# US 8,540,642 B2 · Implantable medical device and method for physiological event monitoring

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- Number: US 8,540,642 B2
- Document ID: US8540642B2
- Status: Granted
- Kind: B2
- Application number: 11/669,345
- Filed: 2007-01-31
- Published: 2008-07-31
- Granted: 2013-09-24
- Earliest claimed: 2007-01-31
- Assignees: Medtronic, Inc.
- Applicants: Geeske Van Oort; Willem Boute; Gustaaf A. P. Stoop
- Inventors: Geeske Van Oort; Willem Boute; Gustaaf A. P. Stoop
- Web page: https://patentgrep.com/patent/US8540642B2

## CPC

- A61N 1/3621: {for treating or preventing abnormally high heart rate}
- A61N 1/3627: {for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy}
- A61N 1/3925: {Monitoring; Protecting}
- 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 uses a method for dynamically managing physiological signal monitoring. A physiological signal is sensed for detecting physiological events in response a first threshold. A determination is made whether a second threshold has been met in response to detecting physiological events. If the second threshold has been met, detailed monitoring of the physiological events is enabled.

## Claims

### Claim 1

A method for use in an implantable medical device, comprising:
storing a first threshold corresponding to detecting a first physiological event;
sensing a first physiological signal corresponding to the first physiological event;
detecting a plurality of the first physiological events in response to the first physiological signal and the first threshold;
storing a second threshold different than the first threshold;
determining, in response to detecting at least one of the plurality of the first physiological events, if the second threshold has been met; and
enabling detailed monitoring of next ones of the detected plurality of the first physiological events in response to the second threshold being met.

### Claim 2 (depends on 1)

The method of claim 1 wherein the first physiological event corresponds to a first event category comprising a plurality of first physiological event types, and the detailed monitoring comprises monitoring the plurality of the first physiological event types.

### Claim 3 (depends on 2)

The method of claim 2 wherein the detailed monitoring comprises storing physiological signal data in memory in response to detecting an event and further comprising;
storing a priority for each of the plurality of first physiological event types,
comparing the priority of one of the plurality of the first physiological event types corresponding to the detected event and the priority of an other of the plurality of the first physiological event types, and
if the priority of the one of the plurality of the first physiological event types corresponding to the detected event is higher than the priority of the other of the plurality of the first physiological event types, overwriting previously stored physiological signal data corresponding to a previously detected event with physiological signal data corresponding to the detected event, the previously detected event corresponding to the other of the plurality of the first physiological event types.

### Claim 4 (depends on 3)

The method of claim 3 wherein the detailed monitoring further comprises:
determining a severity index for the detected event;
comparing the severity index for the detected event to a severity index of a previously stored event of the same event type;
if the severity index for the detected event corresponds to a more severe event than the previously stored event, determining the least severe of a plurality of previously stored events of the same event type; and
overwriting the least severe of the plurality of the previously stored events with physiological data corresponding to the detected event.

### Claim 5 (depends on 2)

The method of claim 2 wherein monitoring the plurality of the first physiological event types comprises discriminating between the plurality of the first physiological event types in response to the first physiological signal.

### Claim 6 (depends on 2)

The method of claim 2 wherein the detailed monitoring further comprises sensing a second physiological signal and wherein monitoring the plurality of the first physiological event types includes detecting at least one of the plurality of the first physiological event types in response to the second physiological signal.

### Claim 7 (depends on 2)

The method of claim 2 further comprising:
storing a third threshold corresponding to detecting a second physiological event;
sensing a second physiological signal corresponding to the second physiological event, the second physiological event corresponding to a second event category comprising a plurality of second physiological event types;
detecting a plurality of the second physiological events in response to the second physiological signal and the third threshold;
storing a fourth threshold different than the third threshold;
determining, in response to detecting at least one of the plurality of the second physiological events, if the fourth threshold has been met; and
enabling detailed monitoring of next ones of the detected plurality of the second physiological events in response to the fourth threshold being met.

### Claim 8 (depends on 7)

The method of claim 7 wherein the detailed monitoring comprises storing physiological signal data upon detecting an event corresponding to one of the first event category and the second event category and further comprising:
storing a priority for each of the first event category and the second event category;
comparing the priority of one of the first and the second event categories corresponding to the detected event and the priority of the other of the first and the second event categories, and
if the priority of the one of the first and the second event categories corresponding to the detected event is higher than the priority of the other of the first and the second event categories, overwriting previously stored physiological signal data corresponding to a previously detected event with physiological data corresponding to the detected event, the previously detected event corresponding to the other of the first and the second event categories.

### Claim 9 (depends on 1)

The method of claim 1 wherein the detailed monitoring comprises storing a detection threshold for each of the plurality of the first physiological event types.

### Claim 10 (depends on 1)

The method of claim 1 wherein the detailed monitoring comprises storing physiological signal data.

### Claim 11 (depends on 10)

The method of claim 10 wherein the physiological signal data includes a snapshot of the first physiological signal.

