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  Method and apparatus for temporarily varying a parameter in an implantable medical deviceUSPTO Application #: 20070016259Title: Method and apparatus for temporarily varying a parameter in an implantable medical device Abstract: 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. (end of abstract)
Agent: Medtronic, Inc. - Minneapolis, MN, US Inventors: Earl E. Bakken, Rebecca M. Bergman, William J. Combs, H. Toby Markowitz USPTO Applicaton #: 20070016259 - Class: 607009000 (USPTO) Related Patent Categories: Surgery: Light, Thermal, And Electrical Application, Light, Thermal, And Electrical Application, Electrical Therapeutic Systems, Heart Rate Regulating (e.g., Pacing) The Patent Description & Claims data below is from USPTO Patent Application 20070016259. Brief Patent Description - Full Patent Description - Patent Application Claims
RELATED APPLICATION [0001] This application is a continuation of U.S. patent application Ser. No. 10/465,351 filed on Jun. 19, 2003, entitled "METHOD AND APPARATUS FOR TEMPORARILY VARYING A PARAMETER IN AN IMPLANTABLE MEDICAL DEVICE", to Bakken, et al., incorporated herein by reference in its entirety. FIELD OF INVENTION [0002] The present invention relates generally to implantable medical devices, and in particular, the present invention relates to an implantable medical device that provides variations of a baseline heart rate to reflect activities of daily living and circadian variation in patients who are sedentary to improve the strength and functioning of the heart. BACKGROUND OF THE INVENTION [0003] Several advances in pacing have occurred over the years by providing improved methods in sensing natural pacing rhythms. For instance, in demand pacing devices, the objective is to provide stimulatory pulses in the absence of the natural heartbeat. That is, the pacemaker or pacemaker/cardioverter/defibrillator is designed to deliver a pulse at a fixed rate as long as no natural heartbeat is sensed. Sensing of the natural frequency of heartbeats can be done to accommodate changes in the natural pacing frequency such as during natural rhythms of sleep or exercise. [0004] Benefits have recently been identified that tend to promote introducing a circadian variation to the rate-adaptive pacemaker base rate, i.e., lowering the base heart rate during sleep or during prolonged periods of inactivity. Several pacemakers or pacemaker/cardioverter/defibrillator are currently available that have two basal rates to more closely match diurnal or circadian heart rate variations (by programming two resting rates). U.S. Pat. No. 3,921,642 to Preston et al. discusses the advantages of providing a pacemaker capable of searching for and detecting the occurrence of natural resting basal heart rates within a predetermined range. U.S. Pat. No. 3,593,718 and in European Patent Application No. 0 089 014 describe pacemakers that respond to changes in respiration rate, for instance during exercise. Alternate means for sensing physical activity and adjusting the pacemaker rate accordingly are described in U.S. Pat. No. 4,776,338. [0005] Clinical evidence is available that tends to show that patients with decreased heart rate variability die earlier than those with normal variability and are a predictor of arrhythmic cardiac death, myocardial infarction, rapid progression of atheroscerosis and death from heart failure. A possible correlation has been identified between sedentary lifestyle and risk of ventricular arrhythmias based on a comparison of occurrences of ventricular arrhythmias in healthy active vs. sedentary men, and men with previous myocardial infarction. Accordingly, the greatest number and highest grades of ventricular arrhythmias during exercise were found in healthy sedentary men. [0006] It is also well know that naturally the heart goes through varied basal rates. For instance, during normal sleep patterns, the heart rate changes depending on the sleep state (e.g., REM sleep, etc.). That is, normally the heart rate is not fixed at a particular rate during sleep. [0007] There is a growing population of patients having implantable pacemaker or pacemaker/cardioverter/defibrillator devices who are largely sedentary and who are therefore likely to be paced at their basal rate for much of the day, since they are unable to achieve any measurable amount of exercise on their own. However, since current adaptive rate pacemakers or pacemaker/cardioverter/defibrillators are designed to find a range of natural rhythms occurring in the patient, whether to slow them during sleep, or to increase the rate during physical activity, with the goal of sensing and establishing a pacing rate within a controlled range of preexisting rates, currently available pacemakers or pacemaker/cardioverter/defibrillators do not address the benefit of having periods of elevated pacing designed into the pacemaker, particularly where no natural rhythm for the elevated pacing rate has been established. SUMMARY OF THE INVENTION [0008] The present invention is directed to 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 determining heart rate variability in response to the stored intervals, 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. [0009] According to an embodiment of the present invention, an implantable medical device includes 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 stored intervals, means for comparing the determined heart rate variability to a predetermined target rate profile, means for 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, and 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 include an acceleration portion including a second time period and a first shape corresponding to adjusting the parameter from the first setting to the second setting, a steady-state portion including a first value corresponding to the second setting and a second value corresponding to the first predetermined time period, and a deceleration portion including a third time period and a second shape corresponding to adjusting the parameter from the second setting to the termination setting. The adjusting means adjusts the parameter from the second setting to the termination setting, prior to 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. BRIEF DESCRIPTION OF THE DRAWINGS [0010] Other advantages and features of the present invention will be readily appreciated as the same becomes better understood by reference to the following detailed description when considered in connection with the accompanying drawings, in which like reference numerals designate like parts throughout the figures thereof and wherein: [0011] FIG. 1 is a schematic diagram of a pacemaker/cardioverter/defibrillator and lead set of a type in which the present invention may usefully be practiced; [0012] FIG. 2 is a schematic diagram of a cardiac pacemaker of a type appropriate for use in practicing the present invention in conjunction with its associated lead system, illustrated in relation to a patient's heart; [0013] FIG. 3 is a functional schematic diagram of an implantable pacemaker/cardioverter/defibrillator of the type illustrated in FIG. 1, in which the present invention may usefully be practiced; [0014] FIG. 4 is a functional schematic diagram of the pacemaker 120 illustrated in FIG. 2; [0015] FIG. 5 is a plan view of an external programmer of a sort appropriate for use in conjunction with the practice of the present invention in conjunction with any of the devices of FIGS. 1 and 2; [0016] FIG. 6 is a functional schematic of a programmer as illustrated in FIG. 5 appropriate for use in conjunction with the invention; [0017] FIG. 7 is a schematic diagram of a patient activator of the type which may be employed with the present invention; [0018] FIG. 8 is a block functional diagram of a patient activator of the type for use in conjunction with the present invention; [0019] FIG. 9 is a flowchart of a method for varying a pacing rate in an implantable medical device according to the present invention; Continue reading... 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