Non-sustained tachyarrhythmia analysis to identify lead related condition

• US 8,660,643 B2
• Filed: 08/08/2012
• Issued: 02/25/2014
• Est. Priority Date: 10/27/2009
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Gunderson, Bruce D.
• Primary Examiner(s): Layno, Carl H
• Assistant Examiner(s): Stice, Paula J
• Application Number:
  US13/569,354
• Publication Number:
  US 20120296386A1
• Time in Patent Office: 566 Days
• Field of Search: None
• US Class Current: 607/14
• CPC Class Codes: A61B 2560/0276 Determining malfunction
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• CPC Class Codes: A61B 5/276 Protection against electrode failure
• CPC Class Codes: A61B 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/363 Detecting tachycardia or bradycardia
• CPC Class Codes: A61N 1/3702 Physiological parameters A61N1/365 takes precedence; evoked response A61N1/371

Abstract

Techniques for determining whether a lead related condition exists based on analysis of a cardiac electrical signal associated with a non-sustained tachyarrhythmia (NST) are described. In some examples, the techniques include determining the duration of intervals between consecutive cardiac events, e.g., R-R intervals, during an NST. The techniques may further include determining one or more metrics based on the durations of the intervals during the NST. Examples of metrics include an average, a minimum, a maximum, a range, a median, a mode, or a mean. A lead related condition is identified based on the values of the one or more metrics, e.g., by comparison to respective thresholds. In some examples, an alert is provided or a therapy modification is suggested if a lead related condition is identified.

Claims

1. A method comprising:

detecting a plurality of cardiac events based on a cardiac electrical signal;

measuring a plurality of intervals between consecutive ones of the detected cardiac events;

detecting a non-sustained tachyarrhythmia based on a subset of the measured intervals meeting a non-sustained tachyarrhythmia criterion;

after detecting the non-sustained tachyarrhythmia, calculating a plurality of metrics using the subset of the measured intervals, wherein the plurality of metrics include an average of the subset of the measured intervals, a range of the subset of the measured intervals, and a minimum of the subset of measured intervals; and

identifying a lead related condition based on the plurality of metrics, wherein identifying the lead related condition comprises;

comparing the average of the subset of measured intervals to a first predetermined threshold;

comparing the minimum of the subset of measured intervals to a second predetermined threshold;

comparing the range of the subset of measured intervals to a third predetermined threshold; and

identifying the lead related condition when the average of the subset of measured intervals is less than the first predetermined threshold, the minimum of the subset of measured intervals is less than the second predetermined threshold, and the range of the subset of measured intervals is greater than the third predetermined threshold.

2. The method of claim 1, wherein identifying the lead related condition comprises:

comparing each of the plurality of metrics to a respective predetermined threshold; and

identifying the lead related condition based on the comparisons.

3. The method of claim 1, further comprising providing an alert in response to identifying the lead related condition.

4. The method of claim 1, further comprising modifying a therapy in response to identifying the lead related condition.

5. The method of claim 1, further comprising modifying at least one parameter associated with detection of the cardiac events based on detecting the lead related condition.

6. The method of claim 1, wherein the cardiac events comprise R-waves, and the intervals comprise R-R intervals.

7. A method comprising:

detecting a plurality of cardiac events based on a cardiac electrical signal;

measuring a plurality of intervals between consecutive ones of the detected cardiac events;

detecting a non-sustained tachyarrhythmia based on a subset of the measured intervals meeting a non-sustained tachyarrhythmia criterion;

after detecting the non-sustained tachyarrhythmia, calculating a plurality of metrics using the subset of the measured intervals, wherein the plurality of metrics include at least two of an average of the subset of the measured intervals, a minimum of the subset of measured intervals, and a range of the subset of the measured intervals; and

identifying a lead related condition based on the plurality of metrics.

8. A system comprising:

an electrical sensing module configured to receive a cardiac electrical signal from one or more electrodes and detect a plurality of cardiac events based on the cardiac electrical signal;

an interval measurement module configured to measure a plurality of intervals between consecutive ones of the detected cardiac events;

a non-sustained tachyarrhythmia detection module configured to detect a non-sustained tachyarrhythmia based on a subset of the measured intervals meeting a non-sustained tachyarrhythmia criterion;

a calculation module configured to calculate a plurality of metrics based on the subset of the measured intervals after the detection of the non-sustained tachyarrhythmia, wherein the plurality of metrics include at least two of an average of the subset of the measured intervals, a minimum of the subset of measured intervals, and a range of the subset of the measured intervals; and

identify a lead related condition based on the plurality of metrics.

