Method and apparatus to perform electrode combination selection

• US 20090043351A1
• Filed: 08/07/2007
• Published: 02/12/2009
• Est. Priority Date: 08/07/2007
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Tockman, Bruce A., Sathaye, Alok S., Brooke, M. Jason
• Granted Patent: US 8,265,736 B2
• Time in Patent Office: Days
• US Class Current: 607/28
• CPC Class Codes: A61N 1/056 Transvascular endocardial electrode systems
• CPC Class Codes: A61N 1/0563 specially adapted for defibrillation or cardioversion
• CPC Class Codes: A61N 1/36514 controlled by a physiological quantity other than heart potential, e.g. blood pressure controlled by two or more physical parameters A61N1/36585
• CPC Class Codes: A61N 1/36564 controlled by blood pressure
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters
• CPC Class Codes: A61N 1/3686 configured for selecting the electrode configuration on a lead A61N1/3688 takes precedence
• CPC Class Codes: A61N 1/3702 Physiological parameters A61N1/365 takes precedence; evoked response A61N1/371
• CPC Class Codes: A61N 1/3704 Circuits specially adapted therefor, e.g. for sensitivity control
• CPC Class Codes: A61N 1/371 Capture, i.e. successful stimulation
• CPC Class Codes: A61N 1/37223 Circuits for electromagnetic coupling
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means

Abstract

Approaches for selecting an electrode combination of multi-electrode pacing devices are described. Electrode combination parameters that support cardiac function consistent with a prescribed therapy are evaluated for each of a plurality of electrode combinations. Electrode combination parameters that do not support cardiac function are evaluated for each of the plurality of electrode combinations. An order is determined for the electrode combinations based on the parameter evaluations. An electrode combination is selected based on the order, and therapy is delivered using the selected electrode combination.

Claims

1. A method comprising:

evaluating, for each electrode combination of a plurality of electrode combinations, one or more first parameters produced by electrical stimulation delivered using the electrode combination, the first parameters supportive of cardiac function consistent with a prescribed therapy;

evaluating, for each electrode combination of the plurality of electrode combinations, one or more second parameters produced by the electrical stimulation delivered using the electrode combination, the second parameters not supportive of cardiac function consistent with the prescribed therapy;

determining an order for at least some of the electrode combinations of the plurality of electrode combinations based on the evaluations of the first parameters and the second parameters;

selecting one or more electrode combinations based on the order; and

delivering an electrical stimulation therapy using the selected one or more electrode combinations, wherein at least one of evaluating the first and second parameters, ordering the electrode combinations, and selecting the electrode combinations for therapy delivery is performed automatically by a cardiac rhythm management (CRM) system.

2. The method of claim 1, wherein evaluating the first parameters comprises evaluating capture threshold.

3. The method of claim 1, wherein evaluating the first parameters comprises evaluating responsiveness to cardiac resynchronization.

4. The method of claim 1, wherein evaluating the first parameters comprises measuring the first parameters for at least one of the plurality of electrode combinations and estimating the first parameters for at least one other of the plurality of electrode combinations.

5. The method of claim 1, wherein evaluating the second parameters comprises detecting at least one of unintended nerve stimulation and unintended muscle stimulation.

6. The method of claim 1, wherein determining the order comprises comparing at least one of the first and second parameters associated with one electrode combination to at least one of the first and second parameters of at least one other electrode combination.

7. The method of claim 1, wherein determining the order comprises grouping the electrode combinations based on predetermined criteria.

8. The method of claim 1, wherein determining the order of at least some electrode combinations comprises ranking at least some electrode combinations based on one or more of capture threshold, therapy energy consumption, undesirable activation of nerve or muscle tissue, anodal cardiac stimulation, degree of responsiveness to resynchronization therapy, impedance, cardiac contractility, electrode combination activation timing, cardiac output, stroke volume, dP/dt, hemodynamics, and historical success of therapy using the electrode combinations.

9. The method of claim 1, wherein determining the order of at least some electrode combinations comprises ranking at least some electrode combinations, the ranking prioritizing electrode combinations with desirable first parameters levels and second parameters levels.

10. The method of claim 1, further comprising:

determining one or more recommended electrode configurations; and

displaying the one or more recommended electrode combinations.

11. The method of claim 1, wherein:

evaluating the first parameters comprises evaluating a capture threshold for each of the plurality of electrode combinations;

evaluating the second parameters comprises sensing extra-cardiac stimulation; and

determining the order comprises identifying at least one electrode combination of the plurality of electrode combinations with the lowest capture threshold that does not cause extra-cardiac stimulation.

12. The method of claim 1, wherein selecting the one or more electrode combinations comprises:

displaying information associated with the one or more electrode combinations; and

receiving input from a human analyst indicating selection of the one or more electrode combinations.

13. The method of claim 1, further comprising:

detecting a change in patient status; and

switching delivering the electrical stimulation therapy from the selected one or more electrode combinations of the plurality of electrode combinations to one or more alternate electrode combinations of the plurality of electrode combinations when the change in patient status is detected, wherein switching to the one or more alternate electrode combinations is based on the order.

