Source: http://www.google.com/patents/US5350404?dq=5,915,131
Timestamp: 2016-05-26 03:05:13
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Patent US5350404 - Lead system for use with an atrial defibrillator and method - Google PatentsSearch Images Maps Play YouTube News Gmail Drive More »Sign inPatentsAn implantable atrial defibrillator provides a pulse of defibrillating electrical energy to the atria of the heart in synchronism with sensed R waves in response to non-coincident sensing of an R wave at first and second areas of the heart. The defibrillating pulse is provided after a predetermined number...http://www.google.com/patents/US5350404?utm_source=gb-gplus-sharePatent US5350404 - Lead system for use with an atrial defibrillator and methodAdvanced Patent SearchPublication numberUS5350404 APublication typeGrantApplication numberUS 08/130,308Publication dateSep 27, 1994Filing dateOct 1, 1993Priority dateApr 12, 1991Fee statusPaidAlso published asCA2083678A1, CA2083678C, CA2298288A1, CA2298288C, CA2434313A1, DE69216736D1, DE69216736T2, DE69233110D1, DE69233110T2, EP0533917A1, EP0533917B1, EP0672434A2, EP0672434A3, EP0672434B1, US5433729, WO1992018198A2, WO1992018198A3Publication number08130308, 130308, US 5350404 A, US 5350404A, US-A-5350404, US5350404 A, US5350404AInventorsJohn M. Adams, Clifton A. Alferness, Paul E. KreyenhagenOriginal AssigneeIncontrol, Inc.Export CitationBiBTeX, EndNote, RefManPatent Citations (5), Referenced by (62), Classifications (19), Legal Events (4) External Links: USPTO, USPTO Assignment, EspacenetLead system for use with an atrial defibrillator and method
3. A device as defined in claim 2 wherein said first lead includes a preshaped bend in the region of said first lead within the coronary sinus for fixing said first lead within the coronary sinus.
4. A device as defined in claim 1 wherein said first electrode is further arranged for being disposed in the right atrial appendage of the heart.
5. A device as defined in claim 4 wherein said first lead further includes a preshaped portion in the region of said first lead within the right atrium for forcing said first electrode into the right atrial appendage.
6. A device as defined in claim 5 wherein said first lead is looped within the right atrium and wherein said first lead further includes a stiffened portion for forcing said first electrode against the inner wall of the right atrium.
7. A device as defined in claim 1 wherein said second lead further includes a third sensing electrode coupled to said electrical activation sensing means.
8. A device as defined in claim 7 wherein said second lead is arranged for disposing said third sensing electrode within the right ventricle of the heart.
9. A device as defined in claim 1 wherein said second electrode and a selected one of said first and second sensing electrodes are coupled to said electrical activation sensing means for sensing electrical activations of the heart between said second electrode and said selected one of said first and second sensing electrodes.
10. A method of monitoring activity of the heart of a patient and delivering cardioverting electrical energy to the atria of the heart of the patient, said method comprising the steps of:providing storage means for storing electrical energy; implanting said storage means beneath the skin of the patient; providing lead means including first lead having first and second electrodes and a second lead including first and second sensing electrodes; implanting said lead means beneath the skin of the patient including steps of disposing said first electrode within the right atrium of the heart, disposing said second electrode within the coronary sinus beneath the left atrium of the heart, and disposing said first and second sensing electrodes within the right ventricle of the heart; coupling said first and second electrodes to said storage means; sensing atrial activity of the heart between said first and second electrodes; sensing electrical activations of the heart between said first and second sensing electrodes; storing said electrical energy in said storage means; and applying, through said first lead, at least a portion of said stored electrical energy between said first and second electrodes to deliver said cardioverting electrical energy to the atria of the heart. 11. A method as defined in claim 10 wherein said second lead includes a third sensing electrode and including the further steps of disposing said third sensing electrode within the right ventricle of the heart and sensing electrical activations of the heart with said first, second, and third sensing electrodes.
12. A method as defined in claim 12 wherein said first electrode is disposed in the right atrial appendage of the heart.
13. A method as defined in claim 10 including the further step of sensing said electrical activations of the heart between said second electrode and a selected one of said first or and second sensing electrodes.
14. A method as defined in claim 13 wherein said first electrode is disposed in the right atrial appendage of the heart.
15. A method as defined in claim 10 wherein said applying step includes applying said electrical energy in the form of a biphasic waveform having a pair equal duration phases and a total energy between 0.5 and 2.1 joules.
16. A method as defined in claim 15 wherein each of said phases has a duration between 2 and 4 milliseconds.
17. An implantable device for monitoring activity of the heart and delivering cardioverting electrical energy to the atria of the heart, said device comprising:storage means for storing said electrical energy; atrial activity sensing means for sensing atrial activity of the heart; electrical activation sensing means for sensing electrical activations of the heart; and lead means including a first electrode, a second electrode, a first sensing electrode, and a second sensing electrode for disposing said first electrode within the right atrium of the heart, for disposing said second electrode within the coronary sinus beneath the left atrium of the heart, and for disposing said first and second sensing electrodes within the right ventricle of the heart; said first and second electrodes being coupled to said storage means for delivering said cardioverting electrical energy to the atria of the heart and to said atrial activity sensing means for sensing atrial activity of the heart; said first and second sensing electrodes being coupled to said electrical activation sensing means for sensing electrical activations of the heart between said first and second sensing electrodes, said second electrode and a selected one of said first and second sensing electrodes being coupled to said electrical activation sensing means for sensing electrical activations of the heart between said second electrode and said selected one of said first and second sensing electrodes, and said lead means being fully implantable beneath the skin of a patient. Description
This is a division of U.S. application Ser. No. 07/856,514, filed Mar. 24, 1992, for IMPROVED ATRIAL DEFIBRILLATOR, LEAD SYSTEMS, AND METHOD, which is a Continuation-in-Part of U.S. application Ser. No. 07/685,130, filed Apr. 12, 1991, for IMPROVED ATRIAL DEFIBRILLATOR AND METHOD, now U.S. Pat. No. 5,282,837.
The present invention generally relates to an atrial defibrillator for delivering a pulse of defibrillating electrical energy to the atria of a human heart. The present invention is more particularly directed to a fully automatic implantable atrial defibrillator which exhibits reduced power consumption, reliable synchronized delivery of defibrillating electrical energy to the atria, and multiple modes of operation including bradycardia pacing. The present invention is further directed to an improved endocardial lead for delivering the defibrillating electrical energy to the atria while minimizing the electrical energy applied to the ventricles. The present invention is still further directed to lead systems for use in an atrial defibrillator and method for monitoring activity of the heart and delivering cardioverting or defibrillating electrical energy to the heart.
Atrial fibrillation occurs suddenly and many times can only be corrected by a discharge of electrical energy to the heart through the skin of the patient by way of an external defibrillator of the type well known in the art- This treatment is commonly referred to as synchronized cardioversion and, as its name implies, involves applying electrical defibrillating energy to the heart in synchronism with a detected electrical activation (R wave) of the heart. The treatment is very painful and, unfortunately, most often only results In temporary relief for patients, lasting but a few weeks.
Synchronizing the delivery of the defibrillating or cardioverting energy with an electrical activation (R wave) of the heart is important to prevent ventricular fibrillation. Ventricular fibrillation is a fatal arrhythmia which can be caused by electrical energy being delivered to the heart at the wrong time in the cardiac cycle, such as during the T wave of the cycle. As a result, it is most desirable to sense electrical activations of the heart to generate synchronization pulses (or signals) in a manner which avoids detecting noise as an electrical activation. Unfortunately, implantable atrial defibrillators proposed to date have not provided either such noise immunity or any other means for assuring reliable synchronization.
