Physiological vibration detection in an implanted medical device

• US 8,588,906 B2
• Filed: 07/13/2010
• Issued: 11/19/2013
• Est. Priority Date: 07/15/2009
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Ternes, David J., Siejko, Krzysztof Z., Ruble, Stephen, Hamann, Jason J.
• Primary Examiner(s): Holmes, Rex R
• Application Number:
  US12/835,325
• Publication Number:
  US 20110015704A1
• Time in Patent Office: 1,225 Days
• Field of Search: 600/529, 600/532, 600/533, 600/538, 600/539, 600/586, 607/2, 607/7, 607/9, 607/27, 607/28, 607/42, 607/62, 607/66
• US Class Current: 607/9
• CPC Class Codes: A61B 2562/0219 Inertial sensors, e.g. accelerometers, gyroscopes, tilt switches
• 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 5/02405 Determining heart rate variability
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/352 Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval
• CPC Class Codes: A61B 5/363 Detecting tachycardia or bradycardia
• CPC Class Codes: A61B 7/00 Instruments for auscultation
• CPC Class Codes: A61B 7/003 Detecting lung or respiration noise
• CPC Class Codes: A61B 7/04 Electric stethoscopes microphones, acoustic transducers therefor H04R
• CPC Class Codes: A61N 1/3601 of respiratory organs
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/36117 for treating hypertension
• CPC Class Codes: A61N 1/36578 controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters

Abstract

An embodiment of an implantable system configured to be implanted in a patient includes an accelerometer, a neural stimulator, and a controller. The neural stimulator is configured to deliver neural stimulation to a neural target. The controller is configured to use the accelerometer to detect laryngeal vibration or coughing, and is configured to deliver a programmed neural stimulation therapy using the neural stimulator and using detected laryngeal vibration or detected coughing as an input to the programmed neural stimulation therapy.

Claims

1. An implantable system configured to be implanted in a patient, comprising:

an accelerometer;

a neural stimulator configured to deliver neural stimulation to a neural target; and

a controller configured to use the accelerometer to detect laryngeal vibration, and configured to deliver a programmed neural stimulation therapy using the neural stimulator and using detected laryngeal vibration as an input to the programmed neural stimulation therapy,

wherein the neural stimulator is configured to deliver the neural stimulation at a neural stimulation frequency, the system further comprising a bandpass filter configured to filter an accelerometer signal to the neural stimulation frequency to detect laryngeal vibration modulated at the neural stimulation frequency, and

wherein the controller is configured to use the accelerometer to detect cough, to deliver the neural stimulation with a programmed duty cycle including a stimulation ON portion and a stimulation OFF portion, to monitor an accelerometer signal for a cough during the ON portion, and to titrate the neural stimulation therapy if the cough occurs during the ON portion of the neural stimulation therapy.

2. The system of claim 1, wherein the controller is configured to deliver the neural stimulation with a programmed duty cycle including a stimulation ON portion and a stimulation OFF portion, to deliver a plurality of neural stimulation pulses during the stimulation ON portion, and to monitor a window of time after a neural stimulation pulse for laryngeal vibration over a threshold.

3. The system of claim 2, wherein the controller is further configured to monitor for laryngeal vibration after each neural stimulation pulse during the stimulation ON portion, and to titrate the neural stimulation therapy if laryngeal vibration occurs more than a threshold number of times during the stimulation ON portion.

4. The system of claim 1, wherein the controller is configured to use the accelerometer to detect cough, and to adjust an intensity of the neural stimulation therapy to a level where laryngeal vibration is detected and cough is not detected.

