Patent Application
20230364435
The disclosure relates, inter alia, to implantable medical devices and, more particularly, it relates to systems, devices, and methods for using internal sensors to preserve an internal power source of implantable medical devices.
Modern healthcare enables patients to lead healthy and full lives. Implantable medical devices (IMDs) are often utilized for such medical advances. For example, IMDs such as pacemakers, implantable cardioverter-defibrillators (ICDs), neurostimulators, and drug pumps can facilitate management of a wide range of ailments, including, but not limited to, cardiac arrhythmias, diabetes, and Parkinson's disease. Patients and medical care providers can monitor the IMD and assess a patient's current and historical physiological state to identify and/or predict impending events or conditions. This monitoring often involves frequent communication with respect to the IMD.
IMDs are increasing in complexity while shrinking in size. One hurdle to achieving such small and highly functional devices is efficient power management of these devices. In particular, many IMDs operate from power sources that have a limited lifespan and/or are not rechargeable. As such, after the IMD is implanted within the human body and the lifespan of the power source has been reached, the IMD may need to be removed. Numerous processes associated with an implantable device directly impact life of a power source of the IMD. For example, an unintended communication connection process between an implantable device and an external device can unnecessarily drain power from a power source of the IMD.
This disclosure describes techniques for preserving an internal power source of an implantable medical device (IMD) using at least one biosensor of the IMD. The IMD may determine, based on signals from one or more biosensors, whether the IMD has changed status, e.g., whether the IMD has been implanted. The determination of whether the IMD has changed status may be used to switch the IMD from a first mode to a second mode. In some examples, such as if IMD has been removed from sterile packaging and implanted in a patient, the IMD may switch from a dormant mode to an activated mode upon a determination that the IMD is implanted in the body of a patient. In some examples, the dormant mode does not include communication with an external computing device, and the activated mode does include communication with an external computing device. Consequently, the techniques for determining when to switch to the activated mode may reduce unintended communications before the device is implanted and preserve the power source of the IMD.
Some other examples of a status of the IMD, which may change, include a pre-implant status and a post-implant status. The pre-implant status may include manufacturing and product testing, a packaged state in which the IMD is in a sterilizable package, and during the implant procedure. The post-implant status may include while implanted in the patient and operating normally, as well as after explant, such as when the IMD needs to be replaced because the battery for the IMD has reached the end of operating life.
The IMD processing circuitry may have different wake-up schedules and may perform different tasks depending on the status. For example, when in the packaged state, the IMD processing circuitry may be in a “shipping mode” or dormant operating mode in which the processing circuitry may be configured to conserve power by having infrequent and short-term wake-ups with few or no sensors active. When implanted, the processing circuitry may be configured to have more frequent wake-ups, relative to a more dormant operating mode, cause the communication circuitry to operate in a secure communication mode, and perform sensing and data gathering according to an in-vivo operating schedule.
In one example, the disclosure describes an implantable medical device (IMD) comprising at least one temperature sensor, at least one biosensor coupled to a plurality of electrodes, and processing circuitry operatively coupled to the temperature sensor and the biosensor. The biosensor is configured to detect heart activity or impedance. The processing circuitry is configured to at least receive a first signal from the temperature sensor; make a first preliminary determination that the IMD is implanted based on the first signal; receive a second signal from the biosensor in response to the first preliminary determination being that the IMD is implanted; make a second preliminary determination that the IMD is implanted based on the second signal; determine that the IMD is implanted based on both the first preliminary determination and the second preliminary determination being that the IMD is implanted; and switch the IMD from a first mode to a second mode based on the determination.
In another example, the disclosure provides a method, the method comprising receiving, via a temperature sensor of an implantable medical device (IMD), a first signal; making a first preliminary determination that the IMD is implanted based on the first signal; receiving, via a biosensor of the IMD, a second signal in response to the first preliminary determination being that the IMD is implanted, wherein the biosensor is configured to detect heart activity or impedance; making a second preliminary determination that the IMD is implanted based on the second signal; determining that the IMD is implanted based on both the first preliminary determination and the second preliminary determination being that the IMD is implanted; and switching the IMD from a first mode to a second mode based on the determination.
In another example, the disclosure provides a non-transitory computer readable storage medium comprising programming instructions that, when executed by processing circuitry of an implantable medical device (IMD), cause the processing circuitry to receive, via a temperature sensor of the IMD, a first signal; make a first preliminary determination that the IMD is implanted based on the first signal; receive, via a biosensor of the IMD, a second signal in response to the first preliminary determination being that the IMD is implanted, wherein the biosensor is configured to detect heart activity or impedance; make a second preliminary determination that the IMD is implanted based on the second signal; determine that the IMD is implanted based on both the first preliminary determination and the second preliminary determination being that the IMD is implanted; and switch the IMD from a first mode to a second mode based on the determination.
In one example, this disclosure describes an implantable medical device (IMD) comprising a communication system: configured for wireless communication, and configured to operate in a first mode and in a second mode; a connection to a plurality of electrodes; one or more sensors ; a processing circuitry operatively coupled to the one or more sensors, wherein the processing circuitry is configured to: determine a status for the IMD based at least on a first preliminary determination that the IMD has changed status, wherein the first preliminary determination is based on a first indication from a first sensor of the one or more sensors; responsive to the first preliminary determination indicating a change of status for the IMD, make a second preliminary determination that the IMD has changed status based on a second indication from a second sensor of the one or more sensors; confirm the change in status for the IMD based on the first preliminary determination and the second preliminary determination, and change the communication system from a first mode to a second mode based on the determination that the IMD.
In another example, this disclosure describes a method of operating an implantable medical device (IMD) comprising making, by processing circuitry of the IMD, a first preliminary determination that the IMD has changed status, wherein the first preliminary determination is based on a first indication from a first sensor of the one or more sensors; responsive to the first preliminary determination indicating a change of status for the IMD, making a second preliminary determination that the IMD has changed status based on a second indication from a second sensor of the one or more sensors; determining whether the IMD has changed status based on the first preliminary determination and the secondary preliminary determination; and responsive to determining that the IMD has changed status, change a wireless communication system of the IMD from a first communication mode to a second communication mode.
In another example, this disclosure describes a non-transitory computer readable storage medium comprising make a first preliminary determination that an implantable medical device (IMD) has changed status, wherein the first preliminary determination is based on a first indication from a first sensor of the one or more sensors; responsive to the first preliminary determination indicating a change of status for the IMD, make a second preliminary determination that the IMD has changed status based on a second indication from a second sensor of the one or more sensors; determine whether the IMD has changed status based on the first preliminary determination and the secondary preliminary determination; and responsive to determining that the IMD has changed status, change a wireless communication system of the IMD from a first communication mode to a second communication mode.
The disclosure also provides means for performing any of the techniques described herein.
The summary is intended to provide an overview of the subject matter described in this disclosure. It is not intended to provide an exclusive or exhaustive explanation of the systems, device, and methods described in detail within the accompanying drawings and description below. Further details of one or more examples of this disclosure are set forth in the accompanying drawings and in the description below. Other features, objects, and advantages will be apparent from the description and drawings, and from the claims.
Like reference characters denote like elements throughout the description and figures.
