Current waveform for anti-bradycardia pacing for a subcutaneous implantable cardioverter-defibrillator

• US 20020107544A1
• Filed: 11/05/2001
• Published: 08/08/2002
• Est. Priority Date: 09/18/2000
• Status: Abandoned Application

• Current Assignee: Cameron Incorporated (Schlumberger NV)
• Original Assignee: Cameron Incorporated (Schlumberger NV)
• Inventors: Ostroff, Alan H., Mezack, Gary R., Rissman, William J.
• Application Number:
  US10/011,506
• Publication Number:
  US 20020107544A1
• Time in Patent Office: Days
• US Class Current: 607/4
• CPC Class Codes: A61N 1/375 Constructional arrangements, e.g. casings
• CPC Class Codes: A61N 1/3756 Casings with electrodes thereon, e.g. leadless stimulators
• CPC Class Codes: A61N 1/3906 characterised by the form of the shockwave
• CPC Class Codes: A61N 1/3956 Implantable devices for applying electric shocks to the heart, e.g. for cardioversion
• CPC Class Codes: A61N 1/39622 Pacing therapy
• CPC Class Codes: A61N 1/3968 Constructional arrangements, e.g. casings A61N1/375 takes precedence
• CPC Class Codes: A61N 1/3975 Power supply A61N1/378 takes precedence

Abstract

A power supply for an implantable cardioverter-defibrillator for subcutaneous positioning between the third rib and the twelfth rib and using a lead system that does not directly contact a patient'"'"'s heart or reside in the intrathorasic blood vessels and for providing anti-bradycardia pacing energy to the heart, comprising a capacitor subsystem for storing the anti-bradycardia pacing energy for delivery to the patient'"'"'s heart; and a battery subsystem electrically coupled to the capacitor subsystem for providing the anti-bradycardia pacing energy to the capacitor subsystem.

Claims

1. A power supply for an implantable cardioverter-defibrillator for subcutaneous positioning between the third rib and the twelfth rib and using a lead system that does not directly contact a patient'"'"'s heart or reside in the intrathorasic blood vessels and for providing anti-bradycardia pacing energy to the heart, the power supply comprising:

a capacitor subsystem for storing the anti-bradycardia pacing energy for delivery to the patient'"'"'s heart; and

a battery subsystem electrically coupled to the capacitor subsystem for providing the anti-bradycardia pacing energy to the capacitor subsystem.

2. The power supply of claim 1, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a peak current that is approximately one milliamp to approximately 250 milliamps.

3. The power supply of claim 2, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a peak current that is approximately one milliamp to approximately 50 milliamps.

4. The power supply of claim 2, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a peak current that is approximately 50 milliamps to approximately 100 milliamps.

5. The power supply of claim 2, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a peak current that is approximately 100 milliamps to approximately 150 milliamps.

6. The power supply of claim 2, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a peak current that is approximately 150 milliamps to approximately 200 milliamps.

7. The power supply of claim 2, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a peak current that is approximately 200 milliamps to approximately 250 milliamps.

8. The power supply of claim 1, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a pulse width that is approximately 1 millisecond to approximately 40 milliseconds.

9. The power supply of claim 8, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a pulse width that is approximately 1 millisecond to approximately 10 milliseconds.

10. The power supply of claim 8 wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a pulse width that is approximately 10 milliseconds to approximately 20 milliseconds.

11. The power supply of claim 8 wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a pulse width that is approximately 20 milliseconds to approximately 30 milliseconds.

12. The power supply of claim 8 wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a pulse width that is approximately 30 milliseconds to approximately 40 milliseconds.

13. The power supply of claim 1, wherein the anti-bradycardia pacing energy comprises a biphasic waveform further comprising a portion that is positive in polarity and a portion that is negative in polarity.

14. The power supply of claim 1, wherein the anti-bradycardia pacing energy comprises a biphasic waveform that is provided at a rate of approximately 20 to approximately 120 stimuli/minute.

