Monitoring short term fluctuations in PR intervals following premature ventricular contractions

• US 7,702,391 B1
• Filed: 11/01/2005
• Issued: 04/20/2010
• Est. Priority Date: 02/17/2005
• Status: Expired due to Fees

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories)
• Inventors: Farazi, Taraneh Ghaffari, Park, Euljoon
• Primary Examiner(s): Layno; Carl H
• Assistant Examiner(s): SARCIONE, JESSICA LYNN
• Application Number:
  US11/265,704
• Time in Patent Office: 1,631 Days
• Field of Search: 607 17- 18, 607/9, 607 25- 26
• US Class Current: 607/25
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/36 Detecting PQ interval, PR interval or QT interval
• CPC Class Codes: A61B 5/7275 Determining trends in physiological measurement data; Predicting development of a medical condition based on physiological measurements, e.g. determining a risk factor
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: G16H 40/63 for local operation
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment

Abstract

Implantable systems, and methods for use therein, perform at least one of a cardiac assessment and an autonomic assessment. Short-term fluctuations in PR intervals, that follow the premature contractions in the ventricles, are monitored. At least one of a cardiac assessment and an autonomic assessment is performed based on the monitored fluctuations in PR intervals that follow the premature contractions in the ventricles. This can include assessing a patient'"'"'s risk of sudden cardiac death (SCD), assessing a patient'"'"'s autonomic tone and/or detecting myocardial ischemic events based on the monitored fluctuations in PR intervals that follow the premature contractions in the ventricles.

Claims

1. For use with an implantable system, a method of performing at least one of a cardiac assessment and an autonomic assessment, comprising:

(a) monitoring short-term fluctuations in PR intervals that follow a premature ventricular contraction; and

(b) performing, using a processor of the implantable system, at least one of a cardiac assessment and an autonomic assessment, based on the monitored fluctuations in PR intervals that follow the premature ventricular contraction.

2. The method of claim 1, wherein step (b) comprises assessing a patient'"'"'s risk of sudden cardiac death (SCD) based on the monitored fluctuations in PR intervals that follow the premature ventricular contraction.

3. The method of claim 1, wherein step (b) comprises assessing a patient'"'"'s autonomic tone based on the monitored fluctuations in PR intervals that follow the premature ventricular contraction.

4. The method of claim 3, wherein step (b) includes at least one of the following:

recognizing a reduction in fluctuations in PR intervals as being indicative of a reduction in parasympathetic tone;

recognizing a reduction in fluctuations in PR intervals as being indicative of an increase in sympathetic tone;

recognizing an increase in fluctuations in PR intervals as being indicative of an increase in parasympathetic tone; and

recognizing an increase in fluctuations in PR intervals as being indicative of a decrease in sympathetic tone.

5. The method of claim 1, wherein step (b) comprises detecting a myocardial ischemic event based on the monitored fluctuations in PR intervals that follow the premature ventricular contraction.

6. The method of claim 5, wherein step (b) comprises detecting a myocardial ischemic event by detecting a temporary blunting of the monitored fluctuations in PR intervals that follow the premature ventricular contraction.

7. The method of claim 1, wherein step (b) comprises assessing a patient'"'"'s risk of sudden cardiac death (SCD) based on the monitored fluctuations in PR intervals that follow the premature ventricular contraction;

and further comprising alerting at least one of a patient and a medical practitioner in response to assessing a high risk of SCD.

8. The method of claim 1, wherein step (b) comprises assessing a patient'"'"'s risk of sudden cardiac death (SCD) based on the monitored fluctuations in PR intervals that follow the premature ventricular contraction;

and further comprising triggering cardiac therapy in response to assessing a high risk of SCD.

9. The method of claim 1, wherein the premature ventricular contraction can be intrinsic, induced or simulated.

10. The method of claim 1, wherein step (a) includes monitoring PR intervals that both precede and follow the premature ventricular contraction, such that PR intervals that precede the premature ventricular contraction can be used in calculating the short-term fluctuations in PR intervals that follow the premature ventricular contraction.

11. The method of claim 1, wherein step (a) includes monitoring short-term fluctuations in PR intervals within beats that follow the premature ventricular contraction.

12. For use with an implantable system, a method of performing at least one of a cardiac assessment and an autonomic assessment, comprising:

(a) monitoring short-term fluctuations in PR intervals the follow each of a plurality of premature ventricular contractions; and

(b) performing, using a processor of the implantable system, the at least one of a cardiac assessment and an autonomic assessment based on the monitored short-term fluctuations in PR intervals the follow the premature ventricular contractions.

13. The method of claim 12, wherein the premature ventricular contractions can be intrinsic, induced or simulated, or combinations thereof.

14. The method of claim 12, wherein a separate assessment is performed at step (b) for each of the premature ventricular contractions.

15. The method of claim 12, wherein a single assessment is performed at step (b) for multiple premature ventricular contractions.

16. The method of claim 12, wherein:

step (a) includes determining a degree of the short-term fluctuations in PR intervals that follow each of the premature ventricular contractions; and

step (b) includes identifying periods, when the determined degree crosses a corresponding threshold in a specified direction, as myocardial ischemic events.

17. The method of claim 16, further comprising:

(c) assessing a patient'"'"'s ischemic burden based on a myocardial ischemic event detected at step (b).

18. The method of claim 12, wherein:

step (a) includes determining a degree of the short-term fluctuations in PR intervals that follow each of the premature ventricular contractions; and

step (b) includes identifying periods, when the determined degree deviates from a baseline by more than a threshold, as periods of myocardial ischemic events.

19. The method of claim 18, further comprising:

(c) assessing a patient'"'"'s ischemic burden based on myocardial ischemic events detected at step (b).

20. The method of claim 12, wherein step (b) comprises assessing a patient'"'"'s risk of sudden cardiac death (SCD) based on the monitored fluctuations in PR intervals that follow the premature ventricular contractions.

21. The method of claim 20, further comprising:

(c) comparing a recently determined risk of SCD to a previously determined risk of SCD to determine whether there has been an increase or a decrease in risk of SCD.

22. The method of claim 20, further comprising:

(c) comparing a recently determined risk of SCD to a previously determined risk of SCD to determine whether there is an imminent risk of an arrhythmia.

23. The method of claim 12, wherein step (b) comprises assessing a patient'"'"'s autonomic tone based on the monitored fluctuations in PR intervals that follow the premature ventricular contractions.

24. An implantable system for performing at least one of a cardiac assessment and an autonomic assessment, comprising:

means for monitoring short-term fluctuations in PR intervals that follow premature ventricular contractions; and

means for performing at least one of a cardiac assessment and an autonomic assessment, based on the monitored fluctuations in PR intervals.

25. The system of claim 24, wherein the means for performing assesses a patient'"'"'s risk of sudden cardiac death (SCD) based on the monitored fluctuations in PR intervals.

26. The system of claim 24, wherein the means for performing assesses a patient'"'"'s autonomic tone based on the monitored fluctuations in PR intervals.

27. The system of claim 24, wherein the means for performing detects myocardial ischemic events based on the monitored fluctuations in PR intervals.

28. The system of claim 24, wherein the means for monitoring monitors PR intervals that both precede and follow each premature ventricular contraction, such that PR intervals that precede the premature ventricular contraction can be used in calculating the short-term fluctuations in PR intervals that follow the premature ventricular contraction.