Methods and systems for determining if an arrhythmia initiated in an atrium or a ventricle

• US 8,374,691 B2
• Filed: 01/10/2011
• Issued: 02/12/2013
• Est. Priority Date: 01/10/2011
• Status: Active Grant

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Inventors: Lall, Carolyn
• Primary Examiner(s): Holmes, Rex R
• Application Number:
  US12/987,487
• Publication Number:
  US 20120179220A1
• Time in Patent Office: 764 Days
• Field of Search: 600/510, 600/518, 607/4, 607/14, 607 17- 18
• US Class Current: 607/14
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• CPC Class Codes: A61B 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 5/30 Input circuits therefor
• CPC Class Codes: A61B 5/308 for electrocardiography [ECG]
• CPC Class Codes: A61B 5/363 Detecting tachycardia or bradycardia
• 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 1/39622 Pacing therapy

Abstract

Validated atrial and/or ventricular interval decreases are used to discriminate between VT and SVT. Atrial and/or ventricular intervals are monitored in order to detect decreases in such intervals (which are indicative in increases in rate). The atrial intervals can be, e.g., AA intervals, and the ventricular intervals can be, e.g., VV intervals. A detected atrial and/or ventricular interval decrease can be a decrease that is greater than an interval decrease threshold. Detected atrial and/or ventricular interval decreases can be validated by examining atrial and/or ventricular intervals before and after a detected atrial and/or ventricular interval decrease. The use of the validated atrial and/or ventricular interval decreases to classify an arrhythmia as SVT or VT can be called arrhythmia initiation analysis, since it is believed to determine whether the initiation of the arrhythmia is in an atrium or a ventricle.

Claims

1. For use by an implantable system, a method for discriminating between ventricular tachycardia (VT) and supraventricular tachycardia (SVT), comprising:

(a) detecting atrial intervals indicative of atrial rate and ventricular intervals indicative of ventricular rate within a window leading up to and following the onset of a tachycardia;

(b) determining whether a valid atrial interval decrease is detected within the window by

(b.1) determining whether an atrial interval decrease that is greater than an atrial interval decrease threshold is detected for a pair of consecutive atrial intervals within the window, and

(b.2) if the atrial interval decrease is detected, determining whether the detected atrial interval decrease is valid based on atrial intervals before and after the detected atrial interval decrease;

(c) determining whether a valid ventricular interval decrease is detected within the window by

(c.1) determining whether a ventricular interval decrease that is greater than a ventricular interval decrease threshold is detected for a pair of consecutive ventricular intervals within the window, and

(c.2) if the ventricular interval decrease is detected, determining whether the detected ventricular interval decrease is valid based on ventricular intervals before and after the detected ventricular interval decrease; and

(d) discriminating between VT and SVT based on results of step (b) and (c);

wherein step (d) comprises determining that the detected atrial intervals and the detected ventricular intervals within the window are indicative of SVT if both a valid atrial interval decrease is detected and a valid ventricular interval decrease is detected within the window, and the valid atrial interval change occurs prior to the valid ventricular interval change.

2. The method of claim 1, wherein:

step (b.2) comprises determining that the detected atrial interval decrease is valid if a predetermined number of atrial intervals before the detected atrial interval decrease are each greater than a preceding atrial interval threshold, and a predetermined number of atrial intervals after the detected atrial interval decrease are each less than a succeeding atrial interval threshold; and

step (c.2) comprises determining that the detected ventricular interval decrease is valid if a predetermined number of ventricular intervals before the detected ventricular interval decrease are each greater than a preceding ventricular interval threshold, and a predetermined number of ventricular intervals after the detected ventricular interval decrease are each less than a succeeding ventricular interval threshold.

3. The method of claim 2, wherein:

step (b.2) comprises determining that the detected atrial interval decrease is valid if at least N of M atrial intervals before the detected atrial interval decrease are each greater than the preceding atrial interval threshold, and at least X of Y atrial intervals after the detected atrial interval decrease are each less than the succeeding atrial interval threshold; and

step (c.2) comprises determining that the detected ventricular interval decrease is valid if at least N of M ventricular intervals before the detected ventricular interval decrease are each greater than the preceding ventricular interval threshold, and at least X of Y ventricular intervals after the detected ventricular interval decrease are each less than the succeeding ventricular interval threshold.

4. The method of claim 1, wherein:

step (d) comprises determining that the detected atrial intervals and the detected ventricular intervals within the window are indicative of SVT if no valid atrial interval decrease is detected and no valid ventricular interval decrease is detected within the window.

