[go: up one dir, main page]

WO2025125943A1 - Système médical configuré pour la surveillance continue d'intervalle qt pendant une hospitalisation pour une charge antiarythmique - Google Patents

Système médical configuré pour la surveillance continue d'intervalle qt pendant une hospitalisation pour une charge antiarythmique Download PDF

Info

Publication number
WO2025125943A1
WO2025125943A1 PCT/IB2024/061509 IB2024061509W WO2025125943A1 WO 2025125943 A1 WO2025125943 A1 WO 2025125943A1 IB 2024061509 W IB2024061509 W IB 2024061509W WO 2025125943 A1 WO2025125943 A1 WO 2025125943A1
Authority
WO
WIPO (PCT)
Prior art keywords
processing circuitry
qtc
interval
interval values
patient
Prior art date
Legal status (The legal status 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 status listed.)
Pending
Application number
PCT/IB2024/061509
Other languages
English (en)
Inventor
Gautham Rajagopal
Shantanu Sarkar
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Medtronic Inc
Original Assignee
Medtronic Inc
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 Medtronic Inc filed Critical Medtronic Inc
Publication of WO2025125943A1 publication Critical patent/WO2025125943A1/fr
Pending legal-status Critical Current
Anticipated expiration legal-status Critical

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
    • A61B5/346—Analysis of electrocardiograms
    • A61B5/349—Detecting specific parameters of the electrocardiograph cycle
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
    • A61B5/346—Analysis of electrocardiograms
    • A61B5/349—Detecting specific parameters of the electrocardiograph cycle
    • A61B5/36—Detecting PQ interval, PR interval or QT interval
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
    • A61B5/346—Analysis of electrocardiograms
    • A61B5/349—Detecting specific parameters of the electrocardiograph cycle
    • A61B5/363—Detecting tachycardia or bradycardia
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/68—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient
    • A61B5/6846—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive
    • A61B5/6847—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive mounted on an invasive device
    • A61B5/686—Permanently implanted devices, e.g. pacemakers, other stimulators, biochips