Implantable medical devices (IMDs) can sense and monitor signals and use those signals to determine various conditions of a patient and/or provide therapy to the patient. Example IMDs include monitors, such as the Reveal LINQ™ or LINQ II™ Insertable Cardiac Monitor, available from Medtronic, Inc., of Minneapolis, Minnesota. Such IMDs may facilitate relatively longer-term monitoring of patients during normal daily activities, and may periodically transmit collected data to a network service, such as the Medtronic CareLink® Network, developed by Medtronic, or some other network linking patient 4 to a clinician. In other examples, IMDs may also deliver therapy based on the sensed and collected data. In some examples the delivered therapy may include electrical stimulation therapy or drug or other fluid delivery.
The example techniques may be used with an IMD 10, which may be configured to be in wireless communication with at least one of external device 12 and other devices not pictured in
In some examples, IMD 10 may sense cardiac electrogram (EGM) signals via the plurality of electrodes and/or operate as a therapy delivery device. For example, IMD 10 may operate as a therapy delivery device to deliver electrical signals to the heart of patient 4, such as an implantable pacemaker, a cardioverter, and/or defibrillator, a drug delivery device that delivers therapeutic substances to patient 4 via one or more catheters, or as a combination therapy device that delivers both electrical signals and therapeutic substances.
In some examples, system 2 may include any suitable number of leads coupled to IMD 10, and each of the leads may extend to any location within or proximate to a heart or in the chest of patient 4. For example, other examples therapy systems may include three transvenous leads and an additional lead located within or proximate to a left atrium of a heart. As other examples, a therapy system may include a single lead that extends from IMD 10 into a right atrium or right ventricle, or two leads that extend into a respective one of a right ventricle and a right atrium.
In some examples, IMD 10 takes the form of the Reveal LINQ™ or LINQ II∩ Insertable Cardiac Monitor (ICM), or another ICM similar to, e.g., a version or modification of, the LINQ™ ICM, available from Medtronic, Inc. Such IMDs may facilitate relatively longer-term monitoring of patients during normal daily activities, and may periodically transmit collected data to a network service, such as the Medtronic CareLink® Network.
External device 12 may be a computing device with a display viewable by a user and an interface for providing input to external device 12 (i.e., a user input mechanism). The user may be a physician technician, surgeon, electrophysiologist, clinician, or patient 4. In some examples, external device 12 may be a notebook computer, tablet computer, computer workstation, one or more servers, cellular phone, personal digital assistant, handheld computing device, networked computing device, or another computing device that may run an application that enables the computing device to interact with IMD 10. For example, external device 12 may be a clinician, physician, or user programmer configured to communicate wirelessly with IMD 10 and perform data transfers between external device 12 and IMD 10. In other examples, external device 12 may include a mobile phone, tablet, laptop, or other similar computing device that includes an application and communication circuitry configured to wirelessly communicate with IMD 10.
External device 12 is configured to communicate with IMD 10 and, optionally, another computing device (not illustrated in
In some examples, the user may use external device 12 to program or otherwise interface with IMD 10. External device 12 may be used to program aspects of sensing or data analysis performed by IMD 10 and/or therapies provided by IMD 10. In addition, external device 12 may be used to retrieve data from IMD 10. The retrieved data may include cardiac EGM segments recorded by IMD 10, e.g., due to IMD 10 determining that an episode of arrhythmia or another malady occurred during the segment, or in response to a request to record the segment from patient 4 or another user. In other examples, the user may also use external device 12 to retrieve information from IMD 10 regarding other sensed physiological parameters of patient 4, such as activity, temperature, tissue impedance, intrathoracic impedance, or posture. Additionally, one or more remote computing devices may interact with IMD 10 in a manner similar to external device 12, e.g., to program IMD 10 and/or retrieve data from IMD 10, via a network.
Processing circuitry of IMD 10 may be configured to perform the example techniques of this disclosure for using internal sensors to determine when to switch operational modes of IMD 10. For example, as described in greater detail elsewhere in this disclosure, the processing circuitry of IMD 10 may analyze temperature values and other values sensed by IMD 10 (e.g., impedance values or heart rate values) to determine whether IMD 10 has changed status. The determination of whether IMD 10 has changed status may be used to switch the IMD from a first mode to a second mode.
In some examples, IMD 10 may use an indication from one or more sensors coupled to IMD 10 to make a first preliminary determination that IMD 10 has changed status, e.g., has been implanted, explanted or some other change in status as described above. Some examples of sensors may include a biological impedance sensor, e.g., an indication of the impedance between two or more electrodes coupled to processing circuitry of IMD 10. Biological impedance may also be referred to as bioimpedance in this disclosure. Other sensors may include temperature sensors, chemical sensors, optical sensors, sound sensors, vibration sensors, motion, or position sensors, such as accelerometers and gyroscopes, magnetic field sensors such as a Hall sensor or other type of magnetometer configured to measure a magnetic field including, ins some examples, the direction, strength, or relative change of a magnetic field near the sensor, as well as other types of sensors.
In some examples IMD 10 may make a first preliminary determination, e.g., when a temperature satisfies a temperature criterion, when a chemical sensor detects the presence of a specified chemical, a bioimpedance satisfies an impedance threshold, the presence, or absence of a magnetic field, and other similar sensing scenarios. In some examples, IMD 10 may obtain temperature data, and other data, via one or more sensing device(s) disposed within or otherwise fixed to IMD 10, such as fixed to the outer housing of IMD 10 or with probes/leads entering into and/or extending out of IMD 10. In some examples, the sensed values monitored by IMD 10 may include raw data sampled by IMD 10, or in some instances, post-processed data, such as smoothened data that has been conditioned by a particular signal processing techniques (e.g., low-pass filter, high-pass filter, band-pass filter, band-stop filter, etc.).
In response to the first preliminary determination being that IMD 10 is implanted, the processing circuitry of IMD 10 may cause IMD 10 to evaluate an indication from a second sensor, such as any of the sensors listed above, e.g., a temperature, an impedance, a heart rate, or other sensed indication. IMD 10 may use the indication from one or more second sensors to make a second preliminary determination of the status of IMD 10, e.g., whether IMD 10 is implanted. For example, IMD 10 may include an impedance sensor configured to provide an electrical signal to fluid and/or tissue of patient 4 between a first electrode and a second electrode. When IMD is implanted into fluid and/or tissue of patient 4, a path between the two electrodes may have a corresponding impedance. The processing circuitry of IMD 10 may receive signals indicative of the corresponding impedance and may make a second preliminary determination of whether IMD 10 is implanted, e.g., when the impedance satisfies an impedance criterion. As another example, IMD 10 may include an electrocardiography (ECG) sensor configured to monitor heart activity of patient 4 and the processing circuitry of IMD 10 may receive signals indicative of heart rate of patient 4 and may make a second preliminary determination of whether IMD 10 is implanted, e.g., when the heart rate satisfies a heart rate criterion. In other examples, a microphone or similar sensor may detect the presence, or absence, of heart sounds to determine the status of IMD 10, e.g., in the sterile packaging, in the process of being implanted, implanted and in place to perform data collection and/or therapy operation, or explanted after end of service life of IMD 10.
Depending on both the first preliminary determination and the second preliminary determination, the processing circuitry of IMD 10 may determine whether IMD 10 has changed status and may switch IMD 10 from a first mode to a second mode based on the determination. In some examples, IMD 10 may be switched from a dormant mode, e.g., a mode does not include communication with an external computing device, to an activated mode, e.g., a mode include communication with an external computing device. In other examples, IMD 10 may change the security level of the communication. For example, when preparing for implant, processing circuitry for IMD 10 may be configured to receive patient identification information, and other data to operate while implanted. In other examples, when implanted, IMD 10 may communicate using one or more encryption handshaking protocols to ensure safety and security for patient 4. When processing circuitry of IMD 10 determines that IMD 10 has been explanted, e.g., based on the indications from one or more sensors, the processing circuitry of IMD 10 may communicate in a less restrictive secure communication mode, such as to communicate with external computing devices for IMD evaluation.