5. The method of claim 1, wherein:

step (d) comprises determining that the detected atrial intervals and the detected ventricular intervals within the window are indicative of SVT if a valid atrial interval decrease is detected and no valid ventricular interval decrease is detected within the window.

6. The method of claim 1, wherein:

step (d) comprises determining that the detected atrial intervals and the detected ventricular intervals within the window are indicative of VT if no valid atrial interval decrease is detected and a valid ventricular interval decrease is detected within the window.

7. The method of claim 1, wherein step (d) comprises:

(d.1) determining that the detected atrial intervals and the detected ventricular intervals within the window are indicative of SVT if

(d.1.a) no valid atrial interval decrease is detected and no valid ventricular interval decrease is detected within the window,

(d.1.b) a valid atrial interval decrease is detected and no valid ventricular interval decrease is detected within the window, or

(d.1.c) both a valid atrial interval decrease is detected and a valid ventricular interval decrease is detected within the window, and the valid atrial interval change occurs prior to the valid ventricular interval change; and

(d.2) determining that the detected atrial intervals and the detected ventricular intervals within the window are indicative of VT if

(d.2.a) no valid atrial interval decrease is detected and a valid ventricular interval decrease is detected within the window, or

(d.2.b) both a valid atrial interval decrease is detected and a valid ventricular interval decrease is detected within the window, and the valid ventricular interval change occurs prior to the valid atrial interval change.

8. The method of claim 1, further comprising:

(e) providing a first type of cardiac therapy if it is determined at step (d) that the detected tachycardia is VT; and

(f) providing a second type of cardiac therapy if it is determined at step (d) that the detected tachycardia is SVT.

9. The method of claim 1, further comprising monitoring for a tachycardia, and performing steps (a), (b), (c) and (d) in response to detecting a tachycardia.

10. The method of claim 1, further comprising monitoring for a tachycardia, and performing steps (a), (b), (c) and (d) in response to detecting a tachycardia where the ventricular rate exceeds a VT threshold but does not exceed a ventricular fibrillation (VF) threshold.

11. The method of claim 1, further comprising monitoring for a tachycardia, and performing steps (a), (b), (c) and (d) in response to detecting a tachycardia where the ventricular rate is less than or substantially equal to the atrial rate.

16. The implantable system of claim 1, wherein:

the arrhythmia detector is configured to determine that the detected atrial interval decrease is valid if at least N of M atrial intervals before the detected atrial interval decrease are each greater than the preceding atrial interval threshold, and at least X of Y atrial intervals after the detected atrial interval decrease are each less than the succeeding atrial interval threshold; and

the arrhythmia detector is configured to determine that the detected ventricular interval decrease is valid if at least N of M ventricular intervals before the detected ventricular interval decrease are each greater than the preceding ventricular interval threshold, and at least X of Y predetermined number of ventricular intervals after the detected ventricular interval decrease are each less than the succeeding ventricular interval threshold.

12. For use by an implantable system, a method for discriminating between ventricular tachycardia (VT) and supraventricular tachycardia (SVT), comprising:

(a) detecting atrial intervals indicative of atrial rate and ventricular intervals indicative of ventricular rate within a window leading up to and following the onset of a tachycardia;

(b) determining whether a valid atrial interval decrease is detected within the window by

(b.1) determining whether an atrial interval decrease that is greater than an atrial interval decrease threshold is detected for a pair of consecutive atrial intervals within the window, and

(b.2) if the atrial interval decrease is detected, determining whether the detected atrial interval decrease is valid based on atrial intervals before and after the detected atrial interval decrease;

(c) determining whether a valid ventricular interval decrease is detected within the window by

(c.1) determining whether a ventricular interval decrease that is greater than a ventricular interval decrease threshold is detected for a pair of consecutive ventricular intervals within the window, and

(c.2) if the ventricular interval decrease is detected, determining whether the detected ventricular interval decrease is valid based on ventricular intervals before and after the detected ventricular interval decrease; and

(d) discriminating between VT and SVT based on results of step (b) and (c);

wherein step (d) comprises determining that the detected atrial intervals and the detected ventricular intervals within the window are indicative of VT if both a valid atrial interval decrease is detected and a valid ventricular interval decrease is detected within the window, and the valid ventricular interval change occurs prior to the valid atrial interval change.

