Method and apparatus for detecting arrhythmias in a medical device

• US 7,761,150 B2
• Filed: 04/28/2006
• Issued: 07/20/2010
• 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:
  US11/380,846
• Publication Number:
  US 20070239047A1
• Time in Patent Office: 1,544 Days
• Field of Search: 600508-510, 600/518, 600/521, 607/4, 607/5, 607/25, 607/14, 607/26
• US Class Current: 607/4
• 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 determining a first characteristic in response to cardiac signals sensed along a first sensing vector over a predetermined sensing window and in response to cardiac signals sensed along a second sensing vector over the predetermined sensing window, determining a second characteristic in response to cardiac signals sensed along the first sensing vector over the predetermined sensing window and in response to cardiac signals sensed along the second sensing vector over the predetermined sensing window, and determining a third characteristic in response to cardiac signals sensed along the first sensing vector over the predetermined sensing window and in response to cardiac signals sensed along the second sensing vector over the predetermined sensing window.

Claims

1. A method of treating a cardiac event with a medical device having therapeutic componentry and a plurality of electrodes, comprising:

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

determining a first characteristic of the cardiac signals sensed by the first sensing vector over a predetermined sensing window and a first characteristic of the cardiac signals sensed by the second sensing vector over the predetermined sensing window;

determining a second characteristic of the cardiac signals sensed by the first sensing vector different from the first characteristic of the first sensing vector over the predetermined sensing window and a second characteristic of the cardiac signals sensed by the second sensing vector different from the first characteristic of the second sensing vector over the predetermined sensing window;

determining a third characteristic of the cardiac signals sensed by the first sensing vector different from the first characteristic of the first sensing vector and the second characteristic of the first sensing vector over the predetermined sensing window and a third characteristic of the cardiac signals sensed by the second sensing vector different from the first characteristic of the second sensing vector and the second characteristic of the second sensing vector over the predetermined sensing window;

delivering a therapy from the therapeutic componentry based at least in part, on;

a relationship of one of the first characteristic sensed by the first sensing vector and the first characteristic sensed by the second sensing vector and one of the second characteristic sensed by the first sensing vector and the second characteristic sensed by the second sensing vector; and

a relationship of one of the first characteristic sensed by the first sensing vector and the first characteristic sensed by the second sensing vector and one of the third characteristic sensed by the first sensing vector and the third characteristic sensed by the second sensing vector.

2. The method of claim 1, wherein determining the first characteristic sensed by the first sensing vector and the first characteristic sensed by the second sensing vector comprises the steps of:

determining first rates of change in the cardiac signals sensed by the first sensing vector;

determining second rates of change in the cardiac signals sensed by the second sensing vector.

3. The method of claim 2:

wherein determining the first rates of change comprises the steps of;

determining a first rate of change threshold based, at least in part, on the cardiac signals sensed by the first sensing vector; and

determining a number of the first rates of change are less than the rate of change threshold; and

wherein the determining the second rates of change comprises the steps of;

determining a second rate of change threshold based, at least in part, on the cardiac signal sensed by the second sensing vector; and

determining number of times the second rates of change are less than the rate of change threshold; and

wherein the number of times the first rates of change are less than the first rate of change threshold is the first characteristic of the cardiac signals sensed by the first sensing vector and the number of times the second rates of change are less than the second rate of change threshold is the first characteristic of the cardiac signals sensed by the second sensing vector.

4. The method of claim 3, wherein determining each of the first rate of change threshold and the second rate of change threshold comprises:

dividing the cardiac signals sensed by the first sensing vector and the second sensing vector, respectively, over the predetermined sensing window into a plurality of sub-segments;

determining largest absolute rates of change for each of the plurality of sub-segments; and

determining the first rate of change threshold and second rate of change threshold, respectively, in response to the largest absolute rates of change for each of the sensing vector and the second sensing vector respectively.

5. The method of claim 4, wherein determining each of the first rate of change threshold and the second rate of change threshold further comprises:

determining whether the largest absolute rates of change for each of the first sensing vector and the second sensing vector are less than a portion of a largest rate of change determined for the cardiac signals sensed by the first sensing vector and the cardiac signals sensed over the second sensing vector, respectively, over the predetermined sensing window; and

setting the largest absolute rates of change for each of the first sensing vector and the second sensing vector equal to the largest rate of change for each of the first sensing vector and the second sensing vector respectively, in response to the largest absolute rates of change being less than the portion of the largest rate of change.

