CN106573149A

CN106573149A - Systems and methods for treating cardiac arrhythmias

Info

Publication number: CN106573149A
Application number: CN201580044686.7A
Authority: CN
Inventors: 杰弗里·E·施塔曼; 霍华德·D·西姆斯; 基思·R·迈莱; 迈克尔·J·凯恩; 威廉姆·J·林德
Original assignee: Cardiac Pacemakers Inc
Current assignee: Cardiac Pacemakers Inc
Priority date: 2014-06-25
Filing date: 2015-06-24
Publication date: 2017-04-19
Also published as: WO2015200527A1; AU2015279939A1; JP2017525415A; EP3160581A1; AU2015279939B2; JP6345813B2

Abstract

Systems and methods for coordinating treatment of abnormal heart activity using multiple implanted devices. In one example, a method of operating a medical system may comprise determining, by a first one of a plurality of implantable medical devices, a presence of an arrhythmia, wherein the first one of a plurality of implantable medical devices uses a first discrimination method to determine the presence of an arrhythmia, determining, by a second one of the plurality of implantable medical devices, a presence of an arrhythmia, wherein the second one of a plurality of implantable medical devices uses a second discrimination method to determine the presence of an arrhythmia, and communicating, by the first one of the plurality of implantable medical devices to a second one of the plurality of implantable medical devices, a message that is indicative of a detected arrhythmia by the first one of a plurality of implantable medical devices.

Description

For treating ARR system and method

Cross-Reference to Related Applications

This application claims the rights and interests of the U.S. Provisional Application No.62/016,918 submitted on June 25th, 2014.The application Or in " the SYSTEMS AND METHODS FOR TREATING CARDIAC submit, entitled of on January 8th, 2015 The part continuation application of the U.S. Patent Application Serial Number 14/592,723 of ARRHYTHMIAS ", it was required in January 10 in 2014 The U.S. Provisional Application No.61/926 that day submits, 068 rights and interests are by way of reference integrally incorporated them herein.

Technical field

The disclosure is related generally to for detecting ARR system, apparatus and method, and is more particularly related to Detect and recognize ARR multiple equipment system, method and apparatus.

Background technology

Pace-making instrument can be used for treating the such a patient i.e. patient being subjected to may cause heart transmission q.s The various cardiac conditions that blood is reduced to the ability of patient body.These cardiac conditions may cause it is quick, irregular and/ Or inadequate heart contraction.In order to help mitigate some in these conditions, various equipment (such as pacemakers, defibrillator etc. Deng) can be implanted in patient body.The equipment can monitor and provide electricity irritation to heart, to help heart correcting Often, effective and/or safe mode is operating.In some cases, patient may have multiple implantation equipment.

The content of the invention

The disclosure relates generally to for the multiple implantation equipment among using patient to coordinate the detection of abnormal heart activity And/or the system and method for the treatment of.Envision multiple implantation equipment can for example include pacemaker, defibrillator, diagnostic device and/or According to desired arbitrarily other suitable implanted equipment.

In the first embodiment, a kind of method for operating medical system can include：By multiple implantable medicals The first implantable medical device in equipment determines ARR generation, wherein, in the plurality of implantable medical device First implantable medical device determines ARR generation using the first differentiating method.In some embodiments, the party Method may further include：Determine ARR by the second implantable medical device in multiple implantable medical devices It is raw, wherein, the second implantable medical device in the plurality of implantable medical device determines the heart using the second differentiating method The uneven generation of rule.Finally, in some embodiments, the method may further include：By the plurality of implantable medical The first implantable medical device in equipment to the second implantable medical device in the plurality of implantable medical device sends Indicate the ARR message detected by the first implantable medical device in the plurality of implantable medical device.

Additionally or in the alternative, in any one in embodiment of above, in the plurality of implantable medical device The first implantable medical device can be leadless cardiac pacemaker (LCP), also, in the plurality of implantable medical device The second implantable medical device be Endermic implantating cardioverter-defibrillators (SICD).

Additionally or in the alternative, in any one in embodiment of above, first differentiating method can be than institute State the second differentiating method and quickly determine ARR generation.

Additionally or in the alternative, in any one in embodiment of above, first differentiating method can only make ARR generation is determined with heart rate, and second differentiating method not only can determine the rhythm of the heart not using heart rate Neat generation.

Additionally or in the alternative, in any one in embodiment of above, second differentiating method can not make ARR generation is determined with heart rate.

Additionally or in the alternative, in any one in embodiment of above, second differentiating method can be used One or more among below：Electronic chart morphology, rate stability/unstability, arrhythmia duration of seizure, the rhythm of the heart are not Comparison and the cardiac conduction time of neat persistent period, blood pressure, heart output, AR and Ventricular Rate.

Additionally or in the alternative, in any one in embodiment of above, second differentiating method can be used Two or more versions for the electronic chart generated by spectral filtering.

Additionally or in the alternative, in any one in embodiment of above, second differentiating method can be used From the signal of one or more electrodes compared with first differentiating method in different cardiac positions.

Additionally or in the alternative, in any one in embodiment of above, in the plurality of implantable medical device The second implantable medical device can from the plurality of implantable medical device the first implantable medical device receive To after the ARR message for indicating to detect, start to determine ARR generation.

In another embodiment, a kind of implantable medical device can include：Housing；It is connected to many of the housing Individual electrode；And the controller being arranged in the housing.In some embodiments, controller can be configured to：Via The plurality of electrode receives electrocardiosignal；Using the first differentiating method and the electrocardiosignal is based at least partially on, it is determined that ARR generation；And after using first differentiating method to determine ARR generation, send and indicate inspection The ARR message for measuring is to the independent implantable medical device separated with the implantable medical device.In addition, In some embodiments in these embodiments, independent armarium can be configured with and the first differentiation side The second different differentiating method of method is determining ARR generation.

Additionally or in the alternative, in any one in embodiment of above, first differentiating method can be used Heart rate is determining ARR generation.

Additionally or in the alternative, in any one in embodiment of above, second differentiating method can be not only ARR generation is only determined using heart rate.

Additionally or in the alternative, in any one in embodiment of above, the independent implantable medical device Can be configured to receive instruction in the first implantable medical device from the plurality of implantable medical device and detect ARR message after, start to determine ARR generation.

Additionally or in the alternative, in any one in embodiment of above, the implantable medical device can be Leadless cardiac pacemaker (LCP) also, independent implantable medical device is Endermic implantating cardioverter-defibrillators (SICD)。

In another embodiment, a kind of implantable medical device system can include：First implantable medical device, It is configured with the first differentiating method to determine arrhythmia；And second implantable medical device, it is configured to make ARR generation is determined with the second differentiating method.In some embodiments, it is determined that after ARR generation, Second implantable medical device can send the ARR message for indicating to detect to the first implantable medical device.Separately Outward, the first differentiating method can be differently configured from the second differentiating method.

Additionally or in the alternative, in any one in embodiment of above, the first implantable medical device can be by It is configured to after the ARR message for indicating to detect is received from the second implantable medical device, starts to determine the rhythm of the heart Uneven generation.

Additionally or in the alternative, in any one in embodiment of above, the first implantable medical device can be by It is configured to after the ARR message for indicating to detect is received from the second implantable medical device, starts to charge up electric shock The capacitor of passage.

Additionally or in the alternative, in any one in embodiment of above, the electric capacity of shock channel is being started to charge up After device, the first implantable medical device can be configured with the second differentiating method to determine ARR generation, and And after ARR generation is determined using the second differentiating method, via shock channel defibrillation pulse is transmitted.

Additionally or in the alternative, in any one in embodiment of above, connecing from the second implantable medical device After receiving the ARR message for indicating to detect, the first implantable medical device can be configured with the second differentiation Method determining ARR generation, and it is determined that after ARR generation, starting to charge up the electric capacity of shock channel Device.

Additionally or in the alternative, in any one in embodiment of above, second differentiating method can be than institute State the first differentiating method and quickly determine ARR generation.

Additionally or in the alternative, in any one in embodiment of above, second differentiating method can only make ARR generation is determined with heart rate, and first differentiating method not only can determine the rhythm of the heart not using heart rate Neat generation.

Additionally or in the alternative, in any one in embodiment of above, first differentiating method can not make ARR generation is determined with heart rate.

Additionally or in the alternative, in any one in embodiment of above, the first differentiating method can use following Among one or more：It is electronic chart morphology, rate stability/unstability, arrhythmia duration of seizure, ARR Comparison and the cardiac conduction time of persistent period, blood pressure, heart output, AR and Ventricular Rate.

Additionally or in the alternative, in any one in embodiment of above, the first implantable medical device can be Endermic implantating cardioverter-defibrillators (SICD) and the second implantable medical device is leadless cardiac pacemaker (LCP).

In another embodiment, a kind of medical apparatus system can include leadless cardiac pacemaker (LCP), should LCP includes：Housing, the multiple electrodes for being connected to housing and setting controller in the housing.In some embodiments, control Device processed can be configured to receive the electrocardiosignal from multiple electrodes, and using the first differentiating method and at least in part Based on the electrocardiosignal for receiving, ARR generation is determined.The system can comprise additionally in Endermic implantating Cardioversion Defibrillator (SICD), SICD include housing, be connected to housing multiple electrodes and controller in the housing is set.Controller Can be configured to：Receive the electrocardiosignal from multiple electrodes；Using the second differentiating method and it is based at least partially on reception The electrocardiosignal for arriving, determines ARR generation；And it is determined that after ARR generation, sending and indicating what is detected ARR message is to LCP.In at least some embodiment, the first differentiating method can be different from the second differentiating method.

Additionally or in the alternative, in any one in embodiment of above, LCP can be configured to receiving finger After showing the ARR message for detecting, begin to use the first differentiating method to determine ARR generation, also, After ARR generation is determined using the first differentiating method, start anti-tachyarrhythmia pacemaker (ATP) treatment.

Above summary is not intended to describe every implementation of the disclosure or each realization.By reference to combining accompanying drawing The following described and claimed for being given, the advantage and achievement of the disclosure and more complete understanding will become clear from and can Understand.

Description of the drawings

The disclosure can be more fully understood from by being considered in conjunction with the accompanying the following description of various illustrated embodiments, its In：

Fig. 1 shows the block diagram of the exemplary medical device that can be used according to the various examples of the disclosure；

Fig. 2 shows the exemplary leadless cardiac pacemaker (LCP) for having electrode according to an example of the disclosure；

Fig. 3 is to include multiple leadless cardiac pacemakers (LCP) and/or other equipment according to another example of the disclosure Exemplary medical device system schematic diagram；

Fig. 4 is the schematic diagram for including LCP and the system of another armarium according to another example of the disclosure；

Fig. 5 is the schematic diagram for including LCP and the system of another armarium according to another example of the disclosure；

Fig. 6 shows showing for multiple leadless cardiac pacemakers (LCP) system of another example according to the disclosure It is intended to；

Fig. 7 shows showing for multiple leadless cardiac pacemakers (LCP) system of another example according to the disclosure It is intended to；

Fig. 8 shows showing for multiple leadless cardiac pacemakers (LCP) system of another example according to the disclosure It is intended to, wherein, two LCP are implanted in the single chamber of heart；

Fig. 9 shows showing for multiple leadless cardiac pacemakers (LCP) system of another example according to the disclosure It is intended to, wherein, a LCP is implanted on the epicardial surface of heart；

Figure 10 is the block diagram for including main equipment and multiple example medical systems from equipment；

Figure 11 shows the illustrative timing of the trigger for causing the second equipment transmission pacemaker impulse from the first equipment Figure；

Figure 12 shows that the trigger from the first equipment causes the second equipment to transmit a series of explanation of pacemaker impulses Property timing diagram；

Figure 13 shows that the trigger from the first equipment causes the second equipment according to treatment agreement transmission row pace-making arteries and veins The illustrative timing diagram of punching；

Figure 14 shows that the trigger from the first equipment causes the second equipment relevant in the sensing QRS wave with heart The illustrative timing diagram of concrete Time Transmission row pacemaker impulse；

Figure 15 can be that the illustrative medical apparatus system by medical apparatus system as described in regard to Fig. 3-Figure 10 is realized The flow chart of illustrative method；And

Figure 16 can be that the illustrative medical apparatus system by medical apparatus system as described in regard to Fig. 3-Figure 10 is realized The flow chart of illustrative method.

