Remote sensing in an implantable medical device

• US 8,862,226 B2
• Filed: 12/05/2013
• Issued: 10/14/2014
• 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 B., Hamann, Jason J.
• Primary Examiner(s): Wieland, Robert N
• Application Number:
  US14/097,286
• Publication Number:
  US 20140094875A1
• Time in Patent Office: 313 Days
• Field of Search: 607/2
• 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 remote sensing electrodes for sensing cardiac activity from a position remote from a heart, the method comprising:

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

monitoring cardiac activity, including remotely detecting cardiac activity using the remote sensing electrodes to detect heart rate during implementation of the neural stimulation therapy.

2. The method of claim 1, wherein delivering the neural stimulation therapy includes delivering electrical stimulation to a vagus nerve.

3. The method of claim 2, wherein delivering electrical stimulation to a vagus nerve includes using a structure configured to be positioned around the vagus nerve to operably position stimulation electrodes for use to electrically stimulate the vagus nerve.

4. The method of claim 1, wherein monitoring cardiac activity includes averaging heart rate over periods of time during the implementation of the neural stimulation therapy.

5. The method of claim 1, wherein monitoring cardiac activity includes trending heart rate.

6. The method of claim 1, further comprising providing diagnostic information using the monitored cardiac activity.

7. The method of claim 1, wherein the remote sensing electrodes include an electrode on a can of the implanted neural stimulation device.

8. The method of claim 1, wherein detecting cardiac activity includes detecting a change in heart rate during the ON portion of the programmed duty cycle.

9. The method of claim 1, wherein monitoring cardiac activity includes using the remote sensing electrodes to detect an electrocardiogram.

10. The method of claim 1, wherein monitoring cardiac activity includes detecting an arrhythmia.

11. The method of claim 1, wherein monitoring cardiac activity includes detecting heart rate variability (HRV).

12. A method for operating an implanted neural stimulation device having a neural stimulator lead and remote sensing electrodes for sensing cardiac activity from a position remote from a heart, the method comprising:

implementing a vagal nerve stimulation therapy stored in the implanted neural stimulation device including delivering the vagal nerve stimulation therapy through the neural stimulator lead, wherein the neural stimulation therapy does not significantly alter heart rate, and the neural stimulation therapy includes a programmed duty cycle, the programmed duty cycle including a stimulation ON portion followed by a stimulation OFF portion, wherein delivering the vagal nerve stimulation therapy includes using a structure configured to be positioned around a vagus nerve to operably position stimulation electrodes for use to electrically stimulate the vagus nerve; and

providing diagnostic information for the neural stimulation, wherein providing diagnostic information includes monitoring cardiac activity, and monitoring cardiac activity includes remotely detecting cardiac activity using the remote sensing electrodes to detect heart rate during implementation of the neural stimulation therapy.

13. The method of claim 12, wherein monitoring cardiac activity includes averaging heart rate over periods of time during the implementation of the neural stimulation therapy.

14. The method of claim 12, wherein monitoring cardiac activity includes trending heart rate.

15. The method of claim 12, monitoring cardiac activity includes:

trending heart rate for stimulation ON portions of the programmed duty cycle and trending heart rate for stimulation OFF Portions of the duty cycle;

or

trending atrioventricular (AV) delay for stimulation ON portions of the programmed duty cycle and trending AV delay for stimulation OFF Portions of the duty cycle;

or

trending heart rate variability (HRV) for stimulation ON portions of the programmed duty cycle and trending HRV for stimulation OFF Portions of the duty cycle.

16. The method of claim 12, wherein the remote sensing electrodes include an electrode on a can of the implanted neural stimulation device.

17. The method of claim 12, wherein detecting cardiac activity includes detecting a change in heart rate during the ON portion of the programmed duty cycle.

18. The method of claim 12, wherein monitoring cardiac activity includes using the remote sensing electrodes to detect an electrocardiogram.

19. The method of claim 12, wherein monitoring cardiac activity includes detecting an arrhythmia.

20. The method of claim 12, wherein monitoring cardiac activity includes detecting heart rate variability (HRV).