Automated phrenic nerve stimulation and pacing capture threshold test

• US 9,555,250 B2
• Filed: 02/20/2014
• Issued: 01/31/2017
• Est. Priority Date: 02/20/2014
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Demmer, Wade M, Kleckner, Karen J
• Primary Examiner(s): Patton, Amanda
• Assistant Examiner(s): EDWARDS, PHILIP CHARLES
• Application Number:
  US14/185,410
• Publication Number:
  US 20150231399A1
• Time in Patent Office: 1,076 Days
• Field of Search: 607/28
• US Class Current: 1/1
• CPC Class Codes: A61B 5/08 Detecting, measuring or recording devices for evaluating the respiratory organs A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/24 Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
• CPC Class Codes: A61B 5/388 Nerve conduction study, e.g. detecting action potential of peripheral nerves
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61N 1/3611 Respiration control stimulating respiratory organs A61N1/3601
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• 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 1/3684 for stimulating the heart at multiple sites of the ventricle or the atrium
• CPC Class Codes: A61N 1/36842 Multi-site stimulation in the same chamber
• CPC Class Codes: A61N 1/36843 Bi-ventricular stimulation
• CPC Class Codes: A61N 1/3686 configured for selecting the electrode configuration on a lead A61N1/3688 takes precedence
• CPC Class Codes: A61N 1/371 Capture, i.e. successful stimulation
• CPC Class Codes: A61N 1/3712 Auto-capture, i.e. automatic adjustment of the stimulation threshold

Abstract

A medical device system and method for determining pacing threshold data that includes a cardiac capture sensor, a phrenic nerve stimulation sensor, a pulse generator selectively coupled to a plurality of electrode vectors to deliver a phrenic nerve stimulation pulse, and a processor coupled to the cardiac capture sensor, the phrenic nerve stimulation sensor and the pulse generator and configured to deliver the phrenic nerve stimulation pulse along the plurality of electrode vectors, determine, for each vector of the plurality of vectors, whether phrenic nerve stimulation is detected in response to the delivered phrenic nerve stimulation, deliver a pacing pulse along only the vectors of the plurality of vectors that phrenic nerve stimulation is determined not to be detected, and determine pacing capture thresholds in response to the delivered pacing pulse.

Claims

1. A medical device system for determining pacing threshold data, comprising:

a cardiac capture sensor;

a phrenic nerve stimulation sensor;

a pulse generator selectively coupled to a plurality of electrode vectors to deliver a phrenic nerve stimulation pulse; and

a processor coupled to the cardiac capture sensor, the phrenic nerve stimulation sensor and the pulse generator and configured to deliver the phrenic nerve stimulation pulse along the plurality of electrode vectors, determine, for each vector of the plurality of vectors, whether phrenic nerve stimulation is detected in response to the delivered phrenic nerve stimulation, determine whether phrenic nerve stimulation is determined as occurring in all of the plurality of electrode vectors, deliver, if phrenic nerve stimulation is not determined as occurring in all of the plurality of electrode vectors, a pacing pulse along only the vectors of the plurality of vectors that phrenic nerve stimulation is determined not to be detected, determine pacing capture thresholds in response to the delivered pacing pulse, adjust an output of subsequently delivered phrenic nerve stimulation pulse along the plurality of electrode vectors if phrenic nerve stimulation is determined as occurring in all of the plurality of electrode vectors, and determine, for each vector of the plurality of vectors, whether phrenic nerve stimulation is detected in response to the delivered adjusted phrenic nerve stimulation.

2. The medical device system of claim 1, wherein the phrenic nerve stimulation pulse comprises a first output amplitude and the pacing pulse comprises a second output amplitude, less than the first output amplitude.

3. The medical device system of claim 1, further comprising a storage device, wherein the processor is configured to store the phrenic nerve stimulation detection determination for all of the vectors of the plurality of vectors, and to store the pacing capture thresholds for only the vectors of the plurality of vectors that phrenic nerve stimulation is determined not to be detected.

4. The medical device system of claim 1, wherein the processor is configured to determine an optimal pacing vector in response to only the pacing capture thresholds for the vectors of the plurality of vectors that phrenic nerve stimulation is determined not to be detected.

5. The medial device system of claim 4, wherein the processor is configured to determine a minimum pacing capture threshold of only the pacing capture thresholds for the vectors of the plurality of vectors that phrenic nerve stimulation is determined not to be detected, and determine the optimal pacing vector in response to the determined minimum pacing capture threshold.

6. The medical device system of claim 1, further comprising a display, wherein the processor is configured to display only the pacing capture thresholds for the vectors of the plurality of vectors that phrenic nerve stimulation is determined not to be detected.

7. The medical device system of claim 1, wherein the phrenic nerve stimulation pulse comprises a first output amplitude, the adjusted phrenic nerve stimulation pulse comprises a second output amplitude less than the first output amplitude, and the pacing pulse comprises a third output amplitude, less than the first output amplitude and the second output amplitude.

8. The medical device system of claim 1, wherein the processor is configured to determine an optimal pacing vector in response to only the pacing capture thresholds for the vectors of the plurality of vectors that phrenic nerve stimulation is determined not to be detected.

