Implantable medical device
IMD devices and treatment methods are discussed and disclosed. An IMD having a lead adapted for placement in an internal thoracic vein (ITV) of a patient may be employed to facilitate atrial sensing. Devices may be used to communicate with one another, such communication configured to allow pacing therapy to a heart of a patient.
1. A method of treating a patient comprising:
sensing an atrial cardiac signal using a first electrode located in an internal thoracic vein (ITV) of the patient and a second electrode, the first electrode and the second electrode operatively coupled to a first medical device;
analyzing a P-wave from the atrial cardiac signal using the first medical device;
determining a therapy using the first medical device based on the analyzed P-wave; and
sending a therapy instruction to a second medical device communicatively coupled to the first medical device.
2. The method of claim 1 , further comprising delivering the therapy to the patient using the second medical device based on the therapy instruction.
3. The method of claim 1 wherein the first medical device is further operatively coupled to a third electrode and the first and second electrodes form a first sensing bipole adapted for atrial sensing, and the third electrode forms, with one of the first or second electrodes, a second sensing bipole adapted for atrial sensing, the method further comprising:
determining propagation of the P-wave using the first and second bipoles;
observing an amplitude of the P-wave using the first medical device; and
confirming detection of the P-wave based on the propagation and the amplitude using the first medical device.
4. The method of claim 1 wherein the first medical device is placed in the patient on the right side of the chest at a subcutaneous or submuscular positon near the clavicle, and the first and second electrodes are disposed on a lead attached to the first medical device and extending into the right brachiocephalic vein and thence into the right ITV, to a desired position relative to the atria.
5. The method of claim 1 wherein the first medical device is placed in the patient on the left side of the chest at an axillary position, and the first and second electrodes are disposed on a lead attached to the first medical device extending medially therefrom to a parasternal location adjacent the sternum and then through an intercostal between two ribs and into the ITV.
6. The method of claim 1 , wherein the first medical device is an implantable cardioverter defibrillator.
7. The method of claim 1 , wherein the second medical device is a leadless cardiac pacemaker (LCP) located in a heart of the patient.
8. The method of claim 1 , wherein the therapy comprises cardiac resynchronization therapy.
9. The method of claim 1 , wherein the therapy comprises Vdd pacing.
10. The method of claim 1 wherein the therapy instruction is a pace command.
11. The method of claim 10 wherein the method further comprises the second medical device issuing a pacing pulse.
12. The method of claim 1 wherein the first medical device comprises a housing containing operational circuitry for sensing atrial signals, and omits a pulse generator, the housing adapted for placement in a blood vessel, wherein the method is performed with the first medical device housing located in a brachiocephalic vein of the patient.