Source: http://www.google.com/patents/US20040049232?dq=6101531
Timestamp: 2016-07-01 08:48:10
Document Index: 729385210

Matched Legal Cases: ['art. 4', 'art. 27', 'art. 58', 'art. 86', '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 US20040049232 - Post-defibrillation pacing methods and devices - Google PatentsSearch Images Maps Play YouTube News Gmail Drive More »Sign inPatentsMethods, systems and computer program products for cardiac pacing are provided. A defibrillation shock is applied to a heart of the patient and a pacing stimulation signal is automatically applied to the heart of the patient subsequent to termination of the delivery of the defibrillation shock. The pacing...http://www.google.com/patents/US20040049232?utm_source=gb-gplus-sharePatent US20040049232 - Post-defibrillation pacing methods and devicesAdvanced Patent SearchPublication numberUS20040049232 A1Publication typeApplicationApplication numberUS 10/238,343Publication dateMar 11, 2004Filing dateSep 10, 2002Priority dateSep 10, 2002Also published asEP1556137A1, US8560063, WO2004024231A1Publication number10238343, 238343, US 2004/0049232 A1, US 2004/049232 A1, US 20040049232 A1, US 20040049232A1, US 2004049232 A1, US 2004049232A1, US-A1-20040049232, US-A1-2004049232, US2004/0049232A1, US2004/049232A1, US20040049232 A1, US20040049232A1, US2004049232 A1, US2004049232A1InventorsRaymond Ideker, Gregory WalcottOriginal AssigneeIdeker Raymond E., Walcott Gregory P.Export CitationBiBTeX, EndNote, RefManPatent Citations (99), Referenced by (11), Classifications (11), Legal Events (1) External Links: USPTO, USPTO Assignment, EspacenetPost-defibrillation pacing methods and devices
US 20040049232 A1Abstract
Methods, systems and computer program products for cardiac pacing are provided. A defibrillation shock is applied to a heart of the patient and a pacing stimulation signal is automatically applied to the heart of the patient subsequent to termination of the delivery of the defibrillation shock. The pacing stimulation may be applied to the heart of the patient within about two seconds of termination of the defibrillation shock. The pacing stimulation signal may be applied to the heart of the patient subsequent to termination of the defibrillation shock irrespective of a characterization of electrical activity detected in the heart. The pacing stimulation may be single and/or paired pacing stimulation. Images(7) Claims(104)
That which is claimed is: 1. A method of cardiac pacing in a patient, comprising: applying a defibrillation shock to a heart of the patient; and automatically applying a pacing stimulation signal to the heart of the patient subsequent to termination of the defibrillation shock. 2. The method of claim 1, wherein the step of automatically applying a pacing stimulation comprises applying a pacing stimulation signal to the heart of the patient within about two seconds of termination of the defibrillation shock. 3. The method of claim 1, wherein the step of automatically applying a pacing stimulation comprises applying a pacing stimulation signal to the heart of the patient subsequent to termination of the defibrillation shock irrespective of a characterization of electrical activity detected in the heart. 4. The method of claim 1, wherein the pacing stimulation signal comprises single pacing stimulation. 5. The method of claim 1, wherein the pacing stimulation signal comprises paired pacing stimulation. 6. The method of claim 4, further comprising the steps of: detecting cardiac activity associated with application of the single pacing stimulation; and selectively applying paired pacing stimulation based on the detected cardiac activity. 7. The method of claim 4, further comprising the steps of: detecting cardiac activity; and selectively applying paired pacing stimulation based on the detected cardiac activity. 8. The method of claim 4, further comprising the steps of: detecting a signal specifying application of paired pacing; and selectively applying paired pacing stimulation based on the detected signal. 9. The method of claim 1, wherein the step of applying a defibrillation shock to a heart of the patient comprises applying a defibrillation shock to a heart of a patient using at least one first set of electrodes; wherein the step of automatically applying a pacing stimulation signal comprises automatically applying a pacing stimulation signal to the heart of the patient subsequent to termination of the defibrillation shock using at least one second set of electrodes; and wherein the first set of electrodes and the second set of electrodes are different sets of electrodes. 10. The method of claim 1, wherein the step of applying a defibrillation shock to a heart of the patient comprises applying a defibrillation shock to a heart of a patient using at least one first set of electrodes; wherein the step of automatically applying a pacing stimulation signal comprises automatically applying a pacing stimulation signal to the heart of the patient subsequent to application of the defibrillation shock using at least one second set of electrodes; and wherein the first set of electrodes and the second set of electrodes are a same set of electrodes. 11. The method of claim 1, further comprising the step of selectively applying paired pacing stimulation to the heart based on at least one of receipt of an external specification and sensed variables associated with cardiac activity. 12. The method of claim 11, wherein the sensed variables associated with cardiac activity comprise a pulse pressure below a predefined threshold, changes in impedance, changes in distance between electrodes, changes in the rate of change of distance between electrodes and/or detection of motion. 13. The method of claim 14, wherein the external specification comprises instruction from a healthcare provider. 14. The method of claim 1, wherein at least one of the defibrillation shock and the pacing stimulation are applied by an implantable device. 15. The method of claim 1, further comprising: detecting cardiac activity and/or function of the heart; and selecting a type of pacing stimulation to apply to the heart of the patient subsequent to termination of the defibrillation shock based on the detected cardiac activity and/or function, and wherein the step of automatically applying comprises automatically applying the selected type of pacing. 16. The method of claim 15, wherein detecting cardiac activity and/or function comprises detecting the cardiac activity and/or function before applying a defibrillation shock to a heart of the patient. 17. The method of claim 15, wherein detecting cardiac activity and/or function comprises detecting the cardiac activity and/or function after applying a defibrillation shock to a heart of the patient. 18. The method of claim 15, wherein the selected type of pacing stimulation comprises single pacing stimulation. 19. The method of claim 15, wherein the selected type of pacing stimulation comprises paired pacing stimulation. 20. The method of claim 15, wherein the selected type of pacing stimulation comprises a combination of single pacing stimulation and paired pacing stimulation. 21. The method of claim 1, further comprising inhibiting application of the pacing stimulation if cardiac activity is detected. 22. The method of claim 21, wherein the detected cardiac activity comprises a detected blood pressure. 23. The method of claim 21, wherein the detected cardiac activity comprises spontaneous electrical activity. 24. A cardiac pacing device, comprising: a controller circuit configured to automatically apply a pacing stimulation signal to a heart of a patient immediately subsequent to termination of a defibrillation shock. 25. The cardiac pacing device of claim 24, wherein the controller circuit is further configured to apply the pacing stimulation within about two seconds of termination of the defibrillation shock. 26. The cardiac pacing device of claim 24, wherein the controller circuit is further configured to automatically apply the pacing stimulation irrespective of a characterization of electrical activity detected in the heart. 27. The cardiac pacing device of claim 24, wherein the pacing stimulation signal comprises single pacing stimulation. 28. The cardiac pacing device of claim 24, wherein the pacing stimulation signal comprises paired pacing stimulation. 29. The cardiac pacing device of claim 27, wherein the controller circuit is further configured to detect cardiac activity of the heart associated with application of the single pacing stimulation and selectively apply paired pacing stimulation based on the detected cardiac activity. 30. The cardiac pacing device of claim 27, wherein the controller circuit is further configured to detect cardiac activity of the heart and selectively apply paired pacing stimulation based on the detected cardiac activity. 31. The cardiac pacing device of claim 24, wherein the controller circuit is further configured to detect a signal specifying application of paired pacing and selectively apply paired pacing stimulation based on the detected signal. 32. The cardiac pacing device of claim 24, wherein the defibrillation shock is applied to a heart of a patient using at least one first set of electrodes and wherein the controller circuit is further configured to apply the pacing stimulation signal to the heart of the patient subsequent to termination of the defibrillation shock using at least one second set of electrodes, wherein the first set of electrodes and the second set of electrodes are different sets of electrodes. 33. The cardiac pacing device of claim 24, wherein the defibrillation shock is applied to a heart of a patient using at least one first set of electrodes and wherein the controller circuit is further configured to apply the pacing stimulation signal to the heart of the patient subsequent to termination of the defibrillation shock using at least one second set of electrodes, wherein the first set of electrodes and the second set of electrodes are the same set of electrodes. 34. The cardiac pacing device of claim 24, wherein the controller circuit is further configured to selectively apply paired pacing stimulation to the heart based on at least one of receipt of an external specification and sensed variables associated with cardiac activity. 35. The cardiac pacing device of claim 34, wherein the sensed variables associated with cardiac activity comprise a pulse pressure below a predefined threshold. 36. The cardiac pacing device of claim 34, wherein the external specification comprises instruction from a healthcare provider. 37. The cardiac pacing device of claim 24, wherein the controller circuit is configured to be disposed within an implantable housing for implantation in the patient. 38. The cardiac pacing device of claim 24, wherein the controller circuit is configured to be external to the patient. 39. The cardiac pacing device of claim 24, further comprising a defibrillator circuit configured to apply the defibrillation shock to the heart of the patient. 40. The cardiac pacing device of claim 39, wherein the defibrillator circuit is further configured to indicate termination of the defibrillation shock to the controller circuit. 41. The cardiac pacing device of claim 39, wherein the defibrillator circuit and the controller circuit are configured to be disposed within an implantable housing for implantation in the patient. 42. The cardiac pacing device of claim 39, wherein the defibrillator circuit and the controller circuit are separate devices. 43. The cardiac pacing device of claim 42, wherein one of the defibrillator circuit and the controller circuit is configured to be disposed within an implantable housing and the other of the defibrillator circuit and the controller circuit is configured to be external to the patient. 44. The cardiac pacing device of claim 24, further comprising at least one set of electrodes for application of the pacing stimulation signal to the heart of the patient. 45. The cardiac pacing device of claim 24, wherein the controller circuit is further configured to apply the pacing stimulation within about one second of termination of the defibrillation shock. 