Source: http://www.google.com/patents/US5433729?dq=patent:5881444
Timestamp: 2015-02-28 21:09:56
Document Index: 33950862

Matched Legal Cases: ['art. 12', 'art.\n20', 'art.\n21', 'art 10', 'art 10', 'art 10', 'art 10', 'art 10', 'art 10', 'art 10', 'art 10', 'art 10', 'art 10', 'art 10', 'art 10']

Patent US5433729 - Atrial defibrillator, lead systems, and method - Google PatentsSearch Images Maps Play YouTube News Gmail Drive More »Sign inAdvanced Patent SearchPatentsAn implantable atrial defibrillator provides a pulse of defibrillating electrical energy to the atria of the heart in synchronism with sensed R waves in response to non-coincident sensing of an R wave at first and second areas of the heart. The defibrillating pulse is provided after a predetermined number...http://www.google.com/patents/US5433729?utm_source=gb-gplus-sharePatent US5433729 - Atrial defibrillator, lead systems, and methodAdvanced Patent SearchPublication numberUS5433729 APublication typeGrantApplication numberUS 07/856,514Publication dateJul 18, 1995Filing dateMar 24, 1992Priority dateApr 12, 1991Fee statusPaidAlso published asCA2083678A1, CA2083678C, CA2298288A1, CA2298288C, CA2434313A1, DE69216736D1, DE69216736T2, DE69233110D1, DE69233110T2, EP0533917A1, EP0533917B1, EP0672434A2, EP0672434A3, EP0672434B1, US5350404, WO1992018198A2, WO1992018198A3Publication number07856514, 856514, US 5433729 A, US 5433729A, US-A-5433729, US5433729 A, US5433729AInventorsJohn M. Adams, Clifton A. Alferness, Paul E. KrevenhagenOriginal AssigneeIncontrol, Inc.Export CitationBiBTeX, EndNote, RefManPatent Citations (48), Referenced by (102), Classifications (19), Legal Events (7) External Links: USPTO, USPTO Assignment, EspacenetAtrial defibrillator, lead systems, and method
11. A method of monitoring activity of the heart of a patient and delivering cardioverting electrical energy to the atria of the heart of the patient, said method comprising the steps of:providing storage means for storing electrical energy; implanting said storage means beneath the skin of the patient; providing lead means, including a first lead having a first electrode and a second lead having a second electrode; implanting said lead means beneath the skin of the patient including the steps of disposing said first electrode within the right atrium of the heart and disposing said second electrode within the coronary sinus beneath the left atrium of the heart; coupling said lead means to said storage means; sensing atrial activity of the heart between said first and second electrodes; storing said electrical energy in said storage means, and applying, through said lead means, at least a portion of said stored electrical energy between said first and second electrodes to deliver said cardioverting electrical energy to the atria of the heart. 12. A method as defined in claim 11 including the further steps of providing a third lead with first, second, and third spaced apart sensing electrodes.
13. A method as defined in claim 12 including the further steps of disposing said first, second, and third spaced apart sensing electrodes of said third lead within the right ventricle of the heart and sensing electrical activations of the heart with said first, second, and third sensing electrodes in the right ventricle.
15. A method as defined in claim 11 wherein said applying step includes applying said electrical energy in the form of a biphasic waveform having a pair of equal duration phases and a total energy between 0.5 and 2.1 joules.
17. A method as defined in claim 11 including the further step of providing a third lead with first and second spaced apart sensing electrodes.
18. A method as defined in claim 17 including the further steps of disposing said first and second spaced apart sensing electrodes of said third lead within the right ventricle of the heart and sensing electrical activations of the heart with said first and second sensing electrodes in the right ventricle.
19. A method as defined in claim 18 wherein said first electrode is disposed in the right atrial appendage of the heart.
20. A method as defined in claim 11 wherein said lead means providing step includes providing a preshaped bend in said second lead for fixing said second lead in the coronary sinus of the heart.
