Configurable cardioversion and defibrillation therapies in the presence of coexisting atrial and ventricular arrhythmia

• US 20040220623A1
• Filed: 04/30/2003
• Published: 11/04/2004
• Est. Priority Date: 04/30/2003
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Hess, Michael F.
• Granted Patent: US 7,313,436 B2
• Time in Patent Office: Days
• US Class Current: 607/4
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions
• CPC Class Codes: A61N 1/3918 characterised by shock pathway, e.g. by electrode configuration
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

An implantable cardioverter defibrillator system and method are provided having configurable shock therapies selected based on an evaluation of the atrial rhythm status following a ventricular tachycardia or fibrillation detection. A dual chamber shock configuration is selected if the ventricular arrhythmia is co-existing with an atrial arrhythmia of recent onset. A ventricular only shock configuration is selected if the ventricular arrhythmia is co-existing with a sustained atrial arrhythmia.

Claims

1. An implantable medical device, comprising:

a plurality of electrodes sensing cardiac signals and delivering therapy within a plurality of chambers of a heart; and

control circuitry selectively controlling, in response to the sensed cardiac signals, delivery of the therapy via selected ones of the plurality of electrodes for a first determined cardiac event in response to presence of a second cardiac event.

2. The device of claim 1, wherein the first cardiac event corresponds to one of a ventricular tachycardia and a ventricular fibrillation, and the second event corresponds to one of atrial tachycardia and atrial fibrillation.

3. The device of claim 1, wherein the control circuitry determines, in response to the sensed cardiac signals corresponding to the second cardiac event, whether the second cardiac event is a sustained cardiac event, and delivers a first therapy in response to the second cardiac event being a sustained cardiac event and delivers a second therapy in response to the second cardiac event not being a sustained cardiac event.

4. The device of claim 3, wherein the control circuitry determines a time duration of the second cardiac event, and determines that the second cardiac event is a sustained cardiac event in response to the determined time duration being greater than a predetermined time period.

5. The device of claim 4, wherein the predetermined time period is approximately 24 hours.

6. The device of claim 3, wherein the first therapy is delivered to more than one chamber of the heart and the second therapy is delivered to a single chamber of the heart.

7. The device of claim 6, wherein the more than one chamber corresponds to a ventricle and an atrium of the heart and the single chamber corresponds to a ventricle of the heart.

8. The device of claim 3, wherein the control circuit delivers the first therapy according to parameters associated with terminating both the first cardiac event and the second cardiac event.

9. The device of claim 8, wherein the parameters include one or more of a shock vector, a shock energy, a tilt, a waveform, and a waveshape.

10. The device of claim 3, wherein the first therapy corresponds to a single shock therapy corresponding to simultaneous termination of both the first cardiac event and the second cardiac event.

11. The device of claim 3, wherein the control circuit delivers the second therapy to the ventricles of the heart.

12. The device of claim 3, wherein the control circuitry monitors success of the second therapy in terminating the first cardiac event and the second cardiac event, determines whether termination of the first cardiac event is delayed as a result of delivery of the second therapy, and delivers a third therapy in response to the termination of the first cardiac event being delayed.

13. The device of claim 3, wherein the control circuitry determines whether the first cardiac event has terminated, adjusts the second therapy and delivers the adjusted second therapy in response to the first cardiac event not being terminated, monitors success of the second therapy and the adjusted second therapy in terminating the first cardiac event to determine whether the second therapy and the adjusted second therapy are acceptable, and adjusts the second therapy to correspond to the adjusted second therapy in response to the second therapy being unacceptable and the adjusted second therapy being acceptable.

14. A method of controlling delivery of therapy in an implantable medical device, comprising:

sensing cardiac signals;

determining whether the sensed cardiac signals correspond to one of a first cardiac event and a second cardiac event;

determining, in response to the sensed cardiac signals corresponding to one of the first cardiac event and the second cardiac event, whether the sensed cardiac signals correspond to a third cardiac event; and

controlling delivery of therapy corresponding to the determined one of the first cardiac event and the second cardiac event in response to the determining of whether the sensed cardiac signals correspond to the third cardiac event.

15. The method of claim 14, wherein the first cardiac event corresponds to ventricular tachycardia, the second event corresponds to ventricular fibrillation, and the third event corresponds to one of atrial tachycardia and atrial fibrillation.

16. The method of claim 14, further comprising:

determining, in response to the sensed cardiac signals corresponding to the third cardiac event, whether the third cardiac event is a sustained cardiac event; and

delivering a first therapy in response to the third cardiac event being a sustained cardiac event and delivering a second therapy in response to the third cardiac event not being a sustained cardiac event.

