Atrial fibrillation type selective cardiovertor and method

• US 5,549,641 A
• Filed: 10/31/1994
• Issued: 08/27/1996
• Est. Priority Date: 10/31/1994
• Status: Expired due to Term

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: InControl, Inc. (Daikin Industries Ltd)
• Inventors: Alferness, Clifton A., Ayers, Gregory M.
• Primary Examiner(s): Kamm, William E.
• Assistant Examiner(s): SCHAETZLE, KENNEDY
• Application Number:
  US08/331,898
• Time in Patent Office: 666 Days
• Field of Search: 607/4, 607/5, 128/705, 128/702
• US Class Current: 607/4
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions
• CPC Class Codes: A61N 1/3918 characterised by shock pathway, e.g. by electrode configuration
• CPC Class Codes: A61N 1/395 for treating atrial fibrillation
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

An atrial cardiovertor/defibrillator provides therapy to the atria corresponding to the type of atrial arrhythmia occurring in the atria of the heart. The atrial cardiovertor/defibrillator includes a memory for storing respective different criteria for each of different types of atrial arrhythmia, a sensor for sensing activity of at least one of the atria of the heart to provide an electrogram signal, and a cardiovertor for providing a corresponding therapy to the heart for each of the different types of atrial arrhythmia. The cardiovertor/defibrillator further includes an atrial arrhythmia detector responsive to the electrogram signal and the stored criteria for identifying one of the types of atrial arrhythmia to cause the cardiovertor to provide therapy to the heart corresponding to the identified atrial arrhythmia.

Claims

1. An atrial cardiovertor/defibrillator comprising:

criteria establishing means for providing a respective different criteria for each of different types of atrial arrhythmia;

a sensor for sensing activity of at least one of the atria of a heart to provide an electrogram signal;

therapy means for providing a corresponding therapy to the heart for each of said different types of atrial arrhythmia; and

classifying means responsive to said electrogram signal and said criteria establishing means for identifying one of said types of atrial arrhythmia and causing said therapy means to provide the therapy to the heart corresponding to said identified one of said types of atria arrhythmia,

wherein the respective different criteria include a first criteria for atrial flutter, a second criteria for atrial fibrillation of intermediate organization, and a third criteria for atrial fibrillation of high disorganization.

2. An atrial cardiovertor/defibrillator as defined in claim 1 wherein the therapy means comprises an atrial pacer and an atrial cardiovertor.

3. An atrial cardiovertor/defibrillator as defined in claim 2 wherein said classifying means causes said atrial pacer to pace the atria upon identifying atrial flutter.

4. An atrial cardiovertor/defibrillator as defined in claim 3 wherein said classifying means causes said cardiovertor to apply cardioverting electrical energy to the atria at an intermediate energy level upon identifying atrial fibrillation of intermediate disorganization.

5. An atrial cardiovertor/defibrillator as defined in claim 4 wherein said classifying means causes said cardiovertor to apply cardioverting electrical energy to the atria at a high energy level upon identifying atrial fibrillation of high disorganization, said high energy level being greater in energy than said intermediate energy level.

6. An atrial cardiovertor/defibrillator as defined in claim 5 further including first means for causing said cardiovertor to delay the application of the high energy level cardioverting energy for a pre-set time period.

7. An atrial cardiovertor/defibrillator as defined in claim 6 further including second means for activating said classifying means at predetermined times during said pre-set time period, said classifying means causing said cardiovertor to apply said intermediate energy level cardioverting energy upon identifying, during said pre-set time period, atrial fibrillation of intermediate disorganization and causing said cardiovertor to apply said high energy level cardioverting energy at the end of said pre-set time period upon failing to identify atrial fibrillation of intermediate disorganization during said pre-set time period.

8. An atrial cardiovertor/defibrillator as defined in claim 1 wherein the therapy means includes an atrial cardiovertor, wherein said classifying means causes said atrial cardiovertor to apply cardioverting electrical energy to the atria at a low energy level upon identifying atrial flutter and to cause said atrial cardiovertor to apply cardioverting electrical energy at an intermediate energy level upon identifying atrial fibrillation of intermediate disorganization, said intermediate energy level being greater in energy than said low energy level.

