Method and apparatus for selecting a sensing vector configuration in a medical device

• US 10,278,601 B2
• Filed: 04/24/2014
• Issued: 05/07/2019
• Est. Priority Date: 04/24/2014
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Greenhut, Saul E, Stadler, Robert W, Zhang, Xusheng
• Primary Examiner(s): D Abreu, Michael J
• Application Number:
  US14/260,408
• Publication Number:
  US 20150305637A1
• Time in Patent Office: 1,839 Days
• CPC Class Codes: A61B 5/25 Bioelectric electrodes therefor
• CPC Class Codes: A61B 5/341 Vectorcardiography [VCG]
• CPC Class Codes: A61B 5/363 Detecting tachycardia or bradycardia
• CPC Class Codes: A61B 5/366 Detecting abnormal QRS complex, e.g. widening
• CPC Class Codes: A61N 1/00 Electrotherapy; Circuits therefor A61N2/00 takes precedence; irradiation apparatus A61N5/00

Abstract

A method and medical device for determining sensing vectors that includes sensing cardiac signals from a plurality of electrodes, the plurality of electrodes forming a plurality of sensing vectors, determining signal differences during a detection window in each of the plurality of sensing vectors, ranking sensing vectors of the plurality of sensing vectors in response to the determined signal differences, and selecting one or more sensing vectors of the plurality of sensing vectors in response to the determined rankings.

Claims

1. A medical device for determining sensing vectors, comprising:

a plurality of electrodes configured to sense cardiac electrogram signals of a patient, wherein the plurality of electrodes are configured to form a plurality of sensing vectors, each of the plurality of sensing vectors for sensing a respective one of the cardiac electrogram signals; and

a processor configured to;

set a detection window in each of the plurality of sensing vectors for each of a plurality of cardiac cycles;

determine, for each of the detection windows, one or more signal differences between a sensing threshold and an amplitude of a portion of the respective sensed cardiac electrogram signal occurring within the detection window;

rank each of the sensing vectors of the plurality of sensing vectors relative to each other based on a vector selection metric determined based on the signal differences; and

select one or more sensing vectors of the plurality of sensing vectors based on the determined rankings; and

therapeutic signal generation circuitry configured to deliver a therapeutic signal to the patient;

wherein the processor is further configured to;

sense, via the selected one or more sensing vectors, one or more cardiac electrogram signals indicative of cardiac arrythmia in the patient; and

in response to sensing the one or more cardiac electrogram signals indicative of cardiac arrythmia in the patient, control the therapeutic signal generation circuitry to deliver the therapy signal to the patient.

2. The medical device of claim 1, wherein the processor is further configured to determine whether the signal differences have been determined for a threshold number of detection windows for each of the plurality of sensing vectors, and identify sensing vectors of the plurality of sensing vectors having signal differences determined for the threshold number of detection windows, wherein ranking sensing vectors of the plurality of sensing vectors comprises ranking only the identified sensing vectors.

3. The medical device of claim 2, wherein the threshold number of detection windows comprises fifteen detection windows.

4. The medical device of claim 2, wherein the processor is further configured to determine whether the cardiac electrogram signal exceeds the sensing threshold during the detection window, and update the determined number of detection windows for the sensing vector in response to the cardiac electrogram signal being determined to exceed the sensing threshold.

5. The medical device of claim 1, wherein setting the detection window comprises, for each of the plurality of cardiac cycles:

sensing an R-wave in response to the cardiac electrogram signal exceeding the sensing threshold;

setting the detection window based on the sensed R-wave so that the detection window has a detection window start point at a predetermined distance from the R-wave and has a detection window width extending from the start point to a detection window end point; and

wherein the processor is further configured to;

determine a minimum signal difference for any of the detection windows having the cardiac electrogram signal sensed within the detection window not exceeding the sensing threshold during the detection window, the minimum signal difference based on the determined signal differences occurring within that detection window, and

determine the vector selection metric based on the minimum signal differences.

6. The medical device of claim 5, wherein the processor is further configured to select a vector of the plurality of vectors having the greatest determined minimum signal difference as a first sensing vector, and select a vector of the plurality of vectors having a next greatest determined minimum signal difference as a second sensing vector.

7. The medical device of claim 1, wherein the processor is further configured to sense an R-wave in response to the cardiac electrogram signal exceeding the sensing threshold, determine a maximum signal amplitude of the cardiac electrogram signal sensed during the detection window, determine a signal difference between the maximum amplitude and the sensing threshold, and determine the vector selection metric based on the determined signal difference between the maximum amplitude and the sending threshold.

8. The medical device of claim 7, wherein the processor is further configured to select a vector of the plurality of vectors having the lowest determined signal threshold difference between the maximum amplitude and the sensing threshold as a first sensing vector, and select a vector of the plurality of vectors having the next lowest determined signal difference between the maximum amplitude and the sensing threshold as a second sensing vector.

9. The medical device of claim 1, wherein the processor is further configured to determine whether a timer has expired, and determine whether signal differences have been determined for a predetermined number of detection windows for a predetermined number of sensing vectors of the plurality of sensing vectors in response to the timer having expired.

10. The medical device of claim 1, wherein setting the detection window in each of the plurality of sensing vectors comprises setting a detection window width to allow analysis of the cardiac electrogram signal in an expected range of the cardiac electrogram signal where a T-wave of a QRS signal associated with a sensed R-wave is likely to occur.

