1. A system comprising:
an implantable medical device configured to deliver pacing stimuli to a heart; and
at least one processor configured to:
for a set of at least two pacing vectors, wherein each vector is at least partially defined by a first electrode and a second electrode:
deliver at least one first pacing stimulus at a first specified pacing energy;
determine whether, in response to the delivered at least one first pacing stimulus, a first cardiac depolarization occurred and whether a first phrenic nerve stimulation occurred, the determination using physiological information received in response to the delivered at least one first pacing stimulus;
adjust the pacing stimulus to determine a first pacing threshold value; and
categorize acceptability of the first electrodes of the at least two pacing vectors using information about at least one of the determined first pacing threshold value, whether the first cardiac depolarization occurred, or whether the first phrenic nerve stimulation occurred;
pair one or more respective categorized acceptable first electrodes with one or more respective candidate second electrodes capable of use therewith, and for a particular pairing:
deliver at least one second pacing stimulus at at least one second pacing energy;
determine whether, in response to the delivered at least one second pacing stimulus, a second cardiac depolarization occurred and whether a second phrenic nerve stimulation occurred, the determination using physiological information received in response to the delivered at least one second pacing stimulus; and
categorize the pairings using information about at least one of whether the second cardiac depolarization occurred or whether the second phrenic nerve stimulation occurred;
evaluate the categorized pairings using information about a margin between the second pacing stimulus and the second phrenic nerve stimulation threshold; and
select at least one pairing, based on the evaluation, for use in subsequent ongoing delivery of pacing stimuli.
2. The system of claim 1, wherein, prior to pairing one or more respective categorized acceptable first electrodes with one or more respective candidate second electrodes capable of use therewith, the at least one processor is configured to:
recommend an electrode for pacing based on the categorized acceptability; and
stop further evaluation of electrodes.
3. The system of claim 1, wherein the set of at least two pacing vectors comprises a set of default pacing vectors stored in a memory device, and wherein the set of at least two pacing vectors is less than the total number of pacing vectors available for pacing.
4. The system of claim 1, wherein the at least one processor is further configured to:
rank or prioritize the categorized acceptable first electrodes.
5. The system of claim 1, wherein the first electrode includes a cathode and the second electrode includes an anode.
6. The system of claim 1, further comprising a user interface, wherein the at least one processor is further configured to:
display, via the user interface, the evaluated categorized pairings, and
wherein the at least one processor configured to select at least one pairing, based on the evaluation, is further configured to:
receive, via the user interface, user input that selects at least one pairing, based on the evaluation.
7. The system of claim 1, further comprising a user interface, wherein the at least one processor configured to select at least one pairing, based on the evaluation, is further configured to:
select, without requiring user intervention, at least one pairing, based on the evaluation.
8. The system of claim 1, wherein the implantable medical device comprises the at least one processor.
9. The system of claim 1, further comprising:
a device external to a patient, wherein the external device comprises the at least one processor.
10. The system of claim 9, wherein the external device comprises at least one of a clinician programmer or a pacing system analyzer, and wherein the external device is configured to transmit information indicating the selected at least one pair of first and second electrodes to the implantable medical device.
11. A computer-readable medium comprising instructions that, upon execution, cause at least one processor to:
for a set of at least two pacing vectors, wherein each vector is at least partially defined by a first electrode and a second electrode:
deliver at least one first pacing stimulus at a first specified pacing energy;
determine whether, in response to the delivered at least one first pacing stimulus, a first cardiac depolarization occurred and whether a first phrenic nerve stimulation occurred, the determination using physiological information received in response to the delivered at least one first pacing stimulus;
adjust the pacing stimulus to determine a first pacing threshold value; and
categorize acceptability of the first electrodes of the at least two pacing vectors using information about at least one of the determined first pacing threshold value, whether the first cardiac depolarization occurred, or whether the first phrenic nerve stimulation occurred;
pair one or more respective categorized acceptable first electrodes with one or more respective candidate second electrodes capable of use therewith, and for a particular pairing:
deliver at least one second pacing stimulus at at least one second pacing energy;
determine whether, in response to the delivered at least one second pacing stimulus, a second cardiac depolarization occurred and whether a second phrenic nerve stimulation occurred, the determination using physiological information received in response to the delivered at least one second pacing stimulus; and
categorize the pairings using information about at least one of whether the second cardiac depolarization occurred or whether the second phrenic nerve stimulation occurred;
evaluate the categorized pairings using information about a margin between the second pacing stimulus and the second phrenic nerve stimulation threshold; and
select at least one pairing, based on the evaluation, for use in subsequent ongoing delivery of pacing stimuli.
