Automatic determination and selection of filtering in a cardiac rhythm management device

• US 10,149,627 B2
• Filed: 11/29/2016
• Issued: 12/11/2018
• Est. Priority Date: 12/02/2015
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Allavatam, Venugopal, Hahn, Stephen J., Herrmann, Keith L., Lanz, Mitchell D., Siejko, Krzysztof Z., Speakman, Benjamin
• Primary Examiner(s): Gedeon, Brian T
• Application Number:
  US15/362,862
• Publication Number:
  US 20170156617A1
• Time in Patent Office: 742 Days
• Field of Search: None
• CPC Class Codes: A61B 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 5/30 Input circuits therefor
• CPC Class Codes: A61B 5/304 Switching circuits
• CPC Class Codes: A61B 5/316 Modalities, i.e. specific diagnostic methods
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/352 Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval
• CPC Class Codes: A61B 5/725 using specific filters therefor, e.g. Kalman or adaptive filters A61B5/316 take precedence
• CPC Class Codes: A61B 5/7282 Event detection, e.g. detecting unique waveforms indicative of a medical condition A61B5/4094, A61B5/4818, A61B5/349, A61B5/0823 take precedence
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/3702 Physiological parameters A61N1/365 takes precedence; evoked response A61N1/371
• CPC Class Codes: A61N 1/3925 Monitoring; Protecting
• CPC Class Codes: A61N 1/3956 Implantable devices for applying electric shocks to the heart, e.g. for cardioversion

Abstract

Methods and/or device facilitating and selecting among multiple modes of filtering a cardiac electrical signal, in which one filtering mode includes additional high pass filtering of low frequency signals, relative to the other filtering mode. The selection filtering modes may include comparing sensed signal amplitude to one or more thresholds, using the multiple modes of filtering. In another example, an additional high pass filter is enabled, over and above a default or baseline filtering mode, and the detected cardiac signal is monitored for indications of possible undersensing, and/or for drops in amplitude toward a threshold, and the additional high pass filter may be disabled upon finding of possible undersensing or drop in signal amplitude.

Claims

1. A cardiac rhythm management device comprising plural sensing electrodes for capturing a cardiac signal and operational circuitry coupled to the plural sensing electrodes for analyzing the cardiac signal, the operational circuitry configured with a selectable filtering mode allowing filtering of the captured cardiac signal according to a first approach and a second approach, the second approach applying an additional high pass filter relative to the first approach, wherein the operational circuitry is configured to operate using the selectable filtering mode as follows:

determining whether to select the first approach or the second approach by measuring a first amplitude of the captured cardiac signal, post filtering via the first approach, and comparing the first amplitude to a first threshold and;

if the first amplitude exceeds the first threshold, enabling the second approach for use in cardiac signal analysis;

or

if the first amplitude does not exceed the first threshold, disabling the second approach for use in cardiac signal analysis; and

detecting cardiac cycles by comparing a received cardiac signal, as filtered by one of the first or second approaches, to a detection threshold and declaring a new cardiac cycle when the received cardiac signal exceeds the detection threshold,

wherein the first amplitude is a measure of the R-wave of one or more cardiac cycles.

2. A cardiac rhythm management device as in claim 1 wherein the operational circuitry is further configured, subsequent to enabling the second approach for use in cardiac signal analysis, to:

determine a second amplitude of the captured cardiac signal after filtering via the second approach;

compare the second amplitude to a second threshold, the second threshold being lower than the first threshold; and

,

if the second amplitude does not exceed the second threshold, disable the second approach for use in cardiac signal analysis, wherein the second amplitude is a measure of the R-wave of one or more cardiac cycles.

3. A cardiac rhythm management device as in claim 1, wherein the operational circuitry is configured to disable the second approach by performing the following:

analyzing intervals between detected cardiac cycles and determining whether plural such intervals exceed one or more predefined thresholds and, if so, to declare long pauses have occurred;

observing whether one or more amplitudes associated with one or more detected cardiac cycles fail to meet a minimum amplitude threshold and, if so, to declare low amplitude; and

the operational circuitry is configured to disable the second approach if both long pauses and low amplitude have been declared at the same time.

4. A cardiac rhythm management device as in claim 1, wherein the operational circuitry is configured to disable the second approach by analyzing intervals between detected cardiac cycles and determining whether plural such intervals exceed one or more predefined thresholds and, if so, to declare long pauses have occurred and disable the second approach.

5. A cardiac rhythm management device as in claim 1, wherein the operational circuitry is configured to disable the second approach by observing whether one or more amplitudes associated with one or more detected cardiac cycles fail to meet a minimum amplitude threshold and, if so, to declare low amplitude and disable the second approach.

6. A cardiac rhythm management device as in claim 1 in which the first approach uses a bandpass filtering in the range of 3 to 40 hertz, and the second approach uses the same bandpass as the first approach with an additional highpass filter at about 9 hertz.

7. A cardiac rhythm management device comprising plural sensing electrodes for capturing a cardiac signal and operational circuitry coupled to the plural sensing electrodes for analyzing the cardiac signal, the operational circuitry configured with a first filtering mode and a second filtering mode, the second filtering mode applying an additional high pass filter relative to the first filtering mode, wherein the operational circuitry is configured to select between the first and second filtering modes by:

capturing data using each of the first filtering mode and the second filtering mode;

analyzing the data captured with each of the first and second filtering modes; and

determining which of the first filtering mode or second filtering mode yields more suitable sensing data by comparing at least one result of the analysis of the data using first filtering mode to at least one result of the analysis of the data using the second filtering mode;

wherein the operational circuitry is further configured to use whichever of the first or second filtering mode yields more suitable sensing data to detected cardiac cycles in the cardiac signal.

