Adjusting Cardiac Pacing Response Sensing Intervals

• US 20120303082A1
• Filed: 11/29/2011
• Published: 11/29/2012
• Est. Priority Date: 12/02/2010
• Status: Abandoned Application

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Dong, Yanting, Shome, Shibaji, McCabe, Aaron, Foster, Clayton, Yost, David W., Hayes, Kenneth N., Brisben, Amy J.
• Application Number:
  US13/306,611
• Publication Number:
  US 20120303082A1
• Time in Patent Office: Days
• US Class Current: 607/17
• CPC Class Codes: A61B 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 5/35 by template matching
• CPC Class Codes: A61B 5/352 Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61B 5/7217 of noise originating from a therapeutic or surgical apparatus, e.g. from a pacemaker
• CPC Class Codes: A61B 5/7267 involving training the classification device
• CPC Class Codes: A61N 1/371 Capture, i.e. successful stimulation
• CPC Class Codes: A61N 1/3712 Auto-capture, i.e. automatic adjustment of the stimulation threshold
• CPC Class Codes: G16H 50/70 for mining of medical data, e.g. analysing previous cases of other patients

Abstract

Discrimination between different types of possible cardiac pacing responses may depend on the timing of expected features that are sensed within a temporal framework. The temporal framework may include classification intervals, blanking periods and appropriately timed back up paces. The classification intervals and blanking periods of the temporal framework are intervals of time that have time parameters that include start time, end time, and length. The relationships and timing parameters of the elements of the temporal framework, e.g., blanking periods, classification intervals, delay periods, and backup pacing, should support detection of features used to discriminate between different types of pacing responses. As the system learns the morphology of the particular patient by analyzing the waveform of the pacing response signal, the temporal framework for pacing response determination may be adjusted to accommodate the individual patient.

Claims

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

delivering a pacing pulse to a heart chamber during a cardiac cycle;

sensing a cardiac pacing response signal of the heart chamber during the cardiac cycle and following the pacing pulse in one or both of a first classification interval and a second classification interval, each of the first and second classification intervals associated with one or more timing parameters including at least a start time;

adapting at least one timing parameter of one or more of the first classification interval, the second classification interval, and one or more blanking periods based on timing of at least one signal feature of the pacing response signal and a temporal relationship between the first classification interval and the second classification interval;

applying the first and second classification intervals having the adapted timing parameters to a subsequent pacing response signal sensed following a subsequent pacing pulse delivered to the heart chamber;

determining if the signal feature of the subsequent pacing response signal falls within the first or second classification intervals that have the adapted timing parameters;

classifying a pacing response of the heart chamber to the subsequent cardiac pacing pulse based on a determination that the signal feature falls within the first or second classification intervals having the adapted timing parameters; and

delivering cardiac therapy based on classification of the pacing response.

2. The method of claim 1, wherein the signal feature comprises a positive or negative peak.

3. The method of claim 1, wherein adapting the timing parameters based on the temporal relationship of the first and second classification intervals comprises adapting a start time of the second classification interval based on an end time of the first classification interval.

4. The method of claim 1, wherein adapting the timing parameter comprises adapting a timing parameter of a blanking period based on a temporal relationship between the blanking period and one or both of the first classification interval and the second classification interval.

5. The method of claim 1, wherein adapting the timing parameter comprises adapting timing parameters of three classification intervals, the first classification interval used to detect possible capture or fusion, the second classification interval used to confirm fusion, and a third classification interval used to confirm capture.

6. The method of claim 1, wherein adapting the timing parameter comprises at least one of:

shortening one or more of the blanking periods and lengthening one or more of the first and second classification intervals; and

lengthening one or more of the blanking periods and shortening one or more of the first and second classification intervals.

7. The method of claim 1, further comprising:

comparing an amount of change in the timing of the signal feature compared to an initial timing of the signal feature to a threshold; and

determining whether to adapt one or more of the first classification interval, the second classification interval, and the one or more blanking periods based on the comparison of the amount of change.

8. The method of claim 1, further comprising:

comparing an amount of change in the timing of the signal feature compared to an initial timing of the signal feature to a threshold; and

determining whether to re-initialize timing parameters of the first classification interval, the second classification interval, and the one or more blanking periods, wherein re-initializing the timing parameters involves acquiring a multi-sample electrogram of a pacing response signal.

9. A cardiac device, comprising:

pacing circuitry configured to deliver a pacing pulse to a heart chamber during a cardiac cycle;

sensing circuitry configured to sense a cardiac pacing response signal of the heart chamber during the cardiac cycle and following the pacing pulse in one or both of a first classification interval and a second classification interval, each of the first and second classification intervals associated with one or more timing parameters including at least a start time;

control circuitry configured to

adapt at least one timing parameter of one or more of the first classification interval, the second classification interval, and one or more blanking periods based on timing of at least one signal feature of the pacing response signal and a temporal relationship between the first classification interval and the second classification interval;

apply the first and second classification intervals having the adapted timing parameters to a subsequent pacing response signal sensed following a subsequent pacing pulse delivered to the heart chamber;

determine if the signal feature of the subsequent pacing response signal falls within the first or second classification intervals that have the adapted timing parameters;

classify a pacing response of the heart chamber to the subsequent cardiac pacing pulse based on a determination that the signal feature falls within the first or second classification intervals having the adapted timing parameters; and

deliver cardiac therapy based on classification of the pacing response.

