# US 2018/0020940 A1 · Implantable cardiac system having an r-spike amplifier > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 2018/0020940 A1 - Document ID: US20180020940A1 - Status: Published application - Kind: A1 - Application number: 15/642,807 - Filed: 2017-07-06 - Published: 2018-01-25 - Earliest claimed: 2016-07-19 - Assignees: BIOTRONIK SE & Co. KG - Applicants: BIOTRONIK SE & Co. KG - Inventors: Thomas Doerr; Dirk Muessig - Web page: https://patentgrep.com/patent/US20180020940A1 ## CPC - A61B 5/352: Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval - A61B 5/346: Analysis of electrocardiograms - A61N 1/365: controlled by a physiological parameter, e.g. heart potential {(evoked response A61N1/371)} - A61N 1/36514: {controlled by a physiological quantity other than heart potential, e.g. blood pressure (controlled by two or more physical parameters A61N1/36585)} - A61N 1/37288: {Communication to several implantable medical devices within one patient} - A61N 1/37512: {Pacemakers} - A61N 1/3756: {Casings with electrodes thereon, e.g. leadless stimulators} - A61N 1/3925: {Monitoring; Protecting} - A61N 1/39622: {Pacing therapy} - A61N 1/3987: {characterised by the timing or triggering of the shock} - A61N 1/3628: {using sub-threshold or non-excitatory signals} - A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D) - A61N: ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY (measurement of bioelectric currents A61B; surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body A61B18/00; anaesthetic apparatus in general A61M; incandescent lamps H01K; infrared radiators for heating H05B) ## Abstract An implantable cardiac system that includes an implantable cardiac pacemaker or leadless pacemaker (iLP) and a second device such as a subcutaneous implantable cardioverter-defibrillator (S-ICD). The pacemaker includes an R-spike amplifier that amplifies stimulated ventricle excitations or R-waves to increase R-wave to T-wave signal to noise ratio and to improve indirect detection of ventricular rhythm classification by the S-ICD. The S-ICD includes an electrode line for defibrillation, a sensing unit and a stimulation detection unit. The S-ICD records a subcutaneous electrocardiogram between shock electrode poles and provides potentially life-saving therapy based thereon. The system significantly increases the specificity and sensitivity of an S-ICD in combination with an implanted cardiac pacemaker or iLP having an R-spike amplifier. ## Claims ### Claim 1 An implantable cardiac system having an R-spike amplifier comprising: an implantable cardiac pacemaker comprising: an electrode; an electrical signal processor coupled with the electrode, wherein the electrical signal processor is configured to detect a ventricle excitation that is either a sensed ventricular excitation or a stimulated ventricular excitation of a heart; and an R-spike amplifier coupled with the electrical signal processor, wherein the R-spike amplifier is configured to amplify the ventricle excitation to create an amplified R-wave or R-spike and output the amplified R-wave and increase an R-wave to T-wave signal to noise ratio associated with the heart. ### Claim 2 (depends on 1) The system according to claim 1, wherein the amplified R-wave is shorter in time duration than the ventricle excitation or longer in the time duration than the ventricle excitation. ### Claim 3 (depends on 1) The system according to claim 1, wherein the amplified R-wave that is output ends before an initial increase in a subsequent T-wave. ### Claim 4 (depends on 1) The system according to claim 1, wherein the implantable cardiac pacemaker is further configured to record a subcutaneous electrocardiogram (ECG) as a time course of electrical activity of the heart, wherein the R-spike amplifier is configured to amplify the ventricle excitation during a fraction of time of the time course of the electrical activity of the heart before a subsequent T-wave and output the amplified R-wave. ### Claim 5 (depends on 1) The system according to claim 1, wherein the implantable cardiac pacemaker is a leadless cardiac pacemaker (iLP) configured to be implanted in a ventricle of the heart. ### Claim 6 (depends on 1) The system according to claim 1, wherein the implantable cardiac pacemaker is further configured to deliver a sub-threshold stimulation pulse after the ventricle excitation is sensed. ### Claim 7 (depends on 1) The system according to claim 1, wherein the implantable cardiac pacemaker is further configured to: deliver a stimulation pulse after the ventricle excitation is sensed based on a heart rate of the heart, such that: when the heart rate is below a first predefined threshold value, the stimulation pulse is delivered as a supra-threshold stimulation pulse; and when the heart rate is above a second predefined threshold value, the stimulation pulse is delivered as a sub-threshold stimulation pulse; and inhibit delivery of the stimulation pulses after the ventricle excitation is sensed based on the heart rate of the heart, such that: when the heart rate lies above the