Atrial defibrillator and method
First Claim
1. An atrial defibrillator for applying an electrical defibrillating pulse to the atria of a human heart, said atrial defibrillator being arranged to apply said electrical defibrillating pulse to the atria in synchronism with depolarization activation waves and comprising:
- first means for sensing depolarization activation waves at a first area of the heart;
second means for sensing said depolarization activation waves at a second area of the heart;
means for detecting non-coincident sensing of said depolarization activation waves at said first area of the heart by said first means and at said second area of the heart by said second means;
storage means for storing electrical energy; and
delivery means coupled to said storage means and being responsive to the non-coincident sensing of a depolarization activation wave at said first and second areas of the heart for applying a predetermined amount of said stored electrical energy to the atria.
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Accused Products
Abstract
An implantable atrial defibrillator provides a pulse of defibrillating electrical energy to the atria of the heart in synchronism with sensed R waves in response to non-coincident sensing of an R wave at first and second areas of the heart. The defibrillating pulse is provided after a predetermined number of consecutive R waves are non-coincidently sensed to assure reliable synchronization. The atrial defibrillator is also operational in a marker mode wherein a number of synchronization marker pulses are delivered to the heart for detection on an externally generated electrocardiogram. The atrial fibrillation detector of the defibrillator is normally disabled and is activated when the sensed ventricular activity indicates a probability of atrial fibrillation to conserve a depletable power source. An endocardial lead is also described which ensures that the delivered atrial defibrillating electrical energy is substantially confined to the atria of the heart.
56 Citations
73 Claims
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1. An atrial defibrillator for applying an electrical defibrillating pulse to the atria of a human heart, said atrial defibrillator being arranged to apply said electrical defibrillating pulse to the atria in synchronism with depolarization activation waves and comprising:
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first means for sensing depolarization activation waves at a first area of the heart; second means for sensing said depolarization activation waves at a second area of the heart; means for detecting non-coincident sensing of said depolarization activation waves at said first area of the heart by said first means and at said second area of the heart by said second means; storage means for storing electrical energy; and delivery means coupled to said storage means and being responsive to the non-coincident sensing of a depolarization activation wave at said first and second areas of the heart for applying a predetermined amount of said stored electrical energy to the atria. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11)
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12. An implantable atrial cardioverter arranged to be powered by a depletable power source for delivering electrical energy to the atria of a human heart in need of cardioversion, said atrial cardioverter comprising:
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sensing means for sensing electrical activations of the heart, said sensing means being continuously operable; means responsive to said sensing means for determining time intervals between said sensed electrical activations; atrial arrhythmia detector means for detecting the presence of an atrial arrhythmia of the heart; disable means for maintaining said atrial arrhythmia detector means normally disabled to avoid excessive consumption of said depletable power source; enable means for enabling said atrial arrhythmia detector means responsive to said determined time intervals; and delivery means responsive to said atrial arrhythmia detector means for delivering said electrical energy to the atria of the heart in response to said atrial arrhythmia detector means detecting atrial arrhythmia of the heart. - View Dependent Claims (13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31)
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32. An atrial defibrillator arranged to be implanted beneath the skin of a patient for applying electrical energy to the atria of a human heart, said atrial defibrillator comprising:
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sensing means for sensing electrical activations of the heart; means for establishing an electrical activation sensing criteria; first delivery means for delivering a first quantity of electrical energy to the atria of the heart responsive to one of said sensed electrical activations satisfying said criteria for cadioverting the atria; second delivery means for delivering at least one pulse of electrical energy to the heart responsive to one of said sensed electrical activations satisfying said criteria, said pulse of electrical energy being of insufficient quantity to cardiovert the heart but of sufficient quantity so as to be detected on an electrocardiogram generated externally to the skin of the patient; and select means for selecting either said first delivery means or said second delivery means. - View Dependent Claims (33, 34, 35, 36, 37, 38, 39, 40, 41, 42)
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43. An atrial defibrillator for applying an electrical defibrillating pulse to the atria of a human heart in synchronism with an electrical activation of the heart, said atrial defibrillator comprising:
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sensing means for sensing electrical activations of the heart; synchronizing pulse generating means responsive to said sensing means for generating a synchronizing pulse for each said sensed electrical activation; counting means for counting said synchronizing pulses provided by said synchronizing pulse generating means; and delivery means responsive to said counting means for applying said electrical defibrillating pulse to the atria after a predetermined number of said synchronizing pulses have been counted by said counter means. - View Dependent Claims (44, 45, 46, 47, 48, 49, 50, 51, 52, 53)
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54. An implantable atrial defibrillator for applying an electrical defibrillating pulse to the atria of a human heart, said atrial defibrillator comprising:
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first means for sensing electrical activations of the heart at the right ventricle; second means for sensing electrical activations of the heart at the left ventricle; enable means responsive to said first means for detecting an abnormal rhythm of the right ventricle and providing an enable control signal; atrial fibrillation detector means including atrial sensing means for sensing atrial activity of at least one of the atria, said atrial fibrillation detector means being activated by said enable control signal for detecting atrial fibrillation of the heart; storage means for storing electrical energy responsive to said atrial fibrillation detector means detecting atrial fibrillation; means for detecting non-coincident sensing of said electrical activations by said first means and said second means; and delivery means responsive to said atrial fibrillation detector means, coupled to said storage means, and being responsive to non-coincident sensing of an electrical activation by said first and second means for applying a predetermined amount of said stored electrical energy to the atria of the heart. - View Dependent Claims (55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67)
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68. An implantable atrial defibrillator for applying cardioverting electrical energy to the atria of the heart when the atria are in need of cardioversion and for pacing a ventricle of the heart, said atrial defibrillator comprising:
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an enclosure adapted to be implanted beneath the skin of a patient; first sensing means within said enclosure for sensing atrial activity of the heart; atrial fibrillation detecting means within said enclosure and responsive to said first sensing means for determining when the atria are in need of cardioversion; cardioverting means within said enclosure and responsive to said atrial fibrillation detecting means for applying cardioverting electrical energy to the atria of the heart when the atria are in need of cardioversion; and pacing means within said enclosure for pacing said ventricle of the heart, said atrial defibrillator further including second sensing means within said enclosure and at least one electrode adapted for electrical contact with said ventricle for sensing electrical activations of said ventricle, wherein said cardioverting means is also responsive to an electrical activation of said ventricle sensed by said second sensing means for applying said cardioverting electrical energy to the atria when the atria are in need of cardioversion and wherein said pacing means is coupled to said at least one electrode for applying pacing electrical energy to said at least one electrode. - View Dependent Claims (69, 70)
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71. An implantable atrial defibrillator for applying cardioverting electrical energy to the atria of a patient'"'"'s heart in need of cardioversion, said atrial defibrillator comprising:
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lead means including a first electrode and a second electrode, said first electrode adapted to make electrical connection to the heart at a point within the coronary sinus or the great vein and said second electrode being adapted to make electrical connection to the heart within a region near to or within the right atrium; sensing means coupled to said first and second electrodes for sensing atrial activity of the heart; atrial fibrillation detecting means coupled to said sensing means for determining, responsive to the sensed atrial activity, if the atria of the heart are in need of cardioversion; and cardioverting means responsive to said atrial fibrillation detecting means and coupled to said first and second electrodes for applying cardioverting electrical energy between said first and second electrodes when the atria are in need of cardioversion. - View Dependent Claims (72, 73)
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Specification