System to provide myocardial and neural stimulation

• US 7,660,628 B2
• Filed: 03/23/2005
• Issued: 02/09/2010
• Est. Priority Date: 03/23/2005
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Garg, Ankur, Zhu, Qingsheng, Kramer, Andrew P., Libbus, Imad, James, Kristofer J., Vanderlinde, Scott
• Primary Examiner(s): Layno; Carl H
• Assistant Examiner(s): Gedeon; Brian T
• Application Number:
  US11/087,935
• Publication Number:
  US 20060217772A1
• Time in Patent Office: 1,784 Days
• Field of Search: 607/2, 607/9, 607/18, 607/115, 607/116
• US Class Current: 607/2
• CPC Class Codes: A61N 1/36057 adapted for stimulating afferent nerves
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/36117 for treating hypertension
• CPC Class Codes: A61N 1/36128 Control systems
• CPC Class Codes: A61N 1/3621 for treating or preventing abnormally high heart rate
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy

Abstract

Various aspects provide an implantable device. In various embodiments, the device comprises at least one port, where each port is adapted to connect a lead with an electrode to the device. The device further includes a stimulation platform, including a sensing circuit connected to the at least one port to sense an intrinsic cardiac signal and a stimulation circuit connected to the at least one port via a stimulation channel to deliver a stimulation signal through the stimulation channel to the electrode. The stimulation circuit is adapted to deliver stimulation signals through the stimulation channel for both neural stimulation therapy and CRM therapy. The sensing and stimulation circuits are adapted to perform CRM functions. The device further includes a controller connected to the sensing circuit and the stimulation circuit to control the neural stimulation therapy and the CRM therapy. Other aspects and embodiments are provided herein.

Claims

1. An implantable device, comprising:

at least one port, each port being adapted to connect a lead with an electrode to the device;

a stimulation platform, the platform including a sensing circuit connected to the at least one port to sense an intrinsic cardiac signal and a stimulation circuit connected to the at least one port via a stimulation channel to deliver a stimulation signal through the stimulation channel to the electrode, the stimulation circuit including a pacing capacitor and circuitry operably connected to the pacing capacitor to use the pacing capacitor to generate the stimulation signal with appropriate parameters to effectively depolarize a neural target for a neural stimulation therapy and to use the pacing capacitor to generate the stimulation signal with appropriate parameters to effectively capture myocardial tissue for a cardiac rhythm management (CRM) therapy; and

a controller connected to the sensing circuit and the stimulation circuit, wherein the controller is adapted to select whether the circuitry connected to the pacing capacitor generates the stimulation signal with the appropriate parameters for the neural stimulation therapy or the stimulation signal with the appropriate parameters for the CRM therapy, and is adapted to control the neural stimulation therapy or CRM therapy.

2. The device of claim 1, wherein the controller is adapted to control the circuitry to deliver the stimulation signal with parameters to effectively depolarize the neural target for the neural stimulation therapy over the stimulation channel to the electrode during a first time and to deliver the signal with parameters to effectively capture myocardial tissue for the CRM therapy over the stimulation channel to the electrode during a second time that is separate from the first time.

3. The device of claim 2, wherein the controller is adapted to control the circuitry to alternate between delivering the stimulation signal with parameters to effectively depolarize the neural target for the neural stimulation therapy and the signal with parameters to effectively capture myocardial tissue for the CRM therapy.

4. The device of claim 1, wherein the stimulation channel to the electrode is a first stimulation channel to a first electrode, the device further comprising a second stimulation channel to a second electrode, the stimulation circuit being adapted to deliver stimulation signals through the first stimulation channel for both neural stimulation therapy and CRM therapy and through the second stimulation channel for both neural stimulation therapy and CRM therapy, wherein the controller is adapted to control the stimulation circuit to provide a neural stimulation signal for neural stimulation therapy through the first stimulation channel to the first electrode and to provide a CRM stimulation signal for CRM therapy through the second stimulation channel to the second electrode.

