Dual-chamber implantable cardiac stimulation system and device with selectable arrhythmia termination electrode configurations and method

• US 6,456,876 B1
• Filed: 02/28/2000
• Issued: 09/24/2002
• Est. Priority Date: 02/28/2000
• Status: Expired due to Term

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories)
• Inventors: Kroll, Mark W.
• Primary Examiner(s): Schaetzle, Kennedy
• Application Number:
  US09/514,737
• Time in Patent Office: 939 Days
• Field of Search: 607/4, 607/5, 607/14, 607/63
• 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 1/39622 Pacing therapy

Abstract

An implantable cardiac stimulation system delivers arrhythmia termination pulses to the ventricles and the atria of a heart. The system includes an implantable cardiac stimulation device, including a conductive enclosure, ventricular arrhythmia termination pulse generator, and an atrial arrhythmia termination pulse generator. A first electrode configuration, including the conductive enclosure, is arranged to be coupled to the ventricular pulse generator to terminate ventricular arrhythmias and a second electrode configuration, electrically independent from the conductive enclosure and confined within the heart, is arranged to be coupled to the atrial pulse generator to terminate atrial arrhythmias.

Claims

1. An implantable cardiac stimulation system for selectively delivering arrhythmia termination pulses to the ventricles and the atria of a patient'"'"'s heart, the system comprising:

an implantable cardiac stimulation device, encapsulated in a conductive enclosure, having a ventricular pulse generator that provides ventricular arrhythmia termination pulses, and an atrial pulse generator that provides atrial arrhythmia termination pulses;

a first electrode configuration, including the conductive enclosure, arranged to be coupled to the ventricular pulse generator, for applying the ventricular arrhythmia termination pulses to the heart;

a second electrode configuration, electrically independent from the conductive enclosure, arranged to be coupled to the atrial pulse generator, for applying the atrial arrhythmia termination pulses to the heart;

wherein the second electrode configuration is one of a plurality of electrode configurations, and wherein the device further Includes an electrode configuration selector that selects the second electrode configuration from among the plurality of electrode configurations; and

wherein the selector selects the second electrode configuration from among the plurality of electrode configurations based upon an arrhythmia terminating characteristic.

2. The system of claim 1 wherein the arrhythmia terminating characteristic is an arrhythmia termination threshold.

3. An implantable cardiac stimulation system for selectively delivering arrhythmia terminating pulses to the ventricles and the atria of a patient'"'"'s heart, the system comprising:

an implantable cardiac stimulation device, encapsulated in a conductive enclosure, having a ventricular pulse generator that provides ventricular arrhythmia terminating pulses, and an atrial pulse generator that provides atrial arrhythmia terminating pulses;

a lead system including a plurality of electrodes defining a first plurality of electrode configurations and a second plurality of electrode configuration, at least one of the first plurality of electrode configurations including the conductive enclosure, and each of the second plurality of electrode configurations being electrically isolated from the conductive enclosure; and

wherein

the implantable cardiac device further includes an electrode configuration selector that couples a selected one of the first plurality of electrode configurations to the ventricular pulse generator and couples a selected one of the second plurality of electrode configurations to the atrial pulse generator.

4. The system of claim 3 wherein:

each one of the first plurality of electrode configurations has a common arrhythmia terminating characteristic; and

wherein

the selector couples the selected one of the first plurality of electrode configurations to the ventricular pulse generator based upon the common arrhythmia terminating characteristic.

5. The system of claim 4 wherein the common arrhythmia terminating characteristic is an arrhythmia termination threshold.

6. The system of claim 3 wherein each one of the second plurality of electrode configurations has a common arrhythmia terminating characteristic, and wherein the selector couples the selected one of the second plurality of electrode configurations to the atrial pulse generator based upon the common arrhythmia terminating characteristic.

7. The system of claim 6 wherein the common arrhythmia terminating characteristic is an arrhythmia termination threshold.

