Surgery: light – thermal – and electrical application – Light – thermal – and electrical application – Electrical therapeutic systems
Reexamination Certificate
1999-11-15
2001-12-04
Getzow, Scott M. (Department: 3762)
Surgery: light, thermal, and electrical application
Light, thermal, and electrical application
Electrical therapeutic systems
Reexamination Certificate
active
06327500
ABSTRACT:
FIELD OF THE INVENTION
The present invention relates to atrial defibrillation methods and apparatus in which at lease two atrial defibrillation pulses are sequentially delivered. In one method, the sequential pulses are delivered along different current pathways. In another method, the sequential pulses are delivered along the same current pathways.
BACKGROUND OF THE INVENTION
Atrial fibrillation is one of the most common cardiac arrhythmia. Health consequences associated with atrial fibrillation include decreased cardiac output, less regular ventricular rhythm, the formation of blood clots in the atria! appendages, and an increased incidence of stroke. While some drugs are available for the treatment of atrial fibrillation, they have a number of side effects which reduce their therapeutic utility.
Unlike patients afflicted with ventricular fibrillation, patients afflicted with atrial fibrillation are conscious. The pain associated with the administration of the defibrillation shock can be severe, and there is a need for means of carrying out atrial defibrillation in a manner that is less painful to the patient being treated.
U.S. Pat. No. 5,165,403 to R. Mehra discloses an implantable lead system useful for defibrillating (or “cardioverting”) the atria of a patient's heart. In the disclosed system, one electrode is positioned in either the great cardiac vein or coronary sinus of the heart, and another electrode is positioned in either the right atrium or superior vena cava of the heart. Configurations for reducing the pain associated with defibrillation are not disclosed.
U.S. Pat. No. 5,209,229 to Gilli discloses an implantable atrial defibrillation device employing multiple implantable electrodes. Upon detection of atrial fibrillation, a first electrode configuration is selected and a defibrillation shock administered. If atrial fibrillation remains after that shock, then a second electrode configuration is selected and a second defibrillation shock administered. Multiple defibrillation pulse dministrations are only used when the initial defibrillation pulse fails, and not as a means to reduce pain associated with atrial defibrillation.
In view of the foregoing, an object of the present invention is to provide methods and apparatus for carrying out atrial defibrillation that will reduce the pain associated therewith.
A further object of the present invention is to provide methods and apparatus for carrying out atrial defibrillation that will reliably treat atrial fibrillation.
A still further object of the present invention is to provide methods and apparatus for treating atrial fibrillation that minimizes the extent of the surgical intervention involved in implanting the necessary defibrillation electrodes, and minimizes the complexity involved in implanting the necessary defibrillation electrodes.
SUMMARY OF THE INVENTION
An implantable system for the defibrillation of the atria of a patient's heart is described herein. The system includes a first pair of atrial defibrillation electrodes configured for delivering a first atrial defibrillation pulse along a first current pathway in the heart, and a pulse generator operatively associated with the first pair of atrial defibrillation electrodes for delivering the first atrial defibrillation pulse. A second pair of atrial defibrillation electrodes configured for delivering a second atrial defibrillation pulse along a second current pathway in the heart is also included, with the second current pathway being different from the first current pathway. A pulse generator is operatively associated with the second pair of atrial defibrillation electrodes for delivering the second atrial defibrillation pulse after the first defibrillation pulse.
In an alternate system disclosed herein, the system is configured so that the first and second atrial defibrillation pulse are delivered along the same current pathway, through the same pair of electrodes.
In both of the foregoing systems, the second defibrillation pulse is delivered without intervening monitoring of the efficacy of the first defibrillation pulse. The present invention thus provides a method of atrial defibrillation by sequentially delivering two atrial defibrillation pulses to the atria of a patient afflicted with atrial fibrillation. The voltage of the pulses and the pain associated therewith is thereby reduced.
As will be apparent to those skilled in the art, the first and second pulses described above may be followed by additional pulses if desired. Additional pulses may be along the same or different current pathways, or along the first or second current pathways. The apparatus described herein may be extended to provide for the administration additional pulses in accordance with known techniques.
