Triggered pacing system

• US 9,669,224 B2
• Filed: 04/23/2015
• Issued: 06/06/2017
• Est. Priority Date: 05/06/2014
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Carney, James K, Kuhn, Jonathan L, Cinbis, Can
• Primary Examiner(s): GETZOW, SCOTT M
• Application Number:
  US14/695,004
• Publication Number:
  US 20150321011A1
• Time in Patent Office: 775 Days
• 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 1/3727 characterised by the modulation technique
• CPC Class Codes: A61N 1/37276 characterised by means for reducing power consumption during telemetry
• CPC Class Codes: A61N 1/37288 Communication to several implantable medical devices within one patient
• CPC Class Codes: A61N 1/3987 characterised by the timing or triggering of the shock

Abstract

A medical device system is configured to sense physiological events by a first device and control a transducer to emit trigger signals in response to the sensed physiological events. A second device detects the trigger signals and delivers therapeutic stimulation pulses in response to the trigger signals. The therapeutic stimulation pulses have a combined total time duration over the sensed physiological events that is greater than the combined total time duration of the trigger signals.

Claims

1. A method for controlling automated delivery of therapeutic stimulation pulses by a medical device system, the method comprising:

sensing a plurality of physiological events by a first device;

controlling a transducer by the first device to emit a plurality of trigger signals in response to the sensed plurality of physiological events, the plurality of trigger signals having a first combined total time duration over the plurality of physiological events;

detecting the plurality of trigger signals by a second device;

delivering a plurality of therapeutic stimulation pulses by the second device in response to detecting the plurality of trigger signals, the plurality of therapeutic stimulation pulses having a second combined total time duration over the plurality of physiological events that is greater than the first combined total time duration;

setting a stimulation pulse control parameter by the first device;

controlling the transducer by the first device to emit at least one of the plurality of trigger signals to contain stimulation pulse control parameter information;

determining by the second device a stimulation pulse control parameter from the detected plurality of trigger signals including the at least one of the plurality of trigger signals containing the stimulation pulse control parameter information; and

delivering at least one of the plurality of stimulation pulses according to the stimulation pulse control parameter; and

further comprising;

performing a capture threshold search to determine the stimulation pulse control parameter by;

controlling the transducer to emit a series of trigger signals to control the second device to deliver a plurality of stimulation pulses at different pulse energies;

sensing by the first device a physiological signal to detect capture by the plurality of stimulation pulses; and

determining by the first device the lowest pulse energy that captures a target tissue in response to the physiological signal.

2. A method for controlling automated delivery of therapeutic stimulation pulses by a medical device system, the method comprising:

sensing a plurality of physiological events by a first device;

controlling a transducer by the first device to emit a plurality of trigger signals in response to the sensed plurality of physiological events, the plurality of trigger signals having a first combined total time duration over the plurality of physiological events;

detecting the plurality of trigger signals by a second device;

delivering a plurality of therapeutic stimulation pulses by the second device in response to detecting the plurality of trigger signals, the plurality of therapeutic stimulation pulses having a second combined total time duration over the plurality of physiological events that is greater than the first combined total time duration; and

further comprising;

determining intervals between the plurality of sensed physiological events;

determining a metric of differences between the intervals;

comparing the metric to a change threshold; and

withholding a trigger signal in response to the metric not meeting the change threshold.

3. A method for controlling automated delivery of therapeutic stimulation pulses by a medical device system, the method comprising:

sensing a plurality of physiological events by a first device;

controlling a transducer by the first device to emit a plurality of trigger signals in response to the sensed plurality of physiological events, the plurality of trigger signals having a first combined total time duration over the plurality of physiological events;

detecting the plurality of trigger signals by a second device;

delivering a plurality of therapeutic stimulation pulses by the second device in response to detecting the plurality of trigger signals, the plurality of therapeutic stimulation pulses having a second combined total time duration over the plurality of physiological events that is greater than the first combined total time duration; and

further comprising;

