Precordial-superior vena cava electrode arrangement for an implantable cardioverter defibrillator

• US 20050131475A1
• Filed: 11/09/2004
• Published: 06/16/2005
• Est. Priority Date: 12/07/2001
• Status: Abandoned Application

• Current Assignee: Karel F.A.A. Smits
• Original Assignee: Karel F.A.A. Smits
• Inventors: Smits, Karel F.A.A.
• Application Number:
  US10/985,341
• Publication Number:
  US 20050131475A1
• Time in Patent Office: Days
• US Class Current: 607/14
• CPC Class Codes: A61N 1/3918 characterised by shock pathway, e.g. by electrode configuration

Abstract

The present invention provides systems, methods, components and medical devices for defibrillating a volume of excitable myocardial tissue. In one aspect, the invention delivers therapy via a pair of electrodes spaced from myocardial tissue with a first electrode disposed in a precordial location and spaced from myocardial tissue and a second electrode disposed in a non-precordial location. Another form of the invention includes methods of delivering cardioversion, defibrillation and/or cardiac pacing therapy by sensing cardiac events with at least a pair of electrodes located in one of a submuscular and a subcutaneous position. In this form of the invention the pair of electrodes are spaced from excitable heart tissue of the subject and cardiac therapy pulses are delivered via at least a pair of electrodes at a sufficient energy level to capture at least one ventricular chamber of the subject.

Claims

1. A method of configuring electrodes for treating tachycardia, comprising:

placing at least a first electrode in a non-precordial position, the first electrode having electrical conductivity with the heart; and

placing a second electrode in a precordial position, the second electrode having electrical conductivity with the heart.

2. A method according to claim 1, wherein the first electrode comprises a metallic coil type electrode.

3. A method according to claim 1, wherein the second electrode comprises at least one of:

a metallic coil type electrode, a patch electrode, a subcutaneous electrode array.

4. A method according to claim 1, wherein the non-precordial position comprises one of a location within a portion of a superior vena cava of a subject and a location within a right ventricular chamber of the subject.

5. A method according to claim 1, wherein the precordial position comprises one of a subcutaneous location and a submuscular location.

6. A method according to claim 1, wherein the second electrode comprises at least two metallic coil type electrodes.

7. A method according to claim 6, wherein at least two metallic coil type electrodes comprise a subcutaneous electrode array.

8. A method according to claim 6, wherein the at least two metallic coil type electrodes are located in one of a subcutaneous location and a submuscular location.

9. A method according to claim 1, wherein the first electrode comprises one of an electrically conductive portion of a housing for an implantable medical device and at least two elongated electrodes, and wherein the first electrode is disposed in one of a subcutaneous and a submuscular position of the subject.

10. A method according to claim 9, wherein the implantable medical device comprises an implantable cardioverter-defibrillator.

11. A method according to claim 1, wherein the non-precordial position comprises one of a location within a portion of a coronary sinus of the subject and a location within a portion of a coronary vein of the subject.

12. A system for defibrillating a volume of myocardial tissue from at least a pair of electrodes spaced from the volume of myocardial tissue, comprising:

a first electrode disposed in a precordial location relative to a volume of myocardial tissue; and

a second electrode disposed in a non-precordial location relative to the volume of myocardial tissue.

13. A system according to claim 12, wherein one of the first electrode and the second electrode is disposed in one of a subcutaneous position of a subject and a submuscular position of the subject.

14. A system according to claim 12, wherein one of the first electrode and the second electrode comprises a metallic coil type electrode.

15. A system according to claim 12, wherein one of the first electrode and the second electrode comprises an electrically conducting portion of a housing for an implantable medical device.

16. A system according to claim 12, wherein one of the first electrode and the second electrode comprises a subcutaneous electrode array.

17. A system according to claim 16, wherein the subcutaneous electrode array comprises at least two elongated medical electrical leads and a distal portion of each of the electrical leads comprises at least one electrically conductive coil.

18. A system according to claim 16, wherein the second electrode comprises the subcutaneous electrode array and said second electrode is disposed in a portion of at least one of an anterior lateral thoracic and a posterior lateral thoracic location of a subject.

19. A system according to claim 12, wherein the volume of myocardial tissue comprises a portion of ventricular tissue.

20. A system according to claim 12, wherein both the first electrode and the second electrode comprise at least one elongated coil type electrode.

21. A system according to claim 12, wherein the first electrode comprises at least two metallic coil type electrodes and the second electrode comprises at least two metallic coil type electrodes.

22. A system according to claim 20, further comprising an implantable cardioverter-defibrillator operatively coupled to both the first and the second electrodes.

23. A system according to claim 12, wherein both the first electrode and the second electrode comprise at least one metallic coil type electrode.

24. A system according to claim 12, wherein both the first electrode and the second electrode comprise a patch type electrode.

