Method and apparatus for arrhythmia classification using atrial signal mapping
First Claim
1. A cardiac rhythm management system coupled to a heart having a right atrium (RA) connected to a superior vena cava, a left atrium (LA), a left ventricle (LV), a sinoatrial (SA) node, an atrial septum, a coronary sinus, and a coronary vein, the system comprising:
- a high RA (HRA) electrode configured for placement near the SA node to sense an RA electrogram;
an LA electrode configured for placement near the LA to sense an LA electrogram;
an atrial septal electrode configured for placement in or near the atrial septum to sense an atrial septal electrogram;
a ventricular electrode configured for placement in or near a ventricle to sense a ventricular electrogram; and
an implantable medical device coupled to the HRA electrode, the LA electrode, the atrial septal electrode, and the ventricular electrode, the implantable medical device including a sensing circuit to sense the RA electrogram, the LA electrogram, the atrial septal electrogram, and the ventricular electrogram, an arrhythmia detection circuit to detect a tachyarrhythmia based in at least one of the RA electrogram, the LA electrogram, the atrial septal electrogram, and the ventricular electrogram, and an arrhythmia classification circuit to classify the detected tachyarrhythmia, the arrhythmia classification circuit including;
an atrial signal mapping module to map an atrial activation sequence based on the RA electrogram, the LA electrogram, and atrial septal electrogram, the atrial activation sequence indicative of an order of regional depolarizations during an atrial depolarization; and
an atrial pattern analyzer to classify the detected tachyarrhythmia based on the atrial activation sequence.
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Accused Products
Abstract
An implantable medical device senses a plurality of electrograms from substantially different atrial locations, detects regional depolarizations from the electrograms, and analyzes timing relationships among the regional depolarizations. The timing relationships provide a basis for effective therapy control and/or prognosis of certain cardiac disorders. In one embodiment, an atrial activation sequence is mapped to show the order of occurrences of the regional depolarizations during an atrial depolarization for classifying a detected tachyarrhythmia by its origin. In another embodiment, conduction time between two atrial locations is measured for monitoring the development of an abnormal atrial conditions and/or the effect of a therapy.
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Citations
53 Claims
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1. A cardiac rhythm management system coupled to a heart having a right atrium (RA) connected to a superior vena cava, a left atrium (LA), a left ventricle (LV), a sinoatrial (SA) node, an atrial septum, a coronary sinus, and a coronary vein, the system comprising:
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a high RA (HRA) electrode configured for placement near the SA node to sense an RA electrogram;
an LA electrode configured for placement near the LA to sense an LA electrogram;
an atrial septal electrode configured for placement in or near the atrial septum to sense an atrial septal electrogram;
a ventricular electrode configured for placement in or near a ventricle to sense a ventricular electrogram; and
an implantable medical device coupled to the HRA electrode, the LA electrode, the atrial septal electrode, and the ventricular electrode, the implantable medical device including a sensing circuit to sense the RA electrogram, the LA electrogram, the atrial septal electrogram, and the ventricular electrogram, an arrhythmia detection circuit to detect a tachyarrhythmia based in at least one of the RA electrogram, the LA electrogram, the atrial septal electrogram, and the ventricular electrogram, and an arrhythmia classification circuit to classify the detected tachyarrhythmia, the arrhythmia classification circuit including;
an atrial signal mapping module to map an atrial activation sequence based on the RA electrogram, the LA electrogram, and atrial septal electrogram, the atrial activation sequence indicative of an order of regional depolarizations during an atrial depolarization; and
an atrial pattern analyzer to classify the detected tachyarrhythmia based on the atrial activation sequence. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12)
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13. A system for tachyarrhythmia detection and classification, the system comprising:
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a sensing circuit to sense a plurality of atrial electrograms and at least one ventricular electrogram;
a rate detection circuit, coupled to the sensing circuit, to detect an atrial rate from at least one atrial electrogram of the plurality of atrial electrograms and a ventricular rate from the at least one ventricular electrogram;
an arrhythmia detection circuit, coupled to the rate detection circuit, to detect a tachyarrhythmia based on at least one of the atrial rate and the ventricular rate; and
an arrhythmia classification circuit coupled to the sensing circuit, the rate detection circuit, and the arrhythmia detection circuit, the arrhythmia classification circuit including;
a 1;
1 tachyarrhythmia detector adapted to classify the detected tachyarrhythmia as a 1;
1 tachyarrhythmia when the atrial rate and the ventricular rate are substantially equal;
an atrial signal mapping module adapted to map an atrial activation sequence based on the plurality of atrial electrograms, the atrial activation sequence indicative of an order of regional depolarizations during an atrial depolarization; and
an atrial pattern analyzer to classify the 1;
1 tachyarrhythmia based on the atrial activation sequence. - View Dependent Claims (14, 15, 16, 17, 18, 19)
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20. A system, coupled to a heart having a right atrium (RA) connected to a superior vena cava, a left atrium (LA), a sinoatrial (SA) node, a coronary sinus, and a coronary vein, for monitoring prognostic factors for atrial fibrillation and heart failure, the system comprising:
