WO2008079347A1 - Dispositif implantable avec plusieurs ensembles de paramètres - Google Patents

Dispositif implantable avec plusieurs ensembles de paramètres Download PDF

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Publication number
WO2008079347A1
WO2008079347A1 PCT/US2007/026191 US2007026191W WO2008079347A1 WO 2008079347 A1 WO2008079347 A1 WO 2008079347A1 US 2007026191 W US2007026191 W US 2007026191W WO 2008079347 A1 WO2008079347 A1 WO 2008079347A1
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WO
WIPO (PCT)
Prior art keywords
therapy control
control parameter
parameter set
management device
cardiac function
Prior art date
Application number
PCT/US2007/026191
Other languages
English (en)
Inventor
Alok S. Sathaye
Shelley M. Cazares
Andrew P. Kramer
Yanting Dong
Xuan Wei
Ankur Garg
Quan Ni
Original Assignee
Cardiac Pacemakers, Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from US11/614,578 external-priority patent/US8868183B2/en
Application filed by Cardiac Pacemakers, Inc. filed Critical Cardiac Pacemakers, Inc.
Publication of WO2008079347A1 publication Critical patent/WO2008079347A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/3627—Heart stimulators for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H20/00—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
    • G16H20/30—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance relating to physical therapies or activities, e.g. physiotherapy, acupressure or exercising
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H40/00—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices
    • G16H40/60—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices
    • G16H40/67—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices for remote operation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
    • A61N1/368—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
    • A61N1/368—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions
    • A61N1/3688—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions configured for switching the pacing mode, e.g. from AAI to DDD
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/372—Arrangements in connection with the implantation of stimulators
    • A61N1/37211—Means for communicating with stimulators
    • A61N1/37252—Details of algorithms or data aspects of communication system, e.g. handshaking, transmitting specific data or segmenting data
    • A61N1/37282—Details of algorithms or data aspects of communication system, e.g. handshaking, transmitting specific data or segmenting data characterised by communication with experts in remote locations using a network

Definitions

  • CRM cardiac rhythm management
  • the sinoatrial node In a normal heart, the sinoatrial node, the heart's predominant natural pacemaker, generates electrical impulses, called action potentials, that propagate through an electrical conduction system to the atria and then to the ventricles of the heart to excite the myocardial tissues.
  • the atria and ventricles contract in the normal atrio-ventricular sequence and synchrony to result in efficient blood- pumping functions indicated by a normal hemodynamic performance.
  • These intrinsic action potentials can be sensed on a surface electrocardiogram (i.e., a "surface ECG signal") obtained from electrodes placed on the patient's skin, or from electrodes implanted within the patient's body (i.e., an "electrogram signal").
  • the surface ECG and electrogram waveforms for example, include artifacts associated with atrial depolarizations ("P-waves") and those associated with ventricular depolarizations ("QRS complexes").
  • CRM systems include, among other things, pacemakers which deliver timed sequences of low energy electrical stimuli, called pace pulses, to the heart. By properly timing the delivery of pace pulses, the heart can be induced to contract in proper rhythm, improving efficiency.
  • defibrillators include defibrillators that are capable of delivering higher energy electrical stimuli to the heart. Such defibrillators include cardioverters, which synchronize the delivery of such stimuli to sensed intrinsic heart activity signals.
  • Defibrillators are often used to treat patients with tachyarrhythmias, which can be thought of as abnormal heart rhythms characterized by a rapid heart rate. Fibrillation is a form of tachyarrhythmia further characterized by an irregular heart rhythm.
  • a CRM device Upon implantation, a CRM device is programmed to perform in response to detected electrical or mechanical disturbances within the heart. How the device is programmed may have a direct impact upon patient outcome.
  • a caregiver may rely upon historical data to determine how to set the programming parameters to be used until the next follow-up appointment, during which time results may be measured and recorded. After a specified period of time, the patient returns for a follow-up visit with the caregiver, the results are evaluated, and the device is re-programmed, if appropriate.
  • an implantable cardiac function management device including a programmable controller can be used to include a user-specifiable therapy control parameter set.
  • the therapy control parameter set may then be configured to include at least one therapy control parameter that is user-configurable to automatically switch from a first parameter value to a second parameter value at a time that occurs between separate user programming sessions of the device.
  • Various attributes of physiological measures may allow for refinement of the parameter sets to adapt to changed conditions of the subject.
  • Example 1 describes an apparatus comprising an implantable cardiac function management device.
  • the implantable cardiac function management device includes a programmable controller.
  • the programmable controller is configured to include a user-specifiable therapy control parameter set.
  • the therapy control parameter set is configured to include at least one therapy control parameter that is user-configurable to automatically switch from a first parameter value to a second parameter value at a time that occurs between separate user programming sessions of the device.
  • Example 2 the apparatus of Example 1 is optionally configured to obtain at least one physiological measure for each combination of parameter values of the therapy control parameter set.
  • Example 3 the apparatus of at least one of Examples 1 or 2 is optionally configured such that at least one physiological measure includes information from a separate and unattached physiological sensor.
  • Example 4 the apparatus of at least one of Examples 1 - 3 optionally includes the controller configured to determine which combination of parameter values contributed to a particular outcome as evidenced by at least one physiological measure.
  • Example 5 the apparatus of at least one of Examples 1 - 4 optionally includes the controller configured to determine which of the first and second parameter value contributed more to the at least one physiological measure.
  • Example 6 the apparatus of at least one of Examples 1 - 5 optionally includes the controller configured to suggest at least one combination of parameter values as a function of past physiological measures.
  • Example 7 the apparatus of at least one of Examples 1 - 6 optionally includes the device having multiple therapy control parameter sets, wherein the device is configured to sequence through two or more of the therapy control parameter sets.
  • Example 8 the apparatus of at least one of Examples 1 - 7 is optionally configured with at least one therapy control parameter set that includes at least one of a user-configurable range and a user-configurable duration.
