WO1999051300A2 - Method and apparatus for reduction of pain from electric stimulation therapies - Google Patents
Method and apparatus for reduction of pain from electric stimulation therapies Download PDFInfo
- Publication number
- WO1999051300A2 WO1999051300A2 PCT/US1999/007767 US9907767W WO9951300A2 WO 1999051300 A2 WO1999051300 A2 WO 1999051300A2 US 9907767 W US9907767 W US 9907767W WO 9951300 A2 WO9951300 A2 WO 9951300A2
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- WIPO (PCT)
- Prior art keywords
- stimulus
- patient
- painful
- electrical
- pulse
- Prior art date
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/36014—External stimulators, e.g. with patch electrodes
- A61N1/36021—External stimulators, e.g. with patch electrodes for treatment of pain
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/38—Applying electric currents by contact electrodes alternating or intermittent currents for producing shock effects
- A61N1/39—Heart defibrillators
- A61N1/3906—Heart defibrillators characterised by the form of the shockwave
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/38—Applying electric currents by contact electrodes alternating or intermittent currents for producing shock effects
- A61N1/39—Heart defibrillators
- A61N1/395—Heart defibrillators for treating atrial fibrillation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/38—Applying electric currents by contact electrodes alternating or intermittent currents for producing shock effects
- A61N1/39—Heart defibrillators
- A61N1/3956—Implantable devices for applying electric shocks to the heart, e.g. for cardioversion
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/3605—Implantable neurostimulators for stimulating central or peripheral nerve system
- A61N1/3606—Implantable neurostimulators for stimulating central or peripheral nerve system adapted for a particular treatment
- A61N1/36071—Pain
Definitions
- This invention relates generally to therapeutic painful stimuli such as electric
- vention relates to reducing the pain and discomfort associated with painful transcuta-
- monitors or combination pacemaker — monitor — defibrillators.
- ICDs Implantable cardioverter-defibrillators
- ICD therapy has been applied to treatment of atrial arrhythmias
- ICD shocks The painful and startling nature of ICD shocks are considered a particular
- matic atrial defibrillator will depend on the reduction of pain to acceptable levels.
- the pain associated with these shocks is to reduce the strength ofthe shock pulse as
- Atrial defibrillation threshold by altering the shape (waveform) ofthe delivered shock
- Atrial defibrillation are low energy shocks acceptable to patients? PACE 1996; 19:
- an implantable atrial defibrillator that provides a warning to a patient prior
- the atrial defibrillator applies a warning electrical shock to the patient's
- the warning shock has an energy level lower than that required to treat the ar ⁇
- ventricular arrhythmias automatically treats the ventricular arrhythmias, but allows
- Atrial arrhythmia is not significantly dysfunctional and is amenable to less
- an implantable atrial defibrillator that determines whether a patient is asleep
- shock waveforms and electrode systems to reduce defibrillation thresholds (and there ⁇
- This method may require a patient to re- main in atrial fibrillation for many hours until the patient falls asleep. Thus it is not
- the Bardy method and apparatus further demonstrate the
- the invention overcomes the limitations and shortcom ⁇
- ioral (startle) response to this stimulus can be diminished by delivering a weak
- PPI pulse inhibition
- the neural circuitry responsible for the sensorimotor modulation of PPI has
- PPI occurs in virtually all mammals, and can be elicited in humans
- duration pulse precedes a high-voltage shock pulse.
- between the prepulse and the shock pulse is set between 30 to 500 ms.
- time interval is determined by a testing method which identifies the optimal interval
- the prepulse and therapeutic shocks may have arbitrary waveforms which
- these are not necessarily identical. For example, these may include monophasic or biphasic
- capacitive-discharge pulses ofthe type presently used in ICDs or a pulse waveform constructed specifically to reduce pain, such as a rounded, slow-rise time, or ascend ⁇
- the physician then adjusts the amplitude ofthe prepulse and intervening time
- shock pulse typically, the shock strength required for cardioversion or defibrillation
- prepulse amplitude and time interval are adjusted in the conscious patient after the
- plitude and time interval are adjusted at a postoperative programming study.
