Method and apparatus for detecting arrhythmias in a medical device

• US 8,160,684 B2
• Filed: 04/28/2006
• Issued: 04/17/2012
• 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): Layno, Carl H
• Assistant Examiner(s): BEHRINGER, LUTHER G
• Application Number:
  US11/380,837
• Publication Number:
  US 20070239046A1
• Time in Patent Office: 2,181 Days
• Field of Search: 607/5, 600/409, 600/413, 600509-512, 600/515, 600/518, 600/519, 600/521
• US Class Current: 600/512
• CPC Class Codes: A61B 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 5/341 Vectorcardiography [VCG]
• 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: A61B 5/363 Detecting tachycardia or bradycardia
• CPC Class Codes: A61B 5/364 Detecting abnormal ECG interval, e.g. extrasystoles, ectopic heartbeats
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61B 5/686 Permanently implanted devices, e.g. pacemakers, other stimulators, biochips A61B5/6861 takes precedence
• CPC Class Codes: A61B 5/7203 for noise prevention, reduction or removal
• CPC Class Codes: A61B 5/7221 Determining signal validity, reliability or quality A61B5/7207 and A61B5/7217 take precedence
• CPC Class Codes: A61B 5/7239 using differentiation including higher order derivatives
• CPC Class Codes: A61N 1/05 for implantation or insertion into the body, e.g. heart electrode A61N1/06 takes precedence
• CPC Class Codes: A61N 1/3621 for treating or preventing abnormally high heart rate
• CPC Class Codes: A61N 1/3925 Monitoring; Protecting
• CPC Class Codes: A61N 1/3956 Implantable devices for applying electric shocks to the heart, e.g. for cardioversion
• CPC Class Codes: A61N 1/3987 characterised by the timing or triggering of the shock
• CPC Class Codes: Y10S 128/901 Suppression of noise in electric signal
• CPC Class Codes: Y10S 128/902 Biological signal amplifier

Abstract

A method of detecting a cardiac event in a medical device that includes sensing cardiac signals from a plurality of electrodes forming a first sensing vector and a second sensing vector, and determining whether the sensing of cardiac signals along the first sensing vector and along the second sensing vector is corrupted by noise. If the cardiac signals sensed along both the first sensing vector and the second sensing vector are not corrupted by noise, a determination is made as to whether the cardiac signals sensed along the first sensing vector and along the second sensing vector are one of a first cardiac event and a second cardiac event. The determination of whether the cardiac signals sensed along the first sensing vector and along the second sensing vector are one of a first cardiac event and a second cardiac event is then confirmed.

Claims

1. A method of detecting a cardiac event in a medical device, comprising:

sensing cardiac signals from a plurality of electrodes, the plurality of electrodes forming a first sensing vector and a second sensing vector;

determining whether the cardiac signals sensed along the first sensing vector and along the second sensing vector are one of a first cardiac event and a second cardiac event different from the first cardiac event; and

if the cardiac signals are one of the first cardiac event and the second cardiac event, confirming the cardiac signals sensed along the first sensing vector and along the second sensing vector are one of the first cardiac event and the second cardiac event to obtain a confirmation based on a first confirming process and a second confirming process different from the first confirming process.

2. The method of claim 1, wherein determining whether the cardiac signals sensed along the first sensing vector and along the second sensing vector is one of a first cardiac event and a second cardiac event comprises:

determining whether RR-intervals associated with the cardiac signals sensed along the first sensing vector and along the second sensing vector are regular;

determining the cardiac signals sensed along the first sensing vector and the second sensing vector corresponds to the first cardiac event in response to the RR-intervals being regular and corresponds to the second cardiac event in response to the RR-intervals not being regular;

delivering a first therapy in response to the cardiac signals sensed along the first sensing vector and the second sensing vector corresponding to the first cardiac event; and

delivering a second therapy in response to the cardiac signals sensed along the first sensing vector and the second sensing vector corresponding to the second cardiac event.

3. The method of claim 2, wherein determining whether RR-intervals associated with the cardiac signals sensed along the first sensing vector and along the second sensing vector are regular comprises:

determining a maximum RR-interval and a minimum RR-interval; and

identifying the RR-intervals as regular in response to determining whether an interval difference corresponding to the maximum RR-interval and the minimum RR-interval is greater than a stability threshold.

