Method and apparatus for using a rest mode indicator to automatically adjust control parameters of an implantable cardiac stimulation device

• US 20030171782A1
• Filed: 03/06/2002
• Published: 09/11/2003
• Est. Priority Date: 03/06/2002
• Status: Active Grant

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Inventors: Boileau, Peter, Florio, Joseph J., Falkenberg, Eric, Bornzin, Gene A., Barstad, Janice
• Granted Patent: US 6,968,232 B2
• Time in Patent Office: Days
• US Class Current: 607/19
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions
• CPC Class Codes: A61N 1/3682 with a variable atrioventricular delay

Abstract

An implantable cardiac stimulation device is described wherein a controller of the cardiac stimulation device controls selected functions of the device based on whether the patient is at rest and further based on whether the patient is prone to vagally-mediated arrhythmias. Functions of the device that may be controlled include, for example, a pacing base rate, an AV/PV delay, and a refractory period as well as overdrive pacing parameters and diagnostic data gathering parameters. In one example, if the patient is not prone to vagally-mediated arrhythmias, the base rate is lowered while the patient is at rest. Also, overdrive pacing parameters are set to be less aggressive. As such, the operation of the cardiac stimulation device is controlled to make it easier for the patient to rest while also reducing power consumption. However, if the patient is prone to vagally-mediated arrhythmias, the base rate is not lowered while the patient is at rest. Overdrive pacing parameters are instead set to be more aggressive, rather than less aggressive. In this manner, the cardiac stimulation device attempts to compensate for any increased risk of arrhythmia that may occur while the patient, who is prone to vagally-mediated arrhythmias, is at rest. Numerous other parameters may be adjusted dependent upon whether the patient is at rest or dependent upon whether the patient is prone to vagally-mediated arrhythmias.

Claims

1. In an implantable cardiac stimulation device for implant within a patient having a controller for controlling functions of the cardiac stimulation device, a method comprising:

determining whether the patient is prone to rest-related physiologic problems;

determining whether the patient is at rest; and

controlling selected functions of the cardiac stimulation device based on a first set of parameters while the patient is at rest and a second set of parameters while the patient is not at rest, with sets of parameters specifying one or more of AV/PV delay, refractory period, overdrive pacing parameters, diagnostic-data gathering parameters and defibrillation capacitor charging parameters.

2. The method of claim 1 wherein the sets of parameters further specify a pacing base rate.

3. The method of claim 1 wherein the implantable cardiac stimulation device includes an activity sensor providing a signal indicative of a level of activity of the patient and wherein the step of determining whether the patient is at rest is performed by comparing the activity level to a predetermined rest-mode triggering level.

4. The method of claim 1 wherein the overdrive pacing parameters of the first set of parameters used while the patient is at rest provide generally less aggressive overdrive pacing than the second set of parameters while the patient is not at rest.

5. The method of claim 1 wherein the diagnostic-data gathering parameters of the first set of parameters used while the patient is at rest provide generally less frequent diagnostic gathering than the diagnostic-data gathering parameters of the second set of parameters while the patient is not at rest.

6. The method of claim 1 wherein the controller further employs a set of vagally vagally-mediated arrhythmia (VMA) rest-mode control parameters and further comprising:

detecting whether the patient is prone to vagally-mediated arrhythmias; and

while the patient is at rest, controlling selected functions of the cardiac stimulation device using the VMA rest-mode control parameters if the patient is prone to vagally-mediated arrhythmias and using the first set of parameters if the patient is not prone to prone to vagally-mediated arrhythmias.

7. The method of claim 6 wherein the implantable cardiac stimulation device also includes a telemetry device for inputting signals for use in controlling operation of the controller and wherein the step of detecting whether the patient is prone to vagally-mediated arrhythmias is performed by inputting a control signal using the telemetry device indicative of whether the patient is prone to vagally-mediated arrhythmias.

8. An implantable cardiac stimulation device for implant within a patient comprising:

control means for controlling selected functions of the device;

storage means for storing sets of control parameters for use by the control means, each set specifying one or more of AV/PV delay, refractory period, and overdrive pacing parameters, diagnostic-data gathering parameters and defibrillation capacitor charging parameters, the storage means storing a first set of control parameters for use while the patient is at rest and a second set of control parameters for use while the patient is not at rest;

sensor means for determining whether the patient is at rest; and

means for determining whether the patient is prone to rest-related physiologic problems; and

wherein the controller means inputs the first set of control parameters from the storage means if the sensor means determines that the patient is at rest and if the means for determining determines that the patient is prone to rest-related physiologic problems, wherein the first set is for use in controlling the selected functions of the device and inputs the second set of control parameters from the storage means if the sensor means determines that the patient is not at rest for use in controlling the selected functions of the device.

9. The device of claim 8 further including telemetry means for receiving a control signal indicative of whether the patient is prone to vagally-mediated arrhythmias.

10. The device of claim 9 wherein the storage means stores a third set of control parameters for use while the patient is at rest if the patient is prone to vagally-mediated arrhythmias and wherein the controller means inputs the third set of control parameters from the storage means if the telemetry means receives a control signal indicating that that the patient is prone to vagally-mediated arrhythmias and if the sensor means determines that the patient is at rest.

11. An implantable cardiac stimulation device for implant within a patient comprising:

a pulse generator that is operative to generate pacing pulses for applying to the heart of a patient;

a sensor that is operative to provide a signal indicative of whether the patient is at rest; and

a controller that is operative to control selected functions of the stimulation device based on a first set of parameters if the patient is at rest and if the patient is prone to rest-related physiologic problems, and based on a second set of parameters if the patient is not at rest.

12. The device of claim 11 wherein the sensor is an activity sensor providing a signal indicative of a level of activity of the patient and wherein the controller operates to determine whether the patient is at rest is by comparing the activity level to a predetermined rest-mode triggering level.

13. The device of claim 11 wherein the overdrive pacing parameters of the first set of parameters used while the patient is at rest provide generally less aggressive overdrive pacing than the second set of parameters while the patient is not at rest.

14. The device of claim 11 wherein the sets of parameters specify one or more of AV/PV delay, refractory period, and overdrive pacing parameters, diagnostic-data gathering parameters and defibrillation capacitor charging parameters, and wherein the diagnostic-data gathering parameters of the first set of parameters used while the patient is at rest provide generally less frequent diagnostic gathering than the diagnostic-data gathering parameters of the second set of parameters while the patient is not at rest.

15. The device of claim 11 further including a telemetry device for inputting a control signal indicative of whether the patient is prone to vagally-mediated arrhythmias.

16. The device of claim 15 wherein the controller is further operative to control selected functions of the cardiac stimulation device using a third set of control parameters while the patient is at rest if the patient is prone to vagally-mediated arrhythmias, the third set being optimized for use with patients prone to vagally-mediated arrhythmias.