Defibrillation electrode and method for employing gatling discharge defibrillation

• US 4,969,463 A
• Filed: 06/06/1989
• Issued: 11/13/1990
• Est. Priority Date: 06/06/1989
• Status: Expired due to Term

• Current Assignee: Mirowski Family Ventures LLC
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Heil, Ronald W. Jr., Mirowski, Mieczyslaw, Dahl, Roger W., Bach, Stanley M. Jr.
• Primary Examiner(s): Jaworski, Francis
• Assistant Examiner(s): Mauuel, George
• Application Number:
  US07/361,978
• Time in Patent Office: 525 Days
• Field of Search: 128/419 P, 128/419 D, 128/419 PG
• US Class Current: 607/5
• CPC Class Codes: A61B 2562/043 in a linear array
• CPC Class Codes: A61B 2562/046 in a matrix array
• CPC Class Codes: A61B 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 5/6852 Catheters
• CPC Class Codes: A61N 1/0587 Epicardial electrode systems; Endocardial electrodes piercing the pericardium
• CPC Class Codes: A61N 1/3956 Implantable devices for applying electric shocks to the heart, e.g. for cardioversion

Abstract

An implantable defibrillation/cardioversion system and method comprising an electrode having a plurality of discrete electrically conductive segments. The conductive segments are electrically isolated from each other and electrically connected to a defibrillation/cardioversion unit. An electrical pulse block is generated and chopped into a plurality of discrete pulse segments by the defibrillation/cardioversion unit and applied to the electrode so that each conductive segment receives a particular electrical pulse assigned from the series of pulses. In this way, the concentration of gas generated from ionic current produced by a high energy defibrillation pulse is reduces and more energy is delivered to the heart, thus reducing the required energy input to the electrode. The electrode may be planar or in a catheter electrode configuration.

Claims

1. A defibriliation system for treating arrhythmias of the human hear with at least two implantable defibrillation electrodes for placement on, about, or in the heart for generating an electric field in the heart, the system comprising:

an implantable defibrillation electrode having a discharge surface region adapted for facing and stimulating the heart, said discharge surface region comprising a plurality and a predetermined number of discrete conductive segments;

pulse generating means for generating a series of discrete electrical pulse segments for supplying electrical energy to said discharge surface region; and

directing means for directing select ones of said discrete electrical pulse segments to a particular one or ones of said discrete conductive segments so that only said particular one or ones and less than all of said predetermined number of said discrete conductive segments receive electrical energy from said pulse generating means at any instant of time.

2. The defibrillation system of claim 1, wherein said discrete conductive segments comprise stacked layers of discrete conductive mesh screens.

3. The defibrillation system of claim 1, wherein said discrete conductive segments comprise electrically conductive wires wound around a cardiac catheter.

4. The defibrillation system of claim 1, and further comprising a conductor means for electrically connecting select ones of said conductive segments together.

5. The defibrillation system of claim 1, wherein said pulse generating means comprises means for generating a series of discrete pulse segments within a single pulse.

6. The defibrillation system of claim 1, wherein said discharge surface region is supported entirely by a single defibrillation electrode.

7. A defibrillation system for treating arrhythmias of the human heart with at least two implantable defibrillation electrodes for placement on, about, or in the heart for generating an electric field in the heart, the system comprising:

an implantable defibrillation electrode having a discharge surface region adapted for facing and stimulating the heart, said discharge surface region comprising a plurality and a predetermined number of discrete conductive segments;

pulse generating means for generating an electrical pulse block;

chopping means for chopping said pulse block into discrete pulse segments; and

directing means for directing select ones of said discrete pulse segments to a particular one or ones of said discrete conductive segments so that only said particular one or ones and less than all of said predetermined number of said discrete conductive segments receive electrical energy from said pulse generating means at any instant of time.

8. The defibrillation system of claim 7, wherein said discrete conductive segments comprise electrically conductive wires wound around a cardiac catheter.

9. The defibrillation system of claim 7, wherein said discrete conductive segments comprise stacked layers of discrete conductive mesh screens.

