# US 10,500,406 B2 · Method and apparatus for discriminating tachycardia events in a medical device using two sensing vectors

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- Number: US 10,500,406 B2
- Document ID: US10500406B2
- Status: Granted
- Kind: B2
- Application number: 15/801,522
- Filed: 2017-11-02
- Published: 2018-03-08
- Granted: 2019-12-10
- Earliest claimed: 2014-04-10
- Assignees: Medtronic, Inc.
- Applicants: Medtronic, Inc.
- Inventors: Xusheng Zhang
- Web page: https://patentgrep.com/patent/US10500406B2

## CPC

- A61N 1/3987: {characterised by the timing or triggering of the shock}
- A61B 5/287: Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
- A61B 5/341: Vectorcardiography [VCG]
- A61B 5/35: by template matching
- A61B 5/361: Detecting fibrillation
- A61B 5/363: Detecting tachycardia or bradycardia
- A61B 5/7207: {of noise induced by motion artifacts}
- A61N: ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY (measurement of bioelectric currents A61B; surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body A61B18/00; anaesthetic apparatus in general A61M; incandescent lamps H01K; infrared radiators for heating H05B)
- A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D)

## Abstract

A method and medical device for detecting a cardiac event that includes sensing cardiac signals from a plurality of electrodes forming a first sensing vector sensing a first interval of the cardiac signal during a predetermined time period and a second sensing vector simultaneously sensing a second interval of the cardiac signal during the predetermined time period, identifying each of the first interval and the second interval as being one of shockable and not shockable in response to first processing of the first interval and the second interval and in response to second processing of one or both of the first interval and the second interval, the second processing being different from the first processing, and determining whether to deliver therapy for the cardiac event in response to identifying each of the first interval and the second interval as being one of shockable and not shockable in response to both the first processing and the second processing of the first interval and the second interval.

## Claims

### Claim 1

A method comprising:
obtaining a first cardiac signal sensed on a first sensing vector formed between a first electrode and a second electrode;
identifying a plurality of analysis windows, each of the plurality of analysis windows extending a predetermined amount of time and including a respective segment of the first cardiac signal having a plurality of R-wave sense events;
analyzing, for each of the plurality of analysis windows, a gross morphology of the respective segment of the first cardiac signal across the entire analysis window;
analyzing, for each of the plurality of analysis windows, a beat-based morphology of each individual one of the plurality of R-wave sense events of the respective segment of the first cardiac signal within the analysis window;
classifying analysis windows of the plurality of analysis windows as shockable when both the gross morphology analysis associated with the respective analysis window results in a shockable classification and the beat-based morphology analysis associated with the respective analysis window results in a shockable classification;
detecting a tachyarrhythmia when a threshold number of the plurality of analysis windows are classified as shockable; and
delivering an electrical therapy in response to detecting the tachyarrhythmia.

### Claim 2 (depends on 1)

The method of claim 1, wherein analyzing, for each of the plurality of analysis windows, the beat-based morphology of each individual one of the plurality of R-wave sense events of the respective segment of the first cardiac signal within the analysis window comprises, for each of the plurality of R-waves within a respective analysis window:
comparing a beat morphology of the respective R-wave sense event to a beat template;
classifying the respective R-wave sense event as a non-match beat when the respective comparison does not meet a match criteria; and
classifying the analysis window as shockable when the number of R-wave sense events classified as non-match beats is greater than a threshold.

### Claim 3 (depends on 2)

The method of claim 2, wherein the threshold is equal to 75 percent of the number of R-wave sense events in the analysis window.

### Claim 4 (depends on 2)

The method of claim 2, further comprising classifying the analysis window as not shockable when the number of R-wave sense events classified as non-match beats is not greater than the threshold.

### Claim 5 (depends on 1)

The method of claim 1, wherein analyzing, for each of the plurality of analysis windows, a gross morphology of the respective segment of the first cardiac signal across the entire analysis window comprises:
determining the segment of the cardiac signal in the analysis window is not noisy;
in response to determining that the segment of the cardiac signal in the respective window is not noisy, determining whether R-R intervals between consecutive R-wave sense events within the analysis window are stable or unstable;
when the R-R intervals within the analysis window are unstable, determining whether the segment of the cardiac signal is within a VF zone based at least on the low slope content and the spectral width of the segment of the cardiac signal;
when the R-R intervals within the analysis window are stable, determining whether the segment of the cardiac signal is within a VT zone based at least on the low slope content and the spectral width of the segment of the cardiac signal; and
classifying the analysis window as shockable based on the gross morphology analysis in response to determining the segment of the cardiac signal is within the VT zone or the VF zone.

### Claim 6 (depends on 1)

The method of claim 1, wherein the gross morphology analysis and the beat-based morphology analysis occur in a second detection state, the method further comprising transitioning from a first detection state to the second detection state based on a heart rate estimate.

### Claim 7 (depends on 1)

The method of claim 1, further comprising:
obtaining a second cardiac signal sensed on a second sensing vector formed between a third electrode and a fourth electrode, at least one of the third electrode and the fourth electrode being different than the first electrode and the second electrode;
identifying a second plurality of analysis windows, each of the second plurality of analysis windows extending the predetermined amount of time and including a respective segment of the second cardiac signal having a plurality of R-wave sense events;
analyzing, for each of the second plurality of analysis windows, a gross morphology of the respective segment of the second cardiac signal across the entire analysis window;
analyzing, for each of the second plurality of analysis windows, a beat-based morphology of each individual one of the plurality of R-wave sense events of the respective segment of the second cardiac signal within the analysis window;
classifying analysis windows of the second plurality of analysis windows as shockable when both the gross morphology analysis associated with the respective analysis window results in a shockable classification and the beat-based morphology analysis associated with the respective analysis window results in a shockable classification; and
detecting the tachyarrhythmia when the threshold number of the first plurality of analysis windows are classified as shockable and a threshold number of the second plurality of analysis windows are classified as shockable.

