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Publication numberUS20030036778 A1
Publication typeApplication
Application numberUS 10/150,434
Publication date20 Feb 2003
Filing date17 May 2002
Priority date18 Sep 2000
Also published asUS7149575, US7349736, US7774058, US7774059, US7835790, US8014862, US8145305, US8386037, US8644926, US20050267537, US20070055309, US20070060957, US20070060958, US20070060960, US20110060379, US20110313501, US20120185005, US20130150942
Publication number10150434, 150434, US 2003/0036778 A1, US 2003/036778 A1, US 20030036778 A1, US 20030036778A1, US 2003036778 A1, US 2003036778A1, US-A1-20030036778, US-A1-2003036778, US2003/0036778A1, US2003/036778A1, US20030036778 A1, US20030036778A1, US2003036778 A1, US2003036778A1
InventorsAlan Ostroff, Paul Erlinger, Gust Bardy
Original AssigneeOstroff Alan H., Paul Erlinger, Bardy Gust H.
Export CitationBiBTeX, EndNote, RefMan
External Links: USPTO, USPTO Assignment, Espacenet
Subcutaneous cardiac stimulator device having an anteriorly positioned electrode
US 20030036778 A1
Abstract
A subcutaneous cardiac device includes a subcutaneous electrode and a housing coupled to the subcutaneous electrode by a lead with a lead wire. The subcutaneous electrode is adapted to be implanted in a frontal region of the patient so as to overlap a portion of the patient's heart.
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Claims(40)
We claim:
1. A method of implanting a cardiac device, the method comprising:
implanting an electrode subcutaneously within a frontal region of a patient's chest; and
implanting a housing within the frontal region of the patient's chest, the housing and the subcutaneous electrode cooperating to provide selective antiarrhythmic, sensing and induction therapy.
2. The method of claim 1, wherein the housing is an active housing, and further wherein the housing and the electrode cooperate to provide selective antiarrhythmic, sensing and induction therapy between the housing and the subcutaneous electrode.
3. The method of claim 1, wherein the subcutaneous electrode is positioned within the frontal region of the patient's chest such that is selected to overlap a peripheral region of a patient's heart.
4. The method of claim 1, wherein the subcutaneous electrode is substantially curvilinear in shape.
5. The method of claim 1, further comprising implanting a second subcutaneous electrode.
6. The method of claim 5, wherein the second subcutaneous electrode is positioned within the frontal region of the patient's chest.
7. The method of claim 5, wherein the second subcutaneous electrode is positioned within the lateral region of the patient's chest.
8. The method of claim 5, wherein the housing is inactive, further comprising applying selective antiarrhythmic, sensing and induction therapy between the subcutaneous electrode and the second subcutaneous electrode.
9. The method of claim 5, wherein the housing is inactive, further comprising applying selective antiarrhythmic, sensing and induction therapy between the subcutaneous electrode and the housing.
10. The method of claim 5, wherein the housing is active, further comprising applying selective antiarrhythmic, sensing and induction therapy between the subcutaneous electrode and the second subcutaneous electrode.
11. The method of claim 5, wherein the housing is active, further providing selective antiarrhythmic, sensing and induction therapy between the subcutaneous electrode and the housing and selective antiarrhythmic, sensing and induction therapy between the second subcutaneous electrode and the housing.
12. The method of claim 1, wherein the subcutaneous electrode further comprises a first part and a second part, wherein the subcutaneous electrode senses intrinsic cardiac activity between the first subcutaneous electrode part and the housing and applies shocks between the subcutaneous electrode and the housing.
13. The method of claim 1, wherein the subcutaneous electrode further comprises a first part and a second part, wherein the subcutaneous electrode senses intrinsic cardiac activity between the first subcutaneous electrode part and the second subcutaneous electrode part.
14. The method of claim 5, wherein the subcutaneous electrode further comprises a first part and a second part, wherein the subcutaneous electrode senses intrinsic cardiac activity between the first subcutaneous electrode part and the second subcutaneous electrode.
15. The method of claim 12, wherein the subcutaneous electrode includes a first segment and a second segment, the first segment and the second segment being collinear.
16. The method of claim 12, wherein the subcutaneous electrode includes a first element and a second element, the first element and the second element being spaced from each other and substantially parallel.
17. A method of applying therapy to a patient comprising:
implanting a first electrode in a first subcutaneous electrode position; and
implanting a housing, wherein the first electrode and the housing cooperate to apply selective antiarrhythmic, sensing and induction therapy;
wherein the first subcutaneous electrode position is disposed in a frontal region of the patient's chest, the first subcutaneous electrode position being selected from one of a sternum, a lateral, an upper and a lower position.
18. The method of claim 17, wherein the housing is implanted in a position that is selected from one of a side, an inframammary and a pectoral position.
19. The method of claim 17, wherein the first subcutaneous electrode position is selected on one side of a heart and the housing position is selected on the other side of the heart in the frontal region of the patient.
20. The method of claim 17, wherein the first subcutaneous electrode position and the housing positions are selected perpendicular to each other.
21. The method of claim 17, the method further comprising implanting a second electrode implanted in a second subcutaneous electrode position in the frontal region of the patient.
22. The method of claim 21, wherein the first subcutaneous electrode position and the second subcutaneous electrode position are selected on opposite sides of a heart in the frontal region of the patient.
23. The method of claim 21, wherein selective antiarrhythmic, sensing and induction therapy is applied between the first electrode and the second electrode.
24. The method of claim 21, wherein selective antiarrhythmic, sensing and induction therapy is applied between the first electrode and the housing and selective antiarrhythmic, sensing and induction therapy is applied between the second electrode and the housing.
25. A cardiac device adapted to provide therapy to a patient with a frontal region defined in the chest area, said cardiac device comprising:
a subcutaneous electrode adapted to be disposed in the frontal region;
a housing; and
a lead electrically coupling the subcutaneous electrode and the housing to generate an electrical field therebetween, the subcutaneous electrode and the housing providing selective antiarrhythmic, sensing and induction therapy.
26. The device of claim 25, wherein the subcutaneous electrode is adapted to be implanted in the frontal region of the patient's chest in a position selected to overlap a peripheral region of the heart.
27. The device of claim 25, wherein the subcutaneous electrode is adapted to be implanted in one of a sternum, a lateral, an upper and a lower position selected in the frontal region.
28. The device of claim 25, wherein the housing is adapted to be implanted in one of a side, an inframammary and a pectoral position.
29. The device of claim 25, further comprising implanting a second subcutaneous electrode.
30. The device of claim 29, wherein the second subcutaneous electrode is positioned within the frontal region of the patient's chest.
31. The device of claim 29, wherein the second subcutaneous electrode is positioned within the lateral region of the patient's chest.
32. The device of claim 29, wherein the housing is inactive, further comprising applying selective antiarrhythmic, sensing and induction therapy between the subcutaneous electrode and the second subcutaneous electrode.
