Methods and apparatus for determining when tachyarrythmia is pace-terminable

• US 5,462,060 A
• Filed: 05/24/1994
• Issued: 10/31/1995
• Est. Priority Date: 05/28/1993
• Status: Expired due to Term

• Current Assignee: Sorin CRM USA (MicroPort Scientific Corp.)
• Original Assignee: Ela Medical S.A. (LivaNova Plc)
• Inventors: Jacobson, Peter, Henry, Christine, Kroiss, Daniel
• Primary Examiner(s): Kamm, William E.
• Assistant Examiner(s): Getzow, Scott M.
• Application Number:
  US08/248,329
• Time in Patent Office: 525 Days
• Field of Search: 128/702, 128/705
• US Class Current: 600/515
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions
• CPC Class Codes: A61N 1/39 Heart defibrillators
• CPC Class Codes: A61N 1/3925 Monitoring; Protecting
• CPC Class Codes: A61N 1/3956 Implantable devices for applying electric shocks to the heart, e.g. for cardioversion

Abstract

Methods and apparatus for classifying cardiac rhythm by analyzing sensed atrial and ventricular heartbeats, and determining if the rhythm might be pace-terminable in a given chamber. The method maintains a histogram of the sensed beat interval in the chamber of interest and a second histogram of conduction time from the other chamber. The method classifies a rhythm as pace terminable in the given chamber when the intervals in that chamber are stable, and the conduction times to that chamber are unstable. It applies further criteria when the intervals in the given chamber are stable, and the conduction times are also stable. Antitachycardia pacing is deliverable to terminate tachyarrhythmias determined to be pace terminable.

Claims

1. A method of analyzing a patient'"'"'s cardiac activity comprising the steps of:

(a) detecting cardiac events in the atrium and the ventricle;

(b) determining an interval between each detected event in a first chamber, each interval having a time length, said first chamber being one of the atrium and the ventricle;

(c) determining a conduction interval between a sensed cardiac event in the first chamber and a preceding sensed cardiac event in the second chamber, each conduction interval having a time length, the second chamber being the other of the atrium and ventricle;

(d) forming an auto-correlation histogram of determined intervals in said first chamber corresponding to a cardiac cycle in the first chamber that is above a sinus rhythm;

(e) forming a cross-correlation histogram of determined conduction intervals corresponding to a cardiac cycle in the first chamber that is above a sinus rhythm;

(f) processing the auto-correlation histogram by

(i) scanning the auto-correlation histogram with a stability window, determining the number of intervals in the stability window for each position of the stability window in the auto-correlation histogram, and determining the maximum number of intervals within said stability window of all of the possible positions of the stability window,

(ii) determining an auto-correlation peak count as said determined maximum number of intervals that satisfy the stability window, and

(iii) providing an auto-correlation total corresponding to the number of the determined intervals in the auto-correlation histogram;

(g) processing the cross-correlation histogram by

(i) scanning the cross-correlation histogram with a conduction time window, determining the number of intervals in the conduction time window for each position of the conduction time window in the cross-correlation histogram and determining the maximum number of determined conduction intervals within said conduction time window of all of the possible positions of said conduction time window,

(ii) determining a cross-correlation peak count as the determined number of maximum determined conduction intervals that satisfy the conduction time window, and

(iii) providing a cross-correlation total corresponding to the number of the determined conduction intervals in the cross-correlation histogram; and

(h) determining whether the patient'"'"'s cardiac events correspond to a tachyarrhythmia that is terminable by a stimulation pulse in the first chamber based on the determined auto-correlation peak and the determined cross-correlation peak.

2. The method of claim 1 wherein step (d) further comprises providing a first plurality of first bins, each first bin corresponding to a different range of interval time lengths, and sorting the determined intervals into said first bins according to the time lengths of said determined intervals, and wherein step (e) further comprises providing a second plurality of second bins, each second bin corresponding to a different range of interval time lengths, and sorting the determined conduction intervals lengths into said second bins according to the time lengths of said determined conduction intervals.

3. The method of claim 2 wherein providing said first plurality of first bins further comprises providing said first bins with contiguous ranges of time intervals over a first time range, and wherein providing said second plurality of second bins further comprises providing said second bins with contiguous ranges of time intervals over a second time range.