17. The method of claim 16, further comprising determining a time duration of the third cardiac event, wherein the third cardiac event is determined to be a sustained cardiac event in response to the determined time duration being greater than a predetermined time period.

18. The method of claim 17, wherein the predetermined time period is approximately 24 hours.

19. The method of claim 16, wherein the first therapy is delivered to more than one chamber of the heart and the second therapy is delivered to a single chamber of the heart.

20. The method of claim 19, wherein the more than one chamber corresponds to a ventricle and an atrium of the heart and the single chamber corresponds to a ventricle of the heart.

21. The method of claim 16, wherein the first therapy is delivered according to parameters associated with terminating both one of the first cardiac event and the second cardiac event, and the third cardiac event.

22. The method of claim 21, wherein the parameters include one or more of a shock vector, a shock energy, a tilt, a waveform, and a waveshape.

23. The method of claim 16, wherein the first therapy corresponds to a single shock therapy corresponding to simultaneous termination of both the one of the first cardiac event and the second cardiac event and the third cardiac event.

24. The method of claim 16, wherein the second therapy is delivered to the ventricles of the heart.

25. The method of claim 16, further comprising:

monitoring success of the second therapy in terminating the one of the first cardiac event and the second cardiac event;

determining whether termination of the one of the first cardiac event and the second cardiac event is delayed as a result of delivery of the second therapy; and

delivering a third therapy in response to the termination of the one of the first cardiac event and the second cardiac event being delayed.

26. The method of claim 16, further comprising:

determining whether the one of the first cardiac event and the second cardiac event has terminated;

adjusting the second therapy and delivering the adjusted second therapy in response to the one of the first cardiac event and the second cardiac event not being terminated;

monitoring success of the second therapy and the adjusted second therapy in terminating the one of the first cardiac event and the second cardiac event to determine whether the second therapy and the adjusted second therapy are acceptable; and

adjusting the second therapy to correspond to the adjusted second therapy in response to the second therapy being unacceptable and the adjusted second therapy being acceptable.

27. An implantable medical device, comprising:

means for sensing cardiac signals;

means for determining whether the sensed cardiac signals correspond to one of a first cardiac event and a second cardiac event;

means for determining, in response to the sensed cardiac signals corresponding to one of the first cardiac event and the second cardiac event, whether the sensed cardiac signals correspond to a third cardiac event; and

means for controlling delivery of therapy corresponding to the determined one of the first cardiac event and the second cardiac event in response to the determining of whether the sensed cardiac signals correspond to the third cardiac event.

28. The device of claim 27, wherein the means for controlling delivers a first therapy in response to the third cardiac event being a sustained cardiac event and a second therapy in response to the third cardiac event not being a sustained cardiac event.

29. The device of claim 28, wherein the first therapy is delivered to a ventricle and an atrium of the heart and the second therapy is delivered to a ventricle of the heart.

30. The device of claim 28, wherein the first therapy is delivered according to parameters associated with terminating both one of the first cardiac event and the second cardiac event, and the third cardiac event.

31. The device of claim 28, wherein the first therapy corresponds to a single shock therapy corresponding to simultaneous termination of both the one of the first cardiac event and the second cardiac event and the third cardiac event.

32. The device of claim 28, further comprising means for monitoring success of the second therapy in terminating the one of the first cardiac event and the second cardiac event and determining whether termination of the one of the first cardiac event and the second cardiac event is delayed as a result of delivery of the second therapy, wherein the means for controlling delivers a third therapy in response to the termination of the one of the first cardiac event and the second cardiac event being delayed.

33. The device of claim 28, further comprising:

means for monitoring whether the one of the first cardiac event and the second cardiac event has terminated; and

means for monitoring success of the second therapy and the adjusted second therapy in terminating the one of the first cardiac event and the second cardiac event to determine whether the second therapy and the adjusted second therapy are acceptable, wherein the means for controlling adjusts the second therapy and delivers the adjusted second therapy in response to the one of the first cardiac event and the second cardiac event not being terminated, and adjusts the second therapy to correspond to the adjusted second therapy in response to the second therapy being unacceptable and the adjusted second therapy being acceptable.

34. A computer readable medium having computer-executable instructions for performing a method comprising:

sensing cardiac signals;

determining whether the sensed cardiac signals correspond to one of a first cardiac event and a second cardiac event;

determining, in response to the sensed cardiac signals corresponding to one of the first cardiac event and the second cardiac event, whether the sensed cardiac signals correspond to a third cardiac event; and

controlling delivery of therapy corresponding to the determined one of the first cardiac event and the second cardiac event in response to the determining of whether the sensed cardiac signals correspond to the third cardiac event.