WO1997039799A1 - Procede de detection de l'arythmie cardiaque - Google Patents

Procede de detection de l'arythmie cardiaque Download PDF

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Publication number
WO1997039799A1
WO1997039799A1 PCT/US1997/006728 US9706728W WO9739799A1 WO 1997039799 A1 WO1997039799 A1 WO 1997039799A1 US 9706728 W US9706728 W US 9706728W WO 9739799 A1 WO9739799 A1 WO 9739799A1
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WO
WIPO (PCT)
Prior art keywords
tachycardia
retrograde
cardiac arrhythmia
classifying
interval
Prior art date
Application number
PCT/US1997/006728
Other languages
English (en)
Inventor
Shelly A. Stevenson
Janice M. Jenkins
Julie A. Thompson
Lorenzo A. Dicarlo
Original Assignee
The Regents Of The University Of Michigan
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by The Regents Of The University Of Michigan filed Critical The Regents Of The University Of Michigan
Priority to AU27389/97A priority Critical patent/AU2738997A/en
Publication of WO1997039799A1 publication Critical patent/WO1997039799A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/3621—Heart stimulators for treating or preventing abnormally high heart rate
    • A61N1/3622—Heart stimulators for treating or preventing abnormally high heart rate comprising two or more electrodes co-operating with different heart regions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/38—Applying electric currents by contact electrodes alternating or intermittent currents for producing shock effects
    • A61N1/39—Heart defibrillators
    • A61N1/3956—Implantable devices for applying electric shocks to the heart, e.g. for cardioversion
    • A61N1/3962—Implantable devices for applying electric shocks to the heart, e.g. for cardioversion in combination with another heart therapy
    • A61N1/39622—Pacing therapy

