Medical device and method for detecting atrioventricular block

1. A medical device comprising:

a motion sensor configured to sense a motion signal;

a control circuit configured to:

determine at least one ventricular event metric from the motion signal sensed over a plurality of atrial cycles;

determine that the at least one ventricular event metric meets atrioventricular block criteria; and

generate an output in response to determining that the ventricular event metric meets the atrioventricular block criteria; and

a memory configured to store the generated output,

wherein the control circuit is configured to determine the at least one ventricular event metric by determining an integration metric based on sample point amplitudes of the motion signal during at least a portion of each atrial cycle of the plurality of atrial cycles.

2. The medical device of claim 1 , further comprising:

a sensing circuit configured to sense a cardiac electrical signal and sense P-waves from the cardiac electrical signal; and

a pulse generator configured to generate atrial pacing pulses;

wherein the control circuit is configured to:

determine a count of the plurality of atrial cycles based on at least one of the P-waves sensed by the sensing circuit and the atrial pacing pulses generated by the pulse generator; and

determine the ventricular event metric by dividing the integration metric by the count of the plurality of atrial cycles.

3. The medical device of claim 1 , wherein the control circuit is further configured to:

establish a ventricular event threshold by:

determining the integration metric for each of a plurality of integration intervals; and

setting the ventricular event threshold based on the determined integration metrics;

wherein determining that the at least one ventricular event metric meets the atrioventricular block criteria comprises determining that at least one integration metric determined from the motion signal sensed over the plurality of atrial cycles is less than the ventricular event threshold.

4. The medical device of claim 1 , wherein the control circuit is configured to:

determine at least one of a time of day, an atrial rate, a patient physical activity level, and a patient posture;

set a detection time interval based on at least one of the time of day, the atrial rate, the patient physical activity level, and the patient posture, where the motion signal is sensed over the plurality of atrial cycles occurring during the detection time interval.

5. The medical device of claim 1 , further comprising:

a sensing circuit configured to sense a cardiac electrical signal;

wherein the control circuit is further configured to:

detect an altered morphology of an atrial P-wave sensed by the sensing circuit; and

determine the atrioventricular block criteria are met in response to detecting the altered P-wave morphology.

6. The medical device of claim 1 , wherein the control circuit is further configured to:

set an atrial blanking window during each atrial cycle of the plurality of atrial cycles; and

determine the ventricular event metric from the motion signal sensed outside the atrial blanking windows.

7. The medical device of claim 1 , further comprising a pulse generator configured to deliver an adjusted pacing therapy in response to the control circuit generating the output.

8. The medical device of claim 1 , further comprising:

a sensing circuit configured to sense a cardiac electrical signal;

and

a telemetry circuit;

wherein the control circuit is configured to generate the output by storing in the memory an episode of at least one of the cardiac electrical signal and the motion signal in response to determining the atrioventricular block criteria are met; and

the telemetry circuit is configured to transmit the stored episode.

9. The medical device of claim 1 , further comprising a sensing circuit configured to sense a cardiac electrical signal, and wherein:

the control circuit is configured to:

determine the at least one ventricular event metric by determining an integration metric from the motion signal over each one of a plurality of integration intervals;

determine that a first one of the determined integration metrics is less than or equal to a ventricular event threshold;

start storing a cardiac signal episode in the memory by storing at least one of the motion signal and the cardiac electrical signal in response to determining that the first one of the determined integration metrics is less than or equal to the ventricular event threshold;

determine that the at least one ventricular event metric meets the atrioventricular block criteria by:

determining a representative value of the integration metrics determined over each one of the plurality of integration intervals; and

determining that the representative value is less than or equal to the ventricular event threshold; and

generate the output by storing the cardiac signal episode extending through at least a portion of the plurality of integration intervals as an atrioventricular block episode in the memory.

