Method for improving cardiac function following delivery of a defibrillation shock
First Claim
1. A method of reducing the likelihood of onset of pulseless electrical activity after defibrillation in a subject afflicted with a fibrillating heart, said method comprising the steps of:
- administering to a subject afflicted with fibrillation a first treatment waveform, said first treatment waveform insufficient to defibrillate said heart and insufficient to reduce the defibrillation threshold of said subject; and
then administering to said subject a second treatment waveform that defibrillates said heart and restores organized electrical activity in said heart;
with said first treatment waveform reducing the likelihood of onset of pulseless electrical activity following said second treatment waveform as compared to that likelihood which would be present in the absence of said first treatment waveform.
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Accused Products
Abstract
A method of reducing the likelihood of pulseless electrical activity (PEA) after defibrillation in a subject comprises administering to a subject afflicted with fibrillation a first treatment waveform, the first treatment waveform insufficient to defibrillate the heart; and then administering to the subject a second treatment waveform that defibrillates the heart and restores organized electrical activity in the heart. The first treatment waveform reduces the likelihood of onset of PEA following the second treatment waveform, as compared to that likelihood which would be present in the absence of the first treatment waveform.
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Citations
206 Claims
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1. A method of reducing the likelihood of onset of pulseless electrical activity after defibrillation in a subject afflicted with a fibrillating heart, said method comprising the steps of:
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administering to a subject afflicted with fibrillation a first treatment waveform, said first treatment waveform insufficient to defibrillate said heart and insufficient to reduce the defibrillation threshold of said subject; and
thenadministering to said subject a second treatment waveform that defibrillates said heart and restores organized electrical activity in said heart;
with said first treatment waveform reducing the likelihood of onset of pulseless electrical activity following said second treatment waveform as compared to that likelihood which would be present in the absence of said first treatment waveform. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19)
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20. A system for the defibrillation of the heart of a patient in need of such treatment, which system provides reduced likelihood of onset of pulseless electrical activity after defibrillation in a subject afflicted with a fibrillating heart, said system comprising:
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a power supply; and
a controller operatively associated with said power supply, said controller configured for delivering a defibrillation sequence comprising a first treatment waveform, said first treatment waveform insufficient to defibrillate said heart and insufficient to reduce the defibrillation threshold of said subject; and
then a second treatment waveform that defibrillates said heart and restores organized electrical activity in said heart;
with said first treatment waveform reducing the likelihood of onset of pulseless electrical activity following said second treatment waveform as compared to that likelihood which would be present in the absence of said first treatment waveform. - View Dependent Claims (21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38)
a plurality of external electrodes operatively associated with said controller, and wherein said first treatment waveform is administered by external electrodes and has an energy of from about 1 to 400 Joules.
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27. A system according to claim 20, further comprising:
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a plurality of internal electrodes operatively associated with said controller;
and wherein said first treatment waveform is administered by internal electrodes and has an energy of from about 0.1 to 50 Joules.
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28. A system according to claim 20, wherein said controller is configured so that said first treatment waveform and said second treatment waveform are sequential.
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29. A system according to claim 20, wherein said controller is configured so that said second treatment waveform immediately follows said first treatment waveform.
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30. A system according to claim 20, wherein said controller is configured so that said second treatment waveform follows said first treatment waveform by from 1 millisecond to 10 seconds.
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31. A system according to claim 20, wherein said controller is configured so that said first treatment waveform and said second treatment waveform are at least partially interleaved.
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32. A system according to claim 20, wherein said controller is configured so that said first treatment waveform is delivered through the same set of electrodes as said second treatment waveform.
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33. A system according to claim 20, wherein said controller is configured so that said first treatment waveform is delivered through a different set of electrodes as said second treatment waveform.
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34. A system according to claim 20, further comprising at least one cutaneous electrode operatively associated with said controller, and wherein said controller is configured so that said first treatment waveform is delivered by said at least one cutaneous electrode.
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35. A system according to claim 20, further comprising at least one subcutaneous electrode operatively associated with said controller, and wherein said first treatment waveform is delivered by said at least one subcutaneous electrode.
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36. A system according to claim 20, further comprising at least one epicardial electrode operatively associated with said controller, and wherein said first treatment waveform is delivered by at least one epicardial electrode.
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37. A system according to claim 20, further comprising at least one transveneous electrode operatively associated with said controller, and wherein said first treatment waveform is delivered by said at least one transveneous electrode.
