Method and apparatus for detecting arrhythmias in a subcutaneous medical device

• US 7,894,894 B2
• Filed: 03/16/2007
• Issued: 02/22/2011
• 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): Patel; Niketa I
• Assistant Examiner(s): EL-KAISSI, HIBA CARINE
• Application Number:
  US11/687,108
• Publication Number:
  US 20070233196A1
• Time in Patent Office: 1,439 Days
• Field of Search: 607/4, 607/5, 607/14, 600/515, 600/517, 600/518
• US Class Current: 607/4
• CPC Class Codes: A61B 5/361 Detecting fibrillation
• CPC Class Codes: A61B 5/363 Detecting tachycardia or bradycardia
• CPC Class Codes: A61B 5/7239 using differentiation including higher order derivatives
• CPC Class Codes: A61N 1/3621 for treating or preventing abnormally high heart rate
• CPC Class Codes: A61N 1/3956 Implantable devices for applying electric shocks to the heart, e.g. for cardioversion

Abstract

A method and apparatus for detecting a cardiac event in a medical device that includes sensing cardiac signals 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 a characteristic associated with cardiac signals sensed along the first sensing vector during a predetermined sensing window, determining the characteristic associated with cardiac signals sensed along the second sensing vector during the predetermined sensing window, comparing the determined characteristic associated with cardiac signals sensed along the first sensing vector and the determined characteristic associated with cardiac signals sensed along the second sensing vector, and delivering a therapy in response to the comparing.

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 different from the first sensing vector;

determining a spectral width of the cardiac signals sensed by the first sensing vector during a predetermined sensing window and a spectral width of the cardiac signals sensed by the second sensing vector during the predetermined sensing window;

determining a normalized mean rectified amplitude of the cardiac signals sensed by the first sensing vector during the predetermined sensing window and a normalized mean rectified amplitude of the cardiac signals sensed by the second sensing vector during the predetermined sensing window; and

delivering a therapy based, at least in part, on a relationship of one of the spectral width of the cardiac signals sensed by the first sensing vector and the spectral width of the cardiac signals sensed by the second sensing vector and one of the normalized mean rectified amplitude of the cardiac signals sensed by the first sensing vector and the normalized mean rectified amplitude of the cardiac signals sensed by the second sensing vector.

2. The method of claim 1, wherein the normalized mean rectified amplitude of the cardiac signals sensed by the first sensing vector and the normalized mean rectified amplitude of the cardiac signals sensed by the second sensing vector are based, at least in part, on a rectified amplitude of the cardiac signals sensed during each of a plurality of sub-segments of the predetermined sensing window by the first sensing vector and the second sensing vector, respectively.

3. The method of claim 2, wherein the spectral width of the cardiac signals sensed by the first sensing vector and the spectral width of the cardiac signals sensed by the second sensing vector are 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.

4. The method of claim 1, wherein the predetermined sensing window is between approximately 0.5 and 10 seconds.

5. The method of claim 1, wherein the plurality of electrodes are positioned non-transvenously.

6. The method of claim 1, further comprising:

generating a threshold based, at least in part, on the one of the spectral width of the cardiac signals sensed by the first sensing vector and the spectral width of the cardiac signals sensed by the second sensing vector and the one of the normalized mean rectified amplitude of the cardiac signals sensed by the first sensing vector and the normalized mean rectified amplitude of the cardiac signals sensed by the second sensing vector; and

wherein the delivering the therapy step is further based, at least in part, on the one of the normalized mean rectified amplitude of the cardiac signals sensed by the first sensing vector and the normalized mean rectified amplitude of the cardiac signals sensed by the second sensing vector being greater than or equal to the threshold.

7. A medical device for treating a cardiac event, the device comprising:

a plurality of electrodes configured to sense cardiac signals, the plurality of electrodes forming a first sensing vector and a second sensing vector;

an energy storage device to store energy associated with delivery of a therapy via the plurality of electrodes; and

a control unit configured to;

determine a normalized mean rectified amplitude of the cardiac signals sensed by the first sensing vector and a normalized mean rectified amplitude of the cardiac signals sensed by the second sensing vector during a predetermined sensing window;

determine a spectral width of the cardiac signals sensed by the first sensing vector and a normalized mean rectified amplitude of the cardiac signals sensed by the second sensing vector during the predetermined sensing window;

deliver the therapy based, at least in part, on a relationship of a maximum one of the normalized mean rectified amplitude of the cardiac signals sensed by the first sensing vector and the normalized mean rectified amplitude of the cardiac signals sensed by the second sensing vector and a minimum one of the spectral width of the cardiac signals sensed by the first sensing vector and the spectral width of the cardiac signals sensed by the second sensing vector.

8. The device of claim 7, wherein the normalized mean rectified amplitude of the cardiac signals sensed by the first sensing vector and the normalized mean rectified amplitude of the cardiac signals sensed by the second sensing vector are based, at least in part, on a rectified amplitude of the cardiac signals sensed during each of a plurality of sub-segments of the predetermined sensing window by the first sensing vector and the second sensing vector, respectively.

9. The device of claim 8, wherein the spectral width of the cardiac signals sensed by the first sensing vector and the spectral width of the cardiac signals sensed by the second sensing vector are 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.

10. The device of claim 7, wherein the predetermined sensing window is between approximately 0.5 and 10 seconds.

11. The device of claim 7, wherein the plurality of electrodes are positioned non-transvenously.

12. The device of claim 7,

wherein the control unit is further configured to generate a threshold based, at least in part, on the maximum one and the minimum one;

and

wherein the control unit delivers the therapy further based, at least in part, the maximum one being greater than or equal to the threshold.

13. 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 different from the first sensing vector;

determining a normalized mean rectified amplitude of the cardiac signals sensed by the first sensing vector and a normalized mean rectified amplitude of the cardiac signals sensed by the second sensing vector during a predetermined sensing window;

determining a spectral width of the cardiac signals sensed by the first sensing vector and a normalized mean rectified amplitude of the cardiac signals sensed by the second sensing vector during the predetermined sensing window;

delivering a therapy based, at least in part, on a relationship of a maximum one of the normalized mean rectified amplitude of the cardiac signals sensed by the first sensing vector and the normalized mean rectified amplitude of the cardiac signals sensed by the second sensing vector and a minimum one of the spectral width of the cardiac signals sensed by the first sensing vector and the spectral width of the cardiac signals sensed by the second sensing vector.

14. The method of claim 13, wherein the normalized mean rectified amplitude of the cardiac signals sensed by the first sensing vector and the normalized mean rectified amplitude of the cardiac signals sensed by the second sensing vector are based, at least in part, on a rectified amplitude of the cardiac signals sensed during each of a plurality of sub-segments of the predetermined sensing window by the first sensing vector and the second sensing vector, respectively.

15. The method of claim 14, wherein the spectral width of the cardiac signals sensed by the first sensing vector and the spectral width of the cardiac signals sensed by the second sensing vector are 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.

16. The method of claim 13, wherein the predetermined sensing window is between approximately 0.5 and 10 seconds.

17. The method of claim 13, wherein the plurality of electrodes are positioned non-transvenously.

18. The method of claim 13, further comprising:

generating a threshold based, at least in part, on the maximum one and the minimum one; and

wherein the delivering the therapy step is further based, at least in part, the maximum one being greater than or equal to the threshold.

19. The method of claim 18, wherein the threshold corresponds to the maximum one being equal to 0.3636×

the minimum one−

15.