Evaluating therapeutic stimulation electrode configurations based on physiological responses

• US 8,538,523 B2
• Filed: 09/14/2012
• Issued: 09/17/2013
• Est. Priority Date: 08/20/2007
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Sommer, John L., Bourn, David Wayne, Marshall, Mark T., Eggen, Michael D., Miyazawa, Gabriela C.
• Primary Examiner(s): DIETRICH, JOSEPH M
• Application Number:
  US13/616,300
• Publication Number:
  US 20130006332A1
• Time in Patent Office: 368 Days
• Field of Search: 607/9, 607/15, 607/17, 607/18
• US Class Current: 607/9
• CPC Class Codes: A61N 1/056 Transvascular endocardial electrode systems
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/36185 Selection of the electrode configuration
• CPC Class Codes: A61N 1/36514 controlled by a physiological quantity other than heart potential, e.g. blood pressure controlled by two or more physical parameters A61N1/36585
• CPC Class Codes: A61N 1/36842 Multi-site stimulation in the same chamber
• CPC Class Codes: A61N 1/36843 Bi-ventricular stimulation
• CPC Class Codes: A61N 1/3686 configured for selecting the electrode configuration on a lead A61N1/3688 takes precedence
• CPC Class Codes: A61N 2001/0585 Coronary sinus electrodes

Abstract

A medical system comprises a plurality of electrodes; at least one sensor configured to output at least one signal based on at least one physiological parameter of a patient; and a processor. The processor is configured to control delivery of stimulation to the patient using a plurality of electrode configurations. Each of the electrode configurations comprises at least one of the plurality of electrodes. For each of the electrode configurations, the processor is configured to determine a first response of target tissue to the stimulation based on the signals, and a second response of non-target tissue to the stimulation based on the signals. The processor is also configured to select at least one of the electrode configurations for delivery of stimulation to the patient based on the first and second responses for the electrode configurations. As examples, the target tissue may be a left ventricle or vagus nerve.

Claims

1. A medical device comprising:

a means for delivering stimulation therapy to a patient using a plurality of electrode configurations;

a means for determining a response of a target tissue for each of the plurality of electrode configurations;

an accelerometer that outputs a signal corresponding to a response of non-target tissue for each of the plurality of electrode configurations;

a means for evaluating the response of the target tissue and the signal corresponding to the response of the non-target tissue for each of the plurality of electrode configurations to determine the relative suitability of the electrode configurations for delivering stimulation therapy to target tissue of the patient; and

a means for presenting an indication of the relative suitability of the of the electrode configurations to a use;

at least one implantable medical lead, wherein the at least one implantable medical lead includes a plurality of electrodes providing the plurality of electrode configurations; and

wherein the at least one implantable medical lead comprises a cardiac pacing lead, wherein the target tissue comprises tissue of the left ventricle of the patient and the non-target tissue comprises tissue of the phrenic nerve of the patient.

2. The device of claim 1, wherein the means for delivering stimulation therapy comprises an implantable pulse generator.

3. The device of claim 2, wherein the means for evaluating comprises a processor which controls the implantable pulse generator to deliver the stimulation to the patient using the plurality of electrode configurations.

4. The device of claim 2, wherein means for presenting an indication comprises an external programmer.

5. The device of claim 1, wherein the first response of target tissue comprises a first capture threshold of target tissue and the second response of non-target tissue comprises a second capture threshold of non-target tissue.

6. The device of claim 5, wherein determining the first and second responses for the electrode configurations includes determining that at least one of the first and second capture thresholds exceeds a maximum stimulation amplitude allowed by the medical system.

7. The device of claim 5, wherein selecting at least one of the electrode configurations for delivery of stimulation to the patient based on the first and second responses for the electrode configurations includes determining a value of a suitability index for each of the electrode configurations based on a ratio of the first second capture threshold to the second capture threshold for each of the electrode configurations.

8. A medical device comprising:

a means for delivering stimulation therapy to a patient using a plurality of electrode configurations;

a means for determining a response of a target tissue for each of the plurality of electrode configurations;

an accelerometer that outputs a signal corresponding to a response of non-target tissue for each of the plurality of electrode configurations;

a means for evaluating the response of the target tissue and the signal corresponding to the response of the non-target tissue for each of the plurality of electrode configurations to determine the relative suitability of the electrode configurations for delivering stimulation therapy to target tissue of the patient; and

a means for presenting an indication of the relative suitability of the of the electrode configurations to a use;

at least one implantable medical lead, wherein the at least one implantable medical lead includes a plurality of electrodes providing the plurality of electrode configurations; and

wherein the target tissue comprises tissue of the vagus nerve of the patient and the non-target tissue comprises muscle tissue of the patient adjacent to the vagus nerve.

9. A medical system comprising:

one or more implantable medical leads, the implantable medical leads including a plurality of electrodes;

one or more sensors configured to output one or more signals based on at least one physiological parameter of a patient; and

a processor configured to;

control delivery of stimulation to the patient using a plurality of electrode configurations, wherein each of the electrode configurations comprises at least one of the plurality of electrodes,

for each of the electrode configurations, determine a first response of the left ventricle of the patient to the stimulation based on the signals and a second response of tissue of the phrenic nerve of the patient to the stimulation based on the signals, wherein the processor determines the second response of tissue of the phrenic nerve using an input from an accelerometer, and

present indications of the first response of the left ventricle of the patient to the stimulation and the second response of tissue of the phrenic nerve of the patient to a user via a user interface.

10. The system of claim 9, wherein the first response of target tissue comprises a first capture threshold of target tissue and the second response of non-target tissue comprises a second capture threshold of non-target tissue.

11. The system of claim 10, wherein determining the first and second responses for the electrode configurations includes determining that at least one of the first and second capture thresholds exceeds a maximum stimulation amplitude allowed by the medical system.

12. The system of claim 10, wherein selecting at least one of the electrode configurations for delivery of stimulation to the patient based on the first and second responses for the electrode configurations includes determining a value of a suitability index for each of the electrode configurations based on a ratio of the first second capture threshold to the second capture threshold for each of the electrode configurations.

13. A medical system comprising:

one or more implantable medical leads, the implantable medical leads including a plurality of electrodes;

one or more sensors configured to output one or more signals based on at least one physiological parameter of a patient; and

a processor configured to;

control delivery of stimulation to the patient using a plurality of electrode configurations, wherein each of the electrode configurations comprises at least one of the plurality of electrodes,

for each of the electrode configurations, determine a first response of the vagus nerve of the patient to the stimulation based on the signals, and a second response of muscle tissue of the patient adjacent to the vagus nerve to the stimulation based on the signals, wherein the processor determines the second response of the muscle tissue of the patient adjacent to the vagus nerve using an input from an accelerometer, and

present indications of the first response of the vagus nerve of the patient to the stimulation and the second response of the muscle tissue of the patient adjacent to the vagus nerve to a user via a user interface.

14. The system of claim 13, wherein the first response of target tissue comprises a first capture threshold of target tissue and the second response of non-target tissue comprises a second capture threshold of non-target tissue.

15. The system of claim 14, wherein determining the first and second responses for the electrode configurations includes determining that at least one of the first and second capture thresholds exceeds a maximum stimulation amplitude allowed by the medical system.

16. The system of claim 14, wherein selecting at least one of the electrode configurations for delivery of stimulation to the patient based on the first and second responses for the electrode configurations includes determining a value of a suitability index for each of the electrode configurations based on a ratio of the first second capture threshold to the second capture threshold for each of the electrode configurations.