Arrhythmia memory for tachyarrhythmia discrimination

• US 7,277,747 B2
• Filed: 11/23/2004
• Issued: 10/02/2007
• Est. Priority Date: 11/23/2004
• Status: Expired due to Fees

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Lin, Yayun, Thompson, Julie, Cazares, Shelley
• Primary Examiner(s): Layno; Carl
• Assistant Examiner(s): LEE, YUN H
• Application Number:
  US10/996,340
• Publication Number:
  US 20060111643A1
• Time in Patent Office: 1,043 Days
• Field of Search: 600/515, 600/518
• US Class Current: 600/518
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• CPC Class Codes: A61B 5/35 by template matching
• CPC Class Codes: A61B 5/363 Detecting tachycardia or bradycardia
• CPC Class Codes: A61B 5/726 using Wavelet transforms
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions

Abstract

This document discusses, among other things, a method of identifying a non-fatal tachyarrhythmia episode by determining a degree of similarity between the episode and a template generated from a previous tachyarrhythmia episode.

Claims

1. A machine-assisted method comprising:

sensing an intrinsic electrical heart signal using an implantable medical device;

detecting a first tachyarrhythmia episode using the intrinsic electrical heart signal;

selecting a first tachyarrhythmia template from a group of two or more candidate supraventricular tachyarrhythmia (SVT) templates;

comparing at least a portion of the intrinsic electrical heart signal obtained during the first tachyarrhythmia episode to the selected first tachyarrhythmia template, the first tachyarrhythmia template representative of a signal morphology of a first type of tachyarrhythmia; and

declaring whether the detected first tachyarrhythmia episode constitutes the first type of tachyarrhythmia based on the comparison.

2. The method of claim 1, wherein:

the comparing comprises determining at least one degree of similarity between the intrinsic electrical heart signal during the first tachyarrhythmia episode and the first tachyarrhythmia template; and

the declaring comprises declaring the first tachyarrhythmia episode to be a supraventricular tachyarrhythmia (SVT) episode if the at least one degree of similarity exceeds at least one threshold value.

3. The method of claim 1, comprising:

detecting a second tachyarrhythmia episode using the intrinsic electrical heart signal;

storing at least part of the intrinsic electrical heart signal during the second tachyarrhythmia episode;

receiving user input declaring the intrinsic electrical heart signal during the second tachyarrhythmia episode to be indicative of the first tachyarrhythmia type, wherein the first tachyarrhythmia type comprises a supraventricular tachyarrhythmia (SVT); and

generating the first tachyarrhythmia template using the intrinsic electrical heart signal during the second tachyarrhythmia episode that was declared by the user input to be indicative of the first tachyarrhythmia type.

4. The method of claim 3, further comprising:

presenting at least a portion of the intrinsic electrical heart signal obtained during the second tachyarrhythmia episode to a user; and

receiving from the user input indicating a segment of the intrinsic electrical heart signal obtained during the second tachyarrhythmia episode to be used to generate the first tachyarrhythmia template.

5. The method of claim 4, further comprising:

presenting a plurality of portions of the intrinsic electrical heart signal corresponding to a plurality of tachyarrhythmia episodes to a user; and

receiving from the user input indicating which of the plurality of portions of the intrinsic electrical signal are to be used to generate one or more first tachyarrhythmia templates.

6. The method of claim 1, further comprising suppressing a ventricular tachyarrhythmia therapy during the first tachyarrhythmia episode of the first type of tachyarrhythmia.

7. The method of claim 1, wherein the selecting the first tachyarrhythmia template from a group of two or more candidate supraventricular tachyarrhythmia (SVT) templates comprises receiving user input and using information from the user input for performing the selecting.

8. The method of claim 1, wherein the detecting the first tachyarrhythmia episode comprises:

monitoring a heart rate; and

when the heart rate exceeds a tachyarrhythmia rate threshold, declaring a detection of the first tachyarrhythmia episode.

9. The method of claim 8, further comprising:

comparing a portion of the intrinsic electrical heart signal obtained during the first tachyarrhythmia episode with a normal sinus rhythm (NSR) template; and

when a second portion of the electrical signal sufficiently correlates to the NSR template, declaring the first tachyarrhythmia episode to be a SVT episode and suppressing a ventricular tachyarrhythmia therapy during the declared SVT episode.

