Method and apparatus for prevention of arrhythmia clusters using overdrive pacing

• US 20030233130A1
• Filed: 06/14/2002
• Published: 12/18/2003
• Est. Priority Date: 06/14/2002
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Zhou, Xiaohong, Mullen, Thomas J., Mehra, Rahul, Olson, Walter H., Padmanabhan, Vasant, George, William J.
• Granted Patent: US 7,076,298 B2
• Time in Patent Office: Days
• US Class Current: 607/9
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions

Abstract

An implantable medical device that includes a microprocessor that characterizes cardiac activity of a patient to enable the implantable medical device to deliver therapy in response to an identified arrhythmia event. A monitor/controller monitors the characterized cardiac activity and the delivered therapy, and controls activation of triggered overdrive pacing subsequent to the delivered therapy.

Claims

1. An implantable medical device, comprising:

a microprocessor characterizing cardiac activity of a patient, the implantable medical device delivering therapy in response to an identified arrhythmia event; and

a monitor/controller monitoring the characterized cardiac activity and the delivered therapy, and controlling activation of triggered overdrive pacing subsequent to the delivered therapy.

2. The implantable medical device of claim 1, wherein the monitor/controller determines whether an arrhythmia event has terminated in response to the delivered therapy, determines whether to terminate triggered overdrive pacing in response to triggered overdrive pacing being active, determines whether the arrhythmia event is associated with an arrhythmia cluster in response to triggered overdrive pacing not being active, and activates triggered overdrive pacing in response to the arrhythmia event being associated with an arrhythmia cluster and triggered overdrive pacing being appropriate.

3. The implantable medical device of claim 2, wherein the monitor/controller determines that the arrhythmia event is associated with an arrhythmia cluster in response to inter-detection intervals associated with a predetermined number of events corresponding to an arrhythmia cluster.

4. The implantable medical device of claim 2, wherein the monitor/controller determines that the arrhythmia event is associated with an arrhythmia cluster in response to a sum of prior inter-detection intervals associated with a predetermined number of arrhythmia events being less than a predetermined time period.

5. The implantable medical device of claim 2, wherein the monitor/controller determines that the arrhythmia event is associated with an arrhythmia cluster in response to an inter-detection interval associated with the arrhythmia event being less than a predetermined time period, a predetermined number of arrhythmia events being detected, and inter-detection intervals associated with the predetermined number of arrhythmia events corresponding to an arrhythmia cluster.

6. The implantable medical device of claim 2, further comprising an ischemia detector detecting whether ischemia is present in the patient, wherein the monitor/controller determines that triggered overdrive pacing is appropriate in response to a heart rate of the patient being less than a predetermined heart rate threshold and ischemia not being present.

7. The implantable medical device of claim 2, further comprising an ischemia detector detecting whether ischemia is present in the patient, wherein the monitor/controller determines that triggered overdrive pacing is appropriate in response to one of a heart rate of the patient being less than a first predetermined heart rate threshold and ischemia not being present, and the heart rate of the patient being less than the first predetermined heart rate threshold, ischemia being present, and the heart rate being less than a second predetermined heart rate threshold.

8. The implantable medical device of claim 2, wherein the monitor/controller determines one or more of a triggered overdrive pacing rate, a triggered overdrive pacing duration, and a step down period.

9. The implantable medical device of claim 8, further comprising a hemodynamic detector detecting hemodynamics of the patient, wherein, the triggered overdrive pacing rate is dynamically adjusted by the monitor/controller, prior to activating the triggered overdrive pacing subsequent to the delivered therapy, based on one of a percentage of a patient'"'"'s heart rate, prior success of triggered overdrive pacing, and the detected hemodynamics of the patient.

10. The implantable medical device of claim 8, wherein the monitor/controller determines, prior to activating the triggered overdrive pacing subsequent to the delivered therapy, that the triggered overdrive pacing duration as being one of a predetermined time period, automatically adjusted based on prior triggered overdrive pacing, automatically adjusted based on events during or subsequent to the step down period, and a percentage of inter-detection intervals between detected arrhythmia events.

11. The implantable medical device of claim 8, wherein the step down period is calculated as a fraction of a time duration for performing triggered overdrive pacing.

