Systems and methods for multi-site cardiac defibrillation using multiple electrode structures

A system for entraining heart tissue comprising

• a pacing module to deliver pacing pulses,
• a controller coupled to the pacing module operable to command the pacing module to deliver pacing pulses having selected pulse characteristics to a heart tissue region,
• a monitoring element to sense electrical events in the heart tissue region and provide a sensed output,
• a processing element coupled to the monitoring element to analyze the sensed outputs according to prescribed criteria and generate an organization-indicating output, which changes in relation to organization of heart rhythm in the heart tissue region, and
• the controller being constructed to alter the pulse characteristics based, at least in part, upon the organization-indicating output.

A method for entraining heart tissue comprising the steps of

• delivering pacing pulses having selected pulse characteristics to a heart tissue region,
• sensing electrical events in the heart tissue region,
• analyzing the sensed electrical events to generate an organization-indicating output, which changes in relation to organization of heart rhythm in the heart tissue region, and
• altering the pulse characteristics based, at least in part, upon the organization-indicating output.

A system for entraining heart tissue comprising

• multiple electrodes,
• a structure constructed to hold the multiple electrodes in a spaced apart array in association with a heart tissue region,
• a pacing module to generate pacing pulses, and
• a controller coupling the pacing module to the array of electrodes held in association with a heart tissue region, the controller being operable in a local pacing mode to deliver pacing pulses to a first number of the electrodes, less than all the electrodes, to entrain a localized area within the heart tissue region, the controller also being operable in successive pacing modes to deliver pacing pulses to a successively greater number of the electrodes to entrain a successively larger area about the localized area.

A method for entraining heart tissue comprising the steps of

• (i) delivering pacing pulses to an array of electrodes held in association with a heart tissue region,
• (ii) controlling the delivering step (i) to deliver pacing pulses to a first number of the electrodes to entrain a first localized area within the heart tissue region,
• (iii) controlling the delivering step (i) to deliver pacing pulses to a second number of the electrodes to entrain a second localized area within the heart tissue region, and
• (iv) controlling the delivering step (i) to merge the first and second localized areas into a combined area to entrain a larger area in the heart tissue region.

A system for defibrillating heart tissue in an atrium comprising

• a monitoring element to sense electrical events in an atrial tissue region undergoing fibrillation and provide a sensed output,
• a processing element coupled to the monitoring element to analyze the sensed output according to prescribed criteria and generate an organization-indicating output, which varies in relation to organization of heart rhythm in the atrial tissue region, the processing element including an assessor that assesses variations in the organization-indication output over time and generates a first status output when improvement in the organization of heart rhythm in the localized area is assessed,
• a pacing module to generate pacing pulses, and
• a controller coupling the pacing module to electrodes held in association with the atrial tissue region, the controller being operable to deliver pacing pulses having pulse characteristics selected to organize heart rhythm in at least a localized area within the atrial tissue region, and
• a defibrillation module constructed and arranged to deliver a low level defibrillation pulse of less than 1 Joule to the entire atrial tissue region upon generation of the first status output.

A method for defibrillating heart tissue in an atrium comprising the steps of

• sensing electrical events in an atrial tissue region undergoing fibrillation,
• generating an organization-indicating output based upon the sensed electrical events, the organization-indicating output varying in relation to organization of heart rhythm sensed in the atrial tissue region,
• locating electrodes in association with the atrial tissue region,
• delivering pacing pulses to the electrodes, the pacing pulses having pulse characteristics selected to organize heart rhythm in at least a localized area within the atrial tissue region,
• assessing variations in the organization-indication output over time, and
• delivering a low level defibrillation pulse of less than 1 Joule to the entire atrial tissue when assessed variations indicate improvement in the organization of heart rhythm in the localized area.

A method for identifying a candidate ablation site in heart tissue comprising the steps of

• holding multiple electrodes along a localized path in association with a heart tissue region subject to fibrillation,
• delivering pacing pulses only along the localized path,
• sensing electrical events along the localized path, and
• generating a candidate ablation site-identification output when the monitoring element senses defibrillation occurring along the localized path as a result of the pacing pulses.