Source: http://www.google.com/patents/US6522917?ie=ISO-8859-1&dq=Frischling
Timestamp: 2015-04-01 09:31:20
Document Index: 106319261

Matched Legal Cases: ['art 100', 'art 100', 'art 100', 'art 100', 'art 100', 'art 100']

Patent US6522917 - Cross chamber interval correlation - Google PatentsSearch Images Maps Play YouTube News Gmail Drive More »Sign inAdvanced Patent SearchPatentsA system and method for discriminating cardiac rhythms occurring in an antegrade direction from cardiac rhythms occurring in a retrograde direction. Atrial and ventricular contractions are sensed, from which atrial and ventricular cycle lengths are determined. Ventricular contractions are also analyzed...http://www.google.com/patents/US6522917?utm_source=gb-gplus-sharePatent US6522917 - Cross chamber interval correlationAdvanced Patent SearchPublication numberUS6522917 B1Publication typeGrantApplication numberUS 09/615,014Publication dateFeb 18, 2003Filing dateJul 12, 2000Priority dateApr 1, 1999Fee statusPaidAlso published asUS6179865, US7062316, US20030109792, WO2000059573A1Publication number09615014, 615014, US 6522917 B1, US 6522917B1, US-B1-6522917, US6522917 B1, US6522917B1InventorsWilliam Hsu, Robert J. SweeneyOriginal AssigneeCardiac Pacemakers, Inc.Export CitationBiBTeX, EndNote, RefManPatent Citations (28), Non-Patent Citations (2), Referenced by (19), Classifications (4), Legal Events (4) External Links: USPTO, USPTO Assignment, EspacenetCross chamber interval correlation
FIG. 1 shows a drawing of a human heart 100. The heart 100 is divided into atrial chambers 110 and ventricular chambers 120. When the heart 100 is in normal sinus rhythm or in sinus tachycardia the contractile wave (action potential) for the heart beat originates in the SA node 130, which is located in the atrial region of the heart 100. In this situation the atrial chambers 110 can be though of as originating the signals to start the contraction of the heart 100. The contractile wave moves from the SA node 130 across the atria and then to the AV node 140. Lines 150 show the direction of the contractile wave as it would move across the atrial chambers 110. The AV node consists of small specialized cells located on the right side of the atrial septum just under the endocardium. The lower portion of the AV node consists of parallel fibers that form the only �bridge� of contiguous cardiac cells crossing the cartilaginous structure that provides support for the cardiac valves and electrically separates atria from ventricles. Propagation of the impulse through this AV nodal region is typically very slow (approximately 0.05 m/s) and therefore a delay is imposed between excitation of the atria and the ventricles. The term AV delay is given to denote this delay. The action potential causing the contractile wave then moves through the AV node and down into the ventricle chambers 120. The contractile wave is distributed quickly and essentially evenly through out the ventricle chambers 120 which allows for near simultaneous contraction of ventricles of the heart 100.
In one embodiment, antegrade pairing and comparing is accomplished by pairing an atrial cycle length with at least one ventricular cycle length started after the start of the atrial cycle length being paired. FIG. 2 shows one embodiment of an antegrade pairing of atrial and ventricular cycle lengths. At 200 there is shown atrial cycle lengths, where 204 indicates the occurrence of atrial contraction. In one embodiment, the atrial contractions are indicated by the sensing of an electrocardiogram P-wave. An atrial cycle length (or P�P-wave interval) constitutes the time between successive atrial contractions as indicated by 208. At 212 there is shown ventricular cycle lengths, where 216 indicates the occurrence of ventricular contraction. In one embodiment, the ventricular contractions are indicated by the sensing of an electrocardiogram R-wave. An ventricular cycle length (or R�R wave interval) constitutes the time between successive ventricular contractions as indicated by 220.
Referring now to FIG. 5, there is shown one embodiment for discriminating physiologic 1:1 antegrade rhythms such as sinus tachycardia (ST) from pathologic 1:1 retrograde rhythms such as ventricular tachycardia (VT). One of the underlying concepts of the present subject matter is based on the observation that during cardiac rhythms characterized by 1:1 atrial-to-ventricular or ventricular-to-atrial association, the cycle length variations in the originating chamber are correlated to the cycle length variations in the responding chamber except for any accompanying delay in the conduction path. For example, delay in the conduction path may be due to the actions of the AV-node or other structures of the conduction path. The resulting observation is that the cycle length variations (R�R or A�A intervals) in the origination chamber are statistically correlated with the cycle length variations in the responding chamber.
