Method and device for three-stage atrial cardioversion therapy
First Claim
1. A three-stage atrial arrhythmia treatment apparatus, comprising:
- at least one electrode adapted to be implanted proximate an atrium of a heart of a patient to deliver far field pulses;
at least one electrode adapted to implanted proximate the atrium of the heart of the patient to deliver near field pulses and sense cardiac signals;
an implantable therapy generator adapted to be implanted in a patient and operably connected to the electrodes, including;
sensing circuitry that senses cardiac signals representative of atrial activity and ventricular activity;
detection circuitry operably connected to the sensing circuitry to evaluate the cardiac signals representative of atrial activity to determine an atrial cycle length and detect an atrial arrhythmia based at least in part on the atrial cycle length;
control circuitry operably connected to the sensing circuitry that, in response to the atrial arrhythmia, controls generation and selective delivery of a three-stage atrial cardioversion therapy to the electrodes with each stage having an inter-stage delay of between 50 to 400 milliseconds and without confirmation of conversion of the atrial arrhythmia during the three-stage atrial cardioversion therapy; and
therapy circuitry operably connected to the electrodes and the control circuitry including;
at least one first stage charge storage circuit selectively coupled to the at least one far field electrode that selectively stores energy for a first stage of the three-stage atrial cardioversion therapy having at least two and less than ten atrial cardioversion pulses of at least 10 volts and not more than 100 volts, wherein the first stage has a total duration of less than one cycle lengths of the atrial arrhythmia and is delivered within a ventricular refractory period to unpin one or more singularities associated with the atrial arrhythmia;
at least one second stage charge storage circuit selectively coupled to the at least one far field electrode that selectively stores a second stage of the three-stage atrial cardioversion therapy having at least five and less than ten far field pulses of less than 50% of a ventricular far-field excitation threshold with pulse coupling interval of between 70-100% of the cycle length of the atrial arrhythmia, wherein the second stage prevents repinning of the one or more singularities associated with the atrial arrhythmia that are unpinned by the first stage; and
at least one third stage charge storage circuit selectively coupled to the near field electrode that selectively stores a third stage of the three-stage cardioversion therapy having at least five and less than ten near field pulses at a voltage of up to three times the atrial capture threshold with a pulse duration of more than 0.2 and less than 5 milliseconds and a pulse coupling interval of between 70-100% of the cycle length of the atrial arrhythmia, wherein the third stage extinguishes the one or more singularities associated with the atrial arrhythmia that are unpinned by the first stage and prevented from repinning by the second stage; and
a battery system operably coupled and providing power to the sensing circuitry, the detection circuitry, the control circuitry and the therapy circuitry.
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Abstract
Methods and apparatus for a three-stage atrial cardioversion therapy that treats atrial arrhythmias within pain tolerance thresholds of a patient. An implantable therapy generator adapted to generate and selectively deliver a three-stage atrial cardioversion therapy and at least two leads, each having at least one electrode adapted to be positioned proximate the atrium of the patient. The device is programmed for delivering a three-stage atrial cardioversion therapy via both a far-field configuration and a near-field configuration of the electrodes upon detection of an atrial arrhythmia. The three-stage atrial cardioversion therapy includes a first stage for unpinning of one or more singularities associated with an atrial arrhythmia, a second stage for anti-repinning of the one or more singularities, both of which are delivered via the far-field configuration of the electrodes, and a third stage for extinguishing of the one or more singularities delivered via the near-field configuration of the electrodes.
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Citations
27 Claims
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1. A three-stage atrial arrhythmia treatment apparatus, comprising:
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at least one electrode adapted to be implanted proximate an atrium of a heart of a patient to deliver far field pulses; at least one electrode adapted to implanted proximate the atrium of the heart of the patient to deliver near field pulses and sense cardiac signals; an implantable therapy generator adapted to be implanted in a patient and operably connected to the electrodes, including; sensing circuitry that senses cardiac signals representative of atrial activity and ventricular activity; detection circuitry operably connected to the sensing circuitry to evaluate the cardiac signals representative of atrial activity to determine an atrial cycle length and detect an atrial arrhythmia based at least in part on the atrial cycle length; control circuitry operably connected to the sensing circuitry that, in response to the atrial arrhythmia, controls generation and selective delivery of a three-stage atrial cardioversion therapy to the electrodes with each stage having an inter-stage delay of between 50 to 400 milliseconds and without confirmation of conversion of the atrial arrhythmia during the three-stage atrial cardioversion therapy; and therapy circuitry operably connected to the electrodes and the control circuitry including; at least one first stage charge storage circuit selectively coupled to the at least one far field electrode that selectively stores energy for a first stage of the three-stage atrial cardioversion therapy having at least two and less than ten atrial cardioversion pulses of at least 10 volts and not more than 100 volts, wherein the first stage has a total duration of less than one cycle lengths of the atrial arrhythmia and is delivered within a ventricular refractory period to unpin one or more singularities associated with the atrial arrhythmia; at least one second stage charge storage circuit selectively coupled to the at least one far field electrode that selectively stores a second stage of the three-stage atrial cardioversion therapy having at least five and less than ten far field pulses of less than 