Source: http://www.google.com/patents/US7764997?dq=4393663
Timestamp: 2014-07-12 11:30:56
Document Index: 46807937

Matched Legal Cases: ['art.\n25', 'art 18', 'art 18', 'art 18', 'art 18', 'art 18', 'art 18', 'art 18', 'art 18']

Patent US7764997 - Method and apparatus for using atrial discrimination algorithms to determine ... - Google PatentsSearch Images Maps Play YouTube News Gmail Drive More »Sign in<nobr>Advanced Patent Search</nobr>PatentsA system and method which employs atrial discrimination algorithms to distinguish between different atrial arrhythmias occurring in a patient for selecting an optimal pacing therapy corresponding to the type of arrhythmia identified. In response to the detection of an atrial rate above the atrial tracking...http://www.google.com/patents/US7764997?utm_source=gb-gplus-sharePatent US7764997 - Method and apparatus for using atrial discrimination algorithms to determine optimal pacing therapy and therapy timingAdvanced Patent SearchPublication numberUS7764997 B2Publication typeGrantApplication numberUS 11/266,955Publication dateJul 27, 2010Filing dateNov 4, 2005Priority dateNov 14, 2000Fee statusPaidAlso published asUS6978177, US20060058849, US20100305639Publication number11266955, 266955, US 7764997 B2, US 7764997B2, US-B2-7764997, US7764997 B2, US7764997B2InventorsVictor T. Chen, David S. Wood, Milton M. MorrisOriginal AssigneeCardiac Pacemakers, Inc.Export CitationBiBTeX, EndNote, RefManPatent Citations (97), Non-Patent Citations (5), Classifications (7), Legal Events (1) External Links: USPTO, USPTO Assignment, EspacenetMethod and apparatus for using atrial discrimination algorithms to determine optimal pacing therapy and therapy timingUS 7764997 B2Abstract A system and method which employs atrial discrimination algorithms to distinguish between different atrial arrhythmias occurring in a patient for selecting an optimal pacing therapy corresponding to the type of arrhythmia identified. In response to the detection of an atrial rate above the atrial tracking rate, discrimination criteria are applied to a detected atrial activity signal to distinguish between different types of supraventricular tachycardia, such as fast atrial flutter and other atrial flutter at a relatively slower rate, which may be occurring in the patient. The pacer is controlled to provide pacing therapy to a heart in a manner corresponding to the type of supraventricular tachycardia identified. The output of an atrial discrimination algorithm may be tracked and the trend thereof used to improve therapy timing. Various embodiments are disclosed herein.
1. A method for distinguishing between different types of rapid regular supraventricular tachycardia, comprising:
establishing an atrial discrimination algorithm including discrimination criteria for distinguishing between different types of rapid regular supraventricular tachycardia;
sensing activity of at least one of the atria of the heart to provide an atrial activity signal;
applying the atrial discrimination algorithm to the atrial activity signal to compare at least one characteristic of said atrial activity signal to the discrimination criteria to identify the type of rapid regular supraventricular tachycardia occurring; and
providing an indication corresponding to the type of rapid regular supraventricular tachycardia identified,
wherein establishing an atrial discrimination algorithm includes establishing discrimination criteria for distinguishing between fast atrial flutter at a first high rate and an other atrial flutter at a second lower rate.
2. The method of claim 1 wherein establishing an atrial discrimination algorithm includes establishing discrimination criteria for distinguishing between fast atrial flutter and a slower rate rapid regular supraventricular tachycardia.
3. The method of claim 1 wherein establishing an atrial discrimination algorithm includes establishing rate-based discrimination criteria for distinguishing between different types of rapid regular supraventricular tachycardia and wherein comparing at least one characteristic of the atrial activity signal to the discrimination criteria includes comparing a rate of the atrial activity signal to the discrimination criteria.
4. The method of claim 1 wherein establishing an atrial discrimination algorithm includes establishing morphology-based discrimination criteria for distinguishing between different types of rapid regular supraventricular tachycardia and wherein comparing at least one characteristic of the atrial activity signal to the discrimination criteria includes comparing a morphology characteristic of the atrial activity signal to the discrimination criteria.
