# US 10,244,957 B2 · Method and apparatus for selecting a sensing vector configuration in a medical device

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- Number: US 10,244,957 B2
- Document ID: US10244957B2
- Status: Granted
- Kind: B2
- Application number: 14/339,980
- Filed: 2014-07-24
- Published: 2015-10-29
- Granted: 2019-04-02
- Earliest claimed: 2014-04-24
- Assignees: Medtronic, Inc.
- Applicants: Medtronic, Inc.
- Inventors: Xusheng Zhang
- Web page: https://patentgrep.com/patent/US10244957B2

## CPC

- A61B 5/341: Vectorcardiography [VCG]
- A61B 5/28: for electrocardiography [ECG]
- A61B 5/349: Detecting specific parameters of the electrocardiograph cycle
- A61B 5/352: Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval
- A61B 5/7221: {Determining signal validity, reliability or quality (preventing, reducing or removing noise induced by motion artefacts A61B5/7207; noise originating from a therapeutic or surgical apparatus A61B5/7217)}
- A61N 1/3621: {for treating or preventing abnormally high heart rate}
- A61N 1/39622: {Pacing therapy}
- A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D)
- A61N: ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY (measurement of bioelectric currents A61B; surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body A61B18/00; anaesthetic apparatus in general A61M; incandescent lamps H01K; infrared radiators for heating H05B)

## Abstract

A method and medical device for determining sensing vectors that includes sensing cardiac signals from a plurality of electrodes, the plurality of electrodes forming a plurality of sensing vectors, determining a sensing vector metric in response to the sensed cardiac signals, determining a morphology metric associated with a morphology of the sensed cardiac signals, determining vector selection metrics in response to the determined sensing vector metric and the determined morphology setting, and selecting a sensing vector of the plurality of sensing vectors in response to the determined vector selection metrics.

## Claims

### Claim 1

A method of determining sensing vectors in a medical device, comprising:
sensing cardiac signals on a plurality of sensing vectors formed from a plurality of electrodes;
determining, for each of the plurality of sensing vectors, a sensing vector metric of the sensed cardiac signals;
determining, for each of the plurality of sensing vectors, a morphology metric associated with a morphology of the sensed cardiac signals, wherein determining the morphology metric comprises:
sensing an R-wave in response to the cardiac signal exceeding a sensing threshold;
determining pulses associated with the sensed R-wave;
determining, for each pulse, whether a pulse width of the pulse is less than a pulse width threshold;
determining, for each pulse, whether a pulse amplitude of the pulse is greater than a pulse amplitude threshold;
determining a number of the determined pulses having both a pulse width less than the pulse width threshold and a pulse amplitude greater than the pulse amplitude threshold; and
setting the morphology metric equal to the determined number of pulses;
determining, for each of the plurality of sensing vectors, vector selection metrics based on at least the determined sensing vector metric and the determined morphology metric; and
selecting a sensing vector of the plurality of sensing vectors based on at least the determined selection metrics.

### Claim 2 (depends on 1)

The method of claim 1, wherein determining a sensing vector metric comprises:
setting a window of time determined based on the sensed R-wave
determining signal differences between the sensed cardiac signal and the sensing threshold during the window of time; and
setting the sensing vector metric based on at least the determined signal differences.

### Claim 3 (depends on 2)

The method of claim 2, wherein selecting a sensing vector comprises:
selecting a sensing vector of the plurality of sensing vectors having the lowest determined signal difference as a first sensing vector; and
selecting a sensing vector of the plurality of sensing vectors having the next lowest determined signal difference as a second sensing vector.

### Claim 4 (depends on 1)

The method of claim 1, wherein the selection metrics include a sensing vector selection metric and a morphology selection metric, the method further comprising:
ranking sensing vectors of the plurality of sensing vectors based on the determined sensing vector selection metric to determine a first vector ranking;
ranking sensing vectors of the plurality of sensing vectors based on the determined morphology selection metric to determine a second vector ranking;
comparing the first vector ranking and the second vector ranking; and
updating the first vector ranking in response to the comparing.

### Claim 5 (depends on 1)

The method of claim 1, further comprising:
analyzing electrical signals sensed on the selected sensing vector;
detecting tachycardia based on the analysis; and
delivering an electrical therapy to a heart in response to detecting the tachycardia.

