Implantable medical device crosstalk evaluation and mitigation

• US 9,597,505 B2
• Filed: 01/30/2009
• Issued: 03/21/2017
• Est. Priority Date: 10/31/2008
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Donofrio, William T., Burnes, John E., Krause, Paul G., Zhou, Xiaohong, Arne, Gerald P., Peichel, David J., Reinke, James D.
• Primary Examiner(s): VOORHEES, CATHERINE M
• Application Number:
  US12/362,781
• Publication Number:
  US 20100114198A1
• Time in Patent Office: 2,972 Days
• Field of Search: 607 2- 9, 607 17- 18, 607 27- 30, 607/60, 600/301, 600508-512
• US Class Current: 1/1
• CPC Class Codes: A61B 5/304 Switching circuits
• CPC Class Codes: A61B 5/308 for electrocardiography [ECG]
• CPC Class Codes: A61B 5/7217 of noise originating from a therapeutic or surgical apparatus, e.g. from a pacemaker
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/3621 for treating or preventing abnormally high heart rate
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/3688 configured for switching the pacing mode, e.g. from AAI to DDD
• CPC Class Codes: A61N 1/3702 Physiological parameters A61N1/365 takes precedence; evoked response A61N1/371
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means
• CPC Class Codes: A61N 1/37282 characterised by communication with experts in remote locations using a network
• CPC Class Codes: A61N 1/3962 in combination with another heart therapy
• CPC Class Codes: A61N 1/39622 Pacing therapy
• CPC Class Codes: A61N 1/39624 Pain reduction therapy

Abstract

Electrical crosstalk between two implantable medical devices or two different therapy modules of a common implantable medical device may be evaluated, and, in some examples, mitigated. In some examples, one of the implantable medical devices or therapy modules delivers electrical stimulation to a nonmyocardial tissue site or a nonvascular cardiac tissue site, and the other implantable medical device or therapy module delivers cardiac rhythm management therapy to a heart of the patient.

Claims

1. A method comprising:

determining whether a therapy module is delivering electrical stimulation to a tissue site within a patient;

sensing electrical cardiac signals according to a first sense mode when the therapy module is delivering electrical stimulation to the tissue site; and

sensing electrical cardiac signals according to a second sense mode when the therapy module is not delivering electrical stimulation to the tissue site, wherein the first and second sense modes define different sense vectors for sensing the electrical cardiac signals.

2. The method of claim 1, wherein the tissue site comprises at least one of a nonmyocardial tissue site or a nonvascular cardiac tissue site.

3. The method of claim 1, wherein the tissue site comprises at least one of an extravascular tissue site or the tissue site proximate to a nerve of the patient.

4. The method of claim 1, wherein sensing electrical cardiac signals according to the first sense mode comprises sensing electrical cardiac signals within a left ventricle of a heart of the patient and outside of a right ventricle of the heart, and wherein sensing electrical cardiac signals according to the second sense mode comprises sensing electrical cardiac signals within the right ventricle of the heart of the patient and outside of the left ventricle of the heart.

5. The method of claim 1, wherein sensing electrical cardiac signals according to the first sense mode comprises sensing electrical cardiac signals via at least two electrodes of a lead electrically connected to a sensing module, and wherein sensing electrical cardiac signals according to the second sense mode comprises sensing electrical cardiac signals via at least one electrode of the lead electrically connected to the sensing module and a housing electrode of a medical device comprising the sensing module.

6. The method of claim 1, wherein sensing electrical cardiac signals according to the first sense mode comprises sensing electrical cardiac signals via each of a plurality of sensing vectors.

7. The method of claim 6, further comprising:

determining a weighted sum of the electrical cardiac signals sensed via each of the plurality of sensing vectors; and

determining cardiac function of the patient based on the weighted sum of the electrical cardiac signals sensed via each of the plurality of sensing vectors.

8. The method of claim 6, further comprising:

determining a difference between the electrical cardiac signals sensed via each of the plurality of sensing vectors; and

determining cardiac function of the patient based on the difference between the electrical cardiac signals sensed via each of the plurality of sensing vectors.

