Lv unipolar sensing or pacing vector

Abstract

An implantable medical device configured to deliver a defibrillation energy to a heart can sense a left ventricular activation using information received from a unipolar sensing or pacing vector defined between a left ventricle and an internal thoracic location external to a heart.

1 . A system configured for sensing a left ventricular activation while avoiding oversensing a right ventricular activation or avoiding sensing a cardiac event other than a left ventricular activation, the system comprising:
 an implantable medical device including:
 a first sensing channel configured to receive information from a left ventricle; 
 a second sensing channel configured to receive information from an internal thoracic location external to a heart; and 
 wherein the implantable medical device is configured to deliver a defibrillation energy to the heart; and 
   a processor configured to receive information from the first and second sensing channels, wherein the left ventricle and the internal thoracic location external to the heart define a unipolar sensing or pacing vector, and wherein the processor is configured to sense a left ventricular activation using the received information from the first and second sensing channels.   
   
   
       2 . The system of  claim 1 , wherein the first sensing channel is configured to electrically couple the left ventricle to the processor, and the second sensing channel is configured to electrically couple the internal thoracic location external to the heart to the processor. 
   
   
       3 . The system of  claim 1 , wherein the implantable medical device is configured to deliver the defibrillation energy to the heart using the sensed left ventricular activation. 
   
   
       4 . The system of  claim 1 , wherein the processor is configured to inhibit energy delivery to the left ventricle using the sensed left ventricular activation. 
   
   
       5 . The system of  claim 1 , wherein the implantable medical device includes a housing, wherein at least a portion of the housing includes a conductor, and wherein the housing is configured to receive information from the internal thoracic location external to the heart. 
   
   
       6 . The system of  claim 1 , including a lead coupled to the first sensing channel, wherein the lead includes an electrode configured to be coupled to and receive information from the left ventricle. 
   
   
       7 . The system of  claim 1 , wherein the unipolar sensing or pacing vector is defined only between the left ventricle and the internal thoracic location external to the heart. 
   
   
       8 . The system of  claim 1 , wherein the implantable medical device is configured to provide a stimulation energy to the heart using the unipolar sensing or pacing vector. 
   
   
       9 . A method for sensing a left ventricular activation while avoiding oversensing a right ventricular activation or avoiding sensing a cardiac event other than a left ventricular activation, the method comprising:
 receiving information from a left ventricle and an internal thoracic location external to a heart using an implantable medical device, wherein the left ventricle and the internal thoracic location external to the heart define a unipolar sensing or pacing vector;   sensing a left ventricular activation using the received information to avoid oversensing a right ventricular activation or to avoid sensing a cardiac event other than a left ventricular activation; and   wherein the implantable medical device is configured to deliver a defibrillation energy to the heart.   
   
   
       10 . The method of  claim 9 , including delivering the defibrillation energy to the heart using the sensed left ventricular activation. 
   
   
       11 . The method of  claim 9 , including inhibiting energy delivery to the left ventricle using the sensed left ventricular activation. 
   
   
       12 . The method of  claim 9 , wherein the receiving the information from the internal thoracic location external to the heart includes receiving information from a housing can electrode. 
   
   
       13 . The method of  claim 9 , wherein the receiving the information from left ventricle includes receiving information from an electrode located proximate to the left ventricle. 
   
   
       14 . The method of  claim 9 , including providing a stimulation energy to the heart using the unipolar sensing or pacing vector. 
   
   
       15 . The method of  claim 9 , including:
 providing an implantable medical device including a housing can electrode, a first lead including a proximal defibrillation coil electrode and a distal defibrillation coil electrode coupled to the implantable medical device, and a second lead including a distal pacing or sensing electrode coupled to the implantable medical device, wherein the housing can electrode is electrically uncoupled from the proximal defibrillation coil electrode;   using the first lead such that the proximal defibrillation coil is located in the right atrium or the superior vena cava and the distal defibrillation coil electrode is located in the right ventricle;   using the second lead such that the distal pacing or sensing electrode is located in the coronary vasculature proximate to the left ventricle; and   unipolarly sensing a left ventricular activation between the distal pacing or sensing electrode and the housing can electrode.   
   
   
       16 . The method of  claim 15 , including delivering a defibrillation shock between the housing can electrode, the proximal defibrillation coil electrode, and the distal defibrillation coil electrode, wherein the housing can electrode is electrically coupled to the proximal defibrillation coil electrode. 
   
   
       17 . An apparatus comprising:
 an implantable medical device including a housing can electrode;   a proximal defibrillation coil electrode operatively coupled to the implantable medical device;   a distal pacing or sensing electrode operatively coupled to the implantable medical device; and   wherein the housing can electrode is electrically uncoupled from the proximal defibrillation coil electrode such that unipolar sensing is performed between the distal pacing or sensing electrode and the housing can electrode.   
   
   
       18 . The apparatus of  claim 17 , wherein the proximal defibrillation coil electrode is disposed along a first lead, and wherein the distal pacing or sensing electrode is disposed on a second lead. 
   
   
       19 . The apparatus of  claim 17 , wherein the first lead is configured such that the proximal defibrillation coil is implantable within the right atrium or the superior vena cava, and wherein the second lead is configured such that the distal pacing or sensing electrode is implantable within the coronary vasculature. 
   
   
       20 . The apparatus of  claim 17 , wherein the unipolar sensing is performed between only distal pacing or sensing electrode and the housing can electrode.