Pacing therapy selection for heart failure treatment

Patent metadata

Field	Value
Publication number	US-12064636-B2
Application number	US-202117361500-A
Country	US
Kind code	B2
Filing date	Jun 29, 2021
Priority date	Jul 30, 2020
Publication date	Aug 20, 2024
Grant date	Aug 20, 2024

Abstract

A method for heart failure management includes monitoring one or more sensor-based parameters for a patient to determine a pacing therapy. If the one or more parameters indicate atrial tachycardia or atrial fibrillation, a first pacing therapy is delivered. If the one or more parameters do not indicate atrial tachycardia or atrial fibrillation, it is determined whether the patient is asleep. If the patient is asleep, a second pacing therapy is delivered. If the one or more parameters do not indicate atrial tachycardia, atrial fibrillation, or that the patient is asleep, the patient's P-wave duration is evaluated with respect to a P-wave duration threshold value. When the patient's P-wave duration is determined to exceed the P-wave duration threshold value, a third pacing therapy is delivered, and when the patient's P-wave duration is determined to not exceed the P-wave duration threshold value, a fourth pacing therapy is delivered.

First claim

What is claimed is:

1. A heart failure management system comprising:
one or more sensors to measure one or more sensor-based parameters;
at least one storage component; and
processing circuitry operably coupled to the one or more sensors and the at least one storage component, the processing circuitry configured to:
determine whether the one or more monitored sensor-based parameters indicate atrial tachycardia or atrial fibrillation;
deliver a first pacing therapy in response to the one or more sensor-based parameters indicating atrial tachycardia or atrial fibrillation;
determine whether the one or more monitored sensor-based parameters indicate the patient is asleep in response to the one or more sensor-based parameters not indicating atrial tachycardia or atrial fibrillation;
deliver a second pacing therapy in response to the one or more sensor-based parameters indicating the patient is asleep;
determine whether the one or more monitored sensor-based parameters indicate the patient's P-wave duration exceeds a P-wave duration threshold value in response to the one or more sensor-based parameters not indicating the patient is asleep, atrial tachycardia, or atrial fibrillation;
deliver a third pacing therapy in response to the one or more sensor-based parameters indicating the patient's P-wave duration exceeds a P-wave duration threshold value; and
deliver a fourth pacing therapy in response to the one or more sensor-based parameters not indicating the patient's P-wave duration exceeds a P-wave duration threshold value.

2. A method for heart failure management comprising:
monitoring one or more sensor-based parameters for a patient;
determining whether the one or more monitored sensor-based parameters indicate atrial tachycardia or atrial fibrillation;
delivering a first pacing therapy in response to the one or more sensor-based parameters indicating atrial tachycardia or atrial fibrillation;
determining whether the one or more monitored sensor-based parameters indicate the patient is asleep in response to the one or more sensor-based parameters not indicating atrial tachycardia or atrial fibrillation;
delivering a second pacing therapy in response to the one or more sensor-based parameters indicating the patient is asleep;
determining whether the one or more monitored sensor-based parameters indicate the patient's P-wave duration exceeds a P-wave duration threshold value in response to the one or more sensor-based parameters not indicating the patient is asleep, atrial tachycardia, or atrial fibrillation;
delivering a third pacing therapy in response to the one or more sensor-based parameters indicating the patient's P-wave duration exceeds the P-wave duration threshold value; and
delivering a fourth pacing therapy in response to the one or more sensor-based parameters not indicating the patient's P-wave duration exceeds the P-wave duration threshold value.

3. The method of claim 2 , wherein the first pacing therapy is a first atrioventricular node stimulation sequence at a voltage greater than a threshold value.

4. The method of claim 3 , wherein the third pacing therapy comprises atrial pacing and a second atrioventricular node stimulation sequence at a voltage less than the threshold value.

5. The method of claim 4 , wherein the fourth pacing therapy comprises the second atrioventricular node stimulation sequence at a voltage less than the threshold value.