4. The method of claim 2 wherein the scanning step (f)(i) further comprises providing said stability window with a time length corresponding to a third plurality of contiguous first bins, the third plurality being less than the first plurality, and wherein the scanning step (g)(i) further comprises providing said conduction time window with a time length corresponding to a fourth plurality of contiguous second bins, the fourth plurality being less than the second plurality.

5. The method of claim 4 wherein providing said first and second bins further comprises providing each first and second bin with a time length range of approximately 16 ms, wherein providing said stability window further comprises providing said stability window with a time length of approximately 64 ms, and wherein providing said conduction time window further comprises providing said conduction time window with a time length of approximately 64 ms.

6. The method of claim 2 wherein step (d) further comprises sorting detected intervals having an interval time length in the range of from 125 ms to 600 ms and wherein step (e) further comprises sorting detected conduction intervals having a conduction interval time length in the range of from 16 ms to 500 ms.

7. The method of claim 1 wherein the scanning step (f)(i) further comprises providing said stability window with a time length corresponding to a subset of said auto-correlation histogram and wherein the scanning step (g)(i) further comprises providing said conduction time window with a time length corresponding to a subset of said cross-correlation histogram.

8. The method of claim 1 wherein steps (d) and (e) further comprise adjusting the contents of the auto-correlation histogram and the cross-correlation histogram respectively to correspond to sensed cardiac activity from a predetermined number of cardiac cycles in the first chamber, including the determined interval and any determined conduction intervals in response to the sensed cardiac events of a recent cardiac cycle and deleting from the histograms the determined interval and any determined conduction intervals of sensed cardiac events of a prior cardiac cycle in the first chamber, the prior cardiac cycle occurring more than said predetermined number of cardiac cycles preceding the recent cardiac cycle, and wherein the steps (f) and (g) further comprise processing the adjusted auto-correlation and cross-correlation histograms respectively.

9. The method of claim 8 wherein adjusting the contents of the auto-correlation and cross-correlation histograms respectively further comprise forming said histograms based on the determined intervals and determined conduction intervals for the 16 most recent cardiac cycles in the first chamber that are above a sinus rhythm, respectively.

10. The method of claim 1 wherein step (b) further comprises determining whether the determined interval exceeds a preselected limit corresponding to a sinus rhythm limit and not performing steps (c) through (g) in response to said determined interval being longer than said preselected limit.

11. The method of claim 10 further comprising determining when the determined intervals exceeds the preselected limit for more than a first predetermined number of cardiac cycles and, in response thereto:

(i) resetting said auto-correlation histogram and said cross-correlation histogram;

(ii) resuming steps (c) through (e) subsequent to step (i), and

(iii) resuming steps (a) through (g) following the occurrence of determined intervals and conduction intervals corresponding to a second predetermined number of cardiac cycles in the first chamber that are above the sinus rhythm subsequent to step (i).

12. The method of claim 11 wherein step (b) further comprises providing said first predetermined number of cardiac cycles as sixteen cardiac cycles and providing said second predetermined number of cardiac cycles as eight cardiac cycles.

13. The method of claim 1 wherein step (h) further comprises determining the existence of stability in the first chamber in response to the quotient of the auto-correlation peak divided by the auto-correlation total exceeding a first fraction, and declaring the tachyarrhythmia not terminable by a stimulation pulse in the first chamber in the absence of stability in the first chamber.

14. The method of claim 1 wherein step (h) further comprises determining the existence of stability in the first chamber in response to the quotient of the auto-correlation peak divided by the auto-correlation total exceeding a first fraction, determining the existence of conduction instability for conduction from the second chamber to the first chamber in response to the quotient of the cross-correlation peak divided by the auto-correlation total not exceeding a second fraction, and declaring the tachyarrhythmia terminable by a stimulation pulse in the first chamber in response to there being stability in the first chamber and conduction instability.

