System and method for discrimination of central and obstructive disordered breathing events

Disordered breathing events may be classified as central, obstructive or a combination of central an obstructive in origin based on patient motion associated with respiratory effort. Central disordered breathing is associated with disrupted respiration with reduced respiratory effort. Obstructive disordered breathing is associated with disrupted respiration accompanied by respiratory effort. A disordered breathing classification system includes a disordered breathing detector and a respiratory effort motion sensor. Components of the disordered breathing classification system may be fully or partially implantable.

Cardiac resynchronization therapy for improved hemodynamics based on disordered breathing detection

The presence of disordered breathing is detected using an implantable medical device. A cardiac condition is detected that is indicative of the patient's cardiac status. Based on the presence of disordered breathing and the cardiac condition, the patient is identified as suitable for a cardiac resynchronization therapy.

CARDIAC RESYNCHRONIZATION THERAPY FOR IMPROVED HEMODYNAMICS BASED ON DISORDERED BREATHING DETECTION

The presence of disordered breathing is detected using an implantable medical device. A cardiac condition is detected that is indicative of the patient's cardiac status. Based on the presence of disordered breathing and the cardiac condition, the patient is identified as suitable for a cardiac resynchronization therapy. 1. (canceled)2. An implantable medical device , comprising:a housing configured for implantation in a patient; and detect presence of sleep disordered breathing;', 'detect a level of cardiac dyssynchrony at least one of within and between cardiac chambers of the patient; and', 'identify if the patient is likely to respond to a cardiac resynchronization therapy based on the presence of disordered breathing and the level of the cardiac condition., 'a processor provided in the housing and configured to3. The device of claim 2 , wherein the processor is further configured to initiate cardiac resynchronization therapy for the patient based on the combined detection of the sleep disordered breathing and the level of the cardiac dyssynchrony.4. The device of claim 3 , further comprising:a pulse generator coupled to the processor;wherein the processor is also configured to enable the pulse generator to deliver the cardiac resynchronization therapy, and wherein enabling comprises at least one of downloading cardiac resynchronization therapy protocol to the implantable medical device, and activating unused cardiac resynchronization therapy protocol stored in memory of the implantable medical device.5. The device of claim 2 , wherein the processor is configured to adjust an atrioventricular delay based on the type of sleep disordered breathing detected by the implantable medical device.6. The device of claim 2 , wherein the processor is configured to detect a QRS complex width exceeding a predetermined value and measure an apnea/hypopnea index exceeding a predetermined value.7. The device of claim 2 , further comprising an implantable sensor arrangement coupled ...

METHOD AND APPARATUS FOR CONTROL OF CARDIAC THERAPY USING NON-INVASIVE HEMODYNAMIC SENSOR

A cardiac rhythm management (CRM) system includes a non-invasive hemodynamic sensing device and an implantable medical device to sense a hemodynamic signal and derive one or more cardiac performance parameters from the hemodynamic signal. The non-invasive hemodynamic sensing device includes at least a portion configured for external attachment to a body in which the implantable medical device is implanted. The one or more cardiac performance parameters are used for various diagnostic, monitoring, and therapy control purposes. 1. A system coupled to a body having external appendages including a finger , a toe , an ear , an arm , and a wrist , the system comprising:a non-invasive hemodynamic sensing device including at least a portion configured to be attached to one of the external appendages, the non-invasive hemodynamic sensing device configured to sense a hemodynamic signal indicative of at least a heart rate, produce hemodynamic data associated with the hemodynamic signal, and transmit the hemodynamic data; and a neural stimulation circuit configured to deliver neural stimulation pulses; and', 'a neural stimulation controller configured to control the delivery of the neural stimulation pulses using one or more neural stimulation parameters for treating a cardiovascular disorder, the neural stimulation controller including a stimulation parameter adjustment module configured to adjust the one or more neural stimulation parameters using one or more cardiac performance parameters, the stimulation parameter adjustment module configured to compare a heart rate parameter representative of the heart rate to a predetermined threshold heart rate and adjust the delivery of the neural stimulation pulses using an outcome of the comparison,, 'an implantable medical device configured to be communicatively coupled to the non-invasive hemodynamic sensing device via a wireless communication link to receive the hemodynamic data, the implantable medical device includingwherein one ...

