Ambulatory phrenic nerve stimulation detection

A system, comprising:

• an implantable medical device (IMD) for implantation in a patient, the IMD including a cardiac pace generator, phrenic nerve stimulation (PS) sensor, a memory, and a controller, wherein the controller is operably connected to the cardiac pace generator to generate cardiac paces,
• wherein the controller includes:
• a trigger module configured to provide trigger for a PS detection procedure and to perform the base test, wherein in performing the base test the trigger module is configured to:
• detect an amplitude of the signal from the PS sensor,
• compare the sensed amplitude to a threshold to detect PS, and
• provide the trigger from the trigger module when the sensed amplitude is higher than the threshold;
• a recognition module configured to analyze a signal from the PS sensor to confirm the PS detection from the base test;
• a PS test module configured to respond to the PS detection confirmed by the recognition module, wherein in responding to the PS detection confirmed by the recognition module, the PS test module is configured to further analyze the signal from the PS sensor to provide further confirmation of the PS detection, wherein confirmation by the PS test module provides greater confidence than confirmation by the recognition module;
• and
• a decision module configured to:
• record the PS detection in the storage within the IMD;
• automatically change a current pacing configuration to another pacing configuration based at least in part on PS detection;
• or
• communicate an alert to an external device based at least in part on PS detection.