Method and apparatus to perform electrode combination selection

• US 20090043352A1
• Filed: 07/24/2008
• 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: Acuna, Andrea E., Brooke, M. Jason
• Granted Patent: US 9,037,239 B2
• Time in Patent Office: Days
• US Class Current: 607/28
• CPC Class Codes: A61N 1/36185 Selection of the electrode configuration
• 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 1/3684 for stimulating the heart at multiple sites of the ventricle or the atrium
• CPC Class Codes: A61N 1/36842 Multi-site stimulation in the same chamber
• CPC Class Codes: A61N 1/36843 Bi-ventricular stimulation
• CPC Class Codes: A61N 1/3686 configured for selecting the electrode configuration on a lead A61N1/3688 takes precedence
• CPC Class Codes: A61N 1/37 Monitoring; Protecting
• CPC Class Codes: A61N 1/3706 Pacemaker parameters stimulation threshold A61N1/371
• CPC Class Codes: A61N 1/3708 for power depletion
• CPC Class Codes: A61N 1/371 Capture, i.e. successful stimulation
• CPC Class Codes: A61N 1/37211 Means for communicating with stimulators
• CPC Class Codes: A61N 1/37241 providing test stimulations
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

The present invention involves approaches for selecting one or more electrode combinations. Various method embodiments can include implanting a plurality of cardiac electrodes supported by one or more leads in a patient, attaching the one or more leads to a patient external analyzer circuit, delivering electrical stimulation to the patient'"'"'s heart using the plurality of cardiac electrodes and the analyzer circuit, evaluating, for each electrode combination of a plurality of electrode combinations of the plurality of cardiac electrodes, one or more first parameters and one or more second parameters produced by the electrical stimulation delivered using the electrode combination, the first parameters supportive of cardiac function consistent with a prescribed therapy and the second parameters not supportive of cardiac function consistent with the prescribed therapy, selecting one or more electrode combinations of the plurality of cardiac electrodes based on the evaluation, the one or more electrode combinations selected as being associated with the one or more first parameters and less associated with the one or more second parameters relative to other electrode combinations of the plurality of cardiac electrodes, programming an implantable pacing circuit to deliver a cardiac pacing therapy that preferentially uses the selected one or more electrode combinations relative to other electrode combinations of the plurality of cardiac electrodes, detaching the one or more leads from the analyzer circuit, attaching the one or more leads to the implantable pacing circuit, and implanting the implantable pacing circuit.

Claims

1. A method comprising:

implanting a plurality of cardiac electrodes supported by one or more leads in a patient;

attaching the one or more leads to a patient external analyzer circuit;

delivering electrical stimulation to the patient'"'"'s heart using the plurality of cardiac electrodes and the analyzer circuit;

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

selecting one or more electrode combinations of the plurality of cardiac electrodes based on the evaluation, the one or more electrode combinations selected as being associated with the one or more first parameters and less associated with the one or more second parameters relative to other electrode combinations of the plurality of cardiac electrodes;

programming an implantable pacing circuit to deliver a cardiac pacing therapy that preferentially uses the selected one or more electrode combinations relative to other electrode combinations of the plurality of cardiac electrodes;

detaching the one or more leads from the analyzer circuit;

attaching the one or more leads to the implantable pacing circuit; and

implanting the implantable pacing circuit.

2. 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 evaluating extra-cardiac stimulation; and

selecting the one or more electrode combinations comprises selecting the electrode combination that has the lowest capture threshold and does not cause extra-cardiac stimulation based on the evaluation.

3. The method of claim 1, further comprising determining an electrode combination ranking, the ranking having higher ranked one or more electrode combinations that are associated with the one or more first parameters and are less associated with the one or more second parameters for the one or more electrode combinations relative to lower ranked electrode combinations of the plurality of cardiac electrodes.

4. The method of claim 1, further comprising receiving input instructions, wherein selecting the one or more electrode combinations is further based at least in part on the input instructions.

