Method and apparatus for atrial arrhythmia episode detection

• US 9,675,269 B2
• Filed: 04/24/2015
• Issued: 06/13/2017
• Est. Priority Date: 02/18/2015
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Hansen, Daniel L, Sarkar, Shantanu, Neitzell, Grant A
• Primary Examiner(s): GETZOW, SCOTT M
• Application Number:
  US14/695,171
• Publication Number:
  US 20160235320A1
• Time in Patent Office: 781 Days
• CPC Class Codes: A61B 5/24 Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
• CPC Class Codes: A61B 5/316 Modalities, i.e. specific diagnostic methods
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/352 Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval
• CPC Class Codes: A61B 5/361 Detecting fibrillation
• CPC Class Codes: A61B 5/363 Detecting tachycardia or bradycardia
• CPC Class Codes: A61B 5/686 Permanently implanted devices, e.g. pacemakers, other stimulators, biochips A61B5/6861 takes precedence
• CPC Class Codes: A61N 1/3624 occurring in the atrium, i.e. atrial tachycardia
• CPC Class Codes: A61N 1/36507 controlled by gradient or slope of the heart potential
• CPC Class Codes: A61N 1/36592 controlled by the heart rate variability
• CPC Class Codes: A61N 1/395 for treating atrial fibrillation
• CPC Class Codes: A61N 1/3987 characterised by the timing or triggering of the shock

Abstract

A method and implantable medical device for determining noise in response to a cardiac signal that includes sensing the cardiac signal, determining a sensing window in response to the sensed cardiac signal, the sensing window comprising a first portion and a second portion, determining a first derivative signal in response to the sensed cardiac signal within only one of the first portion and the second portion of the sensing window, determining a second derivative signal in response to the sensed cardiac signal within the one of the first portion and the second portion of the sensing window, determining whether an amplitude of the second derivative signal satisfies an amplitude threshold, and determining noise in response to the amplitude of the second derivative signal satisfying the amplitude threshold.

Claims

1. A method of determining noise in response to a cardiac signal in an implantable medical device, comprising:

sensing the cardiac signal;

determining a sensing window in response to the sensed cardiac signal, the sensing window comprising a first portion and a second portion;

determining a first derivative signal in response to the sensed cardiac signal within only one of the first portion and the second portion of the sensing window;

determining a second derivative signal in response to the sensed cardiac signal within the one of the first portion and the second portion of the sensing window;

determining whether an amplitude of the second derivative signal satisfies an amplitude threshold; and

determining noise in response to the amplitude of the second derivative signal satisfying the amplitude threshold.

2. The method of claim 1, wherein the first derivative signal and the second derivative signal are determined within the first portion of the sensing window, further comprising:

determining positive and negative zero crossings of the first derivative signal within the first portion;

determining whether a maximum amplitude of the second derivative signal at the positive zero crossings and a minimum amplitude of the second derivative signal at the negative zero crossings satisfy the amplitude threshold; and

determining noise in response to both the maximum amplitude and the minimum amplitude satisfying the amplitude threshold.

3. The method of claim 1, wherein the first derivative signal and the second derivative signal are determined within the first portion of the sensing window, further comprising:

determining positive and negative zero crossings of the first derivative signal within the first portion;

determining whether a maximum amplitude of the second derivative signal at the positive zero crossings and a minimum amplitude of the second derivative signal at the negative zero crossings satisfy the amplitude threshold; and

determining noise in response to only one of the maximum amplitude and the minimum amplitude satisfying the amplitude threshold.

4. The method of claim 1, wherein the first derivative signal and the second derivative signal are determined within the first portion of the sensing window, further comprising:

determining positive and negative zero crossings of the first derivative signal within the first portion;

determining a first number of amplitudes of the second derivative signal at the positive going zero crossing that are greater than a first amplitude threshold;

determining a second number of amplitudes of the second derivative signal at the negative going zero crossing that are less than a second amplitude threshold;

determining a sum of the first number of amplitudes and the second number of amplitudes; and

determining noise in response to the determined sum.

5. The method of claim 4, further comprising:

determining whether a total number of the positive zero crossings and the negative zero crossings is within a zero crossings sum threshold; and

determining noise in response to both the determined sum being greater than an amplitude sum threshold and the total number of the determined positive zero crossings and the negative zero crossings being within the zero crossings sum threshold.

