CN106102830B - 用于改进医疗装置之间的通信的方法和系统 - Google Patents

用于改进医疗装置之间的通信的方法和系统 Download PDF

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CN106102830B
CN106102830B CN201580012568.8A CN201580012568A CN106102830B CN 106102830 B CN106102830 B CN 106102830B CN 201580012568 A CN201580012568 A CN 201580012568A CN 106102830 B CN106102830 B CN 106102830B
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杰弗里·E·施塔曼
威廉姆·J·林德
基思·R·迈莱
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Cardiac Pacemakers Inc
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Abstract

第一医疗装置和第二医疗装置中的至少一个可以在第二医疗装置可以随意地邻近患者、但是在患者的外部的同时被植入在患者内。所述医疗装置中的至少一个具有带有至少两个电极的天线，并且所述医疗装置中的至少一个具有带有至少三个电极的天线。所述医疗装置可以经由第一对电极和第二对电极之间通过患者组织的传导通信来进行通信。所述对电极中的至少一个可以根据第一对电极和第二对电极之间的通信矢量的信号强度而选择。

Description

用于改进医疗装置之间的通信的方法和系统
相关申请
本申请要求2014年1月10日提交的、序号为61/926,101、标题为“METHODS ANDSYSTEMS FOR IMPROVED COMMUNICATION BETWEEN MEDICAL DEVICES(用于改进医疗装置之间的通信的方法和系统)”的美国临时专利申请的权益，该申请整体地通过引用并入本文。
技术领域
本公开一般地涉及医疗装置之间的通信，更具体地，涉及用于改进医疗装置之间的通信的方法和系统。
背景技术
起搏仪器可以用于治疗患有可能导致心脏将足够量的血液递送给患者的身体的能力降低的各种心脏病的患者。这些心脏病可能导致快速的、不规律的和/或低效的心脏收缩。为了帮助缓解这些病况中的一些，各种装置(例如，起搏器、除纤颤器等)可以被植入在患者的身体里。这样的装置可以监视并提供对心脏的电刺激以帮助心脏以更正常的、高效的和/或安全的方式进行操作。在一些情况下，患者可能具有一起操作来检测和/或治疗各种病况的多个装置。
发明内容
本公开一般地涉及医疗装置之间的通信，更具体地，涉及用于改进医疗装置之间的通信的方法和系统。例如，第一医疗装置和第二医疗装置可以被植入在患者内，或者第一医疗装置可以被植入在患者内，第二医疗装置可以邻近患者，但是在患者的外部。所述医疗装置中的至少一个可以具有带有至少两个电极的天线，并且所述医疗装置中的至少一个可以具有带有至少三个电极的天线。所述医疗装置可以通过将信号从发射医疗装置的电极中的两个电极发送到接收医疗装置的至少两个电极来进行通信。设想所述医疗装置可以经由射频(RF)通信、电感耦合、传导通信或任何其他合适的通信技术来进行通信。
将意识到，任何两对电极(诸如属于发射医疗装置的第一对电极和属于接收医疗装置的第二对电极)之间的相对信号强度可以部分取决于接收电极相对于发射电极生成的电磁场的方位。所述系统可以被配置为选择用于发射医疗装置和/或接收医疗装置的特定的一对电极以便帮助改进装置之间的通信的信号强度。可以用于医疗装置之间的通信的电极的不同组合均可以被称为“通信矢量”。在一些情况下，各种通信矢量可以被测试，并且生成最高相对信号强度和/或信噪比的通信矢量可以被选为用于后面的通信。各种通信矢量可以在以下时候被周期性地重新测试：在命令时、当相对信号强度和/或信噪比降至低于阈值时、当相对信号强度和/或信噪比变化阈值时、和/或在所期望的任何其他合适的时间。
公开了在具有第一天线的第一医疗装置和具有第二天线的第二医疗装置之间进行通信的示例方法。第一医疗装置被植入在患者内，第二医疗装置邻近患者，第一天线和/或第二天线具有至少三个电极，另一个天线具有至少两个电极。示例方法包括：
选择具有至少三个电极的天线的第一电极对；
以下操作中的至少一个：在具有至少三个电极的天线的第一电极对和所述另一个天线的电极中的两个电极之间通过患者的组织发送和接收传导通信信号；
选择具有至少三个电极的天线的第二电极对，其中，第二电极对不同于第一电极对；以及
在具有至少三个电极的天线的第二电极对和所述另一个天线的两个电极之间通过所述患者的组织发送传导通信信号。
可替代以上任一实施例地或者除了以上任一实施例之外，所述方法可以进一步包括：
监视与使用第一电极对的传导通信信号的信噪比相关的度量；
如果与使用第一电极对的传导通信信号的信噪比相关的度量降至低于阈值，则：
选择具有至少三个电极的天线的第二电极对；以及
在具有至少三个电极的天线的第二电极对和所述另一个天线的两个电极之间通过患者的组织发送传导通信信号。
可替代以上任一实施例地或者除了以上任一实施例之外，所述方法可以进一步包括：
确定与使用第一电极对的传导通信信号的信噪比相关的第一度量；
确定与使用第二电极对的传导通信信号的信噪比相关的第二度量；以及
基于第一度量和第二度量来选择第一电极对或第二电极对用于后来的通信。
可替代以上任一实施例地或者除了以上任一实施例之外，第二医疗装置可以被植入在患者内，但是与第一医疗装置分隔开。
可替代以上任一实施例地或者除了以上任一实施例之外，第二医疗装置可以被设置在患者的外部，第二天线被定位在患者的皮肤表面上。
可替代以上任一实施例地或者除了以上任一实施例之外，具有至少三个电极的天线可以包括按三角形配置布置的三个电极。
可替代以上任一实施例地或者除了以上任一实施例之外，具有至少三个电极的天线可以包括按矩形配置布置的四个电极。
可替代以上任一实施例地或者除了以上任一实施例之外，具有至少三个电极的天线可以包括按风筝配置布置的四个电极。
