Multiple state morphology-based system detecting ventricular tachycardia and supraventricular tachycardia

• US 6,430,435 B1
• Filed: 11/20/2000
• Issued: 08/06/2002
• Est. Priority Date: 06/17/1998
• Status: Expired due to Term

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Marcovecchio, Alan F., Hsu, William
• Primary Examiner(s): Jastrzab, Jeffrey R.
• Application Number:
  US09/716,622
• Time in Patent Office: 624 Days
• Field of Search: 607/14, 607/25, 600/518-521, 600/515
• US Class Current: 600/518
• 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 1/3956 Implantable devices for applying electric shocks to the heart, e.g. for cardioversion
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

A system for detecting ventricular tachycardia and supraventricular tachycardia using a multiple stage morphology based system. Cardiac signals are sensed from a patient'"'"'s heart and analyzed for the occurrence of a tachycardia event. When a tachycardia event is detected, the method and system analyzes a plurality of features of the sensed cardiac signals in two or more discrimination stages. Each of the two or more discrimination stages classify the tachycardia event as either a ventricular tachycardia or a candidate supraventricular tachycardia event. When a discrimination stage detects the occurrence of a ventricular tachycardia, therapy is delivered to the heart to treat the ventricular tachycardia.

Claims

1. A method, comprising:

analyzing cardiac signals from an arrhythmic cardiac event using a series of at least two discrimination stages;

in each discrimination stage, classifying the arrhythmic cardiac event as an arrhythmic event that requires therapy or an arrhythmic event that does not require therapy; and

after each discrimination stage, providing therapy if the arrhythmic cardiac event is classified as an event that requires therapy.

2. the method of claim 1, wherein each discrimination stage classifies the arrhythmic cardiac event as either a ventricular tachycardia (VT) event or a candidate supraventricular tachycardia (SVT) event.

3. The method of claim 1, wherein analyzing cardiac signals from an arrhythmic cardiac event using a series of at least two discrimination stages includes analyzing a first number of signal features in a first discrimination stage, and analyzing a second number of signal features in a second discrimination stage, wherein the first number of signal features is less than the second number of signal features.

4. The method of claim 3, wherein the second number of signal features includes the first number of signal features.

5. The method of claim 3, wherein the first discrimination stage is more efficient than the second discrimination stage such that the classification of the arrhythmic cardiac event is more efficient and the therapy is more effective.

6. The method of claim 3, wherein one of the at least two discrimination stages is more sensitive in correctly classifying the arrhythmic cardiac event as an event that requires therapy and another of the at least two discrimination stages is more sensitive in correctly classifying the arrhythmic cardiac event as an event that does not require therapy.

7. A method, comprising:

applying a first discrimination stage to analyze cardiac signals and determine whether a tachycardia event is either a ventricular tachycardia (VT) event or a candidate supraventricular tachycardia (SVT) event;

providing therapy if the first discrimination stage classifies the tachycardia event as a VT event;

applying a second discrimination stage to analyze cardiac signals and determine whether a tachycardia event is either a VT event or a SVT event; and

providing therapy if the second discrimination stage classifies the tachycardia event as a VT event.

8. The method of claim 7, wherein applying a first discrimination stage to analyze cardiac signals and applying a second discrimination stage to analyze cardiac signals includes:

analyzing a plurality of cardiac complexes;

determining whether each of the analyzed cardiac complexes is a VT complex or a candidate SVT complex;

counting the number of VT complexes and the number of candidate SVT complexes; and

declaring the tachycardia event to be a VT event or a candidate SVT event based on the number of VT complexes and the number of candidate SVT complexes.

9. The method of claim 8, wherein declaring the tachycardia event to be a VT event or a candidate SVT event based on the number of VT complexes and the number of candidate SVT complexes includes programming a threshold ratio for declaring either a VT event or a candidate SVT event based on the number of VT complexes and the number of candidate SVT complexes.

10. The method of claim 7, wherein:

applying a first discrimination stage includes analyzing a first number of signal features;

applying a second discrimination stage includes analyzing a second number of signal features; and

the first number of signal features is less than the second number of signal features such that the first discrimination stage is more efficient than the second stage.

11. The method of claim 7, wherein applying a first discrimination stage to analyze cardiac signals and determine whether a tachycardia event is either a ventricular tachycardia (VT) event or a candidate supraventricular tachycardia (SVT) event includes:

comparing an R-wave width of a sensed cardiac complex to a template R-wave width; and

declaring the sensed cardiac complex to be a VT complex when the R-wave width of the sensed cardiac complex is greater than the template R-wave width.

