Methods and apparatus for a three-stage ventricular cardioversion and defibrillation therapy that treats ventricular tachycardia and fibrillation at low energy levels. An implantable therapy generator adapted to generate and selectively deliver a three-stage ventricular therapy and at least two leads operably each having at least one electrode adapted to be positioned proximate the ventricle of the patient. The device is programmed to deliver a three-stage therapy via both a far-field configuration and a near-field configuration of the electrodes upon detection of a ventricular arrhythmia. The three-stage therapy includes a first stage for unpinning of one or more singularities associated with the ventricular arrhythmia, a second stage for anti-repinning of the one or more singularities, both of which are delivered via the far-field configuration of the electrodes, and a third stage for extinguishing of the one or more singularities associated delivered via the near-field configuration of the electrodes.

A wearable monitoring and therapeutic device includes at least two sensing electrodes. Each sensing electrode includes a metallic surface integrated in a garment. The device includes at least two therapy electrodes. Each of the at least two therapy electrodes includes a receptacle, and each receptacle includes at least one dose of conductive fluid. The device includes the garment. The garment includes a fabric that is stretchable and that is breathable and/or moisture wicking, and conductive wiring configured to at least partially electrically connect that at least two sensing electrodes to at least one defibrillator component. The device includes the at least one defibrillator component. The at least two therapy electrodes are configured to provide an electric shock to the subject. Prior to the application of the electric shock, each receptacle is configured to release the conductive fluid from the receptacle.

A subcutaneously implantable device includes a housing, a clip attached to a top side of the housing that is configured to anchor the device to a bone, and an electrode that is configured to contact an organ. The clip includes a top portion that is rigid, a bottom portion that is rigid, and an intermediate portion between the top portion and the bottom portion that is configured to permit movement of the top portion with respect to the bottom portion and thereby apply force onto the bone between the top portion and the bottom portion.

A wearable, multiphasic cardioverter defibrillator system and method are provided.

A wearable therapeutic device includes a first therapy electrode and a second therapy electrode, each configured to be electrically coupled to an external defibrillator; and a garment configured to house the first therapy electrode and the second therapy electrode. The garment is configured to releasably receive a replaceable receptacle configured to store a conductive gel in a location proximate to at least one of the first therapy electrode and the second therapy electrode. The garment is configured to releasably receive a receptacle control unit. The receptacle control unit is separate from the replaceable receptacle. The receptacle control unit is configured to activate deployment of the stored conductive gel from the replaceable receptacle.

A multi-modal electrotherapy apparatus including circuitry for administering defibrillation therapy and for administering medium voltage therapy (MVT) adapted to reduce the side effects of MVT. The electrotherapy apparatus is configured to selectively deliver MVT to vectors not involving the ventricles and defibrillation therapy to vectors involving the ventricles. The apparatus can use biphasic waveforms configured to avoid capture of cardiac cells during MVT. The electrotherapy apparatus can minimize the risk of applying MVT at inappropriate times, such as during atrial fibrillation or where conventional ventricular tachycardia or ventricular fibrillation therapy is more appropriate.

A wearable monitoring and therapeutic device includes at least two sensing electrodes. Each sensing electrode includes a metallic surface integrated in a garment. The device includes at least two therapy electrodes. Each of the at least two therapy electrodes includes a receptacle, and each receptacle includes at least one dose of conductive fluid. The device includes the garment. The garment includes a fabric that is stretchable and that is breathable and/or moisture wicking, and conductive wiring configured to at least partially electrically connect that at least two sensing electrodes to at least one defibrillator component. The device includes the at least one defibrillator component. The at least two therapy electrodes are configured to provide an electric shock to the subject. Prior to the application of the electric shock, each receptacle is configured to release the conductive fluid from the receptacle.

A subcutaneous device that includes an electronics-containing housing and a clip configured to anchor the device to an internal structural body component of a patient is injected and anchored to the structural body component. An instrument pre-loaded with the device is caused to be inserted through an incision in the patient and advanced to the structural body component. A pushing force is received on the instrument that causes the clip of the device to be pushed onto the structural body component so that the structural body component is located in a sandwiching region between a top portion of the clip and the housing of the device. Force is applied to the structural body component between the top portion of the clip and the housing of the device to anchor the device to the structural body component.

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 a garment configured to be worn on a torso of a patient. The garment has an anterior portion and a posterior portion. The garment is configured to house at least one defibrillator component, a first therapy electrode disposed in the anterior portion of the garment, a second therapy electrode disposed in the posterior portion of the garment, and an alarm module configured to alert the patient of an impending defibrillation shock from the at least one defibrillator component to be delivered by at least one of the first therapy electrode and the second therapy electrode. The first therapy electrode and the second therapy electrode are configured to be electrically coupled to the at least one defibrillator component. At least one of the first therapy electrode and the second therapy electrode is at least one of woven into the garment and comprises a textile material.