5. An implantable system configured to be implanted in a patient, comprising:

an accelerometer;

a neural stimulator configured to deliver neural stimulation to a neural target; and

a controller configured to use the accelerometer to detect laryngeal vibration or coughing, and configured to deliver a programmed neural stimulation therapy using the neural stimulator and using detected laryngeal vibration or detected coughing as an input to the programmed neural stimulation therapy, wherein the controller is configured to use the accelerometer to detect heart sounds and to use the detected heart sounds to provide an input to the neural stimulation therapy, wherein the controller is configured to determine left ventricular ejection time (LVET) using the detected heart sounds and to use the LVET to provide an input to the neural stimulation therapy.

6. A method, comprising:

using an accelerometer to detect laryngeal vibration or coughing; and

controlling a neural stimulation therapy using detected laryngeal vibration as an input to the neural stimulation therapy, wherein the neural stimulation therapy is delivered with a neural stimulation frequency, the method further comprising bandpass filtering an accelerometer signal to the neural stimulation frequency to detect laryngeal vibration modulated at the neural stimulation frequency,

wherein the accelerator is used to detect cough, the neural stimulation therapy is delivered with a programmed duty cycle, the programmed duty cycle including an ON portion and an OFF portion, and the neural stimulation therapy delivers a plurality of neural stimulation pulses during the ON portion, the method further comprises monitoring an accelerometer signal for a cough during the ON portion, and titrating the neural stimulation therapy if the cough occurs during the ON portion of the neural stimulation therapy.

7. The method of claim 6, wherein the neural stimulation therapy is delivered with a programmed duty cycle, the programmed duty cycle including a stimulation ON portion and a stimulation OFF portion, and the neural stimulation therapy delivers a plurality of neural stimulation pulses during the stimulation ON portion, the method further comprises monitoring a window of time after a neural stimulation pulse for laryngeal vibration over a threshold.

8. The method of claim 7, further comprising monitoring for laryngeal vibration after each neural stimulation pulse, and titrating the neural stimulation therapy if laryngeal vibration occurs more than a threshold number of times during the stimulation ON portion.

9. The method of claim 6, wherein the accelerometer is used to detect cough, and controlling the neural stimulation therapy includes adjusting an intensity of the neural stimulation therapy to a level where laryngeal vibration is detected and cough is not detected.

10. The method of claim 6, wherein controlling the neural stimulation therapy includes:

receiving a manual input from a clinician to initiate a titration process;

periodically initiating the titration process;

or

initiating the titration process in response to detecting a cough or laryngeal vibration.

11. The method of claim 6, wherein controlling the neural stimulation therapy includes limiting an increase of neural stimulation intensity to an upper bound.

12. The method of claim 6, wherein controlling the neural stimulation using detected laryngeal vibration or detected coughing includes offsetting an intensity of the neural stimulation from a first threshold level at which laryngeal vibration was detected or a second threshold level at which coughing was detected.

13. A method, comprising:

using an accelerometer to detect laryngeal vibration or coughing;

controlling a neural stimulation therapy using detected laryngeal vibration or detected coughing as an input to the neural stimulation therapy;

using the accelerometer to detect heart sounds;

using the detected heart sounds to provide an input to the neural stimulation therapy;

determining left ventricular ejection time (LVET) using the detected heart sounds; and

using the LVET to provide an input to the neural stimulation therapy.

14. An implantable system configured to be implanted in a patient, comprising:

an accelerometer;

a neural stimulator configured to deliver neural stimulation to a neural target; and

a controller configured to use the accelerometer to detect laryngeal vibration, and configured to deliver a programmed neural stimulation therapy using the neural stimulator and using detected laryngeal vibration as an input to the programmed neural stimulation therapy,

wherein the neural stimulator is configured to deliver the neural stimulation at a neural stimulation frequency, the system further comprising a bandpass filter configured to filter an accelerometer signal to the neural stimulation frequency to detect laryngeal vibration modulated at the neural stimulation frequency,

wherein the controller is configured to use the accelerometer to detect cough, and to adjust an intensity of the neural stimulation therapy to a level where laryngeal vibration is detected and cough is not detected.

