# US 11,998,344 B2 · Method and apparatus for atrial tachyarrhythmia detection

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- Number: US 11,998,344 B2
- Document ID: US11998344B2
- Status: Granted
- Kind: B2
- Application number: 17/474,387
- Filed: 2021-09-14
- Published: 2021-12-30
- Granted: 2024-06-04
- Earliest claimed: 2018-11-12
- Assignees: Medtronic, Inc.
- Applicants: Medtronic, Inc.
- Inventors: Shantanu Sarkar; Wade M. Demmer; Todd J. Sheldon; Vincent E. Splett
- Web page: https://patentgrep.com/patent/US11998344B2

## CPC

- A61B 5/363: Detecting tachycardia or bradycardia
- A61N 1/36: for stimulation
- A61B 5/33: specially adapted for cooperation with other devices
- A61B 5/346: Analysis of electrocardiograms
- A61B 5/361: Detecting fibrillation
- A61B 5/686: {Permanently implanted devices, e.g. pacemakers, other stimulators, biochips (A61B5/6861 takes precedence)}
- A61N 1/3621: {for treating or preventing abnormally high heart rate}
- A61N 1/3622: {comprising two or more electrodes co-operating with different heart regions}
- A61N 1/36578: {controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone}
- A61N 1/37205: {Microstimulators, e.g. implantable through a cannula}
- A61N 1/3956: {Implantable devices for applying electric shocks to the heart, e.g. for cardioversion}
- A61B 5/0031: {Implanted circuitry}
- A61B 5/287: Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
- A61B 5/352: Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval
- A61B 5/7264: {Classification of physiological signals or data, e.g. using neural networks, statistical classifiers, expert systems or fuzzy systems}
- A61N 1/3624: {occurring in the atrium, i.e. atrial tachycardia}
- A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D)
- 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)

## Abstract

An implantable medical device is configured to determine a first atrial arrhythmia score from ventricular events sensed by a sensing circuit of an implantable medical device and determine a second atrial arrhythmia score from an intraventricular signal comprising atrial mechanical event signals attendant to atrial systole and produced by a sensor of the implantable medical device. An atrial arrhythmia is detected based on the first atrial arrhythmia score and the second atrial arrhythmia score.

## Claims

### Claim 1

A medical device, comprising:
a sensor configured to sense a cardiac mechanical signal;
a cardiac electrical signal sensing circuit configured to sense ventricular events;
a pulse generator configured to generate ventricular pacing pulses; and
a control circuit coupled to the sensor, the sensing circuit, and the pulse generator, the control circuit configured to:
identify a plurality of ventricular events comprising the ventricular pacing pulses delivered by the pulse generator and ventricular events sensed by the cardiac electrical signal sensing circuit;
determine a first atrial arrhythmia score from the identified plurality of ventricular events;
determine a second atrial arrhythmia score from the cardiac mechanical signal by:
determining ventricular cycle lengths between the identified plurality of ventricular events;
sensing atrial events from the cardiac mechanical signal;
determining a count of the ventricular cycle lengths that include exactly one sensed atrial event during the respective ventricular cycle length; and
determining the second atrial arrhythmia score based on the determined count;
determine a percentage of the identified plurality of ventricular events that are ventricular pacing pulses;
determine that the percentage of the identified plurality of ventricular events that are ventricular pacing pulses is greater than a threshold percentage;
determine that atrial arrhythmia criteria are met based on the first atrial arrhythmia score and the second atrial arrhythmia score; and
in response to the percentage of the identified plurality of ventricular events that are ventricular pacing pulses being greater than the threshold percentage, withhold a detection of atrial arrhythmia when the atrial arrhythmia criteria are met based on the first atrial arrhythmia score and the second atrial arrhythmia score.

### Claim 2 (depends on 1)

The medical device of claim 1, further comprising a memory configured to store atrial arrhythmia episode data, wherein:
the control circuit is further configured to:
detect an atrial arrhythmia in response to the percentage of the plurality of ventricular events that are ventricular pacing pulses being less than or equal to the threshold percentage when the atrial arrhythmia criteria are met based on the first atrial arrhythmia score and the second atrial arrhythmia score; and
update the atrial arrhythmia episode data in response to detecting the atrial arrhythmia.

### Claim 3 (depends on 2)

The medical device of claim 2, wherein the pulse generator is further configured to:
generate ventricular pacing pulses according to a first pacing mode; and
in response to the control circuit detecting the atrial arrhythmia, generate the ventricular pacing pulses according to a second pacing mode different than the first pacing mode.

### Claim 4 (depends on 2)

The device of claim 2, further comprising a telemetry circuit configured to transmit the atrial arrhythmia episode data.