### Claim 6

A method of determining sensing vectors in a medical device, comprising:
sensing cardiac signals on a plurality of sensing vectors formed from a plurality of electrodes;
determining, for each of the sensed cardiac signals, a plurality of sensing vector metrics;
determining, for each of the sensed cardiac signals, a plurality of morphology metrics associated with a morphology;
determining, for each of the plurality of sensing vectors, selection metrics based on at least the plurality of determined sensing vector metrics and the plurality of determined morphology metrics, wherein the selection metrics include a sensing vector selection metric and a morphology selection metric; and
ranking vectors of the plurality of sensing vectors based on the determined sensing vector selection metric to determine a first vector ranking;
ranking vectors of the plurality of sensing vectors based on the determined morphology selection metric to determine a second vector ranking;
comparing the first vector ranking and the second vector ranking;
updating the first vector ranking in response to the comparing, wherein the first vector ranking comprises at least a first sensing vector, a second sensing vector and a third sensing vector and the second vector ranking comprises at least a low morphology selection metric associated with a low number of pulses, a medium morphology selection metric and a high morphology selection metric, and wherein comparing the first vector ranking and the second vector ranking comprises determining whether the second vector ranking of one of the first sensing vector and the second sensing vector corresponds to the high morphology metric; and
selecting a sensing vector of the plurality of sensing vectors based on at least one of the first or second vector rankings and at least some of the determined selection metrics.

### Claim 7 (depends on 6)

The method of claim 6, wherein selecting the sensing vector comprises:
selecting the first sensing vector and the second sensing vector when neither one of the first sensing vector or the second sensing vector is determined to correspond to the high morphology selection metric; and
determining whether to select the third sensing vector when at least one of the first sensing vector or the second sensing vector is determined to correspond to the high morphology selection metric.

### Claim 8 (depends on 7)

The method of claim 7, wherein determining whether to select the third sensing vector comprises:
comparing the morphology selection metric of the one of the first sensing vector and the second sensing vector determined to correspond to the high morphology selection metric and the morphology selection metric of the third sensing vector to determine a first relative difference;
comparing the vector selection metric of the one of the first sensing vector or the second sensing vector determined to correspond to the high morphology selection metric and the vector selection metric of the third sensing vector to determine a second relative difference; and
selecting the third sensing vector based on at least the first relative difference and the second relative difference.

### Claim 9 (depends on 8)

The method of claim 8, further comprising:
determining whether the first relative difference is greater than a first difference threshold;
determining whether the second relative difference is less than a second difference threshold; and
updating the selected sensing vectors from the first sensing vector and the second sensing vector to the one of the first sensing vector or the second sensing vector not determined to correspond to the high morphology selection metric and the third sensing vector in response to both the first relative difference being greater than the first difference threshold and the second relative difference being less than the second difference threshold.

### Claim 10 (depends on 6)

The method of claim 6, further comprising:
analyzing electrical signals sensed on the selected sensing vector;
detecting tachycardia based on the analysis; and
delivering an electrical therapy to a heart in response to detecting the tachycardia.

### Claim 11

A medical device, comprising:
a plurality of electrodes capable of forming a plurality of sensing vectors for sensing cardiac signals; and
a processor configured to obtain the cardiac signals sensed via the plurality of sensing vectors, determine, for each of the plurality of sensing vectors, at least one sensing vector metric of the sensed cardiac signals, determine, for each of the plurality of sensing vectors, at least one morphology metric associated with a morphology of the sensed cardiac signals by sensing an R-wave in response to the cardiac signal exceeding a sensing threshold, determining pulses associated with the sensed R-wave, determining, for each pulse, whether a pulse width of the pulse is less than a pulse width threshold, determining, for each pulse, whether a pulse amplitude of the pulse is greater than a pulse amplitude threshold, determining a number of the determined pulses having both a pulse width less than the pulse width threshold and a pulse amplitude greater than the pulse amplitude threshold, and setting the morphology metric equal to the determined number of pulses, determine, for each of the plurality of sensing vectors, selection metrics based on at least the determined sensing vector metric and the determined morphology metric, and select a sensing vector of the plurality of sensing vectors based on at least the determined selection metrics.

### Claim 12 (depends on 11)

The medical device of claim 11, wherein the processor is further configured to set a window of time determined based on the sensed R-wave, determine signal differences between the sensed cardiac signal and the sensing threshold during the window of time, and set the sensing vector metric based on at least the determined signal differences.

### Claim 13 (depends on 12)

The medical device of claim 12, wherein the processor is further configured to select a sensing vector of the plurality of sensing vectors having the lowest determined signal difference as a first sensing vector, and select a sensing vector of the plurality of sensing vectors having the next lowest determined signal difference as a second sensing vector.

### Claim 14 (depends on 11)

The medical device of claim 11, wherein the determined selection metrics include a sensing vector selection metric and a morphology selection metric and the processor is further configured to rank vectors of the plurality of sensing vectors based on at least the determined sensing vector selection metric to determine a first vector ranking, rank vectors of the plurality of sensing vectors based on at least the determined morphology selection metric to determine a second vector ranking, compare the first vector ranking and the second vector ranking, and update the first vector ranking based on at least the comparing.

