Source: http://www.google.com/patents/US20030176894?dq=4316055
Timestamp: 2017-10-21 00:35:09
Document Index: 362749202

Matched Legal Cases: ['art 115', 'art 115', 'art 115', 'art 115', 'art 115', 'art 115', 'art 115', 'art 115']

Patent US20030176894 - Site reversion in cardiac rhythm management - Google Patents
Methods for failure recovery in a cardiac rhythm management system and apparatus capable of carrying out the methods. The methods include applying a first pacing therapy using one or more leads. The methods further include detecting a failure condition on one or more of the leads, wherein the failure...http://www.google.com/patents/US20030176894?utm_source=gb-gplus-sharePatent US20030176894 - Site reversion in cardiac rhythm management
Publication number US20030176894 A1
Also published as EP1313530A2, EP1313530B1, US6493586, US6922589, US20050256547, WO2002018010A2, WO2002018010A3, WO2002018010A9
Publication number 10314875, 314875, US 2003/0176894 A1, US 2003/176894 A1, US 20030176894 A1, US 20030176894A1, US 2003176894 A1, US 2003176894A1, US-A1-20030176894, US-A1-2003176894, US2003/0176894A1, US2003/176894A1, US20030176894 A1, US20030176894A1, US2003176894 A1, US2003176894A1
US 20030176894 A1
a processor coupled to the signal generator, wherein the processor is adapted to cause the signal generator to deliver a first therapy to the first electrode, and to deliver a second therapy to the second electrode in the presence of a failure associated with the first electrode.
2. The cardiac rhythm management system of claim 1, wherein delivering the first therapy to the first electrode includes delivering the first therapy to both the first and second electrodes.
3. The cardiac rhythm management system of claim 2, wherein delivering the first therapy to the first and second electrodes includes delivering a first pulse to the first electrode and a second pulse to the second electrode.
4. The cardiac rhythm management system of claim 1, wherein the pulses applied to the second electrode in the second therapy are substantially similar to the pulses applied to the first electrode in the first therapy.
5. The cardiac rhythm management system of claim 1, wherein the first electrode is adapted to operate in at least one mode selected from the group consisting of bipolar and unipolar, and wherein the processor is further adapted to cause the signal generator to deliver the second therapy only when the first electrode is operating in the unipolar mode.
6. The cardiac rhythm management system of claim 1, wherein the presence of a failure is indicated by detection of a condition selected from the group consisting of an over sense condition, sensed noise, lead impedance outside a predetermined range, capture amplitude voltage outside a predetermined range, intrinsic amplitude outside a predetermined range, detection of unintended non-cardiac stimulation, and failure to detect an expected event.
7. The cardiac rhythm management system of claim 1, wherein the presence of a failure is indicated by detection of a condition selected from the group consisting of an electrical hardware failure, software failure, memory failure and battery depletion.
8. The cardiac rhythm management system of claim 1, including a lead adapted for connection to the signal generator, the lead comprising a main lead body adapted to carry signals to and from the heart, where the first electrode and the second electrode are carried by the main lead body.
a processor coupled to the signal generator, wherein the processor is adapted to cause the signal generator to deliver a first therapy through the at least one electrode of the first lead and to deliver a second therapy through the at least one electrode of the second lead in the presence of a failure detection associated with the first lead.
10. The cardiac rhythm management system of claim 9, wherein delivering the first therapy to the at least one electrode of the first lead includes delivering the first therapy to the at least one electrodes of both the first and second leads.
11. The cardiac rhythm management system of claim 10, wherein delivering the first therapy to the at least one electrodes of the first and second leads includes delivering a first pulse to the at least one electrode on the first lead and a second pulse to the at least one electrode on the second lead.
12. The cardiac rhythm management system of claim 9, wherein the first and second therapy includes pulses, where pulses of the first therapy are substantially similar to pulses of the second therapy.
13. The cardiac rhythm management system of claim 9, wherein the at least one electrode of the first lead is adapted to operate in at least one mode selected from the group consisting of bipolar and unipolar, and wherein the processor is further adapted to cause the signal generator to deliver the second therapy only when the at least one electrode of the first lead is operating in the unipolar mode.
14. The cardiac rhythm management system of claim 9, wherein the presence of a failure is indicated by detection of a condition selected from the group consisting of an over sense condition, sensed noise, lead impedance outside a predetermined range, capture amplitude voltage outside a predetermined range, intrinsic amplitude outside a predetermined range, detection of unintended non-cardiac stimulation, and failure to detect an expected event.
15. The cardiac rhythm management system of claim 9, wherein the presence of a failure is indicated by detection of a condition selected from the group consisting of an electrical hardware failure, software failure, memory failure and battery depletion.
delivering a first therapy through a first electrode and a second electrode;
delivering a second therapy to the second electrode.
17. The method of claim 16, wherein discontinuing the first therapy includes discontinuing the first therapy during the failure associated with the first electrode, and where delivering the second therapy includes delivering the second therapy to the second electrode during the failure associated with the first electrode.
