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다음과 같은 기능을 한번의 로그인으로 사용 할 수 있습니다.
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Kafe 바로가기국가/구분 | United States(US) Patent 등록 |
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국제특허분류(IPC7판) |
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출원번호 | US-0154411 (2008-05-22) |
등록번호 | US-8260421 (2012-09-04) |
발명자 / 주소 |
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출원인 / 주소 |
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대리인 / 주소 |
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인용정보 | 피인용 횟수 : 18 인용 특허 : 397 |
Methods and devices for reducing phrenic nerve stimulation of cardiac pacing systems involve delivering a pacing pulse to a ventricle of a heart. A transthoracic impedance signal is sensed, and a deviation in the signal resulting from the pacing pulse may be used to determine phrenic nerve stimulati
Methods and devices for reducing phrenic nerve stimulation of cardiac pacing systems involve delivering a pacing pulse to a ventricle of a heart. A transthoracic impedance signal is sensed, and a deviation in the signal resulting from the pacing pulse may be used to determine phrenic nerve stimulation. Methods may further involve detecting the phrenic nerve stimulation from the pacing pulse by delivering two or more pacing pulse to the ventricle of the heart, and determining a temporal relationship. A pacing vector may be selected from the two or more vectors that effects cardiac capture and reduces the phrenic nerve stimulation. A pacing voltage and/or pulse width may be selected that provides cardiac capture and reduces the phrenic nerve stimulation. In other embodiments, a pacing pulse width and a pacing voltage may be selected from a patient's strength-duration curve that effects cardiac capture and reduces the phrenic nerve stimulation.
1. A method, comprising: delivering pacing pulses to a ventricle of a heart using one of a plurality of pacing vectors;sensing a transthoracic impedance signal;detecting a breathing event based on a temporal association between pacing pulse delivery during a non-refractory period of the heart and a
1. A method, comprising: delivering pacing pulses to a ventricle of a heart using one of a plurality of pacing vectors;sensing a transthoracic impedance signal;detecting a breathing event based on a temporal association between pacing pulse delivery during a non-refractory period of the heart and a perturbation in the transthoracic impedance signal; andverifying that the detected breathing event is representative of phrenic nerve stimulation resulting from pacing pulse delivery based on detection of an additional perturbation in the transthoracic impedance signal that is temporally associated with an additional pacing pulse delivered during a cardiac refractory period of the heart. 2. The method of claim 1, comprising selecting a pacing vector from the plurality of vectors that effects cardiac capture and reduces the phrenic nerve stimulation. 3. The method of claim 1, comprising selecting a pacing pulse width and a pacing voltage from a preestablished patient strength-duration curve that effects cardiac capture and reduces the phrenic nerve stimulation. 4. The method of claim 1, comprising detecting the breathing event and verifying that the breathing event is representative of phrenic nerve stimulation based on detection of a change in one or both of inspiration and expiration superimposed over a normal breathing pattern, where the change corresponds with pacing pulse delivery timing. 5. The method of claim 1, comprising opening a time window following delivery of each pacing pulse, and evaluating the transthoracic impedance signal during the time window for the perturbation indicative of phrenic nerve stimulation. 6. The method of claim 5, comprising opening the time window following delivery of a left-ventricular pacing pulse and closing the time window after expiration of a predetermined period following left-ventricular pacing pulse delivery. 7. The method of claim 1, comprising evaluating the transthoracic impedance signal for an inspiration event within an evaluation window defined by the pacing pulse and about 500 milliseconds following the pacing pulse. 8. The method of claim 1, comprising altering one or more of a pacing vector, pacing pulse amplitude, and pacing pulse width to reduce the phrenic nerve stimulation. 9. The method of claim 1, comprising searching for one or more of new pacing vectors, pacing parameter settings, and pulse generator control parameters that effect capture with reduced phrenic nerve stimulation. 10. The method of claim 1, comprising changing, in response to operating in an ambulatory mode, a pacing vector or one or more pacing parameters, waiting for the next scheduled pacing pulse to be delivered, and determining if capture occurs using the changed pacing vector or the one or more changed pacing parameters. 11. The method of claim 1, comprising band-pass filtering, centered at a pacing rate, the transthoracic impedance signal to detect the perturbation in the transthoracic impedance signal indicative of phrenic nerve stimulation. 12. The method of claim 1, comprising verifying that the detected breathing event is representative of phrenic nerve stimulation resulting from pacing pulse delivery independent of cardiac motion. 13. A method, comprising: delivering pacing pulses to a ventricle of a heart using one of a plurality of pacing vectors;sensing a transthoracic impedance signal;detecting a breathing event based on a temporal association between pacing pulse delivery during a non-refractory period of the heart and a perturbation in the transthoracic impedance signal; andverifying that the detected breathing event is representative of phrenic nerve stimulation resulting from pacing pulse delivery based on detection of an additional perturbation in the transthoracic impedance signal that is temporally associated with an additional delivered pacing pulse. 14. The method of claim 13, comprising selecting a pacing vector from the plurality of vectors that effects cardiac capture and reduces the phrenic nerve stimulation. 15. The method of claim 13, comprising selecting a pacing pulse width and a pacing voltage from a preestablished patient strength-duration curve that effects cardiac capture and reduces the phrenic nerve stimulation. 16. The method of claim 13, comprising detecting the breathing event and verifying that the breathing event is representative of phrenic nerve stimulation based on detection of a change in one or both of inspiration and expiration superimposed over a normal breathing pattern, where the change corresponds with pacing pulse delivery timing. 17. The method of claim 13, comprising opening a time window following delivery of each pacing pulse, and evaluating the transthoracic impedance signal during the time window for the perturbation indicative of phrenic nerve stimulation. 18. The method of claim 17, comprising opening the time window following delivery of a left-ventricular pacing pulse and closing the time window after expiration of a predetermined period following left-ventricular pacing pulse delivery. 19. The method of claim 13, comprising evaluating the transthoracic impedance signal for an inspiration event within an evaluation window defined by the pacing pulse and about 500 milliseconds following the pacing pulse. 20. The method of claim 13, comprising altering one or more of a pacing vector, pacing pulse amplitude, and pacing pulse width to reduce the phrenic nerve stimulation. 21. The method of claim 13, comprising searching for one or more of new pacing vectors, pacing parameter settings, and pulse generator control parameters that effect capture with reduced phrenic nerve stimulation. 22. The method of claim 13, comprising changing, in response to operating in an ambulatory mode, a pacing vector or one or more pacing parameters, waiting for the next scheduled pacing pulse to be delivered, and determining if capture occurs using the changed pacing vector or the one or more changed pacing parameters. 23. The method of claim 13, comprising band-pass filtering, centered at a pacing rate, the transthoracic impedance signal to detect the perturbation in the transthoracic impedance signal indicative of phrenic nerve stimulation. 24. The method of claim 13, comprising verifying that the detected breathing event is representative of phrenic nerve stimulation resulting from pacing pulse delivery independent of cardiac motion. 25. The method of claim 13, comprising: transmitting information associated with the sensed cardiac signal and the sensed transthoracic impedance signal to a patient-external device;receiving pacing signal information from the patient-external device; andaltering one or more of the pacing vector, a pacing parameter, and a pacing pulse characteristic based on the received pacing signal information.
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