8. The system of claim 3 wherein the atrial arrhythmia termination pulses are rounded to minimize pain to the patient.

9. In an implantable cardiac stimulation device having a conductive housing and an arrhythmia terminating pulse generator, a method of selectively terminating an arrhythmia of the ventricles and atria of a patient'"'"'s heart, the method including the steps

detecting a ventricular arrhythmia of the heart;

coupling a first electrode configuration to the pulse generator when a ventricular arrhythmia is detected, the first electrode configuration including the conductive housing;

triggering the pulse generator to provide a ventricular arrhythmia terminating pulse to the first electrode configuration;

detecting an atrial arrhythmia of the heart;

coupling the pulse generator to a second electrode configuration when an atrial arrhythmia is detected, the second electrode configuration being electrically independent from the conductive housing;

causing the pulse generator to provide an atrial arrhythmia terminating pulse to the second electrode configuration;

wherein the second electrode configuration is one of a plurality of electrode configurations for terminating an arrhythmia of the atria, wherein each electrode configuration of the plurality of electrode configurations has a common arrhythmia termination characteristic; and

wherein

the method further includes the step of selecting the second electrode configuration from among the plurality of electrode configurations based upon the common characteristic.

10. The method of claim 9 wherein the common arrhythmia termination characteristic is a defibrillation threshold.

11. The method of claim 9 wherein the common arrhythmia termination characteristic is a perceived arrhythmia termination discomfort of the patient.

12. The method of claim 9 wherein the atrial arrhythmia termination pulses are rounded to minimize pain to the patient.

13. In an implantable cardiac stimulation device having a conductive enclosure and an arrhythmia terminating pulse generator, a method of terminating an arrhythmia of the ventricles and atria of a patient'"'"'s heart, the method including the steps of:

detecting a ventricular arrhythmia of the heart;

coupling a first electrode configuration of a first plurality of electrode configurations to the pulse generator when a ventricular arrhythmia is detected, the first plurality of electrode configurations having at least one electrode configuration including the conductive enclosure;

triggering the pulse generator to provide a ventricular arrhythmia terminating pulse to the first electrode configuration;

detecting an atrial arrhythmia of the heart;

coupling a second electrode configuration of a second plurality of electrode configurations to the pulse generator when an atrial arrhythmia is detected, each electrode configuration of the second plurality of electrode configurations being electrically independent from the conductive enclosure; and

triggering the pulse generator to provide an atrial arrhythmia terminating pulse to the second electrode configuration.

14. The method of claim 13 wherein:

each electrode configuration of the first plurality of electrode configurations has a common arrhythmia termination characteristic; and

wherein

the method further includes the step of selecting the first electrode configuration from among first plurality of electrode configurations based upon the common characteristic.

15. The method of claim 14 wherein the common arrhythmia termination characteristic is an arrhythmia termination threshold.

16. The method of claim 13 wherein:

each electrode configuration of the second plurality of electrode configurations has a common arrhythmia termination characteristic; and

wherein

the method further includes the further step of selecting the second electrode configuration from among the second plurality of electrode configurations based upon the common characteristic.

17. The method of claim 16 wherein the common arrhythmia termination characteristic is an arrhythmia termination threshold.

18. The method of claim 16 wherein the common arrhythmia termination characteristic is a perceived arrhythmia termination discomfort of the patient.

19. The system of claim 18 wherein:

each one of the second plurality of electrode configurations has a common arrhythmia terminating characteristic; and

wherein

the switch means couples the selected one of the second plurality of electrode configurations to the device means based upon the common arrhythmia terminating characteristic.

20. The system of claim 19 wherein the common arrhythmia terminating characteristic is an arrhythmia termination threshold.

21. An implantable cardiac stimulation system for selectively applying arrhythmia termination pulses to the ventricles and the atria of a patient'"'"'s heart, the system comprising:

implantable cardiac pulse generator means for providing ventricular arrhythmia termination pulses and atrial arrhythmia termination pulses, the pulse generator means being enclosed within a conductive housing;

first electrode means including the conductive housing, for applying the ventricular arrhythmia termination pulses to the heart;

second electrode means, electrically independent from the conductive housing, for applying the atrial arrhythmia termination pulses to the heart;

wherein the second electrode means is one of a plurality of electrode means, and wherein the generator means further includes selector means for selecting the second electrode means from among the plurality of electrode means; and

wherein the selector means includes means for selecting the second electrode means from among the plurality of electrode means responsive to an arrhythmia termination characteristic.

