Flexible neural stimulation engine

• US 8,352,029 B2
• Filed: 05/24/2010
• Issued: 01/08/2013
• Est. Priority Date: 04/28/2005
• Status: Expired due to Fees

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Ternes, David J., Birkholz, Doug M., Yost, David W., Esler, James A.
• Primary Examiner(s): Bertram, Eric D.
• Application Number:
  US12/785,954
• Publication Number:
  US 20100234912A1
• Time in Patent Office: 960 Days
• Field of Search: 607/9
• US Class Current: 607/9
• CPC Class Codes: A61N 1/025 Digital circuitry features of electrotherapy devices, e.g. memory, clocks, processors
• CPC Class Codes: A61N 1/36125 Details of circuitry or electric components
• CPC Class Codes: A61N 1/36135 using physiological parameters
• CPC Class Codes: A61N 1/362 Heart stimulators heart defibrillators A61N1/39
• CPC Class Codes: A61N 1/3682 with a variable atrioventricular delay

Abstract

A method for implementing a neural stimulation therapy mode in an implantable medical device (IMD) comprising the acts of mapping respective device states, defined by one or more timer states that include at least one neural event timer or one or more indications of one or more sensed physiologic events, to associated device actions in a stored neural table, storing an event represented as a device status word and a time stamp in a queue in response to an action input, and comparing one or more current timer states or one or more indications of one or more sensed physiologic events to a device state contained in the neural table and, if found to match, causing performance of one or more associated device actions, wherein the device actions include one or more of a neural stimulation energy delivery or a change in one or more timer states.

Claims

1. A method comprising the acts of:

implementing a neural stimulation therapy mode in an implantable medical device (IMD) comprising stimulation circuitry adapted to provide at least one neural stimulation energy to a patient using at least one neural stimulation electrode, the implementing the neural stimulation therapy mode including;

storing representations of device states as entries of a neural table, wherein a device state is defined by one or more timer states, including at least one neural event timer, or one or more indications of one or more sensed physiologic events;

mapping respective device states to associated device actions in the stored neural table, wherein the device actions include;

one or more of a neural stimulation energy delivery and a change in one or more timer states; and

a set of one or more action inputs, wherein an action input includes at least one of an input to the neural stimulation circuitry and an input to the one or more timers;

detecting a change in a current device state;

searching the neural table entries to identify a match to the current device state in response to the detected change;

applying an action word associated with the identified neural table entry match to action inputs to cause performance of one or more associated device actions, wherein an action input includes at least one of an input to the neural stimulation circuitry and an input to the one or more timers; and

storing an event represented as a device status word and a time stamp in a queue in response to an action input.

2. The method of claim 1, wherein mapping includes:

mapping respective device states to respective stored condition words, the condition words representing a particular device state according to which one or more bits of the word are set or cleared; and

mapping respective condition words to corresponding stored action words that represent corresponding device actions, wherein an action word represents a particular device action according to which one or more bits of the word are set or cleared.

3. The method of claim 2, wherein mapping particular IMD states includes mapping a current device status word bit-by-bit to one or more condition words, and wherein the device status word includes a set of one or more timer outputs and a set of one or more sensing comparator outputs.

4. The method of claim 3, including:

detecting a change in device state by detecting a change in one or more bits of the device status word; and

sequentially comparing one or more condition words with a current device status word when the change in device state is detected.

5. The method of claim 4, wherein storing an event represented as a device status word includes storing an action word in a FIFO queue along with the timestamp when a match is found between the condition word and the current device status word.

6. The method of claim 1, wherein mapping includes:

mapping one or more respective device states to associated device actions in a combined brady and neural table, the device actions include bradycardia energy therapy delivery or one or more changes in one or more timer states; and

comparing one or more current timer states or one or more indications of one or more sensed events to a device state included in the combined brady and neural table and, if found to match, causing performance of one or more associated device actions.

7. The method of claim 1, including sensing one or more physiologic events by detecting when an electrical sensor signal produced by at least one implantable sensor exceeds a specified threshold value, wherein the implantable sensor is selected from the group consisting of:

a) a heart sound sensor;

b) a blood pressure sensor;

c) a cardiac signal sensing circuit adapted to sense intracardiac electrograms;

d) a subcutaneous electrocardiograph (ECG) sensing circuit;

e) a cardiac wall motion sensor;

f) a transthoracic impedance sensor;

g) an intracardiac impedance sensor;

h) an accelerometer; and

i) a temperature sensor.

