MEDICAL MONITORING AND TREATMENT DEVICE WITH EXTERNAL PACING

• US 20130325078A1
• Filed: 05/31/2013
• Published: 12/05/2013
• Est. Priority Date: 05/31/2012
• Status: Active Grant

• Current Assignee: Zoll Medical Corporation (Asahi Kasei Corporation)
• Original Assignee: Zoll Medical Corporation (Asahi Kasei Corporation)
• Inventors: Whiting, Jason T., Kaib, Thomas E., Carlson, Rachel H., Frank, Gregory R.
• Granted Patent: US 8,983,597 B2
• Time in Patent Office: Days
• US Class Current: 607/4
• CPC Class Codes: A61B 2562/17 Comprising radiolucent components
• CPC Class Codes: A61B 5/282 Holders for multiple electrodes for introduction into the body A61B5/287
• CPC Class Codes: A61B 5/361 Detecting fibrillation
• CPC Class Codes: A61B 5/6831 Straps, bands or harnesses
• CPC Class Codes: A61N 1/046 Specially adapted for shock therapy, e.g. defibrillation
• CPC Class Codes: A61N 1/0484 Garment electrodes worn by the patient
• CPC Class Codes: A61N 1/3621 for treating or preventing abnormally high heart rate
• CPC Class Codes: A61N 1/3625 External stimulators
• CPC Class Codes: A61N 1/36592 controlled by the heart rate variability
• CPC Class Codes: A61N 1/371 Capture, i.e. successful stimulation
• CPC Class Codes: A61N 1/3925 Monitoring; Protecting
• CPC Class Codes: A61N 1/3987 characterised by the timing or triggering of the shock

Abstract

A non-invasive bodily-attached ambulatory medical monitoring and treatment device with pacing is provided. The noninvasive ambulatory pacing device includes a battery, at least one therapy electrode coupled to the battery, a memory storing information indicative of a patient'"'"'s cardiac activity, and at least one processor coupled to the memory and the at least one therapy electrode. The at least one processor is configured to identify a cardiac arrhythmia within the information and execute at least one pacing routine to treat the identified cardiac arrhythmia.

Claims

1. A non-invasive bodily-attached ambulatory medical monitoring and treatment device comprising:

a battery;

at least one therapy electrode coupled to the battery;

a memory storing information indicative of a patient'"'"'s cardiac activity; and

at least one processor coupled to the memory and the at least one therapy electrode and configured to;

identify a cardiac arrhythmia within the information; and

execute at least one pacing routine to treat the identified cardiac arrhythmia.

2. The device according to claim 1, wherein the cardiac arrhythmia includes bradycardia and the at least one pacing routine is configured to:

determine that a first interval has passed without detection of a heart beat; and

apply, responsive to determining that the first interval has passed, a pacing pulse via the at least one therapy electrode.

3. The device according to claim 2, wherein the first interval is defined by a base pacing rate and a hysteresis rate.

4. The device according to claim 3, wherein the at least one pacing routine is further configured to:

detect an intrinsic heart beat prior to passage of a second interval;

determine a third interval based on the base pacing rate, the hysteresis rate, and a point where the intrinsic heart beat was detected; and

determine whether another intrinsic heart beat occurs within the third interval.

5. The device according to claim 1, wherein the cardiac arrhythmia includes tachycardia and the at least one pacing routine is configured to:

detect a plurality of intrinsic heart beats prior to passage of a first interval, the plurality of intrinsic heart beats having an intrinsic frequency, the first interval being defined by an anti-tachyarrhythmic pacing rate; and

apply, responsive to detecting the intrinsic frequency, a series of pacing pulses via the at least one therapy electrode, the series of pacing pulses having a frequency above the intrinsic frequency.

6. The device according to claim 1, wherein the cardiac arrhythmia includes an erratic heart rate and the at least one pacing routine is configured to:

identify a first series of heart beats within the information, the first series having a lower frequency;

identify a second series of heart beats within the information, the second series a upper frequency; and

apply, responsive to identifying the erratic heart rate, a series of pacing pulses via the at least one therapy electrode, the series of pacing pulses having a frequency above the lower frequency and below the upper frequency.

