Method and apparatus for treating cardiac arrhythmia using auxiliary pulse

Claim 2

An implantable system for the defibrillation or cardioversion of the heart of a patient in need of such treatment, said system comprising: a primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area; a power supply; and a control circuit operatively associated with said primary electrodes, said auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising an auxiliary pulse sufficient to induce a cessation of propagation in said weak field area through said auxiliary electrode, followed by a defibrillation pulse through said primary electrodes delivered during said cessation of propagation in said weak field area; wherein said control circuit is configured to deliver a biphasic auxiliary pulse and a biphasic defibrillation pulse, with the first phase of said defibrillation pulse in opposite polarity to said auxiliary pulse.

Claim 3

A system according to claim 1, wherein said control circuit is configured so that a trailing edge voltage of said auxiliary pulse is equal to a leading edge voltage of said defibrillation pulse.

Claim 4

A system according to claim 1, wherein said control circuit is configured to deliver a monophasic auxiliary pulse of from 0.5 to 10 milliseconds in duration.

Claim 5

A system according to claim 1, wherein said control circuit is configured to deliver said defibrillation pulse within 20 milliseconds after said auxiliary pulse.

Claim 6

A system according to claim 1, wherein said at least one auxiliary electrode is configured for positioning through the coronary sinus and in either the apical third of the posterior cardiac vein or the apical half of the great cardiac vein.

Claim 7

A system according to claim 1, wherein each of said at least one auxiliary electrode is carried by a transvenous lead.

Claim 8

A system according to claim 1, wherein said power supply includes a capacitor.

Claim 9

A system according to claim 1, wherein said power supply includes a single capacitor, and wherein said control circuit is configured so that both said auxiliary pulse and said defibrillation pulse are generated by the discharge of said single capacitor.

Claim 10

A system according to claim 1, wherein said power supply includes a first and second capacitor, and wherein said control circuit is configured so that said auxiliary pulse is generated by the discharge of said first capacitor and said defibrillation pulse is generated by the discharge of said second capacitor.

Claim 11

A system according to claim 1, wherein said power supply includes a first and second capacitor, and wherein said control circuit is configured so that said auxiliary pulse is generated by the discharge of said first and second capacitors, and said defibrillation pulse is generated by the discharge of said first and second capacitors.

Claim 12

A system according to claim 1, wherein said control circuit is configured so that said auxiliary pulse is not more than 50% of the peak current and not more than 30% of the delivered energy of said defibrillation pulse.

Claim 13

An implantable system for the defibrillation of the ventricles of the heart of a patient in need of such treatment, said system comprising: a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area, with said at least one auxiliary electrode configured for positioning through the coronary sinus and in a vein on the surface of the left ventricle of said heart; a power supply; and a control circuit operatively associated with said primary electrodes, said at least one auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising a biphasic auxiliary pulse through said auxiliary electrode, followed by a biphasic defibrillation pulse through said primary electrodes, with said defibrillation pulse delivered within 20 milliseconds after said auxiliary pulse, and with the first phase of said defibrillation pulse in opposite polarity to said auxiliary pulse.

Claim 14

An implantable system for the defibrillation of the ventricles of the heart of a patient in need of such treatment, said system comprising: a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area, with said at least one auxiliary electrode configured for positioning through the coronary sinus and in a vein on the surface of the left ventricle of said heart; a power supply; and a control circuit operatively associated with said primary electrodes, said at least one auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising a biphasic auxiliary pulse through said auxiliary electrode, followed by a biphasic defibrillation pulse through said primary electrodes, with said defibrillation pulse delivered within 20 milliseconds after said auxiliary pulse, and with the first phase of said defibrillation pulse in opposite polarity to said auxiliary pulse.

Claim 15

A system according to claim 12, wherein said control circuit is configured so that a trailing edge voltage of said auxiliary pulse is equal to a leading edge voltage of said defibrillation pulse.

Claim 16

A system according to claim 12, comprising: a first primary electrode configured for positioning in the superior vena cava or innominate vein; and a second primary electrode configured for positioning in the right ventricle.

Claim 17

A system according to claim 14, wherein said first and second primary electrodes are carried by a common transvenous lead.

