Intracardiac impedance and its applications

• US 9,839,781 B2
• Filed: 05/07/2013
• Issued: 12/12/2017
• Est. Priority Date: 08/22/2005
• Status: Expired due to Fees

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Zhang, Yunlong, Gilkerson, James O., Zhang, Yongxing, Moon, Loell Boyce
• Primary Examiner(s): Mahmood, Nadia A
• Application Number:
  US13/888,835
• Publication Number:
  US 20140336521A1
• Time in Patent Office: 1,680 Days
• Field of Search: 600518, 607 8
• CPC Class Codes: A61B 5/02028 Determining haemodynamic parameters not otherwise provided for, e.g. cardiac contractility or left ventricular ejection fraction
• CPC Class Codes: A61B 5/02444 Details of sensor A61B5/02427 takes precedence
• CPC Class Codes: A61B 5/0538 invasively, e.g. using a catheter
• CPC Class Codes: A61B 5/318 Heart-related electrical modalities, e.g. electrocardiography [ECG]
• CPC Class Codes: A61B 5/361 Detecting fibrillation
• CPC Class Codes: A61B 5/363 Detecting tachycardia or bradycardia
• 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: A61B 5/7239 using differentiation including higher order derivatives
• CPC Class Codes: A61B 5/7242 using integration
• CPC Class Codes: A61B 5/7282 Event detection, e.g. detecting unique waveforms indicative of a medical condition A61B5/4094, A61B5/4818, A61B5/349, A61B5/0823 take precedence
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/3962 in combination with another heart therapy
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

A system to measure intracardiac impedance includes implantable electrodes and a medical device. The electrodes sense electrical signals of a heart of a subject. The medical device includes a cardiac signal sensing circuit coupled to the implantable electrodes, an impedance measurement circuit coupled to the same or different implantable electrodes, and a controller circuit coupled to the cardiac signal sensing circuit and the impedance measurement circuit. The cardiac signal sensing circuit provides a sensed cardiac signal. The impedance measurement circuit senses intracardiac impedance between the electrodes to obtain an intracardiac impedance signal. The controller circuit determines cardiac cycles of the subject using the sensed cardiac signal, and detects tachyarrhythmia using cardiac-cycle to cardiac-cycle changes in a plurality of intracardiac impedance parameters obtained from the intracardiac impedance signal.

Claims

1. A medical device comprising:

a controller circuit configured to;

receive a sensed cardiac cycle and an intracardiac impedance signal;

determine at least two of;

a cardiac-cycle-to-cardiac-cycle change in a value of a baseline intracardiac impedance value calculated, for a particular cardiac cycle, to represent the baseline intracardiac impedance for that particular cardiac cycle;

a cardiac-cycle-to-cardiac-cycle change in a value of maximum intracardiac impedance value calculated, for a particular cardiac cycle, to represent the maximum intracardiac impedance value for that particular cardiac cycle;

or

a cardiac-cycle-to-cardiac-cyclea change in a slope value of an intracardiac impedance waveform signal, for a particular cardiac cycle, the slope value measured at a time corresponding to one-half of a time interval over which a maximum intracardiac impedance change occurs during the particular cardiac cycle; and

generate an indication that the measured at least two of the cardiac-cycle-to-cardiac-cycle changes represent heart failure (HF) decompensation when the changes occur absent detection of an intervening event during the measuring of the intracardiac impedance parameters.

2. The medical device of claim 1, wherein the controller circuit is configured to determine at least one of a heart rate or a depolarization interval using the sensed cardiac signal, and to generate the indication of HF decompensation absent an episode of unstable heart rate or unstable depolarization interval detected using the determined at least one of heart rate or depolarization interval.

3. The medical device of claim 1, wherein the controller circuit is configured to determine at least one of a heart rate or a depolarization interval using the sensed cardiac signal, and to generate the indication of HF decompensation absent an episode of tachycardia detected using the determined at least one of heart rate or depolarization interval.

4. The medical device of claim 1, wherein the medical device includes a therapy circuit coupled to the controller circuit, wherein the controller circuit is operable to initiate a therapy in response to an indication of HT decompensation.

5. The medical device of claim 1, including implantable electrodes, wherein the implantable electrodes includes at least one electrode configured for placement in a left atrium of the heart or a left ventricle of the heart.

6. The medical device of claim 1, including a memory circuit to store intracardiac impedance parameters measured in accordance with at least one cardiac cycle, wherein the controller circuit is further operable to detect tachyarrhythmia using a change from stored intracardiac impedance parameters and measured intracardiac impedance parameters.