12. The computer-readable medium of claim 11, wherein, prior to pairing one or more respective categorized acceptable first electrodes with one or more respective candidate second electrodes capable of use therewith, the at least one processor is configured to:
recommend an electrode for pacing based on the categorized acceptability; and
stop further evaluation of electrodes.
13. The computer-readable medium of claim 11, wherein the set of at least two pacing vectors comprises a set of default pacing vectors stored in a memory device, and wherein the set of at least two pacing vectors is less than the total number of pacing vectors available for pacing.
14. The computer-readable medium of claim 11, wherein the at least one processor is further configured to:
rank or prioritize the categorized acceptable first electrodes.
15. A method of determining at least one cardiac pacing vector, the method comprising:
for a set of at least two pacing vectors, wherein each vector is at least partially defined by a first electrode and a second electrode:
delivering at least one first pacing stimulus at a first specified pacing energy;
determining whether, in response to the delivering the at least one first pacing stimulus, a first cardiac depolarization occurred and whether a first phrenic nerve stimulation occurred, the determining using physiological information received in response to the delivering the at least one first pacing stimulus; and
adjusting the pacing stimulus to determine a first pacing threshold value;
categorizing acceptability of the first electrodes of the at least two pacing vectors using information about at least one of the determined first pacing threshold value, whether the first cardiac depolarization occurred, or whether the first phrenic nerve stimulation occurred;
pairing one or more respective categorized acceptable first electrodes with one or more respective candidate second electrode capable of use therewith, and for a particular pairing:
delivering at least one second pacing stimulus at at least one second pacing energy;
determining whether, in response to the delivering the at least one second pacing stimulus, a second cardiac depolarization occurred and whether a second phrenic nerve stimulation occurred, the determining using physiological information received in response to the delivering the at least one second pacing stimulus; and
categorizing the pairings using information about at least one of whether the second cardiac depolarization occurred or whether the second phrenic nerve stimulation occurred;
evaluating the categorized pairings using information about a margin between the second pacing stimulus and the second phrenic nerve stimulation threshold; and
selecting at least one pairing, based on the evaluation, for use in subsequent ongoing delivery of pacing stimuli.
16. The method of claim 15, further comprising:
prior to pairing one or more respective categorized acceptable first electrodes with one or more respective candidate second electrodes capable of use therewith:
recommending an electrode for pacing based on the categorized acceptability; and
stopping further evaluation of electrodes.
17. The method of claim 15, wherein the set of at least two pacing vectors comprises a set of default pacing vectors stored in a memory device, and wherein the set of at least two pacing vectors is less than the total number of pacing vectors available for pacing.
18. The method of claim 15, further comprising ranking or prioritizing the categorized acceptable first electrodes.
19. The method of claim 15, wherein the first electrode includes a cathode and the second electrode includes an anode.
20. The method of claim 15, further comprising:
selecting, without requiring user intervention, at least one pairing, based on the evaluation.
The claims below are in addition to those above.
All refrences to claim(s) which appear below refer to the numbering after this setence.
1. A method of treating an acromioclavicular (AC) joint injury, comprising:
forming axially aligned passages through a patient’s clavicle and coracoid process;
passing a fastener having a concave surface through the passages;
positioning the concave surface of the fastener against a top surface of the patient’s clavicle with a long axis of the fastener extending perpendicular to a long axis of the clavicle;
positioning a fastener having a planar profile below the patient’s coracoid process; and
adjusting a suture that couples the fasteners to decrease a distance between the fasteners.
2. The method of claim 1 wherein the suture includes a half-hitch knot and adjusting the suture includes pulling on ends of the suture.
3. The method of claim 1 further comprising tying a knot in the suture such that the knot is against an outer surface of the planar fastener.
4. The method of claim 1 wherein passing the fastener having a concave surface through the passages comprises pulling on a second suture attached to the concave fastener.