Claim 18

A system according to claim 12, comprising: a first primary electrode configured for positioning in the superior vena cava or innominate vein; a second primary electrode configured for positioning in the right ventricle; and a second auxiliary electrode positioned near the right ventricular conus; with said control circuit configured for delivering said monophasic auxiliary pulse through said first and second auxiliary electrodes.

Claim 19

A system according to claim 16, with said second auxiliary electrode configured for positioning in the anterior portion of the right atrial appendage or in the right ventricular outflow track.

Claim 20

A system according to claim 16, wherein said second auxiliary electrode is carried by a transvenous lead, and wherein said second auxiliary electrode is positioned on the distal end of said transvenous lead.

Claim 21

A system according to claim 16, wherein said first and second primary electrodes are carried by a common transvenous lead.

Claim 22

A system according to claim 12, wherein said power supply includes a single capacitor, and wherein said control circuit is configured so that both said auxiliary pulse and said defibrillation pulse are generated by the discharge of said single capacitor.

Claim 23

A system according to claim 12, wherein said power supply includes a first and second capacitor, and wherein said control circuit is configured so that said auxiliary pulse is generated by the discharge of said first capacitor and said defibrillation pulse is generated by the discharge of said second capacitor.

Claim 24

A system according to claim 12, wherein said power supply includes a first and second capacitor, and wherein said control circuit is configured so that said auxiliary pulse is generated by the discharge of said first and second capacitors, and said defibrillation pulse is generated by the discharge of said first and second capacitors.

Claim 25

An implantable system for the defibrillation or cardioversion of the heart of a patient in need of such treatment, said system comprising: a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area; a power supply; and a control circuit operatively associated with said primary electrodes, said auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising a defibrillation pulse through said primary electrodes, followed by an auxiliary pulse sufficient to induce a cessation of propagation in said weak field area through said auxiliary electrode; wherein said control circuit is configured to deliver a biphasic auxiliary pulse and a biphasic defrillation pulse; and wherein said control circuit is configured so that a leading edge voltage of said auxiliary pulse is equal to a trailing edge voltage of said defibrillation pulse.

Claim 26

An implantable system for the defibrillation or cardioversion of the heart of a patient in need of such treatment, said system comprising: a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area; a power supply; and a control circuit operatively associated with said primary electrodes, said auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising a defibrillation pulse through said primary electrodes, followed by an auxiliary pulse sufficient to induce a cessation of propagation in said weak field area through said auxiliary electrode; wherein said control circuit is configured to deliver a biphasic auxiliary pulse and a biphasic defrillation pulse; and wherein said control circuit is configured so that a leading edge voltage of said auxiliary pulse is equal to a trailing edge voltage of said defibrillation pulse.

Claim 27

A system according to claim 23, wherein said control circuit is configured to deliver a monophasic auxiliary pulse of from 0.5 to 10 milliseconds in duration.

Claim 28

A system according to claim 23, wherein said control circuit is configured to deliver said defibrillation pulse within 20 milliseconds after said auxiliary pulse.

Claim 29

A system according to claim 23, wherein said at least one auxiliary electrode is configured for positioning through the coronary sinus and in a vein on the surface of the left ventricle of said heart.

Claim 30

A system according to claim 23, wherein said at least one auxiliary electrode is configured for positioning through the coronary sinus and in either the apical third of the posterior cardiac vein or the apical half of the great cardiac vein.

Claim 31

A system according to claim 23, wherein each of said plurality of primary electrodes is carried by a transvenous lead.

Claim 32

A system according to claim 23, wherein each of said at least one auxiliary electrode is carried by a transvenous lead.

Claim 33

A system according to claim 23, wherein said power supply includes a capacitor.

Claim 34

A system according to claim 23, wherein said power supply includes a single capacitor, and wherein said control circuit is configured so that both said auxiliary pulse and said defibrillation pulse are generated by the discharge of said single capacitor.

Claim 35

A system according to claim 23, wherein said power supply includes a first and second capacitor, and wherein said control circuit is configured so that said auxiliary pulse is generated by the discharge of said first capacitor and said defibrillation pulse is generated by the discharge of said second capacitor.

Claim 36

A system according to claim 23, wherein said power supply includes a first and second capacitor, and wherein said control circuit is configured so that said auxiliary pulse is generated by the discharge of said first and second capacitors, and said defibrillation pulse is generated by the discharge of said first and second capacitors.

