WO2011071896A1 - Détection de thérapie simultanée dans des dispositifs médicaux implantables - Google Patents

Détection de thérapie simultanée dans des dispositifs médicaux implantables Download PDF

Info

Publication number
WO2011071896A1
WO2011071896A1 PCT/US2010/059252 US2010059252W WO2011071896A1 WO 2011071896 A1 WO2011071896 A1 WO 2011071896A1 US 2010059252 W US2010059252 W US 2010059252W WO 2011071896 A1 WO2011071896 A1 WO 2011071896A1
Authority
WO
WIPO (PCT)
Prior art keywords
therapy
electrical
pulse
pulses
characteristic
Prior art date
Application number
PCT/US2010/059252
Other languages
English (en)
Inventor
David J. Ternes
Stephen Ruble
Jason J. Hamann
Kenneth L. Baker
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
Application filed by Cardiac Pacemakers, Inc. filed Critical Cardiac Pacemakers, Inc.
Priority to JP2012543201A priority Critical patent/JP5600751B2/ja
Priority to EP10793104.0A priority patent/EP2509683B1/fr
Publication of WO2011071896A1 publication Critical patent/WO2011071896A1/fr

Links

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
    • A61N1/3605—Implantable neurostimulators for stimulating central or peripheral nerve system
    • A61N1/36128—Control systems
    • A61N1/36146—Control systems specified by the stimulation parameters
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/0002—Remote monitoring of patients using telemetry, e.g. transmission of vital signals via a communication network
    • A61B5/0026—Remote monitoring of patients using telemetry, e.g. transmission of vital signals via a communication network characterised by the transmission medium
    • A61B5/0028—Body tissue as transmission medium, i.e. transmission systems where the medium is the human body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/48—Other medical applications
    • A61B5/4848—Monitoring or testing the effects of treatment, e.g. of medication
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
    • A61B5/7203—Signal processing specially adapted for physiological signals or for diagnostic purposes for noise prevention, reduction or removal
    • A61B5/7207—Signal processing specially adapted for physiological signals or for diagnostic purposes for noise prevention, reduction or removal of noise induced by motion artifacts
    • 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
    • A61N1/37—Monitoring; Protecting
    • 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
    • A61N1/37288—Communication to several implantable medical devices within one patient

