Medical monitoring and treatment device with external pacing

1. A non-invasive bodily-attached ambulatory medical monitoring and treatment device comprising:

a battery;

at least one therapy electrode coupled to the battery;

a memory storing information indicative of a patient's cardiac activity;

a plurality of components implementing a plurality of pacing routines, each pacing routine of the plurality of pacing routines corresponding to a respective cardiac arrhythmia of a plurality of cardiac arrhythmias; and

at least one processor coupled to the memory and the at least one therapy electrode and configured to identify, within the information, a cardiac arrhythmia from the plurality of cardiac arrhythmias and respond to the identified cardiac arrhythmia at least in part by executing at least one component of the plurality of components that implements at least one pacing routine corresponding to the identified cardiac arrhythmia to treat the identified cardiac arrhythmia.

2. The device according to claim 1 , wherein the identified cardiac arrhythmia includes bradycardia and the at least one pacing routine is configured to:

determine that a first interval has passed without detection of a heart beat; and

apply, responsive to determining that the first interval has passed, a pacing pulse via the at least one therapy electrode.

3. The device according to claim 2 , wherein the first interval is defined by a base pacing rate and a hysteresis rate.

4. The device according to claim 3 , wherein the at least one pacing routine is further configured to:

detect an intrinsic heart beat prior to passage of a second interval;

determine a third interval based on the base pacing rate, the hysteresis rate, and a point where the intrinsic heart beat was detected; and

determine whether another intrinsic heart beat occurs within the third interval.

5. The device according to claim 1 , wherein the identified cardiac arrhythmia includes tachycardia and the at least one pacing routine is configured to:

detect a plurality of intrinsic heart beats prior to passage of a first interval, the plurality of intrinsic heart beats having an intrinsic frequency, the first interval being defined by an anti-tachyarrhythmic pacing rate; and

apply, responsive to detecting the intrinsic frequency, a series of pacing pulses via the at least one therapy electrode, the series of pacing pulses having a frequency above the intrinsic frequency.

6. The device according to claim 1 , wherein the identified cardiac arrhythmia includes an erratic heart rate and the at least one pacing routine is configured to:

identify a first series of heart beats within the information, the first series having a lower frequency;

identify a second series of heart beats within the information, the second series a upper frequency; and

apply, responsive to identifying the erratic heart rate, a series of pacing pulses via the at least one therapy electrode, the series of pacing pulses having a frequency above the lower frequency and below the upper frequency.

7. The device according to claim 1 , wherein the identified cardiac arrhythmia includes at least one of asystole and pulseless electrical activity and the at least one pacing routine is configured to:

determine that a first interval has passed without detection of a heart beat; and

apply, responsive to determining that the first interval has passed, a pacing pulse via the at least one therapy electrode.

8. The device according to claim 1 , wherein the at least one pacing routine is further configured to:

determine whether the at least one pacing routine resulted in capture; and

adjust, responsive to determining that capture did not result, the characteristics of pacing pulses applied during subsequent executions of the at least one pacing routine.

9. The device according to claim 8 , wherein the characteristics of the pacing pulses subject to adjustment include a pulse energy level, a pulse rate, and a pulse width.

10. The device according to claim 1 , wherein the at least one pacing routine is further configured to:

determine whether the at least one pacing routine resulted in capture; and

adjust, responsive to determining that capture did result, the characteristics of pacing pulses applied during subsequent executions of the at least one pacing routine.

11. A non-invasive bodily-attached ambulatory defibrillator comprising:

a battery;

at least one therapy electrode coupled to the battery;

a memory storing information indicative of a patient's cardiac activity;

a plurality of components implementing a plurality of pacing routines, each pacing routine of the plurality of pacing routines corresponding to a respective cardiac arrhythmia of a plurality of cardiac arrhythmias; and

at least one processor coupled to the memory and the at least one therapy electrode and configured to identify, within the information, a cardiac arrhythmia from the plurality of cardiac arrhythmias and respond to the identified cardiac arrhythmia at least in part by executing at least one component of the plurality of components that implements at least one pacing routine corresponding to the identified cardiac arrhythmia to treat the identified cardiac arrhythmia.

12. The defibrillator according to claim 11 , wherein the identified cardiac arrhythmia includes bradycardia and the at least one pacing routine is configured to:

determine that a first interval has passed without detection of a heart beat; and

apply, responsive to determining that the first interval has passed, a pacing pulse via the at least one therapy electrode.

13. The defibrillator according to claim 12 , wherein the first interval is defined by a base pacing rate and a hysteresis rate.

14. The defibrillator according to claim 13 , wherein the at least one pacing routine is further configured to:

detect an intrinsic heart beat prior to passage of a second interval;

determine a third interval based on the base pacing rate, the hysteresis rate, and a point where the intrinsic heart beat was detected; and

determine whether another intrinsic heart beat occurs within the third interval.

15. The defibrillator according to claim 11 , wherein the identified cardiac arrhythmia includes tachycardia and the at least one pacing routine is configured to:

detect a plurality of intrinsic heart beats prior to passage of a first interval, the plurality of intrinsic heart beats having an intrinsic frequency, the first interval being defined by an anti-tachyarrhythmic pacing rate; and

apply, responsive to detecting the intrinsic frequency, a series of pacing pulses via the at least one therapy electrode, the series of pacing pulses having a frequency above the intrinsic frequency.