25. A method of deploying an implantable cardiac defibrillation system, comprising:

deploying a first electrode into a non-precordial location relative to a heart of a subject; and

inserting a second electrode in one of a submuscular and a subcutaneous position and in a precordial location relative to the heart of the subject.

26. A method according to claim 25, wherein the first electrode comprises a metallic coil type electrode.

27. A method according to claim 25, wherein the second electrode comprises at least one of:

a metallic coil type electrode, a patch electrode, a subcutaneous electrode array.

28. A method according to claim 25, wherein the non-precordial position comprises one of a location within a portion of a superior vena cava of a subject and a location within a right ventricular chamber of the subject.

29. A method according to claim 25, wherein the precordial position comprises one of a subcutaneous location and a submuscular location.

30. A method according to claim 25, wherein the second electrode comprises at least two metallic coil type electrodes.

31. A method according to claim 30, wherein at least two metallic coil type electrodes comprise a subcutaneous electrode array.

32. A method according to claim 30, wherein the at least two metallic coil type electrodes are located in one of a subcutaneous location and a submuscular location.

33. A method according to claim 25, wherein the first electrode comprises one of an electrically conductive portion of a housing for an implantable medical device and at least two elongated electrodes, and wherein the first electrode is disposed in one of a subcutaneous and a submuscular position of the subject.

34. A method according to claim 25, wherein the implantable cardiac defibrillation system comprises an implantable cardioverter-defibrillator.

35. A method according to claim 25, wherein the non-precordial position comprises one of a location within a portion of a coronary sinus of the subject and a location within a portion of a coronary vein of the subject.

36. A method according to claim 25, further comprising:

coupling a proximal portion of the first electrode to operative circuitry of an implantable medical device.

37. A method according to claim 36, wherein the implantable cardiac defibrillation system comprises an implantable cardioverter-defibrillator.

38. A method according to claim 37, wherein a conductive portion of the implantable cardioverter-defibrillator comprises the second electrode.

39. A method of delivering cardiac pacing therapy to a heart of a subject, comprising:

sensing cardiac events with at least a pair of electrodes located in one of a submuscular and a subcutaneous position, wherein the at least a pair of electrodes are spaced from excitable heart tissue of a subject; and

delivering a series of timed cardiac pacing stimulus pulses via the at least a pair of electrodes at a sufficient energy level to capture at least one ventricular chamber of the subject.

40. A method according to claim 39, wherein the at least a pair of electrodes are disposed in a precordial position relative to the excitable heart tissue of the subject.

41. A method according to claim 40, wherein the at least a pair of electrodes couple to a surface portion of an implantable medical device.

42. A method according to claim 41, wherein the at least a pair of electrodes couple in a spaced apart relation upon the surface portion of an implantable medical device.

43. A method according to claim 42, wherein the at least a pair of electrodes comprise at least three electrodes.

44. A method according to claim 39, wherein the at least a pair of electrodes are disposed in a location inward of the intercoastal muscles of the thorax of the subject.

45. A method according to claim 40, further comprising at least one defibrillation electrode coupled to the at least a pair of electrodes.

46. A method according to claim 45, wherein the at least a pair of electrodes comprises at least one ring-type electrode.

47. A method according to claim 45, wherein the at least one defibrillation electrode comprises at least one of:

a patch type electrode, an elongated coil type electrode, a subcutaneous electrode array.

48. A method according to claim 39, wherein the at least a pair of electrodes comprises at least three electrodes and further comprising:

automatically activating different pairs of the at least three electrodes to render a plurality of sensing vector data sets representative of cardiac activity of the subject; and

comparing at least two of the plurality of sensing vector data sets.

49. A method according to claim 48, further comprising:

utilizing a pair of the different pairs for subsequent sensing of cardiac activity of the subject based at least in part on the comparison of the sensing vector data sets.

50. A method according to claim 48, further comprising:

storing in a memory structure at least one metric related to at least one pair of the different pairs.

51. A method according to claim 48, further comprising:

wirelessly transmitting at least one of the data sets and the results of the comparing step to an external device.

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

storing in a memory structure at least a portion of the sensed cardiac events.

53. A method according to claim 52, wherein the portion of the sensed cardiac events comprises at least one of:

a temporal portion of events, a heart rate metric, an arrhythmia metric, an upper rate metric, a lower rate metric, a percent-paced metric, a pacing energy metric, a percent-pacing-capture metric.

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

delivering one of a cardioversion therapy and a defibrillation therapy via the at least one defibrillation electrode in the event that the sensed cardiac events exceed a potentially lethal tachycardia episode threshold.

55. A computer readable medium for storing instructions for performing a method of sensing cardiac activity, delivering cardiac pacing or defibrillation therapy, said medium comprising:

instructions for sensing cardiac events with at least a pair of electrodes located in one of a submuscular and a subcutaneous position and spaced from excitable heart tissue of a subject; and

instructions for delivering a series of timed cardiac pacing stimulus pulses via the at least a pair of electrodes at a sufficient energy level to capture at least one ventricular chamber of the subject.