46. The cardiac pacing device of claim 24: wherein the controller circuit is further configured to detect cardiac activity and/or function of the heart and select a type of pacing stimulation to apply to the heart of the patient subsequent to termination of the defibrillation shock based on the detected cardiac activity and/or function and automatically apply the selected type of pacing stimulation. 47. The cardiac pacing device of claim 46, wherein the controller circuit is further configured to detect the cardiac activity and/or function before applying a defibrillation shock to a heart of the patient. 48. The cardiac pacing device of claim 46, wherein the controller circuit is further configured to detect the cardiac activity and/or function after applying a defibrillation shock to a heart of the patient. 49. The cardiac pacing device of claim 46, wherein the selected type of pacing stimulation comprises single pacing stimulation. 50. The cardiac pacing device of claim 46, wherein the selected type of pacing stimulation comprises paired pacing stimulation. 51. The cardiac pacing device of claim 46, wherein the selected type of pacing stimulation comprises a combination of single pacing stimulation and paired pacing stimulation. 52. The cardiac pacing device of claim 24, wherein the controller circuit is further configured to inhibit application of the pacing stimulation if cardiac activity is detected. 53. The cardiac pacing device of claim 52, wherein the detected cardiac activity comprises a detected blood pressure. 54. The cardiac pacing device of claim 52, wherein the detected cardiac activity comprises spontaneous electrical activity. 55. A system for cardiac pacing, comprising: a first set of electrodes for applying a pacing stimulation to a heart of a patient; and means for automatically applying a pacing stimulation signal to the heart of the patient immediately subsequent to termination of the defibrillation shock utilizing the first set of electrodes. 56. The system of claim 55, wherein the means for automatically applying a pacing stimulation signal comprises means for applying a pacing stimulation signal to the heart of the patient within about two seconds of termination of the defibrillation shock. 57. The system of claim 55, wherein the means for automatically applying a pacing stimulation signal comprises means for applying a pacing stimulation signal to the heart of the patient subsequent to termination of the defibrillation shock irrespective of a characterization of electrical activity detected in the heart. 58. The system of claim 55, wherein the pacing stimulation signal comprises single pacing stimulation. 59. The system of claim 55, wherein the pacing stimulation signal comprises paired pacing stimulation. 60. The system of claim 58, further comprising: means for detecting cardiac activity associated with application of the single pacing stimulation; and means for selectively applying paired pacing stimulation based on the detected cardiac activity. 61. The system of claim 58, further comprising: means for detecting cardiac activity; and means for selectively applying paired pacing stimulation based on the detected cardiac activity. 62. The system of claim 58, further comprising: means for detecting a signal specifying application of paired pacing; and means for selectively applying paired pacing stimulation based on the detected signal. 63. The system of claim 55, wherein the defibrillation shock is applied to a heart of a patient using at least one second set of electrodes; and wherein the first set of electrodes and the second set of electrodes are different sets of electrodes. 64. The system of claim 55, wherein the defibrillation shock is applied to a heart of a patient using at least one second set of electrodes; and wherein the first set of electrodes and the second set of electrodes are a same set of electrodes. 65. The system of claim 55, further comprising means for selectively applying paired pacing stimulation to the heart based on at least one of receipt of an external specification and sensed variables associated with cardiac activity. 66. The system of claim 65, wherein the sensed variables associated with cardiac activity comprise a pulse pressure below a predefined threshold. 67. The system of claim 65, wherein the external specification comprises instruction from a healthcare provider. 68. The system of claim 55, further comprising means for applying a defibrillation shock to the heart of the patient. 69. The system of claim 68, further comprising means for indicating termination of the defibrillation shock to the means for automatically applying. 70. The system of claim 68, wherein the means for applying a defibrillation shock and the means for automatically applying a pacing stimulation signal are configured to be disposed within an implantable housing for implantation in the patient. 71. The system of claim 68, wherein the means for applying a defibrillation shock and the means for automatically applying a pacing stimulation signal are separate devices. 72. The system of claim 71, wherein one of the means for applying a defibrillation shock and the means for automatically applying a pacing stimulation signal is configured to be disposed within an implantable housing and the other of the means for applying a defibrillation shock and the means for automatically applying a pacing stimulation signal is configured to be external to the patient. 73. The system of claim 55, wherein the means for automatically applying a pacing stimulation signal comprises means for automatically applying a pacing stimulation signal within about one second of termination of the defibrillation shock. 74. The system of claim 55, further comprising: means for detecting cardiac activity and/or function of the heart; and means for selecting a type of pacing stimulation to apply to the heart of the patient subsequent to termination of the defibrillation shock based on the detected cardiac activity and/or function, and wherein the means for automatically applying comprises means for automatically applying the selected type of pacing. 75. The system of claim 74, wherein the means for detecting cardiac activity and/or function comprises means for detecting the cardiac activity and/or function before applying a defibrillation shock to a heart of the patient. 76. The system of claim 74, wherein the means for detecting cardiac activity and/or function comprises means for detecting the cardiac activity and/or function after applying a defibrillation shock to a heart of the patient. 77. The system of claim 74, wherein the selected type of pacing stimulation comprises single pacing stimulation. 78. The system of claim 74, wherein the selected type of pacing stimulation comprises paired pacing stimulation. 79. The system of claim 74, wherein the selected type of pacing stimulation comprises a combination of single pacing stimulation and paired pacing stimulation. 80. The system of claim 1, further comprising means for inhibiting application of the pacing stimulation if cardiac activity is detected. 81. The system of claim 80, wherein the detected cardiac activity comprises a detected blood pressure. 82. The system of claim 80, wherein the detected cardiac activity comprises spontaneous electrical activity. 83. A computer program product for controlling cardiac pacing, comprising: a computer readable medium having computer readable program code embodied therein, the computer readable program code comprising: computer readable program code that automatically applies a pacing stimulation signal to the heart of the patient immediately subsequent to termination of the defibrillation shock utilizing a first set of electrodes. 84. The computer program product of claim 83, wherein the computer readable program code that automatically applies a pacing stimulation signal comprises computer readable program code that automatically applies a pacing stimulation signal to the heart of the patient within about two seconds of termination of the defibrillation shock. 85. The computer program product of claim 83, wherein the computer readable program code that automatically applies a pacing stimulation comprises computer readable program code that automatically applies a pacing stimulation signal to the heart of the patient subsequent to termination of the defibrillation shock irrespective of a characterization of electrical activity detected in the heart. 86. The computer program product of claim 83, wherein the pacing stimulation signal comprises single pacing stimulation. 87. The computer program product of claim 83, wherein the pacing stimulation signal comprises paired pacing stimulation. 88. The computer program product of claim 86, further comprising: computer readable program code that detects cardiac activity associated with application of the single pacing stimulation; and computer readable program code that selectively applies paired pacing stimulation based on the detected cardiac activity. 89. The computer program product of claim 86, further comprising: computer readable program code that detects cardiac activity; and computer readable program code that selectively applies paired pacing stimulation based on the detected cardiac activity. 90. The computer program product of claim 86, further comprising: computer readable program code that detects a signal specifying application of paired pacing; and computer readable program code that selectively applies paired pacing stimulation based on the detected signal. 91. The computer program product of claim 83, further comprising computer readable program code that selectively applies paired pacing stimulation to the heart based on at least one of receipt of an external specification and sensed variables associated with cardiac activity. 92. The computer program product of claim 91, wherein the sensed variables associated with cardiac activity comprise a pulse pressure below a predefined threshold. 93. The computer program product of claim 91, wherein the external specification comprises instruction from a healthcare provider. 94. The computer program product of claim 83, further comprising computer readable program code that applies the defibrillation shock to the heart of the patient. 95. The computer program product of claim 94, further comprising computer readable program code that indicate termination of the defibrillation shock to the computer readable program code that automatically applies. 96. The computer program product of claim 83, further comprising: computer readable program code that detects cardiac activity and/or function in the heart; and computer readable program code that selects a type of pacing stimulation to apply to the heart of the patient subsequent to termination of the defibrillation shock based on the detected cardiac activity and/or function, and wherein the computer readable program code that automatically applies further comprises computer readable program code that automatically applies the selected type of pacing. 97. The computer program product of claim 96, wherein the computer readable program code that detects cardiac activity and/or function comprises computer readable program code that detects the cardiac activity and/or function before applying a defibrillation shock to a heart of the patient. 98. The computer program product of claim 96, wherein the computer readable program code that detects cardiac activity and/or function comprises computer readable program code that detects the cardiac activity and/or function after applying a defibrillation shock to a heart of the patient. 99. The computer program product of claim 96, wherein the selected type of pacing stimulation comprises single pacing stimulation. 100. The computer program product of claim 96, wherein the selected type of pacing stimulation comprises paired pacing stimulation. 101. The computer program product of claim 96, wherein the selected type of pacing stimulation comprises a combination of single pacing stimulation and paired pacing stimulation. 102. The computer program product of claim 83, further comprising computer readable program code that inhibits application of the pacing stimulation if cardiac activity is detected. 103. The computer program product of claim 102, wherein the detected cardiac activity comprises a detected blood pressure. 104. The computer program product of claim 102, wherein the detected cardiac activity comprises spontaneous electrical activity.
