Systems, devices, and methods for tachyarrhythmia discrimination or therapy decisions

• US 20060074330A1
• Filed: 07/22/2004
• Published: 04/06/2006
• Est. Priority Date: 07/22/2004
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Thompson, Julie, Dujmovic, Richard Milon Jr., Smith, Valerie
• Granted Patent: US 7,228,176 B2
• Time in Patent Office: Days
• US Class Current: 600/515
• CPC Class Codes: A61B 5/363 Detecting tachycardia or bradycardia
• 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 1/3622 comprising two or more electrodes co-operating with different heart regions
• CPC Class Codes: A61N 1/39622 Pacing therapy
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

This document discusses, among other things, systems, devices, and methods for detecting or classifying tachyarrhythmias or making a therapy decision. In one example, a rate-dependent threshold is used for comparing atrial and ventricular rates for classifying a tachyarrhythmia as a ventricular tachyarrhythmia (VT) or a supraventricular tachyarrhythmia (SVT). In another example, the classification uses an atrial rate cutoff value, a ventricular rate cutoff value, or both. In another example, a tachyarrhythmia detection is tested over a time window with a duration that is automatically adjusted as a substantially continuously monotonically decreasing function of duration vs. rate. These techniques improve the specificity of arrhythmia detection or classification, allow anti-tachyarrhythmia therapy to be better tailored to the particular tachyarrhythmia, or provide more automatic operation making it easier for a physician to use an implantable device.

Claims

1. A system comprising:

an atrial contraction detector circuit, including an atrial rate detector circuit to detect an atrial rate between atrial contractions of a heart;

a ventricular contraction detector circuit, including a ventricular rate detector circuit to detect a ventricular rate between ventricular contractions of the heart; and

a processor, coupled to the atrial and ventricular rate detector circuits, the processor including;

a tachyarrhythmia detection module; and

a tachyarrhythmia classification module including a first comparator for determining if the ventricular rate exceeds the atrial rate by a threshold value, in which the threshold value varies as a function of at least one of the atrial rate and the ventricular rate, and in which if the ventricular rate exceeds the atrial rate by the threshold value corresponding to the at least one of the atrial rate and the ventricular rate, then deeming the tachyarrhythmia to be a ventricular tachyarrhythmia.

2. The system of claim 1, comprising an anti-tachyarrhythmia therapy circuit, coupled to the processor, and delivering an anti-tachyarrhythmia therapy to the ventricle if the tachyarrhythmia is a ventricular tachyarrhythmia.

3. The system of claim 1, in which the threshold value is larger at a lower value of the ventricular rate than at a higher value of the ventricular rate.

4. The system of claim 1, in which the threshold value is a bilinear mapping between the atrial and ventricular rates.

5. The system of claim 1, in which the threshold value is a piecewise linear mapping between the atrial and ventricular rates.

6. The system of claim 1, in which the threshold value is a curvilinear mapping between the atrial and ventricular rates.

7. The system of claim 1, in which if the atrial rate exceeds a cutoff value, then the tachyarrhythmia classification module deems the tachyarrhythmia to be an atrial tachyarrhythmia and not a ventricular tachyarrhythmia, without regard to whether the ventricular rate exceeds the atrial rate by the threshold value.

8. A method comprising:

detecting atrial heart contractions and an atrial rate between the atrial heart contractions of an atrium of a heart;

detecting ventricular heart contractions and a ventricular rate between the ventricular heart contractions of a ventricle of the heart;

detecting a tachyarrhythmia;

determining if the ventricular rate exceeds the atrial rate by a threshold value, in which the threshold value varies as a function of at least one of the atrial rate and the ventricular rate; and

if the ventricular rate exceeds the atrial rate by the threshold value corresponding to the at least one of the atrial rate and the ventricular rate, then deeming the tachyarrhythmia to be a ventricular tachyarrhythmia.

9. The method of claim 8, further comprising delivering an anti-tachyarrhythmia therapy to the ventricle if the tachyarrhythmia is a ventricular tachyarrhythmia.

10. The method of claim 8, in which the threshold value is larger at a lower value of the ventricular rate than at a higher value of the ventricular rate.

11. The method of claim 8, in which the threshold value is a bilinear mapping between the atrial and ventricular rates.

12. The method of claim 8, in which the threshold value is a piecewise linear mapping between the atrial and ventricular rates.

13. The method of claim 8, in which the threshold value is a curvilinear mapping between the atrial and ventricular rates.

14. The method of claim 8, in which if the atrial rate exceeds a cutoff value, then deeming the tachyarrhythmia to be an atrial tachyarrhythmia and not a ventricular tachyarrhythmia, regardless of whether the ventricular rate exceeds the atrial rate by the threshold value.

