An apparatus has advanced amplifier Classes and low pass filter technologies for using software generated ascending or level waveforms that are effective when applying cardiac defibrillation and cardioversion waveforms which significantly reduce damage to the heart muscle. The apparatus comprises a waveform energy control system for delivering software generated waveforms comprising differentially driven Class D and Class B amplifier sections, wherein the Class D amplifier section produces Phase 1 ascending waveforms and has a programmable lowpass filter (LPF) and wherein the Class B amplifier section delivers hard-switched Phase 2 waveforms.

A method for extinguishing a cardiac arrhythmia utilizes destructive interference of the passing of the reentry wave tip of an anatomical reentry through a depolarized region created by a relatively low voltage electric field in such a way as to effectively unpin the anatomical reentry. Preferably, the relatively low voltage electric field is defined by at least one unpinning shock(s) that are lower than an expected lower limit of vulnerability as established, for example, by a defibrillation threshold test. By understanding the physics of the electric field distribution between cardiac cells, the method permits the delivery of an electric field sufficient to unpin the core of the anatomical reentry, whether the precise or estimated location of the reentry is known or unknown and without the risk of inducting ventricular fibrillation. A number of embodiments for performing the method are disclosed.

A wearable therapeutic device includes an external defibrillator configured to monitor electrical heart activity of a patient and a garment housing a first therapy electrode and a second therapy electrode. The first and second therapy electrodes are electrically coupled to the defibrillator. The garment releasably receives a plurality of replaceable receptacles configured to store a conductive gel in locations proximate to the therapy electrodes. A plurality of gas cartridges each disposed on one of the plurality of replaceable receptacles are configured to control a release of the stored conductive gel of the associated one of the plurality of replaceable receptacles by igniting. A plurality of conductive gel firing circuits each associated with and separate from each of the plurality of replaceable receptacles are configured to be operatively coupled to the gas cartridge to control the release of the stored conductive gel upon information being communicated from the external defibrillator.

A wearable monitoring and therapeutic device includes at least two sensing electrodes, including at least one of conductive thread sewn into a garment and/or a metallic surface sewn into the garment. The device includes at least two therapy electrodes and the garment, wherein the garment is configured to be worn about a torso of a subject. The garment includes a breathable and stretchable fabric, an elastic material, and a loose material. The device includes at least one defibrillator component including a power source, a conductive wiring configured to stretch to accommodate the subject's chest size and enhance comfort and couple any of the at least two therapy electrodes and the at least two sensing electrodes to the at least one defibrillator component, an alarm module operatively coupled to the at least one defibrillator component, and one or more response buttons operatively coupled to that at least one defibrillator component.

A method of subcutaneously injecting and anchoring a device to a bone, a muscle, and/or a tissue in a patient, the device having a clip configured to anchor the device to the bone, the muscle, or the tissue, includes making an incision in the patient. An instrument pre-loaded with the device is inserted through the incision. The instrument is advanced to the bone, the muscle, and/or the tissue upon which the device is to be anchored. A clip of the device is pushed onto the bone, the muscle, and/or the tissue using the instrument. The device is anchored to the bone, the muscle, and/or the tissue using the clip on the device.

A subcutaneously implantable device includes a housing, a clip attached to a top side of the housing, and an electrode. The clip is configured to anchor the device to a muscle, a bone, and/or a first tissue. The electrode is configured to contact an organ, a nerve, the first tissue, and/or a second tissue. Circuitry in the housing is in electrical communication with the electrode and is configured to sense an electrical signal from the organ, the nerve, the first tissue, and/or the second tissue through the electrode; deliver electrical stimulation to the organ, the nerve, the first tissue, and/or the second tissue through the electrode; and/or deliver a signal to a drug pump to provide a targeted or systemic therapeutic drug to the organ, the nerve, the first tissue, and/or the second tissue.

An apparatus has advanced amplifier Classes and low pass filter technologies for using software generated ascending or level waveforms that are effective when applying cardiac defibrillation and cardioversion waveforms which significantly reduce damage to the heart muscle. The apparatus comprises a waveform energy control system for delivering software generated waveforms comprising differentially driven Class D and Class B amplifier sections, wherein the Class D amplifier section produces Phase 1 ascending waveforms and has a programmable lowpass filter (LPF) and wherein the Class B amplifier section delivers hard-switched Phase 2 waveforms.

Techniques are disclosed for modulating the generation of charge current by operational circuitry included in an implantable medical device (IMD) for delivery of an induction stimulation pulse waveform by the IMD. The modulation may include modulating a charging circuit of the operational circuitry to facilitate the regulation of the induction stimulation pulse waveform. The techniques include monitoring an electrical parameter of a charging path during the delivery of the induction stimulation pulse and modulating the charging circuit based on the monitored electrical parameter.

A defibrillation device for administering an electrotherapy, such as a dual-sequential defibrillation (DSD) electrotherapy. The defibrillation device can include a defibrillation therapy module, a physiological parameter module and a control module. The defibrillation therapy module can output one or more energies and the physiological parameter module can receive one or more physiological parameters, including electrocardiogram (ECG) data. The control module can analyze the physiological parameters to determine an indication for the administration of an electrotherapy and can determine a DSD electrotherapy. The DSD electrotherapy can be based at least in part on the physiological parameters, the indication for the administration of an electrotherapy or a review of the ECG data.

Methods for terminating fibrillation in a fibrillating heart employing nanosecond pulsed electric fields (nsPEFs) are disclosed. nsPEF defibrillation demonstrates its effectiveness as a new defibrillation modality, achieving reliable defibrillation with energies that are an order of magnitude lower than those needed for conventional defibrillation (millisecond shocks with mono- and bi-phasic waveforms). Tests did not reveal any negative effect of nsPEF defibrillation on cardiac tissue, in particular, cardiac tissue treated with nsPEFs does not exhibit a baseline shift in the optical transmembrane potential signal (distinctive feature that indicates electroporation), or changes in action potential duration or shape. The mechanism of nsPEF defibrillation is likely different from conventional defibrillation since it does not rely on membrane charging but on the basis of displacement currents that flow within nanoseconds after the shock is applied. nsPEFs provide the technology for the next generation of defibrillators that help emergency medical services to treat patients effectively.