Site reversion in cardiac rhythm management

• US 6,922,589 B2
• Filed: 12/09/2002
• Issued: 07/26/2005
• Est. Priority Date: 08/30/2000
• Status: Expired due to Term

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Stahmann, Jeffrey E., Kramer, Andrew P.
• Primary Examiner(s): Schaetzle, Kennedy
• Assistant Examiner(s): DROESCH, KRISTEN L
• Application Number:
  US10/314,875
• Publication Number:
  US 20030176894A1
• Time in Patent Office: 960 Days
• Field of Search: 600372-374, 600/377, 600/381, 600/54, 600/547, 607 4- 5, 607 8- 9, 607 27- 28, 607115-116, 607/119, 607121-123
• US Class Current: 607/27
• CPC Class Codes: A61N 1/3603 Control systems
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/3706 Pacemaker parameters stimulation threshold A61N1/371

Abstract

Methods for failure recovery in a cardiac rhythm management system and apparatus capable of carrying out the methods. The methods include applying a first pacing therapy using one or more leads. The methods further include detecting a failure condition on one or more of the leads, wherein the failure condition prohibits or frustrates application of the first pacing therapy. The methods still further include applying a second pacing therapy using one or more of the leads subsequent to detecting the failure condition. The second pacing therapy is preferably chosen such that the detected failure does not interfere with the second pacing therapy. The second pacing therapy may be applied for only one cardiac cycle. The second pacing therapy may further be applied continuously until the failure condition is resolved, or it may be latched such that physician intervention is required to resume the first pacing therapy.

Claims

1. A method comprising:

delivering a first therapy through a first electrode in a first chamber;

detecting an anomaly associated with the first electrode;

discontinuing the first therapy; and

delivering a second therapy to a second chamber through a second electrode.

2. The method of claim 1, wherein discontinuing the first therapy includes discontinuing the first therapy during the anomaly associated with the first electrode, and where delivering the second therapy includes delivering the second therapy to the second electrode during the anomaly associated with the first electrode.

3. The method of claim 1, including operating the first electrode in at least one mode selected from the group consisting of bipolar and unipolar, and wherein delivering the second therapy to the second electrode only occurs when the first electrode is operating in the unipolar mode.

4. The method of claim 1, wherein detecting the anomaly associated with the first electrode includes but is not limited to detecting a condition selected from the group consisting of an over-sense condition, sensed noise, lead impedance outside a predetermined range, capture amplitude voltage outside a predetermined range, intrinsic amplitude outside a predetermined range, detection of unintended non-cardiac stimulation, and failure to detect an expected event.

5. The method of claim 1, wherein detecting the anomaly includes detecting a failure associated with the first electrode.

6. The method of claim 1, wherein the first therapy is a first pacing therapy and the second therapy is a second pacing therapy.

7. The method of claim 1, including implanting the first electrode and the second electrode through the coronary sinus vein.

8. The method of claim 7, including positioning the first electrode and the second electrode adjacent the left ventricle.

9. A method comprising:

delivering a first therapy through a first lead having at least one electrode in a first chamber;

detecting an anomaly associated with the first lead;

discontinuing the first therapy; and

delivering a second therapy to a second lead in a second chamber after detecting the failure type anomaly.

10. The method of claim 9, wherein discontinuing the first therapy includes discontinuing the first therapy during the anomaly associated with the first lead.

11. The method of claim 9, including operating the at least one electrode of the first lead in at least one mode selected from the group consisting of bipolar and unipolar, and wherein delivering the second therapy only occurs when the at least one electrode of the first lead is operating in the unipolar mode.

12. The method of claim 9, wherein detecting the anomaly associated with the first lead includes but is not limited to detecting a condition selected from the group consisting of an over sense condition, sensed noise, lead impedance outside a predetermined range, capture amplitude voltage outside a predetermined range, intrinsic amplitude outside a predetermined range, detection of unintended non-cardiac stimulation, and failure to detect an expected event.

13. The method of claim 9, wherein detecting the anomaly associated with the first lead includes but is not limited to detecting a condition selected from the group consisting of an electrical hardware failure, software failure, memory failure and battery depletion.