5. A method comprising:
positioning a bone graft in contact with a patient’s glenoid;
forming at least one axially aligned passage through the patient’s glenoid and the bone graft;
passing a first portion of a suture through the passage, wherein a second portion of the suture is coupled to a first fastener;
positioning a surface of the first fastener against a surface of the bone graft opposite a surface of the bone graft in contact with the patient’s glenoid;
positioning a surface of a second fastener against a surface of the glenoid opposite a surface of the glenoid in contact with the bone graft, wherein the second fastener is coupled to a third portion of the suture; and
adjusting the suture such that the first fastener and the second fastener apply pressure between the bone graft and the patient’s glenoid;
wherein the first fastener and the second fastener are not passed through the passage.
6. The method of claim 5 wherein the bone graft is at least a portion of the patient’s coracoid process.
7. The method of claim 6 wherein positioning the portion of the patient’s coracoid process in contact with the patient’s glenoid includes positioning the portion of the patient’s coracoid process upright such that a longest dimension of the patient’s coracoid process is oriented substantially orthogonal to the surface of the glenoid in contact with the patient’s coracoid process.
8. The method of claim 6 wherein positioning the portion of the patient’s coracoid process in contact with the patient’s glenoid includes positioning the portion of the patient’s coracoid process laying down such that a longest dimension of the patient’s coracoid process is oriented substantially parallel to the surface of the glenoid in contact with the patient’s coracoid process.
9. The method of claim 5 wherein the first fastener and the second fastener each have a planar profile.
10. The method of claim 5 wherein the first fastener has a planar profile and the second fastener has a curvature along a longitudinal axis of the second fastener, a length of the second fastener along the longitudinal axis being greater than a width of the second fastener along a lateral axis of the second fastener.
11. The method of claim 10 wherein the second fastener further has a curvature along a lateral axis of the second fastener.
12. The method of claim 5 wherein:
the second fastener has a circular body with a convex surface and a corresponding, opposite concave surface; and
the second fastener defines two holes for receiving suture and a neck protruding from the concave surface that surrounds the two holes, an outer diameter of the neck being less than or equal to a diameter of the passage through the bone graft.
13. The method of claim 5, further comprising folding the suture upon itself prior to passing through the passage.
14. The method of claim 13, wherein the folded suture includes a closed end and wherein coupling a second portion of the suture to the first fastener comprises passing the folded end of the suture through two holes of the first fastener.
15. The method of claim 5, wherein the bone graft is not laterally constrained by the patient’s anatomy.
16. The method of claim 5, wherein the bone graft is maintained in place by constraint consisting essentially of the pressure created by the first and second fasteners between the bone graft and the patient’s glenoid.
17. The method of claim 5, wherein the bone graft is not positioned into contact with the glenoid within a cavity formed within the glenoid.
18. A method comprising:
positioning a bone graft in contact with a patient’s glenoid;
forming two axially aligned passages through the patient’s glenoid and the bone graft;
inserting a bone anchor into each of the two passages in the patient’s glenoid, wherein each bone anchor includes a length of suture that protrudes from the patient’s glenoid when the bone anchor is inserted;
passing a first portion of suture attached to a first of the bone anchors through a first passage in the bone graft after insertion of the first bone anchor into the patient’s glenoid;
passing a second portion of suture attached to a second of the bone anchors through a second passage in the bone graft after insertion of the second bone anchor into the patient’s glenoid;
positioning a surface of a first fastener against an outer surface of the bone graft opposite a surface of the glenoid in contact with the bone graft, wherein the first fastener is coupled to the first portion of suture and the second portion of suture and wherein the first fastener does not extend beneath the outer surface of the bone graft; and
adjusting the suture such that the first fastener applies pressure between the bone graft and the patient’s glenoid.
19. The method of claim 18 wherein the first fastener has a curvature along a longitudinal axis of the first fastener and a curvature along a lateral axis of the first fastener, a length of the first fastener along the longitudinal axis being greater than a width of the first fastener along a lateral axis of the first fastener.
20. The method of claim 18 wherein:
a third portion of suture is attached to the first bone anchor and the first fastener;
a fourth portion of suture is attached to the second bone anchor and the first fastener; and
the first, second, third, and fourth portions of suture are tied together to form a half-hitch knot.