Combined anti-tachycardia pacing (ATP) and high voltage therapy for treating ventricular arrhythmias

• US 6,892,094 B2
• Filed: 04/30/2002
• Issued: 05/10/2005
• Est. Priority Date: 04/30/2002
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Krause, Paul G., Sharma, Vinod, DeGroot, Paul J., Olson, Walter H., Ousdigian, Kevin T., Kaszas, Cameron J., Padmanabhan, Vasant
• Primary Examiner(s): Layno, Carl H.
• Application Number:
  US10/137,517
• Publication Number:
  US 20030204210A1
• Time in Patent Office: 1,106 Days
• Field of Search: 607 4- 5, 607/7
• US Class Current: 607/4
• CPC Class Codes: A61N 1/39622 Pacing therapy
• CPC Class Codes: A61N 1/3987 characterised by the timing or triggering of the shock

Abstract

A system and method for treating an arrhythmia of the heart, involves delivery of anti-tachy pacing (ATP) pulses to the heart, possibly followed by the delivery of a high-voltage shock. ATP delivery is controlled such that the time delivery of any high-voltage shock is not affected by the prior delivery of the ATP pulses. System control may be accomplished using one or more programmable parameters, which may include a user-specified shock energy.

Claims

1. A system for treating an arrhythmia of a heart, comprising:

a first output circuit to deliver anti-tachy pacing (ATP) pulses to the heart;

a second output circuit to deliver a high-voltage shock; and

a control circuit coupled to the first and second output circuits to control delivery of the ATP pulses relative to delivery of the high-voltage shock based on an adjustable parameter, wherein the control circuit includes a circuit to prevent delivery of ATP pulses from impacting a time of delivery of the high-voltage shock and a circuit to control delivery of ATP pulses based on a programmed energy level of the high-voltage shock.

2. The system of claim 1, wherein the second output circuit includes at least one capacitor, and wherein the control circuit includes means for calculating a time required to charge the at least one capacitor based on the programmed energy level of the high-voltage shock.

3. The system of claim 2, wherein the second output circuit includes a battery, and wherein the control circuit includes means for adjusting the estimated time required to charge the at least one capacitor based on life of the battery.

4. The system of claim 3, wherein the control circuit includes means for controlling a length of time for delivering ATP pulses based on the time required to charge the at least one capacitor.

5. The system of claim 1, wherein the control circuit includes means for controlling delivery of the ATP pulses based on a first parameter that determines the amount of time for delivering the ATP pulses.

6. The system of claim 5, wherein the control circuit includes means for controlling delivery of the ATP pulses based on a second parameter that determines an amount of time for determining whether the arrhythmia terminated.

7. The system of claim 6, wherein the control circuit includes means for disabling delivery of the ATP pulses if the sum of the first parameter and the second parameter are greater than the time required to charge the at least one capacitor.

8. The system of claim 6, wherein at least one of the first parameter and the second parameter is programmable.

9. The system of claim 1, wherein the control circuit includes confirming means for detecting whether the arrhythmia has terminated, and wherein the confirming means begins detection prior to the at least one capacitor being charged to the programmed energy level.

10. The system of claim 1, wherein the control circuit includes confirming means for detecting whether the arrhythmia has terminated, and wherein the confirming means performs detection after the at least one capacitor is charged to the programmed energy level.

11. The system of claim 9, wherein the control circuit includes means for synchronizing the second output circuit to deliver a high-voltage shock synchronized with cycles of the heart, and wherein at least a portion of the synchronizing is performed at the same time the confirming means is performing detection.

12. The system of claim 10, wherein the control circuit includes means for synchronizing the second output circuit to deliver a high-voltage shock synchronized with cycles of the heart, and wherein at least a portion of the synchronizing is performed at the same time the confirming means is performing detection.

13. A system for treating an arrhythmia of a heart, comprising:

a first output circuit to deliver anti-tachy pacing (ATP) pulses to the heart;

a second output circuit to deliver a high-voltage shock; and

a control circuit coupled to the first and second output circuits to control delivery of the ATP pulses relative to delivery of the high-voltage shock based on an adjustable parameter, wherein the control circuit includes a circuit to prevent delivery of ATP pulses from impacting a time of delivery of the high-voltage shock, and wherein the control circuit includes means for synchronizing the second output circuit to deliver a high-voltage shock synchronized with cycles of the heart, and wherein the control circuit includes means for controlling delivery of the high-voltage shock based on a programmable Time_to_Shock parameter that determines a period of time substantially from detection of the arrhythmia to a time the synchronizing is initiated.

14. A method of treating an arrhythmia of the heart, comprising:

a.) detecting the arrhythmia;

b.) controlling delivery of anti-tachy pacing (ATP) pulses to the heart based on at least one programmable parameter; and

c.) controlling delivery of a high-voltage shock to the heart based on the at least one programmable parameter in a manner that ensures that a time of delivery of the high-voltage shock is unaffected by the delivery of the ATP pulses, wherein step b.) includes controlling delivery of ATP pulses based on a programmed shock energy of the high-voltage shock.

15. The method of claim 14, wherein step b.) includes using a programmed shock energy to determine a capacitor charging time.

16. The method of claim 14, wherein step b.) includes controlling delivery of the ATP pulses based, at least in part, on a first parameter indicating time available for the delivery of the ATP pulses.

17. The method of claim 16, wherein step b.) includes controlling the delivery of the ATP pulses based, at least in part, on a second parameter indicating a time period for confirming whether the arrhythmia was terminated.

