Confirming sensed atrial events for pacing during resynchronization therapy in a cardiac medical device and medical device system
원문보기
IPC분류정보
국가/구분
United States(US) Patent
등록
국제특허분류(IPC7판)
A61B-005/00
A61N-001/368
A61B-005/0452
A61N-001/375
A61N-001/365
A61B-005/042
A61N-001/362
출원번호
US-0801049
(2015-07-16)
등록번호
US-10004906
(2018-06-26)
발명자
/ 주소
Ghosh, Subham
Du, Juan
Greenhut, Saul E
Hemming, Michael T
출원인 / 주소
Medtronic, Inc.
인용정보
피인용 횟수 :
0인용 특허 :
115
초록▼
A medical device and medical device system for controlling delivery of therapeutic stimulation pulses that includes a sensing device to sense a cardiac signal and emit a trigger signal in response to the sensed cardiac signal, a therapy delivery device to receive the trigger signal and deliver thera
A medical device and medical device system for controlling delivery of therapeutic stimulation pulses that includes a sensing device to sense a cardiac signal and emit a trigger signal in response to the sensed cardiac signal, a therapy delivery device to receive the trigger signal and deliver therapy to the patient in response to the emitted trigger signal, and a processor positioned within the sensing device, the processor configured to determine whether the sensed cardiac signal exceeds a possible P-wave threshold, compare a portion of the sensed cardiac signal to a P-wave template having a sensing window having a length less than a width of the P-wave, confirm an occurrence of a P-wave signal in response to the comparing, emit the trigger signal in response to the occurrence of a P-wave signal being confirmed, and inhibit delivery of the emitting signal in response to the occurrence of a P-wave signal not being confirmed.
대표청구항▼
1. A medical device system for controlling delivery of therapeutic stimulation pulses, the medical device system comprising: a sensing device configured to: sense a cardiac signal of a patient; andemit a trigger signal in response to the sensed cardiac signal;a therapy delivery device configured to:
1. A medical device system for controlling delivery of therapeutic stimulation pulses, the medical device system comprising: a sensing device configured to: sense a cardiac signal of a patient; andemit a trigger signal in response to the sensed cardiac signal;a therapy delivery device configured to: receive the trigger signal; anddeliver therapy to the patient in response to the emitted trigger signal; anda processor positioned within the sensing device, the processor being configured to: determine whether the sensed cardiac signal exceeds a P-wave candidate threshold;compare, in response to a determination that the sensed cardiac signal exceeds the P-wave candidate threshold, a portion of the sensed cardiac signal to a P-wave template, the P-wave template comprising a sensing window having a length less than a width of a P-wave with a predetermined P-wave morphology, the sensing window corresponding to a time window that ends prior to an end of the P-wave with the predetermined P-wave morphology;confirm an occurrence of a P-wave in the sensed cardiac signal in response to the comparison between the portion of the sensed cardiac signal and the P-wave template;generate, in response to the occurrence of the P-wave in the sensed cardiac signal being confirmed, the trigger signal emitted by the sensing device; andinhibit delivery of the trigger signal in response to the occurrence of the P-wave in the sensed cardiac signal not being confirmed. 2. The medical device system of claim 1, wherein the sensing device comprises a subcutaneous device capable of being implanted subcutaneously within a patient and the therapy delivery device comprises a transcatheter intracardiac pacemaker adapted for implantation wholly within a heart chamber. 3. The medical device system of claim 1, wherein the sensing device comprises subcutaneously implanted electrodes to sense the cardiac signal. 4. The medical device system of claim 1, wherein the sensing device comprises a subcutaneously implanted leadless device. 5. The medical device system of claim 1, wherein the length of the sensing window of the P-wave template corresponds to a predetermined percentage of the width of the P-wave with the predetermined P-wave morphology. 6. The medical device system of claim 5, wherein the predetermined percentage is fifty percent (50%). 7. The medical device system of claim 1, wherein the therapeutic stimulation pulses comprise cardiac resynchronization therapy pacing pulses. 8. The medical device system of claim 1, wherein the P-wave candidate threshold comprises at least one of an amplitude or a slope. 