WO2025224689A1

WO2025224689A1 - User interface including rhythm comparison view for cardiac signal viewer

Info

Publication number: WO2025224689A1
Application number: PCT/IB2025/054322
Authority: WO
Inventors: Yiyong Wan
Original assignee: Medtronic Inc
Current assignee: Medtronic Inc
Priority date: 2024-04-26
Filing date: 2025-04-25
Publication date: 2025-10-30
Anticipated expiration: 2026-10-26

Abstract

Example systems, devices, and techniques are described. An example system includes one or more memories configured to store, for each patient of a plurality of patients, a set of flagged cardiac data signal segments and a reference cardiac data signal segment. The system includes processing circuitry coupled to the one or more memories. The processing circuitry is configured to receive, from a user device, a user input indicating a user selection of a patient of the plurality of patients. The processing circuitry is configured to cause the user device to display the reference cardiac data signal segment corresponding to the patient and a first flagged cardiac data signal segment of the set of flagged cardiac data signal segments corresponding to the patient at a same time, wherein the displayed reference cardiac data signal segment and the displayed first flagged cardiac data signal segment do not overlap.

Description

USER INTERFACE INCLUDING RHYTHM

COMPARISON VIEW FOR CARDIAC SIGNAL VIEWER

[0001] This application claims the benefit of U.S. Provisional Patent Application Serial No. 63/639,188, filed April 26, 2024, the entire content of which is incorporated herein by reference.

TECHNICAL FIELD

[0002] This disclosure generally relates to systems, including medical device systems for monitoring patient health.

BACKGROUND

[0003] 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). For example, devices may be configured to sense and/or process cardiac signals (e.g., cardiac electrograms (ECGs) and electrocardiograms (ECGs)) sensed by one or more electrodes. Features of cardiac signals may include the P-wave, Q-wave, R- wave, S-wave, QRS-complex, and T-wave.

SUMMARY

[0004] In general, the disclosure describes techniques for presenting a user interface for displaying a flagged cardiac data signal segment, such as a suspected episode ECG segment, alongside (e.g., side-by-side, above and below, etc.) a reference cardiac data signal segment, such as a reference or “presenting” ECG, at a same time. As used herein, at the same time means that both the flagged cardiac data signal segment and the reference cardiac data signal segment are viewable (e.g., presented for viewing) by a user at a same time on a single display device, whether or not a refresh rate or scan rate of a display device may cause the display device to not display all of both the flagged cardiac data signal segment and the reference cardiac data signal segment simultaneously.

[0005] Medical devices, such as IMDs, ICMs, external devices, or the like, may sense and capture cardiac data, such as ECG signals. Such devices and/or or other external devices, may analyze the captured ECG signals to determine potential events represented in the ECG signals. These devices may send captured ECG data segments around determined potential events to another device, system, and/or service for further analysis, such as by a clinician to discriminate between true episodes and false episodes within the determined potential events. A clinician may then determine appropriate monitoring and/or treatment based on the true events, rather than all potential events as initially determined by a device. [0006] For example, a system may present a user interface on a display with which a clinician may interact when viewing the ECG data segments. For a clinician to accurately interpret the ECG data segments collected from cardiac devices, and to accurately adjudicate the episode, it is important for them to have the context and understanding of the patient's normal heart rhythm and normal ECG morphology.

[0007] Traditionally, a reference ECG data segment of the patient's normal rhythm, also known as a “presenting rhythm,” is provided at the beginning of a report for the clinician to review. For example, the first screen of the user interface may display the reference ECG data segment, which may also be referred to as a presenting ECG data segment. The ECG data for the presenting rhythm segment may be collected by an IMD or other medical device according to a schedule, e.g., daily at a specified time, when the patient is expected to be experiencing a baseline cardiac rhythm absent any arrhythmia or other episode.

[0008] The clinician will then move on to view various flagged cardiac data signal segments, such as flagged episode ECG data segments, such as signal segments flagged as representing possible atrial fibrillation, tachycardia, bradycardia, pause, or the like. When adjudicating a potential cardiac episode, sometimes the clinician will want to review and compare the morphology of the episode ECG data segment corresponding with the potential episode to a reference ECG data segment of the patient's presenting rhythm. Typically, to do so, a clinician is required to navigate to a different screen, or scroll to the top of a page to find that information, potentially losing track of which episode ECG data segment they were evaluating, where in the particular episode ECG data segment they were focused, etc. The difficulty in keeping track of such information is magnified when dealing with tens or hundreds of episode ECG data segments to review.

[0009] As such, the techniques of this disclosure provide a view of a reference cardiac data signal segment of the presenting rhythm and a flagged cardiac data signal segment (e.g., an episode ECG data segment) at a same time on a user interface in a manner in which the reference cardiac signal segment of the presenting rhythm and the flagged cardiac data signal segment do not overlap. In some examples, the reference cardiac data signal segment and the flagged cardiac data signal segment may be displayed at the same time with matching sweep speeds and amplitude magnification. In this manner, a clinician can quickly make a comparison and interpret the flagged cardiac data signal segment more effectively without needing to navigate in the user interface to other views and thereby making it less likely that the clinician will lose their place in their workflow. If the reference cardiac data signal segment and the flagged cardiac data signal segment were to overlap, that would impede the ability for the clinician to quickly make the comparison and interpret the flagged cardiac data signal segment. Additionally, overlap may cause eye fatigue or strain of the clinician who may be reviewing dozens or hundreds of such flagged cardiac data signal segments, leading to potential errors in evaluating the flagged cardiac data signal segments. [0010] When evaluating flagged cardiac data signal segments, a clinician may also desire to visually assess heart rate variability that may be present in a flagged cardiac data signal segment. This task may be difficult and tedious when manually counting the number of units (e.g., milliseconds) being displayed for each heartbeat, such as for each R-R cycle. [0011] Adjustable digital calipers on an ECG viewer is a feature that allows clinicians to make accurate measurements of the ECG waveforms. However, a simple set of calipers is not particularly effective at quickly measuring or determining arrhythmias over multiple heartbeats or determining heart rate variability.

[0012] As such, the techniques of this disclosure may include displaying marching calipers across a flagged cardiac data signal segment, thereby facilitating a clinician to more accurately interpret cardiac data signal segments, such as ECG data segments) collected from cardiac devices, such as evaluating R-R intervals to identify heart rate variability within the cardiac data signal segments. By providing clinicians with a set of marching or repeating calipers that may be adjusted based on a size of a primary caliper, clinicians may be able to more quickly and visually measure or determine arrhythmias and/or identify heart rate variability across multiple heartbeats.

[0013] In one example, a system includes: one or more memories configured to store, for each patient of a plurality of patients, a set of flagged cardiac data signal segments and a reference cardiac data signal segment; and processing circuitry coupled to the one or more memories and configured to: receive, from a user device, a user input indicating a user selection of a patient of the plurality of patients; and cause the user device to display the reference cardiac data signal segment corresponding to the patient and a first flagged cardiac data signal segment of the set of flagged cardiac data signal segments corresponding to the patient at a same time, wherein the displayed reference cardiac data signal segment and the displayed first flagged cardiac data signal segment do not overlap. [0014] In another example, a method includes: receiving, by processing circuitry and from a user device, a user input indicating a user selection of a patient of a plurality of patients; and causing, by the processing circuitry, the user device to display a reference cardiac data signal segment corresponding to the patient and a first flagged cardiac data signal segment of a set of flagged cardiac data signal segments corresponding to the patient at a same time, wherein the displayed reference cardiac data signal segment and the displayed first flagged cardiac data signal segment do not overlap.

[0015] In another example, a non-transitory, computer-readable storage medium stores instructions, which when executed, cause processing circuitry to: receive, from a user device, a user input indicating a user selection of a patient of a plurality of patients; and cause, by the processing circuitry, the user device to display a reference cardiac data signal segment corresponding to the patient and a first flagged cardiac data signal segment of a set of flagged cardiac data signal segments corresponding to the patient at a same time, wherein the displayed reference cardiac data signal segment and the displayed first flagged cardiac data signal segment do not overlap.

[0016] The summary is intended to provide an overview of the subject matter described in this disclosure. It is not intended to provide an exclusive or exhaustive explanation of the systems, device, and methods described in detail within the accompanying drawings and description below. Further details of one or more examples of this disclosure are set forth in the accompanying drawings and in the description below. Other features, objects, and advantages will be apparent from the description and drawings, and from the claims.

BRIEF DESCRIPTION OF DRAWINGS

[0017] FIG. 1 is a conceptual diagram illustrating an example medical system configured to present a user interface including a flagged cardiac data signal segment and a reference cardiac data signal segment at a same time in accordance with one or more techniques of this disclosure. [0018] FIG. 2 is a conceptual diagram illustrating the environment of an example medical system in conjunction with a patient, in accordance with one or more techniques of this disclosure.

[0019] FIG. 3 is a functional block diagram illustrating an example configuration of the insertable cardiac monitor (ICM) of the medical system of FIG. 2 in accordance with one or more techniques described herein.

[0020] FIG. 4A is a perspective drawing illustrating an insertable cardiac monitor.

[0021] FIG. 4B is a perspective drawing illustrating another insertable cardiac monitor. [0022] FIG. 5 is a block diagram illustrating an example configuration of components of an external device.

[0023] FIG. 6 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 an IMD and external device via a network, in accordance with one or more techniques described herein.

[0024] FIG. 7 is a flow diagram illustrating example techniques of presenting cardiac data signal segments according to one or more aspects of this disclosure.

[0025] FIG. 8 is a conceptual diagram illustrating an example ECG viewer user interface according to one or more aspects of this disclosure.

[0026] FIG. 9 is a conceptual diagram illustrating another example ECG viewer user interface according to one or more aspects of this disclosure.

[0027] FIG. 10 is a flow diagram illustrating example cardiac data display techniques according to one or more aspects of this disclosure.

DETAILED DESCRIPTION

[0028] A variety of types of medical devices sense cardiac data, such as ECGs. Some medical devices that sense cardiac data 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 data in these non-invasive 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. The non-invasive devices and methods may be utilized on a temporary basis, for example to monitor a patient during a clinical visit, such as during a doctor’s appointment, or for example for a predetermined period of time, for example for one day (twenty-four hours), or for a period of several days.

