US5797967A — System and method to reduce defibrillation requir…

Claim 1

Independent Claim 75 words

A method of treating cardiac arrhythmia, comprising application by an implantable pacing electrode system of at least one exogenous pacing level shock to at least one region of fibrillating myocardium of selected cardiac tissue, any such region being characterized by a 1:1 phase lock of a local electrogram of that region to a stimulus artifact in that region, such that invasion of intrinsic fibrillation wavefronts into at least one region of fibrillating myocardium is prevented.

Claim 2

Independent Claim 75 words

A method of treating cardiac arrhythmia, comprising application by an implantable pacing electrode system of at least one exogenous pacing level shock to at least one region of fibrillating myocardium of selected cardiac tissue, any such region being characterized by a 1:1 phase lock of a local electrogram of that region to a stimulus artifact in that region, such that invasion of intrinsic fibrillation wavefronts into at least one region of fibrillating myocardium is prevented.

Claim 3

Independent Claim 107 words

A method of applying therapeutic electrical energy to a heart, comprising application by an implantable pacing electrode system of a plurality of different shock strength profiles corresponding to at least one pacing level shock strength to a plurality of regions of selected cardiac tissue, in which the regions have characteristically different arrhythmias convertible to other states by mechanisms which differ from each other, and selecting each of the plurality of shock strength profiles to correspond to each of the plurality of regions according to ability of the profile to provide increased periodicity in each region, such that predictable activation is created in at least one particular region.

Claim 4

Independent Claim 107 words

A method of applying therapeutic electrical energy to a heart, comprising application by an implantable pacing electrode system of a plurality of different shock strength profiles corresponding to at least one pacing level shock strength to a plurality of regions of selected cardiac tissue, in which the regions have characteristically different arrhythmias convertible to other states by mechanisms which differ from each other, and selecting each of the plurality of shock strength profiles to correspond to each of the plurality of regions according to ability of the profile to provide increased periodicity in each region, such that predictable activation is created in at least one particular region.

Claim 5

Dependent Claim 16 words

The method of claim 2, in which the predictable activation is conversion to normal sinus rhythm.

Claim 6

Dependent Claim 33 words

The method of claim 2, in which the predictable activation is conversion to a state which may in turn be converted to normal sinus rhythm by application of at least one defibrillation-level shock.

Claim 7

Dependent Claim 16 words

The method of claim 4, in which the predictable activation is conversion to near-normal sinus rhythm.

Claim 8

Independent Claim 78 words

A method of treating cardiac arrhythmia, comprising the steps of applying at least one pacing level shock to selected cardiac tissue having a relatively low susceptibility to defibrillation-level shock field strength by an implantable pacing level electrode system to create a predictable repolarization state, followed by activating the selected cardiac tissue in a periodic manner to reduce shock strength requirements of a defibrillation-level shock subsequently applied to the selected cardiac tissue by a separate implantable defibrillation electrode system.

Claim 9

Independent Claim 78 words

A method of treating cardiac arrhythmia, comprising the steps of applying at least one pacing level shock to selected cardiac tissue having a relatively low susceptibility to defibrillation-level shock field strength by an implantable pacing level electrode system to create a predictable repolarization state, followed by activating the selected cardiac tissue in a periodic manner to reduce shock strength requirements of a defibrillation-level shock subsequently applied to the selected cardiac tissue by a separate implantable defibrillation electrode system.

Claim 10

Independent Claim 76 words

A method of treating cardiac arrhythmia, comprising the steps of: (a) determining a region of selected cardiac tissue having relatively low susceptibility to defibrillation-level shock field strength, (b) applying a plurality of pacing pulses to the region of selected cardiac tissue by an implantable sub-defibrillation level electrode system, and (c) applying at least one defibrillation-level shock to the selected cardiac tissue by a separate implantable defibrillation electrode system coincident with or after a last pacing pulse.

Claim 11

Independent Claim 76 words

A method of treating cardiac arrhythmia, comprising the steps of: (a) determining a region of selected cardiac tissue having relatively low susceptibility to defibrillation-level shock field strength, (b) applying a plurality of pacing pulses to the region of selected cardiac tissue by an implantable sub-defibrillation level electrode system, and (c) applying at least one defibrillation-level shock to the selected cardiac tissue by a separate implantable defibrillation electrode system coincident with or after a last pacing pulse.