Although the disclosure can make various modifications and alternative forms into, its details is shown by the example in accompanying drawing And will be described in.It should be appreciated, however, that it is not intended to for the scheme of the disclosure to be limited to the specific embodiment. Conversely, it is intended that covers the whole modifications, equivalent and the replacement that fall into spirit and scope of the present disclosure.

Specific embodiment

Should refer to accompanying drawing to read description below, wherein in different figures identical element is by label in the same manner. The illustrative embodiment of description and the Description of Drawings that is not necessarily to scale and it is not intended to limit the scope of the present disclosure.

The heart of normal health causes contraction by the signal of telecommunication inherently generated throughout cardiac conduction.In letter in these Number cause the tissue or muscle cell contraction of heart.The contraction forces blood to be walked out and enters heart, there is provided blood is throughout body Remainder circulation.However, many patients are subjected to the inotropic cardiac condition for affecting their hearts.Some hearts can The pathological tissues for not regenerating or conducting the inherent signal of telecommunication can for example be developed.In some instances, diseased heart tissue with Different rates transmit the signal of telecommunication, thus result in the asynchronous and inadequate contraction of heart.In other instances, heart may So that heart rate becomes low to obtain dangerous low rate to generate inherent signal.In other instances, heart may be with abnormal high Speed generates the signal of telecommunication.In some cases, the exception may the room of developing into quiver state, wherein, the contraction of the ventricle of patient is several Entirely different step and the considerably less blood of heart pumping or even non-pump blood.

Have been developed for many medical apparatus systems to aid in experiencing this abnormal patient.For example, have been developed for using Determine whether patient is subjected to one or more arrhythmias in the inherent electrocardiosignal of sensing and based on the signal of telecommunication for sensing System.The system can also be included for transmitting electricity irritation to patient's heart to treat the ARR energy for detecting Power.In an example, some medical apparatus systems are included for recognizing when (referred to as aroused in interest with too low frequency jitter heart is It is too slow) ability.The system can be transmitted for causing heart with the electrical stimulating therapy of higher safer frequency contraction or " rising Fight pulse ".Some medical apparatus systems can determine heart when with too fast frequency jitter (referred to as tachycardia).The system May further include one or more anti-tachyarrhythmia pacemaker (ATP) therapies.One ATP therapy is included with than inherent generation The faster Frequency Transfer electric stimulation pulse of signal is to heart.Although this may temporarily cause heart faster to be beated, the stimulation Agreement may cause heart to shrink in response to the pacemaker impulse rather than the inherent signal for generating that are transmitted.The ATP therapies are right The frequency of transmitted pacemaker impulse may be reduced afterwards, so as to heart rate is reduced to into lower safer grade.

Other medical apparatus systems may detection fibers vibration state and asynchronous contraction.For example, based on sensing Signal, some systems may can determine heart when in fibrillation state.The system can be further configured to The fibrillation state is treated using electrical stimulating therapy.A kind of therapy includes transmission relatively large amount electric energy to heart (" defibrillation Pulse ") for overwhelming the arbitrarily inherent signal for generating.The therapy can be from electrical standpoint RESET heart, and this can be allowed Normal electrically process adapter.Other medical systems may can sense when that the signal of inherent generation was generated in the different time Or heart is with the different Frequency Transfers signal.These exceptions may cause nonsynchronous invalid heart contraction.The system May further include the ability for managing one or more cardiac resynchronisation therapies (CRT).One kind CRT can be included in heart Upper and/or interior diverse location transmits electricity irritation to heart.If system transmits electricity irritation to diverse location in different time, The method can help the different piece of heart almost to shrink simultaneously or in a synchronous manner.

The disclosure relates generally to for the multiple implantation equipment among using patient to coordinate the detection of abnormal heart activity And/or the system and method for the treatment of.In some instances, medical apparatus system can be included for detecting arrhythmia and transmission The multiple equipment of electrical stimulating therapy.Example system can for example include equipment such as Endermic implantating cardioverter-defibrillators (SICD), outside cardioverter-defibrillators, Implanted cardiac pacemaker (ICP), leadless cardiac pacemaker (LCP) and/or only Diagnosis equipment (can sense electrocardiosignal and/or determine arrhythmia but the equipment for not transmitting electrical stimulating therapy).

Fig. 1 shows (the hereinafter referred to MD of exemplary medical device 100 that can be used according to the various examples of the disclosure 100) block diagram.In some cases, MD 100 can be used to sense inherent cardiomotility, determine it is ARR generation and In response to determining ARR generation transmission electricity irritation.In some instances, MD 100 can be implanted in patient body middle position In particular location (such as near patient's heart) sensing and/or adjust the cardiomotility of heart.In other instances, MD 100 Can be positioned at patient-external to sense and/or adjust the cardiomotility of heart.In an example, heart contraction is generally originated from By in heart generate the signal of telecommunication.These signals of telecommunication conduct through heart tissue, cause the muscle cell contraction of heart.MD 100 can include that such a feature is that this feature allows MD 100 to sense other physical parameters of the signal of telecommunication and/or heart (such as Mechanical Contraction, heart sound, blood pressure, blood oxygen grade etc.).These signals of telecommunication and/or physical characteristics can be considered " heart Activity ".MD 100 can include determining the ability of ARR generation based on the cardiomotility for sensing.In some examples In, MD 100 may can transmit electricity irritation to heart to treat the arrhythmia for arbitrarily detecting.MD 100 can be such as Be configured to transmit electricity irritation, pacemaker impulse, defibrillation pulse etc. so as to realize one or more therapies such as bradycardia therapy, ATP therapies, CRT, defibrillation or other electrical stimulating therapies.

Fig. 1 is the explanation of an exemplary medical device 100.Illustrative MD 100 can include being entirely encapsulated in housing Sensing module 102, impulse generator module 104, processing module 106, telemetry module 108 and battery 110 in 120.MD 100 Can also include lead 112 and electrode 114, electrode 114 be attached to housing 120 and with the module being encapsulated in housing 120 102nd, one or more telecommunications in 104,106 and 108.

Lead 112 may be coupled to and extend the housing 120 of MD 100.In some instances, lead 112 is implanted in It is on the heart of patient or interior.Lead 112 can be included at the various positions being located on lead 112 and away from the one of housing 120 Individual or multiple electrodes 114.Some leads 112 can only include single electrode 114, and other leads 112 can include multiple electricity Pole 114.Generally, electrode 114 is located on lead 112 and causes when lead 112 is implanted in patients, one or more electrodes 114 Contact with the heart tissue of patient.Therefore, electrode 114 can conduct the signal of telecommunication of inherent generation to lead 112.Lead 112 because And the signal of telecommunication that receives can be conducted to one or more modules 102,104,106 and 108 of MD 100.With the side being similar to Formula, MD100 can generate electricity irritation, and lead 112 can conduct the electricity irritation of generation to electrode 114.Electrode 114 then can To conduct the signal of telecommunication to the heart tissue of patient.When the inherent signal of sensing and transmission electricity irritation is discussed, the disclosure can imply Ground considers the conduction during those.

Sensing module 102 is configurable to sense the electrocardio-activity of heart.Sensing module 102 can for example be connected to lead 112 and electrode 114 is connected to by lead 112, and sensing module 102 is configurable to receive by lead 112 and electricity The electrocardiosignal of the conduction of pole 114.In some instances, lead 112 can include various sensors such as accelerometer, blood pressure sensing Device, heart sound transducer, blood oxygen transducer and the other sensors for measuring the physiological parameter of heart and/or patient.At other In example, the sensor can be directly connected to sensing module 102 rather than lead 112.In any case, sensing module 102 are configurable to receive these letters produced by any sensor that sensing module 102 is connected to directly or by lead 112 Number.Sensing module 102 can be alternatively attached to processing module 106 and be configurable to send the signal that receives to process Module 106.

Impulse generator module 104 may be coupled to electrode 114.In some instances, electrode 114 is configurable to generate Electrical stimulation signal is providing electrical stimulating therapy to heart.Impulse generator module 104 can for example by using being stored in MD The energy in battery 110 in 100 generates the signal.Impulse generator module 104 be configurable to generate electrical stimulation signal with One or more in multiple different therapies are just provided.Impulse generator module 104 can for example be configured to generate electricity irritation letter Number providing bradycardia therapy, ATP therapies, cardiac resynchronisation therapy, vibration therapy and other electrical stimulating therapies.Bradycardia Therapy can include generating and transmit pacemaker impulse to attempt increasing heart rate with frequency more faster than the inherent signal of telecommunication for generating. Tachycardia therapy can include ATP therapies as described herein.Cardiac resynchronisation therapy can include same as described herein CRT therapies.Vibration therapy can include transmission bounce pulse to attempt subduing heart and stopping vibration state.In other realities In example, impulse generator module 104 is configurable to generate electrical stimulation signal to provide and those described herein electricity irritation treatment The different electrical stimulating therapy of method is treating the arrhythmia that one or more are detected.

Processing module 106 is configurable to control the operation of MD 100.Processing module 106 can for example be configured to receive to be come The signal of telecommunication of self-inductance measurement module 102.Processing module 106 may be based on the signal for receiving, and determine ARR generation. Based on the arrhythmia for arbitrarily determining, processing module 106 is configurable to control impulse generator module 104 according to one or many Individual therapy generates electricity irritation with one or more arrhythmias determined by treating.Processing module 106 can be received further to be come From the information of telemetry module 108.In some instances, processing module 106 can determine the rhythm of the heart not using the information for receiving Whether occur or take concrete action in response to the information together.Processing module 106 can in addition control telemetry module 108 and send Information is to other equipment.

In some instances, processing module 106 can include preprogrammed chips such as super large-scale integration (VLSI) core Piece or special IC (ASIC).In this embodiment, chip can be pre-programmed with control logic to control MD 100 operation.By using preprogrammed chips, processing module 106 can use the power lower than other programmable circuits, together When be able to maintain that basic function, so as to increase the battery life of MD 100.In other instances, processing module 106 can include Programmable microprocessor.The programmable microprocessor can allow user to adjust the control logic of MD 100, so as to when using pre- The greater flexibility of MD 100 is allowed during programming chip.In some instances, processing module 106 may further include storage Device circuit, and processing module 106 can read information with storage information on memory circuitry and from memory circuitry.At it In his example, MD 100 can include the independent memory circuitry (not shown) communicated with processing module 106, thus process mould Block 106 can read information and to the independent memory circuitry write information from the independent memory circuitry.

