Rate regularization of cardiac pacing for disordered breathing therapy

• US 7,336,996 B2
• Filed: 03/11/2004
• Issued: 02/26/2008
• Est. Priority Date: 09/18/2003
• Status: Expired due to Fees

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Stahmann, Jeffrey E., Hartley, Jesse W., Lee, Kent, Ni, Quan
• Primary Examiner(s): Layno; Carl
• Assistant Examiner(s): MORALES, JON ERIC C
• Application Number:
  US10/798,794
• Publication Number:
  US 20050065566A1
• Time in Patent Office: 1,447 Days
• Field of Search: 607/9, 607/14, 607/17, 607/18, 607/20, 607/25, 600/513, 600/529, 600/533, 600/534, 600/536, 600/538
• US Class Current: 607/17
• CPC Class Codes: A61B 5/0205 Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition
• CPC Class Codes: A61B 5/02405 Determining heart rate variability
• CPC Class Codes: A61N 1/3601 of respiratory organs
• CPC Class Codes: A61N 1/365 controlled by a physiological parameter, e.g. heart potential evoked response A61N1/371
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance

Abstract

An approach to providing disordered breathing therapy includes providing cardiac overdrive pacing using rate regularization. Overdrive pacing therapy may be initiated following detection or prediction of disordered breathing. Characteristics of the disordered breathing or other patient conditions may be used to modify the pacing therapy.

Claims

1. A method for delivering disordered breathing therapy to a patient, comprising:

measuring cardiac intervals between cardiac beats;

computing a first indicated pacing interval based at least on a measured cardiac interval duration and a previous value of the first indicated pacing interval; and

providing cardiac pacing to mitigate disordered breathing based on the first indicated pacing interval.

2. The method of claim 1, further comprising initiating delivery of the disordered breathing therapy based on detection of disordered breathing.

3. The method of claim 1, further comprising initiating delivery of the disordered breathing therapy based on prediction of disordered breathing.

4. The method of claim 1, wherein:

obtaining cardiac intervals comprises obtaining intervals between ventricular beats; and

providing the cardiac pacing to mitigate the disordered breathing comprises providing ventricular pacing.

5. The method of claim 1, wherein:

obtaining the cardiac intervals comprises obtaining intervals between atrial beats; and

providing the cardiac pacing to mitigate the disordered breathing comprises providing atrial pacing.

6. The method of claim 1, further comprising adapting the cardiac pacing based on characteristics of the disordered breathing.

7. The method of claim 1, further comprising adapting the cardiac pacing based on therapy efficacy.

8. The method of claim 1, further comprising adapting the cardiac pacing based on an impact of the therapy on the patient.

9. The method of claim 1, wherein the cardiac interval duration comprises a most recent cardiac interval duration.

10. The method of claim 1, wherein the cardiac interval duration comprises previous cardiac interval duration.

11. The method of claim 1, wherein providing the cardiac pacing to mitigate the disordered breathing comprises providing atrial pacing.

12. The method of claim 1, wherein providing the cardiac pacing to mitigate the disordered breathing comprises providing ventricular pacing.

13. The method of claim 1, wherein providing the cardiac pacing to mitigate the disordered breathing comprises providing bi-ventricular pacing.

14. The method of claim 1, wherein providing the cardiac pacing to mitigate the disordered breathing comprises providing overdrive pacing.

15. The method of claim 1, wherein providing the cardiac pacing to mitigate the disordered breathing comprises pacing at a rate above an intrinsic rate.

16. The method of claim 1, wherein measuring the cardiac intervals comprises measuring each cardiac interval duration between successive cardiac events beginning from an initiating event comprising a sensed or paced cardiac beat.

17. The method of claim 1, wherein measuring the cardiac intervals comprises measuring each cardiac interval duration between successive cardiac events from an initiating event to a terminating event comprising a sensed cardiac beat.

18. The method of claim 1, wherein computing the first indicated pacing interval comprises combining the previous value of the first indicated pacing interval and the measured cardiac interval duration.

19. The method of claim 1, wherein computing the first indicated pacing interval comprises combining the previous value of the first indicated pacing interval and the measured cardiac interval duration using a recursive filter.

20. A system for providing disordered breathing therapy to a patient, comprising:

a circuit configured to detect cardiac beats and measure cardiac intervals between cardiac beats;

a controller coupled to the circuit and configured to compute a first indicated pacing interval based at least on a measured cardiac interval duration and a previous value of the first indicated pacing interval; and

a cardiac pacing circuit coupled to the controller and configured to provide cardiac pacing to mitigate disordered breathing based on the first indicated pacing interval.

21. The therapy system of claim 20, wherein the controller comprises

a timer configured to measure durations of the cardiac intervals.

22. The therapy system of claim 20, wherein the controller comprises:

a timer configured to measure durations of the cardiac intervals between successive cardiac beats; and

a filter configured to combine the previous value of the first indicated pacing interval and the measured cardiac interval duration.

23. The therapy system of claim 20, further comprising disordered breathing detection circuitry coupled to the controller and configured to detect disordered breathing and initiate therapy to mitigate the disordered breathing based on the detection of disordered breathing.

24. The therapy system of claim 20, further comprising a detection system coupled to the controller, the detection system configured to detect one more characteristics of the disordered breathing, wherein the controller is further configured to adjust the cardiac pacing based on the one or more disordered breathing characteristics.

25. The therapy system of claim 20, further comprising a detection system coupled to the controller, the detection system configured to detect an impact of the disordered breathing therapy on the patient, wherein the controller is further configured to adjust the cardiac pacing based on the impact of the disordered breathing therapy on the patient.

26. The therapy system of claim 20, further comprising a disordered breathing prediction unit coupled to the controller and configured to detect disordered breathing and initiate therapy to mitigate the disordered breathing based on the prediction of disordered breathing.

27. The therapy system of claim 20, wherein the cardiac pacing circuit is configured to pace one or more atria.

28. The therapy system of claim 20, wherein the cardiac pacing circuit is configured to pace one or more ventricles.

29. The therapy system of claim 20, wherein the cardiac interval duration comprises a previous cardiac interval duration.

30. The therapy system of claim 20, wherein the cardiac interval duration comprises a most recent cardiac interval duration.

31. A system for providing disordered breathing therapy, comprising:

means for measureing cardiac intervals between cardiac beats;

means for computing a first indicated pacing interval based at least on a cardiac interval duration and a previous value of the first indicated pacing interval; and

means for providing cardiac pacing to mitigate disordered breathing based at least on the first indicated pacing interval.

32. The system of claim 31, further comprising means for initiating the disordered breathing therapy based on detection of disordered breathing.

33. The system of claim 31, further comprising means for initiating the disordered breathing therapy based on prediction of disordered breathing.

34. The system of claim 31, further comprising means for adapting the cardiac pacing based on characteristics of the disordered breathing.

35. The system of claim 31, further comprising means for adapting the cardiac pacing based on therapy efficacy.

36. The system of claim 31, further comprising means for adapting the cardiac pacing based on an impact of the therapy on the patient.