Cardiac rhythm management systems and methods using multiple morphology templates for discriminating between rhythms
First Claim
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1. A system comprising:
- an electrogram sensing circuit, configured to be coupled to at least one electrode for receiving an intrinsic cardiac signal, the electrogram sensing circuit configured to provide cardiac complexes and an indication of heart rate obtained from a subject'"'"'s heart;
a shock circuit, configured to be coupled to at least one electrode to deliver a shock to the heart;
a stored first morphological template, coupled to the electrogram sensing circuit, the stored first morphological template obtained from the heart, in the absence of an arrhythmia, while the subject is resting or inactive;
a stored second morphological template, coupled to the electrogram sensing circuit, the stored second morphological template obtained from the heart under a condition different from that of the first morphological template;
a correlation module, coupled to the first and second morphological templates and the electrogram sensing circuit, the correlation module configured to declare an indication of a first rhythm state if the indication of heart rate exceeds a first predetermined threshold value and a morphology of at least one cardiac complex of the intrinsic cardiac signal correlates to either of the first and second morphological templates, and configured to declare an indication of a second rhythm state if the indication of heart rate exceeds the first predetermined threshold value and a morphology of the at least one cardiac complex of the intrinsic cardiac signal is uncorrelated to both the first and second morphological templates; and
a shock control module, coupled to the correlation module and the shock circuit, the shock control module configured to trigger a shock if the correlation module declares the indication of the second rhythm state, and the shock control module configured to inhibit a shock if the correlation module declares the indication of the first rhythm state.
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Abstract
This document describes systems, devices, and methods that use multiple morphology templates for discriminating between rhythms, such as supraventricular tachyarrhythmias (SVTs) and ventricular tachyarrhythmias (VTs), for delivering a countershock in response to a VT episode, but withholding delivery of such a countershock in response to an SVT episode. In certain examples, the particular morphology used for storing morphological features is selected at least in part using a sensor-indicated activity level of a subject, or a metabolic need of the subject.
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Citations
33 Claims
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1. A system comprising:
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an electrogram sensing circuit, configured to be coupled to at least one electrode for receiving an intrinsic cardiac signal, the electrogram sensing circuit configured to provide cardiac complexes and an indication of heart rate obtained from a subject'"'"'s heart;
a shock circuit, configured to be coupled to at least one electrode to deliver a shock to the heart;
a stored first morphological template, coupled to the electrogram sensing circuit, the stored first morphological template obtained from the heart, in the absence of an arrhythmia, while the subject is resting or inactive;
a stored second morphological template, coupled to the electrogram sensing circuit, the stored second morphological template obtained from the heart under a condition different from that of the first morphological template;
a correlation module, coupled to the first and second morphological templates and the electrogram sensing circuit, the correlation module configured to declare an indication of a first rhythm state if the indication of heart rate exceeds a first predetermined threshold value and a morphology of at least one cardiac complex of the intrinsic cardiac signal correlates to either of the first and second morphological templates, and configured to declare an indication of a second rhythm state if the indication of heart rate exceeds the first predetermined threshold value and a morphology of the at least one cardiac complex of the intrinsic cardiac signal is uncorrelated to both the first and second morphological templates; and
a shock control module, coupled to the correlation module and the shock circuit, the shock control module configured to trigger a shock if the correlation module declares the indication of the second rhythm state, and the shock control module configured to inhibit a shock if the correlation module declares the indication of the first rhythm state. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12)
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13. A system comprising:
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an electrogram sensing circuit, configured to be coupled to at least one electrode for receiving an intrinsic cardiac signal, the electrogram sensing circuit configured to provide cardiac complexes and an indication of heart rate obtained from a subject'"'"'s heart;
a shock circuit, configured to be coupled to at least one electrode to deliver a shock to the heart;
a stored first morphological template, coupled to the electrogram sensing circuit, the stored first morphological template obtained from the heart, in the absence of an arrhythmia, while the subject is resting or inactive;
a stored second morphological template, coupled to the electrogram sensing circuit, the stored second morphological template obtained from the heart under a condition different from that of the first morphological template;
a means, coupled to the first and second morphological templates and the electrogram sensing circuit, for declaring an indication of a first rhythm state if the indication of heart rate exceeds a first predetermined threshold value and a morphology of at least one cardiac complex of the intrinsic cardiac signal correlates to either of the first and second morphological templates;
a means, coupled to the first and second morphological templates and the electrogram sensing circuit, for declaring an indication of a second rhythm state if the indication of heart rate exceeds the first predetermined threshold value and a morphology of the at least one cardiac complex of the intrinsic cardiac signal is uncorrelated to both the first and second morphological templates;
a means, coupled the shock circuit, for triggering a shock if the second rhythm state is declared; and
a means, coupled to the shock circuit, for inhibiting a shock if the first rhythm state is declared.
