Implantable medical device and method for classifying arrhythmia events

• US 8,755,874 B2
• Filed: 05/07/2008
• Issued: 06/17/2014
• Est. Priority Date: 05/07/2008
• Status: Active Grant

• Current Assignee: St. Jude Medical AB (Abbott Laboratories Incorporated)
• Original Assignee: St. Jude Medical AB (Abbott Laboratories Incorporated)
• Inventors: Bjrling, Anders, Bharmi, Rupinder, Broom, Michael, Jrverud, Karin
• Primary Examiner(s): Kahelin, Michael
• Assistant Examiner(s): FAIRCHILD, MALLIKA DIPAYAN
• Application Number:
  US12/989,581
• Publication Number:
  US 20110112419A1
• Time in Patent Office: 2,232 Days
• Field of Search: 607 17- 19, 600515-518, 600/513
• US Class Current: 600/513
• CPC Class Codes: A61B 5/0809 by impedance pneumography
• CPC Class Codes: A61B 5/363 Detecting tachycardia or bradycardia
• CPC Class Codes: A61B 5/7264 Classification of physiological signals or data, e.g. using neural networks, statistical classifiers, expert systems or fuzzy systems neural networks per se G06N3/00; expert systems per se G06N5/00
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters
• CPC Class Codes: A61N 1/395 for treating atrial fibrillation
• CPC Class Codes: A61N 1/3987 characterised by the timing or triggering of the shock
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

In an implantable medical device such as an implantable cardiac defibrillator, and a method for classifying arrhythmia events, IEGM signals are analyzed to detect an arrhythmia event and a respiratory pattern of the patient is sensed. At least one respiratory parameter reflecting characteristics of the respiratory pattern of the patient is determined based on the sensed respiratory pattern and a respiratory measure corresponding to a change of a rate of change of the at least one respiratory parameter is calculated. The detected arrhythmia event is classified based on the respiratory measure and the IEGM signals, wherein arrhythmia events that satisfy at least a first criterion is classified as an arrhythmia event requiring therapy.

Claims

1. An implantable medical device to discriminate between ventricular tachycardias (VTs) and supraventricular tachycardias (SVTs), said implantable medical device being configured to be connected to at least one medical lead adapted to be placed at or within a heart of a patient, said medical lead including at least one electrode adapted to sense electrical activity of said heart and to produce at least one signal representative of said electrical activity, said implantable medical device comprising:

an intra-cardiac electrogram (IEGM) analyzing circuit that receives said signal representative of said electrical activity and to analyse IEGMs of said heart to detect an arrhythmia event;

a sensing circuit that senses a respiratory pattern of said patient and to produce at least one signal representative of said respiratory pattern;

a respiratory parameter determining circuit that determines at least one respiratory parameter reflecting characteristics of the respiratory pattern of said patient based on said sensed respiratory pattern and that determines a respiratory measure corresponding to a change of a rate of change of said at least one respiratory parameter; and

an arrhythmia classifying circuit that classifies the detected arrhythmia event as a VT or SVT based on said respiratory measure, including classifying arrhythmia events that satisfy at least a first criterion for VT as an arrhythmia event requiring therapy;

wherein said respiratory parameter determining circuit determines a respiratory frequency and a tidal volume using said sensed respiratory pattern and that determines a change of a range of change of a weighted combination of said respiratory frequency and said tidal volume.

2. The implantable medical device according to claim 1, wherein said arrhythmia classifying circuit determines said at least first criterion to be satisfied when said respiratory measure is higher than a predetermined threshold value.

3. The implantable medical device according to claim 2, wherein said arrhythmia classifying circuit is configured to:

upon receiving information from said arrhythmia detection circuit that an arrhythmia event has been detected, monitor said respiratory measure;

compare the time points of the respective onset of said detected arrhythmia event and of a respiratory measure being higher than said predetermined threshold; and

determine said at least first criterion to be satisfied if said respiratory measure is higher than a predetermined threshold value and an onset of said change occur within a predetermined period of time from the onset of said detected arrhythmia event.