MEDICAL EVENT LOGBOOK SYSTEM AND METHOD

An event-based approach to collecting and organizing information associated with events affecting respiration is presented. The detection or prediction of an event affecting the respiration of a patient initiates acquisition of information associated with the event. The respiratory logbook system acquires information associated with the event during the event and during intervals proximate in time to the event. The information is organized as a respiratory log entry. The user can access the information by operating a user interface. The information may be presented in textual or graphical form. 1. A method for organizing medical information , comprising:detecting or predicting a respiratory event of a patient;initiating, responsive to the detection or prediction of the respiratory event, collection of medical information associated with the respiratory event;collecting the medical information associated with the respiratory event;organizing the medical information as a respiratory event log entry; anddisplaying on a display at least part of the organized medical information, including a time associated with the respiratory event that corresponds to the displayed information.2. The method of claim 1 , wherein at least one of detecting or predicting the respiratory event claim 1 , initiating the collecting of medical information claim 1 , collecting the medical information claim 1 , and organizing the medical information is performed at least in part implantably.3. The method of claim 1 , wherein collecting the medical information associated with the respiratory event comprises collecting the medical information during the respiratory event.4. The method of claim 1 , wherein collecting the medical information associated with the respiratory event comprises collecting the medical information proximate in time to the respiratory event.5. The method of claim 1 , wherein detecting or predicting the respiratory event comprises detecting or predicting the respiratory event ...

Thoracic or intracardiac impedance detection with automatic vector selection

Vector selection is automatically achieved via a thoracic or intracardiac impedance signal collected in a cardiac function management device or other implantable medical device that includes a test mode and a diagnostic mode. During a test mode, the device cycles through various electrode configurations for collecting thoracic impedance data. At least one figure of merit is calculated from the impedance data for each such electrode configuration. In one example, only non-arrhythmic beats are used for computing the figure of merit. A particular electrode configuration is automatically selected using the figure of merit. During a diagnostic mode, the device collects impedance data using the selected electrode configuration. In one example, the figure of merit includes a ratio of a cardiac stroke amplitude and a respiration amplitude. Other examples of the figure of merit are also described.

ENHANCEMENTS TO THE DETECTION OF PULMONARY EDEMA WHEN USING TRANSTHORACIC IMPEDANCE

This patent document discusses, among other things, systems, devices, and methods for enhancing detection of pulmonary edema using, in addition to thoracic impedance, one or a combination of: physiologic information about a subject, at least one statistical parameter, a user-programmable detection level, at least one parameter associated with a previous pulmonary edema event, and patient symptom information about the subject. In one example, a (base) thoracic impedance threshold is modified to an adjusted thoracic impedance threshold. The adjusted thoracic impedance threshold provides an increased sensitivity of pulmonary edema detection as compared to the base thoracic impedance threshold. In another example, an alert is provided to a subject, a caregiver, or other user based on a pulmonary edema indication determined by the present systems, devices, and methods. In a further example, a therapy (provided to the subject) is adjusted or initiated in response to the pulmonary edema indication.

IMPLANTABLE CARDIAC DEVICE WITH DYSPNEA MEASUREMENT

Cardiac monitoring and/or stimulation methods and systems employing dyspnea measurement. An implantable cardiac device may sense transthoracic impedance and determine a patient activity level. An index indicative of pulmonary function is implantably computed to detect an episode of dyspnea based on a change, trend, and/or value exceeding a threshold at a determined patient activity level. Trending one or more pulmonary function index values may be done to determine a patient's pulmonary function index profile, which may be used to adapt a cardiac therapy. A physician may be automatically alerted in response to a pulmonary function index value and/or a trend of the patient's pulmonary index being beyond a threshold. Computed pulmonary function index values and their associated patient's activity levels may be stored periodically in a memory and/or transmitted to a patient-external device. 1. An implantable cardiac device , comprising:a housing configured for implantation in a patient;an implantable sensor configured to sense transthoracic impedance;an implantable activity sensor configured to make an activity measurement indicative of patient activity;a memory provided in the housing; determine a patient pulmonary function index indicative of patient pulmonary function based at least part on the sensed transthoracic impedance;', 'detect a physiological condition based on the determined index being beyond a threshold, the threshold based at least in part on a plurality of patient pulmonary function index values and associated patient activity levels; and', 'provide an output based, at least in part, on the detected physiological condition., 'a controller provided in the housing and coupled to the respective sensors and the memory, the controller configured to2. The device according to claim 1 , wherein the controller is configured to determine the patient pulmonary function index based at least in part on a ratio of the multiple respiration parameters.3. The device ...

