Method and apparatus for identifying patients with wide QRS complexes

• US 7,283,864 B2
• Filed: 02/10/2005
• Issued: 10/16/2007
• Est. Priority Date: 02/10/2005
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Millerhagen, Jay, Gebauer, Michael, Thomas, Brian P.
• Primary Examiner(s): Layno; Carl H.
• Assistant Examiner(s): Patel; Natasha
• Application Number:
  US11/055,731
• Publication Number:
  US 20060178707A1
• Time in Patent Office: 978 Days
• Field of Search: 600/516, 607/9, 607/25, 607/30
• US Class Current: 600/516
• CPC Class Codes: A61B 5/366 Detecting abnormal QRS complex, e.g. widening
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means
• CPC Class Codes: A61N 1/37258 Alerting the patient
• CPC Class Codes: G16H 40/63 for local operation

Abstract

A medical device programmer or other external system capable of programming an implantable CRM device includes a wide-QRS detection and alerting system. Upon detection of a wide QRS complex, a wide-QRS indicator produces a visual indication of the detection using one or more presentation devices such as a display screen and a printer to alert a physician or other caregiver.

Claims

1. A cardiac rhythm management (CRM) system, comprising:

an implantable medical device including;

a pacing circuit to deliver pacing pulses; and

an implant controller, coupled to the pacing circuit, to control the delivery of the pacing pulses; and

an external system communicatively coupled to the implantable medical device via telemetry, the external system including;

a user interface including one or more user input devices and one or more presentation devices;

a programming circuit, coupled to the user interface, to program the implantable medical device; and

a wide-QRS detection and alerting circuit coupled to the user interface, the wide-QRS detection and alerting circuit including;

a wide-QRS detector to receive an electrocardiogram (ECG) signal and detect a wide QRS complex from the ECG signal; and

a wide-QRS indicator, coupled to the wide-QRS detector, to produce a wide-QRS indication including text directly indicating the detection of the wide QRS complex using the one or more presentation devices in response to the detection of the wide QRS complex.

2. The CRM system of claim 1, wherein the implant controller comprises a cardiac resynchronization therapy (CRT) algorithm execution module to control a delivery of pacing pulses by executing a CRT algorithm.

3. The CRM system of claim 1, wherein the one or more presentation devices comprise a screen, and the wide-QRS indicator comprises an image generator to produce a visual indication of the detection of the wide QRS complex to present on the screen.

4. The CRM system of claim 1, wherein the one or more presentation devices further comprise a printer, and the wide-QRS indicator comprises a message generator to produce a message indicative of the detection of the wide QRS complex to print using the printer.

5. The CRM system of claim 1, wherein the external system comprises a medical device programmer including the user interface, the programming circuit, and the wide-QRS detection and alerting circuit.

6. The CRM system of claim 5, wherein the ECG signal comprises a surface ECG signal, wherein the medical device programmer comprises a surface ECG sensing circuit to sense the surface ECG signal, and wherein the wide-QRS detector is adapted to receive the surface ECG signal and detect the wide QRS complex from the surface ECG signal.

7. The CRM system of claim 1, further comprising a plurality of implantable ECG electrodes, and wherein the implantable medical device comprises a wireless ECG sensing circuit, coupled to the implantable ECG electrodes, to sense a wireless ECG signal being a signal sensed through the plurality of implantable electrodes and approximating a surface ECG signal, and wherein the wide-QRS detector is adapted to receive the wireless ECG signal and detect the wide QRS complex from the wireless ECG signal.

8. The CRM system of claim 7, wherein the plurality of implantable ECG electrodes comprise a plurality of implantable subcutaneous electrodes.

9. A medical device programmer for communicating with an implantable medical device, the medical device programmer comprising:

an external telemetry circuit to communicate with the implantable medical device;

a user interface including one or more user input devices and one or more presentation devices;

a programming circuit, coupled to the user interface an the external telemetry circuit, to program the implantable medical device;

a surface electrocardiogram (ECG) sensing circuit to sense at least one surface ECG signal; and

a wide-QRS detection and alerting circuit coupled to the use interface, the wide-QRS detection and alerting circuit including;

a wide-QRS detector, coupled to the surface ECG sensing circuit, to receive the at least one surface ECG signal and detect a wide QRS complex from the at least one surface ECG signal; and

a wide-QRS indicator coupled to the wide-QRS detector, the wide-QRS indicator adapted to receive an indication of detection of the QRS complex and produce a wide-QRS indication including text directly indicating the detection of the wide QRS complex using the one or more presentation devices when the detection of the wide QRS complex is indicated.

10. The medical device programmer of claim 9, wherein the wide-QRS detector comprises:

a signal input, coupled to the surface ECG sensing circuit, to receive the at least one surface ECG signal;

a QRS width measurement module, coupled to the signal input, to measure a QRS width from the at least one surface ECG signal;

a QRS width comparator including a first input to receive the QRS width, a second input to receive a predetermined threshold QRS width and an output indicative of a detection of a wide QRS complex when the QRS width exceeds the predetermined threshold QRS width.

11. The medical device programmer of claim 10, wherein the one or more user input device comprise a threshold input device to receive the predetermined threshold QRS width.

