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

• US 9,795,312 B2
• Filed: 07/24/2014
• Issued: 10/24/2017
• Est. Priority Date: 04/24/2014
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Greenhut, Saul E, Stadler, Robert W, Zhang, Xusheng
• Primary Examiner(s): Layno, Carl H
• Assistant Examiner(s): GHAND, JENNIFER LEIGH-STEWAR
• Application Number:
  US14/340,189
• Publication Number:
  US 20150305639A1
• Time in Patent Office: 1,188 Days
• CPC Class Codes: A61B 5/25 Bioelectric electrodes therefor
• CPC Class Codes: A61B 5/273 Connection of cords, cables or leads to electrodes
• CPC Class Codes: A61B 5/283 Invasive
• CPC Class Codes: A61B 5/29 for permanent or long-term implantation
• CPC Class Codes: A61B 5/341 Vectorcardiography [VCG]
• CPC Class Codes: A61B 5/352 Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval

Abstract

A method and medical device for determining sensing vectors that includes sensing cardiac signals from a plurality of electrodes, the plurality of electrodes forming a plurality of sensing vectors, setting a blanking period and a blanking period adjustment window for the plurality of sensing vectors in response to the sensed cardiac signals, determining first signal differences during the blanking period adjustment window, and adjusting the blanking period in response to the determined first signal differences.

Claims

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

sensing a cardiac signal obtained from a plurality of electrodes, the plurality of electrodes forming a plurality of sensing vectors;

setting a blanking period and a blanking period adjustment window for the plurality of sensing vectors in response to the sensed cardiac signal as sensed by the sensing vector;

determining, for each one of the plurality of sensing vectors, first minimum signal differences between the sensed cardiac signal as sensed by the sensing vector and a sensing threshold during the blanking period adjustment window;

setting a quality metric window extending subsequent to the blanking period adjustment window;

determining, for each one the plurality of sensing vectors, second minimum signal differences between and the sensed cardiac signal as sensed by the sensing vector and the sensing threshold during the quality metric window;

ranking the sensing vectors of the plurality of sensing vectors based on the determined second minimum signal differences; and

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

2. The method of claim 1, further comprising for each of the sensing vectors, sensing an R-wave in response to the cardiac signal exceeding the sensing threshold, wherein setting the blanking period adjustment window and the quality metric window comprises setting the blanking period adjustment window and the quality metric window individually for each sensing vector based on the sensed R-wave for that sensing vector.

3. The method of claim 2, wherein determining the first minimum signal differences and the second minimum signal differences for each of the sensing vectors comprises:

determining a first value of a plurality of values comprising the first minimum signal differences by determining a minimum signal difference between the cardiac signal sensed by that sensing vector and the sensing threshold during the blanking period adjustment window as set based on the sensed R-wave; and

determining a first value of a plurality of values comprising the second minimum signal differences by determining a minimum signal difference between the cardiac signal sensed by the sensing vector and the sensing threshold during the quality metric window as set based on the sensed R-wave.

4. The method of claim 1,

wherein ranking the sensing vectors of the plurality of sensing vectors based on the determined second minimum signal differences comprises:

determining a vector selection metric for each of the plurality of sensing vectors based on the determined second minimum signal differences;

comparing the determined vector selection metric from each of the plurality of sensing vectors to each other; and

determining a first ranked sensing vector having a first vector selection metric, a second ranked sensing vector having a second vector selection metric less than the first vector selection metric, and a third ranked sensing vector having a third selection metric less than the second selection metric in response to comparing the determined vector selection metrics, wherein selecting the one or more sensing vectors comprises selecting the first ranked sensing vector and the second ranked sensing vector.

5. The method of claim 4, wherein determining the vector selection metric for each of the plurality of sensing vectors based on the determined second minimum signal differences comprises:

determining that a threshold number of second minimum signal differences have been determined for each of the plurality of sensing vectors,

determining, for each of the plurality of sensing vectors, a median value of the second minimum signal differences as sensed by that sensing vector; and

determining the vector selection metric based on the median value of the second minimum signal differences.

