Tiered antitachycardia pacing and pre-pulsing therapy

• US 7,751,887 B1
• Filed: 04/28/2006
• Issued: 07/06/2010
• Est. Priority Date: 04/28/2006
• Status: Active Grant

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories)
• Inventors: Benser, Michael, Kroll, Mark W., Park, Euljoon
• Primary Examiner(s): Schaetzle; Kennedy J
• Assistant Examiner(s): ANTHONY, JESSICA LYNN
• Application Number:
  US11/413,773
• Time in Patent Office: 1,530 Days
• Field of Search: 607/4, 607/9, 607/14, 607/15
• 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 1/368 comprising more than one electrode co-operating with different heart regions A61N1/3622, A61N1/3627 take precedence
• CPC Class Codes: A61N 1/3684 for stimulating the heart at multiple sites of the ventricle or the atrium
• CPC Class Codes: A61N 1/36842 Multi-site stimulation in the same chamber
• CPC Class Codes: A61N 1/36843 Bi-ventricular stimulation
• CPC Class Codes: A61N 1/39622 Pacing therapy
• CPC Class Codes: A61N 1/39624 Pain reduction therapy
• CPC Class Codes: A61N 2001/0585 Coronary sinus electrodes

Abstract

An implantable system applies tiered antitachycardia pacing (ATP) that may be combined with pre-pulsing therapy in order to reduce pain. In one implementation, an exemplary system applies a progression of increasingly potent pacing vectors, progressing in an initial tier from small electrodes inside the heart to later tiers that increasingly use a large electrode surface outside the heart. In the latter tiers, a pre-pulse may be added prior to each ATP pulse to reduce the sensation of pain.

Claims

1. A method, comprising:

detecting a ventricular tachycardia; and

applying a tiered antitachycardia pacing (ATP) therapy consisting of one or more of;

providing ATP through electrodes of progressively larger surface area,

providing ATP through progressively larger volumes of cardiac tissue, or

providing ATP through different pacing vectors.

2. The method as recited in claim 1, further comprising checking whether the ventricular tachycardia has been terminated after each tier of the tiered ATP therapy.

3. The method as recited in claim 1, further comprising applying a pre-pulsing therapy with the tiered ATP therapy.

4. The method as recited in claim 1, wherein applying the tiered ATP therapy includes applying a first tier of the ATP via pacing electrodes.

5. The method as recited in claim 1, wherein providing ATP through different pacing vectors includes providing ATP in a progressive sequence through different pacing vectors, including a vector that uses at least one electrode situated over an epicardium of the heart.

6. The method as recited in claim 1, wherein providing ATP through different pacing vectors includes providing ATP in a progressive sequence through different pacing vectors, including a vector that uses multiple pacing electrodes in combination as a large area electrode.

7. The method as recited in claim 1, wherein providing ATP through different pacing vectors includes providing ATP in a progressive sequence through different pacing vectors, including a vector that uses one or more coronary sinus coil electrodes.

8. The method as recited in claim 1, wherein applying the tiered ATP therapy includes calculating a pulse train for at least some of the tiers of the tiered ATP therapy.

9. The method as recited in claim 1, wherein the pre-pulsing therapy is added to the ATP each time an electrode external to the heart is used to deliver a tier of the tiered ATP.

10. A method, comprising:

applying antitachycardia pacing to treat ventricular tachycardia;

sensing whether the ventricular tachycardia has stopped; and

changing electrode locations to obtain larger electrode surface areas for applying the antitachycardia pacing if the ventricular tachycardia has not stopped.

11. The method as recited in claim 10, further comprising repeating the sensing and the changing electrode locations until the ventricular tachycardia stops.

12. The method as recited in claim 10, wherein the changing electrode locations to obtain larger electrode surface areas for applying the antitachycardia pacing further includes progressively changing from electrodes inside the heart to electrodes outside the heart.

13. An implantable cardiac therapy system comprising:

at least one lead comprising a plurality of electrodes defining a plurality of stimulation vectors;

an implantable cardiac therapy device adapted to be connected to the at least one lead and comprising an antitachycardia pacing module to generate antitachycardia pacing pulses to be delivered via the at least one lead via a selected stimulation vector, wherein the implantable cardiac therapy device further comprises a sensor to sense a ventricular tachycardia and to control the antitachycardia pacing module to generate the antitachycardia pacing pulses, and wherein the implantable cardiac therapy device is operative to change stimulation vectors to obtain larger electrode surface areas if the ventricular tachycardia has not stopped.