CA2534119A1 - Multiple electrode vectors for implantable cardiac treatment devices - Google Patents

Multiple electrode vectors for implantable cardiac treatment devices Download PDF

Info

Publication number
CA2534119A1
CA2534119A1 CA002534119A CA2534119A CA2534119A1 CA 2534119 A1 CA2534119 A1 CA 2534119A1 CA 002534119 A CA002534119 A CA 002534119A CA 2534119 A CA2534119 A CA 2534119A CA 2534119 A1 CA2534119 A1 CA 2534119A1
Authority
CA
Canada
Prior art keywords
electrode
signal
cardiac
sensing
vector
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Abandoned
Application number
CA002534119A
Other languages
French (fr)
Inventor
Jay A. Warren
Gust H. Bardy
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Cameron Health Inc
Original Assignee
Cameron Health, Inc.
Jay A. Warren
Gust H. Bardy
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from US10/856,084 external-priority patent/US7330757B2/en
Priority claimed from US10/858,598 external-priority patent/US7248921B2/en
Priority claimed from US10/863,599 external-priority patent/US7379772B2/en
Application filed by Cameron Health, Inc., Jay A. Warren, Gust H. Bardy filed Critical Cameron Health, Inc.
Publication of CA2534119A1 publication Critical patent/CA2534119A1/en
Abandoned legal-status Critical Current

Links

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Measuring for diagnostic purposes; Identification of persons
    • A61B5/24Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/25Bioelectric electrodes therefor
    • A61B5/276Protection against electrode failure
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Measuring for diagnostic purposes; Identification of persons
    • A61B5/07Endoradiosondes
    • A61B5/076Permanent implantations
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Measuring for diagnostic purposes; Identification of persons
    • A61B5/24Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/25Bioelectric electrodes therefor
    • A61B5/279Bioelectric electrodes therefor specially adapted for particular uses
    • A61B5/28Bioelectric electrodes therefor specially adapted for particular uses for electrocardiography [ECG]
    • A61B5/283Invasive
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Measuring for diagnostic purposes; Identification of persons
    • A61B5/24Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/30Input circuits therefor
    • A61B5/304Switching circuits
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Measuring for diagnostic purposes; Identification of persons
    • A61B5/24Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316Modalities, i.e. specific diagnostic methods
    • A61B5/318Heart-related electrical modalities, e.g. electrocardiography [ECG]
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Measuring for diagnostic purposes; Identification of persons
    • A61B5/72Signal processing specially adapted for physiological signals or for diagnostic purposes
    • A61B5/7203Signal processing specially adapted for physiological signals or for diagnostic purposes for noise prevention, reduction or removal
    • A61B5/7207Signal processing specially adapted for physiological signals or for diagnostic purposes for noise prevention, reduction or removal of noise induced by motion artifacts
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61NELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00Electrotherapy; Circuits therefor
    • A61N1/18Applying electric currents by contact electrodes
    • A61N1/32Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362Heart stimulators
    • A61N1/3621Heart stimulators for treating or preventing abnormally high heart rate
    • A61N1/3622Heart stimulators for treating or preventing abnormally high heart rate comprising two or more electrodes co-operating with different heart regions
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61NELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00Electrotherapy; Circuits therefor
    • A61N1/18Applying electric currents by contact electrodes
    • A61N1/32Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/38Applying electric currents by contact electrodes alternating or intermittent currents for producing shock effects
    • A61N1/39Heart defibrillators
    • A61N1/3925Monitoring; Protecting

Abstract

The implantable cardiac treatment system of the present invention is capable of choosing the most appropriate electrode vector to sense within a particular patient. In certain embodiments, the implantable cardiac treatment system determines the most appropriate electrode vector for continuous sensing based on which electrode vector results in the greatest signal amplitude, or some other useful metric such as signal-to-noise ratio (SNR). The electrode vector possessing the highest quality as measured using the metric is then set as the default electrode vector for sensing. Additionally, in certain embodiments of the present invention, a next alternative electrode vector is selected based on being generally orthogonal to the default electrode vector. In yet other embodiments of the present invention, the next alternative electrode vector is selected based on possessing the next highest quality metric after the default electrode vector. In some embodiments, if analysis of the default vector is ambiguous, the next alternative electrode vector is analyzed to reduce ambiguity.

Description

MULTIPLE ELECTRODE VECTORS FOR IMPLANTABLE
CARDIAC TREATMENT DEVICES
Reference to Related Applications The present application claims the benefit of U.S. Provisional Application Serial No. 60/490,779, filed July 28, 2003, entitled MULTIPLE ELECTRODE
VECTORS IN A SUBCUTANEOUS ICD. This application is also a continuation in part of co-pending U.S. Patent Application No. 10/856,084 filed May 27, 2004, entitled METHOD FOR DISCRIMINATING BETWEEN VENTRICULAR AND
SUPRAVENTRICULAR ARRHYTHMIAS, which claims the benefit of U.S.
to Provisional Application Serial No. 60/474,323, filed May 29, 2003. This application is also a continuation-in-part of co-pending U.S. Application Serial No.
10/863,599, filed June 8, 2004, entitled APPARATUS AND METHOD OF ARRHYTHMIA

CARDIOVERTERIDEFIBRILLATOR, which is a continuation of U.S. Application Serial No. 091990,510, filed November 21, 2001, entitled APPARATUS AND
METHOD OF ARRHYTHMIA DETECTION IN A SUBCUTANEOUS
IMPLANTABLE CARDIOVERTER/DEFIBRILLATOR, pow U.S. Patent No.
6,754,528. This application is also a continuation-in-part of U.S. Patent Application No. 10/858,598 filed June 1, 2004, entitled METHOD AND DEVICES FOR
2o PERFORMING CARDIAC WAVEFORM APPRAISAL, which claims the benefit of U.S. Provisional Application Serial No. 60/475,279, filed June 2, 2003. The disclosure of each of these applications is incorporated herein by reference.
Field of the Invention The present invention relates generally to methods and devices for improving sensing in an implantable cardiac treatment system. More particularly, the present invention relates to the placement of electrodes in an implantable pacing or cardioversion/defibrillation system at defined locations within a patient to create multiple electrode vectors for improved far-field sensing and improved sensing of cardiac events.
3o Back r Implantable cardiac rhythm management devices are an effective treatment in managing irregular cardiac rhythms in particular patients. Implantable cardiac rhythm management devices are capable of recognizing and treating arrhythmias with a variety of therapies. These therapies include anti-bradycardia pacing for treating bradycardia, anti-tachycardia pacing or cardioversion pulsing for treating ventricular tachycardia, and high energy shocking for treating ventricular fibrillation.
Usually, the cardiac rhythm management device delivers these therapies for the treatment of tachycardia in sequence starting with anti-tachycardia pacing and then proceeding to low energy shocks, and then finally to high energy shocks. Sometimes, however, only one of these therapies is selected depending upon the tachyarrhythmia detected.
To effectively deliver treatment, cardiac rhythm management devices must first accurately detect and classify a cardiac event. Through the accurate classification of cardiac events, these cardiac rhythm management devices are able to l0 classify the type of arrhythmia that is occurring (if any) and assess the appropriate therapy to provide to the heart (if indicated). A problem arises, however, when the cardiac rhythm management device misclassifies an event and, as a result, delivers inappropriate therapy or fails to deliver therapy.
Besides being physically painful to the patient, when a cardiac rhythm management device delivers inappropriate treatment, it can be extremely disconcerting. Moreover, delivery of an inappropriate therapy can intensify the malignancy of the cardiac arrhythmia or cause an arrhythmia where one was not present. The accuracy of a sensing architecture is, therefore, an important factor in ensuring that appropriate therapy is delivered to a patient.
2o Summary In a first embodiment, an implantable cardiac treatment system is provided with electrodes disposed at several locations in a patient's thorax. During operation of the system, various sensing vectors can be periodically, repeatedly, or continuously monitored to select the best sensing vector for event detection and classification. A
sensing vector may be selected and then used for analysis. In another embodiment, multiple vectors may be simultaneously analyzed to provide a tiered or prioritized detection scheme, or to provide a secondary check on a higher priority vector.
For example, a first vector may be used as the higher priority vector, and a second vector may be used to verify that sensed with the first vector. Alternatively, ambiguity may 3o be reduced by the use of a second vector to check on a first vector.
Additional embodiments include implantable cardiac treatment systems and operational circuitry for use in implantable cardiac treatment systems which are adapted for performing these methods. Some embodiments take the form of subcutaneous implantable cardiac treatment systems.

