System for ischemia detection based on adjustable paced beat analysis timing

• US 9,415,228 B1
• Filed: 09/14/2015
• Issued: 08/16/2016
• Est. Priority Date: 11/24/2009
• Status: Active Grant

• Current Assignee: Angel Medical Systems, Inc.
• Original Assignee: Angel Medical Systems, Inc.
• Inventors: Fischell, David R., John, Michael Sasha, Hopenfeld, Bruce
• Primary Examiner(s): Voorhees, Catherine
• Assistant Examiner(s): Dinga, Roland
• Application Number:
  US14/853,107
• Time in Patent Office: 337 Days
• Field of Search: 607/4, 607/5, 607/9, 607/14, 607/28, 600/508, 600/509, 600515-518
• US Class Current: 1/1
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/366 Detecting abnormal QRS complex, e.g. widening
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61B 5/7282 Event detection, e.g. detecting unique waveforms indicative of a medical condition A61B5/4094, A61B5/4818, A61B5/349, A61B5/0823 take precedence
• CPC Class Codes: A61N 1/025 Digital circuitry features of electrotherapy devices, e.g. memory, clocks, processors
• CPC Class Codes: A61N 1/368 comprising more than one electrode co-operating with different heart regions A61N1/3622, A61N1/3627 take precedence
• CPC Class Codes: A61N 1/3684 for stimulating the heart at multiple sites of the ventricle or the atrium
• CPC Class Codes: A61N 1/36842 Multi-site stimulation in the same chamber
• CPC Class Codes: A61N 1/36843 Bi-ventricular stimulation
• CPC Class Codes: A61N 1/3702 Physiological parameters A61N1/365 takes precedence; evoked response A61N1/371

Abstract

A device for detecting cardiac ischemia is disclosed. The device includes a processor that is configured to distinguish between ventricularly paced beats and supraventricular beats. The processor applies different ischemia tests to the two different beat types, and generates alert when it detects ischemia. The processor collects and counts the ST segment deviation values for ventricularly paced beats for a pre-set time period. The processor then determines if the number of ventricularly paced beats is insufficient to perform ischemia detection. If so, then the processor collects ST deviation values for additional paced beats. When the processor determines that a sufficient number of ventricularly paced beats have been acquired, it identifies ischemic beats by the application of ischemia detection criteria to the ST deviation values of the collected ventricularly paced beats.

Claims

1. An implantable device with ischemia detection and heart pacing capability, including:

at least one electrode adapted for implantation in a body;

data acquisition circuitry coupled to the electrode to sense signals therefrom and to generate corresponding digital signals;

pacemaker circuitry;

a processor configured to;

distinguish between at least two beat types, including ventricularly paced and supraventricular beats;

collect the values of a heart signal parameter from the digital signals for ventricularly paced beats for a pre-set time period;

count the number of ventricularly paced beats for which heart signal parameter values have been collected;

determine if the number of ventricularly paced beats during the pre-set time period for which heart signal parameter values have been collected is insufficient to perform ischemia detection, and if the number is insufficient, collect values of the heart signal parameter for additional paced beats;

operative upon heart signal parameter values for a sufficient number of ventricularly paced beats being acquired, identify ischemic beats by the application of ischemia detection criteria to the values of the heart signal parameter for ventricularly paced beats.

2. The implantable device of claim 1 wherein the pre-set time period is lengthened to collect additional paced beats.

3. The implantable device of claim 1 wherein the pre-set time period occurs periodically at a pre-set time interval, and the heart signal parameter values for additional paced beats are collected after reducing the pre-set time interval, whereby the heart signal parameter values for additional paced beats are collected more quickly than would occur if the pre-set time interval was not reduced.

4. The implantable device of claim 1 wherein the pre-set time period initially occurs periodically at a pre-set time interval, and the heart signal parameter values of the additional paced beats are collected after configuring the pre-set time period to occur as soon as pacing occurs after a minimum time period has elapsed since a prior heart signal parameter value collection, whereby the heart signal parameter values for additional paced beats may be collected more quickly than would occur if the pre-set time interval was not changed.

5. The implantable device of claim 4 wherein the initial pre-set time interval is 90 seconds.

6. The implantable device of claim 4 wherein the minimum time period is 50 seconds.

7. The implantable device of claim 1 wherein the pre-set time period is 10 seconds.

8. The implantable device of claim 1 wherein the processor determines if the number of ventricularly paced beats during the pre-set time period for which heart signal parameter values have been collected is insufficient by comparing that number to the total number of beats collected during the pre-set time period, thereby deriving a ratio, and further comparing the ratio to a predetermined threshold.