7. The device according to claim 1, wherein the cardiac arrhythmia includes at least one of asystole and pulseless electrical activity and the at least one pacing routine is configured to:

determine that a first interval has passed without detection of a heart beat; and

apply, responsive to determining that the first interval has passed, a pacing pulse via the at least one therapy electrode.

8. The device according to claim 1, wherein the at least one pacing routine is further configured to:

determine whether the at least one pacing routine resulted in capture; and

adjust, responsive to determining that capture did not result, the characteristics of pacing pulses applied during subsequent executions of the at least one pacing routine.

9. The device according to claim 8, wherein the characteristics of the pacing pulses subject to adjustment include a pulse energy level, a pulse rate, and a pulse width.

10. The device according to claim 1, wherein the at least one pacing routine is further configured to:

determine whether the at least one pacing routine resulted in capture; and

adjust, responsive to determining that capture did result, the characteristics of pacing pulses applied during subsequent executions of the at least one pacing routine.

11. A non-invasive bodily-attached ambulatory defibrillator comprising:

a battery;

at least one therapy electrode coupled to the battery;

a memory storing information indicative of a patient'"'"'s cardiac activity; and

at least one processor coupled to the memory and the at least one therapy electrode and configured to;

identify a cardiac arrhythmia within the information; and

execute at least one pacing routine to treat the identified cardiac arrhythmia.

12. The defibrillator according to claim 11, wherein the cardiac arrhythmia includes bradycardia and the at least one pacing routine is configured to:

determine that a first interval has passed without detection of a heart beat; and

apply, responsive to determining that the first interval has passed, a pacing pulse via the at least one therapy electrode.

13. The defibrillator according to claim 12, wherein the first interval is defined by a base pacing rate and a hysteresis rate.

14. The defibrillator according to claim 13, wherein the at least one pacing routine is further configured to:

detect an intrinsic heart beat prior to passage of a second interval;

determine a third interval based on the base pacing rate, the hysteresis rate, and a point where the intrinsic heart beat was detected; and

determine whether another intrinsic heart beat occurs within the third interval.

15. The defibrillator according to claim 11, wherein the cardiac arrhythmia includes tachycardia and the at least one pacing routine is configured to:

detect a plurality of intrinsic heart beats prior to passage of a first interval, the plurality of intrinsic heart beats having an intrinsic frequency, the first interval being defined by an anti-tachyarrhythmic pacing rate; and

apply, responsive to detecting the intrinsic frequency, a series of pacing pulses via the at least one therapy electrode, the series of pacing pulses having a frequency above the intrinsic frequency.

16. The defibrillator according to claim 15, wherein the at least one pacing routine is further configured to detect, after applying the series of pacing pulses, whether another plurality of intrinsic heart beats occur within a second interval, the second interval being defined by the anti-tachyarrhythmic pacing rate.

17. The defibrillator according to claim 11, wherein the cardiac arrhythmia includes an erratic heart rate and the at least one pacing routine is configured to:

identify a first series of heart beats within the information, the first series having a lower frequency;

identify a second series of heart beats within the information, the second series a upper frequency; and

apply, responsive to identifying the erratic heart rate, a series of pacing pulses via the at least one therapy electrode, the series of pacing pulses having a frequency above the lower frequency and below the upper frequency.

18. The defibrillator according to claim 11, wherein the cardiac arrhythmia includes at least one of asystole and pulseless electrical activity and the at least one pacing routine is configured to:

determine that a first interval has passed without detection of a heart beat; and

apply, responsive to determining that the first interval has passed, a pacing pulse via the at least one therapy electrode.

19. The defibrillator according to claim 18, wherein the at least one pacing routine is further configured to apply a defibrillating shock prior to applying the pacing pulse.

