METHOD AND APPARATUS FOR IDENTIFYING OVERSENSING USING FAR-FIELD INTRACARDIAC ELECTROGRAMS AND MARKER CHANNELS

• US 20090292331A1
• Filed: 06/02/2009
• Published: 11/26/2009
• Est. Priority Date: 04/18/2005
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: GUNDERSON, BRUCE D., BOUNDS, CHAD A., PATEL, AMISHA S., BROWN, MARK L.
• Granted Patent: US 8,386,024 B2
• Time in Patent Office: Days
• US Class Current: 607/5
• CPC Class Codes: A61B 5/352 Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval
• CPC Class Codes: A61B 5/363 Detecting tachycardia or bradycardia
• CPC Class Codes: A61B 5/7217 of noise originating from a therapeutic or surgical apparatus, e.g. from a pacemaker
• CPC Class Codes: A61B 5/7239 using differentiation including higher order derivatives
• CPC Class Codes: A61B 5/7264 Classification of physiological signals or data, e.g. using neural networks, statistical classifiers, expert systems or fuzzy systems neural networks per se G06N3/00; expert systems per se G06N5/00
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions
• CPC Class Codes: A61N 1/3702 Physiological parameters A61N1/365 takes precedence; evoked response A61N1/371
• CPC Class Codes: A61N 1/3704 Circuits specially adapted therefor, e.g. for sensitivity control

Abstract

A method for identifying and classifying various types of oversensing in implantable medical devices (IMDs), such as implantable cardioverter defibrillators (ICDs), to assist a physician in choosing corrective action to reduce the likelihood of oversensing and inappropriate therapy delivery. Far-field electrogram (EGM) signals are analyzed to detect the occurrence of R-waves, and the result is compared to the number and pattern of R-waves sensed by the IMD and indicated on the marker channel. A marker channel with more sensed R-waves than indicated by analysis of the far-field EGM indicates the presence of oversensing, including double-counting of R-waves, T-wave oversensing, lead malfunction or failure, poor lead connections, noise associated with electromagnetic interference, non-cardiac myopotentials, etc. Identification of the type of oversensing may be determined by analysis of the number and pattern of marker channel sensed R-waves with respect to the timing of the R-waves detected from the far-field EGM.

Claims

1. A method for identifying oversensing of cardiac events by an implantable medical device, comprising the steps of:

detecting a near-field electrogram signal;

detecting a far-field electrograms signal;

comparing said near-field electrogram with said far-field electrogram;

identifying possible oversensing events based on a result from said comparing step; and

removing, from the possible oversensing events from the identifying step, possible oversensing events that have amplitudes above an amplitude threshold criterion and possible oversensing events that occur outside of a blanking interval period immediately after a preceding intrinsic depolarization.

2. The method of claim 1 wherein the removing step comprises:

first removing, from the possible oversensing events from the identifying step, possible oversensing events that have amplitudes above an amplitude threshold criterion; and

then

second removing, from the possible oversensing events from the first removing step, possible oversensing events that occur outside of a blanking interval period immediately after a preceding intrinsic depolarization.

3. The method of claim 1 wherein the removing step comprises:

first removing, from the possible oversensing events from the identifying step, possible oversensing events that occur outside of a blanking interval period immediately after a preceding intrinsic depolarization; and

then

second removing, from the possible oversensing events from the first removing step, possible oversensing events that have amplitudes above an amplitude threshold criterion to generate an updated identified possible oversensing events.

4. The method of claim 1 wherein the far-field electrogram signal is obtained from one of a pair of defibrillation coil electrodes, a defibrillation coil electrode and an implantable medical device housing, a tip electrode and an implantable medical device housing, a ring electrode and an implantable medical device housing, a tip electrode and a defibrillation coil electrode, a ring electrode and a defibrillation coil electrode and an electrode of one of an atrial lead and a ventricular lead and an electrode from the other one of an atrial lead and a ventricular lead.

5. The method of claim 1 wherein applying the amplitude change criteria comprises:

identifying subsets including one of;

a) increases in amplitude occurring from a first point to a second point within the subset, and from the second point to a third point within the subset, both increases being equal to or greater than a first specified amount,

b) decreases in amplitude occurring from the first point to the second point, and from the second point to the third point, both decreases being equal to or greater than a second specified amount, and

c) a change in amplitude occurring from the first point to the third point having an absolute value that is greater than a third specified amount;

marking the first point of an identified subset as a possible intrinsic depolarization;

identifying a digital sample point within a specified time interval of each possible intrinsic depolarization having the largest absolute value as a possible peak intrinsic depolarization; and

analyzing all subsets in the stream of digital sample points.