In examples in which IMD 10 also operates as a pacemaker, a cardioverter, and/or defibrillator, or otherwise monitors the electrical activity of the heart, IMD 10 may sense electrical signals attendant to the depolarization and repolarization of the heart of patient 4 via electrodes on the housing of IMD 10 or coupled to at least one lead. In some examples, IMD 10 can provide pacing pulses to the heart of patient 4 based on the electrical signals sensed within the heart of patient 4. IMD 10 may also provide defibrillation therapy and/or cardioversion therapy via electrodes located on at least one lead, and or a housing electrode. IMD 10 may detect arrhythmia of the heart of patient 4, such as fibrillation of ventricles, and deliver defibrillation therapy to the heart of patient 4 in the form of electrical pulses.
Although described primarily in the context of examples in which IMD 10 is an insertable cardiac monitor, to simplify the description, in other examples the techniques described herein may be implemented by medical device systems including any one or more implantable or external medical devices, such as any one or more monitors, pacemakers, cardioverters, defibrillators, heart assist devices, such as left-ventricular assist devices, neurostimulators, glucose monitors, blood oxygen sensors, blood flow sensors, drug delivery devices and similar medical devices.
Processing circuitry 50 is an example of the processing circuitry for IMD 10 described above in relation to
Sensing circuitry 52 may monitor signals from sensor(s) 62, which may include one or more temperature sensor(s) 63, accelerometers, gyroscopes, magnetic field sensors, sound sensors, pressure sensors, and/or optical sensors, as examples, as described above in relation to
Examples of a magnetic field sensor may include a Hall sensor or similar sensor. In some examples, a magnet may be included in the sterile packaging. When IMD 10 is removed from the sterile packaging, the magnetic field sensor may indicate a change in status based on no longer detecting a magnetic field from the sterile packaging, e.g., the packaging may include a magnet. In other examples, an implant tool for IMD 10 may include a magnet. Processing circuitry 50 may receive an indication of the magnetic field from the magnet in the implant tool and may determine that IMD 10 is in the process of being implanted.
One or more biosensor(s) 53 of sensing circuitry 52 may be configured to detect activity (e.g., electrical, or mechanical activity of the heart or other tissue of patient 4), blood flow, oxygen level, impedance, or other biological signals from a patient 4. Examples of optical sensors may include, sensors configured to measure blood flow, blood oxygen, blood pressure, or other biological signals. In some examples, the optical sensor for IMD 10 may be configured to measure optical criteria 168 including a light intensity level, a light frequency or other light characteristic. Processing circuitry 50 may determine, based on the indication from the optical sensor, that IMD 10 has been removed from the shipping packaging and is in the presence of fluorescent or LED lighting such as in an operating room. The light quality and intensity may be different when implanted, and processing circuitry 50 may determine the status of IMD 10 based on the indication from the optical sensor compared to optical criteria 168. Although listed separated from sensors 62 in the example of
In some examples, biosensor(s) 53 may include an impedance sensor. In some examples, processing circuitry 50 may be configured to identify and analyze an impedance of the electrical signal sent by biosensor(s) 53 through an electrical path including at least two of electrodes 16. As described herein, an impedance may change depending upon a location of IMD 10. For example, an impedance may decrease when IMD 10 is implanted into tissue and/or fluid of patient 4. For example, processing circuitry 50 may determine whether or not the impedance satisfies impedance criterion 66 as stored in storage device 60.
In some examples, biosensor(s) 53 may include an ECG senor or heart sounds sensor configured to receive electrical signals representing the electrical activity of heart via electrodes 16, and detect a heart rate of patient 4. Processing circuitry 50 may identify a heart rate from the received signal and may determine whether or not the heart rate satisfies heart rate criterion 68 as stored in storage device 60. Processing circuitry 50 may also compare other received indications, as described above, to other sensed criteria 64, as well as store received indications to storage device 60.
In some examples, sensing circuitry 52 may include one or more filters and amplifiers for filtering and amplifying signals received from temperature sensor(s) 63 and/or electrodes 16. For example, sensing circuitry 52 may include one or more low-pass filters having various cutoff frequencies predefined to apply to temperature values obtained from temperature sensor(s) 63, such as from one or more temperature sensors. In some examples, sensing circuitry 52 may include circuitry configured to digitally filter measured temperature values using one or more cutoff frequencies, or otherwise using one or more different filtering processes to achieve different degrees of smoothing of a series of temperature values. For example, sensing circuitry 52 may include certain processing circuitry configured to smooth temperature values determined over time to create smoothened temperature signals. In some examples, sensing circuitry 52 may perform smoothing of temperature values measured by temperature sensor(s) 63, or other received indications, such that processing circuitry 50 may perform various other techniques of this disclosure based on the smoothened received signals. In some examples, processing circuitry 50 may be configured to smooth temperature values and other received indications via biosensors 53 and sensors 62 as determined over time to create smoothened sensed signals (e.g., by performing digital and/or analog filtering).
In some examples, sensing circuitry 52 may be selectively coupled to electrodes 16 via switching circuitry 58 (e.g., to select the electrodes 16 and polarity) in order to sense impedance and/or cardiac signals. Sensing circuitry 52 may sense signals from electrodes 16, e.g., to produce a cardiac EGM or subcutaneous electrocardiogram, in order to facilitate monitoring electrical activity of the heart.
Processing circuitry 50 may cause sensing circuitry 52 to periodically measure a physiological parameters or other parameter values of IMD 10, such as temperature values. For temperature measurements, processing circuitry 50 may control sensing circuitry 52 to obtain a temperature measurement via one or more temperature sensor(s) 63. Because IMD 10 may be configured to include sensing circuitry 52, sensing circuitry may be implemented in one or more processors, such as processing circuitry 50 of IMD 10. Similar to processing circuitry 50, 80, 98 and other circuitry described herein, sensing circuitry 52 may be embodied as one or more hardware modules, software modules, firmware modules, or any combination thereof.
In some examples, processing circuitry 50 may receive sensed measurements from one or more sensor(s) 63 and biosensors 53 via sensing circuitry 52 in order to make a first preliminary determination of whether IMD 10 is implanted. To simplify the explanation, the description will focus on the first preliminary determination being a temperature measurement and the second preliminary determination being an impedance and/or heart rhythm measurement. However, in other examples, processing circuitry 50 may be configured to make the first preliminary determination based on any of the sensors or combinations of sensors above, e.g., magnetic field, optical characteristics and so on, as described above. Similarly, processing circuitry 50 may make the secondary determination based on any sensor, or combination of sensors described above.
In some examples, processing circuitry 50 may control the timing of temperature measurements, or other measurements, based on a schedule. For example, processing circuitry 50 may control the measurement of temperature values on a periodic basis, such as on an hourly or per-minute basis. In one example, temperature sensor(s) 63 may measure temperature values during a particular portion of a day. As an example, temperature sensor(s) 63 may measure temperature values every twenty minutes for a predetermined number of hours, such as between 8 am and 5 pm. In some examples, processing circuitry 50 may determine a measured temperature value by calculating an average of measurements. In this case, the value may be the average of the temperature values measured by temperature sensor(s) 63 during a scheduled measurement period (e.g., a number of measurements taken during one minute each half-hour). The periodic measurements may be on chronic, e.g., continuous, automatic, and long term basis which may provide the patient, and a caregiver for the patient, longitudinal data that may be analyzed and processed over time and during a variety of activities and patient conditions (sleep, rest, exercise, and similar conditions). Such chronic data collection and monitoring may offer advantages over occasional data collection, such as patient visits to a medical facility, or periodic self-data collection by the patient.
