Electrogram storage for suspected non-physiological episodes

• US 8,200,322 B2
• Filed: 07/30/2008
• Issued: 06/12/2012
• Est. Priority Date: 06/02/2008
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Ousdigian, Kevin T., Condie, Catherine R., Kleckner, Karen J., Gunderson, Bruce D.
• Primary Examiner(s): Getzow, Scott
• Assistant Examiner(s): PATTON, AMANDA K
• Application Number:
  US12/182,687
• Publication Number:
  US 20090299422A1
• Time in Patent Office: 1,413 Days
• Field of Search: 607/8, 607/28, 600/515, 600/518
• US Class Current: 600/518
• CPC Class Codes: A61B 2560/0276 Determining malfunction
• CPC Class Codes: A61B 5/053 Measuring electrical impedance or conductance of a portion of the body
• CPC Class Codes: A61B 5/0538 invasively, e.g. using a catheter
• CPC Class Codes: A61B 5/283 Invasive
• CPC Class Codes: A61B 5/361 Detecting fibrillation
• 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 1/3702 Physiological parameters A61N1/365 takes precedence; evoked response A61N1/371
• CPC Class Codes: A61N 1/3704 Circuits specially adapted therefor, e.g. for sensitivity control

Abstract

Techniques for storing electrograms (EGMS) that are associated with sensed episodes or events that may be non-physiological and, instead, associated with a sensing integrity condition are described. In some examples, a device or system identifies suspected non-physiological NSTs, and stores an EGM for the suspected non-physiological NSTs within an episode log. In some examples, a device or system determines whether to store an EGM for a suspected non-physiological episode or event based on whether an impedance integrity criterion has been satisfied. For example, a device or system may store an EGM for a detected short interval if the impedance integrity criterion has been met. In some examples, a device or system determines whether to buffer EGM data based on whether an impedance integrity criterion or other sensing integrity criterion has been met.

Claims

1. A method comprising:

receiving a cardiac electrical signal and monitoring heart rate based on the cardiac electrical signal;

detecting a tachyarrhythmia based on the monitored heart rate exceeding a first predetermined threshold;

determining whether the detected tachyarrhythmia is a non-sustained tachyarrhythmia based on the length of the detected tachyarrhythmia episode;

identifying a plurality of events in the cardiac electrical signal during the detected non-sustained tachyarrhythmia episode as cardiac depolarizations;

determining a rate of at least some of the identified events;

determining that the detected non-sustained tachyarrhythmia is a suspected non-physiological non-sustained tachyarrhythmia caused by a sensing integrity condition, based on the rate of the at least some of the identified events; and

storing an electrogram for the suspected non-physiological non-sustained tachyarrhythmia based on the detection, the electrogram including at least a portion of the cardiac electrical signal.

2. The method of claim 1, further comprising storing a marker channel corresponding to the electrogram in association with the electrogram, wherein the marker channel indicates detection of cardiac events based on the cardiac electrical signal.

3. The method of claim 1, further comprising:

monitoring an impedance of at least one electrical path comprising at least one electrode that senses the cardiac signal; and

determining whether an impedance integrity criterion is met based on the monitored impedance,

wherein storing an electrogram for the suspected non-physiological non-sustained tachyarrhythmia comprises storing the electrogram if the impedance integrity criterion is met.

4. The method of claim 1, further comprising:

detecting a plurality of cardiac events based on the signal prior to detection of the suspected non-physiological non-sustained tachyarrhythmia;

measuring one or more intervals between consecutive ones of the detected cardiac events;

comparing the intervals to a threshold;

identifying one or more short intervals based on the comparison, wherein the short intervals are intervals with lengths shorter than the threshold;

storing an electrogram for each of the one or more short intervals, each of the one or more electrograms for the one or more short intervals including at least a portion of the cardiac electrical signal; and

stopping storage of electrograms for the one or more short intervals in response to detection of the suspected non-physiological non-sustained tachyarrhythmia.

5. The method of claim 4, further comprising:

monitoring an impedance of at least one electrical path comprising at least one electrode that senses the cardiac signal; and

determining whether an impedance integrity criterion is met based on the monitored impedance,

wherein storing one or more electrograms for the one or more short intervals comprises storing the electrograms if the impedance integrity criterion is met.

6. The method of claim 1, further comprising:

determining whether a sensing integrity criterion is met; and

buffering the cardiac electrical signal for storage of the electrogram if the sensing integrity criterion is met.

7. A system comprising:

a memory;

a plurality of electrodes;

an electrical sensing module that receives a cardiac electrical signal from the plurality of electrodes and monitors heart rate based on the cardiac electrical signal;

a non-physiological non-sustained tachyarrhythmia detection module configured to

detect a tachyarrhythmia based on the monitored heart rate exceeding a first predetermined threshold

determine whether the detected tachyarrhythmia is a non-sustained tachyarrhythmia based on the length of the detected tachyarrhythmia episode;

identify a plurality of events in the cardiac electrical signal during the detected non-sustained tachyarrhythmia episode as cardiac depolarizations;

determine a rate of at least some of the identified events; and

determine that the detected non-sustained tachyarrhythmia is a suspected non-physiological non-sustained tachyarrhythmia caused by a sensing integrity condition, based on the rate of the at least some of the identified events; and

an episode storage evaluation module that controls storage of an electrogram for the suspected non-physiological non-sustained tachyarrhythmia within the memory based on the detection, the electrogram including at least a portion of the cardiac electrical signal.