15. The power supply of claim 25, wherein the biphasic waveform is provided after a patient'"'"'s heart rate is greater than or equal to approximately 20 beats/minute.

16. The power supply of claim 1, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a peak current that is approximately one milliamp to approximately 250 milliamps.

17. The power supply of claim 16, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a peak current that is approximately one milliamp to approximately 50 milliamps.

18. The power supply of claim 16, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a peak current that is approximately 50 milliamps to approximately 100 milliamps.

19. The power supply of claim 16, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a peak current that is approximately 100 milliamps to approximately 150 milliamps.

20. The power supply of claim 16, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a peak current that is approximately 150 milliamps to approximately 200 milliamps.

21. The power supply of claim 16, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a peak current that is approximately 200 milliamps to approximately 250 milliamps.

22. The power supply of claim 1, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a pulse width that is approximately 1 millisecond to approximately 40 milliseconds.

23. The power supply of claim 22, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a pulse width that is approximately 1 millisecond to approximately 10 milliseconds.

24. The power supply of claim 22, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a pulse width that is approximately 10 milliseconds to approximately 20 milliseconds.

25. The power supply of claim 22, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a pulse width that is approximately 20 milliseconds to approximately 30 milliseconds.

26. The power supply of claim 22, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a pulse width that is approximately 30 milliseconds to approximately 40 milliseconds.

27. The power supply of claim 1, wherein the anti-bradycardia pacing energy comprises a monophasic waveform that is either positive or negative in polarity.

28. The power supply of claim 1, wherein the anti-bradycardia pacing energy comprises a monophasic waveform that is provided at a rate of approximately 20 to approximately 120 stimuli/minute.

29. The power supply of claim 28, wherein the monophasic waveform is provided after a patient'"'"'s heart rate is greater than or equal to approximately 20 beats/minute.

124. The power supply of claim 1, wherein the battery subsystem and the capacitor system provide a sufficient voltage to provide an anti-bradycardia pacing energy comprising an approximately constant current.

30. Current output system for an implantable cardioverter-defibrillator using a lead system that does not directly contact a patient'"'"'s heart or reside in the intrathorasic blood vessels and for providing anti-bradycardia pacing energy to the heart, the power supply comprising:

an energy storage system for storing the anti-bradycardia pacing energy for delivery to the patient'"'"'s heart; and

an energy source system electrically coupled to the capacitor subsystem for providing the anti-bradycardia pacing energy to the capacitor subsystem.

31. Current output system of claim 30, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a peak current that is approximately one milliamp to approximately 250 milliamps.

32. Current output system of claim 31, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a peak current that is approximately one milliamp to approximately 50 milliamps.

33. Current output system of claim 31, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a peak current that is approximately 50 milliamps to approximately 100 milliamps.

34. Current output system of claim 31, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a peak current that is approximately 100 milliamps to approximately 150 milliamps.

35. Current output system of claim 31, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a peak current that is approximately 150 milliamps to approximately 200 milliamps.

36. Current output system of claim 31, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a peak current that is approximately 200 milliamps to approximately 250 milliamps.

37. Current output system of claim 30, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a pulse width that is approximately 1 millisecond to approximately 40 milliseconds.

38. Current output system of claim 37, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a pulse width that is approximately 1 millisecond to approximately 10 milliseconds.

39. Current output system of claim 37, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a pulse width that is approximately 10 milliseconds to approximately 20 milliseconds.

40. Current output system of claim 37, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a pulse width that is approximately 20 milliseconds to approximately 30 milliseconds.

41. Current output system of claim 37, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a pulse width that is approximately 30 milliseconds to approximately 40 milliseconds.

42. Current output system of claim 30, wherein the anti-bradycardia pacing energy comprises a biphasic waveform further comprising a positive voltage portion and a negative voltage portion.

