State-based atrial event detection

• US 10,694,967 B2
• Filed: 10/18/2017
• Issued: 06/30/2020
• Est. Priority Date: 10/18/2017
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Hemming, Michael T., Greenhut, Saul E.
• Primary Examiner(s): Wehrheim, Lindsey G
• Application Number:
  US15/786,832
• Publication Number:
  US 20190110707A1
• Time in Patent Office: 986 Days
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• CPC Class Codes: A61B 5/02028 Determining haemodynamic parameters not otherwise provided for, e.g. cardiac contractility or left ventricular ejection fraction
• CPC Class Codes: A61B 5/0205 Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition
• CPC Class Codes: A61B 5/02405 Determining heart rate variability
• CPC Class Codes: A61B 5/316 Modalities, i.e. specific diagnostic methods
• CPC Class Codes: A61B 5/318 Heart-related electrical modalities, e.g. electrocardiography [ECG]
• 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: A61B 5/726 using Wavelet transforms
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions
• CPC Class Codes: A61N 1/36507 controlled by gradient or slope of the heart potential
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/37211 Means for communicating with stimulators
• CPC Class Codes: A61N 1/3756 Casings with electrodes thereon, e.g. leadless stimulators
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

An implantable medical device includes a memory storing criteria for transitioning between states of a cardiac cycle model, the states including a P-wave state. The device also includes sensing circuitry that senses a cardiac signal that varies as a function of a cardiac cycle of a patient, and also includes processing circuitry coupled to the sensing circuitry. The processing circuitry is configured to detect an R-wave in the sensed cardiac signal, to determine an elapsed time since the detection of the R-wave, to determine one or more morphological values of a post-R-wave segment of the cardiac signal to compare the elapsed time and the one or more morphological values to the stored criteria for transitioning between the plurality of states of the cardiac cycle model, and to detect a P-wave in the sensed cardiac signal in response to a transition to the P-wave state of the cardiac cycle model.

Claims

1. An implantable medical device comprising:

a memory configured to store criteria for transitioning between a plurality of states of a cardiac cycle model, the plurality of states including a P-wave state;

sensing circuitry configured to sense a cardiac signal that varies as a function of a cardiac cycle of a patient; and

processing circuitry coupled to the sensing circuitry, the processing circuitry being configured to;

detect an R-wave in the sensed cardiac signal;

determine an elapsed time since the detection of the R-wave;

determine one or more morphological values of a post-R-wave segment of the cardiac signal occurring after the detection of the R-wave;

compare the elapsed time and the one or more morphological values to the stored criteria for transitioning between the plurality of states of the cardiac cycle model; and

detect a P-wave in the sensed cardiac signal in response to a transition to the P-wave state of the cardiac cycle model.

2. The implantable medical device of claim 1, further comprising communication circuitry configured to send a signal to another implantable medical device configured to deliver a pacing pulse to the patient, wherein the signal is configured to trigger the other implantable medical device to deliver the pacing pulse at a predetermined time after the detection of the P-wave, the processing circuitry being further configured to control the communication circuitry to send the signal to the other implantable medical device in response to detecting the P-wave.

3. The implantable medical device of claim 1, wherein the criteria comprise probability functions, each of the probability functions determining a probability of a respective state transition as a function of the elapsed time and at least one of the one or more morphological values, and wherein the processing circuitry is configured to determine that the respective state transition has occurred in response to the probability meeting a threshold.

4. The implantable medical device of claim 1, wherein the processing circuitry is configured to apply one or more time-frequency transformations to the post-R-wave segment of the cardiac signal, and determine the one or more morphological values based on the application of the one or more time-frequency transformations to the post R-wave segment of the cardiac signal.

5. The implantable medical device of claim 1, wherein the processing circuitry is configured to:

determine a plurality of morphological values of the post-R-wave segment;

form multiple value profiles of the plurality of morphological values of the post-R-wave segment, wherein each respective value profile corresponds to a respective state of the plurality of states of the cardiac cycle model; and

compare each value profile of the post-R-wave segment to a respective corresponding value profile of the stored criteria.

