Detecting electrical conduction abnormalities in a heart

• US 8,391,964 B2
• Filed: 05/11/2009
• Issued: 03/05/2013
• Est. Priority Date: 05/11/2009
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Musley, Shailesh Kumar V., Splett, Vincent E., Sambelashvili, Aleksandre T.
• Primary Examiner(s): Patel, Niketa
• Assistant Examiner(s): LEVICKY, WILLIAM J
• Application Number:
  US12/463,470
• Publication Number:
  US 20100286541A1
• Time in Patent Office: 1,394 Days
• Field of Search: 600/510
• US Class Current: 600/510
• CPC Class Codes: A61B 5/02405 Determining heart rate variability
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/726 using Wavelet transforms
• CPC Class Codes: A61N 1/3702 Physiological parameters A61N1/365 takes precedence; evoked response A61N1/371

Abstract

Techniques are described for detecting conduction abnormalities in a heart of a patient. In particular, an IMD may be configured to obtain electrical signals corresponding to cardiac activity of the heart of the patient and periodically analyze a most recent electrical signal of the obtained electrical signals to detect an electrical conduction abnormality of the heart. The IMD adjusts a frequency at which the most recent electrical signal is analyzed based on at least one physiological parameter of the patient. For example, the IMD may increase the frequency at which the most recent electrical signal is analyzed when a heart rate parameter has significantly changed and the number of detected premature ventricular contractions (PVCs) is greater than or equal to a threshold number. In this manner, the most recent electrical signal is analyzed at a higher frequency in situations in which conduction abnormalities are more likely.

Claims

1. An implantable medical device (IMD) comprising:

a sensing module configured to acquire cardiac electrical signals corresponding to cardiac activity of a heart of a patient via at least one sensor; and

a processor configured to obtain the cardiac electrical signals corresponding to cardiac activity of the heart of the patient, periodically analyze, at a first frequency, a most recent cardiac electrical signal of the obtained cardiac electrical signals to monitor for an electrical conduction abnormality of the heart, compute at least a heart rate parameter of the patient and a number of premature ventricular contractions (PVCs) using the acquired cardiac electrical signals, compare the heart rate parameter of the patient to a heart rate parameter threshold, compare the number of PVCs to a PVC threshold, and increase the frequency at which the most recent electrical signal is analyzed to a second frequency when the heart rate parameter of the patient is greater than the heart rate parameter threshold and the number of PVCs detected is greater than the PVC threshold, wherein the first frequency and the second frequency are greater than zero.

2. The IMD of claim 1, wherein the processor decreases the frequency at which the most recent electrical signal is analyzed when the heart rate parameter falls below a second heart rate parameter threshold.

3. The IMD of claim 1, wherein the heart rate parameter comprises one of a heart rate and a relative change in the heart rate.

4. The IMD of claim 1, wherein the processor is configured to obtain a template electrogram and determine whether one or more characteristics of the most recent electrical signal have significantly changed relative to the template electrical signal.

5. The IMD of claim 4, wherein the processor analyzes one of an ST segment of the electrical signal, a T-wave segment of the electrical signal and a QRS segment of the electrical signal.

6. The IMD of claim 1, wherein the processor is configured to obtain an EGM corresponding with a most recent beat, obtain a template EGM corresponding to a beat during a normal sinus, and periodically analyze the most recent cardiac electrical signal by comparing the EGM corresponding with a most recent beat to the template EGM using a wavelet transform analysis.

7. The IMD of claim 1, wherein the electrical conduction abnormality is associated with at least one of a cardiac ischemia, a cardiac infarction, a branch bundle block, or fascicular block.

