Site reversion in cardiac rhythm management

Abstract

Methods for failure recovery in a cardiac rhythm management system and apparatus capable of carrying out the methods. The methods include applying a first pacing therapy using one or more leads. The methods further include detecting a failure condition on one or more of the leads, wherein the failure condition prohibits or frustrates application of the first pacing therapy. The methods still further include applying a second pacing therapy using one or more of the leads subsequent to detecting the failure condition. The second pacing therapy is preferably chosen such that the detected failure does not interfere with the second pacing therapy. The second pacing therapy may be applied for only one cardiac cycle. The second pacing therapy may further be applied continuously until the failure condition is resolved, or it may be latched such that physician intervention is required to resume the first pacing therapy.

1 . A method comprising: 
 delivering one or more signals through at least a first electrode in a first pacing protocol for one or more first ventricular chambers of a heart;    monitoring detection of a first failure condition with the first electrode; and    invoking a second pacing protocol for one or more second ventricular chambers subsequent to detecting the first failure condition, including delivering one or more signals for the second pacing protocol.    
   
   
       2 . The method as recited in  claim 1 , wherein the second protocol is used temporarily.  
   
   
       3 . The method as recited in  claim 1 , further comprising monitoring persistence of the first failure condition.  
   
   
       4 . The method as recited in  claim 3 , further comprising resuming the first sensing protocol after the first failure condition is no longer detected.  
   
   
       5 . The method as recited in  claim 4 , further comprising latching the second pacing protocol and requiring intervention before the first pacing protocol is resumed.  
   
   
       6 . The method as recited in  claim 1 , further comprising reverting to a third pacing protocol upon detection of a subsequent failure condition.  
   
   
       7 . The method as recited in  claim 6 , wherein reverting to the third pacing protocol occurs prior to resolution of the first failure condition.  
   
   
       8 . The method as recited in  claim 1 , wherein invoking the second pacing protocol occurs independent of pacing.  
   
   
       9 . The method as recited in  claim 1 , wherein monitoring for detection of the first failure condition includes monitoring for detection of one or more of an over sense condition, sensed noise, lead impedance outside a predetermined range, capture amplitude voltage outside a predetermined range, intrinsic amplitude outside a predetermined range, detection of unintended non-cardiac stimulation, or failure to detect an expected event.  
   
   
       10 . The method as recited in  claim 1 , wherein monitoring for detection of the first failure condition includes monitoring for detection of one or more of electrical hardware failure, software failure, memory failure, or battery depletion.  
   
   
       11 . The method as recited in  claim 1 , further comprising discontinuing the first pacing protocol prior to invoking the second pacing protocol.  
   
   
       12 . A cardiac rhythm management system, comprising: 
 a signal generator electrically coupled with a first electrode, the signal generator electrically coupled with a second electrode; and    a processor coupled with the signal generator, wherein the processor is adapted to cause the signal generator to deliver at least one first signal to a least one first ventricular chamber through at least one electrode in a first protocol, and to deliver at least one second signal to a least one second ventricular chamber through at least one electrode in a second protocol in response to a first failure condition detected with the first electrode.    
   
   
       13 . The cardiac rhythm management system as recited in  claim 12 , wherein the first failure condition is associated with one or more electrodes.  
   
   
       14 . The cardiac rhythm management system as recited in  claim 12 , wherein the at least one first signal includes a set of first pacing pulses.  
   
   
       15 . The cardiac rhythm management system as recited in  claim 12 , wherein the first failure condition relates to at least one or more of an over sense condition, sensed noise, lead impedance outside a predetermined range, capture amplitude voltage outside a predetermined range, intrinsic amplitude outside a predetermined range, detection of unintended non-cardiac stimulation, or failure to detect an expected event.  
   
   
       16 . The cardiac rhythm management system as recited in  claim 12 , wherein the first failure condition relates to one or more of electrical hardware failure, software failure, memory failure, or battery depletion.  
   
   
       17 . The cardiac rhythm management system as recited in  claim 12 , wherein changing between the first protocol and the second protocol includes changing between a bipolar mode to a unipolar mode.  
   
   
       18 . A cardiac rhythm management system, comprising: 
 a signal generator electrically coupled with a first electrode, the signal generator electrically coupled with a second electrode, the first electrode disposed along a first lead, the second electrode disposed along a second lead; and    a processor coupled with the signal generator, wherein the processor causes the signal generator to deliver at least one first signal to a first ventricular chamber through at least the first electrode, and to deliver at least one second signal to a second chamber through the second electrode in response to a first failure condition associated with at least one of the first electrode or the first lead.    
   
   
       19 . The cardiac rhythm management system as recited in  claim 18 , wherein the first failure condition is based on at least one or more of an over sense condition, sensed noise, lead impedance outside a predetermined range, capture amplitude voltage outside a predetermined range, intrinsic amplitude outside a predetermined range, detection of unintended non-cardiac stimulation, or failure to detect an expected event.  
   
   
       20 . The cardiac rhythm management system as recited in  claim 18 , wherein the first failure condition is based on one or more of electrical hardware failure, software failure, or memory failure.  
   
   
       21 . The cardiac rhythm management system as recited in  claim 18 , wherein the processor causes the signal generator to deliver the at least one first signal through the first electrode and the second electrode.  
   
   
       22 . The cardiac rhythm management system as recited in  claim 18 , wherein delivering changes from a bipolar to a unipolar arrangement.