Method and apparatus for avoiding unwanted sensing in a cardiac rhythm management device

Abstract

A cardiac rhythm management device that utilizes blanking or refractory periods to avoid misidentification of artifacts and evoked potentials, wherein the refractory periods are discontinuous and may be dependent upon sensed events, expiration of a predefined timing interval, or stimulation events in the same or other chambers of the heart. The discontinuous refractory periods enhance the ability of the device to sense intrinsic events. The present invention includes separate refractory and floating refractory periods incorporated within the sensing protocol for each selected cycle, thereby increasing the time period for normal sensing.

1. A cardiac rhythm management device capable of detecting intrinsic depolarization events, comprising:
 a pulse generator for selectively stimulating a plurality of sites in at least one chamber of a patient's heart; 
 a sensing circuit configured to receive signals indicative of the depolarization events from a first electrode positioned within a sensing channel for an atrium of the patient's heart and a second electrode positioned within a sensing channel for a ventricle of the patient's heart; and 
 a controller configured to receive data from the sensing circuit and to control the pulse generator, wherein the controller prevents the use of data to detect intrinsic depolarization events during a plurality of programmable refractory periods in timed relation relative to a sensed triggering event in programmably selected from one of a plurality of programmably selectable sensing channels. 
 
     
     
       2. The cardiac rhythm management device, as in  claim 1 , wherein one of the plurality of refractory periods is a floating refractory period that may selectively be applied to said at least one sensing channel for the atrium and said at least one sensing channel for the ventricle. 
     
     
       3. The cardiac rhythm management device, as in  claim 1 , wherein at least one of the programmable refractory periods is initiated a predetermined amount of time after the end of a first refractory period, the first refractory period being initiated coincidental with sensing an intrinsic event. 
     
     
       4. The cardiac rhythm management device, as in  claim 1 , wherein at least one of the programmable refractory periods is triggered by a stimulation of a pre-selected chamber of the heart. 
     
     
       5. The cardiac rhythm management device, as in  claim 1 , wherein the triggering event is a sensed intrinsic event. 
     
     
       6. The cardiac rhythm management device, as in  claim 1 , wherein the triggering event includes a paced event. 
     
     
       7. The cardiac rhythm management device, as in  claim 1 , wherein the triggering event includes an intrinsic atrial event. 
     
     
       8. The cardiac rhythm management device, as in  claim 1 , wherein the triggering event includes an intrinsic ventricular event. 
     
     
       9. The cardiac rhythm management device, as in  claim 1 , wherein the triggering event includes a paced atrial event. 
     
     
       10. The cardiac rhythm management deviceof, as in  claim 1 , wherein the triggering event includes a paced ventricular event. 
     
     
       11. The cardiac rhythm management device, as in  claim 1 , wherein preprogrammed sensed triggering events from the atrium are blanked during a floating refractory period. 
     
     
       12. The cardiac rhythm management device, as in  claim 1 , wherein preprogrammed sensed triggering events from the ventricle are blanked during a floating refractory period. 
     
     
       13. The cardiac rhythm management device, as in either  claim 11  or  claim 12 , wherein the floating refractory period is retriggerable. 
     
     
       14. The cardiac rhythm management device, as in  claim 1 , wherein the controller initiates first and second refractory periods associated with the ventricle dependent upon sensed triggering events occurring in the atrium. 
     
     
       15. The cardiac rhythm management device, as in  claim 1 , wherein the controller initiates first and second refractory periods associated with the atrium dependent upon sensed triggering events occurring in the ventricle. 
     
     
       16. A multi-chamber cardiac rhythm management device functioning in a pre-selected stimulation mode and capable of atrial and ventricular tracking, said device comprising:
 sensing means for sensing at least one of atrial and ventricular events and transmitting signals containing information corresponding to sensed events; 
 stimulation means for selectively stimulating pre-selected chambers of the patient's heart; and 
 a programmable controller coupled to said means for sensing and said stimulation means, wherein during a cardiac cycle said controller manipulates the means for sensing to thereby create a first and second refractory period periods of sensed events for programmably pre-selected chambers selected sites in the patient's heart during the cardiac cycle, wherein the programmably selected sites are programmably selected for applying the first and second refractory periods thereto. 
 
     
     
       17. The cardiac rhythm management device as recited in claim  15  16, wherein the second refractory period is initiated a predetermined amount of time after the end of the first refractory period. 
     
     
       18. The cardiac rhythm management device as recited in  claim 15 , wherein the second refractory period is initiated a predetermined amount of time after the end of the first refractory period. 
     