15. The method of claim 1 wherein step (h) further comprises determining the existence of stability in the first chamber in response to the quotient of the auto-correlation peak divided by the auto-correlation total exceeding a first fraction, determining the existence of conduction instability for conduction from the second chamber to the first chamber in response to the quotient of the cross-correlation peak divided by the auto-correlation peak not exceeding a second fraction, and declaring the tachyarrhythmia terminable by a stimulation pulse in the first chamber in response to there being stability in the first chamber and conduction instability.

16. The method of claim 1 wherein step (h) further comprises:

determining the existence of stability in the first chamber in response to the quotient of the auto-correlation peak divided by the auto-correlation total exceeding a first fraction;

determining the existence of conduction stability for conduction from the second chamber to the first chamber in response to the quotient of the cross-correlation peak divided by the auto-correlation total exceeding a second fraction;

determining an association ratio of the detected events in the first chamber and the second chamber; and

in response to a determined 1;

1 association ratio, (i) determining an acceleration of the determined intervals and identifying the occurrence of an acceleration of rate in the first chamber exceeding a preselected acceleration limit, and (ii) determining the occurrence of a disassociation of conduction between the first and second chambers at the onset of said identified acceleration; and

declaring the tachyarrhythmia terminable by a stimulation pulse in the first chamber in response to there being stability in the first chamber, conduction stability, a determined 1;

1 association ratio, acceleration of rate, and disassociation of conduction at the onset of acceleration.

17. The method of claim 16 wherein determining the association ratio further comprises comparing the quotient of the cross-correlation peak divided by the cross-correlation total to a preset fraction, and determining a 1:

1 association ratio if said quotient is greater than said preset fraction.

18. The method of claim 16 wherein determining the association ratio further comprises determining a 1:

1 association ratio in response to the quotient of the auto-correlation total divided by the cross-correlation total being in a range of from 0.66 to 1.33.

19. The method of claim 1 wherein step (h) further comprises:

determining the existence of stability in the first chamber in response to the quotient of the auto-correlation peak divided by the auto-correlation total exceeding a first fraction;

determining the existence of conduction stability for conduction from the second chamber to the first chamber in response to the quotient of the cross-correlation peak divided by the auto-correlation peak exceeding a second fraction;

determining an association ratio of the detected events in the first chamber and the second chamber;

in response to a determined 1;

1 association ratio, (i) determining an acceleration of the determined intervals and identifying the occurrence of an acceleration of rate in the first chamber exceeding a preselected acceleration limit, and (ii) determining the occurrence of a disassociation of conduction between the first and second chambers at the onset of said identified acceleration; and

declaring the tachyarrhythmia terminable by a stimulation pulse in the first chamber in response to there being stability in the first chamber, conduction stability, a determined 1;

1 association ratio, acceleration of rate, and disassociation of conduction at the onset of acceleration.

20. The method of claim 19 wherein determining the association ratio further comprises comparing the quotient of the cross-correlation peak divided by the cross-correlation total to a preset fraction, and determining a 1:

1 association ratio if said quotient is greater than said preset fraction.

21. The method of claim 19 wherein determining the association ratio further comprises determining a 1:

1 association ratio in response to the quotient of the auto-correlation total divided by the cross-correlation total being in a range of from 0.66 to 1.33.

22. The method of claims 1, 15, 16, or 19 further comprising:

(i) applying antitachycardia pacing to the first chamber in response to a tachyarrhythmia that is determined terminable by a stimulation pulse.

23. A method of analyzing a patient'"'"'s cardiac activity comprising the steps of:

(a) sensing cardiac events in the atrium and the ventricle;

(b) processing the sensed cardiac events including the steps of

(i) determining an interval between each detected event in a first chamber corresponding to a cardiac cycle, each interval having a time length, said first chamber being one of the atrium and the ventricle;

(ii) selecting the determined intervals corresponding to a plurality of cardiac cycles above a sinus rhythm, providing a first total as a count of said selected determined intervals and determining whether said determined intervals satisfy a stability criterion;

(iii) determining a first peak count of the determined intervals that satisfy said stability criterion;

(iv) determining a conduction interval between a sensed cardiac event in the first chamber and each preceding sensed cardiac event in the second chamber for the plurality of cardiac cycles, each conduction interval having a time length, the second chamber being the other of the atrium and ventricle, and providing a second total as a count of said determined conduction intervals;

(v) determining whether each conduction interval time length is within a conduction time stability criterion; and

(vi) determining a second peak count of the determined conduction intervals that are within the conduction time stability criterion; and

(c) determining whether the patient'"'"'s processed cardiac events correspond to a tachyarrhythmia that is terminable by a stimulation pulse in the first chamber based on the determined first and second peaks.

