Implantable cardiac device and method for reduced phrenic nerve stimulation
First Claim
1. A medical device, comprising:
- a plurality of electrodes electrically coupled to a heart;
a pulse delivery circuit configured to deliver a plurality of pacing pulses to a heart using the plurality of electrodes;
a transthoracic impedance sensor configured to sense a transthoracic impedance signal; and
a control circuit coupled to the sensing circuit and the transthoracic impedance sensor, the control circuit configured to determine the presence of phrenic nerve stimulation resulting from the pacing pulses based on deviations in the transthoracic impedance signal corresponding to delivery of the plurality of pacing pulses and verify the presence of phrenic nerve stimulation resulting from the pacing pulses based on an additional deviation in the transthoracic impedance signal corresponding to an additional pulse delivered during a cardiac refractory period of the heart by the pulse delivery circuit using the plurality of electrodes.
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Accused Products
Abstract
Methods and devices for reducing phrenic nerve stimulation of cardiac pacing systems involve delivering a pacing pulse to a ventricle of a heart. A transthoracic impedance signal is sensed, and a deviation in the signal resulting from the pacing pulse may be used to determine phrenic nerve stimulation. Methods may further involve detecting the phrenic nerve stimulation from the pacing pulse by delivering two or more pacing pulse to the ventricle of the heart, and determining a temporal relationship. A pacing vector may be selected from the two or more vectors that effects cardiac capture and reduces the phrenic nerve stimulation. A pacing voltage and/or pulse width may be selected that provides cardiac capture and reduces the phrenic nerve stimulation. In other embodiments, a pacing pulse width and a pacing voltage may be selected from a patient'"'"'s strength-duration curve that effects cardiac capture and reduces the phrenic nerve stimulation.
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Citations
19 Claims
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1. A medical device, comprising:
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a plurality of electrodes electrically coupled to a heart; a pulse delivery circuit configured to deliver a plurality of pacing pulses to a heart using the plurality of electrodes; a transthoracic impedance sensor configured to sense a transthoracic impedance signal; and a control circuit coupled to the sensing circuit and the transthoracic impedance sensor, the control circuit configured to determine the presence of phrenic nerve stimulation resulting from the pacing pulses based on deviations in the transthoracic impedance signal corresponding to delivery of the plurality of pacing pulses and verify the presence of phrenic nerve stimulation resulting from the pacing pulses based on an additional deviation in the transthoracic impedance signal corresponding to an additional pulse delivered during a cardiac refractory period of the heart by the pulse delivery circuit using the plurality of electrodes. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11)
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12. A medical device, comprising:
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means for sensing an electrophysiologic signal from a heart; means for delivering a plurality of pacing pulses to the heart; means for detecting a cardiac signal following the pacing pulse; means for sensing a transthoracic impedance signal; means for detecting a phrenic nerve stimulation from the pacing pulses using a plurality of deviations in the transthoracic impedance signal corresponding to delivery of the plurality of pacing pulses; and means for verifying the presence of phrenic nerve stimulation resulting from the pacing pulses based on an additional deviation in the transthoracic impedance signal corresponding to an additional pulse delivered during a cardiac refractory period. - View Dependent Claims (13, 14, 15, 16, 17, 18, 19)
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Specification