Method and apparatus for enhancing treatable arrhythmia detection specificity by using accumulated patient activity

• US 8,145,307 B2
• Filed: 08/26/2010
• Issued: 03/27/2012
• Est. Priority Date: 08/26/2010
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Zhang, Xusheng, Ghanem, Raja N., Stadler, Robert W., Krause, Paul G., Kleckner, Karen J.
• Primary Examiner(s): Kahelin, Michael
• Application Number:
  US12/869,180
• Publication Number:
  US 20120053477A1
• Time in Patent Office: 579 Days
• Field of Search: 607/19, 600/515
• US Class Current: 607/19
• CPC Class Codes: A61B 5/1118 Determining activity level
• CPC Class Codes: A61B 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• 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: A61N 1/36542 controlled by body motion, e.g. acceleration
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

A method and apparatus for detecting a cardiac event in a medical device determine an activity level count from an activity sensor signal for each of a number of time segments, store an activity level count for each of the time segments in a histogram, and accumulate the stored activity level counts to determine a percentage of time segments having an activity level count above a given activity level count.

Claims

1. A method for detecting a cardiac event in a patient, comprising:

determining an activity level count from an activity sensor signal for each of a plurality of time segments;

storing an activity level count for each of the plurality of time segments in a histogram;

accumulating the stored activity level counts to determine a percentage of time segments having an activity level count above a given activity level count;

establishing an activity level count threshold in response to the accumulated activity level counts;

sensing a cardiac signal from a plurality of electrodes for each of the plurality of time segments;

classifying the cardiac signal for each of the plurality of time segments as one of a treatable segment and a non-treatable segment;

comparing a stored activity level for a given one of the plurality of time segments to the activity level count threshold in response to classifying a treatable segment;

reclassifying the treatable segment as a non-treatable segment if the stored activity level for the given one of the plurality of time segments is greater than the activity level count threshold; and

detecting the cardiac event in response to a treatable segment not being reclassified.

2. The method of claim 1 wherein storing the activity level count for each of the plurality of time segments in a histogram comprises:

storing the activity level count for a current one of the plurality of time segments in a first histogram; and

storing the activity level count for the current one of the plurality of time segments in a second histogram in response to the current one of the plurality of time segments being classified a treatable segment.

3. The method of claim 2 wherein establishing the activity level count threshold comprises determining a percentage of treatable segments in the second histogram having an activity level count above the threshold.

4. The method of claim 1 further comprising storing an activity level count corresponding to the detected cardiac event.

5. The method of claim 4 further comprising determining whether the detected cardiac event is a falsely detected event;

and

adjusting the activity level count threshold in response to the falsely detected event and the stored activity level count.

6. The method of claim 1 further comprising establishing one of a minimum activity level count threshold and a maximum percentage of time segments having an activity level count above the established threshold.

7. The method of claim 3 wherein accumulating activity level counts comprises:

accumulating activity level counts from the first histogram to determine a percentage of the plurality of time segments having an activity level count at or above a given activity level count, and

accumulating activity level counts from the second histogram to determine a percentage of treatable segments having an activity level count at or above a given activity level count, and further comprising

displaying the accumulated activity level counts from the first histogram, the accumulated activity level counts from the second histogram, and the established threshold.

8. The method of claim 1 wherein the accumulated activity level counts used to determine a percentage of time segments above a given activity level correspond to treatable time segments.

9. The method of claim 8 further comprising determining a percentage of previously detected cardiac events being falsely detected cardiac events;

wherein establishing the threshold comprises identifying an accumulated activity level count corresponding to a percentage of treatable time segments at or above the threshold approximately equaling the percentage of falsely detected cardiac events.

10. The method of claim 1 further comprising:

setting a high rate time out interval in response to a treatable segment being reclassified as a non-treatable segment; and

detecting the cardiac event in response to the high rate time out interval expiring.

11. The method of claim 1 further comprising:

establishing a threshold number of treatable segments not being reclassified as non-treatable segments required for detecting the cardiac event; and

adjusting the threshold number in response to a treatable segment being reclassified as a non-treatable segment.