Definitions

  • This application relates generally to medical devices and, more particularly, to systems, devices and methods for detecting concurrent therapies.
  • IMDs implantable medical devices
  • IMDs include implantable cardiac rhythm management (CRM) such as cardiac pacemakers, cardioverters, and defibrillators.
  • CRM devices provide electrical stimulation to selected chambers of the heart in order to treat disorders of cardiac rhythm.
  • An implantable pacemaker for example, is a CRM device that paces the heart with timed pacing pulses.
  • Other IMD examples include spinal cord stimulators, muscle stimulators, and nerve stimulators.
  • neural stimulation referred to as neural stimulation, neurostimulation or neuromodulation
  • Various embodiments of a system for detecting a concurrent electrical therapy applied to a patient comprise an implantable medical device (IMD) configured to be implanted in the patient and configured to detect the concurrent electrical therapy.
  • the concurrent electrical therapy includes a plurality of electrical therapy pulses.
  • the IMD includes a storage, concurrent therapy detection circuitry, and a controller.
  • the storage includes at least one characteristic of the therapy pulses in the concurrent electrical therapy.
  • the concurrent therapy detection circuitry is configured to detect electrical pulses and to extract at least one characteristic of the detected electrical pulses.
  • the controller is configured to compare the at least one characteristic of the detected electrical pulses to the at least one stored characteristic of the therapy pulses and to declare that the concurrent therapy is being applied to the patient if the at least one characteristic of the detected electrical pulses favorably compare to the at least one stored characteristic of the therapy pulses.
  • Various method embodiments detect a concurrent therapy, where the concurrent therapy includes a plurality of therapy pulses. Detecting the concurrent therapy includes detecting at least one electrical pulse, extracting at least one characteristic from the at least one electrical pulse, comparing the at least one characteristic of the detected pulse to at least one characteristic of therapy pulses, and detecting that the concurrent therapy is being applied if the at least one characteristic of the detected pulse favorably compares to the at least one characteristic of the therapy pulses.
  • FIG. 1 illustrates a system with an implantable neural stimulator and an implantable CRM device, according to various embodiments
  • FIG. 2 illustrates various method embodiments.
  • FIG. 3 illustrates an example of a neural stimulation therapy pulse.
  • FIG. 4A illustrates a trapezoidal waveform
  • FIG. 4B illustrates a preconditioning waveform
  • FIG. 4C illustrates a biphasic waveform.
  • FIG. 5A illustrates a pulse
  • FIG. 5B illustrates the transformed signal of FIG. 5 A after pacing through a high-frequency bandpass filter with a center frequency on the order of 30 kHz
  • FIG. 5C illustrates an embodiment of a pulse detect circuit.
  • FIG. 6 illustrates an embodiment of remote pace detection circuitry.
  • FIG. 7 illustrates a flow diagram of an embodiment for detecting pulses using the pace detection circuitry illustrated in FIG. 6.
  • FIG. 8 illustrates potential inputs for various IMD embodiments.
  • FIG. 9 illustrates an embodiment of a method for performing a learn mode to characterize a stimulation waveform for a concurrent therapy.
  • FIG. 10 shows a system diagram of an embodiment of a
  • microprocessor-based implantable device according to various embodiments.
  • FIG. 1 1 illustrates a system with the IMD and with external database devices.
  • Various IMDs stimulate the autonomic nervous system (ANS), which regulates "involuntary" organs.
  • ANS autonomic nervous system
  • involuntary organs include respiratory and digestive organs, and also include blood vessels and the heart.
  • the ANS functions in an involuntary, reflexive manner to regulate glands, to regulate muscles in the skin, eye, stomach, intestines and bladder, and to regulate cardiac muscle and the muscle around blood vessels, for example.
  • the ANS includes the sympathetic nervous system and the parasympathetic nervous system.
  • the sympathetic nervous system is affiliated with stress and the "fight or flight response" to emergencies. Among other effects, the "fight or flight response” increases blood pressure and heart rate to increase skeletal muscle blood flow, and decreases digestion to provide the energy for "fighting or fleeing.”
  • the parasympathetic nervous system is affiliated with relaxation and the "rest and digest response” which, among other effects, decreases blood pressure and heart rate, and increases digestion to conserve energy.
  • the ANS maintains normal internal function and works with the somatic nervous system.
  • the heart rate and force are increased when the sympathetic nervous system is stimulated, and is decreased when the sympathetic nervous system is inhibited (or the parasympathetic nervous system is stimulated).
  • Stimulating the sympathetic and parasympathetic nervous systems can have effects other than heart rate and blood pressure. For example, stimulating the sympathetic nervous system dilates the pupil, reduces saliva and mucus production, relaxes the bronchial muscle, reduces the successive waves of involuntary contraction (peristalsis) of the stomach and the motility of the stomach, increases the conversion of glycogen to glucose by the liver, decreases urine secretion by the kidneys, and relaxes the wall and closes the sphincter of the bladder.
  • Stimulating the parasympathetic nervous system constricts the pupil, increases saliva and mucus production, contracts the bronchial muscle, increases secretions and motility in the stomach and large intestine, increases digestion in the small intention, increases urine secretion, and contracts the wall and relaxes the sphincter of the bladder.
  • the functions associated with the sympathetic and parasympathetic nervous systems are many and can be complexly integrated with each other.
  • Vagal modulation may be used to treat a variety of cardiovascular disorders, including but not limited to heart failure, post-MI (myocardial infarction) remodeling, and hypertension.
  • Heart failure refers to a clinical syndrome in which cardiac function causes a below normal cardiac output that can fall below a level adequate to meet the metabolic demand of tissues.
  • Heart failure may present itself as congestive heart failure (CHF) due to the accompanying venous and pulmonary congestion.
  • CHF congestive heart failure
  • Heart failure can be due to a variety of etiologies such as ischemic heart disease, hypertension and diabetes.
  • Hypertension is a cause of heart disease and other related cardiac co-morbidities. Hypertension occurs when blood vessels constrict.
  • Hypertension generally relates to high blood pressure, such as a transitory or sustained elevation of systemic arterial blood pressure to a level that is likely to induce cardiovascular damage or other adverse consequences.
  • Hypertension has been defined as a systolic blood pressure above 140 mm Hg or a diastolic blood pressure above 90 mm Hg. Consequences of uncontrolled hypertension include, but are not limited to, retinal vascular disease and stroke, left ventricular hypertrophy and failure, myocardial infarction, dissecting aneurysm, and renovascular disease.
  • Cardiac remodeling refers to a complex remodeling process of the ventricles that involves structural, biochemical, neurohormonal, and electrophysiologic factors, which can result following an MI or other cause of decreased cardiac output.
  • Ventricular remodeling is triggered by a physiological compensatory mechanism that acts to increase cardiac output due to so-called backward failure which increases the diastolic filling pressure of the ventricles and thereby increases the so-called preload (i.e., the degree to which the ventricles are stretched by the volume of blood in the ventricles at the end of diastole).
  • preload i.e., the degree to which the ventricles are stretched by the volume of blood in the ventricles at the end of diastole.
  • An increase in preload causes an increase in stroke volume during systole, a phenomena known as the Frank- Starling principle.
  • the ventricles become dilated.
  • the enlargement of the ventricular volume causes increased ventricular wall stress at a given systolic pressure.
  • hemodynamics such as presence or absence of angiotensin converting enzyme (ACE) activity
  • ACE angiotensin converting enzyme
  • the sustained stresses causing hypertrophy induce apoptosis (i.e., programmed cell death) of cardiac muscle cells and eventual wall thinning which causes further deterioration in cardiac function.
  • apoptosis i.e., programmed cell death
  • ventricular dilation and hypertrophy may at first be compensatory and increase cardiac output, the processes ultimately result in both systolic and diastolic dysfunction. It has been shown that the extent of ventricular remodeling is positively correlated with increased mortality in post-MI and heart failure patients.
  • neural stimulation therapies include neural stimulation therapies for respiratory problems such a sleep disordered breathing, for blood pressure control such as to treat hypertension, for cardiac rhythm management, for myocardial infarction and ischemia, for heart failure, for epilepsy, for depression, for pain, for migraines and for eating disorders and obesity.
  • Many proposed neural stimulation therapies include stimulation of the vagus nerve. This listing of other neural stimulation therapies is not intended to be an exhaustive listing.
  • Electrical neural stimulation of the autonomic system for example, can be delivered using any of a nerve cuff, intravascularly-fed lead, or transcutaneous electrodes.
  • a therapy embodiment involves preventing and/or treating ventricular remodeling.
  • Activity of the autonomic nervous system is at least partly responsible for the ventricular remodeling which occurs as a consequence of an MI or due to heart failure. It has been demonstrated that remodeling can be affected by pharmacological intervention with the use of, for example, ACE inhibitors and beta-blockers. Pharmacological treatment carries with it the risk of side effects, however, and it is also difficult to modulate the effects of drugs in a precise manner.
  • Embodiments of the present subject matter employ electrostimulatory means to modulate autonomic activity, referred to as anti- remodeling therapy (ART).
  • ART anti- remodeling therapy
  • RCT remodeling control therapy
  • Such modulation of autonomic activity may act synergistically to reverse or prevent cardiac remodeling.
  • a neural stimulation therapy embodiment treats hypertension by stimulating the baroreflex for sustained periods of time sufficient to reduce hypertension.
  • the baroreflex is a reflex that can be triggered by stimulation of a baroreceptor or an afferent nerve trunk.
  • Baroreflex neural targets include any sensor of pressure changes (e.g. sensory nerve endings that function as a baroreceptor) that is sensitive to stretching of the wall resulting from increased pressure from within, and that functions as the receptor of the central reflex mechanism that tends to reduce that pressure.
  • Baroreflex neural targets also include neural pathways extending from the baroreceptors. Examples of nerve trunks that can serve as baroreflex neural targets include the vagus, aortic and carotid nerves.
  • a myocardial stimulation therapy provides a cardiac therapy using electrical stimulation of the myocardium.
  • Some examples of myocardial stimulation therapies are provided below.
  • a pacemaker is a device which paces the heart with timed pacing pulses, most commonly for the treatment of bradycardia where the ventricular rate is too slow. If functioning properly, the pacemaker makes up for the heart's inability to pace itself at an appropriate rhythm in order to meet metabolic demand by enforcing a minimum heart rate. Implantable devices have also been developed that affect the manner and degree to which the heart chambers contract during a cardiac cycle in order to promote the efficient pumping of blood.
  • These pathways conduct excitatory impulses from the sino-atrial node to the atrial myocardium, to the atrio-ventricular node, and thence to the ventricular myocardium to result in a coordinated contraction of both atria and both ventricles.
  • This both synchronizes the contractions of the muscle fibers of each chamber and synchronizes the contraction of each atrium or ventricle with the contralateral atrium or ventricle.
  • cardiac resynchronization therapy CRT
  • Ventricular resynchronization is useful in treating heart failure because, although not directly inotropic, resynchronization can result in a more coordinated contraction of the ventricles with improved pumping efficiency and increased cardiac output.
  • a CRT example applies stimulation pulses to both ventricles, either simultaneously or separated by a specified biventricular offset interval, and after a specified atrioventricular delay interval with respect to the detection of an intrinsic atrial contraction or delivery of an atrial pace.
  • CRT can be beneficial in reducing the deleterious ventricular remodeling which can occur in post-MI and heart failure patients. Presumably, this occurs as a result of changes in the distribution of wall stress experienced by the ventricles during the cardiac pumping cycle when CRT is applied.
  • the degree to which a heart muscle fiber is stretched before it contracts is termed the preload, and the maximum tension and velocity of shortening of a muscle fiber increases with increasing preload.
  • the degree of tension or stress on a heart muscle fiber as it contracts is termed the afterload.
  • CRT provides pre-excitation of myocardial regions which would otherwise be activated later during systole and experience increased wall stress.
  • the pre-excitation of the remodeled region relative to other regions unloads the region from mechanical stress and allows reversal or prevention of remodeling to occur.
  • an electrical shock delivered without synchronization to the QRS complex can be used to terminate most tachyarrhythmias.
  • the electric shock terminates the tachyarrhythmia by simultaneously depolarizing the myocardium and rendering it refractory.
  • a class of CRM devices known as an implantable cardioverter defibrillator (ICD) provides this kind of therapy by delivering a shock pulse to the heart when the device detects tachyarrhythmias.
  • ICD implantable cardioverter defibrillator
  • Another type of electrical therapy for tachycardia is anti-tachycardia pacing (ATP).
  • ventricular ATP the ventricles are competitively paced with one or more pacing pulses in an effort to interrupt the reentrant circuit causing the tachycardia.
  • Modern ICDs typically have ATP capability, and deliver ATP therapy or a shock pulse when a tachyarrhythmia is detected. ATP may be referred to as overdrive pacing.
  • Other overdrive pacing therapies exist, such as intermittent pacing therapy (IPT), which may also be referred to as a conditioning therapy.
  • IPT intermittent pacing therapy
  • FIG. 1 illustrates a system with an implantable neural stimulator 101 and an implantable CRM device 102, according to various embodiments.
  • the neural stimulator may be configured to stimulate a vagus nerve in the cervical region, as illustrated in the figure.
  • CRM devices include pacemakers, anti-arrhythmia devices such as defibrillators and anti- tachycardia devices, and devices to deliver cardiac resynchronization therapy (CRT).
  • the illustrated neural stimulator has a neural stimulation lead 103 for use to deliver neural stimulation.
  • the illustrated lead embodiment has a nerve cuff electrode 104.
  • Other lead embodiments provide transvascular stimulation of the nerve (e.g. stimulation of the vagus nerve from the internal jugular vein).
  • the neural stimulation lead 103 has neural sensing capabilities, and/or sensing capabilities.
  • the illustrated CRM device 102 includes a right atrial lead 105 and a right ventricle lead 106. Other leads, additional leads, or fewer leads may be used for various device embodiments.
  • the neural stimulator 101 is a vagal nerve stimulator, such as generally illustrated in FIG. 1. In some embodiments, the neural stimulator is a spinal cord stimulator. If a neural stimulator and a CRM device are not designed to communicate with each other, then at least one of the devices includes a concurrent therapy detector, according to various embodiments.
  • therapies such as vagal nerve stimulation therapies or spinal cord stimulation therapies can alter cardiac function, which may affect CRM therapies. Identifying these concurrent therapies can provide diagnostic opportunities as well as opportunities to coordinate the CRM therapies in response to the presence of the concurrent therapy.
  • This disclosure discusses an example when CRM therapy is affected by neural stimulation therapy. Those of ordinary skill in the art will understand that CRM therapies may affect neural therapies. More generally, a first electrical therapy may interfere or enhance a second electrical therapy.
