Patent
Method and apparatus for temporarily varying a parameter in an implantable medical device
| العنوان: | Method and apparatus for temporarily varying a parameter in an implantable medical device |
|---|---|
| Patent Number: | 7,133,718 |
| تاريخ النشر: | November 07, 2006 |
| Appl. No: | 10/465351 |
| Application Filed: | June 19, 2003 |
| مستخلص: | A method and apparatus for varying a parameter in an implantable medical device that includes a plurality of electrodes stimulating heart tissue and sensing cardiac signals, a timing and control device controlling the stimulation of heart tissue by the plurality of electrodes and measuring intervals between the sensed cardiac signals, a storage device storing the measured intervals, and a microprocessor. The microprocessor determines heart rate variability in response to the stored intervals, compares the determined heart rate variability to a predetermined target rate profile, adjusts the parameter from a first setting to a second setting different from the first setting in response to the comparing of the determined heart rate variability and the predetermined target rate profile, and adjusts the parameter from the second setting to a termination setting in response to a termination event or expiration of a first predetermined time period. |
| Inventors: | Bakken, Earl E. (North Kona Coast, HI, US); Bergman, Rebecca M. (North Oaks, MN, US); Combs, William J. (Minnetonka, MN, US); Markowitz, H. Toby (Roseville, MN, US) |
| Assignees: | Medtronic, Inc. (Minneapolis, MN, US) |
| Claim: | 1. A method for temporarily varying a parameter in an implantable medical device, comprising: determining heart rate variability; comparing the determined heart rate variability to a predetermined target rate profile; adjusting the parameter from a first setting to a second setting different from the first setting in response to the comparing of the determined heart rate variability and the predetermined target rate profile; and adjusting the parameter from the second setting to a termination setting in response to expiration of a first predetermined time period. |
| Claim: | 2. The method of claim 1 , further comprising determining whether to initiate a varying of a parameter in response to one of receipt of a patient activation and an internal indication of a predetermined time of day for initiating the varying of a parameter. |
| Claim: | 3. The method of claim 1 , further comprising determining whether a varying of a parameter is appropriate in response to the comparing the determined heart rate variability to a predetermined target rate profile. |
| Claim: | 4. The method of claim 1 , wherein determining heart rate variability includes generating a histogram of heart rates having a plurality of corresponding heart rate bins. |
| Claim: | 5. The method of claim 4 , further comprising determining whether a varying of a parameter is appropriate in response to the comparing the determined heart rate variability to a predetermined target rate profile, wherein the varying of a parameter is determined to be appropriate in response to a percentage of time that heart rates are within one or more of the plurality of heart rate bins. |
| Claim: | 6. The method of claim 4 , further comprising determining whether a varying of a parameter is appropriate in response to the comparing the determined heart rate variability to a predetermined target rate profile, wherein the varying of a parameter is determined to be appropriate in response to a number of beats within one or more of the plurality of heart rate bins. |
| Claim: | 7. The method of claim 1 , further comprising determining whether a varying of a parameter is appropriate in response to the comparing the determined heart rate variability to a predetermined target rate profile, wherein the varying of a parameter is determined to be appropriate in response to change in heart rate variability being less than a predetermined value. |
| Claim: | 8. The method of claim 1 , further comprising: storing exercise time profiles corresponding to variations in the second setting; and selecting a first exercise time profile from the stored exercise time profiles in response to the comparing the determined heart rate variability to a predetermined target rate profile. |
| Claim: | 9. The method of claim 8 , wherein each of the stored exercise time profiles include an acceleration portion corresponding to adjusting the parameter from the first setting to the second setting, a steady-state portion corresponding to the first predetermined time period, and a deceleration portion corresponding to adjusting the parameter from the second setting to the termination setting. |
| Claim: | 10. The method of claim 9 , wherein the first setting corresponds to a predetermined lower pacing rate and the second setting is greater than the predetermined lower pacing rate. |
| Claim: | 11. The method of claim 8 , further comprising: determining whether the predetermined target rate profile would be exceeded in response to the first exercise time profile; and selecting a second exercise time profile from the stored exercise time profiles in response to the predetermined target profile being exceeded. |