4. The method of claim 3, wherein the RR-intervals include twelve RR-intervals, the maximum RR-interval corresponding to the largest RR-interval of the twelve RR-intervals and the minimum RR-interval corresponding to the sixth largest RR-interval of the twelve RR-intervals.

5. The method of claim 1, further comprising the step, if the cardiac signals correspond to the first cardiac event, of determining a first characteristic, a second characteristic and a third characteristic corresponding to the cardiac signals sensed along the first sensing vector and along the second sensing vector, and wherein at least one of the first confirming process and the second confirming process is based, at least in part, on at least one of the first characteristic, the second characteristic, and the third characteristic.

6. The method of claim 5, further comprising:

determining a first boundary corresponding to the first characteristic and the second characteristic;

determining a second boundary corresponding to the first characteristic and the third characteristic;

wherein at least one of the first confirming process and the second confirming process is based, at least in part, on the first characteristic being less than the first boundary and the third characteristic being less than the second boundary; and

further comprising the step of delivering a therapy to the patient based, at least in part, on the confirmation.

7. The method of claim 1 wherein the confirming step obtains the confirmation that the cardiac signals is one of the first cardiac event and the second cardiac event determined in the determining step based, at least in part, on the cardiac signals sensed along both the first sensing vector and the second sensing vector corresponding to the one of first cardiac event and the second cardiac event.

8. The method of claim 7, further comprising the step of delivering a therapy based, at least in part, on the confirmation confirming the cardiac signals are the first cardiac event.

9. The method of claim 1, further comprising:

determining, in response to the cardiac signals sensed along one of the first sensing vector and the second sensing vector being the second cardiac event, rates of change and a range of the cardiac signals sensed along the first sensing vector and along the second sensing vector, wherein the confirming is further based, at least in part, on the rates of change and the range; and

delivering therapy in response to the confirmation.

10. The method of claim 9, wherein determining rates of change and the range comprises:

determining a rate of change threshold based, at least in part, on the cardiac signals sensed along the first sensing vector and the second sensing vector;

determining a number of the rates of change being less than the rate of change threshold; and

delivering therapy based, at least in part, on the number of the rates of change that are less than the rate of change threshold being less than a first boundary and the range being less than a second boundary different from the first boundary.

11. The method of claim 1, further comprising:

identifying the cardiac signals associated with sensing along the first sensing vector as corresponding to the second cardiac event in response to the cardiac signals sensed along the first sensing vector being confirmed as corresponding to the second cardiac event and as not corresponding to the second cardiac event in response to the cardiac signals sensed along the first sensing vector not being confirmed as corresponding to the second cardiac event;

identifying the cardiac signals associated with sensing along the second sensing vector as corresponding to the second cardiac event in response to the cardiac signals sensed along the second sensing vector being confirmed as corresponding to the second cardiac event and as not corresponding to the second cardiac event in response to the cardiac signals sensed along the second sensing vector not being confirmed as corresponding to the second cardiac event; and

delivering therapy in response to the identifying.

12. A method of detecting a cardiac event in a medical device, comprising:

sensing cardiac signals from a plurality of electrodes, the plurality of electrodes forming a first sensing vector and a second sensing vector;

determining whether the cardiac signals sensed along the first sensing vector and along the second sensing vector are one of a first cardiac event and a second cardiac event different from the first cardiac event;

if the cardiac signals are one of the first cardiac event and the second cardiac event, confirming the cardiac signals sensed along the first sensing vector and along the second sensing vector are one of the first cardiac event and the second cardiac event to obtain a confirmation based on a first confirming process and a second confirming process different from the first confirming process;

determining the cardiac signals associated with sensing along both the first sensing vector and the second sensing vector as corresponding to the first cardiac event based, at least in part, on the cardiac signals sensed along both the first sensing vector and the second sensing vector being confirmed as corresponding to the first cardiac event;

determining the cardiac signals associated with sensing along both the first sensing vector and the second sensing vector as not corresponding to the first cardiac event in response to the cardiac signals sensed along one of the first sensing vector and the second sensing vector not being confirmed as corresponding to the first cardiac event;