### Claim 15 (depends on 11)

The device of claim 11, wherein the processor is further configured to analyze electrical signals sensed on the selected sensing vector, detect tachycardia based on the analysis, and deliver an electrical therapy to a heart in response to detecting the tachycardia.

### Claim 16

A medical device, comprising:
a plurality of electrodes capable of forming a plurality of sensing vectors for sensing cardiac signals; and
a processor configured to obtain the cardiac signals sensed via the plurality of sensing vectors, determine, for each of the sensed cardiac signals, a plurality of sensing vector metrics, determine, for each of the sensed cardiac signals, a plurality of morphology metrics associated with a morphology, determine, for each of the plurality of sensing vectors, selection metrics based on at least the plurality of determined sensing vector metrics and the plurality of determined morphology metrics, wherein the selection metrics include a sensing vector selection metric and a morphology selection metric, rank vectors of the plurality of sensing vectors based on the determined sensing vector selection metric to determine a first vector ranking, rank vectors of the plurality of sensing vectors based on the determined morphology selection metric to determine a second vector ranking, compare the first vector ranking and the second vector ranking, and update the first vector ranking in response to the comparing, wherein the first vector ranking comprises at least a first sensing vector, a second sensing vector and a third sensing vector and the second vector ranking comprises at least a low morphology selection metric associated with a low number of pulses, a medium morphology selection metric and a high morphology selection metric, and wherein the processor is further configured to determine whether the second vector ranking of one of the first sensing vector and the second sensing vector corresponds to the high morphology selection metric, and select a sensing vector of the plurality of sensing vectors based on at least one of the first or second vector rankings and at least some of the determined selection metrics.

### Claim 17 (depends on 16)

The medical device of claim 16, wherein the processor is further configured to select the first sensing vector and the second sensing vector in response to neither one of the first sensing vector and the second sensing vector being determined to correspond to the high morphology selection metric, and determine whether to select the third sensing vector in response to at least one of the first sensing vector and the second sensing vector being determined to correspond to the high morphology selection metric.

### Claim 18 (depends on 17)

The medical device of claim 17, wherein the processor is further configured to compare the morphology selection metric of the one of the first sensing vector and the second sensing vector determined to correspond to the high morphology selection metric and the morphology selection metric of the third sensing vector to determine a first relative difference, compare the vector selection of the one of the first sensing vector and the second sensing vector determined to correspond to the high morphology selection metric and the vector selection metric of the third sensing vector to determine a second relative difference, and select the third sensing vector in response to the first relative difference and the second relative difference.

### Claim 19 (depends on 18)

The medical device of claim 18, wherein the processor is further configured to determine whether the first relative difference is greater than a first difference threshold, determine whether the second relative difference is less than a second difference threshold; and update the selected sensing vectors from the first sensing vector and the second sensing vector to the one of the first sensing vector and the second sensing vector not determined to correspond to the high morphology selection metric and the third sensing vector in response to both the first relative difference being greater than the first difference threshold and the second relative difference being less than the second difference threshold.

### Claim 20 (depends on 16)

The device of claim 16, wherein the processor is further configured to analyze electrical signals sensed on the selected sensing vector, detect tachycardia based on the analysis, and deliver an electrical therapy to a heart in response to detecting the tachycardia.

### Claim 21

A non-transitory, computer-readable storage medium storing instructions for causing a processor included in a medical device to perform a method for determining sensing vectors, the method comprising:
sensing cardiac signals on a plurality of sensing vectors formed from a plurality of electrodes;
determining, for each of the plurality of sensing vectors, at least one sensing vector metric of the sensed cardiac signals;
determining, for each of the plurality of sensing vectors, at least one morphology metric associated with a morphology of the sensed cardiac signals, wherein determining a morphology metric comprises:
sensing an R-wave in response to the cardiac signal exceeding a sensing threshold;
determining pulses associated with the sensed R-wave;
determining, for each pulse, whether a pulse width of the pulse is less than a pulse width threshold;
determining, for each pulse, whether a pulse amplitude of the pulse is greater than a pulse amplitude threshold;
determining a number of the determined pulses having both a pulse width less than the pulse width threshold and a pulse amplitude greater than the pulse amplitude threshold; and
setting the morphology metric equal to the determined number of pulses;
determining, for each of the plurality of sensing vectors, selection metrics based on at least the determined sensing vector metric and the determined morphology metric;
selecting a sensing vector of the plurality of sensing vectors based on at least the determined selection metrics
analyzing electrical signals sensed on the selected sensing vector;
detecting tachycardia based on the analysis; and
delivering an electrical therapy to a heart in response to detecting the tachycardia.