### Claim 12 (depends on 11)

The method of claim 11 wherein the detailed monitoring further comprises:
determining a severity index for each of a plurality of previously stored events corresponding to the other of the first and the second event categories;
determining one of the plurality of previously stored events having a lowest severity index; and
overwriting the one of the previously stored events having the lowest severity index with the physiological data corresponding to the detected event.

### Claim 13 (depends on 1)

The method of claim 1 further comprising:
storing a third threshold,
determining if the third threshold has been met in response to the first physiological signal after detailed monitoring has been enabled, and
disabling detailed monitoring in response to the third threshold being met.

### Claim 14

A non-transitory computer-readable medium for storing a set of instructions, which when implemented in an implantable medical device, cause the device to:
store a first threshold corresponding to detecting a first physiological event;
sense a first physiological signal corresponding to the first physiological event;
detect a plurality of the first physiological events in response to the first physiological signal and the first threshold;
store a second threshold different than the first threshold;
determine, in response to detecting at least one of the plurality of the first physiological events, if the second threshold has been met; and
enable detailed monitoring of next ones of the detected plurality of the first physiological events in response to the second threshold being met.

### Claim 15 (depends on 14)

The computer-readable medium of claim 14 wherein the first physiological event corresponds to a first event category comprising a plurality of first physiological event types, and the detailed monitoring comprises monitoring the plurality of the first physiological event types.

### Claim 16 (depends on 15)

The computer-readable medium of claim 15 wherein the detailed monitoring further comprises:
storing physiological signal data in memory in response to detecting an event;
storing a priority for each of the plurality of the first physiological event types,
comparing the priority of one of the plurality of the first physiological event types corresponding to the detected event and the priority of an other of the plurality of the first physiological event types, and
if the priority of the one of the plurality of the first physiological event types corresponding to the detected event is higher than the priority of the other of the plurality of the first physiological event types, overwriting previously stored physiological signal data corresponding to a previously detected event with the physiological signal data corresponding to the detected event, the previously detected event corresponding to the other of the plurality of the first physiological event types.

### Claim 17 (depends on 15)

The computer-readable medium of claim 15 further comprising instructions that cause the system to:
store a third threshold corresponding to detecting a second physiological event;
sense a second physiological signal corresponding to the second physiological event, the second physiological event corresponding to a second event category comprising a plurality of second physiological event types;
detect a plurality of the second physiological events in response to the second physiological signal and the third threshold;
store a fourth threshold different than the third threshold;
determine, in response to detecting at least one of the plurality of the second physiological events, if the fourth threshold has been met; and
enable detailed monitoring of next ones of the detected plurality of the second physiological events in response to the fourth threshold being met.

### Claim 18 (depends on 17)

The computer-readable medium of claim 17 wherein the detailed monitoring comprises storing physiological signal data upon detecting an event corresponding to one of the first physiological event category and the second physiological event category and further comprising instructions that cause the system to:
store a priority for each of the first physiological event category and the second physiological event category;
compare the priority of one of the first and the second event categories corresponding to the detected event and the priority of the other of the first and the second event categories, and
if the priority of the one of the first and the second event categories corresponding to the detected event is higher than the priority of the other of the first and the second event categories, overwrite previously stored physiological signal data corresponding to a previously detected event with physiological signal data corresponding to the detected event, the previously detected event corresponding to the other of the first and the second event categories.

### Claim 19 (depends on 17)

The computer-readable medium of claim 17 wherein the detailed monitoring further comprises:
determining a severity index for the detected event;
comparing the severity index for the detected event to a severity index of a previously stored event of the same event type;
if the severity index for the detected event corresponds to a more severe event than the previously stored event, determining the least severe of a plurality of previously stored events of the same event type; and
overwriting the least severe of the plurality of the previously stored events with the physiological data corresponding to the detected event.

### Claim 20 (depends on 18)

The computer-readable medium of claim 18 wherein the detailed monitoring further comprises:
determining a severity index for each of a plurality of previously stored events corresponding to the other of the first and the second event categories;
determining one of the plurality of previously stored events having a lowest severity index; and
overwriting the one of the previously stored events having the lowest severity index with the physiological data corresponding to the detected event.

### Claim 21 (depends on 15)

The computer-readable medium of claim 15 wherein the detailed monitoring comprises storing a detection threshold for each of the plurality of first physiological event types.

### Claim 22 (depends on 15)

The computer-readable medium of claim 15 wherein monitoring the plurality of the first physiological event types comprises discriminating between the plurality of the first physiological event types in response to the first physiological signal.

### Claim 23 (depends on 15)

The computer-readable medium of claim 15 wherein the detailed monitoring further comprises enabling sensing of a second physiological signal and wherein the monitoring the plurality of the first physiological event types includes detecting at least one of the plurality of the first physiological event types in response to the second physiological signal.

### Claim 24 (depends on 14)

The computer-readable medium of claim 14 wherein the detailed monitoring comprises storing physiological signal data.