18. The method of claim 16, including operating the first electrode in at least one mode selected from the group consisting of bipolar and unipolar, and wherein delivering the second therapy to the second electrode only occurs when the first electrode is operating in the unipolar mode.
19. The method of claim 16, wherein detecting a failure associated with the first electrode includes detecting a condition selected from the group consisting of an over-sense condition, sensed noise, lead impedance outside a predetermined range, capture amplitude voltage outside a predetermined range, intrinsic amplitude outside a predetermined range, detection of unintended non-cardiac stimulation, and failure to detect an expected event.
delivering a first therapy through a first lead having at least one electrode;
delivering a second therapy to a second lead having at least one electrode.
21. The method of claim 20, wherein discontinuing the first therapy includes discontinuing the first therapy during the failure associated with the first lead, and where delivering the second therapy includes delivering the second therapy to the second electrode during the failure associated with the first lead.
22. The method of claim 20, including operating the at least one electrode of the first lead in at least one mode selected from the group consisting of bipolar and unipolar, and wherein delivering the second therapy to the at least one electrode of the second lead only occurs when the at least one electrode of the first lead is operating in the unipolar mode.
23. The method of claim 20, wherein detecting a failure associated with the first lead includes detecting a condition selected from the group consisting of an over sense condition, sensed noise, lead impedance outside a predetermined range, capture amplitude voltage outside a predetermined range, intrinsic amplitude outside a predetermined range, detection of unintended non-cardiac stimulation, and failure to detect an expected event.
24. The method of claim 20, wherein detecting a failure associated with the first lead includes detecting a condition selected from the group consisting of an electrical hardware failure, software failure, memory failure and battery depletion.
This application is a continuation of U.S. patent application Ser. No. 09/650,568, filed on Aug. 30, 2000, the specification of which is hereby incorporated by reference.
[0017]FIG. 2 is a schematic drawing illustrating one embodiment of a cardiac rhythm management device coupled by leads to a heart.
[0018]FIG. 3 is a schematic diagram illustrating generally one embodiment of portions of a cardiac rhythm management device coupled to a heart.
[0019]FIG. 4 is a flowchart showing one embodiment of providing pacing therapy.
[0020]FIG. 5 is a schematic drawing illustrating one embodiment of a portion of a cardiac rhythm management device coupled by leads to a heart.
[0021]FIG. 6 is a flowchart showing one embodiment of providing pacing therapy.
[0022]FIG. 7 is a flowchart showing one embodiment of providing sensing protocols.
[0023]FIG. 8 is a flowchart showing one embodiment of providing sensing protocols.
[0024]FIG. 9 is a schematic drawing illustrating generally one embodiment of portions of a cardiac rhythm management system having a machine readable medium.
[0029]FIG. 1 is a schematic drawing illustrating, by way of example, but not by way of limitation, one embodiment of portions of a cardiac rhythm management system 100 and an environment in which it is used. In FIG. 1, system 100 includes an implantable pacemaker 105, also referred to as an electronics unit, which is coupled by an intravascular endocardial lead 110, or other lead, to a heart 115 of patient 120. Pacemaker 105 is adapted to perform the methods as described herein. System 100 also includes an external programmer 125 providing wireless communication with pacemaker 105 using a telemetry device 130, such as might be used by a physician to initially program or periodically reprogram pacemaker 105. Endocardial lead 110 includes a proximal end 135, which is coupled to pacemaker 105, and a distal end 140, which is coupled to one or more portions of heart 115.
[0030]FIG. 2 is a schematic drawing illustrating, by way of example, but not by way of limitation, one embodiment of device 105 coupled by leads 110A-C to a heart 115, which includes a right atrium 200A, a left atrium 200B, a right ventricle 205A, a left ventricle 205B, and a coronary sinus 220 extending from right atrium 200A. In one such embodiment, system 100 provides biventricular coordination therapy to coordinate right ventricular and left ventricular contractions, such as for congestive heart failure patients. In this embodiment, atrial lead 110A includes electrodes (electrical contacts) disposed in, around, or near the right atrium 200A of heart 115, such as ring electrode 225 and tip electrode 230, for sensing signals and/or delivering pacing therapy to the right atrium 200A. Lead 110A optionally also includes additional electrodes, such as for delivering atrial and/or ventricular cardioversion/defibrillation and/or pacing therapy to heart 115. The embodiment further includes a right ventricular lead 110B having one or more electrodes disposed in, around, or near the right ventricle 205A, such as tip electrode 235 and ring electrode 240, for delivering sensing signals and/or delivering pacing therapy. Lead 110B optionally also includes additional electrodes, such as for delivering atrial and/or ventricular cardioversion/defibrillation and/or pacing therapy to heart 115. The embodiment further includes a left ventricular lead 110C, inserted through coronary sinus 220 and into the great cardiac vein so that its electrodes, which include electrodes 245 and may optionally include electrode 250, are associated with left ventricle 205B for sensing intrinsic heart signals and providing one or more of coordination paces or defibrillation shocks. Lead 110C optionally also includes additional electrodes, such as for delivering atrial and/or ventricular cardioversion/defibrillation and/or pacing therapy to heart 115.
