Integrated cardioverter defibrillator-muscle stimulator for cardiomyoplasty

1 . An implantable medical device comprising:

a stimulating lead comprising one or more electrodes;

an implantable cardioverter defibrillator (ICD) lead comprising:

one or more pace/sense electrodes, and

one or more defibrillation electrodes; and

circuitry configured to:

receive one or more signals indicative of one or more physiologic parameters;

deliver electrical therapy to stimulate a muscle wrapped around a heart via the one or more electrodes of the stimulating lead;

adjust an amount of the electrical therapy delivered, via the one or more electrodes of the stimulating lead, based on the one or more physiologic parameters;

detect a tachyarrhythmia via one or more pace/sense electrodes of the ICD lead; and

based on detecting the tachyarrhythmia:

suspend, for a period of time, delivery of the electrical therapy to stimulate the muscle wrapped around the heart, and

deliver an antitachyarrhythmia shock via the one or more defibrillation electrodes of the ICD lead during the period of time.

2 . The implantable medical device of claim 1 , wherein the circuitry is configured to receive at least one signal of the one or more signals indicative of the one or more physiologic parameters via the one or more electrodes of the stimulating lead.

3 . The implantable medical device of claim 1 , wherein the circuitry is configured to receive at least one signal of the one or more signals indicative of the one or more physiologic parameters via at least one of: the one or more pace/sense electrodes of the ICD lead, the one or more defibrillation electrodes of the ICD lead; or one or more other sensors of the ICD lead.

4 . The implantable medical device of claim 1 , further comprising an accelerometer positioned on the stimulating lead to detect and provide signals to the circuitry indicative of one or more physiologic parameters of the wrapped muscle,

wherein the one or more signals are indicative of one or more physiologic parameters of the wrapped muscle, and the circuitry is configured to determine an amount of fatigue of the wrapped muscle based on the one or more physiologic parameters of the wrapped muscle.

5 . The implantable medical device of claim 4 , wherein the circuitry is configured to adjust the amount of the electrical therapy to be delivered, via the one or more electrodes of the stimulating lead, based, at least in part, on the determined amount of fatigue of the wrapped muscle.

6 . The implantable medical device of claim 1 , wherein the stimulating lead further includes one or more stimulating lead sensors configured to detect and provide the one or more signals indicative of the one or more physiologic parameters.

7 . The implantable medical device of claim 1 , wherein the one or more physiologic parameters include one or more of time, heart failure status, heart failure risk score, myocardial state, activity, muscle fatigue, tissue perfusion, contraction strength of the wrapped muscle, respiration, or posture.

8 . The implantable medical device of claim 1 , wherein the circuitry is configured to adjust the amount of electrical therapy to increase stimulation of the wrapped muscle above an overdrive threshold in response to determining atrial fibrillation, ventricular fibrillation or ventricular tachycardia occurred based, at least in part, on the one or more physiologic parameters.

9 . The implantable medical device of claim 1 , wherein the circuitry is configured to adjust the amount of electrical therapy to increase stimulation of the wrapped muscle in response to determining a level of activity is above a threshold value based, at least in part, on the one or more physiologic parameters.

10 . The implantable medical device of claim 1 , wherein the circuitry is configured to adjust the amount of electrical therapy to decrease stimulation of the wrapped muscle in response to determining heart failure status is below a threshold value based, at least in part, on the one or more physiologic parameters.

11 . The implantable medical device of claim 1 , wherein the circuitry is configured to adjust the amount of electrical therapy to decrease stimulation of the wrapped muscle in response to a tissue perfusion level being above a threshold level based, at least in part, on the one or more physiologic parameters.

12 . The implantable medical device of claim 1 , wherein the circuitry is configured to adjust the amount of electrical therapy based on time of day.

13 . The implantable medical device of claim 1 , wherein the circuitry is configured to adjust the amount of electrical therapy to increase stimulation of the wrapped muscle in response to determining a time of day is daytime based, at least in part, on the one or more physiologic parameters.

14 . The implantable medical device of claim 1 , wherein the circuitry is configured to adjust the amount of electrical therapy to decrease stimulation of the wrapped muscle in response to determining a time of day is nighttime based, at least in part, on the one or more physiologic parameters.

15 . The implantable medical device of claim 1 , wherein the circuitry is configured to adjust the amount of electrical therapy to provide respiratory sinus arrhythmia (RSA) pacing to the wrapped muscle in response to determining a respiration rate based, at least in part, on the one or more physiologic parameters.

16 . An implantable medical system comprising:

an implantable medical device comprising:

a housing; and

circuitry within the housing, the circuitry configured to:

receive one or more signals indicative of one or more physiologic parameters; and

output a signal to cause electrical therapy to be delivered to stimulate a muscle wrapped around a heart based on the one or more physiologic parameters; and

an implantable medical lead configured to be coupled to the medical device and to receive the signal output by the circuitry, the implantable medical lead comprising one or more electrodes to deliver the electrical therapy to stimulate the muscle wrapped around the heart in response to receiving the signal received from the circuitry; and

an implantable cardioverter defibrillator (ICD) lead comprising one or more pace/sense electrodes and one or more defibrillation electrodes,

wherein the circuitry is configured to:

send a second signal to adjust an amount of the electrical therapy to be delivered, via the one or more electrodes of the implantable medical lead, based on the one or more physiologic parameters;

detect a tachyarrhythmia based on a signal received via the one or more pace/sense electrodes of the ICD lead;

based on the detection of the tachyarrhythmia:

suspend, for a period of time, delivery of the electrical therapy to stimulate the muscle wrapped around the heart, and

deliver an antitachyarrhythmia shock via the one or more defibrillation electrodes of the ICD lead during the period of time.

17 . The implantable medical system of claim 16 , further comprising an accelerometer positioned on the medical lead to detect and provide signals to the circuitry indicative of one or more physiologic parameters of the wrapped muscle,

wherein the one or more signals received by the circuitry are indicative of one or more physiologic parameters of the wrapped muscle, and the circuitry is configured to determine an amount of fatigue of the wrapped muscle based on the one or more physiologic parameters of the wrapped muscle, and wherein the circuitry is configured to adjust the amount of the electrical therapy to be delivered, via the one or more electrodes of the implantable medical lead, based, at least in part, on the determined amount of fatigue of the wrapped muscle.

18 . A method comprising:

receiving, via circuitry, one or more signals indicative of one or more physiologic parameters;

determining, via the circuitry, an amount of electrical therapy to deliver to stimulate a muscle wrapped around a heart of a patient based on the one or more physiologic parameters;

delivering, via a stimulating lead, the determined amount of electrical therapy to stimulate the muscle wrapped around the heart of the patient;

receiving, via one or more pace/sense electrodes of an implantable cardioverter defibrillator (ICD) lead, one or more sensed signals indicative of tachyarrhythmia;

detecting, based on the one or more sensed signals indicative of tachyarrhythmia, a tachyarrhythmia;

based on detecting the tachyarrhythmia:

suspending, for a period of time, delivery of the electrical therapy to stimulate the muscle wrapped around the heart, and

delivering, via one or more defibrillation electrodes of the ICD lead, an antitachyarrhythmia shock during the period of time.

19 . The method of claim 18 , further comprising determining, via the circuitry, an amount of fatigue of the wrapped muscle based on the one or more physiologic parameters, and adjusting the amount of the electrical therapy to be delivered based, at least in part, on the determined amount of fatigue of the wrapped muscle.