Adaptive medium voltage therapy for cardiac arrhythmias

摘要

Aspects of the invention are directed to advanced monitoring and control of medium voltage therapy (MVT) in implantable and external devices. Apparatus and methods are disclosed that facilitate dynamic adjustment of MVT parameter values in response to new and changing circumstances such as the patient's condition before, during, and after administration of MVT. Administration of MVT is automatically and dynamically adjusted to achieve specific treatment or life-support objectives, such as prolongation of the body's ability to endure and respond to MVT, specifically addressing the type of arrhythmia or other pathologic state of the patient with targeted treatment, a tiered-intensity MVT treatment strategy, and supporting patients in non life-critical conditions where the heart may nevertheless benefit from a certain level of assistance.

主权项

1. A method for treating arrhythmia in a patient using an electrotherapy device, the method comprising:
providing a patient interface, including a plurality of electrodes and at least one hemodynamic sensor, placed in electrical contact with the patient; generating medium voltage therapy (MVT) via the patient interface as a configurable waveform having a set of adjustable waveform parameters, wherein the waveform is defined by series of pulse trains having an adjustable train repetition rate, the pulse trains being composed of pulses having an adjustable pulse width, an adjustable pulse period, and an adjustable pulse amplitude, the MVT being of an energy level insufficient to shock the heart into a reset state; monitoring the patient via the patient interface for an occurrence of an arrhythmia; monitoring a hemodynamic condition of the patient via the patient interface; based on the arrhythmia monitoring and on the hemodynamic condition monitoring, ascertaining a patient condition that is treatable by the MVT; based on a treatment or life-support objective corresponding to the patient condition treatable by the MVT, initiating application of the MVT to the musculature of the patient via the patient interface to target a selected muscle group, wherein the selected muscle group is repeatedly (a) forced into a contracted state, (b) maintained in the contracted state for a time sufficient to achieve myocardial perfusion, and (c) thereafter allowed to relax, thereby achieving a forced hemodynamic effect sufficient to reduce a rate of degradation of the condition of the patient; adjusting the waveform parameters in furtherance of the treatment or life-support objective such that:
in response to a measured level of cardiac output during application of the MVT targeting a selected first muscle group exceeding a minimal level adequate for the treatment or life-support objective, reducing an intensity of MVT stimulation targeting the first muscle group;in response to a measured reduction of level of cardiac output during application of the MVT targeting a selected first muscle group, targeting a selected second muscle group distinct from the first muscle group with the MVT having adjusted waveform parameters corresponding to the second muscle group.