24. The method of claim 23 wherein steps (b) (ii) and (iii) further comprise:

forming a histogram of the selected determined intervals in said first chamber for a range of interval lengths;

providing the first total as corresponding to the number of the intervals in the histogram; and

scanning the histogram with a stability window having an interval that is a subset of the histogram interval length range, determining the number of intervals in the stability window for each position of the stability window in the histogram, and determining said first peak as the maximum number of intervals within said stability window for all possible positions of the stability window in the auto-correlation histogram.

25. The method of claim 24 wherein forming the histogram further comprises providing a plurality of bins, each bin corresponding to different range of interval time lengths, and sorting the selected determined intervals lengths into said bins according to the time lengths of said intervals.

26. The method of claim 25 wherein providing said plurality of bins further comprises providing each said bin with a time length range of approximately 16 ms and providing said bins with contiguous ranges of time intervals, and wherein the scanning step further comprises providing said stability window with a time length corresponding to a plurality of contiguous bins.

27. The method of claim 25 wherein forming said histogram further comprises sorting selected detected intervals having an interval time length in the range of from 125 ms to 600 ms.

28. The method of claim 24 wherein step (b) further comprises adjusting the plurality of cardiac cycles processed by including sensed cardiac events corresponding to a recent cardiac cycle in the first chamber above the sinus rhythm and deleting previously sensed cardiac events corresponding to cardiac cycles in the first chamber above the sinus rhythm occurring more than a predetermined number of cardiac cycles preceding the recent cardiac cycle, and wherein the step of forming the histogram further comprises updating the histogram so that the histogram contains the selected determined intervals for said predetermined number of cardiac cycles, and wherein said steps of providing said total and scanning the histogram further comprise performing said providing and scanning steps based on said updated histogram.

29. The method of claim 28 wherein adjusting the plurality of cardiac cycles processed further comprises processing the sensed cardiac activity for the 16 most recent cardiac cycles in the first chamber above the sinus rhythm.

30. The method of claim 24 wherein step (b)(i) further comprises determining whether the determined interval exceeds a preselected limit corresponding to a sinus rhythm limit and not performing the processing of steps (b)(ii) through (b)(vi) and (c) in response to said determined interval being longer than said preselected limit.

31. The method of claim 30 further comprising determining when the determined intervals exceed the preselected limit for more than said plurality of cardiac cycles and, in response thereto, resetting said histogram, and selecting for processing cardiac events sensed during a second time period corresponding to a second plurality of cardiac cycles in the first chamber above a sinus rhythm, said second time period being later in time than said first time.

32. The method of claim 23 wherein steps (b)(iv), (v) and (vi) further comprise:

forming a histogram of the determined conduction intervals for a range of interval lengths;

providing the second total as corresponding to the number of the conduction intervals in the cross-correlation histogram; and

scanning the histogram with a conduction time window having an interval that is a subset of the histogram range, determining the number of conduction intervals in the conduction time window for each position of the conduction time window in the histogram, and determining said second peak as the maximum number of conduction intervals within said conduction time window for all possible positions of said conduction time window in the histogram.

33. The method of claim 32 wherein forming the histogram further comprises providing a plurality of bins, each bin having a different range of time interval lengths, and sorting the determined conduction intervals lengths into said bins according to the time lengths of said conduction intervals.

34. The method of claim 33 wherein providing said plurality of bins further comprises providing each said bin with a time length range of approximately 16 ms, providing said bins with contiguous ranges of time intervals, and wherein the scanning step further comprises providing said conduction time window with a time length corresponding to a plurality of contiguous bins.

35. The method of claim 33 wherein forming said histogram further comprises sorting detected conduction intervals having a conduction interval time length in the range of from 16 ms to 500 ms.