在具有带有至少两个电极的第一天线的第一医疗装置和具有带有至少三个电极的第二天线的第二医疗装置之间进行通信的另一示例方法包括：
测试第一天线的所述至少两个电极和第二天线的所述至少三个电极的多对电极中的每对电极之间的通信矢量；
基于通信矢量中的每个的信号强度来选择通信矢量；以及
以下操作中的至少一个：使用选择的通信矢量来在第一医疗装置和第二医疗装置之间发送和接收传导通信。
可替代以上任一实施例地或者除了以上任一实施例之外，第一医疗装置可以包括植入式医疗装置，第二医疗装置可以包括外部装置。
可替代以上任一实施例地或者除了以上任一实施例之外，第一医疗装置可以包括外部装置，第二医疗装置可以包括植入式医疗装置。
可替代以上任一实施例地或者除了以上任一实施例之外，第一医疗装置可以包括第一植入式医疗装置，第二医疗装置可以包括第二植入式医疗装置。
可替代以上任一实施例地或者除了以上任一实施例之外，选择通信矢量可以包括选择具有最强信号强度的通信矢量。
可替代以上任一实施例地或者除了以上任一实施例之外，选择通信矢量可以包括不选择具有最弱信号强度的通信矢量。
还公开了示例通信系统。该示例通信系统包括：
第一医疗装置，其与具有至少两个电极的第一天线进行通信；以及
第二医疗装置，其与具有至少三个电极的第二天线进行通信；
其中，第一医疗装置和第二医疗装置中的至少一个被配置为：
测试第一天线的所述至少两个电极和第二天线的所述至少三个电极的至少两对之间的通信矢量；
从测试的通信矢量选择通信矢量；以及
以下操作中的至少一个：沿着选择的通信矢量发送和接收传导通信。
可替代以上任一实施例地或者除了以上任一实施例之外，所述至少三个电极可以包括按三角形配置布置的三个电极。
可替代以上任一实施例地或者除了以上任一实施例之外，所述至少三个电极可以包括按矩形配置布置的四个电极。
可替代以上任一实施例地或者除了以上任一实施例之外，所述至少三个电极可以包括按风筝配置布置的四个电极。
可替代以上任一实施例地或者除了以上任一实施例之外，第一医疗装置和第二医疗装置中的至少一个可以被植入在患者内。
可替代以上任一实施例地或者除了以上任一实施例之外，第一医疗装置是无引线心脏起搏器(LCP)。
以上总结并非意图描述本公开的每个实施例或每一个实现。通过参照以下结合附图进行的描述和权利要求，优点和成就连同本公开的更完整的理解将变得清楚和被领会。
附图说明
考虑以下结合附图对各种说明性实施例的描述，本公开可以被更完整地理解，在附图中：
图1例示说明根据本公开的各种例子的可以使用的示例性医疗装置的框图；
图2例示说明根据本公开的一个例子的具有电极的示例性无引线心脏起搏器(LCP)；
图3示出包括根据本公开的几个医疗装置的说明性系统；
图4是电极对可以产生的说明性电磁场的示图；
图5是图4的电磁场的一部分的示图，该示图例示说明电极相对于电磁场的不同几何布置；
图6是根据本公开的各种例子的具有带有三个电极的说明性天线的医疗装置的示意图；
图7是根据本公开的各种例子的具有带有四个电极的说明性天线的医疗装置的示意图；
图8是根据本公开的各种例子的四个电极的说明性布置的示意图；
图9是根据本公开的各种例子的四个电极的另一说明性布置的示意图；
图10示出根据本公开的例子的说明性系统；
图11是用于在医疗装置之间进行通信的说明性方法的流程图；
图12是示出用于在医疗装置之间进行通信的另一说明性方法的流程图；
图13是示出用于在医疗装置之间进行通信的又一说明性方法的流程图；以及
图14是示出用于在医疗装置之间进行通信的另一说明性方法的流程图。
虽然本公开可以有各种修改和替代形式，但是其细节已经在附图中被以举例的方式示出，并且将被详细描述。然而，应理解，本发明并不使本公开的各方面限于所描述的特定的说明性实施例。相反，本发明涵盖落在本公开的精神和范围内的所有修改、等同和替代。
具体实施方式
以下描述应参照附图阅读，在附图中，不同附图中的类似元件被相同地编号。描述和不一定按比例绘制的附图描绘说明性实施例，而非意图限制本公开的范围。
正常的健康的心脏包括通过在整个心脏中传导固有地产生的电信号来引起收缩。这些固有信号使心脏的肌细胞或组织收缩。该收缩迫使血液出入心脏，提供血液在身体的整个其余部分中的循环。然而，许多患者患有影响他们的心脏的收缩性的心脏病。例如，一些心脏可能发展有不再产生或传导固有电信号的病变组织。在一些例子中，病变心脏组织以不同的速率传导电信号，从而引起心脏的异步的低效的收缩。在其他例子中，心脏可能以心率变得危险地低的这样的低速率产生固有信号。在还有的其他的例子中，心脏可能以异常地高的速率产生电信号。在一些情况下，这样的异常可能发展到纤维性颤动状态，在纤维性颤动状态下，患者的心脏的收缩几乎是完全异步的，并且心脏泵送非常少的血液、甚至不泵送血液。
许多医疗装置系统已经被开发来辅助经历这样的异常的患者。例如，感测固有心脏电信号并且基于感测到的电信号确定患者是否正患有一种或多种心律失常的系统已经被开发。这样的系统还可以包括将电刺激递送给患者的心脏以便治疗检测到的心律失常的能力。在一个例子中，一些医疗装置系统包括识别心脏何时以太低的速率跳动(称之为心动过缓)的能力。这样的系统可以递送使心脏以更高的、更安全的速率收缩的电刺激疗法或“起搏”脉冲。一些医疗装置系统能够确定心脏合适以太快的速率跳动(称之为心动过速)。这样的系统可以进一步包括一种或多种抗心动过速起搏(ATP)疗法。一种这样的ATP疗法包括以比固有地产生的信号快的速率将电刺激脉冲递送给心脏。尽管这可以暂时地使心脏更快地跳动，但是这样的刺激方案可能使心脏响应于递送的与固有地产生的信号完全不同的起搏脉冲收缩。ATP疗法然后可以使递送的起搏脉冲的速率放慢，从而使心率降至更低的、更安全的水平。
其他医疗装置系统可以能够检测纤维性颤动状态和异步收缩。例如，基于感测到的信号，一些系统可以能够确定心脏何时处于纤维性颤动状态。这样的系统可以进一步被配置为用电刺激疗法来治疗这样的纤维性颤动状态。一种这样的疗法包括以压制任何固有地产生的信号为目标将相对大量的电能递送给心脏(“除颤脉冲”)。从电角度来讲，这样的疗法可以“重置”心脏，这可以允许正常的电处理接管。其他医疗系统可以能够感测固有地产生的信号在不同的时间产生或者心脏以不同的速率传导这样的信号。这些异常可以导致异步的、低效的心脏收缩。所述系统可以进一步包括管理一种或多种心脏再同步疗法(CRT)的能力。一种这样的CRT可以包括将电刺激递送到心脏、心脏上和/或内的不同位置。这样的方法可以帮助心脏的不同部分几乎同时地收缩，或者如果所述系统在不同时间将电刺激递送给不同位置，则以同步的方式收缩。