- Pretreatment pulses and the treatment shock are de ⁇
- pretreatment of a fibrillating heart is expected to achieve temporal organization ofthe
- the invention reduces or
- Transcutaneous or transesophageal electrical pulses Transcutaneous cardiac pacing
- TCP is commonly used in emergency medicine for immediate treatment of unstable
- Transcutaneous or transesophageal cardiac pacing may also be used.
- rhythmias through overdrive pacing or other antitachycardia pacing methods are rhythmias through overdrive pacing or other antitachycardia pacing methods.
- Rapid TEP atrial pacing is used with increasing frequency in conscious pa-
- Atrial pacing combined with two — dimensional echocardiography (echo-pacing) in
- TEP may also be used in conjunction with recording ofthe esophageal ECG as
- TEP has also been used as a method of temporary pacing in patients who have re ⁇
- bradycardia Discomfort and pain, however, from cutaneous nerve stimulation
- transvenous pacing is usually
- transvenous pacemaker leads through the internal
- TCP improvements include (1) large surface area electrodes
- the apparatus contained a pacing unit, an ECG moni ⁇
- the pacing pulse was a rectilinear constant current
- the front electrode was 75 cm 2 and the back electrode was 140
- the Zoll TCP device contained all the presently known improvements.
- ing pulse of 80 mA It was determined that 20 mA caused a prickly sensation ofthe skin, 40 mA was felt as a definite thump, 60 mA was slightly painful, and 80 mA was
- Ventricular pacing thresholds using TCP were determined in 11 of 16
- Thresholds could not be determined in 5 patients due to intolerable chest
- the mean threshold was 61
- sults showed that the pacing was modestly tolerable if used for only a few seconds.
- esophageal therapy is applied.
- TCP is routinely combined with a
- defibrillator to provide a complete cardiac arrest intervention system, offering anti-
- bradycardia and antitachycardia pacing combined with an external defibrillation capa-
- the pacing performs detection, pacing, and defibrillation.
- the pacing performs detection, pacing, and defibrillation.
- programmability range of available devices are pulse durations from 5 ms to 55 ms,
- energy programmability is used to set the energy level at slightly above the pacing
- CPR cardiopulmonary resuscitation
- ents disclose a method and apparatus that feature a pacing pulse comprising of a series
- each pulse has a duration and amplitude that does not permit it to
- bodiments will in fact intensify the patient's perception of pain, particularly for two or
- TCP system that includes a transcutaneous electrical nerve
- TNS stimulation system
- the nerve stimulation pulses are proposed to miti ⁇
- bodiments will in fact intensify the patient's perception of pain, particularly for two or
- transesophageal cardiac pacing and by inhibiting the startle response associated with
- the clinical basis for the present invention is the fundamental physiol ⁇
- the present invention overcomes the limitations and shortcomings ofthe prior art.
- the present invention provides a method and apparatus to pretreat a patient
- FIGURE 1 illustrates a single, startling pulse, an associated measurement of
- FIGURE 2 illustrates a single, startling pulse, an associated measurement of
- FIGURE 3 illustrates an empirically determined relationship of prepulse in ⁇
- FIGURE 4A illustrates an active housing ventricular ICD implanted pecto-
- nary sinus and right ventricle of a patient's heart, and further attached to tip to ring
- pacing and sensing electrodes placed into the right ventricle of a patient's heart.
- FIGURE 4B illustrates an active housing atrial or dual chamber implanted
- FIGURE 5 illustrates the invention's primary defibrillation system compo ⁇
- nents analyzer — programmer, telemetry head, implantable cardioverter — defibrilla-
- FIGURE 6 illustrates the invention's primary ICD hardware and software
- FIGURE 7 illustrates first a monophasic atrial or ventricular defibrillation
- FIGURE 8 illustrates first a biphasic atrial or ventricular defibrillation pulse
- Atrial or ventricular defibrillation pulse and third a high amplitude, pain inhibiting
- biphasic prepulse preceding the biphasic atrial or ventricular defibrillation pulse.
