Methods, systems and computer program products for treating fibrillation in a patient based on the presence of fibrillation following administration of defibrillation therapy

• US 20040049118A1
• Filed: 09/10/2002
• Published: 03/11/2004
• Est. Priority Date: 09/10/2002
• Status: Abandoned Application

• Current Assignee: UAB Research Foundation (University of Alabama System)
• Original Assignee: UAB Research Foundation (University of Alabama System)
• Inventors: Ideker, Raymond E., Walcott, Gregory P.
• Application Number:
  US10/238,342
• Publication Number:
  US 20040049118A1
• Time in Patent Office: Days
• US Class Current: 600/510
• CPC Class Codes: A61N 1/3925 Monitoring; Protecting

Abstract

Methods, systems and computer program products are provided for treating a patient experiencing fibrillation by administering a first defibrillation shock having a first shock value to the patient at a first time and determining if cardiac activity in the patient is influenced by the first defibrillation shock immediately after termination of the first defibrillation shock. An alternate treatment is administered at a second time if the cardiac activity is influenced by the first defibrillation shock immediately after termination of the first defibrillation shock.

Claims

1. A method of treating a patient, comprising:

administering a first defibrillation shock having a first shock value to the patient at a first time;

determining if cardiac activity in the patient is influenced by the first defibrillation shock immediately after termination of the first defibrillation shock; and

administering an alternate treatment at a second time if the cardiac activity is influenced by the first defibrillation shock immediately after termination of the first defibrillation shock.

2. A method according to claim 1, wherein administering an alternate treatment comprises administering an alternate treatment at a second time if cardiac activity is influenced by the first defibrillation shock within about two seconds after termination of the first defibrillation shock.

3. A method according to claim 1, further comprising:

administering a second defibrillation shock having a second shock value that is higher than the first shock value at the second time if the cardiac activity is not influenced by the first defibrillation shock immediately after termination of the first defibrillation shock.

4. A method according to claim 1, wherein cardiac activity comprises cardiac electrical activity and/or blood pressure.

5. A method according to claim 4, wherein cardiac activity comprises fibrillation and/or tachycardia.

6. A method according to claim 1, wherein determining comprises determining if the cardiac activity ceases immediately after termination of the first defibrillation shock and reinitiates within a predetermined time period after the first defibrillation shock;

and

wherein administering an alternate treatment comprises administering a third defibrillation shock having a third shock value that is at least one of substantially equivalent to the first shock value and less than the first shock value if it is determined that the cardiac activity has ceased immediately after termination of the first defibrillation shock and reinitiated within the predetermined time period.

7. A method according to claim 6, wherein the predetermined time period is from about 0 to about 5 minutes after termination of the first defibrillation shock.

8. A method according to claim 1, wherein determining comprises determining if the fibrillation ceases immediately after termination of the first defibrillation shock and reinitiates within a first predetermined time period after the first defibrillation shock and wherein administering an alternate treatment comprises waiting a second predetermined time period if it is determined that the fibrillation ceased after termination of the first defibrillation shock and reinitiated within the first predetermined time period, further comprising:

determining if fibrillation ceases after termination of the second predetermined time period; and

administering a third defibrillation shock having a third shock value that is at least one of substantially equivalent to the first shock value and less than the first shock value after the second predetermined time period if it is determined that the fibrillation has not ceased after termination of the second predetermined time period.

9. A method according to claim 8, wherein the first predetermined time period is from about 0 to about 5 minutes after termination of the first defibrillation shock.

10. A method according to claim 8, wherein the second predetermined time period is from about 10 seconds to about 90 seconds.

11. A method according to claim 1, wherein determining comprises determining if the fibrillation ceases immediately after termination of the first defibrillation shock and reinitiates within a first predetermined time period after termination of the first defibrillation shock and wherein administering an alternate treatment comprises administering cardiopulmonary resuscitation (CPR) for a second predetermined time period if the fibrillation ceased immediately after termination of the first defibrillation shock and reinitiated within the first predetermined time period, further comprising:

determining if the cardiac activity has been influenced by the administration of CPR; and

administering a third defibrillation shock having a third shock value that is at least one of substantially equivalent to the first shock value and less than the first shock value after termination of the second predetermined time period if it is determined that the cardiac activity has not been influenced by the administration of CPR during the second predetermined time period.

12. A method according to claim 11, wherein the first predetermined time period is from about 0 to about 5 minutes after termination of the first defibrillation shock.

13. A method according to claim 11, wherein the second predetermined time period is from about 10 seconds to about 90 seconds after termination of the first defibrillation shock.

