Multi-threshold sensing of cardiac electrical signals in an implantable medical device
An implantable medical device system is configured to sense cardiac events in response to a cardiac electrical signal crossing a cardiac event sensing threshold. A control circuit is configured to determine a drop time interval based on a heart rate and control a sensing circuit to hold the cardiac event sensing threshold at a threshold value during the drop time interval.
1. A medical device comprising:
a therapy delivery circuit configured to deliver an electrical stimulation pulse to a patient's heart;
a control circuit configured to:
schedule a next electrical stimulation pulse to be delivered by the therapy delivery circuit at a pacing interval; and
determine a drop time interval based on the pacing interval; and
a sensing circuit configured to:
receive a cardiac electrical signal;
apply a cardiac event sensing threshold to the cardiac electrical signal by holding the cardiac event sensing threshold at a first threshold value starting after the electrical stimulation pulse until an expiration of the drop time interval determined based on the pacing interval; and
sense a cardiac event attendant to a myocardial depolarization of the patient's heart in response to the cardiac electrical signal crossing the cardiac event sensing threshold.
2. The medical device of claim 1 , wherein the sensing circuit is further configured to adjust the cardiac event sensing threshold from the first threshold value to a minimum sensing threshold value upon expiration of the drop time interval.
3. The medical device of claim 1 , wherein:
the therapy delivery circuit is configured to deliver the electrical stimulation pulse as a cardioversion/defibrillation shock; and
the control circuit is configured to schedule the next electrical stimulation pulse as a post-shock pacing pulse at the pacing interval set to a post-shock pacing interval.
4. The medical device of claim 1 , wherein:
the therapy delivery circuit is configured to deliver the electrical stimulation pulse as a cardiac pacing pulse; and
the control circuit is configured to schedule the next electrical stimulation pulse as a next cardiac pacing pulse at the pacing interval set to one of an anti-tachycardia pacing interval or a lower rate interval for bradycardia pacing.
5. The medical device of claim 1 , wherein the control circuit is further configured to:
establish a maximum threshold limit based on a minimum sensing threshold value equal to a programmed sensitivity setting; and
determine the first threshold value based on the maximum threshold limit.
6. The medical device of claim 5 , wherein:
the control circuit is further configured to determine a starting threshold value of the cardiac event sensing threshold based the maximum threshold limit, the starting threshold value being a greater percentage of the maximum threshold limit than the first threshold value; and
the sensing circuit is further configured to apply the cardiac event sensing threshold to the cardiac electrical signal by:
starting a post-pulse blanking interval and a post-pulse delay interval upon delivery of the electrical stimulation pulse by the therapy delivery circuit;
holding the cardiac event sensing threshold at the starting threshold value from an expiration of the post-pulse blanking interval until an expiration of a post-pulse delay interval; and
upon expiration of the post-pulse delay interval, adjusting the cardiac event sensing threshold from the staring threshold value to the first threshold value.
7. The medical device of claim 5 , wherein the control circuit is further configured to establish the maximum threshold limit based on the minimum sensing threshold value by:
determining a gain based on the programmed sensitivity setting, the gain being inversely related to the programmed sensitivity setting; and
determining the maximum threshold limit as the product of the gain and the programmed sensitivity setting.
8. The medical device of claim 1 , wherein:
the control circuit is further configured to detect an expiration of the pacing interval without the cardiac electrical signal crossing the applied cardiac event sensing threshold; and
the therapy delivery circuit is configured to deliver the next electrical stimulation pulse upon the expiration of the pacing interval.
9. The medical device of claim 1 , wherein:
the control circuit is further configured to:
determine, based on the cardiac electrical signal received by the sensing circuit, a need for one of a first electrical stimulation therapy or a second cardiac electrical stimulation therapy different than the first electrical stimulation therapy;
in response to determining the need for the first electrical stimulation therapy:
compare the drop time interval determined based on the pacing interval to a first minimum drop time interval; and
set the drop time interval used by the sensing circuit to a greatest one of the drop time interval determined based on the pacing interval and the first minimum drop time interval; and
in response to determining the need for the second electrical stimulation therapy:
compare the drop time interval determined based on the pacing interval to a second minimum drop time interval that is different than the first minimum drop time interval; and
set the drop time interval to a greatest one of the drop time interval determined based on the pacing interval and the second minimum drop time interval.