16. The defibrillator according to claim 15 , wherein the at least one pacing routine is further configured to detect, after applying the series of pacing pulses, whether another plurality of intrinsic heart beats occur within a second interval, the second interval being defined by the anti-tachyarrhythmic pacing rate.

17. The defibrillator according to claim 11 , wherein the identified cardiac arrhythmia includes an erratic heart rate and the at least one pacing routine is configured to:

identify a first series of heart beats within the information, the first series having a lower frequency;

identify a second series of heart beats within the information, the second series a upper frequency; and

apply, responsive to identifying the erratic heart rate, a series of pacing pulses via the at least one therapy electrode, the series of pacing pulses having a frequency above the lower frequency and below the upper frequency.

18. The defibrillator according to claim 11 , wherein the identified cardiac arrhythmia includes at least one of asystole and pulseless electrical activity and the at least one pacing routine is configured to:

determine that a first interval has passed without detection of a heart beat; and

apply, responsive to determining that the first interval has passed, a pacing pulse via the at least one therapy electrode.

19. The defibrillator according to claim 18 , wherein the at least one pacing routine is further configured to apply a defibrillating shock prior to applying the pacing pulse.

20. The defibrillator according to claim 11 , wherein the at least one pacing routine is further configured to:

determine whether the at least one pacing routine resulted in capture; and

adjust, responsive to determining that capture did not result, the characteristics of pacing pulses applied during subsequent executions of the at least one pacing routine.

21. The defibrillator according to claim 20 , wherein the characteristics of the pacing pulses subject to adjustment include a pulse energy level, a pulse rate, and a pulse width.

22. The defibrillator according to claim 11 , wherein the at least one pacing routine is further configured to:

determine whether the at least one pacing routine resulted in capture; and

adjust, responsive to determining that capture did result, the characteristics of pacing pulses applied during subsequent executions of the at least one pacing routine.

23. A method of treating cardiac dysfunction using a non-invasive bodily-attached ambulatory medical monitoring and treatment device including a plurality of components implementing a plurality of pacing routines, each pacing routine of the plurality of pacing routines corresponding to a respective cardiac arrhythmia of a plurality of cardiac arrhythmias, the method comprising:

identifying, within information indicative of a patient's cardiac activity by the non-invasive bodily-attached ambulatory medical monitoring and treatment device, a cardiac arrhythmia from the plurality of cardiac arrhythmias; and

responding to the identified cardiac arrhythmia at least in part by executing, by the non-invasive bodily-attached ambulatory medical monitoring and treatment device, at least one component of the plurality of components that implements at least one pacing routine corresponding to the identified cardiac arrhythmia to treat the identified cardiac arrhythmia.

24. The method according to claim 23 , wherein the identified cardiac arrhythmia includes bradycardia and executing the at least one pacing routine includes:

determining that a first interval has passed without detection of a heart beat; and

applying, responsive to determining that the first interval has passed, a pacing pulse via the at least one therapy electrode.

25. The method according to claim 24 , wherein determining that the first interval has passed includes defining the first interval using a base pacing rate and a hysteresis rate.

26. The method according to claim 25 , wherein executing the at least one pacing routine includes:

detecting an intrinsic heart beat prior to passage of a second interval;

determining a third interval based on the base pacing rate, the hysteresis rate, and a point where the intrinsic heart beat was detected; and

determining whether another intrinsic heart beat occurs within the third interval.

27. The method according to claim 23 , wherein the identified cardiac arrhythmia includes tachycardia and executing the at least one pacing routine includes:

detecting a plurality of intrinsic heart beats prior to passage of a first interval, the plurality of intrinsic heart beats having an intrinsic frequency, the first interval being defined by an anti-tachyarrhythmic pacing rate; and

applying, responsive to detecting the intrinsic frequency, a series of pacing pulses via the at least one therapy electrode, the series of pacing pulses having a frequency above the intrinsic frequency.

28. The method according to claim 23 , wherein the identified cardiac arrhythmia includes an erratic heart rate and executing the at least one pacing routine includes:

identifying a first series of heart beats within the information, the first series having a lower frequency;

identifying a second series of heart beats within the information, the second series a upper frequency; and

applying, responsive to identifying the erratic heart rate, a series of pacing pulses via the at least one therapy electrode, the series of pacing pulses having a frequency above the lower frequency and below the upper frequency.

29. The method according to claim 23 , wherein the identified cardiac arrhythmia includes at least one of asystole and pulseless electrical activity and executing the at least one pacing routine includes:

determining that a first interval has passed without detection of a heart beat; and

applying, responsive to determining that the first interval has passed, a pacing pulse via the at least one therapy electrode.

30. The method according to claim 29 , wherein executing the at least one pacing routine includes applying a defibrillating shock prior to applying the pacing pulse.

31. The method according to claim 23 , wherein executing the at least one pacing routine includes:

determining whether the at least one pacing routine resulted in successful capture; and

adjusting, responsive to determining that capture did not result, the characteristics of pacing pulses applied during subsequent executions of the at least one pacing routine.

32. The method according to claim 31 , wherein adjusting the characteristics includes adjusting at least one of a pulse energy level, a pulse rate, and a pulse width.

33. The method according to claim 23 , wherein the non-invasive bodily-attached ambulatory medical monitoring and treatment device includes a non-invasive bodily-attached ambulatory defibrillator and identifying the cardiac arrhythmia includes identifying, by the non-invasive bodily-attached ambulatory defibrillator, the cardiac arrhythmia.