THORACIC OR INTRACARDIAC IMPEDANCE DETECTION WITH AUTOMATIC VECTOR SELECTION

• US 20100056884A1
• Filed: 11/04/2009
• Published: 03/04/2010
• Est. Priority Date: 04/20/2005
• Status: Active Grant

• Current Assignee: Jeffrey E. Stahmann, Jesse W. Hartley, Jiang Ding, Jonathan Kwok, Kent Lee, Yinghong Yu
• Original Assignee: Jeffrey E. Stahmann, Jesse W. Hartley, Jiang Ding, Jonathan Kwok, Kent Lee, Yinghong Yu
• Inventors: Kwok, Jonathan, Stahmann, Jeffrey E., Hartley, Jesse W., Yu, Yinghong, Lee, Kent, Ding, Jiang
• Granted Patent: US 8,014,860 B2
• Time in Patent Office: Days
• US Class Current: 600/301
• CPC Class Codes: A61B 5/0205 Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition
• CPC Class Codes: A61B 5/053 Measuring electrical impedance or conductance of a portion of the body
• CPC Class Codes: A61B 5/0538 invasively, e.g. using a catheter
• CPC Class Codes: A61N 1/36185 Selection of the electrode configuration
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/3686 configured for selecting the electrode configuration on a lead A61N1/3688 takes precedence

Abstract

This document discusses, among other things, a cardiac function management device or other implantable medical device that includes a test mode and a diagnostic mode. During a test mode, the device cycles through various electrode configurations for collecting thoracic impedance data. At least one figure of merit is calculated from the impedance data for each such electrode configuration. In one example, only non-arrhythmic beats are used for computing the figure of merit. A particular electrode configuration is automatically selected using the figure of merit. During a diagnostic mode, the device collects impedance data using the selected electrode configuration. In one example, the figure of merit includes a ratio of a cardiac stroke amplitude and a respiration amplitude. Other examples of the figure of merit are also described.

Claims

1. A system comprising:

an implantable medical device (IMD), the IMD comprising;

an impedance detector circuit, including inputs configured to receive impedance signals from different electrode configurations in a subject'"'"'s thorax;

a cardiac stroke signal filter circuit, coupled to the impedance detector circuit to receive the impedance signals and extract therefrom corresponding cardiac stroke signals;

a respiration signal filter circuit, coupled to the impedance detector circuit to receive the impedance signals and to extract therefrom corresponding respiration signals;

a cardiac stroke amplitude measurement circuit, coupled to the cardiac stroke signal filter circuit to receive the cardiac stroke signals and to extract therefrom corresponding cardiac stroke amplitudes;

a respiration amplitude measurement circuit, coupled to the respiration signal filter circuit to receive the respiration signals and to extract therefrom corresponding respiration amplitudes; and

a processor circuit, including instructions executable or otherwise interpretable to compute a comparative measurement between each cardiac stroke amplitude and each corresponding respiration amplitude from the same electrode configuration, and based on relative values of the comparative measurement associated with each electrode configuration to select a particular electrode configuration for use in obtaining at least one of a cardiac stroke signal and a respiration signal for use in a diagnostic or therapeutic algorithm.

2. The system of claim 1, in which the comparative measurement is a ratio between the cardiac stroke amplitude and the respiration amplitude associated with the same electrode configuration as the cardiac stroke amplitude.

3. The system of claim 2, in which at least one of the cardiac stroke signal and the respiration signal for use in the diagnostic or therapeutic algorithm is a cardiac stroke signal, and the ratio is the cardiac stroke amplitude divided by the respiration amplitude, and the processor circuit operates to select the particular electrode configuration that is associated with the largest value of the corresponding ratio relative to the value of ratios corresponding to another at least one electrode configuration.

4. The system of claim 2, in which at least one of the cardiac stroke signal and the respiration signal for use in the diagnostic or therapeutic algorithm is a respiration signal, and the ratio is the respiration amplitude divided by the cardiac stroke amplitude, and the processor circuit operates to select the particular electrode configuration that is associated with the largest value of the corresponding ratio relative to the value of another one or more ratios corresponding to another one or more electrode configurations.

5. The system of claim 2, in which the processor operates to compare a value of at least one ratio associated with an electrode configuration to a predefined threshold value, and to disable the obtaining at least one of a cardiac stroke signal and a respiration signal for use in a diagnostic or therapeutic algorithm if the value of at least one ratio does not exceed the threshold value.