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38. A system according to claim 20, further comprising at least one transveneous coronary sinus electrode operatively associated with said controller, and wherein said first treatment waveform is delivered by said at least one transveneous coronary sinus electrode.
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39. A method for the external defibrillation of the heart of a patient afflicted with ventricular fibrillation, comprising the steps of:
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externally administering to said patient a first treatment waveform, said first treatment waveform insufficient to defibrillate said heart and insufficient to reduce the defibrillation threshold of said subject; and
thenexternally administering to said subject a second treatment waveform that defibrillates said heart and restores organized electrical activity in said heart. - View Dependent Claims (40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50)
said first treatment waveform is administered for a time of 0.05 to 10 seconds; and
said second treatment waveform is administered within 5 seconds of said first treatment waveform.
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41. A method according to claim 39, further comprising the step of:
generating a warning signal during said first treatment waveform.
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42. A method according to claim 41, wherein said warning signal comprises an auditory, visual, or tactile signal.
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43. A method according to claim 41, wherein said step of externally administering to said patient a first treatment waveform is preceded by the step of:
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determining the presence or absence of a likelihood of pulseless electrical activity following defibrillation, and wherein;
said step of administering said first treatment waveform is carried out if a likelihood of pulseless electrical activity following defibrillation is determined, and said step of administering said first treatment waveform is eliminated if a likelihood of pulseless electrical activity following defibrillation is not determined.
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44. A method according to claim 41, further comprising the step of generating a warning signal prior to said first treatment waveform.
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45. A method according to claim 41, further comprising the step of generating a warning signal during said second treatment waveform.
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46. A method according to claim 39, wherein said first treatment waveform has an energy of from about 1 to 400 Joules.
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47. A method according to claim 39, wherein said second treatment waveform has an energy of from about 100 to 400 Joules.
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48. A method according to claim 39, wherein said first treatment waveform and said second treatment waveform are sequential.
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49. A method according to claim 41, wherein said second treatment waveform immediately follows said first treatment waveform.
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50. A method according to claim 41, wherein said first treatment waveform and said second treatment waveform are at least partially interleaved.
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51. An external defibrillation system for the external defibrillation of the heart of a patient afflicted with ventricular fibrillation, comprising:
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a power supply; and
a controller operatively associated with said power supply, said controller configured for delivering a defibrillation sequence comprising a first treatment waveform, said first treatment waveform insufficient to defibrillate said heart and insufficient to reduce the defibrillation threshold of said subject; and
then a second treatment waveform that defibrillates said heart and restores organized electrical activity in said heart.- View Dependent Claims (52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62)
said first treatment waveform is administered for a time of 0.05 to 10 seconds; - and
said second treatment waveform is administered within 5 seconds of said first treatment waveform.
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53. A system according to claim 51, further comprising a warning signal generator operatively associated with said controller, and with said controller configured to generate a warning signal during said first treatment waveform.
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54. A system according to claim 53, wherein said warning signal generator is an auditory, visual, or tactile signal generator.
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55. A system according to claim 53, further comprising
means for determining the likelihood of pulseless electrical activity following defibrillation configured so that said step of administering said first treatment waveform is carried out if a likelihood of pulseless electrical activity following defibrillation is determined, and said step of administering said first treatment waveform is eliminated if a likelihood of pulseless electrical activity following defibrillation is not determined. -
56. A system according to claim 53, wherein said controller is configured to generate a warning signal prior to said first treatment waveform.
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57. A system according to claim 53, wherein said controller is configured to generate a warning signal during said second treatment waveform.
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58. A system according to claim 51, wherein said controller is configured so that said first treatment waveform has an energy of from about 1 to 400 Joules.
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59. A system according to claim 51, wherein said controller is configured so that said second treatment waveform has an energy of from about 100 to 400 Joules.
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60. A system according to claim 51, wherein said controller is configured so that said first treatment waveform and said second treatment waveform are sequential.
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61. A system according to claim 51, wherein said controller is configured so that said second treatment waveform immediately follows said first treatment waveform.
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62. A system according to claim 51, wherein said controller is configured so that said first treatment waveform and said second treatment waveform are at least partially interleaved.