36. The method of claim 32 wherein step (b) further comprises adjusting the plurality of cardiac cycles processed by including sensed cardiac events corresponding to a recent cardiac cycle in the first chamber above the sinus rhythm and deleting previously sensed cardiac events corresponding to prior cardiac cycles in the first chamber above the sinus rhythm occurring more than a predetermined number of cardiac cycles preceding the recent cardiac cycle, and wherein the step of forming the histogram further comprises updating the histogram so that the histogram contains the determined conduction intervals for said predetermined number of cardiac cycles, and wherein said steps of providing said second total and scanning the histogram further comprise performing said providing and scanning steps based on said updated histogram.

37. The method of claim 36 wherein adjusting the plurality of cardiac cycles processed further comprises processing the sensed cardiac activity for the 16 most recent cardiac cycles in the first chamber above the sinus rhythm.

38. The method of claim 32 wherein step (b)(i) further comprises determining whether the determined interval exceeds a preselected limit corresponding to a sinus rhythm limit and not performing the processing of steps (b)(ii) through (b)(vi) and (c) in response to said determined interval being longer than said preselected limit.

39. The method of claim 38 further comprising determining when the determined intervals exceed the preselected limit for more than said plurality of cardiac cycles and, in response thereto, resetting said histogram, and selecting for processing cardiac events sensed during a second time period corresponding to a second plurality of cardiac cycles in the first chamber above the sinus rhythm, said second time being later in time than said first time.

40. The method of claim 23 wherein step (b) further comprises adjusting the plurality of cardiac cycles processed by including sensed cardiac events corresponding to a recent cardiac cycle in the first chamber above the sinus rhythm and deleting previously sensed cardiac events corresponding to cardiac cycles in the first chamber above the sinus rhythm occurring more than said plurality of cardiac cycles preceding the recent cardiac cycle.

41. The method of claim 40 wherein adjusting the plurality of cardiac cycles processed further comprises processing the sensed cardiac activity for the 16 most recent cardiac cycles in the first chamber above the sinus rhythm.

42. The method of claim 23 wherein step (b)(i) further comprises determining whether the determined interval exceeds a preselected limit corresponding to a sinus rhythm limit and not performing the processing of steps (b)(ii) through (b)(vi) and (c) in response to said determined interval being longer than said preselected limit.

43. The method of claim 42 wherein step (b)(i) further comprises providing said preselected limit to be an interval of approximately 600 ms.

44. The method of claim 42 further comprising determining when the determined intervals exceeds the preselected limit for more than said plurality of cardiac cycles and, in response thereto, selecting for processing cardiac events sensed during a second time period corresponding to a second plurality of cardiac cycles in the first chamber above a sinus rhythm, said second time period being later in time than said first time.

45. The method of claim 42 wherein step (b) further comprises providing said plurality of cardiac cycles as sixteen cardiac cycles.

46. The method of claims 24 or 32 further comprising forming an average of a plurality of determined intervals and sorting rhythms only when the determined average interval time length falls between a preset lower limit and a preset upper limit defining a likely tachycarrhythmia range.

47. The method of claim 46 where the preset lower limit is approximately 375 ms and the preset upper limit is approximately 600 ms.

48. The method of claims 23, 24 or 32 wherein step (c) further comprises determining the existence of stability in the first chamber in response to the quotient of the first peak divided by the first total exceeding a first fraction, and declaring the tachyarrhythmia not terminable by a stimulation pulse in the first chamber in the absence of stability in the first chamber.

49. The method of claims 23, 24, or 32 wherein step (c) further comprises determining the existence of stability in the first chamber in response to the quotient of the first peak divided by the first total exceeding a first fraction, determining the existence of conduction instability for conduction from the second chamber to the first chamber in response to the quotient of the second peak divided by the first total not exceeding a second fraction, and declaring the tachyarrhythmia terminable by a stimulation pulse in the first chamber in response to there being stability in the first chamber and conduction instability.