21. An implantable device for monitoring activity of the heart and delivering cardioverting electrical energy to the atria of the heart, said device comprising:storage means for storing said electrical energy; lead means coupled to said storage means for receiving said electrical energy from said storage means and applying said electrical energy between the right atrium of the heart and the coronary sinus beneath the left atrium of the heart for delivering said electrical energy to the atria of the heart, said lead means including a first lead having a first electrode arranged to be disposed within the right atrial appendage of the heart and a second lead including a second electrode arranged to be disposed within the coronary sinus beneath the left atrium of the heart for delivering said electrical energy to the atria of the heart; atrial activity sensing means for sensing atrial activity of the heart, said atrial activity sensing means being coupled to said first and second electrodes; and electrical activation sensing means for sensing electrical activations of the heart, said lead means including a third lead having first and second spaced apart sensing electrodes coupled to said electrical activation sensing means and for being disposed within the right ventricle of the heart, wherein said second lead includes a preshaped bend in the region of said second lead within the coronary sinus for fixing said second lead within the coronary sinus, said lead means being fully implantable beneath the skin of a patient. Description
This is a continuation-in-part of application Ser. No. 07/685,130, filed Apr. 12, 1991, for IMPROVED ATRIAL DEFIBRILLATOR AND METHOD, now U.S. Pat. No. 5,282,837.
FIG. 10 is a perspective view of the human heart having a lead system configured in accordance with a second lead system preferred embodiment of the present, invention implanted therein;
FIG. 11 is a perspective view of the human heart having a lead system configured in accordance with a third lead system preferred embodiment of the present, invention implanted therein;
FIG. 12 is a perspective view of the human heart having a lead system configured in accordance with, a fourth lead system preferred embodiment of the present invention implanted therein;
Within the enclosure 32, the atrial defibrillator 30 includes a first sense amplifier 50, a second sense amplifier 52, and a third sense amplifier 54. The first sense amplifier 50 forms a first sensing means which, when inputs 50a and 50b are coupled to electrodes 38 and 40 respectively of the first lead 34, senses electrical activations of the right ventricle 12. The second sense amplifier 52 forms a second sensing means which, when inputs 52a and 52b are coupled to electrodes 42 and 44 respectively of the second lead 36, senses electrical activations of the left ventricle 14. The third sense amplifier 54 forms atrial sense means which, when inputs 54a and 54b are coupled to electrodes 44 and 46 respectively of the second lead 36, senses atrial activity of the heart when enabled as will be described hereinafter.
The enclosure 32 of the atrial defibrillator 30 further includes a microprocessor 62. The microprocessor 62 is preferably implemented in a manner to be described thereinafter with respect to the flow diagrams of FIGS. 2 through 6. The implementation of the microprocessor 62 results in a plurality of functional stages. The stages include a first timer 64, a second timer 66, a third timer 68, a synchronization marker controller 70, and a synchronization detector 72. The functional stages of the microprocessor 62 further include a calculator stage including an average calculation stage 74, a standard deviation calculation stage 76, an enable stage 78, a disable stage 80, an atrial arrhythmia detector in the form of an atrial fibrillation detector 82, a first counter 84, a second counter 86, a third counter 88, and a charge delivery and energy control stage 90.
For entering operating parameters into the memory 92, the microprocessor 62 receives programmable operating parameters from an external controller 100 which is external to the skin of the patient. The external controller 100 is arranged to communicate with a receiver/transmitter 102 which is coupled to the microprocessor 62 over a bi-directional bus 104. The receiver/transmitter 102 may be of the type well known in the art for conveying various information which it obtains from the microprocessor 62 to the external controller 100 or for receiving programming parameters from the external controller 100 which the receiver/transmitter 102 then conveys to the microprocessor 62 for storage in the memory 92. To that end, the memory 92 includes a mode selection portion 98 for storing mode selection information to be described. hereinafter.
There are many algorithms known in the art for processing such data to determine if fibrillation is present. One such algorithm is disclosed in a paper: Nitish V. Thakor, Yi-Sheng Zhu and Kong-Yan Pan, "Ventricular Tachycardia and Fibrillation Detection by a Sequential Hypothesis Testing Algorithm," "IEEE Transactions On Biomedical Engineering, " Vol 37, No. 9, pp. 837-843, September 1990. Another such algorithm is disclosed in a paper: Janice Jenkins, Ki Hong Noh, Alain Guezennec, Thomas Bump, and Robert Arzbaecher, "Diagnosis of Atrial Fibrillation Using Electrograms from Chronic Leads: Evaluation of Computer Algorithms," PACE, Vol. 11, pp. 622-631, May 1988. Implementing such algorithms by a microprocessor such as microprocessor 62 is well within the preview of one skilled in the art.