6. The method of claim 1, wherein the first derivative signal and the second derivative signal are determined within the second portion of the sensing window, further comprising:

determining positive and negative zero crossings of the first derivative signal within the second portion;

determining whether a total number of the determined positive zero crossings and the negative zero crossing is greater than a total zero crossings threshold; and

determining noise in response to the total number of the determined positive zero crossings and the negative zero crossing being greater than the total zero crossings threshold.

7. The method of claim 1, wherein the first derivative signal and the second derivative signal are determined within the first portion of the sensing window, further comprising:

determining positive and negative zero crossings of the first derivative signal within the first portion;

determining whether a total number of the determined positive zero crossings and the negative zero crossings is greater than a total zero crossings threshold;

determining a first number of amplitudes of the second derivative signal at the positive going zero crossings of the first derivative signal that are greater than a positive going amplitude threshold;

determining a second number of amplitudes of the second derivative signal at the negative going zero crossings of the first derivative signal that are less than a negative going amplitude threshold;

determining whether a sum of the first number of amplitudes and the second number of amplitudes is greater than a total amplitude threshold; and

determining noise in response to both the total number of the determined positive zero crossings and the negative zero crossings being greater than the total zero crossings threshold and the sum of the first number of amplitudes and the second number of amplitudes being greater than the total amplitude threshold.

8. The method of claim 1, comprising:

determining a first noise condition comprising determining whether a maximum amplitude of the second derivative signal at positive zero crossings of the first derivative signal and a minimum amplitude of the second derivative signal at negative zero crossings of the first derivative signal satisfy a first amplitude threshold;

determining a second noise condition comprising;

determining a first number of amplitudes of the second derivative signal at positive going zero crossings that are greater than a second amplitude threshold; and

determining a second number of amplitudes of the second derivative signal at negative going zero crossings that are less than a third amplitude threshold;

determining a third noise condition comprising determining a total number of positive zero crossings and negative zero crossings of the first derivative signal within the first portion of the sensing window;

determining a fourth noise condition comprising determining a total number of positive zero crossings and negative zero crossings of the first derivative signal within the second portion of the sensing window; and

determining a fifth noise condition comprising;

determining a total number of positive zero crossings and negative zero crossings greater than a total zero crossings threshold;

determining a first number of amplitudes of the second derivative signal at the positive going zero crossings of the first derivative signal that are greater than a positive going amplitude threshold; and

determining a second number of amplitudes of the second derivative signal at negative going zero crossings of the first derivative signal that are less than a negative going amplitude threshold, wherein noise is determined in response to one of the first noise condition, the second noise condition, the third noise condition, the fourth noise condition and the fifth noise condition.

9. The method of claim 1, wherein the medical device comprises a subcutaneous device.

10. The method of claim 1, wherein the sensing window is a P-wave sensing window, the first portion is a baseline portion and the second portion is a P-wave portion.

11. An implantable medical device for determining noise within response to a cardiac signal, comprising:

a plurality of electrodes sensing the cardiac signal; and

a processor configured to determine a P-wave sensing window of the sensed cardiac signal, divide the P-wave sensing window into a baseline portion and a P-wave portion, determine a first derivative signal of the sensed cardiac signal within at least one of the baseline portion and the P-wave portion of the sensing window, determine a second derivative signal of the sense cardiac signal within the at least one of the baseline portion and the P-wave of the sensing window, determine whether an amplitude of the second derivative signal satisfies an amplitude threshold, and determine noise in response to the amplitude of the second derivative signal satisfying the amplitude threshold.

12. The medical device of claim 11, wherein the first derivative signal and the second derivative signal are determined within the baseline portion of the sensing window, the processor further configured to determine positive and negative zero crossings of the first derivative signal within the baseline portion, determine whether a maximum amplitude of the second derivative signal at the positive zero crossings and a minimum amplitude of the second derivative signal at the negative zero crossings satisfy the amplitude threshold, and determine noise in response to both the maximum amplitude and the minimum amplitude satisfying the amplitude threshold.