Telemetry module 108 is configurable to and is positioned at equipment such as sensor, other armarium outside MD 100 etc. Deng communication.The equipment can be positioned inside or outside patient body.Regardless of position, external equipment is (i.e. outside MD 100 Portion still needs not to be exterior) can communicate with realizing one or more hope with MD 100 via telemetry module 108 Function.MD 100 for example can send the signal of telecommunication for sensing to external medical equipment through telemetry module 108.External medical Equipment can use the sent signal of telecommunication to determine ARR generation.MD 100 can in addition through telemetry module 108 from External medical equipment receives sensing electric signals, and MD 100 can determine arrhythmia using the sensing electric signals for receiving Generation.In other instances, the various equipment of system can send and instruct to coordinate the transmission of electrical stimulating therapy.Telemetry module 108 are configurable to use one or more methods and external device communication.Telemetry module 108 can for example via radio frequency (RF) Signal, inductively, optical signal, acoustic signal, conducted communication signals or suitable for any other signals for communicating communicating.Under Text will discuss the communication technology between MD 100 and external equipment in more detail with reference to Fig. 3.

Battery 110 can provide power to MD 100 for its operation.In an example, battery 110 can be not Rechargeable lithium battery.In other instances, non-rechargeable battery can be manufactured by other materials known in the art.Cause It is that in MD 100 is the example of implanted equipment, the access to MD 100 may be restricted, it is therefore necessary to enough Battery capacity come in treatment cycle as transmitted enough therapies on a few days, several weeks, several months or several years.In other instances, battery 110 can be probable life of the lithium rechargeable battery to help increase MD 100.

Generally, MD 100 can be similar in a large amount of existing armarium.MD 100 can for example similar to each Plant implantable medical device.In this example, the housing 120 of MD 100 can be implanted in the Jing regio pectoris domain of patient.Housing 120 Any number of known materials that can be implanted into safely in human body can generally be included, and when implanted can be by each of MD 100 Plant the liquid and tissue encapsulation of component and patient body.

In some instances, MD 100 can be Implanted cardiac pacemaker (ICP).In this example, MD 100 can be with With one or more leads such as lead 112, it is implanted on patient's heart or interior.One or more leads 112 can be with Including one or more electrodes 114 with the heart tissue and/or contacting blood of patient's heart.MD 100 is also configured as sense Survey the inherent electrocardiosignal for generating and one or more arrhythmias are for example determined based on the analysis of sensing signal.MD 100 Can be further configured to be treated via transmission CRT, ATP therapy of lead 112, bradycardia therapy, defibrillation that are implanted in heart Method and/or other therapy types.

In some instances, MD 100 can be subcutaneous cardioverter-defibrillators (SICD).In this example, one of them Lead 112 can include the lead being subcutaneously implanted.In some cases, MD 100 is configurable to sense the electrocardio of inherent generation Signal and one or more arrhythmias are determined based on the analysis of sensing signal.MD 100 can be further configured to response In it is determined that arrhythmia, transmits one or more defibrillation pulses.

In other instances, MD 100 can leadless cardiac pacemaker (more specifically describe with regard to Fig. 2 LCP).In this example, MD 100 can not include the lead 112 extended from housing 120.Conversely, MD 100 can include With respect to the electrode 114 of the coupling of housing 120.In these examples, MD 100 can be implanted on patient's heart in desired position Or it is interior, and be configurable to via transmission CRT, ATP therapy of electrode 114, bradycardia therapy and/or other therapy types.

In some instances, MD 100 can be only diagnosis equipment.In some cases, MD 100 is configurable to sense Survey or receive electrocardiosignal and/or physical parameter such as Mechanical Contraction, heart sound, blood pressure, blood oxygen grade etc..MD 100 can enter one Step is configured to electrocardiosignal and/or the physical parameter for sensing or receiving, and determines ARR generation.In an example In, MD 100 can without impulse generator module 104 because MD 100 can not be configured to it is ARR in response to determining Occur and transmit electricity irritation.Conversely, in response to the arrhythmia for detecting, MD 100 can be the system of armarium A part.In this example, MD 100 can be sent information in the system other equipment and one or more set It is standby to take action for example in response to the information received from MD 100, transmit electrical stimulating therapy.In addition, for example when description sets When standby, term impulse generator can be used for describing can transmit electrical stimulating therapy to any equipment such as ICD of heart, ICP, LCP etc..

In some instances, MD 100 can not be implantable medical device.Conversely, MD 100 can be outside patient body The equipment in portion, and the skin electrode being located on patient body can be included.In this example, MD 100 may can sense table The center of area signal of telecommunication (for example generates and provides the telecommunications that body is delivered to skin by heart or the equipment being implanted in patient body Number).In this example, MD 100 is still configurable to transmit all types of electrical stimulating therapies.However, in other instances, MD 100 can be only diagnosis equipment.

Fig. 2 shows exemplary leadless cardiac pacemaker (LCP) 200.In the example shown, except LCP200 does not include Outside lead 112, LCP 200 includes whole modules and component of MD 100.As shown in Figure 2, LCP 200 can be compact setting Standby, its all components is encapsulated in LCP 200 or direct on housing 120.As shown in Fig. 2 LCP 200 can include remote measurement mould Block 202, impulse generator module 204, processing module 210 and battery 212.These components can have and the MD with reference to Fig. 1 The module of the 100 similar names for the being discussed function similar with component.

In some instances, LCP 200 can include electrical sensing module 206 and mechanical sensing module 208.Electrical sensing module 206 can be similar to the sensing module 102 of MD 100.Electrical sensing module 206 can for example be configured to receive and given birth to by heart Into the signal of telecommunication.Electrical sensing module 206 can be electrically connected with electrode 214.Electrode 214 can conduct the signal of telecommunication of inherent generation and arrive Electrical sensing module 206.Mechanical sensing module 208 is configurable to reception for representing one or more physiological parameters of heart One or more signals.Mechanical sensing module 208 can for example include or telecommunication is to one or more sensors such as acceleration Meter, blood pressure sensor, heart sound transducer, blood oxygen transducer and the other sensors for measuring the physiological parameter of patient.Although Electrical sensing module 206 and mechanical sensing module 208 are described as into independent sensing module with regard to Fig. 2, but electrical sensing module 206 Individual module can be combined into mechanical sensing module 208.

In at least one example, each in the module 202,204,206,208 and 210 shown in Fig. 2 can be real Now on a single integrated circuit chip.In other instances, shown component can realize the multiple integrated electricity in telecommunication each other On the chip of road.Whole modules 202,204,206,208 and 210 and battery 212 can be encapsulated in housing 220.Housing 220 is usual Can include it is known can be implanted into safely in human body and when implantation in patients when can be by the and of module 202,204,206,208 210 and any materials of battery 212 and liquid and tissue encapsulation.

As shown in Fig. 2 LCP 200 can include electrode 212, it can fix but be exposed to LCP relative to housing 220 Tissue and/or blood around 200.On this point, electrode 214 can be integrally provided in any one end of LCP 200 simultaneously And can be with one or more telecommunications in module 202,204,206,208 and 210.In some instances, electrode 214 can be with Only housing 220 is connected to by short connection line so that electrode 214 is not fixed directly with respect to housing 220.In some examples In, LCP 200 can comprise additionally in one or more electrodes 214 '.Electrode 214 ' may be located on the side of LCP 200 and Increased can be used to sense the quantity of the electrode of electrocardio-activity and/or transmission electricity irritation by LCP 200.Electrode 214 and/or electrode 214 ' can be by one or more bio-compatible conductive materials such as known various materials or the alloy that can be implanted into safely in human body Manufacture.In some instances, be connected to LCP 200 electrode 214 and/or electrode 214 ' can have be used for by electrode 214 with The insulation division of adjacent electrode, housing 220 and/or other materials insulation.

In order to LCP 200 is implanted into inside patient body, operator (such as internist, clinician etc.) may need LCP 200 is fixed to into the heart tissue of patient's heart.In order to help fix, LCP 200 can include one or more anchors 216.Anchor 216 can be any one in a large amount of fixed or anchoring mechanisms.Anchor 216 can for example include one or more pin, Nail, screw thread, screw rod, spiral, tooth etc..In some instances, although do not show, but anchor 216 can include be located at can edge The screw thread on its outer surface that at least part of length of anchor 216 extends.Screw thread can provide the friction between heart tissue and anchor To help anchor 216 is fixed in heart tissue.In other instances, anchor 216 can include other structures such as hook, spike etc. To help the engagement organized with surrounding heart.

Can be based on design and the size of various factors selection MD 100 respectively as shown in figs. 1 and 2 and LCP 200. If such as armarium is used to be implanted in heart inner tissue, such as sometimes then can pass through into enter the heart in the case of LCP Dirty femur blood vessel is introducing armarium.In this example, the size of armarium can for example by the bending road of blood vessel Footpath and smoothly navigate without any damage for causing the surrounding tissue for blood vessel.According to an example, femur blood vessel Average diameter can be width in about 4mm to about between 8mm.In order to through the navigation of femur blood vessel to heart, medical treatment sets The standby diameter that can have less than 8mm.In some instances, armarium can be circular cylindrical shape with cross section.So And, it should be noted that armarium can be fabricated to any other suitable shapes such as rectangle, ellipse etc..When by medical treatment Equipment may want to the flattened rectangular armarium with small section when being designed as being subcutaneously implanted.

Above-mentioned Fig. 1 and Fig. 2 describe the various examples of MD 100.In some instances, medical apparatus system can include Multiple armarium.Multiple armarium 100/200 can for example cooperate using detect and treat arrhythmia and/or its His heart abnormality.Some example systems are described below in conjunction with Fig. 3-Figure 10.In the plurality of device systems, it may be desirable to allow One armarium receives various signals of communication with another medical device communication or at least from another armarium.

Fig. 3 shows medical apparatus system and can be used for the example of the communication path of communication by multiple armarium.Institute In showing example, medical apparatus system 300 can include LCP 302 and 304, external medical equipment 306 and other sensors/equipment 310.External equipment 306 can be in the past with regard to the arbitrary equipment described in MD 100.Other sensors/equipment 310 can be with The front arbitrary equipment with regard to described in MD 100.In other instances, other sensors/equipment 310 can include sensor as added Speed meter or blood pressure sensor etc..In other instances, other sensors/equipment 310 can include can be used for programing system 300 One or more equipment external programmer equipment.

The various equipment of system 300 can communicate via communication path 308.LCP 302 and 304 can for example sense inherence Electrocardiosignal and can via communication path 308 send the signal to system 300 one or more other equipments 302/304, 306 and 310.In an example, external equipment 306 can receive the signal and determine the rhythm of the heart based on the signal for receiving Uneven generation.In some cases, external equipment 306 can send the determination and set to one or more of system 300 Standby 302/304,306 and 310.In addition, one or more other equipments 302/304,306 and 310 of system 300 can be based on sending out The ARR determination sent, for example, taken action by transmitting suitable electricity irritation.This explanation is only each of system 300 One in many reasons of the communication between the equipment of kind.

Communication path 308 can represent one or more in various communication means.The equipment of system 300 can such as Jing By RF signals, inductively, optical signal, acoustic signal or suitable for any other signals for communicating communicating, and communicate Path 308 can represent the signal.