  • Example 9 the apparatus of at least one of Examples 1 - 8 is optionally configured such that the sequence occurs symmetrically from an initial parameter set to a final parameter set.
  • Example 10 the apparatus of at least one of Examples 1 - 9 is optionally configured such that the duration is user-specifiable as a period of time.
  • Example 11 the apparatus of at least one of Examples 1 — 10 is optionally configured such that the duration is user-specifiable as expiring upon reaching a threshold of detected events.
  • Example 12 includes a method comprising receiving user input to program a cardiac function management device and using the user input to automatically alter, at a time that occurs between separate user-programming sessions, a parameter value of at least one therapy control parameter.
  • Example 13 the method of Example 12 is optionally performed such that it includes obtaining at least one physiological measure for each combination of parameter values of the therapy control parameter set.
  • Example 14 the method of at least one of Examples 12 - 13 optionally includes determining which of the combination of parameter values contributed to a particular outcome as evidenced by at least one physiological measure.
  • Example 15 the method of at least one of Examples 12 - 14 optionally includes using the user input for automatically sequencing through multiple therapy control parameter sets at times occurring between separate user-programming sessions.
  • Example 16 the method of at least one of Examples 12 - 15 optionally includes using at least one of a user-specified range and a user-specified duration for performing the sequencing.
  • Example 17 the method of at least one of Examples 12 - 16 optionally includes using a user-specified duration that is user-specified as a time.
  • Example 18 the method of at least one of Examples 12 - 17 optionally includes using a user-specified duration that is user-specified as a threshold number of detected events.
  • Example 19 the method of at least one of Examples 12 - 18 is optionally performed such that the sequencing occurs sequentially from the initial parameter set to the final parameter set.
  • Example 20 describes an apparatus comprising means for receiving user input to program a cardiac function management device and means for using the user input to automatically alter, at a time that occurs between separate user- programming sessions, a parameter value of at least one therapy control parameter.
  • Example 21 the apparatus of Example 20 is optionally configured such that it includes means for obtaining at least one physiological measure for each combination of parameter values of the therapy control parameter set.
  • Example 22 the apparatus of at least one of Examples 20 - 21 optionally includes means for automatically sequencing, using the user input, through multiple therapy control parameter sets at times occurring between separate user- programming sessions.
  • the apparatus of at least one of Examples 20 - 22 optionally includes means for using at least one of a user-specified range and a user-specified duration for performing the sequencing.
  • Example 24 describes an example of an apparatus comprising a remote external interface for an implantable cardiac function management device, configured to be communicatively coupled to the implantable cardiac function management device via a network to a local external interface and via telemetry between the local external interface and the implantable cardiac function management device, the remote external interface comprising a communication circuit, configured to communicate with the implantable cardiac function management device; and a processor circuit, configured to perform an analysis of physiologic data received from the implantable cardiac function management device in response to operation of the implantable cardiac function management device using a plurality of therapy control parameter sets, the processor circuit configured to select a particular therapy control parameter set using the analysis.
  • Example 25 the apparatus of Example 24 optionally includes the implantable cardiac function management device.
  • Example 26 the apparatus of Examples 24-25 optionally includes the local external interface.
  • Example 27 the apparatus of Examples 24-26 optionally includes an external sensor device.
  • Example 28 the apparatus of Examples 24-27 optionally includes the processor circuit being located in the network.
  • Example 29 the apparatus of Examples 24-28 optionally includes the remote external interface configured to program the implantable cardiac function management device with one or more of the particular therapy control parameter set and a particular physiological response to store.
  • Example 30 the apparatus of Examples 24-29 optionally includes the remote external interface configured to program the implantable cardiac function management device with an original therapy control parameter set or a default therapy control parameter set.
  • the apparatus of Examples 24-30 optionally includes the local external interface, the network, or the remote external interface configured to suggest to a third party the particular therapy control parameter set to program into the implantable cardiac function management device.
  • Example 32 the apparatus of Examples 24-31 optionally includes the suggestion being based on at least one of an analysis of an aggregation of historic patient data or device performance data.
  • the apparatus of Examples 24-32 optionally includes the remote external interface configured to receive information about at least one of the plurality of therapy control parameter sets from a third party.
  • Example 34 the apparatus of Examples 24-33 optionally includes the remote external interface configured to receive from a third party at least one of a selection of the particular therapy control parameter set or a value for a physiological parameter.
  • Example 35 the apparatus of Examples 24-34 optionally includes the processor configured to perform an analysis of at least one of device performance data or patient feedback data.
  • Example 36 the apparatus of Examples 24-35 optionally includes at least one of the therapy control parameter sets including at least one of an AV delay parameter, a VV offset parameter, a rate response parameter, a tachy detection parameter, a tachy therapy parameter, a pacing amplitude parameter, or a neural stimulation parameter.
  • the therapy control parameter sets including at least one of an AV delay parameter, a VV offset parameter, a rate response parameter, a tachy detection parameter, a tachy therapy parameter, a pacing amplitude parameter, or a neural stimulation parameter.
  • Example 37 the apparatus of Examples 24-36 optionally includes the processor configured to perform the analysis of physiologic data that includes at least one of a heart rate variability, a peripheral pressure, a blood pressure, a body weight, an activity log, a tachy conversion efficacy, a respiration rate, a posture indicator, a hemodynamic response parameter, an electrocardiogram, or a percentage of A/V pacing.
  • physiologic data includes at least one of a heart rate variability, a peripheral pressure, a blood pressure, a body weight, an activity log, a tachy conversion efficacy, a respiration rate, a posture indicator, a hemodynamic response parameter, an electrocardiogram, or a percentage of A/V pacing.
  • Example 38 the apparatus of Examples 24-37 optionally includes the remote external interface configured to communicate with the implantable cardiac function management device during a real time communication session.
