Delivery of cardiac pacing therapy for cardiac remodeling

Patent metadata

Field	Value
Publication number	US-12239840-B2
Application number	US-202217734958-A
Country	US
Kind code	B2
Filing date	May 2, 2022
Priority date	Jun 14, 2018
Publication date	Mar 4, 2025
Grant date	Mar 4, 2025

Abstract

A method and device apparatus to deliver a pacing therapy capable of remodeling a patient's heart over a period of time that includes monitoring one or more parameters in response to a delivered cardiac remodeling pacing, determining whether the cardiac remodeling pacing has an effect on cardiac normalization in response to the monitoring, and adjusting the cardiac remodeling pacing in response to the determined effect on cardiac normalization. The method and device may also perform short-term monitoring of one or more parameters in response to the delivered cardiac remodeling pacing, monitor one or more long-term parameter indicative of a long-term effect of the delivered cardiac remodeling pacing, determine the long-term effect of the delivered cardiac remodeling pacing on cardiac normalization in response to the monitoring, and adjust the cardiac remodeling pacing in response to one or both of the short-term monitoring and the determined long-term effect on cardiac normalization.

First claim

What is claimed:

1. A method comprising:
delivering cardiac remodeling pacing when the patient is inactive by delivering electrical pulses to the patient's heart to increase the patient's heart rate to stimulate one or more of dilation of chambers and muscular endurance of the patient's heart during a plurality of sessions over a period of time, wherein the period of time is greater than or equal to one week, wherein the cardiac remodeling pacing is suspended between each of the plurality of sessions;
monitoring one or more parameters, wherein at least one of the one or more parameters is indicative of an effect of the delivered cardiac remodeling pacing on one or more of dilation of chambers and muscular endurance of the patient's heart;
determining a long-term effect of the delivered cardiac remodeling pacing on one or more of dilation of chambers and muscular endurance of the patient's heart based on the one or more parameters monitored over the period of time, wherein the long-term effect of the delivered cardiac remodeling pacing on one or more of dilation of chambers and muscular endurance of the patient's heart is indicative of the effect of the delivered cardiac remodeling pacing on one or more of dilation of chambers and muscular endurance of the patient's heart over the period of time;
adjusting the cardiac remodeling pacing during a present session of the plurality of sessions in response to the one or more parameters monitored during the present session of the plurality of sessions; and
adjusting the cardiac remodeling pacing in response to the determined long-term effect on one or more of dilation of chambers and muscular endurance of the patient's heart.

2. The method of claim 1 , wherein monitoring the one or more parameters comprises sensing a cardiac signal during delivery of the cardiac remodeling pacing,
wherein determining the long-term effect of the delivered cardiac remodeling pacing on one or more of dilation of chambers and muscular endurance of the patient's heart based on the one or more parameters monitored over the period of time comprises:
determining QRS durations over the period of time based on the sensed cardiac signal, and
determining whether the QRS durations are increasing over the period of time;

wherein adjusting the cardiac remodeling pacing in response to the determined long-term effect on one or more of dilation of chambers and muscular endurance of the patient's heart comprises adjusting the cardiac remodeling pacing in response to determining that the QRS durations are increasing over the period of time.

3. The method of claim 1 , the method further comprising:
dividing each session of the plurality of sessions during which the cardiac remodeling pacing is delivered into predetermined time segments,
wherein determining the long-term effect of the delivered cardiac remodeling pacing on one or more of dilation of chambers and muscular endurance of the patient's heart based on the one or more parameters monitored over the period of time comprises determining, for each of the predetermined time segments, whether AV-block is occurring,
wherein adjusting the cardiac remodeling pacing in response to the determined long-term effect on one or more of dilation of chambers and muscular endurance of the patient's heart comprises inhibiting the cardiac remodeling pacing delivery during the predetermined time segments for which AV-block was determined to occur.

4. The method of claim 1 , wherein determining the long-term effect of the delivered cardiac remodeling pacing on one or more of dilation of chambers and muscular endurance of the patient's heart based on the one or more parameters monitored over the period of time comprises:
determining whether a slope of a cardiac output signal is increasing over the period of time; and
determining long-term improvement on one or more of dilation of chambers and muscular endurance of the patient's heart in response to determining that the slope of the cardiac output signal is increasing over the period of time.

5. The method of claim 1 , wherein monitoring the one or more parameters comprises sensing a cardiac impedance signal during delivery of the cardiac remodeling pacing,
wherein determining the long-term effect of the delivered cardiac remodeling pacing on one or more of dilation of chambers and muscular endurance of the patient's heart based on the one or more parameters monitored over the period of time comprises determining whether there is a predetermined change in impedance indicative of dilation of heart chambers based on the sensed cardiac impedance signal over the period of time,
wherein adjusting the cardiac remodeling pacing in response to the determined long-term effect on one or more of dilation of chambers and muscular endurance of the patient's heart comprises adjusting delivery of the cardiac remodeling pacing in response to determining that the predetermined change in impedance occurred.

6. The method of claim 1 , wherein determining the long-term effect of the delivered cardiac remodeling pacing on one or more of dilation of chambers and muscular endurance of the patient's heart based on the one or more parameters monitored over the period of time comprises determining changes in pulmonary pressure during delivery of the cardiac remodeling pacing over the period of time,
wherein adjusting the cardiac remodeling pacing in response to the determined long-term effect on one or more of dilation of chambers and muscular endurance of the patient's heart comprises adjusting delivery of the cardiac remodeling pacing in response to the determining changes in pulmonary pressure during delivery of the cardiac remodeling pacing over the period of time.

7. The method of claim 1 , wherein adjusting the cardiac remodeling pacing in response to the determined long-term effect on one or more of dilation of chambers and muscular endurance of the patient's heart comprises adjusting a duty cycle of the cardiac remodeling pacing in response to the determined long-term effect on one or more of dilation of chambers and muscular endurance of the patient's heart.

8. The method of claim 1 , wherein determining the long-term effect of the delivered cardiac remodeling pacing on one or more of dilation of chambers and muscular endurance of the patient's heart based on the one or more parameters monitored over the period of time comprises:
determining a recovery rate associated with an amount of time for a heart rate to return to a resting heart rate after delivery of the cardiac remodeling pacing during each session over the plurality of sessions over the period of time; and
comparing the determined recovery rate for each session to a baseline recovery rate,
wherein adjusting the cardiac remodeling pacing in response to the determined long-term effect on one or more of dilation of chambers and muscular endurance of the patient's heart comprises determining whether to suspend delivery of the cardiac remodeling pacing in response to the comparing the determined recovery rate of each session to the baseline recovery rate.

9. The method of claim 1 , wherein monitoring the one or more parameters comprises sensing a cardiac signal during delivery of the cardiac remodeling pacing, wherein determining the long-term effect of the delivered cardiac remodeling pacing on one or more of dilation of chambers and muscular endurance of the patient's heart based on the one or more parameters monitored over the period of time comprises determining whether there is a predetermined change in a systolic time interval based on the sensed cardiac signal over the period of time,
wherein adjusting the cardiac remodeling pacing in response to the determined long-term effect on one or

Assignees

• Medtronic Inc

Inventors

• Sharma Vinod
• Whitman Teresa A
• Jackson Troy E

Classifications

• A61N1/3684

  for stimulating the heart at multiple sites of the ventricle or the atrium · CPC title

• A61N1/36521

  the parameter being derived from measurement of an electrical impedance · CPC title

• A61N1/3627 Primary

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

• A61N1/36114

  Cardiac control, e.g. by vagal stimulation (stimulating the heart A61N1/362) · CPC title

• A61N1/36578

  controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone · CPC title