Adaptive medium voltage therapy for cardiac arrhythmias
First Claim
1. An electrotherapy device for treating arrhythmia in a patient, the device comprising:
- a patient interface including;
a plurality of electrodes adapted to be placed in electrical contact with the patient; and
at least one hemodynamic sensor;
electrotherapy circuitry operatively coupled to the patient interface and including a medium voltage therapy (MVT) pulse generator adapted to supply the MVT via the patient interface as a configurable waveform having a set of adjustable waveform parameters, wherein the waveform is defined by series of pulse trains having an adjustable train repetition rate, the pulse trains being composed of pulses having an adjustable pulse width, an adjustable pulse period, and an adjustable pulse amplitude, the MVT being of an energy level insufficient to shock the heart into a reset state;
patient monitoring circuitry including;
arrhythmia monitoring circuitry operatively coupled to at least a pair of the plurality of electrodes; and
cardiac output monitoring circuitry operatively coupled to the at least one hemodynamic sensor;
a controller operatively coupled to the patient monitoring circuitry and the electrotherapy circuitry, and configured to;
based on an output of the arrhythmia monitoring circuitry and on the cardiac output monitoring circuitry, ascertain a patient condition that is treatable by the MVT;
based on a treatment or life-support objective corresponding to the patient condition treatable by the MVT, cause the electrotherapy circuitry to initiate application of the MVT to the musculature of the patient via the plurality of electrodes to target a selected muscle group, wherein the selected muscle group is repeatedly (a) forced into a contracted state, (b) maintained in the contracted state for a time sufficient to achieve myocardial perfusion, and (c) thereafter allowed to relax, thereby achieving a forced hemodynamic effect sufficient to reduce a rate of degradation of the condition of the patient;
based on continued monitoring by the cardiac output monitoring circuitry during application of the MVT, adjust the waveform parameters in furtherance of the treatment or life-support objective such that;
in response to a measured level of cardiac output during application of the MVT targeting a selected first muscle group exceeding a minimal level adequate for the treatment or life-support objective, reduce an intensity of MVT stimulation targeting the first muscle group;
in response to a measured reduction of level of cardiac output during application of the MVT targeting a selected first muscle group, cause the electrotherapy circuitry to target a selected second muscle group distinct from the first muscle group with the MVT.
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Accused Products
Abstract
Aspects of the invention are directed to advanced monitoring and control of medium voltage therapy (MVT) in implantable and external devices. Apparatus and methods are disclosed that facilitate dynamic adjustment of MVT parameter values in response to new and changing circumstances such as the patient'"'"'s condition before, during, and after administration of MVT. Administration of MVT is automatically and dynamically adjusted to achieve specific treatment or life-support objectives, such as prolongation of the body'"'"'s ability to endure and respond to MVT, specifically addressing the type of arrhythmia or other pathologic state of the patient with targeted treatment, a tiered-intensity MVT treatment strategy, and supporting patients in non life-critical conditions where the heart may nevertheless benefit from a certain level of assistance.
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Citations
19 Claims
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1. An electrotherapy device for treating arrhythmia in a patient, the device comprising:
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a patient interface including; a plurality of electrodes adapted to be placed in electrical contact with the patient; and at least one hemodynamic sensor; electrotherapy circuitry operatively coupled to the patient interface and including a medium voltage therapy (MVT) pulse generator adapted to supply the MVT via the patient interface as a configurable waveform having a set of adjustable waveform parameters, wherein the waveform is defined by series of pulse trains having an adjustable train repetition rate, the pulse trains being composed of pulses having an adjustable pulse width, an adjustable pulse period, and an adjustable pulse amplitude, the MVT being of an energy level insufficient to shock the heart into a reset state; patient monitoring circuitry including; arrhythmia monitoring circuitry operatively coupled to at least a pair of the plurality of electrodes; and cardiac output monitoring circuitry operatively coupled to the at least one hemodynamic sensor; a controller operatively coupled to the patient monitoring circuitry and the electrotherapy circuitry, and configured to; based on an output of the arrhythmia monitoring circuitry and on the cardiac output monitoring circuitry, ascertain a patient condition that is treatable by the MVT; based on a treatment or life-support objective corresponding to the patient condition treatable by the MVT, cause the electrotherapy circuitry to initiate application of the MVT to the musculature of the patient via the plurality of electrodes to target a selected muscle group, wherein the selected muscle group is repeatedly (a) forced into a contracted state, (b) maintained in the contracted state for a time sufficient to achieve myocardial perfusion, and (c) thereafter allowed to relax, thereby achieving a forced hemodynamic effect sufficient to reduce a rate of degradation of the condition of the patient; based on continued monitoring by the cardiac output monitoring circuitry during application of the MVT, adjust the waveform parameters in furtherance of the treatment or life-support objective such that; in response to a measured level of cardiac output during application of the MVT targeting a selected first muscle group exceeding a minimal level adequate for the treatment or life-support objective, reduce an intensity of MVT stimulation targeting the first muscle group; in response to a measured reduction of level of cardiac output during application of the MVT targeting a selected first muscle group, cause the electrotherapy circuitry to target a selected second muscle group distinct from the first muscle group with the MVT. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19)
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Specification