[0029] Some implantable medical devices (IMDs) also sense and monitor cardiac data. The electrodes used by IMDs to sense cardiac data are typically integrated with a housing of the IMD and/or coupled to the IMD via one or more elongated leads. Example IMDs that monitor cardiac data, such as ECGs, include pacemakers and implantable cardioverterdefibrillators, 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 Micra™ Transcatheter Pacing System, available from Medtronic pic. Some IMDs that do not provide therapy, e.g., implantable patient monitors, sense cardiac ECGs. Examples of such an IMD include Reveal LINQ™ and LINQ II™. Such IMDs may facilitate relatively longer-term monitoring of patients during normal daily activities, and may periodically transmit collected data to a network service, such as the Medtronic Carelink™ Network.

[0030] Clinicians may use such a network service to analyze biometric data and monitor patient conditions. For example, a network service may receive biometric data from one or more medical devices corresponding to each patient of a group of patients. This biometric data may include cardiac data, respiratory data, motion data, or other kinds of biometric data. A clinician may use a user interface of a computing device to select patients individually from the group and view biometric data for each of the patients. This may allow the clinician to care for each patient by viewing relevant data.

[0031] One kind of cardiac biometric data that clinicians often analyze is electrocardiogram (ECG) data. ECG data segments indicate cardiac events that occur throughout the cardiac cycle of the patient, such as atrial depolarizations indicated by P- waves in ECG data segments, ventricular depolarizations indicated by R-waves in ECG data segments, and ventricular repolarizations indicated by T-waves in ECG data segments. The clinician may analyze characteristics of cardiac events present in an ECG data segment to determine whether the ECG data segment indicates or does not indicate an arrhythmia. For example, the patient monitoring application may allow the clinician to analyze a set of ECG data segments each corresponding to a suspected arrhythmia event and indicate whether the ECG data segment actually indicates an arrhythmia.

[0032] There may be differences between an ECG data segment that indicates an arrhythmia and an ECG data segment that does not indicate an arrhythmia. For example, a morphology of P-waves in the ECG data segment indicating arrhythmia may be noticeably different than a morphology of P-waves in the normal ECG data segment that does not indicate arrhythmia. This means that it may be beneficial for a clinician to compare a first ECG data segment suspected to indicate an arrhythmia episode with a second ECG data segment, such as a presenting ECG or reference ECG, that is known to not indicate an arrhythmia episode. For example, the user interface may display the first ECG data segment and the second ECG data segment on the same interface screen so that the clinician is able to compare the segments.

[0033] Variation in characteristics of cardiac events may indicate an arrhythmia. For example, when R-waves increase in frequency or decrease in frequency, this indicates a change in heart rate which may be associated with an arrhythmia. Changes in a morphology of P-waves throughout a sequence of cardiac cycles may indicate an arrhythmia. For example, when a P-wave is not detectable in an ECG data segment or a location where a P- wave is expected to be located includes noise, this may indicate atrial fibrillation (AF), one kind of arrhythmia. In any case, it may be beneficial for a clinician to compare portions of an ECG data segment with other portions of the ECG data segment to identify changes that may be associated with one or more arrhythmias.

[0034] In response to the clinician selecting a patient from the group of patients, the user interface may display a flagged cardiac data signal segment (e.g., an ECG data segment) corresponding to a suspected arrhythmia event collected from the patient. The user interface may also display a reference cardiac data signal segment (e.g., a presenting ECG data segment) at the same time as displaying the flagged cardiac data signal segment. The user interface may allow the clinician to scroll through the flagged cardiac data signal segment. The user interface may receive a user input from the clinician indicating whether the flagged cardiac data signal segment indicates an actual arrhythmia event or whether the flagged cardiac data signal segment does not indicate an arrhythmia event. In some examples, in response to the user interface receiving the user input, the user interface may display another flagged cardiac data signal segment corresponding to another suspected arrhythmia event, and the process repeats.

[0035] The user interface may also include a feature that allows the clinician to set a caliper defined by a start time and an end time. The caliper may appear on the screen as two vertical lines imposed on the flagged cardiac data signal segment, one line marking the start time and the other line marking the end time. The user may enable the caliper feature by providing a user input and then subsequently provide user inputs to define the start time and the end time. The user interface may include an option for the clinician to request repeating calipers. In response to the clinician selecting repeating calipers, a sequence of repeating calipers may appear on the user interface imposed on the flagged cardiac data signal segment. Each caliper of the sequence of repeating calipers may include a duration that is the same as the duration of the primary caliper defined based on user input.

[0036] The sequence of repeating calipers imposed on the flagged cardiac data signal segment may assist the clinician in determining whether one or more characteristics of cardiac events are changing over time in a way that indicates an arrhythmia. For example, in the above figure, there are no R-waves in the second-to-last caliper shown on the screen. The amount of time between R-waves also appears to be changing throughout the signal segments. The repeating calipers assist the clinician in identifying these irregularities and determining whether the irregularities are associated with an arrhythmia.

[0037] The techniques include facilitating the evaluation of flagged cardiac data signal segments for potential arrythmia. As such, these techniques facilitate determinations of cardiac wellness, diagnosis of cardiac disease, and risk of cardiac events, including death, and may lead to clinical interventions, including appropriate therapy (e.g., pharmaceutical and/or surgical) to suppress the risk of such cardiac events.

[0038] FIG. 1 is a conceptual diagram illustrating an example medical system configured to present a user interface including a flagged cardiac data signal segment and a reference cardiac data signal segment at a same time (e.g., displayed on a same screen) in accordance with one or more techniques of this disclosure. Techniques described herein as being performed by one or more devices of the example of FIG. 1 may, in some examples, be performed by any of, or any combination of, the devices of FIG. 1.

[0039] In some examples, system 100 may represent a patient monitoring network, such as the Medtronic CareLink® Network. As shown in FIG. 1, system 100 includes computing device 102, display device 104, network 110, networked server 112 (e.g., a computing device), and repository 114. Computing device 102, in some examples, is or is a part of a portable computing device (e.g., a mobile phone, a smartphone, a netbook computer, a notebook computer, a tablet computing device, or a smart watch). In other examples, computing device 102 may be at least a part of a workstation or other non-portable computing device. Computing device 102 may also be configured to control display device 104. Display device 104 may be housed by computing device 102 or external from computing device 102.

[0040] Computing device 102 may be configured to connect to network 110 (e.g., a wired or wireless network). In some examples, computing device 102 may also be configured to communicate with networked server 112 via network 110 to request cardiac data signal segments of various patients. Although network 110 may be a single network, network 110 may be representative of two or more networks configured to provide network access to server 112 and/or repository 114.

[0041] Computing device 102 may include various components that provide respective functionality. For example, computing device 102 may control display device 104. Computing device 102 may include display device 104 or display device 104 may separate from computing device 102. Computing device 102 may include one or more input devices and/or output devices that facilitate user (e.g., a clinician) communication with computing device 102. In one example, computing device 102 may include separate input devices and/or display device 104 may be touch screen interface (e.g., a presence-sensitive display that includes a presence-sensitive input device). In other examples, display device 104 may include a display and one or more buttons, pads, joysticks, mice, tactile devices, or any other device capable of turning user actions into electrical signals that control computing device 102. In any example, the user clinician may interact with the display device or any other input devices to provide input prior to or during the processes described herein.

[0042] In the example of FIG. 1, computing device 102 may be described as a tablet computing device (e.g., a mobile computing device). However, in other examples, computing device 102 may be a smartphone, personal digital assistant (PDA), a desktop computer, a laptop computer, or another type of computing device. In some examples, computing device 102 may be a remote computing device at a clinic or other location remote from the patient. In other examples, computing device 102 may be a medical device programmer configured to control the operation of the medical device collecting ECG data segments from the patient.

[0043] Retrieval of cardiac data signal segments from server 112 and/or repository 114, or transmission of data to such devices, may require a connection between computing device 102 and networked server 112 using network 110. Both computing device 102 and networked server 112 may connect to network 110. Network 110 may be embodied as one or more of the Internet, a wireless network, a wired network, a cellular network, or a fiber optic network. In other words, network 110 may be any data communication protocol or protocols that facilitate data transfer between two or more devices. Networked server 112 may also connect to repository 114 to store and/or retrieve cardiac data signal segments from medical devices, episode classification rules, or the like.

[0044] Networked server 112 and repository 114 may each include one or more servers or databases, respectively. In this manner, networked server 112 and repository 114 may be embodied as any hardware necessary to provide patient reports, cardiac data signal segments, or any other information related to the cardiac data signal segments to computing device 102 or any other computing device. Networked server 112 may include one or more servers, desktop computers, mainframes, minicomputers, or other computing devices capable of executing computer instructions and storing data. In some examples, functions attributable to networked server 112 herein may be attributed to respective different servers for respective functions. Repository 114 may include one or more memories, repositories, hard disks, or any other data storage device. In some examples, repository 114 may be included within networked server 112.

[0045] Repository 114 may be included in, or described as, cloud storage. In other words, cardiac data signal segments, cardiac data signal segment analyses, patient reports, instructions, or any other such information may be stored in one or more locations in the cloud (e.g., one or more repositories 114). Networked server 112 may access the cloud and retrieve the appropriate data as necessary. In some examples, repository 114 may include Relational Database Management System (RDBMS) software. In one example, repository 114 may be a relational database and accessed using a Structured Query Language (SQL) interface that is well known in the art. Repository 114 may alternatively be stored on a separate networked computing device and accessed by networked server 112 through a network interface or system bus. Repository 114 may thus be an RDBMS, an Object Database Management System (ODBMS), Online Analytical Processing (OLAP) database, or any other suitable data management system.

