Implantable medical device crosstalk evaluation and mitigation

• US 8,688,210 B2
• Filed: 01/30/2009
• Issued: 04/01/2014
• Est. Priority Date: 10/31/2008
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Burnes, John E., Krause, Paul G., Donofrio, William T., Arne, Gerald P., Peichel, David J., Zhou, Xiaohong, Reinke, James D.
• Primary Examiner(s): Layno, Carl H
• Assistant Examiner(s): Morales, Jon Eric C
• Application Number:
  US12/362,859
• Publication Number:
  US 20100114203A1
• Time in Patent Office: 1,887 Days
• Field of Search: 607/2, 607/62
• US Class Current: 607/5
• CPC Class Codes: A61B 2560/0271 using a remote monitoring unit
• CPC Class Codes: A61B 5/276 Protection against electrode failure
• CPC Class Codes: A61B 5/283 Invasive
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/361 Detecting fibrillation
• CPC Class Codes: A61B 5/363 Detecting tachycardia or bradycardia
• CPC Class Codes: A61B 5/7217 of noise originating from a therapeutic or surgical apparatus, e.g. from a pacemaker
• 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 1/3622 comprising two or more electrodes co-operating with different heart regions
• CPC Class Codes: A61N 1/365 controlled by a physiological parameter, e.g. heart potential evoked response A61N1/371
• CPC Class Codes: A61N 1/3686 configured for selecting the electrode configuration on a lead A61N1/3688 takes precedence
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means
• CPC Class Codes: A61N 1/37288 Communication to several implantable medical devices within one patient
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

Electrical crosstalk between two implantable medical devices or two different therapy modules of a common implantable medical device may be evaluated, and, in some examples, mitigated. In some examples, one of the implantable medical devices or therapy modules delivers electrical stimulation to a nonmyocardial tissue site or a nonvascular cardiac tissue site, and the other implantable medical device or therapy module delivers cardiac rhythm management therapy to a heart of the patient.

Claims

1. A system comprising:

a first therapy module configured to deliver electrical stimulation to a tissue site within a patient according to a set of stimulation parameter values;

a second therapy module configured to deliver at least one of a pacing, cardioversion or defibrillation therapy to a heart of the patient;

a sensing module configured to sense a cardiac signal of the heart of the patient; and

a processor configured to detect, during a time in which the first therapy module delivers electrical stimulation to the tissue site according to the set of stimulation parameter values, a potential arrhythmia of the heart based on the cardiac signal, control the first therapy module to adjust the delivery of electrical stimulation to the tissue site in response to detecting the potential arrhythmia, determine whether the potential arrhythmia is still detected after the adjustment to the delivery of electrical stimulation to the tissue site by the first therapy module, and, in response to determining the potential arrhythmia is no longer detected after the adjustment to the delivery of electrical stimulation to the tissue site by the first therapy module, initiate a modification to at least one stimulation parameter value of the set of stimulation parameter values according to which the first therapy module delivers electrical stimulation.

2. The system of claim 1, wherein the processor is configured to control the first therapy module to adjust the delivery of the electrical stimulation to the tissue site by at least controlling the first therapy module to suspend the delivery of the electrical stimulation to the tissue site.

3. The system of claim 1, further comprising an electrical stimulator that comprises the first therapy module and an implantable cardiac device that comprises the second therapy module.

4. The system of claim 3, wherein the implantable cardiac device comprises the sensing module.

5. The system of claim 1, further comprising a housing that substantially encloses the first therapy module, the second therapy module, and the sensing module.

6. The system of claim 1, wherein the processor is configured to detect the potential arrhythmia by at least detecting at least one of electrical noise or a true cardiac arrhythmia.

7. The system of claim 1, wherein the tissue site comprises at least one of a nonmyocardial tissue site or a nonvascular cardiac tissue site.

8. The system of claim 1, wherein the tissue site comprises at least one of an extravascular tissue site or the tissue site proximate to a nerve of the patient.