In addition to the foregoing, the lead systems and method disclosed herein reduce battery power consumption and hence lengthen the useful life of an implanted atrial defibrillator employing such lead systems. The lead systems disclosed herein are configured for placing the cardioverting or defibrillating electrodes in the heart at locations which minimize the energy which must be delivered to the atria for cardioverting or defibrillating the same. Furthermore, the cardioverting or defibrillating energy levels disclosed herein are intended to provide a fifty percent probability of successful defibrillation or cardioversion. This is based upon the recognition that atrial fibrillation is not generally life threatening and that if a second delivery of cardioverting or defibrillating electrical energy is required for successful cardioversion or defibrillation, the life of the patient will not be threatened. The end result is less battery power consumption, extended life of the atrial defibrillator, and of greatest importance, less frequent surgical replacement of the atrial defibrillator to provide the patient with greater comfort and less risk commonly attendant to all surgeries.
The present invention provides a lead system for use with an implantable device for monitoring activity of the heart and delivering cardioverting electrical energy to the atria of the heart wherein the device includes storage means for storing the electrical energy. The lead system includes lead means coupled to the storage means for receiving the electrical energy from the storage means. The lead means applies the electrical energy between the right atrium of the heart and at least one of the coronary sinus beneath the left atrium of the heart and the left pulmonary artery adjacent the left atrium of the heart for delivering the electrical energy to the atria of the heart. The lead means is fully implantable beneath the skin of a patient.
The present invention further provides a method of monitoring activity of the heart of a patient and delivering cardioverting electrical energy to the atria of the heart of the patient. The method includes the steps of providing storage means for storing electrical energy, implanting the storage means beneath the skin of the patient, providing lead means, and implanting the lead means beneath the skin of the patient. The method further includes the steps of coupling the lead means to the storage means, storing the electrical energy in the storage means, and applying, through the lead means, at least a portion of the stored electrical energy between the right atrium of the heart and at least one of the coronary sinus beneath the left atrium of the heart and the left pulmonary artery adjacent the left atrium of the heart to deliver the cardioverting electrical energy to the atria of the heart.
FIG. 7 is a top plan view illustrating an endocardial lead embodying the present invention having a plurality of electrodes for sensing electrical activations of the left ventricle, sensing electrical activations of the atria, and applying defibrillating electrical energy to the atria;
FIG. 8 is a cross-sectional view, to an enlarged scale, taken along lines 8--8 of FIG. 7;
FIG. 9 is a perspective view of the human heart having a lead system configured in accordance with a first lead system preferred embodiment of the present invention implanted therein;
FIG. 10 is a perspective view of the human heart having a lead system configured in accordance with a second lead system preferred embodiment of the present invention implanted therein;
FIG. 11 is a perspective view of the human heart having a lead system configured in accordance with a third lead system preferred embodiment of the present invention implanted therein;
FIG. 12 is a perspective view of the human heart having a lead system configured in accordance with a fourth lead system preferred embodiment of the present invention implanted therein;
FIG. 13 is a perspective view of the human heart, with selected portions thereof broken away, having a lead system configured in accordance with a fifth lead system preferred embodiment of the present invention implanted therein;
FIG. 14 is a perspective view of the human heart having a lead system configured in accordance with a sixth lead system preferred embodiment of the present invention implanted therein;
FIG. 15 is a perspective view of the human heart, with selected portions thereof broken away, having a lead system configured in accordance with a seventh lead system preferred embodiment of the present invention implanted therein; and
FIG. 16 is a perspective view of the human heart having a lead system configured in accordance with an eighth lead system preferred embodiment of the present invention implanted therein.
Within the enclosure 32, the atrial defibrillator 30 includes a first sense amplifier 50, a second sense amplifier 52, and a third sense amplifier 54. The first sense amplifier 50 forms a first sensing means which, when inputs 50a and 50b are coupled to electrodes 38 and 40 respectively of the first lead 34, senses electrical activations of the right ventricle 12. The second sense amplifier 52 forms a second sensing means which, when inputs 52a and 52b are coupled to electrodes 42 and 44 respectively of the second lead senses electrical activations of the left ventricle 14. The third sense amplifier 54 forms atrial sense means which, when inputs 54a and 54b are coupled to electrodes 44 and 46 respectively of the second lead 36, senses atrial activity of the heart when enabled as will be described hereinafter.
The enclosure 32 of the atrial defibrillator 30 further includes a microprocessor 62. The microprocessor 62 is preferably implemented in a manner to be described hereinafter with respect to the flow diagrams of FIGS. 2 through 6. The implementation of the microprocessor 62 results in a plurality of functional stages. The stages include a first timer 64, a second timer 66, a third timer 68, a synchronization marker controller 70, and a synchronization detector 72. The functional stages of the microprocessor 62 further include a calculator stage including an average calculation stage 74, a standard deviation calculation stage 76, an enable stage 78, a disable stage 80, an atrial arrhythmia detector in the form of an atrial fibrillation detector 82, a first counter 84, a second counter 86, a third counter 88, and a charge delivery and energy control stage 90.
To complete the identification of the various structural elements within the enclosure 32, the atrial defibrillator 30 further includes a pacer output stage 108. As will be seen hereinafter, the pacer output stage 108 applies stimulating pulses to the right ventricle 12 of the heart 10 when bradycardia pacing is required or synchronization marker pulses to the right ventricle when the atrial defibrillator is in the marker pulse mode. The atrial defibrillator 30 further includes a charger and storage capacitor circuit 110 of the type well known in the art which charges a storage capacitor to a predetermined voltage level and a discharge circuit 112 for discharging the storage capacitor within circuit 110 by a predetermined amount to provide a controlled discharge output of electrical energy when required to the atria of the heart. To that end, the discharge circuit 112 includes outputs 112a and 112b coupled to electrodes 46 and 44 respectively of the second lead 36 for applying the cardioverting or defibrillating electrical energy to the atria. Lastly, the defibrillator 30 includes a depletable power source 114, such a lithium battery, for providing power to the electrical components of the atrial defibrillator 30. As will be seen hereinafter, the atrial defibrillator 30 is arranged to minimize the power consumption of the battery 114 so as to extend the useful life of the atrial defibrillator 30.
If in step 124 the processor had determined that the first timer 64 had expired, it would proceed to step 126 to pace the right ventricle. In so doing, the microprocessor activates the pacer output 108 and causes the pacer output 108 to provide an electrical stimulating pulse to the electrodes 38 and 40 of the first lead 234. The timeout time of the first timer 64 may be, for example, one second and may be programmed into the memory 92 through the external controller 100 and the receiver/transmitter 102.
As can thus be seen, the atrial defibrillator 30 provides bradycardia pacing of the right ventricle and, upon each electrical activation being sensed at the right ventricle, determines the time interval since the first timer 64 was reset by either a sensed electrical activation of the right ventricle or a stimulating pulse being delivered to the right ventricle during bradycardia pacing. Hence, in determining the time intervals, the sensed electrical activations of the right ventricle and the delivery of a stimulating pacing pulse to the right ventricle are considered to be equivalent events in that each results in a depolarization of the right ventricle.
Referring now to FIG. 3, it illustrates the manner in which the atrial defibrillator 30 may be implemented for enabling the atrial fibrillation detector 82. This process begins at step 130 wherein the microprocessor first determines whether the right ventricle has been paced by the pacer output 108. If the If the right ventricle has not been paced, the processor proceeds to step 132 to determine whether an R wave has been detected at the right ventricle. If an R wave has not been detected at the right ventricle, the processor returns to step 130 to once again determine whether the right ventricle has been paced. If the right ventricle has been paced as determined in step 130 or if an R wave has been detected at the right ventricle in step 132, the processor then proceeds to step 134 to calculate an average time interval using the last 20 stored time interval values. This is performed by the average calculation stage 74 of the microprocessor 62.
