Implantable medical devices, systems and methods for reducing T-wave oversensing and arrhythmia undersensing
Described herein are implantable medical devices and systems, and methods for use therewith, for reducing T-wave oversensing and arrhythmia undersensing that occur due to inappropriate filtering of a signal indicative of cardiac electrical activity. A method includes obtaining a signal indicative of cardiac electrical activity, and using a first bandpass filter to produce a first filtered version thereof, using a second bandpass filter to produce a second filtered version thereof, wherein the first bandpass filter passes frequencies within a first frequency range, and the second bandpass filter passes frequencies within a second frequency range that is wider than the first frequency range. The method also includes selectively changing from using the first filtered version of the signal to monitor for a VS event, to using the second filtered version of the signal to monitor for a VS event, based on first criteria, and vice versa, based on second criteria.
1. An apparatus, comprising:
two or more electrodes;
a sensing circuit coupleable to at least two of the electrodes to thereby sense a signal indicative of cardiac electrical activity;
a first bandpass filter configured to pass frequencies within a first frequency range and that can be used to produce a first filtered version of the signal indicative of cardiac electrical activity;
a second bandpass filter configured to pass frequencies within a second frequency range and that can be used to produce a second filtered version of the signal indicative of cardiac electrical activity, wherein the second frequency range is wider than the first frequency range;
an R-wave detector; and
a controller configured to cause only one of the first or second filtered versions of the signal indicative of cardiac electrical activity to be provided to the R-wave detector at a time;
the R-wave detector configured to monitor for a potential ventricular sensed (VS) event based on the only one of the first or second filtered versions of the signal indicative of cardiac electrical activity, which is caused to be provided to the R-wave detector by the controller at the time; and
the controller configured to
determine whether one or more first criteria are satisfied, in response to a said potential VS event being detected by the R-wave detector based on the first filtered version of the signal indicative of cardiac electrical activity; and
change from causing the first filtered version of the signal indicative of cardiac electrical activity to be provided to the R-wave detector, to causing the second filtered version of the signal indicative of cardiac electrical activity to be provided to the R-wave detector, based on results of the determination of whether the one or more first criteria are satisfied.
2. The apparatus of claim 1 , wherein:
the first frequency range passed by the first bandpass filter is one of 6-25 Hz or 8-25 Hz; and
the second frequency range passed by the second bandpass filter is 3-25 Hz.
3. The apparatus of claim 1 , wherein the controller is configured to:
determine whether one or more second criteria are satisfied, in response to a said potential VS event being detected by the R-wave detector based on the second filtered version of the signal indicative of cardiac electrical activity; and
change from causing the second filtered version of the signal indicative of cardiac electrical activity to be provided to the R-wave detector, to causing the first filtered version of the signal indicative of cardiac electrical activity to be provided to the R-wave detector, based on results of the determination of whether the one or more second criteria are satisfied.
4. The apparatus of claim 3 , wherein the one or more first criteria are configured to at least one of:
detect R-wave undersensing; and
reduce a chance of R-wave undersensing during an episode of at least one of ventricular tachycardiac (VT) or ventricular fibrillation (VF).
5. The apparatus of claim 3 , wherein the one or more first criteria include:
(i) a prevalence of T-wave oversensing is below a first specified prevalence threshold, and a specified amount of most recently detected potential VS events each have a peak amplitude below a first specified amplitude threshold;
(ii) a duration of time between the detected potential VS event and an immediately preceding detected potential VS event exceeds a first specified duration threshold; and
(iii) a duration of time between the detected potential VS event and an immediately preceding detected potential VS event exceeds a second specified duration threshold, which is less than the first specified duration threshold, and a peak amplitude of the detected potential VS event is below a second specified amplitude threshold; and
wherein the controller changes from causing the first filtered version of the signal indicative of cardiac electrical activity to be provided to the R-wave detector, to causing the second filtered version of the signal indicative of cardiac electrical activity to be provided to the R-wave detector, in response to the controller determining that at least one of the criteria (i), (ii), or (iii) is true.
6. The apparatus of claim 4 , wherein the one or more first criteria includes:
(iv) at least one of ventricular tachycardiac (VT) or ventricular fibrillation (VF) is (iv) currently being detected; and
wherein the controller changes from causing the first filtered version of the signal indicative of cardiac electrical activity to be provided to the R-wave detector, to causing the second filtered version of the signal indicative of cardiac electrical activity to be provided to the R-wave detector, in response to the controller determining that the criterion (iv) is true.
