Implantable cardiac stimulator for detection and treatment of ventricular arrhythmias
First Claim
1. An implantable cardiac stimulator, comprisingmeans for detecting cardiac arrhythmias in a predetermined heart rate continuum of a patient,means responsive to the detection of an arrhythmia for delivering a predetermined therapy regimen from among a multiplicity of available therapy regimens to treat said detected arrhythmia according to the rate thereof, each of said multiplicity of therapy regimens consisting of prescribed electrical stimuli to be delivered to the patient'"'"'s heart and at least some of said plurality of therapy regimens differing from the others with respect to the aggressiveness of the treatment provided by the respective therapy regimens according to the particular characteristics of the respective stimuli and pattern of delivery thereof, andmeans responsive to a material change of rate of said detected arrhythmia to automatically institute delivery of a different therapy regimen of greater or lesser aggressiveness than that delivered for treatment of the detected arrhythmia prior to said rate change, for treatment of said changed arrhythmia according to whether the rate change is an increase or a decrease from the prior rate, respectively.
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Abstract
An implantable cardiac stimulator integrates the functions of bradycardia and anti-tachycardia pacing-type therapies, and cardioversion and defibrillation shock-type therapies. The stimulator is programmable to provide a multiplicity of hierarchical detection algorithms and therapeutic modalities to detect and treat classes of ventricular tachycardia according to position within rate range classes into which the heart rate continuum is partitioned, and thus according to hemodynamic tolerance, with backup capabilities of defibrillation and bradycardia pacing at the higher and lower regions of the rate continuum outside the range of the ventricular tachycardia classes. Aggressiveness of the therapy is increased with elapsed time and increasing heart rate, and detection criteria are relaxed with increasing heart rate and thus with increasing hemodynamic intolerance of the tachycardia.
839 Citations
65 Claims
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1. An implantable cardiac stimulator, comprising
means for detecting cardiac arrhythmias in a predetermined heart rate continuum of a patient, means responsive to the detection of an arrhythmia for delivering a predetermined therapy regimen from among a multiplicity of available therapy regimens to treat said detected arrhythmia according to the rate thereof, each of said multiplicity of therapy regimens consisting of prescribed electrical stimuli to be delivered to the patient'"'"'s heart and at least some of said plurality of therapy regimens differing from the others with respect to the aggressiveness of the treatment provided by the respective therapy regimens according to the particular characteristics of the respective stimuli and pattern of delivery thereof, and means responsive to a material change of rate of said detected arrhythmia to automatically institute delivery of a different therapy regimen of greater or lesser aggressiveness than that delivered for treatment of the detected arrhythmia prior to said rate change, for treatment of said changed arrhythmia according to whether the rate change is an increase or a decrease from the prior rate, respectively.
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16. An implantable medical device for treating cardiac arrhythmias, comprising
means for dividing the heart rate spectrum into at least three contiguous, successive regions of progressively higher rate ranges, each of said regions representative of a respective class of arrhythmia, means for detecting anywhere within said spectrum an arrhythmia of a patient'"'"'s heart, means for programmably assigning therapies in a regimen for each class according to the rate range thereof, different from the therapy regimens for the other classes, to treat the detected arrhythmia according to the class thereof, and. means responsive to said detected arrhythmia for automatically delivering at least one of the therapies assigned to the respective class of that arrhythmia for application to the patient'"'"'s heart.
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21. A cardiac stimulator for detecting and treating tachyarrhythmias, comprising
means for selectively dividing the heart rate continuum into at least two classes of tachycardia, contiguous to each other and of progressively higher heart rate ranges, the lowest and highest of said classes being bounded respectively by a sinus rate region and a fibrillation region of the continuum, means for selectively adjusting the boundaries between said classes and between the lowest and highest of said classes and the respective sinus rate and fibrillation regions, to correspondingly vary the rate ranges of said classes in a desired manner, means for selectively detecting cardiac episodes within any of said classes and for distinguishing between normal and abnormal tachycardias among such episodes, and means responsive to detection of an abnormal tachycardia for selectively treating same with any of a multiplicity of therapy regimens of selectively varying aggressiveness toward terminating said detected tachycardia.
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30. An implantable medical device for treating cardiac arrhythmias, comprising
means for dividing the heart rate continuum into a plurality of contiguous, progressively higher rate ranges bounded by rates indicative of normal sinus rhythm and fibrillation, respectively, by which to classify an arrhythmia according to rate range within which it arises, means for detecting anywhere within said rate continuum an arrhythmia, said detecting means including means for applying different detection criteria to the different rate ranges, said different detecting criteria being progressively less stringent as said rate ranges become progressively higher, to reflect the increasing hemodynamic intolerance with increasing rate of the arrhythmia and means for stimulating the heart responsive to the detection of an arrhythmia.
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36. An implantable therapy generator for treating ventricular arrhythmias, comprising
means for programmably dividing the heart rate continuum into a plurality of contiguous rate ranges each representing a different tachycardia class by selectively assigning a rate to the boundary between adjacent pairs of the rate ranges, said plurality of rate ranges being bounded at the lower end by a sinus rate region and at the upper end by a fibrillation rate region, means for detecting a tachycardia within any of the tachycardia classes and for distinguishing whether said tachycardia is a normal or abnormal cardiac episode, and means responsive to detection of said tachycardia as an abnormal cardiac episode for delivering to the heart a therapy regimen selected according to the class in which said tachycardia is detected, said regimen differing from at least one of the regimens available to be delivered in response to detection of an abnormal cardiac episode in another of the tachycardia classes.
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49. An implantable medical device for treating ventricular cardiac arrhythmias, comprising
means for programmably dividing a predetermined portion of the heart rate spectrum into a plurality of contiguous, successive regions of progressively higher rate ranges, each region representing a respective class of ventricular tachyarrhythmia, means for detecting anywhere within the predetermined portion of the heart rate spectrum a tachyarrhythmia of a patient'"'"'s heart, means responsive to the detected tachyarrhythmia for automatically delivering a preselected therapy regimen comprising electrical stimuli, adapted to be applied to the ventricles of the patient'"'"'s heart, according to the respective class of the detected tachyarrhythmia, the delivered regimen differing from at least some of a plurality of available preselected therapy regimens respectively assigned to others of said regions for application to the patient'"'"'s heart in response to tachyarrhythmias detected in said other regions.
Specification