Implantable stimulation device having synchronous sampling for a respiration sensor

• US 6,449,509 B1
• Filed: 08/30/2000
• Issued: 09/10/2002
• Est. Priority Date: 08/30/2000
• Status: Expired due to Term

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories)
• Inventors: Mortazavi, Said, Florio, Joseph J., Bornzin, Gene A., Park, Euljoon
• Primary Examiner(s): Schaetzle, Kennedy
• Assistant Examiner(s): DROESCH, KRISTEN L
• Application Number:
  US09/651,623
• Time in Patent Office: 741 Days
• Field of Search: 607/9, 607/17, 607/19, 607/20, 600/509, 600/513, 600/519, 600/521, 600/533, 600/534, 600/536, 600/547, 600/483-484, 128/901
• US Class Current: 607/20
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance

Abstract

An implantable cardiac device that is adapted to periodically measure a body parameter, such as transthoracic impedance, at time periods selected so that the body parameter is primarily indicative of the respiration of the patient. In this way, a ventilation parameter, such as minute ventilation, can be reconstructed from the signals without requiring filtering of the sampled signals. In one embodiment, the implantable cardiac device measures transthoracic impedance during each quiescent period of the heart and thereby obtains a plurality of transthoracic impedance data points which are then used to reconstruct a ventilation signal. As the transthoracic impedance data points are obtained during the quiescent period, the contribution of the heart to the resulting transthoracic impedance measurement can be ignored and the resulting measurements are indicative of the action of the heart. In another embodiment, the implantable cardiac device obtains transthoracic impedance signals during the zero crossings of the measured impedance signal. As the transthoracic signal is measured during the zero crossing of the measured impedance signal, the heart component of the signal is filtered out.

Claims

1. An implantable cardiac device for delivering electrical stimulation to the heart, the device comprising:

a sensing circuit adapted to detect a heart signal indicative of electrical activity of the heart;

an impedance sensor adapted to measure a body parameter that is indicative of the ventilation and cardiac activity of the patient and provide an unfiltered impedance signal indicative thereof; and

a processor which receives the unfiltered impedance signal and the heart signal, wherein the processor is adapted to use the heart signal and the impedance signal to control the delivery of therapeutic stimulation to the heart, wherein the processor is further adapted to trigger the minute ventilation sensor to measure the body parameter indicative of the ventilation and cardiac activity during intervals of time selected so that the contribution to the impedance signal resulting from the action of the heart can be discounted so as to allow the processor to develop a minute ventilation parameter from the unfiltered impedance signal.

2. The device of claim 1, wherein the processor receives a plurality of samples comprising the unfiltered impedance signal and uses the plurality of samples to develop the minute ventilation parameter.

3. The device of claim 1, wherein the measurement of the body parameter by the impedance sensor occurs at a rate that is approximately twice the rate of the heart signal.

4. The device of claim 1, wherein the body parameter indicative of minute ventilation comprises transthoracic impedance.

5. The device of claim 4, further comprising a case electrode and wherein the transthoracic impedance is periodically sampled by delivering a pulse from the at least one lead to the case electrode.

6. The device of claim 4, wherein the sensing circuit provides a IEGM signal to the processor and the processor triggers the impedance sensor to measure the transthoracic impedance during a period of time where the contribution to the transthoracic impedance measurement due to the heart activity is negligible.

7. The device of claim 6, wherein the processor is adapted to induce the impedance sensor to measure the transthoracic impedance during the quiescent periods of the heart as indicated by the heart signal.

8. The device of claim 6, wherein the sensing circuit detects a heart signal that is periodic and wherein the processor triggers the impedance sensor to sample the transthoracic impedance at a selected interval during each cycle of the heart signal.

9. The device of claim 8, wherein the processor uses the transthoracic impedance signals sampled at the selected interval during each cycle of the heart signal to develop a respiration impedance signal indicative of the component of the transthoracic impedance that is due to the ventilation activity of the patient.