6. The implantable medical device of claim 1, wherein the processing circuitry determine one or more wavelet coefficients associated with the cardiac signal sensed by the sensing circuitry as the one or more morphological values.

7. The implantable medical device of claim 6, wherein of the one or more wavelet coefficients comprise one or more wavelet average coefficients, wavelet difference coefficients, or wavelet difference-of-difference coefficients associated with the cardiac signal sensed by the sensing circuitry.

8. The medical device system of claim 1, wherein the R-wave is a first R-wave, the processing circuitry being further configured to:

detect a second R-wave in the sensed cardiac signal, the second R-wave occurring subsequently to the first R-wave;

determine that the second R-wave was detected prior to the P-wave; and

based on the second R-wave being detected prior to the P-wave, update the criteria stored to the memory.

9. The implantable medical device of claim 8, wherein to update the criteria stored to the memory, the processing circuitry is configured to modulate a temporal component of the criteria stored to the memory.

10. The implantable medical device system of claim 1, wherein the sensing circuitry is further configured to sense a respiratory signal that varies as a function of a respiratory cycle of a patient, and wherein the processing circuitry is further configured to update the criteria stored to the memory based on one or more characteristics of the sensed respiratory signal, to obtain a modulated time value.

11. The implantable medical device of claim 10, wherein to update the criteria stored to the memory, the processing circuitry is configured to modulate a temporal component of the criteria stored to the memory.

12. A method comprising:

storing, to a memory of an implantable medical device, criteria for transitioning between a plurality of states of a cardiac cycle model, the plurality of states including a P-wave state;

sensing, by sensing circuitry of the implantable medical device, a cardiac signal that varies as a function of a cardiac cycle of a patient;

detecting, by processing circuitry of the implantable medical device, an R-wave in the sensed cardiac signal;

determining, by the processing circuitry, an elapsed time since the detection of the R-wave;

determining, by the processing circuitry, one or more morphological values of a post-R-wave segment of the cardiac signal occurring after the detection of the R-wave;

comparing, by the processing circuitry, the elapsed time and the one or more morphological values to the stored criteria for transitioning between the plurality of states of the cardiac cycle model; and

detecting, by the processing circuitry, a P-wave in the sensed cardiac signal in response to a transition to the P-wave state of the cardiac cycle model.

13. The method of claim 12, further comprising:

sending, by communication circuitry of the implantable medical device, a signal to another implantable medical device configured to deliver a pacing pulse to the patient, wherein the signal is configured to trigger the other implantable medical device to deliver the pacing pulse at a predetermined time after the detection of the P-wave; and

controlling, by the processing circuitry of the implantable medical device, the communication circuitry to send the signal to the other implantable medical device in response to detecting the P-wave.

14. The method of claim 12, wherein the criteria comprise probability functions, each of the probability functions determining a probability of a respective state transition as a function of the elapsed time and at least one of the one or more morphological values, the method further comprising determining, by the processing circuitry of the implantable medical device, that the respective state transition has occurred in response to the probability meeting a threshold.

15. The method of claim 12, further comprising:

applying, by the processing circuitry of the implantable medical device, one or more time-frequency transformations to the post-R-wave segment of the cardiac signal; and

determining, by the processing circuitry of the implantable medical device, the one or more morphological values based on the application of the one or more time-frequency transformations to the post R-wave segment of the cardiac signal.

16. The method of claim 12, further comprising:

forming, by the processing circuitry of the implantable medical device, multiple value profiles of the plurality of morphological values of the post-R-wave segment, wherein each respective value profile corresponds to a respective state of the plurality of states of the cardiac cycle model; and

comparing, by the processing circuitry of the implantable medical device, each category of morphological values of the post-R-wave segment to a respective corresponding value profile of the stored criteria.

17. The method of claim 16, wherein each respective value profile of the morphological values of the post-R-wave segment comprises a respective set of wavelet coefficients associated with the cardiac signal sensed by the sensing circuitry of the implantable medical device.

18. The method of claim 17, wherein each respective set of wavelet coefficients comprises one of a set of wavelet average coefficients, a set of wavelet difference coefficients, or a set of wavelet difference-of-difference coefficients associated with the cardiac signal sensed by the sensing circuitry of the implantable medical device.

