Device and method for detecting ventricular arrhythmias based on duty cycle characteristics
A computer implemented method and system for detecting an arrhythmia are provided. The method is under control of one or more processors configured with executable instructions. The method obtains far field cardiac activity (CA) signals sensed at electrodes located remote from a heart over a period of time and applies a feature attenuation filter to the CA signals to form modified CA signals. The feature attenuation filter reduces potential T-waves as a feature not of interest. The method calculates a duty cycle (DC) characteristic of the modified CA signals with respect to duty cycle boundaries and detects an arrhythmia based on the DC characteristic.
1 . A computer implemented method for detecting an arrhythmia, comprising,
under control of one or more processors configured with executable instructions:
sensing far field cardiac activity (CA) signals at electrodes located remote from a heart over a period of time;
applying a feature attenuation filter to the CA signals to form modified CA signals, the feature attenuation filter reducing potential T-waves as a feature not of interest;
calculating a duty cycle (DC) characteristic of the modified CA signals with respect to upper and lower duty cycle boundaries and upper and lower sensitivity thresholds, wherein the upper duty cycle boundary having a positive voltage level and the lower duty cycle boundary having a negative voltage level, wherein the upper and lower duty cycle boundaries are at levels within the upper and lower sensitivity thresholds;
detecting an arrhythmia based on the DC characteristic; and
delivering a therapy based on detection of the arrhythmia.
2 . The method of claim 1 , further comprising defining a duration of a measurement window, wherein the calculating includes determining the duty cycle characteristic based on a relation between the measurement window and a segment of the modified CA signals that exceed the upper or lower duty cycle boundaries but do not exceed the upper or lower sensitivity thresholds.
3 . The method of claim 2 , further comprising: determining a series of intervals during which the modified CA signals exceed the upper or lower duty cycle boundaries, but do not exceed the upper or lower sensitivity thresholds; summing the series of intervals; and defining the segment by an interval of time that represents a sum of the series of intervals.
4 . The method of claim 3 , further comprising identifying R-waves in the CA signals that exceed the upper and lower sensitivity thresholds.
5 . The method of claim 2 , further comprising determining regions representing area under the curve of the modified CA signals that falls between the upper duty cycle boundary and the upper sensitivity threshold or the lower duty cycle boundary and the lower sensitivity threshold; and defining the segment based on an area of the regions.
6 . The method of claim 1 , wherein the upper and lower duty cycle boundaries correspond to amplitude boundaries of the modified CA signals.
7 . The method of claim 1 , further comprising implementing the sensing and applying operations by an implantable medical device; and determining the calculating and detecting operations by an external device.
8 . The method of claim 1 , further comprising applying a primary arrhythmia detection algorithm to declare arrhythmias, the one or more processors further configured to utilize the DC characteristic as a confirmation process to deny or verify the arrhythmias declared by the primary arrhythmia detection algorithm.
9 . The method of claim 1 , further comprising: determining one or more characteristics of interest from the CA signals; and dynamically adjusting the upper and lower duty cycle boundaries based on the one or more characteristics of interest from the CA signals.
10 . The method of claim 1 , further comprising defining a duration of a measurement window, wherein the upper and lower duty cycle boundaries further comprise a plurality of threshold levels, wherein the calculating further includes determining the duty cycle characteristic based on i) determining a relation between the measurement window and a segment of the modified CA signals that exceed a first threshold level of the plurality of threshold levels, but do not exceed a second threshold level of the plurality of threshold levels, and ii) applying a weight to the modified CA signals within the segment.
11 . The method of claim 10 , wherein the calculating further includes determining the duty cycle characteristic is further based on i) determining a relation between the measurement window and a second segment of the modified CA signals that exceed the second threshold level but do not exceed a third threshold level of the plurality of threshold levels, and ii) applying a second weight to the modified CA signals within the second segment, wherein the first and second weights are different with respect to each other.
12 . A system for detecting arrhythmias, comprising:
electrodes configured to sense far field cardiac activity (CA) signals over a period of time, the electrodes configured to be located remote from a heart;
a feature attenuation filtering circuit configured to apply a feature attenuation filter to the CA signals to form modified CA signals, the feature attenuation filter reducing potential T-waves as a feature not of interest;
memory to store specific executable instructions; and
one or more processors, that when executing the specific executable instructions, are configured to:
define upper and lower duty cycle boundaries and upper and lower sensitivity thresholds, wherein the upper duty cycle boundary having a positive voltage level and the lower duty cycle boundary having a negative voltage level, wherein the upper and lower duty cycle boundaries are at levels within the upper and lower sensitivity thresholds;
calculate a duty cycle (DC) characteristic of the modified CA signals with respect to the upper and lower duty cycle boundaries and the upper and lower sensitivity thresholds;
detect an arrhythmia based on the DC characteristic; and
deliver a therapy based on detection of the arrhythmia.
13 . The system of claim 12 , wherein the one or more processors are further configured to: define a duration of a measurement window; and determine the duty cycle characteristic based on a relation between the measurement window and a segment of the modified CA signals that exceed the upper or lower duty cycle boundaries but do not exceed the upper and lower sensitivity thresholds.
14 . The system of claim 13 , wherein the one or more processors are further configured to determine a series of intervals during which the modified CA signals exceed the upper or lower duty cycle boundaries, but do not exceed the upper or lower sensitivity thresholds; sum the series of intervals; and define the segment by an interval of time that represents the sum of the series of intervals.
15 . The system of claim 14 , further comprising sensing circuitry configured to utilize the upper and lower sensitivity thresholds in connection with sensing R waves in the CA signals.
16 . The system of claim 13 , wherein the one or more processors are further configured to determine regions representing area under the curve of the modified CA signals that falls between the upper duty cycle boundary and the upper sensitivity threshold or the lower duty cycle boundary and the lower sensitivity threshold; and define the segment based on an area of the regions.
17 . The system of claim 12 , wherein the upper and lower duty cycle boundaries correspond to amplitude boundaries of the modified CA signals.
18 . The system of claim 12 , further comprising: an implantable medical device configured to include the electrodes and feature attenuation filtering circuit; and an external device configured to include the one or more processors that are configured to implement the calculate and detect operations.
19 . The system of claim 12 , wherein the one or more processors are further configured to: determine one or more characteristics of interest from the CA signals; and dynamically adjust the upper and lower duty cycle boundaries based on the one or more characteristics of interest from the CA signals.
20 . The system of claim 12 , wherein the feature attenuation filtering circuit represent a bandpass filter having a passband at 8-15 Hz.
21 . The system of claim 12 , further comprising at least one of a primary channel or a secondary channel associated with the electrodes, wherein the one or more processors are further configured to confirm at least one undersensing condition in advance of calculating the duty cycle characteristic, the at least one undersensing condition based on the CA signals sensed by the at least one of a primary channel or a secondary channel and filtered by the feature attenuation filtering circuit, wherein the at least one undersensing condition includes at least one of sensing R-R intervals or sensing R-wave peak amplitudes.
22 . The system of claim 21 , wherein the one or more processors are further configured to compare the R-R intervals to a predetermined time duration or to determine that X out of Y of the last R-R intervals are long sensed R-R intervals.