5. The method of claim 4, wherein the input instructions indicate the one or more first parameters and the one or more second parameters from a plurality of different parameters upon which the selection of the one or more electrode combinations is based.

6. The method of claim 4, wherein the input instructions indicate boundary conditions comprising one or more of a maximum pulse amplitude at which the implantable pacing circuit is programmed to deliver, a minimum pulse amplitude at which the implantable pacing circuit is programmed to deliver, a maximum pulse width at which the implantable pacing circuit is programmed to deliver, a minimum pulse amplitude at which the implantable pacing circuit is programmed to deliver, and which electrode combinations of the plurality of cardiac electrodes will be used to deliver electrical stimulation and be evaluated, and wherein delivering electrical stimulation to the patient'"'"'s heart using the plurality of cardiac electrodes and the analyzer circuit comprises delivering electrical stimulation within the boundaries indicated by the input instructions.

7. The method of claim 4, wherein the input instructions indicate one or more electrode combinations for which the first parameter is to be directly measured based on the delivery of the electrical stimulation and one or more other electrode combinations for which the first parameter will be estimated and not directly measured.

8. The method of claim 1, further comprising:

comparing respective first and second parameters associated with the electrode combinations between the electrode combinations of the plurality of cardiac electrodes; and

determining a ranking for at least some of the electrode combinations of the plurality of cardiac electrodes, the ranking based on the evaluations of the first and second parameters; and

detecting a change in condition, wherein programming the implantable pacing circuit to deliver the cardiac pacing therapy further comprises programming the implantable pacing circuit to switch delivery of the cardiac pacing therapy from a first prioritized electrode combination of the ranking to a lower prioritized electrode combination of the ranking in response to the detected change in condition.

9. The method of claim 1, further comprising:

identifying a location for implantation of a housing for the implantable pacing circuit, the housing having a housing electrode; and

placing a catheter having an electrode at the location, wherein;

delivering electrical stimulation using the plurality of cardiac electrodes and the analyzer circuit further comprises delivering electrical stimulation between one or more of the plurality of cardiac electrodes and the catheter electrode;

evaluating further comprises evaluating first and second parameters for electrode combinations that use the catheter electrode; and

selecting further comprises selecting one or more electrode combinations that use the housing electrode, wherein the selection of the one or more electrode combinations that use the housing electrode is based on the evaluation of the first and second parameters for the electrode combinations that use the catheter electrode.

10. A cardiac rhythm management system, comprising:

a patient external analyzer device;

a patient implantable cardiac stimulation device;

a plurality of cardiac electrodes provided on one or more patient implantable leads, the one or more leads configured to be coupled to the patient external analyzer circuit and the patient implantable cardiac stimulation device;

evaluation circuitry housed within the patient external analyzer device, the evaluation circuitry configured to execute stored program instructions to cause the patient external analyzer device to evaluate, for each electrode combination of a plurality of electrode combinations of the plurality of cardiac electrodes, one or more first parameters and one or more second parameters produced by electrical stimulation delivered using at least some of the plurality of electrodes, the first parameters supportive of cardiac function consistent with a prescribed therapy and the second parameters not supportive of cardiac function consistent with the prescribed therapy;

an electrode combination processor housed within the patient external analyzer device, the electrode combination processor configured to execute stored program instructions to cause the patient external analyzer device to select one or more electrode combinations of the plurality of cardiac electrodes based on the evaluation, the one or more electrode combinations selected as being associated with the one or more first parameters and less associated with the one or more second parameters relative to other electrode combinations of the plurality of cardiac electrodes; and

programmer circuitry configured to execute stored program instructions to cause the programmer circuitry to program the patient implantable cardiac stimulation device to deliver therapy preferentially using the selected electrode combinations relative to other electrode combinations of the plurality of cardiac electrodes.

