Template-based capture verification for multi-site pacing

• US 20030083711A1
• Filed: 09/19/2002
• Published: 05/01/2003
• Est. Priority Date: 10/26/2001
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Yonce, David J., Ternes, David
• Granted Patent: US 7,286,876 B2
• Time in Patent Office: Days
• US Class Current: 607/27
• CPC Class Codes: A61B 5/35 by template matching
• CPC Class Codes: A61B 5/7203 for noise prevention, reduction or removal
• 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 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/3682 with a variable atrioventricular delay
• CPC Class Codes: A61N 1/3684 for stimulating the heart at multiple sites of the ventricle or the atrium
• CPC Class Codes: A61N 1/36842 Multi-site stimulation in the same chamber
• CPC Class Codes: A61N 1/36843 Bi-ventricular stimulation
• CPC Class Codes: A61N 1/3712 Auto-capture, i.e. automatic adjustment of the stimulation threshold
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

An apparatus and method for verifying capture by first and second pacing pulses in which an evoked response waveform recorded during a pacing event is compared with template waveforms representing capture by the first, second, and both pacing pulses. The evoked response is then classified as representing a type of capture represented by a template waveform if the evoked response waveform highly correlates with one template waveform and has correlation values with the other template waveforms within specified bounds.

Claims

1. A cardiac pacemaker, comprising:

first and second pacing channels, each such channel comprising an electrode for disposing near a chamber of the heart, a pulse generator for outputting pacing pulses, and a channel interface for adjusting the pacing pulse energy;

a controller for controlling the operation of the pulse generators in accordance with a programmed pacing mode;

an evoked response sensing channel comprising an electrode and a sense amplifier for sensing an evoked response generated after a pacing pulse; and

,

wherein the controller is programmed to;

deliver first and second pacing pulses from the first and second pacing channels, respectively, to one or both of the paired atria or to one or both of the paired ventricles during a cardiac cycle;

record an evoked response waveform from the evoked response sensing channel;

correlate the evoked response waveform with template waveforms representing capture by both pacing pulses, capture by the first pacing pulse, and capture by the second pacing pulse; and

,

classify the evoked response as representing a type of capture represented by a template waveform if the evoked response waveform highly correlates with one template waveform and has correlation values with the other template waveforms within specified bounds.

2. The pacemaker of claim 1 wherein the controller is programmed to classify the evoked response as representing a type of capture represented by a template waveform if the evoked response waveform highly correlates with one template waveform and correlates with the other template waveforms to roughly the same extent as the template waveform with which it highly correlates.

3. The pacemaker of claim 1 wherein the first and second pacing channels are right and left ventricular pacing channels, and the controller is programmed to classify the evoked response as representing right ventricular (RV) capture, left ventricular (LV) capture, or biventricular (BiV) capture by correlating the evoked response waveform with RV, LV, and BiV templates representing RV, LV, and BiV capture, respectively.

4. The pacemaker of claim 3 wherein the controller is programmed to:

classify the evoked response as representing BiV capture if the evoked response waveform highly correlates with the BiV template and correlates with each of the RV and LV templates to roughly the same extent as does the BiV template;

classify the evoked response as representing RV capture if the evoked response waveform highly correlates with the RV template and correlates with each of the BiV and LV templates to roughly the same extent as does the RV template; and

,

classify the evoked response as representing LV capture if the evoked response waveform highly correlates with the LV template and correlates with each of the RV and BiV templates to roughly the same extent as does the LV template.

5. The pacemaker of claim 4 wherein the controller is programmed to detect BiV, RV, or LV capture if the evoked response is classified as representing only one of either BiV, RV, or LV capture, respectively.

6. The pacemaker of claim 5 wherein the controller is programmed to detect BiV or RV capture in accordance with the signal energy of the evoked response within a specified sub-window time interval if the evoked response is initially classified as representing both RV and BiV capture.

7. The pacemaker of claim 6 wherein the controller is programmed to detect BiV or RV capture in accordance with whether the signal energy of the evoked response within the specified sub-window time interval is above or below a limit energy value between the signal energies of the BiV and RV templates in the event that the evoked response is initially classified as representing both RV and BiV capture.