10. The device of claim 9, wherein the control circuitry is further configured to adapt the timing parameters based on the temporal relationship of the first and second classification intervals comprises adapting a start time of the second classification interval based on an end time of the first classification interval.

11. The device of claim 9, wherein the control circuitry is further configured to adapt a timing parameter of a blanking period based on a temporal relationship between the blanking period and one or both of the first classification interval and the second classification interval.

12. The device of claim 9, wherein the control circuitry is further configured to adapt timing parameters of three classification intervals, the first classification interval used to detect possible capture or fusion, the second classification interval used to confirm fusion, and a third classification interval used to confirm capture.

13. The device of claim 9, wherein the control circuitry is further configured to:

compare an amount of change in the timing of the signal feature compared to an initial timing of the signal feature to a threshold; and

determine whether to adapt one or both of the first and second classification intervals based on the comparison of the amount of change.

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

delivering at least one pacing pulse to a heart chamber;

sensing a pacing response signal of the heart chamber following the pacing pulse;

detecting a temporal event of the pacing response signal, the temporal event comprising a point in time that falls between a first feature and a second feature of the pacing response signal; and

initializing timing parameters of one or more of pacing response classification intervals and one or more blanking periods based on the detected temporal event so that the first feature falls within a first classification interval and the second feature falls within a second classification interval.

15. The method of claim 14, wherein sensing the pacing response signal further comprises acquiring a multi-sample electrogram of the pacing response signal.

16. The method of claim 14, wherein detecting the temporal event comprises detecting a zero crossing point of the pacing response signal.

17. The method of claim 14, wherein detecting the temporal event comprises detecting an inflection point of the pacing response signal.

18. The method of claim 14, wherein detecting the temporal event comprises detecting a midpoint between a time of occurrence of the first feature and a time of occurrence of the second feature.

19. The method of claim 14, wherein:

detecting the temporal event comprises detecting a zero crossing point, an inflection point or a mid-point of the cardiac signal; and

initializing the timing parameters of the one or more classification intervals and the one or more blanking periods comprises setting a start time of a blanking period and an end time of a classification interval to coincide with the zero crossing point, inflection point or mid-point.

20. The method of claim 14, wherein initializing the timing parameters of the one or more blanking periods comprises initializing to allow sensing of the first or second feature.

21. The method of claim 14, wherein initializing the timing parameters of the one or more blanking periods comprises initializing to prevent sensing of signal features other than the first or the second features.

22. A cardiac device, comprising:

pacing circuitry configured to deliver at least one pacing pulse to a heart chamber;

sensing circuitry configured to sense a pacing response signal of the heart chamber following the pacing pulse and detect a temporal event of the pacing response signal, the temporal event comprising a point in time that falls between a first feature and a second feature of the pacing response signal; and

control circuitry configured to initialize timing parameters of one or more of pacing response classification intervals and one or more blanking periods based on the detected temporal event so that the first feature falls within a first classification interval and the second feature falls within a second classification interval.

23. The device of claim 22, wherein the sensing circuitry is further configured to acquire a multi-sample electrogram of the pacing response signal.

24. The device of claim 22, wherein:

the sensing circuitry is further configured to detect a zero crossing point, an inflection point, or a mid-point of the cardiac signal; and

the control circuitry is further configured to initialize the timing parameters of the one or more classification intervals and the one or more blanking periods and to set a start time of a blanking period and an end time of a classification interval to coincide with the zero crossing point, inflection point, or mid-point.

25. A method, comprising:

delivering a pacing pulse to a left ventricle of a heart;

sensing a cardiac pacing response signal of the left ventricle;

detecting a first peak in a first capture detection interval and detecting a second peak in one of a fusion detection interval and a second capture detection interval that follows the fusion detection interval; and

discriminating between capture and fusion based on the first and second peaks.

26. The method of claim 25, wherein detecting the first peak in the first capture detection interval comprises detecting the first peak in a capture detection region within the first capture detection interval, the capture detection region having upper and lower timing boundaries and upper and lower amplitude boundaries.

27. The method of claim 25, wherein discriminating between capture and fusion comprises classifying the pacing response as potential capture if the first peak falls within the capture detection region and confirming capture if the second peak falls within the second capture detection interval.

28. The method of claim 25, wherein discriminating between capture and fusion comprises classifying the pacing response as fusion if the second peak falls within the fusion detection interval.

29. A device, comprising:

pacing circuitry configured to deliver a pacing pulse to a left ventricle of a heart;

sensing circuitry configured to sense a cardiac pacing response signal of the left ventricle and detect a first peak in a first capture detection interval and detecting a second peak in one of a fusion detection interval and a second capture detection interval that follows the fusion detection interval; and

control circuitry configured to discriminate between capture and fusion based on the first and second peaks.

30. The device of claim 29, wherein the sensing circuitry is configured to detect the first peak in a capture detection region within the first capture detection interval, the capture detection region having upper and lower timing boundaries and upper and lower amplitude boundaries.