POST-SHOCK TREATMENT IN A SUBCUTANEOUS DEVICE

• US 20070055314A1
• Filed: 10/30/2006
• Published: 03/08/2007
• Est. Priority Date: 09/18/2000
• Status: Active Grant

• Current Assignee: Cameron Incorporated (Schlumberger NV)
• Original Assignee: Cameron Incorporated (Schlumberger NV)
• Inventors: RISSMANN, WILLIAM, BARDY, GUST, CAPPATO, RICCARDO
• Granted Patent: US 9,144,683 B2
• Time in Patent Office: Days
• US Class Current: 607/9
• CPC Class Codes: A61N 1/362 Heart stimulators heart defibrillators A61N1/39
• CPC Class Codes: A61N 1/375 Constructional arrangements, e.g. casings
• CPC Class Codes: A61N 1/3756 Casings with electrodes thereon, e.g. leadless stimulators
• CPC Class Codes: A61N 1/3906 characterised by the form of the shockwave
• 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
• CPC Class Codes: A61N 1/3968 Constructional arrangements, e.g. casings A61N1/375 takes precedence
• CPC Class Codes: A61N 1/3975 Power supply A61N1/378 takes precedence

Abstract

A power supply for an implantable cardioverter-defibrillator for subcutaneous positioning between the third rib and the twelfth rib and using a lead system that does not directly contact a patient'"'"'s heart or reside in the intrathoracic blood vessels and for providing anti-bradycardia pacing energy to the heart, comprising a capacitor subsystem for storing the anti-bradycardia pacing energy for delivery to the patient'"'"'s heart; and a battery subsystem electrically coupled to the capacitor subsystem for providing the anti-bradycardia pacing energy to the capacitor subsystem.

Claims

1. A method of medically treating a person comprising:

determining that a defibrillation stimulus has been applied to the person; and

, if so,

determining whether a rate of cardiac events for the person is below a predetermined level; and

, if so,

applying a series of pacing pulses to the person;

wherein the series of pacing pulses is applied between a first electrode disposed at a subcutaneous location over the person'"'"'s ribs as part of a lead assembly, and a second electrode disposed on a canister implanted in the person, the lead assembly being coupled to the canister.

2. The method of claim 1, wherein the predetermined level is in the range of approximately 20 to approximately 40 beats per minute.

3. The method of claim 2, wherein the series of pacing pulses is applied at a rate of approximately 50 stimuli/minute.

4. The method of claim 1, wherein the series of pacing pulses is applied at a rate in the range of approximately 40 to approximately 120 stimuli/minute.

5. The method of claim 1, wherein the series of pacing pulses includes pulses having peak amplitudes greater than 5 volts.

6. The method of claim 1, wherein the series of pacing pulses includes pulses having peak amplitudes in the range of 5-500 volts.

7. The method of claim 1, wherein the canister is disposed at about the level of the inframammary crease of the person and over the person'"'"'s ribs.

8. The method of claim 1, wherein:

the predetermined level is in the range of approximately 20 to approximately 40 beats per minute;

the series of pacing pulses is applied at a rate in the range of approximately 40 to approximately 120 stimuli/minute;

the series of pacing pulses includes pulses having peak amplitudes in the range of 5-500 volts; and

the canister is disposed at about the level of the inframammary crease of the person and over the person'"'"'s ribs.

9. A method of medically treating a person comprising:

determining that a defibrillation stimulus has been applied to the person; and

, if so,

determining whether a rate of cardiac events for the person is below a predetermined level; and

, if so,

applying a series of pacing pulses to the person in response to the detected bradycardia;

wherein the pacing pulses are applied using subcutaneously located means for stimulating the heart.

10. The method of claim 9, wherein the means for stimulating the heart include a canister having an electrode disposed thereon, the electrode being used as one of an anode or a cathode for at least one of the pacing pulses.

11. The method of claims 9, wherein the means for stimulating the heart are disposed subcutaneously over the person'"'"'s ribs on the left side of the person'"'"'s body.

12. The method of claim 9, wherein the predetermined level is in the range of approximately 20 to approximately 40 beats per minute.

13. The method of claim 9, wherein the series of pacing pulses is applied at a rate of approximately 50 stimuli/minute.

14. The method of claim 9, wherein the series of pacing pulses is applied at a rate in the range of approximately 40 to approximately 120 stimuli/minute.

15. The method of claim 9, wherein the series of pacing pulses includes pulses having peak amplitudes in the range of 5-500 volts.

16. The method of claim 9, wherein:

the predetermined level is in the range of approximately 20 to approximately 40 beats per minute;

the series of pacing pulses is applied at a rate in the range of approximately 40 to approximately 120 stimuli/minute; and

the series of pacing pulses includes pulses having peak amplitudes in the range of 5-500 volts.

17. A method of medically treating a person comprising:

providing cardiac pacing pulses to the person at a first rate, wherein the pacing pulses are provided between a first electrode disposed on a lead assembly of an implantable cardiac stimulus system and a second electrode disposed on a canister of the implantable cardiac stimulus system; and

modifying the first rate in response to a physiologic condition;

wherein the lead assembly is disposed subcutaneously over the ribs of the person.

18. The method of claim 17, wherein the physiologic condition is an activity level of the person.

19. The method of claim 17, wherein the physiologic condition is respiration of the person.

20. The method of claim 17, wherein the physiologic condition relates to the output of a pressure sensor.

21. The method of claim 17, wherein the physiologic condition relates to the output of an oxygenation sensor.

22. The method of claim 17, wherein the canister is disposed at about the inframammary crease, and the method further includes determining that the person is likely experiencing a cardiac arrhythmia.

23. The method of claim 22, wherein the method includes determining that the person is likely experiencing a bradycardia condition.

24. The method of claim 17, wherein the cardiac pacing pulses have peak amplitudes in the range of about 5-500 volts.

25. The method of claim 17, further comprising sensing cardiac activity of the person by observing electrical signals captured between a subcutaneously disposed third electrode disposed on the lead assembly and the second electrode.

26. The method of claim 25, wherein a sensing electrode pair having the second and third electrodes is selected from among several available sensing electrode pairs for use in sensing.