SYSTEM AND METHOD FOR CONTROLLING ELECTRICAL STIMULATION BASED ON LOWEST OPERABLE VOLTAGE MULTIPLIER FOR USE WITH IMPLANTABLE MEDICAL DEVICE

• US 20140350623A1
• Filed: 05/24/2013
• Published: 11/27/2014
• Est. Priority Date: 05/24/2013
• Status: Abandoned Application

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories)
• Inventors: Bornzin, Gene A., Fischer, Avi, Tilton, Bryan
• Application Number:
  US13/901,937
• Publication Number:
  US 20140350623A1
• Time in Patent Office: Days
• US Class Current: 607/11
• CPC Class Codes: A61N 1/3686 configured for selecting the electrode configuration on a lead A61N1/3688 takes precedence
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

Techniques are provided for use with implantable devices equipped with programmable voltage multipliers (including voltage dividers.) Candidate pulse widths are determined for selected voltage multipliers and stimulation vectors. Each candidate pulse width corresponds to a lowest pulse energy sufficient to achieve capture within the tissues of the patient (subject to a safety margin) using the selected vector and using the corresponding voltage multiplier. As such, a candidate pulse width represents a preferred or optimal pulse width, at least insofar as energy consumption is concerned. However, depending upon the capabilities of the device, the candidate pulse width might not be achievable. Accordingly, for each programmable vector, the system determines a lowest “operable” voltage multiplier sufficient to generate a pulse at a candidate pulse width subject to the capabilities of the device. The system then determines the corresponding current drain, and the vector achieving the lowest current drain at the lowest operable voltage multiplier is selected for the delivery of stimulation.

Claims

1. A method for use with an implantable medical device equipped for generating electrical stimulation pulses for delivery along stimulation vectors through tissues of a patient in which the device is implanted, the device provided with a set of voltage multipliers connected to a voltage source for providing voltages for the stimulation pulses, the method comprising:

determining candidate pulse widths for selected voltage multipliers and for selected stimulation vectors, each candidate pulse width corresponding to a lowest energy pulse sufficient to achieve capture within the tissues of the patient using a selected vector and using a voltage supplied by a corresponding voltage multiplier;

determining a lowest operable voltage multiplier for the selected vector based on the candidate minimum energy pulse widths; and

controlling generation of stimulation pulses using the lowest operable voltage multiplier for delivery along the selected vector.

2. The method of claim 1 wherein determining candidate pulse widths for selected voltage multipliers comprises:

determining rheobase (Rho) and chronaxie (Chron) values of tissues along the selected stimulation vector; and

for a selected multiplier value (Mutt) corresponding to a particular voltage multiplier, determining a candidate pulse width (PWopt) for the selected vector based at least on the rheobase (Rho) and chronaxie (Chron) values, the multiplier value (Mutt) and a base voltage (Vbat) of the voltage source of the device.

3. The method of claim 2 wherein determining the rheobase (Rho) and chronaxie (Chron) values for the selected vector comprises:

delivering stimulation pulses using at least two different pulse widths (PW1, PW2) along the selected vector, wherein the pulse widths are selected from within a range of programmable pulse widths;

measuring corresponding capture voltage thresholds (Vth1, Vth2); and

determining rheobase (Rho) and chronaxie (Chron) from the two different pulse widths (PW1, PW2) and the corresponding capture voltage thresholds (Vth1, Vth2).

4. The method of claim 3 wherein determining rheobase (Rho) comprises determining:

5. The method of claim 4 wherein determining chronaxie (Chron) comprises determining:

6. The method of claim 2 wherein determining a candidate pulse width (PWopt) for the selected vector and for a selected multiplier value (Mutt) comprises determining:

7. The method of claim 2 wherein the selectable voltage multiplier values of the device include one or more of ⅓

, ¼

, ½

, 1, 2, 3 and 4.

8. The method of claim 2 wherein determining the lowest operable voltage multiplier for a selected vector comprises:

beginning with a lowest selected multiplier value (Mutt), determining whether the candidate pulse width (PWopt) for that voltage multiplier is within a programmable range of pulse widths;

if a currently selected multiplier value (Mutt) has a candidate pulse width (PWopt) within the programmable range of pulse widths, identifying the corresponding voltage multiplier as the lowest operable voltage multiplier; and

if the currently selected multiplier value (Mutt) does not have a candidate pulse width (PWopt) within the programmable range of pulse widths, repeating the procedure with a next higher multiplier value.

9. The method of claim 8 wherein the range of programmable pulse widths comprise a range from 0.05 milliseconds (ms) to 1.0 ms, inclusive.

10. The method of claim 8 wherein if none of the voltage multipliers achieves a candidate pulse width (PWopt) within the range of programmable pulse widths for the selected vector, generating an indicator warning that the selected vector is not suitable.

11. The method of claim 8 wherein if none of the voltage multipliers achieves a candidate pulse width (PWopt) within the range of programmable pulse widths for any programmable vector of the device, generating an indicator warning that none of the programmable vectors of the device is suitable.

12. The method of claim 2 further including determining a pulse charge corresponding to the candidate pulse width (PWopt) for a selected voltage multiplier.

