Method and apparatus for discriminating tachycardia events in a medical device using two sensing vectors

• US 9,808,640 B2
• Filed: 04/10/2014
• Issued: 11/07/2017
• Est. Priority Date: 04/10/2014
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Zhang, Xusheng
• Primary Examiner(s): Carey, Michael
• Assistant Examiner(s): Patel, Natasha
• Application Number:
  US14/250,040
• Publication Number:
  US 20150290468A1
• Time in Patent Office: 1,307 Days
• CPC Class Codes: A61B 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 5/341 Vectorcardiography [VCG]
• CPC Class Codes: A61B 5/35 by template matching
• CPC Class Codes: A61B 5/361 Detecting fibrillation
• CPC Class Codes: A61B 5/363 Detecting tachycardia or bradycardia
• CPC Class Codes: A61B 5/7207 of noise induced by motion artifacts
• CPC Class Codes: A61N 1/3987 characterised by the timing or triggering of the shock

Abstract

A method and medical device for detecting a cardiac event that includes sensing cardiac signals from a plurality of electrodes forming a first sensing vector sensing a first interval of the cardiac signal during a predetermined time period and a second sensing vector simultaneously sensing a second interval of the cardiac signal during the predetermined time period, identifying each of the first interval and the second interval as being one of shockable and not shockable in response to first processing of the first interval and the second interval and in response to second processing of one or both of the first interval and the second interval, the second processing being different from the first processing, and determining whether to deliver therapy for the cardiac event in response to identifying each of the first interval and the second interval as being one of shockable and not shockable in response to both the first processing and the second processing of the first interval and the second interval.

Claims

1. A method of detecting a cardiac event in a medical device, comprising:

sensing cardiac signals from a plurality of electrodes, the plurality of electrodes forming a first sensing vector sensing a first interval of the cardiac signal during a predetermined time period and a second sensing vector simultaneously sensing a second interval of the cardiac signal during the predetermined time period;

identifying each of the first interval and the second interval as being one of shockable or not shockable in response to a first processing of the first interval and the second interval;

identifying each of the first interval and the second interval as being one of shockable or not shockable in response to a second processing of the first interval and the second interval, the second processing being different from the first processing and comprising a beat-based analysis identifying individual beats within the first interval and the second interval;

determining whether to deliver therapy for the cardiac event in response to identifying each of the first interval and the second interval as being one of shockable or not shockable in response to both the first processing of the first interval and the second interval and the second processing of the first interval and the second interval; and

delivering therapy to treat the cardiac event based on identifying each of the first interval and the second interval as being shockable in response to both the first processing and the second processing.

2. The method of claim 1, wherein sensing cardiac signals includes the first sensing vector sensing a plurality of first intervals during the predetermined time period, the plurality of first intervals including the first interval, and the second sensing vector sensing a plurality of second intervals during the predetermined time period, the plurality of second intervals including the second interval, and wherein determining whether to deliver therapy for the cardiac event comprises:

determining whether a predetermined number of the plurality of first intervals and the plurality of second intervals are identified as shockable in response to the first processing; and

determining whether a predetermined number of the plurality of first intervals and the plurality of second intervals are identified as shockable in response to the second processing.

3. The method of claim 1, wherein the first processing comprises a gross morphology analysis of the first interval and the second interval.

4. The method of claim 1, wherein the first processing comprises:

determining whether both the first interval and the second interval are corrupted by noise;

determining whether both the first interval and the second interval are within one of a VF shock zone and a VT shock zone; and

determining, in response to one of the first interval and the second interval not being corrupted by noise and the other of the first interval and the second interval being corrupted by noise, whether the one of the first interval and the second interval determined not to be corrupted by noise is within the VT shock zone.

5. The method of claim 4, wherein the second processing comprises:

comparing each of the identified beats with a beat template and determining a number of the identified beats that are match beats and a number of the identified beats that are non-match beats;

determining whether the number of non-match beats is greater than a non-match threshold; and

identifying the first interval as shockable in response to the number of non-match beats being greater than the non-match threshold.