FIELD OF THE INVENTION [0001] The present invention is related to methods and apparatus for improving cardiac function in subjects. BACKGROUND OF THE INVENTION [0002] The heart is a muscular organ that is covered by a fibrous sac known as the pericardium. The space between the pericardium and the muscular organ is called the pericardial space. The walls of the heart are substantially formed from muscle (the myocardium) that differs from either skeletal or smooth muscle. The heart comprises atria and ventricles, each of which is composed of layers of myocardium that are formed to encase the blood-filled chambers. In operation, when the walls of a chamber contract, they come together similar to a squeezing fist. This contraction of the cardiac muscle is triggered by depolarization of the muscle membrane. To operate properly, the muscle contractions should be coordinated. [0003] If the muscle contractions are not coordinated within the ventricles, blood may be sloshed back and forth within the ventricular cavities instead of being ejected into the aorta and pulmonary arteries. Thus, the complex muscle masses forming the ventricular pumps should contract substantially simultaneously for efficient pumping. [0004] The heart is able to achieve this coordination because of (a) the tight junctions formed between adjacent cardiac fibers (the fibers are joined end to end at structures known as intercalated disks, which provide the points or junctions) which allow action potentials to be transmitted from one cardiac cell to another; and (b) the specialized muscle fibers in certain areas of the heart which provide the conducting system for proper excitation of the heart. The specialized fibers are in contact with fibers of the cardiac muscles to form gap junctions, which permit passage of action potentials from one cell to another. The specialized conduction system is configured, in normal operation, to provide a rapid and coordinated spread of excitation. [0005] Cardiac muscle cells are autorhythmic, i.e., capable of spontaneous, rhythmical self-excitation. The sinoatrial (SA) node is the normal pacemaker for the entire heart or smooth muscle, and it is from this region that the excitation wave starts; it then moves or propagates through the remainder of the myocardium in a synchronized manner. The SA node region of the heart contains a small mass of specialized myocardial cells in the right atrial wall near the entrance of the superior vena cava that have a fast inherent rhythm, which allows the SA node to be the normal pacemaker. In unusual circumstances, other regions of the heart can become more excitable and provide a faster spontaneous rhythm. In this situation, this other region can become the pacemaker and the rhythm for the entire heart. [0006] In normal operation, the cells of the SA node make contact with the surrounding atrial myocardium fibers. Thus, from the SA node, a wave of excitation spreads throughout the right atrium along the atrial myocardial cells via the gap junctions. In addition, the atrial tissue directs the impulse from the SA node directly to the left atrium, to simultaneously contract both atria. [0007] The excitation wave then is distributed to the ventricles by way of a second small mass of specialized cells located at the base of the right atrium near the wall between the ventricles (the atrioventricular (AV) node). The AV node is configured to delay the propagation of action potentials (the wavefront) by about 0.1 second, to allow the atria to contract and empty the blood into the ventricle before ventricular contraction. The wavefront is then quickly dispersed along the specialized conducting fibers (down the interventricular septum to the ventricular free walls) and then through unspecialized (typical) myocardial fibers in the remaining myocardium. [0008] The pumping of blood includes alternate periods of contraction and relaxation. The cardiac muscle has a relatively long refractory period (on the order of about 250 ms). This refractory period is a time during which the membrane is insensitive to stimulus (either totally unable to propagate an excitation wave or only able to do so upon exposure to an increased level of stimulation). [0009] During ventricular fibrillation (VF) a number of independent activation wavefronts propagate simultaneously through the mycodardium. The propagation of these wavefronts may result in uncoordinated activity from the heart that may result in reduced or impaired cardiac function. Resuscitation attempts for cardiac arrest caused by VF include defibrillation shock. The defibrillation shock is intended to break up the propagation of the independent activation wavefronts to allow normal activation. Typically, defibrillation shock which does not result in the return of normal electrical and/or mechanical activity results in one of four potentially problematic outcomes. First, the defibrillation shock fails to halt the fibrillation. Second, the defibrillation shock halts the fibrillation but fibrillation re-occurs in the next few seconds or minutes. Third, the defibrillation shock may halt the fibrillation, but cardiac function does not progress on its own, i.e. asystole or absence of a heartbeat. Fourth, the defibrillation shock is successful and cardiac electrical activity returns after the shock but cardiac mechanical function is either absent or greatly reduced. This fourth condition may be referred to as pulseless electrical activity (PEA). Thus, improvements may be needed in the treatment of VF that may reduce the occurrence of one or more these problematic results. In particular, improvements may be needed to provide a reduction in the incidence of a return to fibrillation and/or of PEA. SUMMARY OF THE INVENTION [0010] Embodiments of the present invention provide methods, systems and computer program products for cardiac pacing in a patient. A defibrillation shock is applied to a heart of the patient and a pacing stimulation signal automatically applied to the heart of the patient subsequent to termination of the defibrillation shock. In certain embodiments of the present invention, the pacing stimulation may be applied to the heart of the patient within about two seconds or less of termination of the defibrillation shock. Furthermore, the pacing stimulation signal may be applied to the heart of the patient subsequent to termination of the defibrillation shock irrespective of a characterization of electrical activity detected in the heart. The defibrillation shock may be for VF, AF and/or other conditions. [0011] In particular embodiments of the present invention, the pacing stimulation signal provides single pacing stimulation. In other embodiments, the pacing stimulation signal provides paired pacing stimulation. Cardiac activity may be detected and paired pacing stimulation selectively applied based on the detected cardiac activity. The detected cardiac activity may be associated with application of the single pacing stimulation. A signal specifying application of paired pacing could also be detected and paired pacing stimulation selectively applied based on the detected signal. [0012] In yet further embodiments of the present invention, the defibrillation shock is applied to the heart of the patient using at least one first set of electrodes and the pacing stimulation signal is applied to the heart of the patient using at least one second set of electrodes. The first set of electrodes and the second set of electrodes may be the same or different sets of electrodes. [0013] In other embodiments of the present invention, paired pacing stimulation is selectively applied to the heart based on receipt of an external specification and/or sensed variables associated with cardiac activity. The sensed variables associated with cardiac activity may include a pulse pressure below a predefined threshold, changes in impedance, changes in distance between electrodes, changes in the rate of change of distance between electrodes and/or detection of motion. The external specification may be operating instructions input from a healthcare provider. [0014] In additional embodiments of the present invention, a cardiac pacing system includes a controller circuit configured to automatically apply a pacing stimulation signal to a heart of a patient immediately subsequent to termination of a defibrillation shock. The controller circuit may be further configured to apply the pacing stimulation within about two seconds or less of termination of the defibrillation shock. Additionally, the controller circuit may be configured to automatically apply the pacing stimulation irrespective of whether normal electrical activity is detected in the heart. [0015] In particular embodiments of the present invention, the pacing controller is configured to provide single pacing stimulation. In other embodiments, the pacing controller is configured to provide paired pacing stimulation. The pacing controller may also be configured to detect cardiac activity and selectively apply paired pacing stimulation based on the detected cardiac activity. The detected cardiac activity may be associated with application of the single pacing stimulation. A signal specifying application of paired pacing could also be detected and paired pacing stimulation selectively applied based on the detected signal. [0016] In still further embodiments of the present invention, the defibrillation shock is applied to a heart of a patient using at least one first set of electrodes and the controller circuit is further configured to apply the pacing stimulation signal to the heart of the patient subsequent to termination of the defibrillation shock using at least one second set of electrodes. The first set of electrodes and the second set of electrodes may be the same or different sets of electrodes. Electrodes may be at other locations within the body or external to the body such as by application to the skin. [0017] The controller circuit may also be configured to selectively apply paired pacing stimulation to the heart based on at least one of receipt of an external specification and/or sensed variables associated with cardiac activity. The sensed variables associated with cardiac activity may be a pulse pressure below a predefined threshold. The external specification may be an instruction from a healthcare provider. [0018] The controller circuit may be configured to be disposed within an implantable housing for implantation in the patient. The controller circuit could also be configured to be external to the patient. [0019] In yet other embodiments of the present invention, the cardiac pacing system includes a defibrillator circuit configured to apply the defibrillation shock to the heart of the patient. The defibrillator circuit may be further configured to indicate termination of the defibrillation shock to the controller circuit. The defibrillator circuit and the controller circuit may be configured to be disposed within an implantable housing for implantation in the patient. The defibrillator circuit and the controller circuit may also be disposed in separate devices. For example, one of the defibrillator circuit and the controller circuit may be configured to be disposed within an implantable housing and the other of the defibrillator circuit and the controller circuit may be configured to be external to the patient. [0020] A cardiac pacing system according to further embodiments of the present invention may also include at least one set of electrodes for application of the pacing stimulation signal to the heart of the patient. [0021] In further embodiments of the present invention, the cardiac pacing system detects cardiac activity and/or function of the heart and selects a type of pacing stimulation to apply to the heart of the patient subsequent to termination of the defibrillation shock based on the detected cardiac activity and/or function. The selected type of pacing may be automatically applied to the patient's heart. The cardiac pacing system may detect the cardiac activity and/or function before or after applying the defibrillation shock to a heart of the patient. The selected type of pacing stimulation may include single pacing stimulation, paired pacing stimulation and/or a combination of the two. [0022] In still further embodiments of the present invention, the cardiac pacing system inhibits application of the pacing stimulation based on the detection of cardiac activity. The detected cardiac activity may include at least one of blood pressure and/or spontaneous electrical activity. [0023] As will be appreciated by those of skill in the art in light of the present disclosure, the present invention may be embodied as systems, methods and/or computer program products.