本公开一般地涉及用于协调使用患者内的多个植入式装置对异常心脏活动的检测和/或治疗的系统和方法。在一些情况下，医疗装置系统可以包括用于检测心律失常并且递送电刺激疗法的多个装置。例如，说明性系统可以包括诸如以下的装置：皮下复律除颤器(S-I CD)、外部复律除颤器、可植入心脏起搏器(ICP)、无引线心脏起搏器(LCP)、和/或仅诊断用装置(可以感测心脏电信号和/或确定心律失常、但是不递送电刺激疗法的装置)。
图1例示说明根据本公开的各种例子的可以使用的示例性医疗装置100(在下文中被称为MD 100)的框图。在一些情况下，MD 100可以用于感测固有心脏活动、确定心律失常的发生、并且响应于确定心律失常发生来递送电刺激。在一些情况下，MD 100可以被植入在患者的身体内、特定的位置(例如，紧邻患者的心脏)，以感测和/或调节心脏的心脏活动。在其他例子中，MD 100可以被安置在患者的外部以感测和/或调节心脏的心脏活动。在一个例子中，心脏收缩一般是由心脏固有地产生的电信号造成的。这些电信号通过心脏组织传导，使心脏的肌细胞收缩。MD 100可以包括允许MD 100感测这样的电信号和/或心脏的其他物理参数(例如，机械收缩、心音、血压、血氧水平等)的特征。这样的电信号和/或物理性质可以被认为是“心脏活动”。MD 100可以包括基于感测到的心脏活动来确定心律失常的发生的能力。在一些例子中，MD 100可以能够将电刺激递送给心脏以便治疗任何检测到的心律失常。例如，MD 100可以被配置为递送电刺激、起搏脉冲、除颤脉冲等以便实现一种或多种疗法，诸如心动过缓疗法、ATP疗法、CRT、除颤或其他电刺激疗法。
图1是示例医疗装置100的例示说明。说明性MD 100可以包括感测模块102、脉冲发生器模块104、处理模块106、遥测模块108以及电池110，这些全都被容纳在壳体120内。MD100可以进一步包括引线112和电极114，引线112和电极114附连到壳体120，并且与容纳在壳体120内的模块102、104、106和108中的一个或多个进行电通信。
引线112可以连接到MD 100的壳体120，并且远离壳体120延伸。在一些例子中，引线112被植入在患者的心脏上或内。引线112可以包含被定位在引线112上的各种位置、离壳体120的各种距离处的一个或多个电极114。一些引线112可以仅包括单个电极114，而其他引线112可以包括多个电极114。一般地，电极114被定位在引线112上，以使得当引线112被植入在患者内时，一个或多个电极114与患者的心脏组织接触。因此，电极114可以将固有地产生的电信号传导给引线112。引线112继而可以将接收到的电信号传导给MD 100的一个或多个模块102、104、106和108。以类似的方式，MD 100可以产生电刺激，引线112可以将产生的电刺激传导给电极114。电极114然后可以将电信号传导给患者的心脏组织。当讨论感测固有信号以及递送电刺激时，本公开可以认为这样的传导隐含在这些处理中。
感测模块102可以被配置为感测心脏的心脏电活动。例如，感测模块102可以连接到引线112并且通过引线112连接到电极114，感测模块102可以被配置为接收通过电极114和引线112传导的心脏电信号。在一些例子中，引线112可以包括各种传感器，诸如加速器、血压传感器、心音传感器、血氧传感器、以及测量心脏和/或患者的生理参数的其他传感器。在其他例子中，这样的传感器可以直接连接到感测模块102，而不是引线112。在任何情况下，感测模块102可以被配置为接收直接或通过引线112连接到感测模块102的任何传感器生成的这样的信号。感测模块102可以另外连接到处理模块106，并且可以被配置为将这样的接收到的信号传送给处理模块106。
脉冲发生器模块104可以连接到电极114。在一些例子中，脉冲发生器模块104可以被配置为产生电刺激信号以将电刺激疗法提供给心脏。例如，脉冲发生器模块104可以通过使用储存在MD 100内的电池110中的能量来产生这样的信号。脉冲发生器模块104可以被配置为产生电刺激信号以便提供若干种不同疗法中的一种或多种。例如，脉冲发生器模块104可以被配置为产生电刺激信号以提供心动过缓疗法、心动过速疗法、心脏再同步疗法和纤维性颤动疗法。心动过缓疗法可以包括以比固有地产生的电信号快的速率产生和递送起搏脉冲以便设法提高心率。心动过速疗法可以包括如本文中所描述的ATP疗法。心脏再同步疗法可以包括本文中也描述的CRT疗法。纤维性颤动疗法可以包括递送纤维性颤动脉冲以设法超控心脏并且停止纤维性颤动状态。在其他例子中，脉冲发生器104可以被配置为产生电刺激信号以提供与本文中描述的那些电刺激疗法不同的电刺激疗法来治疗一种或多种检测到的心律失常。
处理模块106可以被配置为控制MD 100的操作。例如，处理模块106可以被配置为从感测模块102接收电信号。基于接收到的信号，处理模块106可以能够确定心律失常的发生。基于任何确定的心律失常，处理模块106可以被配置为控制脉冲发生器模块104根据一种或多种疗法产生电刺激以治疗确定的一种或多种心率失常。处理模块106可以进一步从遥测模块108接收信息。在一些例子中，处理模块106可以在确定心律失常是否发生时使用这样的接收的信息，或者响应于该信息来采取特定动作。处理模块106可以另外控制遥测模块108将信息发送到其他装置。
在一些例子中，处理模块106可以包括预编程芯片，诸如超大规模集成(VLSI)芯片或专用集成电路(ASIC)。在这样的实施例中，该芯片可以被用控制逻辑预先编程以便控制MD 100的操作。通过使用预编程芯片，处理模块106可以在能够保持基本功能的同时使用比其他可编程电路少的功率，从而增加MD 100的电池寿命。在其他例子中，处理模块106可以包括可编程微处理器。这样的可编程微处理器可以允许用户调整MD 100的控制逻辑，从而使得MD 100的灵活性可以大于使用预编程芯片时。在一些例子中，处理模块106可以进一步包括存储器电路，处理模块106可以将信息存储在存储器电路上以及从存储器电路读取信息。在其他例子中，MD 100可以包括单独的存储器电路(未示出)，该单独的存储器电路与处理模块106进行通信，以使得处理模块106可以对该单独的存储器电路读写信息。