- FIGURE 9 illustrates first a monophasic atrial or ventricular defibrillation
- FIGURE 10 illustrates first a biphasic atrial or ventricular defibrillation pulse
- Atrial or ventricular defibrillation pulse and third a low amplitude, pain inhibiting
- biphasic prepulse preceding the biphasic atrial or ventricular defibrillation pulse.
- FIGURE 11 A illustrates control, charge, and discharge circuitry for charging
- the circuitry illustrates charging and discharging each pulse
- FIGURE 11B illustrates control, charge, and discharge circuitry for charging
- the circuitry illustrates
- FIGURE 12 illustrates control, charge, and discharge circuitry for charging
- circuitry illustrates
- FIGURE 13 A illustrates the effectiveness of prepulse inhibition in reducing
- FIGURE 13B illustrates the effectiveness of prepulse inhibition in reducing
- FIGURE 14A illustrates anterior to posterior transcutaneous pacing or sub-
- threshold stimulation as applied by a transcutaneous pacing or subthreshold stimula ⁇
- FIGURE 14B illustrates atrial pacing or subthreshold stimulation as applied
- transesophageal pacing or subthreshold stimulation apparatus and its electrode
- FIGURE 15 illustrates a block diagram ofthe invention's transcutaneous car-
- FIGURE 16 illustrates a flow diagram of steps executed by the invention's
- transcutaneous cardiac pacing system elements to deliver alternating prepulses
- the startle response is regulated by forebrain circuitry and appears to
- startle plasticity relates to its amplitude modulation when the startle reflex is preceded
- PPI amplitude modulation
- PPI reflects the activation of ubiquitous, “hard- wired,” sensorimotor
- Startle magnitude is increased when the startling stimulus is pre ⁇
- prepulse facilitation is called prepulse facilitation, and is most evident with weak prestimuli.
- Prestimulus modulation changes from facilitation to inhibition with increasing pre ⁇
- the circuitry that mediates PPI is simple and is integrally connected
- the forebrain circuitry "sets the gain" for PPI
- FIGURE 1
- FIGURE 2 illustrate the underlying neurobiologic principles in the attenuation or
- FIGURE 1 demonstrates the amplitude modulation of a patient's perception
- FIGURE 1 represents an intense, painful stimulus 10 to a patient, such as a defibril ⁇
- graph 12 may represent a measure either of a patient's subjective perception ofthe
- bar graph 12 is illustrated in the bar graph 12 as a "5" on a scale from 0 to 10, with 10 representing
- FIGURE 1 represents an intense, painful stimulus 18 to a patient, such as a defibril ⁇
- Painful stimulus 18 is preceded by a weaker prepulse 14 and sepa ⁇
- the bar graph 20 which corresponds to the bar graph 12 in the top panel.
- the measured value is illustrated in the bar graph 20 as a "1" on a scale from 0 to 10.
- FIGURE 1 thereby illustrates that the amplitude, duration, and preceding time inter ⁇
- val for the prepulse were predetermined to modulate the patient's response in the form
- FIGURE 2 demonstrates the amplitude modulation of a patient's
- time-versus-voltage graph in FIGURE 2 again represents an intense stimulus 10 to a
- the bar graph 12 as a "5" on a scale from 0 to 10, with 10 representing a measurement
- the top graph in FIGURE 2 is identical in all respects to the top
- the bottom time-versus-voltage graph in FIGURE 2 represents
- an intense, painful stimulus 26 to a patient such as a defibrillation shock pulse
- Prepulse 22 precedes intense stimulus 26
- predetermined time interval 24 is much
- FIGURE 2 thereby il ⁇
- the pulses may have arbitrary waveform
- stimuli are delivered through headphones with a continuous 70-dB(A) background
- Startle pulses (40 ms-duration bursts of 118-dB(A) white noise) is pre-
- PPI is defined as the per ⁇
- a threshold sensitivity for the reduction of startle amplitude can be identified.
