Gesture-based sensing and medical treatment delivery system

Abstract

An implantable medical device (IMD) includes one or more medical therapy delivery elements, one or more sensors, a memory, and processing circuitry. The processing circuitry is configured to receive a sensed signal from the one or more sensors, determine a posture of the patient based on the received sensed signal, retrieve one or more therapy delivery parameter values stored in the memory, wherein the one or more therapy delivery parameter values correspond to the determined posture, determine that the one or more therapy delivery parameter values for the determined posture were configured within a threshold time period from a current time, and in response to determining that the one or more therapy delivery parameter values were configured within the threshold time period, cause the one or more medical therapy delivery elements to deliver medical therapy to the patient based on the one or more therapy delivery parameter values.

Description

[0001] This application claims the benefit of U.S. Provisional Patent Application Serial No. 63 / 600,905, filed November 20, 2023, the entire contents of which are incorporated herein by reference. Technical Field

[0002] This application relates to medical devices, including implantable medical devices (IMDs) configured to sense electrical signals from a patient and / or deliver medical treatment to the patient. Background Technology

[0003] Medical devices are implanted, partially implanted, and / or worn on a patient's body to sense physiological signals and / or deliver treatment to the patient. In some cases, the medical device system includes one or more IMDs implanted within the patient's body. These one or more IMDs can sense signals from the patient's target tissue and / or deliver medical treatment to the patient's target tissue via sensing elements and / or treatment delivery elements, respectively. The sensing elements and / or treatment delivery elements may not be directly coupled to the target tissue. Instead, an intermediate tissue may exist between the target tissue and the sensing elements and / or treatment delivery elements, through which the sensing elements and / or treatment delivery elements can sense signals from the target tissue and / or deliver medical treatment to the target tissue. Summary of the Invention

[0004] When a patient moves around in a mobile environment or during normal daily activities, they may adopt different postures (e.g., standing, sitting, supine, bending, squatting, lying on their side, leaning forward, leaning backward, etc.) and may shift between these postures. When a patient is in different postures, the target site for sensing and / or therapeutic delivery (e.g., the heart) may be at different distances from one or more elements of the medical device system (such as an implantable medical device (IMD) system), and / or may move in different directions relative to one or more electrodes of the IMD or leads coupled to the IMD (e.g., during a cardiac or respiratory cycle). These varying distances and / or orientations of the target site and one or more electrodes may impede the IMD system's ability to sense desired physiological signals and / or deliver therapeutic stimulation.

[0005] In one example, the target site may be the heart, and the IMD system may include an implantable cardiac device (e.g., an implantable cardioverter-defibrillator (ICD), pacemaker, cardiac resynchronization therapy (CRT) device, or implantable cardiac monitor (ICM)) comprising or coupled to one or more electrodes for sensing cardiac signals and / or delivering cardiac stimulation therapy (e.g., bradycardia pacing, antitachycardia pacing (ATP), CRT, cardioverter-defibrillation, or defibrillation shock). When the patient is in different positions, the varying distances between these one or more electrodes and the heart, while the IMD performs cardiac signal sensing based on the same set of sensing parameter values, may result in oversensing or undersensing of cardiac signals. In some examples, the varying distances between these one or more electrodes and the heart, when the patient is in different positions, may result in the IMD delivering cardiac pacing therapy that is insufficient to capture cardiac tissue or exceeds the capture threshold of cardiac tissue. Delivering cardiac pacing therapy to the patient beyond the capture threshold may lead to increased patient discomfort and / or increased power consumption, which may reduce the overall lifespan of the IMD and the acceptability of pacing therapy.

[0006] This disclosure describes apparatus, systems, and methods for adjusting sensing parameter values ​​and / or treatment delivery parameter values ​​based on a patient's posture. In some examples, the IMD may adjust sensing parameter values ​​based on the patient's posture to increase and / or decrease the sensing sensitivity of the IMD's sensing circuitry. In some examples, the IMD may adjust treatment delivery parameter values ​​based on the patient's posture and deliver medical treatment based on updated treatment delivery parameter values. While this disclosure primarily describes systems and apparatuses configured to sense cardiac signals and deliver cardiac treatment to a patient's heart, the exemplary apparatus, systems, and methods described herein can be performed by other IMDs configured to sense other signals from a patient and / or deliver other medical treatments to a patient. For example, the exemplary apparatus, systems, and methods described herein can be adapted to other situations where the distance and / or orientation between one or more elements of the IMD (e.g., sensing elements and / or treatment delivery elements) and a target location of the patient changes in response to changes in the patient's posture.

[0007] In some examples, an IMD system may be an extravascular implantable cardioverter defibrillator (EV ICD) system comprising one or more ICDs. The one or more ICDs can sense cardiac signals from the patient's cardiac tissue and / or deliver cardiac pacing therapy to the patient's cardiac tissue. The one or more ICDs may not be directly coupled to the cardiac tissue and may sense signals from the cardiac tissue and / or deliver cardiac pacing to the cardiac tissue via intermediate tissue between the cardiac tissue and the one or more ICDs. The one or more ICDs may adjust sensing parameters based on the patient's posture to accurately sense cardiac signals. The one or more ICDs may adjust treatment delivery parameters (e.g., pacing parameters) based on the patient's posture to capture cardiac tissue via cardiac pacing without unnecessary power consumption and / or patient discomfort.

[0008] The example devices, systems, and methods described herein offer several advantages over other IMD systems. Adjusting sensing parameter values ​​based on patient posture can reduce the occurrence of oversensing and / or undersensing by the IMD, which can increase the accuracy of the IMD's determination based on sensing signals and / or increase the efficacy of medical treatments delivered by the IMD at least partially based on sensing signals. Adjusting treatment delivery parameter values ​​based on patient posture can increase the efficacy of medical treatments (e.g., by ensuring that medical treatments capture the patient's cardiac tissue), increase the overall lifespan of the IMD (e.g., by reducing unnecessary energy consumption during medical treatment delivery), and / or reduce patient discomfort caused by the delivery of medical treatments (e.g., by reducing the delivery of over-medical treatments to the patient).

[0009] In some examples, this disclosure describes an implantable medical device (IMD) configured to be implanted in a patient, the IMD including: one or more medical treatment delivery elements; one or more sensors; a memory; and processing circuitry configured to: receive sensing signals from the one or more sensors; determine a patient's posture based on the received sensing signals; retrieve one or more treatment delivery parameter values ​​stored in the memory, wherein the one or more treatment delivery parameter values ​​correspond to the determined posture; determine that the one or more treatment delivery parameter values ​​for the determined posture are configured within a threshold time period from the current time; and, in response to determining that the one or more treatment delivery parameter values ​​are configured within the threshold time period, cause the one or more medical treatment delivery elements to deliver medical treatment to the patient based on the one or more treatment delivery parameter values.

[0010] In some examples, this disclosure describes a method comprising: receiving sensing signals from one or more sensors of an implantable medical device (IMD) implanted in a patient by processing circuitry of the IMD; determining a patient’s posture by the processing circuitry and based on the received sensing signals; retrieving one or more treatment delivery parameter values ​​corresponding to the determined posture by the processing circuitry and from the memory of the IMD; determining by the processing circuitry that the one or more treatment delivery parameter values ​​are configured within a threshold time period from the current time; and, in response to determining that the one or more treatment delivery parameter values ​​are configured within the threshold time period, causing one or more medical treatment delivery elements of the IMD to deliver medical treatment to the patient based on the one or more treatment delivery parameter values.

[0011] In some examples, this disclosure describes an implantable medical device (IMD) configured for implantation in a patient, the IMD comprising: sensing circuitry coupled to one or more electrodes; therapeutic delivery circuitry coupled to the one or more electrodes; one or more sensors; a memory; and processing circuitry configured to: receive sensing signals from the one or more sensors; determine a patient's posture based on the received sensing signals; retrieve one or more sensing parameter values ​​from the memory corresponding to the determined posture; and cause the sensing circuitry to perform an implantable medical device (IMD) based on the one or more retrieved sensing parameters. The value is sensed from the patient via one or more electrodes; in response to determining that the sensed electrical signal meets a threshold condition, cardiac pacing therapy is delivered to the patient, wherein, in order to deliver cardiac pacing therapy, the processing circuitry is configured to: retrieve one or more pacing parameter values ​​stored in memory, wherein the one or more pacing parameter values ​​correspond to a determined posture; determine that the one or more pacing parameter values ​​for the determined posture are configured within a threshold time period from the current time; and in response to determining that the one or more pacing parameter values ​​are configured within the threshold time period, control the therapy delivery circuitry to deliver cardiac pacing therapy to the patient via the one or more electrodes based on the one or more pacing parameter values.

[0012] In some examples, this disclosure describes an implantable medical device (IMD) configured to be implanted in a patient's body, the IMD including: a sensing element coupled to the patient's tissue; one or more sensors; a memory; and processing circuitry configured to: receive sensing signals from the one or more sensors; determine the patient's posture based on the received sensing signals; and, in response to the determined posture, cause the sensing element to sense electrical signals from the tissue based on one or more sensing parameter values ​​stored in the memory, wherein the one or more sensing parameter values ​​correspond to the determined posture.

[0013] This invention 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, apparatus, and methods detailed in the accompanying drawings and the following description. Further details of one or more examples are set forth in the following drawings and description. Other features, objects, and advantages will be apparent from the description and drawings and from the statements provided below. Attached Figure Description

[0014] Referring to the accompanying drawings, elements with the same reference numerals always represent similar elements.

[0015] Figure 1 This is a conceptual front view of a patient with an example implantable medical device (IMD) system implanted extravascularly.

[0016] Figure 2 This is an example of having Figure 1 A conceptual diagram of a patient's side view in an example IMD system.

[0017] Figure 3 This is an example Figure 1 The following is a functional block diagram of an example configuration of components in an example IMD system.

[0018] Figure 4 This is a flowchart illustrating an example process of adjusting the sensing parameter values ​​of an example IMD system based on changes in patient posture.

[0019] Figure 5 This is a flowchart illustrating an example process for adjusting the pacing parameter values ​​of an example IMD system based on changes in patient posture.

[0020] Figure 6 This is a flowchart illustrating an example process of adjusting the sensing parameter values ​​and pacing parameter values ​​of an example IMD system based on changes in patient posture. Detailed Implementation

[0021] An IMD (Intravascular Diagnostic Device) system can be implanted in a patient. The IMD senses signals from the patient's tissue and / or delivers medical treatment to a target location within the patient's body. In some examples, the IMD system may be an extravascular implantable cardioverter defibrillator (EV ICD) system comprising one or more IMDs (e.g., ICDs) implanted in the patient. The IMD system can deliver medical treatment (e.g., cardiac pacing therapy) from one or more electrodes coupled to the IMD through the patient's tissue to the patient's cardiac tissue. If the sensing element and / or treatment delivery element (e.g., electrodes) of the IMD system are not directly coupled to the target tissue (e.g., coupled to the patient's cardiac tissue), the distance between the sensing element and / or treatment delivery element and the target tissue may vary based on the patient's posture. For example, the distance between the sensing element and / or treatment delivery element and the target tissue may differ when the patient is standing, sitting, lying supine, or in another posture.

[0022] In such examples, when a sensing element senses a signal from target tissue based on the same sensing parameter values, the sensing element may oversensitize or undersensitize the signal when the patient is in different postures due to varying distances between the sensing element and the target tissue. In some examples, when a treatment delivery element delivers medical treatment to target tissue based on the same treatment delivery parameter values, the medical treatment may be insufficient to achieve the threshold efficacy or may be too high relative to the threshold efficacy when the patient is in different postures due to varying distances between the treatment delivery element and the target tissue. For example, when an IMD delivers cardiac treatment to a patient, the same magnitude (e.g., pulse amplitude and / or pulse width) may be insufficient to capture cardiac tissue in a first posture and may be greater than the capture threshold for cardiac tissue in a second posture. In such examples, delivering cardiac treatment with pulse amplitude and / or pulse width exceeding the capture threshold may unnecessarily consume power and / or may cause increased patient discomfort for some device configurations (such as, but not limited to, extravascular ICDs).

