SYSTEMS AND METHODS FOR TREATING CARDIAC ARRHYTHMIAS

• US 20170232266A1
• Filed: 05/04/2017
• Published: 08/17/2017
• Est. Priority Date: 02/06/2015
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Koop, Brendan E.
• Granted Patent: US 10,238,882 B2
• Time in Patent Office: Days
• CPC Class Codes: A61B 5/283 Invasive
• CPC Class Codes: A61B 5/29 for permanent or long-term implantation
• CPC Class Codes: A61B 5/35 by template matching
• CPC Class Codes: A61B 5/361 Detecting fibrillation
• CPC Class Codes: A61B 5/363 Detecting tachycardia or bradycardia
• CPC Class Codes: A61B 5/686 Permanently implanted devices, e.g. pacemakers, other stimulators, biochips A61B5/6861 takes precedence
• CPC Class Codes: A61B 5/7246 using correlation, e.g. template matching or determination of similarity
• CPC Class Codes: A61N 1/3621 for treating or preventing abnormally high heart rate
• CPC Class Codes: A61N 1/3624 occurring in the atrium, i.e. atrial tachycardia
• CPC Class Codes: A61N 1/37205 Microstimulators, e.g. implantable through a cannula
• CPC Class Codes: A61N 1/37217 characterised by the communication link, e.g. acoustic or tactile
• CPC Class Codes: A61N 1/37288 Communication to several implantable medical devices within one patient
• CPC Class Codes: A61N 1/3756 Casings with electrodes thereon, e.g. leadless stimulators
• CPC Class Codes: A61N 1/3925 Monitoring; Protecting
• CPC Class Codes: A61N 1/39622 Pacing therapy
• CPC Class Codes: A61N 1/3987 characterised by the timing or triggering of the shock

Abstract

Systems and methods for treating cardiac arrhythmias are disclosed. In one embodiment, an SICD comprises two or more electrodes, a charge storage device, and a controller operatively coupled to two or more of the electrodes and the charge storage device. In some embodiments, the controller is configured to monitor cardiac activity of the heart of the patient, detect an occurrence of a cardiac arrhythmia based on the cardiac activity, and determine a type of the detected cardiac arrhythmia from two or more types of cardiac arrhythmias. If the determined type of cardiac arrhythmia is one of a first set of cardiac arrhythmia types, the controller sends an instruction for reception by an LCP to initiate the application of ATP therapy by the LCP. If the determined type of cardiac arrhythmia is not one of the first set cardiac arrhythmia types, the controller does not send the instruction.

Claims

1. An implantable cardioverter defibrillator (ICD) for delivering a defibrillation shock to a heart of a patient, the ICD comprising:

two or more electrodes;

a charge storage device for storing a charge that can be delivered to shock the heart via two or more of the electrodes;

a controller operatively coupled to two or more of the electrodes and the charge storage device, the controller configured to;

identify an occurrence of a cardiac arrhythmia;

in response to identifying an occurrence of a cardiac arrhythmia;

determine if the identified cardiac arrhythmia is of a first type of cardiac arrhythmia;

wait to initiate charging of the charge storage device of the ICD when the identified cardiac arrhythmia is of the first type of cardiac arrhythmia;

initiate charging of the charge storage device of the ICD when the identified cardiac arrhythmia is not of the first type of cardiac arrhythmia; and

send an instruction for reception by a Leadless Cardiac Pacemaker (LCP) to initiate application of an Anti-Tachyarrhythmia Pacing (ATP) therapy by the LCP.

2. The ICD of claim 1, wherein when the identified cardiac arrhythmia is not of the first type of cardiac arrhythmia, and the instruction was sent to initiate application of an Anti-Tachyarrhythmia Pacing (ATP) therapy by the LCP, the controller is configured to determine if the ATP therapy terminated the identified cardiac arrhythmia, and:

if so, terminate the charging of the charge storage device of the ICD; and

if not, continue to charge the charge storage device of the ICD until charged, and then release charge from the charge storage device to deliver a shock to the heart.

3. The ICD of claim 1, wherein when the identified cardiac arrhythmia is of the first type of cardiac arrhythmia, and the instruction was sent to initiate application of an Anti-Tachyarrhythmia Pacing (ATP) therapy by the LCP, the controller is configured to determine if the ATP therapy terminated the identified cardiac arrhythmia, and:

if so, cease waiting and not initiating the charging of the charge storage device of the ICD; and

if not, cease waiting and initiate charging of the charge storage device of the ICD until charged, and then release charge from the charge storage device to deliver a shock to the heart.

4. The ICD of claim 1, wherein the first type of cardiac arrhythmia is a Monomorphic Ventricular Tachyarrhythmia (MVT).

5. The ICD of claim 1, wherein the controller is configured to:

determine if the identified cardiac arrhythmia is of a first type of cardiac arrhythmia or a second type of cardiac arrhythmia; and

in response to identifying an occurrence of a cardiac arrhythmia, the controller is configured to send the instruction for reception by a Leadless Cardiac Pacemaker (LCP) to initiate application of the ATP therapy by the LCP when the identified cardiac arrhythmia is of the first type of cardiac arrhythmia but not when the identified cardiac arrhythmia is of the second type of cardiac arrhythmia.