9. The medical device system of claim 1, further comprising a storage device, wherein the processor is configured to store only the pacing capture thresholds for the vectors of the plurality of vectors that phrenic nerve stimulation is determined not to be detected.

10. A method for determining pacing threshold data in a medical device system, comprising:

delivering a phrenic nerve stimulation pulse successively along a plurality of electrode vectors;

determining, for each vector of the plurality of vectors, whether phrenic nerve stimulation is detected in response to the delivered phrenic nerve stimulation;

determining whether phrenic nerve stimulation is determined as occurring in all of the plurality of electrode vectors;

delivering, if phrenic nerve stimulation is not determined as occurring in all of the plurality of electrode vectors, a pacing pulse along only the vectors of the plurality of vectors that phrenic nerve stimulation is determined not to be detected;

determining pacing capture thresholds in response to the delivered pacing pulse;

adjusting an output of subsequently delivered phrenic nerve stimulation pulse along the plurality of electrode vectors if phrenic nerve stimulation is determined as occurring in all of the plurality of electrode vectors; and

determining, for each vector of the plurality of vectors, whether phrenic nerve stimulation is detected in response to the delivered adjusted phrenic nerve stimulation.

11. The method of claim 10, wherein the phrenic nerve stimulation pulse comprises a first output amplitude and the pacing pulse comprises a second output amplitude, less than the first output amplitude.

12. The method of claim 10, further comprising:

storing the phrenic nerve stimulation detection determination for all of the vectors of the plurality of vectors; and

storing the pacing capture thresholds for only the vectors of the plurality of vectors that phrenic nerve stimulation is determined not to be detected.

13. The method of claim 10, further comprising determining an optimal pacing vector in response to only the pacing capture thresholds for the vectors of the plurality of vectors that phrenic nerve stimulation is determined not to be detected.

14. The method of claim 13, further comprising:

determining a minimum pacing capture threshold of only the pacing capture thresholds for the vectors of the plurality of vectors that phrenic nerve stimulation is determined not to be detected; and

determining the optimal pacing vector in response to the determined minimum pacing capture threshold.

15. The method of claim 10, further comprising displaying only the pacing capture thresholds for the vectors of the plurality of vectors that phrenic nerve stimulation is determined not to be detected.

16. The method of claim 10, wherein the phrenic nerve stimulation pulse comprises a first output amplitude, the adjusted phrenic nerve stimulation pulse comprises a second output amplitude less than the first output amplitude, and the pacing pulse comprises a third output amplitude, less than the first output amplitude and the second output amplitude.

17. The method of claim 10, further comprising determining an optimal pacing vector in response to only the pacing capture thresholds for the vectors of the plurality of vectors that phrenic nerve stimulation is determined not to be detected.

18. The method of claim 10, further comprising a storage device, wherein the processor is configured to store only the pacing capture thresholds for the vectors of the plurality of vectors that phrenic nerve stimulation is determined not to be detected.

19. A non-transitory, computer-readable storage medium storing instructions for causing a processor included in a medical device system to perform a method for determining pacing threshold data, the method comprising:

delivering a phrenic nerve stimulation pulse successively along a plurality of electrode vectors;

determining, for each vector of the plurality of vectors, whether phrenic nerve stimulation is detected in response to the delivered phrenic nerve stimulation;

determining whether phrenic nerve stimulation is determined as occurring in all of the plurality of electrode vectors;

delivering, if phrenic nerve stimulation is not determined as occurring in all of the plurality of electrode vectors, a pacing pulse along only the vectors of the plurality of vectors that phrenic nerve stimulation is determined not to be detected;

determining pacing capture thresholds in response to the delivered pacing pulse;

if phrenic nerve stimulation is determined as occurring in all of the plurality of electrode vectors, adjusting an output of subsequently delivered phrenic nerve stimulation pulse along the plurality of electrode vectors; and

determining, for each vector of the plurality of vectors, whether phrenic nerve stimulation is detected in response to the delivered adjusted phrenic nerve stimulation.

20. A medical device system for determining pacing threshold data, comprising:

a cardiac capture sensor;

a phrenic nerve stimulation sensor;

a pulse generator selectively coupled to a plurality of electrode vectors to deliver a phrenic nerve stimulation pulse; and

a processor coupled to the cardiac capture sensor, the phrenic nerve stimulation sensor and the pulse generator and configured to deliver the phrenic nerve stimulation pulse along the plurality of electrode vectors, determine, for each vector of the plurality of vectors, whether phrenic nerve stimulation is detected in response to the delivered phrenic nerve stimulation test pulses, determine whether phrenic nerve stimulation is determined as occurring in all of the plurality of electrode vectors, deliver, if phrenic nerve stimulation is not determined as occurring in all of the plurality of electrode vectors, a pacing pulse along only the vectors of the plurality of vectors that phrenic nerve stimulation is determined not to be detected, determine pacing capture thresholds in response to the delivered pacing pulse, adjust an output of subsequently delivered phrenic nerve stimulation pulses along the plurality of electrode vectors if phrenic nerve stimulation is determined as occurring in all of the plurality of electrode vectors, and determine, for each vector of the plurality of vectors, whether phrenic nerve stimulation is detected in response to the delivered adjusted phrenic nerve stimulation.