Distributed subcutaneous defibrillation system

• US 20040220626A1
• Filed: 04/07/2004
• Published: 11/04/2004
• Est. Priority Date: 04/11/2003
• Status: Abandoned Application

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Wagner, Darrell Orvin
• Application Number:
  US10/819,896
• Publication Number:
  US 20040220626A1
• Time in Patent Office: Days
• US Class Current: 607/4
• CPC Class Codes: A61N 1/05 for implantation or insertion into the body, e.g. heart electrode A61N1/06 takes precedence
• CPC Class Codes: A61N 1/0568 with drug delivery
• CPC Class Codes: A61N 1/0587 Epicardial electrode systems; Endocardial electrodes piercing the pericardium
• CPC Class Codes: A61N 1/36542 controlled by body motion, e.g. acceleration
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters
• CPC Class Codes: A61N 1/3956 Implantable devices for applying electric shocks to the heart, e.g. for cardioversion
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

An implantable cardiac device includes first and second cans configured for subcutaneous, non-intrathoracic placement. Device circuitry is housed within and distributed between the first and second cans, including at least detection circuitry, energy delivery circuitry, and control circuitry. Communications circuitry may be included for communicating with a patient-external device. A lead may define a common potential and/or include a control line coupling the cans. Each of the first and second cans may include one or more sense and/or defibrillation electrodes. The cans may be coupled using only a wireless communications. Cardiac therapy may include bi-phasic or multi-phasic pulses concurrent, phased, and/or delayed between the two cans. Embodiments of methods in accordance with the present invention involve providing a first and second can of a cardiac therapy delivery device, each housing circuitry to deliver cardiac therapy concurrently, delayed and/or phased between the two cans.

Claims

1. An implantable cardiac device, comprising;

a plurality of implantable cans, each of the cans configured for subcutaneous, non-intrathoracic placement relative to a heart of a patient; and

device circuitry housed within and distributed between the plurality of cans, the device circuitry comprising at least detection circuitry, energy delivery circuitry, and control circuitry, the energy delivery circuitry configured to deliver a cardiac therapy to the patient'"'"'s heart.

2. The device of claim 1, wherein the device circuitry comprises communications circuitry for effecting communications with a patient-external device.

3. The device of claim 1, wherein the energy delivery circuitry comprises defibrillation energy delivery circuitry.

4. The device of claim 1, wherein the energy delivery circuitry comprises pacing energy delivery circuitry.

5. The device of claim 1, wherein the control circuitry and detection circuitry are housed in a first can of the plurality of cans, and the energy delivery circuitry is housed in a second can of the plurality of cans.

6. The device of claim 1, wherein a lead is coupled to a first can and a second can of the plurality of cans, the lead comprising a conductor defining a common potential for the first and second cans.

7. The device of claim 1, wherein a lead is coupled to a first can and a second can of the plurality of cans, the lead comprising a control line that couples together the device circuitry respectively housed in the first and second cans.

8. The device of claim 1, wherein a lead is coupled to a first can and a second can of the plurality of cans, the lead comprising a power supply line.

9. The device of claim 1, further comprising a power source provided in one of the plurality of cans.

10. The device of claim 1, further comprising at least two power sources provided in at least two of the plurality of cans.

11. The device of claim 1, further comprising a first power source coupled to the energy delivery circuitry and a second power source coupled to at least the detection and control circuitry.

12. The device of claim 1, wherein each of a first can and a second can of the plurality of cans comprises one or more sense electrodes.

13. The device of claim 1, wherein each of a first can and a second can of the plurality of cans comprises one or more defibrillation electrodes.

14. The device of claim 1, wherein a first can of the plurality of cans is coupled to a second can of the plurality of cans using only a wireless communication coupling.

15. The device of claim 1, wherein a first can of the plurality of cans is coupled to a second can of the plurality of cans using a wireless communication coupling and a lead coupling.

16. The device of claim 1, wherein the cardiac therapy comprises a bi-phasic pulse, a first phase of the bi-phasic pulse delivered by a first can of the plurality of cans and a second phase of the bi-phasic pulse delivered by a second can of the plurality of cans.

17. The device of claim 1, wherein the cardiac therapy comprises a multi-phasic pulse, each phase of the multi-phasic pulse delivered by different ones of the plurality of cans.

