阅读说明：本技术 提高心室安全起搏可靠性的方法、电路、存储介质及装置 (Method, circuit, storage medium and device for improving ventricular safe pacing reliability ) 是由 任江波 金华 郝云龙 陈小龙 朱妙娜 刘新蓉 于 2019-10-16 设计创作，主要内容包括：本申请涉及医疗器械领域,具体而言,涉及一种提高心室安全起搏可靠性的方法、电路、存储介质及装置。一种提高心室安全起搏可靠性的方法,包括：获取PVC波和QRS波的平均特征值；创建检测PVC波和QRS波的检测窗口；比对窗口内采集波的特征值与平均特征值,若相同则触发VSP脉冲,若不同则在AVI后发放脉冲VP；若M次VSP脉冲均由QRS波触发,将心房感知灵敏度提高一级。同时本申请还提供了实现所述方法的电路和装置,通过在创建的检测窗口中检测PVC波和QRS波的特征值和平均特征值的关联性,进一步准确的触发VSP脉冲和调整心房感知灵敏度,降低VSP错误的被触发或抑制的次数,提高VSP触发的可靠性。(The present application relates to the field of medical devices, and in particular, to a method, circuit, storage medium, and apparatus for improving ventricular safe pacing reliability. A method of improving ventricular safe pacing reliability, comprising: acquiring the average characteristic values of the PVC waves and the QRS waves; creating a detection window for detecting the PVC wave and the QRS wave; comparing the characteristic value of the collected wave in the window with the average characteristic value, if the characteristic value is the same, triggering a VSP pulse, and if the characteristic value is different, sending a pulse VP after AVI; if the M VSP pulses are triggered by the QRS wave, the atrial sensing sensitivity is improved by one level. Meanwhile, the application also provides a circuit and a device for realizing the method, and the VSP pulse is further accurately triggered and the atrial sensing sensitivity is adjusted by detecting the relevance of the characteristic values and the average characteristic values of the PVC wave and the QRS wave in the created detection window, so that the number of times of triggering or inhibiting the VSP error is reduced, and the VSP triggering reliability is improved.)

1. A method for improving the reliability of safe pacing of a ventricle, characterized by mainly comprising the steps of:

acquiring an average characteristic value of a PVC wave and an average characteristic value of a QRS wave;

creating a detection window for detecting the PVC wave and the QRS wave;

comparing the characteristic value of the collected wave in the detection window with the average characteristic value,

if the VSP pulse is the same as the VSP pulse, triggering the VSP pulse;

if not, then sending out pulse VP after AVI;

if the M VSP pulses are triggered by the QRS wave, the atrial sensing sensitivity is improved by one level.

2. A method for improving the reliability of safe pacing of a ventricle as recited in claim 1 in which said obtaining the average characteristic value of the PVC wave and the average characteristic value of the QRS wave comprises the steps of:

monitoring PVC waves and QRS waves;

when a PVC wave or a QRS wave is detected, acquiring and storing a characteristic value of the PVC wave or the QRS wave;

and when the characteristic value is recorded for N times, averaging the characteristic values of the N times to obtain an average characteristic value and storing the average characteristic value.

3. A method for improving the reliability of safe pacing of a ventricle as claimed in claim 2, wherein when said characteristic value is recorded up to N times, averaging said N characteristic values to obtain an average characteristic value and storing the average characteristic value further comprises the steps of:

and updating the average characteristic value according to time intervals.

4. A method for improving ventricular safe pacing reliability according to claim 1, wherein the creating of the detection windows of PVC waves and QRS waves comprises the steps of:

monitoring an AP event;

when an AP event is detected, acquiring a far-field signal time limit value of a ventricular channel;

when the time limit value of the far-field signal is recorded for N times, acquiring the average time limit value lambda of the far-field signal, and setting the fluctuation value delta of the time limit value of the far-field signal;

if the lambda + delta is less than or equal to the PAVB, setting a detection window for PVC waves and QRS waves from the tail end of the lambda to the tail end of the PAVB;

and if the lambda + delta is larger than the PAVB, expanding the PAVB to obtain a second PAVB, wherein the second PAVB is equal to the lambda + delta, and the detection windows of the PVC wave and the QRS wave are arranged from the tail end of the lambda to the tail end of the second PAVB.

5. A method for improving ventricular safe pacing reliability according to claim 4, further comprising the steps of, after setting the detection window to completion:

and updating the detection window according to a time interval.

6. A method for improving ventricular safe pacing reliability according to claim 1, wherein the comparing includes the steps of:

monitoring characteristic values of PVC waves and QRS waves at the detection window;

triggering a VSP pulse after 100ms of an AP event if the eigenvalue is the same as the average eigenvalue;

if the M VSP pulses are triggered by the QRS waves, atrial sensing sensitivity optimization is started, namely the atrial sensing sensitivity is improved by one level, so that the pacemaker can normally sense the P waves.