12. The implantable medical device of claim 8, wherein the monitor/controller determines whether to terminate triggered overdrive pacing by counting the number of events that have occurred during prior or current triggered overdrive pacing intervals to determine a risk count, determining whether the risk count is greater than a predetermined risk count threshold, and determining whether triggered overdrive pacing adjustments have been exhausted in response to the risk count being greater than the predetermined risk count threshold.

13. The implantable medical device of claim 12, wherein the monitor/controller determines, in response to terminating triggered overdrive pacing, whether to reactivate triggered overdrive pacing.

14. The implantable medical device of claim 13, wherein the monitor/controller determines whether to reactivate triggered overdrive pacing based on one or more of determining whether triggered overdrive pacing has been terminated for a predetermined time period, determining ongoing cardiac activity during normal heart rhythm and during a new event and a new arrhythmia cluster, and determining whether predetermined precursors or events characteristics differ from corresponding predetermined precursors or events characteristics during prior failed triggered overdrive pacing interventions.

15. The implantable medical device of claim 12, wherein the triggered overdrive pacing adjustments include one or more of a triggered overdrive pacing rate, a triggered overdrive pacing threshold, and a step down period.

16. A method for detecting arrhythmias in an implantable medical device, comprising the steps of:

determining whether an arrhythmia event has terminated in response to a delivered therapy;

determining whether triggered overdrive pacing is active;

determining whether to terminate triggered overdrive pacing in response to triggered overdrive pacing being active;

determining whether the arrhythmia event is associated with an arrhythmia cluster in response to triggered overdrive pacing not being active;

determining whether triggered overdrive pacing is appropriate; and

delivering triggered overdrive pacing in response to the arrhythmia event being associated with an arrhythmia cluster and triggered overdrive pacing being appropriate.

17. The method of claim 16, wherein the step of determining whether the arrhythmia event is associated with an arrhythmia cluster comprises the step of determining whether inter-detection intervals associated with a predetermined number of events correspond to an arrhythmia cluster.

18. The method of claim 16, wherein the step of determining whether the arrhythmia event is associated with an arrhythmia cluster comprises the step of determining whether a sum of prior inter-detection intervals associated with a predetermined number of arrhythmia events is less than a predetermined time period.

19. The method of claim 16, wherein the step of determining whether triggered overdrive pacing is appropriate comprises the steps of:

determining whether a heart rate is less than a heart rate threshold; and

determining whether ischemia is present, wherein triggered overdrive pacing is determined to be appropriate in response to the heart rate being less than the heart rate threshold and ischemia not being present.

20. The method of claim 16, wherein the step of determining whether triggered overdrive pacing is appropriate comprises the steps of:

determining whether a heart rate is less than a first heart rate threshold;

determining whether ischemia is present; and

determining whether the heart rate is less than a second heart rate threshold in response to ischemia being present, wherein triggered overdrive pacing is determined to be appropriate in response to one of the heart rate being less than the first heart rate threshold and ischemia not being present, and the heart rate being less than the first heart rate threshold, ischemia being present, and the heart rate being less than the second heart rate threshold.

21. The method of claim 16, wherein the step of delivering triggered overdrive pacing includes determining one or more of a triggered overdrive pacing rate, a triggered overdrive pacing duration, and a step down period.

22. The method of claim 21, wherein the step of delivering triggered overdrive pacing includes one of dynamically adjusting a triggered overdrive pacing rate based on a percentage of a patient'"'"'s heart rate, dynamically adjusting the triggered overdrive pacing rate based on prior success of triggered overdrive pacing, and dynamically adjusting the triggered overdrive pacing rate based on hemodynamics of a patient.

23. The method of claim 21, wherein the triggered overdrive pacing duration is one of programmable at a preset time period, automatically adjusted based on prior triggered overdrive pacing, automatically adjusted based on events during or subsequent to a step down period, and determined as a percentage of inter-detection intervals between detected arrhythmia events.

24. The method of claim 21, wherein the step down period is calculated as a fraction of a time duration for performing triggered overdrive pacing.

25. The method of claim 16, wherein the step of determining whether to terminate triggered overdrive pacing comprises the steps of:

counting the number of events that have occurred during prior or current triggered overdrive pacing intervals to determine a risk count;

determining whether the risk count is greater than a predetermined risk count threshold; and

determining whether triggered overdrive pacing adjustments have been exhausted in response to the risk count being greater than the predetermined risk count threshold.

