Cardiac resynchronization therapy for improved hemodynamics based on disordered breathing detection

Abstract

The presence of disordered breathing is detected using an implantable medical device. A cardiac condition is detected that is indicative of the patient's cardiac status. Based on the presence of disordered breathing and the cardiac condition, the patient is identified as suitable for a cardiac resynchronization therapy.

1 . A method, comprising: 
 detecting presence of disordered breathing using an implantable medical device;    detecting a cardiac condition indicative of the patient's cardiac status; and    identifying the patient as suitable for a cardiac resynchronization therapy based on the presence of disordered breathing and the cardiac condition.    
   
   
       2 . The method of  claim 1 , further comprising delivering at least one of a cardiac pacing therapy other than a cardiac resynchronization therapy, a cardiac shock therapy, and a cardiac neurostimulation therapy.  
   
   
       3 . The method of  claim 1 , wherein detecting the presence of disordered breathing comprises detecting at least one of obstructive sleep apnea, central sleep apnea, hypopnea, orthopnea, paroxysmal nocturnal dyspnea, and Cheyne-Stokes respiration.  
   
   
       4 . The method of  claim 1 , comprising enabling the implantable medical device to perform the cardiac resynchronization therapy based on identifying the patient as suitable for the cardiac resynchronization therapy.  
   
   
       5 . The method of  claim 1 , wherein the implantable medical device comprises a pulse generator and electrodes that are configured for cardiac resynchronization therapy delivery.  
   
   
       6 . The method of  claim 1 , wherein detecting the cardiac condition comprises detecting a ventricular dysynchrony in the patient's heart via an implantable or patient-external sensing arrangement.  
   
   
       7 . The method of  claim 1 , wherein detecting the cardiac condition comprises detecting left ventricular systolic dysfunction via an implantable or patient-external sensing arrangement.  
   
   
       8 . The method of  claim 1 , wherein detecting the cardiac condition comprises detecting a left ventricular systolic dysfunction comprising a left ventricular ejection fraction value less than a predetermined limit.  
   
   
       9 . The method of  claim 1 , wherein detecting the cardiac condition comprises determining that a QRS complex pulse width of a cardiac cycle exceeds a predetermined limit.  
   
   
       10 . The method of  claim 1 , wherein detecting the cardiac condition comprises detecting a ventricular wall motion asynchrony that exceeds a predetermined limit.  
   
   
       11 . The method of  claim 1 , comprising one or more of initiating, terminating, adjusting, or optimizing the cardiac resynchronization therapy in response to detecting the presence of disordered breathing and the cardiac condition.  
   
   
       12 . The method of  claim 1 , wherein detecting the presence of disordered breathing is used to trigger an alert using a patient-external device.  
   
   
       13 . The method of  claim 1 , wherein detecting the presence of disordered breathing comprises detecting an apnea/hypopnea index greater than a predetermined limit.  
   
   
       14 . The method of  claim 1 , comprising enabling the implantable medical device to perform a first cardiac resynchronization therapy in response to detecting obstructive sleep apnea, and enabling the implantable medical device to perform a second cardiac resynchronization therapy after detecting central sleep apnea.  
   
   
       15 . The method of  claim 2 , comprising adjusting an atrioventricular delay based on the detected disordered breathing.  
   
   
       16 . The method of  claim 1 , wherein the cardiac resynchronization therapy comprises selecting a cardiac stimulation vector based on the detected disordered breathing.  
   
   
       17 . An implantable medical device, comprising: 
 a housing configured for implantation in a patient;    a lead system comprising an electrode arrangement and coupled to the housing; and    a processor provided in the housing and coupled to the lead system, the processor configured to detect presence of disordered breathing, detect a cardiac condition indicative of the patient's cardiac status, and identify the patient as suitable for a cardiac resynchronization therapy based on the presence of disordered breathing and the cardiac condition.    
   
   
       18 . The device of  claim 17 , wherein implantable medical device comprises a pulse generator coupled to the processor and configured to deliver at least one of a cardiac pacing therapy other than a cardiac resynchronization therapy, a cardiac shock therapy, and a cardiac neurostimulation therapy.  
   
   
       19 . The device of  claim 18 , wherein the processor is configured to enable the pulse generator to perform the cardiac resynchronization therapy based on identifying the patient as suitable for the cardiac resynchronization therapy.  
   
   
       20 . The device of  claim 18 , wherein the processor is configured to adjust an atrioventricular delay based on the detected disordered breathing.  
   
   
       21 . The device of  claim 17 , wherein the processor is configured to detect at least one of obstructive sleep apnea, central sleep apnea, hypopnea, orthopnea, paroxysmal nocturnal dyspnea, and Cheyne-Stokes respiration.  
   
   
       22 . The device of  claim 17 , further comprising one or both of an implantable sensor arrangement and a patient-external sensor arrangement coupled to the implantable medical device, the processor configured to detect a ventricular dysynchrony in the patient's heart via the one or both of the implantable or patient-external sensing arrangement.  
   
   
       23 . The device of  claim 17 , wherein the processor is coupled to communication circuitry configured to facilitate wireless communication between the processor and a patient-external device or system.  
   
   
       24 . The device of  claim 23 , wherein patient-external device or system is configured to generate a clinician alert to initiate, terminate, adjust, or optimize the cardiac resynchronization therapy.  
   
   
       25 . The device of  claim 17 , wherein the implantable medical device comprises transthoracic impedance measuring circuitry coupled to the processor and configured to detect patient breathing.  
   
   
       26 . An implantable medical device, comprising: 
 means for detecting presence of disordered breathing from within a patient;    means for detecting a cardiac condition indicative of the patient's cardiac status; and    means for identifying the patient as suitable for a cardiac resynchronization therapy based on the presence of disordered breathing and the cardiac condition.    
   
   
       27 . The device of  claim 26 , comprising means for alerting a clinician that the patient is suitable for the cardiac resynchronization therapy.