Automatic adjustment of detection rate threshold in an implantable antitachycardia therapy device

• US 5,882,352 A
• Filed: 05/25/1995
• Issued: 03/16/1999
• Est. Priority Date: 05/25/1995
• Status: Expired due to Term

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories)
• Inventors: Wilkoff, Bruce, Duncan, James L., Causey, James D. III
• Primary Examiner(s): Kamm, William E.
• Assistant Examiner(s): SCHAETZLE, KENNEDY
• Application Number:
  US08/449,970
• Time in Patent Office: 1,391 Days
• Field of Search: 607/4, 607/5, 607/6, 607/14, 607/17-19, 128/706, 128/705
• US Class Current: 607/4
• CPC Class Codes: A61N 1/3621 for treating or preventing abnormally high heart rate
• CPC Class Codes: A61N 1/36514 controlled by a physiological quantity other than heart potential, e.g. blood pressure controlled by two or more physical parameters A61N1/36585

Abstract

An antitachycardia stimulation device that automatically adjusts its detection rate threshold as a function of a sensed physiological parameter indicative of cardiac rate. The implantable antitachycardia stimulation device includes heart rate detection circuitry and antitachycardia therapy circuitry for applying a specific antitachycardia therapy in the event that the detected heart rate falls within at least one tachycardia rate zone. The tachycardia rate zone is defined by a lower threshold limit, and may also be defined by an upper threshold limit if more than one rate zone is used. The lower threshold limit is automatically adjusted as a function of an independently sensed physiological parameter that predicts a normal or natural change in the heart rate. If more then one rate zone is used, other threshold limits may also be adjusted automatically as a separate function of the same sensed physiological parameter. In one embodiment of the invention, the implantable stimulation device comprises a rate-responsive pacemaker, and the sensed physiological parameter used to adjust the rate threshold limit(s) is also used to define a sensor indicated rate signal to control the pacing rate of the pacemaker.

Claims

1. An implantable antitachycardia stimulation device comprising:

pulse generating means for generating stimulation pulses to a patient'"'"'s heart;

sensing means for sensing cardiac activity of the patient'"'"'s heart;

first physiologic sensing means for sensing a physiologic parameter indicative of a normal heart rate, and for generating a first sensor signal representative of the sensed physiologic parameter;

control means, coupled to the pulse generating means, the sensing means, and the first physiological sensing means, for providing a prescribed antitachycardia therapy through the pulse generating means and for terminating a sensed cardiac arrhythmia, the control means including;

rate detection means for detecting the heart rate of the patient based on the cardiac activity sensed through the sensing means;

threshold means for generating at least two rate zone thresholds, a low rate zone threshold signal and a high rate zone threshold signal, the low rate zone threshold signal being a function of the first sensor signal, and the high rate zone threshold signal being a prescribed amount greater than the low rate zone threshold signal at least one rate zone threshold signal as a function of the first sensor signal; and

comparator means for comparing the detected heart rate with the at least one rate zone threshold signal, for determining when the heart rate exceeds the at least one rate zone threshold signal, and for indicating that a cardiac arrhythmia is present.

2. The implantable stimulation device, as set forth in claim 1, wherein the first physiologic sensing means comprises a sensor that senses physical activity of the patient.

3. The implantable stimulation device, as set forth in claim 1, wherein the implantable stimulation device comprises:

second physiologic sensing means for sensing a second physiologic parameter of the heart, and for generating a second sensor signal representative of the second physiologic parameter;

rate-responsive pacing means for determining a sensor indicated rate (SIR) signal based on the second sensor signal, and for controlling the rate of stimulation pulses provided by the pulse generating means according to the sensor indicated rate.

4. The implantable stimulation device, as set forth in claim 3, wherein the second physiological sensing means is adapted to sense a physiologic parameter that is separate from the physiologic parameter sensed by the first physiological sensing means.

5. The implantable stimulation device, as set forth in claim 3, wherein:

the first physiologic sensing means and the second physiologic sensing means comprise a single sensor, and wherein the single sensor generates a raw sensor signal indicative of the sensed physiologic parameter; and

the implantable stimulation device includes sensor processing means for generating the first sensor signal as a first function of the sensed physiologic parameter, and for generating the SIR signal as a second function of the sensed physiologic parameter.

