Automatic multi-level therapy based on morphologic organization of an arrhythmia

• US 20070049974A1
• Filed: 08/23/2005
• Published: 03/01/2007
• Est. Priority Date: 08/23/2005
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Lin, Yayun, Li, Dan
• Granted Patent: US 7,908,001 B2
• Time in Patent Office: Days
• US Class Current: 607/4
• CPC Class Codes: A61B 5/35 by template matching
• CPC Class Codes: A61B 5/363 Detecting tachycardia or bradycardia
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

Methods and systems for selecting tachyarrhythmia therapy based on the morphological organization level of the arrhythmia are described. Morphological organization levels of arrhythmias are associated with cardiac therapies. The morphological organization levels are related to cardiac signal morphologies of the arrhythmias. An arrhythmia episode is detected and the morphological organization level of the arrhythmia episode is determined. A cardiac therapy associated with the morphological organization level of the arrhythmia episode is delivered to treat the arrhythmia. For example, the morphological organization levels may be associated with the cardiac therapies based on one or more of retrospective database analysis patient therapy tolerance, and physician input. The associations may be static or may be dynamically adjusted based on therapy efficacy.

Claims

1. A method for delivering cardiac therapy, comprising:

associating morphological organization levels of arrhythmias with cardiac therapies, the morphological organization levels related to cardiac signal morphologies of the arrhythmias;

detecting an arrhythmia episode;

determining a morphological organization level of the arrhythmia episode; and

delivering a cardiac therapy associated with the morphological organization level of the arrhythmia episode.

2. The method of claim 1, wherein associating the morphological organization levels with the cardiac therapies comprises associating the morphological organization levels with multi-level therapies including a plurality of therapy components.

3. The method of claim 1, wherein associating the morphological organization levels with the cardiac therapies comprises associating one or more of the morphological organization levels with one or more of an anti-tachycardia pacing therapy and a cardiac shock therapy.

4. The method of claim 1, wherein associating the morphological organization levels with the cardiac therapies comprises associating the morphological organization levels with therapy wander times, wherein the therapy wander times represent lengths of time that the cardiac therapies are delivered.

5. The method of claim 1, wherein determining the morphological organization level of the arrhythmia episode comprises determining the morphological organization level based on at least one of morphological regularity of a cardiac electrogram signal of the arrhythmia episode, entropy of the cardiac electrogram, and hemodynamic stability of the arrhythmia episode.

6. The method of claim 5, wherein determining the morphological organization level of the arrhythmia episode comprises determining the morphological organization level based on a combination of at least two of the morphological regularity, the entropy, and the hemodynamic stability.

7. The method of claim 1, wherein determining the morphological organization level of the arrhythmia episode comprises comparing morphologies of one or more of the cardiac beat signals of the arrhythmia episode to a template.

8. The method of claim 1, wherein determining the morphological organization level of the arrhythmia episode based on the morphological regularity of the cardiac beat signals of the arrhythmia episode comprises determining comparing a morphology of a cardiac beat signal of the arrhythmia episode to a morphology of another cardiac beat signal of the arrhythmia episode.

9. The method of claim 1, wherein determining the morphological organization level of the arrhythmia episode comprises determining the morphological organization based on rate irregularity of the arrhythmia episode.

10. The method of claim 1, wherein determining the morphological organization level of the arrhythmia episode comprises determining the morphological organization level based on morphological complexity of a cardiac electrogram signal of the arrhythmia episode.

11. The method of claim 1, wherein determining the morphological organization level of the arrhythmia episode comprises determining the morphological organization based on hemodynamic stability of the arrhythmia episode.

12. The method of claim 1, wherein determining the morphological organization level of the arrhythmia episode comprises determining the morphological organization using one or more thresholds respectively associated with one or more measures of morphological organization.

13. The method of claim 1, wherein associating the morphological organization levels with the cardiac therapies comprises associating the morphological organization levels with the cardiac therapies based on one or more of retrospective database analysis, patient therapy tolerance, and physician input.