As can thus be seen by the implementation illustrated in FIG. 3, the atrial defibrillator 30 activates the atrial fibrillation detector 82, the analog-to-digital converter 60, and the third sense amplifier 54 responsive to the determined time intervals, and preferably, the last twenty time intervals stored in the memory 92. This allows the atrial fibrillation detector 82, the analog-to-digital converter 60, and the third sense amplifier 54 to be normally disabled to avoid excessive consumption of the battery 114. This is particularly important because the algorithms utilized in arrhythmia detectors, such as fibrillation detectors, consume considerable power and if left continuously energized, would require frequent replacement of the defibrillators in which they are employed for the purpose of replacing the depletable power sources, such as a battery.
There are many algorithms known in the art for processing such data to determine if fibrillation is present. One such algorithm is disclosed in a paper: Nitish V. Thakor, Yi-Sheng Zhu and Kong-Yan Pan, "Ventricular Tachycardia and Fibrillation Detection by a Sequential Hypothesis Testing Algorithm," IEEE Transactions On Biomedical Engineering," Vol. 37, No. 9, pp. 837-843, September 1990. Another such algorithm is disclosed in a paper: Janice Jenkins, Ki Hong Nob, Alain Guezennec, Thomas Bump, and Robert Arzbaecher, "Diagnosis of Atrial Fibrillation Using Electrograms from Chronic Leads: Evaluation of Computer Algorithms," PACE, Vol. 11, pp. 622-631, May 1988. Implementing such algorithms by a microprocessor such as microprocessor 62 is well within the preview of one skilled in the art.
If the atrial defibrillator in step 152 determines that atrial fibrillation is currently present in the heart, the microprocessor then proceeds determine whether it is able to obtain a reliable synchronizing pulse for synchronizing the delivery of the defibrillating or cardioverting electrical energy to the atria. This begins in step 158 where the atrial defibrillator microprocessor determines whether an electrical activation has been detected in the right ventricle. If an R wave has not been detected in the right ventricle, the microprocessor performs a loop to once again determine at step 158 if an R wave has been detected in the right ventricle. When an R wave is detected in the right ventricle, the microprocessor proceeds to step 160 to start the third timer 68. After starting timer 68, the processor then proceeds to step 162 to determine whether an R wave has been detected in the left ventricle. If an electrical activation has not been detected at the left ventricle, the microprocessor then returns to step 162 to once again determine whether an R wave has been detected at the left ventricle. When an R wave is detected at the left ventricle, the microprocessor then proceeds to step 164 to stop the third timer 68. In so doing, the third timer 68 will have the time from when the R wave was detected at the right ventricle in step 158 and when the same R wave was detected at the left ventricle in step 162.
Once the atrial fibrillation detector disabled in step 234, the atrial defibrillator returns once again determine the probability of atrial fibrillation and, if there is a probability of atrial fibrillation, to once again enable the atrial fibrillation detector. This begins the implementation of the atrial defibrillator as illustrated in the flow diagrams of FIGS. 4-6.
Referring now to FIG. 7, it illustrates the intravascular second lead 36 which is structured accordance with another aspect of the present invention. As will be noted, the lead 36 includes the first or tip electrode 42, the second or ring electrode 44, and the third electrode 46. Hence, the second electrode proximal to the tip electrode 42, and the third electrode 46 is proximal to the second electrode 44 with the first electrode 42 being at the distal end of the lead.
Referring now to FIG. 9, it illustrates, in perspective view, a human heart 10 having a lead system 250, configured in accordance with a first lead system preferred embodiment of the present invention implanted therein. The portions of the heart 10 particularly noted in FIG. 9 are the right ventricle 12, the left ventricle 14, the right atrium 16, the left atrium 18, the superior vena cava 20, the coronary sinus 22, the great vein 23, and the inferior vena cava 27.
The lead system 250 generally includes a first lead 252 and a second lead 254. The leads 252 and 254 are flexible but preformed so that the leads 252 and 254 may be readily fed into the heart 10 and assume the configurations when implanted as illustrated in the Figure.
The first lead 252 carries or includes a first elongated, large surface area, electrode 256, a distal or tip sense electrode 258, and a ring or proximal sense electrode 260. The electrodes 258, 260, and 256 are spaced apart on the lead 252 so that, when lead 252 is fed into the superior vena cava 20 and into the right ventricle 12 through the right atrium 16 to a position where electrode 258 is at the apex of the right ventricle, the first elongated electrode 256 will be disposed in and in electrical contact with the right atrium 16 of the heart 10. Also, electrodes 258 and 260 will be in electrical contact with the right ventricle of the heart 10.
The second lead 254 includes a second elongated, large surface area, electrode 262, a tip or distal sense electrode 264, and a ring or proximal sense electrode 266. The electrodes 264, 266, and 262 are spaced apart on the second lead 254 so that when the lead 254 is fed into the superior vena cava 20 and into a coronary vein, such as the great vein 23 through the right atrium 16 and the coronary sinus 22 with electrodes 264 and 266 being adjacent the left ventricle within the great vein as illustrated, the second elongated electrode 262 will be disposed within the coronary sinus 22 just beneath the left atrium 18 and adjacent to the left ventricle 14. Since the coronary sinus 22 is in close proximity to the left atrium 18 and the left ventricle 14, electrodes 264 and 266 will be in electrical contact with the left ventricle and electrode 262 will be electrical contact with the left atrium 18.
Blood flow within the great vein 23 and the coronary sinus 22 is in an upward direction and hence would tend to push the lead 254 from the implanted position as illustrated and described above. Hence, to assure fixation of lead 254 in place, the lead 254 preferably provided with a preformed bend at 255 where the lead 254 exits the coronary sinus 22 and enters a coronary vein, such as the great vein 23.
The lead system 250 may be utilized to advantage in association with the atrial defibrillator 30 illustrated in FIG. 1 for monitoring the activity of the heart 10 and for delivering cardioverting or defibrillating electrical energy to the atria 16 and 18 of the heart 10. To that end, the first elongated electrode 256 may be coupled to input 54a of sense amplifier 54 and to output 112a of the discharge circuit 112. The second elongated electrode 262 may be coupled to input 54b of sense amplifier 54 and to output 112b of discharge circuit 112. With such coupling, electrodes 256 and 262 may be utilized for sensing atrial activity of the heart in association with sense amplifier 54. Also, the cardioverting electrical energy provided from the charger and storage capacitor 110 and the discharge circuit 112 will be received by electrodes 256 and 262 for applying the electrical cardioverting energy between the right atrium 16 and the coronary sinus 22 beneath the left atrium 18 and adjacent to the left ventricle 14 to deliver the cardioverting electrical energy to the atria 16 and 18 of the heart 10. By virtue of the locations of the elongated stimulating electrodes 256 and 262, the electrical energy applied to the right ventricle 12 and left ventricle 14 when the atria are cardioverted or defibrillated will be minimized.
For sensing electrical activations of the heart, the first pair of sensing electrodes 258 and 260 carried by the first lead 252 may be coupled to inputs 50a and 50b respectively of sense amplifier 50 and the second pair of sensing electrodes 264 and 266 of the second lead 254 may be coupled to inputs 52a and 52b respectively of sense amplifier 52. This permits sensing of electrical activations of the heart and more specifically electrical activations of the right ventricle 12 and electrical activations of the left ventricle 14. This enables the non-coincident sensing of the depolarization activation waves as previously described for synchronizing the delivery of the cardioverting or defibrillating electrical energy to the atria 16 and 18 in synchronism with a detected electrical activation of the heart.
Referring now to FIG. 10, it illustrates, in perspective view, a human heart 10 having a lead system 270, configured in accordance with a second lead system preferred embodiment of the present invention, implanted therein. The portions of the heart 10 particularly noted in FIG. 10 are the right ventricle 12, the left ventricle 14, the right atrium 16, the right atrial appendage 17, the left atrium 18, the superior vena cava 20, the coronary sinus 22, the great vein 23, and the inferior vena cava 27.
The lead system 270 generally includes a first lead 272 and a second lead 274. The leads 272 and 274 are flexible but preformed so that the leads 272 and 274 may be readily fed into the heart 10 and assume the configurations when implanted as illustrated in the Figure.
