Therapy delivery for identified tachyarrhythmia episode types

• US 8,688,204 B2
• Filed: 05/10/2011
• Issued: 04/01/2014
• Est. Priority Date: 11/29/2006
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Sauer, William H., Cazares, Shelley M., Li, Dan
• Primary Examiner(s): Koharski, Christopher D
• Assistant Examiner(s): Bays, Pamela M
• Application Number:
  US13/104,439
• Publication Number:
  US 20110218449A1
• Time in Patent Office: 1,057 Days
• Field of Search: 600/508, 600/509, 600515-518, 600/510, 606/41.42, 607/14.27
• US Class Current: 600/518
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy

Abstract

Methods and systems for identifying tachyarrhythmia episode types and delivering therapy to mitigate the identified tachyarrhythmia episode types are described. Electrogram signals of cardiac activity are sensed and stored by an implantable cardiac device. Tachyarrhythmia episodes are detected and tachyarrhythmia episode types are identified based on characteristics of the electrogram signals. In preparation for performing ablation, a tachyarrhythmia episode is induced. The features of the induced tachyarrhythmia episode are compared to characteristics of the identified episode types. A similarity between the induced tachyarrhythmia episode and at least one of the episode types identified from the stored electrogram signals is indicated to facilitate performing the ablation.

Claims

1. A cardiac system, comprising:

an implantable sensing system configured to sense first electrogram signals during a first period of time and to sense second electrogram signals during a second period of time;

a tachyarrhythmia detector configured to detect intrinsic tachyarrhythmia episodes using the first electrogram signals and to detect an induced tachyarrhythmia episode using the second electrogram signals;

a data processor configured to;

identify intrinsic tachyarrhythmia episode types based on a comparison of morphological characteristics extracted from the first electrogram signals with morphological characteristics extracted from the second electrogram signals of the induced tachyarrhythmia episode that determines a similarity between the induced tachyarrhythmia episode and at least one intrinsic tachyarrhythmia episode type;

determine a tachyarrhythmia burden for each of the identified intrinsic tachyarrhythmia episode types; and

rank each of the identified intrinsic tachyarrhythmia episode types based on each of the associated tachyarrhythmia burdens; and

a display configured to present information related to the similarity between the induced tachyarrhythmia episode and the at least one intrinsic tachyarrhythmia episode type.

2. The system of claim 1, wherein each of the tachyarrhythmia burdens is based on information about each of the associated intrinsic tachyarrhythmia episode types, the information including one or more of information defining number of occurrences, frequency of occurrences, instability, morphological disorganization, tendency to accelerate to ventricular fibrillation, and responsiveness to treatment.

3. The system of claim 1, wherein the data processor is configured to identify the intrinsic tachyarrhythmia episode types based on morphological characteristics of the first electrogram signals.

4. The system of claim 1, wherein data processor is configured to identify the intrinsic tachyarrhythmia episode types based on one or both of P-R or R-P timing intervals of the first electrogram signals that are compared to the second electrogram signals.

5. The system of claim 1, wherein data processor is configured to identify the intrinsic tachyarrhythmia episode types based on one or both of Fourier analysis and wavelet analysis of the first electrogram signals.

6. The system of claim 1, wherein the data processor is further configured to determine an exit site of one or more of the intrinsic tachyarrhythmia episode types.

7. The system of claim 1, further comprising a pulse generator configured to deliver pacing pulses to induce the induced tachyarrhythmia episode.

8. The system of claim 1, wherein the implantable sensing system includes electrodes disposed in or on left and right ventricles and the first electrogram signals are sensed using the electrodes disposed in or on the left and right ventricles.

9. The system of claim 8, wherein the data processor is further configured to analyze the first electrogram signals sensed using the electrodes disposed in or on the left and right ventricles to determine exit sites of the intrinsic tachyarrhythmia episode types.

10. The system of claim 1, further comprising a pulse generator configured to deliver pacing pulses to induce the induced tachyarrhythmia episode.

11. A cardiac system, comprising:

an implantable sensing system configured to sense first electrogram signals during a first period of time and to sense second electrogram signals during a second period of time;

a tachyarrhythmia detector configured to detect intrinsic tachyarrhythmia episodes using the first electrogram signals and to detect an induced tachyarrhythmia episode using the second electrogram signals;

a data processor configured to;

identify intrinsic tachyarrhythmia episode types based on a comparison of morphological characteristics extracted from the first electrogram signals with morphological characteristics extracted from the second electrogram signals of the induced tachyarrhythmia episode that determines a similarity between the induced tachyarrhythmia episode and at least one intrinsic tachyarrhythmia episode type;

determine a tachyarrhythmia burden for each of the identified intrinsic tachyarrhythmia episode types;

rank each of the identified intrinsic tachyarrhythmia episode types based on each of the associated tachyarrhythmia burdens; and

determine an exit site for each of the identified intrinsic tachyarrhythmia episode types; and

a display configured to present information related to the identified intrinsic tachyarrhythmia episode types and exit sites.

12. The system of claim 11, wherein the display is configured to present information related to the similarity between the induced tachyarrhythmia episode and the at least one intrinsic tachyarrhythmia episode type.

13. The system of claim 11, wherein the display is configured to present information related to the rankings of the episode types.

14. The system of claim 11, wherein the tachyarrhythmia burden is based on information about the associated intrinsic tachyarrhythmia episode type including one or more of number of occurrences, frequency of occurrences, instability, morphological disorganization, tendency to accelerate to ventricular fibrillation, and responsiveness to treatment.

15. The system of claim 11, wherein the data processor is configured to identify the intrinsic tachyarrhythmia episode types based on morphological characteristics of the first electrogram signals.

16. The system of claim 11, wherein the data processor is configured to identify the intrinsic tachyarrhythmia episode types based on:

one or both of P-R timing or R-P timing intervals of the first electrogram signals;

or

one or both of Fourier analysis and wavelet analysis of the first electrogram signals.

17. The system of claim 11, wherein the data processor is configured to discriminate a first type of ventricular tachyarrhythmia episode from a plurality of ventricular tachyarrhythmia episode types.

18. The system of claim 11, wherein the implantable sensing system includes electrodes disposed in or on left and right ventricles and the first electrogram signals are sensed using the electrodes disposed in or on the left and right ventricles.

19. The system of claim 18, wherein the data processor is further configured to analyze the first electrogram signals sensed using the electrodes disposed in or on the left and right ventricles and determine the exit sites of the intrinsic tachyarrhythmia episode types.