6. The method of claim 5 wherein the specified time interval comprises eight digital sample points preceding and eight digital sample points following the possible intrinsic depolarization.

7. The method of claim 5 wherein the representative amplitude corresponds to roughly the 75^th percentile of all possible peak intrinsic depolarization amplitudes, and wherein the fraction is approximately 0.57.

8. The method of claim 1 wherein applying an amplitude threshold criterion comprises:

determining a representative amplitude corresponding to a certain percentile rank of all possible peak intrinsic depolarization amplitudes;

multiplying the representative amplitude by a fraction to obtain the amplitude threshold criterion; and

removing possible peak intrinsic depolarizations with amplitudes below the amplitude threshold criterion from further consideration.

9. The method of claim 1 wherein the step of applying blanking intervals to possible intrinsic depolarizations is performed chronologically beginning with an earliest-occurring possible intrinsic depolarization and ending with a latest-occurring possible intrinsic depolarization.

10. A method for identifying intrinsic depolarizations of a heart chamber by an implantable medical device, comprising the steps of:

detecting a near-field electrogram signal;

detecting a far-field electrograms signal;

comparing said near-field electrogram with said far-field electrogram; and

marking, from possible oversensing events from a result of the comparing step, possible oversensing events that have amplitudes below an amplitude threshold criterion and possible oversensing events that occur within of a blanking interval period immediately after a preceding intrinsic depolarization.

11. The method of claim 10 wherein the marking step comprises:

first marking, from the possible oversensing events from the result of the comparing step, possible oversensing events that have amplitudes below an amplitude threshold criterion; and

then

second marking, from the possible oversensing events marked in the first removing step, possible oversensing events that occur within of a blanking interval period immediately after a preceding intrinsic depolarization.

12. The method of claim 10 wherein the marking step comprises:

first marking, from the possible oversensing events from the result of the comparing step, possible oversensing events that occur within of a blanking interval period immediately after a preceding intrinsic depolarization; and

then

second marking, from the possible oversensing events marked in the first removing step, possible oversensing events that have amplitudes below an amplitude threshold criterion to generate an updated identified possible oversensing events.

13. The method of claim 10 wherein the far-field electrogram signal is obtained from one of a pair of defibrillation coil electrodes, a defibrillation coil electrode and an implantable medical device housing, a tip electrode and an implantable medical device housing, a ring electrode and an implantable medical device housing, a tip electrode and a defibrillation coil electrode, a ring electrode and a defibrillation coil electrode and an electrode of one of an atrial lead and a ventricular lead and an electrode from the other one of an atrial lead and a ventricular lead.

14. The method of claim 10 wherein applying the amplitude change criteria comprises:

identifying subsets including one of;

a) increases in amplitude occurring from a first point to a second point within the subset, and from the second point to a third point within the subset, both increases being equal to or greater than a first specified amount,

b) decreases in amplitude occurring from the first point to the second point, and from the second point to the third point, both decreases being equal to or greater than a second specified amount, and

c) a change in amplitude occurring from the first point to the third point having an absolute value that is greater than a third specified amount;

marking the first point of an identified subset as a possible intrinsic depolarization;

identifying a digital sample point within a specified time interval of each possible intrinsic depolarization having the largest absolute value as a possible peak intrinsic depolarization; and

analyzing all subsets in the stream of digital sample points.

15. The method of claim 14 wherein the specified time interval comprises eight digital sample points preceding and eight digital sample points following the possible intrinsic depolarization.

16. The method of claim 14 wherein the representative amplitude corresponds to roughly the 75^th percentile of all possible peak intrinsic depolarization amplitudes, and wherein the fraction is approximately 0.57.

17. The method of claim 10 wherein applying an amplitude threshold criterion comprises:

determining a representative amplitude corresponding to a certain percentile rank of all possible peak intrinsic depolarization amplitudes;

multiplying the representative amplitude by a fraction to obtain the amplitude threshold criterion; and

removing possible peak intrinsic depolarizations with amplitudes below the amplitude threshold criterion from further consideration.