5. The device of claim 1, wherein the stimulation circuit is adapted to deliver a stimulation signal through the stimulation channel to the electrode to simultaneously depolarize the neural target for the neural stimulation therapy and capture myocardial tissue for the CRM therapy.

6. The device of claim 1 wherein:

the controller is adapted to select a stimulation mode for the stimulation channel;

the controller is adapted to control the stimulation circuit to deliver neural stimulation signals over the stimulation channel to the electrode to depolarize the neural target for the neural therapy in-neural stimulation mode;

the controller is adapted to control the stimulation circuit to deliver CRM stimulation signals over the stimulation channel to the electrode to capture myocardial tissue for the CRM therapy in a CRM stimulation mode; and

the controller is adapted to control the stimulation circuit to use the pacing capacitor to generate a stimulation signal over the stimulation channel effective for simultaneously depolarizing the neural target for the neural stimulation therapy and capturing myocardial tissue for the CRM therapy in a combined neural stimulation and CRM mode.

7. The device of claim 1, wherein the circuitry connected to the pacing capacitor is adapted to adjust at least one of an amplitude or a frequency of the stimulation signal to change from delivering the stimulation signal to depolarize the neural target to delivering the stimulation signal to capture myocardial tissue.

8. An implantable medical device, comprising:

a pace module, including a pacing capacitor;

a stimulation channel to conduct an electrical signal from the pacing capacitor to an electrode;

means for determining a desired therapy to be delivered using the pacing capacitor through the stimulation channel to the electrode;

means for using the pacing capacitor to deliver a cardiac rhythm management (CRM) stimulation signal through the stimulation channel to the electrode to effectively capture a heart muscle for a CRM therapy when the CRM therapy is desired; and

means for using the pacing capacitor to deliver a neural stimulation signal through the stimulation channel to the electrode to effectively depolarize a neural target and elicit a neural response for a neural stimulation therapy when the neural stimulation therapy is desired.

9. The device of claim 8, further comprising means for delivering a stimulation signal through the stimulation channel to simultaneously depolarize the neural target for the neural stimulation therapy and capture myocardial tissue for the CRM stimulation therapy.

10. The device of claim 8, further comprising means for delivering the CRM stimulation signal to the electrode during a first time and delivering the neural stimulation signal to the electrode during a second time that is separate from the first time.

11. The device of claim 8, wherein the stimulation channel includes a first stimulation channel and the electrode includes a first electrode, the device further comprising:

a second stimulation channel to conduct an electrical signal from the pace module to a second electrode;

means for selecting from an available CRM stimulation mode to capture the myocardial tissue or neural stimulation mode to depolarize the neural target for the first stimulation channel, and delivering a CRM stimulation signal through the first stimulation channel to the first electrode; and

means for selecting from an available CRM stimulation mode to capture the myocardial tissue or neural stimulation mode to depolarize the neural target for the second stimulation channel, and delivering a neural stimulation signal through the second stimulation channel to the second electrode.

12. The device of claim 11, wherein the means for selecting from an available CRM stimulation mode or neural stimulation mode includes means for adjusting at least one of an amplitude and a frequency of a stimulation signal generated by the pace module.

13. A method for operating an implantable device to deliver a desired stimulation signal from a pacing capacitor through a stimulation channel to an electrode, comprising:

determining a desired therapy to be delivered using the pacing capacitor through the stimulation channel to the electrode;

upon determining that a cardiac rhythm management (CRM) therapy is desired, delivering a cardiac rhythm management (CRM) stimulation signal using the pacing capacitor through the stimulation channel to the electrode to stimulate myocardial tissue, the CRM stimulation signal having parameters to effectively capture a heart muscle for the CRM therapy; and

upon determining that a neural stimulation therapy is desired, delivering a neural stimulation signal using the pacing capacitor through the stimulation channel to the electrode to depolarize a neural target and elicit an effective neural response for the neural stimulation therapy.

