Abstract
A stimulation system includes an energy source, an electronics unit with a controller, and an actuator that is coupled with the electronics unit and/or the energy source. The actuator emits electromagnetic waves for stimulation of genetically manipulated tissue. The electronics unit is disposed in a housing. The stimulation system is configured for at least temporary implantation in a human or animal body. The controller controls the stimulation of tissue in the body by way of the electromagnetic waves emitted by the actuator. A selector of the stimulation system selects the area of the said tissue for stimulation. The selector includes a masking device for masking certain areas of the tissue, so that an intensity of the stimulation for the masked areas is reduced or equal to zero.
Claims
1. A stimulation system, comprising: a first unit including: a housing; an energy source; an electronics unit with a controller disposed in said housing; an actuator connected with at least one of said electronics unit and said energy source, said actuator being configured to emit electromagnetic waves for stimulation of genetically manipulated tissue; wherein the stimulation system is provided for at least temporary implantation in a human or animal body, and said controller is configured to control a stimulation of tissue by the electromagnetic waves of said actuator; a first fixation device attached to said housing; a second unit, including: at least one masking device configured for masking an area of the tissue, so that an intensity of the stimulation for the masked area is reduced or equal to zero; a second fixation device attached to said at least one masking device; and said first unit configured to be fastened to the tissue by said first fixation device, and said second unit being separate from said first unit, said second unit configured to be fastened to the tissue by said second fixation device independently of said first unit.
Description
BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING
[0261] FIG. 1 is a schematic representation of an exemplary embodiment of the inventive stimulation device in the implanted state with an external device;
[0262] FIG. 2 is a schematic representation of a method for treating bradycardia by means of optical stimulation for at least one exemplary embodiment of the inventive stimulation device;
[0263] FIG. 3 is a schematic representation of a method for treating a tachycardia arrhythmia in the form of a ventricular or atrial tachycardia for at least one exemplary embodiment of the inventive stimulation device;
[0264] FIG. 4 is a schematic representation of a method for treating atrial fibrillation for at least one exemplary embodiment of the inventive stimulation device;
[0265] FIG. 5 is a schematic representation of a method for treating ventricular fibrillation for at least one exemplary embodiment of the inventive stimulation device;
[0266] FIG. 6 is a schematic representation of a method for application of cardiac resynchronization therapy by means of electromagnetic waves for at least one exemplary embodiment of the inventive stimulation device;
[0267] FIG. 7 is a schematic representation of a neurostimulation method by means of electromagnetic waves for at least one exemplary embodiment of the inventive stimulation device;
[0268] FIG. 8 is a schematic representation of an embodiment of an inventive implantable stimulator;
[0269] FIG. 9 is an implantable stimulator according to FIG. 8 with an alternative fixation device;
[0270] FIG. 10 is a block diagram of the implantable stimulator according to one exemplary embodiment of the invention;
[0271] FIG. 8A is a schematic representation of an embodiment of the inventive stimulation device with control of the success of the therapy;
[0272] FIG. 9A is a block diagram of the inventive stimulation device according to one exemplary embodiment;
[0273] FIG. 10A shows sample two-dimensional characteristics of electromagnetic radiators with spatially selective effect;
[0274] FIG. 8B is a schematic representation of an embodiment of the inventive stimulation device with a defibrillation function;
[0275] FIG. 9B is an implantable stimulator according to FIG. 8b with an alternative fixation device;
[0276] FIG. 10B is a block diagram of the inventive stimulation device according to a exemplary embodiment according to FIG. 8b;
[0277] FIGS. 11 through 14 show implementations of the inventive stimulation system with a selector that is designed to select the area of the tissue for the stimulation according to embodiments;
[0278] FIG. 15 is an implementation of the inventive stimulation system with a selector that is designed to select the area of the said tissue for the stimulation, the stimulation system having supports;
[0279] FIG. 16 is a flowchart of the method for the inventive stimulation system according to exemplary embodiments;
[0280] FIG. 17 is a schematic representation of the local pretreatment to produce sensitive areas for electromagnetic radiation;
[0281] FIG. 18 is a schematic representation of the local pretreatment to mask possibly sensitive areas for electromagnetic radiation;