7. The apparatus of claim 3 , wherein the one or more second criteria are used by the controller to reduce a chance of T-wave oversensing causing a false detection of ventricular tachycardiac (VT) or ventricular fibrillation (VF).
8. The apparatus of claim 1 , wherein;
the first and second filtered versions of the signal indicative of cardiac electrical activity are produced in parallel by passing the signal indicative of cardiac electrical activity through the first bandpass filter included within a first channel, and also separately passing the signal indicative of cardiac electrical activity through the second bandpass filter included in a second channel; and
the controller controls whether the first channel or the second channel is coupled to the R-wave detector.
9. The apparatus of claim 1 , wherein:
the controller is configured to make an additional determination whether the one or more first criteria are satisfied each time the R-wave detector detects an additional potential VS event based on the first filtered version of the signal indicative of cardiac electrical activity, and to change from causing the first filtered version of the signal indicative of cardiac electrical activity to causing the second filtered version of the signal indicative of cardiac electrical activity to be provided to the R-wave detector, based on results of the additional determination of whether the one or more first criteria are satisfied.
10. The apparatus of claim 3 , wherein:
the controller is configured to make an additional determination whether the one or more first criteria are satisfied each time the R-wave detector detects an additional potential VS event based on the first filtered version of the signal indicative of cardiac electrical activity, and to change from causing the first filtered version of the signal indicative of cardiac electrical activity to causing the second filtered version of the signal indicative of cardiac electrical activity to be provided to the R-wave detector, based on results of the additional determination of whether the one or more first criteria are satisfied; and
the controller is configured to make an additional determination whether the one or more second criteria are satisfied each time the R-wave detector detects an additional potential VS event based on the second filtered version of the signal indicative of cardiac electrical activity, and to change from causing the second filtered version of the signal indicative of cardiac electrical activity to causing the first filtered version of the signal indicative of cardiac electrical activity to be provided to the R-wave detector, based on results of the additional determination of whether the one or more second criteria are satisfied.
11. An apparatus, comprising:
two or more electrodes;
a sensing circuit coupleable to at least two of the electrodes to thereby sense a signal indicative of cardiac electrical activity;
a first bandpass filter configured to pass frequencies within a first frequency range and that can be used to produce a first filtered version of the signal indicative of cardiac electrical activity;
a second bandpass filter configured to pass frequencies within a second frequency range and that can be used to produce a second filtered version of the signal indicative of cardiac electrical activity, wherein the second frequency range is wider than the first frequency range;
an R-wave detector; and
a controller configured to cause only one of the first or second filtered versions of the signal indicative of cardiac electrical activity to be provided to the R-wave detector at a time;
the R-wave detector configured to monitor for a potential ventricular sensed (VS) event based on the only one of the first or second filtered versions of the signal indicative of cardiac electrical activity, which is caused to be provided to the R-wave detector by the controller at the time; and
the controller configured to
determine whether one or more first criteria are satisfied, in response to a said potential VS event being detected by the R-wave detector based on the first filtered version of the signal indicative of cardiac electrical activity; and
change from causing the first filtered version of the signal indicative of cardiac electrical activity to be provided to the R-wave detector, to causing the second filtered version of the signal indicative of cardiac electrical activity to be provided to the R-wave detector, based on results of the determination of whether the one or more first criteria are satisfied;
determine whether one or more second criteria are satisfied, in response to a said potential VS event being detected by the R-wave detector based on the second filtered version of the signal indicative of cardiac electrical activity; and
change from causing the second filtered version of the signal indicative of cardiac electrical activity to be provided to the R-wave detector, to causing the first filtered version of the signal indicative of cardiac electrical activity to be provided to the R-wave detector, based on results of the determination of whether the one or more second criteria are satisfied;
wherein the one or more second criteria include:
(i) neither ventricular tachycardiac (VT) nor ventricular fibrillation (VF) is currently being detected; and
(ii) a specified amount of most recently detected potential VS events each have a peak amplitude above a further specified amplitude threshold, or have been classified as having been detected due to T-wave oversensing; and
wherein the controller changes from causing the second filtered version of the signal indicative of cardiac electrical activity to be provided to the R-wave detector, to causing the first filtered version of the signal indicative of cardiac electrical activity to be provided to the R-wave detector, in response to the controller determining that both criteria (i) and (ii) are true.