Arrhythmia discrimination based on determination of rate dependency

• US 7,653,431 B2
• Filed: 12/20/2005
• Issued: 01/26/2010
• Est. Priority Date: 12/20/2005
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Cazares, Shelley, Kim, Jaeho, Lin, Yayun, Ricci, Carlos
• Primary Examiner(s): Evanisko; George R
• Assistant Examiner(s): HAYES, ANDREW L
• Application Number:
  US11/312,280
• Publication Number:
  US 20070142737A1
• Time in Patent Office: 1,498 Days
• Field of Search: None
• US Class Current: 600/515
• CPC Class Codes: A61B 5/35 by template matching
• CPC Class Codes: A61B 5/363 Detecting tachycardia or bradycardia
• CPC Class Codes: A61B 5/7264 Classification of physiological signals or data, e.g. using neural networks, statistical classifiers, expert systems or fuzzy systems neural networks per se G06N3/00; expert systems per se G06N5/00
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

Cardiac systems and methods provide for discriminating between supraventricular tachyarrhythmia and ventricular tachyarrhythmia based on a determination that the patient'"'"'s supraventricular rhythm exhibits rate dependency. One approach involves determining if a patient'"'"'s supraventricular rhythm exhibits rate dependent morphology. If the patient'"'"'s supraventricular rhythm is determined to exhibit rate dependent morphology, an implantable device classifies a detected tachyarrhythmia episode based on one or more templates selected from a plurality of rate-indexed templates stored in the device. Determining if the supraventricular rhythm exhibits rate dependent morphology may also include determining one or more rates at which the rate dependent morphology occurs.

Claims

1. A method of discriminating between supraventricular and ventricular tachyarrhythmia, comprising:

obtaining a plurality of cardiac templates from supraventricular cardiac waveforms and associating the plurality of cardiac templates with a plurality of cardiac rates to provide a plurality of rate-indexed templates;

detecting a tachyarrhythmia episode of a patient;

determining an episode cardiac rate for the detected tachyarrhythmia episode;

identifying a closest cardiac rate from the plurality of cardiac rates that is closest to the episode cardiac rate;

initially selecting from the plurality of rate-indexed templates an initial template associated with the closest cardiac rate;

classifying the tachyarrhythmia episode as supraventricular tachyarrhythmia or ventricular tachyarrhythmia based on one or more templates selected from the plurality of rate-indexed templates, staffing with the initial template;

creating supraventricular tachyarrhythmia in the patient by atrial pacing at multiple pacing rates;

sensing cardiac waveforms during the created supraventricular tachyarrhythmia; and

determining if the patient'"'"'s supraventricular rhythm exhibits rate dependent morphology based on morphologies of the cardiac waveforms.

2. The method of claim 1, wherein the atrial pacing is delivered at progressively higher rates.

3. The method of claim 1, wherein the atrial pacing is delivered in accordance with an automated atrial pacing pattern.

4. A method of discriminating between supraventricular and ventricular tachyarrhythmia, comprising:

obtaining a plurality of cardiac templates from supraventricular cardiac waveforms and associating the plurality of cardiac templates with a plurality of cardiac rates to provide a plurality of rate-indexed templates;

detecting a tachyarrhythmia episode of a patient;

determining an episode cardiac rate for the detected tachyarrhythmia episode;

identifying a closest cardiac rate from the plurality of cardiac rates that is closest to the episode cardiac rate;

initially selecting from the plurality of rate-indexed templates an initial template associated with the closest cardiac rate;

classifying the tachyarrhythmia episode as supraventricular tachyarrhythmia or ventricular tachyarrhythmia based on one or more templates selected from the plurality of rate-indexed templates, staffing with the initial template;

creating supraventricular tachyarrhythmia by altering patient activity under controlled conditions;

sensing cardiac waveforms during the created supraventricular tachyarrhythmia; and

determining if the supraventricular rhythm exhibits rate dependent morphology based on the morphologies of the sensed cardiac waveforms.

5. A method of discriminating between supraventricular and ventricular tachyarrhythmia, comprising:

obtaining a plurality of cardiac templates from supraventricular cardiac waveforms and associating the plurality of cardiac templates with a plurality of cardiac rates to provide a plurality of rate-indexed templates;

detecting a tachyarrhythmia episode of a patient;

determining an episode cardiac rate for the detected tachyarrhythmia episode;

identifying a closest cardiac rate from the plurality of cardiac rates that is closest to the episode cardiac rate;

initially selecting from the plurality of rate-indexed templates an initial template associated with the closest cardiac rate;

classifying the tachyarrhythmia episode as supraventricular tachyarrhythmia or ventricular tachyarrhythmia based on one or more templates selected from the plurality of rate-indexed templates, staffing with the initial template;

creating supraventricular tachyarrhythmia by administration of drugs to the patient;

sensing cardiac waveforms during the created supraventricular tachyarrhythmia; and

determining if the supraventricular rhythm exhibits rate dependent morphology based on morphologies of the sensed cardiac waveforms.