7. A method of improving ventricular safe pacing reliability according to claim 1, characterized in that the characteristic value is an area value, or a peak value, or an IEGM waveform.

8. A circuit for improving the safe pacing reliability of a ventricle comprises an MPU, a sensing circuit, a pacing circuit and a safe pacing module of the ventricle, and is characterized by further comprising:

the PVC/QRS wave characteristic value detection circuit module at least comprises a filter, an amplifier, an AD converter and a characteristic value acquisition module and is used for monitoring PVC waves and QRS waves; when a PVC wave or a QRS wave is detected, acquiring a characteristic value of the PVC wave or the QRS wave and sending the characteristic value to a PVC/QRS wave characteristic value storage unit;

a PVC/QRS wave characteristic value storage unit, wherein the PVC/QRS wave characteristic value storage unit is used for storing the characteristic value or the average characteristic value acquired by the PVC/QRS wave characteristic value detection module and activating the timer;

the characteristic value comparison module is used for detecting PVC/QRS waves with average characteristic values and triggering the ventricular safe pacing module, and specifically realizes the following steps:

triggering a VSP pulse after 100ms of an AP event if the eigenvalue of the waves acquired by the detection window is the same as the average eigenvalue; if not, then sending out pulse VP after AVI;

if the M VSP pulses are triggered by the QRS waves, atrial sensing sensitivity optimization is started, namely the atrial sensing sensitivity is improved by one level, so that the pacemaker can normally sense the P waves;

a PVC/QRS wave detection window module, said PVC/QRS wave detection window module comprising at least one filter, an amplifier, an AD converter, a PVC/QRS wave detection window for creating PVC wave and QRS wave detection windows, comprising performing the steps of:

monitoring an AP event;

when an AP event is detected, acquiring a far-field signal time limit value of a ventricular channel;

when the time limit value of the far-field signal is recorded for N times, acquiring the average time limit value lambda of the far-field signal, and setting the fluctuation value delta of the time limit value of the far-field signal;

if the lambda + delta is less than or equal to the PAVB, setting a detection window for PVC waves and QRS waves from the tail end of the lambda to the tail end of the PAVB;

if lambda + delta is larger than PAVB, expanding the PAVB to obtain a second PAVB, wherein the second PAVB is equal to lambda + delta, and a detection window of PVC waves and QRS waves is arranged from the tail end of lambda to the tail end of the second PAVB;

the timer is awakened after acquiring characteristic values of PVC and QRS waves and establishing a detection window of the PVC and QRS waves, and the MPU starts the timer for timing after each AP event.

9. A pacemaker device, wherein the device comprises at least one processor and at least one memory;

the at least one memory is for storing computer instructions;

the at least one processor is configured to execute at least some of the computer instructions to implement the operations of any of claims 1-7.

10. A computer-readable storage medium having stored thereon computer instructions, at least some of which, when executed by a processor, perform operations according to any one of claims 1 to 7.

Technical Field

The present application relates to the field of medical devices, and in particular, to a method, circuit, storage medium, and apparatus for improving ventricular safe pacing reliability.

Background

Patients implanted with dual chamber pacemakers have a steadily increasing posture in recent years. The VSP (ventricular safe pacing) function is a necessary basic function of a dual-chamber pacemaker, and aims to ensure the safety of ventricular pacing.

VSP pulses are not the ventricular pulses that are routinely delivered by dual chamber pacemakers and can only be triggered under certain circumstances. The VSP function is that within 100ms after the AP delivery, if any electrical signal is sensed by the ventricular sense circuitry, the pacemaker will deliver a VSP pulse once at 100 ms. The ventricular channel senses the strength of the electric signal to be changed, the AP event also changes in the time limit of a far-field signal generated by the ventricular channel, and the VSP pulse can be suppressed incorrectly or triggered frequently, so that the ventricular sensing sensitivity and the PAVB are frequently changed, and the pacemaker can trigger the VSP pulse always at the right time, which is not suitable for the original design purpose and is also very difficult.

Therefore, how to detect the characteristic of the PVC (Premature Ventricular contraction) wave or the QRS wave in a specific time period by extracting the characteristic when the Ventricular sense sensitivity or the PAVB setting is not reasonable enough can avoid false triggering or inhibit the VSP pulse, and improve the reliability of VSP triggering becomes a problem to be solved.

