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US 8,412,324 B2Granted
Method and device for treating myocardial ischemia
AssigneeCardiac Pacemakers, Inc.
InventorsRodney W. Salo, Allan C. Shuros, Tamara Colette Baynham
Life of this patent
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Abstract
A method and device for treating myocardial ischemia are described in which the stress experienced by a myocardial region identified as vulnerable to becoming ischemic is varied with pre-excitation pacing. In an unloading mode, pacing is applied in proximity to the vulnerable region to reduce stress and the metabolic demand of the region. In a loading mode, pacing is applied to a region remote from the vulnerable region in order to produce a conditioning effect.
Claims19
A method, comprising:
- identifying a vulnerable ventricular region in a patient that is predisposed to becoming ischemic;
- implanting a cardiac pacing device having first and second electrodes;
- implanting the first electrode near the ventricular region vulnerable to ischemia so that a pacing pulse from the first electrode unloads the vulnerable region during systole as compared with an intrinsic beat;
- implanting the second electrode near a ventricular region remote from the vulnerable region so that a pacing pulse from the second electrode loads the vulnerable region during systole as compared with an intrinsic beat;
- configuring the device to operate in a vulnerable region unloading mode that delivers pacing pulses in accordance with an atrial tracking or AV sequential pacing mode with a specified AV delay interval through a pacing channel configured with the first electrode, a vulnerable region loading mode that delivers pacing pulses in accordance with an atrial tracking or AV sequential pacing mode with a specified AV delay interval through a pacing channel configured with the second electrode, or a normal mode that delivers no pacing pulses to either the first or second electrodes;
- configuring the device to sense a variable that can be correlated with the occurrence of myocardial ischemia and to detect the presence or absence of myocardial ischemia in accordance with the sensed variable;
- configuring the device to measure the patient's exertion level;
- configuring the device to intermittently switch to the vulnerable region loading mode according to a defined schedule if the sensed variable indicates the absence of myocardial ischemia and the measured exertion level is below a specified value;
- and,
- configuring the device to switch to the vulnerable region unloading mode if the sensed variable indicates the presence of myocardial ischemia.
7 more elements
A cardiac device, comprising:
- a controller for controlling the operation of the device;
- a sense amplifier interfaced to the controller for receiving electrograms reflective of cardiac activity;
- a pulse generator operable by the controller for generating pacing pulses;
- a switch matrix operable by the controller for configuring sensing channels by connecting the sensing amplifier to a selected electrode and for configuring pacing channels by connecting the pulse generator to a selected electrode;
- wherein the controller is programmed to configure a pacing channel for a vulnerable region unloading mode with a first electrode adapted for disposition near a vulnerable ventricular region that is predisposed to becoming ischemic;
- wherein the controller is programmed to configure a pacing channel for a vulnerable region loading mode with a second electrode adapted for disposition remote from the vulnerable ventricular region;
- wherein the controller is programmed to operate in a vulnerable region unloading mode that delivers pacing pulses in accordance with an atrial tracking or AV sequential pacing mode with a specified AV delay interval through a pacing channel configured with the first electrode, a vulnerable region loading mode that delivers pacing pulses in accordance with an atrial tracking or AV sequential pacing mode with a specified AV delay interval through a pacing channel configured with the second electrode, or a normal mode that delivers no pacing pulses to either the first or second electrodes;
- an exertion level sensor interfaced to the controller for measuring a patient's exertion level;
- an ischemia sensor interfaced to the controller for sensing a variable that can be correlated with the occurrence of myocardial ischemia and wherein the controller is programmed to detect the presence or absence of myocardial ischemia;
- wherein the controller is programmed to intermittently switch from the normal mode to the vulnerable region loading mode according to a defined schedule if the sensed variable indicates the absence of myocardial ischemia;
- and,
- wherein the controller is programmed to switch from either the normal mode or the vulnerable region loading mode to the vulnerable region unloading mode if the sensed variable indicates the presence of myocardial ischemia.
9 more elements
Dependencies are inferred from the claim text.