IMPLANTABLE CARDIAC DEVICES TO CARDIOVERT, DEFIBRILLATE, OR TREAT CHF USING HIGH POWER PWM CLASS D AMPLIFIERS WITH PROGRAMMABLE IMPEDANCE TRACKING LOWPASS FILTERS

Abstract

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

Claims

1. A waveform energy control system for delivering software generated waveforms within a subcutaneously implantable cardioverter defibrillator comprising differentially driven Class D and Class B or any other class amplifier sections, wherein the Class D amplifier section produces Phase 1 ascending waveforms and has a programmable impedance tracking lowpass filter (LPF) and wherein the Class B or any other class amplifier section delivers fast slew rate, hard-switched Phase 2 waveforms.

2. The control system of claim 1 wherein the Class D amplifier section does not use large power inductors or large capacitors to filter and attenuate high frequency pulse width modulation (PWM) switching content of the Class D amplifier section wherein the Phase 1 ascending ramp waveform signals are produced.

3. The control system of claim 1, wherein the control system is configured to generate ascending waveforms which significantly reduce damage to a patient's heart muscle when cardiac defibrillation or cardioversion electrical shocks are applied.

4. A controller for a cardiac device to treat a cardiac condition in a patient, which comprises: a microcontroller; a digital-to-analog converter (DAC); an analog to digital converter (ADC); and a waveform energy control system comprising differentially driven Class D and Class B or any other class amplifier sections, wherein the Class D amplifier section produces Phase 1 ascending waveforms and has a programmable impedance tracking lowpass filter (LPF) and wherein the Class B or any other class amplifier section delivers fast slew rate, hard-switched Phase 2 waveforms, wherein each of the Class D and Class B or any other class amplifier sections has an input and an output, wherein the microcontroller is operatively connected to the DAC, the DAC is operatively connected to each of the inputs of the Class D and Class B or any other class amplifier sections, the microcontroller is configured to respond to software commands to generate signals to the DAC, the DAC provides signals to the inputs of the Class D and Class B or any other class amplifier sections, and the outputs of the Class D and Class B or any other class amplifier sections deliver constant current, constant voltage, or constant energy ascending arbitrary waveforms or biphasic truncated exponential (BTE) waveforms for pacing, anti-tachycardia pacing (ATP), low-, medium-, or high-voltage therapy, cardioversion or defibrillation electrical shocks to the patient's heart or for providing a late systolic electrical impulse to stimulate the intraventricular septum and bundle branches of the patient's heart to increase the heart's ejection fraction.

5. The controller of claim 4, wherein the Phase 1 waveforms have time periods of from about 1 ms to 300 ms and the Phase 2 waveforms have time periods of from about 500 ns to about 10 ms, configured as ramp, curved, stepped, or BTE waveforms using any voltage of from about 0 VDC to +/1500 VDC for Phase 1 and Phase 2.

6. The controller of claim 4, wherein the patient receives pacing therapy, near or far field ATP, low-, medium-, or high-voltage therapy, or cardioversion or defibrillation electrical shocks to the patient's heart.

7. The controller of claim 4, wherein the cardiac condition treated is ventricular fibrillation (VF) or ventricular tachycardia (VT).

8. The controller of claim 4, wherein the waveforms produced are biphasic waveforms comprising a first phase (Phase 1) having a positive voltage potential with respect to a zero voltage crossing point in the form of an ascending ramp, ascending exponential, ascending chopped, ascending stepped, ascending curved, square, rectilinear, BTE, or any combination of geometric-shaped waveforms, followed by a second phase (Phase 2) having a negative voltage potential with respect to a zero voltage crossing point in the form of an ascending ramp, ascending exponential, ascending chopped, ascending stepped, ascending curved, square, rectilinear, BTE, or any combination of geometric-shaped waveforms, to deliver increasing energy with increasing time.

9. The controller of claim 8, wherein the Phase 1 or Phase 2 defibrillation or cardioversion shock waveforms are produced in response to software commands programmed in a microcontroller.

