Methods and implantable medical systems that implement exposure modes of therapy that allow for continued operation during exposure to a magnetic disturbance
Implantable medical systems enter an exposure mode of operation, either manually via a down linked programming instruction or by automatic detection by the implantable system of exposure to a magnetic disturbance. A controller then determines the appropriate exposure mode by considering various pieces of information including the device type including whether the device has defibrillation capability, pre-exposure mode of therapy including which chambers have been paced, and pre-exposure cardiac activity that is either intrinsic or paced rates. Additional considerations may include determining whether a sensed rate during the exposure mode is physiologic or artificially produced by the magnetic disturbance. When the sensed rate is physiologic, then the controller uses the sensed rate to trigger pacing and otherwise uses asynchronous pacing at a fixed rate.
1. A method of controlling an exposure mode of therapy of an implantable medical device, comprising:
determining a device type of the implantable medical device by accessing device type information stored by the implantable medical device;
upon detecting a need to switch to the exposure mode, selecting the exposure mode of therapy of the implantable medical device based on the device type and a pre-exposure mode of therapy; and
after detecting the need to switch to the exposure mode, implementing the exposure mode of therapy at the implantable medical device by: performing a first sensing of a heart rate using at least one sensing setting; when the first sensing of heart rate indicates at least a first amount of noise is present, implementing an asynchronous pacing mode and then making adjustments to the at least one sensing setting prior to a next sensing of the heart rate that is subsequent to the first sensing and that uses the at least one sensing setting that has been adjusted; and when the first sensing of heart rate indicates that at least the first amount of noise is not present, then implementing a triggered pacing mode.
2. The method of claim 1 , further comprising:
incrementing a revision counter upon making adjustments to the at least one sensing setting; and
subsequent to the next sensing of the heart rate, determining whether the revision counter exceeds a revision counter threshold so that when the revision counter does not exceed the revision counter threshold then making further adjustments to the at least one sensing setting and when the revision counter does exceed the revision counter threshold then not making further adjustments to the at least one sensing setting.
3. The method of claim 1 , wherein determining the type of implantable medical device comprises determining whether the implantable medical device is a type capable of providing a defibrillation therapy and when the implantable medical device is not a type capable of providing defibrillation therapy, then selecting the exposure mode based on device type and the pre-exposure mode comprises implementing a pacing mode that paces a same set of chambers of the heart as the pre-exposure mode.
4. The method of claim 2 , wherein when it is determined that the implantable medical device is capable of providing defibrillation therapy, then selecting the exposure mode based on device type and the pre-exposure mode comprises determining whether a pacing percentage of the device during a period of time prior to implementing the exposure mode exceeds a pacing percentage threshold and when the pacing percentage threshold is not exceeded then selecting a non-pacing mode as the exposure mode.
5. The method of claim 4 , wherein when the pacing percentage threshold is exceeded by the pacing percentage, then determining whether the pre-exposure mode of the implantable medical device provides cardiac resynchronization therapy by pacing only a left ventricle of the heart and when the pre-exposure mode does only pace the left ventricle, then selecting the exposure mode based on device type and the pre-exposure mode comprises selecting a non-pacing mode as the exposure mode.
6. The method of claim 4 , wherein when the pacing percentage threshold is exceeded by the pacing percentage, then selecting the exposure mode based on device type and the pre-exposure mode comprises implementing a pacing mode that paces a same set of chambers of the heart as the pre-exposure mode.
7. The method of claim 2 , wherein when it is determined that the implantable medical device is capable of providing defibrillation therapy, then determining whether the pre-exposure mode of the implantable medical device provides cardiac resynchronization therapy by pacing only a left ventricle of the heart and when the pre-exposure mode does only pace the left ventricle, then selecting the exposure mode based on device type and the pre-exposure mode comprises selecting a non-pacing mode as the exposure mode.
8. The method of claim 7 , wherein when it is determined that the pre-exposure mode does not provide cardiac resynchronization therapy by only pacing the left ventricle, then selecting the exposure mode based on device type and the pre-exposure mode comprises implementing a pacing mode that paces a same set of chambers of the heart as the pre-exposure mode.
9. The method of claim 1 , wherein prior to implementing the exposure mode of therapy there are pre-exposure rates of cardiac activity and wherein the exposure mode of therapy includes providing pacing from the implantable medical device, the method further comprising:
upon detecting a need to switch to the exposure mode, selecting an exposure mode asynchronous pacing rate based on the pre-exposure rates where the exposure mode asynchronous pacing rate is used when in the asynchronous pacing mode; and
implementing the exposure mode asynchronous pacing rate at the implantable medical device while implementing the exposure mode of therapy when the asynchronous pacing mode is being implemented.
