Method and apparatus for treating a tachyarrhythmic patient

• US 6,134,470 A
• Filed: 11/09/1998
• Issued: 10/17/2000
• Est. Priority Date: 11/09/1998
• Status: Expired due to Term

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Hartlaub, Jerome T.
• Primary Examiner(s): Layno, Carl H.
• Application Number:
  US09/188,603
• Time in Patent Office: 708 Days
• Field of Search: 607/14, 607/15, 607/62, 607/117
• US Class Current: 607/14
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions

Abstract

An implantable anti-arrhythmia system which includes a spinal cord stimulator and an implantable heart rhythm monitor, coupled to control the spinal cord stimulator. The implantable heart monitor is adapted to detect the occurrence of tachyarrhythmias or of precursors thereto and in response, trigger the operation of the spinal cord stimulator in order to prevent occurrences of tachyarrhythmias and/or as a stand-alone therapy for termination of tachyarrhythmias and/or to reduce the level of aggressiveness required of an additional therapy such as antitachycardia pacing, cardioversion or defibrillation. The device in most embodiments is expected to include a mechanism for delivering an electrical anti-tachyarrhythmia therapy such as pacing, cardioversion or defibrillation in response to detection of a tachyarrhythmia. However, in some embodiments the spinal cord stimulator may be the only electrical stimulator included in the system. In those embodiments including electronic heart stimulators for termination of tachyarrhythmias, the device may also include a single or dual chamber bradycardia pacemaker. In alternative embodiments anti-tachyarrhythmia therapy might additionally be delivered by means of an implantable drug pump.

Claims

1. An anti-tachyarrhythmia device, comprising:

a heart monitor comprising a tachyarrhythmia detector;

a spinal cord stimulator responsively coupled to the heart monitor and activated in response to detection of a reentrant tachycardia by the tachyarrhythmia detector;

means for delivering an anti-tachyarrhythmia therapy other than spinal cord stimulation in response to failure of spinal cord stimulation to terminate the detected reentrant tachycardia;

a spinal cord stimulation timer initiated in response to activation of the spinal cord stimulator and defining a spinal cord stimulation interval thereafter and wherein said therapy delivering means is activated responsive to expiration of a spinal cord stimulation interval in conjunction with failure of spinal cord stimulation to terminate the detected reentrant tachycardia.

2. A device according to claim 1 wherein the means for delivering an anti-tachyarrhythmia therapy comprises means for delivering an electrical therapy to a patient'"'"'s heart.

3. A device according to claim 1 or claim 2 further comprising means for modifying stimulation parameters of the spinal cord stimulator responsive to expiration of a spinal cord stimulation interval in conjunction with failure of spinal cord stimulation to terminate the detected reentrant tachycardia.

4. A device according to claim 1 wherein the heart monitor further comprises a tachyarrhythmia precursor detector and wherein the spinal cord stimulator is further activated in response to detection of tachyarrhythmia precursors by the tachyarrhythmia precursor detector.

5. A device according to claim 4 comprising a spinal cord stimulation timer initiated in response to activation of the spinal cord stimulator and defining a spinal cord stimulation interval thereafter and further comprising means for modifying stimulation parameters of the spinal cord stimulator responsive to expiration of a spinal cord stimulation interval in conjunction with failure of spinal cord stimulation to terminate the detected tachyarrhythmia precursors.

6. A device according to claim 1 or claim 4 wherein the heart monitor comprises a physiologic sensor.

7. A device according to claim 6 wherein the heart monitor comprises means for detecting tachyarrhythmias responsive to the physiologic sensor.

8. A device according to claim 6 wherein the heart monitor comprises means for detecting tachyarrhythmia precursors responsive to the physiologic sensor.

9. A device according to claim 6 wherein the spinal cord stimulator is responsively coupled to the physiologic sensor and is activated in response to the sensor in the absence of detection of tachyarrhythmia by the tachyarrhythmia detector.