Claim 12

Independent Claim 77 words

A method of treating cardiac arrhythmia in which, coincident with or after the application of a first defibrillation-level shock to a heart, at least one pacing pulse is applied by an implantable pacing electrode system to a localized portion of a region of selected cardiac tissue having relatively low susceptibility to a defibrillation-level shock field strength, to reduce the strength required for the first defibrillation-level shock to defibrillate the heart by a separate implantable defibrillation electrode system.

Claim 13

Independent Claim 77 words

A method of treating cardiac arrhythmia in which, coincident with or after the application of a first defibrillation-level shock to a heart, at least one pacing pulse is applied by an implantable pacing electrode system to a localized portion of a region of selected cardiac tissue having relatively low susceptibility to a defibrillation-level shock field strength, to reduce the strength required for the first defibrillation-level shock to defibrillate the heart by a separate implantable defibrillation electrode system.

Claim 14

Independent Claim 73 words

A method of treating cardiac arrhythmia, comprising the steps of applying a series of pacing pulses to selected cardiac tissue having a relatively low susceptibility to defibrillation-level shock field strength, and application of at least one sub-defibrillation-level shock to the selected cardiac tissue by an implantable sub-defibrillation level electrode system, in which a first sub-defibrillation level shock occurs coincident with or after the application of a last of the series of pacing-level shocks.

Claim 15

Independent Claim 73 words

A method of treating cardiac arrhythmia, comprising the steps of applying a series of pacing pulses to selected cardiac tissue having a relatively low susceptibility to defibrillation-level shock field strength, and application of at least one sub-defibrillation-level shock to the selected cardiac tissue by an implantable sub-defibrillation level electrode system, in which a first sub-defibrillation level shock occurs coincident with or after the application of a last of the series of pacing-level shocks.

Claim 16

Independent Claim 86 words

A method of treating cardiac arrhythmia, comprising application of at least one pacing pulse to selected cardiac tissue by an implantable pacing electrode system, and coordinating delivery of at least one defibrillation shock by a separate implantable defibrillation level electrode system to the pacing pulse applied in at least one area of the selected cardiac tissue where the electric field intensity induced by the defibrillation-level shock is weak, and controlling timing of a last pacing pulse to occur coincident with or after a first defibrillation-level shock.

Claim 17

Independent Claim 86 words

A method of treating cardiac arrhythmia, comprising application of at least one pacing pulse to selected cardiac tissue by an implantable pacing electrode system, and coordinating delivery of at least one defibrillation shock by a separate implantable defibrillation level electrode system to the pacing pulse applied in at least one area of the selected cardiac tissue where the electric field intensity induced by the defibrillation-level shock is weak, and controlling timing of a last pacing pulse to occur coincident with or after a first defibrillation-level shock.

Claim 18

Independent Claim 70 words

A method of treating cardiac arrhythmia, comprising applying at least one pacing pulse by an implantable pacing electrode system to exert control over fibrillating myocardium located in selected cardiac tissue having a relatively low susceptibility to defibrillation-level shock field strength, and controlling timing of a last repetition of an applied pacing pulse to occur coincident with or after a first defibrillation-level shock is delivered by an implantable defibrillation electrode system.

Claim 19

Independent Claim 70 words

A method of treating cardiac arrhythmia, comprising applying at least one pacing pulse by an implantable pacing electrode system to exert control over fibrillating myocardium located in selected cardiac tissue having a relatively low susceptibility to defibrillation-level shock field strength, and controlling timing of a last repetition of an applied pacing pulse to occur coincident with or after a first defibrillation-level shock is delivered by an implantable defibrillation electrode system.

Claim 20

Dependent Claim 24 words

The method of claim 11, in which more than one pacing pulse is applied to produce control exerted over successive regions of fibrillating myocardium.

Claim 21

Dependent Claim 36 words

The method of claim 11, in which the application of any pacing pulse produces a region of fibrillating myocardium characterized by a 1:1 phase lock of a local electrogram to a stimulus artifact of that region.

Claim 22

Independent Claim 27 words

The method of any of claims 7, 9, 10, or 11, in which the pacing pulse is applied prior to the application of the first defibrillation-level shock.

