Overcharged final countershock for an implantable cardioverter defibrillator and method
First Claim
1. A method for operating an implantable cardioverter defibrillator device electrically connected to two or more implanted discharge electrodes located in a human patient to treat myocardial fibrillation, the method comprising the device implemented steps of:
- a) sensing for a myocardial fibrillation in a human patient;
b) charging a capacitive charge storage system at least once to a voltage value at or below a nominal maximum voltage in response to sensing the myocardial fibrillation;
c) discharging the capacitive charge storage system through the two or more implanted discharge electrodes;
d) recharging the capacitive charge storage system at least once to an overcharged voltage in excess of the nominal maximum voltage in response to a sensing of a persistent myocardial fibrillation which the at least one discharge according to step (c) failed to treat; and
e) discharging the capacitive charge storage system through the two or more implanted discharge electrodes to effect a final treatment for the myocardial fibrillation.
4 Assignments
0 Petitions
Accused Products
Abstract
An implantable cardioverter defibrillator (ICD) device in operated in an overcharged final countershock condition so as to provide greater efficacy and broader treatment modality for the device. Instead of delivering a repeated series of up to five countershocks at the maximum rated charging voltage in response to a persistent ventricular arrhythmia as is done in existing ICD systems, an overcharged final countershock is delivered for which the electrolytic capacitor charge storage system of the ICD system is charged at a voltage that exceeds a maximum voltage specification. By delivering an overcharged final countershock, the present invention increases the chances of reversing a persistent ventricular arrhythmia which has become increasingly resistant to electrical therapy the longer the arrhythmia persists. As there is little to no risk in overcharging electrolytic capacitors for delivering the overcharged final countershock, and in fact the added electrical energy may overcome the increasing resistance to electrical countershock therapy, the present invention can deliver a more efficacious programmed therapy regimen than is available on existing ICD systems.
23 Citations
31 Claims
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1. A method for operating an implantable cardioverter defibrillator device electrically connected to two or more implanted discharge electrodes located in a human patient to treat myocardial fibrillation, the method comprising the device implemented steps of:
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a) sensing for a myocardial fibrillation in a human patient; b) charging a capacitive charge storage system at least once to a voltage value at or below a nominal maximum voltage in response to sensing the myocardial fibrillation; c) discharging the capacitive charge storage system through the two or more implanted discharge electrodes; d) recharging the capacitive charge storage system at least once to an overcharged voltage in excess of the nominal maximum voltage in response to a sensing of a persistent myocardial fibrillation which the at least one discharge according to step (c) failed to treat; and e) discharging the capacitive charge storage system through the two or more implanted discharge electrodes to effect a final treatment for the myocardial fibrillation. - View Dependent Claims (2, 3, 4)
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5. A method for operating an implantable cardioverter defibrillator device electrically connected to two or more implanted discharge electrodes located in a human patient to treat myocardial fibrillation, the method comprising the device implemented steps of:
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a) sensing for myocardial fibrillation in the human patient; b) charging a capacitive charge storage system at least once to a maximum nominal voltage in response to sensing a myocardial fibrillation; c) discharging the capacitive charge storage system through the two or more implanted discharge electrodes to effect treatment of the myocardial fibrillation; d) reverting immediately to sensing for myocardial fibrillation; e) repeating steps (b)-(d) a first predetermined number of times if step (d) senses a failure to treat the myocardial fibrillation; f) switching to an overcharged voltage operation if step (d) senses a failure to treat the myocardial fibrillation and the first predetermined number of times have been exceeded; g) overcharging the capacitive charge storage system beyond the maximum nominal voltage; h) discharging the overcharged capacitive charge storage system through the two or more implanted discharge electrodes to effect a final treatment of the myocardial fibrillation; i) reverting immediately to sensing for myocardial fibrillation; j) repeating steps (f)-(h) a second predetermined number of times if step (i) senses a persistent failure to treat the myocardial fibrillation; and k) stopping all myocardial fibrillation treatment efforts after the second predetermined number of times have been exceeded without success in treating the myocardial fibrillation. - View Dependent Claims (6, 7)
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8. An implantable cardioverter defibrillator apparatus electrically connected to two or more implanted discharge electrodes adapted to be located in a human patient for treating myocardial arrhythmias comprising:
