Remote pace detection in an implantable medical device

• US 8,700,146 B2
• Filed: 08/15/2013
• Issued: 04/15/2014
• Est. Priority Date: 07/15/2009
• Status: Expired due to Fees

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Ternes, David J., Baker, Kenneth L.
• Primary Examiner(s): Wieland, Robert N
• Application Number:
  US13/967,919
• Publication Number:
  US 20130331904A1
• Time in Patent Office: 243 Days
• Field of Search: 607/2
• US Class Current: 607/2
• 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 7/00 Instruments for auscultation
• CPC Class Codes: A61B 7/04 Electric stethoscopes microphones, acoustic transducers therefor H04R
• CPC Class Codes: A61N 1/3605 Implantable neurostimulators for stimulating central or peripheral nerve system
• 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 1/36139 with automatic adjustment
• CPC Class Codes: A61N 1/36146 specified by the stimulation parameters
• CPC Class Codes: A61N 1/37211 Means for communicating with stimulators
• CPC Class Codes: A61N 1/37288 Communication to several implantable medical devices within one patient
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients
• CPC Class Codes: G16H 20/70 relating to mental therapies, e.g. psychological therapy or autogenous training
• CPC Class Codes: G16H 40/63 for local operation
• CPC Class Codes: G16H 40/67 for remote operation

Abstract

A system embodiment for stimulating a neural target comprises a neural stimulator, a pace detector, and a controller. The neural stimulator is electrically connected to at least one electrode, and is configured to deliver a neural stimulation signal through the at least one electrode to stimulate the neural target. The pace detector is configured to use at least one electrode to sense cardiac activity and distinguish paced cardiac activity in the sensed cardiac activity from non-paced cardiac activity in the sensed cardiac activity. The controller is configured to control a programmed neural stimulation therapy using the neural stimulator and using detected paced cardiac activity as an input for the neural stimulation therapy.

Claims

1. A system, comprising:

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

a pace detector configured to sense cardiac activity and detect when the sensed cardiac activity includes paced cardiac activity; and

a controller configured to control the neural stimulator to provide a programmed neural stimulation therapy, to communicate with the pace detector, and control the programmed neural stimulation using the detected paced cardiac activity.

2. The system of claim 1, wherein the pace detector is further configured to determine a location of the paced cardiac activity.

3. The system of claim 2, wherein the pace detector is further configured to determine whether the paced cardiac activity is occurring in at least two cardiac locations.

4. The system of claim 2, wherein in determining the location of the paced cardiac activity, the pace detector is configured to determine which heart chamber is being paced.

5. The system of claim 2, wherein in determining the location of the paced cardiac activity, the pace detector is configured to use a characteristic of the paced cardiac activity to determine the location of the paced cardiac activity.

6. The system of claim 5, wherein the paced detector is configured to use a width of a pacing pulse within the paced cardiac activity to determine the location of the paced cardiac activity.

7. The system of claim 2, wherein the pace detector is configured to identify a portion of a cardiac cycle from the sensed cardiac activity and determine a location of a detected pace within the detected paced cardiac activity based on the timing of the identified portion of the cardiac cycle to the detected pace.

8. The system of claim 7, wherein the pace detector is configured to sense an R-wave in the cardiac cycle and to determine that the detected pace is an RV pace when the detected pace follows the sensed R-wave within a time after the sensed R-wave.

9. The system of claim 8, wherein the pace detector is configured to determine that the detected pace is a non-captured RV pace when the detected pace does not follow the sensed R-wave within the time after the sensed R-wave.

10. The system of claim 7, wherein the pace detector is configured to sense a P-wave in the cardiac cycle and to determine that the detected pace an A pace when the detected pace follows the sensed P-wave within a time after the sensed P-wave.

11. The system of claim 10, wherein the pace detector is configured to determine that the detected pace is a non-captured A pace when the detected pace does not follow the sensed P-wave within the time after the sensed P-wave.

12. The system of claim 2, wherein in determining the location of the paced cardiac activity, the pace detector is configured to determine that the paced cardiac activity includes RV paced activity and LV paced activity from biventricular pacing.

13. The system of claim 12, wherein the pace detector is further configured to detect loss of the biventricular pacing.

14. The system of claim 2, wherein in sensing cardiac activity, the pace detector is configured to remotely sense an ECG.

15. The system of claim 14, wherein the pace detector is configured to analyze the sensed ECG to identify a T-wave or an AV delay.

16. The system of claim 2, wherein in sensing cardiac activity, the pace detector is further configured to sense heart sounds.

17. The system of claim 2, wherein the controller is configured to:

detect paced cardiac cycles and non-paced cardiac cycles, and to control the programmed neural stimulation based on a percentage of the paced cardiac cycles over a predetermined time;

or

control to change neural stimulation therapy for extended periods when paced cardiac activity is not detected;

or

control a change in neural stimulation therapy for extended periods of detected paced;

or

detect loss of pacing, and to control neural stimulation upon detecting the loss of pacing.

18. A system, comprising:

an implantable cardiac stimulator configured to pace a first cardiac location and pace a second cardiac location, the implantable cardiac stimulator configured to use a first characteristic pulse to pace the first cardiac location and to use a second characteristic pulse to pace the second location; and

an implantable neural stimulation device, the implantable neural stimulation device including;

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

a pace detector configured to sense cardiac activity, detect when the sensed cardiac activity includes paced cardiac activity, and determine a location of the paced cardiac activity by discriminating between the first and second characteristic pulses; and

a controller configured to control the neural stimulator to provide a programmed neural stimulation therapy, to communicate with the pace detector, and control the programmed neural stimulation using the detected paced cardiac activity.

19. The system of claim 18, wherein the first characteristic pulse has a first pulse width and the second characteristic pulse has a second pulse width different from the first pulse width, the paced detector configured to sense a width of a detected pacing pulse within the paced cardiac activity to determine the location of the paced cardiac activity.

20. The system of claim 18, wherein:

the implantable cardiac stimulator is configured to deliver a cardiac resynchronization therapy (CRT); and

in sensing cardiac activity, the pace detector is configured to remotely sense an ECG; and

the controller configured to control the neural stimulator based on the sensed ECG.