Definitions

  • the present invention relates generally to the detection of cardiac arrhythmia. More particularly, the present invention relates to detection of cardiac arrhythmia by ventriculoatrial (VA) internal analysis.
  • VA ventriculoatrial
  • the heart may be viewed as a spontaneous current generator whose pumping action is effected by spontaneous generation of an electrical impulse (known as an action potential), conduction of the electrical impulse throughout the heart, and subsequent contraction of the heart muscle (myocardium) in response to the impulse. It is, therefore, electrical activity which initiates and controls muscular contraction of the heart.
  • an electrical impulse known as an action potential
  • conduction of the electrical impulse throughout the heart and subsequent contraction of the heart muscle (myocardium) in response to the impulse. It is, therefore, electrical activity which initiates and controls muscular contraction of the heart.
  • the heart's electrical impulse originates in the sino-atrial node and is transmitted (cell-to-cell) to all portions of the atria, resulting in the contraction of the atrial chambers.
  • the electrical impulse continues in its path to reach a cluster of conduction fibrils known as the atrioventricular node, or the A-V node.
  • the A-V node acts as a buffer for impulses from the atria to the ventricles. This allows for proper flow of blood from the atria to the ventricles.
  • the A-V node transmits an impulse that reaches another cluster of fibers known as the bundle of His which comprises left and right bundle branches of the His-Purkinjie system.
  • the bundle branches terminate with the Purkinjie fibers which are attached directly to the myocardial cells.
  • a coordinated wave of electrical impulses effects contraction of many myocardial cells simultaneously, thus causing the heart's pumping action.
  • the action begins in the sino-atrial node from which impulses are provided spontaneously and periodically.
  • the impulses travel to the surrounding cardiac tissue and propagate as a wave of depolarization.
  • contracting of the cardiac muscle of the atria follows after the depolarization.
  • Subsequent ventricular conduction is initiated via the A-V node and the His-Purkinjie system
  • Arrhythmias may be atrial, atrioventricular, or ventricular.
  • Radio frequency ablation Another therapeutic technique is referred to as radio frequency ablation which is directed to neutralizing accessory electrically-conductive pathways of the heart which cause the heart to fail in properly conducting electrical impulses due to some small area of the heart which is skewing the direction of depolarization
  • a catheter is introduced into the heart and high frequency radio waves are delivered to burn away the faulty area of the heart
  • normal conduction of the heart will return and the particular arrhythmia associated with the damaged tissue will be eliminated.
  • One of the most common approaches to the elimination of arrhythmia is electrical therapy in which electrodes are fitted to either the body or the heart for selectively delivering an electrical current or shock to alter the abnormal rhythm of the heart.
  • Implantable cardioverter defibrillator stimulate the heart directly using function generators with specific waveforms to respond to and treat arrhythmias on an "as-needed" basis.
  • ICDs Implantable cardioverter defibrillator
  • function generators with specific waveforms to respond to and treat arrhythmias on an "as-needed" basis.
  • ICDs have emerged as the treatment of choice for malignant tachyarrhymias unresponsive to antiarrhythmic drugs.
  • detection circuitry i.e., insuring true-positives
  • preventing a "no output" situation when an output is actually needed i.e., preventing true negatives.
  • Implantable cardioverter defibrillator have achieved overwhelming success in salvaging thousands of lives by providing immediate electrical therapy for the treatment of potentially lethal arrhythmias. These rhythms are believed to be responsible for over 80% of cases of sudden cardiac death, which is estimated to annually claim 400,000 victims. The vast number of implants of ICDs is exceptional despite its relative infancy in the medical field.
  • a remaining area of improvement in ICD technology relates to refinement of detection criteria such that delivery of shock therapy is prevented when none is needed.
  • the application of electrical shock in response to the incorrect identification of ventricular fibrillation (VF) or ventricular tachycardia (VT) i.e., false positives
  • VF ventricular fibrillation
  • VT ventricular tachycardia
  • false shocks present an unnecessary patient distress.
  • false shocks deplete battery power which renders the device less capable of addressing true urgencies and forces premature explanation.
  • false delivery of therapy can initiate ventricular tachycardia or ventricular fibrillation when none previously existed.
  • ICDs rely predominantly on single (ventricular) chamber analysis of arrhythmias. Rate criteria are set such that ventricular tachycardia and ventricular fibrillation are detected with high sensitivity to ensure dangerous arrhythmias are never missed. High sensitivity, however, comes at the cost of limited specificity. Distinction of VT and VF from nonthreatening supraventricular rhythms remains a severe limitation in present ICDs.
  • the ICD may unnecessarily discharge during any arrhythmia in which the ventricular heart rate exceeds a preprogrammed threshold value. Unnecessary shocks have been reported to occur in 9-41 % of treatments with ICDs.
  • ICDs incorporate an atrial sensing lead in addition to a ventricular sensing lead.
  • ICDs One type of dual-chamber sensing ICD is commercially available from ELA Medical, Co. of France.
  • n:1 (A V) relationship where n does not equal 1
  • atrial tachycardia with anterograde conduction which doesn't need treatment
  • retrograde conduction which needs treatment
  • the present invention addresses the above-discussed problems which have heretofore arisen in correctly discerning between atrial tachycardia and ventricular tachycardia with retrograde where the A:V ratio is 1 :1.