5. The method of claim 1 wherein establishing an atrial discrimination algorithm includes establishing a multi-dimensional threshold function, and wherein applying the atrial discrimination algorithm to the atrial activity signal includes comparing a combination of a plurality of statistics calculated from a set of depolarization intervals determined from the atrial activity signal to the threshold function.
6. The method of claim 1 comprising establishing a maximum atrial tracking rate, deriving an atrial rate from an atrial activity signal, and comparing the derived atrial rate to the maximum atrial tracking rate, and wherein applying the atrial discrimination algorithm to an atrial activity signal includes applying the atrial discrimination algorithm only if the derived atrial rate exceeds the maximum atrial tracking rate.
7. The method of claim 1 comprising controlling pacing of a heart in a manner corresponding to the type supraventricular tachycardia identified.
sensing means for sensing activity of at least one of the atria of a heart;
signal detection means coupled to the sensing means for generating an atrial activity signal based on the sensed activity of the atria of the heart; and
a processor coupled to the signal detection means for receiving the atrial activity signal and for applying an atrial discrimination algorithm including discrimination criteria for distinguishing between different types of rapid regular supraventricular tachycardia to the atrial activity signal to compare at least one characteristic of the atrial activity signal to the discrimination criteria to identify the type of rapid regular supraventricular tachycardia occurring and for providing an indication corresponding to the type of rapid regular supraventricular tachycardia identified,
wherein the atrial discrimination algorithm includes discrimination criteria for distinguishing between fast atrial flutter and a slower rate rapid regular supraventricular tachycardia, and
wherein the atrial discrimination algorithm includes discrimination criteria for distinguishing between fast atrial flutter at a first high rate and another atrial flutter at a second lower rate.
9. The implantable cardiac device of claim 8 wherein the sensing means includes at least one electrode positioned in the heart and wherein the signal detection means is coupled to the electrode by a lead.
10. The implantable cardiac device of claim 8 wherein the atrial discrimination algorithm includes rate-based discrimination criteria for distinguishing between different types of rapid regular supraventricular tachycardia and wherein the processor compares a rate characteristic of the atrial activity signal to the discrimination criteria to identify the type of rapid regular supraventricular tachycardia occurring.
11. The implantable cardiac device of claim 8 wherein the atrial discrimination algorithm includes morphology-based discrimination criteria for distinguishing between different types of rapid regular supraventricular tachycardia and wherein the processor compares a morphology characteristic of the atrial activity signal to the discrimination criteria to identify the type of rapid regular supraventricular tachycardia occurring.
12. The implantable cardiac device of claim 8 wherein the atrial discrimination algorithm includes a multi-dimensional threshold function and wherein the processor compares a combination of a plurality of statistics calculated from a set of depolarization intervals determined from the atrial activity signal to the threshold function to identify the type of rapid regular supraventricular tachycardia occurring.
13. The implantable cardiac device of claim 8 comprising additionally a pacer for providing pacing pulses to the heart and wherein the processor is coupled to the pacer for controlling the pacer to provide pacing of the heart in a manner corresponding to the type of supraventricular tachycardia identified.
14. The implantable cardiac device of claim 13 wherein the pacer is dual chamber bradycardia pacer for providing pacing pulses to ventricles of the heart at a pacing rate based on a detected atrial rate up to a maximum atrial tracking rate and wherein the processor applies the atrial detection algorithm to the atrial activity signal only if the detected atrial rate exceeds the maximum atrial tracking rate.
sensing means for sensing activity of at least one atria of a heart;
signal detection means coupled to the sensing means for generating an atrial activity signal based on the sensed activity of the at least one atria of the heart;
a processor coupled to the signal detection means for receiving the atrial activity signal and for applying an atrial discrimination algorithm to the atrial activity signal to compare at least one characteristic of the atrial activity signal to discrimination criteria, wherein the atrial discrimination algorithm is adapted to discriminate between a fast atrial flutter at a first high rate and another atrial flutter at a second lower rate, and wherein the processor is adapted to provide an indication corresponding to the fast atrial flutter at a first high rate and the other atrial flutter at a second lower rate.
