Methods of monitoring hemodynamic status for rhythm discrimination within the heart

• US 8,725,260 B2
• Filed: 02/05/2009
• Issued: 05/13/2014
• Est. Priority Date: 02/11/2008
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Shuros, Allan C., Li, Dan, Ni, Quan
• Primary Examiner(s): Koharski, Christopher D
• Assistant Examiner(s): MAHMOOD, NADIA AHMAD
• Application Number:
  US12/366,334
• Publication Number:
  US 20090204163A1
• Time in Patent Office: 1,923 Days
• Field of Search: 600/515, 600/516, 600/517, 600/518, 607/17, 607/18, 607/9, 607/14
• US Class Current: 607/18
• CPC Class Codes: A61N 1/36578 controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters

Abstract

Systems and methods of performing rhythm discrimination within a patient'"'"'s body using sensed hemodynamic signals are disclosed. The method can include the steps of receiving an electrical activity signal from an electrode located within or near the heart, detecting an event of the heart based on the received electrical activity signal, sensing one or more mechanical measurements using a sensor located within the body, analyzing a mechanical activity signal received from the sensor, and confirming the type of event based on the mechanical and electrical activity signals. The sensor can comprise a single pressure sensor configured to sense both atrial and ventricular activity within the heart.

Claims

1. A method of performing rhythm discrimination within the body of a patient, comprising:

receiving an electrical activity signal from an electrode located within or adjacent to the heart;

detecting an event of the heart based at least in part on the electrical activity signal;

receiving a physiological mechanical activity signal from a pressure sensor located in a pulmonary artery of the patient, the pressure sensor configured to sense both atrial contraction and ventricular contraction within the heart;

analyzing the physiological mechanical activity signal received from the pressure sensor to determine an atrial contraction parameter and a ventricular contraction parameter associated with the heart; and

confirming the event by comparing the atrial contraction parameter against the ventricular contraction parameter, wherein comparing the atrial contraction parameter against the ventricular contraction parameter comprises determining, based on the physiological mechanical activity signal, an atrium-ventricle (A/V) mechanical delay, and determining a type of the event based on the A/V mechanical delay.

2. The method of claim 1, further comprising providing therapy to the patient based at least in part on the type of event confirmed.

3. The method of claim 1, further comprising activating the sensor within the body upon the detection of the event from the electrical activity signal.

4. The method of claim 3, wherein activating the sensor includes sending a wake-up signal to the sensor causing the sensor to switch between a first state and a second state.

5. The method of claim 1, wherein analyzing the physiological mechanical activity signal received from the sensor includes comparing a right atrial contraction rate to a right ventricular contraction rate.

6. The method of claim 1, wherein confirming the event includes:

determining that the event is a ventricular tachycardia event when an A/V association is attenuated; and

determining that the event is a supraventricular tachycardia event when a fast atrial contraction occurs while a substantially constant A/V association is present.

7. The method of claim 1, further comprising analyzing electromechanical activity within the heart using both the physiological mechanical activity signal and the electrical activity signal.

8. The method of claim 1, further comprising applying an open atrial mechanical window to the sensed physiological mechanical and electrical activity signals.

9. The method of claim 1, wherein analyzing the physiological mechanical activity signal and confirming the event are performed by an implantable medical device.

10. A method of performing rhythm discrimination within the body of a patient, comprising:

providing an implantable medical device including a control unit adapted to run an algorithm for detecting arrhythmia events within the heart;

receiving an electrical activity signal from an electrode located within or adjacent to the heart;

detecting an arrhythmia event of the heart based at least in part on the electrical activity signal;

responsive to detecting the arrhythmia event, prompting a pressure sensor located within a pulmonary artery of the patient to activate and sense one or more physiological pressure measurements associated with the atrial contraction and ventricular contraction of the heart;

determining, based at least in part on the sensed physiological pressure measurements received from the sensor, an atrial contraction rate and a ventricular contraction rate;

confirming the event by comparing the atrial contraction rate against the ventricular contraction rate, wherein confirming the event further comprises determining, based on the sensed physiological pressure measurements, an atrium-ventricle (A/V) mechanical delay, and determining a type of the event based on the A/V mechanical delay; and

providing a therapy to the patient in response to confirming the event.

11. The method of claim 10, where confirming the event includes:

determining that the event is a ventricular tachycardia event when an A/V association is attenuated; and

determining that the event is a supraventricular tachycardia event when a fast atrial contraction occurs while a substantially constant A/V association is present.

12. The method of claim 10, further comprising analyzing electromechanical activity within the heart using both the sensed physiological pressure measurements and the electrical activity signal.

13. The method of claim 10, further comprising applying an open atrial mechanical window to the sensed electrical signals and sensed physiological pressure measurements.

14. A system for performing rhythm discrimination within the body of a patient, comprising:

an electrode configured to sense electrical activity of the heart and to provide an electrical activity signal based on the sensed electrical activity;

a mechanical pressure sensor adapted to be located in a pulmonary artery, the sensor configured to sense a physiological mechanical activity signal comprising both atrial and ventricular contraction of the heart; and

an implantable medical device in communication with the electrode and the sensor, the implantable medical device configured to;

detect an arrhythmia event of the heart based at least in part on the electrical activity signal received from the electrode;

analyze the physiological mechanical activity signal received from the sensor to determine an atrial contraction parameter and a ventricular contraction parameter associated with the heart;

confirm the arrhythmia event by comparing the atrial contraction parameter against the ventricular contraction parameter to determine an atrium-ventricle (A/V) mechanical delay;

determine a type of the event based on the A/V mechanical delay;

provide therapy to the patient based at least in part on the comparison of the atrial contraction parameter against the ventricular contraction parameter, the A/V mechanical delay, and the electrical activity signal received from the electrode.

15. The system of claim 14, wherein the implantable medical device is a pulse generator.