IPC분류정보
국가/구분 |
United States(US) Patent
등록
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국제특허분류(IPC7판) |
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출원번호 |
US-0999853
(2004-11-29)
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등록번호 |
US-7376458
(2008-05-20)
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발명자
/ 주소 |
- Palreddy,Surekha
- Warren,Jay A.
- Ostroff,Alan H.
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출원인 / 주소 |
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대리인 / 주소 |
Pramudji, Wendt, & Tran, LLP
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인용정보 |
피인용 횟수 :
54 인용 특허 :
159 |
초록
▼
Template formation methods for use in implantable cardiac rhythm management devices. In an illustrative method, a signal is captured signal an implanted cardiac rhythm management device, and parameters for analysis of the captured signal are then defined. Then, in the example, additional signals can
Template formation methods for use in implantable cardiac rhythm management devices. In an illustrative method, a signal is captured signal an implanted cardiac rhythm management device, and parameters for analysis of the captured signal are then defined. Then, in the example, additional signals can be captured and used to either verify or discard the captured signal defined parameters. The template formation methods provide for creating a robust template to compare with sensed cardiac complexes. Devices and systems configured to perform template formation and verification methods are also shown.
대표청구항
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What is claimed is: 1. A method of cardiac signal analysis comprising: sensing a first cardiac event; configuring template parameters for analysis of the first cardiac event; defining a first sensed signal for the first cardiac event using the template parameters; sensing a second cardiac event; de
What is claimed is: 1. A method of cardiac signal analysis comprising: sensing a first cardiac event; configuring template parameters for analysis of the first cardiac event; defining a first sensed signal for the first cardiac event using the template parameters; sensing a second cardiac event; defining a second sensed signal for the second cardiac event using the template parameters; comparing the second sensed signal to the first sensed signal to determine whether the first sensed signal and template parameters are suitable for defining a cardiac event template; and if the first sensed signal and template parameters are suitable, retaining the first sensed signal and template parameters for using to define a cardiac event template; or, if the first sensed signal and template parameters are not suitable, discarding the first sensed signal and template parameters from use in defining a cardiac event template. 2. The method of claim 1, wherein the step of configuring template parameters includes selecting a rule for identifying a fiducial point, wherein: the rule is selected from among a set of rules; the rule is selected in light of the characteristics of the first cardiac event; and the rule for identifying a fiducial point becomes one of the template parameters. 3. The method of claim 2, wherein the step of configuring template parameters further includes selecting a number of samples of the first sensed signal around the fiducial point; wherein the configuration of samples around the fiducial point becomes one of the template parameters. 4. The method of claim 3, wherein the step of selecting a number of samples includes identifying the start and end of a cardiac event. 5. The method of claim 4, wherein the cardiac event is a QRS complex. 6. The method of claim 2, wherein the set of rules includes an amplitude rule related to the relative amplitudes of peaks in the sensed signal. 7. The method of claim 6, wherein the set of rules includes a location rule related to the location of a peak in the sensed signal. 8. The method of claim 2 wherein the set of rules includes a location rule related to the location of a peak in the sensed signal. 9. The method of claim 2 wherein the set of rules includes a notch rule related to identifying a notched cardiac signal, wherein the notch rule includes analysis of whether there are multiple peaks within a predefined range of one another in the cardiac signal. 10. The method of claim 9 wherein the notch rule selects the first peak in time if there are multiple peaks within the predefined range. 11. The method of claim 1, wherein the step of configuring template parameters further includes selecting a number of samples of the first sensed signal around a fiducial point in the first sensed signal; wherein the configuration of samples around the fiducial point becomes one of the template parameters. 12. The method of claim 11, wherein the samples are selected using the following steps: first, a number of samples are observed on either side of the fiducial point; next, it is determined whether a desired QRS segment begins and ends within the number of samples; and the number of samples on either side of the fiducial point is adjusted to capture the QRS segment and exclude at least some samples not corresponding to the desired QRS segment. 13. The method of claim 1, wherein the step of configuring template parameters includes observing whether a notched QRS complex is likely, and, if so, adjusting the template parameters to assure that a repeatably detectable fiducial point is chosen. 14. A method of cardiac signal analysis comprising: sampling a signal using electrodes implanted in a patient's torso for capturing cardiac signals; defining a first sensing window around a first fiducial point to capture a QRS segment; observing the definition of the first sensing window to create template parameters; defining a second sensing window around a second fiducial point using the template parameters; comparing data in the first sensing window to data in the second sensing window to verify whether to define a valid template using the template parameters; and if the data in the first sensing window is verified, defining a valid template using the template parameter, or, if the data in the first sensing window is not verified using different parameters to define a valid template. 