Tachycardia hemodynamics detection based on cardiac mechanical sensor signal regularity

• US 8,229,556 B2
• Filed: 09/10/2008
• Issued: 07/24/2012
• Est. Priority Date: 11/21/2007
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Li, Dan
• Primary Examiner(s): Layno, Carl H
• Assistant Examiner(s): Kimball, Jeremiah
• Application Number:
  US12/283,185
• Publication Number:
  US 20090131996A1
• Time in Patent Office: 1,413 Days
• Field of Search: 607/4
• US Class Current: 607/4
• CPC Class Codes: A61N 1/36514 controlled by a physiological quantity other than heart potential, e.g. blood pressure controlled by two or more physical parameters A61N1/36585
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/36564 controlled by blood pressure
• CPC Class Codes: A61N 1/36578 controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone

Abstract

Systems and methods provide for sensing, within a patient and during an event of tachycardia, a signal indicative of a mechanical response of the patient'"'"'s heart to the tachycardia. Regularity of the signal relative to a threshold established for the patient is determined. A state of patient hemodynamics during the tachycardia event is determined based at least in part on the regularity of the signal. One or more anti-tachycardia therapies to treat the tachycardia may be selected based at least in part on the determined state of patient hemodynamics. The selected one or more anti-tachycardia therapies may be delivered to treat the tachycardia.

Claims

1. A method, comprising:

sensing, within a patient using implantable electrodes, an electrical signal indicative of electrical activity of the patient'"'"'s heart;

identifying a tachycardia event based on the electrical signal;

sensing, within the patient and during the tachycardia event, a mechanical response signal indicative of a mechanical response of the patient'"'"'s heart to the tachycardia;

developing a template indicative of the mechanical response of the patient'"'"'s heart to tachycardia based on the mechanical response signal;

sensing a second mechanical response signal indicative of the mechanical response of the patient'"'"'s heart to a subsequent tachycardia event;

determining regularity of the second mechanical response signal relative to a threshold established for the patient by comparing the template to the second mechanical response signal;

determining a state of patient hemodynamics during the subsequent tachycardia event based at least in part on the regularity of the second mechanical response signal, wherein determining the state comprises determining whether the subsequent tachycardia event comprises a stable tachyarrhythmia or unstable tachyarrhythmia;

selecting one or more therapies to treat the subsequent tachycardia event based at least in part on the determined state of patient hemodynamics; and

delivering the selected one or more therapies to treat the subsequent tachycardia event, wherein the steps of developing the template, determining the regularity, determining the state of hemodynamics, selecting, and delivering are performed at least in part by circuitry.

2. The method of claim 1, wherein sensing of the mechanical response signal is initiated following a time delay after identifying the tachycardia event to confirm that the tachycardia event is sustained.

3. The method of claim 1, wherein determining the regularity of the second mechanical response signal comprises extracting morphological features from the second mechanical response signal and the template.

4. The method of claim 3, wherein determining the regularity of the second mechanical response signal comprises:

calculating a feature correlation coefficient by comparing the morphological features extracted from the template and the morphological features extracted from the second mechanical response signal for multiple cardiac cycles of the subsequent tachycardia event; and

calculating a variance of the feature correlation coefficient for the multiple cardiac cycles, wherein a relatively larger variance indicates less regularity and a relatively smaller variance indicates greater regularity.

5. The method of claim 1, wherein determining regularity of the mechanical response signal comprises determining regularity of the second mechanical response signal over multiple cardiac cycles of the subsequent tachycardia event.

6. The method of claim 1, wherein selecting the one or more therapies to treat the subsequent tachycardia event comprises selecting between an anti-tachycardia pacing therapy and a cardioversion or defibrillation therapy, wherein the anti-tachycardia pacing therapy is selected if the subsequent tachycardia event is determined to be stable tachycardia and the cardioversion or defibrillation therapy is selected if the subsequent tachycardia event is determined to be unstable tachycardia.

7. The method of claim 1, wherein determining regularity of the second mechanical response signal relative to the threshold comprises comparing a metric indicative of the regularity of the second mechanical response signal to the threshold.

8. The method of claim 1, further comprising determining the threshold for the patient based on the patient'"'"'s normal sinus rhythm.

9. The method of claim 1, wherein determining the state of patient hemodynamics comprises quantizing the regularity of the mechanical response signal into one of at least three levels comprising high, medium, and low regularity using regularity thresholds between the levels, and wherein high regularity indicates stable hemodynamics, low regularity indicates unstable hemodynamics, and medium regularity indicates blunted hemodynamics.