Definitions

  • This application claims the benefit of U.S. Provisional Patent Application Serial No.63/610,169, filed December 14, 2023, the entire content of which is incorporated herein by reference.
  • TECHNICAL FIELD [0002] This disclosure generally relates to systems including medical devices and, more particularly, to monitoring of patient health using such systems.
  • Cardiac signal analysis may be performed by a variety of devices, such as implantable medical devices (IMDs), insertable cardiac monitors (ICMs) and external devices (e.g., smart watches, fitness monitors, mobile devices, Holter monitors, wearable defibrillators, or the like).
  • IMDs implantable medical devices
  • ICMs insertable cardiac monitors
  • external devices e.g., smart watches, fitness monitors, mobile devices, Holter monitors, wearable defibrillators, or the like.
  • devices may be configured to process cardiac signals (e.g., cardiac electrograms (ECGs) and electrocardiograms (ECGs)) sensed by one or more electrodes.
  • cardiac signals e.g., cardiac electrograms (ECGs) and electrocardiograms (ECGs)
  • ECGs electrocardiograms
  • cardiac signals may include the P-wave, Q-wave, R-wave, S-wave, QRS-complex, and T-wave.
  • a QT interval
  • a QTc interval is a QT interval that has been normalized or corrected with respect to a heart rate using a formula. Accurate detection and delineation of features in cardiac signals, such as QT intervals or QTc intervals, may be of importance for monitoring patient health, such as risk of sudden cardiac death.
  • SUMMARY [0004] In general, the disclosure describes techniques for combining detection of acute health events, such as lethal tachyarrhythmia and SCA, with QT interval monitoring during a monitoring period associated with medication initiation. Certain medications, such as antiarrhythmic medications to treat AF, may cause prolongation of the QT interval in patients.
  • Prolongation of the QT interval can predispose patients to Torsades de Pointes, which is a ventricular tachyarrhythmia that may lead to SCA. Since medication- Atty Ref. No.: A0012141WO01 induced tachyarrhythmias tend to occur shortly after initiation of the medication and can be life-threatening, it is common practice to hospitalize patients for drug initiation under continuous ECG surveillance. [0005] Usually, patients are hospitalized for a few days for antiarrhythmic drug loading in order to monitor for drug induced cardiotoxicity when introducing such a drug to a patient.
  • QT intervals are usually measured at static intervals (e.g., a few times every day) from a 12-lead ECG device.
  • static measurements taken a few times each day may not be sufficient to determine variability in the QT intervals over the day and to measure the changes in QT before and after medication intake.
  • An insertable cardiac monitor (ICM) capable of continuously monitoring QT interval over a long period may be a useful tool for evaluating and managing patients taking QT prolonging drugs, such as antiarrhythmic drugs. Continuous monitoring may include triggered, episodic, and/or periodic sensing of patient signals, without requiring human intervention. Such an ICM may continuously determine QT interval values.
  • a system includes: one or more memories configured to store a plurality of QT interval values; and processing circuitry coupled to the one or more memories and configured to: continuously determine, based on an electrocardiogram Atty Ref.
  • a method includes any of the techniques of this disclosure.
  • a non-transitory, computer-readable storage medium stores instructions, which when executed, cause processing circuitry to perform any of the techniques of this disclosure.
  • FIG.2 is a functional block diagram illustrating an example configuration of the insertable cardiac monitor (ICM) of the medical system of FIG.1.
  • FIG.3A is a perspective drawing illustrating an insertable cardiac monitor.
  • FIG.3B is a perspective drawing illustrating another insertable cardiac monitor.
  • FIG.4 is a functional block diagram illustrating an example configuration of the external device of FIG.1. Atty Ref.
  • FIG.5 is a block diagram illustrating an example system that includes an access point, a network, external computing devices, such as a server, and one or more other computing devices, which may be coupled to the medical device and external device of FIGS.1–4, in accordance with one or more examples of the present disclosure.
  • FIGS.6A and 6B are conceptual diagrams illustrating example primary and secondary sensing channels for an R-wave and a T-wave detector according to the techniques of this disclosure.
  • FIG.7 is a graphical diagram illustrating an example ensemble average plot of QTc intervals computed from IMD 10 data collected during an entire antiarrhythmic hospitalization period for 5 patients in a clinical study.
  • FIG.8 is a graphical diagram illustrating example ensemble QTc trends observed for a period of 2 hours after each dosage of antiarrhythmic drugs during hospitalization period for 5 patients computed from IMD 10 data collected during the clinical study.
  • FIG.9 is a flow diagram illustrating example QT monitoring techniques according to one or more aspects of this disclosure.
