Respiration Sensor Processing for Phrenic Nerve Activation Detection

• US 20100305637A1
• Filed: 05/26/2010
• Published: 12/02/2010
• Est. Priority Date: 05/27/2009
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: McCabe, Aaron R., Rockweiler, Holly E., Laughner, Jacob L.
• Granted Patent: US 8,626,292 B2
• Time in Patent Office: Days
• US Class Current: 607/9
• CPC Class Codes: A61B 2562/0219 Inertial sensors, e.g. accelerometers, gyroscopes, tilt switches
• CPC Class Codes: A61B 5/0205 Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition
• CPC Class Codes: A61B 5/053 Measuring electrical impedance or conductance of a portion of the body
• CPC Class Codes: A61B 5/0809 by impedance pneumography
• CPC Class Codes: A61B 5/113 occurring during breathing
• CPC Class Codes: A61B 5/4041 Evaluating nerves condition
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/36542 controlled by body motion, e.g. acceleration
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters

Abstract

An implantable cardiac device includes a sensor for sensing patient respiration and detecting phrenic nerve activation. A first filter channel attenuates first frequencies of the sensor signal to produce a first filtered output. A second filter channel attenuates second frequencies of the respiration signal to produce a second filtered output. Patient activity is evaluated using the first filtered output and phrenic nerve activation caused by cardiac pacing is detected using the second filtered output.

Claims

1. An implantable medical device, comprising:

a pulse generator configured to deliver cardiac pacing to a heart;

an impedance sensor configured to generate a signal modulated by patient respiration, the sensor signal available at a sensor output terminal;

a first filter channel coupled to the sensor output, the first filter channel configured to attenuate first frequencies of the sensor signal to produce a first filtered output;

a second filter channel, separate from the first filter channel, coupled to the sensor output, the second filter channel configured to attenuate second frequencies of the sensor signal to produce a second filtered output; and

circuitry configured to evaluate patient respiration using the first filtered output and to detect phrenic nerve activation caused by cardiac pacing using the second filtered output.

2. The device of claim 1, wherein the second filtered output substantially comprises phrenic activation signal components and does not substantially include respiration signal components.

3. The device of claim 1, wherein second filter channel comprises a filter having one or more cut off frequencies that are dynamically alterable.

4. The device of claim 1, wherein second filter channel comprises a high pass filter having a low frequency cut off of about 5 Hz.

5. The device of claim 1, further comprising analog circuitry coupled between the sensor output and the first and second filter channels, wherein the second filter channel includes a filter circuit that is substantially matched to an impulse response of the analog circuitry.

6. The device of claim 5, wherein the filter circuit substantially attenuates frequencies other than the impulse response frequencies of the analog circuitry.

7. The device of claim 5, wherein the filter circuitry is individually mapped to the impulse response during device testing.

8. The device of claim 1, wherein the circuitry includes a timer configured to time a phrenic nerve activation detection interval which is started following delivery of a pacing pulse to a cardiac chamber and is stopped before delivery of a subsequent pacing pulse to the cardiac chamber and the circuitry is configured to sense for phrenic nerve activation during the phrenic nerve detection interval.

9. The device of claim 1, further comprising pacing control circuitry configured to adapt a cardiac pacing rate based on evaluation of the patient respiration.

10. The device of claim 1, further comprising a second sensor configured to produce a sensor signal, wherein the circuitry is configured to use both the sensor signal and the second filtered output to detect the phrenic nerve activation.

11. The device of claim 1, further comprising:

an accelerometer configured to generate a signal modulated by acceleration that is available at an accelerometer output terminal;

a third filter channel coupled to the accelerometer output terminal, the third filter channel configured to attenuate third frequencies of the accelerometer signal to produce a third filtered output; and

a fourth filter channel coupled to the accelerometer output, separate from the third filter channel, the fourth filter channel configured to attenuate fourth frequencies of the accelerometer signal to produce a fourth filtered output, wherein the circuitry is configured to detect the phrenic nerve activation using the second filtered output and the fourth filtered output.

12. The device if claim 1, wherein the circuitry is configured to develop a sensor indicated pacing rate based on one or both of the first filtered output and the third filtered output.

13. The device of claim 1, wherein the circuitry is configured to use the first filtered output to determine respiration phase and is configured to use the second filtered output to detect the phrenic nerve activation in conjunction with the respiration phase.

14. A method of operating an implantable medical device, comprising:

sensing patient respiration and generating a sensor signal modulated by patient respiration at a sensor output terminal;

processing the sensor signal through separate signal processing channels, the separate signal processing channels comprising a first signal processing channel having first signal processing characteristics and a second signal processing channel having second signal processing characteristics;

evaluating patient respiration using an output of the first signal processing channel; and

detecting phrenic nerve activation caused by cardiac pacing using an output of the second signal processing channel.

15. The method of claim 14, wherein:

the first signal processing channel comprises first filter circuitry and the first signal processing characteristics are configured to attenuate a first set of frequencies from the sensor signal; and

the second signal processing channel comprises a second filter circuitry and the second signal processing characteristics are configured to attenuate a second set of frequencies from the sensor signal.

16. The method of claim 14, wherein the second signal processing channel comprises a notch filter having characteristics that are adaptable based on cardiac rate.

17. The method of claim 14, wherein the second signal processing characteristics comprise a low frequency cut off that substantially attenuates respiration components and cardiac components from the output of the second signal processing channel.

18. The method of claim 14, wherein detecting the phrenic nerve activation comprises:

starting a phrenic nerve activation detection interval upon or after delivery of a cardiac pace during a cardiac cycle;

ending the phrenic nerve activation detection interval during the cardiac cycle; and

sensing for the phrenic nerve activation during the phrenic nerve detection interval.

19. The method of claim 14, further comprising:

determining a transition zone for phrenic nerve activation;

determining a cardiac capture threshold; and

setting a cardiac pacing energy above the cardiac capture threshold and below a transition zone threshold for phrenic nerve activation.

20. The method of claim 14, further comprising switching from one cardiac pacing electrode configuration to another cardiac pacing electrode configuration based on detection of the phrenic nerve stimulation.

21. A medical device, comprising:

a pulse generator configured to deliver cardiac pacing;

a sensor configured to produce a sensor signal at a sensor output terminal;

programmable signal processing circuitry coupled to the sensor output terminal, the signal processing circuitry programmable to have a first set of signal processing characteristics that produce a first output, the signal processing circuitry programmable to have a second set of signal processing characteristics that produces a second output, wherein at least some of the first signal processing characteristics are different from at least some of the second signal processing characteristics; and

processing circuitry configured to determine a rate-adaptation parameter using the first output and to detect phrenic nerve activation caused by the cardiac pacing using the second output.

22. The medical device of claim 21, wherein the signal processing circuitry comprises an output terminal and is configured to produce the first output at the output terminal during a first time period and to produce the second output at the output terminal during a second time period.

23. The medical device of claim 21, wherein the signal processing circuitry comprises a first output terminal and a second output terminal and the signal processing circuitry is configured to produce the first output at the first output terminal and the second output at the second output terminal.