Periodic electrical lead intergrity testing system and method for implantable cardiac stimulating devices

• US 5,549,646 A
• Filed: 12/06/1994
• Issued: 08/27/1996
• Est. Priority Date: 12/06/1994
• Status: Expired due to Term

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories)
• Inventors: Katz, Samuel M., Schloss, Harold C.
• Primary Examiner(s): Kamm, William E.
• Assistant Examiner(s): LAYNO, CARL HERNANDZ
• Application Number:
  US08/349,862
• Time in Patent Office: 630 Days
• Field of Search: 607/4, 607/5, 607/8
• US Class Current: 607/8
• CPC Class Codes: A61N 1/3706 Pacemaker parameters stimulation threshold A61N1/371
• CPC Class Codes: A61N 1/3937 Monitoring output parameters

Abstract

A periodic electrical lead integrity testing system is provided which periodically tests electrical leads used with an implantable cardiac stimulating device. The system is especially advantageous in multi-functional implantable cardiac stimulating devices. Lead integrity is evaluated by periodically comparing the impedance of the electrical leads to a reference impedance. A pass/fail algorithm is used to determine if electrical lead integrity has been compromised. The system improves the efficacy and safety of implantable cardiac stimulating devices by detecting electrical failures independent of the delivery of therapeutic shocks. The required circuitry adds only minimal complexity and cost to the implantable cardiac stimulating device.

Claims

1. An implantable cardiac stimulating device for administering electrical stimulation to cardiac tissue, said cardiac tissue having periods of refractoriness through at least one electrical lead to interrupt cardiac arrhythmias, the implantable cardiac stimulating device comprising:

high voltage shock delivery circuitry, electrically connected to said at least one electrical lead, for generating a high energy shock and for delivering said shock to cardiac tissue through said at least one electrical lead in response to a shock delivery control signal;

low voltage control circuitry for detecting the onset of a cardiac arrhythmia, for generating said shock delivery control signal to cause said high voltage shock delivery circuitry to generate and deliver said high energy shock, and for generating a lead integrity test control signal to initiate a lead integrity test on said at least one lead, said low voltage control circuitry comprising means for delivering said shock delivery control signal to said high voltage shock delivery control circuitry and further comprising means for detecting refractory periods of said cardiac tissue, wherein said low voltage control circuitry initiates lead integrity tests only during said refractory periods; and

a lead integrity testing circuit, coupled to said at least one electrical lead via said high voltage shock delivery circuitry and to said low voltage control circuitry, for performing said lead integrity test by evaluating the impedance of said at least one electrical lead in response to said lead integrity test control signal and for providing results of said lead integrity test to said low voltage control circuitry.

2. The implantable cardiac stimulating device of claim 1, wherein said means for delivering said shock delivery control signal comprises isolation circuitry for providing a communication interface between said low voltage control circuitry and said high voltage shock delivery circuitry and said lead integrity testing circuit, wherein said isolation circuitry allows communication of said shock delivery control signal, said lead integrity test control signal and said results of said lead integrity test while protecting said low voltage control circuitry from damage by high voltage operations of said high voltage shock delivery circuitry.

3. The implantable cardiac stimulating device of claim 1, wherein the low voltage control circuitry further comprises a memory circuit for storing said results from said lead integrity test.

4. The implantable cardiac stimulating device of claim 1, wherein the low voltage control circuitry further comprises a telemetry circuit for communicating said results to an external programming unit.

5. The implantable cardiac stimulating device of claim 1, wherein the low voltage control circuitry further comprises an annunicator for alerting a patient when said lead integrity testing circuit determines that lead integrity has been compromised.

6. The implantable cardiac stimulating device of claim 5, wherein the annunciation comprises a pattern of annunciation, and wherein the low voltage control circuitry further comprises control logic means for controlling the pattern of annunciation by said annunciator.

7. The implantable cardiac stimulating device of claim 5, wherein the annunciation comprises a frequency of annunciation, and wherein the low voltage control circuitry further comprises control logic means for controlling the frequency of annunciation by said annunciator.