10. The controller of claim 4, wherein shock waveforms are applied internally through a patient's heart and chest and an output waveform is constructed from discrete points in time or equations stored in the microcontroller which at each discrete time point, on the order of microseconds, the microcontroller outputs a new waveform value through the DAC to the amplifiers and at each discrete time point, the current through the patient's heart and chest is converted using an analog-to-digital converter (ADC) wherein a digitized current generated from sense resistors provides electronic feedback to the microcontroller and is sampled at multiple intervals, creating a rolling current average used by the microcontroller and software to calculate power, energy, and voltage in real time for each discrete time point of the output waveform in which the microcontroller then increases or decreases the output waveform to maintain the desired constant current, constant energy, or constant voltage.

11. An implantable cardioverter defibrillator device (ICD), which comprises: a subcutaneous case capable of being positioned under a patient's skin in the pectoral area of the patient's upper left chest; a controller of claim 4 located within the subcutaneous case; and a lead wire transvenously extending from the subcutaneous case and capable of being installed in the patient's right ventricle for pacing, near or far field ATP, low-, medium-, or high-voltage therapy, cardioversion or defibrillation electrical shocks to the patient's heart, for providing a late systolic electrical impulse to stimulate the intraventricular septum and bundle branches of the patient's heart to increase the heart's ejection fraction.

12. The implantable cardioverter defibrillator device of claim 11 which is capable of delivering BTE shock waveforms with a tilt angle and waveform pulse width specified via software commands to provide a constant energy, constant voltage, or constant current mode of operation.

13. The implantable cardioverter defibrillator device of claim 11, wherein, if a shock for defibrillation or cardioversion fails, one or more subsequent voltage pulses, shocks or low-, medium-, or high-voltage therapy may be delivered for defibrillation or cardioversion using any arbitrary ascending waveform or BTE waveform saved in a microcontroller memory.

14. A subcutaneous implantable cardioverter defibrillator device (SICD), which comprises: a subcutaneous case capable of being positioned under a patient's skin on the left side of a patient's rib cage; a controller of claim 4 located within the subcutaneous case; and a lead wire extending from the subcutaneous case and capable of being positioned subcutaneously above or below the patient's sternum for pacing, far field ATP, low-, medium-, or high-voltage therapy, cardioversion or defibrillation electrical shocks to a patient's heart or for providing a late systolic electrical impulse to stimulate the intraventricular septum and bundle branches of the patient's heart to increase the heart's ejection fraction.

15. The subcutaneous implantable cardioverter defibrillator device of claim 14, wherein, if a first shock for defibrillation or cardioversion fails, one or more subsequent shocks or low-, medium-, or high-voltage therapy for defibrillation or cardioversion may be delivered using an arbitrary ascending waveform or BTE waveform saved in a microcontroller memory.

16. A waveform energy control system for delivering software generated waveforms within an implantable device to treat congestive or chronic heart failure comprising one or more differentially driven pulse width modulation (PWM) Class D amplifier sections, wherein each of the one or more Class D amplifier sections produces ascending waveforms and have Phase 1 ascending waveforms and has a programmable impedance tracking lowpass filter (LPF).

17. The control system of claim 16 wherein each of the one or more Class D amplifier sections does not use large power inductors or large capacitors to filter and attenuate the Class D high frequency PWM switching content wherein the ascending ramp waveform signals are produced.

18. A controller for treating a cardiac condition in a patient, which comprises: a microcontroller; a digital-to-analog converter (DAC); an analog to digital converter (ADC); and a waveform energy control system of claim 16, wherein each of the one or more Class D amplifier sections has an input and an output, wherein the microcontroller is operatively connected to the DAC, the DAC is operatively connected to each of the inputs of the Class D amplifier sections, the microcontroller is configured to respond to software commands to generate signals to the DAC, the DAC provides signals to the inputs of the Class D amplifier sections, and the outputs of the Class D amplifier sections deliver constant current, constant voltage, or constant energy ascending arbitrary waveforms for providing a late systolic electrical impulse to stimulate the intraventricular septum and bundle branches of the patient's heart to increase the heart's ejection fraction for treating congestive heart failure.

