Method and apparatus for dual chambered tachyarrhythmia classification and therapy

• US 5,873,897 A
• Filed: 09/19/1997
• Issued: 02/23/1999
• Est. Priority Date: 09/19/1997
• Status: Expired due to Term

• Current Assignee: Sulzer Intermedics, Inc. (Sulzer AG)
• Original Assignee: Sulzer Intermedics, Inc. (Sulzer AG)
• Inventors: Truong, Dat H., Armstrong, Randolph K., Deno, D. Curtis, Cook, Douglas J.
• Primary Examiner(s): Getzow, Scott M.
• Application Number:
  US08/934,361
• Time in Patent Office: 522 Days
• Field of Search: 607/9, 607/14, 607/5
• US Class Current: 607/14
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions
• CPC Class Codes: A61N 1/368 comprising more than one electrode co-operating with different heart regions A61N1/3622, A61N1/3627 take precedence
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

A method and apparatus for classifying and treating tachyarrhythmias. A cardiac stimulator includes an algorithm that uses dual chamber sensing to determine the type of tachyarrhythmia detected. If the tachyarrhythmia is of a type that responds well to ventricular therapy, such as a tachyarrhythmia originating in the ventricle rather than the atrium, the tachyarrhythmia is grouped into a treatable category. Accordingly, the cardiac stimulator applies therapy, or therapies, to the ventricle to remedy the ventricular tachyarrhythmia.

Claims

1. A cardiac stimulator for classifying and treating tachyarrhythmias comprising:

an atrial sensing circuit adapted to deliver an atrial signal correlative to a condition of an atrium of a heart;

a ventricular sensing circuit adapted to deliver a ventricular signal correlative to a condition of a ventricle of the heart;

a pulse generator adapted to deliver electrical stimulation to the ventricle; and

a control circuit coupled to the atrial sensing circuit to receive the atrial signal and coupled to the ventricular sensing circuit to receive the ventricular signal, the control circuit classifying a ventricular tachyarrhythmia into a treatable category or an untreatable category by evaluating an interval between the atrial signal and the ventricular signal to determine the interval'"'"'s stability, if the interval is stable, determining if an A-V interval is abnormal, the control circuit directing the pulse generator to deliver electrical stimulation to the ventricle if said A-V interval is abnormal.

2. The cardiac stimulator, as set forth in claim 1, wherein the control circuit further classifies the ventricular tachyarrhythmia as one of a mild ventricular tachyarrhythmia, a moderate ventricular tachyarrhythmia, and a severe ventricular tachyarrhythmia.

3. The cardiac stimulator, as set forth in claim 2, wherein the electrical stimulation varies depending upon whether the ventricular tachyarrhythmia is classified as a mild ventricular tachyarrhythmia, a moderate ventricular tachyarrhythmia, or a severe ventricular tachyarrhythmia.

4. The cardiac stimulator, as set forth in claim 1, wherein the control circuit determines the stability of the interval by evaluating a plurality of successive intervals.

5. The cardiac stimulator, as set forth in claim 4, wherein the control circuit determines the interval to be stable if time periods of successive intervals do not vary by more than a given amount.

6. The cardiac stimulator, as set forth in claim 5, wherein the control circuit evaluates the atrial signal to determine whether an atrial event is present between two successive ventricular signals to determine the stability of the interval.

7. The cardiac stimulator, as set forth in claim 6, wherein the control circuit determines the interval to be unstable in response to a given number of absences of an atrial event between successive ventricular signals.

8. The cardiac stimulator, as set forth in claim 1, wherein the control circuit determines that the A-V interval is abnormal if said interval is outside a predetermined range.

9. The cardiac stimulator, as set forth in claim 8, wherein said predetermined range is 85 to 300 milliseconds.

10. The cardiac stimulator, as set forth in claim 1, wherein said control circuit, having determined that the interval is stable and that the A-V interval is abnormal, determines if a number of atrial events exceeds a number of ventricular events during a period, and does not direct the pulse generator to deliver electrical stimulation if the number of atrial events exceeds the number of ventricular events.

