Ventricular tachycardia detection algorithm using only cardiac event intervals

• US 9,808,637 B2
• Filed: 08/11/2015
• Issued: 11/07/2017
• Est. Priority Date: 08/11/2015
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Sharma, Vinod, Stadler, Robert W.
• Primary Examiner(s): Heller, Tammie K
• Application Number:
  US14/823,405
• Publication Number:
  US 20170043173A1
• Time in Patent Office: 819 Days
• CPC Class Codes: A61N 1/0573 chacterised by means penetrating the heart tissue, e.g. helix needle or hook
• CPC Class Codes: A61N 1/3621 for treating or preventing abnormally high heart rate
• CPC Class Codes: A61N 1/365 controlled by a physiological parameter, e.g. heart potential evoked response A61N1/371
• CPC Class Codes: A61N 1/36507 controlled by gradient or slope of the heart potential
• CPC Class Codes: A61N 1/37205 Microstimulators, e.g. implantable through a cannula
• CPC Class Codes: A61N 1/3756 Casings with electrodes thereon, e.g. leadless stimulators
• CPC Class Codes: A61N 1/3925 Monitoring; Protecting
• CPC Class Codes: A61N 1/3987 characterised by the timing or triggering of the shock

Abstract

An implantable medical device system includes a pacemaker and an extravascular implantable cardioverter defibrillator (ICD). The pacemaker is configured to acquire a cardiac electrical signal, determine RR intervals from the cardiac electrical signal, apply ventricular tachycardia detection criteria solely to the RR intervals, detect ventricular tachycardia (VT) when the detection criteria are met; and deliver anti-tachycardia pacing in response to detecting the VT before the extravascular ICD delivers a shock therapy.

Claims

1. An intracardiac pacemaker comprising:

a housing sized to fit within a heart;

at least two electrodes disposed on the housing;

a sensing module enclosed within the housing and electrically coupled to the at least two electrodes, the sensing module configured to sense R-waves from a first cardiac electrical signal received from the at least two electrodes coupled to the sensing module;

a pulse generator enclosed within the housing and electrically coupled to the at least two electrodes, the pulse generator configured to generate cardiac pacing pulses for delivery to the heart via the at least two electrodes; and

a control module enclosed within the housing and electrically coupled to the sensing module and the pulse generator, the control module configured to;

determine RR intervals between consecutive ones of the sensed R-waves;

apply RR interval-based ventricular tachycardia (VT) detection criteria solely to the determined RR intervals;

detect a monomorphic VT when the VT detection criteria are met; and

control the pulse generator to deliver anti-tachycardia pacing in response to detecting the monomorphic VT,

wherein applying the detection criteria solely to the determined RR intervals comprises applying at least a non-sinus rhythm criterion, a supraventricular tachycardia rejection criterion that is different than the non-sinus rhythm criterion, and a number of tachycardia intervals to detect criterion to the RR intervals.

2. The intracardiac pacemaker of claim 1, wherein the control module determines a first average of a first group of the RR intervals, determines a second average of a second group of the RR intervals immediately preceding the first group, compares a ratio of the first average to the second average to a predetermined percentage, and determines that the non-sinus rhythm criterion is met when the ratio of the first average to the second average is less than or equal to the predetermined percentage.

3. The intracardiac pacemaker of claim 1, wherein the control module is configured to apply the non-sinus rhythm criterion, determine that the non-sinus rhythm criteria is met, after determining the non-sinus rhythm criterion is met, determine at least one of the determined RR intervals, compare the at least one of the determined RR intervals that is determined after the non-sinus rhythm criterion is met to a maximum tachycardia detection interval plus a fixed hysteresis interval and determine that the supraventricular tachycardia rejection criterion is not met when the at least one of the determined RR interval that is determined after the non-sinus rhythm criterion is met is greater than or equal to the maximum tachycardia detection interval plus the fixed hysteresis interval.

