Recognizing ventricular tachycardia condition using dual chamber sense information

• US 5,978,700 A
• Filed: 05/06/1998
• Issued: 11/02/1999
• Est. Priority Date: 05/07/1997
• Status: Expired due to Term

• Current Assignee: Biotronik Mess-Und Therapiegeraete GmbH & Company Ingenieurbuero Berlin (Biotronik SE & Company KG)
• Original Assignee: Biotronik Mess-Und Therapiegeraete GmbH & Company Ingenieurbuero Berlin (Biotronik SE & Company KG)
• Inventors: Nigam, Indra B.
• Primary Examiner(s): Kamm, William E.
• Assistant Examiner(s): SCHAETZLE, KENNEDY
• Application Number:
  US09/073,345
• Time in Patent Office: 545 Days
• Field of Search: 600/515, 600/518, 600/519, 600/521, 607/4, 607/5, 607/14
• US Class Current: 600/518
• CPC Class Codes: A61B 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 5/363 Detecting tachycardia or bradycardia

Abstract

An apparatus for detecting ventricular tachycardia includes a first and snd calculation unit, each having an input side connected to a ventricle sensor and an atrium sensor, respectively, and to a timer, for calculating the R--R and P--P intervals between respective successive electrical activities in the atrium and in the ventricle. A threshold value memory stores at least one threshold value for the R--R intervals in memory. A first comparator unit compares the R--R intervals with the at least one threshold value. A first and second interval memory store a predetermined number of calculated R--R and P--P intervals, respectively, or mean R--R and mean P--P interval values. A second comparator unit compares the P--P intervals with the R--R intervals. A third and fourth calculation unit, connected to the output of the first and second calculation unit and/or of the first and second interval memory unit, respectively, calculate the change over time between successive P--P and R--R intervals. First and second criterion memories stores predetermined stability criterion for the change over time between successive P--P and R--R intervals, respectively. A third and fourth comparator unit compare the calculated change over time in the P--P and R--R intervals with the associated stability criterion stored in memory.

Claims

1. An apparatus for detecting ventricular tachycardia, comprising

an atrium sensor for sensing electrical activity in an atrium and a ventricle sensor for sensing electrical activity in a ventricle of a heart;

a timer for detecting an instant of occurrence of the respective electrical activity;

a first and second calculation unit, each having an input side connected to the ventricle sensor and the atrium sensor, respectively, and to the timer, for calculating R--R or P--P intervals between successive electrical activities in the ventricle and in the atrium, respectively, and for selectively forming mean R--R and mean P--P interval values over a predetermined period of time or a predetermined number of calculated R--R and P--P intervals, respectively;

a threshold memory for storing at least one threshold value for the R--R intervals or mean R--R interval values;

a first comparator unit, connected to the outputs of the first calculation unit and of the threshold value memory, for comparing the R--R intervals or mean R--R interval values with the at least one threshold value and for outputting a first classification signal characterizing the outcome of the comparison;

first and second interval memory units, connected to the output of the first and second calculation units, respectively, for storing a predetermined number of respective calculated R--R or P--P intervals, or mean R--R or mean P--P interval values in memory;

second comparator unit, connected to the output of one of (a) the first and second calculation units and (b) the first and second interval memory units, for comparing the P--P intervals with the R--R intervals and for outputting a second classification signal characterizing the outcome of the comparison;

a third and fourth calculation unit, connected to the output of at least one of (a) the first and second calculation units and (b) the first and second interval memory units, respectively, for calculating a change over time between successive R--R and P--P intervals or the mean R--R and mean P--P interval values,

first and second criterion memories for storing, respectively, a predetermined stability criterion for the change over time between successive R--R and P--P intervals or mean R--R and mean P--P interval values; and

a third and fourth comparator unit, each having an input side connected to the output of the third and fourth calculation units, respectively, and to the first and second criterion memories, respectively, for comparing the calculated change over time in the R--R or P--P intervals with an associated stability criterion stored in the respective criterion memory and for outputting a third and fourth classification signal characterizing the outcome of the comparison.

