Remote sensing in an implantable medical device

• US 8,626,281 B2
• Filed: 09/25/2012
• Issued: 01/07/2014
• 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): Wieland, Robert N
• Application Number:
  US13/626,628
• Publication Number:
  US 20130023956A1
• Time in Patent Office: 469 Days
• Field of Search: 607/2, 607/9, 607/62, 607/29
• US Class Current: 607/2
• CPC Class Codes: A61B 2562/0219 Inertial sensors, e.g. accelerometers, gyroscopes, tilt switches
• CPC Class Codes: A61B 2562/043 in a linear array
• CPC Class Codes: A61B 5/0255 Recording instruments specially adapted therefor
• CPC Class Codes: A61B 5/0816 Measuring devices for examining respiratory frequency measuring frequency of electric signals G01R23/00
• CPC Class Codes: A61B 5/0823 Detecting or evaluating cough events
• CPC Class Codes: A61B 5/1107 Measuring contraction of parts of the body, e.g. organ, muscle apparatus for measuring work or force in general G01L
• CPC Class Codes: A61B 5/6869 Heart
• 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 1/36053 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 1/36117 for treating hypertension
• CPC Class Codes: A61N 1/36139 with automatic adjustment
• CPC Class Codes: A61N 1/36578 controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone

Abstract

An embodiment uses an accelerometer to sense heart sounds, and determines heart rate information using the sensed heart sounds. An embodiment uses an accelerometer to sense respiratory activity. An embodiment delivers a programmed neural stimulation therapy with a programmed duty cycle, where the programmed duty cycle includes a stimulation ON portion followed by a stimulation OFF portion. An electrode electrically connected to the implanted neural stimulation device is used to remotely detect cardiac activity. The remotely detected cardiac activity is used to detect heart rate information during the stimulation ON portion and to detect heart rate information during the stimulation OFF portion. The detected heart rate information and/or the detected respiration information are used to control a neural stimulation therapy performed by the neural stimulator device and/or are used to provide diagnostic information for the patient'"'"'s condition.

Claims

1. A method for operating an implanted neural stimulation device having a neural stimulator lead and an antenna lead including an electrode, comprising:

implementing a neural stimulation therapy stored in the implanted neural stimulation device including delivering the neural stimulation therapy through the neural stimulator lead and not through the antenna lead, wherein the neural stimulation therapy includes a programmed duty cycle, and the programmed duty cycle includes a stimulation ON portion followed by a stimulation OFF portion;

remotely detecting cardiac activity using the antenna lead with the electrode to detect heart rate information during at least one of the stimulation ON portion or during the stimulation OFF portion;

controlling the neural stimulation therapy using the detected heart rate information; and

using an accelerometer to detect cough or using an accelerometer to monitor laryngeal vibration.

2. The method of claim 1, further comprising identifying R waves from the remotely detected cardiac activity or identifying PQRS waves from the remotely detected cardiac activity.

3. The method of claim 1, further comprising detecting a change in heart rate during the ON portion of the duty cycle and modifying the neural stimulation therapy using the change in heart rate.

4. The method of claim 1, further comprising detecting a change in AV duration during the ON portion of the duty cycle, and modifying the neural stimulation therapy using the change in the AV duration.

5. The method of claim 1, further comprising detecting a change in heart rate during the OFF portion of the duty cycle and modifying the neural stimulation therapy using the change in the heart rate.

6. The method of claim 1, further comprising detecting a change in AV duration during the OFF portion of the duty cycle, and modifying the neural stimulation therapy using the change in the AV duration.

7. The method of claim 1, further comprising detecting an arrhythmia using the detected cardiac activity, and controlling the neural stimulation therapy in response to the detected arrhythmia.

8. The method of claim 1, further comprising:

trending the detected heart rate information during the stimulation ON portion or during the stimulation OFF portion or during both the stimulation ON portion and the stimulation OFF portion; and

controlling the neural stimulation therapy using the trended heart rate for the ON portion or the trended heart rate for the OFF portion or both the trended heart rate for the ON portion and the trended heart rate for the OFF portion.

9. The method of claim 1, further comprising detecting an average heart rate change between the ON portion and the OFF portion of the duty cycle, and monitoring the average heart rate for divergence between the average heart rate during the ON portion and the average heart rate during the OFF portion.

10. The method of claim 1, further comprising:

sensing heart sounds; and

using both the heart sounds and the remotely detected cardiac activity to control the neural stimulation therapy performed by the neural stimulation device.

11. The method of claim 1, further comprising trending heart rate using the remotely detected cardiac activity.

12. The method of claim 1, further comprising trending heart rate variability (HRV) using the remotely detected cardiac activity.

13. The method of claim 1, further comprising trending AV delay using the remotely detected cardiac activity.

14. The method of claim 1, further comprising identifying antitachycardia pacing (ATP) using the remotely detected cardiac activity.

15. The method of claim 1, further comprising determining if a change in the detected cardiac activity is a long-term change, and controlling the neural stimulation therapy if the change is long-term.

16. The method of claim 1, further comprising determining if a change in the detected cardiac activity is a short-term change, and controlling the neural stimulation therapy if the change is short-term.

17. A device, comprising:

a neural stimulator lead;

a neural stimulator configured to deliver a neural stimulation therapy through the neural stimulator lead;

an antenna lead including at least one electrode for use to remotely detect cardiac activity, the neural stimulation therapy not delivered through the antenna lead; and

a controller configured to remotely detect cardiac activity using the antenna lead, and control the neural stimulator using the detected cardiac activity; and

an implantable housing, wherein the neural stimulator and the controller are in the implantable housing.

18. The device of claim 17, wherein the antenna lead includes a lead configured to be tunneled under skin and having a length configured for use in providing wide field vector sensing, wherein the lead includes a distal electrode and the implantable housing includes a can electrode, and wherein the device is configured to use the distal electrode and the can electrode to provide the wide field vector sensing.

19. The device of claim 17, wherein the antenna lead includes a stub lead having a length configured for narrow field vector sensing, wherein the lead includes a distal electrode and the implantable housing includes a can electrode, and wherein the device is configured to use the distal electrode and the can electrode to provide the narrow field vector sensing.

20. A method for operating an implanted neural stimulation device having a neural stimulator lead and an antenna lead including an electrode, comprising:

implementing a neural stimulation therapy stored in the implanted neural stimulation device including delivering the neural stimulation therapy through the neural stimulator lead and not through the antenna lead, wherein the neural stimulation therapy includes a programmed duty cycle, and the programmed duty cycle includes a stimulation ON portion followed by a stimulation OFF portion;

remotely detecting cardiac activity using the antenna lead with the electrode to detect heart rate information during at least one of the stimulation ON portion or during the stimulation OFF portion;

controlling the neural stimulation therapy using the detected heart rate information;

using an accelerometer to sense heart sounds; and

using both the heart sounds and the remotely detected cardiac activity to control the neural stimulation therapy performed by the neural stimulation device.