9. An atrial cardiovertor/defibrillator as defined in claim 8 wherein said classifying means causes said atrial cardiovertor to apply cardioverting electrical energy to the atria at a high energy level upon identifying atrial fibrillation of high disorganization, said high energy level being greater in energy than said intermediate energy level.

10. An atrial cardiovertor/defibrillator as defined in claim 9 further including first means for causing said cardiovertor to delay the application of the high energy level cardioverting energy for a pre-set time period.

11. An atrial cardiovertor/defibrillator as defined in claim 10 further including second means for activating said classifying means at predetermined times during said pre-set time period, said classifying means causing said cardiovertor to apply said intermediate energy level cardioverting energy upon identifying, during said pre-set time period, atrial fibrillation of intermediate disorganization and causing said cardiovertor to apply said high energy level cardioverting energy at the end of said pre-set time period upon failing to identify atrial fibrillation of intermediate disorganization during said pre-set time period.

12. An atrial cardiovertor/defibrillator as defined in claim 1 further including means for activating said classifying means for identifying atrial fibrillation of intermediate disorganization in response to said classifying means identifying atrial fibrillation of high disorganization.

13. An atrial cardiovertor/defibrillator as defined in claim 12 wherein the therapy means includes an atrial cardiovertor, wherein said classifying means causes said atrial cardiovertor to apply cardioverting electrical energy to the atria at an intermediate energy level upon identifying atrial fibrillation of intermediate disorganization.

14. An atrial cardiovertor/defibrillator as defined in claim 13 wherein said classifying means causes said atrial cardiovertor to apply cardioverting electrical energy to the atria at a high energy level upon failing to identify atrial fibrillation of intermediate disorganization after a pre-set time period, said high energy level being greater in energy than said intermediate energy level.

15. An atrial defibrillator comprising:

criteria establishing means for providing a respective different criteria for each of different types of atrial fibrillation;

a sensor for sensing activity of at least one of the atria of a heart to provide an electrogram signal;

therapy means for providing a corresponding therapy to the heart for each of said different types of atrial fibrillation; and

classifying means responsive to said electrogram signal and said criteria establishing means for identifying one of said types of atrial fibrillation and causing said therapy means to provide the therapy to the heart corresponding to said identified one of said types of atrial fibrillation.

16. An atrial defibrillator as defined in claim 15 wherein said sensor includes means for sensing localized activity of the at least one of the atria of the heart.

17. An atrial defibrillator as defined in claim 16 wherein said sensor includes a pair of closely spaced sensing electrodes.

18. An atrial defibrillator as defined in claim 15 further including means for determining atrial cardiac cycle length and wherein the respective different criteria are based upon atrial cardiac cycle length.

19. An atrial defibrillator as defined in claim 18 further including means for determining atrial cardiac cycle length variability and wherein the respective different criteria are further based upon atrial cardiac cycle length variability.

20. An atrial defibrillator as defined in claim 15 wherein the respective different criteria include a first criteria for atrial fibrillation of intermediate organization, and a second criteria for atrial fibrillation of high disorganization.

21. An atrial defibrillator as defined in claim 20 wherein the therapy means comprises an atrial cardiovertor.

22. An atrial defibrillator as defined in claim 21 wherein said classifying means causes said cardiovertor to apply cardioverting electrical energy to the atria upon identifying atrial fibrillation of intermediate disorganization.

23. An atrial defibrillator as defined in claim 22 wherein said cardioverting energy is an intermediate level of energy and wherein said classifying means causes said cardiovertor to apply cardioverting energy at a high energy level upon identifying atrial fibrillation of high disorganization, said high energy level being greater in energy than said intermediate energy level.

24. An atrial defibrillator as defined in claim 23 further including first means for causing said cardiovertor to delay the application of the high energy level cardioverting energy for a pre-set time period.

25. An atrial defibrillator as defined in claim 24 further including second means for activating said classifying means at predetermined times during said pre-set time period, said classifying means causing said cardiovertor to apply said intermediate energy level cardioverting energy upon identifying, during said pre-set time period, atrial fibrillation of intermediate disorganization and causing said cardiovertor to apply said high energy level cardioverting energy at the end of said pre-set time period upon failing to identify atrial fibrillation of intermediate disorganization during said pre-set time period.