14. A method according to claim 1, wherein determining comprises determining if the cardiac activity has ceased immediately after termination of the first defibrillation shock and wherein administering an alternate treatment comprises applying a pacing stimulation signal to the heart of the patient subsequent to termination of the defibrillation shock if it is determined that the cardiac activity has ceased immediately after termination of the first defibrillation shock.

15. A method according to claim 14, wherein applying a pacing stimulation comprises applying a pacing stimulation signal to the heart of the patient within about two seconds of termination of the first defibrillation shock.

16. A method according to claim 14, wherein the pacing stimulation signal comprises single pacing stimulation.

17. A method according to claim 14, wherein the pacing stimulation signal comprises paired pacing.

18. A method according to claim 16, further comprising the steps of:

detecting cardiac activity associated with application of the single pacing stimulation; and

selectively applying paired pacing stimulation based on the detected cardiac activity.

19. A method according to claim 16, further comprising the steps of:

detecting cardiac activity; and

selectively applying paired pacing stimulation based on the detected cardiac activity.

20. A method according to claim 16, further comprising the steps of:

detecting a signal specifying application of paired pacing; and

selectively applying paired pacing stimulation based on the detected signal.

21. A method according to claim 14, wherein the step of applying a defibrillation shock to a heart of the patient comprises applying a defibrillation shock to a heart of a patient using at least one first set of electrodes;

wherein the step of applying a pacing stimulation signal comprises applying a pacing stimulation signal to the heart of the patient subsequent to termination of the defibrillation shock using at least one second set of electrodes; and

wherein the first set of electrodes and the second set of electrodes are different sets of electrodes.

22. A method according to claim 14, wherein the step of applying a defibrillation shock to a heart of the patient comprises applying a defibrillation shock to a heart of a patient using at least one first set of electrodes;

wherein the step of applying a pacing stimulation signal comprises applying a pacing stimulation signal to the heart of the patient subsequent to termination of the defibrillation shock using at least one second set of electrodes; and

wherein the first set of electrodes and the second set of electrodes are a same set of electrodes.

23. A method according to claim 14, wherein the step of applying a pacing stimulation further comprises selectively applying paired pacing stimulation to the heart based on at least one of receipt of an external specification and sensed variables associated with cardiac activity.

24. A method according to claim 23, wherein the sensed variables associated with cardiac activity comprise a pulse pressure below a predefined threshold.

25. A method according to claim 23, wherein the external specification comprises instruction from a healthcare provider.

26. A method according to claim 14, wherein at least one of the defibrillation shock and the pacing stimulation are applied by an implantable device.

27. A method according to claim 1, further comprising:

determining if the cardiac activity has ceased after termination of the second defibrillation shock;

applying a pacing stimulation signal to the heart of the patient subsequent to termination of the second defibrillation shock if it is determined that the cardiac activity has ceased immediately after termination of the second defibrillation shock.

28. A method according to claim 1, wherein the cardiac activity comprises fibrillation and wherein fibrillation comprises at least one of ventricular fibrillation and atrial fibrillation.

29. A method according to claim 1, wherein the method is automated.

30. A method according to claim 1, wherein determining comprises determining if the cardiac activity has ceased immediately after termination of the first defibrillation shock and wherein administering an alternate treatment comprises applying a pacing stimulation signal to the heart of the patient subsequent to termination of the defibrillation shock if it is determined that the cardiac activity has ceased immediately after termination of the first defibrillation shock, further comprising:

detecting cardiac activity and/or function of the heart; and

selecting a type of pacing stimulation to apply to the heart of the patient subsequent to termination of the defibrillation shock based on the detected cardiac activity and/or function, wherein the step of applying comprises applying the selected type of pacing.

31. A method according to claim 30, wherein detecting cardiac activity and/or function comprises detecting the cardiac activity and/or function before applying a defibrillation shock to a heart of the patient.

32. A method according to claim 30, wherein detecting cardiac activity and/or function comprises detecting the cardiac activity and/or function after applying a defibrillation shock to a heart of the patient.

33. A method according to claim 30, wherein the selected type of pacing stimulation comprises single pacing stimulation.

34. A method according to claim 30, wherein the selected type of pacing stimulation comprises paired pacing stimulation.

35. A method according to claim 30, wherein the selected type of pacing stimulation comprises a combination of single pacing stimulation and paired pacing stimulation.