### Claim 5 (depends on 1)

The medical device of claim 1, wherein the control circuit is further configured to:
adjust the first atrial arrhythmia score based on the second atrial arrhythmia score;
compare the adjusted first atrial arrhythmia score to an arrhythmia threshold; and
determine the atrial arrhythmia criteria are met based on the first arrhythmia score and the second arrhythmia score in response to the adjusted first atrial arrhythmia score being greater than the arrhythmia threshold.

### Claim 6 (depends on 1)

The medical device of claim 1, wherein the control circuit is further configured to:
adjust an atrial arrhythmia threshold based on the second atrial arrhythmia score; and
determine the atrial arrhythmia criteria are met based on the first arrhythmia score and the second arrhythmia score in response to the first atrial arrhythmia score being greater than the atrial arrhythmia threshold that is adjusted based on the second atrial arrhythmia score.

### Claim 7 (depends on 1)

The device of claim 1, wherein:
the sensor comprises an accelerometer configured to sense the cardiac mechanical signal as an acceleration signal; and
the control circuit is further configured to determine the second atrial arrhythmia score from the mechanical signal sensed as the acceleration signal by sensing the atrial events from the acceleration signal.

### Claim 8 (depends on 1)

The medical device of claim 1, wherein:
the sensor comprises one of an impedance sensor configured to sense the mechanical signal as an impedance signal and a pressure sensor configured to sense the mechanical signal as a pressure signal; and
the control circuit is further configured to determine the second atrial arrhythmia score from the mechanical signal by sensing the atrial events from one of the impedance signal and the pressure signal.

### Claim 9

A medical device, comprising:
a sensor configured to sense a cardiac mechanical signal;
a cardiac electrical signal sensing circuit configured to sense ventricular events;
a pulse generator configured to generate ventricular pacing pulses; and
a control circuit coupled to the sensor, the sensing circuit, and the pulse generator, the control circuit configured to:
identify a plurality of ventricular events comprising the ventricular pacing pulses delivered by the pulse generator and ventricular events sensed by the cardiac electrical signal sensing circuit;
determine a first atrial arrhythmia score from the identified plurality of ventricular events;
determine a second atrial arrhythmia score from the cardiac mechanical signal by:
determining ventricular cycle lengths between the identified plurality of ventricular events;
sensing atrial events from the cardiac mechanical signal;
determining a count of the ventricular cycle lengths that include exactly one sensed atrial event during the respective ventricular cycle length; and
determining the second atrial arrhythmia score based on the determined count;
determine that atrial arrhythmia criteria are met based on the first atrial arrhythmia score and the second atrial arrhythmia score; and
detect an atrial arrhythmia in response to the atrial arrhythmia criteria being met based on the first atrial arrhythmia score and the second atrial arrhythmia score.

### Claim 10 (depends on 9)

The medical device of claim 9, wherein the control circuit is further configured to:
detect a plurality of atrial events from the cardiac mechanical signal during a single ventricular cycle length; and
detect atrial flutter in response to detecting the plurality of atrial events during the single ventricular cycle length.

### Claim 11

A method, comprising:
sensing a cardiac mechanical signal;
sensing a cardiac electrical signal;
sensing ventricular events from the cardiac electrical signal;
generating ventricular pacing pulses;
identifying a plurality of ventricular events comprising the ventricular pacing pulses and ventricular events sensed from the cardiac electrical signal;
determining a first atrial arrhythmia score from the identified plurality of ventricular events;
determining a second atrial arrhythmia score from the cardiac mechanical signal by:
determining ventricular cycle lengths between the identified plurality of ventricular events;
sensing atrial events from the cardiac mechanical signal;
determining a count of the ventricular cycle lengths that include exactly one sensed atrial event during the respective ventricular cycle length; and
determining the second atrial arrhythmia score based on the determined count;
determining a percentage of the identified plurality of ventricular events that are ventricular pacing pulses;
determining that the percentage of the identified plurality of ventricular events that are ventricular pacing pulses is greater than a threshold percentage;
determining when atrial arrhythmia criteria are met based on the first atrial arrhythmia score and the second atrial arrhythmia score; and
in response to the percentage of the identified plurality of ventricular events that are ventricular pacing pulses being greater than the threshold percentage, withholding a detection of atrial arrhythmia when the atrial arrhythmia criteria are met based on the first atrial arrhythmia score and the second atrial arrhythmia score.

### Claim 12 (depends on 11)

The method of claim 11, further comprising:
detecting an atrial arrhythmia in response to the percentage of the plurality of ventricular events that are ventricular pacing pulses being less than or equal to the threshold percentage when the atrial arrhythmia criteria are met based on the first atrial arrhythmia score and the second atrial arrhythmia score; and
updating atrial arrhythmia episode data stored in a memory in response to detecting the atrial arrhythmia.

