Method and apparatus for discrimination of ventricular tachycardia from ventricular fibrillation and for treatment thereof
First Claim
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1. A cardioverter/defibrillator, comprising:
- treatment means for delivering a first therapy to a patient'"'"'s heart to treat tachycardia and a second therapy to said patient'"'"'s heart to treat fibrillation;
first means for sensing electrical signals from said patient'"'"'s heart indicative of the depolarization of a chamber or chambers of said patient'"'"'s heart;
second means for sensing electrical signals from said patient'"'"'s heart indicative of the depolarization of said chamber or chambers of said patient'"'"'s heart;
first fiducial point detection means, coupled to said first sensing means for determining the time at which the electrical signal sensed by said first sensing means meets first predetermined criteria and for issuing a first fiducial point signal indicative thereof;
second fiducial point detection means, coupled to said first sensing means for determining the time at which the electrical signal sensed by said second sensing means meets second predetermined criteria and for issuing a second fiducial point signal indicative thereof; and
tachycardia/fibrillation discriminator means responsive to said first and second fiducial point signals for measuring the time interval separating the times at which said electrical signals associated with a single depolarization of said chamber or chambers of said patient'"'"'s heart meet said first and second predetermined criteria and for measuring the cumulative variability of said measured time interval over a series of depolarizations of said chamber or chambers of said patient'"'"'s heart and for selecting between said first and second therapies as a function of said measured variability.
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Abstract
An implantable cardioverter/defibrillator provided with method and apparatus for discrimination between ventricular tachycardia and ventricular fibrillation. The device is provided with two pairs of electrodes, each pair of electrodes coupled to processing circuitry for identifying a predetermined fiducal point in the electrical signal associated with a ventricular depolarization. The cumulative beat to beat variability of the intervals separating the two identified fiducal points, over a series of detected depolarizations is analyzed. The result of this analysis is used to distinguish between ventricular tachycardia and ventricular fibrillation.
482 Citations
31 Claims
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1. A cardioverter/defibrillator, comprising:
- treatment means for delivering a first therapy to a patient'"'"'s heart to treat tachycardia and a second therapy to said patient'"'"'s heart to treat fibrillation;
first means for sensing electrical signals from said patient'"'"'s heart indicative of the depolarization of a chamber or chambers of said patient'"'"'s heart; second means for sensing electrical signals from said patient'"'"'s heart indicative of the depolarization of said chamber or chambers of said patient'"'"'s heart; first fiducial point detection means, coupled to said first sensing means for determining the time at which the electrical signal sensed by said first sensing means meets first predetermined criteria and for issuing a first fiducial point signal indicative thereof; second fiducial point detection means, coupled to said first sensing means for determining the time at which the electrical signal sensed by said second sensing means meets second predetermined criteria and for issuing a second fiducial point signal indicative thereof; and tachycardia/fibrillation discriminator means responsive to said first and second fiducial point signals for measuring the time interval separating the times at which said electrical signals associated with a single depolarization of said chamber or chambers of said patient'"'"'s heart meet said first and second predetermined criteria and for measuring the cumulative variability of said measured time interval over a series of depolarizations of said chamber or chambers of said patient'"'"'s heart and for selecting between said first and second therapies as a function of said measured variability. - View Dependent Claims (4, 5, 6, 7)
- treatment means for delivering a first therapy to a patient'"'"'s heart to treat tachycardia and a second therapy to said patient'"'"'s heart to treat fibrillation;
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2. A cardioverter/defibrillator, comprising:
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treatment means for delivering a first therapy to a patient'"'"'s heart to treat tachycardia and a second therapy to said patient'"'"'s heart to treat fibrillation; first means for sensing electrical signals from said patient'"'"'s heart indicative of the depolarization of a chamber or chambers of said patient'"'"'s heart, said first sensing means comprising a first electrode pair; second means for sensing electrical signals from said patient'"'"'s heart indicative of the depolarization of said chamber or chambers of said patient'"'"'s heart, said second sensing means comprising a second electrode pair having at least one electrode not included in said first electrode pair; first fiducial point detection means, coupled to said first sensing means for determining the time at which the electrical signal sensed by said first sensing means meets first predetermined criteria associated with the depolarization of said chamber or chambers of said patient'"'"'s heart and for issuing a first fiducial point signal indicative thereof; second fiducial point detection means, coupled to said first sensing means for determining the time at which the electrical signal sensed by said second sensing means meets second predetermined criteria associated with the depolarization of said chamber or chambers of said patient'"'"'s heart and for issuing a second fiducial point signal indicative thereof; and tachycardia/fibrillation discriminator means responsive to said first and second fiducial point signals for measuring the time interval separating the times at which said electrical signals associated with a single depolarization of said chamber or chambers of said patient'"'"'s heart meet said first and second predetermined criteria and for measuring the cumulative variability of said measured time interval over a series of depolarizations of said chamber or chambers of said patient'"'"'s heart and for selecting between said first and second therapies as a function of said measured variability.
