Implantable cardioverter defibrillator with automatic switching to a pre-set pacing mode following delivery of a shock

7,610,087

10/529430

August 19, 2003

An implantable cardiac stimulator, such as a cardioverter defibrillator, is operable in an autocapture mode. Following the delivery of a defibrillation or cardioversion shock, the stimulator switches from the autocapture mode to a post-shock mode, in which predetermined pacing pulse parameter settings are used for the delivery of pacing pulses. Following the expiration of a predetermined time interval, which may be extendable, the stimulator switches back to the autocapture mode.

Öhman, Magnus (Hässelby, SE); Larsson, Berit (Danderyd, SE)

St. Jude Medical Ab (Jarfalla, SE)

1. An implantable cardiac stimulator comprising: a pacing pulse generator configured to deliver pacing pulses to at least one chamber of a heart; a high energy pulse generator configured to deliver at least one shock selected from the group consisting of cardioversion shocks and defibrillation shocks to at least one chamber of the heart; sensing circuitry configured to interact with the heart to sense intrinsic cardiac activity and cardiac activity resulting from capture following a delivered pacing pulse; and a control unit connected to said pacing pulse generator, said high energy pulse generator and said sensing circuitry that normally operates said pacing pulse generator in a first mode, including executing an autocapture mode, and that automatically switches said pacing pulse generator from operating in said first mode to operate in a second mode following delivery of a shock by said high energy pulse generator for a post-shock duration and, in said second mode, said control unit operating said pacing pulse to deliver pacing pulses with fixed settings for said pacing pulses and the control circuit does not operate the pacing pulse generator in the autocapture mode during the post-shock duration; and said sensing circuitry also being configured to measure signal characteristics of said intrinsic cardiac activity signal following said shock, and wherein said control unit is configured to switch said pacing pulse generator back to said first mode after said post-shock duration, wherein the post-shock duration is extendable by said control unit, dependent on said characteristics of the sensed intrinsic cardiac activity following said shock, until the control unit determines that resumption of said autocapture mode in said first mode will be unaffected by said delivery of said shock.

2. An implantable cardiac stimulator as claimed in claim 1 wherein said post-shock duration is in a range between one minute and fifteen minutes.

3. An implantable cardiac stimulator as claimed in claim 2 wherein said post-shock duration is in a range between five minutes and ten minutes.

4. An implantable cardiac stimulator as claimed in claim 1 wherein said post-shock duration comprises a predetermined basic time interval, and wherein said sensing circuitry measures said signal characteristics prior to expiration of said basic time interval, and wherein said control unit extends said post-shock duration dependent on said characteristics, prior to said expiration of said basic time interval, by adding an extension time interval onto said basic time interval.

5. An implantable cardiac stimulator as claimed in claim 4 wherein said sensing circuitry continues to measure said characteristics prior to expiration of said extension time interval, and wherein said control unit, prior to said expiration of said extension time interval, adds a further extension time interval onto said extension time interval dependent on said characteristics.

6. An implantable cardiac stimulator as claimed in claim 4 wherein said extension time interval is in a range between five minutes and fifteen minutes.

7. An implantable cardiac stimulator as claimed in claim 6 wherein said extension time interval is approximately ten minutes.

8. An implantable cardiac stimulator as claimed in claim 4 wherein said basic time interval is in a range between one minute and fifteen minutes.

9. An implantable cardiac stimulator as claimed in claim 8 wherein said basic time interval is in a range between five minutes and ten minutes.

10. An implantable cardiac stimulator as claimed in claim 1 wherein said characteristics comprise an amplitude of said cardiac activity signal.

11. An implantable cardiac stimulator as claimed in claim 1 wherein said pacing pulse generator includes a pacing pulse delivery arrangement adapted to deliver said pacing pulses to a ventricle of the heart.

12. An implantable cardiac stimulator as claimed in claim 1 wherein said pacing pulse generator includes a pacing pulse delivery arrangement adapted to deliver said pacing pulses to an atrium of the heart.

13. An implantable cardiac stimulator as claimed in claim 1 wherein said high energy pulse generator includes a delivery arrangement adapted to deliver said shock to a ventricle of the heart.

14. An implantable cardiac stimulator as claimed in claim 1 wherein said high energy pulse generator includes a delivery arrangement adapted to deliver said shock to an atrium of the heart.

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edspgr.07610087