Method for discriminating between ventricular and supraventricular arrhythmias
First Claim
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1. A method for discriminating between cardiac rhythms of a patient'"'"'s heart which are appropriate for therapy, the method comprising:
- receiving a cardiac complex using implanted electrodes;
obtaining a cardiac rate using the cardiac complex;
determining whether the cardiac rate;
exceeds a first threshold but does not exceed a second threshold;
or;
exceeds the second threshold;
and;
if the cardiac rate exceeds the second threshold, directing therapy to the heart;
orif the cardiac rate exceeds the first threshold but does not exceed the second threshold, directing further analysis of the cardiac complex to determine whether therapy is indicated;
wherein the further analysis includes a determination of whether the cardiac rate accelerated significantly.
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Abstract
The present invention is directed toward a detection architecture for use in implantable cardiac rhythm devices. The detection architecture of the present invention provides methods and devices for discriminating between arrhythmias. Moreover, by exploiting the enhanced specificity in the origin of the identified arrhythmia, the detection architecture can better discriminate between rhythms appropriate for device therapy and those that are not.
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Citations
56 Claims
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1. A method for discriminating between cardiac rhythms of a patient'"'"'s heart which are appropriate for therapy, the method comprising:
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receiving a cardiac complex using implanted electrodes; obtaining a cardiac rate using the cardiac complex; determining whether the cardiac rate; exceeds a first threshold but does not exceed a second threshold;
or;exceeds the second threshold; and; if the cardiac rate exceeds the second threshold, directing therapy to the heart;
orif the cardiac rate exceeds the first threshold but does not exceed the second threshold, directing further analysis of the cardiac complex to determine whether therapy is indicated; wherein the further analysis includes a determination of whether the cardiac rate accelerated significantly. - View Dependent Claims (2, 3, 4, 5, 6, 7, 10)
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8. A method for discriminating between cardiac rhythms of a patient'"'"'s heart which are appropriate for therapy, the method comprising:
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receiving a cardiac complex using implanted electrodes; obtaining a cardiac rate using the cardiac complex; determining whether the cardiac rate; exceeds a first threshold but does not exceed a second threshold or; exceeds the second threshold; and; if the cardiac rate exceeds the second threshold, directing therapy to the heart;
orif the cardiac rate exceeds the first threshold but does not exceed the second threshold, directing further analysis of the cardiac complex to determine whether therapy is indicated;
wherein the further analysis includes a determination of the interval rate stability between cardiac complexes. - View Dependent Claims (9)
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11. A method of signal analysis comprising:
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receiving a first cardiac complex from a first implanted electrode pair disposed to capture electrical information related to ventricular activity along a first sensing vector; receiving a second cardiac complex from a second implanted electrode pair disposed to capture electrical information related to ventricular activity along a second sensing vector; generating a first metric related to the first cardiac complex; generating a second metric related to the second cardiac complex; and comparing the first metric to the second metric to determine whether a ventricular originating arrhythmia is occurring; wherein the first sensing vector and the second sensing vector are placed at an angle of greater than 45 degrees with respect to one another. - View Dependent Claims (12, 13, 14)
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15. A method of discriminating between cardiac rhythms comprising:
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receiving a cardiac complex from implanted electrodes; obtaining a beat rate and determining whether an arrhythmia is likely; and
, if so;(a) analyzing the cardiac complex using a first mathematical determination to yield a first result, and comparing the first result to a first threshold to yield a first Boolean value; (b) analyzing the cardiac complex using a second mathematical determination to yield a second result, and comparing the second result to a second threshold to yield a second Boolean value; and (c) performing a first Boolean logic function using at least one of the first Boolean value and the second Boolean value to determine whether therapy is needed. - View Dependent Claims (16, 17, 18, 19, 20, 21)
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22. A method of discriminating between cardiac rhythms comprising:
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receiving a cardiac complex from implanted electrodes; obtaining a cardiac rate and determining whether an arrhythmia is likely; and