Brief Description of the Drawings Figures lA-1B illustrate, respectively, representative subcutaneous and intravenous implantable cardiac treatment systems;
Figure 2 shows a subcutaneous implantable cardiac treatment system having an alternative subcutaneous electrode system arrangement;
Figures 3A and 3B show three positions for the placement of an implantable cardiac treatment device and four subcutaneous positions for the placement of an electrode;
Figure 4 illustrates a laterally placed implantable cardiac treatment system to with a parasternally placed electrode;
Figure 5 illustrates a pectorally placed implantable cardiac treatment system with a paxasternally placed electrode;
Figures 6A-6F depict recorded electrocardiograms from several discrete intra-electrode distances;
Figure 7 shows a block diagram of the vector sensing evaluation for determining the periodicity to evaluate the best electrode vector based on observed ambiguous signals; and Figures 8A and 8B show the relationships between two electrode vectors on sensing a cardiac depolarization vector.
2p Detailed Description The following detailed description should be read with reference to the Figures, in which like elements in different Figures are numbered identically.
The Figures, which are not necessarily to scale, depict selected embodiments and are not intended to limit the scope of the invention. Those skilled in the art will recognize that many of the examples and elements of the examples have suitable alternatives that may be utilized.
The present invention is generally related to cardiac rhythm management devices (e.g., an Implantable Cardioverter/Defibrillator (ICD) system) that provide therapy for patients experiencing particular arrhythmias. The present invention is 3o directed toward sensing architectures fox use in cardiac rhythm management devices.
In particular, the present invention is suited for ICD systems capable of detecting and defibrillating harmful arrhythmias. Although the sensing architecture is intended primarily for use in an implantable medical device that provides defibrillation therapy, the invention is also applicable to cardiac rhythm management devices directed toward anti-tachyarrhythmia pacing (ATP) therapy, pacing, and other cardiac rhythm devices capable of performing a combination of therapies to treat rhythm disorders, including external devices.
To date, ICD systems have been epicardial systems or transvenous systems implanted generally as shown in Figure 1B, however, as further explained herein, the present invention is also adapted to function with a subcutaneous ICD system as shown in Figure 1A.
Figure 1A illustrates a subcutaneously placed ICD system. In this illustrative embodiment, the heart 1 is monitored using a canister 2 coupled to a lead system 3.
1o The canister 2 may include an electrode 4 thereon, while the lead system 3 connects to sensing electrodes 5, 6, and a coil electrode 7 that may serve as a shock or stimulus delivery electrode as well as a sensing electrode. The general path between various electrodes define a number of sensing vectors V1, V2, V3, V4. It can be seen that each vector provides a different vector "view" of electrical activity in the heart 1. The system may be implanted subcutaneously as illustrated, for example, in U.S.
Patent Nos. 6,647,292 and 6,721,597, the disclosures of which are both incorporated herein by reference. By subcutaneous placement, it is meant that sensing and therapy can be accomplished with electrode placement that does not require insertion of an electrode into a heart chamber, the heart muscle, or the patient's vasculature.
2o Figure 1 B illustrates a transvenous ICD system. The heart 10 is monitored and treated by a system including a canister 11 coupled to a lead system 12 including atrial electrodes 13 and ventricular electrodes 14. A number of configurations for the electrodes may be used, including placement within the heart, adherence to the heart, or disposition within the patient's vasculature. For example, Olson et al., in U.S.
Patent No. 6,731,978, illustrate electrodes disposed in each chamber of the heart for sensing, as well as shocking electrodes in addition to the sensing electrodes.
The present invention, in some embodiments, is also embodied by operational circuitry including select electrical components provided within the canister 2 (Figure 1A) or canister 11 (Figure 1B). In such embodiments, the operational circuitry may 3o be configured to enable the methods to be performed. In some similar embodiments, the present invention may be embodied in readable instruction sets such as a program encoded in machine or controller readable media, wherein the readable instruction sets are provided to enable the operational circuitry to perform the analysis discussed herein in association with various embodiments. Further embodiments may include a controller or microcontroller adapted to read and execute embodiments discussed herein.
In the system illustrated in Figure 1A, the subcutaneous implantable cardiac treatment device can sense a plurality of electrode vectors. In particular, the configuration depicted can sense at least between the first sensing electrode 6 and the canister or housing electrode 4. The canister or housing electrode 4 can be a part of the housing or canister, the housing or canister itself may be an electrode 4, or alternatively, the electrode can be attached to or on the housing. This sensing relationship forms electrode vector v1. The device can further sense between the first 1o sensing electrode 6 and the second sensing electrode 5 to form electrode vector v2. A
third sensing configuration is created by sensing between the second sensing electrode 5 and the canister electrode 4. This sensing relationship forms electrode vector v3.
The last illustrated electrode vector is between the shocking electrode 7 and the canister electrode 4 forming electrode vector v4. The system depicted in Figure 1 a is illustrative only. The purpose of the figure is to demonstrate some of the possible electrode vectors that can be formed with implantable caxdioverter-defibrillator systems, paxticulaxly with subcutaneous systems. Other electrode arrangements and electrode types may be utilized without deviating from the spirit and scope of the invention.
An alternative subcutaneous embodiment is depicted in Figure 2. A canister 18 is electrically coupled to electrodes 19, 20, 22, with electrodes 19, 20 disposed on a lead 24 and electrode 22 disposed on the canister 18. The several electrodes 19, 20, 22 provide various sensing vectors around heart 26. The illustrative leads and electrodes may have various lengths. As further discussed below, certain sizes and lengths may provide advantageous sensing characteristics.
Figures 3A and 3B show three illustrative subcutaneous positions (X, Y and Z) for the placement of an ICD in a patient's thoracic region. Figure 3A is a view from the front, facing a patient's chest, while Figure 3B is a view from the left of a patient, each view showing only the ICD components and the heart. Position X
is 3o disposed on the left side of the rib cage, inferior to the axm, and is designated herein as the lateral position. Position Y is a frontal position, inferior to the inframammary crease (IC) and is designated herein as the inframaxnmary position. Finally, position Z is also a frontal position and can correspond to a conventional positioning for ICDs.

This position is located superior and to the left of the heart (H) and inferior the collarbone (CB). This position Z is designated herein as the pectoral position.
Similarly, Figures 3A and 3B show four subcutaneous positions (A, B, C and D) for the placement of the subcutaneous electrode system 12 upon a patient's thoracic region. Position A is a parasternal placement that is positioned on the left side of the sternum (ST). Position B is an electrode placement that runs parallel to the sternum (ST), but position B is located laterally as opposed to the parasternal placement of position A. Position C is an electrode placement that is generally orthogonal to positions A and B and is positioned on a line superior to the heart (H).
to Finally, position D is an electrode placement that is parallel with position C, but has the electrode positioned in a line inferior to the patient's heart (H).
Figure 4 illustrates a laterally placed (X) ICD canister 30 with a parasternally placed (position A) subcutaneous electrode system along lead 32. Figure 4 shows the lead 32 traversing subcutaneously along the ribcage and terminating in a position where the subcutaneous electrode system of the lead 32 is disposed vertically and parallel to the patient's sternum (ST). The first sensing electrode 34 is shown positioned at or neax a line superior to the patient's heart (H). A coil electrode 35 is also shown, with the coil electrode 35 coupled for use as a shocking electrode, and, optionally, as an additional sensing electrode.
2o Figure 5 similarly illustrates a pectorally placed (Z) ICD canister 36 with a parasternally placed (position A) subcutaneous electrode system including a lead 38.
Figure 5 also shows the lead 38 traversing subcutaneously along the ribcage and terminating such that the subcutaneous electrode system of the lead 38 is disposed vertically and parallel to the patient's sternum (ST). In contrast to the electrode 2s placement in Figure 3, the first sensing electrode 40 of the subcutaneous electrode system is positioned at or near a line inferior to the patient's heart (H).
Again, a coil electrode 41 serving as a shocking and, if desired, sensing electrode is also illustrated.
The subcutaneous space surrounding a patient's thoracic region is inherently curvaceous. Because the canister 30, 36 (which may include a sensing electrode) and 3o the subcutaneous electrode system on leads 32, 38 are positioned upon this region, the electrodes, canister and lead for the ICD axe rarely, if ever, planar with respect to one another. Thus various vectors may be defined to intersect the heart (H), without necessarily having to place electrodes in the heart (H).

The distance separating the canister 30, 36 and the electrodes on the leads 32, 38 is dependent on the patient's anatomy. With the configurations shown in Figures 4 and 5, in a typical adult patient, the center of the canister 30, 36 is approximately 8 cm to approximately 19 cm away from the center of a shocking coil 35, 41 on the leads 32, 38. Children receiving devices according to the present invention may have separations between the canister and the shocking coil 35, 41 of generally no less than approximately 4 cm.
Subcutaneous embodiments of the present invention benefit from the ability to optimize the infra-electrode distance to maximize the sensing of cardiac electrical l0 activity. Because subcutaneous embodiments of the present invention are not constrained by the location of electrodes within the system or within the patient's thorax, a subcutaneous system may use infra-electrode distances particularly chosen for optimizing far-field signal sensing, or may vary the sensing electrode pair during operation to optimize sensing.
Figure 6A-6F depict observed electrocardiogram (EKG) signals from two small surface area electrodes having differing infra-electrode distances. In these figures, one of the two small surface area electrodes was placed in a fixed position located laterally 0.5" from the sternum, and over the patient's heaxt. The second of the two small surface area electrodes was positioned specific distances from the first electrode to observe and record the change in the resulting EKG.
Initially, the second electrode was placed laterally 0.75" from the fixed electrode, thereby creating an infra-electrode distance of approximately 0.75". An EKG was then observed of the cardiac electrical activity. Figure 6A represents a portion of the recorded EKG where the electrodes possessed an infra-electrode distance of approximately 0.75". Additional EKGs were recorded to measure the sensed cardiac activity after positioning the second electrode laterally approximately 1.25", 2", 2.5", 3.25" and 5.5" away from the fixed electrode position. The resulting EKGs are shown in Figures 6B-6F, respectively. The average observed amplitude for the QRS complex was approximately 1.0 mV in Figure 6A, approximately 2.0 mV in Figure 6B, approximately 4.4 mV for Figure 6C, approximately 5.5 mV for Figure 6D, approximately 7.8 mV for Figure 6E and approximately 9.6 mV for Figure 6F.
Subcutaneous embodiments of the present invention are not constrained by the location of electrodes to intravenous or intracardiac locations. As such, the subcutaneous system may use infra-electrode distances that are particularly chosen for -7_ optimizing far-field signal sensing. It is observed in Figures 6A 6F that increasing the infra-electrode distance results in significantly increased signal amplitudes.
A 100%
increase in amplitude was observed between the recorded cardiac electrical activity in Figure 6B and Figure 6A. A 340% increase in amplitude was observed between the recorded cardiac electrical activity in Figure 6C and Figure 6A. A 450%
increase in amplitude was observed between the recorded cardiac electrical activity in Figure 6D
and Figure 6A. A 680% increase in amplitude was observed between the recorded cardiac electrical activity in Figure 6E and Figure 6A. Finally, an 860%
increase in amplitude was observed between the recorded cardiac electrical activity in Figure 6F
l0 and Figure 6A.
It is appreciated by those skilled in the art that it is desirable to obtain the highest signal amplitudes possible when sensing. Specifically, because detected cardiac electrical signals are processed to classify particular rhythms, the larger the cardiac electrical signal the greater the opportunity to correctly classify a rhythm.
Some embodiments of the present invention provide an enhanced opportunity to correctly classify arrhythmias by using intrxelectrode distances particularly chosen for optimizing far-field signal sensing.
Some embodiments of the present invention are further capable of choosing the most appropriate electrode vector to sense within a particular patient. In one 2o embodiment, (referring to Figure 1 ) after implantation, the ICD is programmed to sense between several available electrode vectors - v1, v2, v3 and v4. The ICD
system then senses a series of cardiac signals using some or all of the available electrode vectors, or a preset number of available electrode vectors. In certain embodiments, the ICD system then determines the most appropriate electrode vector for continuous sensing based on which electrode vector results in the greatest signal amplitude, or performs best using some other metric such as signal-to-noise ratio (SNR). The electrode vector possessing the highest quality metric (e.g., amplitude or SNR) is then set as the default electrode vector for continuous sensing. In certain embodiments, the next alternative electrode vector is selected based on being generally orthogonal to the 3o default electrode vector. For example, if electrode vector v3, is selected as the default vector, the next alternative electrode vector may be v2, an electrode vector generally orthogonal to v3. In yet other embodiments the next alternative electrode vector is selected based on possessing the next highest quality metric after the default electrode vector.
_g_ Recognizing that patient anatomies vary, the present invention is not intended to be limited to purely or strictly orthogonal sensing vectors. In some embodiments, generally orthogonal sensing vectors are considered to exist when two sensing vectors create an angle such that the magnitude of the cosine of the angle is less than about 0.7. In another embodiment, the magnitude of the cosine of the angle is less than about 0.5. In a further embodiment, the magnitude of the cosine of the angle is less than about 0.3. As used herein, the phrase "the magnitude of indicates absolute value when applied to a scalar value such as the cosine of an angle. This angular analysis is used herein because, while two vectors may define a plane, an intersection to of two vectors can define a plurality of angles. Analysis in terms of cosines assures the same result regardless how the vectors are disposed with respect to one another for the purpose of determining the angles therebetween. Dealing only in first quadrant angles, the above noted values for cosines yield angles of between about 45 and 90 degrees, about 60 and 90 degrees, and about 72 and 90 degrees.
In one embodiment of the present invention, the ICD system determines the most appropriate electrode vector based on results of an operation performed on all of the sensed signals. The ICD system independently operates on all of the sensed signals received from each of the possible electrode vectors using the ICD
system's detection architecture. For example, the ICD system may run all of the signals from 2o each of the electrode vectors through a correlation waveform analysis, or a similar operation function. Specifically, the ICD system performs a correlation waveform analysis on electrode vectors v1, v2, v3 and v4 independently. The ICD system then evaluates the results from each of the independently operated-on signals. This evaluation procedure determines the electrode vectors that yield the highest quality metric for rendering a decision. Finally, the ICD system selects the electrode vector yielding the highest quality metric as the default electrode vector for continuous sensing. For example, the ICD system will select the electrode vector v3 as the default electrode vector if it yields the highest quality metric from the four electrode vectors evaluated.
In certain embodiments, the ICD system paretos (prioritizing according to the hierarchy of performance) the electrode vectors. By paretoing the electrode vectors, the ICD system may utilize alternative electrode vectors, in particular the next best performing electrode vectors, when ambiguities arise in analysis of the default electrode vector.