9. The method of claim 1, wherein sensing electrical cardiac signals according to the first sense mode comprises sensing electrical cardiac signals via external electrodes, and sensing electrical cardiac signals according to the second sense mode comprises sensing electrical cardiac signals via implanted electrodes.

10. The method of claim 1, wherein sensing electrical cardiac signals according to the first and second modes comprises sensing electrical cardiac signals via a sensing module, and wherein the first sense mode defines a first sense vector comprising a first subset of electrodes electrically connected to the sensing module and the second sense mode defines a second sense vector comprising a second subset of electrodes electrically connected to the sensing module, the first and second subsets of electrodes comprising at least one different electrode.

11. The method of claim 1, further comprising:

detecting a potential arrhythmia of a heart of the patient based on the electrical cardiac signals sensed according to the first sense mode; and

sensing the electrical cardiac signals according to the second sense mode in response to detecting the potential arrhythmia.

12. The method of claim 11, wherein detecting the potential arrhythmia based on the electrical cardiac signals sensed according to the first sense mode comprises detecting the potential arrhythmia based on the electrical cardiac signals and a non-electrophysiological parameter of the patient indicative of cardiac function.

13. The method of claim 12, wherein the non-electrophysiological parameter comprises at least one of cardiovascular pressure, tissue perfusion, blood oxygen saturation levels, heart sound signals, respiratory rate, intrathoracic impedance, cardiac mechanical activity, muscle movement, ultrasonic signals, heart rate, body temperature, or acoustic signals indicative of cardiac mechanical activity.

14. The method of claim 12, further comprising sensing the non-electrophysiological parameter of the patient indicative of cardiac function with at least one of an external or an implanted sensor.

15. The method of claim 11, wherein the therapy module comprises a first therapy module and the potential arrhythmia comprises a first potential arrhythmia, the method further comprising:

in response to detecting the first potential arrhythmia based on the electrical cardiac signals sensed according to the first sense mode, determining whether a second potential arrhythmia is detected based on the electrical cardiac signals sensed according to the second sense mode; and

delivering at least one of a pacing, cardioversion or defibrillation electrical signal to the heart of the patient with a second therapy module in response to determining the second potential arrhythmia is detected based on the electrical cardiac signals sensed according to the second sense mode.

16. The method of claim 15, wherein detecting the first potential arrhythmia based on the electrical cardiac signals sensed according to the first sense mode comprises detecting the first potential arrhythmia based on the electrical cardiac signals and a plurality of non-electrophysiological parameters of the patient indicative of cardiac function, and wherein determining whether the second potential arrhythmia is detected comprises detecting the second potential arrhythmia of the patient based on the electrical cardiac signals sensed according to the second sense mode and a fewer number of non-electrophysiological parameters of the patient than the first sense mode.

17. The method of claim 15, wherein the first and second therapy modules are enclosed in a common housing.

18. The method of claim 15, wherein the first therapy module is enclosed in a first housing of a first implantable medical device and the second therapy module is enclosed in a second housing of a second implantable medical device that is physically separate from the first implantable medical device.

19. The method of claim 11, further comprising:

determining whether the potential arrhythmia is detected based on the electrical cardiac signals sensed according to the second sense mode; and

sensing electrical cardiac signals according to the first sense mode if the potential arrhythmia is not detected based on the electrical cardiac signals sensed according to the second sense mode.

20. The method of claim 1, wherein the first and second sense modes define at least one of different sensing threshold levels or different amplifier gains for sensing the electrical cardiac signals.

21. The method of claim 1, wherein the first and second sense modes comprise different filters that are applied to the sensed electrical cardiac signals.

22. The method of claim 1, wherein the first and second sense modes comprise different potential arrhythmia event detection algorithms.

23. The method of claim 22, wherein the first sense mode defines an arrhythmia event detection algorithm that detects a potential arrhythmia based on a duration of an S-T segment of a sensed electrical cardiac signal.

24. The method of claim 1, wherein determining whether the therapy module is delivering electrical stimulation comprises at least one of receiving an indication from the therapy module or determining the therapy module is delivering stimulation based on known schedule.

