Sensing integrity determination based on cardiovascular pressure

• US 8,126,553 B2
• Filed: 07/25/2008
• Issued: 02/28/2012
• Est. Priority Date: 06/02/2008
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Mayotte, Mark J.
• Primary Examiner(s): Layno, Carl H
• Assistant Examiner(s): Stice, Paula J
• Application Number:
  US12/180,161
• Publication Number:
  US 20090299429A1
• Time in Patent Office: 1,313 Days
• Field of Search: None
• US Class Current: 607/18
• CPC Class Codes: A61N 1/36564 controlled by blood pressure
• CPC Class Codes: A61N 1/3706 Pacemaker parameters stimulation threshold A61N1/371

Abstract

Electrical noise may be discriminated from sensed heart signals based on cardiovascular pressure. A plurality of detected cardiovascular pressure values are respectively associated with a plurality of detected tachyarrhythmia events. In some examples, a variance in the cardiovascular pressure, e.g., above a threshold range, may indicate that the detected tachyarrhythmia events are at least partially attributable to electrical noise. In some examples, stimulation therapy to a heart of a patient may be controlled based on the detection of a tachyarrhythmia episode and a variability in the cardiovascular pressure values that are associated with the tachyarrhythmia episode. In other examples, a sensing integrity indication may be generated upon determining that a tachyarrhythmia episode was associated with a variable cardiovascular pressure.

Claims

1. A method comprising:

detecting a tachyarrhythmia episode of a heart of a patient, wherein the tachyarrhythmia episode comprises a plurality of detected tachyarrhythmia events;

analyzing a plurality of cardiovascular pressure values, each of the cardiovascular pressure values being associated with a respective one of the detected tachyarrhythmia events, wherein analyzing the plurality of cardiovascular pressure values comprises determining a variability in the plurality of cardiovascular pressure values; and

determining, based on the variability in the plurality of cardiovascular pressure values, whether the detected tachyarrhythmia episode is a false positive detection attributable to electrical noise.

2. The method of claim 1, further comprising controlling therapy delivery to the patient in response to the detected tachyarrhythmia episode based on determining whether the detected tachyarrhythmia episode is the false positive detection attributable to electrical noise.

3. The method of claim 2, wherein controlling therapy delivery comprises controlling a medical device to deliver therapy to the patient.

4. The method of claim 2, wherein controlling therapy delivery comprises controlling a medical device to withhold therapy delivery to the patient.

5. The method of claim 1, further comprising generating a patient or clinician alert.

6. The method of claim 1, wherein the tachyarrhythmia episode comprises at least one of a ventricular fibrillation episode, a ventricular tachycardia episode, a fast ventricular tachycardia episode or a non-sustained tachyarrhythmia episode.

7. The method of claim 1, wherein the each of the cardiovascular pressure values comprises at least one of a pulse pressure value, an average pressure value, a systolic pressure value, or a diastolic pressure value.

8. The method of claim 1, wherein the plurality of detected tachyarrhythmia events comprises a first detected tachyarrhythmia event and a second detected tachyarrhythmia event, and wherein determining the variability in the plurality of cardiovascular pressure values comprises determining whether a first cardiovascular pressure value of the plurality of cardiovascular pressure values associated with the first detected tachyarrhythmia event and a second cardiovascular pressure value of the plurality of cardiovascular pressure values associated with the second detected tachyarrhythmia event are within a threshold range of each other.

9. The method of claim 1, wherein determining the variability in the plurality of cardiovascular pressure values comprises determining whether the cardiovascular pressure associated with at least one detected tachyarrhythmia event of the plurality of detected tachyarrhythmia events varies by a threshold percentage compared to an average pressure value of cardiovascular pressures associated with at least two other detected tachyarrhythmia events of the plurality of detected tachyarrhythmia events.

10. The method of claim 9, wherein the threshold percentage comprises a percentage of between about five percent and about twenty-five percent.

11. The method of claim 1, wherein determining the variability in the plurality of cardiovascular pressure values comprises determining whether at least one of a mean or a median value of the plurality of cardiovascular pressure values is within a threshold range of values.

12. The method of claim 1, wherein determining the variability in the plurality of cardiovascular pressure values comprises:

determining at least one of a mean value or a median value of at least two cardiovascular pressure values of the plurality of cardiovascular pressure values,

determining a plurality of absolute difference values, wherein each absolute difference value of the plurality of absolute difference values comprises an absolute difference between a respective cardiovascular pressure value of the plurality of cardiovascular pressure values and the at least one of the mean value or the median value of the at least two cardiovascular pressure values, and

comparing each absolute difference value of the plurality of absolute difference values to a threshold value or a threshold range of values.