The correlation between atrial and ventricular cycle lengths using antegrade and retrograde pairings is relatively easy to see when the delay across the AV node is constant or nearly constant. However, FIG. 7 shows a typical property of a human AV node. It plots the AV conduction time versus the R�R interval. When the R�R intervals are large (i.e., lower heart rates, approximately 60 to 100 beats/minute) the AV conduction curve has a slope that approaches zero. In FIG. 7, this area is shown at 700. On the other hand, when the R�R interval is decreased (i.e., at faster heart rates), the slope of the AV conduction curve becomes more negative. The section of the AV curves where the slope is approximately −1 is shown as area 710 in FIG. 7.
As the slope of the AV delay versus rate curve becomes negative, the delay required for an impulse to travel across the AV node gets longer and is more sensitive to the prematurity of the impulse. For example, at a R�R rate where the slope is −1, a contraction that occurs 10 msec prematurely (i.e., the R�R interval since the last contraction is 10 msec shorter than the average) will require an additional 10 msec to cross the AV node thus reaching the responding chamber at the same time it would have had the contraction occurred without prematurity.
FIG. 8 shows one embodiment of atrial cycle lengths and ventricular cycle lengths in the super-antegrade association. In one embodiment, the super-antegrade pairs consist of a comparison between a first atrial cycle length, as calculated from a first atrial contraction and a second atrial contraction immediately following the first atrial contraction, and a ventricular cycle length that is started from the action potential that caused the second atrial contraction of the first atrial cycle length. At 800 there is shown atrial cycle lengths, where 804 indicates the occurrence of atrial contraction. An atrial cycle length (or P�P-wave interval) constitutes the time between successive atrial contractions as indicated by 808. At 812 there are shown ventricular cycle lengths, where 816 indicates the occurrence of ventricular contraction. An ventricular cycle length (or R�R wave interval) constitutes the time between successive ventricular contractions as indicated by 820.
FIG. 10 shows one embodiment of a super-antegrade comparison. At 1000 there is shown atrial cycle lengths, where 1004 indicates the occurrence of atrial contraction. An atrial cycle length (or P�P-wave interval) constitutes the time between successive atrial contractions as indicated by 1008. At 1012 there are shown ventricular cycle lengths, where 1016 indicates the occurrence of ventricular contraction. An ventricular cycle length (or R�R wave interval) constitutes the time between successive ventricular contractions as indicated by 1020. In the present embodiment, the atrial chamber is the originating chamber.
As previously discussed, when the R�R-wave interval decreases (the heart rate increasing) the slope of the AV conduction curve may become more negative. As the slope becomes negative, the delay required for an impulse to travel across the AV node depends on the rate at which the node is being activated. When there is a premature contraction from the originating chamber, the resulting AV delay value is increased by a value that corresponds to the prematurity of the originating chamber. Likewise, when the contraction in the originating chamber causes the contraction cycle length to be longer than previously experienced, the AV delay value is decreased by approximately the same amount of time that the signal was early. As the slope of the AV conduction curve changes the values of the antegrade and retrograde correlation coefficients become less distinctive. The correlation coefficients from the super-antegrade and super-retrograde comparisons can then aid in making the determination between antegrade conduction and retrograde conduction.
