Detection of Implantable Lead Failures by Differential EGM Analysis

摘要

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.

主权项

1. 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.