Apparatus and method for heart failure indication based on heart rate, onset and tachyarrhythmia

• US 8,831,714 B2
• Filed: 05/07/2007
• Issued: 09/09/2014
• Est. Priority Date: 05/07/2007
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Lin, Yayun, Cazares, Shelley M., Hopper, Donald L.
• Primary Examiner(s): Layno, Carl H
• Assistant Examiner(s): LEE, ERICA SHENGKAI
• Application Number:
  US11/744,952
• Publication Number:
  US 20080281370A1
• Time in Patent Office: 2,682 Days
• Field of Search: 600/515, 600/518, 600/519, 607/4, 607/14, 607/15
• US Class Current: 600/515
• CPC Class Codes: A61B 5/02028 Determining haemodynamic parameters not otherwise provided for, e.g. cardiac contractility or left ventricular ejection fraction
• CPC Class Codes: A61B 5/02405 Determining heart rate variability
• CPC Class Codes: A61B 5/363 Detecting tachycardia or bradycardia
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/36592 controlled by the heart rate variability
• CPC Class Codes: A61N 1/3702 Physiological parameters A61N1/365 takes precedence; evoked response A61N1/371

Abstract

An indication of an actual or potential heart failure condition is computed. One example includes monitoring a first heart rate preceding a first onset of a first sinus tachyarrhythmia episode. Upon detecting the first sinus tachyarrhythmia episode, the indication is automatically provided using information about the first heart rate and how quickly the first onset occurs.

Claims

1. A method comprising:

monitoring a first heart rate; and

detecting a first sinus tachyarrhythmia episode preceded by the first heart rate;

when the first sinus tachyarrhythmia episode is detected;

determining how quickly a first onset to the first sinus tachyarrhythmia episode occurs by monitoring at least one time interval and calculating how quickly the first onset to the first sinus tachyarrhythmia episode occurs using the time interval; and

automatically providing a congestive heart failure indication using information about the first heart rate and how quickly the first onset to the first sinus tachyarrhythmia episode occurs.

2. The method of claim 1, wherein automatically providing the congestive heart failure indication comprises using an indication that the first heart rate exceeds a specified threshold heart rate.

3. The method of claim 1, wherein the first heart rate immediately precedes first onset of the first sinus tachyarrhythmia episode.

4. The method of claim 1, wherein the automatically providing the congestive heart failure indication includes also using a clinically-obtained functional classification of the patient to determine the congestive heart failure indication.

5. The method of claim 1, comprising initiating or recommending a measurement of a respiratory rate of the patient in response to the congestive heart failure indication.

6. The method of claim 1, comprising initiating or recommending a measurement of an ejection fraction of the patient in response to the congestive heart failure indication.

7. The method of claim 1, comprising initiating or recommending a measurement of a B-type natriuretic peptide (BNP) of the patient in response to the congestive heart failure indication.

8. The method of claim 1, comprising initiating or recommending a measurement of a QRS width of the patient in response to the congestive heart failure.

9. The method of claim 1, comprising initiating or recommending a measurement of a heart rate variability of the patient in response to the congestive heart failure indication.

10. The method of claim 1, comprising measuring an indication of autonomic balance of the patient and wherein the automatically providing the congestive heart failure indication includes also using the measured indication of autonomic balance to determine the congestive heart failure indication.

11. The method of claim 10, comprising measuring heart rate variability of the patient and wherein the automatically providing the congestive heart failure indication includes also using the measured heart rate variability to determine the congestive heart failure indication.

12. The method of claim 1, wherein automatically providing a congestive heart failure indication uses an indication that the first onset occurs more quickly than a specified onset threshold.

13. The method of claim 12, comprising:

detecting a second sinus tachyarrhythmia episode preceded by a second heart rate;

determining a combined indication of the first and second heart rates;

determining a combined indication of how quickly onsets of the first and second sinus tachyarrhythmia episodes occur; and

automatically providing the congestive heart failure indication when the combined indication of the onsets occurs more quickly than the specified onset threshold and the combined indication of the first and second heart rates exceeds a specified threshold heart rate.

14. The method of claim 12, wherein the determining how quickly the first onset occurs includes determining an amount of change between a first cardiac cycle interval and a second cardiac cycle interval and further comprises:

computing the indication that the first onset occurs more quickly than the specified onset threshold by comparing the amount of change between the first and second cardiac cycles to the specified threshold.

15. The method of claim 1, comprising monitoring a degree of pacing of a ventricle and automatically providing the congestive heart failure indication at least in part in response to at least one indication that the degree of pacing of the ventricle exceeds a specified degree of pacing threshold.

16. The method of claim 15, comprising automatically initiating, recommending, or monitoring a first cardiac resynchronization therapy.

17. The method of claim 16, comprising automatically providing a recommendation for a second cardiac resynchronization therapy.