6. The method of claim 1, wherein the second processing comprises:

comparing each of the identified beats with a beat template and determining a number of the identified beats that are match beats and a number of the identified beats that are non-match beats;

determining whether the number of non-match beats is greater than a non-match threshold; and

identifying the first interval as shockable in response to the number of non-match beats being greater than the non-match threshold.

7. The method of claim 1, further comprising:

determining, during the first processing, whether the first interval and the second interval are corrupted by noise;

determining, in response to only one of the first interval and the second interval not being corrupted by noise, whether the one of the first interval and the second interval not corrupted by noise is shockable; and

identifying the cardiac event as one of shockable or not shockable in response to the second processing of only the one of the first interval and the second interval not corrupted by noise.

8. The method of claim 7, wherein sensing cardiac signals includes the first sensing vector sensing a plurality of first intervals during the predetermined time period, the plurality of first intervals including the first interval, and the second sensing vector sensing a plurality of second intervals during the predetermined time period, the plurality of second intervals including the second interval, and wherein determining whether to deliver therapy for the cardiac event comprises:

determining whether a predetermined number of both of the first intervals and the second intervals are identified as shockable in response to the first processing; and

determining, in response to neither of the first interval and the second interval being corrupted by noise, whether the predetermined number of both of the first intervals and the second intervals are identified as shockable in response to the second processing; and

determining, in response to only one of the first interval and the second interval not being corrupted by noise, whether the predetermined number of one of the first intervals and the second intervals that include the one of the first interval and the second interval not corrupted by noise are identified as shockable in response to the second processing.

9. The method of claim 8, wherein the first processing comprises a gross morphology analysis of the first interval and the second interval.

10. The method of claim 1, further comprising:

determining, during the first processing, whether the first interval and the second interval are corrupted by noise;

determining, in response to only one of the first interval and the second interval not being corrupted by noise, whether the one of the first interval and the second interval is a regular interval;

identifying the cardiac event as one of shockable or not shockable in response to the second processing of only the one of the first interval and the second interval and the one of the first interval and the second interval being a regular interval; and

identifying the cardiac event as not shockable in response to one of the first interval and the second interval not being a regular interval.

11. The method of claim 3, further comprising:

identifying both the first interval and the second interval as being one of shockable or not shockable in response to the second processing in response to both the first interval and the second interval being identified as shockable in response to the first processing.

12. The method of claim 1, further comprising transitioning to a new cardiac event detection state based on the identification of each of the first interval and the second interval as being one of shockable or not shockable in response to both the first processing of the first interval and the second interval and the second processing of the first interval and the second interval.

13. A medical device for detecting a cardiac event, comprising:

a plurality of electrodes sensing cardiac signals, the plurality of electrodes forming a first sensing vector sensing a first interval of the cardiac signal during a predetermined time period and a second sensing vector simultaneously sensing a second interval of the cardiac signal during the predetermined time period;

a processor configured to

identify each of the first interval and the second interval as being one of shockable or not shockable in response to a first processing of the first interval and the second interval,

identify each of the first interval and the second interval as being one of shockable or not shockable in response to a second processing of the first interval and the second interval, the second processing being different from the first processing and comprising a beat-based analysis identifying individual beats within the first interval and the second interval, and

determine whether to deliver therapy for the cardiac event in response to identifying each of the first interval and the second interval as being one of shockable or not shockable in response to both the first processing of the first interval and the second interval and the second processing of the first interval; and

a therapy module configured to deliver therapy to treat the cardiac event based on identifying each of the first interval and the second interval as being shockable in response to both the first processing and the second processing.

14. The medical device of claim 13, wherein sensing cardiac signals includes the first sensing vector sensing a plurality of first intervals during the predetermined time period, the plurality of first intervals including the first interval, and the second sensing vector sensing a plurality of second intervals during the predetermined time period, the plurality of second intervals including the second interval, and wherein determining whether to deliver therapy for the cardiac event comprises:

determining whether a predetermined number of first intervals and the second intervals are identified as shockable in response to the first processing; and

determining whether a predetermined number of first intervals and second intervals are identified as shockable in response to the second processing.

