Leadless cardiac pacemaker system for usage in combination with an implantable cardioverter-defibrillator
A cardiac pacing system comprising one or more leadless cardiac pacemakers configured for implantation in electrical contact with a cardiac chamber and configured to perform cardiac pacing functions in combination with a co-implanted implantable cardioverter-defibrillator (ICD). The leadless cardiac pacemaker comprises at least two leadless electrodes configured for delivering cardiac pacing pulses, sensing evoked and/or natural cardiac electrical signals, and bidirectionally communicating with the co-implanted ICD.
1. A cardiac pacing system comprising:
at least one leadless cardiac pacemaker configured for implantation in electrical contact with a cardiac chamber and configured to perform cardiac pacing functions in combination with a co-implanted implantable cardioverter-defibrillator (ICD), the at least one leadless cardiac pacemaker comprising a pulse generator configured to generate pulses adapted to perform cardiac pacing and pulses encoding information for transmission as communication signals, and at least two electrodes configured to deliver generated pulses, sense evoked and/or natural cardiac electrical signals, and bidirectionally communicate with a non-implanted programmer by operation of the pulse generator to encode and transmit generated pulses operative as communication signals, the at least one leadless cardiac pacemaker configured to intercommunicate and directly communicate with a non-implanted programmer via pulses generated by the pulse generator and encoded into communication signals wherein transmitted communication power requirements are essentially met by power consumed in cardiac pacing.
2. The system according to claim 1 further comprising:
the at least one leadless cardiac pacemaker configured to intercommunicate and directly communicate with a non-implanted programmer and the implanted ICD by transmitting pulses generated by the pulse generator and encoded to be operative as communication signals via the at least two electrodes that are also used for delivering pacing pulses.
3. A system according to claim 1 further comprising:
the at least one leadless cardiac pacemaker comprising:
a hermetic housing configured for placement on or attachment to the inside or outside of a cardiac chamber; and
the at least two electrodes proximal to the housing that bidirectional communicates directly with at least one other device within or outside the body.
4. The system according to claim 1 further comprising:
the at least one leadless cardiac pacemaker configured to communicate bidirectionally among a plurality of leadless cardiac pacemakers and the implanted ICD to coordinate pacing pulse delivery via pulses generated by the pulse generator and encoded into communication signal messages that identify an event at an individual pacemaker originating the message and pacemakers receiving the message react as directed by the message depending on the message origin.
5. The system according to claim 1 further comprising:
the at least one leadless cardiac pacemaker configured to communicate bidirectionally via pulses generated by the pulse generator and encoded into communication signals among a plurality of leadless cardiac pacemakers and the implanted ICD to facilitate sensitivity and specificity of the ICD.
6. The system according to claim 1 further comprising:
the at least one leadless cardiac pacemaker configured to communicate via pulses generated by the pulse generator and encoded into communication signals with a subcutaneous-only implantable defibrillator to improve sensitivity and specificity of the subcutaneous-only implantable defibrillator whereby atrial depolarization and ventricular depolarization are uniquely and specifically identified.
7. The system according to claim 1 further comprising:
the at least two electrodes configured to communicate bidirectionally via pulses generated by the pulse generator and encoded into communication signals among a plurality of leadless cardiac pacemakers and the ICD and convey data including designated codes for events detected or created by an individual pacemaker, the individual pacemakers issuing a unique code corresponding to an event type and a location of the individual pacemaker.
8. The system according to claim 1 further comprising:
individual pacemakers of a plurality of leadless cardiac pacemakers configured to deliver at least one pulse generated by the pulse generator and encoded into a code assigned according to pacemaker location and transmit a message to at least one pacemaker of the plurality of leadless cardiac pacemakers via the at least one pulse wherein the code identifies the individual pacemaker originating an event, the at least one pacemaker receiving the message being responsive to the message in a predetermined manner depending on type and location of the event.
9. The system according to claim 1 further comprising:
individual pacemakers a plurality of leadless cardiac pacemakers configured to deliver at least one pulse generated by the pulse generator and encoded into a code assigned according to pacemaker location and transmit a message to at least one pacemaker of the plurality of leadless cardiac pacemakers via the at least one pulse wherein the code identifies the individual pacemaker originating an event, the individual pacemakers further delivering a pacing pulse in absence of encoding whereby, for dual-chamber cardiac pacing, a pacing pulse that is not generated in a first cardiac pacemaker that senses the pacing pulse is necessarily generated in a second cardiac pacemaker.