4. The intracardiac pacemaker of claim 1, wherein the control module is further configured to apply, as part of the detection criteria, a regularity criterion in response to the number of tachycardia intervals to detect criterion being met,

wherein the regularity criterion is applied to a predetermined number of RR intervals ending with an RR interval that causes the number of tachycardia intervals to detect criterion to be met,

the predetermined number of RR intervals being less than the number of tachycardia intervals to detect criterion.

5. The intracardiac pacemaker of claim 4, wherein the control module determines a count for each one of a plurality of RR interval ranges by counting RR intervals of the predetermined number of RR intervals that fall into a given one the plurality of RR interval ranges, determine a sum of at least two of the counts having highest values of the determined counts, compare the sum to a regularity threshold, and determine that the regularity criterion is met when the sum is greater than the regularity threshold.

6. The intracardiac pacemaker of claim 5, wherein the control module is further configured to determine a predetermined percentile cycle length of the predetermined number of RR intervals and set the regularity threshold as a function of the predetermined percentile cycle length.

7. The intracardiac pacemaker of claim 1, wherein the control module is further configured to apply, as part of the detection criteria, a polymorphic ventricular tachyarrhythmia rejection criterion in response to the number of tachycardia intervals to detect criterion being met.

8. The intracardiac pacemaker of claim 7, wherein the control module is configured to determine if each one of a predetermined number of the RR intervals ending with an RR interval that causes the number of tachycardia intervals to detect criterion to be met is greater than or equal to a minimum tachycardia detection interval and determine that the polymorphic ventricular tachyarrhythmia rejection criterion is satisfied when all of the predetermined number of RR intervals are greater than or equal to the minimum tachycardia detection interval.

9. The intracardiac pacemaker of claim 8, wherein the control module withholds the delivery of anti-tachycardia pacing therapy in response to the polymorphic ventricular tachyarrhythmia rejection criterion not being satisfied.

10. An implantable medical device system comprising:

an implantable pacemaker comprising;

a housing sized to fit within a heart;

at least two electrodes disposed on the housing;

a pacemaker sensing module enclosed within the housing and electrically coupled to the at least two electrodes, the pacemaker sensing module configured to obtain R-waves from a first cardiac electrical signal received from the at least two electrodes coupled to the sensing module;

a pulse generator enclosed within the housing and electrically coupled to the at least two electrodes, the pulse generator configured to generate cardiac pacing pulses for delivery to the heart via the at least two electrodes; and

a pacemaker control module enclosed within the housing and electrically coupled to the sensing module and the pulse generator, the pacemaker control module configured to;

determine RR intervals between consecutive ones of the sensed R-waves;

apply RR interval-based ventricular tachycardia detection criteria solely to the determined RR intervals;

detect a monomorphic ventricular tachycardia (VT) when the detection criteria are met; and

control the pulse generator to deliver anti-tachycardia pacing in response to detecting the monomorphic VT,

wherein applying the detection criteria solely to the determined RR intervals comprises applying at least a non-sinus rhythm criterion, a supraventricular tachycardia rejection criterion that is different than the non-sinus rhythm criterion, and a number of tachycardia intervals to detect criterion to the RR intervals

an implantable cardioverter defibrillator (ICD) system comprising;

at least one extravascular defibrillation lead having a plurality of extravascular electrodes;

an ICD coupled to the at least one extravascular defibrillation lead, the ICD comprising;

an ICD sensing module electrically coupled to at least a portion of the plurality of extravascular electrodes to receive a second cardiac electrical signal;

a defibrillation therapy delivery module comprising at least one high voltage capacitor, the defibrillation therapy delivery module being configured to deliver a shock therapy to the heart via at least one of the plurality of extravascular electrodes of the extravascular defibrillation lead;

an ICD control module electrically coupled to the ICD sensing module and the defibrillation therapy delivery module, wherein the ICD control module is configured to;

analyze the second cardiac electrical signal received by the ICD sensing module;

detect the monomorphic VT detected by the pacemaker control module in response to the analyzing of the second cardiac electrical signal; and

control the therapy delivery module to charge the at least one high voltage capacitor in response to detecting the monomorphic VT,

wherein the number of tachycardia intervals to detect criterion comprises requiring a threshold number of the determined RR intervals being less than a tachycardia detection interval,

wherein a maximum time interval including the threshold number of the determined RR intervals that are less than the tachycardia detection interval is shorter than an expected time interval required for detecting the monomorphic VT by the ICD and completing charging of the at least one high voltage capacitor by the ICD.

