Using device based electrograms to identify bundle branch block morphology

• US 8,954,138 B2
• Filed: 11/15/2012
• Issued: 02/10/2015
• Est. Priority Date: 11/16/2011
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Maskara, Barun, Shome, Shibaji, Thakur, Pramodsingh Hirasingh, Patangay, Abhilash
• Primary Examiner(s): Holmes, Rex R
• Application Number:
  US13/677,962
• Publication Number:
  US 20130123653A1
• Time in Patent Office: 817 Days
• Field of Search: 607/9, 607/25, 600515-516
• US Class Current: 600/516
• CPC Class Codes: A61B 5/352 Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval
• CPC Class Codes: A61B 5/366 Detecting abnormal QRS complex, e.g. widening
• CPC Class Codes: A61B 5/686 Permanently implanted devices, e.g. pacemakers, other stimulators, biochips A61B5/6861 takes precedence
• CPC Class Codes: A61B 5/746 Alarms related to a physiological condition, e.g. details of setting alarm thresholds or avoiding false alarms alarms per se G08B
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy

Abstract

A patient QRS duration can be received or determined, such as using one or more patient physiological sensors. A portion of the QRS duration can be determined, such as a right or left ventricular activation time. In an example, the right ventricular activation time can be determined by identifying an onset of a QRS complex and an R-wave peak in the QRS complex. In an example, when the QRS duration exceeds a threshold duration, and the RV activation time does not exceed a second threshold duration, an indication of a cardiac conduction dysfunction can be provided, such as for discriminating between left bundle branch block and right bundle branch block.

Claims

1. An apparatus comprising:

a processor circuit, configured to;

receive or determine a QRS duration representative of a time duration of a QRS complex;

receive or determine an RV activation duration representative of a time duration between (1) an onset of the QRS complex, and (2) an R-wave in a right ventricle;

determine whether the QRS duration exceeds a first threshold value and, when the QRS duration exceeds the first threshold value, determine at least one of;

(1) whether the RV activation duration is shorter than a second threshold value; and

(2) whether a ratio or differential relationship of the RV activation duration to the QRS duration is less than a third threshold value; and

provide an indication of left ventricular conduction dysfunction when it is determined that (1) the RV activation duration is shorter than second threshold value;

or (2) the ratio or differential relationship of the RV activation duration to the QRS duration is less than the third threshold value.

2. The apparatus of claim 1, wherein the processor circuit is configured to provide the indication of left ventricular conduction dysfunction to indicate Left Bundle Branch Block (LBBB) as distinguished from Right Bundle Branch Block (RBBB) or Intraventricular Conduction Delay (IVCD) when it is determined that the RV activation duration is shorter than the second threshold value, wherein the second threshold value is specified at about 45 milliseconds, or when it is determined that the ratio of the RV activation duration to the QRS duration is less than the third threshold value, wherein the third threshold value is specified at about 0.3, and wherein the RV activation duration is representative of a time duration between an onset of the QRS complex and an R-wave peak in a right ventricle.

3. The apparatus of claim 1, wherein the processor circuit is configured to determine whether the QRS duration exceeds the first threshold value and, when the QRS duration exceeds the first threshold value, determine whether the RV activation duration is shorter than the second threshold value, and provide an indication of left ventricular conduction dysfunction when it is determined that the RV activation duration is shorter than the second threshold value.

4. The apparatus of claim 1, wherein the processor circuit is configured to determine whether the QRS duration exceeds the first threshold value and, when the QRS duration exceeds the first threshold value, determine whether a ratio or differential relationship of the RV activation duration interval to the QRS duration is less than the third threshold value, and provide an indication of left ventricular conduction dysfunction when it is determined that the ratio or differential relationship of the RV activation duration to the QRS duration is less than the third threshold value.

5. The apparatus of claim 1, wherein the processor circuit is configured to determine whether the QRS duration exceeds the first threshold value and, when the QRS duration exceeds the first threshold value, determine whether a ratio of the RV activation duration to the QRS duration is less than the third threshold value, and provide an indication of left ventricular conduction dysfunction when it is determined that the ratio of the RV activation duration to the QRS duration is less than the third threshold value.