In at least one example, communication path 308 can represent conducted communication signals.Therefore, the equipment of system 300 can To have the component for allowing conductive communication.In the example that communication path 308 includes conducted communication signals, system 300 Equipment can be communicated with one another by sensing the telecommunication pulse being delivered in patient body by another equipment.Patient body can To conduct these telecommunication pulses to the other equipment of system 300.In this example, the telecommunication pulse transmitted can be with difference In the electric stimulation pulse of any of the above-described electrical stimulating therapy.The equipment of system 300 can for example with the voltage level in subthreshold Transmit the telecommunication pulse.That is, the voltage amplitude of the telecommunication pulse transmitted can be with sufficiently low so as to not capturing heart (for example Contraction is not caused).Although the telecommunication pulse that in some cases one or more are transmitted may capture heart.In addition, In other situations, the electric stimulation pulse for being transmitted can not capture heart, and not telecommunication pulse.In some cases, The telecommunication pulse transmitted can be modulated (such as pulsewidth modulation), or the timing of the telecommunication pulse transmitted can be by Modulation, to encode transmitted information.These are only some examples.

As described above, some example systems can determine ARR generation using multiple equipment, and/or in response to Determine one or more arrhythmias and transmit electrical stimulating therapy.Fig. 3-Figure 10 describes that the heart can be determined using multiple equipment The uneven generation of rule and/or the various example systems of transmission electrical stimulating therapy.However, Fig. 3-Figure 10 should not be regarded as limiting reality Example.For example, Fig. 3-Figure 10 describes how various multiple equipment systems can be coordinated to detect and/or treat the various rhythms of the heart not Together.However, the various combinations of the equipment as described in regard to MD 100 and LCP 200 can simultaneously with hereinafter described for detecting And/or the ARR technology for the treatment of is used together.

Fig. 4 shows the exemplary medical device system 400 including LCP 402 and impulse generator 406.In some examples In, impulse generator 406 can be outside cardioverter-defibrillators or ICD.Impulse generator 406 may, for example, be as closed above In the equipment described in MD 100.In some instances, impulse generator 406 can be SICD.It is outside in impulse generator 406 In the example of cardioverter-defibrillators, electrode 408a, 408b and 408c can be the skin electrodes being located on patient body.In arteries and veins In rushing the example that maker 406 is SICD, electrode 408a, 408b and 408c can be attached to and be implanted near patient body still Be not on heart 410 or in subcutaneous leads.

As illustrated, LCP 402 can be implanted in heart 410.Although LCP 402 is described as being implanted in heart 410 In left ventricle (LV), but in other instances, LCP 402 can be implanted in the different chamber of heart 410.Such as LCP In the right atrium (RA) of 402 left atriums (LA) that can be implanted in heart 410 or heart 410.In other instances, LCP 402 can be implanted in the right ventricle (RV) of heart 410.

In any case, LCP 402 and impulse generator 406 can together operate the rhythm of the heart to determine heart 410 not Neat generation.In some instances, equipment 402 and 406 can be with independent operation sensing the cardiomotility of heart 410.As above institute State, cardiomotility can include the electrocardiosignal for sensing and/or the physiological parameter for sensing.In this example, the Hes of LCP 402 Each in impulse generator 406 can operate to determine the rhythm of the heart independently of one another not based on the cardiomotility for independently sensing Neat generation.When first in LCP 402 or impulse generator 406 makes ARR first to be determined, first sets It is standby to send the first determination to the second equipment.If the cardiomotility that the second equipment of system 400 is sensed based on its own Also make ARR determination for example ARR second to determine, then can confirm that arrhythmia, and system 400 can be with Start to transmit suitable electrical stimulating therapy to heart 410.So, the equipment 402 and 406 of system 400 can be used in determining the rhythm of the heart Uneven generation.In some instances, occur and another when a determination in only equipment 402 and 406 is ARR When not determining ARR generation, system 400 can still start to transmit suitable electrical stimulating therapy to heart 410.

In other instances, only in equipment 402 and 406 actively senses cardiomotility and determines arrhythmia Generation.For example, when enlivening sensor device (such as LCP 402) and determining ARR generation, enlivening sensor device can be with The determination is sent to another equipment (such as impulse generator 406) of system 400.Then system 400 can start transmission and close Suitable electrical stimulating therapy is to heart 410.In another example, enlivening the equipment of sensing cardiomotility can send what is sensed Cardiomotility is to another equipment.The cardiomotility for receiving is then based on, another equipment can determine ARR It is raw.Then system 400 can start to transmit suitable electrical stimulating therapy to heart 410.It is another in some in these examples Individual equipment can in addition send and ARR determine to enlivening sensor device.

In other instances, first only in equipment 402 and 406 continuously senses cardiomotility.First equipment is (for example Impulse generator 406) ARR generation can continuously be determined based on the cardiomotility for sensing.In this example, when When first equipment determines ARR generation, the first equipment can send the determination to the second equipment (such as LCP 402). ARR generation timing really is received, the second equipment can start to sense cardiomotility.Arrived based on the second apparatus senses Cardiomotility, the second equipment can also determine ARR generation.In this example, only the rhythm of the heart is also determined in the second equipment After uneven generation, system 400 can just start to transmit suitable electrical stimulating therapy to heart 410.It is interchangeable at some In example, when the first equipment is sensing cardiomotility and determines whether arrhythmia occurs, the second equipment can be sensed Cardiomotility.In these examples, the second equipment can determine whether arrhythmia occurs simultaneously with the first equipment, but only The determination of ARR generation can be just completed after ARR instruction is received from the first equipment.

In some instances, determine and ARR can include determining that ARR beginning, and system 400 May be configured to determine when to start to transmit electrical stimulating therapy.In some instances, determine that ARR generation can include Determine ARR end.In this example, system 400 is configurable to further determine when to stop transmission electrical stimulating therapy.

Operate to transmit suitable electrical stimulating therapy in the example of heart 410 in system 400, if it is determined that the rhythm of the heart not It is together vibration, then impulse generator 406 can operate to transmit defibrillation pulse to heart 410.It is determined that arrhythmia be the heart In the dynamic example overrun, LCP 402 can transmit ATP therapies to heart 410.It is determined that arrhythmia be bradycardic reality In example, LCP 402 can transmit tachycardia therapy to heart 410.It is determined that arrhythmia be non-synchronous example In, LCP 402 can transmit CRT to heart 410.In some instances, impulse generator 406 and LCP 402 can coordinate with root According to below with respect to one or more technologies described in Figure 11-Figure 16, transmission electrical stimulating therapy is to heart 410.

Fig. 5 shows the exemplary medical device system 500 including LCP 502 and impulse generator 506.In the example In, impulse generator 506 can be Implanted cardiac pacemaker (ICP).Impulse generator 506 may, for example, be such as previously for ICP described in MD 100.In impulse generator 506 is the example of ICP, electrode 504a, 504b and 504c can be via one Multiple leads be implanted on the right ventricle of heart 510 and/or right atrium or in.

LCP 502 can be implanted in heart 510.Although LCP 502 is described as being implanted in the left ventricle of heart 510 (LV) in, but in some instances, LCP 502 can be implanted in the different chamber of heart 510.LCP 502 can be such as In being implanted in the left atrium of heart 510 (LA) or right atrium (RA).In other instances, LCP 502 can be implanted in heart In 510 right ventricle (RV).

In any case, LCP 502 and impulse generator 506 can together operate the rhythm of the heart to determine heart 510 not Neat generation.In some instances, equipment 502 and 506 can be with independent operation sensing the cardiomotility of heart 510.As above institute State, cardiomotility can include the electrocardiosignal for sensing and/or the physiological parameter for sensing.In the He of certain situation LCP 502 Each in impulse generator 506 can operate to determine the rhythm of the heart independently of one another not based on the cardiomotility for independently sensing Neat generation.When first in LCP 502 or impulse generator 506 makes ARR first to be determined, first sets It is standby to send the first determination to the second equipment.If the cardiomotility that the second equipment of system 500 is sensed based on its own Also make ARR determination for example ARR second and determine that then system 500 can confirm that arrhythmia, and can be with Start to transmit suitable electrical stimulating therapy to heart 510.So, the equipment 502 and 506 of system 500 can be used in determining the rhythm of the heart Uneven generation.In some instances, when in only equipment 502 and 506 determines ARR generation, system 500 Suitable electrical stimulating therapy can also be started to transmit to heart 510.

In other instances, only in equipment 502 and 506 actively senses cardiomotility and determines arrhythmia Generation.For example, when enlivening sensor device (such as impulse generator 506) and determining ARR generation, active sensing sets It is standby to send the determination to another equipment (such as LCP 502) of system 500.Then system 500 can start transmission and close Suitable electrical stimulating therapy is to heart 510.In some instances, enlivening the equipment of sensing cardiomotility can send the heart for sensing Dirty work moves another equipment.The cardiomotility for receiving is then based on, another equipment can sense cardiomotility and determination ARR generation.Then system 500 can start to transmit suitable electrical stimulating therapy to heart 510.In some instances, Another equipment can in addition send and ARR determine to enlivening sensor device.

In other instances, first only in equipment 502 and 506 continuously senses cardiomotility.First equipment can be with ARR generation is continuously determined in addition based on the cardiomotility for sensing.In some instances, when the first equipment determines During ARR generation, the first equipment can send the determination to the second equipment.Receiving ARR generation really After fixed, the second equipment can start to sense cardiomotility.Based on the cardiomotility that the second apparatus senses are arrived, the second equipment can also Determine ARR generation.In this example, only after the second equipment also determines ARR generation, system 500 is Suitable electrical stimulating therapy can be started to transmit to heart 510.In some interchangeable examples, when the first equipment is sensed Cardiomotility and when determining whether arrhythmia occurs, the second equipment can sense cardiomotility.In these examples, second Equipment can determine whether arrhythmia occurs simultaneously with the first equipment, but only receive arrhythmia from the first equipment Instruction after can just complete the determination of ARR generation.

In some instances, determine and ARR can include determining that ARR beginning, and system 500 May be configured to determine when to start to transmit electrical stimulating therapy.In some instances, determine that ARR generation can include Determine ARR end.In this example, system 500 is configurable to further determine when to stop transmission electrical stimulating therapy. Just start to transmit electrical stimulating therapy till multiple equipment determines ARR generation to the feelings of heart 510 in system 500 In condition, each determination for not triggering the transmission of electrical stimulating therapy is properly termed as interim determination.

Operate to transmit suitable electrical stimulating therapy in the example of heart 510 in system 500, if it is determined that the rhythm of the heart not It is together tachycardia, any one or two in impulse generator 506 and LCP 502 can transmit ATP therapies to heart 510.It is determined that arrhythmia be bradycardic example in, any one in impulse generator 506 and LCP 502 or two The individual tachycardia therapy that can transmit is to heart 510.It is determined that arrhythmia be the example of non-synchronous in, pulse generate Any one or two in device 506 and LCP 502 can transmit CRT to heart 510.In some instances, impulse generator 506 Can coordinate with basis below with respect to one or more technologies described in Figure 11-Figure 16 with LCP 502, transmission electrical stimulating therapy is arrived Heart 510.