COORDINATED USE OF RESPIRATORY AND CARDIAC THERAPIES FOR SLEEP DISOREDERED BREATHING

Methods and systems involve coordinating therapies used for treating disordered breathing. Disordered breathing therapies may include cardiac electrical stimulation therapy and external respiratory therapy as well as other therapies for treating disordered breathing in a patient. The therapies delivered to the patient may be coordinated to enhance effectiveness of the therapy, to reduce therapy interactions, to improve patient sleep, or to achieve other therapeutic goals. 1. A method for delivering therapy to a patient , comprising:identifying one or more conditions; andcoordinating delivery of a first therapy and a second therapy via an implantable device by shifting therapy burden from the first therapy or the second therapy to the other of the first therapy or the second therapy based on the one or more identified conditions.2. The method of claim 1 , wherein the first therapy includes an electrical stimulation therapy.3. The method of claim 2 , wherein the electrical stimulation therapy includes cardiac pacing.4. The method of claim 2 , wherein the electrical stimulation therapy includes nerve stimulation.5. The method of claim 4 , wherein the nerve stimulation includes hypoglossal nerve stimulation.6. The method of claim 4 , wherein the nerve stimulation includes phrenic nerve stimulation.7. The method of claim 2 , wherein the electrical stimulation therapy includes muscle stimulation.8. The method of claim 1 , wherein the first therapy includes cardiac pacing and the second therapy includes nerve stimulation.9. The method of claim 8 , wherein the nerve stimulation includes hypoglossal nerve stimulation.10. The method of claim 8 , wherein the nerve stimulation includes phrenic nerve stimulation.11. The method of claim 1 , wherein the first therapy includes drug delivery.12. The method of claim 1 , wherein the first therapy includes anti-hypertensive therapy.13. The method of claim 1 , wherein the coordinating delivery includes shifting therapy burden from the ...

AUTONOMIC AROUSAL DETECTION SYSTEM AND METHOD

Various approaches to detecting arousals from sleep involve generating signals modulated by muscle tone, brainwave activity, and/or other nervous system activity associated with a patient's autonomic arousal response. Generating the signals and/or detecting autonomic arousals from sleep may be performed using an implantable device. Arousal information may be useful to identify sleep disorder events associated with arousals from sleep, for diagnostic purposes, and/or for therapy adjustment. 1. A method for adjusting a patient neurostimulation therapy , comprising:sensing one or more physiological conditions modulated by a patient's autonomic arousal response;detecting autonomic arousal events occurring during sleep based on the one or more sensed physiological conditions, wherein at least one of sensing the physiological conditions and detecting the autonomic arousal events is performed at least in part implantably;discriminating between autonomic arousal events associated with sleep disorder events and autonomic arousal events not associated with sleep disorder events; andadjusting the patient neurostimulation therapy based, at least in part, on the discriminated autonomic arousal events.2. The method according to claim 1 , wherein the patient therapy further comprises a cardiac stimulation therapy claim 1 , and wherein the method further comprises adjusting the patient cardiac stimulation therapy based claim 1 , at least in part claim 1 , on the discriminated autonomic arousal events.3. The method according to claim 1 , wherein the patient therapy further comprises a hypertension therapy claim 1 , and wherein the method further comprises adjusting the patient hypertension therapy based claim 1 , at least in part claim 1 , on the discriminated autonomic arousal events.4. The method according to claim 1 , wherein only autonomic arousal events associated with sleep disorder events are used in adjusting the patient neurostimulation therapy.5. The method according to ...

Method and system for heart failure status evaluation based on a disordered breathing index

An evaluation of heart failure status is provided based on a disordered breathing index. Patient respiration is sensed and a respiration signal is generated. Disordered breathing episodes are detected based on the respiration signal. A disordered breathing index is determined based on the disordered breathing episodes. The disordered breathing index is trended and used to evaluate heart failure status. The disordered breathing index may be combined with additional information and/or may take into account patient activity, posture, sleep stage, or other patient information.

