Flexible subcutaneous implantable cardioverter-defibrillator

• US 20050192639A1
• Filed: 04/22/2005
• Published: 09/01/2005
• Est. Priority Date: 09/18/2000
• Status: Active Grant

• Current Assignee: Cameron Health Inc (Boston Scientific Corporation)
• Original Assignee: Cameron Health Inc (Boston Scientific Corporation)
• Inventors: Ostroff, Alan H., Rissmann, William J., Bardy, Gust H., Cappato, Riccardo, Erlinger, Paul J.
• Granted Patent: US 7,363,083 B2
• Time in Patent Office: Days
• US Class Current: 607/5
• CPC Class Codes: A61N 1/375 Constructional arrangements, e.g. casings
• CPC Class Codes: A61N 1/37518 Anchoring of the implants, e.g. fixation
• 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 1/3968 Constructional arrangements, e.g. casings A61N1/375 takes precedence
• CPC Class Codes: A61N 1/3975 Power supply A61N1/378 takes precedence

Abstract

One embodiment of the present invention provides an implantable cardioverter-defibrillator for subcutaneous positioning over a patient'"'"'s ribcage, the implantable cardioverter-defibrillator including a housing, wherein the housing conforms to the patient'"'"'s ribcage when subcutaneously positioned; an electrode disposed upon a portion of the housing; and an electrical circuit located within the housing, wherein the electrical circuit is electrically coupled to the electrode.

Claims

1. An implantable cardioverter/defibrillator of the type including a plurality of components, the implantable cardioverter/defibrillator comprising:

a battery, a capacitor, and circuitry connected thereto for detecting an abnormal heart rhythm, charging the capacitor, and discharging the capacitor to provide a cardioversion/defibrillation shock;

a first structural portion supporting a first cardioversion/defibrillation electrode adapted to be implanted at a first subcutaneous implantation site about the patient'"'"'s thorax directing the first cardioversion/defibrillation electrode toward the patient'"'"'s heart;

a second structural portion supporting a second cardioversion/defibrillation electrode adapted to be implanted at a second subcutaneous implantation site about the patient'"'"'s thorax directing the second cardioversion/defibrillation electrode toward the patient'"'"'s heart; and

a connecting structure including one or more conductors connecting the first and second structural portions together, wherein the battery, capacitor, and circuitry components of the implantable cardioverter/defibrillator are distributed between the first and second structural portions, and the one or more conductors of the connecting structure interconnect the components to enable generation and delivery of cardioversion/defibrillation shocks between the first and second cardioversion/defibrillation electrodes and across the patient'"'"'s heart.

2. The implantable cardioverter/defibrillator of claim 1, wherein the circuitry is adapted to detect tachycardias.

3. The implantable cardioverter/defibrillator of claim 1, whereby the heart is disposed substantially between the first and second cardioversion/defibrillation electrodes.

4. The implantable cardioverter/defibrillator of claim 1, wherein first structural portion is a first housing segment and the second structural portion is a second housing segment.

5. The implantable cardioverter/defibrillator of claim 1, wherein first structural portion is a first canister section and the second structural portion is a second canister section.

6. The implantable cardioverter/defibrillator of claim 1, wherein the first and second structural portions are hermetically sealed.

7. The implantable cardioverter/defibrillator of claim 1, wherein the battery is enclosed within the second structural portion.

8. The implantable cardioverter/defibrillator of claim 1, wherein the capacitor and circuitry are enclosed within the first structural portion.

9. The implantable cardioverter/defibrillator of claim 1, wherein the connecting structure includes a first end and a second end, and is coupled at the first end to the first structural portion and at a second end to the second structural portion.

10. The implantable cardioverter/defibrillator of claim 1, wherein the connecting structure includes a first end and a second end, and wherein at least one of the first and second ends of the connecting structure can be disconnected from the respective first and second structural portions to enable replacement of the first or second structural portions.

11. The implantable cardioverter/defibrillator of claim 1, wherein the connecting structure includes a first end and a second end, and wherein the connecting structure is permanently coupled at the first end to the first structural portion and at the second end to the second structural portion.

12. The implantable cardioverter/defibrillator of claim 1, further including two or more far-field sensing electrodes adapted to provide far-field sensing of cardiac electrical activity.

13. The implantable cardioverter/defibrillator of claim 12, wherein the circuitry includes sensing circuitry coupled to the far-field sensing electrodes.

