Electrogram summary

• US 9,668,668 B2
• Filed: 09/30/2011
• Issued: 06/06/2017
• Est. Priority Date: 09/30/2011
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Kleckner, Karen J., Patel, Amisha S., Gunderson, Bruce D., Ousdigian, Kevin T., Sanchez, Julian
• Primary Examiner(s): Bertram, Eric D.
• Application Number:
  US13/250,515
• Publication Number:
  US 20130085403A1
• Time in Patent Office: 2,076 Days
• Field of Search: 600510
• CPC Class Codes: A61B 5/339 Displays specially adapted therefor
• CPC Class Codes: A61B 5/361 Detecting fibrillation
• CPC Class Codes: A61B 5/363 Detecting tachycardia or bradycardia
• CPC Class Codes: A61B 5/7217 of noise originating from a therapeutic or surgical apparatus, e.g. from a pacemaker

Abstract

The present disclosure is directed to an electrogram summary. In various examples, a subset of cardiac episodes are selected and displayed based on a set of summary rules. The subset of cardiac episodes includes at least one episode from each of a plurality of episode categories with at least one cardiac episode. In some examples, the order in which the cardiac episodes selected are displayed is based on the set of summary rules. The electrogram summary may include images or information regarding each of the selected cardiac episodes.

Claims

1. A method comprising;

receiving cardiac electrogram (EGM) signal data from an implantable medical device (IMD), the EGM signal data including a plurality of detected cardiac episodes;

categorizing, based on the EGM signal data, each of the plurality of cardiac episodes as one of a ventricular tachycardia/ventricular fibrillation (VT/VF) episode, a supraventricular tachycardia (SVT) episode, a non-sustained ventricular tachycardia (VTNS) episode, an atrial tachycardia/atrial fibrillation (AT/AF) episode, a monitored VT episode, or a ventricular oversensing (VOS) episode, wherein categorizing each of the plurality of cardiac episodes comprises categorizing a first episode and a second episode in different episode categories;

determining that the IMD categorized, based on the EGM signal data, the first episode and the second episode to be in a same category;

determining, for at least one of the episode categories, a subset including greater than or equal to one episode and less than a total number of episodes of the at least one episode category;

selecting, using a processor, the first cardiac episode and the second cardiac episode for display based on the categorization of the first episode and the second episode in different episode categories and the determination that the IMD categorized, based on the EGM signal data, the first episode and the second episode to be in the same category, wherein the subset includes at least one of the first cardiac episode and the second cardiac episode; and

displaying, simultaneously, information associated with the first cardiac episode and information associated with the second cardiac episode of the subset of cardiac episodes selected for display via a graphical user interface display, wherein the first cardiac episode and the second cardiac episode each includes a plurality of cardiac depolarization events, and wherein displaying, simultaneously, information associated with the first cardiac episode and information associated with the second cardiac episode of the subset of cardiac episodes comprises displaying, simultaneously, a first image of at least a portion of a first EGM signal from the first cardiac episode and a second image of at least a portion of a second EGM signal from the second cardiac episode.

2. The method of claim 1, wherein the information associated with the first cardiac episode and the information associated with the second cardiac episode includes a thumbnail of the EGM signal data.

3. The method of claim 2, further comprising, in response to user input, rearranging an order of the thumbnails displayed.

4. The method of claim 1, further comprising, in response to receiving a selection of the first cardiac episode based on the displayed information, displaying an image of a portion of the first EGM signal associated the first cardiac episode a portion of a marker channel associated with the first cardiac episode.

5. The method of claim 4, further comprising, in response to user input, adjusting the portion of the first EGM signal displayed.

6. The method of claim 4, further comprising displaying a reference EGM, the reference EGM being an EGM signal collected at a time of transmission of the EGM signal data from the IMD.

7. The method of claim 1, wherein displaying, simultaneously, the information associated with the first cardiac episode and the information associated with the second cardiac episode of the subset of cardiac episodes selected for display comprises:

providing a user interface allowing a user to change the relative position of the first image of the first cardiac episode and the second image of the second cardiac episode; and

comparing a morphology of the image of the EGM signal data associated with the first cardiac episode to the second cardiac episode.

8. The method of claim 1, further comprising displaying a timeline of occurrence for the plurality of cardiac episodes.

9. The method of claim 8, wherein the timeline includes an icon for each of the plurality of cardiac episodes conveying a classification by the IMD for the respective cardiac episodes.