6. A method of discriminating between supraventricular and ventricular tachyarrhythmia, comprising:

obtaining a plurality of cardiac templates from supraventricular cardiac waveforms and associating the plurality of cardiac templates with a plurality of cardiac rates to provide a plurality of rate-indexed templates;

detecting a tachyarrhythmia episode of a patient;

determining an episode cardiac rate for the detected tachyarrhythmia episode;

identifying a closest cardiac rate from the plurality of cardiac rates that is closest to the episode cardiac rate;

initially selecting from the plurality of rate-indexed templates an initial template associated with the closest cardiac rate;

classifying the tachyarrhythmia episode as supraventricular tachyarrhythmia or ventricular tachyarrhythmia based on one or more templates selected from the plurality of rate-indexed templates, staffing with the initial template, the classifying being carried out by an implantable cardiac device; and

determining one or more rates at which a change in morphology of the patient'"'"'s supraventricular cardiac rhythm occurs.

7. A method of discriminating between supraventricular and ventricular tachyarrhythmia, comprising:

obtaining a plurality of cardiac templates from supraventricular cardiac waveforms and associating the plurality of cardiac templates with a plurality of cardiac rates to provide a plurality of rate-indexed templates;

detecting a tachyarrhythmia episode of a patient;

determining an episode cardiac rate for the detected tachyarrhythmia episode;

identifying a closest cardiac rate from the plurality of cardiac rates that is closest to the episode cardiac rate;

initially selecting from the plurality of rate-indexed templates an initial template associated with the closest cardiac rate; and

classifying the tachyarrhythmia episode based on one or more templates selected from the plurality of rate-indexed templates, staffing with the initial template, the classifying being carried out by an implantable cardiac device;

wherein the obtaining comprises interpolating between at least two of the templates and forming the initial template based on the interpolation.

8. A medical system, comprising:

a lead system comprising cardiac electrodes configured to sense cardiac waveforms;

a template generator configured to form a plurality of rate-indexed templates characterizing cardiac waveforms sensed during supraventricular tachyarrhythmia, the rate-indexed templates comprising a plurality of cardiac templates associated with a plurality of cardiac rates;

an arrhythmia classification processor configured to detect a tachyarrhythmia episode and a corresponding cardiac rate from the sensed cardiac waveforms, the classification processor further being configured to;

identify a closest cardiac rate from the plurality of cardiac rates that is closest to the detected cardiac rate;

initially select from the plurality of rate-indexed templates an initial template associated with the closest cardiac rate; and

classify the detected tachyarrhythmia episode using one or more templates selected from the plurality of rate-indexed templates, starting with the initial template;

a cardiac pacing circuit configured to create the supraventricular tachyarrhythmia through atrial pacing; and

a control system configured to determine if the supraventricular rhythm exhibits rate dependent morphology based on the cardiac waveforms sensed during the created supraventricular tachyarrhythmia and to form the plurality of rate-indexed templates using the cardiac waveforms sensed during the supraventricular tachyarrhythmia.

9. The medical system of claim 8, wherein the atrial pacing is delivered at progressively higher rates.

10. The medical system of claim 8, further comprising an automated atrial pacing pattern, and wherein the atrial pacing is delivered in accordance with the automated atrial pacing pattern.

11. A medical system, comprising:

means for forming rate indexed templates characterizing cardiac waveforms sensed during created supraventricular tachyarrhythmia, the rate-indexed templates comprising a plurality of cardiac templates associated with a plurality of cardiac rates;

means for detecting a tachyarrhythmia episode and a corresponding cardiac rate;

means for identifying a closest cardiac rate from the plurality of cardiac rates that is closest to the detected cardiac rate;

means for classifying the cardiac rhythms using selected ones of the rate indexed templates, starting with an initial template from the rate-indexed templates associated with the closest cardiac rate; and

means for creating the supraventricular tachyarrhythmia through atrial pacing.

12. A medical system, comprising:

means for forming rate indexed templates characterizing cardiac waveforms sensed during created supraventricular tachyarrhythmia, the rate-indexed templates comprising a plurality of cardiac templates associated with a plurality of cardiac rates;

means for detecting a tachyarrhythmia episode and a corresponding cardiac rate;

means for identifying a closest cardiac rate from the plurality of cardiac rates that is closest to the detected cardiac rate;

means for classifying the cardiac rhythms using selected ones of the rate indexed templates, starting with an initial template from the rate-indexed templates associated with the closest cardiac rate; and

means for determining if the rate-indexed templates exhibit rate dependent morphology between themselves.