13. The medical device of claim 11, wherein the first derivative signal and the second derivative signal are determined within the baseline portion of the sensing window, the processor further configured to determine positive and negative zero crossings of the first derivative signal within the baseline portion, determine whether a maximum amplitude of the second derivative signal at the positive zero crossings and a minimum amplitude of the second derivative signal at the negative zero crossings satisfy the amplitude threshold, and determine noise in response to only one of the maximum amplitude and the minimum amplitude satisfying the amplitude threshold.

14. The medical device of claim 11, wherein the first derivative signal and the second derivative signal are determined within the baseline portion of the sensing window, the processor further configured to determine positive and negative zero crossings of the first derivative signal within the baseline portion, determine a first number of amplitudes of the second derivative signal at the positive going zero crossing that are greater than a first amplitude threshold, determine a second number of amplitudes of the second derivative signal at the negative going zero crossing that are less than a second amplitude threshold, determine a sum of the first number of amplitudes and the second number of amplitudes, and determine noise based on the determined sum.

15. The medical device of claim 14, wherein the processor is further configured to determine whether a total number of the determined positive zero crossings and the negative zero crossings is within a zero crossings sum threshold, and determine noise in response to both the determined sum being greater than an amplitude sum threshold and the total number of the determined positive zero crossings and the negative zero crossings being within the zero crossings sum threshold.

16. The medical device of claim 11, wherein the first derivative signal and the second derivative signal are determined within the P-wave portion of the sensing window, the processor further configured to determine positive and negative zero crossings of the first derivative signal within the P-wave portion, determine whether a total number of the determined positive zero crossings and the negative zero crossing is greater than a total zero crossings threshold, and determine noise in response to the total number of the determined positive zero crossings and the negative zero crossing being greater than the total zero crossings threshold.

17. The medical device of claim 11, wherein the first derivative signal and the second derivative signal are determined within the baseline portion of the sensing window, the processor further configured to determine positive and negative zero crossings of the first derivative signal within the baseline portion, determine whether a total number of the determined positive zero crossings and the negative zero crossings is greater than a total zero crossings threshold, determine a first number of amplitudes of the second derivative signal at the positive going zero crossings of the first derivative signal that are greater than a positive going amplitude threshold, determine a second number of amplitudes of the second derivative signal at the negative going zero crossings of the first derivative signal that are less than a negative going amplitude threshold, determine whether a sum of the first number of amplitudes and the second number of amplitudes is greater than a total amplitude threshold, and determine noise in response to both the total number of the determined positive zero crossings and the negative zero crossings being greater than the total zero crossings threshold and the sum of the first number of amplitudes and the second number of amplitudes being greater than the total amplitude threshold.

18. The medical device of claim 11, wherein the processor is further configured to determine a first noise condition comprising determining whether a maximum amplitude of the second derivative signal at positive zero crossings of the first derivative signal and a minimum amplitude of the second derivative signal at negative zero crossings of the first derivative signal satisfy a first amplitude threshold, determine a second noise condition comprising determining a first number of amplitudes of the second derivative signal at positive going zero crossings that are greater than a second amplitude threshold, and determining a second number of amplitudes of the second derivative signal at negative going zero crossings that are less than a third amplitude threshold, determine a third noise condition comprising determining a total number of positive zero crossings and negative zero crossings of the first derivative signal within the baseline portion of the sensing window, determine a fourth noise condition comprising determining a total number of positive zero crossings and negative zero crossings of the first derivative signal within the P-wave portion of the sensing window, and determine a fifth noise condition comprising determining a total number of positive zero crossings and negative zero crossings greater than a total zero crossings threshold;

determining a first number of amplitudes of the second derivative signal at the positive going zero crossings of the first derivative signal that are greater than a positive going amplitude threshold; and

determining a second number of amplitudes of the second derivative signal at negative going zero crossings of the first derivative signal that are less than a negative going amplitude threshold, wherein noise is determined in response to one of the first noise condition, the second noise condition, the third noise condition, the fourth noise condition and the fifth noise condition.

19. The medical device of claim 11, wherein the medical device comprises a subcutaneous device.

20. A computer-readable medium storing a set of instructions which cause a processor of an implantable medical device to perform a method of determining a noise of a cardiac signal, comprising:

sensing the cardiac signal;

determining a sensing window of the sensed cardiac signal, the sensing window comprising a first portion and a second portion;

determining a first derivative signal in response to the sensed cardiac signal within only one of the first portion and the second portion of the sensing window;

determining a second derivative signal in response to the sensed cardiac signal within the one of the first portion and the second portion of the sensing window;

determining whether an amplitude of the second derivative signal satisfies an amplitude threshold; and

determining noise in response to the amplitude of the second derivative signal satisfying the amplitude threshold.

