System and method for classifying tachycardia arrhythmias having 1:1 atrial-to-ventricular rhythms

• US 7,203,535 B1
• Filed: 10/13/1999
• Issued: 04/10/2007
• Est. Priority Date: 04/01/1999
• Status: Expired due to Fees

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Lovett, Eric G., Sweeney, Robert J., Hsu, William
• Primary Examiner(s): Pezzuto; Robert E.
• Assistant Examiner(s): Oropeza; Frances P.
• Application Number:
  US09/417,558
• Time in Patent Office: 2,736 Days
• Field of Search: 600/372, 600/373, 600/374, 600/508, 600/509, 600/513, 600/514, 600/515, 600/516, 600/518, 600/519, 600/521, 607/14
• US Class Current: 600/518
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

An implantable cardioverter/defibrillator includes a tachycardia detection system that detects one-to-one (1:1) tachycardia, which is a tachycardia with a one-to-one relationship between atrial and ventricular contractions. When the 1:1 tachycardia is detected, the system discriminates ventricular tachycardia (VT) from supraventricular tachycardia (SVT) based on analysis of a cardiac time interval. Examples of the cardiac time interval include an atrioventricular interval (AVI) and a ventriculoatrial interval (VAI). A template time interval is created during a known normal sinus rhythm. The system measures a tachycardia time interval after detecting the 1:1 tachycardia, and indicates a VT detection if the tachycardia time interval differs from the template time interval by at least a predetermined percentage of the template time interval.

Claims

1. A system, comprising:

at least one cardiac lead including at least three electrodes;

control circuitry coupled to the at least three electrodes, where the control circuitry receives a first cardiac signal which includes indications of ventricular depolarizations and a second cardiac signal which includes indications of atrial depolarizations, and where the control circuitry includes;

a ventricular depolarization detector circuit to detect the occurrence of ventricular depolarizations in the first cardiac signal;

an atrial depolarization detector circuit to detect the occurrence of atrial depolarizations in the second cardiac signal;

a cardiac data analyzing circuit coupled to the ventricular depolarization detector circuit and the atrial depolarization detector circuit, where the cardiac data analyzing circuit analyzes ventricular depolarizations for the occurrence of a tachycardia episode, and when the tachycardia episode occurs the cardiac data analyzing circuit analyzes the ventricular depolarizations and the atrial depolarizations to determine whether a one-to-one association of atrial depolarizations to ventricular depolarizations exists;

a cycle length interval circuit coupled to the cardiac data analyzing circuit, where the cycle length interval circuit calculates both first intervals between detected ventricular depolarizations and first predetermined cardiac events and calculates second intervals between detected atrial depolarizations and second predetermined cardiac events when the cardiac data analyzing circuit detects the tachycardia episode having the one-to-one association of atrial depolarizations to ventricular depolarizations; and

a microprocessor coupled to the cycle length interval circuit, where the microprocessor determines a first variability characteristic for a first predetermined series of the first intervals and a second variability characteristic for a second predetermined series of the second intervals and classifies the tachycardia episode as occurring in either an antegrade direction or a retrograde direction based on a comparison of the first variability characteristic and the second variability characteristic.

2. The system of claim 1, where the first predetermined cardiac events are subsequent ventricular depolarizations detected in the first cardiac signal by the ventricular depolarization detector circuit and the second predetermined cardiac events are subsequent atrial depolarizations detected in the second cardiac signal by the atrial depolarization detector circuit.

3. The system of claim 2, where the microprocessor determines a first variance for the first variability characteristic and a second variance for the second variability characteristic, and classifies the tachycardia episode based on the values of the first variance and the second variance.

4. The system of claim 3, where the cycle length interval circuit calculates atrial—

atrial (AA)-intervals between a detected atrial depolarization and subsequently detected atrial depolarization, and calculates ventricular—

ventricular (VV) intervals between a detected ventricular depolarization and subsequently detected ventricular depolarization; and

the microprocessor determines the first variance for the VV-intervals and the second variance for the AA-intervals, where the microprocessor classifies the tachycardia episode as occurring in the antegrade direction when the second variance is less than or equal to the first variance.

5. The system of claim 3, where the microprocessor classifies the tachycardia episode as occurring in the retrograde direction when the second variance is greater than the first variance.

6. The system of claim 1, where the first predetermined cardiac events are subsequent atrial depolarizations detected in the second cardiac signal by the atrial depolarization detector circuit and the second predetermined cardiac events are subsequent ventricular depolarizations detected in the first cardiac signal by the ventricular depolarization detector circuit.

7. The system of claim 6, where the microprocessor determines a first variance for the first variability characteristic and a second variance for the second variability characteristic, and classifies the tachycardia episode based on the values of the first variance and the second variance.

