Methods and systems for managing fusion and noise in cardiac pacing response classification
First Claim
1. A method for managing fusion, indeterminate or erroneous pacing responses, comprising:
- delivering a first pacing pulse to a heart during a capture threshold test for determining a capture threshold of the heart;
sensing a cardiac response associated with the first pacing pulse;
delivering one or more pacing pulses to the heart at a higher energy level that is expected to capture the heart if the cardiac response associated with the first pacing pulse is determined to be at least one of fusion, indeterminate, and erroneous;
classifying one or more cardiac responses respectively associated with the one or more pacing pulses delivered at the higher energy level that is expected to capture the heart as at least one of capture, fusion, indeterminate and erroneous;
continuing to deliver the one or more pacing pulses at the higher energy level that is expected to capture the heart if each of the one or more cardiac responses is classified as at least one of fusion, indeterminate, and erroneous, and wherein the capture threshold test is terminated if none of a predetermined number of the one or more pacing pulses delivered at the higher energy level that is expected to capture the heart produces the capture response.
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Abstract
Methods and systems for detecting noise in cardiac pacing response classification processes involve determining that a cardiac response classification is possibly erroneous if unexpected signal content is detected. The unexpected signal content may comprise signal peaks that have polarity opposite to the polarity of peaks used to determine the cardiac response to pacing. Fusion/noise management processes include pacing at a relatively high energy level until capture is detected after a fusion, indeterminate, or possibly erroneous pacing response classification is made. The relatively high energy pacing pulses may be delivered until capture is detected or until a predetermined number of paces are delivered.
74 Citations
12 Claims
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1. A method for managing fusion, indeterminate or erroneous pacing responses, comprising:
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delivering a first pacing pulse to a heart during a capture threshold test for determining a capture threshold of the heart; sensing a cardiac response associated with the first pacing pulse; delivering one or more pacing pulses to the heart at a higher energy level that is expected to capture the heart if the cardiac response associated with the first pacing pulse is determined to be at least one of fusion, indeterminate, and erroneous; classifying one or more cardiac responses respectively associated with the one or more pacing pulses delivered at the higher energy level that is expected to capture the heart as at least one of capture, fusion, indeterminate and erroneous; continuing to deliver the one or more pacing pulses at the higher energy level that is expected to capture the heart if each of the one or more cardiac responses is classified as at least one of fusion, indeterminate, and erroneous, and wherein the capture threshold test is terminated if none of a predetermined number of the one or more pacing pulses delivered at the higher energy level that is expected to capture the heart produces the capture response. - View Dependent Claims (2, 3, 4)
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5. A method for managing fusion, indeterminate or possibly erroneous pacing responses, comprising:
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delivering a first pacing pulse to a heart chamber; delivering one or more pacing pulses to the heart chamber if a cardiac response associated with the first pacing pulse is at least one of fusion, indeterminate, and possibly erroneous, the one or more pacing pulses having a pacing energy greater than the first pacing pulse; determining one or more cardiac responses respectively associated with the one or more pacing pulses; continuing to deliver the one or more pacing pulses if each of the one or more cardiac responses is at least one of fusion, indeterminate, and possibly erroneous or until a predetermined number of the one or more pacing pulses has been delivered; and determining that a sensing channel for sensing the cardiac responses is unacceptably noisy if none of the predetermined number of the one or more pacing pulses produces a capture response.
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6. A cardiac rhythm management device, comprising:
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a pulse generator configured to deliver pacing pulses to a heart; a sensing circuit configured to sense cardiac signals of the heart, the sensed cardiac signals respectively associated with the pacing pulses; and a processor coupled to the sensing circuit and the pulse generator, the processor configured to perform a capture threshold test for determining a capture threshold of the heart including delivering a first pacing pulse to the heart, and to receive a sensed signal from the sensing circuit indicative of a cardiac response associated with at least the first pacing pulse, deliver one or more pacing pulses having a pacing energy greater than the first pacing pulse and that is expected to capture the heart if a cardiac response associated with the first pacing pulse is determined to be at least one of fusion, indeterminate, and erroneous, classify one or more cardiac responses respectively associated with the one or more pacing pulses delivered at the pacing energy greater than the first pacing pulse and that is expected to capture the heart, and to continue to deliver the one or more pacing pulses at the pacing energy greater than the first pacing pulse and that is expected to capture the heart if each of the one or more cardiac responses is classified as at least one of fusion, indeterminate, and erroneous, and to terminate the capture threshold test if none of a predetermined number of the one or more pacing pulses having a pacing energy greater than the first pacing pulse and that is expected to produce capture produces a capture response. - View Dependent Claims (7, 8)
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9. A cardiac rhythm management device, comprising:
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a pulse generator configured to deliver pacing pulses to a heart chamber; a sensing circuit configured to sense cardiac signals of the heart chamber, the sensed cardiac signals respectively associated with the pacing pulses; a processor coupled to the sensing circuit and the pulse generator, the processor configured to deliver a first pacing pulse to the heart chamber, deliver one or more pacing pulses having a pacing energy greater than the first pacing pulse to the heart chamber if a cardiac response associated with the first pacing pulse is at least one of fusion, indeterminate, and possibly erroneous, determine one or more cardiac responses respectively associated with the one or more pacing pulses, and continue to deliver the one or more pacing pulses if each of the one or more cardiac responses is at least one of fusion, indeterminate, and possibly erroneous; and wherein the processor is configured to continue to deliver the one or more pacing pulses until a predetermined number of the one or more pacing pulses has been delivered, and to determine that a sensing channel for sensing the cardiac responses is unacceptably noisy if none of the predetermined number of the one or more pacing pulses produces a capture response.
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10. A cardiac rhythm management system for managing fusion, indeterminate or erroneous pacing responses, the system comprising:
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means for determining that a cardiac response associated with a first pacing pulse delivered during a capture threshold test for determining a capture threshold of a heart is at least one of fusion, indeterminate, and erroneous; means for delivering one or more pacing pulses having a pacing energy greater than that of the first pacing pulse and that is expected to capture the heart if the cardiac response associated with the first pacing pulse is determined to be at least one of fusion, indeterminate, and erroneous; means for classifying a cardiac response associated with each of the one or more pacing pulses; means for continuing to deliver the one or more pacing pulses having the pacing energy greater than that of the first pacing pulse if the cardiac response associated with each of the one or more pacing pulses is classified as at least one of fusion, indeterminate, and erroneous; and means for terminating the capture threshold test if none of a predetermined number of the one or more pacing pulses having a pacing energy greater than that of the first pacing pulse produces a capture response. - View Dependent Claims (11, 12)
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Specification