Synchronization of electrical stimulation therapy to treat cardiac arrhythmias

• US 8,452,396 B2
• Filed: 12/30/2010
• Issued: 05/28/2013
• Est. Priority Date: 12/30/2010
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Berg, Gary L.
• Primary Examiner(s): Manuel, George
• Assistant Examiner(s): Wieland, Robert N
• Application Number:
  US12/982,603
• Publication Number:
  US 20120172942A1
• Time in Patent Office: 880 Days
• Field of Search: 607/5, 600/515
• US Class Current: 607/5
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means
• CPC Class Codes: A61N 1/37264 Changing the program; Upgrading firmware
• CPC Class Codes: A61N 1/37282 characterised by communication with experts in remote locations using a network
• CPC Class Codes: A61N 1/3925 Monitoring; Protecting
• CPC Class Codes: A61N 1/39622 Pacing therapy
• CPC Class Codes: A61N 1/3987 characterised by the timing or triggering of the shock

Abstract

Systems and methods are described for analyzing a plurality of beats after detection of a suspected cardiac arrhythmia to determine a beat discriminator, identify a beat subsequent to completion of charging of an implantable medical device by applying the beat discriminator, and synchronize delivery of a shock from the medical device to the identified beat. In some examples, identifying the beat using the beat discriminator may help to accurately synchronize the shock with a beat representative of physiological cardiac events instead of an oversensed beat, e.g., noise sensed signal that is misclassified as a cardiac beat.

Claims

1. A method comprising:

receiving a signal indicative of activity of a heart of a patient;

detecting beats within the signal;

detecting a suspected cardiac arrhythmia based on a plurality of the detected beats;

initiating charging of at least one component of an implantable device configured to deliver a shock to the heart of the patient to treat the cardiac arrhythmia in response to detecting the suspected cardiac arrhythmia;

analyzing the plurality of beats subsequent to the detection of the suspected cardiac arrhythmia to determine a beat discriminator;

in response to completion of the charging, applying the beat discriminator to the signal to identify a beat subsequent to the completion of the charging; and

synchronizing delivery of the shock to the identified beat.

2. The method of claim 1, further comprising resetting the beat discriminator subsequent to synchronizing delivery of the shock to the identified beat.

3. The method of claim 1, wherein analyzing the plurality of the beats subsequent to the detection of the suspected cardiac arrhythmia to determine a beat discriminator comprises analyzing the plurality of the beats during the charging of the at least one component to determine the beat discriminator.

11. The method of claim 1, wherein receiving a signal indicative of activity of a heart of a patient comprises receiving a plurality of signals indicative of activity of the heart of the patient, and wherein detecting beats within the signal comprises detecting beats within each of the plurality of signals and determining a number of beats within each of the plurality of signals, wherein the method further comprises:

comparing the number of beats within each of the plurality of signals to one another; and

selecting one of the plurality of signals based on the comparison.

12. The method of claim 1, further comprising:

displaying, via a display, a graphical representation of the signal and the beat discriminator; and

receiving feedback, via the display, wherein the feedback is related to the beat discriminator.

4. A method, comprising:

receiving a signal indicative of activity of a heart of a patient;

detecting beats within the signal;

detecting a suspected cardiac arrhythmia based on a plurality of the detected beats;

initiating charging of at least one component of an implantable device configured to deliver a shock to the heart of the patient to treat the cardiac arrhythmia in response to detecting the suspected cardiac arrhythmia;

analyzing the plurality of beats subsequent to the detection of the suspected cardiac arrhythmia to determine a beat discriminator;

in response to completion of the charging, applying the beat discriminator to the signal to identify a beat subsequent to the completion of the charging; and

synchronizing delivery of the shock to the identified beat,

wherein analyzing the plurality of beats subsequent to the detection of the suspected cardiac arrhythmia to determine a beat discriminator comprises;

analyzing a plurality of amplitude values, wherein each of the plurality of amplitude values is associated with a respective one of the plurality of beats; and

determining that the plurality of amplitude values comprises a first group of amplitude values and a second group of amplitude values based on analyzing the plurality of amplitude values,

wherein applying the beat discriminator to the signal to identify a beat comprises identifying a beat having an amplitude value falling within the first group of amplitude values.

5. The method of claim 4, wherein the first group of amplitude values at least partially represents a group of physiological cardiac events of the patient and wherein the second group of amplitude values at least partially represents electrical noise.

