Implantable stimulation devices, and methods and systems for use therewith, that automatically adjust stimulation parameters to improve preload in an HF patient

摘要

Methods, systems and devices described herein can be used for automatically adjusting one or more cardiac resynchronization therapy (CRT) pacing parameters (and more generally stimulation parameters), to achieve a long term reduction in left ventricular (LV) diastolic pressure (and more generally, preload) of a heart failure (HF) patient. A reduction in LV diastolic pressure is indicative of a reduction in preload (the force of blood the fills the left ventricle), which is typically indicative of an improvement in a patient's HF condition. In accordance with certain embodiments, when a set of stimulation parameters is tested, the set is tested for a period that is sufficiently long enough to allow the patient's compensatory mechanisms to react to the set of stimulation parameters and achieve a substantially steady-state LV diastolic pressure corresponding to the using the set of stimulation parameters. Such techniques are believed to provide better results than achieved using acute hemodynamic optimization techniques.

主权项

1. A method for automatically adjusting one or more cardiac resynchronization therapy (CRT) pacing parameters to achieve a long term reduction in left ventricular (LV) diastolic pressure of a heart failure (HF) patient, the method comprising:
(a) for each of a plurality of sets of pacing parameters, pacing the patient's heart using the set of pacing parameters for a time period that is long enough to allow the patient's compensatory mechanisms to react to the set of pacing parameters and achieve a steady-state LV diastolic pressure corresponding to the pacing using the set of pacing parameters, wherein a length of each time period is at least one hour; (b) for each of the plurality of sets of pacing parameters used at step (a), obtaining a corresponding measure indicative of the patient's LV diastolic pressure achieved using the set of pacing parameters; (c) comparing the corresponding measures indicative of the patient's LV diastolic pressure achieved using the plurality of sets of pacing parameters and selecting one of the plurality of sets of pacing parameters in dependence on the comparison of the corresponding measures indicative of the patient's LV diastolic pressure achieved using the plurality of sets of pacing parameters; (d) selecting at least one new set of pacing parameters to replace at least one of the sets of pacing parameters not selected at step (c); and (e) repeating steps (a) through (d) one or more times, wherein each time step (a) is repeated, one of the sets of pacing parameters used at step (a) comprises the set of pacing parameters most recently selected at step (c), and at least one of the other sets of pacing parameters used step (a) comprises the at least one new set of pacing parameters most recently selected at step (d); wherein at least steps (c) and (d) are performed automatically using one or more processors.