Cardiac response classification using retriggerable classification windows

• US 9,993,205 B2
• Filed: 06/17/2010
• Issued: 06/12/2018
• Est. Priority Date: 12/12/2003
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Meyer, Scott A., Dong, Yanting, Maniak, Jeremy, Birholz, Doug, Voegele, John
• Primary Examiner(s): Alter, Alyssa M
• Application Number:
  US12/818,066
• Publication Number:
  US 20100256703A1
• Time in Patent Office: 2,917 Days
• Field of Search: 607 28
• CPC Class Codes: A61B 5/35 by template matching
• CPC Class Codes: A61B 5/7217 of noise originating from a therapeutic or surgical apparatus, e.g. from a pacemaker
• 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: A61N 1/371 Capture, i.e. successful stimulation
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

Methods and devices for classifying a cardiac response to pacing involve establishing a retriggerable cardiac response classification window. A first cardiac response classification window is established subsequent to delivery of a pacing pulse. A cardiac signal following the pacing stimulation is sensed in the first classification window. A second cardiac response classification may be triggered if a trigger characteristic is detected in the first classification window. The cardiac signal is sensed in the second classification window if the second classification window is established. The cardiac response to the pacing stimulation is determined based on characteristics of the cardiac signal. The cardiac response may be determined to be one of a captured response, a non-captured response, a non-captured response added to an intrinsic beat, and a fusion/pseudofusion beat, for example.

Claims

1. A method of classifying a cardiac response to a pacing stimulation, comprising:

delivering the pacing stimulation to a heart chamber;

sensing a cardiac signal of the heart chamber following delivery of the pacing stimulation;

detecting a first trigger feature of the cardiac signal within a first predetermined capture detection region;

in response to detecting the first trigger feature of the cardiac signal within the first predetermined capture detection region, continuing to evaluate at least a portion of a QRS waveform of the cardiac signal that occurs after the first trigger feature;

classifying the cardiac response as fusion or capture of the heart chamber based on at least a portion of the QRS waveform of the cardiac signal that occurs after the first trigger feature; and

delivering pacing therapy based on the classification of the cardiac response as fusion or capture.

2. The method of claim 1, wherein classifying the cardiac response as fusion or capture comprises:

determining if a second feature of the cardiac signal, which is part of the QRS waveform of the cardiac signal, falls within a second predetermined capture detection region triggered by detection of the first trigger feature within the first predetermined capture region;

classifying the cardiac response as capture if the first trigger feature of the cardiac signal falls within the first capture detection region and the second feature of the cardiac signal falls within the second predetermined capture detection region; and

classifying the cardiac response as fusion if the second feature of the cardiac signal does not fall within the second predetermined capture detection region triggered by detection of the first trigger feature within the first predetermined capture region.

3. The method of claim 1, wherein the first predetermined capture detection region is bounded by upper and lower time boundaries and upper and lower amplitude boundaries.

4. The method of claim 1, wherein:

the first predetermined capture detection region occurs within a first classification window; and

wherein continuing to evaluate the portion of the QRS waveform of the cardiac signal that occurs after the first trigger feature comprises continuing to evaluate the portion of the QRS waveform of the cardiac signal in one or more additional classification windows.

5. The method of claim 1, wherein discriminating between fusion and capture comprises discriminating between fusion and capture of the left ventricle.

6. The method of claim 1, wherein discriminating between fusion and capture comprises discriminating between fusion and capture of the right ventricle.

7. The method of claim 1, wherein discriminating between fusion and capture comprises discriminating between fusion and capture of an atrial chamber.

8. The method of claim 1, further comprising classifying the cardiac response as an intrinsic beat if the first trigger feature of the cardiac signal falls within an intrinsic detection region.

9. The method of claim 8, wherein the intrinsic detection region is bounded by upper and lower time boundaries and upper and lower amplitude boundaries.