33. The device of claim 29, wherein the housing is inactive, further comprising applying selective antiarrhythmic, sensing and induction therapy between the subcutaneous electrode and the housing.
34. The device of claim 29, wherein the housing is active, further comprising applying selective antiarrhythmic, sensing and induction therapy between the subcutaneous electrode and the second subcutaneous electrode.
35. The device of claim 29, wherein the housing is active, further providing selective antiarrhythmic, sensing and induction therapy between the subcutaneous electrode and the housing and selective antiarrhythmic, sensing and induction therapy between the second subcutaneous electrode and the housing.
36. The device of claim 25, wherein the subcutaneous electrode further comprises a first part and a second part, wherein the subcutaneous electrode senses intrinsic cardiac activity between the first subcutaneous electrode part and the housing and applies shocks between the subcutaneous electrode and the housing.
37. The device of claim 25, wherein the subcutaneous electrode further comprises a first part and a second part, wherein the subcutaneous electrode senses intrinsic cardiac activity between the first subcutaneous electrode part and the second subcutaneous electrode part.
38. The device of claim 29, wherein the subcutaneous electrode further comprises a first part and a second part, wherein the subcutaneous electrode senses intrinsic cardiac activity between the first subcutaneous electrode part and the second subcutaneous electrode.
39. The device of claim 36, wherein the subcutaneous electrode includes a first segment and a second segment, the first segment and the second segment being collinear.
40. The device of claim 36, wherein the subcutaneous electrode includes a first element and a second element, the first element and the second element being spaced from each other and substantially parallel.
Description
    RELATED APPLICATIONS
  • [0001]
    This application is a continuation-in-part of co-pending application Ser. No. 10/011,956, filed on Nov. 5, 2001, entitled Flexible Subcutaneous Implantable Cardioverter-Defibrillator which is a continuation-in-part of co-pending application Ser. No. 09/940,599, filed on Aug. 27, 2001, entitled Canister Design for Implantable Cardioverter-Defibrillators, now ______ which is a continuation-in-part of co-pending application Ser. No. 09/663,607, filed on Sep. 18, 2000, entitled Unitary Subcutaneous Only Implantable Cardioverter Defibrillator and Optional Pacer, now ______.
  • FIELD OF THE INVENTION
  • [0002]
    The present invention relates to a device and method for performing electrical cardiac stimulation, including: cardioversion, defibrillation and, optionally, pacing of the heart using subcutaneous electrodes. More specifically, the present invention relates to implantable cardioverter-defibrillator having at least one subcutaneous electrode, wherein the electrode is positioned generally in the frontal portion of the thorax, thereby creating a substantially uniform electric field across a patient's heart.
  • BACKGROUND OF THE INVENTION
  • [0003]
    The heart is a mechanical pump that is stimulated by electrical impulses. The mechanical action of the heart results in blood flow through a person's body. During a normal heartbeat, the right atrium (RA) of the heart fills with blood from veins within the body. The RA then contracts and blood is moved into the heart's right ventricle (RV). When the RV contracts, blood held within the RV is then pumped into the lungs. Blood returning from the lungs moves into the heart's left atrium (LA) and, after LA contraction, is pumped into the heart's left ventricle (LV). Finally, with the contraction of the left ventricle, blood from the LV is pumped throughout the body. Four heart valves keep the blood flowing in the proper directions during this process.
  • [0004]
    The electrical signal that drives the heart's mechanical contraction starts in the sino-atrial node (SA node). The SA node is a collection of specialized heart cells in the right atrium that automatically depolarize (change their potential). The depolarization wavefront that emanates from the SA node passes across all the cells of both atria and results in the heart's atrial contractions. When the advancing wavefront reaches the atrial-ventricular (AV node), it is delayed so that the contracting atria have time to fill the ventricles. The depolarizing wavefront then passes across the ventricles, causing them to contract and to pump blood to the lungs and body. This electrical activity occurs approximately 72 times a minute in a normal individual and is called normal sinus rhythm.
  • [0005]
    Abnormal electrical conditions can occur that can cause the heart to beat irregularly; these irregular beats are known as cardiac arrhythmias. Cardiac arrhythmias fall into two broad categories: slow heart beats or bradyarrhythmia and fast heart beats or tachyarrhythmia. These cardiac arrhythmias are clinically referred to as bradycardia and tachycardia, respectively.
  • [0006]
    Bradycardia often results from abnormal performance of the AV node. During a bradycardial event, stimuli generated by the heart's own natural pacemaker, the SA node, are improperly conducted to the rest of the heart's conduction system. As a result, other stimuli are generated, although their intrinsic rate is below the SA node's intrinsic rate. Clinical symptoms associated with bradycardia include lack of energy and dizziness, among others. These clinical symptoms arise as a result of the heart beating more slowly than usual.
  • [0007]
    Bradycardia has been treated for years with implantable pacemakers. Their primary function is to monitor the heart's intrinsic rhythm and to generate a stimulus strong enough to initiate a cardiac contraction in the absence of the heart's own intrinsic beat. Typically, these pacemakers operate in a demand mode in which the stimulus is applied only if the intrinsic rhythm is below a predetermined threshold.
  • [0008]
    Tachycardia often progresses to cardiac fibrillation, a condition in which synchronization of cell depolarizations is lost, and instead, there is chaotic, almost random electrical stimulations of the heart. Tachycardia often results from ischemic heart disease in which local myocardium performance is compromised and coordinated contraction of heart tissue is lost which leads to a loss of blood flow to the rest of the body. If fibrillation is left untreated, brain death can occur within several minutes, followed by complete death several minutes later.
  • [0009]
    Application of an electrical stimulus to a critical mass of cardiac tissue can be effective to cause the heart to recover from its chaotic condition and resume normal coordinated propagation of electrical stimulation wavefronts that result in the resumption of normal blood flow. Thus, the application of an electrical stimulus can revert a patient's heart to a sinus cardiac rhythm and the chambers of the heart once again act to pump in a coordinated fashion. This process is known as defibrillation.
  • [0010]
    Cardioversion/defibrillation is a technique employed to counter arrhythmic heart conditions including some tachycardias in the atria and/or ventricles. Typically, electrodes are employed to stimulate the heart with high energy electrical impulses or shocks, of a magnitude substantially greater than the intrinsic cardiac signals. The purpose of these high energy signals is to disrupt the generation of the chaotic cardiac signals and cause the heart to revert to a sinus rhythm.
  • [0011]
    There are two kinds of conventional cardioversion/defibrillation systems: internal cardioversion/defibrillation devices, or ICDs, and external automatic defibrillators, or AEDs. An ICD generally includes a housing containing a pulse generator, electrodes and leads connecting the electrodes to the housing. Traditionally, the electrodes of the ICD are implanted transvenously in the cardiac chambers, or alternatively, are attached to the external walls of the heart. Various structures of these types are disclosed in U.S. Pat. Nos. 4,603,705, 4,693,253, 4,944,300, 5,105,810, 4,567,900 and 5,618,287, all incorporated herein by reference.