Disclosure of Invention

The invention aims to provide a method, a circuit, a storage medium and a device for improving the ventricular safe pacing reliability, which are used for further accurately triggering a VSP pulse and adjusting atrial sensing sensitivity by detecting the relevance of characteristic values and average characteristic values of a PVC wave and a QRS wave in a created detection window, so that the triggering or inhibiting times of VSP errors are reduced, and the VSP triggering reliability is improved.

The embodiment of the application is realized as follows:

a first aspect of embodiments of the present application provides a method for improving ventricular safe pacing reliability, comprising the steps of: acquiring an average characteristic value of a PVC wave and an average characteristic value of a QRS wave; creating a detection window for detecting the PVC wave and the QRS wave; comparing the characteristic value of the wave collected in the detection window with the average characteristic value, and if the characteristic value is the same as the average characteristic value, triggering a VSP pulse; if not, then sending out pulse VP after AVI; if the M VSP pulses are triggered by the QRS wave, the atrial sensing sensitivity is improved by one level.

Optionally, the acquiring the average characteristic value of the PVC wave and the average characteristic value of the QRS wave includes the following steps: monitoring PVC waves and QRS waves; when a PVC wave or a QRS wave is detected, acquiring and storing a characteristic value of the PVC wave or the QRS wave; and when the characteristic value is recorded for N times, averaging the characteristic values of the N times to obtain an average characteristic value and storing the average characteristic value.

Optionally, when the feature value is recorded N times, averaging the N feature values to obtain an average feature value, and storing the average feature value, the method further includes: and updating the average characteristic value according to time intervals.

Optionally, the creating a detection window of PVC waves and QRS waves comprises the steps of: monitoring an AP event; when an AP event is detected, acquiring a far-field signal time limit value of a ventricular channel; when the time limit value of the far-field signal is recorded for N times, acquiring the average time limit value lambda of the far-field signal, and setting the fluctuation value delta of the time limit value of the far-field signal; if the lambda + delta is less than or equal to the PAVB, setting a detection window for PVC waves and QRS waves from the tail end of the lambda to the tail end of the PAVB; and if the lambda + delta is larger than the PAVB, expanding the PAVB to obtain a second PAVB, wherein the second PAVB is equal to the lambda + delta, and the detection windows of the PVC wave and the QRS wave are arranged from the tail end of the lambda to the tail end of the second PAVB.

Optionally, after the setting of the detection window is completed, the method further includes the following steps: and updating the detection window according to a time interval.

Optionally, the aligning comprises the steps of: monitoring characteristic values of PVC waves and QRS waves at the detection window; triggering a VSP pulse after 100ms of an AP event if the eigenvalue is the same as the average eigenvalue; if the M VSP pulses are triggered by the QRS waves, atrial sensing sensitivity optimization is started, namely the atrial sensing sensitivity is improved by one level, so that the pacemaker can normally sense the P waves.

Optionally, the characteristic value is an area value, or a peak value, or an IEGM waveform.

A second aspect of the embodiments of the present application provides a circuit for improving ventricular safe pacing reliability, including an MPU, a sensing circuit, a pacing circuit, and a ventricular safe pacing module, further including:

the PVC/QRS wave characteristic value detection circuit module at least comprises a filter, an amplifier, an AD converter and a characteristic value acquisition module and is used for monitoring PVC waves and QRS waves; when a PVC wave or a QRS wave is detected, acquiring a characteristic value of the PVC wave or the QRS wave and sending the characteristic value to a PVC/QRS wave characteristic value storage unit;

a PVC/QRS wave characteristic value storage unit, wherein the PVC/QRS wave characteristic value storage unit is used for storing the characteristic value or the average characteristic value acquired by the PVC/QRS wave characteristic value detection module and activating the timer;

the characteristic value comparison module is used for detecting PVC/QRS waves with average characteristic values and triggering the ventricular safe pacing module, and specifically realizes the following steps:

triggering a VSP pulse after 100ms of an AP event if the eigenvalue of the waves acquired by the detection window is the same as the average eigenvalue; if not, then sending out pulse VP after AVI;

if the M VSP pulses are triggered by the QRS waves, atrial sensing sensitivity optimization is started, namely the atrial sensing sensitivity is improved by one level, so that the pacemaker can normally sense the P waves;

a PVC/QRS wave detection window module, said PVC/QRS wave detection window module comprising at least one filter, an amplifier, an AD converter, a PVC/QRS wave detection window for creating PVC wave and QRS wave detection windows, comprising performing the steps of:

monitoring an AP event;

when an AP event is detected, acquiring a far-field signal time limit value of a ventricular channel;

when the time limit value of the far-field signal is recorded for N times, acquiring the average time limit value lambda of the far-field signal, and setting the fluctuation value delta of the time limit value of the far-field signal;

if the lambda + delta is less than or equal to the PAVB, setting a detection window for PVC waves and QRS waves from the tail end of the lambda to the tail end of the PAVB;

if lambda + delta is larger than PAVB, expanding the PAVB to obtain a second PAVB, wherein the second PAVB is equal to lambda + delta, and a detection window of PVC waves and QRS waves is arranged from the tail end of lambda to the tail end of the second PAVB;

the timer is awakened after acquiring characteristic values of PVC and QRS waves and establishing a detection window of the PVC and QRS waves, and the MPU starts the timer for timing after each AP event.

