Apparatus and method using ATP return cycle length for arrhythmia discrimination

• US 20040106956A1
• Filed: 12/02/2002
• Published: 06/03/2004
• Est. Priority Date: 12/02/2002
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Sharma, Vinod, Mehra, Rahul, Degroot, Paul J.
• Granted Patent: US 7,149,577 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
• CPC Class Codes: A61N 1/3956 Implantable devices for applying electric shocks to the heart, e.g. for cardioversion

Abstract

An apparatus for discriminating between cardiac events that includes an input circuit receiving signals indicative of the cardiac events, a first output circuit generating pulses in response to the received signals, and a microprocessor determining whether a signal received by the input circuit subsequent to the generated pacing pulses corresponds to a predetermined cardiac event in response to an elapsed time period between the generated pulses and the subsequently received signal and a predetermined discrimination threshold.

Claims

1. An apparatus for discriminating between cardiac events, comprising:

an input circuit receiving signals indicative of the cardiac events;

a first output circuit generating pulses in response to the received signals; and

a microprocessor determining whether a signal received by the input circuit subsequent to the generated pacing pulses corresponds to a first predetermined cardiac event in response to an elapsed time period (T3) between the generated pulses and the subsequently received signal and a predetermined discrimination threshold (T4).

2. The apparatus of claim 1, wherein the microprocessor determines that the signal received by the input circuit subsequent to the generated pacing pulses corresponds to the first predetermined cardiac event in response to the elapsed time period (T3) between the generated pulses and the subsequently received signal being less than the predetermined discrimination threshold (T4) and wherein the microprocessor permits subsequent scheduled delivery of therapy in response to the signal received by the input circuit subsequent to the generated pacing pulses corresponding to the first predetermined cardiac event.

3. The apparatus of claim 1, wherein the microprocessor determines that the signal received by the input circuit subsequent to the generated pacing pulses does not correspond to the first predetermined cardiac event in response to the elapsed time period (T3) between the generated pulses and the subsequently received signal being greater than or equal to the predetermined discrimination threshold (T4) and the microprocessor inhibits subsequent scheduled delivery of therapy in response to the signal received by the input circuit subsequent to the generated pacing pulses not corresponding to the first predetermined cardiac event.

4. The apparatus of claim 1, further comprising a second output circuit for delivering shock therapy, wherein the first output circuit generates the pulses during charging of the second output circuit.

5. The apparatus of claim 1, further comprising a second output circuit for delivering shock therapy, wherein the first output circuit generates the pulses prior to charging of the second output circuit.

6. The apparatus of claim 1, wherein the first output circuit generates the pulses in response to the input circuit receiving consecutive signals, separated by a predetermined time period (T1), corresponding to the rate of the first predetermined cardiac event, and wherein the elapsed time period is normalized to the predetermined time period.

7. The apparatus of claim 1, wherein the first output circuit generates the pulses in response to the input circuit receiving consecutive signals, separated by a predetermined time period (T1), corresponding to the rate of the first predetermined cardiac event, and wherein the predetermined discrimination threshold is a percentage of the predetermined time period.

8. The apparatus of claim 7, wherein the predetermined discrimination threshold corresponds to approximately 190% of the predetermined time period

9. The apparatus of claim 1, wherein the pulses generated by the first output circuit correspond to anti-tachycardia pacing pulses.

10. The apparatus of claim 1, wherein the pulses generated by the first output circuit include a first pulse and a last pulse, and wherein the elapsed time period extends between the last pulse and subsequently received signal.

11. The apparatus of claim 1, wherein the microprocessor determines that the signal received by the input circuit subsequent to the generated pacing pulses corresponds to the first predetermined cardiac event in response to the elapsed time period (T3) between the generated pulses and the subsequently received signal being less than the predetermined discrimination threshold (T4) and permits subsequent scheduled delivery of therapy in response to the signal received by the input circuit subsequent to the generated pacing pulses corresponding to the first predetermined cardiac event, and wherein the microprocessor determines that the signal received by the input circuit subsequent to the generated pacing pulses corresponds to a second predetermined cardiac event in response to the elapsed time period (T3) between the generated pulses and the subsequently received signal being greater than or equal to the predetermined discrimination threshold (T4) and inhibits subsequent scheduled delivery of therapy for the first predetermined cardiac event in response to the signal received by the input circuit subsequent to the generated pacing pulses corresponding to the second predetermined cardiac event.

