Method and apparatus for dual chamber bi-ventricular pacing and defibrillation
First Claim
1. An implantable medical interventional device adapted to provide therapy to a patient to treat cardiac dysrhythmias, said device comprising a pulse generator and a shock generator for providing a plurality of functions corresponding to different levels of therapy including pulse, low energy and high energy shock waveforms configured to terminate respective dysrhythmias;
- said pulse generator adapted for pacing the patient'"'"'s heart by generating stimulating electrical pulses therefor; and
a pair of thin leads dimensioned for insertion respectively into the left and right ventricles of the patient'"'"'s heart when said device is implanted, said pair of thin leads being coupled to said pulse generator and said pulse generator being adapted to energize said pair of thin leads in unison for simultaneous application of said stimulating electrical pulses to the left and right ventricles when said pair of thin leads are inserted respectively therein, each of said leads including a respective electrode adapted to be positioned in stimulating relation to cardiac tissue in a respective one of said ventricles when said leads are inserted therein and, when said leads are energized in unison by said pulse generator, to simultaneously pace said left and right ventricles;
the lead dimensioned for insertion into the left ventricle having an insulative sheath composed of a material of low thrombogenicity and coated at least in part with a biodegradable material to inhibit thrombus formation on the respective lead.
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Abstract
Device and method are disclosed in which leads with pacing and defibrillating electrodes are implanted into both the right and left ventricles of a patient'"'"'s heart to enable simultaneous pacing of both ventricles to reduce the width of the QRS complex of the patient'"'"'s cardiac activity to a more normal duration, and, when appropriate, to apply electrical shock waveforms to both ventricles simultaneously for lower energy defibrillation of the ventricles. In applying the defibrillation therapy, the defibrillating electrode in the left ventricle may be used as the anode and the defibrillating electrode in the right ventricle may be used as the cathode, or both ventricular defibrillating electrodes may be the anode and the metal case in which the shock waveform generator is implanted may be the cathode. Implanting a lead with pacing and defibrillating electrodes in the right atrium enables selective pacing and defibrillation of the atria, in which atrial fibrillation is treated by applying the shock waveform across the right atrial and left ventricular defibrillation electrodes.
133 Citations
33 Claims
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1. An implantable medical interventional device adapted to provide therapy to a patient to treat cardiac dysrhythmias, said device comprising a pulse generator and a shock generator for providing a plurality of functions corresponding to different levels of therapy including pulse, low energy and high energy shock waveforms configured to terminate respective dysrhythmias;
- said pulse generator adapted for pacing the patient'"'"'s heart by generating stimulating electrical pulses therefor; and
a pair of thin leads dimensioned for insertion respectively into the left and right ventricles of the patient'"'"'s heart when said device is implanted, said pair of thin leads being coupled to said pulse generator and said pulse generator being adapted to energize said pair of thin leads in unison for simultaneous application of said stimulating electrical pulses to the left and right ventricles when said pair of thin leads are inserted respectively therein, each of said leads including a respective electrode adapted to be positioned in stimulating relation to cardiac tissue in a respective one of said ventricles when said leads are inserted therein and, when said leads are energized in unison by said pulse generator, to simultaneously pace said left and right ventricles;
the lead dimensioned for insertion into the left ventricle having an insulative sheath composed of a material of low thrombogenicity and coated at least in part with a biodegradable material to inhibit thrombus formation on the respective lead. - View Dependent Claims (2, 3, 4, 5, 6)
- said pulse generator adapted for pacing the patient'"'"'s heart by generating stimulating electrical pulses therefor; and
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7. An implantable medical interventional device adapted to provide therapy to a patient to treat cardiac dysrhythmias, said device comprising a pulse generator and a shock generator for providing a plurality of functions corresponding to different levels of therapy including pulse, low energy and high energy shock waveforms configured to terminate respective dysrhythmias;
- said pulse generator adapted for pacing the patient'"'"'s heart by generating stimulating electrical pulses therefor; and
a pair of thin leads dimensioned for insertion respectively into the left and right ventricles of the patient'"'"'s heart when said device is implanted, said pair of thin leads being coupled to said pulse generator and said pulse generator being adapted to energize said pair of thin leads in unison for simultaneous application of said stimulating electrical pulses to the left and right ventricles when said pair of thin leads are inserted respectively therein, each of said leads including a respective electrode adapted to be positioned in stimulating relation to cardiac tissue in a respective one of said ventricles when said leads are inserted therein and, when said leads are energized in unison by said pulse generator, to simultaneously pace said left and right ventricles;
said shock generator being adapted for defibrillating the patient'"'"'s heart by generating higher voltage electrical shock waveforms therefor; and
each of said pair of leads further including a defibrillation coil coupled to said shock generator and adapted to be positioned within a respective one of said ventricles and, when energized by said shock generator, for applying an electrical shock waveform to establish a substantially homogeneous electric field of sufficient electrical energy in the ventricles for defibrillation thereof. - View Dependent Claims (8, 9, 10)
- said pulse generator adapted for pacing the patient'"'"'s heart by generating stimulating electrical pulses therefor; and
- 11. An implantable defibrillator, comprising a shock generator for generating electrical shock waveforms, a right ventricular lead including a defibrillation electrode coupled to said shock generator and adapted to be positioned in the right ventricle of a patient'"'"'s heart for delivery of electrical shock waveforms thereto, a left ventricular lead including a defibrillation electrode coupled to said shock generator and adapted to be positioned in the left ventricle of the patient'"'"'s heart for delivery of electrical shock waveforms thereto, and means for selectively applying said electrical shock waveforms of predetermined energy content simultaneously to said right and left ventricular defibrillation electrodes to establish a substantially homogeneous electric field distribution in the ventricles for defibrillation thereof.