[0046] System 100 may be used to present cardiac data signal segments, such as ECG data segments, including an episode ECG 109 and a reference ECG 108 on user interface 106 at a same time, such that a clinician need not navigate to another screen or scroll up or down to view both the episode ECG and the reference ECG. Episode ECG 109 may represent a cardiac data signal segment of a detected potential arrythmia of a patient. Reference ECG 108 may represent a cardiac data signal segment of a normal resting heart cardiac rhythm of the patient, for example, captured at a time when the patient is likely to be resting, such as the middle of the night. In one example, processing circuitry of server 112 may be configured to receive, from a user device, a user input indicating a user selection of a patient of a plurality of patients. The plurality of patients may be, for example, patients whose ECG data segments are collected by system 100. Processing circuitry of server 112 (and/or of computing device 102) may cause display device 104 to display a reference cardiac data signal segment (e.g., reference ECG 108) corresponding to the patient and a first flagged cardiac data signal segment (e.g., episode ECG 109) of a set of flagged cardiac data signal segments corresponding to the patient at a same time. In other words, a clinician may be able to view both the first flagged cardiac data signal segment and the reference data signal segment on display device 104 without scrolling up and down or manipulating a user interface to change screens between the first flagged cardiac data signal segment and the reference cardiac data signal segment. The displayed reference cardiac data signal segment and the displayed first flagged cardiac data signal segment do not overlap, as shown in user interface 106. For example, reference ECG 108 and episode ECG 109 are displayed each on their own graph and are physically separated from each other on display device 104.

[0047] As shown in FIG. 1, computing device 102 is displaying reference ECG 108 and episode ECG 109 at a same time (e.g., on a same screen) of user interface 106. Computing device 102 may control display device 104 to display user interface 106.

[0048] The ECG data segments may have been originally obtained by a medical device associated with a patient, such as implanted medical device (IMD) 10 of FIG. 2. Server 112 may receive the ECG data segments periodically from the medical device and store the ECG data segments in repository 114 for later retrieval. In some examples, each set of episode ECG data segments may be collected from a patient in response to an associated medical device detecting a cardiac episode, such as an arrhythmia. For example, the medical device may be configured to monitor ECG data segments of the patient and, based on the ECG data segments, detect a potential cardiac episode. The medical device may send the ECG data segments associated with the potential cardiac episode to server 112 or repository 114, for example, via network 110 for review by the clinician. As such, the clinician may review ECG data segments of potential cardiac episodes to determine whether an actual cardiac episode has occurred, what type of cardiac episode has occurred, and/or to determine appropriate medical treatment for the patient based on the clinician’ s assessment of the ECG data segments.

[0049] In some examples, the medical device may continuously collect ECG data segments and store the segment of ECG data segments that corresponds to a detected cardiac episode. In addition to the ECG data segments, the medical device may generate markers indicative of sensed heart beats and/or paced beats.

[0050] The medical device may also collect reference or presenting ECG data segments, which the medical device may send to server 112 or repository 114, for example, via network 110. Display device 104 in presenting user interface 106 may display both an episode ECG data segments and a reference ECG data segments on a same screen, such that the clinician may compare the episode ECG data segments to the reference ECG data segments, without changing screens or scrolling up and down to view content not shown on user interface 106.

[0051] In some examples, the medical device may previously identify the detected cardiac episode included in the ECG data segments as one of a plurality of episode types. In other examples, server 112 may analyze the ECG data segments to identify, based on one or more signal characteristics, the episode type included in the ECG data segments. Signal characteristics may include frequency of sensed cardiac cycles, atrial-to-atrial (A-A) intervals, ventricular-to-ventricular (V-V) intervals, or any other distinguishing characteristics. Although the ECG data segments is described as including one cardiac episode, the cardiac episode may be a plurality of the same type of cardiac episode. In other words, a series of arrhythmic cardiac cycles may be referred to as a cardiac episode and identified as one type of episode.

[0052] The medical device and server 112 may recognize a plurality of different episode types (e.g., different types of arrhythmias). These episode types may include at least two of a treated ventricular tachycardia/ventricular fibrillation (VT/VF) episode, a monitored VT episode, a non-sustained ventricular tachycardia (VTNS) episode, a high-rate non-sustained ventricular tachycardia (VTNS) episode, a VT/VF episode with treatment withheld, a supraventricular tachycardia (SVT) episode, a ventricular oversensing (VOS) episode, a fast atrial and ventricular rate episode, a treated atrial tachycardia/atrial fibrillation (AT/AF) episode, and a monitored AT/AF episode.

[0053] The portions of the ECG data segments to be selected may be selected based on the identified episode type (e.g., determined according to rules for the identified episode type). In some examples, one or more of the different episode types may be associated with respective one or more episode subtypes. In other words, a first set of portions of the ECG data segments may be selected for one episode subtype of an episode type and a second set of portions of the ECG data segments may be selected for another episode subtype of the same episode type. In this manner, the different episode subtypes may be associated with respective selections of portions of the ECG data segments for presentation on user interface 106. These respective selections of portions may be different from each other.

[0054] In some examples, server 112 may be configured to classify the detected cardiac episode of the ECG data segments as one of the respective one or more episode subtypes of the episode type. Based on this classified episode subtype (e.g., in accordance with rules associated with the classified episode subtype), server 112 may select the one or more portions of the ECG data segments. These subtypes of episodes may provide more relevant portions, or snippets, of the ECG data segments for the specific events of the episode subtype.

[0055] Each of the selected portions of the ECG data segments may be determined by a respective time length for each portion with respect to an event within the ECG data segments. In this manner, server 112 may determine the time length of the respective portions of the ECG data segments based on the classified episode subtype. In addition, server 112 may be configured to determine the number of the portions of the ECG signal to be selected. This determined number may be based on the identified episode type and/or classified episode subtype.

[0056] Each determined portion may correspond to an event relevant to the episode type and subtype. For example, if detection, the first treatment, and termination events of the episode are applicable to the episode type, then server 112 may be instructed to select a portion of the ECG data segments that includes each of the events. In this manner, each selected portion of the ECG data segments is associated with a respective one or more events associated with the detected cardiac episode. Example events may include one or more of an onset of the cardiac episode, a medical device detection of the cardiac episode, a first delivered therapy, a last delivered therapy, or a termination of the cardiac episode.

[0057] In some examples, user interface 106 may be presented in an interactive form through which the clinician may confirm or negate a suspected cardiac episode, classify a suspected cardiac episode, make notes, request additional information, or the like. In response to receiving user input from the clinician, computing device 102 may perform the operation corresponding to the user input request and/or request server 112 to perform the operation. In some examples, upon confirming or negating a suspected cardiac event, computing device 102 may store an indication of the confirmation or negation of the suspected cardiac event and control display device 104 to load a new version of user interface 106 including another episode ECG in place of episode ECG 109. In this manner, the clinician may relatively easily go through a number of suspected cardiac episodes associated with a patient, comparing each episode ECG with reference ECG 108, and confirming/negating suspected cardiac events without repetitively paging through different screens or scrolling up and down.

[0058] FIG. 2 is a conceptual diagram illustrating the environment of an example medical system in conjunction with a patient, in accordance with one or more techniques of this disclosure. The example techniques described herein may be used with data collected by IMD 10 or any other device capable of collecting ECG data segments. IMD 10 may be in wireless communication with at least one of external device 12 and/or other devices not pictured in FIG. 1 through which IMD 10 may communicate with server 112 or repository 114 of FIG. 1. In some examples, 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. 2), and is configured to sense a cardiac ECG via the plurality of electrodes. In some examples, IMD 10 takes the form of the Reveal LINQ™ or LINQ II™ ICM available from Medtronic, Inc., of Minneapolis, Minnesota, which may be inserted subcutaneously, or another ICM similar to, e.g., a version or modification of, the Reveal LINQ™ or LINQ II™ ICM.

[0059] 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 (e.g., a user input mechanism). In some examples, 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, such as server 112, via wireless communication, for example via network 110. External device 12, for example, 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).

[0060] External device 12 may be used to configure operational parameters for IMD 10. External device 12 may be used to retrieve data from IMD 10, such as reference ECG data segments and episode ECG data segments. 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. For example, external device 12 may retrieve information related to potential cardiac episodes detected by IMD 10 over a time period. The time period may be predetermined, for example, 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. External device 12 may also retrieve 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.

[0061] FIG. 3 is a functional block diagram illustrating an example configuration of IMD 10 of FIG. 2 in accordance with one or more techniques described herein. In the illustrated example, IMD 10 includes electrodes 16Aand 16B (collectively “electrodes 16”), antenna 26, processing circuitry 50, sensing circuitry 52, communication circuitry 54, storage device 56, switching circuitry 58, and sensors 62. Although the illustrated example includes two electrodes 16, IMDs including or coupled to more than two electrodes 16 may implement the techniques of this disclosure in some examples.

[0062] 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.

[0063] 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. Sensing circuitry 52 may include one or more rectifiers, filters, amplifiers, comparators, and/or analog-to-digital converters, in some examples.

[0064] Sensing circuitry 52 may also provide one or more digitized cardiac ECG signals to processing circuitry 50 for analysis. Processing circuitry 50 may be configured to detect potential cardiac episodes in sensed cardiac ECGs. For example, processing circuitry 50 may compare morphologies of sensed ECGs to ECG templates of known cardiac episodes or use other techniques to detect a potential cardiac episode. In some examples, processing circuitry 50 may store the digitized cardiac ECG, snippets thereof, and/or any indication of a potential cardiac episode, and/or type of cardiac episode in storage device 56. Processing circuitry 50 may also store digitized cardiac ECG of a time when patient 4 is likely to be resting, such as at 3 AM, to provide a presenting or reference ECG. Processing circuitry 50 of IMD 10, and/or processing circuitry of another device that retrieves data from IMD 10, may analyze the ECG to detect potential cardiac episodes.

[0065] Communication circuitry 54 may include any suitable hardware, firmware, software or any combination thereof for communicating with another device, such as external device 12, another networked computing device, or another IMD or sensor. Under the control of processing circuitry 50, communication circuitry 54 may receive downlink telemetry from, as well as send uplink telemetry to external device 12 or another device with the aid of an internal or external antenna, e.g., antenna 26. In addition, processing circuitry 50 may communicate with a networked computing device via an external device (e.g., external device 12) and a computer network, such as the Medtronic CareLink® Network. Antenna 26 and communication circuitry 54 may be configured to transmit and/or receive signals via inductive coupling, electromagnetic coupling, Near Field Communication (NFC), Radio Frequency (RF) communication, Bluetooth®, WiFi, or other proprietary or non-proprietary wireless communication schemes.

