METHOD AND APPARATUS FOR DETECTING NON-SUSTAINING VENTRICULAR TACHYARRHYTHMIA

• US 20070293894A1
• Filed: 06/16/2006
• Published: 12/20/2007
• Est. Priority Date: 06/16/2006
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Zhang, Yunlong, Kim, Jaeho
• Granted Patent: US 7,689,282 B2
• Time in Patent Office: Days
• US Class Current: 607/5
• CPC Class Codes: A61N 1/3621 for treating or preventing abnormally high heart rate
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

An implantable medical device controls an anti-tachyarrhythmia therapy by detecting a tachyarrhythmia episode from a cardiac signal and analyzing the detected tachyarrhythmia episode in a tachyarrhythmia detection and analysis process to determine whether the anti-tachyarrhythmia therapy needs to be delivered. The tachyarrhythmia detection and classification process includes detection of inhibitory events each indicating that the tachyarrhythmia episode is of a type not to be treated by the anti-tachyarrhythmia therapy or that the tachyarrhythmia episode is not sustaining. The detection of each of the inhibitory events causes the tachyarrhythmia detection and classification process to be restarted or extended, or the delivery of the anti-tachyarrhythmia therapy to be withheld.

Claims

1. An implantable medical device, comprising:

a sensing circuit to sense a cardiac signal; and

a controller adapted to control a delivery of an anti-tachyarrhythmia therapy, the controller including;

a tachyarrhythmia detector coupled to the sensing circuit, the tachyarrhythmia detector adapted to detect a predetermined type initiation event indicative of a tachyarrhythmia episode from the cardiac signal, to start a tachyarrhythmia detection and classification process in response to the detection of the predetermined type initiation event, and to restart or extend the tachyarrhythmia detection and classification process in response to a detection of a predetermined type inhibitory event, the tachyarrhythmia detection and classification process determining whether the tachyarrhythmia episode sustains and is to be treated by the delivery of the anti-tachyarrhythmia therapy; and

an inhibitory event detector coupled to the tachyarrhythmia detector, the inhibitory event detector adapted to detect the predetermined type inhibitory event from the cardiac signal, the predetermined type inhibitory event indicative of a need to inhibit the delivery of the anti-tachyarrhythmia therapy.

2. The implantable medical device of claim 1, further comprising a defibrillation circuit to deliver cardioversion/defibrillation pulses, wherein the controller comprises a defibrillation controller coupled to the tachyarrhythmia detector and the defibrillation circuit, the defibrillation controller adapted to control the delivery of the cardioversion/defibrillation pulses, and wherein the delivery of the anti-tachyarrhythmia therapy comprises a delivery of one or more of the cardioversion/defibrillation pulses.

3. The implantable medical device of claim 1, further comprising a pacing circuit to deliver pacing pulses, wherein the controller comprises a pacing controller coupled to the tachyarrhythmia detector and the pacing circuit, the pacing controller adapted to control the delivery of the pacing pulses according to an anti-tachyarrhythmia pacing (ATP) algorithm, and wherein the delivery of the anti-tachyarrhythmia therapy comprises a delivery of one or more of the pacing pulses.

4. The implantable medical device of claim 1, wherein the controller comprises:

a beat detector to detect heart beats from the cardiac signal;

a heart rate detector to detect a heart rate associated with each of the detected heart beats; and

a beat classifier adapted to classify each of the detected heart beat as one of a fast beat and a slow beat using the heart rate associated with the each of the detected heart beats, the fast beat being a detected heart beat associated with a heart rate within a tachyarrhythmia detection zone, the slow beat being one of a detected heart beat associated with a heart rate below the tachyarrhythmia detection zone and a paced heart beat.

5. The implantable medical device of claim 4, wherein the inhibitory event detector comprises an arrhythmia pattern detector adapted to detect a predetermined type arrhythmia pattern and indicate the detection of the predetermined type inhibitory event when the predetermined type arrhythmia pattern is detected, the predetermined type arrhythmia pattern including repetitive beat sequences each including a first number (F) of the fast beats followed by a second number (S) of the slow beats, wherein in the numbers F and S fall into one or more predetermined patterns.

