System and method for cardioversion using scan stimulation

• US 5,995,871 A
• Filed: 10/29/1997
• Issued: 11/30/1999
• Est. Priority Date: 10/29/1997
• Status: Expired due to Fees

• Current Assignee: Stephen B. Knisley
• Original Assignee: UAB Research Foundation (University of Alabama System)
• Inventors: Knisley, Stephen B.
• Primary Examiner(s): Kamm, William E.
• Assistant Examiner(s): LAYNO, CARL HERNANDZ
• Application Number:
  US08/960,448
• Time in Patent Office: 762 Days
• Field of Search: 607/5, 607/9, 607/15, 607/14
• US Class Current: 607/15
• 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 1/3956 Implantable devices for applying electric shocks to the heart, e.g. for cardioversion

Abstract

A method and system for applying therapeutic electrical pulses to the heart includes a plurality of spaced apart electrodes. Each electrode in electrical communication with a pulse generator and are operative to deliver at least one energy pulse to a patient'"'"'s heart. Sensors and electrical communication with a controller are operative to detect an abnormal rhythm in the patient'"'"'s heart and transmit a signal to a controller to indicate an abnormal rhythmic condition. The controller is configured to receive the abnormal rhythmic signal from the sensor and cause the pulse generator to emit a sequence of spatially and temporally distinct pulses through the electrodes, each pulse passing through at least one of the electrodes.

Claims

1. A method for applying therapeutic electrical pulses to the heart comprising the steps of:

providing a plurality of spaced-apart electrodes, each electrode in electrical communication with a heart fiber adjacent to the electrode;

directing a sequence of spatially and temporally distinct anti-tachyarrhythmia pulses to the heart wherein the sequence comprises a first pulse to the heart through a first electrode at a time T1, a second pulse to the heart through a second electrode at a time T2, occurring at least two milliseconds after T1.

2. The method of claim 1 wherein the step of providing a plurality of electrodes includes the step of providing a plurality of elongated electrodes, at least one electrode extending substantially parallel to an elongated fiber of the heart proximate to such electrode.

3. The method of claim 1 further including the step of detecting an abnormal heart rhythm.

4. The method of claim 1 wherein the step of providing a plurality of electrodes includes the step of providing at least four electrodes.

5. A method for applying therapeutic electrical pulses to the heart comprising the steps of:

providing a plurality of electrodes, each electrode in electrical communication with a heart fiber adjacent to such electrode;

providing a pulse generator which generates anti-tachyarrhythmia energy pulses;

detecting an abnormal heart rhythm;

directing a first pulse to the heart through a first electrode at a time T1; and

directing a second pulse to the heart through a second electrode at a time T2, T2 occurring at least two milliseconds after T1.

6. The method of claim 5 further comprising the steps of:

directing a third pulse to the heart through a third electrode at time T3, T3 being later in time than T2;

directing a fourth pulse to the heart through a fourth electrode at time T4, T4 being later in time than T3;

directing a fifth pulse to the heart through a fifth electrode at time T5, T5 being later in time than T4; and

directing a sixth pulse to the heart through a sixth electrode at time T6, T6 being later in time than T5.

7. The method of claim 5 further including the steps of:

directing a third pulse to the heart through a third electrode at time T1; and

directing a fourth pulse to the heart through a fourth electrode at time T2.

8. The method of claim 7 wherein directing said first and third pulses includes directing pulses having the same polarity.

9. The method of claim 7 wherein directing said first and third pulses includes directing pulses having opposite polarity.

10. The method of claim 5 further including the steps of:

directing a third pulse to the heart through a third electrode at time T3, T3 being later in time than T2;

directing a fourth pulse to the heart through a fourth electrode at time T1;

directing a fifth pulse to the heart through a fifth electrode at time T2; and

directing a sixth pulse to the heart through a sixth electrode at time T3.

11. The method of claim 5 wherein the step of providing a plurality of electrodes includes the step of providing a plurality of elongated electrodes, at least one electrode extending substantially parallel to an elongated fiber of the heart proximate to such electrode.

12. The method of claim 5 further including the step of storing the sequence of spatially and temporally applied pulses directed to the heart.

13. A system for applying therapeutic electrical pulses to the heart comprising:

a power source;

a controller in electrical communication with the power source;

pulse means in electrical communication with the controller and power source, the pulse means configured to generate a sequence of energy pulses;

a plurality of spaced apart elongated electrodes, each electrode in electrical communication with the pulse means, each electrode configured to deliver at least one of the energy pulses generated by the pulse means to a patient'"'"'s heart; and

detecting means in electrical communication with the controller, the detecting means operative to detect an abnormal rhythmic condition in the patient'"'"'s heart and transmit a signal to the controller to indicate an abnormal rhythmic condition, the controller being operative to receive the signal indicative of an abnormal rhythmic condition and to cause the pulse means to direct a sequence of spatially and temporally distinct pulses to the patient'"'"'s heart through the electrodes, each pulse passing through at least one of the electrodes.

14. The system of claim 13 comprising at least four electrodes.

15. The system of claim 13 wherein each of the plurality of spatially and temporally distinct pulses has a beginning and an ending, the beginning of each pulse being spaced apart from the beginning of the immediately preceding pulse.

16. The system of claim 15 wherein the beginning of each pulse is spaced apart from the ending of the immediately preceding pulse by no more than 100 microseconds.

17. The system of claim 13 further including memory means in electrical communication with the controller.

18. The system of claim 17 wherein the memory means is configured to store at least two different sequences of spatially and temporally distinct pulses.

