Phrenic nerve stimulation detection with posture sensing

• US 9,211,415 B2
• Filed: 02/26/2014
• Issued: 12/15/2015
• Est. Priority Date: 03/13/2013
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Saha, Sunipa, Rockweiler, Holly, McCabe, Aaron R., Siejko, Krzysztof Z., Hatlestad, John D.
• Primary Examiner(s): Layno, Carl H
• Assistant Examiner(s): Wu, Eugene
• Application Number:
  US14/191,094
• Publication Number:
  US 20140277280A1
• Time in Patent Office: 657 Days
• Field of Search: 607/9, 607/11, 607/15, 607/20, 607/27, 607/28
• US Class Current: 1/1
• CPC Class Codes: A61B 5/0205 Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition
• CPC Class Codes: A61N 1/3601 of respiratory organs
• CPC Class Codes: A61N 1/36535 controlled by body position or posture
• CPC Class Codes: A61N 1/3702 Physiological parameters A61N1/365 takes precedence; evoked response A61N1/371
• CPC Class Codes: A61N 1/371 Capture, i.e. successful stimulation

Abstract

A method and a system of phrenic nerve stimulation detection in conjunction with posture sensing is disclosed. In an embodiment, the method may include receiving a trigger for conducting a pace-induced phrenic nerve stimulation (PS) search using the IMD within the patient. On receiving the trigger, the IMD may be used for conducting the PS search. A procedure of conducting the PS search may include measuring a posture of the patient using an implantable posture sensor, searching for PS while the patient is in the measured posture and obtaining a PS result from the PS search for the measured posture. The method may include recording both the PS result and the measured posture in a memory of the IMD.

Claims

1. A method performed using an implantable medical device (IMD) within a patient, the method comprising:

receiving a trigger for conducting a pace-induced phrenic nerve stimulation (PS) search using the IMD within an ambulatory patient, wherein receiving the trigger includes deriving a posture trigger from the implantable posture sensor, wherein deriving the posture trigger includes searching for a recently-conducted PS search for the measured posture within a programmed time period leading up to a current time, and providing the posture trigger if the programmed time period does not include the PS search;

in response to the trigger, conducting the PS search using the IMD, wherein conducting the PS search includes;

measuring a posture of the patient using an implantable posture sensor;

searching for PS while the patient is in the measured posture and obtaining a PS search result from the PS search for the measured posture; and

recording in a memory of the IMD both the PS search result and the measured posture.

2. The method of claim 1, wherein the IMD is configured with more than one pacing configuration, wherein searching for PS includes searching for PS for each of the more than one pacing configurations while the patient is in the measured posture, and recording includes recording in the memory the PS result for each of the more than one pacing configurations.

3. The method of claim 2, wherein recording in the memory includes recording the PS result for each of the more than one pacing configurations at more than one time period after implant.

4. The method of claim 1, further comprising determining if there is a posture change during the PS search for the measured posture, and aborting the PS search for the measured posture.

5. The method of claim 4, further comprising measuring a new posture resulting from the posture change and beginning a PS search for the new posture.

6. The method of claim 4, further comprising determining that the patient returned to the measured posture, and restarting the PS search for the measured posture.

7. The method of claim 1, wherein the IMD is configured with more than one pacing configuration for pacing the patient, the method further comprising evaluating a detected PS event and automatically switching the pacing configuration from a first pacing configuration to a second pacing configuration based on the evaluated detected PS event and previous search results for the second pacing configuration.

8. The method of claim 7, wherein evaluating the detected PS event includes detecting a changed patient posture corresponding to the detected PS event, and automatically switching the pacing configuration includes switching the pacing configuration to another pacing configuration until the patient moves out of the changed patient posture.

9. The method of claim 1, wherein the trigger includes an external trigger signal.

10. The method of claim 1, wherein implantable posture sensor includes a three-axis accelerometer.

11. The method of claim 1, further comprising communicating the PS result and the measured posture to an external device, wherein the external device is configured to display the PS result and the measured posture.

12. A system, comprising:

an implantable medical device (IMD) for implantation in a patient, the IMD including;

a posture sensor;

a pace-induced phrenic nerve stimulation (PS) sensor;

a memory; and

a controller, wherein the controller is operably connected to the posture sensor to detect posture and the PS sensor to detect phrenic nerve stimulation;

wherein the controller is configured to;

receive a trigger for conducting a PS search, wherein the trigger includes a posture trigger, and the controller is configured to derive the posture trigger from the posture sensor;

conduct the PS search in response to the trigger, wherein the PS search conducted by the controller includes;

measuring a posture of the patient using the posture sensor;

searching for PS using the PS sensor while the patient is in the measured posture and obtaining a PS result from the PS search for the measured posture; and

recording in the memory both the PS result and the measured posture,

wherein the controller is configured to determine if a PS search was successfully conducted for the measured posture within a programmed time period leading up to a current time, and to provide the posture trigger if the PS search was not conducted within the programmed time period.

13. The system of claim 12, wherein the system is configured to pace in more than one pacing configuration, wherein the controller is configured to search for PS for each of the more than one pacing configurations while the patient is in the measured posture, and record in the memory the PS result for each of the more than one pacing configurations.

14. The system of claim 13, wherein the controller is configured to record in memory the PS result for each of the more than one pacing configurations at more than one time period after implant.

15. The system of claim 12, further wherein the controller is configured to use the posture sensor to detect a posture change during the PS search for the measured posture, and to abort or restart the PS search for the detected posture change.

16. The system of claim 12, wherein:

the controller is configured with a pacing configuration for generating paces; and

the controller is configured to;

detect a PS using the PS detector;

perform an evaluation of the detected PS; and

automatically switch the pacing configuration based on the evaluation.

17. The system of claim 16, wherein in performing the evaluation the controller is configured to detect a changed patient posture, and switch the pacing configuration to another pacing configuration until the patient moves out of the changed patient posture.

18. The system of claim 12, further comprising:

an external device, wherein the IMD and the external device are configured to communicate,

wherein the IMD is configured to;

conduct a plurality of PS searches, including at least one PS search for each one of a number of different measured postures, wherein the number includes at least two different measured postures; and

for each one of the measured postures record in the memory the PS result and the measured posture; and

communicate the PS result and the measured posture to the external device, the external device including a display, and

wherein the external device includes a display and is configured to present on the display the PS result and the measured posture for each one of the measured postures.

19. The system of claim 12, wherein the posture sensor includes an accelerometer.

20. The system of claim 12, wherein the PS detector includes an accelerometer.