10. The medical device of claim 1 , further comprising a housing enclosing the therapy delivery circuit, the control circuit and the sensing circuit, the housing configured to receive a lead carrying at least one electrode; and
the sensing circuit is configured to receive the cardiac electrical signal and sense the cardiac event when the at least one electrode is not in contact with myocardial tissue.
11. A method comprising:
delivering an electrical stimulation pulse to a patient's heart;
scheduling a next electrical stimulation pulse to be delivered at a pacing interval;
determining a drop time interval based on the pacing interval;
receiving a cardiac electrical signal by sensing circuitry of a medical device;
applying by the sensing circuitry a cardiac event sensing threshold to the cardiac electrical signal by holding the cardiac event sensing threshold at a first threshold value starting after the electrical stimulation pulse until an expiration of the drop time interval determined based on the pacing interval; and
sensing a cardiac event attendant to a myocardial depolarization of the patient's heart in response to the cardiac electrical signal crossing the cardiac event sensing threshold.
12. The method of claim 11 , further comprising adjusting the cardiac event sensing threshold from the first threshold value to a minimum sensing threshold value upon expiration of the drop time interval.
13. The method of claim 11 , further comprising:
delivering the electrical stimulation pulse as a cardioversion/defibrillation shock; and
scheduling the next electrical stimulation pulse as a post-shock pacing pulse at the pacing interval set to a post-shock pacing interval.
14. The method of claim 11 , further comprising:
delivering the electrical stimulation pulse as a cardiac pacing pulse; and
scheduling the next electrical stimulation pulse as a next cardiac pacing pulse at the pacing interval set to one of an anti-tachycardia pacing interval or a lower rate interval for bradycardia pacing.
15. The method of claim 11 , further comprising:
establish a maximum threshold limit based on a minimum sensing threshold value equal to a programmed sensitivity setting; and
determine the first threshold value based on the maximum threshold limit.
16. The method of claim 15 , further comprising:
determining a starting threshold value of the cardiac event sensing threshold based the maximum threshold limit, the starting threshold value being a greater percentage of the maximum threshold limit than the first threshold value; and
applying the cardiac event sensing threshold to the cardiac electrical signal by:
starting a post-pulse blanking interval and a post-pulse delay interval upon delivery of the electrical stimulation pulse;
holding the cardiac event sensing threshold at the starting threshold value from an expiration of the post-pulse blanking interval until an expiration of a post-pulse delay interval; and
upon expiration of the post-pulse delay interval, adjusting the cardiac event sensing threshold from the staring threshold value to the first threshold value.
17. The method of claim 15 , wherein the control circuit is further configured to establish the maximum threshold limit based on the minimum sensing threshold value by:
determining a gain based on the programmed sensitivity setting, the gain being inversely related to the programmed sensitivity setting; and
determining the maximum threshold limit as the product of the gain and the programmed sensitivity setting.
18. The method of claim 11 , further comprising:
detecting an expiration of the pacing interval without the cardiac electrical signal crossing the applied cardiac event sensing threshold; and
delivering the next electrical stimulation pulse upon the expiration of the pacing interval.
19. The method of claim 11 , further comprising:
determining, based on the cardiac electrical signal received by the sensing circuit, a need for one of a first electrical stimulation therapy or a second cardiac electrical stimulation therapy different than the first electrical stimulation therapy;
in response to determining the need for the first electrical stimulation therapy:
comparing the drop time interval determined based on the pacing interval to a first minimum drop time interval; and
setting the drop time interval used by the sensing circuit to a greatest one of the drop time interval determined based on the pacing interval and the first minimum drop time interval; and
in response to determining the need for the second electrical stimulation therapy:
comparing the drop time interval determined based on the pacing interval to a second minimum drop time interval that is different than the first minimum drop time interval; and
setting the drop time interval to a greatest one of the drop time interval determined based on the pacing interval and the second minimum drop time interval.
20. A non-transitory, computer-readable medium storing a set of instructions which, when executed by a control circuit of a medical device, cause the medical device to:
deliver an electrical stimulation pulse to a patient's heart;
schedule a next electrical stimulation pulse to be delivered at a pacing interval;
determine a drop time interval based on the pacing interval;
receive a cardiac electrical signal by sensing circuitry of the medical device;
apply a cardiac event sensing threshold to the cardiac electrical signal by holding the cardiac event sensing threshold at a first threshold value starting after the electrical stimulation pulse until an expiration of the drop time interval determined based on the pacing interval; and
sense a cardiac event attendant to a myocardial depolarization of the patient's heart in response to the cardiac electrical signal crossing the cardiac event sensing threshold.