43. Current output system of claim 30, wherein the anti-bradycardia pacing energy comprises a biphasic waveform that is provided at a rate of approximately 20 to approximately 120 stimuli/minute.

44. Current output system of claim 43, wherein the biphasic waveform is provided after a patient'"'"'s heart rate is greater than or equal to approximately 20 beats/minute.

45. Current output system of claim 30, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a peak current that is approximately one milliamp to approximately 250 milliamps.

46. Current output system of claim 45, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a peak current that is approximately one milliamp to approximately 50 milliamps.

47. Current output system of claim 45, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a peak current that is approximately 50 milliamps to approximately 100 milliamps.

48. Current output system of claim 45, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a peak current that is approximately 100 milliamps to approximately 150 milliamps.

49. Current output system of claim 45, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a peak current that is approximately 150 milliamps to approximately 200 milliamps.

50. Current output system of claim 45, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a peak current that is approximately 200 milliamps to approximately 250 milliamps.

51. Current output system of claim 30, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a pulse width that is approximately 1 millisecond to approximately 40 milliseconds.

52. Current output system of claim 51, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a pulse width that is approximately 1 millisecond to approximately 10 milliseconds.

53. Current output system of claim 51, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a pulse width that is approximately 10 milliseconds to approximately 20 milliseconds.

54. Current output system of claim 51, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a pulse width that is approximately 20 milliseconds to approximately 30 milliseconds.

55. Current output system of claim 51, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a pulse width that is approximately 30 milliseconds to approximately 40 milliseconds.

56. Current output system of claim 30, wherein the anti-bradycardia pacing energy comprises a monophasic waveform that is either positive or negative in polarity.

57. Current output system of claim 30, wherein the anti-bradycardia pacing energy comprises a monophasic waveform that is provided at a rate of approximately 20 to approximately 120 stimuli/minute.

58. Current output system of claim 57, wherein the monophasic waveform is provided after a patient'"'"'s heart rate is greater than or equal to approximately 20 beats/minute.

60. The implantable cardioverter-defibrillator of claim 59, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a peak current that is approximately one milliamp to approximately 250 milliamps.

61. The implantable cardioverter-defibrillator of claim 60, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a peak current that is approximately one milliamp to approximately 50 milliamps.

62. The implantable cardioverter-defibrillator of claim 60, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a peak current that is approximately 50 milliamps to approximately 100 milliamps.

63. The implantable cardioverter-defibrillator of claim 60, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a peak current that is approximately 100 milliamps to approximately 150 milliamps.

64. The implantable cardioverter-defibrillator of claim 60, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a peak current that is approximately 150 milliamps to approximately 200 milliamps.

65. The implantable cardioverter-defibrillator of claim 60, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a peak current that is approximately 200 milliamps to approximately 250 milliamps.

66. The implantable cardioverter-defibrillator of claim 60, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a pulse width that is approximately 1 millisecond to approximately 40 milliseconds.

67. The implantable cardioverter-defibrillator of claim 66, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a pulse width that is approximately 1 millisecond to approximately 10 milliseconds.

68. The implantable cardioverter-defibrillator of claim 66, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a pulse width that is approximately 10 milliseconds to approximately 20 milliseconds.

69. The implantable cardioverter-defibrillator of claim 66, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a pulse width that is approximately 20 milliseconds to approximately 30 milliseconds.

70. The implantable cardioverter-defibrillator of claim 66, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a pulse width that is approximately 30 milliseconds to approximately 40 milliseconds.

71. The implantable cardioverter-defibrillator of claim 60, wherein the anti-bradycardia pacing energy comprises a biphasic waveform further comprising a portion that is positive in polarity and a portion that is negative in polarity.

72. The implantable cardioverter-defibrillator of claim 60, wherein the anti-bradycardia pacing energy comprises a biphasic waveform that is provided at a rate of approximately 20 to approximately 120 stimuli/minute.

