ELECTROGRAM SUMMARY

• US 20130085403A1
• Filed: 09/30/2011
• Published: 04/04/2013
• Est. Priority Date: 09/30/2011
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Gunderson, Bruce D., Kleckner, Karen J., Ousdigian, Kevin T., Patel, Amisha S., Sanchez, Julian
• Granted Patent: US 9,668,668 B2
• Time in Patent Office: Days
• US Class Current: 600/510
• CPC Class Codes: A61B 5/339 Displays specially adapted therefor
• CPC Class Codes: A61B 5/361 Detecting fibrillation
• CPC Class Codes: A61B 5/363 Detecting tachycardia or bradycardia
• CPC Class Codes: A61B 5/7217 of noise originating from a therapeutic or surgical apparatus, e.g. from a pacemaker

Abstract

The present disclosure is directed to an electrogram summary. In various examples, a subset of cardiac episodes are selected and displayed based on a set of summary rules. The subset of cardiac episodes includes at least one episode from each of a plurality of episode categories with at least one cardiac episode. In some examples, the order in which the cardiac episodes selected are displayed is based on the set of summary rules. The electrogram summary may include images or information regarding each of the selected cardiac episodes.

Claims

1. A method comprising

receiving cardiac electrogram (EGM) signal data from an implantable medical device (IMD), the EGM signal data including a plurality of detected cardiac episodes;

categorizing each of the plurality of cardiac episodes as one of a ventricular tachycardia/ventricular fibrillation (VT/VF) episode, a supraventricular tachycardia (SVT) episode, a non-sustained ventricular tachycardia (VTNS) episode, an atrial tachycardia/atrial fibrillation (AT/AF) episode, a monitored VT episode, or a ventricular oversensing (VOS) episode; and

selecting, using a processor, a subset of the plurality of cardiac episodes for display, wherein, for each episode category including at least one episode, the subset includes greater than or equal to one episode and less than or equal to a predetermined number of episodes.

2. The method of claim 1, further comprising displaying information associated with each of the subset of cardiac episodes selected for display.

3. The method of claim 2, wherein the information associated with each of the subset of the plurality of cardiac episodes includes a thumbnail of the EGM signal data.

4. The method of claim 3, further comprising, in response to user input, rearranging an order of the thumbnails displayed.

5. The method of claim 2, further comprising, in response to receiving a selection of one of the cardiac episodes based on the displayed information, displaying an image of a portion of the EGM signal associated with the selected cardiac episode and a portion of a marker channel associated with the selected cardiac episode.

6. The method of claim 5, further comprising, in response to user input, adjusting the portion of the EGM signal displayed.

7. The method of claim 5, further comprising displaying a reference EGM, the reference EGM being an EGM signal collected at a time of transmission of the EGM signal data from the IMD.

8. The method of claim 2, further comprising, in response to receiving a selection of a first one of the cardiac episodes based on the displayed information, and a selection of a second one of the cardiac episodes based on the displayed information,

displaying an image of a portion of the EGM signal data associated with the first selected cardiac episode;

displaying an image of a portion of the EGM signal data associated with the second selected cardiac episode; and

providing a user interface allowing a user to enable a user to change the relative position of the image of the first selected cardiac episode and the second selected cardiac episode;

comparing a morphology of the image of the EGM signal data associated with the first.

9. The method of claim 1, further comprising displaying a timeline of occurrence for the plurality of cardiac episodes.

10. The method of claim 9, wherein the timeline includes an icon for each of the plurality of cardiac episodes conveying a classification by the IMD for the respective cardiac episodes.

11. The method of claim 9, wherein the timeline includes an indication of cycle length for each of the plurality of cardiac episodes.

12. The method of claim 9, wherein the timeline includes an indication of a retrospective analysis classification for each of the plurality of cardiac episodes.

13. The method of claim 9, wherein the timeline includes an indication of an episode characteristic for each of the plurality of cardiac episodes.

14. The method of claim 1, wherein selecting the subset of VT/VF episodes for display comprises selecting the VT/VF episodes for display from among the VT/VF episodes received from the IMD based on at least one of:

number of shocks or number of anti-tachycardia pacing pulses in each VT/VF episode;

most recent VT/VF episode;

A to V ratio of each VT/VF episode;

or

duration of each VT/VF episode.

15. The method of claim 14, further comprising prioritizing an order the subset of VT/VF episodes are displayed, wherein the VT/VF episodes are prioritized based on at least one of:

number of shocks or number of anti-tachycardia pacing pulses in each VT/VF episode;

time of occurrence;

duration of each of the VT/VF episodes;

a stored predetermined prioritization of selection criteria;

or

stored physician preferences.

