Method for delivering atrial defibrillation therapy

• US 20030088285A1
• Filed: 12/30/2002
• Published: 05/08/2003
• Est. Priority Date: 09/14/2000
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Morris, Milton M., Lang, Douglas J., Girouard, Steven D., Marcovecchio, Alan F.
• Granted Patent: US 6,687,541 B2
• Time in Patent Office: Days
• US Class Current: 607/5
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/395 for treating atrial fibrillation
• CPC Class Codes: A61N 1/3956 Implantable devices for applying electric shocks to the heart, e.g. for cardioversion
• CPC Class Codes: A61N 1/3987 characterised by the timing or triggering of the shock

Abstract

An apparatus and method for delivering electrical shock therapy in order to treat atrial tachyarrhythmias such as fibrillation is disclosed. In accordance with the method, atrial defibrillation shocks are delivered synchronously with an R wave if the current R-R interval meets one or more safety criteria so as to be considered shockable. A shockable R-R interval may be defined as one that exceeds the previous QT interval by a specified therapy margin. In one embodiment, the previous QT interval is estimated based upon the measured preceding R-R interval.

Claims

1. A system for delivering an atrial defibrillation shock pulse, the system comprising:

an atrial sensing channel to detect atrial fibrillation;

a ventricular sensing channel to sense ventricular depolarizations (R waves);

a shock pulse generator to generate the atrial defibrillation shock pulse; and

a controller coupled to the atrial channel, the ventricular channel, and the shock pulse generator, the controller being programmed to;

measure a first R-R interval associated with a first R-wave;

estimate a first QT interval based on the first R-R interval;

measure a second R-R interval associated with a second R-wave subsequent to the first R-wave; and

deliver the atrial defibrillation shock pulse synchronously with the second R-wave if the second R-R interval is longer than the first QT interval.

2. The system of claim 1, comprising an implantable cardioverter/defibrillator.

3. The system of claim 2, further comprising a pacemaker.

4. The system of claim 1, wherein the controller is programmed to deliver the atrial defibrillation shock pulse synchronously with the second R-wave if the second R-R interval is longer than the first QT interval by a specified therapy margin.

5. The system of claim 4, wherein the controller is programmed to deliver the atrial defibrillation shock pulse synchronously with the second R-wave if:

the second R-R interval is longer than the first QT interval by the specified therapy margin; and

the second R-R interval is longer than a specified minimum value.

6. The system of claim 4, wherein the specified therapy margin is approximately 60 milliseconds.

7. The system of claim 4, wherein the controller is programmed to deliver the atrial defibrillation shock pulse synchronously with the second R-wave if the second R-R interval exceeds a specified sufficiently-long interval irrespective of the length of the first QT interval and the therapy margin.

8. The system of claim 4, further comprising an impedance measurement circuit adapted to detect an impedance signal indicative of ventricular systole for validating the R-wave sensing.

9. A method for delivering an atrial defibrillation shock pulse, the method comprising:

detecting an episode of atrial fibrillation;

sensing ventricular depolarizations (R waves);

measuring a first R-R interval associated with a first R-wave;

estimating a first QT interval based on the first R-R interval;

measuring a second R-R interval associated with a second R-wave subsequent to the first R-wave; and

delivering the atrial defibrillation shock pulse synchronously with the second R-wave if the second R-R interval is longer than the first QT interval.

10. The method of claim 9, wherein delivering the atrial defibrillation shock pulse comprises delivering the atrial defibrillation shock pulse synchronously with the second R-wave if the second R-R interval is longer than the first QT interval by a specified therapy margin.

11. The method of claim 10, wherein delivering the atrial defibrillation shock pulse comprises delivering the atrial defibrillation shock pulse synchronously with the second R-wave if:

the second R-R interval is longer than the first QT interval by the specified therapy margin; and

the second R-R interval is longer than a specified minimum value.

12. The method of claim 11, wherein the specified therapy margin is approximately 60 milliseconds.

13. The method of claim 11, wherein delivering the atrial defibrillation shock pulse comprises delivering the atrial defibrillation shock pulse synchronously with the second R-wave if the second R-R interval exceeds a specified sufficiently-long interval irrespective of the length of the first QT interval and the therapy margin.

14. The method of claim 11, further comprising detecting an impedance signal indicative of ventricular systole to improve a reliability of the R-wave sensing.

15. A method for delivering cardiac defibrillation therapy, the method comprising:

detecting fibrillation;

sensing ventricular depolarizations (R waves);

measuring R-R intervals each associated with one of the R waves;

determining whether a current R-R interval exceeds a specified sufficiently-long interval (SL), the current R-R interval associated with a current R wave;

delivering a defibrillation shock pulse synchronously with the current R wave if the current R-R interval exceeds the SL; and

delivering the defibrillation shock pulse synchronously with a current R wave if;

the current R-R interval exceeds a specified minimum interval (MI); and

the current R-R interval exceeds a value given as K ln (R-R_prev)−

C+TM, wherein K and C are each a specified constant and TM is a specified therapy margin, and R-R_prev is a previous R-R interval associated with an R wave immediately preceding the current R-wave.

16. The method of claim 15, further comprising detecting an impedance signal indicative of ventricular systole, and wherein measuring R-R intervals each associated with one of the R-waves comprises measuring the R-R intervals each associated with the one of the R-waves and an impedance signal detected synchronously with the one of the R-waves.

17. The method of claim 15, further comprising determining values of MI, SL, K, C, and TM based upon population data.

18. The method of claim 15, further comprising tailoring values of MI, SL, K, C, and TM to an individual patient.

19. The method of claim 15, further comprising determining values of MI, SL, K, C, and TM based upon at least one of population data and individual patient data.

20. The method of claim 19, wherein K and C are approximately 166.2 and 715.5, respectively, and wherein the R-R intervals are measured in milliseconds.

21. The method of claim 19, wherein K and C are approximately 185.5 and 812.3, respectively, and wherein the R-R intervals are measured in milliseconds.

22. The method of claim 19, wherein TM is approximately 60 milliseconds.