determining by the second device an interval between successive ones of the plurality of trigger signals;

storing the determined interval as a trigger interval;

starting a delay time by the second device in response to detecting one of the plurality of trigger signals;

delivering a first one of the plurality of therapeutic stimulation pulses after the delay time expires;

scheduling a next one of the plurality of therapeutic stimulation pulses by starting the trigger interval upon delivering the first one of the plurality of therapeutic stimulation pulses;

adjusting the next one of the plurality of therapeutic stimulation pulses in response to detecting a next one of the plurality of trigger signals during the trigger interval; and

delivering the next one of the plurality of therapeutic stimulation pulses without adjustment upon expiration of the trigger interval if the next one of the plurality of trigger signals is not detected during the trigger interval.

4. A method for controlling automated delivery of therapeutic stimulation pulses by a medical device system, the method comprising:

sensing a plurality of physiological events by a first device;

controlling a transducer by the first device to emit a plurality of trigger signals in response to the sensed plurality of physiological events, the plurality of trigger signals having a first combined total time duration over the plurality of physiological events;

detecting the plurality of trigger signals by a second device;

delivering a plurality of therapeutic stimulation pulses by the second device in response to detecting the plurality of trigger signals, the plurality of therapeutic stimulation pulses having a second combined total time duration over the plurality of physiological events that is greater than the first combined total time duration; and

further comprising;

controlling the transducer by the first device to emit the next one of the plurality of trigger signals at a control time interval after a sensed physiological event, the control time interval being set at a targeted therapy time interval less a delay time by the second device in response to detecting one of the plurality of trigger signals.

5. A method for controlling automated delivery of therapeutic stimulation pulses by a medical device system, the method comprising:

sensing a plurality of physiological events by a first device;

controlling a transducer by the first device to emit a plurality of trigger signals in response to the sensed plurality of physiological events, the plurality of trigger signals having a first combined total time duration over the plurality of physiological events;

detecting the plurality of trigger signals by a second device;

delivering a plurality of therapeutic stimulation pulses by the second device in response to detecting the plurality of trigger signals, the plurality of therapeutic stimulation pulses having a second combined total time duration over the plurality of physiological events that is greater than the first combined total time duration; and

further comprising;

monitoring a remaining voltage of a battery of the second device by a control module of the second device;

in response to the remaining battery voltage reaching a threshold, adjusting an amplitude of the therapeutic stimulation pulses;

sensing a physiological signal by the first device;

determining by the first device that the amplitude of the therapeutic stimulation pulses has been adjusted in response to the physiological signal; and

generating an alert signal by the first device in response to determining that the amplitude has been adjusted.

6. A method for controlling automated delivery of therapeutic stimulation pulses by a medical device system, the method comprising:

sensing a plurality of physiological events by a first device;

controlling a transducer by the first device to emit a plurality of trigger signals in response to the sensed plurality of physiological events, the plurality of trigger signals having a first combined total time duration over the plurality of physiological events;

detecting the plurality of trigger signals by a second device;

delivering a plurality of therapeutic stimulation pulses by the second device in response to detecting the plurality of trigger signals, the plurality of therapeutic stimulation pulses having a second combined total time duration over the plurality of physiological events that is greater than the first combined total time duration; and

further comprising;

controlling the transducer to emit each of the plurality of trigger signals comprising a plurality of pulses separated by respective pulse intervals;

setting a noise rejection interval during the pulse intervals; and

rejecting a detected trigger signal pulse if a pulse is detected during the noise rejection interval.

