Multiple vector fluid localization

• US 10,292,649 B2
• Filed: 05/26/2016
• Issued: 05/21/2019
• Est. Priority Date: 10/27/2009
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Thakur, Pramodsingh Hirasingh, Patangay, Abhilash, Lee, Kent
• Primary Examiner(s): Flory, Christopher A
• Application Number:
  US15/165,817
• Publication Number:
  US 20160270688A1
• Time in Patent Office: 1,090 Days
• Field of Search: 600300, 600301, 600345, 600483, 600484, 600506, 600528, 600529, 607 5, 607 9, 607 17, 607 27
• CPC Class Codes: A61B 5/01 Measuring temperature of body parts ; Diagnostic temperature sensing, e.g. for malignant or inflamed tissue clinical contact thermometers G01K13/20
• CPC Class Codes: A61B 5/053 Measuring electrical impedance or conductance of a portion of the body
• CPC Class Codes: A61B 5/0537 Measuring body composition by impedance, e.g. tissue hydration or fat content
• CPC Class Codes: A61B 5/0538 invasively, e.g. using a catheter
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61B 5/4875 Hydration status, fluid retention of the body
• CPC Class Codes: A61B 5/4878 Evaluating oedema
• CPC Class Codes: A61B 5/6869 Heart
• CPC Class Codes: A61B 5/7282 Event detection, e.g. detecting unique waveforms indicative of a medical condition A61B5/4094, A61B5/4818, A61B5/349, A61B5/0823 take precedence
• CPC Class Codes: A61B 5/74 Details of notification to user or communication with user or patient indicating measured values G01D7/00; user input means input or output arrangements for computers G06F3/00
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/3702 Physiological parameters A61N1/365 takes precedence; evoked response A61N1/371

Abstract

A differential or relative measurement between an orthogonal measurement vector and another measurement vector can be used to determine the location where fluid accumulation is occurring or the local change in such fluid accumulation. This can help diagnose or treat infection or hematoma or seroma at a pocket of an implanted cardiac rhythm management device, other implanted medical device, or prosthesis. It can also help diagnose or treat pulmonary edema, pneumonia, pulmonary congestion, pericardial effusion, pericarditis, pleural effusion, hemodilution, or another physiological condition.

Claims

1. A system comprising:

an impedance measurement circuit configured to measure tissue impedance using a plurality of impedance vectors including first and second impedance vectors; and

a detector circuit communicatively coupled to the impedance measurement circuit, configured to generate a fluid status indicator using the measured tissue impedance including a relative measure between a change in first impedance measurements according to the first impedance vector and a change in second impedance measurements according to the second impedance vector, the fluid status indicator indicating fluid accumulation at a body location;

wherein the first impedance vector includes a first excitation vector for providing a first excitation signal, and a first response vector for sensing a first response to the first excitation signal, the first excitation vector being non-orthogonal to the first response vector; and

wherein the second impedance vector includes a second excitation vector for providing a second excitation signal, and a second response vector for sensing a second response to the second excitation signal, the second excitation vector being substantially orthogonal to the second response vector.

2. The system of claim 1, further comprising an interface unit configured to communicate the fluid status indicator to a user or an automated process.

3. The system of claim 1, wherein the detector circuit is configured to generate the fluid status indicator indicating fluid accumulation at a device pocket for an implantable device using the first and second tissue impedance measurements,

wherein the second impedance vector includes the second excitation vector provided between a first left ventricular electrode and a pectoral electrode, the second response vector provided between a second left ventricular electrode and one of a right atrial electrode, a right ventricular electrode, or a superior vena cava electrode.

4. The system of claim 1, wherein the detector circuit is configured to generate the fluid status indicator indicating fluid accumulation at a device pocket for an implantable device using the first and second impedance measurements,

wherein the second impedance vector includes the second excitation vector provided between a first left ventricular electrode and a pectoral electrode, the second response vector provided between the pectoral electrode and one of a right atrial electrode or a superior vena cava electrode.

