Prioritized rule based method and apparatus for diagnosis and treatment of arrhythmias

• US 6,178,350 B1
• Filed: 01/19/2000
• Issued: 01/23/2001
• Est. Priority Date: 05/14/1996
• Status: Expired due to Term

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Gillberg, Jeffrey M., Olson, Walter H.
• Primary Examiner(s): Getzow, Scott M.
• Application Number:
  US09/487,189
• Time in Patent Office: 370 Days
• Field of Search: 607/4, 607/14, 607/9, 607/5
• US Class Current: 607/4
• CPC Class Codes: A61B 5/283 Invasive
• CPC Class Codes: A61B 5/29 for permanent or long-term implantation
• CPC Class Codes: A61B 5/361 Detecting fibrillation
• CPC Class Codes: A61B 5/363 Detecting tachycardia or bradycardia
• CPC Class Codes: A61B 5/7264 Classification of physiological signals or data, e.g. using neural networks, statistical classifiers, expert systems or fuzzy systems neural networks per se G06N3/00; expert systems per se G06N5/00
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

An implantable anti-tachyarrhythmia device which delivers anti-tachyarrhythmia therapies to a patient'"'"'s heart in response to detection of tachyarrhythmias. The device defines first criteria indicating the presence of atrial tachycardia and second criteria indicating the presence of atrial fibrillation, and compares the time elapsed since the either the first or second criteria were initially met to a defined time duration. In response to the defined duration having passed and either of the first or second criteria being met, the device triggers delivery of an appropriate anti-tachyarrhythmia therapy. The timer is reset on detection of termination of atrial tachyarrhythmia, but not on failure of the first and second criteria to be met. The first and second criteria are defined such that they can not be concurrently met.

Claims

1. A method of treating tachyarrhythmia in a patient, comprising:

implanting in the patient a device capable of monitoring the patient'"'"'s heart rhythm and capable of delivering a ventricular anti-tachyarrhythmia therapy;

monitoring the patient'"'"'s heart rhythm using the device;

determining whether the monitored heart rhythm meets defined atrial fibrillation criteria;

determining whether the monitored heart rhythm meets defined ventricular tachyarrhythmia criteria;

responsive to said atrial fibrillation and ventricular tachyarrhythmia criteria both being met, triggering delivery of said ventricular anti-tachyarrhythmia therapy.

3. The method of claim 1 wherein determining whether the monitored heart rhythm meets defined atrial fibrillation criteria comprises determining whether the monitored heart rhythm meets a defined criterion indicative of A-V dissociation.

4. The method of claim 1 or claim 2 or claim 3 wherein determining whether the monitored heart rhythm meets defined ventricular tachyarrhythmia criteria comprises determining whether the monitored heart rhythm meets a defined ventricular rate criterion.

5. The method of claim 1 or claim 2 or claim 3 wherein determining whether the monitored heart rhythm meets defined ventricular tachyarrhythmia criteria comprises determining whether the monitored heart rhythm meets a ventricular rate regularity criterion.

2. The method of 1 wherein determining whether the monitored heart rhythm meets defined atrial fibrillation criteria comprises determining whether the monitored heart rhythm comprises a required count of occurrences of defined atrial and ventricular beat patterns indicative of atrial fibrillation.

6. A method of treating tachyarrhythmia in a patient, comprising:

implanting in the patient a device capable of sensing atrial and ventricular beats of the patient'"'"'s heart and capable of delivering a ventricular anti-tachyarrhythmia therapy;

sensing atrial and ventricular beats using the device;

determining whether the sensed atrial and ventricular beats meet defined tachyarrhythmia criteria;

determining whether the sensed atrial and ventricular beats meet defined sinus tachycardia criteria, including determining whether the sensed atrial and ventricular beats comprise a defined number of sequential occurrences of atrial and ventricular beat patterns indicative that said device has sensed a ventricular beat as an atrial beat; and

responsive to said tachyarrhythmia criteria being met and said sinus tachycardia criteria simultaneously not being met, triggering delivery of said anti-tachyarrhythmia therapy.

7. A method of treating tachyarrhythmia in a patient, comprising:

implanting in the patient a device capable of monitoring the patient'"'"'s heart rhythm and capable of delivering a ventricular anti-tachyarrhythmia therapy;

monitoring the patient'"'"'s heart rhythm using the device;

determining whether the monitored heart rhythm meets defined supra-ventricular tachyarrhythmia criteria, comprising determining whether the monitored heart rhythm meets a criterion indicative of A-V dissociation;

determining whether the monitored heart rhythm meets defined ventricular tachyarrhythmia criteria;

responsive to said supra-ventricular and ventricular tachyarrhythmia criteria both being met, triggering delivery of said ventricular anti-tachyarrhythmia therapy.