[0066] In some examples, storage device 56 includes computer-readable instructions that, when executed by processing circuitry 50, cause IMD 10 and processing circuitry 50 to perform various functions attributed to IMD 10 and processing circuitry 50 herein. Storage device 56 may include any volatile, non-volatile, magnetic, optical, or electrical media, such as a random access memory (RAM), read-only memory (ROM), non-volatile RAM (NVRAM), electrically-erasable programmable ROM (EEPROM), flash memory, or any other digital media. Storage device 56 may store, as examples, programmed values for one or more operational parameters of IMD 10 and/or data collected by IMD 10 for transmission to another device using communication circuitry 54. Data stored by storage device 56 and transmitted by communication circuitry 54 to one or more other devices may include a reference ECG, episode ECGs, data indicative of an episode associated with respective episode ECGs, and/or the like.

[0067] Processing circuitry 50 may monitor an ECG of patient 4 continuously. If processing circuitry 50 detects any cardiac episodes, then processing circuitry 50 store ECG data segments associated with the cardiac episode in storage device 56 and/or may control communication circuitry 60 to send the ECG data segments associated with the cardiac episode to a patient monitoring service, such as to server 112 of FIG. 1. [0068] FIG. 4A is a perspective drawing illustrating an IMD 10A, which may be an example configuration of IMD 10 of FIGS. 1 and 2 as an ICM. In the example shown in FIG. 4 A, IMD 10A may be embodied as a monitoring device having housing 412, proximal electrode 416A and distal electrode 416B. Housing 412 may further comprise first major surface 414, second major surface 418, proximal end 420, and distal end 422. Housing 412 encloses electronic circuitry located inside the IMD 10A and protects the circuitry contained therein from body fluids. Housing 412 may be hermetically sealed and configured for subcutaneous implantation. Electrical feedthroughs provide electrical connection of electrodes 416A and 416B.

[0069] In the example shown in FIG. 4A, IMD 10A is defined by a length /., a width W and thickness or depth D and is in the form of an elongated rectangular prism wherein the length L is much larger than the width W, which in turn is larger than the depth D. In one example, the geometry of the IMD 10A - in particular a width W greater than the depth D - is selected to allow IMD 10A to be inserted under the skin of the patient using a minimally invasive procedure and to remain in the desired orientation during insertion. For example, the device shown in FIG. 4A includes radial asymmetries (notably, the rectangular shape) along the longitudinal axis that maintains the device in the proper orientation following insertion. For example, the spacing between proximal electrode 416A and distal electrode 416B may range from 5 millimeters (mm) to 55 mm, 30 mm to 55 mm, 35 mm to 55 mm, and from 40 mm to 55 mm and may be any range or individual spacing from 5 mm to 60 mm. In addition, IMD 10A may have a length L that ranges from 30 mm to about 70 mm. In other examples, the length L may range from 5 mm to 60 mm, 40 mm to 60 mm, 45 mm to 60 mm and may be any length or range of lengths between about 30 mm and about 70 mm. In addition, the width of major surface 414 may range from 3 mm to 15, mm, from 3 mm to 10 mm, or from 5 mm to 15 mm, and may be any single or range of widths between 3 mm and 15 mm. The thickness of depth D of IMD 10A may range from 2 mm to 15 mm, from 2 mm to 9 mm, from 2 mm to 5 mm, from 5 mm to 15 mm, and may be any single or range of depths between 2 mm and 15 mm. In addition, IMD 10A according to an example of the present disclosure is has a geometry and size designed for ease of implant and patient comfort. Examples of IMD 10A described in this disclosure may have a volume of three cubic centimeters (cm) or less, 1.5 cubic cm or less or any volume between three and 1.5 cubic centimeters. [0070] In the example shown in FIG. 4 A, once inserted within the patient, the first major surface 414 faces outward, toward the skin of the patient while the second major surface 418 is located opposite the first major surface 414. In addition, in the example shown in FIG. 4 A, proximal end 420 and distal end 422 are rounded to reduce discomfort and irritation to surrounding tissue once inserted under the skin of the patient. IMD 10A, including instrument and method for inserting IMD 10A is described, for example, in U.S. Patent Publication No. 2014/0276928, incorporated herein by reference in its entirety.

[0071] Proximal electrode 416A is at or proximate to proximal end 420, and distal electrode 416B is at or proximate to distal end 422. Proximal electrode 416A and distal electrode 416B are used to sense cardiac ECG signals, e.g., ECG signals, thoracically outside the ribcage, which may be sub-muscularly or subcutaneously. Cardiac signals may be stored in a memory of IMD 10 A, and data may be transmitted via integrated antenna 430 A to another device, which may be another implantable device or an external device, such as external device 12. In some example, electrodes 416A and 416B may additionally or alternatively be used for sensing any bio-potential signal of interest, which may be, for example, an ECG, EEG, EMG, or a nerve signal, or for measuring impedance, from any implanted location.

[0072] In the example shown in FIG. 4A, proximal electrode 416A is at or in close proximity to the proximal end 420 and distal electrode 416B is at or in close proximity to distal end 422. In this example, distal electrode 416B is not limited to a flattened, outward facing surface, but may extend from first major surface 414 around rounded edges 424 and/or end surface 426 and onto the second major surface 418 so that the electrode 416B has a three-dimensional curved configuration. In some examples, electrode 416B is an uninsulated portion of a metallic, e.g., titanium, part of housing 412.

[0073] In the example shown in FIG. 4A, proximal electrode 416A is located on first major surface 414 and is substantially flat, and outward facing. However, in other examples proximal electrode 416A may utilize the three-dimensional curved configuration of distal electrode 416B, providing a three-dimensional proximal electrode (not shown in this example). Similarly, in other examples distal electrode 416B may utilize a substantially flat, outward facing electrode located on first major surface 414 similar to that shown with respect to proximal electrode 416A. The various electrode configurations allow for configurations in which proximal electrode 416A and distal electrode 416B are located on both first major surface 414 and second major surface 418. In other configurations, only one of proximal electrode 416A and distal electrode 416B is located on both major surfaces 414 and 418, and in still other configurations both proximal electrode 416A and distal electrode 416B are located on one of the first major surface 414 or the second major surface 418 (e.g., proximal electrode 416A located on first major surface 414 while distal electrode 416B is located on second major surface 418). In another example, IMD 10A may include electrodes on both major surface 414 and 418 at or near the proximal and distal ends of the device, such that a total of four electrodes are included on IMD 10 A. Electrodes 416A and 416B may be formed of a plurality of different types of biocompatible conductive material, e.g., stainless steel, titanium, platinum, iridium, or alloys thereof, and may utilize one or more coatings such as titanium nitride or fractal titanium nitride.

[0074] In the example shown in FIG. 4A, proximal end 420 includes a header assembly 428 that includes one or more of proximal electrode 416A, integrated antenna 430 A, antimigration projections 432, and/or suture hole 434. Integrated antenna 430A is located on the same major surface (i.e., first major surface 414) as proximal electrode 416A and is also included as part of header assembly 428. Integrated antenna 430 A allows IMD 10A to transmit and/or receive data. In other examples, integrated antenna 430A may be formed on the opposite major surface as proximal electrode 416A or may be incorporated within the housing 412 of IMD 10 A. In the example shown in FIG. 4 A, anti-migration projections 432 are located adjacent to integrated antenna 430A and protrude away from first major surface 414 to prevent longitudinal movement of the device. In the example shown in FIG. 4A, anti-migration projections 432 include a plurality (e.g., nine) small bumps or protrusions extending away from first major surface 414. As discussed above, in other examples antimigration projections 432 may be located on the opposite major surface as proximal electrode 416A and/or integrated antenna 430A. In addition, in the example shown in FIG. 4A, header assembly 428 includes suture hole 434, which provides another means of securing IMD 10A to the patient to prevent movement following insertion. In the example shown, suture hole 434 is located adjacent to proximal electrode 416A. In one example, header assembly 428 is a molded header assembly made from a polymeric or plastic material, which may be integrated or separable from the main portion of IMD 10 A.

[0075] FIG. 4B is a perspective drawing illustrating another IMD 10B, which may be another example configuration of IMD 10 from FIGS. 2 and 3 as an ICM. IMD 10B of FIG. 4B may be configured substantially similarly to IMD 10A of FIG. 4A, with differences between them discussed herein.

[0076] IMD 10B may include a leadless, subcutaneously-implantable monitoring device, e.g., an ICM. IMD 10B includes housing having a base 440 and an insulative cover 442. Proximal electrode 416C and distal electrode 416D may be formed or placed on an outer surface of cover 442. Various circuitries and components of IMD 10B, e.g., described above with respect to FIG. 3, may be formed or placed on an inner surface of cover 442, or within base 440. In some examples, a battery or other power source of IMD 10B may be included within base 440. In the illustrated example, antenna 430B is formed or placed on the outer surface of cover 442 but may be formed or placed on the inner surface in some examples. In some examples, insulative cover 442 may be positioned over an open base 440 such that base 440 and cover 442 enclose the circuitries and other components and protect them from fluids such as body fluids. The housing including base 440 and insulative cover 442 may be hermetically sealed and configured for subcutaneous implantation.

[0077] Circuitries and components may be formed on the inner side of insulative cover 442, such as by using flip-chip technology. Insulative cover 442 may be flipped onto a base 440. When flipped and placed onto base 440, the components of IMD 10B formed on the inner side of insulative cover 442 may be positioned in a gap 444 defined by base 440. Electrodes 416C and 416D and antenna 430B may be electrically connected to circuitry formed on the inner side of insulative cover 442 through one or more vias (not shown) formed through insulative cover 442. Insulative cover 442 may be formed of sapphire (i.e., corundum), glass, parylene, and/or any other suitable insulating material. Base 440 may be formed from titanium or any other suitable material (e.g., a biocompatible material). Electrodes 416C and 446D may be formed from any of stainless steel, titanium, platinum, iridium, or alloys thereof. In addition, electrodes 446C and 446D may be coated with a material such as titanium nitride or fractal titanium nitride, although other suitable materials and coatings for such electrodes may be used.