  • the apparatus of Examples 24-38 optionally includes the processor circuit configured to adjust therapy control parameter sets using the analysis of the physiologic data.
  • Example 40 the apparatus of Examples 24-39 optionally includes the adjustment of the therapy control parameter sets uses at least one of a gradient search, an evolution algorithm, a simulated annealing method, a simplex algorithm, or a simplex algorithm.
  • a process includes receiving over a network physiologic data from an implantable cardiac function management device, the physiologic data resulting from operation of the implantable cardiac function management device using a plurality of therapy control parameter sets; analyzing the physiologic data; and selecting a particular therapy control parameter set using the analysis.
  • Example 42 the process of Example 41 optionally includes programming the implantable cardiac function management device with the particular therapy control parameter set.
  • Example 43 the process of Examples 41-42 optionally includes programming the implantable cardiac function management device with an original therapy control parameter set or a default therapy control parameter set.
  • Example 44 the process of Examples 41-43 optionally includes providing to a third party a suggestion of the particular therapy control parameter set to program into the implantable cardiac function management device.
  • Example 45 the process of Examples 41-44 optionally includes automatically adjusting the particular therapy control parameter set or a particular therapy control parameter and automatically programming the adjusted particular therapy control parameter set or the particular therapy control parameter into the implantable cardiac function management device.
  • Example 46 the process of Examples 41-45 optionally includes receiving, at the remote external interface, from a third party, the one or more therapy control parameter sets.
  • Example 47 the process of Examples 41-46 optionally includes receiving, at the remote external interface, an interval range for at least one parameter in the therapy control parameter sets, a time interval that the cardiac function management device is configured to operate with at least one of the therapy control parameter sets, or a value for a physiological parameter.
  • Example 48 the process of Examples 41-47 optionally includes communicating with the implantable cardiac function management device in real time.
  • Example 49 the process of Examples 41-48 optionally includes adjusting parameter sets using the analysis of the physiologic data.
  • Example 50 the process of Examples 41-49 optionally includes adjusting the parameter search space using at least one of a gradient search, an evolution algorithm, a simulated annealing method, or a simplex algorithm.
  • an apparatus includes means for receiving over a network physiologic data from an implantable cardiac function management device, the physiologic data resulting from operation of the implantable cardiac function management device using a plurality of therapy control parameter sets; means for analyzing the physiologic data; and means for selecting a particular therapy control parameter set using the analysis.
  • an apparatus includes an implantable cardiac function management device including a programmable controller, the programmable controller configured to include a user-specifiable therapy control parameter set, wherein the therapy control parameter set is configured to include at least one therapy control parameter that is user-configurable to automatically switch from a first parameter value to a second parameter value at a time that occurs between separate user programming sessions of the device.
  • Example 53 the apparatus of Example 52 is optionally configured such that the controller obtains at least one physiological measure for each combination of parameter values of the therapy control parameter set.
  • Example 54 the apparatus of Examples 52-53 is optionally configured such that the at least one physiological measure includes information from a separate and unattached physiological sensor.
  • Example 55 the apparatus of Examples 52-54 is optionally configured such that the controller determines which combination of parameter values contributed to a particular outcome as evidenced by at least one physiological measure.
  • Example 56 the apparatus of Examples 52-55 is optionally configured such that the controller determines which of the first and second parameter value contributed more to the at least one physiological measure.
  • Example 57 the apparatus of Examples 52-56 is optionally configured such that the controller suggests at least one combination of parameter values as a function of past physiological measures.
  • Example 58 the apparatus of Examples 52-57 is optionally configured such that the device includes multiple therapy control parameter sets, and the device sequences through two or more of the therapy control parameter sets.
  • the apparatus of Examples 52-58 optionally includes a remote external interface for the implantable cardiac function management device, configured to be communicatively coupled to the implantable cardiac function management device via a network to a local external interface and via telemetry between the local external interface and the implantable cardiac function management device, the remote external interface comprising a communication circuit, configured to communicate with the implantable cardiac function management device, and a processor circuit, configured to perform an analysis of physiologic data received from the implantable cardiac function management device in response to operation of the implantable cardiac function management device using a plurality of the therapy control parameter sets, the processor circuit configured to select a particular therapy control parameter set using the analysis.
  • a remote external interface for the implantable cardiac function management device configured to be communicatively coupled to the implantable cardiac function management device via a network to a local external interface and via telemetry between the local external interface and the implantable cardiac function management device
  • the remote external interface comprising a communication circuit, configured to communicate with the implantable cardiac function management device, and a processor circuit, configured to perform an analysis of
  • Example 60 the apparatus of Examples 52-59 optionally includes one or more of the implantable cardiac function management device, the local external interface, and an external sensor device.
  • Example 61 the apparatus of Examples 52-60 is optionally configured such that the remote external interface programs the implantable cardiac function management device with one or more of the particular therapy control parameter sets and a particular physiological response to store.
  • Example 62 the apparatus of Examples 52-61 is optionally configured such that the remote external interface programs the implantable cardiac function management device with an original therapy control parameter set or a default therapy control parameter set.
  • Example 63 the apparatus of Examples 52-62 is optionally configured such that the local external interface, the network, or the remote external interface suggests to a third party the particular therapy control parameter set to program into the implantable cardiac function management device.
  • Example 64 the apparatus of Examples 52-63 is optionally configured such that the suggestion is based on at least one of an analysis of an aggregation of historic patient data or device performance data.
  • Example 65 the apparatus of Examples 52-64 is optionally configured such that the processor performs an analysis of at least one of device performance data or patient feedback data.
  • Example 66 the apparatus of Examples 52-65 is optionally configured such that the processor circuit adjusts one or more therapy control parameter sets using the analysis of the physiologic data.
  • Example 67 the apparatus of Examples 52-66 is optionally configured such that the adjustment of the one or more therapy control parameter sets comprises using the analysis of the physiologic data to reduce a parameter space for which the processor circuit then analyzes the physiologic data.
