Method for detecting vagus capture

• US 8,818,524 B2
• Filed: 08/28/2013
• Issued: 08/26/2014
• Est. Priority Date: 08/23/2011
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Hincapie Ordonez, Juan Gabriel, Hahn, Stephen J., Ternes, David J., Arcot-Krishnamurthy, Shantha, Hamann, Jason J.
• Primary Examiner(s): Wieland, Robert N
• Application Number:
  US14/012,607
• Publication Number:
  US 20130345591A1
• Time in Patent Office: 363 Days
• Field of Search: 607/62
• US Class Current: 607/62
• CPC Class Codes: A61B 5/296 for electromyography [EMG]
• CPC Class Codes: A61B 5/389 Electromyography [EMG]
• CPC Class Codes: A61B 5/395 Details of stimulation, e.g. nerve stimulation to elicit EMG response
• CPC Class Codes: A61B 5/4035 Evaluating the autonomic nervous system
• CPC Class Codes: A61N 1/0556 Cuff electrodes
• 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

Abstract

Some embodiments provide a system for delivering neurostimulation. Some system embodiments comprise a lead configured to be implanted in the body, a stimulation output circuit configured to deliver neurostimulation pulses to the vagus nerve through the lead, an EMG sensing circuit configured to use the lead to sense EMG signals from laryngeal muscle activity, and an evoked muscular response detection circuit configured to use the EMG signals sensed by the EMG sensing circuit to detect evoked laryngeal muscle activity evoked by the neurostimulation pulse.

Claims

1. A method for detecting vagus nerve capture using an implanted lead, comprising:

delivering neurostimulation pulses through the lead to a vagus nerve;

sensing EMG signals from laryngeal muscle activity using the lead; and

detecting evoked laryngeal muscle activity evoked by the neurostimulation pulses using the sensed EMG signals.

2. The method of claim 1, wherein the lead includes a vagal nerve cuff, and wherein sensing EMG signals includes sensing EMG signals from laryngeal muscle activity using electrodes on the vagal nerve cuff.

3. The method of claim 2, wherein delivering neurostimulation pulses includes delivering neurostimulation pulses to the vagus nerve using the electrodes on the vagal nerve cuff.

4. The method of claim 1, wherein the lead is configured to be intravascularly inserted into an internal jugular vein, and wherein delivering neurostimulation pulses includes transvascularly stimulating the vagus nerve using the lead in the internal jugular vein, and sensing EMG signals from laryngeal activity includes using the lead in the internal jugular vein to sense EMG signals.

5. The method of claim 1, wherein the lead has a first set of electrodes and a second set of electrodes, and the first set of electrodes is proximate to a distal end of the lead, wherein sensing EMG signals from laryngeal activity includes using the first set of electrodes to sense EMG signals from laryngeal muscle activity, and delivering neurostimulation pulses includes using the second set of electrodes to deliver neurostimulation pulses to the vagus nerve through the lead.

6. The method of claim 1, wherein the lead is configured to be implanted extravascularly within a carotid sheath, wherein delivering neural stimulation includes using the lead implanted extravascularly within the carotid sheath to stimulate the vagus nerve, and sensing EMG signals from laryngeal activity includes using the lead implanted extravascularly within the carotid sheath to sense EMG signals from laryngeal activity.

7. The method of claim 1, wherein:

the lead has a first set of electrodes and a second set of electrodes, wherein the first set of electrodes is proximate to a distal end of the lead and, when implanted, the second set of electrodes is more caudal than the first set of electrodes and is more cranial than a point where the recurrent laryngeal nerve branches from the vagus nerve;

sensing EMG signals from laryngeal activity includes using the first set of electrodes to sense EMG signals from laryngeal muscle activity; and

delivering neural stimulation pulses includes using the second set of electrodes to deliver neurostimulation pulses to the vagus nerve through the lead.

8. The system of claim 1, further comprising:

timing a delay interval after delivery of one of the neurostimulation pulses, and timing a detection window starting upon expiration of the delay interval; and

detecting the evoked laryngeal muscle activity by comparing the sensed EMG signals within the detection window to a template or by comparing a value derived from the sensed EMG signals within the detection window to a threshold value.

9. The method of claim 8, wherein the detection window begins about 8 ms and ends about 12 ms after delivery of one of the stimulation pulses.

10. The method of claim 8, wherein detecting the evoked laryngeal muscle activity includes comparing the sensed EMG signals to a patient-specific template.

11. The method of claim 8, further comprising generating an active recharge pulse after each neurostimulation pulse, and completing the active recharge pulse during the time delay interval.

12. The method of claim 8, further comprising generating a passive recharge after each neurostimulation pulse, interrupting the passive recharge during the detection window, and resuming the passive recharge after completion of the detection window.

13. The method of claim 1, further comprising measuring one or more characteristic parameters of the evoked laryngeal muscle activity and generating a signal representative of the one or more characteristic parameters.

14. The method of claim 1, enabling detection of the evoked laryngeal muscle activity according to a programmed schedule.

15. The method of claim 1, further comprising enabling detection of the evoked laryngeal muscle activity in response to a physician-initiated command signal.

16. The method of claim 1, further comprising enabling detection of the evoked laryngeal muscle activity in response to a patient-initiated command signal.

17. The method of claim 1, further comprising detecting an event, and automatically enabling detection of the evoked laryngeal muscle activity in response to detecting the event.

18. The method of claim 1, further comprising sensing context to provide a contextual signal, and using the contextual signal and the sensed EMG signals to detect evoked laryngeal muscle activity evoked by the neurostimulation pulses.

19. The method of claim 1, further comprising automatically adjusting a parameter of the neurostimulation pulses, using a control circuit, to evoke desired laryngeal muscle activity.

20. The method of claim 1, wherein the method is performed by an implanted medical device.