[0078] In the example shown in FIG. 4B, the housing of IMD 10B defines a length /., a width W and thickness or depth D and is in the form of an elongated rectangular prism wherein the length L is much larger than the width W, which in turn is larger than the depth D, similar to IMD 10A of FIG. 4A. For example, the spacing between proximal electrode 416C and distal electrode 416D may range from 5 mm to 50 mm, from 30 mm to 50 mm, from 35 mm to 45 mm, and may be any single spacing or range of spacings from 5 mm to 50 mm, such as approximately 40 mm. In addition, IMD 10B may have a length L that ranges from 5 mm to about 70 mm. In other examples, the length L may range from 30 mm to 70 mm, 40 mm to 60 mm, 45 mm to 55 mm, and may be any single length or range of lengths from 5 mm to 50 mm, such as approximately 45 mm. In addition, the width W may range from 3 mm to 15 mm, 5 mm to 15 mm, 5 mm to 10 mm, and may be any single width or range of widths from 3 mm to 15 mm, such as approximately 8 mm. The thickness or depth D of IMD 10B may range from 2 mm to 15 mm, from 5 mm to 15 mm, or from 3 mm to 5 mm, and may be any single depth or range of depths between 2 mm and 15 mm, such as approximately 4 mm. IMD 10B may have a volume of three cubic centimeters (cm) or less, or 1.5 cubic cm or less, such as approximately 1.4 cubic cm.

[0079] In the example shown in FIG. 4B, once inserted subcutaneously within the patient, outer surface of cover 442 faces outward, toward the skin of the patient. In addition, as shown in FIG. 4B, proximal end 446 and distal end 448 are rounded to reduce discomfort and irritation to surrounding tissue once inserted under the skin of the patient. In addition, edges of IMD 10B may be rounded.

[0080] FIG. 5 is a block diagram illustrating an example configuration of components of external device 12. In the example of FIG. 5, external device 12 includes processing circuitry 80, communication circuitry 82, storage device 84, and user interface 86.

[0081] Processing circuitry 80 may include one or more processors that are configured to implement functionality and/or process instructions for execution within external device 12. For example, processing circuitry 80 may be capable of processing instructions stored in storage device 84. Processing circuitry 80 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 80 may include any suitable structure, whether in hardware, software, firmware, or any combination thereof, to perform the functions ascribed herein to processing circuitry 80.

[0082] Communication circuitry 82 may include any suitable hardware, firmware, software or any combination thereof for communicating with another device, such as IMD 10. Under the control of processing circuitry 80, communication circuitry 82 may receive downlink telemetry from, as well as send uplink telemetry to, IMD 10, or another device. Communication circuitry 82 may be configured to transmit or receive signals via inductive coupling, electromagnetic coupling, Near Field Communication (NFC), Radio Frequency (RF) communication, Bluetooth®, WiFi, or other proprietary or non-proprietary wireless communication schemes. Communication circuitry 82 may also be configured to communicate with devices other than IMD 10 via any of a variety of forms of wired and/or wireless communication and/or network protocols.

[0083] Storage device 84 may be configured to store information within external device 12 during operation. Storage device 84 may include a computer-readable storage medium or computer-readable storage device. In some examples, storage device 84 includes one or more of a short-term memory or a long-term memory. 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.

[0084] 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 reference ECG data segments and episode ECG data segments. For example, processing circuitry 80 may transmit an instruction to IMD 10 which requests IMD 10 to export collected data (e.g., reference ECG data segments and/or episode ECG data segments) to external device 12. In turn, external device 12 may receive the collected data from IMD 10 and store the collected data in storage device 84. Processing circuitry 80 may implement any of the techniques described herein to analyze cardiac ECGs received from IMD 10, e.g., to detect potential cardiac episodes in ECG data segments.

[0085] A user, such as a clinician or patient 4, may interact with external device 12 through user interface 86. User interface 86 includes a display (not shown), such as a liquid crystal display (LCD) or a light emitting diode (LED) display or other type of screen, with which processing circuitry 80 may present information related to IMD 10, e.g., cardiac ECGs. In addition, user interface 86 may include an input mechanism to receive input from the user. The input mechanisms may include, for example, any one or more of buttons, a keypad (e.g., an alphanumeric keypad), a peripheral pointing device, a touch screen, or another input mechanism that allows the user to navigate through user interfaces presented by processing circuitry 80 of external device 12 and provide input. In other examples, user interface 86 also includes audio circuitry for providing audible notifications, instructions or other sounds to the user, receiving voice commands from the user, or both.

[0086] FIG. 6 is a block diagram illustrating an example system that includes an access point 91, a network 93, external computing devices, such as a server 95, and one or more other computing devices 101A-101N (collectively, “computing devices 101”), which may be coupled to IMD 10 and external device 12 via network 93, in accordance with one or more techniques described herein. In this example, IMD 10 may use communication circuitry 54 to communicate with external device 12 via a first wireless connection, and to communicate with an access point 91 via a second wireless connection. In the example of FIG. 5, access point 91, external device 12, server 95, and computing devices 101 are interconnected and may communicate with each other through network 93. Network 93 may be an example of network 110 of FIG. 1. Server 95 may be an example of server 112 of FIG. 1. Storage device 97 may be an example of repository 114 of FIG. 1. Any of computing devices 101 may be examples of computing device 102 of FIG. 1.

[0087] Access point 91 may include a device that connects to network 93 via any of a variety of connections, such as telephone dial-up, digital subscriber line (DSL), or cable modem connections. In other examples, access point 91 may be coupled to network 93 through different forms of connections, including wired or wireless connections. In some examples, access point 91 may be a user device, such as a tablet or smartphone, that may be co-located with the patient. IMD 10 may be configured to transmit data, such as patient cardiac activity data and indications of episode data, and/or indications of changes in patient health, to access point 91. Access point 91 may then communicate the retrieved data to server 95 via network 93.

[0088] In some cases, 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. In some cases, 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 functionality, which may be similar to that provided by the Medtronic CareLink® Network. [0089] In some examples, 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. For example, computing device 101 A may present user interface 106 of FIG. 1. For example, the clinician may view reference ECG data segments and an episode ECG data segments on a same screen and confirm or negate a potential cardiac episode associated with the episode ECG data segments. 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. In some examples, 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. A computing 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. For example, 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. In further examples, 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.

[0090] In the example illustrated by FIG. 6, server 95 includes a storage device 97, e.g., to store data retrieved from IMD 10, and processing circuitry 99. Although not illustrated in FIG. 6 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. For example, 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, or any combination thereof, to perform the functions ascribed herein to processing circuitry 99. Processing circuitry 99 of server 95 and/or the processing circuitry of computing devices 101 may implement any of the techniques described herein to analyze information or data received from IMD 10, e.g., to determine whether the health status of a patient has changed.

[0091] 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.

[0092] FIG. 7 is a flow diagram illustrating example techniques of presenting cardiac data signal segments according to one or more aspects of this disclosure. IMD 10 may detect potential arrhythmia episodes (700). For example, IMD 10 may compare morphologies of captured ECG data segments to various templates to determine one or more arrhythmia episodes in the ECG data segments.

[0093] IMD 10 may send cardiac data signal segments to system 100 which may be a patient monitoring system (e.g., a clinic’s cardiac management system) (702). For example, IMD 10 may send, via external device 12, a detected episode ECG and a presenting ECG to server 112 (FIG. 1).

[0094] Server 112 may process the received data and make the received data available in system 100 (704). For example, server 112 may ingest the received data and store the received data in repository 114.

[0095] Server 112 may send to computing device 102 a notification of an episode detection for a patient (e.g., patient 4) and may present a clinician on display device 104 cardiac data of the patient (706), permitting the clinician to view details of the episode detection. For example, server 112 may alert the clinician via SMS text message, email, workflow notification, or the like, that there is episode ECG data segments ready for review by the clinician. The clinician may access the episode ECG data segments via computing device 102 which may display the episode ECG data segments on display device 104.

[0096] A clinician may view an episode ECG data segment, but may desire to compare the episode ECG data segment to the patient’s presenting or reference ECG data segment. For example, the clinician may determine that they would make a better-informed decision as to whether the episode ECG data segment is indicative of an actual cardiac episode or not by comparing the episode ECG data segment to the reference ECG data segment. As such, computing device 102 or server 112 may present a GUI on display device 104 for viewing the reference cardiac data signal segment (708). For example, the GUI may be configured to accept user input to display the reference ECG data segment together with the episode ECG data segment at a same time (e.g., on a same screen)

[0097] Computing device 102 and/or server 112 may receive user input to load the reference cardiac data (710). For example, the clinician may click on the GUI to load the reference ECG data segment next to the episode ECG data segment. This may cause computing device 102 to load user interface 106 in display device 104. User interface 106 may include a first label for the presenting ECG data segments and a second label for the episode ECG data segments identifying each as such, to enable the clinician to identify which ECG data segment is the reference ECG data segment and which ECG data segment is the episode ECG data segment. In some examples, user interface 106 presents both the reference ECG data segment and the episode ECG data segment with a same scale and sweep speed to allow the clinician to easily compare the ECG morphologies of the two.

[0098] In some examples, computing device 102 and/or server 112 may receive user input to adjust the sweep speed of the cardiac data signal segments (712). Computing device 102 and/or server 112 may, in response to the user input, adjust the sweep speed for both the reference cardiac data signal segment and the episode cardiac data signal segment (714). In some examples, computing device 102 and/or server 112 may receive user input to adjust an amplitude (716) of either the reference cardiac data signal segment, the episode cardiac data signal segment, or both the reference cardiac data signal segment and the episode cardiac data signal segment together simultaneously. Computing device 102 and/or server 112 may, in response to the user input, adjust the amplitude of at least one of the reference cardiac data signal segment or the episode cardiac data signal segment (718). When adjusting both the reference cardiac data signal segment and the episode cardiac data signal segment, computing device 102 and/or server 112 may do so simultaneously in response to a single user input.

[0099] Server 112 may receive user input to move forward in a workflow and, in response, present the next item in the workflow (720). For example, the clinician may complete their assessment of the episode ECG, and enter their findings in computing device 102. In response to receiving the findings, server 112 may cause display device 104 to display a next episode ECG data segment for evaluation by the clinician.

[0100] FIG. 8 is a conceptual diagram illustrating an example ECG viewer user interface according to one or more aspects of this disclosure. User interface 800 may be an example of user interface 106 of FIG. 1. A clinician using user interface 800 may select via a GUI 802 a presenting mode in which both presenting ECG strip 810 and an episodic ECG strip 812 are presented on a same screen (e.g., side-by-side). As used herein, side-by-side means both the presenting ECG strip and the episodic ECG strip are presented on a same screen, and may, but does not necessarily include any connotation of whether they are horizontally or vertically adjacent to each other. While presenting ECG strip 810 is depicted above episodic ECG strip 812 in user interface 800, it should be understood that any other arrangement on a screen of user interface 800 that includes both presenting ECG strip 810 and episodic ECG strip 812 is within the scope of this disclosure.

