Pacing in the presence of electromagnetic interference
This disclosure provides a pacing technique that reduces the effect of oversensing caused by noise on pacing therapy. The IMD delivers a pacing pulse subsequent to sensing an electrical signal on the lead when the sensed electrical signal coincides with an independently detected noise signal and the sensed electrical signal occurs during a period of time of an expected intrinsic cardiac signal. The IMD may, in some instances, trigger delivery of the pacing pulse during the escape interval instead of waiting for the escape interval to expire. Pacing in accordance with the techniques of this disclosure may allow for improved therapy during an MRI procedure by decreasing the risk associated with inappropriate pacing inhibition as well as decreasing the risk associated with pacing during the vulnerable period of the cardiac cycle.
1. A method comprising:
sensing an electrical signal on an implantable medical lead implanted within a chamber of a heart;
determining whether the sensed electrical signal coincides with a sensed noise signal;
determining whether the sensed electrical signal occurs during a period of time of an expected intrinsic cardiac signal; and
triggering delivery of a pacing pulse on the implantable medical lead implanted within the chamber of the heart in which the electrical signal is sensed before expiration of an escape interval associated with the chamber of the heart in which the electrical signal is sensed when the sensed electrical signal coincides with a sensed noise signal and the sensed electrical signal occurs during the period of time of the expected intrinsic cardiac signal.
2. The method of claim 1 , further comprising withholding delivery of a pacing pulse when the sensed electrical signal does not coincide with a sensed noise signal.
3. The method of claim 1 , further comprising ignoring the sensed electrical signal for purposes of therapy delivery when the sensed electrical signal coincides with a sensed noise signal and does not occur during the period of time of the expected intrinsic cardiac signal.
4. The method of claim 1 , further comprising triggering delivery of a pacing pulse on the implantable medical lead implanted within the chamber of the heart in which the electrical signal is sensed upon expiration of the escape interval associated with the chamber of the heart in which the electrical signal is sensed when no electrical signal is sensed on the implantable medical lead.
5. The method of claim 1 , wherein triggering delivery of the pacing pulse before expiration of the escape interval associated with the chamber of the heart in which the electrical signal is sensed comprises triggering delivery of the pacing pulse within approximately one hundred (100) milliseconds after sensing the electrical event and prior to the expiration of the escape interval.
6. The method of claim 1 , further comprising determining the period of time of the expected intrinsic cardiac signal based on stored data regarding recent cardiac electrophysiological activity.
7. The method of claim 6 , wherein determining the period of time of the expected intrinsic cardiac signal based on stored data regarding recent cardiac electrophysiological activity comprises determining the period of time of the expected intrinsic cardiac signal based on stored data regarding at least one of recent heart rate, recent heart rate variability, and recent pacing percentage.
8. The method of claim 1 , further comprising monitoring for the noise signal using a noise detection module that is separate from the sensing module used to sense the electrical signal of the implantable medical lead.
9. The method of claim 1 , further comprising detecting a condition indicative of the presence of an MRI device and transitioning, in response to detecting the condition, to a pacing mode in which delivery of the pacing pulse is triggered before expiration of the escape interval when the sensed electrical signal coincides with a sensed noise signal and the sensed electrical signal occurs during the period of time of the expected intrinsic cardiac signal.
10. An implantable medical system comprising:
an implantable medical lead implanted within a chamber of a heart and including at least one electrode;
an implantable medical device comprising:
a noise detection module that detects noise signals;
a sensing module that detects an electrical signal of the chamber of the heart on the implantable medical lead;
a therapy module that delivers pacing therapy to the chamber of the heart via the implantable medical lead; and
a control module that determines whether the sensed electrical signal on the implantable medical lead implanted within the chamber of the heart coincides with a sensed noise signal, determines whether the sensed electrical signal occurs during a period of time of an expected intrinsic cardiac signal, and controls the therapy module to deliver a pacing pulse on the implantable medical lead implanted within the chamber of the heart before expiration of an escape interval associated with the chamber of the heart in which the electrical signal is sensed when the sensed electrical signal coincides with a sensed noise signal and the sensed electrical signal occurs during the period of time of the expected intrinsic cardiac signal.
11. The system of claim 10 , wherein the control module withholds delivery of a pacing pulse when the sensed electrical signal does not coincide with a sensed noise signal.
12. The system of claim 10 , wherein the control module ignores the sensed electrical signal for purposes of therapy delivery when the sensed electrical signal coincides with a sensed noise signal and does not occur during the period of time of the expected intrinsic cardiac signal.
13. The system of claim 10 , wherein the control module triggers delivery of a pacing pulse upon expiration of the escape interval associated with the chamber of the heart in which the electrical signal is sensed when no electrical signal is sensed on the implantable medical lead.
14. The system of claim 10 , wherein the control module triggers delivery of the pacing pulse within approximately one hundred (100) milliseconds after sensing the electrical event and prior to the expiration of the escape interval.
15. The system of claim 10 , wherein the control module determines the period of time of the expected intrinsic cardiac signal based on stored data regarding recent cardiac electrophysiological activity.
16. The system of claim 15 , wherein the control module determines the period of time of the expected intrinsic cardiac signal based on stored data regarding at least one of recent heart rate, recent heart rate variability, and recent pacing percentage.
17. The system of claim 10 , further comprising a magnetic field sensor, wherein the control module detects a condition indicative of the presence of an MRI device based on the output of the magnetic field sensor and transitions, in response to detecting the condition, to a pacing mode in which delivery of the pacing pulse is triggered before expiration of the escape interval when the sensed electrical signal coincides with a sensed noise signal and the sensed electrical signal occurs during the period of time of the expected intrinsic cardiac signal.
18. The system of claim 10 , wherein the chamber of the heart comprises a ventricle of the heart.
19. A computer-readable storage medium comprising instructions that, when executed, cause an implantable medical device to:
sense an electrical signal on an implantable medical lead implanted within a chamber of a heart;
determine whether the sensed electrical signal coincides with a sensed noise signal;
determine whether the sensed electrical signal occurs during a period of time of an expected intrinsic cardiac signal; and
trigger delivery of a pacing pulse on the implantable medical lead implanted within the chamber of the heart in which the electrical signal is sensed before expiration of an escape interval associated with the chamber of the heart in which the electrical signal is sensed when the sensed electrical signal coincides with a sensed noise signal and the sensed electrical signal occurs during the period of time of the expected intrinsic cardiac signal.