[0282] FIGS. 19A and 19B are examples with locally pretreated areas for stimulation by means of electromagnetic radiation;
[0283] FIG. 20 is a schematic representation of selective therapy by placing the actuators to use the anatomical qualities of the tissue for shading, according to exemplary embodiments of this invention;
[0284] FIG. 21 is a block diagram of one embodiment of an inventive stimulator;
[0285] FIG. 22 is a graphical representation of the pulse discharge of an ICD, this pulse discharge controlling an inventive stimulator, which has the capability of performing therapy by means of electromagnetic radiation, so that the inventive stimulator delivers a pulsed therapy;
[0286] FIG. 23 is a table showing sample combinations of stimulation and shock vectors between right ventricle, housing of the stimulation device, and right atrium ;
[0287] FIG. 24 is a block diagram of one embodiment of the inventive device in which the device comprises application means to deliver a substance to the tissue;
[0288] FIG. 25 is a schematic representation of one exemplary embodiment of the inventive implantable device, the device being fixed to the tissue by means of a fixation device;
[0289] FIG. 26 is a schematic representation of one sample implementation of the inventive device. The device has actuators or sensors for electromagnetic radiation, which are incorporated into the fixation unit;
[0290] FIG. 27 is a schematic representation of another sample implementation of the inventive device. The device has actuators or sensors for electromagnetic radiation, which are incorporated into the fixation unit;
[0291] FIG. 28 shows an example of a preferred sequence of events in the signal processing of the inventive method; and
[0292] FIG. 29 shows an example of a sequence of events in the signal processing of the inventive method.
DETAILED DESCRIPTION OF THE INVENTION
[0293] Referring now to the figures of the drawing in detail and first, particularly, to FIG. 1 thereof, there is shown an implantable stimulator according to the invention. The stimulator is implanted into the body tissue of the patient 10 and comprises a hermetically sealed housing 11. Here this housing is anchored in the body tissue by means of a fixation device 12. The implant housing 11 comprises an energy source 13, a controller 14, and an actuator 15, the latter being designed to be able to deliver electromagnetic radiation 16, e.g., in the range of visible light, to a body tissue 17 that has been pretreated beforehand, for example by means of genetic, especially optogenetic manipulation and, for example, to evoke an action potential, i.e., to trigger a stimulation by means of electromagnetic radiation. In addition, the implant can be read out and/or programmed by means of an external device 18, e.g., a telemetry unit.
[0294] FIG. 2 illustrates a method for treatment of bradycardia by means of stimulation of genetically manipulated tissue, preferably optogenetically manipulated tissue. The schematized ECG 700 first shows a regular heartbeat 710 in the form of an intrinsic QRS complex. In the proposed process, this QRS complex is first recorded 720 and then a time interval 730 is started, which corresponds to an expected heart rate. If this expected interval 740 passes without another intrinsic QRS complex being recorded, then an optical stimulation 750 is triggered, which triggers a stimulated QRS complex in the preferably optogenetically pretreated myocardial tissue.
[0295] FIG. 3 illustrates a method for treatment of a tachycardia arrhythmia in the form of a ventricular or atrial tachycardia. The schematized ECG 200 first shows a regular contraction 210 of a ventricle. To monitor the cardiac rhythm, each of these contractions is recorded and starts a time measurement until the next recorded contraction (t1 . . . t8). In the example shown, now a too rapid heart rate begins in the form of tachycardia 230, which is first recorded over a few heartbeats and confirmed 240. After confirmation 240, a predetermined optical stimulation sequence 250 is delivered to the preferably pretreated myocardium, causing a series of stimulated excitations which, as a rule, end the tachycardia and restore a regular rhythm 260.
[0296] FIG. 4 illustrates a method for treatment of atrial fibrillation. The schematized ECG 300 first shows a QRS complex in a sinus rhythm 310. Then, atrial fibrillation 320 spontaneously begins. This is first recorded and confirmed 330. Once this atrial fibrillation 320 is confirmed, an optical stimulation 350 is delivered to the atria of the pretreated heart, however it is synchronized with and offset in time to a QRS complex (cardioversion). This terminates the atrial fibrillation and restores a regular sinus rhythm 360.
[0297] FIG. 5 illustrates a method for treatment of ventricular fibrillation. The schematized ECG 400 first shows a QRS complex in a sinus rhythm 410. Then, ventricular fibrillation 420 spontaneously begins, which is first recorded and then confirmed 430. Once this ventricular fibrillation 420 is confirmed, a large-area optical stimulation 440 is triggered in the area of the preferably optogenetically pretreated ventricles, terminating the ventricular fibrillation and restoring a sinus rhythm 450.
