Multiple electrode vectors for implantable cardiac treatment devices
The implantable cardiac treatment system of the present invention is capable of choosing the most appropriate electrode vector to sense within a particular patient. In certain embodiments, the implantable cardiac treatment system determines the most appropriate electrode vector for continuous sensing based on which electrode vector results in the greatest signal amplitude, or some other useful metric such as signal-to-noise ratio (SNR). The electrode vector possessing the highest quality as measured using the metric is then set as the default electrode vector for sensing. Additionally, in certain embodiments of the present invention, a next alternative electrode vector is selected based on being generally orthogonal to the default electrode vector. In yet other embodiments of the present invention, the next alternative electrode vector is selected based on possessing the next highest quality metric after the default electrode vector. In some embodiments, if analysis of the default vector is ambiguous, the next alternative electrode vector is analyzed to reduce ambiguity.
1. A method of cardiac signal analysis comprising:
capturing a cardiac event along first and second sensing vectors using electrodes implanted in a patient to yield first and second event representations, along each of the first and second sensing vectors respectively, of the cardiac event, wherein:
the first sensing vector is defined between an implantable cardiac stimulus device (ICSD) canister and a first electrode on a lead attached to the implantable cardiac stimulus device canister;
the second sensing vector is defined between the ICSD canister and a second electrode on the lead; and
the ICSD canister is disposed at a lateral position on the left side of the patient's ribcage inferior to the arm and the lead extends to a parasternal location such that the first electrode is superior to the heart, each of the ICSD canister, with the lead disposed subcutaneously between the ribs and the skin of the patient without entering a blood vessel or contacting the heart of the patient;
analyzing the cardiac event by use of the first event representation to reach a first result;
observing whether the first result is determinative and, if not,
analyzing the cardiac event by use of the second event representation; wherein:
the step of determining whether the first result is determinative is performed in a manner wherein, if the first result unambiguously indicates a non-malignant cardiac rhythm, the first result is found to be determinative and the second event representation is not analyzed.
2. The method of claim 1 , wherein the step of analyzing the cardiac event by use of the first event representation includes observing a correlation between the first event representation and an event template, wherein the first result is related to the correlation.
3. The method of claim 2 , wherein the first result is a score from correlation waveform analysis performed between the first event representation and the cardiac template.
4. The method of claim 1 , wherein the step of capturing the cardiac event includes:
observing the cardiac event with a first electrode set defining the first sensing vector, the first electrode set being disposed in a position for far-field sensing of the cardiac event; and
observing the cardiac event with a second electrode set defining the second sensing vector, the second electrode set being disposed in a position for far-field sensing of the cardiac event.
5. The method of claim 1 , wherein the step of capturing the cardiac event includes:
observing the cardiac event with a first electrode set defining the first sensing vector, the first electrode set being disposed subcutaneously inside the patient; and
observing the cardiac event with a second electrode set defining the second sensing vector, the second electrode set being disposed subcutaneously inside the patient.
6. The method of claim 1 , wherein the step of capturing the cardiac event includes:
observing the cardiac event with a first electrode set defining the first sensing vector, the first electrode set being disposed outside the patient's thoracic cavity; and
observing the cardiac event with a second electrode set defining the second sensing vector, the second electrode set being disposed outside the patient's thoracic cavity.
7. The method of claim 1 further comprising determining whether the first result is determinative of a malignant arrhythmia and, if so, delivering therapy to the patient.
8. A method of cardiac signal analysis comprising:
capturing a cardiac event along first and second sensing vectors using electrodes implanted in a patient to yield first and second event representations;
analyzing the cardiac event by use of the first event representation to reach a first result;
observing whether the first result is determinative and, if not,
analyzing the cardiac event by use of the second event representation; wherein
the step of analyzing the cardiac event by use of the first event representation includes observing a correlation between the first event representation and an event template, wherein the first result is related to the correlation; and
the first result is the variance in a set of correlation waveform analysis scores, the set of correlation waveform analysis scores including a correlation waveform analysis score for the first event representation and the event template, and a number of correlation waveform analysis scores for first event representations for previous cardiac events and corresponding event templates, wherein the first result is determinative of a polymorphic ventricular tachycardia or a ventricular fibrillation if the variance is high.
9. The method of claim 8 further comprising, if the variance is high and indicates polymorphic ventricular tachycardia or a ventricular fibrillation, delivering therapy to the patient.
10. A method of cardiac signal analysis comprising:
capturing an individual cardiac event along first and second sensing vectors using electrodes implanted in a patient to yield first and second event representations along each of the first and second sensing vectors respectively, of the cardiac event, wherein:
the first sensing vector is defined between an implantable cardiac stimulus device (ICSD) canister and a first electrode on a lead attached to the implantable cardiac stimulus device canister;
the second sensing vector is defined between the ICSD canister and a second electrode on the lead; and
the lead is disposed subcutaneously between the ribs and the skin of the patient without entering a blood vessel or contacting the heart of the patient;
analyzing the first and second event representations to generate a first metric corresponding to the first event representation and a second metric corresponding to the second event representation;
comparing the first metric to the second metric; and
selecting one of the first or second event representations as a primary event representation, and identifying the non-selected event representation as an alternate event representation for the individual cardiac event;
subsequent to selecting a primary event representation and an alternate event representation for a number of cardiac events, identifying a primary sensing vector and identifying an alternate sensing vector;
performing cardiac analysis of later cardiac events and performing the following steps to determine whether a given cardiac event appears to indicate malignant or benign cardiac rhythm:
analyzing the given cardiac event using signals captured with the primary sensing vector to generate a first result;
observing whether the first result is determinative; and, if not,
analyzing the given cardiac event by use of the alternate sensing vector.
11. The method of claim 10 , wherein the step of determining whether the first result is determinative is performed in a manner wherein, if the first result unambiguously indicates a non-malignant cardiac rhythm, the first result is found to be determinative.
12. The method of claim 10 , wherein the step of analyzing the primary event representation includes observing a correlation between the primary event representation and an event template, wherein the first result is related to the correlation.
13. The method of claim 12 , wherein the first result is a score from correlation waveform analysis performed between the primary event representation and the cardiac template.
14. The method of claim 10 further comprising, if the first event representation is determinative and indicates a treatable condition exists, delivering therapy to the patient.
15. A method of cardiac signal analysis comprising:
A) capturing a cardiac event along first and second sensing vectors from sensors implanted in a patient to yield first and second event representations along each of the first and second sensing vectors respectively, of the cardiac event, wherein:
the first sensing vector is defined between an implantable cardiac stimulus device (ICSD) canister and a first electrode on a lead attached to the implantable cardiac stimulus device canister;
the second sensing vector is defined between the ICSD canister and a second electrode on the lead; and
the lead is disposed subcutaneously between the ribs and the skin of the patient without entering a blood vessel or contacting the heart of the patient;
B) analyzing the cardiac event by use of the first event representation to reach a first result;
C) observing whether the first result is determinative and, if not, analyzing the cardiac event by use of the second event representation;
wherein:
the step of determining whether the first result is determinative is performed in a manner wherein, if the first result unambiguously indicates a non-malignant cardiac rhythm, the first result is found to be determinative;
the step of analyzing the cardiac event by use of the first event representation includes observing a correlation between the first event representation and an event template, wherein the first result is related to the correlation.
16. The method of claim 15 , wherein steps A, B, and C are performed for a plurality of cardiac events to determine whether the patient is experiencing a malignant cardiac condition.
17. The method of claim 15 further comprising analyzing the first event representation to determine whether it is determinative that a treatable condition exists and, if so, delivering therapy to the patient.