Systems and methods for leadless pacing and shock therapy

• US 8,744,572 B1
• Filed: 01/31/2013
• Issued: 06/03/2014
• Est. Priority Date: 01/31/2013
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Greenhut, Saul E., Nehls, Robert J., Olson, Walter H., Zhang, Xusheng, Demmer, Wade M., Jackson, Troy E.
• Primary Examiner(s): MANUEL, GEORGE C
• Application Number:
  US13/756,085
• Time in Patent Office: 488 Days
• Field of Search: 607/4
• US Class Current: 607/4
• CPC Class Codes: A61N 1/056 Transvascular endocardial electrode systems
• CPC Class Codes: A61N 1/3621 for treating or preventing abnormally high heart rate
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters
• CPC Class Codes: A61N 1/37288 Communication to several implantable medical devices within one patient
• CPC Class Codes: A61N 1/3756 Casings with electrodes thereon, e.g. leadless stimulators
• CPC Class Codes: A61N 1/39622 Pacing therapy
• CPC Class Codes: A61N 1/3987 characterised by the timing or triggering of the shock

Abstract

Techniques and systems for monitoring cardiac arrhythmias and delivering electrical stimulation therapy using a subcutaneous implantable cardioverter defibrillator (SICD) and a leadless pacing device (LPD) are described. For example, the SICD may detect a tachyarrhythmia within a first electrical signal from a heart and determine, based on the tachyarrhythmia, to deliver anti-tachyarrhythmia shock therapy to the patient to treat the detected arrhythmia. The LPD may receive communication from the SICD requesting the LPD deliver anti-tachycardia pacing to the heart and determine, based on a second electrical signal from the heart sensed by the LPD, whether to deliver anti-tachycardia pacing (ATP) to the heart. In this manner, the SICD and LPD may communicate to coordinate ATP and/or cardioversion/defibrillation therapy. In another example, the LPD may be configured to deliver post-shock pacing after detecting delivery of anti-tachyarrhythmia shock therapy.

Claims

1. A method comprising:

sensing a first electrical signal from a heart of a patient;

detecting a tachyarrhythmia within the sensed first electrical signal;

determining, by a subcutaneous implantable cardioverter defibrillator (SICD) and based on the detected tachyarrhythmia, to deliver anti-tachyarrhythmia shock therapy to the patient to treat the detected arrhythmia;

receiving, by a leadless pacing device (LPD) implanted within the heart of the patient, communication from the SICD requesting the LPD deliver anti-tachycardia pacing to the heart;

sensing, by the LPD, a second electrical signal from the heart of the patient; and

determining, by the LPD and based on the second electrical signal, whether to deliver anti-tachycardia pacing to the heart from the LPD

wherein determining whether to deliver anti-tachycardia pacing comprises determining, by the LPD and based on the second electrical signal, not to deliver anti-tachycardia pacing;

wherein the method further comprises, in response to determining not to deliver anti-tachycardia pacing, transmitting, by the LPD and to the SICD, communication identifying the determination not to deliver anti-tachycardia pacing; and

further comprising;

receiving, by the SICD, the communication identifying the determination not to deliver anti-tachycardia pacing; and

overturning, based on the received communication identifying the determination not to deliver anti-tachycardia pacing, the determination to deliver anti-tachyarrhythmia shock therapy to the patient.

2. A method comprising:

sensing a first electrical signal from a heart of a patient;

detecting a tachyarrhythmia within the sensed first electrical signal;

determining, by a subcutaneous implantable cardioverter defibrillator (SICD) and based on the detected tachyarrhythmia, to deliver anti-tachyarrhythmia shock therapy to the patient to treat the detected arrhythmia;

receiving, by a leadless pacing device (LPD) implanted within the heart of the patient, communication from the SICD requesting the LPD deliver anti-tachycardia pacing to the heart;

sensing, by the LPD, a second electrical signal from the heart of the patient; and

determining, by the LPD and based on the second electrical signal, whether to deliver anti-tachycardia pacing to the heart from the LPD

wherein determining whether to deliver anti-tachycardia pacing comprises determining, by the LPD and based on the second electrical signal, not to deliver anti-tachycardia pacing; and

further comprising;

determining, by the SICD, that the LPD did not deliver anti-tachycardia pacing; and

adjusting, by the SICD and based on the non-delivery of anti-tachycardia pacing, at least one of a tachyarrhythmia detection criteria and a therapy parameter.