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a first electrode configured for placement in the RA or superior vena cava near the SA node to sense an RA electrogram indicative of cardiac depolarizations in an upper RA region including the SA node;
a second electrode configured for placement in the coronary sinus or coronary vein near the LA to sense an LA electrogram indicative of cardiac depolarizations in the LA;
a sensing circuit coupled to the first electrode to sense the RA electrogram and coupled to the second electrode to sense the LA electrogram;
an event detection circuit, coupled to the sensing circuit, to detect an RA event from the RA electrogram and an LA event from the LA electrogram during an atrial depolarization; and
an inter-atrial interval measurement circuit, coupled to the event detection circuit, to measure an inter-atrial interval between the RA event and the LA event. - View Dependent Claims (21, 22, 23, 24, 25, 26, 27)
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28. A method for classifying a tachyarrhythmia by origin, comprising:
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receiving an atrial activation sequence indicative of an order of occurrence of a right atrial (RA) event, an atrial septal event, and an left atrial (LA) event during an atrial depolarization;
classifying the tachyarrhythmia as a tachyarrhythmia of RA origin if the RA event occurs first in the atrial activation sequence;
classifying the tachyarrhythmia as a tachyarrhythmia of LA origin if the LA event occurs first in the atrial activation sequence; and
classifying the tachyarrhythmia as a tachyarrhythmia of atrial septal or ventricular origin if the atrial septal event occurs first in the atrial activation sequence. - View Dependent Claims (29, 30, 31)
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32. A method for detecting and classifying tachyarrhythmia in a heart having a right atrium (RA), a left atrium (LA), a left ventricle (LV), a sinoatrial (SA) node, and an atrial septum, the method comprising:
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sensing a plurality of atrial electrograms indicative of regional depolarizations in a plurality of substantially different atrial locations and at least one ventricular electrogram;
detecting an atrial rate from at least one atrial electrogram of the plurality of atrial electrograms and a ventricular rate from the at least one ventricular electrogram;
detecting a tachyarrhythmia based on at least one of the atrial rate and the ventricular rate;
classifying the detected tachyarrhythmia as a 1;
1 tachyarrhythmia when the atrial rate and the ventricular rate are substantially equal;
mapping an atrial activation sequence based on the plurality of atrial electrograms, the atrial activation sequence indicative of an order of occurrence of regional depolarizations in the plurality of substantially different atrial locations during an atrial depolarization; and
classifying the 1;
1 tachyarrhythmia based on the atrial activation sequence. - View Dependent Claims (33, 34, 35, 36, 37, 38, 39, 40)
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41. A method for monitoring a heart having a right atrium (RA) connected to a superior vena cava, a left atrium (LA), a sinoatrial (SA) node, an atrial septum, a coronary sinus, and a coronary vein, the method comprising:
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sensing an RA electrogram using an electrode placed in the RA or the superior vena cava near the SA node, the RA electrogram indicative of cardiac depolarizations in an upper RA region including the SA node;
sensing an LA electrogram using an electrode placed in the coronary sinus or coronary vein near the LA, the LA electrogram indicative of cardiac depolarizations in the LA;
detecting an RA event from the RA electrogram and an LA event from the LA electrogram for each atrial depolarization; and
measuring an inter-atrial interval between the RA event and the LA event. - View Dependent Claims (42, 43, 44, 45, 46, 47)
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48. A lead for electrically coupling an implantable medical device to a heart having a right atrium (RA) connected to a vena cava, a left atrium (LA), a left ventricle (LV), a sinoatrial (SA) node, an atrial septum, a coronary sinus, a coronary vein, the lead comprising:
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an elongate lead body having a primary end and a distal end, the primary end coupled to a connector configured for connecting to the implantable medical device;
first, second, and third conductors disposed within the lead body and coupled to the connector;
an LA electrode coupled to the first conductor and configured for placement in the coronary sinus or coronary vein near the LA;
an atrial septal electrode coupled to the second conductor and configured for placement in the coronary sinus near the atrial septum; and
a high RA (HRA) electrode coupled to the third conductor and configured for placement in the RA or the superior vena cava near the SA node. - View Dependent Claims (49, 50)
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51. A lead for electrically coupling an implantable medical device to a heart having a right atrium (RA) connected to a superior vena cava, a sinoatrial (SA) node, and an atrial septum, the lead comprising:
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an elongate lead body having a primary end and a distal end, the primary end coupled to a connector configured for connecting to the implantable medical device;
first and second conductors disposed within the lead body and coupled to the connector;
a high RA (HRA) electrode coupled to the first conductor and configured for placement in the RA or the superior vena cava near the SA node; and
a second RA electrode coupled to the second conductor and configured for placement in the RA. - View Dependent Claims (52, 53)
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Specification