Apparatus and method for detecting abnormal cardiac rhythms using evoked potential measurements in an arrhythmia control system
First Claim
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1. An arrhythmia detection and antiarrhythmia pacing device adapted to be implanted in a patient for the reversion of tachycardias, comprising:
- means for generating heart stimulation pulses,means for measuring an evoked potential of the patient'"'"'s heart that is responsive to said stimulation pulses,means based upon the sensing of an evoked potential for periodically ascertaining the value of a measured arrhythmia detection control parameter,means for detecting changes over time in said measured arrhythmia detection control parameter, andmeans responsive to said detecting means for classifying a cardiac rhythm as a pathological tachycardia when said arrhythmia detection control parameter changes in a first predetermined direction and magnitude within a predetermined number of cardiac cycles, and for classifying a cardiac rhythm as a benign physiological tachycardia when said arrhythmia detection control parameter changes in a second predetermined direction and magnitude within a predetermined number of cardiac cycles.
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Abstract
In an implantable antiarryhythmia pacemaker, an automatic cardiac arrhythmia detection and classification monitoring apparatus and method for measuring stimulated intracardiac electrogram potentials, deriving therefrom a paced depolarization integral (PDI), analyzing time-based changes in the PDI, detecting and classifying harmful cardiac rhythms while distinguishing harmful from benign tachycardias, and automatically establishing and initiating an appropriate therapy, if necessary, to revert the arrhythmia condition.
344 Citations
31 Claims
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1. An arrhythmia detection and antiarrhythmia pacing device adapted to be implanted in a patient for the reversion of tachycardias, comprising:
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means for generating heart stimulation pulses, means for measuring an evoked potential of the patient'"'"'s heart that is responsive to said stimulation pulses, means based upon the sensing of an evoked potential for periodically ascertaining the value of a measured arrhythmia detection control parameter, means for detecting changes over time in said measured arrhythmia detection control parameter, and means responsive to said detecting means for classifying a cardiac rhythm as a pathological tachycardia when said arrhythmia detection control parameter changes in a first predetermined direction and magnitude within a predetermined number of cardiac cycles, and for classifying a cardiac rhythm as a benign physiological tachycardia when said arrhythmia detection control parameter changes in a second predetermined direction and magnitude within a predetermined number of cardiac cycles. - View Dependent Claims (2, 3)
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4. An arrhythmia detection and antiarrhythmia pacing device adapted to be implanted in a patient for the reversion of tachycardias, comprising:
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means for generating heart stimulation pulses, means for measuring an evoked potential of the patient'"'"'s heart that is responsive to said stimulation pulses, means based upon the sensing of an evoked potential for periodically ascertaining the value of a measured arrhythmia detection control parameter, means for detecting changes over time in said measured arrhythmia detection control parameter, means responsive to said detecting means for classifying a cardiac rhythm as a pathological tachycardia when said arrhythmia detection control parameter changes in a first predetermined direction and magnitude within a predetermined number of cardiac cycles, and for classifying a cardiac rhythm as a benign physiological tachycardia when said arrhythmia detection control parameter changes in a second predetermined direction and magnitude within a predetermined number of cardiac cycles, and means responsive to classification of the cardiac rhythm as a pathological tachycardia by said classifying means for controlling said generating means to operate in a dual-chamber antitachycardia pacing mode in which atrial and ventricular pacing pulses are generated and delivered in a series of pulse trains with each train consisting of a series of pacing pulses delivered in rapid succession in an alternating sequence to the ventricle and to the atrium.
