Coordinated medium voltage therapy for improving effectiveness of defibrillation therapy

• US 9,421,391 B2
• Filed: 06/01/2015
• Issued: 08/23/2016
• Est. Priority Date: 12/12/2012
• Status: Active Grant

• Current Assignee: Galvani, Ltd.
• Original Assignee: Galvani, Ltd.
• Inventors: Gilman, Byron, Kroll, Mark
• Primary Examiner(s): Gedeon, Brian T
• Assistant Examiner(s): Tejani, Ankit D
• Application Number:
  US14/727,343
• Publication Number:
  US 20150367138A1
• Time in Patent Office: 449 Days
• Field of Search: None
• US Class Current: 1/1
• CPC Class Codes: A61N 1/36003 of motor muscles, e.g. for walking assistance
• CPC Class Codes: A61N 1/3621 for treating or preventing abnormally high heart rate
• CPC Class Codes: A61N 1/3918 characterised by shock pathway, e.g. by electrode configuration
• CPC Class Codes: A61N 1/3925 Monitoring; Protecting
• CPC Class Codes: A61N 1/3962 in combination with another heart therapy
• CPC Class Codes: A61N 1/3987 characterised by the timing or triggering of the shock

Abstract

Automated treatment of arrhythmia utilizing an electrotherapy device. Time-coordinated applications of medium-voltage therapy (MVT) followed by high-voltage therapy (HVT) include a first MVT waveform to a first target region and a second MVT waveform to a second target region, such that the HVT is synchronized relative to a first compression cycle corresponding to activation of the first target region, and to a second compression cycle corresponding to activation of the second target region resulting from the administration of the MVT.

Claims

1. An electrotherapy device for treating cardiac arrhythmia in a patient, the device comprising:

electrotherapy circuitry operatively coupled to a patient interface and including;

a medium voltage therapy (MVT) circuit constructed to administer a MVT via the patient interface to each of a plurality of target regions of the patient, the MVT having an insufficient energy level to shock the heart into a reset state, but having an energy level and a variable waveform that causes musculature in each corresponding target region to be (a) electrically activated into a contracted state, (b) electrically maintained in the contracted state for a compression duration, and (c) thereafter allowed to relax, thereby achieving a forced compression and release of that target region, wherein the plurality of target regions includes a first target region having primarily skeletal musculature, and a second target region having primarily myocardial musculature; and

a high voltage therapy (HVT) circuit constructed to administer a HVT via the patient interface, wherein the HVT is of an energy level sufficient to shock the heart into a reset state; and

a controller circuit operatively coupled to the patient monitoring circuitry and the electrotherapy circuitry, the controller circuit programmed to, in response to a detection of a presence of an arrhythmia treatable by the HVT;

cause the electrotherapy circuitry to administer the MVT, and

cause the electrotherapy circuitry to administer the HVT in coordination with administration of the MVT.

2. The electrotherapy device of claim 1, wherein the patient interface includes a plurality of electrodes, each electrode configured to be positioned in electrical contact with the patient.

3. The electrotherapy device of claim 1, wherein the controller circuit is further programmed to cause the electrotherapy circuitry to administer the MVT as a series of repeated, time-coordinated, applications of a first MVT waveform to the first target region and a second MVT waveform to the second target region.

4. The electrotherapy device of claim 3, wherein the controller circuit is further programmed to cause the electrotherapy circuitry to administer the HVT in time-coordinated response to the applications of the MVT, such that the HVT is synchronized relative to (a) a first compression cycle corresponding to activation of the first target region, and (b) a second compression cycle corresponding to activation of the second target region, resulting from the administration of the MVT.

5. The electrotherapy device of claim 3, wherein the sequence of the time-coordinated applications of the MVT includes the first MVT waveform, followed immediately by the second MVT waveform.

6. The electrotherapy device of claim 5, wherein the second MVT waveform has an amplitude between 10% and 50% of the first MVT waveform.

7. The electrotherapy device of claim 5, wherein the first MVT waveform is applied for a duration of between 200 and 300 milliseconds and wherein the second MVT waveform is applied for a duration of between 200 and 250 milliseconds and initiated during the last 100-150 milliseconds of the first MVT waveform.

8. The electrotherapy device of claim 1, further comprising a patient monitoring circuitry including an arrhythmia monitoring circuit, the patient monitoring circuitry operatively coupled to the patient interface.

