METHOD AND DEVICE FOR PROVIDING ANTI-TACHYARRHYTHMIA THERAPY

• US 20070260283A1
• Filed: 05/08/2006
• Published: 11/08/2007
• Est. Priority Date: 05/08/2006
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Li, Dan
• Granted Patent: US 8,255,049 B2
• Time in Patent Office: Days
• US Class Current: 607/4
• CPC Class Codes: A61N 1/3605 Implantable neurostimulators for stimulating central or peripheral nerve system
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/3621 for treating or preventing abnormally high heart rate
• CPC Class Codes: A61N 1/36564 controlled by blood pressure
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

Various system embodiments comprise at least one sensor input adapted to receive at least one sensed signal associated with a tachyarrhythmia, a feature set extractor adapted to extract at least two features from the at least one sensed signal associated with the tachyarrhythmia, a feature set generator adapted to form a feature set using the at least two features extracted by the feature set extractor, at least one generator adapted for use to selectively apply an anti-tachycardia pacing (ATP) therapy and a neural stimulation (NS) therapy, and a controller adapted to respond to the feature set. The controller is adapted to initiate the NS therapy when the feature set corresponds to criteria for applying the NS therapy to modify the tachyarrhythmia, and initiate the ATP therapy to terminate the modified tachyarrhythmia. Other aspects and embodiments are provided herein.

Claims

1. A system, comprising:

at least one sensor input adapted to receive at least one sensed signal associated with a tachyarrhythmia;

a feature set extractor adapted to extract at least two features from the at least one sensed signal associated with the tachyarrhythmia;

a feature set generator adapted to form a feature set using the at least two features extracted by the feature set extractor;

at least one generator adapted for use to selectively apply an anti-tachycardia pacing (ATP) therapy, and a neural stimulation therapy; and

a controller adapted to respond to the feature set, the controller being adapted to initiate the NS therapy when the feature set corresponds to criteria for applying the NS therapy to modify the tachyarrhythmia, and initiate the ATP therapy to terminate the modified tachyarrhythmia.

2. The system of claim 1, wherein the at least one sensor input includes an input to receive an electrogram (EGM) signal.

3. The system of claim 1, wherein the at least one sensor input includes an input to receive a signal from a hemodynamic sensor.

4. The system of claim 1, wherein the at least two features are selected from a heart rate, a stability of the heart rate, an irregularity of an electrogram morphology, or a pressure.

5. The system of claim 4, wherein the at least two features include a heart rate, a stability of the heart rate, an irregularity of an electrogram morphology, or a pressure.

6. The system of claim 4, wherein the pressure, the heart rate and the heart rate stability indicates that the tachyarrhythmia is hemodynamically stable but the heart rate is fast and unstable.

7. The system of claim 4, wherein the criteria for applying the NS therapy to modify the tachyarrhythmia includes:

the pressure is higher than a first pressure threshold, the heart rate is higher than a first heart rate threshold and lower than a second heart rate threshold, and the heart rate stability is higher than a first threshold and lower than a second threshold.

8. The system of claim 1, wherein the at least one generator is incorporated in a housing of a single implantable medical device.

9. The system of claim 1, wherein the at least one generator includes a first generator incorporated in a housing of a first implantable medical device, and a second generator incorporated in a housing of a second implantable medical device.

10. The system of claim 1, further comprising at least one electrode adapted to stimulate a vagus nerve.

11. The system of claim 10, further comprising an intravascularly-fed electrode adapted for use in transvascularly stimulating the vagus nerve from an internal jugular vein.

12. The system of claim 10, further comprising a subcutaneously-fed lead nerve cuff electrode adapted for use in stimulating the vagus nerve.

13. A system, comprising:

means for applying a neural stimulation (NS) therapy to modify a ventricular tachycardia (VT); and

means for applying an anti-tachycardia pacing (ATP) therapy to terminate the modified VT.

14. The system of claim 13, wherein the means for applying the NS therapy to modify the VT includes means for comparing a composite feature set from at least one sensed signal associated with the VT until sensed signals associated with the modified VT has a composite feature set that indicates that the ATP therapy will be successful in terminating the modified VT.

15. The system of claim 14, wherein the composite feature set includes at least two features from the at least one sensed signal, the at least two features being selected from a heart rate, a stability of the heart rate, an irregularity of an electrogram morphology, or a pressure.

16. A method, comprising:

applying a neural stimulation (NS) therapy to modify a ventricular tachycardia (VT); and

applying an anti-tachycardia pacing (ATP) therapy to terminate the modified VT.

17. The method of claim 16, further comprising determining if the VT is still present after the NS therapy is applied, wherein applying the ATP therapy includes applying the ATP therapy only if the VT remains present after the NS therapy.

18. The method of claim 16, further comprising determining if the VT has been modified for the ATP therapy after the NS therapy is applied, wherein applying the ATP therapy includes applying the ATP therapy when it is determined that the VT has been modified for the ATP therapy.

19. The method of claim 18, further comprising applying shock therapy when it is determined that the NS therapy did not modify the VT for the ATP therapy.

20. The method of claim 19, wherein applying shock therapy includes applying shock therapy after a time out has occurred.