  • Sensing algorithms in implantable medical devices may be compromised when noise within the device sensing channel bandwidth(s) interferes with the sensing functions.
  • Noise sensed by a pacemaker could be mistaken by the device for a legitimate cardiac event and lead to inhibition of pacing or inappropriate pacing due to tracking of false atrial senses or triggered pacing of false ventricular senses in a cardiac resynchronization therapy (CRT) device.
  • Inhibition of pacing could lead to long periods of asystole.
  • Inappropriate pacing could lead to impaired cardiac function or be proarrhythmic.
  • Noise sensed by an implantable cardiac defibrillator (ICD) could cause inappropriate ATP or shock therapy delivery due to mistaken diagnosis of ventricular tachycardia.
  • sensing algorithms e.g. increase threshold or provide blanking windows
  • present subject matter is not limited to the modification of sensing algorithms, as various embodiments identified below mitigate competition with a concurrent therapy, coordinate a complementary concurrent therapy, provide enhanced diagnostics accounting for the concurrent therapy, or various combinations thereof.
  • the therapies delivered by the implanted devices may interfere with each other.
  • Examples of interference include inappropriate sensing of the therapy of one implanted device by another implanted device, and competing therapies (e.g. a pacemaker attempting to drive the heart rate higher while a neurostimulator is attempting to reduce the heart rate).
  • competing therapies e.g. a pacemaker attempting to drive the heart rate higher while a neurostimulator is attempting to reduce the heart rate.
  • Various embodiments of the present subject matter detect concurrent therapy, enabling the coordination of therapies among multiple implanted devices to mitigate these types of interferences.
  • the therapies delivered by the implanted devices may complement each other.
  • Various embodiments of the present subject matter detect concurrent therapy, to trigger or enable coordination of complementary therapies among multiple implanted devices.
  • One example of complementary therapies involves a pacemaker and a neurostimulator that are implanted in the same patient. If the neurostimulator recognizes the pacemaker, neural therapy can be gated to the timing cycles of the right atrium, right ventricle or left ventricle pacing signal. Another example sets a maximum and minimum heart rate by which
  • neurostimulation could be inhibited or initiated. If an atrial or ventricular tachyarrhythmia event develops, the pacemaker could send out a signal to enable a high level of continuous neurostimulation.
  • Another example includes a wireless implantable pressure sensor in the pulmonary artery and a neurostimulator implanted in the same patient.
  • the pressure sensor could send out a signal that enables neurostimulation in response to a decompensation event.
  • the therapies delivered by the implanted devices may not interfere or compliment each other, but may still provide valuable diagnostic information.
  • Various embodiments of the present subject matter detect concurrent therapy and inform the user that the concurrent therapies exist.
  • Various embodiments use one of the devices to be the primary diagnostic gatherer for the implanted devices.
  • One example involves a cardiac device implanted along with a neurostimulator. If the cardiac device recognizes the neurostimulation signal, it can time stamp the presence of the neural pacing. The physician could then run a diagnostic report which divides the data into neurostimulation present or not present. If a favorable improvement is shown when neurostimulation is on, this could lead to programming changes. This could also be automated within the cardiac device.
  • FIG. 2 illustrates various method embodiments.
  • a pulse is detected at 207.
  • a concurrent therapy is declared.
  • the concurrent therapy is declared if the detected pulse has characteristics of the pulses used in the concurrent therapy. If it is determined that a concurrent therapy is present, some embodiments store or present real-time marker information 209, some embodiments modify CRM sensing characteristics 210, some embodiments distinguish diagnostic information gathered during the presence of concurrent therapy from the other periods 21 1, and some embodiments alter CRM therapy or features based on detection of concurrent therapy 212.
  • the present subject matter is capable of detecting multiple therapies from different manufacturers without needing communication circuitry in each device to enable communication between devices and without needing to develop a consensus among implantable device manufacturers around a communication standard.
  • sensors and diagnostics are grouped into one primary medical device (e.g. the CRM device by way of example and not limitation), thereby simplifying the secondary medical device and therapy.
  • each IMD implanted medical device type is designed to identify and adapt to only those electrical therapies that affect its therapy, regardless of the manufacturer of those other electrical therapies.
  • Various embodiments store or present real-time marker information. Some embodiments convey various levels of detail of the externally or internally delivered concurrent therapy without establishing device-to-device
  • Some embodiments modify CRM sensing characteristics. Some embodiments reclassify fast beats associated with detected pulses. Some embodiments remove the fast beats from an ECG and note with a marker. Some embodiments change sensing threshold during presence of detected pulses, extend a blanking period, or extend a refractory, etc.
  • HRV a neural stimulation therapy delivered to an autonomic target can alter cardiac conduction. Therefore, by way of example and not limitation, HRV during the detected concurrent therapy may differ from that when the neural stimulation is not concurrent. Knowledge of this concurrent therapy provides diagnostic insight. By way of another example, AV delays may change during the concurrent therapy which may cause the loss of CRT. This information may be used to appropriately reprogram the device. Thus, various embodiments distinguish diagnostic information gathered during the presence of concurrent therapy from other periods.
  • Some embodiments change the response of the CRM device when neuromodulation therapy is either recognized or communicated. For example, some embodiments suppress noise, some embodiments use noise response algorithms, some embodiments raise a sensing threshold during a period of neuromodulation therapy, some embodiments alter brady therapy because of physical changes that occur during neuromodulation therapy delivery
  • immediate term not long-term like remodeling
  • some embodiments alter characteristics or response of other sensors, such as minute ventilation, while neuromodulation therapy is being delivered.
  • brady and tachy detection thresholds are implemented with separate brady and tachy detection thresholds.
  • the amplitude of "normal" brady sensed P-Waves and R- Waves are typically larger than the amplitudes of tachy sensed atrial or ventricular fibrillation.
  • Tachy therapies are initiated only if a tachycardia event is sensed using the tachy detection threshold and if the bradycardia is lost as sensed using the brady detection threshold
  • the dual threshold approach assumes that normal cardiac function continues in the presence of noise.
  • a sensing threshold may stairstep down after a sense or pace.
  • the secondary threshold may be consulted during the tachy episode. If the secondary threshold sense detects were within a brady range, the device could declare the episode as noise induced.
  • the device responds by delaying shock therapy for ' ⁇ ' (or indefinite) seconds since noise is generally of limited time as long as ventricular senses are occurring above the secondary threshold at a typical brady rate. Some device embodiments delay shock therapy while pacing the atrial at a lower rate level as long as there are ventricular senses above the secondary threshold. This assumes that normal conduction from an AS or APA is still occurring or that there is a ventricular escape beat.
  • the secondary brady threshold is used to confirm the tachyarrhythmia. Muscle noise and periodic noise can get around current noise detection windows and cause oversensing. A secondary brady threshold protects against inappropriate therapies in such cases.
  • Some embodiments briefly blank or ignore the signal every period of the noise signal, and some embodiments characterize the periodic signal as noise based on periodicity, width, amplitude, slope, etc., and subtract from the overall signal. Some embodiments include a notation on real-time strip and programmer display that periodic noise has been detected.
  • Some embodiments respond to a detected arrhythmia by validating that an arrhythmia was detected.
  • An intrinsic event e.g. sinus node source or escape beat
  • a window timeframe e.g. around 80 BPM to around 25 BPM range
  • PVCs premature ventricular contractions
  • escape beats when in ventricular fibrillation.
  • both muscle noise amplitude and external noise amplitude is less than P-Wave or R-Wave amplitude.
  • An autonomic neural stimulation therapy can alter cardiac conduction.
  • Some embodiments are configured to alter CRM therapy, in response to the detection of a concurrent therapy, to tailor the therapy to the individual's medical therapy treatment.
  • the CRM therapy may be altered during the autonomic neural stimulation therapy to use a modified AV delay, use a modified AV delay offset, suspend AV delay search hysteresis, use a modified lower rate limit (LRL), modify the rhythm identification template gathering, and use modified pace amplitudes because of an altered captured threshold.
  • LTL lower rate limit
  • CRM Complementary metal-oxide-semiconductor
  • various embodiments of a CRM system are configured to distinguish between types of concurrent therapy (e.g. pain management versus high blood pressure therapy) and have different responses based on that determination such as markers only for one and modified diagnostic gathering for the other.
  • Various embodiments consolidate information into devices without the need to create device-to-device communications.
  • the CRM therapies respond to the concurrent therapies providing holistic therapy delivery.
  • various embodiments detect a pulse to detect whether a concurrent therapy is present, as generally illustrated at 208.
  • a characteristic of many stimulation pulses is sharp leading and falling edges.
  • FIG. 3 illustrates an example of a neural stimulation therapy pulse.
  • the illustrated pulse 313 has sharp rising and falling edges, and the sharp transitions at the rising edge 314 and the falling edge 315 of the waveform cause significant high-frequency energy.
  • Other waveforms or pulses have potential for neural stimulation.
  • FIG. 4A illustrates a trapezoidal waveform
  • FIG. 4B illustrates a pre-conditioning waveform
  • FIG. 4C illustrates a biphasic waveform.
  • These waveforms like the single pulse, have sharp transitions that also cause high-frequency energy. Thus, these waveforms may be detected in a manner similar to that discussed below.
  • FIG. 5 A illustrates a pulse 516.
  • FIG. 5B illustrates the transformed signal 517 of FIG. 5A after pacing through a high-frequency bandpass filter with a center frequency on the order of 30 kHz.
  • the rising edge of the pulse in FIG. 5A results in a positive signal in FIG. 5B that decays during the pulse; and the falling edge of the pulse in FIG. 5A results in a negative signal in FIG. 5B.
  • FIG. 5C illustrates a pulse detect circuit, including high-frequency band pass filter 518 to receive the pulse 516 and detect the high-frequency components attributable to the sharp rising edge, the sharp falling edge, or both the sharp rising and falling edges of the stimulation signal, as illustrated by the transformed signal 517.
  • the output 517 of the high-frequency bandpass filter is fed into processing circuitry 519 such as a positive edge-triggered D flip-flop and logged as a "detect" signal 520.
  • the "detect" signal 520 is received by control logic 521 of the IMD to process appropriately.
  • Some embodiments apply various criteria to the pulse to confirm that it is consistent with concurrent therapy pulses. Additionally, FIG.
  • control logic 2 illustrates some ways in which various embodiments of the control logic respond to the detected concurrent therapy.
  • a pre-conditioning waveform or true biphasic waveform would result in a different spike pattern in the output for each pulse, but is conceptually the same.
  • Some embodiments include variable sensing thresholds, discussed below, to reject noise or higher frequency filtering for edge detection. Those refinements will improve detection of concurrent therapies by reducing false detections.
  • the present subject matter uses the pulse detection as a basis for detecting concurrent therapy. Telemetry and other electrical signals such as those used for minute ventilation could confound detection of a concurrent therapy for an amount of time. For some therapies, this amount of time may be inconsequential and, thus, the simpler detection circuitry may be sufficient.
  • FIGS. 6-7 illustrate an embodiment for distinguishing a concurrent therapy from other electrical signals such as telemetry by way of example and not limitation.
  • the output of the high-frequency bandpass includes a paired signal of a positive-going spike and a negative-going spike occurring within a defined time period.
  • the positive spike could lead the negative spike or vice versa depending on the sensing vector in relationship to the signal source and also the polarity of the pulse.
  • a neural stimulation therapy may deliver stimulation pulses with a pulse width ranging from 10 ⁇ 8 to 1000 ⁇ 8 with 300 ⁇ 8 typical.
  • a pulse detect can be declared if a paired set of spikes occur within the defined pulse width timeframe.
  • FIG. 6 illustrates an embodiment of remote pace detection circuitry.
  • the input signal 622 comes from sense electrodes, and passes through a bandpass filter 623 illustrated with a center frequency of approximately 30 KHz.
  • the pace detection circuitry creates two detection signals.
  • a first detection signal 624 is generated when the rising edge of a pace pulse passes through the bandpass filter at a level greater than the positive threshold 625.
  • a second detection signal 626 is generated when the falling edge of a pace pulse passes through the bandpass filter at a level more negative than the negative threshold 627.
  • the combination of the two detection signals as received by the digital state machine or microcontroller 628, results in a pace detection.
  • the illustrated circuit includes a cascaded amplifier 629A and 629B that functions as a comparator, and a sample and hold circuit 630A and 630B clocked by a lMHz system clock.
  • FIG. 7 illustrates a flow diagram of an embodiment for detecting pulses using the pace detection circuitry illustrated in FIG. 6.
  • State 1 represented at 731, is a state in which the circuit waits for the first pulse. If the first pulse is positive, three timers are started and the circuit enters State 2P, represented at 732. These timers include a first timer identified as a really short timer (RST), a second timer identified as a short timer (ST), and a third timer identified as a long timer (LT). The names given to these timers represent a manner of degree, and are not intended to be limiting.
  • State 2P is a state in which the circuit waits for the first timer (RST) to expire.
  • the end of the time represented by RST represents a beginning of a time frame for an expected negative pulse to occur after the positive pulse sensed at 731.
  • the circuit enters State 3P, represented at 733, which is a state in which the circuit waits for the expected negative pulse. If the second timer (ST) expires without a negative pulse, the circuit returns to State 1 at 731. If a negative pulse occurs, the circuit enters State 4, represented at 734, which is a state in which the circuit waits for the expiration of the third timer (LT). When the third timer (LT) expires, the circuit returns to State 1. If the first pulse is negative, three timers are started and the circuit enters State 2N, represented at 735.
  • timers include a first timer identified as a really short timer (RST), a second timer identified as a short timer (ST), and a third timer identified as a long timer (LT).
  • RST really short timer
  • ST short timer
  • LT long timer
  • the names given to these timers represent a manner of degree, and are not intended to be limiting.
  • the timers associated with the negative pulse may or may not be the same as the timers associated with the positive pulse.
  • State 2N is a state in which the circuit waits for the first timer (RST) to expire.
  • the end of the time represented by RST represents a beginning of a time frame for an expected positive pulse to occur after the negative pulse sensed at 731.
  • the circuit enters State 3N, represented at 736, which is a state in which the circuit waits for the expected positive pulse. If the second timer (ST) expires without a positive pulse, the circuit returns to State 1 at 731. If a positive pulse occurs, the circuit enters State 4, represented at 734, which is a state in which the circuit waits for the expiration of the third timer (LT). When the third timer (LT) expires, the circuit returns to State 1.
