U.S. patent application number 12/277101 was filed with the patent office on 2009-06-18 for supraventricular tachy sensing vector.
This patent application is currently assigned to Cardiac Pacemakers, Inc.. Invention is credited to Ron A. Balczewski, James O. Gilkerson, David L. Perschbacher.
Application Number | 20090157133 12/277101 |
Document ID | / |
Family ID | 40404967 |
Filed Date | 2009-06-18 |
United States Patent
Application |
20090157133 |
Kind Code |
A1 |
Perschbacher; David L. ; et
al. |
June 18, 2009 |
SUPRAVENTRICULAR TACHY SENSING VECTOR
Abstract
A system includes a pulse generator including a can electrode
and a lead couplable to the pulse generator, the lead including a
distal coil electrode and a proximal coil electrode, wherein both
of the coil electrodes are electrically uncoupled from the can
electrode such that a unipolar sensing vector is provided between
at least one of the coil electrodes and the can electrode.
Inventors: |
Perschbacher; David L.;
(Coon Rapids, MN) ; Gilkerson; James O.;
(Stillwater, MN) ; Balczewski; Ron A.;
(Bloomington, MN) |
Correspondence
Address: |
SCHWEGMAN, LUNDBERG & WOESSNER/BSC-CRM
PO BOX 2938
MINNEAPOLIS
MN
55402
US
|
Assignee: |
Cardiac Pacemakers, Inc.
St paul
CA
|
Family ID: |
40404967 |
Appl. No.: |
12/277101 |
Filed: |
November 24, 2008 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
61007635 |
Dec 13, 2007 |
|
|
|
Current U.S.
Class: |
607/9 |
Current CPC
Class: |
A61N 1/3925 20130101;
A61N 1/3702 20130101; A61N 1/36592 20130101; A61N 1/3622 20130101;
A61N 1/39622 20170801; A61B 5/363 20210101; A61B 5/341
20210101 |
Class at
Publication: |
607/9 |
International
Class: |
A61N 1/362 20060101
A61N001/362 |
Claims
1. A system comprising: a pulse generator including a can
electrode; and a lead couplable to the pulse generator, the lead
including a distal coil electrode and a proximal coil electrode,
wherein both of the coil electrodes are electrically uncoupled from
the can electrode such that a unipolar sensing vector is provided
between at least one of the coil electrodes and the can
electrode.
2. The system of claim 1, wherein the sensing vector is provided
between the distal electrode and the can electrode.
3. The system of claim 1, wherein the sensing vector is provided
between the proximal electrode and the can electrode.
4. The system of claim 1, wherein a second sensing vector is
provided between the distal coil electrode and the proximal coil
electrode.
5. The system of claim 1, wherein the pulse generator is configured
such that the unipolar sensing vector can alternate between the
distal coil electrode and the can electrode and the proximal
electrode and the can electrode.
6. The system of claim 1, wherein the pulse generator is configured
such that a first unipolar sensing vector between the distal coil
electrode and the can electrode and a second unipolar sensing
vector between the proximal electrode and the can electrode occur
simultaneously.
7. The system of claim 1, wherein the pulse generator is configured
to distinguish between VT and SVT using the unipolar sensing
vector.
8. A system comprising: a pulse generator including a can
electrode; and a lead couplable to the pulse generator, the lead
including a distal coil electrode and a proximal coil electrode,
and further including a tip pacing/sensing electrode and a ring
electrode, wherein the proximal coil electrode and the distal coil
electrode are electrically uncoupled from the can electrode such
that a unipolar sensing vector is provided between the distal
electrode and the can electrode.
9. The system of claim 8, wherein a second unipolar sensing vector
is provided between the proximal electrode and the can
electrode.
10. The system of claim 8, wherein a third sensing vector is
provided between the distal coil electrode and the proximal coil
electrode.
11. The system of claim 8, wherein the lead is configured such that
the proximal coil electrode is implantable in the right atrium and
the distal coil electrode is implantable in the right
ventricle.
12. The system of claim 8, wherein the pulse generator is
configured to distinguish between VT and SVT using the unipolar
sensing vector.
13. An apparatus comprising: a pulse generator including a housing
can electrode; electronics located within the pulse generator; and
an electrical connection between the housing can electrode and the
electronics; wherein the electronics and electrical connection are
configured such that when a lead is coupled to the pulse generator,
a distal coil electrode on the lead is electrically uncoupled from
the housing can electrode by the electrical pathway and a proximal
coil electrode on the lead is electrically uncoupled from the
housing can electrode, such that a unipolar sensing vector is
provided between at least one of the coil electrodes and the can
electrode.
14. The apparatus of claim 13, wherein the pulse generator is
configured such that the unipolar sensing vector is provided
between the distal coil electrode and the can electrode.
