Method and device for three-stage atrial cardioversion therapy

Patent metadata

Field	Value
Publication number	US-9289620-B2
Application number	US-201414257620-A
Country	US
Kind code	B2
Filing date	Apr 21, 2014
Priority date	Dec 11, 2007
Publication date	Mar 22, 2016
Grant date	Mar 22, 2016

Abstract

Methods and apparatus for a three-stage atrial cardioversion therapy that treats atrial arrhythmias within pain tolerance thresholds of a patient. An implantable therapy generator adapted to generate and selectively deliver a three-stage atrial cardioversion therapy and at least two leads, each having at least one electrode adapted to be positioned proximate the atrium of the patient. The device is programmed for delivering a three-stage atrial cardioversion therapy via both a far-field configuration and a near-field configuration of the electrodes upon detection of an atrial arrhythmia. The three-stage atrial cardioversion therapy includes a first stage for unpinning of one or more singularities associated with an atrial arrhythmia, a second stage for anti-repinning of the one or more singularities, both of which are delivered via the far-field configuration of the electrodes, and a third stage for extinguishing of the one or more singularities delivered via the near-field configuration of the electrodes.

First claim

The invention claimed is:

1. A method for controlling an implantable therapy generator adapted to be implanted in a patient and operably connected to at least one far field electrode and at least two near field electrodes to sense cardiac signals and deliver atrial arrhythmia therapy to the patient, the method comprising configuring the implantable therapy generator to:
detect an atrial arrhythmia based on evaluation of cardiac signals; and
in response to the atrial arrhythmia, deliver an atrial cardioversion therapy without confirmation of conversion of the atrial arrhythmia during the atrial cardioversion therapy, the atrial cardioversion therapy having at least three stages including:
a first stage set of pulses delivered via the at least one far field electrode within a ventricular refractory period to unpin one or more singularities associated with the atrial arrhythmia;
a first inter-stage delay subsequent to the first stage set of pulses;
a second stage set of pulses delivered via the at least one far field electrode to inhibit repinning of the one or more singularities;
a second inter-stage delay subsequent to the second stage set of pulses;
a third stage set of pulses delivered via the at least two near field electrodes to extinguish the one or more singularities;
wherein at least one of the inter-stage delays has a duration of between 50 to 400 milliseconds.

2. The method of claim 1 , wherein evaluation of cardiac signals includes determination of an atrial cycle length and configuring the implantable therapy generator is performed such that:
the first stage includes at least two and less than ten atrial cardioversion pulses of at least 10 volts and not more than 100 volts;
the second stage includes at least five and less than ten far field pulses with a pulse coupling interval between far field pulses of between 70-100% of the atrial cycle length; and
the third stage includes at least five and less than ten near field pulses at a voltage of up to three times an atrial capture threshold with a pulse duration of more than 0.2 and less than 5 milliseconds and a pulse coupling interval of between 70-100% of the atrial cycle length.

3. The method of claim 1 , wherein configuring the implantable therapy generator is performed such that the atrial cardioversion therapy is delivered in a sequence of one of the first stage, one of the second stage and one of the third stage.

4. The method of claim 1 , wherein configuring the implantable therapy generator is performed such that the atrial cardioversion therapy is delivered in a sequence of one of the first stage, one of the second stage, one of the first stage, one of the second stage and one of the third stage.

5. The method of claim 1 , wherein configuring the implantable therapy generator is performed such that each of the first stage, the second stage, and the third stage are delivered in accordance with a set of therapy parameters for the pulses of each stage that are programmed in response to feedback of the patient so as to provide an effective treatment of the atrial arrhythmia for the patient at a pain sensation in response to the atrial cardioversion therapy that is tolerable to the patient.

6. The method of claim 1 , wherein configuring the implantable therapy generator is performed such that a heuristic learning algorithm dynamically modifies a set of therapy parameters for the pulses of each stage in response to an effectiveness of the atrial cardioversion therapy.