A third aspect of embodiments of the present application provides a pacemaker device, the apparatus comprising at least one processor and at least one memory;

the at least one memory is for storing computer instructions;

the at least one processor is configured to execute at least part of the computer instructions to implement the operations of any one of the methods provided in the first aspect of the embodiments of the present application.

A fourth aspect of this embodiment of the present application provides a computer-readable storage medium, where the computer-readable storage medium stores computer instructions, and when at least part of the computer instructions are executed by a processor, the computer-readable storage medium implements the operations according to any one of the methods provided in the first aspect of this embodiment of the present application.

The beneficial effects of the embodiment of the application include: the application provides a method, a circuit, a storage medium and a device for improving the safe pacing reliability of a ventricle, which further accurately trigger a VSP pulse and adjust atrial sensing sensitivity by detecting the relevance of characteristic values and average characteristic values of a PVC wave and a QRS wave in a created detection window, reduce the number of times of triggering or inhibiting VSP errors and improve the triggering reliability of the VSP.

Drawings

In order to more clearly illustrate the technical solutions of the embodiments of the present application, the drawings that are required to be used in the embodiments will be briefly described below, it should be understood that the following drawings only illustrate some embodiments of the present application and therefore should not be considered as limiting the scope, and for those skilled in the art, other related drawings can be obtained from the drawings without inventive effort.

FIG. 1 shows that VSP pulses are erroneously suppressed or triggered as the PAVB and ventricular sense sensitivity change;

FIG. 2 is a flowchart illustrating an embodiment of the present application for obtaining an average characteristic value of a PVC wave or a QRS wave;

FIG. 3 shows a flowchart for creating a detection window for PVC waves and QRS waves according to an embodiment of the present application;

FIG. 4 shows a flow chart illustrating the identification of PVC and QRS waves and the triggering of VSP pulses after AP according to one embodiment of the present application.

FIG. 5 is a simplified block diagram of a circuit for improving ventricular safe pacing reliability according to one embodiment of the present application;

FIG. 6 shows a schematic diagram of an extended PAVB according to an embodiment of the application;

FIG. 7 is a graph illustrating the effect of improving ventricular safe pacing reliability after applying the method of the present application according to one embodiment of the present application;

wherein, 100-PMU; 200-a sensing circuit; 300-a pacing circuit; 400-ventricular safe pacing; 500-a timer; 600-a PVC/QRS wave characteristic value detection module; 601-eigenvalue collection module; 700-PVC/QRS wave characteristic value storage unit; 800-PVC/QRS wave detection window module; 801-PVC/QRS wave detection window; 900-eigenvalue alignment module.

Detailed Description

Certain exemplary embodiments will now be described to provide an overall understanding of the principles of the structure, function, manufacture, and use of the devices and methods disclosed herein. One or more examples of these embodiments are illustrated in the accompanying drawings. Those of ordinary skill in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments and that the scope of the various embodiments of the present application is defined solely by the claims. Features illustrated or described in connection with one exemplary embodiment may be combined with features of other embodiments. Such modifications and variations are intended to be included within the scope of the present application.

Reference throughout this specification to "embodiments," "some embodiments," "one embodiment," or "an embodiment," etc., means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment. Thus, appearances of the phrases "in various embodiments," "in some embodiments," "in at least one other embodiment," or "in an embodiment," or the like, throughout this specification are not necessarily all referring to the same embodiment. Furthermore, the particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments. Thus, the particular features, structures, or characteristics shown or described in connection with one embodiment may be combined, in whole or in part, with the features, structures, or characteristics of one or more other embodiments, without limitation. Such modifications and variations are intended to be included within the scope of the present application.

The heart is composed of atria (atrial) and ventricles (ventricles), and under normal conditions, the atria contract first, the ventricles contract later (with a certain time difference), and finally the heart relaxes again, and so on. The following two conditions trigger a VSP (ventricular safe Pacing) pulse.

A PVC (Premature Ventricular Contracion) falls within 100ms after the atrial pacing pulse and is sensed by the Ventricular sense circuitry, the pacemaker delivers a VSP pulse.