36. A method according to claim 1, wherein determining comprises determining if the cardiac activity has ceased immediately after termination of the first defibrillation shock and wherein administering an alternate treatment comprises applying a pacing stimulation signal to the heart of the patient subsequent to termination of the defibrillation shock if it is determined that the cardiac activity has ceased immediately after termination of the first defibrillation shock, the method further comprising inhibiting application of the pacing stimulation if cardiac activity is detected.

37. A method according to claim 36, wherein the detected cardiac activity comprises a detected blood pressure.

38. A method according to claim 36, wherein the detected cardiac activity comprises spontaneous electrical activity.

39. A method of treating a patient, the method comprising:

detecting the influence of a first defibrillation shock on the patient immediately subsequent to termination of the first defibrillation shock.

40. A method according to claim 39, further comprising:

administering the first defibrillation shock having a first shock value to the patient at a first time, wherein detecting comprises determining if cardiac activity in the patient is influenced by the first defibrillation shock immediately after termination of the first defibrillation shock; and

administering an alternate treatment at a second time if the cardiac activity is influenced by the first defibrillation shock immediately after termination of the first defibrillation shock.

41. A method according to claim 40, wherein administering an alternate treatment comprises administering an alternate treatment at a second time if cardiac activity is influenced by the first defibrillation shock within about two seconds after termination of the first defibrillation shock.

42. A method according to claim 40, further comprising:

administering a second defibrillation shock having a second shock value that is higher than the first shock value at the second time if the cardiac activity is not influenced by the first defibrillation shock immediately after termination of the first defibrillation shock.

43. A method according to claim 40, wherein cardiac activity comprises cardiac electrical activity and/or blood pressure.

44. A method according to claim 43, wherein cardiac activity comprises fibrillation.

45. A method according to claim 40, wherein determining comprises determining if the cardiac activity ceases immediately after termination of the first defibrillation shock and reinitiates within a predetermined time period after the first defibrillation shock;

and

wherein administering an alternate treatment comprises administering a third defibrillation shock having a third shock value that is at least one of substantially equivalent to the first shock value and less than the first shock value if it is determined that the cardiac activity has ceased immediately after termination of the first defibrillation shock and reinitiated within the predetermined time period.

46. A method according to claim 45, wherein the predetermined time period is from about 0 to about 5 minutes after termination of the first defibrillation shock.

47. A method according to claim 40, wherein determining comprises determining if the fibrillation ceases immediately after termination of the first defibrillation shock and reinitiates within a first predetermined time period after the first defibrillation shock and wherein administering an alternate treatment comprises waiting a second predetermined time period if it is determined that the fibrillation ceased after termination of the first defibrillation shock and reinitiated within the first predetermined time period, further comprising:

determining if fibrillation ceases after termination of the second predetermined time period; and

administering a third defibrillation shock having a third shock value that is at least one of substantially equivalent to the first shock value and less than the first shock value after the second predetermined time period if it is determined that the fibrillation has not ceased after termination of the second predetermined time period.

48. A method according to claim 47, wherein the first predetermined time period is from about 0 to about 5 minutes after termination of the first defibrillation shock.

49. A method according to claim 47, wherein the second predetermined time period is from about 10 seconds to about 90 seconds.

50. A method according to claim 40, wherein determining comprises determining if the fibrillation ceases immediately after termination of the first defibrillation shock and reinitiates within a first predetermined time period after termination of the first defibrillation shock and wherein administering an alternate treatment comprises administering cardiopulmonary resuscitation (CPR) for a second predetermined time period if the fibrillation ceased immediately after termination of the first defibrillation shock and reinitiated within the first predetermined time period, further comprising:

determining if the cardiac activity has been influenced by the administration of CPR; and

administering a third defibrillation shock having a third shock value that is at least one of substantially equivalent to the first shock value and less than the first shock value after termination of the second predetermined time period if it is determined that the cardiac activity has not been influenced by the administration of CPR during the second predetermined time period.

51. A method according to claim 50, wherein the first predetermined time period is from about 0 to about 5 minutes after termination of the first defibrillation shock.

52. A method according to claim 50, wherein the second predetermined time period is from about 10 seconds to about 90 seconds after termination of the first defibrillation shock.

53. A method according to claim 40, wherein determining comprises determining if the cardiac activity has ceased immediately after termination of the first defibrillation shock and wherein administering an alternate treatment comprises applying a pacing stimulation signal to the heart of the patient subsequent to termination of the defibrillation shock if it is determined that the cardiac activity has ceased immediately after termination of the first defibrillation shock.

54. A method according to claim 53, wherein applying a pacing stimulation comprises applying a pacing stimulation signal to the heart of the patient within about two seconds of termination of the first defibrillation shock.