11. The medical device of claim 1, wherein the plurality of electrodes capable of forming a plurality of sensing vectors for sensing cardiac electrogram signals comprise:

one or more electrodes capable of forming a horizontal sensing vector for sensing cardiac electrogram signals;

one or more electrodes capable of forming a diagonal sensing vector for sensing cardiac electrogram signals; and

one or more electrodes capable of forming a vertical sensing vector for sensing cardiac electrogram signals.

12. A method of determining sensing vectors in a medical device, comprising:

sensing, by a medical device, cardiac electrogram signals of a patient from a plurality of electrodes, wherein the plurality of electrodes are configured to form a plurality of sensing vectors, each of the plurality of sensing vectors for sensing a respective one of the cardiac electrogram signals;

for each of a plurality of cardiac cycles, setting, by a processor, a detection window in each of the plurality of sensing vectors;

determining, by the processor and for each of the detection windows, one or more signal differences between a sensing threshold and an amplitude of a portion of the respective sensed cardiac electrogram signal occurring within the detection window;

ranking, by the processor, each of the sensing vectors of the plurality of sensing vectors relative to each other based on a vector selection metric determined based on the signal differences;

selecting, by the processor, one or more sensing vectors of the plurality of sensing vectors based on the determined rankings;

sensing, by the processor and via the selected one or more sensing vectors, one or more cardiac electrogram signals indicative of cardiac arrythmia in the patient; and

in response to sensing the one or more cardiac electrogram signals indicative of cardiac arrythmia in the patient, controlling, by the processor, a therapeutic signal generation circuitry of the medical device to deliver a therapeutic signal to the patient.

13. The method of claim 12, further comprising:

determining whether the signal differences have been determined for a threshold number of detection windows for each of the plurality of sensing vectors; and

identifying sensing vectors of the plurality of sensing vectors having signal differences determined for the threshold number of detection windows, wherein ranking sensing vectors of the plurality of sensing vectors comprises ranking only the identified sensing vectors.

14. The method of claim 13, wherein the threshold number of detection windows comprises fifteen detection windows.

15. The method of claim 13, further comprising:

determining whether the cardiac electrogram signal exceeds the sensing threshold during the detection window; and

updating the determined number of detection windows for the sensing vector in response to the cardiac electrogram signal being determined to exceed the sensing threshold.

16. The method of claim 12, wherein setting the detection window and determining signal differences comprises, for each of the plurality of cardiac cycles:

sensing an R-wave in response to the cardiac electrogram signal exceeding the sensing threshold;

setting the detection window based on the sensed R-wave so that the detection window has a detection window start point at a predetermined distance from the sensed R-wave and has a detection window width extending from the detection window start point to a detection window end point;

determining a minimum signal difference for any of the detection windows having a cardiac electrogram signal sensed within the detection window not exceeding the sensing threshold during the detection window, the minimum signal difference based on the determined signal differences occurring within that detection window, and

determining the vector selection metric based on the minimum signal differences.

17. The method of claim 16, wherein selecting one or more sensing vectors of the plurality of sensing vectors comprises:

selecting a vector of the plurality of vectors having the greatest determined minimum signal difference as a first sensing vector; and

selecting a vector of the plurality of vectors having a next greatest determined minimum signal difference as a second sensing vector.

18. The method of claim 12, wherein determining signal differences during a detection window in each of the plurality of sensing vectors comprises:

sensing an R-wave in response to the cardiac electrogram signal exceeding the sensing threshold;

determining a maximum signal amplitude of the cardiac electrogram signal sensed during the detection window;

determining a signal difference between the maximum amplitude and the sensing threshold; and

determining the vector selection metric based on the determined signal difference between the maximum amplitude and the sensing threshold.

19. The method of claim 18, wherein selecting one or more sensing vectors of the plurality of sensing vectors comprises:

selecting a vector of the plurality of vectors having the lowest determined signal difference between the maximum amplitude and the sensing threshold as a first sensing vector; and

selecting a vector of the plurality of vectors having the next lowest determined signal difference between the maximum amplitude and the sensing threshold as a second sensing vector.

20. The method of claim 12, further comprising:

determining whether a timer has expired; and

determining whether signal differences have been determined for a predetermined number of detection windows for a predetermined number of sensing vectors of the plurality of sensing vectors in response to the timer having expired.

21. The method of claim 12, wherein setting the detection window in each of the plurality of sensing vectors comprises setting a detection window width to allow analysis of the cardiac electrogram signal in an expected range of the cardiac electrogram signal where a T-wave of a QRS signal associated with a sensed R-wave is likely to occur.

22. A non-transitory, computer-readable storage medium storing instructions for causing a processor included in a medical device to perform a method for determining sensing vectors, the method comprising:

sensing cardiac electrogram signals from a plurality of electrodes, wherein the plurality of electrodes are configured to form a plurality of sensing vectors, each of the plurality of sensing vectors for sensing a respective one of the cardiac electrogram signals;

for each of a plurality of cardiac cycles, setting a detection window in each of the plurality of sensing vectors;

determining, for each of the detection windows, one or more signal differences between a sensing threshold and an amplitude of a portion of the respective sensed cardiac electrogram signal occurring within the detection window;

ranking each of the sensing vectors of the plurality of sensing vectors relative to each other based on a vector selection metric determined based on the signal differences;

selecting one or more sensing vectors of the plurality of sensing vectors based on the determined rankings;

sensing via the selected one or more sensing vectors, one or more cardiac electrogram signals indicative of cardiac arrythmia in the patient; and

in response to sensing the one or more cardiac electrogram signals indicative of cardiac arrythmia in the patient, controlling delivery of a therapeutic signal to the patient.