15. The medical device of claim 13, wherein the first processing comprises a gross morphology analysis of the first interval.

16. The medical device of claim 13, wherein the first processing comprises:

determining whether both the first interval and the second interval are corrupted by noise;

determining whether both the first interval and the second interval are within one of a VF shock zone and a VT shock zone; and

determining, in response to one of the first interval and the second interval not being corrupted by noise and the other of the first interval and the second interval being corrupted by noise, whether the one of the first interval and the second interval determined not to be corrupted by noise is within the VT shock zone.

17. The medical device of claim 16, wherein the second processing comprises:

comparing each of the identified beats with a beat template and determining a number of the identified beats that are match beats and a number of the identified beats that are non-match beats;

determining whether the number of non-match beats greater than a non-match threshold; and

identifying the first interval as shockable in response to the number of non-match beats being greater than the non-match threshold.

18. The medical device of claim 13, wherein the second processing comprises:

comparing each of the identified beats with a beat template and determining a number of the identified beats that are match beats and a number of the identified beats that are non-match beats;

determining whether the number of non-match beats is greater than a non-match threshold; and

identifying the first interval as shockable in response to the number of non-match beats being greater than the non-match threshold.

19. The medical device of claim 13, wherein the processor is further configured to determine, during the first processing, whether the first interval and the second interval are corrupted by noise, determine, in response to only one of the first interval and the second interval being not corrupted by noise, whether the one of the first interval and the second interval not corrupted by noise is shockable, and identify the cardiac event as one of shockable or not shockable in response to second processing of only the one of the first interval and the second interval not corrupted by noise.

20. The medical device of claim 19, wherein sensing cardiac signals includes the first sensing vector sensing a plurality of first intervals during the predetermined time period, the plurality of first intervals including the first interval, and the second sensing vector sensing a plurality of second intervals during the predetermined time period, the plurality of second intervals including the second interval, and wherein determining whether to deliver therapy for the cardiac event comprises:

determining whether a predetermined number of both of the first intervals and the second intervals are identified as shockable in response to the first processing; and

determining, in response to neither of the first interval and the second interval being corrupted by noise, whether the predetermined number of both of the first intervals and the second intervals are identified as shockable in response to the second processing; and

determining, in response to only one of the first interval and the second interval not being corrupted by noise, whether the predetermined number of one of the first intervals and the second intervals that include the one of the first interval and the second interval not corrupted by noise are identified as shockable in response to the second processing.

21. The medical device of claim 20, wherein the first processing comprises a gross morphology analysis of the first interval.

22. The medical device of claim 13, wherein the processor is further configured to determine, during the first processing, whether the first interval and the second interval are corrupted by noise, determine, in response to only one of the first interval and the second interval not being corrupted by noise, whether the one of the first interval and the second interval is a regular interval, identify the cardiac event as one of shockable or not shockable in response to the second processing of only the one of the first interval and the second interval and the one of the first interval and the second interval being a regular interval, and identify the cardiac event as not shockable in response to one of the first interval and the second interval not being a regular interval.

23. The medical device of claim 15, wherein the processor is configured to

identify both the first interval and the second interval as being one of shockable or not shockable in response to the second processing in response to both the first interval and the second interval being identified as shockable in response to the first processing.

24. The medical device of claim 13, wherein the processing is configured to transition to a new cardiac event detection state based on the identification of each of the first interval and the second interval as being one of shockable or not shockable in response to both the first processing of the first interval and the second interval and the second processing of the first interval and the second interval.