6. The implantable medical device of claim 5, wherein the arrhythmia pattern detector is adapted to detect predetermined type arrhythmia patterns in which:

F is equal to or greater than 3 if S is equal to 1;

F is equal to or greater than 4 if S is equal to 2;

F is equal to or greater than 8 if S is equal to 3; and

F is equal to or greater than 8 if S is equal to 4.

7. The implantable medical device of claim 5, wherein the repetitive beat sequences include at least two beat sequences having different ratios of F to S each falling into one of a plurality of predetermined patterns.

8. The implantable medical device of claim 4, wherein the inhibitory event detector comprises a slow beat analyzer to analyze each of the slow beats to detect normal slow beats and indicate the detection of the predetermined type inhibitory event when one or more of the normal slow beats are detected.

9. The implantable medical device of claim 8, wherein the inhibitory event detector is adapted to indicate the detection of the predetermined type inhibitory event when one or more paced beats are detected.

10. The implantable medical device of claim 8, wherein the inhibitory event detector comprises a correlation analyzer to analyze a correlation between a slow beat morphology and a template beat morphology and declare a detection of the normal slow beat when the slow beat morphology and the template beat morphology substantially correlate, the slow beat morphology being a morphology of the cardiac signal sensed during one of the detected slow beats.

11. The implantable medical device of claim 4, wherein the tachyarrhythmia detector comprises a tachyarrhythmia detection module including:

a detection timer adapted to start a tachyarrhythmia detection window in response to the detection of the predetermined type initiation event, the tachyarrhythmia detection window including a predetermined number of consecutively detected beats; and

a detection declaration module adapted to declare a detection of tachyarrhythmia when a number of the fast beats detected during the tachyarrhythmia detection window equals or exceeds a predetermined detection threshold.

12. The implantable medical device of claim 11, wherein the detection timer is adapted to restart the tachyarrhythmia detection window in response to the detection of the predetermined type inhibitory event.

13. The implantable medical device of claim 11, wherein the tachyarrhythmia detector comprises a tachyarrhythmia verification module coupled to the tachyarrhythmia detection module, the tachyarrhythmia verification module including:

a duration timer adapted to start a tachyarrhythmia verification duration when the detection of tachyarrhythmia is declared and to time the tachyarrhythmia verification duration; and

a verification declaration module adapted to declare that the tachyarrhythmia episode sustains when a number of the fast beats detected during a verification window equals or exceeds a predetermined verification threshold, the verification window being a moving window ending with each heart beat detected during the tachyarrhythmia verification duration and including a predetermined number of consecutively detected heart beats.

14. The implantable medical device of claim 13, wherein the duration timer is adapted to extend the tachyarrhythmia verification duration in response to the detection of the predetermined type inhibitory event.

15. The implantable medical device of claim 13, wherein the tachyarrhythmia detector further comprises a tachyarrhythmia classification module adapted to classify the tachyarrhythmia episode when the tachyarrhythmia verification duration expires.

16. The implantable medical device of claim 15, wherein the tachyarrhythmia detector further comprises a tachyarrhythmia reconfirmation module including:

a reconfirmation timer adapted to start a tachyarrhythmia reconfirmation window when a preparation for the delivery of the anti-tachyarrhythmia therapy is completed, the tachyarrhythmia reconfirmation window including a predetermined number of consecutively detected beats; and

a reconfirmation declaration module adapted to declare a reconfirmation of tachyarrhythmia when a number of the fast beats detected during the tachyarrhythmia reconfirmation window equals or exceeds a predetermined reconfirmation threshold and the predetermined type inhibitory event is not detected during the tachyarrhythmia reconfirmation window.

17. The implantable medical device of claim 16, wherein the reconfirmation timer is adapted to restart the tachyarrhythmia reconfirmation window if the predetermined type inhibitory event is detected during the tachyarrhythmia reconfirmation window.

