Feature based sensing for leadless pacing therapy

• US 10,596,383 B2
• Filed: 04/03/2018
• Issued: 03/24/2020
• Est. Priority Date: 04/03/2018
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Ghosh, Subham
• Primary Examiner(s): Gedeon, Brian T
• Application Number:
  US15/944,050
• Publication Number:
  US 20190299012A1
• Time in Patent Office: 721 Days
• Field of Search: None
• CPC Class Codes: A61N 1/056 Transvascular endocardial electrode systems
• CPC Class Codes: A61N 1/3621 for treating or preventing abnormally high heart rate
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/36507 controlled by gradient or slope of the heart potential
• CPC Class Codes: A61N 1/3688 configured for switching the pacing mode, e.g. from AAI to DDD
• CPC Class Codes: A61N 1/3712 Auto-capture, i.e. automatic adjustment of the stimulation threshold
• CPC Class Codes: A61N 1/37288 Communication to several implantable medical devices within one patient
• CPC Class Codes: A61N 1/3756 Casings with electrodes thereon, e.g. leadless stimulators
• CPC Class Codes: A61N 1/3956 Implantable devices for applying electric shocks to the heart, e.g. for cardioversion

Abstract

A method and system that includes an implantable cardioverter defibrillator (ICD) determining signal characteristics of a cardiac signal within a signal evaluation window positioned along a first portion of a cardiac cycle and determining whether a P-wave occurs within the signal evaluation window associated with the first portion of the cardiac cycle. The signal evaluation window is adjusted to be positioned along a second portion of the cardiac cycle in response to the P-wave not occurring within the signal evaluation window and signal characteristics of the cardiac signal are determined within the adjusted signal evaluation window. A determination is made as to whether a P-wave occurs in response to the signal characteristics determined within the adjusted signal evaluation window, and the ICD delivers a trigger signal to a leadless pacing device instructing delivery of ventricular pacing therapy by the leadless pacing device whenever a P-wave is determined to occur.

Claims

1. A method of delivering a cardiac pacing therapy, comprising:

sensing a cardiac signal;

determining signal characteristics of the cardiac signal within a signal evaluation window positioned along a first portion of a cardiac cycle;

determining whether a P-wave occurs within the signal evaluation window associated with the first portion of the cardiac cycle in response to the determined signal characteristics;

adjusting the signal evaluation window to be positioned along a second portion of the cardiac cycle in response to the P-wave not occurring within the signal evaluation window;

determining signal characteristics of the cardiac signal within the signal evaluation window positioned along the second portion of the cardiac cycle;

determining whether a P-wave occurs in response to the signal characteristics determined within the signal evaluation window positioned along the second portion of the cardiac cycle; and

delivering ventricular pacing therapy in response to a P-wave being determined to occur.

2. The method of claim 1, further comprising:

determining a cycle length between the P-wave determined for the cardiac cycle and a P-wave determined for a previous cardiac cycle; and

adjusting a blanking period for subsequent delivery of ventricular pacing therapy in response to the determined cycle length.

3. The method of claim 1, further comprising:

determining a cycle length between the P-wave determined for the cardiac cycle and a P-wave determined for a previous cardiac cycle; and

adjusting a width of the signal evaluation window in response to the determined cycle length.

4. The method of claim 1, further comprising:

determining whether a first difference between a maximum amplitude of the cardiac signal within the signal evaluation window and an amplitude of the cardiac signal at a start of the signal evaluation window is greater than an amplitude threshold;

determining whether a second difference between the maximum amplitude of the cardiac signal within the signal evaluation window and an amplitude of the cardiac signal at an end of the signal evaluation window is greater than the amplitude threshold; and

determining a P-wave occurs within the signal evaluation window in response to both the first difference and the second difference being greater than the amplitude threshold.

5. The method of claim 4, further comprising determining a P-wave does not occur within the signal evaluation window in response to at least one of the first difference and the second difference not being greater than the amplitude threshold.

6. The method of claim 1, further comprising:

determining whether a first difference between an amplitude of the cardiac signal at a start of the signal evaluation window and a minimum amplitude of the cardiac signal within the signal evaluation window and is greater than an amplitude threshold;

determining whether a second difference between an amplitude of the cardiac signal at an end of the signal evaluation window and the minimum amplitude of the cardiac signal within the signal evaluation window is greater than the amplitude threshold; and

determining a P-wave occurs within the signal evaluation window in response to both the first difference and the second difference being greater than the amplitude threshold.