21. An implantable medical device for determining noise in a cardiac signal, comprising:

a plurality of electrodes configured to sense the cardiac signal; and

a processor configured to determine a P-wave sensing window associated with at least one cardiac event in the sensed cardiac signal, the sensing window comprising a first portion corresponding to a baseline portion and a second portion corresponding to a P-wave portion, determine a first derivative signal of the cardiac signal within the sensing window, determine a second derivative signal of the cardiac signal within the sensing window, identify a noise event within the sensing window based at least on the analysis of amplitudes of the second derivative signal.

22. The medical device of claim 21, wherein the processor is further configured to determine positive going and negative going zero crossings in the first derivative signal within the first portion of the sensing window, determine amplitudes of the second derivative signal at the positive going and negative going zero crossings, determine a maximum amplitude of the determined amplitudes at the positive going zero crossings, determine a minimum amplitude of the determined amplitudes at the negative going zero crossings, and identifying the noise event within the sensing window based on at least one of the maximum amplitude and the minimum amplitude.

23. The medical device of claim 22, wherein the processor is configured to identify the noise event within the sensing window when both the maximum amplitude is greater than a first threshold amplitude and the minimum amplitude is less than a second threshold amplitude.

24. The medical device of claim 23, wherein the processor is configured to identify the noise event within the sensing window when either the maximum amplitude is greater than a third threshold amplitude or the minimum amplitude is less than a fourth threshold amplitude.

25. The medical device of claim 24, wherein the third threshold is greater than the first threshold and the fourth threshold is less than the second threshold.

26. The medical device of claim 21, wherein the processor is further configured to determine positive going and negative going zero crossings in the first derivative signal within the first portion of the sensing window, determine amplitudes of the second derivative signal at the positive going and negative going zero crossings, determine a first number of the determined amplitudes of the second derivative signal at the positive going zero crossing that are greater than a fifth threshold amplitude, determine a second number of the determined amplitudes of the second derivative signal at the negative going zero crossing that are less than a sixth threshold amplitude, determine a sum of the first number of amplitudes and the second number of amplitudes, and identify the noise event within the sensing window based on the determined sum.

27. The medical device of claim 26, wherein the processor is configured to identify the noise event within the sensing window when the sum is greater than a threshold sum.

28. The medical device of any one of claim 27, wherein the processor is further configured to determine a total number of zero crossings within the first portion of the sensing window by summing the number of determined positive going and negative going zero crossings within the first portion of the sensing window, and identify the noise event within the sensing window when both the determined sum is equal to the threshold sum and the total number of zero crossings is within a predetermined range.

29. The medical device of claim 21, wherein the processor is further configured to determine positive going and negative going zero crossings in the first derivative signal within the second portion of the sensing window, determine a total number of the determined positive zero crossings and the negative zero crossings in first derivative signal of the second portion of the sensing window, and identify the noise event within the sensing window when the total number of zero crossings in first derivative signal of the second portion of the sensing window is greater than a total zero crossings threshold.

30. The medical device of claim 21, wherein the processor is further configured to determine positive going and negative going zero crossings of the first derivative signal within the first portion of the sensing window, determine a total number of the determined positive going zero crossings and the negative going zero crossings within the first portion of the sensing window, determine a first number of amplitudes of the second derivative signal at the positive going zero crossings within the first portion of the sensing window that are greater than a positive going amplitude threshold, determine a second number of amplitudes of the second derivative signal at the negative going zero crossings within the first portion of the sensing window that are less than a negative going amplitude threshold, determine whether a sum of the first number of amplitudes and the second number of amplitudes is greater than a threshold number, and identify the noise event in the sensing window when both the total number of the determined positive zero crossings and the negative zero crossings are greater than the total zero crossings threshold and the sum of the first number of amplitudes and the second number of amplitudes are greater than the threshold number.

31. The medical device of claim 21, wherein the medical device comprises a subcutaneous device.

32. The medical device of claim 21, wherein the baseline portion of the P-wave sensing window precedes the P-wave portion of the P-wave sensing window.