Implantable cardioverter defibrillators

Abstract

The present invention relates to an implantable cardioverter defibrillator 1 having a housing 2 comprising a processor, a memory unit, a single electrode connection port 3, a stimulation unit configured to provide electrical pulses to electrodes 4, 14 connected to the electrode connection port 3 in order to stimulate a human or animal heart 5, and a detection unit configured to receive electrical signals of the same heart 5 from the same electrodes 4, 14. According to one aspect of the invention, the electrode connection port 3 is configured to receive a percutaneous intravenous implantable electrode 4 or a substernal implantable electrode 14, and the memory unit comprises a computer readable program for causing the processor to operate the stimulation unit and / or the detection unit in a first operating mode when the percutaneous intravenous implantable electrode 4 is connected to the electrode connection port 3 and to operate in a second operating mode when the substernal implantable electrode 14 is connected to the electrode connection port 3.

Description

[Technical field]

[0001] The invention relates to an implantable cardioverter defibrillator according to the preamble of claim 1 and to a defibrillation device comprising such an implantable cardioverter defibrillator according to the preamble of claim 6. [Background technology]

[0002] An implantable cardioverter-defibrillator (ICD) is implanted within a patient's body and is capable of defibrillating and optionally cardioversion by pacing the heart. It is generally possible to connect different types of electrodes to an ICD and program the ICD accordingly to function properly with the selected electrodes.

[0003] US Patent Publication No. 5,411,528 describes an electrically programmable polarized connector for an implantable body tissue stimulator such as an ICD. In this context, it is described that a physician may program the memory of the ICD with the type of lead (e.g., transvenous, pericardial patch, subcutaneous, etc.) and the placement of the lead (e.g., right or left ventricle, atrium, superior vena cava, coronary sinus, etc.). The US patent further describes the possibility that any treating physician may interrogate the ICD to determine the exact shock configuration and, if necessary, continue to evaluate the effect of the electrode polarity and change the effect accordingly.

[0004] U.S. Patent Publication No. 5,441,518 describes an implantable multi-chamber cardioversion and defibrillation system with multiple independently controllable and programmable switched electrode discharge paths. This independently controlled switching device provides control over the polarity, phase, direction and timing of all cardioversion and defibrillation countershocks and allows modification of subsequent countershocks after the first countershock. The switching device is preferably programmable prior to implantation of the system and can be reprogrammed after implantation of the system.

[0005] US Patent Publication 2004 / 0215240 describes a reconfigurable cardiac device including a housing in which a detection circuit and an energy delivery circuit are provided. One or more subcutaneous, non-intrathoracic electrodes are coupled to the energy delivery and detection circuit. A lead interface is provided on the housing and coupled to the energy delivery and detection circuit. The lead interface is configured to receive at least one lead including one or more intrathoracic lead electrodes. A controller is provided in the housing and coupled to the lead interface and the energy delivery and detection circuit. The system is operable in a first configuration with subcutaneous electrodes in the absence of leads, and also in a second configuration using at least one or more of the lead electrodes. The system is capable of cardiac activity sensing and cardiac stimulation in each of the first and second system configurations, respectively. [Prior art documents] [Patent documents]

[0006] [Patent Document 1] U.S. Patent Publication No. 5,411,528 [Patent Document 2] U.S. Patent Publication No. 2004 / 0215240 Summary of the Invention [Problem to be solved by the invention]

[0007] It is an object of the present invention to provide an implantable defibrillator which can be used generally for a variety of applications and which offers a higher level of ease of use and safety than defibrillators known from the prior art. [Means for solving the problem]

[0008] This object is achieved with an implantable cardioverter defibrillator having the features of claim 1. Such an implantable cardioverter defibrillator (ICD) has a housing comprising a processor, a memory unit, exactly one electrode connection port, a stimulation unit and a detection unit. The stimulation unit is configured to provide electrical pulses to electrodes connected to the electrode connection port in order to stimulate the human or animal heart. The detection unit is designed to receive the same cardiac electrical signals with the help of the same electrodes. Due to the single signal electrode connection port only one electrode can be connected to the ICD at a time.

[0009] According to an aspect of the invention, the electrode connection port is configured to receive either a percutaneously implanted electrode or a substernal implanted electrode, and the memory unit further comprises a computer readable program for causing the processor to operate the stimulation unit and / or the detection unit in a first operating mode when a percutaneously implanted electrode is connected to the electrode connection port, and for causing the processor to operate the stimulation unit and / or the detection unit in a second operating mode when a substernal implanted electrode is connected to the electrode connection port.

