Methods and systems for lowering blood pressure through reduction of ventricle filling
View Patent ↗Systems and methods for reducing ventricle filling volume are disclosed. In some embodiments, a stimulation circuit may be used to stimulate a patient's heart to reduce ventricle filling volume or even blood pressure. When the heart is stimulated at a consistent rate to reduce blood pressure, the cardiovascular system may over time adapt to the stimulation and revert back to the higher blood pressure. In some embodiments, the stimulation pattern may be configured to be inconsistent such that the adaptation response of the heart is reduced or even prevented. In some embodiments, a stimulation circuit may be used to stimulate a patient's heart to cause at least a portion of an atrial contraction to occur while the atrioventricular valve is closed. Such an atrial contraction may deposit less blood into the corresponding ventricle than when the atrioventricular valve is opened throughout an atrial contraction.
1. A method, carried out with an implanted heart muscle stimulator associated with a heart of a patient, for treating a blood pressure disorder in the patient, the patient having a pretreatment blood pressure, the method comprising:
stimulating the heart, comprising causing to cause an atrium thereof to contract while a heart valve associated with the atrium is closed such that the atrial contraction distends the atrium, and the distending atrium results in reducing the patient's blood pressure from the pretreatment blood pressure, by causing the atrium to contract at a time when pressure in a ventricle of the heart is about maximal so that active force of the atrial contraction increases atrial stretch above maximal passive atrial stretch caused by contraction of the ventricle.
2. The method of claim 1 , wherein stimulating the heart comprises causing a timing of a maximal contraction of the atrium that coincides with an end of an isovolumic period of the ventricle.
3. The method of claim 1 , wherein stimulating the heart comprises causing a timing of a maximal contraction of the atrium that coincides with a rapid ejection period of the ventricle.
4. The method of claim 2 , further comprising periodically setting the timing based on data from at least one of an external sensor and a closed loop of one or more implanted sensors.
5. The method of claim 3 , further comprising periodically setting the timing based on data from at least one of an external sensor and a closed loop of one or more implanted sensors.
6. The method of claim 1 , wherein stimulating the heart comprises stimulating the ventricle to cause the ventricle to commence contraction before the end of contraction of the atrium.
7. The method of claim 1 , wherein stimulating the heart comprises stimulating the heart to cause the atrium to commence contraction about 60 ms or less before closure of the heart valve.
8. The method of claim 1 , wherein stimulating the heart comprises delivering one or more stimulation pulses to the ventricle between about 0 ms and about 50 ms before onset of excitation in the atrium.
9. The method of claim 1 , wherein stimulating the heart comprises delivering one or more stimulation pulses to the ventricle between about 0 ms and about 70 ms after onset of excitation in the atrium.
10. The method of claim 1 , wherein stimulating the heart comprises timing ventricle excitation such that ventricle contraction begins before commencement of atrial contraction.
11. The method of claim 1 , wherein stimulating the heart comprises delivering a stimulation pulse having a first stimulation setting, and wherein the method further comprises delivering a stimulation pulse having a second stimulation setting different from the first stimulation setting, wherein the second stimulation setting is configured to reduce or prevent atrial kick in the ventricle.
12. The method of claim 1 , wherein increasing the atrial stretch above the maximal passive atrial stretch invokes a hormonal response from the patient's body.
13. The method of claim 12 , wherein the hormonal response comprises release of a natriuretic peptide.
14. The method of claim 1 , wherein stimulating the heart comprises stimulating the ventricle to cause the ventricle to commence contraction at such timing that the peak of atrial contraction occurs when the ventricle is at about maximal stretch.
15. A device for treating a blood pressure disorder in a patient, the patient having a pretreatment blood pressure, the device comprising:
a stimulation circuit configured to deliver a stimulation pulse to at least one cardiac chamber of a heart of the patient; and
a processor circuit coupled to the stimulation circuit, the processor circuit configured to operate in an operating mode in which at least one of the cardiac chambers is stimulated to cause an atrium of the heart to contract while a heart valve associated with the atrium is closed such that the atrial contraction distends the atrium, and the distending atrium results in reducing the patient's blood pressure from the pretreatment blood pressure, by causing the atrium to contract at a time when pressure in a ventricle of the heart is about maximal so that active force of the atrial contraction increases atrial stretch above maximal passive atrial stretch caused by contraction of the ventricle.
16. The device of claim 15 , wherein the operating mode includes stimulating the at least one of the cardiac chamber to cause a timing of a maximal contraction of the atrium that coincides with an end of an isovolumic period of the ventricle.
17. The device of claim 15 , wherein the operating mode includes stimulating the at least one of the cardiac chamber to cause a timing of a maximal contraction of the atrium that coincides with a rapid ejection period of the ventricle.
18. The device of claim 16 , wherein the operating mode includes periodically setting the timing based on data from at least one of an external sensor and a closed loop of one or more implanted sensors.
19. The device of claim 17 , wherein the operating mode includes periodically setting the timing based on data from at least one of an external sensor and a closed loop of one or more implanted sensors.
20. The device of claim 15 , wherein the operating mode includes stimulating the ventricle to cause the ventricle to commence contraction before the end of contraction of the atrium.
21. The device of claim 15 , wherein the operating mode includes stimulating the heart to cause the atrium to commence contraction about 60 ms or less before closure of the heart valve.
22. The device of claim 15 , wherein the operating mode includes delivering one or more stimulation pulses to the ventricle between about 0 ms and about 50 ms before onset of excitation in the atrium.
23. The device of claim 15 , wherein the operating mode includes delivering one or more stimulation pulses to the ventricle between about 0 ms and about 70 ms after onset of excitation in the atrium.
24. The device of claim 15 , wherein the operating mode includes timing ventricle excitation such that ventricle contraction begins before commencement of atrial contraction.
25. The device of claim 15 , wherein the operating mode includes delivering a stimulation pulse having a first stimulation setting, and wherein the processor circuit is configured to deliver a stimulation pulse having a second stimulation setting different from the first stimulation setting, wherein the second stimulation setting is configured to reduce or prevent atrial kick in the ventricle.
26. The device of claim 15 , wherein increasing the atrial stretch above the maximal passive atrial stretch invokes a hormonal response from the patient's body.
27. The device of claim 26 , wherein the hormonal response comprises release of a natriuretic peptide.
28. The device of claim 15 , wherein the operating mode includes stimulating the ventricle to cause the ventricle to commence contraction at such timing that the peak of atrial contraction occurs when the ventricle is at about maximal stretch.
29. A method, carried out with an implanted heart muscle stimulator associated with a heart of a patient, for treating a blood pressure disorder in the patient, the patient having a pretreatment blood pressure, the method comprising:
stimulating a heart such that an atrium of the heart contracts while a heart valve associated with the atrium is closed and reaches approximately peak atrial contraction when stretch in a ventricle of the heart is about maximal;
increasing, by active force of the atrial contraction, an atrial stretch of the atrium above a maximal passive atrial stretch caused by contraction of the ventricle; and
reducing, by the increased atrial stretch, the patient's blood pressure from the pretreatment blood pressure,
wherein stimulating the heart comprises stimulating the ventricle to cause the ventricle to commence contraction at such time that the atrium of the heart contracts while the heart valve associated with the atrium is closed and reaches approximately peak atrial contraction when stretch in the ventricle of the heart is about maximal.
30. The method of claim 29 , wherein the increased atrial stretch invokes a hormonal response from the patient's body.