Method and apparatus for generation and selection of tachycardia therapy hierarchy

• US 20040167579A1
• Filed: 02/20/2003
• Published: 08/26/2004
• Est. Priority Date: 02/20/2003
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Sharma, Vinod, Degroot, Paul J.
• Granted Patent: US 7,107,098 B2
• Time in Patent Office: Days
• US Class Current: 607/14
• CPC Class Codes: A61N 1/3621 for treating or preventing abnormally high heart rate
• CPC Class Codes: A61N 1/3956 Implantable devices for applying electric shocks to the heart, e.g. for cardioversion
• CPC Class Codes: G16H 20/30 relating to physical therapies or activities, e.g. physiotherapy, acupressure or exercising
• CPC Class Codes: G16H 40/63 for local operation
• CPC Class Codes: G16Z 99/00 Subject matter not provided for in other main groups of this subclass

Abstract

A method and apparatus for generating and selecting therapies, or hierarchies of therapies, that may be used to treat episodes of atrial or ventricular tachycardia. A characteristic of a detected tachycardia event is determined, and a hierarchy of therapies to treat the detected tachycardia event is selected in response to the determined characteristic.

Claims

1. A method for providing therapy in an implantable medical device, comprising:

detecting a tachycardia event;

determining a characteristic of the detected tachycardia event; and

selecting a hierarchy of therapies to treat the detected tachycardia event in response to the determined characteristic.

2. The method of claim 1, further comprising:

applying a therapy corresponding to the selected hierarchy of therapies;

determining whether the applied therapy terminates the detected tachycardia event;

storing historical effectiveness of the applied therapy; and

updating the selected hierarchy of therapies in response to the stored historical effectiveness.

3. The method of claim 1, wherein the characteristic includes at least one of a cycle length of the tachycardia, a morphology of the tachycardia, a metric of suddenness of onset of the tachycardia, a metric of decline of arterial pressure and a metric of decline of cerebral perfusion.

4. The method of claim 1, wherein determining the characteristic of the tachycardia event comprises:

comparing the characteristic to a corresponding characteristic template;

computing a degree of resemblance between the characteristic and the corresponding characteristic template; and

determining that the characteristic matches the corresponding characteristic template in response to the degree of resemblance exceeding a predetermined threshold, and wherein selecting a hierarchy of therapies comprises selecting a hierarchy associated with the corresponding characteristic template in response to determining that the characteristic matches the corresponding characteristic template.

5. The method of claim 1, wherein determining the characteristic of the tachycardia event comprises:

comparing the characteristic to a corresponding characteristic template;

computing a degree of resemblance between the characteristic and the corresponding characteristic template; and

determining that the characteristic does not match the corresponding characteristic template in response to the degree of resemblance being less than or equal to a predetermined threshold, and wherein selecting a hierarchy of therapies comprises selecting a default hierarchy in response to determining that the characteristic does not match the corresponding characteristic template.

6. The method of claim 1, wherein the therapies in the hierarchy include one of anti-tachycardia pacing therapies and cardioversion therapies.

7. The method of claim 2, further comprising determining whether the applied therapy accelerates the tachycardia event.

8. The method of claim 1, wherein the hierarchy of therapies corresponds to a single therapy.

9. An implantable medical device, comprising:

a plurality of electrodes detecting a tachycardia event;

a processor determining a characteristic of the detected tachycardia event and selecting a hierarchy of therapies to treat the detected tachycardia event in response to the determined characteristic.

10. The implantable medical device of claim 9, further comprising a storage device, wherein the processor applies a therapy, via the plurality of electrodes, corresponding to the selected hierarchy of therapies, determines whether the applied therapy terminates the detected tachycardia event, stores historical effectiveness of the applied therapy in the storage device, and updates the selected hierarchy of therapies in response to the stored historical effectiveness.

11. The implantable medical device of claim 9, wherein the characteristic includes at least one of a cycle length of the tachycardia, a morphology of the tachycardia, a metric of suddenness of onset of the tachycardia, a metric of decline of arterial pressure and a metric of decline of cerebral perfusion.

12. The implantable medical device of claim 9, wherein the processor compares the characteristic to a corresponding characteristic template, computes a degree of resemblance between the characteristic and the corresponding characteristic template, and determines that the characteristic matches the corresponding characteristic template in response to the degree of resemblance exceeding a predetermined threshold, and wherein the processor selects a hierarchy associated with the corresponding characteristic template in response to determining that the characteristic matches the corresponding characteristic template.

13. The implantable medical device of claim 9, wherein the processor compares the characteristic to a corresponding characteristic template, computes a degree of resemblance between the characteristic and the corresponding characteristic template, and determines that the characteristic does not match the corresponding characteristic template in response to the degree of resemblance being less than or equal to a predetermined threshold, and wherein the processor selects a default hierarchy in response to determining that the characteristic does not match the corresponding characteristic template.

14. The implantable medial device of claim 9, wherein the therapies in the hierarchy include one of anti-tachycardia pacing therapies and cardioversion therapies.

15. The implantable medical device of claim 10, wherein the processor determines whether the applied therapy accelerates the tachycardia event.

16. The implantable medical device of claim 9, wherein the hierarchy of therapies corresponds to a single therapy.

17. A computer-readable medium comprising instructions for causing a programmable processor to:

detect a tachycardia event;

determine a characteristic of the detected tachycardia event; and

select a hierarchy of therapies to treat the detected tachycardia event in response to the determined characteristic.

18. An implantable medical device comprising:

means for detecting a tachycardia event;

means for determining a characteristic of the detected tachycardia event; and

means for selecting a hierarchy of therapies to treat the detected tachycardia event in response to the determined characteristic.