Implantable cardiac stimulator for detection and treatment of ventricular arrhythmias

40 Pages·2013·3.23 MB·English

United States Patent [19]
[11] Patent Number: 4,830,006
Haluska et a1. [45] Date of Patent: May 16, 1989
[54] INIPLANTABLE CARDIAC STIMULATOR 4,475,551 10/1984 Langer et al. ................ .. 128/419 D
FOR DETECTION AND TREATMENT OF 4,485,818 12/1984 Leckrone et a1. . 128/419 PG
mm A AR HY HM AS 4,523,595 l/1985 Zibell .................... .. 128/419 D
vE CUL R R T I 4,541,430 9/1985 Elmquist et al. 128/419 PG
[75] Inventors: Edward A. Haluska, Angleton; 4,552,154 11/1985 Hartlaub .......... .. 128/419 PG
Stephen J, Whistler, Lake Jackson; 4,574,437 3/1986 Segevstad et al. 128/419 PG
Ross (;_ Baker, Jr‘; Richard V_ calfee, 4,577,633 3/1986 Berkovits et al. . 128/419 PG
both of Houston, an of Tex 4,662,377 5/1987 Heilman et a1. .............. .. 1213/419 D
[73] Assignee: Intermedics, Inc., Angleton, Tex. pri'fm'y Exami'fer—Fran°is Jaworski
Assistant Exammer——George Manuel
[21] APP1- N04 8751218 Attorney, Agent, or Firm-Russell J. Egan; Donald R.
[22] Filed: Jun. 17, 1986 Greene
[51] Int. 01.4 ...................... .. A61N 1/00; H05G 00/00 [57] ABSTRACT
11:5. Cl. . . - - - . . . . . . . . . . . . . . . . . . . - . - .. An implantable cardiac Stimulator integrates the func
Fleld of Search .......... .. PG, D, tions of bradycardia and anti_tachycardia pacing_type
128/705’ 706 therapies, and cardioversion and de?brillation shock
[56] References Cited type therapies. The stimulator is programmable to pro
vide a multiplicity of hierarchical detection algorithms
U'S' PATENT DOCUMENTS and therapeutic modalities to detect and treat classes of
3,693,627 9/ 1972 Berkovits ...................... .. 128/419 P ventricular tachycardia according to position within
31698386 10/1972 Fned - - - - - - ~ - ~ - ' ~ " 128/705 rate range classes into which the heart rate continuum is
3'698’398 10/1972 Biarkovlts “ 128/419 P partitioned, and thus according to hemodynamic toler
3,832,994 9/1974 Blcher et a1. . ..... .. 128/705 . . . . . .
3 942 534 3/1976 Allen et a1. ..... .. 1213/419 PG an“, wlth backup capablm‘es °f de?bnnatlon and
41230302 7/1981 Baker, Jr. a a1. 128/419 PG bradycardia Pacing at the higher and lower regions of
4,312,356 1/1982 Sowton er a1. 128/419 PG the rate continuum outside the range of the ventricular
4,375,817 3/1983 Engle et a1. .... .. 128/419 PG tachycardia classes. Aggressiveness of the therapy is
4,393,536 3/1983 NaPPhOIZ et a1‘ 128/419 PG increased with elapsed time and increasing heart rate,
i’gg’?gg 21533231252131‘ and detection criteria are relaxed with increasing heart
41427011 l/1984 Spurrell et a1. 1211/419 PG rate and till“ “"111 mcreasmg hemodynamlc mmlerance
4,432,375 2/1934 Angel et a1. . . . . . . . . . . . .. 128/706 °f the ‘ac Y°ard1a~
4,440,172 4/1984 Langer .... .. .. 128/419 D
4,473,078 9/ 1984 Angel ........................... .. 128/419 D 65 Claims, 14 Drawing Sheets
I‘ __________________________________________________ “I
I VUNREG I
I ,4__ PROGRAMMING a: ANT. RowER souRcE ' CTI$HER |
I DATA TRANS. SECTION SECTION SECTIONS:
I VREG I
I __I '0 35 ea I
I 22 / / 3/ |
I ANALOG \ I
I
I REED __,\__ RATE ' I
I SWITCH LIMITER PACING I
I MICRORROCESSOR/ SECTION I
I MEMORY (VOLTAGE MULT. I
I SECTION aouTpuT CKT) I
I CRYSTAL _,,__ I
I OSCILLATOR
I 3 7 |
I 20/ \ I I
I ISOLATION / ___° To FACING, |
I __-——"——"-— PROTECTION SENS|NG I
II ECG 40 c1Rcu1T .___,, ELECTRODE Il
| THERAPY
I GENERATOR SENsE AMDI-IFIER ISOLATED 1-1v GENERAT'N _, I
| 25* SIECTION EXOUTDUT SECTION TO Hv I
WITH AGCIBP -—-o PATCH
I FILTERS 8c (WITH OUTPUT SHORT ELECTRODE I
I QUAD COIMPARATORI CIRCUIT PROTECTION —o I
I_
US. Patent ‘May 16,1989 Sheet 1 of 14 4,830,006
HEART
RATE
(Rpm)
SINUS I TACH-l TACH'Z TACH~3 FIB I
NORMAL I WELL ' MODERATELY ‘ POORLY I NON- r
TOLERATED TOLERATED TOLERATED TOLERATED
HEMODYNAMIC INTOLERANCE ———>
|_:|G.TG
SINUS TACH-I TACH-2 TACH-S FIB
150 I75 260 27's
L ' | ' ' HEART
PROGRAMMABLE RbATE
RATE BOUNDARIES ' (pm)
' HEART
RATE
1 (Rpm)
SINUS TACH-l TAcH-z TACH-B' FIB I
\?/__-_J%/___J\_W__J%__
A B c D
‘ F | G20
HEART
RATE
(bRmT
smus ' TACH-l ' TAcH-z TACH-3 FIB I
US. Patent May 16,1989 Sheet 2 of 14 4,830,006
SINUS I TACH-l I TAcH-2 I TAcI+3 I FIB
y if j‘ W Jay-é HEART
Hmxsoams HD6198 HF? RATE
(bpm)
F1630
SINUS TACH-I TAcI+2 TACH-3 FIB
HEART
REDETECT PEDETECT FIEDETECT RATE
Hnams HF? HF? (bpm)
TnAINs
EVENT ‘ b ‘ ’ , i I I i
FINAL SA 52 $3 3.4
SENSE ‘
|__|__|._.|___|
COUPLING BCL
INTERVAL
F164
U.S._Patent May 16,1989 Sheet 3 0f 14 4,830,006
IDLE FOR
— $§J§AEET NO'SE REMAINOER
OF CYCLE
QUIET
Y
SENSE RATE TIME OUT ‘ PACE
TIME ’ TIME
SENSE
EVENT
THERARY ‘
TIME
POST-SENSE POST-PACE OR
AND NO THERAPY POST-THERAPY
I I
SENSE RACE
REFRACTORY REFRACTORY
TIME TIME
COMMON
~ REFRACTORY <
TIME
7
UPDATE
TIME I: I G 5