     
       19. The cardiac rhythm management device as recited in claim  15  16, wherein the controller is programmed such that the second refractory period is initiated if intrinsic events from the atrium are sensed. 
     
     
       20. The cardiac rhythm management device as recited in claim  15  16, wherein the controller is programmed such that the second refractory period is initiated if intrinsic events from the ventricle are sensed. 
     
     
       21. The cardiac rhythm management device as recited in claim  15  16, wherein sensed events from the atrium are blanked during the second refractory period. 
     
     
       22. The cardiac rhythm management device as recited in claim  15  16, wherein sensed events from the ventricles are blanked during the second refractory period. 
     
     
       23. The cardiac rhythm management device as recited in claim  15  16, wherein the controller initiates first and second refractory periods associated with the ventricles dependent upon events occurring in the atrium. 
     
     
       24. The cardiac rhythm management device as recited in claim  15  16, wherein the controller initiates first and second refractory periods associated with the atrium dependent upon events occurring in the ventricle. 
     
     
       25. A cardiac rhythm management device capable of uni-polar or bipolar atrial and ventricular stimulation, said cardiac rhythm management device including:
 (a) a controller; 
 (b) means for stimulating at least one of an atrium or ventricle of a heart, said means being electrically coupled to said controller; 
 (c) sensing means for sensing a cardiac electrogram, said sensing means electrically coupled to the controller; 
 (d) an atrial lead having an atrial electrode electrically coupled to the controller; 
 (e) a ventricular lead having a ventricular electrode electrically coupled to the controller; and 
 (f) said controller having means for defining a refractory period and a floating refractory period for a predetermined cardiac cycle for a programmable programmably selectable chamber of the heart that is programmably selectable for applying the refractory period and the floating refractory period thereto. 
 
     
     
       26. The cardiac rhythm management device recited in  claim 25 , wherein the sensing means includes a programmably designate sensing channel for the atrium and a programmably designated sensing channel of the ventricle wherein the controller selects the sensing channel in creating the refractory period and floating refractory period. 
     
     
       27. The cardiac rhythm management device as recited in  claim 25 , wherein the floating refractory period is initiated a preprogrammed amount of time after the end of the refractory period. 
     
     
       28. The cardiac rhythm management device as recited in  claim 26 , wherein the floating refractory period is initiated a preprogrammed amount of time after the end of the refractory period. 
     
     
       29. The cardiac rhythm management device as recited in  claim 25 , wherein the floating refractory period is initiated if intrinsic events from the atrium are sensed. 
     
     
       30. The cardiac rhythm management device as recited in  claim 25 , wherein the floating refractory period is initiated if intrinsic events from the ventricle are sensed. 
     
     
       31. The cardiac rhythm management device as recited in  claim 25 , wherein sensed events from the atrium are blanked during the floating refractory period. 
     
     
       32. The cardiac rhythm management device as recited in  claim 25 , wherein sensed events from the ventricles are blanked during the floating refractory period. 
     
     
       33. The cardiac rhythm management device as recited in  claim 25 , wherein the controller initiates a refractory period and floating refractory period associated with the ventricles dependent upon preprogrammed triggering vents occurring in the atrium. 
     
     
       34. The cardiac rhythm management device as recited in  claim 25 , wherein the controller initiates a refractory period and floating refractory period associated with the atrium dependent upon preprogrammed triggering events occurring in the ventricles. 
     
     
       35. The cardiac rhythm management device as in any one of  claims 25 - 34  wherein the floating refractory period is retriggerable. 
     
     
       36. A method for stimulating a pre-selected chamber of a patient's heart using a cardiac rhythm management device of the type which senses and determines independently atrial and ventricular depolarization events and includes a plurality of programmed timing and stimulation intervals, said method comprising the steps of:
 a) sensing cardiac electrograms and detecting an intrinsic events occurring in pre-selected chambers of the patient's heart; then 
 b) identifying a time times at which unwanted potentials of the intrinsic events are sensed; 
 c) initiating a first interval for blanking detected events for a first predetermined portion of a cardiac cycle; 
 d) initiating a second interval for blanking detected events for a second predetermined portion of the cardiac cycle; and 
 programming a sensing channel to which the first interval and the second interval are applied; 
 programming timing of the second interval using the identified times; and 
 e) stimulating pre-selected chambers in accordance with a predetermined stimulation protocol so long as an intrinsic cardiac event having an amplitude exceeding a predetermined amount is not sense sensed between the first and second intervals. 
 
     
     
       37. The method as recited in  claim 36 , wherein the second interval is initiated a predetermined amount of time after an end of the first interval. 
     
