Systems and methods for leadless pacing and shock therapy

• US 9,072,914 B2
• Filed: 02/12/2014
• Issued: 07/07/2015
• 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, Reinke, James D
• Primary Examiner(s): MANUEL, GEORGE C
• Application Number:
  US14/178,711
• Publication Number:
  US 20140214104A1
• Time in Patent Office: 510 Days
• Field of Search: 607/4
• US Class Current: 1/1
• 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 of coordinating operation of a subcutaneous implantable cardioverter defibrillator (SICD) and a pacing device (PD) implanted within a heart of a patient using one-way communication from the SICD to the PD, the method comprising:

determining, by the SICD and based on a detected tachyarrhythmia, to deliver anti-tachyarrhythmia therapy to the patient to treat the detected tachyarrhythmia;

transmitting, by the SICD, a communication from the SICD to the PD requesting the PD deliver anti-tachyarrhythmia therapy to the patient in accordance with a communication protocol;

determining, by the SICD and without direct communication from PD to the SICD in accordance with the communication protocol, that the PD did not deliver anti-tachyarrhythmia therapy; and

adjusting, by the SICD and based on the determination that the PD did not deliver anti-tachyarrhythmia therapy, at least one of a tachyarrhythmia detection criteria and a therapy parameter of the SICD.

2. The method of claim 1, further comprising determining, by the PD, not to deliver anti-tachyarrhythmia therapy, wherein the tachyarrhythmia therapy comprises anti-tachycardia pacing.

3. The method of claim 1, wherein determining by the SICD to deliver anti-tachyarrhythmia therapy comprises determining to deliver anti-tachycardia pacing.

4. The method of claim 1, wherein determining by the SICD to deliver anti-tachyarrhythmia therapy comprises determining to deliver high voltage shock therapy.

5. The method of claim 1, further comprising:

receiving, by the PD, the communication from the SICD requesting the PD deliver anti-tachyarrhythmia therapy to the patient; and

in the absence of a determination by the PD not to deliver anti-tachyarrhythmia therapy, delivering, by the PD, anti-tachyarrhythmia therapy as requested by the SICD.

6. The method of claim 1, wherein adjusting, by the SICD and based on the determination that the PD did not deliver anti-tachyarrhythmia therapy, comprises adjusting a detection parameter and further comprising:

subsequently determining, by the SICD and based on a tachyarrhythmia detected using the adjusted detection parameter to deliver anti-tachyarrhythmia therapy to the patient.

7. The method of claim 1, further comprising:

detecting, by SICD and without direct communication from PD to the SICD in accordance with the communication protocol, the delivery of anti-tachyarrhythmia therapy by the PD;

transmitting, by the SICD to the PD, a communication identifying that the delivered anti-tachyarrhythmia therapy has not captured a rhythm of the heart; and

determining, by the PD, at least one updated parameter value that at least partially defines additional anti-tachyarrhythmia therapy.

8. The method of claim 7, further comprising:

subsequent to delivering anti-tachyarrhythmia therapy that has not captured a rhythm of the heart, delivering, by the PD, anti-tachyarrhythmia therapy defined at least partially by the determined updated parameter value.

9. The method of claim 1, further comprising, subsequent to determining, by the SICD, to deliver anti-tachyarrhythmia therapy:

entering, by the SICD, an anti-tachycardia pacing detection mode;

while operating in the anti-tachycardia pacing detection mode, filtering anti-tachyarrhythmia pacing signals from the sensed signals on one or more detection channels of a sensing module of the SICD.

10. The method of claim 1, further comprising, subsequent to determining, by the SICD, to deliver anti-tachyarrhythmia therapy:

entering, by the SICD, an anti-tachycardia pacing detection mode;

while operating in the anti-tachycardia pacing detection mode, implementing an algorithm that discriminates between intrinsic beats and pacing pulses.

11. The method of claim 1, wherein adjusting at least one of a tachyarrhythmia detection criteria and a therapy parameter comprises adjusting, by the SICD and based on the determination that the PD did not deliver anti-tachyarrhythmia therapy, one or more tachyarrhythmia detection rules to reduce sensitivity to detecting tachyarrhythmias.

12. The method of claim 1, further comprising sending, by the SICD and based on the determination that the PD did not deliver anti-tachycardia pacing, a second communication in accordance with the communication protocol, wherein the SICD sends the second communication using at least one of a different communication vector and a higher power.

13. An implantable cardioverter defibrillator (ICD) comprising:

one or more electrodes configured to be implanted external to a heart of a patient;

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

a communication module configured to transmit communication messages in accordance with a communication protocol to a pacing device (PD) 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 electrical signal sensed by the sensing module;

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

transmit, via the communication module and based on the determination to delivery anti-tachyarrhythmia therapy, a communication message to the PD requesting the PD to deliver anti-tachycardia pacing to the heart of the patient;

determine, without direct communication from PD to the SICD in accordance with the communication protocol, whether the PD delivered anti-tachycardia pacing; and

adjusting, based on the determination of whether the PD delivered anti-tachycardia pacing, operation of the ICD.

14. The ICD of claim 13, wherein the processor determines that the PD did not deliver anti-tachycardia pacing and adjusts operation of the ICD by adjusting a therapy parameter.

15. The ICD of claim 14, wherein the processor adjusts the therapy parameter by terminating charging and ceasing delivery of the anti-tachyarrhythmia therapy.

16. The ICD of claim 13, wherein the processor determines that the PD did not deliver anti-tachycardia pacing and adjusts operation of the ICD by adjusting a tachyarrhythmia detection criteria to reduce sensitivity to detecting tachyarrhythmias.

17. The ICD of claim 13, wherein the processor determines that the PD did not deliver anti-tachycardia pacing and adjusts operation of the ICD by adjusting a tachyarrhythmia detection parameter and subsequently determines, based on a tachyarrhythmia detected using the adjusted detection parameter, to deliver anti-tachyarrhythmia therapy to the patient.

18. The ICD of claim 13, wherein the processor determines that the PD delivered anti-tachycardia pacing and adjusts operation of the ICD by filtering the anti-tachyarrhythmia pacing signals from the electrical signals sensed on one or more detection channels of the sensing module.

19. The ICD of claim 13, wherein the processor determines that the PD delivered anti-tachycardia pacing and adjusts operation of the ICD by implementing an algorithm that discriminates between intrinsic beats and pacing pulses.

20. A method of coordinating operation of a subcutaneous implantable cardioverter defibrillator (SICD) and a pacing device (PD) implanted within a heart of a patient using one-way communication from the SICD to the PD, the method comprising:

determining, by the SICD and based on a detected tachyarrhythmia, to deliver anti-tachyarrhythmia therapy to the patient to treat the detected tachyarrhythmia;

sending, by the SICD, a first communication in accordance with a communication protocol requesting the PD delivery anti-tachycardia pacing;

receiving, by the PD, the first communication from the SICD requesting the PD deliver anti-tachycardia pacing to the heart of the patient;

determining, by the PD, not to deliver anti-tachycardia pacing to the patient;

determining, by the SICD and without direct communication from PD to the SICD in accordance with the communication protocol, that the PD did not anti-tachycardia pacing; and

sending, by the SICD and based on the determination that the PD did not deliver anti-tachycardia pacing, a second communication in accordance with the communication protocol, wherein the second communication is sent using at least one of a different communication vector and a higher power signal.