8. The implantable cardiac stimulating device of claim 1, wherein:

said implantable cardiac stimulating device delivers said electrical stimulation through a plurality of electrical leads;

said low voltage control circuitry generates a lead selection control signal that identifies at least one lead of said plurality of leads to be tested; and

said high voltage shock delivery circuitry, in response to said lead selection control signal, couples said identified at least one lead to said lead integrity testing circuit for lead integrity testing and wherein said low voltage control circuitry further comprises means for delivering said lead selection control signal to said high voltage shock delivery control circuitry.

9. The implantable cardiac stimulating device of claim 8, wherein to evaluate the impedances of said plurality of electrical leads, said lead integrity testing circuit applies a low energy test pulse through each of said identified at least one lead in response to said lead integrity test control signal.

10. The implantable cardiac stimulating device of claim 8, wherein said low voltage control circuitry further comprises:

means for selecting a sequence of therapies, wherein each therapy comprises a selection of at least one lead of said plurality of electrical leads; and

memory means for storing said selected sequence of therapies.

11. The implantable cardiac stimulating device of claim 10, wherein said low voltage control circuitry further comprises control means for modifying said stored selected sequence of therapies in response to said results from said lead integrity test.

12. The implantable cardiac stimulating device of claim 1, wherein said low voltage control circuitry initiates said lead integrity test independently of delivery of said high energy shock.

13. The implantable cardiac stimulating device of claim 1, wherein to evaluate the impedance of said lead, said lead integrity testing circuit applies a low energy test pulse through said lead in response to said lead integrity test control signal.

14. The implantable cardiac stimulating device of claim 13, wherein said lead integrity testing circuit compares the impedance of said lead to a reference impedance.

15. The implantable cardiac stimulating device of claim 14, wherein said lead integrity testing circuit provides a logic signal to said low voltage control circuitry when lead integrity has been compromised.

16. The implantable cardiac stimulating device of claim 13, wherein said low energy test pulse comprises a pulse width, said implantable cardiac stimulating device further comprising means for selecting the pulse width of said low energy test pulse.

17. The implantable cardiac stimulating device of claim 13, wherein said low energy test pulse comprises a pulse amplitude, said implantable cardiac stimulating device further comprising means for selecting the pulse amplitude of said low energy test pulse.

18. The implantable cardiac stimulating device of claim 17, wherein said low energy test pulse comprises a pulse width, said implantable cardiac stimulating device further comprising means for selecting the pulse width of said low energy test pulse.

19. The implantable cardiac stimulating device of claim 1, wherein said low voltage control circuitry initiates lead integrity tests at predetermined intervals.

20. The implantable cardiac stimulating device of claim 19, further comprising means for selecting said predetermined intervals.

21. An implantable cardiac stimulating device for administering electrical stimulation to cardiac tissue through a plurality of electrical leads to interrupt cardiac arrhythmias, the implantable cardiac stimulating device comprising:

high voltage shock delivery circuitry, electrically connected to said plurality of electrical leads, for generating a high energy shock and for delivering said shock to cardiac tissue through said plurality of electrical leads in response to a shock delivery control signal;

low voltage control circuitry for detecting the onset of a cardiac arrhythmia, for generating said shock delivery control signal to cause said high voltage shock delivery circuitry to generate and deliver said high energy shock, and for generating a lead integrity test control signal to initiate a lead integrity test on at least one of said plurality of electrical leads, said low voltage control circuitry comprising means for delivering said shock delivery control signal and said lead selection control signal to said high voltage shock delivery control circuitry and said low voltage control circuitry generates a lead selection control signal that identifies said at least one of said plurality of electrical leads to be tested; and

a lead integrity testing circuit, coupled to said plurality of electrical leads via said high voltage shock delivery circuitry and to said low voltage control circuitry, for performing said lead integrity test by evaluating the impedance of said at least one of said plurality of electrical leads in response to said lead integrity test control signal and for providing results of said lead integrity test to said low voltage control circuitry,