[0023] The apparatus, systems, and methods described herein can adjust sensing parameter values ​​and / or treatment delivery parameter values ​​based on the patient's posture. In some examples, the IMD can adjust sensing parameter values ​​based on the patient's posture to increase or decrease the IMD's sensing sensitivity. For example, when the patient is in a posture where the target tissue and the sensing element are separated by a greater distance, the IMD can increase the sensing sensitivity, and vice versa. In some examples, the IMD can adjust treatment delivery parameter values ​​based on the patient's posture to control the efficacy of medical treatment delivered by the IMD. For example, when the patient is in a posture where the target tissue and the treatment delivery element are closer, the IMD can reduce the amplitude and / or pulse width and / or frequency of the medical treatment to suppress unintended delivery of overtreatment (e.g., medical treatment with an amplitude and / or frequency exceeding the minimum amplitude and / or frequency required for successful treatment of the patient). In some examples, when the patient is in a posture where the target tissue and the treatment delivery element are further apart, the IMD can increase the amplitude and / or pulse width and / or frequency of the medical treatment to ensure that the delivered medical treatment is effective. In some examples, where the IMD senses signals along a sensing vector and / or delivers medical treatment along a treatment delivery vector, the IMD may adjust one or more vectors based on the patient's posture.

[0024] Adjusting sensing and / or treatment delivery parameters based on patient posture using an IMD can offer several advantages over other IMDs or IMD systems. For example, an IMD can adjust sensing parameters based on patient posture, which may reduce sensing sensitivity when the sensing element is closer to the target tissue and vice versa. Adjusting sensing sensitivity in response to the distance between the sensing element and the target tissue can suppress and / or reduce oversensing or undersensing of signals by the IMD. In some examples, the IMD can adjust treatment delivery parameters based on patient posture, which controls the magnitude and / or frequency of medical treatment, ensuring that the medical treatment delivers an effective therapeutic effect on the target tissue without unnecessarily consuming power or other resources, or causing patient discomfort.

[0025] While the example devices, systems, and methods in this disclosure are primarily described with reference to an ICD configured to sense electrical signals from a patient's heart and / or deliver electrical energy to the patient's heart, example IMDs, IMD systems, and / or methods may sense signals from another target tissue in the patient and / or deliver medical treatment to another target tissue in the patient. Target tissue may include, but is not limited to, another organ of the patient, nerves of the patient, or tissue adjacent to the patient's body cavity.

[0026] As used herein, relational terms such as “first” and “second”, “above” and “below”, “front” and “back” may be used only to distinguish one entity or element from another entity or element, without requiring or implying any physical or logical relationship or order between such entities or elements.

[0027] Figure 1 This is a conceptual front view of a patient 102 with an example implantable medical device (IMD) 100 implanted intrathoracically or extravascularly. Figure 2 This is an example of having Figure 1 A conceptual diagram of a patient 102 in a sample IMD system 100. The IMD system 100 (also referred to herein as "System 100") may be, but is not limited to, an ICD system or an EV ICD system. System 100 may include an IMD 106 connected to an implantable medical lead 108. An IMD may include, but is not limited to, an ICD.

[0028] ICD 106 may include a hermetically sealed housing forming components protecting the ICD 106. The housing of ICD 106 may be formed of a conductive material such as titanium or a titanium alloy, and may serve as a housing electrode (sometimes referred to as a can electrode). In some embodiments, ICD 106 may be formed to have or include multiple electrodes on the housing. ICD 106 may also include a connector assembly (also referred to as a connector block or plug) including electrical feedthroughs through which electrical connections are made between the conductors of lead 108 and electronic components housed within the housing of ICD 106. As will be further described in detail herein, the housing may house one or more processors, memories, transmitters, receivers, sensors, sensing circuitry, therapeutic circuitry, power supplies, and other suitable components. The housing is configured for implantation in a patient, such as patient 102.

[0029] The ICD 106 can be implanted outside the left thoracic cavity of patient 102, such as subcutaneously and extrathoracically (subcutaneously or submuscularly). In some examples, the ICD 106 can be implanted between the left posterior axillary line and the left anterior axillary line of patient 102. The lead 108 may include an elongated lead body 110 having a distal portion 110A, the size of which is designed for implantation at an extravascular location near the heart 104, such as extravascular. Figure 1 and Figure 2 As illustrated, or outside the thoracic cavity. For example, the lead 108 may extend from the ICD 106 toward the center of the trunk of the patient 102 (e.g., toward the xiphoid process 116 of the patient 102) subcutaneously and extrathoracically (e.g., subcutaneously or submuscularly) to the extrathoracic cavity. At a location near the xiphoid process 116, the lead body 110 may bend or otherwise rotate and extend upward. The bend may be pre-formed and / or the lead body 110 may be flexible to facilitate bending. Figure 1 and Figure 2 In the illustrated example, the lead body 110 extends upward below the sternum 112 and outside the blood vessel in a direction substantially parallel to the sternum 112.

[0030] The distal portion 110A of the guide 108 may be located substernal, such that the distal portion 110A of the guide 108 extends substantially upward within the anterior mediastinum along the posterolateral aspect of the sternum 112. The anterior mediastinum can be considered as being laterally defined by the pleura, posteriorly by the pericardium, and anteriorly by the sternum 112. In some cases, the anterior wall of the anterior mediastinum may also be formed by the transverse thoracic muscle and one or more costal cartilages. The anterior mediastinum comprises a certain amount of loose connective tissue (such as celluloid), adipose tissue, some lymphatic vessels, lymph nodes, substernal muscle tissue (e.g., the transverse thoracic muscle), thymus, branches of the intrathoracic arteries, and the intrathoracic vein (ITV).

[0031] The lead body 110 may extend upwards outside the thoracic cavity (rather than within the thoracic cavity), for example, subcutaneously or submuscularly above the thoracic cavity / sternum 112. The lead 108 may be implanted at other locations, such as above the sternum 112, offset to the right of the sternum 112, or laterally angled from the proximal or distal end of the sternum 112. In some examples, the lead 108 may be implanted within extracardiac vessels within the thoracic cavity, such as the ITV, intercostal veins, epigastric veins, or azygos vein, hemiazygos vein, and accessory hemiazygos vein. In some examples, the orientation of the distal portion 110A of the lead 108 may differ from... Figure 1 and Figure 2 The exemplified orientations include those orthogonal to or otherwise transverse to the sternum 112 and / or below the heart 104. In such examples, the distal portion 110A of the lead 108 may be at least partially located within the anterior mediastinum. In some examples, the distal portion 110A of the lead 108 may be positioned between the heart 104 and the lungs, and within the pleural cavity.

[0032] The lead body 110 may have a generally tubular or cylindrical shape and may be defined with a diameter of approximately 3 to 9 Frenchies (Fr). However, lead bodies with a diameter less than 3 Fr or greater than 9 Fr may also be used. In another configuration, the lead body 110 may have a flat, strip-like, or paddle-like shape along at least a portion of its length, having a solid woven filament or mesh structure. In such an example, the width of the lead body 110 may be from 1 millimeter (mm) to 3.5 mm. Other lead body designs may be used without departing from the scope of this application.

[0033] The lead body 110 may be formed of a non-conductive material including silicone, polyurethane, fluoropolymers, mixtures thereof, and other suitable materials, and shaped to form one or more cavities (not shown); however, the technology is not limited to such configurations. The distal portion 110A may be manufactured to be biased in a desired configuration, or alternatively, may be manipulated by a clinician into a desired configuration. For example, the distal portion 110A may be composed of a malleable material, allowing a clinician to manipulate the distal portion 110A into a desired configuration, wherein the distal portion remains unchanged before being manipulated into a different configuration.

[0034] The lead body 110 may include a proximal portion 110B and a distal portion 110A, which include a sensing / therapeutic element 114 (e.g., electrode 114) configured to deliver medical treatment (e.g., electrical energy) to the heart 104 or to sense electrical signals from the heart 104. In some examples, instead of the heart 104 or other than the heart, the sensing / therapeutic element 114 may deliver medical treatment to another target tissue of the patient 102. The distal portion 110A may be anchored to a desired location within the patient 102, for example, substernal or subcutaneously, by suturing the distal portion 110A to the muscle, tissue, or bone of the patient 102 at, for example, at the xiphoid process entry site. In some examples, the distal portion 110A may be anchored to the patient 102 or by using rigid fangs, tips, barbs, clips, screws and / or other protruding elements or flanges, discs, compliant fangs, flaps, porous structures such as mesh elements, and metallic or non-metallic scaffolds that promote tissue growth for bonding, bioadhesive surfaces and / or any other non-puncture elements.

[0035] The distal portion 110A includes one or more sensing / therapeutic elements 114. Each element 114 may be a therapeutic delivery element and / or a sensing element. Each sensing / therapeutic element 114 may deliver medical treatment to target tissue of the patient 102. The medical treatment may include, but is not limited to, chemicals or energy (e.g., thermal energy, cryogenic energy, electrical energy). In some examples, in addition to delivering medical treatment, one or more of the sensing / therapeutic elements 114 may also sense signals (e.g., electrical signals) from the patient 102. The sensing / therapeutic element 114 may include one or more electrodes. The electrodes may be configured to deliver cardiac pacing therapy and / or anti-tachyarrhythmia (e.g., cardioversion / defibrillation) shocks to the heart 104 of the patient 102. In some examples, the distal portion 110A includes a plurality of pacing, sensing, or defibrillation electrodes spaced apart from each other along the length of the distal portion 110A. In some examples, such as Figure 1 As illustrated, the distal portion 110A includes two sensing / therapeutic elements 114. In other examples, the distal portion 110A may include one, three, or more sensing / therapeutic elements 114.

[0036] Sensing / therapeutic elements 114 may be disposed around or within the lead body 110 of the distal portion 110A, or alternatively, may be embedded within the wall of the lead body 110. In one configuration, the sensing / therapeutic element 114 may be a coil electrode formed of a conductor. The conductor may be formed of one or more conductive polymers, ceramics, metal-polymer composites, semiconductors, metals, or metal alloys, including but not limited to platinum, tantalum, titanium, niobium, zirconium, ruthenium, indium, gold, palladium, iron, zinc, silver, nickel, aluminum, molybdenum, stainless steel, MP35N, carbon, copper, polyaniline, polypyrrole, and combinations of other polymers. In another configuration, each sensing / therapeutic element in the sensing / therapeutic element 114 may be a flat strip electrode, a paddle electrode, a braided or woven electrode, a mesh electrode, a directional electrode, a patch electrode, or another type of electrode configured to sense electrical signals from the heart 104 of the patient 102 and / or deliver electrical signals to the heart.

[0037] In some examples, one or more electrodes (e.g., sensing elements of sensing / treatment element 114 and / or sensing element 106) may be configured to deliver low-voltage (e.g., relative to other treatments such as anti-tachyarrhythmic shocks) electrical pulses to heart 104 and / or sense cardiac electrical activity, such as depolarization and repolarization of heart 104. Electrodes may be electrically isolated from adjacent electrodes by an electrically insulating material. Each electrode may have its own separate conductor along lead body 110, such that a voltage can be applied to or sensed via each electrode independently of the other electrode.

[0038] The proximal portion 110B of the lead body 110 may include one or more connectors to electrically couple the lead 108 to the IMD 106. The IMD 106 may also include a connector assembly including electrical feedthroughs through which electrical connections are made between the one or more connectors of the lead 108 and electronic components included within a housing. The housing of the IMD 106 may house one or more processors, memories, transmitters, receivers, sensors, sensing circuitry, therapeutic circuitry, power supplies (capacitors and batteries), and / or other components. The components of the IMD 106 may generate and deliver electrical therapy, such as antitachycardia pacing, cardioversion or defibrillation shocks, post-shock pacing, and / or bradycardia pacing.