13. The method of claim 1, wherein determining the variability in the plurality of cardiovascular pressure values comprises:

determining at least one of a mean value or a median value of at least two cardiovascular pressure values of the plurality of cardiovascular pressure values,

determining a plurality of absolute difference values, wherein each absolute difference value of the plurality of absolute difference values comprises an absolute difference between a respective cardiovascular pressure value of the plurality of pressure values and the at least one of the mean value or the median value of the at least two cardiovascular pressure values;

determining at least one of a mean value or a median value of the plurality of absolute difference values, and

determining whether the at least one of the determined mean value or the determined median value of the plurality of absolute difference values is within a threshold range of the at least one of the mean value or the median value of the at least two cardiovascular pressure values of the plurality of cardiovascular pressure values.

14. The method of claim 13, wherein the threshold range comprises a percentage of about five percent to about twenty-five percent of the at least one of the mean value or the median value of the at least two cardiovascular pressure values of the plurality of cardiovascular pressure values.

15. The method of claim 1, further comprising:

determining whether any of the plurality of detected tachyarrhythmia events comprises a short interval;

generating a count of a number of the detected tachyarrhythmia events that comprise a short interval; and

analyzing the plurality of cardiovascular pressure values if the count is greater than or equal to a threshold value.

16. The method of claim 1, further comprising:

comparing each cardiovascular pressure value of the plurality of cardiovascular pressure values to a first threshold pressure value;

generating a count of a number of cardiovascular pressure values of the plurality of cardiovascular pressure values that are less than or equal to the first threshold pressure value; and

analyzing the plurality of cardiovascular pressure values if the count is greater than or equal to a second threshold value.

17. The method of claim 1, wherein determining, based on the variability in the plurality of cardiovascular pressure values, whether the detected tachyarrhythmia episode is the false positive detection attributable to electrical noise comprises:

determining whether the variability in the plurality of cardiovascular pressure values is greater than a threshold variability value;

determining that the detected tachyarrhythmia episode is the false positive detection attributable to electrical noise if the variability in the plurality of cardiovascular pressure values is greater than the threshold variability value; and

determining that the detected tachyarrhythmia episode is not the false positive detection attributable to electrical noise if the variability in the plurality of cardiovascular pressure values is less than the threshold variability value.

18. The method of claim 1, wherein determining the variability in the plurality of cardiovascular pressure values comprises determining a peak-to-peak variability in the plurality of cardiovascular pressure values.

19. A system comprising:

a pressure sensor configured to generate a signal indicative of cardiovascular pressure within a heart of a patient; and

a processor configured to detect a tachyarrhythmia episode of the heart of the patient, wherein the tachyarrhythmia episode comprises a plurality of tachyarrhythmia events, wherein the processor is further configured to analyze a plurality of cardiovascular pressure values based on the signal generated by the pressure sensor by at least determining a variability in the plurality of cardiovascular pressure values, each of the cardiovascular pressure values being associated with a respective one of the tachyarrhythmia events, and wherein the processor is further configured to determine, based on the variability of the plurality of cardiovascular pressure values, whether the detected tachyarrhythmia episode is a false positive detection attributable to electrical noise.

20. The system of claim 19, further comprising a medical device, wherein the processor is further configured to control the medical device to deliver therapy to the patient in response to detecting the tachyarrhythmia episode based on determining whether the detected tachyarrhythmia episode is a false positive detection attributable to electrical noise.

21. The system of claim 19, further comprising a medical device, wherein the processor is configured to control the medical device to withhold therapy delivery to the patient based on determining whether the detected tachyarrhythmia episode is a false positive detection attributable to electrical noise.

22. The system of claim 19, wherein the plurality of detected tachyarrhythmia events comprises a first detected tachyarrhythmia event and a second detected tachyarrhythmia event, and wherein the processor is configured to determine the variability in the plurality of cardiovascular pressure values by at least determining whether a first cardiovascular pressure value of the plurality of cardiovascular pressure values associated with the first detected tachyarrhythmia event and a second cardiovascular pressure value of the plurality of cardiovascular pressure values associated with the second detected tachyarrhythmia event are within a threshold range of each other.

23. The system of claim 19, wherein the processor is configured to determine the variability in the plurality of cardiovascular pressure values by at least determining whether the cardiovascular pressure associated with at least one detected tachyarrhythmia event of the plurality of detected tachyarrhythmia events varies by a threshold percentage compared to an average cardiovascular pressure value of cardiovascular pressures associated with at least two other detected tachyarrhythmia events of the plurality of detected tachyarrhythmia events.