Claim 37

An implantable system for the defibrillation of the ventricles of the heart of a patient in need of such treatment, said system comprising: a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area, with said at least one auxiliary electrode configured for positioning through the coronary sinus and in a vein on the surface of the left ventricle of said heart; a power supply; and a control circuit operatively associated with said primary electrodes, said at least one auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising a biphasic defibrillation pulse through said primary electrodes followed by a biphasic auxiliary pulse through said auxiliary electrode, with said auxiliary pulse delivered within 20 milliseconds after said auxiliary pulse, and with the first phase of said defibrillation pulse in opposite polarity to said auxiliary pulse; wherein said system further comprises a first primary electrode configured for positioning in the superior vena cava or innominate vein; a second primary electrode configured for positioning in the right ventricle; and a second auxiliary electroden positioning near the right ventricular conus; with said control circuit configured for delivering said monophasic auxiliary pulse through said first and second auxiliary electrode.

Claim 38

An implantable system for the defibrillation of the ventricles of the heart of a patient in need of such treatment, said system comprising: a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area, with said at least one auxiliary electrode configured for positioning through the coronary sinus and in a vein on the surface of the left ventricle of said heart; a power supply; and a control circuit operatively associated with said primary electrodes, said at least one auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising a biphasic defibrillation pulse through said primary electrodes followed by a biphasic auxiliary pulse through said auxiliary electrode, with said auxiliary pulse delivered within 20 milliseconds after said auxiliary pulse, and with the first phase of said defibrillation pulse in opposite polarity to said auxiliary pulse; wherein said system further comprises a first primary electrode configured for positioning in the superior vena cava or innominate vein; a second primary electrode configured for positioning in the right ventricle; and a second auxiliary electroden positioning near the right ventricular conus; with said control circuit configured for delivering said monophasic auxiliary pulse through said first and second auxiliary electrode.

Claim 39

A system according to claim 34, wherein said control circuit is configured so that a leading edge voltage of said auxiliary pulse is equal to a trailing edge voltage of said defibrillation pulse.

Claim 40

A system according to claim 34, with said second auxiliary electrode configured for positioning in the anterior portion of the right atrial appendage or in the right ventricular outflow track.

Claim 41

A system according to claim 34, wherein said second auxiliary electrode is carried by a transvenous lead, and wherein said second auxiliary electrode is positioned on the distal end of said transvenous lead.

Claim 42

A system according to claim 34, wherein said first and second primary electrodes are carried by a common transvenous lead.

Claim 43

A system according to claim 34, wherein said power supply includes a single capacitor, and wherein said control circuit is configured so that both said auxiliary pulse and said defibrillation pulse are generated by the discharge of said single capacitor.

Claim 44

A system according to claim 34, wherein said power supply includes a first and second capacitor, and wherein said control circuit is configured so that said auxiliary pulse is generated by the discharge of said first capacitor and said defibrillation pulse is generated by the discharge of said second capacitor.

Claim 45

A system according to claim 34, wherein said power supply includes a first and second capacitor, and wherein said control circuit is configured so that said auxiliary pulse is generated by the discharge of said first and second capacitors, and said defibrillation pulse is generated by the discharge of said first and second capacitors.

Claim 46

An electrode lead useful for the cardioversion or defibrillation of a patient's heart, comprising: an elongate transvencous electrode lead having a distal end portion, with said lead configured for positioning said distal end portion within the right atrial appendage; and a primary electrode connected to said electrode lead and positioned on said distal end portion; further comprising a secondary pace/sense electrode connected to said electrode lead at said distal end portion; wherein said secondary pace/sense electrode is connected to said electrode lead in a position proximal to said electrode.

Claim 47

An electrode lead useful for the cardioversion or defibrillation of a patient's heart, comprising: an elongate transvencous electrode lead having a distal end portion, with said lead configured for positioning said distal end portion within the right atrial appendage; and a primary electrode connected to said electrode lead and positioned on said distal end portion; further comprising a secondary pace/sense electrode connected to said electrode lead at said distal end portion; wherein said secondary pace/sense electrode is connected to said electrode lead in a position proximal to said electrode.