遥测模块108可以被配置为与被安置在MD 100外部的装置(诸如传感器、其他医疗装置等)进行通信。这样的装置可以被安置在患者的身体的外部或内部。无论位置如何，外部装置(即，在MD 100的外部，但是不一定在患者的身体的外部)可以经由遥测模块108与MD100进行通信以实现一种或多种期望的功能。例如，MD 100可以通过遥测模块108将感测到的电信号传送给外部医疗装置。该外部医疗装置可以在确定发生心律失常时使用传送的电信号。MD 100可以另外通过遥测模块108从该外部医疗装置接收感测的电信号，MD 100可以在确定发生心律失常时使用接收到的感测到的电信号。遥测模块108可以被配置为使用一种或多种方法来与外部装置进行通信。例如，遥测模块108可以经由射频(RF)信号、电感耦合、光学信号、声学信号、传导通信信号或任何其他的适合于通信的信号来进行通信。下面将参照图3来更详细地讨论MD 100和外部装置之间的通信技术。
电池110可以将电功率提供给MD 100以供用其操作。在一个例子中，电池110可以是不可充电的基于锂的电池。在其他例子中，不可充电电池可以由本领域中已知的其他合适的材料制成。因为在MD 100是可植入装置的例子中，对MD 100的访问可能是有限的，所以有必要具有足以在治疗时间段期间(诸如几天、几周、几月或几年)递送足够的疗法的容量的电池。在其他例子中，电池110可以是可充电的基于锂的电池，以便便利于提高MD 100的可用寿命。
一般来说，MD 100可以类似于若干种现有的医疗装置之一。例如，MD 100可以类似于各种可植入医疗装置。在这样的例子中，MD 100的壳体120可以被植入在患者的经胸廓区域中。壳体120一般可以包括对植入在人体中安全的若干种已知材料中的任何一个，并且当被植入时，可以密封地使MD 100的各种组件与患者身体的流体和组织阻隔。
在一些例子中，MD 100可以是可植入心脏起搏器(ICP)。在这样的例子中，MD 100可以具有被植入在患者的心脏上或内的一个或多个引线，例如，引线112。所述一个或多个引线112可以包括与患者的心脏的心脏组织和/或血液接触的一个或多个电极。MD 100还可以被配置为感测固有地产生的心脏电信号并且基于感测到的信号的分析来确定例如一种或多种心律失常。MD 100可以进一步被配置为经由植入在心脏内的引线112递送CRT、ATP疗法、心动过缓疗法、除颤疗法和/或其他疗法类型。
在一些情况下，MD 100可以是经皮复律除颤器(S-ICD)。在这样的例子中，引线112之一可以包括经皮植入的引线。在一些情况下，MD 100可以被配置为感测固有地产生的心脏电信号并且基于感测到的信号的分析确定一种或多种心律失常。MD 100可以进一步被配置为响应于确定心律失常来递送一个或多个除颤脉冲。
在还有的其他的例子中，MD 100可以是无引线心脏起搏器(LCP——关于图2进行了更具体地描述)。在这样的例子中，MD 100可以不包括远离壳体120延伸的引线112。相反，MD 100可以包括相对于壳体120耦合的电极114。在这些例子中，MD 100可以被植入在患者的心脏上或内、期望的位置处，并且可以被配置为经由电极114递送CRT、ATP疗法、心动过缓疗法和/或其他疗法类型。
在一些情况下，MD 100可以是仅诊断用装置。在一些情况下，MD 100可以被配置为感测或接收心脏电信号和/或物理参数(诸如机械收缩、心音、血压、血氧水平等)。MD 100可以进一步被配置为基于感测到的或接收到的心脏电信号和/或物理参数来确定心律失常的发生。在一个例子中，MD 100可以去掉脉冲发生模块104，因为MD 100可以不被配置为响应于确定发生心律失常来递送电刺激。相反，为了对检测到的心律失常做出响应，MD 100可以是医疗装置系统的一部分。在这样的系统中，MD 100可以将信息传送给该系统内的其他装置，并且所述其他装置中的一个或多个可以响应于从MD 100接收信息来采取动作，例如，递送电刺激疗法。术语脉冲发生器可以用于描述能够将电刺激疗法(诸如I CD、I CP、LCP等)递送给心脏的任何这样的装置。在一些情况下，根据需要，MD 100可以是神经刺激装置或任何其他医疗装置。
在一些例子中，MD 100可以不是可植入医疗装置。相反，MD 100可以是在患者的身体外部的装置，并且可以包括被放置在患者的身体上的皮肤电极。在这样的例子中，MD 100可以能够感测表面心脏电信号(例如，心脏或植入在患者的身体内的装置产生的并且通过身体传导到皮肤的电信号)。在这样的例子中，MD 100仍可以被配置为递送各种类型的电刺激疗法。然而，在其他例子中，MD 100可以是仅诊断用装置、神经刺激器和/或其他可植入医疗装置。
图2是示例性无引线心脏起搏器(LCP)200的例示说明。在所示的例子中，LCP 200可以包括MD 100的全部模块和组件，除了LCP 200可以不包括引线112之外。在图2中可以看出，LCP 200可以是所有组件被容纳在LCP 200内或者壳体200正上面的紧凑装置。如图2中所示，LCP 200可以包括遥测模块202、脉冲发生器模块204、处理模块210以及电池212。这样的组件可以具有与结合图1的MD 100讨论的类似命名的模块和组件类似的功能。
在一些例子中，LCP 200可以包括电感测模块206和机械感测模块208。电感测模块206可以类似于MD 100的感测模块102。例如，电感测模块206可以被配置为接收心脏固有地产生的电信号。电感测模块206可以与电极214电连接，电极214可以将固有地产生的电信号传导给电感测模块206。机械感测模块208可以被配置为接收表示心脏的一个或多个生理参数的一个或多个信号。例如，机械感测模块208可以包括一个或多个传感器或者与一个或多个传感器进行电通信，所述传感器诸如加速器、血压传感器、心音传感器、血氧传感器以及测量患者的生理参数的其他传感器。尽管关于图2被描述为单独的感测模块，但是在一些例子中，电感测模块206和机械感测模块208可以被组合为单个模块。
