Cardiac response classification using multiple classification windows

• US 8,831,726 B2
• Filed: 01/15/2008
• Issued: 09/09/2014
• Est. Priority Date: 12/11/2003
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Kim, Jaeho, Bocek, Joseph, Meyer, Scott A., Haefner, Paul A., Sih, Haris J.
• Primary Examiner(s): EVANISKO, GEORGE ROBERT
• Application Number:
  US12/008,876
• Publication Number:
  US 20080154324A1
• Time in Patent Office: 2,429 Days
• Field of Search: 607/9, 607 26- 28, 600/510
• US Class Current: 607/28
• CPC Class Codes: A61B 5/35 by template matching
• CPC Class Codes: A61B 5/7217 of noise originating from a therapeutic or surgical apparatus, e.g. from a pacemaker
• 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 1/371 Capture, i.e. successful stimulation
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

Methods and devices for classifying a cardiac response to pacing involve establishing a plurality of classification windows relative to and following a pacing pulse. One or more characteristics of a cardiac signal sensed following the pacing pulse are detected within one or more particular classification windows. The characteristics may be compared to one or more references. Classification of the cardiac response may be performed based on the comparison of the one or more characteristics to the one or more references and the particular classification windows in which the one or more characteristics are detected.

Claims

1. A method of operating an implantable cardiac device to classify a cardiac response to a pacing pulse, comprising:

sensing cardiac electrical activity following the pacing pulse and providing a cardiac electrical activity signal corresponding to the cardiac electrical activity;

analyzing the cardiac electrical activity signal in multiple classification time intervals;

detecting a peak of the cardiac electrical activity signal in a classification time interval of the multiple classification time intervals;

comparing the cardiac electrical activity signal to a morphological template representative of a non-captured, intrinsic beat;

classifying the cardiac pacing response based the comparison of the cardiac electrical activity signal to the intrinsic template, including identifying the cardiac pacing response as an intrinsic beat in response to the cardiac electrical activity signal being correlated to the intrinsic template and further identifying the cardiac pacing response as one of responses that do not include intrinsic beats in response to the cardiac electrical activity signal not being correlated to the intrinsic template, and further based on the classification time interval in which the peak of the cardiac electrical activity signal is detected; and

controlling delivery of pacing therapy based at least in part on classification of the cardiac pacing response.

2. The method of claim 1, wherein classifying the cardiac pacing response comprises further classifying the cardiac pacing response as either a captured response or the intrinsic beat.

3. The method of claim 1, wherein classifying the cardiac pacing response comprises further classifying the cardiac pacing response as one of capture, fusion and the intrinsic beat.

4. The method of claim 1, wherein:

the pacing pulse is delivered using a first electrode combination; and

sensing the cardiac electrical activity is performed using a second electrode combination, wherein the second electrode combination is different from the first electrode combination.

5. The method of claim 1, further comprising comparing the cardiac electrical activity signal to a morphological template representative of a captured response, wherein classifying the cardiac pacing response comprises classifying based on comparison of the cardiac electrical activity signal to both the intrinsic template and the captured response template.

6. The method of claim 1, further comprising comparing the cardiac electrical activity signal to a morphological template representative of a captured response, wherein classifying the cardiac pacing response comprises detecting fusion if the cardiac electrical activity signal is not similar to the captured response template and the intrinsic template.

7. The method of claim 1, wherein:

the intrinsic template comprises a peak width; and

comparing the cardiac electrical activity signal to the intrinsic template comprises comparing a peak width of the cardiac electrical activity signal to the intrinsic template peak width.

8. The method of claim 7, further comprising comparing the cardiac electrical activity signal to a morphological template representative of a captured response, the captured response template comprising a peak width, wherein classifying the cardiac pacing response comprises discriminating based on comparison of a peak width of the cardiac electrical activity signal to one or both of the intrinsic template peak width and the captured response template peak width.

9. The method of claim 1, wherein:

comparing the cardiac electrical activity signal to the intrinsic template comprises comparing a peak width of the cardiac electrical activity signal to a template peak width; and

classifying the cardiac pacing response further comprises discriminating based on the peak width comparison.

10. A body implantable cardiac rhythm management system capable of determining a cardiac pacing response, the system comprising:

cardiac electrodes configured to be electrically coupled to one or more heart chambers;

a pulse generator configured to deliver pacing pulses to the one or more heart chambers;

sensing circuitry configured to provide a cardiac electrical activity signal corresponding to cardiac electrical activity associated with each pacing pulse;

a template processor configured to provide a signal template representing a non-captured, intrinsic beat;

a cardiac response classification processor configured to determine a correlation between the cardiac electrical activity signal and the intrinsic template and classify the cardiac pacing response by identifying the cardiac pacing response as an intrinsic beat in response to the cardiac electrical activity signal and the intrinsic template being correlated and further identifying the cardiac pacing response as one of responses that do not include intrinsic beats in response to the cardiac electrical activity signal and the intrinsic template not being correlated, wherein the cardiac response classification processor is further configured to analyze the cardiac electrical activity signal relative to multiple classification time intervals and to classify the cardiac pacing response further based on a classification time interval of the multiple classification time intervals in which a peak of the cardiac electrical activity signal is detected; and

a controller configured to control subsequent pacing pulses based at least in part on classification of the cardiac pacing response.

11. The system of claim 10, wherein the pacing pulses are delivered via a first electrode combination of the cardiac electrodes and the sensing circuitry is configured to sense the cardiac electrical activity via a second electrode combination of the cardiac electrodes which is different from the first electrode combination.

12. The system of claim 11, wherein the first electrode combination comprises at least one pacing electrode and the second electrode combination comprises at least two defibrillation electrodes.

13. The system of claim 10, further comprising a switch matrix configured to couple one of a plurality of first electrode combinations of the cardiac electrodes to the pulse generator and to couple one of a plurality of second electrode combinations of the cardiac electrodes to the sensing circuitry.

14. The system of claim 10, wherein:

the template processor is configured to provide a signal template indicative of a captured response; and

the cardiac response classification processor is configured to compare the cardiac electrical activity signal to the captured response template and to classify the cardiac pacing response based on comparison of the cardiac electrical activity signal to the captured response template.

15. The system of claim 14, wherein the cardiac response classification processor is configured to classify the cardiac pacing response as fusion if the cardiac electrical activity signal is not similar to either the captured response template or the intrinsic template.

16. The system of claim 10, wherein the number of classification time intervals is greater than two.

17. A cardiac rhythm management system capable of classifying a cardiac response to a pacing pulse, the system comprising:

a sensing system configured to sense cardiac electrical activity following the pacing pulse and to provide a cardiac electrical activity signal corresponding to the cardiac electrical activity;

means for comparing the cardiac electrical activity signal to a morphological template representative of a non-captured, intrinsic beat;

means for classifying the cardiac pacing response based on the comparison, including means for identifying the cardiac pacing response as an intrinsic beat in response to the cardiac electrical activity signal being correlated to the intrinsic template and further identifying the cardiac pacing response as one of responses that do not include intrinsic beats in response to the cardiac electrical activity signal not being correlated to the intrinsic template; and

pulse generator circuitry configured to control delivery of pacing therapy based at least in part on classification of the cardiac pacing response,

wherein the means for classifying further comprises means for analyzing the cardiac electrical activity signal in a plurality of classification time intervals, means for determining a classification interval of the plurality of classification time intervals in which a peak of the cardiac electrical activity signal occurs, and further means for classifying the cardiac pacing response based on the classification interval in which the peak of the cardiac electrical activity signal occurs.