- FIGURE 3 clearly illustrates the important relationship 48 between prepulse
- One example would be an acoustically derived pres ⁇
- prepulse inhibition was en ⁇
- Medication may be administered on an as-needed basis to patients in
- FIGURES 4A, 4B, 5 and 6 illustrate the principle physical elements ofthe
- the figures illustrate a fully implantable atrial or ventricular cardioverter—
- ICD defibrillator pulse generator
- FIGURES 4A and 4B The portions ofthe heart illustrated in FIGURES 4A and 4B are the right atrium 34 (RA), the left atrium
- LA left ventricle
- RV right ventricle 38
- LV left ventricle
- ICD pulse generator 30 generally includes a housing 46 for hermetically seal ⁇
- endocardial high-voltage lead 42 a right ventricle endocardial high-
- Each ofthe leads comprise an insulative lead body.
- High- voltage leads 40, 42, and 44 further comprise electrodes capable of conducting
- high voltage currents and defibrillation coil electrodes may be fabricated from
- Leads 40, 42, and 44 are used to deliver a prepulse or a high- voltage defibrillation
- Lead 50 further comprise a tip electrode
- Lead 52 further comprise a tip electrode and a ring elec-
- trode and is constructed to enable bipolar sensing of electrical activations ofthe right
- ventricle 38 Although they are shown separately in FIGURE 4 for clarity, one or
- the high-voltage leads 40, 42, and 44 and one or more ofthe pace-sense leads are more ofthe high-voltage leads 40, 42, and 44 and one or more ofthe pace-sense leads
- the endocardial leads 40, 42, 44, 50 and 52 are arranged for establishing electrical contact with the heart and to be implanted beneath the skin of a patient and so as to
- ICD 30 includes electrode switching circuitry 188.
- Leads 40, 42, 44, 50 and 52 are coupled to the electrode switching circuitry via con-
- nector block 48 Leads 50 and 52 are further coupled communicatively to pacer tim ⁇
- Lead 50 therefore forms a complete pace/sensing lead system for pacing and sensing
- Lead 52 therefore forms a complete
- pace/sensing lead system for pacing and sensing electrical activations ofthe right
- ICD 30 The primary external components of ICD 30 are illustrated in FIGURE 5.
- implantable elements ICD pulse generator 30 and en ⁇
- docardial leads illustrated by right ventricle lead 44 which are shown within the hu ⁇
- An analyzer-programmer system 130 is comparatively
- Analyzer-programmer system 130 is coupled to a telemetry
- corded electrical activations in the form of atrial or ventricular electrograms via te-
- lemetry relay 134 from ICD 30. Telemetry relay 134 is employed near or on the pa ⁇
- telemetry signals 136 comprising infrared, visible,
- Analyzer-programmer sys- tern 130 and telemetry relay 134 are well appreciated by those skilled in the art.
- the internal circuits and programming 150 of ICD 30 are illustrated in FIG.
- FIGURE 6 and generally include electrode switching circuitry 188, electrogram
- sensing and conditioning circuitry 154 pacer timing/control circuitry 174, sense am ⁇
- plification and digitizing circuitry 156 microprocessor 152, random access memory
- tachyarrhythmia and fibrillation detection software 158 address/data bus 178,
- control software 160 charging and delivery control circuitry 180, charging circuitry
- a battery 166 is electrically and
- FIGURE 7 illustrates a monophasic atrial or ventricular defibrillation pulse
- pulse 70 serves as the intense, painful stimulus 18 of FIGURE 1.
- biphasic prepulse 76 serves as the weaker prepulse 14 of FIGURE 1 and is separated by a predetermined time interval 74.
- FIGURE 8 il ⁇
- the biphasic atrial or ventricular defibrillation pulse the biphasic atrial or ventricular defibrillation pulse.