10. The method of claim 8, wherein the timeline includes an indication of cycle length for each of the plurality of cardiac episodes.

11. The method of claim 8, wherein the timeline includes an indication of a retrospective analysis classification for each of the plurality of cardiac episodes.

12. The method of claim 8, wherein the timeline includes an indication of an episode characteristic for each of the plurality of cardiac episodes.

13. The method of claim 1, wherein determining, for at least one of the episode categories, a subset including greater than or equal to one episode and less than a total number of episodes of the at least one episode category comprises determining VT/VF episodes for the subset from among the VT/VF episodes received from the IMD based on at least one of:

number of shocks or number of anti-tachycardia pacing pulses in each VT/VF episode;

most recent VT/VF episode;

A to V ratio of each VT/VF episode;

or

duration of each VT/VF episode.

14. The method of claim 13, further comprising prioritizing an order the subset of VT/VF episodes for display, wherein the VT/VF episodes are prioritized based on at least one of:

number of shocks or number of anti-tachycardia pacing pulses in each VT/VF episode;

time of occurrence;

duration of each of the VT/VF episodes;

a stored predetermined prioritization of selection criteria;

or stored physician preferences.

15. The method of claim 1, wherein determining, for at least one of the episode categories, a subset including greater than or equal to one episode and less than a total number of episodes of the at least one episode category comprises determining SVT episodes for the subset from among the SVT episodes received from the IMD based on at least one of:

duration of each SVT episode;

morphology of each SVT episode;

reason for withholding treatment for each SVT episode,

V rate of each SVT episode.

16. The method of claim 15, further comprising prioritizing an order the subset of SVT episodes for display, wherein the SVT episodes are prioritized based on at least one of:

duration of each SVT episode;

fastest V rates of the SVT episodes;

time of occurrence;

a stored predetermined prioritization of selection criteria;

or

stored physician preferences.

17. The method of claim 1, wherein determining, for at least one of the episode categories, a subset including greater than or equal to one episode and less than a total number of episodes of the at least one episode category comprises determining monitored VT episodes for the subset from among the monitored VT episodes received from the IMD based on at least one of:

different V rate than the rest of the monitored VT episodes;

different A rate than the rest of the monitored VT episodes;

duration of each of the monitored VT episodes;

V rates of each of the monitored VT episodes;

or

time of occurrence of each of the monitored VT episodes.

18. The method of claim 17, further comprising prioritizing an order the subset of monitored VT episodes for display, wherein the monitored VT episodes are prioritized based on at least one of:

time of occurrence;

duration of the monitored VT episodes;

a stored predetermined prioritization of selection criteria;

or

stored physician preferences.

19. The method of claim 1, wherein determining, for at least one of the episode categories, a subset including greater than or equal to one episode and less than a total number of episodes of the at least one episode category comprises determining VTNS episodes for the subset from among the VTNS episodes received from the IMD based on at least one of:

number of beats within each VTNS episode;

time of occurrence of each VTNS episode;

or

retrospective analysis classification of each VTNS episode.

20. The method of claim 19, further comprising prioritizing an order the subset of VTNS episodes for display, wherein the VTNS episodes are prioritized based on at least one of:

number of beats within each VTNS episode;

time of occurrence;

a stored predetermined prioritization of selection criteria;

or

stored physician preferences.

21. The method of claim 1, wherein determining, for at least one of the episode categories, a subset including greater than or equal to one episode and less than a total number of episodes of the at least one episode category comprises determining AT/AF episodes for the subset from among the AT/AF episodes received from the IMD based on at least one of:

length of each of the AT/AF episodes;

occurrence of far-field R-waves in of the AT/AF episodes;

degree of A-A interval regularity or each of the AT/AF episodes;

or

time of occurrence of each of the AT/AF episodes.

22. The method of claim 21, further comprising prioritizing an order the subset of AT/AF episodes for display, wherein the AT/AF episodes are prioritized based on at least one of:

length of the AT/AF episode;

time of occurrence;

a stored predetermined prioritization of selection criteria;

or

stored physician preferences.

23. The method of claim 1, further comprising displaying each cardiac episode of the determined subset as a part of an EGM summary.

24. The method of claim 1, further comprising defining the less than the total number of episodes of the at least one episode category.

25. The method of claim 24, further comprising receiving user input indicating the less than the total number of episodes of the at least one episode category, wherein defining the less than the total number of episodes of the at least one episode category comprising defining the less than the total number of episodes of the at least one episode category based on the received user input.