25. A system comprising:

a therapy module that delivers electrical stimulation to a tissue site within a patient;

a sensing module that senses electrical cardiac signals of the patient; and

a processor that determines whether the therapy module is delivering electrical stimulation to the tissue site, controls the sensing module to sense electrical cardiac signals according to a first sense mode when the therapy module is delivering electrical stimulation to the tissue site, and controls the sensing module to sense electrical cardiac signals according to a second sense mode when the therapy module is not delivering electrical stimulation to the tissue site, wherein the first and second sense modes define different sense vectors for sensing the electrical cardiac signals.

26. The system of claim 25, wherein the tissue site comprises at least one of a nonmyocardial tissue site or a nonvascular cardiac tissue site.

27. The system of claim 25, wherein the tissue site comprises at least one of an extravascular tissue site or the tissue site proximate to a nerve of the patient.

28. The system of claim 25, wherein in the first sense mode, the sensing module senses electrical cardiac signals within a left ventricle of a heart of the patient and outside of a right ventricle of the heart, and in the second sense mode, the sensing module senses electrical cardiac signals within the right ventricle of the heart of the patient and outside of the left ventricle of the heart.

29. The system of claim 25, wherein in the first sense mode, the sensing module senses electrical cardiac signals via at least two electrodes of a lead electrically connected to a sensing module, and in the second sense mode, the sensing module senses electrical cardiac signals via at least one electrode of the lead and a housing electrode of a medical device comprising the sensing module.

30. The system of claim 25, wherein in the first sense mode, the sensing module senses electrical cardiac signals via each of a plurality of sensing vectors.

31. The system of claim 25, wherein in the first sense mode, the sensing module senses electrical cardiac signals via external electrodes, and in the second sense mode, the sensing module senses electrical cardiac signals via implanted electrodes.

32. The system of claim 25, further comprising a plurality of electrodes coupled to the sensing module, wherein the first sense mode defines a first sense vector comprising a first subset of electrodes of the plurality of electrodes and the second sense mode defines a second sense vector comprising a second subset of electrodes of the plurality of electrodes, the first and second subsets of electrodes comprising at least one different electrode.

33. The system of claim 25, wherein the processor detects a potential arrhythmia of the patient based on the electrical cardiac signals sensed by the sensing module according to the first sense mode, and controls the sensing module to sense the electrical cardiac signals according to the second sense mode upon detecting the potential arrhythmia.

34. The system of claim 33, wherein the sensing module comprises a first sensing module, the system further comprising a second sensing module that senses a non-electrophysiological parameter of the patient indicative of cardiac function, wherein the processor detects the potential arrhythmia of the patient based on the electrical cardiac signals sensed by the first sensing module according to the first sense mode and the non-electrophysiological parameter sensed by the second sensing module.

35. The system of claim 34, wherein the second sensing module is implanted within the patient.

36. The system of claim 34, wherein the second sensing module is external to the patient.

37. The system of claim 34, wherein the non-electrophysiological parameter of the patient comprises at least one of cardiovascular pressure, tissue perfusion, blood oxygen saturation levels, heart sound signals, respiratory rate, intrathoracic impedance, cardiac mechanical activity, muscle movement, ultrasonic signals, heart rate, body temperature, or acoustic signals indicative of cardiac mechanical activity.

38. The system of claim 33, wherein the therapy module comprises a first therapy module and the potential arrhythmia comprises a first potential arrhythmia, the system further comprising a second therapy module that delivers at least one of a pacing, cardioversion or defibrillation electrical signal to a heart of the patient, wherein, in response to detecting the first potential arrhythmia based on the electrical cardiac signals sensed according to the first sense mode, the processor determines whether a second potential arrhythmia is detected based on the electrical cardiac signals sensed by the sensing module according to the second sense mode and controls the second therapy module to deliver the at least one of a pacing, cardioversion or defibrillation electrical signal to the heart of the patient in response to determining the second potential arrhythmia is detected based on the electrical cardiac signals sensed according to the second sense mode.