For certain embodiments of the present invention, the evaluation of the best electrode vectors for sensing are updated periodically by the physician. A
programmer responsive to the ICD system may receive transmissions from the ICD
system. Amongst others, the transmissions from the programmer characterize the cardiac activity sensed by each electrode vector. The physician may then select the optimal electrode vector for the particular patient and set that chosen electrode vector as the default. The programmer may additionally enable the physician to elect alternative schemes for instances where the signal from the default electrode vector is compromised. Additionally, the programmer may select the optimal electrode vector to and elect alternative schemes automatically based on the received transmissions from the ICD system.
In yet alternative embodiments, the evaluation of the best electrode vectors for sensing is updated periodically by the ICD system, whether that decision is made a priori (e.g., by signal amplitude) or ex post facto (e.g., after operating on the unprocessed signal data). For example, initially the highest quality metric (e.g., highest amplitude signal) is sensed using electrode vector v1. Sometime after implantation, however, the ICD system may determine that the highest quality metric is experienced when sensing through the electrode vector v2. Conversely, it may be periodically determined that the best electrode vector continues to remain with 2o electrode vector vz during the entire life of the device.
An example of an a priori update would be one where the SNR is measured for each of several vectors over time. If a muscle artifact develops after implantation, or if a fibroid forms around one of the sensing electrodes, then the relative SNR of the several sensing vectors may change over time. If one of the sensing vectors provides a superior SNR to that of the initially chosen vector, then the later update may select a different vector.
An example of an ex post facto update would be one where a particular sensing vector is chosen for a period of time, but proves to be unsuitable for analysis, for example, due to noise artifacts. For example, if a beat validation scheme is used 3o as explained in co-pending U.S. Patent Application No. 10/858,598 filed June 1, 2004, entitled METHOD AND DEVICES FOR PERF~RMING CARDIAC
WAVEFORM APPRAISAL, which is incorporated herein by reference, then consistent failure to capture validated beats may indicate that the chosen vector is unsuitable. Likewise, if a template formation system relies upon captured data, then a failure to capture a template meeting chosen validity criteria may indicate that the chosen vector is unsuitable. In such cases, another sensing vector may be chosen by looking at the next best sensing vector. For example, if a first vector is chosen for sensing because it has a best amplitude of sensed vectors, supposing that first vector proves to be unsuitable for template formation, then a second vector having the second best amplitude may be chosen.
The periodicity used to evaluate the best electrode vector is preferably based on whether the sensed cardiac electrical signal is ambiguous to the ICD
system's detection architecture. With respect to this invention, ambiguity concerns whether the 1o sensed cardiac electrical signal is difficult to comprehend, understand, or classify by the ICD system's detection architecture. This process is illustrated by example in Figure 7.
Referring now to Figure 7, a cardiac electrical signal is sensed through electrode vector v1. The sensed signal is then operated on by the detection architecture of the ICD system. The result of this operation is hen evaluated.
In certain embodiments, the ICD system will evaluate whether the operated-on signal equates unambiguously to a normal sinus rhythm. If the result of the operation unambiguously indicates a normal sinus rhythm, then the ICD system repeats the procedure and senses another cardiac electrical signal to operate upon.
However, if 2o the result of the operation is ambiguous, or the operated-on signal indicates a rhythm other than normal sinus, then the process enters a second stage 50. Some illustrative explanations of ambiguity can be found in U.S. Patent Application No.
10/856,084 filed May 27, 2004, entitled METHOD FOR DISCRIMINATING BETWEEN
VENTRICULAR AND SUPRAVENTRICULAR ARRHYTHMIAS, which is incorporated herein by reference.
In the second stage 50, the sensing of the next cardiac electrical signal in time is performed through an alternative electrode vector. In some embodiments, the alternative electrode vector used for this sensing is one that is generally orthogonal to the electrode vector used to sense the previous signal. For example, if the previous 3o cardiac electrical signal was sensed through electrode vector v1, the next cardiac electrical signal would be sensed through electrode vector v2. In alternative embodiments of the present invention, any of the remaining electrode vectors may be used to sense the next cardiac electrical signal in the second stage 50. For example, a next highest amplitude sensing vector may be chosen.

This subsequently sensed signal is then operated on by the detection architecture of the ICD system. The result of this operation is again evaluated. If the result of the operation unambiguously indicates a normal sinus rhythm from this alternative electrode vector, then the ICD system repeats the procedure and senses another cardiac signal to operate upon. In certain embodiments, subsequently sensed cardiac signals following the second stage 50 continue to be sensed through the electrode vector used for evaluation in the second stage 50. Thus in the previous example, all subsequently sensed cardiac electrical signals would be sensed using electrode vector v2. However, in particular embodiments, this is only true if the result l0 of the second stage 50 operation unambiguously indicates a normal sinus rhythm. If the result of the second stage 50 is again ambiguous, or the operated-on signal unambiguously indicates a rhythm other than normal sinus, then future sensed cardiac electrical signals may once again be processed using the default electrode vector -here being v1.
In yet alternative embodiments, the next cardiac electrical signal following any second stage 50 evaluation is again initially sensed through the default electrode vector - for this example v1. In this embodiment, the default electrode vector is changed only after a series of unambiguous evaluations utilizing the second stage 50 and its alternative electrode vector.
The ICD device of the present invention may also sense between multiple electrode vectors continuously and/or independently of one another. This ability allows the present invention to evaluate the same cardiac electrical signal in time from numerous vector viewpoints. Additionally, this ability permits the ICD system to evaluate the best electrode vector based on observed ambiguous signals without failing to operate and evaluate each sensed cardiac signal. Specifically, a cardiac electrical signal is sensed through an electrode vector, for example, v1. The sensed signal is then operated on by the detection architecture of the ICD system.
The result of this operation is then evaluated. If the result of the operation is ambiguous, or the operated-on signal unambiguously indicates a rhythm other than normal sinus, then 3o the process enters a second stage 50.
In the second stage 50 of this embodiment, a cardiac electrical signal sensed at the same time as the sample already evaluated, but with different electrodes, is evaluated. Therefore, both the signal previously operated on and the one which is to be operated on in the second stage 50 occurred at the same time - although acquired through a different electrode vector. The sensed signal from v2 is then operated on by the detection architecture of the ICD system. The result of this operation is again evaluated. If the result of the operation unambiguously indicates a normal sinus rhythm in this second electrode vector, then the ICD system repeats the procedure and senses another cardiac electrical signal in which to operate upon.
The general ability to sense between multiple sensing vectors particularly enhances specificity for detection architectures that discriminate between arrhythmias.
Specifically, sensing between multiple electrode vectors enhances specificity in discriminating the origin and type of arrhythmia. In one example of the present to invention, a cardiac complex representative of normal sinus rhythm (NSR) is captured from each of electrode vector v1 and electrode vector v2, and then stored.
These are stored as NSR template 1 and NSR template 2, respectively. Because electrode vectors v1 and v2 are at different angles to the heart, their respective templates may differ significantly even though they may be based upon the same cardiac events.
From beat to beat, sensed complexes may be compared to their respective NSR templates. As an example, in certain vector orientations ventricular originating arrhythmias may resemble an NSR. With ICD systems that sense only one electrode vector, some ventricular arrhythmias may not be distinguishable to a detection architecture. In the present invention, however, the chances of failing to classify a particular rhythm are reduced through the use of multiple views. In particular, although a ventricular originating arrhythmia may resemble the NSR template in one view, it would be highly unlikely that a second electrode vector would also sense the same complex as resembling its NSR template.
Ventricular originating arrhythmias often exhibit a polarity flip with relation to their NSR. If this polarity flip goes undetected because of positioning in one electrode vector, a generally orthogonally positioned second electrode vector would most likely sense such a flip when compared to its NSR template. Thus, the detection algorithm would classify the uncharacteristic complex, or series of complexes, and assess the complexes as a ventricular arrhythmia.
3o In one embodiment, an initial analysis of the default electrode vector captured using a default electrode pair may yield an ambiguous result. For example, if a correlation waveform analysis is performed to compare a sensed signal to an NSR
template, the waveform analysis may indicate that NSR is not occurring.
However, it may not be clear from the initial analysis what type of arrhythmia is occurring (for example, a supraventricular arrhythmia which does not require treatment, or a ventricular arrhythmia that does require treatment). In the illustrative example, a second level of analysis may be performed using a signal captured using different electrodes to differentiate treatable and untreatable arrhythmias. The method may then return to observing only the default electrode pair.
Figures 8A and 8B demonstrate the relationship between two electrode vectors in sensing a cardiac depolarization vector. More specifically, Figures 8A and graphically illustrate the electrode vectors formed in the ICD system between the active canister 64 and the first sensing ring 62, and the first sensing ring 62 and the to second sensing ring 60. These vectors are labeled, respectively, v1 and va.
Figure 8A
and 8B further illustrate a cardiac depolarization vector M. ' The cardiac depolarization vector M cannot be completely described by measuring only one of the two electrode vectors shown in Figures 8A and 8B. More information about the cardiac depolarization vector M can be acquired using two electrode vectors.
Thus, , the resulting ECG derived from three or more electrodes will more accurately define a depolarization vector M, or a fraction thereof.
For the cardiac depolarization vector M, the voltage induced in the direction of electrode vector v1 is given by the component of M in the direction of v1. In vector algebra, this can be denoted by the dot product um = M ~ y where u,,1 is the scalar voltage measured in the direction of electrode vector v1.
Figures 8A and 8B further depict an electrode vector v2 oriented in space. The effect of the cardiac depolarization vector M as it relates to electrode vector v2 differs, however, between Figures 8A and 8B.
Figure 8A illustrates a cardiac depolarization vector M that includes components in both vector directions, and so is sensed and measured with scalar voltages along both electrode vectors. The cardiac depolarization vector M in Figure 8A is oriented in space such that both electrode vectors v1 and v2 sense scalar voltages u~l and uV2, respectively. Although the scalar voltage u,,1 predominates, the scalar 3o voltage uva is sensed and can be used for discriminating differences in the magnitude and the direction of the cardiac depolarization vector M.
In contrast, the electrode vector v2 in Figure 8B is oriented orthogonally to the cardiac depolarization vector M. In this embodiment, the component of M along the direction of vector electrode va is zero because the v2 electrode vector senses no voltage as a result of the cardiac depolarization vector; no voltage is induced in the direction of v2. In contrast, the scalar voltage along v1 parallels the depolarization vector M and fully captures M.
With the ability to ascertain the cardiac depolarization vector M, Figures 8A
and 8B further depict how the present invention may be utilized to enhance a particular attribute of the sensed signal. For example, the present invention may be utilized to enhance the signal-to-noise ratio (SNR) for an ICD system. In illustration, suppose that most patients demonstrate a cardiac depolarization vector M
similar to 1o that depicted in Figure 8A. For these patients, sensing along electrode vector v1 alone would result in a sufficiently high SNR to sense and detect most arrhythmias, while vector va provides information that may be relevant for sensing if analysis of v1 contains some ambiguity.
There may be patients, however, who exhibit a cardiac depolarization vector M similar to the one depicted in Figure 8B. These patients could exhibit a cardiac depolarization vector M at the time of implant, or after developing a pathology that changes the cardiac depolarization vector M over time to represent the one depicted in Figure 8B. For these patients, sensing along electrode vector v2 alone would result in an extremely low SNR. Furthermore, the ICD system may not be able to detect 2o certain arrhythmic events if this were the only sensing vector the ICD
system possessed. However, knowledge that v2 has such a low magnitude indicates greater directional information than just analyzing v1.
As described above, sensing sensitivity depends on the orientation of the cardiac depolarization vector M with respect to the orientation of the sensing electrodes.
The operational circuitry used in the implantable medical devices of the present invention may be configured to include such controllers, microcontrollers, logic devices, memory, and the like, as selected, needed, or desired for performing the steps for which each is configured.
3o In addition to uses in an ICD system, the present invention is also applicable to pacing systems. For example, in a pacing system a number of electrodes may be disposed to define several sensing vectors, and the present invention may guide the selection of and periodic updating of sensing vectors.