2. The apparatus of claim 1, wherein the second comparator unit includes a divider, a quotient memory, a tolerance range memory and a comparator stage, and the divider has inputs connected to the outputs of one of (a) the first and second calculation units and (b) the first and second interval memory units;

the output of the divider is connected to an input of the comparator stage; and

the comparator has further inputs connected to the output of the quotient memory and of the tolerance range memory, respectively, such that the divider calculates a quotient from the R--R and P--P intervals or mean R--R and mean P--P interval values stored in memory, and the calculated quotient is tested in the comparator stage for whether it represents an integer within a predetermined tolerance range.

3. The apparatus of claim 1, further comprising:

a fifth calculation unit having an input side connected to the atrium sensor, the ventricle sensor and the timer, for calculating a P-R interval between a respective electrical activity in the atrium and a chronologically next activity in the ventricle, and for selectively forming a mean P-R interval value over a predetermined period of time or a predetermined number of calculated time intervals;

a third interval memory, connected to the output of the fifth calculation unit, for storing a predetermined number of calculated P-R intervals or mean P-R interval values, respectively;

a sixth calculation unit, connected to the output of at least one of the fifth calculation unit and the third interval memory, for calculating changes over time between successive P-R intervals or mean P-R interval values;

a third criterion memory for storing a predetermined regularity and a monotony criterion for the change over time in the P-R intervals or mean P-R interval values; and

a fifth comparator unit having an input side connected to the output of the sixth calculation unit and to the third criterion memory, for comparing the calculated change over time in the P-R intervals with the regularity and monotony criterion stored in memory and for outputting a fifth and sixth classification signal characterizing the outcome of the comparison.

4. The apparatus of claim 3, wherein at least one of the first, second and fifth calculation units includes:

an interval number memory for storing a predetermined number of intervals to be detected for time averaging;

an addition and integration stage, connected to the output of the interval number memory, for determining a total duration of the stored number of successive intervals; and

a division stage, connected to the output of the addition and integration stage and of the interval number memory, for forming the respective mean interval value.

5. The apparatus of claim 3, wherein the first, second and third interval memories each have at least three separate memory regions.

6. The apparatus of claim 3, wherein at least one of the third, fourth and sixth calculation units is for performing a calculation of a trend in development over time among more than two of the time intervals calculated in a respective one of first, second and fifth calculation units or stored in a respective one of the first, second and third intervale memory units.

7. The apparatus of claim 1, further comprising:

a comparison value memory for storing an R--R comparison interval or an R--R deviation amount and a further comparator unit having an input side connected to the outputs of the first calculation unit, the first interval memory and the comparison value memory, for comparing a current R--R interval or mean R--R interval value with the R--R comparison interval stored in memory or a preceding R--R interval, taking into account the R--R deviation amount and for outputting a further classification signal characterizing the outcome of the comparison.

8. The apparatus of claim 7, further comprising a comparison value calculation unit, having an input connected to the output of the first interval memory for calculating on an ongoing basis the R--R comparison interval or the R--R deviation amount from the current R--R interval and wherein the comparison value memory has an input side connected to an output of the comparison value calculation unit.

9. The apparatus of claim 1, further comprising a flow control device and a program memory for controlling the operation of the apparatus in accordance with a flowchart stored in memory by sequential polling and processing of the classification signals into control signals for controlling at least one of individual components of the apparatus and automatic activation of a cardiac therapy device associated with the apparatus.

10. The apparatus of claim 9, wherein the flow control device includes:

a partial outcome memory having a plurality of columns and a delete input, wherein the classification signals, obtained in one of a predetermined number of successive test passes and/or condition statements are each delivered to one column, and the entire contents of the partial outcome memory are deleted automatically in the presence of the first classification signal having a certain value; and

a logical processing unit having inputs connected separately with the outputs of the individual columns, wherein the memory contents of the partial outcome memory are linked in columns, in each case after a test pass, and from this a total calculation signal is obtained with regard to the presence of a ventricular tachycardia (VT condition).