9. A medical device system for controlling delivery of therapeutic stimulation pulses, the medical device system comprising: a sensing device configured to: sense a cardiac signal of a patient; andemit a trigger signal in response to the sensed cardiac signal;a therapy delivery device configured to: receive the trigger signal; anddeliver therapy to the patient in response to the emitted trigger signal; anda processor positioned within the sensing device, the processor being configured to: determine whether the cardiac signal comprises a T-wave;determine, in response to a determination that the cardiac signal comprises a T-wave, whether the sensed cardiac signal exceeds a P-wave candidate threshold;compare, in response to a determination that the sensed cardiac signal exceeds the P-wave candidate threshold, a portion of the sensed cardiac signal to a P-wave template, the P-wave template comprising a sensing window having a length less than a width of a P-wave with a predetermined P-wave morphology, the sensing window corresponding to a time window that ends prior to an end of the P-wave with the predetermined P-wave morphology;confirm an occurrence of a P-wave in the sensed cardiac signal in response to the comparison between the portion of the sensed cardiac signal and the P-wave template;generate, in response to the occurrence of a P-wave in the sensed cardiac signal being confirmed, the trigger signal emitted by the sensing device; andinhibit delivery of the trigger signal in response to one of the T-wave not occurring and the occurrence of the P-wave in the sensed cardiac signal not being confirmed. 10. The medical device system of claim 9, wherein the sensing device comprises a subcutaneous device capable of being implanted subcutaneously within a patient and the therapy delivery device comprises a transcatheter intracardiac pacemaker adapted for implantation wholly within a heart chamber. 11. The medical device system of claim 9, wherein the sensing device comprises subcutaneously implanted electrodes to sense the cardiac signal. 12. The medical device system of claim 9, wherein the sensing device comprises a subcutaneously implanted leadless device. 13. The medical device system of claim 9, wherein the length of the sensing window of the P-wave template corresponds to a predetermined percentage of the width of the P-wave with the predetermined P-wave morphology. 14. The medical device system of claim 13, wherein the predetermined percentage is fifty percent (50%). 15. The medical device system of claim 9, wherein the therapeutic stimulation pulses comprise cardiac resynchronization therapy pacing pulses. 16. The medical device system of claim 9, wherein the P-wave candidate threshold comprises at least one of an amplitude or a slope. 17. A method of delivering therapeutic stimulation pulses, the method comprising: sensing a cardiac signal of a patient;receiving a trigger signal;delivering therapy to the patient via a therapy delivery device in response to the emitted trigger signal;determining whether the sensed cardiac signal exceeds a P-wave candidate threshold;comparing, in response to determining that the sensed cardiac signal exceeds the P-wave candidate threshold, a portion of the sensed cardiac signal to a P-wave template, the P-wave template comprising a sensing window having a length less than a width of a P-wave with a predetermined P-wave morphology, the sensing window corresponding to a time window that ends prior to an end of the P-wave with the predetermined P-wave morphology;confirming an occurrence of a P-wave in the sensed cardiac signal in response to the comparison between the portion of the sensed cardiac signal and the P-wave template;generating the trigger signal in response to the occurrence of the P-wave in the sensed cardiac signal being confirmed; andinhibiting delivery of the trigger signal in response to the occurrence of the P-wave in the sensed cardiac signal not being confirmed. 18. The method of claim 17, wherein the sensing device comprises a subcutaneous device capable of being implanted subcutaneously within a patient and the therapy delivery device comprises a transcatheter intracardiac pacemaker adapted for implantation wholly within a heart chamber. 19. The method of claim 17, wherein the sensing device comprises subcutaneously implanted electrodes to sense the cardiac signal. 20. The method of claim 17, wherein the sensing device comprises a subcutaneously implanted leadless device. 21. The method of claim 17, wherein the length of the sensing window of the P-wave template corresponds to a predetermined percentage of the width of the P-wave with the predetermined P-wave morphology. 22. The method of claim 21, wherein the predetermined percentage is fifty percent (50%). 