HYPERTENSION HIS BUNDLE PACING

Abstract

The present invention relates to an implantable device for stimulating a heart and lowering blood pressure, comprising: a stimulation unit configured to stimulate the His bundle or the left-bundle branch of the heart, and a sensing unit for detecting atrial activity of the heart. According to the present invention the stimulation unit is configured to stimulate the His bundle or the left bundle branch immediately before or immediately after detection of an atrial activity.

Claims

1. An implantable device for stimulating a heart and lowering blood pressure, comprising: a stimulation unit configured to stimulate the His bundle or the left-bundle branch of the heart, and a sensing unit for detecting atrial activity of the heart, wherein the stimulation unit is configured to stimulate the His bundle or the left bundle branch immediately before or immediately after detection of an atrial activity.

2. The implantable device according to claim 1, wherein the atrial sensing unit is configured to detect atrial activity of the heart using a ground electrode contact located outside the heart.

3. The implantable device according to claim 1, wherein the stimulation unit is configured to stimulate the His bundle or the left-bundle branch less than 80 ms before detection of an atrial activity.

4. The implantable device according to claim 1, wherein the stimulation unit is configured to stimulate the His bundle or the left-bundle branch less than 80 ms after detection of an atrial activity.

5. The implantable device according to claim 1, wherein the implantable device is configured to suspend the stimulation of the His bundle and/or of the left bundle branch.

6. The implantable device according to claim 1, wherein the implantable device is configured to suspend the stimulation of the His bundle and/or the left bundle branch after a predefined number of heart cycles or after a predetermined time period for at least one heart cycle or for a predetermined time period, wherein preferably said number is a natural number between one and ten.

7. The implantable device according to claim 1, wherein the implantable device is configured to control suspension of the stimulation of the His bundle and/or the left bundle branch depending on one or more parameters recorded by the implantable device or by another device and assignable to the systemic blood pressure.

8. The implantable device according to claim 1, wherein the implantable device comprises an electrode lead electrically connected to the stimulation unit and the sensing unit, wherein the electrode lead comprises a first electrode contact configured to be fixed to a proximal portion of the His bundle and to stimulate the His bundle, and a second electrode contact for sensing said atrial activity.

9. The implantable device according to claim 1, wherein the implantable device comprises an electrode lead comprising an electrode contact configured to be positioned in the region of the ventricular septum, wherein the implantable device is configured to stimulate the left bundle branch.

10. Method for lowering blood pressure by means of His bundle or left bundle branch stimulation using an implantable device according to claim 1, wherein His bundle stimulation or left bundle branch stimulation is applied to the heart immediately before or immediately after detection of an atrial activity of the heart.

11. The implantable device according to claim 1, wherein the stimulation unit is configured to stimulate the His bundle or the left-bundle branch less than 10 ms before detection of an atrial activity.

12. The implantable device according to claim 1, wherein the stimulation unit is configured to stimulate the His bundle or the left-bundle branch less than 10 ms after detection of an atrial activity.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0026] In the following embodiments, further features and advantages of the present invention shall be described with reference to the Figures which depict preferred embodiments of the present invention, wherein:

[0027] FIG. 1 shows an embodiment of an implantable device according to the present invention;

[0028] FIG. 2 shows a flow chart, wherein the functions of an embodiment of the implantable device as well as of the method according to the present invention may be carried out according to this flow chart; and

[0029] FIG. 3 shows schematically an electrode lead according to an embodiment of the present invention for achieving stimulation of the left bundle branch (LBB).

DETAILED DESCRIPTION

[0030] FIG. 1 shows an embodiment of an implantable medical device 200 according to the present invention for conducting a blood pressure-lowering stimulation of the heart H of a patient that suffers from hypertension. The device 200 comprises a stimulation unit 201 configured to stimulate the His bundle HIS or the left-bundle branch LBB of the heart H of the patient, and a sensing unit 202 for detecting atrial activity of the heart H. According to the present invention, the stimulation unit 201 is configured to stimulate the His bundle HIS or the left bundle branch LBB immediately before or immediately after detection of an atrial activity sensed by the sensing unit 202.

[0031] Furthermore, the device 200 preferably comprises an electrode lead 210 with at least two electrode contact 210a, 210b. The electrode lead 210 is configured to be implanted in such a way that a first electrode contact 210a forming a stimulation electrode contact is fixed in the proximal region of the His bundle HIS and at least a second electrode contact 210b is arranged in such a way that the intrinsic activation of the right atrium RA can be perceived via the sensing unit 202. To this end, the second electrode contact 210b is connected to the stimulation unit 201 and the first electrode contact 210a is connected to the stimulation unit 201 to apply electrical stimulation pulses to the His bundle HIS.

[0032] For stimulating the left bundle branch LBB, the device can comprise an electrode lead which is implanted in a ventricular, deep septal position to reach the LBB.

[0033] FIG. 2 shows a flow chart of a method for lowering blood pressure. Particularly, the implantable device 200 can be configured to perform these steps.

[0034] First, the blood pressure-lowering therapy is initiated 100 by programming and activating the stimulation parameters.

[0035] Subsequently, the blood pressure-lowering His bundle stimulation takes place by stimulating 110 the His bundle HIS immediately after each atrial perception, which causes the filling of the right ventricle to end prematurely (AV time shortened by the AV-His time) due to the atrial contraction (reduced preload) and as a result there is less wall tension in the right ventricle, which in turn causes a negative inotropy and thus a reduction in the blood pressure for this heartbeat. This stimulation is repeated as long as a predefined number of His stimulations 120, N have taken place.

[0036] When the number of stimulated His intervals is reached 120, J, the His stimulation is switched off 130 and the rhythm is only monitored.

[0037] His stimulation is stopped with the aim of preventing blood pressure counter regulation by the baroreceptors.

[0038] After a defined number of intrinsic heartbeats 140, J, His stimulation 110 is reactivated.

[0039] FIG. 3 schematically shows an electrode lead 370 according to an embodiment of the present invention in the implanted position, which can be screwed very deeply into the myocardium in order to reach the two left legs 330 of the LBB. The ventricular conduction system consists of the AV node 310, the HIS bundle 320, the two left legs 330 and the right leg 340. The electrode lead 370 is implanted from the right ventricle RV and positioned on the right ventricular septum 150. The stimulation pole 380 is positioned so deep in the septum that it is positioned in or near the left leg 330 and thus primarily stimulates the left leg before the division of the left leg.

[0040] The present invention advantageously enables a device-based therapy for permanent systemic blood pressure reduction with physiological stimulation.

[0041] It will be apparent to those skilled in the art that numerous modifications and variations of the described examples and embodiments are possible in light of the above teachings of the disclosure. The disclosed examples and embodiments are presented for purposes of illustration only. Other alternate embodiments may include some or all of the features disclosed herein. Therefore, it is the intent to cover all such modifications and alternate embodiments as may come within the true scope of this invention, which is to be given the full breadth thereof. Additionally, the disclosure of a range of values is a disclosure of every numerical value within that range, including the end points.