  • the introduction of dual chamber sensing in antitachycardia devices allows for computationally inexpensive measurements of VA intervals.
  • the present invention provides a method of classifying a cardiac arrhythmia with a 1 :1 confounding relationship as either an atrial tachycardia or a ventricular tachycardia with retrograde
  • the method includes the steps of measuring a characteristic (e.g , the VA interval) of a tachycardia and comparing the characteristic to an established range of acceptable values
  • the method of the present invention includes the step of classifying the cardiac arrhythmia as a retrograde conduction when the characteristic is between the upper boundary and the lower boundary of the acceptable range and as an anterograde conduction when the characteristic is beyond the range of acceptable values.
  • the present invention provides a method for reducing unnecessary shock treatments from an anti-tachycardia device by discerning between atrial tachycardias having anterograde and retrograde conductions with confounding 1 1 relationships
  • the method includes the initial steps of placing a first lead of a dual chamber sensor in operative sensory association with a ventricular chamber of a patient's heart and placing a second lead of the dual chamber sensor in operative sensory association with the atrial chamber of the patient's heart
  • the dual chamber sensor is operatively associated with the anti-tachycardia device and a plurality of signals provided by the first and second leads of the dual chamber sensor are used to measure the VA interval of the tachycardia
  • the VA interval of the tachycardia is compared against established upper and lower boundaries
  • the tachycardia is classified as a retrograde conduction when the VA interval is between the upper and lower boundaries and classified as an anterograde conduction when the VA interval is outside the upper and lower boundaries
  • Figure 1 is a schematic diagram of an implantable cardioverter defibrillator embodying the present invention for applying defibnllating electrical energy to a human heart shown in operative association with a human heart
  • Figure 2 is a simplified flow chart showing the general steps of the method of the present invention.
  • Figure 3 is a flow chart setting forth the establishment of an algorithm using VA interval criterion to classify 1 -1 retrograde activation according to the present invention.
  • Figure 4 is a simplified flow chart showing the general steps involved in applying the algorithm of the present invention for identifying VT with retrograde.
  • Figure 5 is a graph plotting the mean VA interval of naturally occurring anterograde and retrograde conductions
  • FIG. 1 a schematic diagram of an implantable cardioverter defibrillator 10 is shown in operative association with a human heart 12.
  • the portions of the heart 10 illustrated include the right ventricle 14, the left ventricle 16, the right atrium 18, and the left atrium 20, and the superior vena cava 22.
  • the ICD 10 generally includes an enclosure 24 for hermetically sealing the internal circuit elements to be described hereinafter, and first and second leads 26 and 28.
  • the enclosure 24 and first and second leads 26 and 28 are arranged to be implanted beneath the skin of a patient in a conventional manner so as to render the ICD 10 fully implantable.
  • the first lead 26 generally includes an electrode 30. As illustrated, the first lead 26 is flexible and is passed down the superior vena cava 22, so that the electrode 30 is preferably positioned high in the right atrium 18.
  • the second lead 28 is also flexible and similarly includes an electrode 32. As illustrated, the second lead 28 is fed through the superior vena cava 22, into the right atrium 18, and then into the right ventricle 14.
  • the electrodes 30 and 32 of the first and second leads 34 and 36, respectively, provide dual-chamber sensing of heart activity.
  • the electrode 32 further provides for the delivery of defibnllating electrical energy to the heart 10.
  • the contents within the enclosure 24 of the ICD 10 is largely convention in nature and is shown to include a pair of amplifiers 36 and 38 for receiving signals from the electrodes 30 and 32.
  • the enclosure further includes a microprocessor 40 which conventionally includes one or more counters, a time stamp, comparators, and in-dwelling software, all of which cooperate in a well known manner to detect tachycardias without a 1 :1 confounding relationship.
  • the otherwise conventional in-dwelling software has been modified to incorporate an algorithm in accordance with the present invention for detecting tachycardias with a 1 :1 confounding relationship.
  • the microprocessor 40 is arranged to operate in conjunction with a memory 42.
  • the contents within the enclosure 24 of the ICD 10 is further shown to include a discharge circuit 44 coupled to the electrode 32 for applying cardioverting or defibnllating electrical energy to the heart 12.
  • a depletable power source 46 such as a lithium battery, for providing power to the electrical components of the ICD 10.
  • FIG 2 is a flow chart illustrating the general steps of the present invention.
  • the Start 50 of the application of the present invention begins upon receipt by the ICD of signals from the electrodes 30 and 32.
  • the VA interval of the tachycardia is compared with predetermined acceptable boundaries 54 and 56 (shown in Figure 5).
  • the predetermined boundaries 54 and 56 are established such that the tachycardia is classified as a retrograde conduction which requires treatment if the VA interval of the tachycardia is within the boundaries 54 and 56. Conversely, if the VA interval of the tachycardia is beyond the predetermined boundaries 54 and 56, the tachycardia is classified as an anterograde conduction which does not require treatment.
  • shock therapy by the ICD is delivered to the patient's heart 12, if and only if, the VA interval of the tachycardia is within the predetermined boundaries 54 and 56. Otherwise, the method of the present invention returns to the Start point 50 for analysis of subsequent tachycardias with confounding 1 :1 relationships.