wherein said high voltage shock delivery circuitry, in response to said lead selection control signal, couples said identified at least one of said plurality of electrical leads to said lead integrity testing circuit for lead integrity testing, and further wherein to evaluate the impedances of said plurality of electrical leads, said lead integrity testing circuit applies a low energy test pulse through each of said identified at least one of said plurality of electrical leads in response to said lead integrity test control signal and further wherein said lead integrity testing circuit applies a different low energy test pulse through each of said identified at least one of said plurality of electrical leads in response to said lead integrity test control signal.

22. The implantable cardiac stimulating device of claim 21, wherein said low energy test pulse comprises a pulse width, said implantable cardiac stimulating device further comprising means for selecting the pulse width uniquely for the low energy test pulse associated with each electrical lead.

23. The implantable cardiac stimulating device of claim 21, wherein said low energy test pulse comprises a pulse amplitude, said implantable cardiac stimulating device further comprising means for selecting the pulse amplitude uniquely for the low energy test pulse associated with each electrical lead.

24. The implantable cardiac stimulating device of claim 23, wherein said low energy test pulse comprises a pulse width, said implantable cardiac stimulating device further comprising means for selecting the pulse width uniquely for the low energy test pulse associated with each electrical lead.

25. An implantable cardiac stimulating device coupled to a pacing lead system for delivering pacing pulses to cardiac tissue and for sensing signals representative of natural cardiac activity, and coupled to a plurality of high energy shocking leads for delivering high energy shocks to cardiac tissue, comprising:

a pacing and device control circuit comprising;

pacing pulse regulation and delivery circuitry for generating, in response to pacing pulse control signals, pacing pulses which are delivered to said cardiac tissue through said pacing lead system,

means for sensing signal representative of natural cardiac activity,

processing circuitry for amplifying and digitizing said sensed signals, and

microprocessor and logic control circuitry for analyzing said amplified and digitized signals to detect cardiac arrhythmias, for providing pacing pulse control signals and high energy shock control signals in accordance with said detected arrhythmias, and for providing lead integrity test control signals to initiate lead integrity tests on said plurality of high energy shocking leads; and

a high energy shock delivery and control circuit comprising;

a communication interface coupled to said microprocessor and logic control circuitry of said pacing and device control circuit,

high voltage shock delivery circuitry, electrically connected to said plurality of high energy shocking leads, for generating, in response to high energy shock generation control signals, high energy shocks which are delivered to cardiac tissue through said plurality of high energy shocking leads;

high energy shock control circuitry, coupled to said communication interface, for providing said high energy shock generation control signals in response to said high energy shock control signals provided by said microprocessor and logic control circuitry,

isolation circuitry for providing a communication path between said high voltage shock delivery circuitry and said high energy shock control circuitry and for providing a communication path to said communication interface while protecting said high energy shock control circuitry, said communication interface, and said pacing and device control circuit from high voltage operations of said high voltage shock delivery circuitry, and

impedance comparison circuitry, directly coupled to said high voltage shock delivery circuitry and coupled to said microprocessor and logic control circuitry through said isolation circuitry and said communication interface, for performing lead integrity tests on said plurality of high energy shocking leads in response to said lead integrity test control signals and for providing results of said lead integrity tests to said microprocessor and logic control circuitry, wherein, to evaluate the impedance of said lead, said impedance comparison circuitry applies at least one low energy test pulse through said plurality of high energy shocking leads in response to said lead integrity test control signals.

26. The implantable cardiac stimulating device of claim 25, wherein said pacing and device control circuit further comprises memory, coupled to said microprocessor and logic control circuitry, for storing results from said lead integrity tests.

27. The implantable cardiac stimulating device of claim 25, wherein said pacing and device control circuit further comprises telemetry circuitry, coupled to said microprocessor and logic control circuitry, for communicating said results to an external programming unit.