13. The method of claim 12 wherein determining the pulse charge corresponding to the candidate pulse width (PW) comprises:

determining the impedance (R) of the selected vector; and

determining the pulse charge corresponding to the candidate pulse width (PWopt) for the vector using the lowest operable voltage multiplier (Mutt) for that vector and the determined impedance (R).

14. The method of claim 13 wherein the pulse charge is determined using:

15. The method of claim 12 further including converting the pulse charge to one or more of:

a relative vector combination efficiency;

a charge drawn from battery per pulse value;

an energy from battery per pulse value;

a microampere value of battery current drain associated with pacing;

an incremental increase in current drain value; and

an incremental expected decrease in longevity value.

16. The method of claim 12 wherein a lowest operable voltage multiplier and corresponding pulse charge are determined for each of a plurality of stimulation vectors.

17. The method of claim 16 further including selecting a particular vector from among the plurality of stimulation vectors based on the pulse charge values.

18. The method of claim 17 wherein the vector having the lowest pulse charge value is selected and wherein generation of stimulation pulses is controlled to use the candidate pulse width corresponding to the lowest operable voltage multiplier for that vector.

19. The method of claim 17 wherein selecting a particular vector from among the plurality of stimulation vectors is performed to select a vector from among a set of vectors capable of both anodal and cathodal stimulation.

20. The method of claim 1 further including determining whether delivery of stimulation pulses using the candidate pulse width corresponding to the lowest operable voltage multiplier along the selected vector triggers phrenic nerve stimulation within the patient and, if so, rejecting that vector.

21. The method of claim 1 wherein all of the steps are performed by the implantable device.

22. The method of claim 1 wherein at least one of the steps is performed by an external system equipped to communicate with the implantable device.

23. The method of claim 22 wherein the external system is a programmer device.

25. The method of claim 1 further including resetting a safety margin associated with stimulation pulses based on energy optimization for setting one or more of a Vstim value and a PWopt value for the selected stimulation vector where Vstim is a stimulation voltage value and PWopt is a pulse width value.

26. The method of claim 25 wherein the safety margin is set to a first value during an initial post-implant acute phase and to a second value during a subsequent chronic implant phase.

27. The method of claim 1 further including assessing interventricular conduction delays and wherein controlling generation of stimulation pulses is also based, at least in part, on the interventricular conduction delays.

28. The method of claim 1 wherein a selected stimulation vector can include a combination of vectors.

24. The method of claim 24 wherein the programmer device is equipped with a “

one button”

energy optimization function that controls the operation of each of said steps for each of a set of stimulation vectors.

29. A system within an implantable medical device equipped for generating electrical stimulation pulses for delivery along stimulation vectors through tissues of a patient in which the device is implanted, the device provided with a set of voltage multipliers connected to a voltage source for providing voltages for the stimulation pulses, the system comprising:

a voltage multiplier-based pulse width determination system operative for a selected stimulation vector to determine candidate pulse widths for selected voltage multipliers, each candidate pulse width corresponding to a lowest energy pulse sufficient to achieve capture within the tissues of the patient using the selected vector and using a voltage supplied by a corresponding voltage multiplier;

a lowest operable voltage multiplier determination system operative to determine a lowest operable voltage multiplier based on the candidate minimum energy pulse widths; and

a voltage multiplier-based stimulation control system operative to control generation of stimulation pulses using the lowest operable voltage multiplier for delivery along the selected vector.

30. An external system for use with an implantable medical device equipped for generating electrical stimulation pulses for delivery along stimulation vectors through tissues of a patient in which the device is implanted, the implantable device provided with a set of voltage multipliers connected to a voltage source for providing voltages for the stimulation pulses, the external system comprising:

a voltage multiplier-based pulse width determination system operative for a selected stimulation vector to determine candidate pulse widths for selected voltage multipliers, each candidate pulse width corresponding to a lowest energy pulse sufficient to achieve capture within the tissues of the patient using the selected vector and using a voltage supplied by a corresponding voltage multiplier;

a lowest operable voltage multiplier determination system operative to determine a lowest operable voltage multiplier based on the candidate minimum energy pulse widths; and

a voltage multiplier-based stimulation control system operative to generate control signals for sending to the implantable device for controlling the device to generate stimulation pulses using the lowest operable voltage multiplier for delivery along the selected vector.

31. A system for use with an implantable medical device equipped for generating electrical stimulation pulses for delivery along stimulation vectors through tissues of a patient in which the device is implanted, the device provided with a set of voltage multipliers connected to a voltage source for providing voltages for the stimulation pulses, the system comprising:

means for determining candidate pulse widths for selected voltage multipliers and for a selected stimulation vector, each candidate pulse width corresponding to a lowest energy pulse sufficient to achieve capture within the tissues of the patient using the selected vector and using a voltage supplied by a corresponding voltage multiplier;

means for determining a lowest operable voltage multiplier for the selected vector based on the candidate minimum energy pulse widths; and

means for controlling generation of stimulation pulses using the lowest operable voltage multiplier for delivery along the selected vector.