Hemodynamic status assessment during tachycardia

• US 8,838,240 B2
• Filed: 09/10/2008
• Issued: 09/16/2014
• Est. Priority Date: 11/21/2007
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Li, Dan, Siejko, Krzysztof, Patangay, Abhilash
• Primary Examiner(s): Heller, Tammie K
• Application Number:
  US12/283,234
• Publication Number:
  US 20090131999A1
• Time in Patent Office: 2,197 Days
• Field of Search: 607/14, 607/15, 607/17, 600513-518
• US Class Current: 607/17
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/36564 controlled by blood pressure
• 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 provide for sensing, during an event of tachycardia, hemodynamic signals concurrently from at least two spatially separated locations within a patient, and quantifying a spatial relationship between the hemodynamic signals. Hemodynamic stability or state of the patient during the tachycardia event is determined based at least in part on the quantified spatial relationship. One or more anti-tachycardia therapies to treat the tachycardia may be selected based at least in part on the determined stability or state of patient hemodynamics, and the selected one or more anti-tachycardia therapies may be delivered to treat the tachycardia. The hemodynamic signals may comprise at least two, or a mixed combination, of cardiac impedance signals, cardiac chamber pressure signals, arterial pressure signals, heart sounds; and acceleration signals.

Claims

1. A method, comprising:

sensing, during an event of tachycardia, concurrently by at least two different types of sensors at least two different types of hemodynamic signals, wherein the at least two different types of sensors are located at at least two spatially separated locations within a patient;

quantifying a spatial relationship between the sensed at least two different types of hemodynamic signals;

determining a state of patient hemodynamics during the tachycardia event based at least in part on the quantified spatial relationship;

selecting one or more anti-tachycardia therapies to treat the tachycardia based at least in part on the determined state of patient hemodynamics; and

delivering the selected one or more anti-tachycardia therapies to treat the tachycardia.

2. The method of claim 1, wherein quantifying the spatial relation comprises quantifying a change in propagation of the sensed hemodynamic signals.

3. The method of claim 1, wherein quantifying the spatial relationship comprises computing a correlation between the sensed hemodynamic signals.

4. The method of claim 1, wherein determining the state of patient hemodynamics during the tachycardia event comprises determining whether the tachycardia event is a stable tachyarrhythmia or an unstable tachyarrhythmia.

5. The method of claim 1, wherein determining the state of patient hemodynamics during the tachycardia event comprises comparing a metric indicative of the quantified spatial relationship to a threshold.

6. The method of claim 5, comprising determining the threshold for a particular patient in relation to the patient'"'"'s normal sinus rhythm.

7. The method of claim 1, wherein:

determining the state of patient hemodynamics during the tachycardia event comprises determining whether the tachycardia event is a stable tachyarrhythmia or an unstable tachyarrhythmia; and

selecting the one or more anti-tachycardia therapies comprises selecting at least one anti-tachycardia pacing therapy in response to determining that the tachycardia event is a stable tachyarrhythmia, and selecting at least one cardioversion or defibrillation therapy in response to determining that the tachycardia event is an unstable tachyarrhythmia.

8. The method of claim 1, wherein the sensed hemodynamic signals comprise at least two, of a mixed combination, of cardiac impedance signals, cardiac chamber pressure signals, arterial pressure signals, heart sounds, and acceleration signals.

9. A method, comprising:

sensing, during an event of tachycardia, concurrently by at least two different types of sensors at least two different types of hemodynamic signals, wherein the at least two different types of sensors are located at at least two spatially separated locations concurrently within a patient;

quantifying a spatial relationship between sensed at least two different types of hemodynamic signals; and

determining hemodynamic stability of the patient during the tachycardia event based at least in part on the quantified spatial relationship.

10. The method of claim 9, wherein quantifying the spatial relation comprises quantifying a change in propagation of the sensed hemodynamic signals.

11. The method of claim 9, wherein quantifying the spatial relationship comprises computing a cross-correlation, cross-covariance , cross-spectra, coherence, mutual information or cross-entropy between the sensed hemodynamic signals.

12. The method of claim 9, wherein determining hemodynamic stability comprises discriminating between a stable and an unstable state of patient hemodynamics.

13. The method of claim 9, comprising delivering or withholding defibrillation therapy to treat the tachycardia based at least in part on the patient'"'"'s hemodynamic stability.

14. The method of claim 9, comprising delivering an anti-tachycardia therapy associated with the hemodynamic stability of the patient during the tachycardia event.

15. The method of claim 14, comprising tracking the patient'"'"'s hemodynamics to assess effectiveness of the anti-tachycardia therapy.

16. The method of claim 9, wherein the sensed hemodynamic signals comprise at least two, of a mixed combination, of cardiac impedance signals, cardiac chamber pressure signals, arterial pressure signals, heart sounds, and acceleration signals.

17. An implantable system, comprising:

at least two different types of implantable hemodynamic sensors adapted for spatially-separated positioning relative to a patient'"'"'s heart and for sensing hemodynamic signals;

a lead comprising one or more electrodes;

detection circuitry coupled to the lead;

energy delivery circuitry coupled to the lead; and

a processor coupled to the hemodynamic sensors, lead, detection circuitry, and energy delivery circuitry, the processor configured to sense, during an event of tachycardia, at least two different types of hemodynamic signals concurrently from the hemodynamic sensors, quantify a spatial relationship between the at least two different types of sensed hemodynamic signals, and determine a hemodynamic status of the patient during the tachycardia event based at least in part on the quantified spatial relationship, the processor configured to deliver one or more anti-tachycardia therapies associated with the hemodynamic status of the patient.

18. The system of claim 17, wherein the processor is configured to quantify the spatial relation based on a detected change in propagation of the sensed hemodynamic signals.

19. The system of claim 17, wherein the processor is configured to quantify the spatial relationship by computing a correlation between the sensed hemodynamic signals.

20. The system of claim 17, wherein the processor is configured to quantify the spatial relationship by computing a cross-correlation, cross-covariance, cross-spectra, coherence, mutual information or cross-entropy between the sensed hemodynamic signals.

21. The system of claim 17, wherein the processor is configured to discriminate between a stable and an unstable state of patient hemodynamics, and to deliver the one or more anti-tachycardia therapies based on stability of patient hemodynamics.

22. The system of claim 17, wherein the processor is configured to deliver or withhold defibrillation therapy to treat the tachycardia based at least in part on the patient'"'"'s hemodynamic status.

23. The system of claim 17, wherein the at least two implantable hemodynamic sensors comprise at least two, of a mixed combination, of cardiac impedance sensors, cardiac chamber pressure sensors, arterial pressure sensors, heart sound sensors, accelerometers, and microphones.