73. The implantable cardioverter-defibrillator of claim 72, wherein the biphasic waveform is provided after a patient'"'"'s heart rate is greater than or equal to approximately 20 beats/minute.

74. The implantable cardioverter-defibrillator of claim 60, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a peak current that is approximately one milliamp to approximately 250 milliamps.

75. The implantable cardioverter-defibrillator of claim 74, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a peak current that is approximately one milliamp to approximately 50 milliamps.

76. The implantable cardioverter-defibrillator of claim 74, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a peak current that is approximately 50 milliamps to approximately 100 milliamps.

77. The implantable cardioverter-defibrillator of claim 74, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a peak current that is approximately 100 milliamps to approximately 150 milliamps.

78. The implantable cardioverter-defibrillator of claim 74, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a peak current that is approximately 150 milliamps to approximately 200 milliamps.

79. The implantable cardioverter-defibrillator of claim 60, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a peak current that is approximately 200 milliamps to approximately 250 milliamps.

80. The implantable cardioverter-defibrillator of claim 60, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a pulse width that is approximately 1 millisecond to approximately 40 milliseconds.

81. The implantable cardioverter-defibrillator of claim 80, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a pulse width that is approximately 1 millisecond to approximately 10 milliseconds.

82. The implantable cardioverter-defibrillator of claim 80, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a pulse width that is approximately 10 milliseconds to approximately 20 milliseconds.

83. The implantable cardioverter-defibrillator of claim 80, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a pulse width that is approximately 20 milliseconds to approximately 30 milliseconds.

84. The implantable cardioverter-defibrillator of claim 80, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a pulse width that is approximately 30 milliseconds to approximately 40 milliseconds.

85. The implantable cardioverter-defibrillator of claim 60, wherein the anti-bradycardia pacing energy comprises a monophasic waveform that is either positive or negative in polarity.

86. The implantable cardioverter-defibrillator of claim 60, wherein the anti-bradycardia pacing energy comprises a monophasic waveform that is provided at a rate of approximately 20 to approximately 120 stimuli/minute.

87. The implantable cardioverter-defibrillator of claim 86, wherein the monophasic waveform is provided after a patient'"'"'s heart rate is greater than or equal to approximately 20 beats/minute.

59. An implantable cardioverter-defibrillator for subcutaneous positioning between the third rib and the twelfth rib within a patient, the implantable cardioverter-defibrillator comprising:

a housing having an electrically conductive surface on an outer surface of the housing;

a lead assembly electrically coupled to the housing and having an electrode, wherein the lead assembly does not directly contact the patient'"'"'s heart or reside in the intrathorasic blood vessels;

a capacitor subsystem located within the housing and electrically coupled to the electrically conductive surface and the electrode for storing anti-bradycardia pacing energy and for delivering the anti-bradycardia pacing energy to the patient'"'"'s heart through the electrically conductive surface and the electrode; and

a battery subsystem electrically coupled to the capacitor subsystem for providing the anti-bradycardia pacing energy to the capacitor subsystem.

88. A method for supplying power for an implantable cardioverter-defibrillator for subcutaneous positioning between the third rib and the twelfth rib and using a lead system that does not directly contact a patient'"'"'s heart or reside in the intrathorasic blood vessels and for providing anti-bradycardia pacing energy to the heart, the method comprising:

generating anti-bradycardia pacing energy;

storing the anti-bradycardia pacing energy; and

delivering the anti-bradycardia pacing energy to the patient'"'"'s heart.

89. The method of claim 88, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a peak current that is approximately one milliamp to approximately 250 milliamps.

90. The method of claim 89, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a peak current that is approximately one milliamp to approximately 50 milliamps.

91. The method of claim 89, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a peak current that is approximately 50 milliamps to approximately 100 milliamps.

92. The method of claim 89, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a peak current that is approximately 100 milliamps to approximately 150 milliamps.