15. The method of claim 14, wherein the electrodes are subcutaneously implanted in the patient. 16. The method of claim 14, wherein the step of defining a first sensing window includes identifying a fiducial point by selecting a rule from among a set of rules in light of the characteristics of the QRS segment in the first sensing window, wherein the rule selected for identifying a fiducial point becomes one of the template parameters. 17. The method of claim 16, wherein the step defining a first sensing window around a first fiducial point includes identifying the start and end of a cardiac event. 18. The method of claim 17, wherein the cardiac event is a QRS complex. 19. The method of claim 16, wherein the set of rules includes: an amplitude rule related to the relative amplitudes of peaks in the sampled signal; and a location rule related to the location of a peak in the sampled signal. 20. The method of claim 14, wherein the step of defining a first sensing window includes selecting a number of samples around a fiducial point, wherein the configuration of samples around the fiducial point becomes one of the template parameters. 21. The method of claim 20, wherein the samples are selected using the following steps: a fiducial point is selected; then a number of samples are observed on either side of the fiducial point; then it is determined whether a desired QRS segment begins and ends within the number of samples; and the number of samples on either side of the fiducial point is adjusted to capture the QRS segment and exclude at least some samples not corresponding to the desired QRS segment. 22. The method of claim 14, wherein the step of defining a first sensing window includes observing whether a notched QRS complex is likely, and, if so, adjusting the template parameters to assure that a repeatably detectable fiducial point is chosen. 23. A method of cardiac signal analysis including forming a template for cardiac event comparisons, the step of forming a template comprising: sensing a first cardiac event; identifying a first fiducial point in the first cardiac event using a set of rules; sensing a second cardiac event; identifying a second fiducial point in the second cardiac event using the set of rules; determining whether the first fiducial point and second fiducial point were identified using the same rule; and, if so, retaining the first cardiac event for forminga template, or, if not, discarding the first cardiac event. 24. A method of cardiac signal template formation comprising: receiving a first cardiac signal from implanted electrodes; selecting a fiducial point in the first cardiac signal; forming a template around the fiducial point; attempting to verify the template by receiving additional cardiac signals and using the template to compare the additional cardiac signals to the first cardiac signal wherein the template is verified if the additional cardiac signals and the first cardiac signal, when compared, are found to be similar, and the template is not verified if the additional cardiac signals and the first cardiac signal, when compared, are found to be dissimilar; and, if the template is verified, retaining the template for use in cardiac signal analysis or, if the template is not verified, rejecting the template for use in cardiac signal analysis. 25. The method of claim 24, wherein the step of selecting a fiducial point includes identifying a fiducial point by selecting a rule from among a set of rules in light of the characteristics of first cardiac signal, wherein the rule selected for identifying a fiducial point becomes one of the template parameters. 26. The method of claim 25, wherein the step forming a template around the fiducial point includes identifying the start and end of a cardiac event. 27. The method of claim 26, wherein the cardiac event is a QRS complex. 28. The method of claim 25, wherein the set of rules includes an amplitude rule related to the relative amplitudes of peaks in the cardiac signal. 29. The method of claim 28, wherein the set of rules further includes a location rule related to the location of a peak in the cardiac signal. 30. The method of claim 25, wherein the set of rules includes a location rule related to the location of a peak in the cardiac signal. 31. The method of claim 24, wherein the step of forming a template includes selecting a number of samples around the fiducial point, wherein the configuration of samples around the fiducial point becomes one of the template parameters. 32. The method of claim 31, wherein the samples are selected using the following steps: a number of samples are observed on either side of the fiducial point; it is determined whether a desired QRS segment begins and ends within the number of samples; and the number of samples on either side of the fiducial point is adjusted to capture the QRS segment and exclude at least some samples not corresponding to the desired QRS segment. 33. The method of claim 24, wherein the step of selecting a fiducial point includes observing whether a notched QRS complex is likely, and, if so, adjusting the template parameters to assure that a repeatably detectable fiducial point is chosen. 34. An implantable cardioverter/defibrillator comprising: a lead electrode assembly including a number of electrodes; and a canister housing operational circuitry; wherein: the lead electrode assembly is coupled to the canister; and the operational circuitry is configured to perform steps of discriminating between cardiac rhythms of a patient's heart which are appropriate for therapy, the steps including: sensing a first cardiac event; configuring template parameters for analysis of the first cardiac event; defining a first sensed signal for the first cardiac event using the template parameters; sensing a second cardiac event; defining a second sensed signal for the second cardiac event using the template parameters; comparing the second sensed signal to the first sensed signal to determine whether the first sensed signal and template parameters are suitable for defining a cardiac event template; and if the first sensed signal and template parameters are suitable, retaining the first sensed signal and template parameters for further analysis; or, if the first sensed signal and template parameters are not suitable, discarding the first sensed signal and template parameters from use in defining a cardiac event template. 