Neural stimulation with avoidance of inappropriate stimulation

• US 20060116737A1
• Filed: 11/30/2004
• Published: 06/01/2006
• Est. Priority Date: 11/30/2004
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Libbus, Imad
• Granted Patent: US 8,126,559 B2
• Time in Patent Office: Days
• US Class Current: 607/44
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/36117 for treating hypertension
• CPC Class Codes: A61N 1/36139 with automatic adjustment
• CPC Class Codes: A61N 1/36175 Pulse width or duty cycle
• CPC Class Codes: A61N 1/36178 Burst or pulse train parameters
• CPC Class Codes: A61N 1/37264 Changing the program; Upgrading firmware

Abstract

Various aspects of the present subject matter provide an implantable medical device. In various embodiments, the device comprises a pulse generator, a first monitor and a controller. The pulse generator is adapted to generate a neural stimulation signal for a neural stimulation therapy. The neural stimulation signal has at least one adjustable parameter. The first monitor is adapted to detect an undesired effect. In some embodiments, the undesired effect is myocardial infarction. The controller is adapted to respond to the first monitor and automatically adjust the at least one adjustable parameter of the neural stimulation signal to avoid the undesired effect of the neural stimulation therapy. Other aspects are provided herein.

Claims

1. An implantable medical device, comprising:

a pulse generator to generate a neural stimulation signal for a neural stimulation therapy, the neural stimulation signal having at least one adjustable parameter;

a first monitor to detect an undesired effect; and

a controller adapted to respond to the first monitor and automatically adjust the at least one adjustable parameter of the neural stimulation signal to avoid the undesired effect of the neural stimulation therapy.

2. The implantable medical device of claim 1, further comprising a second monitor to detect a desired effect of the neural stimulation therapy, wherein the controller is further adapted to respond to the second monitor and automatically adjust the at least one adjustable parameter of the neural stimulation signal to achieve the desired effect of the neural stimulation therapy while avoiding the undesired effect.

3. The implantable medical device of claim 2, further comprising a sensor to sense a feedback parameter indicative of the desired effect, wherein the controller is adapted to sense the feedback parameter before and during a neural stimulation burst to determine a detected feedback parameter change, to compare the detected feedback parameter change to a desired feedback parameter change, and to adjust the at least one adjustable parameter of the neural stimulation signal such that the detected feedback parameter change corresponds with the desired feedback parameter change.

4. The implantable medical device of claim 3, wherein the desired feedback parameter change includes a programmable value.

5. The implantable medical device of claim 4, wherein the programmable value is indicative of a desired heart rate change in response to the neural stimulation burst.

6. The implantable medical device of claim 4, wherein the programmable value is indicative of a desired blood pressure change in response to the neural stimulation burst.

7. The implantable medical device of claim 4, wherein the programmable value is indicative of a desired change in respiration in response to the neural stimulation burst.

8. The implantable medical device of claim 1, wherein the at least one adjustable parameter includes an amplitude of the neural stimulation signal.

9. The implantable medical device of claim 1, wherein the at least one adjustable parameter includes an amplitude and a frequency of the neural stimulation signal.

10. The implantable medical device of claim 1, wherein the first monitor is adapted to detect myocardial capture.

11. The implantable medical device of claim 1, wherein the neural activity is applied to at least one target nerve, and the first monitor is adapted to detect neural activity in a non-target nerve.

12. The implantable medical device of claim 1, wherein the first monitor is adapted to detect capture of a smooth muscle.

13. An implantable device, comprising:

a neural stimulator, including;

a pulse generator to generate a neural stimulation signal for a neural stimulation therapy; and

a modulator to adjust at least one stimulation parameter of the neural stimulation signal;

a first monitor to monitor at least one feedback parameter and provide a first signal indicative of the parameter during the neural stimulation therapy and a second signal indicative of the feedback parameter without the neural stimulation;

a second monitor to monitor myocardial capture from the neural stimulation therapy and provide a third signal indicative of a detected myocardial capture; and

a controller adapted to respond to the first, second and third signals, determine a detected change for the at least one stimulation parameter based on the first and second signals, and provide a therapy control signal to the modulator based on the third signal and the detected change to achieve a desired change for the at least one stimulation parameter while avoiding myocardial capture.

14. The implantable device of claim 13, wherein the at least one stimulation parameter includes an amplitude of the neural stimulation signal.

15. The implantable device of claim 14, wherein the at least one stimulation parameter further includes a frequency of the neural stimulation signal.

16. The implantable device of claim 15, wherein the controller is adapted to adjust the amplitude of the neural stimulation signal in an attempt to avoid myocardial capture while providing effective neural stimulation therapy, and adjust the frequency of the neural stimulation signal if adjusting the amplitude alone is unable to both avoid myocardial capture and provide effective neural stimulation therapy.

