System and Method for Achieving Regular Slow Ventricular Rhythm in Response to Atrial Fibrillation

23:

• A method for post-operatively controlling ventricular rate comprising:
• placing an epicardial lead at a fat pad of a heart during open heart surgery, the heart having an atrioventricular (“AV”) node and the fat pad containing parasympathetic ganglia that supply the AV node;
• completing the open heart surgery with the epicardial lead intact;
• monitoring for atrial fibrillation post-operatively;
• applying vagal stimulation to the fat pad through the epicardial lead when atrial fibrillation is detected in the atrial fibrillation monitoring step, to obtain a lower ventricular rate;
• and
• removing the epicardial lead.

26:

• A method for post-operatively controlling ventricular rate in a heart of a patient, the heart having an atrioventricular (“AV”) node and a fat pad containing parasympathetic ganglia that supply the AV node, and a temporary epicardial lead being placed at the fat pad, the method comprising:
• monitoring for atrial fibrillation post-operatively;
• and
• applying vagal stimulation to the fat pad through the temporary epicardial lead when atrial fibrillation is detected in the atrial fibrillation monitoring step, to obtain a ventricular rate of an acceptable physiological level.

The method of claim 26 wherein the applying step comprises:

• delivering a level of vagal stimulation;
• determining whether the ventricular rate is at the acceptable physiological level as a result of the delivering step;
• and
• repeating the delivering step and the determining step with the level of vagal stimulation increased if the ventricular rate exceeds the acceptable physiological level.

33:

• A method for post-operatively controlling ventricular rate in a heart of a patient, the heart having an atrioventricular node, an atrioventricular nodal fat pad, and a temporary epicardial lead:
• that is placed at the atrioventricular nodal fat pad, the method comprising:
• monitoring post-operatively an electrocardiogram for atrial fibrillation;
• intermittently delivering a level of vagal stimulation to the atrioventricular nodal fat pad through the temporary epicardial lead when atrial fibrillation is detected:
• in the atrial fibrillation monitoring step;
• determining whether ventricular rate is at an acceptable physiological level as a result of the delivering step;
• repeating the delivering step and the monitoring step with the level of vagal stimulation increased if the ventricular rate exceeds the acceptable physiological level;
• and
• terminating the delivering step if the ventricular rate is at the acceptable physiological level, or if the level of vagal stimulation reaches a predetermined maximum level of vagal stimulation.

An apparatus for postoperatively controlling ventricular rate in a heart of a patient, the heart having an atrioventricular (“AV”) node and a fat pad containing parasympathetic ganglia that supply the AV node, and a temporary epicardial lead being placed at the fat pad, the apparatus comprising:

• a stimulation driver electrically coupled to the temporary epicardial lead;
• a source of monitoring signals indicative of atrial fibrillation;
• a microprocessor or microcontroller for processing the signals and controlling “the stimulation” driver;
• and
• a memory comprising instructions for detecting atrial fibrillation from the monitoring signals;
• and
• applying vagal stimulation to the fat pad through the temporary epicardial lead when atrial fibrillation is detected, to obtain a ventricular rate of an acceptable physiological level.

38:

• The apparatus of claim 34 wherein the applying instruction comprises instructions for:
• delivering a level of vagal stimulation;
• determining whether the ventricular rate is at the acceptable physiological level as a result of the delivering instruction;
• and
• repeating the delivering instruction and the determining instruction with the level of vagal stimulation increased if the ventricular rate exceeds the acceptable physiological level.

40:

• A storage medium containing a set of computer instructions for post-operatively controlling ventricular rate in a heart of a patient, the heart having an atrioventricular (“AV”) node and a fat pad containing parasympathetic ganglia that supply the AV node, and a temporary epicardial lead being placed at the fat pad, the set of instructions comprising instructions for:
• monitoring for atrial fibrillation;
• and
• applying vagal stimulation to the fat pad through the temporary epicardial lead when atrial fibrillation is detected in the atrial fibrillation monitoring step, to obtain a ventricular rate of an acceptable physiological level.