Arrhythmia classification and therapy selection

• US 20060074331A1
• Filed: 09/30/2004
• Published: 04/06/2006
• Est. Priority Date: 09/30/2004
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Bocek, Joseph, Kim, Jaeho, Lovett, Eric G.
• Granted Patent: US 7,894,893 B2
• Time in Patent Office: Days
• US Class Current: 600/515
• CPC Class Codes: A61B 5/35 by template matching
• CPC Class Codes: A61B 5/7264 Classification of physiological signals or data, e.g. using neural networks, statistical classifiers, expert systems or fuzzy systems neural networks per se G06N3/00; expert systems per se G06N5/00
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

Different types of cardiac arrhythmia are classified based on the morphology of the arrhythmic beats. Cardiac beats associated with an arrhythmic episode are compared to a plurality of representative beat morphologies, each representative beat morphology characterizing a type of arrhythmia of the heart. An arrhythmic episode may be classified as a particular type of arrhythmia if the morphology of the arrhythmic cardiac beats matches a representative beat morphology characterizing the particular type of arrhythmia. An appropriate therapy for the particular type of arrhythmia may be selected based on the arrhythmia classification. A particular type of arrhythmia may be associated with one or more therapies used to treat the arrhythmia. The therapy used to treat the arrhythmia may comprise a therapy identified as a previously successful therapy.

Claims

1. A method for discriminating between types of arrhythmia affecting one or more heart chambers, comprising:

detecting cardiac beats associated with an arrhythmic episode;

comparing a morphology of each cardiac beat to a plurality of representative beat morphologies respectively associated with a plurality of types of arrhythmia; and

classifying the arrhythmic episode as a particular type of arrhythmia if the morphologies of the cardiac beats are consistent with a representative beat morphology of the particular type of arrhythmia.

2. The method of claim 1, wherein comparing the morphology of each cardiac beat to the plurality of representative beat morphologies associated with the plurality of types of arrhythmia comprises comparing the morphology of each cardiac beat to the plurality of representative beat morphologies in a selected order.

3. The method of claim 1, further comprising associating a set of arrhythmia discrimination parameters with the particular type of arrhythmia, wherein comparing the morphology of each cardiac beat to the plurality of representative beat morphologies comprises comparing the morphology of each cardiac beat to the representative beat morphology using the set of arrhythmia discrimination parameters associated with the particular type of arrhythmia.

4. The method of claim 3, further comprising modifying the one or more of the arrhythmia discrimination parameters to enhance characterization of the particular type of arrhythmia.

5. The method of claim 1, wherein:

comparing the morphology each cardiac beat to the plurality of representative beat morphologies comprises comparing the morphology of each cardiac beat to a plurality of representative beat morphology templates; and

classifying the arrhythmic episode as the particular type of arrhythmia comprises classifying the arrhythmic episode as the particular type of arrhythmia if the morphologies of the cardiac beats are consistent with a representative beat morphology template associated with the particular type of arrhythmia.

6. The method of claim 1, further comprising classifying the arrhythmic episode as an unknown type of arrhythmia if the morphologies of the cardiac beats are not consistent with the plurality of representative beat morphologies.

7. The method of claim 6, further comprising:

attempting to acquire a new representative beat morphology associated with the unknown type of arrhythmia; and

classifying the arrhythmic episode as a new type of arrhythmia associated with the new representative beat morphology if the new representative beat morphology associated with the unknown type of arrhythmia is acquired.

8. The method of claim 7, further comprising classifying the arrhythmic episode as an uncharacterizable arrhythmia if the new representative beat morphology is not acquired.

9. A method for delivering cardiac therapy to a patient, comprising:

associating one or more cardiac therapies respectively with one or more types of cardiac arrhythmia;

detecting cardiac beats of an arrhythmic episode;

comparing a morphology of each cardiac beat to a plurality of representative beat morphologies respectively associated with a plurality of types of cardiac arrhythmia;

classifying the arrhythmic episode as a particular type of cardiac arrhythmia if the morphologies of the cardiac beats are consistent with a representative beat morphology of the particular type of cardiac arrhythmia; and

delivering one or more particular therapies associated with the particular type of cardiac arrhythmia if the arrhythmic episode is classified as the particular type of cardiac arrhythmia.

10. The method of claim 9, further comprising:

classifying the arrhythmic episode as an unknown type of cardiac arrhythmia if the morphology of the cardiac beats is not consistent with any of the plurality of representative beat morphologies; and

delivering one or more selected therapies to treat the unknown arrhythmia if the arrhythmic episode is classified as the unknown type of cardiac arrhythmia.

11. The method of claim 9, wherein associating the one or more cardiac therapies respectively with the one or more types of cardiac arrhythmia comprises associating at least one cardiac therapy with an arrhythmia that was successfully treated using the at least one cardiac therapy.