  • Continuous monitoring of QT intervals may allow identification of long QT intervals, which may indicate a need for medical intervention.
  • continuous monitoring of QT intervals may be performed using an insertable cardiac monitor (ICM).
  • ICM insertable cardiac monitor
  • This disclosure describes an example algorithm which may monitor the QT interval with an ICM, such as a Reveal LINQTM or LINQ IITM available from Medtronic, Inc., of Minneapolis, Minnesota, which may be inserted subcutaneously.
  • ICM such as a Reveal LINQTM or LINQ IITM available from Medtronic, Inc., of Minneapolis, Minnesota, which may be inserted subcutaneously.
  • An ICM capable of continuously monitoring QT intervals may be a useful tool for evaluating and managing patients taking QT prolonging drugs, such as antiarrhythmic drugs, such as during a hospitalization period for drug initiation.
  • QT prolonging drugs such as antiarrhythmic drugs
  • a variety of types of medical devices sense cardiac ECGs. Some medical devices that sense cardiac ECGs are non-invasive, e.g., using a plurality of electrodes placed in contact with external portions of the patient, such as at various locations on the skin of the patient.
  • the electrodes used to monitor the cardiac ECG in these non-invasive Atty Ref. No.: A0012141WO01 processes may be attached to the patient using an adhesive, strap, belt, or vest, as examples, and electrically coupled to a monitoring device, such as an electrocardiograph, Holter monitor, or other electronic device.
  • the electrodes are configured to sense electrical signals associated with the electrical activity of the heart or other cardiac tissue of the patient, and to provide these sensed electrical signals to the electronic device for further processing and/or display of the electrical signals.
  • Example IMDs that monitor cardiac ECGs include pacemakers and implantable cardioverter- defibrillators, which may be coupled to intravascular or extravascular leads, as well as pacemakers with housings configured for implantation within the heart, which may be leadless.
  • An example of pacemaker configured for intracardiac implantation is the MicraTM Transcatheter Pacing System, available from Medtronic plc.
  • any medical device configured to sense a cardiac ECG (which may also be referred to as a cardiac electrogram (EGM)) via implanted or external electrodes, including the examples identified herein, may implement the techniques of this disclosure for measuring QT intervals.
  • the techniques include evaluation of the cardiac ECG using criteria configured to provide a desired sensitivity and specificity of QT interval detection despite noise and depolarization morphology variations due to varying electrode positions.
  • the techniques of this disclosure for identifying QT intervals may facilitate determinations of cardiac wellness, and risk of sudden cardiac death, and may lead to clinical interventions to suppress the risk of sudden cardiac death. Atty Ref.
  • FIG.1 illustrates the environment of an example medical system 2 in conjunction with a patient 4, in accordance with one or more techniques of this disclosure.
  • the example techniques may be used with an IMD 10, which may be in wireless communication with at least one of external device 12 and other devices not pictured in FIG.1.
  • IMD 10 is implanted outside of a thoracic cavity of patient 4 (e.g., subcutaneously in the pectoral location illustrated in FIG.1).
  • IMD 10 may be positioned near the sternum near or just below the level of the heart of patient 4, e.g., at least partially within the cardiac silhouette.
  • IMD 10 includes a plurality of electrodes (not shown in FIG.1), and is configured to sense a cardiac ECG via the plurality of electrodes.
  • IMD 10 takes the form of the Reveal LINQTM or LINQ IITM ICM, or another ICM similar to, e.g., a version or modification of, the Reveal LINQTM or LINQ IITM ICM.
  • External device 12 may be a computing device with a display viewable by the user and an interface for providing input to external device 12 (i.e., a user input mechanism).
  • external device 12 may be a notebook computer, tablet computer, workstation, one or more servers, cellular phone, personal digital assistant, or another computing device that may run an application that enables the computing device to interact with IMD 10.
  • External device 12 is configured to communicate with IMD 10 and, optionally, another computing device (not illustrated in FIG.1), via wireless communication.
  • External device 12 may communicate via near-field communication technologies (e.g., inductive coupling, NFC or other communication technologies operable at ranges less than 10–20 cm) and far-field communication technologies (e.g., RF telemetry according to the 802.11 or Bluetooth® specification sets, or other communication technologies operable at ranges greater than near-field communication technologies).
  • near-field communication technologies e.g., inductive coupling, NFC or other communication technologies operable at ranges less than 10–20 cm
  • far-field communication technologies e.g., RF telemetry according to the 802.11 or Bluetooth® specification sets, or other communication technologies operable at ranges greater than near-field communication technologies.
