System and method for decompensation detection and treatment based on patient hemodynamics

A method of operating an implanted cardiac rhythm management system in a patient, the method comprising:

• applying an electrical stimulus to the patient's heart at a first set of pacing parameters including an LRL setting;
• acquiring a CVP signal from a pressure sensor implanted in a coronary vein of the patient;
• calculating a baseline CV-EDP value from the CVP signal corresponding to a first interval;
• monitoring average CV-EDP values over a predetermined time interval subsequent to the first interval;
• comparing each of average CV-EDP values to the baseline CV-EDP value;
• automatically increasing the LRL setting in response to a difference (ΔCV-EDP) between at least one of the average CV-EDP values and the baseline average CV-EDP value exceeding a predetermined threshold;
• and
• subsequently automatically reducing the LRL setting upon detecting a predetermined event.

An implantable rate adaptive cardiac rhythm management system configured for applying pacing stimuli to a patient's heart, the pacing stimuli defined by pacing parameters including a pacing rate and an LRL setting, the system comprising:

• a plurality of implantable medical electrical leads configured to sense cardiac electrical activity and to deliver the pacing stimuli, at least one of the leads being configured for chronic implantation within a coronary vein of the patient's heart and including a pressure sensor configured to generate a coronary venous pressure (CVP) signal indicative of fluid pressure within the coronary vein;
• an implantable pulse generator operatively coupled to the leads configured to generate the pacing stimuli, the pulse generator including a control system configured to:
• acquire the CVP signal from the pressure sensor;
• calculate an average coronary venous end diastolic pressure (CV-EDP) value from the CVP signal;
• monitor the calculated average CV-EDP value over a predetermined interval;
• dynamically adjust the LRL setting responsive to the detection of a first or a second predetermined event based on the calculated average CV-EDP value.