7. The method of claim 1 , wherein evaluation of cardiac signals includes determination of an atrial cycle length and configuring the implantable therapy generator is performed such that a pulse coupling interval of the first stage and the second stage is between 70-100% of an atrial arrhythmia cycle length.

8. The method of claim 1 , wherein configuring the implantable therapy generator is performed such that the first stage pulses are at least 10 volts and not more than 100 volts.

9. The method of claim 1 , wherein configuring the implantable therapy generator is performed such that the first stage consists of two pulses.

10. The method of claim 1 , wherein evaluation of cardiac signals includes determination of an atrial cycle length and configuring the implantable therapy generator is performed such that the first stage has a total duration of less than the atrial cycle length.

11. The method of claim 1 , wherein configuring the implantable therapy generator is performed such that the first stage pulses comprise biphasic pulses.

12. A method for delivering atrial arrhythmia therapy to a patient, the method comprising:
implanting an implantable therapy generator in the patient;
implanting at least one far field electrode and at least two near field electrodes proximate an atrium of a heart of the patient that are operably connected to the implantable therapy generator; and
causing the implantable therapy generator to:
sense and evaluate cardiac signals to detect an atrial arrhythmia; and
in response to the atrial arrhythmia, deliver an atrial cardioversion therapy without confirmation of conversion of the atrial arrhythmia during the atrial cardioversion therapy, the atrial cardioversion therapy having at least three stages including:
a first stage set of pulses delivered via the at least one far field electrode within a ventricular refractory period to unpin a reentry wave associated with the atrial arrhythmia;
a first inter-stage delay subsequent to the first stage;
a second stage set of pulses delivered via the at least one far field electrode to inhibit repinning of the reentry wave;
a second inter-stage delay subsequent to the second stage; and
a third stage set of pulses delivered via the at least two near field electrodes to extinguish the reentry wave;
wherein at least one of the inter-stage delays has a duration of between 50 to 400 milliseconds.

13. The method of claim 12 , wherein sense and evaluate cardiac signals includes determination of an atrial cycle length and deliver the atrial cardioversion therapy is performed such that:
the first stage includes at least two and less than ten atrial cardioversion pulses of at least 10 volts and not more than 100 volts;
the second stage includes at least five and less than ten far field pulses with a pulse coupling interval between far field pulses of between 70-100% of the atrial cycle length; and
the third stage includes at least five and less than ten near field pulses at a voltage of up to three times an atrial capture threshold with a pulse duration of more than 0.2 and less than 5 milliseconds and a pulse coupling interval of between 70-100% of the atrial cycle length.

14. The method of claim 12 , wherein deliver the atrial cardioversion therapy is performed such that the atrial cardioversion therapy is delivered in a sequence of one of the first stage, one of the second stage and one of the third stage.

15. The method of claim 12 , wherein deliver the atrial cardioversion therapy is performed such that the atrial cardioversion therapy is delivered in sequence of one of the first stage, one of the second stage, one of the first stage, one of the second stage and one of the third stage.

16. The method of claim 12 , wherein deliver the atrial cardioversion therapy is performed such that each of the first stage, the second stage, and the third stage are delivered in accordance with a set of therapy parameters for the pulses of each stage that are programmed in response to feedback of the patient so as to provide an effective treatment of the atrial arrhythmia for the patient at a pain se

Assignees

• Univ Washington

Inventors

• Efimov Igor R
• Li Wenwen
• Janardhan Ajit

Classifications

• A61N1/3906

  characterised by the form of the shockwave · CPC title

• A61N1/3956 Primary

  Implantable devices for applying electric shocks to the heart, e.g. for cardioversion · CPC title

• A61N1/365

  controlled by a physiological parameter, e.g. heart potential {(evoked response A61N1/371)} · CPC title

• A61N1/3684

  for stimulating the heart at multiple sites of the ventricle or the atrium · CPC title

• A61N1/0592

  Introducing the lead through the pericardium with a needle · CPC title