Apparatus and method for treating ventricular tachyarrhythmias

• US 6,151,524 A
• Filed: 08/18/1999
• Issued: 11/21/2000
• Est. Priority Date: 04/30/1997
• Status: Expired due to Term

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Gilkerson, James O., Linder, William J., Krig, David B., Zimmer, William L., Dreher, Robert D., Wald, Jan D.
• Primary Examiner(s): Schaetzle, Kennedy
• Assistant Examiner(s): EVANISKO, GEORGE ROBERT
• Application Number:
  US09/376,245
• Time in Patent Office: 461 Days
• Field of Search: 607/14, 607/4, 607/5, 600/518
• 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 1/395 for treating atrial fibrillation
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

A system and method for selectively treating a ventricular tachycardia based on sensed atrial and ventricular intervals from the patient'"'"'s heart. A detection window of the ten most recent atrial and ventricular intervals are analyzed for the occurrence of either tachycardia or fibrillation. When a majority of the sensed intervals are satisfied, the apparatus starts a duration time interval. Ventricular intervals and atrial intervals are compare, ventricular interval greater than the atrial interval by a bias factor the system delivers tachycardia therapy to the heart. Alternatively, the method withholds tachycardia therapy to the heart when the atrial rate is classified as atrial fibrillation and the ventricular response is unstable.

Claims

1. A method, comprising:

sensing atrial events and ventricular events;

calculating an average atrial rate from the sensed atrial events;

determining an average ventricular rate from sensed ventricular events;

determining ventricular interval rates from pairs of consecutively sensed ventricular events in a detection window, wherein the detection window is a predetermined series of ventricular events;

comparing each of the ventricular interval rates in the detection window to a lower rate threshold value for each of two or more rate zones, wherein each of the two or more rate zones include a ventricular tachycardia therapy deliverable when the detection window is satisfied;

classifying a ventricular interval rate of the ventricular interval rates as a fast ventricular interval for a rate zone of the two or more rate zones when the ventricular interval rate is equal to or greater than the lower rate threshold value of the rate zone;

declaring the detection window satisfied when a first predetermined percentage of the ventricular interval rates in the detection window are classified as fast ventricular intervals for the rate zone of the two or more rate zones;

starting a duration time interval once the detection window is declared satisfied;

inhibiting ventricular tachycardiac therapy with at least one programmable detection enhancement algorithm during a sustaned duration time period, wherein the sustained duration time period is started at the expiration of the duration time interval; and

applying the inhibited ventricular tachycardia therapy for the rate zone when the average ventricular rate becomes greater than the average atrial rate by at least the bias factor during the sustained duration time period.

2. The method of claim 1, including:

determining a ventricular rate from sensed ventricular events;

wherein inhibiting ventricular tachycardiac therapy with at least one programmable detection enhancement algorithm includes determining whether the ventricular rate is unstable during the sustained duration time period; and

inhibiting ventricular tachycardia therapy when the ventricular rate is unstable for the sustained duration time period.

3. The method of claim 2, including:

determining whether the ventricular rate is stable during the sustained duration time period;

determining the occurrence of atrial fibrillation from the sensed atrial events; and

inhibiting ventricular tachycardia therapy when the ventricular rate is unstable and atrial fibrillation is occurring.

4. The method of claim 3, including:

determining whether the ventricular rate becomes stable during the sustained duration time period; and

applying the ventricular tachycardia therapy for the rate zone when there is atrial fibrillation and the ventricular rate becomes stable during the sustained duration time period.

5. The method of claim 3, wherein determining the occurrence of atrial fibrillation from the sensed atrial events includes identifying an atrial fibrillation after the duration time interval ends when more than a predetermined majority number of a set of sensed atrial intervals is shorter than an atrial fibrillation interval threshold value, and when more than a predetermined quorum number of subsequent sets of sensed atrial intervals remain shorter than the atrial fibrillation interval threshold value.

6. The method of claim 1, wherein applying ventricular tachycardia therapy includes applying the ventricular tachycardia therapy for the rate zone after the sustained duration time period ends.

7. The method of claim 1, including applying the ventricular tachycardia therapy for the rate zone when the average ventricular rate is greater than the average atrial rate by at least the bias factor during the duration time interval.

8. The method of claim 1, including:

programming an onset rate value;

determining an onset rate for the ventricular rate; and

when the onset rate of the ventricular rate is below the programmed onset rate value, inhibiting the ventricular tachycardia therapy for the sustained duration time period.

9. The method of claim 1, including declaring the detection window remains satisfied when a second predetermined percentage of the ventricular interval rates following the detection window are classified as fast ventricular intervals for the rate zone;

and

resetting the duration time interval to zero when the detection window fails to remain satisfied during the duration time interval.