Method and apparatus for atrial arrhythmia episode detection

• US 9,962,102 B2
• Filed: 04/24/2015
• Issued: 05/08/2018
• Est. Priority Date: 02/18/2015
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Sarkar, Shantanu, Hansen, Daniel L, Neitzell, Grant A
• Primary Examiner(s): WEHRHEIM, LINDSEY GAIL
• Application Number:
  US14/695,156
• Publication Number:
  US 20160235321A1
• Time in Patent Office: 1,110 Days
• CPC Class Codes: A61B 5/24 Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
• CPC Class Codes: A61B 5/316 Modalities, i.e. specific diagnostic methods
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/352 Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval
• CPC Class Codes: A61B 5/361 Detecting fibrillation
• 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 1/3624 occurring in the atrium, i.e. atrial tachycardia
• CPC Class Codes: A61N 1/36507 controlled by gradient or slope of the heart potential
• CPC Class Codes: A61N 1/36592 controlled by the heart rate variability
• CPC Class Codes: A61N 1/395 for treating atrial fibrillation
• CPC Class Codes: A61N 1/3987 characterised by the timing or triggering of the shock

Abstract

A method and implantable medical device for determining a flutter event in response to a cardiac signal that includes sensing the cardiac signal, determining a sensing window in response to the sensed cardiac signal, the sensing window having a first portion and a second portion. A first derivative signal and a second derivative signal are determined in response to the sensed cardiac signal within the first portion and the second portion of the sensing window, and a sum of amplitudes of the second derivative signal within one or both of the first portion and the second portion of the sensing window is determined, and the flutter event is determined in response to the determined sum of amplitudes.

Claims

1. A method of determining a flutter event within a cardiac signal in an implantable medical device, comprising:

sensing the cardiac signal using a plurality of electrodes;

detecting, with a processor of the implantable medical device coupled to the plurality of electrodes, an R-wave within the sensed cardiac signal;

determining, with the processor, a sensing window associated with the R-wave detected within the sensed cardiac signal, the sensing window comprising a first portion and a second portion;

determining, with the processor, a first derivative signal of the segments of the sensed cardiac signal within the first portion and the second portion of the sensing window;

determining, with the processor, a second derivative signal of the segments of the sensed cardiac signal within the first portion and the second portion of the sensing window;

determining, with the processor, a sum of amplitudes of the second derivative signal within one or both of the first portion and the second portion of the sensing window; and

detecting, with the processor, the flutter event based on at least the determined sum of amplitudes.

2. The method of claim 1, further comprising:

determining one of a relative difference within one of the first portion and the second portion of the sensing window, and a relative difference between the first portion and the second portion of the sensing window in response to the determined first derivative signal; and

determining the flutter event in response to the determined sum of amplitudes and the determined relative difference.

3. The method of claim 2, further comprising:

determining whether a total number of amplitudes of the second derivative signal located at positive and negative zero crossings of the first derivative signal within the first portion of the sensing window exceed an amplitude threshold;

determining whether a total number of amplitudes of the second derivative signal located at positive going zero crossings of the first derivative signal within the first portion of the sensing window exceed a positive going amplitude threshold;

determining whether a total number of amplitudes of the second derivative signal located at negative going zero crossings of the first derivative signal within the first portion of the sensing window exceed a negative going amplitude threshold; and

determining whether a total number of zero crossings of the first derivative signal within the first portion of the sensing window exceed a zero crossings threshold.

4. The method of claim 2, wherein the medical device comprises a subcutaneous device.

5. The method of claim 1, further comprising:

determining a first total number of amplitudes of the second derivative signal within the first portion of the sensing window that satisfy an amplitude threshold;

determining a second total number of amplitudes of the second derivative signal within the second portion of the sensing window that satisfy the amplitude threshold; and

determining the relative difference between the first total number of amplitudes and the second total number of amplitudes.

6. The method of claim 1, further comprising:

determining a total number of amplitudes of the second derivative signal within the first portion of the sensing window that satisfy an amplitude threshold;

determining a total number of the zero crossings within the first portion of the sensing window; and

determining the relative difference between the total number of amplitudes of the second derivative signal within the first portion of the sensing window that satisfy the amplitude threshold and the total number of the zero crossings within the first portion of the sensing window.

7. The method of claim 1, further comprising:

determining whether a total number of amplitudes of the second derivative signal located at positive zero crossings of the first derivative signal within both the first portion and the second portion of the sensing window exceed an amplitude threshold;

determining a total number of positive zero crossings within both the first portion and the second portion of the sensing window; and

determining the relative difference between the total number of amplitudes of the second derivative signal located at positive zero crossings of the first derivative signal within both the first portion and the second portion of the sensing window and the total number of positive zero crossings within both the first portion and the second portion of the sensing window.

8. The method of claim 1, further comprising:

determining whether a total number of amplitudes of the second derivative signal located at negative zero crossings of the first derivative signal within both the first portion and the second portion of the sensing window exceed an amplitude threshold;

determining a total number of negative zero crossings within both the first portion and the second portion of the sensing window; and

determining the relative difference between the total number of amplitudes of the second derivative signal located at negative zero crossings of the first derivative signal within both the first portion and the second portion of the sensing window and the total number of negative zero crossings within both the first portion and the second portion of the sensing window.

