Method and apparatus for synchronizing neural stimulation to cardiac cycles
First Claim
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1. A neural stimulation system coupled to a living subject having a circulatory system, the neural stimulation system comprising:
- a stimulation output circuit to deliver neural stimulation pulses;
a plurality of electrodes configured to sense a plurality of subcutaneous electrocardiogram (ECG) vectors indicative of cardiac cycles each including a predetermined type timing reference event, the plurality of electrodes configured for placement external to the circulatory system;
a reference event detection circuit coupled to the plurality of electrodes, the reference event detection circuit adapted to detect the predetermined type timing reference event using the plurality of subcutaneous ECG vectors;
a cardiac parameter measurement circuit coupled to the plurality of electrodes and adapted to measure an atrioventricular interval;
a stimulation control circuit coupled to the stimulation output circuit and the reference event detection circuit and adapted to adjust delivery of neural stimulation pulses using the measured atrioventricular interval, the stimulation control circuit including;
an offset interval generator adapted to produce an offset interval starting with the predetermined type timing reference event; and
a pulse delivery controller adapted to start a delivery of a burst of the neural stimulation pulses when the offset interval expires; and
an implantable housing configured to contain at least the stimulation output circuit, the reference event detection circuit, the cardiac parameter measurement circuit, and the stimulation control circuit, the implantable housing including a hermetically sealed can being an electrode of the plurality of electrodes.
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Abstract
A neural stimulator senses a reference signal indicative of cardiac cycles each including a predetermined type timing reference event using a sensor external to the heart and blood vessels. The delivery of the neural stimulation pulses are synchronized to that timing reference event. Examples of the timing reference event include a predetermined cardiac event such as a P-wave or an R-wave detected from a subcutaneous ECG signal, a predetermined type heart sound detected from an acoustic signal, and a peak detected from a hemodynamic signal related to blood flow or pressure.
282 Citations
20 Claims
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1. A neural stimulation system coupled to a living subject having a circulatory system, the neural stimulation system comprising:
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a stimulation output circuit to deliver neural stimulation pulses; a plurality of electrodes configured to sense a plurality of subcutaneous electrocardiogram (ECG) vectors indicative of cardiac cycles each including a predetermined type timing reference event, the plurality of electrodes configured for placement external to the circulatory system; a reference event detection circuit coupled to the plurality of electrodes, the reference event detection circuit adapted to detect the predetermined type timing reference event using the plurality of subcutaneous ECG vectors; a cardiac parameter measurement circuit coupled to the plurality of electrodes and adapted to measure an atrioventricular interval; a stimulation control circuit coupled to the stimulation output circuit and the reference event detection circuit and adapted to adjust delivery of neural stimulation pulses using the measured atrioventricular interval, the stimulation control circuit including; an offset interval generator adapted to produce an offset interval starting with the predetermined type timing reference event; and a pulse delivery controller adapted to start a delivery of a burst of the neural stimulation pulses when the offset interval expires; and an implantable housing configured to contain at least the stimulation output circuit, the reference event detection circuit, the cardiac parameter measurement circuit, and the stimulation control circuit, the implantable housing including a hermetically sealed can being an electrode of the plurality of electrodes. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8)
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9. A neural stimulation system, comprising:
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a stimulation output circuit to deliver neural stimulation pulses; implantable electrodes configured to sense a subcutaneous electrocardiogram (ECG) signal; a cardiac parameter measurement circuit coupled to the implantable electrodes, the cardiac parameter measurement circuit adapted to measure one or more cardiac parameters including an atrioventricular interval from the subcutaneous ECG signal; a cardiac event detection circuit coupled to the implantable electrodes, the cardiac event detection circuit adapted to detect predetermined type cardiac events from the subcutaneous ECG signal; a stimulation control circuit coupled to the stimulation output circuit, the cardiac parameter measurement circuit, and the cardiac event detection circuit, the stimulation control circuit adapted to adjust the delivery of the neural stimulation pulses based on the measured one or more cardiac parameters including the atrioventricular interval and including a synchronization module adapted to synchronize the delivery of the neural stimulation pulses to the predetermined type cardiac events; and an implantable housing including a hermetically sealed can adapted to house the stimulation output circuit, the cardiac event detection circuit, and the stimulation control circuit, the can including at least one conductive portion made of electrically conductive material; wherein the implantable electrodes include a can electrode including the at least one conductive portion of the can. - View Dependent Claims (10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20)
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Specification