18. The device of claim 1, wherein the energy delivery circuitry is provided in each of the plurality of cans, and wherein the control circuitry coordinates delayed energy delivery from one of the plurality of cans relative to other ones of the plurality of cans.

19. The device of claim 1, wherein the energy delivery circuitry is provided in each of the plurality of cans, and wherein the control circuitry coordinates substantially simultaneous energy delivery the plurality of cans.

20. An implantable cardiac device, comprising;

a first can configured for subcutaneous, non-intrathoracic placement relative to a heart of a patient;

a second can configured for subcutaneous, non-intrathoracic placement relative to the patient'"'"'s heart;

device circuitry housed within and distributed between the first and second cans, the device circuitry comprising at least detection circuitry and control circuitry;

a first energy storage device and first energy delivery circuitry housed in the first can, the first energy delivery circuitry coupled to the first energy storage device and configured to deliver a cardiac therapy to the patient'"'"'s heart; and

second energy delivery circuitry housed within the second can and configured to deliver a cardiac therapy to the patient in coordination with the first energy delivery circuitry.

21. The device of claim 20, wherein the first and second energy delivery circuitry are conductively coupled in series.

22. The device of claim 20, wherein an output of the first energy delivery circuitry is electrically coupled to at least a portion of the first can, an output of the second energy delivery circuitry is electrically coupled to at least a portion of the second can, and the first and second energy delivery circuitry are conductively coupled in series.

23. The device of claim 20, wherein the first and second energy delivery circuitry are conductively coupled in series, and a combined output defibrillation voltage of the first and second energy delivery circuitry is greater than about 800 Volts.

24. The device of claim 20, wherein an output stage of the first and second energy delivery circuitry comprises a current-limiting field-effect transistor.

25. The device of claim 20, wherein an output stage of the first and second energy delivery circuitry comprises an insulated gate bipolar transistor.

26. The device of claim 20, wherein the first energy delivery circuitry comprises a first insulated gate bipolar transistor, the second energy delivery circuitry comprises a second insulated gate bipolar transistor, and the first and second insulated gate bipolar transistors are connected in series.

27. The device of claim 20, wherein the first energy delivery circuitry comprises a first transistor, the second energy delivery circuitry comprises a second transistor, and the first and second transistors are configured to provide a combined output energy greater than about 40 Joules.

28. The device of claim 20, wherein the first energy delivery circuitry comprises a first transistor, the second energy delivery circuitry comprises a second transistor, and the first and second transistors are configured to provide a combined output energy greater than about 100 Joules.

29. The device of claim 20, wherein the first can is electrically coupled to the second can using a conductor, a potential of the conductor defining a common potential between the first can and the second can.

30. The device of claim 20, wherein the first can is coupled to the second can using only a wireless communication coupling.

31. The device of claim 20, wherein:

the first energy delivery circuitry further comprises;

a first output terminal, a first input terminal, and a first capacitor, the first input terminal coupled to the first capacitor; and

a first switch coupled between the first input terminal and the first output terminal; and

the second energy delivery circuitry further comprises;

a second output terminal, a second input terminal, and a second capacitor, the second input terminal coupled to the second capacitor; and

a second switch coupled between the second input terminal and the second output terminal;

wherein the first output terminal is electrically coupled to the second input terminal.

32. The device of claim 20, wherein:

the first energy delivery circuitry further comprises;

a first input terminal, a first output terminal, and a first capacitor; and

a first switch and a second switch respectively coupled between the first input terminal and the first output terminal; and

the second energy delivery circuitry further comprises;

a second input terminal, a second output terminal, and a second capacitor; and

a third switch and a fourth switch respectively coupled between the second input terminal and the second output terminal;

wherein the first output terminal is electrically coupled to the second input terminal.

33. A method, comprising:

providing a first can of a cardiac therapy delivery device configured for subcutaneous, non-intrathoracic placement relative to a heart of a patient;

providing a second can of the cardiac therapy delivery device configured for subcutaneous, non-intrathoracic placement relative to the patient'"'"'s heart, each of the first and second cans housing circuitry of the cardiac therapy delivery device; and

delivering a cardiac therapy to the patient'"'"'s heart using each of the first and second cans.

34. The method of claim 33, wherein the cardiac therapy is delivered by each of the first and second cans concurrently.

35. The method of claim 33, wherein delivering the cardiac therapy comprises delaying energy delivery by the second can relative to energy delivery by the first can.