5. The system of claim 1, wherein the detector circuit is configured to generate the fluid status indicator indicating fluid accumulation at a pericardial region using the first and second impedance measurements,

wherein the second impedance vector includes the second excitation vector provided between a first right ventricular electrode and a left ventricular electrode, the second response vector provided between a second right ventricular electrode and one of a right atrial electrode or a superior vena cava electrode.

6. The system of claim 1, wherein the detector circuit is configured to generate the fluid status indicator indicating fluid accumulation at a lung region using the first and second impedance measurements,

wherein the second impedance vector includes the second excitation vector provided between a first left ventricular electrode and a pectoral electrode, the second response vector provided between a second right ventricular electrode and a right atrial electrode.

7. The system of claim 1, wherein the detector circuit is configured to generate the fluid status indicator using a composite of the first and second impedance measurements.

8. The system of claim 7, wherein the composite includes a weighted combination of the first and second impedance measurements weighted by respective weight factors.

9. The system of claim 1, wherein the detector circuit is configured to:

determine a fractional change of the first impedance measurements from a baseline first impedance measurement, and a fractional change of the second impedance measurements from a baseline second impedance measurement; and

generate the fluid status using a relative measure of the fractional change of the first impedance measurements and the fractional change of the second impedance measurements.

10. The system of claim 9, wherein the detector circuit is configured to determine the fluid accumulation region as one of:

a pocket region;

a pericardial region;

a lung region;

or

a global region.

11. The system of claim 1, wherein the detector circuit is configured to localize, among a plurality of regions, a fluid accumulation region using impedance measurements according to the plurality of impedance vectors.

12. The system of claim 1, wherein relative measure includes a ratio between the first and second impedance measurements.

13. The system of claim 1, wherein the relative measure includes a difference between the first and second impedance measurements.

14. The system of claim 1, wherein the first or second impedance measurement includes respective impedance timing parameters.

15. The system of claim 1, wherein the first or second impedance measurement includes respective cumulative changes in impedance over time.

16. A method, comprising:

measuring tissue impedance using a plurality of impedance vectors including first and second impedance vectors, including;

measuring first tissue impedance according to a first impedance vector, including applying a first excitation signal to a first excitation vector and sensing a first response to the first excitation signal from a first response vector, the first excitation vector being non-orthogonal to the first response vector, the first excitation vector being non-orthogonal to the first response vector; and

measuring second tissue impedance according to a different second impedance vector, including applying a second excitation signal to a second excitation vector and sensing a second response to the second excitation signal from a second response vector, the second excitation vector being substantially orthogonal to the second response vector; and

generating a fluid status indicator using a relative measure between a change in the first impedance measurements and a change in the second impedance measurements, the fluid status indicator indicating fluid accumulation at a body location.

17. The method of claim 16, further comprising localizing a fluid accumulation region using impedance measurements according to the plurality of impedance vectors.

18. A system, comprising:

means for measuring tissue impedance using a plurality of impedance vectors, including means for measuring first tissue impedance according to a first impedance vector and means for measuring second tissue impedance according to a second impedance vector, wherein;

the first impedance vector including a first excitation vector for providing a first excitation signal, and a first response vector for sensing a first response to the first excitation signal, the first excitation vector being non-orthogonal to the first response vector; and

the second impedance vector includes a second excitation vector for providing a second excitation signal, and a second response vector for sensing a second response to the second excitation signal, the second excitation vector being substantially orthogonal to the second response vector; and

means for generating a fluid status indicator using a relative measure between a change in the first impedance measurements and a change in the second impedance measurements, the fluid status indicator indicating fluid accumulation at a body location.

19. The system of claim 18, wherein the means for generating the fluid status indicator includes one or more of:

means for generating an indicator of fluid accumulation at a device pocket for an implantable device using the impedance measurements according to the first and second impedance vectors selected for detecting fluid status at the device pocket;

means for generating an indicator of fluid accumulation at a pericardial region using the impedance measurements according to the first and second impedance vectors selected for detecting fluid status at the pericardial region;

or

means for generating an indicator of fluid accumulation at a lung region using the impedance measurements according to the first and second impedance vectors selected for detecting fluid status at the lung region.

20. The system of claim 18, wherein the means for generating the fluid status indicator includes means for localizing a fluid accumulation region using impedance measurements according to the plurality of impedance vectors.