Claim 23

Dependent Claim 31 words

The method of claim 14 in which a last pacing pulse occurs within about one mean activation interval, calculated immediately prior to a first sub-defibrillation-level shock, from the first defibrillation-level shock.

Claim 24

Independent Claim 28 words

The method of any of claims 7, 8, 9, 10, or 11, in which the pacing pulse is applied simultaneously with the application of the first defibrillation-level shock.

Claim 25

Independent Claim 24 words

The method of any of claims 1, 2, 6, 7, 8, 9, 10, or 11, in which the selected cardiac tissue is ventricular tissue.

Claim 26

Independent Claim 49 words

The method of any of claims 1, 2, 6, 7, 8, 9, 10, or 11, in which the selected cardiac tissue is atrial tissue, and the method further comprises postponing application of any defibrillation-level shock which would occur within the T-wave of ventricular activation cycle until after ventricular depolarization.

Claim 27

Independent Claim 115 words

A system for applying therapeutic electrical energy to a heart, comprising a first generator of a plurality of pacing pulses, a second generator of at least one defibrillation-level shock, a first electrode system coupled to the first generator for delivering the pacing pulses to a first location including at least a region of selected cardiac tissue having a relatively low susceptibility to defibrillation-level shock field strength, a second electrode system coupled to the second generator for delivering the defibrillation-level shock to the heart from a second location, in which the system further comprises timers which control delivery of a first defibrillation-level shock to occur coincident with or after the delivery of a last pacing pulse.

Claim 28

Independent Claim 115 words

A system for applying therapeutic electrical energy to a heart, comprising a first generator of a plurality of pacing pulses, a second generator of at least one defibrillation-level shock, a first electrode system coupled to the first generator for delivering the pacing pulses to a first location including at least a region of selected cardiac tissue having a relatively low susceptibility to defibrillation-level shock field strength, a second electrode system coupled to the second generator for delivering the defibrillation-level shock to the heart from a second location, in which the system further comprises timers which control delivery of a first defibrillation-level shock to occur coincident with or after the delivery of a last pacing pulse.

Claim 29

Dependent Claim 24 words

The system of claim 19 in which the system applies the first pacing pulse prior to when the system applies the first defibrillation shock.

Claim 30

Dependent Claim 31 words

The system of claim 19 in which a last pacing pulse occurs within about one mean activation interval, calculated immediately prior to a first pacing pulse, from the first defibrillation shock.

Claim 31

Dependent Claim 22 words

The system of claim 19 in which the last pacing pulse is applied simultaneously with the application of the first defibrillation shock.

Claim 32

Dependent Claim 14 words

The system of claim 19 in which the selected cardiac tissue is ventricular tissue.

Claim 33

Dependent Claim 38 words

The system of claim 19 in which the selected cardiac tissue is atrial tissue, and the timers further postpone application of any defibrillation-level shock which would occur within the T-wave of ventricular activation cycle until after ventricular depolarization.

Claim 34

Dependent Claim 68 words

The system of claim 19, in which the second generator further includes a capacitor network, where the capacitor network has a capacitance in the range of 20 to 400 μF, and where the second generator generates at least one sub-defibrillation-level shock having morphology congruent with a defibrillation-level shock but strength below a defibrillation threshold of the selected cardiac tissue, by terminating the discharge waveform of the capacitor network.

Claim 35

Dependent Claim 17 words

The system of claim 25 in which the at least one sub-defibrillation-level shock is a pacing-level shock.

Claim 36

Dependent Claim 23 words

The system of claim 25, in which the capacitor network comprises at least one capacitor used for applying at least one defibrillation-level shock.

Claim 37

Dependent Claim 19 words

The system of claim 19 in which the first and second generators are combined into a single implantable device.

Annuity Stage	Window Opens	Payment Deadline	Surcharge Period Until	Estimated Fee	Status
3.5 Years (Year 4)	2001-08-24	2002-02-23	2002-08-25	$2000.00	Window Closed / Lapsed
7.5 Years (Year 8)	2005-08-24	2006-02-23	2006-08-25	$3760.00	Window Closed / Lapsed
11.5 Years (Year 12)	2009-08-24	2010-02-23	2010-08-25	$7700.00	Window Closed / Lapsed

System and method to reduce defibrillation requirements

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