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5. An arrhythmia detection and antiarrhythmia pacing device adapted to be implanted in a patient for the reversion of tachycardias, comprising:
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means for generating heart stimulation pulses, means for measuring an evoked potential of the patient'"'"'s heart that is responsive to said stimulation pulses, means based upon the sensing of an evoked potential for periodically ascertaining the value of a measured arrhythmia detection control parameter, means for detecting changes over time in said measured arrhythmia detection control parameter, means responsive to said detecting means for classifying a cardiac rhythm as a pathological tachycardia when said arrhythmia detection control parameter changes in a first predetermined direction and magnitude within a predetermined number of cardiac cycles, and for classifying a cardiac rhythm as a benign physiological tachycardia when said arrhythmia detection control parameter changes in a second predetermined direction and magnitude within a predetermined number of cardiac cycles, means responsive to said detecting means for measuring short-term uniformity of said arrhythmia detection control parameter, and means for classifying a cardiac rhythm as fibrillation when said arrhythmia detection control parameter changes in a third predetermined direction and magnitude within a predetermined number of cardiac cycles and said short-term uniformity measurement changes in a fourth predetermined directions and magnitude within a predetermined number of cardiac cycles, - View Dependent Claims (6, 7)
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8. An arrhythmia detection and antiarrhythmia pacing device adapted to be implanted in a patient for the reversion of tachycardias, comprising:
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means for generating heart stimulation pulses, means for measuring an evoked potential of the patient'"'"'s heart that is responsive to said stimulation pulses, means based upon the sensing of an evoked potential for periodically ascertaining the value of a measured arrhythmia detection control parameter, means for detecting changes over time in said measured arrhythmia detection control parameter, means for sensing heartbeats, means responsive to said heartbeat sensing means for determining a heart rate, and means responsive to said detecting means and said heart rate determining means for classifying a cardiac rhythm as a pathological tachycardia when said arrhythmia detection control parameter changes in a first predetermined direction and magnitude within a predetermined number of cardiac cycles and said heart rate is faster than a predetermined tachycardia rate, and for classifying a cardiac rhythm as a benign physiological tachycardia when said arrhythmia detection control parameter changes in a second predetermined direction and magnitude within a predetermined number of cardiac cycles and said heart rate is faster than said tachycardia rate. - View Dependent Claims (9, 10)
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11. An arrhythmia detection and antiarrhythmia pacing device adapted to be implanted in a patient for the reversion of tachycardias, comprising:
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means for generating heart stimulation pulses, means for measuring an evoked potential of the patient'"'"'s heart that is responsive to said stimulation pulses, means based upon the sensing of an evoked potential for periodically ascertaining the value of a measured arrhythmia detection control parameter, means for detecting changes over time in said measured arrhythmia detection control parameter, means for sensing heartbeats, means responsive to said heartbeat sensing means for determining a heart rate, means responsive to said detecting means and said heart rate determining means for classifying a cardiac rhythm as a pathological tachycardia when said arrhythmia detection control parameter changes in a first predetermined direction and magnitude within a predetermined number of cardiac cycles and said heart rate is faster than a predetermined tachycardia rate, and for classifying a cardiac rhythm as a benign physiological tachycardia when said arrhythmia detection control parameter changes in a second predetermined direction and magnitude within a predetermined number of cardiac cycles and said heart rate is faster than said tachycardia rate, and means responsive to classification of the cardiac rhythm as a pathological tachycardia by said classifying means for controlling said generating means to operate in an antitachycardia pacing mode, wherein said antiarrhythmia pacing device operates in a dual-chamber antitachycardia pacing mode in which atrial and ventricular pacing pulses are generated and delivered in a series of pulse trains with each train consisting of a series of pacing pulses delivered in rapid succession in an alternating sequence to the ventricle and to the atrium.
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12. An arrhythmia detection and antiarrhythmia pacing device adapted to be implanted in a patient for the reversion of tachycardias, comprising:
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means for generating heart stimulation pulses, means for measuring an evoked potential of the patient'"'"'s heart that is responsive to said stimulation pulses, means based upon the sensing of an evoked potential for periodically ascertaining the value of a measured arrhythmia detection control parameter, means for detecting changes over time in said measured arrhythmia detection control parameter, means for sensing heartbeats, means responsive to said heartbeat sensing means for determining a heart rate, means responsive to said detecting means and said heart rate determining means for classifying a cardiac rhythm as a pathological tachycardia when said arrhythmia detection control parameter changes in a first predetermined direction and magnitude within a predetermined number of cardiac cycles and said heart rate is faster than a predetermined tachycardia rate, and for classifying a cardiac rhythm as a benign physiological tachycardia when said arrhythmia detection control parameter changes in a second predetermined direction and magnitude within a predetermined number of cardiac cycles and said heart rate is faster than said tachycardia rate, means responsive to said detecting means for measuring short-term uniformity of said arrhythmia detection control parameter, and means for classifying a cardiac rhythm as fibrillation when said heart rate is faster than a predetermined fibrillation rate, said arrhythmia detection control parameter changes in a third predetermined direction and magnitude within a predetermined number of cardiac cycles, and said short-term uniformity measurement changes in a fourth predetermined direction and magnitude within a predetermined number of cardiac cycles. - View Dependent Claims (13, 14)