26. The method of claim 1, wherein displaying, simultaneously, information associated with the first cardiac episode and information associated with the second cardiac episode of the subset of cardiac episodes selected for display comprises displaying the plurality of cardiac depolarization events for each of the first cardiac episode and the second cardiac episode simultaneously.

27. The method of claim 1, wherein the subset includes the first episode and the second episode for the at least one episode category.

28. The method of claim 1, wherein categorizing each of the plurality of cardiac episodes comprises categorizing the first episode and the second episode in a same episode category.

29. The method of claim 1, wherein categorizing each of the plurality of cardiac episodes comprises categorizing the first episode and a third episode in a same episode category, further comprising:

determining a first EGM signal morphology of the first episode and a third EGM signal morphology of the third episode are substantially similar;

selecting the first episode but not the third episode for display based on the determination that the first EGM signal morphology of the first episode and the third EGM signal morphology of the third episode are substantially similar; and

displaying information associated with the first episode but not the third episode based on the selection of the first episode but not the third episode for display.

30. A system comprising:

a communication module configured to receive electrogram (EGM) signal data from an implantable cardiac device, the EGM signal data including a plurality of cardiac episodes;

a graphical user interface; and

a processor configured to;

categorize, based on the EGM signal data, each of the plurality of cardiac episodes as one of a ventricular tachycardia/ventricular fibrillation (VT/VF) episode, a supraventricular tachycardia (SVT) episode, a non-sustained ventricular tachycardia (VTNS) episode, an atrial tachycardia/ atrial fibrillation (AT/AF) episode, a monitored VT episode, or a ventricular oversensing (VOS) episode;

categorize a first episode and a second episode in different episode categories;

determine that the IMD categorized, based on the EGM signal data, the first episode and the second episode to be in a same category;

determine for at least one of the episode categories, a subset including greater than or equal to one episode and less than a total number of episodes of the at least one episode category;

select the first cardiac episode and the second cardiac episode for display based on the categorization of the first episode and the second episode in different episode categories and the determination that the IMD categorized, based on the EGM signal data, the first episode and the second episode to be in the same category, wherein the subset includes at least one of the first cardiac episode and the second cardiac episode; and

via the graphical user interface, display, simultaneously, a first image of at least a portion of a first EGM signal from the first cardiac episode and a second image of at least a portion of a second EGM signal from the second cardiac episode, wherein the first cardiac episode and the second cardiac episode each includes a plurality of cardiac depolarization events.

31. The system of claim 30, wherein the processor is configured to display, via the graphical user interface, a first thumbnail of the EGM signal data associated with the first cardiac episode and the second cardiac episode.

32. The system of claim 31, wherein the processor is configured to rearrange an order of the thumbnails displayed via the graphical user interface in response to user input.

33. The system of claim 30, wherein the processor is configured to, in response to the device receiving a selection of the first cardiac episode based on the displayed information, display, via the graphical user interface, an image of a portion of the first EGM signal associated the first cardiac episode a portion of a marker channel associated with the first cardiac episode.

34. The system of claim 33, wherein the processor is configured to adjust the portion of the first EGM signal displayed in response to receipt of user input.

35. The system of claim 33, wherein the graphical user interface is further configured to display a reference EGM, the reference EGM being an EGM signal collected at a time of transmission.

36. The system of claim 30, wherein the processor is configured to

compare a morphology of the image of the EGM signal data associated with the first cardiac episode and a morphology of the image of the EGM signal data associated with the second cardiac episode.

37. The system of claim 30, wherein the user interface comprises a graphical user interface configured to display a timeline of occurrence for the plurality of cardiac episodes.

38. The system of claim 37, wherein the timeline includes an icon for each of the plurality of cardiac episodes conveying a classification by the IMD for the respective cardiac episodes.

39. The system of claim 37, wherein the timeline includes an indication of cycle length for each of the plurality of cardiac episodes.

40. The system of claim 37, wherein the timeline includes an indication of a retrospective analysis classification for each of the plurality of cardiac episodes.

41. The system of claim 37, wherein the timeline includes an indication of an episode characteristic for each of the plurality of cardiac episodes.

42. The system of claim 30, wherein the processor is configured to determine a subset of VT/VF episodes based on at least one of:

number of shocks or number of anti-tachycardia pacing pulses in each VT/VF episode

most recent VT/VF episode;

A to V ratio of each VT/VF episode;

or

duration of each VT/VF episode.