9. The electrotherapy device of claim 1, the MVT circuit constructed to administer a MVT via the patient interface to each of a plurality of target regions of the patient, wherein the plurality of target regions includes a first target region having primarily skeletal musculature, and a second target region having primarily myocardial musculature.

11. The electrotherapy device of claim 8, wherein the patient interface includes a plurality of electrodes, each electrode configured to be positioned in electrical contact with the patient.

10. An electrotherapy device for treating cardiac arrhythmia in a patient, the device comprising:

electrotherapy circuitry operatively coupled to a patient interface and including;

a medium voltage therapy (MVT) circuit constructed to administer a MVT via the patient interface to each of a plurality of target regions of the patient; and

a high voltage therapy (HVT) circuit constructed to administer a HVT via the patient interface; and

a controller circuit operatively coupled to the patient monitoring circuitry and the electrotherapy circuitry, the controller circuit programmed to, in response to a detection of a presence of an arrhythmia treatable by the HVT;

cause the electrotherapy circuitry to administer the MVT, the MVT having an insufficient energy level to shock the heart into a reset state but having an energy level and a variable waveform that causes musculature in each corresponding target region to be (a) electrically activated into a contracted state, (b) electrically maintained in the contracted state for a compression duration, and (c) thereafter allowed to relax, thereby achieving a forced compression and release of that target region, wherein the plurality of target regions includes a first target region having primarily skeletal musculature, and a second target region having primarily myocardial musculature; and

cause the electrotherapy circuitry to administer the HVT in coordination with administration of the MVT, wherein the HVT is of an energy level sufficient to shock the heart into a reset state.

12. The electrotherapy device of claim 10, wherein the controller circuit is further programmed to cause the electrotherapy circuitry to administer the MVT as a series of repeated, time-coordinated, applications of a first MVT waveform to the first target region and a second MVT waveform to the second target region.

13. The electrotherapy device of claim 12, wherein the controller circuit is further programmed to cause the electrotherapy circuitry to administer the HVT in time-coordinated response to the applications of the MVT, such that the HVT is synchronized relative to (a) a first compression cycle corresponding to activation of the first target region, and (b) a second compression cycle corresponding to activation of the second target region, resulting from the administration of the MVT.

14. The electrotherapy device of claim 12, wherein the sequence of the time-coordinated applications of the MVT includes the first MVT waveform, followed immediately by the second MVT waveform.

15. The electrotherapy device of claim 14, wherein the second MVT waveform has an amplitude between 10% and 50% of the first MVT waveform.

16. The electrotherapy device of claim 14, wherein the first MVT waveform is applied for a duration of between 200 and 300 milliseconds and wherein the second MVT waveform is applied for a duration of between 200 and 250 milliseconds and initiated during the last 100-150 milliseconds of the first MVT waveform.

17. The electrotherapy device of claim 10, further comprising a patient monitoring circuitry including an arrhythmia monitoring circuit, the patient monitoring circuitry operatively coupled to the patient interface.

18. The electrotherapy device of claim 10, the MVT circuit constructed to administer a MVT via the patient interface to each of a plurality of target regions of the patient, wherein the plurality of target regions includes a first target region having primarily skeletal musculature, and a second target region having primarily myocardial musculature.

19. A method, comprising:

providing an electrotherapy device to a user; and

providing instructions recorded on a tangible medium to the user, the instructions including;

causing the electrotherapy device to initiate operation, the electrotherapy device configured to;

administer medium voltage therapy (MVT) as a series of repeated, time-coordinated, applications of MVT waveforms to first and second target regions of a patient in response to a detection of a presence of an arrhythmia treatable by high-voltage therapy (HVT) based on automated patient monitoring by the electrotherapy device, wherein the first target region has primarily skeletal musculature and the second target region has primarily myocardial musculature; and

administer the HVT in response to the detection of the presence of the arrhythmia treatable by the HVT, and in time-coordinated response to a sequence of the time-coordinated applications of the MVT;

wherein the time-coordinated applications of the MVT include a first MVT waveform to the first target region and a second MVT waveform to the second target region, such that the HVT is synchronized relative to at least one of;

(a) a first compression cycle corresponding to activation of the first target region, and (b) a second compression cycle corresponding to activation of the second target region, resulting from the administration of the MVT.