Implantable cardioverter-defibrillator (ICD) tachyarrhythmia detection modifications responsive to detected pacing

• US 10,154,794 B2
• Filed: 04/15/2015
• Issued: 12/18/2018
• Est. Priority Date: 04/25/2014
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Stadler, Robert W., Zhang, Xusheng, Sharma, Vinod, Reinke, James D., Schmid, Barbara J.
• Primary Examiner(s): FAIRCHILD, MALLIKA DIPAYAN
• Application Number:
  US14/687,010
• Publication Number:
  US 20150305641A1
• Time in Patent Office: 1,343 Days
• CPC Class Codes: A61B 5/316 Modalities, i.e. specific diagnostic methods
• CPC Class Codes: A61B 5/346 Analysis of electrocardiograms
• CPC Class Codes: A61B 5/363 Detecting tachycardia or bradycardia
• CPC Class Codes: A61B 5/686 Permanently implanted devices, e.g. pacemakers, other stimulators, biochips A61B5/6861 takes precedence
• CPC Class Codes: A61N 1/3621 for treating or preventing abnormally high heart rate
• CPC Class Codes: A61N 1/37264 Changing the program; Upgrading firmware
• CPC Class Codes: A61N 1/37288 Communication to several implantable medical devices within one patient
• CPC Class Codes: A61N 1/3756 Casings with electrodes thereon, e.g. leadless stimulators
• CPC Class Codes: A61N 1/3962 in combination with another heart therapy
• CPC Class Codes: A61N 1/39622 Pacing therapy
• CPC Class Codes: A61N 1/3987 characterised by the timing or triggering of the shock

Abstract

An implantable medical device comprises a sensing module configured to obtain electrical signals from one or more electrodes and a control module configured to process the electrical signals from the sensing module in accordance with a tachyarrhythmia detection algorithm to monitor for a tachyarrhythmia. The control module detects initiation of a pacing train delivered by a second implantable medical device, determines a type of the detected pacing train, and modifies the tachyarrhythmia detection algorithm based on the type of the detected pacing train.

Claims

1. A method comprising:

obtaining, with a sensing module of a medical device, cardiac electrical signals;

processing, with a control module of the medical device, the cardiac electrical signals from the sensing module in accordance with a tachyarrhythmia detection algorithm to monitor for a tachyarrhythmia;

detecting, with the control module of the medical device, initiation of a pacing train delivered by a second implantable medical device;

determining, with the control module of the medical device, a type of the detected pacing train, wherein determining the type of detected pacing train comprises;

computing at least two cycle lengths using at least three most recently detected pacing spikes,

estimating a cycle length of the pacing train based on the at least two computed cycle lengths,

comparing the estimated cycle length of the pacing train to at least one cycle length threshold, and

determining the type of the detected pacing train based on the comparison;

modifying, with the control module of the medical device, a tachyarrhythmia detection algorithm based on the type of the detected pacing train; and

delivering, with a therapy module of the medical device, a shock therapy based on the tachyarrhythmia detection algorithm.

2. The method of claim 1, wherein determining a type of the detected pacing train comprises analyzing one or more of an onset of the heart rate immediately prior to the detected pacing train, a regularity of the pacing pulse intervals, a consistency of the pacing artifact amplitude, a consistency of the pacing pulse slew rate, and/or a consistency of the pacing pulse polarity.

3. The method of claim 1, further comprising:

obtaining an electrical signal sensed on an implantable electrical lead coupled to the IMD; and

analyzing at least one of an amplitude and a slew rate of the electrical signal to detect pacing pulses in the electrical signal, wherein detecting initiation of the pacing train comprises detecting initiation of the pacing train using the detected pacing pulses.

4. The method of claim 1, further comprising implementing a tachyarrhythmia detection algorithm having one or more stages, wherein at least one of the stages analyzes a morphology of a plurality of predetermined segments of the sensed electrical signal and further wherein modifying the tachyarrhythmia detection algorithm comprises holding the morphology analysis in a current state in response to detecting the type of the pacing train to be anti-tachycardia pacing (ATP).

5. The method of claim 4, further comprising:

detecting termination of the pacing train; and

resuming the morphology analysis of the tachyarrhythmia detection algorithm in response to detecting the termination of the pacing train.

6. The method of claim 5, wherein detecting termination of the pacing train comprises detecting termination of the pacing train when no pacing spikes have been detected for a threshold period of time.

7. The method of claim 6, wherein detecting termination of the pacing train when no pacing spikes have been detected for a threshold period of time comprises detecting termination of the pacing train when no pacing spikes have been detected for at least two times an estimated cycle length of the pacing train.

8. The method of claim 5, wherein detecting termination of the pacing train comprises detecting termination of the pacing train when the amount of time since detecting the initiation of the pacing train exceeds a threshold amount of time.

9. The method of claim 1, wherein detecting initiation of the pacing train by analyzing the sensed electrical signals on the implantable electrical lead comprises detecting initiation of the pacing train pulses when two pacing pulses are detected within a threshold period of time.