18. The method of claim 10 wherein the step of applying blanking intervals to possible intrinsic depolarizations is performed chronologically beginning with an earliest-occurring possible intrinsic depolarization and ending with a latest-occurring possible intrinsic depolarization.

19. A method of detecting the occurrence of intrinsic depolarizations of a heart chamber comprising:

obtaining a far-field electrogram signal comprising a stream of digital sample points;

generating identified possible intrinsic depolarizations by applying amplitude change criteria to subsets of the stream of digital sample points, the subsets comprising at least three digital sample points within the stream;

removing, from the identified possible intrinsic depolarizations, possible intrinsic depolarizations that occur within a blanking interval period immediately after a preceding intrinsic depolarization to generate first updated identified possible intrinsic depolarizations;

then

removing, from the first updated identified possible intrinsic depolarizations, possible intrinsic depolarizations that have amplitudes below an amplitude threshold criterion to generate second updated identified possible depolarizations; and

marking the second updated identified possible intrinsic depolarizations as sensed events from the far-field electrogram signal.

20. The method of claim 19 wherein the far-field electrogram signal is obtained from one of a pair of defibrillation coil electrodes, a defibrillation coil electrode and an implantable medical device housing, a tip electrode and an implantable medical device housing, a ring electrode and an implantable medical device housing, a tip electrode and a defibrillation coil electrode, a ring electrode and a defibrillation coil electrode and an electrode of one of an atrial lead and a ventricular lead and an electrode from the other one of an atrial lead and a ventricular lead.

21. The method of claim 19 wherein applying the amplitude change criteria comprises:

identifying subsets including one of;

a) increases in amplitude occurring from a first point to a second point within the subset, and from the second point to a third point within the subset, both increases being equal to or greater than a first specified amount,

b) decreases in amplitude occurring from the first point to the second point, and from the second point to the third point, both decreases being equal to or greater than a second specified amount, and

c) a change in amplitude occurring from the first point to the third point having an absolute value that is greater than a third specified amount;

marking the first point of an identified subset as a possible intrinsic depolarization;

identifying a digital sample point within a specified time interval of each possible intrinsic depolarization having the largest absolute value as a possible peak intrinsic depolarization; and

analyzing all subsets in the stream of digital sample points.

22. The method of claim 21 wherein the specified time interval comprises eight digital sample points preceding and eight digital sample points following the possible intrinsic depolarization.

23. The method of claim 19 wherein applying an amplitude threshold criterion comprises:

determining a representative amplitude corresponding to a certain percentile rank of all possible peak intrinsic depolarization amplitudes;

multiplying the representative amplitude by a fraction to obtain the amplitude threshold criterion; and

removing possible peak intrinsic depolarizations with amplitudes below the amplitude threshold criterion from further consideration.

24. The method of claim 23 wherein the representative amplitude corresponds to roughly the 75^th percentile of all possible peak intrinsic depolarization amplitudes, and wherein the fraction is approximately 0.57.

25. The method of claim 19 wherein the step of applying blanking intervals to possible intrinsic depolarizations is performed chronologically beginning with an earliest-occurring possible intrinsic depolarization and ending with a latest-occurring possible intrinsic depolarization.

26. A method for identifying oversensing of cardiac events, comprising the steps of:

obtaining a far-field electrogram signal comprising a stream of digital sample points;

generating identified possible intrinsic depolarizations by applying amplitude change criteria to subsets of the stream of digital sample points, the subsets comprising at least three digital sample points within the stream;

marking, from the identified possible intrinsic depolarizations, possible intrinsic depolarizations that occur outside of a blanking interval period immediately after a preceding intrinsic depolarization to generate first updated identified possible intrinsic depolarizations;

then

marking, from the first updated identified possible intrinsic depolarizations, possible intrinsic depolarizations that have amplitudes above an amplitude threshold criterion to denote sensed events from the far-field electrogram signal.

27. The method of claim 26 wherein the far-field electrogram signal is obtained from one of a pair of defibrillation coil electrodes, a defibrillation coil electrode and an implantable medical device housing, a tip electrode and an implantable medical device housing, a ring electrode and an implantable medical device housing, a tip electrode and a defibrillation coil electrode, a ring electrode and a defibrillation coil electrode and an electrode of one of an atrial lead and a ventricular lead and an electrode from the other one of an atrial lead and a ventricular lead.

