METHOD AND APPARATUS TO PERFORM ELECTRODE COMBINATION SELECTION

• US 20130268018A1
• Filed: 04/24/2013
• Published: 10/10/2013
• Est. Priority Date: 08/07/2007
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers
• Original Assignee: Cardiac Pacemakers
• Inventors: Brooke, M. Jason, Acuna, Andrea
• Granted Patent: US 10,022,548 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

Electrical stimulation may be delivered to a patient'"'"'s heart using a plurality of cardiac electrodes. Each electrode combination may be evaluated based on one or more first parameters and one or more second parameters. In many cases, the one or more first parameters are supportive of cardiac function consistent with a prescribed therapy and the one or more second parameters are not supportive of cardiac function consistent with the prescribed therapy. The electrode combination selected to deliver a cardiac pacing therapy may be more associated with the one or more first parameters supportive of cardiac function consistent with the prescribed therapy and less associated with the one or more second parameters inconsistent with cardiac function.

Claims

1-20. -20. (canceled)

21. A method, comprising:

establishing a programmable parameter and a plurality of values of the parameter to be compared;

enabling a module to perform a measurement for each of the plurality of values and related to energy expenditure of a battery of an implantable medical device operating according to each of the plurality of values;

implementing a processor to compute an energy expenditure for each of the plurality of values using the measurements; and

generating a graphical user interface displaying information corresponding to the computed energy expenditure for the plurality of values.

22. The method of claim 21, wherein establishing a programmable parameter and plurality of values of the parameter comprises storing in memory of the implantable medical device a plurality of pacing electrode vectors available for pacing a heart chamber.

23. The method of claim 22, wherein enabling a module to perform measurements comprises enabling a capture threshold measurement module to perform capture threshold measurements for each of the plurality of pacing electrode vectors and enabling an impedance measurement module to perform impedance measurements for each of the plurality of pacing electrode vectors.

24. The method of claim 23, wherein performing the capture threshold measurements comprises measuring a conduction time and comparing the conduction time to a capture detection threshold.

25. The method of claim 23, further comprising implementing the processor to compute the energy expenditure for each of the plurality of values using the capture threshold measurements, the impedance measurements, and a safety pacing margin.

26. The method of claim 22, further comprising enabling the implantable medical device to automatically select one of the plurality of pacing vectors having a minimum computed energy expenditure for pacing the heart chamber.

27. The method of claim 21, further comprising establishing a predicted frequency of therapy delivery and using the predicted frequency in computing the energy expenditures.

28. The method of claim 21, wherein generating the graphical user interface comprises computing an estimated longevity of the implantable medical device power source for each of the at least two parameter values.

29. The method of claim 28, further comprising establishing a reference longevity and displaying a difference in longevity relative to the reference longevity for each of the parameter values.

30. The method of claim 21, further comprising measuring a physiological benefit associated with each of the plurality of parameter values, determining a relative physiological benefit for each of the plurality of parameter values with respect to one of the parameter values, and displaying the relative physiological benefit corresponding to each of the plurality of parameter values in the graphical user interface.

31. The method of claim 30, wherein measuring the physiological benefit comprises measuring an intrinsic activation time at each of a plurality of pacing electrodes, and determining the relative physiological benefit for each of the plurality of values comprises determining a difference between the intrinsic activation times at each of the plurality of pacing electrodes and one of the plurality associated with a longest activation time.

32. The method of claim 21, further comprising determining whether an undesired side effect is associated with each of the plurality of parameter values and displaying in the graphical user interface information corresponding to the presence of an undesired side effect for each of the plurality of parameter values.

33. An implantable medical device system, comprising:

a programmer comprising a processor, a user interface and a telemetry module; and

an implantable medical device comprising a battery, a telemetry circuit, a module, and a processor and associated memory, the implantable medical device configured to establish a programmable parameter and a plurality of values of the parameter to be compared;

enable the module to perform a measurement for each of the plurality of values and related to energy expenditure of the battery when operating according to each of the plurality of values;

implement the processor to compute an energy expenditure for each of the plurality of values using the measurements; and

transmit energy expenditure information to the programmer, the programmer configured to generate a graphical user interface displaying information corresponding to the computed energy expenditure for the plurality of values.

34. The system of claim 33, wherein establishing a programmable parameter and plurality of values of the parameter comprises storing in memory of the implantable medical device a plurality of pacing electrode vectors available for pacing a heart chamber.

35. The system of claim 34, wherein enabling the module to perform measurements comprises enabling a capture threshold measurement module to perform capture threshold measurements for each of the plurality of pacing electrode vectors and enabling an impedance measurement module to perform impedance measurements for each of the plurality of pacing electrode vectors.

36. The system of claim 35, wherein performing capture threshold measurements comprises measuring a conduction time and comparing the conduction time to a capture detection threshold.

37. The system of claim 35, further comprising implementing the processor to compute the energy expenditure for each of the plurality of values using the capture threshold measurements, the impedance measurements, and a safety pacing margin.

38. The system of claim 34, wherein the implantable medical device is enabled to automatically select one of the plurality of pacing vectors having a minimum computed energy expenditure for pacing the heart chamber.

