Methods and devices for reducing phrenic nerve stimulation of cardiac
pacing systems involve delivering a pacing pulse to a ventricle of a
heart. A transthoracic impedance signal is sensed, and a deviation in the
signal resulting from the pacing pulse may be used to determine phrenic
nerve stimulation. Methods may further involve detecting the phrenic
nerve stimulation from the pacing pulse by delivering two or more pacing
pulse to the ventricle of the heart, and determining a temporal
relationship. A pacing vector may be selected from the two or more
vectors that effects cardiac capture and reduces the phrenic nerve
stimulation. A pacing voltage and/or pulse width may be selected that
provides cardiac capture and reduces the phrenic nerve stimulation. In
other embodiments, a pacing pulse width and a pacing voltage may be
selected from a patient's strength-duration curve that effects cardiac
capture and reduces the phrenic nerve stimulation.