The first lead 272 carries or includes a first elongated, large surface area, electrode 276, a distal or tip sense electrode 278, and a ring or proximal sense electrode 280. The electrodes 278, 280, and 276 are spaced apart on the lead 272 so that when lead 272 is fed into the superior vena cava 20 and into the right ventricle 12 through the right atrium 16 to a position where electrode 278 is at the apex of the right ventricle, the first elongated electrode 276 will be disposed in and in electrical contact with the right atrium 16 of the heart 10. It will be further noted that the lead 270 is looped or pigtailed in the region of electrode 276 so that the electrode 276 is disposed in the right atrial appendage 17. Also, electrodes 278 and 280 will be in electrical contact with the right ventricle of the heart 10.
The second lead 274 includes a second elongated, large surface area, electrode 282, a tip or distal sense electrode 284, and a ring or proximal sense electrode 286. The electrodes 284, 286, and 282 are spaced apart on the second lead 274 so that when the lead 274 is fed into the superior vena cava 20 and into a coronary vein such as the great vein 23 through the right atrium 16 and coronary sinus 22 with electrodes 284 and 286 being adjacent the left ventricle within the great vein 23 as illustrated, the second elongated electrode 282 will be disposed within the coronary sinus 22 just beneath the left atrium 18 and adjacent to the left ventricle 14. Since the coronary sinus 22 is in close proximity to the left atrium 18 and the left ventricle 14, electrodes 284 and 286 will be in electrical contact with the left ventricle and electrode 282 will be in electrical contact with the left atrium 18.
Blood flow within the great vein 23 and the coronary sinus 22 is in an upward direction and hence would tend to push the lead 274 from the implanted position as illustrated and described above. Hence, to assure fixation of lead 274 in place, the lead 274 is preferably provided with a preformed bend at 275 where the lead 274 exits the coronary sinus 22 and enters a coronary vein, such as the great vein 23.
The lead system 270 may be utilized to advantage in association with the atrial defibrillator 30 illustrated in FIG. 1 for monitoring the activity of the heart 10 and for delivering cardioverting or defibrillating electrical energy to the atria 16 and 18 of the heart 10. To that end, the first elongated electrode 276 may be coupled to input 54a of sense amplifier 54 and to output 112a of the discharge circuit 112. The second elongated electrode 282 may be coupled to input 54b of sense amplifier 54 and to output 112b of discharge circuit 112. With such coupling, electrodes 276 and 282 may be utilized for sensing atrial activity of the heart in association with sense amplifier 54. Also, the cardioverting electrical energy provided from the charger and storage capacitor 110 and the discharge circuit 112 will be received by electrodes 276 and 282 for applying the electrical cardioverting energy between the right atrium 16 and the coronary sinus 22 beneath the left atrium 18 and adjacent to the left ventricle 14 to deliver the cardioverting electrical energy to the atria 16 and 18 of the heart 10. By virtue of the locations of the elongated stimulating electrodes 276 and 282, the electrical energy applied to the right ventricle 12 and left ventricle 14 when the atria are cardioverted or defibrillated will be minimized.
For sensing electrical activations of the heart, the first pair of sensing electrodes 278 and 280 carried by the first lead 272 may be coupled to inputs 50a and 50b respectively of sense amplifier 50 and the second pair of sensing electrodes 284 and 286 of the second lead 274 may be coupled to inputs 52a and 52b respectively of sense amplifier 52. This permits sensing of electrical activations of the heart and more specifically electrical activations of the right ventricle 12 and electrical activations of the left ventricle 14. This enables the non-coincident sensing of the depolarization activation waves as previously described for synchronizing the delivery of the cardioverting or defibrillating electrical energy to the atria 16 and 18 in synchronism with a detected electrical activation of the heart.
Referring now to FIG. 11, it illustrates, in perspective view, a human heart 10 having a lead system 290, configured in accordance with a third lead system preferred embodiment of the present invention, implanted therein. The portions of the heart 10 particularly noted in FIG. 11 are the right ventricle 12, the left ventricle 14, the right atrium 16, the left atrium 18, the superior vena cava 20, the coronary sinus 22, the great vein 23, and the inferior vena cava 27.
The lead system 290 generally includes a first lead 292 and a second lead 294. The leads 292 and 294 are flexible but preformed so that the leads 292 and 294 may be readily fed into the heart 10 and assume the configurations when implanted as illustrated in the Figure.
The second lead 294 carries or includes a first tip or distal sense electrode 296, a second medial sense electrode 298, and a third proximal sense electrode 300. The electrodes 296, 298, and 300 are spaced apart on the lead 294 so that when lead 294 is fed into the superior vena cava 20 and into the right ventricle 12 through the right atrium 16 to a position where electrode 296 is at the apex of the right ventricle, all three of the electrodes 296, 298, and 300 will be disposed in and in electrical contact with the right ventricle 12 of the heart 10.
The second lead 292 includes a first elongated, large surface area, electrode 302 and second elongated, large surface area, electrode 304. The electrodes 302 and 304 are spaced apart on the first lead 292 so that when the lead 292 is fed into the superior vena cava 20 and into the coronary sinus 22 as illustrated through the right atrium 16 with the second elongated electrode 304 disposed within the coronary sinus 22 just beneath the left atrium 18 and adjacent to the left ventricle 14, the first elongated electrode 302 will be disposed in and in electrical contact with the right atrium 16. Since the coronary sinus 22 is in close proximity to the left atrium 18, electrode 304 will be in electrical contact with the left atrium 18. Lead 292 may also be provided with a preformed bend at 293 to assist in fixing lead 292 in place against blood flow in the coronary sinus 22.
The lead system 290 may be utilized to advantage in association with the atrial defibrillator 30 illustrated in FIG. 1 for monitoring the activity of the heart 10 and for delivering cardioverting or defibrillating electrical energy to the atria 16 and 18 of the heart 10. To that end, the first elongated electrode 302 may be coupled to input 54a of sense amplifier 54 and to output 112a of the discharge circuit 112. The second elongated electrode 304 may be coupled to input 54b of sense amplifier 54 and to output 112b of discharge circuit 112. With such coupling, electrodes 302 and 304 may be utilized for sensing atrial activity of the heart in association with sense amplifier 54. Also, the cardioverting electrical energy provided from the charger and storage capacitor 110 and the discharge circuit 112 will be received by electrodes 302 and 304 for applying the electrical cardioverting energy between the right atrium 16 and the coronary sinus 22 beneath the left atrium 18 and adjacent to the left ventricle 14 to deliver the cardioverting electrical energy to the atria 16 and 18 of the heart 10. By virtue of the locations of the elongated stimulating electrodes 302 and 304, the electrical energy applied to the right ventricle 12 and left ventricle 14 when the atria are cardioverted or defibrillated will be minimized.
For sensing electrical activations of the heart, a first pair of the sensing electrodes 296 and 298 carried by the second lead 294 may be coupled to inputs 50b and 50a respectively of sense amplifier 50 and a second pair of the sensing electrodes 298 and 300 of the second lead 294 may be coupled to inputs 52b and 52a respectively of sense amplifier 52. This permits sensing of electrical activations of the heart and more specifically electrical activations at two different areas of the right ventricle 12. This enables the non-coincident sensing of the depolarization activation waves as previously described for synchronizing the delivery of the cardioverting or defibrillating electrical energy to the atria 16 and 18 in synchronism with a detected electrical activation of the heart.
Referring now to FIG. 12, it illustrates., in perspective view, a human heart 10 having a lead system 310, configured in accordance with a fourth lead system preferred embodiment of the present invention, implanted wherein. The portions of the heart 10 particularly noted in FIG. 12 are the right ventricle 12, the left ventricle 14, the right atrium 16, the right atrial appendage 17, the left atrium 18, the superior vena cava 20, the coronary sinus 22, the great vein 23, and the inferior vena cava 27.