  • [0012]
    In addition, U.S. Pat. Nos. 5,342,407 and 5,603,732, incorporated herein by reference, disclose an ICD with a pulse generator implanted in the abdomen and two electrodes. In one embodiment (FIG. 22), the two electrodes 188,190 are implanted subcutaneously and disposed in the thoracic region, outside of the ribs and on opposite sides of the heart. In another embodiment (FIG. 23), one electrode 206 is attached to the epicardial tissues and another electrode 200 is disposed inside the rib cage. In a third embodiment (FIG. 24), one electrode 208 is disposed away from the heart and the other electrode 210 is disposed inside the right ventricle. This system is very complicated and it is difficult to implant surgically.
  • [0013]
    Recently, some ICDs have been made with an electrode on the housing of the pulse generator, as illustrated in U.S. Pat. Nos. 5,133,353, 5,261,400, 5,620,477, and 5,658,325, all incorporated herein by reference.
  • [0014]
    ICDs have proven to be very effective for treating various cardiac arrhythmias and are now an established therapy for the management of life threatening cardiac rhythms, such as ventricular fibrillation. However, commercially available ICDs have several disadvantages. First, commercially available ICDs must be implanted using somewhat complex and expensive surgical procedures that are performed by specially trained physicians. Moreover, lead placement procedures require special room equipped for fluoroscopy. These rooms are limited in number and therefore, limit the number of lead placement procedures, and ultimately the number of ICDs, that may be implanted in any given day.
  • [0015]
    Second, commercially available ICDs rely on transvenous leads for the placement of at least one electrode within the cardiac chambers. It has been found that over a period of time, transvenous lead electrodes may get dislodged from the cardiac tissues. Additionally, complications such as broken leads and undesirable tissue formations deposits on the electrodes are not uncommon. These problems are especially acute when leads carry two or more electrodes. Moreover, infection is a concern when implanting leads within a patient's vasculature.
  • [0016]
    Third, removing these ICDs and replacing them, if necessary, also requires complicated surgical procedures that may be more life-threatening than the initial implantation.
  • SUMMARY OF THE INVENTION
  • [0017]
    One embodiment of the present invention provides a subcutaneous cardiac stimulator device adapted to generate an electric field across the heart using at least one subcutaneous electrode positioned at a location selected to minimize the degree of surgical intervention.
  • [0018]
    In yet another embodiment, the present invention provides a subcutaneous cardiac stimulator device that does not include any leads extending into, or touching, a patient's heart or venous system. The electrodes can be positioned in a sternum position, a lateral position, an upper and/or a lower position with respect to the heart.
  • [0019]
    The present invention provides a device, which in one embodiment, has a curvilinear electrode that is positioned subcutaneously in the frontal or chest area of the body such that it overlaps a peripheral region of the heart. The term ‘curvilinear electrode’ is used herein to designate an electrode having an elongated configuration with a substantially uniform cross-section along its length and having a cross-sectional diameter that is much smaller than its length by at least an order of magnitude.
  • [0020]
    The housing of the ICD device of the present invention can be active or inactive. If the housing is active, it is implanted in a position selected to generate an electric field with the electrode so that current passes through the heart and is effective to induce shocks therein. If the housing is inactive, then a separate electrode is also implanted subcutaneously and cooperates with the first electrode to generate the required electric field. Moreover, housing embodiments of the present invention can be implanted in a side position, an inframammary position or a pectoral position in the body.
  • BRIEF DESCRIPTION OF THE DRAWINGS
  • [0021]
    [0021]FIG. 1 shows a block diagram of a subcutaneous cardiac device having one or two subcutaneous electrodes constructed in accordance with this invention;
  • [0022]
    [0022]FIG. 2A is a diagrammatic view of the chest or frontal region of the patient with some of the possible electrode and housing positions in accordance with this invention;
  • [0023]
    [0023]FIG. 2B is a partial diagrammatic view of the side of the patient showing possible positions of the electrode and the housing;
  • [0024]
    [0024]FIGS. 3A and 3B show a frontal view and a side view of an active housing in the inframammary position and an electrode in the upper position;
  • [0025]
    [0025]FIGS. 3C and 3D show the electrical field generated with the configuration of FIGS. 3A and 3B, respectively;
  • [0026]
    [0026]FIGS. 4A and 4B show a frontal and a side view of an inactive housing in the inframammary position with an electrode in the sternum and a second electrode in the lateral position;
  • [0027]
    [0027]FIGS. 4C and 4D show frontal view and a top view of the electrical field generated in the configuration of FIGS. 4A and 4B;
  • [0028]
    [0028]FIGS. 5A and 5B show a frontal view and a side view of an active housing in the side position and an electrode in the sternum position;
  • [0029]
    [0029]FIGS. 6A and 6B show a frontal view and a side view of an inactive housing in the side position and electrodes in the top and lower positions;
  • [0030]
    [0030]FIGS. 7A and 7B show a frontal view and a side view of an active housing in the pectoral position and an electrode in the lower position;
  • [0031]
    [0031]FIGS. 8A and 8B show a frontal view and a side view of an inactive housing in the pectoral position and electrodes in the sternum and lateral positions;
  • [0032]
    [0032]FIGS. 9A and 9B show a frontal view and a side view of an inactive housing on the right side of the heart and electrodes in the top and lower positions;
  • [0033]
    [0033]FIGS. 10A and 10B show a frontal view and a side view of an active housing in the inframammary position and an electrode in sternum position;
  • [0034]
    [0034]FIGS. 10C and 10D show a frontal and a top view of the electrical field generated by the configuration of FIGS. 10A and 10B;
  • [0035]
    [0035]FIGS. 11A and 11B show a frontal and a side view of an active housing in the side position and an electrode in the lower position;
  • [0036]
    [0036]FIGS. 12A and 12B show a frontal and a side view of an active housing and two electrodes in the sternum and lateral positions;
  • [0037]
    [0037]FIG. 12C shows the electrical field generated by one embodiment of the FIG. 12A configuration;
  • [0038]
    [0038]FIG. 13A shows a frontal view of an active housing in the side position with electrodes in the upper and lower positions;
  • [0039]
    [0039]FIG. 13B shows a frontal view of an active housing in the inframammary position and electrodes in the sternum and lateral positions;
  • [0040]
    FIGS. 14A-14D show frontal view configuration of an active housing with an electrode positioned on either side of the sternum;
  • [0041]
    FIGS. 15A-15D show an active housing, a segmented electrode and various stimulations applied therebetween;
  • [0042]
    [0042]FIG. 16 shows an active housing and two electrodes disposed adjacent to the sternum; and
  • [0043]
    [0043]FIG. 17 shows an active housing and two electrodes disposed adjacent to the sternum, one of the electrodes being multi-segmented.