[0032]FIG. 3 is a schematic diagram illustrating generally, by way of example, but not by way of limitation, one embodiment of portions of device 105, which is coupled to heart 115. Device 105, as shown in FIG. 3, includes a power source 300, an atrial sensing circuit 305, a right ventricular sensing circuit 310, a left ventricular sensing circuit 340, an atrial therapy circuit 315, a right ventricular therapy circuit 320, a left ventricular therapy circuit 350 and a controller 325. The therapy circuits may also be referred to as signal generators for producing pulses applied to the heart. It should be noted that many of the elements of device 105 are optional, depending upon the desired pacing mode. For example, an atrial therapy circuit 315 would not be required for pacing modes such as VVI, VDD or others not utilizing atrial pacing. As a further example, individual sensing circuits 305, 310 or 340 would not be required where their associated leads 110 are utilized only for application of therapy. Other combinations and permutations will be apparent to those skilled in the art.
[0058]FIG. 4 is a flowchart showing one embodiment of providing pacing therapy. In FIG. 4, a first pacing therapy is applied in action box 410. The first pacing therapy may be applied using one or more leads each having at least one electrode, and involving one or more chambers of the heart. Individual leads may be used for sensing only, pacing only, both sensing and pacing, or neither sensing nor pacing. Furthermore, individual leads may have two or more electrodes acting independently. Leads or electrodes not used for sensing or pacing will be referred to as redundant.
[0059]FIG. 5 is a schematic illustrating but one example of a system having the capability for lead redundancy as described above. FIG. 5 generally depicts a portion of the device of FIG. 2, although some leads are omitted for clarity. FIG. 5 differs from FIG. 2 in that right ventricle lead 110B is replaced by a first right ventricle lead 110B and a second right ventricle lead 110B2. One or both of the right ventricle leads 110B may be actively sensing or pacing during the first pacing therapy. While there are only two right ventricle leads 110B depicted in FIG. 5, additional right ventricle leads may be utilized. Although there may be a practical limit as to how many leads may be associated with an individual chamber of the heart, the methods described herein may be applied to any number of available leads. Furthermore, use of the right ventricle as an example for FIG. 5 is not limiting and redundant or multiple leads may be utilized in any chamber of the heart. In addition, electrodes 235 1/235 2 may act as redundant electrodes to electrodes 240 1/240 2, respectively.
[0064]FIG. 6 is a flowchart of another embodiment of providing pacing therapy through a cardiac rhythm management device. The device applies a pacing therapy in action box 610 as a first pacing therapy. The device determines if a failure indication has been detected in decision box 620. If no failure is indicated, the device continues to apply the first pacing therapy and monitor for detection of failure. If lead failure is indicated, control is passed to action box 630.
[0072]FIG. 8 is a flowchart an embodiment of sensing cardiac signals through a cardiac rhythm management device. The device senses one or more cardiac signals in action box 810 in a first sensing protocol. The device determines if a failure indication has been detected in decision box 820. If no failure is indicated, the device continues to sense cardiac signals using the first sensing protocol and monitor for detection of failure. If lead failure is indicated, control is passed to action box 830.
Although specific embodiments have been illustrated and described herein, it will be appreciated by those of ordinary skill in the art that any arrangement which is calculated to achieve the same purpose may be substituted for the specific embodiments shown. Many adaptations of the invention will be apparent to those of ordinary skill in the art. For example, use of markers or other display mechanisms to indicate reversion or the number of reversions may be used to assist the physician during interrogation of the cardiac rhythm management device. Different lead types, numbers of leads, and utilized heart chambers can be varied from the examples depicted herein. As examples, rather than a biventricular three-chamber therapy as described with reference to FIG. 2, a biatrial three-chamber therapy or biatrial/biventricular four-chamber therapy could be accommodated by the embodiments described herein. Accordingly, this application is intended to cover any adaptations or variations of the invention. It is manifestly intended that this invention be limited only by the following claims and equivalents thereof. What is claimed is:
US20010041918 * Feb 28, 2000 Nov 15, 2001 Cardiac Pacemakers Inc. Multi-site hybrid hardware-based cardiac pacemaker
US8442635 * Feb 22, 2011 May 14, 2013 Cardiac Pacemakers, Inc. Automatic electrode integrity management systems and methods
US8923962 * Feb 4, 2013 Dec 30, 2014 Cardiac Pacemakers, Inc. Safety control system for implantable neural stimulator
US9364676 * Sep 24, 2010 Jun 14, 2016 Biotronik Crm Patent Ag Biventricular cardiac stimulator
US20130150927 * Feb 4, 2013 Jun 13, 2013 Cardiac Pacemakers, Inc. Safety control system for implantable neural stimulator
International Classification A61N1/362, A61N1/08, A61N1/37
Cooperative Classification A61N1/3627, A61N1/3706, A61N2001/083