  • the predetermined boundaries 54 and 56 for acceptable values of the
  • VA interval can be established through cardiac pacing and by analysis of naturally occurring arrhythmias.
  • a flow chart is provided which illustrates the general steps of establishing an algorithm using VA interval analysis to classify 1 :1 retrograde activation with paced data.
  • 1 :1 anterograde pacings and 1 :1 retrograde pacings are analyzed. More particularly, 1 :1 anterograde conductions from patients during atrial pacing (AP) at predetermined cycle lengths and 1 :1 retrograde conductions from patients during ventricular pacing (VP) at similarly cycle lengths are analyzed.
  • AP atrial pacing
  • VP ventricular pacing
  • Step 62 selected statistical analysis tools are used to calculate the moving averages of successive VA intervals (mean VA intervals) for each passage of 1 :1 retrograde and anterograde conductions analyzed.
  • Step 64 a plurality of the mean VA intervals are randomly selected from the VP passages and are used as a training set.
  • the tightest boundaries in which the mean intervals of all randomly selected VP passages are correctly classified are used to establish an upper boundary 54 and a lower boundary 56.
  • the paced rhythms were used to establish an upper boundary 54 of 234 msec, and a lower boundary 56 of 132 msec.
  • Step 68 verification is conducted to determine that a certain number of the last-determined moving averages fall within the upper and lower limits 54 and 56 of the boundary criterion to account for premature beats and outliers.
  • Step 70 the remaining passages of VP and AP are compared with the predetermined boundaries for purposes of verifying the integrity of the established boundaries 54 and 56.
  • the boundaries 54 and 56 for acceptable values of mean VA intervals may also be established through analysis of naturally occurring tachycardias with 1 :1 confounding relationships. More particularly, by plotting mean VA intervals for retrograde tachycardias having confounding 1 :1 relationships, predetermined boundaries 54 and 56 may be established defining an acceptable range of values. The predetermined boundaries 54 and 56 are preferably chosen to encompass substantially all the retrograde conductions to thereby minimize false negatives and also minimize the false positives. In one particular application which will be described in detail below, naturally occurring rhythms established an upper boundary 14 of 240 msec. and a lower boundary 16 of 80 msec. With reference now to Figure 4, general Step 52 of Figure 2 is addressed in greater detail. More specifically, Figure 4 is a simplified flow chart showing the general steps involved in applying the algorithm of the present invention for identifying VT with retrograde. In Step 80, signals are received by the microprocessor 40 from the electrodes 30 and 32 of the first and second leads 26 and 28.
  • Step 82 if an atrial signal (A) is received, the time interval from the previous atrial signal is computed to establish an AA interval and the time interval from the previous (V) is computed to establish a VA interval. If a ventricular signal is received, the time interval from the previous ventrical signal is computed to establish an W interval and the time interval from the previous atrial signal is computed to establish an AV interval
  • Step 84 the moving average of the last three VA intervals is calculated.
  • Step 86 the moving average of the last three AV intervals is calculated.
  • Step 88 a determination of whether the VA interval is less than or equal to the upper boundary 54 and greater than or equal to the lower boundary 56.
  • the upper boundary 54 is 240 msec
  • the lower boundary 56 is 80 msec.
  • Step 90 the rhythm is classified as a VT with retrograde which requires electrical therapy if a positive determination is made in Step 88.
  • verfication is made that a certain number of the last- determined moving averages fail within the upper and lower boundaries 54 and 56 to account for premature beats and outliers
  • verification requires 9 of 12 of the last-determined moving averages to fall within the boundaries 54 and 56.
  • Example 1 illustrates the application of the above-described method according to the present invention with paced and naturally occurring rhythms.
  • VA intervals in milliseconds for all episodes of anterograde and retrograde conductions were plotted
  • the open squares represent anterograde conductions.
  • the closed diamonds represent retrograde conductions.
  • Upper and lower boundaries 14 and 16 for classifying the conductions were determined which maximized true positives and minimized false positives.
  • Patients with 1.1 retrograde conductions had mean VA intervals in the narrow range of 80 msec. - 240 msec in 29/30 (96.7%) occurrences.
  • Patients with 1 :1 anterograde conductions had mean VA intervals in this range at a rate of 21/42 (50%)
  • Table 1 Patient Episodes Classified by VA Interval Boundaries of 80-240 msec. One of the 30 (3.3%) retrogrades was incorrectly classified as an anterograde (i e., false negatives) Of the 42 anterogrades, 21/42 (50%) were correctly classified while 21/42 (50%) were classified as retrogrades
  • the present invention provides a reduction of false shocks by 50% compared to conventional ICD methods, thereby significantly reducing unnecessary patient distress, saving battery power, and avoiding the possible initiation of ventricular tachycardia or ventricular fibrillation when none previously existed
  • 1 6 invention imposes little in additional computation, which is an important consideration for all implantable devices, and greatly reduces the possibility of false shocks in 1 : 1 atrial tachycardias.
  • the present invention provides a method of cardiac arrhythmia detection which has enhanced specificity of diagnosis in ambiguous 1 :1 tachycardias.
  • the method uses VA interval measurements at the cost of minimum loss in sensitivity for ventricular tachycardia detection.
  • the present invention imposes little in additional computation for dual-chamber sensing ICDs and greatly reduces the possibility of false shocks in 1 :1 supraventricular tachycardias.