  • DETAILED DESCRIPTION OF THE INVENTION
  • [0044]
    Referring now to the drawings, FIG. 1 shows an implantable cardiac device 10 constructed in accordance with one embodiment of the present invention. The device 10 includes a housing 12 containing a pulse generator (not shown), an electrode 14 and a lead 16. The electrode 14 is connected to the pulse generator through a header 18 disposed on the housing 12.
  • [0045]
    In particular embodiments of the present invention, the housing 12 can act as an active housing. In this embodiment, the housing 12 itself, comprises a second electrode for the ICD device 10. An active canister housing 12 is formed either with a continuously conductive surface, or with a separate conductive zone 20. The conductive surface or zone 20 of an active canister housing 12 is connected electrically to the circuitry disposed in the housing 12. If the whole housing 12 is used as an active electrode, then its surface area presents a low interface resistance with the patient's tissues, thereby lowering the losses in the tissue/electrode interface. In alternative embodiments, the housing 12 may be inactive, in which case the housing 12 is electrically isolated from its internal circuitry.
  • [0046]
    [0046]FIG. 1 further depicts a second electrode 14′ that is connected to the header 18 by a second lead 16′. Particular embodiments of the present invention may utilize a second 16′ or third (not shown) lead with optional electrode.
  • [0047]
    The housing 12 can be a conventional defibrillator housing used for programmable electronic circuitry that senses intrinsic cardiac activity and generates antiarrhythmic therapy (defibrillation shocks and/or pacing pulses) in the usual manner. To facilitate implantation, the circuity contained within the housing can also induce ventricular fibrillation for the purposes of testing the defibrillation threshold (DFT). DFT testing can be accomplished by delivering a shock during the vulnerable period of the cardiac cycle (T-wave) or by rapid pacing approximately 20 to 100 Hz for several seconds or by the application of direct current for several seconds or by the alternating current between 20 and 100 Hz for several seconds.
  • [0048]
    In particular embodiments, the housing 12 has a generally oval shape or a square shape with rounded corners. Although the housing 12 is illustrated as being square or rectangular, the housing 12 may also comprise any additional shapes conventionally known in the art. Moreover, the housing 12 is made of titanium and/or other similar biocompatible materials commonly used for implantable devices.
  • [0049]
    The housing 12 generally comprises a footprint in the range of 30-50 cm and may be about 1.2 cm deep.
  • [0050]
    Electrode 14 is a subcutaneous electrode that is positioned under the skin and refrains from directly contacting the patient's heart. The subcutaneous electrode 14 may embody numerous shapes and sizes. For example, the electrode 14 may be planar, or may have a cross section of other shapes, e.g. circular. The electrode could be made from a coil, it could be braided or woven, or could be made by other similar means. In particular embodiments of the present invention, the electrode 14 is a curvilinear electrode. The term ‘curvilinear electrode’ is used herein to designate an electrode having an elongated rod-shaped configuration which could be straight or could be somewhat curved, and have a substantially uniform cross-section along its length and having a cross-sectional diameter that is much smaller than its length by at least an order of magnitude. Generally, the electrode 14 has a length of about 2-10 cm and a diameter of about 1-5 mm.
  • [0051]
    In electrodes 14 that are curvilinear, the tip of the electrode 14 may be rounded or formed with a dull point, as at 19 to assist its implantation. The electrode 14, or at least its outer surface, is made of an electrically conducting biocompatible material. The electrode 14 is preferably made of the titanium or stainless steel. Other electrode materials, conventionally known in the art, may additionally be used to form the electrode 14. In addition, particular electrode 14 embodiments may be coated with platinum or platinum alloy such as platinum iridium.
  • [0052]
    In general, the electrode 14 is flexible. Implanting a flexible electrode 14 minimizes discomfort associated with the implantation of the electrode 14 within the patient. In order to facilitate insertion of the electrode 14 within the patient, additional supporting mechanisms may be utilized during the insertion process. For example, a removable stylet may be used during the insertion process. After the electrode is properly positioned within the patient, the stylet is then removed from the electrode 14 (for example, from within the aperture formed from a coil electrode); rendering the electrode 14 flexible to conform to the patient's body for its duration. Additional insertion mechanisms, known in the art, may also be utilized to insert the flexible electrode 14. One insertion mechanism, for example, is the use of a peal away rigid sheath.
  • [0053]
    The electrode(s) and the housing 12 can be implanted using various configurations. While these configurations differ in the positioning of the electrode(s) and the housing 12, what they have in common is that least one electrode is disposed in the frontal or anterior region of the patient. The housing or the other electrode is then positioned so that it interfaces with the first electrode to generate an electrical field that passes through the heart and is effective to defibrillate the heart. In particular embodiments, the at least one electrode is disposed in the frontal or anterior region such that it overlaps a peripheral region of the heart as viewed from the front.
  • [0054]
    Four electrode positions and three housing positions are identified in FIGS. 2A and 2B. In these figures, the heart is designated by the letter H, the sternum is indicated by an axis ST, the collar bone is indicated by a line CB and the inframammary crease is indicated by line IC. The lateral outline of the rib cage is indicated by line R and the skin extending outwardly from the rib cage laterally under the armpit is designated by the line SU, while the skin disposed in front of the rib cage is indicated by line SF. Obviously FIGS. 2A and 2B are not to scale, and the various tissues and bone structures shown therein are used to identify the relative locations of the electrode(s) 14, 14′ and the housing 12 with respect to these physiological landmarks. The tunneling path used for the electrode placement is not necessary represented by the path indicated by the lead 16.
  • [0055]
    Four electrode positions are defined herein as positions A, B, C and D. As seen in the Figures, position A is a vertical position on the right side of the heart adjacent to the sternum. This position A is designated herein as the sternum position. Position B is disposed on the left side of the heart opposite from position A. Position B is also designated herein as the lateral position. Position C is a substantially horizontal position near the top of the heart and is designated herein as the upper position. Finally, position D is a substantially horizontal position near the bottom of the heart and is designated the lower position.
  • [0056]
    It is important to note that all four of these electrode positions are disposed subcutaneously, i.e., between the rib cage R and the skin SF in the frontal or anterior chest area. Several of these electrodes positions are further depicted overlapping either the top, bottom, left or right peripheral region of the heart.
  • [0057]
    The tissues bounded by these four electrode positions are generally fatty tissues and/or comprise bony material—both having a relatively high electrical resistivity as compared to the resistivity of the cardiac tissues. Positioning the electrodes in the frontal or anterior chest area allow the naturally forming resistivity differential to better force electric current through the patient's heart, rather than shunting into surrounding tissue.
