Antitachycardial pacing
First Claim
1. A method of operating an implantable cardioverter-defibrillator (ICD), the ICD having output means for delivering electrical stimulation of a predetermined polarity, amplitude, shape and duration, the method comprising:
- sensing the onset of arrhythmia;
applying biphasic stimulation at a first intensity level selected from the group consisting of at the diastolic depolarization threshold, below the diastolic depolarization threshold or above the diastolic depolarization threshold wherein biphasic stimulation comprises;
a first stimulation phase with a first phase polarity, a first phase amplitude, a first phase shape and a first phase duration; and
a second stimulation phase with a second phase polarity, a second phase amplitude, a second phase shape and a second phase duration; and
determining whether capture has occurred.
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Accused Products
Abstract
Protocols for antitachycardial pacing including biphasic stimulation administered at, or just above, the diastolic depolarization threshold potential; biphasic or conventional stimulation initiated at, or just above, the diastolic depolarization threshold potential, reduced, upon capture, to below threshold; and biphasic or conventional stimulation administered at a level set just below the diastolic depolarization threshold potential. These protocols result in reliable cardiac capture with a lower stimulation level, thereby causing less damage to the heart, extending battery life, causing less pain to the patient and having greater therapeutic effectiveness. In those protocols using biphasic cardiac pacing, a first and second stimulation phase is administered. The first stimulation phase has a predefined polarity, amplitude and duration. The second stimulation phase also has a predefined polarity, amplitude and duration. The two phases are applied sequentially. Contrary to current thought, anodal stimulation is first applied and followed by cathodal stimulation. In this fashion, pulse conduction through the cardiac muscle is improved together with the increase in contractility.
140 Citations
29 Claims
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1. A method of operating an implantable cardioverter-defibrillator (ICD), the ICD having output means for delivering electrical stimulation of a predetermined polarity, amplitude, shape and duration, the method comprising:
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sensing the onset of arrhythmia;
applying biphasic stimulation at a first intensity level selected from the group consisting of at the diastolic depolarization threshold, below the diastolic depolarization threshold or above the diastolic depolarization threshold wherein biphasic stimulation comprises;
a first stimulation phase with a first phase polarity, a first phase amplitude, a first phase shape and a first phase duration; and
a second stimulation phase with a second phase polarity, a second phase amplitude, a second phase shape and a second phase duration; and
determining whether capture has occurred. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27)
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28. A method of operating an implantable cardioverter-defibrillator (ICD), the ICD having output means for delivering electrical stimulation of a predetermined polarity, amplitude, shape and duration, the method comprising:
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sensing the onset of arrhythmia;
applying stimulation selected from the group consisting of biphasic stimulation and conventional stimulation at a first intensity level selected from the group consisting of at the diastolic depolarization threshold, below the diastolic depolarization threshold or above the diastolic depolarization threshold;
determining whether capture has occurred;
increasing the stimulation intensity level by predefined increments until capture does occurs; and
upon capture, continuing stimulation selected from the group consisting of biphasic stimulation and conventional stimulation at a second intensity level below the diastolic depolarization threshold.
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29. A method of operating an implantable cardioverter-defibrillator (ICD), the ICD having output means for delivering electrical stimulation of a predetermined polarity, amplitude, shape and duration, the method comprising:
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defining a first stimulation phase with a positive polarity, a first phase amplitude, a first phase shape and a first phase duration, wherein said first phase amplitude is about 0.5 to 3.5 volts, wherein said first phase duration is about one to nine milliseconds and wherein said first stimulation phase is initiated greater than 200 milliseconds after completion of a cardiac beating cycle;
defining a second phase with a negative polarity, a second phase amplitude, a second phase shape and a second phase duration, wherein said second phase amplitude is about four volts to twenty volts and wherein said second phase duration is about 0.2 to 0.9 milliseconds; and
sensing the onset of arrhythmia;
applying the first stimulation phase and the second stimulation phase in sequence to the cardiac tissue;
determining whether capture has occurred; and
increasing the stimulation intensity level by predefined increments until capture occurs.
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Specification