10. The method of claim 9, wherein detecting initiation of the pacing train when two pacing pulses are detected within a threshold period of time comprises detecting initiation of the pacing train when two pacing pulses are detected within 1500 milliseconds of one another.

11. The method of claim 1, wherein estimating the cycle length of the pacing train based on the at least two most recently computed cycle lengths comprises estimating the cycle length of the pacing train as a shortest of the two most recent computed cycle lengths.

12. The method of claim 1, further comprising:

implementing a tachyarrhythmia detection algorithm that analyzes segments of the electrical signals of a predetermined length and classifies each segment as shockable or non-shockable;

wherein determining a type of the detected pacing train comprises determining the pacing train to be a fast bradycardia pacing train and modifying to the tachyarrhythmia detection algorithm comprises;

comparing a morphology of a first sensed event within one of the segments with a morphology of a predetermined number of subsequent sensed events within the segments; and

classifying the rhythm as shockable or non-shockable based on at least the number of subsequent sensed events having a morphology that matches the morphology of the first sensed event of the tachyarrhythmia.

13. The method of claim 12, wherein classifying the rhythm as shockable or non-shockable based on at least the number of subsequent sensed events having a morphology that matches the morphology of the first sensed event of the tachyarrhythmia comprises classifying the tachyarrhythmia as non-shockable when the number of subsequent sensed events having a morphology that matches the morphology of the first sensed event of the tachyarrhythmia is greater than or equal to a lower threshold and less than or equal to an upper threshold.

14. A medical device comprising:

a sensing module configured to obtain cardiac electrical signals;

a control module configured to process the cardiac electrical signals from the sensing module in accordance with a tachyarrhythmia detection algorithm to monitor for a tachyarrhythmia, detect initiation of a pacing train delivered by a second implantable medical device, computes at least two cycle lengths using at least three most recently detected pacing spikes, estimates a cycle length of the pacing train based on the at least two computed cycle lengths, compares the estimated cycle length of the pacing train to at least one cycle length threshold, determine a type of the detected pacing train based on the comparison, and modify the tachyarrhythmia detection algorithm based on the type of the detected pacing train; and

a therapy module configured to deliver a shock therapy based on the tachyarrhythmia detection algorithm.

15. The device of claim 14, wherein the control module determines the type of the detected pacing train by analyzing one or more of an onset of a heart rate immediately prior to the detected pacing train, a regularity of pacing pulse intervals, a consistency of a pacing artifact amplitude, a consistency of a pacing pulse slew rate, and/or a consistency of a pacing pulse polarity.

16. The device of claim 14, wherein the control module analyzes at least one of an amplitude and a slew rate of the cardiac electrical signals to detect pacing pulses in the cardiac electrical signals and detects initiation of the pacing train using the detected pacing pulses.

17. The device of claim 14, wherein the tachyarrhythmia detection algorithm includes at least one stage in which the control module analyzes a morphology of a plurality of predetermined segments of the sensed cardiac electrical signal and the control module modifies the tachyarrhythmia detection algorithm by holding the morphology analysis in a current state in response to detecting the type of the pacing train to be anti-tachycardia pacing (ATP).

18. The device of claim 17, wherein the control module detects termination of the pacing train and resumes the morphology analysis of the tachyarrhythmia detection algorithm in response to detecting the termination of the pacing train.

19. The device of claim 18, wherein the control module detects termination of the pacing train when no pacing spikes have been detected for a threshold period of time.

20. The device of claim 19, wherein the threshold period of time is at least two times an estimated cycle length of the pacing train.

21. The device of claim 18, wherein the control module detects termination of the pacing train when the amount of time since detecting the initiation of the pacing train exceeds a threshold amount of time.

22. The device of claim 14, wherein the control module detects initiation of the pacing train pulses when two pacing pulses are detected within a threshold period of time.

23. The device of claim 22, wherein the threshold period of time is 1500 milliseconds.

24. The device of claim 14, wherein the control module estimates the cycle length as a shortest of the at least two computed cycle lengths.

25. The device of claim 14, wherein:

the tachyarrhythmia detection algorithm analyzes segments of the cardiac electrical signals of a predetermined length and classifies each segment as shockable or non-shockable and

the control module determines a type of the detected pacing train to be a fast bradycardia pacing train and modifies to the tachyarrhythmia detection algorithm by comparing a morphology of a first sensed event within one of the segments with a morphology of a predetermined number of subsequent sensed events within the segments and classifying the rhythm as shockable or non-shockable based on at least the number of subsequent sensed events having a morphology that matches the morphology of the first sensed event of the tachyarrhythmia.

26. The device of claim 25, wherein the control module classifies the rhythm as non-shockable when the number of subsequent sensed events having a morphology that matches the morphology of the first sensed event of the tachyarrhythmia is greater than or equal to a lower threshold and less than or equal to an upper threshold.