  • External device 12 may be used to retrieve data from IMD 10, such as QT intervals.
  • the retrieved data may include values of physiological parameters measured by IMD 10, indications of episodes of arrhythmia or other maladies detected by IMD 10, and physiological signals recorded by IMD 10.
  • external device 12 may retrieve information related to detection of QT intervals by IMD 10, such as QT interval trends or QT metrics over a time period.
  • the time period may be predetermined, for example, Atty Ref. No.: A0012141WO01 hourly, daily or weekly, or may be otherwise based on the timing of the last retrieval of information by external device 12, or may be determined by a user of external device 12, such as by entering a command on external device 12 requesting the information from IMD 10.
  • the time period may be 2 hours.
  • External device 12 may also retrieve cardiac electrogram (ECG) segments recorded by IMD 10, e.g., due to IMD 10 determining that an episode of arrhythmia or another malady occurred during the segment, or in response to a request to record the segment from patient 4 or another user.
  • ECG cardiac electrogram
  • Processing circuitry of medical system 2 e.g., of IMD 10, external device 12, and/or of one or more other computing devices, may be configured to perform the example techniques of this disclosure for monitoring QT intervals such as when patient 4 is in a hospital for drug introduction.
  • the processing circuitry of medical system 2 may analyze a cardiac ECG sensed by IMD 10 to determine QT intervals in the cardiac ECG.
  • FIG.2 is a functional block diagram illustrating an example configuration of IMD 10 of FIG.1 in accordance with one or more techniques described herein.
  • IMD 10 includes electrodes 16A and 16B (collectively “electrodes 16”), antenna 26, processing circuitry 50, sensing circuitry 52, communication circuitry 54, storage device 56, switching circuitry 58, and sensors 62.
  • electrodes 16 collectively “electrodes 16”
  • antenna 26 processing circuitry 50, sensing circuitry 52, communication circuitry 54, storage device 56, switching circuitry 58, and sensors 62.
  • IMDs including or coupled to more than two electrodes 16 may implement the techniques of this disclosure in some examples.
  • Processing circuitry 50 may include fixed function circuitry and/or programmable processing circuitry. Processing circuitry 50 may include any one or more of a microprocessor, a controller, a digital signal processor (DSP), an application specific integrated circuit (ASIC), a field-programmable gate array (FPGA), or equivalent discrete or analog logic circuitry. In some examples, processing circuitry 50 may include multiple components, such as any combination of one or more microprocessors, one or more controllers, one or more DSPs, one or more ASICs, or one or more FPGAs, as well as other discrete or integrated logic circuitry. The functions attributed to processing circuitry 50 herein may be embodied as software, firmware, hardware or any combination thereof. Atty Ref.
  • Sensing circuitry 52 may be selectively coupled to electrodes 16 via switching circuitry 58, e.g., to select the electrodes 16 and polarity, referred to as the sensing vector, used to sense a cardiac ECG, as controlled by processing circuitry 50. Sensing circuitry 52 may sense signals from electrodes 16, e.g., to produce a cardiac ECG, in order to facilitate monitoring the electrical activity of the heart. Sensing circuitry 52 also may monitor signals from sensors 62, which may include one or more accelerometers, pressure sensors, and/or optical sensors, as examples. In some examples, sensing circuitry 52 may include one or more filters and amplifiers for filtering and amplifying signals received from electrodes 16 and/or sensors 62.
  • processing circuitry 50 may control communication circuitry 60 to provide an alert to the clinician to notify the clinician of the arrhythmia(s) and/or to recommend that the clinician modify the drug dosage.
  • processing circuitry of IMD 10, computing device 12, HMS 22, and/or any other devices described with respect to FIG.1 may correlate QTc interval trends with the occurrence of arrhythmias to determine whether there is any association between the two and may notify the clinician of any such association.
  • processing circuitry 50 may determine one or more baseline QTc intervals from a sensed ECG before the administration of antiarrhythmic drugs.
  • Storage device 84 may include, for example, RAM, DRAM, SRAM, magnetic discs, optical discs, flash memories, or forms of EPROM or EEPROM. In some examples, storage device 84 is used to store data indicative of instructions for execution by processing circuitry 80. Storage device 84 may be used by software or applications running on external device 12 to temporarily store information during program execution. [0057] Data exchanged between external device 12 and IMD 10 may include operational parameters. External device 12 may transmit data including computer readable instructions which, when implemented by IMD 10, may control IMD 10 to change one or more operational parameters and/or export collected data, such as QT intervals or QTc intervals.
