Implementing a subcutaneous medical electrode system involves positioning a number of electrode subsystems in relation to a heart so that noise cancellation provides an improved signal to noise ratio of the cardiac signal and/or to provide one electrode arrangement preferential for cardiac signals a
Implementing a subcutaneous medical electrode system involves positioning a number of electrode subsystems in relation to a heart so that noise cancellation provides an improved signal to noise ratio of the cardiac signal and/or to provide one electrode arrangement preferential for cardiac signals and another arrangement preferential for noise signals. One of the electrode subsystems so positioned may include one or more can electrodes located on a housing enclosing a medical device. The medical device may be configured to provide therapeutic, diagnostic, or monitoring functions, including, for example, cardiac arrhythmia therapy.
대표청구항▼
What is claimed is: 1. An implantable cardiac device, comprising: a pulse generator comprising a controller configured to execute program instruction stored in memory, the pulse generator and the memory provided in a can configured for implantation; a rigid support structure coupled to, and spaced
What is claimed is: 1. An implantable cardiac device, comprising: a pulse generator comprising a controller configured to execute program instruction stored in memory, the pulse generator and the memory provided in a can configured for implantation; a rigid support structure coupled to, and spaced apart from, the can; and a plurality of implantable electrodes coupled to the pulse generator, the rigid support structure configured to maintain the plurality of implantable electrodes in respective subcutaneous extra-thoracic locations and in a spaced relationship with respect to cardiac tissue and vasculature, the plurality of electrodes comprising: a first combination of electrodes mounted to the support structure in a fixed spaced relationship along a first plane with respect to other electrodes of the plurality of implantable electrodes, the first electrode combination positioned on the support structure in a manner to preferentially sense a first type of signal relative to other electrodes of the plurality of implantable electrodes; and a second combination of electrodes mounted to the support structure in a fixed spaced relationship along a second plane with respect to other electrodes of the plurality of implantable electrodes, the second electrode combination positioned on the support structure in a manner to preferentially sense a second type of signal relative to the electrodes of the first electrode combination, wherein the first plane is in an orthogonal relationship with respect to the second plane and controller execution of the program instructions causes the implantable cardiac device to select one of the first combination of electrodes or the second combination of electrodes for sensing a cardiac signal as the first type or the second type of signal, select the other of the first combination of electrodes and the second combination of electrodes for sensing a noise signal as the other of the first type and the second type of signal, and remove content from the cardiac signal based on the content of the noise signal, the selection of the first combination of electrodes or the second combination of electrodes for sensing the cardiac signal and the other of the first combination of electrodes and the second combination of electrodes for sensing the noise signal based on a test performed using the plurality of electrodes. 2. The device of claim 1, wherein the can and the rigid support structure are maintained in a spaced apart relationship on opposite sides of the heart by a rigid elongated structure attached to the can and the support structure. 3. The device of claim 1, wherein the controller is configured such that the test comprises identifying a cardiac signal component and a noise component of signals acquired by each of the first combination of electrodes and the second combination of electrodes and comparing respective cardiac signal components and noise signal components between the first and second electrode combinations. 4. The device of claim 1, wherein the test comprises: controller selection of the first combination of electrodes or the second combination of electrodes for sensing the cardiac signal based on which electrode combination provides a cardiac signal response that exceeds a threshold; and controller selection of the first combination of electrodes or the second combination of electrodes for sensing the noise signal based on which electrode combination provides a noise component response. 5. The device of claim 1, wherein the test comprises: controller selection of the first combination of electrodes or the second combination of electrodes for sensing the cardiac signal based on which electrode combination provides a cardiac signal response that exceeds a signal-to-noise ratio threshold; and controller selection of the second combination of electrodes or the second combination of electrodes for sensing the noise signal based on which electrode combination provides a cardiac signal response substantially lower than the signal-to-noise ratio threshold. 6. The device of claim 1, wherein the test comprises: controller selection of the first combination of electrodes or the second combination of electrodes for sensing the cardiac signal based on which electrode combination provides a cardiac signal response that exceeds a threshold; and controller selection of the second combination of electrodes or the second combination of electrodes for sensing the noise signal based on which electrode combination provides a cardiac signal response substantially lower than the threshold. 7. The device of claim 1, wherein the cardiac device is configured such that the cardiac signals sensed by the selected first combination of electrodes or the second combination of electrodes comprise a cardiac signal component and a noise component, and the controller is further configured to execute stored program instructions to reduce the noise component of the cardiac signals using a noise component of the noise signals sensed by the other of the first combination of electrodes and second combination of electrodes subtracted from the cardiac signal. 