In one illustrative example, the present invention is embodied in an implantable cardiac treatment system comprising an implantable canister housing operational circuitry and a plurality of electrodes electrically coupled to the operational circuitry wherein the operational circuitry is configured and coupled to the electrodes to define at least a first implanted electrode pair and a second implanted electrode pair. The operational circuitry may be configured to perform the steps of capturing a first signal from the first implanted electrode pair, constructing a first template using the first signal, capturing a second signal from the second implanted electrode pair, constructing a second template using the second signal, and capturing a 1o signal using the first and second electrode pairs and using the first and second templates to determine whether a treatable cardiac condition exists.
Numerous characteristics and advantages of the invention covered by this document have been set forth in the foregoing description. It will be understood, however, that this disclosure is, in many aspects, only illustrative. Changes may be made in details, particularly in matters of shape, size and arrangement of parts without exceeding the scope of the invention. The invention's scope is defined, of course, in the language in which the claims axe expressed.

Claims (25)

1. An implantable electrical cardiac treatment device comprising:
first, second, and third electrodes, the second electrode provided at a first distance from the first electrode along a lead assembly, the third electrode provided at a second distance from the first electrode along a lead assembly; and operational circuitry electrically coupled to the first, second and third electrodes such that sensing can be performed using any pair chosen therefrom;
wherein the operational circuitry is adapted to perform the following steps:
observe a signal metric between at least two of the following sensor pairs: first-second, first-third, and second-third;
select a default sensor pair for use in cardiac signal analysis by determining which pair performs the best as measured by the signal metric.
2. The device of claim 1, wherein the first electrode is a housing electrode.
3. The device of claim 1, wherein the operational circuitry is adapted to perform the following steps:
perform data analysis of sensed cardiac signals;
determine whether the default sensor pair is providing a suitable signal for cardiac signal analysis; and if not, selecting a different sensor pair for use in cardiac signal analysis.
4. The device of claim 1, wherein the operational circuitry is adapted to provide an output signal using one of the electrode pairs.
5. The device of claim 1, further comprising a fourth electrode disposed as part of the lead assembly, the fourth electrode being a coil electrode, wherein the operational circuitry is configured to provide an output signal using the first electrode and the fourth electrode.
6. The device of claim 5, wherein the operational circuitry is adapted to consider electrode pairs including the fourth electrode and any of the first, second and third electrodes when performing the steps of observing a signal metric and selecting a default electrode pair.
7. The device of claim 1, wherein the operational circuitry is adapted to perform the following data. analysis:
analyzing a first signal captured from the default electrode pair to determine whether:
a normal sinus rhythm has been sensed;
an arrhythmia has been sensed; or ambiguity is present; and if ambiguity is present, selecting a second electrode pair using the signal metric and analyzing a second signal captured from the second electrode pair.
8. The device of claim 7, wherein the operational circuitry is adapted such that the second signal temporally corresponds to at least part of the first signal.
9. A method of cardiac signal analysis comprising:
implanting an implantable electrical cardiac treatment device and associated lead assembly into a patient such that operational circuitry housed in the device is coupled to first, second, and third electrodes;
observing a signal metric between two pairs of electrodes chosen from the first, second and third electrodes;
identifying a default electrode pair based upon observation of the signal metric; and using the default electrode pair for sensing of cardiac signals.
10. The method of claim 9, further comprising:
determining whether the default electrode pair provides a suitable signal for cardiac signal analysis; and if not, using a different electrode pair for sensing cardiac signals.
11. The method of claim 9, wherein one of the electrodes is provided such that it is on a housing electrode.
12. The method of claim 11, further comprising generating a cardiac stimulus using an electrode pair including the housing electrode.
13. The method of claim 9, further comprising:
performing data analysis of sensed cardiac signals;
determining whether the default sensor pair provides a suitable signal for cardiac signal analysis; and, if not, using a different sensor pair in cardiac signal analysis.
14. The method of claim 9, further comprising:
analyzing a first signal captured from the default electrode pair to determine whether:
a normal sinus rhythm has been sensed;
an arrhythmia has been sensed; or ambiguity is present; and if ambiguity is present, selecting a second electrode pair using the signal metric and analyzing a second signal captured from the second electrode pair.
15. The method of claim 14, wherein the second signal temporally corresponds to at least part of the first signal.
16. The method of claim 7, wherein the step of implanting an implantable electrical cardiac treatment device and associated lead assembly into a patient includes disposing the lead electrode assembly such that the first, second, and third electrodes define at least two generally orthogonal sensing vectors.
17. The method of claim 16, wherein the lead electrode assembly is disposed such that two sensing vectors create at an angle such that the magnitude of the cosine of the angle is less than about 0.7.
18. The method of claim 17, wherein the magnitude of the cosine of the angle is less than about 0.5.
19. The method of claim 18, wherein the magnitude of the cosine of the angle is less than about 0.3.
20. A method of operating an implantable electrical cardiac treatment device having operational circuitry for performing cardiac performance evaluation and treatment, the method comprising:
coupling first, second, and third implanted electrodes to the operational circuitry;
observing a sensing metric for selected pairs of the implanted electrodes; and identifying a default electrode pair for use in evaluation of cardiac signals.
21. A method as in claim 20, further comprising identifying a second best electrode pair for use in evaluation of cardiac signals.
22. A method as in claim 21, further comprising analyzing cardiac signals by:
analyzing a first signal captured using the default electrode pair to determine whether:
the first signal indicates a normal sinus rhythm;
the first signal indicates a particular arrhythmia; or the first signal indicates ambiguity; and if the first signal indicates ambiguity, analyzing a second signal captured using the second best electrode pair.
23. A method of cardiac signal analysis comprising:
capturing a first signal from a first implanted electrode pair;
constructing a first template using the first signal;
capturing a second signal from a second implanted electrode pair;
constructing a second template using the second signal; and capturing a signal using the first and second electrode pairs and using the first and second templates to determine whether a treatable cardiac condition exists.
24. The method of claim 23, wherein:
the first implanted electrode pair has a first sensing vector;

the second implanted electrode pair has a second sensing vector; and the first and second sensing vectors form an angle, wherein the magnitude of the cosine of the angle is less than about 0.5.
25. An implantable cardiac treatment system comprising an implantable canister housing operational circuitry and a plurality of electrodes electrically coupled to the operational circuitry wherein the operational circuitry is configured and coupled to the electrodes to define at least a first implanted electrode pair and a second implanted electrode pair, the operational circuitry being configured to perform the steps of:
capturing a first signal from the first implanted electrode pair;
constructing a first template using the first signal;
capturing a second signal from the second implanted electrode pair;
constructing a second template using the second signal; and capturing a signal using the first and second electrode pairs and using the first and second templates to determine whether a treatable cardiac condition exists.
CA002534119A 2003-07-28 2004-07-28 Multiple electrode vectors for implantable cardiac treatment devices Abandoned CA2534119A1 (en)

Applications Claiming Priority (11)

Application Number Priority Date Filing Date Title
US49077903P 2003-07-28 2003-07-28
US60/490,779 2003-07-28
US10/856,084 US7330757B2 (en) 2001-11-21 2004-05-27 Method for discriminating between ventricular and supraventricular arrhythmias
US10/856,084 2004-05-27
US10/858,598 US7248921B2 (en) 2003-06-02 2004-06-01 Method and devices for performing cardiac waveform appraisal
US10/858,598 2004-06-01
US10/863,599 2004-06-08
US10/863,599 US7379772B2 (en) 2001-11-21 2004-06-08 Apparatus and method of arrhythmia detection in a subcutaneous implantable cardioverter/defibrillator
US10/901,258 2004-07-27
US10/901,258 US7392085B2 (en) 2001-11-21 2004-07-27 Multiple electrode vectors for implantable cardiac treatment devices
PCT/US2004/024426 WO2005011809A2 (en) 2003-07-28 2004-07-28 Multiple electrode vectors for implantable cardiac treatment devices

Publications (1)

Publication Number Publication Date
CA2534119A1 true CA2534119A1 (en) 2005-02-10

Family

ID=34120124

Family Applications (1)

Application Number Title Priority Date Filing Date
CA002534119A Abandoned CA2534119A1 (en) 2003-07-28 2004-07-28 Multiple electrode vectors for implantable cardiac treatment devices

Country Status (10)

Country Link
US (3) US7392085B2 (en)
EP (2) EP1659934B1 (en)
JP (1) JP4477000B2 (en)
CN (1) CN100548211C (en)
AT (1) ATE413837T1 (en)
AU (1) AU2004261227B2 (en)
CA (1) CA2534119A1 (en)
DE (1) DE602004017749D1 (en)
ES (1) ES2317046T3 (en)
WO (1) WO2005011809A2 (en)