18. An apparatus comprising:

a heart rate monitor circuit;

a sinus tachyarrhythmia episode detection circuit;

a sinus tachyarrhythmia onset detector circuit, configured to determine how quickly a first onset to the first sinus tachyarrhythmia episode occurs by monitoring at least one time interval and calculating how quickly the first onset to the first sinus tachyarrhythmia episode occurs using the time interval; and

a congestive heart failure indication detector circuit, coupled to at least one of the heart rate monitor circuit, the sinus tachyarrhythmia episode detection circuit, and the sinus tachyarrhythmia onset detector circuit,

wherein the congestive heart failure indication detector circuit is configured to provide a congestive heart failure indication when the first sinus tachyarrhythmia episode is detected, by using information about the first heart rate preceding the first sinus tachyarrhythmia episode and information about how quickly the first onset to the first sinus tachyarrhythmia episode occurs.

19. The apparatus of claim 18, wherein the heart rate monitor circuit is configured to be coupled to at least one external electrode.

20. The apparatus of claim 18, comprising a sinus tachyarrhythmia onset comparator circuit, configured to determine whether how quickly the first onset occurs exceeds a specified onset threshold.

21. The apparatus of claim 20, wherein the congestive heart failure indication detector circuit is configured to indicate an actual or potential congestive heart failure condition at least in response to at least one indication that the first onset occurs more quickly than the specified onset threshold.

22. The apparatus of claim 18, comprising a heart rate comparator circuit, configured to determine whether a first heart rate preceding the first onset of the first sinus tachyarrhythmia episode exceeds a specified heart rate threshold.

23. The apparatus of claim 18, wherein the apparatus includes an implantable medical device.

24. The apparatus of claim 23, wherein the heart rate monitor circuit is configured to be coupled to at least one implantable electrode.

25. The apparatus of claim 23, wherein the implantable medical device includes a wireless communication circuit configured to communicate information about the indicator to a local or remote external user interface.

26. The apparatus of claim 23, wherein the implantable medical device includes a cardiac rhythm management device including an electrostimulation delivery circuit that is configured to be controlled using information about the indicator.

27. An apparatus comprising:

a heart rate monitor circuit configured to detect a first heart rate and a second heart rate;

a sinus tachyarrhythmia episode detection circuit configured to detect a first sinus tachyarrhythmia episode preceded by the first heart rate, and to detect a second sinus tachyarrhythmia episode preceded by the second heart rate;

means for determining how quickly a first onset to the first sinus tachyarrhythmia episode occurs by monitoring at least one time interval and calculating how quickly the first onset to the first sinus tachyarrhythmia episode occurs using the time interval; and

means for automatically providing a congestive heart failure indication using an indication that the first onset occurs more quickly than a specified onset threshold together with an indication that a first heart rate exceeds a specified threshold heart rate, wherein the first heart rate precedes the first onset to the first sinus tachyarrhythmia episode.

28. The apparatus of claim 27, wherein the means for determining how quickly a first onset to the first sinus tachyarrhythmia episode occurs includes a heart rate comparator circuit, configured to determine whether a first heart rate preceding the first onset of the first sinus tachyarrhythmia episode exceeds a specified threshold heart rate value.

29. The apparatus of claim 27, wherein the means for automatically providing a congestive heart failure indication includes an indicator, coupled to at least one of a sinus tachyarrhythmia onset detector circuit and a heart rate monitor circuit, the indicator configured to indicate the actual or potential congestive heart failure condition at least in response to at least one indication that the first onset occurs more quickly than a specified onset threshold together with at least one indication the first heart rate exceeds a specified threshold heart rate.

30. A method comprising:

monitoring a first heart rate; and

detecting a first sinus tachyarrhythmia episode preceded by the first heart rate;

when the first sinus tachyarrhythmia episode is detected;

determining how quickly a first onset to the first sinus tachyarrhythmia episode occurs; and

automatically providing an indication of an actual or potential congestive heart failure condition using information about the first heart rate and how quickly the first onset to the first sinus tachyarrhythmia episode occurs,

wherein automatically providing an indication of an actual or potential congestive heart failure condition uses an indication that the first onset occurs more quickly than a specified onset threshold;

detecting a second sinus tachyarrhythmia episode preceded by a second heart rate;

determining a combined indication of the first and second heart rates;

determining a combined indication of how quickly onsets of the first and second sinus tachyarrhythmia episodes occur; and

automatically providing the indication of the congestive heart failure condition when the combined indication of the onsets occurs more quickly than the specified onset threshold and the combined indication of the first and second heart rates exceeds a specified threshold heart rate.

31. A method comprising:

monitoring a first heart rate; and

detecting a first sinus tachyarrhythmia episode preceded by the first heart rate;

when the first sinus tachyarrhythmia episode is detected;

determining how quickly a first onset to the first sinus tachyarrhythmia episode occurs; and

automatically providing a congestive heart failure indication using information about the first heart rate and how quickly the first onset to the first sinus tachyarrhythmia episode occurs, wherein automatically providing a congestive heart failure indication uses an indication that the first onset occurs more quickly than a specified onset threshold;

detecting a second sinus tachyarrhythmia episode preceded by a second heart rate;

determining a combined indication of the first and second heart rates;

determining a combined indication of how quickly onsets of the first and second sinus tachyarrhythmia episodes occur; and

automatically providing the congestive heart failure indication when

the combined indication of how quickly onsets of the first and second sinus tachyarrhythmia episodes occur indicates that the onsets of the first and second sinus tachyarrhythmia episodes occur more quickly than the specified onset threshold, and

the combined indication of the first and second heart rates exceeds a specified threshold heart rate.