Cross-channel noise detector in implantable medical devices

• US 9,101,773 B2
• Filed: 01/26/2010
• Issued: 08/11/2015
• Est. Priority Date: 02/06/2009
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Li, Dan, Perschbacher, David L.
• Primary Examiner(s): Koharski, Christopher D
• Assistant Examiner(s): CAREY, MICHAEL JAMES
• Application Number:
  US12/693,512
• Publication Number:
  US 20100204745A1
• Time in Patent Office: 2,023 Days
• Field of Search: 600/518, 607/25, 607/27
• US Class Current: 1/1
• CPC Class Codes: A61N 1/3704 Circuits specially adapted therefor, e.g. for sensitivity control
• CPC Class Codes: A61N 1/3718 Monitoring of or protection against external electromagnetic fields or currents
• CPC Class Codes: A61N 1/3925 Monitoring; Protecting

Abstract

An apparatus comprises a primary cardiac signal sensing circuit to sense a first cardiac signal, a secondary cardiac signal sensing to sense a second cardiac signal, and an arrhythmia detection circuit. The primary sensing circuit includes at least first and second implantable electrodes, and the secondary sensing circuit includes a third implantable electrode to deliver high-energy shock therapy. The arrhythmia detection circuit detects tachyarrhythmia using the primary sensing circuit, determines correspondence between events sensed with the primary sensing circuit and events sensed with the secondary sensing circuit, and deems whether a detected rhythm is indicative of noise or is indicative of an arrhythmia according to the determined correspondence.

Claims

1. An apparatus comprising:

a primary cardiac signal sensing circuit configured to sense at least a first cardiac signal, the primary cardiac signal sensing circuit including or configured to be coupled to at least first and second implantable electrodes;

at least one secondary cardiac signal sensing circuit configured to sense at least a second cardiac signal, the secondary cardiac signal sensing circuit including or configured to be coupled to at least a third implantable electrode, different from the first and second electrode, configured to deliver high-energy shock therapy; and

an arrhythmia detection circuit communicatively coupled to the primary and secondary cardiac signal sensing circuits, wherein the arrhythmia detection circuit is configured to;

detect an episode of tachyarrhythmia using the primary sensing circuit;

determine a measure of one-to-one correspondence of one or more depolarization events sensed with the primary sensing circuit to one or more depolarization events sensed with the secondary sensing circuit during the detected episode of tachyarrhythmia; and

generate an indication of whether a detected rhythm is indicative of noise or is indicative of tachyarrhythmia according to the determined measure of correspondence.

2. The apparatus of claim 1, wherein the arrhythmia detection circuit is configured to:

calculate variability of a delay between a depolarization event sensed with the primary sensing circuit and depolarization event sensed with the secondary sensing circuit; and

deem that the detected rhythm is indicative of noise when the calculated delay variability exceeds a threshold variability value.

3. The apparatus of claim 2, wherein the arrhythmia detection circuit is configured to:

calculate a moving average of the variability; and

deem that the detected rhythm is indicative of noise when the calculated moving average of the variability exceeds the threshold variability value.

4. The apparatus of claim 1, wherein the arrhythmia detection circuit is configured to:

determine a number of events sensed with the primary sensing circuit and a number of events sensed with the secondary sensing circuit; and

deem that the detected rhythm is indicative of noise when the number of events sensed with the primary sensing circuit during a period of time exceeds the number of events sensed with the secondary sensing circuit during the same time period by a threshold value.

5. The apparatus of claim 4, wherein the arrhythmia detection circuit is configured to:

calculate a ratio of the number of events sensed with the primary sensing circuit to the number of events sensed with the secondary sensing circuit during the time period; and

deem that the detected rhythm is indicative of noise when the calculated ratio exceeds a threshold ratio value.

6. The apparatus of claim 1, wherein the arrhythmia detection circuit is configured to:

determine a measure of complexity of a morphology of the first cardiac signal and a measure of complexity of a morphology of the second cardiac signal; and

deem that the detected rhythm is indicative of noise when the measure of complexity of the first cardiac signal differs from the measure of complexity of the second cardiac signal by more than a threshold value.