In some examples, sensing circuitry 52 may be configured to sample temperature and other measurements at a particular sampling rate. In such examples, sensing circuitry 52 may be configured to perform downsampling of the received temperature measurements. For example, sensing circuitry 52 may perform downsampling in order to decrease the throughput rate for processing circuitry 50. This may be particularly advantageous where sensing circuitry 52 has a high sampling rate when active.
As used herein, the term “temperature value” or “sensed value” is used in a broad sense to indicate any collected, measured, and/or calculated value. In some examples, temperature values are derived from temperature signals received from one or more temperature sensor(s) 63. For example, temperature values and other sensed values may include an average (e.g., mean, mode, standard deviation) of signals received from one or more sensor(s) 62 or biosensors 53.
Once processing circuitry 50 determines a temperature, processing circuitry 50 may make a first preliminary determination of whether IMD 10 is implanted based on the temperature. For example, processing circuitry 50 may determine whether or not the temperature satisfies temperature criterion 64 as stored in storage device 60.
In response to a first preliminary determination being that IMD 10 is implanted, processing circuitry 50 may activate one or more other sensors 62 or biosensors 53. For example, processing circuitry 50 may receive impedance measurements from one or more biosensor(s) 53 of sensing circuitry 52 and may make a second preliminary determination of whether IMD 10 is implanted based on the received impedance measurements. In some examples, processing circuitry 50 controls biosensor(s) 53 to perform one or more impedance, or other measurements in response to the first preliminary determination being that IMD 10 is implanted, removed from the shipping packaging, inserted into an implant tool and other changes of device status.
Once processing circuitry 50 determines an impedance, processing circuitry 50 may a second preliminary determination of whether IMD 10 is implanted.
In response to a first preliminary determination being that IMD 10 is implanted, processing circuitry 50 may receive an indication from a second sensor, such as an indication of heart activity from one or more biosensor(s) 53 of sensing circuitry 52 and may make a second preliminary determination of whether IMD 10 is implanted based on the received signal. In some examples, processing circuitry 50 may turn on a second sensor, such as one of biosensor(s) 53 to monitor heart activity of patient 4 in response to the first preliminary determination being that IMD 10 is implanted. Since performance of the second sensor, e.g., by biosensor(s) 53 may consume power, activation of biosensor(s) 53 for monitoring in response to the first preliminary determination being that IMD 10 is implanted may conserve power source 91 of IMD 10, when compared to operating more than one sensor before making a preliminary determination.
In some examples, processing circuitry 50 may determine the status of IMD 10 based on a specified sequence of sensed events. For example, processing circuitry may receive an indication that the light characteristics have changed, followed by detecting the magnetic field from the implant tool and later followed by an indication that the temperature of IMD 10 is within a specified range. The sequence may indicate that IMD 10 was removed from the packaging and has been implanted. Of course, processing circuitry 50 may be configured to detect any other similar sequence using any combination of sensors described above to determine the status of IMD 10. In some examples, IMD 10 may be implanted and start to perform normal operation, e.g., data collection and secure transmission of data, without the use of an external computing device, e.g., external device 12 of
In the example illustrated in
Sensing circuitry 52 may provide one or more temperature, impedance, optical, magnetic, heart rate, and other values to processing circuitry 50 for analysis, e.g., for analysis to determine a change in status and when to switch IMD 10 from a first mode to a second mode according to the techniques of this disclosure. In some examples, processing circuitry 50 may store the temperature, impedance, heart rate and other sensor values to storage device 60. Processing circuitry 50 of IMD 10 may analyze sensed values to determine whether IMD 10 is implanted or otherwise changed status according to the techniques of this disclosure. Processing circuitry 50 may use the determination of the status, e.g., whether IMD 10 is implanted to switch the IMD from a first mode to a second mode.
Communication system 26 may include any suitable hardware, firmware, software, or any combination thereof for communicating with another device, such as external device 12, another networked computing device, or another IMD or sensor. In this disclosure communication system 26 may also be referred to as communication circuitry 26. Under the control of processing circuitry 50, communication system 26 may receive downlink telemetry from, as well as send uplink telemetry to external device 12 or another device with the aid of an internal or external antenna. In addition, processing circuitry 50 may communicate with a networked computing device via an external device (e.g., external device 12) and a computer network, such as the Medtronic CareLink® Network. Communication system 26 may be configured to transmit and/or receive signals via inductive coupling, electromagnetic coupling, near-field communications, RF communication, Bluetooth®, WI-FI™, or other proprietary or non-proprietary wireless communication schemes. For example, processing circuitry 50 may provide data to be uplinked to external device 12 via communication system 26 and control signals using an address/data bus. In some examples, communication system 26 may provide received data to processing circuitry 50 via a multiplexer.
In some examples, as illustrated by
In some examples, storage device 60 includes computer-readable instructions that, when executed by processing circuitry 50, cause IMD 10 and processing circuitry 50 to perform various functions attributed to IMD 10 and processing circuitry 50 herein. Storage device 60 may include any volatile, non-volatile, magnetic, optical, or electrical media. For example, storage device 60 may include random access memory (RAM), read-only memory (ROM), non-volatile RAM (NVRAM), electrically-erasable programmable ROM (EEPROM), erasable programmable ROM (EPROM), flash memory, or any other digital media. Storage device 60 may store, as examples, programmed values for one or more operational parameters of IMD 10 and/or data collected by IMD 10 for transmission to another device using communication system 26. Data stored by storage device 60 and transmitted by communication system 26 to one or more other devices may include cardiac electrical or mechanical data, impedance values, heart rate values, or temperature values.
As described above, e.g., in relation to
The various components of IMD 10 are coupled to power source 91, which may include a rechargeable or non-rechargeable battery. A non-rechargeable battery may be capable of holding a charge for several years, while a rechargeable battery may be inductively charged from an external device, such as external device 12, on a daily, weekly, or annual basis, for example.
In the example shown in
One or more of communication system 26, sensor(s) 62, and/or circuitries 50-60 may be formed on the inner side of insulative cover 76, such as by using flip-chip technology. Insulative cover 76 may be flipped onto a housing 15. When flipped and placed onto housing 15, the components of IMD 10 formed on the inner side of insulative cover 76 may be positioned in a gap 78 defined by housing 15. Power source 91 of IMD 10 may be housed within housing 15. Electrodes 16 may be electrically connected to switching circuitry 58 through one or more vias (not shown) formed through insulative cover 76. Insulative cover 76 may be formed of sapphire (i.e., corundum), glass, parylene, and/or any other suitable insulating material. Housing 15 may be formed from titanium or any other suitable material (e.g., a biocompatible material). Electrodes 16 may be formed from any of stainless steel, titanium, platinum, iridium, or alloys thereof. In addition, electrodes 16 may be coated with a material such as titanium nitride or fractal titanium nitride, although other suitable materials and coatings for such electrodes may be used.