10. The method of claim 1, comprising:

detecting a second tachyarrhythmia episode using the intrinsic electrical heart signal;

receiving user input declaring the second tachyarrhythmia episode to be of a type that does not require ventricular antitachyarrhythmia therapy;

generating the first tachyarrhythmia template from the intrinsic electrical heart signal obtained during the second tachyarrhythmia episode, wherein the first tachyarrhythmia template is representative of an intrinsic electrical heart signal that does not require ventricular anti-tachyarrhythmia therapy; and

suppressing a ventricular tachyarrhythmia therapy when the first tachyarrhythmia episode constitutes the first type of tachyarrhythmia, otherwise delivering a ventricular anti-tachyarrhythmia therapy in response to the first tachyarrhythmia therapy episode.

11. The method of claim 1, comprising:

monitoring information about a patient; and

using the information about the patient for selecting as the first tachyarrhythmia template at least one supraventricular tachyarrhythmia (SVT) template, the at least one SVT template selected from a group of two or more candidate SVT templates.

12. The method of claim 11, wherein each candidate SVT template is associated with a heart rate at which a prior tachyarrhythmia episode used to generate the SVT template was observed, and wherein the monitoring information includes monitoring a patient'"'"'s heart rate and wherein the selecting the first tachyarrhythmia template includes selecting the candidate SVT template having an associated heart rate that is closest to the monitored heart rate.

13. The method of claim 12, in which selecting the first tachyarrhythmia template includes selecting as the first tachyarrhythmia template the candidate SVT template having an associated heart rate that is second closest to the heart rate of the first tachyarrhythmia episode.

14. The method of claim 11, wherein the comparing includes determining degrees of similarity between the portion of the intrinsic electrical heart signal obtained during the first tachyarrhythmia episode and multiple SVT templates.

15. The method of claim 11, comprising:

identifying at least one portion of the intrinsic electrical heart signal that is indicative of SVT; and

storing at least one portion of the intrinsic electrical heart signal that is indicative of SVT as a candidate SVT template.

16. The method of claim 15, wherein the storing includes discarding an older SVT template.

17. The method of claim 15, wherein the storing includes discarding a SVT template associated with a discontinued drug therapy regimen.

18. The method of claim 15, wherein the storing includes receiving an input from a user designating a SVT template to be discarded, and discarding the designated SVT template.

19. The method of claim 15, further comprising tracking the degree of similarity of the intrinsic electrical heart signal from the first tachyarrhythmia episode to the candidate SVT templates, and discarding a candidate SVT template exhibiting the least frequent similarity with the intrinsic electrical heart signal during the first tachyarrhythmia episode.

20. The method of claim 15, wherein the storing includes discarding an SVT template with a heart rate similar to heart rates at which other SVT templates were identified.

21. The method of claim 15, wherein the storing includes discarding an SVT template that is most similar to other SVT templates.

22. The method of claim 11, wherein the comparing comprises determining at least one degree of similarity between a portion of the intrinsic electrical heart signal and the first tachyarrhythmia template, comprising:

determining at least one first degree of similarity between a portion of the intrinsic electrical heart signal from the first tachyarrhythmia episode and a first SVT template; and

when the first degree of similarity does not exceed a threshold, determining at least one second degree of similarity between the portion of the intrinsic electrical heart signal from the first tachyarrhythmia episode and a second SVT template.

23. The method of claim 11, wherein the monitoring information about the patient includes monitoring at least one of the patient'"'"'s neural activity, sleep state, hemodynamic status, transthoracic impedance, and cardiac impedance.

24. The method of claim 1, comprising selecting the first tachyarrhythmia template from a group of candidate templates by comparing a current drug therapy regimen to drug therapy regimens associated with the respective candidate templates.

25. The method of claim 1, comprising:

comparing at least a portion of the intrinsic electrical heart signal obtained during the first tachyarrhythmia episode to a normal sinus rhythm (NSR) template and, if the portion of the intrinsic electrical heart signal during the first tachyarrhythmia episode is determined to be not sufficiently similar to the NSR template, then performing the comparing at least a portion of the intrinsic electrical heart signal obtained during the first tachyarrhythmia episode to the first tachyarrhythmia template, otherwise declaring that the first tachyarrhythmia episode constitutes the first type of tachyarrhythmia.

