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

• US 7,212,859 B1
• Filed: 07/26/2002
• Issued: 05/01/2007
• Est. Priority Date: 02/28/2000
• Status: Expired due to Fees

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories)
• Inventors: Kroll, Mark W.
• Primary Examiner(s): Schaetzle; Kennedy
• Application Number:
  US10/206,460
• Time in Patent Office: 1,740 Days
• Field of Search: 607/4, 607/5, 607/63, 607/14
• US Class Current: 607/14
• 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 at least one of a ventricle and an atrium of a patient'"'"'s heart, the system comprising:

an implantable cardiac stimulation device encapsulated in a conductive enclosure;

a ventricular pulse generator and an atrial pulse generator disposed within the conductive enclosure, the ventricular pulse generator providing ventricular arrhythmia termination pulses and the atrial pulse generator providing atrial arrhythmia termination pulses;

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

wherein the first electrode configuration is one of a plurality of arrhythmia termination electrode configurations;

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

wherein the second electrode is one of a plurality of arrhythmia termination electrode configurations;

an electrode configuration selector to select one of the plurality of electrode configurations based upon an arrhythmia terminating characteristic; and

wherein the arrhythmia terminating characteristic is based on minimizing atrial arrhythmia termination discomfort of the patient by confining each atrial arrhythmia termination electrode configuration of the plurality of arrhythmia termination electrode configurations to within the heart.

2. The system of claim 1 wherein the arrhythmia terminating characteristic is based upon ventricular defibrillation threshold.

3. The system of claim 1 wherein the atrial arrhythmia termination pulses are rounded to minimize pain to the patient.

4. The system of claim 1 wherein the arrhythmia termination characteristic is based upon atrial defibrillation threshold.

5. An implantable cardiac stimulation system for selectively delivering arrhythmia termination pulses to at least one of a ventricle and an atrium of a patient'"'"'s heart, the system comprising:

a pulse generator that provides arrhythmia termination pulses;

a plurality of electrode configurations coupled to the pulse generator to apply atrial and ventricular arrhythmia termination pulses to the heart;

at least one of the electrode configurations comprising first and second electrodes adapted for placement in different regions of the heart and coupled together to a cathode and a third electrode that defines an anode; and

an electrode configuration selector to select one of the plurality of electrode configurations based upon an arrhythmia terminating characteristic;

wherein circuitry is operative to deliver the arrhythmia termination pulses between the cathodal and anodal electrodes when the at least one electrode configuration is selected by the electrode configuration selector;

wherein the plurality of electrode configurations further comprises;

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

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

wherein the electrode configuration selector selects the second electrode configuration from among the plurality of atrial arrhythmia termination electrode configurations based upon an arrhythmia terminating characteristic; and

wherein the arrhythmia terminating characteristic is based on minimizing atrial arrhythmia termination discomfort of the patient by confining each atrial arrhythmia termination electrode configuration of the plurality of electrode configurations to within the heart.

6. The system of claim 5 wherein the first electrode comprises an electrode in a right atrium, the second electrode comprises an electrode in a coronary sinus, and the third electrode comprises an electrode in a right ventricle.

7. The system of claim 5 wherein the arrhythmia terminating characteristic is based upon ventricular defibrillation threshold.

8. The system of claim 5 wherein the atrial arrhythmia termination pulses are rounded to minimize pain to the patient.

9. The system of claim 5 wherein the arrhythmia termination characteristic is based upon atrial defibrillation threshold.

10. A method for selectively delivering arrhythmia termination pulses to at least one of a ventricle and an atrium of a patient'"'"'s heart, the method comprising:

placing a plurality of electrode configurations in different regions of the heart, one of the placings comprising;

placing first and second electrodes in different regions of the heart;

coupling together the first and second electrodes to define an anode; and

placing at least a third electrode in a region of the heart, wherein the third electrode defines a cathode;

selecting the one of the plurality of electrode configurations based upon an arrhythmia terminating characteristic; and

delivering one or more arrhythmia termination pulses between the cathodal and anodal electrodes when the one of the plurality of electrode configurations is selected; and

detecting a ventricular arrhythmia of the heart;

coupling a first additional electrode configuration to a pulse generator when a ventricular arrhythmia is detected, the first additional electrode configuration including a conductive housing to encapsulate an implantable cardiac stimulation device;

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

detecting an atrial arrhythmia of the heart;

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

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

11. The method of claim 10 wherein the arrhythmia terminating characteristic is based upon ventricular defibrillation threshold.

12. The method of claim 10 wherein delivering one or more arrhythmia termination pulses comprises atrial arrhythmia termination pulses that are rounded to minimize pain to the patient.

13. The method of claim 10 wherein the arrhythmia termination characteristic is based upon atrial defibrillation threshold and a degree of perceived pain by the patient.

14. A method for selectively delivering arrhythmia termination pulses to at least one of a ventricle and an atrium of a patient'"'"'s heart, the method comprising:

detecting a ventricular arrhythmia of the heart;

coupling a first electrode configuration to a pulse generator when a ventricular arrhythmia is detected, the first electrode configuration including a conductive housing to encapsulate an implantable cardiac stimulation device;

wherein the first electrode configuration is one of a plurality of arrhythmia termination electrode configurations;

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

detecting an atrial arrhythmia of the heart;

triggering 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; and

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 arrhythmia termination configurations for terminating an arrhythmia of the atria, and wherein each atrial arrhythmia terminating electrode configuration of the plurality of arrhythmia termination electrode configurations is configured to within the heart to minimize atrial arrhythmia termination discomfort of the patient.

15. The method of claim 14 wherein the arrhythmia terminating characteristic is based upon ventricular defibrillation threshold.

16. The method of claim 14 wherein delivering one or more arrhythmia termination pulses comprises atrial arrhythmia termination pulses that are rounded to minimize pain to the patient.

17. The method of claim 14 wherein the arrhythmia termination characteristic is based upon atrial defibrillation threshold and a degree of perceived pain by the patient.