8. The pacemaker of claim 6 wherein the specified sub-window time interval is approximately 200-300 ms following a pace.

9. The pacemaker of claim 3 wherein the controller is programmed to detect either asystole or a fusion beat in accordance with the total signal energy of the evoked response waveform in the event the evoked response waveform is not classified as either BiV, RV, or LV capture.

10. The pacemaker of claim 1 wherein the controller is programmed to acquire template waveforms representing capture by the first, second, or both pacing pulses by:

outputting a pacing pulse or pulses with sufficient energy to cause capture;

recording a first evoked response from a pacing pulse or pulses;

recording a second evoked response from a subsequent pacing pulse or pulses;

correlating the first and second recorded evoked responses; and

,

forming a template waveform by averaging the first and second recorded evoked responses only if the first and second template waveforms are correlated to a specified extent.

11. A method for operating a cardiac pacemaker, comprising:

outputting first and second pacing pulses to one or both of the paired atria or to one or both of the paired ventricles during a cardiac cycle in accordance with a programmed pacing mode;

sensing an evoked response generated after a pacing pulse;

recording an evoked response waveform from the evoked response sensing channel;

correlating the evoked response waveform with template waveforms representing capture by both pacing pulses, capture by the first pacing pulse, and capture by the second pacing pulse; and

,

classifying the evoked response as representing a type of capture represented by a template waveform if the evoked response waveform highly correlates with one template waveform and has correlation values with the other template waveforms within specified bounds.

12. The method of claim 11 further comprising classifying the evoked response as representing a type of capture represented by a template waveform if the evoked response waveform highly correlates with one template waveform and correlates with the other template waveforms to roughly the same extent as the template waveform with which it highly correlates.

13. The method of claim 11 wherein the first and second pacing pulses are output to the right and left ventricles, and further comprising classifying the evoked response as representing right ventricular (RV) capture, left ventricular (LV) capture, or biventricular (BiV) capture by correlating the evoked response waveform with RV, LV, and BiV templates representing RV, LV, and BiV capture, respectively.

14. The method of claim 13 further comprising:

classifying the evoked response as representing BiV capture if the evoked response waveform highly correlates with the BiV template and correlates with each of the RV and LV templates to roughly the same extent as does the BiV template;

classifying the evoked response as representing RV capture if the evoked response waveform highly correlates with the RV template and correlates with each of the BiV and LV templates to roughly the same extent as does the RV template; and

,

classifying the evoked response as representing LV capture if the evoked response waveform highly correlates with the LV template and correlates with each of the RV and BiV templates to roughly the same extent as does the LV template.

15. The method of claim 14 further comprising detecting BiV, RV, or LV capture if the evoked response is classified as representing only one of either BiV, RV, or LV capture, respectively.

16. The method of claim 15 further comprising detecting BiV or RV capture in accordance with the signal energy of the evoked response within a specified sub-window time interval if the evoked response is initially classified as representing both RV and BiV capture.

17. The method of claim 16 further comprising detecting BiV or RV capture in accordance with whether the signal energy of the evoked response within the specified sub-window time interval is above or below a limit energy value between the signal energies of the BiV and RV templates in the event is the evoked response is initially classified as representing both RV and BiV capture.

18. The method of claim 16 wherein the specified sub-window time interval is approximately 200-300 ms following a pace.

19. The method of claim 13 further comprising detecting either asystole or a fusion beat in accordance with the total signal energy of the evoked response waveform in the event the evoked response waveform is not classified as either BiV, RV, or LV capture.

20. A method for acquiring template waveforms representing capture by first, second, or both pacing pulses, comprising the steps of:

outputting a pacing pulse or pulses with sufficient energy to cause capture;

recording a first evoked response from a pacing pulse or pulses;

recording a second evoked response from a subsequent pacing pulse or pulses;

correlating the first and second recorded evoked responses; and

,

forming a template waveform by averaging the first and second recorded evoked responses only if the first and second template waveforms are correlated to a specified extent.