Implantable cardiac device for reduced phrenic nerve stimulation
First Claim
1. A medical device, comprising:
- a plurality of electrodes electrically coupled to a heart;
a pulse generator coupled to the plurality of electrodes and configured to sense cardiac activity and deliver pacing pulses to a heart using at least some of the plurality of electrodes;
a transthoracic impedance sensor configured to sense a transthoracic impedance signal; and
a control circuit coupled to the pulse generator and the transthoracic impedance sensor, the control circuit configured to detect a breathing event based on a temporal association between pacing pulse delivery during a non-refractory period of the heart and a perturbation in the transthoracic impedance signal, the control circuit further configured to verify that the detected breathing event is representative of phrenic nerve stimulation resulting from pacing pulse delivery based on detection of an additional perturbation in the transthoracic impedance signal that is temporally associated with an additional pacing pulse delivered during a cardiac refractory period of the heart.
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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
28 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 generator coupled to the plurality of electrodes and configured to sense cardiac activity and deliver pacing pulses to a heart using at least some of the plurality of electrodes; a transthoracic impedance sensor configured to sense a transthoracic impedance signal; and a control circuit coupled to the pulse generator and the transthoracic impedance sensor, the control circuit configured to detect a breathing event based on a temporal association between pacing pulse delivery during a non-refractory period of the heart and a perturbation in the transthoracic impedance signal, the control circuit further configured to verify that the detected breathing event is representative of phrenic nerve stimulation resulting from pacing pulse delivery based on detection of an additional perturbation in the transthoracic impedance signal that is temporally associated with an additional pacing pulse delivered during a cardiac refractory period of the heart. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14)
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15. A medical device, comprising:
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a plurality of electrodes electrically coupled to a heart; a pulse generator coupled to the plurality of electrodes and configured to sense cardiac activity and deliver pacing pulses to a heart using at least some of the plurality of electrodes; a transthoracic impedance sensor configured to sense a transthoracic impedance signal; and a control circuit coupled to the pulse generator and the transthoracic impedance sensor, the control circuit configured to detect a breathing event based on a temporal association between pacing pulse delivery during a non-refractory period of the heart and a perturbation in the transthoracic impedance signal, the control circuit further configured to verify that the detected breathing event is representative of phrenic nerve stimulation resulting from pacing pulse delivery based on detection of an additional perturbation in the transthoracic impedance signal that is temporally associated with an additional delivered pacing pulse. - View Dependent Claims (16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28)
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Specification