7. A method for controlling automated delivery of therapeutic stimulation pulses by a medical device system, the method comprising:

sensing a plurality of physiological events by a first device;

controlling a transducer by the first device to emit a plurality of trigger signals in response to the sensed plurality of physiological events, the plurality of trigger signals having a first combined total time duration over the plurality of physiological events;

detecting the plurality of trigger signals by a second device;

delivering a plurality of therapeutic stimulation pulses by the second device in response to detecting the plurality of trigger signals, the plurality of therapeutic stimulation pulses having a second combined total time duration over the plurality of physiological events that is greater than the first combined total time duration; and

further comprising;

controlling the transducer to emit first ones of the plurality of trigger signals with a first trigger signal parameter and second ones of the plurality of trigger signals with a second trigger signal parameter different than the first trigger signal parameter;

detecting the first ones of the plurality of trigger signals by the second device, the second device configured to detect the first trigger signal parameter; and

detecting the second ones of the plurality of trigger signals by a third device configured to detect the second trigger signal parameter and deliver therapeutic stimulation pulses in response to detecting the second ones of the plurality of trigger signals.

8. A medical device system for controlling automated delivery of therapeutic stimulation pulses, comprising:

a transducer for emitting a trigger signal;

a first device configured to;

sense a plurality of physiological events; and

control the transducer to produce a plurality of trigger signals in response to the sensed plurality of physiological events, the plurality of trigger signals having a first combined total time duration over the plurality of physiological events;

a second device configured to;

detect the plurality of trigger signals; and

deliver a plurality of therapeutic stimulation pulses in response to detecting the plurality of trigger signals, the plurality of therapeutic stimulation pulses having a second combined total time duration over the plurality of physiological events that is greater than the first combined total time duration;

wherein the first device is further configured to;

set a stimulation pulse control parameter; and

control the transducer to emit at least one of the plurality of trigger signals to contain stimulation pulse control parameter information; and

the second device is further configured to;

determine a stimulation pulse control parameter from the detected plurality of trigger signals including the at least one of the plurality of trigger signals containing the stimulation pulse control parameter information; and

deliver at least one of the plurality of stimulation pulses according to the stimulation pulse control parameter; and

wherein;

the first device and the second device are configured to perform a capture threshold search to determine the stimulation pulse control parameter by;

controlling the transducer by the first device to emit a series of trigger signals to control the second device to deliver a plurality of stimulation pulses at different pulse energies;

sensing by the first device a physiological signal to detect capture by the plurality of stimulation pulses; and

determining by the first device the lowest pulse energy that captures a target tissue in response to the physiological signal.

9. A medical device system for controlling automated delivery of therapeutic stimulation pulses, comprising:

a transducer for emitting a trigger signal;

a first device configured to;

sense a plurality of physiological events; and

control the transducer to produce a plurality of trigger signals in response to the sensed plurality of physiological events, the plurality of trigger signals having a first combined total time duration over the plurality of physiological events;

a second device configured to;

detect the plurality of trigger signals; and

deliver a plurality of therapeutic stimulation pulses in response to detecting the plurality of trigger signals, the plurality of therapeutic stimulation pulses having a second combined total time duration over the plurality of physiological events that is greater than the first combined total time duration; and

wherein;

the first device is further configured to;

determine intervals between the plurality of sensed physiological events;

determine a metric of differences between the intervals;

compare the metric to a change threshold; and

control the transducer to withhold a trigger signal in response to the metric not meeting the change threshold.

10. A medical device system for controlling automated delivery of therapeutic stimulation pulses, comprising:

a transducer for emitting a trigger signal;

a first device configured to;

sense a plurality of physiological events; and

control the transducer to produce a plurality of trigger signals in response to the sensed plurality of physiological events, the plurality of trigger signals having a first combined total time duration over the plurality of physiological events;

a second device configured to;

detect the plurality of trigger signals; and

deliver a plurality of therapeutic stimulation pulses in response to detecting the plurality of trigger signals, the plurality of therapeutic stimulation pulses having a second combined total time duration over the plurality of physiological events that is greater than the first combined total time duration; and

wherein the second device is further configured to;

determine an interval between successive ones of the plurality of trigger signals;

store the determined interval as a trigger interval;

start a delay time in response to detecting one of the plurality of trigger signals;

deliver a first one of the plurality of therapeutic stimulation pulses after the delay time expires;

schedule a next one of the plurality of therapeutic stimulation pulses by starting the trigger interval upon delivering the first one of the plurality of therapeutic stimulation pulses;

adjust the next one of the plurality of therapeutic stimulation pulses in response to detecting a next one of the plurality of trigger signals during the trigger interval; and

deliver the next one of the plurality of therapeutic stimulation pulses without adjustment upon expiration of the trigger interval if the next one of the plurality of trigger signals is not detected during the trigger interval.