| Claim: | 12. The method of claim 1 , further comprising determining whether to adjust the parameter from the second setting to the termination setting prior to expiration of the first predetermined time period. |
| Claim: | 13. The method of claim 12 , wherein the parameter is adjusted from the second setting to the termination setting prior to expiration of the first predetermined time period in response to one of a programming session, a magnet, a cardiac arrhythmia, spontaneous rate greater than the second setting, and rate response greater than the second setting. |
| Claim: | 14. The method of claim 1 , wherein determining heart rate variability includes generating a histogram of heart rates having a plurality of corresponding heart rate bins, and further comprising, determining, prior to adjusting the parameter from the first setting to the second setting, whether a current generated histogram is consistent with a predetermined number of previously generated histograms. |
| Claim: | 15. The method of claim 9 , further comprising: determining whether the target rate profile has been reached; repeating adjusting of the parameter from the first setting to the second setting and from the second setting to the termination setting in response to the target rate profile not being reached; and updating one or more of the acceleration portion, the steady state portion and the deceleration portion in response to the target rate profile being reached. |
| Claim: | 16. The method of claim 1 , wherein the termination setting corresponds to one of a spontaneous rate, a rate response rate, and the first setting. |
| Claim: | 17. The method of claim 8 , further comprising; storing information corresponding to the selected exercise time profile; and outputting the stored information to an external device. |
| Claim: | 18. An implantable medical device, comprising: a plurality of electrodes stimulating heart tissue and sensing cardiac signals; a timing and control device controlling the stimulation of heart tissue by the plurality of electrodes and measuring intervals between the sensed cardiac signals; a storage device storing the measured intervals; and a microprocessor determining heart rate variability in response to the stored intervals, comparing the determined heart rate variability to a predetermined target rate profile, adjusting a parameter from a first setting to a second setting different from the first setting in response to the comparing of the determined heart rate variability and the predetermined target rate profile, and adjusting the parameter from the second setting to a termination setting in response to expiration of a first predetermined time period. |
| Claim: | 19. The device of claim 18 , further comprising a patient activator generating a patient request for adjusting the parameter, wherein the timing and control device generates an indication of a programmed time of day for initiating the adjusting of the parameter, and the microprocessor initiates the adjusting of the parameter in response to receipt of one of the patient request from the patient activator and the indication of the programmed time of day from the timing and control unit. |
| Claim: | 20. The device of claim 18 , wherein the microprocessor compares the determined heart rate variability to the predetermined target rate profile and determines the adjusting of the parameter is appropriate in response to the comparing of the determined heart rate variability to the predetermined target rate profile. |
| Claim: | 21. The device of claim 20 , wherein the microprocessor generates a histogram of heart rates having a plurality of corresponding heart rate bins, and determines the adjusting of the parameter is appropriate in response to a percentage of time that heart rates are within one or more of the plurality of heart rate bins. |
| Claim: | 22. The device of claim 20 , wherein the microprocessor generates a histogram of heart rates having a plurality of corresponding heart rate bins, and determines the adjusting of the parameter is appropriate in response to a number of beats within one or more of the plurality of heart rate bins. |
| Claim: | 23. The device of claim 18 , wherein the microprocessor compares the determined heart rate variability to the predetermined target rate profile and determines the adjusting of the parameter is appropriate in response to change in heart rate variability being less than a predetermined value. |
| Claim: | 24. The device of claim 18 , wherein the storage device stores exercise time profiles corresponding to variations in the second setting, and the microprocessor selects a first exercise time profile from the stored exercise time profiles in response to the comparison of the determined heart rate variability to the predetermined target rate profile. |
| Claim: | 25. The device of claim 24 , wherein each of the stored exercise time profiles include an acceleration portion corresponding to adjusting the parameter from the first setting to the second setting, a steady-state portion corresponding to the second setting, and a deceleration portion corresponding to adjusting the parameter from the second setting to the termination setting. |