15. The system of claim 14, wherein the controller is configured to deliver the neural stimulation with a programmed duty cycle including a stimulation ON portion and a stimulation OFF portion, to deliver a plurality of neural stimulation pulses during the stimulation ON portion, and to monitor a window of time after a neural stimulation pulse for laryngeal vibration over a threshold.

16. The system of claim 15, wherein the controller is further configured to monitor for laryngeal vibration after each neural stimulation pulse during the stimulation ON portion, and to titrate the neural stimulation therapy if laryngeal vibration occurs more than a threshold number of times during the stimulation ON portion.

17. A method, comprising:

using an accelerometer to detect laryngeal vibration or coughing; and

controlling a neural stimulation therapy using detected laryngeal vibration as an input to the neural stimulation therapy, wherein the neural stimulation therapy is delivered with a neural stimulation frequency, the method further comprising bandpass filtering an accelerometer signal to the neural stimulation frequency to detect laryngeal vibration modulated at the neural stimulation frequency,

wherein the accelerometer is used to detect cough, and controlling the neural stimulation therapy includes adjusting an intensity of the neural stimulation therapy to a level where laryngeal vibration is detected and cough is not detected.

18. The method of claim 17, wherein the neural stimulation therapy is delivered with a programmed duty cycle, the programmed duty cycle including a stimulation ON portion and a stimulation OFF portion, and the neural stimulation therapy delivers a plurality of neural stimulation pulses during the stimulation ON portion, the method further comprises monitoring a window of time after a neural stimulation pulse for laryngeal vibration over a threshold.

19. The method of claim 18, further comprising monitoring for laryngeal vibration after each neural stimulation pulse, and titrating the neural stimulation therapy if laryngeal vibration occurs more than a threshold number of times during the stimulation ON portion.

20. The method of claim 17, wherein controlling the neural stimulation therapy includes:

receiving a manual input from a clinician to initiate a titration process;

periodically initiating the titration process;

or

initiating the titration process in response to detecting a cough or laryngeal vibration.

21. The method of claim 17, wherein controlling the neural stimulation therapy includes limiting an increase of neural stimulation intensity to an upper bound.

22. The method of claim 17, wherein controlling the neural stimulation using detected laryngeal vibration or detected coughing includes offsetting an intensity of the neural stimulation from a first threshold level at which laryngeal vibration was detected or a second threshold level at which coughing was detected.

23. A method, comprising:

using an accelerometer to detect laryngeal vibration or coughing; and

controlling a neural stimulation therapy using detected laryngeal vibration as an input to the neural stimulation therapy, wherein the neural stimulation therapy is delivered with a neural stimulation frequency, the method further comprising bandpass filtering an accelerometer signal to the neural stimulation frequency to detect laryngeal vibration modulated at the neural stimulation frequency,

wherein controlling the neural stimulation using detected laryngeal vibration or detected coughing includes offsetting an intensity of the neural stimulation from a first threshold level at which laryngeal vibration was detected or a second threshold level at which coughing was detected.

24. The method of claim 23, wherein the neural stimulation therapy is delivered with a programmed duty cycle, the programmed duty cycle including a stimulation ON portion and a stimulation OFF portion, and the neural stimulation therapy delivers a plurality of neural stimulation pulses during the stimulation ON portion, the method further comprises monitoring a window of time after a neural stimulation pulse for laryngeal vibration over a threshold.

25. The method of claim 23, further comprising monitoring for laryngeal vibration after each neural stimulation pulse, and titrating the neural stimulation therapy if laryngeal vibration occurs more than a threshold number of times during the stimulation ON portion.

26. The method of claim 23, wherein controlling the neural stimulation therapy includes:

receiving a manual input from a clinician to initiate a titration process;

periodically initiating the titration process;

or

initiating the titration process in response to detecting a cough or laryngeal vibration.

27. The method of claim 23, wherein controlling the neural stimulation therapy includes limiting an increase of neural stimulation intensity to an upper bound.