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15. A method of detecting and reverting cardiac arrhythmias of a patient'"'"'s heart using an anti-arrhythmia pacing device, comprising the steps of:
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generating heart stimulation pulses, measuring an evoked potential of the patient'"'"'s heart that is responsive to said generated stimulation pulses, periodically ascertaining the value of a measured arrhythmia detection control parameter which is based upon the sensing of an evoked potential, detecting changes over time in said measured arrhythmia detection control parameter, and classifying a cardiac rhythm as a pathological tachycardia when said arrhythmia detection control parameter changes in a first predetermined direction and magnitude within a predetermined number of cardiac cycles, and classifying a cardiac rhythm as a benign physiological tachycardia when said arrhythmia detection control parameter changes in a second predetermined direction and magnitude within a predetermined number of cardiac cycles. - View Dependent Claims (16, 17)
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18. A method of detecting and reverting cardiac arrhythmias of a patient'"'"'s heart using an antiarrhythmia pacing device, comprising the steps of:
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generating heart stimulation pulses. measuring an evoked potential of the patient'"'"'s heart that is responsive to said generated stimulation pulses, periodically ascertaining the value of a measured arrhythmia detection control parameter which is based upon the sensing of an evoked potential, detecting changes over time in said measured arrhythmia detection control parameter, classifying a cardiac rhythm as a pathological tachycardia when said arrhythmia detection control parameter changes in a first predetermined direction and magnitude within a predetermined number of cardiac cycles, and classifying a cardiac rhythm as a benign physiological tachycardia when said arrhythmia detection control parameter changes in a second predetermined direction and magnitude within a predetermined number of cardiac cycles, controlling said generating means to operate in a dual-chamber antitachycardia pacing mode in response to classifying a cardiac rhythm as a pathological tachycardia, and generating and delivering a series of pulse trains in the heart'"'"'s atrium and in the heart'"'"'s ventricle, with each train consisting of a series of pacing pulses delivered in rapid succession in an alternating sequence to the ventricle and to the atrium.
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19. A method of detecting and reverting cardiac arrhythmias of a patient'"'"'s heart using an antiarrhythmia pacing device, comprising the steps of:
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generating heart stimulation pulses, measuring an evoked potential of the patient'"'"'s heart that is responsive to said generated stimulation pulses, periodically ascertaining the value of a measured arrhythmia detection control parameter which is based upon the sensing of an evoked potential, detecting changes over time in said measured arrhythmia detection control parameter, classifying a cardiac rhythm as a pathological tachycardia when said arrhythmia detection control parameter changes in a first predetermined direction and magnitude within a predetermined number of cardiac cycles, and classifying a cardiac rhythm as a benign physiological tachycardia when said arrhythmia detection control parameter changes in a second predetermined direction and magnitude within a predetermined number of cardiac cycles, measuring short-term uniformity of said arrhythmia detection control parameter, and classifying a cardiac rhythm as fibrillation when said arrhythmia detection control parameter changes in a third predetermined direction and magnitude within a predetermined number of cardiac cycles and said short-term uniformity measurement changes in a fourth predetermined direction and magnitude within a predetermined number of cardiac cycles. - View Dependent Claims (20, 21)
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22. A method of detecting and reverting cardiac arrhythmias of a patient'"'"'s heart using an anti-arrhythmia pacing device, comprising the steps of:
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generating heart stimulation pulses, measuring an evoked potential of the patient'"'"'s heart that is responsive to said stimulation pulses, periodically ascertaining the value of a measured arrhythmia detection control parameter which is based upon the sensing of an evoked potential, detecting changes over time in said measured arrhythmia detection control parameter, sensing heartbeats, timing the interval between sensed heartbeats to determine a heart rate, and classifying a cardiac rhythm as a pathological tachycardia when said arrhythmia detection control parameter changes in a first predetermined direction and magnitude within a predetermined number of cardiac cycles and said heart rate is faster than a predetermined tachycardia rate, and classifying a cardiac rhythm as a benign physiological tachycardia when said arrhythmia detection control parameter changes in a second predetermined direction and magnitude within a predetermined number of cardiac cycles and said heart rate is faster than said tachycardia rate. - View Dependent Claims (23, 24)
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25. A method of detecting and reverting cardiac arrhythmias of a patient'"'"'s heart using an antiarrhythmia pacing device, comprising the steps of:
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generating heart stimulation pulses, measuring an evoked potential of the patient'"'"'s heart that is responsive to said stimulate pulses, periodically ascertaining the value of a measured arrhythmia detection control parameter which is based upon the sensing of an evoked potential, detecting changes over time in said measured arrhythmia detection control parameter, sensing heartbeats, timing the interval between sensed heartbeats to determine a heart rate, classifying a cardiac rhythm as a pathological tachycardia when said arrhythmia detection control parameter changes in a first predetermined direction and magnitude within a predetermined number of cardiac cycles and said heart rate is faster than a predetermined tachycardia rate, and classifying a cardiac rhythm as a benign physiological tachycardia when said arrhythmia detection control parameter changes in a second predetermined direction and magnitude within a predetermined number of cardiac cycles and said heart rate is faster than said tachycardia rate, controlling said generating means to operate in a dual-chamber antitachycardia pacing mode in response to classifying a cardiac rhythm as a pathological tachycardia, and generating and delivering a series of pulse trains in the heart'"'"'s atrium and in the heart'"'"'s ventricle, with each train consisting of a series of pacing pulses delivered in rapid succession in an alternating sequence to the ventricle and to the atrium.
