# US 10,945,670 B2 · Minute volume sensor optimization using quadripolar leads

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- Number: US 10,945,670 B2
- Document ID: US10945670B2
- Status: Granted
- Kind: B2
- Application number: 15/642,512
- Filed: 2017-07-06
- Published: 2018-01-11
- Granted: 2021-03-16
- Earliest claimed: 2016-07-06
- Assignees: Cardiac Pacemakers, Inc.
- Applicants: Cardiac Pacemakers, Inc.
- Inventors: Qi An; Yinghong Yu; Yi Zhang; Viktoria A. Averina; Pramodsingh Hirasingh Thakur
- Web page: https://patentgrep.com/patent/US10945670B2

## CPC

- A61B 5/686: {Permanently implanted devices, e.g. pacemakers, other stimulators, biochips (A61B5/6861 takes precedence)}
- A61B 5/076: {Permanent implantation}
- A61B 5/086: {by impedance pneumography}
- A61B 5/4836: {Diagnosis combined with treatment in closed-loop systems or methods (A61B5/0036 takes precedence)}
- A61B 5/7203: {for noise prevention, reduction or removal}
- A61B 5/7278: {Artificial waveform generation or derivation, e.g. synthesizing signals from measured signals}
- A61B 5/7285: {for synchronizing or triggering a physiological measurement or image acquisition with a physiological event or waveform, e.g. an ECG signal}
- A61N 1/36521: {the parameter being derived from measurement of an electrical impedance}
- A61N 1/36535: {controlled by body position or posture}
- A61N 1/368: comprising more than one electrode co-operating with different heart regions {(A61N1/3622, A61N1/3627 take precedence)}
- A61B 5/0205: Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition
- A61B 5/0538: invasively, e.g. using a catheter
- A61B 5/0816: {Measuring devices for examining respiratory frequency (measuring frequency of electric signals G01R23/00)}
- A61B 5/091: Measuring volume of inspired or expired gases, e.g. to determine lung capacity
- A61B 5/1116: {Determining posture transitions}
- A61B 5/287: Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
- A61B 5/7221: {Determining signal validity, reliability or quality (preventing, reducing or removing noise induced by motion artefacts A61B5/7207; noise originating from a therapeutic or surgical apparatus A61B5/7217)}
- A61B 2562/0209: Special features of electrodes classified in A61B5/24, A61B5/25, A61B5/283, A61B5/291, A61B5/296, A61B5/053
- A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D)
- A61N: ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY (measurement of bioelectric currents A61B; surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body A61B18/00; anaesthetic apparatus in general A61M; incandescent lamps H01K; infrared radiators for heating H05B)

## Abstract

An apparatus comprises a respiration sensing circuit configured for coupling electrically to a plurality of electrodes and for sensing a respiration signal representative of respiration of a subject; a signal processing circuit electrically coupled to the respiration sensing circuit and configured to extract a respiration parameter from a sensed respiration signal and determine a signal performance metric for the sensed respiration signal using the respiration parameter; and a control circuit. The control circuit is configured to: initiate sensing of a plurality of respiration signals using different electrode combinations of the plurality of electrodes and determining of the signal performance metric for the sensed respiration signals; and enable an electrode combination from the plurality of electrodes and for use in monitoring respiration of the subject according to the signal performance metric.

## Claims

### Claim 1

An apparatus comprising:
a respiration sensing circuit configured for coupling electrically to a plurality of electrodes and for sensing a respiration signal representative of respiration of a subject;
a signal processing circuit electrically coupled to the respiration sensing circuit and configured to extract a respiration parameter from a sensed respiration signal and determine a signal performance metric for the sensed respiration signal using the respiration parameter; and
a control circuit configured to:
determine one or more electrodes of the plurality of electrodes that are non-contacting electrodes, wherein the one or more non-contacting electrodes are less likely to be in contact with coronary vein tissue of the subject than the other electrodes;
initiate sensing of a plurality of respiration signals using different electrode combinations of the plurality of electrodes, each of the electrode combinations including at least one of the one or more non-contacting electrode; and
determining the signal performance metric for the plurality of sensed respiration signals; and
select one of the electrode combinations for use in monitoring respiration of the subject according to the signal performance metric.

### Claim 2 (depends on 1)

The apparatus of claim 1, wherein the signal processing circuit is configured to extract a measure of tidal volume from the sensed respiration signal, wherein the signal performance metric includes a signal-to-noise ratio (SNR) calculated using measured tidal volume.

### Claim 3 (depends on 1)

The apparatus of claim 1, wherein the signal processing circuit is configured to extract a measure of respiration rate (RR) from the sensed respiration signal and monitor when RR information is unavailable in sensed respiration signals, wherein the signal performance metric for an electrode combination includes an amount of RR information available from respiration signals sensed using the electrode combination.

### Claim 4 (depends on 1)

The apparatus of claim 1, including the plurality of electrodes and a device housing, wherein the plurality of electrodes include multiple electrodes configured to be implantable in or adjacent to one or more heart chambers of the subject and at least one electrode formed using the device housing, and wherein the electrode combinations include at least one electrode implantable in or adjacent to a heart chamber.

### Claim 5 (depends on 1)

The apparatus of claim 1, including the plurality of electrodes and a device housing, wherein the plurality of electrodes include multiple electrodes included in a lead configured to be implantable in or adjacent to a left ventricle (LV) of the subject and at least one electrode formed using the device housing, wherein the electrode combinations include at least one electrode included in the lead and the at least one electrode formed using the device housing.