26. A machine-assisted method comprising:

sensing an intrinsic electrical heart signal using an implantable medical device;

detecting a first tachyarrhythmia episode using the intrinsic electrical heart signal;

comparing at least a portion of the intrinsic electrical heart signal obtained during the first tachyarrhythmia episode to a first tachyarrhythmia template, the first tachyarrhythmia template representative of a signal morphology of a first type of tachyarrhythmia, wherein the comparing comprises determining at least one degree of similarity between a portion of the intrinsic electrical heart signal and the first tachyarrhythmia template, including computing a feature correlation coefficient for each of a plurality of portions of the intrinsic electrical heart signal detected during the first tachyarrhythmia episode, and further comprising withholding treatment if at least a predetermined fraction of the feature correlation coefficients exceed a predetermined threshold, wherein the computing the feature correlation coefficient comprises computing a feature correlation coefficient for each of a plurality of sequential heart beats during the first tachyarrhythmia episode and wherein the predetermined fraction and the predetermined threshold are programmably selectable; and

declaring whether the detected first tachyarrhythmia episode constitutes the first type of tachyarrhythmia based on the comparison.

27. The method of claim 26, comprising selecting the threshold using one or more statistics from other patients having one or more similar characteristics.

28. The method of claim 27, comprising selecting the threshold using information about one or more of the patient'"'"'s age, disease history, and medication.

29. A system comprising:

an implantable sensor configured to sense an intrinsic electrical heart signal;

a tachyarrhythmia detector, coupled to the sensor, the tachyarrhythmia detector configured for detecting a first tachyarrhythmia episode using the intrinsic electrical heart signal;

a first tachyarrhythmia template, representative of a signal morphology of a first type of tachyarrhythmia;

a processor, coupled to the first tachyarrhythmia template and the tachyarrhythmia detector, the processor configured for comparing at least a portion of the intrinsic electrical heart signal obtained during the tachyarrhythmia episode to the first tachyarrhythmia template, the processor declaring whether the detected first tachyarrhythmia episode constitutes the first type of tachyarrhythmia based on the comparison, in which the processor is configured to determine whether anti-tachyarrhythmia therapy should be delivered in response to the first tachyarrhythmia episode by determining a heart rate from the intrinsic electrical heart signal, selecting as the first tachyarrhythmia template an SVT template having a heart rate that is closest to the heart rate of the intrinsic electrical heart signal, determining at least one degree of similarity between a portion of the intrinsic electrical heart signal and the first tachyarrhythmia template.

30. The system of claim 29, in which the processor is further configured to suppress a ventricular anti-tachyarrhythmia therapy if at least one degree of similarity between the intrinsic electrical heart signal and the first tachyarrhythmia template exceeds a threshold value.

31. The system of claim 29, wherein the processor is further configured to store in a memory as a candidate SVT template a portion of the intrinsic heart signal that is representative of a SVT episode.

32. The system of claim 31, wherein the processor is configured to discard an oldest candidate template from the memory to make room for a new SVT template.

33. The system of claim 31, wherein the processor is configured to discard an SVT template that has been least frequently selected.

34. The system of claim 29, comprising an anti-tachyarrhythmia therapy circuit configured to deliver ventricular anti-tachyarrhythmia therapy, and wherein the processor is configured to compare the intrinsic electrical heart signal during the first tachyarrhythmia episode to an NSR template that represents a normal sinus rhythm, and to suppress the ventricular anti-tachyarrhythmia therapy if at least one degree of similarity between the NSR template and the portion of the intrinsic electrical heart signal during the first tachyarrhythmia episode exceeds a threshold value.

35. The system of claim 29, comprising a memory circuit configured to store at least a portion of the intrinsic electrical heart signal obtained during the first tachyarrhythmia episode.

36. The system of claim 29, wherein at least a portion of the system is implantable, the system comprising a wireless communication circuit, wherein a recorded portion of the intrinsic electrical heart signal can be communicated to a non-implanted device through the wireless communication circuit.

37. The system of claim 36, wherein the non-implanted device includes a display that is configured to display a graphical representation of a recorded portion of the intrinsic heart signal to a user.

38. A system comprising:

means for sensing an intrinsic electrical heart signal using an implantable medical device;

means for detecting a first tachyarrhythmia episode using the intrinsic electrical heart signal;

means for selecting a first tachyarrhythmia template from a group of two or more candidate supraventricular tachyarrhythmia (SVT) templates;

means for comparing at least a portion of the intrinsic electrical heart signal obtained during the first tachyarrhythmia episode to the selected first tachyarrhythmia template, the first tachyarrhythmia template representative of a signal morphology of a first type of tachyarrhythmia; and

means for declaring whether the detected first tachyarrhythmia episode constitutes the first type of tachyarrhythmia based on the comparison.