Families Citing this family (141)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7194302B2 (en) 2000-09-18 2007-03-20 Cameron Health, Inc. Subcutaneous cardiac stimulator with small contact surface electrodes
US7751885B2 (en) * 2000-09-18 2010-07-06 Cameron Health, Inc. Bradycardia pacing in a subcutaneous device
US7146212B2 (en) * 2000-09-18 2006-12-05 Cameron Health, Inc. Anti-bradycardia pacing for a subcutaneous implantable cardioverter-defibrillator
US6721597B1 (en) 2000-09-18 2004-04-13 Cameron Health, Inc. Subcutaneous only implantable cardioverter defibrillator and optional pacer
US7092754B2 (en) * 2000-09-18 2006-08-15 Cameron Health, Inc. Monophasic waveform for anti-bradycardia pacing for a subcutaneous implantable cardioverter-defibrillator
US20040199082A1 (en) * 2003-04-03 2004-10-07 Ostroff Alan H. Selctable notch filter circuits
US8825157B2 (en) * 2003-07-28 2014-09-02 Cameron Health, Inc. Vector switching in an implantable cardiac stimulus system
US7400217B2 (en) * 2003-10-30 2008-07-15 Avago Technologies Wireless Ip Pte Ltd Decoupled stacked bulk acoustic resonator band-pass filter with controllable pass bandwith
US7376458B2 (en) 2004-11-29 2008-05-20 Cameron Health, Inc. Method for defining signal templates in implantable cardiac devices
US7477935B2 (en) * 2004-11-29 2009-01-13 Cameron Health, Inc. Method and apparatus for beat alignment and comparison
US7655014B2 (en) * 2004-12-06 2010-02-02 Cameron Health, Inc. Apparatus and method for subcutaneous electrode insertion
US8160697B2 (en) 2005-01-25 2012-04-17 Cameron Health, Inc. Method for adapting charge initiation for an implantable cardioverter-defibrillator
US8229563B2 (en) * 2005-01-25 2012-07-24 Cameron Health, Inc. Devices for adapting charge initiation for an implantable cardioverter-defibrillator
US7555338B2 (en) * 2005-04-26 2009-06-30 Cameron Health, Inc. Methods and implantable devices for inducing fibrillation by alternating constant current
US7499751B2 (en) * 2005-04-28 2009-03-03 Cardiac Pacemakers, Inc. Cardiac signal template generation using waveform clustering
US20070135847A1 (en) * 2005-12-12 2007-06-14 Kenknight Bruce H Subcutaneous defibrillation system and method using same
US8301254B2 (en) 2006-01-09 2012-10-30 Greatbatch Ltd. Cross-band communications in an implantable device
US8175703B2 (en) * 2006-01-25 2012-05-08 Cardiac Pacemakers, Inc. Cardiac resynchronization therapy parameter optimization
US7894894B2 (en) 2006-03-29 2011-02-22 Medtronic, Inc. Method and apparatus for detecting arrhythmias in a subcutaneous medical device
US8435185B2 (en) 2006-03-29 2013-05-07 Medtronic, Inc. Method and apparatus for detecting arrhythmias in a medical device
US7941214B2 (en) * 2006-03-29 2011-05-10 Medtronic, Inc. Method and apparatus for detecting arrhythmias in a subcutaneous medical device
US7991471B2 (en) * 2006-03-29 2011-08-02 Medtronic, Inc. Method and apparatus for detecting arrhythmias in a subcutaneous medical device
US9327133B2 (en) * 2006-04-19 2016-05-03 Medtronic, Inc. Implantable medical device
US7596410B1 (en) 2006-04-28 2009-09-29 Pacesetter, Inc. Tiered antitachycardia pacing and pre-pulsing therapy
US7751887B1 (en) 2006-04-28 2010-07-06 Pacesetter, Inc. Tiered antitachycardia pacing and pre-pulsing therapy
EP2029226B1 (en) * 2006-05-26 2012-07-11 Cameron Health, Inc. Programmer and associated method for use in sensing vector selection with an implantable medical device
US20070276452A1 (en) * 2006-05-26 2007-11-29 Cameron Health, Inc. Implantable medical device systems having initialization functions and methods of operation
US8200341B2 (en) 2007-02-07 2012-06-12 Cameron Health, Inc. Sensing vector selection in a cardiac stimulus device with postural assessment
US7783340B2 (en) 2007-01-16 2010-08-24 Cameron Health, Inc. Systems and methods for sensing vector selection in an implantable medical device using a polynomial approach
US7623909B2 (en) * 2006-05-26 2009-11-24 Cameron Health, Inc. Implantable medical devices and programmers adapted for sensing vector selection
US8788023B2 (en) 2006-05-26 2014-07-22 Cameron Health, Inc. Systems and methods for sensing vector selection in an implantable medical device
US9962098B2 (en) 2006-06-02 2018-05-08 Global Cardiac Monitors, Inc. Heart monitor electrode system
US7899535B2 (en) * 2006-06-16 2011-03-01 Cardiac Pacemakers, Inc. Automatic electrode integrity management systems and methods
US20100058480A1 (en) * 2006-07-13 2010-03-04 Sven-Erik Hedberg Information management in devices worn by a user
US20080015644A1 (en) * 2006-07-14 2008-01-17 Cameron Health, Inc. End of life battery testing in an implantable medical device
US8718793B2 (en) 2006-08-01 2014-05-06 Cameron Health, Inc. Electrode insertion tools, lead assemblies, kits and methods for placement of cardiac device electrodes
US7877139B2 (en) 2006-09-22 2011-01-25 Cameron Health, Inc. Method and device for implantable cardiac stimulus device lead impedance measurement
US8014851B2 (en) * 2006-09-26 2011-09-06 Cameron Health, Inc. Signal analysis in implantable cardiac treatment devices
US7904153B2 (en) * 2007-04-27 2011-03-08 Medtronic, Inc. Method and apparatus for subcutaneous ECG vector acceptability and selection
US8369944B2 (en) 2007-06-06 2013-02-05 Zoll Medical Corporation Wearable defibrillator with audio input/output
US8271082B2 (en) 2007-06-07 2012-09-18 Zoll Medical Corporation Medical device configured to test for user responsiveness
US8140154B2 (en) 2007-06-13 2012-03-20 Zoll Medical Corporation Wearable medical treatment device
US7974689B2 (en) 2007-06-13 2011-07-05 Zoll Medical Corporation Wearable medical treatment device with motion/position detection
US20090062671A1 (en) * 2007-08-02 2009-03-05 Brockway Brian P Periodic sampling of cardiac signals using an implantable monitoring device
US8265736B2 (en) 2007-08-07 2012-09-11 Cardiac Pacemakers, Inc. Method and apparatus to perform electrode combination selection
US9037239B2 (en) 2007-08-07 2015-05-19 Cardiac Pacemakers, Inc. Method and apparatus to perform electrode combination selection
JP5438687B2 (en) * 2007-12-13 2014-03-12 カーディアック ペースメイカーズ, インコーポレイテッド A system that provides unipolar detection vectors
WO2009092055A1 (en) 2008-01-18 2009-07-23 Cameron Health, Inc. Data manipulation following delivery of a cardiac stimulus in an implantable cardiac stimulus device
CA2717446C (en) 2008-03-07 2016-10-25 Cameron Health, Inc. Methods and devices for accurately classifying cardiac activity
US8565878B2 (en) 2008-03-07 2013-10-22 Cameron Health, Inc. Accurate cardiac event detection in an implantable cardiac stimulus device
AU2009244153B2 (en) 2008-05-07 2014-03-13 Cameron Health, Inc. Methods and devices for accurately classifying cardiac activity
US20100042012A1 (en) * 2008-08-15 2010-02-18 Karim Alhussiny Diagnostic device for remote sensing and transmitting biophysiological signals
US20150201858A1 (en) * 2008-08-15 2015-07-23 Global Cardiac Monitors, Inc. Diagnostic device for remote sensing and transmitting biophysiological signals
WO2010068934A1 (en) 2008-12-12 2010-06-17 Cameron Health, Inc. Implantable defibrillator systems and methods with mitigations for saturation avoidance and accommodation
CA2766866A1 (en) 2009-06-29 2011-01-20 Cameron Health, Inc. Adaptive confirmation of treatable arrhythmia in implantable cardiac stimulus devices
US8744555B2 (en) 2009-10-27 2014-06-03 Cameron Health, Inc. Adaptive waveform appraisal in an implantable cardiac system
US8265737B2 (en) 2009-10-27 2012-09-11 Cameron Health, Inc. Methods and devices for identifying overdetection of cardiac signals
US20110106191A1 (en) * 2009-10-30 2011-05-05 Medtronic, Inc. Implantable medical device noise mode
US8548573B2 (en) * 2010-01-18 2013-10-01 Cameron Health, Inc. Dynamically filtered beat detection in an implantable cardiac device
CN103025379B (en) 2010-05-18 2016-02-17 佐尔医药公司 Wearable therapeutic device
WO2011146482A1 (en) 2010-05-18 2011-11-24 Zoll Medical Corporation Wearable ambulatory medical device with multiple sensing electrodes
US9974944B2 (en) 2010-07-29 2018-05-22 Cameron Health, Inc. Subcutaneous leads and methods of implant and explant
US9937355B2 (en) 2010-11-08 2018-04-10 Zoll Medical Corporation Remote medical device alarm
WO2012078857A2 (en) 2010-12-09 2012-06-14 Zoll Medical Corporation Electrode with redundant impedance reduction
WO2012078937A1 (en) 2010-12-10 2012-06-14 Zoll Medical Corporation Wearable therapeutic device
US9427564B2 (en) 2010-12-16 2016-08-30 Zoll Medical Corporation Water resistant wearable medical device
EP2661506A4 (en) * 2011-01-06 2014-11-19 Univ Illinois Scn5a splice variants for use in methods relating to sudden cardiac death and need for implanted cadiac defibrillators
EP4152340A1 (en) 2011-03-25 2023-03-22 Zoll Medical Corporation System and method for adapting alarms in a wearable medical device
US9684767B2 (en) 2011-03-25 2017-06-20 Zoll Medical Corporation System and method for adapting alarms in a wearable medical device
WO2012135028A1 (en) 2011-03-25 2012-10-04 Zoll Medical Corporation Method of detecting signal clipping in a wearable ambulatory medical device
US8897860B2 (en) * 2011-03-25 2014-11-25 Zoll Medical Corporation Selection of optimal channel for rate determination
US8588895B2 (en) 2011-04-22 2013-11-19 Cameron Health, Inc. Robust rate calculation in an implantable cardiac stimulus or monitoring device
US9782578B2 (en) 2011-05-02 2017-10-10 Zoll Medical Corporation Patient-worn energy delivery apparatus and techniques for sizing same
US9849291B2 (en) 2011-06-09 2017-12-26 Cameron Health, Inc. Antitachycardia pacing pulse from a subcutaneous defibrillator
WO2013033238A1 (en) 2011-09-01 2013-03-07 Zoll Medical Corporation Wearable monitoring and treatment device
EP2793696B1 (en) 2011-12-23 2016-03-09 Cardiac Pacemakers, Inc. Physiological status indicator apparatus
WO2013130957A2 (en) 2012-03-02 2013-09-06 Zoll Medical Corporation Systems and methods for configuring a wearable medical monitoring and/or treatment device
BR112014029589A2 (en) 2012-05-31 2017-06-27 Zoll Medical Corp medical monitoring and external pacemaker treatment device
US11097107B2 (en) 2012-05-31 2021-08-24 Zoll Medical Corporation External pacing device with discomfort management
BR112014029588A2 (en) 2012-05-31 2017-06-27 Zoll Medical Corp system and methods for detecting health disorders
US10328266B2 (en) 2012-05-31 2019-06-25 Zoll Medical Corporation External pacing device with discomfort management
US10905884B2 (en) 2012-07-20 2021-02-02 Cardialen, Inc. Multi-stage atrial cardioversion therapy leads
US8750998B1 (en) * 2012-12-06 2014-06-10 Medtronic, Inc. Effective capture test
US9999393B2 (en) 2013-01-29 2018-06-19 Zoll Medical Corporation Delivery of electrode gel using CPR puck
US8880196B2 (en) 2013-03-04 2014-11-04 Zoll Medical Corporation Flexible therapy electrode
US9149645B2 (en) 2013-03-11 2015-10-06 Cameron Health, Inc. Methods and devices implementing dual criteria for arrhythmia detection
US9579065B2 (en) 2013-03-12 2017-02-28 Cameron Health Inc. Cardiac signal vector selection with monophasic and biphasic shape consideration
US10471267B2 (en) * 2013-05-06 2019-11-12 Medtronic, Inc. Implantable cardioverter-defibrillator (ICD) system including substernal lead
US10668270B2 (en) 2013-05-06 2020-06-02 Medtronic, Inc. Substernal leadless electrical stimulation system
US10556117B2 (en) * 2013-05-06 2020-02-11 Medtronic, Inc. Implantable cardioverter-defibrillator (ICD) system including substernal pacing lead
US9717923B2 (en) 2013-05-06 2017-08-01 Medtronic, Inc. Implantable medical device system having implantable cardioverter-defibrillator (ICD) system and substernal leadless pacing device
JP6488483B2 (en) 2013-06-28 2019-03-27 ゾール メディカル コーポレイションZOLL Medical Corporation System and method for performing treatment using portable medical device
US9986928B2 (en) * 2013-12-09 2018-06-05 Medtronic, Inc. Noninvasive cardiac therapy evaluation
JP6470291B2 (en) 2013-12-18 2019-02-13 カーディアック ペースメイカーズ, インコーポレイテッド System and method for facilitating selection of one or more vectors in a medical device
US9750942B2 (en) 2013-12-18 2017-09-05 Cardiac Pacemakers, Inc. Systems and methods for determining parameters for each of a plurality of vectors
US9457191B2 (en) 2013-12-18 2016-10-04 Cardiac Pacemakers, Inc. System and method for assessing and selecting stimulation vectors in an implantable cardiac resynchronization therapy device
US9788742B2 (en) 2014-02-04 2017-10-17 Cameron Health, Inc. Impedance waveform monitoring for heart beat confirmation
WO2015123198A1 (en) 2014-02-12 2015-08-20 Zoll Medical Corporation System and method for adapting alarms in a wearable medical device
US9526908B2 (en) 2014-04-01 2016-12-27 Medtronic, Inc. Method and apparatus for discriminating tachycardia events in a medical device
US10376705B2 (en) 2014-04-01 2019-08-13 Medtronic, Inc. Method and apparatus for discriminating tachycardia events in a medical device
US9808640B2 (en) 2014-04-10 2017-11-07 Medtronic, Inc. Method and apparatus for discriminating tachycardia events in a medical device using two sensing vectors
US9352165B2 (en) 2014-04-17 2016-05-31 Medtronic, Inc. Method and apparatus for verifying discriminating of tachycardia events in a medical device having dual sensing vectors
US10244957B2 (en) * 2014-04-24 2019-04-02 Medtronic, Inc. Method and apparatus for selecting a sensing vector configuration in a medical device
US10278601B2 (en) 2014-04-24 2019-05-07 Medtronic, Inc. Method and apparatus for selecting a sensing vector configuration in a medical device
US10252067B2 (en) 2014-04-24 2019-04-09 Medtronic, Inc. Method and apparatus for adjusting a blanking period during transitioning between operating states in a medical device
US9795312B2 (en) 2014-04-24 2017-10-24 Medtronic, Inc. Method and apparatus for adjusting a blanking period for selecting a sensing vector configuration in a medical device
US10154794B2 (en) 2014-04-25 2018-12-18 Medtronic, Inc. Implantable cardioverter-defibrillator (ICD) tachyarrhythmia detection modifications responsive to detected pacing
US10226197B2 (en) 2014-04-25 2019-03-12 Medtronic, Inc. Pace pulse detector for an implantable medical device
US10448855B2 (en) 2014-04-25 2019-10-22 Medtronic, Inc. Implantable medical device (IMD) sensing modifications responsive to detected pacing pulses
US9669224B2 (en) 2014-05-06 2017-06-06 Medtronic, Inc. Triggered pacing system
US9492671B2 (en) 2014-05-06 2016-11-15 Medtronic, Inc. Acoustically triggered therapy delivery
US9610025B2 (en) 2014-07-01 2017-04-04 Medtronic, Inc. Method and apparatus for verifying discriminating of tachycardia events in a medical device having dual sensing vectors
US9168380B1 (en) * 2014-07-24 2015-10-27 Medtronic, Inc. System and method for triggered pacing
US9554714B2 (en) 2014-08-14 2017-01-31 Cameron Health Inc. Use of detection profiles in an implantable medical device
CN107072577A (en) 2014-10-17 2017-08-18 心脏起搏器股份公司 The system that multiple location trapped state is determined based on sensing heart sound
US9566012B2 (en) 2014-10-27 2017-02-14 Medtronic, Inc. Method and apparatus for selection and use of virtual sensing vectors
US9549681B2 (en) 2014-11-18 2017-01-24 Siemens Medical Solutions Usa, Inc. Matrix-based patient signal analysis
WO2016100906A1 (en) 2014-12-18 2016-06-23 Zoll Medical Corporation Pacing device with acoustic sensor
WO2016149583A1 (en) 2015-03-18 2016-09-22 Zoll Medical Corporation Medical device with acoustic sensor
US9993171B2 (en) 2015-04-08 2018-06-12 Cameron Health, Inc. Automated screening methods and apparatuses for implantable medical devices
US9737223B2 (en) 2015-05-13 2017-08-22 Medtronic, Inc. Determining onset of cardiac depolarization and repolarization waves for signal processing
US10092761B2 (en) 2015-07-01 2018-10-09 Cardiac Pacemakers, Inc. Automatic vector selection for multi-site pacing
US10617402B2 (en) 2015-07-22 2020-04-14 Cameron Health, Inc. Minimally invasive method to implant a subcutaneous electrode
US9782094B2 (en) 2015-07-31 2017-10-10 Medtronic, Inc. Identifying ambiguous cardiac signals for electrophysiologic mapping
US9610045B2 (en) 2015-07-31 2017-04-04 Medtronic, Inc. Detection of valid signals versus artifacts in a multichannel mapping system
US10321834B2 (en) 2015-10-23 2019-06-18 Cardiac Pacemakers, Inc. Multi-vector sensing in cardiac devices using a hybrid approach
EP3380189B1 (en) 2015-11-23 2020-08-12 Zoll Medical Corporation Garments for wearable medical devices
US10149627B2 (en) 2015-12-02 2018-12-11 Cardiac Pacemakers, Inc. Automatic determination and selection of filtering in a cardiac rhythm management device
US11617538B2 (en) 2016-03-14 2023-04-04 Zoll Medical Corporation Proximity based processing systems and methods
JP6911108B2 (en) * 2016-10-14 2021-07-28 ブリンク デバイス, エルエルシーBlink Device, Llc Quantitative neuromuscular blockage detection system and method
US11009870B2 (en) 2017-06-06 2021-05-18 Zoll Medical Corporation Vehicle compatible ambulatory defibrillator
US10751526B2 (en) 2017-10-25 2020-08-25 Cardiac Pacemakers, Inc. Subcutaneous lead implantation
US10646707B2 (en) 2017-11-30 2020-05-12 Zoll Medical Corporation Medical devices with rapid sensor recovery
US11419539B2 (en) 2017-12-22 2022-08-23 Regents Of The University Of Minnesota QRS onset and offset times and cycle selection using anterior and posterior electrode signals
US10960213B2 (en) 2018-03-12 2021-03-30 Zoll Medical Corporation Verification of cardiac arrhythmia prior to therapeutic stimulation
US11568984B2 (en) 2018-09-28 2023-01-31 Zoll Medical Corporation Systems and methods for device inventory management and tracking
WO2020069308A1 (en) 2018-09-28 2020-04-02 Zoll Medical Corporation Adhesively coupled wearable medical device
WO2020139880A1 (en) 2018-12-28 2020-07-02 Zoll Medical Corporation Wearable medical device response mechanisms and methods of use
EP3760114B1 (en) * 2019-07-05 2024-01-24 Sorin CRM SAS Subcutaneous implantable medical device for processing signals from a subcutaneous implantable medical device
CN213609416U (en) 2019-10-09 2021-07-06 Zoll医疗公司 Treatment electrode part and wearable treatment device
WO2023016736A1 (en) * 2021-08-09 2023-02-16 Biotronik Se & Co. Kg Method for iegm-based monitoring of an electrode status of an implantable device