39. The system of claim 33, wherein the processor is further configured to establish a predicted frequency of therapy delivery and using the predicted frequency in computing the energy expenditures.

40. The system of claim 33, wherein generating the graphical user interface comprises computing an estimated longevity of the implantable medical device power source for each of the at least two parameter values.

41. The system of claim 40, wherein generating the graphical user interface further comprises establishing a reference longevity and displaying a difference in longevity relative to the reference longevity for each of the parameter values.

42. The system of claim 33, wherein the implantable medical device is further configured to measure a physiological benefit associated with each of the plurality of parameter values, determine a relative physiological benefit for each of the plurality of parameter values with respect to one of the parameter values, wherein generating the graphical user interface comprises displaying the relative physiological benefit corresponding to each of the plurality of parameter values in the graphical user interface.

43. The system of claim 42, wherein measuring the physiological benefit comprises measuring an intrinsic activation time at each of a plurality of pacing electrodes, and determining the relative physiological benefit for each of the plurality of values comprises determining a difference between the intrinsic activation times at each of the plurality of pacing electrodes and one of the plurality associated with a longest activation time.

44. The system of claim 33, wherein the implantable medical device is further configured to determine whether an undesired side effect is associated with each of the plurality of parameter values and generating the graphical user interface further comprises displaying information corresponding to the presence of an undesired side effect for each of the plurality of parameter values.

45. A non-transitory computer-readable medium storing a set of instructions which when implemented in an implantable medical device system cause the system to perform a method, the method comprising:

establishing a programmable parameter and a plurality of values of the parameter to be compared;

performing a measurement for each of the plurality of values and related to energy expenditure of a battery of an implantable medical device operating according to each of the plurality of values;

computing an energy expenditure for each of the plurality of values using the measurements; and

generating a graphical user interface displaying information corresponding to the computed energy expenditure for the plurality of values.

46. A method, comprising:

establishing a programmable parameter and a plurality of values of the parameter to be compared;

enabling a module to perform a measurement for each of the plurality of values related to energy consumption of a battery of an implantable medical device operating according to each of the plurality of values;

computing an energy consumption for each of the plurality of values using the measurements; and

generating a graphical user interface displaying information corresponding to the computed energy consumption for the plurality of values.

47. The method of claim 46, wherein each of the plurality of values corresponds to a different electrode combination of the implantable medical device.

48. The method of claim 46, wherein the parameter is a capture threshold parameter.

49. The method of claim 46, wherein establishing a programmable parameter and plurality of values of the parameter comprises storing in memory of the implantable medical device a plurality of pacing electrode vectors available for pacing a heart chamber.

50. The method of claim 49, wherein enabling a module to perform measurements comprises enabling a module to perform capture threshold measurements for each of the plurality of pacing electrode vectors and enabling a module to perform impedance measurements for each of the plurality of pacing electrode vectors.

51. The method of claim 50, wherein performing the capture threshold measurements comprises measuring a conduction time and comparing the conduction time to a capture detection threshold.

52. The method of claim 50, further comprising computing the energy consumption for each of the plurality of values using the capture threshold measurements, the impedance measurements, and a safety pacing margin.

53. The method of claim 49, further comprising enabling the implantable medical device to automatically select one of the plurality of pacing vectors having a minimum computed energy expenditure for pacing the heart chamber.

54. The method of claim 46, further comprising establishing a predicted frequency of therapy delivery and using the predicted frequency in computing the energy consumption.

55. The method of claim 46, wherein generating the graphical user interface comprises computing an estimated longevity of the implantable medical device power source for each of the at least two parameter values.

56. The method of claim 55, further comprising establishing a reference longevity and displaying a difference in longevity relative to the reference longevity for each of the parameter values.

57. The method of claim 46, further comprising measuring a physiological benefit associated with each of the plurality of parameter values, determining a relative physiological benefit for each of the plurality of parameter values with respect to one of the parameter values, and displaying the relative physiological benefit corresponding to each of the plurality of parameter values in the graphical user interface.

58. The method of claim 57, wherein measuring the physiological benefit comprises measuring an intrinsic activation time at each of a plurality of pacing electrodes, and determining the relative physiological benefit for each of the plurality of values comprises determining a difference between the intrinsic activation times at each of the plurality of pacing electrodes and one of the plurality associated with a longest activation time.

59. The method of claim 46, further comprising determining whether an undesired side effect is associated with each of the plurality of parameter values and displaying in the graphical user interface information corresponding to the presence of an undesired side effect for each of the plurality of parameter values.

60. An implantable medical device system, comprising:

a programmer comprising a processor, a user interface and a telemetry module; and

an implantable medical device comprising a battery, a telemetry circuit, and a processor and associated memory,

the implantable medical device configured to establish a programmable parameter and a plurality of values of the parameter to be compared;

perform a measurement for each of the plurality of values related to energy expenditure of the battery when operating according to each of the plurality of values;

compute an energy consumption for each of the plurality of values using the measurements; and

transmit energy expenditure information to the programmer,

the programmer configured to generate a graphical user interface displaying information corresponding to the computed energy consumption for the plurality of values.

61. The system of claim 60, wherein each of the plurality of values corresponds to a different electrode combination of the implantable medical device.

62. The system of claim 60, wherein the parameter is a capture threshold parameter.