Systems and related methods for optimization of multi-electrode nerve pacing
First Claim
1. A method for determining a relationship between charge and diaphragm response for an electrode combination, comprising:
- inserting a plurality of electrodes into one or more blood vessels of a patient, wherein the plurality of electrodes include the electrode combination;
using the electrode combination, stimulating a phrenic nerve with a plurality of stimulation pulses, wherein each stimulation pulse includes a corresponding charge, and the corresponding charges differ among the plurality of stimulation pulses;
determining a recruitment curve relating the corresponding charges to diaphragm responses resulting from the corresponding charges, wherein the recruitment curve also relates undelivered charges to diaphragm responses expected from the undelivered charges; and
after determining the recruitment curve;
a) stimulating the phrenic nerve with the electrode combination, b) using the recruitment curve, determining an expected diaphragm response, to the stimulation, and c) comparing an actual diaphragm response to the expected diaphragm response.
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Accused Products
Abstract
This disclosure describes, among other embodiments, systems and related methods for selecting electrode combinations to be used during nerve pacing procedures. A first set of electrode combinations of a nerve pacing system, such as a phrenic nerve pacing system for diaphragm activation, may be mapped (or tested) to determine the location of the electrode combinations relative to a target nerve. Once the general location of the target nerve is known, a more localized second set of electrode combinations may be tested to determine the most suitable electrode combinations for nerve stimulation. At various stages of the mapping process, electrode combinations that are non-optimal may be discarded as candidates for use in a nerve pacing procedure. The systems and methods described herein may allow for the selection of electrode combinations that are most suitable for stimulation of the left and right phrenic nerves during diaphragm pacing.
649 Citations
20 Claims
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1. A method for determining a relationship between charge and diaphragm response for an electrode combination, comprising:
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inserting a plurality of electrodes into one or more blood vessels of a patient, wherein the plurality of electrodes include the electrode combination; using the electrode combination, stimulating a phrenic nerve with a plurality of stimulation pulses, wherein each stimulation pulse includes a corresponding charge, and the corresponding charges differ among the plurality of stimulation pulses; determining a recruitment curve relating the corresponding charges to diaphragm responses resulting from the corresponding charges, wherein the recruitment curve also relates undelivered charges to diaphragm responses expected from the undelivered charges; and after determining the recruitment curve;
a) stimulating the phrenic nerve with the electrode combination, b) using the recruitment curve, determining an expected diaphragm response, to the stimulation, and c) comparing an actual diaphragm response to the expected diaphragm response. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11)
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12. A method for determining a relationship between charge and diaphragm response for an electrode combination, comprising:
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with a ventilator, assisting a plurality of breaths of a patient; inserting a plurality of electrodes into one or more blood vessels of the patient, wherein the plurality of electrodes include the electrode combination; during end-expiratory phases of a plurality of breaths, emitting a plurality of stimulation pulses from the electrode combination, wherein each stimulation pulse includes a corresponding charge, and the corresponding charges differ among the plurality of stimulation pulses; measuring diaphragm responses to the plurality of stimulation pulses; determining a recruitment curve relating the corresponding charges to the measured diaphragm responses and relating other undelivered charges to a plurality of expected diaphragm responses; and after determining the recruitment curve;
a) stimulating the phrenic nerve with the electrode combination, b) using the recruitment curve, determining an expected diaphragm response of the plurality of expected responses to the stimulation, and c) comparing an actual diaphragm response to the expected diaphragm response. - View Dependent Claims (13, 14, 15, 16, 17, 18, 19, 20)
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Specification