6. The ICD of claim 5, wherein the first type of cardiac arrhythmia is a Monomorphic Ventricular Tachyarrhythmia (MVT) and the second type of cardiac arrhythmia is a Polymorphic Ventricular Tachyarrhythmia (PVT).

7. The ICD of claim 5, wherein the first type of cardiac arrhythmia is a Monomorphic Ventricular Tachyarrhythmia (MVT) and the second type of cardiac arrhythmia is a Supra Ventricular Tachyarrhythmia (SVT).

8. The ICD of claim 1, wherein the controller is configured to:

determine if the identified cardiac arrhythmia is of a first type of cardiac arrhythmia or a second type of cardiac arrhythmia; and

in response to identifying an occurrence of a cardiac arrhythmia, the controller is configured to send the instruction for reception by a Leadless Cardiac Pacemaker (LCP) to initiate application of the ATP therapy by the LCP when the identified cardiac arrhythmia is of the first type of cardiac arrhythmia and when the identified cardiac arrhythmia is of the second type of cardiac arrhythmia.

9. The ICD of claim 1, wherein in response to identifying an occurrence of a cardiac arrhythmia, the controller is configured to send the instruction for reception by a Leadless Cardiac Pacemaker (LCP) to initiate application of the ATP therapy by the LCP only when the identified cardiac arrhythmia is of the first type of cardiac arrhythmia.

10. The ICD of claim 9, wherein the first type of cardiac arrhythmia is a Monomorphic Ventricular Tachyarrhythmia (MVT).

11. The ICD of claim 1, wherein the ICD is a Subcutaneous Implantable Cardioverter Defibrillator (SICD).

12. An implantable cardioverter defibrillator (ICD) for delivering a defibrillation shock to a heart of a patient, the ICD comprising:

two or more electrodes;

a charge storage device for storing a charge that can be delivered to shock the heart via two or more of the electrodes;

a controller operatively coupled to two or more of the electrodes and the charge storage device, the controller configured to;

identify an occurrence of a cardiac arrhythmia;

in response to identifying an occurrence of a cardiac arrhythmia;

determine if the identified cardiac arrhythmia is not of one or more predetermined types of cardiac arrhythmias;

wait to initiate charging of the charge storage device of the ICD when the identified cardiac arrhythmia is determined not to be of the one or more predetermined types of cardiac arrhythmias;

initiate charging of the charge storage device of the ICD when the identified cardiac arrhythmia is not determined to be not of the one or more predetermined types of cardiac arrhythmias; and

send an instruction for reception by a Leadless Cardiac Pacemaker (LCP) to initiate application of an ATP therapy by the LCP.

13. The ICD of claim 12, wherein the one the controller is configured to send an instruction for reception by a Leadless Cardiac Pacemaker (LCP) to initiate application of an ATP therapy by the LCP when the identified cardiac arrhythmia is determined not to be of the one or more predetermined types of cardiac arrhythmias.

14. The ICD of claim 12, wherein the one or more predetermined types of cardiac arrhythmias comprises a Polymorphic Ventricular Tachyarrhythmia (PVT).

15. The ICD of claim 12, wherein the one or more predetermined types of cardiac arrhythmias comprises a Supra Ventricular Tachyarrhythmia (SVT).

16. The ICD of claim 12, wherein the one or more predetermined types of cardiac arrhythmias comprises a Polymorphic Ventricular Tachyarrhythmia (PVT) and a Supra Ventricular Tachyarrhythmia (SVT).

17. The ICD of claim 12, wherein if the identified cardiac arrhythmia is not of the one or more predetermined types of cardiac arrhythmias, the controller is further configured to determine if the ATP therapy terminated the identified cardiac arrhythmia, and:

if so, cease waiting and not initiating the charging of the charge storage device of the ICD; and

if not, cease waiting and initiate charging of the charge storage device of the ICD until charged, and then release charge from the charge storage device to deliver a shock to the heart.

18. A method implemented by an implantable cardioverter defibrillator (ICD), wherein the ICD includes a charge storage device for storing a charge that can be delivered to shock the heart of a patient, the method comprising:

determining an occurrence of a cardiac arrhythmia;

determining if the identified cardiac arrhythmia has one or more predetermined characteristics;

waiting to initiate charging of the charge storage device of the ICD if the identified cardiac arrhythmia is determined to have the one or more predetermined characteristics; and

initiating charging of the charge storage device of the ICD when the identified cardiac arrhythmia is determined to not have the one or more predetermined characteristics; and

sending an instruction for reception by a Leadless Cardiac Pacemaker (LCP) to initiate application of an Anti-Tachyarrhythmia Pacing (ATP) therapy by the LCP when the identified cardiac arrhythmia is determined to have the one or more predetermined characteristics.

19. The method of claim 18, wherein the waiting step waits to initiate charging of the charge storage device of the ICD while the ATP therapy is applied.

20. The method of claim 19 further comprising:

determine if the ATP therapy terminated the identified cardiac arrhythmia, and;

if so, cease waiting and not initiating the charging of the charge storage device of the ICD; and

if not, cease waiting and initiate charging of the charge storage device of the ICD until charged, and then release charge from the charge storage device to deliver a shock to the heart.