Respiratory parameters for arrhythmia detection and therapy

• US 8,639,324 B2
• Filed: 01/19/2012
• Issued: 01/28/2014
• Est. Priority Date: 02/02/2011
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Elferri, Efdal, McPherson, Randall L., Hopper, Donald L., Seim, Gary T., Gilkerson, James O., Li, Dan, Perschbacher, David L.
• Primary Examiner(s): Layno, Carl H
• Assistant Examiner(s): PIATESKI, ERIN M
• Application Number:
  US13/353,515
• Publication Number:
  US 20120197323A1
• Time in Patent Office: 740 Days
• Field of Search: 607/4, 607/5, 600/484
• US Class Current: 607/4
• CPC Class Codes: A61B 5/0538 invasively, e.g. using a catheter
• CPC Class Codes: A61B 5/0809 by impedance pneumography
• CPC Class Codes: A61B 5/091 Measuring volume of inspired or expired gases, e.g. to determine lung capacity
• CPC Class Codes: A61B 5/363 Detecting tachycardia or bradycardia
• CPC Class Codes: A61B 5/686 Permanently implanted devices, e.g. pacemakers, other stimulators, biochips A61B5/6861 takes precedence
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

An implantable or ambulatory medical device can include a cardiac signal sensing circuit configured to provide a sensed cardiac depolarization signal of a heart of a subject, a respiration sensing circuit configured to provide a signal representative of respiration of the subject, and a control circuit communicatively coupled to the cardiac signal sensing circuit and the respiration circuit. The control circuit includes a tachyarrhythmia detection circuit configured to determine heart rate using the depolarization signal, determine a respiration parameter of the subject using the respiration signal, calculate a ratio using the determined heart rate and the determined respiration parameter, generate an indication of tachyarrhythmia when the calculated ratio satisfies a specified detection ratio threshold value, and provide the indication of tachyarrhythmia to a user or process.

Claims

1. An implantable or other ambulatory medical apparatus comprising:

a cardiac signal sensing circuit configured to provide a sensed cardiac depolarization signal of a heart of a subject;

a respiration sensing circuit configured to provide a signal representative of respiration of the subject; and

a control circuit communicatively coupled to the cardiac signal sensing circuit and the respiration circuit, wherein the control circuit includes a tachyarrhythmia detection circuit configured to;

determine heart rate using the depolarization signal;

determine a respiration parameter of the subject using the respiration signal;

calculate a ratio of the determined heart rate and the determined respiration parameter and determine a normal baseline value of the ratio;

generate an indication of tachyarrhythmia when the calculated ratio satisfies a ventricular tachycardia ratio detection zone, wherein a value of the calculated ratio of the ventricular tachycardia detection zone is a substantial increase over the normal baseline value of the ratio; and

provide the indication of tachyarrhythmia to a user or process.

2. The apparatus of claim 1,

wherein the tachyarrhythmia detection circuit includes a minute ventilation (MV) circuit configured to determine MV from the respiration signal as the respiration parameter, and

wherein the tachyarrhythmia detection circuit is configured to calculate the ratio using the determined heart rate and the determined MV.

3. The apparatus of claim 2, wherein the tachyarrhythmia detection circuit is configured to:

compare the determined heart rate to a specified lowest tachyarrhythmia rate (LTR) detection threshold value, and

calculate the ratio when the determined heart rate satisfies the specified LTR detection threshold.

4. The apparatus of claim 3, including:

a therapy circuit communicatively coupled to the control circuit and configured to selectively deliver electrical cardioversion/defibrillation shock therapy and electrical pacing stimulation energy to the heart;

wherein the control circuit is configured to;

initiate delivery of cardioversion/defibrillation shock therapy in response to the indication of tachyarrhythmia when the calculated ratio satisfies the ventricular tachycardia ratio detection zone; and

initiate delivery of anti-tachyarrhythmia pacing (ATP) therapy in response to the indication of tachyarrhythmia otherwise.

5. The apparatus of claim 3, wherein the tachyarrhythmia detection circuit is configured to generate an indication of tachyarrhythmia when the determined heart rate and the calculated ratio satisfy the LTR detection threshold and the specified ventricular tachycardia ratio detection zone, respectively, for a specified minimum detection time duration threshold value.

6. The apparatus of claim 2, wherein the MV circuit is configured to:

extract respiration rate from the respiration signal;

determine tidal volume using the respiration signal; and

calculate MV of the subject using the respiration rate and tidal volume.

7. The apparatus of claim 2, including:

a memory circuit integral to, or communicatively coupled to, the control circuit,

wherein the tachyarrhythmia detection circuit is configured to;

compare the determined heart rate to a specified lowest tachyarrhythmia rate (LTR) detection threshold value;

generate an indication of slow tachyarrhythmia when the heart rate is less than the specified LTR detection threshold value and the calculated ratio satisfies a specified ventricular tachycardia ratio detection zone value; and

store the indication of slow tachyarrhythmia using the memory circuit.

8. The apparatus of claim 1, including:

an activity sensing circuit configured to provide a signal representative of activity of the subject;

wherein the tachyarrhythmia detection circuit is configured to;

detect that the determined heart rate satisfies a specified lowest tachyarrhythmia rate (LTR) detection threshold value;

generate an indication of tachyarrhythmia when the calculated ratio satisfies the specified ventricular tachycardia ratio detection zone value; and

generate an indication of activity-induced tachyarrhythmia when the specified detection ratio threshold value is not satisfied and an activity level indicated by the activity signal exceeds an activity level threshold value.

9. The apparatus of claim 1, wherein the respiration sensing circuit includes an intra-thoracic impedance sensing circuit configured to provide an impedance signal representative of respiration of the subject.

10. The apparatus of claim 1, wherein the respiration sensing circuit includes an accelerometer, and wherein respiration signal includes an acceleration signal representative of motion of the thorax region of the subject.

11. The apparatus of claim 1, wherein the value of the calculated ratio of the ventricular tachycardia detection zone is an order of magnitude increase over the normal baseline value of the ratio.