[0010] Thus, the presently claimed ICD automatically detects the type of electrode connected to the electrode connection port, so that the correct electrode configuration can be automatically selected and applied by the ICD. As a result, the physician can no longer inadvertently program the ICD incorrectly. Furthermore, the presently claimed ICD only provides one connection port for a single electrode. Thus, the possibility of inadvertently selecting the wrong connection port for an electrode is no longer an issue. Although there are ICDs on the market that determine the configuration of the connected electrode according to the connection port into which the electrode is inserted, such a possibility is clearly a source of error, when an electrode is inserted into an electrode connection port that is not intended for this type of electrode. To prevent this source of error, different adapters or electrode connectors are used to avoid the selection of the wrong electrode connection port. However, this increases the number of required parts and also the overall complexity of ICD systems known from the prior art.

[0011] The presently claimed ICD does not require any adapters, but rather any percutaneous intravenous implantable electrode and any substernal implantable electrode with defined or standardized connections can be connected to the electrode connection port.

[0012] The presently claimed ICD can thus be used with percutaneous intravenous or substernal electrodes without electrode selection prior to implantation, which reduces the computational effort of the physician implanting the ICD in the patient. Regardless of the number of patients who require percutaneous intravenous or substernal electrodes, the physician can use a larger shared facility for the ICD, and its use is not limited to the specific type of electrodes connected to the ICD.

[0013] In one embodiment, the stimulation unit is capable of applying a desired cardiac therapy to the heart of a human or animal patient wearing an ICD, suitable therapies being shock therapy, anti-tachycardic pacing (ATP), or constant pacing (anti-bradycardia pacing).

[0014] In one embodiment, the first operating mode has a first set of parameters and algorithms for generating electrical pulses by the stimulation unit and sensing electrical signals by the detection unit. Similarly, the second operating mode has a second set of parameters and algorithms for generating electrical pulses by the stimulation unit and sensing electrical signals by the detection unit. In this context, the second set is different from the first set. Thus, the parameters and algorithms required for sensing and stimulation are specifically adapted to the type of electrodes connected to the electrode ports of the ICD.

[0015] In one embodiment, data on the selected parameters and algorithms may be communicated to a programming device and displayed to a user to allow individual control of the selected parameters and algorithms. Additionally, the programming device may allow adaptation of the individual parameters and algorithms of a selected set of parameters and algorithms.

[0016] In one embodiment, the first set of parameters and algorithms and the second set of parameters and algorithms comprise a shock energy of the electrical pulse to be generated by the stimulation unit, where for electrodes implanted substernally, the required shock energy is typically higher than for electrodes implanted via a percutaneous intravenous technique.

[0017] In one embodiment, the first set of parameters and algorithms and the second set of parameters and algorithms also have information on the shock path that any electrical shock to be delivered by the stimulation unit should take. As with shock energy, the shock path may also be significantly different when using intravenously implanted electrodes than when using substernal implanted electrodes.

[0018] In one embodiment, the first set of parameters and algorithms and the second set of parameters and algorithms include parameters that control activation or deactivation of a pacing function of the ICD. In the case of substernal implanted connected electrodes, such pacing function is typically not necessary. In contrast, when percutaneous intravenous implanted electrodes are used in connection with an ICD, the ICD can perform functions according to the pacing function of the heart to be stimulated.

[0019] In one embodiment, the first operating mode (i.e., the operating mode selected when a percutaneous intravenous implantable electrode is connected to the electrode connection port of the ICD housing) includes a safety device or system that prevents the stimulation unit from generating electrical pulses having too high a voltage and / or energy. More precisely, the safety device prevents the generation of pulses having a voltage and / or energy above a pre-determined threshold.

[0020] In one embodiment the threshold value is 60 J or is in the range of 40 J to 60 J, particularly in the range of 45 J to 55 J, particularly around 50 J. Such a threshold value is selected if the energy of the generated pulses should be limited by the safety device in the first mode of operation.

[0021] In one embodiment, the threshold value is 1000 V or is in the range of 500 V to 1000 V, in particular in the range of 600 V to 900 V, in particular in the range of 700 V to 800 V. Such a threshold value is selected if the voltage of the generated pulses should be limited by the safety device in the first operating mode.

