System for displaying cardiac arrhythmia data

• US 6,016,442 A
• Filed: 03/25/1998
• Issued: 01/18/2000
• Est. Priority Date: 03/25/1998
• Status: Expired due to Term

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Lang, Douglas J., Hsu, William
• Primary Examiner(s): KIM, WON TAE C
• Application Number:
  US09/047,647
• Time in Patent Office: 664 Days
• Field of Search: 600/518
• US Class Current: 600/518
• CPC Class Codes: A61N 1/3702 Physiological parameters A61N1/365 takes precedence; evoked response A61N1/371
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means
• CPC Class Codes: G16H 15/00 ICT specially adapted for medical reports, e.g. generation or transmission thereof
• CPC Class Codes: G16H 40/63 for local operation
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems
• CPC Class Codes: G16Z 99/00 Subject matter not provided for in other main groups of this subclass

Abstract

A medical device system and method of plotting symbols representing complexes of selected arrhythmic events on an interactive display screen, for organizing, displaying and interacting with a patient'"'"'s recorded arrhythmia episodes. Stored arrhythmic episode are selected from a plurality of arrhythmic episodes, where the stored arrhythmic episode having a plurality of complexes. A similarity value and a dissimilarity value is calculated for each complex of the plurality of complexes of the selected arrhythmic episode with respect to normal sinus rhythm complexes. Symbols representing the arrhythmic complexes are then plotted as a function of the calculated similarity values and the dissimilarity values on an interactive display screen. Additional information relating to the arrhythmic event is elicited through interacting with the symbols displayed on the interactive display screen.

Claims

1. A method comprising the steps of:

selecting a stored arrhythmic episode from a plurality of arrhythmic episodes, the stored arrhythmic episode having a plurality of complexes;

calculating a similarity value and a dissimilarity value for each complex of the plurality of complexes of the selected arrhythmic episode with respect to normal sinus rhythm complexes; and

plotting one or more symbols representing the complexes as a function of the calculated similarity values and the dissimilarity values on an interactive display screen.

2. The method of claim 1, including the steps of selecting symbols representing at least one arrhythmic episode on the interactive display screen;

requesting one or more electrocardiogram signal channels of the at least one arrhythmic episode through the interactive display screen; and

displaying one or more channels of an electrocardiogram signal of the selected arrhythmic episode on the interactive display screen.

3. The method of claim 1, including the steps of selecting symbols representing at least one arrhythmic episode on the interactive display screen;

requesting information relating to a therapy regimen provided to treat the selected arrhythmic episode through the interactive display screen; and

displaying an informational message on the interactive display screen related to the therapy regimen provided to treat the selected arrhythmic episode.

4. The method of claim 1, where the step of calculating a similarity value and a dissimilarity value for each complex includes the steps of:

determining an arrhythmic vector, A, for each complex of the plurality of complexes based on predetermined waveform characteristics of cardiac QRS-waves recorded during the arrhythmic episode, the arrhythmic vector including a set of numbers, each number associated with a particular morphological point of the complex;

determining a normal rhythm vector, N, based on predetermined waveform characteristics of cardiac QRS-waves recorded during normal sinus rhythm, the normal rhythm vector including a set of numbers, each number associated with a particular morphological point of the normal sinus rhythm; and

calculating the similarity value with the equation [A·

N]/[N·

N] and the dissimilarity value with the equation SQRT [(A·

A)/(N·

N)-((A·

N)/(N·

N))² ] for each complex of the arrhythmic event.

5. The method of claim 1, where the step of plotting further includes the step of plotting one or more symbols on a discrimination plane having a similarity coordinate axis and a dissimilarity coordinate axis which is orthogonal to the similarity coordinate axis.

6. The method of claim 5, including the steps of defining one or more notice regions on the discrimination plane through the interactive display screen;

storing the defined one or more notice regions;

plotting one or more symbols on the discrimination plane; and

displaying an advisory message on the interactive display screen if at least one symbol is plotted within one or more notice regions on the interactive display.

7. The method of claim 1, including the step of grouping symbols representing one or more arrhythmic episodes within a defined boundary on the interactive display screen.

8. The method of claim 7, where the step of grouping includes the step of drawing the defined boundary around selected symbols on the interactive display screen.

9. The method of claim 8, including the steps of determining a representative electrocardiogram signal for the one or more arrhythmic episodes contained within the defined boundaries;

and

retrievably storing the representative electrocardiogram signal.

10. The method of claim 9, including the steps of displaying one or more of the defined boundaries;

selecting one or more of the defined boundaries; and

displaying the stored representative electrocardiogram signal of the selected one or more defined boundaries on the interactive display screen.