### Claim 25 (depends on 24)

The computer-readable medium of claim 24 wherein the physiological signal data includes a snapshot of the first physiological signal.

### Claim 26 (depends on 14)

The computer-readable medium of claim 14 further comprising instructions that cause the system to:
store a third threshold,
determine if the third threshold has been met in response to the first physiological signal after detailed monitoring has been enabled, and
disable detailed monitoring in response to the third threshold being met.

### Claim 27

An implantable medical device, comprising:
a first physiological sensor for sensing a first physiological signal corresponding to a first physiological event;
a detection module for detecting a plurality of the first physiological events in response to the first physiological signal and a first threshold;
a control module configured to determine, in response to the detection module detecting at least one of the plurality of the first physiological events, if a second threshold has been met, the second threshold being different than the first threshold, and in response to the second threshold being met enable detailed monitoring of next ones of the detected plurality of the first physiological events.

### Claim 28 (depends on 27)

The device of claim 27 wherein the first physiological event corresponds to a first event category comprising a plurality of first physiological event types, and the detailed monitoring comprises monitoring the plurality of the first physiological event types.

### Claim 29 (depends on 28)

The device of claim 28 further comprising a memory for storing a priority for each of the plurality of the first physiological event types and wherein the detailed monitoring comprises storing physiological signal data in the memory in response to detecting an event corresponding to the first event category;
wherein the control module being further configured to compare the priority of one of the plurality of the first physiological event types corresponding to the detected event and the priority of an other of the plurality of the first physiological event types, and
if the priority of the one of the plurality of the first physiological event types corresponding to the detected event is higher than the priority of the other of the plurality of the first physiological event types, overwriting previously stored physiological signal data corresponding to a previously detected event with the physiological signal data corresponding to the detected event, the previously detected event corresponding to the other of the plurality of the first physiological event types.

### Claim 30 (depends on 29)

The device of claim 29 wherein the control module being further configured to determine a severity index for the detected event, compare the severity index for the detected event to a severity index of a previously stored event of the same event type, and if the severity index for the detected event corresponds to a more severe event than the previously stored event, determine the least severe of a plurality of previously stored events of the same event type and overwrite the least severe of the plurality of the previously stored events with the physiological data corresponding to the detected event.

### Claim 31 (depends on 28)

The device of claim 28 further comprising:
a second physiological sensor for sensing a second physiological signal corresponding to a second physiological event, the second physiological event corresponding to a second event category comprising a plurality of second physiological event types;
wherein the detection module being configured to detect a plurality of the second physiological events in response to the second physiological signal and a third threshold; and
wherein the control module being configured to determine, in response to the detection module detecting at least one of the plurality of the second physiological events, if a fourth threshold has been met and in response to the fourth threshold being met enable detailed monitoring of next ones of the detected plurality of the second physiological events.

### Claim 32 (depends on 31)

The device of claim 31 further comprising a memory for storing a priority of each of the first event category and the second event category and
wherein the memory includes a portion allocated for storing physiological data and the detailed monitoring includes storing physiological signal data in the memory portion upon detecting an event;
wherein the control module being configured to compare the priority of one of the first and the second event categories corresponding to the detected event and the priority of the other of the first and the second event categories, and if the priority of the one of the first and the second event categories corresponding to the detected event is higher than the priority of the other of the first and the second event categories, overwrite previously stored physiological signal data corresponding to a previously detected event with the physiological signal data corresponding to the detected event, the previously detected event corresponding to the other of the first and the second event categories.

### Claim 33 (depends on 32)

The device of claim 32 wherein the control module being further configured to determine a severity index for each of a plurality of previously stored events corresponding to the other of the first and the second event categories, determine one of the plurality of previously stored events having a lowest severity index, and overwrite the one of the previously stored events having the lowest severity index with the physiological data corresponding to the detected event.

### Claim 34 (depends on 28)

The device of claim 28 wherein the detailed monitoring comprises storing a detection threshold for each of the plurality of the first physiological event types.

### Claim 35 (depends on 28)

The device of claim 28 wherein monitoring the plurality of the first physiological event types comprises discriminating between the plurality of the first physiological event types in response to the first physiological signal.

### Claim 36 (depends on 28)

The device of claim 28 further comprising a second physiological sensor for sensing a second physiological signal and wherein the detailed monitoring comprises sensing of the second physiological signal and detecting at least one of the plurality of the first physiological event types in response to the second physiological signal.

### Claim 37 (depends on 27)

The device of claim 27 further comprising a memory and wherein the detailed monitoring comprises storing physiological signal data in the memory.

### Claim 38 (depends on 37)

The device of claim 37 wherein the physiological signal data includes a snapshot of the first physiological signal.

### Claim 39 (depends on 27)

The device of claim 27 wherein the control module being further configure to determine if a third threshold has been met in response to the first physiological signal after detailed monitoring has been enabled and disable detailed monitoring in response to the third threshold being met.