IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR (ICD) SYSTEM INCLUDING SUBSTERNAL LEAD

• US 20140330327A1
• Filed: 04/25/2014
• Published: 11/06/2014
• Est. Priority Date: 05/06/2013
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: DeGroot, Paul J., McVenes, Rick D., Thompson-Nauman, Amy E., Christie, Melissa G.T., Dolan, Becky L.
• Granted Patent: US 10,471,267 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 1/3956 Implantable devices for applying electric shocks to the heart, e.g. for cardioversion
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

Substernal implantable cardioveter-defibrillator (ICD) systems and methods for providing substernal electrical stimulation therapy to treat malignant tachyarrhythmia, e.g., ventricular tachycardia (VT) and ventricular fibrillation (VF) are described. In one example, an implantable cardioveter-defibrillator (ICD) system includes an ICD implanted in a patient and an implantable medical electrical lead. The lead includes an elongated lead body having a proximal end and a distal portion, a connector at the proximal end of the lead body configured to couple to the ICD, and one or more electrodes along the distal portion of the elongated lead body. The distal portion of the elongated lead body of the lead is implanted substantially within an anterior mediastinum of the patient and the ICD is configured to deliver electrical stimulation to a heart of the patient using the one or more electrodes.

Claims

1. An implantable cardioveter-defibrillator (ICD) system comprising:

an ICD implanted subcutaneously in a patient;

an implantable medical electrical lead that includes;

an elongated lead body having a proximal end and a distal portion;

a connector at the proximal end of the lead body configured to couple to the ICD; and

one or more electrodes along the distal portion of the elongated lead body,

wherein the distal portion of the elongated lead body of the lead is implanted substantially within an anterior mediastinum of the patient and the ICD is configured to deliver electrical stimulation to a heart of the patient using the one or more electrodes.

2. The ICD system of claim 1, wherein the one or more electrodes includes a defibrillation electrode and the electrical stimulation comprises one of a cardioversion shock and a defibrillation shock.

3. The ICD system of claim 2, wherein the ICD is configured to deliver the one of the cardioversion shock and the defibrillation shock having an energy less than 60 Joules (J).

4. The ICD system of claim 2, wherein the ICD is configured to deliver the one of the cardioversion shock and the defibrillation shock having an energy between 40-50 Joules (J).

5. The ICD system of claim 2, wherein the ICD is configured to deliver the one of the cardioversion shock and the defibrillation shock having an energy between 35-60 Joules (J).

6. The ICD system of claim 2, wherein the distal portion of the lead is implanted substantially within the anterior mediastinum such that the defibrillation electrode is located over one of a cardiac silhouette of a ventricle of the heart as observed via an anterior-posterior (AP) fluoroscopic view of the heart.

7. The ICD system of claim 1, wherein the one or more electrodes includes at least one pacing electrode and the ICD is configured to provide one of bradycardia pacing, antitachycardia (ATP) pacing, and post-shock pacing to the patient via the at least one pacing electrode.

8. The ICD system of claim 7, wherein the at least one pacing electrode comprises two pacing electrodes and the ICD is configured to provide one of bradycardia pacing, antitachycardia (ATP) pacing, and post-shock pacing to the patient via a therapy vector between the two pacing electrodes.

9. The ICD system of claim 1, wherein the ICD is configured to deliver pacing pulses having pulse widths greater than two (2) milliseconds.

10. The ICD system of claim 1, wherein the ICD is configured to deliver pacing pulses having pulse widths between two (2) and three (3) milliseconds.

11. The ICD system of claim 1, wherein the ICD is configured to deliver pacing pulses having pulse widths between approximately one and a half (1.5) milliseconds and twenty (20) milliseconds.

12. The ICD system of claim 1, wherein the ICD is configured to deliver pacing pulses having pulse widths greater than two (2) milliseconds and less than eight (8) milliseconds.

13. The ICD system of claim 1, wherein the ICD is configured to deliver pacing pulses having pulse amplitudes between approximately one (1) and twenty (20) volts.

14. The ICD system of claim 1, wherein the distal portion of the lead is implanted substantially within the anterior mediastinum such that the defibrillation electrode is located substantially over an atrium of the heart and the ICD is configured to deliver a shock using the one or more electrodes to terminate atrial fibrillation (AF).

15. A method comprising:

detecting a tachycardia with the implantable cardioverter-defibrillator (ICD) system having an ICD and a medical electrical lead, the medical electrical lead having a proximal end coupled to the ICD and a distal portion including one or more electrodes implanted substantially within an anterior mediastinum of a patient;

generating an electrical stimulation with the ICD in response to detecting the tachycardia; and

delivering the electrical stimulation to a heart of the patient via the one or more electrodes implanted substantially within the anterior mediastinum of the patient.

16. The method of claim 15, wherein the one or more electrodes comprise a defibrillation electrode and one or more pacing electrodes, further wherein generating the electrical stimulation with the ICD in response to detecting the tachycardia and delivering the electrical stimulation to the heart comprises:

generating anti-tachycardia pacing (ATP) pulses with the ICD in response to detecting the tachycardia;

delivering the ATP pulses to the heart via one or more pacing electrodes implanted substantially within the anterior mediastinum of the patient;

generating one of one or more shocks with the ICD; and

delivering the one or more shocks to the heart via the defibrillation electrode implanted substantially within the anterior mediastinum of the patient.

17. The method of claim 16, wherein generating and delivering the one or more shocks comprises generating and delivering one or more shocks, each shock having an energy between 35-60 Joules (J).

18. The method of claim 16, wherein generating and delivering the one or more ATP pulses comprises generating and delivering the one or more ATP pulses each of the ATP pulses having a pulse width between approximately one and a half (1.5) milliseconds and twenty (20) milliseconds.

19. An implantable cardioveter-defibrillator (ICD) system comprising:

an ICD implanted in a patient;

an implantable medical electrical lead that includes;

an elongated lead body having a proximal end and a distal portion;

a connector at the proximal end of the lead body configured to couple to the ICD; and

a plurality of electrodes along the distal portion of the elongated lead body, the plurality of electrodes including a defibrillation electrode and at least two sensing electrodes, wherein the distal portion of the elongated lead body is implanted substantially within an anterior mediastinum of the patient,

wherein the ICD is configured to detect tachycardia using electrical signals sensed via the at least two sensing electrodes and to deliver one or more shocks to a heart of the patient via the defibrillation electrode in response to detecting tachycardia.

20. The ICD system of claim 19, wherein the ICD is configured to deliver the one or more shocks having an energy between 35-60 Joules (J).

21. The ICD system of claim 19, wherein the distal portion of the lead is implanted substantially within the anterior mediastinum such that a therapy vector from the defibrillation electrode to the ICD is substantially across the ventricles of the heart.