10. An anti-tachyarrhythmia device, comprising:

a heart monitor comprising a tachyarrhythmia precursor detector;

a spinal cord stimulator coupled to the heart monitor and activated in response to detection of tachyarrhythmia precursors by the tachyarrhythmia precursor detector;

a spinal cord stimulation timer initiated in response to activation of the spinal cord stimulator and defining a series of successive spinal cord stimulation intervals thereafter and further comprising means for modifying stimulation parameters of the spinal cord stimulator for a spinal cord stimulation interval responsive to expiration of a preceding spinal cord stimulation interval in conjunction with failure of spinal cord stimulation to terminate the detected tachyarrhythmia precursors.

11. A device according to claim 10 wherein the heart monitor comprises a physiologic sensor.

12. A device according to claim 11 wherein the heart monitor comprises means for detecting tachyarrhythmia precursors responsive to the physiologic sensor.

13. A device according to claim 12 wherein the spinal cord stimulator is responsively coupled to the physiologic sensor is activated in response to the sensor in the absence of detection of tachyarrhythmia precursors by the tachyarrhythmia detector.

14. An anti-tachyarrhythmia device, comprising:

a heart monitor comprising a tachyarrhythmia detector;

a spinal cord stimulator operable to deliver spinal cord stimulation therapy; and

means for modifying stimulation parameters of the spinal cord stimulation therapy responsive to detection of a tachyarrhythmia by the tachyarrhythmia detector.

15. A device according to claim 14 further comprising means for delivering an anti-tachyarrhythmia therapy other than spinal cord stimulation in response to failure of spinal cord stimulation to terminate the detected tachyarrhythmia.

16. An anti-tachyarrhythmia device, comprising:

a heart monitor comprising a tachyarrhythmia precursor detector;

a spinal cord stimulator operable to deliver spinal cord stimulation therapy; and

means for modifying stimulation parameters of the spinal cord stimulation therapy responsive to detection of tachyarrhythmia precursors by the tachyarrhythmia precursor detector.

17. A device according to claim 16 further comprising means for further modifying stimulation parameters of the spinal cord stimulation therapy responsive to failure of spinal cord stimulation to terminate the detected tachyarrhythmia precursors.

18. An anti-tachyarrhythmia device, comprising:

a heart monitor comprising means for detecting a plurality of tachyarrhythmias;

means for delivering an anti-tachyarrhythmia therapy other than spinal cord stimulation;

a spinal cord stimulator responsively coupled to the heart monitor and activated in response to detection of a first one of the tachyarrhythmias;

a spinal cord stimulation timer initiated in response to activation of the spinal cord stimulator and defining a spinal cord stimulation interval thereafter;

means for activating the anti-tachyarrhythmia therapy delivering means responsive to expiration of a spinal cord stimulation interval in conjunction with failure of spinal cord stimulation to terminate the detected tachyarrhythmia; and

means responsive to detection of a second one of the tachyarrhythmias for activating the anti-tachyarrhythmia therapy delivering means independent of expiration of any spinal cord stimulation interval.

19. A device according to claim 18 wherein the means for delivering an anti-tachyarrhythmia therapy comprises means for delivering an electrical therapy to a patient'"'"'s heart.

20. A device according to claim 18 or claim 19 comprising means for activating the spinal cord stimulator responsive to detection of the second one of the tachyarrhythmias, concurrent with activation of the anti-tachyarrhythmia therapy delivering means.

21. A device according to claim 20 wherein the anti-tachyarrhythmia therapy delivering means comprises means for delivering first and second anti-tachyarrhythmia therapies and wherein the means for activating the anti-tachyarrhythmia therapy delivering means responsive to expiration of a spinal cord stimulation interval comprises means for activating the anti-tachyarrhythmia therapy delivering means to deliver the first anti-tachyarrhythmia therapy and wherein the means for activating the anti-tachyarrhythmia therapy delivering means independent of expiration of any spinal cord stimulation interval comprises means for activating the anti-tachyarrhythmia therapy delivering means to deliver the second anti-tachyarrhythmia therapy.