  • This algorithm is looking for pulses of opposite polarity that occur between RST and ST apart, where RST and ST are respectively the minimum and maximum expected pacing pulse widths. Once a pace is detected, the algorithm waits a time corresponding to the third timer (LT) from the beginning of the pace before looking for another pulse, where the time corresponding to the third timer (LT) is the expected minimum pulse interval.
  • Pulse frequency may be used, in place of pulse widths or in addition to pulse widths, to determine the presence of a concurrent therapy.
  • a neural therapy may deliver stimulation pulses with a frequency ranging from 2 Hz to 1200 Hz with 20 Hz typical.
  • pulse frequency is used alone to detect the presence of the concurrent therapy, the detection of either positive-going spikes or negative-going spikes at the defined consistent frequency will result in the same confidence that a concurrent therapy has been detected with simpler circuitry.
  • a cardiac pace pulse for example, can be declared as a concurrent therapy from another implanted medical device by sensing the leading edge of the pulse, the ending edge of the pulse, the timing between leading and ending edges within tolerance of defined interval, or various combinations thereof. Capture could also be confirmed via a wide vector internal electrogram. Some embodiments apply detection criteria. By way of example and not limitation, a cardiac pace pulse will not occur at a rate faster than high pacing limit (e.g. 3 Hz) and anti-tachycardia pacing (ATP) will occur at a rate between a lower ATP limit (3 Hz ) and a higher ATP limit (e.g. 20 Hz).
  • high pacing limit e.g. 3 Hz
  • ATP anti-tachycardia pacing
  • a neural therapy pulse can be declared as a concurrent therapy by another implanted device by sensing the leading edge of the pulse, the ending edge of the pulse, the timing between leading and ending edges within tolerance of defined interval, or various combinations thereof.
  • some embodiments detect two or more consecutive pulses, or two or more consecutive rising edge detections, or two or more consecutive falling edge detections within tolerance of defined rate.
  • FIG. 8 illustrates potential inputs for various IMD embodiments. These inputs will be discussed in more detail below.
  • the inputs include an enable if it is known that concurrent therapy exists 837, customizable concurrent therapy specifics 838 such as pulse width, dosing on/off ratio, waveform type, frequency or other therapy specifics for the pulses in the therapy, desired device response(s) to the concurrent therapy 839 such as modifying the sensing or therapy parameters, parameters to search for or learn concurrent therapy from either stored or real-time data 840, and a database of concurrent therapies 841.
  • various embodiments receive concurrent therapy information from a clinician.
  • the clinician inputs into the primary implanted device one or more of the following parameters: existence of a concurrent therapy (enable/disable concurrent detection feature) 837 and customizable concurrent therapy specifics 838 such as pulse width, frequency, dosing (off/on ratio), and waveform type.
  • a concurrent therapy enableable/disable concurrent detection feature
  • customizable concurrent therapy specifics 838 such as pulse width, frequency, dosing (off/on ratio), and waveform type.
  • the implanted medical device is able to use the inputted parameters to customize the bandpass filtering, the pulse width criteria, the frequency criteria and any other criteria explicitly to detect the known concurrent therapy using the detection techniques previously described. This flexibility in the design allows the device to adapt to a manufacturer's concurrent therapy without prior knowledge during design of the details of that concurrent therapy.
  • the clinician is able to confirm that the implanted device is accurately determined by the presence of a concurrent therapy after input of the above parameters.
  • the clinician can enter a desired device response 839 to the detected concurrent therapy.
  • Such responses include but are not limited to diagnostic acknowledgement of a detected concurrent therapy (e.g. markers), mitigations for oversensing of concurrent therapy, enhanced diagnostics that distinguish between periods when the concurrent therapy is ON and when the concurrent therapy is OFF, closed-loop of therapy tied to onset of detected concurrent therapy, closed-loop of therapy tied to cessation of detected concurrent therapy, closed-loop of therapy tied to presence of detected concurrent therapy, and modified therapy parameters during presence of detected concurrent therapy.
  • Some embodiments modify sensing parameters, such as may be used for a triggering event to begin, end or change a therapy, or as may be used to provide a closed loop feedback for the therapy.
  • the implanted device is configured to respond to a clinician instruction to search for any concurrent therapy.
  • the device or the device's supporting external equipment such as a programmer is configured to gather sensed electrical data for a period of time (one minute by way of example and not limitation) and analyze that data for a concurrent therapy.
  • Some embodiments look for the sharp edges characteristic of a concurrent therapy waveform, determine a therapy waveform pulse width, and determine a therapy pulse frequency.
  • the bandpass filtering, the pulse width criteria, the frequency criteria and any other criteria explicitly to detect the known concurrent therapy can be entered or adjusted for the concurrent therapy that has been characterized via this clinician-initiated process.
  • the clinician can confirm that the implanted device is accurately determined by the presence of a concurrent therapy after input of the above parameters.
  • the concurrent therapy may be initiated before and delivered during the time when the device is searching for the concurrent delivery.
  • the clinician may initiate the concurrent therapy just prior to instructing the device to search for the concurrent therapy, or initiate the concurrent therapy while the device is searching.
  • the clinician may select from the gathered sensed electrical data (real-time data or from stored data ) either the period of time there is a concurrent therapy or a pulse from the concurrent therapy.
  • the device or the device's supporting external equipment is configured to analyze this sensed data. Some embodiments look for the sharp edges characteristic of a concurrent therapy waveform, determine a therapy waveform pulse width, determine a therapy pulse frequency, or various combinations thereof.
  • the bandpass filtering, the pulse width criteria, the frequency criteria and other criteria explicitly may be programmed or modified to detect the known concurrent therapy using the concurrent therapy that has been characterized via this clinician-initiated process.
  • the clinician may confirm that the implanted device is accurately determined by the presence of a concurrent therapy after input of the above parameters.
  • the concurrent therapy can be learned and characterized for use by the implanted medical device to detect the concurrent therapy.
  • the clinician can program or input how the device responds to a detected concurrent therapy.
  • Some embodiments provide a trigger for the device to characterize concurrent therapy.
  • the trigger could be a magnet or other user-applied external trigger. This addresses a situation where the concurrent therapy is implanted at a later date and the clinician is not available to reprogram or characterize.
  • the trigger could be a consistent noise window extension or a tachy detection with certain criteria (i.e. very periodic senses indicating oversensing of the concurrent therapy). This addresses a situation where there is concern that the concurrent therapy could adversely affect the primary implanted device but there is a reluctance to alter that primary implanted device's sensing or therapy characteristics unless needed.
  • FIG. 9 illustrates an embodiment of a method for performing a learn mode to characterize a stimulation waveform for a concurrent therapy.
  • a learn mode is initiated. This may be initiated by the clinician, for example.
  • the periodic noise source (other concurrent therapy delivered by a TENS system or an IMD, for example) is started at 943.
  • the device analyses captures and stores characteristic s of the pulses that can be used to distinguish the pulses from other electrical signals.
  • the learn mode ends at 945. The learn mode can be repeated to learn other sources of potential concurrent therapy.
  • various embodiments use a database 840 containing the electrical pulse characteristics of potential concurrent therapies.
  • the primary device's supporting external equipment 1 156 such as the programmer is programmed with a database containing the electrical pulse characteristics of specific other secondary devices (e.g. neural stimulation device 1 157).
  • a clinician enters the secondary device's identifying information, such as manufacturer and model number, into the programmer of the primary device (e.g. CRM device 1 158).
  • the programmer programs the relevant information for characterizing and detecting the concurrent therapy into the implanted device (e.g. the primary device for the two or more implanted devices).
  • the primary device's programmer supports a connection to an external database via an Internet connection or some other network 1159
  • the programmer could download the relevant information from the external database 1160, illustrated as electrical pulse information for various IMDs in a remote storage location, rather than being required to keep information for all devices stored on the programmer.
  • the external database server is integrated with or is capable of connecting to electronic medical records (EMR) systems 1161
  • EMR electronic medical records
  • the external database server could download not only the secondary device's electrical characteristics, but also details of that specific patient's therapy delivered by the secondary device. These details of the patient's specific therapy may result in a more accurate and consistent coordination of therapies between devices.
  • FIG. 10 shows a system diagram of an embodiment of a
  • the controller of the device is a microprocessor 1046 which communicates with a memory 1047 via a bidirectional data bus.
  • the controller could be implemented by other types of logic circuitry (e.g., discrete components or programmable logic arrays) using a state machine type of design.
  • logic circuitry should be taken to refer to either discrete logic circuitry or to the programming of a microprocessor.
  • sensing and pacing channels designated “A” through “C” comprising bipolar leads with ring electrodes 1048A-C and tip electrodes 1049 A-C, sensing amplifiers 1050A-C, stimulus or pulse generators 1051A-C, and channel interfaces 1052A-C.
  • Each channel thus includes a pacing channel made up of the pulse generator connected to the electrode and a sensing channel made up of the sense amplifier connected to the electrode.
  • the channel interfaces 1052 A-C communicate bidirectionally with the microprocessor 1046, and each interface may include analog-to-digital converters for digitizing sensing signal inputs from the sensing amplifiers and registers that can be written to by the microprocessor in order to output pacing pulses, change the pacing pulse amplitude, and adjust the gain and threshold values for the sensing amplifiers.
  • the sensing circuitry of the pacemaker detects a chamber sense, either an atrial sense or ventricular sense, when an electrogram signal (i.e., a voltage sensed by an electrode representing cardiac electrical activity) generated by a particular channel exceeds a specified detection threshold. Pacing algorithms used in particular pacing modes employ such senses to trigger or inhibit pacing.
  • the intrinsic atrial and/or ventricular rates can be measured by measuring the time intervals between atrial and ventricular senses, respectively, and used to detect atrial and ventricular tachyarrhythmias.
  • the electrodes of each bipolar lead are connected via conductors within the lead to a switching network 1053 controlled by the microprocessor.
  • the switching network is used to switch the electrodes to the input of a sense amplifier in order to detect intrinsic cardiac activity and to the output of a pulse generator in order to deliver a pacing pulse.
  • the switching network also enables the device to sense or pace either in a bipolar mode using both the ring and tip electrodes of a lead or in a unipolar mode using only one of the electrodes of the lead with the device housing (can) 1054 or an electrode on another lead serving as a ground electrode.
  • the figure illustrates a telemetry interface 1055 connected to the microprocessor, which can be used to communicate with an external device.
  • the microprocessor 1046 is capable of performing therapy routines (e.g. CRM therapy or neural stimulation therapy), and is also configured to control sensing (e.g. thresholds, timing, verification of sensed events).
  • the illustrated system include therapy detection circuitry 1056 to detect pulses of a concurrent therapy, and the microprocessor is capable of performing concurrent therapy detection routines to analyze signals and declare whether or not a concurrent therapy is present.
  • the therapy detection circuitry is configured to detect electrical pulses and configured for use to extract at least one characteristic of the detected electrical pulses. For example, some therapy detection circuitry embodiments are configured for use to extract pulse width or pulse frequency information from the detected pulses.
  • Some therapy detection circuitry includes a high frequency filter to detect pulse edges.
  • the microprocessor for example, can use this information to detect pulse widths between rising and falling edges of the pulses and to detect pulse frequency.
  • the microcontroller is also capable of performing diagnostic routines.
  • the microcontroller is capable of responding to a detected concurrent therapy by initiating or adjusting therapy, by initiating or adjusting sensing, or by initiating or adjusting diagnostic routines.
  • myocardial therapy routines include bradycardia pacing therapies, anti-tachycardia shock therapies such as cardioversion or defibrillation therapies, anti-tachycardia pacing therapies (ATP), and cardiac resynchronization therapies (CRT).
  • FIG. 10 illustrated a microprocessor-based implantable device configured to deliver CRM therapy.
  • the device is configured to deliver trains of pulses to elicit a desired action potential in a nerve.
  • nerve cuffs for the nerve electrodes, and some embodiments provide intravascular electrodes for stimulation of neural targets within the vessel (e.g. baroreceptors or
  • neural stimulation routines include, but are not limited to, therapies to provide physical conditioning and therapies to treat ventricular remodeling, hypertension, sleep disordered breathing, blood pressure control such as to treat hypertension, cardiac rhythm management, myocardial infarction and ischemia, heart failure, epilepsy, depression, for pain, migraines, eating disorders and obesity, and movement disorders.
  • the present subject matter is not limited to a particular therapy.
  • modules and other circuitry shown and described herein can be implemented using software, hardware, firmware and combinations of software and hardware.
  • the methods illustrated in this disclosure are not intended to be exclusive of other methods within the scope of the present subject matter. Those of ordinary skill in the art will understand, upon reading and comprehending this disclosure, other methods within the scope of the present subject matter.
  • the above-identified embodiments, and portions of the illustrated embodiments are not necessarily mutually exclusive. These embodiments, or portions thereof, can be combined.
  • the methods are implemented using a sequence of instructions which, when executed by one or more processors, cause the processor(s) to perform the respective method.
  • the methods are implemented as a set of instructions contained on a computer- accessible medium such as a magnetic medium, an electronic medium, or an optical medium.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Animal Behavior & Ethology (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • General Health & Medical Sciences (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Pathology (AREA)
  • Radiology & Medical Imaging (AREA)
  • Surgery (AREA)
  • Medical Informatics (AREA)
  • Biophysics (AREA)
  • Physics & Mathematics (AREA)
  • Molecular Biology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Signal Processing (AREA)
  • Artificial Intelligence (AREA)
  • Computer Vision & Pattern Recognition (AREA)
  • Physiology (AREA)
  • Psychiatry (AREA)
  • Computer Networks & Wireless Communication (AREA)
  • Cardiology (AREA)
  • Neurology (AREA)
  • Neurosurgery (AREA)
  • Electrotherapy Devices (AREA)