16. A method for providing therapy to a heart, comprising:
establishing discrimination criteria for distinguishing at least two different types of supraventricular tachycardia having regular rapid supraventricular heart rates;
sensing activity of at least one atria of the heart to provide an atrial activity signal;
determining that an atrial rate is above a predetermined atrial tracking rate for performing ventricular pacing such that the atrial rate is higher than the ventricular rate;
in response to determining that the atrial rate is above the predetermined atrial tracking rate, providing an atrial discrimination therapy output based on the atrial activity signal, including comparing at least one characteristic of the atrial activity signal to the discrimination criteria to identify one of the at least two different types of supraventricular tachycardia having regular rapid supraventricular heart rates; and
providing an atrial anti-tachycardia pacing therapy to the heart for an identified first one of the at least two different types of supraventricular tachycardia and providing a ventricular pacing therapy for an identified second one of the at least two different types of supraventricular tachycardia,
trending the atrial discrimination therapy output; and
timing a pacing therapy based on the trended atrial discrimination therapy output.
18. A method for providing pacing therapy to a heart, comprising:
comparing at least one characteristic of the atrial activity signal to the discrimination criteria to identify one of the at least two different types of supraventricular tachycardia having regular rapid supraventricular heart rates; and
providing an indication corresponding to the type of regular rapid supraventricular tachycardia identified,
19. The method of claim 18 wherein providing an indication corresponding to the type of regular rapid supraventricular tachycardia identified includes controlling pacing of the heart in a first manner for an identified first one of the at least two different types of supraventricular tachycardia and in a second manner for an identified second one of the at least two different types of supraventricular tachycardia.
20. The method of claim 19 wherein controlling pacing of the heart in a first manner for an identified first one of the at least two different types of supraventricular tachycardia and in a second manner for an identified second one of the at least two different types of supraventricular tachycardia includes controlling pacing of the heart to provide atrial antitachycardia pacing to the heart if a slower rate supraventricular tachycardia is identified as occurring and providing a second type of pacing control if a fast atrial flutter is identified as occurring.
21. The method of claim 19 wherein controlling pacing of the heart in a first manner for an identified first one of the at least two different types of supraventricular tachycardia and in a second manner for an identified second one of the at least two different types of supraventricular tachycardia includes providing an atrial anti-tachycardia pacing therapy to the heart for an identified first one of the at least two different types of supraventricular tachycardia and providing a ventricular pacing therapy for an identified second one of the at least two different types of supraventricular tachycardia.
22. The method of claim 18 wherein establishing discrimination criteria includes establishing an atrial discrimination algorithm, the algorithm providing discrimination criteria for distinguishing different types of regular rapid supraventricular tachycardia.
means for sensing activity of at least one atria of the heart to provide an atrial activity signal;
means for comparing at least one characteristic of the atrial activity signal to discrimination criteria to identify one of at least two different types of supraventricular tachycardia having regular rapid supraventricular heart rates; and
means for providing an indication corresponding to the type of regular rapid supraventricular tachycardia identified,
signal detection means coupled to the means for sensing to generate an atrial activity signal based on the sensed activity of the at least one atria of the heart; and
a processor coupled to the signal detection means for receiving the atrial activity signal and for applying an atrial discrimination algorithm including discrimination criteria for distinguishing different types of rapid regular supraventricular tachycardia to the atrial activity signal to compare at least one characteristic of the atrial activity signal to the discrimination criteria to identify a type of rapid regular supraventricular tachycardia occurring, the processor including the means for providing an indication corresponding to the type of rapid regular supraventricular tachycardia identified,
wherein the atrial discrimination algorithm is adapted to discriminate between a fast atrial flutter at a first high rate and an other atrial flutter at a second lower rate, and wherein the processor is adapted to provide an indication corresponding to an identified one of the fast atrial flutter at a first high rate and the other atrial flutter at a second lower rate.
24. The device of claim 23 further comprising means for providing pacing pulses to a heart, wherein the means for providing an indication controls the means for providing pacing pulses to a heart.
25. The device of claim 23 wherein the means for providing pacing pulses to a heart includes a dual chamber bradycardia pacer for providing pacing pulses to ventricles of the heart at a pacing rate based on a detected atrial rate up to a maximum atrial tracking rate; and the means for providing an indication applies an atrial detection algorithm only if the detected atrial rate exceeds the maximum atrial tracking rate.