7. The medical device of claim 6, wherein the control circuit is configured to store at least one trend for at least one intracardiac impedance parameter.

8. The medical device of claim 7, wherein the control circuit is configured to change at least one therapy parameter of the medical device according to the trending.

9. The medical device of claim 7, wherein the control circuit is configured to generate an indication that cardiac remodeling has occurred according to the trending.

10. The medical device of claim 1, comprising:

a cardiac cycle sensing circuit configured to provide the sensed cardiac cycle; and

an impedance measurement circuit configured to provide the intracardiac impedance signal.

11. A method of operating a medical device, comprising:

determining, using a controller circuit configured to receive a sensed cardiac cycle and an intracardiac impedance signal, at least two of;

a cardiac-cycle-to-cardiac-cycle change in a value of a baseline intracardiac impedance value calculated, for a particular cardiac cycle, to represent the baseline intracardiac impedance for that particular cardiac cycle;

a cardiac-cycle-to-cardiac-cycle change in a value of maximum intracardiac impedance value calculated, for a particular cardiac cycle, to represent the maximum intracardiac impedance value for that particular cardiac cycle; and

a cardiac-cycle-to-cardiac-cycle change in a slope value of an intracardiac impedance waveform signal, for a particular cardiac cycle, the slope value measured at a time corresponding to one-half of a time interval over which a maximum intracardiac impedance change occurs during the particular cardiac cycle; and

generating, using the controller circuit, an indication that the measured at least two of the cardiac-cycle-to-cardiac-cycle changes represent heart failure (HF) decompensation when the changes occur absent detection of an intervening event during the measuring of the intracardiac impedance parameters.

12. The method of claim 11, comprising:

determining, using the controller circuit, at least one of a heart rate or a depolarization interval using the sensed cardiac signal; and

generating, using the controller circuit, the indication of HF decompensation absent an episode of unstable heart rate or unstable depolarization interval using the determined at least one of heart rate or depolarization interval.

13. The method of claim 11, comprising:

determining, using the controller circuit, at least one of a heart or a depolarization interval using the sensed cardiac signal, and

generating, using the controller circuit, the indication of HF decompensation absent an episode of tachycardia detected using the determined at least one of heart rate or depolarization interval.

14. The method of claim 11, comprising initiating a therapy, using a therapy circuit coupled to the controller circuit, in response to a generated indication of HF decompensation.

15. The method of claim 11, comprising:

storing intracardiac impedance parameters measured in accordance with at least one cardiac cycle in the memory circuit; and

detecting, using the controller circuit, tachyarrhythmia using a change from stored intracardiac impedance parameters and measured intracardiac impedance parameters.

16. The method of claim 11, comprising:

changing at least one therapy parameter of the medical device according to the at least generated indication that the measured at least two of the cardiac-cycle-to-cardiac-cycle changes represent heart failure (HF) decompensation using the control circuit.

17. The method of claim 11, comprising:

trending the at least one generated indication using the control circuit; and

generating an indication that cardiac remodeling has occurred according to the trending using the control circuit.

18. A system, comprising:

a controller circuit configured to;

receive a sensed cardiac cycle information and an intracardiac impedance signal;

determine a cardiac-cycle-to-cardiac-cycle intracardiac impedance change using

the received sensed cardiac cycle information and the intracardiac impedance signal;

generate an indication of heart failure (HF) decompensation using the determined cardiac-cycle-to-cardiac-cycle intracardiac impedance change and the received cardiac cycle information.

19. The system of claim 18, wherein, to determine the cardiac-cycle-to-cardiac-cycle intracardiac impedance change, the controller circuit is configured to determine at least two of:

a cardiac-cycle-to-cardiac-cycle change in a value of a baseline intracardiac impedance value calculated, for a particular cardiac cycle, to represent the baseline intracardiac impedance for that particular cardiac cycle;

a cardiac-cycle-to-cardiac-cycle change in a value of maximum intracardiac impedance value calculated, for a particular cardiac cycle, to represent the maximum intracardiac impedance value for that particular cardiac cycle;

or

a cardiac-cycle-to-cardiac-cycle change in a slope value of an intracardiac impedance waveform signal, for a particular cardiac cycle, the slope value measured at a time corresponding to one-half of a time interval over which a maximum intracardiac impedance change occurs during the particular cardiac cycle.

20. The system of claim 18, wherein the controller circuit is configured to:

determine if a cardiac rate is stable or constant using the sensed cardiac cycle information; and

generate the indication of HF decompensation using a decrease in the determined cardiac-cycle-to-cardiac-cycle intracardiac impedance and a determined stable or constant determined cardiac rate.