# US 2014/0194942 A1 · Method and apparatus to perform electrode combination selection > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 2014/0194942 A1 - Document ID: US20140194942A1 - Status: Published application - Kind: A1 - Application number: 14/209,364 - Filed: 2014-03-13 - Published: 2014-07-10 - Earliest claimed: 2007-08-07 - Assignees: Cardiac Pacemakers, Inc. - Applicants: Cardiac Pacemakers, Inc. - Inventors: Alok S. Sathaye; M. Jason Brooke; Bruce A. Tockman - Web page: https://patentgrep.com/patent/US20140194942A1 ## CPC - A61N 1/3686: {configured for selecting the electrode configuration on a lead (A61N1/3688 takes precedence)} - A61N 1/056: {Transvascular endocardial electrode systems} - A61N 1/0563: {specially adapted for defibrillation or cardioversion} - A61N 1/36514: {controlled by a physiological quantity other than heart potential, e.g. blood pressure (controlled by two or more physical parameters A61N1/36585)} - A61N 1/36564: {controlled by blood pressure} - A61N 1/36585: {controlled by two or more physical parameters} - A61N 1/3702: {Physiological parameters (A61N1/365 takes precedence; evoked response A61N1/371)} - A61N 1/3704: {Circuits specially adapted therefor, e.g. for sensitivity control} - A61N 1/371: {Capture, i.e. successful stimulation} - A61N 1/37223: {Circuits for electromagnetic coupling} - A61N 1/37247: {User interfaces, e.g. input or presentation means} - 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 Approaches for selecting an electrode combination of multi-electrode pacing devices are described. Electrode combination parameters that support cardiac function consistent with a prescribed therapy are evaluated for each of a plurality of electrode combinations. Electrode combination parameters that do not support cardiac function are evaluated for each of the plurality of electrode combinations. An order is determined for the electrode combinations based on the parameter evaluations. An electrode combination is selected based on the order, and therapy is delivered using the selected electrode combination. ## Claims ### Claim 1 A medical device comprising: at least one implantable lead, wherein the at least one implantable lead includes two or more electrodes configured to be adjacent a heart of a patient; an accelerometer providing an output signal, the accelerometer configured to monitor for stimulation of a phrenic nerve of the patient; a controller operatively coupled to the at least one implantable lead and the accelerometer, the controller configured to: deliver stimulation to two or more different electrode configurations, wherein the two or more different electrode configurations each use at least one of the two or more electrodes of the implantable lead; determine a capture threshold of a heart of the patient for each of the two or more different electrode configurations; determine whether the phrenic nerve of the patient was stimulated for each of the two or more different electrode configurations using the output signal of the accelerometer; and outputting a measure related to the capture threshold and whether the phrenic nerve of the patient was stimulated for each of the two or more different electrode configurations ### Claim 2 (depends on 1) The medical device of claim 1, wherein the controller is further configured to evaluate, for each of the two or more different electrode configurations, the capture threshold and whether the phrenic nerve of the patient was stimulated, and to determine a relative ranking of the two or more different electrode configurations for delivering stimulation therapy to the heart of the patient. ### Claim 3 (depends on 2) The medical device of claim 2, further comprising a user interface that presents an indication of the relative ranking of the electrode configurations to a user. ### Claim 4 (depends on 3) The medical device of claim 3, wherein the relative ranking is indicated by an order of display of the electrode configurations on a display of the user interface. ### Claim 5 (depends on 2) The medical device of claim 2, wherein a first electrode combination having a first capture threshold is ranked higher than a second electrode combination having a second capture threshold if the first capture threshold is lower than the second capture threshold, and if the first electrode combination does not stimulate the phrenic nerve. ### Claim 6 (depends on 1) The medical device of claim 1 further comprising a user interface that presents an indication of the capture threshold and whether the phrenic nerve was stimulated for each of the two or more different electrode configurations. ### Claim 7 (depends on 1) The medical device of claim 1, further comprising a user interface that presents a recommended electrode combination to a user. ### Claim 8 (depends on 7) The medical device of claim 7, wherein the user interface is configured to visually highlight the recommended electrode combination on a display. ### Claim 9 (depends on 1) The medical device of claim 1, wherein the controller comprises a pacing circuit for facilitating delivery of stimulation to the patient using the two or more different electrode configurations. ### Claim 10 A medical device comprising: a power supply; a controller powered by the power supply, the controller configured to: deliver stimulation to two or more different electrode configurations of an implantable medical lead that has two or more electrodes, and determine a capture threshold of a heart chamber for each of the two or more different electrode configurations, and determine whether a phrenic nerve is stimulated for each of the two or more different electrode configurations using an output signal of an accelerometer; and outputting an indication of the capture threshold and whether the phrenic nerve was stimulated for each of the two or more different electrode configurations. ### Claim 11 (depends on 10) The medical device of claim 10, wherein the controller is further configured to evaluate, for each of the two or more different electrode configurations, the capture threshold and whether the phrenic nerve of the patient was stimulated, and to determine a relative ranking of the two or more different electrode configurations for delivering stimulation therapy to the heart chamber of the patient. ### Claim 12 (depends on 11) The medical device of claim 11, wherein the outputted indication of the capture threshold and whether the phrenic nerve was stimulated for each of the two or more different electrode configurations includes a measure related to the relative ranking. ### Claim 13 (depends on 10) The medical device of claim 10, wherein the controller further comprises a switch matrix for switching between the two or more different electrode configurations. ### Claim 14 (depends on 10) The medical device of claim 10, wherein the power supply and controller are situated in a housing, and the accelerometer is in the housing. ### Claim 15 (depends on 10) The medical device of claim 10, wherein the power supply and controller are part of an implantable medical device. ### Claim 16 (depends on 15) The medical device of claim 15, wherein the implantable medical lead is operatively coupled to the implantable medical device. ### Claim 17 (depends on 10) The medical device of claim 10, wherein the power supply and controller are part of a programmer. ### Claim 18 (depends on 17) The medical device of claim 17, wherein the implantable medical lead is operatively coupled to the programmer. ### Claim 19 A method comprising: delivering stimulation to two or more different electrode configurations of an implantable medical lead that has two or more electrodes; in response to the delivered stimulation, determining a capture threshold of a heart chamber for each of the two or more different electrode configurations, and determining whether a phrenic nerve is stimulated for each of the two or more different electrode configurations using an output signal of an accelerometer; determining a relative ranking of the two or more different electrode configurations for delivering stimulation therapy to the heart chamber of the patient based, at least in part, on the capture threshold and whether the phrenic nerve was stimulated for each of the two or more different electrode configurations; allowing selection of a selected electrode configuration from the two or more different electrode configurations; and programming an implantable medical device to deliver stimulation therapy to the heart chamber of the patient using the selected electrode configuration. ### Claim 20 (depends on 19) The method of claim 19, further comprising: outputting the relative ranking of the two or more different electrode configurations to a user interface.