Method and apparatus for detecting arrhythmias in a medical device

• US 7,734,333 B2
• Filed: 04/28/2006
• Issued: 06/08/2010
• Est. Priority Date: 03/29/2006
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Ghanem, Raja N., Stadler, Robert W., Zhang, Xusheng
• Primary Examiner(s): Layno; Carl H
• Assistant Examiner(s): Behringer; Luther G
• Application Number:
  US11/380,815
• Publication Number:
  US 20070239045A1
• Time in Patent Office: 1,502 Days
• Field of Search: 600/301, 600508-510, 600/515, 600/518, 600/521, 600/512, 607/5, 607/27, 607/28, 607/60, 128901-902
• US Class Current: 600/512
• CPC Class Codes: A61B 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 5/341 Vectorcardiography [VCG]
• CPC Class Codes: A61B 5/352 Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval
• CPC Class Codes: A61B 5/361 Detecting fibrillation
• CPC Class Codes: A61B 5/363 Detecting tachycardia or bradycardia
• CPC Class Codes: A61B 5/364 Detecting abnormal ECG interval, e.g. extrasystoles, ectopic heartbeats
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61B 5/686 Permanently implanted devices, e.g. pacemakers, other stimulators, biochips A61B5/6861 takes precedence
• CPC Class Codes: A61B 5/7203 for noise prevention, reduction or removal
• CPC Class Codes: A61B 5/7221 Determining signal validity, reliability or quality A61B5/7207 and A61B5/7217 take precedence
• CPC Class Codes: A61B 5/7239 using differentiation including higher order derivatives
• CPC Class Codes: A61N 1/05 for implantation or insertion into the body, e.g. heart electrode A61N1/06 takes precedence
• CPC Class Codes: A61N 1/3621 for treating or preventing abnormally high heart rate
• CPC Class Codes: A61N 1/3925 Monitoring; Protecting
• CPC Class Codes: A61N 1/3956 Implantable devices for applying electric shocks to the heart, e.g. for cardioversion
• CPC Class Codes: A61N 1/3987 characterised by the timing or triggering of the shock
• CPC Class Codes: Y10S 128/901 Suppression of noise in electric signal
• CPC Class Codes: Y10S 128/902 Biological signal amplifier

Abstract

A method of detecting a cardiac event in a medical device that includes sensing a cardiac signal from a plurality of electrodes, determining amplitudes of the sensed cardiac signal during a predetermined sensing window, determining a noise to signal ratio corresponding to the determined amplitudes, and determining the sensed cardiac signal during the predetermined sensing window is corrupted by noise in response to the determined noise to signal ratio being greater than a noise to signal ratio threshold.

Claims

1. A method of detecting a cardiac event in a medical device, comprising:

sensing a cardiac signal from a plurality of electrodes, the plurality of electrodes forming a first sensing vector and a second sensing vector different from the first sensing vector;

determining first amplitudes of the sensed cardiac signal sensed along the first sensing vector during a predetermined sensing window;

determining second amplitudes of the sensed cardiac signal sensed along the second sensing vector during the predetermined sensing window;

determining a first noise to signal ratio corresponding to the determined first amplitudes;

determining a second noise to signal ratio corresponding to the determined second amplitudes;

comparing the first noise to signal ratio to a noise to signal ratio threshold;

identifying the first sensing vector as noisy in response to the comparing the first noise to signal ratio to the noise to signal ratio threshold;

comparing the second noise to signal ratio to the noise to signal threshold;

identifying the second sensing vector as noisy in response to the comparing the second noise to signal ratio to the noise to signal threshold; and

delivering therapy in response to the identifying.

2. The method of claim 1, wherein determining a first noise to signal ratio and a second noise to signal ratio comprises determining a ratio of a highpass mean rectified amplitude corresponding to the sensed cardiac signal during the predetermined sensing window to a lowpass mean rectified amplitude corresponding to the sensed cardiac signal during the predetermined sensing window.

3. The method of claim 2, further comprising:

determining an average of absolute values of lowpass sample amplitudes corresponding to the determined amplitudes as the lowpass mean rectified amplitude;

determining an average of absolute values of the determined amplitudes to generate a raw mean rectified amplitude; and

determining a difference between the raw mean rectified amplitude and the lowpass mean rectified amplitude as the highpass mean rectified amplitude.

4. The method of claim 1, further comprising:

determining a first metric of signal energy content associated with the sensed cardiac signal sensed along the first sensing vector during the predetermined sensing window;

determining a second metric of signal energy content associated with the sensed cardiac signal sensed along the second sensing vector during the predetermined sensing window; and

determining the sensed cardiac signal during the predetermined sensing window is corrupted by noise in response to one of the first metric of signal energy content and the second metric of signal energy content being greater than a first signal energy content threshold corresponding to a value greater than a signal energy content associated with the detected cardiac event.