55. A method according to claim 53, wherein the pacing stimulation signal comprises single pacing stimulation.

56. A method according to claim 53, wherein the pacing stimulation signal comprises paired pacing.

57. A method according to claim 55, further comprising the steps of:

detecting cardiac activity associated with application of the single pacing stimulation; and

selectively applying paired pacing stimulation based on the detected cardiac activity.

58. A method according to claim 55, further comprising the steps of:

detecting cardiac activity; and

selectively applying paired pacing stimulation based on the detected cardiac activity.

59. A method according to claim 55, further comprising the steps of:

detecting a signal specifying application of paired pacing; and

selectively applying paired pacing stimulation based on the detected signal.

60. A method according to claim 53, wherein the step of applying a defibrillation shock to a heart of the patient comprises applying a defibrillation shock to a heart of a patient using at least one first set of electrodes;

wherein the step of applying a pacing stimulation signal comprises applying a pacing stimulation signal to the heart of the patient subsequent to termination of the defibrillation shock using at least one second set of electrodes; and

wherein the first set of electrodes and the second set of electrodes are different sets of electrodes.

61. A method according to claim 53, wherein the step of applying a defibrillation shock to a heart of the patient comprises applying a defibrillation shock to a heart of a patient using at least one first set of electrodes;

wherein the step of applying a pacing stimulation signal comprises applying a pacing stimulation signal to the heart of the patient subsequent to termination of the defibrillation shock using at least one second set of electrodes; and

wherein the first set of electrodes and the second set of electrodes are a same set of electrodes.

62. A method according to claim 53, wherein the step of applying a pacing stimulation further comprises selectively applying paired pacing stimulation to the heart based on at least one of receipt of an external specification and sensed variables associated with cardiac activity.

63. A method according to claim 62, wherein the sensed variables associated with cardiac activity comprise a pulse pressure below a predefined threshold.

64. A method according to claim 62, wherein the external specification comprises instruction from a healthcare provider.

65. A method according to claim 53, wherein at least one of the defibrillation shock and the pacing stimulation are applied by an implantable device.

66. A method according to claim 40, further comprising:

determining if the cardiac activity has ceased after termination of the second defibrillation shock;

applying a pacing stimulation signal to the heart of the patient subsequent to termination of the second defibrillation shock if it is determined that the cardiac activity has ceased immediately after termination of the second defibrillation shock.

67. A method according to claim 40, wherein the cardiac activity comprises fibrillation and wherein fibrillation comprises at least one of ventricular fibrillation and atrial fibrillation.

68. A method according to claim 40, wherein the method is automated.

69. A method according to claim 40, wherein determining comprises determining if the cardiac activity has ceased immediately after termination of the first defibrillation shock and wherein administering an alternate treatment comprises applying a pacing stimulation signal to the heart of the patient subsequent to termination of the defibrillation shock if it is determined that the cardiac activity has ceased immediately after termination of the first defibrillation shock, further comprising:

detecting cardiac activity and/or function of the heart; and

selecting a type of pacing stimulation to apply to the heart of the patient subsequent to termination of the defibrillation shock based on the detected cardiac activity and/or function, wherein the step of applying comprises applying the selected type of pacing.

70. A method according to claim 69, wherein detecting cardiac activity and/or function comprises detecting the cardiac activity and/or function before applying a defibrillation shock to a heart of the patient.

71. A method according to claim 69, wherein detecting cardiac activity and/or function comprises detecting the cardiac activity and/or function after applying a defibrillation shock to a heart of the patient.

72. A method according to claim 69, wherein the selected type of pacing stimulation comprises single pacing stimulation.

73. A method according to claim 69, wherein the selected type of pacing stimulation comprises paired pacing stimulation.

74. A method of claim 69, wherein the selected type of pacing stimulation comprises a combination of single pacing stimulation and paired pacing stimulation.

75. A method according to claim 40, wherein determining comprises determining if the cardiac activity has ceased immediately after termination of the first defibrillation shock and wherein administering an alternate treatment comprises applying a pacing stimulation signal to the heart of the patient subsequent to termination of the defibrillation shock if it is determined that the cardiac activity has ceased immediately after termination of the first defibrillation shock, the method further comprising inhibiting application of the pacing stimulation if cardiac activity is detected.