[0039] The IMD 106 can sense signals from the heart 104 via sensing elements and / or sensing / treatment elements 114 based on one or more sensing parameters. These one or more sensing parameters may include, but are not limited to, a sensing threshold, threshold timing, sensing sensitivity, or a sensing vector. The sensing vector instructs the IMD 106 to select which of the multiple sensing elements and / or sensing / treatment elements 114 to sense the signal. The IMD 106 can deliver medical treatment (e.g., cardiac pacing signals) to a target tissue (e.g., the heart 104) via sensing / treatment elements 114 based on one or more treatment delivery parameters. These one or more treatment delivery parameters may include, but are not limited to, treatment dose, treatment frequency, treatment duration, or treatment delivery vector. The treatment delivery vector instructs the IMD 106 to select which of the multiple sensing / treatment elements 114 to deliver the medical treatment. In some examples, where the IMD 106 is configured to deliver cardiac pacing to the heart 104, the treatment delivery parameters include pacing parameters. Pacing parameters may include, but are not limited to, pacing amplitude, pacing pulse width, pacing frequency, or pacing vector.

[0040] The sensing / therapeutic elements 114 on the lead body 110 may not be directly coupled to the heart 104. The distance between each of the sensing / therapeutic elements 114 and the heart 104 may change accordingly as the patient 102 shifts position. For example, the distance between the sensing / therapeutic elements 114 and the heart 104 may be greater when the patient 102 is supine compared to when the patient 102 is squatting. The IMD 106 may adjust sensing parameter values ​​based on the patient 102's posture to account for the distance between the sensing / therapeutic elements 114 and the heart 104, and prevent oversensing or undersensing of signals from the heart 104. The IMD 106 may adjust treatment delivery parameter values ​​(e.g., pacing parameter values) to account for the distance between the sensing / therapeutic elements 114 and the heart 104, and ensure adequate capture of cardiac tissue from the heart 104. The IMD 106 can adjust pacing parameter values ​​to deliver cardiac pacing with the minimum pacing amplitude, pacing pulse width, and / or pacing frequency required to capture cardiac tissue when the patient 102 is in this position, for example, to reduce the power consumption used to deliver cardiac pacing and / or to reduce patient discomfort caused by delivering cardiac pacing.

[0041] Figure 3 This is an example Figure 1 The following is a functional block diagram of an example configuration of components in an example IMD system 100. Figure 3As illustrated, IMD 106 includes sensor 202, sensing circuitry 204, therapeutic delivery circuitry 206, processing circuitry 208, communication circuitry 210, memory 212, and power supply 214. In some examples, IMD 106 may include more or fewer components. The described circuitry and other components may be implemented together on shared hardware components or separately as discrete but interoperable hardware or software components. The depiction of different features is intended to highlight different functional aspects and does not necessarily imply that such circuitry and other components must be implemented by separate hardware or software components. Rather, the functionality associated with one or more circuitry and components may be performed by separate hardware or software components or integrated within shared or separate hardware or software components.

[0042] Sensor 202 may include one or more components configured to sense the orientation of IMD 106. These components may include, but are not limited to, an accelerometer 203, a gyroscope, or an inertial measurement unit (IMU). Accelerometer 203 may include a 3-axis accelerometer. Sensor 202 can sense a signal corresponding to the orientation of IMD 106. Sensor 202 can send the sensed signal corresponding to the orientation of IMD 106 to processing circuitry 208. The orientation of IMD 106 within patient 102 may differ when patient 102 is in different postures. Therefore, the orientation of IMD 106 may correspond to the posture of patient 102, and the posture change of patient 102 may be determined at least in part based on the orientation change of IMD 106 detected by sensor 202.

[0043] Sensor 202 may be disposed within or outside the housing of IMD 106. Sensor 202 may be disposed in an implantable device separate from and communicating with IMD 106. In some examples, sensor 202 may be disposed within an external device worn by or coupled to the patient (e.g., a wearable band around the torso of patient 102, an external patch fixed to the torso of patient 102). Sensor 202 may sense signals from patient 102 and may include, but is not limited to, a glucose monitor, electrodes, a pulse oximeter, a microphone, an optical sensor, etc. Sensor 202 may sense signals corresponding to one or more physiological parameters of patient 102, including but not limited to electrocardiogram (ECG) signals from heart 104, blood pressure level of patient 102, oxygen saturation level of patient 102, electrical signals in the nerves of patient 102, brain activity of patient 102, and / or glucose level of patient 102.

[0044] Sensing circuitry 204 may be electrically coupled to some or all of the sensors 202 and / or sensing / therapeutic elements 114. Sensing circuitry 204 may sense signals (e.g., electrical signals) corresponding to one or more physiological parameters of the patient 102 via one or more sensors 202 and / or one or more sensing / therapeutic elements 114 (e.g., via one or more electrodes of sensing / therapeutic element 114). Sensing circuitry 204 may process the acquired signals to determine physiological parameter values. Sensing circuitry 204 may send the acquired signals to processing circuitry 208, which may determine physiological parameter values ​​at least in part based on the acquired signals.

[0045] The components of sensing circuit 204 can be analog, digital, or a combination thereof. Sensing circuit 204 may include, for example, one or more sensing amplifiers, filters, rectifiers, threshold detectors, or analog-to-digital converters (ADCs). Sensing circuit 204 can convert the sensed signal into a digital form and provide the digital signal to processing circuit 208 for processing or analysis. For example, sensing circuit 204 can amplify the signal from the sensing electrode and convert the amplified signal into a multi-bit digital signal via an ADC. In some examples, where IMD 106 is configured to sense cardiac signals from heart 104, sensing circuit 204 can compare the processed signal with a threshold to detect the presence of atrial or ventricular depolarization (e.g., P wave or R wave) and indicate the presence of atrial depolarization (e.g., P wave) or ventricular depolarization (e.g., R wave) to processing circuit 208.

[0046] Processing circuitry 208 can process signals from sensing circuitry 204 to monitor the electrical activity or other physiological activity of the heart 104 of patient 102. Processing circuitry 208 can receive signals from sensor 202 via sensing circuitry 204 and can process the signals received from sensor 202 to determine the posture of patient 102. In some examples, IMD 106 may be implanted in patient 102 such that the posture of patient 102 (e.g., standing, supine) may not be perfectly aligned with the sensing axis of sensor 202 (e.g., the sensing axis of accelerometer 203). For example, the outer surface of IMD 106 may not be parallel to the frontal axis or another reference axis of patient 102. In such examples, processing circuitry 208 can receive user input (e.g., from a user, from a clinician) to correspond one or more sensed orientations to one or more postures (e.g., corresponding a first orientation to a standing posture, and a second orientation to a supine posture). Processing circuitry 208 can determine the posture of patient 102 based at least in part on changes detected from one or more stored orientations. In some examples, patient 102 may not be in a specific posture, but rather in a general sense of it. For example, patient 102 may be standing but tilted in one direction. In another example, patient 102 may be supine but reclining on a sloping surface. Processing circuitry 208 may assign an orientation range (e.g., an angular range detected by sensor 202) to each posture state and may determine the current posture of patient 102 based at least in part on the overlap between the sensed orientation (e.g., sensed angle) from sensor 202 and the orientation range of a particular posture. Processing circuitry 208 may store various posture states and their corresponding orientations and / or orientation ranges in memory 212.

[0047] Processing circuitry 208 may store signals acquired by sensing circuitry 204, as well as any data derived from the sensed signals (e.g., generated electrogram (EGM) waveforms, labeled channel data, blood oxygen saturation, blood glucose levels, brain activity, blood pressure levels, neural electrical activity, and / or the posture of subject 102), in memory 212. Processing circuitry 208 may analyze EGM waveforms and / or labeled channel data to detect arrhythmias (e.g., bradycardia or tachycardia). In other examples, processing circuitry 208 may determine the occurrence of a medical condition by comparing at least the sensed signals with threshold conditions stored in memory 212. In response to the detection of a medical condition (e.g., arrhythmia), processing circuitry 208 may control treatment delivery circuitry 206 to deliver medical treatment to target tissue of patient 102 via one or more of the sensing / treatment elements 114. For example, in response to the detection of a cardiac event, the processing circuit 208 may control the treatment delivery circuit 206 to deliver the desired treatment to treat the cardiac event, such as a defibrillation shock, a cardioversion shock, or cardiac pacing (e.g., antitachycardia pacing (ATP), post-shock pacing, or bradycardia pacing).

[0048] Processing circuitry 208 may adjust one or more sensing parameter values ​​based at least in part on the posture of patient 102. The sensing parameter values ​​may correspond to one or more sensing parameters. These one or more sensing parameters may include, but are not limited to, a sensing threshold, threshold timing, sensing sensitivity, or sensing vector. Processing circuitry 208 may control sensing circuitry 204 to sense signals from patient 102 along one or more sensing vectors. The sensing threshold may correspond to a threshold amplitude of one or more electrical signals of heart 104 indicating the onset of a cardiac event (e.g., arrhythmia). The threshold timing may correspond to a threshold timing between adjacent electrical signals and / or portions of electrical signals (e.g., portions of the QRS complex of the electrical signal of heart 104) indicating the onset of a cardiac event. The processing circuit 208 may adjust one or more sensing parameter values ​​based on the posture of the patient 102 to reduce oversensing or undersensing of signals by the sensing circuit 204 due to changes in distance between the target tissue (e.g., heart 104) and the IMD 106 (e.g., the housing of the IMD 106, the sensing element of the IMD 106, and the sensing / treatment element 114 of the system 100). For example, the processing circuit 208 may adjust one or more sensing parameter values ​​to reduce oversensing or undersensing of the sensing circuit 204.

[0049] Processing circuit 208 can store sensing parameter values ​​corresponding to different posture states in memory 212. Posture states may include standing, sitting, squatting, supine, etc. Different posture states may have the same or different sensing parameter values. Processing circuit 208 can receive sensing parameter values ​​and accompanying data from an external device (e.g., from an external programmer operated by a clinician) via communication circuit 210. For each sensing parameter value, the data may indicate one or more corresponding postures. Sensing parameter values ​​can be determined based on sensing signals from patient 102 when patient 102 is in different postures. In some examples, sensing parameter values ​​are determined at least in part based on sensing signals from multiple other patients who are physiologically similar to patient 102 (e.g., have the same or similar height, weight, age, sex, and / or body type as patient 102). Processing circuit 208 can receive default sensing parameter values ​​and accompanying data from an external device via communication circuit 210. Processing circuit 208 can store the received sensing parameter values ​​and accompanying data in determiner 212.

[0050] When processing circuitry 208 determines the posture of patient 102 or a change in the posture of patient 102, processing circuitry 208 may retrieve sensing parameter values ​​corresponding to the current posture of patient 102 from memory 212. Processing circuitry 208 may control sensing circuitry 204 to sense signals from patient 102 based at least in part on the retrieved sensing parameter values. In some examples, patient 102 may be in a posture not stored in memory 212. In such examples, processing circuitry 208 may retrieve default sensing parameter values ​​from memory 212 and control sensing circuitry 204 to sense signals from patient 102 based at least in part on the retrieved default sensing parameter values. The default sensing parameter values ​​may be independent of the posture of patient 102.

[0051] Therapeutic delivery circuit 206 is configured to generate a medical treatment and deliver it to a target tissue of patient 102. For example, therapeutic delivery circuit 206 is configured to deliver electrical therapy to heart 104. In some examples, therapeutic delivery circuit 208 is configured to deliver medical treatment to other target tissues within patient 102. Medical treatment may include, but is not limited to, delivering chemicals, electrical energy, thermal energy, radio frequency (RF) energy, microwave energy, or cryogenic energy to target tissues.

[0052] The treatment delivery circuit 206 may include one or more pulse generators, capacitors, and / or other components capable of generating and / or storing energy for delivery as a medical treatment (e.g., pacing therapy, defibrillation therapy, cardioversion therapy, cardiac resynchronization therapy, other treatments, or combinations thereof). In some cases, the treatment delivery circuit 206 may include a first set of components configured to provide pacing therapy and a second set of components configured to provide defibrillation therapy. In some cases, the treatment delivery circuit 206 may utilize the same set of components to provide both pacing therapy and defibrillation therapy. In still other cases, the treatment delivery circuit 206 may share some of the defibrillation therapy components and the pacing therapy components, while using other components only for defibrillation or pacing. The processing circuit 208 may control the treatment delivery circuit 206 to deliver the generated treatment to the heart 104 via one or more combinations of sensing / treatment elements 114. Although Figure 3 Not shown, but IMD 106 may include a switching circuit that can be configured by processing circuitry 208 to control which of the sensing / treatment elements 114 is connected to treatment delivery circuitry 206 and sensing circuitry 204.