12. The apparatus of claim 11, wherein the microprocessor initiates therapy corresponding to the second predetermined cardiac event in response to determining that the signal received by the input circuit subsequent to the generated pacing pulses corresponds to the second predetermined cardiac event.

13. The apparatus of claim 1, wherein the first predetermined cardiac event is a ventricular tachycardia and the second predetermined cardiac even is a supraventricular tachycardia, and wherein the microprocessor determines that the subsequently received signal corresponds to the supraventricular tachycardia in response to the elapsed time period being greater than or equal to the predetermined discrimination threshold and that the subsequently received signal corresponds to the ventricular tachycardia in response to the elapsed time period being less than the predetermined discrimination threshold.

14. The apparatus of claim 13, wherein the microprocessor initiates supraventricular tachycardia therapies in response to determining that the subsequently received signal corresponds to a supraventricular tachycardia.

15. The apparatus of claim 1, wherein the first output circuit generates the pulses in response to the input circuit receiving consecutive signals, separated by a predetermined time period (T1), corresponding to the rate of the first predetermined cardiac event, and wherein the pulses generated by the output circuit are separated by a predetermined interval (T2) that is a function of the predetermined time period (T1).

16. The apparatus of claim 10, wherein the pulses generated by the first output circuit are one of burst pulses, ramp pulses and ramp-plus pacing pulses.

17. An apparatus for discriminating between cardiac events, comprising:

an input circuit receiving signals indicative of the cardiac events;

a first output circuit generating pulses in response to the input circuit receiving consecutive signals, separated by a predetermined time period (T1), corresponding to the rate of a first predetermined cardiac event; and

a microprocessor determining whether a signal received by the input circuit subsequent to the generated pacing pulses corresponds to the first predetermined cardiac event in response to an elapsed time period (T3) between the generated pulses and the subsequently received signal and a predetermined discrimination threshold (T4).

18. The apparatus of claim 17, wherein the microprocessor determines that the signal received by the input circuit subsequent to the generated pacing pulses corresponds to the first predetermined cardiac event in response to the elapsed time period (T3) between the generated pulses and the subsequently received signal being less than the predetermined discrimination threshold (T4) and permits subsequent scheduled delivery of therapy in response to the signal received by the input circuit subsequent to the generated pacing pulses corresponding to the first predetermined cardiac event.

19. The apparatus of claim 17, wherein the microprocessor determines that the signal received by the input circuit subsequent to the generated pacing pulses does not correspond to the first predetermined cardiac event in response to the elapsed time period (T3) between the generated pulses and the subsequently received signal being greater than or equal to the predetermined discrimination threshold (T4) and inhibits subsequent scheduled delivery of therapy in response to the signal received by the input circuit subsequent to the generated pacing pulses not corresponding to the first predetermined cardiac event.

20. The apparatus of claim 17, further comprising a second output circuit for delivering shock therapy, wherein the first output circuit generates the pulses during charging of the second output circuit.

21. The apparatus of claim 17, further comprising a second output circuit for delivering shock therapy, wherein the first output circuit generates the pulses prior to charging of the second output circuit.

22. The apparatus of claim 17, wherein the microprocessor determines that the signal received by the input circuit subsequent to the generated pacing pulses corresponds to the first predetermined cardiac event in response to the elapsed time period (T3) between the generated pulses and the subsequently received signal being less than the predetermined discrimination threshold (T4) and permits subsequent scheduled delivery of therapy in response to the signal received by the input circuit subsequent to the generated pacing pulses corresponding to the first predetermined cardiac event, and wherein the microprocessor determines that the signal received by the input circuit subsequent to the generated pacing pulses corresponds to a second predetermined cardiac event in response to the elapsed time period (T3) between the generated pulses and the subsequently received signal being greater than or equal to the predetermined discrimination threshold (T4) and inhibits subsequent scheduled delivery of therapy for the first predetermined cardiac event in response to the signal received by the input circuit subsequent to the generated pacing pulses corresponding to the second predetermined cardiac event.

23. The apparatus of claim 22, wherein the microprocessor initiates therapy corresponding to the second predetermined cardiac event in response to the determining that the signal received by the input circuit subsequent to the generated pacing pulses corresponds to the second predetermined cardiac event.

24. The apparatus of claim 17, wherein the first predetermined cardiac event is a ventricular tachycardia and the second predetermined cardiac event is a supraventricular tachycardia, and wherein the microprocessor determines that the subsequently received signal corresponds to the supraventricular tachycardia in response to the elapsed time period being greater than or equal to the predetermined discrimination threshold.