10. The defibrillation system of claim 7, and further including conductive means for electrically connecting together select ones of said discrete conductive segments.

11. A defibrillation system for treating arrhythmias of the human heart with at least two implantable defibrillation electrodes for placement on, about, or in the heart for generating an electric field in the heart, the system comprising:

an implantable defibrillation electrode having a discharge surface region adapted for facing and stimulating the heart, said discharge surface region comprised of a plurality and a predetermined number of discrete conductive segments;

insulation means positioned between said conductive segments for insulating said segments from one another;

a defibrillator unit including a pulse generator for generating an electrical pulse block, means for chopping said pulse block into discrete pulse segments, and means for directing said discrete pulse segments to select ones of said output terminals; and

lead means comprising a plurality of electrical conductors for electrically connecting select ones of said conductive segments on said discharge region of said electrode with said defibrillator unit for directing select ones of said discrete pulse segments to a particular one or ones of said discrete conductive segments so that only said particular one or ones and less than all of said predetermined number of said discrete conductive segments receive electrical energy from said pulse generator at any instant of time.

12. The defibrillation system of claim 11, wherein said means to direct said electrical pulses comprises a switching circuit.

13. The defibrillation system of claim 11, wherein said discrete conductive segments comprise stacked layers of discrete conductive mesh screens.

14. The defibrillation system of claim 11, wherein said discrete conductive segments comprise electrically conductive wires wound around a cardiac catheter.

15. A defibrillation system for treating arrhythmias of the human heart with at least two implantable defibrillation electrodes for placement on or about the heart for generating an electric field in the heart, the system comprising:

at least one implantable defibrillation electrode having a discharge surface region adapted for facing and stimulating the heart, said discharge region comprised of a plurality and a predetermined number of discrete conductive segments, insulation means positioned between conductive segments for insulating said conductive segments from one another, said electrode further including conductor means for electrically connecting select ones of said discrete conductive segments together;

a defibrillator unit including a pulse generator for generating an electrical pulse block, means for chopping said pulse block into discrete pulse segments, and means to direct said discrete pulse segments to select ones of said output terminals; and

a lead having a plurality of electrical conductors for electrically connecting select ones of said conductive segments on said discharge region of said electrode with said defibrillator unit for directing select ones of said discrete pulse segments to a particular one or ones of said discrete conductive segments so that only said particular one or ones and less than all of said predetermined number of said discrete conductive segments receive electrical energy from said pulse generator at any instant of time.

16. The defibrillation system of claim 15, wherein said means to direct said electrical pulses comprises a switching circuit.

17. The electrode of claim 15, wherein said discrete conductive segments comprise electrically conductive wires wound around the length of a catheter.

18. An implantable defibrillation electrode adapted for attachment to the human heart for applying electrical energy to said heart in conjunction with at least one another implantable electrode, said electrode being connected to a pulse generator means for producing a series of discrete pulse segments, the electrode comprising:

a discharge surface region for facing and stimulating the heart, said discharge region comprised of a plurality and a predetermined number of discrete conductive segments, an insulation element positioned on a back surface region of said electrode opposite said discharge surface region; and

lead means for electrically connecting said electrode to said pulse generator so that a particular one or ones of said discrete conductive segments of said discharge region receive select ones of said discrete pulse segments for supplying electrical energy to said discharge surface region so that only said particular one or ones and less than all of said predetermined number of said discrete conductive segments receive electrical energy from said pulse generator at any instant of time.

19. The implantable defibrillation electrode of claim 18, and further including insulator means positioned between said conductive segments for electrically isolating said conductive segments.

20. The electrode of claim 18, wherein said discrete conductive segments comprise stacked layers of discrete conductive mesh screens.

21. The electrode of claim 18, wherein said discrete conductive segments comprise electrically conductive wires wound around a cardiac catheter.

22. The electrode of claim 18, and further comprising conductor means for electrically connecting together select ones of said discrete conductive segments.