26. A method for providing pacing therapy to a heart, comprising:
analyzing the atrial activity signal to discriminate between at least two different types of supraventricular tachycardia having regular rapid supraventricular heart rates;
providing a first pacing therapy for an identified first one of the at least two different types of supraventricular tachycardia and a second pacing therapy for an identified second one of the at least two different types of supraventricular tachycardia; and
trending the atrial activity signal to appropriately time at least one of the first and second pacing therapies,
the first one of the at least two different types of supraventricular tachycardia includes a first atrial flutter at a first rate;
the second one of the at least two different types of supraventricular tachycardia includes a second atrial flutter at a second rate, the second rate being slower than the first rate;
the first pacing therapy includes ventricular pacing; and
the second pacing therapy includes atrial anti-tachycardia pacing. Description
CROSS-REFERENCE TO RELATED APPLICATION(S) This application is a division of U.S. patent application Ser. No. 09/712,600, filed on Nov. 14, 2000, now issued as U.S. Pat. No. 6,978,177, the specification of which is incorporated herein by reference.
FIELD OF THE INVENTION The present invention pertains generally to medical devices and more particularly to medical devices for monitoring activity of the heart and providing therapy thereto including implantable bradycardia pacemakers and the like.
BACKGROUND OF THE INVENTION Various types of medical devices are employed to monitor electrical or other activity of the heart and to provide therapy to the heart in response to the detection of irregular cardiac rhythms. Such devices may be implantable beneath the skin of a patient, i.e., in the patient's chest. Such implantable devices include a hermetically sealed canister containing electronic circuitry for implementing the functions of the device, one or more electrodes implanted in one or more of the ventricles or atria of the heart, or in close proximity thereto, and leads for connecting the electrodes to the circuitry within the device canister. The device circuitry includes circuitry for detecting electrical signals produced by the heart, which signals are picked up at the electrodes, along with circuitry, typically implemented in a microprocessor, for analyzing the thus detected cardiac signals. The device may also include circuitry for providing therapy in the form of electrical signals applied to the heart. Such signals are provided to the heart, via the leads and electrodes mounted in the heart, in response to the detection of an irregular cardiac rhythm by the analysis circuitry based on the detected cardiac activity signals. The implantable device may also include a transmitter/receiver, for transmitting cardiac activity and other information to an external device for, e.g., storage and/or further analysis, and for receiving information, such as programming instructions, from the external device via, for example, an RF link.
An example of such an implantable cardiac device is a bradycardia pacemaker. A bradycardia pacemaker provides relatively low level electrical pulses to the heart to stimulate heart activity when the natural cardiac rate provided by the heart is too low. A dual chamber bradycardia pacemaker includes electrodes positioned in both the atria and ventricles of the heart for detecting naturally occurring atrial and ventricular activations and for providing pacing pulses to the atria and/or ventricles as needed. Such a device monitors the time between sensed and paced atrial and ventricular activations and provides pacing pulses as needed to maintain an adequate heart rate. For example, such a device will note the occurrence of a sensed or paced atrial or ventricular event and, if a subsequent naturally occurring atrial and/or ventricular event is not sensed within a certain time (escape interval) following the fist sensed or paced event, a pacing pulse will be applied to the atria and/or ventricles to maintain a desired heart rate.
Many modern implantable cardiac devices combine the features of a cardiac pacemaker with those of a cardiac defibrillator. Such devices provide bradycardia pacing in a normal manner, along with monitoring of the ventricles and/or atria to detect for occurrences of ventricular or atrial fibrillation. If ventricular or atrial fibrillation is detected, defibrillating or cardioverting electrical energy is applied to the ventricles or atria in a conventional manner in an attempt to restore a more stable cardiac rhythm. Such devices may incorporate algorithms for distinguishing between, e.g., different rates of ventricular tachycardia, which may be pacing terminable, e.g., via antitachycardia pacing, and ventricular fibrillation, which is not pacing terminable, i.e., requires defibrillation. An example of such an algorithm is described, for example, in U.S. Pat. No. 5,342,402 to Olson, et al. U.S. Pat. No. 6,314,321, filed Jun. 30, 1999, by Milton M. Morris, and entitled Therapy-Selection Methods for Implantable Heart Monitors, which application is assigned to the assignee of the present application, describes an algorithm for distinguishing between pacing terminable and non-pacing terminable atrial and ventricular arrythmias. An implantable cardiac device may also distinguish between different degrees of atrial fibrillation, e. g., between atrial fibrillation of high disorganization and atrial fibrillation of intermediate organization, to provide different levels of atrial defibrillation therapy depending upon the degree of disorganization. The application of such a function in an atrial defibrillator is described in U.S. Pat. No. 5,549,641 to Ayers, et al.
