Implantable cardiac stimulation device with automatic evoked response sensing electrode configuration selection and method

• US 7,233,827 B1
• Filed: 06/09/2004
• Issued: 06/19/2007
• Est. Priority Date: 09/05/2000
• Status: Expired due to Term

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories)
• Inventors: Florio, Joseph J., Bornzin, Gene A., Mann, Brian M., Sloman, Laurence S., Sholder, Jason A.
• Primary Examiner(s): Layno; Carl
• Assistant Examiner(s): Bertram; Eric D.
• Application Number:
  US10/865,124
• Time in Patent Office: 1,105 Days
• Field of Search: 607/28
• US Class Current: 607/28
• CPC Class Codes: A61N 1/36185 Selection of the electrode configuration
• CPC Class Codes: A61N 1/3686 configured for selecting the electrode configuration on a lead A61N1/3688 takes precedence
• CPC Class Codes: A61N 1/371 Capture, i.e. successful stimulation

Abstract

An implantable cardiac stimulation device applies pacing stimulation pulses to a heart and senses evoked responses to the pacing stimulation pulses. A pulse generator applies the stimulation pacing pulses to the heart in accordance with a pacing configuration. A sensor control selects an evoked response sensing electrode configuration from among a plurality of evoked response sensing electrode configurations in response to the pacing configuration. A sensor is then programmed to sense the evoked responses with the selected evoked response sensing electrode configuration. In accordance with a preferred embodiment, signal-to-noise ratios obtained with the various electrode configurations are used to select a best electrode configuration for sensing evoked responses.

Claims

1. An implantable cardiac stimulation device to apply pacing stimulation pulses to a heart and to sense evoked responses in response to the pacing stimulation pulses, the device comprising:

at least one cardiac lead adapted for placement in electrical contact with the heart, the at least one lead comprising a plurality of electrodes that define a plurality of pacing configurations and a plurality of sensing configurations for the heart;

a pulse generator to apply the stimulation pacing pulses to the heart in accordance with a selected one of the pacing configurations;

a sensor control that maintains lists of potential sensing configurations for each of the pacing configurations, wherein the sensor control is operative to test each sensing configuration in the list for the selected pacing configuration and to automatically select an evoked response sensing electrode configuration from among a plurality of evoked response sensing electrode configurations based on the results of the test, and wherein the plurality of evoked response sensing electrode configurations refers to sensing as a function of electrode implantation sites of the cardiac lead; and

a sensor to sense the evoked responses with the automatically selected evoked response sensing electrode configuration;

wherein the sensor control includes an evoked response sensing electrode configuration evaluator that determines which one of the available evoked response sensing electrode configurations has a greatest measure of a predetermined evoked response sensing characteristic; and

wherein the evaluator determines which one of the available evoked response sensing electrode configurations provides a greatest signal-to-noise ratio.

2. The device of claim 1 wherein each pacing configuration is defined by pacing mode, lead type, and lead implant location.

3. The device of claim 1 wherein the sensor control includes a processor that is programmed to select the evoked response sensing electrode configuration from among the plurality of available evoked response sensing electrode configurations corresponding to the pacing configuration.

4. The device of claim 3 wherein the pulse generator is arranged to apply pacing stimulation pulses to a ventricle of the heart and wherein the processor is programmed to select a ventricular evoked response sensing electrode configuration from among the plurality of available evoked response sensing electrode configurations.

5. The device of claim 3 wherein the pulse generator is arranged to apply pacing stimulation pulses to an atrium of the heart and wherein the processor is programmed to select an atrial evoked response sensing electrode configuration from among the plurality of available evoked response sensing electrode configurations.

