Atrial arrhythmia episode detection in a cardiac medical device

1. A method of detecting a cardiac event in a medical device, comprising:

sensing a cardiac signal;

identifying R-waves in the cardiac signal attendant ventricular depolarizations;

determining RR-intervals between successive R-waves in the sensed cardiac signal;

detecting an atrial tachyarrhythmia based on an analysis of the RR-intervals;

iteratively sensing groups of a predetermined number of P-waves attendant atrial depolarizations in response to detecting the atrial tachyarrhythmia; and

confirming the atrial tachyarrhythmia based on an analysis of the iteratively sensed groups of P-waves.

2. The method of claim 1 , wherein confirming the atrial tachyarrhythmia based on the analysis of the iteratively sensed groups of P-waves comprises:

determining P-wave parameters associated with each P-wave of the predetermined number of P-waves;

determining relative differences between the P-wave parameters;

determining whether each of the P-waves of the predetermined number of P-waves of an iteratively sensed group match each other based on the determined relative differences;

determining whether the predetermined number of P-waves of the iteratively sensed group match a P-wave template; and

updating a counter in response to the iteratively sensed group of P-waves matching each other and matching the P-wave template, wherein the atrial tachyarrhythmia is confirmed in response to the counter remaining less than a counter threshold at expiration of a predetermined time period.

3. The method of claim 2 , wherein determining relative differences between the P-wave parameters, comprises:

determining a relative width difference for each of the P-waves; and

determining a relative amplitude difference for each of the P-waves.

4. The method of claim 2 , further comprising:

determining the P-wave template prior to detecting the atrial tachyarrhythmia by sensing a second predetermined number of P-waves when a predetermined number of RR-intervals are greater than an interval threshold;

determining a baseline slope of each of the second predetermined number of P-waves;

adjusting each one of the second predetermined number of P-waves using the respective determined baseline slope, the adjusted P-wave having a zero baseline slope;

modifying each one of the adjusted P-waves by setting all points of the adjusted P-waves having an opposite polarity of a peak amplitude of the adjusted P-wave to zero;

determining a center of area of each of the modified P-waves;

aligning the centers of area of each of the modified P-waves; and

generating a P-wave template from the aligned, modified P-waves.

5. The method of claim 1 , wherein iteratively sensing the groups of the predetermined number of P-waves comprises:

determining P-wave windows based on the determined RR-intervals; and

adjusting P-waves within the P-wave windows by determining a modified P-wave baseline.

6. The method of claim 2 , further comprising:

determining a maximum amplitude of each of the P-waves;

determining, for each of the P-waves, a first minimum point and a second minimum point as a portion of the maximum amplitude;

determining an area of each of the P-waves based on a baseline extending between the first minimum baseline point and the second minimum baseline point;

determining a center of area window of each of the P-waves based on the area and a time interval extending between the first minimum point and the second minimum point; and

determining the P-wave parameters from the center of area windows determined for each of the respective P-waves.

7. The method of claim 6 , wherein determining the center of area window of each of the P-waves comprises:

determining an amplitude of the center of area window from the area and the time interval between the first minimum point and the second minimum point of the respective P-wave; and

determining a width of the center of area window based on the time interval from the first minimum point and the second minimum point.

8. The method of claim 7 , wherein determining the P-wave parameters, comprises:

determining a relative width difference based on the widths of the center of area windows determined for the P-waves; and

determining a relative amplitude difference based on the amplitudes of the center of area windows determined for the P-waves.

9. The method of claim 1 , wherein the atrial tachyarrhythmia is atrial fibrillation.

10. The method of claim 9 , further comprising at least one of withholding a ventricular therapy and storing an episode of the cardiac signal in response to confirming the atrial tachyarrhythmia.

11. A medical device for detecting a cardiac event, comprising:

sensing circuitry configured to receive a cardiac signal from a plurality of electrodes coupled to the medical device; and

a processor configured to:

identify R-waves in the cardiac signal attendant ventricular depolarizations;

determine RR-intervals between successive R-waves in the sensed cardiac signal,

detect an atrial tachyarrhythmia based on an analysis of the RR-intervals; iteratively sense groups of a predetermined number of P-waves attendant atrial depolarizations in response to detecting the atrial tachyarrhythmia; and

confirm the atrial tachyarrhythmia based on an analysis of the iteratively sensed groups of P-waves.