### Claim 13 (depends on 12)

The method of claim 12, further comprising:
generating ventricular pacing pulses according to a first pacing mode; and
in response to detecting the atrial arrhythmia, generating the ventricular pacing pulses according to a second pacing mode different than the first pacing mode.

### Claim 14 (depends on 12)

The method of claim 12, further comprising transmitting the atrial arrhythmia episode data.

### Claim 15 (depends on 11)

The method of claim 11, further comprising:
adjusting the first atrial arrhythmia score based on the second atrial arrhythmia score;
comparing the adjusted first atrial arrhythmia score to an arrhythmia threshold; and
determining that the atrial arrhythmia criteria are met based on the first arrhythmia score and the second arrhythmia score in response to the adjusted first atrial arrhythmia score being greater than the arrhythmia threshold.

### Claim 16 (depends on 11)

The method of claim 11, further comprising:
adjusting an atrial arrhythmia threshold based on the second atrial arrhythmia score; and
determining the atrial arrhythmia criteria are met based on the first arrhythmia score and the second arrhythmia score in response to the first atrial arrhythmia score being greater than the atrial arrhythmia threshold that is adjusted based on the second atrial arrhythmia score.

### Claim 17 (depends on 11)

The method of claim 11, further comprising:
sensing the cardiac mechanical signal by sensing an acceleration signal; and
determining the second atrial arrhythmia score from the mechanical signal sensed as the acceleration signal by sensing the atrial events from the acceleration signal.

### Claim 18 (depends on 11)

The method of claim 11, further comprising:
sensing the cardiac mechanical signal by sensing one of an impedance signal and a pressure signal; and
determining the second atrial arrhythmia score from the mechanical signal by sensing the atrial events from one of the impedance signal and the pressure signal.

### Claim 19

A method, comprising:
sensing a cardiac mechanical signal;
sensing a cardiac electrical signal;
sensing ventricular events from the cardiac electrical signal;
generating one or more ventricular pacing pulse;
identifying a plurality of ventricular events comprising the one or more ventricular pacing pulses and ventricular events sensed from the cardiac electrical signal;
determining a first atrial arrhythmia score from the identified plurality of ventricular events;
determining a second atrial arrhythmia score from the cardiac mechanical signal by:
determining ventricular cycle lengths between the identified plurality of ventricular events;
sensing atrial events from the cardiac mechanical signal;
determining a count of the ventricular cycle lengths that include exactly one sensed atrial event during the respective ventricular cycle length; and
determining the second atrial arrhythmia score based on the determined count;
determining that atrial arrhythmia criteria are met based on the first atrial arrhythmia score and the second atrial arrhythmia score; and
detect an atrial arrhythmia in response to the atrial arrhythmia criteria being met based on the first atrial arrhythmia score and the second atrial arrhythmia score.

### Claim 20 (depends on 19)

The method of claim 19, further comprising:
detecting a plurality of atrial events from the cardiac mechanical signal during a single ventricular cycle length; and
detecting atrial flutter in response to detecting the plurality of atrial events during the single ventricular cycle length.

### Claim 21

A non-transitory, computer-readable storage medium comprising a set of instructions which, when executed by a control circuit of a medical device, cause the medical device to:
sense a cardiac mechanical signal;
sense a cardiac electrical signal;
sense ventricular events from the cardiac electrical signal;
generate ventricular pacing pulses;
identify a plurality of ventricular events comprising the ventricular pacing pulses and ventricular events sensed from the cardiac electrical signal;
determine a first atrial arrhythmia score from the identified plurality of ventricular events;
determine a second atrial arrhythmia score from the cardiac mechanical signal by:
determining ventricular cycle lengths between the identified plurality of ventricular events;
sensing atrial events from the cardiac mechanical signal;
determining a count of the ventricular cycle lengths that include exactly one sensed atrial event during the respective ventricular cycle length; and
determining the second atrial arrhythmia score based on the determined count;
determine a percentage of the identified plurality of ventricular events that are ventricular pacing pulses;
determine that the percentage of the identified plurality of ventricular events that are ventricular pacing pulses is greater than a threshold percentage;
determine when atrial arrhythmia criteria are met based on the first atrial arrhythmia score and the second atrial arrhythmia score; and
in response to the percentage of the identified plurality of ventricular events that are ventricular pacing pulses being greater than the threshold percentage, withhold a detection of atrial arrhythmia when the atrial arrhythmia criteria are met based on the first atrial arrhythmia score and the second atrial arrhythmia score.