If the atrial defibrillator in step 152 determines that atrial fibrillation is currently present in the heart, the microprocessor then proceeds to determine whether it is able to obtain a reliable synchronizing pulse for synchronizing the delivery of the defibrillating or cardioverting electrical energy to the atria. This begins in step 158 where the atrial defibrillator microprocessor determines whether an electrical activation has been detected in the right. ventricle. If an R wave has not been detected in the right ventricle, the microprocessor performs a loop to once again determine at step 158 if an R wave has been detected in the right ventricle. When an R wave is detected in the right ventricle, the microprocessor proceeds to step 160 to start the third timer 68. After starting timer 68, the processor then proceeds to step 162 to determine whether an R wave has been detected in the left ventricle. If an electrical activation has not been detected at the left ventricle, the microprocessor then returns to step 162 to once again determine whether an R wave has been detected at the left ventricle. When an R wave is detected at the left ventricle, the microprocessor then proceeds to step 164 to stop the third timer 68. In so doing, the third timer 68 will have the time from when the R wave was detected at the right ventricle in step 158 and when the same R wave was detected at the left ventricle in step 162.
The second lead 254 includes a second elongated, large surface area, electrode 262, a tip or distal sense electrode 264, and a ring or proximal sense electrode 266. The electrodes 264, 266, and 262 are spaced apart on the second lead 254 so that when the lead 254 is fed into the superior vena cava 20 and into a coronary vein, such as the great vein 23 through the right atrium 16 and the coronary sinus 22 with electrodes 264 and 266 being adjacent the left ventricle within the great vein as illustrated, the second elongated electrode 262 will be disposed within the coronary sinus 22 just beneath the left atrium 18 and adjacent to the left ventricle 14. Since the coronary sinus 22 is in close proximity to the left atrium 18 and the left ventricle 14, electrodes 264 and 266 will be in electrical contact with the left ventricle and electrode 262 will be in electrical contact with the left atrium 18.
Blood flow within the great vein 23 and the coronary sinus 22 is in an upward direction and hence would tend to push the lead 254 from the implanted position as illustrated and described above. Hence, to assure fixation of lead 254 in place, the lead 254 is preferably provided with a preformed bend at 255 where the lead 254 exits the coronary sinus 22 and enters a coronary vein, such as the great vein 23.
The lead system 290 may be utilized to advantage in association with the atrial defibrillator 30 illustrated in FIG. 1 for monitoring the activity of the heart 10 and for delivering cardioverting or defibrillating electrical energy to the atria 16 and 18 of the heart 10. To that end, the first elongated electrode 302 may be coupled to input 54a of sense amplifier 54 and to output 112a of the discharge circuit. 112. The second elongated electrode 304 may be coupled to input 54b of sense amplifier 54 and to output 112b of discharge circuit 112. With such coupling, electrodes 302 and 304 may be utilized for sensing atrial activity of the heart in association with sense amplifier 54. Also, the cardioverting electrical energy provided from the charger and storage capacitor 110 and the discharge circuit 112 will be received by electrodes 302 and 304 for applying the electrical cardioverting energy between the right atrium 16 and the coronary sinus 22 beneath the left atrium 18 and adjacent to the left ventricle 14 to deliver the cardioverting electrical energy to the atria 16 and 18 of the heart 10. By virtue of the locations of the elongated stimulating electrodes 302 and 304, the electrical energy applied to the right ventricle 12 and left ventricle 14 when the atria are cardioverted or defibrillated will be minimized.
Referring now to FIG. 12, it illustrates, in perspective view, a human heart 10 having a lead system 310, configured in accordance with a fourth lead system preferred embodiment of the present invention, implanted wherein. The portions of the heart 10 particularly noted in FIG. 12 are the right ventricle 12, the left ventricle 14, the right atrium 16, the right atrial appendage 17, the left atrium 18, the superior vena cava 20, the coronary sinus 22, the great vein 23, and the inferior vena cava 27.
It will be noted that the lead 312 is looped or pigtailed in the right atrium 16 so that the first electrode 322 is disposed in the right atrial appendage 17. To assist in assuring that electrode 322 is in the right atrial appendage 17, the lead 312 is provided with a first preformed bend at 313 in the area where lead 312 enters the right atrium 16 from the superior vena cava 20 and a stiffened section 315 to force the electrode 322 against the inner wall of the right atrium 16 in the right atrial appendage 17. The lead 12 is further provided with a second preformed bend at 317 to assist in fixing lead 312 in place against blood flow in the coronary sinus 22.
