Arrhythmia discrimination based on determination of rate dependency

• US 9,119,547 B2
• Filed: 01/12/2010
• Issued: 09/01/2015
• Est. Priority Date: 12/20/2005
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Kim, Jaeho, Lin, Yayun, Ricci, Carlos Alberto, Cazares, Shelley
• Primary Examiner(s): FLORY, CHRISTOPHER A
• Application Number:
  US12/686,122
• Publication Number:
  US 20100121209A1
• Time in Patent Office: 2,058 Days
• Field of Search: 600/515, 600518-519, 600/516
• US Class Current: 1/1
• CPC Class Codes: A61B 5/35 by template matching
• 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: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

Cardiac systems and methods provide for discriminating between supraventricular tachyarrhythmia and ventricular tachyarrhythmia based on a determination that the patient'"'"'s supraventricular rhythm exhibits rate dependency. One approach involves determining if a patient'"'"'s supraventricular rhythm exhibits rate dependent morphology. If the patient'"'"'s supraventricular rhythm is determined to exhibit rate dependent morphology, an implantable device classifies a detected tachyarrhythmia episode based on one or more templates selected from a plurality of rate-indexed templates stored in the device. Determining if the supraventricular rhythm exhibits rate dependent morphology may also include determining one or more rates at which the rate dependent morphology occurs.

Claims

1. A method of operating a medical device, comprising:

sensing supraventricular tachycardia (SVT) waveforms during one or more SVT episodes;

measuring heart rates associated with the SVT waveforms;

characterizing morphologies of the SVT waveforms; and

determining whether the morphologies of the SVT waveforms are dependent or independent with respect to heart rate comprising determining one or more rates at which a change in morphology occurs, wherein at least one of characterizing and determining is implemented at least in part by circuitry.

2. The method of claim 1, wherein:

sensing the SVT waveforms comprises inducing the one or more SVT episodes and sensing the SVT waveforms of the one or more induced SVT episodes;

characterizing morphologies of the SVT waveforms comprises generating SVT templates of the SVT waveforms; and

determining whether the morphologies of the plurality of SVT waveforms are dependent or independent with respect to heart rate comprises determining whether the SVT templates exhibit rate dependent morphology over the measured heart rates.

3. The method of claim 1, further comprising:

enabling rate dependent morphology SVT detection if the morphologies of the SVT waveforms are determined to be dependent with respect to heart rate; and

disabling rate dependent morphology SVT detection if the morphologies of the SVT waveforms are determined to be independent with respect to heart rate.

4. The method of claim 1, further comprising discriminating between SVT and ventricular tachycardia for a subsequently sensed arrhythmia episode, wherein discriminating is at least in part based on SVT morphology rate dependency.

5. The method of claim 1, wherein the one or more episodes of SVT are induced by pacing one or more atrial chambers at a plurality of SVT rates.

6. The method of claim 1, wherein the one or more episodes of SVT are drug induced.

7. The method of claim 1, wherein the one or more episodes of SVT are induced by prescription of elevated intensity patient activities.

8. The method of claim 1, wherein the one or more episodes of SVT are intrinsic.

9. The method of claim 1, further comprising forming a plurality of templates, one template for each SVT waveform of the SVT waveforms and indexing the SVT templates according to heart rate.

10. The method of claim 9, further comprising:

sensing one or more waveforms of a subsequent arrhythmia episode; and

comparing the one or more waveforms to one or more of the plurality of templates until a match is found, the comparison starting with a template indexed to a heart rate measured during a time that the one or more waveforms of the subsequent arrhythmia are sensed.

11. A medical system, comprising:

a plurality of cardiac electrodes;

sensing circuitry configured to sense supraventricular tachycardia (SVT) waveforms during one or more episodes of SVT through the cardiac electrodes;

control circuitry configured to measure heart rates associated with the SVT waveforms, characterize morphologies of the SVT waveforms, and determine whether the morphologies of the SVT waveforms are dependent or independent with respect to rate comprising determining one or more rates at which a change in morphology occurs.

12. The system of claim 11, wherein the control circuitry is configured to:

generate SVT templates based on the SVT waveforms;

indexing the SVT templates to heart rates at which an SVT waveforms used to generate the SVT templates are respectively sensed; and

determine whether morphologies of the SVT waveforms are dependent or independent with respect to heart rate by determining whether the SVT templates exhibit rate dependent morphology over the heart rates.

13. The system of claim 11, wherein the control circuitry is configured to enable rate dependent morphology SVT detection if morphologies of the SVT waveforms are dependent with respect to heart rate, and disable rate dependent morphology SVT detection if the morphologies of the SVT waveforms are independent with respect to heart rate.

14. The system of claim 11, wherein the control circuitry is configured to discriminate between SVT and ventricular tachycardia for subsequent arrhythmia episodes sensed by the sensing circuitry based on SVT morphology rate dependency.

15. The system of claim 11, wherein the system further comprises therapy circuitry configured to induce the one or more episodes of SVT.

16. The system of claim 11, wherein the system further comprises pacing therapy circuitry configured to induce the one or more episodes of SVT by pacing one or more atrial chambers at a plurality of SVT rates using one or more of the cardiac electrodes.

17. The system of claim 11, wherein the control circuitry is configured to identify intrinsic SVT.

18. The system of claim 11, wherein the control circuitry is configured to form a plurality of templates, one template for each SVT waveform and index the plurality of templates according to heart rate to index the SVT waveforms according to heart rate.

19. The system of claim 18, wherein the sensing circuitry is configured to sense one or more waveforms of a subsequent arrhythmia episode and the control circuitry is configured to compare the one or more waveforms of the subsequent arrhythmia episode to one or more of the templates until a match is found, the comparison starting with a template indexed to a heart rate occurring when the one or more waveforms of the subsequent arrhythmia are sensed.

20. A medical system, comprising:

a plurality of cardiac electrodes;

sensing circuitry configured to sense supraventricular tachycardia (SVT) waveforms during one or more episodes of SVT through the cardiac electrodes;

means for characterizing morphologies of the SVT waveforms; and

means for determining whether the morphologies of the SVT waveforms are dependent or independent with respect to rate wherein the means for determining is configured to determine one or more rates at which a change in morphology occurs.