Atrioventricular conduction is normal and Atrial undersensing, i.e., Atrial sensing sensitivity is low, in which case an Atrial pacing pulse AP (Atrial Pace) is delivered because the pacemaker cannot sense AS (Atrial Sens), and a VSP pulse is delivered if the QRS wave produced by atrioventricular conduction falls just within 100ms after the Atrial pacing pulse and is sensed by the ventricular sensing circuitry.

The safety of VSP pulses is manifested in two ways:

first, if the ventricular sense circuit senses a PVC or QRS wave 100ms after AP, the VSP pulse will fall in the physiological refractory period, i.e., the VSP pulse will not stimulate the T wave, and is therefore safe.

Second, if the ventricular sense circuit senses far-field disturbances 100ms after the AP, the VSP pulses avoid the potential risk of ventricular arrest.

FIG. 1 illustrates the false suppression or triggering of VSP pulses with a change in the PAVB (post-atrial ventricular blanking) and ventricular sense sensitivity.

At I and V, the PVC or QRS wave falls within 100ms after the atrial pacing pulse AP and is sensed by the ventricular circuit, and the VSP pulse is delivered at 100ms, falls within the physiologic refractory period, and is therefore safe.

However, the underlying condition for triggering the VSP pulse is that the ventricular sense circuitry senses the electrical signal within 100ms after the atrial pacing pulse.

At II and VI, because the PAVB is set too long, the pacemaker cannot sense the electrical signal of PVC or QRS wave within 100ms because the PAVB value at I and V is increased from epsilon to (epsilon + delta epsilon) at II and VI, so that VSP pulse is inhibited wrongly, and the conventional Ventricular pacing pulse VP (Ventricular Pace) is delivered at the end of the conventional AVI (AV interval), so that the VP has a high probability of falling outside the physiological refractory period and even stimulating T wave, thereby bringing about safety hazard.

At III and VII, when the ventricular sense sensitivity range is increased from + -eta at I and V to + -eta + delta eta at III and VII, the time window in which the pacemaker can sense the PVC or QRS wave electric signal is reduced from phi at I and V to phi at III and VII

Also, the pacemaker is unable to sense the electrical signal of a PVC or QRS wave within 100ms, resulting in false suppression of VSP pulses.

For cases in III and VII, we can make the electrical signal of the PVC or QRS wave correctly sensed by the ventricular sense circuit by shortening the PAVB. However, in practice, as shown at VIII in the figure, when PAVB is scaled from ε to (ε - Δ ε'), there is a high probability that the ventricular sense circuit will be disturbed by the far-field signal, resulting in false and frequent triggering of VSP pulses.

AS shown at iv in fig. 1, since there is no far-field perception behind AS, and therefore PAVB is not set, the PVC or QRS wave behind AS is generally always correctly perceived, so VSP pulses are not triggered after AS.

In this regard, VSP pulses can be properly triggered when reasonable ventricular sense sensitivity and PAVB are set.

If the PAVB setting is too long, the VSP pulses may be erroneously suppressed, which may result in the last VP pulse of the AVI stimulating the T-wave.

The PAVB setting is too short and VSP pulses may be triggered incorrectly and frequently.

Since the VSP corresponds to a shortened, non-physiological AV (Atrioventricular) interval, although such VSP pulses are safe, they are not designed to be avoided as much as possible.

The intensity of the electrical signal sensed by the ventricular channel can be changed, and the time limit of the far-field signal generated by the AP in the ventricular channel can also be changed, so that the reasonable ventricular sensing sensitivity and the PAVB are set, and the pacemaker can trigger the VSP pulse always at the right time.

The purpose of the application is to more safely and reliably deliver the VSP pulse through a PVC/QRS wave detection window under the general setting condition of ventricular sense sensitivity or PAVB (Pan visual basic) so as to avoid the VSP pulse from being mistakenly inhibited and simultaneously reduce the mistaken triggering of the VSP pulse as much as possible.

The embodiment of the application provides a method for improving the safe pacing reliability of a ventricle.

First, the average characteristic value of the PVC wave and the average characteristic value of the QRS wave are obtained, as shown in fig. 2.

The PVC and QRS waves are monitored at all times while the pacemaker is operating properly.

When the pacemaker detects a PVC wave or a QRS wave, the PVC/QRS wave characteristic value detection module is started to record the characteristic value of the PVC wave or the QRS wave, and if the PVC wave or the QRS wave is not detected, the pacemaker waits for the next interval to continue monitoring.

And when the frequency of recording the PVC or QRS wave reaches N times, calculating the average value of the characteristic values acquired for N times as the average characteristic value of the PVC or QRS wave, and storing the average value in a PVC/QRS wave characteristic value storage unit. In this embodiment, N is 10 times.

