Phrenic nerve stimulation detection

• US 9,031,651 B2
• Filed: 02/28/2013
• Issued: 05/12/2015
• Est. Priority Date: 03/27/2012
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Rockweiler, Holly, Saha, Sunipa, Dong, Yanting
• Primary Examiner(s): Koharski, Christopher D
• Assistant Examiner(s): CAREY, MICHAEL JAMES
• Application Number:
  US13/781,177
• Publication Number:
  US 20130261476A1
• Time in Patent Office: 803 Days
• Field of Search: 600/510, 607/11, 607/17, 607/28
• US Class Current: 607/28
• CPC Class Codes: A61B 2562/0219 Inertial sensors, e.g. accelerometers, gyroscopes, tilt switches
• 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 5/24 Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
• CPC Class Codes: A61B 5/4052 efferent nerves, i.e. nerves that relay impulses from the central nervous system
• 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: A61B 5/7221 Determining signal validity, reliability or quality A61B5/7207 and A61B5/7217 take precedence
• CPC Class Codes: A61B 5/7246 using correlation, e.g. template matching or determination of similarity

Abstract

In an example, a system includes a cardiac pulse generator configured to generate cardiac paces to pace the heart, a sensor configured to sense a physiological signal for use in detecting pace-induced phrenic nerve stimulation where the pace-induced phrenic nerve stimulation is phrenic nerve stimulation induced by electrical cardiac pace signals, and a phrenic nerve stimulation detector configured to analyze the sensed physiological signal to detect PS beats where the PS beats are cardiac paces that induce phrenic nerve stimulation. The detector may be configured to correlate signal data for sensed beat signals to a PS template to detect PS beats, or may be configured to analyze morphological features of sensed beat signals to detect PS beats, or may be configured to detect PS beats using a combination that both correlates signal data for sensed beat signals to a PS template and analyzes morphological features of sensed beat signals.

Claims

1. A method for detecting PS beats, wherein the PS beats are cardiac paces that induce phrenic nerve stimulation, the method comprising:

pacing a heart with cardiac paces;

sensing a physiological signal for use in detecting PS beats, wherein sensing the physiological signal includes sensing beat signals from a window of time defined based on cardiac pace times;

identifying morphological features for a sensed beat signal; and

using the identified morphological features to determine if the sensed beat signal is a PS beat, wherein using the identified morphological features to determine if the sensed beat signal is a PS beat includes at least one of;

analyzing the identified morphological features using weight-based scoring of the identified morphological features, wherein weight-based scoring weights some morphological features differently when determining if the sensed beat signal is the PS beat;

or

analyzing the identified morphological features using a decision tree to determine if the sensed beat signal is the PS beat.

2. The method of claim 1, wherein using the identified morphological features to determine if the sensed beat signal is a PS beat includes using the weight-based scoring of the identified morphological features to analyze the identified morphological features.

3. The method of claim 2, wherein the morphological features include features selected from the group of features consisting of:

peak timing;

amplitude;

peak-to-peak amplitude;

slope leading to peak;

slope leading away from peak, timing and amplitude of surrounding extrema, area under signal, and signal frequency components.

4. The method of claim 2, further comprising identifying noisy beat signals and removing noisy beat signals from use in the weight-based scoring of the identified morphological features.

5. The method of claim 1, wherein using the identified morphological features to determine if the sensed beat signal is a PS beat includes using the decision tree to analyze the identified morphological features.

6. The method of claim 1, wherein using the identified morphological features to determine if the sensed beat signal is a PS beat includes using a combination of the weight-based scoring of the identified morphological features and the decision tree to analyze the identified morphological features.

7. The method of claim 6, wherein using the combination includes identifying if the determination has a high degree of confidence using at least one decision point within the decision tree to quickly declare that the sensed beat signal is a PS beat or a NoPS beat with the high degree of confidence.

8. The method of claim 7, wherein using the combination further includes scoring the morphological features if unable to quickly declare that the sensed beat signal is a PS beat or is a NoPS beat.

9. The method of claim 8, wherein using the combination further includes using at least one additional decision point in the tree if the scored morphological features are unable to declare with a high degree of confidence that the beat signal is the PS beat or a NoPS beat.