### Claim 6 (depends on 5)

The apparatus of claim 5, wherein the lead is configured to be implantable in a coronary vein of the left ventricle, wherein the signal processing circuit includes an impedance sensing circuit configured to determine impedance between the at least one electrode included in the lead and the at least one electrode formed using the device housing, and wherein the control circuit is configured to enable the electrode combination for use in monitoring respiration of the subject according to the signal performance metric and having a lowest determined impedance.

### Claim 7 (depends on 1)

The apparatus of claim 1, including a posture sensor circuit configured to provide a posture signal that includes posture information of the subject; and a posture calculation circuit configured to determine posture of the subject using the posture information, wherein the control circuit is configured to: initiate the sensing of the plurality of respiration signals using different electrode combinations of the plurality of electrodes and the determining of the signal performance metric for the sensed respiration signals according to a determined posture; and select the electrode combination for use in monitoring respiration of the subject according to the signal performance metric and the determined posture.

### Claim 8 (depends on 1)

The apparatus of claim 1, including a timer circuit integral to, or electrically coupled to the control circuit, wherein the control circuit is configured to: initiate the sensing of the plurality of respiration signals using different electrode combinations of the plurality of electrodes and the determining of the signal performance metric for the sensed respiration signals according to a time of day; and select the electrode combination for use in monitoring minute ventilation of the subject according to the signal performance metric and the time of day.

### Claim 9 (depends on 1)

The apparatus of claim 1, including: a cardiac signal sensing circuit configured for coupling electrically to the plurality of electrodes and to sense cardiac activation within a subject's body using the electrodes; and a stimulus circuit configured for coupling electrically to the plurality of electrodes, wherein the control circuit is configured to select the electrode combination according to the signal performance metric for use in determining minute ventilation information of the subject and to adjust a cardiac pacing therapy parameter using the minute ventilation information.

### Claim 10

A method of controlling operation of an ambulatory medical device connectable to a plurality of electrodes, the method comprising:
determining one or more electrodes of the plurality of electrodes that are non-contacting electrodes, wherein the one or more non-contacting electrodes are less likely to be in contact with coronary vein tissue of the subject than the other electrodes;
sensing of a plurality of respiration signals using different electrode combinations of the plurality of electrodes, each of the electrode combinations including at least one of the one or more non-contacting electrode, wherein the respiration signal is representative of respiration of a subject;
extracting a respiration parameter from the sensed respiration signals and determining a signal performance metric for the sensed respiration signals; and
selecting one of the electrode combinations for use in monitoring respiration of the subject according to the signal performance metric.

### Claim 11 (depends on 10)

The method of claim 10, including extracting a measure of tidal volume from the sensed respiration signal, wherein the signal performance metric includes a signal-to-noise ratio (SNR) calculated using measured tidal volume.

### Claim 12 (depends on 10)

The method of claim 10, including extracting a measure of respiration rate (RR) from the sensed respiration signal and monitor when RR information is unavailable in sensed respiration signals, wherein the signal performance metric for an electrode combination includes an amount of RR information available from respiration signals sensed using the electrode combination.

### Claim 13 (depends on 10)

The method of claim 10, wherein the different electrode combinations include at least one electrode implantable in or adjacent to a heart chamber and the at least one electrode formed using the device housing.

### Claim 14 (depends on 10)

The method of claim 10, wherein the plurality of electrodes include multiple electrodes included in a lead configured to be implantable in or adjacent to a left ventricle (LV) of the subject and at least one electrode formed using the device housing, wherein the electrode combinations include at least one electrode included in the lead and the at least one electrode formed using the device housing.

### Claim 15 (depends on 14)

The method of claim 14, including determining impedance between electrode combinations including at least one electrode included in a lead configured to be implantable in a coronary vein of the left ventricle and the at least one electrode formed using the device housing, and enable electrode combination for use in monitoring respiration of the subject according to the signal performance metric and having a lowest determined impedance.

### Claim 16 (depends on 10)

The method of claim 10, including:
sensing the plurality of respiration signals using different electrode combinations of the plurality of electrodes;
determining the signal performance metric for the sensed respiration signals according to a device-determined patient posture; and
selecting the electrode combination for use in monitoring respiration of the subject according to the signal performance metric and the determined posture.

### Claim 17 (depends on 10)

The method of claim 10, including:
sensing the plurality of respiration signals using different electrode combinations of the plurality of electrodes;
determining the signal performance metric for the sensed respiration signals according to a time of day; and
selecting the electrode combination for use in monitoring minute ventilation of the subject according to the signal performance metric and the time of day.

### Claim 18 (depends on 10)

The method of claim 10, including:
sensing cardiac activation within a subject's body using the plurality of electrodes;
selecting the electrode combination according to the signal performance metric for use in determining minute ventilation information of the subject; and
adjusting a cardiac pacing therapy parameter using the minute ventilation information.

### Claim 19 (depends on 10)

The method of claim 10, including:
delivering pacing pulses using combinations of the plurality of electrodes that include one electrode of the plurality of electrodes as a pacing cathode and the other electrodes as the pacing anode;
sensing cardiac activation resulting from the pacing pulses;
determining a cardiac capture pulse energy level threshold for the electrodes using the sensed cardiac activation; and
enabling an electrode combination from the plurality of electrodes having the highest determined cardiac capture pulse energy level threshold for use in monitoring respiration of the subject.

### Claim 20 (depends on 19)

The method of claim 19, including:
selecting the electrode combination for use in determining minute ventilation information of the subject; and
adjusting a cardiac pacing therapy parameter using the minute ventilation information.