The characteristic value is a peak value, or an area, or an IEGM (intracavitary electrocardiogram) waveform, or the like.

In at least another embodiment, the characteristic value is a peak value, a PVC/QRS characteristic value detection module is started to detect, and the detection result is output to a value comparator, and the comparator records the PVC or QRS peak value.

In at least another embodiment, the feature value is an area, the PVC/QRS feature value detection module is started to perform detection, and the detection result is output to a comparator, the comparator is specifically set as an integrator, and the integrator calculates the area of the PVC wave or the QRS wave.

In at least another embodiment, the feature value is an IEGM waveform, the PVC/QRS feature value detection module is enabled to perform detection, and the detection result is output to a comparator, the comparator is specifically set to IEGM, and the IEGM records the PVC or QRS waveform.

In at least one other embodiment, to ensure the validity and reliability of the data, the PVC/QRS wave characteristic values are updated periodically, for example every 24 hours.

Second, a detection window for detecting the PVC wave and the QRS wave is created, as shown in fig. 3.

AP events are monitored at times while the pacemaker is operating properly.

When the pacemaker detects the AP, it immediately begins to acquire far field signals of the ventricular channel.

When acquiring the far-field signals N times, the average time limit of the far-field signals is defined as λ, and the fluctuation value of the time limit of the far-field signals is defined as δ, in this embodiment, N is defined as 10 times.

If the lambda + delta is less than or equal to the PAVB, the detection windows of the PVC wave and the QRS wave are directly arranged from the tail end of the lambda to the tail end of the PAVB.

If lambda + delta > PAVB, making PAVB ═ lambda + delta, avoiding behind AP VSP pulse by mistake and trigger frequently, and set the lambda end to the end of optimized PAVB for the detection window of PVC wave and QRS wave.

Thirdly, comparing the characteristic value of the wave collected in the detection window with the average characteristic value after the AP occurs, and triggering a VSP pulse if the characteristic value is the same as the average characteristic value; if not, then pulse VP is issued after AVI. If both M VSP pulses are triggered by a QRS wave, the atrial sensitivity is increased by one step, as shown in FIG. 4.

Based on the already stored values of the PVC and QRS wave characteristics, and the creation of a completed detection window for the PVC and QRS waves, the pacemaker will automatically begin identifying the PVC and QRS waves after each AP event.

The pacemaker starts a characteristic value acquisition module to acquire PVC waves and QRS waves, and compares the characteristic value with the stored average characteristic value.

If the eigenvalue is the same as the average eigenvalue, a VSP pulse is triggered 100ms after the AP event. From a theoretical analysis, a VSP pulse triggered by a QRS wave can be avoided because this QRS is a P wave produced by atrioventricular conduction that is not sensed by the pacemaker. Therefore, when M VSP pulses triggered by QRS waves occur, the atrial sensing sensitivity can be optimized immediately, that is, the atrial sensing sensitivity is improved by one level, so that the pacemaker can normally sense P waves, and in the embodiment, the value of M is 3 times.

Specific implementations of the above method are described in detail below in connection with a circuit for improving ventricular safe pacing reliability as provided herein. A circuit for improving the reliability of safe pacing of ventricle, comprising an MPU100, a sensing circuit 200, a pacing circuit 300, a safe pacing module 400 of ventricle, further comprising: a PVC/QRS wave feature value detection module 600, a PVC/QRS wave feature value storage unit 700, a feature value comparison module 900, a PVC/QRS wave detection window module 800 and a timer 500, as shown in FIG. 5.

For a dual chamber pacemaker, it is easy to identify its own intrinsic ventricular activation VS (ventricular activation) and PVC in the VA interval, so that the corresponding characteristic values can be collected as templates.

During the VA interval, the pacemaker MPU (micro processor Unit) 100 immediately starts the PVC/QRS characteristic value detection module 600 to perform characteristic value detection after the sensing circuit 200 recognizes the PVC event. In this embodiment, the PVC/QRS feature value detecting module 600 includes at least one filter, at least one amplifier, at least one AD converter and a feature value acquiring module 601, and the PVC/QRS feature value detecting module 600 processes the corresponding electrical signal of the PVC, so as to obtain the corresponding feature value of the PVC.

During the AV interval, after the MPU100 recognizes the VS event through the sensing circuit 200, the PVC/QRS characteristic value detection module 600 is started to perform characteristic value detection. The PVC/QRS feature value detection module 600 processes the corresponding electrical signal of the QRS wave, and then may obtain the corresponding feature value of the QRS wave.