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15. A device-implemented method of treating cardiac dysrhythmias with an implantable medical interventional device adapted to deliver therapy to an implant patient, wherein the device possesses the capability to provide at least pacing therapy to the patient'"'"'s heart, said method including the steps of:
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sensing a need for ventricular pacing; and
responding to said sensed need by delivering pacing pulses simultaneously to both ventricles of the patient'"'"'s heart; and
wherein said device possesses the capability to provide a plurality of functions corresponding to different therapies for treatment of dysrhythmias, and further including the steps of; sensing ventricular fibrillation; and
responding to said sensed ventricular fibrillation by delivering an electrical shock waveform simultaneously to both ventricles of the patient'"'"'s heart to establish an electric field of relatively uniform distribution and sufficient electrical energy simultaneously in the ventricles for defibrillation thereof. - View Dependent Claims (16, 17, 18)
delivering sense signals indicative of ventricular fibrillation to said device from separate right and left ventricular leads coupled thereto, and delivering electrical shock waveforms simultaneously to said right and left ventricular leads from a shock generator of said device. -
17. The device-implemented method of claim 15, further including the steps of:
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sensing atrial fibrillation; and
responding to said sensed atrial fibrillation by delivering an electrical shock waveform between the right atrium and selectively either of the right and left ventricles of the patient'"'"'s heart to establish an electric field of sufficient electrical energy through the atrium for defibrillation thereof.
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18. The device-implemented method of claim 15, including
delivering sense signals indicative of ventricular fibrillation to said device from separate right and left ventricular leads coupled thereto, delivering sense signals indicative of atrial fibrillation to said device from a right atrial lead coupled thereto, and delivering electrical shock waveforms from a shock generator of said device to said right atrial lead and said right and left ventricular leads as necessary for defibrillation.
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19. An implantable medical interventional device adapted to provide therapy to a patient to treat cardiac dysrhythmias, said device comprising therapy-providing apparatus responsive to different types of dysrhythmia for providing a level of therapy appropriate respectively thereto, including electrical pulse and shock waveforms of sufficiently high energy content to pace and defibrillate respectively;
- and therapy-application apparatus for application of therapy simultaneously to both ventricles of the patient'"'"'s heart, including a right ventricular lead and a left ventricular lead each including a pacing electrode and a defibrillating electrode separately coupled to said therapy-providing apparatus.
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20. A method for providing a patient with an implanted medical interventional device to treat cardiac dysrhythmias, wherein the device performs a plurality of functions corresponding to different levels of therapy for treatment of different types of dysrhythmias, and responds to each different type of dysrhythmia to generate any of a plurality of electrical waveform therapies, including at least electrical pulse and shock waveform therapies, appropriate to terminate the respective sensed dysrhythmia, the method comprising the steps of implanting said device in the patient, implanting an electrical lead in the patient that includes an electrode for delivering at least one of said pulse and shock waveform therapies from the device in each of the right and left ventricles of the patient'"'"'s heart, and electrically connecting each lead to said device to enable said electrode thereof to receive at least one of the therapies;
- and prior to implanting the lead, the step of coating at least a portion of the electrical lead to be implanted in the left ventricle with a biodegradable carrier impregnated with a thrombus inhibitor adapted to be time-released into blood in the locality of said portion of the lead in the left ventricle during disintegration of said carrier, to avoid embolization of a thrombus thereat.
- View Dependent Claims (21, 22)
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23. A method for providing a patient with an implanted medical interventional device to treat cardiac dysrhythmias, wherein the device performs a plurality of functions corresponding to different levels of therapy for treatment of different types of dysrhythmias, and responds to each different type of dysrhythmia to generate any of a plurality of electrical waveform therapies, including at least electrical pulse and shock waveform therapies, appropriate to terminate the respective sensed dysrhythmia, the method comprising the steps of implanting said device in the patient, implanting an electrical lead that includes an electrode for delivering at least one of said pulse and shock waveform therapies from the device in each of the right and left ventricles of the patient'"'"'s heart, and electrically connecting each lead to said device to enable said electrode thereof to receive at least one of the therapies;
- and, wherein the step of implanting the electrical lead in the left ventricle includes puncturing one of the subclavian and brachiocephalic arteries, inserting the lead through the puncture, and advancing the lead through the aortic valve into the left ventricle until said electrode is properly located therein.
- View Dependent Claims (24, 25, 26, 27, 28, 29, 30, 31, 32)
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33. A method for providing therapy to a patient from a medical interventional device adapted to be implanted to treat cardiac dysrhythmias, comprising the steps of simultaneously stimulating the right and left ventricles of the patient'"'"'s heart to perform ventricular pacing for enhancing hemodynamics, and defibrillating the heart by applying electrical defibrillation shocks to a point in the left ventricle to terminate ventricular fibrillation.
Specification