  • Example 68 the apparatus of Examples 52-67 is optionally configured such that the optimization algorithm includes at least one of a gradient search, an evolution algorithm, a simulated annealing method, or a simplex algorithm.
  • the optimization algorithm includes at least one of a gradient search, an evolution algorithm, a simulated annealing method, or a simplex algorithm.
  • a method includes receiving user input to program a cardiac function management device, and using the user input to automatically alter, at a time that occurs between separate user-programming sessions, a parameter value of at least one therapy control parameter.
  • Example 70 the method of Example 69 optionally includes obtaining at least one physiological measure for each combination of parameter values of the therapy control parameter set.
  • Example 71 the method of Examples 69-70 optionally includes determining which of the combination of parameter values contributed to a particular outcome as evidenced by at least one physiological measure.
  • Example 72 the method of Examples 69-71 optionally includes using the user input for automatically sequencing through multiple therapy control parameter sets at times occurring between separate user-programming sessions.
  • the method of Examples 69-72 optionally includes receiving over a network physiologic data from the cardiac function management device, the physiologic data resulting from operation of the cardiac function management device using a plurality of therapy control parameter sets, analyzing the physiologic data, and selecting a particular therapy control parameter set using the analysis.
  • Example 74 the method of Examples 69-73 optionally includes programming the implantable cardiac function management device with the particular therapy control parameter set.
  • Example 75 the method of Examples 69-74 optionally includes providing to a third party a suggestion of the particular therapy control parameter set to program into the implantable cardiac function management device.
  • Example 76 the method of Examples 69-75 optionally includes automatically adjusting the particular therapy control parameter set or a particular therapy control parameter and automatically programming the adjusted particular therapy control parameter set or the particular therapy control parameter into the implantable cardiac function management device.
  • Example 77 the method of Examples 69-76 optionally includes receiving, at the remote external interface, from a third party, the one or more therapy control parameter sets.
  • Example 78 the method of Examples 69-77 optionally includes receiving, at the remote external interface, an interval range for at least one parameter in the therapy control parameter sets, a time interval that the cardiac function management device is configured to operate with at least one of the therapy control parameter sets, or a value for a physiological parameter.
  • the method of Examples 69-78 optionally includes adjusting the therapy control parameter sets using the analysis of the physiologic data.
  • Example 80 the method of Examples 69-79 optionally includes using the analysis of the physiologic data to reduce a parameter space in which the physiologic data is then analyzed.
  • an apparatus includes a means for receiving user input to program a cardiac function management device, and a means for using the user input to automatically alter, at a time that occurs between separate user- programming sessions, a parameter value of at least one therapy control parameter.
  • Example 82 the apparatus of Example 81 optionally includes a means for obtaining at least one physiological measure for each combination of parameter values of the therapy control parameter set.
  • Example 83 the apparatus of Examples 81-82 optionally includes a means for automatically sequencing, using the user input, through multiple therapy control parameter sets at times occurring between separate user-programming sessions.
  • the apparatus of Examples 81-83 optionally includes a means for using at least one of a user-specified range and a user- specified duration for performing the sequencing.
  • FIG. 1 illustrates an example of portions of a system which utilizes a device for monitoring and controlling electrical signals of the heart.
  • FIG. 2 is a flow chart illustrating generally an example of portions of a technique for programming multiple parameter sets and storing responses.
  • FIG. 3 is a flow chart illustrating generally an example of how the results of the multiple parameter sets are evaluated and revised, such as for optimization.
  • FIG. 4 is a flow chart illustrating generally an example of how multiple parameter sets may operate concurrently.
  • FIG. 5 is a flow chart, similar to FIG. 2, but illustrating an example of a technique in which an external device parameter is read as part of the programmed parameters.
  • FIG. 6 is a flow chart of an example, similar to FIG. 2, in which the implantable cardiac function management device includes a target outcome which is later compared against the results.
  • FIG. 7 illustrates an example of an implantable medical device in telemetric communication with a local external system and a remote external system.
  • FIG. 8 illustrates an example in block diagram form of a remote external system in telemetric communication with a local external system and an implantable medical device.
  • FIG. 9 illustrates an example process to program an implantable medical device with a therapy control parameter set.
  • FIG. 10 illustrates another example process to program an implantable medical device with a therapy control parameter set.
  • FIG. 11 illustrates another example process to program an implantable medical device with a therapy control parameter set.
  • FIG. 12 is a graph illustrating an example of a process to reduce search parameter sets for CRT optimization.
  • implantable medical devices such as neurostimulation devices, gastrointestinal stimulation devices, retinal implants, cochlear implants and including CRM devices, such as pacemakers, cardiac function management devices (CFMDs), implantable cardioverter-defibrillators (ICDs), pacer-def ⁇ brillators, and single or multi-chamber cardiac resynchronization therapy (CRT) devices that use pacing.
  • CRM devices such as pacemakers, cardiac function management devices (CFMDs), implantable cardioverter-defibrillators (ICDs), pacer-def ⁇ brillators, and single or multi-chamber cardiac resynchronization therapy (CRT) devices that use pacing.
  • CTR cardiac resynchronization therapy
  • the device may also be programmed to monitor and store one or more measured physiological parameters using a given programmed parameter set.
  • the programmed parameter set contains a single parameter adjusted among one or more values within a specified range.
  • the programmed parameter set comprises multiple parameters adjusted among one or more values within a specified range.
  • the programmed parameter set is determined as a function of one or more measured physiological parameters such as by use of an algorithm to calculate a value for use in at least one programmed parameter set.
  • the device may identify safe limits such that an adverse condition would prompt a stop condition for at least one parameter set.
  • the monitored or stored information may indicate information about the patient's response to a given parameter set and thereby can sometimes be used to determine an improved programmed parameter set.