Then, the characteristic value of the PVC or QRS wave is stored in the PVC/QRS wave characteristic value storage unit 700.

A characteristic value comparison module 900, configured to detect a PVC wave or a QRS wave having the average characteristic value, and trigger the ventricular safe pacing module 400. In this embodiment, the eigenvalue comparison module 900 is a comparator, which is used to record the negative peak of the PVC wave and the positive peak of the QRS wave as the eigenvalues thereof.

In at least one other embodiment, the eigenvalue comparison module 900 is an integrator that records the area formed by the PVC and QRS waves, respectively, and the baseline.

In at least one other embodiment, the eigenvalue comparison module 900 is an IEGM electrocardiographic data acquisition module that records the accurate waveforms of the PVC wave and the QRS wave.

In at least another embodiment, the eigenvalue comparison module 900 is any combination of a comparator, an integrator, and an IEGM electrocardiographic data acquisition module.

After pacemaker MPU100 recognizes an AP event via pacing circuit 300, PVC/QRS feature detection module 600 processes the waveform, and in this embodiment, PVC/QRS feature detection module 600 includes at least one filter, at least one amplifier, and at least one AD converter to process the waveform in the ventricular channel, so as to record the time limit λ of the far-field signal generated by atrial pacing pulse AP in the ventricular channel.

The interval from the lambda end of the far-field signal time limit to the PAVB end is set as a PVC/QRS wave detection window.

In order to set a reasonable PVC/QRS wave detection window, δ is assumed to be the fluctuation value of the far-field signal time limit, and in the present embodiment, δ is 10 ms. If lambda + delta is less than or equal to PAVB, directly setting the tail end of the time limit lambda of the far-field signal to the tail end of the PAVB as a PVC/QRS wave detection window; if lambda + delta > PAVB, immediately optimizing PAVB to make PAVB become lambda + delta, and setting the window from the lambda end of far-field signal time limit to the optimized PAVB end as the PVC/QRS wave detection window. The purpose of optimizing the PAVB is to ensure that a far-field signal falls within the PAVB, avoid the problem that a pacemaker frequently senses the far-field signal within a paced AV interval to falsely trigger the VSP, and improve the reliability of the system.

Fig. 6 illustrates a detailed description of the extended PAVB of the embodiment of the present application.

As shown in FIG. 6, if λ + δ > PAVB, at I and II, the pacemaker can sense the electrical signal of the PVC or QRS wave and trigger the VSP pulse because the PVC and QRS wave appear outside the PAVB, and the pacemaker will not operate abnormally obviously.

However, at iii, if neither the PVC nor QRS wave is present, the pacemaker will be disturbed by the far field signal and trigger a VSP pulse. This means that after each AP the pacemaker may falsely trigger the VSP. Therefore, as shown at iv, it is necessary to extend PAVB to λ + δ to ensure that the pacemaker is working properly.

After the PVC/QRS wave detection window module establishes the PVC wave and QRS wave detection windows, the timer is awakened, and the MPU starts the timer after each AP event. At the same time, the PVC/QRS wave detection window triggers the PVC/QRS wave characteristic value comparison module 900.

In this embodiment, the characteristic value comparing module 900 is specifically configured as a comparator, as shown in fig. 5, the comparator compares the electrocardiographic data acquired and sent by the characteristic value acquiring module 601 with the average characteristic value of the PVC/QRS wave characteristic value storage unit 700, and if the former is consistent with the average characteristic value of the PVC or QRS wave in the storage unit, the VSP pulse is set and triggered after 100 ms. In an embodiment, a comparator is set to trigger the VSP pulses, thereby reducing the number of times the VSP pulses are erroneously suppressed.

If N times of VSP pulses triggered by QRS waves occur, it is indicated that undersensing may exist in the atrium, atrial sensing sensitivity optimization is performed, atrial sensing sensitivity can be improved by one level, and in the embodiment, N is 3.

Fig. 7 shows an effect schematic applied to an embodiment of the present application.

As shown in fig. 7, at i and iii, although the PAVB setting is too long, going from epsilon to (epsilon + delta epsilon), the pacemaker is still able to recognize the PVC and QRS waves and trigger the VSP pulse due to the presence of the PVC/QRS wave detection window.

At II and IV, when the ventricular perception sensitivity range is enlarged from +/-eta to +/-eta (eta + delta eta), the time window of the pacemaker for perceiving the electric signal of the PVC wave or the QRS wave is reduced from phi to

But due to the presence of the PVC/QRS wave detection window, the pacemaker is also able to recognize PVC and QRS waves and trigger VSP pulses.