  • server 95 may be configured to provide a secure storage site for data that has been collected from IMD 10 and/or external device 12.
  • server 95 may assemble data in web pages or other documents for viewing by trained professionals, such as clinicians, via computing devices 101.
  • One or more aspects of the illustrated system of FIG.5 may be implemented with general network technology and Atty Ref. No.: A0012141WO01 functionality, which may be similar to that provided by the Medtronic CareLink® Network.
  • one or more of computing devices 101 may be a tablet or other smart device located with a clinician, by which the clinician may program, receive alerts from, and/or interrogate IMD 10.
  • the clinician may enter an indication that patient 4 has taken medication and/or receive alerts or other indications for viewing through a computing device 101.
  • the clinician may also access patient data and/or indications of patient health collected by IMD 10 through a computing device 101, such as when patient 4 is in between clinician visits, to check on a status of a medical condition.
  • the clinician may enter instructions for a medical intervention for patient 4 into an application executed by computing device 101, such as based on a status of a patient condition determined by IMD 10, external device 12, server 95, or any combination thereof, or based on other patient data known to the clinician.
  • Device 101 then may transmit the instructions for medical intervention to another of computing devices 101 located with patient 4 or a caregiver of patient 4.
  • such instructions for medical intervention may include an instruction to change a drug dosage, timing, or selection, to schedule a visit with the clinician, or to seek medical attention.
  • a computing device 101 may generate an alert to patient 4 based on a status of a medical condition of patient 4, which may enable patient 4 proactively to seek medical attention prior to receiving instructions for a medical intervention. In this manner, patient 4 may be empowered to take action, as needed, to address his or her medical status, which may help improve clinical outcomes for patient 4.
  • server 95 includes a storage device 97, e.g., to store data retrieved from IMD 10, and processing circuitry 99.
  • computing devices 101 may similarly include a storage device and processing circuitry.
  • Processing circuitry 99 may include one or more processors that are configured to implement functionality and/or process instructions for execution within server 95.
  • processing circuitry 99 may be capable of processing instructions stored in storage device 97.
  • Processing circuitry 99 may include, for example, microprocessors, DSPs, ASICs, FPGAs, or equivalent discrete or integrated logic circuitry, or a combination of any of the foregoing devices or circuitry. Accordingly, processing circuitry 99 may include any suitable structure, whether in hardware, software, firmware, Atty Ref. No.: A0012141WO01 or any combination thereof, to perform the functions ascribed herein to processing circuitry 99.
  • Storage device 97 may include a computer-readable storage medium or computer-readable storage device. In some examples, storage device 97 includes one or more of short-term memories or long-term memories. Storage device 97 may include, for example, RAM, DRAM, SRAM, magnetic discs, optical discs, flash memories, or forms of EPROM or EEPROM. In some examples, storage device 97 is used to store data indicative of instructions for execution by processing circuitry 99.
  • FIGS.6A and 6B are conceptual diagrams illustrating example primary and secondary sensing channels for R-wave detection and a T-wave detector.
  • sensing circuitry 52 of IMD 10 may sense R-waves by using dual channel sensing techniques of FIGS.6A and 6B.
  • Cardiac signals (e.g., signals from electrode 16A and electrode 16B) may be filtered by band-pass filter 100.
  • band-pass filter 100 may have a passband in the range of about 10 Hz to 32 Hz.
  • band- pass filter 100 may have a non-linear response as shown.
  • band-pass filter 100 may have a generally linear response.
  • the band-passed signal may then be rectified by rectifier 102.
  • secondary sensing channel 110 may blank fixed threshold process 106 for 520 ms after the R-wave sense. In this example, secondary sensing channel 106 may not blank the primary channel from sensing.
  • IMD 10 may band-pass the ECG signal, from electrode 16A and electrode 16B, e.g., using band-pass filter 90.
  • the band-pass filter may be a 6-20 Hz band-pass filter.
  • the band-passed signal may be rectified by rectifier 92.
  • FIG.6B primary sensing channel 108 and secondary sensing Atty Ref.
  • R-wave senses 95 may be utilized by T-wave sensor 94 to determine a search window for a T-wave.
  • R-wave senses 95 may be utilized by T-wave sensor 94 to determine a search window for a T-wave.
  • FIG. 1 A0012141WO01 channel 110 determines R-wave senses 95.
  • FIG. 1 A0012141WO01 channel 110 determines R-wave senses 95.
  • R-wave senses 95 may be utilized by T-wave sensor 94 to determine a search window for a T-wave.
  • the x-axis represents time, beginning at time 08:00 on a first day and ending after 10:00 on a third day.
  • the y-axis represents CTC in msecs between 360 and 480.