12. The method of claim 9, wherein delivering the one or more particular therapies comprises delivering the one or more particular therapies in a selected order.

13. The method of claim 12, wherein delivering the one or more particular therapies in the selected order comprises delivering the one or more particular therapies based on a history of effectiveness of the one or more particular therapies.

14. The method of claim 9, further comprising:

classifying the arrhythmic episode as an unknown type of cardiac arrhythmia if the morphologies of the cardiac beats are not consistent with any of the plurality of representative beat morphologies;

attempting to acquire a new representative beat morphology associated with the unknown type of cardiac arrhythmia;

associating the new representative beat morphology with a new type of cardiac arrhythmia if the new representative beat morphology is acquired.

15. The method of claim 14, further comprising:

delivering one or more selected therapies to terminate the new type of cardiac arrhythmia;

determining if a particular one of the selected therapies is successful; and

associating the successful therapy with the new type of cardiac arrhythmia.

16. The method of claim 14, further comprising determining that the cardiac beats are an uncharacterizable cardiac arrhythmia if the representative beat morphology is not acquired.

17. The method of claim 16, further comprising:

delivering one or more selected therapies to terminate the uncharacterizable cardiac arrhythmia;

determining if a particular one of the one or more selected therapies is successful; and

associating the successful therapy with the uncharacterizable cardiac arrhythmia.

18. The method of claim 9, wherein:

associating the one or more cardiac therapies respectively with the one or more types of cardiac arrhythmia comprises associating one or more previously successful cardiac therapies with each of the one or more types of cardiac arrhythmia; and

delivering the one or more particular therapies comprises delivering the one or more previously successful cardiac therapies.

19. A cardiac arrhythmia classification system, comprising:

a sensor system comprising electrodes for electrically coupling to a heart, the sensor system configured to detect cardiac beats associated with an arrhythmic episode of the heart;

an arrhythmia classification processor coupled to the sensor system, the arrhythmia classification processor configured to compare a morphology of each cardiac beat to a plurality of representative beat morphologies respectively associated with a plurality of types of arrhythmia and classify the arrhythmic episode as a particular type of arrhythmia if the morphologies of the cardiac beats are consistent with a representative beat morphology of a particular type of arrhythmia.

20. The system of claim 19, wherein the arrhythmia classification processor is configured to classify the arrhythmic episode as an unknown type of arrhythmia if the morphologies of the cardiac beats are not consistent with the plurality of representative beat morphologies.

21. The system of claim 19, wherein the arrhythmia classification processor is configured to compare the morphology of each cardiac beat to plurality of representative beat morphology templates and classify the arrhythmic episode as the particular type of arrhythmia if the morphologies of the cardiac beats are consistent with a representative beat morphology template associated with the particular type of arrhythmia.

22. The system of claim 19, wherein the arrhythmia classification processor is configured to compare the morphology of each cardiac beat to the plurality of representative beat morphologies in a selected order.

23. The system of claim 19, wherein the arrhythmia classification processor is configured to classify the arrhythmic episode as an unknown type of arrhythmia if the morphologies of the cardiac beats are not consistent with the plurality of representative beat morphologies, determine that the arrhythmic episode is characterizable as a new type of arrhythmia if the cardiac beats are classified as the unknown type of arrhythmia and determine a representative beat morphology associated with the new type of arrhythmia.

24. The system of claim 19, wherein the arrhythmia classification processor is configured to classify the arrhythmic episode as an unknown type of arrhythmia if the morphologies of the cardiac beats are not consistent with the plurality of representative beat morphologies and determine that the cardiac beats are morphologically uncharacterizable if a representative beat morphology cannot be acquired for the cardiac beats.

25. A cardiac therapy system, comprising:

a sensor system comprising electrodes for electrically coupling to a heart, the sensor system configured to detect cardiac beats of an arrhythmic episode of the heart;

an arrhythmia classification processor coupled to the sensor system, the arrhythmia classification processor configured to compare a morphology of each cardiac beat to plurality of representative beat morphologies respectively associated with a plurality of types of arrhythmia and classify the arrhythmic episode as a particular type of arrhythmia if the morphologies of the cardiac beats are consistent with a representative beat morphology of a particular type of arrhythmia; and

a therapy unit coupled to the arrhythmia classification processor, the therapy unit configured to associate one or more cardiac therapies respectively with the one or more types of arrhythmia and deliver one or more particular therapies associated with the particular type of arrhythmia if the cardiac beats are characterized as the particular type of arrhythmia.

26. The system of claim 25, wherein the arrhythmia classification processor is configured to classify the arrhythmic episode as an unknown type of arrhythmia if the morphology of the cardiac beats is not consistent with any of the plurality of representative beat morphologies.