5. The method of claim 1, further comprising:

determining a first metric of signal energy content associated with the sensed cardiac signal sensed along the first sensing vector during the predetermined sensing window;

determining a second metric of signal energy content associated with the sensed cardiac signal sensed along the second sensing vector during the predetermined sensing window; and

determining the sensed cardiac signal during the predetermined sensing window is corrupted by noise in response to one of the first metric of signal energy content and the second metric of signal content being one of greater than a first signal energy content threshold and less than a second signal energy content threshold, the first signal energy content threshold corresponding to a value greater than a signal energy content associated with the detected cardiac event and the second signal energy content threshold corresponding to asystole episodes.

6. The method of claim 5, wherein the first signal energy content threshold is approximately 0.013 mV and the second signal energy content threshold is approximately 1.5 mV.

7. The method of claim 5, wherein the metric of signal energy content corresponds to a mean rectified amplitude associated with the determined amplitudes during the predetermined sensing window.

8. The method of claim 1, wherein the noise to signal ratio threshold is 0.0703.

9. The method of claim 1, wherein the plurality of electrodes are positioned non-intravenously.

10. The method of claim 1, wherein the first signal energy content threshold is approximately 0.013 mV.

11. A method of detecting a cardiac event in a medical device, comprising:

sensing a cardiac signal from a plurality of electrodes, the plurality of electrodes forming a first sensing vector and a second sensing vector different from the first sensing vector;

determining amplitudes of the sensed cardiac signal during a predetermined sensing window for each of the first sensing vector and the second sensing vector;

determining a first noise to signal ratio associated with the first sensing vector and a second noise to signal ratio associated with the second sensing vector corresponding to the determined amplitudes as a ratio of a highpass mean rectified amplitude corresponding to the sensed cardiac signal during the predetermined sensing window to a lowpass mean rectified amplitude corresponding to the sensed cardiac signal during the predetermined sensing window;

comparing the first noise to signal ratio and the second noise to signal ratio to a noise to signal ratio threshold;

determining a first metric of signal energy content associated with the sensed cardiac signal during the predetermined sensing window for the first sensing vector;

determining a second metric of signal energy content associated with the sensed cardiac signal during the predetermined sensing window for the second sensing vector;

comparing the first metric of signal energy content and the second metric of signal energy content to a first signal energy content threshold and a second signal energy content threshold, the first signal energy content threshold corresponding to a value greater than a signal energy content associated with the detected cardiac event and the second signal energy content threshold corresponding to asystole episodes; and

identifying the detected cardiac event as a shockable event in response to the comparing.

12. The method of claim 11, further comprising:

determining an average of absolute values of lowpass sample amplitudes corresponding to the determined amplitudes as the lowpass mean rectified amplitude;

determining an average of absolute values of the determined amplitudes to generate a raw mean rectified amplitude; and

determining a difference between the raw mean rectified amplitude and the lowpass mean rectified amplitude as the highpass mean rectified amplitude.

13. The method of claim 12, wherein the metric of signal energy content corresponds to a mean rectified amplitude associated with the determined amplitudes during the predetermined sensing window.

14. A non-transitory computer readable medium having computer executable instructions for performing a method comprising:

sensing a cardiac signal from a plurality of electrodes, the plurality of electrodes forming a first sensing vector and a second sensing vector different from the first sensing vector;

determining first amplitudes of the sensed cardiac signal sensed along the first sensing vector during a predetermined sensing window;

determining second amplitudes of the sensed cardiac signal sensed along the second sensing vector during the predetermined sensing window;

determining a first noise to signal ratio corresponding to the determined first amplitudes;

determining a second noise to signal ratio corresponding to the determined second amplitudes;

identifying the first sensing vector as noisy in response to the comparing the first noise to signal ratio to the noise to signal ratio threshold;

comparing the second noise to signal ratio to the noise to signal threshold;

identifying the second sensing vector as noisy in response to the comparing the second noise to signal ratio to the noise to signal threshold; and

delivering therapy in response to the identifying.

15. The computer readable medium of claim 14, wherein determining a first noise to signal ratio and a second noise to signal ratio comprises determining a ratio of a highpass mean rectified amplitude corresponding to the sensed cardiac signal during the predetermined sensing window to a lowpass mean rectified amplitude corresponding to the sensed cardiac signal during the predetermined sensing window, the method further comprising:

determining an average of absolute values of lowpass sample amplitudes corresponding to the determined amplitudes as the lowpass mean rectified amplitude;

determining an average of absolute values of the determined amplitudes to generate a raw mean rectified amplitude; and

determining a difference between the raw mean rectified amplitude and the lowpass mean rectified amplitude as the highpass mean rectified amplitude.