14. The method of claim 1, wherein evaluating the one or more first parameters comprises evaluating two or more different first parameters produced by electrical stimulation delivered using the electrode combination, the two or more different first parameters supportive of cardiac function consistent with the prescribed therapy

15. A cardiac rhythm management system, comprising:

a plurality of cardiac electrodes electrically coupled respectively to a plurality of electrode combinations;

circuitry configured to evaluate, for each electrode combination of a plurality of electrode combinations, one or more first parameters produced by electrical stimulation delivered using the electrode combination, the first parameters supportive of cardiac function consistent with a prescribed therapy;

circuitry configured to evaluate, for each electrode combination of the plurality of electrode combinations, one or more second parameters produced by the electrical stimulation delivered using the electrode combination, the second parameters not supportive of cardiac function consistent with the prescribed therapy;

an electrode combination processor configured to determine an order for at least some of the electrode combinations of the plurality of electrode combinations based on the evaluations of the first parameters and the second parameters; and

a therapy circuit configured to deliver electrical stimulation therapy using the electrode combinations.

16. The system of claim 15, wherein the circuitry to evaluate the one or more first parameters and the circuitry to evaluate the one or more second parameters is at least partially contained within an implantable housing, each of the cardiac electrodes of the plurality of cardiac electrodes coupled to the housing.

17. The system of claim 15, wherein the electrode combination processor is housed within the implantable housing.

18. The system of claim 15, further comprising communications circuitry configured to facilitate wireless data transfer between contents of the implantable housing and a patient external device, the patient external device comprising the electrode combination processor.

19. The system of claim 15, further comprising a patient-external programmer comprising:

communications circuitry configured to facilitate wireless data transfer between an implanted device and the patient-external programmer; and

a display configured to display information associated with the evaluation of the one or more first parameters, the one or more second parameters, and the order of the at least some of the electrode combinations.

20. The system of claim 19, wherein the electrode combination used to deliver the electrical stimulation therapy is selected by a human, the selection being transmitted from the patient-external programmer to the implanted device.

21. The system of claim 15, wherein the circuitry configured to evaluate the one or more first parameters is configured to detect whether electrical therapy delivered using each respective electrode combination of the plurality of electrode combinations improves cardiac function or cardiac output relative to cardiac function or cardiac output without the electrical therapy delivered using the respective electrode combination.

22. The system of claim 15, wherein the circuitry configured to evaluate the one or more second parameters is configured to detect whether electrical therapy delivered using each respective electrode combination of the plurality of electrode combinations stimulates nerves or tissue, the stimulation of the nerves or tissue not improving cardiac function consistent with a prescribed therapy relative to cardiac function without the electrical therapy delivered using the respective electrode combination.

23. The system of claim 15, further comprising a patient-external programmer, wherein the electrode combination processor is configured to determine the order for at least some of the electrode combinations of the plurality of electrode combinations based on one or more electrode combination criteria input into the patient-external programmer by a human.

24. The system of claim 15, further comprising an electrode combination selection processor, the electrode combination selection processor configured to select the electrode combination through which the electrical stimulation therapy is delivered, wherein the selection is based on the order of the at least some of the electrode combinations.

25. The system of claim 15, wherein the electrode combination selection processor is configured to select another electrode combination through which the electrical stimulation therapy is delivered and command the therapy circuit to switch from delivering the electrical stimulation using the electrode combination to the another electrode combination, wherein the selection of the another electrode combination is based on the order of the at least some of the electrode combinations.

26. The system of claim 15, wherein one of the first parameters is a capture threshold and one of the second parameters is extra-cardiac stimulation.

27. The system of claim 15, wherein the electrode combination processor is further configured to determine the order for at least some of the electrode combinations of the plurality of electrode combinations based on the evaluations of at least two different first parameters and one or more of the second parameters.

28. A system for selecting an electrode combination, the system comprising:

a plurality of cardiac electrodes attached to an implantable housing and electrically coupled respectively to a plurality of electrode combinations;

circuitry configured to evaluate, for each electrode combination of a plurality of electrode combinations, one or more first parameters produced by electrical stimulation delivered using the electrode combination, the first parameters supportive of cardiac function consistent with a prescribed therapy;

circuitry configured to evaluate, for each electrode combination of the plurality of electrode combinations, one or more second parameters produced by the electrical stimulation delivered using the electrode combination, the second parameters not supportive of cardiac function consistent with a prescribed therapy;

means for determining an order for at least some of the electrode combinations of the plurality of electrode combinations based on the evaluations of the first parameters and the second parameters; and

a therapy circuit configured to deliver an electrical stimulation therapy using at least one of the electrode combinations of the plurality of electrode combinations.

29. The system of claim 28, further comprising means for selecting the electrode combination through which the electrical stimulation therapy is delivered, wherein the selection is based on the order.