SYSTEM FOR NEURALLY-MEDIATED ANTI-ARRHYTHMIC THERAPY

• US 20080086174A1
• Filed: 10/04/2006
• Published: 04/10/2008
• Est. Priority Date: 10/04/2006
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Pastore, Joseph M., Libbus, Imad
• Granted Patent: US 8,983,598 B2
• Time in Patent Office: Days
• US Class Current: 607/5
• CPC Class Codes: A61N 1/0504 Subcutaneous electrodes
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/3956 Implantable devices for applying electric shocks to the heart, e.g. for cardioversion

Abstract

According to an embodiment of a method, a predetermined cardiac activity indicated for an antitachycardia shock is detected. Neural stimulation is applied to lower a defibrillation threshold in preparation for the shock, and the shock is subcutaneously delivered. According to one embodiment, neural stimulation is applied as part of a prophylactic therapy. A predetermined cardiac activity indicated for an antitachycardia shock is detected, and the shock is subcutaneously delivered. Other aspects and embodiments are provided herein.

Claims

1. A method, comprising:

detecting a predetermined cardiac activity indicated for an antitachycardia shock;

applying neural stimulation to lower a defibrillation threshold in preparation for the shock; and

subcutaneously delivering the shock.

2. The method of claim 1, further comprising applying neural stimulation as part of a prophylactic therapy.

3. The method of claim 2, wherein the prophylactic therapy includes intermittent vagal stimulation to prevent ventricular fibrillation.

4. The method of claim 2, wherein the prophylactic therapy includes intermittent vagal stimulation to prevent development of a cardiac disease.

5. The method of claim 2, wherein applying neural stimulation as part of the prophylactic therapy includes monitoring heart rate, and adjusting the neural stimulation if the heart rate falls below a programmable threshold.

6. The method of claim 1, wherein applying neural stimulation to lower a defibrillation threshold includes initiating the neural stimulation to lower the defibrillation threshold less than 10 seconds before delivering the shock.

7. The method of claim 1, wherein applying neural stimulation to lower a defibrillation threshold includes applying neural stimulation for a duration between approximately 5 to approximately 7 seconds.

8. The method of claim 1, wherein subcutaneously delivering the shock includes delivering the shock between at least one electrode on at least one subcutaneously implanted lead and an electrode on a subcutaneously implanted device housing.

9. The method of claim 1, wherein applying neural stimulation to lower a defibrillation threshold includes applying the neural stimulation through a nerve cuff electrode.

10. A method, comprising:

applying neural stimulation as part of a prophylactic therapy;

detecting a predetermined cardiac activity indicated for an antitachycardia shock; and

subcutaneously delivering the shock.

11. The method of claim 10, wherein the prophylactic therapy includes intermittent vagal stimulation to prevent ventricular fibrillation.

12. The method of claim 10, wherein the prophylactic therapy includes intermittent vagal stimulation to prevent development of a cardiac disease.

13. The method of claim 10, wherein applying neural stimulation as part of the prophylactic therapy includes monitoring heart rate, and adjusting the neural stimulation if the heart rate falls below a programmable threshold.

14. A system, comprising:

means for detecting a predetermined cardiac activity indicated for an antitachycardia shock;

means for subcutaneously delivering the shock; and

means for applying a neural stimulation therapy.

15. The system of claim 14, wherein the means for detecting the predetermined cardiac activity includes means for detecting the predetermined cardiac activity using a subcutaneous implantable cardioverter defibrillator (ICD).

16. The system of claim 14, wherein the means for detecting, the means for applying and the means for subcutaneously delivering are provided by a single implantable medical device.

17. The system of claim 14, wherein the means for detecting, the means for applying and the means for subcutaneously delivering are provided by at least two implantable medical devices, including an implantable nerve stimulator and the subcutaneous defibrillator.

18. The system of claim 14, wherein the means for applying a neural stimulation therapy includes means for lowering a defibrillation threshold in preparation for the shock.

19. The system of claim 14, wherein the means for applying a neural stimulation therapy includes means for applying a prophylactic neural stimulation therapy.