  • one measured physiological parameter may indicate how the heart reacts during one or more specific activities that, when repeated, can identify a value for a programmed parameter set or determinable condition or outcome.
  • a "target" physiological outcome may be specified, and the stored physiological information corresponding to a particular programmed parameter set may be compared against this target such as to determine whether any changes should be made to the programmed parameter set.
  • Each programmable parameter set may fit as part of a larger optimization program which uses ranges of parameter settings (e.g., AV delay range) and durations of each parameter set occurring in time (e.g., period of forty-eight hours).
  • ranges of parameter settings e.g., AV delay range
  • durations of each parameter set occurring in time e.g., period of forty-eight hours.
  • DOE design of experiments
  • a model, or series of models can be developed to help determine what variables (e.g., parameter sets) affect a response of interest (e.g., % AV pacing).
  • DOE design of experiments
  • a model, or series of models can be developed to help determine what variables (e.g., parameter sets) affect a response of interest (e.g., % AV pacing).
  • Using this method one can determine certain variables, and can separate any dependent variables, which change in response to a change in one or more other variables, from any independent variables, which do not change in response to a
  • the automatic variation in one or more parameters coupled with automatic analysis of one or more corresponding results obtained for different values of the one or more parameter, can be used to select (or to help a caregiver select) a set of parameter values that will produce a high probability of a desired response. This can reduce or eliminate clinician guess work and can obtain useful information about the effect of designed variations of one or more parameter values during the period of time between the implant of a device and the next patient follow-up,or between follow- ups. This can save time and allow much more information to be presented to the caregiver for tailoring the device for the patient.
  • implanting a CRM device may involve programming a set of default parameter values based upon historical information about the subject's physiological condition before implantation.
  • One or more parameter values can be controllably varied, and one or more specified indicators can then be monitored until the next follow-up between the caregiver and the subject.
  • any recorded results may be reviewed by the caregiver, who may decide to modify one or more device parameter values, or automatically evaluated by the implanted device itself or by an ancillary external device. This may provide an early indication of the subject's response to a given therapy.
  • FIG. 1 illustrates portions of a system 100 that uses a device 104 (e.g., implantable cardiac function management device), such as for monitoring one or more electrical signals of the heart 102.
  • the device 104 may be coupled to one or more lead wires 106 having a first coil electrode 108, a second coil electrode 110, and a tip electrode 112, however, a leadless implementation is also possible.
  • An electrogram signal may be detected from one or more intrinsic electrical signals occurring within the heart 102, thereby providing information about heart contractions, such as an indication of heart rate, and information about how the values of the control parameters of the device 104 affect the rate.
  • a control module 114 includes a programmable controller 116, which may be capable of performing several functions.
  • programmable controller 116 may select a user-specifiable therapy control parameter value from a parameter table 120 as a result of receiving input from a user or caregiver.
  • the parameter table 120 may contain a listing of one or more adjustable parameters, each having specified candidate values and a duration within which each such candidate value is to be applied.
  • a specified range of a given control parameter may limit the candidate values of a particular parameter, such as by specifying a minimum value or maximum value.
  • one possible therapy control parameter may include an atrioventricular (AV) delay that may have a specified range of possible candidate AV delay times that may be selected for a given parameter set.
  • the AV delay may be associated with one or more parameter sets 124, 126 and 128.
  • Each parameter set may include one or more user-specifiable therapy control parameters having a user-configurable range (or other specification of candidate values) and a user- configurable duration.
  • the duration of a specified candidate control parameter, within a particular parameter set may include an associated period of time, such as forty eight hours, during which time a selected AV delay candidate value will be applied as part of a specified parameter set (e.g., 124, 126 or 128).
  • a timer 122 may be used to count the duration for using a given parameter value or for using an entire parameter set (e.g., 124, 126 or 128).
  • a parameter value will automatically switch from one value to another between parameter sets, such as to perform a DOE style variation in parameter values using the different parameter sets.
  • the user-configurable duration may expire upon the measure module 119 reaching a threshold value.
  • the device 104 cycles through various different parameter sets (e.g., 124, 126 or 128), such as during the period of time between an implant of the device 104 and a remote or local follow-up between a caregiver and the subject.
  • an initial or first parameter set 124 may represent a first set of user-specified values and corresponding durations of specified device control or operating parameters from the parameter table 120.
  • the first parameter set 124 may list an AV delay parameter with a parameter value of 5 ms to be applied for a duration of forty-eight hours from a start to an end of a period during which the first parameter set 124 is in effect.
  • a second parameter set 126 (SET 2 ), may represent a second set of specified parameters from the parameter table 120.
  • the second parameter set 126 may be automatically put into effect upon the completion of a duration of the first parameter set 124 or of one or more durations of one or more specified therapy control parameters within a first parameter set 124.
  • the second parameter set 126 may be automatically activated before the completion of the duration of the first parameter set 124, for example, upon measuring a response that meets a particular threshold value.
  • the second parameter set 126 may automatically alter at least one parameter value from the first parameter set 124.
  • a final parameter set 128 (SET N ), may represent the last parameter set among a number of specified parameter sets.
  • the programmable controller 116 may obtain information about the one or more physiological measures in association with a combination of control parameter values in effect during a timer period when the physiological measure was obtained.
  • Examples of one or more physiological measures to be monitored include but are not limited to heart rate, blood pressure, percent atrial or ventricular pacing, etc.
  • a separate and unattached implantable or external physiological sensor may be used to obtain one or more physiological measures.
  • external device 130 may provide a physiological measure — and may interact with or operate independently of the programmed parameter sets. In certain examples, the external device 130 may include a weight scale, a blood pressure cuff, etc.
  • FIG. 2 is a flow chart illustrating generally an example of portions of a technique for programming multiple parameter sets and storing responses.
  • the start of a programming cycle (or beginning of a first parameter set) follows the implant of an ICD or other implantable medical device.
