Multiple pulse defibrillation for subcutaneous implantable cardiac devices
First Claim
1. A method of delivering a subcutaneous defibrillation therapy from an extra-thoracic location, comprising:
- selecting at least a pair of subcutaneous electrodes from a plurality of subcutaneous electrodes positioned extra-thoracically relative to a patient'"'"'s heart, the pair selected to provide an increased cardiac signal-to-noise ratio relative to other pairs of the plurality of subcutaneous electrodes;
sensing a fibrillation event using the selected pair of subcutaneous electrodes of the plurality of subcutaneous electrodes;
determining a fibrillation cycle length associated with the sensed fibrillation event; and
delivering, using one or more combinations of electrodes of the plurality of subcutaneous electrodes, a plurality of defibrillation pulses to treat the fibrillation event, wherein delivery of a latter pulse of the defibrillation pulses subsequent to a former pulse of the defibrillation pulses is separated in time by a first delay associated with the fibrillation cycle length.
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Abstract
Cardiac stimulation methods and systems provide for multiple pulse defibrillation, and involve sensing a fibrillation event, determining a fibrillation cycle length associated with the fibrillation event, and delivering a plurality of defibrillation pulses to treat the fibrillation event. Defibrillation pulses are delivered using a combination of subcutaneous non-intrathoracic electrodes. Delivery of each defibrillation waveform subsequent to a first defibrillation waveform is separated in time by a delay associated with the fibrillation cycle length. Delays between defibrillation waveform delivery may be associated with a percentage of the fibrillation cycle length.
53 Citations
27 Claims
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1. A method of delivering a subcutaneous defibrillation therapy from an extra-thoracic location, comprising:
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selecting at least a pair of subcutaneous electrodes from a plurality of subcutaneous electrodes positioned extra-thoracically relative to a patient'"'"'s heart, the pair selected to provide an increased cardiac signal-to-noise ratio relative to other pairs of the plurality of subcutaneous electrodes; sensing a fibrillation event using the selected pair of subcutaneous electrodes of the plurality of subcutaneous electrodes; determining a fibrillation cycle length associated with the sensed fibrillation event; and delivering, using one or more combinations of electrodes of the plurality of subcutaneous electrodes, a plurality of defibrillation pulses to treat the fibrillation event, wherein delivery of a latter pulse of the defibrillation pulses subsequent to a former pulse of the defibrillation pulses is separated in time by a first delay associated with the fibrillation cycle length. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13)
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14. A system for delivering a subcutaneous defibrillation therapy from an extra-thoracic location, comprising:
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a housing configured for subcutaneous placement relative to a patient'"'"'s heart; detection circuitry provided in the housing, the detection circuitry configured to detect a fibrillation event; energy delivery circuitry provided in the housing; a plurality of combinations of electrodes configured for subcutaneous extra-thoracic placement relative to the patient'"'"'s heart, the electrodes of each electrode combination coupled to the detection and energy delivery circuitry; and a controller provided in the housing and coupled to the detection and energy delivery circuitry, the controller configured to select a pair of subcutaneous electrodes from the plurality of electrode combinations based on an increased cardiac signal-to-noise ratio associated with the selected pair of subcutaneous electrodes relative to other pairs of the plurality of electrode combinations and to determine a fibrillation cycle length associated with the fibrillation event using the selected pair of subcutaneous electrodes, the controller coordinating delivery of a latter defibrillation pulse following a delay relative to delivery of a former defibrillation pulse, the delay defining a percentage of the fibrillation cycle length. - View Dependent Claims (15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26)
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27. A system for delivering a subcutaneous defibrillation therapy from an extra-thoracic location, comprising:
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means for selecting a pair of subcutaneous electrodes from a plurality of subcutaneous extra-thoracic electrodes, the pair selected to provide an increased cardiac signal-to-noise ratio relative to other pairs of the plurality of subcutaneous extra-thoracic electrodes; means for sensing a fibrillation event using the selected pair of subcutaneous extra-thoracic electrodes of the plurality of subcutaneous extra-thoracic electrodes; means for determining a fibrillation cycle length associated with the fibrillation event; means for delivering, using a first combination of electrodes of the plurality of subcutaneous extra-thoracic electrodes, a former defibrillation pulse to treat the fibrillation event; and means for delivering, using the first combination or a second combination of electrodes of the plurality of subcutaneous extra-thoracic electrodes, a latter defibrillation pulse following a delay relative to delivery of the former defibrillation pulse to treat the fibrillation event, the delay associated with a percentage of the fibrillation cycle length.
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Specification