Implantable cardiac stimulation system and method for automatic capture verification calibration
First Claim
1. A method of calibrating an automatic capture verification feature for use in an implantable cardiac stimulation device, comprising:
- collecting cardiac signal data and calculating a paced depolarization integral, for a plurality of stimulation output settings;
determining a capture detection threshold; and
comparing the capture detection threshold to a computed value based on the paced depolarization integral, for determining if automatic capture verification is recommended.
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Abstract
An implantable cardiac stimulation device and associated method perform an automatic calibration procedure for evaluating whether automatic capture verification can be recommended. The calibration procedure calculates and displays a number of variables for use by a medical practitioner in programming automatic capture operating parameters. An average paced depolarization integral (PDI) is determined from the cardiac signals following delivery of multiple stimulation pulse below and above capture threshold such that both pure lead polarization signals and evoked response signals may be analyzed. From the paced depolarization integral data, a capture threshold, a stimulation response curve, a minimum evoked response, a maximum lead polarization, an evoked response sensitivity, an evoked response safety margin, and a polarization safety margin are determined. Based on these variables, the calibration procedure determines if automatic capture verification can be recommended. If so, the stimulation device calculates a capture detection threshold. The automatic capture verification recommendation and the estimated calibration variables are displayed.
132 Citations
74 Claims
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1. A method of calibrating an automatic capture verification feature for use in an implantable cardiac stimulation device, comprising:
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collecting cardiac signal data and calculating a paced depolarization integral, for a plurality of stimulation output settings;
determining a capture detection threshold; and
comparing the capture detection threshold to a computed value based on the paced depolarization integral, for determining if automatic capture verification is recommended. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55)
setting a minimum evoked response;
setting a maximum lead polarization;
setting an evoked response sensing margin;
setting an evoked response sensitivity;
setting an evoked response safety margin; and
setting a polarization signal safety margin.
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36. The method of claim 35, wherein the step of setting the minimum evoked response includes setting a minimum average characteristic cardiac signal value for a stimulation output equal to or greater than a capture threshold.
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37. The method of claim 35, wherein the step of setting the maximum lead polarization includes setting a maximum average characteristic cardiac signal value for a stimulation output less than a capture threshold.
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38. The method of claim 35, wherein the step of setting the evoked response sensing margin includes setting a difference between a minimum evoked response less twice its standard deviation and a maximum lead polarization plus twice its standard deviation.
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39. The method of claim 35, wherein the step of setting the evoked response sensitivity includes setting a sum of one-third of the evoked response sensing margin and a maximum lead polarization plus twice its standard deviation.
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40. The method of claim 39, wherein the step of setting the evoked response sensitivity includes identifying a cardiac signal exceeding an evoked response sensitivity as a capture signal.
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41. The method of claim 35, wherein the step of setting the evoked response safety margin includes setting a quotient of a minimum average evoked response divided by an evoked response sensitivity.
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42. The method of claim 35, wherein the step of setting the polarization safety margin includes setting a quotient of an evoked response sensitivity divided by a maximum lead polarization.
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43. The method of claim 35, further including the step of using a set of calibration variables for programming automatic capture operating parameters.
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44. The method of claim 2, wherein the step of determining the plurality of variables further includes displaying a variable relating to the operation of automatic capture verification.
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45. The method of claim 2, wherein the step of comparing the capture detection threshold includes comparing the capture detection threshold to an acceptable minimum value, so that automatic capture is not recommended if the capture detection threshold is less than an acceptable minimum value.
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46. The method of claim 2, wherein the step of comparing the capture detection threshold to a predetermined value includes comparing a lead polarization to an acceptable maximum, so that automatic capture is not recommended if a lead polarization signal is greater than an acceptable maximum value.
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47. The method of claim 2, further including the step of not recommending automatic capture if a capture threshold is not determined.
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48. The method of claim 2, wherein the step of comparing the capture detection threshold to a predetermined value includes comparing an evoked response safety margin to a minimum acceptable value, so that automatic capture is not recommended if the evoked response safety margin is less than an acceptable minimum value.
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49. The method of claim 2, wherein the step of comparing the capture detection threshold to a predetermined value includes comparing a polarization safety margin to a minimum acceptable value, so that automatic capture is not recommended if the polarization safety margin is less than an acceptable minimum value.
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50. The method of claim 2, wherein the step of comparing the capture detection threshold to a predetermined value includes comparing a slope of a response curve to a maximum acceptable value, so that automatic capture is not recommended if the slope of the response curve is greater than an acceptable maximum value.
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51. The method of claim 2, further including displaying a message indicating that automatic capture verification is recommended if at least one predefined condition is met.
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52. The method of claim 51, further including displaying a message indicating that automatic capture verification is not recommended if the predefined condition is not met.
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53. The method of claim 2, further including determining a first set of variables relating to the operation of automatic capture if automatic capture is recommended, and determining a second set of variables relating to the operation of automatic capture if automatic capture verification is not recommended.
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54. The method of claim 53 further including a step of prioritizing a plurality of conditions required for recommending automatic capture verification.
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55. The method of claim 54, further including displaying the first set of variables if automatic capture is recommended and displaying the second set of variables if automatic capture is not recommended.
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56. A cardiac stimulation device capable of calibrating an automatic capture verification feature, comprising:
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a pulse generator that selectively generates stimulation energy;
a lead, connected to the pulse generator, that delivers the stimulation energy to one or more cardiac chambers;
a sensing circuit, coupled to the lead, that collects cardiac signal data for a plurality of stimulation output settings;
a calculator that calculates paced depolarization integrals from the cardiac signal data;
a control circuit, connected to the sensing circuit, that determines a capture detection threshold; and
wherein the control circuit compares the capture detection threshold to a computed value based on the paced depolarization integral, for determining if automatic capture verification is recommended. - View Dependent Claims (57, 58, 59, 60, 61, 62, 63, 64, 65)
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66. A cardiac stimulation device capable of calibrating an automatic capture verification feature, comprising:
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means for collecting cardiac signal data and for calculating a paced depolarization integral, for a plurality of stimulation output settings;
means for determining a capture detection threshold; and
means for comparing the capture detection threshold to a computed value based on the paced depolarization integral, to determine if automatic capture verification is recommended. - View Dependent Claims (67, 68, 69, 70, 71, 72, 73, 74)
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Specification