23. The method of claim 17, wherein the therapeutic stimulation pulses comprise cardiac resynchronization therapy pacing pulses. 24. The method of claim 17, wherein the P-wave candidate threshold comprises at least one of an amplitude or a slope. 25. A method of delivering therapeutic stimulation pulses, the method comprising: sensing a cardiac signal of a patient;receiving a trigger signal;delivering therapy to the patient via a therapy delivery device in response to the emitted trigger signal;determining whether the cardiac signal comprises a T-wave;determining, in response to a T-wave occurring, whether the sensed cardiac signal exceeds a P-wave candidate threshold;comparing, in response to determining that the sensed cardiac signal exceeds the P-wave candidate threshold, a portion of the sensed cardiac signal to a P-wave template, the P-wave template comprising a sensing window having a length less than a width of a P-wave with a predetermined P-wave morphology, the sensing window corresponding to a time window that ends prior to an end of the P-wave with the predetermined P-wave morphology;confirming an occurrence of a P-wave in the sensed cardiac signal in response to the comparison between the portion of the sensed cardiac signal and the P-wave template;generating the trigger signal in response to the occurrence of the P-wave in the sensed cardiac signal being confirmed; andinhibiting delivery of the trigger signal in response to one of the T-wave not occurring and the occurrence of the P-wave in the sensed cardiac signal not being confirmed. 26. The method of claim 25, wherein the sensing device comprises a subcutaneous device capable of being implanted subcutaneously within a patient and the therapy delivery device comprises a transcatheter intracardiac pacemaker adapted for implantation wholly within a heart chamber. 27. The method of claim 25, wherein the sensing device comprises subcutaneously implanted electrodes to sense the cardiac signal. 28. The method of claim 25, wherein the sensing device comprises a subcutaneously implanted leadless device. 29. The method of claim 25, wherein the length of the sensing window of the P-wave template corresponds to a predetermined percentage of the width of the P-wave with the predetermined P-wave morphology. 30. The method of claim 29, wherein the predetermined percentage is fifty percent (50%). 31. The method of claim 25, wherein the therapeutic stimulation pulses comprise cardiac resynchronization therapy pacing pulses. 32. The method of claim 25, wherein the possible P-wave threshold comprises at least one of an amplitude or a slope. 33. A medical device for controlling delivery of therapeutic stimulation pulses, the medical device comprising: a subcutaneous sensing device comprising subcutaneously implanted electrodes configured to sense a cardiac signal of a patient;an emitting device configured to emit a trigger signal to deliver the therapeutic stimulation pulses in response to the sensed cardiac signal; anda processor positioned within the subcutaneous sensing device, the processor configured to: determine whether the sensed cardiac signal exceeds a P-wave candidate threshold,compare, in response to a determination that the sensed cardiac signal exceeds the P-wave candidate threshold, a portion of the sensed cardiac signal to a P-wave template, the P-wave template comprising a sensing window having a length less than a width of a P-wave with a predetermined P-wave morphology, the sensing window corresponding to a time window that ends prior to an end of the P-wave with the predetermined P-wave morphology;confirm an occurrence of a P-wave in the sensed cardiac signal in response to the comparison between the portion of the sensed cardiac signal and the P-wave template;generate, in response to the occurrence of the P-wave in the sensed cardiac signal being confirmed, the trigger signal emitted by the emitting device; andinhibit delivery of the trigger signal in response to the occurrence of the P-wave in the sensed cardiac signal not being confirmed. 34. The medical device of claim 33, wherein the length of the sensing window of the P-wave template corresponds to a predetermined percentage of the width of the P-wave with the predetermined P-wave morphology. 35. The medical device of claim 34, wherein the predetermined percentage is fifty percent (50%). 36. The medical device of claim 33, wherein the therapeutic stimulation pulses comprise cardiac resynchronization therapy pacing pulses. 37. The medical device of claim 33, wherein the P-wave candidate threshold comprises at least one of an amplitude or a slope.
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