, if so;(a) analyzing the cardiac complex using a first metric to determine whether a malignant arrhythmia is occurring and, if so, determining that therapy is indicated; (b) if not, then analyzing the cardiac complex using a second metric to determine whether a malignant arrhythmia is occurring and, if so, determining that treatment is indicated; wherein; the first metric is a comparison of the cardiac complex width to a threshold wherein, if the width is greater than the threshold value it is determined that a malignant arrhythmia is occurring; and the second metric is a comparison of the correlation of the cardiac complex and a template to the correlation of a number of recent cardiac complexes to the template to yield a variability, wherein if the variability is high then it is determined that a malignant arrhythmia is occurring. - View Dependent Claims (23, 24)
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25. An implantable cardioverter/defibrillator comprising:
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a lead electrode assembly including a number of electrodes; and a canister housing operational circuitry; wherein; the lead electrode assembly is coupled to the canister; and the operational circuitry is configured to perform steps for discriminating between cardiac rhythms of a patient'"'"'s heart which are appropriate for therapy, the steps including; receiving a cardiac complex using the lead electrode assembly; obtaining a cardiac rate using the cardiac complex; determining whether the cardiac rate; exceeds a first threshold but does not exceed a second threshold;
or;exceeds the second threshold; and
;if the cardiac rate exceeds the second threshold, directing therapy to the heart;
orif the cardiac rate exceeds the first threshold but does not exceed the second threshold, directing further analysis of the cardiac complex to determine whether therapy is indicated; wherein the operational circuitry is configured such that the further analysis includes a determination of the interval rate stability between cardiac complexes. - View Dependent Claims (26, 27, 28, 29, 30, 31)
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32. An implantable cardioverter/defibrillator comprising:
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a lead electrode assembly including a number of electrodes; and a canister housing operational circuitry; wherein; the lead electrode assembly is coupled to the canister; and the operational circuitry is configured to perform steps for discriminating between cardiac rhythms of a patient'"'"'s heart which are appropriate for therapy, the steps including; receiving a cardiac complex using the lead electrode assembly; obtaining a cardiac rate using the cardiac complex; determining whether the cardiac rate; exceeds a first threshold but does not exceed a second threshold;
or;exceeds the second threshold; and
;if the cardiac rate exceeds the second threshold, directing therapy to the heart;
orif the cardiac rate exceeds the first threshold but does not exceed the second threshold, directing further analysis of the cardiac complex to determine whether therapy is indicated; wherein the operational circuitry is configured such that the further analysis includes a determination of whether the cardiac rate accelerated significantly. - View Dependent Claims (33)
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34. An implantable cardioverter/defibrillator comprising:
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a lead electrode assembly including a number of electrodes; and a canister housing operational circuitry; wherein; the lead electrode assembly is coupled to the canister; and the operational circuitry is configured to perform steps for discriminating between cardiac rhythms of a patient'"'"'s heart which are appropriate for therapy, the steps including; receiving a cardiac complex using at least one electrode on the lead electrode assembly; analyzing the cardiac complex to determine whether a patient is likely experiencing an arrhythmia; and comparing a portion of the cardiac complex to a template by performing a mathematical calculation between the cardiac complex and the template; wherein the comparing step is performed only if it is determined that the patient is likely experiencing an arrhythmia; and
the operational circuitry is configured to further perform the step of selecting a template for use in the comparison step in response to an observed event occurring prior to the receipt of the cardiac complex.- View Dependent Claims (35, 36, 37, 38)
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39. An implantable cardioverter/defibrillator comprising:
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a lead electrode assembly including a number of electrodes; and a canister housing operational circuitry;
wherein;the lead electrode assembly is coupled to the canister; and the operational circuitry is configured to perform steps for discriminating between cardiac rhythms of a patient'"'"'s heart which are appropriate for therapy, the steps including; receiving a cardiac complex using at least one electrode on the lead electrode assembly; analyzing the cardiac complex to determine whether a patient is likely experiencing an arrhythmia; and comparing a portion of the cardiac complex to a template by performing a mathematical calculation between the cardiac complex and the template; wherein the comparing step is performed only if it is determined that the patient is likely experiencing an arrhythmia, and the step of receiving a cardiac complex from an implanted electrode pair includes; receiving a first electrical signal from a first combination of electrodes; receiving a second electrical signal from a second combination of electrodes; comparing the first electrical signal to the second electrical signal to determine which electrical signal is more amenable to data analysis; and using the electrical signal that is more amenable to data analysis as the cardiac complex for comparison with the template. - View Dependent Claims (40)
