Fast post-antitachycardia pacing redetection algorithm

• US 7,616,994 B2
• Filed: 05/24/2004
• Issued: 11/10/2009
• Est. Priority Date: 05/24/2004
• Status: Expired due to Fees

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Li, Dan
• Primary Examiner(s): Layno; Carl H.
• Assistant Examiner(s): Heller; Tammie K.
• Application Number:
  US10/852,080
• Publication Number:
  US 20050261744A1
• Time in Patent Office: 1,996 Days
• Field of Search: 607/4, 607/14
• US Class Current: 607/14
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions

Abstract

A method comprising detecting a ventricular tachycardia heart rhythm in a patient, providing anti-tachycardia pacing (ATP) therapy to the patient in response to the ventricular tachycardia heart rhythm, waiting a first time duration after the ATP therapy ends, and monitoring ventricular depolarizations after the first time duration has elapsed. The monitoring includes measuring time intervals between the ventricular depolarizations, and if a consecutive number of the intervals between the ventricular depolarizations are shorter than a first threshold interval value, then the method includes deeming that the ventricular tachycardia rhythm persists. Otherwise, if a fraction of the intervals between the ventricular depolarizations are shorter than a second threshold interval value, then the method includes deeming that the ventricular tachycardia heart rhythm persists, and otherwise deeming that the ventricular tachycardia rhythm is converted.

Claims

1. A method comprising:

detecting a ventricular tachycardia heart rhythm in a patient using an implantable medical device (IMD);

providing anti-tachycardia pacing (ATP) therapy to the patient in response to the ventricular tachycardia heart rhythm;

in response to the ATP therapy ending, determining an efficacy of the ATP therapy using the IMD by;

waiting a first time duration after the ATP therapy ends during which time sensed ventricular depolarizations are ignored, wherein the first time duration exceeds first and second tachycardia detection threshold interval values;

establishing a redetection time duration after the first time duration has elapsed;

monitoring the ventricular depolarizations during the redetection duration, wherein the monitoring includes;

measuring time intervals between the ventricular depolarizations;

determining if a specified consecutive number of the intervals between the ventricular depolarizations are shorter than the first tachycardia detection threshold interval value, and, if so, then deeming that the ventricular tachycardia rhythm persists; and

concurrently determining if, during the same redetection duration, a predetermined fraction of the consecutive intervals between the ventricular depolarizations are shorter than the second tachycardia detection threshold interval value that is different than the first threshold interval value, and, if so, then deeming that the ventricular tachycardia heart rhythm persists, wherein the fraction is less than 100%, otherwise,

providing an indication of efficacy of the ATP therapy indicating whether the ventricular tachycardia rhythm is converted.

2. The method if claim 1, wherein the monitoring the ventricular depolarizations includes measuring a ventricular depolarization rate, wherein the method further includes measuring an atrial depolarization rate for the patient, and wherein the deeming that the ventricular tachycardia rhythm is converted, includes first performing an additional test, wherein the additional test includes:

if the ventricular rate exceeds the atrial rate by a threshold rate difference value then deeming that the ventricular tachycardia heart rhythm persists, otherwise,

deeming that the ventricular tachycardia rhythm is converted.

3. The method of claim 1, wherein the monitoring the ventricular depolarizations after the first time duration includes monitoring the ventricular depolarizations during a second time duration, and wherein the deeming that the ventricular tachycardia rhythm is converted includes deeming the ventricular tachycardia rhythm is converted if the second time duration elapses without deeming that the ventricular tachycardia rhythm persists.

4. The method of claim 1, wherein the monitoring the ventricular depolarizations includes monitoring the ventricular depolarizations using an implantable medical device.

5. The method of claim 1, wherein the method further includes providing anti-tachycardia therapy if deeming that the ventricular tachycardia heart rhythm persists.

6. The method of claim 5, wherein the providing the anti-tachycardia therapy includes providing defibrillation therapy.

7. The method of claim 5, wherein the providing the anti-tachycardia therapy includes providing ATP therapy.

8. The method of claim 5, wherein the providing the anti-tachycardia therapy includes providing drug therapy.

9. A system, comprising:

an implantable medical device comprising;

a signal sensing circuit coupled to at least one electrode, the electrode located to sense a cardiac signal of a ventricle of a heart of a patient;

a therapy circuit; and

a controller coupled to the signal sensing circuit and the therapy circuit, wherein the controller;

detects a ventricular tachycardia heart rhythm from the cardiac signal;

initiates anti-tachycardia pacing (ATP) therapy to the patient in response to the ventricular tachycardia heart rhythm and, in response to the ATP therapy ending and in order to determine an efficacy of the APT therapy;

waits a first time duration after the ATP therapy ends during which time sensed ventricular depolarizations are ignored, wherein the first time duration exceeds first and second tachycardia detection threshold interval values;

initiates a redetection time duration after the first time duration expires;

measures time intervals between ventricular depolarizations after providing ATP therapy and during the redetection time duration;

compares the intervals to the first tachycardia detection threshold interval value; and

determines if a consecutive number of the intervals are shorter than the first threshold interval value, and, if so, then deems that the ventricular tachycardia rhythm persists, and

concurrently determines if, during the same redetection time duration, a predetermined fraction of the consecutive intervals are shorter than the second tachycardia detection threshold interval value that is different than the first threshold interval value, and if so, then deems that the ventricular tachycardia heart rhythm persists, wherein the predetermined fraction is less than 100%, otherwise

provides an indication of efficacy of the ATP therapy indicating whether the ventricular tachycardia heart rhythm is converted.