8. The device of claim 1, further comprising: a first electrode shield positioned on the cardiac device relative to the plurality of implantable electrodes to shield one or more electrodes of the second combination of electrodes from electrical cardiac activity with respect to at least one electrode of the first combination of electrodes; and a second electrode shield positioned on the cardiac device relative to the plurality of implantable electrodes to shield one or more electrodes of the first combination of electrodes from electrical noise with respect to at least one electrode of the second combination of electrodes. 9. The device of claim 1, further comprising at least one electrode shield positioned on the cardiac device relative to the plurality of implantable electrodes to shield one or more electrodes of the second combination of electrodes from electrical cardiac activity with respect to at least one electrode of the first combination of electrodes. 10. The device of claim 1, wherein the cardiac device is configured such that the cardiac signals sensed by the selected first combination of electrodes or the second combination of electrodes comprise a cardiac component and a noise component, and the controller is configured to execute stored program instructions to linearly combine the sensed cardiac signals with the sensed noise signals sensed by the other of the first combination of electrode and the second combination of electrodes to reduce the noise component of the cardiac signals. 11. The device of claim 1, wherein the controller executes the stored program instructions such that: the combination of electrodes selected to sense the cardiac signal is selected because during the test it provides a cardiac signal response that exceeds a signal-to-noise ratio threshold; and the combination of electrodes selected to sense the noise signal is selected because during the test it provides a cardiac signal response substantially lower than the signal-to-noise ratio threshold. 12. The device of claim 1, wherein the controller executes the stored program instructions such that: the combination of electrodes selected to sense the cardiac signal is selected because during the test it provides a cardiac signal response that exceeded a first signal-to-noise ratio threshold; and the combination of electrodes selected to sense the noise signal is selected because during the test it provides a cardiac signal response lower than a second signal-to-noise ratio threshold. 13. The device of claim 1, wherein the controller executes the stored program instructions such that: the combination of electrodes selected to sense the cardiac signal is selected because during the test it provides a cardiac signal response that exceeds a threshold; and the combination of electrodes selected to sense the noise signal is selected because during the test it provides a cardiac signal response substantially lower than the threshold. 14. The device of claim 1, wherein the controller executes the stored program instructions such that: the combination of electrodes selected to sense the cardiac signal is selected because during the test it provides a cardiac signal response that exceeds a first threshold; and the combination of electrodes selected to sense the noise signal is selected because during the test it provides a cardiac signal response lower than a second threshold. 15. The device of claim 1, wherein the support structure is circular or elliptical in shape. 16. The device of claim 15, wherein the first electrode combination includes at least one electrode from the second electrode combination. 17. The device of claim 15, wherein the second electrode combination includes at least one electrode from the first electrode combination. 18. The device of claim 1, wherein the support structure is polygonal in shape. 19. The device of claim 1, wherein the support structure is curved in shape. 20. The device of claim 1, wherein the support structure is arrow shaped. 21. The device of claim 1, further comprising one or more tines provided on the support structure. 22. An implantable cardiac device, comprising: a pulse generator comprising a controller configured to execute program instructions stored in memory, the pulse generator and the memory provided in a can configured for implantation; a rigid support structure coupled to, and spaced apart from, the can; and a plurality of implantable electrodes coupled to the pulse generator, the plurality of electrodes comprising: a first combination of electrodes mounted to the support structure in a fixed spaced relationship with respect to other electrodes of the plurality of implantable electrodes, the first combination of electrodes positioned on the support structure in a manner to preferentially sense a first type of signal relative to other electrodes of the plurality of implantable electrodes; and a second combination of electrodes, at least one of the electrodes of the second combination of electrodes mounted to the can in a fixed spaced relationship with respect to other electrodes of the plurality of implantable electrodes, the second combination of electrodes positioned on the cardiac device in a manner to preferentially sense a second type of signal relative to the electrodes of the first combination of electrodes, the support structure configured to maintain the first combination of electrodes in respective subcutaneous extra-thoracic locations and in a spaced relationship with respect to cardiac tissue and vasculature, wherein controller execution of the program instructions causes the implantable cardiac device to select one of the first combination of electrodes or the second combination of electrodes for sensing a cardiac signal as the first type or the second type of signal, select the other of the first combination of electrodes and the second combination of electrodes for sensing a noise signal as the other of the first type and the second type of signal, and remove content from the cardiac signal based on the content of the noise signal, the selection of the first combination of electrodes or the second combination of electrodes for sensing the cardiac signal and the other of the first combination of electrodes and the second combination of electrodes for sensing the noise signal based on a test performed using the plurality of implantable electrodes. 