10. The medical device of claim 1 , further comprising a sensing circuit configured to:

sense a cardiac electrical signal; and

sense far field R-waves from the cardiac electrical signal

wherein the control circuit is further configured to:

determine that far field R-wave sensing from the cardiac electrical signal is lost;

in response to detecting the loss of the far field R-wave sensing, enable atrioventricular block detection based on the motion signal; and

determine the at least one ventricular event metric in response to the atrioventricular block detection being enabled.

11. A medical device comprising:

a motion sensor configured to sense a motion signal;

a control circuit configured to:

determine at least one feature of the motion signal during each atrial cycle of a plurality of atrial cycles;

determine each atrial cycle of the plurality of atrial cycles as one of an atrioventricular block cycle or an atrioventricular conduction cycle based on the at least one feature of the motion signal;

determine at least one ventricular event metric from the motion signal sensed over a plurality of atrial cycles by determining a count of the atrioventricular block cycles;

determine that the at least one ventricular event metric meets atrioventricular block criteria in response to the count of atrioventricular block cycles being greater than a threshold value; and

generate an output in response to determining that the ventricular event metric meets the atrioventricular block criteria; and

a memory configured to store the generated output.

12. The medical device of claim 11 , wherein the control circuit is further configured to determine the at least one ventricular event metric from the motion signal by:

determining a fiducial point of the motion signal during each atrial cycle of the plurality of atrial cycles;

for each atrial cycle of the plurality of atrial cycles, determining an atrioventricular activation time from an atrial event to the fiducial point of the motion signal; and

determining the ventricular event metric based on the atrioventricular activation times determined over the plurality of atrial cycles.

13. The medical device of claim 11 , further comprising a pulse generator configured to deliver an adjusted pacing therapy in response to the control circuit generating the output.

14. The medical device of claim 11 , further comprising:

a sensing circuit configured to sense a cardiac electrical signal; and

a telemetry circuit;

wherein the control circuit is configured to generate the output by storing in the memory an episode of at least one of the cardiac electrical signal and the motion signal in response to determining the atrioventricular block criteria are met; and

the telemetry circuit is configured to transmit the stored episode.

15. The medical device of claim 11 , further comprising a sensing circuit configured to:

sense a cardiac electrical signal; and

sense far field R-waves from the cardiac electrical signal

wherein the control circuit is further configured to:

determine that far field R-wave sensing from the cardiac electrical signal is lost;

in response to detecting the loss of the far field R-wave sensing, enable atrioventricular block detection based on the motion signal; and

determine the at least one ventricular event metric in response to the atrioventricular block detection being enabled.

16. A medical device comprising:

a motion sensor configured to sense a motion signal;

a control circuit configured to:

detect a condition for monitoring for atrioventricular block;

determine at least one ventricular event metric from the motion signal sensed over a plurality of atrial cycles in response to detecting the condition for monitoring for atrioventricular block;

determine that the at least one ventricular event metric meets atrioventricular block criteria; and

generate an output in response to determining that the ventricular event metric meets the atrioventricular block criteria; and

a memory configured to store the generated output.

17. The medical device of claim 16 , further comprising a pulse generator configured to deliver an adjusted pacing therapy in response to the control circuit generating the output.

18. The medical device of claim 16 , further comprising:

a sensing circuit configured to sense a cardiac electrical signal; and

a telemetry circuit;

wherein the control circuit is configured to generate the output by storing in the memory an episode of at least one of the cardiac electrical signal and the motion signal in response to determining the atrioventricular block criteria are met; and

the telemetry circuit is configured to transmit the stored episode.

19. A method, comprising:

sensing a motion signal;

determining at least one ventricular event metric from the motion signal sensed over a plurality of atrial cycles;

determining that the at least one ventricular event metric meets atrioventricular block criteria;

generating an output in response to determining the atrioventricular block criteria are met; and

storing the generated output,

wherein determining the at least one ventricular event metric comprises determining an integration metric based on sample point amplitudes of the motion signal during at least a portion of each atrial cycle of the plurality of atrial cycles.

20. The method of claim 19 , further comprising:

sensing a cardiac electrical signal;

sensing P-waves from the cardiac electrical signal;

generating atrial pacing pulses;

determining a count of the plurality of atrial cycles based on at least one of the sensed P-waves and the atrial pacing pulses; and

determining the ventricular event metric by dividing the integration metric by the count of the plurality of atrial cycles.