10. The method of claim 9 , wherein selecting the exposure mode pacing rate based on the pre-exposure rates comprises determining whether an average rate of cardiac activity occurring during a period prior to implementing the exposure mode exceeds a rate threshold, when the average rate does not exceed the threshold then pacing at a pre-defined fixed rate as the exposure mode pacing rate and when the average does exceed the threshold then pacing at a rate equal to the average rate plus a fixed adjustment up to a pre-defined upper limit.
11. The method of claim 10 , wherein the pre-exposure rates of cardiac activity are intrinsic rates.
12. The method of claim 11 , wherein the pre-exposure rates of cardiac activity are paced rates.
13. An implantable medical system comprising:
a device for providing electrical sensing and pacing; and
a controller that is in control of the device to provide an exposure mode of therapy by the device and that is configured to determine a device type, detect a need to switch to the exposure mode, select the exposure mode of therapy of the device based on the device type and a pre-exposure mode of therapy, and after detecting the need to switch to the exposure mode implement the exposure mode of therapy at the device by: performing a first sensing of a heart rate using at least one sensing setting; when the first sensing of heart rate indicates at least a first amount of noise is present, implementing an asynchronous pacing mode and then making adjustments to the at least one sensing setting prior to a next sensing of the heart rate that is subsequent to the first sensing and that uses the at least one sensing setting that has been adjusted; and when the first sensing of heart rate indicates that at least the first amount of noise is not present, then implementing a triggered pacing mode.
14. A method of controlling an exposure mode of therapy of an implantable medical device, comprising:
determining a device type of the implantable medical device;
upon detecting a need to switch to the exposure mode, selecting the exposure mode of therapy of the implantable medical device based on the device type and a pre-exposure mode of therapy;
implementing the exposure mode of therapy at the implantable medical device by: performing a first sensing of a heart rate using at least one sensing setting; when the first sensing of heart rate indicates at least a first amount of noise is present, implementing an asynchronous pacing mode and then making adjustments to the at least one sensing setting prior to a next sensing of the heart rate that is subsequent to the first sensing and that uses the at least one sensing setting that has been adjusted; and when the first sensing of heart rate indicates that at least the first amount of noise is not present, then implementing a triggered pacing mode;
incrementing a revision counter upon making adjustments to the at least one sensing setting; and
subsequent to the next sensing of the heart rate, determining whether the revision counter exceeds a revision counter threshold so that when the revision counter does not exceed the revision counter threshold then making further adjustments to the at least one sensing setting and when the revision counter does exceed the revision counter threshold then not making further adjustments to the at least one sensing setting.
15. A method of controlling an exposure mode of therapy of an implantable medical device, comprising:
determining a device type of the implantable medical device;
upon detecting a need to switch to the exposure mode, selecting the exposure mode of therapy of the implantable medical device based on the device type and a pre-exposure mode of therapy; and
implementing the exposure mode of therapy at the implantable medical device by: performing a first sensing of a heart rate using at least one sensing setting; when the first sensing of heart rate indicates at least a first amount of noise is present, implementing an asynchronous pacing mode and then making adjustments to the at least one sensing setting prior to a next sensing of the heart rate that is subsequent to the first sensing and that uses the at least one sensing setting that has been adjusted; and when the first sensing of heart rate indicates that at least the first amount of noise is not present, then implementing a triggered pacing mode;
wherein determining the type of implantable medical device comprises determining whether the implantable medical device is a type capable of providing a defibrillation therapy and when the implantable medical device is not a type capable of providing defibrillation therapy, then selecting the exposure mode based on device type and the pre-exposure mode comprises implementing a pacing mode that paces a same set of chambers of the heart as the pre-exposure mode.
16. A method of controlling an exposure mode of therapy of an implantable medical device, comprising:
determining a device type of the implantable medical device;
upon detecting a need to switch to the exposure mode, selecting the exposure mode of therapy of the implantable medical device based on the device type and a pre-exposure mode of therapy;
implementing the exposure mode of therapy at the implantable medical device by: performing a first sensing of a heart rate using at least one sensing setting; when the first sensing of heart rate indicates at least a first amount of noise is present, implementing an asynchronous pacing mode and then making adjustments to the at least one sensing setting prior to a next sensing of the heart rate that is subsequent to the first sensing and that uses the at least one sensing setting that has been adjusted; and when the first sensing of heart rate indicates that at least the first amount of noise is not present, then implementing a triggered pacing mode;
wherein prior to implementing the exposure mode of therapy there are pre-exposure rates of cardiac activity and wherein the exposure mode of therapy includes providing pacing from the implantable medical device, the method further comprising:
upon detecting a need to switch to the exposure mode, selecting an exposure mode asynchronous pacing rate based on the pre-exposure rates where the exposure mode asynchronous pacing rate is used when in the asynchronous pacing mode; and
implementing the exposure mode asynchronous pacing rate at the implantable medical device while implementing the exposure mode of therapy when the asynchronous pacing mode is being implemented.