Electrode placement determination for subcutaneous cardiac monitoring and therapy
First Claim
1. An electrode placement method, comprising:
- locating a plurality of skin surface electrodes on a thorax of a patient at initial locations, the plurality of surface of electrodes comprising an array of surface electrode elements;
determining a surface pacing level relative to a pacing limit using at least two of the surface electrodes; and
selecting or rejecting one or more surface electrode locations based on the surface pacing level being within the pacing limit by scanning the array of surface electrode elements for their associated pacing levels, the selected one or more surface electrode locations corresponding to one or more acceptable subcutaneous electrode locations.
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Accused Products
Abstract
Methods and devices of cardiac electrode placement involve locating electrodes on a thorax of a patient. Surface pacing levels are determined relative to a pacing limit. Surface electrode locations are selected or rejected based on the level being within a limit. Electrodes may be relocated to new locations, and new surface pacing levels determined, until a new surface pacing level falls within the pacing limit. Selecting or rejecting electrode locations involves selecting locations suitable for implantation of subcutaneous cardiac electrodes and implanting at the selected locations. An automated method uses an array of surface electrode elements that are scanned for their associated pacing levels, such as by selecting one or more electrode element locations having the lowest pacing levels, which may correspond to locations suitable for implantation of a subcutaneous cardiac electrode and housing, a subcutaneous electrode array, a unitary subcutaneous defibrillation system, or other suitable implantable cardiac device.
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Citations
54 Claims
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1. An electrode placement method, comprising:
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locating a plurality of skin surface electrodes on a thorax of a patient at initial locations, the plurality of surface of electrodes comprising an array of surface electrode elements; determining a surface pacing level relative to a pacing limit using at least two of the surface electrodes; and selecting or rejecting one or more surface electrode locations based on the surface pacing level being within the pacing limit by scanning the array of surface electrode elements for their associated pacing levels, the selected one or more surface electrode locations corresponding to one or more acceptable subcutaneous electrode locations. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16)
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17. An electrode placement method, comprising:
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selecting one or more skin surface electrode locations as a function of a surface cardiac pacing level; and determining one or more subcutaneous electrode implant locations using the selected one or more surface electrode locations based at least in part on a pre-established proportionality relationship between surface cardiac pacing level and subcutaneous defibrillation level. - View Dependent Claims (18, 19, 20, 21, 22, 23, 24, 25)
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26. A medical system, comprising:
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a pulse generator configured to deliver a pacing stimulus at a stimulus level; detection circuitry; a plurality of skin surface electrodes coupled to the pulse generator and to the detection circuitry, the plurality of surface electrodes configured for positioning on a thorax of a patient relative to a patient'"'"'s heart; a controller coupled to the pulse generator and detection circuitry, the controller determining acceptable subcutaneous electrode locations based at least in part on detection of capture or non-capture resulting from delivery of the pacing stimulus at the stimulus level; and a recording arrangement coupled to the controller and configured to record capture threshold data or non-capture data determined for selected thoracic locations of the plurality of surface electrodes. - View Dependent Claims (27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41)
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42. A medical system, comprising:
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means for positioning a plurality of skin surface electrodes on a thorax of a patient relative to a patient'"'"'s heart; means for determining a surface pacing level relative to a pacing limit using at least two of the surface electrodes; and means for selecting or rejecting one or more surface electrode locations based on the surface pacing level being within the pacing limit based at least in part on a pre-established proportionality relationship between surface pacing level and subcutaneous defibrillation level, the selected one or more surface electrode locations corresponding to one or more acceptable subcutaneous electrode locations. - View Dependent Claims (43, 44)
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45. A medical system, comprising:
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means for selecting one or more skin surface electrode locations as a function of a surface cardiac pacing level; means for determining one or more subcutaneous electrode implant locations using the selected one or more surface electrode locations; and means for determining suitability of the one or more subcutaneous electrode implant locations based at least in part on a pre-established proportionality relationship between the surface cardiac pacing level and a subcutaneous defibrillation level.
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46. A medical system, comprising:
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a pulse generator configured to deliver a pacing stimulus at a stimulus level; an electrode support assembly; a plurality of skin surface electrodes coupled to the pulse generator and supported by the electrode support assembly, the plurality of electrodes having a fixed spatial relationship relative to one another and configured for positioning on a thorax of a patient relative to the patient'"'"'s heart; detection circuitry; and a controller coupled to the pulse generator and detection circuitry, the controller determining acceptable subcutaneous electrode locations based at least in part on detection of capture or non-capture resulting from delivery of the pacing stimulus at the stimulus level, and at least in part on a pre-established proportionality relationship between the pacing level of the pacing stimulus and a subcutaneous defibrillation level. - View Dependent Claims (47)
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48. An electrode placement method, comprising:
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providing at least a pair of skin surface electrodes situated on a support structure, the pair of surface electrodes comprising a first and second surface electrodes having a fixed spatial relationship relative to one another; locating the first surface electrode at a first location on a thorax of a patient; moving the support structure to locate the second surface electrode at a second location on the patient'"'"'s thorax; inducing an arrhythmia in the patient using the first and second surface electrodes; determining a surface pacing threshold for effecting cardiac capture using the first and second surface electrodes; selecting one or more surface electrode locations as a function of the surface pacing threshold; and determining one or more subcutaneous electrode implant locations using the selected one or more surface electrode locations. - View Dependent Claims (49, 50, 51, 52, 53, 54)
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Specification