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63. A method of reducing the likelihood of onset of pulseless electrical activity after defibrillation with an implantable defibrillator in a subject afflicted with a fibrillating heart, said method comprising the steps of:
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administering to a subject afflicted with fibrillation a first treatment waveform, said first treatment waveform insufficient to defibrillate said heart and insufficient to reduce the defibrillation threshold of said subject; and
thenadministering to said subject a second treatment waveform that defibrillates said heart and restores organized electrical activity in said heart;
with said first treatment waveform reducing the likelihood of onset of pulseless electrical activity following said second treatment waveform as compared to that likelihood which would be present in the absence of said first treatment waveform. - View Dependent Claims (64, 65, 66, 67, 68, 69, 70, 71, 72)
said first electrode selected from the group consisting of right ventricle, superior vena cava, and right atrium electrodes; and
said second electrode selected from the group consisting of thoracic, superior vena cava, left ventricle, coronary sinus, left ventricle vein electrodes and left and right ventricle junction vein electrodes.
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67. A method according to claim 63, wherein said second treatment waveform is delivered between at least a first electrode and second electrode;
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said first electrode selected from the group consisting of right ventricle, superior vena cava, and right atrium electrodes; and
said second electrode selected from the group consisting of thoracic, superior vena cava, left ventricle, coronary sinus, left ventricle vein electrodes, and left and right ventricle junction electrodes.
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68. A method according to claim 63, wherein said first treatment waveform has an energy of from about 0.1 to 50 Joules.
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69. A method according to claim 63, wherein said second treatment waveform has an energy of from about 1 to 50 Joules.
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70. A method according to claim 63, wherein said first treatment waveform and said second treatment waveform are sequential.
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71. A method according to claim 63, wherein said second treatment waveform immediately follows said first treatment waveform.
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72. A method according to claim 63, wherein said first treatment waveform and said second treatment waveform are at least partially interleaved.
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73. An implantable defibrillator for defibrillating the heart of a subject in need thereof, comprising:
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a power supply; and
a controller operatively associated with said power supply, said controller configured for delivering a defibrillation sequence comprising a first treatment waveform, said first treatment waveform insufficient to defibrillate said heart and insufficient to reduce the defibrillation threshold of said subject; and
then a second treatment waveform that defibrillates said heart and restores organized electrical activity in said heart;
with said first treatment waveform reducing the likelihood of onset of pulseless electrical activity following said second treatment waveform as compared to that likelihood which would be present in the absence of said first treatment waveform.- View Dependent Claims (74, 75, 76, 77, 78, 79, 80, 81, 82, 84)
said first electrode selected from the group consisting of right ventricle, superior vena cava, and right atrium electrodes; and
said second electrode selected from the group consisting of thoracic, superior vena cava, left ventricle, coronary sinus, left ventricle vein electrodes, and left and right ventricle junction vein electrodes.
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77. A system according to claim 73, further comprising at least a first electrode and a second electrode, and wherein said controller is configured so that said second treatment waveform is delivered between said first electrode and second electrode;
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said first electrode selected from the group consisting of right ventricle, superior vena cava, and right atrium electrodes; and
said second electrode selected from the group consisting of thoracic, superior vena cava, left ventricle, coronary sinus, left ventricle vein electrodes, and left and right ventricle junction vein electrodes.
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78. A system according to claim 73, said controller configured so that said first treatment waveform has an energy of from about 0.1 to 50 Joules.
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79. A system according to claim 73, said controller configured so that said second treatment waveform has an energy of from about 1 to 50 Joules.
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80. A system according to claim 73, said controller configured so that said first treatment waveform and said second treatment waveform are sequential.
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81. A system according to claim 73, said controller configured so that said second treatment waveform immediately follows said first treatment waveform.
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82. A system according to claim 73, said controller configured so that said first treatment waveform and said second treatment waveform are at least partially interleaved.
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84. A system according to claim 81, said controller configured so that
said first treatment waveform is administered for a time of 0.05 to 10 seconds; - and
said second treatment waveform is administered within 5 seconds of said first treatment waveform.