7. The method of claim 6, further comprising determining a P-wave does not occur within the signal evaluation window in response to at least one of the first difference and the second difference not being greater than the amplitude threshold.

8. The method of claim 1, further comprising:

determining whether a first difference between a maximum amplitude of the cardiac signal within the signal evaluation window and an amplitude of the cardiac signal at a start of the signal evaluation window is greater than an amplitude threshold;

determining whether a second difference between the maximum amplitude of the cardiac signal within the signal evaluation window and an amplitude of the cardiac signal at an end of the signal evaluation window is greater than the amplitude threshold;

determining whether a third difference between the amplitude of the cardiac signal at the start of the signal evaluation window and a minimum amplitude of the cardiac signal within the signal evaluation window and is greater than the amplitude threshold;

determining whether a fourth difference between the amplitude of the cardiac signal at the end of the signal evaluation window and the minimum amplitude of the cardiac signal within the signal evaluation window is greater than the amplitude threshold; and

determining a P-wave occurs within the signal evaluation window in response to one of both the first difference and the second difference being greater than the amplitude threshold, and both the third difference and the fourth difference being greater than the amplitude threshold.

9. The method of claim 8, further comprising determining a P-wave does not occur within the signal evaluation window in response to both the first difference and the second difference not being greater than the amplitude threshold and both the third difference and fourth difference not being greater than the amplitude threshold.

10. The method of claim 9, further comprising:

determining a cycle length between the P-wave determined for the cardiac cycle and a P-wave determined for a previous cardiac cycle; and

adjusting a blanking period for subsequent delivery of ventricular pacing therapy in response to the determined cycle length.

11. The method of claim 9, further comprising:

determining a cycle length between the P-wave determined for the cardiac cycle and a P-wave determined for a previous cardiac cycle; and

adjusting a width of the signal evaluation window in response to the determined cycle length.

12. A cardiac pacing system for delivering a cardiac pacing therapy, comprising:

an implantable cardioverter defibrillator (ICD), the ICD comprising a housing;

a lead having a lead body and electrically coupled to the housing of the ICD;

a plurality of electrodes positioned along the lead body;

a control circuit positioned within the housing of the ICD and configured to determine a cardiac signal sensed between two electrodes of the plurality of electrodes positioned along the lead body or between the housing of the ICD and an electrode of the plurality of electrodes positioned along the lead body, determine signal characteristics of the cardiac signal within a signal evaluation window positioned along a first portion of a cardiac cycle, determine whether a P-wave occurs within the signal evaluation window associated with the first portion of the cardiac cycle in response to the determined signal characteristics, adjust the signal evaluation window to be positioned along a second portion of the cardiac cycle in response to the P-wave not occurring within the signal evaluation window, determine signal characteristics of the cardiac signal within the signal evaluation window positioned along the second portion of the cardiac cycle, determine whether a P-wave occurs in response to the signal characteristics determined within the signal evaluation window positioned along the second portion of the cardiac cycle, and deliver a trigger signal in response to a P-wave being determined to occur;

a leadless pacing device comprising a housing;

a plurality of electrodes positioned along the housing of the leadless pacing device; and

a control circuit positioned within the housing of the leadless pacing device and configured to receive the trigger signal from the ICD and deliver a ventricular pacing therapy via the plurality of electrodes positioned along the housing of the leadless pacing device.

13. The cardiac pacing system of claim 12, wherein the control circuit positioned within the housing of the ICD is configured to determine a cycle length between the P-wave determined for the cardiac cycle and a P-wave determined for a previous cardiac cycle, and adjust a blanking period for subsequent delivery of ventricular pacing therapy in response to the determined cycle length.

14. The cardiac pacing system of claim 12, wherein the control circuit positioned within the housing of the ICD is configured to determine a cycle length between the P-wave determined for the cardiac cycle and a P-wave determined for a previous cardiac cycle, and adjust a width of the signal evaluation window in response to the determined cycle length.