19. The controller of claim 18, wherein the waveforms produced are monophasic waveforms comprising a first phase (Phase 1) having a positive voltage potential with respect to a zero voltage crossing point in the form of an ascending ramp, ascending exponential, ascending chopped, ascending stepped, ascending curved, square, rectilinear, or any combination of geometric-shaped waveforms.

20. The controller of claim 19, wherein the Phase 1 waveforms are produced in response to software commands programmed in the microcontroller.

21. The controller of claim 18, wherein late systolic stimulus waveforms are applied internally through a patient's heart and chest and an output waveform is constructed from discrete points in time or equations stored in the microcontroller which at each discrete time point, on the order of microseconds, the microcontroller outputs a new waveform value through the DAC to the amplifiers and at each discrete time point, the current through the patient's heart and chest is converted using an analog-to-digital converter (ADC) wherein a digitized current generated from sense resistors provides electronic feedback to the microcontroller and is sampled at multiple intervals, creating a rolling current average used by the microcontroller and software to calculate power, energy, and voltage in real time for each discrete time point of the output waveform in which the microcontroller then increases or decreases the output waveform to maintain the desired constant current, constant energy, or constant voltage.

22. An implantable device (ICD) for treating congestive or chronic heart failure in a patient, which comprises: a subcutaneous case capable of being positioned under a patient's skin in the pectoral area of the patient's upper left chest; a controller of claim 18 located within the subcutaneous case; and a lead wire extending from the subcutaneous case and capable of being positioned subcutaneously above or below the patient's sternum for providing a late systolic electrical impulse to stimulate the intraventricular septum and bundle branches of the patient's heart to increase the heart's ejection fraction.

23. An implantable device (SICD) for treating congestive or chronic heart failure in a patient, which comprises: a subcutaneous case capable of being positioned under a patient's skin on the left side of a patient's rib cage; a controller of claim 18 located within the subcutaneous case; and a lead wire transvenously extending from the subcutaneous case and capable of being installed in the patient's right ventricle for providing a late systolic electrical impulse to stimulate the intraventricular septum and bundle branches of the patient's heart to increase the heart's ejection fraction.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0188] For a more comprehensive understanding of the invention, reference is made to the following description taken in connection with the accompanying drawings, in which:

[0189] FIG. 1 is a schematic of a typical H-Bridge Class D switching power amplifier. The two large inductors in concert with the two capacitors serve as the LPFs that allow the signal of interest to be delivered into the load while attenuating the high frequency PWM switching frequencies to drive the power semiconductors at a very high efficiency.

[0190] FIG. 2 is a schematic of a new class of hybrid Class DB power amplifier according to the invention whereby Phase 1 and Phase 2 waveforms are delivered into a resistive load.

[0191] FIG. 3 is a schematic of a new LPF design that employs a solid state high power semiconductor LPF that does not require a large inductor with a magnetic core or large high voltage capacitors. Positive and negative LPFs are employed for the Class D Phase 1 amplifier. A Phase 2 waveform is delivered using the Class B amplifier, which does not require an LPF.

[0192] FIG. 4 depicts a dual polarity semiconductor LPF whereby all positive and negative high frequency PWM signals are filtered and attenuated while allowing the waveforms and signals of interest to pass into the load through four Class D amplifiers. The load can be a resistive load, an inductive load, or any appropriate load, including, but not limited to, any power circuit, motor drive, audio power amplifier, or any high power electronics device that requires a high power LPF to filter out any PWM pulses in place of using large inductors and capacitors.

[0193] FIG. 5 shows different LPF array tunable circuits whereby a microcontroller manages several resistor/capacitor (RC) low current, LPFs in real time based upon the changing chest and heart impedance to optimize and miniaturize the new LPF that replaces the old style inductor, capacitor LPF. The purpose of a real time tunable filter is to minimize ripple filter from the waveform or signals of interest and to employ smaller LPF components that facilitate miniaturization.