6. The method of claim 2 , wherein the second pacing therapy is overdrive pacing delivered at a predetermined frequency for a predetermined amount of time.

7. The method of claim 2 , wherein the P-wave duration threshold value is 120 ms.

8. The method of claim 2 , wherein the patient has heart failure with preserved ejection fraction.

9. A method for heart failure management comprising:
monitoring one or more sensor-based parameters for a patient;
determining whether the one or more monitored sensor-based parameters indicate atrial tachycardia or atrial fibrillation;
delivering a first pacing therapy in response to the one or more sensor-based parameters indicating atrial tachycardia or atrial fibrillation;
determining whether the one or more monitored sensor-based parameters indicate the patient is asleep in response to the one or more sensor-based parameters not indicating atrial tachycardia or atrial fibrillation; and
delivering a second pacing therapy in response to the one or more sensor-based parameters indicating the patient is asleep.

10. The method of claim 9 , wherein the first pacing therapy is an atrioventricular node stimulation sequence at a voltage greater than a threshold value.

11. The method of claim 9 , wherein the second pacing therapy is overdrive pacing delivered at a predetermined frequency for a predetermined amount of time.

12. The method of claim 11 , further comprising:
determining whether the patient's atrioventricular interval exceeds a threshold interval in response to delivering the overdrive pacing;
delivering DDD mode pacing with a predetermined atrioventricular interval in response to the patient's atrioventricular interval exceeding the threshold interval; and
monitoring the patient's atrioventricular interval in response to the patient's atrioventricular interval not exceeding the threshold interval.

13. A method for heart failure management comprising:
monitoring one or more sensor-based parameters for a patient;
determining whether the one or more monitored sensor-based parameters indicate atrial tachycardia or atrial fibrillation;
delivering a first pacing therapy in response to the one or more sensor-based parameters indicating atrial tachycardia or atrial fibrillation;
determining whether the one or more monitored sensor-based parameters indicate the patient's P-wave duration exceeds a P-wave duration threshold value in response to the one or more sensor-based parameters not indicating atrial tachycardia or atrial fibrillation;
delivering a second pacing therapy in response to the one or more sensor-based parameters indicating the patient's P-wave duration exceeds a P-wave duration threshold value; and
delivering a third pacing therapy in response to the one or more sensor-based parameters not indicating the patient's P-wave duration exceeds a P-wave duration threshold value.

14. The method of claim 13 , wherein the first pacing therapy comprises a first atrioventricular node stimulation sequence at a first voltage greater than a threshold value.

15. The method of claim 14 , wherein the second pacing therapy comprises atrial pacing and a second atrioventricular node stimulation sequence at a second voltage less than the threshold value.

16. The method of claim 15 , wherein the third pacing therapy comprises the second atrioventricular node stimulation sequence at a third voltage less than the threshold value.

17. A method for heart failure management comprising:
monitoring one or more sensor-based parameters for a patient;
determining whether the one or more monitored sensor-based parameters indicate the patient's P-wave duration exceeds a P-wave duration threshold value;
delivering a first atrioventricular node stimulation therapy in response to the one or more sensor-based parameters indicating the patient's P-wave duration exceeds a P-wave duration threshold value; and
delivering a second atrioventricular node stimulation therapy in response to the one or more sensor-based parameters not indicating the patient's P-wave duration exceeds a P-wave duration threshold value.

18. The method of claim 17 , wherein the fi

Assignees

• Medtronic Inc

Inventors

• Kornet Lilian
• Jackson Troy E

Classifications

• A61N1/3702

  Physiological parameters (A61N1/365 takes precedence; evoked response A61N1/371) · CPC title

• A61N1/3688

  configured for switching the pacing mode, e.g. from AAI to DDD · CPC title

• A61N1/025

  Digital circuitry features of electrotherapy devices, e.g. memory, clocks, processors · CPC title

• A61N1/3624 Primary

  occurring in the atrium, i.e. atrial tachycardia · CPC title

• A61N1/3627

  for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy · CPC title