28. The implantable cardiac stimulating device of claim 25, wherein said pacing and device control circuit further comprises an annunciator, coupled to said microprocessor and logic control circuit, for alerting a patient when said results indicate that lead integrity has been compromised.

29. The implantable cardiac stimulating device of claim 25, wherein:

said microprocessor and logic control circuitry generates high energy lead selection signals that identify leads of said plurality of high energy shocking leads to be tested; and

said microprocessor and logic control communicates said high energy lead selection signals to said high energy shock control circuitry, which in turn communicates said high energy lead selection signals through said isolation circuitry to said high voltage shock delivery circuitry which responsively couples said identified leads to said impedance comparison circuitry for lead integrity testing.

30. The implantable cardiac stimulating device of claim 25, wherein said microprocessor and logic control circuitry initiates said lead integrity tests independently of delivery of said high energy shocks.

31. The implantable cardiac stimulating device of claim 25, wherein said impedance comparison circuitry compares the impedance of said plurality of high energy shocking leads to a reference impedance while said low energy test pulses are being applied.

32. The implantable cardiac stimulating device of claim 31, wherein said impedance comparison circuitry provides a logic signal to said microprocessor and logic control circuitry when the integrity of said plurality of high energy shocking leads has been compromised.

33. The implantable cardiac stimulating device of claim 25, wherein said microprocessor and logic control circuitry initiates lead integrity tests at predetermined intervals.

34. The implantable cardiac stimulating device of claim 25, wherein said impedance comparison circuit comprises:

a reference voltage supply;

a reference impedance;

a switch for coupling said reference voltage supply to said plurality of high energy shocking leads and said reference impedance in response to said lead integrity test control signals;

a comparator for comparing the impedance of said plurality of leads to the impedance of said reference impedance, wherein said comparator provides a logic signal indicating that lead integrity has been compromised when the impedance of said plurality of leads exceeds the impedance of said reference impedance; and

a latch for temporarily storing said logic signal for subsequent retrieval by said microprocessor and logic control circuitry.

35. In an implantable cardiac stimulating device detachably coupled to a lead in contact with cardiac tissue, the implantable cardiac stimulating device including:

high voltage shock delivery circuitry, electrically coupled to said lead, for generating high energy shocks and for delivering said high energy shocks to cardiac tissue through said lead,

low voltage control circuitry for detecting the onset of cardiac arrhythmias and for causing said high voltage shock delivery circuitry to generate and deliver said high energy shocks in response to a detected cardiac arrhythmias,

means for evaluating the integrity of said lead and for generating test results, and

means for passing signals between said high voltage shock delivery circuit and said low voltage control circuitry,

a method for evaluating the integrity of said lead comprising the steps of;

generating a low energy test pulse with said high voltage shock delivery circuitry;

applying said low energy test pulse to said lead in response to a lead integrity test control signal provided by said low voltage control circuitry;

evaluating the integrity of said lead while said test pulse is being applied;

generating test results indicative of whether lead integrity has been compromised; and

providing said test results to said low voltage control circuitry.

36. The method of claim 35, wherein said providing step comprises providing said test results to said low voltage control circuitry through said means for passing signals, wherein said means for passing signals comprises an isolation circuit which protects said low voltage control circuitry from high voltage operations of said high voltage shock delivery circuitry.

37. The method of claim 35, further comprising the step of storing said test results in a memory.

38. The method claim 35, further comprising the step of using a telemetry circuit to telemetrically communicate said test results to an external programming unit.

39. The method of claim 35, further comprising the step of using an annunciator to alert a patient when said test results indicate that lead integrity has been compromised.

40. The method of claim 35, wherein said applying step comprises applying said low energy test pulse independently of delivery of said high energy shocks.

41. The method of claim 35, wherein said evaluating step comprises the step of comparing the impedance of said lead to a reference impedance.

42. The method of claim 35, wherein said cardiac stimulating device further includes means for detecting refractory periods of said cardiac tissue, the method further comprising the step of:

generating said lead integrity test control signal, said lead integrity test control signal being generated only when a refractory period of said cardiac tissue is detected by said means for detecting refractory periods.