- Atrial or ventricular defibrillation pulse 78 serves as the intense, painful stimulus 18 of
- FIGURE 1 Note that in FIGURES 7 and 8 the weaker strength ofthe prepulses
- pulse duration ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇
- FIGURE 9 illustrates a monophasic atrial or ventricular defibrillation pulse
- sic atrial or ventricular defibrillation pulse and a low amplitude, pain inhibiting, bi ⁇
- the monophasic atrial or ventricular defibrillation pulse 70 serves as the in ⁇
- phasic prepulse 98 or the low amplitude, pain inhibiting, biphasic prepulse 100 serves
- FIGURE 10 illustrates a biphasic atrial or ventricular defi ⁇
- brillation pulse 78 a low amplitude, pain inhibiting, monophasic prepulse 98 preced ⁇
- the biphasic atrial or ventricular defibrillation pulse is the biphasic atrial or ventricular defibrillation pulse
- FIGURE 11A illustrates hardware and software elements that implement the
- tion circuitry primarily designed for monophasic atrial or ventricular defibrillation
- FIGURE 11 A illustrates charge circuitry 82, capacitor system 84, dis ⁇
- Charging and delivery controller 160 of ICD 30 is coupled com ⁇
- address/data bus 184 (which may be separate from
- controller 160 operates charging cir ⁇
- Circuitry 82 via control lines 182.
- Charge circuitry 82 charges capacitor system 84 to
- controller 160 first utilizes discharge control circuitry 80 and operates switching cir ⁇
- cuitry 88 via control lines 86 to output a monophasic, truncated exponential prepulse
- the circuitry illustrates charging and discharging a prepulse and a cardioversion
- Prepulse 72 and 76 have leading-edge
- Discharge control circuitry 80 modulates the prepulse waveform duration
- FIGURE 11B illustrates hardware and software elements that implement the
- defibrillation circuitry primarily designed for biphasic atrial or ventricular defibrilla ⁇
- FIGURE 11B illustrates charge circuitry 82, capacitor system 84,
- Charging and delivery controller 160 of ICD 30 is coupled communica-
- address/data bus 184 (which may be separate from ad ⁇
- controller 160 operates charging cir ⁇
- the charge circuitry 82 charges capacitor system 84 to
- controller 160 first utilizes discharge control circuitry 80 and operates switching cir-
- cuitry 94 and 96 via control lines 90 and 92 to output a monophasic 72 or biphasic 76
- FIGURE 11B illustrates
- FIGURE 11B further illustrates charging and discharging circuitry
- Prepulse 72 and 76 have leading-edge voltages equivalent to leading-
- Discharge control circuitry 80 modulates the prepulse waveform duration and modulates the pre ⁇
- Capacitor system 84 illustrated in FIGURES 9A and 9B represents a conven ⁇
- Capacitor system 84 is implemented with one or
- system 84 stores 0 to 40 joules (J) of energy, preferably 2 to 20 J for ventricular defi ⁇
- brillation and 0.05 to 15 J for atrial defibrillation may be charged to 1000 V for
- FIGURE 12 illustrates hardware and software elements that implement the
- FIGURE 12 illustrates charge and capacitor circuitry 104, discharge control
- circuitry 102 discharge control lines 108 and 110, and discharge switching circuitry
- FIGURE 12 further illustrates charge and capacitor circuitry 106
- discharge control circuitry 102 discharge control lines 112 and 114, and discharge
- Charging and delivery controller 160 of ICD 30 is coupled commu ⁇
- address/data bus 184 (which may be separate from ad ⁇
- controller 160 operates charging cir ⁇
- the charge circuitry 104 charges its capaci- tor system to a predetermined energy and voltage level for a low- voltage, low-energy
- the charge circuitry 106 charges its capacitor system to a predetermined
- controller 160 first utilizes discharge control
- circuitry 102 and operates switching circuitry 116 and 118 via control lines 108 and
- the circuitry illustrates charging and discharging each pulse from separate circuitry.
