Prediction and Prevention of Cardiovascular Insult
In a method of providing therapy to a patient to prevent an occurrence of a dangerous cardiac event, a cardiac signal sensed over multiple cardiac cycles is received. A risk of impending cardiovascular insult is determined, using the received cardiac signal, by assessing an indicator of proarrhythmogenic substrate and a change in sympathovagal balance. A therapy comprising acupuncture to modulate sympathovagal balance is administered based on the determined risk.
1 . A method of providing therapy to a patient to prevent an occurrence of a dangerous cardiac event, the method comprising:
receiving a cardiac signal sensed over multiple cardiac cycles;
determining, using the received cardiac signal, a risk of impending cardiovascular insult by assessing an indicator of proarrhythmogenic substrate and a change in sympathovagal balance; and
administering, based on the determined risk, a therapy comprising acupuncture to modulate sympathovagal balance.
2 . The method of claim 1 , further comprising detecting, using the received cardiac signal, a cardiac instability trigger for use in determining the risk of cardiovascular insult.
3 . The method of claim 2 , wherein the cardiac instability trigger is one or more ectopic beats.
4 . The method of claim 1 , wherein the indicator of proarrhythmogenic substrate is an alternans burden that exceeds a predetermined threshold.
5 . The method of claim 4 , wherein in the alternans burden is a repolarization alternans burden determined from the cardiac signal.
6 . The method of claim 4 , wherein in the alternans burden is a QRS alternans burden determined from the cardiac signal.
7 . The method of claim 4 , wherein in the alternans burden is a mechanical alternans burden determined from the cardiac signal.
8 . The method of claim 1 , wherein the indicator of proarrhythmogenic substrate is a hypertension burden determined from the cardiac signal.
9 . The method of claim 1 , wherein the indicator of proarrhythmogenic substrate is one or more delayed afterdepolarizations, determined from the cardiac signal, that exceed a predetermined threshold.
10 . The method of claim 1 , wherein the indicator of proarrhythmogenic substrate is a QT interval change that exceeds a predetermined threshold.
11 . The method of claim 1 , wherein the change in sympathovagal balance is estimated from a heart rate variability measurement determined from the cardiac signal.
12 . The method of claim 1 , wherein the change in sympathovagal balance is estimated from a heart rate increase measurement determined from the cardiac signal.
13 . The method of claim 1 , wherein the therapy modulates sympathovagal balance by activating parasympathetic drive.
14 . The method of claim 1 , wherein the acupuncture comprises electro-acupuncture applied to one or more cardiovascular acupoints.
15 . The method of claim 1 , wherein the acupuncture comprises magneto-acupuncture applied to one or more cardiovascular acupoints.
16 . The method of claim 1 , wherein the cardiac signal is an electrocardiogram signal.
17 . The method of claim 1 , wherein the cardiac signal is a blood pressure signal.
18 . The method of claim 1 , wherein the impending cardiovascular insult is arrhythmia.
19 . The method of claim 1 , wherein the impending cardiovascular insult is acute myocardial ischemia.
20 . The method of claim 1 , further comprising initiating an alarm to alert an emergency responder to the impending cardiovascular insult.
21 . The method of claim 1 , further comprising issuing an alert in a manner that allows a preventative action to be taken to prevent the dangerous cardiac event.
22 . The method of claim 21 , wherein the preventative action comprises donning a wearable external defibrillator, and wherein the patient performs the action in response to the alert.
23 . A system for providing therapy to prevent an occurrence of a dangerous cardiac event, comprising:
a monitoring component that receives a cardiac signal sensed over multiple cardiac cycles;
a processing component that determines, using the received cardiac signal, a risk of impending cardiovascular insult by assessing an indicator of proarrhythmogenic substrate and a change in sympathovagal balance; and
a therapy component that administers, based on the determined risk a therapy comprising acupuncture to modulate sympathovagal balance.