8. An implantable medical device comprising:

a sensing module configured to acquire cardiac electrical signals corresponding to cardiac activity of a heart of a patient via at least one sensor; and

a processor configured to obtain the cardiac electrical signals corresponding to cardiac activity of the heart of the patient, periodically analyze, at a first frequency, a most recent cardiac electrical signal of the obtained cardiac electrical signals to monitor for an electrical conduction abnormality of the heart, compute at least a heart rate parameter of the patient and a number of premature ventricular contractions (PVCs) using the acquired cardiac electrical signals, compare the heart rate parameter of the patient to a heart rate parameter threshold, compare the number of PVCs to a PVC threshold, increases the frequency at which the most recent electrical signal is analyzed to a second frequency that is larger than the first frequency when the heart rate parameter has changed by the heart parameter threshold and further increases the frequency at which the most recent electrical signal is analyzed to a third frequency that is larger than the second frequency when the number of detected premature ventricular contractions (PVCs) is greater than the PVC threshold.

9. A method comprising:

obtaining electrical signals corresponding to cardiac activity of a heart of a patient;

periodically analyzing, at a first frequency, a most recent electrical signal of the obtained electrical signals to monitor for an electrical conduction abnormality of the heart;

obtaining at least a heart rate parameter of the patient and a number of premature ventricular contractions (PVCs);

comparing the heart rate parameter of the patient to a heart rate parameter threshold;

comparing the number of PVCs to a PVC threshold; and

increasing the frequency at which the most recent electrical signal is analyzed to a second frequency when the heart rate parameter of the patient is greater than the heart rate parameter threshold and the number of PVCs detected is greater than the PVC threshold, wherein the first frequency and the second frequency are greater than zero.

10. The method of claim 9, further comprising decreasing the frequency at which the most recent electrical signal is analyzed when the heart rate parameter falls below a second heart rate parameter threshold.

11. The method of claim 9, wherein analyzing the most recent electrical signal of the heart comprises determining whether one or more characteristics of the most recent electrical signal have significantly changed relative to a template electrical signal.

12. The method of claim 11, wherein analyzing the most recent electrical signal of the heart comprises analyzing one of an ST segment of the electrical signal, a T-wave segment of the electrical signal and a QRS segment of the electrical signal.

13. The method of claim 9, wherein the electrical conduction abnormality is associated with at least one of a cardiac ischemia, a cardiac infarction, a branch bundle block, or a fascicular block.

14. The method of claim 9, further comprising performing one of a therapy delivery, a patient notification, an event log in memory and a transmission of a communication in response to detecting the electrical conduction abnormality.

15. The method of claim 9, wherein periodically analyzing a most recent cardiac electrical signal comprises comparing an EGM corresponding with a most recent beat to a template EGM corresponding to a beat during a normal sinus rhythm using a wavelet transform analysis.

16. An implantable medical device comprising:

obtaining electrical signals corresponding to cardiac activity of a heart of a patient;

periodically analyzing, at a first frequency, a most recent electrical signal of the obtained electrical signals to monitor for an electrical conduction abnormality of the heart;

obtaining at least a heart rate parameter of the patient and a number of premature ventricular contractions (PVCs)

comparing the heart rate parameter of the patient to a heart rate parameter threshold

comparing the number of PVCs to a PVC threshold;

increasing the frequency at which the most recent electrical signal is analyzed to a second frequency that is larger than the first frequency when the heart rate parameter has changed by the heart parameter threshold; and

further increasing the frequency at which the most recent electrical signal is analyzed to a third frequency that is larger than the second frequency when the number of detected premature ventricular contractions (PVCs) is greater than the PVC threshold.

17. An implantable medical device (IMD) comprising:

means for obtaining electrical signals corresponding to cardiac activity of a heart of a patient;

means for periodically analyzing, a first frequency, a most recent electrical signal of the obtained electrical signals to monitor for an electrical conduction abnormality of the heart;

means for obtaining at least a heart rate parameter of the patient and a number of premature ventricular contractions (PVCs);

means for comparing the heart rate parameter of the patient to a heart rate parameter threshold and the number of PVCs to a PVC threshold; and

means for increasing the frequency at which the most recent electrical signal is analyzed to a second frequency when the heart rate parameter of the patient is greater than the heart rate parameter threshold and the number of PVCs detected is greater than the PVC threshold, wherein the first frequency and the second frequency are greater than zero.

18. The device of claim 17, wherein the adjusting means further decreases the frequency at which the most recent electrical signal is analyzed when the heart rate parameter falls below a second heart rate parameter threshold.