6. An implantable antitachycardia stimulation device comprising:

pulse generating means for generating stimulation pulses to a patient'"'"'s heart;

sensing means for sensing cardiac activity of the patient'"'"'s heart;

first physiologic sensing means for sensing a physiologic parameter indicative of a normal heart rate, and for generating a first sensor signal representative of the sensed physiologic parameter;

control means, coupled to the pulse generating means, the sensing means, and the first physiological sensing means, for providing a prescribed antitachycardia therapy through the pulse generating means and for terminating a sensed cardiac arrhythmia, the control means including;

rate detection means for detecting the heart rate of the patient based on the cardiac activity sensed through the sensing means;

threshold means for generating at least two rate zone thresholds, a low rate zone threshold signal and a high rate zone threshold signal, the low rate zone threshold signal being a first function of the first sensor signal, and the high rate zone threshold signal being a second function of the first sensor signal; and

comparator means for comparing the detected heart rate with the at least one rate zone threshold signal, for determining when the heart rate exceeds the at least one rate zone threshold signal, and for indicating that a cardiac arrhythmia is present.

7. The implantable stimulation device, as set forth in claim 6, wherein the first physiologic sensing means comprises a sensor that senses physical activity of the patient.

8. The implantable stimulation device, as set forth in claim 6, wherein the implantable stimulation device comprises:

second physiologic sensing means for sensing a second physiologic parameter of the heart, and for generating a second sensor signal representative of the second physiologic parameter;

rate-responsive pacing means for determining a sensor indicated rate (SIR) signal based on the second sensor signal, and for controlling the rate of stimulation pulses provided by the pulse generating means according to the sensor indicated rate.

9. The implantable stimulation device, as set forth in claim 8, wherein the second physiological sensing means is adapted to sense a physiologic parameter that is separate from the physiologic parameter sensed by the first physiological sensing means.

10. The implantable stimulation device as set forth in claim 8, wherein:

the first physiologic sensing means and the second physiologic sensing means comprise a single sensor, and wherein the single sensor generates a raw sensor signal indicative of the sensed physiologic parameter; and

the implantable stimulation device includes sensor processing means for generating the first sensor signal as a first function of the sensed physiologic parameter, and for generating the SIR signal as a second function of the sensed physiologic parameter.

11. An implantable antitachycardia stimulation device comprising:

pulse generating means for generating stimulation pulses to a patient'"'"'s heart;

sensing means for sensing cardiac activity of the patient'"'"'s heart;

first physiologic sensing means for sensing a physiologic parameter indicative of a normal heart rate, and for generating a first sensor signal representative of the sensed physiologic parameter;

second physiologic sensing means for sensing a second physiologic parameter of the heart, and for generating a second sensor signal representative of the second physiolgic parameter;

rate-responsive pacing means for determining a sensor indicated rate (SIR) signal based on the second sensor signal, and for controlling the rate of stimulation pulses provided by the pulse generating means according to the sensor indicated rate;

control means, coupled to the pulse generating means, the sensing means, and the first physiological sensing means, for providing a prescribed antitachycardia therapy through the pulse generating means and for terminating a sensed cardiac arrhythmia, the control means including;

rate detection means for detecting the heart rate of the patient based on the cardiac activity sensed through the sensing means;

threshold means for generating at least one rate zone threshold signal as a function of the first sensor signal; and

comparator means for comparing the detected heart rate with the at least one rate zone threshold signal, for determining when the heart rate exceeds the at least one rate zone threshold signal, and for indicating that a cardiac arrhythmia is present.

12. The implantable stimulation device, as set forth in claim 11, wherein the first physiologic sensing means comprises a sensor that senses physical activity of the patient.

13. The implantable stimulation device, as set forth in claim 11, wherein the implantable stimulation device comprises:

second physiologic sensing means for sending a second physiologic parameter of the heart, and for generating a second sensor signal representative of the second physiolgic parameter;

rate-responsive pacing means for determining a sensor indicated rate (SIR) signal based on the second sensor signal, and for controlling the rate of stimulation pulses provided by the pulse generating means according to the sensor indicated rate.

14. The implantable stimulation device, as set forth in claim 11, wherein the second physiological sensing means is adapted to sense a physiologic parameter that is separate from the physiologic parameter sensed by the first physiological sensing means.

15. An implantable antitachycardia therapy device, comprising:

heart rate detection means for detecting a heart rate;

antitachycardia therapy means for generating stimulation pulses for application to a heart when the detected heart rate exceeds a first threshold signal;

physiologic sensing means for generating a sensor signal as a function of a sensed physiologic parameter of the heart; and

processing means, coupled to the physiologic sensing means and the heart rate detection means, for generating the first threshold signal such that the first threshold signal assumes a minimum value if the sensor signal is less than a low sensor signal value, and the first threshold signal assumes a maximum value if the sensor signal is greater than a high sensor signal value and wherein the relationship between the sensor signal and the first threshold signal intermediate the low sensor signal value and the high sensor signal value is linear.