25. The apparatus of claim 24, wherein the microprocessor initiates SVT therapies in response to determining that the subsequently received signal corresponds to the supraventricular tachycardia.

26. The apparatus of claim 17, wherein the elapsed time period is normalized to the predetermined time period.

27. The apparatus of claim 26, wherein the predetermined discrimination threshold corresponds to approximately 190% of the predetermined time period

28. The apparatus of claim 27, wherein the pulses generated by the first output circuit correspond to anti-tachycardia pacing pulses.

29. The apparatus of claim 27, wherein the pulses generated by the first output circuit include a first pulse and a last pulse, and wherein the elapsed time period extends between the last pulse and the subsequently received signal.

30. The apparatus of claim 27, wherein the pulses generated by the first output circuit are separated by a predetermined interval (T2) that is a function of the predetermined time period (T1).

31. The apparatus of claim 27, wherein the pulses generated by the first output circuit are one of burst pulses, ramp pulses and ramp-plus pacing pulses.

32. A method of discriminating between cardiac events, comprising:

receiving signals indicative of the cardiac events;

generating pulses in response to the received signals; and

determining that a signal received by the input circuit subsequent to the generated pacing pulses corresponds to a first predetermined cardiac event in response to an elapsed time period (T3) between the generated pulses and the subsequently received signal and a predetermined discrimination threshold (T4).

33. The method of claim 32, wherein the step of determining further comprises determining that the signal received by the input circuit subsequent to the generated pacing pulses corresponds to the first predetermined cardiac event in response to the elapsed time period (T3) between the generated pulses and the subsequently received signal being less than the predetermined discrimination threshold (T4), and permitting subsequent scheduled delivery of therapy in response to the signal received by the input circuit subsequent to the generated pacing pulses corresponding to the first predetermined cardiac event.

34. The method of claim 32, wherein the step of determining further comprises determining that the signal received by the input circuit subsequent to the generated pacing pulses does not correspond to the first predetermined cardiac event in response to the elapsed time period (T3) between the generated pulses and the subsequently received signal being greater than or equal to the predetermined discrimination threshold (T4), and inhibiting subsequent scheduled delivery of therapy in response to the signal received by the input circuit subsequent to the generated pacing pulses not corresponding to the first predetermined cardiac event.

35. The method of claim 32, further comprising charging an output circuit for delivering shock therapy in response to detection of the first cardiac event, wherein the pulses are generated during charging of the output circuit.

36. The method of claim 32, further comprising charging an output circuit for delivering shock therapy in response to detection of the first cardiac event, wherein the pulses are generated prior to charging of the output circuit.

37. The method of claim 32, wherein the pulses are generated in response to receipt of consecutive signals, separated by a predetermined time period (T1), corresponding to the rate of the first predetermined cardiac event, and wherein the elapsed time period is normalized to the predetermined time period.

38. The method of claim 32, wherein the pulses are generated in response to receipt of consecutive signals, separated by a predetermined time period (T1), corresponding to the rate of the predetermined cardiac event, and wherein the predetermined discrimination threshold is a percentage of the predetermined time period.

39. The method of claim 32, wherein the predetermined discrimination threshold corresponds to approximately 190% of the predetermined time period

40. The method of claim 32, the step of determining further comprising determining that the signal received subsequent to the generated pacing pulses corresponds to the first predetermined cardiac event in response to the elapsed time period (T3) between the generated pulses and the subsequently received signal being less than the predetermined discrimination threshold (T4), permitting subsequent scheduled delivery of therapy in response to the signal received subsequent to the generated pacing pulses corresponding to the first predetermined cardiac event, determining that the signal received by the input circuit subsequent to the generated pacing pulses corresponds to a second predetermined cardiac event in response to the elapsed time period (T3) between the generated pulses and the subsequently received signal being greater than or equal to the predetermined discrimination threshold (T4), and inhibiting subsequent scheduled delivery of therapy for the first predetermined cardiac event in response to the signal received by the input circuit subsequent to the generated pacing pulses corresponding to a second predetermined cardiac event.

41. The method of claim 40, further comprising initiating therapy corresponding to the second predetermined cardiac event in response to the determining that the signal received by the input circuit subsequent to the generated pacing pulses corresponds to the second predetermined cardiac event.

42. The method of claim 32, wherein the pulses are generated in response to receipt of consecutive signals, separated by a predetermined time period (T1), corresponding to the rate of the first predetermined cardiac event, and wherein the pulses are separated by a predetermined interval (T2) that is a function of the predetermined time period (T1).