Method and apparatus to perform electrode combination selection

• US 8,615,297 B2
• Filed: 08/27/2012
• Issued: 12/24/2013
• 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:
  US13/595,688
• Publication Number:
  US 20120323291A1
• Time in Patent Office: 484 Days
• Field of Search: 607/2, 607/8, 607/9, 607/28, 607/27, 607/30, 607/32
• US Class Current: 607/9
• 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 method comprising:

evaluating, for each electrode combination of a plurality of electrode combinations, one or more first parameters associated with electrical stimulation delivered using the electrode combination, the first parameters supportive of cardiac function consistent with a prescribed therapy;

evaluating, for each electrode combination of the plurality of electrode combinations, one or more second parameters associated with the electrical stimulation delivered using the electrode combination, the second parameters not supportive of cardiac function consistent with the prescribed therapy;

based on the evaluations of the first parameters and the second parameters for each electrode combination of the plurality of electrode combinations, determining an order for at least some of the electrode combinations of the plurality of electrode combinations;

selecting one or more electrode combinations based on the order; and

delivering an electrical stimulation therapy using the selected one or more electrode combinations.

2. The method of claim 1, further comprising repeating the evaluations of the first parameters and the second parameters for each electrode combination of the plurality of electrode combinations, the determining step, the selecting step in response to one or more of:

loss of capture, change in posture, change in disease state, detection of non-therapeutic activation, change in patient activity state, a predetermined schedule event and an update command given by a human or system.

3. The method of claim 1, wherein determining the order of at least some electrode combinations comprises ranking at least some electrode combinations based on one or more of capture threshold, therapy energy consumption, undesirable activation of nerve or muscle tissue, anodal cardiac stimulation, degree of responsiveness to resynchronization therapy, impedance, cardiac contractility, electrode combination activation timing, cardiac output, stroke volume, dP/dt, hemodynamics, and historical success of therapy using the electrode combinations.

4. The method of claim 1, wherein at least one of evaluating the first and second parameters, ordering the electrode combinations, and selecting the electrode combinations for therapy delivery is performed automatically by a cardiac rhythm management (CRM) system.

5. The method of claim 1, wherein evaluating the first parameters comprises evaluating a capture threshold.

6. The method of claim 1, wherein evaluating the first parameters comprises evaluating a responsiveness to cardiac resynchronization.

7. The method of claim 1, wherein evaluating the second parameters comprises detecting at least one of unintended nerve stimulation and unintended muscle stimulation.

8. The method of claim 1, wherein determining the order comprises comparing at least one of the first and second parameters associated with one electrode combination to at least one of the first and second parameters of at least one other electrode combination.

9. The method of claim 1, wherein determining the order of at least some electrode combinations comprises ranking at least some electrode combinations, the ranking prioritizing electrode combinations with desirable first parameters levels and second parameters levels.

10. The method of claim 1, further comprising:

determining one or more recommended electrode combinations; and

displaying the one or more recommended electrode combinations on a display of an evaluation unit that is external of a patient.

11. The method of claim 1, wherein:

evaluating the first parameters comprises evaluating a capture threshold for each of the plurality of electrode combinations;

evaluating the second parameters comprises sensing extra-cardiac stimulation; and

determining the order comprises identifying at least one electrode combination of the plurality of electrode combinations with the lowest capture threshold that does not cause extra-cardiac stimulation.

12. The method of claim 1, wherein selecting the one or more electrode combinations comprises:

displaying information associated with the one or more electrode combinations on a display of an evaluation unit that is external of a patient; and

receiving input from a human analyst via the evaluation unit indicating selection of the one or more electrode combinations.

13. The method of claim 1, further comprising:

detecting a change in patient status; and

switching delivery of the electrical stimulation therapy from the selected one or more electrode combinations of the plurality of electrode combinations to one or more alternate electrode combinations of the plurality of electrode combinations when the change in patient status is detected, wherein switching to the one or more alternate electrode combinations is based on the order determined by the determining step.

14. The method of claim 1, wherein evaluating the one or more first parameters comprises evaluating two or more different first parameters associated with electrical stimulation delivered using the electrode combination, the two or more different first parameters supportive of cardiac function consistent with the prescribed therapy.

15. The method of claim 1, further comprising:

displaying for each of two or more of the plurality of electrode combinations, one or more of the first parameters and one or more of the second parameters on an electronic display;

accepting a user input from a user; and

ordering the two or more of the plurality of electrode combinations on the display based, at least in part, on the user input and the evaluations of the first parameters and the second parameters for each of the two or more of the plurality of electrode combinations.

16. A method comprising:

evaluating, for each electrode combination of a plurality of electrode combinations, one or more first parameters associated with electrical stimulation delivered using the electrode combination, the first parameters supportive of cardiac function consistent with a prescribed therapy;

evaluating, for each electrode combination of the plurality of electrode combinations, one or more second parameters associated with the electrical stimulation delivered using the electrode combination, the second parameters not supportive of cardiac function consistent with the prescribed therapy;

displaying for each of two or more of the plurality of electrode combinations, one or more of the first parameters and one or more of the second parameters on an electronic display, resulting in displayed information on the display;

accepting a user input from a user;

ordering the two or more of the plurality of electrode combinations on the display based, at least in part, on the user input and the evaluations of the first parameters and the second parameters for each of the two or more of the plurality of electrode combinations;

selecting an electrode combination from the two or more electrode combinations displayed on the display; and

delivering an electrical stimulation therapy using the selected electrode combination.

17. The method of claim 16, wherein the displayed information is organized on the display according to one or more groups or categories.

18. A method comprising:

evaluating, for each electrode combination of a plurality of electrode combinations, one or more first parameters associated with electrical stimulation delivered using the electrode combination, the first parameters supportive of cardiac function consistent with a prescribed therapy;

evaluating, for each electrode combination of the plurality of electrode combinations, one or more second parameters associated with the electrical stimulation delivered using the electrode combination, the second parameters not supportive of cardiac function consistent with the prescribed therapy;

displaying for each of two or more of the plurality of electrode combinations, one or more of the first parameters and one or more of the second parameters on an electronic display;

accepting a user input from a user; and

ordering the two or more of the plurality of electrode combinations on the display based, at least in part, on the user input.

19. The method of claim 18 further comprising:

selecting an electrode combination from the two or more electrode combinations; and

delivering an electrical stimulation therapy using the selected electrode combination.