6. The method of claim 4, further comprising determining a threshold amplitude value greater than each of the amplitude values in the second group of amplitude values, wherein identifying a beat having an amplitude value falling within the first group of amplitude values comprises identifying a beat based on applying the threshold amplitude value to the signal subsequent to completion of the charging.

7. The method of claim 4, wherein each of the amplitude values of the first group of amplitude values exceeds each of the amplitude values of the second group of amplitude values by at least a predetermined value.

8. The method of claim 7, wherein the predetermined value is approximately 0.5 milliVolts (mV).

9. The method of claim 7, wherein analyzing the plurality of beats occurs during a particular amount of time, and wherein the method further comprises determining that the first group of amplitude values includes an appropriate number of amplitude values relative to the particular amount of time, and wherein synchronizing delivery of the shock to the identified beat comprises synchronizing delivery of the shock to the identified beat if the first group of amplitude values includes an appropriate number of amplitude values relative to the particular amount of time.

10. The method of claim 9,

further comprising determining a threshold amplitude value greater than each of the amplitude values in the second group of amplitude values, wherein identifying a beat having an amplitude value falling within the first group of amplitude values comprises identifying a beat based on applying the threshold amplitude value to the signal subsequent to completion of the charging,

wherein the method further comprises modifying the threshold amplitude value until the first group of amplitude values includes the appropriate number of amplitude values.

13. A system comprising:

a signal generator configured to deliver a shock to a heart of a patient to treat a cardiac arrhythmia of the patient;

a sensing module configured to sense a signal indicative of activity of the heart of the patient; and

a processor comprising;

a signal receiving module configured to receive the signal,

a beat detection module configured to detect beats within the signal,

an arrhythmia detection module configured to detect a suspected cardiac arrhythmia based on a plurality of the detected beats,

a charge initiating module configured to initiate charging of at least one component of the signal generator in response to detecting the suspected cardiac arrhythmia,

a beat analysis module configured to analyze the plurality of the beats subsequent to the detection of the suspected cardiac arrhythmia to determine a beat discriminator,

a beat identification module configured to, in response to completion of the charging of the signal generator, apply the beat discriminator to the signal to identify a beat subsequent to the completion of the charging of the signal generator, and

a shock synchronization module configured to control the signal generator to synchronize delivery of the shock to the identified beat.

14. The system of claim 13, wherein the beat analysis module analyzes the plurality of beats during the charging of the at least one component to determine the beat discriminator.

15. A system, comprising:

a signal generator configured to deliver a shock to a heart of a patient to treat a cardiac arrhythmia of the patient;

a sensing module configured to sense a signal indicative of activity of the heart of the patient; and

a processor comprising;

a signal receiving module configured to receive the signal,

a beat detection module configured to detect beats within the signal,

an arrhythmia detection module configured to detect a suspected cardiac arrhythmia based on a plurality of the detected beats,

a charge initiating module configured to initiate charging of at least one component of the signal generator in response to detecting the suspected cardiac arrhythmia,

a beat analysis module configured to analyze the plurality of the beats subsequent to the detection of the suspected cardiac arrhythmia to determine a beat discriminator,

a beat identification module configured to, in response to completion of the charging of the signal generator, apply the beat discriminator to the signal to identify a beat subsequent to the completion of the charging of the signal generator, and

a shock synchronization module configured to control the signal generator to synchronize delivery of the shock to the identified beat,

wherein the beat analysis module analyzes the plurality of beats by analyzing a plurality of amplitude values, wherein each of the plurality of amplitude values is associated with a respective one of the plurality of beats, and determines that the plurality of amplitude values comprises a first group of amplitude values and a second group of amplitude values based on analyzing the plurality of amplitude values, and wherein the beat identification module applies the beat discriminator to the signal to identify a beat by identifying a beat having an amplitude value falling within the first group of amplitude values.

16. The system of claim 15, wherein the first group of amplitude values at least partially represents a group of physiological cardiac events of the patient and wherein the second group of amplitude values at least partially represents electrical noise.

17. The system of claim 15, wherein the processor is configured to determine a threshold amplitude value greater than each of the amplitude values in the second group of amplitude values and wherein the beat identification module applies the beat discriminator to the signal to identify a beat subsequent to the completion of the charging by identifying a beat based on applying the threshold amplitude value to the signal subsequent to completion of the charging.