Claim 48

An electrode lead according to claim 42, wherein said secondary pace/sense electrode comprises a pair of ring electrodes.

Claim 49

An implantable system for the defibrillation of the ventricles of the heart of a patient in need of such treatment, said system comprising: a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart, said plurality of primary electrodes including an electrode configured for positioning in the right ventricle; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area, with said at least one auxiliary electrode configured for positioning through the coronary sinus and in a vein on the surface of the left ventricle of said heart; a power supply; and a control circuit operatively associated with said primary electrodes, said at least one auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising a biphasic defibrillation pulse through said primary electrodes followed by a biphasic auxiliary pulse through said auxiliary electrode, with said auxiliary pulse delivered within 20 milliseconds after said defibrillation pulse, and with the first phase of said defibrillation pulse in opposite polarity to said auxiliary pulse.

Claim 50

An implantable system for the defibrillation of the ventricles of the heart of a patient in need of such treatment, said system comprising: a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart, said plurality of primary electrodes including an electrode configured for positioning in the right ventricle; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area, with said at least one auxiliary electrode configured for positioning through the coronary sinus and in a vein on the surface of the left ventricle of said heart; a power supply; and a control circuit operatively associated with said primary electrodes, said at least one auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising a biphasic defibrillation pulse through said primary electrodes followed by a biphasic auxiliary pulse through said auxiliary electrode, with said auxiliary pulse delivered within 20 milliseconds after said defibrillation pulse, and with the first phase of said defibrillation pulse in opposite polarity to said auxiliary pulse.

Claim 51

A system according to claim 44, further comprising a housing configured for being implanted in the left thoracic region of said patient, said housing containing said power supply and said control circuit, and with said housing having an active external portion serving as a second primary electrode.

Claim 52

A system according to claim 45, wherein said auxiliary pulse is delivered between said auxiliary electrode and said second primary electrode.

Claim 53

A system according to claim 44, further comprising a second primary electrode configured for positioning in the superior vena cava or innominate vein.

Claim 54

A system according to claim 47, wherein said auxiliary pulse is delivered between said auxiliary electrode and said second primary electrode.

Claim 55

A system according to claim 44, further comprising: a housing configured for being implanted in the left thoracic region of said patient, said housing containing said power supply and said control circuit, and with said housing having an active external portion serving as a second primary electrode; and a third primary electrode configured for positioning in the superior vena cava or innominate vein; wherein said second and third primary electrodes are electrically common.

Claim 56

A system according to claim 49, wherein said auxiliary pulse is delivered between said auxiliary electrode, and said second and third electrically common primary electrodes.

Claim 57

A system according to claim 44, wherein said control circuit is configured so that a leading edge voltage of said auxiliary pulse is equal to a trailing edge voltage of said defibrillation pulse.

Claim 58

An implantable system for the defibrillation of the ventricles of the heart of a patient in need of such treatment, said system comprising: a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart, said plurality of primary electrodes including an electrode configured for positioning in the right ventricle; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area, with said at least one auxiliary electrode configured for positioning through the coronary sinus and in a vein on the surface of the left ventricle of said heart; a power supply; and a control circuit operatively associated with said primary electrodes, said at least one auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising an auxiliary pulse through said auxiliary electrode followed by a biphasic defibrillation pulse through said primary electrodes, with said defibrillation pulse delivered within 20 milliseconds after said auxiliary pulse, and with the first phase of said defibrillation pulse in opposite polarity to said auxiliary pulse; further comprising a housing configured for being implanted in the left thoracic region of said patient, said housing containing said power supply and said control circuit and with said housing having an active external portion serving as a second primary electrode.

Claim 59

An implantable system for the defibrillation of the ventricles of the heart of a patient in need of such treatment, said system comprising: a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart, said plurality of primary electrodes including an electrode configured for positioning in the right ventricle; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area, with said at least one auxiliary electrode configured for positioning through the coronary sinus and in a vein on the surface of the left ventricle of said heart; a power supply; and a control circuit operatively associated with said primary electrodes, said at least one auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising an auxiliary pulse through said auxiliary electrode followed by a biphasic defibrillation pulse through said primary electrodes, with said defibrillation pulse delivered within 20 milliseconds after said auxiliary pulse, and with the first phase of said defibrillation pulse in opposite polarity to said auxiliary pulse; further comprising a housing configured for being implanted in the left thoracic region of said patient, said housing containing said power supply and said control circuit and with said housing having an active external portion serving as a second primary electrode.