在至少一个例子中，图2中所示的模块202、204、206、208和210均可以在单个集成电路芯片上实现。在其他例子中，所示的组件可以在彼此电通信的多个集成电路芯片中实现。模块202、204、206、208和210以及电池212都可以被包含在壳体220内。壳体220一般可以包括已知对植入在人体内安全的任何材料，并且当LCP 200被植入在患者内时，可以密封地使模块202、204、206、208和210以及电池212与流体和组织阻隔。
如图2中所描绘的，LCP 200可以包括电极214，电极214可以相对于壳体220固定，但是暴露于包围LCP 200的组织和/或血液。就这一点而论，电极214一般可以被设置在LCP200的任一端上，并且可以与模块202、204、206、208和210中的一个或多个电通信。在一些例子中，电极214可以仅通过短连接导线连接到壳体220，以使得电极214未直接相对于壳体220固定。在一些例子中，LCP 200可以另外还包括一个或多个电极214’。电极214’可以被定位在LCP 200的侧面，并且增加LCP 200可以通过其感测心脏电活动和/或递送电刺激的电极的数量。电极214和/或214’可以由已知对植入在人体内安全的一种或多种生物相容性导电材料(诸如各种金属或合金)构成。在一些情况下，连接到LCP 200的电极214和/或214’可以具有使电极214与相邻电极、壳体220和/或其他材料电隔离的绝缘部分。
为了将LCP 200植入在患者的身体内，操作者(例如，医师、临床医生等)可能需要将LCP 200贴附到患者的心脏的心脏组织。为了便利于固定，LCP 200可以包括一个或多个锚216。锚216可以是若干种固定或锚定机构中的任何一个。例如，锚216可以包括一个或多个销、卡钉、螺纹、螺钉、螺旋、尖齿等。在一些例子中，尽管未示出，锚216可以包括在其外表面上的可以沿着锚216的至少部分长度延展的螺纹。螺纹可以提供心脏组织和锚之间的摩擦以帮助将锚216固定在心脏组织内。在其他例子中，锚216可以包括便利于与周围的心脏组织啮合的其他结构，诸如倒钩、长钉等。
分别如图1和图2中所示的MD 100和LCP 200的设计和尺寸可以基于各种因素而选择。例如，如果医疗装置用于植入在心内膜组织上，诸如有时像LCP的情况那样，则该医疗装置可以通过股静脉而被引入到心脏中。在这样的情况下，医疗装置的尺寸可以诸如被平滑地导航通过静脉的弯曲路径、而不对静脉的周围组织引起任何损害。根据一个例子，股静脉的平均直径可以在大约4毫米(mm)至大约8mm之间。为了通过股静脉导航到心脏，医疗装置可以具有小于8mm的直径。在一些例子中，医疗装置可以具有截面为圆形的圆柱形形状。然而，应指出，医疗装置可以由任何其他合适的形状(诸如矩形、椭圆形等)构成。当医疗装置被设计为皮下植入时，平直的矩形形状的具有低轮廓的医疗装置可能是期望的。
虽然I MD 100和LCP 200被描述为合适的示例医疗装置，但是设想本公开可更广泛地适用于任何两个(或更多个)医疗装置之间的通信。
图3是医疗装置系统300的示意图。如所示，医疗装置系统300包括第一MD 310、第二MD 320和第三MD 320。MD 310、第二MD 320和第三MD 320均可以表示被配置为递送电刺激、起搏脉冲、除颤脉冲等以便实现一种或多种疗法(诸如ATP疗法、CRT或其他电刺激疗法)的各种不同的医疗装置中的任何一个，并且根据需要，是仅诊断用或其他医疗装置。MD310、第二MD 320和第三MD 320均可以包括引线，或者是无引线的。将意识到，虽然图3中示出了三个医疗装置，但是系统300可以包括仅一个或两个医疗装置，或者可以包括四个或更多个医疗装置，这依特定应用而定。
在一些实施例中，MD 310、第二MD 320和第三MD 320如果存在，均可以被植入和/或被定位在患者附近。在一些实施例中，MD 310可以被植入，MD 320可以在患者的外部，MD330可以是可选的。MD 320可以包括皮肤贴片，该皮肤贴片包括两个或更多个电极。在一些情况下，MD 310、第二MD 320和第三MD 320中的一个或多个可以是被配置为与一个或多个植入式医疗装置进行通信和/或对一个或多个植入式医疗装置进行编程的医疗装置编程器或通信器。例如，MD 320可以是被配置为与一个或多个植入式医疗装置(诸如MD 310和MD330)进行通信和/或对一个或多个植入式医疗装置(诸如MD 310和MD 330)进行编程的医疗装置编程器或通信器。在一些实施例中，MD 310可以被植入在患者内，MD 320和/或MD 330也可以被植入在患者内，但是与MD 310和对方分隔开。
如所示，MD 310包括第一电极312和第二电极314。MD 320包括第一电极322、第二电极324和第三电极326。MD 330包括第一电极332、第二电极334、第三电极336和第四电极338。在这个例子中，MD 310具有可以用于感测、起搏另一个医疗装置和/或与另一个医疗装置进行通信的单个电极对315。MD 320具有第一电极322和第二电极324之间的第一电极对325、第二电极324和第三电极326之间的第二电极对327、以及第一电极322和第三电极326之间的第三电极对329，这些电极对均可以被单个地或组合地用于感测、起搏另一个医疗装置和/或与另一个医疗装置进行通信。MD 330具有第一电极332和第二电极334之间的第一电极对333、第二电极334和第三电极336之间的第二电极对335、第三电极336和第四电极338之间的第三电极对337、第一电极332和第四电极338之间的第四电极对339、第一电极332和第三电极336之间的第五电极对331、以及第二电极334和第四电极338之间的第六电极对341，这些电极对均可以被单个地或组合地用于感测、起搏另一个医疗装置和或与另一个医疗装置进行通信。
将意识到，在特定电极对处接收的相对信号强度可以是至少部分地电极对相对于发射电极对正在产生的电磁场的相对方位的函数。图4是包括阴极电极410和阳极电极420的电极对产生的程式化或理想化电磁场400。这是程式化电磁场400，如同它将出现在均质传导介质中的那样。因为患者在医疗装置附近和周围的组织不是均质的，所以实际的电磁场将与所示的电磁场有所不同。电磁场400可以被认为包括等位线430和电场线440。图5提供了放大部分500，其例示说明相对于等位线430和电场线440的电极方位的影响。