  • [0058]
    Because the electrode placement of the present invention refrains from accessing the vasculature of the patient, serious risks of infection are greatly reduced. Infections arising from the present invention would be more likely localized and easily treatable. Whereas, infections arising from prior art devices that utilize leads that access the patient's vasculature, tend to pose more serious risks to the patient's health.
  • [0059]
    In addition, positioning the electrodes in the frontal or anterior chest area eliminates the requirement of fluoroscopy. The use of fluoroscopy adds additional cost and risks to an ICD implantation procedure. Specifically, the physician must wear protective lead shielding and utilize specially designed electrophysiology laboratories equipped for fluoroscopy. Electrode placement in the present invention, however, follows predominant anatomical landmarks that are easily accessible, and are highly identifiable. Fluoroscopy, therefore, is not required because the ICD embodiments of the present invention are positioned in the subcutaneous frontal portion of the patient's chest, which is readily accessible to a physician without the need for fluoroscopy.
  • [0060]
    [0060]FIGS. 2A and 2B show three subcutaneous positions X, Y, Z for the housing 12. Position X is disposed on the left side of the rib cage, under the arm, and is designated herein as the side position. Position Y is a frontal position, under the inframammary crease IC and is designated herein as the inframammary position. Finally, position Z is also a frontal position and it corresponds to the conventional position for ICDs, above and to the left of heart under the collarbone CB. This position Z is designated herein as the pectoral position.
  • [0061]
    In the following discussion, the various configurations are now described with the housing being disposed at one of the locations X, Y or Z. Except as noted, for each housing position, two electrode configurations are disclosed: one for an active housing and a single electrode; and a second for an inactive housing, a first electrode and a second electrode.
  • [0062]
    In FIGS. 3A and 3B, the housing 12 is an active housing and is shown implanted at position Y, or inframammary position. The electrode 14 is disposed horizontally in the upper position C. The lead 16 is threaded subcutaneously to the device. As illustrated in the Figures, the housing 12 and electrode 14 are both disposed outside the front portion of the rib cage, with the housing 12 being disposed below the heart H and the electrode 14 being disposed in the upper position at a level with the top portion of the heart H. Thus, in this embodiment, the housing 12 and the electrode 14 are positioned above and below the center of the heart C.
  • [0063]
    The tissues between the housing 12 and the electrode 14 are fatty tissues and/or bony material that have a much higher resistivity then that of the muscle between the ribs. Therefore, when a voltage is applied between the electrode 14 and the housing, current naturally follows the path of least resistance. In the position illustrated in FIGS. 3A and 3B, as with all the other embodiments depicted in the Figures herein, the applied voltage follows the lower conductivity of the heart muscle, and not the fat or bone. The electric field formed across the heart by this position is shown in detail in FIGS. 3C and 3D. Thus, the positions illustrated better direct a sufficient amount of current to be forced through the heart causing its defibrillation.
  • [0064]
    In FIGS. 4A and 4B, the housing 12 is an inactive housing shown implanted in the inframammary position Y and electrodes 14 and 14′ are implanted in the sternum and lateral positions A and B, respectively. In this case, the electric field is established between the electrodes 14 and 14′, as illustrated in FIGS. 4C and 4D. Again, because the tissues between the electrodes are fatty tissues and/or bony material, they have a higher resistivity then the cardiac tissues, and accordingly, electric current flows through the heart, rather than along a direct path between the two electrodes.
  • [0065]
    In FIGS. 5A and 5B, the housing 12 is an active housing implanted in the side position X and electrode 14 is in the sternum position A.
  • [0066]
    In FIGS. 6A and 6B, the housing 12 is an inactive housing implanted at the side position X and the electrodes 14, 14′ are oriented horizontally at the upper and lower positions C and D, respectively.
  • [0067]
    In FIGS. 7A and 7B, the housing 12 is an active housing disposed at the pectoral position Z and electrode 14 is oriented horizontally at the lower position D.
  • [0068]
    In FIGS. 8A and 8B, the housing 12 is an inactive housing disposed at the pectoral position Z and electrodes 14 and 14′ are arranged vertically at the sternum position A and lateral position B, respectively.
  • [0069]
    In FIGS. 9A and 9B, the housing 12 is inactive and is positioned above the heart, between the electrodes 14, 14′ in positions C and D, respectively.
  • [0070]
    In the configurations described so far, an electric field is generated between a first electrode disposed horizontally or vertically along a front portion of the rib cage and either the housing or a second electrode disposed on an opposite side of the heart. However, other configurations may also be used in which the second electrode or housing is disposed along the front portion of the rib cage at a right angle with respect to a longitudinal axis of the first electrode. One such configuration is shown in FIGS. 10A and 10B. In this configuration, the first electrode 14A is disposed in the septum position A and the housing 12 is disposed in the inframammary position Y. As seen in FIGS. 10C and 10D (FIG. 10D being a top view), when a voltage is applied to between these two elements, an electric field is generated through the heart. However, the linear distance between the two elements generating the field has to be sufficiently large to insure that a substantial portion of the electric current passes through the heart and is not shunted directly between the first electrode and the housing. For this reason, the electrode in FIGS. 10A and 10B is shorter than the electrodes in the previous embodiments. For example, the electrode 14A may have half the length of the other electrodes 14, 14′. In addition, the electrode 14A is positioned as far as possible from the housing 12 while still being superimposed on a peripheral region of the heart.
  • [0071]
    [0071]FIGS. 11A and 11B show a configuration in which the active housing is in the side position X and the electrode 14A is in the lower position and has a shorter length.
  • [0072]
    In the following configurations, an active housing 12 is used with two short electrodes 14A, 14A′, the two electrodes being shorted to each other so that the electric field is generated between each electrode and the housing.
  • [0073]
    In FIGS. 12A and 12B the active housing 12 is in pectoral position and the electrodes 14A, 14A′ are in the sternum and lateral positions, respectively. In this configuration, the active housing 12 may generate an electric field with electrode 14A alone. Alternatively, the active housing 12 may generate an electric field with electrode 14A′ alone. Finally, the active housing 12 may generate an electric field with both electrode 14A and electrode 14A′. The electric field created by such an arrangement is depicted in FIG. 12C. In this configuration, the electric field forms a broad wave front that traverses through the heart.
  • [0074]
    In FIG. 13A the active housing is in the side position and the electrodes 14A and 14A′ are in the upper and lower positions, respectively. Similar to FIG. 12A, the active housing 12 may generate at least three distinct electric fields—with electrode 14A alone, with electrode 14A′ alone, and with both electrode 14A and electrode 14A′.
  • [0075]
    In FIG. 13B (which is a front view) the active housing is in the inframammary position and the electrodes 14A, 14A′ are in the sternum and lateral positions, respectively.
  • [0076]
    In the following configurations, an electric field is generated between a first electrode disposed horizontally along a front portion of the rib cage and a housing disposed on the opposite side of the sternum. These embodiments describe a fifth and sixth electrode placement (C′ and D′, respectively). Moreover these embodiments encompass a fourth and fifth housing placement (Y′ and Z′, respectively).