43. An implantable cardiac stimulating device for administering electrical stimulation to cardiac tissue, said cardiac tissue having periods of refractoriness, through at least one lead to interrupt cardiac arrhythmias, the implantable cardiac stimulating device comprising:

shock delivery circuitry, electrically coupled to said at least one lead, for generating a high energy shock and for delivering said high energy shock to cardiac tissue through said at least one lead in response to a shock delivery control signal;

control circuitry for detecting the onset of a cardiac arrhythmia, for generating said shock delivery control signal to cause said shock delivery circuitry to generate and deliver said high energy shock, and for generating a lead integrity test control signal to initiate a lead integrity test on said at least one lead;

a lead integrity testing circuit, coupled to said at least one lead, for performing said lead integrity test in response to said lead integrity test control signal and for providing results of said lead integrity test to said control circuitry, wherein said lead integrity testing circuit performs said lead integrity test by applying a low energy test pulse to said at least one lead and further wherein the result of said lead integrity test comprises a pass/fail indication of the integrity of said at least one lead;

a means for passing signals between said lead integrity testing circuit and said control circuitry; and

a means for passing signals between said shock delivery circuit and said control circuitry.

44. The implantable cardiac stimulating device of claim 43, wherein the control circuitry further comprises a memory circuit for storing said results from said lead integrity test.

45. The implantable cardiac stimulating device of claim 43, wherein the control circuitry further comprises a telemetry circuit for communicating said results to an external programming unit.

46. The implantable cardiac stimulating device of claims 43, wherein the control circuitry further comprises an annunciator for alerting a patient when said result of said lead integrity test is a fail indication.

47. The implantable cardiac stimulating device of claim 46, wherein the annunciation comprises a pattern of annunciation, and wherein the control circuitry further comprises control logic means for controlling the pattern of annunciation by said annunciator.

48. The implantable cardiac stimulating device of claim 46, wherein the annunciation comprises a frequency annunciation, and wherein the control circuitry further comprises control logic means for controlling the frequency of annunciation by said annunciator.

49. The implantable cardiac stimulating device of claim 43, wherein:

said implantable cardiac stimulating device delivers said electrical stimulation through a plurality of electrical leads;

said control circuitry generates a lead selection control signal that identifies at least one lead of said plurality of leads to be tested; and

said shock delivery circuitry, in response to said lead selection control signal, couples said identified at least one lead to said lead integrity testing circuit for lead integrity testing.

50. The implantable cardiac stimulating device of claim 49, wherein to evaluate the impedances of said plurality of electrical leads, said lead integrity testing circuit applies said low energy test pulse through each of said identified at least one lead in response to said lead integrity test control signal.

51. The implantable cardiac stimulating device of claim 50, wherein said lead integrity testing circuit applies a different low energy test pulse through each of said identified at least one lead in response to said lead integrity test control signal.

52. The implantable cardiac stimulating device of claim 51, wherein said low energy test pulse comprises a pulse width, said implantable cardiac stimulating device further comprising means for selecting the pulse width uniquely for the low energy test pulse associated with each electrical lead.

53. The implantable cardiac stimulating device of claim 51, wherein said low energy test pulse comprises a pulse amplitude, said implantable cardiac stimulating device further comprising means for selecting the pulse amplitude uniquely for the low energy test pulse associated with each electrical lead.

54. The implantable cardiac stimulating device of claim 53, wherein said low energy test pulse comprises a pulse width, said implantable cardiac stimulating device further comprising means for selecting the pulse width uniquely for the low energy test pulse associated with each electrical lead.

55. The implantable cardiac stimulating device of claim 49, wherein said control circuitry further comprises:

means for selecting a sequence of therapies, wherein each therapy comprises a selection of at least one lead of said plurality of electrical leads; and

memory means for storing said selected sequence of therapies.