Implantable cardiac device with dyspnea measurement

Cardiac monitoring and/or stimulation methods and systems employing dyspnea measurement. An implantable cardiac device may sense transthoracic impedance and determine a patient activity level. An index indicative of pulmonary function is implantably computed to detect an episode of dyspnea based on a change, trend, and/or value exceeding a threshold at a determined patient activity level. Trending one or more pulmonary function index values may be done to determine a patient's pulmonary function index profile, which may be used to adapt a cardiac therapy. A physician may be automatically alerted in response to a pulmonary function index value and/or a trend of the patient's pulmonary index being beyond a threshold. Computed pulmonary function index values and their associated patient's activity levels may be stored periodically in a memory and/or transmitted to a patient-external device.

IMPLANTABLE CARDIAC DEVICE WITH DYSPNEA MEASUREMENT

Cardiac monitoring and/or stimulation methods and systems employing dyspnea measurement. An implantable cardiac device may sense transthoracic impedance and determine a patient activity level. An index indicative of pulmonary function is implantably computed to detect an episode of dyspnea based on a change, trend, and/or value exceeding a threshold at a determined patient activity level. Trending one or more pulmonary function index values may be done to determine a patient's pulmonary function index profile, which may be used to adapt a cardiac therapy. A physician may be automatically alerted in response to a pulmonary function index value and/or a trend of the patient's pulmonary index being beyond a threshold. Computed pulmonary function index values and their associated patient's activity levels may be stored periodically in a memory and/or transmitted to a patient-external device. 1. (canceled)2. A system , comprising:a respiration sensor configured to sense respiration of a patient;an activity sensor configured to sense an activity level of the patient; determine a patient index based at least part on the sensed respiration of the patient;', 'detect a physiological condition based on the determined patient index being beyond a threshold, wherein the threshold is based at least in part on the sensed activity level of the patient; and', 'provide an output based, at least in part, on the detected physiological condition., 'a controller operatively coupled to the respiration sensor and the activity sensor, the controller configured to3. The system of claim 2 , wherein the controller is configured to determine the patient index based at least in part on a ratio of a respiratory rate value and a tidal volume value for the patient.4. The system of claim 2 , wherein the threshold is based on a profile developed by the controller using a plurality of previous patient index values and associated activity levels of the patient acquired over time.5. The system of claim ...

Multi-sensor blending in a rate responsive cardiac pacemaker

A multi-sensor blending circuit (12) for use in a rate responsive cardiac pacemaker. The blending logic circuit (12) blends delta pacing rate signals from two or more sensors (22) which measure physical and physiological parameters of a patient. Programmable equations stored in the blending logic circuit (12) determine which percentages or a ratio of the delta pacing rate sensor signals comprise a single delta pacing rate signal as a function of the delta pacing rate. This delta pacing rate signal is provided to the pacing control circuitry (14) of a pacemaker. The blending ratios are dynamically determined based on the pacing rate established at the most recent cardiac cycle. The blending equations are comprised of several programmable variables, wherein the equations can be programmed by the external programmer (16) in view of clinical data.

Implantable device employing movement sensing for detecting sleep-related disorders

Methods and systems for evaluating a pathological condition include acquiring movement information, such as electromyogram (EMG) information, and sleep disordered breathing (SDB) information, and detecting the presence of a pathological condition using both movement and SDB information. Methods may involve sensing physiological signals including at least muscle movement signals. Sleep-related disorders are detected using the sensed physiological signals, the sleep-related disorders including at least an involuntary muscle movement disorder and sleep-disordered breathing. Methods and systems also provide for detecting and treating a sleep-related disorder using movement and SDB information. Cardiac, respiratory, nerve stimulation, drug, or a combination of such therapies may be delivered to treat a detected or diagnosed pathological condition.

Autonomic arousal detection system and method

Various approaches to detecting arousals from sleep involve generating signals modulated by muscle tone, brainwave activity, and/or other nervous system activity associated with a patient's autonomic arousal response. Generating the signals and/or detecting autonomic arousals from sleep may be performed using an implantable device. Arousal information may be useful to identify sleep disorder events associated with arousals from sleep, for diagnostic purposes, and/or for therapy adjustment.

Implantable cardiac device with dyspnea measurement

Cardiac monitoring and/or stimulation methods and systems employing dyspnea measurement. An implantable cardiac device may sense transthoracic impedance and determine a patient activity level. An index indicative of pulmonary function is implantably computed to detect an episode of dyspnea based on a change, trend, and/or value exceeding a threshold at a determined patient activity level. Trending one or more pulmonary function index values may be done to determine a patient's pulmonary function index profile, which may be used to adapt a cardiac therapy. A physician may be automatically alerted in response to a pulmonary function index value and/or a trend of the patient's pulmonary index being beyond a threshold. Computed pulmonary function index values and their associated patient's activity levels may be stored periodically in a memory and/or transmitted to a patient-external device.