6. The method of claim 1, wherein determining the second characteristic of the first sensing vector and the second characteristic of the second sensing vector comprises determining a difference between a mean frequency and a fundamental frequency of the cardiac signals sensed by the first sensing vector and the second sensing vector, respectively.

7. The method of claim 1, wherein determining the third characteristic of the first sensing vector and the third characteristic of the second sensing vector comprises:

determining a first amplitude associated with the cardiac signals sensed by the first sensing vector and a second amplitude associated with the cardiac signals sensed by the second sensing vector.

8. The method of claim 1 wherein the first characteristic corresponds to low slope content, the second characteristic corresponds to spectral width, and the third characteristic corresponds to a normalized mean rectified amplitude.

9. The method of claim 1, wherein the relationship of one of the first characteristic sensed by the first sensing vector and the first characteristic sensed by the second sensing vector and one of the second characteristic sensed by the first sensing vector and the second characteristic sensed by the second sensing vector is defined based, at least in part, on:

a minimum one of the first characteristic of the cardiac signals sensed by the first sensing vector and the first characteristic of the cardiac signals sensed by the second sensing vector;

a minimum one of the second characteristic of the cardiac signals sensed by the first sensing vector and the second characteristic of the cardiac signals sensed by the second sensing vector; and

a first boundary associated with the minimum one of the first characteristic and the minimum one of the second characteristic.

10. The method of claim 9, wherein the relationship of one of the first characteristic sensed by the first sensing vector first characteristic sensed by the second sensing vector and one of the third characteristic sensed by the first sensing vector and the third characteristic sensed by the second sensing vector is defined based, at least in part, on:

a maximum one of the third characteristic of the cardiac signals sensed by the first sensing vector and the third characteristic of the cardiac signals sensed by the second sensing vector; and

a second boundary associated with the minimum one of the first characteristic and the maximum one of the third characteristic.

11. The method of claim 10, wherein delivering the therapy from the therapeutic componentry is further based, at least in part, on:

both the minimum of the first characteristic being less than the first boundary and the maximum of the third characteristic being greater than the second boundary; and

at least one of the minimum of the first characteristic not being less than the first boundary and the maximum of the third characteristic not being greater than the second boundary.

12. A method of treating a cardiac event with a medical device having therapeutic componentry and a plurality of electrodes, comprising:

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

determining a first characteristic of the cardiac signals sensed by the first sensing vector over a predetermined sensing window and a first characteristic of the cardiac signals sensed by the second sensing vector over the predetermined sensing window;

determining a second characteristic of the cardiac signals sensed by the first sensing vector different from the first characteristic of the first sensing vector over the predetermined sensing window and a second characteristic of the cardiac signals sensed by the second sensing vector different from the first characteristic of the second sensing vector over the predetermined sensing window;

determining a third characteristic of the cardiac signals sensed by the first sensing vector different from the first characteristic of the first sensing vector and the second characteristic of the first sensing vector over the predetermined sensing window and a third characteristic of the cardiac signals sensed by the second sensing vector different from the first characteristic of the second sensing vector and the second characteristic of the second sensing vector over the predetermined sensing window; and

delivering a therapy from the therapeutic componentry based, at least in part, on;

a minimum one of the first characteristic of the cardiac signals sensed by the first sensing vector and the first characteristic of the cardiac signals sensed by the second sensing vector;

a minimum one of the second characteristic of the cardiac signals sensed by the first sensing vector and the second characteristic of the cardiac signals sensed the second sensing vector; and

a maximum one of the third characteristic of the cardiac signals sensed by the first sensing vector and the third characteristic of the cardiac signals sensed by the second sensing vector.

13. The method of claim 12, wherein delivering a therapy from the therapeutic componentry is further based, at least in part, on:

determining a first boundary corresponding to the minimum one of the first characteristic of the cardiac signals sensed by the first sensing vector and the first characteristic of the cardiac signals sensed by the second sensing vector and the minimum one of the second characteristic of the cardiac signals sensed by the first sensing vector and the second characteristic of the cardiac signals sensed the second sensing vector;

determining a second boundary corresponding to the minimum one of the first characteristic of the cardiac signals sensed by the first sensing vector and the first characteristic of the cardiac signals sensed by the second sensing vector and the maximum one of the third characteristic of the cardiac signals sensed by the first sensing vector and the third characteristic of the cardiac signals sensed by the second sensing vector;

delivering the therapy if the minimum one of the first characteristic is less than the first boundary and the maximum one of the third characteristic is less than the second boundary.

