Method and apparatus for controlling anti-tachyarrhythmia pacing using hemodynamic sensor
First Claim
1. A cardiac rhythm management (CRM) system, comprising:
- a sensing circuit to sense at least one cardiac signal;
a tachyarrhythmia detector, coupled to the sensing circuit, to detect a cardiac cycle length from the at least one cardiac signal and detect a tachyarrhythmia episode using the detected cardiac cycle length;
a hemodynamic sensor to sense a hemodynamic signal indicative of hemodynamic performance;
a hemodynamic parameter detector, coupled to the hemodynamic sensor, to detect a hemodynamic parameter from the hemodynamic signal;
a pacing circuit to deliver pacing pulses;
a therapy controller coupled to the tachyarrhythmia detector, the hemodynamic parameter detector, and the pacing circuit, the therapy controller including;
a therapy selector adapted to compare an arrhythmic value of the hemodynamic parameter detected during the detected tachyarrhythmia episode to a normal range of the hemodynamic parameter and to select an anti-tachyarrhythmia pacing (ATP) algorithm in response to the arrhythmic value of the hemodynamic parameter falling within the normal range of the hemodynamic parameter and a cardioversion/defibrillation algorithm in response to the arrhythmic value of the hemodynamic parameter falling out of the normal range of the hemodynamic parameter;
a characteristic feature detector adapted to detect a predetermined type morphological feature of the hemodynamic signal, the predetermined type morphological feature temporally associated with an aortic valve closure and a pulmonary valve closure; and
an ATP controller, coupled to the therapy selector and the characteristic feature detector, to control the delivery of the pacing pulses by executing the selected ATP algorithm, the ATP controller adapted to select the detected predetermined type morphological feature as a beginning point of an ATP window and initiate a delivery of a burst of the pacing pulses within the ATP window to interrupt a reentrant loop causing the tachyarrhythmia.
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Abstract
A cardiac rhythm management (CRM) system includes an implantable medical device that delivers anti-tachyarrhythmia therapies including anti-tachyarrhythmia pacing (ATP) and at least one hemodynamic sensor that senses a hemodynamic signal. When a tachyarrhythmia episode is detected, the CRM system analyzes the hemodynamic signal to determine whether and/or when to deliver an ATP. In one embodiment, a hemodynamic parameter extracted from the hemodynamic signal is used to predict the potential effectiveness of ATP in terminating the detected tachyarrhythmia episode. In another embodiment, a characteristic feature detected from the hemodynamic signal is used to determine an ATP window during which a delivery of ATP is initiated.
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Citations
26 Claims
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1. A cardiac rhythm management (CRM) system, comprising:
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a sensing circuit to sense at least one cardiac signal; a tachyarrhythmia detector, coupled to the sensing circuit, to detect a cardiac cycle length from the at least one cardiac signal and detect a tachyarrhythmia episode using the detected cardiac cycle length; a hemodynamic sensor to sense a hemodynamic signal indicative of hemodynamic performance; a hemodynamic parameter detector, coupled to the hemodynamic sensor, to detect a hemodynamic parameter from the hemodynamic signal; a pacing circuit to deliver pacing pulses; a therapy controller coupled to the tachyarrhythmia detector, the hemodynamic parameter detector, and the pacing circuit, the therapy controller including; a therapy selector adapted to compare an arrhythmic value of the hemodynamic parameter detected during the detected tachyarrhythmia episode to a normal range of the hemodynamic parameter and to select an anti-tachyarrhythmia pacing (ATP) algorithm in response to the arrhythmic value of the hemodynamic parameter falling within the normal range of the hemodynamic parameter and a cardioversion/defibrillation algorithm in response to the arrhythmic value of the hemodynamic parameter falling out of the normal range of the hemodynamic parameter; a characteristic feature detector adapted to detect a predetermined type morphological feature of the hemodynamic signal, the predetermined type morphological feature temporally associated with an aortic valve closure and a pulmonary valve closure; and an ATP controller, coupled to the therapy selector and the characteristic feature detector, to control the delivery of the pacing pulses by executing the selected ATP algorithm, the ATP controller adapted to select the detected predetermined type morphological feature as a beginning point of an ATP window and initiate a delivery of a burst of the pacing pulses within the ATP window to interrupt a reentrant loop causing the tachyarrhythmia. - View Dependent Claims (2, 3, 4, 5, 6)
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7. A method for operating a cardiac rhythm management (CRM) device, the method comprising:
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sensing at least one cardiac signal; detecting a cardiac cycle length using the at least one cardiac signal; detecting a tachyarrhythmia episode using the detected cardiac cycle length; sensing a hemodynamic signal indicative of hemodynamic performance; detecting a hemodynamic parameter from the hemodynamic signal; producing an arrhythmic value of the hemodynamic parameter being a value of the hemodynamic parameter detected during the detected tachyarrhythmia episode; comparing the arrhythmic value of the hemodynamic parameter to a normal range of the hemodynamic parameter; selecting anti-tachyarrhythmia pacing (ATP) in response to the arrhythmic value of the hemodynamic parameter falling within the normal range of the hemodynamic parameter and a cardioversion/defibrillation algorithm in response to the arrhythmic value of the hemodynamic parameter falling out of the normal range of the hemodynamic parameter; detecting a predetermined type morphological feature of the hemodynamic signal the predetermined type morphological feature temporally associated with an aortic valve closure and a pulmonary valve closure; selecting the predetermined type morphological feature as a beginning point of an ATP window; and initiating a delivery of a burst of ATP pulses within the ATP window to interrupt a reentrant loop causing the tachyarrhythmia. - View Dependent Claims (8, 9, 10, 11, 12)
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13. A cardiac rhythm management (CRM) system, comprising:
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a sensing circuit to sense at least one cardiac signal; a tachyarrhythmia detector, coupled to the sensing circuit, to detect a tachyarrhythmia episode from the at least one cardiac signal; a hemodynamic sensor to sense a hemodynamic signal indicative of hemodynamic performance; a pacing circuit to deliver pacing pulses; a therapy controller coupled to the tachyarrhythmia detector, the hemodynamic sensor, and the pacing circuit, the therapy controller including; a characteristic feature detector adapted to detect a predetermined type characteristic feature of the hemodynamic signal, the predetermined type characteristic feature being a morphological feature temporally associated with an aortic valve closure and a pulmonary valve closure; and an anti-tachyarrhythmia pacing (ATP) controller coupled to the characteristic feature detector, the ATP controller adapted to select the detected predetermined type morphological feature as a beginning point of an ATP window and initiate a delivery of a burst of the pacing pulses within the ATP window. - View Dependent Claims (14, 15, 16, 17, 18, 19)
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20. A method for operating a cardiac rhythm management (CRM) device, the method comprising:
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sensing at least one cardiac signal; detecting a tachyarrhythmia episode from the at least one cardiac signal; sensing a hemodynamic signal indicative of hemodynamic performance; detecting a predetermined type characteristic feature of the hemodynamic signal, the predetermined type characteristic feature being a morphological feature temporally associated with an aortic valve closure and a pulmonary valve closure; selecting the predetermined type morphological feature as a beginning point of an anti-tachyarrhythmia pacing (ATP) window; and initiating a delivery of a burst of ATP pulses within the ATP window to interrupt a reentrant loop causing the tachyarrhythmia. - View Dependent Claims (21, 22, 23, 24, 25, 26)
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Specification