Cardiac rhythm management system with exercise test interface

• US 20050065443A1
• Filed: 09/22/2003
• Published: 03/24/2005
• Est. Priority Date: 09/22/2003
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Ternes, David
• Granted Patent: US 7,532,924 B2
• Time in Patent Office: Days
• US Class Current: 600/509
• CPC Class Codes: A61B 5/0006 ECG or EEG signals
• CPC Class Codes: A61B 5/0205 Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition
• CPC Class Codes: A61B 5/021 Measuring pressure in heart or blood vessels A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/02405 Determining heart rate variability
• CPC Class Codes: A61B 5/029 Measuring or recording blood output from the heart, e.g. minute volume A61B8/065 takes precedence
• CPC Class Codes: A61B 5/11 Measuring movement of the entire body or parts thereof, e.g. head or hand tremor, mobility of a limb for measuring pulse A61B5/02 ;A61B5/1038 takes precedence; motion detection to correct for motion artifacts in physiological signals A61B5/721
• CPC Class Codes: A61B 5/333 Recording apparatus specially adapted therefor
• CPC Class Codes: A61B 5/35 by template matching
• CPC Class Codes: A61B 5/363 Detecting tachycardia or bradycardia
• CPC Class Codes: A61B 5/364 Detecting abnormal ECG interval, e.g. extrasystoles, ectopic heartbeats
• CPC Class Codes: A61B 5/4884 inducing physiological or psychological stress, e.g. applications for stress testing
• CPC Class Codes: A61N 1/3702 Physiological parameters A61N1/365 takes precedence; evoked response A61N1/371

Abstract

This document discusses, among other things, cardiac rhythm management systems, devices, and methods providing an exercise test interface. A patient exercise episode is identified using at least one predetermined criteria. Data associated with the episode is obtained. A summary of the episode is displayed for a user. The displayed summary includes at least one prognostic indicator obtained from the data associated with the episode. Examples of prognostic indicators include, among other things, ectopic beats, runs of ectopic beats, rate of decrease of heart rate during a post-exercise recovery portion of the episode, a maximum attained heart rate for comparison to a maximum age-predicted heart rate, as well as other prognostic indicators.

Claims

1. A method comprising:

identifying a patient exercise episode using at least one predetermined criteria;

obtaining data associated with the episode; and

displaying a summary of the episode, including displaying at least one prognostic indicator obtained from the data associated with the episode.

2. The method of claim 1, in which the identifying the patient exercise episode comprises identifying the episode that includes both an exercise period and a post-exercise recovery period.

3. The method of claim 1, in which the obtaining data includes obtaining heart rate data, and in which the identifying the patient exercise episode using at least one predetermined criteria includes using at least one heart rate threshold, wherein heart rates that substantially continuously exceed the heart rate threshold define the episode.

4. The method of claim 1, in which the obtaining data includes obtaining metabolic need sensor data, and in which the identifying the patient exercise episode using at least one predetermined criteria includes using at least one metabolic need sensor threshold, wherein metabolic need sensor levels that substantially continuously exceed the metabolic need sensor threshold define the episode.

5. The method of claim 1, in which the identifying the patient exercise episode using at least one predetermined criteria includes using at least one user-provided trigger.

6. The method of claim 5, in which the using the at least one user-provided trigger includes defining at least one of the beginning of the episode and the end of the episode using the at least one user-provided trigger.

7. The method of claim 1, further comprising communicating the data from an implantable cardiac rhythm management device within the patient.

8. The method of claim 1, in which the displaying the at least one prognostic indicator includes displaying an indication of how many ectopic beats occurred during the episode.

9. The method of claim 1, in which the displaying the at least one prognostic indicator includes displaying an indication of how many ectopic beats occurred during an exercise portion of the episode.

10. The method of claim 1, in which the displaying the at least one prognostic indicator includes displaying an indication of how many ectopic beats occurred during a post-exercise recovery portion of the episode.

11. The method of claim 1, in which the displaying the at least one prognostic indicator includes displaying at least one indication of how many runs of sequential ectopic beats occurred during the episode.

12. The method of claim 1, in which the displaying the at least one prognostic indicator includes displaying at least one indication of how many runs of sequential ectopic beats occurred during an exercise portion of the episode.

13. The method of claim 1, in which the displaying the at least one prognostic indicator includes displaying at least one indication of how many runs of sequential ectopic beats occurred during a post-exercise recovery portion of the episode.

14. The method of claim 1, in which the displaying the at least one prognostic indicator includes displaying an indication of a rate of decrease of the patient'"'"'s heart rate during a post-exercise recovery portion of the episode.

