Defibrillator with improved hemodynamic response and enhanced myocardial stability
DCFirst Claim
1. An implantable defibrillator adapted to deliver cardiac pacing, cardioversion and defibrillation therapies in selective response to dysrhythmia detection from an implant patient'"'"'s cardiac signal, the defibrillator comprising:
- a sensor of the patient'"'"'s heart rate;
a cardioverter/defibrillator for producing electrical shocks of adjustable energy level to be applied to the patient'"'"'s heart in response to applicable detected levels of pathologic accelerated heart rate;
a rate controllable generator responsive to a pacing dysrhythmia sensed by said heart rate sensor for generating cardiac pacing pulses at a rate designed to correct said sensed dysrhythmia for application to the patient'"'"'s heart;
an optimizer for matching the cardiac pacing rate of said generator to the hemodynamic needs of the implant patient under conditions of rest and physical activity;
including sensing and distinguishing periods of patient physical activity and rest, and generating a signal representative thereof to control the cardiac pacing rate accordingly as well as according to the extent of activity; and
a processor for processing the control signal generated by the optimizer to enhance sensitivity and specificity thereof by detecting physical activity of the patient and for applying the enhanced processed control signal to said rate controllable generator to appropriately adjust the pacing rate thereof;
said processor including a filter for passing substantially only components of the control signal in a frequency band below approximately 10 Hz;
whereby said defibrillator is adapted to suppress an acceleration of cardiac dysrhythmias by developing and delivering a pacing therapy that matches the patient'"'"'s hemodynamic needs.
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Abstract
An implanted defibrillator provides a device-implemented method of delivering cardiac pacing, cardioversion and defibrillation therapies in selective response to dysrhythmia detection of an implant patient'"'"'s cardiac signal. The patient'"'"'s heart rate is sensed, and cardioversion/defibrillation therapies are delivered by the device by producing electrical shocks of adjustable energy level for application to the patient'"'"'s heart in response to applicable detected levels of pathologic accelerated heart rate. A match between the generated cardiac pacing rate and the contemporaneous hemodynamic needs of the implant patient under conditions of rest and physical activity is optimized by sensing periods of patient physical activity and rest and generating a signal representative thereof to control the cardiac pacing rate accordingly and according to the extent of activity by means of an accelerometer mounted on hybrid electronic circuitry of the device. The pacing rate is optimized by confirmation or no confirmation from the output signal of the accelerometer with a second, complementary sensor electrically coupled to electronic circuitry of the defibrillator.
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Citations
24 Claims
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1. An implantable defibrillator adapted to deliver cardiac pacing, cardioversion and defibrillation therapies in selective response to dysrhythmia detection from an implant patient'"'"'s cardiac signal, the defibrillator comprising:
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a sensor of the patient'"'"'s heart rate;
a cardioverter/defibrillator for producing electrical shocks of adjustable energy level to be applied to the patient'"'"'s heart in response to applicable detected levels of pathologic accelerated heart rate;
a rate controllable generator responsive to a pacing dysrhythmia sensed by said heart rate sensor for generating cardiac pacing pulses at a rate designed to correct said sensed dysrhythmia for application to the patient'"'"'s heart;
an optimizer for matching the cardiac pacing rate of said generator to the hemodynamic needs of the implant patient under conditions of rest and physical activity;
including sensing and distinguishing periods of patient physical activity and rest, and generating a signal representative thereof to control the cardiac pacing rate accordingly as well as according to the extent of activity; and
a processor for processing the control signal generated by the optimizer to enhance sensitivity and specificity thereof by detecting physical activity of the patient and for applying the enhanced processed control signal to said rate controllable generator to appropriately adjust the pacing rate thereof;
said processor including a filter for passing substantially only components of the control signal in a frequency band below approximately 10 Hz;
whereby said defibrillator is adapted to suppress an acceleration of cardiac dysrhythmias by developing and delivering a pacing therapy that matches the patient'"'"'s hemodynamic needs. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8)
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9. An implanted defibrillator device-implemented method of delivering cardiac pacing, cardioversion and defibrillation therapies in selective response to dysrhythmia detection of an implant patient'"'"'s cardiac signal, said method comprising the steps of:
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sensing the patient'"'"'s heart rate;
delivering cardioversion/defibrillation therapies by producing electrical shocks of adjustable energy level for application to the patient'"'"'s heart in response to applicable detected levels of pathologic accelerated heart rate; and
optimizing a match between the generated cardiac pacing rate and the contemporaneous hemodynamic needs of the implant patient under conditions of rest and physical activity;
including sensing periods of patient physical activity and rest and generating a signal representative thereof to control the cardiac pacing rate accordingly and according to the extent of activity by means of an accelerometer mounted onto and integrated within hybrid electronic circuitry.- View Dependent Claims (10, 11, 12, 13, 14)
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15. An implantable medical interventional device for responding to detection of any of a plurality of cardiac dysrhythmias in a human patient by performing an appropriate therapy including cardiac pacing, cardioversion or defibrillation according to the nature of the detected dysrhythmia, said device comprising:
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a first sensor for detecting any of said plurality of cardiac dysrhythmias;
a generator of pacing pulses and electrical shocks for delivery to the patient'"'"'s heart according to whether a detected dysrhythmia is bradycardia or a relatively slow pathologic tachycardia on the one hand, or a relatively fast tachycardia or fibrillation on the other hand; and
an optimizer for substantially matching the patient'"'"'s heart rate to hemodynamic demand under conditions of physical activity and rest of the patient, including;
a second sensor for sensing periods of patient activity and rest as imposing different hemodynamic demands on the patient'"'"'s cardiovascular system, and for producing a signal representative of applicable hemodynamic demand, and a signal processor for said second sensor signal to detect physical activity of the patient and the extent thereof, and for applying the processed signal to said generator to vary the pacing rate to conform to the patient'"'"'s hemodynamic demand. - View Dependent Claims (16, 17, 18, 19, 20)
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21. An implantable defibrillator-implemented method of delivering cardiac pacing, cardioversion and defibrillation therapies in selective response to dysrhythmia detection an implant patient'"'"'s cardiac signal, said method comprising the steps of:
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sensing the patient'"'"'s heart rate;
providing a capability to deliver cardioversion/defibrillation therapies at least partially in the form of electrical shocks of adjustable energy level for application to the patient'"'"'s heart in response to detected extent of pathologic accelerated heart rate; and
optimizing a match between a generated cardiac pacing rate and contemporaneous hemodynamic needs of the implant patient by controlling the cardiac pacing rate according to detected conditions of physical activity and rest, including adapting the pacing rate dependent on said detection, and further reducing the pacing rate under prolonged conditions of physical rest by the patient. - View Dependent Claims (22, 23, 24)
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Specification