23. The electrode of claim 18, wherein said lead means comprises a plurality of electrical conductors, and said pulse generator means further includes a plurality of output terminals for receiving select ones of said discrete pulse segments, and wherein said plurality of electrical conductors electrically connect select ones of said discrete conductive segments with select ones of said output terminals.

24. The implantable defibrillation electrode of claim 18, wherein said discharge surface region is supported entirely by a single defibrillation electrode.

25. A method for stimulating the human heart experiencing an arrhythmia by applying electrical energy to the heart via at least two electrodes implanted on or about said heart, at least one of said electrodes comprising a discharge surface region having a plurality of discrete electrically conductive segments, said electrode being electrically connected to a pulse generator, said pulse generator producing a series of discrete electrical pulse segments which together define a total desired amount of electrical energy, the method comprising the steps of:

(a) applying a discrete electrical pulse segment to a first discrete conductive segment of said electrode at a first instant of time;

(b) applying a discrete electrical pulse segment to a second discrete conductive segment on said electrode at a second instant of time subsequent to said first intent of time; and

(c) repeating steps (a) and (b) a predetermined number of times so that only one discrete conductive segment is energized at any instant of time and until the total desired amount of electrical energy is delivered to the heart.

26. A method for stimulating the human heart experiencing an arrhythmia by applying electrical energy to the heart via at least two electrodes implanted or or in the region of the heart, a first electrode comprising a discharge surface region having a plurality and a predetermined number of discrete electrically conductive segments for stimulating said heart, conductor elements for connecting together select ones of said conductive segments into first and second discrete groups, said electrode being electrically connected to a pulse generator, said pulse generator producing a series of discrete electrical pulse segments which together define a total desired amount of electrical energy, the method comprising the steps of:

(a) applying a discrete electrical pulse segment to said first group of discrete conductive segments on said first electrode at a first instant of time;

(b) applying a discrete electrical pulse segment to said second group of discrete conductive segments on said first electrode at a second instant of time subsequent to said first instant; and

(c) repeating (a) and (b) a predetermined number of times so that only a single group and less than all of said predetermined number of discrete conductive segments is energized at any instant of time and until the total desired amount of electrical energy is delivered to the heart.

27. A method for stimulating the human heart experiencing an arrhythmia by applying electrical energy to the heart via at least two electrodes implanted on or in the region of the heart, a first electrode comprising a discharge surface region having a plurality and a predetermined number of discrete conductive segments for stimulating the heart, the method comprising the steps of:

producing a series of discrete pulse segments; and

directing select ones of said discrete pulse segments to a particular one or ones of said discrete conductive segments so that only said particular one or ones and less than all of said predetermined number of said discrete conductive segments are energized at any instant of time.

28. A method for stimulating the human heart experiencing an arrhythmia by applying electrical energy to the heart via at least two electrodes implanted on or in the region of the heart, a first electrode comprising a discharge surface region having a plurality and a predetermined number of discrete conductive segments for stimulating the heart, the method comprising the steps of:

generating a pulse block;

chopping said pulse block into a series of discrete pulse segments; and

directing select ones of said discrete pulse segments to a particular one or ones of said discrete conductive segments so that only said particular one or ones and less than all of said predetermined number of said discrete conductive segments are energized at any instant of time until said pulse block is exhausted.

29. An implantable defibrillation electrode for attachment to the human heart for applying electrical energy to said heart in conjunction with at least one other implantable electrode, said electrode for being connected to a pulse generator producing a series of discrete pulse segments, said pulse segments being conducted to select ones of a plurality of output terminals of said pulse generator, the electrode comprising:

a discharge surface comprised of a plurality of conductive mesh screens alternately stacked;

a non-conductive mask element extending over substantially the entire discharge surface and having apertures for exposing said conductive mesh screens on the discharge surface;

an insulation element positioned on the surface opposite said discharge surface region; and

a lead having a plurality of electrical conductors for connecting select ones of said output terminals of said pulse generator with select ones of said conductive mesh screens.

