System and method for distinguishing among cardiac ischemia, hypoglycemia and hyperglycemia using an implantable medical device

• US 20060167517A1
• Filed: 01/25/2005
• Published: 07/27/2006
• Est. Priority Date: 01/25/2005
• Status: Active Grant

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Inventors: Benser, Michael, Boileau, Peter, Gill, Jong, Florio, Joseph J., Bharmi, Rupinder, Min, Xiaoyi, Bornzin, Gene A.
• Granted Patent: US 7,502,644 B2
• Time in Patent Office: Days
• US Class Current: 607/25
• CPC Class Codes: A61B 5/14532 for measuring glucose, e.g. by tissue impedance measurement
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/358 Detecting ST segments
• CPC Class Codes: A61B 5/364 Detecting abnormal ECG interval, e.g. extrasystoles, ectopic heartbeats
• CPC Class Codes: A61N 1/3621 for treating or preventing abnormally high heart rate
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/36557 controlled by chemical substances in blood
• CPC Class Codes: A61N 1/3925 Monitoring; Protecting
• CPC Class Codes: A61N 1/3962 in combination with another heart therapy
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

Techniques are described for detecting ischemia, hypoglycemia or hyperglycemia based on intracardiac electrogram (IEGM) signals. Ischemia is detected based on a shortening of the interval between the QRS complex and the end of a T-wave (QTmax), alone or in combination with a change in ST segment elevation. Alternatively, ischemia is detected based on a change in ST segment elevation combined with minimal change in the interval between the QRS complex and the end of the T-wave (QTend). Hypoglycemia is detected based on a change in ST segment elevation along with a lengthening of either QTmax or QTend. Hyperglycemia is detected based on a change in ST segment elevation along with minimal change in QTmax and in QTend. By exploiting QTmax and QTend in combination with ST segment elevation, changes in ST segment elevation caused by hypo/hyperglycemia can be properly distinguished from changes caused by ischemia.

Claims

1. A method for use with an implantable medical device for detecting cardiac ischemia in a patient in which the device is implanted, the method comprising:

tracking repolarization peak-based intervals representative of intervals between depolarization events and peaks of corresponding repolarization events within electrical cardiac signals; and

detecting an episode of cardiac ischemia based on a decrease in the repolarization peak-based intervals.

2. The method of claim 1 wherein the repolarization peak-based intervals are representative of intervals between QRS complexes and peaks of corresponding T-waves (QTmax intervals).

3. The method of claim 1 further including the step of tracking patient heart rate and wherein the repolarization peak-based intervals are normalized based on heart rate.

4. The method of claim 1

wherein the step of tracking repolarization peak-based intervals is performed to track a baseline interval based on a moving average;

and

wherein the step of detecting an episode of cardiac ischemia based on a significant decrease in the repolarization peak-based intervals is performed to detect a decrease relative to the baseline interval.

5. The method of claim 1 wherein the step of detecting an episode of cardiac ischemia based on a significant decrease in the repolarization peak-based intervals includes the step of determining if the decrease exceeds a predetermined repolarization peak-based cardiac ischemia detection threshold.

6. The method of claim 1 and further comprising:

tracking repolarization end-based intervals representative of intervals between depolarization events and ends of corresponding repolarization events within electrical cardiac signals; and

detecting an episode of cardiac ischemia based on the combination of a decrease in the repolarization peak-based intervals and a lack of significant change in durations of the repolarization end-based intervals.

7. The method of claim 1 further including the step of recording diagnostic information representative of the repolarization peak-based intervals.

8. The method of claim 7 wherein the diagnostic information includes an ischemic burden derived from the repolarization peak-based intervals.

9. The method of claim 1 further including the step of controlling therapy in response to the detection of an episode of cardiac ischemia.

10. The method of claim 9 wherein an implantable drug pump is provided and wherein the step of controlling therapy in response to the detection of an episode of cardiac ischemia includes the step of delivering anti-thrombolytic medications to the patient using the drug pump.