10. The device of claim 9, wherein the processor triggers the minute ventilation signal to sample the transthoracic impedance at ¼

and ¾

of the period T of each cycle of the heart signal.

11. An implantable cardiac device for delivering electrical stimulation to the heart of a patient, the device comprising:

means for stimulating the heart of a patient;

sensing means for providing a signal indicative of the function of the heart;

ventilation means for measuring a body parameter indicative of the patient'"'"'s ventilation and for providing a parameter signal indicative thereof;

processing means for processing the parameter signal from the ventilation means to develop a ventilation parameter, wherein the processing means induces the ventilation means to measure the body parameter during time periods when the contribution of the heart to the body parameter can be discounted so that the ventilation parameter can be developed by the processing means without filtering to remove the contribution of the heart to the ventilation parameter.

12. The device of claim 11, wherein the sensing means provides an intracardiac electrogram signal to the processing means and the processing means uses the intracardiac electrogram signal to induce the ventilation means to measure the body parameter during a quiescent period of the heart'"'"'s activity.

13. The device of claim 12, wherein the means for stimulating the heart of the patient comprises at least one lead adapted to be positioned in the heart of the patient and further adapted to provide pacing pulses to the heart of the patient.

14. The device of claim 13, wherein the processing means is positioned within a casing that is adapted to be implanted in the body of the patient.

15. The device of claim 14, wherein the ventilation means measures the transthoracic impedance between the at least one lead and the casing.

16. The device of claim 11, wherein the processing means receives a plurality of parameter signals from the ventilation means so that the processing means develops the ventilation parameter from the plurality of parameter signals.

17. The device of claim 16, wherein the ventilation means is adapted to obtain at least four parameter samples during each respiration cycle and wherein the processing means is adapted to use the at least four parameter samples to develop the ventilation parameter.

18. The device of claim 11, wherein the processing means uses the signal from the sensing means to determine the frequency of a heart impedance signal which corresponds to the heart contribution to the ventilation parameter and wherein the processing means uses the signal from the sensing means to induce the ventilation means to measure the body parameter at approximately the zero crossings of the heart impedance signal.

19. The device of claim 11, wherein the ventilation means measures the transthoracic impedance of the patient and provides the parameter signal that is indicative of the transthoracic impedance, wherein the parameter signal includes a component of the transthoracic impedance that is due to the patient'"'"'s heart activity and a component of the transthoracic impedance that is due to the patient'"'"'s ventilation activity.

20. The device of claim 19, wherein the processing means uses the signal from the sensing means to determine the frequency of a heart impedance signal which corresponds to the component of the transthoracic impedance that is due the patient'"'"'s heart activity and wherein the processing means uses the sensor signal to induce the ventilation means to measure the transthoracic impedance at a selected interval during each cycle of the heart impedance signal such that a ventilation impedance parameter can be developed by the processing means.

21. The device of claim 20, wherein the processing means develops a ventilation impedance signal by fitting a curve to the measured transthoracic impedance wherein the curve corresponds to the component of the transthoracic impedance that is due to the patient'"'"'s ventilation activity.

22. The device of claim 20, wherein the processing means uses the ventilation impedance signal curve to determine a minute ventilation parameter.

23. An implantable cardiac device, comprising:

a sensor adapted to obtain a heart signal indicative of the action of the heart;

an impedance measurement circuit that obtains transthoracic impedance measurements; and

a control unit that receives the heart signal and triggers the impedance measurement circuit to obtain the impedance measurements during a time period selected based on the heart signal so that the contribution to the impedance measurement due to the activity of the heart is negligible so that the impedance measurement is primarily indicative of the respiration of the patient, the control unit further programmed to control stimulation therapy based on the impedance measurement.

24. The device of claim 23, wherein the control unit is positioned within a casing that is adapted to be implanted within the body of a patient and wherein the impedance measurement circuit measures the impedance between at least one implantable lead electrode and the casing.