12. The method of claim 11, wherein the template R-wave width is determined as either an average or a median of R-wave width of cardiac complexes sensed during normal sinus rhythm.

13. The method of claim 11, wherein the sensed cardiac complex has four features formed by detected major deflection points in the sensed cardiac complex, and the R-wave width of the sensed cardiac complex is determined by the distance between the second and fourth feature.

14. The method of claim 7, wherein applying a first discrimination stage to analyze cardiac signals and determine whether a tachycardia event is either a ventricular tachycardia (VT) event or a candidate supraventricular tachycardia (SVT) event includes:

recording the polarity of a largest amplitude feature of a normal cardiac complex sensed during normal sinus rhythm;

detecting a largest amplitude feature of a sensed cardiac complex; and

declaring the sensed cardiac complex to be a VT complex if the polarity of the largest amplitude feature of the sensed cardiac complex is different than the polarity of the large amplitude feature of the normal cardiac complex.

15. The method of claim 7, wherein:

applying a first discrimination stage includes performing either an R-wave width discrimination procedure or an R-wave polarity discrimination procedure;

applying a second discrimination stage includes performing either the R-wave width discrimination procedure or the R-wave polarity discrimination procedure, which ever discrimination procedure was not performed in the first discrimination stage;

the R-wave width discrimination procedure includes;

comparing an R-wave width of a sensed cardiac complex to a template R-wave width; and

declaring the sensed cardiac complex to be a VT complex when the R-wave width of the sensed cardiac complex is greater than the template R-wave width; and

the R-wave polarity discrimination procedure includes;

recording the polarity of a largest amplitude feature of a normal cardiac complex sensed during normal sinus rhythm;

detecting a largest amplitude feature of a sensed cardiac complex; and

declaring the sensed cardiac complex to be a VT complex if the polarity of the largest amplitude feature of the sensed cardiac complex is different than the polarity of the large amplitude feature of the normal cardiac complex.

16. The method of claim 7, wherein:

applying a first discrimination stage includes performing a first discrimination procedure that includes performing either an R-wave width discrimination procedure or an R-wave polarity discrimination procedure;

applying a second discrimination stage includes performing a second discrimination procedure that analyzes the similarity of a sensed cardiac complex to a normal sinus rhythm template complex;

the R-wave width discrimination procedure includes;

comparing an R-wave width of the sensed cardiac complex to a template R-wave width; and

declaring the sensed cardiac complex to be a VT complex when the R-wave width of the sensed cardiac complex is greater than the template R-wave width; and

the R-wave polarity discrimination procedure includes;

recording the polarity of a largest amplitude feature of a normal cardiac complex sensed during normal sinus rhythm;

detecting a largest amplitude feature of a sensed cardiac complex; and

declaring the tachycardia event to be a VT complex if the polarity of the largest amplitude feature of the sensed cardiac complex is different than the polarity of the large amplitude feature of the normal cardiac complex.

17. The method of claim 16, wherein performing a second discrimination procedure includes:

providing a normal feature vector (N) for a normal sinus rhythm complex;

determining a sensed feature vector (A) for a sensed cardiac complex;

determining a similarity value (a∥

) for A by projecting A onto N; and

determining a dissimilarity value (a⊥

) for A based on the determined vector A and the similarity value a∥

.

18. The method of claim 17, wherein:

providing a normal feature vector (N) for a normal sinus rhythm complex includes providing a four dimensional normal rhythm vector, N=[N1, N2, N3, N4]; and

determining a sensed feature vector (A) for a sensed cardiac complex includes determining a four dimensional feature vector, A=[A1, A2, A3, A4].

19. The method of claim 17, wherein determining a similarity value (a∥

) for A by projecting A onto N includes performing the calculation;

a∥

=[A·

N]/[N·

N].

20. The method of claim 17, wherein determining a dissimilarity value (a⊥

) for A includes performing the calculation;

a⊥

=SQRT[(A·

A)/(N·

N)—

(a∥

)²].

