Automatic baroreflex modulation responsive to adverse event

Abstract

A system for providing baroreflex stimulation comprises a sensor to detect a parameter and provide a signal indicative of the parameter, and a baroreflex stimulator. The baroreflex stimulator includes a driver to provide a control signal adapted to deliver a baroreflex therapy, and a controller to receive the signal indicative of the parameter and modulate the control signal based on the signal indicative of the parameter to change the baroreflex therapy from a first baroreflex therapy to a second baroreflex therapy.

1 . A baroreflex stimulator, comprising:
 an electrode adapted to be positioned proximate to sensory nerve endings for a receptor sensitive to pressure;   an implantable pulse generator configured to provide a baroreflex stimulation signal through the electrode to the sensory nerve endings to control blood pressure through a baroreflex response that reduces coronary vascular resistance and increases blood flow;   means for receiving a signal regarding a detected adverse event: and   means for controlling blood pressure using the implantable device and the electrode. wherein the means for controlling blood pressure includes:
 means for performing a first baroreflex therapy when the adverse event is not detected, wherein the means for performing the first baroreflex therapy includes means for delivering a first baroreflex stimulation signal through the electrode to the sensory nerve endings; and 
 means for adjusting blood pressure for the predetermined adverse event when the adverse event is detected, wherein the means for adjusting blood pressure includes means for automatically performing a second baroreflex therapy when the adverse event is detected, and wherein the means for automatically performing the second baroreflex therapy includes means for delivering a second baroreflex stimulation signal through the electrode to the sensory nerve endings. 
   
   
   
       2 . The baroreflex stimulator of  claim 1 , wherein: the means for receiving a signal regarding a detected adverse event includes means for receiving a signal regarding a detected adverse cardiac event; and the means for controlling blood pressure includes means for performing the first baroreflex therapy when the adverse cardiac event is not detected, and means for automatically performing the second baroreflex therapy when the cardiac event is detected. 
   
   
       3 . The baroreflex stimulator of  claim 2 , wherein: the means for receiving a signal regarding a detected adverse event includes means for receiving a signal regarding a detected arrhythmia; and the means for controlling blood pressure includes means for performing the first baroreflex therapy when the arrhythmia is not detected, and means for automatically performing the second baroreflex therapy when the arrhythmia is detected. 
   
   
       4 . The baroreflex stimulator of  claim 3 , wherein: the means for receiving a signal regarding a detected adverse event includes means for receiving a signal regarding a detected tachycardia; and the means for controlling blood pressure includes means for performing the first baroreflex therapy when the tachycardia is not detected, and means for automatically performing the second baroreflex therapy when the tachycardia is detected. 
   
   
       5 . The baroreflex stimulator of  claim 3 , wherein: the means for receiving a signal regarding a detected adverse event includes means for receiving a signal regarding a detected fibrillation; and the means for controlling blood pressure includes means for performing the first baroreflex therapy when the fibrillation is not detected, and means for automatically performing the second baroreflex therapy when the fibrillation is detected. 
   
   
       6 . The baroreflex stimulator of  claim 2 , wherein: the means for receiving a signal regarding a detected adverse event includes means for receiving a signal regarding a detected non-arrhythmic cardiac event; and the means for controlling blood pressure includes means for performing the first baroreflex therapy when the non-arrhythmic cardiac event is not detected, and means for automatically performing the second baroreflex therapy when the non-arrhythmic cardiac event is detected. 
   
   
       7 . The baroreflex stimulator of  claim 1 , wherein: the means for receiving a signal regarding a detected adverse event includes means for receiving a signal regarding a detected non-cardiac event; and the means for controlling blood pressure includes means for performing the first baroreflex therapy when the non-cardiac event is not detected, and means for automatically performing the second baroreflex therapy when the non-cardiac event is detected. 
   
   
       8 . The baroreflex stimulator of  claim 7 , wherein: the means for receiving a signal regarding a detected adverse event includes means for receiving a signal regarding a stroke; and the means for controlling blood pressure includes means for performing the first baroreflex therapy when the stroke is not detected, and means for automatically performing the second baroreflex therapy when the stroke is detected. 
   