[0053] The processing circuit 208 can adjust treatment delivery parameter values ​​(e.g., pacing parameter values) based at least in part on the posture of the patient 102. The pacing parameter values ​​may correspond to one or more pacing parameters. Pacing parameters may include, but are not limited to, pacing amplitude, pacing pulse width, pacing frequency; or pacing vector. The processing circuit 208 can control the treatment delivery circuit 206 to deliver cardiac pacing to the heart 104 to capture cardiac tissue without unnecessarily consuming power and / or causing patient discomfort.

[0054] Processing circuit 208 can determine treatment delivery parameter values ​​for each postural state by performing a treatment delivery management test. Processing circuit 208 can control communication circuit 210 to output alarms to one or more external devices. Alarms can indicate that IMD 106 is currently performing or will perform a treatment delivery management test, and can indicate the time and / or duration of the treatment delivery management test. Alarms can notify patient 102 of potential discomfort caused by the treatment delivery management test and can provide patient 102 with information on activities to avoid during the treatment delivery management test (e.g., operating a motor vehicle). Processing circuit 208 can control communication circuit 210 to output alarms for at least a period of time (e.g., 30 minutes, 1 hour, 24 hours) prior to the start of the treatment delivery management test. Processing circuit 208 can delay or cancel the treatment delivery management test in response to user input received via communication circuit 210.

[0055] During treatment delivery management testing, processing circuitry 208 can generate one or more test treatment delivery parameter values ​​for each treatment delivery parameter. Processing circuitry 208 can control treatment delivery circuitry 206 to deliver medical treatment to target tissue based on different combinations of test treatment delivery parameter values, and select test treatment delivery parameter values ​​sufficient to effectively deliver medical treatment to the target tissue. For each posture, the determined treatment delivery parameter values ​​may correspond to a minimum medical treatment duration, frequency, and / or magnitude value that corresponds to the delivered medical treatment capable of achieving a threshold level of efficacy (e.g., 90% chance of efficacy, 95% chance of efficacy). For example, processing circuitry 208 may determine, for each posture, a minimum pacing amplitude, pacing pulse width, and / or pacing pulse frequency sufficient to capture cardiac tissue of heart 104. When determining treatment delivery parameter values, processing circuit 208 can adjust the selected test treatment delivery parameter values ​​such that the determined treatment delivery parameter values ​​are separated from the minimum required parameter values ​​(e.g., test treatment delivery parameter values) by at least a threshold margin (e.g., at least 5%, at least 10%), for example, to ensure the efficacy of medical treatment delivered based on the determined treatment delivery parameter values. Processing circuit 208 can store the determined treatment delivery parameter values ​​and corresponding data in memory 212. For each stored treatment delivery parameter value, the corresponding data can indicate the corresponding posture and timestamp during treatment delivery management testing.

[0056] Processing circuitry 208 may periodically (e.g., every 24 hours, every 2 days, every 3 days, weekly) perform treatment delivery management tests for each postural state, for example, to take into account changes in the physiological and / or disease state of patient 102. For each postural state, processing circuitry 208 may automatically perform a treatment delivery management test based on a determination by processing circuitry 208 that a test has not been performed within a threshold time period, for example, in the past 24 hours. Processing circuitry 208 may determine whether a treatment delivery management test has already been performed within the threshold time period when it is determined that patient 102 is in the corresponding posture. When patient 102 adopts the corresponding posture, for example, in a walking environment, processing circuitry 208 may perform a treatment delivery management test.

[0057] In some examples, processing circuitry 208 determines the posture of patient 102 based on signals received from sensing circuitry 204 and retrieves treatment delivery parameter values ​​corresponding to the determined posture from memory 212. Processing circuitry 208 may determine whether the retrieved treatment delivery parameter value was determined within a threshold time period from the current time. If the retrieved treatment delivery parameter value was determined within the threshold time period, processing circuitry 208 may control treatment delivery circuitry 206 to deliver medical treatment to patient 102 based on the retrieved treatment delivery parameter value. If the retrieved treatment delivery parameter value was not determined within the threshold time period, processing circuitry 208 may perform a treatment delivery management test to determine updated treatment delivery parameter values ​​and control treatment delivery circuitry 206 to deliver medical treatment to patient 102 based on the updated treatment delivery parameter values. Processing circuitry 208 may cause treatment delivery circuitry 206 to deliver medical treatment to patient 102 based on outdated treatment delivery parameter values ​​or based on default treatment delivery parameter values ​​until the treatment delivery management test is completed or if there is insufficient time to complete the treatment delivery management test.

[0058] The communication circuit 210 may include any suitable hardware, firmware, software, or any combination thereof for communicating with another device, such as a clinician programmer, a patient monitoring device, etc. For example, the communication circuit 210 may include appropriate modulation, demodulation, frequency conversion, filtering, and amplifier components for transmitting and receiving data via an antenna. The communication circuit 210 may communicate with another implantable device and / or external device of the system 100 via one or more wireless communication standards or protocols, including but not limited to 3G, 4G, 5G, Wi-Fi (e.g., 802.11 or 802.15 ZigBee), and Bluetooth. ® or Bluetooth ® Low power consumption (BLE).

[0059] The various components of IMD 106 may include any one or more processors, controllers, digital signal processors (DSPs), application-specific integrated circuits (ASICs), field-programmable gate arrays (FPGAs), or equivalent discrete or integrated circuits, including analog, digital, or logic circuits. Processing circuitry 208 may include fixed-function circuitry and / or programmable processing circuitry. Functions attributable to processing circuitry 208 herein may be embodied in software, firmware, hardware, or any combination thereof.

[0060] Memory 212 may include computer-readable instructions that, when executed by processing circuitry 208 or other components of IMD 106, cause one or more components of IMD 106 to perform various functions categorized under those components in this disclosure. Memory 212 may include any volatile, non-volatile, magnetic, optical, or electrical medium, such as random access memory (RAM), read-only memory (ROM), non-volatile RAM (NVRAM), static non-volatile RAM (SRAM), electrically erasable programmable ROM (EEPROM), flash memory, or any other non-volatile computer-readable storage medium.

[0061] Figure 4 This is a flowchart illustrating an example process for adjusting the sensing parameter values ​​of an example IMD system 100 based on changes in patient posture. Although Figure 4 The example process in the text is mainly described by referring to sensing cardiac signals from the heart 104 of patient 102, but... Figure 4 The example process illustrated herein can be performed by other example IMD systems configured to sense other signals from target tissue of patient 102, as described herein. Although Figure 4 The example process illustrated herein is primarily described as being executed by IMD 106 (e.g., by processing circuitry 208 of IMD 106), but the example process may be executed by one or more other computing devices within system 100 (including one or more external computing devices configured to communicate with IMD 106).

[0062] System 100 can determine sensing parameter values ​​(302) for each of two or more different posture states. Posture states may include, but are not limited to, standing, sitting, squatting, supine, etc. In some examples, posture states may be defined based on different regions measured by a sphere-based 3-axis accelerometer. The distance between the target tissue within patient 102 and the IMD 106 and / or components coupled to the IMD 106 of system 100 may vary in different posture states. For example, the distance may be greater when patient 102 is in a supine posture state compared to a squatting posture state. System 100 (e.g., processing circuitry 208 of IMD 106) can determine sensing parameter values ​​for one or more sensing parameters for each posture state. Sensing parameters may include sensing thresholds, threshold timing, sensing sensitivity, or sensing vectors. For each posture state, the determined sensing parameter values ​​may take into account the distance between the IMD 106 (e.g., between sensor 202 of system 100 and / or sensing / treatment element 114) and the target tissue (e.g., the heart 104 of patient 102). For example, when the distance increases due to a change in posture, system 100 can adjust the sensing parameter values ​​to increase sensing sensitivity, and vice versa. The sensing parameter values ​​may be the same or different between different posture states. In some examples, system 100 receives sensing parameter values ​​corresponding to each of the different posture states from one or more external devices (e.g., from a clinician programmer, a patient monitoring device, etc.). A clinician can input the sensing parameter values ​​into system 100 via these one or more external devices. The received sensing parameter values ​​can be stored in the memory of system 100 (e.g., in memory 212 of IMD 106). For each stored sensing parameter value, system 100 can assign one or more corresponding posture states.

[0063] In some examples, the sensing parameter values ​​determined for each posture state may include one or more sensing templates. Each sensing template may include, but is not limited to, specific sensing parameter values ​​for the sensing template. Each sensing template may correspond to the identification of one or more medical conditions experienced by patient 102. Each sensing template may include one or more sensing criteria for the corresponding medical condition. Sensing criteria may include, but are not limited to, threshold behaviors of sensing signals that satisfy specific sensing parameter values ​​stored in the sensing template. For each posture, system 100 may store two or more different sensing templates, wherein each sensing template may correspond to the identification of a different medical condition.

[0064] In some examples, the sensing template includes one or more EGM morphology identification templates. System 100 may apply the EGM morphology identification templates to identify cardiac medical conditions experienced by patient 102 based on a comparison between the morphology of cardiac signals and EGM signals, such as those stored in the EGM morphology identification templates. Example EGM morphology identification templates may include instructions for applying one or more algorithms, including but not limited to wavelet EGM identification algorithms.

[0065] System 100 may receive sensing signals (304) from sensor 202. Sensor 202 may include accelerometer 203 and / or other sensors configured to determine the position and / or orientation of IMD 106 and / or sensing / therapeutic element 114 of system 100. Other sensors may include, but are not limited to, accelerometers, gyroscopes, or IMUs. The sensing signals may indicate the position and / or orientation of sensor 202, and by extension, indicate the position and / or orientation of IMD 106 and / or sensing / therapeutic element 114. The sensing signals may indicate changes in the position and / or orientation of sensor 202 over time, and by extension, indicate changes in the position and / or orientation of IMD 106 and / or sensing / therapeutic element 114 over time. In some examples, sensor 202 may be disposed within another IMD of system 100 and / or may be disposed on an external device or wearable device of system 100. For example, sensor 202 may be disposed on a strap worn around the torso of patient 102. In such an example, sensor 202 can communicate wirelessly with IMD 106 and can send sensing signals to IMD 106 (e.g., to processing circuitry 208 of IMD 106).

[0066] System 100 can determine the posture of patient 102 (306) at least in part based on received sensing signals. System 100 (e.g., processing circuitry 208 of IMD 106 of system 100) can determine the position, orientation, positional changes, and / or orientation changes of IMD 106 and / or sensing / therapeutic element 114 based on the sensing signals. System 100 can compare the determined position and / or orientation of IMD 106 and / or sensing / therapeutic element 114 with a range of stored position and / or orientation for posture states, and determine the current posture of patient 102 based on the overlap between the determined position and / or orientation and the range of stored position and / or orientation for a particular posture state. For example, system 100 can determine that patient 102 is standing based on the overlap between the determined orientation of IMD 106 and the range of orientation stored in system 100 for standing posture states. Since the body position of patient 102 may change in a particular posture, each posture state may correspond to a range of positions and / or orientations. For example, patient 102 may lean in one direction while standing.

[0067] The IMD 106 can be implanted in the patient 102 at a specific location and orientation, such that the IMD 106 and / or sensing / therapeutic element 114 are offset from one or more anatomical planes of the patient 102. For example, the IMD 106 can be offset from the frontal plane of the patient 102, such that the outer surface of the IMD 106 is not parallel to the frontal plane of the patient 102. In such examples, a clinician can input the patient 102's postural state into the system 100 via one or more external devices during and / or after the implantation of the IMD 106. The system 100 can associate the location and / or orientation of the IMD 106 at a specific time with the postural state received by the system 100 during that specific time period. For example, the system 100 can associate the first orientation of the IMD 106 with a standing posture based on determining that the IMD 106 is in a first orientation during a first time period and based on receiving information from one or more external devices that the patient 102 is standing during the first time period. System 100 may determine the current posture of patient 102 based at least in part on the deviation of the determined position and / or orientation from one or more orientations associated with a known posture stored in system 100 and / or the overlap between the determined position and / or orientation and the position and / or orientation associated with a known posture.