12. The medical device of claim 11 , wherein the processor is configured to confirm the atrial tachyarrhythmia based on the analysis of the iteratively sensed groups of P-waves by:

determining P-wave parameters associated with each P-wave of the predetermined number of P-waves;

determining relative differences between the P-wave parameters;

determining whether each of the P-waves of the predetermined number of P-waves of an iteratively sensed group match each other based on the determined relative differences;

determining whether the predetermined number of P-waves of the iteratively sensed group match a P-wave template; and

updating a counter in response to the iteratively sensed group of P-waves matching each other and matching the P-wave template, wherein the atrial tachyarrhythmia is confirmed in response to the counter remaining less than a counter threshold at expiration of a predetermined time period.

13. The medical device of claim 12 , wherein the processor is configured to determine relative differences between the P-wave parameters by:

determining a relative width difference for each of the P-waves; and

determining a relative amplitude difference for each of the P-waves.

14. The medical device of claim 12 , wherein the processor is further configured to:

determine the P-wave template prior to detecting the atrial tachyarrhythmia by sensing a second predetermined number of P-waves when a predetermined number of RR-intervals are greater than an interval threshold;

determine a baseline slope of each of the second predetermined number of P-waves;

adjust each one of the second predetermined number of P-waves using the respective determined baseline slope, the adjusted P-wave having a zero baseline slope;

modify each one of the adjusted P-waves by setting all points of the adjusted P-waves having an opposite polarity of a peak amplitude of the adjusted P-wave to zero;

determine a center of area of each of the modified P-waves;

align the centers of area of each of the modified P-waves; and

generate a P-wave template from the aligned, modified P-waves.

15. The medical device of claim 11 , wherein the processor is configured to iteratively sense the groups of the predetermined number of P-waves by:

determining P-wave windows based on the determined RR-intervals; and

adjusting P-waves within the P-wave windows by determining a modified P-wave baseline.

16. The medical device of claim 12 , wherein the processor is further configured to:

determine a maximum amplitude of each of the P-waves;

determine, for each of the P-waves, a first minimum point and a second minimum point as a portion of the maximum amplitude;

determine an area of each of the P-waves based on a baseline extending between the first minimum baseline point and the second minimum baseline point;

determine a center of area window of each of the P-waves based on the area and a time interval extending between the first minimum point and the second minimum point; and

determine the P-wave parameters from the center of area windows determined for each of the respective P-waves.

17. The medical device of claim 16 , wherein the processor is configured to determine the center of area window of each of the P-waves by:

determining an amplitude of the center of area window from the area and the time interval between the first minimum point and the second minimum point of the respective P-wave; and

determining a width of the center of area window based on the time interval from the first minimum point and the second minimum point.

18. The medical device of claim 17 , wherein the processor is further configured to determine the P-wave parameters, by:

determining a relative width difference based on the widths of the center of area windows determined for the P-waves; and

determining a relative amplitude difference based on the amplitudes of the center of area windows determined for the P-waves.

19. The medical device of claim 11 , wherein the processor is configured to detect the atrial tachyarrhythmia as atrial fibrillation.

20. The medical device of claim 19 , further comprising therapy output circuitry and a memory, wherein the processor is further configured to provide a response to confirming the atrial tachyarrhythmia, the response comprising at least one of controlling the therapy output circuitry to withhold a ventricular therapy and storing an episode of the cardiac signal in the memory.

21. The medical device of claim 11 , wherein the plurality of electrodes are carried by an extra-cardiovascular lead.

22. A non-transitory, computer-readable storage medium storing instructions for causing a processor included in a medical device to perform a method for detecting a cardiac event, the method comprising:

sensing a cardiac signal;

identifying R-waves in the cardiac signal attendant ventricular depolarizations;

determining RR-intervals between successive R-waves in response to the sensed cardiac signal;

detecting an atrial tachyarrhythmia based on an analysis of the RR-intervals;

iteratively sensing groups of a predetermined number of P-waves attendant atrial depolarizations in response to detecting the atrial tachyarrhythmia; and

confirming the atrial tachyarrhythmia based on an analysis of the iteratively sensed groups of P-waves.

23. The medical device of claim 11 , wherein the processor is configured to iteratively sense the groups of the predetermined number of P-waves by:

setting a timer; and

iteratively sensing the groups of the predetermined number of P-waves until the timer expires.