Method and device for providing anti-tachyarrhythmia therapy

• US 9,084,898 B2
• Filed: 08/08/2012
• Issued: 07/21/2015
• Est. Priority Date: 05/08/2006
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Li, Dan
• Primary Examiner(s): Bertram, Eric D.
• Assistant Examiner(s): Bays, Pamela M
• Application Number:
  US13/569,208
• Publication Number:
  US 20120296383A1
• Time in Patent Office: 1,077 Days
• Field of Search: 607/6, 607/9, 607/14, 607/18, 607/116, 607/117, 607/118, 600/508, 600/509
• US Class Current: 1/1
• CPC Class Codes: A61N 1/3605 Implantable neurostimulators for stimulating central or peripheral nerve system
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/3621 for treating or preventing abnormally high heart rate
• CPC Class Codes: A61N 1/36564 controlled by blood pressure
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

Various system embodiments comprise at least one sensor input adapted to receive at least one sensed signal associated with a tachyarrhythmia, a feature set extractor adapted to extract at least two features from the at least one sensed signal associated with the tachyarrhythmia, a feature set generator adapted to form a feature set using the at least two features extracted by the feature set extractor, at least one generator adapted for use to selectively apply an anti-tachycardia pacing (ATP) therapy and a neural stimulation (NS) therapy, and a controller adapted to respond to the feature set. The controller is adapted to initiate the NS therapy when the feature set corresponds to criteria for applying the NS therapy to modify the tachyarrhythmia, and initiate the ATP therapy to terminate the modified tachyarrhythmia. Other aspects and embodiments are provided herein.

Claims

1. A system, comprising:

at least one sensor input adapted to receive at least one sensed signal associated with a tachyarrhythmia;

a feature set extractor adapted to extract at least two features from the at least one sensed signal associated with the tachyarrhythmia;

a feature set generator adapted to form a feature set using the at least two features extracted by the feature set extractor;

at least one generator adapted for use to selectively apply a shock therapy, an anti-tachycardia pacing (ATP) therapy, and a neural stimulation (NS) therapy; and

a controller adapted to respond to the feature set, the controller being adapted to initiate the shock therapy when the feature set corresponds to criteria for applying the shock therapy, initiate the ATP therapy when the feature set corresponds to criteria for applying the ATP therapy, and initiate the NS therapy when the feature set corresponds to criteria for applying the NS therapy, wherein the controller is configured to detect a ventricular tachycardia (VT), characterize the detected VT to distinguish between a moderately fast rate and a very fast rate, distinguish between a stable rhythm and an unstable rhythm and distinguish among significantly unstable hemodynamics, stable hemodynamics, and modest hemodynamic compromise, and initiate the NS therapy when the detected VT is characterized by a combination of all of the following;

a moderately fast rate, an unstable rhythm and a modest hemodynamic compromise.

2. The system of claim 1, wherein the controller is adapted to

determine if the feature set corresponds to the criteria for applying the ATP therapy, then determine if the feature set corresponds to the criteria for applying the shock therapy if the feature set did not correspond to the ATP therapy.

3. The system of claim 1, wherein the at least one sensor input includes an input to receive an electrogram (EGM) signal.

4. The system of claim 1, wherein the at least one sensor input includes an input to receive a signal from a hemodynamic sensor.

5. The system of claim 1, wherein the at least two features are selected from a heart rate, a stability of the heart rate, an irregularity of an electrogram morphology, or a pressure.

6. The system of claim 1, wherein the NS therapy is adapted to modify the tachyarrhythmia to be amenable to the ATP therapy, the feature set extractor is adapted to extract features from the modified tachyarrhythmia, the feature set generator is adapted to form a corresponding feature set for the modified tachyarrhythmia, and the controller is adapted to initiate the ATP therapy when the feature set for the modified tachyarrhythmia corresponds to criteria for applying the ATP therapy.

7. The system of claim 1, wherein the controller is adapted to use the feature set generator to construct the feature set in response to the detected VT.

8. The system of claim 7, wherein:

the NS therapy is initiated to modify the detected VT when the detected VT is characterized by a moderately fast rate, an unstable rhythm and a modest hemodynamic compromise; and

initiate the ATP therapy to terminate the modified VT.

9. The system of claim 1, wherein the controller is adapted to use the feature set generator to construct the feature set in response to the detected VT,

wherein the criteria for applying the NS therapy includes criteria to modify the detected VT, the criteria including:

the pressure is higher than a first pressure threshold, the heart rate is higher than a first heart rate threshold and lower than a second heart rate threshold, and the heart rate stability is higher than a first threshold and lower than a second threshold.