16. The method of claim 1, wherein selecting the subset of SVT episodes for display comprises selecting the SVT episodes for display from among the SVT episodes received from the IMD based on at least one of:

duration of each SVT episode;

morphology of each SVT episode;

reason for withholding treatment for each SVT episode,

V rate of each SVT episode.

17. The method of claim 16, further comprising prioritizing an order the subset of SVT episodes are displayed, wherein the SVT episodes are prioritized based on at least one of:

duration of each SVT episode;

fastest V rates of the SVT episodes;

time of occurrence;

a stored predetermined prioritization of selection criteria;

or

stored physician preferences.

18. The method of claim 1, wherein selecting the subset of monitored VT episodes for display comprises selecting the monitored VT episodes for display from among the monitored VT episodes received from the IMD based on at least one of:

different V rate than the rest of the monitored VT episodes;

different A rate than the rest of the monitored VT episodes,

duration of each of the monitored VT episodes;

V rates of each of the monitored VT episodes;

or

time of occurrence of each of the monitored VT episodes.

19. The method of claim 18, further comprising prioritizing an order the subset of monitored VT episodes are displayed, wherein the monitored VT episodes are prioritized based on at least one of:

time of occurrence;

duration of the monitored VT episodes;

a stored predetermined prioritization of selection criteria;

or

stored physician preferences.

20. The method of claim 1, wherein selecting the subset of VTNS episodes for display comprises selecting the VTNS episodes for display from among the VTNS episodes received from the IMD based on at least one of:

number of beats within each VTNS episode;

time of occurrence of each VTNS episode;

or

retrospective analysis classification of each VTNS episode.

21. The method of claim 20, further comprising prioritizing an order the subset of VTNS episodes are displayed, wherein the VTNS episodes are prioritized based on at least one of:

number of beats within each VTNS episode;

time of occurrence;

a stored predetermined prioritization of selection criteria;

or

stored physician preferences.

22. The method of claim 1, wherein selecting the subset of AT/AF episodes for display comprises selecting the AT/AF episodes for display from among the AT/AF episodes received from the IMD based on at least one of:

length of each of the AT/AF episodes;

occurrence of far-field R-waves in of the AT/AF episodes;

degree of A-A interval regularity or each of the AT/AF episodes;

or

time of occurrence of each of the AT/AF episodes.

23. The method of claim 22, further comprising prioritizing an order the subset of AT/AF episodes are displayed, wherein the AT/AF episodes are prioritized based on at least one of:

length of the AT/AF episode;

time of occurrence;

a stored predetermined prioritization of selection criteria;

or

stored physician preferences.

24. The method of claim 1, further comprising displaying each of the selected cardiac episodes as a part of an EGM summary.

25. A system comprising:

a communication module configured to receive electrogram (EGM) signal data from an implantable cardiac device, the EGM signal data including a plurality of cardiac episodes;

a processor configured to

categorize each of the plurality of cardiac episodes as one of a ventricular tachycardia/ventricular fibrillation (VT/VF) episode, a supraventricular tachycardia (SVT) episode, a non-sustained ventricular tachycardia (VTNS) episode, an atrial tachycardia/atrial fibrillation (AT/AF) episode, a monitored VT episode, or a ventricular oversensing (VOS) episode; and

select a subset of the plurality of cardiac episodes for display, wherein, for each episode category including at least one episode, the subset includes greater than or equal to one episode and less than or equal to a predetermined number episodes; and

a user interface.

26. The system of claim 25, wherein the user interface is a graphical user interface configured to display information associated with each of the subset of the plurality of cardiac episodes selected for display.

27. The system of claim 26, wherein the graphical user interface is further configured to display a thumbnail of the EGM signal data associated with each of the subset of the plurality of cardiac episodes.

28. The system of claim 27, wherein the graphical user interface is further configured to rearrange an order of the thumbnails displayed in response to user input.

29. The system of claim 26, wherein the graphical user interface is further configured to, in response to the device receiving a selection of one of the cardiac episodes based on the displayed information, display an image of a portion of the EGM signal associated with the selected cardiac episode and a portion of a marker channel associated with the selected cardiac episode.

30. The system of claim 29, a user interface configured to receive user input, and the graphical user interface further configured to adjust the portion of the EGM signal display in response to receipt of user input by the user interface.

31. The system of claim 29, wherein the graphical user interface is further configured to display a reference EGM, the reference EGM being an EGM signal collected at a time of transmission.

32. The system of claim 26, the graphical user interface further configured to, in response to receiving a selection of one of the cardiac episode based on the displayed information and a selection of a second of the cardiac episodes based on the displayed information,

display an image of a portion of the EGM signal data associated with the first selected cardiac episode;

display an image of a portion of the EGM signal data associated with the second selected cardiac episode; and

compare a morphology of the image of the EGM signal data associated with the first selected cardiac episode and a morphology of the image of the EGM signal data associated with the second selected cardiac episode.