Method and apparatus for adjusting the sensing threshold of a cardiac rhythm management device

A method and apparatus for automatically adjusting the sensing threshold of cardiac rhythm management devices. The invention is particularly suited for implementation in devices such as implantable cardiac pacemakers and implantable cardioverter/defibrillators. A method and apparatus are provided in which a noise level and signal level for a sensing channel are determined for each cardiac cycle with the sensing threshold of the channel being adjusted in accordance therewith.

System promoting atrial pacing

Method and apparatus for adjusting the sensing threshold of a cardiac rhythm management device

A method and apparatus for automatically adjusting the sensing threshold of cardiac rhythm management devices. The invention is particularly suited for implementation in devices such as implantable cardiac pacemakers and implantable cardioverter/defibrillators. A method and apparatus are provided in which a noise level and signal level for a sensing channel are determined for each cardiac cycle with the sensing threshold of the channel being adjusted in accordance therewith.

Cardiac rhythm management system with non-invasive hemodynamic sensor

A cardiac rhythm management (CRM) system includes a non-invasive hemodynamic sensing device and an implantable medical device to sense a hemodynamic signal and derive one or more cardiac performance parameters from the hemodynamic signal. The non-invasive hemodynamic sensing device includes at least a portion configured for external attachment to a body in which the implantable medical device is implanted. The one or more cardiac performance parameters are used for various diagnostic, monitoring, and therapy control purposes.

Multi-sensor blending in a rate responsive cardiac pacemaker

A multi-sensor blending circuit (12) for use in rate responsive cardiac pacemaker. The blending logic circuit (12) blends delta pacing rate signals from two or more sensors (22) which measure physical and physiological parameters of a patient. Programmable equations stored in the blending logic circuit (12) determine which percentages or a ratio of the delta pacing rate sensor signals comprise a single delta pacing rate signal as a function of the delta pacing rate. This delta pacing rate signal is provided to the pacing control circuitry (14) of a pacemaker. The blending ratios are dynamically determined based on the pacing rate established at the most recent cardiac cycle. The blending equations are comprised of several programmable variables, wherein the equations can be programmed by the external programmer (16) in view of clinical data.

Cardiac rhythm management device using transthoracic impedance

A cardiac rhythm management (CRM) device detects transthoracic impedance, extracts ventilation or other information, and adjusts a delivery rate of the CRM therapy accordingly. A four-phase sequence of alternating direction current pulse stimuli is periodically delivered to a patient's thorax. A transthoracic impedance signal is extracted using a weighted demodulation. Signal processing extracts ventilation information and removes cardiac stroke information using an adaptive lowpass filter. The adaptive filter cutoff frequency is based on the patient's heart rate; a higher cutoff frequency is provided for higher heart rates. Peak/valley detection indicates tidal volume, which is integrated to extract minute ventilation (MV). Short and long term averages are formed and compared to establish a MV indicated rate. Rate adjustment ignores MV information when a noise-measurement exceeds a threshold. An interference avoidance circuit delays delivery of the stimuli when telemetry pulses or other interfering signals are detected.

Automatic threshold sensitivity adjustment for cardiac rhythm management devices

An implanting cardiac rhythm management device (10) includes a controller (28) adapted to receive digitized electrocardiogram signals from leads (14) placed on or in the heart, and incorporates an auto-sense algorithm which automatically adjusts the sensing threshold dependent upon an average or maximum amplitude of noise detected during a period following a sensed cardiac depolarization. The sensing threshold is automatically set on a beat to beat basis at a level such that the signal to noise ratio exceeds a preset value.

Patient monitoring, diagnosis, and/or therapy systems and methods

Systems and methods involve an implantable device configured to perform at least one cardiac-related function, a patient-external respiratory therapy device, and a communication channel configured to facilitate communication between the implantable device and the respiratory therapy device. The implantable and respiratory therapy devices operate cooperatively via the communication channel to provide one or more of patient monitoring, diagnosis, and therapy. The communication channel may be configured to facilitate communication between an external processing system and at least one of the implantable device and the respiratory therapy device. The processing system is communicatively coupled to at least one of the implantable and respiratory therapy devices via the communication channel to provide one or more of patient monitoring, diagnosis, and therapy.