- Prepulse 98 and 100 are programmable to permit the ability to have stored energies
- Capacitor systems 104 and 106 illustrated in FIGURE 12 represent conven ⁇
- Capacitor systems 104 and 106 may each be im-
- ICD 30 tive capacitance values for ICD 30 in the range of 10 to 250 microfarads ( ⁇ F), pref ⁇
- Capacitor systems 104 and 106 each store 0 to 40
- J joules (J) of energy, preferably 2 to 20 J for ventricular defibrillation and 0.05 to 15 J for atrial defibrillation, and each system may be charged to 1000 V for the leading-
- capacitor systems 104 and 106 provide for prepulse waveform design substantially
- pacitor system 104 is designed with different capacitive values and energy capabilities
- tem 104 implements the prepulse therapy with different capacitor values, stored and
- pacitor system 104 implements a square waveform and rounded waveform as a pre ⁇
- Capacitor systems 104 may be implemented as a pacing circuit and provide
- pacing pulses for prepulses 98 and 100.
- the remainder ofthe invention is dedicated to the provision of cardiac pacing
- the apparatus may correspond to that apparatus disclosed in US Patent Number
- FIGURES 4A through 12 the exemplary apparatus is illustrated by FIGURES 4A through 12.
- sensing electrodes 52 are located on or in the
- sensing and conditioning circuitry 154 which preferably takes the form of an auto ⁇
- sensing electrodes 50 are located on or in the right atrium 34 and are coupled to the
- tioning circuitry 154 may correspond to circuitry disclosed in US Patent Number
- Electrode switching circuitry 188 is
- trodes is controlled by microprocessor 152 using the data and address bus 178, which
- verter circuitry 156 for conversion to multi-bit digital signals and to the random ac ⁇
- processor 152 may employ digital signal processing techniques to characterize the
- digitized signals stored in memory 176 to recognize and classify the patient's heart
- Microprocessor 152 may employ any ofthe numerous signal processing
- the pacer timing/control circuitry 174 includes programmable digital counters
- cuitry also controls escape intervals associated with anti-tachyarrhythmia pacing in both the atrium and the ventricle, employing any anti-tachyarrhythmia pacing thera ⁇
- Intervals defined by pacing circuitry 174 include atrial and ventricular pacing
- pacing pulses The durations of these intervals are determined by microprocessor 152,
- Pacer circuitry 174 via address/data bus 178. Pacer circuitry 174 also determines the ampli ⁇
- the escape interval counters within pacer timing/control cir ⁇
- cuitry 174 are reset upon sensing of R- waves and P-waves as indicated by signals on
- pacer output circuitry which are coupled to
- the escape interval counters are also reset on generation of
- interval timers are determined by microprocessor 152, via address/data bus 178.
- ory 176 used to detect the presence of tachy arrhythmias.
- Microprocessor 152 operates as an interrupt driven device, and is responsive to
- pacer timing / control circuitry 174 take place
- R — P interval tricular depolarization
- memory 176 is configured as a plurality of recirculating buffers, capable of holding a
- the tachyarrhythmia and fibrillation detector 158 operates the algorithms that
- tricular tachyarrhythmias may correspond to tachyar ⁇
- rhythmia detection algorithms known to the art. There are many algorithms known in
- rhythmia is present.
- presence of atrial or ventricular tachyarrhythmia is present.
- Olson Onset and stability for ventricular tachyarrhythmia detection in an implantable
- Atrial fibrillation detection method
- microprocessor by a microprocessor is well within the preview of one skilled in the art.
- processor 152 into the pacing timing and control circuitry 174 to control the operation
- microprocessor 152 employs an escape interval counter to control timing of
- cardioversion and defibrillation pulses as well as associated refractory periods.
- microprocessor 152 activates the therapy charging and
- circuit 164 powered by the battery 166 and under the control of high voltage charging
- the voltage on the high voltage capacitors is monitored, and in re ⁇
- timing of the delivery ofthe defibrillation or cardioversion pulse is con ⁇
- microprocessor 152 then returns the device to cardiac pacing and
- pulses is accomplished by the therapy discharge circuitry 168, under control of cir ⁇
- Therapy control circuitry 180 determines whether a
- Electrodes are involved in delivery ofthe pulse.
- electrodes intended to be coupled together during delivery ofthe pulse are coupled together during delivery ofthe pulse.