15. A system comprising:

an atrial contraction detector circuit, including an atrial rate detector circuit to detect an atrial rate between atrial contractions of a heart;

a ventricular contraction detector circuit, including a ventricular rate detector circuit to detect a ventricular rate between ventricular contractions of the heart;

an anti-tachyarrhythmia therapy circuit; and

a processor, coupled to the atrial and ventricular rate detector circuits and the anti-tachyarrhythmia therapy circuit, the processor including;

a tachyarrhythmia detection module; and

a tachyarrhythmia therapy module, including a first comparator for determining if the ventricular rate exceeds the atrial rate by a threshold value, in which the threshold value varies as a function of at least one of the atrial rate and the ventricular rate, and triggering the delivering an anti-tachyarrhythmia therapy to the ventricle by the anti-tachyarrhythmia therapy circuit only if the ventricular rate exceeds the atrial rate by the threshold value corresponding to the at least one of the atrial rate and the ventricular rate.

16. The system of claim 15, in which the triggering the delivering the anti-tachyarrhythmia therapy to the ventricle also requires at least one other ventricular tachyarrhythmia therapy delivery criterion to be met before the delivering the anti-tachyarrhythmia therapy to the ventricle.

17. The system of claim 15, in which the threshold value is larger at a lower value of the ventricular rate than at a higher value of the ventricular rate.

18. The system of claim 15, in which the threshold value is a bilinear mapping between the atrial and ventricular rates.

19. The system of claim 15, in which the threshold value is a piecewise linear mapping between the atrial and ventricular rates.

20. The system of claim 15, in which the threshold value is a curvilinear mapping between the atrial and ventricular rates.

21. The system of claim 15, in which if the atrial rate exceeds a cutoff value, then the tachyarrhythmia classification module deems the tachyarrhythmia to be an atrial tachyarrhythmia and not a ventricular tachyarrhythmia, without regard to whether the ventricular rate exceeds the atrial rate by the threshold value.

22. A method comprising:

detecting atrial heart contractions and an atrial rate between the atrial heart contractions of an atrium of a heart;

detecting ventricular heart contractions and a ventricular rate between the ventricular heart contractions of a ventricle of the heart;

detecting a tachyarrhythmia;

determining if the ventricular rate exceeds the atrial rate by a threshold value, in which the threshold value varies as a function of at least one of the atrial rate and the ventricular rate; and

delivering an anti-tachyarrhythmia therapy to the ventricle only if the ventricular rate exceeds the atrial rate by the threshold value corresponding to the at least one of the atrial rate and the ventricular rate.

23. The method of claim 22, in which the delivering the anti-tachyarrhythmia therapy to the ventricle includes also requires at least one other ventricular tachyarrhythmia therapy delivery criterion to be met before the delivering the anti-tachyarrhythmia therapy to the ventricle.

24. The method of claim 22, in which the threshold value is larger at a lower value of the ventricular rate than at a higher value of the ventricular rate.

25. The method of claim 22, in which the threshold value is a bilinear mapping between the atrial and ventricular rates.

26. The method of claim 22, in which the threshold value is a piecewise linear mapping between the atrial and ventricular rates.

27. The method of claim 22, in which the threshold value is a curvilinear mapping between the atrial and ventricular rates.

28. The method of claim 22, in which if the atrial rate exceeds a cutoff value, then deeming the tachyarrhythmia to be an atrial tachyarrhythmia and not a ventricular tachyarrhythmia, regardless of whether the ventricular rate exceeds the atrial rate by the threshold value.

29. A system comprising:

an atrial contraction detector circuit, including an atrial rate detector circuit to detect an atrial rate between atrial contractions of a heart;

a ventricular contraction detector circuit, including a ventricular rate detector circuit to detect a ventricular rate between ventricular contractions of the heart; and

a processor, coupled to the atrial and ventricular rate detector circuits, the processor including;

a tachyarrhythmia detection module; and

a tacharrhythmia classification module, including a first comparator for classifying a tachyarrhythmia as an atrial tachyarrhythmia if an atrial rate exceeds an atrial rate cutoff value, and including a second comparator for otherwise determining if the ventricular rate exceeds the atrial rate by a threshold value, and in which if the ventricular rate exceeds the atrial rate by the threshold value, then deeming the tachyarrhythmia to be a ventricular tachyarrhythmia unless the atrial rate exceeds the atrial rate cutoff value.

30. The system of claim 29, further comprising an anti-tachyarrhythmia therapy circuit for delivering an anti-tachyarrhythmia therapy to the ventricle if the tachyarrhythmia is a ventricular tachyarrhythmia.

31. The system of claim 29, in which the threshold value varies as a function of at least one of the atrial rate and the ventricular rate.

32. The system of claim 31, in which the threshold value is a bilinear mapping between atrial and ventricular rate.

33. The system of claim 31, in which the threshold value is a piecewise linear mapping between atrial and ventricular rate.

34. A method comprising:

detecting atrial heart contractions and an atrial rate between the atrial heart contractions of an atrium of a heart;

detecting ventricular heart contractions and a ventricular rate between the ventricular heart contractions of a ventricle of the heart;

detecting a tachyarrhythmia; and

if the atrial rate exceeds a cutoff value, then deeming the tachyarrhythmia to be an atrial tachyarrhythmia and not a ventricular tachyarrhythmia, and otherwise determining if the ventricular rate exceeds the atrial rate by a threshold value, and if the ventricular rate exceeds the atrial rate by the threshold value, then deeming the tachyarrhythmia to be a ventricular tachyarrhythmia.

