Method and apparatus for discrimination of ventricular and supraventricular tachycardia

• US 5,243,980 A
• Filed: 06/30/1992
• Issued: 09/14/1993
• Est. Priority Date: 06/30/1992
• Status: Expired due to Term

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Mehra, Rahul
• Primary Examiner(s): Kamm, William E.
• Assistant Examiner(s): MANUEL, GEORGE C
• Application Number:
  US07/906,806
• Time in Patent Office: 441 Days
• Field of Search: 128/419 PG, 128/419 D, 128/419 P, 128/419 PT, 128/419 S, 128/786, 128/697, 128/703, 128/704, 128/705
• US Class Current: 607/6
• CPC Class Codes: A61N 1/056 Transvascular endocardial electrode systems
• CPC Class Codes: A61N 1/0587 Epicardial electrode systems; Endocardial electrodes piercing the pericardium
• CPC Class Codes: A61N 1/3621 for treating or preventing abnormally high heart rate
• CPC Class Codes: A61N 1/365 controlled by a physiological parameter, e.g. heart potential evoked response A61N1/371
• CPC Class Codes: A61N 1/3962 in combination with another heart therapy
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

A method for discrimination between ventricular and supraventricular tachycardia and an apparatus for performing the method. In response to the detection of the occurrence of an tachycardia, stimulus pulses are delivered to one or both of the SA and AV nodal fat pads. The response of the heart rhythm to these stimulus pulses is monitored. Depending upon the change or lack of change in the heart rhythm, a diagnosis is made as to the origin of the tachycardia.

Claims

1. A method of discriminating between a rapid heart rhythm of ventricular origin and rapid heart rhythm of supraventricular origin, comprising:

monitoring the occurrence of depolarizations of said heart;

measuring the rate of said monitored depolarizations;

electrically stimulating the fat pad or fat pads associated with the SA node and/or the AV node of said heart if a rapid heart rhythm is detected;

determining whether stimulating said fat pad or fat pads results in a change in said detected rapid rhythm of said heart; and

diagnosing whether said detected rapid heart rhythm is of a ventricular or a supraventricular origin as a function of whether stimulating said fat pad or pads results in a change in said detected rapid rhythm of said heart.

2. A method according to claim 1, wherein said determining step comprises determining whether the rate of depolarization of the ventricles of said heart is slowed as a result of stimulation of said fat pad or pads.

3. A method according to claim 1, wherein said determining step comprises determining whether the rate of depolarization of the atria of said heart is slowed as a result of stimulation of said fat pad or pads.

4. A method according to claim 1, wherein said determining step comprises determining whether the interval separating depolarizations of the atria of said heart from depolarizations of the ventricles of said heart is extended as a result of stimulation of said fat pad or pads.

5. A method according to claim 1 wherein said determining step comprises determining the percentage of depolarizations of the atria of said heart leading to depolarizations of the ventricles of said heart and for determining whether said percentage is reduced as a result of stimulation of said fat pad or pads.

6. A method according to claim 1 wherein said stimulating step comprises stimulation of said fat pad or pads by means of one or more electrical pulses synchronized to the detected depolarizations of the atrium of said heart.

7. A method according to claim 1 wherein said stimulating step comprises stimulation of said fat pad or pads by means of one or more electrical pulses synchronized to the detected depolarizations of the ventricle of said heart.

8. A method of discriminating between a rapid heart rhythm of sinus origin and rapid heart rhythm of non-sinus origin, comprising:

monitoring the occurrence of depolarizations of said heart;

measuring the rate of said monitored depolarizations;

electrically stimulating the fat pad associated with the SA node of said heart if a rapid heart rhythm is detected;

determining whether stimulating said fat pad results in a change in said detected rapid rhythm of said heart; and

diagnosing whether said detected rapid heart rhythm is of a sinus or a non-sinus origin as a function of whether stimulating said fat pad or pads results in a change in said detected rapid rhythm of said heart.

9. A method according to claim 8, wherein said determining step comprises determining whether the rate of depolarization of the ventricles of said heart is slowed as a result of stimulation of said fat pad.

10. A method according to claim 8, wherein said determining step comprises determining whether the rate of depolarization of the atria of said heart is slowed as a result of stimulation of said fat pad.

11. A method according to claim 8 wherein said stimulating step comprises stimulation of said fat pad or pads by means of one or more electrical pulses synchronized to the detected depolarizations of the atrium of said heart.

