Method and system for improving impedance data quality in the presence of pacing pulses

• US 9,026,208 B2
• Filed: 02/25/2013
• Issued: 05/05/2015
• Est. Priority Date: 02/25/2013
• Status: Active Grant

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Inventors: Morley, Bruce A., Bornzin, Gene A., Gupta, Kritika, Bharmi, Rupinder, Sloman, Laurence S., Karst, Edward, Hou, Wenbo, Shah, Riddhi
• Primary Examiner(s): Holmes, Rex R
• Application Number:
  US13/776,494
• Publication Number:
  US 20140243917A1
• Time in Patent Office: 799 Days
• Field of Search: 607 17- 20
• US Class Current: 607/18
• CPC Class Codes: A61B 5/0535 Impedance plethysmography for measuring blood flow A61B5/0295
• CPC Class Codes: A61B 5/0538 invasively, e.g. using a catheter
• CPC Class Codes: A61B 5/686 Permanently implanted devices, e.g. pacemakers, other stimulators, biochips A61B5/6861 takes precedence
• CPC Class Codes: A61B 5/7217 of noise originating from a therapeutic or surgical apparatus, e.g. from a pacemaker
• CPC Class Codes: A61N 1/3621 for treating or preventing abnormally high heart rate
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/3684 for stimulating the heart at multiple sites of the ventricle or the atrium
• CPC Class Codes: A61N 1/36842 Multi-site stimulation in the same chamber
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

An implantable medical device, comprised of at least one lead configured to be located proximate to a heart, the at least one lead including electrodes, at least a portion of the electrodes configured to sense cardiac activity. A therapy module configured to control delivery of pacing pulses in accordance with a therapy timing and based on the cardiac sensed activity sensed. Cardiac impedance (CI) sensor circuitry configured to be coupled to at least a first combination of the electrodes to sense cardiac impedance (CI), the CI sensor circuitry generating an impedance data stream associated with a corresponding CI sensing vector.

Claims

1. An implantable medical device, comprising:

at least one lead configured to be located proximate to a heart, the at least one lead including electrodes, at least a portion of the electrodes configured to sense cardiac activity;

a therapy module configured to control delivery of pacing pulses in accordance with a therapy timing and based on the cardiac activity sensed;

cardiac impedance (CI) sensor circuitry configured to be coupled to at least a first combination of the electrodes to sense cardiac impedance (CI), the CI sensor circuitry generating an impedance data stream associated with a corresponding CI sensing vector;

a CI module configured to manage the CI sensor circuitry to collect impedance data during active CI collection windows; and

an artifact reduction (AR) module configured to

shift at least one of i) the therapy timing of the therapy module or ii) the active CI collection windows forward or backward, to avoid delivery of the pacing pulses during the active CI collection windows during which the CI sensor circuitry collects impedance data.

2. The device of claim 1, wherein the CI module is configured to manage the CI sensor circuitry by turning the CI sensor circuitry ON and OFF during periodic sample intervals, each of the sample intervals having an active segment in which the CI sensor circuitry is ON and generates a corresponding sample sub-set of the impedance data, each of the sample intervals having an inactive segment in which the CI sensor circuitry is OFF and does not generate the impedance data, the CI module processing the impedance data collected over at least one cardiac cycle to provide an impedance sample set for the at least one cardiac cycle.

3. The device of claim 1, wherein the therapy module is configured to control discharge of a coupling capacitor electrically connected in series with a first electrode that delivers the pacing pulses, the therapy module managing a time at which the coupling capacitor discharges to interleave discharge of the coupling capacitor between active segments of the sample interval.

4. The device of claim 1, wherein the AR module is configured to shift the therapy timing to interleave the pacing pulses between the active CI collection windows.

5. The device of claim 1, wherein the wherein the AR module is configured to manage the active CI collection windows by shifting the active CI collection windows relative to the pacing pulses to avoid overlap of the pacing pulses and the active CI collection windows.

6. The device of claim 1, wherein the CI sensor circuitry is configured to turn ON and OFF during periodic sample intervals, each of the sample intervals having an active segment in which a sample sub-set of the impedance data is collected, each of the sample intervals having an inactive segment in which sample sub-sets are not collected, the therapy module managing a time at which a coupling capacitor discharges to overlap discharge of the coupling capacitor with the inactive segments of the sample intervals.