11. The method of claim 9 wherein an implantable cardiac stimulation device is provided and wherein the step of delivering therapy in response to the detection of an episode of cardiac ischemia includes the step of reducing a pacing rate employed by the stimulation device.

12. The method of claim 1 wherein an implantable cardiac defibrillation device is provided with defibrillation shock capacitors and wherein the capacitors are charged in response to the detection of an episode of cardiac ischemia.

13. The method of claim 1 further including the step of generating a warning signal in response to detection of an episode of cardiac ischemia.

14. The method of claim 13 wherein an implantable warning device is provided and wherein the step of generating a warning signal includes the step of delivering a perceptible warning signal to the patient via the implantable warning device.

15. The method of claim 13 for use with an external warning device and wherein the step of generating a warning signal includes the step of transmission control signals to the external warning device for controlling the external device to generate warning signals for warning the patient.

16. The method of claim 1 further including the steps of:

tracking ST segments representative of segments of the cardiac signals between depolarization events and corresponding repolarization events; and

confirming detection of an episode of cardiac ischemia based on a change in elevation of the ST segments.

17. A system for use with an implantable medical device for detecting cardiac ischemia in a patient in which the device is implanted comprising:

a timing unit operative to track repolarization peak-based intervals representative of intervals between depolarization events and peaks of corresponding repolarization events within electrical cardiac signals; and

a cardiac ischemia detection unit operative to detect an episode of cardiac ischemia based on a decrease in the repolarization peak-based intervals.

18. A system for use with an implantable medical device for detecting cardiac ischemia in a patient in which the device is implanted comprising:

a timing unit operative to track QTmax values representative of intervals between QRS complexes and peaks of corresponding T-waves within electrical cardiac signals;

a cardiac ischemia detection unit operative to detect an episode of cardiac ischemia based on a decrease in the QTmax intervals;

a warning system operative to warn the patient in response to detection of ischemia; and

a therapy control unit operative to control therapy delivered to the patient in response to detection of ischemia

19. A system for use with an implantable medical device for detecting cardiac ischemia in a patient in which the device is implanted comprising:

means for tracking repolarization peak-based intervals representative of intervals between depolarization events and peaks of corresponding repolarization events within electrical cardiac signals; and

means for detecting an episode of cardiac ischemia based on a decrease in the repolarization peak-based intervals.

20. A method for use with an implantable medical device for detecting cardiac ischemia in a patient in which the device is implanted comprising:

tracking elevations of segments of cardiac signals between depolarization events and corresponding repolarization events within electrical cardiac signals;

detecting a possible ischemia based on a change in elevation of the ST segments;

tracking repolarization-based intervals representative of intervals between depolarization events and corresponding repolarization events within the electrical cardiac signals; and

verifying the detection of ischemia based on an examination of the repolarization-based intervals.

21. A method for use with an implantable medical device for detecting ischemia within a patient in which the device is implanted comprising the steps of:

tracking activation/deactivation-based intervals between electrical cardiac signals representative of electrical activation of the ventricles and electrical cardiac signals representative of corresponding deactivation of the ventricles; and

detecting ischemia based on an examination of the activation/deactivation-based intervals.

22. The method of claim 21 wherein the activation/deactivation-based intervals are representative of intervals between QRS complexes and selected features of corresponding T-waves.

23. A method for use with an implantable medical device for distinguishing among medical conditions within a patient in which the device is implanted comprising the steps of:

tracking activation/deactivation-based intervals between electrical cardiac signals representative of electrical activation of the ventricles and electrical cardiac signals representative of corresponding deactivation of the ventricles; and

distinguishing among ischemia, hypoglycemia and hyperglycemia based on an examination of the activation/deactivation-based intervals.

24. The method of claim 23 wherein the activation/deactivation-based intervals are representative of intervals between QRS complexes and selected features of corresponding T-waves.