21. The method of claim 18, further comprising reapplying the NS therapy when it is determined that the NS therapy did not modify the VT for the ATP therapy.

22. The method of claim 21, further comprising adjusting NS therapy parameters before reapplying the NS therapy.

23. The method of claim 16, wherein applying the NS therapy to modify the VT includes comparing a composite feature set from at least one sensed signal associated with the VT until sensed signals associated with the modified VT has a composite feature set that indicates that the ATP therapy will be successful in terminating the modified VT.

24. The method of claim 16, wherein the composite feature set includes at least two features from the at least one sensed signal, the at least two features being selected from a heart rate, a stability of the heart rate, an irregularity of an electrogram morphology, or a pressure.

25. A system, comprising:

at least one sensor input adapted to receive at least one sensed signal associated with a tachyarrhythmia;

a feature set extractor adapted to extract at least two features from the at least one sensed signal associated with the tachyarrhythmia;

a feature set generator adapted to form a feature set using the at least two features extracted by the feature set extractor;

at least one generator adapted for use to selectively apply a shock therapy, an anti-tachycardia pacing (ATP) therapy, and a neural stimulation therapy; and

a controller adapted to respond to the feature set, the controller being adapted to initiate the shock therapy when the feature set corresponds to criteria for applying the shock therapy, initiate the ATP therapy when the feature set corresponds to criteria for applying the ATP therapy, and initiate the NS therapy when the feature set corresponds to criteria for applying the NS therapy.

26. The system of claim 25, wherein the controller is adapted to

determine if the feature set corresponds to the criteria for applying the ATP therapy, then determine if the feature set corresponds to the criteria for applying the shock therapy if the feature set did not correspond to the ATP therapy.

27. The system of claim 25, wherein the at least one sensor input includes an input to receive an electrogram (EGM) signal.

28. The system of claim 25, wherein the at least one sensor input includes an input to receive a signal from a hemodynamic sensor.

29. The system of claim 25, wherein the at least two features are selected from a heart rate, a stability of the heart rate, an irregularity of an electrogram morphology, or a pressure.

30. The system of claim 25, wherein the NS therapy is adapted to modify the tachyarrhythmia to be amenable to the ATP therapy, the feature set extractor is adapted to extract features from the modified tachyarrhythmia, the feature set generator is adapted to form a corresponding feature set for the modified tachyarrhythmia, and the controller is adapted to initiate the ATP therapy when the feature set for the modified tachyarrhythmia corresponds to criteria for applying the ATP therapy.

31. A system, comprising:

means for receiving at least one sensed signal associated with a tachyarrhythmia;

means for extracting at least two features from the at least one sensed signal associated with the tachyarrhythmia and forming a feature set using the at least two features;

means for providing a shock therapy when the feature set corresponds to criteria for applying the shock therapy;

means for providing an anti-tachycardia pacing (ATP) therapy when the feature set corresponds to criteria for applying the ATP therapy; and

means for providing a neural stimulation (NS) therapy when the feature set corresponds to criteria for applying the NS therapy to modify the tachyarrhythmia to be amenable to the ATP therapy.

32. The system of claim 31, wherein the means for receiving at least one sensed signal associated with the tachyarrhythmia includes means for receiving a heart rate value, a heart rate stability value, a regularity value for an electrogram morphology, and pressure value.

33. A method, comprising:

receiving at least one sensed signal associated with a tachyarrhythmia;

extracting at least two features from the at least one sensed signal associated with the tachyarrhythmia and forming a feature set using the at least two features;

providing a shock therapy when the feature set corresponds to criteria for applying the shock therapy;

providing an anti-tachycardia pacing (ATP) therapy when the feature set corresponds to criteria for applying the ATP therapy; and

providing a neural stimulation (NS) therapy when the feature set corresponds to criteria for applying the NS therapy to modify the tachyarrhythmia to be amenable to the ATP therapy.

34. The method of claim 33, wherein receiving at least one sensed signal associated with the tachyarrhythmia includes receiving a heart rate value, a heart rate stability value, a regularity value for an electrogram morphology, and pressure value.

35. The method of claim 33, wherein the criteria for applying the shock therapy includes:

criteria that indicates the tachyarrhythmia is hemodynamically unstable above a higher unstability threshold value;

criteria that indicates the tachyarrhythmia has a heart rate above a higher rate threshold;

or

criteria that indicates the tachyarrhythmia is hemodynamically unstable above a lower unstability threshold value and below the higher unstability value, that indicates the tachyarrhythmia has a heart rate above a lower rate threshold and below the higher unstability value, and indicates that the tachyarrhythmia has an irregular heart rate and morphology.

36. The method of claim 33, wherein the criteria for applying the ATP therapy includes:

criteria that indicates the tachyarrhythmia is slow and stable;

criteria that indicates the tachyarrhythmia is hemodynamically stable and slow;

or

criteria that indicates the tachyarrhythmia is hemodynamically stable and has a moderate rate and a regular morphology.

37. The method of claim 33, wherein the criteria for applying neural stimulation includes criteria that indicates the tachyarrhythmia is hemodynamically stable and has a fast and unstable rate.