[0194] FIG. 6 depicts different LPF array tunable circuits whereby a microcontroller manages several inductor/capacitor (LC) low current, LPFs in real time based upon the changing chest and heart impedance to optimize and miniaturize the LPF that replaces the old style inductor, capacitor LPF. The purpose of a real time tunable filter is to minimize ripple filter from the waveform or signals of interest and to employ smaller LPF components that facilitate miniaturization while simultaneously tracking and adjusting for the changing chest and heart impedance.

[0195] FIG. 7 represents typical examples of ascending waveforms that have been used in animal studies to deliver increasing energy with increasing time as compared to the standard BTE waveforms that can only deliver decreasing energy with increasing time.

DETAILED DESCRIPTION OF THE INVENTION

[0196] Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood to one of ordinary skill in the art to which this invention belongs. Although any methods, devices or materials similar or equivalent to those described herein can be used in the practice or testing of the invention, the preferred methods, devices, and materials are now described.

[0197] In FIG. 1, a schematic of a classic H-Bridge Class D amplifier is depicted. The basic operation comprises an H-bridge circuit 10 which differentially drives a low-impedance load 12. A signal from input 14 travels through pulse width modulator (PWM) 16 to low side drivers 20 and high side drivers 22. The waveform voltage and current in a Class D PWM amplifier has high frequency switching pulses that must be filtered out with an LPF. The LPF comprises high current, high voltage inductors 24, 26 in combination with filter capacitors 30,32. This high frequency filter arrangement allows the signal of interest, in this case an ascending ramp shock waveform, to be delivered to the load 12 with minimal high frequency ripple riding on the fundamental ramp output signal to drive the power semiconductors at a very high efficiency.

[0198] FIG. 2 is a schematic of a Class DB H-bridge amplifier circuit 50 which uses a power field effect transistor (FET). As shown, a positive phase 1 waveform passing through amplifier 56 is differentially driven through an LPF power FET 58 through the resistive load 60 (which is the heart that will undergo defibrillation). The waveform further travels through a negative LPF 62 and on to a negative amplifier 66. The proposed LPF power FET filters 58,62 replace the large inductors 24,26 as well as the large capacitors 30,32 shown in FIG. 1. Furthermore, a Phase 2 or negative pulse, is delivered through the heart load 60 through Class B amplifiers 70,72 and 78,80 which are driven differentially through the heart load 60. However, these amplifiers are not switched using PWM. Instead, they are hard switched, which will employ a fast slew rate for the negative Phase 2 waveform. At the completion of the Phase 2 waveform, the voltage returns to electrophysiology Zero (EP0), or 0 volts Amplifier high voltage rails have polarities of plus and minus as depicted 82,88. Class D and B amplifiers are driven differentially by microcontroller 25.

[0199] FIG. 3 is a schematic diagram of the circuit of a Phase 1 waveform only LPF. On the left half of the circuit, the output of amplifier 90 drives the LPF, which consists of power FET 92, power diode 94, blocking diode 100, Zener clamp 102, timing resistor 104, and timing capacitor 110. The output of amplifier 90 drives the LPF, which is connected to the heart load 60. On the opposite side of the load 60, the signal is driven through a second LPF for the negative portion of the Phase 1 waveform. This LPF consists of a power diode 122, power FET 124, Zener clamp 126, blocking diode 130, timing resistor 132, and timing capacitor 134. The input to this LPF is driven by amplifier 140.

