Thoracic impedance detection with blood resistivity compensation

• US 7,672,718 B2
• Filed: 06/16/2008
• Issued: 03/02/2010
• Est. Priority Date: 08/19/2004
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Stahmann, Jeffrey E., Hatlestad, John D., Moon, Boyce
• Primary Examiner(s): Nasser; Robert L
• Application Number:
  US12/139,948
• Publication Number:
  US 20080249433A1
• Time in Patent Office: 624 Days
• Field of Search: None
• US Class Current: 600/547
• CPC Class Codes: A61B 5/053 Measuring electrical impedance or conductance of a portion of the body
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance

Abstract

This document discusses, among other things, a cardiac rhythm management device or other implantable medical device that uses thoracic impedance to determine how much fluid is present in the thorax, such as for detecting or predicting congestive heart failure, pulmonary edema, pleural effusion, hypotension, or the like. The thoracic fluid amount determined from the thoracic impedance is compensated for changes in blood resistivity, which may result from changes in hematocrit level or other factors. The blood-resistivity-compensated thoracic fluid amount can be stored in the device or transmitted to an external device for storage or display. The blood-resistivity-compensated thoracic fluid amount can also be used to adjust a cardiac pacing, cardiac resynchronization, or other cardiac rhythm management or other therapy to the patient. This document also discusses applications of the devices and methods for predicting or indicating anemia.

Claims

1. A method comprising:

detecting a thoracic impedance signal of a thorax of a subject;

detecting a blood resistivity signal by sensing between at least two intravascular or intracardiac electrodes disposed in the same chamber of the heart or the same blood vessel; and

using a signal processing circuit, extracting physiological information from the thoracic impedance signal, the extracting physiological information including using the blood resistivity signal to reduce or eliminate an effect of a change in blood resistivity on the physiological information.

2. The method of claim 1, wherein extracting physiological information includes extracting cardiac stroke information from the thoracic impedance signal.

3. The method of claim 1, wherein extracting physiological information includes extracting respiration information from the thoracic impedance signal.

4. The method of claim 1, wherein extracting physiological information includes extracting an abdominal fluid indication from the thoracic impedance signal.

5. The method of claim 1, comprising filtering the thoracic impedance signal to obtain a near-DC thoracic impedance signal, wherein the physiological information is generated at least in part by using the near-DC thoracic impedance signal.

6. The method of claim 5, wherein filtering the thoracic impedance signal includes accounting for posture.

7. The method of claim 1, wherein detecting the blood resistivity includes using first and second intravascular electrodes.

8. The method of claim 1, wherein detecting the blood resistivity signal includes measuring the blood resistivity at like times during at least one of a cardiac cycle and a respiratory cycle.

9. The method of claim 1, comprising:

storing a history of the physiological information; and

determining whether a physiological trend is present using the history of physiological information.

10. The method of claim 9, comprising determining whether heart failure decompensation is present using a physiological trend determination.

11. The method of claim 1, comprising transmitting the physiological information from an implantable medical device to an external device.

12. The method of claim 11, comprising displaying the physiological information on the external device.

13. A system comprising:

an implantable medical device including;

a thoracic impedance measurement circuit configured to provide a thoracic impedance signal;

a blood resistivity measurement circuit configured to provide a blood resistivity signal sensed between at least two intravascular or intracardiac electrodes disposed in the same chamber of the heart or the same blood vessel; and

a controller coupled to the blood resistivity measurement circuit, the controller configured to extract physiological information from the thoracic impedance signal, the controller configured to use the blood resistivity signal to reduce or eliminate an effect of a change in blood resistivity on the physiological information.

14. The system of claim 13, wherein the controller is configured to extract cardiac stroke information from the thoracic impedance signal.

15. The system of claim 13, wherein the controller is configured to extract respiration information from the thoracic impedance signal.

16. The system of claim 13, wherein the controller is configured to extract an abdominal fluid indication from the thoracic impedance signal.

17. The system of claim 13, comprising an external device in communication with the implantable medical device, the external device configured to receive the physiological information from the implantable medical device.

18. The system of claim 17, wherein the external device is configured to display the physiological information.

19. A system comprising:

means for detecting a thoracic impedance signal of a thorax of a subject;

means for detecting a blood resistivity signal sensed between at least two intravascular or intracardiac electrodes disposed in the same chamber of the heart or the same blood vessel; and

means for extracting physiological information from the thoracic impedance signal using the blood resistivity signal to reduce or eliminate an effect of a change in blood resistivity on the physiological information.

20. The system of claim 19, wherein the means for extracting physiological information includes means for extracting one of cardiac stroke information, respiration information, or an abdominal fluid indication from the thoracic impedance signal.