11. The method of claim 9, including the step of calculating an average electrocardiogram for the representative electrocardiogram signal.

12. The method of claim 8, including the steps of retrievably storing therapy regimens delivered to treat each of the one or more arrhythmic episodes;

retrievably storing a time at which each of the one or more arrhythmic episodes occurred;

selecting one or more stored arrhythmic episodes; and

displaying on the interactive display an informational message related to the therapy regimen delivered to the selected one or more arrhythmic episodes.

13. The method of claim 7, where the step of grouping includes the steps of programming electronic control circuitry to determine the defined boundary on the interactive display screen;

and

the electronic control circuitry creating the defined boundary around selected symbols on the interactive display screen.

14. The method of claim 7, including the steps of designating one or more defined boundaries as a notice boundary;

and

retrievably storing the positions of one or more notice boundaries on the interactive display screen.

15. The method of claim 14, including the steps of requesting that one or more stored notice boundaries be retrieved;

plotting the one or more retrieved notice boundaries on the interactive display screen;

plotting the one or more symbols on the interactive display screen; and

displaying a notice on the interactive display screen if at least one symbol is plotted within one or more notice boundaries on the interactive display screen.

16. The method of claim 1, including the steps of identifying one or more mistakenly treated arrhythmias;

changing a programmable parameter of a cardiac defibrillator in a medical device programmer based on the identified mistakenly treated arrhythmias; and

simulating in the medical device programmer the effect of the changed parameter on the cardiac data received from the cardiac defibrillator to determine if appropriately treated arrhythmias would receive treatment and mistakenly treated arrhythmia would fail to receive treatment under the simulation in the medical device programmer.

17. A method comprising the steps of:

selecting a stored arrhythmic episode from a plurality of arrhythmic episodes, the stored arrhythmic episode having a plurality of complexes;

calculating a similarity value and a dissimilarity value for each complex of the plurality of complexes of the selected arrhythmic episode with respect to normal sinus rhythm complexes, the step of calculating including the steps of;

determining an arrhythmic vector, A, for each complex of the plurality of complexes based on predetermined waveform characteristics of cardiac QRS-waves recorded during the arrhythmic episode, the arrhythmic vector including a set of numbers, each number associated with a particular morphological point of the complex;

determining a normal rhythm vector, N, based on predetermined waveform characteristics of cardiac QRS-waves recorded during normal sinus rhythm, the normal rhythm vector including a set of numbers, each number associated with a particular morphological point of the normal sinus rhythm; and

calculating the similarity value with the equation [A·

N]/[N·

N] and the dissimilarity value with the equation SQRT [(A·

A)/(N·

N)-((A·

N)/(N·

N))² ] for each complex of the arrhythmic event;

plotting on an interactive display screen one or more symbols representing the complexes as a function of the calculated similarity values and the dissimilarity values on a discrimination plane having a similarity coordinate axis and a dissimilarity coordinate axis which is orthogonal to the similarity coordinate axis; and

grouping symbols representing one or more arrhythmic episodes within a defined boundary on the interactive display screen.

18. The method of claim 17, including the steps of designating one or more defined boundaries as a notice boundary;

and

retrievably storing the positions of one or more notice boundaries on the interactive display screen.

19. The method of claim 18, including the steps of requesting that one or more stored notice boundaries be retrieved;

plotting the one or more retrieved notice boundaries on the interactive display screen;

plotting the one or more symbols on the interactive display screen; and

displaying a notice on the interactive display screen if at least one symbol is plotted within one or more notice boundaries on the interactive display screen.

20. The method of claim 17, including the steps of determining a representative electrocardiogram signal for the one or more arrhythmic episodes contained within the defined boundaries;

and

retrievably storing the representative electrocardiogram signal.

21. The method of claim 20, including the steps of displaying one or more of the defined boundaries;

selecting one or more of the defined boundaries; and

displaying the stored representative electrocardiogram signal of the selected one or more defined boundaries on the interactive display screen.

22. The method of claim 17, including the steps of retrievably storing therapy regimens delivered to treat each of the one or more arrhythmic episodes;

retrievably storing a time at which each of the one or more arrhythmic episodes occurred;

selecting one or more stored arrhythmic episodes; and

displaying on the interactive display an informational message related to the therapy regimen delivered to the selected one or more arrhythmic episodes.

23. A method comprising the steps of:

calculating a morphological metric value for each complex of an arrhythmic episode from predetermined morphology characteristics of each complex and predetermined morphology characteristics of normal sinus rhythm complexes; and

plotting symbols representing each complex as a function of the morphological metric values on an interactive display screen.

