Implantable medical device crosstalk evaluation and mitigation

• US 8,774,918 B2
• Filed: 01/30/2009
• Issued: 07/08/2014
• 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): Layno, Carl H
• Assistant Examiner(s): LEE, ERICA SHENGKAI
• Application Number:
  US12/362,838
• Publication Number:
  US 20100114201A1
• Time in Patent Office: 1,985 Days
• Field of Search: 607 1- 18, 607115-118, 600/515
• US Class Current: 607/14
• 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 1/025 Digital circuitry features of electrotherapy devices, e.g. memory, clocks, processors
• CPC Class Codes: A61N 1/0551 Spinal or peripheral nerve electrodes
• CPC Class Codes: A61N 1/36185 Selection of the electrode configuration
• CPC Class Codes: A61N 1/3621 for treating or preventing abnormally high heart rate
• CPC Class Codes: A61N 1/3686 configured for selecting the electrode configuration on a lead A61N1/3688 takes precedence
• CPC Class Codes: A61N 1/3702 Physiological parameters A61N1/365 takes precedence; evoked response A61N1/371
• CPC Class Codes: A61N 1/3706 Pacemaker parameters stimulation threshold A61N1/371
• CPC Class Codes: A61N 1/3718 Monitoring of or protection against external electromagnetic fields or currents
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means
• CPC Class Codes: A61N 1/37288 Communication to several implantable medical devices within one patient
• 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;

monitoring cardiac function of a heart of a patient according to a first sense mode in response to determining the therapy module is delivering electrical stimulation to the tissue site;

monitoring cardiac function of the heart of the patient according to a second sense mode in response to determining the therapy module is not delivering electrical stimulation to the tissue site

detecting a potential arrhythmia of the heart of the patient based on the cardiac function monitored according to the first sense mode;

in response to detecting the potential arrhythmia, stopping the monitoring of cardiac function according to the first sense mode and monitoring cardiac function of the heart of the patient according to the second sense mode, wherein the first and second sense modes comprise at least one different sensing parameter; and

determining whether the potential arrhythmia is detected based on the cardiac function monitored according to the second sense mode.

2. The method of claim 1, wherein the therapy module comprises a first therapy module, the method further comprising delivering at least one of a pacing, cardioversion or defibrillation electrical therapy to the heart of the patient with a second therapy module in response to determining the potential arrhythmia is detected based on the cardiac function monitored according to the second sense mode.

3. The method of claim 2, wherein the first and second therapy modules are enclosed in a common housing.

4. The method of claim 2, 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.

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

6. 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.

7. The method of claim 1, wherein monitoring cardiac function according to the first sense mode and monitoring cardiac function according to the second mode comprises sensing electrical cardiac signals, and wherein the first and second sense modes define different sense vectors for sensing the electrical cardiac signals.

8. The method of claim 1, wherein monitoring cardiac function 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 monitoring cardiac function 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.

9. The method of claim 1, wherein monitoring cardiac function of the heart of the patient according to the second sense mode comprises monitoring cardiac function of the heart of the patient based on at least one different non-electrophysiological parameter of the patient compared to the first sense mode.

10. The method of claim 9, wherein monitoring cardiac function of the heart of the patient according to the second sense mode comprises monitoring cardiac function of the heart of the patient based on fewer non-electrophysiological parameters of the patient compared to the first sense mode.

11. The method of claim 1, wherein monitoring cardiac function of the heart of the patient according to the first sense mode comprises monitoring at least one non-electrophysiological parameter of the patient, the non-electrophysiological parameter comprising 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.

12. The method of claim 1, further comprising monitoring cardiac function of the heart of the patient according to the first sense mode in response to determining the potential arrhythmia is not detected based on the cardiac function monitored according to the second sense mode.

13. The method of claim 1, wherein monitoring cardiac function according to the first sense mode and monitoring cardiac function according to the second mode comprises sensing electrical cardiac signals, and wherein the first and second sense modes define at least one of different sensing threshold levels or different amplifier gains for sensing electrical cardiac signals.

14. The method of claim 1, wherein monitoring cardiac function according to the first sense mode and monitoring cardiac function according to the second mode comprises sensing electrical cardiac signals, and wherein the first and second sense modes comprise different filters that are applied to sensed electrical cardiac signals.

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

16. The method of claim 15, 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.

17. 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 a known schedule.

18. The method of claim 1, further comprising controlling, with the processor, the therapy module to suspend delivery of electrical stimulation to the tissue site in response to detecting the potential arrhythmia based on the cardiac function monitored according to the first sense mode.

19. A system comprising:

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

a second therapy module that delivers at least one of a pacing, cardioversion or defibrillation electrical signal to the heart of the patient;

a sensing module that monitors cardiac function of the heart of the patient; and

a processor that determines whether the first therapy module is delivering electrical stimulation to the tissue site, controls the sensing module to monitor cardiac function of the heart of the patient according to a first sense mode in response to determining the first therapy module is delivering electrical stimulation to the tissue site and controls the sensing module to monitor cardiac function of the heart of the patient according to a second sense mode in response to determining the first therapy module is not delivering electrical stimulation to the tissue site, detects a potential arrhythmia of the heart of the patient based on the cardiac function monitored according to the first sense mode, in response to detecting the potential arrhythmia, controls the sensing module to stop monitoring cardiac function according to the first sense mode and monitor cardiac function of the heart of the patient according to the second sense mode, wherein the first and second sense modes comprise at least one different sensing parameter value, and determines whether the potential arrhythmia is detected based on the cardiac function monitored according to the second sense mode.