50. The method of claims 23, 24 or 32 wherein step (c) further comprises determining the existence of stability in the first chamber in response to the quotient of the first peak divided by the first total exceeding a first fraction, determining the existence of conduction instability for conduction from the second chamber to the first chamber in response to the quotient of the second peak divided by the first peak not exceeding a second fraction, and declaring the tachyarrhythmia terminable by a stimulation pulse in the first chamber in response to there being stability in the first chamber and conduction instability.

51. The method of claims 23, 24 or 32 wherein step (c) further comprises:

determining the existence of stability in the first chamber in response to the quotient of the first peak divided by the first total exceeding a first fraction;

determining the existence of conduction stability for conduction from the second chamber to the first chamber in response to the quotient of the second peak divided by the first total exceeding a second fraction;

determining an association ratio of the detected events in the first chamber and in the second chamber; and

in response to determined 1;

1 association ratio, (i) determining an acceleration of the determined intervals and identifying the occurrence of an acceleration of rate in the first chamber exceeding a preselected acceleration limit, and (ii) determining the occurrence of a disassociation of conduction between the first and second chambers at the onset of said identified acceleration; and

declaring the tachyarrhythmia terminable by a stimulation pulse in the first chamber in response to there being stability in the first chamber, conduction stability, a determined 1;

1 association ratio, acceleration of rate, and disassociation of conduction at the onset of acceleration.

52. The method of claim 51 wherein determining the association ratio further comprises comparing the quotient of the second peak divided by the second total to a present fraction, and determining a 1:

1 association ratio if said quotient is greater than said preset fraction.

53. The method of claim 51 wherein determining the association ratio further comprises determining a 1:

1 association ratio in response to the quotient of the first total divided by the second total being in a range of from 0.66 to 1.33.

54. The method of claims 23, 24 or 32 wherein step (c) further comprises:

determining the existence of stability in the first chamber in response to the quotient of the first peak divided by the first total exceeding a first fraction;

determining the existence of conduction stability for conduction from the second chamber to the first chamber in response to the quotient of the second peak divided by the first peak exceeding a second fraction;

determining an association ratio of the detected events in the first chamber and the second chamber; and

in response to a determined 1;

1 association ratio, (i) determining an acceleration of the determined intervals and identifying the occurrence of an acceleration of rate in the first chamber exceeding a preselected acceleration limit, and (ii) determining the occurrence of a disassociation of conduction between the first and second chambers at the onset of said identified acceleration; and

declaring the tachyarrhythmia terminable by a stimulation pulse in the first chamber in response to there being stability in the first chamber, conduction stability, a determined 1;

1 association ratio, acceleration of rate, and disassociation of conduction at the onset of acceleration.

55. The method of claim 54 wherein determining the association ratio further comprises comparing the quotient of the second peak divided by the second total to a present fraction, and determining a 1:

1 association ratio if said quotient is greater than said preset fraction.

56. The method of claim 54 wherein determining the association ratio further comprises declaring a 1:

1 association ratio in response to the quotient of the first total divided by the second total being in a range of from 0.66 to 1.33.

57. The method of claims 23, 24, or 32, further comprising:

(d) applying antitachycardia pacing to the first chamber in response to a tachyarrhythmia that is determined terminable by a stimulation pulse.

58. Apparatus for analyzing a patient'"'"'s cardiac activity comprising:

means for sensing cardiac events in the atrium and the ventricle;

means for processing the sensed cardiac events comprising

first means for determining an interval between each detected event corresponding to a cardiac cycle in a first chamber, each interval having a time length, said first chamber being one of the atrium and the ventricle;

second means for selecting the determined intervals above a sinus rhythm and corresponding to a plurality of cardiac cycles, determining whether the selected determined intervals satisfy a stability criterion;

third means for determining a first peak count of the selected determined intervals that satisfy said stability criterion;

first count means for providing a first total of the number of selected determined intervals;

fourth means for determining a conduction interval between a sensed cardiac event in the first chamber and each preceding sensed cardiac event in the second chamber for the plurality of cardiac cycles, each determined conduction interval having a time length, the second chamber being the other of the atrium and ventricle;

fifth means for determining whether each determined conduction interval time length is within a conduction time stability criterion;

sixth means for determining a second peak count of the determined conduction intervals that are within the conduction time stability criterion; and

second count means for providing a second total as a count of said determined conduction intervals; and

seventh means for determining whether the patient'"'"'s processed cardiac events correspond to a tachyarrhythmia that is terminable by a stimulation pulse in the first chamber based on the determined first and second peaks.

