Method and apparatus for preventing cardiac arrhythmias with endovascular stimulation

• US 8,792,979 B2
• Filed: 10/16/2006
• Issued: 07/29/2014
• Est. Priority Date: 03/25/2002
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Cates, Adam W.
• Primary Examiner(s): BOCKELMAN, MARK
• Application Number:
  US11/549,704
• Publication Number:
  US 20070129763A1
• Time in Patent Office: 2,843 Days
• Field of Search: 607 4- 5, 607/9, 607/14, 607/17, 607/25
• US Class Current: 607/5
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/3962 in combination with another heart therapy
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

Certain cardiac arrhythmias can be prevented by appropriate electrical stimulation of autonomic nerves innervating the heart. An implantable cardiac rhythm management device is configured to deliver such stimulation when an autonomic imbalance is predicted to be present via an endovascular electrode. Autonomic imbalance may be predicted to be present based upon circadian rhythms, detected heart rates, or detected heart rate variability.

Claims

1. An implantable device, comprising:

a pulse generator configurable into a parasympathetic channel for delivering stimulation to parasympathetic nerves;

a sensing amplifier configurable into a cardiac sensing channel for measuring the patient'"'"'s heart rate;

a controller programmed to detect an autonomic imbalance due to increased sympathetic activity when a calculated ratio of low frequency to high frequency variation in the measured heart rate is above a specified threshold; and

,

wherein the controller is programmed to deliver parasympathetic stimulation when an autonomic imbalance due to increased sympathetic activity is detected.

2. The device of claim 1 wherein the controller is further programmed to detect a tachyarrhythmia from the measured heart rate in accordance with rate-based criteria.

3. The device of claim 2 further comprising a shock pulse generator and wherein the controller is further programmed to deliver shock therapy upon detection of a tachyarrhythmia.

4. The device of claim 2 further comprising a pulse generator for delivering anti-tachycardia pacing and wherein the controller is further programmed to deliver anti-tachycardia pacing upon detection of a tachyarrhythmia.

5. The device of claim 2 wherein the controller is further programmed to suspend detection of an autonomic balance and delivery of parasympathetic stimulation when a tachyarrhythmia is detected.

6. The device of claim 1 wherein the controller is further programmed to measure atrial and ventricular rates from atrial and ventricular sensing channels.

7. The device of claim 1 wherein the controller is further programmed to detect an autonomic imbalance due to increased sympathetic activity when the measured heart rate is above a higher limit value.

8. The device of claim 7 wherein the controller is further programmed to modify the higher limit value in accordance with a measured exertion level in order to take into account the effects of metabolic demand on autonomic activity.

9. The device of claim 1 further comprising an endovascular electrode tier incorporation into the parasympathetic stimulation channel.

10. The device of claim 1 wherein controller further comprises a timer and is configured to deliver parasympathetic stimulation at timed intervals when autonomic imbalance is predicted to be present based upon known circadian rhythms.

11. A method for operating an implantable device, comprising:

measuring a patient'"'"'s heart rate;

detecting an autonomic imbalance due to increased sympathetic activity when a calculated ratio of low frequency to high frequency variation in the measured heart rate is above a specified threshold; and

,

delivering parasympathetic stimulation when an autonomic imbalance due to increased sympathetic activity is detected.

12. The method of claim 11 further comprising detecting a tachyarrhythmia from the measured heart rate in accordance with rate-based criteria.

13. The method of claim 12 further comprising delivering shock therapy upon detection of a tachyarrhythmia.

14. The method of claim 12 further comprising delivering anti-tachycardia pacing upon detection of a tachyarrhythmia.

15. The method of claim 12 further comprising suspending detection of an autonomic balance and delivery of parasympathetic stimulation when a tachyarrhythmia is detected.

16. The method of claim 11 further comprising measuring atrial and ventricular rates from atrial and ventricular sensing channels.

17. The method of claim 11 further comprising detecting an autonomic imbalance due to increased sympathetic activity when the measured heart rate is above a higher limit value.

18. The method of claim 17 further comprising modifying the higher limit value in accordance with a measured exertion level in order to take into account the effects of metabolic demand on autonomic activity.

19. The method of claim 11 wherein the parasympathetic stimulation is delivered using an endovascular electrode.

20. The method of claim 11 further comprising delivering parasympathetic stimulation at timed intervals when autonomic imbalance is predicted to be present based upon known circadian rhythms.