Patent CitationsCited PatentFiling datePublication dateApplicantTitleUS4515161Jan 10, 1984May 7, 1985Vitafin N.V.Dual chamber pacemaker system with V-A time measurement apparatus and methodUS4543963Nov 22, 1983Oct 1, 1985Gessman Lawrence JMethod and apparatus for differentiating antegrade from retrograde P-waves and for preventing pacemaker generated tachycardiaUS4572192Sep 21, 1983Feb 25, 1986Board Of Regents For The University Of OklahomaSystem for prevention of paroxysmal supraventricular tachycardiaUS4577634Jul 2, 1985Mar 25, 1986Gessman Lawrence JMethod and apparatus for alleviating paroxysmal atrail tachycardiaUS4802483Mar 5, 1987Feb 7, 1989Siemens AktiengesellschaftHeart pacemaker for avoiding pacemaker mediated tachycardia at mode switchingUS4860749Jan 6, 1988Aug 29, 1989Wayne State UniversityTachycardia detection for automatic implantable cardioverter/defibrillator with atrial and ventricular sensing capabilityUS4917115Jul 11, 1988Apr 17, 1990Vitatron Medical B. V.Pacing system and method for physiological stimulation of the heart utilizing Doppler meansUS5228438Oct 8, 1991Jul 20, 1993Siemens Pacesetter, Inc.Implantable pacemaker including means and method of terminating a pacemaker-mediated tachycardia during rate adaptive pacingUS5253644Sep 8, 1989Oct 19, 1993Siemens AktiengesellschaftPMT detecting pacemakerUS5327900Apr 28, 1992Jul 12, 1994Telectronics Pacing Systems, Inc.Apparatus and method for discriminating between heart rhythms with similar atrial and ventricular ratesUS5351696Apr 23, 1993Oct 4, 1994Medtronic, Inc.Method and apparatus for intracardiac electrogram morphologic analysisUS5370125Feb 1, 1994Dec 6, 1994Telectronics Pacing Systems, Inc.Apparatus and method for discriminating between associated and dissociated cardiac rhythmsUS5383910 *Feb 19, 1993Jan 24, 1995Medtronic, Inc.Method and apparatus for tachyarrhythmia detection and treatmentUS5476482Apr 12, 1994Dec 19, 1995Telectronics Pacing Systems, Inc.Pacemaker programmer-based automatic retrograde conduction measurementUS5496350Apr 12, 1994Mar 5, 1996Telectronics Pacing Systems, Inc.Apparatus and method for detecting, confirming and terminating pacemaker mediated tachycardiaUS5551427Feb 13, 1995Sep 3, 1996Altman; Peter A.Apparatus for locally modifying electrical actionUS5697377Nov 22, 1995Dec 16, 1997Medtronic, Inc.Catheter mapping system and methodUS5738105Oct 24, 1995Apr 14, 1998Angeion CorporationFor an implantable cardiac arrhythmia therapy deviceUS5755736Jul 16, 1997May 26, 1998Medtronic, Inc.Prioritized rule based method and apparatus for diagnosis and treatment of arrhythmiasUS5776072Dec 28, 1995Jul 7, 1998Cardiac Pacemakers, Inc.Discrimination of atrial and ventricular signals from a single cardiac leadUS5810739Dec 19, 1996Sep 22, 1998Pacesetter, Inc.Methods and apparatus for classifying cardiac events with an implantable cardiac deviceUS5885221Dec 22, 1997Mar 23, 1999Cardiac Pacemakers, Inc.Discrimination of atrial and ventricular signals from a single cardiac leadUS5978700May 6, 1998Nov 2, 1999Biotronik Mess-Und Therapiegeraete Gmbh & Co. Ingenierbuero BerlinRecognizing ventricular tachycardia condition using dual chamber sense informationUS5983126Aug 1, 1997Nov 9, 1999Medtronic, Inc.Catheter location system and methodUS6179865Apr 1, 1999Jan 30, 2001Cardiac Pacemakers, Inc.Cross chamber interval correlationEP0540141A1Jul 23, 1992May 5, 1993Telectronics N.V.Apparatus and method for discriminating between heart rhythms with similar atrial and ventricular ratesEP0879621A2May 6, 1998Nov 25, 1998BIOTRONIK Mess- und Therapieger�te GmbH &amp; Co Ingenieurb�ro BerlinDevice for detection of