US2012116472A1PendingUtilityA1

Systems and methods for determining an optimal defibrillation shock waveform

23
Individually held — no corporate assignee on recordPriority: Jun 29, 2006Filed: Jan 13, 2012Published: May 10, 2012
Est. expiryJun 29, 2026(expired)· nominal 20-yr term from priority
Inventors:Michael R. Pittaro
A61N 1/3906
23
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Claims

Abstract

Methods and systems for determining an optimal defibrillation shock waveform for application to the heart of a patient may include measuring and/or collecting information for a cardiac waveform of a patient, produced as a result of either an electrical stimulus applied to a heart of the patient, which may be a pacing shock/stimulus and/or a defibrillation shock waveform, or as the result of intrinsic cardiac activation; determining a characteristic of the cardiac waveform; comparing the determined characteristic of the cardiac waveform to a plurality of values for the characteristic with optional reference to the defibrillator system impedance, wherein each value of the characteristic is associated with a predetermined value for a parameter of an optimal defibrillation shock waveform; and selecting the predetermined value for the parameter of the optimal defibrillation shock waveform based on the comparison.

Claims

exact text as granted — not AI-modified
1 . A method for determining an optimal defibrillation shock waveform for use by an implantable defibrillation system, said method comprising:
 obtaining a cardiac electrogram of a patient's heart, wherein the cardiac electrogram is a measure of the varying electrical potential between two electrodes positioned adjacent the heart and is characterized by one or more of a baseline, at least one peak above a baseline, and at least one trough below a baseline;   determining a value of at least one characteristic of the cardiac electrogram; and   selecting a predetermined value for at least one parameter of an optimal defibrillation shock waveform, wherein the at least one parameter is based on the determined value of the at least one characteristic of the cardiac electrogram;   wherein the at least one parameter defines the optimal defibrillation shock waveform and is selected from a group consisting of: a total energy of an optimal defibrillation shock waveform, a voltage of an optimal defibrillation shock waveform, a current of an optimal defibrillation shock waveform, a time period for a first phase of an optimal defibrillation shock waveform, a time period for second phase of an optimal defibrillation shock waveform for the patient, a time period for a third phase of a defibrillator shock waveform, a tilt of an optimal defibrillation shock waveform, and a polarity of a phase of a defibrillator shock waveform.   
     
     
         2 . The method of  claim 1 , wherein selecting the predetermined value for the at least one parameter of the optimal defibrillation shock waveform includes making reference to a measured defibrillator system impedance. 
     
     
         3 . The method of  claim 1 , wherein selecting the predetermined value for the at least one parameter of the optimal defibrillation shock waveform comprises comparing the determined value of the at least one characteristic of the cardiac electrogram to a plurality of values of the at least one characteristic of the cardiac electrogram, wherein each value is associated with a specific predetermined value for the at least one parameter of an optimal defibrillation shock waveform. 
     
     
         4 . The method of  claim 1 , further comprising applying the selected predetermined value for the at least one parameter to the defibrillation system. 
     
     
         5 . The method of  claim 1 , wherein prior to determining the value of the at least one characteristic of the cardiac electrogram, the method further comprises measuring and/or collecting information of the cardiac electrogram. 
     
     
         6 . The method of  claim 1 , wherein the cardiac electrogram is produced either as the result of an electrical stimulus applied to the heart of the patient, which may be from a pacing shock/stimulus and/or a defibrillation shock waveform, or as the result of intrinsic cardiac activation. 
     
     
         7 . The method of  claim 1 , further comprising determining one or more of the predetermined values of the at least one parameter for an optimal defibrillation shock waveform. 
     
     
         8 . The method of  claim 7 , wherein the one or more predetermined values of the at least one parameter for an optimal defibrillation shock waveform is determined substantially in real-time. 
     
     
         9 . The method of  claim 7 , wherein the one or more predetermined values of the at least one parameter for an optimal defibrillation shock waveform is determined after measuring and/or collecting information of the cardiac electrogram. 
     