24. The system of claim 19, wherein the processor is configured to determine the variability in the plurality of cardiovascular pressure values by at least determining whether at least one of a mean or a median value of the plurality of cardiovascular pressure values is within a threshold range of values.

25. The system of claim 19, wherein the processor is configured to determine the variability in the plurality of cardiovascular pressure values by at least determining at least one of a mean value or a median value of at least two cardiovascular pressure values of the plurality of cardiovascular pressure values, determining a plurality of absolute difference values, wherein each absolute difference value of the plurality of absolute difference values comprises an absolute difference between a respective cardiovascular pressure value of the plurality of cardiovascular pressure values and the at least one of the mean value or the median value of the at least two cardiovascular pressure values, and comparing each absolute difference value of the plurality of absolute difference values to a threshold value or a threshold range of values.

26. The system of claim 19, wherein the processor is configured to determine the variability in the plurality of cardiovascular pressure values by at least:

determining at least one of a mean value or a median value of at least two cardiovascular pressure values of the plurality of cardiovascular pressure values,

determining a plurality of absolute difference values, wherein each absolute difference value of the plurality of absolute difference values comprises an absolute difference between a respective cardiovascular pressure value of the plurality of pressure values and the at least one of the mean value or the median value of the at least two cardiovascular pressure values,

determining at least one of a mean value or a median value of the plurality of absolute difference values, and

determining whether the at least one of the determined mean value or the determined median value of the plurality of absolute difference values is within a threshold range of the at least one of the mean value or the median value of the at least two cardiovascular pressure values of the plurality of cardiovascular pressure values.

27. The system of claim 19, wherein the processor is further configured to determine whether any of the plurality of detected tachyarrhythmia events comprises a short interval, generate a count of a number of the detected tachyarrhythmia events that comprise a short interval, and analyze the plurality of cardiovascular pressure values if the count is greater than or equal to a threshold value.

28. The system of claim 19, wherein the processor is further configured to compare each cardiovascular pressure value of the plurality of cardiovascular pressure values to a first threshold pressure value, generate a count of a number of cardiovascular pressure values of the plurality of cardiovascular pressure values that are less than or equal to the first threshold pressure value, and analyze the plurality of cardiovascular pressure values if the count is greater than or equal to a second threshold value.

29. The system of claim 19, further comprising a sensing module configured to generate a signal indicative of electrical activity within the heart, wherein the processor is configured to detect the tachyarrhythmia episode based on the signal generated by the sensing module.

30. The system of claim 19, wherein each of the cardiovascular pressure values of the plurality of cardiovascular pressure values comprises at least one of a pulse pressure value, an average pressure value, a systolic pressure value, or a diastolic pressure value.

31. The system of claim 19, wherein the tachyarrhythmia episode comprises at least one of a ventricular fibrillation episode, a ventricular tachycardia episode, a fast ventricular tachycardia episode or a non-sustained tachyarrhythmia episode.

32. The system claim 19, wherein the processor is configured to determine, based on the variability in the plurality of cardiovascular pressure values, whether the detected tachyarrhythmia episode is a false positive detection attributable to electrical noise by at least determining whether the variability in the plurality of cardiovascular pressure values is greater than a threshold variability value, determining that the detected tachyarrhythmia episode is the false positive detection attributable to electrical noise if the variability in the plurality of cardiovascular pressure values is greater than the threshold variability value, and determining that the detected tachyarrhythmia episode is not the false positive detection attributable to electrical noise if the variability in the plurality of cardiovascular pressure values is less than the threshold variability value.

33. A system comprising:

means for detecting a tachyarrhythmia episode of a heart of a patient, wherein the tachyarrhythmia episode comprises a plurality of detected tachyarrhythmia events;

means for analyzing a plurality of cardiovascular pressure values, each of the pressure values being associated with a respective one of the tachyarrhythmia events, wherein the means for analyzing the plurality of cardiovascular pressure values determines a variability in the plurality of cardiovascular pressure values; and

means for determining, based on the variability in the plurality of cardiovascular pressure values, whether the detected tachyarrhythmia episode is a false positive detection attributable to electrical noise.

34. A non-transitory computer-readable medium comprising instructions that cause a programmable processor to:

detect a tachyarrhythmia episode of a heart of a patient, wherein the tachyarrhythmia episode comprises a plurality of detected tachyarrhythmia events;

analyze a plurality of cardiovascular pressure values by at least determining a variability in the plurality of cardiovascular pressure values, each of the pressure values being associated with a respective one of the tachyarrhythmia events; and

determine, based on the variability in the plurality of cardiovascular pressure values, whether the detected tachyarrhythmia episode is a false positive detection attributable to electrical noise.