10. The system of claim 1, further comprising at least one electrode adapted to stimulate a vagus nerve, wherein the NS therapy includes vagus nerve stimulation therapy.

11. The system of claim 10, wherein the electrode includes an intravascularly-fed electrode adapted fur use in transvascularly stimulating the vagus nerve from an internal jugular vein.

12. The system of claim 10, wherein the electrode includes a subcutaneously-fed lead nerve cuff electrode adapted for use in stimulating the vagus nerve.

13. A system, comprising:

means for receiving at least one sensed signal associated with a tachyarrhythmia;

means for extracting at least two features from the at least one sensed signal associated with the tachyarrhythmia and forming a feature set using the at least two features;

means for providing a shock therapy when the feature set corresponds to criteria for applying the shock therapy;

means for providing an anti-tachycardia pacing (ATP) therapy when the feature set corresponds to criteria for applying the ATP therapy; and

means for providing a neural stimulation (NS) therapy when the feature set corresponds to criteria for applying the NS therapy to modify the tachyarrhythmia to be amenable to the ATP therapy, wherein the means for providing the NS therapy is configured to detect a ventricular tachycardia (VT), characterize the detected VT to distinguish between a moderately fast rate and a very fast rate, distinguish between a stable rhythm and an unstable rhythm, and distinguish among significantly unstable hemodynamics, stable hemodynamics, and modest hemodynamic compromise, and initiate the NS therapy when the detected VT is characterized by a combination of all of the following;

a moderately fast rate, an unstable rhythm and a modest hemodynamic compromise.

14. The system of claim 13, wherein the means for receiving at least one sensed signal associated with the tachyarrhythmia includes means for receiving a heart rate value, a heart rate stability value, a regularity value for an electrogram morphology, and pressure value.

15. A method, comprising:

receiving from at least one sensor at least one sensed signal associated with a tachyarrhythmia;

extracting at least two features from the at least one sensed signal associated with the tachyarrhythmia and forming a feature set using the at least two features;

providing a shock therapy when the feature set corresponds to criteria for applying the shock therapy;

providing an anti-tachycardia pacing (ATP) therapy when the feature set corresponds to criteria for applying the ATP therapy; and

providing a neural stimulation (NS) therapy when the feature set corresponds to criteria for applying the NS therapy to modify the tachyarrhythmia to be amenable to the ATP therapy,

wherein the shock therapy, the ATP therapy, and the NS therapy are provided using at least one generator;

wherein providing the NS therapy includes using a controller to;

detect a ventricular tachycardia (VT),

characterize the detected VT to distinguish between a moderately fast rate and a very fast rate, distinguish between a stable rhythm and an unstable rhythm, and

distinguish among significantly unstable hemodynamics, stable hemodynamics, and modest hemodynamic compromise, and

initiate the NS therapy when the detected VT is characterized by a combination of all of the following;

a moderately fast rate, an unstable rhythm and a modest hemodynamic compromise.

16. The method of claim 15, wherein receiving at east one sensed signal associated with the tachyarrhythmia includes receiving a heart rate value, a heart rate stability value, a regularity value for an electrogram morphology, and pressure value.

17. The method of claim 15, wherein the criteria for applying the shock therapy includes:

criteria that indicates the tachyarrhythmia is hemodynamically unstable above a higher unstability threshold value;

criteria that indicates the tachyarrhythmia has a heart rate above a higher rate threshold;

or

criteria that indicates the tachyarrhythmia is hemodynamically unstable above a lower unstability threshold value and below the higher unstability value, that indicates the tachyarrhythmia has a heart rate above a lower rate threshold and below the higher unstability value, and indicates that the tachyarrhythmia has an irregular heart rate and morphology.

18. The method of claim 15, wherein the criteria for applying the ATP therapy includes:

criteria that indicates the tachyarrhythmia is slow and stable;

criteria that indicates the tachyarrhythmia is hemodynamically stable and slow;

or

criteria that indicates the tachyarrhythmia is hemodynamically stable and has a moderate rate and a regular morphology.

19. The method of claim 15, wherein the criteria for applying neural stimulation includes criteria that indicates the tachyarrhythmia is hemodynamically stable and has a fast and unstable rate.

20. The method of claim 15, further comprising:

detecting a ventricular tachycardia (VT);

constructing the feature set in response to the detected VT;

initiating the NS therapy to modify the detected VT when the detected VT is characterized by a moderately fast rate, an unstable rhythm and a modest hemodynamic compromise; and

initiating the ATP therapy to terminate the modified VT.