12. A method of treating tachycardias in a heart, comprising:

monitoring the occurrence of depolarizations of said heart;

measuring the rate of said monitored depolarizations;

electrically stimulating the fat pad or fat pads associated with the SA node and/or the AV node of said heart if a rapid heart rhythm is detected;

determining whether stimulating said fat pad or fat pads results in a change in said detected rapid rhythm of said heart;

diagnosing whether said detected rapid heart rhythm is of a ventricular or a supraventricular origin as a function of whether stimulating said fat pad or pads results in a change in said detected rapid rhythm of said heart;

selecting a therapy to be delivered to said heart as a function of said diagnosing step; and

delivering said selected therapy.

13. A method according to claim 12, wherein said determining step comprises determining whether the rate of depolarization of the ventricles of said heart is slowed as a result of stimulation of said fat pad or pads.

14. A method according to claim 12, wherein said determining step comprises determining whether the rate of depolarization of the atria of said heart is slowed as a result of stimulation of said fat pad or pads.

15. A method according to claim 12, wherein said determining step comprises determining whether the interval separating depolarizations of the atria of said heart from depolarizations of the ventricles of said heart is extended as a result of stimulation of said fat pad or pads.

16. A method according to claim 12, wherein said determining step comprises determining the percentage of depolarizations of the atria of said heart leading to depolarizations of the ventricles of said heart and for determining whether said percentage is reduced as a result of stimulation of said fat pad or pads.

17. A method according to claim 12 wherein said stimulating step comprises stimulation of said fat pad or pads by means of one or more electrical pulses synchronized to the detected depolarizations of the atrium of said heart.

18. A method according to claim 12 wherein said stimulating step comprises stimulation of said fat pad or pads by means of one or more electrical pulses synchronized to the detected depolarizations of the ventricle of said heart.

19. A method of treating tachycardias in a heart, comprising:

monitoring the occurrence of depolarizations of said heart;

measuring the rate of said monitored depolarizations;

electrically stimulating the fat pad associated with the SA node of said heart if a rapid heart rhythm is detected;

determining whether stimulating said fat pad results in a change in said detected rapid rhythm of said heart;

diagnosing whether said detected rapid heart rhythm is of a sinus or a non-sinus origin as a function of whether stimulating said fat pad or pads results in a change in said detected rapid rhythm of said heart;

selecting a therapy to be delivered to said heart as a function of said diagnosing step; and

delivering said selected therapy.

20. A method according to claim 19, wherein said determining step comprises determining whether the rate of depolarization of the ventricles of said heart is slowed as a result of stimulation of said fat pad.

21. A method according to claim 19, wherein said determining step comprises determining whether the rate of depolarization of the atria of said heart is slowed as a result of stimulation of said fat pad.

22. A method according to claim 19 wherein said stimulating step comprises stimulation of said fat pad or pads by means of one or more electrical pulses synchronized to the detected depolarizations of the atrium of said heart.

23. Apparatus for discriminating between a rapid heart rhythm of ventricular origin and rapid heart rhythm of supraventricular origin, comprising:

means for monitoring the occurrence of depolarizations of said heart;

means for measuring the rate of said monitored depolarizations;

means for electrically stimulating the fat pad or fat pads associated with the SA node and/or the AV node of said heart if a rapid heart rhythm is detected;

means for determining whether stimulating said fat pad or fat pads results in a change in said detected rapid rhythm of said heart; and

means for diagnosing whether said detected rapid heart rhythm is of a ventricular or a supraventricular origin as a function of whether stimulating said fat pad or pads results in a change in said detected rapid rhythm of said heart.

24. An apparatus according to claim 23, wherein said determining means comprises means for determining whether the rate of depolarization of the ventricles of said heart is slowed as a result of stimulation of said fat pad or pads.

25. An apparatus according to claim 23, wherein said determining means comprises means for determining whether the rate of depolarization of the atria of said heart is slowed as a result of stimulation of said fat pad or pads.

26. An apparatus according to claim 23, wherein said determining means comprises means for determining whether the interval separating depolarizations of the atria of said heart from depolarizations of the ventricles of said heart is extended as a result of stimulation of said fat pad or pads.

27. An apparatus according to claim 23 wherein said determining means comprises means for determining the percentage of depolarizations of the ventricles of said heart and for determining whether said percentage is reduced as a result of stimulation of said fat pad or pads.

28. An apparatus according to claim 23 wherein said stimulating means comprises means for stimulation of said fat pad or pads by means of one or more electrical pulses synchronized to the detected depolarizations of the atrium of said heart.