8. The method of claim 1, wherein mapping device states to device actions in a stored neural table includes mapping device states to device actions in the stored neural table representing timed neural stimulation.

9. The method of claim 1, wherein the IMD includes sensing circuitry adapted to sense exertion of the patient, and wherein mapping device states to device actions in a stored neural table includes mapping device states to device actions in the stored neural table representing neural stimulation in response to a sensed exertion level of the patient.

10. The method of claim 1, wherein mapping device states to device actions in a stored neural table includes mapping device states to device actions in the stored neural table representing neural stimulation energy delivery to one or more of a parasympathetic nerve, a baroreceptors, and a vagus nerve.

11. The method of claim 1, wherein mapping device states to device actions includes mapping a device state, that includes expiration of a neural escape timer, to a device action stored in the stored neural table, wherein the device action includes delivery of neural stimulation energy.

12. The method of claim 1, wherein mapping device states to device actions includes mapping a device state, that includes sensing a physiologic event, to a device action, that includes resetting a neural escape timer.

13. The method of claim 1,

wherein the stimulation circuitry is adapted to provide bradycardia pacing energy;

wherein mapping device states includes mapping respective device states to associated device actions in a combination brady table and neural table; and

wherein comparing the timer states and the indications of events includes comparing the current timer states or the indications of the sensed physiologic events to a device state contained in the combination brady table and neural table.

14. The method of claim 13, wherein the device actions include any combination of bradycardia pacing energy delivery, neural stimulation energy delivery, and one or more changes in one or more timer states.

15. The method of claim 14, wherein mapping device states to device actions includes mapping a device state, that includes expiration of a ventricular pacing interval, to a device action stored in the stored neural table, wherein the device action includes delivery of bradycardia pacing stimulation energy to a ventricle and neural stimulation energy to a parasympathetic nerve.

16. The method of claim 14, wherein mapping device states to device actions includes mapping a device state, that includes expiration of a atrial-ventricular pacing interval (AVI) and a sensed exertion level that exceeds a specified threshold exertion level output, to a device action stored in the stored neural table, wherein the device action includes delivery of bradycardia pacing stimulation energy to a ventricle and neural stimulation energy to a parasympathetic nerve.

17. The method of claim 16, including the mapping the sensed exertion level to a cardiac output, and where in the device state includes expiration of the AVI and a cardiac output that exceeds a specified threshold cardiac output.

18. The method of claim 14, wherein mapping device states to device actions includes mapping a device state, that includes expiration of a left ventricular pacing interval (LVPI) and a sensed exertion level that is less than a specified exertion level output, to a device action stored in the stored neural table, wherein the device action includes delivery of bradycardia pacing stimulation energy to a ventricle and inhibiting neural stimulation energy to a parasympathetic nerve.

19. The method of claim 13, including changing operation of the IMD by loading one or both of a different brady table and a different neural table into a memory of the IMD.

20. A tangible computer readable medium containing device performable instructions which, when performed by a computing device, result in the computing device performing a method comprising the acts of:

storing representations of device states as entries of a neural table, wherein a device state is defined by one or more timer states, including at least one neural event timer, or one or more indications of one or more sensed physiologic events;

mapping respective device states to associated device actions in the stored neural table, wherein the device actions include;

one or more of a neural stimulation energy delivery and a change in one or more timer states; and

a set of one or more action inputs, wherein an action input includes at least one of an input to neural stimulation circuitry and an input to the one or more timers, wherein the neural stimulation circuitry is adapted deliver the neural stimulation energy to a patient;

detecting a change in a current device state;

searching the neural table entries to identify a match to the current device state in response to the detected change;

applying an action word associated with the identified neural table entry match to action inputs to cause performance of one or more associated device actions, wherein an action input includes at least one of an input to the neural stimulation circuitry and an input to the one or more timers; and

storing an event represented as a device status word and a time stamp in a queue in response to an action input.