The lead system 310 generally includes a first lead 312 and a second lead 314. The leads 312 and 314 are flexible but preformed so that the leads 312 and 314 may be readily fed into the heart 10 and assume the configurations when implanted as illustrated in the Figure.
The second lead 314 carries or includes a first tip or distal sense electrode 316, a second medial sense electrode 318, and a third proximal sense electrode 320. The electrodes 316, 318, and 320 are spaced apart on the lead 314 so that when lead 314 is fed into the superior vena cava 20 and into the right ventricle 12 through the right atrium 16 to a position where electrode 316 is at the apex of the right ventricle, all three electrodes 316, 318, and 320 will be disposed in and in electrical contact with the right ventricle 12 of the heart 10.
The first lead 312 includes a first elongated, large surface area, electrode 322 and a second elongated, large surface area, electrode 324. The electrodes 322 and 324 are spaced apart on the first lead 312 so that when the lead 312 is fed into the superior vena cava 20 and into the coronary sinus 22 as illustrated through the right atrium 16 with the second elongated electrode 324 disposed within the coronary sinus 22 just beneath the left atrium 18 and adjacent to the left ventricle 14, the first elongated electrode 322 will be disposed in and in electrical contact with the right atrium 16. Since the coronary sinus 22 is in close proximity to the left atrium 18, electrode 324 will be in electrical contact with the left atrium 18.
It will be noted that the lead 312 is looped or pigtailed in the right atrium 16 so that the first electrode 322 is disposed in the right atrial appendage 17. To assist in assuring that electrode 322 is in the right atrial appendage 17, the lead 312 is provided with a first preformed bend at 313 in the area where lead 312 enters the right atrium 16 from the superior vena cava 20 and a stiffened section 315 to force the electrode against the inner wall of the right atrium 16 in the right atrial appendage 17. The lead 12 is further provided with a second preformed bend at 317 to assist in fixing lead 312 in place against blood flow in the coronary sinus 22.
The lead system 310 may be utilized to advantage in association with the atrial defibrillator 30 illustrated in FIG. 1 for monitoring the activity of the heart 10 and for delivering cardioverting or defibrillating electrical energy to the atria 16 and 18 of the heart 10. To that end, the first elongated electrode 322 may be coupled to input 54a of sense amplifier 54 and to output 112a of the discharge circuit 112. The second elongated electrode 324 may be coupled to input 54b of sense amplifier 54 and to output 112b of discharge circuit 112. With such coupling, electrodes 322 and 324 may be utilized for sensing atrial activity of the heart in association with sense amplifier 54. Also, the cardioverting electrical energy provided from the charger and storage capacitor 110 and the discharge circuit 112 will be received by electrodes 322 and 324 for applying the electrical cardioverting energy between the right atrium 16 and the coronary sinus 22 beneath the left atrium 18 and adjacent to the left ventricle 14 to deliver the cardioverting electrical energy to the atria 16 and 18 of the heart 10. By virtue of the locations of the elongated stimulating electrodes 322 and 324, the electrical energy applied to the right ventricle 12 and left ventricle 14 when the atria are cardioverted or defibrillated will be minimized.
For sensing electrical activations of the heart, a first pair of the sensing electrodes 316 and 318 carried by the second lead 314 may be coupled to inputs 50b and 50a respectively of sense amplifier 50 and a second pair of the sensing electrodes 318 and 320 of the second lead 314 may be coupled to inputs 52b and 52a respectively of sense amplifier 52. This permits sensing of electrical activations of the heart and more specifically electrical activations at two different areas of the right ventricle 12. This enables the non-coincident sensing of the depolarization activation waves as previously described for synchronizing the delivery of the cardioverting or defibrillating electrical energy to the atria 16 and 18 in synchronism with a detected electrical activation of the heart.
Referring now to FIG. 13, it illustrates, in perspective view, a human heart 10 having a lead system 330, configured in accordance with a fifth lead system preferred embodiment of the present invention, implanted therein. The portions of the heart 10 particularly noted in FIG. 13 are the right ventricle 12, the left ventricle 14, the right atrium 16, the left atrium 18, the superior vena cava 20, the left pulmonary artery 21, and the inferior vena cava 27.
The lead system 330 generally includes a first lead 332 and a second lead 334. The leads 332 and 334 are flexible but preformed so that the leads 332 and 334 may be readily fed into the heart 10 and assume the configurations when implanted as illustrated in the Figure.
The second lead 334 carries or includes a first tip or distal sense electrode 336, a second medial sense electrode 338, and a third proximal sense electrode 340. The electrodes 336, 338, and 340 are spaced apart on the lead 334 so that when lead 334 is fed into the superior vena cava 20 and into the right ventricle 12 through the right atrium 16 to a position where electrode 336 is at the apex of the right ventricle, all three sense electrodes 336, 338, and 340 will be disposed in and in electrical contact with the right ventricle 12 of the heart 10.
The first lead 332 includes a first elongated, large surface area, electrode 342 and a second elongated, large surface area, electrode 344. The electrodes 342 and 344 are spaced apart on the first lead 332 so that when the lead 332 is fed into the superior vena cava 20 and into the left pulmonary artery 21 as illustrated through the right atrium 16 and the right ventricle 12 with the second elongated electrode 344 disposed within the left pulmonary artery 21 adjacent to the left atrium 18, the first elongated electrode 342 will be disposed in and in electrical contact with the right atrium 16. Since the left pulmonary artery 21 is in close proximity to the left atrium 18, electrode 344 will be in electrical contact with the left atrium 18. To assist in holding the lead 332 in place, the lead 332 is provided with a preformed bend at 333 where the lead 332 enters the right ventricle 12 from the right atrium 16.
The lead system 330 may be utilized to advantage in association with the atrial defibrillator 30 illustrated in FIG. 1 for monitoring the activity of the heart 10 and for delivering cardioverting or defibrillating electrical energy to the atria 16 and 18 of the heart 10. To that end, the first elongated electrode 342 may be coupled to input 54a of sense amplifier 54 and to output 112a of the discharge circuit 112. The second elongated electrode 344 may be coupled to input 54b of sense amplifier 54 and to output 112b of discharge circuit 112. With such coupling, electrodes 342 and 344 may be utilized for sensing atrial activity of the heart in association with sense amplifier 54. Also, the cardioverting electrical energy provided from the charger and storage capacitor 110 and the discharge circuit 112 will be received by electrodes 342 and 344 for applying the electrical cardioverting energy between the right atrium 16 and the left pulmonary artery 21 and adjacent to the left atrium 18 to deliver the cardioverting electrical energy to the atria 16 and 18 of the heart 10. By virtue of the locations of the elongated stimulating electrodes 342 and 344, the electrical energy applied to the right ventricle 12 and left ventricle 14 when the atria are cardioverted or defibrillated will be minimized.
For sensing electrical activations of the heart, a first pair of the sensing electrodes 336 and 338 carried by the second lead 334 may be coupled to inputs 50b and 50a respectively of sense amplifier 50 and a second pair of the sensing electrodes 338 and 340 of the second lead 334 may be coupled to inputs 52b and 52a respectively of sense amplifier 52. This permits sensing of electrical activations of the heart and more specifically electrical activations at two different areas of the right ventricle 12. This enables the non-coincident sensing of the depolarization activation waves as previously described for synchronizing the delivery of the cardioverting or defibrillating electrical energy to the atria 16 and 18 in synchronism with a detected electrical activation of the heart.
Referring now to FIG. 14, it illustrates, in perspective view, a human heart 10 having a lead system 350, configured in accordance with a sixth lead system preferred embodiment of the present invention, implanted therein. The portions of the heart 10 particularly noted in FIG. 14 are the right ventricle 12, the left ventricle 14, the right atrium 16, the right atrial appendage 17, the left atrium 18, the superior vena cava 20, the coronary sinus 22, the great vein 23, and the inferior vena cava 27.
