MANAGING CROSS THERAPY DELIVERY IN A MULTIPLE THERAPY IMPLANTABLE DEVICE

• US 20130165985A1
• Filed: 12/05/2012
• Published: 06/27/2013
• Est. Priority Date: 12/27/2011
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Ternes, David J., Ruble, Stephen, Stahmann, Jeffrey E., Hamann, Jason J.
• Granted Patent: US 8,805,502 B2
• Time in Patent Office: Days
• US Class Current: 607/25
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/36167 Timing, e.g. stimulation onset
• CPC Class Codes: A61N 1/362 Heart stimulators heart defibrillators A61N1/39
• CPC Class Codes: A61N 1/3704 Circuits specially adapted therefor, e.g. for sensitivity control

Abstract

An apparatus comprises a cardiac signal sensing circuit configured to sense an electrical cardiac signal from at least one of an atrium or ventricle of a heart of a subject, a therapy circuit configured to provide electrical pacing therapy and electrical neural stimulation therapy to the subject, and a control circuit. The control circuit is configured to initiate delivery of the electrical pacing therapy, initiate a blanking period in a time relationship to the delivery of electrical pacing therapy, and initiate delivery of the electrical neural stimulation therapy to the subject during the blanking period. At least one sense amplifier of the cardiac signal sensing circuit is disabled during the blanking period.

Claims

1. An apparatus comprising:

a cardiac signal sensing circuit configured to sense an electrical cardiac signal from at least one of an atrium or ventricle of a heart of a subject, wherein the cardiac signal sensing circuit includes at least one sense amplifier circuit;

a therapy circuit configured to provide electrical pacing therapy and electrical neural stimulation therapy to the subject; and

a control circuit configured to;

initiate delivery of the electrical pacing therapy;

initiate a blanking period in a time relationship to the delivery of electrical pacing therapy, wherein the at least one sense amplifier is disabled during the blanking period; and

initiate delivery of the electrical neural stimulation therapy to the subject during the blanking period.

2. The apparatus of claim 1, wherein the control circuit is configured to selectively initiate delivery of the neural stimulation therapy during the blanking period and increase the blanking period when the neural stimulation therapy is initiated during the blanking period.

3. The apparatus of claim 1, wherein the control circuit is configured to:

initiate the pacing therapy at a lower rate limit or upon expiration of a lower rate limit interval to at least one of an atrium or ventricle in the absence of intrinsic cardiac activity; and

suspend delivery of neural stimulation therapy when initiating the pacing therapy within a specified range of the lower rate limit or lower rate limit interval.

4. The apparatus of claim 1, wherein the control circuit includes a counter circuit and a timer circuit, wherein the control circuit is configured to:

track a number of neural stimulation therapy pulses delivered over a specified time interval; and

initiate additional delivery of neural stimulation therapy during at least one subsequent blanking period to meet a specified neural stimulation therapy delivery target when the number of neural stimulation therapy pulses delivered is less than the specified neural stimulation therapy delivery target.

5. The apparatus of claim 4, wherein the predetermined neural stimulation therapy delivery target includes at least one of a specified number of neural stimulation therapy electrical pulses delivered per hour and a specified number of neural stimulation therapy electrical pulses delivered per day.

6. The apparatus of claim 1, wherein the control circuit includes a tachyarrhythmia detection circuit, and wherein the control circuit is configured to suspend tachyarrhythmia detection by the tachyarrhythmia detection circuit during delivery of neural stimulation therapy.

7. The apparatus of claim 1, wherein the control circuit includes a counter circuit and is configured to:

track a number of neural stimulation therapy pulses delivered over a specified time interval; and

initiate additional delivery of neural stimulation therapy to meet a specified neural stimulation therapy delivery target when the IMD is providing pacing therapy outside of the specified range of the at least one of the lower rate limit or the lower rate limit interval.

8. The apparatus of claim 1,

wherein the therapy circuit is configured to provide bi-ventricular pacing therapy, and

wherein the control circuit is configured to:

initiate a blanking period in a time relationship to a pace delivered as part of the bi-ventricular pacing therapy; and

limit delivery of neural stimulation therapy to during the blanking period.

