Rhythm discrimination using information indicative of lead motion

• US 8,478,392 B2
• Filed: 06/24/2011
• Issued: 07/02/2013
• Est. Priority Date: 06/29/2010
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Sweeney, Robert J., Shuros, Allan C., Siejko, Krzysztof Z., Olson, David C., Ingle, Frank
• Primary Examiner(s): MANUEL, GEORGE C
• Application Number:
  US13/168,481
• Publication Number:
  US 20110319779A1
• Time in Patent Office: 739 Days
• Field of Search: 600/515
• US Class Current: 600/515
• CPC Class Codes: A61B 5/02133 by using induced vibration of the blood vessel
• CPC Class Codes: A61B 5/026 Measuring blood flow A61B3/1233, A61B3/1241 take precedence
• CPC Class Codes: A61N 1/36142 for improving safety
• 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 1/36578 controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone

Abstract

Systems and methods for rhythm discrimination using the motion of an implantable lead are described. In an example, an implantable medical device can include a receiver circuit configured to be electrically coupled to an implantable lead and be configured to obtain information indicative of a movement of the implantable lead due at least in part to a motion of a heart. The device can include an arrhythmia detection circuit configured to determine an arrhythmia status using the information indicative of the movement of the implantable lead and an arrhythmia classification circuit configured to determine one or more of a location or a type of an arrhythmia, using the information indicative of the movement of the implantable lead, when the arrhythmia status indicates that an arrhythmia is occurring or has occurred.

Claims

1. An apparatus including an implantable medical device, the implantable medical device (IMD) comprising:

a receiver circuit, configured to be electrically coupled to an implantable lead, the receiver circuit configured to receive a response to an excitation signal applied to a conductor in the lead, the response modulated according to a change in an electrical characteristic of at least one conductor in the lead to provide information indicative of a movement of the implantable lead, the movement due at least in part to a motion of a heart;

an arrhythmia detection circuit configured to determine an arrhythmia status using the response information indicative of the movement of the implantable lead; and

an arrhythmia classification circuit, coupled to the arrhythmia detection circuit, the arrhythmia classification circuit configured to determine one or more of a location or a type of an arrhythmia, using the response information indicative of the movement of the implantable lead, in response to the arrhythmia detection circuit determining an arrhythmia status indicating that an arrhythmia is occurring or has occurred.

2. The apparatus of claim 1, wherein the arrhythmia classification circuit is configured to determine the location of the arrhythmia.

3. The apparatus of claim 1, wherein the arrhythmia classification circuit is configured to determine the type of the arrhythmia.

4. The apparatus of claim 1, wherein the IMD comprises an excitation circuit configured to provide a non-tissue stimulating, non-therapeutic electrical excitation signal to the implantable lead, the signal comprising a time varying signal including a first range of frequencies.

5. The apparatus of claim 4, wherein the information indicative of a movement of the implantable lead includes one or more of magnitude information, or phase information, corresponding to one or more frequencies included in the first range of frequencies, the magnitude information, or phase information, determined at least in part using an electrical response signal provided by the implantable lead in response to the excitation signal and the movement of the implantable lead.

6. The apparatus of claim 5, wherein one or more of the magnitude information, or the phase information, includes a time-varying portion corresponding to the movement of the implantable lead.

7. The apparatus of claim 1, further comprising an implantable lead configured to be located within or near the heart, the implantable lead including an electrode configured to provide one or more of electrostimulation to the heart or to sense cardiac electrical activity.

8. The apparatus of claim 7, wherein the implantable lead comprises a piezoelectric acoustic transducer configured to receive acoustic information indicative of the movement of the implantable lead, the piezoelectric acoustic transducer coupled to a conductor included in the implantable lead.

9. The apparatus of claim 1, wherein the arrhythmia classification circuit is configured to determine one or more of an arrhythmia type or arrhythmia location using morphology information or interval information indicative of lead movement corresponding to successive cardiac cycles.

10. The apparatus of claim 1, wherein the IMD comprises a sensing circuit configured to obtain information indicative of cardiac electrical activity, the sensing circuit coupled to the arrhythmia detection circuit;

and

wherein the arrhythmia detection circuit is configured to determine an arrhythmia status using the information indicative of the movement of the implantable lead and information obtained via the sensing circuit.