BRIEF DESCRIPTION OF THE DRAWINGS [0024] [0024]FIG. 1 is a schematic illustration of a human heart. [0025] [0025]FIG. 2 is a schematic illustration of a human heart. [0026] [0026]FIG. 3 is a block diagram illustrating embodiments of the present invention. [0027] [0027]FIG. 4 is a flowchart illustrating operations according to embodiments of the present invention. [0028] [0028]FIG. 5 is a flowchart illustrating operations according to further embodiments of the present invention. [0029] [0029]FIG. 6 is a flowchart illustrating operations according to further embodiments of the present invention. [0030] [0030]FIG. 7 is a flowchart illustrating operations according to further embodiments of the present invention.
DESCRIPTION OF EMBODIMENTS OF THE INVENTION [0031] The present invention will now be described more fully hereinafter with reference to the accompanying figures, in which embodiments of the invention are shown. This invention may, however, be embodied in many different forms and should not be construed as limited to the embodiments set forth herein. Like numbers refer to like elements throughout. In the figures, certain features, elements and/or components may be exaggerated for clarity. [0032] The present invention may be used for pacing the heart after application of a defibrillation shock. Subjects according to the present invention can be any animal subject, are preferably mammalian subjects (e.g., humans, canines, felines, bovines, caprines, ovines, equines, rodents, porcines, and/or lagomorphs), and more preferably are human subjects. [0033] Embodiments of the present invention provide for the automatic application of a pacing stimulation upon termination of a defibrillation shock. As used herein, “automatic” and “automatically” refer to providing the pacing stimulation irrespective of detected heart activity such that the shock may be applied irrespective of whether success or failure of the defibrillation shock is detected or whether the heart has returned to a pre-shock normalcy. The defibrillation shock may be a ventricular fibrillation shock and/or an atrial fibrillation shock. Pacing stimulation may be applied through some or all of the same electrode(s) that provide the defibrillation shock or may be applied through different electrodes. Furthermore, the pacing may be single and/or paired pacing. [0034] One or more sets of electrodes may be placed at one or more sites. References to an electrode herein may refer to one or more electrodes associated with a stimulation site. Accordingly, references to stimulation of an electrode or application of a stimulation signal may refer to stimulation of the one or more electrodes associated with a stimulation site or path. The various stimulation sites utilized may depend on the particular patient and/or pacing regime. Such sites may, for example, include those described in U.S. Pat. Nos. 4,929,688 and 6,285,907, the disclosures of which are incorporated herein by reference as if set forth fully herein. Similarly, differing electrode configurations and locations may also be utilized with embodiments of the present invention. For example, the placement and type of electrodes may be as described in U.S. patent application Ser. No. 09/742,651 filed Dec. 21, 2000 and entitled “PACING METHODS AND DEVICES FOR TREATING CARDIAC ARRHYTHMIAS AND FIBRILLATION,” the disclosure of which is incorporated herein by reference as if set forth in its entirety. Suitable commercially available electrodes may include defibrillation and/or pacing electrodes well known to those of skill in the art. In some embodiments, the electrodes that are adapted to reside in the heart in the vein(s) of a subject may be particularly suitable. See also, U.S. Pat. Nos. 5,107,834, 5,224,476, 5,978,704, and 6,002,962, the contents of which are hereby incorporated by reference as if recited in full herein. [0035] The catheters or electrodes may also include sensors for measuring cardiac function. For example, a catheter may include one or more stimulation electrodes and/or sensors for sensing one or more of the onset of a treatment condition or the intrinsic cardiac cycle. See U.S. Pat. No. 5,978,704, entitled, Method and Apparatus for Treating Cardiac Arrhythmia, the contents of which are hereby incorporated by reference as if recited in full herein. Furthermore, according to embodiments of the present invention, the sensors may also include sensors for detecting indicators of cardiac function, such as, for example, measuring changes in impedance, changes in distance between electrodes and/or the rate of change of distance and/or detection of motion through, for example, use of an accelerometer. As used herein, motion refers to acceleration, velocity, displacement, integrals of acceleration, displacement and/or velocity and/or derivatives of acceleration, displacement and/or velocity. Furthermore, detection of cardiac function and/or characteristics may be carried out as described in concurrently filed and commonly assigned U.S. patent application Ser. No. ______ (Attorney Docket No. 5656-24) entitled “METHODS, SYSTEMS AND COMPUTER PROGRAM PRODUCTS FOR TREATING FIBRILLATION IN A PATIENT BASED ON THE PRESENCE OF FIBRILLATION FOLLOWING ADMINISTRATION OF DEFIBRILLATION THERAPY,” or as described in U.S. patent application Ser. No. ______ (Attorney Docket No. 5656-25) entitled “DEVICES FOR DETECTING THE PRESENCE OF CARDIAC ACTIVITY FOLLOWING ADMINISTRATION OF DEFIBRILLATION THERAPY,” the disclosures of which are incorporated herein as if set forth in their entirety. [0036] Anatomically, the heart includes a fibrous skeleton, valves, the trunks of the aorta, the pulmonary artery, and the muscle masses (myocardium) of the cardiac chambers (i.e., right and left atria and right and left ventricles). The schematically illustrated portions of the heart 10 shown in one or more of FIGS. 1 or 2 include the right ventricle “RV” 20, the left ventricle “LV” 30, the right atrium “RA” 40 (the term “right atrium” herein including the superior vena cava and innominate vein), the left atrium “LA” 50 (and parts thereof), the superior vena cava 48, the coronary sinus “CS” 42, the great cardiac vein 44, the left pulmonary artery 45 (the term “left pulmonary artery” herein includes the main pulmonary artery and the right ventricular outflow tract), and the coronary sinus ostium or “OS” 41. FIG. 1 also illustrates the epicardium 55 (shown in dotted line) surrounding the walls of the heart (i.e., the myocardium) and the pericardial space 58 therebetween. FIG. 2 also illustrates the pulmonary veins 52 and neighboring regions. Other regions of interest may include the atrial septum, right and left atrial appendages, and the tricuspid annulus. FIG. 1 also illustrates the conducting system 60, the SA node 62 and the AV node 64. [0037] As mentioned above, the desired sites or localized region(s) selected for placement of the electrodes, the stimulation sites, defibrillation and/or pacing the heart according to embodiments of the present invention may vary depending on the physiology or ailment of the patient and/or the particular selected pacing protocol employed. As such, the electrodes may be positioned in a number of regions, internal and/or external to the body, and by a number of different techniques so that they are proximate to and/or in contact with the desired localized region of the myocardium or other sites of interest. For example, electrodes may be placed directly on the surface of the patient's chest. By way of further example, one or more electrodes can be positioned in the natural lumens of the heart (atriums, ventricles, veins, arteries, etc.), or in the pericardial space, on the outer, inner surfaces of the cardiac walls, or within the thickness of the muscle walls. The electrodes may be positioned into the body of the subject by surgical techniques or by inserting them using locating catheters holding same, and the like. In some embodiments, certain electrodes are configured and sized such that each is able to contact the tissue at a respective stimulation or sensing site during the heartbeats. As used herein, “localized” refers to the electrical stimuli being delivered to a portion of the heart rather than to the entire heart. [0038] Thus, as noted above, the pacing electrodes may be positioned in the pericardial space or other localized regions of the heart. For example, the pacing electrode(s) can be held on a catheter and inserted into the endocardium or threaded through the heart and inserted into the veins in the heart (threaded through the OS and looped into the veins). In some embodiments, pacing of the left atrium may be performed by locating an electrode(s) to extend in a portion of the left atrium and into the pulmonary veins to help eradicate or control fibrillation activation in this region. Locating one or more electrodes in the pulmonary vein may be particularly suitable for the treatment of atrial fibrillation. Other exemplary placements are discussed below. [0039] As described above, the driving force for the flow of blood in the heart comes from the active contraction of the cardiac muscle. This