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83. A defibrillation system for the defibrillation of the heart of a patient afflicted with ventricular fibrillation, comprising:
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a detector for detecting electrical activity from the heart of said patient during ventricular fibrillation;
a power supply;
a signal analyzer for determining the likelihood of pulseless electrical activity in said patient after delivery of a defibrillation treatment waveform to said patient; and
a controller operatively associated with said detector, said power supply and said signal analyzer, said controller configured for delivering a defibrillation sequence, said defibrillation sequence optionally comprising a first treatment waveform, said first treatment waveform insufficient to defibrillate said heart, and then delivering a second treatment waveform that defibrillates said heart and restores organized electrical activity in said heart;
and wherein said first treatment waveform is delivered when a high likelihood of pulseless electrical activity after defibrillation is determined, and said first treatment waveform is not delivered when a low likelihood of pulseless electrical activity after defibrillation is determined. - View Dependent Claims (85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111)
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112. A system for defibrillation of the heart of a patient afflicted with ventricular fibrillation, comprising:
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a detector for detecting electrical activity from the heart of said patient during ventricular fibrillation;
a power supply;
a controller operatively associated with said detector and said power supply, said controller configured for delivering a defibrillation sequence, said defibrillation sequence optionally comprising a first treatment waveform, said first treatment waveform insufficient to defibrillate said heart, and then delivering a second treatment waveform that defibrillates said heart and restores organized electrical activity in said heart;
and wherein said first treatment waveform is delivered when a high likelihood of pulseless electrical activity after defibrillation is determined, and said first treatment waveform is not delivered when a low likelihood of pulseless electrical activity after defibrillation is determined. - View Dependent Claims (113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 125, 126, 127, 128, 129, 130, 131, 132, 133)
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134. A method for the external defibrillation of the heart of a patient afflicted with ventricular fibrillation, comprising the steps of:
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externally administering to said patient a first treatment waveform, said first treatment waveform insufficient to defibrillate said heart; and
externally administering to said subject a second treatment waveform that defibrillates said heart and restores organized electrical activity to said heart;
wherein said first treatment waveform is administered when a high likelihood of pulseless electrical activity after defibrillation is determined, and said first treatment waveform is not administered when a low likelihood of pulseless electrical activity after defibrillation is determined. - View Dependent Claims (135, 136, 137, 138, 139, 140, 141, 142, 143, 144, 145, 146, 147, 148, 149, 150, 151, 152, 153, 154)
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155. A method of reducing the likelihood of onset of pulseless electrical activity after defibrillation in a subject afflicted with a fibrillating heart, said method comprising the steps of:
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determining a likelihood of pulseless electrical activity following defibrillation of said heart;
if the likelihood of pulseless electrical activity above a predetermined amount, administering to a subject afflicted with fibrillation a first treatment waveform, said first treatment waveform insufficient to defibrillate said heart; and
thenadministering to said subject a second treatment waveform that defibrillates said heart and restores organized electrical activity in said heart;
with said first treatment waveform reducing the likelihood of onset of pulseless electrical activity following said second treatment waveform as compared to that likelihood which would be present in the absence of said first treatment waveform. - View Dependent Claims (156, 157, 158, 159, 160, 161, 162, 163, 164, 165, 166, 167, 168, 169, 170, 171, 172, 173, 174, 175, 176, 177, 178, 179, 180)
assessing the viability of said heart.
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157. A method according to claim 156, wherein the step of assessing the viability of said heart further comprises:
analyzing a waveform of said heart during ventricular fibrillation.
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158. A method according to claim 156, wherein the step of assessing the viability of said heart further comprises:
analyzing a waveform of said heart during ventricular fibrillation as a function of the duration the patient has been in ventricular fibrillation.
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159. A method according to claim 156, wherein the step of assessing the viability of said heart further comprises:
analyzing a waveform of said heart during ventricular fibrillation as a function of physiological measurements indicative of blood flow.
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160. A method according to claim 156, wherein the step of assessing the viability of said heart further comprises:
analyzing a waveform of said heart during ventricular fibrillation as a function of cardiac motion.
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161. A method according to claim 156, wherein the step of assessing the viability of said heart further comprises:
analyzing a waveform of said heart during ventricular fibrillation as a function of user inputs.
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162. A method according to claim 155, wherein said fibrillation is ventricular fibrillation.
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163. A method according to claim 155, wherein said first treatment waveform comprises a single electrical pulse.
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164. A method according to claim 155, wherein said first treatment waveform comprises a series of electrical pulses.
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165. A method according to claim 155, wherein said first treatment waveform is insufficient to reduce the defibrillation threshold of said subject.
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166. A method according to claim 155, wherein said second treatment waveform comprises a single electrical pulse.
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167. A method according to claim 155, wherein said second treatment waveform comprises a series of electrical pulses.
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168. A method according to claim 155, wherein said first treatment waveform is administered by external electrodes and has an energy of from about 1 to 400 Joules.