35. The implantable cardioverter/defibrillator of claim 34, wherein the operational circuitry is configured such that the step of configuring template parameters includes selecting a rule for identifying a fiducial point, and: the rule is selected from among a set of rules; the rule is selected in light of the characteristics of the first cardiac event; and the rule for identifying a fiducial point becomes one of the template parameters. 36. The implantable cardioverter/defibrillator of claim 35, wherein the operational circuitry is configured such that the step of configuring template parameters further includes selecting a number of samples of the first sensed signal around the fiducial point, and the configuration of samples around the fiducial point becomes one of the template parameters. 37. The implantable cardioverter/defibrillator of claim 36, wherein the operational circuitry is configured such that the step of selecting a number of samples includes identifying the start and end of a cardiac event. 38. The implantable cardioverter/defibrillator of claim 37, wherein the operational circuitry is configured such that the cardiac event is a QRS complex. 39. The implantable cardioverter/defibrillator of claim 35, wherein the operational circuitry is configured such that the set of rules includes an amplitude rule related to the relative amplitudes of peaks in the sensed signal. 40. The implantable cardioverter/defibrillator of claim 39, wherein the operational circuitry is configured such that the set of rules includes a location rule related to the location of a peak in the sensed signal. 41. The implantable cardioverter/defibrillator of claim 35, wherein the operational circuitry is configured such that the set of rules includes a location rule related to the location of a peak in the sensed signal. 42. The implantable cardioverter/defibrillator of claim 35, wherein the operational circuitry is configured such that the set of rules includes a notch rule related to identifying a notched cardiac signal, wherein the notch rule includes analysis of whether there are multiple peaks within a predefined range of one another in the cardiac signal. 43. The implantable cardioverter/defibrillator of claim 42, wherein the operational circuitry is configured such that the notch rule selects the first peak in time if there are multiple peaks within the predefined range. 44. The implantable cardioverter/defibrillator of claim 34, wherein the operational circuitry is configured such that the step of configuring template parameters further includes selecting a number of samples of the first sensed signal around a fiducial point in the first sensed signal; wherein the configuration of samples around the fiducial point becomes one of the template parameters. 45. The implantable cardioverter/defibrillator of claim 44, wherein the operational circuitry is configured such that the samples are selected using the following steps: first, a number of samples are observed on either side of the fiducial point; next, it is determined whether a desired QRS segment begins and ends within the number of samples; and the number of samples on either side of the fiducial point is adjusted to capture the QRS segment and exclude at least some samples not corresponding to the desired QRS segment. 46. The implantable cardioverter/defibrillator of claim 34, wherein the operational circuitry is configured such that the step of configuring template parameters includes observing whether a notched QRS complex is likely, and, if so, adjusting the template parameters to assure that a repeatably detectable fiducial point is chosen. 47. The implantable cardioverter/defibrillator of claim 34, wherein the operational circuitry comprises a readable medium including an instruction set for performing the steps of discriminating. 48. An implantable cardioverter/defibrillator comprising: a lead electrode assembly including a number of electrodes; and a canister housing operational circuitry; wherein: the lead electrode assembly is coupled to the canister; and the operational circuitry is configured to perform steps of discriminating between cardiac rhythms of a patient's heart which are appropriate for therapy, the steps including: sampling a signal using the lead electrode assembly while implanted in a patient's torso in locations chosen for capturing cardiac signals; defining a first sensing window around a first fiducial point to capture a QRS segment; observing the definition of the first sensing window to create template parameters; defining a second sensing window around a second fiducial point using the template parameters; comparing data in the first sensing window to data in the second sensing window to verify whether to define a valid template using the template parameters; and if the data in the first sensing window is verified, defining a valid template using the template parameter, or, if the data in the first sensing window is not verified using different parameters to define a valid template. 49. The implantable cardioverter/defibrillator of claim 48, wherein the operational circuitry is configured such that the step of defining a first sensing window includes identifying a fiducial point by selecting a rule from among a set of rules in light of the characteristics of the QRS segment in the first sensing window, wherein the rule selected for identifying a fiducial point becomes one of the template parameters. 50. The implantable cardioverter/defibrillator of claim 49, wherein the operational circuitry is configured such that the step defining a first sensing window around a first fiducial point includes identifying the start and end of a cardiac event. 51. The implantable cardioverter/defibrillator of claim 50, wherein the operational circuitry is configured such that the cardiac event is a QRS complex. 52. The implantable cardioverter/defibrillator of claim 49, wherein the operational circuitry is configured such that the set of rules includes: an amplitude rule related to the relative amplitudes of peaks in the sampled signal; and a location rule related to the location of a peak in the sampled signal. 