Near field-based systems and methods for assessing impedance and admittance for use with an implantable medical device

• US 8,670,820 B2
• Filed: 08/09/2010
• Issued: 03/11/2014
• Est. Priority Date: 08/09/2010
• Status: Active Grant

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Inventors: Gutfinger, Dan E., Qu, Fujian, Soriano, Alex, Rooke, Ryan, Nabutovsky, Yelena, Shah, Riddhi, Blomqvist, Andreas
• Primary Examiner(s): Layno, Carl H
• Assistant Examiner(s): Wu, Eugene
• Application Number:
  US12/853,130
• Publication Number:
  US 20120035493A1
• Time in Patent Office: 1,310 Days
• Field of Search: 600/508, 600/509, 600/512, 600/513, 607/24, 607/28
• US Class Current: 600/513
• CPC Class Codes: A61B 2562/0219 Inertial sensors, e.g. accelerometers, gyroscopes, tilt switches
• CPC Class Codes: A61B 5/02028 Determining haemodynamic parameters not otherwise provided for, e.g. cardiac contractility or left ventricular ejection fraction
• CPC Class Codes: A61B 5/029 Measuring or recording blood output from the heart, e.g. minute volume A61B8/065 takes precedence
• CPC Class Codes: A61B 5/0538 invasively, e.g. using a catheter
• CPC Class Codes: A61B 5/4878 Evaluating oedema
• CPC Class Codes: A61B 5/686 Permanently implanted devices, e.g. pacemakers, other stimulators, biochips A61B5/6861 takes precedence
• CPC Class Codes: A61B 7/00 Instruments for auscultation

Abstract

A new model is provided for understanding and exploiting impedance or admittance values measured by implantable medical devices, such as pacemakers or cardiac resynchronization devices (CRTs.) The device measures impedance along vectors extending through tissues of the patient between various pairs of electrodes. The device then converts the vector-based impedance measurements into near-field individual electrode-based impedance values. This is accomplished, in at least some examples, by converting the vector-based impedance measurements into a set of linear equations to be solved while ignoring far-field contributions to the impedance measurements. The device solves the linear equations to determine the near-field impedance values for the individual electrodes, which are representative of the impedance of tissues in the vicinity of the electrodes. The device then performs or controls various device functions based on the near-field values, such as analyzing selected near-field values to detect heart failure or pulmonary edema.

Claims

1. A method for use with an implantable medical device for implant within a patient, the method comprising:

detecting vector-based immittance measurements within tissues of the patient using a plurality of electrodes coupled to the device;

converting the vector-based immittance measurements to individual electrode-based immittance values, wherein the individual electrode-based immittance measurements corresponding to a particular electrode are relative near-field immittance values and the relative near-field immittance values are representative of the immittance of tissues in sufficiently close proximity to the electrode to exclude substantially all far-field immittance contributions;

controlling at least one device function in response to the individual electrode-based immittance values; and

detecting one or more cardiac parameters based on the relative near-field immittance values.

2. The method of claim 1 wherein converting the vector-based immittance measurements into relative near-field immittance values is achieved by ignoring far-field contributions to the vector-based impedance measurements.

3. The method of claim 2 wherein converting the vector-based immittance measurements into relative near-field immittance values includes:

converting at least N vector-based impedance measurements (v1, v2, . . . , vN) into a set of linear equations to be solved while ignoring the far-field contributions to the impedance measurements, where N is at least three; and

solving the set of linear equations to yield a set of relative near-field impedance values (e1, e2, . . . , eN).

4. The method of claim 3 further including converting the set of near-field impedance values (e1, e2, . . . , eN) into a corresponding set of near-field admittance values (a1, a2, . . . , aN).

5. The method of claim 4 further including estimating left atrial pressure (LAP) based on selected near-field admittance values (a1, a2, . . . , aN).

6. The method of claim 5 wherein the device is equipped with an LVring electrode and wherein the selected near-field admittance values are values corresponding to the LVring electrode.

7. The method of claim 6 wherein estimating LAP includes calculating left ventricular end diastolic volume (LV EDV) based on LVring admittance and then converting LV EDV into LAP.

8. The method of claim 7 wherein converting LV EDV into LAP is performed using an exponential formula.

9. The method of claim 6 wherein estimating LAP includes calculating:

zLAP=YNF/LV RING*SlopeNF/Y+BaselineNF/Y

where YNF/LV RING represents near-field admittance values associated with the LVring electrode and wherein SlopeNF/Y and BaselineNF/Y are predetermined values representative of a linear correlation of YNF/LV RING to patient LAP.