11. The cardiac stimulator, as set forth in claim 10, wherein the control circuit determines that the A-V interval is abnormal if said interval is outside a predetermined range.

12. The cardiac stimulator, as set forth in claim 11, wherein said predetermined range is 85 to 300 milliseconds.

13. A cardiac stimulator comprising:

an atrial sensing circuit adapted to deliver an atrial signal correlative to atrial events occurring in an atrium of a heart;

a ventricular sensing circuit adapted to deliver a ventricular signal correlative to ventricular events occurring in a ventricle of the heart;

a pulse generator adapted to deliver electrical stimulation to the ventricle; and

a control circuit executing an algorithm for controlling the control circuit, the control circuit coupled to the atrial sensing circuit to receive the atrial signal and coupled to the ventricular sensing circuit to receive the ventricular signal, the algorithm;

determining an interval between ventricular events;

determining whether the interval between ventricular events indicates a ventricular tachyarrhythmia;

if the interval between ventricular events indicates a ventricular tachyarrhythmia, determining whether an interval between atrial events and ventricular events is stable;

if the interval between atrial events and ventricular events is stable, determining whether the interval between atrial events and ventricular events is normal;

if the interval between atrial events and ventricular events is normal, withholding treatment of the ventricular tachyarrhythmia;

if the interval between atrial events and ventricular events is not normal, comparing a relative frequency of atrial events and ventricular events;

if the frequency of atrial events is greater than the frequency of ventricular events, withholding treatment of the ventricular tachyarrhythmia; and

if the frequency of atrial events is not greater than the frequency of ventricular events, directing the control circuit to direct the pulse generator to deliver electrical stimulation to the ventricle.

14. The cardiac stimulator, as set forth in claim 13, wherein the algorithm further classifies the ventricular tachyarrhythmia as one of a mild ventricular tachyarrhythmia, a moderate ventricular tachyarrhythmia, and a severe ventricular tachyarrhythmia.

15. The cardiac stimulator, as set forth in claim 13, wherein the electrical stimulation varies depending upon whether the ventricular tachyarrhythmia is classified as a mild ventricular tachyarrhythmia, a moderate ventricular tachyarrhythmia, or a severe ventricular tachyarrhythmia.

16. The cardiac stimulator, as set forth in claim 13, wherein the algorithm determines the stability of the interval between atrial events and ventricular events by evaluating a plurality of successive intervals between atrial events and ventricular events.

17. The cardiac stimulator, as set forth in claim 16, wherein the algorithm determines the interval between atrial events and ventricular events to be stable if time periods of successive intervals between atrial events and ventricular events do not vary by more than a given amount.

18. The cardiac stimulator, as set forth in claim 13 wherein the algorithm further determines:

if the interval between atrial events and ventricular events is not stable, determining whether the interval between ventricular events is stable;

if the interval between ventricular events is stable, directing the control circuit to direct the pulse generator to deliver electrical stimulation to the ventricle;

if the interval between ventricular events is not stable, withholding treatment of the ventricular tachyarrhythmia.

19. The cardiac stimulator, as set forth in claim 18, further comprising

means for comparing a frequency of atrial events with a frequency of ventricular events if the interval between atrial events and ventricular events is not normal;

means for withholding treatment of the ventricular tachyarrhythmia if the frequency of atrial events is greater than the frequency of ventricular events; and

means for treating the ventricular tachyarrhythmia if the frequency of atrial events is not greater than the frequency of ventricular events in the given time.

20. The cardiac stimulator, as set forth in claim 19, wherein the control circuit determines that the A-V interval is abnormal if said interval is outside a predetermined range.

21. The cardiac stimulator, as set forth in claim 20, wherein said predetermined range is 85 to 300 milliseconds.

22. The cardiac stimulator, as set forth in claim 19, further comprising

means for determining whether the interval between ventricular events is stable if the interval between atrial events and ventricular events is not stable;

means for treating the ventricular tachyarrhythmia if the interval between ventricular events is stable; and

means for withholding treatment of the ventricular tachyarrhythmia if the interval between ventricular events is not stable.