56. A medium according to claim 55, wherein the at least a pair of electrodes are disposed in a precordial position relative to the excitable heart tissue of the subject.

57. A medium according to claim 56, wherein the at least a pair of electrodes couple to a surface portion of an implantable medical device.

58. A medium according to claim 57, wherein the at least a pair of electrodes are coupled in a spaced apart relation upon the surface portion of an implantable medical device.

59. A medium according to claim 58, wherein the at least a pair of electrodes comprise at least three electrodes.

60. A medium according to claim 55, wherein the at least a pair of electrodes are disposed in a location inward of the intercoastal muscles of the thorax of the subject.

61. A medium according to claim 56, further comprising at least one defibrillation electrode coupled to the at least a pair of electrodes.

62. A medium according to claim 61, wherein the at least a pair of electrodes comprises at least one ring-type electrode.

63. A medium according to claim 61, wherein the at least one defibrillation electrode comprises at least one of:

a patch type electrode, an elongated coil type electrode, a subcutaneous electrode array.

64. A medium according to claim 55, wherein the at least a pair of electrodes comprises at least three electrodes and further comprising:

instructions for automatically activating different pairs of the at least three electrodes to render a plurality of sensing vector data sets representative of cardiac activity of the subject; and

instructions for comparing at least two of the plurality of sensing vector data sets.

65. A medium according to claim 64, further comprising:

instructions for electrically connecting a pair of the different pairs for subsequent sensing of cardiac activity of the subject based at least in part on the comparison of the sensing vector data sets.

66. A medium according to claim 64, further comprising:

instructions for storing in a memory structure at least one metric related to at least one pair of the different pairs.

67. A medium according to claim 64, further comprising:

instructions for wirelessly transmitting at least one of the data sets and the results of the comparing step to an external device.

68. A medium according to claim 55, further comprising:

instructions for storing in a memory structure at least a portion of the sensed cardiac events.

69. A medium according to claim 55, further comprising:

means for delivering one of a cardioversion therapy and a defibrillation therapy via the at least one defibrillation electrode in the event that the sensed cardiac events exceed a potentially lethal tachycardia episode threshold.

79. A system according to claim 55, wherein the at least a pair of electrodes comprises at least three electrodes and further comprising:

means for automatically activating different pairs of the at least three electrodes to render a plurality of sensing vector data sets representative of cardiac activity of the subject; and

means for comparing at least two of the plurality of sensing vector data sets.

80. A medium according to claim 79, further comprising:

means for electrically connecting a pair of the different pairs for subsequent sensing of cardiac activity of the subject based at least in part on the comparison of the sensing vector data sets.

81. A medium according to claim 79, further comprising:

means for storing in a memory structure at least one metric related to at least one pair of the different pairs.

82. A medium according to claim 79, further comprising:

means for wirelessly transmitting at least one of the data sets and the results of the comparing step to an external device.

70. A system for defibrillating a volume of excitable myocardial tissue, comprising:

means for sensing cardiac events with at least a pair of electrodes located in one of a submuscular and a subcutaneous position and spaced from excitable heart tissue of a subject; and

means for delivering a series of timed cardiac pacing stimulus pulses via the at least a pair of electrodes at a sufficient energy level to capture at least one ventricular chamber of the subject.

71. A system according to claim 70, wherein the at least a pair of electrodes are disposed in a precordial position relative to the excitable heart tissue of the subject.

72. A medium according to claim 71, wherein the at least a pair of electrodes couple to a surface portion of an implantable medical device.

73. A medium according to claim 72, wherein the at least a pair of electrodes are coupled in a spaced apart relation upon the surface portion of an implantable medical device.

74. A medium according to claim 73, wherein the at least a pair of electrodes comprise at least three electrodes.

75. A system according to claim 70, wherein the at least a pair of electrodes are disposed in a location inward of the intercoastal muscles of the thorax of the subject.

76. A medium according to claim 71, further comprising at least one defibrillation electrode coupled to the at least a pair of electrodes.

77. A medium according to claim 76, wherein the at least a pair of electrodes comprises at least one ring-type electrode.

78. A medium according to claim 76, wherein the at least one defibrillation electrode comprises at least one of:

a patch type electrode, an elongated coil type electrode, a subcutaneous electrode array.

83. A system according to claim 70, further comprising:

means for storing in a memory structure at least a portion of the sensed cardiac events.

84. A system according to claim 70, further comprising:

means for delivering one of a cardioversion therapy and a defibrillation therapy via the at least one defibrillation electrode in the event that the sensed cardiac events exceed a potentially lethal tachycardia episode threshold.