  • [0077]
    In FIG. 14A, the active housing 12 is in the pectoral position on the left side of the sternum (position Z), and the electrode 14 is in a substantially lower horizontal position on the right side of the sternum (position D′).
  • [0078]
    In FIG. 14B, the active housing 12 is in the pectoral position on the right side of the sternum (position Z′), and the electrode 14 is in the substantially lower horizontal position on the left side of the sternum (position D).
  • [0079]
    In FIG. 14C, the active housing 12 is in the inframammary position on the left side of the sternum (position Y), and the electrode 14 is in a substantially upper horizontal position on the right side of the sternum (position C′).
  • [0080]
    In FIG. 14D, the active housing 12 is in the inframammary position on the right side of the sternum (position Y′), and the electrode 14 is in a substantially upper horizontal position on the left side of the sternum (position C).
  • [0081]
    The cardiac device 10 can be used to apply defibrillation and pacing therapy. In the configuration shown in the Figures discussed so far, sensing can be effected by using the same elements that are used for defibrillation and/or pacing. Induction for DFT testing purposes can also use the same elements that are used for defibrillation and/or pacing.
  • [0082]
    Alternatively, separate electrodes can be provided for sensing and/or pacing. In one embodiment shown in FIG. 15A, a segmented electrode 30 is provided which can have approximately the same length as the electrode 14 in FIG. 1. The electrode 30 consists of three segments: an end electrode 32, an intermediate segment 34 made of a non-conductive material and a main electrode 36. The end electrode 32 can have a tip with a reduced diameter, similar to the tip 19 on electrode 14 in FIG. 1.
  • [0083]
    Preferably the three segments have substantially the same cross section so that the electrode 30 can be implanted easily in a tunnel in any of the electrode positions discussed above in a manner similar to electrode 14. The axial length of end electrode 32 can be up to 50% of the total length of the segmented electrode 30. The intermediate segment 34 can have a negligible axial dimension as long as it electrically isolates the end electrode 32 from the main electrode 36.
  • [0084]
    The main electrode 36 is connected to the housing 12 through a lead 38 and a connector 40 attached to the header. Similarly, segment 32 is connected by a lead 42 to header 18 through a connector 44. Alternatively, the two wires 38, 42 can be incorporated into a common lead 46. In this latter configuration, preferably, the segments 34, 36 are hollow to allow the wire 42 to pass therethrough and connect to the end electrode 32, as illustrated in FIG. 15A by the phantom line. Device 10A, shown in FIG. 15A, and incorporating electrode 30, housing 12 and lead 46 can be configured to operate in several modes. In one mode, shown in FIG. 15A, sensing and ventricular shocks can be applied between the main electrode 36 and the housing 12, while pacing can be applied between the end electrode 32 and the housing 12. This embodiment is particularly advantageous because it avoids stimulating the abdomen.
  • [0085]
    [0085]FIGS. 15B, 15C and 15D show other modes of operation. In FIG. 15B a mode is shown wherein pacing, sensing and induction are implemented between the end electrode and the housing and shock is applied between the main electrode and the housing. In FIG. 15C pacing and a shock can be applied between the end electrode 32 and the housing 12. Sensing is accomplished between the main electrode 36 and the housing 12. In addition, a shock can also be applied between the main electrode and the housing 12. Alternatively, during defibrillation the end and the main electrodes could be shorted and shock could be applied between both electrodes and the housing.
  • [0086]
    In FIG. 15D, pacing, sensing, induction and a shock is applied between the end electrode and the housing. A shock is additionally applied between the main electrode and the housing.
  • [0087]
    In the embodiments described so far, a single electrode element is envisioned that may be segmented but is disposed in a single tunnel at the various electrode positions. However, it may be advantageous in some instances to provide two electrode elements. FIG. 16 shows one multi-element electrode configuration. In this configuration, two electrode elements 50 and 52 are provided, each having a structure similar to electrode 14 or 14′. The electrode elements are adapted to be implanted parallel to each other. For example, the two elements can be implanted on either side of the sternum ST. In this configuration, each electrode element 50, 52 is provided with its own lead wire 54, 56 coupling the same to the housing 12 through a header 18 and a respective connector (not shown). The lead wires can be provided in a single lead, or in separate leads. Each of these electrode elements 50, 52 can be used for sensing, pacing, induction or shocks
  • [0088]
    In another multi-electrode element embodiment shown, in FIG. 17, two electrode elements 60, 62 are provided. Electrode element 60 is similar to electrode 14 or 14′ in FIG. 1 while electrode element 62 is multi-segmented, and thus it is similar to the electrode 30 of FIG. 16A. That is, electrode element 62 includes an end electrode 64, an intermediate segment 66 and a main electrode 68. Preferably, in this embodiment, electrode element 62 and the main electrode 68 are electrically connected to each other and connected to the housing 12 by a common lead wire 70, while end electrode 64 is connected to the housing by a second lead wire 72. Alternatively, the electrode element 62 could be connected to the end electrode 64. In addition, both elements 60, 62 could be segmented.
  • [0089]
    Numerous characteristics and advantages of the invention covered by this document have been set forth in the foregoing description. It will be understood, however, that this disclosure is, in many aspects, only illustrative. Changes may be made in details, particularly in matters of shape, size and arrangement of parts without exceeding the scope of the invention. The invention's scope is defined in the language in which the appended claims are expressed.