The lead system 350 generally includes a first lead 352, a second lead 354, and a third lead 356. The leads 352, 354, and 356 are flexible but preformed so that the leads 352, 354, and 356 may be readily fed into the heart 10 and assume the configurations when implanted as illustrated in the Figure.
The third lead 356 carries or includes a first tip or distal sense electrode 358, a second medial sense electrode 360, and a third proximal sense electrode 362. The electrodes 358, 360, and 362 are spaced apart on the lead 356 so that when lead 356 is fed into the superior vena cava 20 and into the right ventricle 12 through the right atrium 16 to a position where electrode 358 is at the apex of the right ventricle, all three sense electrodes 358, 360, and 362 will be disposed in and in electrical contact with the right ventricle 12 of the heart 10.
The second lead 354 includes a second elongated, large surface area, electrode 364. When the lead 354 is fed into the superior vena cava 20 and into the coronary sinus 22 through the right atrium 16 as illustrated, the second elongated electrode 364 will be disposed within the coronary sinus just beneath the left atrium 18 and adjacent to the left ventricle 14. Since the coronary sinus 22 is in close proximity to the left atrium 18, electrode 364 will be in electrical contact with the left atrium 18. To assist in fixing lead 354 in place against blood flow, the lead 354 is provided with a preformed bend at 355 as described with respect to previous embodiments.
The first lead 352 carries or includes a first elongated, large surface area, electrode 366. The lead 352 is fed into the superior vena cava 20 and into the right atrium 16. The lead 352, in the region of the electrode 366, has a preformed upturn to form a "j" so that the first elongated electrode 366 is disposed within and in electrical contact with the right atrium 16 and more specifically within the right atrial appendage 17.
The lead system 350 may be utilized to advantage in association with the atrial defibrillator 30 illustrated in FIG. 1 for monitoring the activity of the heart 10 and for delivering cardioverting or defibrillating electrical energy to the atria 16 and 18 of the heart 10. To that end, the first elongated electrode 366 may be coupled to input 54a of sense amplifier 54 and to output 112a of the discharge circuit 112. The second elongated electrode 364 may be coupled to input 54b of sense amplifier 54 and to output 112b of discharge circuit 112. With such coupling, electrodes 364 and 366 may be utilized for sensing atrial activity of the heart in association with sense amplifier 54. Also, the cardioverting electrical energy provided from the charger and storage capacitor 110 and the discharge circuit 112 will be received by electrodes 366 and 364 for applying the electrical cardioverting energy between the right atrium 16 and the coronary sinus 22 beneath the left atrium 18 and adjacent to the left ventricle 14 to deliver the cardioverting electrical energy to the atria 16 and 18 of the heart 10. By virtue of the locations of the elongated stimulating electrodes 354 and 366, the electrical energy applied to the right ventricle 12 and left ventricle 14 when the atria are cardioverted or defibrillated will be minimized.
For sensing electrical activations of the heart, a first pair of the sensing electrodes 358 and 360 carried by the third lead 356 may be coupled to inputs 50b and 50a respectively of sense amplifier 50 and a second pair of the sensing electrodes 360 and 362 of the third lead 356 may be coupled to inputs 52b and 52a respectively of sense amplifier 52. This permits sensing of electrical activations of the heart and more specifically electrical activations at two different areas of the right ventricle 12. This enables the non-coincident sensing of the depolarization activation-waves as previously described for synchronizing the delivery of the cardioverting or defibrillating electrical energy to the atria 16 and 18 in synchronism with a detected electrical activation of the heart.
Referring now to FIG. 15, it illustrates, in perspective view, a human heart 10 having a lead system 370, configured in accordance with a seventh lead system preferred embodiment of the present invention, implanted therein. The portions of the heart 10 particularly noted in FIG. 15 are the right ventricle 12, the left ventricle 14, the right atrium 16, the right atrial appendage 17, the left atrium 18, the superior vena cava 20, the left pulmonary artery 21, and the inferior vena cava 27.
The lead system 370 generally includes a first lead 372, a second lead 374, and a third lead 376. The leads 372, 374, and 376 are flexible but preformed so that the leads 372, 374, and 376 may be readily fed into the heart 10 and assume the configurations when implanted as illustrated in the Figure.
The third lead 376 carries or includes a first tip or distal sense electrode 378, a second medial sense electrode 380, and a third proximal sense electrode 380. The electrodes 378, 380, and 382 are spaced apart on the lead 376 so that when lead 376 is fed into the superior vena cava 20 and into the right ventricle 12 through the right atrium 16 to a position where electrode 378 is at the apex of the right ventricle, all three sense electrodes 378, 380, and 382 will be disposed in and in electrical contact with the right ventricle 12 of the heart 10.
The second lead 374 includes a second elongated, large surface area, electrode 384. When the lead 374 is fed into the superior vena cava 20 and into the left pulmonary artery 21 through the right atrium 16 and right ventricle 12 as illustrated, the second elongated electrode 384 will be disposed within the left pulmonary artery 21 adjacent to the left atrium 18. Since the left pulmonary artery 21 is in close proximity to the left atrium 18, electrode 384 will be in electrical contact with the left atrium 18. Also, to assist in fixing lead 374 in place, lead 374 is provided with a preformed bend at 375 where the lead 374 enters the right ventricle 12 from the right atrium 16.
The first lead 372 carries or includes a first elongated, large surface area, electrode 386. The lead 372 is fed into the superior vena cava 20 and in the right atrium 16. The lead 372, in the region of the electrode 386, is upturned to form a "j" so that the first elongated electrode 386 is disposed within and in electrical contact with the right atrium 16 and more specifically within the right atrial appendage 17.
The lead system 370 may be utilized to advantage in association with the atrial defibrillator 30 illustrated in FIG. 1 for monitoring the activity of the heart 10 and for delivering cardioverting or defibrillating electrical energy to the atria 16 and 18 of the heart 10. To that end, the first elongated electrode 386 may be coupled to input 54a of sense amplifier 54 and to output 112a of the discharge circuit 112. The second elongated electrode 284 may be coupled to input 54b of sense amplifier 54 and to output 112b of discharge circuit 112. With such coupling, electrodes 384 and 386 may be utilized for sensing atrial activity of the heart in association with sense amplifier 54. Also, the cardioverting electrical energy provided from the charger and storage capacitor 110 and the discharge circuit 112 will be received by electrodes 386 and 384 for applying the electrical cardioverting energy between the right atrium 16 and the left pulmonary artery 21 adjacent to the left atrium 18 to deliver the cardioverting electrical energy to the atria 16 and 18 of the heart 10. By virtue of the locations of the elongated stimulating electrodes 386 and 384, the electrical energy applied to the right ventricle 12 and left ventricle 14 when the atria are cardioverted or defibrillated will be minimized.
For sensing electrical activations of the heart, a first pair of the sensing electrodes 378 and 380 carried by the third lead 376 may be coupled to inputs 50b and 50a respectively of sense amplifier 50 and a second pair of the sensing electrodes 380 and 382 of the third lead 376 may be coupled to inputs 52b and 52a respectively of sense amplifier 52. This permits sensing of electrical activations of the heart and more specifically electrical activations at two different areas of the right ventricle 12. This enables the non-coincident sensing of the depolarization activation waves as previously described for synchronizing the delivery of the cardioverting or defibrillating electrical energy to the atria 16 and 18 in synchronism with a detected electrical activation of the heart.
Referring now to FIG. 16, it illustrates, in perspective view, a human heart 10 having a lead system 390, configured in accordance with a Eighth lead system preferred embodiment of the present invention, implanted wherein. The portions of the heart 10 particularly noted in FIG. 12 are the right ventricle 12, the left ventricle 14, the right atrium 16, the right atrial appendage 17, the left atrium 18, the superior vena cava 20, the coronary sinus 22, the great vein 23, and the inferior vena cava 27.