24. The method of claim 23, including the step of selecting a stored arrhythmic episode from a plurality of arrhythmic episodes, the step of calculating includes the step of:

calculating for the morphological metric value a similarity value and a dissimilarity value for each complex of an arrhythmic episode with respect to normal sinus rhythm complexes; and

the step of plotting includes the step of plotting one or more symbols representing the complexes as a function of the calculated similarity values and the dissimilarity values on the interactive display screen.

25. A method of graphically depicting arrhythmic episodes, comprising the steps of:

electronically recording signals representing an arrhythmic episode, where the arrhythmic episode has a plurality of complexes;

processing the plurality of complexes to derive an arrhythmic vector for each complex of the plurality of complexes, the act of processing including the acts of;

isolating each complex of the plurality of complexes according to a known morphological template;

recording waveform characteristics at predetermined morphological points of each complex, including maxima and minima, such that each complex is represented by the arrhythmic vector, the arrhythmic vector including a set of numbers, each number associated with a particular morphological point of the complex;

storing each arrhythmic vector associated with each complex;

comparing each arrhythmic vector with a normal rhythm vector, the normal rhythm vector including a set of numbers associated with a set of numbers characterizing a normal sinus rhythm complex; and

mapping a symbol representing similarity of each arrhythmic vector to the normal rhythm vector.

26. A medical device system, comprising:

a cardiac defibrillator including electronic control circuitry for determining the occurrence of an arrhythmic episode of a heart;

a medical device programmer having programmer electronic circuitry coupled to an interactive display screen and the electronic control circuitry of the cardiac defibrillator, where the programmer electronic circuitry receives stored arrhythmic episodes from the electronic control circuitry, the arrhythmic episodes having a plurality of complexes, and where the one or more stored arrhythmic episodes are selected through the interactive display, for which the programmer electronic control circuitry calculates a similarity value and a dissimilarity value for each complex of the selected arrhythmic episode with respect to normal sinus rhythm complexes, and plots one or more symbols representing the complexes as a function of the calculated similarity values and the dissimilarity values on the interactive display screen.

27. The medical device system of claim 26, where a user selects symbols representing at least one arrhythmic episode on the interactive display screen, and requests through the interactive display screen one or more electrocardiogram signal channels of the at least one arrhythmic episode be displayed on the interactive display screen.

28. The medical device system of claim 26, where a user selects a symbol representing an arrhythmic episode on the interactive display screen, and requests an informational message on the interactive display screen relating to a therapy regimen provided to treat the selected arrhythmic episode.

29. The medical device system of claim 26, where the programmer electronic circuitry determines for the one or more arrhythmic episodes arrhythmic vectors, A, for each complex of the plurality of complexes based on predetermined waveform characteristics of cardiac QRS waves recorded during the arrhythmic episode, the arrhythmic vector including a set of numbers, each number associated with a particular morphological point of the complex;

and determines a normal rhythm vector, N, based on predetermined waveform characteristics of cardiac QRS-waves recorded during normal sinus rhythm, the normal rhythm vector including a set of numbers, each number associated with a particular morphological point of the normal sinus rhythm, where the programmer electronic circuitry calculates a similarity value with the equation [A·

N]/[N·

N] and the dissimilarity value with the equation SQRT [(A·

A)/(N·

N)-((A·

N)/(N·

N))² ] for each complex of the arrhythmic event, and plots symbols at the similarity and dissimilarity values of the arrhythmic complexes on a discrimination plane having a similarity coordinate axis and a dissimilarity coordinate axis which is orthogonal to the similarity coordinate axis.

30. The medical device system of claim 26, where the symbols representing one or more arrhythmic episodes are grouped together within a defined boundary created on the interactive display screen.

31. The medical device system of claim 30, where the interactive display screen is used to designate one or more defined boundaries as notice boundaries which are then retrievably stored within the programmer electronic circuitry.

32. The medical device system of claim 31, where a used requests that one or more stored notice boundaries be retrieved from the programmer electronic circuitry and plotted on the interactive display screen, and the programmer electronic circuitry displays a notice on the interactive display screen if symbols are plotted within one or more notice boundaries on the interactive display screen.

33. The medical device system of claim 26, where at least one cardiac defibrillator parameter is changed in the medical device programmer, the programmer electronic circuity simulates the effect of the changed cardiac defibrillator parameter using cardiac data received from the cardiac defibrillator, and indicates if appropriately treated arrhythmias would have received treatment and mistakenly treated arrhythmia would have fail to receive treatment under the simulation in the medical device programmer.