10. A method, comprising:

identifying an event of tachycardia based on an electrical cardiac signal indicative of electrical activity of a patient'"'"'s heart;

sensing, within the patient and during the event of tachycardia, a mechanical response signal indicative of a mechanical response of the patient'"'"'s heart to the tachycardia;

determining a metric indicative of regularity of the mechanical response signal over a plurality of cardiac cycles of the tachycardia event relative to one or more thresholds established for the patient by computing an entropy estimate of the mechanical response signal'"'"'s regularity;

quantizing the regularity metric into one of a plurality of discrete levels of hemodynamic stability for assessing a state of patient hemodynamics during the tachycardia event; and

determining whether the tachycardia is stable or unstable based on the quantization of the regularity metric, wherein the steps of identifying, determining the metric, quantizing, and determining tachycardia stability are implemented at least in part by circuitry.

11. The method of claim 10, wherein quantizing the regularity metric into one of a plurality of discrete levels of hemodynamic stability comprises quantizing the regularity metric into one of three levels using two regularity thresholds, the three levels representative of very stable hemodynamics, very unstable hemodynamics, and blunted hemodynamics.

12. The method of claim 10, wherein the entropy estimate is computed as a negative natural logarithm of a conditional probability of the mechanical response signal being self-similar.

13. The method of claim 12, wherein the conditional probability ranges between 0 and 1, wherein 1 indicates that the mechanical response signal under investigation is regular and 0 indicates that the mechanical response signal is irregular.

14. The method of claim 10, wherein a larger entropy estimate indicates higher irregularity.

15. The method of claim 10, wherein the entropy estimate is indicative of the conditional probability estimate of the heart rhythm to be predictable or regular.

16. The method of claim 10, wherein the plurality of discrete levels of hemodynamic stability comprises stable and unstable levels, and the regularity metric is quantized into one of stable and unstable levels.

17. The method of claim 10, comprising delivering an anti-tachycardia therapy associated with the level of hemodynamic stability of the patient during the tachycardia event.

18. The method of claim 17, comprising tracking the patient'"'"'s hemodynamics to assess effectiveness of the anti-tachycardia therapy.

19. An implantable system, comprising:

an implantable cardiac mechanical sensor configured to produce a signal indicative of a mechanical response of a patient'"'"'s heart to an event of tachycardia;

a lead comprising one or more electrodes configured to receive an electrical signal indicative of electrical activity of the patient'"'"'s heart;

detection circuitry coupled to the lead;

energy delivery circuitry coupled to the lead; and

a processor coupled to the sensor, lead, detection circuitry, and energy delivery circuitry, the processor configured to identify a tachycardia event based on the electrical signal, receive the signal indicative of the mechanical response during the tachycardia event, determine regularity of the signal indicative of the mechanical response over a plurality of cardiac cycles of the tachycardia event relative to a threshold established for the patient by performing singular value decomposition on the signal, and determine a status of patient hemodynamics during the tachycardia event based at least in part on the regularity of the signal by determining whether the tachycardia event is stable tachycardia or unstable tachycardia based on the regularity of the signal, the processor configured to deliver one or more anti-tachycardia therapies associated with the hemodynamic status of the patient.

20. The system of claim 19, wherein a spread of eigenvalues or singular values from the performance of the singular value decomposition on the signal indicates elevated irregularity of cardiac rhythm during the tachycardia event.

21. The system of claim 19, wherein the processor performance of the singular value decomposition on the signal indicates dominance of the major component of the signal.

22. The system of claim 19, wherein the processor is configured to determine the state of patient hemodynamics during the tachycardia event by comparing a metric indicative of regularity of the signal to a threshold developed in relation to a normal sinus rhythm condition of the patient.

23. The system of claim 19, wherein the processor is configured to discriminate between a stable and an unstable state of patient hemodynamics based on regularity of the signal, and to deliver the one or more anti-tachycardia therapies based on stability of patient hemodynamics.

24. The system of claim 19, wherein the sensor comprises at least one of an intracardiac pressure sensor, an intravascular pressure sensor, an accelerometer, a microphone, an impedance sensor configured to sense transthoracic impedance, an impedance sensor configured to sense intracardiac impedance, and an impedance sensor configured to sense intra-myocardial impedance.

25. An implantable system, comprising:

an implantable cardiac mechanical sensor configured to produce a mechanical response signal indicative of a mechanical response of a patient'"'"'s heart to an event of tachycardia;

a lead comprising one or more electrodes configured to receive an electrical signal indicative of electrical activity of the patient'"'"'s heart;

detection circuitry coupled to the lead;

energy delivery circuitry coupled to the lead; and

a processor coupled to the sensor, lead, detection circuitry, and energy delivery circuitry, the processor configured to identify a tachycardia event based on the electrical signal, receive the mechanical response signal indicative of the mechanical response during the tachycardia event, determine regularity of at least a portion of the mechanical response signal that is indicative of the mechanical response of the patient'"'"'s heart to the tachycardia event over multiple cardiac cycles by determining the width of the dominant spectral peak of the mechanical response signal in the frequency domain, determine a status of patient hemodynamics during the tachycardia event by determining whether the tachycardia event is stable tachycardia or unstable tachycardia based on the regularity of the mechanical response signal, and deliver one or more anti-tachycardia therapies based on the hemodynamic status of the patient.