在图5的例示说明中，假设医疗装置包括第一电极510、第二电极520和第三电极530。第一电极对矢量A可以被认为存在于第一电极510和第二电极520之间。第二电极对矢量B可以被认为存在于第一电极510和第三电极530之间。第三电极对矢量C可以被认为存在于第二电极520和第三电极530之间。将意识到，电极对矢量A、B和C之一之间的相对信号强度将受(电极对矢量A、B和C之一的)接收天线和发射天线(如图4中所示的阴极410和阳极420)生成的局部电场之间的角度的影响。可以看出，接收到的信号将是信号强度乘以对应的电极对矢量A、B或C和电场线440之间的角度θ的余弦的倍数。电极对矢量均表示医疗装置的一对电极。电极对A、B或C中的被选择用于通信的特定的一个电极对与发射天线的电极对(例如，如图4中所示的阴极410和阳极420)的组合可以被认为是“通信矢量”。
如所示，电极对矢量A形成90度的角度θA。因为90度的余弦为零，所以电极对矢量A(在第一电极510和第二电极520之间)将不接收信号。电极对矢量B形成15度的角度θB。15度的余弦为0.97，因此电极对矢量B将接收该位置处的信号的强度的97％的信号。电极对矢量C形成45度的角度θC。45度的余弦为0.71，因此电极对矢量C将接收该位置处的信号的强度的71％的信号。因此，将意识到，通过具有从其选择的几个电极对或电极对矢量可以便利于系统300(图3)的装置MD 310、MD 320和MD 330选择帮助提高用于它们之间的通信的相对信号强度和/或信噪比的电极对或电极对矢量。图5中所示的角度仅仅是说明性的，因为在实践中，包括电极510、520和530的医疗装置可以具有相对于电磁场400(图4)的任何特定方位，并且当患者呼吸、心脏泵送、或者患者以其他方式移动时，该方位可以随着时间而改变。设想医疗装置可以具有可以被成对地用于帮助改进医疗装置之间的通信的两个、三个、四个或更多个电极。
图6例示说明包括第一电极610、第二电极620和第三电极630的医疗装置(MD)600。总共三个电极对矢量640、650和660可以使用MD 600的三个电极形成。MD 600可以表示植入式医疗装置或外部医疗装置。在一些情况下，MD 600可以表示被固定到患者的皮肤的外部贴片，并且可以与植入式医疗装置(诸如无引线心脏起搏器(LCP))进行通信。如所示，电极610、620和630可以相等地间隔，形成等边三角形。在一些实施例中，电极610、620和630可以改为不等地间隔，从而形成非等边三角形。
图7例示说明包括第一电极710、第二电极720、第三电极730和第四电极740的医疗装置(MD)700。在图7中，总共6个电极对矢量750、752、754、756、758和760可以使用MD 700的电极形成。MD 700可以表示植入式医疗装置或外部医疗装置。MD 700可以例如表示被固定到患者的皮肤的外部贴片。如所示，电极710、720、730和740按风筝图案围绕MD 700间隔。在一些实施例中，电极710、720、730和740可以改为按各种不同的图案围绕MD 700间隔。将意识到，电极710、720、730和740的对之间的相对角度可以通过改变相对尺寸(即，MD 700的电极之间的间隔的长度和/或宽度)而变化。
图8和9提供具有按直线配置(图8)或风筝状配置(图9)布置的4个电极的医疗装置中的可能的电极对矢量角度的另外的例子。将意识到，这些仅仅是说明性的，因为图8中的角度可以通过改变延伸通过这四个电极的正方形或矩形的长度和宽度而变化。类似地，图9中的角度可以通过改变延伸通过这四个电极的风筝形状的长度和宽度而变化。
可以看出，具有两个电极可以提供在接收天线的位置处可能没有或者基本上没有信号强度的情况，这依接收天线相对于发射的电场的方位而定。具有三个电极提供可以被选择的三个可能的电极对矢量，由此选择具有最大信号强度的电极对矢量，可以帮助改进接收天线接收到的信号强度。具有四个电极提供可以被选择的六个可能的电极对矢量。在一些情况下，为了提供甚至更多的矢量，电极中的两个或更多个可以被有效地短路在一起，以使得短路的电极共同作为一个电极作用。例如，具体关于图7，电极730和740可以被有效地短路在一起，并且可以作为单个电极(例如，阳极)作用，电极710或电极720可以作为另一个电极(例如，阴极)作用。这仅仅是一个例子。
在一些情况下，本文中所描述的医疗装置，包括MD 100、LCP 200、MD 310、MD 320、MD 330、MD 600或MD 700可以被编程或者被以其他方式配置为测试各种通信矢量并且选择适当的通信矢量用于通信。在一些实施例中，最强通信矢量可以被选择。在一些实施例中，最弱通信矢量可以被排除使用。在一些实施例中，根据通信的目的，几个通信矢量可以被组合使用。
在一些情况下，一个矢量可以在单个通信的第一部分期间被使用，第二矢量可以在该通信的第二部分期间被使用。当例如装置编程器或S-ICD正在与LCP进行通信时，这可以发生。LCP可以在心脏的每次跳动期间移动，并且各个电极之间的角度可以随着时间而改变。在一些情况下，可能有利的是，使用第一矢量来开始通信，然后随着LCP移动，切换到第二矢量来完成通信。
可替代地，或者另外地，通信可以使用两个或更多个矢量来同时执行。这可以提供一个或多个冗余通信路径，以使得如果一个通信路径变得不太有效或者掉落，则冗余的通信路径(一个或多个)可以被使用。例如，具体关于图7，通信可以使用第一矢量754和第二矢量758来同时执行，第一矢量754在电极730和740之间延伸，第二矢量758在电极720和740之间延伸。然后，如果使用第一矢量754的通信变得不太有效或者掉落，则所述系统可以仍使用第二矢量758来进行通信。在一些情况下，通信可以使用两个使用来同时执行，并且所述系统可以选择具有最高信号强度的通信路径、提供成功传输的通信路径，和/或可以使用用于从所述两个或更多个通信路径选择的任何其他标准。在一些情况下，通信可以使用多个矢量来执行，并且结果可以被比较。如果结果没有差异，则任何一个结果可以被使用。如果存在差异，则其他标准可以被用于帮助识别正确的结果。例如，奇偶校验位和/或校验和可以被用于识别哪些传输是成功的。如果没有传输是成功的，则向发送者通知使用不同的矢量或矢量集重复传输的信号可以被发送。