Minimizing hemodynamic compromise during post-mi pacing

Using sub-threshold unipolar pacing markers to improve the interpretation of surface ekg in pacemaker patient

A pacemaker including a marker code generator generating marker codes between an indifferent electrode disposed on the pacemaker housing and the pacemaker can serving as a reference electrode. Marker code signals are generated proximate the pacemaker rather than proximate cardiac tissue, and thus can be generated at a large potential for sensing by surface EKG, and can also be generated simultaneously while pacing the heart and not necessarily in the refractory period. The pacemaker facilitates the interpretation of surface EKG, and can be sensed and recorded by commercially available two-channel holter monitors which can be taken home with the patient. Thus, marker code signals can be sensed and recorded while at home and played back for the physician at a later time for analysis. The marker code generator can be selectively turned on by the external programmer such that battery life depreciation is not appreciable. The pacemaker can be adapted with either a unipolar or bipolar endocardial lead.

Methods and systems for control of gas therapy

A gas therapy system involves sensing the blood gas concentration of the patient and adapting a gas therapy based on the sensed gas concentration. Disordered breathing may be detected bases on blood gas concentration, and gas or cardiac electrical therapy may be adapted to treat the detected disordered breathing. One or more of sensing the blood gas concentration, detecting disordered breathing, or adapting the therapy may be performed at least in part implantably. The gas therapy is delivered to the patient through an external respiratory device, such as a positive airway pressure device.

Coordinated use of respiratory and cardiac therapies for sleep disordered breathing

Methods and systems involve coordinating therapies used for treating disordered breathing. Disordered breathing therapies may include cardiac electrical stimulation therapy and external respiratory therapy as well as other therapies for treating disordered breathing in a patient. The therapies delivered to the patient may be coordinated to enhance effectiveness of the therapy, to reduce therapy interactions, to improve patient sleep, or to achieve other therapeutic goals.

System and method for discrimination of central and obstructive disordered breathing events

Disordered breathing events may be classified as central, obstructive or a combination of central an obstructive in origin based on patient motion associated with respiratory effort. Central disordered breathing is associated with disrupted respiration with reduced respiratory effort. Obstructive disordered breathing is associated with disrupted respiration accompanied by respiratory effort. A disordered breathing classification system includes a disordered breathing detector and a respiratory effort motion sensor. Components of the disordered breathing classification system may be fully or partially implantable.

Method and apparatus for adjusting the sensing threshold of a cardiac rhythm management device

A method and apparatus for automatically adjusting the sensing threshold of cardiac rhythm management devices. The invention is particularly suited for implementation in devices such as implantable cardiac pacemakers and implantable cardioverter/defibrillators. A method and apparatus are provided in which a noise level and signal level for a sensing channel are determined for each cardiac cycle with the sensing threshold of the channel being adjusted in accordance therewith.

Detection of disordered breathing

Devices and methods for detecting disordered breathing involve determining that the patient is asleep and sensing one or more signals associated with disordered breathing indicative of sleep-disordered breathing while the patient is asleep. Sleep-disordered breathing is detected using the sensed signals associated with disordered breathing. The sensed signals associated with disordered breathing may also be used to acquire a respiration pattern of one or more respiration cycles. Characteristics of the respiration pattern are determined. The respiration pattern is classified as a disordered breathing episode based on the characteristics of the respiration pattern. One or more processes involved in the detection of disordered breathing are performed using an implantable device.

Detection of disordered breathing

Devices and methods for detecting disordered breathing involve determining that the patient is asleep and sensing one or more signals associated with disordered breathing indicative of sleep-disordered breathing while the patient is asleep. Sleep-disordered breathing is detected using the sensed signal associated with disordered breathing. The sensed signals associated with disordered breathing may also be used to acquire a respiration pattern of one or more respiration cycles. Characteristics of the respiration pattern are determined. The respiration pattern is classified as a disordered breathing episode based on the characteristics of the respiration pattern. One or more processes involved in the detection of disordered breathing are performed using an implantable device.