76. A method according to claim 75, wherein the detected cardiac activity comprises a detected blood pressure.

77. A method according to claim 75, wherein the detected cardiac activity comprises spontaneous electrical activity.

78. A system for treating a patient, comprising:

a defibrillator circuit that is configured to administer a first defibrillation shock having a first shock value to the patient at a first time;

a detector circuit configured to determine if cardiac activity in the patient is influenced by the first defibrillation shock immediately after termination of the first defibrillation shock; and

a controller circuit configured to administer an alternate treatment at a second time if the cardiac activity is influenced by the first defibrillation shock immediately after termination of the first defibrillation shock.

79. A system according to claim 78, wherein the controller circuit configured to administer an alternate treatment is further configured to administer an alternate treatment at the second time if cardiac activity is influenced by the first defibrillation shock within about two seconds after termination of the first defibrillation shock.

80. A system according to claim 78, wherein the controller circuit is further configured to administer a second defibrillation shock having a second shock value that is higher than the first shock value at the second time if the cardiac activity is not influenced by the first defibrillation shock immediately after termination of the first defibrillation shock.

81. A system according to claim 78, wherein cardiac activity comprises cardiac electrical activity and/or blood pressure.

82. A system according to claim 81, wherein cardiac activity comprises fibrillation.

83. A system according to claim 78, wherein the controller circuit is further configured to:

determine if the cardiac activity ceases immediately after termination of the first defibrillation shock and reinitiates within a predetermined time period after the first defibrillation shock; and

administer a third defibrillation shock having a third shock value that is at least one of substantially equivalent to the first shock value and less than the first shock value if it is determined that the cardiac activity has ceased immediately after termination of the first defibrillation shock and reinitiated within the predetermined time period.

84. A system according to claim 83, wherein the predetermined time period is from about 0 to about 5 minutes after termination of the first defibrillation shock.

85. A system according to claim 78, wherein the controller circuit is further configured to:

determine if the fibrillation ceases immediately after termination of the first defibrillation shock and reinitiates within a first predetermined time period after the first defibrillation shock;

wait a second predetermined time period if it is determined that the fibrillation ceased after termination of the first defibrillation shock and reinitiated within the first predetermined time period; and

determine if fibrillation ceases after termination of the second predetermined time period; and

administer a third defibrillation shock having a third shock value that is at least one of substantially equivalent to the first shock value and less than the first shock value after the second predetermined time period if it is determined that the fibrillation has not ceased after termination of the second predetermined time period.

86. A system according to claim 85, wherein the first predetermined time period is from about 0 to about 5 minutes after termination of the first defibrillation shock.

87. A system according to claim 85, wherein the second predetermined time period is from about 10 seconds to about 90 seconds.

88. A system according to claim 78, wherein the controller circuit is further configured to:

determine if the cardiac activity ceases immediately after termination of the first defibrillation shock and reinitiates within a first predetermined time period after termination of the first defibrillation shock;

administer cardiopulmonary resuscitation (CPR) for a second predetermined time period if the cardiac activity ceased immediately after termination of the first defibrillation shock and reinitiated within the first predetermined time period;

determine if the cardiac activity has been influenced by the administration of CPR; and

administer a third defibrillation shock having a third shock value that is at least one of substantially equivalent to the first shock value and less than the first shock value after termination of the second predetermined time period if it is determined that the cardiac activity has not been influenced by the administration of CPR during the second predetermined time period.

89. A system according to claim 88, wherein the first predetermined time period is from about 0 to about 5 minutes after termination of the first defibrillation shock.

90. A system according to claim 88, wherein the second predetermined time period is from about 10 seconds to about 90 seconds after termination of the first defibrillation shock.

91. A system according to claim 78, wherein the controller circuit is further configured to:

determine if the cardiac activity has ceased immediately after termination of the first defibrillation shock; and

apply a pacing stimulation signal to the heart of the patient subsequent to termination of the defibrillation shock if it is determined that the cardiac activity has ceased immediately after termination of the first defibrillation shock.

92. A system according to claim 91, wherein the controller circuit is further configured to apply a pacing stimulation signal to the heart of the patient within about two seconds of termination of the first defibrillation shock.

93. A system according to claim 91, wherein the pacing stimulation signal comprises single pacing stimulation.

94. A system according to claim 91, wherein the pacing stimulation signal comprises paired pacing stimulation.

95. A system according to claim 93, wherein the controller is further configured to:

detect cardiac activity associated with application of the single pacing stimulation; and

selectively apply paired pacing stimulation based on the detected cardiac activity.

96. A system according to claim 93, wherein the controller is further configured to:

detect cardiac activity; and

selectively apply paired pacing stimulation based on the detected cardiac activity.