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3. A cardioverter/defibrillator, comprising:
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treatment means for delivering a first therapy to a patient'"'"'s heart to treat tachycardia and a second therapy to said patient'"'"'s heart to treat fibrillation; first means for sensing electrical signals from said patient'"'"'s heart indicative of the depolarization of a chamber or chambers of said patient'"'"'s heart; second means for sensing electrical signals from said patient'"'"'s heart indicative of the depolarization of said chamber or chambers of said patient'"'"'s heart; first fiducial point detection means, coupled to said first sensing means for determining the time at which the electrical signal sensed by said first sensing means meets first predetermined criteria associated with the depolarization of said chamber or chambers of said patient'"'"'s heart and for issuing a first fiducial point signal indicative thereof; second fiducial point detection means, coupled to said first sensing means for determining the time at which the electrical signal sensed by said second sensing means meets second predetermined criteria associated with the depolarization of said chamber or chambers of said patient'"'"'s heart, said first criteria differing from said second criteria, and for issuing a second fiducial point signal indicative thereof; and tachycardia/fibrillation discriminator means responsive to said first and second fiducial point signals for measuring the time interval separating the times at which said electrical signals associated with a single depolarization of said chamber or chambers of said patient'"'"'s heart meet said first and second predetermined criteria and for measuring the cumulative variability of said measured time intervals over a series of depolarizations of said chamber or chambers of said patient'"'"'s heart and for selecting between said first and second therapies as a function of said measured variability.
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8. A cardioverter/defibrillator, comprising:
- treatment means for delivering a first therapy to a patient'"'"'s heart to treat tachycardia and a second therapy to said patient'"'"'s heart to treat fibrillation;
first means for sensing electrical signals from said patient'"'"'s heart indicative of the depolarization of a chamber or chambers of said patient'"'"'s heart and for issuing a first fiducial point signal indicative thereof, said first sensing means comprising a first electrode pair; second means for sensing electrical signals from said patient'"'"'s heart indicative of the depolarization of said chamber or chambers of said patient'"'"'s heart and for issuing a second fiducial point signal indicative thereof, said second sensing means comprising a second electrode pair including at least one electrode not included in said first electrode pair; tachycardia/fibrillation discriminator means responsive to said first and second fiducal point signals for cumulatively measuring the depolarization to depolarization variability of the direction of depolarization wavefront propagation within said chamber or chambers of said patient'"'"'s heart over a series of depolarizations of said patient'"'"'s heart and for selecting between said first and second therapies as a function of said measured variability. - View Dependent Claims (9)
- treatment means for delivering a first therapy to a patient'"'"'s heart to treat tachycardia and a second therapy to said patient'"'"'s heart to treat fibrillation;
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10. A cardioverter/defibrillator, comprising:
- treatment means for delivering a first therapy to a patient'"'"'s heart to treat tachycardia and a second therapy to said patient'"'"'s heart to treat fibrillation;
first means for sensing electrical signals from said patient'"'"'s heart indicative of the depolarization of a chamber or chambers of said patient'"'"'s heart and for issuing a first fiducial point signal indicative thereof in response to said signals from said patient'"'"'s heart meeting first criteria; second means for sensing electrical signals from said patient'"'"'s heart indicative of the depolarization of said chamber or chambers of said patient'"'"'s heart and for issuing a second fiducial point signal indicative thereof in response to said signals from said patient'"'"'s heart meeting second criteria differing from said first criteria; tachycardia/fibrillation discriminator means responsive to said first and second fiducal point signals for cumulatively measuring the depolarization to depolarization variability of the direction of depolarization wavefront propagation within said chamber or chambers of said patient'"'"'s heart over a series of depolarizations of said patient'"'"'s heart and for selecting between said first and second therapies as a function of said measured variability. - View Dependent Claims (11, 12)
- treatment means for delivering a first therapy to a patient'"'"'s heart to treat tachycardia and a second therapy to said patient'"'"'s heart to treat fibrillation;
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13. A defibrillator, comprising:
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treatment means for delivering a therapy to a patient'"'"'s heart to treat to treat fibrillation; first means for sensing electrical signals from said patient'"'"'s heart indicative of the depolarization of a chamber or chambers of said patient'"'"'s heart and for providing a first fiducal point signal indicative thereof, said first sensing means comprising a first electrode pair; second means for sensing electrical signals from said patient'"'"'s heart indicative of the depolarization of said chamber or chambers of said patient'"'"'s heart and for providing a second fiducal point signal indicative thereof, said second sensing means comprising a second electrode pair including at least one electrode not included in said first electrode pair; fibrillation detection means responsive to said first and second fiducal point signals for cumulatively measuring the depolarization to depolarization variability of the direction of depolarization wavefront propagation within said chamber or chambers of said patient'"'"'s heart over a series of depolarizations of said patient'"'"'s heart and for detecting fibrillation and initiating said therapy as a function of said measured variability. - View Dependent Claims (16, 17)