Method and apparatus for delivering defibrillation shock therapy while reducing electrical dispersion due to ventricular conduction disorder

A method and device for delivering defibrillation shock therapy in patients having an inter-ventricular conduction disorder is presented. Ventricular resynchronization therapy is employed to reduce the dispersion of ventricular depolarization which takes place due to the conduction disorder and reduces the safety margin of shocks delivered synchronously with ventricular beats. The method may be employed in the treatment of atrial or ventricular tachyarrhythmias.

Medical Event Logbook System and Method

An event-based approach to collecting and organizing information associated with events affecting respiration is presented. The detection or prediction of an event affecting the respiration of a patient initiates acquisition of information associated with the event. The respiratory logbook system acquires information associated with the event during the event and during intervals proximate in time to the event. The information is organized as a respiratory log entry. The user can access the information by operating a user interface. The information may be presented in textual or graphical form.

Enhancements to the detection of pulmonary edema when using transthoracic impedance

This patent document discusses, among other things, systems, devices, and methods for enhancing detection of pulmonary edema using, in addition to thoracic impedance, one or a combination of: physiologic information about a subject, at least one statistical parameter, a user-programmable detection level, at least one parameter associated with a previous pulmonary edema event, and patient symptom information about the subject. In one example, a (base) thoracic impedance threshold is modified to an adjusted thoracic impedance threshold. The adjusted thoracic impedance threshold provides an increased sensitivity of pulmonary edema detection as compared to the base thoracic impedance threshold. In another example, an alert is provided to a subject, a caregiver, or other user based on a pulmonary edema indication determined by the present systems, devices, and methods. In a further example, a therapy (provided to the subject) is adjusted or initiated in response to the pulmonary edema indication.

System and method for detecting an involuntary muscle movement disorder

Methods and systems are directed to evaluating a pathological condition and involve acquiring muscle movement signals, such as electromyogram (EMG) or accelerometer signals, and detecting the presence of the pathological condition. Methods and systems also provide for detecting sleep-related involuntary muscle disorders and non sleep-related involuntary muscle disorders using muscle movement signals. Drug therapy, transcutaneous electric nerve stimulation therapy, or other therapy may be delivered to treat a detected or diagnosed involuntary muscle disorder.

Automatic activation of medical processes

Systems and methods involve automatic activation, de-activation or modification of therapies or other medical processes based on brain state. A medical system includes a sensor system having one or more sensors configured to sense signals related to the brain state of the patient. A brain state analyzer detects various brain states, including sleep stage and/or brain seizures. A controller uses the brain state detection information to control a medical system configured to perform at least one respiratory or cardiac process. Methods involve sensing signals related to brain state and determining the brain state of a patient based on the sensed signals. At least one respiratory or cardiac medical process is controlled based on the patient's brain state.

Methods and devices for implementing time of day pacing adjustments

Methods and systems are directed to delivering cardiac pacing therapy to a patient. A pacing therapy associated with one or more pacing parameters is delivered. Alternate cardiac pacing therapies associated with one or more alternate pacing parameters are transitioned to, based on a sleep/wake cycle of the patient. Interactions between the pacing parameters of the pacing therapy and the alternate pacing parameters are resolved. Resolving pacing parameters may be based on analysis of lower rate limits and/or lower rate hysteresis.

Methods and systems for implantably monitoring external breathing therapy

An implantable device is used to monitor one or more conditions associated with an external breathing therapy delivered to the patient. The device may monitor therapy parameters including therapy effectiveness, impact of the therapy on the patient, therapy usage, compliance with a prescribed usage, therapy interactions, and/or other parameters.

Method and apparatus for mimicking respiratory sinus arrhythmia with cardiac pacing controlled via external respiration therapy device

Methods and systems involve adjusting cardiac pacing based on information acquired via a respiratory therapy device. A medical system includes a respiratory therapy device having one or more sensors and a therapy delivery unit. The one or more sensors are configured to sense respiration cycles. The therapy delivery unit is configured to deliver an external respiratory therapy to the patient. The medical system also includes a pulse generator configured to deliver cardiac pacing pulses to the patient. A controller is coupled to the one or more sensors and the pulse generator. The control unit configured to adjust a cardiac pacing rate based on the patient's respiration cycles.