Abstract

Les seuls critères de fréquence ventriculaire et auriculaire entraînent une ambiguïté dans le cas de la tachycardie auriculaire (AT) avec conduction rétrograde. L'introduction de la détection double chambre dans les dispositifs contre la tachycardie permet des mesures informatiques peu onéreuses des intervalles auriculoventriculaires. La présente invention concerne les problèmes qui surviennent en cas de tachycardie présentant des rapports 1/1 déconcertants. Selon cette invention, en se fondant uniquement sur les fréquences auriculaire et ventriculaire, toutes les tachycardies 1/1 serait classées comme tachycardies ventriculaires (VT), ce qui entraînerait l'application de secousses fausses. Il est possible d'augmenter potentiellement la spécificité de la tachycardie 1/1 ambiguë en utilisant des mesures (82) d'intervalles auriculoventriculaires, au prix d'une perte minimale de la sensibilité pour la détection de la VT. L'algorithme appliqué impose un faible supplément de calcul pour des défibrillateurs à synchronisation automatique implantables à détection double chambre et réduit fortement la possibilité de fausses secousses dans la tachycardie auriculaire 1/1.
PCT/US1997/006728 1996-04-19 1997-04-18 Procede de detection de l'arythmie cardiaque WO1997039799A1 (fr)

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Application Number Priority Date Filing Date Title
AU27389/97A AU2738997A (en) 1996-04-19 1997-04-18 Method for cardiac arrhythmia detection

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US1637096P 1996-04-19 1996-04-19
US60/016,370 1996-04-19

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Cited By (13)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2000059573A1 (fr) * 1999-04-01 2000-10-12 Cardiac Pacemakers, Inc. Correlation d'intervalle entre les cavites cardiaques
WO2000062859A1 (fr) * 1999-04-19 2000-10-26 Cardiac Pacemakers, Inc. Systeme permettant de prevenir un double comptage d'evenements
US6480741B1 (en) 1999-09-07 2002-11-12 Cardiac Pacemakers, Inc. Heart monitors with robust interval measurements
US7174209B2 (en) * 2001-10-17 2007-02-06 Cardiac Pacemakers, Inc. Algorithm for discrimination of 1:1 tachycardias
US7228176B2 (en) 2004-07-22 2007-06-05 Cardiac Pacemakers, Inc. Systems, devices, and methods for tachyarrhythmia discrimination or therapy decisions
US7606620B2 (en) 2000-05-13 2009-10-20 Cardiac Pacemakers, Inc. System and method for detection enhancement programming
US7974685B2 (en) 2004-07-22 2011-07-05 Cardiac Pacemakers, Inc. Systems, devices, and methods for tachyarrhythmia discrimination or therapy decisions
US9138590B2 (en) 2004-10-28 2015-09-22 Cardiac Pacemakers, Inc. Implantable medical device sensing and selecting wireless ECG and intracardiac electrogram
US9592391B2 (en) 2014-01-10 2017-03-14 Cardiac Pacemakers, Inc. Systems and methods for detecting cardiac arrhythmias
US9669230B2 (en) 2015-02-06 2017-06-06 Cardiac Pacemakers, Inc. Systems and methods for treating cardiac arrhythmias
US10449361B2 (en) 2014-01-10 2019-10-22 Cardiac Pacemakers, Inc. Systems and methods for treating cardiac arrhythmias
US10463866B2 (en) 2014-07-11 2019-11-05 Cardiac Pacemakers, Inc. Systems and methods for treating cardiac arrhythmias
US10758737B2 (en) 2016-09-21 2020-09-01 Cardiac Pacemakers, Inc. Using sensor data from an intracardially implanted medical device to influence operation of an extracardially implantable cardioverter

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US4860749A (en) * 1988-01-06 1989-08-29 Wayne State University Tachycardia detection for automatic implantable cardioverter/defibrillator with atrial and ventricular sensing capability
US5167224A (en) * 1990-10-24 1992-12-01 Ela Medical Method for detecting and controlling endless loop tachycardias of a heart being controlled by a cardiac pulse generator
US5327900A (en) * 1991-11-01 1994-07-12 Telectronics Pacing Systems, Inc. Apparatus and method for discriminating between heart rhythms with similar atrial and ventricular rates