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a) sensing means for sensing a myocardial arrhythmia in the human patient; b) capacitive charge storage means electrically connected to the two or more implanted electrodes for storing an electrical charge; c) power source means for charging the capacitive charge storage means to a charging voltage; d) control means for selectively controlling the power source means and the capacitive charge storage means in response to the sensing of the myocardial arrhythmia in order to deliver at least one electrical countershock to the two or more electrodes in accordance with a programmable therapy regimen stored in the apparatus, the control means including; d0) means for storing the programmable therapy regimen; d1) means for regulating a charging voltage applied by the power source means to the capacitive charge storage means in response to a charging voltage value indicated in the programmable therapy regimen; d2) means for selectively discharging the capacitive charge storage means as an electrical countershock in response to a reconfirmed sensing of the myocardial fibrillation by the sensing means; d3) means for counting a successive number of failed electrical countershocks in the programmable therapy regimen when the sensing means determines that the electrical countershock was not successful in treating the myocardial fibrillation; and d4) means for resetting the means for counting to zero after a successful treatment of the myocardial fibrillation, wherein at least one of the voltages in the programmable therapy regimen is a maximum nominal voltage and at least another of the voltages in the programmable therapy regimen is an overcharged voltage greater than the maximum voltage. - View Dependent Claims (9, 10, 11, 12, 13)
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14. A method for operating an implantable cardioverter defibrillator device electrically connected to two or more implanted discharge electrodes located in a human patient to treat myocardial high rate ventricular tachycardia, the method comprising the device implemented steps of:
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a) sensing for a myocardial high rate ventricular tachycardia in a human patient; b) charging a capacitive charge storage system at least once to a voltage value below a nominal maximum voltage in response to sensing the myocardial high rate ventricular tachycardia; c) discharging the capacitive charge storage system in synchrony with an R wave through the two or more implanted discharge electrodes; d) recharging the capacitive charge storage system at least once to a voltage value at the nominal maximum voltage in response to a sensing of a persistent myocardial high rate ventricular tachycardia which the at least one discharge according to step (c) failed to treat; e) discharging the capacitive charge storage system in synchrony with an R wave through the two or more implanted discharge electrodes; f) recharging the capacitive charge storage system at least once to a voltage value at the nominal maximum voltage in response to a sensing of a persistent myocardial high rate ventricular tachycardia which the at least one discharge according to step (e) failed to treat; g) discharging the capacitive charge storage system asynchronously through the two or more implanted discharge electrodes; h) recharging the capacitive charge storage system at least once to an overcharged voltage value in excess of the nominal maximum voltage in response to a sensing of a persistent myocardial high rate ventricular tachycardia which the at least one discharge according to step (g) failed to treat; and i) discharging the capacitive charge storage system asynchronously through the two or more implanted discharge electrodes. - View Dependent Claims (15, 16, 17, 18, 19, 20, 21)
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22. A method for operating an implantable cardioverter defibrillator device electrically connected to two or more implanted discharge electrodes located in a human patient to treat myocardial low rate ventricular tachycardia, the method comprising the device implemented steps of:
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a) sensing for a myocardial low rate ventricular tachycardia in a human patient; b) charging a capacitive charge storage system at least once to a voltage value below a nominal maximum voltage in response to sensing the myocardial low rate ventricular tachycardia; c) discharging the capacitive charge storage system in synchrony with an R wave through the two or more implanted discharge electrodes; d) recharging the capacitive charge storage system at least once to a voltage value at the nominal maximum voltage in response to a sensing of a persistent myocardial low rate ventricular tachycardia which the at least one discharge according to step (c) failed to treat; e) discharging the capacitive charge storage system in synchrony with an R wave through the two or more implanted discharge electrodes; f) recharging the capacitive charge storage system at least once to a voltage value at the nominal maximum voltage in response to a sensing of a persistent myocardial low rate ventricular tachycardia which the at least one discharge according to step (e) failed to treat; g) discharging the capacitive charge storage system asynchronously through the two or more implanted discharge electrodes; h) recharging the capacitive charge storage system at least once to an overcharged voltage value in excess of the nominal maximum voltage in response to a sensing of a persistent myocardial low rate ventricular tachycardia which the at least one discharge according to step (g) failed to treat; and i) discharging the capacitive charge storage system asynchronously through the two or more implanted discharge electrodes. - View Dependent Claims (23, 24, 25, 26, 27, 28, 29, 30, 31)
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Specification