Method and device for three-stage atrial cardioversion therapy
First Claim
1. An implantable therapy generator, comprising:
- detection circuitry configured to evaluate one or more sensed cardiac signals representative of atrial activity and detect an atrial arrhythmia;
control circuitry operably connected to the detection circuitry that, in response to the atrial arrhythmia, controls generation and selective delivery of a therapy without confirmation of conversion of the atrial arrhythmia during the therapy, the therapy including;
a first stage set of electrical pulses delivered via a first implantable electrode within a ventricular refractory period to destabilize a reentry associated with the atrial arrhythmia; and
a second stage set of electrical pulses delivered via at least two of the first implantable electrode and a second implantable electrode, the second stage set of electrical pulses to terminate the reentry;
wherein the first stage and the second stage are separated by a delay having a duration between 50 to 400 milliseconds,wherein the first implantable electrode comprises a far field electrode, and wherein the second implantable electrode comprises a near field electrode,wherein the far field electrode is a portion of an exterior surface of a housing of the implantable therapy generator.
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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
25 Claims
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1. An implantable therapy generator, comprising:
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detection circuitry configured to evaluate one or more sensed cardiac signals representative of atrial activity and detect an atrial arrhythmia; control circuitry operably connected to the detection circuitry that, in response to the atrial arrhythmia, controls generation and selective delivery of a therapy without confirmation of conversion of the atrial arrhythmia during the therapy, the therapy including; a first stage set of electrical pulses delivered via a first implantable electrode within a ventricular refractory period to destabilize a reentry associated with the atrial arrhythmia; and a second stage set of electrical pulses delivered via at least two of the first implantable electrode and a second implantable electrode, the second stage set of electrical pulses to terminate the reentry; wherein the first stage and the second stage are separated by a delay having a duration between 50 to 400 milliseconds, wherein the first implantable electrode comprises a far field electrode, and wherein the second implantable electrode comprises a near field electrode, wherein the far field electrode is a portion of an exterior surface of a housing of the implantable therapy generator. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9)
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10. An implantable therapy generator, comprising:
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detection circuitry configured to evaluate one or more sensed cardiac signals representative of atrial activity and detect an atrial arrhythmia; and control circuitry operably connected to the detection circuitry that, in response to the atrial arrhythmia, controls generation and delivery of a therapy without confirmation of conversion of the atrial arrhythmia during the therapy, the therapy including; a first stage set of electrical pulses delivered via a first implantable electrode within a ventricular refractory period to unpin one or more singularities associated with the atrial arrhythmia; a second stage set of electrical pulses delivered via the first implantable electrode to inhibit repinning of the one or more singularities; and a third stage set of electrical pulses delivered via a second implantable electrode to extinguish the one or more singularities; wherein each stage is separated by an inter-stage delay and wherein at least one of the inter-stage delays has a duration of between 50 to 400 milliseconds. - View Dependent Claims (11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22)
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23. A method, comprising:
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providing an implantable therapy generator configured for coupling to a plurality of implantable electrodes; and providing instructions recorded on at least one tangible medium and including; implanting the therapy generator and the plurality of electrodes within a patient; and causing the implanted therapy generator to deliver a three-stage atrial arrhythmia therapy which includes a first stage delivered to the at least one far field electrode for unpinning of one or more singularities associated with an atrial arrhythmia, a second stage delivered to the at least one far field electrode for anti-repinning of the one or more singularities associated with the atrial arrhythmia, and a third stage delivered to the at least one near field electrodes for extinguishing of the one or more singularities associated with the atrial arrhythmia, wherein each stage is separated by an inter-stage delay and wherein at least one of the inter-stage delays has a duration of between 50 to 400 milliseconds. - View Dependent Claims (24)
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25. An implantable therapy generator, comprising:
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detection circuitry configured to evaluate one or more sensed cardiac signals representative of atrial activity and detect an atrial arrhythmia; control circuitry operably connected to the detection circuitry that, in response to the atrial arrhythmia, controls generation and selective delivery of a therapy without confirmation of conversion of the atrial arrhythmia during the therapy, the therapy including; a first stage set of electrical pulses delivered via a first implantable electrode within a ventricular refractory period to destabilize a reentry associated with the atrial arrhythmia; and a second stage set of electrical pulses delivered via at least two of the first implantable electrode and a second implantable electrode, the second stage set of electrical pulses to terminate the reentry; wherein the first stage and the second stage are separated by a delay having a duration between 50 to 400 milliseconds wherein the first stage has a total duration of 30% to 50% of one cycle length of the atrial arrhythmia, the cycle length determined by the detection circuitry based on the one or more sensed cardiac signals.
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Specification