Automatic pacing configuration switcher

• US 9,295,843 B2
• Filed: 05/06/2013
• Issued: 03/29/2016
• Est. Priority Date: 05/18/2012
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Enrooth, Eric K., Saha, Sunipa, Siejko, Krzysztof Z., Hayes, Kenneth N., McCabe, Aaron R.
• Primary Examiner(s): KAHELIN, MICHAEL WILLIAM
• Application Number:
  US13/887,818
• Publication Number:
  US 20130310891A1
• Time in Patent Office: 1,058 Days
• US Class Current: 1/1
• CPC Class Codes: A61N 1/36071 Pain
• CPC Class Codes: A61N 1/36185 Selection of the electrode configuration
• CPC Class Codes: A61N 1/36507 controlled by gradient or slope of the heart potential
• CPC Class Codes: A61N 1/36535 controlled by body position or posture
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters
• CPC Class Codes: A61N 1/3686 configured for selecting the electrode configuration on a lead A61N1/3688 takes precedence

Abstract

A system or apparatus can provide electrostimulations via an electrode configuration that can be selected from multiple electrode configurations, the electrostimulations of the type for inducing a desired heart contraction, or a neurostimulation response. The system or apparatus can allow communicating with an external device to receive an input indicating a degree of patient discomfort with an electrostimulation delivered using a first electrode configuration, and can associate information about the degree of discomfort with information about the corresponding first electrode configuration for use by a controller circuit in determining a second electrode configuration for delivering a subsequent electrostimulation.

Claims

1. An apparatus comprising:

an implantable electronics unit, the implantable electronics unit including;

an electrostimulation circuit, configured to provide a first electrostimulation to a target tissue using a first electrostimulation energy and a first electrode configuration selected from multiple electrode configurations;

a communication circuit, configured to communicate with an external device to receive an input indicating a degree of patient discomfort produced by unintended stimulation of a non-target tissue different from the target tissue by the first electrostimulation delivered using the first electrostimulation energy and the first electrode configuration; and

a controller circuit, coupled to the electrostimulation circuit and the communication circuit, the controller circuit comprising a stimulation detector circuit configured to detect the unintended stimulation of the non-target tissue, wherein the controller circuit is configured to use information about the degree of patient discomfort to provide a second electrostimulation using at least one of a second electrostimulation energy that is different from the first electrostimulation energy or a second electrostimulation configuration that is different from the first electrostimulation configuration.

2. The apparatus of claim 1,

wherein the communication circuit is configured to communicate with the external device to receive the input indicating the degree of patient discomfort, quantified within a specified range, associated with the first electrostimulation delivered using the first electrode configuration;

wherein the controller circuit is configured to associate information about the corresponding first electrostimulation energy with information about the corresponding first electrode configuration for use in determining the second electrode configuration for delivering the subsequent second electrostimulation.

3. The apparatus of claim 1,

wherein the controller circuit is configured to first test whether the first electrostimulation energy can be adjusted to reduce the degree of patient discomfort while obtaining a desired heart contraction or a desired neurostimulation response before switching from the first electrode configuration to the determined second electrode configuration to reduce the degree of patient discomfort.

4. The apparatus of claim 1,

wherein the controller circuit is configured to also associate information about the corresponding patient posture with information about the corresponding first electrode configuration for use in determining the second electrode configuration for delivering the subsequent electrostimulation.

5. The apparatus of claim 1,

wherein the implantable electronics unit comprises a memory circuit configured to store information about the degree of discomfort associated with individual electrode configurations of the multiple electrode configurations.

6. The apparatus of claim 5,

wherein the memory circuit is configured to store information about the electrostimulation energy associated with the degree of discomfort associated with the individual electrode configurations of the multiple electrode configurations.

7. The apparatus of claim 1,

wherein the stimulation detector circuit includes an extracardiac stimulation detector circuit, and wherein the controller circuit is configured to determine the second electrode configuration at least in part using information from the extracardiac stimulation detector circuit and information from the input indicating the degree of patient discomfort with the first electrostimulation delivered using the first electrode configuration.

8. The apparatus of claim 1,

wherein the controller circuit includes an automatic electrode configuration selection module that is configured to determine the second electrode configuration at least in part using information about at least one of a capture threshold, an electrostimulation impedance, or a posture.

9. The apparatus of claim 1,

wherein the input indicating the degree of patient discomfort provides a binary-valued indication of the degree of patient discomfort.

10. The apparatus of claim 1,

wherein the input indicating the degree of patient discomfort provides an indication quantifying the degree of patient discomfort, within a specified range having more than two values.

11. The apparatus of claim 1,

wherein the input indicating the degree of patient discomfort provides an indication quantifying the degree of patient discomfort, within a specified range having at least ten values.

12. The apparatus of claim 1,

wherein the controller circuit is configured to reprogram the electrostimulation circuit to switch from delivering the electrostimulations using the first electrode configuration to delivering the electrostimulations using the determined second electrode configuration;

and

wherein the controller circuit is configured to revert from the second electrode configuration to the first electrode configuration unless an input confirming suitability of the second electrode configuration is received within a specified time period.

13. The apparatus of claim 12, wherein the controller circuit is configured to revert from the second electrode configuration to the first electrode configuration unless an input confirming suitability of the second electrode configuration in a plurality of postures is received within a specified time period.

14. The apparatus of claim 1,

wherein the stimulation detector circuit includes an extracardiac stimulation detector circuit;

and

wherein the controller circuit is configured to switch between

(1) determining the second electrode information using information from the input indicating the degree of patient discomfort with the electrostimulation delivered using the first electrode configuration; and

(2) determining the second electrode configuration using information from the extracardiac stimulation detector circuit.

15. The apparatus of claim 14,

wherein the controller circuit is configured to use the input to switch between (1) and (2).

16. An apparatus comprising:

an implantable electronics unit, the implantable electronics unit including;

an electrostimulation circuit, configured to provide a first electrostimulation to a target tissue using a first electrostimulation energy and a first electrode configuration selected from multiple electrode configurations;

a communication circuit, configured to communicate with an external device to receive an input indicating a degree of patient discomfort produced by unintended stimulation of a non-target tissue different from the target tissue by the first electrostimulation delivered using the first electrostimulation energy and the first electrode configuration; and

a controller circuit, coupled to the electrostimulation circuit and the communication circuit, the controller circuit comprising a stimulation detector circuit configured to detect the unintended stimulation of the non-target tissue, wherein the controller circuit is configured to associate information about the degree of patient discomfort associated with the first electrostimulation with information about the corresponding first electrode configuration, for use in determining a second electrode configuration for delivering a subsequent electrostimulation.