US 5,209,229 A · Apparatus and method employing plural electrode configurations for cardioversion of atrial fibrillation in an arrhythmia control system

Abstract

An implantable device and a method for the automatic detection of atrial arrhythmias and for providing low energy atrial cardioversion therapy for such arrhythmias, with minimal tissue damage and power drain, is disclosed. The device is capable of being incorporated within, and is disclosed as part of, an implantable automatic pacemaker defibrillator/cardioverter having the ability to also provide high energy ventricular defibrillation therapy, as well as dual chamber antitachycardia pacing therapy and bradycardia support pacing. Tripolar atrial and ventricular endocardial leads, each including tip and ring pacing electrodes and a braid cardioverting electrode therein, are employed in conjunction with a subcutaneous electrode lead in delivering therapy from the device to the patient, allowing the device to be implanted in and used by a patient without the need to open the patient's chest cavity. A number of different cardioverting electrode configurations are selectable for the multiple implantable electrodes, and automatic switching from one electrode configuration to another is employed if cardioversion is not achieved using the first configuration.

Claims59

Dependent claims

An implantable atrial cardioverting device for the reversion of atrial tachycardias, comprising:

means for storing electrical energy;
means for detecting the presence of an atrial tachycardia;
an electrode lead system including a plurality of electrode leads therein, each of said leads including a cardioverting electrode having a substantially larger surface area and lower electrode impedance than the surface area and impedance of a pacing lead electrode, at least one of said leads being an atrial endocardial electrode lead;
a plurality of atrial cardioversion electrode configurations, each of said configurations including at least two of said electrode leads;
switching means responsive to the detection of an atrial tachycardia by said detecting means for selectively connecting said energy storage means to one of said atrial cardioversion electrode configurations;
means for setting the level of electrical energy stored in said electrical energy storing means to an appropriate level for an atrial cardioversion shock;
and,
means for discharging said stored electrical energy across said selected atrial cardioversion electrode configuration.

5 more elements

An implantable cardioverting/defibrillating device for the reversion of tachycardias, comprising:

means for storing electrical energy;
means for detecting the presence of an atrial tachycardia;
means for detecting the presence of a ventricular tachycardia;
an electrode lead system including a plurality of electrode leads therein, each of said leads including a cardioverting electrode having a substantially larger surface area and lower electrode impedance than the surface area and impedance of a pacing lead electrode, at least a first one of said leads being an atrial endocardial electrode lead and a second one of said leads being a ventricular endocardial electrode lead;
a plurality of atrial cardioversion electrode configurations, each of said configurations including at least two of said electrode leads;
a plurality of ventricular defibrillating electrode configurations, each of said configurations including at least two of said electrode leads;
first switching means responsive to the detection of an atrial tachycardia by said atrial tachycardia detecting means for selectively connecting said energy storage means to one of said atrial cardioversion electrode configurations;
second switching means responsive to the detection of a ventricular tachycardia by said ventricular tachycardia detecting means for selectively connecting said energy storage means to one of said ventricular defibrillating electrode configurations;
means for setting the level of electrical energy stored in said electrical energy storing means to an appropriate level for an atrial cardioversion shock;
means for setting the level of electrical energy stored in said electrical energy storing means to an appropriate level for a ventricular defibrillation shock;
and,
means for discharging said stored electrical energy across a selected one of said atrial and ventricular electrode configurations.

9 more elements

A method of operating an implantable atrial tachycardia cardioverting device, said device including an electrode lead system having a plurality of electrode leads therein, each of which leads includes a cardioverting electrode having a substantially larger surface area and lower electrode impedance than the surface area and electrode impedance of a pacing lead electrode, at least one of said leads being an atrial endocardial electrode lead, said device further including a plurality of atrial cardioversion electrode configurations, each of said configurations including at least two of said electrode leads, said method comprising the steps of:

A) detecting the presence of an atrial tachycardia;
B) storing a charge of electrical energy at an appropriate level for an atrial cardioversion shock;
C) connecting said stored charge of electrical energy to one of said electrode configurations;
D) delivering cardioversion shock therapy across said one of said electrode configurations;
E) determining whether said shock therapy has reverted said atrial tachycardia and, if it has not,
F) storing another charge of electrical energy at an appropriate level for an atrial cardioversion shock;
G) connecting said stored other charge of electrical energy to another one of said electrode configurations;
and,
H) delivering cardioversion shock therapy across said other one of said electrode configurations.

6 more elements

A method of operating an implantable tachycardia converting device, said device including an electrode lead system having a plurality of electrode leads therein, each of which leads includes a cardioverting electrode having a substantially larger surface area and lower impedance than the surface area and impedance of a pacing lead electrode, at least one of said leads being an atrial endocardial electrode lead and one of said leads being a ventricular endocardial electrode lead, said device further including a plurality of cardioversion electrode configurations, each of said configurations including at least two of said electrode leads, said method comprising the steps of:

A) detecting the presence of a tachycardia and classifying the tachycardia as either an atrial or a ventricular tachycardia;
B) storing a charge of electrical energy at an appropriate level for delivering cardioversion shock therapy corresponding to the type of tachycardia detected;
C) connecting said stored charge of electrical energy to one of said electrode configurations;
D) delivering said corresponding cardioversion shock therapy across said one of said electrode configurations;
E) again detecting the presence of a tachycardia and classifying the tachycardia as either an atrial or a ventricular tachycardia;
F) storing another charge of electrical energy at an appropriate level for delivering cardioversion shock therapy corresponding to the type of the tachycardia detected in step (E);
G) connecting said stored other charge of electrical energy to another one of said electrode configurations;
and,
H) delivering said corresponding cardioversion shock therapy across said other one of said electrode configurations.

6 more elements

Dependencies are inferred from the claim text.

Apparatus and method employing plural electrode configurations for cardioversion of atrial fibrillation in an arrhythmia control system

Life of this patent

Apparatus and method employing plural electrode configurations for cardioversion of atrial fibrillation in an arrhythmia control system

Life of this patent

Abstract

Claims59