30. A defibrillation system for treating arrhythmias of the human heart with at least two implantable defibrillation electrodes for placement on, about, or in the heart for generating an electric field in the heart, the system comprising:

an implantable defibrillation electrode having a discharge surface region adapted for facing and stimulating the heart, said discharge surface region comprising a plurality and a predetermined number of discrete conductive segments;

capacity means for storing and discharging electrical energy;

capacitor charging means for charging said capacitor means to a predetermined voltage;

a plurality of output terminals connected to select ones of said discrete conductive segments of said electrode;

a plurality of switching means, each of said switching means being electrically connected to a first terminal of said capacitor means and capable of being electrically connected to a select one of said output terminals; and

timing generator means connected to said plurality of switching means for generating a triggering sequence signal to trigger select ones of said plurality of switching means to connect a particular one or ones of said discrete conductive segments to said capacitor means for discrete predetermined time intervals as said capacitor means discharges for conveying select ones of said discrete pulse segments to said particular one or ones of said discrete conductive segments so that only said particular one or ones and less than all of said predetermined number of said discrete conductive segments are energized at any instant of time.

31. The system of claim 30, and further comprising a plurality of polarity switching means, each being connected to a second terminal of said capacitor means and to said timing generator means, and connected between each of said switching means and said output terminals, said polarity switching means being controlled by a polarity sequence signal produced by said timing generator means concurrently with said triggering sequence signal for reversing the polarity of said discrete pulse segments conveyed to said discrete conductive segments.

32. A defrillation system for treating arrhythmias of the human heart with at least two implantable defibrillation electrodes for placement on, about, or in the heart for generating an electric field in the heart, the system comprising:

an implantable defibrillation electrode having a discharge surface region adapted for facing and stimulating the heart, said discharge surface region comprising a plurality and a predetermined amount of discrete conductive segments;

generating means for generating electrical energy in the form of a defibrillation waveform; and

directing means for directing said electrical energy to select one or ones of said discrete conductive segments so that only said select one or ones and less than all of said predetermined number of said discrete conductive segments are energized at any instant of time.

33. An implantable defibrillation electrode adapted for attachment to the human heart for applying electrical energy to said heart in conjunction with at least one other implantable electrode, said electrode being connected to a pulse generator means for producing electrical energy in the form of a defibrillation waveform, the electrode comprising:

a discharge surface region for facing and stimulating the heart, said discharge surface region comprised of a plurality and a predetermined number of discrete conductive segments, an insulation element positioned on a back surface region of said electrode opposite said discharge surface region; and

lead means for electrically connecting said electrode to said pulse generator means for directing said electrical energy to select one or ones of said discrete conductive segments so that only said select one or ones and less than all of said predetermined number of said discrete conductive segments are energized at any instant of time.

34. A gatling discharge defibrillation system for treating arrhythmias of the human heart with at least two implantable defibrillation electrodes for placement on, about, or in the heart for generating an electric field in the heart, the system comprising:

an implantable defibrillation electrode having a discharge surface region adapted for facing and stimulating the heart, said discharge surface region comprising a plurality and a predetermined number of discrete conductive segments;

pulse generating means for generating a series of discrete pulse segments; and

directing means for directing select ones of said discrete pulse segments to a particular one or ones of said discrete conductive segments so that only said particular one or ones and less than all of said predetermined number of discrete conductive segments are energized at any instant of time for confining insulative gas produced as a result of the conversion of electric current to ionic current at an interface of said discharge surface region and the heart to each of said particular one or ones of said discrete conductive segments during each of said pulse segments, thereby lowering the amount of insulative gas across the entire discharge surface region to facilitate the conversion of electric current to ionic current across said discharge surface region.

35. A method for performing gatling discharge defibrillation of a fibrillating heart comprising the steps of:

placing at least two defibrilation electrodes on or about the heart;

producing a series of discrete electrical pulse segments which together define a total desired amount of electrical energy;

segmenting at least one of said defibrillation electrodes to define a discharge surface region comprised of a plurality and a predetermined number of discrete conductive segments; and

directing select ones of said discrete electrical pulse segments to a particular one or ones of said discrete conductive segments so that only said particular one or ones and less than all of said predetermined number of said discrete conductive segments are energized at any instant of time.