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41. An implantable cardioverter/defibrillator comprising:
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a lead electrode assembly including a number of electrodes; and a canister housing operational circuitry; wherein; the lead electrode assembly is coupled to the canister; the operational circuitry is configured to perform steps for discriminating between cardiac rhythms of a patient'"'"'s heart which are appropriate for therapy, the steps including; receiving a first cardiac complex from a first implanted electrode pair disposed to capture electrical information related to ventricular activity along a first sensing vector; receiving a second cardiac complex from a second implanted electrode pair disposed to capture electrical information related to ventricular activity along a second sensing vector; generating a first metric related to the first cardiac complex; generating a second metric related to the second cardiac complex; and comparing the first metric to the second metric to determine whether a ventricular originating arrhythmia is occurring; and the lead electrode assembly is configured to enable the first sensing vector and the second sensing vector to be placed at an angle of greater than 45 degrees with respect to one another. - View Dependent Claims (42, 43)
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44. An implantable cardioverter/defibrillator comprising:
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a lead electrode assembly including a number of electrodes; and a canister housing operational circuitry; wherein; the lead electrode assembly is coupled to the canister; and the operational circuitry is configured to perform steps for discriminating between cardiac rhythms of a patient'"'"'s heart which are appropriate for therapy, the steps including; receiving a cardiac complex from implanted electrodes; obtaining a beat rate and determining whether an arrhythmia is likely; and
, if so;(a) analyzing the cardiac complex using a first mathematical determination to yield a first result, and comparing the first result to a first threshold to yield a first Boolean value; (b) analyzing the cardiac complex using a second mathematical determination to yield a second result, and comparing the second result to a second threshold to yield a second Boolean value; (c) performing a first Boolean logic function using at least one of the first Boolean value and the second Boolean value to determine whether therapy is needed. - View Dependent Claims (45, 46, 47, 48, 49, 50)
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51. An implantable cardioverter/defibrillator comprising:
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a lead electrode assembly including a number of electrodes; and a canister housing operational circuitry;
wherein;the lead electrode assembly is coupled to the canister; and the operational circuitry is configured to perform steps for discriminating between cardiac rhythms of a patient'"'"'s heart which are appropriate for therapy, the steps including; receiving a cardiac complex from implanted electrodes; obtaining a beat rate and determining whether an arrhythmia is likely; and
, if so, analyzing the cardiac complex using a first metric to determine whether a malignant arrhythmia is occurring and;if so, determining that therapy is indicated; if not, analyzing the cardiac complex using a second metric to determine whether a malignant arrhythmia is occurring and, if so, determining that treatment is indicated;
wherein the operational circuitry is configured such that the first metric is a comparison of the cardiac complex width to a threshold wherein, if the width is greater than the threshold value it is determined that a malignant arrhythmia is occurring, and the second metric is a comparison of the correlation of the cardiac complex and a template to the correlation of a number of recent cardiac complexes to the template to yield a variability, wherein if the variability is high then it is determined that a malignant arrhythmia is occurring. - View Dependent Claims (52, 53)
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54. An implantable cardioverter/defibrillator comprising:
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a lead electrode assembly including a number of electrodes; and a canister housing operational circuitry;
wherein;the lead electrode assembly is coupled to the canister; and the operational circuitry is configured to perform steps for discriminating between cardiac rhythms of a patient'"'"'s heart which are appropriate for therapy, the steps including; receiving a cardiac complex from implanted electrodes; obtaining a beat rate and determining whether an arrhythmia is likely; and
, if so, analyzing the cardiac complex using a first metric to determine whether a malignant arrhythmia is occurring and;if so, determining that therapy is indicated; if not, analyzing the cardiac complex using a second metric to determine whether a malignant arrhythmia is occurring and, if so, determining that treatment is indicated;
wherein the operational circuitry is configured such that the first metric is a comparison of a threshold to a correlation between the cardiac complex and a template wherein, if the correlation is low, then it is determined that a malignant arrhythmia is occurring, and the second metric is a determination of the variability of the correlation between the cardiac complex and the template to correlations between recent cardiac complexes and the template wherein, if the variability is high, then it is determined that a malignant arrhythmia is occurring. - View Dependent Claims (55, 56)
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Specification