  • a device may be implanted within the body of a subject for monitoring intrinsic cardiac signals and, at 205, a control module (similar to control module 114 of FIG. 1) may be programmed with more than one parameter set (SETi, . . . , SET N ).
  • a program may specify a first set of parameter values for first parameter set SETi and an associated duration. During at least a portion of the duration of the first parameter set SETi, one or more physiological measures may be monitored and recorded.
  • the first parameter set SETi may be monitored for completion of its specified duration. If the duration has not yet reached completion, the control module 114 will continue to monitor. If however, at 210, duration of the first parameter set SETi has reached completion, at 215, the monitored potential outcome variables may be stored and associated with first parameter set SETi for later reference or retrieval. Additionally, at 215, the second parameter set SET 2 may be loaded by the control module 114 to begin the next phase of the programming cycle. In certain examples, the control module 114 may be programmed to delay the start of a subsequent parameter set for a specified duration, such as to establish a steady-state or reference condition before activating the next parameter set. In certain examples, this may involve returning to an interim parameter set between successive trial parameter sets.
  • the second parameter set (SET 2 ) may be monitored for completion of its specified duration. Until its duration reaches completion, the control module 114 will continue to monitor and may record one or more specified outcome variables. Upon completion of the duration, at 225, the monitored potential outcome variables may be stored and associated with the second parameter set SET 2 for later reference or retrieval. At 215, the final parameter set SET N may be loaded by the control module 114 to begin the final phase of the programming cycle. At 230, duration of the final parameter set SET N is monitored by the control module 114 until completion of its duration. Upon completion of its duration, at 235, the monitored potential outcome variables may be stored. At 240, the caregiver may review the results associated with one or more parameter sets (SETi, . . . , SET N ). The caregiver may then use this information to choose, at 205, a parameter set for subsequent operation, or to create another DOE of multiple parameter sets to be executed before another follow-up.
  • FIG. 3 is a flow chart illustrating generally an example of how the monitored results of the multiple parameter sets can be evaluated and parameter values improved or optimized, such as that performed at 240 of FIG. 2.
  • a follow-up may be scheduled to review the results obtained from the one or more parameter sets (SETi, • • • , SET N ).
  • the stored results may be evaluated to determine if a change in one or more programmed parameter values is warranted, or if further monitoring of results for different parameter sets is warranted.
  • the caregiver may choose to have the information presented in a trended or other graphical representation to better represent the connection between a particular parameter set (or chosen therapy) and a corresponding monitored physiological measure.
  • the caregiver may make a determination as to the effectiveness of the applied therapy (associated with the corresponding parameter sets).
  • the therapy may be deemed effective if one or more parameter sets caused a desired outcome in one or more monitored physiological measures. If the caregiver determines that the therapy was effective (e.g., best outcome reached), at 315, the identified one or more control parameter values are chosen from the one or more parameter sets (SET 1 -SET N ) and at 320, the control module 114 may be programmed to use the chosen parameter values for a subsequent specified duration or indefinitely, during which time the control module 114 may continue to monitor one or more physiological measures, if the user desires. Upon completion of the best outcome duration, at 300, a follow-up may occur.
  • one or more programmed parameter sets can be revised, such as for further experimentation and monitoring.
  • the one or more parameter sets (SETi, . . . , SET N ) are monitored until their durations have completed, thereafter, at 335, the results associated with physiological measures are stored.
  • a follow up is carried out.
  • FIG. 4 is a flow chart illustrating generally an example of how multiple parameter sets may operate concurrently.
  • a device may be implanted within the body of a subject for monitoring intrinsic cardiac signals.
  • a control module 114 (similar to control module 114 of FIG. 1) may be programmed with more than one parameter set (SETi, . . , SET N ).
  • one or more parameter sets such as first parameter set SET] 410, second parameter set SET 2 420 and final parameter set SET N 430 may occur concurrently or be subject to overlap of varying durations.
  • the control module 114 may monitor physiological measures for each parameter set in combination or separately until each has completed its duration. Upon completion of the duration of the first parameter set SETi 410, second parameter set SET 2 420 and final parameter set SET N 430, the control module 114 will store the monitored results at 415 (SET,), 425 (SET 2 ) and 435 (SET N ), respectively. At 440, all of the results are reviewed by the caregiver at the next follow-up visit with the subject.
  • the control module 114 may collect information from an external device 130 to be used as part of the therapy for the subject and as a variable to be analyzed with the implantable cardiac rhythm management device and related specified parameter sets.
  • the caregiver may implant an implantable cardiac rhythm management device at 500 and, at 505, one or more programmable parameter sets may be programmed with a one or more parameters having a range or varying values and a duration.
  • the control module 114 waits for the parameter set's duration to elapse.
  • the control module 114 recurrently or periodically checks for a completed duration and initiates a read operation to obtain updated information from the external device 515, e.g., just before such completion.
  • the duration of one or more parameter sets has reached completion, and the monitored physiological measures may be stored and associated with the particular parameter set for future reference or retrieval.
  • any remaining parameter sets may be loaded by the control module 114 to begin the next phase of the programming cycle.
  • the results may be reviewed by a caregiver at a follow-up, such as before repeating a new cycle of parameter sets.
  • a caregiver may indicate a desired outcome or target value for a particular physiological measure, in anticipation of reaching the target value during implementation of one or more control parameters or among one or more parameter sets.
  • one or more quantitative criteria based upon one or more monitored physiological parameters may prompt the control module 114 to select one or more parameter sets.
  • a system 100 may include one or more sensors to measure right and left ventricular pressure and a target value that can be specified by a user or caregiver.
  • this target value may represent an increase in ventricular pressure over time (dP/dt), an increase in stroke volume, or a decrease in mechanical dyssynchrony.
  • the control module 114 may determine which parameter set resulted in reaching the target value and may further select a next parameter set based upon this determination. In such cases, there may be a need to store a target result within the control module 114 and later compare a monitored result to the target value.