16. The implantable antitachycardia therapy device, as set forth in claim 15, wherein the antitachycardia therapy means comprises:

means for generating a first type of therapy when the detected heart rate exceeds the first threshold signal, and for generating a second type of therapy when the detected heart rate exceeds a second threshold signal, the second threshold signal being greater than the first threshold signal, the second threshold signal being generated by the processing means.

17. The implantable antitachycardia therapy device, as set forth in claim 15, wherein the antitachycardia therapy means comprises:

threshold detection means for determining if the heart rate exceeds the first threshold signal, and if so generating a mode control signal; and

therapy control means for generating a prescribed sequence of stimulation pulses in response to the mode control signal.

18. The implantable antitachycardia therapy device, as set forth in claim 17, wherein the threshold detection means includes means for detecting in which of a plurality of rate zones the heart rate lies.

19. The implantable antitachycardia therapy device, as set forth in claim 15 wherein the sensed physiologic parameter comprises physical activity.

20. An implantable antitachycardia therapy device, comprising:

heart rate detection means for detecting a heart rate;

antitachycardia therapy means for generating stimulation pulses for application to a heart when the detected heart rate exceeds a first threshold signal;

physiologic sensing means for generating sensor signal as a function of a sensed physiologic parameter of the heart; and

processing means, coupled to the physiologic sensing means and the heart rate detection means, for generating the first threshold signal as a prescribed function of the sensor signal,

wherein the prescribed function is defined such that the first threshold signal assumes a minimum value if the sensor signal is less than a low sensor signal value and assumes a maximum value if the sensor signal is greater than a high sensor signal value and assumes one of a plurality of threshold values intermediate the minimum value and the maximum value depending upon which of a respective plurality of sensor signal reference values intermediate the low and high sensor signal values is exceeded by the sensor signal.

21. The implantable antitachycardia therapy device, as set forth in claim 20, wherein the antitachycardia therapy means comprises:

means for generating a first type of therapy when the detected heart rate exceeds the first threshold signal, and for generating a second type of therapy when the detected heart rate exceeds a second threshold signal, the second threshold signal being greater than the first threshold signal, the second threshold signal being generated by the processing means.

22. The implantable antitachycardia therapy device, as set forth in claim 20, wherein the antitachycardia therapy means comprises:

threshold detection means for determining if the heart rate exceeds the first threshold signal, and if so generating a mode control signal; and

therapy control means for generating a prescribed sequence of stimulation pulses in response to the mode control signal.

23. The implantable antitachycardia therapy device, as set forth in claim 22, wherein the threshold detection means includes means for detecting in which of a plurality of rate zones the heart rate lies.

24. The implantable antitachycardia therapy device, as set forth in claim 20, wherein the sensed physiologic parameter comprises physical activity.

25. A method for adjusting the detection rate threshold in an implantable antitachycardia therapy device, the device including rate detection means for detecting a heart rate, sensor means for sensing a physiologic parameter, and antitachycardia therapy means for selectively generating a prescribed stimulation sequence for terminating a sensed tachycardia, the method comprising the steps of:

(a) detecting the heart rate with the rate detection means;

(b) sensing the physiologic parameter with the sensor means;

(c) automatically defining a detection rate threshold signal by defining a minimum detection rate threshold signal corresponding to physiologic parameters less than a low physiologic parameter, defining a maximum detecting rate threshold signal corresponding to physiologic parameters greater than a high physiologic parameter and defining the detection rate threshold signal to assume a linear relationship relative to the sensed physiologic parameter for physiologic parameters intermediate the low and high physiologic parameters;

(d) determining if the sensed heart rate is greater than the detection rate threshold signal;

(e) invoking a programmed mode of operation of the therapy device in the event that the sensed heart rate is less than the detection rate threshold signal; and

(f) invoking an antitachycardia therapy node of operation of the therapy device in the event that the sensed heart rate is greater than the detection rate threshold signal;

whereby the detection rate threshold signal is automatically adjusted as a function of the sensed physiologic parameter, and further whereby the antitachycardia therapy mode is invoked only when the detected heart rate exceeds the adjusted detection rate threshold signal.

26. The method, as set forth in claim 25, wherein:

step (c) comprises automatically defining a plurality of detection rate threshold signals;

step (d) comprises determining if the sensed heart rate exceeds one of the detection rate threshold signal; and

step (f) comprises invoking an appropriate one of a plurality of antitachycardia therapy modes of operation whenever the heart rate exceeds one of the detection rate threshold signals.

27. An implantable antitachycardia therapy device, comprising:

heart rate detection means for detecting a heart rate;

antitachycardia therapy means for generating stimulation pulses for application to a heart when the detected heart rate exceeds a first threshold signal;

physiologic sensing means for generating a sensor signal as a function of a sensed physiologic parameter of the heart; and

processing means, coupled to the physiologic sensing means and the heart rate detection means, for generating at least a low rate zone threshold signal and a high rate zone threshold signal, the low rate zone threshold signal being a first function of the sensor signal, and the high rate zone thresold signal being a second function of the sensor signal.