  • Time 902 represents a time of the delivery of a first dose of antiarrhythmic medication.
  • Interval 912 represents a 2-hour period after time 902.
  • Time 904 represents a time of the delivery of a second dose of antiarrhythmic medication.
  • Interval 914 represents a 2-hour period after time 904.
  • Time 906 represents a time of the delivery of a third dose of antiarrhythmic medication.
  • Interval 916 represents a 2-hour period after time 906.
  • Time 908 represents a time of the delivery of a fourth dose of antiarrhythmic medication.
  • Interval 918 represents a 2-hour period after time 908.
  • Time 910 represents a time of the delivery of a fifth dose of antiarrhythmic medication.
  • Interval 920 represents a 2-hour period after time 910.
  • the baseline QTc before the third dose was 429.7 ⁇ 40.9 msec.
  • FIG.8 is a graphical diagram illustrating example ensemble QTc trends observed for a period of 2 hours after each dosage of antiarrhythmic drugs during hospitalization period for 5 patients computed from IMD 10 data collected during the clinical study. Metrics such as minimum and maximum QTc values, magnitude of change in the QTc values, and the time interval between the maximum and minimum QTc intervals for the 2-hour period after each dosage are shown for the first, second, third, and fourth dose.
  • the baseline QTc intervals may be determined based on an ECG signal sensed by IMD 10 prior to the patient arriving at the hospital, during the patient arriving at the hospital, or after the patient arrives at the hospital.
  • the baseline QTc intervals are determined based on a sensed ECG signal sensed by IMD 10 prior to administration of an antiarrhythmic drug.
  • the processing circuitry may continuously determine QTc intervals during a hospitalization period (1102). For example, the processing circuitry may determine QTc intervals while the patient is being monitored for potential cardiotoxicity.
  • the continuous determination of QT interval values may include the exclusion of QT interval values for heart beats determined to be noisy.
  • the processing circuitry may send an alert (1108) to the clinician.
  • the alert may include a recommendation to change a dosage of the medication.
  • the processing circuitry may continue monitoring for arrhythmia (1110). For example, the processing circuitry may monitor the sensed ECG signal from IMD 10 to monitor for arrhythmia. The processing circuitry may determine whether an arrythmia is detected (1112).
  • the processing circuitry may use any technique discussed herein or any other technique to detect an arrythmia based on a sensed ECG signal.
  • the processing circuitry may send an alert (1114).
  • the alert may include an indication of the arrythmia Atty Ref. No.: A0012141WO01 and, in some examples, may include information regarding QTc trends.
  • the processing circuitry may determine whether the medication is taken or delivered (1116). For example, upon delivering medication or the patient otherwise taking the medication, a clinician may input an indication via computing device 12, that the patient has taken the medication.
  • the processing circuitry may use such an indication to determine whether a patient has taken the medication. [0084] If the processing circuitry determines that the patient has taken the medication (the “YES” path from box 1116), the processing circuitry may monitor QTc trends and arrhythmias for a period of time (e.g., 2 hours) after the medication intake (1118).
  • the QTc trends may include QTc metrics such as a maximum QTc, minimum QTc, magnitude of change in QTc, time duration between maximum and minimum QTc, and/or the like during that period of time (e.g., 2 hours) after medication intake.
  • Such trends in the period of time after the administration of medication may be useful for a clinician in evaluating antiarrhythmic medication loading of patient 4 and determining an appropriate dosage of the antiarrhythmic medication for patient 4.
  • the processing circuitry may record and share the QTc trends and any indications of arrhythmias with the clinician (1120). If the processing circuitry determines that the patient has not taken the medication (the “NO” path from box 1116), the processing circuitry may return to box 1102. [0086] While the techniques herein are described as being performed by various elements, such as sensing circuitry 52 and processing circuitry 50, in some examples, other elements or a combination of elements may perform the techniques.
  • sensing circuitry 52 may perform techniques described as being performed by processing circuitry 50
  • processing circuitry 50 may perform techniques described as being performed by sensing circuitry 52
  • a combination of sensing circuitry 52 and processing circuitry 50 may perform techniques described as being performed by either.
  • the techniques described in this disclosure may be implemented, at least in part, in hardware, software, firmware, or any combination thereof.
  • various aspects of the techniques may be implemented within one or more microprocessors, DSPs, ASICs, FPGAs, or any other equivalent integrated or discrete logic QRS circuitry, as well Atty Ref. No.: A0012141WO01 as any combinations of such components, embodied in external devices, such as physician or patient programmers, stimulators, or other devices.