53. The implantable cardioverter/defibrillator of claim 48, wherein the operational circuitry is configured such that the step of defining a first sensing window includes selecting a number of samples around a fiducial point, wherein the configuration of samples around the fiducial point becomes one of the template parameters. 54. The implantable cardioverter/defibrillator of claim 53, wherein the operational circuitry is configured such that the samples are selected using the following steps: a fiducial point is selected; then a number of samples are observed on either side of the fiducial point; then it is determined whether a desired QRS segment begins and ends within the number of samples; and the number of samples on either side of the fiducial point is adjusted to capture the QRS segment and exclude at least some samples not corresponding to the desired QRS segment. 55. The implantable cardioverter/defibrillator of claim 48, wherein the operational circuitry is configured such that the step of defining a first sensing window includes observing whether a notched QRS complex is likely, and, if so, adjusting the template parameters to assure that a repeatably detectable fiducial point is chosen. 56. The implantable cardioverter/defibrillator of claim 48, wherein the operational circuitry comprises a readable medium including an instruction set for performing the steps of discriminating. 57. An implantable cardioverter/defibrillator comprising: a lead electrode assembly including a number of electrodes; and a canister housing operational circuitry; wherein: the lead electrode assembly is coupled to the canister; and the operational circuitry is configured to perform steps of discriminating between cardiac rhythms of a patient's heart which are appropriate for therapy, the steps including forming a template using at least the steps of: sensing a first cardiac event; identifying a first fiducial point in the first cardiac event using a set of rules; sensing a second cardiac event; identifying a second fiducial point in the second cardiac event using the set of rules; determining whether the first fiducial point and second fiducial point were identified using the same rule; and, if so retaing the first cardiac event for forming a template; and, if not, discarding the first cardiac event. 58. An implantable cardioverter/defibrillator comprising: a lead electrode assembly including a number of electrodes; and a canister housing operational circuitry; wherein: the lead electrode assembly is coupled to the canister; and the operational circuitry is configured to perform steps of discriminating between cardiac rhythms of a patient's heart which are appropriate for therapy, the steps including forming a template using at least the steps of: receiving a first cardiac signal from the lead electrode assembly; selecting a fiducial point in the first cardiac signal; forming a template around the fiducial point; attempting to verify the template by receiving additional cardiac signals and using the template to compare the additional cardiac signals to the first cardiac signal wherein the template is verified if the additional cardiac signals and the first cardiac signal, when compared, are found to be similar, and the template is not verified if the additional cardiac signals and the first cardiac signal, when compared, are found to be dissimilar; and, if the template is verified, retaining the template for use in cardiac signal analysis or, if the template is not verified, rejecting the template for use in cardiac signal analysis. 59. The implantable cardioverter/defibrillator of claim 58, wherein the operational circuitry is configured such that the step of selecting a fiducial point includes identifying a fiducial point by selecting a rule from among a set of rules in light of the characteristics of first cardiac signal, wherein the rule selected for identifying a fiducial point becomes one of the template parameters. 60. The implantable cardioverter/defibrillator of claim 59, wherein the operational circuitry is configured such that the step forming a template around the fiducial point includes identifying the start and end of a cardiac event. 61. The implantable cardioverter/defibrillator of claim 58, wherein the operational circuitry is configured such that the set of rules includes an amplitude rule related to the relative amplitudes of peaks in the cardiac signal. 62. The implantable cardioverter/defibrillator of claim 60, wherein the operational circuitry is configured such that the set of rules further includes a location rule related to the location of a peak in the cardiac signal. 63. The implantable cardioverter/defibrillator of claim 59, wherein the operational circuitry is configured such that the set of rules includes a location rule related to the location of a peak in the cardiac signal. 64. The implantable cardioverter/defibrillator of claim 58, wherein the operational circuitry is configured such that the step of forming a template includes selecting a number of samples around the fiducial point, wherein the configuration of samples around the fiducial point becomes one of the template parameters. 65. The implantable cardioverter/defibrillator of claim 64, wherein the operational circuitry is configured such that the samples are selected using the following steps: a number of samples are observed on either side of the fiducial point; it is determined whether a desired QRS segment begins and ends within the number of samples; and the number of samples on either side of the fiducial point is adjusted to capture the QRS segment and exclude at least some samples not corresponding to the desired QRS segment. 66. The implantable cardioverter/defibrillator of claim 58, wherein the operational circuitry is configured such that the step of selecting a fiducial point includes observing whether a notched QRS complex is likely, and, if so, adjusting the template parameters to assure that a repeatably detectable fiducial point is chosen. 67. The implantable cardioverter/defibrillator of claim 58, wherein the operational circuitry comprises a readable medium including an instruction set for performing the steps of discriminating.
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