Abstract

La présente invention concerne divers modes de réalisation de procédé destinés à détecter une thérapie simultanée, ladite thérapie simultanée comprenant une pluralité d'impulsions de thérapie. La détection de la thérapie simultanée comprend la détection d'au moins une impulsion électrique, l'extraction d'au moins une caractéristique à partir de la ou des impulsions électriques, la comparaison de la ou des caractéristiques de l'impulsion détectée à la ou aux caractéristiques des impulsions de thérapie, et la détection de l'application de la thérapie simultanée si la ou les caractéristiques de l'impulsion détectée soutiennent la comparaison avec la ou les caractéristiques des impulsions de thérapie.
PCT/US2010/059252 2009-12-08 2010-12-07 Détection de thérapie simultanée dans des dispositifs médicaux implantables WO2011071896A1 (fr)

Priority Applications (2)

Application Number Priority Date Filing Date Title
JP2012543201A JP5600751B2 (ja) 2009-12-08 2010-12-07 埋め込み型医療装置における併用療法検出
EP10793104.0A EP2509683B1 (fr) 2009-12-08 2010-12-07 Détection de thérapie simultanée dans des dispositifs médicaux implantables

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US26761009P 2009-12-08 2009-12-08
US61/267,610 2009-12-08

Publications (1)

Publication Number Publication Date
WO2011071896A1 true WO2011071896A1 (fr) 2011-06-16

Family

ID=43537913

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US2010/059252 WO2011071896A1 (fr) 2009-12-08 2010-12-07 Détection de thérapie simultanée dans des dispositifs médicaux implantables

Country Status (4)

Country Link
US (2) US8548585B2 (fr)
EP (1) EP2509683B1 (fr)
JP (1) JP5600751B2 (fr)
WO (1) WO2011071896A1 (fr)

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8548585B2 (en) 2009-12-08 2013-10-01 Cardiac Pacemakers, Inc. Concurrent therapy detection in implantable medical devices
US8805494B2 (en) 2005-05-10 2014-08-12 Cardiac Pacemakers, Inc. System and method to deliver therapy in presence of another therapy
JP2014533578A (ja) * 2011-11-28 2014-12-15 カーディアック ペースメイカーズ， インコーポレイテッド マルチプル治療用埋め込み型装置におけるクロス治療センシングの管理

