Nonvascular implantable defibrillator and method
A power supply for an implantable cardioverter-defibrillator for subcutaneous positioning between the third rib and the twelfth rib and using a lead system that does not directly contact a patient's heart or reside in the intrathoracic blood vessels and for providing anti-tachycardia pacing energy to the heart, comprising a capacitor subsystem for storing the anti-tachycardia pacing energy for delivery to the patient's heart; and a battery subsystem electrically coupled to the capacitor subsystem for providing the anti-tachycardia pacing energy to the capacitor subsystem.
1. A method of treating a patient comprising providing a voltage difference between two electrodes placed in the torso of the patient at non-vascular locations, the two electrodes disposed such that a first electrode is placed on an implanted canister containing circuitry for providing the voltage difference, and a second electrode is disposed as part of a lead system coupled to the canister; wherein the two electrodes are placed in the torso of the patient at locations exclusive of the heart, such locations being non-epicardial and non-intracardiac, and all electrodes and leads of the system are disposed between the patient's ribcage and skin.
2. The method of claim 1 , wherein the electrodes are disposed such that a line drawn between the first and second electrodes intersects a portion of the heart.
3. The method of claim 2 , wherein the first electrode is disposed along the inframammary crease.
4. The method of claim 1 , further comprising sensing a portion of the patient's cardiac rhythm using the first electrode and a third electrode also disposed in the patient exclusive of the patient's heart and between the patient's ribcage and skin.
5. The method of claim 4 , wherein the voltage difference is provided at a time in the patient's cardiac rhythm chosen to induce fibrillation.
6. The method of claim 4 , wherein the voltage difference is provided at a time in the patient's cardiac rhythm chosen to alleviate fibrillation.
7. The method of claim 4 , wherein the voltage difference is provided at a time in the patient's cardiac rhythm chosen to improve pacing of the cardiac rhythm.
8. The method of claim 7 wherein the voltage difference is provided to treat tachyarrhythmia by artificially pacing the cardiac rhythm.
9. The method of claim 1 , wherein the voltage difference is provided at a time in the patient's cardiac rhythm chosen to induce fibrillation.
10. The method of claim 1 , wherein the voltage difference is provided at a time in the patient's cardiac rhythm chosen to alleviate fibrillation.
11. The method of claim 1 , wherein the voltage difference is provided at a time in the patient's cardiac rhythm chosen to improve pacing of the cardiac rhythm.
12. The method of claim 11 wherein the voltage difference is provided to treat a tachyarrhythmia by artificially pacing the cardiac rhythm.
13. The method of claim 1 , wherein the first electrode is disposed along the left axillary line.
14. A method of treating a patient comprising:
implanting an electrical stimulus device into the torso of the patient; and
implanting a lead system into the torso of the patient;
wherein:
the electrical stimulus device includes a housing and circuitry contained in the housing, the housing including an electrode;
the lead system is implanted such that the patient's heart is not contacted or entered by the lead system; and
the circuitry is adapted to provide a stimulus to the patient's heart using a first electrode disposed as part of the lead system and the electrode on the housing.
15. The method of claim 14 , wherein the circuitry is adapted to operate in a number of modes, wherein a first mode is configured to induce fibrillation of the patient's heart.
16. The method of claim 15 , wherein the first mode includes a configuration for sensing at least a part of the patient's cardiac rhythm and providing a stimulus corresponding to the patient's T-wave.
17. The method of claim 15 , wherein the first mode includes a configuration for outputting a stimulus for a duration approximating a period of the patient's cardiac rhythm.
18. The method of claim 14 , wherein the circuitry is adapted to operate in a number of modes, wherein a first mode is configured to provide a pacing output to control the patient's heart rate.
19. The method of claim 18 , wherein the first mode is adapted to treat tachycardia.
20. The method of claim 14 , wherein the circuitry is adapted to operate in a number of modes, wherein a first mode is configured to provide a defibrillation output to cause fibrillation of the patient's heart to stop.
21. The method of claim 14 , wherein the circuitry is adapted to operate in a number of modes including:
a first mode configured to induce fibrillation of the patient's heart; and
a second mode configured to provide cardiac therapy.
22. The method of claim 21 , wherein the second mode is adapted to treat bradycardia.
23. The method of claim 21 , wherein the second mode is adapted to treat tachycardia.
24. The method of claim 21 , wherein the second mode is adapted to treat fibrillation.
25. The method of claim 14 , wherein the circuitry is adapted to operate in a number of modes including:
a first mode configured to induce fibrillation of the patient's heart;
a second mode configured to provide pacing therapy; and
a third mode configured to treat fibrillation of the patient's heart.