Evaluating a patient condition using autonomic balance information in implatable cardiac devices

• US 7,899,519 B2
• Filed: 06/28/2005
• Issued: 03/01/2011
• Est. Priority Date: 06/28/2005
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Carlson, Gerrard Merrill, Kenknight, Bruce H., Zhu, Qingsheng
• Primary Examiner(s): Layno; Carl H.
• Assistant Examiner(s): MORALES, JON ERIC C
• Application Number:
  US11/168,614
• Publication Number:
  US 20060293604A1
• Time in Patent Office: 2,072 Days
• Field of Search: 600/509, 600/519, 600/515, 600/529, 600/513, 600/483, 600/484
• US Class Current: 600/509
• 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 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/4809 Sleep detection, i.e. determining whether a subject is asleep or not
• CPC Class Codes: A61B 5/4812 Detecting sleep stages or cycles
• CPC Class Codes: A61M 16/0051 with alarm devices
• CPC Class Codes: A61M 16/024 including calculation means, e.g. using a processor
• CPC Class Codes: A61M 2230/04 Heartbeat characteristics, e.g. ECG, blood pressure modulation
• CPC Class Codes: A61M 2230/10 Electroencephalographic signals
• CPC Class Codes: A61M 2230/63 Motion, e.g. physical activity
• CPC Class Codes: A61M 2230/65 Impedance, e.g. conductivity, capacity
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions
• CPC Class Codes: A61N 1/365 controlled by a physiological parameter, e.g. heart potential evoked response A61N1/371

Abstract

Systems and methods for evaluating a patient condition using autonomic balance information involve providing an implantable cardiac device that acquires a cardiac waveform from a patient. One or more characteristics associated with autonomic balance of the patient are detected and used to evaluate a patient condition, such as sleep onset, sleep stage, cardiac vulnerability over a predetermined duration, and sleep disordered breathing. Patient activity levels may be sensed and used to evaluate the patient'"'"'s condition, such as for determining a level of systemic stress. Characteristics associated with the autonomic balance include calculating an LF/HF ratio waveform and/or determining one or more morphological features of the LF/HF ratio waveform. Coordination with a patient-external device may facilitate transmission of information about one or more of the cardiac waveform, the one or more characteristics associated with the autonomic balance, and a marked cardiac waveform.

Claims

1. A method, comprising:

acquiring a cardiac waveform from a patient using an implantable cardiac device provided in a patient;

detecting one or more characteristics associated with autonomic balance of the patient; and

using the one or more autonomic balance characteristics to evaluate one or more patient conditions, the one or more patient conditions comprising sleep onset.

2. The method of claim 1, wherein the one or more patient conditions comprise sleep stage.

3. The method of claim 1, wherein the one or more patient conditions comprise cardiac vulnerability over a predetermined duration.

4. The method of claim 3, wherein the predetermined duration is during patient sleep.

5. The method of claim 1, wherein the one or more patient conditions comprise sleep disordered breathing.

6. The method of claim 1, comprising:

sensing a patient activity level; and

further evaluating the patient'"'"'s condition using the sensed patient activity level.

7. The method of claim 6, wherein further evaluating the patient'"'"'s condition comprises determining a level of systemic stress.

8. The method of claim 1, wherein detecting the one or more characteristics associated with the autonomic balance comprises calculating an LF/HF ratio waveform and determining one or more morphological features of the LF/HF ratio waveform.

9. The method of claim 1, comprising generating a marked cardiac waveform using the cardiac waveform and one or more symbols indicating the one or more characteristics associated with the autonomic balance.

10. The method of claim 9, further comprising transmitting information about one or more of the cardiac waveform, the one or more characteristics associated with the autonomic balance, and the marked cardiac waveform to a patient-external device.

11. A cardiac system, comprising:

a housing configured for implantation in a patient;

a plurality of electrodes coupled to the housing and configured for sensing a cardiac waveform;

a memory; and

a controller provided in the housing and coupled to the memory and the plurality of electrodes, the controller configured to detect one or more characteristics associated with an autonomic balance of the patient, and use the one or more autonomic balance characteristics to detect patient sleep and evaluate a patient condition.

12. The system of claim 11, comprising a patient-external device, wherein the controller and the patient-external device are coupled to respective communication devices to facilitate wireless communication between the patient-external device and the controller.

13. The system of claim 11, wherein the controller is configured to classify the cardiac waveform as associated with one or more of sleep state, sleep stage, and sleep apnea.

14. The system of claim 11, comprising a lead coupled to the controller and configured for implantation in a patient, wherein one or more of the plurality of electrodes is supported by the lead.

15. A cardiac system, comprising:

means for acquiring a cardiac waveform;

means for detecting one or more characteristics associated with an autonomic balance of a patient; and

means for detecting patient sleep and evaluating a patient condition using the one or more characteristics associated with the autonomic balance.

16. The system of claim 15, comprising means for determining a patient activity level using the transthoracic impedance.

17. The system of claim 15, comprising means for calculating an LF/HF ratio.

18. The system of claim 15, comprising means for generating a marked cardiac waveform using the cardiac waveform and one or more symbols indicating the one or more characteristics associated with the autonomic balance.

19. The system of claim 18, further comprising means for transmitting information about one or more of the cardiac waveform, the one or more characteristics associated with the patient autonomic balance, and the marked cardiac waveform to a patient-external device.