Method and apparatus to perform electrode combination selection

• US 9,008,775 B2
• Filed: 03/13/2014
• Issued: 04/14/2015
• 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:
  US14/209,364
• Publication Number:
  US 20140194942A1
• Time in Patent Office: 397 Days
• Field of Search: None
• US Class Current: 607/28
• 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 medical device comprising:

at least one implantable lead, wherein the at least one implantable lead includes two or more electrodes configured to be adjacent a heart of a patient;

an accelerometer providing an output signal, the accelerometer configured to monitor for stimulation of a phrenic nerve of the patient;

a controller operatively coupled to the at least one implantable lead and the accelerometer, the controller configured to;

deliver stimulation to two or more different electrode configurations, wherein the two or more different electrode configurations each use at least one of the two or more electrodes of the implantable lead;

determine a capture threshold of a heart of the patient for each of the two or more different electrode configurations;

determine an activation threshold of the phrenic nerve of the patient for each of the two or more different electrode configurations using the output signal of the accelerometer; and

outputting a measure related to the capture threshold and a measure of the activation threshold of the phrenic nerve for each of the two or more different electrode configurations.

2. The medical device of claim 1, wherein the controller is further configured to evaluate, for each of the two or more different electrode configurations, the capture threshold and the activation threshold of the phrenic nerve, and to determine a relative ranking of the two or more different electrode configurations for delivering stimulation therapy to the heart of the patient.

3. The medical device of claim 2, further comprising a user interface that presents an indication of the relative ranking of the electrode configurations to a user.

4. The medical device of claim 3, wherein the relative ranking is indicated by an order of display of the electrode configurations on a display of the user interface.

5. The medical device of claim 2, wherein a first electrode combination having a first capture threshold is ranked higher than a second electrode combination having a second capture threshold if the first capture threshold is lower than the second capture threshold, and if the first capture threshold is lower than the phrenic nerve activation threshold of the first electrode combination.

6. The medical device of claim 1 further comprising a user interface that presents an indication of the capture threshold and the activation threshold of the phrenic nerve for each of the two or more different electrode configurations.

7. The medical device of claim 1, further comprising a user interface that presents a recommended electrode combination to a user.

8. The medical device of claim 7, wherein the user interface is configured to visually highlight the recommended electrode combination on a display.

9. The medical device of claim 1, wherein the controller comprises a pacing circuit for facilitating delivery of stimulation to the patient using the two or more different electrode configurations.

10. A medical device comprising:

a power supply;

a controller powered by the power supply, the controller configured to;

deliver stimulation to two or more different electrode configurations of an implantable medical lead that has two or more electrodes, and determine a capture threshold of a heart chamber for each of the two or more different electrode configurations, and determine an activation threshold of a phrenic nerve for each of the two or more different electrode configurations using an output signal of an accelerometer;

output an indication of the capture threshold and the activation threshold of the phrenic nerve for each of the two or more different electrode configurations;

receive a selection of one of the two or more different electrode configurations, resulting in a selected electrode configuration; and

deliver stimulation therapy to the heart chamber of the patient using the selected electrode configuration.

11. The medical device of claim 10, wherein the controller is further configured to evaluate, for each of the two or more different electrode configurations, the capture threshold and the activation threshold of the phrenic nerve of the patient, and to determine a relative ranking of the two or more different electrode configurations for delivering stimulation therapy to the heart chamber of the patient.

12. The medical device of claim 11, wherein the outputted indication of the capture threshold and the activation threshold of the phrenic nerve for each of the two or more different electrode configurations includes a measure related to the relative ranking.

13. The medical device of claim 10, wherein the controller further comprises a switch matrix for switching between the two or more different electrode configurations.

14. The medical device of claim 10, wherein the power supply and controller are situated in a housing, and the accelerometer is in the housing.

15. The medical device of claim 10, wherein the power supply and controller are part of an implantable medical device.

16. The medical device of claim 15, wherein the implantable medical lead is operatively coupled to the implantable medical device.

17. The medical device of claim 10, wherein the power supply and controller are part of a programmer.

18. The medical device of claim 17, wherein the implantable medical lead is operatively coupled to the programmer.

19. A method comprising:

delivering stimulation to two or more different electrode configurations of an implantable medical lead that has two or more electrodes;

in response to the delivered stimulation, determining a capture threshold of a heart chamber for each of the two or more different electrode configurations, and determining an activation threshold of a phrenic nerve for each of the two or more different electrode configurations using an output signal of an accelerometer;

determining a relative ranking of the two or more different electrode configurations for delivering stimulation therapy to the heart chamber of the patient based, at least in part, on the capture threshold and the activation threshold of the phrenic nerve for each of the two or more different electrode configurations;

allowing selection of a selected electrode configuration from the two or more different electrode configurations; and

programming an implantable medical device to deliver stimulation therapy to the heart chamber of the patient using the selected electrode configuration.

20. The method of claim 19, further comprising:

outputting the relative ranking of the two or more different electrode configurations to a user interface.