97. A system according to claim 93, wherein the controller is further configured to:

detect a signal specifying application of paired pacing; and

selectively apply paired pacing stimulation based on the detected signal.

98. A system according to claim 91, wherein the defibrillator circuit is further configured to apply a defibrillation shock to a heart of the patient using at least one first set of electrodes;

wherein controller circuit is further configured to apply a pacing stimulation signal to the heart of the patient subsequent to termination of the defibrillation shock using at least one second set of electrodes; and

wherein the first set of electrodes and the second set of electrodes are different sets of electrodes.

99. A system according to claim 91, wherein the defibrillator circuit is further configured to apply a first defibrillation shock to a heart of a patient using at least one first set of electrodes;

wherein the controller is further configured to apply a pacing stimulation signal to the heart of the patient subsequent to termination of the first defibrillation shock using at least one second set of electrodes; and

wherein the first set of electrodes and the second set of electrodes are a same set of electrodes.

100. A system according to claim 99, wherein the controller circuit is further configured to apply paired pacing stimulation to the heart based on at least one of receipt of an external specification and sensed variables associated with cardiac activity.

101. A system according to claim 100, wherein the sensed variables associated with cardiac activity comprise a pulse pressure below a predefined threshold.

102. A system according to claim 100, wherein the external specification comprises instruction from a healthcare provider.

103. A system according to claim 101, wherein at least one of the defibrillation shock and the pacing stimulation are applied by an implantable device.

104. A system according to claim 78:

wherein the detector circuit is further configured to determine if the cardiac activity has ceased after termination of the second defibrillation shock; and

wherein the controller circuit if further configured to apply a pacing stimulation signal to the heart of the patient subsequent to termination of the second defibrillation shock if it is determined that the cardiac activity has ceased immediately after termination of the second defibrillation shock.

105. A system according to claim 78, wherein the cardiac activity comprises fibrillation and wherein fibrillation comprises at least one of ventricular fibrillation and atrial fibrillation.

106. A system according to claim 78, wherein the method is automated.

107. A system according to claim 91, wherein the controller circuit is further configured to:

detect cardiac activity and/or function of the heart;

select a type of pacing stimulation to apply to the heart of the patient subsequent to termination of the defibrillation shock based on the detected cardiac activity and/or function; and

apply the selected type of pacing.

108. A system according to claim 107, wherein the controller circuit is further configured to detect cardiac activity and/or function before administering a defibrillation shock to a heart of the patient.

109. A system according to claim 107, w wherein the controller circuit is further configured to detect cardiac activity and/or function after administering a defibrillation shock to a heart of the patient.

110. A system according to claim 107, wherein the selected type of pacing stimulation comprises single pacing stimulation.

111. A system according to claim 107, wherein the selected type of pacing stimulation comprises paired pacing stimulation.

112. A system according to claim 107, wherein the selected type of pacing stimulation comprises a combination of single pacing stimulation and paired pacing stimulation.

113. A system according to claim 91, wherein the controller circuit is further configured to inhibit administration of the pacing stimulation if cardiac activity is detected.

114. A system according to claim 113, wherein the detected cardiac activity comprises a detected blood pressure.

115. A system according to claim 113, wherein the detected cardiac activity comprises spontaneous electrical activity.

116. A system for treating a patient, the system comprising:

a detector circuit configured to detect cardiac activity in the patient immediately after termination of a first defibrillation shock; and

a controller circuit configured to administer an alternate treatment based on the immediate detection.

117. A system according to claim 116, further comprising:

a defibrillator configured to administer the first defibrillation shock having a first shock value to the patient at a first time, wherein the detector circuit is further configured to determine if cardiac activity in the patient is influenced by the first defibrillation shock immediately after termination of the first defibrillation shock and wherein the controller circuit is further configured to administer an alternate treatment at a second time if the cardiac activity is influenced by the first defibrillation shock immediately after termination of the first defibrillation shock.

118. A computer program product for treating a patient, comprising:

a computer readable medium having computer readable program code embodied therein, the computer readable program code comprising;

computer readable program code that administers a first defibrillation shock having a first shock value to the patient at a first time;

computer readable program code that determines if cardiac activity in the patient is influenced by the first defibrillation shock immediately after termination of the first defibrillation shock; and

computer readable program code that administers an alternate treatment at a second time if the cardiac activity is influenced by the first defibrillation shock immediately after termination of the first defibrillation shock.

119. A computer program product according to claim 118, wherein the computer readable program code that administers an alternate treatment comprises computer readable program code that administers an alternate treatment at a second time if cardiac activity is influenced by the first defibrillation shock within about two seconds after termination of the first defibrillation shock.