10. The system of claim 9, wherein the implantable medical device further includes:

an atrial signal sensing circuit coupled to at least one second electrode and the controller, the at least one second electrode located to sense a cardiac signal of an atrium of the heart; and

wherein the controller is further operable in measuring both a ventricular depolarization rate and an atrial depolarization rate for the patient, and if the ventricular depolarization rate exceeds the atrial depolarization rate by a threshold rate difference value then deem that the ventricular tachycardia heart rhythm persists, otherwise deem that the ventricular tachycardia rhythm is converted.

11. The system of claim 9, wherein the controller is operable to time a programmable wait duration after providing ATP therapy and before measuring time intervals to determine whether ventricular tachycardia persists after the providing ATP therapy.

12. The system of claim 9, wherein the controller is operable to time a programmable redetection duration during which the controller measures the time intervals between the ventricular depolarizations, and wherein the controller deems the ventricular tachycardia heart rhythm is converted if the redetection duration elapses without deeming that the ventricular tachycardia heart rhythm persisted.

13. The system of claim 9, wherein the therapy circuit includes a defibrillation therapy circuit and the implantable medical device provides defibrillation therapy if the ventricular tachycardia heart rhythm is deemed to persist.

14. The system of claim 13, wherein the implantable medical device provides ATP therapy while the defibrillation therapy circuit is charging, and wherein the controller is operable to determine if the ventricular tachycardia rhythm is converted while the defibrillation therapy circuit is charging.

15. The system of claim 14, wherein the controller is operable to abort the charging of the defibrillation therapy circuit if the ventricular tachycardia rhythm is deemed converted.

16. The system of claim 9, wherein the implantable medical device provides ATP therapy if the ventricular tachycardia heart rhythm is deemed to persist.

17. The system of claim 9, wherein the therapy circuit includes a drug therapy circuit and the implantable medical device provides drug therapy if the ventricular tachycardia heart rhythm is deemed to persist.

18. The system of claim 9, wherein the implantable medical device further includes a memory coupled to the controller, wherein the controller is operable to store patient information about whether a ventricular tachycardia heart rhythm was converted.

19. The system of claim 9, wherein the system further includes an external device operable to communicate with the implantable device, wherein the external device includes a display to display patient information about at least one of a redetection duration and whether a ventricular tachycardia heart rhythm was converted.

20. The system of claim 19, wherein the patient information includes a histogram of patient information about at least one of a redetection duration and whether a ventricular tachycardia heart rhythm was converted.

21. The system of claim 19, wherein the external device is operable to communicate with a computer network.

22. A method comprising:

measuring first time intervals between ventricular depolarizations of a heart during a tachyarrhythmia detection time duration, the measuring including using an implantable medical device (IMD);

measuring both a ventricular depolarization rate and an atrial depolarization rate of the heart;

determining if a specified consecutive number of intervals between the ventricular depolarizations are shorter than a first tachycardia detection threshold interval value and, if so, then deeming that a ventricular tachycardia rhythm exists;

concurrently determining if, during the same tachyarrhythmia detection time duration, a predetermined fraction of the consecutive intervals between the ventricular depolarizations are shorter than a second tachycardia detection threshold interval value that is different than the first threshold interval value, and, if so, then deeming that the ventricular tachycardia heart rhythm exists, wherein the fraction is less than 100%; and

concurrently determining if, during the same tachyarrhythmia detection time duration, the ventricular rate exceeds the atrial rate by a threshold rate difference value and, if so, then deeming that the ventricular tachycardia heart rhythm exists, otherwise

deeming that the ventricular tachycardia heart rhythm does not exist;

initiating ATP therapy if deeming that the ventricular tachycardia heart rhythm exists;

in response to the ATP therapy ending, determining an efficacy of the ATP therapy using the IMD by;

waiting a first time duration after the ATP therapy ends, wherein the first time duration exceeds both the first and second tachycardia detection threshold interval values, and wherein during the first time duration any sensed ventricular depolarizations are ignored; and

initiating a tachyarrhythmia redetection time period after the first time duration elapses; and

providing an indication of efficacy of the ATP therapy indicating whether the ventricular tachycardia is converted.

23. The method of claim 22, wherein the method further includes providing therapy to the heart if the ventricular tachycardia heart rhythm is deemed to exist.

24. The method of claim 23, wherein providing therapy to the heart includes providing anti-tachycardia pacing (ATP) therapy.

25. The method of claim 24, wherein the method further includes:

during the tachyarrhythmia redetection time period, measuring second time intervals between ventricular depolarizations, and also measuring both a second ventricular depolarization rate and a second atrial depolarization rate and, during the tachyarrhythmia redetection time period;

determining if a consecutive number of second intervals between ventricular depolarizations are shorter than the first tachyarrhythmia detection threshold interval value, and, if so, then deeming that the ventricular tachycardia rhythm persists,

concurrently determining if, during the same tachyarrhythmia redetection time period, a predetermined fraction of the second intervals between ventricular depolarizations are shorter than the second tachyarrhythmia detection threshold interval value, and, if so, then deeming that the ventricular tachycardia heart rhythm persists, and

concurrently determining if, during the same tachyarrhythmia redetection time period, the second ventricular rate exceeds the second atrial rate by a threshold rate difference value and, if so, then deeming that the ventricular tachycardia heart rhythm persists, otherwise

deeming that the ventricular tachycardia heart rhythm is converted.