10. The system according to claim 1 further comprising:
individual pacemakers of a plurality of leadless cardiac pacemakers configured to convey to at least one pacemaker of the plurality of leadless cardiac pacemakers at least one pulse generated by the pulse generator and encoded into a signal indicating occurrence of a sensed heartbeat at the individual pacemaker location via generation of at least one pulse triggered by the sensed heartbeat in a natural refractory period following the sensed heartbeat.
11. The system according to claim 1 further comprising:
individual pacemakers of the plurality of leadless cardiac pacemakers configured to receive conducted communication from a co-implanted cardioverter-defibrillator (ICD) that configures the individual pacemakers to deliver overdrive anti-tachycardia pacing in response to a detected tachyarrhythmia.
12. The system according to claim 1 further comprising:
individual pacemakers of the plurality of leadless cardiac pacemakers configured for operation in a particular location and a particular functionality at manufacture and/or at programming by an external programmer.
13. The system according to claim 1 further comprising:
the plurality of leadless cardiac pacemakers comprising a right ventricular leadless cardiac pacemaker and a left ventricular leadless cardiac pacemaker configured to operate with atrio-ventricular (AV) delays wherein a left ventricular pacing pulse can be delivered before, after, or substantially simultaneously with a right ventricular pacing pulse.
14. The system according to claim 13 further comprising:
the right-ventricular leadless cardiac pacemaker configured to:
set ventricular-to-ventricular (VV) escape interval longer than a predetermined atrial-to-atrial (AA) escape interval to enable backup ventricular pacing at a low rate corresponding to the VV escape interval in case of failure of a triggered signal from a co-implanted atrial leadless cardiac pacemaker.
15. The system according to claim 1 further comprising:
the at least two electrodes configured to communicate bidirectionally among the plurality of leadless cardiac pacemakers and transmit pulses generated by the pulse generator and encoded into data including designated codes for events detected or created by an individual pacemaker, the codes encoding information using a technique selected from a group consisting of encoding in pacing pulse width, encoding in binary-coded notches in a pacing pulse, encoding as modulation of off-time between pacing pulses, and encoding of multiple pulses comprising absence and presence of pulses and time between pulses including refractory and/or subliminal pulses.
16. The system according to claim 1 further comprising:
an atrial leadless cardiac pacemaker further configured to:
time a prolonged post-ventricular atrial refractory period (PVARP) after recycling in presence of the premature signal whereby pacemaker-mediated tachycardia is prevented.
17. The system according to claim 1 further comprising:
an implanted cardioverter-defibrillator (ICD) comprising a case and pair of electrodes mounted on or near the case, the ICD configured to receive and transmit conducted communication using a pulse modulated or frequency modulated signal wherein the ICD detects communication pulses from co-implanted leadless cardiac pacemakers and transmits information to the co-implanted leadless cardiac pacemakers.
18. The system according to claim 1 further comprising:
an implanted cardioverter-defibrillator (ICD) configured to receive conducted communication using at least two implantable electrodes.
19. The system according to claim 1 further comprising:
individual pacemakers of the plurality of leadless cardiac pacemakers comprising:
a receiving amplifier/filter adapted for multiple controllable gain settings; and
a processor configured to control gain setting for the receiving amplifier/filter, invoke a low-gain setting for normal operation and detect presence of at least one pulse, and, invoke a high-gain setting for detecting information encoded in the at least one pulse.
20. The system according to claim 1 further comprising:
individual pacemakers of the plurality of leadless cardiac pacemakers comprising:
a tank capacitor switched across a pair of the at least two electrodes and adapted for charging and discharging wherein a pacing pulse is generated;
a charge pump circuit coupled to the tank capacitor and adapted for controlling charging of the tank capacitor; and
a processor that controls recharging of the tank capacitor wherein recharging is discontinued when a battery terminal voltage falls below a predetermined value to ensure sufficient voltage for powering the leadless cardiac pacemaker.