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14. A defibrillator, comprising:
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treatment means for delivering a therapy to a patient'"'"'s heart to treat to treat fibrillation; first means for sensing electrical signals from said patient'"'"'s heart indicative of the depolarization of a chamber or chambers of said patient'"'"'s heart and for providing a first fiducal point signal indicative thereof in response to said electrical signals meeting first predetermined criteria; second means for sensing electrical signals from said patient'"'"'s heart indicative of the depolarization of said chamber or chambers of said patient'"'"'s heart and for providing a second fiducal point signal indicative thereof in response to said electrical signals meeting second predetermined criteria differing from said first predetermined criteria; fibrillation detection means responsive to said first and second fiducal point signals for cumulatively measuring the depolarization to depolarization variability of the direction of depolarization wavefront propagation within said chamber or chambers of said patient'"'"'s heart over a series of depolarizations of said patient'"'"'s heart and for detecting fibrillation and initiating said therapy as a function of said measured variability. - View Dependent Claims (15)
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18. A cardioverter, comprising:
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treatment means for delivering a therapy to a patient'"'"'s heart to treat to treat tachycardia; first means for sensing electrical signals from said patient'"'"'s heart indicative of the depolarization of a chamber or chambers of said patient'"'"'s heart and for providing a first fiducal point signal indicative thereof, said first sensing means comprising a first electrode pair; second means for sensing electrical signals from said patient'"'"'s heart indicative of the depolarization of a chamber or chambers of said patient'"'"'s heart and for providing a second fiducal point signal indicative thereof, said second sensing means comprising a second electrode pair including at least one electrode not included in said first electrode pair; tachycardia detection means responsive to said first and second fiducal point signals for cumulatively measuring the depolarization to depolarization variability of the direction of depolarization wavefront propagation within said chamber or chambers of said patient'"'"'s heart over a series of depolarizations of said patient'"'"'s heart and for detecting tachycardia and initiating said therapy as a function of said measured variability. - View Dependent Claims (22, 23)
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19. A cardioverter, comprising:
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treatment means for delivering a therapy to a patient'"'"'s heart to treat to treat tachycardia; first means for sensing electrical signals from said patient'"'"'s heart indicative of the depolarization of a chamber or chambers of said patient'"'"'s heart and for providing a first fiducal point signal indicative thereof in response to said electrical signals meeting first criteria; second means for sensing electrical signals from said patient'"'"'s heart indicative of the depolarization of a chamber or chambers of said patient'"'"'s heart and for providing a second fiducal point signal indicative thereof in response to said electrical signals meeting second predetermined criteria differing from said first criteria; tachycardia detection means responsive to said first and second fiducal point signals for cumulatively measuring the depolarization to depolarization variability of the direction of depolarization wavefront propagation within said chamber or chambers of said patient'"'"'s heart over a series of depolarizations of said patient'"'"'s heart and for detecting tachycardia and initiating said therapy as a function of said measured variability. - View Dependent Claims (20, 21, 26, 27, 28, 29, 30, 31)
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24. A tachycardia/fibrillation discriminator, comprising:
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first means for sensing electrical signals from said patient'"'"'s heart indicative of the depolarization of a chamber or chambers of said patient'"'"'s heart and for providing a first fiducal point signal indicative thereof, said first sensing means comprising a first electrode pair; second means for sensing electrical signals from said patient'"'"'s heart indicative of the depolarization of said chamber or chambers of said patient'"'"'s heart and for providing a second fiducal point signal indicative thereof, said second sensing means comprising a second electrode pair including at least one electrode not included in said first electrode pair; means responsive to said first and second fiducal point signals for measuring the cumulative variability of the direction of depolarization wavefront propagation within said chamber or chambers of said patient'"'"'s heart over a series of depolarizations of said patient'"'"'s heart and for providing an output indicative of the detection of tachycardia or fibrillation as a function of said measured variability.
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25. A tachycardia/fibrillation discriminator, comprising:
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first means for sensing electrical signals from said patient'"'"'s heart indicative of the depolarization of a chamber or chambers of said patient'"'"'s heart and for providing a first fiducal point signal indicative thereof in response to said electrical signals meeting first criteria; second means for sensing electrical signals from said patient'"'"'s heart indicative of the depolarization of said chamber or chambers of said patient'"'"'s heart and for providing a second fiducal point signal indicative thereof in response to said electrical signals meeting second criteria differing from said first criteria; means responsive to said first and second fiducal point signals for measuring the cumulative variability of the direction of depolarization wavefront propagation within said chamber or chambers of said patient'"'"'s heart over a series of depolarizations of said patient'"'"'s heart and for providing an output indicative of the detection of tachycardia or fibrillation as a function of said measured variability.
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Specification