  • processor processing circuitry
  • controller or “control module” may generally refer to any of the foregoing logic circuitry, alone or in combination with other logic circuitry, or any other equivalent circuitry, and alone or in combination with other digital or analog circuitry.
  • processor processing circuitry
  • controller or “control module” may generally refer to any of the foregoing logic circuitry, alone or in combination with other logic circuitry, or any other equivalent circuitry, and alone or in combination with other digital or analog circuitry.
  • processor processing circuitry
  • controller or “control module” may generally refer to any of the foregoing logic circuitry, alone or in combination with other logic circuitry, or any other equivalent circuitry, and alone or in combination with other digital or analog circuitry.
  • a non-transitory computer-readable storage medium such as RAM, ROM, NVRAM, EEPROM, FLASH memory, magnetic media, optical media, or the like.
  • the instructions may be executed to support one or more aspects of the functionality described in this disclosure.
  • Various examples have been described. These and other examples are within the scope of
  • a system comprising: one or more memories configured to store a plurality of QT interval values; and processing circuitry coupled to the one or more memories and configured to: continuously determine, based on an electrocardiogram (ECG) of a patient sensed by sensing circuitry of an implantable medical device, the plurality of QT interval values, wherein the patient is hospitalized for antiarrhythmic medication loading; determine at least one of whether a first QT interval value of the plurality of QT interval values meets a first threshold or whether a change in magnitude of a difference between two QT interval values of the plurality of QT interval values meets a second threshold; and based on at least one of a determination that the first QT interval value meets the first threshold or the change in magnitude of the difference between the two QT interval values meets the second threshold, generate a first indication for output.
  • ECG electrocardiogram
  • Example 2 The system of Example 1, wherein the processing circuitry is further configured to: determine, based on the ECG, an indication of an arrhythmia; and based on the determination of the indication of the arrhythmia, generate a second ndication for output.
  • Example 3 The system of Example 1 or Example 2, wherein the processing circuitry is further configured to: determine an occurrence of an administration of a medication to the patient; determine, based on the administration of the medication and within a time period after the administration of the medication, one or more metrics Atty Ref. No.: A0012141WO01 associated with the plurality of QT interval values; and generate a third indication for output, the third indication comprising the one or more metrics.
  • Example 5 The system of Example 3 or Example 4, wherein the plurality of QT interval values comprises corrected QT (QTc) interval values, and the one or more metrics comprise at least one of a maximum QTc value within the time period, minimum QTc value within the time period, magnitude of change between the maximum QTc value within the time period and the minimum QTc value within the time period, a time duration between the maximum QTc value within the time period and the minimum QTc within the time period, or a time difference between the determination of the occurrence of the administration of the medication and the maximum QTc value within the time period.
  • QTc corrected QT
  • Example 6 The system of Example 5, wherein the time period is of a predetermined length.
  • Example 7. The system of any of Examples 1-4, wherein the plurality of QT interval values comprises corrected QT (QTc) interval values.
  • Example 8. The system of any of Examples 1-7, wherein the first indication comprises a recommendation to change a dosage of the medication.
  • Example 9. The system of any of Examples 1-8, wherein the processing circuitry is further configured to output the first indication.
  • Example 10. The system of any of Examples 1-9, further comprising the implantable medical device. [0100] Example 11. The system of Example 10, wherein the implantable medical device comprises an insertable cardiac monitor. [0101] Example 12.
  • Example 13 A method performed by the system of any of Examples 1- 12. Atty Ref. No.: A0012141WO01 [0103] Example 14. Non-transitory computer-readable storage media storing instructions, which when executed by processing circuitry, cause the processing circuitry to perform the method of Example 13.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Cardiology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Molecular Biology (AREA)
  • Pathology (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Physics & Mathematics (AREA)
  • Medical Informatics (AREA)
  • Biophysics (AREA)
  • Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Measurement And Recording Of Electrical Phenomena And Electrical Characteristics Of The Living Body (AREA)