[0298] FIG. 6 illustrates a cardiac resynchronization method for stimulation of genetically manipulated tissue, preferably optogenetically manipulated tissue. This figure schematically shows the intracardiac ECG leads from both ventricles of the heart 500: the left ventricle (LV; 510) and the right ventricle (RV, 520). The ECG leads first show a time delay 530 in the left ventricular heartbeats with respect to the right ventricular heartbeats. This offset is the expression of a so-called left bundle branch block, which in the case of advanced structural damage to the heart muscle requires therapy in the form of a resynchronization of both ventricles. Here this resynchronization is performed by means of simultaneous or quasi-simultaneous optical stimulation 540, 550 of both ventricles of the heart, permanently producing a mechanical contraction 560 of both ventricles at the same time.
[0299] FIG. 7 illustrates an example of neurostimulation of genetically manipulated tissue, preferably optogenetically manipulated tissue. In the example shown, the left side depicts an EEG detail 610 of an epileptic seizure. For treatment, an optical stimulation sequence 620 is delivered to one or more preferably optogenetically pretreated brain regions, to bring about termination 630 of this epileptic seizure. The method of optical neurostimulation shown here is intended to serve as a representative application illustrating all others, e.g., spinal cord stimulation, other applications of deep brain stimulation or cortical stimulation, insulated nerve stimulation, muscle stimulation, etc.
[0300] FIG. 8 shows a possible embodiment of an inventive implantable stimulator. This stimulator consists of a battery 81 and implant electronics 82, both of which are in a hermetically sealed housing, the implant electronics 82 comprising the components of the block diagram shown in FIG. 10. On the bottom of the housing there is a light source 83 that is also hermetically sealed, however it is sealed in such a way that the frequency spectrum of this light source can penetrate the hermetic sealing and excite the target tissue (here myocardium 85). Here the implant is fixed in the myocardium 85 with a helix 84.
[0301] FIG. 9 shows the implantable stimulator from FIG. 8 consisting of a battery 81 and implant electronics 82, however with an alternative fixation device 94 in the form of barbs made, e.g., of nitinol, on the side. On the bottom of the housing there is a light source 93 that is hermetically sealed in such a way that the frequency spectrum of this light source can penetrate the hermetic sealing and excite the target tissue (here myocardium 95).
[0302] FIG. 10 shows the block diagram of the implantable stimulator 100. The latter comprises an energy source 101, a sensor interface 102 for detection of a feature representing a heartbeat, connected with a detection unit 103, which in turn signals the detection of heartbeats to the connected controller 104. This controller 104 is connected with a therapy generator 105, which upon receipt of a trigger signal from the controller 104 excites an LED 106 that is connected to the therapy generator and thus emits a light signal that stimulates the myocardial tissue. The therapy generator 105 can vary the intensity, duration, signal form, and color of the light signal.
[0303] FIG. 8a shows a possible embodiment of an inventive implantable stimulator with control of the success of the therapy. This stimulator consists of a battery 8a1 and implant electronics 8a2, both of which are in a hermetic housing, the implant electronics 8a2 comprising the components of the block diagram from FIG. 9a. On the bottom of the housing there is a light source 8a3 that is also hermetically sealed, however it is sealed in such a way that the frequency spectrum of this light source can penetrate the hermetic sealing and excite the target tissue (here myocardium 8a5). Here the implant is fixed in the myocardium 8a5 with a helix 8a4. In this exemplary embodiment, the implant electronics 8a2 additionally comprise a 3D accelerometer 8a6, which is used to control of the success of the therapy by evaluating, after every optical stimulation, whether an acceleration of the implant fixed to the myocardium has been detected. In this case, the stimulation is considered effective, since contraction of the cardiac tissue leads to acceleration. If the acceleration fails to appear, the stimulation is considered ineffective and is repeated, e.g., with higher amplitude, or alternatively an ineffective stimulation is signaled to a remote monitoring system.
[0304] FIG. 9a shows the block diagram of the implantable stimulator 9a0. The latter comprises an energy source 9a1, a sensor interface 9a2 for detection of a feature representing a heartbeat, connected with a detection unit 9a3, which in turn signals the detection of heartbeats to the connected controller 9a4. This controller 9a4 is connected with a therapy generator 9a5, which upon receipt of a trigger signal from the controller 9a4 excites an LED 9a6 that is connected to the therapy generator and thus emits a light signal that stimulates the myocardial tissue. The therapy generator 9a5 can vary the intensity, duration, signal form, and color of the light signal.