Multiple defibrillation pulses have been used in the treatment of ventricular fibrillation (see, e.g., U.S. Pat. No. 5,224,476 to Ideker and Guse and references cited therein). However, patients in ventricular defibrillation are typically unconscious and in an immediate life-threatening condition, and reduction of pain is not a compelling object.
REFERENCES:
patent: 3825015 (1974-07-01), Berkovits
patent: 3995623 (1976-12-01), Blake et al.
patent: 4355646 (1982-10-01), Kallok et al.
patent: 4365639 (1982-12-01), Goldreyer
patent: 4444195 (1984-04-01), Gold
patent: 4499907 (1985-02-01), Kallok et al.
patent: 4567901 (1986-02-01), Harris
patent: 4643201 (1987-02-01), Stokes
patent: 5165403 (1992-11-01), Mehra
patent: 5209229 (1993-05-01), Gilli
patent: 5224476 (1993-07-01), Ideker et al.
patent: 5235977 (1993-08-01), Hirschberg et al.
patent: 5235978 (1993-08-01), Hirschberg et al.
patent: 5251624 (1993-10-01), Bocek et al.
patent: 5267559 (1993-12-01), Jin et al.
patent: 5269298 (1993-12-01), Adams et al.
patent: 5292338 (1994-03-01), Bardy
patent: 5304139 (1994-04-01), Adams et al.
patent: 5304218 (1994-04-01), Alferness
patent: 5312444 (1994-05-01), Bocek et al.
patent: 5314430 (1994-05-01), Bardy
patent: 5324309 (1994-06-01), Kallok
patent: 5332400 (1994-07-01), Alferness
patent: 5348021 (1994-09-01), Adams et al.
patent: 5350402 (1994-09-01), Infinger et al.
patent: 5387233 (1995-02-01), Alferness et al.
patent: 5395373 (1995-03-01), Ayers
patent: 5403351 (1995-04-01), Saksena
patent: 5403354 (1995-04-01), Adams et al.
patent: 5405375 (1995-04-01), Ayers et al.
patent: 5411527 (1995-05-01), Alt
patent: 5431681 (1995-07-01), Helland
patent: 5431683 (1995-07-01), Bowald et al.
patent: 5433729 (1995-07-01), Adams et al.
patent: 5441519 (1995-08-01), Sears
patent: 5443491 (1995-08-01), Snichelotto
patent: 5456706 (1995-10-01), Pless et al.
patent: 5464432 (1995-11-01), Infinger et al.
patent: 5470348 (1995-11-01), Neubauer et al.
patent: 5476498 (1995-12-01), Ayers
patent: 5476499 (1995-12-01), Hirschberg
patent: 5486199 (1996-01-01), Kim et al.
patent: 0601340A1 (1993-11-01), None
patent: 0653223A2 (1994-10-01), None
Cooper et al.,Internal Cardioversion of Atrial Fibrillation in Sheep, Atrial Fibrillation: Mechanisms and Therapeutic Strategies, pp. 325-332 (1994).
Luderitz et al.,Nonpharmacologic Strategies for Treating Atrial Fibrillation, The American Journal of Cardiology, vol. 77, Jan. 25, 1996, pp. 45A-52A.
Cooper et al.,Internal Cardioversion of Atrial Fibrillation in Sheep, Circulation, vol. 87, No. 5, May 1993, pp. 1673-1685.
Cardiac Rhythm Management Laboratory:In Vivo Study Protocol, Internal Atrial Defibrillation in Sheep Using Sequential Biphasic Waveforms, CRM Laboratory, University of Alabama—Birmingham Medical Center, Oct., 1995.
Feeser et al.,Strength-Duration and Probability of Success Curves for Defibrillation with Biphasic Waveforms, Circulation, vol. 82, No. 6, Dec. 1990, pp. 2128-2141.
Kroll, Mark W.,A Minimal Model of the Monophasic Defibrillation Pulse, PACE, vol. 16, Apr. 1993, Part I, pp. 769-777.
Cooper Randolph A.
Ideker Raymond E.
Getzow Scott M.
Myers Bigel & Sibley & Sajovec
UAB Research Foundation
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