  • the target may be representative of one or a combination of multiple physiological measures.
  • the control module 114 may be configured to identify which parameter set produces a target result and to store that information. For example, this may include identifying and storing the parameter set associated with the largest increase in ventricular pressure or a largest decrease in mechanical dyssynchrony.
  • the caregiver implants an implantable cardiac device within the body of a subject.
  • the caregiver specifies a target value for one or more physiological measures.
  • the control module 114 may be programmed with one or more parameter sets, as discussed above.
  • one or more physiological quantities corresponding to a parameter set may be monitored by the control module 114 until a completed duration is reached.
  • the monitored results may be stored by the control module 114.
  • the results of at least one parameter set associated with past physiological measures may be reviewed and compared against the one or more targets at 605.
  • the next parameter set may be loaded, or alternatively, based upon the comparison of the results from the prior parameter set, a modified parameter set may be programmed by the control module 114 to run next.
  • the caregiver may have a specified range within which the program may operate and refine a parameter set with the goal of reaching a specified target without additional follow- ups.
  • a proposed set of parameter settings may be suggested at 610, to be reviewed by the caregiver at the next follow-up.
  • the device may use one or more search techniques to explore measured physiological parameters and improve or optimize a programmed parameter set.
  • search techniques may include, but are not limited to hill climbing, genetic search, heuristic search, A* ("A star") search, simulated annealing, or min-max.
  • FIG. 7 is a block diagram illustrating an example of a medical device system 700, and portions of an environment in which it is used.
  • the environment includes a body 702 with a heart 705.
  • system 700 can include an implantable medical device 710, a lead system 715, an external sensor device 717, a local external system 720, and a remote external system 725.
  • the local external system 720 is coupled to the implantable medical device 710 via a telemetry link 730
  • the remote external system 725 is coupled to the local external system 720 via a telemetry link 740.
  • the external sensor device 717 senses electrical, vibration, or other physiological information from the body 702.
  • the external sensor device 717 is coupled to the local external system 720 via telemetry link 730.
  • FIG. 8 illustrates an example of the remote external system 725 including a remote external interface 810.
  • the remote external interface 810 can include one or more of a processor, a server, and a display unit.
  • the remote external interface 810 is configured to be coupled to the implantable medical device 710 via the communication link 740 (such as a wireless link or a network connection) to the local external interface or system 720, and via the telemetry link 730 between the local external interface 720 and the implantable medical device 710.
  • the remote external system 725 can include a communication circuit 815 and a processor circuit 820.
  • the communication circuit 815 is configured to communicate with the implantable medical device 710. This communication can be in real time. As noted above, this communication can use the links 730 and 740 and the local external interface 720.
  • the processor circuit 820 is configured to perform an analysis of physiologic data that is received from the implantable medical device 710. This data is captured by the implantable medical device 710 in response to operation of the implantable medical device 710 using a plurality of therapy control parameter sets. The processor circuit 820 is further configured to select a particular therapy control parameter set based on its analysis of the physiologic data.
  • a particular therapy control parameter set may include one or more of an AV delay parameter, a VV offset parameter, a rate response parameter, a tachy detection parameter, a tachy therapy parameter, a pacing amplitude parameter, or a neural stimulation parameter.
  • the physiologic data received by the remote external interface 725 can include one or more of a heart rate, a heart rate variability, a peripheral pressure, a blood pressure, a body weight, an activity log, a tachy conversion efficacy, a respiration rate, a posture indicator, a hemodynamic response parameter, an electrocardiogram, or a percentage of atrial or ventricular pacing.
  • a dual sensor adaptive-rate pacing system such as one with an accelerometer and a minute ventilation sensor, typically requires a parameter search of response factors for both of the sensors. Given that each sensor may have a range of response factor settings, for example 1 through 16 for both sensors, the combinations of the parameter settings rise to 256 possibilities, providing a difficult task for a clinician to accomplish.
  • the parameter search algorithms such as a gradient search, an evolution algorithm, a simulated annealing method, or a simplex algorithm, only a limited combination are needed to reach an optimal response factor combination for the two sensors.
  • both delay settings have a range of timing intervals that can be programmed.
  • a parameter search algorithm can be used with consideration of patient response through measurements from both internal or external sensors. A convergence to the optimal combination of AV and W delay settings can be found more quickly than the a step-wise search through every possible combination of the two parameters.
  • FIG. 9 illustrates an example of a process 900 to program an implantable medical device with a particular therapy control parameter set.
  • physiologic data is received from an implantable medical device.
  • the physiologic data can be transmitted from an implantable medical device such as device 710 through a network such as the local external system 720, the telemetry links 730 and 740, and received at the remote external system 725.
  • the physiologic data can result from operation of the implantable medical device using a plurality of therapy control parameter sets.
  • the physiologic data is analyzed. This analysis can be performed by a processor such as processor circuit 820.
  • the processor circuit selects one of the particular therapy control parameter sets based on its analysis of the plurality of the sets.
  • FIG. 10 illustrates another example of a process 1000 to program an implantable medical device with a particular therapy control parameter set.
  • physiologic data is received at 910.
  • a check is made to determine if the system is set for an active programming mode. If the system is set for active programming mode, then at 920, the physiologic data is analyzed. In an example, device performance data or patient feedback data can also be analyzed. For example, if a patient indicates that he did not feel well when a particular therapy control parameter set was in place and executing, then a health care provider can decide not to use that therapy control parameter set again.
  • the processor circuit determines if one or more of the therapy control parameter sets are acceptable. If the processor circuit determines that one or more therapy control parameter sets are acceptable, then at 940, the implantable medical device is programmed with the particular therapy control parameter set selected by the processor circuit. If the processor circuit determines at 925 that none of the therapy control parameter sets are acceptable, then at 927, the implantable medical device is programmed to its original or default therapy control parameter set. At 929, a health care provider is informed of the results, and suggestions are provided to the health care provider. An example suggestion would be to change a particular parameter in the parameter set to a certain value, and resubmit the altered parameter set to the implantable medical device via the remote external system 725.