6. The system of claim 1, in which the processor includes:

a test mode for performing the acts of measuring the impedance signals from the different electrode configurations, calculating the comparative measurement associated with electrode configuration, and selecting a particular electrode configuration; and

a diagnostic mode to extract diagnostic impedance data using the selected particular electrode configuration.

7. The system of claim 6, further including a clock circuit to schedule repeated execution of the test mode.

8. The system of claim 6, further including:

a heart rate detector circuit, coupled to the processor, the heart rate detector circuit configured to detect a change in heart rate; and

a posture detector circuit, coupled to the processor, the posture detector circuit configured to detect a change in posture;

wherein the processor is configured to trigger the test mode upon detection of at least one of a change in heart rate or a change in posture.

9. The system of claim 1, in which the comparative measurement associated with each electrode configuration comprises a noise measurement of at least one of a respiration component or a cardiac stroke component of the impedance signal from each respective electrode configuration.

10. A system comprising:

an implantable medical device (IMD), the IMD comprising;

an impedance detector circuit, configured to;

measure a first impedance signal between at least first and second electrodes, which define a first electrode configuration, in a subject'"'"'s thorax; and

measure a second impedance signal between at least third and fourth electrodes, which define a second electrode configuration, in a subject'"'"'s thorax, wherein at least one of the third and fourth electrodes is a different electrode from at least one of the first and second electrodes; and

a processor circuit, coupled to the impedance detector circuit, the processor circuit configured to;

calculate a first figure of merit using the first impedance signal;

calculate a second figure of merit using the second impedance signal; and

use values of the first and second figures of merit as a basis for automatically selecting one of the first and second electrode configurations for subsequent diagnostic extraction of one of the first and second impedance signals;

wherein the first and second figures of merit comprise at least one of;

(1) an amplitude measurement of a respiration component of the first and second impedance signals, respectively;

(2) an amplitude measurement of a cardiac stroke component of the first and second impedance signals, respectively;

or (3) an amplitude measurement of a near-DC fluid status component of the first and second impedance signals, respectively.

11. The system of claim 10, in which the processor includes:

a test mode for performing the acts of measuring the first and second impedance signals, calculating the first and second figures of merit, and automatically selecting one of the first and second electrode configurations; and

a diagnostic mode to extract diagnostic impedance data using the selected one of the first and second electrode configurations.

12. The system of claim 11, further including a clock circuit to schedule repeated execution of the test mode.

13. The system of claim 11, further including:

a heart rate detector circuit, coupled to the processor, the heart rate detector circuit configured to detect a change in heart rate; and

a posture detector circuit, coupled to the processor, the posture detector circuit configured to detect a change in posture;

wherein the processor is configured to trigger the test mode upon detection of at least one of a change in heart rate or a change in posture.

14. The system of claim 10, in which the first figure of merit comprises an amplitude measurement of a respiration component of the first impedance signal;

and in which the second figure of merit comprises an amplitude measurement of a respiration component of the second impedance signal.

15. The system of claim 10, in which the first figure of merit comprises an amplitude measurement of a cardiac stroke component of the first impedance signal;

and in which the second figure of merit comprises an amplitude measurement of a cardiac stroke component of the second impedance signal.

16. The system of claim 10, in which first figure of merit comprises an amplitude measurement of a near-DC fluid status component of the first impedance signal;

and in which the second figure of merit comprises an amplitude measurement of a near-DC fluid status component of the second impedance signal.

17. The system of claim 10, in which the first figure of merit comprises a noise measurement of a respiration component of the first impedance signal;

and in which the second figure of merit comprises a noise measurement of a respiration component of the second impedance signal.

18. The system of claim 17, in which the noise measurement of the respiration component of the first impedance signal comprises a cardiac stroke component of the first impedance signal;

and in which the noise measurement of the respiration component of the second impedance signal comprises a cardiac stroke component of the second impedance signal.

19. The system of claim 10, in which the first figure of merit comprises a noise measurement of a cardiac stroke component of the first impedance signal;

and in which the second figure of merit comprises a noise measurement of a cardiac stroke component of the second impedance signal.

20. The system of claim 19, in which the noise measurement of the cardiac stroke component of the first impedance signal comprises a respiration component of the first impedance signal;

and in which the noise measurement of the cardiac stroke component of the second impedance signal comprises a respiration component of the second impedance signal.