6. The apparatus of claim 1, wherein the processor circuit is configured to provide the indication of left ventricular conduction dysfunction to indicate Left Bundle Branch Block (LBBB) as distinguished from Right Bundle Branch Block (RBBB) or Intraventricular Conduction Delay (IVCD).

7. The apparatus of claim 1, wherein the processor circuit is configured to provide an indication of Right Bundle Branch Block (RBBB) or Intraventricular Conduction Delay (ICD) when it is determined that (1) the RV activation duration is longer than the second threshold value;

or (2) the ratio or differential relationship of the RV activation duration to the QRS duration exceeds the third threshold value.

8. The apparatus of claim 1, wherein the processor circuit is configured to determine the QRS duration using a signal obtained from a cardioversion or defibrillation shock electrode.

9. The apparatus of claim 1, wherein the processor circuit is configured such that the first threshold value is specified between about 110 ms and about 135 ms.

10. The apparatus of claim 1, wherein the processor circuit is configured such that the second threshold value is specified between about 40 ms and about 50 ms.

11. The apparatus of claim 1, wherein the processor circuit is configured such that the ratio or differential relationship of the RV activation duration to the QRS duration is a ratio, and wherein the third threshold value is specified between about 0.2 and about 0.4.

12. The apparatus of claim 1, wherein the processor circuit is configured to trend information about at least one of:

the RV activation duration, the ratio or differential relationship of the RV activation duration to the QRS duration, or the indication of left ventricular conduction dysfunction, and to use the trended information to generate an alert or to adjust a therapy control signal.

13. The apparatus of claim 12, wherein the alert is configured to indicate at least one of myocardial ischemia or myocardial infarction in response to a rate of change over a specified period of time of the trended information.

14. The apparatus of claim 1, wherein the processor circuit is configured to receive heart rate information and to use the heart rate information to adjust at least one of the first threshold value, the second threshold value, or the third threshold value, or to provide a heart rate dependent indication of left ventricular conduction dysfunction.

15. The apparatus of claim 1, wherein the RV activation duration is representative of a time duration between a heart valve closure and an R-wave peak in a right ventricle.

16. The apparatus of claim 1, further comprising multiple electrodes, wherein the processor circuit is configured to provide the indication of left ventricular conduction dysfunction also using an activation sequence across the multiple electrodes.

17. The apparatus of claim 1, wherein the processor circuit is configured to provide an indication of Right Bundle Branch Block (RBBB) or Intraventricular Conduction Delay (IVCD) when it is determined that the RV activation duration is longer than the second threshold value.

18. An apparatus comprising:

a processor circuit, configured to;

receive or determine a QRS duration representative of a time duration of a QRS complex;

receive or determine an RV activation duration representative of a time duration between (1) an onset of the QRS complex, and (2) an R-wave in a right ventricle;

receive or determine an LV activation duration representative of a time duration between (1) an onset of the QRS complex, and (2) an R-wave in a left ventricle;

determine whether the QRS duration exceeds a first threshold value and, when the QRS duration exceeds the first threshold value, determine at least one of;

(1) whether the RV activation duration is shorter than a second threshold value;

(2) whether a ratio or differential relationship of the RV activation duration to the QRS duration is less than a third threshold value;

(3) whether the LV activation duration is longer than a fourth threshold value; and

(4) whether a ratio or differential relationship of the LV activation duration to the QRS duration is greater than a fifth threshold value; and

provide an indication of left ventricular conduction dysfunction when it is determined that (1) the RV activation duration is shorter than second threshold value;

(2) the LV activation duration is longer than fourth threshold value;

(3) the ratio or differential relationship of the RV activation duration to the QRS duration is less than the third threshold value;

or (4) the ratio or differential relationship of the LV activation duration to the QRS duration is greater than the fifth threshold value.

19. The apparatus of claim 18, wherein the processor circuit is configured to provide an indication of Right Bundle Branch Block (RBBB) when it is determined that the LV activation duration is shorter than the fourth threshold value.