[0068] System 100 may receive the range of position and / or orientation for each posture state, or may determine the range of position and / or orientation based on a specific posture and / or orientation associated with each posture state. For example, system 100 may determine the possible orientation range of a standing posture as all possible orientations of IMD 106 and / or sensing / therapeutic element 114 within a threshold tolerance range of a first orientation (e.g., all orientations of the angular position of IMD 106 within a threshold tolerance range of a first angular position of the first orientation). The threshold tolerance range may be as high as about ±10%. In some examples, the threshold tolerance range is as high as about ±5%. The threshold tolerance range may be consistent across two or more different posture states, or may be unique for each posture state.

[0069] System 100 may determine whether a sense parameter value corresponding to a determined posture is stored in IMD 106 (308). System 100 may determine whether a match exists between the determined posture and a stored posture. System 100 may determine whether any sense parameter value corresponding to the posture is stored based on the match between the determined posture and the stored posture. For example, when system 100 determines that patient 102 is standing, system 100 may determine whether any of the stored sense parameter values ​​corresponds to the standing posture state. In response to determining that a sense parameter value corresponding to the determined posture is not stored in IMD 106 (the "No" branch of 308), system 100 may adjust the sense parameter to a default sense parameter value (310A). The default sense parameter value may be stored in system 100 (e.g., in system 100's memory 212) and may be independent of patient 102's posture. The default sense parameter value may include a value corresponding to one or more of the sense parameters.

[0070] In response to determining that a sense parameter value corresponding to the determined posture is stored in IMD 106 (the "Yes" branch of 308), system 100 may adjust the sense parameters to the sense parameter value corresponding to the posture (310B). System 100 may retrieve the stored sense parameter value corresponding to the determined posture (e.g., from memory 212). For example, in response to determining that patient 102 is standing upright, system 100 may retrieve the stored sense parameter value corresponding to the standing posture state. System 100 may then adjust the sense parameters to retrieve the sense parameter value.

[0071] In some examples, patient 102 may transition to a specific posture simply by changing positions or within a short, instantaneous time period (e.g., less than one minute). In such examples, system 100 may determine the amount of time patient 102 has been in the determined posture, and if patient 102 has been in the determined posture for at least a minimum threshold time period, the sensing parameters may be adjusted. The minimum threshold time period may be up to five minutes, for example, up to one minute. System 100 may adjust the sensing parameters to a sensing parameter value corresponding to the posture in response to the minimum threshold time period being met (310B).

[0072] In some examples, the patient 102's posture may change continuously (e.g., the patient 102 may be in each of multiple postures within a transient time period). For example, the patient 102 may transition from a first posture (e.g., standing) to alternating between a second posture (e.g., prone) and a third posture (e.g., squatting). In such examples, the patient 102 may be neither in the second nor the third posture for a sufficient amount of time to satisfy a minimum threshold time period, but no longer in the first posture. In some examples, the system 100 may determine the time period between the current time and the determined posture change based on the determined posture change, and the system 100 may adjust the sensing parameters to default sensing parameter values ​​(310A) in response to determining that the time period between the current time and the determined posture change is greater than or equal to a maximum threshold time period. The maximum threshold time period may be up to five minutes, for example, up to one minute.

[0073] System 100 may determine whether a maximum threshold time period has not been met based on the determination that patient 102 has been in a determined posture for at least a minimum threshold time period. If system 100 determines that patient 102 is in a specific posture (e.g., a second or third posture) after a determined posture change from a first posture, system 100 may be unsure whether the maximum threshold time period has been met. If system 100 determines that there has been a posture change from a first posture and patient 102 has not maintained a specific posture after the posture change (e.g., patient 102 alternates between a second and a third posture after the posture change), system 100 may determine whether the maximum threshold time period has been met.

[0074] When patient 102 is in this posture, system 100 can sense electrical signals from patient 102 based on adjusted sensing parameter values ​​(312). IMD 106 of system 100 can sense electrical signals from target tissue (e.g., from heart 104) of patient 102 based on adjusted sensing parameter values. For example, processing circuitry 208 of IMD 106 can control sensing circuitry 204 to sense electrical signals from heart 104 via sensor 202, sensing elements, and / or treatment delivery elements, and based on adjusted sensing parameter values. For example, processing circuitry 208 can control sensing circuitry 204 to sense electrical signals along a sensing vector indicated in the adjusted sensing parameter values. In some examples, processing circuitry 208 can identify the onset of one or more medical conditions at least in part based on the sensed electrical signals satisfying a sensing threshold and / or sensing timing, wherein the sensing threshold and / or sensing timing are indicated by adjusted sensing parameter values.

[0075] In some examples, where system 100 stores sensing templates for various postures, system 100 can determine whether one or more stored sensing templates for the determined posture have been generated, validated, or updated within a threshold time period prior to the current time. System 100 can validate the sensing templates based on clinician input and / or information received from one or more external devices and / or systems, confirming the determination made by system 100 based on the application of the sensing templates. System 100 can update the sensing templates by adjusting one or more sensing parameter values ​​and / or sensing criteria stored in the sensing templates, for example, in response to changes in the sensing signal over time or changes in the patient's physiological and / or disease state. If the sensing templates have not been generated, validated, or updated within the threshold time period, system 100 can update the sensing templates before applying them to the sensed electrical signals. In some examples, where system 100 does not have sufficient time to update the sensing templates, system 100 can apply outdated and / or default sensing templates to the sensed electrical signals; the threshold time period can be up to 24 hours, 1 week, or 1 month.

[0076] When the patient 102 is in the same posture, the system 100 may continue to sense electrical signals from the patient 102 based on adjusted sensing parameter values ​​(e.g., continuously and periodically). The system 100 may continue to receive sensing signals (304) from the sensors of the IMD 106 and perform steps 304 to 312 to adjust the sensing parameter values ​​as the posture of the patient 102 changes over time.

[0077] Figure 5 This is a flowchart illustrating an example process for adjusting the pacing parameter values ​​of an example IMD system 100 based on changes in patient posture. Although Figure 5 The example procedure described in the text is primarily based on the delivery of cardiac pacing therapy to the heart 104 of patient 102, but... Figure 5 The example process illustrated herein can be performed by other example IMD systems to deliver additional medical treatments to the target tissue of patient 102, as described herein. For example, system 100 may implement... Figure 5 The procedures illustrated herein are used to perform treatment delivery management tests and determine treatment delivery parameter values, for example, as previously described herein. Although Figure 5 The example process illustrated herein is primarily described as being executed by IMD 106 (e.g., by processing circuitry 208 of IMD 106), but the example process may be executed by one or more other computing devices within system 100 (including one or more external computing devices).

[0078] System 100 can generate pacing parameter values ​​(402) for each of two or more postural states via a pacing management test. The pacing parameter values ​​may correspond to one or more pacing parameters, including but not limited to pacing amplitude, pacing pulse width, pacing voltage, pacing frequency, or pacing vector. During the pacing management test, system 100 can determine, for each postural state, the minimum pacing parameter values ​​required to capture cardiac tissue from the heart 104 of patient 102. For example, system 100 can determine the minimum pacing amplitude and / or pacing pulse width required to capture cardiac tissue when patient 102 is standing, when patient 102 is sitting, etc. System 100 can select multiple test pacing parameter values ​​for each of one or more pacing parameters. System 100 can deliver various electrical therapies to heart 104, each defined by a different combination of test pacing parameter values. The electrical therapies may include, but are not limited to, cardiac pacing therapy or cardiac shock therapy. System 100 iteratively selects test pacing parameter values ​​and delivers electrical therapy to heart 104 based on the selected test pacing parameter values ​​until system 100 determines the minimum pacing parameter value corresponding to the electrical therapy configured to deliver the minimum amount of electrical energy to capture cardiac tissue. Pacing management testing can be performed by processing circuitry 208 of IMD 106.

[0079] In some examples, a clinician may perform a pacing management test and input the determined pacing parameter values ​​into system 100 (e.g., into IMD 106 of system 100) via a clinician programmer, patient monitoring device, etc. In some examples, system 100 (e.g., IMD 106 of system 100) may perform the pacing management test automatically, for example, after a threshold time period has elapsed since a previous test, or after a change in one or more physiological signals of the patient is detected. System 100 may notify patient 102 of the test and instruct patient 102 to adopt various postures. Once patient 102 has adopted each posture, system 100 may perform a pacing management test for that posture. System 100 may perform the pacing management test until system 100 has determined the pacing parameter values ​​for one or more posture states stored in system 100. In some examples, system 100 may perform the pacing management test when patient 102 is in a walking environment, for example, whenever patient 102 adopts a corresponding posture during normal daily activities.

[0080] Once system 100 determines the pacing parameter values, it can store them in its memory (e.g., in memory 212). The stored pacing parameter values ​​may not be changed; for example, they may be the minimum pacing parameter values ​​determined by system 100 during pacing management testing. In some examples, system 100 may adjust the minimum pacing parameter values ​​such that each adjusted pacing parameter value is at least a threshold margin larger than the corresponding minimum pacing parameter value. For example, for each posture, system 100 may determine adjusted pacing amplitude, adjusted pacing pulse width, adjusted pacing voltage, and / or adjusted pacing frequency that are at least a threshold margin larger than the minimum pacing amplitude, minimum pacing pulse width, minimum pacing voltage, and / or minimum pacing frequency, respectively. The threshold margin may be a percentage of the minimum pacing parameter value (e.g., 5%, 10%, 15%). The threshold margin may be consistent for two or more pacing parameters, or it may be unique for each pacing parameter. Then, the system 100 can store the adjusted minimum pacing parameters in the memory of the system 100.

[0081] System 100 may store corresponding data in memory for each stored pacing parameter value. For each stored pacing parameter value, the corresponding data may indicate one or more posture states associated with that value and a timestamp corresponding to when System 100 determined the corresponding pacing parameter value. The time when System 100 determines the corresponding pacing parameter value may be during the time when System 100 performs a pacing management test, during which time System 100 determines the corresponding pacing parameter value.

[0082] System 100 can receive sensing signals from sensor 202 (404). System 100 can determine the posture of patient 102 at least in part based on the sensing signals (406). The system can receive sensing signals from sensor 202 and, respectively, determine the posture of patient 102 based on the sensing signals. Figure 4 The example procedures illustrated in steps 304 and 306 and the determination of the patient 102’s posture as described in more detail earlier herein.

[0083] System 100 can determine whether a pacing parameter value corresponding to the determined posture is stored in system 100 (408). For example, when system 100 determines that patient 102 is standing, system 100 can determine whether any of the stored pacing parameter values ​​corresponds to the standing posture.

[0084] In response to determining that the pacing parameter value corresponding to the posture is not stored in system 100 (the "No" branch of 408), system 100 may determine an updated pacing parameter value for the posture (412A). System 100 may determine the updated pacing parameter value for the posture by performing a pacing management test while patient 102 is in the posture. Once system 100 determines the updated pacing parameter value, system 100 may store the updated pacing parameter value and the corresponding data in system 100's memory.

[0085] In response to the determination that a pacing parameter value corresponding to a posture is stored in system 100 (the "Yes" branch of 408), system 100 may determine whether the pacing parameter value was generated within a threshold time period from the current time (e.g., via a pacing management test) (410). System 100 may retrieve a timestamp corresponding to the retrieved pacing parameter value and compare it to the current time (e.g., as determined by system 100, as received by system 100) to determine whether the retrieved pacing parameter value was generated within a threshold time period from the current time. The threshold time period may depend on the type of medical treatment delivered to patient 102 and / or the severity of the medical condition to be addressed by the medical treatment. The threshold time period may be up to approximately 24 hours. In some examples, the threshold time period may be up to approximately 1 week. Each posture state can be analyzed independently. For example, determining that no pacing parameter value was generated for a standing posture state within a threshold time period from the current time does not affect determining whether a pacing parameter value was generated for a supine posture state within a threshold time period from the current time, and vice versa.