identifying the cardiac signals associated with sensing along the first sensing vector as corresponding to the second cardiac event in response to the cardiac signals sensed along the first sensing vector being confirmed as corresponding to the second cardiac event and as not corresponding to the second cardiac event in response to the cardiac signals sensed along the first sensing vector not being confirmed as corresponding to the second cardiac event;

identifying the cardiac signals associated with sensing along the second sensing vector as corresponding to the second cardiac event in response to the cardiac signals sensed along the second sensing vector being confirmed as corresponding to the second cardiac event and as not corresponding to the second cardiac event in response to the cardiac signals sensed along the second sensing vector not being confirmed as corresponding to the second cardiac event; and

delivering therapy based, at least in part, on the determining steps and the identifying steps.

13. The method of claim 12, wherein determining whether the cardiac signals sensed along the first sensing vector and along the second sensing vector is one of a first cardiac event and a second cardiac event comprises:

determining whether RR-intervals associated with the cardiac signals sensed along the first sensing vector and along the second sensing vector are regular; and

determining the cardiac signals sensed along the first sensing vector and the second sensing vector corresponds to the first cardiac event in response to the RR-intervals being regular and corresponds to the second cardiac event in response to the RR-intervals not being regular;

delivering a first therapy in response to the cardiac signals sensed along the first sensing vector and the second sensing vector corresponding to the first cardiac event; and

delivering a second therapy in response to the cardiac signals sensed along the first sensing vector and the second sensing vector corresponding to the second cardiac event.

14. The method of claim 13, wherein determining whether RR-intervals associated with the cardiac signals sensed along the first sensing vector and along the second sensing vector are regular comprises:

determining a maximum RR-interval and a minimum RR-interval; and

identifying the RR-intervals as regular in response to determining whether an interval difference corresponding to the maximum RR-interval and the minimum RR-interval is greater than a stability threshold.

15. The method of claim 14, wherein the RR-intervals include twelve RR-intervals, the maximum RR-interval corresponding to the largest RR-interval of the twelve RR-intervals and the minimum RR-interval corresponding to the sixth largest RR-interval of the twelve RR-intervals.

16. The method of claim 12, further comprising the step, if the cardiac signals correspond to the first cardiac event, of determining a first characteristic, a second characteristic and a third characteristic corresponding to the cardiac signals sensed along the first sensing vector and along the second sensing vector, and wherein at least one of the first confirming process and the second confirming process is based, at least in part, on at least one of the first characteristic, the second characteristic, and the third characteristic.

17. The method of claim 16, further comprising:

determining a first boundary corresponding to the first characteristic and the second characteristic;

determining a second boundary corresponding to the first characteristic and the third characteristic;

wherein at least one of the first confirming process and the second confirming process is based, at least in part, on the first characteristic being less than the first boundary and the third characteristic being less than the second boundary; and

further comprising the step of delivering a therapy to the patient based, at least in part, on the confirmation.

18. The method of claim 12, further comprising:

determining, in response to the cardiac signals sensed along one of the first sensing vector and the second sensing vector being the second cardiac event, rates of change and a range of the cardiac signals sensed along the first sensing vector and along the second sensing vector, wherein the confirming is further based, at least in part, on the rates of change and the range; and

delivering therapy in response to the confirming.

19. The method of claim 18, wherein determining rates of change and a range comprises:

determining a rate of change threshold in response to the cardiac signals sensed along the first sensing vector and the second sensing vector;

determining a number of the rates of change being less than the rate of change threshold; and

delivering therapy in response to the number of the rates of change that are less than the rate of change threshold being less than a first boundary and the range being less than a second boundary different from the first boundary.

20. A non-transitory computer readable medium having computer executable instructions for performing a method comprising:

sensing cardiac signals from a plurality of electrodes, the plurality of electrodes forming a first sensing vector and a second sensing vector;

determining whether the cardiac signals sensed along the first sensing vector and along the second sensing vector are one of a first cardiac event and a second cardiac event different from the first cardiac event; and

if the cardiac signals are one of the first cardiac event and the second cardiac event, confirming the cardiac signals sensed along the first sensing vector and along the second sensing vector are one of the first cardiac event and the second cardiac event to obtain a confirmation based on a first confirming process and a second confirming process different from the first confirming process.