Families Citing this family (18)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8473049B2 (en) 2005-05-25 2013-06-25 Cardiac Pacemakers, Inc. Implantable neural stimulator with mode switching
US8406876B2 (en) * 2005-04-05 2013-03-26 Cardiac Pacemakers, Inc. Closed loop neural stimulation synchronized to cardiac cycles
US8457747B2 (en) 2008-10-20 2013-06-04 Cyberonics, Inc. Neurostimulation with signal duration determined by a cardiac cycle
US8805502B2 (en) 2011-12-27 2014-08-12 Cardiac Pacemakers, Inc. Managing cross therapy delivery in a multiple therapy implantable device
US8868178B2 (en) 2012-12-11 2014-10-21 Galvani, Ltd. Arrhythmia electrotherapy device and method with provisions for mitigating patient discomfort
US9440074B2 (en) 2013-02-18 2016-09-13 Cardiac Pacemakers, Inc. Method and system for indicating neurostimulation delivery
JP6190033B2 (ja) 2013-03-14 2017-08-30 カーディアック ペースメイカーズ， インコーポレイテッド 再入院を回避するための心不全管理
US10154794B2 (en) * 2014-04-25 2018-12-18 Medtronic, Inc. Implantable cardioverter-defibrillator (ICD) tachyarrhythmia detection modifications responsive to detected pacing
US10448855B2 (en) 2014-04-25 2019-10-22 Medtronic, Inc. Implantable medical device (IMD) sensing modifications responsive to detected pacing pulses
US10226197B2 (en) 2014-04-25 2019-03-12 Medtronic, Inc. Pace pulse detector for an implantable medical device
CN106470598B (zh) * 2014-07-01 2020-03-10 心脏起搏器股份公司 用于检测医疗治疗的系统
US20160015280A1 (en) * 2014-07-17 2016-01-21 Elwha Llc Epidermal electronics to monitor repetitive stress injuries and arthritis
US10279201B2 (en) * 2014-07-17 2019-05-07 Elwha Llc Monitoring and treating pain with epidermal electronics
US10390755B2 (en) * 2014-07-17 2019-08-27 Elwha Llc Monitoring body movement or condition according to motion regimen with conformal electronics
US10383550B2 (en) * 2014-07-17 2019-08-20 Elwha Llc Monitoring body movement or condition according to motion regimen with conformal electronics
US10279200B2 (en) * 2014-07-17 2019-05-07 Elwha Llc Monitoring and treating pain with epidermal electronics
US10099053B2 (en) * 2014-07-17 2018-10-16 Elwha Llc Epidermal electronics to monitor repetitive stress injuries and arthritis
WO2017095771A1 (fr) * 2015-12-02 2017-06-08 Cardiac Pacemakers, Inc. Détermination et sélection automatiques de la filtration dans un dispositif de gestion du rythme cardiaque

Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1999004329A2 (fr) * 1997-07-21 1999-01-28 Kristin Ann Farry Developpement de programmes de classification pour traitement et commande de signal
US6304772B1 (en) * 1999-08-30 2001-10-16 Ge Medical Systems Information Technologies, Inc. Method and apparatus for automatically detecting and interpreting paced electrocardiograms
US6477404B1 (en) * 2000-03-01 2002-11-05 Cardiac Pacemakers, Inc. System and method for detection of pacing pulses within ECG signals
US20090030484A1 (en) * 2007-04-30 2009-01-29 Cochlear Limited Bilateral prosthesis synchronization
US7542794B1 (en) * 2005-05-24 2009-06-02 Infinite Biomedical Technologies, Llc Method of extracting and evaluating paced heart beats using max-min transform analysis
US7565195B1 (en) * 2005-04-11 2009-07-21 Pacesetter, Inc. Failsafe satellite pacemaker system