25. A non-transitory, computer-readable storage medium storing instructions for causing a processor included in a medical device to perform a method for determining a cardiac event, the method comprising:

sensing cardiac signals from a plurality of electrodes, the plurality of electrodes forming a first sensing vector sensing a first interval of the cardiac signal during a predetermined time window and a second sensing vector simultaneously sensing a second interval of the cardiac signal during the predetermined time window;

identifying each of the first interval and the second interval as being one of shockable or not shockable in response to a first processing of the first interval and the second interval;

identifying each of the first interval and the second interval as being one of shockable or not shockable in response to a second processing of the first interval and the second interval, the second processing being different from the first processing and comprising a beat-based analysis identifying individual beats within the first interval;

determining whether to deliver therapy for the cardiac event in response to identifying each of the first interval and the second interval as being one of shockable or not shockable in response to both the first processing of the first interval and the second interval and the second processing of the first interval; and

delivering therapy to treat the cardiac event based on identifying each of the first interval and the second interval as being shockable in response to both the first processing and the second processing.

26. The non-transitory, computer-readable storage medium of claim 25, wherein the method further comprises:

identifying both the first interval and the second interval as being one of shockable or not shockable in response to the second processing in response to both the first interval and the second interval being identified as shockable in response to the first processing.

27. A method comprising:

sensing cardiac signals from a plurality of electrodes, the plurality of electrodes forming a first sensing vector sensing a first set of cardiac signals during a time window and a second sensing vector simultaneously sensing a second set of cardiac signals during the time window;

performing a first processing of the first set of cardiac signals and the second set of cardiac signals to identify each of the first set of cardiac signals and the second set of cardiac signals as being shockable or not shockable; and

performing a second processing of the first set of cardiac signals and the second set of cardiac signals to identify each of the first set of cardiac signals and the second set of cardiac signals as being shockable or not shockable, wherein the second processing is different than the first processing and comprises a beat-based analysis identifying individual beats within the first interval;

determining, based on the first processing and the second processing, whether to deliver cardiac therapy; and

delivering therapy to treat the cardiac event based on the identifications of the first and second sets of cardiac signals being shockable.

28. The method of claim 27, wherein the first processing comprises a gross morphology analysis of the first set of cardiac signals and the second set of cardiac signals.

29. The method of claim 28, wherein the second processing comprises:

comparing each of the identified beats with a beat template to identify non-match beats;

determining that the identified beats include a number of non-match beats, the number of non-match beats being greater than a non-match threshold;

responsive to determining that the number of non-match beats is greater than the non-match threshold, identifying the first set of cardiac signals as shockable.

30. The method of claim 27, wherein the second processing comprises:

comparing each of the identified beats with a beat template to identify non-match beats;

determining that the identified beats include a number of non-match beats, the number of non-match beats being greater than a non-match threshold; and

responsive to determining that the number of non-match beats is greater than the non-match threshold, identifying the first set of cardiac signals as shockable.

31. The method of claim 27,

wherein performing the first processing includes identifying the first set of cardiac signals as shockable and identifying the second set of cardiac signals as shockable,

wherein performing the second processing includes identifying the first set of cardiac signals as shockable, and

wherein the method further comprises:

performing a second processing of the second set of cardiac signals and identifying the second set of cardiac signals as shockable.

32. The method of claim 27,

wherein performing the first processing includes identifying the first set of cardiac signals as both not corrupted by noise and shockable and identifying the second set of cardiac signals as corrupted by noise,

wherein performing the second processing includes identifying the first set of cardiac signals as shockable.

33. The method of claim 27,

wherein performing the first processing includes identifying the first set of cardiac signals as both not corrupted by noise and characterized by regular intervals and identifying the second set of cardiac signals as corrupted by noise,

wherein performing the second processing includes identifying the first set of cardiac signals as shockable.

34. The method of claim 27, wherein determining whether to deliver cardiac therapy includes transitioning to an armed state based on identifications of the first and second sets of cardiac signals as being shockable.

35. The method of claim 27, wherein determining whether to deliver cardiac therapy includes transitioning to a not concerned state based on identifications of the first and second sets of cardiac signals as being not shockable.