18. The method of claim 17, wherein the delivery of the ATP pulses is disabled if the sum of the first and the second parameters is greater than the time available for the delivery of the ATP pulses.

19. The method of claim 18, wherein at least one of the first parameter and the second parameter is programmable.

20. The method of claim 19, wherein the method is performed by an implantable medical device including a battery, and wherein step b.) includes adjusting the capacitor charging time based on a lifetime of the battery.

21. The method of claim 20, wherein step b.) includes adjusting at least one of the first parameter and the second parameter based, at least in part, on the adjusted capacitor charging time.

22. The method of claim 18, wherein at least one of the first parameter and the second parameter is a predetermined minimum system value.

23. The method of claim 16, wherein step c.) includes synchronizing delivery of the high-voltage shock to a rhythm of the heart, and wherein step b.) includes controlling the delivery of the ATP pulses based, at least in part, on a second parameter indicating a time period extending substantially from detection of the arrhythmia to initiation of the synchronizing of delivery of the high-voltage shock.

24. The method of claim 16, further comprising the step of confirming whether the arrhythmia was terminated.

25. The method of claim 24, wherein the step of confirming whether the arrhythmia is terminated is performed after expiration of the capacitor charging time.

26. The method of claim 24, wherein the step of confirming whether the arrhythmia is terminated is initiated before expiration of the capacitor charging time.

27. The method of claim 25, wherein step c.) includes synchronizing delivery of the high-voltage shock to a rhythm of the heart.

28. The method of claim 26, wherein step c.) includes synchronizing delivery of the high-voltage shock to a rhythm of the heart.

29. The method of claim 27, wherein a portion of the time for confirming whether the arrhythmia was terminated is performed while synchronizing delivery of the high-voltage shock.

30. The method of claim 28, wherein a portion of the time for confirming whether the arrhythmia was terminated is performed while synchronizing delivery of the high-voltage shock.

31. The method of claim 25, wherein the step of confirming whether the arrhythmia is terminated is performed substantially until the time of delivery of the high-voltage shock.

32. The method of claim 26, wherein the step of confirming whether the arrhythmia is terminated is performed substantially until the time of delivery of the high-voltage shock.

33. A system for treating an arrhythmia of a heart, comprising:

a first output circuit to deliver anti-tachy pacing (ATP) pulses to the heart;

at least one capacitor to store a high-voltage shock;

a second output circuit to deliver the high-voltage shock stored by the capacitor subsequent to a charge-time for charging the at least one capacitor and a synchronization period for synchronizing delivery of the high-voltage shock;

a control circuit coupled to the first and second output circuits to control delivery of the ATP pulses relative to delivery of the high-voltage shock based on an adjustable parameter; and

sensor processing circuitry determining whether the ATP pulses successfully treat the arrhythmia during a confirmation period, wherein the charge-time for charging the at least one capacitor terminates at a charge time end and wherein the confirmation period and the synchronization period are initiated subsequent to the charge time end.

34. The system of claim 33, wherein the confirmation period occurs simultaneously with the synchronization period.

35. The system of claim 33, wherein the synchronization period is initiated subsequent to completion of the confirmation period and the sensor processing circuitry determines the ATP pulses have not successfully treated the arrhythmia.

36. The system of claim 33, wherein the synchronization period is initiated subsequent to initiation of the confirmation period.

37. The system of claim 33, wherein the adjustable parameter is a programmable time-to-shock period and wherein the synchronization period and the confirmation period are initiated subsequent to the time-to-shock period.

38. The system of claim 37, wherein expiration of the time-to-shock period initiates the confirmation period and the synchronization period is initiated at a predetermined time subsequent to the initiation of the confirmation period.

39. The system of claim 38, wherein the synchronization period is initiated during the confirmation period.

40. The system of claim 38, wherein the synchronization period is initiated subsequent to the confirmation period.

41. The system of claim 37, wherein the programmable time-to-shock period corresponds to a programmable number of beats.

42. The system of claim 37, wherein the programmable time-to-shock period corresponds to a predetermined time period.

43. The system of claim 37, wherein the first output circuit delivers the ATP pulses for a first time period, and the sum of the first time period and the confirmation period is less than the programmable time-to-shock period.

44. A system for treating an arrhythmia of a heart, comprising:

a first output circuit to deliver anti-tachy pacing (ATP) pulses to the heart;

a second output circuit to deliver a high-voltage shock; and

a control circuit coupled to the first and second output circuits to control delivery of the ATP pulses relative to delivery of the high-voltage shock, the control circuit includes means for controlling delivery of the ATP pulses based on a first parameter that determines the amount of time for delivering the ATP pulses.

45. The system of claim 44, wherein the control circuit includes means for controlling delivery of the ATP pulses based on a second parameter that determines an amount of time for determining whether the arrhythmia terminated.

46. The system of claim 45, wherein the control circuit includes means for disabling delivery of the ATP pulses if the sum of the first parameter and the second parameter are greater than the time required to charge the at least one capacitor.

47. The system of claim 45, wherein at least one of the first parameter and the second parameter is programmable.

48. The system of claim 44, wherein the second output circuit includes at least one capacitor, and wherein the control circuit includes means for calculating a time required to charge the at least one capacitor based on the programmed energy level of the high-voltage shock.

49. The system of claim 48, wherein the second output circuit includes a battery, and wherein the control circuit includes means for adjusting the estimated time required to charge the at least one capacitor based on life of the battery.

50. The system of claim 48, wherein the control circuit includes means for controlling a length of time for delivering ATP pulses based on the time required to charge the at least one capacitor.