US. Patent May 16,1989 Sheet 5 of 14 4,830,006
68
MICROPROCESSOR
MICROPROCESSOR
CONTROLLED
F4“ \/+
I l
l I| ___ /O6
: l03 §—_//5
I >
|
I
: I00
I
|
I__ __
TO
BANDPASS
SENSING/ AMPLIFIER
PACING SECTION
LEAD
//2
FIGB
AGC
AMPLIFIER
SECTION

US. Patent May 16,1989 Sheet 7 of 14 4,830,006
l- _ _ _ T _ _ _ _ _ _ _ —-‘—‘
T I
I |
K
: || LIL
' I
' 1
l I
FROM : INNER TARGET :
ABMAPNLDlPFAISESR < |l__ COMPARATORS _:
SECTION —————————— —
FIGTO
COMPARATOR OUTER TARGET
SECTION / |_ ____ ___C_OEFZ\R_ALOES_J V 1
/5/ % ,—/
TO
MlCRO
PRQCESSOR
TO GATE TO GATE
OF 22/ OF 225
H615
OUTRUT
SHORT CIRCUIT
PROTECTION
4,830,006
US. Patent May 16,1989 Sheet 8 of 14
COMPAPATOP
INPUT SIGNAL
_ _ _ _ _ _ _ _ _ _ — _ — _ _ _ _ VOU
————— —1@@;-WU
REFERENCE
LOGIC
OUTPUTS ‘ I
| I
V L O
EXAMPLEI COMPAPATOP INPUT SIGNAL
WITH LOGIC OUTPUTS
FIGII