Patent Citations
Cited PatentFiling datePublication dateApplicantTitle
US5241960 *8 Jul 19927 Sep 1993Angeion CorporationDefibrillator pulse generator
US5279293 *31 Mar 199218 Jan 1994Siemens AktiengesellschaftImplantable defibrillator with fibrillation-inducing capability and method for inducing fibrillation
US5300106 *7 Jun 19915 Apr 1994Cardiac Pacemakers, Inc.Insertion and tunneling tool for a subcutaneous wire patch electrode
US5411547 *9 Aug 19932 May 1995Pacesetter, Inc.Implantable cardioversion-defibrillation patch electrodes having means for passive multiplexing of discharge pulses
US5925069 *7 Nov 199720 Jul 1999Sulzer Intermedics Inc.Method for preparing a high definition window in a conformally coated medical device
US5935154 *8 Dec 199710 Aug 1999Cardiac Pacemakers, Inc.Implantable tissue stimulator incorporating deposited multilayer capacitor
US6058328 *24 Jan 19972 May 2000Pacesetter, Inc.Implantable stimulation device having means for operating in a preemptive pacing mode to prevent tachyarrhythmias and method thereof
US6093173 *9 Sep 199825 Jul 2000Embol-X, Inc.Introducer/dilator with balloon protection and methods of use
US6144879 *1 Oct 19977 Nov 2000Gray; Noel DesmondHeart pacemaker
US6148230 *30 Jan 199814 Nov 2000Uab Research FoundationMethod for the monitoring and treatment of spontaneous cardiac arrhythmias
US6241751 *22 Apr 19995 Jun 2001Agilent Technologies, Inc.Defibrillator with impedance-compensated energy delivery
US6280462 *12 Oct 200028 Aug 2001Cardiac Pacemakers, Inc.Implantable intravenous cardiac stimulation system with pulse generator housing serving as optional additional electrode
Referenced by
Citing PatentFiling datePublication dateApplicantTitle
US704707112 Mar 200416 May 2006Cardiac Pacemakers, Inc.Patient stratification for implantable subcutaneous cardiac monitoring and therapy
US723682930 Aug 200426 Jun 2007Pacesetter, Inc.Implantable leadless cardiac device with flexible flaps for sensing
US739208128 Feb 200324 Jun 2008Cardiac Pacemakers, Inc.Subcutaneous cardiac stimulator employing post-shock transthoracic asystole prevention pacing
US77023994 Dec 200320 Apr 2010Cardiac Pacemakers, Inc.Subcutaneous electrode and lead with phoresis based pharmacological agent delivery
US770686624 Jun 200427 Apr 2010Cardiac Pacemakers, Inc.Automatic orientation determination for ECG measurements using multiple electrodes
US771591615 May 200711 May 2010Cardiac Pacemakers, Inc.Multi-parameter arrhythmia discrimination
US773434331 May 20068 Jun 2010Synecor, LlcImplantable intravascular device for defibrillation and/or pacing
US774733510 Dec 200429 Jun 2010Synecor LlcImplantable medical device having pre-implant exoskeleton
US776115820 Dec 200520 Jul 2010Cardiac Pacemakers, Inc.Detection of heart failure decompensation based on cumulative changes in sensor signals
US778794617 Sep 200431 Aug 2010Cardiac Pacemakers, Inc.Patient monitoring, diagnosis, and/or therapy systems and methods
US779703614 Mar 200514 Sep 2010Cardiac Pacemakers, Inc.Cardiac activation sequence monitoring for ischemia detection
US78051859 May 200528 Sep 2010Cardiac Pacemakers, In.Posture monitoring using cardiac activation sequences
US784028220 Jul 200923 Nov 2010Synecor LlcMethod and apparatus for retaining medical implants within body vessels
US786523323 Feb 20044 Jan 2011Cardiac Pacemakers, Inc.Subcutaneous cardiac signal discrimination employing non-electrophysiologic signal
US788749313 Sep 200415 Feb 2011Cardiac Pacemakers, Inc.Implantable device employing movement sensing for detecting sleep-related disorders
US789015930 Sep 200415 Feb 2011Cardiac Pacemakers, Inc.Cardiac activation sequence monitoring and tracking
US789955430 Oct 20071 Mar 2011Synecor LlcIntravascular System and Method
US79791228 Apr 200412 Jul 2011Cardiac Pacemakers, Inc.Implantable sudden cardiac death prevention device with reduced programmable feature set
US799607130 Jun 20099 Aug 2011Cardiac Pacemakers, Inc.Biopotential signal source separation using source impedances
US800255318 Aug 200323 Aug 2011Cardiac Pacemakers, Inc.Sleep quality data collection and evaluation
US802403917 Oct 200720 Sep 2011Cardiac Pacemakers, Inc.Subcutaneous cardiac sensing and stimulation system employing blood sensor
US811686815 Mar 200414 Feb 2012Cardiac Pacemakers, Inc.Implantable device with cardiac event audio playback
US82390454 Jun 20037 Aug 2012Synecor LlcDevice and method for retaining a medical device within a vessel
US851553528 Jan 201020 Aug 2013Cardiac Pacemakers, Inc.Implantable cardiac device with dyspnea measurement
US852704829 Jun 20063 Sep 2013Cardiac Pacemakers, Inc.Local and non-local sensing for cardiac pacing
US853522213 Mar 200717 Sep 2013Cardiac Pacemakers, Inc.Sleep detection using an adjustable threshold
US8565872 *28 Dec 200622 Oct 2013Medtronic ATS Medical, Inc.Anti-coagulation and demineralization system for conductive medical devices
US860635617 Aug 200410 Dec 2013Cardiac Pacemakers, Inc.Autonomic arousal detection system and method
US862627630 Jul 20107 Jan 2014Cardiac Pacemakers, Inc.Cardiac activation sequence monitoring for ischemia detection
US865775615 Feb 201125 Feb 2014Cardiac Pacemakers, Inc.Implantable device employing movement sensing for detecting sleep-related disorders
US875099215 Aug 201310 Jun 2014Cardiac Pacemakers, Inc.Implantable cardiac device with dyspnea measurement
US884319620 Sep 201123 Sep 2014Cardiac Pacemakers, Inc.Subcutaneous cardiac sensing and stimulation system
US895414616 Apr 201410 Feb 2015Cardiac Pacemakers, Inc.Implantable cardiac device with dyspnea measurement
US89562959 Sep 201317 Feb 2015Cardiac Pacemakers, Inc.Sleep detection using an adjustable threshold
US901481912 Nov 201321 Apr 2015Cardiac Pacemakers, Inc.Autonomic arousal detection system and method
US902296221 Oct 20045 May 2015Boston Scientific Scimed, Inc.Apparatus for detecting and treating ventricular arrhythmia
US92778859 Feb 20158 Mar 2016Cardiac Pacemakers, Inc.Implantable cardiac device with dyspnea measurement
US96555403 Jan 201123 May 2017Cardiac Pacemakers, Inc.Subcutaneous cardiac signal discrimination employing non-electrophysiologic signal
US20040204728 *2 Sep 200314 Oct 2004Paul HaefnerUltrasonic subcutaneous dissection tool incorporating fluid delivery
US20040204734 *23 Jul 200314 Oct 2004Wagner Darrell OrvinTunneling tool with subcutaneous transdermal illumination
US20040204735 *23 Jul 200314 Oct 2004Shiroff Jason AlanSubcutaneous dissection tool incorporating pharmacological agent delivery
