Method of and apparatus for classifying arrhythmias using scatter plot analysis

• US 8,195,280 B2
• Filed: 12/31/2009
• Issued: 06/05/2012
• Est. Priority Date: 10/31/2005
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Van Dam, Peter M., Groen, Joanneke G.
• Primary Examiner(s): Layno, Carl H
• Assistant Examiner(s): MALAMUD, DEBORAH LESLIE
• Application Number:
  US12/650,893
• Publication Number:
  US 20100106035A1
• Time in Patent Office: 887 Days
• Field of Search: 600508-509, 600/512, 600/515, 600/523, 128/920, 128/922, 128/923
• US Class Current: 600/515
• CPC Class Codes: A61B 5/02405 Determining heart rate variability
• 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 5/7264 Classification of physiological signals or data, e.g. using neural networks, statistical classifiers, expert systems or fuzzy systems neural networks per se G06N3/00; expert systems per se G06N5/00
• CPC Class Codes: A61N 1/395 for treating atrial fibrillation
• CPC Class Codes: A61N 1/3956 Implantable devices for applying electric shocks to the heart, e.g. for cardioversion
• CPC Class Codes: G06F 2218/18 by plotting the signal segments against each other, e.g. analysing scattergrams
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems
• CPC Class Codes: Y10S 128/92 Computer assisted medical diagnostics
• CPC Class Codes: Y10S 128/922 including image analysis
• CPC Class Codes: Y10S 128/923 by comparison of patient data to other data

Abstract

A method of classifying arrhythmias using scatter plot analysis to define a measure of variability of a cardiac rhythm parameter such as for example, without limitation, R-R interval, A-A interval, and the slope of a portion of a cardiac signal, is disclosed. The variability measurement is derived from a scatter plot of a cardiac rhythm parameter, employing a region counting technique that quantifies the variability of the cardiac rhythm parameter while minimizing the computational complexity. The method may be employed by an implantable medical device or system, such as an implantable pacemaker or cardioverter defibrillator, or by an external device or system, such as a programmer or computer. The variability measurement may be correlated with other device or system information to differentiate between atrial flutter and atrial fibrillation, for example. The variability information may also be used by the device or system to select an appropriate therapy for a patient.

Claims

1. A system for classifying arrhythmias, the system comprising:

a sensor for acquiring a cardiac signal;

first processing means for deriving a recurring cardiac rhythm parameter from the cardiac signal and storing the parameter as a series of values;

a database for plotting a point on a scatter plot for each pair of successive stored values, wherein an abscissa of the point is a first value of a pair of successive stored values, and

an ordinate of the point is a second value of the pair of successive stored values,

and wherein the scatter plot is divided into a plurality of regions;

second processing means for deriving a measure of variability by counting the number of regions that have one or more points plotted therein; and

a comparator for comparing the measure of variability to a variability threshold.

2. The system of claim 1 wherein the plurality of regions includes generally rectangular portions of the scatter plot.

3. The system of claim 1 wherein the plurality of regions includes generally curved portions of the scatter plot.

4. The system of claim 1 wherein the recurring cardiac rhythm parameter is derived from R-R intervals of the cardiac signal.

5. The system of claim 1 wherein the recurring cardiac rhythm parameter is derived from P-P intervals of the cardiac signal.

6. The system of claim 1 wherein the recurring cardiac rhythm parameter is derived from an amplitude of a portion of the cardiac signal.

7. The system of claim 1 wherein the recurring cardiac rhythm parameter is a slope of a portion of the cardiac signal.

8. The system of claim 1, further comprising means for selecting a therapy based on the result of comparing the measure of variability to a threshold.

9. The system of claim 1 further comprising means for measuring a rate derived from a recurring cardiac rhythm parameter.

10. The system of claim 9, wherein the comparator further compares the rate to a rate threshold.

11. The system of claim 10, further comprising means for classifying an arrhythmia based on the comparing of the measure of variability to the variability threshold and the comparing of the rate to a rate threshold.

12. The system of claim 1, wherein the means for deriving a measure of variability divides the number of regions counted containing one or more plotted points by the number of points in the window, N, to calculate a percent variability.

13. The system of claim 1, wherein the wherein the means for deriving a measure of variability weights the value of each plotted point by a weighting factor during counting the number of regions that contain one or more plotted points, the weighting factor capable of varying by region in the scatter plot.

14. A system for classifying arrhythmias, the system comprising:

a sensor for acquiring a cardiac signal;

first processing means for deriving a recurring cardiac rhythm parameter from the cardiac signal and storing the parameter as a series of values;

a database for plotting a point on a scatter plot for each pair of successive stored values, wherein an abscissa of the point is a first value of a pair of successive stored values and an ordinate of the point is a second value of the pair of successive stored values and wherein the scatter plot is divided into a plurality of regions;

second processing means for deriving a measure of variability by counting the number of regions that have one or more points plotted therein;

means for measuring a rate derived from a recurring cardiac rhythm parameter and

a comparator for comparing the measure of variability to a variability threshold and for comparing the rate to a rate threshold threshold;

means for classifying an arrhythmia based on the comparing of the measure of variability to the variability threshold and the comparing of the rate to the rate threshold, wherein the arrhythmia is classified as atrial fibrillation (AF) when the rate and variability meet specified AF criteria.

15. The system of claim 14 wherein the arrhythmia is classified as atrial flutter (AFL) when the rate and variability meet specified AFL criteria.