35. The method of claim 34, further comprising delivering an anti-tachyarrhythmia therapy to the ventricle if the tachyarrhythmia is a ventricular tachyarrhythmia.

36. The method of claim 34, in which the threshold value varies as a function of at least one of the atrial rate and the ventricular rate.

37. The method of claim 36, in which the threshold value is a bilinear mapping between atrial and ventricular rate.

38. The method of claim 36, in which the threshold value is a piecewise linear mapping between atrial and ventricular rate.

39. A system comprising:

an atrial contraction detector circuit, including an atrial rate detector circuit to detect an atrial rate between atrial contractions of a heart;

a ventricular contraction detector circuit, including a ventricular rate detector circuit to detect a ventricular rate between ventricular contractions of the heart;

an anti-tachyarrhythmia therapy circuit; and

a processor, coupled to the atrial and ventricular rate detector circuits and the anti-tachyarrhythmia therapy circuit, the processor including;

a tachyarrhythmia detection module; and

a tacharrhythmia therapy module, including a first comparator for classifying a tachyarrhythmia as an atrial tachyarrhythmia if an atrial rate exceeds an atrial rate cutoff value, and including a second comparator for otherwise determining if the ventricular rate exceeds the atrial rate by a threshold value, and triggering the delivering of anti-tachyarrhythmia therapy to the ventricle only if the ventricular rate exceeds the atrial rate by the threshold value and the atrial rate is below the atrial rate cutoff value.

40. The system of claim 39, in which the triggering the delivering the anti-tachyarrhythmia therapy to the ventricle also requires at least one other ventricular tachyarrhythmia therapy delivery criterion to be met before the delivering the anti-tachyarrhythmia therapy to the ventricle.

41. The system of claim 39, in which the threshold value varies as a function of at least one of the atrial rate and the ventricular rate.

42. The system of claim 39, in which the threshold value is a bilinear mapping between atrial and ventricular rate.

43. The system of claim 39, in which the threshold value is a piecewise linear mapping between atrial and ventricular rate.

44. A method comprising:

detecting atrial heart contractions and an atrial rate between the atrial heart contractions of an atrium of a heart;

detecting ventricular heart contractions and a ventricular rate between the ventricular heart contractions of a ventricle of the heart;

detecting a tachyarrhythmia; and

triggering a delivering of anti-tachyarrhythmia therapy to the ventricle only if the atrial rate is less than a cutoff value and the ventricular rate exceeds the atrial rate by a threshold value.

45. The method of claim 44, in which the triggering the delivering the anti-tachyarrhythmia therapy to the ventricle also requires at least one other ventricular tachyarrhythmia therapy delivery criterion to be met before the delivering the anti-tachyarrhythmia therapy to the ventricle.

46. The method of claim 44, in which the threshold value varies as a function of at least one of the atrial rate and the ventricular rate.

47. The method of claim 46, in which the threshold value is a bilinear mapping between atrial and ventricular rate.

48. The method of claim 46, in which the threshold value is a piecewise linear mapping between atrial and ventricular rate.

49. A system comprising:

a ventricular contraction detector circuit, including a ventricular rate detector circuit to detect a ventricular rate between ventricular contractions of a heart;

an anti-tachyarrhythmia therapy circuit; and

a processor, coupled to the atrial and ventricular rate detector circuits and the anti-tachyarrhythmia therapy circuit, the processor including;

a tachyarrhythmia detection module; and

a tacharrhythmia therapy module, including an initial tachyarrhythmia detection indication and a duration timer measuring a subsequent first duration period that is substantially continuously decreasing monotonically with increasing ventricular rate, and triggering a delivering of ventricular anti-tachyarrhythmia therapy only if the initial tachyarrhythmia indication is detected and during the subsequent first duration period, a second tachyarrhythmia indication is detected using at least one tachyarrhythmia detection criterion.

50. The system of claim 49, in which the initial tachyarrhythmia indication comprises a comparator for detecting a fixed number of heart contractions at a rate that exceeds a first rate cutoff value.

51. The system of claim 49, in which the second tachyarrhythmia indication includes a comparator for monitoring, during the first duration period, for a first number of fast ventricular contractions out of a second number of ventricular contractions observed during the first duration period.

52. A method comprising:

detecting ventricular heart contractions and a ventricular rate between the ventricular heart contractions of a ventricle of a heart;

detecting an initial tachyarrhythmia indication;

if the initial tachyarrhythmia indication is detected, then detecting, during a first duration period, a second tachyarrhythmia indication using at least one tachyarrhythmia criterion, the first duration period substantially continuously decreasing monotonically with increasing ventricular rate; and

if the second tachyarrhythmia indication is detected, then delivering an anti-tachyarrhythmia therapy to the heart.

53. The method of claim 52, in which the detecting the initial tachyarrhythmia indication comprises detecting a fixed number of heart contractions at a rate that exceeds a first rate cutoff value.

54. The method of claim 52, in which the detecting the second tachyarrhythmia indication includes monitoring, during the first duration period, for a first number of fast ventricular contractions out of a second number of ventricular contractions observed during the first duration period.