Subcutaneous Cardiac Sensing and Stimulation System

• US 20120071942A1
• Filed: 09/20/2011
• Published: 03/22/2012
• Est. Priority Date: 04/11/2003
• Status: Active Grant

• Current Assignee: Apurv Kamath, Darrell Orvin Wagner, Marina Brockway, Paul Haefner
• Original Assignee: Apurv Kamath, Darrell Orvin Wagner, Marina Brockway, Paul Haefner
• Inventors: Kamath, Apurv, Haefner, Paul, Wagner, Darrell Orvin, Brockway, Marina
• Granted Patent: US 8,843,196 B2
• Time in Patent Office: Days
• US Class Current: 607/14
• CPC Class Codes: A61B 17/3203 Fluid jet cutting instruments
• CPC Class Codes: A61B 17/3415 for introducing tubes or catheters, e.g. gastrostomy tubes, drain catheters A61B17/3417 takes precedence; body piercing catheter guide needles A61M25/06
• CPC Class Codes: A61B 17/3417 Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating syringe needles A61M5/32; dilators A61M29/00
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2017/320044 Blunt dissectors blunt suture needles A61B2017/06085
• CPC Class Codes: A61B 2017/320084 Irrigation sleeves
• CPC Class Codes: A61B 2018/00392 Transmyocardial revascularisation
• CPC Class Codes: A61B 2090/3945 Active visible markers, e.g. light emitting diodes
• CPC Class Codes: A61B 2090/3979 infrared
• CPC Class Codes: A61B 2217/005 with suction drainage system
• CPC Class Codes: A61B 2217/007 with irrigation system
• CPC Class Codes: A61B 90/30 Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
• 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 1/056 Transvascular endocardial electrode systems
• CPC Class Codes: A61N 1/0568 with drug delivery
• CPC Class Codes: A61N 1/0587 Epicardial electrode systems; Endocardial electrodes piercing the pericardium
• CPC Class Codes: A61N 1/36542 controlled by body motion, e.g. acceleration
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters
• CPC Class Codes: A61N 1/37 Monitoring; Protecting
• CPC Class Codes: A61N 1/3925 : Monitoring; Protecting
• CPC Class Codes: A61N 1/3956 : Implantable devices for applying electric shocks to the heart, e.g. for cardioversion
• CPC Class Codes: A61N 1/3962 : in combination with another heart therapy
• CPC Class Codes: A61N 1/39622 : Pacing therapy
• CPC Class Codes: A61N 1/3987 : characterised by the timing or triggering of the shock

Abstract

Cardiac systems and methods using ECG and blood information for arrhythmia detection and discrimination. Detection circuitry is configured to produce an ECG. An implantable blood sensor configured to produce a blood sensor signal is coupled to a processor. The processor is coupled to the detection and energy delivery circuitry, and used to evaluate and treat cardiac rhythms using both the cardiac electrophysiologic and blood sensor signals. The blood sensor is configured for subcutaneous non-intrathoracic placement and provided in or on the housing, on a lead coupled to the housing, and/or separate to the housing and coupled to the processor via hardwire or wireless link. The blood sensor may be configured for optical sensing, using a blood oxygen saturation sensor or pulse oximeter. A cardiac rhythm may be evaluated using the electrocardiogram signal and the blood sensor signal, and tachyarrhythmias may be treated after confirmation using the blood sense signal.

Claims

1. A device, comprising:

a housing configured for implantation in a patient;

an electrode arrangement configured to electrically couple to a heart of the patient;

a detector provided in the housing and coupled to the electrode arrangement, the detector configured to produce a cardiac electrophysiologic signal;

energy delivery circuitry provided in the housing and coupled to the electrode arrangement, the energy delivery circuitry configured to deliver at least an antitachycardia electrical therapy to the heart;

an implantable blood sensor configured to produce a blood sensor signal; and

a processor provided in the housing and coupled to the blood sensor, the detector, and the energy delivery circuitry, the processor configured to discriminate between a tachyarrhythmia requiring antitachycardia electrical therapy and a condition that does not require antitachycardia electrical therapy using the cardiac electrophysiologic signal and the blood sensor signal, the processor configured to assess afterload of a left ventricle of the heart using at least the blood sensor signal.