18. The implantable medical device of claim 16, further comprising a defibrillation circuit adapted to deliver ventricular cardioversion/defibrillation pulses, wherein the controller comprises a defibrillation controller adapted to control the delivery of the ventricular cardioversion/defibrillation pulses, and wherein:

the sensing circuit is adapted to sense a ventricular electrogram;

the beat detector is adapted to detect ventricular events as the heart beats from the ventricular electrogram;

the tachyarrhythmia detector is adapted to declare a detection of ventricular tachyarrhythmia (VT) when at least eight fast beats are detected during the tachyarrhythmia detection window, wherein the tachyarrhythmia detection window includes ten consecutively detected heart beats;

the verification declaration module is adapted to declare that the VT sustains when at least six fast beats are detected during the verification window, wherein the verification window includes ten consecutively detected heart beats;

the tachyarrhythmia classification module is adapted to classify the detected tachyarrhythmia as one of VT and supraventricular tachyarrhythmia (SVT); and

the tachyarrhythmia reconfirmation module is adapted to declare a reconfirmation of tachyarrhythmia when at least two fast beats are detected during the tachyarrhythmia reconfirmation window, wherein the tachyarrhythmia reconfirmation window includes three consecutively detected beats.

19. The implantable medical device of claim 18, wherein the defibrillation controller comprises:

a defibrillation preparation controller adapted to start the preparation for the delivery of one or more of the cardioversion/defibrillation pulses when the detected tachyarrhythmia is classified; and

a defibrillation delivery controller adapted to cause a delivery of one or more of the cardioversion/defibrillation pulses when the reconfirmation of tachyarrhythmia is declared.

20. A method for operating an implantable medical device, the method comprising:

sensing a cardiac signal;

detecting a predetermined type initiation event indicative of a tachyarrhythmia episode from the cardiac signal;

starting a tachyarrhythmia detection and classification process when the predetermined type initiation event is detected;

detecting a predetermined type inhibitory event from the cardiac signal, the predetermined type inhibitory event indicative of a need to inhibit a delivery of an anti-tachyarrhythmia therapy; and

restarting or extending the tachyarrhythmia detection and classification process when the predetermined type inhibitory event is detected.

21. The method of claim 20, further comprising determining whether the tachyarrhythmia episode sustains and is treatable by the delivery of the anti-tachyarrhythmia therapy during the tachyarrhythmia detection and classification process.

22. The method of claim 21, wherein the delivery of the anti-tachyarrhythmia therapy comprises a delivery of one or more cardioversion/defibrillation pulses.

23. The method of claim 21, wherein the delivery of the anti-tachyarrhythmia therapy comprises a delivery of one or more pacing pulses according to an anti-tachyarrhythmia pacing (ATP) algorithm.

24. The method of claim 21, further comprising:

detecting heart beats from the cardiac signal;

detecting a heart rate associated with each of the detected heart beats; and

classifying each of the detected heart beat as one of a fast beat and a slow beat using the heart rate associated with the each of the detected heart beat, the fast beat being a detected heart beat associated with a heart rate within a tachyarrhythmia detection zone, the slow beat being one of a detected heart beat associated with a heart rate below the tachyarrhythmia detection zone and a paced heart beat.

25. The method of claim 24, wherein detecting the predetermined type inhibitory event comprises:

detecting a predetermined type arrhythmia pattern including repetitive beat sequences each including a first number (F) of the fast beats followed by a second number (S) of the slow beats, wherein in the numbers F and S fall into one or more predetermined patterns; and

indicating the detection of the predetermined type inhibitory event when the predetermined type arrhythmia pattern is detected.

26. The method of claim 25, wherein indicating the detection of the predetermined type inhibitory event when the predetermined type arrhythmia pattern is detected comprises indicating the detection of the predetermined type inhibitory event when F is equal to or greater than 3 if S is equal to 1, when F is equal to or greater than 4 if S is equal to 2, when F is equal to or greater than 8 if S is equal to 3, and when F is equal to or greater than 8 if S is equal to 4.

27. The method of claim 25, wherein the repetitive beat sequences include at least two beat sequences having different ratios of F to S each falling into one of a plurality of predetermined patterns.

28. The method of claim 24, wherein detecting the predetermined type inhibitory event comprises:

analyzing each of the slow beats to detect normal slow beats; and

indicating the detection of the predetermined type inhibitory event when one or more of the normal slow beats are detected.

