Control of neural modulation therapy using cervical impedance

• US 9,162,063 B2
• Filed: 08/04/2014
• Issued: 10/20/2015
• Est. Priority Date: 02/07/2012
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Stahmann, Jeffrey E., Ruble, Stephen B., Hamann, Jason J., Ternes, David J.
• Primary Examiner(s): MANUEL, GEORGE C
• Application Number:
  US14/451,023
• Publication Number:
  US 20140343637A1
• Time in Patent Office: 442 Days
• US Class Current: 1/1
• 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: A61N 1/36053 adapted for vagal stimulation A61N1/36114 takes precedence
• CPC Class Codes: A61N 1/3606 adapted for a particular treatment
• 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 1/3614 based on impedance measurement
• CPC Class Codes: A61N 1/36164 Sub-threshold or non-excitatory signals non-excitatory signals to the heart A61N1/3628

Abstract

An implantable apparatus can comprise an electrical test energy delivery circuit configured to provide an electrical test signal to a cervical location in a patient body. A detector circuit can use the electrical test signal to detect cervical impedance and generate a cervical impedance signal representing fluctuations in the detected cervical impedance. The implantable apparatus can comprise a therapy delivery circuit, such as configured to provide electrical neural modulation therapy using a neural modulation timing parameter, and a processor circuit that can be coupled to the electrical test energy delivery circuit, the detector circuit, and the therapy delivery circuit. The processor circuit can be configured to determine a pulsatile signal or pulse pressure signal, such as using the cervical impedance signal, identify a characteristic of the pulsatile signal or pulse pressure signal, and control a neural modulation therapy using the timing parameter and the identified pulse pressure signal characteristic.

Claims

1. A method comprising:

detecting fluctuations in a cervical vessel dimension of a patient, wherein detecting the fluctuations includes measuring a cervical impedance of the patient over time;

determining pulsatile information using the detected fluctuations in the cervical vessel dimension of the patient; and

providing a neural modulation therapy coordination with a characteristic of the pulsatile information.

2. The method of claim 1, wherein the providing the neural modulation therapy includes providing an electrical neural modulation therapy in coordination with the characteristic of the pulsatile information.

3. The method of claim 2, wherein the providing the electrical neural modulation therapy includes providing the electrical neural modulation therapy at or near a cervical neural target including at least one of a vagus nerve, a carotid sinus nerve, a hypoglossal nerve, a glossopharyngeal nerve, and a phrenic nerve.

4. The method of claim 2, wherein the providing the electrical neural modulation therapy includes providing the electrical neural modulation therapy to modulate neural activity in a nerve that innervates one or more baroreceptors.

5. The method of claim 2, wherein the providing the electrical neural modulation therapy includes providing the electrical neural modulation therapy to modulate neural activity in a nerve that innervates one or more chemoreceptors.

6. The method of claim 2, wherein the providing the electrical neural modulation therapy includes providing the electrical neural modulation therapy to modulate neural activity in a spinal neural target, including in one of a cervical, thoracic, lumbar, or sacral spinal region.

7. The method of claim 2, wherein the providing the electrical neural modulation therapy includes providing the electrical neural modulation therapy to modulate neural activity in a cardiac nerve or cardiac fat pad.

8. The method of claim 2, wherein the providing the electrical neural modulation therapy includes providing the electrical neural modulation therapy to modulate neural activity in a renal nerve.

9. The method of claim 1, further comprising adjusting a neural modulation therapy parameter in response to an identified characteristic of the pulsatile signal, and wherein the providing the neural modulation therapy includes using the adjusted neural modulation therapy parameter.

10. The method of claim 1, further comprising receiving information about the patient'"'"'s heart rate;

wherein the providing the neural modulation therapy includes in coordination with the characteristic of the pulsatile information and using the information about the patient'"'"'s heart rate.

11. The method of claim 1, further comprising receiving an indication of a patient'"'"'s posture from a posture detection circuit;

wherein the providing the neural modulation therapy includes in coordination with the characteristic of the pulsatile information and using the indication of the patient'"'"'s posture.

12. The method of claim 1, further comprising:

identifying a peak time using the pulsatile information; and

adjusting the neural modulation therapy using an adjustable delay and the identified peak time.

13. The method of claim 1, wherein the providing the neural modulation therapy includes providing an autonomic neural modulation therapy to the patient in coordination with the patient'"'"'s intrinsic neural activity.

14. The method of claim 1, further comprising:

receiving cardiac activity information from the patient; and

identifying a cardiac refractory period in the received cardiac activity information;

wherein the providing the neural modulation therapy includes providing the neural modulation therapy to the patient in coordination with the identified cardiac refractory period.

15. The method of claim 1, wherein the determining the pulsatile information using the detected fluctuations in the cervical vessel dimension of the patient includes determining a pulse pressure signal;

and

wherein the providing the neural modulation therapy includes in coordination with a characteristic of the pulse pressure signal.

16. A method comprising:

detecting fluctuations in a cervical vessel dimension of a patient, wherein detecting the fluctuations includes measuring a cervical impedance of the patient over time;

determining a pulsatile signal based on the detected fluctuations in the cervical vessel dimension of the patient;

identifying a patient physiological cycle; and

providing a neural modulation therapy in coordination with the identified patient physiological cycle, wherein a parameter of the neural modulation therapy is determined in part using a first characteristic of the pulsatile signal.

17. The method of claim 16, wherein the identifying the patient physiological cycle includes using a different second characteristic of the determined pulsatile signal to identify a portion of the patient physiological cycle.

18. The method of claim 16, wherein the identifying the patient physiological cycle includes identifying a portion of a cardiac cycle using a measured cardiac activity signal.

19. The method of claim 16, further comprising identifying the first characteristic of the pulsatile signal, the first characteristic including at least one of:

an amplitude of the pulsatile signal;

a frequency determined using the pulsatile signal;

a shape of the pulsatile signal;

an integral of a portion of the pulsatile signal;

a derivative of a portion of the pulsatile signal;

a ratio of characteristics derived from the pulsatile signal;

or

a sum, difference, linear combination, or product of characteristics derived from the pulsatile signal.

20. A medical device for controlling at least a portion of a neural modulation therapy, the device comprising:

a detector circuit configured to detect cervical impedance of a patient and generate a cervical impedance signal representing fluctuations in the detected cervical impedance over time;

a therapy delivery circuit configured to provide neural modulation therapy to the patient using a neural modulation therapy timing parameter, the timing parameter corresponding to a specified portion of a physiologic cycle of the patient; and

a processor circuit, coupled to the detector circuit and the therapy delivery circuit, the processor circuit configured to;

determine a pulsatile signal using the cervical impedance signal;

identify at least one characteristic of the pulsatile signal; and

control delivery of the neural modulation therapy using the neural modulation therapy timing parameter and the at least one identified characteristic of the pulsatile signal.