The beneficial effect of this application lies in: through detecting the relevance of the characteristic values and the average characteristic values of the PVC waves and the QRS waves in the created detection window, the VSP pulse is further accurately triggered, the atrial sensing sensitivity is adjusted, the number of times that the VSP is mistakenly triggered or inhibited is reduced, and the VSP triggering reliability is improved.

It should be appreciated that the present application provides a pacemaker device comprising at least one processor and at least one memory. In some embodiments, the electronic device may be implemented by hardware, software, or a combination of software and hardware. Wherein the hardware portion may be implemented using dedicated logic; the software portions may be stored in a memory for execution by a suitable instruction execution system, such as a microprocessor or specially designed hardware. Those skilled in the art will appreciate that the methods and systems described above may be implemented using computer executable instructions and/or embodied in processor control code, such code being provided, for example, on a carrier medium such as a diskette, CD-or DVD-ROM, a programmable memory such as read-only memory (firmware), or a data carrier such as an optical or electronic signal carrier. The electronic device of the present application may be implemented not only by a hardware circuit such as a very large scale integrated circuit or a gate array, a semiconductor such as a logic chip, a transistor, or the like, or a programmable hardware device such as a field programmable gate array, a programmable logic device, or the like, but also by software executed by various types of processors, for example, and by a combination of the above hardware circuit and software (for example, firmware).

Moreover, those skilled in the art will appreciate that aspects of the present application may be illustrated and described in terms of several patentable species or situations, including any new and useful combination of processes, machines, manufacture, or materials, or any new and useful improvement thereon. Accordingly, various aspects of the present application may be embodied entirely in hardware, entirely in software (including firmware, resident software, micro-code, etc.) or in a combination of hardware and software. The above hardware or software may be referred to as "data block," module, "" engine, "" unit, "" component, "or" system. Furthermore, aspects of the present application may be represented as a computer product, including computer readable program code, embodied in one or more computer readable media.

The computer storage medium may comprise a propagated data signal with the computer program code embodied therewith, for example, on baseband or as part of a carrier wave. The propagated signal may take any of a variety of forms, including electromagnetic, optical, etc., or any suitable combination. A computer storage medium may be any computer-readable medium that can communicate, propagate, or transport a program for use by or in connection with an instruction execution system, apparatus, or device. Program code located on a computer storage medium may be propagated over any suitable medium, including radio, cable, fiber optic cable, RF, or the like, or any combination of the preceding.

Computer program code required for the operation of various portions of the present application may be written in any one or more programming languages, including an object oriented programming language such as Java, Scala, Smalltalk, Eiffel, JADE, Emerald, C + +, C #, VB.NET, Python, and the like, a conventional programming language such as C, Visual Basic, Fortran 2003, Perl, COBOL 2002, PHP, ABAP, a dynamic programming language such as Python, Ruby, and Groovy, or other programming languages, and the like. The program code may execute entirely on the user's computer, partly on the user's computer, as a stand-alone software package, partly on the user's computer and partly on a remote computer or entirely on the remote computer or server. In the latter scenario, the remote computer may be connected to the user's computer through any network format, such as a Local Area Network (LAN) or a Wide Area Network (WAN), or the connection may be made to an external computer (for example, through the Internet), or in a cloud computing environment, or as a service, such as a software as a service (SaaS).

Additionally, the order in which elements and sequences of the processes described herein are processed, the use of alphanumeric characters, or the use of other designations, is not intended to limit the order of the processes and methods described herein, unless explicitly claimed. While various presently contemplated embodiments of the invention have been discussed in the foregoing disclosure by way of example, it is to be understood that such detail is solely for that purpose and that the appended claims are not limited to the disclosed embodiments, but, on the contrary, are intended to cover all modifications and equivalent arrangements that are within the spirit and scope of the embodiments herein. For example, although the system components described above may be implemented by hardware devices, they may also be implemented by software-only solutions, such as installing the described system on an existing server or mobile device.

Similarly, it should be noted that in the preceding description of embodiments of the application, various features are sometimes grouped together in a single embodiment, figure, or description thereof for the purpose of streamlining the disclosure aiding in the understanding of one or more of the embodiments. This method of disclosure, however, is not intended to require more features than are expressly recited in the claims. Indeed, the embodiments may be characterized as having less than all of the features of a single embodiment disclosed above.

The entire contents of each patent, patent application publication, and other material cited in this application, such as articles, books, specifications, publications, documents, and the like, are hereby incorporated by reference into this application. Except where the application is filed in a manner inconsistent or contrary to the present disclosure, and except where the claim is filed in its broadest scope (whether present or later appended to the application) as well. It is noted that the descriptions, definitions and/or use of terms in this application shall control if they are inconsistent or contrary to the statements and/or uses of the present application in the material attached to this application.