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. A device for treating cardiac arrhythmias by delivering electrical stimulation to a heart of a patient, the device comprising:
detection circuitry operably connected to sensing circuitry to evaluate one or more sensed biological signals representative of electrical activity of the heart and detect an arrhythmia; and
control circuitry that, in response to the arrhythmia, controls delivery of a therapy including:
a first set of electrical pulses delivered via a first electrode, the first set of electrical pulses configured to destabilize a reentry associated with the arrhythmia;
a second set of electrical pulses delivered via the first electrode and a second electrode, the second set of pulses configured to terminate the reentry; and
a pre-determined inter-stage delay separating the first and second sets of electrical pulses,
wherein the first set of electrical pulses generates an electric field having a voltage gradient within the heart of the patient of less than 4.5V/cm and more than 0.25 V/cm.
2. The device of claim 1 , wherein the device comprises an implantable therapy generator and wherein the first and second electrodes are implantable.
3. The device of claim 1 , wherein the first set of electrical pulses is configured to unpin the arrhythmia.
4. The device of claim 1 , wherein the first set of electrical pulses has an energy that is higher than conventional anti-tachycardia pacing pulses.
5. The device of claim 1 , wherein an energy level of electrical pulses in the second set is less than an energy level of electrical pulses in the first set.
6. The device of claim 2 , wherein the first electrode comprises a far-field electrode.
7. The device of claim 2 , wherein the second electrode comprises a near-field electrode.
8. The device of claim 1 , wherein the first set of electrical pulses are delivered as a function of a cycle length of the arrhythmia.
9. The device of claim 1 , wherein the first set of electrical pulses are delivered over a period of about 100-150 ms.
10. The device of claim 9 , wherein a duration of the first set of electrical pulses is about 10 ms and a number of the pulses of the first set is 3 to 4.
11. A device for treating cardiac arrhythmias by delivering electrical stimulation to a heart of a patient, the device comprising:
detection circuitry operably connected to sensing circuitry to evaluate one or more sensed biological signals representative of electrical activity of the heart and detect an arrhythmia; and
control circuitry that, in response to the arrhythmia, controls delivery of a therapy including:
a first set of electrical pulses delivered via a first electrode, the first set of electrical pulses configured to destabilize a reentry associated with the arrhythmia;
a second set of electrical pulses delivered via the first electrode and a second electrode, the second set of pulses configured to terminate the reentry; and
a pre-determined inter-stage delay separating the first and second sets of electrical pulses,
wherein the therapy is delivered without confirmation of conversion of the arrhythmia during the therapy.
12. The device of claim 11 , wherein the device comprises an implantable therapy generator and wherein the first and second electrodes are implantable.
13. The device of claim 11 , wherein the first set of electrical pulses is configured to unpin the arrhythmia.
14. The device of claim 11 , wherein the first set of electrical pulses has an energy that is higher than conventional anti-tachycardia pacing pulses.
15. The device of claim 11 , wherein an energy level of electrical pulses in the second set is less than an energy level of electrical pulses in the first set.
16. The device of claim 12 , wherein the first electrode comprises a far-field electrode.
17. The device of claim 12 , wherein the second electrode comprises a near-field electrode.
18. The device of claim 11 , wherein the first set of electrical pulses are delivered as a function of a cycle length of the arrhythmia.
19. The device of claim 1 , wherein the first set of electrical pulses are delivered over a period of about 100-150 ms.
20. The device of claim 19 , wherein a duration of the first set of electrical pulses is about 10 ms and a number of the pulses of the first set is 3 to 4.