39. The system of claim 38, wherein the sensing module comprises a first sensing module, the system further comprising a second sensing module that senses a plurality of non-electrophysiological parameters of the patient indicative of cardiac function, wherein the processor detects the first potential arrhythmia based on the electrical cardiac signals sensed by the first sensing module according to the first sense mode and a plurality of non-electrophysiological parameters sensed by the second sensing module, and determines whether the second potential arrhythmia is detected based on the electrical cardiac signals sensed by the first sensing module according to the second sense mode and a fewer number of non-electrophysiological parameters sensed by the second sensing module than in the first sense mode.

40. The system of claim 33, wherein the processor determines whether the second potential arrhythmia is detected based on the electrical cardiac signals sensed by the sensing module according to the second sense mode, and controls the sensing module to sense electrical cardiac signals according to the first sense mode if the second potential arrhythmia is not detected based on the electrical cardiac signals sensed according to the second sense mode.

41. The system of claim 25, wherein the first and second sense modes define at least one of different sensing threshold levels or different amplifier gains for sensing the electrical cardiac signals.

42. The system of claim 25, wherein the first and second sense modes comprise different filters that are applied to the sensed electrical cardiac signals.

43. The system of claim 25, wherein the first and second sense modes comprise different potential arrhythmia event detection algorithms.

44. The system of claim 43, wherein the first sense mode defines an arrhythmia event detection algorithm that detects a potential arrhythmia based on a duration of an S-T segment of a sensed electrical cardiac signal.

45. The system of claim 25, wherein the therapy module and sensing module are enclosed in a common housing.

46. The system of claim 25, wherein the therapy module is enclosed in a first housing of a first implantable medical device and the sensing module is enclosed in a second housing of a second implantable medical device that is physically separate from the first implantable medical device.

47. A system comprising:

means for determining whether a therapy module is delivering electrical stimulation to a tissue site within a patient;

means for sensing electrical cardiac signals according to a first sense mode when the therapy module is delivering electrical stimulation to the tissue site; and

means for sensing electrical cardiac signals according to a second sense mode when the therapy module is not delivering electrical stimulation to the tissue site, wherein the first and second sense modes define different sense vectors for sensing the electrical cardiac signals.

48. The system of claim 47, further comprising:

means for detecting a potential arrhythmia of the patient based on the electrical cardiac signals sensed according to the first sense mode; and

means for sensing the electrical cardiac signals according to the second sense mode upon detecting the potential arrhythmia.

49. The system of claim 48, further comprising means for sensing a non-electrophysiological parameter of the patient indicative of cardiac function, wherein the means for detecting the potential arrhythmia of the patient based on the electrical cardiac signals sensed according to the first sense mode comprises means for detecting the arrhythmia based on the electrical cardiac signals and the non-electrophysiological parameter of the patient indicative of cardiac function.

50. A non-transitory computer-readable medium comprising instructions that cause a programmable processor to:

determine whether a therapy module is delivering electrical stimulation to a tissue site within a patient;

control a sensing module to sense electrical cardiac signals according to a first sense mode when the therapy module is delivering electrical stimulation to the tissue site; and

control the sensing module to sense electrical cardiac signals according to a second sense mode when the therapy module is not delivering electrical stimulation to the tissue site, wherein the first and second sense modes define different sense vectors for sensing the electrical cardiac signals.

51. The non-transitory computer-readable medium of claim 50, wherein the instructions cause the programmable processor to:

detect a potential arrhythmia of the patient based on the electrical cardiac signals sensed according to the first sense mode; and

control the sensing module to sense the electrical cardiac signals according to the second sense mode upon detecting the potential arrhythmia.

52. A system comprising:

a therapy module that delivers electrical stimulation to a tissue site within a patient;

a sensing module that senses electrical cardiac signals of the patient; and

a processor that determines whether the therapy module is delivering electrical stimulation to the tissue site, and, in response to determining the therapy module is delivering electrical stimulation to the tissue site, controls the sensing module to sense electrical cardiac signals according to a first sense mode, and, in response to determining the therapy module is not delivering electrical stimulation to the tissue site, controls the sensing module to sense electrical cardiac signals according to a second sense mode, wherein the first and second sense modes define different sense vectors for sensing the electrical cardiac signals.