14. The method of claim 13, wherein the first boundary corresponds to the sum of 0.93 and the product the minimum one of the second characteristic of the cardiac signal sensed the first sensing vector and the second characteristic of the cardiac signal sensed by the second sensing vector and −

0.004, and wherein the second boundary corresponds to the sum of 8.16 and the product of 68 and the minimum one of the first characteristic of the cardiac signals sensed by the first sensing vector and the first characteristic of the cardiac signals sensed by the second sensing vector.

15. A non-transitory computer readable medium having computer executable instructions for performing a method of treating a cardiac event with a medical device having therapeutic componentry and a plurality of electrodes comprising:

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

determining a first characteristic of the cardiac signals sensed by the first sensing vector over a predetermined sensing window and a first characteristic of the cardiac signals sensed by the second sensing vector over the predetermined sensing window;

determining a second characteristic of the cardiac signals sensed by the first sensing vector different from the first characteristic of the first sensing vector over the predetermined sensing window and a second characteristic of the cardiac signals sensed by the second sensing vector different from the first characteristic of the second sensing vector over the predetermined sensing window;

determining a third characteristic of the cardiac signals sensed by the first sensing vector different from the first characteristic of the first sensing vector and the second characteristic of the first sensing vector over the predetermined sensing window and a third characteristic of the cardiac signals sensed by the second sensing vector different from the first characteristic of the second sensing vector and the second characteristic of the second sensing vector over the predetermined sensing window;

delivering a therapy from the therapeutic componentry based, at least in part, on;

a relationship of one of the first characteristic sensed by the first sensing vector and the first characteristic sensed by the second sensing vector and one of the second characteristic sensed by the first sensing vector and the second characteristic sensed by the second sensing vector; and

a relationship of one of the first characteristic sensed by the first sensing vector and the first characteristic sensed by the second sensing vector and one of the third characteristic sensed by the first sensing vector and the third characteristic sensed by the second sensing vector.

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

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

determining a first characteristic in response to the cardiac signals sensed along the first sensing vector over a predetermined sensing window and in response to the cardiac signals sensed along the second sensing vector over the predetermined sensing window;

determining a second characteristic in response to the cardiac signals sensed along the first sensing vector over the predetermined sensing window and in response to the cardiac signals sensed alone he second sensing vector over the predetermined sensing window;

determining a third characteristic in response to the cardiac signals sensed along the first sensing vector over the predetermined sensing window and in response to the cardiac signals sensed along the second sensing vector over the predetermined sensing window;

defining a second shock zone in response to the first characteristic associated with a predetermined one of the first sensing vector and the second sensing vector and the second characteristic associated with a predetermined one of the first sensing vector and the second sensing vector;

defining a first shock zone in response to the first characteristic associated with a predetermined one of the first sensing vector and the second sensing vector and the third characteristic associated with a predetermined one of the first sensing vector and the second sensing vector; and

detecting the sensed cardiac signals as being associated with the event in response to the first shock zone and the second shock zone;

wherein defining a first shock zone comprises;

determining a minimum of the first characteristic associated with the first sensing vector and the first characteristic associated with the second sensing vector;

determining a minimum of the second characteristic associated with the first sensing vector and the second characteristic associated with the second sensing vector; and

defining a first boundary associated with the minimum of the first characteristic and the minimum of the second characteristic;

wherein defining a first shock zone comprises;

determining a minimum of the first characteristic associated with the first sensing vector and the first characteristic associated with the second sensing vector;

determining a minimum of the second characteristic associated with the first sensing vector and the second characteristic associated with the second sensing vector; and

defining a first boundary associated with the minimum, of the first characteristic and the minimum of the second characteristic;

wherein detecting the sensed cardiac signals comprises;

determining whether the minimum of the first characteristic is less than the first boundary;

determining whether the maximum of the third characteristic is greater than the second boundary;

identifying the both the first sensing vector and the second sensing vector as being shockable in response to both the minimum of the first characteristic being less than the first boundary and the maximum of the third characteristic being greater than the second boundary; and

identifying the both the first sensing vector and second sensing vector as being not shockable in response to one of the minimum of the first characteristic not being less than the first boundary and the maximum of the third characteristic not being greater than the second boundary; and

wherein the first characteristic corresponds to low slope content, the second characteristic corresponds to spectral width, and the third characteristic corresponds to a normalized mean rectified amplitude.

17. The method of claim 16, wherein the cardiac event is ventricular tachycardia.