14. The implantable cardioverter/defibrillator of claim 1, wherein:

the first structural portion supports a first pacing electrode;

the second structural portion supports a second pacing electrode; and

the circuitry further comprises a pacing pulse generator for generating pacing pulses, the pacing pulse generator coupled to the first pacing electrode.

15. The implantable cardioverter/defibrillator of claim 14, wherein the connector structure comprises a pacing conductor coupled between the pacing pulse generator and the second pacing electrode, whereby the pacing pulse generator generates pacing pulses that are delivered to the heart between the first and second pacing electrodes.

16. The implantable cardioverter/defibrillator of claim 1, further including a third cardioversion/defibrillation electrode and means for selectively delivering cardioversion/defibrillation shocks among selected pairs of the first, second and third cardioversion/defibrillation electrodes.

17. The implantable cardioverter/defibrillator of claim 1, further comprising means for selectively delivering cardioversion/defibrillation shocks having one of a monophasic waveform or a biphasic waveform.

18. An implantable cardioverter/defibrillator comprising:

a first structure supporting a first cardioversion/defibrillation electrode adapted to be implanted at a first subcutaneous implantation site about the patient'"'"'s thorax directing the first cardioversion/defibrillation electrode toward the patient'"'"'s heart;

a second structure supporting a second cardioversion/defibrillation electrode adapted to be implanted at a second subcutaneous implantation site about the patient'"'"'s thorax directing the second cardioversion/defibrillation electrode toward the patient'"'"'s heart, whereby the heart is disposed substantially between the first and second cardioversion/defibrillation electrodes;

a connection structure connecting the first and second structures together;

cardioversion/defibrillation shock generating means enclosed within the first or second structure and coupled to the first and second cardioversion/defibrillation electrodes;

a battery enclosed within the first or second structure and coupled to the cardioversion/defibrillation shock generating means; and

means for triggering generation and delivery of cardioversion/defibrillation shocks between the first and second cardioversion/defibrillation electrodes and across the patient'"'"'s heart.

19. The implantable cardioverter/defibrillator of claim 18, wherein the first structure is a first housing segment and the second structure is a second housing segment.

20. The implantable cardioverter/defibrillator of claim 18, wherein the first structure is a first canister section and the second structure is a second canister section.

21. The implantable cardioverter/defibrillator of claim 18, wherein the first and second structures are hermetically sealed.

22. The implantable cardioverter/defibrillator of claim 18, wherein the means for triggering generation and delivery of cardioversion/defibrillation shocks comprises at least one capacitor, and circuitry for detecting a tachyarrhythmia, charging the capacitor, and discharging the capacitor to provide a cardioversion/defibrillation shock.

23. The implantable cardioverter/defibrillator of claim 18, wherein the battery is enclosed within the second structure.

24. The implantable cardioverter/defibrillator of claim 18, wherein the cardioversion/defibrillation shock generating means and the means for triggering generation and delivery of cardioversion/defibrillation shocks are enclosed within the first structure.

25. The implantable cardioverter/defibrillator of claim 18, wherein the first and second structures supporting the electrodes each include a first end and a second end, the first end being free and the second end being attached to the connection structure, the first and second structures also each including a width and a nominal thickness;

and wherein the free end of at least one of the first and second structures is tapered from the nominal thickness to a lesser thickness to ease subcutaneous advancement.

26. A method of implanting an implantable cardioverter-defibrillator within a patient, the method comprising:

providing a cardioverter-defibrillator comprising a first structural portion, a second structural portion and a connecting structure interconnecting the first and second structural portions;

making a surgical incision into subcutaneous space between the patient'"'"'s skin and ribcage;

inserting the first structural portion through the incision and advancing the first structural portion subcutaneously to a first subcutaneous implantation site;

inserting the second structural portion through the incision and advancing the second structural portion subcutaneously to a second subcutaneous implantation site spaced from the first subcutaneous implantation site so that the connecting structure is disposed subcutaneously between the first and second structural portions; and

closing the incision.

27. The method of claim 26, wherein first structural portion is a first housing segment and the second structural portion is a second housing segment.

28. The method of claim 26, wherein first structural portion is a first canister section and the second structural portion is a second canister section.

29. The method of claim 26, wherein the first and second structural portions are hermetically sealed.

30. The method of claim 26, wherein the first and second structural portions supporting the electrodes each include a first end and a second end, the first end being free and the second end being attached to the connecting structure, the first and second structures also each including a width and a nominal thickness;

and wherein the free end of at least one of the first and second structural portions is tapered from the nominal thickness to a lesser thickness to ease the subcutaneous advancement.