ventricular tachycardiaWO1997039799A1Apr 18, 1997Oct 30, 1997Dicarlo Lorenzo AMethod for cardiac arrhythmia detection* Cited by examinerNon-Patent CitationsReference1LeCarpentier, G.L., et al., "Differentiation of sinus tachycardia from ventricular tachycardia with 1:1 ventriculoatrial conduction in dual chamber implantable cardioverter defibrillators: feasibility of a criterion based on atrioventricular interval.", PACE 1994; 17(Pt.I), 1818-1831, (1994).2Thompson, J.A. et al., "Ventriculoatrial conduction metrics for classification of ventricular tachycardia with 1:1 retrograde conduction with dual-chamber sensing implantable cardioverter defibrillators", J. of Electrocardiography 1998; 31, 152-156, (1998).Referenced byCiting PatentFiling datePublication dateApplicantTitleUS7062326Feb 6, 2003Jun 13, 2006Cardiac Pacemakers, Inc.Method and apparatuses for monitoring hemodynamic activities using an intracardiac impedance-derived parameterUS7212849Oct 28, 2004May 1, 2007Cardiac Pacemakers, Inc.Methods and apparatuses for arrhythmia detection and classification using wireless ECGUS7228176Jul 22, 2004Jun 5, 2007Cardiac Pacemakers, Inc.Systems, devices, and methods for tachyarrhythmia discrimination or therapy decisionsUS7299086Mar 5, 2004Nov 20, 2007Cardiac Pacemakers, Inc.Wireless ECG in implantable devicesUS7328063Nov 30, 2004Feb 5, 2008Cardiac Pacemakers, Inc.Method and apparatus for arrhythmia classification using atrial signal mappingUS7430446Jan 20, 2005Sep 30, 2008Cardiac Pacemakers, Inc.Methods and apparatuses for cardiac arrhythmia classification using morphology stabilityUS7567836Jan 30, 2006Jul 28, 2009Cardiac Pacemakers, Inc.ECG signal power vector detection of ischemia or infarctionUS7756578Feb 17, 2006Jul 13, 2010Cardiac Pacemakers, Inc.Rhythm discrimination of sudden onset and one-to-one tachyarrythmiaUS7818051Oct 26, 2007Oct 19, 2010Cardiac Pacemakers, Inc.Wireless ECG in implantable devicesUS8032217Mar 15, 2010Oct 4, 2011Cardiac Pacemakers, Inc.Zoneless tachyarrhythmia detection with real-time rhythm monitoringUS8055332Sep 29, 2010Nov 8, 2011Cardiac Pacemakers, Inc.Wireless ECG in implantable devicesUS8239020Mar 29, 2007Aug 7, 2012Cardiac Pacemakers, Inc.Implantable medical device sensing wireless ECG as substitute for intracardiac electrogramUS8244348Sep 8, 2008Aug 14, 2012Cardiac Pacemakers, Inc.Method and apparatus for cardiac arrhythmia classification using template band-based morphology analysisUS8301234Nov 3, 2011Oct 30, 2012Cardiac Pacemakers, Inc.Wireless ECG in implantable devicesUS8386039Jun 29, 2010Feb 26, 2013Cardiac Pacemakers, Inc.Rhythm discrimination of sudden onset and one-to-one tachyarrhythmiaUS8403830Aug 2, 2011Mar 26, 2013Cardiac Pacemakers, Inc.Rhythm discrimination enhancement�AV driveUS8639317Oct 22, 2012Jan 28, 2014Cardiac Pacemakers, Inc.Wireless ECG in implantable devicesUS8768444Nov 1, 2011Jul 1, 2014Cardiac Pacemakers, Inc.Method and apparatus for arrhythmia classification using atrial signal mappingUS8827895Feb 12, 2013Sep 9, 2014Cardiac Pacemakers, Inc.Rhythm discrimination enhancement�AV driveClassifications U.S. Classification600/518International ClassificationA61N1/362Cooperative ClassificationA61N1/3622European ClassificationA61N1/362A2Legal EventsDateCodeEventDescriptionJul 23, 2014FPAYFee paymentYear of fee payment: 12Jul 21, 2010FPAYFee paymentYear of fee payment: 8Aug 18, 2006FPAYFee paymentYear of fee payment: 4Dec 2, 2003CCCertificate of correctionRotateOriginal ImageGoogle Home - Sitemap - USPTO Bulk Downloads - Privacy Policy - Terms of Service - About Google Patents - Send FeedbackData provided by IFI CLAIMS Patent Services