The lead system 330 may be utilized to advantage in association with the atrial defibrillator 30 illustrated in FIG. 1 for monitoring the activity of the heart 10 and for delivering cardioverting or defibrillating electrical energy to the atria 16 and 18 of the heart 10. To that end, the first elongated electrode 342 may be coupled to input 54a of sense amplifier 54 and to output 112a of the discharge circuit 112. The second elongated electrode 344 may be coupled to input 54b of sense amplifier 54 and to output 112b of discharge circuit 112. With such coupling, electrodes 342 and 344 may be utilized for sensing atrial activity of the heart in association with sense amplifier 54. Also, the cardioverting electrical energy provided from the charger and storage capacitor 110 and the discharge circuit 112 will be received by electrodes 342 and 344 for applying the electrical cardioverting energy between the right atrium 16 and LEFT PULMONARY ARTERY 21 and adjacent to the left ATRIUM 18 to deliver the cardioverting electrical energy to the atria 16 and 18 of the heart 10. By virtue of the locations of the elongated stimulating electrodes 342 and 344, the electrical energy applied to the right ventricle 12 and left ventricle 14 when the atria are cardioverted or defibrillated will be minimized.
The lead system 350 generally includes a first lead 352, a second lead 354, and a third lead 356. The leads 352, 354, and 356 are flexible but preformed so that the leads 352,354, and 356 may be readily fed into the heart 10 and assume the configurations when implanted as illustrated in the Figure.
For sensing electrical activations of the heart, a first pair of the sensing electrodes 358 and 360 carried by the third lead 356 may be coupled to inputs 50b and 50a respectively of sense amplifier 50 and a second pair of the sensing electrodes 360 and 362 of the third lead 356 may be coupled to inputs 52b and 52a respectively of sense amplifier 52. This permits sensing of electrical activations of the heart and more specifically electrical activations at two different areas of the right ventricle 12. This enables the non-coincident sensing of the depolarization activation waves as previously described for synchronizing the delivery of the cardioverting or defibrillating electrical energy to the atria 16 and 18 in synchronism with a detected electrical activation of the heart.
The lead system 390 may be utilized to advantage in association with the atrial defibrillator 30 illustrated in FIG. 1 for monitoring the activity of the heart 10 and for delivering cardioverting or defibrillating electrical energy to the atria 16 and 18 of the heart 10. To that end, the first elongated electrode 402 may be coupled to input 54a of sense amplifier 54 and to output 112a of the discharge circuit 112. The second elongated electrode 404 may be coupled to input 54b of sense amplifier 54 and to output 112b of discharge circuit 112. With such coupling, electrodes 402 and 404 may be utilized for sensing atrial activity of the heart in association with sense amplifier 54. Also, the cardioverting electrical energy provided from the charger and storage capacitor 110 and the discharge circuit 112 will be received by electrodes 402 and 404 for applying the electrical cardioverting energy between the right atrium 16 and the coronary sinus 22 beneath the left atrium 18 and adjacent to the left ventricle 14 to deliver the cardioverting electrical energy to the atria 16 and 18 of the heart 10. By virtue of the locations of the elongated stimulating electrodes 402 and 404, the electrical energy applied to the right ventricle 12 and left ventricle 14 when the atria are cardioverted or defibrillated will be minimized.
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MINNESOTAFree format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:INCONTROL, INC.;REEL/FRAME:009781/0901Effective date: 19990202Feb 16, 1999FPAYFee paymentYear of fee payment: 4Feb 16, 1999SULPSurcharge for late paymentOct 31, 1995CCCertificate of correctionMar 24, 1992ASAssignmentOwner name: INCONTROL, INC., WASHINGTONFree format text: ASSIGNMENT OF ASSIGNORS INTEREST.;ASSIGNORS:ADAMS, JOHN M.;ALFERNESS, CLIFTON A.;KREYENHAGEN, PAUL E.;REEL/FRAME:006091/0141Effective date: 19920320RotateOriginal ImageGoogle Home - Sitemap - USPTO Bulk Downloads - Privacy Policy - Terms of Service - About Google Patents - Send FeedbackData provided by IFI CLAIMS Patent Services