Abstract

Différents modes de réalisation de la présente invention concernent un système, et une méthode associée et des supports de stockage lisibles par ordinateur stockant des instructions, comprenant un ou plusieurs des éléments suivants : une mémoire configurée pour stocker une pluralité de valeurs d'intervalle QT ; et un circuit de traitement configuré pour : déterminer en continu, sur la base d'un ECG d'un patient détecté par un dispositif médical implantable, la pluralité de valeurs d'intervalle QT ; déterminer si une première valeur d'intervalle QT de la pluralité de valeurs d'intervalle QT satisfait un premier seuil ou si un changement d'amplitude d'une différence entre deux valeurs d'intervalle QT de la pluralité de valeurs d'intervalle QT satisfait un deuxième seuil ; et en fonction d'au moins l'une parmi une détermination du fait que la première valeur d'intervalle QT satisfait un premier seuil ou que le changement d'amplitude de la différence entre les deux valeurs d'intervalle QT satisfait le deuxième seuil, génère une première indication pour la sortie.
PCT/IB2024/061509 2023-12-14 2024-11-18 Système médical configuré pour la surveillance continue d'intervalle qt pendant une hospitalisation pour une charge antiarythmique Pending WO2025125943A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US202363610169P 2023-12-14 2023-12-14
US63/610,169 2023-12-14

Publications (1)

Publication Number Publication Date
WO2025125943A1 true WO2025125943A1 (fr) 2025-06-19

Family

ID=93841204

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/IB2024/061509 Pending WO2025125943A1 (fr) 2023-12-14 2024-11-18 Système médical configuré pour la surveillance continue d'intervalle qt pendant une hospitalisation pour une charge antiarythmique

Country Status (1)

Country Link
WO (1) WO2025125943A1 (fr)

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20030130708A1 (en) * 2002-01-08 2003-07-10 Von Arx Jeffrey A. Two-hop telemetry interface for medical device
US20140276928A1 (en) 2013-03-15 2014-09-18 Medtronic, Inc. Subcutaneous delivery tool
US11576606B2 (en) 2020-04-02 2023-02-14 Medtronic, Inc. Cardiac signal QT interval detection
US20230107996A1 (en) * 2021-10-06 2023-04-06 Cardiac Pacemakers, Inc. Ambulatory detection of qt prolongation

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20030130708A1 (en) * 2002-01-08 2003-07-10 Von Arx Jeffrey A. Two-hop telemetry interface for medical device
US20140276928A1 (en) 2013-03-15 2014-09-18 Medtronic, Inc. Subcutaneous delivery tool
US11576606B2 (en) 2020-04-02 2023-02-14 Medtronic, Inc. Cardiac signal QT interval detection
US11589794B2 (en) 2020-04-02 2023-02-28 Medtronic, Inc. Cardiac signal QT interval detection
US20230181083A1 (en) 2020-04-02 2023-06-15 Medtronic, Inc. Cardiac signal qt interval detection
US20230107996A1 (en) * 2021-10-06 2023-04-06 Cardiac Pacemakers, Inc. Ambulatory detection of qt prolongation

Similar Documents

Publication Publication Date Title
US11701062B2 (en) Detection of noise signals in cardiac signals
US12121332B2 (en) Performing one or more pulse transit time measurements based on an electrogram signal and a photoplethysmography signal
US12369834B2 (en) Triggering storage of electrocardiographs for detected premature ventricular contractions (PVCs)
US11589794B2 (en) Cardiac signal QT interval detection
JP7682100B2 (ja) 偽の心静止検出の識別
US20250281099A1 (en) Premature ventricular contraction (pvc) detection
US20210106253A1 (en) Detecting one or more patient coughs based on an electrogram signal and an accelerometer signal
US20240156402A1 (en) Determining an efficacy of a treatment program
WO2025125943A1 (fr) Système médical configuré pour la surveillance continue d'intervalle qt pendant une hospitalisation pour une charge antiarythmique
WO2025210417A1 (fr) Système médical pour la détermination d'un score de risque pour prédire la survenue d'arythmies et/ou d'arrêt cardiaque soudain
US20240138743A1 (en) Premature ventricular contraction (pvc) detection using an artificial intelligence model
WO2025153901A1 (fr) Système configuré pour identifier des anomalies dans des transmissions d'électrocardiogramme programmées régulièrement à partir d'un dispositif médical
WO2025224689A1 (fr) Interface utilisateur comprenant une vue de comparaison de rythme pour un observateur de signal cardiaque
WO2025088405A1 (fr) Système comprenant un dispositif médical implantable conçu pour surveiller une valvulopathie mitrale

Legal Events

Date Code Title Description
121 Ep: the epo has been informed by wipo that ep was designated in this application

Ref document number: 24820471

Country of ref document: EP

Kind code of ref document: A1