10. A cardiac device, comprising:

a pacing pulse generator configured to generate cardiac pacing pulses;

a sensing system configured to sense a cardiac pacing response signal of a heart chamber following delivery of a pacing pulse to the heart chamber; and

a cardiac response classification system configured to detect a first trigger feature of the cardiac signal within a first classification window, and, in response to detecting the first trigger feature of the cardiac signal, to continue to evaluate at least a portion of a QRS waveform of the cardiac signal that occurs after the first trigger feature, the cardiac response classification system further configured to discriminate between fusion and capture of the heart chamber based on the portion of the QRS waveform of the cardiac signal that occurs after the first trigger feature.

11. The device of claim 10, further comprising one or more left ventricular electrodes coupled to the sensing system, wherein the heart chamber is the left ventricle and the cardiac pacing response signal is sensed via the left ventricular electrodes.

12. The device of claim 11, wherein the pacing pulse generator is configured to deliver a back up pace if noncapture of the heart chamber is detected by the cardiac response classification system.

13. The device of claim 10, wherein the pacing pulse is delivered using a first electrode vector and the cardiac pacing response signal is sensed using a second electrode vector.

14. The device of claim 10, wherein the cardiac response classification system is configured to determine if the first trigger feature occurs within a first capture detection region, the first capture detection region bounded by upper and lower time boundaries and upper and lower amplitude boundaries.

15. The device of claim 10, wherein:

the cardiac response classification system is configured to continue to evaluate the cardiac signal in one or more additional classification windows that extend after the first classification window.

16. The device of claim 15, wherein the cardiac response classification system is configured to adapt one or both of an amplitude coordinate and a timing coordinate of the first classification window based on previous captured responses.

17. A cardiac device, comprising:

a pacing pulse generator configured to generate cardiac pacing pulses;

a sensing system configured to sense a cardiac pacing response signal of a heart chamber following delivery of a pacing pulse to the heart chamber; and

a cardiac response classification system configured to sense for a trigger feature of the cardiac signal within a first classification window, and, in response to detecting the trigger feature of the cardiac signal within the first classification window to continue to evaluate at least a portion of a QRS waveform of the cardiac signal that occurs after the first classification window in one or more additional classification windows, the cardiac response classification system further configured to discriminate between fusion and capture of the heart chamber based at least in part on the portion of the QRS waveform of the cardiac signal that occurs in the one or more additional classification windows.

18. The device of claim 17, wherein the cardiac response classification system is configured to determine if the trigger feature occurs within a capture detection region of the first classification window.

19. The device of claim 17, wherein the cardiac response classification system is configured to discriminate between fusion and capture of the heart chamber based on a timing of a feature that occurs within one of the one or more additional classification windows.

20. The device of claim 17, wherein the cardiac response classification system is configured to discriminate between fusion and capture of the left ventricle.

21. A method of operating a cardiac device, comprising:

delivering the pacing stimulation to a heart chamber during a cardiac cycle;

sensing a cardiac signal of the heart chamber during the cardiac cycle and following delivery of the pacing stimulation;

determining if a trigger feature of the cardiac signal occurs within one or more detection regions, the detection regions having upper and lower timing boundaries and upper and lower amplitude boundaries;

in response to determining that a cardiac signal trigger feature falls within one of the detection regions, continuing to evaluate at least a portion of a QRS waveform of the cardiac signal that occurs after the determined trigger feature;

classifying the cardiac signal based on one or more of detection of the trigger feature within the one or more detection regions and at least a portion of the QRS waveform of the cardiac signal that occurs after the determined trigger feature; and

delivering pacing therapy based on classification of the cardiac signal.

22. A cardiac device configured to implement the method of claim 21.

23. A method of classifying a cardiac response to a pacing stimulation, comprising:

delivering the pacing stimulation to a heart chamber;

sensing a cardiac signal of the heart chamber following delivery of the pacing stimulation;

searching for a first feature of a QRS waveform associated with the cardiac signal within a first capture detection region;

if the first feature is detected within the first capture detection region, searching for a second feature of the QRS waveform within a second capture detection region;

classifying the cardiac response as fusion or capture of the heart chamber based, at least in part, on whether the first feature of the QRS waveform was detected in the first capture detection region and/or whether the second feature of the QRS waveform was detected in the second capture detection region; and

delivering pacing therapy based on the classification of the cardiac response as fusion or capture.