28. The implantable antitachycardia therapy device, as set forth in claim 27, wherein the antitachycardia therapy means comprises:

means for generating a first type of therapy when the detected heart rate exceeds the low rate zone threshold signal and for generating a second type of therapy when the detected heart rate exceeds the high rate zone threshold signal.

29. The implantable antitachycardia therapy device, as set forth in claim 27, wherein:

the processing means includes means for defining the first function such that the low rate zone threshold signal assumes a minimum value if the sensor signal is less than a low sensor signal value, and the low rate zone threshold signal assumes a maximum value if the sensor signal is greater than a high sensor signal value.

30. The implantable antitachycardia therapy device, as set forth in claim 29, wherein the processing means comprises:

means for defining the first function a being a linear relationship between the sensor signal and the low rate zone threshold signal intermediate the low sensor signal value and the high sensor signal value.

31. The implantable antitachycardia therapy device, as set forth in claim 29, wherein the processing means comprises:

means for defining the first function such that the low rate zone threshold signal assumes one of a plurality of threshold values intermediate the minimum value and the maximum value depending upon which of a respective plurality of sensor signal reference values intermediate the low and high sensor signal values is-exceeded by the sensor signal.

32. The implantable antitachycardia therapy device, as set forth in claim 27, wherein the antitachycardia therapy means comprises:

threshold detection means for determining if the heart rate exceeds the low rate zone threshold signal, and if so generating a mode control signal; and

therapy control means for generating a prescribed sequence of stimulation pulses in response to the mode control signal.

33. The implantable antitachycardia therapy device, as set forth in claim 32, wherein the threshold detection means includes means for detecting in which of a plurality of rate zones the heart rate lies.

34. The implantable antitachycardia therapy device, as set forth in claim 27, wherein the sensed physiologic parameter comprises physical activity.

35. A method for adjusting the detection rate threshold in an implantable antitachycardia therapy device, the device including rate detection means for detecting a heart rate, sensor means for sensing a physiologic parameter, and antitachycardia therapy means for selectively generating a prescribed stimulation sequence for terminating a sensed tachyeardia, the method comprising the steps of:

(a) detecting the heart rate with the rate detection means;

(b) sensing the physiologic parameter with the sensor means;

(c) automatically defining at least two rate zone detection thresholds, a low rate zone detection threshold signal defined as a first function of the physiologic parameter sensed by the sensor means and a high rate zone detection threshold signal defined as a second function of the physiologic parameter sensed by the sensor means;

(d) determining if the sensed heart rat is greater than the low rate zone detection threshold signal;

(e) invoking a programmed mode of operation of the therapy device in the event that the sensed heart rate is less than the low rate zone detection threshold signal; and

(f) invoking an antitachycardia therapy mode of operation of the therapy device in the event that the sensed heart rate is greater than the detection rate threshold signal; and

whereby the low rate zone detection threshold signal is automatically adjusted as a function of the sensed physiologic parameter, and further whereby the antitachycardia therapy mode is invoked only when the detected heart rate exceeds the adjusted low rate zone detection threshold signal.

36. The method, as set forth in claim 35, wherein:

step (c) comprises automatically defining a plurality of rate zone detection threshold signals;

step (d) comprises determining if the sensed heart rate exceeds one of the rate zone detection threshold signals; and

step (f) comprises invoking an appropriate one of a plurality of antitachycardia therapy modes of operation whenever the heart rate exceeds one of the rate zone detection threshold signals.

37. The method, as set forth in claim 35, wherein step (c) comprises:

defining the low rate zone detection threshold signal as corresponding to physiologic parameters less the a low physiologic parameter;

defining the high rate-zone detection threshold signal as corresponding to physiologic parameters greater than a high physiologic parameter; and

defining the rate zone detection threshold signal to be a prescribed function of the physiologic parameter for physiologic parameters intermediate the low and high physiologic parameters.

38. The method, as set forth in claim 37, wherein the step of defining the rate zone detection threshold signal to be a prescribed function of the physiologic parameter for physiologic parameters intermediate the low and high physiologic parameters comprises:

defining the rate zone detection threshold signal to assume a linear relationship relative to the sensed physiologic parameter.

39. The method, as set forth in claim 37, wherein the step of defining the rate zone detection threshold signal to be a prescribed function of the physiologic parameter or physiologic parameters intermediate the low and high physiologic parameters comprises:

defining the rate zone detection threshold signal to assume a stair-step relationship relative to the sensed physiologic parameter.