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169. A method according to claim 155, wherein said first treatment waveform is administered by internal electrodes and has an energy of from about 0.1 to 50 Joules.
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170. A method according to claim 155, wherein said first treatment waveform and said second treatment waveform are sequential.
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171. A method according to claim 155, wherein said second treatment waveform immediately follows said first treatment waveform.
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172. A method according to claim 155, wherein said second treatment waveform follows said first treatment waveform by from 1 millisecond to 10 seconds.
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173. A method according to claim 155, wherein said first treatment waveform and said second treatment waveform are at least partially interleaved.
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174. A method according to claim 155, wherein said first treatment waveform is delivered through the same set of electrodes as said second treatment waveform.
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175. A method according to claim 155, wherein said first treatment waveform is delivered through a different set of electrodes as said second treatment waveform.
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176. A method according to claim 155, wherein said first treatment waveform is delivered by at least one cutaneous electrode.
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177. A method according to claim 155, wherein said first treatment waveform is delivered by at least one subcutaneous electrode.
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178. A method according to claim 155, wherein said first treatment waveform is delivered by at least one epicardial electrode.
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179. A method according to claim 155, wherein said first treatment waveform is delivered by at least one transveneous electrode.
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180. A method according to claim 155, wherein said first treatment waveform is delivered by at least one transveneous coronary sinus electrode positioned in the coronary sinus or a cardiac vein.
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181. A system for the defibrillation of the heart of a patient in need of such treatment, which system provides reduced likelihood of onset of pulseless electrical activity after defibrillation in a subject afflicted with a fibrillating heart, said system comprising:
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a power supply; and
a controller operatively associated with said power supply, said controller configured for determining a likelihood of pulseless electrical activity following defibrillation of said heart in a subject afflicted with fibrillation, and, if the likelihood of pulseless electrical activity above a predetermined amount, delivering a defibrillation sequence comprising a first treatment waveform, said first treatment waveform insufficient to defibrillate said heart; and
then a second treatment waveform that defibrillates said heart and restores organized electrical activity in said heart;
with said first treatment waveform reducing the likelihood of onset of pulseless electrical activity following said second treatment waveform as compared to that likelihood which would be present in the absence of said first treatment waveform. - View Dependent Claims (182, 183, 184, 185, 186, 187, 188, 189, 190, 191, 192, 193, 194, 195, 196, 197, 198, 199, 200, 201, 202, 203, 204, 205, 206)
a plurality of external electrodes operatively associated with said controller, and wherein said first treatment waveform is administered by external electrodes and has an energy of from about 1 to 400 Joules.
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195. A system according to claim 181, further comprising:
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a plurality of internal electrodes operatively associated with said controller;
and wherein said first treatment waveform is administered by internal electrodes and has an energy of from about 0.1 to 50 Joules.
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196. A system according to claim 181, wherein said controller is configured so that said first treatment waveform and said second treatment waveform are sequential.
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197. A system according to claim 181, wherein said controller is configured so that said second treatment waveform immediately follows said first treatment waveform.
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198. A system according to claim 181, wherein said controller is configured so that said second treatment waveform follows said first treatment waveform by from 1 millisecond to 10 seconds.
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199. A system according to claim 181, wherein said controller is configured so that said first treatment waveform and said second treatment waveform are at least partially interleaved.
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200. A system according to claim 181, wherein said controller is configured so that said first treatment waveform is delivered through the same set of electrodes as said second treatment waveform.
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201. A system according to claim 181, wherein said controller is configured so that said first treatment waveform is delivered through a different set of electrodes as said second treatment waveform.
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202. A system according to claim 181, further comprising at least one cutaneous electrode operatively associated with said controller, and wherein said controller is configured so that said first treatment waveform is delivered by said at least one cutaneous electrode.
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203. A system according to claim 181, further comprising at least one subcutaneous electrode operatively associated with said controller, and wherein said first treatment waveform is delivered by said at least one subcutaneous electrode.
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204. A system according to claim 181, further comprising at least one epicardial electrode operatively associated with said controller, and wherein said first treatment waveform is delivered by at least one epicardial electrode.
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205. A system according to claim 181, further comprising at least one transveneous electrode operatively associated with said controller, and wherein said first treatment waveform is delivered by said at least one transveneous electrode.
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206. A system according to claim 181, further comprising at least one transveneous coronary sinus electrode operatively associated with said controller, and wherein said first treatment waveform is delivered by said at least one transveneous coronary sinus electrode.
Specification