33. The system of claim 25, further comprising a graphical user interface configured to display a timeline of occurrence for the plurality of cardiac episodes.

34. The system of claim 33, wherein the timeline includes an icon for each of the plurality of cardiac episodes conveying a classification by the IMD for the respective cardiac episodes.

35. The system of claim 33, wherein the timeline includes an indication of cycle length for each of the plurality of cardiac episodes.

36. The system of claim 33, wherein the timeline includes an indication of a retrospective analysis classification for each of the plurality of cardiac episodes.

37. The system of claim 33, wherein the timeline includes an indication of an episode characteristic for each of the plurality of cardiac episodes.

38. The system of claim 25, wherein the processor if further configured to select the subset of VT/VF episodes based on at least one of:

number of shocks or number of anti-tachycardia pacing pulses in each VT/VF episode most recent VT/VF episode;

A to V ratio of each VT/VF episode;

or

duration of each VT/VF episode.

39. The system of claim 38, wherein the processor is further configured to prioritize an order the subset of VT/VF episodes are displayed, wherein the VT/VF episodes are prioritized based on at least one of:

number of shocks or number of anti-tachycardia pacing pulses in each VT/VF episode;

time of occurrence;

duration of each of the VT/VF episodes;

a stored predetermined prioritization of selection criteria;

or

stored physician preferences.

40. The system of claim 25, wherein the processor if further configured to select the subset of SVT episodes based on at least one of:

duration of each SVT episode;

morphology of each SVT episode;

reason for withholding treatment for each SVT episode,

V rate of each SVT episode.

41. The system of claim 40, wherein the processor is further configured to prioritize an order the subset of SVT episodes are displayed, wherein the SVT episodes are prioritized based on at least one of:

duration of each SVT episode;

fastest V rates of the SVT episodes;

time of occurrence;

a stored predetermined prioritization of selection criteria;

or

stored physician preferences.

42. The system of claim 25, wherein the processor if further configured to select the subset of monitored VT episodes based on at least one of:

different V rate than the rest of the monitored VT episodes;

different A rate than the rest of the monitored VT episodes,

duration of each of the monitored VT episodes;

V rates of each of the monitored VT episodes;

or

time of occurrence of each of the monitored VT episodes.

43. The system of claim 42, wherein the processor is further configured to prioritize an order the subset of monitored VT episodes are displayed, wherein the monitored VT episodes are prioritized based on at least one of:

time of occurrence;

duration of the monitored VT episodes;

a stored predetermined prioritization of selection criteria;

or

stored physician preferences.

44. The system of claim 25, wherein the processor if further configured to select the subset of VTNS episodes based on at least one of:

number of beats within each VTNS episode;

time of occurrence of each VTNS episode;

or

retrospective analysis classification of each VTNS episode.

45. The system of claim 44, wherein the processor is further configured to prioritize an order the subset of VTNS episodes are displayed, wherein the VTNS episodes are prioritized based on at least one of:

number of beats within each VTNS episode;

time of occurrence;

a stored predetermined prioritization of selection criteria;

or

stored physician preferences.

46. The system of claim 25, wherein the processor if further configured to select the subset of AT/AF episodes based on at least one of:

length of each of the AT/AF episodes;

occurrence of far-field R-waves in of the AT/AF episodes;

degree of A-A interval regularity or each of the AT/AF episodes;

or

time of occurrence of each of the AT/AF episodes.

47. The system of claim 46, wherein the processor is further configured to prioritize an order the subset of AT/AF episodes are displayed, wherein the AT/AF episodes are prioritized based on at least one of:

length of the AT/AF episode;

time of occurrence;

a stored predetermined prioritization of selection criteria;

or

stored physician preferences.

48. The system of claim 25, wherein the processor if further configured to produce an EGM summary, wherein each of the selected cardiac episodes is a part of the EGM summary and wherein the user interface is further configured to display the EGM summary.

49. A computer-readable medium comprising instructions for causing a programmable processor to:

receive cardiac electrogram (EGM) signal data from an implantable medical device (IMD), the EGM signal data including a plurality of detected cardiac episodes;

categorize each of the plurality of cardiac episodes as one of a ventricular tachycardia/ventricular fibrillation (VT/VF) episode, a supraventricular tachycardia (SVT) episode, a non-sustained ventricular tachycardia (VTNS) episode, an atrial tachycardia/atrial fibrillation (AT/AF) episode, a monitored VT episode, or a ventricular oversensing (VOS) episode; and

select a subset of the plurality of cardiac episodes for display, wherein, for each episode category including at least one episode, the subset includes greater than or equal to one episode and less than or equal to a predetermined number of episodes.