6. The method of claim 4, further comprising:

determining a blanking period adjustment metric for each of at least the first ranked sensing vector and the second ranked sensing vector of the plurality of sensing vectors based on the determined first minimum signal differences for each of at least the first ranked sensing vector and the second ranked sensing vector of the plurality of sensing vectors;

comparing a first blanking period adjustment metric determined for the first ranked sensing vector to the first vector selection metric and a second blanking period adjustment metric determined for the second ranked sensing vector to the second vector selection metric; and

determining whether to adjust the blanking period based on comparing the first and second blanking period adjustment metrics to the first and second vector selection metrics.

7. The method of claim 6, wherein determining a blanking period adjustment metric for each of the plurality of sensing vectors based on the determined first minimum signal differences comprises:

determining, for each of the plurality of sensing vectors, a median value of the first minimum signal differences as sensed by that sensing vector; and

setting the blanking period adjustment metric for the sensing vector based on the median value determined for that sensing vector.

8. The method of claim 6, wherein determining whether to adjust the blanking period based on comparing one of the blanking period adjustment metrics to one of the vector selection metrics comprises:

determining that the blanking period adjustment metric is less than a proportion of the vector selection metric and is less than a minimum blanking period threshold; and

adjusting the blanking period based on these determinations.

9. The method of claim 8, wherein the proportion is one half and the minimum blanking period threshold is 0.05 millivolts.

10. The method of claim 1, further comprising determining whether to adjust the blanking period for one or more of the plurality of sensing vectors based on the determined first minimum signal differences for that sensing vector.

11. The method of claim 10, wherein adjusting the blanking period comprises increasing the blanking period to extend within the blanking period adjustment window.

12. The method of claim 10, wherein determining whether to adjust the blanking period for the one or more of the plurality of sensing vectors comprises, for each of the one or more of the plurality of sensing vectors:

determining a blanking period adjustment metric based on the determined first minimum signal differences for the sensing vector;

comparing the determined blanking period adjustment metric to a threshold; and

determining whether to adjust the blanking period for the sensing vector based on the comparison.

13. The method of claim 12, wherein comparing the determined blanking period adjustment metric to the threshold comprises comparing the determined blanking period adjust metric to at least one of a predetermined threshold or a threshold determined based on the determined second minimum signal differences for the sensing vector.

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

a sense amplifier configured to sense a cardiac signal obtained from a plurality of electrodes capable of forming a plurality of sensing vectors for sensing the cardiac signal; and

a processor configured to;

set a blanking period and a blanking period adjustment window for the plurality of sensing vectors in response to the sensed cardiac signal as sensed by the sensing vector,

determine, for each one of the plurality of sensing vectors, first minimum signal differences between the sensed cardiac signal as sensed by the sensing vector and a sensing threshold during the blanking period adjustment window,

set a quality metric window extending subsequent to the blanking period adjustment window,

determine, for each one of the plurality of sensing vectors, second minimum signal differences between the sensed cardiac signal as sensed by the sensing vector and the sensing threshold during the quality metric window,

rank the sensing vectors of the plurality of sensing vectors based on the determined second minimum signal differences, and

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

15. The medical device of claim 14, wherein the processor is further configured to, for each of the sensing vectors, detect an R-wave in response to the cardiac signal exceeding the sensing threshold, and to set the blanking period adjustment window and the quality metric window comprising setting the blanking period adjustment window and the quality metric window individually for each sensing vector based on the sensed R-wave for that sensing vector.

16. The medical device of claim 14, wherein to rank the sensing vectors of the plurality of sensing vectors based on the determined second minimum signal differences, the processor is further configured to:

determine a vector selection metric for each of the plurality of sensing vectors based on the determined second minimum signal differences, compare the determined vector selection metric from each of the plurality of sensing vectors, and determine a first ranked sensing vector having a first vector selection metric, a second ranked sensing vector having a second vector selection metric less than the first vector selection metric, and a third ranked sensing vector having a third selection metric less than the second selection metric in response to comparing the determined vector selection metrics, wherein selecting the one or more sensing vectors comprises selecting the first ranked sensing vector and the second ranked sensing vector.