15. The apparatus of claim 13, wherein the pulse generator is
configured such that the unipolar sensing vector is provided
between the proximal electrode and the can electrode.
16. The apparatus of claim 13, wherein a second sensing vector is
provided between the distal coil electrode and the proximal coil
electrode.
17. The apparatus of claim 13, wherein the pulse generator is
configured to distinguish between VT and SVT using the unipolar
sensing vector.
18. A method comprising: providing a pulse generator including a
can electrode; and coupling a lead to the pulse generator, the lead
including at least one proximal coil electrode which is
electrically isolated from the can electrode, and the lead
including a distal coil electrode which is electrically isolated
from the can electrode; implanting the lead such that the proximal
coil electrode is located in the right atrium and the distal coil
electrode is located in the right ventricle; and sensing heart
signals using a unipolar sensing vector between at least one of the
coil electrode and the can electrode.
19. The method of claim 18, wherein sensing heart signals includes
differentiating between SVT signals and VT signals.
20. The method of claim 18, wherein the lead includes one or more
distal pacing and/or sensing electrodes.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application claims the benefit under 35 U.S.C. 119(e)
of U.S. Provisional Application No. 61/007,635, filed on Dec. 13,
2007, which is hereby incorporated by reference in its
entirety.
TECHNICAL FIELD
[0002] This relates to the field of medical devices, and more
specifically to a sensing vector for an implantable device.
BACKGROUND
[0003] Pulse generators and leads having electrodes implanted in or
about the heart have been used to reverse certain life threatening
arrhythmia, or to stimulate contraction of the heart. Electrical
energy is applied to the heart via an electrode to return the heart
to normal rhythm. Leads are usually positioned on, in, or near the
ventricle or the atrium and the lead terminal pins are attached to
a pacemaker or defibrillator which is implanted subcutaneously. The
pulse generator is configured to utilize the electrodes to receive
signals from the heart which can indicate certain cardiac
events.
SUMMARY
[0004] A system includes a pulse generator including a can
electrode and a lead couplable to the pulse generator, the lead
including a distal coil electrode and a proximal coil electrode,
wherein both of the coil electrodes are electrically uncoupled from
the can electrode such that a unipolar sensing vector is provided
between at least one of the coil electrodes and the can
electrode.
BRIEF DESCRIPTION OF THE DRAWINGS
[0005] FIG. 1 shows a lead and pulse generator in accordance with
one embodiment.
[0006] FIG. 2 shows a schematic representation of a lead and pulse
generator in accordance with one embodiment.
DETAILED DESCRIPTION
[0007] In the following detailed description, reference is made to
the accompanying drawings which form a part hereof, and in which is
shown by way of illustration specific embodiments in which the
invention may be practiced. These embodiments are described in
sufficient detail to enable those skilled in the art to practice
the invention, and it is to be understood that other embodiments
may be utilized and that structural changes may be made without
departing from the scope of the present invention. Therefore, the
following detailed description is not to be taken in a limiting
sense, and the scope of the present invention is defined by the
appended claims and their equivalents.
[0008] FIG. 1 shows a view of a lead 100 coupled to a pulse
generator 150. In one embodiment, lead 100 is adapted to deliver
defibrillation shock energy to a heart. Certain embodiments deliver
pacing pulses to a heart. Pulse generator 150 can be implanted in a
surgically-formed pocket in a patient's chest or other desired
location. Pulse generator 150 generally includes electronic
components to perform signal analysis, processing, and control.
Pulse generator 150 can include a power supply such as a battery, a
capacitor, and other components housed in a case or can 151. The
device can include microprocessors to provide processing and
evaluation to determine and deliver electrical shocks and pulses of
different energy levels and timing for ventricular defibrillation,
cardioversion, and pacing to a heart in response to cardiac
arrhythmia including fibrillation, tachycardia, and
bradycardia.
[0009] In one embodiment, lead 100 includes a lead body 105
extending from a proximal end 107 to a distal end 109 and having an
intermediate portion 111. Lead 100 includes one or more conductors,
such as coiled conductors or other conductors, to conduct energy
from pulse generator 150 to one or more electrodes, such as a
distal defibrillation coil electrode 120 configured to be implanted
in right ventricle 20, and a proximal defibrillation coil electrode
122 configured to be implanted in right atrium 22 or superior vena
cava 24. The superior vena cava and the right atrium are called the
supraventricular portion of the heart. In one embodiment, the lead
100 can include a tip electrode 130 and a distal ring electrode 132
for ventricular sensing and pacing. Some embodiments include one or
more proximal ring electrodes for atrial sensing and pacing.