19. The method of claim 12, wherein the R-wave is a first R-wave, the processing circuitry being further configured to:

detecting, by the processing circuitry of the implantable medical device, a second R-wave in the sensed cardiac signal, the second R-wave occurring subsequently to the first R-wave;

determining, by the processing circuitry of the implantable medical device, that the second R-wave was detected prior to the P-wave; and

updating, by the processing circuitry of the implantable medical device, based on the second R-wave being detected prior to the P-wave, the criteria stored to the memory of the implantable medical device.

20. The method of claim 19, wherein updating the criteria stored to the memory of the implantable medical device comprises modulating, by the processing circuitry of the implantable medical device, a temporal component of the criteria stored to the memory of the implantable medical device.

21. The method of claim 12, further comprising:

sensing, by the sensing circuitry of the implantable medical device, a respiratory signal that varies as a function of a respiratory cycle of a patient; and

updating, by the processing circuitry of the implantable medical device, the criteria stored to the memory based on one or more characteristics of the sensed respiratory signal, to obtain a modulated time value.

22. The method of claim 21, wherein updating the criteria stored to the memory of the implantable medical device comprises modulating, by the processing circuitry of the implantable medical device, a temporal component of the criteria stored to the memory of the implantable medical device.

23. A non-transitory computer-readable storage medium encoded with instructions that, when executed, cause one or more processors of an implantable medical device to:

store, to the computer-readable storage medium, criteria for transitioning between a plurality of states of a cardiac cycle model, the plurality of states including a P-wave state;

sense, using sensing circuitry of the implantable medical device, a cardiac signal that varies as a function of a cardiac cycle of a patient;

detect an R-wave in the sensed cardiac signal;

determine an elapsed time since the detection of the R-wave;

determine one or more morphological values of a post-R-wave segment of the cardiac signal occurring after the detection of the R-wave;

compare the elapsed time and the one or more morphological values to the stored criteria for transitioning between the plurality of states of the cardiac cycle model; and

detect a P-wave in the sensed cardiac signal in response to a transition to the P-wave state of the cardiac cycle model.

24. An implantable medical device comprising:

means for storing criteria for transitioning between a plurality of states of a cardiac cycle model, the plurality of states including a P-wave state;

means for sensing a cardiac signal that varies as a function of a cardiac cycle of a patient;

means for detecting an R-wave in the sensed cardiac signal;

means for determining an elapsed time since the detection of the R-wave;

means for determining one or more morphological values of a post-R-wave segment of the cardiac signal occurring after the detection of the R-wave;

means for comparing the elapsed time and the one or more morphological values to the stored criteria for transitioning between the plurality of states of the cardiac cycle model; and

means for detecting a P-wave in the sensed cardiac signal in response to a transition to the P-wave state of the cardiac cycle model.

25. A medical device system comprising:

a first implantable medical device comprising;

a memory configured to store criteria for transitioning between a plurality of states of a cardiac cycle model, the plurality of states including a P-wave state;

sensing circuitry configured to sense a cardiac signal that varies as a function of a cardiac cycle of a patient;

processing circuitry coupled to the sensing circuitry, the processing circuitry being configured to;

detect an R-wave in the sensed cardiac signal;

determine an elapsed time since the detection of the R-wave;

determine one or more morphological values of a post-R-wave segment of the cardiac signal occurring after the detection of the R-wave;

compare the elapsed time and the one or more morphological values to the stored criteria for transitioning between the plurality of states of the cardiac cycle model; and

detect a P-wave in the sensed cardiac signal in response to a transition to the P-wave state of the cardiac cycle model; and

communication circuitry configured to generate a signal to deliver a pacing pulse at a predetermined time after the detection of the P-wave, the processing circuitry being further configured to control the communication circuitry to send the signal in response to detecting the P-wave; and

a second implantable medical device configured to;

receive the signal sent by the communication circuitry of the first implantable medical device; and

in response to receiving the signal, deliver a pacing pulse to the patient.