Anti-tachyarrhythmia system with selectively activated detection enhancements

• US 7,840,265 B2
• Filed: 11/04/2008
• Issued: 11/23/2010
• Est. Priority Date: 12/18/2007
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Gilkerson, James O., Perschbacher, David L., Kalgren, James
• Primary Examiner(s): Manuel; George
• Application Number:
  US12/264,771
• Publication Number:
  US 20090157126A1
• Time in Patent Office: 749 Days
• Field of Search: 607/4, 607/5, 607/14
• US Class Current: 607/4
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• 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: A61B 5/7435 Displaying user selection data, e.g. icons in a graphical user interface
• CPC Class Codes: A61B 5/7475 User input or interface means, e.g. keyboard, pointing device, joystick
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means
• CPC Class Codes: A61N 1/395 for treating atrial fibrillation
• CPC Class Codes: G16H 20/30 relating to physical therapies or activities, e.g. physiotherapy, acupressure or exercising
• CPC Class Codes: G16H 40/63 for local operation
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

A cardiac rhythm management (CRM) system includes an implantable cardioverter defibrillator (ICD) and an external system. The ICD detects a tachyarrhythmia episode and classifies the detected tachyarrhythmia episode using none, one, or more of detection enhancements selected according to a selection command including a classification mode. The detection enhancements are each an algorithm for detecting and analyzing one or more indications of a type of the detected tachyarrhythmia episode. The external system allows a user to select the classification mode from a plurality of available classification modes each using none, one, or more of the detection enhancements.

Claims

1. An external system for communicating with an implantable cardioverter defibrillator (ICD), the ICD having a plurality of detection enhancement modules configured to perform detection enhancements being algorithms for detecting and analyzing indications of type of tachyarrhythmia, the external system comprising:

a user interface configured to present a plurality of available classification modes and receive a user selection of a classification mode from the plurality of available classification modes, the available classification modes each specifying whether each detection enhancement module of the plurality of detection enhancement modules, including a morphology analyzer configured to analyze a correlation between a tachyarrhythmic waveform of a cardiac signal sensed during a detected tachyarrhythmia episode and a template waveform, is to be activated or deactivated according to a pre-selected set of none, one, or more of the detection enhancements.

2. The external system of claim 1, wherein the user interface is configured to allow the user selection of a first classification mode according to which none of the detection enhancement modules is to be activated.

3. The external system of claim 1, wherein the user interface is configured to present the plurality of available classification modes each specifying whether each of a rate comparator, an onset rate analyzer, a stability analyzer, an atrial fibrillation (AF) detector, and the morphology analyzer is to be activated or deactivated, the rate comparator configured to determine whether a ventricular rate is substantially higher than an atrial rate, the onset rate analyzer configured to determine whether a detected tachyarrhythmia episode has a gradual onset or a sudden onset as indicated by the ventricular rate, the stability analyzer configured to determine whether the ventricular rate is stable, the atrial AF detector configured to detect AF using the atrial rate.

4. The external system of claim 3, wherein the user interface is configured to allow the user selection of a second classification mode according to which the rate comparator, the onset rate analyzer, the stability analyzer, and the AF detector are to be activated, and the morphology analyzer is to be deactivated.

5. The external system of claim 3, wherein the user interface is configured to allow the user selection of a third classification mode according to which the rate comparator, the stability analyzer, the AF detector, and the morphology analyzer are activated, and the onset rate analyzer is deactivated.

6. The external system of claim 3, wherein the user interface is configured to allow the user selection of one of:

a first classification mode according to which none of the detection enhancement modules is activated;

a second classification mode according to which the rate comparator, the onset rate analyzer, the stability analyzer, and the AF detector are activated, and the morphology analyzer is deactivated; and

a third classification mode according to which the rate comparator, the stability analyzer, the AF detector, and the morphology analyzer are activated, and the onset rate analyzer is deactivated.

7. A cardiac rhythm management system, comprising:

an implantable cardioverter defibrillator (ICD) including;

a tachyarrhythmia detector configured to detect a tachyarrhythmia episode; and

a tachyarrhythmia classifier coupled to the tachyarrhythmia detector and configured to classify the detected tachyarrhythmia episode, the tachyarrthythmia classifier including;

a plurality of detection enhancement modules each configured to perform one of a plurality of detection enhancements each being an algorithm for detecting and analyzing one or more indications of a type of the detected tachyarrhythmia episode, the plurality of detection enhancement modules including a morphology analyzer configured to analyze a correlation between a tachyarrhythmic waveform of a cardiac signal sensed during the detected tachyarrhythmia episode and a template waveform; and

a selective activator configured to receive a selection command and activate or deactivate each detection enhancement module of the plurality of detection enhancement modules according to the selection command; and

an external system configured to be communicatively coupled to the ICD, the external system including;

a user input device configured to receive a user selection of a classification mode from a plurality of available classification modes each specifying whether each detection enhancement module of the plurality of detection enhancement modules is to be activated or deactivated according to a pre-selected set of none, one, or more of the detection enhancements; and

an external controller configured to produce the selection command in response to the user selection.