contraction can be detected as an electrical signal. The cardiac contraction is triggered by electrical impulses traveling in a wave propagation pattern which begins at the cells of the SA node and the surrounding atrial myocardial fibers then travels into the atria and subsequently passing through the AV node and, after a slight delay, into the ventricles. Sensing cardiac activation or contractions while pacing can provide data to the pacing system (controller or cardiac monitor) which can be assessed to determine and adjust, as needed, a number of operational parameters such as, for example: (a) when to stop the pacing stimulation; (b) the speed or rate of the pacing stimulation (increase or decrease the pacing rate), the duration or intensity of the stimulation pulse(s); (c) whether the tissue is being successfully captured; and (d) the number of pulses/pulse trains to be relayed to the localized region. [0040] According to embodiments of the present invention, pacing is applied to the heart automatically after application of a defibrillation shock. As used herein, “pacing” may include stimulation having any cycle length or combination of cycle lengths. For example, pacing may include single pacing, paired pacing or any combination of the two. The pacing stimulation may be provided to reduce the likelihood of redevelopment of arrhythmia and/or to improve mechanical function of the heart. Furthermore, the timing of pacing stimulation may be controlled by feedback such as described in U.S. patent application Ser. No. 10/210,587 filed Jul. 31, 2002 and entitled “Pacing Methods and Devices Using Feedback Controlled Timing,” the disclosure of which is incorporated herein by reference as if set forth fully herein. [0041] A system for providing automatic application of pacing according to certain embodiments of the present invention is illustrated in FIG. 3. As seen in FIG. 3, a defibrillation/pacing system 100 according to certain embodiments of the present invention includes a pacing controller circuit 110 and a defibrillator circuit 112. The pacing controller circuit 110 and defibrillator circuit 112 have one or more sets of electrodes 115 and 118 that are placed in particular locations or regions of the heart 10 as discussed above (the sites shown are by way of example only). The particular location may depend on the particular application for defibrillation and/or pacing. Such locations will be apparent to those of skill in the art in light of the above disclosure and will, therefore, not be described further herein. As described above, the same electrodes may be utilized for defibrillation as are used for pacing. Alternatively, different ones or sets of electrodes may be used for defibrillation as are used for pacing. Finally, combinations of common and different electrodes may be used for defibrillation and pacing. As shown in FIG. 3, a sensor 120 may also be provided to sense cardiac function such that the pacing controller circuit 110 may control application of pacing stimulation as described herein. Furthermore, the pacing controller circuit 110 may receive external inputs, for example, from a healthcare provider, to further control the application of pacing as discussed below. The pacing controller circuit 110 includes an automatic pacing circuit 111 that automatically applies pacing stimulation after a defibrillation shock. [0042] The pacing controller circuit 110 and/or defibrillator circuit 112 may be provided as part of an external device (such as a remote housing which holds the operating components therein), or may be configured to be disposed in a single or dual biocompatible implantable housing(s) that holds the operating circuitry in a hermetically sealed body. Similarly, one of the pacing controller circuit 110 or the defibrillator circuit 112 could be incorporated in an external device while the other of the pacing controller circuit 110 and the defibrillator circuit 112 be disposed in an implantable housing for implantation in a patient. The pacing controller 110 and/or defibrillator circuit 112 can include an electronic circuit that includes one or more amplifiers (not shown) for amplifying sensed cardiac signals and/or for providing stimulation to the electrodes 115 and/or 118. The pacing controller 110 and/or defibrillator circuit 112 may also include conventional circuitry to analyze the amplified signals to detect the onset or presence of an atrial and/or ventricular arrhythmia or fibrillation condition and to identify when or if ventricular fibrillation (or other arrhythmia, depending on the specific treatment for which the device is configured) is present. Furthermore, the defibrillator circuit 112 may be a conventional defibrillator circuit. However, as described in further detail below, in certain embodiments of the present invention the defibrillator circuit 112 provides a signal to the pacing controller circuit 110 that is provided to the automatic pacing circuit 111 or the automatic pacing circuit 111 monitors the operation of the defibrillator circuit 112 from which the automatic pacing circuit 111 may determine when a defibrillation shock has terminated. [0043] In certain embodiments, the pacing controller 110 and/or defibrillator circuit 112 can be used to time a defibrillation shock pulse to reduce the likelihood that associated defibrillation shock pulses are delivered during sensitive portions of the cardiac cycle so as to reduce the possibility of inducing ventricular fibrillation. Ventricular sensing for timing the shocks for atrial defibrillation may be performed from the RV and/or LV electrodes used as in defibrillation devices known to those of skill in the art. See U.S. Pat. No. 5,978,704, the contents of which were incorporated by reference hereinabove. [0044] In operation, according to certain embodiments of the present invention, the defibrillator circuit 112 applies a defibrillation shock to the heart 10 through the electrode(s) 115. The defibrillator circuit 112 notifies the pacing controller circuit 110 when the defibrillation shock has terminated and the automatic pacing circuit 111 automatically applies pacing stimulation to the heart 10 through the electrode(s) 118. Alternatively, the pacing controller circuit 110 could sense the termination of the defibrillation shock, be notified of the initiation of the shock and wait a predefined time period or utilize other similar techniques to determine that the defibrillation shock has terminated. The pacing controller circuit 110 may also sense cardiac function utilizing the sensor 120 so as to control the timing of or operative application of the pacing stimulation as described herein. If sensing of cardiac function is performed immediately after the application of the defibrillator shock, such sensing may be carried out be disconnecting sensor leads from sensing circuitry during application of the defibrillator pulse, for example, through the use of a relay. Systems and operations for sensing cardiac function/characteristics immediately after application of a defibrillator pulse are described in U.S. patent application Ser. No. ______ (Attorney Docket No. 5656-25) which has been incorporated herein by reference as if set forth in its entirety. [0045] While embodiments of the present invention are described herein with reference to the particular division of function and/or architecture illustrated in FIG. 3, as will be appreciated by those of skill in the art in light of the present disclosure, other division of functions and/or architectures may be utilized while still benefiting from the teachings of the present invention. For example, the defibrillator circuit 112 and the pacing controller circuit 110 may be separate devices or may be a single device. Furthermore, the pacing controller circuit 110 may be incorporated into the defibrillator circuit 112. Thus, the architecture illustrated in FIG. 3 is provided for illustrative purposes only and should not be construed as limiting the scope of the present invention. [0046] [0046]FIG. 4 is a flowchart illustrating operations according to embodiments of the present invention. As seen in FIG. 4, a defibrillation shock is applied to the heart 10 (block 300), for example, by the defibrillator circuit 112. Termination of the defibrillation shock is determined (block 302), for example, by the defibrillator circuit 112 notifying the pacing controller circuit 110 of termination of the shock, the pacing controller circuit 110 detecting termination of the shock or the pacing controller circuit 110 waiting a sufficient time to assure that the defibrillation shock has terminated. After termination of the defibrillation shock (block 302), pacing stimulation is automatically applied to the heart 10 (block 304) by, for example, the automatic pacing circuit 111. Thus, the application of the pacing stimulation may be carried out automatically irrespective of whether normal heart function has been detected or whether normal electrical activity has been detected in the heart. [0047] According to certain embodiments of the present invention, the pacing stimulation is applied immediately