2. The device of claim 1, wherein the processor is configured to analyze a morphology of the blood sensor signal as part of assessing afterload of the left ventricle.

3. The device of claim 1, wherein the processor is configured to verify that the cardiac electrophysiologic signal comprises a cardiac signal having a QRS complex using at least the blood sensor signal.

4. The device of claim 1, wherein the processor is configured to withhold delivery of antitachycardia electrical therapy in response to determining, using at least the blood sensor signal, that the condition does not require antitachycardia electrical therapy.

5. The device of claim 1, wherein the blood sensor comprises a pressure transducer.

6. The device of claim 1, wherein the blood sensor is configured to sense pulse pressure.

7. The device of claim 1, wherein the blood sensor comprises a flow sensor.

8. The device of claim 1, wherein the blood sensor comprises an acoustic sensor.

9. The device of claim 1, wherein the processor is further configured to assess cardiac function using at least the blood sensor signal.

10. The device of claim 1, wherein the processor is further configured to assess oxygen saturation and changes in oxygen saturation using at least the blood sensor signal.

18. The device of claim 1, wherein the processor is further configured to assess oxygen saturation and changes in oxygen saturation using at least the blood sensor signal.

11. A device, comprising:

a housing configured for implantation in a patient;

an electrode arrangement configured to electrically couple to a heart of the patient;

a detector provided in the housing and coupled to the electrode arrangement, the detector configured to produce a cardiac electrophysiologic signal;

energy delivery circuitry provided in the housing and coupled to the electrode arrangement, the energy delivery circuitry configured to deliver at least an antitachycardia electrical therapy to the heart;

an implantable blood sensor configured to produce a blood sensor signal; and

a processor provided in the housing and coupled to the blood sensor, the detector, and the energy delivery circuitry, the processor configured to discriminate between a tachyarrhythmia requiring antitachycardia electrical therapy and a condition that does not require antitachycardia electrical therapy using the cardiac electrophysiologic signal and the blood sensor signal, the processor configured to assess cardiac function of the patient'"'"'s heart using at least the blood sensor signal.

12. The device of claim 11, wherein the processor is configured to verify that the cardiac electrophysiologic signal comprises a cardiac signal having a QRS complex using at least the blood sensor signal.

13. The device of claim 11, wherein the processor is configured to withhold delivery of antitachycardia electrical therapy in response to determining, using at least the blood sensor signal, that the condition does not require antitachycardia electrical therapy.

14. The device of claim 11, wherein the blood sensor comprises a pressure transducer.

15. The device of claim 11, wherein the blood sensor is configured to sense pulse pressure.

16. The device of claim 11, wherein the blood sensor comprises a flow sensor.

17. The device of claim 11, wherein the blood sensor comprises an acoustic sensor.

19. A method, comprising:

implantably producing a cardiac electrophysiologic signal indicative of electrical activity of a patient'"'"'s heart;

implantably producing a blood sensor signal;

discriminating between a tachyarrhythmia requiring antitachycardia electrical therapy and a condition that does not require antitachycardia electrical therapy using the cardiac electrophysiologic signal and the blood sensor signal;

delivering antitachycardia electrical therapy to the patient'"'"'s heart to treat the tachyarrhythmia requiring antitachycardia electrical therapy; and

assessing one or both of afterload of a left ventricle of the heart and cardiac function of the patient'"'"'s heart using at least the blood sensor signal.

20. The method of claim 19, comprising assessing afterload of the left ventricle and cardiac function of the patient'"'"'s heart using at least the blood sensor signal.