Family Cites Families (145)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3710374A (en) 1970-03-16 1973-01-09 Wester Instr Inc Dual-slope and analog-to-digital converter wherein two analog input signals are selectively integrated with respect to time
US3653387A (en) 1970-05-08 1972-04-04 Cardiac Electronics Inc Protector circuit for cardiac apparatus
USRE30387E (en) 1972-03-17 1980-08-26 Medtronic, Inc. Automatic cardioverting circuit
US3911925A (en) 1974-05-23 1975-10-14 Jr Joe B Tillery Ear trimming forceps
US4030509A (en) 1975-09-30 1977-06-21 Mieczyslaw Mirowski Implantable electrodes for accomplishing ventricular defibrillation and pacing and method of electrode implantation and utilization
US4184493A (en) 1975-09-30 1980-01-22 Mieczyslaw Mirowski Circuit for monitoring a heart and for effecting cardioversion of a needy heart
US4164946A (en) 1977-05-27 1979-08-21 Mieczyslaw Mirowski Fault detection circuit for permanently implanted cardioverter
US4157720A (en) 1977-09-16 1979-06-12 Greatbatch W Cardiac pacemaker
US4248237A (en) 1978-03-07 1981-02-03 Needle Industries Limited Cardiac pacemakers
US4210149A (en) 1978-04-17 1980-07-01 Mieczyslaw Mirowski Implantable cardioverter with patient communication
US4223678A (en) 1978-05-03 1980-09-23 Mieczyslaw Mirowski Arrhythmia recorder for use with an implantable defibrillator
US4191942A (en) 1978-06-08 1980-03-04 National Semiconductor Corporation Single slope A/D converter with sample and hold
US4291707A (en) 1979-04-30 1981-09-29 Mieczyslaw Mirowski Implantable cardiac defibrillating electrode
US4314095A (en) 1979-04-30 1982-02-02 Mieczyslaw Mirowski Device and method for making electrical contact
US4254775A (en) 1979-07-02 1981-03-10 Mieczyslaw Mirowski Implantable defibrillator and package therefor
US4375817A (en) 1979-07-19 1983-03-08 Medtronic, Inc. Implantable cardioverter
US4300567A (en) 1980-02-11 1981-11-17 Mieczyslaw Mirowski Method and apparatus for effecting automatic ventricular defibrillation and/or demand cardioversion through the means of an implanted automatic defibrillator
US4407288B1 (en) 1981-02-18 2000-09-19 Mieczyslaw Mirowski Implantable heart stimulator and stimulation method
US4693253A (en) 1981-03-23 1987-09-15 Medtronic, Inc. Automatic implantable defibrillator and pacer
US4402322A (en) 1981-03-25 1983-09-06 Medtronic, Inc. Pacer output circuit
US4750494A (en) 1981-05-12 1988-06-14 Medtronic, Inc. Automatic implantable fibrillation preventer
US4765341A (en) 1981-06-22 1988-08-23 Mieczyslaw Mirowski Cardiac electrode with attachment fin
US4424818A (en) 1982-02-18 1984-01-10 Medtronic, Inc. Electrical lead and insertion tool
US4450527A (en) 1982-06-29 1984-05-22 Bomed Medical Mfg. Ltd. Noninvasive continuous cardiac output monitor
DE3300672A1 (en) 1983-01-11 1984-07-12 Siemens AG, 1000 Berlin und 8000 München HEART PACEMAKER SYSTEM
US4550502A (en) 1983-04-15 1985-11-05 Joseph Grayzel Device for analysis of recorded electrocardiogram
US4548209A (en) 1984-02-06 1985-10-22 Medtronic, Inc. Energy converter for implantable cardioverter
US4595009A (en) 1984-02-06 1986-06-17 Medtronic, Inc. Protection circuit for implantable cardioverter
US4603705A (en) 1984-05-04 1986-08-05 Mieczyslaw Mirowski Intravascular multiple electrode unitary catheter
US4567900A (en) 1984-06-04 1986-02-04 Moore J Paul Internal deployable defibrillator electrode
US4589420A (en) 1984-07-13 1986-05-20 Spacelabs Inc. Method and apparatus for ECG rhythm analysis
US4727877A (en) 1984-12-18 1988-03-01 Medtronic, Inc. Method and apparatus for low energy endocardial defibrillation
US4800883A (en) 1986-04-02 1989-01-31 Intermedics, Inc. Apparatus for generating multiphasic defibrillation pulse waveform
US4768512A (en) 1986-05-13 1988-09-06 Mieczyslaw Mirowski Cardioverting system and method with high-frequency pulse delivery
US4944300A (en) 1987-04-28 1990-07-31 Sanjeev Saksena Method for high energy defibrillation of ventricular fibrillation in humans without a thoracotomy
US5044374A (en) 1987-06-18 1991-09-03 Medtronic, Inc. Medical electrical lead
US4830005A (en) 1987-07-23 1989-05-16 Siemens-Pacesetter, Inc. Disposable in-package load test element for pacemakers
US5509923A (en) 1989-08-16 1996-04-23 Raychem Corporation Device for dissecting, grasping, or cutting an object
US5215081A (en) 1989-12-28 1993-06-01 Telectronics Pacing Systems, Inc. Method and device for measuring subthreshold defibrillation electrode resistance and providing a constant energy shock delivery
US5713926A (en) 1990-04-25 1998-02-03 Cardiac Pacemakers, Inc. Implantable intravenous cardiac stimulation system with pulse generator housing serving as optional additional electrode
US5133353A (en) 1990-04-25 1992-07-28 Cardiac Pacemakers, Inc. Implantable intravenous cardiac stimulation system with pulse generator housing serving as optional additional electrode
US5230337A (en) 1990-06-06 1993-07-27 Cardiac Pacemakers, Inc. Process for implanting subcutaneous defibrillation electrodes
US5203348A (en) 1990-06-06 1993-04-20 Cardiac Pacemakers, Inc. Subcutaneous defibrillation electrodes
US5105810A (en) 1990-07-24 1992-04-21 Telectronics Pacing Systems, Inc. Implantable automatic and haemodynamically responsive cardioverting/defibrillating pacemaker with means for minimizing bradycardia support pacing voltages
US5271411A (en) 1990-09-21 1993-12-21 Colin Electronics Co., Ltd. Method and apparatus for ECG signal analysis and cardiac arrhythmia detection
US5109842A (en) 1990-09-24 1992-05-05 Siemens Pacesetter, Inc. Implantable tachyarrhythmia control system having a patch electrode with an integrated cardiac activity system
US5105826A (en) 1990-10-26 1992-04-21 Medtronic, Inc. Implantable defibrillation electrode and method of manufacture
US5193550A (en) * 1990-11-30 1993-03-16 Medtronic, Inc. Method and apparatus for discriminating among normal and pathological tachyarrhythmias
US5137025A (en) 1990-12-17 1992-08-11 Turner Ii Henry H Nomogram for electrocardiographic interpretation and method of use
US5531765A (en) 1990-12-18 1996-07-02 Ventritex, Inc. Method and apparatus for producing configurable biphasic defibrillation waveforms
US5129392A (en) 1990-12-20 1992-07-14 Medtronic, Inc. Apparatus for automatically inducing fibrillation
US5405363A (en) 1991-03-15 1995-04-11 Angelon Corporation Implantable cardioverter defibrillator having a smaller displacement volume
AU654552B2 (en) 1991-04-05 1994-11-10 Medtronic, Inc. Subcutaneous multi-electrode sensing system
US5300106A (en) 1991-06-07 1994-04-05 Cardiac Pacemakers, Inc. Insertion and tunneling tool for a subcutaneous wire patch electrode
US5144946A (en) 1991-08-05 1992-09-08 Siemens Pacesetter, Inc. Combined pacemaker substrate and electrical interconnect and method of assembly
US5191901A (en) 1991-08-29 1993-03-09 Mieczyslaw Mirowski Controlled discharge defibrillation electrode
US5423326A (en) 1991-09-12 1995-06-13 Drexel University Apparatus and method for measuring cardiac output
US5184616A (en) 1991-10-21 1993-02-09 Telectronics Pacing Systems, Inc. Apparatus and method for generation of varying waveforms in arrhythmia control system
US5313953A (en) 1992-01-14 1994-05-24 Incontrol, Inc. Implantable cardiac patient monitor
JPH0621492Y2 (en) 1992-02-07 1994-06-08 日本光電工業株式会社 Defibrillator with ECG monitor
US5261400A (en) 1992-02-12 1993-11-16 Medtronic, Inc. Defibrillator employing transvenous and subcutaneous electrodes and method of use
US5306291A (en) 1992-02-26 1994-04-26 Angeion Corporation Optimal energy steering for an implantable defibrillator
US5601607A (en) 1992-03-19 1997-02-11 Angeion Corporation Implantable cardioverter defibrillator housing plated electrode
US5376103A (en) 1992-03-19 1994-12-27 Angeion Corporation Electrode system for implantable defibrillator
US5255692A (en) 1992-09-04 1993-10-26 Siemens Aktiengesellschaft Subcostal patch electrode
DE69323374T2 (en) 1992-09-30 1999-06-10 Cardiac Pacemakers Inc Foldable cushion electrode for cardiac defibrillation with an area without conductors, which serves as a hinge
US5697953A (en) 1993-03-13 1997-12-16 Angeion Corporation Implantable cardioverter defibrillator having a smaller displacement volume
US5366496A (en) 1993-04-01 1994-11-22 Cardiac Pacemakers, Inc. Subcutaneous shunted coil electrode
US5411547A (en) 1993-08-09 1995-05-02 Pacesetter, Inc. Implantable cardioversion-defibrillation patch electrodes having means for passive multiplexing of discharge pulses
US5411539A (en) 1993-08-31 1995-05-02 Medtronic, Inc. Active can emulator and method of use
US5439485A (en) 1993-09-24 1995-08-08 Ventritex, Inc. Flexible defibrillation electrode of improved construction
US5431693A (en) 1993-12-10 1995-07-11 Intermedics, Inc. Method of verifying capture of the heart by a pacemaker
US5527346A (en) 1993-12-13 1996-06-18 Angeion Corporation Implantable cardioverter defibrillator employing polymer thin film capacitors
US5464447A (en) 1994-01-28 1995-11-07 Sony Corporation Implantable defibrillator electrodes
US5476503A (en) 1994-03-28 1995-12-19 Pacesetter, Inc. Sense array intelligent patch lead for an implantable defibrillator and method
US5620477A (en) 1994-03-31 1997-04-15 Ventritex, Inc. Pulse generator with case that can be active or inactive