8. The cardiac rhythm management device of claim 7 wherein the operational circuitry is configured to:

perform a vector selection sequence using signals from at least first and second sensing vectors defined by the plurality of electrodes in a first iteration with the first filtering mode applied to yield a first selected vector, and in a second iteration with the second filtering mode applied to yield a second selected vector;

determining which of the first filtering mode or second filtering mode yields more suitable sensing data by assessing;

a) whether the first selected vector and the second selected vector are the same sensing vector; and

b) whether an amplitude measure for the second selected vector exceeds an amplitude threshold;

such that, if both a) and b) are true, the operational circuitry is configured to select and use the second filtering mode for sensing cardiac signals, and otherwise the operational circuitry is configured to select and use the first filtering mode for sensing cardiac signals.

9. The cardiac rhythm management device of claim 7 wherein the operational circuitry is configured to determine which of the first and second filtering modes yields more suitable sensing data by:

detecting cardiac cycles by comparing a received cardiac signal to a detection threshold and declaring a new cardiac cycle when the received cardiac signal exceeds the detection threshold in each of;

a first data stream, on data filtered using the first filtering mode; and

in a second data stream, on data filtered using the second filtering mode;

and thereby yielding two sets of detected cardiac cycle data;

aligning the two sets of detected cardiac cycle data; and

determining which of the first filtering mode and second filtering mode is providing more accurate cardiac cycle detection.

10. The cardiac rhythm management device of claim 9 wherein the operational circuitry is configured to determine whether one or more detected cardiac cycles are noisy;

and

wherein the operational circuitry is configured to find that whichever of the first and second filtering mode has fewer noisy detected cardiac cycles yields more suitable sensing data.

11. The cardiac rhythm management device of claim 9 wherein the operational circuitry is configured to determine whether one or more detected cardiac cycles are overdetected;

and

wherein the operational circuitry is configured to find that whichever of the first and second filtering modes has fewer overdetected cardiac cycles yields more suitable sensing data.

12. The cardiac rhythm management device of claim 9 wherein the operational circuitry is configured for:

identifying R-waves and T-waves associated with individual detected cardiac cycles;

calculating an R;

T ratio for each of the first and second filtering modes; and

finding that whichever of the first and second filtering modes yields a larger R;

T ratio.

13. The cardiac rhythm management device of claim 7 wherein operational circuitry is configured to determine whether an amplitude measure of the signal as sensed using the first filtering mode exceeds a first threshold and, if not, identify the first filtering mode as yielding more suitable sensing data.

14. The cardiac rhythm management device of claim 13 wherein the operational circuitry is further configured such that, if the amplitude measure of the signal as sensed using the first filtering mode does exceed the first threshold, the operational circuitry is configured to:

determine whether an amplitude measure of the signal as sensed using the second filtering mode exceeds a second threshold and;

if the signal as sensed using the second filtering mode exceeds the second threshold, to identify the second filtering mode as yielding more suitable sensing data; and

otherwise to identify the first filtering mode as yielding more suitable sensing data.

15. The cardiac rhythm management device of claim 7 wherein the operational circuitry is configured to determine whether possible undersensing is occurring and, if so, to disable the second filtering mode and activate the first filtering mode.

16. A method of operation in a cardiac rhythm management device comprising plural sensing electrodes for capturing a cardiac signal and operational circuitry coupled to the plural sensing electrodes for analyzing the cardiac signal, the operational circuitry configured with a selectable filtering mode allowing filtering of the captured cardiac signal according to a first approach and a second approach, the second approach applying an additional high pass filter relative to the first approach, the method comprising:

determining whether to select the first approach or the second approach by measuring a first amplitude of the captured cardiac signal, as filtered using the first approach, and comparing the first amplitude to a first threshold and;

if the first amplitude exceeds the first threshold, enabling the second approach for use in cardiac signal analysis;

or

if the first amplitude does not exceed the first threshold, disabling the second approach for use in cardiac signal analysis; and

detecting one or more cardiac cycles by comparing a received cardiac signal, as filtered by one of the first or second approaches, to a detection threshold and declaring a new cardiac cycle when the received cardiac signal exceeds the detection threshold,

wherein the first amplitude is a measure of the R-wave of one or more cardiac cycles.

17. A method as in claim 16 further comprising, subsequent to enabling the second approach for use in cardiac signal analysis and detecting one or more cardiac cycles therewith:

determining a second amplitude of the captured cardiac signal after filtering via the second approach;

comparing the second amplitude to a second threshold, the second threshold being lower than the first threshold; and

, if the second amplitude does not exceed the second threshold,

disabling the second approach for use in cardiac signal analysis,

wherein the second amplitude is a measure of the R-wave of one or more cardiac cycles.

18. A method as in claim 16 further comprising, subsequent to enabling the second approach for use in cardiac signal analysis and detecting two or more cardiac cycles having intervals therebetween:

analyzing intervals between detected cardiac cycles; and

determining whether plural such intervals exceed one or more predefined thresholds and, if so, disabling the second approach.

19. A method as in claim 16 further comprising, subsequent to enabling the second approach for use in cardiac signal analysis and detecting two or more cardiac cycles having intervals therebetween, observing whether one or more amplitudes associated with one or more detected cardiac cycles fail to meet a minimum amplitude threshold and, if so, disabling the second approach.

20. A method as in claim 16 wherein:

the first approach uses a bandpass filtering in the range of 3 to 40 hertz; and

the second approach uses a bandpass filtering in the range of about 9 to 40 hertz.