[0101] User interface 800 may include labels 804 labeling presenting ECG strip 810 and episodic ECG strip 812 so as to clearly indicate which ECG data segment is which. Presenting ECG strip 810 may represent ECG data segments captured by IMD 10 while patient 4 is resting, such as in the middle of the night. For example, IMD 10 may be configured to capture presenting ECG strip 810 at a time when it is likely that patient 4 is at rest. In some examples, IMD 10 may periodically capture new presenting ECG data segments. In this manner, presenting ECG strip 810 may be a good representation of a resting heartbeat for patient 4. A resting heartbeat may be less likely to include an arrythmia than an active heartbeat.

[0102] GUI 802 may represent a view selector through which a user may toggle between different views, such as a focused view, an HR plot, and a presenting view, such as that of user interface 800.

[0103] In the example of user interface 800, presenting ECG strip 810 is displayed directly above episodic ECG strip 812. In some examples, the sweep speeds of both presenting ECG strip 810 and episodic ECG strip 812 match the selected speed of a dropdown menu 814, depicted in the upper left of FIG. 8. In this manner, a user comparing presenting ECG strip 810 and episodic ECG strip 812 may be viewing a same length of time across both ECG strips, which may facilitate a faster and/or more accurate review of episodic ECG strip 812 and determination whether episodic ECG strip 812 may represent a true cardiac episode.

[0104] GUI 806 is a shaded block appearing along a section of heartrate display 816. A user may navigate episodic ECG strip 812 freely across the entire duration of the detected episode while presenting ECG strip 810 remains stationary. For example, a user may click and drag GUI 806 along a portion of heartrate display 816 to navigate along episodic ECG strip 812. The portion of episodic ECG strip 812 that is displayed in user interface 800 may coincide with the position and width of GUI 806. In other words, episodic ECG strip 812 may include portions not currently being displayed in user interface 800, such as portions which coincide with portions of heartrate display 816 to the left of and to the right of GUI 806. The entirety of what is displayed in episodic ECG strip 812 at a given time may be associated with the time of heartrate data within the width of GUI 806. In some examples, the width of GUI 806 is based on the selected speed in dropdown menu 814. For example, if the selected speed was faster, then the width of GUI 806 may be larger as the amount of time being represented in episodic ECG strip 812 that is displayed may be larger.

[0105] On an initial load of user interface 800 in presenting mode, such as displaying both presenting ECG strip 810 and episodic ECG strip 812, an amplitude magnification of both presenting ECG strip 810 and episodic ECG strip 812 may match such that the amplitude range displayed for both presenting ECG strip 810 and episodic ECG strip 812 may be identical. As shown, user interface 800 may include magnification adjustment GUIs 808 for each of presenting ECG strip 810 and episodic ECG strip 812 which may permit a user to individually increase and/or decrease a magnification scale of the amplitude (e.g., the y-axis) of presenting ECG strip 810 and/or episodic ECG strip 812.

[0106] FIG. 9 is a conceptual diagram illustrating another example ECG viewer user interface according to one or more aspects of this disclosure. A clinician using user interface 900 may select via a GUI 902 a focused mode which may display a focused view of episode ECG segment 912, which may be an example of episode ECG strip 812 of FIG. 8.

[0107] User interface 900 may include a caliper tool GUI 904. When a clinician clicks on, or otherwise activates, caliper tool GUI 904, user interface 900 may enable and display primary calipers 906 on episode ECG segment 912. Primary calipers 906 may include a left handle 908A and a right handle 908B (collectively “handles 908”). A clinician may use handles 908 to manipulate primary calipers 906. For example, a clinician may click on and drag left handle 908A to the left or right horizontally along episode ECG segment 912 to move a left edge 920A of primary calipers 906 without moving right edge 920B. This may expand or contract the horizontal distance between left edge 920A and right edge 920B. Similarly, a clinician may click on and drag right handle 908B to the left or right horizontally along episode ECG segment 912 to move right edge 920B of primary calipers 906 without moving left edge 920A. In some examples, a clinician may click on and drag another portion of or area within primary calipers 906 to move primary calipers 906 to the left or right horizontally along episode ECG segment 912 without changing a horizontal distance between left edge 920A and right edge 920B, such that left edge 920A and right edge 920B move together a same distance. In some examples, when user interface 900 displays primary calipers 906, user interface 900 also displays a timing measurement 922 that represents the distance between left edge 920A and right edge 920B in increments of time as reflected in the x-axis of episode ECG segment 912, in this example, 600ms.

[0108] User interface 900 may include a GUI 930 for displaying marching calipers as represented by lines 910. The marching calipers are essentially a representation of primary calipers 906 duplicated along the length (e.g., in both directions) of episode ECG segment 912. The horizontal distance between each neighboring line of lines 910 equals the horizontal distance between left edge 920A and right edge 920B. As such, the location of the marching calipers (e.g., lines 910) is dictated by the horizontal size of primary caliper 906. In some examples, the marching calipers repeat indefinitely across the entire episode ECG strip. As such, user interface 900 may display marching calipers and thereby facilitate a clinician to more accurately interpret ECG data segments collected from cardiac devices, such as evaluating R-R intervals to identify heart rate variability within the ECG data segments.

[0109] As such, user interface 900 may display marching calipers and thereby facilitate a clinician to more accurately interpret ECG data segments collected from cardiac devices, such as evaluating R-R intervals to identify heart rate variability within the ECG data segments.

[0110] FIG. 10 is a flow diagram illustrating example cardiac data display techniques according to one or more aspects of this disclosure. While FIG. 10 is described with respect to server 112 of FIG. 1, the techniques of FIG. 10 may be performed by any device capable of performing them. [oni] Server 112 may receive, from a user device, a user input indicating a user selection of a patient of the plurality of patients (1000). For example, server 112 may receive from computing device 102 a user input from a clinician indicating a particular patient, such as patient 4, of a plurality of patients for whom cardiac data may be stored in repository 114.

[0112] Server 112 may cause the user device to display a reference cardiac data signal segment corresponding to the patient and a first flagged cardiac data signal segment of a set of flagged cardiac data signal segments corresponding to the patient at a same time, wherein the displayed reference cardiac data signal segment and the displayed first flagged cardiac data signal segment do not overlap (1002). For example, server 112 may cause computing device 102 to display on display device 104 reference ECG 108 and episode ECG 109 at the same time, as shown in user interface 106 and/or user interface 800 (FIG. 8), such that reference ECG 108 and episode ECG 109 are both visible, but are physically separated from each other (e.g., do not overlap). By displaying both the reference cardiac data signal segment and the first flagged cardiac data signal segment at the same time, a clinician may be able to more efficiently evaluate the first flagged cardiac data signal segment for possible indications of arrythmia than if the clinician were to have to excessively scroll or have to change screens of a user interface between a screen displaying the reference cardiac data signal segment and a screen displaying the first flagged cardiac data signal segment.

[0113] In some examples, prior to causing the user device to display the reference cardiac data and the first flagged cardiac data signal segment at the same time, server 112 may cause the user device to display the first flagged cardiac data signal segment and a GUI (e.g., GUI 802 of FIG. 8), the GUI configured to enable a user selection of displaying the reference cardiac data and the first flagged cardiac data signal segment at the same time. In some examples, server 112 may receive, from the user device via the GUI, an indication of the selection of displaying the reference cardiac data and the first flagged cardiac data signal segment at the same time. In some examples, server 112 causing the user device to display the reference cardiac data signal segment and the first flagged cardiac data signal segment at the same time is responsive to receiving the indication.

[0114] In some examples, server 112 may send alert to the user device indicating that the set of flagged cardiac data signal segments is ready for review. In some examples, the displayed reference cardiac data signal segment and the displayed first flagged cardiac data signal segment have a same first sweep speed. For example, the x-axis of presenting ECG strip 810 and episode ECG strip 812 (FIG. 8) may be of a same scale. In some examples, server 112 may, responsive to user input, cause the user device to display to an updated reference cardiac data signal segment and an updated first flagged cardiac data signal segment having a same second sweep speed. For example, a clinician may select a new sweep speed via dropdown menu 814 and server 112 may cause computing device 102 to control display device 104 to display presenting ECG strip 810 and episode ECG strip 812 with a second sweep speed, such as 50 mm/s.

[0115] In some examples, the displayed reference cardiac data signal segment and the displayed first flagged cardiac data signal segment have a same amplitude scale, and wherein the processing circuitry is further configured to, responsive to user input, adjust the amplitude scale of the displayed reference cardiac data signal segment, the displayed first flagged cardiac data signal segment, or both the displayed reference cardiac data signal segment and the displayed first flagged cardiac data signal segment.

[0116] In some examples, the same time is a first same time. In some examples, server 112 may receive, from the user device, a user input indicating whether the first flagged cardiac data signal segment indicates a first arrhythmia episode. Server 112 may cause the user device to display the reference cardiac data signal segment corresponding to the patient and a second flagged cardiac data signal segment of the set of flagged cardiac data signal segments corresponding to the patient at a second same time. Server 112 may receive, from the user device, a user input indicating whether the second flagged cardiac data signal segment indicates a second arrhythmia episode.

[0117] In some examples, computing device 102 and/or server 112 may receive, from the user device, a user input including a request to define a start of a primary caliper at a first time relative to the first flagged cardiac data signal segment. In some examples, computing device 102 and/or server 112 may cause the user device (e.g., display device 104) to display a first vertical line (e.g. left edge 920A) on the first flagged cardiac data signal segment at the first time. In some examples, computing device 102 and/or server 112 may receive, from the user device, a user input including a request to define an end of the primary caliper at a second time relative to the first flagged cardiac data signal segment. In some examples, computing device 102 and/or server 112 may cause the user device to display a second vertical line (e.g., right edge 920B) on the first flagged cardiac data signal segment at the second time, the first vertical line and the second vertical line defining the primary caliper having a duration equal to a difference between the first time and the second time. In some examples, computing device 102 and/or server 112 may receive, from the user device, a user input including a request to display a sequence of repeating calipers based on the primary caliper. In some examples, computing device 102 and/or server 112 may cause the user device to display a sequence of vertical lines (e.g., vertical lines 910) on the cardiac data signal segment including the first horizontal line and the second horizontal line, wherein each pair of consecutive vertical lines of the sequence of vertical lines defines a respective caliper of the sequence of repeating calipers having a duration equal to the duration of the primary caliper.