Claim 60

A system according to claim 52, wherein said auxiliary pulse is delivered between said auxiliary electrode and said second primary electrode.

Claim 61

A system according to claim 52, wherein said control circuit is configured so that a leading edge voltage of said auxiliary pulse is equal to a trailing edge voltage of said defibrillation pulse.

Claim 62

An implantable defibrillator, comprising: a housing; a power supply contained within said housing, with said power supply including a storage capacitor; and a control circuit contained within said housing and operatively associated with said power supply, said control circuit configured for delivering a cardioversion sequence comprising an auxiliary pulse and a defibrillation pulse; said housing having a volume less than 35 cubic centimeters.

Claim 63

An implantable defibrillator, comprising: a housing; a power supply contained within said housing, with said power supply including a storage capacitor; and a control circuit contained within said housing and operatively associated with said power supply, said control circuit configured for delivering a cardioversion sequence comprising an auxiliary pulse and a defibrillation pulse; said housing having a volume less than 35 cubic centimeters.

Claim 64

An implantable defibrillator according to claim 55, said power supply further comprising a battery.

Claim 65

An implantable defibrillator according to claim 55, wherein said control circuit is configured so that said defibrillation pulse follows said auxiliary pulse, and so that a trailing edge voltage of said auxiliary pulse is equal to a leading edge voltage of said defibrillation pulse.

Claim 66

An implantable defibrillator according to claim 55, wherein said control circuit is configured so tat said auxiliary pulse follows said defibrillation pulse, and so that a trailing edge voltage of said defibrillation pulse is equal to a leading edge voltage of said auxiliary pulse.

Claim 67

An implantable defibrillator according to claim 55, said housing having a volume of at least 5 cubic centimeters.

Claim 68

An implantable system for the defibrillation or cardioversion of the heart of a patient in need of such treatment, said system comprising: a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area; a power supply; and a control circuit operatively associated with said primary electrodes, said auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising an auxiliary pulse sufficient to induce a cessation of propagation in said weak field area through said auxiliary electrode, followed by a defibrillation pulse through said primary electrodes delivered during said cessation of propagation in said weak field area; wherein said at least one auxiliary electrode is configured for positioning through the coronary sinus and in a vein on the surface of the left ventricle of said heart.

Claim 69

An implantable system for the defibrillation or cardioversion of the heart of a patient in need of such treatment, said system comprising: a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area; a power supply; and a control circuit operatively associated with said primary electrodes, said auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising an auxiliary pulse sufficient to induce a cessation of propagation in said weak field area through said auxiliary electrode, followed by a defibrillation pulse through said primary electrodes delivered during said cessation of propagation in said weak field area; wherein said at least one auxiliary electrode is configured for positioning through the coronary sinus and in a vein on the surface of the left ventricle of said heart.

Claim 70

An implantable system for the defibrillation or cardioversion of the heart of a patient in need of such treatment, said system comprising: a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area; a power supply; and a control circuit operatively associated with said primary electrodes, said auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising an auxiliary pulse sufficient to induce a cessation of propagation in said weak field area through said auxiliary electrode, followed by a defibrillation pulse through said primary electrodes delivered during said cessation of propagation in said weak field area; wherein said at least one auxiliary electrode is configured for positioning through the coronary sinus and in a vein on the postero-lateral surface of the left ventricle of said heart.

Claim 71

An implantable system for the defibrillation or cardioversion of the heart of a patient in need of such treatment, said system comprising: a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area; a power supply; and a control circuit operatively associated with said primary electrodes, said auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising an auxiliary pulse sufficient to induce a cessation of propagation in said weak field area through said auxiliary electrode, followed by a defibrillation pulse through said primary electrodes delivered during said cessation of propagation in said weak field area; wherein said at least one auxiliary electrode is configured for positioning through the coronary sinus and in a vein on the postero-lateral surface of the left ventricle of said heart.

