Atrial interval based heart rate variability diagnostic for cardiac rhythm management system

• US 6,748,272 B2
• Filed: 05/18/2001
• Issued: 06/08/2004
• Est. Priority Date: 03/08/2001
• Status: Expired due to Term

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Stahmann, Jeffrey E., Carlson, Gerrard M., Baker, Kenneth L.
• Primary Examiner(s): Evanisko, George R.
• Application Number:
  US09/861,017
• Publication Number:
  US 20020128564A1
• Time in Patent Office: 1,117 Days
• Field of Search: 607/4, 607/5, 607/9, 607/14, 600/508, 600/509, 600/515-518
• US Class Current: 607/14
• CPC Class Codes: A61B 5/02405 Determining heart rate variability
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/353 Detecting P-waves
• CPC Class Codes: A61B 5/4035 Evaluating the autonomic nervous system
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/3629 in combination with non-electric therapy
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means
• CPC Class Codes: A61N 1/37252 Details of algorithms or data aspects of communication system, e.g. handshaking, transmitting specific data or segmenting data

Abstract

A cardiac rhythm management system acquires atrial heart rate variability data. The system provides a graphic or other indication of patient well-being based on the atrial heart rate variability data. Such atrial heart rate variability information provides an indication of the autonomic balance between the sympathetic and parasympathetic/vagal components of the autonomic nervous system. One example of the system also provides time-domain processing of frequency components of the atrial heart rate interval signal to obtain the indication of patient well-being.

Claims

1. A method including:

detecting, over a time period, intrinsic atrial heart contractions;

sampling P-P intervals between the intrinsic atrial heart contractions to obtain a time-domain P-P interval signal;

filtering the P-P interval signal to obtain a time-domain second signal including frequency components substantially in a first frequency band, wherein the second signal is influenced by both sympathetic and parasympathetic components of the autonomic nervous system;

filtering the P-P interval signal to obtain a time-domain third signal including frequency components substantially in a second frequency band, wherein the third signal is influenced by the parasympathetic component of the autonomic nervous system and not substantially influenced by the sympathetic component of the autonomic nervous system;

determining a time domain variance of each of the second and third signals; and

providing an indication associated with a balance between sympathetic and parasympathetic components of the autonomic nervous system based on the variances of the time-domain second and third signals.

2. The method of claim 1, in which providing the indication includes determining a ratio of the variances of the second and third signals.

3. The method of claim 1, further including disposing an atrial electrode in an atrium of a heart.

4. The method of claim 1, further including:

calculating at least one beat-to-beat P-P time difference between successive P-P time intervals; and

adjusting a cardiac rhythm management therapy using the at least one P-P time difference.

5. The method of claim 1, wherein, when a ventricular rate smoothing or ventricular rate regulation is turned on to reduce variability in the ventricular heart rate, then using the detecting the intrinsic atrial heart contractions for the providing the indication of the balance between sympathetic and parasympathetic components of the autonomic nervous system.

6. A system including:

an atrial electrode configured for being associated with an atrium;

an atrial sense amplifier, including an atrial sense amplifier input coupled to the atrial electrode for receiving, over a time period, intrinsic atrial electrical depolarizations therefrom, and including an atrial sense amplifier output;

a P-P interval timer, including a P-P timer input coupled to the atrial sense amplifier output for receiving intrinsic atrial electrical depolarizations, and including an P-P timer output providing a P-P interval signal based on a P-P interval between successive atrial heart contractions;

a low frequency (LF) bandpass filter, coupled to the P-P timer output for receiving the P-P interval signal, the LF bandpass filter providing a time-domain LF signal output that is influenced by both the sympathetic and parasympathetic components of the autonomic nervous system;

a high frequency (HF) bandpass filter, coupled to the P-P timer output for receiving the P-P interval signal, the HF bandpass filter providing a time-domain HF signal output having higher frequency components than the LF signal output, the HF signal output being influenced by the parasympathetic component of the autonomic nervous system and not substantially influenced by the sympathetic component of the autonomic nervous system;

an LF variance module coupled to the LF bandpass filter for receiving the LF signal, the LF variance module providing a resulting LF variance signal;

a HF variance module, coupled to the HF bandpass filter for receiving the HF signal, the HF variance module providing a resulting HF variance signal; and

an autonomic balance indicator module, coupled to the LF and HF variance modules, and providing an indication of a balance between sympathetic and parasympathetic components of an autonomic nervous system based on using the LF and HF variance signals.

7. The system of claim 6, in which the autonomic balance indicator module provides the indication of the balance between sympathetic and parasympathetic components of the autonomic nervous system based on a ratio of a low frequency component of the P-P interval signal to a high frequency component of the P-P interval signal.

8. The system of claim 6, further including a therapy module coupled to the autonomic balance indicator module, the therapy module to provide a cardiac rhythm management therapy based on using the indication of the balance.

9. The system of claim 8, wherein the autonomic balance indicator provides the balance indication using a ratio of the LF and HF variance signals.

10. The system of claim 8, wherein, when a ventricular rate smoothing or ventricular rate regulation is turned on to reduce variability in the ventricular heart rate, then the autonomic balance indicator operates to use the detecting the intrinsic atrial heart contractions for the providing the indication of the balance between sympathetic and parasympathetic components of the autonomic nervous system.