[0022] Any combination of the voltages and energies mentioned above is possible and encompassed by the embodiments of the present invention.

[0023] In one embodiment, the ICD is capable of generating energy pulses having energies greater than 20 J to deliver shock pulses with sufficiently high shock energies for cardioversion and / or defibrillation. Depending on the type of electrodes connected, delivered shock energies in the range of 10 J to 60 J, in particular in the range of 30 J to 45 J, or in the range of 20 J to 120 J, in particular in the range of 30 J to 100 J, in particular in the range of 40 J to 90 J, in particular in the range of 50 J to 80 J, in particular in the range of 60 J to 110 J, in particular in the range of 70 J to 100 J, in particular in the range of 80 J to 90 J are particularly suitable.

[0024] In one embodiment, the housing is 70 cm 3 Smaller volumes, especially 20cm 3 From 70cm 3 Within the range of 30 cm 3 From 65cm 3 Within the range of 40 cm 3 From 60cm 3 Within the range of 50 cm 3 From 55cm 3 The volume is in the range of

[0025] In one embodiment, the housing has a thickness not exceeding 13 mm, in particular in the range of 5 mm to 13 mm, in particular in the range of 6 mm to 12 mm, in particular in the range of 7 mm to 11 mm, in particular in the range of 8 mm to 10 mm.

[0026] In one embodiment, the housing has rounded edges with a radius greater than 1 mm for at least each section, in particular in the range of 1 mm to 5 mm, in particular in the range of 1.5 mm to 4.5 mm, particularly in the range of 2 mm to 4 mm, in particular in the range of 2.5 mm to 3.5 mm.

[0027] In one embodiment, the ICD has the capability to transmit data to a home monitoring system to allow easy monitoring of the proper functioning of the ICD.

[0028] In one embodiment, an ICD may be implanted subcutaneously, which may then be labeled as an ICD.

[0029] In one aspect, the invention relates to a defibrillation device comprising an implantable cardioverter defibrillator according to any of the preceding descriptions and an electrode connected to an electrode connection port of the implantable cardioverter defibrillator. As explained above, the electrode is either a percutaneous intravenous electrode or a substernal electrode. All electrodes that may be connected to the electrode connection port of the ICD have the same connector type, regardless of the specific type of electrode. Particularly suitable connectors are the IS-1, DF-1, IS4, and DF4 connectors. These types of connectors are standardized and commercially available connectors, so that the ICD can be connected to a number of widely available electrodes.

[0030] In one embodiment, the memory unit of the ICD contains a computer readable program that, when executed on a processor, causes the processor to perform the steps described below.

[0031] First, the sensing unit and electrodes are used to measure at least one physiological parameter of a patient in which a defibrillator is implanted.

[0032] At least one physiological parameter is then used to determine whether the connected electrode is implanted via a percutaneous intravenous technique or substernal implantation.

[0033] Finally, if the electrodes are identified as percutaneous intravenous implanted electrodes, the implantable cardioverter defibrillator is automatically operated in a first mode of operation. Similarly, if the electrodes are identified as substernal implanted electrodes, the ICD is operated in a second mode of operation. Such automatic detection of the electrode type of already implanted electrodes allows for a particularly safe and reliable operation of the ICD and its connected electrodes.

[0034] In one embodiment, the at least one physiological parameter is selected from the group consisting of impedance and electrocardiogram. The impedance between an intravenously implanted electrode and the housing of the ICD is significantly higher than the impedance between a substernal implanted electrode and the housing of the ICD. Thus, impedance is a particularly reliable measure for determining whether an electrode connected to an electrode connection port of an ICD is an intravenously implanted electrode or a substernal implanted electrode.

[0035] Another reliable measure to determine whether the connected electrode is a substernal or intravenous electrode is evaluation of the electrocardiogram recorded by the electrode, since the signal present in the electrocardiogram differs depending on the location where the electrocardiogram is obtained.

[0036] In one embodiment, the at least one physiological parameter is an electrocardiogram, and determining whether the connected electrode is a percutaneous intravenous or substernal implanted electrode includes analyzing the temporal occurrence of signals detected in the electrocardiogram. Such timing analysis of the electrocardiogram can also reveal whether the connected electrode is a percutaneous intravenous or substernal implanted electrode.