56. The implantable cardiac stimulating device of claim 55, wherein said control circuitry further comprises control means for modifying said stored selected sequence of therapies in response to said results from said lead integrity test.

57. The implantable cardiac stimulating device of claim 43, wherein said control circuitry initiates said lead integrity test independently of delivery of said high energy shock.

58. The implantable cardiac stimulating device of claim 43, wherein said lead integrity testing circuit compares the impedance of said lead to a reference impedance.

59. The implantable cardiac stimulating device of claim 58, wherein said lead integrity testing circuit provides a logic signal to said control circuitry when lead integrity has been compromised.

60. The implantable cardiac stimulating device of claim 43, wherein said low energy test pulse comprises a pulse width, said implantable cardiac stimulating device further comprising means for selecting the pulse width of said low energy test pulse.

61. The implantable cardiac stimulating device of claim 43, wherein said low energy test pulse comprises a pulse amplitude, said implantable cardiac stimulating device further comprising means for selecting the pulse amplitude of said low energy test pulse.

62. The implantable cardiac stimulating device of claim 61, wherein said low energy test pulse comprises a pulse width, said implantable cardiac stimulating device further comprising means for selecting the pulse width of said low energy test pulse.

63. The implantable cardiac stimulating device of claim 43, wherein said low voltage control circuitry initiates lead integrity tests at predetermined intervals.

64. The implantable cardiac stimulating device of claim 63, further comprising means for selecting said predetermined intervals.

65. The implantable cardiac stimulating device of claim 43, said control circuitry further comprising means for detecting refractory periods of said cardiac tissue, wherein said control circuitry initiates lead integrity tests only during said refractory periods.

66. The implantable cardiac stimulating device of claim 65, wherein said control circuitry initiates lead integrity tests at predetermined intervals.

67. The implantable cardiac stimulating device of claim 66, further comprising means for selecting said predetermined intervals.

68. In an implantable cardiac stimulating device detachably coupled to a lead in contact with cardiac tissue, the implantable cardiac stimulating device including:

high voltage shock delivery circuitry, electrically coupled to said lead, for generating high energy shocks and for delivering said high energy shocks to cardiac tissue through said lead,

control circuitry for detecting the onset of cardiac arrhythmias and for causing said high voltage shock delivery circuitry to generate and deliver said high energy shocks in response to a detected cardiac arrhythmias,

means for detecting refractory periods of said cardiac tissue,

means for evaluating the integrity of said lead and for generating test results, and

a means for passing signals between said high voltage shock delivery circuit and said control circuitry,

a method for evaluating the integrity of said lead comprising the steps of;

generating a lead integrity test control signal, said lead integrity test control signal being generated only when a refractory period of said cardiac tissue is detected by said means for detecting refractory periods;

generating a test pulse with said high voltage shock delivery circuitry;

applying said test pulse to said lead in response to said lead integrity test control signal provided by said low voltage control circuitry;

evaluating the integrity of said lead while said test pulse is being applied;

generating test results indicative of whether lead integrity has been compromised; and

providing said test results to said control circuitry.

69. An implantable cardiac stimulating device for administering electrical stimulation to cardiac tissue, said cardiac tissue having periods of refractoriness, through at least one lead to interrupt cardiac arrhythmias, the implantable cardiac stimulating device comprising:

shock delivery circuitry, electrically coupled to said at least one lead, for generating a high energy shock and for delivering said high energy shock to cardiac tissue through said at least one lead in response to a shock delivery control signal;

control circuitry for detecting the onset of a cardiac arrhythmia, for detecting refractory periods of said cardiac tissue, for generating said shock delivery control signal to cause said shock delivery circuitry to generate and deliver said high energy shock, and for generating a lead integrity test control signal to initiate a lead integrity test on said at least one lead, wherein said control circuitry initiates lead integrity tests only during said refractory periods;

a lead integrity testing circuit, coupled to said at least one lead, for performing said lead integrity test in response to said lead integrity test control signal and for providing results of said lead integrity test to said control circuitry, wherein the result of said lead integrity test comprises a pass/fail indication of the integrity of said at least one lead;

a means for passing signals between said lead integrity testing circuit and said control circuitry; and

a means for passing signals between said shock delivery circuit and said control circuitry.