14. The method of claim 1, wherein delivering the cardiac therapy associated with the morphological organization level of the arrhythmia episode comprises:

delivering one or more components of the cardiac therapy; and

sensing for redetection of the arrhythmia following delivery of one or more of the therapy components.

15. The method of claim 14, further comprising sensing for redetection of the arrhythmia more often for a more organized arrhythmia episode and sensing for redetection of the arrhythmia less often for a less organized arrhythmia episode.

16. The method of claim 1, wherein associating the morphological organization levels with the cardiac therapies comprises statically associating the morphological organization levels with the cardiac therapies.

17. The method of claim 1, wherein associating the morphological organization levels with the cardiac therapies comprises dynamically associating the morphological organization levels with the cardiac therapies.

18. The method of claim 1, wherein associating the morphological organization levels with the cardiac therapies comprises associating the morphological organization levels with the cardiac therapies based on one or more of historical data, patient therapy tolerance and physician input.

19. The method of claim 1, wherein associating the morphological organization levels with the cardiac therapies comprises dynamically changing the association of the morphological organization levels with the cardiac therapies based on efficacy of the cardiac therapies.

20. The method of claim 1, further comprising:

determining an efficacy of the delivered cardiac therapy; and

modifying at least one of the morphological organization level associated with the cardiac therapy and a therapy parameter based on an efficacy of the delivered cardiac therapy.

21. A cardiac rhythm management device, comprising:

a processor configured to associate morphological organization levels of arrhythmias with cardiac therapies, the morphological organization levels related to cardiac signal morphologies of the arrhythmias, the processor further configured to determine a morphological organization level of an arrhythmia episode;

an arrhythmia detector configured to detect the arrhythmia episode; and

therapy circuitry configured to deliver a cardiac therapy associated with the morphological organization level of the arrhythmia episode.

22. The device of claim 21, wherein the processor is configured to determine the morphological organization level of the arrhythmia episode based on at least one of morphological regularity of a cardiac electrogram signal of the arrhythmia episode, entropy of the cardiac electrogram signal, rate regularity of the arrhythmia episode, and hemodynamics of the arrhythmia episode.

23. The device of claim 21, wherein the processor is configured to compare morphologies of one or more cardiac beat signals of the arrhythmia episode to a template to determine the morphological organization of the arrhythmia episode.

24. The device of claim 21, wherein the processor is configured to compare a morphology of one cardiac beat signal of the arrhythmia episode to a morphology of another cardiac beat signal of the arrhythmia episode to determine the morphological organization of the arrhythmia episode.

25. The device of claim 21, further comprising a hemodynamics sensor, wherein the processor is configured to determine morphological organization of the arrhythmia episode based on an output of the hemodynamics sensor.

26. The device of claim 25, wherein the hemodynamics sensor comprises an impedance sensor.

27. The device of claim 25, wherein the hemodynamics sensor comprises a pressure sensor.

28. The device of claim 21, wherein the processor is configured to associate the morphological organization levels with the cardiac therapies based on one or more of retrospective database analysis, patient therapy tolerance, and physician input.

29. The device of claim 21, wherein the therapy circuitry is configured to deliver one or more of an anti-tachyarrhythmia pacing therapy and a shock therapy.

30. The device of claim 21, wherein the arrhythmia detector is configured to sense for redetection of the arrhythmia episode following delivery of the one or more therapy components of the cardiac therapy.

31. The device of claim 21, wherein the processor is configured to statically associate the morphological organization levels with the cardiac therapies.

32. The device of claim 21, wherein the processor is configured to dynamically associate the morphological organization levels with the cardiac therapies.

33. The device of claim 21, wherein the processor is configured to modify the association of the morphological organization levels with the cardiac therapies based on efficacy of the cardiac therapies.

34. The device of claim 21, wherein the processor is configured to determine an efficacy of the delivered cardiac therapy and to modify at least one of the morphological organization level associated with the cardiac therapy and a therapy parameter based on the efficacy of the delivered cardiac therapy.

35. The device of claim 21, further comprising a memory, wherein the memory stores a library of the cardiac therapies and an association map between the morphological organization levels and the cardiac therapies.

36. The device of claim 21, wherein the device is patient implantable.