Device and Method To Discriminate Between Supraventricular Tachycardias And Ventricular Arrhythmias

Abstract

This invention provides a method to discriminate between ventricular arrhythmia and supraventricular tachycardia by detecting an earliest arriving electrical signal following antitachycardia pacing. Also disclosed is an implantable cardiac defibrillator that is capable of simultaneous atrioventricular anti-tachycardia pacing bursts and detecting an earliest arriving electrical signal. The discrimination capability reduces the incidence of inappropriate shocks from dual-chamber implantable cardiac defibrillators to near zero and provides a method to differentially diagnose supraventricular tachycardia from ventricular tachycardia.

1 . A device, comprising:
 a) a implantable pacemaker element;   b) a implantable defibrillator element connected to said pacemaker element; and   c) a plurality of atrial and ventricular pacing leads connected to said pacemaker element, wherein said pacing leads are configured for simultaneous activation.   
     
     
         2 . The device of  claim 1 , further comprising a plurality of atrial and ventricular defibrillation leads connected to said defibrillator element. 
     
     
         3 . The device of  claim 1 , further comprises a plurality of atrial and ventricular sensing leads connected to said pacemaker element. 
     
     
         4 . The device of  claim 1 , wherein said pacemaker element further comprises a storage memory connected to said sensing leads. 
     
     
         5 . The device of  claim 1 , wherein said device is capable of detecting an earliest arriving electrical signal. 
     
     
         6 . A method, comprising:
 a) providing:
 i) a patient implanted with a device, comprising;
 1) a implantable pacemaker element; and 
 2) a plurality of atrial and ventricular pacing leads connected to said pacemaker element, wherein said pacing leads are configured for simultaneous activation and coursing to the ventricles and atria; and 
 
 ii) a plurality of sensing leads connected to said pacemaker coursing to the ventricles and atria; 
   b) initiating one or more pacing bursts by said pacemaker element, wherein said ventricles and atria are simultaneously paced; and   c) detecting an earliest arriving electrical signal following termination of said pacing bursts.   
     
     
         7 . The method of  claim 6 , wherein prior to step b) a cardiac arrhythmia is detected in said patient. 
     
     
         8 . The method of  claim 6 , wherein said earliest arriving electrical signal is from the ventricles. 
     
     
         9 . The method of  claim 6 , wherein said earliest arriving electrical signal is from the atria. 
     
     
         10 . The method of  claim 6 , further comprising step d) defibrillating said ventricles under conditions such that normal sinus rhythm is restored. 
     
     
         11 . A method, comprising:
 a) providing;
 i) a patient; 
 ii) an electrocardiogram array; 
 iii) a plurality of intracardiac quadripole catheters, wherein said catheters are configured for simultaneous atrial and ventricular pacing; and 
 iv) a computer configured to receive electrical signals from said catheters; 
   b) placing said array on the skin surface of said patient;   c) inserting said catheters into said patient;   d) simultaneously pacing said atria and ventricles; and   e) detecting with said computer an earliest arriving electrical signal.   
     
     
         12 . The method of  claim 11 , wherein said earliest arriving electrical signal is from the ventricles. 
     
     
         13 . The method of  claim 11 , wherein said earliest arriving electrical signal is from the atria. 
     
     
         14 . The method of  claim 11 , wherein said earliest arriving electrical signal is from the junction between the atria and ventricles. 
     
     
         15 . The method of  claim 11 , further comprising step f) diagnosing said patient as having ventricular tachycardia. 
     
     
         16 . The method of  claim 10 , further comprising step f) diagnosing said patient as having supraventricular tachycardia. 
     
     
         17 . The method of  claim 10 , further comprising step f) diagnosing said patient as having atrioventricular nodal reentrant tachycardia. 
     
     
         18 . The method of  claim 10 , wherein said computer is connected to a data readout device. 
     
     
         19 . A method to detect the origin of a cardiac arrhythmia, comprising:
 a) providing;
 i) a patient exhibiting cardiac arrhythmia; 
 ii) a system comprising a plurality of pacing leads and a plurality of sensing leads; 
   b) simultaneously pacing the atria and ventricles of said patient; and   c) sensing with said sensing leads said atrial and ventricular electrical activity after said pacing under conditions such that the earliest arriving electrical signal is detected.   
     
     
         20 . The method of  claim 19 , wherein said earliest arriving electrical signal is from the ventricles. 
     
     
         21 . The method of  claim 19 , wherein said earliest arriving electrical signal is from the atria. 
     
     
         22 . The method of  claim 19 , wherein said earliest arriving electrical signal is from the junction between the atria and ventricles. 
     
     
         23 . The method of  claim 19 , further comprising step d) diagnosing said patient as having ventricular tachycardia. 
     
     
         24 . The method of  claim 19 , further comprising step d) diagnosing said patient as having supraventricular tachycardia. 
     
     
         25 . The method of  claim 19 , further comprising step d) diagnosing said patient as having atrioventricular nodal reentrant tachycardia. 
     
     
         26 . The method of  claim 19 , wherein said computer is connected to a data readout device.