Claim 72

An implantable system for the defibrillation or cardioversion of the heart of a patient in need of such treatment, said system comprising; a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area; a power supply; and a control circuit operatively associated with said primary electrodes, said auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising an auxiliary pulse sufficient to induce a cessation of propagation in said weak field area through said auxiliary electrode, followed by a defibrillation pulse through said primary electrodes delivered during said cessation of propagation in said weak field area; wherein each of said plurality of primary electrodes is carried by a transvenous lead.

Claim 73

An implantable system for the defibrillation or cardioversion of the heart of a patient in need of such treatment, said system comprising; a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area; a power supply; and a control circuit operatively associated with said primary electrodes, said auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising an auxiliary pulse sufficient to induce a cessation of propagation in said weak field area through said auxiliary electrode, followed by a defibrillation pulse through said primary electrodes delivered during said cessation of propagation in said weak field area; wherein each of said plurality of primary electrodes is carried by a transvenous lead.

Claim 74

An implantable system for the defibrillation or cardioversion of the heart of a patient in need of such treatment, said system comprising: a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area; a power supply; and a control circuit operatively associated with said primary electrodes, said auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising an auxiliary pulse sufficient to induce a cessation of propagation in said weak field area through said auxiliary electrode, followed by a defibrillation pulse through said primary electrodes delivered during said cessation of propagation in said weak field area; wherein said power supply includes a 20 to 400 microfarad capacitor.

Claim 75

An implantable system for the defibrillation or cardioversion of the heart of a patient in need of such treatment, said system comprising: a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area; a power supply; and a control circuit operatively associated with said primary electrodes, said auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising an auxiliary pulse sufficient to induce a cessation of propagation in said weak field area through said auxiliary electrode, followed by a defibrillation pulse through said primary electrodes delivered during said cessation of propagation in said weak field area; wherein said power supply includes a 20 to 400 microfarad capacitor.

Claim 76

An implantable system for the defibrillation or cardioversion of the heart of a patient in need of such treatment, said system comprising: a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area; a power supply; and a control circuit operatively associated with said primary electrodes, said auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising a defibrillation pulse through said primary electrodes, followed by an auxiliary pulse sufficient to induce a cessation of propagation in said weak field area through said auxiliary electrode; wherein said control circuit is configured to deliver a monophasic auxiliary pulse of from 0.5 to 10 milliseconds in duration.

Claim 77

An implantable system for the defibrillation or cardioversion of the heart of a patient in need of such treatment, said system comprising: a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area; a power supply; and a control circuit operatively associated with said primary electrodes, said auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising a defibrillation pulse through said primary electrodes, followed by an auxiliary pulse sufficient to induce a cessation of propagation in said weak field area through said auxiliary electrode; wherein said control circuit is configured to deliver a monophasic auxiliary pulse of from 0.5 to 10 milliseconds in duration.

Claim 78

An implantable system for the defibrillation or cardioversion of the heart of a patient in need of such treatment, said system comprising: a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area; a power supply; and a control circuit operatively associated with said primary electrodes, said auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising a defibrillation pulse through said primary electrodes, followed by an auxiliary pulse sufficient to induce a cessation of propagation in said weak field area through said auxiliary electrode; wherein said at least one auxiliary electrode is configured for positioning through the coronary sinus and in a vein on the postero lateral surface of the left ventricle of said heart.

Claim 79

An implantable system for the defibrillation or cardioversion of the heart of a patient in need of such treatment, said system comprising: a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area; a power supply; and a control circuit operatively associated with said primary electrodes, said auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising a defibrillation pulse through said primary electrodes, followed by an auxiliary pulse sufficient to induce a cessation of propagation in said weak field area through said auxiliary electrode; wherein said at least one auxiliary electrode is configured for positioning through the coronary sinus and in a vein on the postero lateral surface of the left ventricle of said heart.

Claim 80

An implantable system for the defibrillation or cardioversion of the heart of a patient in need of such treatment, said system comprising: a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area; a power supply; and a control circuit operatively associated with said primary electrodes, said auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising a defibrillation pulse through said primary electrodes, followed by an auxiliary pulse sufficient to induce a cessation of propagation in said weak field area through said auxiliary electrode; wherein said power supply includes a 20 to 400 microfarad capacitor.