11. The system of claim 10, wherein the one or more first parameters concern a capture threshold, the one or more second parameters concern extra-cardiac stimulation, and the patient external analyzer device is configured such that the one or more electrode combinations are selected by the electrode combination processor as having the lowest capture threshold that does not cause extra-cardiac stimulation relative to other electrode combinations of the plurality of electrode combinations.

12. The system of claim 10, wherein the electrode combination processor is further configured to execute stored program instructions to cause the patient external analyzer device to determine an electrode combination ranking, the ranking having higher ranked one or more electrode combinations that are associated with the one or more first parameters and are less associated with the one or more second parameters relative to lower ranked electrode combinations of the plurality of cardiac electrodes, and wherein the programmer circuitry is further configured to program the patient implantable cardiac stimulation device to deliver therapy preferentially using higher ranked electrode combinations relative to other electrode combinations of the plurality of cardiac electrodes based on the ranking.

13. The system of claim 12, wherein the patient implantable cardiac stimulation device includes a processor configured to execute stored program instructions to cause the patient implantable cardiac stimulation device to switch delivery of cardiac pacing therapy from using a first prioritized electrode combination of the ranking to a lower prioritized electrode combination of the ranking in response to a detected change in condition.

14. The system of claim 10, wherein the patient external analyzer device further comprises an instruction input module, and wherein the electrode combination processor is further configured to execute stored program instructions to cause the patient external analyzer device to select the one or more electrode combinations of the plurality of cardiac electrodes based on instructions input through the input module.

15. The system of claim 14, wherein the electrode combination processor is further configured to execute stored program instructions to cause the patient external analyzer device to select the one or more electrode combinations of the plurality of cardiac electrodes based on instructions input through the input module, the instructions specifying the one or more first parameters and the one or more second parameters from a plurality of different parameters upon which the selection of the one or more electrode combinations is to be based.

16. The system of claim 14, wherein execution of the input instructions cause the patient external analyzer device to deliver electrical stimulation using the plurality of cardiac electrodes to be analyzed by the electrode combination processor using pulse parameter boundaries comprising one or more of a maximum pulse amplitude, a minimum pulse amplitude, a maximum pulse width, a minimum pulse width, and which electrode combinations of the plurality of electrodes will be used for delivery of stimulation and be evaluated by the electrode combination processor.

17. The system of claim 14, wherein the electrode combination processor is further configured to execute stored program instructions to cause the patient external analyzer device to directly measure the first parameter for one or more of the electrode combinations based on the delivery of electrical stimulation and estimate the first parameter for one or more other electrode combinations and not directly measure the first parameter for the one or more other electrode combinations based on the input instruction specifying which electrode combinations to directly measure and which electrode combinations to estimate.

18. The system of claim 10, wherein the programmer circuitry is housed within the patient external analyzer device.

19. The system of claim 10, further comprising a non-implantable catheter coupled to the patient external analyzer device, the catheter comprising an electrode that is a part of the plurality of electrodes that make up the one or more electrode combinations that the electrode combination processor is configured to evaluate and select the one or more electrode combinations from, wherein the patient implantable cardiac stimulation device comprises a housing electrode, and wherein the patient external analyzer device is programmed such that if an electrode combination that includes the catheter electrode is selected, then the patient implantable cardiac stimulation device is programmed by the programming circuitry to preferentially use the housing electrode for therapy delivery relative to electrode combinations that do not use the housing electrode.

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

a patient external analyzer device;

a patient implantable cardiac stimulation device;

a plurality of cardiac electrodes provided on one or more leads, the one or more leads configured to be coupled to the patient external analyzer device and the patient implantable cardiac stimulation device;

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

means for selecting one or more electrode combinations of the plurality of cardiac electrodes based on the evaluation, the one or more electrode combinations selected as being associated with the one or more first parameters and less associated with the one or more second parameters relative to other electrode combinations of the plurality of cardiac electrodes; and

means for programming the implantable pacing circuit to deliver electrical therapy preferentially using the one or more selected electrode combinations relative to other electrode combinations of the plurality of electrode combinations based on the selection of the one or more electrode combinations.