20. The system of claim 19, wherein the processor controls the second therapy module to deliver at least one of a pacing, cardioversion or defibrillation electrical signal to the heart of the patient in response to determining the potential arrhythmia is detected based on the cardiac function monitored according to the second sense mode.

21. The system of claim 19, wherein the tissue site comprises at least one of a nonmyocardial tissue site or a nonvascular cardiac tissue site.

22. The system of claim 19, wherein the tissue site comprises at least one of an extravascular tissue site or the tissue site proximate to a nerve of the patient.

23. The system of claim 19, wherein the sensing module monitors cardiac function according to the first sense mode and the second sense mode by at least sensing electrical cardiac signals, and wherein the first and second sense modes define different sense vectors for sensing the electrical cardiac signals.

24. The system of claim 19, wherein, in the second sense mode, the sensing module monitors cardiac function of the heart of the patient based on at least one different non-electrophysiological parameter of the patient compared to the first sense mode.

25. The system of claim 24, wherein, in the second sense mode, the sensing module monitors cardiac function of the heart of the patient based on fewer non-electrophysiological parameters of the patient compared to the first sense mode.

26. The system of claim 19, wherein, in the first sense mode, the sensing module monitors cardiac function of the heart of the patient by at least monitoring at least one non-electrophysiological parameter of the patient, the non-electrophysiological parameter comprising 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.

27. The system of claim 19, further comprising a housing that encloses the first and second therapy modules.

28. The system of claim 19, further comprising a first implantable medical device comprising the first therapy module and a second implantable medical device comprising the second therapy module, wherein the second implantable medical device is physically separate from the first implantable medical device.

29. The system of claim 19, wherein the processor controls the sensing module to stop monitoring cardiac function of the heart of the patient according to the second sense mode and monitor cardiac function of the heart of the patient according to the first sense mode in response to determining the potential arrhythmia is not detected based on the cardiac function monitored according to the second sense mode.

30. The system of claim 19, wherein the sensing module monitors cardiac function according to the first sense mode and the second sense mode by at least sensing electrical cardiac signals, and wherein the first and second sense modes define at least one of different sensing threshold levels or different amplifier gains for sensing electrical cardiac signals.

31. The system of claim 19, wherein the sensing module monitors cardiac function according to the first sense mode and the second sense mode by at least sensing electrical cardiac signals, and wherein the first and second sense modes comprise different filters that are applied to sensed electrical cardiac signals.

32. The system of claim 19, wherein the first and second sense modes comprise different potential arrhythmia event detection algorithms.

33. The system of claim 19, wherein, in response to detecting the potential arrhythmia based on cardiac function monitored according to the first sense mode, the processor controls the therapy module to suspend delivery of electrical stimulation to the tissue site.

34. A system comprising:

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

means for monitoring cardiac function of a heart of a patient, wherein the means for monitoring cardiac function monitors cardiac function according to a first sense mode in response to determining the first therapy module is delivering electrical stimulation to the tissue site and monitors cardiac function according to a second sense mode in response to determining the first therapy module is not delivering electrical stimulation to the tissue site;

means for detecting a potential arrhythmia of the heart of the patient based on the cardiac function monitored according to the first sense mode;

means for stopping the monitoring of cardiac function according to a first sense mode and controlling the means for monitoring cardiac function of the heart of the patient to monitor cardiac function according to the second sense mode in response to detection of the potential arrhythmia, wherein the first and second sense modes comprise at least one different sensing parameter value;

means for determining whether the potential arrhythmia is detected based on the cardiac function monitored according to the second sense mode; and

means for 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 potential arrhythmia is detected based on the cardiac function monitored according to the second sense mode.

35. The system of claim 34, wherein the means for monitoring cardiac function monitors cardiac function by at least sensing electrical cardiac signals, wherein the first and second sense modes define different sense vectors for sensing the electrical cardiac signals.

36. The system of claim 34, wherein the means for monitoring cardiac function of the heart of the patient according to the second sense mode comprises means for monitoring cardiac function of the heart of the patient based on at least one different non-electrophysiological parameter of the patient compared to the first sense mode.

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

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

control a sensing module to monitor cardiac function of a heart of a patient according to a first sense mode in response to determining the therapy module is delivering electrical stimulation to the tissue site;

control the sensing module to monitor cardiac function of the heart of the patient according to a second sense mode in response to determining the therapy module is not delivering electrical stimulation to the tissue site;

detect a potential arrhythmia of the heart of the patient based on the cardiac function monitored according to the first sense mode;

in response to detecting the potential arrhythmia, control the sensing module to stop the monitoring of cardiac according to a first sense mode and monitor cardiac function of the heart of the patient according to the second sense mode, wherein the first and second sense modes comprise at least one different sensing parameter value;

determine whether the potential arrhythmia is detected based on the cardiac function monitored according to the second sense mode; and

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