36. The method of claim 33, wherein one of the first and second cans defines a first electrode for the cardiac therapy delivery device, and the other of the first and second cans defines a second electrode for the cardiac therapy delivery device.

37. The method of claim 33, wherein each of the first and second cans defines an electrode of a first polarity for the cardiac therapy delivery device, and a conductor coupled between the first and second cans defines an electrode of a second polarity for the cardiac therapy delivery device.

38. The method of claim 33, further comprising detecting cardiac activity using one of the first and second cans.

39. The method of claim 33, further comprising detecting cardiac activity using each of the first and second cans.

40. The method of claim 33, further comprising detecting cardiac activity using one of the first and second cans, and delivering the cardiac therapy from the other of the first and second cans.

41. The method of claim 33, further comprising supplying power to the circuitry of the cardiac therapy delivery device from one of the first and second cans.

42. The method of claim 33, further comprising supplying power to the circuitry of the cardiac therapy delivery device from each of the first and second cans.

43. The method of claim 33, further comprising supplying energy for the cardiac therapy delivery from one of the first and second cans.

44. The method of claim 33, further comprising supplying energy for the cardiac therapy delivery from each of the first and second cans.

45. The method of claim 33, further comprising positioning the first and second cans in relation to a heart so that a majority of ventricular tissue is included within a volume defined between the first and second cans.

46. The method of claim 33, further comprising:

positioning the first can in relation to a superior aspect of the heart; and

positioning the second can in relation to an inferior aspect of the heart.

47. The method of claim 33, further comprising positioning one of the first and second cans parallel to a ventricular free wall and extending a predetermined distance beyond an apex of the patient'"'"'s heart.

48. The method of claim 33, further comprising switchably coupling the first can to the second can for delivering the cardiac therapy.

49. The method of claim 33, further comprising switchably coupling the first can to the second can in series for delivering the cardiac therapy.

50. The method of claim 33, further comprising delivering a shock to the patient'"'"'s heart, the shock having a potential greater than about 800 Volts.

51. The method of claim 33, further comprising delivering a shock to the patient'"'"'s heart, the shock having a potential greater than about 1200 Volts.

52. The method of claim 33, further comprising delivering a shock to the patient'"'"'s heart, the shock having a total energy greater than about 40 Joules.

53. The method of claim 33, further comprising delivering a shock to the patient'"'"'s heart, the shock having a total energy greater than about 100 Joules.

54. The method of claim 33, further comprising delivering a shock to the patient'"'"'s heart, the shock comprising a multi-phasic pulse, at least a first phase of the multi-phasic pulse delivered by the first can and at least a second phase of the multi-phasic pulse delivered by the second can.

55. An implantable cardiac device, comprising;

a first can configured for subcutaneous, non-intrathoracic placement relative to a heart of a patient;

a second can configured for subcutaneous, non-intrathoracic placement relative to the patient'"'"'s heart, each of the first and second cans comprising means for housing circuitry of the implantable cardiac device; and

means for delivering cardiac therapy to a patient'"'"'s heart using each of the first and second cans.

56. The device of claim 55, wherein the delivering means comprises means for storing and discharging defibrillation therapy energy, the storing and discharging means housed in one of the first and second cans.

57. The device of claim 55, wherein the delivering means comprises means for storing and discharging defibrillation therapy energy, the storing and discharging means housed in each of the first and second cans.

58. The device of claim 55, further comprising means for detecting activity of the heart, the detecting means housed in one of the first and second cans.

59. The device of claim 55, further comprising means for detecting activity of the heart, the detecting means housed in each of the first and second cans.

60. The device of claim 55, further comprising means for detecting activity of the heart, and the delivering means comprises means for storing and discharging defibrillation therapy energy, wherein:

the storing and discharging means is housed in one of the first and second cans; and

the detecting means is housed in the other of the first and second cans.

61. The device of claim 55, wherein the delivering means comprises means for delivering a shock to cardiac tissue included within a volume defined between the first and second cans, the shock having a total energy greater than about 40 Joules.

62. The device of claim 55, wherein the delivering means comprises means for delivering a shock to cardiac tissue included within a volume defined between the first and second cans, the shock having a potential greater than about 800 Volts.