7. The device of claim 6, wherein the coupling capacitor accumulates a coupling charge in connection with delivery of the pacing pulse, the therapy module controlling the coupling capacitor to discharge the coupling charge in a separated divided manner over multiple inactive segments of the sample intervals.

8. An implantable medical device, comprising:

at least one lead configured to be located proximate to a heart, the at least one lead including electrodes, at least a portion of the electrodes configured to sense cardiac activity;

a therapy module configured to control delivery of pacing pulses in accordance with a therapy timing and based on the cardiac activity sensed;

cardiac impedance (CI) sensor circuitry configured to be coupled to at least a first combination of the electrodes to sense cardiac impedance (CI), the CI sensor circuitry generating an impedance data stream associated with a corresponding CI sensing vector;

a CI module configured to manage the CI sensor circuitry to collect impedance data during active CI collection windows, wherein the CI sensor circuitry is configured to turn ON and OFF during periodic sample intervals, each of the sample intervals having an active segment in which a sample sub-set of the impedance data is collected, each of the sample intervals having an inactive segment in which sample sub-sets are not generate, the therapy module managing a time at which the pacing pulse is delivered to interleave the pacing pulse between active segments of the sample interval; and

an artifact reduction (AR) module configured to at least one of;

A) manage at least one of i) the therapy timing of the therapy module and ii) the active CI collection windows, to avoid delivery of the pacing pulses during the active CI collection windows during which the CI sensor circuitry collects impedance data; and

B) identify a reconstruction region in the impedance data and reconstruct a sample sub-set of the impedance data that occurs during the reconstruction region to at least partially remove artifacts in the impedance data stream associated with a pacing pulse.

9. The device of claim 8, wherein the AR module designates a beginning of the reconstruction region based on a time at which a corresponding pacing pulse is delivered, the reconstruction region having a predetermined artifact duration, the artifacts caused by at least one of i) the pacing pulses and ii) the coupling capacitor discharge.

10. The device of claim 8, wherein the artifacts are caused by at least one of i) the pacing pulses and ii) the coupling capacitor discharge and the reconstruction region has an artifact duration based on at least one of a width of the pacing pulse, a blanking interval following the pacing pulse, and a coupling capacitor discharge interval associated with the pacing pulse.

11. The device of claim 8, wherein the AR module is configured to replace the sample sub-set of the impedance data, that occurs during the reconstruction region, with a synthetic sample sub-set by at least one of:

A) applying a polynomial fit equation that connects valid sample sub-sets before and after the reconstruction region to bridge the reconstruction region;

B) applying interpolation to connect valid sample sub-sets before and after the reconstruction region to bridge the reconstruction region; and

C) applying a sinusoidal curve fitting filter to the impedance data before, within and after the reconstruction regions.

12. The device of claim 8, wherein the AR module is configured to apply at least one of high and low pass filters to the impedance data, the at least one of high and low pass filters having filter characteristics configured to at least partially correct for artifacts in the sample sub-set collected while delivering a pacing pulse.

13. A method for processing impedance data sensed by an implantable medical device (IMD), the IMD having at least one lead configured to be located proximate to a heart, the at least one lead including electrodes, at least a portion of the electrodes configured to sense cardiac activity, the method comprising:

controlling delivery of pacing pulses in accordance with a therapy timing and based on cardiac activity sensed;

providing cardiac impedance (CI) sensor channel configured to be coupled to at least a first combination of the electrodes to sense cardiac impedance (CI);

generating an impedance data stream, over the CI sensor channel, associated with a corresponding CI sensing vector;

managing the CI sensor channel to collect impedance data during active CI collection windows; and

performing artifact reduction (AR) by

shifting at least one of i) the therapy timing of the therapy module or ii) the active CI collection windows forward or backward, to avoid delivery of the pacing pulses during the active CI collection windows during which the CI sensor channel collects impedance data.

14. The method of claim 13, further comprising controlling discharge of a coupling capacitor electrically connected in series with a first electrode that delivers the pacing pulses, and managinge a time at which the coupling capacitor discharges to interleave discharge of the coupling capacitor between active segments of the sample interval.

15. The method of claim 13, further comprising shifting the therapy timing to interleave the pacing pulses between the active CI collection windows.

16. The method of claim 13, wherein the active CI collection windows is managed by shifting the active CI collection windows relative to the pacing pulses to avoid overlap of the pacing pulses and the active CI collection windows.