10. The method of claim 3 wherein the plurality of electrodes include:

an LVring electrode, an RVring electrode, an RAring electrode, a case electrode and an RVcoil electrode.

11. The method of claim 10 wherein the vector-based impedance measurements include an LVring-case measurement, an RVring-case measurement, an RAring-case measurement, an RVcoil-case measurement, an LVring-RAring measurement, and an LVring-RVring measurement.

12. The method of claim 1 wherein detecting one or more cardiac parameters includes detecting changes in the relative near-field immittance corresponding to a selected electrode and associating that change with a change in fluid content and/or tissue composition within a corresponding anatomical structure associated with the electrode.

13. The method of claim 12 wherein the selected electrode is an LVring electrode and wherein the corresponding structure associated with the electrode includes one or more of a coronary vein, an LV chamber, an LV myocardium, and pericardial space of the heart of the patient.

14. The method of claim 12 wherein the selected electrode is an RVring electrode and wherein the corresponding structure associated with the electrode includes one or more of an RV chamber and RV myocardium of the heart of the patient.

15. The method of claim 12 wherein the selected electrode is an RAring electrode and wherein the corresponding structure associated with the electrode includes one or more of an RA chamber and RA myocardium of the heart of the patient.

16. The method of claim 12 wherein the selected electrode is a case electrode and wherein the corresponding structure associated with the electrode is a device pocket.

17. The method of claim 12 wherein the selected electrode is an RVcoil electrode and wherein the corresponding structure associated with the electrode includes one or more of an RV chamber and RV myocardium of the heart of the patient.

18. The method of claim 1 wherein the vector-based immittance measurements correspond to an impedance polygon.

19. The method of claim 18 wherein the vector-based immittance measurements correspond to an impedance triangle.

20. The method of claim 1 wherein detecting one or more cardiac parameters based on the relative near-field immittance values includes detecting parameters representative of changes in fluid volume content indicative of one or more of heart failure and pulmonary edema.

21. The method of claim 1 wherein detecting one or more cardiac parameters based on the relative near-field immittance values includes detecting parameters representative of lead anomalies including one or more of lead dislodgement, lead failure, lead infection, lead abrasion, and lead perforation of cardiac tissue.

22. The method of claim 1 wherein detecting one or more cardiac parameters based on the relative near-field immittance values includes detecting parameters representative of one or both of the onset of cardiac pacing and the termination of cardiac pacing.

23. The method of claim 1 wherein detecting one or more cardiac parameters based on the relative near-field immittance values includes estimating volumes which include one or more of left ventricular (LV) volume and pericardial fluid volume based on a near-field immittance signal corresponding to an LVring electrode.

24. The method of claim 1 wherein detecting one or more cardiac parameters based on the relative near-field immittance values includes estimating right ventricular (RV) volume based on a near-field immittance signal corresponding to an RVring electrode.

25. The method of claim 1 wherein detecting one or more cardiac parameters based on the relative near-field immittance values includes detecting parameters representative of lead pocket infection based on a near-field immittance signal corresponding to a device housing electrode.

26. The method of claim 1 wherein the vector-based immittance measurements are bipolar immittance measurements.

27. The method of claim 1 wherein the vector-based immittance measurements are quadripolar immittance measurements measured using a set of electrodes, wherein current electrodes of the set and corresponding voltage electrodes of the set are in close proximity to one another.

28. A system use with an implantable medical device for implant within a patient, the system comprising:

a vector-based immittance detector operative to detect vector-based immittance measurements within tissues of the patient using a plurality of electrodes coupled to the device;

a immittance converter operative to convert the vector-based immittance measurements into individual electrode-based immittance values, wherein the individual electrode-based immittance measurements corresponding to a particular electrode are relative near-field immittance values and the relative near-field immittance values are representative of the immittance of tissues in sufficiently close proximity to the electrode to exclude substantially all far-field immittance contributions; and

a controller operative to control at least one device function in response to the individual electrode-based immittance values, wherein the at least one device function includes detecting one or more cardiac parameters based on the relative near-field immittance values.

29. A system use with an implantable medical device for implant within a patient, the system comprising:

means for detecting vector-based immittance measurements within tissues of the patient using a plurality of electrodes coupled to the device;

means for converting the vector-based immittance measurements into individual electrode-based immittance values, wherein the individual electrode-based immittance measurements corresponding to a particular electrode are relative near-field immittance values and the relative near-field immittance values are representative of the immittance of tissues in sufficiently close proximity to the electrode to exclude substantially all far-field immittance contributions; and

means for controlling at least one device function in response to the individual electrode-based immittance values, wherein the at least one device function includes detecting one or more cardiac parameters based on the relative near-field immittance values.