after the defibrillation shock has been terminated. As used herein, the term “immediately” refers to application of the pacing stimulation before a conventional electro-cardiagram can detect cardiac activity to determine if the defibrillation shock successfully halted fibrillation. Thus, for example, application of the pacing stimulation carried out in less than about 2 to 4 seconds after the termination of the defibrillation shock may be considered immediately after termination of the defibrillation shock. In particular embodiments of the present invention, the pacing stimulation is applied within about 2 seconds or less of termination of the defibrillation shock, in further embodiments the pacing stimulation is applied within about 1 second or less of the termination of the defibrillation shock, and in still further embodiments of the present invention, the pacing stimulation is applied within about 0.5 seconds or less of the termination of the defibrillation shock. [0048] As briefly described above, the pacing stimulation may be single pacing and/or paired pacing. For single pacing, the pacing stimulation may be applied utilizing conventional timing relationships. Furthermore, conventional paired pacing may also be utilized according to certain embodiments of the present invention. For example, the timing between each pair of stimulation pulses may be constant and the timing between pulses within a pair may be constant. The pacing rate for single and/or paired pacing may be predefined or may be based on sensed variable, including cardiac electrical activity before or after the defibrillation shock as is known to those of skill in the art. The strength of the pacing stimulus may be predefined or may be dynamically established utilizing autocapture techniques known to those of skill in the art. Paired pacing could also be selectively utilized based on operator specification and/or sensed variables, such as pulse pressure lower than a predefined value, heat rate, timing and/or morphology of at least one intrinsic ventricular beat, changes in impedance, changes in distance and/or displacement and/or the rate of change of distance between two locations, and/or motion of a location associated with the heart. Electrode locations as described above may be utilized for single and/or paired pacing. [0049] [0049]FIG. 5 is a flowchart illustrating operations according to further embodiments of the present invention. As seen in FIG. 5, cardiac activity and/or function is detected in the heart (block 500). Although the detection of cardiac activity and/or function is illustrated as occurring before application of the defibrillation shock in FIG. 5, the present invention is not limited to this configuration. For example, cardiac activity may be detected after the application of the defibrillation shock without departing from the teachings of the present invention. A type of pacing stimulation is selected based on the detected cardiac activity and/or function (block 502). For example, a series of detected electrical signals (cardiac activity) may indicate that the patient would not respond to single pacing stimulation, therefore, paired pacing stimulation may be selected for this patient based upon the electrical signals. Similarly, a low pulse pressure may indicate impaired cardiac function, which may be improved by paired pacing. The type of pacing stimulation selected may include single pacing stimulation, paired pacing stimulation and/or a combination of the two. [0050] The defibrillation shock is applied to the heart 10 (block 300), for example, by the defibrillator circuit 112. Termination of the defibrillation shock is determined (block 302), for example, by the defibrillator circuit 112 notifying the pacing controller circuit 110 of termination of the shock, the pacing controller circuit 110 detecting termination of the shock or the pacing controller circuit 110 waiting a sufficient time to assure that the defibrillation shock has terminated. After termination of the defibrillation shock (block 302), the selected pacing stimulation (block 502) is automatically applied to the heart 10 (block 304) by, for example, the automatic pacing circuit 111. [0051] [0051]FIG. 6 is a flowchart illustrating operations according to further embodiments of the present invention. As seen in FIG. 6, after initiation of application of the defibrillation shock (block 300) and termination of the defibrillation shock (block 302) as described above with reference to FIG. 4, a pacing stimulation signal is applied to the heart 10 (block 304). Still referring to FIG. 6, it is determined if cardiac activity is present (block 310). Cardiac activity may be detected by detecting, for example, blood pressure, spontaneous electrical activity or the like. If it is determined that cardiac activity is present (block 310), pacing is inhibited (block 315). Pacing may be inhibited by, for example, halting pacing and/or pacing less frequently. If, on the other hand, it is determined that cardiac activity is not present (block 310), pacing continues uninterrupted (block 313). [0052] Further embodiments of the present invention utilizing paired pacing are also illustrated in FIG. 7. As illustrated in FIG. 7, after initiation of application of the defibrillation shock (block 300) and termination of the defibrillation shock (block 302) as described above with reference to FIG. 4, a first pacing stimulation signal is applied to the heart 10 (block 320). Still referring to FIG. 7, activity of the heart is detected that results from the application of the first pacing stimulation signal (block 322). Based on detected cardiac activity associated with or responsive to the application of the first stimulation signal (block 324), a second stimulation signal is selectively applied to the heart 10 (block 326) so as to selectively provide paired pacing based on the detected cardiac activity. The selective application of the second stimulation signal to provide paired pacing may be based on the nature of the sensed cardiac activity. Thus, if the detected cardiac activity is indicative of low cardiac function, the second stimulation signal may be applied so as to provide paired pacing to improve mechanical function of the heart. For example, the sensed cardiac function may include sensing low pulse pressure impedance signals, heat rate, timing and/or morphology of at least one intrinsic ventricular beat, changes in impedance, changes in distance and/or displacement and/or the rate of change of distance between two locations, and/or motion of a location associated with the heart. Thus, according to the embodiments illustrated in FIG. 7, the second stimulus is provided to provide paired pacing based on cardiac activity corresponding to the first stimulus (single pacing). [0053] In further embodiments of the present invention, paired pacing may be initiated by receipt of a signal from an external source, such as a healthcare professional, that may be utilized to selectively activate paired pacing. In such a case, the operations of FIG. 7 could be modified by modifying block 322 to determine if the signal from the external source is detected. If so, the second stimulation of block 326 would be provided. In an implantable device, the signal from an external source may be a radio frequency signal or other such technique for communicating with an implantable device. Similarly, a software switch may be set to provide the signal from an external source. In an external device, a switch setting (either hardware or software) may be utilized to select between single pacing and paired pacing. [0054] In still further embodiments of the present invention, the detected cardiac activity need not be responsive to the application of the first stimulation signal. In such embodiments, FIG. 7 could be modified such that activity of the heart is detected irrespective of whether the activity results from application of the first stimulation signal (block 322). Based on the detected cardiac activity (block 324), a second stimulation signal is selectively applied to the heart 10 (block 326) so as to selectively provide paired pacing based on the detected cardiac activity. [0055] As will be appreciated by one of skill in the art, the present invention may be embodied as a method, data processing system, or computer program product. Accordingly, the present invention may take the form of an entirely hardware embodiment, an entirely software embodiment or an embodiment combining software and hardware aspects, all generally referred to herein as a “circuit.” Furthermore, the present invention may take the form of a computer program product on a computer-usable storage medium having computer-usable program code means embodied in the medium. Any suitable computer readable medium may be utilized including, a memory device, hard disks, CD-ROMs, optical storage devices, a transmission media, such as a wireless transmission media and/or those supporting the Internet or an intranet, or magnetic storage devices. [0056] The present invention is described herein with reference to flowchart illustrations and/or