In the example shown in
In the example shown in
Proximal electrode 206A is at or proximate to proximal end 210, and distal electrode 206B is at or proximate to distal end 212. Proximal electrode 206A and distal electrode 206B are used to sense cardiac signals, e.g., ECG signals, and measure interstitial impedance thoracically outside the ribcage, which may be sub-muscularly or subcutaneously. ECG signals and impedance measurements may be stored in a memory of IMD 104A, and data may be transmitted via integrated antenna 216A to another device, which may be another implantable device or an external device, such as one or more of patient computing devices 106. In some example, electrodes 206A and 206B may additionally or alternatively be used for sensing any bio-potential signal of interest, which may be, for example, an electrogram (EGM), EEG, electromyogram (EMG), or a nerve signal, from any implanted location. Housing 202 may house the circuitry of IMD 104 as illustrated in
In the example shown in
In the example shown in
The various electrode configurations allow for configurations in which proximal electrode 206A and distal electrode 206B are located on both first major surface 204 and second major surface 208. In other configurations, such as that shown in
In the example shown in
IMD 104B may include a leadless, subcutaneously-implantable monitoring device, e.g. an ICM. IMD 104B includes housing having a base 223 and an insulative cover 222. Proximal electrode 206C and distal electrode 206D may be formed or placed on an outer surface of cover 222. Various circuitries and components of IMD 104B, e.g., described with respect to
Circuitries and components may be formed on the inner side of insulative cover 222, such as by using flip-chip technology. Insulative cover 222 may be flipped onto a base 223. When flipped and placed onto base 223, the components of IMD 104B formed on the inner side of insulative cover 222 may be positioned in a gap 224 defined by base 223. Electrodes 206C and 206D and antenna 216B may be electrically connected to circuitry formed on the inner side of insulative cover 222 through one or more vias (not shown) formed through insulative cover 222. Insulative cover 222 may be formed of sapphire (i.e., corundum), glass, parylene, and/or any other suitable insulating material. Base 223 may be formed from titanium or any other suitable material (e.g., a biocompatible material). Electrodes 206C and 206D may be formed from any of stainless steel, titanium, platinum, iridium, or alloys thereof. In addition, electrodes 206C and 206D may be coated with a material such as titanium nitride or fractal titanium nitride, although other suitable materials and coatings for such electrodes may be used.
In the example shown in
In the example shown in
Processing circuitry 80 may include one or more processors that are configured to implement functionality and/or process instructions for execution within external device 12. For example, processing circuitry 80 may be capable of processing instructions stored in storage device 84. Processing circuitry 80 may include, for example, microprocessors, DSPs, ASICs, FPGAs, or equivalent discrete or integrated logic circuitry, or a combination of any of the foregoing devices or circuitry. Accordingly, processing circuitry 80 may include any suitable structure, whether in hardware, software, firmware, or any combination thereof, to perform the functions ascribed herein to processing circuitry 80.
Communication circuitry 82 may include any suitable hardware, firmware, software, or any combination thereof for communicating with another device, such as IMD 10 using any of the secure or non-secure communication protocols described above in relation to
Storage device 84 may be configured to store information within external device 12 during operation. Storage device 84 may include a computer-readable storage medium or computer-readable storage device. In some examples, storage device 84 includes one or more of a short-term memory or a long-term memory. Storage device 84 may include, for example, RAM, DRAM, SRAM, magnetic discs, optical discs, flash memories, or forms of EPROM or EEPROM. In some examples, storage device 84 is used to store data indicative of instructions for execution by processing circuitry 80. Storage device 84 may be used by software or applications running on external device 12 to temporarily store information during program execution. Storage device 84 may also store historical temperature data, current temperature data, etc.
External device 12 can additionally or alternatively include a peripheral pointing device, such as a mouse, via which the user may interact with the user interface. In some examples, a display of external device 12 may include a touch screen display, and a user may interact with external device 12 via the display. It should be noted that the user may also interact with external device 12 remotely via a networked computing device.
Data exchanged between external device 12 and IMD 10 may include operational parameters (e.g., such as a communication rate). External device 12 may transmit data including computer readable instructions which, when implemented by IMD 10, may control IMD 10 to change one or more operational parameters and/or export collected data. For example, processing circuitry 80 may transmit an instruction to IMD 10 which requests IMD 10 to export collected data (e.g., diagnostic data) to external device 12. In turn, external device 12 may receive the collected data from IMD 10 and store the collected data in storage device 84.
A user, such as a clinician or patient 4, may interact with external device 12 through user interface 86. User interface 86 includes a display (not shown), such as a liquid crystal display (LCD) or a light emitting diode (LED) display or other type of screen, with which processing circuitry 80 may present information related to IMD 10, e.g., cardiac EGMs. In addition, user interface 86 may include an input mechanism to receive input from the user. The input mechanisms may include, for example, any one or more of buttons, a keypad (e.g., an alphanumeric keypad), a peripheral pointing device, a touch screen, or another input mechanism that allows the user to navigate through user interfaces presented by processing circuitry 80 of external device 12 and provide input. In other examples, user interface 86 also includes audio circuitry for providing audible notifications, instructions, or other sounds to the user, receiving voice commands from the user, or both.
Power source 108 delivers operating power to the components of external device 12. Power source 108 may include a battery and a power generation circuit to produce the operating power. In some embodiments, the battery may be rechargeable to allow extended operation. Recharging may be accomplished by electrically coupling power source 108 to a cradle or plug that is connected to an alternating current (AC) outlet. In addition or alternatively, recharging may be accomplished through proximal inductive interaction between an external charger and an inductive charging coil within external device 12. In other embodiments, traditional batteries (e.g., nickel cadmium or lithium ion batteries) may be used. In addition, external device 12 may be directly coupled to an alternating current outlet to power external device 12. Power source 108 may include circuitry to monitor power remaining within a battery. In this manner, user interface 86 may provide a current battery level indicator or low battery level indicator when the battery needs to be replaced or recharged. In some cases, power source 108 may be capable of estimating the remaining time of operation using the current battery.
Access point 90 may include a device that connects to network 92 via any of a variety of connections, such as telephone dial-up, digital subscriber line (DSL), or cable modem connections. In other examples, access point 90 may be coupled to network 92 through different forms of connections, including wired or wireless connections. In some examples, access point 90 may be a user device, such as a tablet or smartphone that may be co-located with the patient. IMD 10 may be configured to transmit data, such as temperature values, heart rate values, impedance values, and/or cardiac electrograms (EGMs), to access point 90. Access point 90 may then communicate the retrieved data to server 94 via network 92.
In some cases, server 94 may be configured to provide a secure storage site for data that has been collected from IMD 10 and/or external device 12. In some cases, server 94 may assemble data in web pages or other documents for viewing by trained professionals, such as clinicians, via computing devices 100. One or more aspects of the illustrated system of
In some examples, one or more of computing devices 100 may be a tablet or other smart device located with a clinician, by which the clinician may program, receive data from, and/or interrogate IMD 10. For example, the clinician may access data collected by IMD 10 through a computing device 100, such as when patient 4 is in between clinician visits, to check on a status of a medical condition. In some examples, the clinician may enter instructions for a medical intervention for patient 4 into an application executed by computing device 100, such as based on patient data known to the clinician. Device 100 then may transmit the instructions for medical intervention to another of computing devices 100 located with patient 4 or a caregiver of patient 4. For example, such instructions for medical intervention may include an instruction to change a drug dosage, timing, or selection, to schedule a visit with the clinician, or to seek medical attention. In further examples, a computing device 100 may generate an alert to patient 4 based on a status of a medical condition of patient 4, which may enable patient 4 proactively to seek medical attention prior to receiving instructions for a medical intervention. In this manner, patient 4 may be empowered to act, as needed, to address his or her medical status, which may help improve clinical outcomes for patient 4.
