Atrial and ventricular tachyarrhythmia detection system and method

• US 20020147407A1
• Filed: 04/06/2001
• Published: 10/10/2002
• Est. Priority Date: 04/06/2001
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Seim, Gary
• Granted Patent: US 6,658,286 B2
• Time in Patent Office: Days
• US Class Current: 600/513
• CPC Class Codes: A61B 5/363 Detecting tachycardia or bradycardia
• CPC Class Codes: A61B 5/7264 Classification of physiological signals or data, e.g. using neural networks, statistical classifiers, expert systems or fuzzy systems neural networks per se G06N3/00; expert systems per se G06N5/00
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

Detecting atrial and ventricular tachyarrhythmias involves classifying atrial interval rates in an atrial window having a first length and ventricular interval rates in a ventricular window having a second length. The second length of the ventricular window differs from the first length of the atrial window to enhance detection of ventricular arrhythmias relative to atrial arrhythmia detection. The atrial and ventricular interval rates in the respective windows are classified as fast or acceptable with respect to predefined thresholds. A ventricular episode is declared in response to satisfying the ventricular window according to a second satisfaction criterion. An atrial episode is declared in response to satisfying the atrial window according to a first satisfaction criterion.

Claims

1. A method implemented with an implantable medical device, comprising:

developing atrial and ventricular interval rates from sensed atrial and ventricular events, respectively;

classifying atrial interval rates in an atrial window, the atrial window having a first length and a first satisfaction criterion;

classifying ventricular interval rates in a ventricular window, the ventricular window having a second length and a second satisfaction criterion, the second length of the ventricular window differing from the first length of the atrial window to enhance detection of ventricular arrhythmias relative to atrial arrhythmia detection;

declaring a ventricular episode in response to satisfying the ventricular window by comparing classified ventricular interval rates to the second satisfaction criterion; and

declaring an atrial episode in response to satisfying the atrial window by comparing classified atrial interval rates to the first satisfaction criterion.

2. The method of claim 1, wherein the first length of the atrial window is greater than the second length of the ventricular window.

3. The method of claim 1, wherein the first length of the atrial window length is between two times and four times the second length of the ventricular window.

4. The method of claim 1, wherein the first length of the atrial window is at least four times greater than the second length of the ventricular window.

5. The method of claim 1, wherein the first satisfaction criterion is different from the second satisfaction criterion.

6. The method of claim 1, wherein each the first and second satisfaction criterion represents a predetermined number, a predetermined percentage or a predetermined ratio of the classified atrial and ventricular interval rates relative to the first and second lengths.

7. The method of claim 1, wherein the first satisfaction criterion represents a predetermined number, percentage or ratio of the atrial interval rates classified as fast atrial interval rates relative to the first length, and the second satisfaction criterion represents a predetermined number or percentage of the ventricular interval rates classified as fast ventricular interval rates relative to the second length.

8. The method of claim 1, wherein the first satisfaction criterion represents about 80 percent of the atrial interval rates classified as fast atrial interval rates and the second satisfaction criterion represents about 80 percent of the ventricular interval rates classified as fast ventricular interval rates.

9. The method of claim 1, further comprising verifying that the declared atrial episode is a sustained atrial episode in response to the atrial window being satisfied by a third satisfaction criterion for subsequent atrial interval rates.

10. The method of claim 9, wherein each of the first and third satisfaction criterion represents a predetermined number, percentage or ratio of the atrial interval rates classified as fast atrial interval rates relative to the first length, and the third satisfaction criterion is less than the first satisfaction criterion.

11. The method of claim 10, wherein the first satisfaction criterion represents about 80 percent of the atrial interval rates classified as fast atrial interval rates and the third satisfaction criterion represents about 60 percent of the subsequent atrial interval rates classified as fast atrial interval rates.

12. The method of claim 1, further comprising verifying that the declared ventricular episode is a sustained ventricular episode in response to the ventricular window being satisfied by a fourth satisfaction criterion for subsequent ventricular interval rates.

13. The method of claim 12, wherein each of the second and fourth satisfaction criterion represents a predetermined number, percentage or ratio of the ventricular interval rates classified as fast ventricular interval rates relative to the second length, and the fourth satisfaction criterion is less than the second satisfaction criterion.