27. The system of claim 25, wherein the therapy unit is configured to deliver one or more selected therapies to treat the unknown arrhythmia if the arrhythmic episode is classified as the unknown type of arrhythmia.

28. The system of claim 25, wherein the therapy unit is configured to associate one or more previously successful cardiac therapies with each of the one or more types of arrhythmia.

29. The system of claim 25, wherein the therapy unit is configured to deliver the one or more particular therapies in a selected order.

30. The system of claim 25, wherein the arrhythmia classification processor is configured to classify the arrhythmic episode as an unknown type of arrhythmia if the morphologies of the cardiac beats are not consistent with any of the plurality of representative beat morphologies, attempt to acquire a representative beat morphology associated with the unknown type of arrhythmia, associate the representative beat morphology with a new type of arrhythmia if the representative beat morphology is acquired, and classify the arrhythmic episode as the new type of arrhythmia if the representative beat morphology is acquired.

31. The system of claim 30, wherein the therapy unit is configured to deliver one or more selected therapies to terminate the new type of arrhythmia, determine if a particular one of the selected therapies is successful, and associate the successful therapy with the new type of arrhythmia.

32. The system of claim 30, wherein the arrhythmia classification processor is further configured to determine that the arrhythmic episode comprises an uncharacterizable arrhythmia if the representative beat morphology is not acquired.

33. The system of claim 32, wherein the therapy unit is configured to deliver one or more selected therapies to terminate the uncharacterizable arrhythmia, determine if a particular one of the one or more selected therapies is successful, and associate the successful therapy with the uncharacterizable arrhythmia.

34. A system for classifying cardiac beats, comprising:

means for detecting cardiac beats associated with an arrhythmic episode;

means for comparing a morphology of each cardiac beat to plurality of representative beat morphologies respectively associated with plurality of types of arrhythmia; and

means for classifying the arrhythmic episode as a particular type of arrhythmia if the morphologies of the cardiac beats are consistent with a representative beat morphology of a particular type of arrhythmia.

35. The system of claim 34, further comprising:

means for comparing the morphology of each cardiac beat to a plurality of representative beat morphology templates; and

means for classifying the arrhythmic episode as the particular type of arrhythmia if the morphologies of the cardiac beats are consistent with a representative beat morphology template associated with the particular type of arrhythmia.

36. The system of claim 34, further comprising:

means for classifying the arrhythmic episode as an unknown type of arrhythmia if the morphologies of the cardiac beats are not consistent with the plurality of representative beat morphologies;

means for acquiring a new representative beat morphology associated with the unknown type of arrhythmia; and

means for classifying the arrhythmic episode as a new type of arrhythmia associated with the new representative beat morphology.

37. A system for delivering cardiac therapy to a patient, comprising:

means for associating one or more cardiac therapies respectively with one or more types of arrhythmia;

means for detecting cardiac beats associated with a arrhythmic episode of one or more heart chambers;

means for comparing a morphology of each cardiac beat to plurality of representative beat morphologies respectively associated with the plurality of types of arrhythmia;

means for classifying the arrhythmic episode as a particular type of arrhythmia if the morphologies of the cardiac beats are consistent with a representative beat morphology of the particular type of arrhythmia; and

means for delivering one or more particular therapies associated with the particular type of arrhythmia if the arrhythmic episode is classified as the particular type of arrhythmia.

38. The system of claim 37, further comprising means for classifying the arrhythmic episode as an unknown type of arrhythmia if the morphology of the cardiac beats is not consistent with any of the plurality of representative beat morphologies.

39. The system of claim 37, further comprising:

means for classifying the arrhythmic episode as an unknown type of arrhythmia if the morphologies of the cardiac beats are not consistent with any of the plurality of representative beat morphologies;

means for attempting to acquire a representative beat morphology associated with the unknown type of arrhythmia;

means for associating the representative beat morphology with a new type of arrhythmia if the representative beat morphology is acquired; and

means for classifying the arrhythmic episode as the new type of arrhythmia if the representative beat morphology is acquired.

40. The system of claim 39, further comprising:

means for delivering one or more selected therapies to terminate the new type of arrhythmia;

means for determining if a particular one of the selected therapies is successful; and

means for associating the successful therapy with the new type of arrhythmia.

41. The system of claim 39, further comprising means for determining that the arrhythmic episode comprises an uncharacterizable arrhythmia if the representative beat morphology is not acquired.

42. The system of claim 41, further comprising:

means for delivering one or more selected therapies to terminate the uncharacterizable arrhythmia;

means for determining if a particular one of the one or more selected therapies is successful; and

means for associating the successful therapy with the uncharacterizable arrhythmia.