121. A computer program product according to claim 118, wherein cardiac activity comprises cardiac electrical activity and/or blood pressure.

122. A computer program product according to claim 121, wherein cardiac activity comprises fibrillation.

123. A computer program product according to claim 118, wherein the computer readable program code that administers an alternate treatment further comprises:

computer readable program code that determines if the cardiac activity ceases immediately after termination of the first defibrillation shock and reinitiates within a predetermined time period after the first defibrillation shock; and

computer readable program code that administers a third defibrillation shock having a third shock value that is at least one of substantially equivalent to the first shock value and less than the first shock value if it is determined that the cardiac activity has ceased immediately after termination of the first defibrillation shock and reinitiated within the predetermined time period.

124. A computer program product according to claim 123, wherein the predetermined time period is from about 0 to about 5 minutes after termination of the first defibrillation shock.

125. A computer program product according to claim 118, wherein the computer readable program code that administers an alternate treatment further comprises:

computer readable program code that determines if the cardiac activity ceases immediately after termination of the first defibrillation shock and reinitiates within a first predetermined time period after the first defibrillation shock;

computer readable program code that waits a second predetermined time period if it is determined that the cardiac activity ceased after termination of the first defibrillation shock and reinitiated within the first predetermined time period; and

computer readable program code that determines if cardiac activity ceases after termination of the second predetermined time period; and

computer readable program code that administers a third defibrillation shock having a third shock value that is at least one of substantially equivalent to the first shock value and less than the first shock value after the second predetermined time period if it is determined that the cardiac activity has not ceased after termination of the second predetermined time period.

126. A computer program product according to claim 125, wherein the first predetermined time period is from about 0 to about 5 minutes after termination of the first defibrillation shock.

127. A computer readable program code according to claim 125, wherein the second predetermined time period is from about 10 seconds to about 90 seconds.

131. A computer program product according to claim 118, wherein the computer readable program code that administers an alternate treatment comprises:

computer readable program code that determines if the cardiac activity has ceased immediately after termination of the first defibrillation shock; and

computer readable program code that applies a pacing stimulation signal to the heart of the patient subsequent to termination of the defibrillation shock if it is determined that the cardiac activity has ceased immediately after termination of the first defibrillation shock.

132. A computer program product according to claim 131, wherein the computer readable program code that applies a pacing stimulation further comprises computer readable program code that applies a pacing stimulation signal to the heart of the patient within about two seconds of termination of the first defibrillation shock.

133. A computer program product according to claim 131, wherein the pacing stimulation signal comprises single pacing stimulation.

134. A computer program product according to claim 131, wherein the pacing stimulation signal comprises paired pacing stimulation.

135. A computer program product according to claim 131, further comprising:

computer readable program code that detects cardiac activity associated with application of the single pacing stimulation; and

computer readable program code that selectively applies paired pacing stimulation based on the detected cardiac activity.

136. A computer program product according to claim 134, further comprising:

computer readable program code that detects cardiac activity; and

computer readable program code that selectively applies paired pacing stimulation based on the detected cardiac activity.

137. A computer program product according to claim 134, further comprises:

computer readable program code that detects a signal specifying application of paired pacing; and

computer readable program code that selectively applies paired pacing stimulation based on the detected signal.

138. A computer program product according to claim 131, wherein the computer readable program code that administers a first defibrillation shock having a first shock value to the patient at a first time comprises computer readable program code that administers a first defibrillation shock to a heart of a patient using at least one first set of electrodes;

wherein the computer readable program code that applies a pacing stimulation signal comprises computer readable program code that applies a pacing stimulation signal to the heart of the patient subsequent to termination of the first defibrillation shock using at least one second set of electrodes; and

wherein the first set of electrodes and the second set of electrodes are different sets of electrodes.

139. A computer program product according to claim 131, wherein the computer readable program code that administers a first defibrillation shock having a first shock value to the patient at a first time comprises computer readable program code that administers a first defibrillation shock to a heart of a patient using at least one first set of electrodes;

wherein the computer readable program code that applies a pacing stimulation signal comprises computer readable program code that applies a pacing stimulation signal to the heart of the patient subsequent to termination of the first defibrillation shock using at least one second set of electrodes; and

wherein the first set of electrodes and the second set of electrodes are a same set of electrodes.

140. A computer program product according to claim 131, further comprising computer readable program code that selectively applies paired pacing stimulation to the heart based on at least one of receipt of an external specification and sensed variables associated with cardiac activity.

