Episode classifier algorithm

• US 8,774,909 B2
• Filed: 09/26/2011
• Issued: 07/08/2014
• Est. Priority Date: 09/26/2011
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Patel, Amisha S., Gunderson, Bruce D., Brown, Mark L.
• Primary Examiner(s): Bertram, Eric D.
• Assistant Examiner(s): So, Elizabeth K
• Application Number:
  US13/245,585
• Publication Number:
  US 20130079654A1
• Time in Patent Office: 1,016 Days
• Field of Search: 600508-528
• US Class Current: 600/518
• CPC Class Codes: A61B 5/24 Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
• CPC Class Codes: A61B 5/361 Detecting fibrillation
• CPC Class Codes: A61B 5/363 Detecting tachycardia or bradycardia
• CPC Class Codes: A61N 1/3702 Physiological parameters A61N1/365 takes precedence; evoked response A61N1/371

Abstract

The present disclosure is directed to the classification of cardiac episodes using an algorithm. In various examples, an episode classification algorithm evaluates electrogram signal data from a near-field channel and a far-field channel. The episode classification algorithm classifies the cardiac episode based on the evaluation of the electrogram signal data for at least one of the near-field and far-field channels. In some examples, a cardiac episode being classified may be an episode that resulted in treatment being provided by an implantable medical device. Possible classifications of the cardiac episode may include, for example, unknown, inappropriate, appropriate, supraventricular tachycardia, ventricular tachycardia, ventricular fibrillation or ventricular over-sensing.

Claims

1. A method comprising:

receiving stored episode data generated by an implantable medical device, the stored episode data including sensed atrial events and sensed ventricular events for both a near-field channel and a far-field channel;

determining, in response to the received data, instances where the implantable medical device identified a cardiac episode being detected in response to the episode data for at least one of the near-field channel and the far-field channel;

evaluating, in response to the received data, whether the determined instances should have been identified by the implantable medical device as a cardiac episode being detected, the evaluation including;

classifying the cardiac episode as unknown, supraventricular tachycardia, ventricular tachycardia/ventricular fibrillation, or ventricular over-sensing based on episode data for the near-field channel;

classifying the cardiac episode as unknown, supraventricular tachycardia ventricular tachycardia/ventricular fibrillation, or ventricular over-sensing based on episode data for the far-field channel;

comparing the classifications from the near-field channel and the far-field channel to determine a final classification,

wherein, when at least one of the classifications is ventricular over-sensing, determining the final classification comprises determining that the final classification is ventricular over-sensing,

wherein, when the classifications of both the near-field channel and the far-field channel are unknown, determining the final classification comprises determining that the final classification is unknown,

wherein, when the classification of the far-field channel is a known result, determining the final classification comprises determining that the final classification is the classification of the far-field channel, and

wherein, when the classification of the near-field channel is a known result and the classification of the far-field channel is unknown, determining the final classification comprises determining that the final classification is the classification of the near-field channel.

2. The method of claim 1, further comprising determining whether the near-field channel has spontaneous regular sensing and determining whether the far-field channel has spontaneous regular sensing.

3. The method of claim 2, further comprising, in response to a determination of no spontaneous regular sensing on the near-field channel, classifying the near-field channel as unknown.

4. The method of claim 2, further comprising, in response to a determination of no spontaneous regular sensing on the far-field channel, classifying the far-field channel as unknown.

5. The method of claim 2, further comprising, in response to a determination of spontaneous regular sensing on a given channel, determining a ratio of sensed atrial events to sensed ventricular events.

6. The method of claim 5, further comprising,

in response to a determination of a 1:

1 ratio of sensed atrial events to sensed ventricular events, determining whether there is variability in the beat-to-beat cycle lengths of RR intervals and PP interval;

in response to determining that there is variability in the beat-to-beat cycle lengths of RR intervals and PP intervals, determining whether the change in interval length is led by the RR interval or the PP interval.

7. The method of claim 6, further comprising classifying the cardiac event as a supraventricular tachycardia in response to a determination that the PP interval is leading the change in interval length and classifying the cardiac event as a ventricular tachycardia or ventricular fibrillation is the RR interval is leading the change in interval.