图10提供说明性医疗系统，在该说明性医疗系统中，LCP 782被示为贴附到心脏788的左心室的内部，LCP 784被示为贴附到心脏788的右心室的内部。在一些实施例中，可以存在植入在心脏788中的附加的LCP。在其他情况下，可以仅存在一个LCP，诸如LCP 784。在一些实施例中，一个或多个LCP可以被固定到心脏788的外部。在图10中，示出了示例S ICD 786。示例S I CD 786包括支承一个或多个电极792、794和796的引线790。在一些实施例中，引线790可以包括多于三个的电极。在一些情况下，一旦引线790已经被植入，电极792、794和796就可以被认为邻近患者的胸骨垂直地对齐。可选地，附加的电极可以被设置在引线790的水平(一旦被植入)部分上。将意识到，如所示，S I CD 786可以被认为具有总共四个电极，因为SI CD 786的壳体也可以起电极的作用。在一些情况下，引线790可以被皮下地邻近心脏788定位。在一些情况下，说明性医疗系统可以包括外部贴片，诸如前面关于图7讨论的用于连接到外部医疗装置的MD 700。
在一些情况下，可能期望在LCP 782、LCP 784、S I CD 786和/或MD 700中的两个或更多个之间进行通信。例如将意识到，对于LCP 782和MD 700之间的通信，在MD 700上可以存在总共四个(或更多个)电极，在LCP 782上可以存在总共两个至四个(或更多个)电极，因此许多不同的通信矢量可以被如前面所讨论的那样测试和选择。在一些情况下，特别是在S I CD 786和所示的其他装置中的任何一个之间进行通信时，将意识到电极792、794和796在引线790的远端附近被以主要直线的方式布置。因此，在一些情况下，在这三个电极之间进行选择以用于与LCP 782或784的通信矢量中可能不能大幅改变该矢量的几何形状，因此可能不能大幅改进该通信矢量。在一些实施例中，与S I CD 786的通信可以受益于还考虑一个或多个can电极，诸如S I CD 786的can电极797。当被如此提供时，S I CD可以具有四个不同的电极792、794、796和797，每个LCP 782和784可以具有两个至四个(或更多个)电极。这可以提供从其选择的具有各种不同矢量几何形状的许多矢量。可替代地，或者另外地，S I CD电极792、794和796可以被以非直线的方式(诸如按交叉图案)布置。
电极792、794、796、797和S I CD 786壳体中的一个或全部仅用于通信；可替代地，电极792、794、796、797和S I CD 786壳体中的一个或全部可以用于其他目的，诸如感测生理参数(例如，固有心脏活动、胸阻抗)和/或递送一种或多种电疗法(例如，复律/除颤电击、心脏起搏、神经刺激疗法)。
在一些情况下，将意识到，哪个或哪些特定的矢量对在任何特定的一对装置之间进行通信最有用可以随着时间而改变。例如，LCP 782和/或LCP 784如果存在，可以随着每次心跳稍微移动和改变方位。当患者呼吸以及他们的胸部升降时，S I CD 786和外部装置(诸如MD 700)也可以移动。因此，在一些实施例中，可能有利的是对通信的一部分使用第一矢量，然后随着一个或多个装置相对于彼此移动，诸如随着心跳和/或患者呼吸,切换到第二矢量来继续进行通信。在一些情况下，信号强度、出错率和/或通信参数可以随着时间被监视，并且如果期望，矢量可以被自动地切换。虽然第一矢量和第二矢量在这里被用作例子，但是如果需要，设想所述系统可以在多于两个的不同的矢量之间切换。设想矢量可以被实时地或近乎实时地切换，和/或不时地(例如，每一分钟、每一小时、每一天、每一月、每次医生到访、和/或任何其他合适的时间)被更新。
图11是示出可以经由本文中所描述的医疗装置(包括MD 100、LCP 200、MD 310、MD320、MD 330、MD 600或MD 700)中的任何一个执行的说明性方法1000的流程图。在方框1010，选择具有至少三个电极的天线的第一电极对。如在方框1020一般地看到的，通信信号(诸如传导通信信号)可以通过患者的组织在具有至少三个电极的天线的第一电极对和另一个天线的两个电极之间发送。在方框1030，选择具有至少三个电极的天线的第二电极对。选择的第二电极对不同于选择的第一电极对。如在方框1040一般地看到的，通信信号再次通过患者的组织在具有至少三个电极的天线的第一电极对和另一个天线的两个电极之间发送。
图12是示出可以经由本文中所描述的医疗装置(包括MD 100、LCP 200、MD 310、MD320、MD 330、MD 600或MD 700)中的任何一个执行的说明性方法1100的流程图。在方框1110，选择具有至少三个电极的天线的第一电极对。如在方框1120一般地看到的，通信信号通过患者的组织在具有至少三个电极的天线的第一电极对和另一个天线的两个电极之间发送。在方框1130，选择具有至少三个电极的天线的第二电极对。第二电极对不同于选择的第一电极对。如在方框1140一般地看到的，通信信号可以通过患者的组织在具有至少三个电极的天线的第一电极对和另一个天线的两个电极之间发送。
在操作期间，如在方框1150看到的，可以监视与使用第一电极对的传导通信信号的信噪比相关的度量。如果与该信噪比相关的度量降至低于阈值或者改变多于阈值，则如方框1160处一般地所示的，选择具有至少三个电极的天线的第二电极对。在方框1170，然后可以通过患者的组织在具有至少三个电极的天线的第二电极对和所述另一个天线的所述两个电极之间发送通信信号。
图13是示出可以经由本文中所描述的医疗装置(包括MD 100、LCP 200、MD 310、MD320、MD 330、MD 600或MD 700)中的任何一个执行的说明性方法1200的流程图。在方框1210，选择具有至少三个电极的天线的第一电极对。如在方框1220一般地看到的，通信信号通过患者的组织在具有至少三个电极的天线的第一电极对和另一个天线的两个电极之间发送。在方框1230，选择具有至少三个电极的天线的第二电极对。第二电极对不同于选择的第一电极对。如在方框1240一般地看到的，通信信号可以通过患者的组织在具有至少三个电极的天线的第一电极对和另一个天线的两个电极之间发送。
在操作期间，在方框1280，确定与使用第一电极对的通信信号的信噪比相关的第一度量。如在方框1290一般地指示的，确定与使用第二电极对的通信信号的信噪比相关的第二度量。在方框1292，基于第一度量和第二度量来选择第一电极对或第二电极对用于后面的通信。
