Prioritized rule based method and apparatus for diagnosis and treatment of arrhythmias

• US 20040249420A1
• Filed: 03/26/2004
• Published: 12/09/2004
• Est. Priority Date: 05/14/1996
• Status: Abandoned Application

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Kaemmerer, William F., Brown, Mark L., Olson, Walter H.
• Application Number:
  US10/810,116
• Publication Number:
  US 20040249420A1
• 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 anti-tachyarrhythmia device which delivers anti-tachyarrhythmia therapies to a patient'"'"'s heart in response to detection of tachyarrhythmias. The device defines first criteria indicating the presence of atrial tachycardia and second criteria indicating the presence of atrial fibrillation, and compares the time elapsed since the either the first or second criteria were initially met to a defined time duration. In response to the defined duration having passed and either of the first or second criteria being met, the device triggers delivery of an appropriate anti-tachyarrhythmia therapy. The timer is reset on detection of termination of atrial tachyarrhythmia, but not on failure of the first and second criteria to be met. The first and second criteria are defined such that they can not be concurrently met.

Claims

1. A processor-based method for determining whether to deliver or to withhold a cardiac rhythm management therapy in response to the occurrence of atrial and ventricular events, comprising, in a dual chamber implantable pulse generator:

sensing cardiac depolarization events;

determining a cardiac grammar based on the sensed events for a plurality of cardiac cycles;

applying a priority-rule based logic set to the cardiac grammar to determine if each clause of a plurality of rules of said priority-rule based logic set is firing; and

withholding a therapy or delivering the cardiac rhythm management based on a highest priority rule of the priority-rule based logic for which all clauses are firing.

2. A method according to claim 1, wherein the cardiac depolarization events comprise a plurality of atrial-based events and a plurality of ventricular-based events.

3. A method according to claim 1, wherein the cardiac rhythm management therapy includes at least a one of:

an atrial anti-arrhythmia-only therapy;

a ventricular anti-arrhythmia-only therapy;

a cardioversion therapy;

a defibrillation therapy;

an anti-tachycardia pacing therapy;

an anti-arrhythmia therapy.

4. A method according to claim 3, wherein the anti-arrhythmia therapy comprises a one of:

a nerve stimulation therapy;

or

a drug administration therapy.

5. A method according to claim 3, wherein the anti-tachycardia pacing therapy further comprises:

a plurality of anti-tachycardia pacing therapies, wherein each one of said plurality of anti-tachycardia pacing therapies having a different operating parameter than the other of said anti-tachycardia pacing therapies

6. A method according to claim 3, wherein the defibrillation therapy further comprises:

a plurality of defibrillation therapies, wherein each of said plurality of defibrillation therapies is programmed to deliver a different amount of defibrillation energy.

7. A method according to claim 3, wherein the cardioversion therapy further comprises:

a plurality of cardioversion therapies, wherein each of said plurality of cardioversion therapies is programmed to deliver a different amount of cardioversion energy.

8. A method according to claim 6, further comprising:

in the event that a first defibrillation therapy does not terminate an arrhythmia, reconfirming the presence of an arrhythmia wherein defibrillation is an appropriate anti-arrhythmia therapy; and

delivering an increased-energy defibrillation therapy, wherein said increased-energy defibrillation therapy comprises a one of the plurality of defibrillation therapies.

9. A method according to claim 6, further comprising:

in the event that a first cardioversion therapy does not terminate an arrhythmia, reconfirming the presence of an arrhythmia wherein cardioversion is an appropriate anti-arrhythmia therapy; and

delivering an increased-energy cardioversion therapy, wherein said increased-energy cardioversion therapy comprises a one of the plurality of cardioversion therapies.

10. A computer readable media for storing instructions for determining whether to deliver or to withhold a cardiac rhythm management therapy in response to the occurrence of atrial and ventricular events, comprising, in a dual chamber implantable pulse generator:

instructions for sensing cardiac depolarization events;

instructions for determining a cardiac grammar based on the sensed events for a plurality of cardiac cycles;

instructions for applying a priority-rule based logic set to the cardiac grammar to determine if each clause of a plurality of rules of said priority-rule based logic set is firing; and

instructions for withholding a therapy or delivering the cardiac rhythm management based on a highest priority rule of the priority-rule based logic for which all clauses are firing.

11. A medium according to claim 10, wherein the cardiac depolarization events comprise a plurality of atrial-based events and a plurality of ventricular-based events.

12. A medium according to claim 10, wherein the cardiac rhythm management therapy includes at least a one of:

an atrial anti-arrhythmia-only therapy;

a ventricular anti-arrhythmia-only therapy;

a cardioversion therapy;

a defibrillation therapy;

an anti-tachycardia pacing therapy;

an anti-arrhythmia therapy.

13. A medium according to claim 12, wherein the anti-arrhythmia therapy comprises a one of:

a nerve stimulation therapy;

or

a drug administration therapy.

14. A medium according to claim 12, wherein the anti-tachycardia pacing therapy further comprises:

a plurality of anti-tachycardia pacing therapies, wherein each one of said plurality of anti-tachycardia pacing therapies having a different operating parameter than the other of said anti-tachycardia pacing therapies.

15. A system for determining whether to deliver or to withhold a cardiac rhythm management therapy in response to the occurrence of atrial and ventricular events, comprising, in a dual chamber implantable pulse generator:

means for sensing cardiac depolarization events;

means for determining a cardiac grammar based on the sensed events for a plurality of cardiac cycles;

means for applying a priority-rule based logic set to the cardiac grammar to determine if each clause of a plurality of rules of said priority-rule based logic set is firing; and

means for withholding a therapy or delivering the cardiac rhythm management based on a highest priority rule of the priority-rule based logic for which all clauses are firing.

16. A system according to claim 15, wherein the cardiac depolarization events comprise a plurality of atrial-based events and a plurality of ventricular-based events.

17. A system according to claim 15, wherein the cardiac rhythm management therapy includes at least a one of:

an atrial anti-arrhythmia-only therapy;

a ventricular anti-arrhythmia-only therapy;

a cardioversion therapy;

a defibrillation therapy;

an anti-tachycardia pacing therapy;

an anti-arrhythmia therapy.

18. A system according to claim 17, wherein the anti-arrhythmia therapy comprises a one of:

a nerve stimulation therapy;

or

a drug administration therapy.

19. A system according to claim 17, wherein the anti-tachycardia pacing therapy further comprises a plurality of anti-tachycardia pacing therapies, wherein each one of said plurality of anti-tachycardia pacing therapies having a different operating parameter than the other of said anti-tachycardia pacing therapies.