[0200] FIG. 4 is a schematic of a dual polarity LPF that may be employed whereby both Phase 1 and Phase 2 waveforms use a Class D PWM circuit topology. Also, both Phase 1 and Phase 2 waveforms have the high frequency PWM switching energy filtered by the new LPF circuits. The output of amplifier 160 drives power FET 162, power diode 164, blocking diode 170, Zener clamp 202, timing resistor 204, and timing capacitor 210. This circuit further connects to the second filter of opposite polarity and drives power FET 220, power diode 222, Zener clamp 224, blocking diode 228, timing resistor 232, and timing capacitor 236. This Phase 1 and Phase 2 biphasic waveform then passes through a heart load 60 for the negative portion of the waveform into power FET 242, power diode 244, Zener clamp 248, blocking diode 250, timing resistor 272, and timing capacitor 256. The output of this filter section drives the opposite polarity filter through power FET 260, power diode 262, Zener clamp 264, blocking diode 266, timing resistor 270, and timing capacitor 252, returning through Class D amplifier 280. This filter arrangement provides a complete replacement for the two large inductors and two large capacitors 24,26,30,40 for a full Class D amplifier configuration.

[0201] FIG. 5 represents a schematic of a microcontroller digital resistor capacitor (RC) LPF array 330 which provides very specific high frequency filtering while simultaneously tracking the heart and chest impedance from the beginning of an ascending ramp waveform shock to the peak voltage of an ascending ramp shock. This filter array will change its characteristics dynamically and progressively throughout the waveform delivery. The signal coming from the output of amplifier 300 will be driven into an RC LPF array 330 which consists of two or more combinations of R, C, and FET switches as commanded from microcontroller 310. The microcontroller 310 will sample and track the chest and heart impendence and make adjustments to the dynamic LPF array in conjunction with the appropriate power FET 312, power diode 314, Zener clamp 318, blocking diode 320, timing resistor 324, and timing capacitor 326. This RC LPF array 330 circuitry is repeated for single or dual polarity LPFs for one or both amplifiers within the system. In another embodiment of an RC LPF array 336, a different configuration of the RC connectivity is used which will be commanded from a microcontroller 310 and will still be driven in conjunction with the appropriate power FET 312, power diode 314, Zener clamp 318, blocking diode 320, timing resistor 324, and timing capacitor 326.

[0202] FIG. 6 represents a schematic of a microcontroller digital inductor capacitor (LC) LPF which provides very specific high frequency filtering while simultaneously tracking the heart and chest impedance from the beginning of an ascending ramp waveform shock to the peak voltage of an ascending ramp shock. This filter will change its characteristics dynamically and progressively throughout the waveform delivery. The signal coming from the output of amplifier 400 will be driven into an LC LPF array 402 which consists of two or more combinations of L, C, and FET switches as commanded from microcontroller 410. The microcontroller 410 will sample and track the chest and heart impendence and make adjustments to the dynamic LC LPF array in conjunction with the appropriate power FET 412, power diode 416, Zener clamp 418, blocking diode 422, timing inductor 424, and timing capacitor 430. This LC LPF array 402 circuitry is repeated for single or dual polarity LC LPFs for one or both amplifiers within the system. In another embodiment of an LC LPF array 430, a different configuration of the LC connectivity is used which will be commanded from the microcontroller 410 and will still be driven in conjunction with the appropriate power FET 412, power diode 4160, Zener clamp 418, blocking diode 422, timing inductor 424, and timing capacitor 430.

[0203] FIG. 7 depicts a few possible Phase 1 and Phase 2 ascending ramp waveforms 500.

[0204] In the claims, any reference signs placed between parentheses shall not be construed as limiting the claim. The word comprising or including does not exclude the presence of elements or steps other than those listed in a claim. In a device claim enumerating several means, several of these means may be embodied by one and the same item of hardware. The word a or an preceding an element does not exclude the presence of a plurality of such elements. In any device claim enumerating several means, several of these means may be embodied by one and the same item of hardware. The mere fact that certain elements are recited in mutually different dependent claims does not indicate that these elements cannot be used in combination.

[0205] Although the invention has been described in detail for the purpose of illustration based on what is currently considered to be the most practical and preferred embodiments, it is to be understood that such detail is solely for that purpose and that the invention is not limited to the disclosed embodiments, but, on the contrary, is intended to cover modifications and equivalent arrangements that are within the spirit and scope of the appended claims. For example, it is to be understood that the present invention contemplates that, to the extent possible, one or more features of any embodiment can be combined with one or more features of any other embodiment.