9. The method of claim 1, further comprising:

determining whether a total number of amplitudes of the second derivative signal located at both positive and negative zero crossings of the first derivative signal within both the first portion and the second portion of the sensing window satisfy an amplitude threshold;

determining whether a total number of zero crossings within both the first portion and the second portion of the sensing window satisfy a zero crossings threshold; and

determining the relative difference between the determined total number of amplitudes of the second derivative signal and the determined total number of zero crossings.

10. An implantable medical device for determining a flutter event within a cardiac signal, comprising:

a plurality of electrodes sensing the cardiac signal; and

a processor configured to detect an R-wave within the sensed cardiac signal, determine a sensing window associated with the R-wave detected within the sensed cardiac signal, the sensing window comprising a first portion and a second portion, determine a first derivative signal of the segments of the sensed cardiac signal within the first portion and the second portion of the sensing window, determine a second derivative signal of the segments of the sensed cardiac signal within the first portion and the second portion of the sensing window;

determine a sum of amplitudes of the second derivative signal within one or both of the first portion and the second portion of the sensing window, and detecting the flutter event based on at least the determined sum of amplitudes.

11. The medical device of claim 10, wherein the processor is further configured to determine one of a relative difference within one of the first portion and the second portion of the sensing window, and a relative difference between the first portion and the second portion of the sensing window in response to the determined first derivative signal, and determine the flutter event in response to the determined sum of amplitudes and the determined relative difference.

12. The medical device of claim 11, wherein the processor is further configured to determine whether a total number of amplitudes of the second derivative signal located at positive and negative zero crossings of the first derivative signal within the first portion of the sensing window exceed an amplitude threshold, determine whether a total number of amplitudes of the second derivative signal located at positive going zero crossings of the first derivative signal within the first portion of the sensing window exceed a positive going amplitude threshold, determine whether a total number of amplitudes of the second derivative signal located at negative going zero crossings of the first derivative signal within the first portion of the sensing window exceed a negative going amplitude threshold, and determine whether a total number of zero crossings of the first derivative signal within the first portion of the sensing window exceed a zero crossings threshold.

13. The medical device of claim 11, wherein the medical device comprises a subcutaneous device.

14. The medical device of claim 10, wherein the processor is further configured to determine a first total number of amplitudes of the second derivative signal within the first portion of the sensing window that satisfy an amplitude threshold, determine a second total number of amplitudes of the second derivative signal within the second portion of the sensing window that satisfy the amplitude threshold, and determine the relative difference between the first total number of amplitudes and the second total number of amplitudes.

15. The medical device of claim 10, wherein the processor is further configured to determine a total number of amplitudes of the second derivative signal within the first portion of the sensing window that satisfy an amplitude threshold, determine a total number of the zero crossings within the first portion of the sensing window, and determine the relative difference between the total number of amplitudes of the second derivative signal within the first portion of the sensing window that satisfy the amplitude threshold and the total number of the zero crossings within the first portion of the sensing window.

16. The medical device of claim 10, wherein the processor is further configured to determine whether a total number of amplitudes of the second derivative signal located at positive zero crossings of the first derivative signal within both the first portion and the second portion of the sensing window exceed an amplitude threshold, determine a total number of positive zero crossings within both the first portion and the second portion of the sensing window, and determine the relative difference between the total number of amplitudes of the second derivative signal located at positive zero crossings of the first derivative signal within both the first portion and the second portion of the sensing window and the total number of positive zero crossings within both the first portion and the second portion of the sensing window.

17. The medical device of claim 10, wherein the processor is further configured to determine whether a total number of amplitudes of the second derivative signal located at negative zero crossings of the first derivative signal within both the first portion and the second portion of the sensing window exceed an amplitude threshold, determine a total number of negative zero crossings within both the first portion and the second portion of the sensing window, and determine the relative difference between the total number of amplitudes of the second derivative signal located at negative zero crossings of the first derivative signal within both the first portion and the second portion of the sensing window and the total number of negative zero crossings within both the first portion and the second portion of the sensing window.

18. The medical device of claim 10, wherein the processor is further configured to determine whether a total number of amplitudes of the second derivative signal located at both positive and negative zero crossings of the first derivative signal within both the first portion and the second portion of the sensing window satisfy an amplitude threshold, determine whether a total number of zero crossings within both the first portion and the second portion of the sensing window satisfy a zero crossings threshold, and determine the relative difference between the determined total number of amplitudes of the second derivative signal and the determined total number of zero crossings.

19. The implantable medical device of claim 10, further comprising a telemetry circuit, wherein the processor is configured to control the telemetry circuit to uplink data associated with the detected flutter event.

20. The implantable medical device of claim 10, further comprising circuitry configured to generate and deliver an electrical stimulation therapy via the plurality of electrodes.

21. A non-transitory computer-readable medium storing a set of instructions which cause a processor of an implantable medical device to perform a method of determining a flutter event within a cardiac signal, comprising:

sensing the cardiac signal;

detecting an R-wave within the sensed cardiac signal;

determining a sensing window associated with the R-wave detected within the sensed cardiac signal, the sensing window comprising a first portion and a second portion;

determining a first derivative signal of the segments of the sensed cardiac signal within the first portion and the second portion of the sensing window;

determining a second derivative signal of the segments of the sensed cardiac signal within the first portion and the second portion of the sensing window;

determining a sum of amplitudes of the second derivative signal within one or both of the first portion and the second portion of the sensing window; and

detecting the flutter event based on at least the determined sum of amplitudes.