12. A medical device for detecting cardiac events, comprising:

an activity sensor to sense a signal correlated to a level of patient activity;

a plurality of electrodes to sense cardiac electrical signals; and

a controller configured to;

determine an activity level count from the activity sensor signal for each of a plurality of time segments;

store an activity level count for each of the plurality of time segments in a histogram;

accumulate the stored activity level counts to determine a percentage of time segments having an activity level count above a given activity level count;

establish an activity level count threshold in response to the accumulated activity level counts;

classify the cardiac signal for each of the plurality of time segments as one of a treatable segment and a non-treatable segment;

compare a stored activity level for a given one of the plurality of time segments to the activity level count threshold in response to classifying a treatable segment; and

reclassify the treatable segment as a non-treatable segment if the stored activity level for the given one of the plurality of time segments is greater than the activity level count threshold.

13. The device of claim 12 wherein the controller is further configured to store the activity level count for a current one of the plurality of time segments in a first histogram, and

store the activity level count for the current one of the plurality of time segments in a second histogram in response to the current one of the plurality of time segments being classified a treatable segment.

14. The device of claim 13 wherein the controller is further configured to determine a percentage of treatable segments in the second histogram having an activity level count above the threshold.

15. The device of claim 12 wherein the controller is further configured to detect a cardiac event in response to the cardiac signal being classified as treatable, and store an activity level count corresponding to the detected cardiac event.

16. The device of claim 15 wherein the controller is further configured to receive data indicating that the detected cardiac event is a falsely detected event, and adjust the activity level count threshold in response to the falsely detected event and the stored activity level count.

17. The device of claim 12 wherein the controller is further configured to establish one of a minimum activity level count threshold and a maximum percentage of time segments having an activity level count above the established threshold.

18. The device of claim 13 wherein the controller is configured to accumulate activity level counts from the first histogram to determine a percentage the plurality of time segments having an activity level count at or above a given activity level count, and accumulate activity level counts from the second histogram to determine a percentage of treatable segments having an activity level count at or above a given activity level count, and wherein the controller is further configured to generate a display of the accumulated activity level counts from the first histogram, the accumulated activity level counts from the second histogram, and the established threshold.

19. The device of claim 12 wherein the accumulated activity level counts used to determine a percentage of time segments above a given activity level correspond to treatable time segments.

20. The device of claim 19 wherein the controller is further configured to determine a percentage of previously detected cardiac events being falsely detected cardiac events, and establish the threshold by identifying an accumulated activity level count corresponding to a percentage of treatable time segments above the threshold approximately equaling the percentage of falsely detected cardiac events.

21. The device of claim 12 further comprising a therapy delivery module, wherein the controller is further configured to set a high rate timer in response to a treatable segment being reclassified as a non-treatable segment and control the therapy delivery module to delivery an arrhythmia therapy in response to the high rate timer expiring.

22. The device of claim 12 wherein the controller is further configured to store a threshold number of treatable segments not being reclassified as non-treatable segments required for detecting the cardiac event, and adjust the threshold number in response to a treatable segment being reclassified as a non-treatable segment.

23. A non-transient computer-readable medium storing a set of instructions that cause a medical device processor to:

determine an activity level count from an activity sensor signal for each of a plurality of time segments;

store an activity level count for each of the plurality of time segments in a histogram;

accumulate the stored activity level counts to determine a percentage of time segments having an activity level count above a given activity level count;

establish an activity level count threshold in response to the accumulated activity level counts;

sense a cardiac signal from a plurality of electrodes for each of the plurality of time segments;

classify the cardiac signal for each of the plurality of time segments as one of a treatable segment and a non-treatable segment;

compare a stored activity level for a given one of the plurality of time segments to the activity level count threshold in response to classifying a treatable segment;

reclassify the treatable segment as a non-treatable segment if the stored activity level for the given one of the plurality of time segments is greater than the activity level count threshold; and

detect the cardiac event in response to a treatable segment not being reclassified.