Method and apparatus to perform electrode combination selection

• US 9,539,429 B2
• Filed: 06/24/2013
• Issued: 01/10/2017
• 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: Brooke, M. Jason, Acuna, Andrea
• Primary Examiner(s): Layno, Carl H
• Assistant Examiner(s): Morales, Jon Eric C
• Application Number:
  US13/925,413
• Publication Number:
  US 20140005741A1
• Time in Patent Office: 1,296 Days
• Field of Search: 607 27- 28
• US Class Current: 1/1
• CPC Class Codes: A61N 1/36185 Selection of the electrode configuration
• 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 1/3684 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 1/37 Monitoring; Protecting
• CPC Class Codes: A61N 1/3706 Pacemaker parameters stimulation threshold A61N1/371
• CPC Class Codes: A61N 1/3708 for power depletion
• CPC Class Codes: A61N 1/371 Capture, i.e. successful stimulation
• CPC Class Codes: A61N 1/37211 Means for communicating with stimulators
• CPC Class Codes: A61N 1/37241 providing test stimulations
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

The present invention involves approaches for selecting one or more electrode combinations. Various method embodiments can include implanting a plurality of cardiac electrodes supported by one or more leads in a patient, attaching the one or more leads to a patient external analyzer circuit, delivering electrical stimulation to the patient'"'"'s heart using the plurality of cardiac electrodes and the analyzer circuit, evaluating, for each electrode combination of a plurality of electrode combinations of the plurality of cardiac electrodes, one or more first parameters and one or more second parameters produced by the electrical stimulation delivered using the electrode combination, selecting one or more electrode combinations of the plurality of cardiac electrodes based on the evaluation, and programming an implantable pacing circuit to deliver a cardiac pacing therapy that preferentially uses the selected one or more electrode combinations relative to other electrode combinations of the plurality of cardiac electrodes.

Claims

1. A method for programming an implantable CRM device using an external programmer that has a display, wherein the CRM device includes an implantable lead having two or more electrodes, and wherein the CRM device is capable of selecting an electrode combination from a plurality of electrode combinations for use during therapy, the method comprising:

establishing communication between the implantable CRM device and the external programmer;

measuring or estimating a number of parameter values for each of two or more of the electrode combinations, wherein the number of parameter values include;

a value related to a capture threshold for the corresponding electrode combination;

a value indicative of battery consumption for the corresponding electrode combination, wherein the battery consumption corresponds to the measured or estimated value related to the capture threshold of the corresponding electrode combination;

a value related to an impedance for the corresponding electrode combination; and

a value related to phrenic nerve stimulation for the corresponding electrode combination; and

displaying on the display of the external programmer a table that includes, for each of at least two of the two or more electrode combinations, the value related to the capture threshold, the value indicative of the battery consumption, the value related to the impedance, and the value related to phrenic nerve stimulation;

selecting an electrode combination for therapy based, at least in part, on the table; and

uploading the selected electrode combination to the CRM device.

2. The method of claim 1, wherein the table is a multi-dimensional table.

3. The method of claim 1, wherein the number of parameter values further includes a value related to depolarization and/or repolarization wave characteristics of the heart.

4. The method of claim 1, wherein the number of parameter values further includes a value related to ventricular synchronization.

5. A method, comprising:

identifying, for each electrode combination of two or more electrode combinations, values for two or more parameters, wherein at least one of the two or more parameters is indicative of a measured or estimated capture threshold for the corresponding electrode combination, and at least one of the two or more parameters is indicative of battery consumption for the corresponding electrode combination, wherein the parameter indicative of battery consumption corresponds to the measured or estimated capture threshold for the corresponding electrode combination; and

simultaneously displaying on a display the value for the capture threshold parameter and the value for the battery consumption parameter for each of the two or more electrode combinations.

6. The method of claim 5, wherein the value related to the capture threshold for the corresponding electrode combination is measured by the implantable medical device.

7. The method of claim 5, wherein at least one of the two or more parameters relates to an impedance for the corresponding electrode combination, and wherein at least one of the two or more parameters relates to phrenic nerve stimulation for the corresponding electrode combination, the method further including:

graphically displaying on the display the value related to the impedance and the value related to phrenic nerve stimulation for each of the two or more electrode combinations.

8. The method of claim 7, wherein the value related to the impedance for the corresponding electrode combination is measured by the implantable medical device.

9. The method of claim 7, wherein the value related to phrenic nerve stimulation for the corresponding electrode combination relates to whether phrenic nerve stimulation was identified or not for the corresponding electrode combination.

10. The method of claim 5, wherein the value related to the battery consumption for the corresponding electrode combination and the value related to the capture threshold for the corresponding electrode combination are displayed in a table on the display.

11. The method of claim 10, wherein the table is a multi-dimensional table.

12. The method of claim 5, wherein the display is a display of an external programmer.

13. The method of claim 12, further comprising:

using the external programmer to select an electrode combination for therapy based, at least in part, on the value related to the battery consumption and the value related to the capture threshold for each of two or more electrode combinations; and

uploading the selected electrode combination to the implantable medical device.

14. A programmer for programming an implantable Cardiac Rhythm Management (CRM) device, wherein the CRM device includes an implantable lead having two or more electrodes, and wherein the CRM device is capable of selecting an electrode combination from a plurality of electrode combinations for use during therapy, the programmer comprising:

a user interface including a display;

an I/O unit for communicating with an implantable CRM device;

a data processor coupled to the display and the I/O unit, the data processor programmed to;

read values for a number of parameters for each of two more of the plurality of electrode combinations of the implantable medical device, wherein the number of parameter values include;

a value related to a measured or estimated capture threshold for the corresponding electrode combination;

a value indicative of battery consumption for the corresponding electrode combination, wherein the value indicative of the battery consumption corresponds to the measured or estimated capture threshold for the corresponding electrode combination, and the value indicative of the battery consumption for the corresponding electrode combination is different from a value indicative of the battery consumption for at least one other of the plurality of electrode combinations;

a value related to an impedance for the corresponding electrode combination; and

a value related to phrenic nerve stimulation for the corresponding electrode combination; and

simultaneously display on the display of the user interface the value related to the capture threshold, the value indicative of the battery consumption, the value related to the impedance, and the value related to phrenic nerve stimulation for each of at least two of the two or more electrode combinations;

allow a user to select an electrode combination via the user interface based, at least in part, on the values of the number of parameters; and

upload the selected electrode combination to the CRM device via the I/O unit.

15. The programmer of claim 14, wherein the data processor is programmed to graphically display the values for each of the number of parameters for each of at least two of the two or more electrode combinations in a table format.

16. The programmer of claim 15, wherein the table is a multi-dimensional table.

17. The programmer of claim 14, wherein the number of parameters include a parameter related to ventricular synchronization.

18. The programmer of claim 14, wherein the data processor is configured to obtain values for one or more of the parameters from the CRM device and to store the obtained values in a memory.

19. The programmer of claim 14, wherein the data processor is configured to read values for the number of parameters for each of two more electrode combinations from a memory.