US5522852A (en) 1994-04-26 1996-06-04 Incontrol, Inc. Selective cardiac activity analysis atrial fibrillation detection system and method and atrial defibrillator utilizing same
IT1272265B (en) 1994-06-06 1997-06-16 Medtronic Inc Societa Del Minn IMPROVEMENT IN CARDIAC STIMULATOR SYSTEMS
US5645586A (en) 1994-07-08 1997-07-08 Ventritex, Inc. Conforming implantable defibrillator
US5486199A (en) 1994-07-20 1996-01-23 Kim; Jaeho System and method for reducing false positives in atrial fibrillation detection
JP3139305B2 (en) 1994-08-24 2001-02-26 株式会社村田製作所 Capacitive acceleration sensor
FR2725579B1 (en) * 1994-10-06 1996-10-31 Despres Francois COMMUNICATION METHOD IN A TELECOMMUNICATIONS NETWORK
US5534022A (en) 1994-11-22 1996-07-09 Ventritex, Inc. Lead having an integrated defibrillation/sensing electrode
US5534019A (en) 1994-12-09 1996-07-09 Ventritex, Inc. Cardiac defibrillator with case that can be electrically active or inactive
US5531766A (en) 1995-01-23 1996-07-02 Angeion Corporation Implantable cardioverter defibrillator pulse generator kite-tail electrode system
US5509928A (en) 1995-03-02 1996-04-23 Pacesetter, Inc. Internally supported self-sealing septum
US5545186A (en) * 1995-03-30 1996-08-13 Medtronic, Inc. Prioritized rule based method and apparatus for diagnosis and treatment of arrhythmias
US5607455A (en) 1995-05-25 1997-03-04 Intermedics, Inc. Method and apparatus for automatic shock electrode enabling
US5814090A (en) 1995-06-07 1998-09-29 Angeion Corporation Implantable medical device having heat-shrink conforming shield
US5658321A (en) 1995-06-09 1997-08-19 Ventritex, Inc. Conductive housing for implantable cardiac device
US5690683A (en) 1995-06-19 1997-11-25 Cardiac Pacemakers, Inc. After potential removal in cardiac rhythm management device
US5658317A (en) 1995-08-14 1997-08-19 Cardiac Pacemakers, Inc. Threshold templating for digital AGC
US5690685A (en) * 1995-10-27 1997-11-25 Angeion Corporation Automatic battery-maintaining implantable cardioverter defibrillator and method for use
US5558098A (en) 1995-11-02 1996-09-24 Ventritex, Inc. Method and apparatus for detecting lead sensing artifacts in cardiac electrograms
US6014586A (en) * 1995-11-20 2000-01-11 Pacesetter, Inc. Vertically integrated semiconductor package for an implantable medical device
US5674260A (en) 1996-02-23 1997-10-07 Pacesetter, Inc. Apparatus and method for mounting an activity sensor or other component within a pacemaker using a contoured hybrid lid
US5895414A (en) * 1996-04-19 1999-04-20 Sanchez-Zambrano; Sergio Pacemaker housing
US5800465A (en) * 1996-06-18 1998-09-01 Medtronic, Inc. System and method for multisite steering of cardiac stimuli
US5919211A (en) * 1996-06-27 1999-07-06 Adams; Theodore P. ICD power source using multiple single use batteries
US5643328A (en) 1996-07-19 1997-07-01 Sulzer Intermedics Inc. Implantable cardiac stimulation device with warning system having elongated stimulation electrode
US6058328A (en) * 1996-08-06 2000-05-02 Pacesetter, Inc. Implantable stimulation device having means for operating in a preemptive pacing mode to prevent tachyarrhythmias and method thereof
US5766226A (en) 1996-12-09 1998-06-16 Angeion Corporation Switched discharge pathways for ICD having multiple output capacitors
US5776169A (en) 1997-04-28 1998-07-07 Sulzer Intermedics Inc. Implantable cardiac stimulator for minimally invasive implantation
US5836976A (en) 1997-04-30 1998-11-17 Medtronic, Inc. Cardioversion energy reduction system
US6067471A (en) * 1998-08-07 2000-05-23 Cardiac Pacemakers, Inc. Atrial and ventricular implantable cardioverter-defibrillator and lead system
US5925069A (en) * 1997-11-07 1999-07-20 Sulzer Intermedics Inc. Method for preparing a high definition window in a conformally coated medical device
US5827197A (en) 1997-11-14 1998-10-27 Incontrol, Inc. System for detecting atrial fibrillation notwithstanding high and variable ventricular rates
US5919222A (en) * 1998-01-06 1999-07-06 Medtronic Inc. Adjustable medical electrode lead
US6345198B1 (en) * 1998-01-23 2002-02-05 Pacesetter, Inc. Implantable stimulation system for providing dual bipolar sensing using an electrode positioned in proximity to the tricuspid valve and programmable polarity
US6185450B1 (en) * 1998-01-26 2001-02-06 Physio-Control Manufacturing Corporation Digital sliding pole fast-restore for an electrocardiograph display
US5999853A (en) * 1998-03-02 1999-12-07 Vitatron Medical, B.V. Dual chamber pacemaker with single pass lead and with bipolar and unipolar signal processing capability
US6029086A (en) * 1998-06-15 2000-02-22 Cardiac Pacemakers, Inc. Automatic threshold sensitivity adjustment for cardiac rhythm management devices
US6026325A (en) * 1998-06-18 2000-02-15 Pacesetter, Inc. Implantable medical device having an improved packaging system and method for making electrical connections
US6093173A (en) * 1998-09-09 2000-07-25 Embol-X, Inc. Introducer/dilator with balloon protection and methods of use
US6044297A (en) * 1998-09-25 2000-03-28 Medtronic, Inc. Posture and device orientation and calibration for implantable medical devices
US6266554B1 (en) * 1999-02-12 2001-07-24 Cardiac Pacemakers, Inc. System and method for classifying cardiac complexes
US6223078B1 (en) * 1999-03-12 2001-04-24 Cardiac Pacemakers, Inc. Discrimination of supraventricular tachycardia and ventricular tachycardia events
US6377844B1 (en) * 1999-03-13 2002-04-23 Dave Graen R-wave detector circuit for sensing cardiac signals
US6115628A (en) * 1999-03-29 2000-09-05 Medtronic, Inc. Method and apparatus for filtering electrocardiogram (ECG) signals to remove bad cycle information and for use of physiologic signals determined from said filtered ECG signals
US6266567B1 (en) * 1999-06-01 2001-07-24 Ball Semiconductor, Inc. Implantable epicardial electrode
US6411844B1 (en) * 1999-10-19 2002-06-25 Pacesetter, Inc. Fast recovery sensor amplifier circuit for implantable medical device
US6516225B1 (en) * 1999-12-28 2003-02-04 Pacesetter, Inc. System and method for distinguishing electrical events originating in the atria from far-field electrical events originating in the ventricles as detected by an implantable medical device
US6699200B2 (en) * 2000-03-01 2004-03-02 Medtronic, Inc. Implantable medical device with multi-vector sensing electrodes
US6567691B1 (en) * 2000-03-22 2003-05-20 Medtronic, Inc. Method and apparatus diagnosis and treatment of arrhythias
SE524080C2 (en) * 2000-05-19 2004-06-22 Premetec Ab Device with hose
US6647292B1 (en) 2000-09-18 2003-11-11 Cameron Health Unitary subcutaneous only implantable cardioverter-defibrillator and optional pacer
US6754528B2 (en) * 2001-11-21 2004-06-22 Cameraon Health, Inc. Apparatus and method of arrhythmia detection in a subcutaneous implantable cardioverter/defibrillator
US6721597B1 (en) * 2000-09-18 2004-04-13 Cameron Health, Inc. Subcutaneous only implantable cardioverter defibrillator and optional pacer
US6684100B1 (en) * 2000-10-31 2004-01-27 Cardiac Pacemakers, Inc. Curvature based method for selecting features from an electrophysiologic signals for purpose of complex identification and classification
EP1273531A1 (en) * 2001-07-02 2003-01-08 Crisplant A/S A storage system for storing items to be distributed
ATE554824T1 (en) * 2001-08-30 2012-05-15 Medtronic Inc DEVICE FOR DETECTING MYOCARDIAL ISCHEMIA
US6892092B2 (en) * 2001-10-29 2005-05-10 Cardiac Pacemakers, Inc. Cardiac rhythm management system with noise detector utilizing a hysteresis providing threshold
US6708062B2 (en) * 2001-10-30 2004-03-16 Medtronic, Inc. Pacemaker having adaptive arrhythmia detection windows
US6909916B2 (en) * 2001-12-20 2005-06-21 Cardiac Pacemakers, Inc. Cardiac rhythm management system with arrhythmia classification and electrode selection
US7020523B1 (en) * 2002-04-16 2006-03-28 Pacesetter, Inc. Methods and systems for automatically switching electrode configurations
US7027862B2 (en) * 2002-07-25 2006-04-11 Medtronic, Inc. Apparatus and method for transmitting an electrical signal in an implantable medical device
US7738959B2 (en) * 2002-09-30 2010-06-15 Medtronic, Inc. Method and apparatus for performing stimulation threshold searches
US7031764B2 (en) * 2002-11-08 2006-04-18 Cardiac Pacemakers, Inc. Cardiac rhythm management systems and methods using multiple morphology templates for discriminating between rhythms
US7016730B2 (en) * 2002-11-15 2006-03-21 Cardiac Pacemakers, Inc. Method of operating implantable medical devices to prolong battery life
US20050004615A1 (en) * 2003-04-11 2005-01-06 Sanders Richard S. Reconfigurable implantable cardiac monitoring and therapy delivery device
US7167747B2 (en) * 2003-05-13 2007-01-23 Medtronic, Inc. Identification of oversensing using sinus R-wave template
US7181281B1 (en) * 2003-10-08 2007-02-20 Pacesetter, Inc. ICD using MEMS for optimal therapy
US7266409B2 (en) * 2004-12-01 2007-09-04 Medtronic, Inc. Method and apparatus for determining oversensing in a medical device
US7996072B2 (en) * 2004-12-21 2011-08-09 Cardiac Pacemakers, Inc. Positionally adaptable implantable cardiac device
US8577455B2 (en) * 2005-01-18 2013-11-05 Medtronic, Inc. Method and apparatus for arrhythmia detection in a medical device

