Respiratory-based cardiac remodeling pacing therapy

Patent metadata

Field	Value
Publication number	US-12508428-B2
Application number	US-202318101799-A
Country	US
Kind code	B2
Filing date	Jan 26, 2023
Priority date	Jan 26, 2023
Publication date	Dec 30, 2025
Grant date	Dec 30, 2025

Abstract

Systems, devices, and methods for performing respiratory-based cardiac remodeling pacing therapy are described in this disclosure. A patent's respiration may be monitored, and the lower pacing limit for the cardiac remodeling pacing and support pacing therapy delivered to a patient may be adjusted based on the monitored respiration to achieve or restore respiratory sinus arrhythmia.

First claim

What is claimed:

1 . An implantable medical device comprising:
a pacing electrode to be positioned proximate a patient's heart to deliver pacing therapy to the patient's heart; a respiration sensor to determine the patient's respiration rate; and a computing apparatus operably coupled to the pacing electrode and the respiration sensor, the computing apparatus configured to:
deliver pacing to the patient's heart using at least the pacing electrode based on a lower rate limit, wherein the lower rate limit is a minimum pacing rate delivered to the patient,
monitor the patient's respiration using the respiration sensor,
adjust the lower rate limit based on the patient's respiration to restore respiratory sinus arrhythmia (RSA), and
initiate cardiac remodeling pacing comprising increasing the lower rate limit, wherein the cardiac remodeling pacing is configured to provide or cause cardiac remodeling of physical structures of the patient's heart.

2 . The device of claim 1 , wherein adjusting the lower rate limit based on the patient's respiration rate to restore RSA comprises:
determining exhalation based on the patient's monitored respiration; increasing the lower rate limit during exhalation by a RSA value; determining inhalation based on the patient's monitored respiration; and decreasing the lower rate limit during inhalation by the RSA value.

3 . The device of claim 2 , wherein the RSA value is less than or equal to 15 beats per minute.

4 . The device of claim 2 , wherein the RSA value is based on one or more of the patient's heart rate, respiration rate, and activity level.

5 . The device of claim 2 , wherein the computing apparatus is further configured to decrease the RSA value during the cardiac remodeling pacing.

6 . The device of claim 1 , wherein increasing the lower rate limit comprises increasing the lower rate limit to a cardiac remodeling pacing rate.

7 . The device of claim 6 , wherein the cardiac remodeling pacing rate is greater than or equal to 100 beats per minute.

8 . The device of claim 1 , wherein increasing the lower rate limit comprises gradually increasing the lower rate limit according to ramp rate until the lower rate limit is equal to a cardiac remodeling pacing rate.

9 . The device of claim 8 , wherein the ramp rate is greater than or equal to 1 beat per minute increase for every 8 cardiac cycles.

10 . The device of claim 1 , wherein the lower rate limit is initially set to a minimum lower rate limit, wherein the minimum lower rate limit is greater than or equal to 60 beats per minute.

11 . The device of claim 1 , wherein the pacing electrode to be positioned proximate a portion of the cardiac conduction system of the patient's heart to deliver cardiac conduction system pacing therapy to the patient's heart, wherein delivering pacing using at least the pacing electrode based on the lower rate limit comprises delivering cardiac conduction system pacing therapy using at least the pacing electrode based on the lower rate limit.

12 . The device of claim 1 , wherein the cardiac remodeling pacing is initiated in response to inactive times periods when the patient is inactive or asleep.

13 . A method comprising:
delivering pacing to a patient's heart based on a lower rate limit, wherein the lower rate limit is a minimum pacing rate delivered to the patient; monitoring the patient's respiration; adjusting the lower rate limit based on the patient's respiration to restore respiratory sinus arrhythmia (RSA); and initiating cardiac remodeling pacing comprising increasing the lower rate limit, wherein the cardiac remodeling pacing is configured to provide or cause cardiac remodeling of physical structures of the patient's heart.

14 . The method of claim 13 , wherein adjusting the lower rate limit based on the patient's respiration rate to restore RSA comprises:
determining exhalation based on the patient's monitored respiration; increasing the lower rate limit during exhalation by a RSA value; determining inhalation based on the patient's monitored respiration; and decreasing the lower rate limit during inhalation by the RSA value.

15 . The method of claim 14 , wherein the RSA value is less than or equal to 15 beats per minute.

16 . The method of claim 14 , wherein the RSA value is based on one or more of the patient's heart rate, respiration rate, and activity level.

17 . The method of claim 14 , wherein the method further comprises decreasing the RSA value during the cardiac remodeling pacing.

18 . The method of claim 13 , wherein increasing the lower rate limit comprises increasing the lower rate limit to a cardiac remodeling pacing rate.

19 . The method of claim 18 , wherein the cardiac remodeling pacing rate is greater than or equal to 100 beats per minute.

20 . The method of claim 13 , wherein increasing the lower rate limit comprises gradually increasing the lower rate limit according to ramp rate until the lower rate limit is equal to a cardiac remodeling pacing rate.

21 . The method of claim 20 , wherein the ramp rate is greater than or equal to 1 beat per minute increase for every 8 cardiac cycles.

22 . The method of claim 13 , wherein the lower rate limit is initially set to a minimum lower rate limit, wherein the minimum lower rate limit is greater than or equal to 60 beats per minute.

23 . The method of claim 13 , wherein delivering pacing to a patient's heart based on the lower rate limit comprises delivering cardiac conduction system pacing therapy to the patient's cardiac conduction system based on the lower rate limit.

24 . The method of claim 13 , wherein the cardiac remodeling pacing is initiated in response to inactive times periods when the patient is inactive or asleep.

25 . An implantable medical device comprising:
a pacing electrode to be positioned proximate a patient's heart to deliver pacing therapy to the patient's heart; a respiration sensor to determine a respiration rate of the patient; and a computing apparatus operably coupled to the pacing electrode and the respiration sensor, the computing apparatus configured to:
switch between delivering support pacing to the patient's heart using at least the pacing electrode based on a support pacing rate or delivering cardiac remodeling pacing to the patient's heart using at least the pacing electrode to provide cardiac remodeling based on a cardiac remodeling pacing rate, wherein the cardiac remodeling pacing rate is greater than the support pacing rate, wherein the cardiac remodeling pacing is configured to provide or cause cardiac remodeling of physical structures of the patient's heart;
monitor the patient's respiration rate using the respiration sensor; and
adjust the cardiac remodeling pacing rate and the support pacing rate based on the patient's respiration rate to restore respiratory sinus arrhythmia (RSA).

26 . The device of claim 25 , wherein adjusting the cardiac remodeling pacing rate and the support pacing rate on the patient's respiration rate to restore RSA comprises:
determining exhalation based on the patient's monitored respiration; increasing the cardiac remodeling pacing rate and the support pacing rate during exhalation by a RSA value; determining inhalation based on the patient's monitored respiration; and decreasing the cardiac remodeling pacing rate and the support pacing rate during inhalation by

Assignees

• Medtronic Inc

Inventors

• Hoffman Matthew J
• Jackson Troy E
• Eggen Michael D

Classifications

• A61N1/3702

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

• A61B5/4836

  Diagnosis combined with treatment in closed-loop systems or methods (A61B5/0036 takes precedence) · CPC title

• A61N1/36514 Primary

  controlled by a physiological quantity other than heart potential, e.g. blood pressure (controlled by two or more physical parameters A61N1/36585) · CPC title

• A61B5/0816

  Measuring devices for examining respiratory frequency (measuring frequency of electric signals G01R23/00) · CPC title

• A61N1/3627 Primary

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