43. The system of claim 42, wherein the processor is configured to prioritize an order the subset of VT/VF episodes for display, wherein the VT/VF episodes are prioritized based on at least one of:

number of shocks or number of anti-tachycardia pacing pulses in each VT/VF episode;

time of occurrence;

duration of each of the VT/VF episodes;

a stored predetermined prioritization of selection criteria;

or

stored physician preferences.

44. The system of claim 30, wherein the processor is configured to determine a subset of SVT episodes based on at least one of:

duration of each SVT episode;

morphology of each SVT episode;

reason for withholding treatment for each SVT episode,

V rate of each SVT episode.

45. The system of claim 44, wherein the processor is configured to prioritize an order the subset of SVT episodes for display, wherein the SVT episodes are prioritized based on at least one of:

duration of each SVT episode;

fastest V rates of the SVT episodes;

time of occurrence;

a stored predetermined prioritization of selection criteria;

or

stored physician preferences.

46. The system of claim 30, wherein the processor is configured to determine a subset of monitored VT episodes based on at least one of:

different V rate than the rest of the monitored VT episodes;

different A rate than the rest of the monitored VT episodes,

duration of each of the monitored VT episodes;

V rates of each of the monitored VT episodes;

or

time of occurrence of each of the monitored VT episodes.

47. The system of claim 46, wherein the processor is configured to prioritize an order the subset of monitored VT episodes for display, wherein the monitored VT episodes are prioritized based on at least one of:

time of occurrence;

duration of the monitored VT episodes;

a stored predetermined prioritization of selection criteria;

or

stored physician preferences.

48. The system of claim 30, wherein the processor is configured to determine a subset of VTNS episodes based on at least one of:

number of beats within each VTNS episode;

time of occurrence of each VTNS episode;

or

retrospective analysis classification of each VTNS episode.

49. The system of claim 48, wherein the processor is configured to prioritize an order the subset of VTNS episodes for display, wherein the VTNS episodes are prioritized based on at least one of:

number of beats within each VTNS episode;

time of occurrence;

a stored predetermined prioritization of selection criteria;

or

stored physician preferences.

50. The system of claim 30, wherein the processor is configured to determine a subset of AT/AF episodes based on at least one of:

length of each of the AT/AF episodes;

occurrence of far-field R-waves in of the AT/AF episodes;

degree of A-A interval regularity or each of the AT/AF episodes;

or

time of occurrence of each of the AT/AF episodes.

51. The system of claim 50, wherein the processor is configured to prioritize an order the subset of AT/AF episodes for display, wherein the AT/AF episodes are prioritized based on at least one of:

length of the AT/AF episode;

time of occurrence;

a stored predetermined prioritization of selection criteria;

or

stored physician preferences.

52. The system of claim 30, wherein the processor is configured to produce an EGM summary, wherein each of the selected cardiac episode of the determined subset is a part of the EGM summary and wherein the user interface is further configured to display the EGM summary.

53. The system of claim 30, wherein the processor is configured to define the less than the total number of episodes of the at least one episode category.

54. The system of claim 53, wherein the user interface is configured to receive user input indicating the less than the total number of episodes of the at least one episode category, and wherein the processor is configured to define the less than the total number of episodes of the at least one episode category based on the received user input.

55. The system of claim 30, wherein the processor is configured to, via the graphical user interface display, display the plurality of cardiac depolarization events for each of the first cardiac episode and the second cardiac episode simultaneously.

56. The system of claim 30, wherein the subset includes the first episode and the second episode for the at least one episode category.

57. The system of claim 30, wherein the processor is configured to categorize the first episode and the second episode in a same episode category.

58. The system of claim 30, wherein the processor is configured to:

categorize the first episode and a third episode in a same episode category;

determine a first EGM signal morphology of the first episode and a third EGM signal morphology of the third episode are substantially similar;

select the first episode but not the third episode for display based on the determination that the first EGM signal morphology of the first episode and the third EGM signal morphology of the third episode are substantially similar; and

display information associated with the first episode but not the third episode based on the selection of the first episode but not the third episode for display.