6. An implantable cardiac stimulation device to apply pacing stimulation pulses to a heart and to sense evoked responses in response to the pacing stimulation pulses, the device comprising:

at least one cardiac lead adapted for placement in electrical contact with the heart, the at least one lead comprising a plurality of electrodes that define a plurality of pacing configurations and a plurality of sensing configurations for the heart;

a pulse generator to apply the stimulation pacing pulses to the heart in accordance with a selected one of the pacing configurations;

a sensor control that maintains lists of potential sensing configurations for each of the pacing configurations, wherein the sensor control is operative to test each sensing configuration in the list for the selected pacing configuration and to automatically select an evoked response sensing electrode configuration from among a plurality of evoked response sensing electrode configurations based on the results of the test, and wherein the plurality of evoked response sensing electrode configurations refers to sensing as a function of electrode implantation sites of the cardiac lead; and

a sensor to sense the evoked responses with the automatically selected evoked response sensing electrode configuration;

wherein the sensor control includes a processor that is programmed to select the evoked response sensing electrode configuration from among the plurality of available evoked response sensing electrode configurations corresponding to the pacing configuration;

wherein the processor is programmed to measure a sensing characteristic of each of the plurality of available evoked response sensing electrode configurations and to select the evoked response sensing electrode configuration having a greatest sensing characteristic measurement; and

wherein the sensing characteristic is signal-to-noise ratio.

7. A method of sensing evoked responses of a heart, the method comprising:

placing at least one cardiac lead in electrical contact with the heart, the at least one cardiac lead comprising a plurality of electrodes that define a plurality of pacing configurations and a plurality of sensing configurations for the heart;

stimulating the heart in accordance with a selected one of the pacing configurations;

maintaining lists of potential sensing configurations for each of the pacing configurations;

testing each sensing configuration in the list corresponding with the selected pacing configuration;

automatically selecting an evoked response sensing electrode configuration from among a plurality of evoked response sensing electrode configurations based on the results of the test, wherein the plurality of evoked response sensing electrode configurations refers to sensing as a function of electrode implantation sites of the at least one cardiac lead; and

sensing the evoked responses with the automatically selected evoked response sensing electrode configuration;

wherein the automatically selecting an evoked response sensing electrode configuration comprises determining which one of the available evoked response sensing electrode configurations has a greatest measure of a predetermined evoked response sensing characteristic; and

wherein the sensing characteristic is signal-to-noise ratio.

8. The method of claim 7 further comprising:

storing in a memory at least one available evoked response sensing electrode configuration corresponding to each respective one of a plurality of pacing configurations;

wherein the selecting an evoked response sensing electrode configuration comprises selecting from the memory the selected evoked response sensing electrode configuration from the available evoked response electrode configurations corresponding to the pacing configuration.

9. The method of claim 7 wherein each pacing configuration is defined by pacing mode, lead type, and lead implant location.

10. The method of claim 7 wherein the stimulating the heart in accordance with a pacing configuration comprises applying pacing stimulation pulses to a ventricle of the heart and wherein the selecting an evoked response sensing electrode configuration comprises selecting a ventricular evoked response sensing electrode configuration from among the plurality of available evoked response sensing electrode configurations.

11. The method of claim 7 wherein the stimulating the heart in accordance with a pacing configuration comprises applying pacing stimulation pulses to an atrium of the heart and wherein the selecting an evoked response sensing electrode configuration comprises selecting an atrial evoked response sensing electrode configuration from among the plurality of available evoked response sensing electrode configurations.

12. A method of sensing evoked responses of a heart, the method comprising:

placing at least one cardiac lead in electrical contact with the heart, the at least one cardiac lead comprising a plurality of electrodes that define a plurality of pacing configurations and a plurality of sensing configurations for the heart;

stimulating the heart in accordance with a selected one of the pacing configurations;

maintaining lists of potential sensing configurations for each of the pacing configurations;

testing each sensing configuration in the list corresponding with the selected pacing configuration;

automatically selecting an evoked response sensing electrode configuration from among a plurality of evoked response sensing electrode configurations based on the results of the test, wherein the plurality of evoked response sensing electrode configurations refers to sensing as a function of electrode implantation sites of the at least one cardiac lead; and

sensing the evoked responses with the automatically selected evoked response sensing electrode configuration;

wherein the selecting an evoked response sensing electrode configuration comprises measuring a sensing characteristic of each of the Plurality of evoked response sensing electrode configurations and selecting an evoked response sensing electrode configuration based on the sensing characteristic of each of the plurality of evoked response sensing electrode configurations; and

wherein the sensing characteristic is signal-to-noise ratio.