20. The defibrillator according to claim 11, wherein the at least one pacing routine is further configured to:

determine whether the at least one pacing routine resulted in capture; and

adjust, responsive to determining that capture did not result, the characteristics of pacing pulses applied during subsequent executions of the at least one pacing routine.

21. The defibrillator according to claim 20, wherein the characteristics of the pacing pulses subject to adjustment include a pulse energy level, a pulse rate, and a pulse width.

22. The defibrillator according to claim 11, wherein the at least one pacing routine is further configured to:

determine whether the at least one pacing routine resulted in capture; and

adjust, responsive to determining that capture did result, the characteristics of pacing pulses applied during subsequent executions of the at least one pacing routine.

23. A method of treating cardiac dysfunction using a non-invasive bodily-attached ambulatory medical monitoring and treatment device, the method comprising:

identifying, by the non-invasive bodily-attached ambulatory medical monitoring and treatment device, a cardiac arrhythmia within information indicative of a patient'"'"'s cardiac activity; and

executing, by the non-invasive bodily-attached ambulatory medical monitoring and treatment device, at least one pacing routine to treat the identified cardiac arrhythmia.

24. The method according to claim 23, wherein the cardiac arrhythmia includes bradycardia and executing the at least one pacing routine includes:

determining that a first interval has passed without detection of a heart beat; and

applying, responsive to determining that the first interval has passed, a pacing pulse via the at least one therapy electrode.

25. The method according to claim 24, wherein determining that the first interval has passed includes defining the first interval using a base pacing rate and a hysteresis rate.

26. The method according to claim 25, wherein executing the at least one pacing routine includes:

detecting an intrinsic heart beat prior to passage of a second interval;

determining a third interval based on the base pacing rate, the hysteresis rate, and a point where the intrinsic heart beat was detected; and

determining whether another intrinsic heart beat occurs within the third interval.

27. The method according to claim 23, wherein the cardiac arrhythmia includes tachycardia and executing the at least one pacing routine includes:

detecting a plurality of intrinsic heart beats prior to passage of a first interval, the plurality of intrinsic heart beats having an intrinsic frequency, the first interval being defined by an anti-tachyarrhythmic pacing rate; and

applying, responsive to detecting the intrinsic frequency, a series of pacing pulses via the at least one therapy electrode, the series of pacing pulses having a frequency above the intrinsic frequency.

28. The method according to claim 23, wherein the cardiac arrhythmia includes an erratic heart rate and executing the at least one pacing routine includes:

identifying a first series of heart beats within the information, the first series having a lower frequency;

identifying a second series of heart beats within the information, the second series a upper frequency; and

applying, responsive to identifying the erratic heart rate, a series of pacing pulses via the at least one therapy electrode, the series of pacing pulses having a frequency above the lower frequency and below the upper frequency.

29. The method according to claim 23, wherein the cardiac arrhythmia includes at least one of asystole and pulseless electrical activity and executing the at least one pacing routine includes:

determining that a first interval has passed without detection of a heart beat; and

applying, responsive to determining that the first interval has passed, a pacing pulse via the at least one therapy electrode.

30. The method according to claim 29, wherein executing the at least one pacing routine includes applying a defibrillating shock prior to applying the pacing pulse.

31. The method according to claim 23, wherein executing the at least one pacing routine includes:

determining whether the at least one pacing routine resulted in successful capture; and

adjusting, responsive to determining that capture did not result, the characteristics of pacing pulses applied during subsequent executions of the at least one pacing routine.

32. The method according to claim 31, wherein adjusting the characteristics to includes adjusting at least one of a pulse energy level, a pulse rate, and a pulse width.

33. The method according to claim 23, wherein the non-invasive bodily-attached ambulatory medical monitoring and treatment device includes a non-invasive bodily-attached ambulatory defibrillator and identifying the cardiac arrhythmia includes identifying, by the non-invasive bodily-attached ambulatory defibrillator, the cardiac arrhythmia.