Claim 81

An implantable system for the defibrillation or cardioversion of the heart of a patient in need of such treatment, said system comprising: a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area; a power supply; and a control circuit operatively associated with said primary electrodes, said auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising a defibrillation pulse through said primary electrodes, followed by an auxiliary pulse sufficient to induce a cessation of propagation in said weak field area through said auxiliary electrode; wherein said power supply includes a 20 to 400 microfarad capacitor.

Claim 82

An implantable system for the defibrillation or cardioversion of the heart of a patient in need of such treatment, said system comprising: a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area; a power supply; and a control circuit operatively associated with said primary electrodes, said auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising a defibrillation pulse through said primary electrodes, followed by an auxiliary pulse sufficient to induce a cessation of propagation in said weak field area through said auxiliary electrode; wherein said control circuit is configured so that said auxiliary pulse is not more than 50% of the peak current and not more than 30% of the delivered energy of said defibrillation pulse.

Claim 83

An implantable system for the defibrillation or cardioversion of the heart of a patient in need of such treatment, said system comprising: a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area; a power supply; and a control circuit operatively associated with said primary electrodes, said auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising a defibrillation pulse through said primary electrodes, followed by an auxiliary pulse sufficient to induce a cessation of propagation in said weak field area through said auxiliary electrode; wherein said control circuit is configured so that said auxiliary pulse is not more than 50% of the peak current and not more than 30% of the delivered energy of said defibrillation pulse.

Claim 84

An implantable system for the defibrillation of the ventricles of the heart of a patient in need of such treatment, said system comprising: a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area, with said at least one auxiliary electrode configured for positioning through the coronary sinus and in a vein on the surface of the left ventricle of said heart; a power supply; and a control circuit operatively associated with said primary electrodes, said at least one auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising a biphasic defibrillation pulse through said primary electrodes followed by a biphasic auxiliary pulse through said auxiliary electrode, with said auxiliary pulse delivered within 20 milliseconds after said auxiliary pulse, and with the first phase of said defibrillation pulse in opposite polarity to said auxiliary pulse; said system comprising a first primary electrode configured for positioning in the superior vena cava or innominate vein; and a second primary electrode configured for positioning in the right ventricle.

Claim 85

An implantable system for the defibrillation of the ventricles of the heart of a patient in need of such treatment, said system comprising: a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area, with said at least one auxiliary electrode configured for positioning through the coronary sinus and in a vein on the surface of the left ventricle of said heart; a power supply; and a control circuit operatively associated with said primary electrodes, said at least one auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising a biphasic defibrillation pulse through said primary electrodes followed by a biphasic auxiliary pulse through said auxiliary electrode, with said auxiliary pulse delivered within 20 milliseconds after said auxiliary pulse, and with the first phase of said defibrillation pulse in opposite polarity to said auxiliary pulse; said system comprising a first primary electrode configured for positioning in the superior vena cava or innominate vein; and a second primary electrode configured for positioning in the right ventricle.

Claim 86

An implantable system for the defibrillation of the ventricles of the heart of a patient in need of such treatment, said system comprising: a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area, with said at least one auxiliary electrode configured for positioning through the coronary sinus and in a vein on the surface of the left ventricle of said heart; a power supply; and a control circuit operatively associated with said primary electrodes, said at least one auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising a biphasic defibrillation pulse through said primary electrodes followed by a biphasic auxiliary pulse through said auxiliary electrode, with said auxiliary pulse delivered within 20 milliseconds after said auxiliary pulse, and with the first phase of said defibrillation pulse in opposite polarity to said auxiliary pulse.

Claim 87

An implantable system for the defibrillation of the ventricles of the heart of a patient in need of such treatment, said system comprising: a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area, with said at least one auxiliary electrode configured for positioning through the coronary sinus and in a vein on the surface of the left ventricle of said heart; a power supply; and a control circuit operatively associated with said primary electrodes, said at least one auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising a biphasic defibrillation pulse through said primary electrodes followed by a biphasic auxiliary pulse through said auxiliary electrode, with said auxiliary pulse delivered within 20 milliseconds after said auxiliary pulse, and with the first phase of said defibrillation pulse in opposite polarity to said auxiliary pulse.