70. In an implantable cardiac stimulating device detachably coupled to a lead in contact with cardiac tissue, the implantable cardiac stimulating device including:

high voltage shock delivery circuitry, electrically coupled to said lead, for generating high energy shocks and for delivering said high energy shocks to cardiac tissue through said lead, said high voltage shock delivery circuitry coupled to at least one high voltage capacitor for generating said high energy shocks,

control circuitry for detecting the onset of cardiac arrhythmias and for causing said high voltage shock delivery circuitry to generate and deliver said high energy shocks in response to a detected cardiac arrhythmias,

means for evaluating the integrity of said lead and for generating test results, and

a means for passing signals between said high voltage shock delivery circuit and said control circuitry,

a method for evaluating the integrity of said lead comprising the steps of;

generating a lead integrity test control signal;

generating a test pulse with said high voltage shock delivery circuitry, said test pulse generated independently of said at least one high voltage capacitor;

applying said test pulse to said lead in response to said lead integrity test control signal provided by said low voltage control circuitry;

evaluating the integrity of said lead while said test pulse is being applied;

generating test results indicative of whether lead integrity has been compromised; and

providing said test results to said control circuitry.

71. An implantable cardiac stimulating device for administering electrical stimulation to cardiac tissue, said cardiac tissue having periods of refractoriness, through at least one lead to interrupt cardiac arrhythmias, the implantable cardiac stimulating device comprising:

shock delivery circuitry, electrically coupled to said at least one lead, for generating a high energy shock and for delivering said high energy shock to cardiac tissue through said at least one lead in response to a shock delivery control signal, wherein said shock delivery circuitry comprises at least one high voltage capacitor for generating said high energy shock;

control circuitry for detecting the onset of a cardiac arrhythmia, for generating said shock delivery control signal to cause said shock delivery circuitry to generate and deliver said high energy shock, and for generating a lead integrity test control signal to initiate a lead integrity test on said at least one lead;

a lead integrity testing circuit, coupled to said at least one lead, for performing said lead integrity test in response to said lead integrity test control signal and for providing results of said lead integrity test to said control circuitry, wherein the result of said lead integrity test comprises a pass/fail indication of the integrity of said at least one lead and wherein said lead integrity test is performed independently of said at least one high voltage capacitor;

a means for passing signals between said lead integrity testing circuit and said control circuitry; and

a means for passing signals between said shock delivery circuit and said control circuitry.

72. An implantable cardiac stimulating device for administering electrical stimulation to cardiac tissue through at least one lead, the implantable cardiac stimulating device comprising:

means for detecting refractory periods of said cardiac tissue; and

means for performing a lead integrity test on said at least one lead, wherein said lead integrity test is initiated only during detected refractory periods of said cardiac tissue.

73. The implantable cardiac stimulating device of claim 72, further comprising means for storing results of said lead integrity test.

74. The implantable cardiac stimulating device of claim 72, further comprising means for communicating results of said lead integrity test to an external programming unit.

75. The implantable cardiac stimulating device of claim 72, wherein said means for performing is electrically coupled to said lead, and said means for performing comprises means for applying a test pulse to said at least one lead.

76. The implantable cardiac stimulating device of claim 75, wherein said test pulse comprises a pulse width, said implantable cardiac stimulating device further comprising means for selecting the pulse width of said test pulse.

77. The implantable cardiac stimulating device of claim 75, wherein said test pulse comprises a pulse amplitude, said implantable cardiac stimulating device further comprising means for selecting the pulse amplitude of said test pulse.

78. The implantable cardiac stimulating device of claim 72, wherein said means for performing initiates lead integrity tests at predetermined intervals.

79. The implantable cardiac stimulating device of claim 78, further comprising means for selecting said predetermined intervals.