4. The implantable medical device according to claim 1, further comprising:

an impedance measuring circuit that, during impedance measuring sessions, measures at least one impedance signal between at least a first pair of electrodes being configured to be connected to said implantable medical device, said electrodes being located such that measured impedance signals substantially reflects the respiratory pattern of said patient; and

wherein said respiratory parameter determining circuit determines said at least one respiratory parameter based on said measured impedance signals.

5. The implantable medical device according to claim 1, further comprising:

an activity sensor that senses a level of physiological activity of said patient and that produces a signal representative of a current status of said physiological activity of said patient; and

wherein said arrhythmia classifying circuit determines that said at least one first criterion is not satisfied when an activity level of said patient is above a predetermined level.

6. The implantable medical device according to claim 1, wherein said arrhythmia classifying circuit classifies an arrhythmia event that satisfies at least said first criterion as an arrhythmia event requiring shock treatment and classifies an arrhythmia event that satisfies at least a second criterion an arrhythmia event requiring anti-arrhythmia pacing.

7. A method to discriminate between ventricular tachycardias (VTs) and supraventricular tachycardias (SVTs) in an implantable medical device, the implantable medical device being configured to be connected to at least one medical lead adapted to be placed at or within a heart of a patient, said medical lead including at least one electrode adapted to sense electrical activity of said heart and to produce at least one signal representative of said electrical activity, wherein said method comprises:

analyzing IEGMs of said heart to detect an arrhythmia event;

sensing a respiratory pattern of said patient producing at least one signal representative of said respiratory pattern;

determining at least on respiratory parameter reflecting characteristics of the respiratory pattern of said patient based on said sensed respiratory pattern;

determining a respiratory measure corresponding to a change of a rate of change of said at least on respiratory parameter; and

classifying the detected arrhythmia event as a VT or SVT based on said respiratory measure, wherein arrhythmia events that satisfy at least a first criterion for VT is classified as an arrhythmia event requiring therapy;

wherein said determining at least one respiratory parameter reflecting comprises determining a respiratory frequency and a tidal volume using said sensed respiratory pattern and wherein said determining a respiratory measure comprises determining a change of a rate of change of a weighted combination of said respiratory frequency and said tidal volume.

8. The method according to claim 7, wherein said classifying comprises:

determining said at least first criterion to be satisfied when said respiratory measure is higher than a predetermined threshold value.

9. The method according to claim 8, wherein said classifying further comprises;

upon receiving information from said arrhythmia detection circuit that an arrhythmia event has been detected, monitoring said respiratory measure;

comparing the time points for the respective onset of said detected arrhythmia event and of a respiratory measure being higher than said predetermined threshold; and

determining said at least first criterion for VT to be satisfied if said respiratory measure is higher than a predetermined threshold value and an onset of said change occur within a predetermined period of time from the onset of said detected arrhythmia event.

10. The method according to claim 7, further comprising, during impedance measuring sessions, measuring at least one impedance signal between at least a first pair of electrodes configured to be connected to said implantable medical device, said electrodes being located such that measured impedance signals substantially reflects the respiratory pattern of said patient;

and wherein said determining said respiratory parameter includes determining said at least one respiratory parameter based on said measured impedance signals.

11. The method according to claim 7, further comprising:

sensing a level of physiological activity of said patient; and

wherein said classifying comprises determining that said at least one first criterion for VT is not satisfied if an activity level of said patient is above a predetermined level.

12. The method according to claim 7, wherein said classifying further comprises:

classifying an arrhythmia event that satisfies at least said first criterion for VT as an arrhythmia event requiring shock treatment; and

classifying an arrhythmia event that satisfies at least a second criterion for SVT as an arrhythmia event requiring anti-arrhythmia pacing.