Arrhythmia electrotherapy device and method with provisions for mitigating patient discomfort

An electrotherapy apparatus adapted for subcutaneous implantation for applying far-field pacing therapy for treating a patient experiencing an arrhythmia, the apparatus comprising:

• a power source adapted to supply energy for operation of the apparatus;
• electrotherapy administration circuitry electrically coupled to the power source and to a set of patient terminals, and constructed to generate electrotherapy pulses using the energy from the power source and apply a series of the electrotherapy pulses via the patient terminals in response to a control signal, the electrotherapy pulses being far-field pacing pulses, each delivering sufficient charge, through a set of electrodes positioned subcutaneously in far-field fashion relative to a heart of the patient, to initiate a cardiac cycle;
• monitoring circuitry electrically coupled with the power source and the set of patient terminals, and constructed to monitor the patient for indicia of the arrhythmia;
• controller circuitry electrically coupled with the power source, the electrotherapy administration circuitry, and the monitoring circuitry, the controller circuitry including a processor and a data storage device containing instructions that, when executed by the processor, cause the controller circuitry to read an output of the monitoring circuitry and determine any presence of the arrhythmia based on that output, and to generate the control signal causing the electrotherapy administration circuitry to apply the series of electrotherapy pulses;
• wherein the electrotherapy administration circuitry includes a pulse shaping circuit constructed such that, in operation, the pulse shaping circuit applies a half-wave sinusoidal pulse wave shape for at least a major part of a duration of each pulse, the sinusoidal pulse waves shape including a rising portion and a falling portion.

A method for treating an arrhythmia in a patient using an electrotherapy device, the method comprising:

• monitoring, by the electrotherapy device, the patient for indicia of the arrhythmia;
• determining, by the electrotherapy device, the presence of the arrhythmia based on the indicia;
• applying to the patient, by the electrotherapy device, a series of electrotherapy pulses in response to the presence of the arrhythmia as a result of the determining, each of the pulses of the series having a rising edge, a peak amplitude, and a trailing edge;
• applying, by the electrotherapy device, a first slew rate for a first portion of each rising edge of each pulse of the series of electrotherapy pulses, and a second slew rate for a second portion of each rising edge of each pulse of the series of electrotherapy pulses.

An electrotherapy apparatus for treating a patient experiencing an arrhythmia, the apparatus comprising:

• a power source adapted to supply energy for operation of the apparatus;
• electrotherapy administration circuitry electrically coupled to the power source and to a set of patient terminals, and constructed to generate electrotherapy pulses using the energy from the power source and apply a series of the electrotherapy pulses via the patient terminals in response to a control signal;
• wherein the set of patient terminals are selectively switchably couplable to a plurality different electrodes in response to an electrode selection signal generated by the controller circuitry, wherein each selected subset of the electrodes represents a corresponding electrotherapy application vector;
• monitoring circuitry electrically coupled with the power source and the set of patient terminals, and constructed to monitor the patient for indicia of the arrhythmia;
• controller circuitry electrically coupled with the power source, the electrotherapy administration circuitry, and the monitoring circuitry, the controller circuitry including a processor and a data storage device containing instructions that, when executed by the processor, cause the controller circuitry to:
• read an output of the monitoring circuitry and determine any presence of the arrhythmia based on that output, and to generate the control signal causing the electrotherapy administration circuitry to apply the series of electrotherapy pulses;
• store a plurality of approved electrotherapy application vectors, each one of which is associated with a corresponding set of electrotherapy pulse parameters including a minimum peak pulse amplitude limit established during in-situ testing in the patient;
• execute a parameter setting input module utilizing communication circuitry to accept configuration instructions to vary the electrotherapy application vector.