3. A method comprising:

sensing a first electrical signal from a heart of a patient;

detecting a tachyarrhythmia within the sensed first electrical signal;

determining, by a subcutaneous implantable cardioverter defibrillator (SICD) and based on the detected tachyarrhythmia, to deliver anti-tachyarrhythmia shock therapy to the patient to treat the detected arrhythmia;

receiving, by a leadless pacing device (LPD) implanted within the heart of the patient, communication from the SICD requesting the LPD deliver anti-tachycardia pacing to the heart;

sensing, by the LPD, a second electrical signal from the heart of the patient; and

determining, by the LPD and based on the second electrical signal, whether to deliver anti-tachycardia pacing to the heart from the LPD;

in response to the determination to deliver anti-tachyarrhythmia shock therapy to the patient, transmitting, by the SICD and to the LPD, communication requesting the LPD deliver anti-tachycardia pacing to the heart and entering, by the SICD, an anti-tachycardia pacing detection mode for detecting anti-tachycardia pacing therapy delivered by the LPD; and

further comprising;

delivering, via one or more electrodes of the LPD, anti-tachycardia pacing to the heart of the patient;

detecting, by at least one electrode of the SICD, the delivered anti-tachycardia pacing therapy during the anti-tachycardia pacing detection mode;

transmitting, by the SICD and to the LPD, communication identifying that the delivered anti-tachycardia pacing has not captured a rhythm of the heart; and

determining, by the LPD, at least one updated parameter value that at least partially defines additional anti-tachycardia pacing.

4. A system comprising:

a subcutaneous implantable cardioverter defibrillator (SICD) comprising a first set of electrodes and configured to;

sense a first electrical signal from a heart of a patient via the one or more first electrodes;

detect a tachyarrhythmia within the sensed first electrical signal; and

determine, based on the detected tachyarrhythmia, to deliver anti-tachyarrhythmia shock therapy to the patient to treat the detected arrhythmia; and

a leadless pacing device (LPD) comprising a second set of electrodes and configured to be implanted within the heart of the patient, wherein the LPD is configured to;

receive communication from the SICD requesting the LPD deliver anti-tachycardia pacing to the heart;

sense a second electrical signal from the heart of the patient via the second set of electrodes; and

determine, based on the second electrical signal, whether to deliver anti-tachycardia pacing to the heart

wherein the LPD is configured to;

determine, based on the second electrical signal, not to deliver anti-tachycardia pacing, and

in response to the determination not to deliver anti-tachycardia pacing, transmit, to the SICD, communication identifying the determination not to deliver anti-tachycardia pacing; and

wherein the SICD is configured to;

receive the communication from the LPD identifying the determination not to deliver anti-tachycardia pacing; and

overturn, based on the received communication identifying the determination not to deliver anti-tachycardia pacing, the determination to deliver anti-tachyarrhythmia shock therapy to the patient.

5. A subcutaneous implantable cardioverter defibrillator (SICD), the SICD comprising:

a housing configured to be implanted in a patient external to a rib cage of the patient;

one or more electrodes configured to be disposed external to the rib cage;

a shock module configured to at least partially deliver anti-tachyarrhythmia shock therapy to a patient via the one or more electrodes;

a communication module configured to at least one of transmit or receive communication messages between a leadless pacing device (LPD) configured to be implanted within a heart of the patient;

a sensing module configured to sense an electrical signal from the heart of the patient via the one or more electrodes; and

a processor configured to;

detect a tachyarrhythmia within the sensed electrical signal;

determine, based on the detected tachyarrhythmia, to deliver anti-tachyarrhythmia shock therapy to the patient to treat the detected tachyarrhythmia; and

transmit, via the communication module and prior to delivering anti-tachyarrhythmia shock therapy, a communication message to the LPD requesting the LPD deliver anti-tachycardia pacing to the heart of the patient.

