Exercise triggered cardiovascular pressure measurement

• US 10,376,159 B2
• Filed: 12/20/2016
• Issued: 08/13/2019
• Est. Priority Date: 12/20/2016
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Morris, Mary M., Klepfer, Ruth N., Kleckner, Karen J., Lauer, Joel R.
• Primary Examiner(s): Weare, Meredith
• Application Number:
  US15/384,709
• Publication Number:
  US 20180168463A1
• Time in Patent Office: 966 Days
• CPC Class Codes: A61B 2562/0219 Inertial sensors, e.g. accelerometers, gyroscopes, tilt switches
• CPC Class Codes: A61B 5/0024 for multiple sensor units attached to the patient, e.g. using a body or personal area network
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• CPC Class Codes: A61B 5/02055 Simultaneously evaluating both cardiovascular condition and temperature
• CPC Class Codes: A61B 5/0215 by means inserted into the body catheters A61M25/00
• CPC Class Codes: A61B 5/024 Detecting, measuring or recording pulse rate or heart rate A61B5/0205, A61B5/021 take precedence
• CPC Class Codes: A61B 5/0816 Measuring devices for examining respiratory frequency measuring frequency of electric signals G01R23/00
• CPC Class Codes: A61B 5/1118 Determining activity level
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61B 5/686 Permanently implanted devices, e.g. pacemakers, other stimulators, biochips A61B5/6861 takes precedence
• CPC Class Codes: A61B 5/6876 Blood vessel
• CPC Class Codes: A61B 5/7221 Determining signal validity, reliability or quality A61B5/7207 and A61B5/7217 take precedence
• CPC Class Codes: A61N 1/365 controlled by a physiological parameter, e.g. heart potential evoked response A61N1/371
• CPC Class Codes: A61N 1/3956 Implantable devices for applying electric shocks to the heart, e.g. for cardioversion
• CPC Class Codes: A61N 1/3987 characterised by the timing or triggering of the shock
• CPC Class Codes: G16H 20/30 relating to physical therapies or activities, e.g. physiotherapy, acupressure or exercising
• CPC Class Codes: G16H 40/63 for local operation

Abstract

Systems, devices disclosed provide example methods comprising determining that a triggering event has occurred based on statuses for a set of physiological parameters associated with the patient, the physiological parameters indicative of the patient engaging in a patient initiated physical activity, generating a trigger output signal in response to the determination that the triggering event has occurred, wirelessly transmitting the trigger output signal to a pressure sensing device implanted in a vessel of the patient, triggering, based on receiving the trigger output signal, the pressure sensing device to sense a cardiovascular pressure of the patient; and transmitting, by the pressure sensing device, a wireless signal comprising data corresponding to the sensed cardiovascular pressure of the patient.

Claims

1. A method comprising:

determining, by processing circuity of an implantable medical device implanted in a patient, that a triggering event has occurred based on statuses for a set of physiological parameters associated with the patient, the physiological parameters indicative of the patient engaging in a patient initiated physical activity;

generating, by trigger circuitry of the implantable medical device, a trigger output signal in response to the determination that the triggering event has occurred;

wirelessly transmitting, by a communication circuitry of the implantable medical device, the trigger output signal to a pressure sensing device implanted in a vessel of the patient;

triggering, based on receiving the trigger output signal at a communication circuitry of the pressure sensing device, the pressure sensing device to sense a cardiovascular pressure of the patient; and

transmitting, by the communication circuitry of the pressure sensing device, a wireless signal to the implantable medical device, the wireless signal comprising data corresponding to the sensed cardiovascular pressure of the patient; and

wherein determining that the triggering event has occurred based on at least one status for the set of physiological parameters associated with the patient further comprises;

determining, by a timer in the implantable medical device, if a minimum amount of time has elapsed since a last triggering event has occurred, and

generating a trigger output signal only if the minimum amount of time has elapsed and only then in response to the determination that the triggering event has occurred based on the statuses for the set of physiological parameters associated with the patient.

2. The method of claim 1, wherein determining that the triggering event has occurred comprises:

monitoring, by a processing circuitry of the implantable medical device, a value for each of the set of physiological parameters associated with the patient to determine a current value for each of the set of physiological parameters;

comparing, by the processing circuitry of the implantable medical device, each of the current values of the set of physiological parameters to a threshold value for that physiological parameter to determine a status for each of the physiological parameters, and

automatically determining, by the trigger circuitry, that the triggering event has occurred if each of the determined statuses for the set of physiological parameters indicates that the current value for each of the physiological parameters satisfies the threshold value defined for that physiological parameter.

3. The method of claim 2, wherein the monitored physiological parameters comprise at least one of a measurement of an activity count for the patient, a measurement of a heart rate for the patient, and a measurement of a respiration rate of the patient.

4. The method of claim 2, wherein generating the trigger output signal in response to the determination that the triggering event has occurred comprises:

performing, by the trigger circuitry, a logical AND function of the statuses for each of the physiological parameters; and

a providing a status of an output of the logical AND function as an output from the trigger circuitry.

5. The method of claim 1, wherein triggering the pressure sensing device to sense a cardiovascular pressure of the patient comprises triggering the pressure sensing device to sense a pulmonary artery pressure of the patient.

6. The method of claim 1, wherein triggering the pressure sensing device to sense the cardiovascular pressure of the patient comprises sensing the cardiovascular pressure of the patient over a predetermined window of time.

7. The method of claim 6, wherein sensing the cardiovascular pressure of the patient comprises sensing a plurality of pressure values of a pulmonary artery pressure of the patient at a predefined sampling rate over a time period of the predetermined window of time.

