Method for low-voltage termination of cardiac arrhythmias by effectively unpinning anatomical reentries
A method for extinguishing a cardiac arrhythmia utilizes destructive interference of the passing of the reentry wave tip of an anatomical reentry through a depolarized region created by a relatively low voltage electric field in such a way as to effectively unpin the anatomical reentry. Preferably, the relatively low voltage electric field is defined by at least one unpinning shock(s) that are lower than an expected lower limit of vulnerability as established, for example, by a defibrillation threshold test. By understanding the physics of the electric field distribution between cardiac cells, the method permits the delivery of an electric field sufficient to unpin the core of the anatomical reentry, whether the precise or estimated location of the reentry is known or unknown and without the risk of inducting ventricular fibrillation. A number of embodiments for performing the method are disclosed.
1. An implantable system for treating ventricular tachyarrhythmias, the implantable system comprising:
a plurality of implantable electrodes; and
an implantable therapy generator operably connected to the plurality of implantable electrodes, the implantable therapy generator programmed to:
detect a ventricular tachyarrhythmia in a heart of a patient;
establish a termination window associated with the ventricular tachyarrhythmia;
deliver an unpinning shock via the plurality of electrodes to the patient within the termination window that generates a relatively low voltage field to create a depolarized region in the heart to extinguish the ventricular tachycardia by destructively interfering with a reentry wave associated with the ventricular tachyarrhythmia so as to effectively unpin the reentry wave,
wherein the unpinning shock is delivered at an energy that is higher than conventional anti-tachycardia pacing pulses and lower than an expected lower limit of vulnerability of the patient for the ventricular tachyarrhythmia such that the relatively low voltage field created by the unpinning shock is sufficient to unpin the reentry wave from a location in the heart without increasing a risk of ventricular fibrillation.
2. The system of claim 1 wherein the implantable therapy generator is programmed to deliver multiple pulses for each unpinning shock, wherein at least two of the pulses are delivered through different electrode paths in order to present alternative wave fronts to the reentry wave so as to produce an equivalent of a vector rotating field to the reentry wave.
3. The system of claim 1 wherein the implantable therapy generator is programmed to deliver at least one anti-repinning pulse subsequent to delivering the at least one unpinning shock and within the termination window to extinguish the reentry wave that is unpinned from the location in the heart, the at least one anti-repinning pulse having an energy that is less than the at least one unpinning shock.
4. The system of claim 1 wherein the implantable therapy generator is programmed to define the termination window as a time period based on a frequency of the ventricular tachyarrhythmia.
5. A method for treating ventricular tachyarrhythmias in a patient, comprising:
providing an implantable therapy generator including programmably-operably circuitry to be implanted in a patient and operably connected to a plurality of implantable electrodes; and
configuring the programmably-operably circuitry of the implantable therapy generator to detect and terminate a ventricular tachyarrhythmia, including by:
establishing a termination window associated with the ventricular tachyarrhythmia; and
deliver an unpinning shock via the plurality of electrodes to the patient within the termination window that generates a relatively low voltage field to create a depolarized region in the heart to extinguish the ventricular tachyarrhythmia by destructively interfering with a reentry wave associated with the ventricular tachyarrhythmias so as to effectively unpin the reentry wave,
wherein the unpinning shock is delivered at an energy that is higher than conventional anti-tachycardia pacing pulses and lower than an expected lower limit of vulnerability of the patient for the ventricular tachyarrhythmia such that the relatively low voltage field created by the unpinning shock is sufficient to unpin the reentry wave from a location in the heart without increasing a risk of ventricular fibrillation.
6. The method of claim 5 wherein configuring the programmably-operably circuitry of the implantable therapy generator to deliver the unpinning shock includes delivering multiple pulses for each unpinning shock, wherein at least two of the pulses are delivered through different electrode paths in order to present alternative wave fronts to the reentry wave so as to produce an equivalent of a vector rotating field to the reentry wave.
7. The method of claim 5 wherein configuring the programmably-operably circuitry of the implantable therapy generator causes deliver of at least one anti-repinning pulse subsequent to delivering the at least one unpinning shock and within the termination window to extinguish the reentry wave that is unpinned from the location, the at least one anti-repinning pulse having an energy that is less than the at least one unpinning shock.
8. The method of claim 5 wherein configuring the programmably-operably circuitry of the implantable therapy generator defines the termination window as a time period based on a frequency of the ventricular tachyarrhythmia.
9. A method for controlling an implantable therapy generator adapted to be implanted in a patient and operably connected to a plurality of implantable electrodes, the method comprising configuring the implantable therapy generator to:
detect a ventricular tachyarrhythmiain a heart of a patient;
establish a termination window associated with the ventricular tachyarrhythmia;
within the termination window, deliver an unpinning shock via the plurality of electrodes that generates a relatively low voltage field to depolarize a region in the heart for extinguishing the ventricular tachyarrhythmia by destructively interfering with a reentry wave associated with the ventricular tachyarrhythmia so as to effectively unpin the reentry wave,
wherein the unpinning shock is delivered at an energy that is higher than conventional anti-tachycardia pacing pulses and lower than an expected lower limit of vulnerability of the patient for the ventricular tachyarrhythmia such that the relatively low voltage field created by the unpinning shock is sufficient to unpin the reentry wave from a location in the heart without increasing a risk of ventricular fibrillation.
10. The method of claim 9 wherein configuring the implantable therapy generator to deliver the unpinning shock includes delivery of multiple pulses for each unpinning shock, wherein at least two of the pulses are delivered through different electrode paths in order to present alternative wave fronts to the reentry wave so as to produce an equivalent of a vector rotating field to the reentry wave.
11. The method of claim 9 wherein configuring the implantable therapy generator further includes delivery of at least one anti-repinning pulse subsequent to delivering the at least one unpinning shock and within the termination window to extinguish the reentry wave that is unpinned from the location, the at least one anti-repinning pulse having an energy that is less than the at least one unpinning shock.
12. The method of claim 9 wherein configuring the implantable therapy generator defines the termination window as a time period based on a frequency of the ventricular tachyarrhythmia.