System und verfahren zum umgang mit atemstörungen

Patientenüberwachungs-, diagnose- und/oder therapiesysteme und -verfahren

Vorrichtung zur steuerung des herzrhythmus unter verwendung der transthorakalen impedanz

Minimierung von hämodynamischem kompromiss bei pacing nach einem mi

Thoracic or intracardiac impedance selecting vector automatically

A cardiac function management device or other implantable medical device includes a test mode and a diagnostic mode. During a test mode, the device cycles through various electrode configurations for collecting thoracic impedance data. At least one figure of merit is calculated from the impedance data for each such electrode configuration. In one example, only non-arrhythmic beats are used for computing the figure of merit. A particular electrode configuration is automatically selected using the figure of merit. During a diagnostic mode, the device collects impedance data using the selected electrode configuration. In one example, the figure of merit includes a ratio of a cardiac stroke amplitude and a respiration amplitude. Other examples of the figure of merit are also described.

Thoracic or intracardiac impedance selecting vector automatically

A cardiac function management device or other implantable medical device includes a test mode and a diagnostic mode. During a test mode, the device cycles through various electrode configurations for collecting thoracic impedance data. At least one figure of merit is calculated from the impedance data for each such electrode configuration. In one example, only non-arrhythmic beats are used for computing the figure of merit. A particular electrode configuration is automatically selected using the figure of merit. During a diagnostic mode, the device collects impedance data using the selected electrode configuration. In one example, the figure of merit includes a ratio of a cardiac stroke amplitude and a respiration amplitude. Other examples of the figure of merit are also described.

Thoracic or intracardiac impedance selecting vector automatically

A cardiac function management device or other implantable medical device includes a test mode and a diagnostic mode. During a test mode, the device cycles through various electrode configurations for collecting thoracic impedance data. At least one figure of merit is calculated from the impedance data for each such electrode configuration. In one example, only non-arrhythmic beats are used for computing the figure of merit. A particular electrode configuration is automatically selected using the figure of merit. During a diagnostic mode, the device collects impedance data using the selected electrode configuration. In one example, the figure of merit includes a ratio of a cardiac stroke amplitude and a respiration amplitude. Other examples of the figure of merit are also described.

Thorax- oder intrakardialimpedanzbestimmung mit automatischer vektorwahl

Thoracic or intracardiac impedance selecting vector automatically

A cardiac function management device or other implantable medical device includes a test mode and a diagnostic mode. During a test mode, the device cycles through various electrode configurations for collecting thoracic impedance data. At least one figure of merit is calculated from the impedance data for each such electrode configuration. In one example, only non-arrhythmic beats are used for computing the figure of merit. A particular electrode configuration is automatically selected using the figure of merit. During a diagnostic mode, the device collects impedance data using the selected electrode configuration. In one example, the figure of merit includes a ratio of a cardiac stroke amplitude and a respiration amplitude. Other examples of the figure of merit are also described.

Thorax- oder intrakardialimpedanzbestimmung mit automatischer vektorwahl

System providing ventricular pacing and biventricular coordination

A cardiac rhythm management system includes techniques for computing an indicated pacing interval, AV delay, or other timing interval. In one embodiment, a variable indicated pacing interval is computed based at least in part on an underlying intrinsic heart rate. The indicated pacing interval is used to time the delivery of biventricular coordination therapy even when ventricular heart rates are irregular, such as in the presence of atrial fibrillation. In another embodiment, a variable filter indicated AV interval is computed based at least in part on an underlying intrinsic AV interval. The indicated AV interval is used to time the delivery of atrial tracking biventricular coordination therapy when atrial heart rhythms are not arrhythmic. Other indicated timing intervals may be similarly determined. The indicated pacing interval, AV delay, or other timing interval can also be used in combination with a sensor indicated rate indicator.

System providing ventricular pacing and biventricular coordination

A cardiac rhythm management system includes techniques for computing an indicated pacing interval, AV delay, or other timing interval. In one embodiment, a variable indicated pacing interval is computed based at least in part on an underlying intrinsic heart rate. The indicated pacing interval is used to time the delivery of biventricular coordination therapy even when ventricular heart rates are irregular, such as in the presence of atrial fibrillation. In another embodiment, a variable filter indicated AV interval is computed based at least in part on an underlying intrinsic AV interval. The indicated AV interval is used to time the delivery of atrial tracking biventricular coordination therapy when atrial heart rhythms are not arrhythmic. Other indicated timing intervals may be similarly determined. The indicated pacing interval, AV delay, or other timing interval can also be used in combination with a sensor indicated rate indicator.