In the example illustrated by
Storage device 96 may include a computer-readable storage medium or computer-readable storage device. In some examples, storage device 96 includes one or more of a short-term memory or a long-term memory. Storage device 96 may include, for example, RAM, DRAM, SRAM, magnetic discs, optical discs, flash memories, or forms of EPROM or EEPROM. In some examples, storage device 96 is used to store data indicative of instructions for execution by processing circuitry 98.
In some examples, processing circuitry, e.g., processing circuitry 50 of IMD 10, may receive a first signal indicating one or more temperature values from temperature sensor(s) 63 (602). For example, processing circuitry 50 may obtain raw temperature data from one or more of temperature sensor(s) 63. Temperature sensor(s) 63 may detect temperature in and/or around IMD 10. As described above in relation to
In some examples, processing circuitry 50 may obtain temperature values from temperature sensor(s) 63 over time. In some examples, processing circuitry 50 may obtain temperature values from temperature sensor(s) 63 every second, every minute, hourly, daily, etc. or may obtain temperature values from temperature sensor(s) 63 in an aperiodic fashion. For example, processing circuitry 50 may control temperature sensor(s) 63 to perform random temperature measurements at random times during a set time period (e.g., randomly throughout each day).
Processing circuitry 50 may receive a first signal from temperature sensor(s) 63, e.g., via sensing circuitry 52, and may determine a temperature value of IMD 10 based on the first signal. In some examples, processing circuitry 50 may determine temperature values of IMD 10 over time as a series of discrete temperature values and determine a temperature value based on the series of discrete temperature values. In some examples, processing circuitry 50 may determine the temperature values at a sampling rate during each of a plurality of sampling periods during a predefined time period. For example, processing circuitry 50 may determine temperature values at a sampling rate of twice every hour over the course of a 24-hour time period. In another example, processing circuitry 50 may determine temperature values at a sampling rate of once every hour during specific times of the day, such as between 8:00 am and 5:00 pm. In some examples, processing circuitry 50 may determine temperature values at a sampling rate of once per minute.
In some examples, processing circuitry 50 of IMD 10, may make a first preliminary determination of whether IMD 10 has changed status, including whether the IMD has been implanted based on the obtained temperature (604), or from some indication from any of the sensors described above in relation to
In some examples, biosensor(s) 53 may include an impedance sensor. Biosensor(s) 53 may send a second signal indicating an impedance value to processing circuitry 50 and processing circuitry 50 may identify an impedance value based on the second signal. For example, biosensor(s) 53 may include sample and hold circuitry to sample the voltage across the resistance. Using this voltage, processing circuitry 50 may calculate the impedance. Processing circuitry 50 and biosensor(s) 53 may sample the voltage with a sampling rate that is sufficiently high enough to reliably identify the impedance signal. For example, processing circuitry 50 and biosensor(s) 53 may sample the voltage rate with a sampling rate around 1000 hertz.
In some examples, biosensor(s) 53 may include an ECG sensor or heart sounds sensor, such as a microphone. Biosensor(s) 53 may send a second signal indicating heart activity to processing circuitry 50 and processing circuitry 50 may identify a heart rate value based on the second signal. For example, biosensor(s) 53 may include an ECG sensor configured to detect electrical signals produced by heart activity via electrodes 16. Using the electrical signals, processing circuitry 50 may determine a heart rate of patient 4.
In some examples, processing circuitry, e.g., processing circuitry 50 of IMD 10, may make a second preliminary determination of whether IMD 10 is implanted based on the impedance value, the heart rate value, or any other sensed value (608). For example, processing circuitry 50 may make the second preliminary determination based on whether or not the impedance value satisfies impedance criterion 66 as stored in storage device 60. As another example, processing circuitry 50 may make the second preliminary determination based on whether or not the heart rate value satisfies heart rate criterion 68 as stored in storage device 60. If the second preliminary determination is that IMD 10 has been implanted (“NO” branch of 608), processing circuitry 50 may repeat actions (602) through (606), as needed. If the second preliminary determination is that IMD 10 has been implanted (“YES” branch of 608), processing circuitry 50 may determine that IMD 10 has been implanted based on both the first preliminary determination and the second preliminary determination being that IMD 10 has been implanted (610).
Use of a single sensor, such as temperature signals alone to determine whether an IMD has been implanted may be prone to false triggering. For instance, it may be difficult to distinguish based on temperature signals whether an IMD has been implanted in a patient versus whether the IMD has been in a warm environment. The consequences of false triggering may result in wasteful drain on the resources and may shorten the lifespan of the IMD.
The techniques of this disclosure may improve the detection capabilities of IMDs. Using both the temperature signal and the second signal, e.g., the impedance signal or the heart rate signal, to determine whether IMD 10 has been implanted may be more robust than using only the temperature signal or the second signal alone to determine whether IMD 10 has been implanted. This is because processor circuitry 50 may be able to use the second preliminary determination based on the second signal as a check on the first preliminary determination based on the temperature signal. Additionally, examples in which impedance sensing or heart activity monitoring is activated in response to sensed temperature satisfying a temperature criterion may avoid unnecessary expenditure of energy associated with impedance or heart rate measurements.
In response to the determination being that IMD 10 is implanted or has otherwise changed status, processing circuitry 50 may then cause IMD 10 to switch from a first mode to a second mode (612), e.g., a first operational mode to a second operational mode. For example, IMD 10 may be switched from a dormant mode, e.g., a mode does not include communication with an external computing device such as external device 12 or access point 90, to an activated mode, e.g., a mode include communication with an external computing device, upon a determination that IMD 10 is implanted in the body of patient 4. Processing circuitry 50 may cause IMD 10 to switch operation mode in accordance with any of the examples provided elsewhere in this disclosure. Accordingly, the techniques of this disclosure may preserve power source 91 of IMD 10 and may reduce unintended communication connection process between IMD 10 and an external device, such as external device 12.
Other advantages of the IMD of this disclosure may include, that IMD 10 may be configured to start operating based on confirming a change in status for the IMD. For example, in response to a confirmation that IMD 10 is implanted, IMD 10 may begin monitoring patient bioelectrical signals, or performing other tasks, without the need of a start-up procedure using a dedicated programmer for IMD 10.
In some examples, processing circuitry 50 may receive a first signal indicating one or more temperature values from temperature sensor(s) 63 and determine a temperature based on the first signal (702). For example, processing circuitry 50 may apply a low-pass filter to smooth the one or more temperature values and determine an average of the one or more smoothened temperature values.
In some examples, processing circuitry 50 may smooth the temperature values sensed over time to decrease an amount of noise in sensed temperature values caused by various factors, including environmental factors. For example, processing circuitry 50 may apply a low-pass filter to a plurality of temperature values using a digital filter or in some instances, an analog filter. In one example, processing circuitry 50 may apply a digital filter that increases signal-to-noise ratio (SNR) to create a smoothened temperature signal by filtering out high frequency noise or other high frequency variations from temperature values determined over time. In another example, processing circuitry 50 may smoothen the temperature values using a low pass differentiator filter that performs smoothing based on predefined coefficients and/or smoothing differentiator filter functions to remove high frequency variations in temperature values determined over time. In some examples, processing circuitry 50 may apply a low-pass filter that passes low-frequency temperature variations while impeding high-frequency temperature variations. The low-pass filter may have a predefined cutoff frequency that attenuates temperature variations exceeding that of the cutoff frequency. Processing circuitry 50 may then determine a temperature value by calculating an average of the smoothened temperature values.