A limitation of current bradycardia pacemakers and similar implantable cardiac devices is the response of such devices to detected supraventricular tachycardias, such as atrial flutter. Supraventricular tachycardias are rapid heart rates due to a pacemaker anywhere above the ventricular level, i.e., the sinus node, the atria, or the atria ventricular junction. Atrial flutter, in particular, is a rapid regular atrial contraction. As discussed above, a typical bradycardia pacemaker will respond to a supraventricular tachycardia by mode switching such that ventricular pacing does not track the atrial rate. Nevertheless, a rapid supraventricular arrythmia may induce a ventricular arrhythmia as well. What is desired, therefore, is an implantable pacemaker or other cardiac device which controls a pacemaker to provide an appropriate pacing therapy in response to the detection of a supraventricular tachycardia. In particular, what is desired is an implantable cardiac pacemaker or other device which employs discrimination algorithms to distinguish between different rapid regular atrial arrhythmias (e.g., fast atrial flutter and other atrial flutter) and which provides an appropriate pacing therapy, in either the atria or ventricles, corresponding to the type of arrhythmia identified.
SUMMARY OF THE INVENTION The present invention provides a system and method which employs atrial discrimination algorithms to distinguish between different atrial arrhythmias occurring in a patient for selecting an optimal pacing therapy corresponding to the type of arrhythmia identified. The present invention may be implemented, for example, in an otherwise conventional bradycardia pacemaker or other implantable cardiac device. In a bradycardia pacemaker, for example, in response to the detection of an atrial rate above the atrial tracking rate, discrimination criteria are applied to a detected atrial activity signal to distinguish between different types of supraventricular tachycardia which may be occurring. For example, the discrimination criteria may be included in a discrimination algorithm for distinguishing between the occurrence of a high rate atrial flutter and a relatively lower rate supraventricular tachycardia. Pacer circuitry may then be controlled to provide optimal pacing in response to the type of atrial arrhythmia detected.
DETAILED DESCRIPTION OF THE INVENTION An exemplary implantable cardiac device 10 incorporating a system and method for using atrial discrimination algorithms to determine optimal pacing therapy in accordance with the present invention is illustrated in, and will be described in detail with reference to, FIG. 1. The implantable cardiac device 10 includes a hermetically sealed canister 12 which encloses circuitry for detecting and analyzing cardiac arrhythmias and for providing therapy therefore, as will be discussed in more detail below. The circuitry within the canister 12 is connected via one or more leads 14 to one or more electrodes 16 which are implanted in or near the chambers of a patient's heart 18. Depending upon the specific application and functionality of the implantable cardiac device 10, electrodes 16 may be positioned in or near the ventricles, atria or, preferably, both the atria and ventricles of the heart 18. The electrodes 16 pick up electrical signals produced in the chambers of the heart 18 and provide electrical contact for electrical pulses or shocks which are delivered to the chambers of the heart 18 to pace or defibrillate/cardiovert the heart 18. In a dual chamber bradycardia pacemaker, for example, electrodes 16 are positioned in or near both the atria and ventricles of the heart 18 to detect atrial and ventricular activity of the heart 18 and to provide pacing pulses to the atria and ventricles. A plurality of leads 14 may be required to connect the electrodes 16 positioned in or near the heart 18 to the circuitry within the device canister 12. As is known in the art, multiple electrodes 16 may be coupled to the circuitry within the canister 12 via a single one of the leads 14. The canister 12, leads 14, and electrodes 16 are preferably designed such that the entire device 10 is implantable beneath the skin of a patient.