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26. A method of detecting and reverting cardiac arrhythmias of a patient'"'"'s heart using an antiarrhythmia pacing device, comprising the steps of:
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generating heart stimulation pulses, measuring an evoked potential of the patient'"'"'s heart that is responsive to said stimulation pulses, periodically ascertaining the value of a measured arrhythmia detection control parameter which is based upon the sensing of an evoked potential, detecting changes over time in said measured arrhythmia detection control parameter, sensing heartbeats, timing the interval between sensed heartbeats to determine a heart rate, classifying a cardiac rhythm as a pathological tachycardia when said arrhythmia detection control parameter changes in a first predetermined direction and magnitude within a predetermined number of cardiac cycles and said heart rate is faster than a predetermined tachycardia rate, and classifying a cardiac rhythm as a benign physiological tachycardia when said arrhythmia detection control parameter changes in a second predetermined direction and magnitude within a predetermined number of cardiac cycles and said heart rate is faster than said tachycardia rate, measuring short-term uniformity of said arrhythmia detection control parameter, and classifying a cardiac rhythm as fibrillation when said heart rate is faster than a predetermined fibrillation rate, said arrhythmia detection control parameter changes in a third predetermined direction and magnitude within a predetermined number of cardiac cycles, and said short-term uniformity measurement changes in a fourth predetermined direction and magnitude within a predetermined number of cardiac cycles. - View Dependent Claims (27, 28)
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29. An arrhythmia detection and antiarrhythmia pacing device adapted to be implanted in a patient for the reversion of tachycardias, comprising:
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means for generating heart stimulation pulses, means for measuring an evoked potential of the patient'"'"'s heart that is responsive to said stimulation pulses, means based upon the sensing of an evoked potential for periodically ascertaining the value of a measured arrhythmia detection control parameter, means for detecting changes over time in said measured arrhythmia detection control parameter, means for sensing heartbeats, means responsive to said heartbeat sensing means for determining a heart rate, and means responsive to said detecting means and said heart rate determining means for classifying a cardiac rhythm as asystole when said heart rate is slower than a predetermined bradycardia rate and said arrhythmia detection control parameter remains essentially unchanged within a predetermined number of cardiac cycles, and for classifying a cardiac rhythm as fibrillation when said heart rate is slower than a predetermined bradycardia rate and said arrhythmia detection control parameter changes in a predetermined direction and magnitude within a predetermined number of cardiac cycles. - View Dependent Claims (30)
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31. A method of detecting and reverting cardiac arrhythmias of a patient'"'"'s heart using an antiarrhythmia pacing device, comprising the steps of:
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generating heart stimulation pulses, measuring an evoked potential of the patient'"'"'s heart that is responsive to said stimulation pulses, periodically ascertaining the value of a measured arrhythmia detection control parameter which is based upon the sensing of an evoked potential, detecting changes over time in said measured arrhythmia detection control parameter, sensing heartbeats, timing the interval between sensed heartbeats to determine a heart rate, and classifying a cardiac rhythm as asystole when said heart rate is slower than a predetermined bradycardia rate and said arrhythmia detection control parameter remains essentially unchanged within a predetermined number of cardiac cycles, and classifying a cardiac rhythm as fibrillation when said heart rate is slower than a predetermined bradycardia rate and said arrhythmia detection control parameter changes in a predetermined direction and magnitude within a predetermined number of cardiac cycles.
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Specification