11. The apparatus of claim 1, wherein the receiver circuit is configured to obtain information indicative of lead motion from at least two different locations within or near the heart;

and

wherein the arrhythmia classification circuit is configured to determine the one or more of the type or location of the arrhythmia using information about the location of lead motion.

12. The apparatus of claim 11, further comprising a first lead located within or near a first location of the heart;

and

a second lead located within or near a second location of the heart.

13. The apparatus of claim 1, comprising a therapy generation circuit, coupled to the arrhythmia classification circuit, the therapy generation circuit configured to provide a therapy in response to information about at least one of the arrhythmia status or the location or the type of an arrhythmia.

14. The apparatus of claim 13, wherein the therapy generation circuit is configured to be inhibited from generating an arrhythmia therapy when the information about at least one of the arrhythmia status or the location or the type of an arrhythmia indicates that an arrhythmia is one or more of supraventricular in origin or hemodynamically stable.

15. The apparatus of claim 1, wherein the arrhythmia detection circuit is configured to determine interval information about one or more time intervals between successive cardiac contractions;

and

wherein the arrhythmia detection circuit is configured to determine an arrhythmia status using the interval information.

16. An implantable medical device (IMD) including a processor-readable medium comprising instructions that, when executed by the processor, cause the IMD to:

obtain a response to an excitation signal applied to a conductor in an implantable lead, the response modulated according to a change in an electrical characteristic of at least one conductor in the lead to provide information indicative of a movement of the implantable lead, the movement due at least in part to a motion of a heart;

determine an arrhythmia status using the response information indicative of the movement of the implantable lead; and

determine one or more of a location or a type of an arrhythmia, using the response information indicative of the movement of the implantable lead, in response to the determined arrhythmia status indicating that an arrhythmia is occurring or has occurred.

17. The IMD of claim 16, wherein the processor readable medium comprises instructions that, when executed by the processor, cause the IMD to determine a location of an arrhythmia, using the information indicative of the movement of the implantable lead, in response to the determination that an arrhythmia is occurring or has occurred.

18. The IMD of claim 16, wherein the processor readable medium comprises instructions that, when executed by the processor, cause the IMD to determine a type of an arrhythmia, using the information indicative of the movement of the implantable lead, in response to the determination that an arrhythmia is occurring or has occurred.

19. The IMD of claim 16, wherein the processor readable medium comprises instructions that, when executed by the processor, cause the IMD to:

determine interval information about one or more time intervals between successive cardiac contractions; and

determine the arrhythmia status using the interval information.

20. The IMD of claim 16, wherein the processor-readable medium comprises instructions that, when executed by the processor, cause the IMD to determine one or more of an arrhythmia type or an arrhythmia location using morphology information or interval information indicative of lead movement corresponding to successive cardiac cycles.

21. The IMD of claim 16, wherein the processor-readable medium comprises instructions that, when executed by the processor, cause the IMD to:

obtain information indicative of cardiac electrical activity; and

determine an arrhythmia status using the information indicative of the movement of the implantable lead and the information indicative of cardiac electrical activity.

22. The IMD of claim 16, wherein the processor-readable medium comprises instructions that, when executed by the processor, cause the IMD to provide an arrhythmia therapy using a therapy generation circuit in response to information about at least one of the arrhythmia status or the one or more of the location or the type of the arrhythmia.

23. The IMD of claim 22, wherein the processor-readable medium comprises instructions that, when executed by the processor, cause the IMD to inhibit generation of the arrhythmia therapy by the therapy generation circuit when the arrhythmia classification information indicates that an arrhythmia is one or more of supraventricular in origin or hemodynamically stable.

24. An apparatus including an implantable medical device, the implantable medical device (IMD) comprising:

a means of receiving, via an electrical coupling of an implantable lead to the IMD, a response to an excitation signal applied to a conductor of the implantable lead, the response modulated according to a change in an electrical characteristic of at least one conductor in the lead to provide information indicative of a movement of the implantable lead, the movement due at least in part to a motion of a heart;

a means of determining an arrhythmia status using the response information indicative of the movement of the implantable lead; and

a means of determining one or more of a location or a type of an arrhythmia, using the response information indicative of the movement of the implantable lead, in response to the determined arrhythmia status indicating that an arrhythmia is occurring or has occurred.