8. The system of claim 7, wherein the episode storage evaluation module controls storage of a marker channel corresponding to the electrogram in association with the electrogram, wherein the marker channel indicates detection of cardiac events based on the cardiac electrical signal.

9. The system of claim 7, further comprising an impedance integrity module that monitors an impedance of at least one electrical path comprising at least one of the electrodes, and determines whether an impedance integrity criterion is met based on the monitored impedance, wherein the episode storage evaluation module controls storage of the electrogram if the impedance integrity criteria is met.

10. The system of claim 7,

wherein the electrical sensing module detects a plurality of cardiac events based on the signal prior to detection of the suspected non-physiological non-sustained tachyarrhythmia by the non-physiological non-sustained tachyarrhythmia detection module,

the system further comprising a short interval detection module that measures one or more intervals between consecutive ones of the detected events, compares the intervals to a threshold, and identifies one or more short intervals based on the comparison, and

wherein the episode storage evaluation module controls storage of an electrogram for each of the one or more short intervals, each of the one or more electrograms for the one or more short intervals including at least a portion of the cardiac electrical signal, and stops storage of electrograms for short intervals in response to detection of the suspected non-physiological non-sustained tachyarrhythmia by the non-physiological non-sustained tachyarrhythmia detection module.

11. The system of claim 10, further comprising an impedance integrity module that monitors an impedance of at least one electrical path comprising at least one of the electrodes, and determines whether an impedance integrity criterion is met based on the monitored impedance, wherein the episode storage evaluation module controls storage of the electrograms for the one or more short intervals if the impedance integrity criteria is met.

12. The system of claim 7, further comprising a sensing integrity module that determines whether a sensing integrity criterion is met, wherein the episode storage evaluation module buffers the cardiac electrical signal for storage of the electrogram if the sensing integrity criterion is met.

13. The system of claim 12, wherein the sensing integrity module comprises an impedance integrity module that monitors an impedance of at least one electrical path comprising at least one of the electrodes, and determines whether an impedance integrity criterion is met based on the monitored impedance.

14. The system of claim 7, further comprising an implantable medical device coupled to the electrodes and comprising the memory, the electrical sensing module, and a processor, wherein the processor comprises the non-physiological non-sustained tachyarrhythmia detection module and the episode storage evaluation module.

15. The system of 14, wherein the implantable medical device comprises at least one of a cardiac pacemaker, a cardioverter, or a defibrillator.

16. A system comprising:

means for receiving a cardiac electrical signal;

means for monitoring heart rate based on the cardiac signal;

means for detecting a tachyarrhythmia based on the monitored heart rate exceeding a first predetermined threshold;

means for determining whether the detected tachyarrhythmia is a non-sustained tachyarrhythmia based on the length of the detected tachyarrhythmia episode;

means for identifying a plurality of events in the cardiac electrical signal during the detected non-sustained tachyarrhythmia episode as cardiac depolarizations;

means for determining a rate of at least some of the identified events;

means for determining that the detected non-sustained tachyarrhythmia is a suspected non-physiological non-sustained tachyarrhythmia caused by a sensing integrity condition, based on the rate of the at least some of the identified events; and

means for storing an electrogram for the suspected non-physiological non-sustained tachyarrhythmia based on the detection, the electrogram including at least a portion of the cardiac electrical signal.

17. A computer readable medium comprising instructions that cause a processor to:

detect a tachyarrhythmia based on a cardiac electrical signal and a monitored heart rate exceeding a first predetermined threshold;

detect a tachyarrhythmia based on the monitored heart rate exceeding a first predetermined threshold

determine whether the detected tachyarrhythmia is a non-sustained tachyarrhythmia based on the length of the detected tachyarrhythmia episode;

identify a plurality of events in the cardiac electrical signal during the detected non-sustained tachyarrhythmia episode as cardiac depolarizations;

determine a rate of at least some of the identified events; and

determine that the detected non-sustained tachyarrhythmia is a suspected non-physiological non-sustained tachyarrhythmia caused by a sensing integrity condition, based on the rate of the at least some of the identified events; and

control storage of an electrogram for the suspected non-physiological non-sustained tachyarrhythmia based on the detection, the electrogram including at least a portion of the cardiac electrical signal.

18. A system comprising:

a memory;

a plurality of electrodes;

an electrical sensing module that receives a cardiac electrical signal from the plurality of electrodes and measures an impedance of an electrical path comprising the electrodes; and

a processor that identifies a plurality of events within the cardiac electrical signal, compares an interval between two consecutive events to a threshold, and determines whether to store an electrogram for the interval within the memory based on the comparison and the impedance measurement, the electrogram including at least a portion of the cardiac electrical signal, wherein the processor detects a suspected non-physiological non-sustained tachyarrhythmia based on the cardiac electrical signal, and determines not to store the electrogram for the interval based on the detection of the non-physiological non-sustained tachyarrhythmia.