25. The device of claim 24, wherein the sensor obtains an IEGM signal from the at least one lead electrode.

26. The device of claim 25, wherein the control unit evaluates the IEGM signal and triggers the impedance measurement circuit to measure the transthoracic impedance during a time period when the IEGM signal indicates a quiescent period for the heart.

27. The device of claim 26, wherein the control unit triggers the impedance measurement circuit to obtain the transthoracic impedance measurement after a pre-selected delay period following the heart signal indicating the occurrence of an R-wave.

28. The device of claim 27, wherein the delay period is approximately 700 ms.

29. The device of claim 23, wherein the control unit is adapted to obtain at least four data points for each respiration cycle of the patient and then use these four data points to mathematically reconstruct a respiration waveform of the patient.

30. The device of claim 29, wherein the control unit is adapted to obtain a minute ventilation parameter from the reconstructed respiration waveform of the patient.

31. A method of obtaining a ventilation parameter for an implantable cardiac device which can be used to provide therapeutic stimulation to the heart of the patient, the method comprising:

obtaining a heart signal indicative of the electrical function of the heart;

evaluating the heart signal so as to determine a quiescent time period;

periodically measuring the transthoracic impedance of the patient during the quiescent time period, wherein the quiescent time period is selected so that the contribution of the heart to resulting impedance measurement is reduced such that an impedance measurement indicative of the patient'"'"'s ventilation can be obtained with reduced filtering of the sampled measurement; and

processing the periodically obtained impedance measurements to produce a ventilation parameter that can be used to vary the delivery of therapeutic stimulation to the heart of the patient.

32. The method of claim 31, wherein obtaining a heart signal comprises obtaining an IEGM signal from a lead implanted in the heart.

33. The method of claim 32, wherein evaluating the heart signal so as to determine a quiescent period comprises:

determining the occurrence of an R-wave; and

measuring a delay period following the occurrence of the R-wave, wherein the delay period is selected so that the quiescent time period corresponds to the delay period following the occurrence of the R-wave.

34. The method of claim 31, wherein periodically measuring the transthoracic impedance of the patient comprises sending a impedance measurement waveform from the lead implanted to a case electrode within the body of the patient.

35. The method of claim 34, wherein periodically measuring the transthoracic impedance measurement comprises obtaining at least four impedance measurements during each ventilation cycle of the patient.

36. The method of claim 35, wherein processing the periodically obtained impedance measurements to obtain the ventilation parameter comprises mathematically reconstructing a ventilation signal corresponding to the ventilation of the patient.

37. The method of claim 36, wherein processing the periodically obtained impedance measurement further comprises producing a minute ventilation parameter from the ventilation signal.

38. The method of claim 37, further comprising adjusting the delivery of therapeutic stimulation to the heart based at least in part on the minute ventilation parameter.

39. A method of obtaining a ventilation parameter for an implantable cardiac device which can be used to provide therapeutic stimulation to the heart of the patient, the method comprising:

obtaining a heart signal indicative of the function of the heart;

evaluating the heart signal so as to determine the frequency of the heart signal and the corresponding period;

periodically measuring the transthoracic impedance of the patient at a selected interval during each period of the heart signal such that the resulting transthoracic impedance measurements are indicative of the patient'"'"'s ventilation activity; and

processing the periodically obtained transthoracic impedance measurements so as to obtain a curve that corresponds to the component of the transthoracic impedance that is the result of the patient'"'"'s ventilation activity without filtering the heart component of the transthoracic impedance measurements.

40. The method of claim 39, wherein obtaining a heart signal comprises obtaining an IEGM signal from a lead implanted in the heart.

41. The method of claim 39, wherein periodically measuring the transthoracic impedance comprises obtaining at least four impedance measurements during each ventilation cycle of the patient.

42. The method of claim 39, further comprising evaluating the curve that corresponds to the component of the transthoracic impedance that is the result of the patient'"'"'s ventilation activity so as to produce a minute ventilation parameter from the curve.