26. An atrial defibrillator as defined in claim 20 further including means for activating said classifying means for identifying atrial fibrillation of intermediate disorganization in response to said classifying means identifying atrial fibrillation of high disorganization.

27. An atrial defibrillator as defined in claim 26 wherein said classifying means causes said cardiovertor to apply cardioverting electrical energy to the atria upon identifying atrial fibrillation of intermediate disorganization.

28. An atrial defibrillator as defined in claim 27 wherein said cardioverting energy is an intermediate level of energy and wherein said classifying means causes said cardiovertor to apply cardioverting energy at a high energy level upon failing to identify atrial fibrillation of intermediate disorganization during a pre-set time period, said high energy level being greater in energy than said intermediate energy level.

29. A method of administering electrotherapy to the atria of a patient'"'"'s heart to restore a normal atrial rhythm, said method comprising the steps of:

establishing a respective different criteria for each of different types of atrial arrhythmia;

sensing activity of at least one of the atria of the patient'"'"'s heart to provide an electrogram signal;

applying said electrogram signal to each said criteria identify one of said types of atrial arrhythmia; and

applying electrotherapy to the heart in a manner corresponding to the identified one of said types of atrial arrhythmia,

wherein the respective different criteria include a first criteria for atrial flutter, a second criteria for atrial fibrillation of intermediate organization, and a third criteria for atrial fibrillation of high disorganization.

30. A method as defined in claim 29 wherein said second applying step includes pacing the atria upon identifying atrial flutter.

31. A method as defined in claim 30 wherein said second applying step includes applying cardioverting electrical energy to the atria at an intermediate energy level upon identifying atrial fibrillation of intermediate disorganization.

32. A method as defined in claim 31 wherein said second applying step includes applying cardioverting electrical energy to the atria at a high energy level upon identifying atrial fibrillation of high disorganization, said high energy level being greater in energy than said intermediate energy level.

33. A method as defined in claim 32 further including the step of delaying the application of the high energy level cardioverting energy for a pre-set time period.

34. A method as defined in claim 33 further including the step of re-identifying the atrial arrhythmia type during said pre-set time period, applying said intermediate energy level cardioverting energy upon identifying, during said pre-set time period, atrial fibrillation of intermediate disorganization and applying said high energy level cardioverting energy at the end of said pre-set time period upon failing to identify atrial fibrillation of intermediate disorganization during said pre-set time period.

35. A method as defined in claim 29 wherein said second applying step includes applying cardioverting electrical energy to the atria at a low energy level upon identifying atrial flutter, and applying cardioverting electrical energy to the atria at an intermediate energy level upon identifying atrial fibrillation of intermediate disorganization, said intermediate energy level being greater in energy than said low energy level.

36. A method as defined in claim 35 wherein said second applying step further includes applying cardioverting electrical energy to the atria at a high energy level upon identifying atrial fibrillation of high disorganization, said high energy level being greater in energy than said intermediate energy level.

37. A method as defined in claim 36 further including the step of delaying the application of the high energy level cardioverting energy for a pre-set time period.

38. A method as defined in claim 37 further including the step of re-identifying the atrial arrhythmia type during said pre-set time period, applying said intermediate energy level cardioverting energy upon identifying, during said pre-set time period, atrial fibrillation of intermediate disorganization and applying said high energy level cardioverting energy at the end of said pre-set time period upon failing to identify atrial fibrillation of intermediate disorganization during said pre-set time period.

39. A method as defined in claim 29 further including the step of re-identifying the atrial arrhythmia type for atrial fibrillation of intermediate disorganization after identifying atrial fibrillation of high disorganization.

40. A method as defined in claim 29 wherein said second applying step includes applying cardioverting electrical energy to the atria at an intermediate energy level upon identifying atrial fibrillation of intermediate disorganization.

41. A method as defined in claim 30 wherein said second applying step further includes applying cardioverting electrical energy to the atria at a high energy level upon failing to identify atrial fibrillation of intermediate disorganization during a pre-set time period.