11. The system of claim 10, wherein the first device is further configured to control the transducer to emit the next one of the plurality of trigger signals at a control time interval after a sensed physiological event, the control time interval being set at a targeted therapy time interval less the delay time.

12. A medical device system for controlling automated delivery of therapeutic stimulation pulses, comprising:

a transducer for emitting a trigger signal;

a first device configured to;

sense a plurality of physiological events; and

control the transducer to produce a plurality of trigger signals in response to the sensed plurality of physiological events, the plurality of trigger signals having a first combined total time duration over the plurality of physiological events;

a second device configured to;

detect the plurality of trigger signals; and

deliver a plurality of therapeutic stimulation pulses in response to detecting the plurality of trigger signals, the plurality of therapeutic stimulation pulses having a second combined total time duration over the plurality of physiological events that is greater than the first combined total time duration;

wherein;

the second device comprises a control module and a battery coupled to the control module, the control module configured to;

monitor a remaining voltage of the battery;

adjust an amplitude of at least a portion of the therapeutic stimulation pulses in response to the remaining battery voltage reaching a threshold;

the first device configured to;

sense a physiological signal;

determine that the amplitude of the plurality of the therapeutic stimulation pulses has been adjusted in response to the physiological signal; and

generate an alert signal in response to determining that the amplitude has been adjusted.

13. A medical device system for controlling automated delivery of therapeutic stimulation pulses, comprising:

a transducer for emitting a trigger signal;

a first device configured to;

sense a plurality of physiological events; and

control the transducer to produce a plurality of trigger signals in response to the sensed plurality of physiological events, the plurality of trigger signals having a first combined total time duration over the plurality of physiological events;

a second device configured to;

detect the plurality of trigger signals; and

deliver a plurality of therapeutic stimulation pulses in response to detecting the plurality of trigger signals, the plurality of therapeutic stimulation pulses having a second combined total time duration over the plurality of physiological events that is greater than the first combined total time duration;

wherein;

the first device is configured to;

control the transducer to emit each of the plurality of trigger signals comprising a plurality of pulses separated by respective pulse intervals;

the second device is configured to;

set a noise rejection interval during each of the pulse intervals; and

reject a detected trigger signal pulse if the detected trigger signal pulse is detected during the noise rejection interval.

14. A medical device system for controlling automated delivery of therapeutic stimulation pulses, comprising:

a transducer for emitting a trigger signal;

a first device configured to;

sense a plurality of physiological events; and

control the transducer to produce a plurality of trigger signals in response to the sensed plurality of physiological events, the plurality of trigger signals having a first combined total time duration over the plurality of physiological events;

a second device configured to;

detect the plurality of trigger signals; and

deliver a plurality of therapeutic stimulation pulses in response to detecting the plurality of trigger signals, the plurality of therapeutic stimulation pulses having a second combined total time duration over the plurality of physiological events that is greater than the first combined total time duration; and

further comprising a third device, wherein;

the first device is configured to;

control the transducer to emit first ones of the plurality of trigger signals with a first trigger signal parameter and second ones of the plurality of trigger signals with a second trigger signal parameter different than the first trigger signal parameter;

the second device is configured to detect the first ones of the plurality of trigger signals by detecting trigger signals of the plurality of trigger signals having the first trigger signal parameter; and

the third device is configured to;

detect the second ones of the plurality of trigger signals by detecting trigger signals of the plurality of trigger signals having the second trigger signal parameter; and

deliver therapeutic stimulation pulses in response to detecting the second ones of the plurality of trigger signals.