图14是示出可以经由本文中所描述的医疗装置(包括MD 100、LCP 200、MD 310、MD320、MD 330、MD 600或MD 700)中的任何一个执行的说明性方法1300的流程图。在方框1310，测试第一天线的至少两个电极和具有至少三个电极的第二天线的多对电极中的每对电极之间的通信矢量。在实施例中，周期性地测试通信矢量，例如，每秒、每分钟、每天或每月一次。在另一个实施例中，仅当通信参数未能满足预定标准时才测试通信矢量。在一些实施例中，在诊所到访期间测试通信矢量。在其他实施例中，在医疗装置和被配置为向位于远处的临床医生提供装置或患者数据的外部系统之间交互期间测试通信矢量。如方框1320处一般地指示的，基于通信矢量中的一个或多个的通信参数来选择通信矢量。通信参数可以例如是绝对信号强度、相对信号强度和/或信噪比、或影响或可能影响通信的任何其他的参数。在方框1330，使用选择的通信矢量来在第一医疗装置和第二医疗装置之间发送传导通信。
如以上详述的，本文中提及的医疗装置可以是任何合适的医疗装置。在一些非限制性例子中，方法1000、1100、1200、1300可以根据需要被用在LCP和医疗装置编程器或通信器、LCP和皮下可植入复律除颤器(S I CD)、LCP和共同植入式诊断装置、LCP和神经刺激器装置、LCP和另一个LCP、和/或任何其他合适的医疗装置之间的通信中。
在一些实施例中，代替发送通信信号或者除了发送通信信号之外，本文中所描述的这些方法中的任何一个可以包含接收通信。在一些实施例中，用于发送通信信号的通信矢量的选择或确定可以与用于接收通信信号的通信矢量相同。在一些实施例中，用于发送通信信号的通信矢量的选择或确定可以不同于用于接收通信信号的通信矢量。
本领域技术人员将认识到，本公开可以以不同于本文中描述和设想的特定实施例的各种形式表现。作为一个例子，如本文中所描述的，各种例子包括被描述为执行各种功能的一个或多个模块。然而，其他例子可以包括将所描述的功能划分在比所描述的模块多的模块上的附加模块。另外，其他例子可以将所描述的功能合并到更少的模块中。另外，在不脱离所附权利要求中所描述的本公开的范围和精神的情况下，可以进行形式和细节上的变更。

Claims (13)

1.一种通信系统，包括：
第一医疗装置，所述第一医疗装置具有第一天线，所述第一天线具有至少两个电极；以及
第二医疗装置，所述第二医疗装置具有第二天线，所述第二天线具有至少三个电极，其中所述第二医疗装置包括与所述第二医疗装置的至少三个电极相关联的用于将所述第二医疗装置的至少三个电极固定到患者的皮肤上的皮肤贴片；
其中，所述第一医疗装置和所述第二医疗装置中的至少一个被配置为：
测试所述第一天线的所述至少两个电极和所述第二天线的所述至少三个电极的至少两对电极之间的通信矢量；
从测试的通信矢量选择通信矢量；以及
以下操作中的至少一个：使用选择的通信矢量发送和接收传导通信信号；
其中所述通信矢量表示用于在所述第一医疗装置和所述第二医疗装置之间进行通信的电极的不同组合。
2.根据权利要求1所述的通信系统，其中，所述至少三个电极包括按三角形配置布置的三个电极。
3.根据权利要求1所述的通信系统，其中，所述至少三个电极包括按矩形配置或风筝形状配置布置的四个电极。
4.根据权利要求1所述的通信系统，其中，所述第一医疗装置被植入在患者内。
5.根据权利要求1-4中的任何一个所述的通信系统，其中，所述第一医疗装置是无引线心脏起搏器(LCP)。
6.一种在具有第一天线的第一医疗装置和具有第二天线的第二医疗装置之间进行通信的方法，其中，所述第一医疗装置可植入在患者内，所述第二医疗装置被设置在所述患者的外部，并且其中，所述第一天线具有至少两个电极，所述第二天线具有至少三个电极，所述方法包括：
选择具有至少三个电极的所述第二天线的第一电极对；
以下操作中的至少一个：在具有至少三个电极的所述第二天线的第一电极对和所述第一天线的两个电极之间通过所述患者的组织发送和接收传导通信信号；
选择具有至少三个电极的所述第二天线的第二电极对，其中，所述第二电极对不同于所述第一电极对；以及
在具有至少三个电极的所述第二天线的第二电极对和所述第一天线的两个电极之间通过所述患者的组织发送传导通信信号，
其中所述第二医疗装置包括与所述第二天线相关联的皮肤贴片，其中所述第二天线借助于所述皮肤贴片被固定在患者的皮肤表面上。
7.根据权利要求6所述的方法，还包括：
监视与使用所述第一电极对的传导通信信号的信噪比相关的度量；
如果与使用所述第一电极对的传导通信信号的信噪比相关的所述度量降至低于阈值，则：
选择具有至少三个电极的所述第二天线的所述第二电极对；以及
在具有至少三个电极的所述第二天线的所述第二电极对和所述第一天线的所述两个电极之间通过所述患者的组织发送传导通信信号。
8.根据权利要求6所述的方法，还包括：
确定与使用所述第一电极对的传导通信信号的信噪比相关的第一度量；
确定与使用所述第二电极对的传导通信信号的信噪比相关的第二度量；以及
基于所述第一度量和所述第二度量来选择所述第一电极对或所述第二电极对用于后来的通信。
9.根据权利要求6至8中的任何一个所述的方法，其中，具有至少三个电极的所述第二天线包括按三角形配置布置的三个电极、按矩形配置布置的四个电极、或按风筝形状配置布置的四个电极。
10.一种在具有第一天线的第一医疗装置和具有第二天线的第二医疗装置之间进行通信的方法，所述第一天线具有至少两个电极，所述第二天线具有至少三个电极，其中所述第二医疗装置包括与所述第二天线相关联的皮肤贴片以用于将所述第二医疗装置的至少三个电极固定到患者的皮肤上，所述方法包括：
测试所述第一天线的所述至少两个电极和所述第二天线的所述至少三个电极的多对电极中的每对电极之间的通信矢量；基于所述通信矢量中的每个的信号强度来选择通信矢量；以及
以下操作中的至少一个：使用选择的通信矢量来在所述第一医疗装置和所述第二医疗装置之间发送和接收传导通信信号。
11.根据权利要求10所述的方法，其中，所述第一医疗装置包括植入式医疗装置，所述第二医疗装置包括外部医疗装置。
12.根据权利要求10所述的方法，其中，所述第一医疗装置包括外部医疗装置。
13.根据权利要求10-12中的任何一个所述的方法，其中，选择通信矢量包括选择具有最强信号强度的通信矢量和/或不选择具有最弱信号强度的通信矢量。
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