SYSTEM AND METHOD FOR DECOMPENSATION DETECTION AND TREATMENT BASED ON PATIENT HEMODYNAMICS

• US 20100305649A1
• Filed: 05/26/2010
• Published: 12/02/2010
• Est. Priority Date: 06/01/2009
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Maskara, Barun, Liu, Lili, Alvarez, Guy, Meyer, Scott A.
• Granted Patent: US 8,423,140 B2
• Time in Patent Office: Days
• US Class Current: 607/23
• CPC Class Codes: A61N 1/36564 controlled by blood pressure

Abstract

A system and method for detecting and treating symptoms of early decompensation utilizing a cardiac rhythm management. The system applies an electrical stimulus to the patient'"'"'s heart at a first set of pacing parameters including a lower rate limit (LRL) setting, and acquires a coronary venous pressure (CVP) signal from a pressure sensor implanted in a coronary vein of the patient. An average coronary venous end diastolic pressure (CV-EDP) value is calculated from the CVP signal. The system monitors the average CV-EDP value over a predetermined interval, and dynamically adjusts the LRL setting responsive to the detection of a first or a second predetermined event based on the average CV-EDP value.

Claims

1. A method of operating an implanted cardiac rhythm management system in a patient, the method comprising:

applying an electrical stimulus to the patient'"'"'s heart at a first set of pacing parameters including a lower rate limit (LRL) setting;

acquiring a coronary venous pressure (CVP) signal from a pressure sensor implanted in a coronary vein of the patient;

calculating an average coronary venous end diastolic pressure (CV-EDP) value from the CVP signal;

monitoring the average CV-EDP value over a predetermined interval; and

dynamically adjusting the LRL setting responsive to the detection of a first or a second predetermined event based on the average CV-EDP value.

2. The method of claim 1 wherein dynamically adjusting the LRL setting includes increasing the LRL setting in response to detecting the first predetermined event.

6. The method of claim 1 wherein the second predetermined event is an expiration of a predetermined time period for applying the electrical stimulus at the increased LRL setting.

7. The method of claim 1 wherein calculating the average CV-EDP value includes generating a CVP waveform based on the CVP signal and calculating an average CV-EDP value over a predetermined interval based on the CVP waveform.

8. The method of claim 7 wherein the first predetermined event is an increase in the average CV-EDP value over a selected interval exceeding a predetermined threshold.

3. The method of claim 3 wherein the first predetermined event is an increase in the average CV-EDP value indicative of an onset of early decompensation symptoms.

4. The method of claim 3 wherein dynamically adjusting the LRL setting includes reducing the LRL setting upon detecting the second predetermined event.

5. The method of claim 4 wherein the second predetermined event is a reduction in the average CV-EDP value indicating the termination of early decompensation symptoms.

9. A method of operating an implanted cardiac rhythm management system in a patient, the method comprising:

applying an electrical stimulus to the patient'"'"'s heart at a first set of pacing parameters including an LRL setting;

acquiring a CVP signal from a pressure sensor implanted in a coronary vein of the patient;

calculating a baseline CV-EDP value from the CVP signal corresponding to a first interval;

monitoring average CV-EDP values over a predetermined time interval subsequent to the first interval;

comparing each of average CV-EDP values to the baseline CV-EDP value;

automatically increasing the LRL setting in response to a difference (Δ

CV-EDP) between at least one of the average CV-EDP values and the baseline average CV-EDP value exceeding a predetermined threshold; and

subsequently automatically reducing the LRL setting upon detecting a predetermined event.

10. The method of claim 9 wherein the predetermined event includes the Δ

CV-EDP returning to below the predetermined threshold.

11. The method of claim 9 wherein the predetermined event is an expiration of a predetermined time period for applying the electrical stimulus at the increased LRL setting.

12. The method of claim 9 wherein the baseline CV-EDP value is a rolling average CV-EDP value over a plurality of cardiac cycles or a predetermined time interval.

13. The method of claim 9 further comprising recalculating the baseline CV-EDP value after reducing the LRL setting upon detecting the predetermined event.

14. The method of claim 9 wherein the predetermined threshold is a programmed percentage change in any of the plurality of average CV-EDP values relative to the baseline CV-EDP value.

15. The method of claim 9 monitoring average CV-EDP values includes generating a CVP waveform based on the CVP signal and calculating an average CV-EDP value over a predetermined interval based on the CVP waveform.

16. The method of claim 9 wherein the automatically increasing the LRL setting includes maintaining the LRL setting at the increased setting for a prescribed time interval.

17. The method of claim 16 further comprising increasing the LRL if the predetermined event is not detected after the prescribed time interval.

18. The method of claim 17 further comprising increasing the LRL up to a prescribed maximum LRL if the predetermined event is not detected after the prescribed time interval.

19. An implantable rate adaptive cardiac rhythm management system configured for applying pacing stimuli to a patient'"'"'s heart, the pacing stimuli defined by pacing parameters including a pacing rate and an LRL setting, the system comprising:

a plurality of implantable medical electrical leads configured to sense cardiac electrical activity and to deliver the pacing stimuli, at least one of the leads being configured for chronic implantation within a coronary vein of the patient'"'"'s heart and including a pressure sensor configured to generate a coronary venous pressure (CVP) signal indicative of fluid pressure within the coronary vein;

an implantable pulse generator operatively coupled to the leads configured to generate the pacing stimuli, the pulse generator including a control system configured to;

acquire the CVP signal from the pressure sensor;

calculate an average coronary venous end diastolic pressure (CV-EDP) value from the CVP signal;

monitor the calculated average CV-EDP value over a predetermined interval;

dynamically adjust the LRL setting responsive to the detection of a first or a second predetermined event based on the calculated average CV-EDP value.

20. The system of claim 19 wherein the pulse generator is further configured to estimate and monitor average left ventricular end diastolic pressure (LV-EDP) values based on the CVP signal.