36. A method for performing gatling discharge defibrillation of a fibrillating heart comprising the steps of:

placing at least two defibrillation electrodes on or about the heart;

segmenting at least one of said defibrillation electrodes to define a discharge surface region comprised of a plurality and a predetermined number of discrete conductive segments;

producing an electrical pulse block of a predetermined duration;

chopping said electrical pulse block into a plurality of discrete electrical pulse segments; and

directing select ones of said discrete electrical pulse segments to a particular one or ones of said discrete conductive segments so that only said particular one or ones and less than all of said predetermined number of said discrete conductive segments is energized at any instant of time until said electrical pulse block is exhausted.

37. A defibrillation system for treating arrhythmias of the human heart with at least two implantable defibrillation electrodes for placement on, about, or in the heart for generating an electric field in the heart, the system comprising:

an implantable defibrillation electrode having a discharge surface region adapted for facing and stimulating the heart, said discharge surface region comprising a plurality of discrete conductive segments in the form stacked layers of discrete conductive mesh screens;

pulse generating means for generating a series of discrete electrical pulse segments for supplying electrical energy to said discharge surface region; and

directing means for directing select ones of said discrete electrical pulse segments to select ones of said discrete conductive segments.

38. A defibrillation system for treating arrhythmias of the human heart with at least two implantable defibrillation electrodes for placement on, about, or in the heart for generating an electric field in the heart, the system comprising:

an implantable defibrillation electrode having a discharge surface region adapted for facing and stimulating the heart, said discharge surface region comprising a plurality of discrete conductive segments in the form of stacked layers of discrete conductive mesh screens;

a pulse generating means for generating an electrical pulse block;

chopping means for chopping said pulse block into discrete pulse segments; and

directing means for directing select ones of said discrete pulse segments to select ones of said discrete conductive segments.

39. A defibrillation system for treating arrhythmias of the human heart with at least two implantable defibrillation electrodes for placement on, about, or in the heart for generating an electric field in the heart, the system comprising:

an implantable defibrillation electrode having a discharge surface region adapted for facing and stimulating the heart, said discharge surface region comprised of a plurality of discrete conductive segments in the form of stacked layers of discrete conductive mesh screens;

insulating means positioned between said conductive segments for insulating said segments from one another;

a defibrillator unit including a pulse generator for generating an electrical pulse block, means for chopping said pulse block into discrete pulse segments, and means for directing said and

lead means comprising a plurality of electrical conductors for electrically connecting select ones of said conductive segments on said discharge region of said electrode with said defibrillator unit for directing select ones of said discrete pulse segments to a select ones of said discrete conductive segments.

40. An implantable defibrillation electrode adapted for attachment to the human heart for applying electrical energy to said heart in conjunction with at least one other implantable electrode, said electrode being connected to a pulse generator means for producing a series of discrete pulse segments, the electrode comprising:

a discharge surface region for facing and stimulating the heart, said discharge region comprised of a plurality of discrete conductive segments in the form of stacked layers of discrete conductive mesh screens, and insulation element positioned on a back surface region of said electrode opposite said discharge surface region; and

lead means for electrically connecting said electrode to said pulse generator for directing select ones of said discrete conductive segments of said discharge region to select ones of said discrete pulse segments for supplying electrical energy to said discharge surface region.

41. A defibrillation system for treating arrhythmias of the human heart with at least two implantable defibrillation electrodes for placement on, about, or in the heart for generating an electric field in the heart, the system comprising:

an implantable defibrillation electrode having a discharge surface region adapted for facing and stimulating the heart, said discharge surface region comprising a plurality of discrete conductive segments;

generating means for generating electrical energy in the form of a defibrillation waveform; and

directing means for directing said electrical energy to select one or ones of said discrete conductive segments so that only a portion of said discharge surface region is energized at any instant of time.