Identifying lead problems using amplitudes of far-field cardiac events

• US 9,199,078 B1
• Filed: 10/24/2014
• Issued: 12/01/2015
• Est. Priority Date: 10/24/2014
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Gunderson, Bruce D.
• Primary Examiner(s): GETZOW, SCOTT M
• Application Number:
  US14/522,722
• Time in Patent Office: 403 Days
• US Class Current: 1/1
• CPC Class Codes: A61N 1/05 for implantation or insertion into the body, e.g. heart electrode A61N1/06 takes precedence
• CPC Class Codes: A61N 1/0563 specially adapted for defibrillation or cardioversion
• CPC Class Codes: A61N 1/3925 Monitoring; Protecting

Abstract

An implantable medical device capable of sensing cardiac signals and delivering cardiac electrical stimulation therapies is enabled to detect a short circuit condition on a sensing or therapy vector. A cardiac signal is sensed by a sensing module coupled to electrodes. A control module detects a short circuit condition in response to a significant drop in amplitude of far-field cardiac events coincident to near-field cardiac events. In some instances, the short circuit condition is detected in response an abnormal impedance on the far-field sensing vector and/or a matching morphology of the far-field cardiac electrical signal including the coincident FF cardiac event in addition to the significant drop in amplitude of the coincident FF cardiac events.

Claims

1. A method comprising:

obtaining a near-field (NF) cardiac electrical signal sensed via a NF sensing vector between a first pair of electrodes located within a first chamber of a heart;

obtaining a far-field (FF) cardiac electrical signal sensed via a FF sensing vector between a second pair of electrodes, wherein at least one of the second pair of electrodes is located outside the first heart chamber of the heart;

detecting a NF cardiac event in the NF cardiac electrical signal;

determining an amplitude of a FF cardiac event in the FF cardiac electrical signal coincident the detected NF cardiac event;

comparing the amplitude of the coincident FF cardiac event to a threshold amplitude; and

detecting a short circuit condition on the FF sensing vector when the amplitude of the coincident FF cardiac event is less than the threshold amplitude.

2. The method of claim 1, further comprising:

in response to the amplitude of the coincident FF cardiac event being less than the threshold amplitude, comparing a morphology of a portion of the FF cardiac electrical signal that includes the coincident FF cardiac event to a morphology template,

wherein detecting the presence of the short circuit condition comprises detecting the presence of the short circuit condition when the amplitude of the coincident FF cardiac event is less than the threshold amplitude and the morphology of the coincident FF cardiac event matches the morphology template.

3. The method of claim 2, wherein the comparing of the morphology of the portion of the FF cardiac electrical signal that includes the coincident FF cardiac event to the morphology template is independent of amplitude.

4. The method of claim 2, further comprising:

in response to the amplitude of the coincident FF cardiac event being less than the threshold amplitude and the morphology of the coincident FF cardiac event matching the morphology template, obtaining one or more impedance measurements of the FF sensing vector; and

comparing the one or more impedance measurements of the FF sensing vector to an impedance threshold;

wherein detecting the presence of the short circuit condition comprises detecting the presence of the short circuit condition when the amplitude of the coincident FF cardiac event is less than the threshold amplitude, the morphology of the coincident FF cardiac event matches the morphology template, and at least one of the one or more impedance measurements is less than the impedance threshold.

5. The method of claim 1, wherein obtaining the FF cardiac electrical signal sensed via the FF sensing vector comprises obtaining a FF cardiac electrical signal sensed via a FF sensing vector between a first electrode on a lead and a second electrode on a housing of the an implantable medical device.

6. The method of claim 1, further comprising:

in response to the amplitude of the coincident FF cardiac event being less than the threshold amplitude, obtaining one or more impedance measurements of the FF sensing vector; and

comparing the one or more impedance measurements of the FF sensing vector to an impedance threshold;

wherein detecting the presence of the short circuit condition comprises detecting the presence of the short circuit condition when the amplitude of the coincident FF cardiac event is less than the threshold amplitude and at least one of the one or more impedance measurements is less than the impedance threshold.

7. The method of claim 1, further comprising periodically sensing the FF cardiac electrical signal via the FF sensing vector.

8. The method of claim 1, further comprising sensing the FF cardiac electrical signal via the FF sensing vector in response to detecting at least one of a pre-identified heart rate, a pre-identified motion, a pre-identified pressure, a pre-identified respiration, and a pre-identified body posture.

9. The method of claim 1, further comprising:

periodically obtaining one or more impedance measurements of the FF sensing vector; and

comparing the one or more impedance measurements of the FF sensing vector to an impedance threshold;

in response to at least one of the one or more impedance measurements being less than the impedance threshold, sensing a far-field (FF) cardiac electrical signal via the FF sensing vector.

10. The method of claim 1, wherein the threshold amplitude is determined based on the amplitude of one or more previously detected cardiac events.

