| CPC A61N 1/36507 (2013.01) [A61B 5/283 (2021.01); A61B 5/316 (2021.01); A61N 1/056 (2013.01); A61B 2018/00351 (2013.01); A61B 2018/00613 (2013.01); A61B 2018/00839 (2013.01); A61B 18/12 (2013.01); A61N 1/327 (2013.01)] | 19 Claims |

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1. A method of triggering electroporation, the method comprising:
inserting a lead in or around a heart of a patient, the lead comprising a first electrode, a second electrode, and a third electrode that are both sensing and delivering electrodes;
delivering electroporation stimulation to the heart below a threshold during a cardiac cycle of the patient;
measuring a first electrocardiogram between the first and second electrodes of the lead;
measuring a second electrocardiogram between the first and third electrodes of the lead;
comparing the first and second electrocardiograms;
identifying signals common to the first and second electrocardiograms;
removing the signals common to the first and second electrocardiograms, thereby creating a modified electrocardiogram;
determining whether the modified electrocardiogram comprises a cardiac signal;
identifying a vulnerable period in the cardiac cycle by detecting a signal summation in the cardiac signal; and
in response to: i) determining that the modified electrocardiogram comprises the cardiac signal, and ii) identifying the vulnerable period of the cardiac cycle, delivering electroporation stimulation above the threshold to the heart during the cardiac cycle except during the vulnerable period by using at least one of the first, second, and third electrodes after the cardiac signal is determined,
wherein the threshold comprises a voltage of about 10 microvolts to about 100 microvolts.
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