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14. A system comprising:
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an electrogram sensing circuit, configured to be coupled to at least one electrode for receiving an intrinsic cardiac signal, the electrogram sensing circuit configured to provide cardiac complexes and an indication of heart rate obtained from a subject'"'"'s heart;
a stored first morphological template, coupled to the electrogram sensing circuit, the stored first morphological template obtained from the heart, in the absence of an arrhythmia, while the subject is resting or inactive;
a stored second morphological template, coupled to the electrogram sensing circuit, the stored second morphological template obtained from the heart under a condition different from that of the first morphological template; and
a correlation module, coupled to the electrogram sensing circuit and the first and second morphological templates, the correlation module configured to discriminate between first and second rhythm states using a comparison of a morphology of at least one cardiac complex of the intrinsic cardiac signal to at least one of the first and second morphological templates, the at least one of the first and second morphological templates selected using the indication of heart rate provided by the electrogram sensing circuit. - View Dependent Claims (15, 16, 17)
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18. A system comprising:
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an electrogram sensing circuit, configured to be coupled to at least one electrode for receiving an intrinsic cardiac signal, the electrogram sensing circuit configured to provide cardiac complexes and an indication of heart rate obtained from a subject'"'"'s heart;
a stored first morphological template, coupled to the electrogram sensing circuit, the stored first morphological template obtained from the heart, in the absence of an arrhythmia, while the subject is resting or inactive;
a stored second morphological template, coupled to the electrogram sensing circuit, the stored second morphological template obtained from the heart under a condition different from that of the first morphological template; and
a means, coupled to the electrogram sensing circuit and the first and second morphological templates, for discriminating between first and second rhythm states using a comparison of a morphology of at least one cardiac complex of the intrinsic cardiac signal to at least one of the first and second morphological templates, the at least one of the first and second morphological templates selected using the indication of heart rate provided by the electrogram sensing circuit.
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19. A system comprising:
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a first electrode, sized and shaped for being implanted in or near a subject'"'"'s heart, the first electrode configured for sensing a heart rate from cardiac complexes;
a second electrode, sized and shaped for being implanted in or near the heart, the second electrode configured for sensing a morphology of a cardiac complex. an electrogram sensing circuit, configured to be coupled to the first and second electrodes for receiving respective first and second intrinsic cardiac signals, the electrogram sensing circuit configured to provide cardiac complexes and an indication of heart rate obtained from the heart;
a sensor, including a sensor output indicative of activity or metabolic need of the subject;
a shock circuit, configured to be coupled to the second electrode for delivering a shock to the heart;
a stored first morphological template, coupled to the electrogram sensing circuit, the stored first morphological template obtained from the heart in the absence of an arrhythmia while the subject is resting or inactive;
a stored second morphological template, coupled to the electrogram sensing circuit and the sensor, the stored second morphological template obtained from the heart under a different sensor output condition from that of the first morphological template;
a correlation module, coupled to the first and second morphological templates, the correlation module including first and second predetermined thresholds, the second predetermined threshold representing a higher heart rate value than the first predetermined threshold, the correlation module configured to declare a supraventricular tachyarrhythmia (SVT) if the heart rate value exceeds the first predetermined threshold but is less than the second predetermined threshold and a morphology of at least one cardiac complex of second intrinsic cardiac signal correlates to either of the first and second morphological templates, and configured to declare a ventricular tachyarrhythmia (VT) if at least one of;
(a) the heart rate value exceeds the second predetermined threshold; and
(b) the heart rate value exceeds the first predetermined threshold but is less than the second predetermined threshold and a morphology of the at least one cardiac complex of the second intrinsic cardiac signal is uncorrelated to both the first and second morphological templates; and
a shock control module, coupled to the correlation module and the shock circuit, the shock control module configured to trigger a shock if the correlation module declares the VT, and the shock control module configured to inhibit a shock if the correlation module declares the SVT. - View Dependent Claims (20, 21)
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22. A system comprising:
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a first electrode, sized and shaped for being implanted in or near a subject'"'"'s heart, the first electrode configured for sensing a heart rate from cardiac complexes;
a second electrode, sized and shaped for being implanted in or near the heart, the second electrode configured for sensing a morphology of a cardiac complex. an electrogram sensing circuit, configured to be coupled to the first and second electrodes for receiving respective first and second intrinsic cardiac signals, the electrogram sensing circuit configured to provide cardiac complexes and an indication of heart rate obtained from the heart;
a sensor, including a sensor output indicative of activity or metabolic need of the subject;
a shock circuit, configured to be coupled to the second electrode for delivering a shock to the heart;
a stored first morphological template, coupled to the electrogram sensing circuit, the stored first morphological template obtained from the heart in the absence of an arrhythmia while the subject is resting or inactive;
a stored second morphological template, coupled to the electrogram sensing circuit and the sensor, the stored second morphological template obtained from the heart under a different sensor output condition from that of the first morphological template;
a means, coupled to the first and second morphological templates, for declaring a supraventricular tachyarrhythmia (SVT) if (1) the heart rate value exceeds a first predetermined threshold but is less than a second predetermined threshold and (2) a morphology of at least one cardiac complex of second intrinsic cardiac signal correlates to either of the first and second morphological templates;
a means, coupled to the first and second morphological templates, for declaring a ventricular tachyarrhythmia (VT) if at least one of;
(a) the heart rate value exceeds the second predetermined threshold; and
(b) the heart rate value exceeds the first predetermined threshold but is less than the second predetermined threshold and a morphology of the at least one cardiac complex of the second intrinsic cardiac signal is uncorrelated to both the first and second morphological templates; and
a shock control module, coupled to the shock circuit, the shock control module configured to trigger a shock if a VT is declared, and the shock control module configured to inhibit a shock if an SVT is declared.
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23. A method comprising:
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obtaining a first morphological template from a subject'"'"'s heart in the absence of an arrhythmia, while the subject is resting or inactive;
obtaining a second morphological template from the heart under a condition different from that of the first morphological template;
obtaining at least one cardiac complex;
determining a degree of correlation between the at least one cardiac complex and at least one of the first and second morphological templates; and
declaring one of first and second rhythm states at least in part using the determined degree of correlation. - View Dependent Claims (24, 25, 26, 27, 28, 29, 30, 31, 32, 33)
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Specification