59. A non-transitory computer-readable medium comprising instructions for causing a programmable processor to:

receive cardiac electrogram (EGM) signal data from an implantable medical device (IMD), the EGM signal data including a plurality of detected cardiac episodes;

categorize, based on the EGM signal data, each of the plurality of cardiac episodes as one of a ventricular tachycardia/ventricular fibrillation (VT/VF) episode, a supraventricular tachycardia (SVT) episode, a non-sustained ventricular tachycardia (VTNS) episode, an atrial tachycardia/ atrial fibrillation (AT/AF) episode, a monitored VT episode, or a ventricular oversensing (VOS) episode;

categorize a first episode and a second episode in different episode categories;

determine that the IMD categorized, based on the EGM signal data, the first episode and the second episode to be in a same category;

determine for at least one of the episode categories, a subset including greater than or equal to one episode and less than a total number of episodes of the at least one episode category;

select the first cardiac episode and the second cardiac episode for display based on the categorization of the first episode and the second episode in different episode categories and the determination that the IMD categorized, based on the EGM signal data, the first episode and the second episode to be in the same category, wherein the subset includes at least one of the first cardiac episode and the second cardiac episode; and

display, simultaneously, a first image of at least a portion of a first EGM signal from the first cardiac episode and a second image of at least a portion of a second EGM signal from the second cardiac episode, wherein the first cardiac episode and the second cardiac episode each includes a plurality of cardiac depolarization events.

60. A method comprising;

receiving cardiac electrogram (EGM) signal data from an implantable medical device (IMD), the EGM signal data including a plurality of detected cardiac episodes;

categorizing, based on the EGM signal data, each of the plurality of cardiac episodes as one of a ventricular tachycardia/ventricular fibrillation (VT/VF) episode, a supraventricular tachycardia (SVT) episode, a non-sustained ventricular tachycardia (VTNS) episode, an atrial tachycardia/ atrial fibrillation (AT/AF) episode, a monitored VT episode, or a ventricular oversensing (VOS) episode;

determining, for at least one of the episode categories, a subset including greater than or equal to one episode and less than a total number of episodes of the at least one episode category;

selecting, using a processor, a first cardiac episode and a second cardiac episode for display, wherein the subset includes at least one of the first cardiac episode and the second cardiac episode;

displaying, simultaneously, information associated with the first cardiac episode and information associated with the second cardiac episode of the subset of cardiac episodes selected for display via a graphical user interface display, wherein the first cardiac episode and the second cardiac episode each includes a plurality of cardiac depolarization events, and wherein displaying, simultaneously, information associated with the first cardiac episode and information associated with the second cardiac episode of the subset of cardiac episodes comprises displaying, simultaneously, a first image of at least a portion of a first EGM signal from the first cardiac episode and a second image of at least a portion of a second EGM signal from the second cardiac episode,

wherein categorizing each of the plurality of cardiac episodes comprises categorizing the first episode and a third episode in a same episode category;

determining a first EGM signal morphology of the first episode and a third EGM signal morphology of the third episode are substantially similar;

selecting the first episode but not the third episode for display based on the determination that the first EGM signal morphology of the first episode and the third EGM signal morphology of the third episode are substantially similar; and

displaying information associated with the first episode but not the third episode based on the selection of the first episode but not the third episode for display.

61. A system comprising:

a communication module configured to receive electrogram (EGM) signal data from an implantable cardiac device, the EGM signal data including a plurality of cardiac episodes;

a graphical user interface; and

a processor configured to;

categorize, based on the EGM signal data, each of the plurality of cardiac episodes as one of a ventricular tachycardia/ventricular fibrillation (VT/VF) episode, a supraventricular tachycardia (SVT) episode, a non-sustained ventricular tachycardia (VTNS) episode, an atrial tachycardia/ atrial fibrillation (AT/AF) episode, a monitored VT episode, or a ventricular oversensing (VOS) episode;

determine for at least one of the episode categories, a subset including greater than or equal to one episode and less than a total number of episodes of the at least one episode category;

select a first cardiac episode and a second cardiac episode for display, wherein the subset includes at least one of the first cardiac episode and the second cardiac episode;

via the graphical user interface, display, simultaneously, a first image of at least a portion of a first EGM signal from the first cardiac episode and a second image of at least a portion of a second EGM signal from the second cardiac episode, wherein the first cardiac episode and the second cardiac episode each includes a plurality of cardiac depolarization events;

categorize the first episode and a third episode in a same episode category;

determine a first EGM signal morphology of the first episode and a third EGM signal morphology of the third episode are substantially similar;

select the first episode but not the third episode for display based on the determination that the first EGM signal morphology of the first episode and the third EGM signal morphology of the third episode are substantially similar; and

display information associated with the first episode but not the third episode based on the selection of the first episode but not the third episode for display.