block and/or flow diagrams of methods, apparatus (systems) and computer program products according to embodiments of the invention. It will be understood that each block of the flowchart illustrations and/or block diagrams, and combinations of blocks in the flowchart illustrations and/or block diagrams, can be implemented by computer program instructions. These computer program instructions may be provided to a processor of a general purpose computer, special purpose computer, or other programmable data processing apparatus to produce a machine, such that the instructions, which execute via the processor of the computer or other programmable data processing apparatus, create means for implementing the functions specified in the flowchart and/or block and/or flow diagram block or blocks. [0057] These computer program instructions may also be stored in a computer-readable memory that can direct a computer or other programmable data processing apparatus to function in a particular manner, such that the instructions stored in the computer-readable memory produce an article of manufacture including instruction means which implement the function specified in the flowchart and/or block diagram block or blocks. [0058] The computer program instructions may also be loaded onto a computer or other programmable data processing apparatus to cause a series of operational steps to be performed on the computer or other programmable apparatus to produce a computer implemented process such that the instructions which execute on the computer or other programmable apparatus provide steps for implementing the functions specified in the flowchart and/or block diagram block or blocks. [0059] While embodiments of the present invention have been described with reference to a particular architecture and/or division of functions, the present invention should not be construed as limited to such architecture and/or division. Thus, other architectures and/or division of functions capable of carrying out the operations described herein may be utilized while still falling within the teachings of the present invention. Furthermore, while embodiments of the present invention have been described with reference to particular circuits, such circuits may include discrete components, processors, such as a microprocessor and/or signal processor, analog circuits, digital circuits and/or combinations thereof. Furthermore, embodiments of the present invention may be provided as an entirely hardware embodiment, an entirely software embodiment or combinations of hardware and software. [0060] With regard to the operations illustrated in the flowcharts described above, as will be appreciated by those of skill in the art in light of the present disclosure, embodiments of the present invention are not limited to the specific sequence or sequences of operations described therein. Thus, for example, operations in the flowcharts may be provided out of sequence or concurrently. Similarly, other sequences of operations may be utilized while still providing the feedback adjustment according to embodiments of the present invention. Accordingly, the present invention should not be construed as limited to the particular operations or sequence of operations illustrated in the flowcharts. [0061] The foregoing is illustrative of the present invention and is not to be construed as limiting thereof. Although a few exemplary embodiments of this invention have been described, those skilled in the art will readily appreciate that many modifications are possible in the exemplary embodiments without materially departing from the novel teachings and advantages of this invention. Accordingly, all such modifications are intended to be included within the scope of this invention as defined in the claims. In the claims, means-plus-function clauses, where used, are intended to cover the structures described herein as performing the recited function and not only structural equivalents but also equivalent structures. Therefore, it is to be understood that the foregoing is illustrative of the present invention and is not to be construed as limited to the specific embodiments disclosed, and that modifications to the disclosed embodiments, as well as other embodiments, are intended to be included within the scope of the appended claims. The invention is defined by the following claims, with equivalents of the claims to be included therein. Patent CitationsCited PatentFiling datePublication dateApplicantTitleUS3825015 *Dec 14, 1972Jul 23, 1974American Optical CorpSingle catheter for atrial and ventricular stimulationUS3995623 *Feb 11, 1976Dec 7, 1976American Hospital Supply CorporationMultipurpose flow-directed catheterUS4355646 *Nov 26, 1980Oct 26, 1982Medtronic, Inc.Transvenous defibrillating leadUS4365639 *Mar 11, 1981Dec 28, 1982Applied Cardiac ElectrophysiologyCatheter, cardiac pacemaker and method of pacingUS4366486 *Mar 16, 1981Dec 28, 1982Northern Illinois Gas CompanyLow profile antenna for data transpondersUS4444195 *Nov 2, 1981Apr 24, 1984Cordis CorporationCardiac lead having multiple ring electrodesUS4499907 *Nov 15, 1982Feb 19, 1985Medtronic, Inc.Energy limiting cardioversion leadUS4559946 *Jun 18, 1982Dec 24, 1985Mieczyslaw MirowskiMethod and apparatus for correcting abnormal cardiac activity by low energy shocksUS4567901 *Dec 15, 1983Feb 4, 1986Cordis CorporationPrebent ventricular/atrial cardiac pacing leadUS4637397 *May 30, 1985Jan 20, 1987Case Western Reserve UniversityTriphasic wave defibrillationUS4643201 *Feb 2, 1981Feb 17, 1987Medtronic, Inc.Single-pass A-V leadUS4693253 *Mar 23, 1981Sep 15, 1987Medtronic, Inc.Automatic implantable defibrillator and pacerUS4708145 *Sep 11, 1985Nov 24, 1987Medtronic, Inc.Sequential-pulse, multiple pathway defibrillation methodUS4735206 *Oct 7, 1986Apr 5, 1988Brunswick Manufacturing Co., Inc.Method and apparatus for defibrillating and pacing the heartUS4800883 *Apr 2, 1986Jan 31, 1989Intermedics, Inc.Apparatus for generating multiphasic defibrillation pulse waveformUS4850357 *Jan 12, 1988Jul 25, 1989Cardiac Pacemakers, Inc.Biphasic pulse generator for an implantable defibrillatorUS4901725 *Jan 29, 1988Feb 20, 1990Telectronics N.V.Minute volume rate-responsive pacemakerUS4928688 *Jan 23, 1989May 29, 1990Mieczyslaw MirowskiMethod and apparatus for treating hemodynamic disfunctionUS5107834 *Jan 30, 1991Apr 28, 1992Cardiac Pacemakers, Inc.Low energy multiple shock defibrillation/cardioversion discharge technique and electrode configurationUS5165403 *Feb 26, 1991Nov 24, 1992Medtronic, Inc.Difibrillation lead system and method of useUS5184616 *Oct 21, 1991Feb 9, 1993Telectronics Pacing Systems, Inc.Apparatus and method for generation of varying waveforms in arrhythmia control systemUS5201808 *Feb 10, 1992Apr 13, 1993Telectronics Pacing Systems, Inc.Minute volume rate-responsive pacemaker employing impedance sensing on a unipolar leadUS5209229 *May 20, 1991May 11, 1993Telectronics Pacing Systems, Inc.Apparatus and method employing plural electrode configurations for cardioversion of atrial fibrillation in an arrhythmia control systemUS5224476 *Feb 24, 1992Jul 6, 1993Duke UniversityMethod and apparatus for controlling fibrillation or tachycardiaUS5230337 *Jul 14, 1992Jul 27, 1993Cardiac Pacemakers, Inc.Process for implanting subcutaneous defibrillation electrodesUS5235977 *Jun 9, 1992Aug 17, 1993Siemens AktiengesellschaftElectrode arrangement for an implantable defibrillator/cardioverterUS5235978 *Jun 9, 1992Aug 17, 1993Siemens AktiengesellschaftImplantable arrangement for the defibrillation or cardioversion of a heartUS5251624 *Jun 22, 1992Oct 12, 1993Incontrol, Inc.Pulse generator for use in an implantable atrial defibrillatorUS5267559 *Oct 23, 1992Dec 7, 1993Incontrol, Inc.Atrial defibrillator and method for providing atrial sensingUS5269298 *Oct 23, 1992Dec 14, 1993Incontrol, Inc.Atrial defibrillator and method for providing synchronized delayed cardioversionUS5269319 *Aug 30, 1991Dec 14, 1993Cardiac Pacemakers, Inc.Unitary intravascular defibrillating catheter with bipolar sensingUS5282836 *Oct 23, 1992Feb 1, 1994Incontrol, Inc.Atrial defibrillator and method for providing pre-cardioversion pacingUS5292338 *Jul 30, 1992Mar 8, 1994Medtronic, Inc.Atrial defibrillator employing transvenous and subcutaneous electrodes and method of useUS5303702 *Dec 23, 1991Apr 19, 1994Ela MedicalAutomatic adjustment of the control function for a rate adaptive pacemakerUS5304139 *Aug 3, 1992Apr 19, 1994Incontrol, Inc.Improved lead configuration for an atrial defibrillatorUS5304218 *Jun 2, 1992Apr 19, 1994Incontrol, Inc.Cardiac lead implanting arrangement and methodUS5312444 *Jul 13, 1993May 17, 1994Incontrol, Inc.Crosspoint switch with improved discharge control for use in an implantable defibrillatorUS5313953 *Jan 14, 1992May 24, 1994Incontrol, Inc.Implantable cardiac patient monitorUS5314430 *Jun 24, 1993May 24, 1994Medtronic, Inc.Atrial defibrillator employing transvenous and subcutaneous electrodes and method of useUS5324309 *Sep 25, 1992Jun 28, 1994Medtronic, Inc.Overlapping pulse cardioversion or defibrillationUS5328442 *Nov 20, 1992Jul 12, 1994Siemens