15. The method of claim 1, in which the displaying the at least one prognostic indicator includes displaying an indication of a maximum heart rate obtained by the patient during the episode.

16. The method of claim 15, in which the displaying the at least one prognostic indicator includes displaying an indication of an age-predicted maximum heart rate for the patient for comparison to the indication of the maximum heart rate obtained by the patient during the episode.

17. The method of claim 16, in which the displaying the at least one prognostic indicator includes displaying an indication of a comparison between the maximum heart rate obtained by the patient during the episode and the indication of the age-predicted maximum heart rate for the patient.

18. The method of claim 1, in which the displaying the at least one prognostic indicator includes displaying a resting heart rate associated with the episode.

19. The method of claim 18, in which the displaying the resting heart rate includes flagging an elevated value of the resting heart rate.

20. The method of claim 1, in which the displaying the at least one prognostic indicator includes displaying a heart rate variability associated with the episode.

21. The method of claim 20, in which the displaying the heart rate variability includes flagging a low heart rate variability.

22. The method of claim 1, in which the displaying the at least one prognostic indicator includes displaying an indication of T-wave altemans associated with the episode.

23. The method of claim 22, in which the displaying the indication of T-wave alternans includes displaying an accompanying heart rate corresponding to an onset of the T-wave alternans associated with the episode.

24. The method of claim 1, in which the displaying the at least one prognostic indicator includes displaying an indication of heart rate turbulence associated with the episode.

25. The method of claim 1, in which the displaying the at least one prognostic indicator includes displaying an indication of QT dispersion associated with the episode.

26. The method of claim 1, in which the displaying the at least one prognostic indicator includes displaying an indication of paroxysmal atrial tachyarrhythmia associated with the episode.

27. The method of claim 1, in which the displaying the summary includes displaying a graph of heart rate vs. time during at least a portion of the episode.

28. The method of claim 27, in which the displaying the graph includes displaying an ectopic beat indicator associated with each ectopic beat occurring during the episode.

29. The method of claim 27, in which the displaying the graph includes displaying an indication of the age-predicted maximum heart rate for the patient.

30. The method of claim 27, in which the displaying the graph includes displaying a first indicator of at least one exercise period during the episode.

31. The method of claim 30, in which the displaying the graph also includes displaying a second indicator of at least one post-exercise recovery period during the episode.

32. The method of claim 31, in which the displaying the first indicator includes displaying a first background color and the displaying the second indicator includes displaying a different second background color.

33. The method of claim 1, in which the displaying the summary includes displaying a graph of patient activity vs. time, during the episode, in visual correspondence with the graph of heart rate vs. time during the episode.

34. The method of claim 1, in which the displaying the summary includes displaying a heart electrical activity signal associated with the episode.

35. The method of claim 1, further including storing the data associated with the episode.

36. The method of claim 35, further including storing the data associated with multiple occurrences of the episode.

37. A computer readable medium including instructions for:

identifying a patient exercise episode using at least one predetermined criteria;

obtaining data associated with the episode; and

displaying a summary of the episode, including displaying at least one prognostic indicator obtained from the data associated with the episode.

38. A system comprising:

a processor circuit, including at least one predetermined criteria to identify a exercise episode of a patient, and including a data input circuit to receive data associated with the episode;

a memory storage circuit, coupled to the data input circuit to store the data; and

an external display, including a displayed summary of the episode, the summary including at least one displayed prognostic indicator obtained from the data associated with the episode.

39. The system of claim 38, in which the episode includes an exercise period and a post-exercise recovery period.

40. The system of claim 38, in which the data input circuit receives heart rate data, and in which the at least one predetermined criteria includes at least one heart rate threshold that defines the episode for heart rates substantially continuously exceeding the at least one heart rate threshold.

41. The system of claim 38, in which the data input circuit receives activity sensor data, and in which the at least one predetermined criteria includes at least one activity sensor threshold that defines the episode for activity sensor levels that substantially continuously exceed the activity sensor threshold.

42. The system of claim 38, in which the processor includes a user-input circuit to receive at least one user-provided trigger identifying the episode.

43. The system of claim 38, in which the at least one displayed prognostic indicator includes an indication of how many ectopic beats occurred during the episode.

44. The system of claim 38, in which the at least one displayed prognostic indicator includes an indication of how many ectopic beats occurred during an exercise portion of the episode.

45. The system of claim 38, in which the at least one displayed prognostic indicator includes an indication of how many ectopic beats occurred during a post-exercise recovery portion of the episode.

46. The system of claim 38, in which the at least one displayed prognostic indicator includes an indication of how many sequential runs of ectopic beats occurred during the episode.