- Patent Number 4,953,551 issued to Mehra or US Patent Number 4,800,883 issued to
- Winstrom incorporated herein by reference in its entirety, may also be used in con ⁇
- junction with a apparatus embodying the invention for delivery of biphasic pulses.
- tricular defibrillation may be accomplished using higher pulse energy levels than re ⁇
- electrodes 40 used for atrial defibrillation.
- electrodes 40 right electrodes
- Atrial/superior vena cava and 42 coronary sinus/great vein
- Electrodes 40 and 44 right ventricle might be employed for
- Electrode 40 coupled to electrode 46 (device housing).
- Atrial/superior vena cava electrode 40 the coronary sinus/great cardiac vein electrode
- electrodes 40 and 46 are coupled in common with one another, and the ventricular de ⁇
- ventricle electrode 44 In another particularly desirable embodiment ofthe invention
Abstract
Description
Claims
Priority Applications (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
EP99916539A EP1076582A4 (en) | 1998-04-08 | 1999-04-08 | Method and apparatus for reduction of pain from electric stimulation therapies |
AU34839/99A AU3483999A (en) | 1998-04-08 | 1999-04-08 | Method and apparatus for reduction of pain from electric stimulation therapies |
Applications Claiming Priority (4)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US8116498P | 1998-04-08 | 1998-04-08 | |
US60/081,164 | 1998-04-08 | ||
US09/152,382 US6091989A (en) | 1998-04-08 | 1998-09-14 | Method and apparatus for reduction of pain from electric shock therapies |
US09/152,382 | 1998-09-14 |
Publications (2)
Publication Number | Publication Date |
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WO1999051300A2 true WO1999051300A2 (en) | 1999-10-14 |
WO1999051300A3 WO1999051300A3 (en) | 1999-12-02 |
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Application Number | Title | Priority Date | Filing Date |
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PCT/US1999/007767 WO1999051300A2 (en) | 1998-04-08 | 1999-04-08 | Method and apparatus for reduction of pain from electric stimulation therapies |
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US (3) | US6091989A (en) |
EP (1) | EP1076582A4 (en) |
AU (1) | AU3483999A (en) |
WO (1) | WO1999051300A2 (en) |
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US7155286B1 (en) | 2004-05-26 | 2006-12-26 | Pacesetter, Inc. | System and method for reducing pain associated with cardioversion shocks generated by implantable cardiac stimulation devices |
US7158826B1 (en) | 2003-04-30 | 2007-01-02 | Pacesetter, Inc. | System and method for generating pain inhibition pulses using an implantable cardiac stimulation device |
US7231255B1 (en) | 2004-05-26 | 2007-06-12 | Pacesetter, Inc. | System and method for reducing pain associated with cardioversion shocks generated by implantable cardiac stimulation devices |
US7480531B1 (en) | 2004-05-26 | 2009-01-20 | Pacesetter, Inc. | System and method for reducing pain associated with cardioversion shocks generated by implantable cardiac stimulation devices |
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US6772007B1 (en) | 1997-05-14 | 2004-08-03 | Pacesetter, Inc. | System and method of generating a low-pain multi-step defibrillation waveform for use in an implantable cardioverter/defibrillator (ICD) |
WO2001037931A1 (en) * | 1999-11-24 | 2001-05-31 | Cardiac Pacemakers, Inc. | Method and apparatus for termination of cardiac tachyarrhythmias |
US6456876B1 (en) * | 2000-02-28 | 2002-09-24 | Pacesetter, Inc. | Dual-chamber implantable cardiac stimulation system and device with selectable arrhythmia termination electrode configurations and method |
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Publication number | Publication date |
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EP1076582A4 (en) | 2004-07-07 |
US6091989A (en) | 2000-07-18 |
WO1999051300A3 (en) | 1999-12-02 |
AU3483999A (en) | 1999-10-25 |
US6711442B1 (en) | 2004-03-23 |
US6438418B1 (en) | 2002-08-20 |
EP1076582A2 (en) | 2001-02-21 |
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