Family Cites Families (151)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3421511A (en) 1965-12-10 1969-01-14 Medtronic Inc Implantable electrode for nerve stimulation
SE346468B (fr) 1969-02-24 1972-07-10 Lkb Medical Ab
ES226859Y (es) 1977-03-03 1977-11-16 Marcapasos cardiaco de ritmo controlado por senales de regu-lacion detectadas en las vias yno los receptores nerviosos.
US4592359A (en) 1985-04-02 1986-06-03 The Board Of Trustees Of The Leland Stanford Junior University Multi-channel implantable neural stimulator
DE3535504A1 (de) 1985-10-04 1987-04-09 Siemens Ag Herzschrittmacher
US4791931A (en) 1987-08-13 1988-12-20 Pacesetter Infusion, Ltd. Demand pacemaker using an artificial baroreceptor reflex
US4960129A (en) 1988-12-05 1990-10-02 Trustees Of The University Of Pennsylvania Methods of observing autonomic neural stimulation and diagnosing cardiac dynamical dysfunction using heartbeat interval data to analyze cardioventilatory interactions
US5111815A (en) 1990-10-15 1992-05-12 Cardiac Pacemakers, Inc. Method and apparatus for cardioverter/pacer utilizing neurosensing
US5437285A (en) 1991-02-20 1995-08-01 Georgetown University Method and apparatus for prediction of sudden cardiac death by simultaneous assessment of autonomic function and cardiac electrical stability
US5199428A (en) 1991-03-22 1993-04-06 Medtronic, Inc. Implantable electrical nerve stimulator/pacemaker with ischemia for decreasing cardiac workload
EP0532144B1 (fr) 1991-09-12 1999-02-24 BIOTRONIK Mess- und Therapiegeräte GmbH & Co Ingenieurbüro Berlin Système de thérapie cardiaque
US5203326A (en) 1991-12-18 1993-04-20 Telectronics Pacing Systems, Inc. Antiarrhythmia pacer using antiarrhythmia pacing and autonomic nerve stimulation therapy
US5330507A (en) 1992-04-24 1994-07-19 Medtronic, Inc. Implantable electrical vagal stimulation for prevention or interruption of life threatening arrhythmias
US5243980A (en) 1992-06-30 1993-09-14 Medtronic, Inc. Method and apparatus for discrimination of ventricular and supraventricular tachycardia
EP0647149B1 (fr) 1992-06-30 1997-01-15 Medtronic, Inc. Appareil de traitement de troubles cardiaques
JPH07504597A (ja) 1992-06-30 1995-05-25 メドトロニック　インコーポレーテッド 電気的医療用刺激器と電気的刺激方法
US5792187A (en) 1993-02-22 1998-08-11 Angeion Corporation Neuro-stimulation to control pain during cardioversion defibrillation
US5411531A (en) 1993-09-23 1995-05-02 Medtronic, Inc. Method and apparatus for control of A-V interval
US5522854A (en) 1994-05-19 1996-06-04 Duke University Method and apparatus for the prevention of arrhythmia by nerve stimulation
EP0688578B1 (fr) 1994-06-24 1999-11-10 Pacesetter AB Détecteur d'arythmie
EP0688579B1 (fr) 1994-06-24 2001-08-22 St. Jude Medical AB Dispositif de thérapie cardiaque
US5662689A (en) 1995-09-08 1997-09-02 Medtronic, Inc. Method and apparatus for alleviating cardioversion shock pain
US5700282A (en) 1995-10-13 1997-12-23 Zabara; Jacob Heart rhythm stabilization using a neurocybernetic prosthesis
US20020169485A1 (en) 1995-10-16 2002-11-14 Neuropace, Inc. Differential neurostimulation therapy driven by physiological context
US5626621A (en) 1995-11-07 1997-05-06 Medtronic, Inc. Dual chamber, multi-mode external pacemaker
US6073048A (en) 1995-11-17 2000-06-06 Medtronic, Inc. Baroreflex modulation with carotid sinus nerve stimulation for the treatment of heart failure
US5731848A (en) 1995-12-22 1998-03-24 Samsung Electronics Co., Ltd. Digital VSB detector with bandpass phase tracker using Ng filters, as for use in an HDTV receiver
US5690681A (en) 1996-03-29 1997-11-25 Purdue Research Foundation Method and apparatus using vagal stimulation for control of ventricular rate during atrial fibrillation
US6449507B1 (en) 1996-04-30 2002-09-10 Medtronic, Inc. Method and system for nerve stimulation prior to and during a medical procedure
US6628987B1 (en) 2000-09-26 2003-09-30 Medtronic, Inc. Method and system for sensing cardiac contractions during vagal stimulation-induced cardiopalegia
US6532388B1 (en) 1996-04-30 2003-03-11 Medtronic, Inc. Method and system for endotracheal/esophageal stimulation prior to and during a medical procedure
US6006134A (en) 1998-04-30 1999-12-21 Medtronic, Inc. Method and device for electronically controlling the beating of a heart using venous electrical stimulation of nerve fibers
US7269457B2 (en) 1996-04-30 2007-09-11 Medtronic, Inc. Method and system for vagal nerve stimulation with multi-site cardiac pacing
US6058331A (en) 1998-04-27 2000-05-02 Medtronic, Inc. Apparatus and method for treating peripheral vascular disease and organ ischemia by electrical stimulation with closed loop feedback control
US5928272A (en) 1998-05-02 1999-07-27 Cyberonics, Inc. Automatic activation of a neurostimulator device using a detection algorithm based on cardiac activity
WO1999065561A1 (fr) 1998-06-19 1999-12-23 Cordis Webster, Inc. Methode et appareil de traitement vasculaire de la tachycardie et de la fibrillation
US6668191B1 (en) 1998-10-26 2003-12-23 Birinder R. Boveja Apparatus and method for electrical stimulation adjunct (add-on) therapy of atrial fibrillation, inappropriate sinus tachycardia, and refractory hypertension with an external stimulator
US20030212440A1 (en) 2002-05-09 2003-11-13 Boveja Birinder R. Method and system for modulating the vagus nerve (10th cranial nerve) using modulated electrical pulses with an inductively coupled stimulation system
US6134470A (en) 1998-11-09 2000-10-17 Medtronic, Inc. Method and apparatus for treating a tachyarrhythmic patient
EP1023917B1 (fr) 1999-01-28 2004-07-14 SORIN BIOMEDICA CRM S.r.l. Stimulateur cardiaque avec inhibition électrotonique
DE60032490T2 (de) 1999-03-03 2007-09-27 Cochlear Ltd., Lane Cove Gerät zur optimierung der funktion eines kochlearen implantates
US6178349B1 (en) 1999-04-15 2001-01-23 Medtronic, Inc. Drug delivery neural stimulation device for treatment of cardiovascular disorders
US6341236B1 (en) 1999-04-30 2002-01-22 Ivan Osorio Vagal nerve stimulation techniques for treatment of epileptic seizures
US7840278B1 (en) 1999-06-25 2010-11-23 Puskas John D Devices and methods for vagus nerve stimulation
DE19929705A1 (de) 1999-06-29 2001-01-04 Biotronik Mess & Therapieg Verfahren zur Bestimmung der Baroreflex-Latenzzeit und Baroreflex-Sensitivität
US6272377B1 (en) 1999-10-01 2001-08-07 Cardiac Pacemakers, Inc. Cardiac rhythm management system with arrhythmia prediction and prevention
US6473644B1 (en) 1999-10-13 2002-10-29 Cyberonics, Inc. Method to enhance cardiac capillary growth in heart failure patients
ATE365574T1 (de) 1999-11-30 2007-07-15 Biotronik Gmbh & Co Kg Gerät zur regelung der herzfrequenz und der herzpumpkraft
DE10061169B4 (de) 1999-11-30 2006-07-27 Biotronik Meß- und Therapiegeräte GmbH & Co. Ingenieurbüro Berlin Implantierbares Gerät zur Diagnose und Unterscheidung von supraventrikulären und ventrikulären Tachykardien
US6415183B1 (en) 1999-12-09 2002-07-02 Cardiac Pacemakers, Inc. Method and apparatus for diaphragmatic pacing
US6487450B1 (en) 2000-02-24 2002-11-26 Cedars-Sinai Medical Center System and method for preventing Sudden Cardiac Death by nerve sprouting from right stellate ganglion
US6466822B1 (en) 2000-04-05 2002-10-15 Neuropace, Inc. Multimodal neurostimulator and process of using it
US6371922B1 (en) 2000-04-07 2002-04-16 Cardiac Pacemakers, Inc. Method for measuring baroreflex sensitivity and therapy optimization in heart failure patients
US6511500B1 (en) 2000-06-06 2003-01-28 Marc Mounir Rahme Use of autonomic nervous system neurotransmitters inhibition and atrial parasympathetic fibers ablation for the treatment of atrial arrhythmias and to preserve drug effects
DE60018556T2 (de) 2000-07-11 2006-03-02 Sorin Biomedica Crm S.R.L., Saluggia Implantierbarer Herzschrittmacher mit automatischer durch Sympathiko-Vagal Abgleichung gesteuerter Betriebsartumschaltung
US6985774B2 (en) 2000-09-27 2006-01-10 Cvrx, Inc. Stimulus regimens for cardiovascular reflex control
US6522926B1 (en) 2000-09-27 2003-02-18 Cvrx, Inc. Devices and methods for cardiovascular reflex control
US7158832B2 (en) 2000-09-27 2007-01-02 Cvrx, Inc. Electrode designs and methods of use for cardiovascular reflex control devices
US7499742B2 (en) 2001-09-26 2009-03-03 Cvrx, Inc. Electrode structures and methods for their use in cardiovascular reflex control
US6850801B2 (en) 2001-09-26 2005-02-01 Cvrx, Inc. Mapping methods for cardiovascular reflex control devices
CA2323983A1 (fr) 2000-10-19 2002-04-19 Universite De Sherbrooke Neurostimulateur programmable
DE60134878D1 (de) 2000-10-26 2008-08-28 Medtronic Inc Vorrichtung zur elektrischen stimulation des nervensystems zur therapie ventrikulärer fehlfunktionen, herzversagen und anderer kardialer zustände
US7218964B2 (en) 2000-10-26 2007-05-15 Medtronic, Inc. Closed-loop neuromodulation for prevention and treatment of cardiac conditions
DE60139411D1 (de) 2000-10-26 2009-09-10 Medtronic Inc Gerät zur minimierung der wirkungen einer herzverletzung
DE60140072D1 (de) 2000-10-26 2009-11-12 Meditronic Inc Vorrichtung zur minimierung der wirkungen eines herzinsults
CA2328568A1 (fr) 2000-12-12 2002-06-12 Universite De Sherbrooke Prothese nerveuse implantable et programmable
US6904315B2 (en) 2000-12-14 2005-06-07 Medtronic, Inc. Atrial aware VVI: a method for atrial synchronous ventricular (VDD/R) pacing using the subcutaneous electrode array and a standard pacing lead
US6564096B2 (en) 2001-02-28 2003-05-13 Robert A. Mest Method and system for treatment of tachycardia and fibrillation
EP1395330A1 (fr) 2001-04-20 2004-03-10 The Board of Regents for the University of Oklahoma Neuromodulation cardiaque et procedes d'utilisation correspondants
US6928320B2 (en) 2001-05-17 2005-08-09 Medtronic, Inc. Apparatus for blocking activation of tissue or conduction of action potentials while other tissue is being therapeutically activated
US20050010263A1 (en) 2001-07-27 2005-01-13 Patrick Schauerte Neurostimulation unit for immobilizing the heart during cardiosurgical operations
US6622041B2 (en) 2001-08-21 2003-09-16 Cyberonics, Inc. Treatment of congestive heart failure and autonomic cardiovascular drive disorders
US7778703B2 (en) 2001-08-31 2010-08-17 Bio Control Medical (B.C.M.) Ltd. Selective nerve fiber stimulation for treating heart conditions
US7778711B2 (en) 2001-08-31 2010-08-17 Bio Control Medical (B.C.M.) Ltd. Reduction of heart rate variability by parasympathetic stimulation
US6934583B2 (en) 2001-10-22 2005-08-23 Pacesetter, Inc. Implantable lead and method for stimulating the vagus nerve
US20030149450A1 (en) 2002-02-01 2003-08-07 Mayberg Marc R. Brainstem and cerebellar modulation of cardiovascular response and disease
US20040002635A1 (en) 2002-02-04 2004-01-01 Hargrove Jeffrey B. Method and apparatus for utilizing amplitude-modulated pulse-width modulation signals for neurostimulation and treatment of neurological disorders using electrical stimulation
US6928324B2 (en) 2002-02-14 2005-08-09 Pacesetter, Inc. Stimulation device for sleep apnea prevention, detection and treatment
US6937896B1 (en) 2002-02-26 2005-08-30 Pacesetter, Inc. Sympathetic nerve stimulator and/or pacemaker
EP1483018A1 (fr) 2002-03-14 2004-12-08 Brainsgate Ltd. Technique de regulation de la pression sanguine
US7123959B2 (en) 2002-03-25 2006-10-17 Cardiac Pacemakers, Inc. Method and apparatus for preventing cardiac arrhythmias with endovascular stimulation
US7123967B2 (en) 2002-05-13 2006-10-17 Pacesetter, Inc. Implantable neural stimulation device providing activity, rest, and long term closed-loop peripheral vascular disease therapy and method
US7277761B2 (en) 2002-06-12 2007-10-02 Pacesetter, Inc. Vagal stimulation for improving cardiac function in heart failure or CHF patients
US7123961B1 (en) 2002-06-13 2006-10-17 Pacesetter, Inc. Stimulation of autonomic nerves
US7027858B2 (en) 2002-09-11 2006-04-11 Medtronic, Inc. Methods and apparatus for cardiac R-wave sensing in a subcutaneous ECG waveform
EP1578487B1 (fr) 2002-10-15 2012-01-25 Medtronic, Inc. Desactivation selective de canaux dans un systeme de dispositif medical
DE60307882T2 (de) 2002-10-31 2007-03-15 Medtronic, Inc., Minneapolis Fehlersichere programmierung einer implantierbaren medizinischen vorrichtung
US20030229380A1 (en) 2002-10-31 2003-12-11 Adams John M. Heart failure therapy device and method
US20040088009A1 (en) 2002-10-31 2004-05-06 Degroot Paul J. Auxilary central nervous system pre-pulse for shock pain inhibition
JP4177086B2 (ja) 2002-11-25 2008-11-05 テルモ株式会社 心臓治療装置
US7305265B2 (en) 2002-11-25 2007-12-04 Terumo Kabushiki Kaisha Heart treatment equipment for treating heart failure
EP1426078A1 (fr) 2002-12-04 2004-06-09 Terumo Kabushiki Kaisha Equipement de traitment du coeur pour la prévention d'arythmie mortelle
JP4252830B2 (ja) 2003-03-24 2009-04-08 テルモ株式会社 心臓治療装置
US7155278B2 (en) 2003-04-21 2006-12-26 Medtronic, Inc. Neurostimulation to treat effects of sleep apnea
US7039466B1 (en) 2003-04-29 2006-05-02 Advanced Bionics Corporation Spatial decimation stimulation in an implantable neural stimulator, such as a cochlear implant
JP4213522B2 (ja) 2003-05-30 2009-01-21 テルモ株式会社 心臓治療装置
EP1648558A4 (fr) 2003-06-13 2015-05-27 Biocontrol Medical B C M Ltd Applications de la stimulation vagale
US7620446B2 (en) 2003-07-31 2009-11-17 Medtronic, Inc. Monitoring P-waves to detect degradation of atrial myocardium
US8396565B2 (en) 2003-09-15 2013-03-12 Medtronic, Inc. Automatic therapy adjustments
US8442643B2 (en) 2003-10-02 2013-05-14 Medtronic, Inc. Medical device programmer with reduced-noise power supply
US7657312B2 (en) 2003-11-03 2010-02-02 Cardiac Pacemakers, Inc. Multi-site ventricular pacing therapy with parasympathetic stimulation
US7783353B2 (en) 2003-12-24 2010-08-24 Cardiac Pacemakers, Inc. Automatic neural stimulation modulation based on activity and circadian rhythm
US7706884B2 (en) 2003-12-24 2010-04-27 Cardiac Pacemakers, Inc. Baroreflex stimulation synchronized to circadian rhythm
US8396560B2 (en) 2004-11-18 2013-03-12 Cardiac Pacemakers, Inc. System and method for closed-loop neural stimulation
WO2005063332A1 (fr) 2003-12-24 2005-07-14 Cardiac Pacemakers, Inc. Systeme de stimulation du baroreflexe
US7460906B2 (en) 2003-12-24 2008-12-02 Cardiac Pacemakers, Inc. Baroreflex stimulation to treat acute myocardial infarction
US8200331B2 (en) 2004-11-04 2012-06-12 Cardiac Pacemakers, Inc. System and method for filtering neural stimulation
US7869881B2 (en) 2003-12-24 2011-01-11 Cardiac Pacemakers, Inc. Baroreflex stimulator with integrated pressure sensor
US8126560B2 (en) 2003-12-24 2012-02-28 Cardiac Pacemakers, Inc. Stimulation lead for stimulating the baroreceptors in the pulmonary artery
US20050149129A1 (en) 2003-12-24 2005-07-07 Imad Libbus Baropacing and cardiac pacing to control output
US7647114B2 (en) 2003-12-24 2010-01-12 Cardiac Pacemakers, Inc. Baroreflex modulation based on monitored cardiovascular parameter
US8126559B2 (en) 2004-11-30 2012-02-28 Cardiac Pacemakers, Inc. Neural stimulation with avoidance of inappropriate stimulation
US7769450B2 (en) 2004-11-18 2010-08-03 Cardiac Pacemakers, Inc. Cardiac rhythm management device with neural sensor
US20050149132A1 (en) 2003-12-24 2005-07-07 Imad Libbus Automatic baroreflex modulation based on cardiac activity
US7431699B2 (en) 2003-12-24 2008-10-07 Cardiac Pacemakers, Inc. Method and apparatus for third heart sound detection
US20050149133A1 (en) 2003-12-24 2005-07-07 Imad Libbus Sensing with compensation for neural stimulator
US8024050B2 (en) 2003-12-24 2011-09-20 Cardiac Pacemakers, Inc. Lead for stimulating the baroreceptors in the pulmonary artery
US7643875B2 (en) 2003-12-24 2010-01-05 Cardiac Pacemakers, Inc. Baroreflex stimulation system to reduce hypertension
US7486991B2 (en) 2003-12-24 2009-02-03 Cardiac Pacemakers, Inc. Baroreflex modulation to gradually decrease blood pressure
US7873413B2 (en) 2006-07-24 2011-01-18 Cardiac Pacemakers, Inc. Closed loop neural stimulation synchronized to cardiac cycles
US7509166B2 (en) 2003-12-24 2009-03-24 Cardiac Pacemakers, Inc. Automatic baroreflex modulation responsive to adverse event
US7299086B2 (en) 2004-03-05 2007-11-20 Cardiac Pacemakers, Inc. Wireless ECG in implantable devices
US7260431B2 (en) 2004-05-20 2007-08-21 Cardiac Pacemakers, Inc. Combined remodeling control therapy and anti-remodeling therapy by implantable cardiac device
US20060020297A1 (en) 2004-07-20 2006-01-26 Gerber Martin T Neurostimulation system with distributed stimulators
US20060074453A1 (en) 2004-10-04 2006-04-06 Cvrx, Inc. Baroreflex activation and cardiac resychronization for heart failure treatment
US8175705B2 (en) 2004-10-12 2012-05-08 Cardiac Pacemakers, Inc. System and method for sustained baroreflex stimulation
US7414534B1 (en) * 2004-11-09 2008-08-19 Pacesetter, Inc. Method and apparatus for monitoring ingestion of medications using an implantable medical device
ATE468154T1 (de) 2004-11-18 2010-06-15 Cardiac Pacemakers Inc Vorrichtung für herzrhythmusmanagement mit neurosensor
US9089691B2 (en) 2004-12-07 2015-07-28 Cardiac Pacemakers, Inc. Stimulator for auricular branch of vagus nerve
US8600521B2 (en) 2005-01-27 2013-12-03 Cyberonics, Inc. Implantable medical device having multiple electrode/sensor capability and stimulation based on sensed intrinsic activity
US7561918B2 (en) * 2005-01-28 2009-07-14 Cyberonics, Inc. Autocapture in a neurostimulator
US7613511B2 (en) 2005-03-09 2009-11-03 Cardiac Pacemakers, Inc. Implantable vagal stimulator for treating cardiac ischemia
US7587238B2 (en) 2005-03-11 2009-09-08 Cardiac Pacemakers, Inc. Combined neural stimulation and cardiac resynchronization therapy
US7769446B2 (en) 2005-03-11 2010-08-03 Cardiac Pacemakers, Inc. Neural stimulation system for cardiac fat pads
US7840266B2 (en) 2005-03-11 2010-11-23 Cardiac Pacemakers, Inc. Integrated lead for applying cardiac resynchronization therapy and neural stimulation therapy
US7660628B2 (en) 2005-03-23 2010-02-09 Cardiac Pacemakers, Inc. System to provide myocardial and neural stimulation
US8473049B2 (en) 2005-05-25 2013-06-25 Cardiac Pacemakers, Inc. Implantable neural stimulator with mode switching
US8406876B2 (en) 2005-04-05 2013-03-26 Cardiac Pacemakers, Inc. Closed loop neural stimulation synchronized to cardiac cycles
US7493161B2 (en) 2005-05-10 2009-02-17 Cardiac Pacemakers, Inc. System and method to deliver therapy in presence of another therapy
US7542800B2 (en) 2005-04-05 2009-06-02 Cardiac Pacemakers, Inc. Method and apparatus for synchronizing neural stimulation to cardiac cycles
US7555341B2 (en) 2005-04-05 2009-06-30 Cardiac Pacemakers, Inc. System to treat AV-conducted ventricular tachyarrhythmia
US7499748B2 (en) 2005-04-11 2009-03-03 Cardiac Pacemakers, Inc. Transvascular neural stimulation device
US7881782B2 (en) 2005-04-20 2011-02-01 Cardiac Pacemakers, Inc. Neural stimulation system to prevent simultaneous energy discharges
US20060241725A1 (en) 2005-04-25 2006-10-26 Imad Libbus Method and apparatus for simultaneously presenting cardiac and neural signals
US7570999B2 (en) 2005-12-20 2009-08-04 Cardiac Pacemakers, Inc. Implantable device for treating epilepsy and cardiac rhythm disorders
US7769464B2 (en) * 2007-04-30 2010-08-03 Medtronic, Inc. Therapy adjustment
US20090018596A1 (en) 2007-05-15 2009-01-15 Cvrx, Inc. Baroreflex activation therapy device with pacing cardiac electrical signal detection capability
US7665195B1 (en) 2008-09-25 2010-02-23 Jose Fernando Vazquez-Perez Method and apparatus for ecological burial
US8260412B2 (en) * 2008-10-31 2012-09-04 Medtronic, Inc. Implantable medical device crosstalk evaluation and mitigation
US20100285196A1 (en) 2009-05-11 2010-11-11 The Quaker Oats Company Method for preparing puffed cakes using a rotary cooker
WO2011071896A1 (fr) 2009-12-08 2011-06-16 Cardiac Pacemakers, Inc. Détection de thérapie simultanée dans des dispositifs médicaux implantables