  • the device is first reprogrammed back to its original therapy control parameter set.
  • a health care provider examines the data resulting from the use of the plurality of therapy control parameter sets.
  • the health care provider determines if any of the plurality of therapy control parameter sets produced acceptable results. If the health care provider determines that one or more therapy control parameter sets produced acceptable results, than at 965, the health care provider programs the implantable medical device with his or her choice of a therapy control parameter set. This determination can be based on one or more suggestions or other information provided by the remote external system 725.
  • Such suggestions can be based on the patient's historic data maintained at the remote external system, or an aggregation of historic data from a plurality of patients. If no acceptable results are found, then at 970, a new plurality of therapy control parameter sets can be transmitted to the implantable medical device.
  • the new therapy control parameter sets can be provided by the health care provider via the remote external interface 810, and may or may not be based on suggestions provided by the remote external system 725.
  • a health care provider can provide an interval range for one or more parameters in a parameter set. This can be input at the remote external interface 810.
  • a health care provider can also provide at the remote external interface 810 a time interval that the implantable medical device can operate with at least one of the therapy control parameter sets.
  • a health care provider can also provide a particular value for a physiological parameter in the therapy control parameter set.
  • the processor circuit 820 can adjust a parameter search space based on the analysis of the physiologic data.
  • the A-V delay can be altered based on the results generated with other known values of the A-V delay.
  • the parameter search space can be adjusted using one or more of a gradient search, an evolution algorithm, a simulated annealing method, or a simplex algorithm.
  • FIG. 11 illustrates another example process 1100 to program an implantable medical device with a therapy control parameter set.
  • a physician determines a number of parameter sets 1 through N (or a range of a parameter to be evaluated) to be used in the implantable medical device.
  • the external interface can provide to a physician one or more recommended parameter sets to be investigated based on data from a large patient data base.
  • the processor circuit on the remote external system programs the implantable medical device with the parameter set 1 , and informs the implantable medical device which physiological response to monitor and store.
  • the processor circuit can also perform an analysis of the physiological response and adjust the parameter sets accordingly.
  • the processor circuit can also serve as storage of the physiological responses for different parameter sets.
  • the physician can make the decision as to what parameter set to use.
  • the processor circuit retrieves the physiological response corresponding to the parameter set 1 via the communication circuit. The retrieval of these physiological responses can be performed at physician-determined intervals.
  • the processor circuit serially programs the implantable medical device with the other parameter sets, and retrieves the physiological responses generated during the device operation with each of these parameter sets.
  • the processor circuit analyzes the physiological response and selects a particular parameter set as a preferred configuration for the implantable medical device.
  • the processor transmits a message to the external interface informing a physician that the results are ready for review.
  • FIG. 12 is a graph illustrating an example of a process to reduce a search parameter space for CRT optimization.
  • a search parameter space can include a number of parameter sets or a number of parameters and parameter values within one or more parameter sets.
  • CRT AV and VV delay optimization to reach optimized value, all combinations of AV and VV delay need to be examined.
  • 6 AV delay and 5 VV delays are investigated. This results in a total of 30 possible AV and VV combinations.
  • the simplex optimization algorithm is used as an example in FIG. 12. First, 3 AV and VV combinations within a physician determined range are chosen by the processor circuit. The physiological response, in this case, blood pressure (SBP re i (mmHg)), corresponding to each of the 3 AV and W combinations (point 1, 2, 3 on FIG.
  • SBP re i blood pressure
  • the AV and VV combination at point 1 produces the least desirable response.
  • a new parameter set 4 is then generated by reflection into the parameter space opposite the undesirable result.
  • parameter set 5 is generated by comparing the response from AV and VV combinations at points 2, 3, and 4, and reflecting into the parameter space opposite the least desirable combination at point 2.
  • parameter set represented by point 6 is generated by comparing a response from parameter sets at points 3, 4, and 5, and the physiological response from the parameter set at point 6 is collected.
  • the parameter set at point 7 is then chosen based on comparing the responses from parameter sets at points 4, 5, and 6, and reflecting into the parameter space opposite the least desirable parameter set, that is, set 4.
  • the physiological response from the parameter set at point 7 is then collected.
  • the search is stopped and the parameter set at point 6 is chosen as the optimal AV and W combination. From this example, it can be seen that by using optimization algorithms, the parameter search sets can be significantly reduced, from 30 to 7 in this example.

Abstract

Un dispositif implantable comprenant un contrôleur programmable peut être utilisé pour comprendre un ensemble de paramètres de commande de thérapie spécifiable par un utilisateur. L'ensemble de paramètres de commande de thérapie peut ensuite être configuré pour comprendre au moins un paramètre de commande de thérapie qui est configurable par l'utilisateur pour commuter automatiquement d'une première valeur de paramètre à une seconde valeur de paramètre à un moment qui se présente entre des sessions de programmation d'utilisateur séparées du dispositif. Une interface externe à distance peut être comprise, laquelle est configurée pour être couplée de façon communicative au dispositif. L'interface externe à distance peut être configurée pour effectuer une analyse de données physiologiques reçues par le dispositif en réponse au fonctionnement du dispositif à l'aide d'une pluralité d'ensembles de paramètres de commande de thérapie. L'interface externe à distance peut en outre être configurée pour sélectionner un ensemble de paramètres de commande de thérapie particulier utilisant l'analyse.
PCT/US2007/026191 2006-12-21 2007-12-21 Dispositif implantable avec plusieurs ensembles de paramètres WO2008079347A1 (fr)

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US8868183B2 (en) 2006-12-21 2014-10-21 Cardiac Pacemakers, Inc. Method and apparatus to implement multiple parameter sets in an implantable device

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