21. The method of claim 19 , further comprising:

establishing a ventricular event threshold by:

determining the integration metric for each of a plurality of integration intervals; and

setting the ventricular event threshold based on the determined integration metrics;

wherein determining that the at least one ventricular event metric meets the atrioventricular block criteria comprises determining that at least one integration metric determined from the motion signal sensed over the plurality of atrial cycles is less than the ventricular event threshold.

22. The method of claim 19 , further comprising:

determining at least one of a time of day, an atrial rate, a patient physical activity level, and a patient posture;

setting a detection time interval based on at least one of the time of day, the atrial rate, the patient physical activity level, and the patient posture, where the motion signal is sensed over the plurality of atrial cycles occurring during the detection time interval.

23. The method of claim 19 , further comprising:

determining at least one feature of the motion signal during each atrial cycle of the plurality of cycles;

determining each atrial cycle of the plurality of atrial cycles as one of an atrioventricular block cycle or an atrioventricular conduction cycle based on the at least one feature of the motion signal;

determining the ventricular event metric by determining a count of the atrioventricular block cycles; and

determining that the ventricular event metric meets atrioventricular block criteria in response to the count of atrioventricular block cycles being greater than a threshold value.

24. The method of claim 19 , further comprising:

sensing a cardiac electrical signal;

detecting an altered morphology of an atrial P-wave sensed from the cardiac electrical signal; and

determining the atrioventricular block criteria are met in response to detecting the altered P-wave morphology.

25. The method of claim 19 , wherein determining the at least one ventricular event metric from the motion signal comprises:

determining a fiducial point of the motion signal during each atrial cycle of the plurality of atrial cycles;

for each atrial cycle of the plurality of atrial cycles, determining an atrioventricular activation time from an atrial event to the fiducial point of the motion signal; and

determining the ventricular event metric based on the atrioventricular activation times determined over the plurality of atrial cycles.

26. The method of claim 19 , further comprising:

setting an atrial blanking window during each atrial cycle of the plurality of atrial cycles; and

determining the ventricular event metric from the motion signal sensed outside the atrial blanking windows.

27. The method of claim 19 , further comprising adjusting a pacing therapy in response to generating the output.

28. The method of claim 19 , further comprising:

sensing a cardiac electrical signal;

generating the output by storing an episode of at least one of the cardiac electrical signal and the motion signal in response to determining the atrioventricular block criteria are met; and

transmitting the stored episode.

29. The method of claim 19 , further comprising:

detecting a condition for monitoring for atrioventricular block; and

determining the at least one ventricular event metric from the motion signal in response to detecting the condition for monitoring for atrioventricular block.

30. The method of claim 19 , further comprising:

sensing a cardiac electrical signal;

determining the at least one ventricular event metric by determining an integration metric from the motion signal over each one of a plurality of integration intervals;

determining that a first one of the determined integration metrics is less than or equal to a ventricular event threshold;

starting storage of a cardiac signal episode in the memory by storing at least one of the motion signal and the cardiac electrical signal in response to determining that the first one of the determined integration metrics is less than or equal to the ventricular event threshold;

determining that the at least one ventricular event metric meets the atrioventricular block criteria by:

determining a representative value of the integration metrics determined over each one of the plurality of integration intervals; and

determining that the representative value is less than or equal to the ventricular event threshold; and

generating the output by storing the cardiac signal episode extending through at least a portion of the plurality of integration intervals as an atrioventricular block episode in the memory.

31. 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 motion signal;

determine at least one ventricular event metric from the motion signal sensed over a plurality of atrial cycles by determining an integration metric based on sample point amplitudes of the motion signal during at least a portion of each atrial cycle of the plurality of atrial cycles;

determine that the at least one ventricular event metric meets atrioventricular block criteria;

generate an output in response to determining the atrioventricular block; and

store the output in a memory of the medical device.