8. The method of claim 6, wherein determining whether the change in interval length is led by the RR interval or the PP interval further comprises determining the amount of change between successive RR intervals and successive PP intervals, comparing the amount of change to a predetermined threshold, and in response to an amount of change above the threshold, comparing an amount of change in the RR interval to the amount of change in the PP interval for successive cycles.

9. A system comprising:

an implantable medical device including;

a processor configured to diagnosis cardiac episodes based on an EGM signal data sensed by a sensing module, the EGM signal data including sensed atrial events and sensed ventricular events for both a near-field channel and a far-field channel; and

a memory configured to store episode data comprising a portion of the EGM signal data associated with the diagnosis of the cardiac episodes; and

an external computing device configured to;

receive episode data stored in the implantable medical device,

determine, in response to the received data, instances where the implantable medical device identified a cardiac episode being detected in response to the sensing data for at least one of the near-field channel and the far-field channel;

evaluate, in response to the received data, whether the determined instances should have been identified by the implantable medical device as a cardiac episode being detected, the evaluation including;

classifying the cardiac episode as unknown, supraventricular tachycardia, ventricular tachycardia/ventricular fibrillation, or ventricular over-sensing based on episode data for the near-field channel;

classifying the cardiac episode as unknown, supraventricular tachycardia, or ventricular tachycardia/ventricular fibrillation, or ventricular over-sensing based the episode on the far-field channel;

comparing the results from the near-field channel and the far-field channel to determine the final classification,

wherein, when at least one of the classifications is ventricular over-sensing, determining the final classification comprises determining that the final classification is ventricular over-sensing,

wherein, when the classification of both the near-field channel and far-field channel are unknown, determining the final classification comprises determining the final classification is unknown,

wherein, when the classification of the far-field channel is a known result, determining the final classification comprises determining the final classification is the classification of the far-field channel , and

wherein, when the classification of the near field channel is a known and the classification of the far-field channel is unknown determining the final classification comprises determining that the final classification is the classification of the near-field channel.

10. A device comprising:

a communication module configured to;

receive stored episode data, the stored episode data generated by an implantable medical device, the stored episode data including sensed atrial events and sensed ventricular events for both a near-field channel and a far-field channel; and

a processor configured to;

determine in response to the received data, instances where the implantable medical device identified a cardiac episode being detected in response to the sensing data for at least one of the near-field channel and the far-field channel;

evaluate, in response to the received data, whether the determined instances should have been identified by the implantable medical device as a cardiac episodes being detected, the evaluation including;

classifying the cardiac episode as unknown, supraventricular tachycardia, ventricular tachycardia/ventricular fibrillation, or ventricular over-sensing based on episode data for the near-field channel;

classifying the cardiac episode as unknown, supraventricular tachycardia, ventricular tachycardia/ventricular fibrillation, or ventricular over-sensing based on episode data for the far-field channel;

comparing the classification the near-field channel and the far-field channel to determine a final classification,

wherein, when at least one of the classifications is ventricular over-sensing, determining the final classification comprises determining that the final classification is ventricular over-sensing,

wherein, when the classification of both the near-field channel and far-field channel are unknown, determining the final classification comprising determining that the final classification is unknown,

wherein, when the classification of the far-field channel is a known result, determining the final classification comprises determining that the final classification is the classification of the far-field channel, and

wherein, when the classification of the near-field channel is a known result and the classification of the far-field channel is unknown, determining the final classification is the classification of the near-field channel.

11. The device of claim 10, the processor further configured to determine whether the near-field channel has spontaneous regular sensing and to determine whether the far-field channel has spontaneous regular sensing.

12. The device of claim 11, wherein the processor is further configured to, in response to a determination of no spontaneous regular sensing on the near-field channel, classify the near-field channel as unknown.

13. The device of claim 11, wherein the processor is further configured to, in response to a determination of no spontaneous regular sensing on the far-field channel, classify the far-field channel as unknown.