Fig. 6 shows the exemplary medical device system 600 including LCP 602 and LCP 606.LCP 602 and LCP 606 It is shown as being implanted in heart 610.Although LCP 602 and LCP 606 are described as being implanted in the left ventricle of heart 610 respectively (LV) and in the right ventricle of heart 610, but in other instances, LCP 602 and LCP 606 can be implanted in heart 610 In different chamber.System 600 can include the LCP 602 and LCP 606 being for example implanted in two atrium of heart 610. In other examples, system 600 can include the LCP 602 and LCP being implanted in an atrium and a ventricle of heart 610 606.In more examples, system 600 can include LCP 602 and the LCP being implanted in the combination in any in ventricle and atrium 606.In other instances, system 600 can include the LCP 602 and LCP 606 being implanted in the identical chamber of heart 610.

Anyway, and in other situations, LCP 602 and LCP 606 can operate together to determine the heart of heart 610 The uneven generation of rule.In some instances, equipment 602 and 606 can be with independent operation sensing the cardiomotility of heart 610.Such as Upper described, cardiomotility can include the electrocardiosignal for sensing and/or the physiological parameter for sensing.In some instances, LCP Each in 602 and LCP 606 can operate ARR independently to be determined based on the cardiomotility for independently sensing Occur.When first in LCP 602 or LCP 606 makes ARR first to be determined, first equipment can send First determines to the second equipment.If the second equipment of system 600 also makes the rhythm of the heart based on the cardiomotility that its own is sensed Uneven usual practice really for example ARR second determines that then system 600 can confirm that arrhythmia and can start transmission properly Electrical stimulating therapy to heart 610.So, the equipment 602 and 606 of system 600 can be used in determining ARR generation. In some examples, when in only equipment 602 and 606 determines ARR generation, system 600 can start transmission and close Suitable electrical stimulating therapy is to heart 610.

In other instances, only in equipment 602 and 606 actively senses cardiomotility and determines arrhythmia Generation.In some in these examples, when enlivening sensor device (such as LCP 606) and determining ARR generation, Enlivening sensor device can send the determination to another equipment (such as LCP 602) of system 600.System 600 and then can be with Start to transmit suitable electrical stimulating therapy to heart 610.In some instances, enlivening the equipment of sensing cardiomotility can send The cardiomotility for sensing is to another equipment.The cardiomotility for receiving is then based on, another equipment can determine the rhythm of the heart Uneven generation.Then system 600 can start to transmit suitable electrical stimulating therapy to heart 610.In these examples one In a little, another equipment can in addition send and ARR determine to enlivening sensor device and/or another equipment.

In some instances, first only in equipment 602 or 606 can continuously sense cardiomotility.First equipment It is additionally based on the cardiomotility for sensing and continuously determines ARR generation.In this example, when the first equipment determines the heart When restraining uneven generation, the first equipment can send the determination to the second equipment.In the determination for receiving ARR generation Afterwards, the second equipment can start to sense cardiomotility.Based on the cardiomotility that the second apparatus senses are arrived, the second equipment can also be true Fixed ARR generation.In this example, only after the second equipment also determines ARR generation, system 600 just may be used To start to transmit suitable electrical stimulating therapy to heart 610.In some interchangeable examples, when the first equipment is sensing the heart Dirty work is dynamic and when determining whether arrhythmia occurs, the second equipment can sense cardiomotility.In these examples, second sets It is standby to determine whether arrhythmia occurs simultaneously with the first equipment, but only receive from the first equipment it is ARR The occurent determination of arrhythmia can be just completed after instruction.

In some instances, determine and ARR can include determining that ARR beginning, and system 600 May be configured to determine when to start to transmit electrical stimulating therapy.In some instances, determine that ARR generation can include Determine ARR end.In this example, system 600 is configurable to further determine when to stop transmission electrical stimulating therapy. Just start to transmit electrical stimulating therapy till multiple equipment determines ARR generation to the feelings of heart 610 in system 600 In condition, each determination for not triggering the transmission of electrical stimulating therapy is properly termed as interim determination.

Operate to transmit suitable electrical stimulating therapy in the example of heart 610 in system 600, if it is determined that the rhythm of the heart not It is together tachycardia, any one or two in LCP 606 and LCP 602 can transmit ATP therapies to heart 610.True Fixed arrhythmia is in bradycardic example, and any one or two in LCP 606 and LCP 602 can transmit aroused in interest Therapy of overrunning is to heart 610.It is determined that arrhythmia be the example of non-synchronous in, in LCP 606 and LCP 602 appoint Anticipating, one or two can transmit CRT to heart 610.In some instances, pulse generator 606 and LCP 602 can coordinate with One or more technologies according to below with respect to Figure 11-Figure 16, transmission electrical stimulating therapy is to heart 610.

Although without the need for described in Fig. 4-Fig. 6, an equipment in two equipment of system 400,500 or 600 can Being only diagnosis equipment.In this example, after one or more equipment determine ARR generation, only diagnosis is with setting It is standby to transmit electrical stimulating therapy.Conversely, can be by can when needed transmit suitable electrical stimulating therapy in the system Another equipment transmission electrical stimulating therapy.

Fig. 7 shows that the example medical with three independent LCP for including LCP 702, LCP 704 and LCP 706 sets Standby system 700.Although system 700 is described as having LCP 702, the LCP 704 and LCP being implanted in respectively in LV, RV and LA 706, but other examples can include LCP 702, LCP 704 and the LCP 706 being implanted in the different chamber of heart 710. System 700 can for example include the LCP being implanted in two atrium and a ventricle of heart 710.In other instances, unite 700 can be including the LCP being implanted in two ventricles and an atrium of heart 710.More generally useful, it is contemplated that system 700 can be with Including the LCP being implanted in the combination in any of ventricle and atrium.In some instances, system 700 can include being implanted in heart Two or more LCP 702, LCP 704 and LCP 706 in 710 identical chamber.

In force, any one that system 700 can be in the technology according to above for Fig. 4-Fig. 6 is operating. However, in some instances, system 700 at least can be operated differently in some extent.For example, start to pass in system 700 Suitable electrical stimulating therapy is passed to before heart 710, the majority in only LCP 702, LCP 704 and LCP 706 is it needs to be determined that the heart The uneven generation of rule.For example, in some instances, all can independently sense in LCP 702, LCP 704 and LCP 706 Cardiomotility and determine ARR generation.In some cases, only in LCP 702, LCP 704 and LCP 706 Majority determines that system 700 can just transmit suitable electrical stimulating therapy to heart 710 after ARR generation.At some In situation, in LCP be designed based on LCP and whether they can be determined ARR by other from LCP Hair growth promoting is sent to main LCP.Main LCP may then determine whether that the great majority in LCP 702, LCP 704 and LCP 706 have determined ARR generation, and can if it is indicate to transmit suitable electrical stimulating therapy to heart 710.In some examples In, main LCP can indicate LCP 702, LCP 704 and LCP according to detected ARR type and/or position Concrete LCP in 706 transmits electrical stimulating therapy to heart 710.

Alternatively and in some instances, system 700 start to transmit suitable electrical stimulating therapy to heart 710 it Before, only single LCP is it needs to be determined that ARR generation.In other instances, arrive in the suitable electrical stimulating therapy of systems communicate Heart 710, all three LCP 702, LCP 704 and LCP 706 may be it needs to be determined that ARR generations.

In some cases, in only LCP 702, LCP 704 and LCP 706 can actively sense cardiomotility And determine ARR generation.It is determined that after ARR generation, enlivening sensor device can send determination to it One or two in his equipment.In some cases, in other equipment one or two then can start sensing and Determine ARR generation.In some instances, after first in other equipment determines ARR generation, it is System 700 can start to transmit suitable electrical stimulating therapy to heart 710.In other instances, when two in other equipment are true After fixed ARR generation, system 700 can start to transmit suitable electrical stimulating therapy to heart 710.

In some instances, LCP 702, LCP 704 and LCP 706 can be arranged to daisy chain configuration.For example, sense is enlivened Measurement equipment can only send ARR determination to (alternatively, only other two reception in other two equipment One in equipment can from enliven testing equipment receive determination after take action).Then receiving device can start ARR generation is actively detected and determined.It is determined that after ARR generation, receiving device can send determination To last equipment.Then last equipment can start to sense and determine ARR generation.In some instances, Only when last equipment determines ARR generation, system 700 just starts to transmit suitable electrical stimulating therapy to heart 710.In some interchangeable examples, various equipment can simultaneously enliven sensing and determine ARR generation.However, Some of them equipment only may can receive arrhythmia and send out in cascade system for example disclosed above from another equipment Just complete to make the ARR determination of generation after raw instruction.

And according to the description of system 400,500 and 700, in some instances, determine that ARR generation can be wrapped The ARR beginning of determination is included, and system 700 may be configured to determine when to start to transmit electrical stimulating therapy.In some realities In example, determine and ARR can include determining that ARR end.In this example, system 700 can be configured To further determine when to stop transmission electrical stimulating therapy.In system 700 till multiple LCP equipment determine ARR generation Just start to transmit suitable electrical stimulating therapy in the example of heart 710, do not trigger each determination of the transmission of electrical stimulating therapy It is properly termed as interim determination.

Operate to transmit suitable electrical stimulating therapy in the example of heart 710 in system 700, if it is determined that the rhythm of the heart not It is together tachycardia, then one or more in LCP 702, LCP 704 and LCP 706 can transmit ATP therapies to heart 710.It is determined that arrhythmia be bradycardic example in, one or more in LCP 702, LCP 704 and LCP 706 Tachycardia therapy can be transmitted to heart 710.It is determined that arrhythmia be the example of non-synchronous in, LCP 702, One or more transmitted CRT in LCP 704 and LCP 706 arrive heart 710.It is envisioned that the Hes of not all LCP 702,704 706 can transmit electrical stimulating therapy in response to ARR detection.For example, only in LCP 702,704 and 706 can To transmit electrical stimulating therapy.In other examples, two in LCP 702,704 and 706 can transmit electrical stimulating therapy.One In a little examples, LCP 702,704 and 706 can coordinate with basis below with respect to one or more technologies described in Figure 11-Figure 16, Transmission electrical stimulating therapy is to heart 710.

According to foregoing description, it can be seen that the system how technology can expand to even more than three LCP equipment.Example Such as, in four LCP device systems, any one, two, that three or four equipment can be used to starting transmission in system is suitable ARR generation is determined before electrical stimulating therapy.In some examples, all, some or a LCP equipment can be most It is just active to sense and determine ARR generation.In the example for all enlivening sensing is not all of, in an active sensing Equipment determines ARR generation and sends the determination to after the other equipment of system, and at least one other of system sets It is standby to start active sensing cardiomotility and determine ARR generation.Above-mentioned technology can expand to again including appoint (such as five, six, seven or arbitrarily other quantity is individual can actually be implanted into patient for meaning quantity LCP equipment or other equipment Internal equipment) system.In addition, in some replaceable examples, the multiple or armamentarium of system can simultaneously enliven sense Survey cardiomotility and determine ARR generation, the equipment is configurable to until setting from another except one or more Standby receiving just completes arrhythmia and occurs outside the making of determination till arrhythmia is indicated.

In addition, though the technology is described above for three or more LCP equipment, but the technology can apply to With regard to any system described in Fig. 4-Fig. 5.For example, any one in system 400 and 500 may further include the 3rd equipment Such as the 2nd LCP equipment.Within the system, three equipment can be operated according to any of the above-described technology of system 700, wherein, arteries and veins Rushing maker can sense arrhythmia and/or transmission electrical stimulating therapy.In other instances, it is any in system 400 and 500 One can be with multiple optional equipments.For example, any one in addition to impulse generator 406 and 506, in system 400 and 500 The LCP equipment that three, four, five or any amount can be used in implantation patient can be included.Therefore, in this example, Equipment can together be operated according to any of the above-described technology.

