Subcutaneous implantation medical device with multiple parasternal-anterior electrodes

1. A subcutaneous implantable medical device (SIMD), comprising:

a pulse generator (PG) configured to be positioned subcutaneously within a lateral region of a chest of a patient, the PG having a housing that includes a PG electrode, the PG having an electronics module; and

an elongated lead that is electrically coupled to the pulse generator, the elongated lead including a first electrode that is configured to be positioned subcutaneously along a first parasternal region proximate a sternum of the patient and a second electrode that is configured to be positioned subcutaneously at an anterior region of the patient, wherein the first and second electrodes are coupled to be electrically common with one another, wherein the PG is further configured to be positioned relative to a vertical direction substantially aligned with an apex of a heart to define at least one shocking vector between the PG and the first and second electrodes that passes through a ventricle of the heart, wherein the electronics module is configured to provide electrical shocks for antiarrhythmic therapy along the at least one shocking vector, wherein the lead, the first electrode and the second electrode are not attached to bone.

2. The SIMD of claim 1 , wherein the anterior region represents a second parasternal region, the second electrode configured to be oriented to extend in a common direction with the first electrode, the first and second electrodes located on left and right sides of the sternum, the first and second electrodes configured to be spaced apart by a distance of between 1.5 cm and 8 cm as measured in a direction transverse to a midline of the sternum.

3. The SIMD of claim 2 , wherein the first and second electrodes are configured to be positioned along opposite sides of the sternum and separated from one another by a predetermined distance greater than a width of the sternum.

4. The SIMD of claim 2 , wherein at least one of the first and second electrodes has an active length of 7-11 cm and the predetermined distance separating the first and second electrodes is 6.0 to 8.5 cm.

5. The SIMD of claim 1 , wherein the anterior region is locate proximate to a lower end of the sternum, the second electrode configured to be oriented to extend in a non-parallel direction relative to a direction of the first electrode, the second electrode located at relative to a midline of the sternum that is vertically below the first electrode, the first electrode having a length that is greater than a length of the second electrodes.

6. The SIMD of claim 5 , wherein the length of the first electrode is 7.0 cm to 11.0 cm, and the length of the second electrode is 5.0 cm to 6.5 cm.

7. The SIMD of claim 1 , wherein the lead includes a lead body having a base segment with a proximal end to be electrically coupled to a header of the PG, the lead including first and second distal branches at a distal end of the lead, the first and second electrodes provided on the first and second distal branches, respectively.

8. The SIMD of claim 7 , wherein the lead body further comprises a Y-connector connecting the first and second distal branches to a distal end of the base segment.

9. The SIMD of claim 1 , wherein the pulse generator and the first and second electrodes define the at least one shocking vector that provides to a defibrillation threshold of at most 20 Joules.

10. The SIMD of claim 1 , wherein the pulse generator and the first and second electrodes define the at least one shocking vector there between through a left ventricle that exhibits an impedance along the shocking vector that is no more than 64 ohms.

11. The SIMD of claim 1 , wherein the pulse generator and the first and second electrodes define the at least one shocking vector there between that exhibits an impedance along the shocking vector that is no more than 56.2 ohms.

12. The SIMD of claim 1 , wherein either:

i) the first and second electrodes are configured to be positioned along opposite sides of the sternum or

ii) the second electrodes is configured to extend transversely to the sternum and to be located proximate to a lower end of the sternum in a non-parallel orientation with the first electrode.

13. The SIMD of claim 1 , wherein the first and second electrodes are configured to be positioned beneath skin, but above layers of skeletal muscle tissue, rib bones, and costal cartilage.

14. A method comprising:

implanting a pulse generator (PG) within a lateral region of a chest of a patient, the PG having a housing that includes a PG electrode; and

implanting at least one lead having first and second electrodes that are coupled to be electrically common with one another, wherein the first and second electrodes are elongated, the implanting comprising positioned the first electrode subcutaneously along a first parasternal region proximate to a sternum of the patient and positioning the second electrode subcutaneously at an anterior region of the patient and positioning the PG relative to a vertical direction substantially aligned with an apex of a heart to define at least one shocking vector between the PG and the first and second electrodes that passes through a ventricle of the heart;

attaching the lead, the first electrode and the second electrode to muscle tissue; and

configuring the electronics module to provide electrical shocks for antiarrhythmic therapy along the at least one shocking vector.

15. The method of claim 14 , further comprising positioning the first and second electrodes at a dual parasternal position on left and right sides of the sternum, extending in a common direction and spaced apart by a distance of 1.5 cm to 8.5 cm.

16. The method of claim 15 , further comprising positioning the first and second electrodes along opposite sides of the sternum.

17. The method of claim 15 , wherein at least one of the first and second electrodes has an active length of 8-11 cm and the predetermined distance separating the first and second electrodes is 6.0 to 8.5 cm.

18. The method of claim 15 , wherein the pulse generator is configured to generate a defibrillating energy of at most 40 Joules.

19. The method of claim 14 , further comprising positioning the second electrode proximate to a lower end of the sternum and orienting the second electrode to extend in a non-parallel direction relative to a direction of the first electrode, locating the second electrode at a position, relative to a midline of the sternum, that is vertically below the first electrode.

20. The method of claim 19 , wherein the non-parallel direction orients a longitudinal axis of the second electrode perpendicular to a longitudinal axis of the first electrode.

21. The method of claim 14 , wherein the implanting further comprises either:

i) positioning the first and second electrodes along opposite sides of the sternum; or

ii) positioning the second electrodes to extend transversely to the sternum and to be located proximate to a lower end of the sternum in a non-parallel orientation with the first electrode.

22. The method of claim 14 , wherein the implanting further comprises positioning the first and second electrodes beneath skin, but above layers of skeletal muscle tissue, rib bones, and costal cartilage.