11. An implantable medical system comprising:

at least one medical electrical lead including;

a plurality of electrodes carried by the at least one medical electrical lead; and

a plurality of electrical conductors, each of the plurality of electrical conductors electrically connected to a respective one of the plurality of electrodes;

an implantable medical device electrically coupled to the at least one medical electrical lead, the implantable medical device including;

a housing at least partially formed of a conductive material, the conductive material forming a housing electrode;

a sensing module electrically coupled to a near field (NF) sensing vector between a first pair of electrodes of the plurality of electrodes carried by the lead and located within a first chamber of a heart to obtain a NF cardiac electrical signal and electrically coupled to a far-field (FF) sensing vector between a second pair of electrodes, at least one of the second pair of electrodes being located outside the first heart chamber of the heart, to obtain a FF cardiac electrical signal;

a control module electrically coupled to the sensing module, wherein the control module detects a NF cardiac event in the NF cardiac electrical signal, determines an amplitude of a FF cardiac event in the FF cardiac electrical signal coincident the detected NF cardiac event, compares the amplitude of the coincident FF cardiac event to a threshold amplitude, and detects a short circuit condition on the FF sensing vector when the amplitude of the coincident FF cardiac event is less than the threshold amplitude.

12. The implantable medical system of claim 11, wherein the control module, in response to the amplitude of the coincident FF cardiac event being less than the threshold amplitude, compares a morphology of a portion of the FF cardiac electrical signal that includes the coincident FF cardiac event to a morphology template and detects the presence of the short circuit condition when the amplitude of the coincident FF cardiac event is less than the threshold amplitude and the morphology of the coincident FF cardiac event matches the morphology template.

13. The implantable medical system of claim 12, wherein the control module compares the morphology of the portion of the FF cardiac electrical signal that includes the coincident FF cardiac event to the morphology template in a manner that is independent of amplitude.

14. The implantable medical system of claim 12, further comprising:

an impedance measurement module that, in response to the amplitude of the coincident FF cardiac event being less than the threshold amplitude and the morphology of the coincident FF cardiac event matching the morphology template, obtains one or more impedance measurements of the FF sensing vector,

wherein the control module compares the one or more impedance measurements of the FF sensing vector to an impedance threshold and detects the presence of the short circuit condition when the amplitude of the coincident FF cardiac event is less than the threshold amplitude, the morphology of the coincident FF cardiac event matches the morphology template, and at least one of the one or more impedance measurements is less than the impedance threshold.

15. The implantable medical system of claim 11, wherein the second pair of electrodes of the FF sensing vector comprises a first electrode of the plurality of electrodes carried on the lead and the housing electrode.

16. The implantable medical system of claim 11, wherein the second pair of electrodes of the FF sensing vector comprises a first electrode of the plurality of electrodes carried on the lead and a second electrode of the plurality of electrodes carried on the lead, the second electrode of the plurality of electrodes carried on the lead being located outside the first heart chamber of the heart.

17. The implantable medical system of claim 11, further comprising:

an impedance measurement module that, in response to the amplitude of the coincident FF cardiac event being less than the threshold amplitude, obtains one or more impedance measurements of the FF sensing vector,

wherein the control module compares the one or more impedance measurements of the FF sensing vector to an impedance threshold and detects the presence of the short circuit condition when the amplitude of the coincident FF cardiac event is less than the threshold amplitude and at least one of the one or more impedance measurements is less than the impedance threshold.

18. The implantable medical system of claim 11, further comprising:

a physiological sensor configured to measure at least one of motion, pressure, respiration, or body posture,

wherein the control module detects at least one of a pre-identified motion, a pre-identified pressure, a pre-identified respiration, or a pre-identified body posture based on the output of the physiological sensor and controls the sensing module to obtain the FF cardiac electrical signal via the FF sensing vector in response to detecting at least one of a pre-identified motion, a pre-identified pressure, a pre-identified respiration, and a pre-identified body posture.

19. The implantable medical system of claim 11, further comprising:

an impedance measurement module that periodically obtains one or more impedance measurements of the FF sensing vector,

wherein the control module compares the one or more impedance measurements of the FF sensing vector to an impedance threshold and in response to at least one of the one or more impedance measurements being less than the impedance threshold, controls the sensing module to obtain the FF cardiac electrical signal via the FF sensing vector.

20. The implantable medical system of claim 11, wherein the threshold amplitude is determined based on the amplitude of one or more previously detected cardiac events.

21. The implantable medical system of claim 11, wherein the sensing module includes:

a first sensing channel that obtains the NF cardiac electrical signal via the NF sensing vector, the first sensing channel including a first sensing amplifier; and

a second sensing channel the obtains the FF cardiac electrical signal via the FF sensing vector, the second sensing channel including a second sensing amplifier that is periodically powered on to obtain the FF cardiac electrical signal via the FF sensing vector.