In some instances, many device systems are possible being capable of electrical stimulating therapy more more effective than single device systems communicate.Example Such as, before starting to transmit electrical stimulating therapy, example system can determine which equipment of system senses first heart Wave of depolarization.In this example, the system can instruct the equipment transmission electrical stimulating therapy for sensing wave of depolarization first.This can permit Perhaps the system transmits electrical stimulating therapy where closer to ARR origin, and this can increase the effect of electrical stimulating therapy Rate.

In the example of system 700, one of equipment of system 700 can independently determine according to any of the above-described technology The interim determination of the other equipment of ARR generation or top-up system 700.One of equipment of system 700 is (for example Main equipment) can determine that transmission ATP therapies instruct another equipment transmission ATP of system 700 to treat to heart 710 or determination Method.Before transmitting ATP therapies or instructing another equipment transmission ATP therapy, one of equipment of system 700 can be true Which equipment for determining system 700 senses first the inherent heart wave of depolarization of heart 710.The equipment for sensing the wave of depolarization first Then can start to transmit ATP therapies.

Above description is only how system can be operated with by the equipment of the inherent heart wave of depolarization for sensing heart first One example of transmission electrical stimulating therapy.In other instances, the type of arrhythmia and therapy can be with difference.Further, since This feature is not any concrete configuration or quantity of associate device, so any system described herein may further include the spy Levy.Only restriction arbitrarily in system can be whether the equipment of system can transmit suitable electrical stimulating therapy.

Many device systems can be used for helping providing atrium arrhythmia and ventricular arrhythmia it is uneven between differentiation.For example, Example system described herein can be that atrium arrhythmia or ventricular arrhythmia are uneven operating differently according to arrhythmia More effectively to treat the arrhythmia.

Used as an illustrative example, one of equipment of system 700 can be independently true according to any of the above-described technology The interim determination of the other equipment of fixed ARR generation or top-up system 700.In addition, the equipment of system 700 can be true It is atrial tachycardia or ventricular tachycardia to determine tachycardia.If tachycardia is atrial tachycardia, system 700 One or more equipment can determine and do not transmit electrical stimulating therapy.If tachycardia is ventricular tachycardia, system 700 One or more equipment can be otherwise determined that whether whether tachycardic frequency be polymorphic higher than threshold value and electrocardiosignal Signal.If tachycardia rate is less than threshold value and electrocardiosignal is not polymorphic signal, one or more of system 700 set It is standby to transmit or instruct the distinct device of system 700 to transmit ATP therapies to heart 710.If tachycardia rate is higher than threshold Value or electrocardiosignal are polymorphic signals, then one or more equipment of system 700 can transmit or instruct the difference of system 700 Equipment transmits defibrillation pulse to heart 710.Make a distinction between the atrium arrhythmia and ventricular arrhythmia are uneven and different Ground can increase the efficiency of the electrical stimulating therapy of transmission in response to different types of arrhythmia and reduce the electricity of arbitrarily transmission The negative results of irritation therapy.Above description is only how disclosed system can be operated with various arrhythmias Between make a distinction and transmit in response to different determination arrhythmias an example of electrical stimulating therapy.

Fig. 8 and Fig. 9 show other exemplary implantation positions of many medical apparatus systems and configuration.The armarium of Fig. 8 System 800 for example shows three LCP equipment, LCP 802,804 and 806.Two of which LCP equipment LCP 802 and 804 is shown In being shown as the single chamber for being implanted in heart 810.In other instances, whole three equipment can be implanted in the list of heart 810 In individual chamber.Although two LCP 802 and 804 are shown as being implanted in the LV of heart 810, in other instances, the heart Dirty 810 any chamber can include multiple implantation LCP equipment.Multiple equipment is implanted in single chamber can strengthen transmission The efficiency of electricity irritation, because multiple equipment can increase the cardiac position transmission near the source for causing signal as arrhythmia The chance of electrical stimulating therapy.As described in previously for other systems, any other systems as herein described such as He of system 400 500 can include one or more equipment for being implanted according to hope in the single chamber of heart.

The armarium 900 of Fig. 9 includes the LCP 902 being implanted on the epicardial surface of heart 910.LCP 904 and 906 It is shown as being implanted in the endocardial surface of heart 910.In some instances, one or more optional equipments of system 900 can To be implanted on epicardial surface.In some instances, the equipment being implanted on the epicardial surface of heart can sense inherence Electrocardiosignal and/or the suitable electrical stimulating therapy of transmission are to heart.Therefore, any system as herein described can be included according to uncommon Prestige is implanted in one or more equipment of the endocardial surface of heart.

As it appears from the above, in some embodiments, an equipment in medical system can as main equipment and other Equipment can be used as from equipment.Figure 10 is to include main equipment 1002 and multiple illustrative doctors from equipment 1004,1006 and 1008 Treat the block diagram of device systems 1000.In the example shown, main equipment 1002 can by the body of patient with from equipment 1004, 1006 and 1008 conductive communications.In other instances, main equipment and can be via different communication mechanisms as by penetrating from equipment Frequently (RF) signal, inductively, optical signal, acoustic signal or other suitable communication mechanisms communications.

In an example, main equipment 1002 can be ICD equipment such as ICD or SICD, and be configurable to from one It is individual or multiple from the reception heart information of equipment 1004,1006 and 1008.In some cases, can be LCP from equipment.Lead to The heart information of letter can include for example by the electrocardiosignal sensed from equipment 1004,1006 and 1008, by from equipment 1004, 1006 and 1008 make primarily determine that or by from equipment 1004,1006 and 1008 sense or determine other information.One In a little examples, main equipment 1002 can also sense cardiomotility.In this example, main equipment 1002 can be based on its own sensing Cardiomotility and/or from the cardiomotility received from equipment 1004,1006 and 1008, determine ARR generation. In some examples, main equipment 1002 can determine that the cardiomotility of one or more equipment from system 1000 indicates the rhythm of the heart not Neat generation.In some cases, although each in the multiple equipment of system 1000 can sense cardiomotility, but only Individual equipment such as main equipment 1002 can make the determination that arrhythmia occurs and suitable electrical stimulating therapy is wished.

In response to determining ARR generation, main equipment 1002 can determine transmission electrical stimulating therapy.In an example In, main equipment 1002 can determine suitable electrical stimulating therapy based on ARR type.In addition, main equipment 1002 can be true Fixed which or which equipment should transmit electrical stimulating therapy.Main equipment 1002 can instruct one or more equipment (to potentially include Main equipment itself) electrical stimulating therapy desired by actual transfer.Main equipment 1002 can be operated according to any aforementioned techniques.Master sets Standby 1002 can for example it is determined that it is ARR actually occur before determine ARR generation one or more are interim It is determined that.Main equipment 1002 can make a distinction between atrium arrhythmia and ventricular arrhythmia are uneven in addition and based on a determination that Arrhythmia type is transmitting suitable electrical stimulating therapy.In some instances, main equipment 1002 can be based on which or which Equipment senses first the heart wave of depolarization of cardiac cycle, determines which or which equipment needs to transmit electrical stimulating therapy.

In some instances, the multiple equipment of system 1000 can determine ARR generation.For example, from equipment 1004th, 1006 and 1008 each can determine it is ARR generation and the determination can be sent to main equipment 1002.One In a little examples, the determination can be considered reality or interim determine.The determination received based on this, main equipment 1002 can be with The technology according to disclosed in arbitrarily previously determines ARR generation.Based on ARR determination, main equipment 1002 can be passed Pass and/or specify one or more the suitable electrical stimulating therapies of transmission from equipment 1004,1006 and 1008.

In some cases, main equipment 1002 and all can enliven from equipment 1004,1006 and 1008 it are not Ground sensing arrhythmia.For example, as it was previously stated, in some instances, only main equipment 1002 and from equipment 1004,1006 and 1008 In it is single or be not all of that sensing arrhythmia can be enlivened.In at least one example, enlivening sensor device can send out Cardiomotility is sent to main equipment 1002.Based on the cardiomotility for receiving, main equipment 1002 can determine ARR generation. It is determined that after ARR generation, main equipment 1002 can instruct the second equipment of system 1000 to start actively to sense the heart Dirty work is moved.Second equipment can in addition send the cardiomotility of sensing to main equipment 1002.Also, main equipment 1002 can be with base Determine ARR generation in the cardiomotility received from the second equipment.Occur really one or more arrhythmias are made After fixed, main equipment 1002 can be transmitted or instruct one or more transmission from equipment 1004,1006 and 1008 suitable Electrical stimulating therapy.In other instances, equipment can send arrhythmia and occur to determine to main equipment 1002, to replace sending sense The cardiac data for measuring.In some cases, main equipment 1002 can not sense cardiomotility.Conversely, main equipment 1002 can be with Based on those cardiomotilitys received from equipment from sensing cardiomotility and/or determination, make arrhythmia and determine.

In some cases, main equipment 1002 can be that LCP equipment, outside cardioverter-defibrillators, ICP or only diagnosis are used Equipment.In some instances, main equipment 1002 can have similar hardware configuration with from equipment 1004,1006 with 1008, but It is that they can be provided with different softwares.In some instances, even if the shared identical hardware and software feature of armamentarium, " slave pattern " is could be arranged to from equipment 1004,1006 and 1008 while main equipment 1002 could be arranged to " holotype ".In addition, In some instances, the equipment of system 1000 can be configured to main equipment and between equipment switch.For example, external programmer Can according to the arbitrary equipment for being desirably connected to the system and the arbitrary equipment that changes the system programming.

Figure 11-Figure 14 describes to coordinate one or more suitable electrical stimulating therapies of equipment transmission of armarium and arrives The various methods and/or techniques of heart.Figure 11 shows at least two armarium 1102 that can coordinate medical apparatus system With the first technology of 1104 transmission electrical stimulating therapies.In the example shown in Figure 11, medical apparatus system for example system 400,500, The first armarium 1102 of any one in 600 or any other suitable systems can send multiple triggers 1106 To the second armarium 1104 of the system.One or more triggers 1106 can cause the second armarium 1108 to transmit Electrical stimulating therapy such as pacemaker impulse 1108 arrives heart.In the example of Figure 11, the first armarium 1102 can send multiple Trigger 1106, and each trigger 1106 can cause the second armarium 1104 to transmit single pacemaker impulse 1108。

In some instances, the first armarium 1102 can send will be delivered to heart by the second armarium 1104 Pacemaker impulse 1108 one or more parameters.For example, the first armarium 1102 can send one or more signals to Second armarium 1104, during for indicating for example for the voltage amplitude of corresponding pacemaker impulse 1108, pulse width, coupling Between interval (from inherent heart signal to the time interval pacemaker impulse) and/or other suitable parameters).In some examples In, one or more signals can be encoded in trigger 1106, or can be arranged in independent signal.In some feelings In condition, each trigger 1106 may be used also in addition to causing the second armarium 1104 to transmit corresponding pacemaker impulse 1108 To encode the voltage amplitude and/or pulse width that have for example corresponding pacemaker impulse 1108 of information.In some instances, a triggering Signal 1106 can encode voltage amplitude, pulse width and/or any other suitable pacing parameters.Thereafter, second is medical Equipment 1104 can transmit follow-up pacemaker impulse 1108 according to the pacing parameter of the transmission, until the second armarium 1104 from Till first armarium 1102 receives different parameters.