8. The system of claim 7, wherein the ICD comprises:

a cardiac sensing circuit configured to sense an atrial electrogram and a ventricular electrogram; and

a rate detector configured to detect an atrial rate from the atrial electrogram and a ventricular rate from the ventricular electrogram,

and wherein the tachyarrhythmia detector is configured to detect the tachyarrhythmia episode using at least the ventricular rate.

9. The system of claim 8, wherein the plurality of detection enhancement modules comprises the morphology analyzer and one or more of:

a rate comparator configured to determine whether the ventricular rate is substantially higher than the atrial rate;

an onset rate analyzer configured to determine whether the detected tachyarrhythmia episode has a gradual onset or a sudden onset as indicated by the ventricular rate;

a stability analyzer configured to determine whether the ventricular rate is stable; and

an atrial fibrillation (AF) detector configured to detect AF using the atrial rate.

10. The system of claim 9, wherein the user input device is configured to allow the user selection of a first classification mode according to which none of the detection enhancement modules is activated.

11. The system of claim 9, wherein the plurality of detection enhancement modules comprises at least the rate comparator, the onset rate analyzer, the stability analyzer, and the AF detector, and wherein the user input device is configured to allow the user selection of a second classification mode according to which the rate comparator, the onset rate analyzer, the stability analyzer, and the AF detector are activated.

12. The system of claim 9, wherein the plurality of detection enhancement modules comprises at least the rate comparator, the stability analyzer, the AF detector, and the morphology analyzer, and wherein the user input device is configured to allow the user selection of a third classification mode according to which the rate comparator, the stability analyzer, the AF detector, and the morphology analyzer are activated.

13. The system of claim 9, wherein the plurality of detection enhancement modules comprises the rate comparator, the onset rate analyzer, the stability analyzer, the AF detector, and the morphology analyzer, wherein the user input device is configured to allow the user selection of one of:

a first classification mode according to which none of the detection enhancement modules is activated;

a second classification mode according to which the rate comparator, the onset rate analyzer, the stability analyzer, and the AF detector are activated, and the morphology analyzer is deactivated; and

a third classification mode according to which the rate comparator, the stability analyzer, the AF detector, and the morphology analyzer are activated, and the onset rate analyzer is deactivated.

14. A method for operating an implantable cardioverter defibrillator (ICD), the method comprising:

receiving a user selection of a classification mode from a plurality of available classification modes using an external system communicatively coupled to the ICD;

producing a selection command in response to the user selection;

activating each used detection enhancement module of a plurality of detection enhancement modules according to the selection command, the plurality of detection enhancement modules including a morphology analyzer configured to analyze a correlation between a tachyarrhythmic waveform of a cardiac signal sensed during a detected tachyarrhythmia episode and a template waveform, the each used detection enhancement module being a detection enhancement module used in the classification mode; and

deactivating each unused detection enhancement module of the plurality of detection enhancement modules according to the selection command, the each unused detection enhancement module being a detection enhancement module not used in the classification mode,

wherein the plurality of detection enhancement modules are in the ICD and each configured to perform one of a plurality of detection enhancements each being an algorithm for detecting and analyzing one or more indications of a type of the detected tachyarrhythmia episode.

15. The method of claim 14, comprising:

sensing an atrial electrogram and a ventricular electrogram;

detecting an atrial rate from the atrial electrogram;

detecting a ventricular rate from the ventricular electrogram; and

detecting the tachyarrhythmia episode using at least the ventricular rate.

16. The method of claim 15, wherein activating the each used detection enhancement module of the plurality of detection enhancement modules comprises activating none, one, or more of:

a rate comparator configured to determine whether the ventricular rate is substantially higher than the atrial rate;

an onset rate analyzer configured to determine whether the detected tachyarrhythmia episode has a gradual onset or a sudden onset as indicated by the ventricular rate;

a stability analyzer configured to determine whether the ventricular rate is stable;

an atrial fibrillation (AF) detector configured to detect AF using the atrial rate; and

the morphology analyzer.

17. The method of claim 16, comprising providing a first classification mode of the plurality of available classification modes for the user selection, the first classification mode using none of the detection enhancement modules.

18. The method of claim 16, comprising providing a second classification mode of the plurality of available classification modes for the user selection, wherein the rate comparator, the onset rate analyzer, the stability analyzer, and the AF detector are used in the second classification mode, and the morphology analyzer is not used in the second classification mode.

19. The method of claim 16, comprising providing a third classification mode of the plurality of available classification modes for the user selection, wherein the rate comparator, the stability analyzer, the AF detector, and the morphology analyzer are used in the third classification mode, and the onset rate analyzer is not used in the third classification mode.

20. The method of claim 16, comprising providing first, second, and third classification modes of the plurality of available classification modes for the user selection, wherein:

none of the detection enhancement modules is used in the first classification mode;

the rate comparator, the onset rate analyzer, the stability analyzer, and the AF detector are used, and the morphology analyzer is not used, in the second classification mode; and

the rate comparator, the stability analyzer, the AF detector, and the morphology analyzer are used, and the onset rate analyzer is not used, in the third classification mode.