In some examples, processing circuitry 50 may determine whether or not the temperature satisfies temperature criterion 64, or other sensed indication compared to the predetermined criteria as stored in storage device 60 (704). Processing circuitry 50 may make this determination in any of various ways. In some examples, processing circuitry 50 may determine that the temperature satisfies temperature criterion 64 based on the temperature meeting a predefined threshold value (e.g., 37 degree Celsius), within a predetermined range, based on a specified sequence of events and other criteria as described above in relation to
In response to determining that the temperature satisfies temperature criterion 64 as stored in storage device 60 (“YES” branch of 704), processing circuitry 50 may make a first preliminary determination that IMD 10 is implanted in the body of patient 4 (706). However, if processing circuitry 50 determines that the temperature has not satisfied temperature criterion 64 as stored in storage device 60 (“NO” branch of 704), processing circuitry 50 continue to obtain sample values from temperature sensor(s) 63 and determine whether IMD 10 has been implanted.
In some examples, processing circuitry 50 may receive a second signal indicating one or more impedance values from biosensor(s) 53 and determine an impedance value based on the second signal (802). For example, processing circuitry 50 may cause biosensor(s) 53 to send an electrical signal to fluid and/or tissue in an electrical path between a first electrode 16A and a second electrode 16B of IMD 10. Processing circuitry 50 may then identify an impedance of the signal between these two electrodes.
In some examples, processing circuitry 50 may determine whether or not the impedance satisfies impedance criterion 66 as stored in storage device 60 (804). Processing circuitry 50 may make this determination in any of various ways. In some examples, processing circuitry 50 may determine that the impedance satisfies impedance criterion 66 based on the impedance meeting a predefined range. For example, processing circuitry 50 may determine whether or not the impedance that is below an impedance threshold as stored in storage device 60. The impedance threshold may include a static value where a momentary spike is sufficient processing circuitry 50 to determine that IMD 10 is implanted in the body of patient 4. Alternatively, the impedance threshold may include an average impedance magnitude over a period of time (e.g., over one or two seconds).
In response to determining that the impedance satisfies impedance criterion 66 as stored in storage device 60 (“YES” branch of 804), processing circuitry 50 may make a second preliminary determination that IMD 10 is implanted in the body of patient 4 (806). However, if processing circuitry 50 determines that the impedance has not satisfied impedance criterion 66 as stored in storage device 60 (“NO” branch of 804), processing circuitry 50 continue to obtain sample values from sensor(s) 62 and determine whether IMD 10 has been implanted.
In some examples, processing circuitry 50 may receive a second signal indicating heart activity from biosensor(s) 53 and determine a heart rate based on the second signal (808). For example, processing circuitry 50 may receive signal indicating heart activity from biosensor(s) 53 and may process the signal to obtain a heart rate of patient 4.
In some examples, processing circuitry 50 may determine whether or not the heart rate satisfies heart rate criterion 68 as stored in storage device 60 (810). Processing circuitry 50 may make this determination in any of various ways. In some examples, processing circuitry 50 may determine that the heart rate satisfies heart rate criterion 68 based on the heart rate is within a heart rate range. In one example, the heart rate range is between 30 beats per minutes (bpm) to 200 bpm.
In response to determining that the heart rate satisfies heart rate criterion 68 as stored in storage device 60 (“YES” branch of 810), processing circuitry 50 may make a second preliminary determination that IMD 10 is implanted in the body of patient 4 (812). However, if processing circuitry 50 determines that the heart rate has not satisfied heart rate criterion 68 as stored in storage device 60 (“NO” branch of 810), processing circuitry 50 continue to obtain sample values from sensor(s) 62 and determine whether IMD 10 has been implanted.
In some examples, processing circuitry 50 is configured to switch IMD 10 from a first mode to a second mode (1002). In some examples, IMD 10 may be switched from a dormant mode (e.g., a first mode does not include communication with an external computing device) to an activated mode (e.g., a second mode include communication with an external computing device). For instance, processing circuitry 50 may be configured to activate communication system 26 upon IMD 10 being switched to the activated mode (1004). In some examples, IMD 10 may be switched from a low-power mode to a high-power mode (e.g., from a first mode includes a relatively low power consumption to a second mode includes a relatively high power consumption).
In some examples, processing circuitry 50 is configured to activate communication system 26 to transmit a message to an external device (1006), such as external device 12. IMD 10 may transmits the message according to a protocol stored in storage device 60. In some examples, the protocol includes Bluetooth® protocol such as a BTLE protocol having a low-power mode and a high-power mode. For example, in the low-power mode, IMD 10 may transmit a message including a set of advertisements at a first advertisement rate. Additionally, in the high-power mode, IMD 10 may transmit a message including a set of advertisements at a second advertisement rate, where the second advertisement rate is greater than the first advertisement rate. In other examples, IMD 10 does not transmit any advertisements in dormant mode and IMD 10 initiates the transmission of advertisements after switching to activated mode.
Data exchanged between external device 12 and IMD 10 may include any data stored in storage device 60. External device 12 may transmit data including computer readable instructions which, when implemented by IMD 10, may control IMD 10 to export collected data. For example, processing circuitry 50 may transmit an instruction to IMD 10 which requests IMD 10 to export collected data to external device 12. In turn, external device 12 may receive the collected data from IMD 10 and store the collected data in storage device 84.
In some examples, in order to preserve power for testing after explant of an IMD, the IMD may stay locked until certain sensor conditions are met. As illustrated in
In response to determining that the temperature has not satisfied temperature criterion 64 as stored in storage device 60 (“NO” branch of 1104), processing circuitry 50 continue to obtain sample values from temperature sensor(s) 63 and determine whether temperature criterion 64 has been satisfied. However, if the temperature satisfies temperature criterion 64 as stored in storage device 60 (“YES” branch of 1104), processing circuitry 50 may activate communication system 26. For example, processing circuitry 50 may activate communication system 26 to enable IMD 10 to receive unsecured communications from external device 12 for a predefined time window (1106), e.g., communication system 26 may operate in a first communication mode.
During that time window, processing circuitry 50 may receive a command from external device 12 and may verify the command by comparing the received command with a command stored in storage device 60 (1108). For example, if the received command matches an unlock command stored in storage device 60, processing circuitry 50 may switch IMD 10 from a first communication mode to a second communication mode. In some examples, IMD 10 may be switched from a locked mode (e.g., a first communication mode does not permit unsecured communication with an external computing device) to an unlocked mode (e.g., a second communication mode that permits unsecured communication with an external computing device). Communication system 26 may operate in any of several different communication modes. As described above in relation to
The techniques described in this disclosure may be implemented, at least in part, in hardware, software, firmware, or any combination thereof. For example, various aspects of the techniques may be implemented within one or more microprocessors, DSPs, ASICs, FPGAs, or any other equivalent integrated or discrete logic QRS circuitry, as well as any combinations of such components, embodied in external devices, such as physician or patient programmers, stimulators, or other devices. The terms “processor” and “processing circuitry” may generally refer to any of the foregoing logic circuitry, alone or in combination with other logic circuitry, or any other equivalent circuitry, and alone or in combination with other digital or analog circuitry.