50% of a ventricular far-field excitation threshold with pulse coupling interval of between 70-100% of the cycle length of the atrial arrhythmia, wherein the second stage prevents repinning of the one or more singularities associated with the atrial arrhythmia that are unpinned by the first stage; and at least one third stage charge storage circuit selectively coupled to the near field electrode that selectively stores a third stage of the three-stage cardioversion therapy having at least five and less than ten near field pulses at a voltage of up to three times the atrial capture threshold with a pulse duration of more than 0.2 and less than 5 milliseconds and a pulse coupling interval of between 70-100% of the cycle length of the atrial arrhythmia, wherein the third stage extinguishes the one or more singularities associated with the atrial arrhythmia that are unpinned by the first stage and prevented from repinning by the second stage; and a battery system operably coupled and providing power to the sensing circuitry, the detection circuitry, the control circuitry and the therapy circuitry. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16)
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17. An atrial arrhythmia treatment apparatus, comprising:
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an implantable therapy generator adapted to be implanted in a patient, including; means for detecting an atrial arrhythmia and determining a cycle length of the atrial arrhythmia; means for generating a three-stage atrial cardioversion therapy, including; means for generating a first stage of the three-stage atrial cardioversion therapy having at least two and less than ten biphasic atrial cardioversion pulses of 10 volts to 100 volts for unpinning of one or more singularities associated with an atrial arrhythmia, wherein the first stage has a total duration of 30% to 50% of the cycle lengths of the atrial arrhythmia and is delivered within a ventricular refractory period; means for generating a second stage of the three-stage atrial cardioversion therapy having at least five and less than ten far field pulses of less than a ventricular far-field excitation threshold with a pulse coupling interval of between 70-100% of the cycle length of the atrial arrhythmia for anti-repinning of the one or more singularities associated with the atrial arrhythmia; and means for generating a third stage of the three-stage cardioversion therapy having at least five and less than ten near field pulses of one-and-a-half times to three-times the atrial capture threshold and a pulse coupling interval of between 70-100% of the cycle length of the atrial arrhythmia for extinguishing of the one or more singularities associated with the atrial arrhythmia; and means for controlling delivery of the three-stage atrial cardioversion therapy in response to detection of the atrial arrhythmia with each stage having an inter-stage delay of between 50 to 400 milliseconds and without confirmation of conversion of the atrial arrhythmia until after delivery of the third stage; and at least two leads adapted to be operably connected to the implantable therapy generator, each lead having at least one electrode adapted to be positioned proximate an atrium of a heart of the patient through which the three-stage atrial cardioversion therapy is selectively delivered to the atrium of the heart, such that the means for generating the first stage and the means for generating the second stage are selectively coupled by the means for controlling delivery to a far-field configuration of the electrodes and the means for generating the third stage are selectively coupled by the means for controlling delivery to a near-field configuration of the electrodes. - View Dependent Claims (18, 19, 20, 21, 22, 23, 24, 25, 26)
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27. A method of treating atrial arrhythmias comprising:
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(a) providing an atrial arrhythmia treatment device including an implantable therapy generator adapted to generate and selectively deliver a three-stage atrial cardioversion therapy and at least two leads operably connected to the implantable therapy generator, each lead having at least one electrode adapted to be positioned proximate the atrium of a heart of the patient; (b) providing instructions for implanting the atrial arrhythmia treatment device in a patient during a surgical procedure; (c) providing instructions for configuring the atrial arrhythmia treatment device at a time after completion of the surgical procedure, including instructions for programming the atrial arrhythmia treatment device with a set of therapy parameters for delivering a three-stage atrial cardioversion therapy to a patient via both a far-field configuration and a near-field configuration of the electrodes upon detection of an atrial arrhythmia by the atrial arrhythmia treatment device, wherein the three-stage atrial cardioversion therapy includes; a first stage of the three-stage atrial cardioversion therapy having at least two and less than ten atrial cardioversion pulses of at least 10 volts and not more than 100 volts for unpinning of one or more singularities associated with an atrial arrhythmia, the first stage having a total duration of less than two cycle lengths of the atrial arrhythmia and being delivered within a ventricular refractory period; a second stage of the three-stage atrial cardioversion therapy having at least five and less than ten far field pulses of less than a ventricular far-field excitation threshold with a pulse duration of more than 5 and less than 20 milliseconds and a pulse coupling interval of between 70-100% of the cycle length of the atrial arrhythmia for anti-repinning of the one or more singularities associated with the atrial arrhythmia; and a third stage of the three-stage cardioversion therapy having at least five and less than ten near field pulses at a voltage ranging from substantially one-and-a-half to three times the atrial capture threshold with a pulse duration of more than 0.2 and less than 5 milliseconds and a pulse coupling interval of between 70-100% of the cycle length of the atrial arrhythmia for extinguishing of the one or more singularities associated with the atrial arrhythmia, and wherein the three-stage atrial cardioversion therapy is delivered in response to detection of the atrial arrhythmia with each stage having an inter-stage delay of between 50 to 400 milliseconds and without confirmation of conversion of the atrial arrhythmia until after delivery of the third stage.
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Specification