59. The apparatus of claim 58 wherein the second and third determining means further comprise:

a histogram of the selected determined intervals in said first chamber for a range of interval lengths;

a stability window having an interval that is a subset of the histogram interval length range; and

means for scanning the histogram with the stability window and determining said first peak as the maximum number of determined intervals within said stability window for all possible positions of the stability window in the auto-correlation histogram, wherein first total corresponds to the number of the determined intervals in the histogram.

60. The apparatus of claim 59 wherein the histogram further comprises a plurality of bins, each bin corresponding to different range of interval time lengths, and the selected determined intervals lengths are sorted into said bins according to the time lengths of said intervals.

61. The apparatus of claim 60 wherein said plurality of bins further comprises contiguous bins, each bin having a time length range of approximately 16 ms, and wherein the stability window has a time length corresponding to a plurality of contiguous bins.

62. The apparatus of claim 58 wherein the fifth and sixth determining means further comprise:

a histogram of the determined conduction intervals for a range of interval lengths;

a conduction time window having an interval that is a subset of the histogram range; and

means for scanning the histogram with the conduction time window and determining said second peak as the maximum number of determined conduction intervals within said conduction time window for all possible positions of said conduction time window in the histogram, wherein the second total corresponds to the number of the determined conduction intervals in the histogram.

63. The apparatus of claim 62 wherein the histogram further comprises a plurality of bins, each bin having a different range of time interval lengths, and the determined conduction intervals lengths are sorted into said bins according to the time lengths of said determined conduction intervals.

64. The apparatus of claim 63 wherein said plurality of bins further comprises contiguous bins, each bin having a time length range of approximately 16 ms, and wherein the conduction time window has a time length corresponding to a plurality of contiguous bins.

65. The apparatus of claim 59 or 62 wherein the processing means further comprises means for including sensed cardiac events corresponding to a recent cardiac cycle in the first chamber above the sinus rhythm and deleting previously sensed cardiac events corresponding to cardiac cycles in the first chamber above the sinus rhythm occurring more than a predetermined number of cardiac cycles preceding the recent cardiac cycle, and further comprises means for updating the histogram so that the histogram contains the determined intervals for said predetermined number of cardiac cycles.

66. The apparatus of claims 59 or 62 wherein the first determining means further comprises eighth means for determining whether the determined interval exceeds a preselected limit corresponding to a sinus rhythm limit wherein said second, third, fourth, fifth and sixth determining means do not operate in response to said eighth determining means determining that the determined interval is longer than said preselected limit.

67. The apparatus of claim 66 wherein the eighth determining means determines when the determined intervals exceeds the preselected limit for more than said plurality of cardiac cycles and, in response thereto, resets said histogram, and selects for processing cardiac events sensed during a second time corresponding to a second plurality of cardiac cycles in the first chamber above a sinus rhythm, said second time being later in time than said first time.

68. The apparatus of claim 58 wherein the processing means further comprises means for adjusting the plurality of cardiac cycles processed by including sensed cardiac events corresponding to a recent cardiac cycle in the first chamber above the sinus rhythm and deleting previously sensed cardiac events corresponding to cardiac cycles in the first chamber above the sinus rhythm occurring more than said plurality of cardiac cycles preceding the recent cardiac cycle.

69. The apparatus of claim 58 wherein said first determining means further comprises eighth means for determining whether the determined interval exceeds a preselected limit corresponding to a sinus rhythm limit, wherein said second, third, fourth, fifth and sixth determining means do operate not in response to the eighth determining means determining that said determined interval is longer than said preselected limit.

70. The apparatus of claim 69 wherein said preselected limit is approximately 600 ms.

71. The apparatus of claims 59 or 62 further comprising means for determining an average of a plurality of determined intervals and means for sorting intervals to form said histogram only when the determined average interval time length falls between a preset lower limit and a preset upper limit defining a likely tachyarrhythmia range.