An exemplary highly accurate algorithm which may be implemented in an energy-efficient manner to distinguish between different types of arrhythmias is described in U.S. Pat. No. 6,314,321, filed on Jun. 30, 1999, by Milton M. Morris, and entitled, �Therapy-Selection Methods for Implantable Heart Monitors,� which is assigned to the assignee of the present application, and which is incorporated herein by reference. This method employs three statistics, a range statistic, a minimum interval statistic, and a dispersion index, each of which may be calculated from a set of atrial depolarization intervals which indicate the time between successive depolarizations of the atria of a heart. After excluding selected intervals at each extreme, e.g., selected ones of the shortest and longest intervals in the set, the range statistic is calculated as the difference between a first and last one of the remaining intervals, the minimum interval is calculated as the smallest of the remaining intervals, and the dispersion index may be calculated as the standard deviation of the remaining intervals. A scalar quantity, defined as the interval dispersion assessment (IDA), may be calculated as a function of the three statistics. The IDA is compared to one or more threshold values to determine the atrial arrhythmia which is characterized by the particular calculated IDA value. Although the above-referenced patent application describes use of the IDA to distinguish between pacing terminable (e.g., atrial flutter) and non-pacing terminable (e.g., atrial fibrillation) arrhythmias, by selection of the appropriate threshold values this algorithm may also be employed to distinguish between different types of pacing terminable atrial arrhythmias (e.g., between different types of supraventricular tachycardia, fast atrial flutter, or other atrial flutter).
An atrial (supraventricular) arrhythmia may induce a ventricular arrhythmia. Ventricular rate regulation (VRR) controls pacing of the ventricles to regularize the ventricular rate and lengthen short ventricular contraction intervals. It has been found that pacing the ventricles at a rate slightly above the mean ventricular rate can suppress spontaneous ventricular activity. This may be achieved by pacing the ventricles such that, following each sensed beat, the ventricular pacing interval is decreased, and following each paced beat, the pacing interval is increased. An exemplary VRR pacing control method, is described in U.S. patent application Ser. No. 09/316,515, filed May 21, 1999, entitled Method and Apparatus for Treating Irregular Ventricular Contractions Such as During Atrial Arrhythmia, by David B. Krig, et al., which application is assigned to the assignee of the present application. In this application, a VRR pacing interval is calculated based upon a most recent detected V-V interval and the previous VRR pacing interval. For V-V intervals terminating in an intrinsic event, the VRR pacing interval is decreased by an amount related to the previous VRR interval. For V-V intervals terminating in a paced event, the VRR pacing interval is increased by an amount related to the previous VRR pacing interval. The VRR pacing interval is employed as the minimum pacing interval when, e.g., an atrial arrhythmia is detected. Thus, in response to an increasing or irregular ventricular rate, the ventricular pacing rate will increase (shorter pacing interval more likely to result in pacing), whereas the pacing rate will slow to a steady intrinsic rate in response to slowing/stabilization of intrinsic ventricular activity. VRR thus operates to increase the rate of ventricular contractions carefully, to avoid pacing the heart at an unnecessarily high rate. VRR methods other than those described herein may also be employed in accordance with the present invention, e.g., in response to the determination by an atrial discrimination algorithm that a relatively rapid rate supraventricular tachycardia (e.g., atrial flutter) is occurring.
Rate Smoothing is a variation of upper rate behavior in a pacemaker which was introduced by Cardiac Pacemakers, Inc. of St. Paul, Minn., as a method of preventing marked changes in cycle length not only at the upper rate limit of a dual chamber pacemaker but also at any time that the sinus rate is accelerating or decelerating. With Rate Smoothing, the pacer 34 is programmed to a percentage change that will be allowed between VV cycles, that is, e.g., 3, 6, 9, or 12 percent. For example, if the VV cycle length is stable at 900 milliseconds during atrial tracking pacing, Rate Smoothing is �on� at 6 percent, and the atrial rate suddenly accelerates, the subsequent VV cycle cannot accelerate by more than 54 milliseconds, which is 6 percent of 900 milliseconds. The ventricular rate is therefore relatively smooth.
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