14. The method of claim 13, wherein the second satisfaction criterion represents about 80 percent of the ventricular interval rates classified as fast ventricular interval rates and the fourth satisfaction criterion represents about 60 percent of the subsequent ventricular interval rates classified as fast ventricular interval rates.

15. The method of claim 1, wherein a plurality of atrial and ventricular windows are operative with respect to each of a plurality of atrial and ventricular rate zones, respectively.

16. The method of claim 15, wherein each of the developing, classifying, and declaring processes are operative with respect to each of the plurality of atrial and ventricular rate zones, respectively.

18. The method of claim 17, further comprising inhibiting or delaying the atrial arrhythmia therapy during a time period in which initiation of ventricular arrhythmia therapy is being determined.

19. The method of claim 17, further comprising inhibiting or delaying the atrial arrhythmia therapy if the atrial and ventricular interval rates are substantially equal.

20. The method of claim 17, further comprising inhibiting or delaying the atrial arrhythmia therapy if an average of the ventricular interval rates is greater than an average of the atrial interval rates.

21. The method of claim 17, further comprising inhibiting or delaying the atrial arrhythmia therapy if an average of the atrial interval rates fails to exceed an average of the ventricular interval rates by at least a predetermined factor.

22. The method of claim 17, further comprising inhibiting or delaying the atrial arrhythmia therapy if a representative atrial rate developed from the atrial interval rates fails to exceed a representative ventricular rate developed from the ventricular interval rates by at least a predetermined factor.

23. The method of claim 22, wherein the representative atrial and ventricular rates represent an average or mean of the atrial and ventricular interval rates, respectively.

24. The method of claim 17, wherein the first length of the atrial window is greater than the second length of the ventricular window.

25. The method of claim 17, wherein the first length of the atrial window length is between two times and four times the second length of the ventricular window.

26. The method of claim 17, wherein the first length of the atrial window is at least four times greater than the second length of the ventricular window.

27. The method of claim 17, wherein each the first and second satisfaction criterion represents a predetermined number, a predetermined percentage or a predetermined ratio of the classified atrial and ventricular interval rates relative to the first and second lengths.

28. The method of claim 17, wherein the first satisfaction criterion represents a predetermined number, percentage or ratio of the atrial interval rates classified as fast atrial interval rates relative to the first length, and the second satisfaction criterion represents a predetermined number or percentage of the ventricular interval rates classified as fast ventricular interval rates relative to the second length.

29. The method of claim 17, further comprising verifying that the declared atrial episode is a sustained atrial episode in response to the atrial window being satisfied by a third satisfaction criterion for subsequent atrial interval rates, each of the first and third satisfaction criterion representing a predetermined number, percentage or ratio of the atrial interval rates classified as fast atrial interval rates relative to the first length, and the third satisfaction criterion is less than the first satisfaction criterion.

30. The method of claim 17, further comprising verifying that the declared ventricular episode is a sustained ventricular episode in response to the ventricular window being satisfied by a fourth satisfaction criterion for subsequent ventricular interval rates, each of the second and fourth satisfaction criterion representing a predetermined number, percentage or ratio of the ventricular interval rates classified as fast ventricular interval rates relative to the second length, and the fourth satisfaction criterion is less than the second satisfaction criterion.

31. The method of claim 17, wherein a plurality of atrial and ventricular windows are operative with respect to each of a plurality of atrial and ventricular rate zones, respectively.

32. The method of claim 31, wherein each of the developing, providing, and determining processes are operative with respect to each of the plurality of atrial and ventricular rate zones, respectively.

17. A method implemented with an implantable medical device, comprising:

developing atrial and ventricular interval rates from sensed atrial and ventricular events, respectively;

providing an atrial window having a first length and a first satisfaction criterion;

providing a ventricular window having a second length and a second satisfaction criterion, the second length of the ventricular window differing from the first length of the atrial window to enhance detection of ventricular arrhythmias relative to atrial arrhythmia detection;

determining if the atrial and ventricular windows are satisfied according to the first and second satisfaction criteria, respectively;

determining, in response to satisfaction of the ventricular window, whether ventricular arrhythmia therapy is to be initiated; and

determining whether atrial arrhythmia therapy is to be initiated in response to satisfaction of the atrial window and non-initiation of ventricular arrhythmia therapy.