     
         10 . The method of  claim 1 , wherein the cardiac electrogram is an intracardiac electrogram. 
     
     
         11 . The method of  claim 1 , wherein the cardiac electrogram is a surface electrocardiogram. 
     
     
         12 . The method of  claim 1 , wherein the at least one characteristic of the cardiac waveform is selected from a group consisting of: a time period between points or portions of the cardiac electrogram, a slope of a portion of the cardiac electrogram, an area under the curve (AUC) of at least a portion of the cardiac electrogram, a time period between a pacing stimulus and a point of the cardiac electrogram, and a mathematical analysis of the electrogram. 
     
     
         13 . The method of  claim 1 , wherein determining the optimal defibrillation shock waveform includes determining an impedance of an implanted defibrillator system for applying the defibrillation shock waveform to the heart of the patient. 
     
     
         14 . A system for determining an optimal defibrillation shock waveform for use by an implantable defibrillation system, said system comprising:
 means for obtaining a cardiac electrogram of a patient's heart, wherein the cardiac electrogram is a measure of the varying electrical potential between two electrodes positioned adjacent the heart and is characterized by one or more of a baseline, at least one peak above a baseline, and at least one trough below a baseline;   determining means for determining a value of at least one characteristic of the cardiac electrogram; and   selecting means for selecting a predetermined value for at least one parameter of an optimal defibrillation shock waveform, wherein the at least one parameter is based on the determined value of the at least one characteristic of the cardiac electrogram;   wherein the at least one parameter defines the optimal defibrillation shock waveform and is selected from a group consisting of: a total energy of an optimal defibrillation shock waveform, a voltage of an optimal defibrillation shock waveform, a current of an optimal defibrillation shock waveform, a time period for a first phase of an optimal defibrillation shock waveform, a time period for second phase of an optimal defibrillation shock waveform for the patient, a time period for a third phase of a defibrillator shock waveform, a tilt of an optimal defibrillation shock waveform, and a polarity of a phase of a defibrillator shock waveform.   
     
     
         15 . The system of  claim 14 , wherein the selecting means comprises comparing means for comparing the determined value of the at least one characteristic of the cardiac electrogram and optionally a defibrillator system impedance to a plurality of first values of the at least one characteristic of the cardiac electrogram, wherein each first value is associated with a specific predetermined value for the at least one parameter of an optimal defibrillation shock waveform. 
     
     
         16 . The system of  claim 14 , further comprising application means for applying the selected predetermined value for the at least one parameter to the defibrillation system. 
     
     
         17 . The system of  claim 14 , further comprising measuring and/or collecting means for measuring and/or collecting information of the cardiac electrogram. 
     
     
         18 . The system of  claim 14 , further comprising electrical stimulus means for applying an electrical stimulus to the heart of the patient. 
     
     
         19 . The system of  claim 14 , wherein determining means determines one or more of the predetermined values of the at least one parameter for an optimal defibrillation shock waveform. 
     
     
         20 . The system of  claim 19 , wherein the one or more predetermined values of the at least one parameter of an optimal defibrillation shock waveform is determined substantially in real-time. 
     
     
         21 . The system of  claim 19 , wherein the one or more predetermined values of the at least one parameter of an optimal defibrillation shock waveform is determined after measuring and/or collecting information of the cardiac electrogram. 
     
     
         22 . The system of  claim 18 , wherein the electrical stimulus comprises a pacing stimulus or a defibrillation shock waveform. 
     
     
         23 . The system of  claim 14 , wherein the cardiac electrogram is an intracardiac electrogram. 
     
     
         24 . The system of  claim 14 , wherein the cardiac electrogram is a surface electrocardiogram. 
     
     
         25 . The system of  claim 14 , wherein the at least one characteristic of the cardiac electrogram is selected from a group consisting of: a time period between points or portions of the cardiac electrogram, a slope of a portion of the cardiac electrogram, an area under the curve (AUC) of at least a portion of the cardiac electrogram, a time period between a pacing stimulus and a point of the cardiac electrogram, and a mathematical analysis of the electrogram.

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