7. The apparatus of claim 1, wherein the arrhythmia detection circuit is configured to:

calculate a measure of similarity between the first and second cardiac signals, wherein the measure of similarity includes at least one of a cross-covariance of the first and second cardiac signals, a cross-correlation of the first and second cardiac signals, and a coherence of the first and second cardiac signals; and

deem that the detected rhythm is indicative of an arrhythmia when the measure of similarity satisfies a similarity measure threshold value.

8. The apparatus of claim 1, including:

at least one of a first filter circuit included in the primary sensing circuit or a second filter circuit included in the secondary sensing circuit; and

a switching circuit communicatively coupled to the primary sensing circuit, the secondary sensing circuit, and the arrhythmia detection circuit, wherein the switching circuit is configured to switch at least one of the first filter circuit to the secondary sensing circuit or the second filter circuit to the primary sensing circuit; and

wherein, when detecting the rhythm, the arrhythmia detection circuit is configured to;

determine a rate of events sensed with at least one of the primary sensing circuit and the secondary sensing circuit;

switch at least one of the first filter circuit included with the primary sensing circuit to the secondary sensing circuit, and the second filter circuit included with the secondary sensing circuit to the primary sensing circuit;

determine a rate of events sensed with the sensing circuit when the filter circuit is switched; and

deem that the detected rhythm is indicative of noise when the determined rate of depolarization events changes by more than a threshold rate value after the filter circuit is switched.

9. The apparatus of claim 1, including a switching circuit communicatively coupled to the primary sensing circuit, secondary sensing circuit, and the arrhythmia detection circuit, wherein the switching circuit is configured to switch at least one of the electrodes of the primary sensing circuit to the secondary sensing circuit and the electrodes of the secondary sensing circuit to the primary sensing circuit, and

wherein, when detecting the rhythm, the arrhythmia detection circuit is configured to:

determine a rate of events sensed with at least one of the primary sensing circuit and the secondary sensing circuit;

switch the electrodes of at least one of the primary sensing circuit to the secondary sensing circuit and the secondary sensing circuit to the primary sensing circuit;

determine a rate of events sensed with the sensing circuit when the electrodes are switched, and

deem that the detected rhythm is indicative of noise when the determined rate of events changes by more than a threshold rate value after the electrodes are switched.

10. The apparatus of claim 1, including:

a therapy circuit communicatively coupled to the electrodes of the primary and secondary sensing circuits;

a tachyarrhythmia detection circuit, communicatively coupled to the primary and secondary sensing circuits, configured to determine whether a detected rhythm deemed to be an arrhythmia instead of noise is a valid tachyarrhythmia, and

wherein the tachyarrhythmia detection circuit is configured to initiate delivery of a therapy to the heart using the therapy circuit when the tachyarrhythmia is determined to be valid.

11. A method comprising:

sensing a first cardiac signal using a primary sensing circuit, wherein the primary sensing circuit includes or is configured to be coupled to a first and a second implantable electrode;

sensing a second cardiac signal using at least one secondary sensing circuit, the secondary sensing circuit including or configured to be coupled to at least a third implantable electrode, different from the first and second electrodes, configured to deliver high-energy shock therapy;

detecting an episode of tachyarrhythmia using the primary sensing circuit;

determining a measure of one-to-one correspondence of one or more depolarization events in the first cardiac signal sensed with the primary sensing circuit to one or more depolarization events in the second cardiac signal sensed with the secondary sensing circuit during the detected episode of tachyarrhythmia; and

generating an indication of whether the detected rhythm is indicative of noise or is indicative of tachyarrhythmia according to the determined measure of correspondence.

12. The method of claim 11,

wherein determining correspondence between events includes calculating variability of a delay between an event sensed with the primary sensing circuit and an event sensed with the secondary sensing circuit, and

wherein deeming whether the detected rhythm is indicative of noise or of an arrhythmia includes deeming that depolarization events sensed with the primary sensing circuit are indicative of noise when the calculated delay variability exceeds a threshold variability value.

