Discrimination of supraventricular tachycardia and ventricular tachycardia events

• US 6,687,540 B2
• Filed: 11/21/2001
• Issued: 02/03/2004
• Est. Priority Date: 03/12/1999
• 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.
• Primary Examiner(s): EVANISKO, GEORGE ROBERT
• Application Number:
  US09/990,151
• Publication Number:
  US 20020032469A1
• Time in Patent Office: 804 Days
• Field of Search: 607/4, 607/5, 607/14, 600/518
• US Class Current: 607/5
• CPC Class Codes: A61B 5/35 by template matching
• CPC Class Codes: A61N 1/3956 Implantable devices for applying electric shocks to the heart, e.g. for cardioversion

Abstract

A method and system for discrimination of supraventricular tachycardia and ventricular tachycardia events. Morphological features points are extracted from normal sinus rhythm (NSR) complexes and used to generate a NSR template. A numerical convolution is performed using the NSR template and the feature points for each sensed NSR to give a NSR filter output. Using a plurality of NSR complexes, a median NSR filter output template is determined, where the median NSR filter output template has a median value for each value in the NSR filter output. The median NSR filter output template is then used during a tachycardia event to distinguish tachycardia events as either ventricular tachycardia events or supraventricular tachycardia events.

Claims

1. A system, comprising:

a microprocessor;

an input circuit adapted for receiving a number of rate signals and a number of morphology signals from an endocardial lead, wherein the microprocessor is coupled to the input circuit and is adapted to sense a tachycardia event, and wherein the number of morphology signals includes a number of tachycardia complexes associated with the tachycardia event and a number of normal sinus rhythm (NSR) complexes;

a morphology analyzing circuit coupled to the input circuit for extracting a plurality of tachyvcardia feature points from each of the number of tachycardia complexes and a plurality of NSR feature points from each of the numnber of NSR complexes;

a template generating circuit coupled to the morphology analyzing circuit for receiving the plurality of NSR feature points and for generating a NSR template from the plurality of NSR feature points extracted from the number of NSR cardiac complexes; and

a filter output response circuit

for receiving the NSR template, the plurality of NSR feature points and the plurality of tachycardia feature points,

for generating a NSR filter output from the NSR template and the plurality of NSR feature points for each of the number of NSR complexes,

for determining a NSR filter output template using the NSR filter output for each of the number of NSR complexes, and

for generating a tachycardia complex output from the NSR filter output template and the plurality of tachycardia feature points for each of the number of tachycardia complexes,

wherein the microprocessor is coupled to the filter output response circuit and is adapted to compare the tachycardia complex output to the NSR filter output template to form a differentiation value, and to compare the differentiation value to a predetermined value to classify each of the number of tachycardia complexes as a ventricular tachycardia complex or a supraventricular tachycardia complex.

2. The system of claim 1, wherein the microprocessor is adapted for declaring a ventricular tachycardia event if the number of ventricular tachycardia complexes exceeds a predetermined threshold value.

3. The system of claim 1, wherein the microprocessor is adapted for declaring a supraventricular tachycardia event if the number of supraventricular tachycardia complexes exceeds a predetermined threshold value.

4. The system of claim 1, wherein the filter output response circuit is adapted for convolving the plurality of NSR feature points with the NSR template to generate the NSR filter output and for convolving the plurality of tachycardia feature points with the NSR filter output template to generate the tachycardia complex output.

5. The system of claim 1, wherein the system further includes an R-wave detector coupled to the input circuit for receiving the rate signal and conveying a processed rate signal to the microprocessor.

6. The system of claim 1, further including an output circuit coupled to the microprocessor, wherein the output circuit is adapted for being coupled to the endocardial lead and for delivering cardioversion and defibrillation therapy through the endocardial lead.

7. A system, comprising:

a microprocessor;

an endocardial lead having at least one pacing electrode and at least one defibrillation electrode;

an input circuit coupled to the endocardial lead for receiving a number of tachycardia complexes and a number of normal sinus rhythm (NSR) complexes;

an R-wave detector coupled to the input circuit for conveying a rate signal to the microprocessor, wherein the microprocessor is adapted to sense a tachycardia event;

a morphology analyzing circuit coupled to the input circuit for extracting a plurality of tachycardia feature points from each of the number of tachycardia complexes and a plurality of NSR feature points from each of the number of NSR complexes;

a template generating circuit coupled to the morphology analyzing circuit for generating an NSR template from the plurality of NSR feature points extracted from the number of NSR cardiac complexes;

a filter output response circuit

for receiving the NSR template from the template generating circuit, and the plurality of NSR feature points and the plurality of tachycardia feature points from the morphology analyzing circuit,

for generating a NSR filter output from the NSR template and the plurality of NSR feature points for each of the number of NSR complexes,

for determining a NSR filter output template using the NSR filter output for each of the number of NSR complexes, and

for generating a tachycardia complex output from the NSR filter output template and the plurality of tachycardia feature points for each of the number of tachycardia complexes,

the microprocessor being coupled to the filter output response circuit and adapted to compare the tachycardia complex output to the NSR filter output template to form a differentiation value, and to compare the differentiation value to a predetermined value to classify each of the number of tachycardia complexes as a ventricular tachycardia complex or a supraventricular tachycardia complex; and

an output circuit coupled to the microprocessor and to the endocardial lead for delivering cardioversion and defibrillation therapy through the endocardial lead.

8. The system of claim 7, wherein the input circuit includes:

a first amp having an input coupled to the at least one pacing electrode and an output coupled to the R-wave detector; and

a second amp having an input coupled to the at least one defibrillation electrode and an output coupled to the morphology analyzer.

9. The system of claim 7, wherein the microprocessor is adapted for declaring a ventricular tachycardia event if the number of ventricular tachycardia complexes exceeds a predetermined threshold value.

10. The system of claim 7, wherein the microprocessor is adapted for declaring a supraventricular tachycardia event if the number of supraventricular tachycardia complexes exceeds a predetermined threshold value.

11. The system of claim 7, wherein the filter output response circuit is adapted for convolving the plurality of NSR feature points with the NSR template to generate the NSR filter output, and for convolving the plurality of tachycardia feature points with the NSR filter output template to generate the tachycardia complex output for the microprocessor.

12. The system of claim 11, wherein the filter output response circuit is adapted for determining a median NSR output template from the NSR filter output for each of the number of NSR complexes, and the microprocessor is adapted to compare the tachycardia complex output to the NSR filter output by summing a numerical difference between the tachycardia complex output and the median NSR output template to form the differentiation value that is compared to the predetermined value to classify each of the number of tachycardia complexes.

13. The system of claim 12, wherein the microprocessor is adapted for declaring a supraventricular tachycardia event if the number of supraventricular tachycardia complexes exceeds a predetermined threshold value, and for providing a signal to the cardioversion/defibrillation output circuit to deliver supraventricular tachycardia therapy if the microprocessor declares the supraventricular tachycardia event.