Electrogram Storage for Non-Physiological Episodes
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Solution Overview
Problem
Implantable medical devices face challenges in accurately distinguishing between physiological and non-physiological cardiac events due to sensing integrity conditions, such as lead-related issues and noise misidentification, which can affect the integrity of cardiac rhythm monitoring and therapy delivery.
Innovation Solution
The system stores electrograms (EGMs) associated with suspected non-physiological events and uses impedance integrity criteria to determine the validity of sensed episodes, incorporating morphological analysis and confirmatory indications from multiple sensing channels to differentiate between actual tachyarrhythmias and noise, thereby improving sensing integrity evaluation.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If EGMs are stored for all suspected non-physiological events, then sensing integrity assessment completeness is improved, but memory resource consumption increases
Solution Approach 1:
The system changes the parameter of EGM storage by introducing impedance integrity criteria as a filtering condition. EGMs are stored selectively based on whether they meet both the non-physiological event detection and the impedance integrity threshold, transforming the storage decision from unconditional to conditionally parameter-based
Solution Approach 2:
The system extracts and separates true sensing integrity events from false positives by applying impedance integrity filtering. Only EGMs that pass both the non-physiological detection and the impedance integrity test are stored, extracting the valuable diagnostic information while discarding noise
2Measurement precision
If impedance integrity criteria are applied to filter EGMs, then false positives are reduced, but sensing integrity assessment accuracy may be compromised
Solution Approach 1:
The system uses impedance integrity measurements as feedback to validate the authenticity of detected non-physiological events. The impedance data provides continuous monitoring feedback that confirms whether lead conditions are stable enough to support the detected events as genuine
Solution Approach 2:
Lead impedance serves as an intermediary parameter that mediates between the raw EGM signal and the final diagnostic conclusion. It acts as a verification layer that confirms the physiological plausibility of detected events before they are stored for analysis
3Measurement precision
If morphological analysis and multiple sensing channels are used, then event differentiation accuracy is improved, but device complexity increases
Solution Approach 1:
The system segments the sensing integrity assessment into multiple independent analysis channels, each examining different aspects of the cardiac signal. By dividing the analysis into morphological features, impedance trends, and multi-channel correlations, the complex problem becomes manageable through structured segmentation
Solution Approach 2:
The sensing system performs multiple functions simultaneously using the same hardware infrastructure. The same electrodes and signal processing circuitry are used for both standard cardiac monitoring and the enhanced morphological analysis, making the system multi-functional without requiring completely separate dedicated components
Data Source
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AI summary
Techniques for storing electrograms (EGMs) that are associated with sensed episodes or events that may be non-physiological and, instead, associated with a sensing integrity condition are described. In some examples, a device or system identifies suspected non-physiological NSTs, and stores an EGM for the suspected non-physiological NSTs within an episode log. In some examples, a device or system determines whether to store an EGM for a suspected non- physiological episode or event based on whether an impedance integrity criterion has been satisfied. For example, a device or system may store an EGM for a detected short interval if the impedance integrity criterion has been met. In some examples, a device or system determines whether to buffer EGM data based on whether an impedance integrity criterion or other sensing integrity criterion has been met.