Neurostimulation in a neural fulcrum zone for the treatment of chronic cardiac dysfunction

A method of operating an implantable medical device (IMD), the method comprising:

• generating a plurality of stimulation signals configured to stimulate a nerve of a patient, each stimulation signal of the plurality of stimulation signals having a duty cycle, a frequency, an amplitude, and a pulse width, wherein generating the plurality of stimulation signals comprises adjusting at least one of the duty cycle, the amplitude, or the pulse width while maintaining a fixed frequency across the plurality of stimulation signals;
• detecting a cardiac parameter response of the patient during the generation of the plurality of stimulation signals;
• identifying a range of the adjusted at least one of the duty cycle, the pulse width, or the amplitude that results in the cardiac parameter response being between a baseline cardiac parameter and a cardiac parameter decrease threshold;
• and
• delivering a plurality of stimulation signals at a duty cycle, a frequency, an amplitude, and a pulse width resulting in the cardiac parameter response being between the baseline cardiac parameter and the cardiac parameter decrease threshold.

An implantable medical device (IMD), comprising:

• a neurostimulator configured to deliver a stimulation signal to a nerve of a patient;
• and
• a control system programmed to:
• generate a plurality of stimulation signals configured to stimulate a nerve of a patient, each stimulation signal of the plurality of stimulation signals having a duty cycle, a frequency, an amplitude, and a pulse width, wherein control system is programmed to generate the plurality of stimulation signals by adjusting at least one of the duty cycle, the amplitude, or the pulse width while maintaining a fixed frequency across the plurality of stimulation signals;
• detect a cardiac parameter response of the patient during the generation of the plurality of stimulation signals;
• identify a range of the adjusted at least one of the duty cycle, the pulse width, or the amplitude that results in the cardiac parameter response being between a baseline cardiac parameter and a cardiac parameter decrease threshold;
• and
• deliver a plurality of stimulation signals at a duty cycle, a frequency, an amplitude, and a pulse width resulting in the cardiac parameter response being between the baseline cardiac parameter and the cardiac parameter decrease threshold.