In some instances, can be sent to second before system determines arbitrarily ARR generation medical for the parameter Equipment 1104.For example, the first armarium 1102 or another equipment can be in implantation or in programming ession for telecommunication or afterwards The parameter is sent to the second armarium 1104.In other instances, the parameter for example can be pre-programmed into second at factory In armarium 1104.In these examples, parameter can independently be sent to the second armarium with trigger 1106 1104。

Although being described above for two equipment, the technology of Figure 11 can expand to and be including optional equipment System.For example in many device systems, individual equipment can send multiple trigger commands to the multiple equipment of system, cause multiple setting It is standby to transmit corresponding pacemaker impulse.In this example, the first equipment can the slightly different time send the trigger to Multiple distinct devices, so as to cause each receiving device in slightly different Time Transmission pacemaker impulse.In another example, First equipment can send the single trigger for triggering multiple distinct devices.

In some instances, the first equipment can only send trigger in other multiple equipments.For example, One equipment can send other equipment of the trigger in relative to many device systems, and last senses the depolarization of heart The concrete equipment of ripple.In other instances, if it is desired to which then multiple equipment can send trigger to multiple other equipments. In some examples, the first equipment can be subcutaneous cardioverter-defibrillators (S-ICD) and other equipment can be without the lead heart Dirty pacemaker (LCP), but this is only an example.

Figure 12 show at least two equipment transmission electrical stimulating therapy that can coordinate armarium another is illustrative Technology.Among the example of Figure 12, any one in system such as system 400,500,600 or arbitrarily other suitable systems First armarium 1202 can send trigger 1206 to the second armarium 1204 of system, and trigger 1206 can be with Cause the transmission electrical stimulating therapy of the second armarium 1204 and transmit multiple pacemaker impulses 1208 in the example shown to heart. In fig. 12, the first armarium 1202 can send the armarium of trigger 1206 to the second 1204, and it can cause Two armarium 1204 transmit multiple pacemaker impulses 1208.

In some instances, the first armarium 1202 can send will be delivered to heart by the second armarium 1204 Pacemaker impulse 1208 one or more parameters.For example, the first armarium 1202 can send one or more signals to Second armarium 1204 is indicating voltage amplitude, pulse width and/or any other suitable parameter of pacemaker impulse 1208. Alternately or in addition, the first armarium 1202 can send burst length parameter, pulse frequency (between pacemaker impulse Time interval), coupling time interval and/or other pulse informations to the second armarium 1204.Burst length parameter can With the pacemaker impulse 1208 for indicating be transmitted in response to receiving single trigger 1206 by the second armarium 1204 Desired number.

In some instances, one or more signals can be coded in trigger 1206 or on.For example, triggering letter Numbers 1206 in addition to causing the second armarium 1204 to transmit a string of pacemaker impulses 1208, can encode information and such as pace arteries and veins Rush 1208 voltage amplitude, pulse width, string length, pulse frequency and/or any other suitable parameters.In some instances, First armarium 1202 can send delay parameter, for indicating that the second armarium 1204 should be from the first armarium 1202 receive how long start transmission pacemaker impulse 1208 after trigger 1206.

In some instances, before system determines arbitrarily ARR generation, the parameter can be sent to the second doctor Treatment equipment 1204.For example, in implantation or in programming ession for telecommunication or afterwards, the first armarium 1202 or another equipment The parameter can be sent to the second armarium 1204.In other instances, the parameter for example can be pre-programmed at factory In second armarium 1204.

In some instances, the first armarium 1202 can send beginning trigger 1206 and stop trigger 1206a.For example, starting trigger 1206 can cause the second armarium 1204 to start according to one or more parameters such as electricity Pressure range parameter, pulse width parameter and/or other specification transmission pacemaker impulse 1208.Next first armarium 1202 may be used Stop trigger 1206a (showing in dotted lines) to transmit.Stopping triggering 1206a can cause the second armarium 1204 Stop transmission pacemaker impulse 1208.In some instances, after the transmission of the first armarium 1202 stops triggering 1206a, it is One or more equipment of system may determine whether still arrhythmia.Determine really in an equipment of system and still send out In the ARR example of life, the first armarium 1202 can send another and start the medical treatment of trigger 1206 to the second and set Standby 1204.

Although being described above for two equipment, the technology of Figure 12 can expand to and be including optional equipment System.For example in many device systems, individual equipment can send multiple trigger commands to multiple miscellaneous equipments of system, cause many Individual miscellaneous equipment according to send or store parameter transmission pacemaker impulse 1208.For example, it is single to set in many device systems It is standby to send multiple trigger commands to the multiple equipment of system, cause multiple equipment to transmit corresponding pacemaker impulse.In the reality In example, the first equipment can send the trigger to multiple distinct devices in the slightly different time, so as to cause each to connect Receiving unit is in slightly different Time Transmission pacemaker impulse.

In some instances, the first equipment can only send trigger in other multiple equipments.For example, One equipment can send other equipment of the trigger in relative to many device systems, and last senses the depolarization of heart The concrete equipment of ripple.In other instances, if it is desired to which then multiple equipment can send trigger to multiple other equipments. In some examples, the first equipment can be subcutaneous cardioverter-defibrillators (SICD) and other equipment can be leadless cardiac Pacemaker (LCP), but this is only an example.

Figure 13 show can coordinate armarium at least two equipment transmit electrical stimulating therapy to heart another Illustrative technique.It is any one in system such as system 400,500,600 or arbitrarily other suitable systems in the example of Figure 13 The first individual armarium 1302 can send trigger 1306 to the second armarium 1304 of system, trigger 1306 For example multiple pacemaker impulses 1308 of the transmission electrical stimulating therapy of the second armarium 1304 can be caused to arrive heart.It is shown in fig. 13 Example in, the first armarium 1302 can send the armarium of trigger 1306 to the second 1304, trigger 1306 The second armarium 1304 can be caused to transmit electrical stimulating therapy according to intended therapy agreement.

In some instances, the first armarium 1302 (or another armarium) can send one or more therapies Agreement is to the second armarium 1304.Figure 13 illustrates a kind of such therapy agreement.Explanation Sex therapy agreement described in Figure 13 Including three independent periods for being respectively labeled as 1310,1312 and 1314.Therapy agreement can cause the second armarium 1304 The transmission pacemaker impulse 1308 during the cycle very first time 1310.Therapy agreement can additionally result in the second armarium 1304 and exist Stop transmission pacemaker impulse 1308 during second time cycle 1312.In some instances, therapy agreement can additionally result in Another equipment of one armarium 1302, the second armarium 1304 and/or system is true during the second time cycle 1312 It is fixed whether arrhythmia still to occur.If it is determined that still there is arrhythmia, then illustrate that Sex therapy agreement can cause second Armarium 1304 continues to transmit pacemaker impulse 1308 during the 3rd time cycle 1314.In some instances, in week time Pacing parameter (such as pacemaker impulse time interval) in phase 1310 from it is different in the time cycle 1314.Set in neither one It is standby to determine that still generation arrhythmia and the determination are sent to the second armarium during the second time cycle 1312 In 1304 example, therapy agreement can cause the second armarium 1304 not transmit pace-making during the 3rd time cycle 1314 Pulse.This can only be sent to an example of the therapy agreement of the second armarium 1304.Other examples can include The such a therapy agreement i.e. therapy agreement includes greater or lesser time cycle and/or different logics are used for what to be indicated When transmit or do not transmit electric stimulation pulse 1308.

In some instances, therapy agreement can include parameter such as voltage amplitude, pulse width, the arteries and veins of pacemaker impulse 1308 Rush string length and/or parameter.In some cases, the parameter can not be a part for therapy agreement, and can assist from therapy View individually sends.As described by above for Figure 11 and Figure 12, the parameter and/or therapy agreement can send in various manners To the second armarium 1304.For example, the parameter and/or therapy agreement can be before triggers 1306 or and trigger 1306 send together.In other instances, the parameter can be sent to the second doctor before system determines ARR generation Treatment equipment 1304.For example, the first armarium 1302 or another equipment can in implantation or programming ession for telecommunication or it After send the parameter to the second armarium 1304.In other instances, the parameter for example can be pre-programmed at factory In two armarium 1304.In the case of wherein the second armarium 1304 includes the therapy agreement of multiple storages, in factory Place's pre-programmed is previously sent to the second armarium 1304, and the first armarium 1302 can simply refer to or select to pass Which the therapy agreement being stored in the second armarium 1304 passed.

Although being described above for two equipment, the technology of Figure 13 can expand to and be including optional equipment System.For example in many device systems, individual equipment can send trigger 1306 to the multiple equipment of system, cause multiple setting It is standby according to the parameter that sends or store and/or therapy agreement transmit pacemaker impulse 1308.In this example, the first equipment can be with The trigger is sent to multiple distinct devices, in the slightly different time so as to cause each receiving device slightly different Time Transmission pacemaker impulse.

In some instances, system be able to may be grasped in any combination using some or all in above-mentioned technology Make.In this example, each equipment of system can be received for indicating which operator scheme the equipment should be operated in Signal of communication.In some cases, each equipment can have address, and can by reference to suitable address by equipment it Between communication be oriented to concrete equipment.In some cases, if it is desired to then simply by communication broadcast to armamentarium.

Figure 13 shows that another at least two equipment transmission electrical stimulating therapy that can coordinate medical apparatus system is said Bright property technology.Figure 11 above-Figure 13 describes how multiple equipment can be coordinated with by sending one or more triggers Transmission electricity irritation to heart, wherein trigger cause one or more armarium to transmit electrical stimulating therapy to heart.Figure 14 Show when equipment is received for the trigger 1106 for transmitting electrical stimulating therapy and when actual transfer electrical stimulating therapy When between concrete timing considerations.

In fig. 14 in shown example, when arrhythmia is detected, the first armarium 1402 sends trigger 1406 to the second armarium 1404.According to any of the above-described technology, after trigger 1406 is received, the second armarium 1404 can transmit pacemaker impulse 1408 to heart.In some cases, the second armarium 1404 can not receive it is tactile Transmit pacemaker impulse 1408 after signalling 1406 immediately, as shown in figure 14.For example, the second armarium 1404 is made in heart It is probably helpful that pacemaker impulse is transmitted during the concrete cycle of cardiac cycle.

Heart signal 1414 can be used to recognize the cardiac cycle of heart.In the example shown, heart signal 1414 includes QRS Ripple 1410, it can be sensed in some cases by the second armarium 1404.Generally, heart can not the contraction of heart it Just shrink in response to electricity irritation afterwards (i.e. should not be during the cycle).After having pass by special time after contractions, heart Cell can respond once more to electricity irritation and shrink.Therefore, heart contraction is caused with bigger chance in order to transmit electrical stimulating therapy Or bigger chance terminates arrhythmia, the second armarium 1404 can wait pacemaker impulse to be passed until expiring in the cycle Till.

