ENHANCED REPORTING OF PATHOLOGICAL EPISODES

• US 20110130666A1
• Filed: 11/01/2010
• Published: 06/02/2011
• Est. Priority Date: 11/30/2009
• Status: Abandoned Application

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Gilliam, F. Roosevelt, Perschbacher, David L., Mahajan, Deepa, Li, Dan, Dong, Yanting
• Application Number:
  US12/916,843
• Publication Number:
  US 20110130666A1
• Time in Patent Office: Days
• US Class Current: 600/484
• CPC Class Codes: A61B 5/02028 Determining haemodynamic parameters not otherwise provided for, e.g. cardiac contractility or left ventricular ejection fraction
• CPC Class Codes: A61B 5/0215 by means inserted into the body catheters A61M25/00
• CPC Class Codes: A61B 5/02438 with portable devices, e.g. worn by the patient
• CPC Class Codes: A61B 5/0816 Measuring devices for examining respiratory frequency measuring frequency of electric signals G01R23/00
• CPC Class Codes: A61B 5/14503 invasive, e.g. introduced into the body by a catheter or needle or using implanted sensors A61B5/1459, A61B5/1464, A61B5/1473, A61B5/1482, A61B5/14865 take precedence
• CPC Class Codes: A61B 5/35 by template matching
• CPC Class Codes: A61B 5/363 Detecting tachycardia or bradycardia
• CPC Class Codes: A61B 7/00 Instruments for auscultation
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/36557 controlled by chemical substances in blood
• CPC Class Codes: A61N 1/36564 controlled by blood pressure
• CPC Class Codes: A61N 1/36578 controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone

Abstract

An apparatus comprises a sensor circuit configured to produce a time-varying physiologic sensor signal of a subject and a pathology detection circuit communicatively coupled to the sensor. The pathology detection circuit is configured to detect a first pathological episode using the sensed physiologic sensor signal, deem that the first pathological episode has ended, detect at least one second pathological episode using the sensed physiologic sensor signal, and indicate the first and second pathological episodes as one pathological episode if the first and second episode are detected within a specified time interval.

Claims

1. An apparatus comprising:

a sensor circuit configured to produce a time-varying physiologic sensor signal of a subject; and

a pathology detection circuit communicatively coupled to the sensor and configured to;

detect a first pathological episode using the physiologic sensor signal;

deem that the first pathological episode has ended;

detect at least one second pathological episode using the physiologic sensor signal; and

indicate the first and second pathological episodes as one pathological episode if the first and second episodes are detected within a specified time interval.

2. The apparatus of claim 1:

wherein the sensor circuit includes an implantable cardiac signal sensing circuit configured to produce a sensed cardiac signal representative of cardiac activity of a subject; and

wherein the pathology detection circuit is configured to;

detect a first episode of arrhythmia using the sensed cardiac signal;

deem that the first episode of arrhythmia has ended;

detect at least one second episode of arrhythmia using the sensed cardiac signal; and

indicate the first and second episodes of arrhythmia as one episode of arrhythmia if the first and second episodes are detected within the specified time interval.

3. The apparatus of claim 2, wherein the pathology detection circuit is configured to adjust at least one arrhythmia detection parameter when one or more arrhythmia episodes are detected within the specified time interval of a previous arrhythmia episode.

4. The apparatus of claim 3, wherein, when multiple tachyarrhythmia episodes are detected within the specified time interval, the pathology detection circuit is configured to, at least one of:

reduce an atrial tachyarrhythmia response entry count;

increase an atrial tachyarrhythmia response exit count;

or

reduce a tachyarrhythmia detection rate zone threshold.

5. The apparatus of claim 2, wherein the pathology detection circuit is configured to:

determine whether the first and second episodes are one episode of arrhythmia by applying an additional detection criterion to the first and second arrhythmia episodes when the second episode is detected within the specified time interval; and

indicate the first and second episodes of arrhythmia as one episode of arrhythmia according to the additional detection criterion.