[0305] The detection unit 9a3 is further connected with a 3D accelerometer 9a7, which is used to control the success of the therapy by evaluating, after every optical stimulation, whether an acceleration of the implant fixed to the myocardium has been detected. In this case, the stimulation is considered effective, since contraction of the cardiac tissue leads to acceleration. If the acceleration fails to appear, the stimulation is considered ineffective and is repeated, e.g., with higher intensity, duration, an alternative signal form, or another color.
[0306] FIG. 10a shows examples of two-dimensional characteristics of electromagnetic radiators with spatially selective effect.
[0307] FIG. 8b shows a possible embodiment of an inventive implantable defibrillator. This defibrillator consists of a high-power LED 8b1 and encapsulated implant electronics along with an energy source 8b2, both of which are in a hermetically sealed housing, the implant electronics comprising the components of the block diagram shown in FIG. 3. On the bottom of the housing there is another local light source 8b3, which is arranged and dimensioned in such a way that this local light source 8b3 can only trigger a local depolarization in the pretreated myocardium 8b5. Here the implant is fixed in the myocardium 8b5 with a helix 8b4. The high-power LED 8b1 is dimensioned so that it can, for the purpose of defibrillation, “shine through” almost the entire heart, so that a simultaneous depolarization of all excitable myocardial cells at the moment of defibrillation is possible.
[0308] FIG. 9b shows the implantable stimulator from FIG. 8b, however with an alternative fixation device 9b4 in the form of nitinol barbs on the side. On the bottom of the housing there is a light source 9b3 that is hermetically sealed in such a way that the frequency spectrum of this light source can penetrate the hermetic sealing and excite the target tissue (here myocardium 9b5).
[0309] FIG. 10b shows the block diagram of the implantable stimulator 100 according to FIG. 8b. The latter comprises an energy source 10b1, a sensor interface 10b2 for detection of a feature representing a heartbeat, connected with a detection unit 10b3, which in turn signals the detection of heartbeats to the connected controller 10b4. This controller 10b4 is connected with a therapy generator 10b5, which upon receipt of a trigger signal from the controller 10b4 excites an LED 10b6 that is connected to the therapy generator and thus emits a light signal that stimulates the myocardial tissue. The therapy generator 10b5 can vary the intensity, duration, signal form, and color of the light signal.
[0310] FIG. 11 shows a typical implementation. The implant 110 is fastened to organ tissue by means of a fixation device 113 and has an electromagnetic radiator 111 that is masked by means of the masking device or mask 112, in order to have electromagnetic energy radiated onto the treated tissue 115 only within the effective cones 114 and 1141.
[0311] FIG. 12 discloses the implementation in which the masking device or mask 122 represents a second unit and is fastened by means of a fixation device 1221 independently of the implant, in order to prevent the penetration of electromagnetic energy into the covered tissue regions. The implant 120 is fastened to the organ tissue by means of a fixation device 123 and has an electromagnetic radiator 121 that is masked by means of the mask 122. The therapy acts on the treated tissue 125 only in the unmasked regions 126 and 1261.
[0312] FIG. 13 shows an implementation with locally pretreated tissue. Although the effective range 136 of the radiation covers all the tissue 135, the radiation only acts on the tissue in the regions 137 and 1371. The implant 130 is fastened to the organ tissue by means of a fixation device 133 and has an electromagnetic radiator 131. The therapy acts on the treated tissue 135 only in the pretreated regions 137 and 1371.
[0313] FIG. 14 discloses a solution with tissue that reacts in a locally frequency-specific (or polarization-specific) manner or is pretreated to do so. Depending on the frequency (band) or polarization of the radiator, only the one 148 or the other 1481 region shows an effect. Although the effective range 146 of the radiation covers all the tissue 145, the radiation only acts on the tissue in the regions 148 and 1481. The implant 140 is fastened to the organ tissue by means of a fixation device 143 and has an electromagnetic radiator 141.