33. A body implantable system, comprising:

at least one lead comprising atrial and ventricular electrodes;

a detector, coupled to the at least one lead, that senses atrial events and ventricular events;

memory configured to define an atrial window, having a first length and a first satisfaction criterion, and a ventricular window, having a second length and a second satisfaction criterion, the second length of the ventricular window differing from the first length of the atrial window to enhance detection of ventricular arrhythmias relative to atrial arrhythmia detection; and

a control circuit coupled to the detector and memory, the control circuit classifying atrial and ventricular interval rates in the atrial and ventricular windows, respectively, declaring a ventricular episode in response to satisfying the ventricular window by comparing classified ventricular interval rates to the second satisfaction criterion, and declaring an atrial episode in response to satisfying the atrial window by comparing classified atrial interval rates to the first satisfaction criterion.

34. The system of claim 33, wherein the control circuit determines whether to initiate ventricular therapy in response to the declared ventricular episode, the control circuit inhibiting or delaying application of atrial arrhythmia therapy during a time period in which initiation of ventricular arrhythmia therapy is being determined.

35. The system of claim 33, wherein the control circuit determines whether to initiate atrial therapy in response to the declared atrial episode, the control circuit inhibiting or delaying the atrial arrhythmia therapy if the atrial and ventricular interval rates are substantially equal.

36. The system of claim 33, wherein the control circuit determines whether to initiate atrial therapy in response to the declared atrial episode, the control circuit inhibiting or delaying the atrial arrhythmia therapy if an average of the ventricular interval rates is greater than an average of the atrial interval rates.

37. The system of claim 33, wherein the control circuit determines whether to initiate atrial therapy in response to the declared atrial episode, the control circuit inhibiting or delaying the atrial arrhythmia therapy if an average of the atrial interval rates fails to exceed an average of the ventricular interval rates by at least a predetermined factor.

38. The system of claim 33, wherein the control circuit determines whether to initiate atrial therapy in response to the declared atrial episode, the control circuit inhibiting or delaying the atrial arrhythmia therapy if a representative atrial rate developed from the atrial interval rates fails to exceed a representative ventricular rate developed from the ventricular interval rates by at least a predetermined factor.

39. The system of claim 38, wherein the representative atrial and ventricular rates represent an average or mean of the atrial and ventricular interval rates, respectively.

40. The system of claim 33, wherein the first length of the atrial window is greater than the second length of the ventricular window.

41. The system of claim 33, wherein the first length of the atrial window length is between two times and four times the second length of the ventricular window.

42. The system of claim 33, wherein the first length of the atrial window is at least four times greater than the second length of the ventricular window.

43. The system of claim 33, wherein each the first and second satisfaction criterion represents a predetermined number, a predetermined percentage or a predetermined ratio of the classified atrial and ventricular interval rates relative to the first and second lengths.

44. The system of claim 33, wherein the first satisfaction criterion represents a predetermined number, percentage or ratio of the atrial interval rates classified as fast atrial interval rates relative to the first length, and the second satisfaction criterion represents a predetermined number or percentage of the ventricular interval rates classified as fast ventricular interval rates relative to the second length.

45. The system of claim 33, wherein the control circuit verifies that the declared atrial episode is a sustained atrial episode in response to the atrial window being satisfied by a third satisfaction criterion for subsequent atrial interval rates, each of the first and third satisfaction criterion representing a predetermined number, percentage or ratio of the atrial interval rates classified as fast atrial interval rates relative to the first length, and the third satisfaction criterion is less than the first satisfaction criterion.

46. The system of claim 33, wherein the control circuit verifies that the declared ventricular episode is a sustained ventricular episode in response to the ventricular window being satisfied by a fourth satisfaction criterion for subsequent ventricular interval rates, each of the second and fourth satisfaction criterion representing a predetermined number, percentage or ratio of the ventricular interval rates classified as fast ventricular interval rates relative to the second length, and the fourth satisfaction criterion is less than the second satisfaction criterion.

47. The system of claim 33, wherein the memory is configured to define a plurality of atrial and ventricular windows operative with respect to each of a plurality of atrial and ventricular rate zones, respectively.

48. The system of claim 47, wherein the control circuit performs the classifying and respective declaring operations with respect to each of the plurality of atrial and ventricular rate zones, respectively.