141. A computer program product according to claim 140, wherein the sensed variables associated with cardiac activity comprise a pulse pressure below a predefined threshold.

142. A computer program product according to claim 140, wherein the external specification comprises instruction from a healthcare provider.

143. A computer program product according to claim 140, wherein at least one of the defibrillation shock and the pacing stimulation are applied by an implantable device.

144. A computer program product according to claim 118, further comprising:

computer readable program code that determines if the cardiac activity has ceased after termination of the second defibrillation shock; and

computer readable program code that applies a pacing stimulation signal to the heart of the patient subsequent to termination of the second defibrillation shock if it is determined that the cardiac activity has ceased immediately after termination of the second defibrillation shock.

145. A computer program product according to claim 118, wherein the cardiac activity comprises fibrillation and wherein fibrillation comprises at least one of ventricular fibrillation and atrial fibrillation.

146. A computer program product according to claim 118, wherein the computer program product is automated.

147. A computer program product according to claim 131, wherein the computer readable program code that administers an alternate treatment further comprises:

computer readable program code that detects cardiac activity and/or function in the heart;

computer readable program code that selects a type of pacing stimulation to apply to the heart of the patient subsequent to termination of the defibrillation shock based on the detected cardiac activity and/or function; and

computer readable program code that applies the selected type of pacing.

148. A computer program product according to claim 147, wherein the computer readable program code that detects cardiac activity and/or function comprises computer readable program code that detects the cardiac activity and/or function before applying a defibrillation shock to a heart of the patient.

149. A computer program product according to claim 147, wherein the computer readable program code that detects cardiac activity and/or function comprises computer readable program code that detects the cardiac activity and/or function after applying a defibrillation shock to a heart of the patient.

150. A computer program product according to claim 147, wherein the selected type of pacing stimulation comprises single pacing stimulation.

151. A computer program product according to claim 147, wherein the selected type of pacing stimulation comprises paired pacing stimulation.

152. A computer program product according to claim 147, wherein the selected type of pacing stimulation comprises a combination of single pacing stimulation and paired pacing stimulation.

153. A computer program product according to claim 131, wherein the computer program code that administers further comprises computer readable program code that inhibits application of the pacing stimulation if cardiac activity is detected.

154. A computer program product according to claim 153, wherein the detected cardiac activity comprises a detected blood pressure.

155. A computer program product according to claim 153, wherein the detected cardiac activity comprises spontaneous electrical activity.

120. A computer program product according to claim 1118, further comprising:

computer readable program code that administers a second defibrillation shock having a second shock value that is higher than the first shock value at the second time if the cardiac activity is not influenced by the first defibrillation shock immediately after termination of the first defibrillation shock.

128. A computer program product according to claim 1118, wherein the computer readable program code that administers an alternate treatment further comprises:

computer readable program code that determines if the cardiac activity ceases immediately after termination of the first defibrillation shock and reinitiates within a first predetermined time period after termination of the first defibrillation shock;

computer readable program code that administers cardiopulmonary resuscitation (CPR) for a second predetermined time period if the cardiac activity ceased immediately after termination of the first defibrillation shock and reinitiated within the first predetermined time period;

computer readable program code that determines if the cardiac activity has been influenced by the administration of CPR; and

computer readable program code that administers a third defibrillation shock having a third shock value that is at least one of substantially equivalent to the first shock value and less than the first shock value after termination of the second predetermined time period if it is determined that the cardiac activity has not been influenced by the administration of CPR during the second predetermined time period.

129. A computer program product according to claim 128, wherein the first predetermined time period is from about 0 to about 5 minutes after termination of the first defibrillation shock.

130. A computer program product according to claim 128, wherein the second predetermined time period is from about 10 seconds to about 90 seconds after termination of the first defibrillation shock.

156. A computer program product for treating a patient, comprising:

a computer readable medium having computer readable program code embodied therein, the computer readable program code comprising;

computer readable program code that detects cardiac activity in the patient immediately after termination of a first defibrillation shock; and

computer readable program code that administers an alternate treatment based on the immediate detection.

157. A computer program product according to claim 156, further comprising:

computer readable program code that administers the first defibrillation shock having a first shock value to the patient at a first time, wherein the computer readable program code that detectors further comprises computer readable program code that determines if cardiac activity in the patient is influenced by the first defibrillation shock immediately after termination of the first defibrillation shock and wherein the computer readable program code that administers further comprises computer readable program code that administers an alternate treatment at a second time if the cardiac activity is influenced by the first defibrillation shock immediately after termination of the first defibrillation shock.