Positionally adaptable implantable cardiac device

• US 20060167502A1
• Filed: 12/21/2004
• Published: 07/27/2006
• Est. Priority Date: 12/21/2004
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Haefner, Paul Allan
• Granted Patent: US 7,996,072 B2
• Time in Patent Office: Days
• US Class Current: 607/4
• CPC Class Codes: A61N 1/05 for implantation or insertion into the body, e.g. heart electrode A61N1/06 takes precedence
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions
• CPC Class Codes: A61N 1/3956 Implantable devices for applying electric shocks to the heart, e.g. for cardioversion

Abstract

Cardiac sensing and/or stimulation devices and methods that adapt to implant location and positioning, and may employ automated vector selection from multiple electrodes. Devices include a housing having a first face opposing a second face, and an edge extending around the perimeter. A pulse generator and controller are coupled to three or more electrodes. Electrode arrangement facilitates selection of the particular electrodes that sense cardiac activity irrespective of one or more of positioning of the device, rotation of the housing, and which of the first and second faces of the housing is orientated toward the patient'"'"'s skin. A first vector may be selected that provides for sensing cardiac activity, and a second vector may sense skeletal muscle activity. The vectors may be selected based on amplitude or signal-to-noise ratio exceeding a predetermined threshold. Methods may involve delivering defibrillation or cardioversion energy and/or determining cardiac rhythm states using selected vectors.

Claims

1. An implantable cardiac device, comprising:

a housing having a first face opposing a second face, and an edge extending from a perimeter of the first face to a perimeter of the second face;

a pulse generator comprising a controller provided in the housing; and

a plurality of electrodes coupled to the pulse generator and arranged in a spaced relationship on the housing;

wherein the arrangement of the plurality of electrodes facilitates controller selection of particular electrodes of the plurality of electrodes that provide for sensing of cardiac activity irrespective of positional orientation of the housing within a patient.

2. The device of claim 1, wherein the arrangement of the plurality of electrodes facilitates controller selection of the particular electrodes that provide for sensing of cardiac activity irrespective of changes in positional orientation of the housing within the patient.

3. The device of claim 1, wherein the arrangement of the plurality of electrodes facilitates controller selection of the particular electrodes that provide for sensing of cardiac activity irrespective of rotation of the housing within the patient.

4. The device of claim 1, wherein the arrangement of the plurality of electrodes facilitates controller selection of the particular electrodes that provide for sensing of cardiac activity irrespective of which of the first and second faces of the housing is orientated toward the patient'"'"'s skin.

5. The device of claim 1, wherein the arrangement of the plurality of electrodes facilitates controller selection of the particular electrodes that provide for sensing of cardiac activity irrespective of both of rotation of the housing within the patient and which of the first and second faces of the housing is orientated toward the patient'"'"'s skin.

6. The device of claim 1, wherein the arrangement of the plurality of electrodes facilitates controller selection of a first set of electrodes that preferentially provide for sensing of cardiac activity and a second set of electrodes that preferentially provide for sensing of skeletal muscle activity.

7. The device of claim 1, wherein controller selection of the particular electrodes provides for sensing a cardiac signal having an amplitude or signal-to-noise ratio that exceeds a predetermined threshold.

8. The device of claim 1, wherein the pulse generator is configured to deliver defibrillation or cardioversion energy.

9. The device of claim 1, wherein the plurality of electrodes comprises at least three electrodes positioned on the edge of the housing and wrapping over a portion of the first and second faces of the housing.

10. The device of claim 1, wherein the plurality of electrodes comprises at least three electrodes positioned on the first face of the housing and at least three electrodes positioned on the second face of the housing.

11. The device of claim 1, wherein the controller is configured to determine cardiac rhythm states using selected sets of the plurality of electrodes.

12. A method of sensing cardiac activity, comprising:

providing an implantable housing that supports a plurality of electrodes arranged in a spaced relationship in or on a housing, the housing and the plurality of electrodes configured for subcutaneous, non-intrathoracic placement in a patient, the plurality of electrodes selectively combinable to define a plurality of sense vectors;

selecting a sense vector of the plurality of sense vectors useful for sensing cardiac activity; and

using the selected sense vector or selecting another of the plurality of sense vectors to facilitate sensing of cardiac activity irrespective of positional orientation of the housing within the patient.

13. The method of claim 12, wherein using the selected sense vector or selecting another of the plurality of sense vectors facilitates sensing of cardiac activity irrespective of changes in positional orientation of the housing within a patient.

14. The method of claim 12, wherein using the selected sense vector or selecting another of the plurality of sense vectors facilitates sensing of cardiac activity irrespective of rotation of the housing within the patient.

15. The method of claim 12, wherein using the selected sense vector or selecting another of the plurality of sense vectors facilitates sensing of cardiac activity irrespective of which of a first face and a second face of the housing is orientated toward the patient'"'"'s skin.

16. The method of claim 12, wherein using the selected sense vector or selecting another of the plurality of sense vectors facilitates sensing of cardiac activity irrespective of both of rotation of the housing within the patient and which of a first face and a second face of the housing is orientated toward the patient'"'"'s skin.

17. The method of claim 12, further comprising selecting a first sense vector that preferentially provides for sensing of cardiac activity and a second sense vector that preferentially provides for sensing of skeletal muscle activity.

18. The method of claim 12, wherein selecting the sense vector useful for sensing cardiac activity comprises selecting a sense vector of the plurality of sense vectors that provides for sensing a cardiac signal having an amplitude or signal-to-noise ratio that exceeds a predetermined threshold.

19. The method of claim 12, further comprising delivering defibrillation or cardioversion energy to the patient'"'"'s heart in response to detecting a cardiac condition requiring delivery of defibrillation or cardioversion energy.

20. The method of claim 12, further comprising determining cardiac rhythm states using selected ones of the plurality of sense vectors.

21. An implantable cardiac device, comprising:

an implantable housing that supports a plurality of electrodes arranged in a spaced relationship in or on a housing, the housing and the plurality of electrodes configured for subcutaneous, non-intrathoracic placement in a patient, the plurality of electrodes selectively combinable to define a plurality of sense vectors;

means for selecting a sense vector of the plurality of sense vectors useful for sensing cardiac activity; and

means for using the selected sense vector or selecting another of the plurality of sense vectors to facilitate sensing of cardiac activity irrespective of positional orientation of the housing within the patient.