9. The system of claim 1, wherein the set of stimulation parameter values comprises a first set of stimulation parameter values, the processor being configured to modify the at least one stimulation parameter value of the first set of stimulation parameter values to generate a second set of stimulation parameter values having at least one different stimulation parameter value than the first set, and wherein the processor is configured to control the first therapy module to deliver electrical stimulation to the tissue site according to the second set of stimulation parameter values.

10. The system of claim 1, wherein the processor is configured to determine, based on the cardiac signal, whether the potential arrhythmia is still detected after the modification to the at least one stimulation parameter value of the set of stimulation parameter values, and control the second therapy module to deliver the at least one of a pacing, cardioversion or defibrillation electrical signal to the heart of the patient in response to determining the potential arrhythmia is still detected after the modification to the at least one stimulation parameter of the set of stimulation parameter values.

11. The system of claim 1, wherein the processor is configured to control the first therapy module to adjust the delivery of electrical stimulation at a first time, and the at least one stimulation parameter of the set of stimulation parameter values of the first therapy module comprises a first value of a first stimulation parameter, wherein the processor is configured to detect, based on the cardiac signal, the potential arrhythmia after the modification to the first value of the first stimulation parameter, control the first therapy module to adjust the delivery of the electrical stimulation to the tissue site at a second time in response to detecting the potential arrhythmia after the modification to the first value of the first stimulation parameter, determine, based on the cardiac signal, whether the potential arrhythmia is detected after the adjustment to the delivery of electrical stimulation to the tissue site by the first therapy module at the second time, and modify a second value of a second stimulation parameter of the set of stimulation parameter values in response to determining the potential arrhythmia is not detected after the adjustment to the delivery of electrical stimulation to the tissue site at the second time.

12. The system of claim 1, wherein the processor is configured to control the first therapy module to adjust the delivery of electrical stimulation at a first time, and the at least one stimulation parameter of the set of stimulation parameter values of the first therapy module comprises a value of a stimulation parameter, wherein the processor is configured to detect, based on the cardiac signal, the potential arrhythmia after the modification to the value of the stimulation parameter, control the first therapy module to adjust the delivery of the electrical stimulation to the tissue site at a second time in response to detecting the potential arrhythmia after the modification to the value of the stimulation parameter, determine, based on the cardiac signal, whether the potential arrhythmia is detected after the adjustment to the delivery of electrical stimulation to the tissue site at the second time, and further modify the value of the stimulation parameter of the first therapy module in response to determining the potential arrhythmia is not detected after the adjustment to the delivery of electrical stimulation to the tissue site at the second time.

13. The system of claim 1, wherein the processor is configured to detect, based on the cardiac signal, the potential arrhythmia after the modification to the at least one stimulation parameter of the set of stimulation parameter values of the first therapy module, control the first therapy module to adjust the delivery of the electrical stimulation to the tissue site in response to detecting the potential arrhythmia after the modification to the at least one stimulation parameter of the first therapy module, and generate an interference indication in response to detecting the potential arrhythmia after the modification to the at least one stimulation parameter of the set of stimulation parameter values.

14. The system of claim 13, further comprising an external device, wherein the processor is configured to transmit the interference indication to a user via the external device.

15. The system of claim 14, wherein the external device comprises the processor.

16. The system of claim 13, wherein the interference indication comprises at least one of a visible alert, an audible alert or a somatosensory alert.

17. The system of claim 1, wherein the first therapy module comprises the processor.

18. The system of claim 1, wherein the second therapy module comprises the processor.

19. The system of claim 1, wherein the processor is configured to, in response to detecting the potential arrhythmia based on the cardiac signal after modifying the at least one stimulation parameter of the set of stimulation parameter values of the first therapy module, determine whether the potential arrhythmia comprises a true arrhythmia and control the second therapy module to deliver therapy to the heart of the patient in response to determining the potential arrhythmia comprises a true arrhythmia.

20. The system of claim 19, wherein the processor is configured to characterize a type of the true arrhythmia and select a treatment based on the type of true arrhythmia, wherein the second therapy module is configured to deliver therapy to the heart of the patient based on the selected treatment.