6. The apparatus of claim 5, wherein the pathology detection circuit is configured to obtain, as the additional detection criteria, at least one of:

similarity of heart rate among detected episodes;

an assessment of heart rate stability;

or

a morphology analysis of the detected arrhythmia.

7. The apparatus of claim 5, including:

a second implantable sensor circuit configured to produce a second sensor signal representative of hemodynamic function of the heart, and

wherein the pathology detection circuit is configured to determine whether the first and second episodes are one episode of arrhythmia according to the second sensor signal.

8. The apparatus of claim 1, wherein the sensor circuit includes at least one of:

an implantable respiration sensor configured to produce a sensed respiration signal representative of respiration activity of the subject, wherein the first and second pathological episodes include episodes of fast respiration rate;

an implantable blood pressure sensor configured to produce a sensed pressure signal representative of blood pressure of the subject, wherein the first and second pathological episodes include episodes of one or more low blood pressure and high blood pressure;

an implantable blood gas sensor configured to produce a sensor signal associated with changes in the fluid oxygen saturation of blood, wherein the first and second pathological episodes include episodes of a low level of oxygen saturation in blood;

an implantable chemical sensor configured to produce a sensor signal associated with changes in the blood pH, wherein the first and second pathological episodes include episodes of a change in blood pH that exceeds a specified change value;

or

a heart sound sensor configured to produce a heart sound signal associated with mechanical activity of a patient'"'"'s heart, wherein the first and second pathological episodes include episodes of a change in a measured heart sound parameter that exceeds a specified change value.

9. The apparatus of claim 8, wherein the pathology detection circuit is configured to indicate the first pathological episode and the second pathological episode as one pathological episode according to additional detection criteria, wherein the additional detection criteria includes at least one of:

similarity of morphology of the physiologic sensor signal during the detected episodes;

similarity of device-determined posture of the subject during the episodes;

or

similarity of device-determined activity level of the subject during the episodes.

10. The apparatus of claim 1, wherein the pathology detection circuit includes a pathological episode counter, and

wherein the pathology detection circuit is configured to:

update the pathological episode counter upon detecting the first pathological episode;

maintain an episode count of the pathological episode counter when one or more later pathological episodes are detected within the specified time interval of a previous pathological episode; and

update the pathological episode counter upon detecting a later pathological episode after the time interval expires.

11. A system comprising:

an implantable medical device (IMD) comprising;

an implantable sensor configured to produce a time-varying physiologic sensor signal of a subject; and

a pathology detection circuit communicatively coupled to the sensor and configured to;

detect a first pathological episode using the physiologic sensor signal;

deem that the first pathological episode has ended;

detect at least one second pathological episode using the physiologic sensor signal; and

indicate the first and second pathological episodes as one pathological episode if the first and second episodes are detected within a specified time interval; and

a communication circuit communicatively coupled to the pathology detection circuit and configured to communicate information wirelessly with an external device, wherein the pathology detection circuit is configured to communicate an indication of the one pathological episode to the external device; and

the external device, comprising;

a user interface;

a communication circuit; and

a processor communicatively coupled to the user interface and the communication circuit and configured to display the first and second pathological episodes as one pathological episode according to an indication received from the IMD.

12. The system of claim 11, wherein the processor is configured to:

display the indicated one pathological episode as multiple pathological episodes according to input received via a user interface at the external device;

display the multiple pathological episodes using multiple segments of the physiologic sensor signal according to input received via the user interface; and

display a statistic related to a pathological episode in association with a segment of the physiologic sensor signal according to information received from the IMD.

13. The system of claim 11,

wherein the pathology detection circuit is configured to:

detect the first pathological episode using a first segment of the physiologic sensor signal;

detect the second pathologic episode using a second segment of the physiologic sensor signal;

transmit representations of the first and second segments to the external device; and

wherein the processor is configured to;

display a statistic related to the detected pathology as one episode; and

display a pathological statistic related to each of the first and second segments.