8. The system of claim 7, where the cycle length interval circuit calculates atrial-ventricular (AV)-intervals between a detected atrial depolarization and subsequently detected ventricular depolarization, and calculates ventricular-atrial (VA)-intervals between a detected ventricular depolarization and subsequently detected atrial depolarization;

and

the microprocessor determines the first variance for the VA-intervals and the second variance for the AV-intervals, where the microprocessor classifies the tachycardia episode as occurring in the antegrade direction when the second variance is less than or equal to the first variance.

9. The system of claim 8, where the microprocessor classifies the tachycardia episode as occurring in the retrograde direction when the second variance is greater than the first variance.

10. The system of claim 1, where the first predetermined series includes a number of first intervals and the second predetermined series includes the number of second intervals and the number is a programmable value of at least five (5) which is stored in the microprocessor.

11. A method, comprising:

detecting atrial depolarizations and ventricular depolarizations;

detecting a tachycardia episode from the ventricular depolarizations, where the tachycardia episode has a one-to-one association of atrial depolarizations to ventricular depolarizations;

during the tachycardia episode that has the one-to-one association of atrial depolarizations to ventricular depolarizations, measuring first intervals between the ventricular depolarizations and first predetermined cardiac events and second intervals between the atrial depolarizations and second predetermined cardiac events; and

classifying the tachycardia episode based on a comparison of variability characteristics of a series of the first intervals and a series of the second intervals; and

where classifying the tachycardia episode includes calculating a first interval characteristic from the first intervals and a second interval characteristic from the second intervals; and

where calculating the first interval characteristic includes calculating a first variance value from the first intervals, calculating the second interval characteristic includes calculating a second variance value from the second intervals, and classifying the tachycardia episode includes classifying the tachycardia episode based on the first variance value and the second variance value; and

where the first predetermined cardiac events are subsequent ventricular depolarizations and the second predetermined cardiac events are subsequent atrial depolarizations, where measuring the first intervals includes calculating ventricular—

ventricular (VV)-intervals between the detected ventricular depolarizations and subsequently detected ventricular depolarizations, and measuring the second intervals includes calculating atrial—

atrial (AA)-intervals between the detected atrial depolarizations and subsequently detected atrial depolarizations; and

where classifying the tachycardia episode includes classifying the tachycardia episode as an antegrade rhythm when the second variance is less than or equal to the first variance.

12. The method of claim 11, where classifying the tachycardia episode includes classifying the tachycardia episode as a retrograde rhythm when the second variance is greater than the first variance.

13. A method, comprising:

detecting atrial depolarizations and ventricular depolarizations;

detecting a tachycardia episode from the ventricular depolarizations, where the tachycardia episode has a one-to-one association of atrial depolarizations to ventricular depolarizations;

during the tachycardia episode that has the one-to-one association of atrial depolarizations to ventricular depolarizations, measuring first intervals between the ventricular depolarizations and first predetermined cardiac events and second intervals between the atrial depolarizations and second predetermined cardiac events; and

classifying the tachycardia episode based on a comparison of variability characteristics of a series of the first intervals and a series of the second intervals; and

where classifying the tachycardia episode includes calculating a first interval characteristic from the first intervals and a second interval characteristic from the second intervals; and

where calculating the first interval characteristic includes calculating a first variance value from the first intervals calculating the second interval characteristic includes calculating a second variance value from the second intervals, and classifying the tachycardia episode includes classifying the tachycardia episode based on the first variance value and the second variance value; and

where the first predetermined cardiac events are subsequent atrial depolarizations and the second predetermined cardiac events are subsequent ventricular depolarizations, where measuring the first intervals includes calculating ventricular-atrial (VA)-intervals between the detected ventricular depolarizations and subsequently detected atrial depolarizations, and measuring the second intervals includes calculating atrial-ventricular (AV)-intervals between the detected atrial depolarizations and subsequently detected ventricular depolarizations; and

where classifying the tachycardia episode includes classifying the tachycardia episode as an antegrade rhythm when the second variance is less than or equal to the first variance.

14. The method of claim 13, where classifying the tachycardia episode includes classifying the tachycardia episode as a retrograde rhythm when the second variance is greater than the first variance.

15. A method comprising:

receiving a first cardiac signal;

receiving a second cardiac signal;

detecting a tachycardia episode based on the first cardiac signal and the second cardiac signal;

selecting a first series of intervals based on predetermined features in the first cardiac signal and the second cardiac signal;

selecting a second series of intervals based on predetermined features in the first cardiac signal and the second cardiac signal;

determining a first characteristic based on variability of the first series;

determining a second characteristic based on variability of the second series;

comparing the first characteristic with the second characteristic; and

classifying the tachycardia episode based on the comparison; and

wherein classifying the tachycardia episode includes classifying the tachycardia episode as an antegrade direction tachycardia episode when the first characteristic has a value greater than the second characteristic.