13. An implantable system capable of discriminating between ventricular tachycardia (VT) and supraventricular tachycardia (SVT), comprising:

a monitor configured to detect atrial intervals indicative of atrial rate and ventricular intervals indicative of ventricular rate within a window leading up to and following the onset of a tachycardia; and

an arrhythmia discriminator configured to;

determine whether a valid atrial interval decrease is detected within the window by determining whether an atrial interval decrease that is greater than an atrial interval decrease threshold is detected for a pair of consecutive atrial intervals within the window,

if the atrial interval decrease is detected, determine whether the detected atrial interval decrease is valid based on atrial intervals before and after the detected atrial interval decrease,

determine whether a valid ventricular interval decrease is detected within the window by determining whether a ventricular interval decrease that is greater than a ventricular interval decrease threshold is detected for a pair of consecutive ventricular intervals within the window,

if the ventricular interval decrease is detected, determine whether the detected ventricular interval decrease is valid based on ventricular intervals before and after the detected ventricular interval decrease, and

discriminate between VT and SVT based on the determinations;

wherein the arrhythmia detector is configured to determine that the detected atrial intervals and the detected ventricular intervals within the window are indicative of SVT if both a valid atrial interval decrease is detected and a valid ventricular interval decrease is detected within the window, and the valid atrial interval change occurs prior to the valid ventricular interval change.

14. An implantable system capable of discriminating between ventricular tachycardia (VT) and supraventricular tachycardia (SVT), comprising:

a monitor configured to detect atrial intervals indicative of atrial rate and ventricular intervals indicative of ventricular rate within a window leading up to and following the onset of a tachycardia; and

an arrhythmia discriminator configured to;

determine whether a valid atrial interval decrease is detected within the window by determining whether an atrial interval decrease that is greater than an atrial interval decrease threshold is detected for a pair of consecutive atrial intervals within the window,

if the atrial interval decrease is detected, determine whether the detected atrial interval decrease is valid based on atrial intervals before and after the detected atrial interval decrease,

determine whether a valid ventricular interval decrease is detected within the window by determining whether a ventricular interval decrease that is greater than a ventricular interval decrease threshold is detected for a pair of consecutive ventricular intervals within the window,

if the ventricular interval decrease is detected, determine whether the detected ventricular interval decrease is valid based on ventricular intervals before and after the detected ventricular interval decrease, and

discriminate between VT and SVT based on the determinations;

wherein the arrhythmia detector is configured to determine that the detected atrial intervals and the detected ventricular intervals within the window are indicative of VT if both a valid atrial interval decrease is detected and a valid ventricular interval decrease is detected within the window, and the valid ventricular interval change occurs prior to the valid atrial interval change.

15. The implantable system of claim 14, wherein:

the arrhythmia detector is configured to determine that the detected atrial interval decrease is valid if a predetermined number of atrial intervals before the detected atrial interval decrease are each greater than a preceding atrial interval threshold, and a predetermined number of atrial intervals after the detected atrial interval decrease are each less than a succeeding atrial interval threshold; and

the arrhythmia detector is configured to determine that the detected ventricular interval decrease is valid if a predetermined number of ventricular intervals before the detected ventricular interval decrease are each greater than a preceding ventricular interval threshold, and a predetermined number of ventricular intervals after the detected ventricular interval decrease are each less than a succeeding ventricular interval threshold.

17. The implantable system of claim 14, wherein:

the arrhythmia detector is configured to determine that the detected atrial intervals and the detected ventricular intervals within the window are indicative of SVT if no valid atrial interval decrease is detected and no valid ventricular interval decrease is detected within the window.

18. The implantable system of claim 14, wherein:

the arrhythmia detector is configured to determine that the detected atrial intervals and the detected ventricular intervals within the window are indicative of SVT if a valid atrial interval decrease is detected and no valid ventricular interval decrease is detected within the window.

19. The implantable system of claim 14, wherein:

the arrhythmia detector is configured to determine that the detected atrial intervals and the detected ventricular intervals within the window are indicative of VT if no valid atrial interval decrease is detected and a valid ventricular interval decrease is detected within the window.

20. The implantable system of claim 14, wherein:

the arrhythmia detector is configured to discriminate between VT and SVT based on the determination and additional criteria.

21. The implantable system of claim 14, wherein the implantable system provides a first type of cardiac therapy if it is determined that the detected tachycardia is VT;

and

provides a second type of cardiac therapy if it is determined that the detected tachycardia is SVT.