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1999004329A2 (fr) * 1997-07-21 1999-01-28 Kristin Ann Farry Developpement de programmes de classification pour traitement et commande de signal
US6304772B1 (en) * 1999-08-30 2001-10-16 Ge Medical Systems Information Technologies, Inc. Method and apparatus for automatically detecting and interpreting paced electrocardiograms
US6477404B1 (en) * 2000-03-01 2002-11-05 Cardiac Pacemakers, Inc. System and method for detection of pacing pulses within ECG signals
US7565195B1 (en) * 2005-04-11 2009-07-21 Pacesetter, Inc. Failsafe satellite pacemaker system
US7542794B1 (en) * 2005-05-24 2009-06-02 Infinite Biomedical Technologies, Llc Method of extracting and evaluating paced heart beats using max-min transform analysis
US20090030484A1 (en) * 2007-04-30 2009-01-29 Cochlear Limited Bilateral prosthesis synchronization

Cited By (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8805494B2 (en) 2005-05-10 2014-08-12 Cardiac Pacemakers, Inc. System and method to deliver therapy in presence of another therapy
US9504836B2 (en) 2005-05-10 2016-11-29 Cardiac Pacemakers, Inc. System and method to deliver therapy in presence of another therapy
US8548585B2 (en) 2009-12-08 2013-10-01 Cardiac Pacemakers, Inc. Concurrent therapy detection in implantable medical devices
US9227068B2 (en) 2009-12-08 2016-01-05 Cardiac Pacemakers, Inc. Concurrent therapy detection in implantable medical devices
JP2014533578A (ja) * 2011-11-28 2014-12-15 カーディアック ペースメイカーズ， インコーポレイテッド マルチプル治療用埋め込み型装置におけるクロス治療センシングの管理

Also Published As

Publication number Publication date
JP2013512763A (ja) 2013-04-18
JP5600751B2 (ja) 2014-10-01
US9227068B2 (en) 2016-01-05
US8548585B2 (en) 2013-10-01
EP2509683A1 (fr) 2012-10-17
US20110137360A1 (en) 2011-06-09
EP2509683B1 (fr) 2017-08-23
US20140005494A1 (en) 2014-01-02

Similar Documents

Publication Publication Date Title
US9227068B2 (en) Concurrent therapy detection in implantable medical devices
US10668287B2 (en) Neural stimulation with transient response between doses
US9867987B2 (en) Remote detection of physiological parameter using an implantable medical device
US9962548B2 (en) Closed loop neural stimulation synchronized to cardiac cycles
US8862226B2 (en) Remote sensing in an implantable medical device
US9031650B2 (en) Closed loop neural stimulation synchronized to cardiac cycles
US8934970B2 (en) Physiological vibration detection in an implanted medical device

Legal Events

Date Code Title Description
121 Ep: the epo has been informed by wipo that ep was designated in this application

Ref document number: 10793104

Country of ref document: EP

Kind code of ref document: A1

121 Ep: the epo has been informed by wipo that ep was designated in this application

Ref document number: 10793104

Country of ref document: EP

Kind code of ref document: A1

NENP Non-entry into the national phase

Ref country code: DE

WWE Wipo information: entry into national phase

Ref document number: 2012543201

Country of ref document: JP

REEP Request for entry into the european phase

Ref document number: 2010793104

Country of ref document: EP

WWE Wipo information: entry into national phase

Ref document number: 2010793104

Country of ref document: EP