Cardiac tachyarrhythmia therapy selection based on patient response information

• US 8,140,153 B2
• Filed: 04/30/2010
• Issued: 03/20/2012
• Est. Priority Date: 11/23/2004
• Status: Expired due to Fees

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Cazares, Shelley M.
• Primary Examiner(s): Layno, Carl H
• Assistant Examiner(s): MALAMUD, DEBORAH LESLIE
• Application Number:
  US12/771,691
• Publication Number:
  US 20100211126A1
• Time in Patent Office: 690 Days
• Field of Search: 600509-510, 600/518, 607/4, 607/9, 607/14
• US Class Current: 607/4
• CPC Class Codes: A61B 5/35 by template matching
• CPC Class Codes: A61B 5/361 Detecting fibrillation
• CPC Class Codes: A61B 5/363 Detecting tachycardia or bradycardia
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions
• CPC Class Codes: A61N 1/365 controlled by a physiological parameter, e.g. heart potential evoked response A61N1/371
• CPC Class Codes: A61N 1/3925 Monitoring; Protecting
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

Cardiac treatment methods and devices providing templates representative of past tachyarrhythmia events, each template associated with a therapy. A cardiac waveform is detected, and if it corresponds to a particular template associated with a previous therapy that was satisfactory in terminating a past event, the previous therapy is delivered again. If unsatisfactory, the previous therapy is eliminated as an option. If, for example, the previous therapy was an antitachycardia pacing therapy unsatisfactory in terminating the past tachyarrhythmia event, delivery of the antitachycardia pacing therapy is eliminated as an option. Instead of ATP therapy, one or more of a cardioversion, defibrillation, or alternate anti-tachycardia pacing therapy may be associated with the particular template. Cardiac waveforms and templates may correspond in terms of one or more of morphology, timing, drug regimen, medication, neural activity, patient activity, hemodynamic status, cardiac tissue impedance, transthoracic impedance, or other information corresponding to the episode.

Claims

1. A method, comprising:

storing one or more cardiac signal templates representative of one or more of a patient'"'"'s past tachyarrhythmia episodes in memory;

associating the one or more templates stored in memory with a tachyarrhythmia therapy to treat tachyarrhythmia episodes;

detecting a cardiac waveform;

comparing a particular template of the one or more stored templates with the cardiac waveform for a match;

delivering a tachyarrhythmia therapy associated with the particular template based on the match between the particular template and the cardiac waveform;

determining whether the delivered therapy associated with the particular template was unsatisfactory in terminating a tachyarrhythmia associated with the particular template; and

eliminating the tachyarrhythmia therapy as an option for treating a subsequent tachyarrhythmia episode associated in memory with the particular template if the therapy is determined unsatisfactory.

2. The method of claim 1, wherein:

the tachyarrhythmia therapy comprises an antitachycardia pacing (ATP) therapy; and

eliminating the therapy comprises eliminating the ATP therapy as an option for treating the subsequent tachyarrhythmia episode associated in memory with the particular template if the ATP therapy is determined unsatisfactory in terminating the tachyarrhythmia episode.

3. The method of claim 1, wherein:

the tachyarrhythmia therapy comprises an antitachycardia pacing (ATP) therapy;

eliminating the therapy comprises eliminating the ATP therapy as an option for treating the subsequent tachyarrhythmia episode associated in memory with the particular template if the ATP therapy is determined unsatisfactory in terminating the tachyarrhythmia episode; and

the method comprising associating one or more of a cardioversion therapy, a defibrillation therapy, or an alternate ATP therapy with the particular template.

4. The method of claim 1, comprising associating one or more of a cardioversion therapy, a defibrillation therapy, or an alternate ATP therapy with the particular template if the therapy is eliminated.

5. The method of claim 1, wherein comparing comprises determining correspondence between the cardiac waveform and the particular template in terms of morphology.

6. The method of claim 1, wherein comparing comprises determining correspondence between the cardiac waveform and the particular template in terms of timing.

7. The method of claim 1, wherein comparing comprises determining correspondence between the cardiac waveform and the particular template in terms of neural activity information.

8. The method of claim 1, wherein comparing comprises determining correspondence between the cardiac waveform and the particular template in terms of at least one of a drug regimen, medication information, patient activity information, hemodynamic status information, cardiac tissue impedance information, transthoracic impedance information, and respiratory information.

9. The method of claim 1, comprising deleting a particular template of the one or more templates if the particular template is older than a predetermined age, or has not matched to a cardiac waveform for a predetermined time, or has matched to past arrhythmias least frequently relative to other templates, or represents a heart-rate similar to other existing templates.