15. The cardiac pacing system of claim 12, wherein the control circuit positioned within the housing of the ICD is configured to determine whether a first difference between a maximum amplitude of the cardiac signal within the signal evaluation window and an amplitude of the cardiac signal at a start of the signal evaluation window is greater than an amplitude threshold, determine whether a second difference between the maximum amplitude of the cardiac signal within the signal evaluation window and an amplitude of the cardiac signal at an end of the signal evaluation window is greater than the amplitude threshold, and determine a P-wave occurs within the signal evaluation window in response to both the first difference and the second difference being greater than the amplitude threshold.

16. The cardiac pacing system of claim 15, wherein the control circuit positioned within the housing of the ICD is configured to determine a P-wave does not occur within the signal evaluation window in response to at least one of the first difference and the second difference not being greater than the amplitude threshold.

17. The cardiac pacing system of claim 12, wherein the control circuit positioned within the housing of the ICD is configured to determine whether a first difference between an amplitude of the cardiac signal at a start of the signal evaluation window and a minimum amplitude of the cardiac signal within the signal evaluation window and is greater than an amplitude threshold, determine whether a second difference between an amplitude of the cardiac signal at an end of the signal evaluation window and the minimum amplitude of the cardiac signal within the signal evaluation window is greater than the amplitude threshold, and determine a P-wave occurs within the signal evaluation window in response to both the first difference and the second difference being greater than the amplitude threshold.

18. The cardiac pacing system of claim 17, wherein the control circuit positioned within the housing of the ICD is configured to determine a P-wave does not occur within the signal evaluation window in response to at least one of the first difference and the second difference not being greater than the amplitude threshold.

19. The cardiac pacing system of claim 12, wherein the control circuit positioned within the housing of the ICD is configured to determine whether a first difference between a maximum amplitude of the cardiac signal within the signal evaluation window and an amplitude of the cardiac signal at a start of the signal evaluation window is greater than an amplitude threshold, determine whether a second difference between the maximum amplitude of the cardiac signal within the signal evaluation window and an amplitude of the cardiac signal at an end of the signal evaluation window is greater than the amplitude threshold, determine whether a third difference between the amplitude of the cardiac signal at the start of the signal evaluation window and a minimum amplitude of the cardiac signal within the signal evaluation window and is greater than the amplitude threshold, determine whether a fourth difference between the amplitude of the cardiac signal at the end of the signal evaluation window and the minimum amplitude of the cardiac signal within the signal evaluation window is greater than the amplitude threshold, and determine a P-wave occurs within the signal evaluation window in response to one of both the first difference and the second difference being greater than the amplitude threshold, and both the third difference and the fourth difference being greater than the amplitude threshold.

20. The cardiac pacing system of claim 19, wherein the control circuit positioned within the housing of the ICD is configured to determine a P-wave does not occur within the signal evaluation window in response to both the first difference and the second difference not being greater than the amplitude threshold and both the third difference and fourth difference not being greater than the amplitude threshold.

21. The cardiac pacing system of claim 20, wherein the control circuit positioned within the housing of the ICD is configured to determine a cycle length between the P-wave determined for the cardiac cycle and a P-wave determined for a previous cardiac cycle, and adjust a blanking period for subsequent delivery of ventricular pacing therapy in response to the determined cycle length.

22. The cardiac pacing system of claim 20, wherein the control circuit positioned within the housing of the ICD is configured to determine a cycle length between the P-wave determined for the cardiac cycle and a P-wave determined for a previous cardiac cycle, and adjust a width of the signal evaluation window in response to the determined cycle length.

23. A non-transitory computer readable medium storing instructions which cause a cardiac pacing device system to perform a method comprising:

sensing a cardiac signal;

determining signal characteristics of the cardiac signal within a signal evaluation window positioned along a first portion of a cardiac cycle;

determining whether a P-wave occurs within the signal evaluation window associated with the first portion of the cardiac cycle in response to the determined signal characteristics;

adjusting the signal evaluation window to be positioned along a second portion of the cardiac cycle in response to the P-wave not occurring within the signal evaluation window;

determining signal characteristics of the cardiac signal within the signal evaluation window positioned along the second portion of the cardiac cycle;

determining whether a P-wave occurs in response to the signal characteristics determined within the signal evaluation window positioned along the second portion of the cardiac cycle; and

delivering ventricular pacing therapy in response to a P-wave being determined to occur.