Method and apparatus for the monitoring and treatment of spontaneous cardiac arrhythmias

• US 7,346,392 B2
• Filed: 01/31/2003
• Issued: 03/18/2008
• Est. Priority Date: 09/12/2000
• Status: Expired due to Fees

• Current Assignee: UAB Research Foundation (University of Alabama System)
• Original Assignee: UAB Research Foundation (University of Alabama System)
• Inventors: KenKnight, Bruce H.
• Primary Examiner(s): Schaetzle; Kennedy J.
• Application Number:
  US10/355,857
• Publication Number:
  US 20030114887A1
• Time in Patent Office: 1,873 Days
• Field of Search: 607/4, 607/5, 607/119, 607/122
• US Class Current: 607/5
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions
• CPC Class Codes: A61N 1/3956 Implantable devices for applying electric shocks to the heart, e.g. for cardioversion

Abstract

An implantable apparatus for the detection and monitoring of spontaneous cardiac electrogram features in a comprises a cardiac monitoring device and a plurality of subcutaneous cardiac sensing electrodes electrically connected to the monitoring device. The sensing electrodes are configured for sensing cardiac electrogram features when implanted in spatially separate locations in a patient. A storage device contained within the monitoring device is operably associated with the subcutaneous electrodes and stores the cardiac electrogram features. Preferably, the plurality of subcutaneous electrodes are carried by a single elongate lead. A downloading device such as telemetry apparatus or transcutaneous electrical connectors may be provided so that the stored information can be downloaded to a separate apparatus external to the patient. In a preferred embodiment, the apparataus is a defibrillator. Methods of using such apparatus are also disclosed.

Claims

1. An implantable defibrillation apparatus that detects and monitors spontaneous cardiac electrogram features in a patient, said apparatus comprising:

an implantable cardiac defibrillator;

a plurality of subcutaneous cardiac sensing electrodes electrically connected to said defibrillator, said sensing electrodes configured for sensing cardiac electrogram features when implanted in spatially separate locations in a patient, said sensing electrodes being sufficiently separated such that each sensing electrode is connected to said defibrillator via a discrete lead portion, wherein one of the subcutaneous electrodes is configured for positioning adjacent the xiphoid process of the patient, and another of the subcutaneous electrodes is configured for positioning adjacent the left axilla of the patient;

at least one elongate transveneous catheter flexibly configured for insertion into the heart of the patient, said catheter carrying at least one defibrillation electrode and said catheter connected to said defibrillator; and

a detector carried within said defibrillator and operably associated with said sensing electrodes and said at least one defibrillation electrode, said detector configured for detecting the likelihood of a spontaneous cardiac arrhythmia and delivering a treatment pulse through said at least one defibrillation electrode, wherein said defibrillator is configured for implantation in the left pre-pectoral position, wherein said plurality of subcutaneous electrodes are carried by a single elongate lead.

2. An apparatus according to claim 1, wherein said defibrillation electrode is a ventricular defibrillation electrode.

3. An apparatus according to claim 1, wherein said defibrillation electrode is an atrial defibrillation electrode.

4. An apparatus according to claim 1, said elongate lead further carrying at least one defibrillation electrode.

5. A defibrillation method that includes detecting cardiac electrogram features in a patient in need thereof, said method comprising:

providing a plurality of subcutaneous sensing electrodes implanted in spatially separate locations in the patient;

providing an implantable cardiac defibrillator operably associated with said subcutaneous sensing electrodes, said sensing electrodes being sufficiently separated such that each sensing electrode is connected to said defibrillator via a discrete lead portion and wherein said defibrillator is implanted in the left pre-pectoral position in the patient;

providing at least one elongate transveneous catheter inserted into the heart of the patient, said catheter connected to said defibrillator and carrying at least one defibrillation electrode;

detecting electrical activity including cardiac electrogram features of the heart of the patient through said subcutaneous sensing electrodes;

determining the likelihood of a spontaneous cardiac arrhythmia from said detected electrical activity; and

then

administering a therapeutic pulse to the heart through said at least one defibrillation electrode upon the determination of a likelihood of occurrence of a spontaneous cardiac arrhythmia, wherein one of the subcutaneous electrodes is positioned adjacent the xiphoid process of the patient, and another of the subcutaneous electrodes is positioned adjacent the left axilla of the patient.

6. A method according to claim 5, wherein said therapeutic pulse is an atrial therapeutic pulse.

7. A method according to claim 5, wherein said therapeutic pulse is a ventricular therapeutic pulse.

8. A method according to claim 5, further comprising the step of storing said detected electrical activity in said defibrillator.

9. A method according to claim 8, further comprising the step of downloading said stored electrical activity to an external device.

10. A method according to claim 8, further comprising the steps of:

analyzing said stored electrical activity following said downloading step; and

then generating a therapeutic recommendation for managing cardiac arrhythmia for the patient based on said stored electrical activity.

11. A method according to claim 5, wherein said plurality of subcutaneous electrodes are carried by a single elongate lead.

12. A method according to claim 5, wherein said detecting step comprises the step of detecting an event selected from the group consisting of QT interval, PR interval, ST interval, RT interval, T wave duration, QRS duration, R wave morphology, and T wave morphology.