     
       38. The method as recited in  claim 36 , wherein the second interval is initiated when an intrinsic event from the atrium is sensed. 
     
     
       39. The method as recited in  claim 36 , wherein the second interval is initiated when an intrinsic event from the ventricle is sensed. 
     
     
       40. The method as recited in  claim 36  wherein the blanked event is associated with the atriums. 
     
     
       41. The method as recited in  claim 36 , wherein the blanked event is associated with the ventricle. 
     
     
       42. A method for programming a cardiac rhythm management device to enhance its ability to sense intrinsic depolarization events while avoiding detection of artifacts and after-potentials comprisingthe step of:
 (a) examining cardiac electrogram data originating from programmably selectable sites in a heart to identify unwanted potentials; 
 (b) determining a temporal relationship between the unwanted potentials and a known, repeatable, intrinsic or paced event; 
 (c) programming the known, repeatable, intrinsic or paced event as a trigger event that initiates a blanking or refractory period in a sensing channel exhibiting the unwanted potential; 
 (d) programming a delay value that starts with the trigger event and extends to a point in time before which the unwanted potential is predicted not to occur; and 
 (e) programming a duration of the blanking or refractory period that begins with the end of the delay value and extends to cover a period of time during which the unwanted potential is predicted to occur. 
 
     
     
       43. The cardiac rhythm management device as in any one  claim 16  or  17 - 24  of claims 16, 17 and 19-24 wherein the second refractory period is retriggerable. 
     
     
       44. A cardiac rhythm management device capable of detecting intrinsic depolarization events, comprising:
 a sensing circuit configured to receive signals indicative of the depolarization events from a first electrode positioned within a sensing channel for an atrium of a patient's heart and a second electrode positioned within a sensing channel for a ventricle of the patient's heart; and   a controller configured to receive data from the sensing circuit and prevent use of data to detect intrinsic depolarization events during one or more programmable refractory periods in timed relation relative to a sensed triggering event programmably selected from one of a plurality of sensing channels.   
     
     
       45. The cardiac rhythm management device, as in claim 44, wherein one of the one or more programmable refractory periods is a floating refractory period that is initiated a programmable amount of time after the end of a first refractory period, the first refractory period being initiated coincidental with the sensed triggering event. 
     
     
       46. The cardiac rhythm management device, as in claim 44, comprising a pulse generator configurable to selectively stimulate a plurality of sites in at least one chamber of the patient's heart, and wherein the controller is configured to control the pulse generator and prevent the use of data to detect intrinsic depolarization events during the plurality of programmable refractory periods in controlling the pulse generator. 
     
     
       47. The cardiac rhythm management device, as in claim 46, wherein at least one of the programmable refractory periods is triggered by a stimulation of a pre-selected chamber of the heart. 
     
     
       48. The cardiac rhythm management device, as in claim 46, wherein the triggering event is a sensed intrinsic event. 
     
     
       49. The cardiac rhythm management device, as in claim 46, wherein the triggering event includes a paced event. 
     
     
       50. The cardiac rhythm management device, as in claim 46, wherein the triggering event includes an intrinsic atrial event. 
     
     
       51. The cardiac rhythm management device, as in claim 46, wherein the triggering event includes an intrinsic ventricular event. 
     
     
       52. The cardiac rhythm management device, as in claim 46, wherein the triggering event includes a paced atrial event. 
     
     
       53. The cardiac rhythm management device, as in claim 46, wherein the triggering event includes a paced ventricular event. 
     
     
       54. The cardiac rhythm management device, as in claim 45, wherein preprogrammed sensed triggering events from the atrium are blanked during the floating refractory period. 
     
     
       55. The cardiac rhythm management device, as in claim 45, wherein preprogrammed sensed triggering events from the ventricle are blanked during the floating refractory period. 
     
     
       56. The cardiac rhythm management device as in any one of claims 45, 54, and 55, wherein the floating refractory period is retriggerable. 
     
     
       57. The cardiac rhythm management device, as in claim 46, wherein the controller initiates first and second refractory periods associated with the ventricle dependent upon sensed triggering events occurring in the atrium. 
     
     
       58. The cardiac rhythm management device, as in claim 46, wherein the controller initiates first and second refractory periods associated with the atrium dependent upon sensed triggering events occurring in the ventricle. 
     
