;

detect a level of cardiac dyssynchrony at least one of within and between cardiac chambers of the patient; and

identify if the patient is likely to respond to a cardiac resynchronization therapy based on the presence of disordered breathing and the level of the cardiac dyssynchrony.

2. The device of claim 1, wherein the processor is further configured to initiate cardiac resynchronization therapy for the patient based on the combined detection of the sleep disordered breathing and the level of the cardiac dyssynchrony.

3. The device of claim 2, further comprising:

a pulse generator coupled to the processor;

wherein the processor is also configured to enable the pulse generator to deliver the cardiac resynchronization therapy, and wherein enabling comprises at least one of downloading cardiac resynchronization therapy protocol to the implantable medical device, and activating unused cardiac resynchronization therapy protocol stored in memory of the implantable medical device.

4. The device of claim 1, wherein the processor is configured to adjust an atrioventricular delay based on the type of sleep disordered breathing detected by the implantable medical device.

5. The device of claim 1, wherein the processor is configured to detect a QRS complex width exceeding a predetermined value and measure an apnea/hypopnea index exceeding a predetermined value.

6. The device of claim 1, further comprising an implantable sensor arrangement coupled to the implantable medical device, the processor configured to detect a ventricular dyssynchrony in the patient'"'"'s heart via the implantable sensor arrangement.

7. The device of claim 1, further comprising a patient-external sensor arrangement coupled to the implantable medical device, the processor configured to detect a ventricular dyssynchrony in the patient'"'"'s heart via the patient-external sensor arrangement.

8. The device of claim 1, wherein the processor is coupled to communication circuitry configured to facilitate wireless communication between the processor and a patient-external device or system.

9. The device of claim 8, wherein the patient-external device or system is configured to generate a clinician alert to initiate, terminate, adjust, or optimize the cardiac resynchronization therapy based on the combined detection of the sleep disordered breathing and the cardiac dyssynchrony.

10. The device of claim 5, wherein the processor is configured to detect a QRS complex width exceeding 120 milliseconds and measure an apnea/hypopnea index value exceeding 15 episodes per hour.

11. The device of claim 1, wherein the detected cardiac dyssynchrony is an impaired left-ventricular function that is not reflected in the patient'"'"'s general functional status as assessed by New York Heart Association (NYHA) functional class.

12. A system, comprising:

a housing configured for implantation in a patient; and

a processor provided in the housing and configured to;

detect presence of sleep disordered breathing;

detect a level of cardiac dyssynchrony at least one of within and between cardiac chambers of the patient;

identify if the patient is likely to respond to a cardiac resynchronization therapy based on the presence of disordered breathing and the level of the cardiac dyssynchrony; and

if the patient is identified as likely to respond, provide or alter cardiac resynchronization therapy for the patient based on the combined detection of the sleep disordered breathing and the level of the cardiac dyssynchrony.

13. The system of claim 12, wherein the system comprises a pulse generator and electrodes that are configured to be arranged in multiple heart chambers of the patient for cardiac resynchronization therapy delivery.

14. The system of claim 12, wherein the processor is configured to adjust an atrioventricular delay based on a type of the sleep disordered breathing detected.

15. A method, comprising:

detecting presence of sleep disordered breathing using a processor within an implantable medical device in a patient;

detecting a cardiac dyssynchrony at least one of within and between cardiac chambers of the patient using the processor; and

determining if the patient is likely to respond to cardiac resynchronization therapy based on a level of the cardiac dyssynchrony using the processor.

16. The method of claim 15, further comprising initiating cardiac resynchronization therapy for the patient based on the combined detection of the sleep disordered breathing and the cardiac dyssynchrony and the determination.

17. The method of claim 15, wherein detecting presence of sleep disordered breathing comprises detecting at least one of obstructive sleep apnea, central sleep apnea, hypopnea, orthopnea, paroxysmal nocturnal dyspnea, and Cheyne-Stokes respiration.

18. The method of claim 15, further comprising:

enabling the implantable medical device to perform the cardiac resynchronization therapy based on the combined detection of the sleep disordered breathing and the cardiac dyssynchrony, wherein the enabling comprises at least one of downloading a cardiac resynchronization therapy protocol to the implantable medical device, and activating an unused cardiac resynchronization therapy protocol stored in memory of the implantable medical device.

19. The method of claim 15, wherein detecting the presence of sleep disordered breathing comprises measuring an apnea/hypopnea index exceeding a predetermined value, and wherein detecting the cardiac dyssynchrony comprises detecting a QRS complex width exceeding a predetermined value.

20. The method of claim 15, wherein detecting the cardiac dyssynchrony comprises one or more of detecting left ventricular systolic dysfunction, detecting a left ventricular systolic dysfunction comprising a left ventricular ejection fraction value less than a predetermined limit, determining that a QRS complex width of a cardiac cycle exceeds a predetermined limit, and detecting a ventricular wall motion asynchrony that exceeds a predetermined limit.