14. The method of claim 13, further comprising delivering a stimulation signal through the stimulation channel to simultaneously depolarize the neural target for the neural stimulation therapy and capture myocardial tissue for the CRM stimulation therapy.

15. The method of claim 13, further comprising delivering the CRM stimulation signal to the electrode during a first time and delivering the neural stimulation signal to the electrode during a second time that is separate from the first time.

16. The method of claim 13, wherein the stimulation channel includes a first stimulation channel and the electrode includes a first electrode, and the device includes a second stimulation channel to conduct an electrical signal from the pace module to a second electrode, the method further comprising:

means for selecting from an available CRM stimulation mode to capture the myocardial tissue or neural stimulation mode to depolarize the neural target for the first stimulation channel, and delivering a CRM stimulation signal through the first stimulation channel to the first electrode to capture the myocardial tissue; and

means for selecting from an available CRM stimulation mode to capture the myocardial tissue or neural stimulation mode to depolarize the neural target for the second stimulation channel, and delivering a neural stimulation signal through the second stimulation channel to the second electrode to depolarize the neural target.

17. The device of claim 16, wherein selecting from an available CRM stimulation mode or neural stimulation mode includes adjusting at least one of an amplitude and a frequency of a stimulation signal generated by the pace module.

18. A method for making an implantable medical device, comprising:

connecting a controller to a memory;

connecting the controller to a sensing module adapted to sense intrinsic cardiac signals over a sensing channel from an electrode;

connecting the controller to a stimulation module adapted to generate stimulation signals on a stimulation channel to the electrode, wherein the stimulation module includes a pacing capacitor and circuitry connected to the pacing capacitor to use the pacing capacitor to generate the stimulation signals; and

storing computer instructions in the memory to be performed by the controller, the computer instructions including instructions to perform a neural stimulation therapy using the pacing capacitor to generate a neural stimulation signal effective to depolarize a neural target for the neural stimulation therapy, and to perform a cardiac rhythm management (CRM) therapy using the pacing capacitor to generate a CRM stimulation signal to effectively capture myocardial tissue for the CRM therapy, wherein the computer instructions to perform the CRM therapy include instructions to perform the CRM therapy using the sensing module and the stimulation module, the computer instructions further including instructions to receive a therapy selection input, to generate the neural stimulation signal on the stimulation channel to the electrode if the neural stimulation therapy is selected, and to generate the CRM stimulation signal on the stimulation channel to the electrode if the neural CRM therapy is selected.

19. The method of claim 18, wherein:

the stimulation channel is a first stimulation channel and the electrode is a first electrode;

the stimulation module is adapted to generate stimulation signals on a second stimulation channel to a second electrode;

the computer instructions stored in the memory further include instructions to select a therapy mode for each of the first and second stimulation channels, and to generate a corresponding stimulation signal on the first and second stimulation channels according to the selected therapy mode.

20. The method of claim 19, wherein the therapy mode is selected from a group comprising a neural stimulation therapy mode, and a CRM stimulation therapy mode.

21. The method of claim 19, wherein the therapy mode is selected from a group comprising a neural stimulation therapy mode, a CRM stimulation therapy mode, and a combined neural stimulation and CRM stimulation therapy mode.

22. The method of claim 18, wherein the computer instructions include instructions to generate the neural stimulation signal on the stimulation channel to the electrode during a first time, and to generate a CRM stimulation signal on the stimulation channel to the electrode during a second time separate from the first time.

23. The method of claim 22, wherein the instructions include instructions to generate the neural stimulation signal and the CRM stimulation signal using a time division multiplexing scheme.

24. The method of claim 18, wherein the instructions include instructions to generate a stimulation signal on the stimulation channel to simultaneously perform the neural stimulation therapy and the CRM therapy.