Pacesetter, Inc.

Duke University

Other

Rajesh Pendekanti

Patrick D Wolf

A system and method for providing improved defibrillation thresholds. In one embodiment of the invention, following the detection of fibrillation, a pacing pulse train is applied to a pacing electrode placed in the low gradient region of the left ventricular freewall to capture the tissue. In one embodiment, a pacing rate of about 80-95% of the VF cycle length is applied to achieve capture. Once capture of the tissue of the critical region is achieved, a high energy shock is delivered when the captured tissue is in the process of activation. The defibrillation shock is delivered at the end of the pacing train, with a coupling interval of either about 80-95% of the pacing rate (i.e., about 64-90% of the VF cycle length), or, alternatively, about 5-20% of the pacing rate (i.e., about 4-19% of the VF cycle length). In an alternative embodiment of the invention, a sensing electrode array is placed in the low gradient region of the left ventricular freewall to monitor such time as a substantial percentage of the tissue of the low gradient region is in the process of activation, i.e., on the downstroke of the respective EGMs, and then delivering the defibrillation shock at that instant.

Method and apparatus for improving the probability of success of defibrillation shocks

Methods and apparatus for achieving atrial defibrillation in a heart. Atrial pacing is first conducted from multiple pacing sites in an independent (asynchronous) manner so as to have the desired effect of maximizing the extent of phase-locked area of atrial tissue. Next, an ADF shock is introduced, if still needed, to achieve atrial defibrillation. ADFT energy requirements have been shown to be dramatically reduced on account of using pacing rates set proportionally to the sensed local atrial fibrillation cycle lengths such that large areas of atrial tissues are phase-locked, and consequently atrial defibrillation can be effected in the patient with greatly reduced energy requirements for ADFTs.

Atrial defibrillation methods and apparatus

Method and apparatus for improving the probability of success of

Methods and apparatus for achieving atrial defibrillation in a heart. Atrial pacing is first conducted from a single pacing site so as to have the desired effect of maximizing the extent of phase-locked area of atrial tissue. Next, an ADF shock is introduced, if still needed, to achieve atrial defibrillation. ADFT energy requirements have been shown to be dramatically reduced on account of using a pacing rate set proportionally to the atrial fibrillation cycle length such that large areas of atrial tissues are phase-locked, and consequently atrial defibrillation can be effected in the patient with greatly reduced energy requirements for ADFTs.

Methods and apparatus for achieving atrial defibrillation in a heart. Atrial pacing is first conducted from multiple pacing sites in a synchronous manner so as to have the desired effect of maximizing the extent of phase-locked area of atrial tissue. Next, an ADF shock is introduced, if still needed, to achieve atrial defibrillation. ADFT energy requirements have been shown to be dramatically reduced on account of using pacing rates set proportionally to the sensed atrial fibrillation cycle length(s) such that large areas of atrial tissues are phase-locked, and consequently atrial defibrillation can be effected in the patient with greatly reduced energy requirements for ADFTs.

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Sunnyvale, CA, United States of America

Rajesh Pendekanti