8. The method of claim 1, wherein triggering the pressure sensing device to sense the cardiovascular pressure of the patient further comprises:

triggering the pressure sensing device to transition from a low-power mode to a sensing mode; and

sensing, by the pressure sensing device, the cardiovascular pressure of the patient while the pressure sensing device is in the sensing mode.

9. The method of claim 8, further comprising:

completing the sensing of the cardiovascular pressure of the patient over a predetermined window of time;

completing the transmission of the wireless signal sent from the pressure sensing device to the implantable medical device, and

transitioning the pressure sensing circuitry from the sensing mode back to the low-power mode.

10. The method of claim 1, further comprising:

receiving, by the communication circuitry of the implanted medical device, a request signal transmitted to the implanted medical device from an external device;

initiating, by a timer, a predefined time period in response to receiving the request signal; and

generating, by the trigger circuitry, the trigger output signal only if during the predefined time period the triggering event occurs based on the statuses for the set of physiological parameters associated with the patient being indicative that the patient is engaging in a patient initiated physical activity.

11. The method of claim 1, further comprising:

receiving, by the communication circuitry of the implantable medical device, a request signal transmitted to the implantable medical device from an external device; and

generating, by the trigger circuitry, the trigger output signal regardless of the statuses of the set of physiological parameters.

12. The method of claim 1, wherein sensing the cardiovascular pressure of the patient further comprises determining, by the processing circuitry of the implantable medical device, at least one of a systolic pressure value, a diastolic pressure value, and a mean value for each cycle of the cardiovascular pressures associated with a heartbeat of the patient.

13. An implantable medical device, comprising:

processing circuitry configured to receive input signals from one or more sensors, the input signals comprising signals generated in response to measured physiological parameters associated with a patient, and to determine a status for each of a set of input parameters based on the measured physiological parameters, the status for each of the set of input parameters indicative of whether or not current value for the input parameter satisfies a threshold value for that input parameter;

trigger circuitry configured to automatically generate a trigger output signal based at least in part on a determination that the statuses of the input parameters are indicative of the patient engaging in a patient initiated physical activity;

communication circuitry configured to receive the trigger output signal generated by the trigger circuitry, and to wirelessly transmit the trigger output signal to a pressure sensing device that is adapted to be implanted in a vessel of the cardiovascular system of the patient, the pressure sensing device configured to sense a cardiovascular pressure upon receipt of the trigger output signal; and

a timer, the timer configured to provide a status indication that is indicative of whether a minimum time period has elapsed since the last occurrence of the trigger circuitry issuing a trigger output signal;

the trigger circuitry configured to receive that status indication provided by the timer, and to only issue a trigger output signal if the status indication indicates that the minimum time period has elapsed since the last issuance of a trigger output signal.

14. The implantable medical device of claim 13, wherein the determination of a status for each of a set of input parameters based on the measured physiological parameters comprises the processing circuitry configured to:

monitor input signals provided by the one or more sensor circuits to determine a current value for each of the set of input parameters based the monitored input signals;

compare each of the current values of the set of input parameters to at least one threshold value defined for that input parameter to determine if the current value for each input parameter satisfies the at least one threshold value defined for that input parameter.

15. The implantable medical device of claim 13, wherein at least one of the input signals received from the one or more sensors includes an accelerometer output signal generated by an accelerometer included within the implantable medical device, the processing circuitry configured to receive the accelerometer output signal from the accelerometer and to generate a current value for an activity count of the patient indicative of whether a patient has taken a step based at least in part on the accelerometer output signal.

16. The implantable medical device of claim 13, wherein the trigger circuitry comprises a logic circuit configured to logically AND the statuses of the set of input parameters, and to automatically generate the trigger output signal if all the statuses of input parameters are indicative of a positive status.

17. The implantable medical device of claim 13, wherein the communication circuitry is configured to receive an “

immediate”

request signal transmitted from an external device;

the trigger circuitry configured to receive the “

immediate”

request signal from the communication circuitry, to initiate a timer to time a predefined time period in response to receiving the “

immediate”

request signal, and to generate the trigger output signal only if during the predefined time period the triggering event has occurred based on the statuses for the set of physiological parameters associated with the patient being indicative that the patient is engaging in some form of patient initiated physical activity.

18. The implantable medical device of claim 13, wherein the communication circuitry is configured to receive an “

immediate”

request signal transmitted from an external device;

the trigger circuitry configured to receive the “

immediate”

request signal from the communication circuitry, and to generate the trigger output signal regardless of the statuses for the set of physiological parameters associated with the patient being indicative that the patient is engaging in some form of patient initiated physical activity.

19. The implantable medical device of claim 13, further comprising:

a housing adapted to be implanted at a position outside of a heart of the patient, the housing including sensor circuitry coupled to a plurality of electrodes located on an outer surface of the housing, the sensor circuitry and the plurality of electrodes configured sense an EGM signal generated by the heart of the patient.

20. The implantable medical device of claim 13, further comprising:

a housing adapted to be implanted outside a heart of the patient, the housing including sensing circuitry coupled to at least one lead including one or more electrodes adapted to be placed in electrical contact with selected portions of the cardiac anatomy of the patient and configured to sense an cardiac EGM signal generated by the heart of the patient, the housing further comprising a therapy delivery circuitry coupled to the one or more electrodes, the therapy delivery circuitry configured to provide electrical stimulation to the electrodes to deliver at least one of pacing or defibrillation to the patient based at least in part on the sensed EGM signal.

21. The implantable medical device of claim 13, wherein the pressure sensing device is adapted to be implanted in the pulmonary artery of the patient and is configured to sense a pulmonary artery pressure of the patient upon receiving the trigger output signal.