Cardiac rhythm management system with arrhythmia classification and electrode selection

• US 20060052830A1
• Filed: 11/03/2005
• Published: 03/09/2006
• Est. Priority Date: 12/20/2001
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Spinelli, Julio C., Stahmann, Jeffrey E., Zhu, Qingsheng, Kramer, Andrew P.
• Granted Patent: US 7,738,957 B2
• Time in Patent Office: Days
• US Class Current: 607/4
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions
• CPC Class Codes: A61N 1/36843 Bi-ventricular stimulation

Abstract

A system, method, or device classifies an arrhythmia according to the temporal order in which a depolarization wave associated with a particular heart contraction is received at a plurality of electrodes. One or more antiarrhythmia therapies is mapped to each arrhythmia classification. When a particularly classified arrhythmia is detected, the correspondingly mapped therapy list is selected and an appropriate antiarrhythmia therapy delivered. In one example, the particular therapy delivered in response to an arrhythmia depends at least in part on its historical success in treating arrhythmias of that classification.

Claims

1. A cardiac rhythm management device, comprising:

a plurality of electrodes, at least a first electrode of the plurality of electrodes configured to electrically couple to a right ventricle and at least a second electrode of the plurality of electrodes configured to electrically couple to a left ventricle;

an energy output circuit, coupled to the first and the second electrodes;

an arrhythmia detection circuit configured to detect tachyarrhythmia; and

a control processor coupled to the arrhythmia detection circuit and configured to select one or more electrical stimulation therapies to treat tachyarrhythmia based on a history of success of the selected one or more therapies at treating tachyarrhythmia, and to control the energy output circuit to deliver the selected one or more therapies via at least one of the first and the second electrodes.

2. The device of claim 1, wherein the control processor is configured to classify a type of tachyarrhythmia and to select the one or more therapies to treat the classified type of tachyarrhythmia.

3. The device of claim 2, wherein the one or more therapies are mapped to the classified type of tachyarrhythmia.

4. The device of claim 2, wherein the control processor is configured to select the one or more therapies based on previous successful treatment of the classified type of tachyarrhythmia using the selected one or more therapies.

5. The device of claim 1, wherein the selected one or more therapies comprise electrical stimulation delivered via the right ventricular electrode or the left ventricular electrode.

6. The device of claim 1, wherein the selected one or more therapies comprise electrical stimulation delivered to both the right ventricular electrode and the left ventricular electrode.

7. The device of claim 1, wherein the control processor is configured to select the one or more therapies from available therapies based on rankings of the history of success of the selected one or more therapies and to deliver the selected one or more therapies in order of the rankings.

8. The device of claim 7, wherein the control processor is configured to initially deliver a first therapy having a higher ranking and to deliver a second therapy having a next higher ranking if the first therapy is unsuccessful.

9. The device of claim 7, wherein the control processor is configured to the rankings of the selected one or more therapies based on success of the selected one or more therapies at treating tachyarrhythmia.

10. The device of claim 1, wherein the history of success of the selected one or more therapies comprises an undesirability of delivering the selected one or more therapies.

11. The device of claim 1, wherein the undesirability of delivering the selected one or more therapies comprises pain experienced by a patient when the selected one or more therapies are delivered to the patient.

12. The device of claim 1, wherein the history of success of the selected one or more therapies comprises a history of causing a decrease in heart rate below a threshold.

13. The device of claim 1, wherein each of the selected one or more therapies comprises a plurality of therapies.

14. The device of claim 13, wherein the plurality of therapies comprises a plurality of therapies ranked according to history of success in treating tachyarrhythmia.

15. The device of claim 13, wherein the plurality of therapies comprises a plurality of therapies unranked according to history of success in treating tachyarrhythmia.

16. The device of claim 13, wherein the plurality of therapies comprises one or more anti-tachyarrhythmia pacing therapies.

17. The device of claim 13, wherein the plurality of therapies comprises one or more cardioversion therapies.

18. The device of claim 13, wherein the plurality of therapies comprises one or more defibrillation therapies.

19. The device of claim 1, wherein the selected one or more therapies include a first therapy and a second therapy, wherein electrodes used to deliver the first therapy differ from electrodes used to deliver the second therapy.

20. The device of claim 1, wherein the selected one or more therapies include a first therapy and a second therapy, wherein a temporal offset between electrical stimulations delivered by electrodes associated with the first therapy differ from a temporal offset between electrical stimulations delivered by electrodes associated with the second therapy.

21. A method for operating a cardiac device, comprising:

detecting tachyarrhythmia; and

selecting one or more therapies to treat tachyarrhythmia based on history of success of the selected one or more therapies, at least one of the selected one or more therapies associated with electrical stimulation delivered via a left ventricular electrode.

22. The method of claim 21, wherein:

detecting tachyarrhythmia comprises classifying a type of tachyarrhythmia; and

selecting the one or more therapies comprises selecting the one or more therapies to treat the classified type of tachyarrhythmia.

23. The method of claim 22, wherein the selected one or more therapies are mapped to the classified type of tachyarrhythmia.

24. The method of claim 21, further comprising delivering the selected one or more therapies.

25. The method of claim 24, wherein:

selecting the one or more therapies comprises selecting the one or more therapies based on rankings of the history of success of the selected one or more therapies; and

delivering the selected one or more therapies comprises delivering the selected one or more therapies in order of the ratings.

26. The method of claim 25, further comprising modifying the rankings of the selected one or more therapies based on success of the selected one or more therapies at treating a tachyarrhythmia episode.

27. The method of claim 21, wherein at least another of the selected one or more therapies is associated with electrical stimulation delivered via a right ventricular electrode.

28. The method of claim 21, wherein at least another of the selected one or more therapies is associated with electrical stimulation delivered via the left ventricular electrode and a right ventricular electrode.

29. A cardiac device comprising:

means for detecting tachyarrhythmia; and

means for selecting one or more therapies to treat tachyarrhythmia based on history of success of the selected one or more therapies, at least one of the selected one or more therapies associated with electrical stimulation delivered via a left ventricular electrode.

30. The device of claim 29, further comprising:

means for selecting the one or more therapies based on rankings of the history of success of the selected one or more therapies; and

means for delivering the selected one or more therapies in order of the ratings.

31. The method of claim 30, further comprising means for modifying the rankings of the selected one or more therapies based on success of the selected one or more therapies at treating a tachyarrhythmia episode.