93. The method of claim 89, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a peak current that is approximately 150 milliamps to approximately 200 milliamps.

94. The method of claim 89, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a peak current that is approximately 200 milliamps to approximately 250 milliamps.

95. The method of claim 88, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a pulse width that is approximately 1 millisecond to approximately 40 milliseconds.

96. The method of claim 95, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a pulse width that is approximately 1 millisecond to approximately 10 milliseconds.

97. The method of claim 95, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a pulse width that is approximately 10 milliseconds to approximately 20 milliseconds.

98. The method of claim 95, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a pulse width that is approximately 20 milliseconds to approximately 30 milliseconds.

99. The method of claim 95, wherein the anti-bradycardia pacing energy comprises a biphasic waveform having a pulse width that is approximately 30 milliseconds to approximately 40 milliseconds.

100. The method of claim 88, wherein the anti-bradycardia pacing energy comprises a biphasic waveform further comprising a portion that is positive in polarity and a portion that is negative in polarity.

101. The method of claim 88, wherein the anti-bradycardia pacing energy comprises a biphasic waveform that is provided at a rate of approximately 20 to approximately 120 stimuli/minute.

102. The method of claim 101, wherein the biphasic waveform is provided after a patient'"'"'s heart rate is greater than or equal to approximately 20 beats/minute.

103. The method of claim 88, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a peak current that is approximately one milliamp to approximately 250 milliamps.

104. The method of claim 103, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a peak current that is approximately one milliamp to approximately 50 milliamps.

105. The method of claim 103, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a peak current that is approximately 50 milliamps to approximately 100 milliamps.

106. The method of claim 103, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a peak current that is approximately 100 milliamps to approximately 150 milliamps.

107. The method of claim 103, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a peak current that is approximately 150 milliamps to approximately 200 milliamps.

108. The method of claim 103, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a peak current that is approximately 200 milliamps to approximately 250 milliamps.

109. The method of claim 88, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a pulse width that is approximately 1 millisecond to approximately 40 milliseconds.

110. The method of claim 109, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a pulse width that is approximately 1 millisecond to approximately 10 milliseconds.

111. The method of claim 109, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a pulse width that is approximately 10 milliseconds to approximately 20 milliseconds.

112. The method of claim 109, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a pulse width that is approximately 20 milliseconds to approximately 30 milliseconds.

113. The method of claim 109, wherein the anti-bradycardia pacing energy comprises a monophasic waveform having a pulse width that is approximately 30 milliseconds to approximately 40 milliseconds.

114. The method of claim 88, wherein the anti-bradycardia pacing energy comprises a monophasic waveform that is either positive or negative in polarity.

115. The method of claim 88, wherein the anti-bradycardia pacing energy comprises a monophasic waveform that is provided at a rate of approximately 20 to approximately 120 stimuli/minute.

116. The method of claim 115, wherein the monophasic waveform is provided after a patient'"'"'s heart rate is greater than or equal to approximately 20 beats/minute.

117. The method of claim 88, wherein the implantable cardioverter-defibrillator is subcutaneously positioned between the third and fourth ribs.

118. The method of claim 88, wherein the implantable cardioverter-defibrillator is subcutaneously positioned between the fourth and sixth ribs.

119. The method of claim 88, wherein the implantable cardioverter-defibrillator is subcutaneously positioned between the sixth and eighth ribs.

120. The method of claim 88, wherein the implantable cardioverter-defibrillator is subcutaneously positioned between the eighth and tenth ribs.

121. The method of claim 88, wherein the implantable cardioverter-defibrillator is subcutaneously positioned between the tenth and twelfth ribs.

122. The method of claim 88, wherein the implantable cardioverter-defibrillator provides anti-bradycardia pacing energy to the heart for treatment of atrial fibrillation.

123. The method of claim 88, wherein the implantable cardioverter-defibrillator provides anti-bradycardia pacing energy to the heart for treatment of ventrical fibrillation.