29. The method of claim 28, wherein detecting the predetermined type inhibitory event further comprises indicating the detection of the predetermined type inhibitory event when one or more paced beats are detected.

30. The method of claim 28, wherein analyzing the each of the slow beats to detect normal slow beats comprises:

analyzing a correlation between a slow beat morphology and a template beat morphology, the slow beat morphology being a morphology of the cardiac signal sensed during the each of the detected slow beats; and

declaring a detection of the normal slow beat when the slow beat morphology and the template beat morphology substantially correlate.

31. The method of claim 24, wherein determining whether the tachyarrhythmia episode sustains and is treatable by the delivery of the anti-tachyarrhythmia therapy comprises:

starting a tachyarrhythmia detection window in response to the predetermined type initiation event, the tachyarrhythmia detection window including a predetermined number of consecutively detected beats; and

declaring a detection of tachyarrhythmia when a number of the fast beats detected during the tachyarrhythmia detection window equals or exceeds a predetermined detection threshold.

32. The method of claim 31, further comprising restarting the tachyarrhythmia detection window in response to the detection of the predetermined type inhibitory event.

33. The method of claim 31, wherein determining whether the tachyarrhythmia episode sustains and is treatable by the delivery of the anti-tachyarrhythmia therapy further comprises:

starting a tachyarrhythmia verification duration when the detection of tachyarrhythmia is declared; and

declaring a verification of tachyarrhythmia if a number of the fast beats detected during a verification window equals or exceeds a predetermined verification threshold throughout the tachyarrhythmia verification duration, the verification window being a moving window ending with each heart beat detected during the tachyarrhythmia verification duration and including a predetermined number of consecutively detected heart beats.

34. The method of claim 33, further comprising extending the tachyarrhythmia verification duration in response to the detection of the predetermined type inhibitory event.

35. The method of claim 33, wherein determining whether the tachyarrhythmia episode sustains and is treatable by the delivery of the anti-tachyarrhythmia therapy further comprises classifying the detected tachyarrhythmia when the verification of tachyarrhythmia is declared, wherein the delivery of the anti-tachyarrhythmia therapy comprises a delivery of a cardioversion/defibrillation pulse, and further comprising starting a therapy preparation process if the detected tachyarrhythmia classified as a treatable tachyarrhythmia.

36. The method of claim 35, further comprising:

starting a tachyarrhythmia reconfirmation window when the therapy preparation process is completed, the tachyarrhythmia reconfirmation window including a predetermined number of consecutively detected beats;

declaring a reconfirmation of tachyarrhythmia when a number of the fast beats detected during the tachyarrhythmia reconfirmation window equals or exceeds a predetermined reconfirmation threshold and the predetermined type inhibitory event is not detected during the tachyarrhythmia reconfirmation window; and

delivering the cardioversion/defibrillation pulse when the reconfirmation of tachyarrhythmia is declared.

37. The method of claim 36, further comprising restarting the tachyarrhythmia reconfirmation window if the predetermined type inhibitory event is detected during the tachyarrhythmia reconfirmation window.

38. The method of claim 36, wherein:

sensing the cardiac signal comprises sensing a ventricular electrogram;

detecting the heart beats comprises detecting ventricular events as the heart beats from the ventricular electrogram;

starting the tachyarrhythmia detection and classification process if the predetermined type initiation event is detected comprises starting a ventricular tachyarrhythmia (VT) detection and classification process if three consecutively detected heart beats are classified as the fast beats;

declaring the detection of tachyarrhythmia comprises declaring a detection of VT when at least eight fast beats are detected during the tachyarrhythmia detection window, wherein the tachyarrhythmia detection window includes ten consecutively detected heart beats;

declaring that the tachyarrhythmia sustains comprises declaring that the VT sustains when at least six fast beats are detected during the verification window, wherein the verification window includes ten consecutively detected heart beats;

classifying the detected VT comprises confirming the detection of VT by discriminating between VT and supraventricular tachyarrhythmia (SVT); and

declaring the reconfirmation of tachyarrhythmia comprises a reconfirmation of VT when at least two fast beats are detected during the tachyarrhythmia reconfirmation window, wherein the tachyarrhythmia reconfirmation window includes three consecutively detected beats.