Methods and systems for lowering blood pressure through reduction of ventricle filling
Inventors
Mika, Yuval • Sherman, Darren • Schwartz, Robert S. • Van Tassel, Robert A. • Burkhoff, Daniel
Assignees
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Publication Number
US-11097108-B2
Publication Date
2021-08-24
Expiration Date
Abstract
Systems and methods for reducing ventricle filling volume are disclosed. In some embodiments, a stimulation circuit may be used to stimulate a patient's heart to reduce ventricle filling volume or even blood pressure. When the heart is stimulated at a consistent rate to reduce blood pressure, the cardiovascular system may over time adapt to the stimulation and revert back to the higher blood pressure. In some embodiments, the stimulation pattern may be configured to be inconsistent such that the adaptation response of the heart is reduced or even prevented. In some embodiments, a stimulation circuit may be used to stimulate a patient's heart to cause at least a portion of an atrial contraction to occur while the atrioventricular valve is closed. Such an atrial contraction may deposit less blood into the corresponding ventricle than when the atrioventricular valve is opened throughout an atrial contraction.
Core Innovation
The invention addresses a blood pressure disorder in a patient by using an implanted heart muscle stimulator to treat the patient based on atrial contraction timing. A future anticipated contraction of an atrium associated with a ventricle is determined, and one or more stimulation pulses are delivered to the ventricle a pacing time interval before the future anticipated contraction begins.
The ventricle begins contracting before the future anticipated contraction of the atrium begins, and the treatment reduces blood pressure to below the pretreatment blood pressure by at least one of reduced ventricular filling or increased atrial stretch. The timing relationship between ventricular stimulation and the future anticipated atrial contraction is used to affect ventricular filling and atrial stretch, which are linked to the resulting blood pressure reduction.
The disclosed approaches further include sensing-based and adaptive delivery concepts, in which stimulation delivery to cardiac chambers can be inhibited when natural excitation occurs. Pacing delivery rates can be increased or decreased based on sensed natural excitations exceeding or falling below predetermined thresholds over a given time frame.
Claims Coverage
The partial content includes three independent claims that cover anticipatory ventricular pacing for blood pressure reduction, adaptive stimulation delivery based on sensed natural excitation and thresholds, and a system for treating a blood pressure disorder with a stimulation circuit and controller executing the anticipatory pacing interval.
Anticipated atrial contraction pacing for blood pressure reduction
Determining a future anticipated contraction of an atrium; delivering one or more stimulation pulses to a ventricle a pacing time interval before the future anticipated contraction such that the ventricle begins contracting before the future anticipated contraction begins; and reducing blood pressure to below pretreatment blood pressure by at least one of reduced ventricular filling or increased atrial stretch.
Adaptive stimulation inhibiting and rate adjustment based on natural excitation
Delivering stimulation pulses to an atrium and a ventricle at a first delivery rate expected to be higher than a natural heart rate; sensing whether a natural excitation occurs between delivery of the stimulation pulses; when the natural excitation occurs, inhibiting delivery of next stimulation pulses; when an amount of sensed natural excitations exceeds a predetermined higher threshold over a given time frame, identifying the natural heart rate as higher than the first delivery rate and increasing the first delivery rate to a second delivery rate higher than the natural heart rate; and when an amount of sensed natural excitations is lower than a predetermined lower threshold over a given time frame, decreasing the first delivery rate to a third delivery rate to avoid over-excitation of the heart.
System with controller-executed anticipatory pacing interval to reduce blood pressure
A stimulation circuit configured to deliver a stimulation pulse to at least one cardiac chamber; and at least one controller configured to execute delivery to a ventricle a pacing time interval before a future anticipated contraction of an atrium associated with the ventricle such that the ventricle begins contracting before the future anticipated contraction begins, thereby reducing blood pressure to below the pretreatment blood pressure by at least one of reduced ventricular filling or increased atrial stretch.
Across the independent claims, the central inventive theme is anticipatory cardiac stimulation relative to a future anticipated atrial contraction to cause the ventricle to begin contracting first and thereby reduce blood pressure below a pretreatment level via reduced ventricular filling and/or increased atrial stretch, with an additional independent claim covering adaptive delivery inhibition and rate adjustment based on sensed natural excitations and thresholds.
Stated Advantages
Reducing blood pressure of the patient to below the pretreatment blood pressure by at least one of reduced ventricular filling or increased atrial stretch.
Documented Applications
Treating a blood pressure disorder in a patient using an implanted heart muscle stimulator and timed ventricular stimulation relative to a future anticipated contraction of an atrium.
Reducing blood pressure of a patient using stimulation pulses delivered to an atrium and a ventricle with rate adaptation based on sensed natural excitation relative to predetermined higher and lower thresholds.
Treating a blood pressure disorder using a system with a stimulation circuit and a controller configured to deliver ventricular stimulation at a pacing time interval before a future anticipated atrial contraction.
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