The lead system 310 generally includes a first lead 392 and a second lead 394. The leads 392 and 394 are flexible but preformed so that the leads 392 and 394 may be readily fed into the heart 10 and assume the configurations when implanted as illustrated in the Figure.
The second lead 394 carries or includes a first tip or distal sense electrode 396 and a second medial sense electrode 398. The electrodes 396 and 398 are spaced apart on the lead 394 so that when lead 394 is fed into the superior vena cava 20 and into the right ventricle 12 through the right atrium 16 to a position where electrode 396 is at the apex of the right ventricle, the electrodes 396 and 398 will be disposed in and in electrical contact with the right ventricle 12 of the heart 10.
The first lead 392 includes a first elongated, large surface area, electrode 402 and a second elongated, large surface area, electrode 404. The electrodes 402 and 404 are spaced apart on the first lead 392 so that when the lead 392 is fed into the superior vena cava 20 and into the coronary sinus 22 as illustrated through the right atrium 16 with the second elongated electrode 404 disposed within the coronary sinus 22 just beneath the left atrium 18 and adjacent to the left ventricle 14, the first elongated electrode 402 will be disposed in and in electrical contact with the right atrium 16. Since the coronary sinus 22 is in close proximity to the left atrium 18, electrode 404 will be in electrical contact with the left atrium 18.
It will be noted that the lead 392 is looped or pigtailed in the right atrium 16 so that the first electrode 402 is disposed in the right atrial appendage 17. To assist in assuring that electrode 402 is in the right atrial appendage 17, the lead 392 is provided with a first preformed bend at 393 in the area where lead 392 enters the right atrium 16 from the superior vena cava 20 and a stiffened section 395 to force the electrode 402 against the inner wall of the right atrium 16 in the right atrial appendage 17. The lead 12 is further provided with a second preformed bend at 397 to assist in fixing lead 392 in place against blood flow in the coronary sinus 22.
The lead system 390 may be utilized to advantage in association with the atrial defibrillator 30 illustrated in FIG. 1 for monitoring the activity of the heart 10 and for delivering cardioverting or defibrillating electrical energy to the atria 16 and 18 of the heart 10. To that end, the first elongated electrode 402 may be coupled to input 54a of sense amplifier 54 and to output 112a of the discharge circuit 112. The second elongated electrode 404 may be coupled to input 54b of sense amplifier 54 and to output 112b of discharge circuit 112. With such coupling, electrodes 402 and 404 may be utilized for sensing atrial activity of the heart in association with sense amplifier 54. Also, the cardioverting electrical energy provided from the charger and storage capacitor 110 and the discharge circuit 112 will be received by electrodes 402 and 404 for applying the electrical cardioverting energy between the right atrium 16 and the coronary sinus 22 beneath the left atrium 18 and adjacent to the left ventricle 34 to deliver the cardioverting electrical energy to the atria 16 and 18 of the heart 10. By virtue of the locations of the elongated stimulating electrodes 402 and 404, the electrical energy applied to the right ventricle 12 and left ventricle 14 when the atria are cardioverted or defibrillated will be minimized.
For sensing electrical activations of the heart, the sensing electrodes 396 and 398 carried by the second lead 394 may be coupled to inputs 50b and 50a respectively of sense amplifier 50 and electrodes 404 and 396 may be coupled to inputs 52b and 52a respectively of sense amplifier 52. This permits sensing of electrical activations of the heart and more specifically electrical activations at two different areas of the heart 10. This enables the non-coincident sensing of the depolarization activation waves as previously described for synchronizing the delivery of the cardioverting or defibrillating electrical energy to the atria 16 and 18 in synchronism with a detected electrical activation of the heart.
As previously mentioned, and in accordance with the preferred embodiments of the present invention, the paths for applying the cardioverting or defibrillating electrode energy to the atria are between the right atrium and the coronary sinus beneath the left atrium and between the right atrium and the left pulmonary artery adjacent the left atrium. The applied cardioverting or defibrillating electrical energy preferably has a biphasic waveform wherein the energy is of one polarity during a first time period or phase and of opposite polarity during an immediately succeeding second time period or phase. Preferably the first and second time periods are of equal duration, of for example, two to four milliseconds. Also, for the right atrium to coronary sinus path, the total quantity of applied electrical energy is preferably between 0.5 and 2.1 joules. For the right atrium to pulmonary artery path, the total quantity of applied electrical energy is preferably between 1.0 and 5.5 joules. Pulse generators for generating such biphasic electrical energy waveforms are well known in the art.
These energy levels are much lower than the energy levels utilized for the ventricular defibrillation and the energy level previously though necessary for atrial defibrillation. It is believed that these relatively low energy levels are obtainable because the lead systems disclosed herein place the most fibrillation atrial tissue between the electrodes which apply the cardioverting or defibrillating electrical energy.
The foregoing electrode placement which results in lower required applied energy has a number of advantages. First and foremost, the lower applied energies result in less discomfort to the patient when applied. Second, because less battery power is consumed during cardioversion or defibrillation, the implanted atrial defibrillator will have a longer useful life requiring less frequent defibrillator replacement. Third, the energy is concentrated on the atria and hence less energy is received by the ventricles reducing the risk of inducing ventricular fibrillation.
Patent CitationsCited PatentFiling datePublication dateApplicantTitleUS4401126 *Jun 13, 1980Aug 30, 1983Bertil ReenstiernaEndocardial, implantable lead for pacemakerUS4643201 *Feb 2, 1981Feb 17, 1987Medtronic, Inc.Single-pass A-V leadUS5014696 *Dec 15, 1988May 14, 1991Medtronic, Inc.Endocardial defibrillation electrode systemUS5111811 *Mar 26, 1990May 12, 1992Medtronic, Inc.Cardioversion and defibrillation lead system with electrode extension into the coronary sinus and great veinUS5165403 *Feb 26, 1991Nov 24, 1992Medtronic, Inc.Difibrillation lead system and method of use* Cited by examinerReferenced byCiting PatentFiling datePublication dateApplicantTitleUS5545204 *Mar 7, 1994Aug 13, 1996Cammilli; LeonardoSequential cardiostimulation system (DDD) using a single electrocatheter inserted through the coronary sinusUS5554175 *Nov 29, 1994Sep 10, 1996Incontrol, Inc.Therapy termination in an atrial defibrillator and methodUS5562709 *Apr 18, 1995Oct 8, 1996Incontrol, Inc.Atrial defibrillator having both specific and sensitive R wave detectionUS5571159 *Apr 4, 1994Nov 5, 1996Alt; EckhardTemporary atrial defibrillation catheter