29. An apparatus according to claim 23 wherein said stimulating means comprises means for stimulation of said fat pad or pads by means of one or more electrical pulses synchronized to the detected depolarizations of the ventricle of said heart.

30. An apparatus for discriminating between a rapid heart rhythm of sinus origin and rapid heart rhythm of non-sinus origin, comprising:

means for monitoring the occurrence of depolarizations of said heart;

means for measuring the rate of said monitored depolarizations;

means for electrically stimulating the fat pad associated with the SA node of said heart if a rapid heart rhythm is detected;

means for determining whether stimulating said fat pad results in a change in said detected rapid rhythm of said heart; and

means for diagnosing whether said detected rapid heart rhythm is of a sinus or a non-sinus origin as a function of whether stimulating said fat pad or pads results in a change in said detected rapid rhythm of said heart.

31. An apparatus according to claim 30, wherein said determining means comprises means for determining whether the rate of depolarization of the ventricles of said heart is slowed as a result of stimulation of said fat pad.

32. An apparatus according to claim 30, wherein said determining means comprises means for determining whether the rate of depolarization of the atria of said heart is slowed as a result of stimulation of said fat pad.

33. An apparatus according to claim 30 wherein said stimulating means comprises means for stimulation of said fat pad or pads by means of one or more electrical pulses synchronized to the detected depolarizations of the atrium of said heart.

34. An apparatus for treating tachycardias in a heart, comprising:

means for monitoring the occurrence of depolarizations of said heart;

means for measuring the rate of said monitored depolarizations;

means for electrically stimulating the fat pad or fat pads associated with the SA node and/or the AV node of said heart if a rapid heart rhythm is detected;

means for determining whether stimulating said fat pad or fat pads results in a change in said detected rapid rhythm of said heart;

means for diagnosing whether said detected rapid heart rhythm is of a ventricular or a supraventricular origin as a function of whether stimulating said fat pad or pads results in a change in said detected rapid rhythm of said heart;

means for selecting a therapy to be delivered to said heart as a function of said diagnosing step; and

means for delivering said selected therapy.

35. An apparatus according to claim 34, wherein said determining means comprises means for determining whether the rate of depolarization of the ventricles of said heart is slowed as a result of stimulation of said fat pad or pads.

36. An apparatus according to claim 34, wherein said determining means comprises means for determining whether the rate of depolarization of the atria of said heart is slowed as a result of stimulation of said fat pad or pads.

37. An apparatus according to claim 34, wherein said determining means comprises means for determining whether the interval separating depolarizations of the atria of said heart from depolarizations of the ventricles of said heart is extended as a result of stimulation of said fat pad or pads.

38. An apparatus according to claim 34, wherein said determining means comprises means for determining the percentage of depolarizations of the atria of said heart leading to depolarizations of the ventricles of said heart and for determining whether said percentage is reduced as a result of stimulation of said fat pad or pads.

39. An apparatus according to claim 34 wherein said stimulating means comprises means for stimulation of said fat pad or pads by means of one or more electrical pulses synchronized to the detected depolarizations of the atrium of said heart.

40. An apparatus according to claim 34 wherein said stimulating means comprises stimulation of said fat pad or pads by means of one or more electrical pulses synchronized to the detected depolarizations of the ventricle of said heart.

41. An apparatus for treating tachycardias in a heart, comprising:

means for monitoring the occurrence of depolarizations of said heart;

means for measuring the rate of said monitored depolarizations;

means for electrically stimulating the fat pad associated with the SA node of said heart if a rapid heart rhythm is detected;

means for determining whether stimulating said fat pad results in a change in said detected rapid rhythm of said heart;

means for diagnosing whether said detected rapid heart rhythm is of a sinus or a non-sinus origin as a function of whether stimulating said fat pad or pads results in a change in said detected rapid rhythm of said heart;

means for selecting a therapy to be delivered to said heart as a function of said diagnosing step; and

means for delivering said selected therapy.

42. An apparatus according to claim 41, wherein said determining means comprises determining whether the rate of depolarization of the ventricles of said heart is slowed as a result of stimulation of said fat pad.

43. An apparatus according to claim 41, wherein said determining means comprises means for determining whether the rate of depolarization of the atria of said heart is slowed as a result of stimulation of said fat pad.

44. An apparatus according to claim 41 wherein said stimulating means comprises means for stimulation of said fat pad or pads by means of one or more electrical pulses synchronized to the detected depolarizations of the atrium of said heart.