[0086] In response to determining that the pacing parameter value was not generated within a threshold time period from the current time (the "No" branch of 410), system 100 may determine an updated pacing parameter value for the posture (412A). System 100 may determine the updated pacing parameter value for the posture by performing a pacing management test while patient 102 is in that posture. Once system 100 determines the updated pacing parameter value, system 100 may store the updated pacing parameter value and the corresponding data in system 100's memory.

[0087] In response to determining that the pacing parameter value was generated within a threshold time period from the current time (the "Yes" branch of 410), system 100 may retrieve the pacing parameter value for that posture (412B). System 100 may retrieve the pacing parameter value stored in the memory of system 100 (e.g., stored in memory 212).

[0088] System 100 can deliver electrical therapy (414) to patient 102 based on pacing parameter values. The electrical therapy may include, but is not limited to, cardiac pacing therapy or cardiac shock therapy. In some examples, processing circuitry 208 of IMD 106 can control treatment delivery circuitry 206 to deliver electrical therapy defined by retrieved pacing parameter values. For example, processing circuitry 208 can adjust existing pacing parameter values ​​to retrieved pacing parameter values ​​and control treatment delivery circuitry 206 to deliver electrical therapy based on retrieved pacing parameter values ​​(e.g., based on retrieved pacing amplitude, pacing pulse width, pacing voltage, pacing frequency, and / or pacing vector). Treatment delivery circuitry 206 can generate electrical energy according to the retrieved pacing parameter values ​​and deliver the electrical energy to the tissue of patient 102 via one or more of the sensing / treatment elements 114. The electrical energy can travel from one or more sensing / treatment elements 114 through the tissue of patient 102 and into the cardiac tissue of heart 104.

[0089] In some examples, system 100 may not have sufficient time to generate updated pacing parameter values ​​via the application of a pacing management test. In such examples, system 100 may retrieve and apply previous or default pacing parameter values ​​for the posture to deliver electrical therapy to patient 102. Previous pacing parameters may include pacing parameter values ​​generated by system 100 prior to the current time for at least a threshold time period (e.g., at least 24 hours). Default pacing parameter values ​​may be independent of patient 102's posture. System 100 may deliver electrical therapy to patient 102 as needed based on previous or default pacing parameters until system 100 completes the pacing management test for that posture. After the pacing management test is completed, system 100 may apply updated pacing parameter values ​​and deliver further electrical therapy based on the updated pacing parameter values.

[0090] In some examples, such as those previously discussed in this article... Figure 4 The patient 102 may change to a particular posture only between postures or within a short period of time (e.g., less than one minute). In such an example, the system 100 may retrieve pacing parameter values ​​for that posture in response to determining that a minimum threshold time period is met (412B).

[0091] In some examples, such as those previously discussed in this article... Figure 4 The patient 102's posture can change continuously (e.g., the patient 102 is in each of multiple postures within a transient time period). In such an example, the system 100 may adjust the pacing parameters to default pacing parameter values ​​in response to determining that the time interval between the current time and the determined posture change is greater than or equal to a maximum threshold time interval. The system 100 may also adjust the pacing parameters to default pacing parameter values ​​in accordance with the previous provisions of this document. Figure 4 The example process described above determines whether the minimum or maximum threshold time period has been met.

[0092] System 100 can iteratively execute steps 404 to 414 to deliver electrical therapy to patient 102. System 100 can continue to receive sensing signals (404) from sensor 202 of IMD 106 and determine the posture of patient 102 (406) at least in part based on the sensing signals. System 100 can determine changes in the posture of patient 102 and can implement steps 406 to 414 to adjust pacing parameter values ​​based on changes in the posture of patient 102.

[0093] Figure 6 This is a flowchart illustrating an example process of adjusting the sensing parameter values ​​and pacing parameter values ​​of an example IMD system 100 based on changes in patient posture. Although Figure 6 The example process illustrated herein is primarily described as being executed by IMD 106 (e.g., by processing circuitry 208 of IMD 106), but the example process may be executed by one or more other computing devices within system 100 (including one or more external computing devices).

[0094] System 100 may receive sensing signals from sensor 202 (502) and determine the posture of patient 102 at least in part based on the sensing signals (504). System 100 may receive sensing signals from sensor 202 and, according to one or more example processes previously described herein (e.g., as per [reference to...]), [the system may determine the posture of patient 102]. Figure 3 and Figure 4 The posture of patient 102 is determined by the above.

[0095] System 100 can sense electrical signals from patient 102 based on sensing parameter values ​​corresponding to the posture of patient 102 (506). System 100 can determine, adjust, or select sensing parameter values ​​for the posture at least in part based on the posture of patient 102. System 100 can sense electrical signals from patient 102 based on sensing parameter values ​​of the posture. For example, processing circuitry 208 of IMD 106 of system 100 can control sensing circuitry 204 to sense electrical signals from target tissue (e.g., heart 104) of patient 102 based on sensing parameter values ​​corresponding to the posture. System 100 can sense electrical signals from target tissue (e.g., heart 104) of patient 102 according to one or more example processes described herein (e.g., as per [reference to...]). Figure 3 and Figure 4 The aforementioned method is used to determine, adjust, or select sensing parameter values ​​for the posture of patient 102.

[0096] System 100 can determine whether a sensed electrical signal satisfies one or more threshold conditions (508) for delivering medical treatment. System 100 can analyze the sensed electrical signal to identify one or more physiological signals, including but not limited to cardiac signals. For example, system 100 can convert the sensed electrical signal into an EGM waveform and / or labeled channel data. System 100 can analyze the physiological signal (e.g., EGM waveform and / or labeled channel data) and determine whether the physiological signal satisfies one or more threshold conditions indicating the onset and / or occurrence of a cardiac condition such as arrhythmia (e.g., bradycardia or tachycardia). Threshold conditions may include, but are not limited to, threshold timing of one or more phases of the cardiac signal (e.g., one or more portions of the EGM waveform or QRS complex), threshold amplitude of one or more phases of the cardiac signal, or one or more other threshold conditions corresponding to the onset or occurrence of a cardiac condition.

[0097] Based on the determination that the sensed electrical signal does not meet one or more threshold conditions (the "No" branch of 508), system 100 may continue to receive the sensed signal from sensor 202 of IMD 106 (502), and sense the electrical signal from patient 102 according to steps 504 to 506. Based on the determination that the sensed electrical signal meets one or more threshold conditions (the "Yes" branch of 508), system 100 may deliver medical treatment to patient 102 according to pacing parameter values ​​corresponding to the posture (510). The medical treatment may include electrical therapy configured to restore the heart rhythm of heart 104 to a baseline heart rhythm. The electrical therapy may include, but is not limited to, cardiac pacing therapy or cardiac shock therapy. System 100 may follow one or more example procedures described herein (e.g., as per [reference to...]). Figure 3 and Figure 5 The pacing parameter values ​​are determined, adjusted, or selected based on the patient's posture.

[0098] System 100 iteratively implements steps 502 to 510 to sense electrical signals from patient 102 and delivers medical treatment to patient 102 based on the sensed electrical signals. Figure 5 In the illustrated process, system 100 iteratively performs steps 502 to 510 to detect changes in the posture of patient 102, adjusts sensing parameter values ​​and pacing parameter values ​​based on the new posture, and senses electrical signals from patient 102 based on the adjusted sensing parameter values ​​and pacing parameter values, respectively, and delivers medical treatment to patient 102.

[0099] In some examples, such as those previously discussed in this article... Figure 4The patient 102 may change positions only or within a short period of time (e.g., less than one minute) to a particular position. In such examples, the system 100 may adjust the sensing parameter values ​​and / or pacing parameter values ​​corresponding to the patient 102's position based on a minimum threshold time period.

[0100] In some examples, such as those previously discussed in this article... Figure 4 The patient 102's posture can change continuously (e.g., the patient 102 is in each of multiple postures within a transient time period). In such an example, in response to determining that the time interval between the current time and the determined posture change is greater than or equal to a maximum threshold time interval, the system 100 may adjust the sensing parameters to default sensing parameter values ​​and / or adjust the pacing parameters to default pacing parameter values. The system 100 may also adjust the sensing parameters to default pacing parameter values ​​according to the previous description herein. Figure 4 The example process described above determines whether the minimum or maximum threshold time period has been met.

[0101] It should be understood that the various aspects disclosed herein can be combined with combinations different from those specifically presented in the specification and drawings. It should also be understood that, depending on the example, certain actions or events of any of the processes or methods described herein may be performed in a different order, or may be completely added, combined, or omitted (e.g., performing these techniques may not require all the described actions or events). Furthermore, although some aspects of this disclosure are described for clarity as being performed by a single module, unit, or circuit, it should be understood that the techniques of this disclosure can be performed by combinations of units, modules, or circuits associated with, for example, a medical device.

[0102] In one or more examples, the described techniques may be implemented in hardware, software, firmware, or any combination thereof. If implemented in software, the functionality may be stored as one or more instructions or code on a computer-readable medium and executed by a hardware-based processing unit. The computer-readable medium may include a non-transitory computer-readable medium that corresponds to a tangible medium, such as a data storage medium (e.g., RAM, ROM, EEPROM, flash memory, or any other medium that can be used to store desired program code in the form of instructions or data structures and that is accessible by a computer).

[0103] Instructions can be executed by one or more processors (such as one or more digital signal processors (DSPs)), general-purpose microprocessors, application-specific integrated circuits (ASICs), field-programmable arrays (FPGAs), or other equivalent integrated or discrete logic circuits. Therefore, the terms "processor" or "processing circuit" as used herein may refer to any of the foregoing structures or any other physical structure suitable for implementing the described techniques. Furthermore, these techniques can be fully implemented in one or more circuit or logic elements.

[0104] Additionally, it should be noted that the system described herein is not limited to the treatment of human patients. In alternative examples, the system may be implemented in non-human patients, such as primates, canines, equines, pigs, and felines. These other animals may undergo clinical or research treatments that may benefit from the subject matter of this disclosure.

[0105] The following examples illustrate the techniques described herein.

[0106] Example 1: An implantable medical device (IMD) configured for implantation in a patient, the IMD comprising: one or more medical treatment delivery elements; one or more sensors; a memory; and processing circuitry configured to: receive sensing signals from the one or more sensors; determine the patient's posture based on the received sensing signals; retrieve one or more treatment delivery parameter values ​​stored in the memory, wherein the one or more treatment delivery parameter values ​​correspond to the determined posture; determine that the one or more treatment delivery parameter values ​​for the determined posture are configured within a threshold time period from the current time; and, in response to determining that the one or more treatment delivery parameter values ​​are configured within the threshold time period, cause the one or more medical treatment delivery elements to deliver medical treatment to the patient based on the one or more treatment delivery parameter values.

[0107] Example 2: According to the IMD of Example 1, the processing circuit is configured to: determine that none of the plurality of treatment delivery parameter values ​​stored in the memory corresponds to the determined posture; in response to determining that none of the plurality of treatment delivery parameter values ​​corresponds to the determined posture, retrieve one or more default treatment delivery parameter values ​​stored in the memory; and cause the one or more medical treatment delivery elements to deliver the medical treatment to the patient based on the one or more default treatment delivery parameter values.

[0108] Example 3: According to any one of Examples 1 and 2, the IMD, wherein the processing circuit is configured to: determine that the one or more treatment delivery parameter values ​​are not configured within the threshold time period; in response to determining that the one or more treatment delivery parameter values ​​are not configured within the threshold time period, determine one or more updated treatment delivery parameter values ​​when the patient is in a determined posture; and store the one or more updated treatment delivery parameter values ​​and corresponding data in the memory, wherein for each updated treatment delivery parameter value among the one or more updated treatment delivery parameter values, the corresponding data includes the corresponding posture and time when the processing circuit determines the corresponding updated treatment delivery parameter value.