In fig. 14 in shown example, the first armarium 1402 can be after the first QRS wave 1410 and One time 1430 sends trigger 1406.After trigger 1406 is received, the second armarium 1404 can be waited Next QRS wave 1410.After the second time 1432 sensed QRS wave 1410, the second armarium 1404 can wait pre- The time cycle 1412 is defined afterwards just in the transmission of the 3rd time 1434 pacemaker impulse 1408.Time cycle 1412 can be predefined as So that second armarium 1404 should not the phase in cycle in the non-of heart when the second armarium 1404 transmits pacemaker impulse 1408 Between or terminating ARR Time Transmission pacemaker impulse 1408 with bigger probability.The pace-making arteries and veins of each subsequent delivery Punching 1408 should not can be transmitted subsequently non-during the cycle.For example, can be in the predefined of and then each follow-up QRS wave 1410 Time cycle 1412 transmits pacemaker impulse 1408.In some instances, the time predefined cycle 1412 can be from such as first Armarium 1402 is sent to the parameter of the pacemaker impulse 1408 of the second armarium 1404, but without the need for so.

In some instances, transmitting electrical stimulating therapy can be by the transmission of therapy and one to the second armarium of heart Or multiple defibrillation pulse synchronizations.Used as an example, armarium may be configured to transmit the LCP of ATP therapies.System can With the SICD for further including to be configured to transmit defibrillation pulse.After system determines ARR generation, on arbitrarily State technology, SICD can send trigger to LCP with according to ATP therapies agreement according to herein in regard to Figure 11-Figure 14 Any illustrative technique transmission pacemaker impulse.During LCP transmits the time of ATP therapies, SICD can be to capacitor etc. Charge with transmitting defibrillation pulse.In SICD so that after fully charged to the capacitor etc. for defibrillation pulse, SICD can be with example Such as communicated with LCP to stop transmitting ATP therapies by sending stopping trigger.In other instances, LCP can be configured It is that for example in response to storage or reception burst length parameter, (it can be used for electricity with SICD only for special time amount Fully charged the spent time consistency or inconsistent of container), transmit ATP.After LCP stops transmission ATP therapies, system Can determine and still occur arrhythmia.If the system determine that still there is arrhythmia, then SICD can transmit defibrillation pulse To heart.If the system determine that no longer there is arrhythmia, then system can return normal operating state.

In some instances, LCP equipment can be triggering transmission equipment, wherein, the triggering to SICD causes SICD to start For defibrillation pulse charges.Depend on whether still to detect arrhythmia, another communication from LCP can cause SICD Transmission defibrillation pulse is abandoned transmitting defibrillation pulse.

In some instances, SICD determines whether arrhythmia.SICD can by its own or with from one Or the input that multiple LCP or other equipment are received combines, it is determined whether arrhythmia occurs.Then SICD can send tactile Signal to start ATP therapies.After trigger is received, before starting to transmit ATP therapies, LCP can be based on it The logic of itself, verifies ARR presence.For example, LCP can sense or receive the electrocardiogram (ECG) data of sensing and from the number According to determine whether occur arrhythmia.

In some cases, LCP or SICD can identify when arrhythmia using different differentiating methods. LCP for example quickly can recognize arrhythmia than SICD in less heart beating.LCP can for example in eight (8) secondary heart beatings Arrhythmia is recognized afterwards, and SICD can could recognize arrhythmia after 24 (24) secondary heart beatings.In some examples In, LCP only can recognize or distinguish arrhythmia using heart rate, and SICD can use electronic chart morphology additional or generation Arrhythmia is recognized or distinguished for heart rate.Can differently realize in LCP and SICD for arrhythmia identification and/or Other examples of the technology of differentiation include rate stability/unstability, time interval (such as rhythm of the heart of the given change of heart rate Uneven duration of seizure), the ARR persistent period, blood pressure, heart output, the comparison of atrium frequency and ventricle frequency, with frequency Spectral filter is created multiple versions of electronic chart, (is for example risen using electrode, using different type sensing electrode in different cardiac positions Fight electrode and electric-shock electrode), the cardiac conduction time (such as PR time intervals).

In some cases, LCP may operate in the sluggish communication link having in normal condition to SICD.At this In example, LCP can not receive or can prevent the signal such as trigger sent from SICD.In this example, LCP can be with Only activate communication link after LCP itself has determined that ARR generation.In other instances, LCP can be only in LCP certainly Body determine ARR probability it is very high or following (such as 1-60 minutes) occur ARR probability very it is high it Communication link is just activated afterwards.In this example, the inactive battery life that can increase LCP of communication link is kept.

Although describing some in above example with regard to LCP and SICD, disclosed methods and techniques can be used for Including any appropriate system of system disclosed herein, such as system including different types of equipment and/or including difference The system of number of devices.

Figure 15 is showing the flow chart of the illustrative method 1500 that can be realized by illustrative medical system.In Figure 15 In, as shown in 1502, first in multiple implantable medical devices determines transmission anti-tachyarrhythmia pacemaker therapy to patient Heart.For example, one or more in multiple implantable medical devices can sense and/or receive cardiac data.Based on sensing And/or the cardiac data for receiving, one or more in multiple implantable medical devices can such as according to as herein described any Technology determines ARR generation.Next, first in multiple implantable medical devices can send a message to it is multiple Second in implantable medical device.As shown in 1504, the message can indicate second in multiple implantable medical devices Individual transmission anti-tachyarrhythmia pacemaker (ATP) therapy is to patient's heart.For example, first in multiple implantable medical devices can be with Such as according to any of the above-described technology, trigger is sent to second in multiple implantable medical devices.As shown in 1506, ring Ying Yu receives the message, and second in multiple implantable medical devices can pass anti-tachyarrhythmia pacemaker (ATP) therapy and arrive Patient's heart.For example, second in multiple implantable medical devices can be such as according to any of the above-described technology in response to receiving Trigger transmits ATP therapies.

Figure 16 is showing the flow chart of the illustrative method 1600 that can be realized by illustrative medical system.In Figure 16 In, as shown in 1602, first in multiple implantable medical devices determines ARR generation, wherein, multiple implantation One or more in formula armarium can include SICD.In an example, SICD can sense one or more hearts Signal and/or receive one or more electrocardiosignaies from other equipment.SICD can be based on sensing and/or the heart signal for receiving Analysis, determine ARR generation.First (such as SICD) as shown in 1604, in multiple implantable medical devices Then can be in response to determining ARR generation, transmission anti-tachyarrhythmia pacemaker therapy is to patient's heart.For example, SICD can With arrhythmia determined by determination it is tachycardia and may further determine that and wish that system is aroused in interest in response to determined by Overrun and transmit ATP therapies.In some cases, as shown in 1606, SICD then can in response to determine tachycardia, The capacitor of shock channel is charged before transmission defibrillation pulse.In some instances, capacitor is charged and can take up tool The time of the non-momentary of body.As shown in 1608, then SICD can send out to second in multiple implantable medical devices Message is sent to transmit anti-tachyarrhythmia pacemaker therapy to heart, wherein, second in multiple implantable medical devices can be Without lead pacemaker.For example, SICD for example can send trigger to LCP according to any of the above-described technology.Such as in 1610 places Show, then LCP can transmit anti-tachyarrhythmia pacemaker (ATP) therapy to patient's heart during the charging of the capacitor of SICD. In some instances, LCP can coordinate the transmission of ATP therapies with the defibrillation pulse of SICD, as described in regard to Figure 14.

Those skilled in the art will be recognized that the disclosure can be expressed as the concrete reality except being described herein and envisioning Various forms outside example.For example, as described herein, various examples include one or more moulds for being described as performing various functions Block.However, other examples can include being divided into described function the attached of the more modules of module than saying description herein Plus module.In addition, other examples can be merged into described function in less module with other examples.Therefore, not On the premise of departing from the scope of the present disclosure as described in the appended claims and spirit, the deviation of form and details can be made.

Claims

1. a kind of method for operating medical system, methods described includes：

ARR generation is determined by the first implantable medical device in multiple implantable medical devices, wherein, it is described many The first implantable medical device in individual implantable medical device determines ARR generation using the first differentiating method；

ARR generation is determined by the second implantable medical device in multiple implantable medical devices, wherein, it is described many The second implantable medical device in individual implantable medical device determines ARR generation using the second differentiating method；

In from the first implantable medical device in the plurality of implantable medical device to the plurality of implantable medical device The second implantable medical device send indicate by the plurality of implantable medical device the first implantable medical device examine The ARR message for measuring.

2. method according to claim 1, wherein, the first implantable medical device in multiple implantable medical devices is The second implantable medical device in leadless cardiac pacemaker (LCP) also, multiple implantable medical devices is to be subcutaneously implanted Formula cardioverter-defibrillators (SICD).

3. the method according to claim 1 or any one of 2, wherein, first differentiating method is than secondth area Point method quickly determines ARR generation.

4. the method according to any one of Claim 1-3, wherein, first differentiating method is only using heart rate Determine ARR generation, and second differentiating method not only determines ARR generation using heart rate.

5. method according to claim 4, wherein, second differentiating method does not use heart rate ARR to determine Occur.

6. the method according to claim 4 or any one of 5, wherein, second differentiating method is using among following One or more：It is electronic chart morphology, rate stability/unstability, arrhythmia duration of seizure, ARR lasting Comparison and the cardiac conduction time of time, blood pressure, heart output, AR and Ventricular Rate.

7. the method according to any one of claim 4-6, wherein, second differentiating method is used by spectral filtering Two or more versions of the electronic chart of generation.

8. the method according to any one of claim 1-7, wherein, second differentiating method use from it is described First differentiating method compares the signal of one or more electrodes in different cardiac positions.

9. the method according to any one of claim 1-8, wherein, second in the plurality of implantable medical device At least one of below implantable medical device execution：In the first implanted from the plurality of implantable medical device Armarium is received after the ARR message for indicating to detect, and starts to determine ARR generation；With from institute State the first implantable medical device in multiple implantable medical devices receive indicate the ARR message that detects it Afterwards, complete to determine ARR generation.

10. a kind of implantable medical device, including：

Housing；

It is connected to the multiple electrodes of the housing；And

The controller being arranged in the housing, the controller is configured to：

Electrocardiosignal is received via the plurality of electrode；

Using the first differentiating method and the electrocardiosignal is based at least partially on, determines ARR generation；And

After using first differentiating method to determine ARR generation, it is ARR that transmission instruction is detected Message to the independent implantable medical device separated with the implantable medical device,

Wherein, independent armarium is configured with second differentiating methods different from first differentiating method to determine ARR generation.

11. implantable medical devices according to claim 10, wherein, first differentiating method is determined using heart rate ARR generation.

12. implantable medical devices according to any one of claim 10-11, wherein, second differentiating method ARR generation is not only determined using heart rate.

13. implantable medical devices according to any one of claim 10-12, wherein, second differentiating method Do not use heart rate to determine ARR generation.

14. implantable medical devices according to any one of claim 10-13, wherein, second differentiating method Using one or more among following：Electronic chart morphology, rate stability/unstability, arrhythmia duration of seizure, the heart Comparison and the cardiac conduction time of rule uneven persistent period, blood pressure, heart output, AR and Ventricular Rate.

15. implantable medical devices according to any one of claim 10-14, wherein, the independent implanted Armarium is configured at least one among execution below：

Receive in the first implantable medical device from the plurality of implantable medical device and indicate the rhythm of the heart for detecting not After neat message, start to determine ARR generation；With

Receive in the first implantable medical device from the plurality of implantable medical device and indicate the rhythm of the heart for detecting not After neat message, complete to determine ARR generation.