47. The system of claim 38, in which the at least one displayed prognostic indicator includes an indication of how many sequential runs of ectopic beats occurred during an exercise portion of the episode.

48. The system of claim 38, in which the at least one displayed prognostic indicator includes an indication of how many sequential runs of ectopic beats occurred during a post-exercise recovery portion of the episode.

49. The system of claim 38, in which the at least one displayed prognostic indicator includes an indication of a rate of decrease of the patient'"'"'s heart rate during a post-exercise recovery portion of the episode.

50. The system of claim 38, in which the at least one displayed prognostic indicator includes an indication of a maximum heart rate obtained by the patient during the episode.

51. The system of claim 50, in which the at least one displayed prognostic indicator includes an indication of an age-predicted maximum heart rate for the patient for comparison to the indication of the maximum heart rate obtained by the patient during the episode.

52. The system of claim 51, in which the at least one displayed prognostic indicator includes an indication of a comparison between the maximum heart rate obtained by the patient during the episode and the indication of the age-predicted maximum heart rate for the patient.

53. The system of claim 38, in which the at least one displayed prognostic indicator includes a resting heart rate associated with the episode.

54. The system of claim 38 in which the at least one prognostic indicator indicates an elevated value of the resting heart rate.

55. The system of claim 38, in which the at least one prognostic indicator includes an indication of heart rate variability associated with the episode.

56. The system of claim 38, in which the at least one prognostic indicator indicates a low heart rate variability.

57. The system of claim 55, in which the at least one prognostic indicator includes an indication of T-wave alternans associated with the episode.

58. The system of claim 38, in which the at least one prognostic indicator includes an indication of a heart rate corresponding to an onset of a T-wave alternans associated with the episode.

59. The system of claim 38, in which the at least one prognostic indicator includes an indication of heart rate turbulence associated with the episode.

60. The system of claim 38, in which the at least one prognostic indicator includes an indication of QT dispersion associated with the episode.

61. The system of claim 38, in which the at least one prognostic indicator includes an indication of paroxysmal atrial tachyarrhythmia associated with the episode.

62. The system of claim 38, in which the displayed summary includes a displayed graph of heart rate vs. time during at least a portion of the episode.

63. The system of claim 62, in which the graph includes an ectopic beat indicator associated with each ectopic beat occurring during the episode.

64. The system of claim 62, in which the graph includes an indication of the age-predicted maximum heart rate for the patient.

65. The system of claim 62, in which the graph includes a first indicator of at least one exercise period during the episode.

66. The system of claim 65, in which the graph further includes a second indicator of at least one post-exercise refractory period during the episode.

67. The system of claim 66, in which the first and second indicators include different background colors.

68. The system of claim 38, in which the summary includes a displayed graph of patient activity vs. time during the episode.

69. The system of claim 38, in which the summary includes a displayed heart electrical activity signal associated with the episode.

70. The system of claim 38, in which the processor is located in an implantable device.

71. The system of claim 38, in which the processor is located in an external device.

72. A system comprising:

a processor circuit, including at least one predetermined criteria to identify a exercise episode of a patient, and including a data input circuit to receive data associated with the episode;

a memory storage circuit, coupled to the data input circuit to store the data; and

means for displaying a summary of the episode, including displaying at least one displayed prognostic indicator obtained from the data associated with the episode.

73. The system of claim 72, in which the episode includes an exercise period and a post-exercise recovery period.

74. The system of claim 72, in which the data input circuit receives heart rate data, and in which the at least one predetermined criteria includes at least one heart rate threshold that defines the episode for heart rates substantially continuously exceeding the at least one heart rate threshold.

75. The system of claim 72, in which the data input circuit receives activity sensor data, and in which the at least one predetermined criteria includes at least one activity sensor threshold that defines the episode for activity sensor levels that substantially continuously exceed the activity sensor threshold.

76. The system of claim 72, in which the processor includes a user-input circuit to receive at least one user-provided trigger identifying the episode.

77. The system of claim 72, in which the at least one displayed prognostic indicator includes an indication of how many ectopic beats occurred during the episode.

78. The system of claim 72, in which the at least one displayed prognostic indicator includes an indication of how many ectopic beats occurred during an exercise portion of the episode.

79. The system of claim 72, in which the at least one displayed prognostic indicator includes an indication of how many ectopic beats occurred during a post-exercise recovery portion of the episode.

80. The system of claim 72, in which the at least one displayed prognostic indicator includes an indication of a rate of decrease of the patient'"'"'s heart rate during a post-exercise recovery portion of the episode.