26. The method of claim 25, wherein the step of determining whether to terminate triggered overdrive pacing includes the step of determining, in response to determining to terminate triggered overdrive pacing, whether to reactivate triggered overdrive pacing.

27. The method of claim 26, wherein the step of determining whether to reactivate triggered overdrive pacing includes one or more of determining whether triggered overdrive pacing has been terminated for a predetermined time period, determining ongoing cardiac activity during normal heart rhythm and during a new event and a new arrhythmia cluster, and determining whether predetermined precursors or events characteristics differ from corresponding predetermined precursors or events characteristics during prior failed triggered overdrive pacing interventions.

28. The method of claim 25, wherein the triggered overdrive pacing adjustments include one or more of a triggered overdrive pacing rate, a triggered overdrive pacing threshold, and a step down period.

29. An implantable medical device, comprising:

a microprocessor characterizing cardiac activity of a patient, the implantable medical device delivering therapy in response to an identified arrhythmia event;

a monitor/controller monitoring the characterized cardiac activity and the delivered therapy, and controlling activation of triggered overdrive pacing subsequent to the delivered therapy, the monitor/controller determining, prior to activation of triggered overdrive pacing, one or more of a triggered overdrive pacing rate, a triggered overdrive pacing duration, and a step down period;

an ischemia detector detecting whether ischemia is present in the patient; and

a hemodynamics detector detecting hemodynamics of the patient, wherein the monitor/controller determines whether an arrhythmia event has terminated in response to the delivered therapy, determines whether to terminate triggered overdrive pacing in response to triggered overdrive pacing being active, determines whether the arrhythmia event is associated with an arrhythmia cluster in response to triggered overdrive pacing not being active, and activates triggered overdrive pacing in response to the arrhythmia event being associated with an arrhythmia cluster and triggered overdrive pacing being appropriate, wherein the monitor/controller determines that triggered overdrive pacing is appropriate in response to a heart rate of the patient being less than a first predetermined threshold and ischemia not being present, and wherein, prior to activating the triggered overdrive pacing, the triggered overdrive pacing rate is dynamically adjusted by the monitor/controller based on one of a percentage of a patient'"'"'s heart rate, prior success of triggered overdrive pacing, and the detected hemodynamics of the patient, the triggered overdrive pacing duration is determined as being one of a predetermined time period, automatically adjusted based on prior triggered overdrive pacing, automatically adjusted based on events during or subsequent to the step down period, and a percentage of inter-detection intervals between detected arrhythmia events, and the step down period is calculated as a fraction of a time duration for performing triggered overdrive pacing.

30. The implantable medical device of claim 29, wherein the monitor/controller determines that the arrhythmia event is associated with an arrhythmia cluster in response to inter-detection intervals associated with a predetermined number of arrhythmia events corresponding to an arrhythmia cluster.

31. The implantable medical device of claim 29, wherein the monitor/controller determines that the arrhythmia event is associated with an arrhythmia cluster in response to a sum of prior inter-detection intervals associated with a predetermined number of arrhythmia events being less than a predetermined time period.

32. The implantable medical device of claim 29, wherein the monitor/controller determines that triggered overdrive pacing is appropriate in response to the heart rate of the patient being less than the first predetermined threshold, ischemia being present, and the heart rate being less than a second predetermined threshold.

33. The implantable medical device of claim 29, wherein the monitor/controller determines whether to terminate triggered overdrive pacing by counting the number of events that have occurred during prior or current triggered overdrive pacing intervals to determine a risk count, determining whether the risk count is greater than a predetermined risk count threshold, and determining whether triggered overdrive pacing adjustments have been exhausted in response to the risk count being greater than the predetermined risk count threshold.

34. The implantable medical device of claim 33, wherein the monitor/controller determines, in response to terminating triggered overdrive pacing, whether to reactivate triggered overdrive pacing.

35. The implantable medical device of claim 34, wherein the monitor/controller determines whether to reactivate triggered overdrive pacing based on one or more of determining whether triggered overdrive pacing has been terminated for a predetermined time period, determining ongoing cardiac activity during normal heart rhythm and during a new event and a new arrhythmia cluster, and determining whether predetermined precursors or events characteristics differ from corresponding predetermined precursors or events characteristics during prior failed triggered overdrive pacing interventions.

36. The implantable medical device of claim 35, wherein the triggered overdrive pacing adjustments include one or more of a triggered overdrive pacing rate, a triggered overdrive pacing threshold, and a step down period.