19. The system of claim 18 wherein each stored sequence of spatially and temporally distinct pulses is associated with an indicator, also stored in memory, which associates the sequence of pulses with at least one type of abnormal rhythmic condition detectable by the detecting means.

20. The system of claim 13 wherein the controller is further operative to direct a first sequence of spatially and temporally distinct pulses to the heart and, if the detecting means transmits a signal indicative of an abnormal rhythmic condition in the patient'"'"'s heart to the controller after application of the first sequence of pulses, the controller being further operative to direct a second sequence of pulses to the heart.

21. The system of claim 20 wherein the second sequence of pulses differs from the first sequence of pulses.

22. The system of claim 13 wherein the electrodes are operative to detect electrical activation of heart fibers proximate to each such electrode.

23. A system for applying therapeutic electrical pulses to a heart comprising:

I. a plurality of spaced apart electrodes configured to be disposed in contact with a heart;

II. sensor means configured to be disposed in contact with the heart;

III. a pulse generator in electrical communication with the plurality of electrodes, the pulse generator being operative to apply a pattern of temporally and spatially separated pulses to the heart through the plurality of electrodes;

IV. a controller in electrical communication with the plurality of electrodes, the sensor means and the pulse generator, the controller performing the steps of;

a. receiving a first signal pattern from the sensor means, the first signal pattern being indicative of a first heart rhythm;

b. determining if therapeutic electrical pulses are to be applied to the heart;

if therapeutic electrical pulses are to be applied to the heart,

c. generating a first control signal;

d. directing the first control signal to the pulse generator to cause the pulse generator to apply a first pattern of temporally and spatially separated pulses to the plurality of electrodes;

e. receiving a second signal pattern from the sensor means, the second signal pattern being indicative of a second heart rhythm;

f. determining if therapeutic electrical pulses are to be applied to the heart;

if therapeutic electrical pulses are to be applied to the heart,

g. generating a second control signal;

h. directing the second control signal to the pulse generator to cause the pulse generator to apply a second pattern of temporally and spatially separated pulses to the plurality of electrodes; and

if therapeutic electrical pulses are not to be applied to the heart,

i. storing the second control signal in association with the second signal pattern.

25. The system claimed in claim 23 wherein the steps of determining if therapeutic electrical pulses are to be directed to the heart include the steps of:

the artificial neural network comparing the received signal pattern with at least one stored pattern indicative of acceptable heart rhythms;

if the received signal pattern is comparable to at least one stored pattern indicative of an acceptable heart rhythm, therapeutic electrical pulses are not to be directed to the heart; and

if the received signal pattern is not comparable to at least one stored pattern indicative of an acceptable heart rhythm, therapeutic electrical pulses are to be directed to the heart.

24. The system claimed 23 wherein the steps of determining if therapeutic electrical pulses are to be applied to the heart includes the steps of:

sending the received signal pattern from the controller to an artificial neural network configured to recognize a signal pattern indicative of an abnormal heart rhythm; and

the controller then receiving from the artificial neural network a signal indicating if therapeutic electrical pulses are to be directed to the heart.

26. A method for applying therapeutic electrical pulses to the heart comprising the steps of:

providing a plurality of spaced apart electrodes configured to be disposed in contact with a heart;

providing sensor means configured to be disposed in contact with the heart;

providing a pulse generator in electrical communication with the plurality of electrodes and sensor means, the pulse generator being operative to apply a pattern of temporally and spatially separated pulses to the heart through the plurality of electrodes;

receiving a first signal pattern from the sensor means, the first signal pattern being indicative of a first heart rhythm;

determining if therapeutic electrical pulses are to be applied to the heart;

storing the first control signal in association with the first signal pattern;

if therapeutic electrical pulses are to be applied to the heart, generating a first control signal;

directing the first control signal to the pulse generator to cause the pulse generator to apply a first pattern of temporally and spatially separated pulses through the plurality of electrodes;

receiving a second signal pattern from the sensor means, the second signal pattern being indicative of a second heart rhythm;

determining if therapeutic electrical pulses are to be applied to the heart;

and if therapeutic electrical pulses are to be applied to the heart, generating a second control signal directing the second control signal to the pulse generator to cause the pulse generator to direct a second pattern of temporally and spatially separated pattern of pulses to the plurality of electrodes; and

if therapeutic electrical pulses are not to be applied to the heart, storing the second control signal in association with the second signal pattern.

27. A method for applying therapeutic electrical pulses to the heart comprising the steps of:

providing a plurality of electrodes, each electrode in electrical communication with a heart fiber adjacent to such electrode;

providing a pulse generator which generates energy pulses;

detecting an abnormal heart rhythm;

directing a first pulse to the heart through a first electrode at a time T1;

directing a second pulse to the heart through a second electrode at a time T2, T2 being later in time than T1;

directing a third pulse to the heart through a third electrode at a time T3, T3 being later in time than T2;

directing a fourth pulse to the heart through a fourth electrode at a time T4, T4 being later in time than T3;

directing a fifth pulse to the heart through a fifth electrode at a time T5, T5 being later in time than T4; and

directing a sixth pulse to the heart through a sixth electrode at a time T6, T6 being later in time than T5.

28. A method for applying therapeutic electrical pulses to the heart comprising the steps of:

providing a plurality of electrodes, each electrode in electrical communication with a heart fiber adjacent to such electrodes;

providing a pulse generator which generates energy pulses;

detecting an abnormal heart rhythm;

directing a first pulse to the heart through a first electrode at a time T1;

directing a second pulse to the heart through a second electrode at a time T2, T2 being later in time than T1;

directing a third pulse to the heart through a third electrode at a time T1; and

directing a fourth pulse to the heart through a fourth electrode at a time T2.