     
       59. A cardiac rhythm management device, comprising:
 a controller;   sensing means for sensing a cardiac electrogram, said sensing means electrically coupled to the controller;   an atrial lead having an atrial electrode electrically coupled to the controller;   a ventricular lead having a ventricular electrode electrically coupled to the controller; and   said controller having means for defining a refractory period and a floating refractory period in a cardiac cycle for a programmably selectable site in a heart, wherein the programmably selectable site is programmably selectable for applying the refractory period and the floating refractory period thereto.   
     
     
       60. The cardiac rhythm management device as recited in claim 59, wherein the sensing means includes a programmably designated sensing channel for the atrium and a programmably designated sensing channel for the ventricle wherein the controller selects the sensing channel in creating the refractory period and floating refractory period. 
     
     
       61. The cardiac rhythm management device as recited in claim 59, wherein the floating refractory period is initiated a preprogrammed amount of time after the end of the refractory period. 
     
     
       62. The cardiac rhythm management device as recited in claim 59, wherein the floating refractory period is initiated if intrinsic events from the atrium are sensed. 
     
     
       63. The cardiac rhythm management device as recited in claim 59, wherein the floating refractory period is initiated if intrinsic events from the ventricle are sensed. 
     
     
       64. The cardiac rhythm management device as recited in claim 59, wherein sensed events from the atrium are blanked during the floating refractory period. 
     
     
       65. The cardiac rhythm management device as recited in claim 59, wherein sensed events from the ventricles are blanked during the floating refractory period. 
     
     
       66. The cardiac rhythm management device as recited in claim 59, wherein the controller initiates a refractory period and floating refractory period associated with the ventricles dependent upon preprogrammed triggering events occurring in the atrium. 
     
     
       67. The cardiac rhythm management device as recited in claim 59, wherein the controller initiates a refractory period and floating refractory period associated with the atrium dependent upon preprogrammed triggering events occurring in the ventricles. 
     
     
       68. The cardiac rhythm management device as recited in any one of claims 59-67 wherein the floating refractory period is retriggerable. 
     
     
       69. A cardiac rhythm management device capable of detecting intrinsic depolarization events, comprising:
 a pulse generator for selectively stimulating a plurality of sites in at least one chamber of a patient's heart;   a sensing circuit configured to receive signals indicative of the depolarization events from a first electrode positioned within a sensing channel for an atrium of the patient's heart and a second electrode positioned within a sensing channel for a ventricle of the patient's heart; and   a controller configured to receive data from the sensing circuit and to control the pulse generator, wherein the controller prevents the use of data to detect intrinsic depolarization events during a plurality of programmable refractory periods in timed relation relative to a sensed triggering event programmably selected from one of a plurality of programmably selectable sensing channels, wherein at least one of the programmable refractory periods is initiated a predetermined amount of time after the end of a first refractory period, the first refractory period being initiated coincidental with sensing an intrinsic event.   
     
     
       70. A multi-chamber cardiac rhythm management device functioning in a pre-selected stimulation mode and capable of atrial and ventricular tracking, said device comprising:
 sensing means for sensing at least one of atrial and ventricular events and transmitting signals containing information corresponding to sensed events;   stimulation means for selectively stimulating pre-selected chambers of a patient's heart; and   a programmable controller coupled to said means for sensing and said stimulation means, wherein during a cardiac cycle said controller manipulates the means for sensing to thereby create first and second refractory periods of sensed events for programmably pre-selected chambers of the patient's heart during the cardiac cycle, wherein the second refractory period is initiated a predetermined amount of time after the end of the first refractory period.   
     
     
       71. A cardiac rhythm management device capable of detecting intrinsic depolarization events, comprising:
 a sensing circuit configured to receive signals indicative of the depolarization events from a first electrode positioned within a sensing channel for an atrium of a patient's heart and a second electrode positioned within a sensing channel for a ventricle of the patient's heart; and   a controller configured to receive data from the sensing circuit and prevent use of data to detect intrinsic depolarization events during one or more programmable refractory periods in timed relation relative to a sensed triggering event programmably selected from one of a plurality of sensing channels, wherein one of the one or more programmable refractory periods is a floating refractory period that is initiated a programmable amount of time after the end of a first refractory period, the first refractory period being initiated coincidental with the sensed triggering event.   
     
     
       72. A cardiac rhythm management device, comprising:
 a controller;   sensing means for sensing a cardiac electrogram, said sensing means electrically coupled to the controller;   an atrial lead having an atrial electrode electrically coupled to the controller;   a ventricular lead having a ventricular electrode electrically coupled to the controller; and   said controller having means for defining a refractory period and a floating refractory period in a cardiac cycle for a programmably selectable site in a heart, wherein the floating refractory period is initiated a preprogrammed amount of time after the end of the refractory period.