23. The device of claim 22, wherein the electrodes of the first combination of electrodes are arranged along a first plane and the electrodes of the second combination of electrodes are arranged along a second plane, and the first plane is orthogonal with respect to the second plane. 24. The device of claim 22, wherein the controller is configured to execute stored program instructions such that the test comprises identifying a cardiac signal component and a noise component of signals acquired by each of the first combination of electrodes and the second combination of electrodes and comparing the respective cardiac signal components and noise signal components between the first and second electrode combinations. 25. The device of claim 22, wherein the controller is configured to execute stored program instructions such that the test comprises: controller selection of the first combination of electrodes or the second combination of electrodes for sensing the cardiac signal based on which electrode combination provides a cardiac signal response that exceeds a threshold; and controller selection of the first combination of electrodes or the second combination of electrodes for sensing the noise signal based on which electrode combination provides a noise component response. 26. The device of claim 22, wherein the controller is configured to execute stored program instructions such that the test comprises: controller selection of the first combination of electrodes or the second combination of electrodes for sensing the cardiac signal based on which electrode combination provides a cardiac signal response that exceeds a signal-to-noise ratio threshold; and controller selection of the second combination of electrodes or the second combination of electrodes for sensing the noise signal based on which electrode combination provides a cardiac signal response substantially lower than the signal-to-noise ratio threshold. 27. The device of claim 22, wherein the first electrode combination includes at least one electrode from the second electrode combination. 28. The device of claim 22, wherein the second electrode combination includes at least one electrode from the first electrode combination. 29. The device of claim 22, wherein the controller is configured to execute stored program instructions and control the cardiac device such that the cardiac signals sensed by the selected first combination of electrodes or second combination of electrodes comprise a cardiac signal component and a noise component, and the controller is configured to execute stored program instructions to reduce the noise component of the cardiac signals using the noise signals sensed by the other of the first combination of electrodes and the second combination of electrodes. 30. The device of claim 22, wherein the controller is configured to execute stored program instructions and control the cardiac device such that the cardiac signals sensed by the selected first combination of electrodes or second combination of electrodes comprise a cardiac signal component and a noise component, and the controller is configured to execute stored program instructions to linearly combine the sensed cardiac signals with the noise signals sensed by the other of the first combination of electrode and the second combination of electrodes to reduce the noise component of the cardiac signals. 31. The device of claim 22, wherein the controller is configured to execute stored program instructions and control the cardiac device such that the cardiac signals sensed by the selected first combination of electrodes or second combination of electrodes comprise a cardiac signal component and a noise component, and the controller is configured to execute stored program instructions to select a therapy using the noise component. 32. The device of claim 22, wherein at least two electrodes of the first combination of electrodes are arranged in an orthogonal relationship with respect to at least two electrodes of the second combination of electrodes. 33. The device of claim 22, wherein the can and the support structure are maintained in a spaced apart relationship by a rigid elongated structure attached to the can and the support structure. 34. The device of claim 33, wherein the rigid elongated structure is configured to maintain the can and the support structure in a fixed relationship on opposing sides of the heart. 35. The device of claim 33, wherein the rigid elongated support structure can be distorted under manual force to take and maintain a desired shape. 36. The device of claim 22, further comprising at least one electrode shield positioned on the cardiac device relative to the plurality of implantable electrodes to shield one or more electrodes of the second combination of electrodes from electrical cardiac activity with respect to at least one electrode of the first combination of electrodes. 37. The device of claim 22, further comprising: a first electrode shield positioned on the cardiac device relative to the plurality of implantable electrodes to shield one or more electrodes of the second combination from electrical cardiac activity with respect to at least one electrode of the first combination; and a second electrode shield positioned on the cardiac device relative to the plurality of implantable electrodes to shield one or more electrodes of the first combination of electrodes from electrical noise with respect to at least one electrode of the second combination of electrodes. 38. The device of claim 22, wherein the support structure is circular or elliptical in shape. 39. The device of claim 22, wherein the support structure is polygonal in shape. 40. The device of claim 22, wherein the support structure is curved in shape. 41. The device of claim 22, wherein the support structure is arrow shaped. 42. The device of claim 22, further comprising one or more tines provided on the support structure.
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