Patent Citations (3)

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Publication number Priority date Publication date Assignee Title
US4860749A (en) * 1988-01-06 1989-08-29 Wayne State University Tachycardia detection for automatic implantable cardioverter/defibrillator with atrial and ventricular sensing capability
US5167224A (en) * 1990-10-24 1992-12-01 Ela Medical Method for detecting and controlling endless loop tachycardias of a heart being controlled by a cardiac pulse generator
US5327900A (en) * 1991-11-01 1994-07-12 Telectronics Pacing Systems, Inc. Apparatus and method for discriminating between heart rhythms with similar atrial and ventricular rates

Cited By (22)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6522917B1 (en) 1999-04-01 2003-02-18 Cardiac Pacemakers, Inc. Cross chamber interval correlation
WO2000059573A1 (fr) * 1999-04-01 2000-10-12 Cardiac Pacemakers, Inc. Correlation d'intervalle entre les cavites cardiaques
US7373203B2 (en) 1999-04-19 2008-05-13 Cardiac Pacemakers, Inc. Cardiac rhythm management system with prevention of double counting of events
WO2000062859A1 (fr) * 1999-04-19 2000-10-26 Cardiac Pacemakers, Inc. Systeme permettant de prevenir un double comptage d'evenements
US6240313B1 (en) 1999-04-19 2001-05-29 Cardiac Pacemakers, Inc. Cardiac rhythm management system with prevention of double counting of events
US6754534B2 (en) 1999-04-19 2004-06-22 Cardiac Pacemakers, Inc. Cardiac rhythm management system with prevention of double counting of events
US8682435B2 (en) 1999-04-19 2014-03-25 Cardiac Pacemakers, Inc. Cardiac rhythm management system with prevention of double counting of events
US6480741B1 (en) 1999-09-07 2002-11-12 Cardiac Pacemakers, Inc. Heart monitors with robust interval measurements
US6973348B2 (en) 1999-09-07 2005-12-06 Cardiac Pacemakers, Inc. Heart monitors with robust interval measurements
US7606620B2 (en) 2000-05-13 2009-10-20 Cardiac Pacemakers, Inc. System and method for detection enhancement programming
US7908007B2 (en) 2000-05-13 2011-03-15 Cardiac Pacemakers, Inc. System and method for detection enhancement programming
US7174209B2 (en) * 2001-10-17 2007-02-06 Cardiac Pacemakers, Inc. Algorithm for discrimination of 1:1 tachycardias
US7228176B2 (en) 2004-07-22 2007-06-05 Cardiac Pacemakers, Inc. Systems, devices, and methods for tachyarrhythmia discrimination or therapy decisions
US7974685B2 (en) 2004-07-22 2011-07-05 Cardiac Pacemakers, Inc. Systems, devices, and methods for tachyarrhythmia discrimination or therapy decisions
US9138590B2 (en) 2004-10-28 2015-09-22 Cardiac Pacemakers, Inc. Implantable medical device sensing and selecting wireless ECG and intracardiac electrogram
US9592391B2 (en) 2014-01-10 2017-03-14 Cardiac Pacemakers, Inc. Systems and methods for detecting cardiac arrhythmias
US10449361B2 (en) 2014-01-10 2019-10-22 Cardiac Pacemakers, Inc. Systems and methods for treating cardiac arrhythmias
US10463866B2 (en) 2014-07-11 2019-11-05 Cardiac Pacemakers, Inc. Systems and methods for treating cardiac arrhythmias
US9669230B2 (en) 2015-02-06 2017-06-06 Cardiac Pacemakers, Inc. Systems and methods for treating cardiac arrhythmias
US10238882B2 (en) 2015-02-06 2019-03-26 Cardiac Pacemakers Systems and methods for treating cardiac arrhythmias
US11020595B2 (en) 2015-02-06 2021-06-01 Cardiac Pacemakers, Inc. Systems and methods for treating cardiac arrhythmias
US10758737B2 (en) 2016-09-21 2020-09-01 Cardiac Pacemakers, Inc. Using sensor data from an intracardially implanted medical device to influence operation of an extracardially implantable cardioverter

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