[0109] Example 4: According to the IMD of Example 3, wherein the processing circuit is configured to cause the one or more medical treatment delivery elements to deliver the medical treatment to the patient based on the one or more treatment delivery parameter values ​​until the processing circuit has determined the one or more updated treatment delivery parameter values.

[0110] Example 5: According to any one of Examples 3 or 4, the processing circuit is configured to: in response to determining the one or more updated treatment delivery parameter values, cause the one or more medical treatment delivery elements to deliver the medical treatment to the patient based on the one or more updated treatment delivery parameter values.

[0111] Example 6: According to any one of Examples 3 to 5, in order to determine the one or more updated treatment delivery parameter values, the processing circuit is configured to: generate one or more test treatment delivery parameter values; cause the one or more medical treatment delivery elements to deliver the medical treatment to the patient based on the one or more test treatment delivery parameter values ​​when the patient is in a determined posture; determine that the delivered medical treatment meets a threshold condition; and in response to determining that the delivered medical treatment meets the threshold condition, select the one or more updated treatment delivery parameter values ​​based on the one or more test treatment delivery parameter values.

[0112] Example 7: According to the IMD of Example 6, wherein the medical treatment includes cardiac pacing therapy, and wherein, in order to determine that the delivered medical treatment satisfies the threshold condition, the processing circuit is configured to determine that the cardiac pacing therapy has captured the patient's cardiac tissue.

[0113] Example 8: According to any one of Examples 3 to 7, the IMD further includes a communication circuit coupled to the processing circuit, wherein the processing circuit is configured to: before determining the one or more updated treatment delivery parameter values, cause the communication circuit to output an alarm to one or more external devices, the alarm indicating that the IMD is delivering the medical treatment to the patient.

[0114] Example 9: An IMD according to any one of Examples 1 to 8, wherein the determined posture includes a first posture, wherein the one or more treatment delivery parameter values ​​include one or more first treatment delivery parameter values, and wherein the processing circuit is configured to: determine, based on a received sensing signal, that the patient moves from the first posture to a second posture, the second posture being different from the first posture; retrieve from the memory one or more second treatment delivery parameter values ​​corresponding to the second posture; determine that the processing circuit has determined the one or more second treatment delivery parameter values ​​for the determined posture within the threshold time period; and in response to determining that the processing circuit has determined the one or more second treatment delivery parameter values ​​within the threshold time period, cause the one or more medical treatment delivery elements to deliver medical treatment to the patient based on the one or more second treatment delivery parameter values ​​when the patient is in the second posture.

[0115] Example 10: According to any one of Examples 1 to 9, the IMD, wherein the processing circuit is configured to: determine a change in one or more sensing signals while the patient remains in the same posture based on received sensing signals; determine one or more updated treatment delivery parameter values ​​while the patient is in the determined posture based on the determined changes in the one or more sensing signals; and store the one or more updated treatment delivery parameter values ​​and corresponding data in the memory, wherein for each updated treatment delivery parameter value among the one or more updated treatment delivery parameter values, the corresponding data includes the corresponding posture and time when the processing circuit determines the corresponding updated treatment delivery parameter value.

[0116] Example 11: The IMD according to any one of Examples 1 to 10, wherein the one or more sensors include an accelerometer.

[0117] Example 12: According to any one of Examples 1 to 11, the medical treatment includes cardiac pacing therapy, and the one or more medical treatment delivery elements include a treatment delivery circuit configured to deliver the cardiac pacing therapy via one or more electrodes.

[0118] Example 13: The IMD according to Example 12, wherein one or more electrodes are configured to be implanted outside the patient's heart.

[0119] Example 14; According to any one of Examples 12 and 13, the one or more treatment delivery parameter values ​​include one or more pacing parameter values, and each of the one or more pacing parameter values ​​corresponds to at least one pacing parameter, the at least one pacing parameter including one or more of the following: pacing amplitude; pacing pulse width; pacing frequency; or pacing vector.

[0120] Example 15: IMD according to any one of Examples 1 to 14, wherein the threshold time period includes 24 hours.

[0121] Example 16: A method comprising: receiving sensing signals from one or more sensors of an implantable medical device (IMD) implanted in a patient by processing circuitry; determining a posture of the patient by the processing circuitry and based on the received sensing signals; retrieving one or more treatment delivery parameter values ​​corresponding to the determined posture by the processing circuitry and from a memory of the IMD; determining by the processing circuitry that the one or more treatment delivery parameter values ​​are configured within a threshold time period from a current time; and, in response to determining that the one or more treatment delivery parameter values ​​are configured within the threshold time period, causing one or more medical treatment delivery elements of the IMD to deliver medical treatment to the patient based on the one or more treatment delivery parameter values.

[0122] Example 17: According to the method of Example 16, the method further includes: determining by the processing circuit that none of the plurality of treatment delivery parameter values ​​stored in the memory corresponds to the determined posture; in response to determining that none of the plurality of treatment delivery parameter values ​​corresponds to the determined posture, retrieving one or more default treatment delivery parameter values ​​stored in the memory by the processing circuit; and causing the processing circuit to deliver medical treatment to the patient by the one or more medical treatment delivery elements based on the one or more default treatment delivery parameter values.

[0123] Example 18: The method according to any one of Examples 16 and 17, the method further comprising: determining by the processing circuit that the one or more treatment delivery parameter values ​​are not configured within the threshold time period; in response to determining that the one or more treatment delivery parameter values ​​are not configured within the threshold time period, determining by the processing circuit one or more updated treatment delivery parameter values ​​when the patient is in a determined posture; and storing by the processing circuit the one or more updated treatment delivery parameter values ​​and corresponding data in the memory, wherein for each updated treatment delivery parameter value among the one or more updated treatment delivery parameter values, the corresponding data includes the corresponding posture and time when the processing circuit determines the corresponding updated treatment delivery parameter value.

[0124] Example 19: According to the method of Example 18, the method further includes: causing the processing circuit to deliver the medical treatment to the patient by the one or more medical treatment delivery elements based on the one or more treatment delivery parameter values, until the processing circuit determines the one or more updated treatment delivery parameter values.

[0125] Example 20: The method according to any one of Examples 18 or 19, the method further comprising: in response to determining the one or more updated treatment delivery parameter values, the processing circuit causing the one or more medical treatment delivery elements to deliver the medical treatment to the patient based on the one or more updated treatment delivery parameter values.

[0126] Example 21: The method according to any one of Examples 18 to 20, wherein determining the one or more updated treatment delivery parameter values ​​comprises: generating one or more test treatment delivery parameter values ​​by the processing circuit; causing the one or more medical treatment delivery elements to deliver the medical treatment to the patient based on the one or more test treatment delivery parameter values ​​by the processing circuit; determining by the processing circuit that the delivered medical treatment meets a threshold condition; and in response to determining that the delivered medical treatment meets the threshold condition, selecting one or more updated treatment delivery parameter values ​​by the processing circuit based on the one or more test treatment delivery parameter values.

[0127] Example 22: The method according to Example 21, wherein the medical treatment includes cardiac pacing therapy, and wherein determining that the delivery of the medical treatment satisfies the threshold condition includes: determining by the processing circuitry that the cardiac pacing therapy has captured the patient's cardiac tissue.

[0128] Example 23: The method according to any one of Examples 18 to 22, the method further comprising: before determining the one or more updated treatment delivery parameter values, the processing circuit causing the communication circuit of the IMD to output an alarm to one or more external devices, wherein the alarm indicates that the IMD is delivering the medical treatment to the patient.

[0129] Example 24: The method according to any one of Examples 16 to 23, wherein the determined posture includes a first posture, wherein the one or more treatment delivery parameter values ​​include one or more first treatment delivery parameter values, and wherein the method further includes: determining, by the processing circuit, based on received sensing signals, that the patient moves from the first posture to a second posture, the second posture being different from the first posture; retrieving, by the processing circuit, one or more second treatment delivery parameter values ​​corresponding to the second posture; determining, by the processing circuit, that the one or more second treatment delivery parameter values ​​are configured within the threshold time period; and, in response to determining that the processing circuit has determined the one or more second treatment delivery parameter values ​​within the threshold time period, causing the one or more medical treatment delivery elements to deliver medical treatment to the patient based on the one or more second treatment delivery parameter values.

[0130] Example 25: The method according to any one of Examples 16 to 24, the method further comprising: determining, by the processing circuit, a change in one or more sensing signals while the patient remains in the same posture based on the received sensing signals; determining, by the processing circuit, one or more treatment delivery parameter values ​​while the patient is in the determined posture based on the determined change in the one or more sensing signals; and storing, by the processing circuit, the one or more updated treatment delivery parameter values ​​and corresponding data in the memory, wherein for each updated treatment delivery parameter value among the one or more updated treatment delivery parameter values, the corresponding data includes the corresponding posture and time when the processing circuit determines the corresponding updated treatment delivery parameter value.

[0131] Example 26: The method according to any one of Examples 16 to 25, wherein the one or more sensors include an accelerometer.

[0132] Example 27: The method according to any one of Examples 16 to 26, wherein the medical treatment includes cardiac pacing therapy, and wherein the one or more medical treatment delivery elements include a treatment delivery circuit configured to deliver the cardiac pacing therapy via one or more electrodes.

[0133] Example 28: According to the method of Example 27, the one or more treatment delivery parameter values ​​include one or more pacing parameter values, and each of the one or more pacing parameter values ​​corresponds to at least one pacing parameter, the at least one pacing parameter including one or more of the following: pacing amplitude; pacing pulse width; pacing frequency; or pacing vector.

[0134] Example 29: The method according to any one of Examples 16 to 28, wherein the threshold time period includes 24 hours.

[0135] Example 30: An implantable medical device (IMD) configured for implantation in a patient, the IMD comprising: a sensing circuit coupled to one or more electrodes; a treatment delivery circuit coupled to the one or more electrodes; one or more sensors; a memory; and a processing circuit configured to: receive sensing signals from the one or more sensors; determine the patient's posture based on the received sensing signals; retrieve one or more sensing parameter values ​​of one or more sensing parameters from the memory, the one or more sensing parameter values ​​corresponding to the determined posture; and cause the sensing circuit to transmit the one or more retrieved sensing parameter values ​​via the one or more sensors. An electrode senses an electrical signal from the patient; in response to determining that the sensed electrical signal meets a threshold condition, cardiac pacing therapy is delivered to the patient, wherein, in order to deliver the cardiac pacing therapy, the processing circuitry is configured to: retrieve one or more pacing parameter values ​​stored in the memory, wherein the one or more pacing parameter values ​​correspond to a determined posture; determine that the one or more pacing parameter values ​​for the determined posture are configured within a threshold time period from the current time; and in response to determining that the one or more pacing parameter values ​​are configured within the threshold time period, control the therapy delivery circuitry to deliver the cardiac pacing therapy to the patient via the one or more electrodes based on the one or more pacing parameter values.

[0136] Example 31: The IMD according to Example 30, wherein the threshold condition corresponds to the onset of one or more types of arrhythmias.

[0137] Example 32: According to any one of Examples 30 and 31, the IMD, wherein the processing circuit is configured to: determine that none of the plurality of pacing parameter values ​​stored in the memory corresponds to the determined posture; in response to determining that none of the plurality of pacing parameter values ​​corresponds to the determined posture, retrieve one or more default pacing parameter values ​​stored in the memory; and control the treatment delivery circuit to deliver the cardiac pacing treatment to the patient via the one or more electrodes and based on the one or more default pacing parameter values.

[0138] Example 33: An IMD according to any one of Examples 30 to 32, wherein the processing circuitry is configured to: determine that the one or more pacing parameter values ​​are not configured within the threshold time period; in response to determining that the one or more pacing parameter values ​​are not configured within the threshold time period, determine one or more updated pacing parameter values ​​when the patient is in a determined posture; store the one or more updated pacing parameter values ​​and corresponding data in the memory, wherein for each of the one or more pacing parameter values, the corresponding data includes the corresponding posture and time when the processing circuitry determines the corresponding updated pacing parameter value; and control the treatment delivery circuitry to deliver the cardiac pacing treatment to the patient via the one or more electrodes and based on the one or more updated pacing parameter values.