For aspects implemented in software, at least some of the functionality ascribed to the systems and devices described in this disclosure may be embodied as instructions on a computer-readable storage medium such as RAM, ROM, NVRAM, DRAM, SRAM, Flash memory, magnetic discs, optical discs, flash memories, or forms of EPROM or EEPROM. The instructions may be executed to support one or more aspects of the functionality described in this disclosure.
In addition, in some aspects, the functionality described herein may be provided within dedicated hardware and/or software modules. Depiction of different features as modules or units is intended to highlight different functional aspects and does not necessarily imply that such modules or units must be realized by separate hardware or software components. Rather, functionality associated with one or more modules or units may be performed by separate hardware or software components, or integrated within common or separate hardware or software components. Also, the techniques could be fully implemented in one or more circuits or logic elements. The techniques of this disclosure may be implemented in a wide variety of devices or apparatuses, including an IMD, an external programmer, a combination of an IMD and external programmer, an integrated circuit (IC) or a set of ICs, and/or discrete electrical circuitry, residing in an IMD and/or external programmer.
The techniques of this disclosure may also be understood based on the following examples.
Example 1: An implantable medical device (IMD) comprising a communication system: configured for wireless communication, and configured to operate in a first mode and in a second mode; a connection to a plurality of electrodes; one or more sensors; a processing circuitry operatively coupled to the one or more sensors, wherein the processing circuitry is configured to: determine a status for the IMD based at least on a first preliminary determination that the IMD has changed status, wherein the first preliminary determination is based on a first indication from a first sensor of the one or more sensors; responsive to the first preliminary determination indicating a change of status for the IMD, make a second preliminary determination that the IMD has changed status based on a second indication from a second sensor of the one or more sensors; confirm the change in status for the IMD based on the first preliminary determination and the second preliminary determination, and change the communication system from a first mode to a second mode based on the determination that the IMD.
Example 2: The IMD of example 1, wherein the first mode is a first communication mode and a second mode is a second communication mode different from the first communication mode; wherein the first communication mode and the second communication mode respectively comprise any one of: inactive, active, a first secure communication mode, a second secure communication mode different from the first secure communication mode, and an unsecure communication mode.
Example 3: The IMD of example 2, wherein the communication system is inactive in the first communication mode, and wherein responsive to changing to the second communication mode, the processing circuitry is configured to cause the communication system to wirelessly broadcast a plurality of advertisement messages to establish a wireless communication session with an external computing device.
Example 4: The IMD of any of examples 1 through 3, wherein the status for the IMD comprises any one of: pre-implant, post-implant, production, shipping, dormant, during implantation, implanted, and explanted.
Example 5: The IMD of any of examples 1 through 4, wherein the processing circuitry is configured to switch the IMD from operating in a first operating mode to operating in a second operating mode based on a determination that the IMD is implanted.
Example 6: The IMD of example 5, wherein the second operating mode comprises higher power consumption than the first operating mode.
Example 7: The IMD of any of examples 1 through 6, wherein the first preliminary determination and the second preliminary determination comprise a sequence of events, and wherein the processing circuitry is configured to determine the status for the IMD based on the sequence of events.
Example 8: The IMD of example 7, wherein the sequence of events comprises three or more events.
Example 9: The IMD of any of examples 1 through 8, wherein the IMD comprises an insertable cardiac monitor that further comprises a housing for the communication system, the processing circuitry, and the biosensor, wherein the plurality of electrodes are positioned on the housing.
Example 10: A method of operating an implantable medical device (IMD) comprising making, by processing circuitry of the IMD, a first preliminary determination that the IMD has changed status, wherein the first preliminary determination is based on a first indication from a first sensor of the one or more sensors; responsive to the first preliminary determination indicating a change of status for the IMD, making a second preliminary determination that the IMD has changed status based on a second indication from a second sensor of the one or more sensors; determining whether the IMD has changed status based on the first preliminary determination and the secondary preliminary determination; and responsive to determining that the IMD has changed status, change a wireless communication system of the IMD from a first communication mode to a second communication mode.
Example 11: The method of example 10, wherein the first communication mode and the second communication mode respectively comprise any one of: inactive, active, a first secure communication mode, a second secure communication mode different from the first secure communication mode, and an unsecure communication mode.
Example 12: The method of any of examples 10 and 11, wherein the communication system is inactive in the first communication mode, the method further comprising responsive to changing to the second communication mode, causing the wireless communication system to wirelessly broadcast a plurality of advertisement messages to establish a wireless communication session with an external computing device.
Example 13: The method of any of examples 10 through 12, the status for the IMD comprises any one of: pre-implant, post-implant, production, shipping, dormant, during implantation, implanted, and explanted.
Example 14: The method of any of examples 10 through 13, further comprising switching the IMD from operating in a first operating mode to operating in a second operating mode based on a determination that the IMD is implanted.
Example 15: The method of example 14, wherein the second operating mode comprises higher power consumption than the first operating mode.
Example 16: The method of any of examples 10 through 15, wherein the first preliminary determination and the second preliminary determination comprise a sequence of events, the method further comprising determining the status for the IMD based on the sequence of events.
Example 17: The method of any of examples 10 through 16, the method further comprising responsive to determining that the IMD has changed status to an implanted status, chronically monitoring patient bioelectrical signals.
Example 18: The method of any of examples 10 through 17, wherein the IMD comprises an insertable cardiac monitor that further comprises a housing for the communication system, the processing circuitry, and the biosensor, wherein the plurality of electrodes are positioned on the housing.
Example 19: A non-transitory computer readable storage medium comprising make a first preliminary determination that an implantable medical device (IMD) has changed status, wherein the first preliminary determination is based on a first indication from a first sensor of the one or more sensors; responsive to the first preliminary determination indicating a change of status for the IMD, make a second preliminary determination that the IMD has changed status based on a second indication from a second sensor of the one or more sensors; determine whether the IMD has changed status based on the first preliminary determination and the secondary preliminary determination; and responsive to determining that the IMD has changed status, change a wireless communication system of the IMD from a first communication mode to a second communication mode.
Example 20: The non-transitory computer readable storage medium of example 19, wherein the communication system is inactive in the first communication mode, wherein the instructions cause the processing circuitry to responsive to changing to the second communication mode, cause the wireless communication system to wirelessly broadcast a plurality of advertisement messages to establish a wireless communication session with an external computing device.
Furthermore, although described primarily with reference to examples that provide an infection status to indicate a device pocket infection in response to detecting temperature changes in the device pocket, other examples may additionally or alternatively automatically modify a therapy in response to detecting the infection status in the patient. The therapy may be, as examples, a substance delivered by an implantable pump, a delivery of antibiotics, etc. These and other examples are within the scope of the following claims.
This application is a Continuation-in-Part of U.S. patent application Ser. No. 18/045,184, filed on Oct. 10, 2022, which is a Continuation of U.S. patent application Ser. No. 16/935,047, now U.S. Pat. No. 11,464,985, filed Jul. 21, 2020, and which claims the benefit of U.S. Provisional Patent Application Ser. No. 63/030,037, filed on May 26, 2020, the entire content of each of which is incorporated herein by reference.
| Number | Date | Country | |
|---|---|---|---|
| 63030037 | May 2020 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 16935047 | Jul 2020 | US |
| Child | 18045184 | US |
| Number | Date | Country | |
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| Parent | 18045184 | Oct 2022 | US |
| Child | 18358578 | US |