13. The method of claim 12,

wherein calculating variability of the delay includes calculating a moving average of the variability, and

wherein deeming whether the detected rhythm is indicative of noise includes deeming that events sensed with the primary sensing circuit are indicative of noise when the calculated delay variability average exceeds the threshold variability value.

14. The method of claim 11,

wherein determining correspondence between events includes determining a number of events sensed with the primary sensing circuit during a period of time and a number of events sensed with the secondary sensing circuit during the same time period, and

wherein deeming whether the detected rhythm is indicative of noise or of an arrhythmia includes deeming that the detected rhythm is indicative of noise when the number of events sensed during the time period with the primary sensing circuit exceeds the number of events sensed with the secondary sensing circuit during the time period by a threshold value.

15. The method of claim 14, including:

calculating a ratio of the number of events sensed with the primary sensing circuit during the time period to the number of events sensed with the secondary sensing circuit during the time period, and

wherein deeming whether the detected rhythm is indicative of noise or an arrhythmia includes deeming that the detected rhythm is indicative of noise when the ratio exceeds a threshold ratio value.

16. The method of claim 11,

wherein determining correspondence between events sensed in the primary sensing circuit and events sensed in the secondary sensing circuit includes determining a measure of complexity of a morphology of the first cardiac signal and a measure of complexity of a morphology of the second cardiac signal, and

wherein deeming whether the detected rhythm is indicative of noise or an arrhythmia includes deeming that the detected rhythm is indicative of noise when the measure of complexity of the first cardiac signal differs from the measure of complexity of the second cardiac signal by more than a threshold value.

17. The method of claim 11,

wherein determining correspondence between events sensed with the primary sensing circuit and events sensed with the secondary sensing circuit includes determining a measure of similarity between the first and second cardiac signals,

wherein the measure of similarity includes at least one of a cross-covariance of the first and second cardiac signals, a cross-correlation of the first and second cardiac signals, and a coherence of the first and second cardiac signals, and

wherein deeming whether the detected rhythm is indicative of noise or an arrhythmia includes deeming that the detected rhythm is indicative of arrhythmia when the measure of similarity satisfies a similarity measure threshold value.

18. The method of claim 11, wherein determining correspondence between events sensed with the primary sensing circuit and events sensed with the secondary sensing circuit includes:

using a first filter circuit included in the primary sensing circuit to filter the first cardiac signal and a second filter circuit included in the secondary sensing circuit to filter the second cardiac signal;

determining a rate of events with at least one of the primary sensing circuit and the secondary sensing circuit;

switching at least one of the first filter circuit to the secondary sensing switched or the second filter circuit to the primary sensing circuit;

determining a rate of events sensed with the sensing circuit when the filter circuit is switched; and

wherein deeming whether the detected rhythm is indicative of noise or an arrhythmia includes deeming that the detected rhythm is indicative of noise when the determined rate of events changes by more than a threshold rate value after the filter circuit is switched.

19. The method of claim 11, wherein determining correspondence between events sensed with the primary sensing circuit and events sensed with the secondary sensing circuit includes:

determining a rate of events sensed with at least one of the primary sensing circuit and the secondary sensing circuit;

switching the electrodes of at least one of the primary sensing circuit to the secondary sensing circuit and the secondary sensing circuit to the primary sensing circuit;

determining a rate of events sensed with the sensing circuit when the electrodes are switched, and

wherein deeming whether the detected rhythm is indicative of noise or an arrhythmia includes deeming that the detected rhythm is indicative of noise when the determined rate of events changes by more than a threshold rate value after the electrodes are switched.

20. The method of claim 11, including:

determining whether the detected rhythm is a valid tachyarrhythmia when the detected rhythm is deemed to be an arrhythmia; and

delivering at least one of anti-tachycardia pacing and high-energy shock therapy using at least one implantable electrode when the detected rhythm is deemed to be a valid tachyarrhythmia.