### Claim 8 (depends on 7)

The method of claim 7, wherein the gross morphology analysis of the segments of the first and second cardiac signal includes determining one or more of the segments within the first plurality of analysis windows of the first cardiac signal are noisy, the method further comprising:
determining not to utilize the respective ones of the first plurality of analysis windows of the first cardiac signal determined to be noisy in the gross morphology analysis of the first cardiac signal;
determining not to utilize the respective ones of the first plurality of analysis windows of the first cardiac signal determined to be noisy in the beat-based morphology analysis of the first cardiac signal.

### Claim 9

A medical device comprising:
a sense amplifier configured to obtain a first cardiac signal sensed on a first sensing vector formed between a first electrode and a second electrode;
a processor configured to:
identify a plurality of analysis windows, each of the plurality of analysis windows extending a predetermined amount of time and including a respective segment of the first cardiac signal having a plurality of R-wave sense events;
analyze, for each of the plurality of analysis windows, a gross morphology of the respective segment of the first cardiac signal across the entire analysis window;
analyze, for each of the plurality of analysis windows, a beat-based morphology of each individual one of the plurality of R-wave sense events of the respective segment of the first cardiac signal within the analysis window;
classify analysis windows of the plurality of analysis windows as shockable when both the gross morphology analysis associated with the respective analysis window results in a shockable classification and the beat-based morphology analysis associated with the respective analysis window results in a shockable classification;
detect a tachyarrhythmia when a threshold number of the plurality of analysis windows are classified as shockable; and
one or more high voltage capacitors configured to be charged in response to detecting the tachyarrhythmia and discharged between a pair of cardioversion-defibrillation electrodes to deliver an electrical therapy in response to detecting the tachyarrhythmia.

### Claim 10 (depends on 9)

The medical device of claim 9, wherein the processor is configured to, during the beat-based morphology for each of the plurality of R-waves within a respective analysis window:
compare a beat morphology of the respective R-wave sense event to a beat template;
classify the respective R-wave sense event as a non-match beat when the respective comparison does not meet a match criteria; and
classify the analysis window as shockable when the number of R-wave sense events classified as non-match beats is greater than a threshold.

### Claim 11 (depends on 10)

The medical device of claim 10, wherein the threshold is equal to 75 percent of the number of R-wave sense events in the analysis window.

### Claim 12 (depends on 10)

The medical device of claim 10, wherein the processor is further configured to classify the analysis window as not shockable when the number of R-wave sense events classified as non-match beats is not greater than the threshold.

### Claim 13 (depends on 9)

The medical device of claim 9, wherein the processor is configured to, during the gross morphology analysis of the respective segment of the first cardiac signal:
determine the segment of the cardiac signal in the analysis window is not noisy;
in response to determining that the segment of the cardiac signal in the respective window is not noisy, determine whether R-R intervals between consecutive R-wave sense events within the analysis window are stable or unstable;
when the R-R intervals within the analysis window are stable, determine whether the segment of the cardiac signal is within a VT zone based at least on the low slope content and the spectral width of the segment of the cardiac signal;
when the R-R intervals within the analysis window are unstable, determine whether the segment of the cardiac signal is within a VF zone based at least on the low slope content and the spectral width of the segment of the cardiac signal; and
classify the analysis window as shockable based on the gross morphology analysis in response to determining the segment of the cardiac signal is within the VT zone or the VF zone.

### Claim 14 (depends on 9)

The medical device of claim 9, wherein the gross morphology analysis and the beat-based morphology analysis occur in a second detection state, the processor further configured to transition from a first detection state to the second detection state based on a heart rate estimate.

### Claim 15 (depends on 9)

The medical device of claim 9, further comprising:
a second sense amplifier configured to obtain a second cardiac signal sensed on a second sensing vector formed between a third electrode and a fourth electrode, at least one of the third electrode and the fourth electrode being different than the first electrode and the second electrode;
the processor further configured to:
identify a second plurality of analysis windows, each of the second plurality of analysis windows extending the predetermined amount of time and including a respective segment of the second cardiac signal having a plurality of R-wave sense events;
analyze, for each of the second plurality of analysis windows, a gross morphology of the respective segment of the second cardiac signal across the entire analysis window;
analyze, for each of the second plurality of analysis windows, a beat-based morphology of each individual one of the plurality of R-wave sense events of the respective segment of the second cardiac signal within the analysis window;
classify analysis windows of the second plurality of analysis windows as shockable when both the gross morphology analysis associated with the respective analysis window results in a shockable classification and the beat-based morphology analysis associated with the respective analysis window results in a shockable classification; and
detect the tachyarrhythmia when the threshold number of the first plurality of analysis windows are classified as shockable and a threshold number of the second plurality of analysis windows are classified as shockable.

### Claim 16 (depends on 15)

The medical device of claim 15, wherein the gross morphology analysis of the segments of the first and second cardiac signal includes determining one or more of the segments within the first plurality of analysis windows of the first cardiac signal are noisy, the processor further configured to:
determine not to utilize the respective ones of the first plurality of analysis windows of the first cardiac signal determined to be noisy in the gross morphology analysis of the first cardiac signal;
determine not to utilize the respective ones of the first plurality of analysis windows of the first cardiac signal determined to be noisy in the beat-based morphology analysis of the first cardiac signal.

### Claim 17 (depends on 9)

The medical device of claim 9, wherein the predetermined amount of time comprises 3-seconds.