[0010] Lead 100 can include lead terminal pins which are attached
to pulse generator 150 at a header. The system can include a
unipolar system with the housing can 151 acting as an electrode or
a bipolar system with a pulse between two electrodes 120, 122, or
electrodes 130, 132.
[0011] The present system is directed to providing a
supraventricular tachycardia sensing vector. The present system
provides a technique to better distinguish supraventricular
tachycardia (SVT) from ventricular tachycardia (VT). For example,
in a past approach, the proximal coil 122 was electrically coupled
to can electrode 151 and tachycardia sensing was performed using
the distal coil 120 to both the can 151 plus the proximal coil 122.
However, this configuration results in difficulties in
distinguishing between SVT and VT.
[0012] In one embodiment, the present system electrically isolates
the can electrode 151 from proximal coil electrode 122 and from the
distal coil electrode 120 to provide a supraventricular tachy
sensing vector. For example, coil electrode 122 can be electrically
isolated from the can electrode 151 and a unipolar sensing vector
can be from the proximal coil electrode 122 to the can electrode
151. In one embodiment, a unipolar sensing vector can be from the
distal coil 120 to the can electrode 151. In one embodiment, a
sensing vector can be from distal coil 120 to proximal electrode
122. These configurations are useful for distinguishing between SVT
and VT.
[0013] In other embodiments, the present system uncouples the
proximal electrode 122 from the can 151 and provides sensing
utilizing one or more of electrodes 130, 132.
[0014] The term sensing vector is described herein by the location
of the two electrodes used by a sensing channel within the pulse
generator. The sensing channel uses the electrical signal that
exists between the two electrodes to sense cardiac activity.
Different sense vectors will present different aspects of the
cardiac signal to the sensing channel. In the present embodiments,
the sense vectors have improved performance for sensing SVT because
these vectors produce a larger SVT to VT signal ratio than in the
past.
[0015] Thus in various examples, both of the coil electrodes 120,
122 are electrically uncoupled from the can electrode 151 such that
a unipolar sensing vector is provided between at least one of the
coil electrodes and the can electrode 151. For example, the sensing
vector can be provided between the distal electrode 120 and the can
electrode 151, or the sensing vector can be provided between the
proximal electrode 122 and the can electrode 151. In another
example a second sensing vector can be provided between the distal
coil electrode 120 and the proximal coil electrode 122.
[0016] In another example, the pulse generator can be configured
such that the unipolar sensing vector can alternate between the
distal coil electrode 120 and the can electrode 151 and the
proximal electrode 122 and the can electrode 151. In one
embodiment, the pulse generator is configured such that a first
unipolar sensing vector between the distal coil electrode 120 and
the can electrode 151 and a second unipolar sensing vector between
the proximal electrode 122 and the can electrode 151 occur
simultaneously.
[0017] The pulse generator can be configured to distinguish between
VT and SVT using the unipolar sensing vectors discussed above. For
example, one technique to distinguish between VT and SVT is to use
a template of the correlation between shock vector electrograms and
RV rate vector electrograms during normal sinus rhythm. When an
arrhythmia is detected, the template is compared to the on-going
rhythm; if the rhythm matches the existing template, then it is
believed that the origin of the rhythm is supraventricular and the
device withholds therapy--the assumption being that a
supraventricular rhythm follows the same conduction pathway as
normal sinus rhythm, and thus the correlation of the two vectors
during SVT would match the normal sinus rhythm template, and
therapy can be delivered.
[0018] However, if the correlation of the vectors during the rhythm
does not match the template, then it is assumed that the rhythm is
VT (i.e. the rhythm is not using the normal conduction
pathway).
[0019] Further embodiments can use a different template created
from the new vectors described herein. This new template would
provide more power to discriminate problem cases using the template
described above--and thus more information from the combination of
more vectors would yield more discrimination power.
[0020] In one embodiment, electrode 122 is disposed along the lead
such that the electrode 122 is configured to be located in the
right atrium 22 or superior vena cava 24 after implantation.
[0021] FIG. 2 shows a schematic representation of portions of the
system described above, in accordance with one embodiment. The lead
includes a first conductor 202 coupled between the coil electrode
122 and electronics 201 within the pulse generator 150. The lead
also includes a second conductor 203 coupled between distal coil
electrode 120 and electronics 201. The can electrode 151 is also
coupled to the electronics 201. Electronics 201 includes
electrically pathways which provide that the electrodes 122, and
120 are electrically insulated from the can electrode 151. As
discussed, the electronics 201 can be configured to allow the
various connections to be uncoupled or coupled as desired.
[0022] It is understood that the above description is intended to
be illustrative, and not restrictive. Many other embodiments will
be apparent to those of skill in the art upon reviewing the above
description. The scope of the invention should, therefore, be
determined with reference to the appended claims, along with the
fall scope of equivalents to which such claims are entitled.
* * * * *