Claim 88

An implantable system according to claim 69, wherein said first and second primary electrodes are carried by a common transvenous lead.

Claim 89

An implantable system for the defibrillation of the ventricles of the heart of a patient in need of such treatment, said system comprising: a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart, said plurality of primary electrodes including an electrode configured for positioning in the right ventricle; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area, with said at least one auxiliary electrode configured for positioning through the coronary sinus and in a vein on the surface of the left ventricle of said heart; a power supply; and a control circuit operatively associated with said primary electrodes, said at least one auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising an auxiliary pulse through said auxiliary electrode followed by a biphasic defibrillation pulse through said primary electrodes, with said defibrillation pulse delivered within 20 milliseconds after said auxiliary pulse, and with the first phase of said defibrillation pulse in opposite polarity to said auxiliary pulse; further comprising a second primary electrode configured for positioning in the superior vena cava or innominate vein.

Claim 90

An implantable system for the defibrillation of the ventricles of the heart of a patient in need of such treatment, said system comprising: a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart, said plurality of primary electrodes including an electrode configured for positioning in the right ventricle; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area, with said at least one auxiliary electrode configured for positioning through the coronary sinus and in a vein on the surface of the left ventricle of said heart; a power supply; and a control circuit operatively associated with said primary electrodes, said at least one auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising an auxiliary pulse through said auxiliary electrode followed by a biphasic defibrillation pulse through said primary electrodes, with said defibrillation pulse delivered within 20 milliseconds after said auxiliary pulse, and with the first phase of said defibrillation pulse in opposite polarity to said auxiliary pulse; further comprising a second primary electrode configured for positioning in the superior vena cava or innominate vein.

Claim 91

A system according to claim 71, wherein said auxiliary pulse is delivered between said auxiliary electrode and said second primary electrode.

Claim 92

An implantable system for the defibrillation of the ventricles of the heart of a patient in need of such treatment, said system comprising: a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart, said plurality of primary electrodes including an electrode configured for positioning in the right ventricle; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area, with said at least one auxiliary electrode configured for positioning through the coronary sinus and in a vein on the surface of the left ventricle of said heart; a power supply; and a control circuit operatively associated with said primary electrodes, said at least one auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising an auxiliary pulse through said auxiliary electrode followed by a biphasic defibrillation pulse through said primary electrodes, with said defibrillation pulse delivered within 20 milliseconds after said auxiliary pulse, and with the first phase of said defibrillation pulse in opposite polarity to said auxiliary pulse, said system further comprising: a housing configured for being implanted in the left thoracic region of said patient, said housing containing said power supply and said control circuit, and with said housing having an active external portion serving as a second primary electrode; and a third primary electrode configured for positioning in the superior vena cava or innominate vein; wherein said second and third primary electrodes are electrically common.

Claim 93

An implantable system for the defibrillation of the ventricles of the heart of a patient in need of such treatment, said system comprising: a plurality of primary electrodes configured for delivering a defibrillation pulse along a predetermined current pathway in a first portion of said heart, said current pathway defining a weak field area in a second portion of said heart, said plurality of primary electrodes including an electrode configured for positioning in the right ventricle; at least one auxiliary electrode configured for delivering an auxiliary pulse to said weak field area, with said at least one auxiliary electrode configured for positioning through the coronary sinus and in a vein on the surface of the left ventricle of said heart; a power supply; and a control circuit operatively associated with said primary electrodes, said at least one auxiliary electrode, and said power supply, said control circuit configured for delivering a cardioversion sequence comprising an auxiliary pulse through said auxiliary electrode followed by a biphasic defibrillation pulse through said primary electrodes, with said defibrillation pulse delivered within 20 milliseconds after said auxiliary pulse, and with the first phase of said defibrillation pulse in opposite polarity to said auxiliary pulse, said system further comprising: a housing configured for being implanted in the left thoracic region of said patient, said housing containing said power supply and said control circuit, and with said housing having an active external portion serving as a second primary electrode; and a third primary electrode configured for positioning in the superior vena cava or innominate vein; wherein said second and third primary electrodes are electrically common.

Claim 94

A system according to claim 73, wherein said auxiliary pulse is delivered between said auxiliary electrode, and said second and third electrically common primary electrodes.