9. A system comprising:

an electrical sensing module configured to receive a cardiac electrical signal from one or more electrodes and detect a plurality of cardiac events based on the cardiac electrical signal;

an interval measurement module configured to measure a plurality of intervals between consecutive ones of the detected cardiac events;

a non-sustained tachyarrhythmia detection module configured to detect a non-sustained tachyarrhythmia based on a subset of the measured intervals meeting a non-sustained tachyarrhythmia criterion;

a calculation module configured to calculate a plurality of metrics based on the subset of the measured intervals after the detection of the non-sustained tachyarrhythmia, wherein the plurality of metrics include an average of the subset of the measured intervals, a range of the subset of the measured intervals, and a minimum of the subset of measured intervals; and

a lead integrity evaluation module configured to compare the average of the subset of measured intervals to a first predetermined threshold, compare the minimum of the subset of measured intervals to a second predetermined threshold, compare the range of the subset of measured intervals to a third predetermined threshold, and identify a lead related condition when the average of the subset of measured intervals is less than the first predetermined threshold, the minimum of the subset of measured intervals is less than the second predetermined threshold, and the range of the subset of measured intervals is greater than the third predetermined threshold.

10. The system of claim 9, further comprising a signal generator configured to deliver therapy via the one or more electrodes, and wherein the lead integrity evaluation module is configured to modify delivery of therapy by the signal generator in response to identification of the lead related condition.

11. The system of claim 9, wherein the lead integrity evaluation module is configured to:

compare each of the plurality of metrics to a respective predetermined threshold; and

identify the lead related condition based on the comparisons.

12. The system of claim 9, wherein the lead integrity evaluation module is configured to modify at least one parameter associated with detection of the cardiac events by the electrical sensing module based on the identification of the lead related condition.

13. The system of claim 9, further comprising a telemetry module configured to transmit information regarding at least one of an alert, a therapy modification, or a sensing modification if a lead related condition exists.

14. The system of claim 9, wherein the non-sustained tachyarrhythmia detection module is configured to identify a plurality of events in the cardiac electrical signal as cardiac depolarizations, determine a rate of at least some of the events, and detect the non-sustained tachyarrhythmia based on the rate.

15. The system of claim 9, wherein the cardiac events comprise R-waves, and the intervals comprise R-R intervals.

16. The system of claim 9, further comprising an implantable medical device that comprises the electrical sensing module, the interval measurement module, the non-sustained tachyarrhythmia detection module, the calculation module, and the lead integrity evaluation module.

17. A system comprising:

means for detecting a plurality of cardiac events based on a cardiac electrical signal;

means for measuring a plurality of intervals between consecutive ones of the detected cardiac events;

means for detecting a non-sustained tachyarrhythmia based on a subset of the measured intervals meeting a non-sustained tachyarrhythmia criterion;

means for calculating a plurality of metrics based on the subset of the measured intervals after detecting the non-sustained tachyarrhythmia, wherein the plurality of metrics include an average of the subset of the measured intervals, a range of the subset of the measured intervals, and a minimum of the subset of measured intervals; and

means for identifying a lead related condition based on the plurality of metrics, wherein the means for identifying the lead related condition;

compares the average of the subset of measured intervals to a first predetermined threshold;

compares the minimum of the subset of measured intervals to a second predetermined threshold;

compares the range of the subset of measured intervals to a third predetermined threshold; and

identifies the lead related condition when the average of the subset of measured intervals is less than the first predetermined threshold, the minimum of the subset of measured intervals is less than the second predetermined threshold, and the range of the subset of measured intervals is greater than the third predetermined threshold.

18. A non-transitory computer readable storage medium comprising instructions that, when executed, cause a processor to:

detect a plurality of cardiac events based on a cardiac electrical signal;

measure a plurality of intervals between consecutive ones of the detected cardiac events;

detect a non-sustained tachyarrhythmia based on a subset of the measured intervals meeting a non-sustained tachyarrhythmia criterion;

after detecting the non-sustained tachyarrhythmia, calculate a plurality of metrics based on the subset of the measured intervals, wherein the plurality of metrics include an average of the subset of the measured intervals, a range of the subset of the measured intervals, and a minimum of the subset of measured intervals;

compare the average of the subset of measured intervals to a first predetermined threshold;

compare the minimum of the subset of measured intervals to a second predetermined threshold;

compare the range of the subset of measured intervals to a third predetermined threshold; and

identify a lead related condition, when the average of the subset of measured intervals is less than the first predetermined threshold, the minimum of the subset of measured intervals is less than the second predetermined threshold, and the range of the subset of measured intervals is greater than the third predetermined threshold.