first predefined threshold value and below the second predefined threshold value, the stimulation pulse is not delivered. ### Claim 8 (depends on 1) The system according to claim 1, wherein the implantable cardiac pacemaker further comprises a stimulation electrode and a stimulation unit coupled to the stimulation electrode. ### Claim 9 (depends on 8) The system according to claim 8, wherein the implantable cardiac pacemaker further comprises: a sensing unit coupled to the electrode; and a control unit coupled to the sensing unit, the stimulation electrode and the electrode. ### Claim 10 (depends on 9) The system according to claim 9, wherein the sensing unit is coupled to the electrical signal processor and is configured to transmit an indication to the control unit that indicates natural ventricular activity of the heart. ### Claim 11 (depends on 10) The system according to claim 10, wherein the implantable cardiac pacemaker further comprises an elevation unit, wherein the elevation unit is controlled by the control unit and is configured to deliver an electrical signal increase that corresponds to an R-wave when the control unit receives the indication that indicates the natural ventricular activity or when a stimulation pulse is delivered via the stimulation unit. ### Claim 12 (depends on 11) The system according to claim 11, wherein the electrical signal increase comprises an increase of the R-wave in electrical activity of the heart to form the amplified R-wave or R-spike. ### Claim 13 (depends on 1) The system according to claim 1, wherein the implantable cardiac pacemaker is operated in a VVT operating mode. ### Claim 14 (depends on 1) The system according to claim 1, further comprising: a subcutaneous implantable cardioverter-defibrillator communicatively coupled to the implantable cardiac pacemaker, wherein the subcutaneous implantable cardioverter-defibrillator comprises: an electrode line that comprises two shock electrode poles, wherein the subcutaneous implantable cardioverter-defibrillator is configured to record a second subcutaneous electrocardiogram (ECG) between the two shock electrode poles; a stimulation detection unit coupled with the electrode line wherein the stimulation detection unit is configured to identify and detect a characteristic feature in the subcutaneous electrocardiogram; and a sensing unit coupled with the stimulation detection unit wherein the sensing unit is configured to obtain the characteristic feature in the subcutaneous electrocardiogram and sense the amplified R-wave based on the increase in the R-wave to T-wave signal to noise ratio associated with the heart. ### Claim 15 (depends on 14) The system according to claim 14, wherein the electrical signal processor is further configured to amplify the ventricular tachyarrhythmia that is detected, such that the second subcutaneous electrocardiogram further comprises the ventricular tachyarrhythmia as amplified. ### Claim 16 (depends on 14) The system according to claim 14, wherein the implantable cardiac pacemaker further comprises a pacemaker stimulation detection unit coupled to the electrical signal processor, wherein the pacemaker stimulation detection unit is configured to detect a stimulation from the subcutaneous implantable cardioverter-defibrillator and classify the stimulation as effective or ineffective, and wherein the R-spike amplifier is further configured to amplify stimulated ventricle excitation only when the pacemaker stimulation detection unit classifies the stimulation as effective. ### Claim 17 (depends on 14) The system according to claim 14, wherein the implantable cardiac pacemaker further comprises a classification unit configured to detect and classify ventricular tachyarrhythmia from more than one the ventricle excitation, such that the implantable cardiac pacemaker is further configured to deliver an antitachycardia stimulation when the ventricular tachyarrhythmia is detected, and wherein the subcutaneous implantable cardioverter-defibrillator is further configured to trigger a defibrillation shock when a rate of the antitachycardia stimulation exceeds a predefined ventricular tachyarrhythmia threshold value. ### Claim 18 (depends on 14) The system according to claim 14, wherein the subcutaneous implantable cardioverter-defibrillator further comprises a classification unit configured to detect and classify ventricular tachyarrhythmia or tachycardia and ventricular fibrillation. ### Claim 19 (depends on 14) The system according to claim 14, wherein the sensing unit of the subcutaneous implantable cardioverter-defibrillator is further configured to detect the amplified R-wave and calculate an R-wave to T-wave signal to noise ratio to minimize T-wave over-sensing. ### Claim 20 (depends on 19) The system according to claim 19, wherein the subcutaneous implantable cardioverter-defibrillator is further configured to send a message to the implantable cardiac pacemaker to alter an amplification factor utilized by the R-spike amplifier to create the amplified R-wave based on the R-wave to T-wave signal to noise ratio.