42. A method of administering electrotherapy to the atria of a patient'"'"'s heart to restore a normal atrial rhythm from fibrillation, said method comprising the steps of:

establishing a respective different criteria for each of different types of atrial fibrillation;

sensing activity of at least one of the atria of the patient'"'"'s heart to provide an electrogram signal;

comparing at least one characteristic of said electrogram signal to each said criteria and identifying from the comparison one of said types of atrial fibrillation; and

,

applying electrotherapy to the heart in a manner corresponding to the identified one of said types of atrial fibrillation.

43. A method as defined in claim 42 wherein said sensing step includes sensing localized activity of the at least one of the atria of the heart.

44. A method as defined in claim 43 wherein said sensing step includes sensing said localized activity between a pair of closely spaced locations of the at least one of the atria.

45. A method as defined in claim 42 wherein said comparison step includes determining atrial cardiac cycle length from said electrogram signal and wherein the respective different criteria are based upon atrial cardiac cycle length.

46. A method as defined in claim 45 wherein said comparing step further includes determining atrial cardiac cycle length variability and wherein the respective different criteria are further based upon atrial cardiac cycle length variability.

47. A method as defined in claim 46 wherein the respective different criteria include a first criteria for atrial fibrillation of intermediate organization, and a second criteria for atrial fibrillation of high disorganization.

48. A method as defined in claim 47 wherein said applying step includes applying cardioverting electrical energy to the atria upon identifying atrial fibrillation of intermediate disorganization.

49. A method as defined in claim 48 wherein said cardioverting energy is an intermediate level of said energy and wherein said applying step includes applying cardioverting electrical energy to the atria at a high energy level upon identifying atrial fibrillation of high disorganization, said high energy level being greater in energy than said intermediate energy level.

50. A method as defined in claim 49 further including the step of delaying the application of the high energy level cardioverting energy for a pre-set time period.

51. A method as defined in claim 50 further including the step of re-identifying the atrial arrhythmia type classifying during said pre-set time period, applying said intermediate energy level cardioverting energy upon identifying, during said pre-set time period, atrial fibrillation of intermediate disorganization and applying said high energy level cardioverting energy at the end of said pre-set time period upon failing to identify atrial fibrillation of intermediate disorganization during said pre-set time period.

52. A method as defined in claim 47 further including the step of re-identifying the atrial arrhythmia type for atrial fibrillation of intermediate disorganization after identifying atrial fibrillation of high disorganization.

53. A method as defined in claim 52 wherein said applying step includes applying cardioverting electrical energy to the atria upon identifying atrial fibrillation of intermediate disorganization.

54. A method as defined in claim 53 wherein said cardioverting energy is an intermediate level of said energy and wherein said applying step includes applying cardioverting electrical energy to the atria at a high energy level upon failing to identify atrial fibrillation of intermediate disorganization during a pre-set time interval, said high energy level being greater in energy than said intermediate energy level.

55. An atrial cardiovertor/defibrillator comprising:

criteria establishing means for providing a respective different criteria for each of different types of atrial arrhythmia;

a sensor for sensing activity of at least one of the atria of a heart to provide an electrogram signal;

therapy means for providing a corresponding therapy to the heart for each of said different types of atrial arrhythmia; and

classifying means responsive to said electrogram signal and said criteria establishing means for identifying one of said types of atrial arrhythmia and causing said therapy means to provide the therapy to the heart corresponding to said identified one of said types of atrial arrhythmia,

wherein the respective different criteria include criteria for atrial fibrillation of intermediate organization and criteria for atrial fibrillation of high disorganization.

56. A method of administering electrotherapy to the atria of a patient'"'"'s heart to restore a normal atrial rhythm, said method comprising the steps of:

establishing a respective different criteria for each of different types of atrial arrhythmia;

sensing activity of at least one of the atria of the patient'"'"'s heart to provide an electrogram signal;

applying said electrogram signal to each said criteria to identify one of said types of atrial arrhythmia; and

applying electrotherapy to the heart in a manner corresponding to the identified one of said types of atrial arrhythmia,

wherein the respective different criteria include criteria for atrial fibrillation of intermediate organization and criteria for atrial fibrillation of high disorganization.