27. A system comprising:

an implantable cardiac pacemaker device; and

an extravascular implantable cardioverter-defibrillator (ICD) system that includes;

at least one lead comprising one or more electrodes; and

an ICD device electrically connected to the at least one lead, the ICD device comprising;

a sensing module configured to obtain cardiac electrical signals; and

a control module configured to process the cardiac electrical signals from the sensing module in accordance with a tachyarrhythmia detection algorithm to monitor for a tachyarrhythmia, wherein the control module is further configured to detect initiation of a pacing train delivered by the implantable cardiac pacemaker device, determine a type of the detected pacing train, and modify the tachyarrhythmia detection algorithm based on the type of the detected pacing train; and

wherein the control module detects the type of pacing train to be an anti-tachycardia pacing (ATP) train and the modification of the tachyarrhythmia detection algorithm results in a delay of a shock; and

a therapy module configured to deliver the shock after the delay.

28. The system of claim 27, wherein the modification of the tachyarrhythmia detection algorithm results in the delay of the shock for up to 10 seconds.

29. A medical device comprising:

a sensing module configured to obtain cardiac electrical signals; and

a control module configured to process the cardiac electrical signals from the sensing module in accordance with a tachyarrhythmia detection algorithm to monitor for a tachyarrhythmia, detect initiation of a pacing train delivered by a second implantable medical device, determine a type of the detected pacing train, and modify the tachyarrhythmia detection algorithm based on the type of the detected pacing train,

wherein the tachyarrhythmia detection algorithm includes at least one stage in which the control module analyzes a morphology of a plurality of predetermined segments of the sensed cardiac electrical signal and the control module modifies the tachyarrhythmia detection algorithm by holding the morphology analysis in a current state in response to detecting the type of the pacing train to be anti-tachycardia pacing (ATP); and

a therapy module configured to deliver a shock therapy based on the tachyarrhythmia detection algorithm.

30. The device of claim 29, wherein the control module detects termination of the pacing train and resumes the morphology analysis of the tachyarrhythmia detection algorithm in response to detecting the termination of the pacing train.

31. The device of claim 30, wherein the control module detects termination of the pacing train when no pacing spikes have been detected for a threshold period of time.

32. The device of claim 31, wherein the threshold period of time is at least two times an estimated cycle length of the pacing train.

33. The device of claim 30, wherein the control module detects termination of the pacing train when the amount of time since detecting the initiation of the pacing train exceeds a threshold amount of time.

34. A medical device comprising:

a sensing module configured to obtain cardiac electrical signals; and

a control module configured to process the cardiac electrical signals from the sensing module in accordance with a tachyarrhythmia detection algorithm to monitor for a tachyarrhythmia, detect initiation of a pacing train delivered by a second implantable medical device, determine a type of the detected pacing train, and modify the tachyarrhythmia detection algorithm based on the type of the detected pacing train,

wherein the tachyarrhythmia detection algorithm analyzes segments of the cardiac electrical signals of a predetermined length and classifies each segment as shockable or non-shockable and

wherein the control module determines a type of the detected pacing train to be a fast bradycardia pacing train and modifies to the tachyarrhythmia detection algorithm by comparing a morphology of a first sensed event within one of the segments with a morphology of a predetermined number of subsequent sensed events within the segments and classifying the rhythm as shockable or non-shockable based on at least the number of subsequent sensed events having a morphology that matches the morphology of the first sensed event of the tachyarrhythmia; and

a therapy module configured to deliver a shock therapy based on the tachyarrhythmia detection algorithm.

35. The device of claim 34, wherein the control module classifies the rhythm as non-shockable when the number of subsequent sensed events having a morphology that matches the morphology of the first sensed event of the tachyarrhythmia is greater than or equal to a lower threshold and less than or equal to an upper threshold.

36. A medical device comprising:

a sensing module configured to obtain cardiac electrical signals; and

a control module configured to process the cardiac electrical signals from the sensing module in accordance with a tachyarrhythmia detection algorithm to monitor for a tachyarrhythmia, detect initiation of a pacing train delivered by a second implantable medical device, determine a type of the detected pacing train, and modify the tachyarrhythmia detection algorithm based on the type of the detected pacing train, wherein the tachyarrhythmia detection algorithm includes a plurality of stages comprising at least a first stage and a second stage,

wherein the control module is configured to modify the tachyarrhythmia detection algorithm by modifying a tachyarrhythmia detection analysis of the second stage; and

a therapy module configured to deliver a shock therapy based on the tachyarrhythmia detection algorithm.

37. The device of claim 36, wherein the control module is configured to analyze a morphology of a plurality of segments of the sensed cardiac electrical signal in the second stage and modify the tachyarrhythmia detection algorithm by modifying the morphology analysis.

38. A medical device comprising:

a sensing module configured to obtain cardiac electrical signals; and

a control module configured to process the cardiac electrical signals from the sensing module in accordance with a tachyarrhythmia detection algorithm to monitor for a tachyarrhythmia, detect initiation of a pacing train delivered by a second implantable medical device, determine a type of the detected pacing train, and modify the tachyarrhythmia detection algorithm based on the type of the detected pacing train,

wherein the control module is configured to determine the type of the detected pacing train by at least analyzing an onset of the heart rate immediately prior to the detected pacing train; and

a therapy module configured to deliver a shock therapy based on the tachyarrhythmia detection algorithm.