[0314] FIG. 15 shows a solution with radiators 151 and 1511 that lie distal of the implant housing and that are either put on the treated tissue directly (not shown) or by means of a support 154 with a fixation 156. The support also assumes the role of a mask and shades the rest of the organ. The radiators are supplied through a lead 1515 from the implant 150. Alternatively, the implant itself can assume the role of a support. Then, the radiators are fastened directly to the housing. The implant 150 is fastened to the organ tissue by means of a fixation device 153.
[0315] FIG. 16 shows the flowchart of the method for the inventive stimulation system according to exemplary embodiments. After the start 160, the pretreatment 161 is performed, followed by the implantation and fastening of the stimulator 162. After that, the test 163 of the effectiveness of the therapy is carried out. If the test is not successful, the process is improved in step 164. Otherwise, the method is ended (165).
[0316] FIG. 17 shows the tissue 175 with the pretreated areas 177 and 1771. The stimulator 170 with electromagnetic actuator 171 is fastened to the tissue by means of the fixation 173.
[0317] FIG. 18 shows the tissue 185 with the areas 182 that have been masked by pretreatment. Thus, only the areas 186 and 1861 are stimulable by the radiation that is output from the actuator 181. The implant 180 is fastened to the organ tissue by means of a fixation device 183 and has an electromagnetic radiator 181.
[0318] FIGS. 19A and 19B show an example with locally pretreated areas 198 and 1981 which, however, are sensitive to different frequencies of the electromagnetic radiation. The selective effect of the therapy is achieved by the actuator 191 outputting electromagnetic radiation once at one frequency 199, as shown in FIG. 19A, and another time at another frequency 1991, as shown in FIG. 19B. Although the effective range 196 of the radiation covers all the tissue 195, the radiation only acts on the tissue in the regions 198 and 1981. The implant 190 is fastened to the organ tissue by means of a fixation device 193 and has an electromagnetic radiator 191.
[0319] FIG. 20 shows an example of performing selective therapy by placing the actuators to make use of anatomical qualities of the tissue for shading. FIG. 20 shows how selective therapy is achieved by placing the actuators 201 and 2011 (connected with the stimulator 200 by leads 2015 and 2016) to make use of anatomical shapes 202 of the tissue 205 for shading. The implant 200 is fastened to the organ tissue by means of a fixation device 203.
[0320] FIG. 21 shows the block diagram of the stimulator described in the claims that can output optical therapy. The stimulator 210 comprises an energy source 211, at least one energy storage 214, a charging device 213 for the energy storage 214, and a device for release of the energy 215. Also shown is an actuator 216 that has a light source 218 and a current limiter 217 (e.g., a resistor or a diode). The stimulator 210 has a controller 212. The stimulator 210 comprises a detection unit 2125. Actuator 216 can be implemented in the form of a unit that is separable from rest of the inventive device and can have an interface 219 for making contact.
[0321] FIG. 22 shows the pulse discharge of an ICD, this pulse discharge controlling an inventive optical therapy actuator to output a pulsed therapy.
[0322] In one embodiment of the invention, already known electrical stimulation devices (e.g., cardiac pacemakers, neurostimulators) can be supplemented with an actuator for emitting electromagnetic radiation, to carry out stimulation by means of electromagnetic waves. Apart from the actuator, the stimulation device requires only slight modifications, or none at all.
[0323] FIG. 23 shows a table presenting sample combinations of stimulation and shock vectors between the right ventricle (RV), the housing of the stimulation device (CAN), and the right atrium (RA). For example, the second and third rows of the table represent a combination of two vectors: a first vector from housing CAN to right ventricle RV for the stimulation by an inventive actuator, and a second shock vector between housing CAN and the right atrium RA. In a commercially available ICD, these electrical poles can be implemented by a right ventricular shock coil, the ICD housing, and a supraventricular shock coil. In each case, a vector leads from a first pole marked by the cross to a second pole. The stimulation can be carried out by electromagnetic radiation through an inventive actuator, or by known electrical stimulation, or by a combination of the two.
[0324] FIG. 24 is a block diagram of one embodiment of the inventive device comprising application means to deliver a substance to the tissue. The device 241 is implanted in the body 240. It has a reservoir 242 for the therapeutic substance and supply lines 2435, 2425, and 2445. The reservoir is filled through a port 243. Under the control of the controller 247, the pump pumps the substance to the device/tissue interface or application means 245, which treat the organ 246 with this substance through an optional mask 2455. A control unit 249 detects, among other things, the reservoir level and reports it externally through the telemetry unit 2495. To test the effectiveness, the therapy unit 248 outputs, under control of the controller 247, a test signal 2485. The reaction is detected by a detection unit (not shown) and reported to the control unit.
