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
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.
1 Assignment
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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
148 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
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, 20)
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21. 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
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 (22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40)
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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29. A system according to claim 21, 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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30. A system according to claim 21, wherein said controller is configured so that said first treatment waveform and said second treatment waveform are sequential.
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31. A system according to claim 21, wherein said controller is configured so that said second treatment waveform immediately follows said first treatment waveform.
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32. A system according to claim 21, 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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33. A system according to claim 21, 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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34. A system according to claim 21, 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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35. A system according to claim 21, 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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36. A system according to claim 21, 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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37. A system according to claim 21, 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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38. A system according to claim 21, futher 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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39. system according to claim 21, 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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40. A system according to claim 21, 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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41. 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
thenexternally administering to said subject a second treatment waveform that defibrillates said heart and restores organized electrical activity in said heart;
wherein said first treatment waveform has an energy of from about 1 to about 400 Joules. - View Dependent Claims (42, 43, 44, 45, 46, 47, 48, 49)
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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43. A method according to claim 41, further comprising the steps of:
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optionally generating a warning signal prior to said first treatment waveform;
thengenerating a warning signal during said first treatment waveform, and then optionally generating a warning signal during said second treatment waveform.
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44. A method according to claim 43, wherein said warning signal comprises an auditory, visual, or tactile signal.
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45. A method according to claim 43, 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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46. A method according to claim 41, wherein said second treatment waveform has an energy of from about 100 to 400 Joules.
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47. A method according to claim 41, wherein said first treatment waveform and said second treatment waveform are sequential.
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48. A method according to claim 41, wherein said second treatment waveform immediately follows said first treatment waveform.
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49. 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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50. 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 having an energy from about 1 to 400 Joules; and
then a second treatment waveform that defibrillates said heart and restores organized electrical activity in said heart.- View Dependent Claims (51, 52, 53, 54, 55, 56, 57, 58)
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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52. A system according to claim 50, further comprising a warning signal generator operatively associated with said controller, and with said controller configured to:
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optionally generating a warning signal prior to said first treatment waveform;
thengenerating a warning signal during said first treatment waveform, and then optionally generating a warning signal during said second treatment waveform.
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53. A system according to claim 52, wherein said warning signal generator is an auditory, visual, or tactile signal generator.
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54. A system according to claim 52, 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. -
55. A system according to claim 50, 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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56. A system according to claim 50, wherein said controller is configured so that said first treatment waveform and said second treatment waveform are sequential.
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57. A system according to claim 50, wherein said controller is configured so that said second treatment waveform immediately follows said first treatment waveform.
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58. A system according to claim 50, 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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59. 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
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 (60, 61, 62, 63, 64, 65, 66, 67, 68)
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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63. A method according to claim 59, 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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64. A method according to claim 59, wherein said first treatment waveform has an energy of from about 0.1 to 50 Joules.
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65. A method according to claim 59, wherein said second treatment waveform has an energy of from about 1 to 50 Joules.
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66. A method according to claim 59, wherein said first treatment waveform and said second treatment waveform are sequential.
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67. A method according to claim 59, wherein said second treatment waveform immediately follows said first treatment waveform.
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68. A method according to claim 59, wherein said first treatment waveform and said second treatment waveform are at least partially interleaved.
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69. An implantable defibrillator for defibrillating the heart of a subject in need therof, 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
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 (70, 71, 72, 73, 74, 75, 76, 77, 78)
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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73. A system according to claim 69, 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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74. A system according to claim 69, said controller configured so that said first treatment waveform has an energy of from about 0.1 to 50 Joules.
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75. A system according to claim 69, said controller configured so that said second treatment waveform has an energy of from about 1 to 50 Joules.
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76. A system according to claim 69, said controller configured so that said first treatment waveform and said second treatment waveform are sequential.
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77. A system according to claim 69, said controller configured so that said second treatment waveform immediately follows said first treatment waveform.
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78. A system according to claim 69, said controller configured so that said first treatment waveform and said second treatment waveform are at least partially interleaved.
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79. 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 (80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105)
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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81. A system according to claim 79, further comprising a user interface operatively associated with said controller, and with said controller confignred to:
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optionally generating a warning signal prior to said first treatment waveform;
thengenerating a warning signal during said first treatment waveform, and then optionally generating a warning signal during said second treatment waveform.
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82. A system according to claim 81, wherein said warning signal is an auditory, visual, or tactile signal.
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83. A system according to claim 81, wherein said defibrillator is an external defibrillator.
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84. A system according to claim 79, 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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85. A system according to claim 79, 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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86. A system according to claim 79, wherein said controller is configured so that said first treatment waveform and said second treatment waveform are sequential.
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87. A system according to claim 79, wherein said controller is configured so that said second treatment waveform immediately follows said first treatment waveform.
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88. A system according to claim 79, 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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89. A system according to claim 79, wherein said signal analyzer determines the likelihood of pulseless electrical activity by determining a viability index associated with the viability of the heart.
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90. A system according to claim 89, wherein said first treatment waveform is delivered when the viability index indicates a high likelihood of pulseless electrical activity.
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91. A system according to claim 90, wherein the viability index is determined based on the duration for which the patient is in ventricular fibrillation.
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92. A system according to claim 90, wherein the viability index is determined based on an analysis of the patient waveform during ventricular fibrillation.
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93. A system according to claim 92, wherein the analysis of the patient waveform produces a power spectrum of the patient waveform.
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94. A system according to claim 92, wherein the analysis of the patient waveform produces a scaling structure of the patient waveform.
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95. A system according to claim 92, wherein the analysis of the patient waveform produces an amplitude and frequency of the patient waveform.
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96. A system according to claim 92, wherein the analysis of the patient waveform produces a median frequency of the patient waveform.
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97. A system according to claim 92, wherein the analysis of the patient waveform produces a centroid frequency of the patient waveform.
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98. A system according to claim 92, wherein the analysis of the patient waveform produces a combination of at least two of a power spectrum, a scaling structure, an amplitude and frequency, a median frequency and a centroid frequency of the patient waveform.
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99. A system according to claim 90, wherein the viability index is determined based on cardiac motion of the patient'"'"'s heart.
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100. A system according to claim 90, wherein the viability index is determined based on user input.
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101. A system according to claim 90, wherein the viability index is determined based on physiological measurements indicative of blood flow.
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102. A system according to claim 101, wherein the physiological measurements are electrical measurements.
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103. A system according to claim 101, wherein the physiological measurements are physical measurements.
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104. A system according to claim 101, wherein the physiological measurements are chemical measurements.
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105. A system according to claim 101, wherein the physiological measurements are a combination of at least two of electrical measurements, physical measurements are chemical measurements.
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106. 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 (107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 125, 126, 127)
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128. 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 (129, 130, 131, 132, 133, 134, 135, 136, 137, 138, 139, 140, 141, 142, 143, 144, 145, 146, 147, 148)
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Specification