Quantifying autonomic tone with thoracic impedance

• US 8,435,186 B2
• Filed: 01/29/2010
• Issued: 05/07/2013
• Est. Priority Date: 01/29/2010
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Hettrick, Douglas A., Hefner, Donald J., Sarkar, Shantanu, Zielinski, Todd M.
• Primary Examiner(s): HINDENBURG, MAX F
• Application Number:
  US12/696,753
• Publication Number:
  US 20110190654A1
• Time in Patent Office: 1,194 Days
• Field of Search: 600/508, 600/547, 607/6
• US Class Current: 600/508
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• CPC Class Codes: A61B 5/0215 by means inserted into the body catheters A61M25/00
• CPC Class Codes: A61B 5/02405 Determining heart rate variability
• CPC Class Codes: A61B 5/053 Measuring electrical impedance or conductance of a portion of the body
• CPC Class Codes: A61B 5/08 Detecting, measuring or recording devices for evaluating the respiratory organs A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/11 Measuring movement of the entire body or parts thereof, e.g. head or hand tremor, mobility of a limb for measuring pulse A61B5/02 ;A61B5/1038 takes precedence; motion detection to correct for motion artifacts in physiological signals A61B5/721
• CPC Class Codes: A61B 5/1116 Determining posture transitions
• CPC Class Codes: A61B 5/4035 Evaluating the autonomic nervous system
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/36535 controlled by body position or posture
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means
• CPC Class Codes: A61N 1/37258 Alerting the patient

Abstract

The disclosure describes techniques for quantifying the autonomic nervous system (ANS) health of a patient with thoracic impedance measurements. Thoracic impedance may be measured utilizing cardiac electrodes and an implantable medical device housing or other electrodes located on or within the patient. Since greater variability in thoracic impedance may indicate better health of the ANS, monitoring impedance changes in a patient may be used to quantify autonomic tone of the ANS, and ultimately, overall patient health. In some examples, thoracic impedance may be measured in response to a change in patient posture for acute monitoring or at predetermined times over several days, weeks, or months for more chronic monitoring of the patient. An implantable medical device may independently analyze the impedance measurements and transmit an alert to the patient or clinician when impedance changes indicate a change in patient health.

Claims

1. A method comprising:

detecting a posture change of a patient;

in response to detecting the posture change, obtaining a plurality of thoracic impedance values of the patient via a plurality of electrodes, wherein the plurality of impedance values are obtained during a period of time during which a variation of the plurality of impedance value is a result of the posture change; and

generating a value of at least one autonomic parameter based on the variation of the plurality of thoracic impedance values that are a result of the posture change, the autonomic parameter value indicative of a relative autonomic nervous system (ANS) health of the patient,

wherein greater variation of the plurality of impedance values that are a result of the posture change indicates greater ANS health.

2. The method of claim 1, wherein the at least one autonomic parameter value comprises at least one of an amplitude change of the impedance values, a difference between the impedance values, a variability of the impedance values, a variance of the impedance values, a standard deviation of the impedance values, a mean difference of the impedance values, or a standard error of the impedance values.

3. The method of claim 1, further comprising:

comparing the value of the autonomic parameter to at least one earlier value of the autonomic parameter; and

identifying the ANS health of the patient as one of declining, improving, or steady based upon the comparison.

4. The method of claim 1, further comprising detecting a physiological event of the patient, wherein obtaining the thoracic impedance values comprises measuring the thoracic impedance values in response to detecting the physiological event.

5. The method of claim 1, wherein the first posture change comprises one of standing up, sitting up, sitting down, reclining back, laying down, starting to exercise, or stopping exercise.

6. The method of claim 1, wherein obtaining the plurality of thoracic impedance values comprises measuring the plurality of thoracic impedance values with an implanted medical device.

7. The method of claim 6, wherein generating the value of the at least one autonomic parameter comprises generating the value by the implanted medical device.

8. The method of claim 6, further comprising storing at least one of the thoracic impedance values and the generated autonomic parameter value in a memory of an implanted medical device.

9. The method of claim 8, further comprising transmitting at least one of the stored thoracic impedance values or the stored autonomic parameter value from the implanted medical device to an external computing device.

10. The method of claim 9, further comprising presenting a plurality of values of the autonomic parameter in at least one of a graphical or numerical format on the external computing device.

11. The method of claim 10, further comprising presenting a trend of the values of the autonomic parameter.

12. A system comprising:

a posture module configured to detect a posture change of a patient;

a plurality of electrodes;

a sensing module configured to, in response to detection of the posture change by the posture module, obtain a plurality of thoracic impedance values of the patient via the electrodes, wherein the plurality of impedance values are obtained during a period of time during which a variation of the plurality of impedance value is a result of the posture change; and

a processor configured to generate a value of at least one autonomic parameter based on the variation of the plurality of thoracic impedance values that are a result of the posture change, the autonomic parameter value indicative of a relative autonomic nervous system (ANS) health of the patient,

wherein greater variation of the plurality of impedance values that are a result of the posture change indicates greater ANS heath.

13. The system of claim 12, wherein the at least one autonomic parameter value comprises at least one of an amplitude change of the impedance values, a difference between the impedance values, a variability of the impedance values, a variance of the impedance values, a standard deviation of the impedance values, a mean difference of the impedance values, or a standard error of the impedance values.

14. The system of claim 12, further comprising an implantable medical device coupled to the electrodes, wherein the implantable medical device comprises the sensing module.

15. The system of claim 14, wherein the implantable medical device comprises the processor.

16. The system of claim 14, further comprising an external computing device, wherein the implantable medical device is configured to transmit at least one of the thoracic impedance values or the autonomic parameter value to the external computing device.

17. The system of claim 16, wherein the external computing device is configured to present a plurality of values of the autonomic parameter in at least one of a graphical or numerical format.

18. The system of claim 17, wherein the external computing device is configured to present a trend of the values of the autonomic parameter.

19. A system comprising:

means for detecting a posture change of a patient;

means for, in response to detecting the posture change, obtaining a plurality of thoracic impedance values of the patient via a plurality of electrodes, wherein the plurality of impedance values are obtained during a period of time during which a variation of the plurality of impedance value is a result of the posture change; and

means for generating a value of at least one autonomic parameter based on the variation of the plurality of thoracic impedance values that are a result of the posture change, the autonomic parameter value indicative of a relative autonomic nervous system (ANS) health of the patient,

wherein greater variation of the plurality of impedance values that are a result of the posture change indicates greater ANS health.

20. A computer-readable storage medium comprising instructions that cause a processor to:

detect a posture change of a patient;

in response to detecting the posture change, obtain a plurality of thoracic impedance values of the patient via a plurality of electrodes, wherein the plurality of impedance values are obtained during a period of time during which a variation of the plurality of impedance value is a result of the posture change; and

generate a value of at least one autonomic parameter based on the variation of the thoracic impedance values that are a result of the posture change, the autonomic parameter value indicative of a relative autonomic nervous system (ANS) health of the patient,

wherein greater variation of the plurality of impedance values that are a result of the posture change indicates greater ANS health.