and methodUS5628774 *Apr 27, 1995May 13, 1997Incontrol, Inc.Cardiac lead with composite insulating structureUS5645569 *Jun 4, 1996Jul 8, 1997Incontrol, Inc.Post atrial cardioversion atrial pacing and methodUS5676687 *Oct 11, 1996Oct 14, 1997Incontrol, Inc.Post atrial cardioversion high rate atrial pacing with gradual rate returnUS5690683 *Jun 19, 1995Nov 25, 1997Cardiac Pacemakers, Inc.After potential removal in cardiac rhythm management deviceUS5755765 *Jan 24, 1997May 26, 1998Cardiac Pacemakers, Inc.Pacing lead having detachable positioning memberUS5755766 *Jan 24, 1997May 26, 1998Cardiac Pacemakers, Inc.Open-ended intravenous cardiac leadUS5800497 *Jul 17, 1997Sep 1, 1998Medtronic, Inc.Medical electrical lead with temporarily stiff portionUS5803928 *Jan 24, 1997Sep 8, 1998Cardiac Pacemakers, Inc.Side access "over the wire" pacing leadUS5843130 *Mar 31, 1997Dec 1, 1998Masood AkhtarSystem for delivering atrial defibrillation shocksUS5853426 *Jun 2, 1997Dec 29, 1998Pacesetter, Inc.Method and apparatus for delivering atrial defibrillaton therapy with improved effectivenessUS5873896 *May 27, 1997Feb 23, 1999Uab Research FoundationCardiac device for reducing arrhythmiaUS6068651 *Mar 26, 1998May 30, 2000Pacesetter, Inc.Atrial defibrillation lock out featureUS6219582Dec 30, 1998Apr 17, 2001Daig CorporationTemporary atrial cardioversion catheterUS6266563 *Sep 7, 1999Jul 24, 2001Uab Research FoundationMethod and apparatus for treating cardiac arrhythmiaUS6438412Feb 7, 2001Aug 20, 2002Cardiac Evaluation Center, Inc.Memory loop ECG recorder with continuous recordingUS6438426 *Mar 23, 2001Aug 20, 2002Daig CorporationTemporary atrial cardioversion catheterUS6671560Feb 20, 2002Dec 30, 2003Cardiac Pacemakers, Inc.Modified guidewire for left ventricular access leadUS6701183Apr 6, 2001Mar 2, 2004Lechnolgies, LlcLong term atrial fibrillation monitorUS6721598Aug 31, 2001Apr 13, 2004Pacesetter, Inc.Coronary sinus cardiac lead for stimulating and sensing in the right and left heart and systemUS6745081Aug 31, 2001Jun 1, 2004Pacesetter, Inc.Coronary Sinus Cardiac Lead For Stimulating and Sensing The Atria of the Right and Left Heart and SystemUS6748268Aug 31, 2001Jun 8, 2004Pacesetter, Inc.Three lead universal pacing and shocking systemUS6748277Oct 11, 2001Jun 8, 2004Pacesetter, Inc.Medical catheter/lead body design and means of manufacture thereofUS6760619 *Aug 31, 2001Jul 6, 2004Pacesetter, Inc.Two lead universal defibrillation, pacing and sensing systemUS6901288Oct 2, 2001May 31, 2005Cardiac Pacemakers, Inc.Sealing assembly for intravenous leadUS6952616 *Mar 30, 2001Oct 4, 2005Micronet Medical, Inc.Medical lead and method for electrode attachmentUS7117031Jan 16, 2004Oct 3, 2006Lohman Technologies, LlcLong term cardiac monitorUS7412290Oct 20, 2004Aug 12, 2008Cardiac Pacemakers, Inc.Seal for use with medical device and systemUS7515963Dec 16, 2003Apr 7, 2009Cardiac Pacemakers, Inc.Method of patient initiated electro-cardiogram storage, status query and therapy activationUS7555349Jun 30, 2009Advanced Neuromodulation Systems, Inc.Lead body and method of lead body constructionUS7657324Feb 2, 2010Cardiac Pacemakers, Inc.Seal for use with cardiac leadUS7774934Dec 8, 2005Aug 17, 2010Cardiac Pacemakers, Inc.Method for making a terminal connectorUS7881795Feb 27, 2009Feb 1, 2011Cardiac Pacemakers, Inc.Method of patient initiated electro-cardiogram storage, status query and therapy activationUS8150533Dec 18, 2008Apr 3, 2012Advanced Neuromodulation Systems, Inc.Medical lead and method for medical lead manufactureUS8209035Jun 26, 2012Cardiac Pacemakers, Inc.Extendable and retractable lead having a snap-fit terminal connectorUS8285398Jul 7, 2010Oct 9, 2012Cardiac Pacemakers, Inc.Lead with terminal connector assemblyUS8518063Jul 2, 2008Aug 27, 2013Russell A. HouserArteriotomy closure devices and techniquesUS8961541Oct 31, 2008Feb 24, 2015Cardio Vascular Technologies Inc.Vascular closure devices, systems, and methods of useUS8992567Sep 21, 2009Mar 31, 2015Cardiovascular Technologies Inc.Compressible, deformable, or deflectable tissue closure devices and method of manufactureUS20020038139 *Mar 30, 2001Mar 28, 2002Micronet Medical, Inc.Medical lead and method for electrode attachmentUS20020111664 *Apr 5, 2002Aug 15, 2002Cardiac Pacemakers, Inc.Low profile, ventricular, transvenous, epicardial defibrillation leadUS20040215091 *Jan 16, 2004Oct 28, 2004Lohman Jack E.Long term atrial fibrillation monitorUS20040230246 *May 15, 2003Nov 18, 2004Stein Richard E.Patient controlled therapy management and diagnostic device with human factors interfaceUS20040230247 *Dec 17, 2003Nov 18, 2004Stein Richard E.Patient controlled therapy management and diagnostic device with human factors interfaceUS20050085885 *Oct 20, 2004Apr 21, 2005Cardiac Pacemakers, Inc.Expandable seal for use with medical device and systemUS20050256557 *Mar 8, 2005Nov 17, 2005Wessman Bradley JMedical lead and method for medical lead manufactureUS20060111768 *Jan 11, 2006May 25, 2006Micronet Medical, Inc.Lead body and method of lead body constructionUS20060276716 *Jun 7, 2005Dec 7, 2006Jennifer HealeyAtrial fibrillation detection method and apparatusUS20070265667 *May 15, 2006Nov 15, 2007Dirk MuessigSemi-automatic atrial defibrillation system, implantable atrial defibrillator and portable communication deviceUS20090163972 *Feb 27, 2009Jun 25, 2009Axelrod Jay WMethod of patient initiated electro-cardiogram storage, status query and therapy activationUSRE38515Dec 6, 2001May 18, 2004Cardiac Pacemakers, Inc.Atrial defibrillation system having patient selectable atrial fibrillation detectionEP0965359A2Jun 10, 1999Dec 22, 1999Morgan Technologies LimitedTransvenous defibrillation lead system for use in middle cardiac veinEP1627660A1 *Oct 25, 2004Feb 22, 2006Biotronik GmbH &amp; Co. KGTwo lead three-chamber pacing system for CHF patientsEP1857144A2Apr 14, 2007Nov 21, 2007BIOTRONIK CRM Patent AGSemi-automatic atrial defibrillation system, implantable atrial defibrillator and portable communication deviceEP1902748A1Jan 23, 1998Mar 26, 2008Cardiac Pacemakers, Inc.Cardiac lead arrangementWO1998032375A1Jan 23, 1998Jul 30, 1998Cardiac Pacemakers, Inc.Side access 'over the wire' pacing leadWO1998032485A1Jan 23, 1998Jul 30, 1998Cardiac Pacemakers, Inc.Pacing lead having detachable positioning memberWO1998032486A1Jan 23, 1998Jul 30, 1998Cardiac Pacemakers, Inc.Cardiac lead arrangementWO1999052592A1Feb 12, 1999Oct 21, 1999Cardiac Pacemakers, Inc.Atrial defibrillation system including a portable audible speech communication device* Cited by examinerClassifications U.S. Classification607/5, 607/122, 607/4International ClassificationA61N1/05, A61N1/39, A61N1/372Cooperative ClassificationA61N1/3987, A61N1/056, A61N1/395, A61N1/0563, A61N2001/0585, A61N1/3956, A61N1/3962, A61N1/3918European ClassificationA61N1/39M, A61N1/05N, A61N1/05N1, A61N1/39M2, A61N1/39BLegal EventsDateCodeEventDescriptionDec 1, 1997FPAYFee paymentYear of fee payment: 4Mar 1, 1999ASAssignmentOwner name: CARDIAC PACEMAKERS, INC., MINNESOTAFree format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:INCONTROL, INC.;REEL/FRAME:009781/0901Effective date: 19990202Dec 3, 2001FPAYFee paymentYear of fee payment: 8Mar 27, 2006FPAYFee paymentYear of fee payment: 12RotateOriginal ImageGoogle Home - Sitemap - USPTO Bulk Downloads - Privacy Policy - Terms of Service - About Google Patents - Send FeedbackData provided by IFI CLAIMS Patent Services