Subcutaneous cardiac stimulation device providing anti-tachycardia pacing therapy and method

• US 7,260,433 B1
• Filed: 09/08/2004
• Issued: 08/21/2007
• Est. Priority Date: 09/08/2004
• Status: Active Grant

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories)
• Inventors: Kroll, Mark W., Falkenberg, Eric, Bornzin, Gene A.
• Primary Examiner(s): Layno; Carl
• Assistant Examiner(s): Patel; Natasha
• Application Number:
  US10/937,656
• Time in Patent Office: 1,077 Days
• Field of Search: 607/4, 607/28, 607/14, 607/5, 607/17, 607/24, 600515- 8, 600/526, 600/518
• US Class Current: 607/14
• CPC Class Codes: A61N 1/0504 Subcutaneous electrodes
• 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 1/3702 Physiological parameters A61N1/365 takes precedence; evoked response A61N1/371
• CPC Class Codes: A61N 1/37288 Communication to several implantable medical devices within one patient
• CPC Class Codes: A61N 1/3756 Casings with electrodes thereon, e.g. leadless stimulators

Abstract

An implantable subcutaneous cardiac device includes at least two subcutaneous electrodes adapted for placement external to a heart beneath the skin of a patient. The device further includes an arrhythmia detector that detects a sustained tachyarrhythmia of the heart and a pulse generator that delivers anti-tachycardia pacing pulses to the subcutaneous electrodes in response to detection of a sustained tachyarrhythmia. The pacing pulses preferably have waveforms devoid of any exponential voltage decay and include rounded or substantially constant portions to minimize pain.

Claims

1. A system comprising:

an implantable subcutaneous device comprising;

at least two subcutaneous electrodes adapted for placement external to a heart;

a cardiac output monitor that monitors cardiac output;

an arrhythmia detector that detects a tachyarrhythmia of the heart;

a first pulse generator that delivers one or more of anti-tachycardia pacing therapy, cardioversion therapy or defibrillation therapy to the heart using the at least two subcutaneous electrodes;

a telemetry device;

a processor programmed to withhold anti-tachycardia pacing therapy upon onset of a tachyarrhythmia, while cardiac output is monitored for a decrease in value and to output a command through the telemetry device to deliver anti-tachycardia pacing pulses in response to detection of a decrease in cardiac output accompanying the tachyarrhythmia; and

a fully implanted stimulation device comprising;

at least one intracardiac electrode adapted for placement within a heart;

a second pulse generator that delivers one or more of anti-tachycardia pacing therapy, cardioversion therapy or defibrillation therapy to the heart using the at least one intracardiac electrode in response to the command from the telemetry device.

2. The system of claim 1 wherein the processor is further programmed to monitor for termination of tachyarrhythmia upon delivery of anti-tachyarrhythmia therapy by the fully implanted stimulation device and, if tachyarrhythmia has not terminated, to output a command to the first pulse generator to delivery anti-tachycardia pacing pulses using the at least two subcutaneous electrodes.

3. The system of claim 2 wherein the processor is further programmed to output a command to the first pulse generator to deliver percutaneous nerve stimulation pulses to the at least two subcutaneous electrodes prior to delivering the anti-tachycardia pacing pulses.

4. The system of claim 2 wherein the processor is further programmed to monitor for termination of tachyarrhythmia upon delivery of anti-tachyarrhythmia pulses by the subcutaneous device and, if tachyarrhythmia has not terminated, to output a command to the first pulse generator to delivery either a cardioversion shock or defibrillation shock to the heart using the subcutaneous electrodes.

5. The system of claim 2 wherein the processor is further programmed to monitor for termination of tachyarrhythmia upon delivery of anti-tachyarrhythmia pulses by the subcutaneous device and, if tachyarrhythmia has not terminated, to output a command to the second pulse generator through the telemetry device to delivery either a cardioversion shock or defibrillation shock to the heart using the at least one intracardiac electrode.