8. A method of treating tachyarrhythmia in a patient, comprising:

implanting in the patient a device capable of monitoring the patient'"'"'s heart rhythm and capable of delivering an anti-tachyarrhythmia therapy;

monitoring heart rhythm using the device;

determining whether said monitored heart rhythm currently meets defined atrial tachyarrhythmia criteria;

after determining that the monitored heart rhythm has met the defined atrial tachyarrhythmia criteria, determining whether the monitored heart rhythm meets defined atrial tachyarrhythmia termination criteria;

on said atrial tachyarrhythmia criteria being met, initiating timing of an interval extending until said atrial tachyarrhythmia termination criteria are met, timing of said interval continuing even while said atrial tachyarrhythmia criteria cease to be met;

responsive to said interval exceeding a defined duration concurrent with said atrial tachyarrhythmia criteria being met, triggering delivery of said anti-arrhythmia therapy.

9. The method of claim 8, wherein;

implanting the device comprises implanting a device capable of delivering first and second therapies;

said atrial tachyarrhythmia criteria comprise defined first and second criteria indicative of atrial fibrillation and atrial tachycardia, respectively;

timing of said interval is initiated on either of said first and second criteria being met; and

triggering delivery comprises, responsive to said time interval exceeding said defined duration concurrent with said first criteria being met, triggering delivery of said first anti-arrhythmia therapy and, responsive to said time interval exceeding said defined duration concurrent with said second criteria being met, triggering delivery of said second anti-arrhythmia therapy.

10. The method of claim 9 wherein said first and second criteria can not be concurrently met.

11. A method of treating tachyarrhythmia in a patient, comprising:

implanting in the patient a device capable of monitoring the patient'"'"'s heart rhythm and capable of delivering an anti-tachyarrhythmia therapy;

monitoring heart rhythm using the device;

determining whether the monitored heart rhythm currently meets defined atrial tachyarrhythmia criteria;

after determining that the monitored heart rhythm has met the defined atrial tachyarrhythmia criteria, determining whether the monitored heart rhythm currently meets defined atrial tachyarrhythmia termination criteria, the atrial tachyarrhythmia termination criteria comprising criteria other than failure to currently meet the atrial tachyarrhythmia criteria;

on said atrial tachyarrhythmia criteria being met, initiating timing of an interval extending until said atrial tachyarrhythmia termination criteria are met, timing of said interval continuing even while said atrial tachyarrhythmia criteria cease to be met;

responsive to said interval exceeding a defined duration concurrent with said atrial tachyarrhythmia criteria being met, triggering delivery of said anti-arrhythmia therapy.

12. The method of claim 11, wherein;

implanting the device comprises implanting a device capable of delivering first and second therapies;

said atrial tachyarrhythmia criteria comprise defined first and second criteria indicative of atrial fibrillation and atrial tachycardia, respectively;

timing of said interval is initiated on either of said first and second criteria being met; and

triggering delivery comprises, responsive to said time interval exceeding said defined duration concurrent with said first criteria being met, triggering delivery of said first anti-arrhythmia therapy and, responsive to said time interval exceeding said defined duration concurrent with said second criteria being met, triggering delivery of said second anti-arrhythmia therapy.

13. The method of claim 12 wherein said first and second criteria cannot be concurrently met.

14. The method of claim 12 wherein said first and second criteria comprise atrial fibrillation and atrial tachycardia criteria, respectively.

15. The method of claim 14, wherein;

said first and second therapies are and atrial tachycardia therapies, respectively; and

triggering delivery comprises, responsive to said time interval exceeding said defined duration concurrent with said atrial fibrillation criteria being met, triggering delivery of said atrial fibrillation criteria therapy and, responsive to said time interval exceeding said defined duration concurrent with said atrial tachycardia criteria being met, triggering delivery of said atrial tachycardia therapy.

16. The method of claim 15 wherein said atrial tachycardia criteria and atrial fibrillation criteria comprise atrial tachycardia and atrial fibrillation rate zones, respectively.

17. The method of claim 12 wherein said atrial tachycardia criteria both comprise atrial cycle length regularity criteria.

18. The method of claim 11 wherein said atrial tachyarrhythmia criteria comprise means for defining an atrial tachyarrhythmia rate zone.

19. The method of claim 18 wherein said atrial tachyarrhythmia criteria comprise atrial cycle length regularity criteria.