10. The method of claim 1, further comprising, if the cardiac waveform matches two or more of the templates:

selecting a template of the two or more templates associated with a treatment satisfactory in terminating the tachyarrhythmia episode, and delivering its associated tachyarrhythmia therapy;

or

selecting a most recently used or generated template associated with a treatment satisfactory in terminating the tachyarrhythmia episode, and delivering its associated tachyarrhythmia therapy;

or

selecting the most frequently matched template associated with a treatment satisfactory in terminating the tachyarrhythmia episode, and delivering its associated tachyarrhythmia therapy;

or

selecting the template associated with a treatment satisfactory in terminating the tachyarrhythmia episode whose rate information most closely corresponds to the detected cardiac waveform, and delivering its associated tachyarrhythmia therapy.

11. A method, comprising:

storing one or more cardiac signal templates representative of one or more of a patient'"'"'s past tachyarrhythmia episodes in memory;

associating the one or more templates stored in memory with a tachyarrhythmia therapy to treat tachyarrhythmia episodes;

detecting a cardiac waveform;

comparing a particular template of the one or more stored templates with the cardiac waveform for a match;

delivering a tachyarrhythmia therapy associated with the particular template based on the match between the particular template and the cardiac waveform;

determining whether the delivered therapy associated with the particular template was unsatisfactory or satisfactory in terminating a tachyarrhythmia associated with the particular template; and

managing the stored signal templates at least by deleting the particular template if the particular template is older than a predetermined age, or the particular template has not matched to a cardiac waveform for a predetermined time, or the particular template has matched to past arrhythmias least frequently relative to other stored templates, or the particular template represents a heart-rate similar to other stored templates.

12. The method of claim 11, wherein the tachyarrhythmia therapy comprises an antitachycardia pacing (ATP) therapy.

13. A cardiac therapy system, comprising:

a detector arrangement configured to detect a cardiac waveform;

therapy delivery circuitry configured to deliver one or more cardiac electrical therapies to treat tachyarrhythmia episodes detected by the detector arrangement;

a memory configured to store one or more cardiac signal templates representative of one or more of a patient'"'"'s past tachyarrhythmia episodes; and

a processor coupled to the memory, the processor configured to associate the one or more templates in the memory with a tachyarrhythmia therapy to treat tachyarrhythmia episodes, the processor configured to compare a particular template of the one or more stored templates with the cardiac waveform for a match and cooperate with the therapy delivery circuitry to deliver a tachyarrhythmia therapy associated with the particular template based on the match between the particular template and the cardiac waveform, the processor configured to cooperate with the detector arrangement to determine whether the delivered therapy associated with the particular template was unsatisfactory in terminating a tachyarrhythmia associated with the particular template, and the processor configured to eliminate the tachyarrhythmia therapy as an option for treating a subsequent tachyarrhythmia episode associated in the memory with the particular template if the therapy is determined unsatisfactory.

14. The system of claim 13, wherein:

the therapy delivery circuitry is configured to deliver an antitachycardia pacing (ATP) therapy; and

the processor is configured to eliminate the ATP therapy as an option for treating the subsequent tachyarrhythmia episode associated in the memory with the particular template if the ATP therapy is determined unsatisfactory in terminating the tachyarrhythmia episode.

15. The system of claim 13, wherein:

the therapy delivery circuitry is configured to deliver an antitachycardia pacing (ATP) therapy; and

the processor is configured to eliminate the ATP therapy as an option for treating the subsequent tachyarrhythmia episode associated in the memory with the particular template if the ATP therapy is determined unsatisfactory in terminating the tachyarrhythmia episode, the processor configured to associate one or more of a cardioversion therapy, a defibrillation therapy, or an alternate ATP therapy with the particular template stored in the memory.

16. The system of claim 13, wherein the processor is configured to associate one or more of a cardioversion therapy, a defibrillation therapy, or an alternate ATP therapy with the particular template stored in the memory if the therapy is eliminated.

17. The system of claim 13, wherein the processor is configured to determine correspondence between the cardiac waveform and the particular template in terms of morphology.

18. The system of claim 13, wherein the processor is configured to determine correspondence between the cardiac waveform and the particular template in terms of timing.

19. The system of claim 13, wherein the processor is configured to determine correspondence between the cardiac waveform and the particular template in terms of at least one of neural activity information, a drug regimen, medication information, patient activity information, hemodynamic status information, cardiac tissue impedance information, transthoracic impedance information, and respiratory information.

20. The system of claim 13, wherein the processor is configured to delete a particular template of the one or more templates stored in the memory if the particular template is older than a predetermined age, or has not matched to a cardiac waveform for a predetermined time, or has matched to past arrhythmias least frequently relative to other templates, or represents a heart-rate similar to other existing templates.