[0325] FIG. 25 shows the inventive implantable device 250, which is fixed to the tissue 254 by means of a fixation device 251 and which has a sensor 252 to detect electromagnetic radiation 256 that exits as primary radiation from the excitable (optionally pretreated) cell structures 255 to be observed, if the latter form action potentials.
[0326] In an alternative implementation/application scenario, the implantable device 250 has an additional actuator 253 for the production of electromagnetic radiation 257. This electromagnetic radiation 257 is modulated by the excitable (optionally pretreated) cell structures 255 to be observed, depending on their action potentials, and returns to the sensor 252 in the form of secondary radiation 256.
[0327] FIG. 26 discloses an implementation with actuators and sensors for electromagnetic radiation that are incorporated into the fixing unit. Here the fixing unit 261 consists of a shaft 2611 with folding, lockable arms 2612 that carry, e.g., the sensors 262. The actuators 263 are fixed opposite, e.g., on the housing 260. During implantation, the arms are aligned in the direction of the shaft, pushed through the organ wall 268, and then folded down and in locked in the position in which they lie opposite the actuators on the other side of the wall.
[0328] FIG. 27 discloses another implementation with actuators 273 and sensors 272 for electromagnetic radiation incorporated into the fixing unit. This involves the fixing unit 271 of the actuators 273 and sensors 272 being in the form of a pincer 270. A lead 271 leads to the device (not shown).
[0329] FIG. 28 shows an example of the preferred sequence of events in an implantation according to the inventive method. The steps shown are: [0330] 280 starting the implantation [0331] 281 pretreating the target tissue [0332] 282 determining the suitable implantation site [0333] 283 positioning the device until the suitable implantation site is reached [0334] 2835 adjusting the position [0335] 284 fixing [0336] 285 setting parameters and starting the detection method (incl. processing and analysis) [0337] 286 testing [0338] 2865 adjusting the parameters [0339] 287 ending the implantation.
[0340] FIG. 29 shows an example of a preferred sequence of events in the signal processing of the inventive method. The steps shown are: [0341] 290 starting the detection (measurement) [0342] 291 amplifying, [0343] 2911 demodulating, [0344] 2912 analog filtering, [0345] 292 AD conversion; [0346] 2921 digital filtering; [0347] 2922 determining the signal strength; [0348] 2923 determining the threshold; [0349] 293 segmenting; [0350] 2931 event detection; [0351] 2932 determining periodicity; [0352] 294 classifying rhythms [0353] 295 ending the detection (measurement).
[0354] The invention entirely or partly eliminates the disadvantageous effects of galvanically coupled therapeutic electrical currents for the therapy of cardiac tissue, neuronal tissue, or muscle tissue.
[0355] This selective therapeutic approach opens new possibilities for multifocal therapy, without having to implant a separate probe for each stimulation site. The large-area multifocal therapy that it allows makes it possible to produce excitation patterns that represent natural spatiotemporal relationships much better than before.
[0356] The energy demand requirements of such implants can be substantially reduced. Furthermore, completely new designs of such implants are possible.
[0357] In the context of the invention, the following terms are used as synonyms for the inventive implantable device for detection of electromagnetic waves that are emitted from genetically manipulated tissue, and/or for stimulation of genetically manipulated tissue by means of electromagnetic waves: stimulator, stimulation device, device for stimulation, stimulation system (device is at least part of what is described as a stimulation system).
[0358] The following terms should be understood as follows: [0359] “wave train” is understood to mean a continuous electromagnetic wave; [0360] “electromagnetic radiation” and “electromagnetic wave” are used as synonyms; [0361] ATP has the meaning “antitachycardia pacing”; [0362] IPG has the meaning “implantable pulse generator”; and [0363] ICD has the meaning “implantable cardioverter-defibrillator.”
[0364] It will be apparent to those skilled in the art that numerous modifications and variations of the described examples and embodiments are possible in light of the above teaching. The disclosed examples and embodiments are presented for purposes of illustration only. Other alternate embodiments may include some or all of the features disclosed herein. Therefore, it is the intent to cover all such modifications and alternate embodiments as may come within the true scope of this invention.