17. The medical device of claim 16, wherein to determine the vector selection metric for each of the plurality of sensing vectors based on the determined second minimum signal differences, the processor is further configured to:

determine that a threshold number of second minimum signal differences have been determined for each of the plurality of sensing vectors;

determine, for each of the plurality of sensing vectors, a median value of the second minimum signal differences as sensed by that sensing vector; and

determine the vector selection metric based on the median value of the second minimum signal differences.

18. The medical device of claim 16, wherein the processor is further configured to determine a blanking period adjustment metric for each of the plurality of sensing vectors in response to the determined first minimum signal differences, compare a first blanking period adjustment metric determined for the first ranked sensing vector to the first vector selection metric and a second blanking period adjustment metric determined for the second ranked sensing vector to the second vector selection metric, and determine whether to adjust the blanking period in response to comparing the first and second blanking period adjustment metrics to the first and second vector selection metrics.

19. The medical device of claim 18, wherein to determine a blanking period adjustment metric for each of the plurality of sensing vectors based on the determined first minimum signal differences, the processor is further configured to:

determine, for each of the plurality of sensing vectors, a median value of the first minimum signal differences as sensed by that sensing vector; and

set the blanking period adjustment metric for the sensing vector based on the median value determined for that sensing vector.

20. The medical device of claim 18, wherein to determine whether to adjust the blanking period based on comparing one of the blanking period adjustment metrics to one of the vector selection metrics, the processor is further configured to:

determine that the first blanking period adjustment metric is less than a proportion of the first vector selection metric and is less than a minimum blanking period threshold, and

adjust the blanking period based on these determinations.

21. The medical device of claim 20, wherein the proportion is one half and the minimum blanking period threshold is 0.05 millivolts.

22. The medical device of claim 14, wherein the processor is further configured to determine whether to adjust the blanking period for one or more of the plurality of sensing vectors based on the determined first minimum signal differences for that sensing vector.

23. The medical device of claim 22, wherein adjusting the blanking period comprises increasing the blanking period to extend within the blanking period adjustment window.

24. The medical device of claim 22, wherein to determine whether to adjust the blanking period for the one or more of the plurality of sensing vectors for each of the one or more of the plurality of sensing vectors, the processor is further configured to:

determine a blanking period adjustment metric based on the determined first minimum signal differences for the sensing vector;

compare the determined blanking period adjustment metric to a threshold; and

determine whether to adjust the blanking period for the sensing vector based on the comparison.

25. The medical device of claim 24, wherein the processor is further configured to compare the determined blanking period adjustment metric to the threshold by comparing the determined blanking period adjust metric to at least one of a predetermined threshold or a threshold determined based on the determined second minimum signal differences for the sensing vector.

26. The medical device of claim 14, wherein to determine the first minimum signal differences and the second minimum signal differences for each of the sensing vectors, the processor is further configured to:

determine a first value of a plurality of values comprising the first minimum signal differences by determining a minimum signal difference between the cardiac signal sensed by that sensing vector and the sensing threshold during the blanking period adjustment window as set based on the sensed R-wave; and

determine a first value of a plurality of values comprising the second minimum signal differences by determining a minimum signal difference between the cardiac signal sensed by the sensing vector and the sensing threshold during the quality metric window as set based on the sensed R-wave.

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

sensing a cardiac signal obtained from a plurality of electrodes, the plurality of electrodes forming a plurality of sensing vectors;

setting a blanking period and a blanking period adjustment window for the plurality of sensing vectors in response to the sensed cardiac signal as sensed by the sensing vector;

determining, for each one of the plurality of sensing vectors, first minimum signal differences between the sensed cardiac signal as sensed by the sensing vector and a sensing threshold during the blanking period adjustment window;

setting a quality metric window extending subsequent to the blanking period adjustment window;

determining, for each one the plurality of sensing vectors, second minimum signal differences between and the sensed cardiac signal as sensed by the sensing vector and the sensing threshold during the quality metric window;

ranking the sensing vectors of the plurality of sensing vectors based on the determined second minimum signal differences; and

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