US 2017/0120045 A1 · Detection of Implantable Lead Failures by Differential EGM Analysis

Abstract

A method and system for the diagnosis of anomalies in a lead attached to an implantable medical device, such as an implantable cardioverter defibrillator (ICD), including an insulation breach resulting in a short circuit of the high-voltage shock pulse. Determination that the defibrillation pathway is shorted may be made by initial analysis of a Reference EGM and Diagnostic EGM and subsequent analysis of Differential Diagnostic EGMs. Upon determining if a specific defibrillation pathway is shorted, the nonessential defibrillation electrode of that pathway may be excluded from the defibrillation circuit, delivering defibrillation current only between functioning defibrillation electrodes. Alternatively, the ICD system can confirm the presence of a lead anomaly with one or more alternative diagnostic approaches. Patient and remote-monitoring alerts may be initiated.

Claims16

Dependent claims

An automated method of diagnosing an anomaly in an implantable lead of an implantable medical device, comprising:

monitoring electrogram (EGM) signals continuously from both a reference pathway (Reference EGM) and from a diagnostic pathway (Diagnostic EGM) that includes at least one conductor in the implantable lead;
validating events automatically in the Reference EGM;
comparing the Diagnostic EGM with the Reference EGM automatically to determine if anomalous signals are present on the Diagnostic EGM, and if a sufficient number of such anomalous signals are present;
analyzing at least two additional Differential Diagnostic EGMs automatically, each recorded between one electrode used to generate the Diagnostic EGM and an EGM not included in the Diagnostic EGM current pathway;
applying the principle of differential signal analysis automatically to the analysis of the at least two additional Differential Diagnostic EGMs to make a determination of an electrode responsible for the anomalous signals;
and
initiating one or more responses automatically to compensate for, or notify a user of, the determination of the electrode responsible for the anomalous signals.

4 more elements

An automated method of diagnosing an anomaly in an implantable lead of an implantable cardioverter defibrillator (ICD) attached to a dual-coil defibrillation lead, comprising:

monitoring electrogram (EGM) signals from a Reference EGM and a Diagnostic EGM continuously that includes at least one conductor in the implantable lead;
validating ventricular events in the Reference EGM automatically;
comparing the Diagnostic EGM with the Reference EGM automatically to determine if noncardiac signals are present on the Diagnostic EGM, and if such signals are present;
analyzing at least one additional Differential Diagnostic EGM recorded automatically between at least one high-voltage electrode and at least one pace-sense electrode to determine an electrode responsible for the noncardiac signals;
determining if a nonessential high-voltage electrode should be excluded from a defibrillation pathway to prevent shorting during a therapeutic shock;
automatically initiating one or more of the following responses;
excluding the nonessential high-voltage electrode determined when analyzing the at least one additional Differential Diagnostic EGM recorded automatically between at least one high-voltage electrode and at least one pace-sense electrode from the defibrillation pathway;
initiating one or more additional diagnostic tests to confirm that the electrode identified when comparing the Diagnostic EGM with the Reference EGM shorts the defibrillation pathway;
initiating a patient alert;
and
initiating a remote-monitoring alert.

8 more elements

Dependencies are inferred from the claim text.

Detection of Implantable Lead Failures by Differential EGM Analysis

Life of this patent

Detection of Implantable Lead Failures by Differential EGM Analysis

Life of this patent

Abstract

Claims16