Remote pace detection in an implantable medical device

• US 8,515,534 B2
• Filed: 09/26/2012
• Issued: 08/20/2013
• Est. Priority Date: 07/15/2009
• 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., Baker, Kenneth L.
• Primary Examiner(s): Manuel, George
• Assistant Examiner(s): Wieland, Robert N
• Application Number:
  US13/627,551
• Publication Number:
  US 20130023957A1
• Time in Patent Office: 328 Days
• Field of Search: 607/2, 607/4, 607/50
• US Class Current: 607/2
• CPC Class Codes: A61B 5/024 Detecting, measuring or recording pulse rate or heart rate A61B5/0205, A61B5/021 take precedence
• CPC Class Codes: A61B 7/00 Instruments for auscultation
• CPC Class Codes: A61B 7/04 Electric stethoscopes microphones, acoustic transducers therefor H04R
• CPC Class Codes: A61N 1/3605 Implantable neurostimulators for stimulating central or peripheral nerve system
• CPC Class Codes: A61N 1/36053 adapted for vagal stimulation A61N1/36114 takes precedence
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/36139 with automatic adjustment
• CPC Class Codes: A61N 1/36146 specified by the stimulation parameters
• CPC Class Codes: A61N 1/37211 Means for communicating with stimulators
• CPC Class Codes: A61N 1/37288 Communication to several implantable medical devices within one patient
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients
• CPC Class Codes: G16H 20/70 relating to mental therapies, e.g. psychological therapy or autogenous training
• CPC Class Codes: G16H 40/63 for local operation
• CPC Class Codes: G16H 40/67 for remote operation

Abstract

A system embodiment for stimulating a neural target comprises a neural stimulator, a pace detector, and a controller. The neural stimulator is electrically connected to at least one electrode, and is configured to deliver a neural stimulation signal through the at least one electrode to stimulate the neural target. The pace detector is configured to use at least one electrode to sense cardiac activity and distinguish paced cardiac activity in the sensed cardiac activity from non-paced cardiac activity in the sensed cardiac activity. The controller is configured to control a programmed neural stimulation therapy using the neural stimulator and using detected paced cardiac activity as an input for the neural stimulation therapy.

Claims

1. A system for stimulating a neural target, comprising:

a neural stimulator configured to stimulate the neural target;

a pace detector configured to sense cardiac activity and detect when the sensed cardiac activity includes paced cardiac activity; and

a controller configured to control a programmed neural stimulation therapy using the neural stimulator and using detected paced cardiac activity as an input for the neural stimulation therapy.

2. The system of claim 1, wherein the controller is configured to synchronize neural stimulation on a remotely detected pace.

3. The system of claim 1, wherein the controller is configured to withhold neural stimulation upon detecting a remotely detected pace.

4. The system of claim 1, wherein the controller is configured to alter neural stimulation upon detecting a remotely detected pace.

5. The system of claim 1, wherein the detected paced cardiac activity includes detected paces, the controller is configured to determine a pacing rate of the detected paces, and the controller is configured to control the programmed neural stimulation based on whether the pacing rate of the detected paces is above a lower rate limit (LRL).

6. The system of claim 1, wherein the system is configured to detect a premature ventricular contraction, and the controller is configured to control the programmed neural stimulation upon detection of the premature ventricular contraction.

7. The system of claim 1, wherein the controller is configured to detect paced cardiac cycles and non-paced cardiac cycles, and to control the programmed neural stimulation based on a percentage of the paced cardiac cycles over a predetermined time.

8. The system of claim 1, wherein the controller is configured to control to change neural stimulation therapy for extended periods when paced cardiac activity is not detected.

9. The system of claim 1, wherein the controller is configured to control a change in neural stimulation therapy for extended periods of detected paced.

10. The system of claim 1, wherein the controller is configured to detect loss of pacing, and to control neural stimulation upon detecting the loss of pacing.

11. The system of claim 1, wherein the controller is configured to detect a pacing rate and changes in the pacing rate, and to control the programmed neural stimulation using the detected changes in the pacing rate during times without neural stimulation.

12. The system of claim 1, wherein the controller is configured to detect a pacing rate and changes in the pacing rate, and to control the programmed neural stimulation using the detected changes in pacing rate during times of neural stimulation.

13. The system of claim 1, wherein the pace detector is configured to detect overdrive pacing in the sensed cardiac activity, wherein the controller is configured to modify the programmed neural stimulation therapy using the detected paced cardiac activity and to return to an unmodified neural stimulation therapy when overdrive pacing is no longer detected.

14. The system of claim 1, wherein the pace detector is configured to detect overdrive pacing in the sensed cardiac activity, wherein the controller is configured to modify the programmed neural stimulation therapy using the detected paced cardiac activity and to return to an unmodified neural stimulation therapy when an antiarrhythmia shock is detected.

15. The system of claim 1, wherein the pace detector is configured to detect overdrive pacing in the sensed cardiac activity, wherein the controller is configured to modify the programmed neural stimulation therapy using the detected paced cardiac activity and to return to an unmodified neural stimulation therapy after expiration of a post overdrive pacing period.

16. The system of claim 1, wherein the programmed neural stimulation therapy has a duty cycle with a stimulation ON portion and a stimulation OFF portion, and the controller is configured to:

distinguish between detected paced cardiac activity during the stimulation ON portion and detected paced cardiac activity during the stimulation OFF portion; and

modify the neural stimulation therapy using the detected paced cardiac activity during the stimulation ON portion and the detected paced cardiac activity during the stimulation OFF portion.

17. The system of claim 16, wherein in modify the neural stimulation therapy using the detected paced cardiac activity during the stimulation ON portion, the controller is configured to detect a change in the detected paced cardiac activity during the stimulation ON portion, and use the detected change to modify the neural stimulation therapy.

18. The system of claim 16, wherein in modify the neural stimulation therapy using the detected paced cardiac activity during the stimulation OFF portion, the controller is configured to detect a change in the detected paced cardiac activity during the stimulation OFF portion, and use the detected change to modify the neural stimulation therapy.

19. The system of claim 1, wherein the pace detector is configured to monitor pulse widths and modify the neural stimulation therapy using the monitored pulse widths.

20. The system of claim 1, wherein the pace detector is configured to use a rising edge or a falling edge or both the rising and falling edges of the sensed cardiac activity to detect when the sensed cardiac activity includes paced cardiac activity.