6. A method comprising:

receiving, by a leadless pacing device (LPD), an indication of a detected cardiac arrhythmia eligible for anti-tachyarrhythmia shock therapy, wherein the LPD comprises a set of electrodes and is configured to be implanted within a heart of a patient;

in response to receiving the indication, enabling, by the LPD, a shock detector configured to detect delivery of anti-tachyarrhythmia shock therapy, wherein the LPD comprises the shock detector;

detecting, by the shock detector, delivery of anti-tachyarrhythmia shock therapy; and

in response to the detection, delivering, by the LPD and via at least a subset of the set of electrodes, post-shock pacing therapy to the heart of the patient; and

further comprising;

tracking, by the LPD, a period of time following detection of delivery of anti-tachyarrhythmia shock therapy;

determining, by the LPD, that the period of time exceeds a timeout threshold; and

in response to the determination, disabling, by the LPD, the shock detector.

7. A method comprising:

receiving, by a leadless pacing device (LPD), an indication of a detected cardiac arrhythmia eligible for anti-tachyarrhythmia shock therapy, wherein the LPD comprises a set of electrodes and is configured to be implanted within a heart of a patient;

in response to receiving the indication, enabling, by the LPD, a shock detector configured to detect delivery of anti-tachyarrhythmia shock therapy, wherein the LPD comprises the shock detector;

detecting, by the shock detector, delivery of anti-tachyarrhythmia shock therapy; and

in response to the detection, delivering, by the LPD and via at least a subset of the set of electrodes, post-shock pacing therapy to the heart of the patient; and

wherein detecting delivery of anti-tachyarrhythmia shock therapy comprises detecting a first delivery of anti-tachyarrhythmia shock therapy, and wherein the method further comprises;

detecting a second delivery of anti-tachyarrhythmia shock therapy; and

in response to the detection of the second delivery of anti-tachyarrhythmia shock therapy, re-starting, by the LPD, delivery of post-shock pacing therapy to the heart of the patient.

8. A method comprising:

receiving, by a leadless pacing device (LPD), an indication of a detected cardiac arrhythmia eligible for anti-tachyarrhythmia shock therapy, wherein the LPD comprises a set of electrodes and is configured to be implanted within a heart of a patient;

in response to receiving the indication, enabling, by the LPD, a shock detector configured to detect delivery of anti-tachyarrhythmia shock therapy, wherein the LPD comprises the shock detector;

detecting, by the shock detector, delivery of anti-tachyarrhythmia shock therapy; and

in response to the detection, delivering, by the LPD and via at least a subset of the set of electrodes, post-shock pacing therapy to the heart of the patient; and

further comprising;

tracking, by the LPD, a period of time following delivery of post-shock pacing therapy;

determining, by the LPD, that the period of time exceeds a timeout threshold; and

in response to the determination, terminating, by the LPD, delivery of post-shock pacing therapy.

9. A subcutaneous implantable cardioverter defibrillator (SICD), the SICD comprising:

a housing configured to be implanted in a patient external to a rib cage of the patient;

one or more electrodes configured to be disposed external to the patient'"'"'s heart;

a shock module configured to at least partially deliver anti-tachyarrhythmia shock therapy to a patient via the one or more electrodes;

a communication module configured to at least one of transmit or receive communication messages between a leadless pacing device (LPD) configured to be implanted within a heart of the patient;

a sensing module configured to sense an electrical signal from the heart of the patient via the one or more electrodes; and

a processor configured to;

detect a tachyarrhythmia within the sensed electrical signal;

determine, based on the detected tachyarrhythmia, to deliver anti-tachyarrhythmia shock therapy to the patient to treat the detected tachyarrhythmia; and

transmit, via the communication module and prior to delivering anti-tachyarrhythmia shock therapy, a communication message to the LPD requesting the LPD deliver anti-tachycardia pacing to the heart of the patient.