Also Published As

Publication number Publication date
DE602004017749D1 (en) 2008-12-24
US7953489B2 (en) 2011-05-31
US20050049644A1 (en) 2005-03-03
ATE413837T1 (en) 2008-11-15
US20050192507A1 (en) 2005-09-01
JP4477000B2 (en) 2010-06-09
EP1774906B1 (en) 2013-05-29
CN1859870A (en) 2006-11-08
US7392085B2 (en) 2008-06-24
EP1774906A1 (en) 2007-04-18
EP1659934B1 (en) 2008-11-12
CN100548211C (en) 2009-10-14
US20100076513A1 (en) 2010-03-25
AU2004261227A1 (en) 2005-02-10
WO2005011809A3 (en) 2005-05-06
US7627367B2 (en) 2009-12-01
ES2317046T3 (en) 2009-04-16
WO2005011809A2 (en) 2005-02-10
JP2007500549A (en) 2007-01-18
EP1659934A2 (en) 2006-05-31
AU2004261227B2 (en) 2010-04-29

Similar Documents

Publication Publication Date Title
AU2004261227B2 (en) Multiple electrode vectors for implantable cardiac treatment devices
US9345899B2 (en) Vector switching in an implantable cardiac stimulus system
CN1829554B (en) Method for discriminating between ventricular and supraventricular arrhythmias
CN107072576B (en) Rhythm discriminator without influence of body posture
US6526313B2 (en) System and method for classifying cardiac depolarization complexes with multi-dimensional correlation
US7908001B2 (en) Automatic multi-level therapy based on morphologic organization of an arrhythmia
US7818056B2 (en) Blending cardiac rhythm detection processes
US6484055B1 (en) Discrimination of supraventricular tachycardia and ventricular tachycardia events
US20070167986A1 (en) Method and apparatus for post-processing of episodes detected by a medical device
CN104114085A (en) T-wave oversensing
CN101912667A (en) Be used to distinguish the method for chamber property and supraventricular arrhythmia
US8204581B2 (en) Method to discriminate arrhythmias in cardiac rhythm management devices
US20220339452A1 (en) System for detecting magnetic resonance generated gradient field using an implanted medical device
ES2410592T3 (en) Cardiac signal analysis method and implantable cardiac treatment system

Legal Events

Date Code Title Description
EEER Examination request
FZDE Discontinued

Effective date: 20140812