Pacesetter, Inc.System and method for stimulating a heart having undergone cardiac myoplasty using a single-chamber pacemakerUS5331966 *Dec 16, 1993Jul 26, 1994Medtronic, Inc.Subcutaneous multi-electrode sensing system, method and pacerUS5332400 *Dec 24, 1992Jul 26, 1994Incontrol, Inc.Atrial defibrillator and method for providing pre-cardioversion warningUS5344430 *Apr 8, 1993Sep 6, 1994Medtronic, Inc.Method and apparatus for termination of ventricular tachycardia and ventricular fibrillationUS5348021 *Mar 31, 1992Sep 20, 1994Incontrol, Inc.Apparatus and method for reliably detecting a depolarization activation wave of the heart and atrial defibrillator utilizing sameUS5350402 *May 26, 1993Sep 27, 1994Incontrol, Inc.Atrial defibrillator and method for providing T wave detection and interval timing prior to cardioversionUS5366485 *Oct 27, 1992Nov 22, 1994Angeion CorporationApparatus for defibrillation pretreatment of a heartUS5387233 *Nov 3, 1993Feb 7, 1995Incontrol, Inc.Intravenous cardiac lead with improved fixation and methodUS5395373 *Jan 7, 1993Mar 7, 1995Incontrol, Inc.Atrial defibrillator and method for setting energy threshold valuesUS5403351 *Jan 11, 1993Apr 4, 1995Saksena; SanjeevMethod of transvenous defibrillation/cardioversion employing an endocardial lead systemUS5403354 *Aug 29, 1994Apr 4, 1995Incontrol, Inc.Defibrillator and method utilizing three channel sensingUS5405375 *Jan 21, 1994Apr 11, 1995Incontrol, Inc.Combined mapping, pacing, and defibrillating catheterUS5411527 *Aug 31, 1992May 2, 1995Intermedics, Inc.Difibrillation electrodes and implantationUS5417717 *May 16, 1994May 23, 1995Cardiac Pacemakers, Inc.Implantable cardiac function monitor and stimulator for diagnosis and therapy deliveryUS5423772 *Aug 13, 1993Jun 13, 1995Daig CorporationCoronary sinus catheterUS5431681 *Sep 22, 1993Jul 11, 1995Pacesetter, Inc.Combination pacing and defibrillating lead having sensing capabilityUS5431682 *Sep 2, 1993Jul 11, 1995Pacesetter AbImplantable heart defibrillatorUS5431683 *Dec 6, 1993Jul 11, 1995Pacesetter AbElectrode system for a defibrillatorUS5433729 *Mar 24, 1992Jul 18, 1995Incontrol, Inc.Atrial defibrillator, lead systems, and methodUS5433730 *Oct 7, 1993Jul 18, 1995Intermedics, Inc.Conductive pouch electrode for defibrillationUS5441519 *Feb 6, 1995Aug 15, 1995Incontrol, Inc.Implantable atrial defibrillator having delayed intervention therapyUS5443491 *Sep 12, 1994Aug 22, 1995M.E.D.I.C.O. Italia S.R.L.Three-pole electrocatheterUS5447519 *Mar 19, 1994Sep 5, 1995Medtronic, Inc.Method and apparatus for discrimination of monomorphic and polymorphic arrhythmias and for treatment thereofUS5456706 *Jan 4, 1994Oct 10, 1995Ventritex, Inc.Cardiac defibrillation lead having defibrillation and atrial sensing electrodesUS5464429 *Sep 1, 1993Nov 7, 1995Pacesetter AbApparatus for producing heart defibrillation sequences from stimulation pulses and defibrillation shocksUS5464432 *Apr 25, 1994Nov 7, 1995Incontrol, Inc.Implantable atrial defibrillator having an intermittently activated fibrillation detectorUS5470348 *Jan 12, 1995Nov 28, 1995Pacesetter AbDevice for stimulating living tissueUS5476498 *Aug 15, 1994Dec 19, 1995Incontrol, Inc.Coronary sinus channel lead and methodUS5476499 *Nov 17, 1994Dec 19, 1995Pacesetter AbMedical electrode lead with atrial electrode at the distal and ventricular electrode between the distal and proximal endsUS5486199 *Jul 20, 1994Jan 23, 1996Kim; JaehoSystem and method for reducing false positives in atrial fibrillation detectionUS5487753 *Mar 16, 1995Jan 30, 1996Telectronics Pacing Systems, Inc.Rate-responsive pacemaker with anaerobic threshold adaptation and methodUS5489293 *Mar 31, 1994Feb 6, 1996Ventritex, Inc.Method and apparatus for treating cardiac tachyarrhythmiaUS5522853 *Nov 21, 1994Jun 4, 1996Angeion CorporationMethod and apparatus for progressive recruitment of cardiac fibrillationUS5531764 *Apr 14, 1994Jul 2, 1996Angeion CorporationImplantable defibrillator system and method having successive changeable defibrillation waveformsUS5554176 *Jul 19, 1994Sep 10, 1996Telectronics Pacing Systems, Inc.Implantable electrode and sensor lead apparatusUS5560369 *Sep 22, 1994Oct 1, 1996Pacesetter, Inc.Cardiac arrhythmia detection system for an implantable stimulation device and methodUS5578064 *Aug 11, 1994Nov 26, 1996Intermedics, Inc.Rate responsive cardiac pacemaker with impedance sensingUS5584865 *Sep 26, 1994Dec 17, 1996Pacesetter AbDefibrillator with output stage using switching network and three electrodeUS5609621 *Aug 4, 1995Mar 11, 1997Medtronic, Inc.Right ventricular outflow tract defibrillation leadUS5620471 *Jun 16, 1995Apr 15, 1997Pacesetter, Inc.System and method for discriminating between atrial and ventricular arrhythmias and for applying cardiac therapy thereforUS5645569 *Jun 4, 1996Jul 8, 1997Incontrol, Inc.Post atrial cardioversion atrial pacing and methodUS5683429 *Apr 30, 1996Nov 4, 1997Medtronic, Inc.Method and apparatus for cardiac pacing to prevent atrial fibrillationUS5697953 *Jan 11, 1996Dec 16, 1997Angeion CorporationImplantable cardioverter defibrillator having a smaller displacement volumeUS5718718 *Mar 4, 1996Feb 17, 1998Angeion CorporationMethod and apparatus for polarity reversal of consecutive defibrillation countershocks having back biasing precharge pulsesUS5800469 *Apr 16, 1997Sep 1, 1998Nappholz; Tibor A.Pacemaker with anaerobic threshold determinationUS5800470 *Mar 11, 1996Sep 1, 1998Medtronic, Inc.Respiratory muscle electromyographic rate responsive pacemakerUS5861012 *Oct 18, 1996Jan 19, 1999Medtronic, Inc.Atrial and ventricular capture detection and threshold-seeking pacemakerUS5978705 *Mar 13, 1998Nov 2, 1999Uab Research FoundationMethod and apparatus for treating cardiac arrhythmia using auxiliary pulseUS5987354 *Oct 14, 1997Nov 16, 1999Uab Research FoundationDual shock atrial defibrillation apparatusUS6002962 *Apr 14, 1998Dec 14, 1999Uab Research FoundationImplantable triphasic waveform defibrillatorUS6006131 *Aug 13, 1996Dec 21, 1999Uab Research FoundationDual current pathway atrial defibrillation apparatusUS6070101 *Apr 22, 1999May 30, 2000Medtronic, Inc.Multiple channel, sequential, cardiac pacing systemsUS6148230 *Jan 30, 1998Nov 14, 2000Uab Research FoundationMethod for the monitoring and treatment of spontaneous cardiac arrhythmiasUS6263241 *Apr 30, 1999Jul 17, 2001Intermedics, Inc.Method and apparatus for treatment of cardiac electromechanical dissociationUS6275730 *Sep 7, 1999Aug 14, 2001Uab Research FoundationMethod and apparatus for treating cardiac arrythmiaUS6285907 *May 21, 1999Sep 4, 2001Cardiac Pacemakers, Inc.System providing ventricular pacing and biventricular coordinationUS6327500 *Nov 15, 1999Dec 4, 2001Uab Research FoundationDual shock atrial defibrillation apparatusUS6772005 *Dec 21, 2000Aug 3, 2004Medtronic, Inc.Preferred ADI/R: a permanent pacing mode to eliminate ventricular pacing while maintaining backup supportUS20030009199 *Jun 28, 2002Jan 9, 2003Botronik Mess-Und Therapiegeraete Gmbh & Co. Ingenieubuero BerlinElectrical therapy device* Cited by examinerReferenced byCiting PatentFiling datePublication dateApplicantTitleUS7079891 *Feb 25, 2003Jul 18, 2006PacesetterSystem and method for providing cardioversion therapy and overdrive pacing using an implantable cardiac stimulation deviceUS7113822 *Feb 25, 2003Sep 26, 2006Pacesetter, Inc.System and method for providing cardioversion therapy and overdrive pacing using an implantable cardiac stimulation deviceUS9123215May 14, 2013Sep 1, 2015GM Global Technology Operations LLCAlert systems and methods for a vehicleUS9132774May 14, 2013Sep 15, 2015GM Global Technology Operations LLCAlert systems and methods for a vehicleUS9153108May 14, 2013Oct 6, 2015GM Global Technology Operations LLCAlert systems and methods for a vehicleUS9266451May 14, 2013Feb 23, 2016GM Global Technology Operations LLCAlert systems and methods for a vehicleUS9349263May 14, 2013May 24, 2016GM Global Technology Operations LLCAlert systems and methods for a vehicleUS20070109104 *Oct 30, 2006May 17, 2007Gm Global Technology Operations, Inc.Active material based haptic alert systemUS20100069986 *Aug 11, 2009Mar 18, 2010Cardiac Pacemakers, IncSystems and methods for increasing pacing output after external high-energy electrical shockCN103569013A *Jun 21, 2013Feb 12, 2014通用汽车环球科技运作有限责任公司Warning system and method for vehiclesWO2005099814A1 *Apr 12, 2005Oct 27, 2005Patrick SchauerteDevice for hemodynamic stabilization during tachycardias* Cited by examinerClassifications U.S. Classification607/4International ClassificationA61B5/0402, A61B5/11, A61N1/39, A61B5/05, A61N1/362, A61B5/0215Cooperative ClassificationA61N1/3962, A61N1/3622, A61N1/3688European ClassificationA61N1/39M2Legal EventsDateCodeEventDescriptionSep 10, 2002ASAssignmentOwner name: UAB RESEARCH FOUNDATION, ALABAMAFree format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:IDEKER, RAYMOND E.;WALCOTT, GREGORY P.;REEL/FRAME:013283/0164Effective date: 20020910RotateOriginal ImageGoogle Home - Sitemap - USPTO Bulk Downloads - Privacy Policy - Terms of Service - About Google Patents - Send FeedbackData provided by IFI CLAIMS Patent Services