22. The system of claim 21 wherein the arrhythmia termination characteristic is an arrhythmia termination threshold.

23. An implantable cardiac stimulation system for selectively delivering arrhythmia terminating pulses to the ventricles and atria of a patient'"'"'s heart, the system comprising:

implantable device means for providing ventricular arrhythmia terminating pulses and atrial arrhythmia terminating pulses, the device means being housed within a conductive enclosure;

lead means for delivering the ventricular and atrial arrhythmia terminating pulses to the ventricles and atria, respectively, the lead means including a first plurality of electrode configurations and a second plurality of electrode configurations, at least one of the first plurality of electrode configurations including the conductive enclosure, and each one of the second plurality of electrode configurations being electrically isolated from the conductive enclosure; and

the implantable device means further including switch means for coupling a selected one of the first plurality of electrode configurations to the device means for delivering the ventricular arrhythmia terminating pulses and a selected one of the second plurality of electrode configurations to the device means for delivering the atrial arrhythmia terminating pulses.

24. The system of claim 23 wherein:

each one of the first plurality of electrode configurations has a common arrhythmia terminating characteristic; and

wherein

the switch means couples the selected one of the first plurality of electrode configurations the device means based upon the common arrhythmia terminating characteristic.

25. The system of claim 24 wherein the common arrhythmia terminating characteristic is an arrhythmia termination threshold.

26. A dual-chamber cardiac stimulation device for use with a lead system providing a first plurality of electrode configurations to deliver arrhythmia termination pulses to the ventricles of a patient'"'"'s heart and a second plurality of electrode configurations to deliver arrhythmia termination pulses to the atria of the patient'"'"'s heart, the device comprising:

a conductive enclosure;

a pulse generator that provides atrial and ventricular arrhythmia termination pulses;

a detector that detects atrial and ventricular arrhythmias;

a first plurality of terminals, wherein a first pair of the first plurality of terminals are selectively coupled to the pulse generator and adapted for electrical connection to any one of the first plurality of electrode configurations to direct the arrhythmia termination pulses to the ventricles, at least one terminal of the first plurality of terminals being coupled to the conductive enclosure;

a second plurality of terminals, wherein a second pair of the second plurality of terminals are selectively coupled to the pulse generator and adapted for electrical connection to any one of the second plurality of electrode configurations to direct the arrhythmia termination pulses to the atria, each one of the second plurality of terminals being electrically isolated from the conductive enclosure; and

an electrode configuration selector that couples the first pair of terminals to the pulse generator in response to the detection of a ventricular arrhythmia and couples the second pair of terminals to the pulse generator in response to the detection of an atrial arrhythmia.

27. The device of claim 26 wherein the selector couples the second pair of terminals, from among the second plurality of terminals, based upon an arrhythmia terminating characteristic.

28. The device of claim 27 wherein the arrhythmia terminating characteristic is an arrhythmia terminating threshold.

29. A method of terminating an arrhythmia of the ventricles and atria of a patient'"'"'s heart with a single implantable cardiac stimulation device, the method minimizing atrial arrhythmia termination discomfort of the patient while maintaining ventricular arrhythmia termination effectiveness and including the steps of:

detecting a ventricular arrhythmia of the heart;

coupling a ventricular arrhythmia termination electrode configuration to the device when a ventricular arrhythmia is detected, wherein the ventricular arrhythmia termination electrode configuration has at least one electrode external to the heart;

triggering the device to provide a ventricular arrhythmia terminating pulse to the ventricular arrhythmia terminating electrode configuration;

selecting one atrial arrhythmia terminating electrode configuration from among a plurality of atrial arrhythmia terminating electrode configurations based upon an atrial arrhythmia terminating characteristic common to each atrial arrhythmia terminating electrode configuration, wherein each atrial arrhythmia terminating electrode configuration of the plurality of atrial arrhythmia terminating electrode configurations is confined to within the heart to minimize atrial arrhythmia termination discomfort of the patient;

detecting an atrial arrhythmia of the heart;

coupling the selected atrial arrhythmia terminating electrode configuration to the device when an atrial arrhythmia is detected; and

triggering the pulse generator to provide an atrial arrhythmia terminating pulse to the selected atrial arrhythmia terminating electrode configuration.