21. The system of claim 1, wherein the at least one stimulation parameter value comprises at least one of a current amplitude, a voltage amplitude, a slew rate, a pulse width, a pulse rate, a continuous waveform frequency, a duty cycle, an electrode combination, a timing of the delivery of the electrical stimulation relative to a cardiac cycle of the heart of the patient, a waveform shape or a signal envelope of the electrical stimulation signal.

22. The system of claim 1, wherein the first therapy module is configured to deliver electrical stimulation to the tissue site via a subset of electrodes electrically coupled to the first therapy module, wherein the processor is configured to initiate the modification to the at least one stimulation parameter value of the set of stimulation parameter values by at least initiating a modification to the subset of electrodes to define a guarded cathode arrangement.

23. The system of claim 1, further comprising a memory storing a plurality of therapy programs with which the first therapy module generates electrical stimulation, wherein the set of stimulation parameter values comprises a first therapy program of the plurality of therapy programs, and wherein the processor is configured to initiate the modification to the at least one stimulation parameter value of the set of stimulation parameter values by at least selecting a second therapy program from the plurality of therapy programs stored in memory.

24. A system comprising:

means for delivering at least one of a pacing, cardioversion or defibrillation electrical signal to a heart of a patient;

means for delivering electrical stimulation to a tissue site within a patient according to a set of stimulation parameter values;

means for detecting a potential arrhythmia of a heart of the patient during a time in which the means for delivering electrical stimulation delivers electrical stimulation to the tissue site according to the set of stimulation parameter values;

means for adjusting the delivery of the electrical stimulation to the tissue site by the means for delivering electrical stimulation in response to detecting the potential arrhythmia;

means for determining whether the potential arrhythmia is still detected after the adjustment to the delivery of electrical stimulation to the tissue site by the means for delivering electrical stimulation; and

means for modifying at least one stimulation parameter value of the set of stimulation parameter values, according to which the means for delivering electrical stimulation delivers electrical stimulation, in response to determining the potential arrhythmia is no longer detected after the adjustment to the delivery of the electrical stimulation to the tissue site by the means for delivering electrical stimulation.

25. The system of claim 24, further comprising:

means for determining whether the potential arrhythmia is still detected after the means for modifying the at least one stimulation parameter modifies the at least one stimulation parameter;

means for adjusting the delivery of the electrical stimulation to the tissue site in response to determining the potential arrhythmia is still detected after modifying the at least one stimulation parameter; and

means for generating an interference indication in response to determining the potential arrhythmia is still detected after modifying the at least one stimulation parameter.

26. A system comprising:

a first implantable medical device configured to deliver electrical stimulation to a tissue site within a patient according to a set of stimulation parameter values;

a second implantable medical device configured to deliver at least one of a pacing, cardioversion or defibrillation therapy to a heart of the patient;

a sensing module configured to sense an electrical cardiac signal of the heart of the patient; and

a processor configured to detect, during a time in which the first implantable medical device delivers electrical stimulation to the tissue site according to the set of stimulation parameter values, a potential arrhythmia of the heart based on the electrical cardiac signal, control the first implantable medical device to adjust the delivery of electrical stimulation to the tissue site in response to detecting the potential arrhythmia, determine whether the potential arrhythmia is still detected after the adjustment to the delivery of electrical stimulation to the tissue site by the first implantable medical device, and, in response to determining the potential arrhythmia is no longer detected after the adjustment to the delivery of electrical stimulation to the tissue site by the first implantable medical device, modify at least one stimulation parameter value of the set of stimulation parameter values according to which the first therapy module delivers electrical stimulation.

27. The system of claim 26, wherein the processor is configured to control the first implantable medical device to adjust the delivery of the electrical stimulation to the tissue site by at least controlling the first implantable medical device to suspend the delivery of the electrical stimulation to the tissue site.

28. The system of claim 26, wherein the tissue site comprises at least one of a nonmyocardial tissue site or a nonvascular cardiac tissue site.