18. The system of claim 15, wherein each of the amplitude values of the first group of amplitude values exceeds each of the amplitude values of the second group of amplitude values by at least a predetermined value.

19. A system comprising:

means for receiving a signal indicative of activity of a heart of a patient;

means for detecting beats within the signal;

means for detecting a suspected cardiac arrhythmia based on a plurality of the detected beats;

means for initiating charging of at least one component of an implantable device configured to deliver a shock to the heart of the patient to treat the cardiac arrhythmia in response to detecting the suspected cardiac arrhythmia;

means for analyzing the plurality of the beats subsequent to the detection of the suspected cardiac arrhythmia to determine a beat discriminator;

means for, in response to completion of the charging, applying the beat discriminator to the signal to identify a beat subsequent to the completion of the charging; and

means for synchronizing delivery of the shock to the identified beat.

20. A system, comprising:

means for receiving a signal indicative of activity of a heart of a patient;

means for detecting beats within the signal;

means for detecting a suspected cardiac arrhythmia based on a plurality of the detected beats;

means for initiating charging of at least one component of an implantable device configured to deliver a shock to the heart of the patient to treat the cardiac arrhythmia in response to detecting the suspected cardiac arrhythmia;

means for analyzing the plurality of the beats subsequent to the detection of the suspected cardiac arrhythmia to determine a beat discriminator;

means for, in response to completion of the charging, applying the beat discriminator to the signal to identify a beat subsequent to the completion of the charging; and

means for synchronizing delivery of the shock to the identified beat,

wherein the means for analyzing a plurality of the beats analyzes the plurality of beats by analyzing a plurality of amplitude values, wherein each of the plurality of amplitude values is associated with a respective one of the plurality of beats, and determines that the plurality of amplitude values comprises a first group of amplitude values and a second group of amplitude values based on analyzing the plurality of amplitude values, and wherein the means for applying the beat discriminator applies the beat discriminator to the signal to identify a beat by identifying a beat having an amplitude value falling within the first group of amplitude values.

21. The system of claim 20, wherein the first group of amplitude values at least partially represents a group of physiological cardiac events of the patient and wherein the second group of amplitude values at least partially represents electrical noise.

22. A non-transitory computer-readable storage medium comprising instructions that cause a processor to:

receive a signal indicative of activity of a heart of a patient;

detect beats within the signal;

detect a suspected cardiac arrhythmia based on a plurality of the detected beats;

initiate charging of at least one component of an implantable device configured to deliver a shock to the heart of the patient to treat the cardiac arrhythmia in response to detecting the suspected cardiac arrhythmia;

analyze the plurality of the beats subsequent to the detection of the suspected cardiac arrhythmia to determine a beat discriminator;

in response to completion of the charging, apply the beat discriminator to the signal to identify a beat subsequent to the completion of the charging; and

synchronize delivery of the shock to the identified beat.

23. A non-transitory computer-readable storage medium, comprising:

receive a signal indicative of activity of a heart of a patient;

detect beats within the signal;

detect a suspected cardiac arrhythmia based on a plurality of the detected beats;

initiate charging of at least one component of an implantable device configured to deliver a shock to the heart of the patient to treat the cardiac arrhythmia in response to detecting the suspected cardiac arrhythmia;

analyze the plurality of the beats subsequent to the detection of the suspected cardiac arrhythmia to determine a beat discriminator;

in response to completion of the charging, apply the beat discriminator to the signal to identify a beat subsequent to the completion of the charging; and

synchronize delivery of the shock to the identified beat,

wherein the instructions cause the processor to analyze the plurality of beats subsequent to the detection of the suspected cardiac arrhythmia to determine a beat discriminator analyzing a plurality of amplitude values, wherein each of the plurality of amplitude values is associated with a respective one of the plurality of beats, and determine that the plurality of amplitude values comprises a first group of amplitude values and a second group of amplitude values based on analyzing the plurality of amplitude values, wherein the instructions cause the processor to apply the beat discriminator to the signal to identify a beat by identifying a beat having an amplitude value falling within the first group of amplitude values.

24. The computer-readable storage medium of claim 23, wherein the first group of amplitude values at least partially represents a group of physiological cardiac events of the patient and wherein the second group of amplitude values at least partially represents electrical noise.