14. The device of claim 11, wherein the processor is further configured to, in response to a determination of spontaneous regular sensing on a given channel, determine a ratio of sensed atrial events to sensed ventricular events.

15. The device of claim 14, wherein the processor is further configured to:

in response to a determination of a 1;

1 ratio of sensed atrial events to sensed ventricular events, determine whether there is variability in the beat-to-beat cycle lengths of RR intervals and PP interval; and

in response to determining that there is variability in the beat-to-beat cycle lengths of RR intervals and PP intervals, determine whether the change in interval length is led by the RR interval or the PP interval.

16. The device of claim 15, wherein the processor if further configured to classify the cardiac event as a supraventricular tachycardia in response to a determination that the PP interval is leading the change in interval length and classifying the cardiac event as a ventricular tachycardia or ventricular fibrillation is the RR interval is leading the change in interval.

17. The device of claim 15, wherein the processor is further configured to, determine the amount of change between successive RR intervals and successive PP intervals, comparing the amount of change to a predetermined threshold, and in response to an amount of change above the threshold, comparing an amount of change in the RR interval to the amount of change in the PP interval for successive cycles.

18. A system comprising:

means for receiving stored episode data, the stored data generated by an implantable medical device , the stored episode data including sensed atrial events and sensed ventricular events for both a near-field channel and a far-field channel;

means for determining in response to the received data, instances where the implantable medical device identified a cardiac event being detected in response to the episode data for at least one of the near-field channel and the far-field channel;

means for evaluating, in response to the received data, whether the determined instances should have been identified by the implantable medical device as a cardiac event being detected, the evaluation including;

means for classifying the cardiac event as unknown, supraventricular tachycardia, ventricular tachycardia/ventricular fibrillation, or ventricular over-sensing based on episode data for the near-field channel;

means for classifying the cardiac event as unknown, supraventricular tachycardia, ventricular tachycardia/ventricular fibrillation, or ventricular over-sensing based on episode data for the far-field channel;

means for comparing the classifications from the near-field channel and the far-field channel to determine the final classification,

wherein, when at least one of the classifications is ventricular over-sensing, determining the final classification comprises determining that the final classification is ventricular over-sensing,

wherein, when the classification of the near-field channel and the far-field channel are unknown, determining the final classification comprises determining that the final classification is unknown,

wherein, when the classification of the far-field channel as a known result, determining the final classification comprises determining the final classification is the classification of the far-field channel, and

wherein, when the classification of near-field channel is a known result and the classification of the far-field channel is unknown, determining the final classification comprises determining that the final classification is the classification of the near-field channel.

19. A non-transitory computer-readable medium comprising instructions for causing a programmable processor to:

determine in response to receiving episode data, instances where the implantable medical device identified a cardiac event being detected in response to the episode data for at least one of a near-field channel and a far-field channel, wherein the received episode data includes stored episode data generated by an implantable medical device, the stored episode data includes sensed atrial evens and sensed ventricular event for both the near-field channel and the far-field channel; and

evaluate, in response to the received data, whether the determined instances should have been identified by the implantable medical device as a cardiac event being detected, the evaluation including;

classifying the cardiac event as unknown, supraventricular tachycardia, ventricular tachycardia/ventricular fibrillation, or ventricular over-sensing based on episode data for the near-field channel;

classifying the cardiac event as unknown, supraventricular tachycardia, ventricular tachycardia/ventricular fibrillation, or ventricular over-sensing based on episode data for the far-field channel;

comparing the classifications from the near-field channel and the far-field channel to determine the final classification,

wherein, when at least one of the classifications is ventricular over-sensing, determining the final classification comprises determining that the final classification is ventricular over-sensing,

wherein, when the classification of both the near-field channel and far-field channel is unknown, determining the final classification comprising determining that the final classification is unknown,

wherein, when the classification of the far-field channel is known, determining the final classification comprises determining that the final classification is the classification of the far-field channel, and

wherein, when the classification of the near-field channel is a known result and the classification of the far-field channel is unknown, determining the final classification comprises determining that the final classification is the classification of the near-field channel.