11. The system of claim 10, wherein:

the pacemaker control module is configured to apply the non-sinus rhythm criterion, determine that the non-sinus rhythm criterion is met, determine N predetermined RR intervals, and apply the number of tachycardia intervals to detect criterion by determining whether at least M out of the N predetermined RR intervals that are determined after the non-sinus rhythm criterion is satisfied are less than a maximum tachycardia detection interval, where M and N are predefined values;

the ICD control module is configured to detect the monomorphic VT by analyzing at least one n-second time interval of the second cardiac electrical signal; and

M is selected to be at least a maximum possible number of RR intervals that could occur at the maximum tachycardia detection interval in the n-second time interval.

12. The system of claim 10, wherein the ICD control module is further configured to wait for an ATP delay period after detecting the monomorphic VT and before controlling the defibrillation therapy delivery module to charge the high voltage capacitor when a previously detected episode of the monomorphic VT has been successfully terminated by anti-tachycardia pacing delivered by the pacemaker.

13. The system of claim 10, wherein the pacemaker control module determines a first average of a first group of the RR intervals, determines a second average of a second group of the RR intervals immediately preceding the first group, compares a ratio of the first average to the second average to a predetermined percentage, and determines that the non-sinus rhythm criterion is met when the ratio of the first average to the second average is less than or equal to the predetermined percentage.

14. The system of claim 10, wherein the pacemaker control module is configured to apply the non-sinus rhythm criterion, determine that the non-sinus rhythm criteria is met, after determining the non-sinus rhythm criterion is met, determine at least one of the determined RR intervals, compare the at least one of the determined RR intervals that is determined after the non-sinus rhythm criterion is met to a maximum tachycardia detection interval plus a fixed hysteresis interval and determine that the supraventricular tachycardia rejection criterion is not met in response to the at least one RR interval that is determined after the non-sinus rhythm criterion is met is less greater than or equal to the maximum tachycardia detection interval plus the fixed hysteresis interval.

15. The system of claim 10, wherein the pacemaker control module is further configured to apply, as part of the detection criteria, a regularity criterion in response to the number of tachycardia intervals to detect criterion being met,

wherein the regularity criterion is applied to a predetermined number of RR intervals ending with an RR interval that causes the number of tachycardia intervals to detect criterion to be met,

the predetermined number of RR intervals being less than the number of tachycardia intervals to detect criterion.

16. The system of claim 15, wherein the pacemaker control module determines a count for each one of a plurality of RR interval ranges by counting RR intervals of the predetermined number of RR intervals that fall into a given one the plurality of RR interval ranges, determine a sum of at least two of the counts having highest values of the determined counts, compare the sum to a regularity threshold, and determine that the regularity criterion is met when the sum is greater than the regularity threshold.

17. The system of claim 10, wherein the pacemaker control module is further configured to apply, as part of the detection criteria, a polymorphic ventricular tachyarrhythmia rejection criterion in response to the number of tachycardia intervals to detect criterion being met,

wherein the pacemaker control module is configured to determine if each one of a predetermined number of the RR intervals ending with an RR interval that causes the number of tachycardia intervals to detect criterion to be met is greater than or equal to a minimum tachycardia detection interval and determine that the polymorphic ventricular tachyarrhythmia rejection criterion is satisfied when all of the predetermined number of the RR intervals are greater than or equal to the minimum tachycardia detection interval.