[0118] In some examples, the duration is a first duration. In some examples, computing device 102 and/or server 112 may receive, from the user device, a user input including a request to move either the first vertical line or the second vertical line to a third time relative to the first flagged cardiac data signal segment. In some examples, computing device 102 and/or server 112 may cause the user device to display an updated primary caliper having a second duration equal to a difference between either the first time and the second time or the second time and the third time. In some examples, computing device 102 and/or server 112 may cause the user device to display an update sequence of vertical lines on the first flagged cardiac data signal segment, wherein each pair of consecutive updated vertical lines of the sequence of updated vertical lines defines an updated respective caliper of a sequence of updated repeating calipers having a duration equal to the second duration.

[0119] In some examples, computing device 102 and/or server 112 may receive, from the user device, a user input including a request to move both the start of the primary caliper to a third time and the end of the primary caliper to a fourth time relative to the first flagged cardiac data signal segment, wherein the difference between the third time and the fourth time is equal to difference between the first time and the second time. In some examples, cause the user device to move the first vertical line on the first flagged cardiac data signal segment to the third time and the second vertical line on the first flagged cardiac data signal segment to the fourth time. In some examples, computing device 102 and/or server 112 may cause the user device to move the sequence of vertical lines on the first flagged cardiac data signal segment in accordance with the movement of the first vertical line and the second vertical line. [0120] In some examples, computing device 102 and/or server 112 may cause the user device to display a representation of heart rate data at the same time as displaying the reference cardiac data signal segment and the first flagged cardiac data signal segment, the representation of the heart rate data coinciding in time with the first flagged cardiac data signal segment and being different than the first flagged cardiac data.

[0121] While the techniques herein are described as being performed by various elements, in some examples, other elements or a combination of elements may perform the techniques.

[0122] The techniques described in this disclosure may be implemented, at least in part, in hardware, software, firmware, or any combination thereof. For example, 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 as any combinations of such components, embodied in external devices, such as physician or patient programmers, stimulators, or other devices. The terms “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.

[0123] For aspects implemented in software, at least some of the functionality ascribed to the systems and devices described in this disclosure may be embodied as instructions on 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.

[0124] This disclosure includes the following non-limiting examples.

[0125] Example 1. A system comprising: one or more memories configured to store, for each patient of a plurality of patients, a set of flagged cardiac data signal segments and a reference cardiac data signal segment; and processing circuitry coupled to the one or more memories and configured to: receive, from a user device, a user input indicating a user selection of a patient of the plurality of patients; and cause the user device to display the reference cardiac data signal segment corresponding to the patient and a first flagged cardiac data signal segment of the set of flagged cardiac data signal segments corresponding to the patient at a same time, wherein the displayed reference cardiac data signal segment and the displayed first flagged cardiac data signal segment do not overlap.

[0126] Example 2. The system of example 1, wherein the processing circuitry is further configured to: prior to causing the user device to display the reference cardiac data and the first flagged cardiac data signal segment at the same time, causing the user device to display the first flagged cardiac data signal segment and a graphical user interface (GUI), the GUI configured to enable a user selection of displaying the reference cardiac data and the first flagged cardiac data signal segment at the same time; and receive, from the user device via the GUI, an indication of the selection of displaying the reference cardiac data and the first flagged cardiac data signal segment at the same time, wherein causing the user device to display the reference cardiac data signal segment and the first flagged cardiac data signal segment at the same time is responsive to receiving the indication.

[0127] Example s. The system of example 1 or example 2, wherein the processing circuitry is further configured to control communication circuitry to send an alert to the user device indicating that the set of flagged cardiac data signal segments is ready for review.

[0128] Example 4. The system of any of examples 1-3, wherein the displayed reference cardiac data signal segment and the displayed first flagged cardiac data signal segment have a same first sweep speed, and wherein the processing circuitry is further configured to, responsive to user input, cause the user device to display to an updated reference cardiac data signal segment and an updated first flagged cardiac data signal segment having a same second sweep speed.

[0129] Example 5. The system of any of examples 1-4, wherein the displayed reference cardiac data signal segment and the displayed first flagged cardiac data signal segment have a same amplitude scale, and wherein the processing circuitry is further configured to, responsive to user input, adjust the amplitude scale of the displayed reference cardiac data signal segment, the displayed first flagged cardiac data signal segment, or both the displayed reference cardiac data signal segment and the displayed first flagged cardiac data signal segment.

[0130] Example 6. The system of any of examples 1-5, wherein the same time is a first same time, and wherein the processing circuitry is further configured to: receive, from the user device, a user input indicating whether the first flagged cardiac data signal segment indicates a first arrhythmia episode; cause the user device to display the reference cardiac data signal segment corresponding to the patient and a second flagged cardiac data signal segment of the set of flagged cardiac data signal segments corresponding to the patient at a second same time; and receive, from the user device, a user input indicating whether the second flagged cardiac data signal segment indicates a second arrhythmia episode.

[0131] Example 7. The system of any of examples 1-6, wherein the processing circuitry is further configured to cause the user device to: receive, from the user device, a user input including a request to define a start of a primary caliper at a first time relative to the first flagged cardiac data signal segment; cause the user device to display a first vertical line on the first flagged cardiac data signal segment at the first time; receive, from the user device, a user input including a request to define an end of the primary caliper at a second time relative to the first flagged cardiac data signal segment; cause the user device to display a second vertical line on the first flagged cardiac data signal segment at the second time, the first vertical line and the second vertical line defining the primary caliper having a duration equal to a difference between the first time and the second time; receive, from the user device, a user input including a request to display a sequence of repeating calipers based on the primary caliper; and cause the user device to display a sequence of vertical lines on the cardiac data signal segment including the first horizontal line and the second horizontal line, wherein each pair of consecutive vertical lines of the sequence of vertical lines defines a respective caliper of the sequence of repeating calipers having a duration equal to the duration of the primary caliper.

[0132] Example 8. The system of example 7, wherein the duration is a first duration, and wherein the processing circuitry is further configured to: receive, from the user device, a user input including a request to move either the first vertical line or the second vertical line to a third time relative to the first flagged cardiac data signal segment; cause the user device to display an updated primary caliper having a second duration equal to a difference between either the first time and the second time or the second time and the third time; and cause the user device to display an update sequence of vertical lines on the first flagged cardiac data signal segment, wherein each pair of consecutive updated vertical lines of the sequence of updated vertical lines defines an updated respective caliper of a sequence of updated repeating calipers having a duration equal to the second duration. [0133] Example 9. The system of example 7, wherein the processing circuitry is further configured to: receive, from the user device, a user input including a request to move both the start of the primary caliper to a third time and the end of the primary caliper to a fourth time relative to the first flagged cardiac data signal segment, wherein the difference between the third time and the fourth time is equal to difference between the first time and the second time; cause the user device to move the first vertical line on the first flagged cardiac data signal segment to the third time and the second vertical line on the first flagged cardiac data signal segment to the fourth time; and cause the user device to move the sequence of vertical lines on the first flagged cardiac data signal segment in accordance with the movement of the first vertical line and the second vertical line.

[0134] Example 10. The system of any of examples 1-9, wherein the processing circuitry is further configured to cause the user device to display a representation of heart rate data at the same time as displaying the reference cardiac data signal segment and the first flagged cardiac data signal segment, the representation of the heart rate data coinciding in time with the first flagged cardiac data signal segment and being different than the first flagged cardiac data.

[0135] Example 11. A method comprising: receiving, by processing circuitry and from a user device, a user input indicating a user selection of a patient of a plurality of patients; and causing, by the processing circuitry, the user device to display a reference cardiac data signal segment corresponding to the patient and a first flagged cardiac data signal segment of a set of flagged cardiac data signal segments corresponding to the patient at a same time, wherein the displayed reference cardiac data signal segment and the displayed first flagged cardiac data signal segment do not overlap.

[0136] Example 12. The method of example 11, further comprising: causing, by the processing circuitry and prior to causing the user device to display the reference cardiac data and the first flagged cardiac data signal segment at the same time, the user device to display the first flagged cardiac data signal segment and a graphical user interface (GUI), the GUI configured to enable a user selection of displaying the reference cardiac data and the first flagged cardiac data signal segment at the same time; and receiving, by the processing circuitry and from the user device via the GUI, an indication of the selection of displaying the reference cardiac data and the first flagged cardiac data signal segment at the same time, wherein causing the user device to display the reference cardiac data signal segment and the first flagged cardiac data signal segment at the same time is responsive to receiving the indication.

[0137] Example 13. The method of example 11 or example 12, further comprising controlling, by the processing circuitry, communication circuitry to send an alert to the user device indicating that the set of flagged cardiac data signal segments is ready for review.

[0138] Example 14. The method of any of examples 11-13, wherein the displayed reference cardiac data signal segment and the displayed first flagged cardiac data signal segment have a same first sweep speed, and wherein the method further comprises causing, by the processing circuitry and responsive to user input, the user device to display to an updated reference cardiac data signal segment and an updated first flagged cardiac data signal segment having a same second sweep speed.

[0139] Example 15. The method of any of examples 11-14, wherein the displayed reference cardiac data signal segment and the displayed first flagged cardiac data signal segment have a same amplitude scale, and wherein the method further comprises adjusting, by the processing circuitry and responsive to user input, the amplitude scale of the displayed reference cardiac data signal segment, the displayed first flagged cardiac data signal segment, or both the displayed reference cardiac data signal segment and the displayed first flagged cardiac data signal segment.

[0140] Example 16. The method of any of examples 11-15, wherein the same time is a first same time, and wherein the method further comprises: receiving, by the processing circuitry and from the user device, a user input indicating whether the first flagged cardiac data signal segment indicates a first arrhythmia episode; causing, by the processing circuitry, the user device to display the reference cardiac data signal segment corresponding to the patient and a second flagged cardiac data signal segment of the set of flagged cardiac data signal segments corresponding to the patient at a second same time; and receiving, by the processing circuitry and from the user device, a user input indicating whether the second flagged cardiac data signal segment indicates a second arrhythmia episode.