14. The method as recited in claim 9, wherein discontinuing the first therapy and delivering the second therapy include reverting from a bipolar therapy to a unipolar therapy.

15. The method as recited in claim 9, further comprising positioning the first lead and the at least one electrode in the right ventricle, and positioning the second lead adjacent the left ventricle.

16. The method as recited in claim 9, further comprising positioning the first lead and the at least one electrode in the right atrium, and positioning the second lead adjacent the left atrium.

17. The method as recited in claim 9, further comprising positioning the first lead and the at least one electrode adjacent the left ventricle, and positioning the second lead in the right ventricle.

18. The method as recited in claim 9, further comprising positioning the first lead and the at least one electrode adjacent the left atrium, and positioning the second lead in the right atrium.

19. The method as recited in claim 9, further comprising coupling the first lead to a first atrium and coupling the second lead to a first ventricle.

22. The cardiac rhythm management system of claim 15, wherein delivering the first therapy to the first and second electrodes includes delivering a first pulse to the first electrode and a second pulse to the second electrode.

20. A cardiac rhythm management system, comprising:

a signal generator;

a first electrode adapted for connection to the signal generator;

a second electrode adapted for connection to the signal generator;

means for indicating presence of a failure with the first electrode; and

means for reverting from delivering a first therapy to the first electrode in a first chamber, to delivering a second therapy to the second electrode in a second chamber in the presence of a failure associated with the first electrode.

21. The cardiac rhythm management system of claim 20, wherein delivering the first therapy to the first electrode includes delivering the first therapy to both the first and second electrodes.

23. The cardiac rhythm management system of claim 20, including a lead adapted for connection to the signal generator, the lead comprising a main lead body adapted to carry signals to and from the heart, where the first electrode and the second electrode are carried by the main lead body.

24. The cardiac rhythm management system of claim 23, where the lead is adapted to be implanted through the coronary sinus vein.

25. A cardiac rhythm management system, comprising:

a signal generator;

a first electrode adapted for connection to the signal generator;

a second electrode adapted for connection to the signal generator; and

a processor coupled to the signal generator, wherein the processor is adapted to cause the signal generator to deliver a first therapy to a first chamber through the first electrode, and to deliver a second therapy to a second chamber through the second electrode in the presence of an anomaly associated with the first electrode.

26. The cardiac rhythm management system of claim 25, wherein delivering the first therapy to the first electrode includes delivering the first therapy through both the first and second electrodes.

27. The cardiac rhythm management system of claim 26, wherein delivering the first therapy through the first and second electrodes includes delivering a first pulse to the first electrode and a second pulse to the second electrode.

28. The cardiac rhythm management system of claim 27, wherein the pulses applied to the second electrode in the second therapy are substantially similar to the pulses applied to the first electrode in the first therapy.

29. The cardiac rhythm management system of claim 25, wherein the first electrode is adapted to operate in at least one mode selected from the group consisting of bipolar and unipolar, and wherein the processor is further adapted to cause the signal generator to deliver the second therapy only when the first electrode is operating in the unipolar mode.

30. The cardiac rhythm management system of claim 25, wherein the presence of the anomaly is indicated by detection of a condition selected from the group consisting of an over sense condition, sensed noise, lead impedance outside a predetermined range, capture amplitude voltage outside a predetermined range, intrinsic amplitude outside a predetermined range, detection of unintended non-cardiac stimulation, and failure to detect an expected event.

31. The cardiac rhythm management system of claim 25, wherein the presence of the anomaly is indicated by detection of a condition selected from the group consisting of an electrical hardware failure, software failure, memory failure and battery depletion.

32. The cardiac rhythm management system of claim 25, including a lead adapted for connection to the signal generator, the lead comprising a main lead body adapted to carry signals to and from the heart, where the first electrode and the second electrode are carried by the main lead body.

33. The cardiac rhythm management system of claim 25, further comprising:

a first lead having at least one of the first or second electrodes;

a second lead having the other of the first or second electrodes.