28. The method of claim 26 wherein applying the amplitude change criteria comprises:

identifying subsets including one of;

a) increases in amplitude occurring from a first point to a second point within the subset, and from the second point to a third point within the subset, both increases being equal to or greater than a first specified amount,

b) decreases in amplitude occurring from the first point to the second point, and from the second point to the third point, both decreases being equal to or greater than a second specified amount, and

c) a change in amplitude occurring from the first point to the third point having an absolute value that is greater than a third specified amount;

marking the first point of an identified subset as a possible intrinsic depolarization;

identifying a digital sample point within a specified time interval of each possible intrinsic depolarization having the largest absolute value as a possible peak intrinsic depolarization; and

analyzing all subsets in the stream of digital sample points.

29. The method of claim 28 wherein the specified time interval comprises eight digital sample points preceding and eight digital sample points following the possible intrinsic depolarization.

30. The method of claim 26 wherein applying an amplitude threshold criterion comprises:

determining a representative amplitude corresponding to a certain percentile rank of all possible peak intrinsic depolarization amplitudes;

multiplying the representative amplitude by a fraction to obtain the amplitude threshold criterion; and

removing possible peak intrinsic depolarizations with amplitudes below the amplitude threshold criterion from further consideration.

31. The method of claim 30 wherein the representative amplitude corresponds to roughly the 75^th percentile of all possible peak intrinsic depolarization amplitudes, and wherein the fraction is approximately 0.57.

36. The method of claim 26 wherein the step of applying blanking intervals to possible intrinsic depolarizations is performed chronologically beginning with an earliest-occurring possible intrinsic depolarization and ending with a latest-occurring possible intrinsic depolarization.

37. A method for identifying oversensing of cardiac events, comprising the steps of:

obtaining a far-field electrogram signal comprising a stream of digital sample points;

generating identified possible intrinsic depolarizations by applying amplitude change criteria to subsets of the stream of digital sample points, the subsets comprising at least three digital sample points within the stream;

marking, from the identified possible intrinsic depolarizations, possible intrinsic depolarizations that have amplitudes above an amplitude threshold criterion to generate first updated identified possible intrinsic depolarizations;

then

marking, from the first updated identified possible intrinsic depolarizations, possible intrinsic depolarizations that occur outside of a blanking interval period immediately after a preceding intrinsic depolarization to denote sensed events from the far-field electrogram signal.

38. The method of claim 37 wherein the far-field electrogram signal is obtained from one of a pair of defibrillation coil electrodes, a defibrillation coil electrode and an implantable medical device housing, a tip electrode and an implantable medical device housing, a ring electrode and an implantable medical device housing, a tip electrode and a defibrillation coil electrode, a ring electrode and a defibrillation coil electrode and an electrode of one of an atrial lead and a ventricular lead and an electrode from the other one of an atrial lead and a ventricular lead.

39. The method of claim 37 wherein applying the amplitude change criteria comprises:

identifying subsets including one of;

a) increases in amplitude occurring from a first point to a second point within the subset, and from the second point to a third point within the subset, both increases being equal to or greater than a first specified amount,

b) decreases in amplitude occurring from the first point to the second point, and from the second point to the third point, both decreases being equal to or greater than a second specified amount, and

c) a change in amplitude occurring from the first point to the third point having an absolute value that is greater than a third specified amount;

marking the first point of an identified subset as a possible intrinsic depolarization;

identifying a digital sample point within a specified time interval of each possible intrinsic depolarization having the largest absolute value as a possible peak intrinsic depolarization; and

analyzing all subsets in the stream of digital sample points.

40. The method of claim 39 wherein the specified time interval comprises eight digital sample points preceding and eight digital sample points following the possible intrinsic depolarization.

41. The method of claim 37 wherein applying an amplitude threshold criterion comprises:

determining a representative amplitude corresponding to a certain percentile rank of all possible peak intrinsic depolarization amplitudes;

multiplying the representative amplitude by a fraction to obtain the amplitude threshold criterion; and

removing possible peak intrinsic depolarizations with amplitudes below the amplitude threshold criterion from further consideration.

42. The method of claim 41 wherein the representative amplitude corresponds to roughly the 75^th percentile of all possible peak intrinsic depolarization amplitudes, and wherein the fraction is approximately 0.57.

43. The method of claim 37 wherein the step of applying blanking intervals to possible intrinsic depolarizations is performed chronologically beginning with an earliest-occurring possible intrinsic depolarization and ending with a latest-occurring possible intrinsic depolarization.