[0141] Example 17. The method of any of examples 11-16, further comprising: receiving, by the processing circuitry and from the user device, a user input including a request to define a start of a primary caliper at a first time relative to the first flagged cardiac data signal segment; causing, by the processing circuitry, the user device to display a first vertical line on the first flagged cardiac data signal segment at the first time; receiving, by the processing circuitry and from the user device, a user input including a request to define an end of the primary caliper at a second time relative to the first flagged cardiac data signal segment; causing, by the processing circuitry, the user device to display a second vertical line on the first flagged cardiac data signal segment at the second time, the first vertical line and the second vertical line defining the primary caliper having a duration equal to a difference between the first time and the second time; receiving, by the processing circuitry and from the user device, a user input including a request to display a sequence of repeating calipers based on the primary caliper; and causing, by the processing circuitry, the user device to display a sequence of vertical lines on the cardiac data signal segment including the first horizontal line and the second horizontal line, wherein each pair of consecutive vertical lines of the sequence of vertical lines defines a respective caliper of the sequence of repeating calipers having a duration equal to the duration of the primary caliper.

[0142] Example 18. The method of example 17, wherein the duration is a first duration, and wherein the method further comprises: receiving, by the processing circuitry and from the user device, a user input including a request to move either the first vertical line or the second vertical line to a third time relative to the first flagged cardiac data signal segment; causing, by the processing circuitry, the user device to display an updated primary caliper having a second duration equal to a difference between either the first time and the second time or the second time and the third time; and causing, by the processing circuitry, the user device to display an update sequence of vertical lines on the first flagged cardiac data signal segment, wherein each pair of consecutive updated vertical lines of the sequence of updated vertical lines defines an updated respective caliper of a sequence of updated repeating calipers having a duration equal to the second duration.

[0143] Example 19. The method of example 17, wherein the method further comprises: receiving, by the processing circuitry and from the user device, a user input including a request to move both the start of the primary caliper to a third time and the end of the primary caliper to a fourth time relative to the first flagged cardiac data signal segment, wherein the difference between the third time and the fourth time is equal to difference between the first time and the second time; causing, by the processing circuitry, the user device to move the first vertical line on the first flagged cardiac data signal segment to the third time and the second vertical line on the first flagged cardiac data signal segment to the fourth time; and causing, by the processing circuitry, the user device to move the sequence of vertical lines on the first flagged cardiac data signal segment in accordance with the movement of the first vertical line and the second vertical line.

[0144] Example 20. Non-transitory, computer-readable storage media storing instructions, which when executed by processing circuitry, cause the processing circuitry to: receive, from a user device, a user input indicating a user selection of a patient of a plurality of patients; and cause, by the processing circuitry, the user device to display a reference cardiac data signal segment corresponding to the patient and a first flagged cardiac data signal segment of a set of flagged cardiac data signal segments corresponding to the patient at a same time, wherein the displayed reference cardiac data signal segment and the displayed first flagged cardiac data signal segment do not overlap.

[0145] Various examples have been described. These and other examples are within the scope of the following claims.

Claims

CLAIMS: What is claimed is:

1. A system comprising: one or more memories configured to store, for each patient of a plurality of patients, a set of flagged cardiac data signal segments and a reference cardiac data signal segment; and processing circuitry coupled to the one or more memories and configured to: receive, from a user device, a user input indicating a user selection of a patient of the plurality of patients; and cause the user device to display the reference cardiac data signal segment corresponding to the patient and a first flagged cardiac data signal segment of the set of flagged cardiac data signal segments corresponding to the patient at a same time, wherein the displayed reference cardiac data signal segment and the displayed first flagged cardiac data signal segment do not overlap.

2. The system of claim 1, wherein the processing circuitry is further configured to: prior to causing the user device to display the reference cardiac data and the first flagged cardiac data signal segment at the same time, causing the user device to display the first flagged cardiac data signal segment and a graphical user interface (GUI), the GUI configured to enable a user selection of displaying the reference cardiac data and the first flagged cardiac data signal segment at the same time; and receive, from the user device via the GUI, an indication of the selection of displaying the reference cardiac data and the first flagged cardiac data signal segment at the same time, wherein causing the user device to display the reference cardiac data signal segment and the first flagged cardiac data signal segment at the same time is responsive to receiving the indication.

3. The system of claim 1 or claim 2, wherein the processing circuitry is further configured to control communication circuitry to send an alert to the user device indicating that the set of flagged cardiac data signal segments is ready for review.

4. The system of any of claims 1-3, wherein the displayed reference cardiac data signal segment and the displayed first flagged cardiac data signal segment have a same first sweep speed, and wherein the processing circuitry is further configured to, responsive to user input, cause the user device to display to an updated reference cardiac data signal segment and an updated first flagged cardiac data signal segment having a same second sweep speed.

5. The system of any of claims 1-4, wherein the displayed reference cardiac data signal segment and the displayed first flagged cardiac data signal segment have a same amplitude scale, and wherein the processing circuitry is further configured to, responsive to user input, adjust the amplitude scale of the displayed reference cardiac data signal segment, the displayed first flagged cardiac data signal segment, or both the displayed reference cardiac data signal segment and the displayed first flagged cardiac data signal segment.

6. The system of any of claims 1-5, wherein the same time is a first same time, and wherein the processing circuitry is further configured to: receive, from the user device, a user input indicating whether the first flagged cardiac data signal segment indicates a first arrhythmia episode; cause the user device to display the reference cardiac data signal segment corresponding to the patient and a second flagged cardiac data signal segment of the set of flagged cardiac data signal segments corresponding to the patient at a second same time; and receive, from the user device, a user input indicating whether the second flagged cardiac data signal segment indicates a second arrhythmia episode.

7. The system of any of claims 1-6, wherein the processing circuitry is further configured to cause the user device to: receive, from the user device, a user input including a request to define a start of a primary caliper at a first time relative to the first flagged cardiac data signal segment; cause the user device to display a first vertical line on the first flagged cardiac data signal segment at the first time; receive, from the user device, a user input including a request to define an end of the primary caliper at a second time relative to the first flagged cardiac data signal segment; cause the user device to display a second vertical line on the first flagged cardiac data signal segment at the second time, the first vertical line and the second vertical line defining the primary caliper having a duration equal to a difference between the first time and the second time; receive, from the user device, a user input including a request to display a sequence of repeating calipers based on the primary caliper; and cause the user device to display a sequence of vertical lines on the cardiac data signal segment including the first horizontal line and the second horizontal line, wherein each pair of consecutive vertical lines of the sequence of vertical lines defines a respective caliper of the sequence of repeating calipers having a duration equal to the duration of the primary caliper.

8. The system of claim 7, wherein the duration is a first duration, and wherein the processing circuitry is further configured to: receive, from the user device, a user input including a request to move either the first vertical line or the second vertical line to a third time relative to the first flagged cardiac data signal segment; cause the user device to display an updated primary caliper having a second duration equal to a difference between either the first time and the second time or the second time and the third time; and cause the user device to display an update sequence of vertical lines on the first flagged cardiac data signal segment, wherein each pair of consecutive updated vertical lines of the sequence of updated vertical lines defines an updated respective caliper of a sequence of updated repeating calipers having a duration equal to the second duration.

9. The system of claim 7, wherein the processing circuitry is further configured to: receive, from the user device, a user input including a request to move both the start of the primary caliper to a third time and the end of the primary caliper to a fourth time relative to the first flagged cardiac data signal segment, wherein the difference between the third time and the fourth time is equal to difference between the first time and the second time; cause the user device to move the first vertical line on the first flagged cardiac data signal segment to the third time and the second vertical line on the first flagged cardiac data signal segment to the fourth time; and cause the user device to move the sequence of vertical lines on the first flagged cardiac data signal segment in accordance with the movement of the first vertical line and the second vertical line.

10. The system of any of claims 1-9, wherein the processing circuitry is further configured to cause the user device to display a representation of heart rate data at the same time as displaying the reference cardiac data signal segment and the first flagged cardiac data signal segment, the representation of the heart rate data coinciding in time with the first flagged cardiac data signal segment and being different than the first flagged cardiac data.

1 1. A method comprising: receiving, by processing circuitry and from a user device, a user input indicating a user selection of a patient of a plurality of patients; and causing, by the processing circuitry, the user device to display a reference cardiac data signal segment corresponding to the patient and a first flagged cardiac data signal segment of a set of flagged cardiac data signal segments corresponding to the patient at a same time, wherein the displayed reference cardiac data signal segment and the displayed first flagged cardiac data signal segment do not overlap.

12. The method of claim 11, further comprising: causing, by the processing circuitry and prior to causing the user device to display the reference cardiac data and the first flagged cardiac data signal segment at the same time, the user device to display the first flagged cardiac data signal segment and a graphical user interface (GUI), the GUI configured to enable a user selection of displaying the reference cardiac data and the first flagged cardiac data signal segment at the same time; and receiving, by the processing circuitry and from the user device via the GUI, an indication of the selection of displaying the reference cardiac data and the first flagged cardiac data signal segment at the same time, wherein causing the user device to display the reference cardiac data signal segment and the first flagged cardiac data signal segment at the same time is responsive to receiving the indication.

13. The method of claim 11 or claim 12, further comprising controlling, by the processing circuitry, communication circuitry to send an alert to the user device indicating that the set of flagged cardiac data signal segments is ready for review.

14. The method of any of claims 11-13, wherein the displayed reference cardiac data signal segment and the displayed first flagged cardiac data signal segment have a same first sweep speed, and wherein the method further comprises causing, by the processing circuitry and responsive to user input, the user device to display to an updated reference cardiac data signal segment and an updated first flagged cardiac data signal segment having a same second sweep speed.

15. Non-tr nsit ry, computer-readable storage media storing instructions, which when executed by processing circuitry, cause the processing circuitry to: receive, from a user device, a user input indicating a user selection of a patient of a plurality of patients; and cause, by the processing circuitry, the user device to display a reference cardiac data signal segment corresponding to the patient and a first flagged cardiac data signal segment of a set of flagged cardiac data signal segments corresponding to the patient at a same time, wherein the displayed reference cardiac data signal segment and the displayed first flagged cardiac data signal segment do not overlap.