Method and apparatus to perform electrode combination selection

• US 9,427,588 B2
• Filed: 03/24/2015
• Issued: 08/30/2016
• Est. Priority Date: 08/07/2007
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Sathaye, Alok S., Brooke, M. Jason, Tockman, Bruce A.
• Primary Examiner(s): Gedeon, Brian T
• Application Number:
  US14/667,240
• Publication Number:
  US 20150190639A1
• Time in Patent Office: 525 Days
• Field of Search: None
• US Class Current: 1/1
• CPC Class Codes: A61N 1/056 Transvascular endocardial electrode systems
• CPC Class Codes: A61N 1/0563 specially adapted for defibrillation or cardioversion
• CPC Class Codes: A61N 1/36514 controlled by a physiological quantity other than heart potential, e.g. blood pressure controlled by two or more physical parameters A61N1/36585
• CPC Class Codes: A61N 1/36564 controlled by blood pressure
• 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
• CPC Class Codes: A61N 1/3702 Physiological parameters A61N1/365 takes precedence; evoked response A61N1/371
• CPC Class Codes: A61N 1/3704 Circuits specially adapted therefor, e.g. for sensitivity control
• CPC Class Codes: A61N 1/371 Capture, i.e. successful stimulation
• CPC Class Codes: A61N 1/37223 Circuits for electromagnetic coupling
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means

Abstract

Approaches for selecting an electrode combination of multi-electrode pacing devices are described. Electrode combination parameters that support cardiac function consistent with a prescribed therapy are evaluated for each of a plurality of electrode combinations. Electrode combination parameters that do not support cardiac function are evaluated for each of the plurality of electrode combinations. An order is determined for the electrode combinations based on the parameter evaluations. An electrode combination is selected based on the order, and therapy is delivered using the selected electrode combination.

Claims

1. A patient external device, comprising:

communication circuitry for receiving sensed data, wherein the sensed data comprises information associated with a capture threshold for each of two or more electrode combinations and information associated with a phrenic nerve activation for each of the two or more electrode combinations;

a user interface comprising a display;

a controller operatively coupled to the communications circuitry and the display, the controller configured to;

access the information received via the communication circuitry and display an indication of a capture threshold and an indication of phrenic nerve activation for each of two or more electrode combinations on the display;

accept a selection of one of the two or more displayed electrode combinations from a user via the user interface; and

program an implantable device via the communication circuitry to use the selected electrode combination to delivery therapy.

2. The patient external device of claim 1, wherein the sensed data further comprises information associated with an impedance for each of two or more electrode combinations, and wherein the controller is configured to display an indication of an impedance for each of two or more electrode combinations on the display.

3. The patient external device of claim 2, wherein the controller is configured to display the indication of the impedance along with the indication of the capture threshold and the indication of phrenic nerve activation on the display for each of two or more electrode combinations.

4. The patient external device of claim 1, wherein the sensed data further comprises information associated with depolarization and/or repolarization wave characteristics for each of two or more electrode combinations, and wherein the controller is configured to display an indication of a depolarization and/or repolarization wave characteristic for each of two or more electrode combinations on the display.

5. The patient external device of claim 4, wherein the controller is configured to display the indication of the depolarization and/or repolarization wave characteristic along with the indication of the capture threshold and the indication of phrenic nerve activation on the display for each of two or more electrode combinations.

6. The patient external device of claim 1, wherein:

the sensed data further comprises information associated with an impedance for each of two or more electrode combinations and information associated with depolarization and/or repolarization wave characteristics for each of two or more electrode combinations; and

the controller is further configured to display on the display an indication of an impedance for each of two or more electrode combinations on the display and an indication of a depolarization and/or repolarization wave characteristic along with the indication of the capture threshold and the indication of phrenic nerve activation for each of two or more electrode combinations.

7. The patient external device of claim 1, wherein the patient external device comprises a programmer.

8. The patient external device of claim 1, wherein the sensed data that comprises information associated with the capture threshold for each of two or more electrode combinations is received from an implantable device.

9. The patient external device of claim 1, wherein the sensed data that comprises information associated with the phrenic nerve activation for each of two or more electrode combinations is received from an implantable device.

10. The patient external device of claim 1, wherein the information associated with the phrenic nerve activation for each of two or more electrode combinations comprises information on whether phrenic nerve activation occurred or not for at least some of the two or more electrode combinations.

11. The patient external device of claim 1, wherein the information associated with the phrenic nerve activation for each of two or more electrode combinations comprises a phrenic nerve activation threshold for at least some of the two or more electrode combinations.

12. The patient external device of claim 1, wherein the display is a touch screen display.

13. The patient external device of claim 1, wherein the communication circuitry comprises a telemetry link for communicating with an implantable device, and wherein at least some of the sensed data is received from the implantable device via the telemetry link.

14. A programmer, comprising:

a telemetry link for communicating with an implantable device, wherein the implantable device comprises two or more available electrode combinations for pacing the heart, the telemetry link configured to receive sensed data from the implantable device, wherein the sensed data comprises information associated with a capture threshold for each of two or more electrode combinations and information associated with a phrenic nerve activation for each of the two or more electrode combinations;

a user interface comprising a display;

a controller operatively coupled to the telemetry link and the display, the controller configured to;

access the information received via the telemetry link and display an indication of a capture threshold and an indication of phrenic nerve activation for each of two or more electrode combinations on the display;

accept a selection of one of the two or more displayed electrode combinations from a user via the user interface; and

program the implantable device via the telemetry link to use the selected electrode combination to delivery therapy.

15. The programmer of claim 14, wherein the sensed data further comprises information associated with an impedance for each of two or more electrode combinations, and wherein the controller is configured to display an indication of an impedance for each of two or more electrode combinations on the display.

16. The programmer of claim 15, wherein the controller is configured to display the indication of the impedance along with the indication of the capture threshold and the indication of phrenic nerve activation on the display for each of two or more electrode combinations.

17. The programmer of claim 14, wherein the sensed data further comprises information associated with depolarization and/or repolarization wave characteristics for each of two or more electrode combinations, and wherein the controller is configured to display an indication of a depolarization and/or repolarization wave characteristic for each of two or more electrode combinations on the display.

18. The programmer of claim 17, wherein the controller is configured to display the indication of the depolarization and/or repolarization wave characteristic along with the indication of the capture threshold and the indication of phrenic nerve activation on the display for each of two or more electrode combinations.

19. The programmer of claim 14, wherein:

the sensed data further comprises information associated with an impedance for each of two or more electrode combinations and information associated with depolarization and/or repolarization wave characteristics for each of two or more electrode combinations; and

the controller is further configured to display on the display an indication of an impedance for each of two or more electrode combinations on the display and an indication of a depolarization and/or repolarization wave characteristic along with the indication of the capture threshold and the indication of phrenic nerve activation for each of two or more electrode combinations.

20. A patient external device, comprising:

communication circuitry for receiving sensed data, wherein the sensed data comprises information associated with one or parameters that are supportive of cardiac function for each of two or more electrode combinations and information associated with one or more parameters that are not-supportive of cardiac function for each of the two or more electrode combinations;

a user interface comprising a display;

a controller operatively coupled to the communications circuitry and the display, the controller configured to;

access the information received via the communication circuitry and display an indication of one or parameters that are supportive of cardiac function and one or more parameters that are not-supportive of cardiac function for each of two or more electrode combinations on the display;

accept a selection of one of the two or more displayed electrode combinations from a user via the user interface; and

program an implantable device via the communication circuitry to use the selected electrode combination to delivery therapy.