12. The medical device programmer of claim 9, wherein the one or more presentation devices comprise a screen, and the wide-QRS indicator comprises an image generator to produce a visual indication of the detection of the wide QRS complex to present on the screen.

13. The medical device programmer of claim 12, wherein the one or more presentation devices further comprise a printer, and the wide-QRS indicator comprises a message generator to produce a message indicative of the detection of the wide QRS complex to print using the printer.

14. The medical device programmer of claim 13, wherein the one or more user input device comprise a programming input device receiving at least pacing parameters for programming the implantable medical device.

15. An external system for communicating with an implantable medical device coupled to implantable electrodes, the external system comprising;

an external telemetry circuit to receive at least one wireless electrocardiogram (ECG) signal from the implantable medical device, the wireless ECG signal being a signal sensed through the implantable electrodes and approximating a surface ECG signal;

a programming circuit, coupled to the external telemetry circuit, to program the implantable medical device;

a user interface including one or more presentation devices; and

a wide-QRS detection and alerting circuit coupled to the external telemetry circuit and the user interface, the wide-QRS detection and alerting circuit including;

a wide-QRS detector to receive the at least one wireless ECG signal and detect a wide QRS complex from the at least one wireless ECG signal; and

a wide-QRS indicator coupled to the wide-QRS detector, the wide-QRS detector adapted to produce a wide-QRS indication including text directly indicating the detection of the wide QRS complex using the one or more presentation devices, the wide-QRS indication being an indication of a detection of the wide QRS complex.

16. The external system of claim 15, wherein the wide-QRS detector comprises:

a signal input, coupled to the external telemetry circuit, to receive the at least one wireless ECG signal;

a QRS width measurement module, coupled to the signal input, to measure a QRS width from the at least one wireless ECG signal; and

a QRS width comparator including a first input to receive the QRS width, a second input to receive a predetermined threshold QRS width, and an output indicative of a detection of a wide QRS complex when the QRS width exceeds the predetermined threshold QRS width.

17. The external system of claim 16, wherein the user interface comprises a threshold input device to receive the predetermined threshold QRS width.

18. The external system of claim 17, wherein the user interface further comprises a programming input device receiving commands and therapy parameters for programming the implantable medical device.

19. The external system of claim 17, wherein the one or more presentation devices comprise a screen, and the wide-QRS indicator comprises an image generator to produce a visual indication of the detection of the wide QRS complex to present on the screen.

20. The external system of claim 17, wherein the one or more presentation devices further comprise a printer, and the wide-QRS indicator comprises a message generator to produce a message indicative of the detection of the wide QRS complex to print using the printer.

21. The external system of claim 20, comprising an external device communicatively coupled to the implantable medical device via the telemetry, a remote device, and a telecommunication network coupled between the external device and the remote device.

22. The external system of claim 21, wherein the remote device comprises at least one of the one or more presentation devices.

23. A method for operating a medical device programmer communicating with an implantable medical device, the method comprising:

sensing a surface electrocardiogram (ECG) signal using a surface ECG sensing circuit of the medical device programmer;

measuring a QRS width from the surface ECG signal;

detecting a wide QRS complex by comparing the measured QRS width to a predetermined threshold QRS width; and

presenting a visual indication including text directly indicating a detection of the wide QRS complex using a presentation device of the medical device programmer in response to the detection of the wide QRS complex.

24. The method of claim 23, wherein presenting the visual indication comprises presenting the visual indication of the detection of the wide QRS complex on a display screen of the medical device programmer.

25. The method of claim 23, wherein presenting the visual indication comprises printing a message indicative of the detection of the wide QRS complex using a printer of the medical device programmer.

26. The method of claim 23, further comprising receiving the predetermined threshold QRS width through a user input device of the external system.

27. The method of claim 26, further comprising programming the implantable medical device using the medical device programmer before measuring the QRS width.

28. The method of claim 27, wherein programming the implantable medical device comprises programming the implantable medical device to start delivering pacing pulses.

29. The method of claim 27, wherein programming the implantable medical device comprises programming the implantable medical device to stop delivering pacing pulses.

30. The method of claim 27, wherein programming the implantable medical device comprises programming the implantable medical device to adjust one or more pacing parameters.

31. A method for operating an external system communicating with an implantable medical device coupled to implantable electrodes, the method comprising:

receiving a wireless electrocardiogram (ECG) signal from the implantable medical device, the wireless ECG signal being a signal sensed through the implantable electrodes and approximating a surface ECG signal;

measuring a QRS width from the wireless ECG signal;

detecting a wide QRS complex by comparing the QRS width to a predetermined threshold QRS width; and

presenting a visual indication of a detection of the wide QRS complex including text directly indicating the detection of wide QRS complex using a presentation device of the external system in response to the detection of the wide QRS complex.

32. The method of claim 31, wherein presenting the visual indication of the detection of the wide QRS complex comprises presenting the visual indication of the detection of the wide QRS complex on a display screen of the external system.

33. The method of claim 31, wherein presenting the visual indication of the detection of the wide QRS complex comprises printing a message indicative of the detection of the wide QRS complex using a printer of the external system.

34. The method of claim 31, further comprising receiving the predetermined threshold QRS width through a user input device of the external system.

35. The method of claim 34, further comprising programming the implantable medical device to adjust a delivery of pacing pulses in response to the detection of the wide QRS complex.