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

摘要

Systems and methods are provided for delivering neurostimulation therapies to patients for treating chronic heart failure. A neural fulcrum zone is identified and ongoing neurostimulation therapy is delivered within the neural fulcrum zone. This neural fulcrum zone corresponds to a combination of stimulation parameters at which autonomic engagement is achieved, while the tachycardia-inducing stimulation effects are offset by the bradycardia-inducing effects, thereby minimizing side effects such as significant heart rate changes while providing a therapeutic level of stimulation.

主权项

1. A method of operating an implantable medical device (IMD) comprising a neurostimulator coupled to an electrode assembly, the neurostimulator adapted to deliver a stimulation signal to a patient, the method comprising:
activating the IMD to generate a plurality of stimulation signals, each stimulation signal of the plurality of stimulation signals having at least one parameter setting that is different as compared to a corresponding parameter setting of the other stimulation signals of the plurality of stimulation signals; detecting a heart rate of the patient during the generation of the plurality of stimulation signals, wherein a tachycardia condition is detected with the tachycardia condition defined by a heart rate increase corresponding to a first subset of the plurality of stimulation signals and wherein a bradycardia condition is detected with the bradycardia condition defined by a heart rate reduction of greater than about 5% corresponding to a second subset of the plurality of stimulation signals; and defining a neural fulcrum zone corresponding to a third subset of the plurality of stimulation signals during which a transition heart rate response is identifiable, the transition heart rate response being between a heart rate associated with the tachycardia condition and a heart rate associated with the bradycardia condition, the transition heart rate further comprising a heart rate reduction inclusively between about 0% and about 5%.