17. The implantable device of claim 13, wherein the controller, neural stimulator, and the second monitor are adapted to cooperate to generate a neural stimulation burst signal, direct the neural stimulation burst signal to a neural stimulation electrode, wait a blanking period to depolarize the neural stimulation electrode, and sense for a myocardial activation using the neural stimulation electrode.

18. The implantable device of claim 13, wherein the controller, neural stimulator, and the second monitor are adapted to cooperate to generate a neural stimulation burst signal, direct the neural stimulation burst signal to a neural stimulation electrode, and sense for a myocardial activation using the neural stimulation electrode and another electrode.

19. The implantable device of claim 13, wherein the controller, neural stimulator, and the second monitor are adapted to cooperate to interrupt the neural stimulation therapy, provide a neural stimulation burst signal, direct the neural stimulation burst signal to a neural stimulation electrode, sense for a myocardial capture that is responsive to the neural stimulation burst signal, and continue the neural stimulation therapy after sensing for the myocardial capture.

20. An implantable medical device, comprising:

means for applying neural stimulation therapy to at least one targeted nerve, including generating a neural stimulation signal for use to provide the neural stimulation therapy;

means for monitoring a patient for an undesired response to the neural stimulation signal; and

means for automatically adjusting at least one parameter of the neural stimulation signal to avoid the undesired response to the neural stimulation signal.

21. The implantable medical device of claim 20, wherein the means for monitoring a patient for an undesired response to the neural stimulation signal includes means for monitoring myocardial capture in response to the neural stimulation therapy.

22. The implantable medical device of claim 20, wherein the means for monitoring a patient for an undesired response to the neural stimulation signal includes means for monitoring neural traffic in a non-targeted nerve in response to the neural stimulation therapy.

23. The implantable medical device of claim 20, wherein the means for monitoring a patient for an undesired response to the neural stimulation signal includes means for monitoring a contraction of a smooth muscle in response to the neural stimulation therapy.

24. The implantable medical device of claim 20, wherein the at least one parameter includes amplitude.

25. A method, comprising:

applying neural stimulation therapy to at least one targeted nerve, including generating a neural stimulation signal for use to provide the neural stimulation therapy;

monitoring a patient for an undesired response to the neural stimulation signal; and

automatically adjusting at least one parameter of the neural stimulation signal to avoid the undesired response to the neural stimulation signal.

26. The method of claim 25, wherein:

applying neural stimulation therapy to at least one targeted nerve includes generating a neural stimulation burst signal and directing the neural stimulation burst signal to a neural stimulation electrode; and

monitoring a patient for an undesired response includes waiting a blanking period to depolarize the neural stimulation electrode, and sensing for a myocardial activation using the neural stimulation electrode.

27. The method of claim 25, wherein:

applying neural stimulation therapy to at least one targeted nerve includes generating a neural stimulation burst signal and directing the neural stimulation burst signal to a neural stimulation electrode; and

monitoring a patient for an undesired response includes sensing for a myocardial activation using the neural stimulation electrode and another electrode.

28. The method of claim 25, wherein:

monitoring a patient for an undesired response includes interrupting the neural stimulation therapy, providing a neural stimulation burst signal and directing the neural stimulation burst signal to a neural stimulation electrode, sensing for a myocardial capture that is responsive to the neural stimulation burst signal, and continuing the neural stimulation therapy after sensing for the myocardial capture.

29. A method, comprising:

applying neural stimulation therapy to at least one targeted nerve, including generating a neural stimulation signal for use to provide the neural stimulation therapy;

monitoring a patient for both a desired response and an undesired response to the neural stimulation signal; and

automatically adjusting at least one parameter of the neural stimulation signal to achieve the desired response and avoid the undesired response to the neural stimulation signal.

30. The method of claim 29, wherein automatically adjusting at least one parameter of the neural stimulation signal to achieve the desired response and avoid the undesired response to the neural stimulation signal includes automatically changing an amplitude of the neural stimulation signal to achieve the desired response and avoid the undesired response to the neural stimulation signal.

31. The method of claim 30, wherein automatically adjusting at least one parameter of the neural stimulation signal to achieve the desired response and avoid the undesired response to the neural stimulation signal further includes changing a frequency of the neural stimulation signal to achieve the desired response and avoid the undesired response to the neural stimulation signal if changing the amplitude is unable to achieve the desired response and avoid the undesired response to the neural stimulation signal.

32. The method of claim 29, wherein automatically adjusting at least one parameter of the neural stimulation signal to achieve the desired response and avoid the undesired response to the neural stimulation signal includes automatically adjusting at least one of an amplitude, a frequency, a burst frequency, a pulse width a duty cycle and a morphology of the neural stimulation signal.