| Claim: | 26. The device of claim 25 , wherein the first setting corresponds to a predetermined lower pacing rate and the second setting is greater than the predetermined lower pacing rate. |
| Claim: | 27. The device of claim 24 , wherein the microprocessor determines whether the predetermined target rate profile would be exceeded in response to the first exercise time profile, and selects a second exercise time profile from the stored exercise time profiles in response to the predetermined target profile being exceeded. |
| Claim: | 28. The device of claim 18 , wherein the microprocessor adjusts the parameter from the second setting to the termination setting, prior to expiration of the first predetermined time period, in response to detecting one of a programming session, a magnet, a cardiac arrhythmia, spontaneous rate greater than the second setting, and rate response greater than the second setting. |
| Claim: | 29. The device of claim 18 , wherein the microprocessor generates a histogram of heart rates and determines, prior to adjusting the parameter from the first setting to the second setting, whether a current generated histogram is consistent with a predetermined number of previously generated histograms. |
| Claim: | 30. The device of claim 25 , wherein the microprocessor determines whether the target rate profile has been reached, repeats adjusting of the parameter from the first setting to the second setting and from the second setting to the termination setting in response to the target rate profile not being reached, and updates one or more of the acceleration portion, the steady state portion, and the deceleration portion in response to the target rate profile being reached. |
| Claim: | 31. The device of claim 18 , wherein the termination setting corresponds to one of a spontaneous rate, a rate response rate, and the first setting. |
| Claim: | 32. The device of claim 24 , further comprising an output device outputting information corresponding to the selected exercise time profiles. |
| Claim: | 33. An implantable medical device, comprising: means for determining heart rate variability; means for comparing the determined heart rate variability to a predetermined target rate profile; means for adjusting a parameter from a first setting to a second setting different from the first setting in response to the comparing of the determined heart rate variability and the predetermined target rate profile; and means for adjusting the parameter from the second setting to a termination setting in response to expiration of a first predetermined time period. |
| Claim: | 34. A computer readable medium having computer executable instructions for performing a method comprising: determining heart rate variability; comparing the determined heart rate variability to a predetermined target rate profile; adjusting the parameter from a first setting to a second setting different from the first setting in response to the comparing of the determined heart rate variability and the predetermined target rate profile; and adjusting the parameter from the second setting to a termination setting in response to expiration of a first predetermined time period. |
| Claim: | 35. An implantable medical device, comprising: means for stimulating heart tissue and sensing cardiac signals; means for controlling timing of the stimulation of heart tissue and measuring intervals between the sensed cardiac signals; means for determining heart rate variability in response to the intervals; means for comparing the determined heart rate variability to a predetermined target rate profile; means for adjusting a parameter from a first setting to a second setting different from the first setting in response to the comparing of the determined heart rate variability and the predetermined target rate profile, and adjusting the parameter from the second setting to a termination setting in response to expiration of a first predetermined time period; means for selecting a first exercise time profile from stored exercise time profiles in response to the comparison of the determined heart rate variability to the predetermined target rate profile, each of the stored exercise time profiles including an acceleration portion corresponding to adjusting the parameter from the first setting to the second setting, a steady-state portion corresponding to the first predetermined time period, and a deceleration portion corresponding to adjusting the parameter from the second setting to the termination setting, wherein the adjusting means adjusts the parameter from the second setting to the termination setting, prior to expiration of the first predetermined time period, in response to detecting one of a programming session, a magnet, a cardiac arrhythmia, spontaneous rate greater than the second setting, and rate response greater than the second setting. |
| Claim: | 36. The device of claim 35 , further comprising means for generating a patient request for adjusting the parameter, wherein the controlling means generates an indication of a programmed time of day for initiating the adjusting of the parameter, and the adjusting means initiates adjusting of the parameter in response to one of the patient request and the indication of the programmed time of day for initiating the adjusting of the parameter. |
