System and Method for Distinguishing Among Cardiac Ischemia, Hypoglycemia and Hyperglycemia Using an Implantable Medical Device

• US 20090177104A1
• Filed: 01/27/2009
• Published: 07/09/2009
• Est. Priority Date: 01/25/2005
• Status: Active Grant

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories)
• Inventors: Boileau, Peter, Gill, Jong, Florio, Joseph J., Bharmi, Rupinder, Min, Xiaoyi, Bornzin, Gene A., Benser, Michael E.
• Granted Patent: US 8,180,441 B2
• Time in Patent Office: Days
• US Class Current: 600/517
• 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 paced repolarization peak-based intervals representative of intervals between depolarization events induced by pacing pulses delivered by the implantable medical device, and peaks of corresponding repolarization events within electrical cardiac signals;

tracking sensed repolarization peak-based intervals separate from the paced repolarization peak-based intervals, wherein the sensed repolarization peak-based intervals comprise intervals representative of intervals between intrinsic depolarization events and peaks of corresponding repolarization events within electrical cardiac signals; and

detecting an episode of cardiac ischemia based on a decrease in at least one of the paced repolarization peak-based intervals and the sensed 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:

tracking repolarization peak-based intervals is performed to track a baseline interval based on a moving average; and

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 detecting an episode of cardiac ischemia based on a 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 further including recording diagnostic information representative of the repolarization peak-based intervals.

7. The method of claim 6 wherein the diagnostic information includes an ischemic burden derived from the repolarization peak-based intervals.

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

9. The method of claim 8 wherein an implantable drug pump is provided and wherein controlling therapy in response to the detection of an episode of cardiac ischemia includes delivering anti-thrombotic medications to the patient using the drug pump.

10. The method of claim 8 wherein an implantable cardiac stimulation device is provided and wherein delivering therapy in response to the detection of an episode of cardiac ischemia includes reducing a pacing rate employed by the stimulation device.

11. 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.

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

13. The method of claim 12 wherein an implantable warning device is provided and wherein generating a warning signal includes the step of delivering a perceptible warning signal to the patient via the implantable warning device.

14. The method of claim 12 for use with an external warning device and wherein 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.

15. The method of claim 1 further including:

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.

16. 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 paced QTmax values representative of intervals between QRS complexes induced by pacing pulses delivered by the implantable medical device, and peaks of corresponding T-waves within electrical cardiac signals and to separately track sensed QTmax values representative of intervals between intrinsic QRS complexes and peaks of corresponding T-waves within electrical cardiac signals; and

a cardiac ischemia detection unit operative to detect an episode of cardiac ischemia based on a decrease in at least one of the paced QTmax intervals and the sense QTmax intervals.

17. 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.