9. The apparatus of claim 1, wherein the therapy circuit is connectable to electrodes configured to provide electrical neural stimulation therapy to at least one of:

a spinal cord;

a vagus nerve;

a baroreceptor;

a location in or near an azygos vein;

a location near the vena cava;

or

one or more cardiac fat pads.

10. An apparatus comprising:

a cardiac signal sensing circuit configured to sense an electrical cardiac signal from at least one of an atrium or ventricle of a heart of a subject, wherein the cardiac signal sensing circuit includes at least one sense amplifier circuit;

a therapy circuit configured to provide electrical pacing therapy and electrical neural stimulation therapy to the subject; and

a control circuit configured to;

initiate delivery of the electrical pacing therapy;

initiate a refractory period in a time relationship to at least one of the delivery of electrical pacing therapy or a sensed intrinsic cardiac depolarization, wherein the at least one sense amplifier is enabled during the refractory period but electrical signals sensed by the at least one sense amplifier are ignored by the IMD;

selectively initiate neural stimulation therapy to the subject during the refractory period; and

increase the refractory period when the neural stimulation therapy is initiated during the refractory period.

11. A method comprising:

initiating delivery of electrical pacing therapy to a heart of a subject using an implantable medical device (IMD);

initiating a blanking period in the IMD in a time relationship to the delivery of electrical pacing therapy, wherein one or more sense amplifiers of the IMD are disabled during the blanking period; and

providing electrical neural stimulation therapy to the subject using the IMD during the blanking period.

12. The method of claim 11, including lengthening the blanking period when the neural stimulation therapy is scheduled to be delivered by the IMD during the blanking period.

13. The method of claim 12, including limiting the lengthening of the blanking period according to a specified lowest tachyarrhythmia detection rate.

14. The method of claim 11, including:

tracking a number of electrical pulses delivered as part of the neural stimulation therapy over a specified time interval; and

scheduling, in the IMD, additional delivery of neural stimulation therapy during one or more subsequent blanking periods to meet a predetermined neural stimulation delivery target when the number of electrical pulses delivered is less than the neural stimulation delivery target.

15. The method of claim 14, wherein the predetermined neural stimulation delivery target includes at least one of a specified number of neural stimulation therapy electrical pulses delivered per hour and a specified number of neural stimulation therapy electrical pulses delivered per day.

16. The method of claim 11, including suspending tachyarrhythmia detection by the IMD during delivery of neural stimulation therapy.

17. The method of claim 11, including:

establishing at least one of a lower rate limit or lower rate limit interval in the IMD; and

suspending delivery of neural stimulation therapy when providing electrical pacing therapy within a specified range of the lower rate limit or lower rate limit interval.

18. The method of claim 11, including:

establishing at least one of a lower rate limit or lower rate limit interval in the IMD;

tracking a number of electrical pulses delivered as part of the neural stimulation therapy over a second time interval; and

scheduling, in the IMD, additional delivery of neural stimulation therapy to meet a predetermined neural stimulation therapy delivery target when the IMD is providing pacing therapy outside of the specified range of the at least one of the lower rate limit or the lower rate limit interval.

19. The method of claim 11,

wherein initiating delivery of electrical pacing therapy includes initiating delivery of bi-ventricular pacing therapy,

wherein initiating a blanking period includes initiating a blanking period in a time relationship to a pace delivered as part of the bi-ventricular pacing therapy, and

wherein providing neural stimulation therapy includes limiting delivery of the neural stimulation therapy to during the blanking period.

20. A method comprising:

initiating delivery of electrical pacing therapy to a heart of a subject using an implantable medical device (IMD);

initiating a refractory period in the IMD in a time relationship to the delivery of electrical pacing therapy, wherein one or more sense amplifiers are enabled during the refractory period but electrical signals sensed by the one or more amplifiers are ignored by the IMD; and

providing neural stimulation therapy to the subject during the refractory period,

wherein initiating a refractory period includes initiating a first refractory period of a first time duration when neural stimulation therapy is not scheduled to be delivered by the IMD during the refractory period and initiating a second refractory period of a second time duration when neural stimulation therapy is scheduled to be delivered by the IMD during the refractory period.