21. The method of claim 17, wherein:

the similarity value and dissimilarity value comprise a discrimination point (a∥

, a⊥

);

a similarity/dissimilarity plane is created with normalized vectors N/|N| and A/|N|;

the similarity/dissimilarity plane has orthogonal axes a∥ and

a⊥

;

the similarity/dissimilarity plane has a VT region and a non-VT region, and a boundary that separates the VT region from the non-VT region;

the discrimination point is plotted on the similarity/dissimilarity plane; and

the sensed cardiac complex from which the sensed feature vector A is determined is declared a VT complex if the discrimination point is located in the VT region of the similarity/dissimilarity plane.

22. The method of claim 21, wherein the sensed cardiac complex from which the sensed feature vector A is determined is declared a SVT complex if the discrimination point is located in the non-VT region of the similarity/dissimilarity plane.

23. The method of claim 21, wherein the boundary that separates the VT region from the non-VT region is a fixed boundary.

24. The method of claim 21, wherein the boundary that separates the VT region from the non-VT region is a programmable boundary.

25. A method, comprising:

applying a first discrimination stage to analyze cardiac signals and determine whether a tachycardia event is either a ventricular tachycardia (VT) event or a candidate supraventricular tachycardia (SVT) event;

providing therapy if the first discrimination stage classifies the tachycardia event as a VT event;

applying a second discrimination stage to analyze the similarity of a sensed cardiac complex to a normal sinus rhythm complex; and

providing therapy if the second discrimination stage classifies the tachycardia event as a VT event.

26. The method of claim 25, wherein applying a second discrimination stage includes:

providing a normal feature vector (N) for a normal sinus rhythm complex;

determining a sensed feature vector (A) for a sensed cardiac complex;

determining a similarity value (a∥

) for A by projecting A onto N; and

determining a dissimilarity value (a⊥

) for A based on the determined vector A and the similarity value a∥

.

27. The method of claim 26, wherein:

providing a normal feature vector (N) for a normal sinus rhythm complex includes providing a four dimensional normal rhythm vector, N=[N1, N2, N3, N4]; and

determining a sensed feature vector (A) for a sensed cardiac complex includes determining a four dimensional feature vector, A=[A1, A2, A3, A4].

28. The method of claim 27, wherein determining a similarity value (a∥

) for A by projecting A onto N includes performing the calculation;

a∥

=[A·

N]/[N·

N].

29. The method of claim 27, wherein determining a dissimilarity value (a⊥

) for A includes performing the calculation;

a⊥

=SQRT[(A·

A)/(N·

N)—

(a∥

)²].

30. The method of claim 27, wherein:

the similarity value and dissimilarity value comprise a discrimination point (a∥

, a⊥

);

a similarity/dissimilarity plane is created with normalized vectors N/|N| and A/|N|;

the similarity/dissimilarity plane has orthogonal axes a∥ and

a⊥

;

the similarity/dissimilarity plane has a VT region and a non-VT region, and a boundary that separates the VT region from the non-VT region;

the discrimination point is plotted on the similarity/dissimilarity plane; and

the sensed cardiac complex from which the sensed feature vector A is determined is declared a VT complex if the discrimination point is located in the VT region of the similarity/dissimilarity plane.

31. The method of claim 30, wherein the sensed cardiac complex from which the sensed feature vector A is determined is declared a SVT complex if the discrimination point is located in the non-VT region of the similarity/dissimilarity plane.

32. The method of claim 30, wherein the boundary that separates the VT region from the non-VT region is a fixed boundary.

33. The method of claim 30, wherein the boundary that separates the VT region from the non-VT region is a programmable boundary.

34. The method of claim 25, wherein applying a first discrimination stage to analyze cardiac signals and determine whether a tachycardia event is either a ventricular tachycardia (VT) event or a candidate supraventricular tachycardia (SVT) event includes:

comparing an R-wave width of a sensed cardiac complex to a template R-wave width; and

declaring the sensed cardiac complex to be a VT complex when the R-wave width of the sensed cardiac complex is greater than the template R-wave width.

35. The method of claim 25, wherein applying a first discrimination stage to analyze cardiac signals and determine whether a tachycardia event is either a ventricular tachycardia (VT) event or a candidate supraventricular tachycardia (SVT) event includes:

recording the polarity of a largest amplitude feature of a normal cardiac complex sensed during normal sinus rhythm;

detecting a largest amplitude feature of a sensed cardiac complex; and

declaring the sensed cardiac complex to be a VT complex if the polarity of the largest amplitude feature of the sensed cardiac complex is different than the polarity of the large amplitude feature of the normal cardiac complex.