[0139] Example 34: According to the IMD of Example 33, wherein the processing circuit is configured to control the treatment delivery circuit to deliver the cardiac pacing treatment to the patient based on the one or more pacing parameter values ​​until the processing circuit has determined the one or more updated pacing parameter values.

[0140] Example 35: According to any one of Examples 33 or 34, in order to determine the one or more updated pacing parameter values, the processing circuitry is configured to: generate one or more test pacing parameter values; deliver the cardiac pacing therapy to the patient based on the one or more test pacing parameter values ​​while the patient is in a determined posture; determine that the delivered cardiac pacing therapy meets a threshold condition; and, in response to determining that the delivered cardiac pacing therapy meets the threshold condition, select the one or more updated pacing parameter values ​​based on the one or more test pacing parameter values.

[0141] Example 36: According to the IMD of Example 35, in order to determine that the delivered cardiac pacing therapy satisfies the threshold condition, the processing circuit is configured to determine that the cardiac pacing therapy captures the patient's cardiac tissue when the patient is in a determined posture.

[0142] Example 37: An IMD according to any one of Examples 30 to 36, wherein the determined posture includes a first posture, wherein one or more sensing parameter values ​​include one or more first sensing parameter values, wherein the one or more pacing parameter values ​​include one or more first pacing parameter values, wherein the electrical signal includes a first electrical signal, and wherein the processing circuitry is configured to: determine, based on the received sensing signal, that the patient has changed from the first posture to a second posture, the second posture being different from the first posture; retrieve one or more second sensing parameter values ​​corresponding to the second posture from the memory; cause the one or more electrodes to sense a second electrical signal from the patient based on the one or more retrieved second sensing parameter values; retrieve one or more second pacing parameter values ​​corresponding to the second posture from the memory; determine that the one or more second pacing parameter values ​​are configured within the threshold time period; and in response to determining that the one or more second pacing parameter values ​​are configured within the threshold time period, control the treatment delivery circuitry to deliver the cardiac pacing treatment to the patient via the one or more electrodes and based on the one or more second pacing parameter values ​​while the patient is in the second posture.

[0143] Example 38: The IMD according to any one of Examples 30 to 37, wherein the one or more sensors include an accelerometer.

[0144] Example 39: The IMD according to any one of Examples 30 to 38, wherein one or more electrodes are implanted outside the patient's heart.

[0145] Example 40: According to any one of Examples 30 to 39, the one or more pacing parameter values ​​correspond to one or more pacing parameters, which include one or more of the following: pacing amplitude; pacing pulse width; pacing frequency; or pacing vector.

[0146] Example 41: IMD according to any one of Examples 30 to 40, wherein the threshold time period includes 24 hours.

[0147] Example 42: An implantable medical device (IMD) configured for implantation in a patient, the IMD comprising: a sensing element coupled to the patient's tissue; one or more sensors; a memory; and processing circuitry configured to: receive sensing signals from the one or more sensors; determine the patient's posture based on the received sensing signals; and

[0148] In response to a determined posture, the sensing element senses electrical signals from the tissue based on one or more sensing parameter values ​​stored in the memory, wherein the one or more sensing parameter values ​​correspond to the determined posture.

[0149] Example 43: According to the IMD of Example 42, wherein the processing circuit is configured to: determine that none of the plurality of sensing parameter values ​​stored in the memory corresponds to the determined posture; and in response to determining that none of the plurality of sensing parameter values ​​corresponds to the determined posture, cause the sensing element to deliver the medical treatment to the patient based on one or more default sensing parameter values ​​stored in the memory.

[0150] Example 44: An IMD according to any one of Examples 42 and 43, wherein the determined posture includes a first posture, wherein the one or more sensing parameter values ​​include one or more first sensing parameter values, and wherein the processing circuitry is configured to: determine, based on received sensing signals, that the patient has moved from the first posture to a second posture, the second posture being different from the first posture; and retrieve from the memory one or more second sensing parameter values ​​corresponding to the second posture; and in response to determining that the patient is in the second posture, cause the one or more sensing elements to sense the electrical signal from the tissue based on the one or more second sensing parameter values ​​stored in the memory, wherein the one or more second sensing parameter values ​​correspond to the second posture.

[0151] Example 45: The IMD according to any one of Examples 42 to 44, wherein the one or more sensors include an accelerometer.

[0152] Example 46: According to any one of Examples 42 to 45, the IMD, wherein the sensing element includes a sensing circuit configured to sense the electrical signal via one or more electrodes.

[0153] Example 47: The IMD according to Example 46, wherein one or more electrodes are implanted outside the patient's heart.

[0154] Example 48: According to any one of Examples 42 to 47, the one or more sensing parameter values ​​include one or more of the following: sensing threshold; threshold timing value; sensing sensitivity value; or sensing vector.

[0155] Example 49: According to any one of Examples 42 to 48, the IMD, wherein the memory is configured to: store one or more sensing templates, wherein each of the one or more sensing templates corresponds to a different posture of the patient, wherein the sensing element senses the electrical signal from the tissue based on the one or more sensing parameter values, the processing circuitry is configured to: retrieve one of the one or more sensing templates from the memory, wherein the sensing template corresponds to a determined posture, and wherein the sensing template is defined by the one or more sensing parameter values; and apply the sensing template to cause the sensing element to sense the electrical signal based on the one or more sensing parameter values.

[0156] Example 50: According to the IMD of Example 49, the electrical signal includes a cardiac signal, and at least one of the one or more sensing templates includes an electrogrammography (EGM) morphological sensing algorithm.

[0157] Example 51: According to the IMD described in Example 50, the EGM morphological sensing algorithm includes a wavelet morphological sensing algorithm.

[0158] Example 52: According to any one of Examples 49 to 51, in order to apply the sensing template to enable the sensing element to sense the electrical signal based on the one or more sensing parameter values, the processing circuit is configured to: determine whether the sensing template has been generated, verified, or updated within a threshold time period prior to the current time; apply the sensing template in response to determining that the sensing template has been generated, verified, or updated within the threshold time period; and update at least one of the one or more sensing parameter values ​​in response to determining that the sensing template has not been generated, verified, or updated within the threshold time period.

[0159] Example 53: The IMD according to Example 52, wherein the threshold time period includes 24 hours.

[0160] Those skilled in the art should understand that this application is not limited to the content specifically shown and described above. Furthermore, unless otherwise stated above, it should be noted that all drawings are not to scale. Various modifications and variations are possible based on the foregoing teachings without departing from the scope and spirit of this application, the scope and spirit of which are defined only by the appended claims.

Claims

1. An implantable medical device (IMD) configured for implantation in a patient, the IMD comprising: One or more medical therapeutic delivery elements; One or more sensors; Memory; and Processing circuit, the processing circuit being configured to: Receive sensing signals from the one or more sensors; The patient's posture is determined based on the received sensor signals; Retrieve one or more treatment delivery parameter values ​​stored in the memory, wherein the one or more treatment delivery parameter values ​​correspond to the determined posture; It is determined that the one or more treatment delivery parameter values ​​for the determined posture are configured within a threshold time period from the current time; as well as In response to determining that the one or more treatment delivery parameter values ​​are configured within the threshold time period, the one or more medical treatment delivery elements deliver medical treatment to the patient based on the one or more treatment delivery parameter values.

2. The IMD according to claim 1, wherein the processing circuit is configured as follows: It was determined that none of the multiple treatment delivery parameter values ​​stored in the memory corresponded to the determined posture; In response to determining that none of the plurality of treatment delivery parameter values ​​corresponds to the determined posture, one or more default treatment delivery parameter values ​​stored in the memory are retrieved; as well as The one or more medical treatment delivery elements deliver the medical treatment to the patient based on the one or more default treatment delivery parameter values.

3. The IMD according to any one of claims 1 and 2, wherein the processing circuit is configured to: Determine that the one or more treatment delivery parameter values ​​are not configured within the threshold time period; In response to determining that the one or more treatment delivery parameter values ​​are not configured within the threshold time period, one or more updated treatment delivery parameter values ​​are determined when the patient is in the determined posture; and The one or more updated treatment delivery parameter values ​​and corresponding data are stored in the memory, wherein for each of the one or more updated treatment delivery parameter values, the corresponding data includes the corresponding posture and time when the processing circuit determines the corresponding updated treatment delivery parameter value.

4. The IMD of claim 3, wherein the processing circuitry is configured to: cause the one or more medical treatment delivery elements to deliver the medical treatment to the patient based on the one or more treatment delivery parameter values, until the processing circuitry has determined the one or more updated treatment delivery parameter values.

5. The IMD according to any one of claims 3 or 4, wherein the processing circuitry is configured to: In response to determining the one or more updated treatment delivery parameter values, the one or more medical treatment delivery elements deliver the medical treatment to the patient based on the one or more updated treatment delivery parameter values.

6. The IMD according to any one of claims 3 to 5, wherein, in order to determine the one or more updated treatment delivery parameter values, the processing circuitry is configured to: Generate one or more test treatment delivery parameter values; The one or more medical treatment delivery elements deliver the medical treatment to the patient based on the one or more test treatment delivery parameter values ​​while the patient is in a determined posture; Determine that the delivered medical treatment meets the threshold conditions; as well as In response to determining that the delivered medical treatment meets the threshold condition, one or more updated treatment delivery parameter values ​​are selected based on the one or more test treatment delivery parameter values.

7. The IMD of claim 6, wherein the medical treatment includes cardiac pacing therapy, and wherein, in order to determine that the delivered medical treatment satisfies the threshold condition, the processing circuitry is configured to determine that the cardiac pacing therapy has captured the patient's cardiac tissue.

8. The IMD according to any one of claims 3 to 7, wherein the IMD further comprises a communication circuit coupled to the processing circuit, and wherein the processing circuit is configured to: Before determining the one or more updated treatment delivery parameter values, the communication circuitry outputs an alarm to one or more external devices, the alarm indicating that the IMD is delivering the medical treatment to the patient.

9. The IMD according to any one of claims 1 to 8, wherein the determined posture includes a first posture, wherein the one or more treatment delivery parameter values ​​include one or more first treatment delivery parameter values, and wherein the processing circuitry is configured to: Based on the received sensing signals, it is determined that the patient moves from the first posture to a second posture, which is different from the first posture; Retrieve one or more second treatment delivery parameter values ​​corresponding to the second posture from the memory; The processing circuit determines the one or more second treatment delivery parameter values ​​for the determined posture within the threshold time period; as well as In response to determining that the processing circuit has determined the one or more second treatment delivery parameter values ​​within the threshold time period, the one or more medical treatment delivery elements deliver medical treatment to the patient based on the one or more second treatment delivery parameter values ​​while the patient is in the second posture.

10. The IMD according to any one of claims 1 to 9, wherein the processing circuit is configured to: Based on the received sensing signals, determine the changes in one or more sensing signals while the patient remains in the same posture; Based on the determined changes in the one or more sensing signals, one or more updated treatment delivery parameter values ​​are determined when the patient is in the determined posture; as well as The one or more updated treatment delivery parameter values ​​and corresponding data are stored in the memory, wherein for each of the one or more updated treatment delivery parameter values, the corresponding data includes the corresponding posture and time when the processing circuit determines the corresponding updated treatment delivery parameter value.

11. The IMD according to any one of claims 1 to 10, wherein the one or more sensors include an accelerometer.

12. The IMD according to any one of claims 1 to 11, wherein the medical treatment includes cardiac pacing therapy, and wherein the one or more medical treatment delivery elements include a treatment delivery circuit configured to deliver the cardiac pacing therapy via one or more electrodes.

13. The IMD of claim 12, wherein the one or more electrodes are configured to be implanted outside the patient's heart.

14. The IMD of any one of claims 12 and 13, wherein the one or more treatment delivery parameter values ​​comprise one or more pacing parameter values, and wherein each of the one or more pacing parameter values ​​corresponds to at least one pacing parameter, the at least one pacing parameter comprising one or more of the following: Pacing amplitude; Pulse width at pacing; Pacing rate; or Pacing vector.

15. The IMD according to any one of claims 1 to 14, wherein the threshold time period includes 24 hours.

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