Activity sensor processing for phrenic nerve activation detection

• US 9,403,018 B2
• Filed: 03/23/2015
• Issued: 08/02/2016
• Est. Priority Date: 05/27/2009
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: McCabe, Aaron R., Rockweiler, Holly E., Laughner, Jacob I.
• Primary Examiner(s): DIETRICH, JOSEPH M
• Application Number:
  US14/665,752
• Publication Number:
  US 20150190643A1
• Time in Patent Office: 498 Days
• US Class Current: 1/1
• CPC Class Codes: A61B 5/0809 by impedance pneumography
• CPC Class Codes: A61B 5/103 Detecting, measuring or recording devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes A61B5/08 takes precedence; measuring aids for tailors A41H1/00; measuring instruments specially adapted for dentistry A61C19/04
• CPC Class Codes: A61B 5/24 Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
• CPC Class Codes: A61B 5/30 Input circuits therefor
• CPC Class Codes: A61B 5/686 Permanently implanted devices, e.g. pacemakers, other stimulators, biochips A61B5/6861 takes precedence
• CPC Class Codes: A61B 5/6869 Heart
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/36542 controlled by body motion, e.g. acceleration
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters
• CPC Class Codes: A61N 1/3702 Physiological parameters A61N1/365 takes precedence; evoked response A61N1/371

Abstract

An implantable cardiac device includes a sensor for sensing patient activity and detecting phrenic nerve activation. A first filter channel attenuates first frequencies of the sensor signal to produce a first filtered output. A second filter channel attenuates second frequencies of the accelerometer signal to produce a second filtered output. Patient activity is evaluated using the first filtered output and phrenic nerve activation caused by cardiac pacing is detected using the second filtered output.

Claims

1. An implantable medical device, comprising:

a pulse generator configured to deliver cardiac pacing to a heart;

an accelerometer configured to generate an acceleration signal at an accelerometer output terminal;

a first filter channel configured to attenuate first frequencies of the acceleration signal to produce a first physiological signal, wherein the first physiological signal provides a measure of a patient'"'"'s respiration;

a second filter channel, separate from the first filter channel, the second filter channel configured to attenuate second frequencies of the acceleration signal to produce a second physiological signal indicative of phrenic nerve activation; and

circuitry configured to;

determine one or more characteristics of a patient'"'"'s state based at least in part on the first physiological signal, identify a phase of respiration of the patient using the first physiological signal, to detect phrenic nerve activation in a time relation to the phase of respiration caused by cardiac pacing during the phase of respiration based at least in part on the second physiological signal, and to adjust a value of at least parameter of the cardiac pacing based on detected phrenic nerve activation.

2. The device of claim 1, wherein the first filter channel comprises a high frequency cutoff of less than 4 Hz.

3. The device of claim 1, wherein the second filter channel comprises a low frequency cutoff of more than 5 Hz.

4. The device of claim 1, wherein the second filter channel comprises an adaptable notch filter.

5. The device of claim 1, wherein the second filter channel has an adaptable low frequency cutoff.

6. The device of claim 1, wherein one or both of the first filter channel and the second filter channel comprises both analog and digital filters.

7. The device of claim 1, further comprising analog circuitry coupled between the accelerometer output terminal and the first and second filter channels, wherein one or more of the first filter channel and the second filter channel includes a filter circuit that is substantially matched to an impulse response of the analog circuitry.

8. The device of claim 7, wherein the filter circuit substantially attenuates frequencies other than the impulse response frequencies of the analog circuitry.

9. The device of claim 7, wherein the filter circuit is individually mapped to the impulse response during device testing.

10. The device of claim 1, wherein the circuitry includes a timer configured to time a phrenic nerve activation detection interval which is started upon or after delivery of a pacing pulse by the pulse generator to a cardiac chamber and is stopped before delivery of a subsequent pacing pulse to the cardiac chamber.

11. The device of claim 1, wherein the one or more characteristics of the patient'"'"'s state comprises a patient'"'"'s activity.

12. The device of claim 1, wherein the one or more characteristics of the patient'"'"'s state comprises a patient'"'"'s respiration.

13. The device of claim 1, wherein the first physiological signal is used to provide a measure of a patient'"'"'s activity level.

14. The device of claim 1, wherein the first physiological signal is used to provide a measure of a patient'"'"'s metabolic demand.

15. A medical device, comprising:

a pulse generator configured to deliver cardiac pacing;

an accelerometer configured to generate an acceleration signal at an accelerometer output terminal;

circuitry coupled to the accelerometer output terminal, the circuitry configured to have a first set of signal processing characteristics that produce a first physiological signal, the circuitry configured to have a second set of signal processing characteristics that produces a second physiological signal, the first physiological signal indicative of respiration and the second physiological signal indicative of phrenic nerve activation, wherein at least some of the first signal processing characteristics are different from at least some of the second signal processing characteristics; and

the circuitry configured to;

determine one or more characteristics of a patient'"'"'s state based at least in part on the first physiological signal, identify a phase of respiration of the patient using the first physiological signal, to detect phrenic nerve activation in a time relation to the identified phase of respiration caused by cardiac pacing during the phase of respiration based at least in part on the second physiological signal.

16. The medical device of claim 15, wherein the one or more characteristics of the patient'"'"'s state comprises one or more of a characteristic related to a patient'"'"'s activity, a patient'"'"'s respiration, and a patient'"'"'s posture.

17. A method of operating an implantable medical device, comprising:

sensing one or more characteristics of a patient using an accelerometer, and generating a sensor signal at a sensor output terminal of the accelerometer;

filtering the sensor signal through separate filter channels to produce a first physiological signal and a second physiological signal, the separate filter channels comprising a first filter channel having first filter characteristics configured to attenuate a first set of frequencies from the sensor signal and a second filter channel having second filter characteristics configured to attenuate a second set of frequencies from the sensor signal;

detecting one or more characteristics of respiration using the first physiological signal;

detecting, in a time relation to an identified phase of respiration, phrenic nerve activation caused by cardiac pacing during the identified phase of respiration using the second physiological signal; and

producing an output in response to detecting phrenic nerve activation.

18. The method of claim 17, wherein detecting the phrenic nerve activation comprises:

sensing for the phrenic nerve activation in the second physiological signal during a phrenic nerve activation detection interval initiated after a cardiac pacing pulse is delivered to a cardiac chamber and terminated before a subsequent cardiac pacing pulse is delivered to the cardiac chamber.