   
       9 . The baroreflex stimulator of  claim 7 , wherein: the means for receiving a signal regarding a detected adverse event includes means for receiving a signal regarding a precursor to a cardiac arrhythmia; and the means for controlling blood pressure includes means for performing the first baroreflex therapy when the precursor to the cardiac arrhythmia is not detected, and means for automatically performing the second baroreflex therapy when the precursor to the cardiac arrhythmia is detected. 
   
   
       10 . The baroreflex stimulator of  claim 1 , wherein the baroreflex stimulation signal has an amplitude, and the means for modulating the baroreflex stimulation signal includes means for adjusting the amplitude of the baroreflex stimulation signal. 
   
   
       11 . The baroreflex stimulator of  claim 1 , wherein the baroreflex stimulation signal has a frequency, and the means for modulating the baroreflex stimulation signal includes means for adjusting the frequency of the baroreflex stimulation signal. 
   
   
       12 . The baroreflex stimulator of  claim 1 , wherein the baroreflex stimulation signal has a duty cycle, and the means for modulating the baroreflex stimulation signal includes means for adjusting the duty cycle of the baroreflex stimulation signal. 
   
   
       13 . The baroreflex stimulator of  claim 1 , wherein the baroreflex stimulation signal has a morphology, and the means for modulating the baroreflex stimulation signal includes means for adjusting the morphology of the baroreflex stimulation signal. 
   
   
       14 . The stimulator of  claim 1 , wherein the electrode and the implantable pulse generator are configured to target the sensory nerve endings with the baroreflex stimulation signal while avoiding other neural pathways to stimulate a desired response while reducing undesired effects of the stimulation. 
   
   
       15 . A system for providing baroreflex stimulation, comprising:
 an adverse event detector to sense a predetermined adverse event and provide a signal indicative of the adverse event; and   a baroreflex stimulator, including:
 a pulse generator to provide a baroreflex stimulation signal for baroreflex therapy; and 
 a modulator to receive the signal indicative of the adverse event and to modulate the baroreflex stimulation signal based on the signal indicative of the adverse event, wherein the pulse generator and modulator are configured to cooperate to adjust blood pressure for the adverse event by providing a first baroreflex therapy when the adverse event is not detected and providing and a second baroreflex therapy when the adverse event is detected, wherein the baroreflex stimulation signal for the first baroreflex therapy is different than the baroreflex therapy for the second baroreflex therapy. 
   
   
   
       16 . The system of  claim 15 , wherein the baroreflex signal has an amplitude, and the modulator includes a modulator to modulate the amplitude based on the signal indicative of the adverse event. 
   
   
       17 . The system of  claim 15 , wherein the baroreflex signal has a frequency, and the modulator includes a modulator to modulate the frequency based on the signal indicative of the adverse event. 
   
   
       18 . The system of  claim 15 , wherein the baroreflex signal has a burst frequency, and the modulator includes a modulator to modulate the burst frequency based on the signal indicative of the adverse event. 
   
   
       19 . The system of  claim 15 , further comprising a waveform generator to produce baroreceptor signals of a desired morphology, wherein the modulator includes a modulator to change the morphology of the baroreflex stimulation signal based on the signal indicative of the adverse event. 
   
   
       20 . The system of  claim 15 , further comprising an implantable medical device, wherein the implantable medical device includes the adverse event detector and the baroreflex stimulator. 
   
   
       21 . The system of  claim 15 , wherein the adverse event includes an arrhythmia. 
   
   
       22 . The system of  claim 21 , wherein the arrhythmia includes ventricular tachycardia. 
   
   
       23 . The system of  claim 21 , wherein the arrhythmia includes atrial tachycardia. 
   
   
       24 . The system of  claim 21 , wherein the arrhythmia includes ventricular fibrillation. 
   
   
       25 . The system of  claim 21 , wherein the arrhythmia includes atrial fibrillation. 
   
   
       26 . The system of  claim 15 , wherein the adverse cardiac event includes a non-arrhythmic cardiac event. 
   
   
       27 . The system of  claim 15 , wherein the adverse event includes a non-cardiac event. 
   
   
       28 . The system of  claim 14 , wherein the non-cardiac event includes a stroke.