72. The apparatus of claims 58, 59 or 62 wherein the seventh determining means further comprises means for determining the existence of stability in the first chamber in response to the quotient of the first peak divided by the first total exceeding a first fraction, and means for declaring the tachyarrhythmia not terminable by a stimulation pulse in the first chamber in the absence of stability in the first chamber.

73. The apparatus of claims 58, 59 or 62 wherein the seventh determining means further comprises means for determining the existence of stability in the first chamber in response to the quotient of the first peak divided by the first total exceeding a first fraction, means for determining the existence of conduction instability for conduction from the second chamber to the first chamber in response to the quotient of the second peak divided by the first total not exceeding a second fraction, and means for declaring the tachyarrhythmia terminable by a stimulation pulse in the first chamber in response to there being stability in the first chamber and conduction instability.

74. The apparatus of claims 58, 59 or 62 wherein the seventh determining means further comprises means for determining the existence of stability in the first chamber in response to the quotient of the first peak divided by the first total exceeding a first fraction, means for determining the existence of conduction instability for conduction from the second chamber to the first chamber in response to the quotient of the second peak divided by the first peak not exceeding a second fraction, and means for declaring the tachyarrhythmia terminable by a stimulation pulse in the first chamber in response to there being stability in the first chamber and conduction instability.

75. The apparatus of claims 58, 59 or 62 wherein the seventh determining means further comprises:

means for determining the existence of stability in the first chamber in response to the quotient of the first peak divided by the first total exceeding a first fraction;

means for determining the existence of conduction stability for conduction from the second chamber to the first chamber in response to the quotient of the second peak divided by the first total exceeding a second fraction;

means for determining an association ratio of the detected events in the first chamber and in the second chamber;

means, responsive to a determined 1;

1 association ratio, for determining an acceleration of the determined intervals and identifying the occurrence of an acceleration of rate in the first chamber exceeding a preselected acceleration limit;

means, responsive to a determined 1;

1 association ratio for determining the occurrence of a disassociation of conduction between the first and second chambers at the onset of said identified acceleration; and

means for declaring the tachyarrhythmia terminable by a stimulation pulse in the first chamber in response to there being stability in the first chamber, conduction stability, a determined 1;

1 association ratio, acceleration of rate, and disassociation of conduction at the onset of acceleration.

76. The apparatus of claim 75 wherein the association ratio determining means further comprises means for determining a 1:

1 association ratio in response to the quotient of the second peak divided by the second total being greater than a preset fraction.

77. The apparatus of claim 75 wherein the association ratio determining means further comprises means for determining a 1:

1 association ratio in response to the quotient of the first total divided by the second total being in a range of from 0.66 to 1.33.

78. The apparatus of claims 58, 59 or 62 wherein the seventh determining means further comprises:

means for determining the existence of stability in the first chamber in response to the quotient of the first peak divided by the first total exceeding a first fraction;

means for determining the existence of conduction stability for conduction from the second chamber to the first chamber in response to the quotient of the second peak divided by the first peak exceeding a second fraction;

means for determining an association ratio of the detected events in the first chamber and the second chamber;

means, responsive to a determined 1;

1 association ratio, for determining an acceleration of the determined intervals and identifying the occurrence of an acceleration of rate in the first chamber exceeding a preselected acceleration limit, means for determining the occurrence of a disassociation of conduction between the first and second chambers at the onset of said identified acceleration; and

means for declaring the tachyarrhythmia terminable by a stimulation pulse in the first chamber in response to there being stability in the first chamber, conduction stability, a determined 1;

1 association ratio, acceleration of rate, and disassociation of conduction at the onset of acceleration.

79. The apparatus of claim 78 wherein the association ratio determining means further comprises means for determining a 1:

1 association ratio in response to the quotient of the second peak divided by the second total being greater than a preset fraction.

80. The apparatus of claim 78 wherein the association ratio determining means further comprises means for determining a 1:

1 association ratio in response to the quotient of the first total divided by the second total being in a range of from 0.66 to 1.33.

81. The apparatus of claims 58, 59, or 62, further comprising:

means for applying an antitachycardia pacing therapy to the first chamber in response to a tachyarrhythmia that is determined terminable by a stimulation pulse.