14. A method comprising:

detecting a first pathological episode of a subject with a medical device, wherein the first pathological episode is detected using a sensed time-varying physiologic sensor signal;

deeming, with the medical device, that the first pathological episode has ended;

detecting at least one second pathological episode with the medical device; and

deeming, with the medical device, that the first and second pathological episodes are one episode if the first and second episodes are detected within a specified time interval.

15. The method of claim 14,

wherein detecting a first pathological episode includes detecting a first episode of arrhythmia with an IMD;

wherein deeming that the first pathological episode has ended includes deeming that the first episode of arrhythmia has ended;

wherein detecting at least one second pathological episode includes detecting at least one second episode of arrhythmia with the IMD; and

wherein deeming that the first and second pathological episodes are one episode includes deeming that the first and second episodes of arrhythmia are one episode of arrhythmia if the first and second episodes are detected within the specified time interval.

16. The method of claim 15, including adjusting at least one arrhythmia detection parameter if multiple arrhythmia episodes are detected within the specified time interval of a previous arrhythmia episode.

17. The method of claim 16, wherein adjusting at least one arrhythmia detection parameter includes at least one of:

reducing an atrial tachyarrhythmia response entry count;

increasing an atrial tachyarrhythmia response exit count;

or

reducing a tachyarrhythmia rate detection zone threshold.

18. The method of claim 15, including:

determining whether the first and second episodes are one episode of arrhythmia by applying an additional detection criterion to the first and second arrhythmia episodes when the second episode is detected within the specified time interval, and

wherein indicating the first and second episodes of arrhythmia as one episode of arrhythmia includes indicating the first and second episodes of arrhythmia as one episode of arrhythmia according to the additional detection criteria.

19. The method of claim 18, wherein the additional detection criteria includes at least one of:

an assessment of heart rhythm stability;

a morphology analysis of the detected arrhythmia;

or

an assessment of hemodynamic stability.

20. The method of claim 14, wherein detecting the first and second pathological episodes with the medical device includes detecting at least one of:

first and second episodes of fast respiration rate;

first and second episodes of one or more of low blood pressure and high blood pressure;

first and second episodes of low levels of oxygen saturation in blood;

first and second episodes of a change in blood pH that exceeds a specified change value;

or

first and second episodes of a change in a measured heart sound parameter that exceeds a specified change value.

21. The method of claim 20, wherein deeming that the first and second pathological episodes are one pathological episode includes deeming that the first and second pathological episodes are one pathological episode according to additional detection criteria, wherein the additional detection criteria includes at least one of:

similarity of morphology of the physiologic sensor signal during the detected first and second episodes;

similarity of device-determined posture of the subject during the first and second episodes;

or

similarity of device-determined activity level of the subject during the first and second episodes.

22. The method of claim 14, including:

updating a pathological episode counter upon detecting the first pathological episode;

maintaining an episode count when one or more later pathological episodes are detected within the specified time interval of a previous pathological episode; and

updating the arrhythmia episode counter upon detecting a later pathological episode after the specified time interval expires.

23. The method of claim 14, wherein the medical device is an IMD, and wherein indicating the first and second pathological episodes as one pathological episode includes:

transmitting the indication from the IMD to an external device; and

displaying the first and second pathological episodes as one pathological episode or as multiple pathological episodes according to input received via a user interface at the external device.

24. The method of claim 23, including

displaying the multiple pathological episodes using multiple segments of the physiologic sensor signal when prompted to do so via the user interface;

and

displaying statistics related to each pathological episode in association with the associated signal segment.

25. The method of claim 24, wherein displaying statistics includes displaying at least one of:

a sensed cardiac depolarization rate during each pathological episode;

a duration of each pathological episode;

or

a signal morphology of the physiologic sensor signal during each pathological episode.