US20040215239 *8 Apr 200428 Oct 2004Mike FavetImplantable sudden cardiac death prevention device with reduced programmable feature set
US20040215240 *8 Apr 200428 Oct 2004Lovett Eric G.Reconfigurable subcutaneous cardiac device
US20040220626 *7 Apr 20044 Nov 2004Wagner Darrell OrvinDistributed subcutaneous defibrillation system
US20040220628 *5 Apr 20044 Nov 2004Wagner Darrell OrvinSubcutaneous defibrillation timing correlated with induced skeletal muscle contraction
US20040220629 *2 Apr 20044 Nov 2004Apurv KamathSubcutaneous cardiac sensing and stimulation system employing blood sensor
US20040225329 *19 Mar 200411 Nov 2004Wagner Darrell OrvinElectrode placement determination for subcutaneous cardiac monitoring and therapy
US20040230129 *19 Mar 200418 Nov 2004Paul HaefnerMulti-parameter arrhythmia discrimination
US20040230230 *19 Jun 200318 Nov 2004Lindstrom Curtis CharlesMethods and systems involving subcutaneous electrode positioning relative to a heart
US20040230243 *17 Dec 200318 Nov 2004Paul HaefnerNoise canceling cardiac electrodes
US20040230273 *7 Nov 200318 Nov 2004Cates Adam W.Subcutaneous electrode and lead with temporary pharmacological agents
US20040230274 *4 Dec 200318 Nov 2004Ron HeilSubcutaneous electrode and lead with phoresis based pharmacological agent delivery
US20040230280 *18 Dec 200318 Nov 2004Cates Adam W.Helical fixation elements for subcutaneous electrodes
US20040230281 *23 Dec 200318 Nov 2004Ron HeilExpandable fixation elements for subcutaneous electrodes
US20040249417 *4 Jun 20039 Dec 2004Terrance RansburyImplantable intravascular device for defibrillation and/or pacing
US20040249431 *4 Jun 20039 Dec 2004Terrance RansburyDevice and method for retaining a medical device within a vessel
US20050004615 *24 Feb 20046 Jan 2005Sanders Richard S.Reconfigurable implantable cardiac monitoring and therapy delivery device
US20050043765 *4 Jun 200424 Feb 2005Williams Michael S.Intravascular electrophysiological system and methods
US20050107838 *17 Aug 200419 May 2005Lovett Eric G.Subcutaneous cardiac rhythm management with disordered breathing detection and treatment
US20050113710 *13 Sep 200426 May 2005Stahmann Jeffrey E.Implantable device employing movement sensing for detecting sleep-related disorders
US20050115561 *17 Sep 20042 Jun 2005Stahmann Jeffrey E.Patient monitoring, diagnosis, and/or therapy systems and methods
US20050131464 *24 Sep 200416 Jun 2005Heinrich Stephen D.Apparatus for detecting and treating ventricular arrhythmia
US20050143776 *21 Oct 200430 Jun 2005Cardiac Pacemakers, Inc.Apparatus for detecting and treating ventricular arrhythmia
US20050154437 *10 Dec 200414 Jul 2005Williams Michael S.Implantable medical device having pre-implant exoskeleton
US20050228471 *29 Oct 200413 Oct 2005Williams Michael SMethod and apparatus for retaining medical implants within body vessels
US20050234431 *10 Feb 200520 Oct 2005Williams Michael SIntravascular delivery system for therapeutic agents
US20050288600 *24 Jun 200429 Dec 2005Yi ZhangAutomatic orientation determination for ECG measurements using multiple electrodes
US20060069322 *30 Sep 200430 Mar 2006Yi ZhangCardiac activation sequence monitoring and tracking
US20060116593 *14 Mar 20051 Jun 2006Yi ZhangCardiac activation sequence monitoring for ischemia detection
US20060253043 *9 May 20059 Nov 2006Yi ZhangPosture monitoring using cardiac activation sequences
US20060253044 *9 May 20059 Nov 2006Yi ZhangArrhythmia discrimination using electrocardiograms sensed from multiple implanted electrodes
US20060253162 *9 May 20059 Nov 2006Yi ZhangClosed loop cardiac resynchronization therapy using cardiac activation sequence information
US20060253164 *9 May 20059 Nov 2006Yi ZhangAutomatic capture verification using electrocardiograms sensed from multiple implanted electrodes
US20070049975 *1 Sep 20051 Mar 2007Cates Adam WActive can with dedicated defibrillation and sensing electrodes
US20070135847 *12 Dec 200514 Jun 2007Kenknight Bruce HSubcutaneous defibrillation system and method using same
US20070142732 *20 Dec 200521 Jun 2007Marina BrockwayDetection of heart failure decompensation based on cumulative changes in sensor signals
US20070156214 *28 Dec 20065 Jul 2007Pederson Brian DAnti-coagulation and demineralization system for conductive medical devices
US20070161873 *13 Mar 200712 Jul 2007Cardiac Pacemakers, Inc.Sleep detection using an adjustable threshold
US20070293896 *15 May 200720 Dec 2007Paul HaefnerMulti-parameter arrhythmia discrimination
US20080004665 *29 Jun 20063 Jan 2008Mccabe Aaron RDetermination of cardiac pacing parameters based on non-localized sensing
US20080009909 *29 Jun 200610 Jan 2008Sathaye Alok SLocal and non-local sensing for cardiac pacing
US20080077219 *30 Oct 200727 Mar 2008Williams Michael SIntravascular electrophysiological system and methods
US20080091242 *17 Oct 200717 Apr 2008Apurv KamathSubcutaneous cardiac sensing and stimulation system employing blood sensor
US20080140139 *31 Oct 200712 Jun 2008Heinrich Stephen DApparatus for detecting and treating ventricular arrhythmia
US20090048583 *14 Oct 200819 Feb 2009Williams Michael SIntravascular delivery system for therapeutic agents
US20090270750 *30 Jun 200929 Oct 2009Apurv KamathBiopotential Signal Source Separation Using Source Impedances
US20090281521 *20 Jul 200912 Nov 2009Williams Michael SMethod and apparatus for retaining medical implants within body vessels
US20100057151 *6 Dec 20074 Mar 2010Peter OsypkaDevice for the defibrillation of the heart
US20100137931 *28 Jan 20103 Jun 2010Hopper Donald LImplantable Cardiac Device With Dyspnea Measurement
US20100298729 *30 Jul 201025 Nov 2010Yi ZhangCardiac Activation Sequence Monitoring for Ischemia Detection
EP1778342A2 *8 Jul 20052 May 2007ATS Medical Inc.Anti-coagulation and demineralization system for conductive medical devices
EP1778342A4 *8 Jul 200513 Feb 2008Ats Med IncAnti-coagulation and demineralization system for conductive medical devices
WO2007070416A1 *11 Dec 200621 Jun 2007Cardiac Pacemakers, Inc.Subcutaneous defibrillation system and method using same
WO2008104209A1 *6 Dec 20074 Sep 2008Peter OsypkaDevice for the defibrillation of the heart
WO2014120728A1 *29 Jan 20147 Aug 2014Medtronic, Inc.Tandem series coupled implantable subcutaneous cardioverter defibrillators and method
Classifications
U.S. Classification607/9
International ClassificationA61N1/39, A61N1/375
Cooperative ClassificationA61N1/3968, A61N1/3975, A61N1/3906, A61N1/3956, A61N1/3918, A61N1/3756, A61N1/375
European ClassificationA61N1/39B, A61N1/39N, A61N1/375, A61N1/39M
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