| Claim: | 37. The device of claim 36 , wherein the determining means generates a histogram of heart rates having a plurality of corresponding heart rate bins, and determines the adjusting of the parameter is appropriate in response to a percentage of time that heart rates are within one or more of the plurality of heart rate bins. |
| Claim: | 38. The device of claim 35 , wherein the determining means generates a histogram of heart rates having a plurality of corresponding heart rate bins, and determines the adjusting of the parameter is appropriate in response to a number of beats within one or more of the plurality of heart rate bins. |
| Claim: | 39. The device of claim 35 , wherein the first setting corresponds to a predetermined lower pacing rate and the second setting is greater than the predetermined lower pacing rate. |
| Claim: | 40. The device of claim 35 , wherein the comparing means determines whether the predetermined target rate profile would be exceeded in response to the first exercise time profile, and selects a second exercise time profile from the stored exercise time profiles in response to the predetermined target profile being exceeded. |
| Claim: | 41. The device of claim 35 , wherein the determining means generates a histogram of heart rates and determines, prior to the adjusting of the parameter from the first setting to the second setting, whether a current generated histogram is consistent with a predetermined number of previously generated histograms. |
| Claim: | 42. The device of claim 35 , wherein the comparing means determines whether the target rate profile has been reached, and the adjusting means repeats adjusting of the parameter from the first setting to the second setting and from the second setting to the termination setting in response to the target rate profile not being reached, and updates one or more of the acceleration portion, the steady state portion and the deceleration portion in response to the target rate profile being reached. |
| Claim: | 43. The device of claim 35 , wherein the termination setting corresponds to one of a spontaneous rate, a rate response rate, and the first setting. |
| Claim: | 44. The device of claim 37 , further comprising means for outputting information corresponding to the selected exercise time profiles. |
| Current U.S. Class: | 607/9 |
| Patent References Cited: | 3593718 July 1971 Krasner et al. 3921642 November 1975 Preston et al. 3941135 March 1976 Sturm et al. 4374382 February 1983 Markowitz 4428378 January 1984 Anderson et al. 4702253 October 1987 Nappholz et al. 4711245 December 1987 Higgins et al. 4776338 October 1988 Lekholm et al. 4795542 January 1989 Ross et al. 5088488 February 1992 Markowitz et al. 5107833 April 1992 Barsness 5117824 June 1992 Keimel et al. 5168871 December 1992 Grevious 5292343 March 1994 Blanchette et al. 5304208 April 1994 Inguaggiato et al. 5312452 May 1994 Salo 5314450 May 1994 Thompson 5324315 June 1994 Grevious 5342404 August 1994 Alt et al. 5354319 October 1994 Wyborny et al. 5383909 January 1995 Keimel 5464434 November 1995 Alt 5466245 November 1995 Spinelli et al. 5476483 December 1995 Bornzin et al. 5545186 August 1996 Olson et al. 5562711 October 1996 Yerich et al. 5622428 April 1997 Bonnet 5733312 March 1998 Schloss et al. 5755736 May 1998 Gillberg et al. 5766288 June 1998 Thiele et al. 5814087 September 1998 Renirie 5836975 November 1998 DeGroot 5891044 April 1999 Golosarky et al. 5891176 April 1999 Bornzin 5919209 July 1999 Schouten 5957957 September 1999 Sheldon 5964788 October 1999 Greenhut 5991661 November 1999 Park et al. 6049735 April 2000 Hartley et al. 6055454 April 2000 Heemels 6058328 May 2000 Levine et al. 6122536 September 2000 Sun et al. 6128534 October 2000 Park et al. 6141590 October 2000 Renirie et al. 6249700 June 2001 Alt 6253107 June 2001 Albrecht et al. 6529772 March 2003 Carlson et al. 6766194 July 2004 Kroll 2002/0082664 June 2002 Kerver 2003/0074029 April 2003 Deno et al. 089014 October 1983 |
| Other References: | Viitasalo, et al., “Ventricular Arrhythmias During Exercise Testing, Jogging, and Sedentary Life: A Compative Study of Healthy Physically Active Men, Healthy Sedentary Men, and Men with Previous Myocardial Infarction”, Chest, vol. 76, pp. 21-26, Jul. 1979. cited by other Park, et al., “Activity-Controlled Circadian Base Rate”, PACE, vol. 21, pp. 2182-2186, Nov. 1998, Part II. cited by other “Intraoperative Transesophageal Dobutamine Stress Echocardiography for Perioperative Risk Assessment in Patients with an Increased Risk of Ischemic Cardiac Events”, http://www.anaesthesie.ch/eng/tee/tee.htm. cited by other Malik, et al., Heart Rate Variability: Standards of Measurement, Physiological Interpretation, and Clinical Use, Circulation, vol. 93(5), pp. 1043-1065, Mar. 1, 1996. cited by other |
| Assistant Examiner: | Mullen, Kristen |
| Primary Examiner: | Pezzuto, Robert E. |
| Attorney, Agent or Firm: | Soldner, Michael C. Wolde-Michael, Girma |
| رقم الانضمام: | edspgr.07133718 |
| قاعدة البيانات: | USPTO Patent Grants |
| الوصف غير متاح. |