20. A system, comprising:

a sensor adapted to detect a predetermined cardiac activity indicated for a defibrillation shock;

a vagal nerve stimulator adapted to deliver vagal nerve stimulation; and

a defibrillator adapted to subcutaneously deliver the defibrillation shock.

21. The system of claim 20, wherein the sensor is adapted to detect the predetermined cardiac activity using at least one electrode, and the defibrillator is adapted to subcutaneously deliver the defibrillation shock using the at least one electrode used to detect the predetermined cardiac activity.

22. The system of claim 20, wherein the vagal nerve stimulator is adapted to deliver vagal nerve stimulation using a nerve cuff electrode.

23. The system of claim 20, including one implantable device housing adapted to house both the vagal nerve stimulator and the defibrillator.

24. The system of claim 20, including a first implantable housing adapted to house the vagal nerve stimulator and a second implantable housing adapted to house the defibrillator.

25. The system of claim 24, wherein the first implantable housing includes the sensor adapted to detect the predetermined cardiac activity.

26. The system of claim 24, wherein the second implantable housing includes the sensor adapted to detect the predetermined cardiac activity.

27. The system of claim 20, wherein the vagal nerve stimulator is adapted to deliver vagal nerve stimulation to lower a defibrillation threshold for the defibrillation shock.

28. The system of claim 20, wherein the vagal nerve stimulator is adapted to deliver vagal nerve stimulation as a prophylactic therapy.

29. An implantable device, comprising:

a shock pulse generator adapted to subcutaneously deliver an antitachycardia shock using at least one subcutaneous lead with at least one electrode;

a cardiac activity sensor adapted to detect cardiac activity signals;

a nerve stimulator generator adapted to deliver vagal nerve stimulation; and

a microprocessor adapted to detect a predetermined cardiac activity indicated for the antitachycardia shock using the cardiac activity detected by the cardiac activity sensor, to control the nerve stimulator generator to deliver vagal nerve stimulation, and to control the shock pulse generator to deliver the antitachycardia shock.

30. The device of claim 29, further comprising at least one lead with one electrode adapted for use in delivering the vagal nerve stimulation from the nerve stimulator generator.

31. The device of claim 29, further comprising at least one satellite electrode adapted for use in wirelessly delivering the vagal nerve stimulation from the nerve stimulator generator.

32. The device of claim 29, wherein the microprocessor is adapted to control the nerve stimulator generator to deliver nerve stimulation to lower a defibrillation threshold in response to detecting the predetermined cardiac activity, and to control the shock pulse generator to deliver the antitachycardia shock after delivering the vagal nerve stimulation.

33. The device of claim 32, wherein the microprocessor is adapted to control the nerve stimulator generator to deliver vagal nerve stimulation to lower a defibrillation threshold for a duration between approximately 5 seconds to approximately 7 seconds.

34. The device of claim 32, wherein the microprocessor is adapted to control the shock pulse generator to deliver the antitachycardia shock within one minute after initiating the vagal nerve stimulation to lower the defibrillation threshold.

35. The device of claim 32, wherein the microprocessor is adapted to control the shock pulse generator to deliver the antitachycardia shock within 10 seconds after initiating the vagal nerve stimulation to lower the defibrillation threshold.

36. The device of claim 29, wherein the microprocessor is adapted to control the nerve stimulator generator to deliver nerve stimulation as part of a prophylactic therapy.

37. A system, comprising:

a neural stimulator adapted to deliver vagal nerve stimulation to lower a defibrillation threshold; and

a subcutaneous implantable cardioverter defibrillator (ICD) adapted to deliver an antitachycardia shock, wherein the neural stimulator and the subcutaneous ICD are adapted to communicate allowing the neural stimulator to lower the defibrillation threshold after an antitachycardia event has occurred in preparation for delivery of the antitachycardia shock.

38. The system of claim 37, wherein the subcutaneous ICD is adapted to detect a predetermined cardiac activity indicated for the antitachycardia shock.

39. The system of claim 37, wherein the neural stimulator is adapted to deliver vagal nerve stimulation to lower the defibrillation threshold for a duration less than 10 seconds before subcutaneous ICD delivers the antitachycardia shock.