23. The cardiac stimulator, as set forth in claim 22, wherein the control circuit determines that the A-V interval is abnormal if said interval is outside a predetermined range.

24. The cardiac stimulator, as set forth in claim 23, wherein said predetermined range is 85 to 300 milliseconds.

25. A cardiac stimulator comprising:

means for determining an interval between ventricular events;

means for determining whether the interval between ventricular events indicates a ventricular tachyarrhythmia;

means for determining whether an interval between atrial events and ventricular events is stable if the interval between ventricular events indicates a ventricular tachyarrhythmia;

means for determining whether the interval between atrial events and ventricular events is normal if the interval between atrial events and ventricular events is stable; and

means for withholding treatment of the ventricular tachyarrhythmia if the interval between atrial events and ventricular events is normal.

26. The cardiac stimulator, as set forth in claim 25, wherein the control circuit determines that the A-V interval is abnormal if said interval is outside a predetermined range.

27. The cardiac stimulator, as set forth in claim 26, wherein said predetermined range is 85 to 300 milliseconds.

28. A method of classifying and treating tachyarrhythmias comprising the steps of:

(a) determining an interval between ventricular events;

(b) determining whether the interval between ventricular events indicates a ventricular tachyarrhythmia;

(c) determining whether an interval between atrial events and ventricular events is stable if the interval between ventricular events indicates a ventricular tachyarrhythmia;

(d) determining whether the interval between atrial events and ventricular events is normal if the interval between atrial events and ventricular events is stable; and

(e) withholding treatment of the ventricular tachyarrhythmia if the interval between atrial events and ventricular events is normal.

29. The method, as set forth in claim 28, wherein step (c) comprises the step of determining the interval between atrial events and ventricular events to be stable if time periods of successive intervals between atrial events and ventricular events do not vary by more than a given amount.

30. The method, as set forth in claim 29, wherein step (c) comprises the step of evaluating the atrial events to determine whether an atrial event is present between two successive ventricular events to determine the stability of the interval between the atrial events and ventricular events.

31. The method, as set forth in claim 30, wherein step (c) comprises the step of determining the interval between atrial events and ventricular events to be unstable in response to a given number of absences of an atrial event between successive ventricular events.

32. The method, as set forth in claim 28, wherein step (d) comprises determining that the A-V interval is abnormal if said interval is outside a predetermined range.

33. The method, as set forth in claim 32, wherein said predetermined range is 85 to 300 milliseconds.

34. The method, as set forth in claim 28, further comprising the steps of

(f) comparing a number of atrial events in a given time with a number of ventricular events in the given time if the interval between atrial events and ventricular events is not normal;

(g) withholding treatment of the ventricular tachyarrhythmia if the number of atrial events in the given time is greater than the number of ventricular events in the given time; and

(h) treating the ventricular tachyarrhythmia if the number of atrial events in the given time is not greater than the number of ventricular events in the given time.

35. The method, as set forth in claim 34, wherein step (d) comprises determining that the A-V interval is abnormal if said interval is outside a predetermined range.

36. The cardiac stimulator, as set forth in claim 35, wherein said predetermined range is 85 to 300 milliseconds.

37. The method according to claim 35, further comprising the steps of

(i) determining whether the interval between ventricular events is stable if the interval between atrial events and ventricular events is not stable;

(j) treating the ventricular tachyarrhythmia if the interval between ventricular events is stable; and

(k) withholding treatment of the ventricular tachyarrhythmia if the interval between ventricular events is not stable.

38. The method, as set forth in claim 37, wherein step (d) further comprises determining that the A-V interval is abnormal if said interval is outside a predetermined range.

39. The method, as set forth in claim 38, wherein said predetermined range is 85 to 300 milliseconds.