10. A method for detecting PS beats, wherein the PS beats are cardiac paces that induce phrenic nerve stimulation, the method comprising:

pacing a heart with cardiac paces;

sensing a physiological signal for use in detecting PS beats, wherein sensing the physiological signal includes sensing beat signals from a window of time defined based on cardiac pace times;

scoring morphological features of the sensed beat signals;

using the score to identify those sensed beat signals that can be declared PS beats with a high degree of confidence and those sensed beat signals that can be declared NoPS beats with a high degree of confidence, and to identify those sensed beats that cannot be declared with the high degree of confidence as either a PS beat or a NoPS beat; and

correlating those sensed beats that cannot be declared with a high degree of confidence to a PS template, and declaring the sensed beats that are correlated with the PS template to be a PS beat.

11. A system, comprising:

a cardiac pulse generator configured to generate cardiac paces to pace the heart;

a sensor configured to sense a physiological signal for use in detecting pace-induced phrenic nerve stimulation, wherein the pace-induced phrenic nerve stimulation is phrenic nerve stimulation induced by electrical cardiac pace signals;

a phrenic nerve stimulation detector configured to analyze the sensed physiological signal to detect PS beats, wherein the PS beats are cardiac paces that induce phrenic nerve stimulation, wherein;

the phrenic nerve stimulation detector is configured to correlate signal data for sensed beat signals to a PS template to detect PS beats;

or

the phrenic nerve stimulation detector is configured to analyze morphological features of sensed beat signals to detect PS beats, including weight some morphological features differently to detect PS beats or use a decision tree to analyze the identified morphological features to detect PS beats;

or

the phrenic nerve stimulation detector is configured to detect PS beats using a combination that both correlates signal data for sensed beat signals to a PS template and analyzes morphological features of sensed beat signals.

12. The system of claim 11, wherein the phrenic nerve stimulation detector is configured to correlate signal data for sensed beat signals to a PS template to detect PS beats, and is configured to build a library of beat-type templates, wherein in building the library the phrenic nerve stimulation detector is configured to:

determine if beat signal data for a currently-analyzed beat signal matches an existing beat-type template in the library, and create a new beat-type template if there is no match or increasing a tally for the beat-type template if there is a match; and

declare that one of the beat type templates to be a PS template when the tally for one of the beat-type templates reaches a defined threshold.

13. The system of claim 11, wherein the phrenic nerve stimulation detector is configured to weight some morphological features differently to detect PS beats.

14. The system of claim 13, wherein the morphological features include features selected from the group of features consisting of:

peak timing;

amplitude;

peak-to-peak amplitude;

slope leading to peak;

slope leading away from peak, timing and amplitude of surrounding extrema, area under signal, and signal frequency components.

15. The system of claim 13, in analyzing morphological features the phrenic nerve detector is configured to indentify noisy beat signals and remove noisy beat signals from use in the weight-based scoring of the identified morphological features.

16. The system of claim 11, wherein the phrenic nerve stimulation detector is configured to use a decision tree to analyze the identified morphological features to detect PS beats.

17. The system of claim 11, wherein the phrenic nerve stimulation detector is configured to analyze morphological features of sensed beat signals to detect PS beats, wherein in analyzing morphological features the phrenic nerve detector is configured to use a combination of weighting some morphological features different and using a decision tree to analyze the identified morphological features to detect PS beats.

18. The system of claim 11, wherein the phrenic nerve stimulation detector is configured to detect PS beats using a combination that both correlates signal data for sensed beat signals to a PS template and analyzes morphological features of sensed beat signals.

19. The system of claim 18, wherein the phrenic nerve stimulation detector is configured to store beat signal data for the sensed beat signals in beat-type templates within a library, wherein the phrenic nerve stimulation detector is configured to:

determine if beat signal data for a currently-analyzed beat signal matches an existing beat-type template in the library;

score the beat signal data for the sensed beat signals when there is no match;

create a score-generated PS template if the score favorably compares to a defined threshold for the score;

create a new beat-type template when there is no match and the score does not favorably compare to the defined threshold for the score;

increase a tally for the beat-type template when there is a match and declare the beat type template to be a clustering-generated PS template when the tally reaches a defined tally threshold; and

detect PS beats using the score-generated PS template or the clustering-generated PS template.

20. The system of claim 18, wherein the phrenic nerve stimulation detector is configured to use the weight-based score to identify those sensed beat signals that can be declared PS beats with a high degree of confidence and those sensed beat signals that can be declared NoPS beats with a high degree of confidence, correlate sensed beats that cannot be declared with the high degree of confidence to a PS template, and declare the sensed beats that are correlated with the PS template to be PS beats.