[0037] In one embodiment, the at least one physiological parameter is an electrocardiogram, and the determining step includes a morphology analysis of a signal detected in the electrocardiogram. In addition to the temporal occurrence of the signal, the morphology of the signal in the electrocardiogram also varies depending on the location of the acquisition of the electrocardiogram.

[0038] In one embodiment, the computer readable program causes the processor to read an electronic identifier of the electrode, the electronic identifier including information about whether the connected electrode is a percutaneous intravenous or substernal implanted electrode. Thus, not only can the patient's physiological parameters be used to distinguish between percutaneous intravenous and substernal implanted electrodes, but such an electronic identifier is also present on or in the implanted electrode. A suitable electronic identifier is one that works on the basis of radio-frequency identification (RFID). When using RFID, the electrode in one embodiment includes a transponder, while the ICD acts as the readout device.

[0039] In one embodiment, the defibrillator is configured to deliver electrical pulses having a voltage of at least 60V between the poles of the electrodes and the poles of the implantable cardioverter defibrillator in the first and second operating modes. Electrical pulses having such voltages can typically be denoted as high voltage pulses and are particularly suitable for achieving cardioversion / defibrillation. In one embodiment, the voltage of such electrical pulses is in the range of 60V to 1000V, in particular in the range of 80V to 900V, in particular in the range of 100V to 800V, in particular in the range of 200V to 700V, in particular in the range of 300V to 600V, in particular in the range of 400V to 500V.

[0040] In one embodiment, the connection port comprises a plurality of connector poles. In this context, a first connection configuration between the connector poles and the poles of the electrodes in a first operating mode is different from a second connection configuration between the connector poles and the poles of the electrodes in a second operating mode. As a result, it is possible to control the poles of the connected electrodes in different ways depending on the selected operating mode.

[0041] In one embodiment, the connection port comprises four connector poles providing low, low, high and high voltages in succession from the most proximal connector pole to the most distal connector pole. In this context, the term "low voltage" refers to a voltage in the range of 0.1 V to less than 60 V (e.g. 59.9 V), in particular in the range of 1 V to 55 V, in particular in the range of 5 V to 50 V, in particular in the range of 10 V to 40 V, in particular in the range of 20 V to 30 V. Alternatively or additionally, the term "high voltage" refers to a voltage in the range of 60 V to 1000 V, in particular in the range of 80 V to 900 V, in particular in the range of 100 V to 800 V, in particular in the range of 200 V to 700 V, in particular in the range of 300 V to 600 V, in particular in the range of 400 V to 500 V.

[0042] In one embodiment, the first connection configuration establishes electrical contact between the first connector pole (the most proximal connector pole) and a pole of the tip electrode, between the second connector pole (distal to and adjacent to the first connector pole) and a pole of the ring electrode, and between the fourth connector pole (the most distal connector pole) and a pole of the shock coil electrode. In this electrical connection configuration, the third connector pole (between the second and fourth connector poles) is not used.

[0043] In one embodiment, the second connection arrangement establishes electrical contact between the first connector pole (the proximal-most connector pole) and a pole of a sensing electrode, between the second connector pole (distal to and adjacent to the first connector pole) and another pole of a sensing electrode, between the third connector pole (distal to and adjacent to the second connector pole, as well as proximal to and adjacent to the fourth connector pole) and a pole of a shock coil electrode, and between the fourth connector pole (the distal-most connector pole) and a pole of a shock coil electrode. In one embodiment, both lines connected to the shock coil supply electrical energy to different ends of the shock coil in each case.

[0044] In one embodiment, the defibrillator is compatible with methods that utilize magnetic resonance imaging (MRI compatible), which facilitates further evaluation of the patient in whom the defibrillator is implanted, which facilitates further diagnostic and therapeutic evaluation of the patient.

[0045] In one aspect, the present invention relates to a first method for operating a defibrillation device according to the previous description. As previously described, such a defibrillation device comprises an implantable cardioverter defibrillator (ICD) having a housing with a processor, a memory unit and a single electrode connection port. The defibrillation device further comprises electrodes connected to the electrode connection port. The housing of the ICD further comprises a stimulation unit and a detection unit. The stimulation unit functions to provide electrical pulses to the electrodes to stimulate the human or animal heart. The detection unit functions to receive the same cardiac electrical signals with the aid of the electrodes. The method comprises the steps described below.

[0046] First, the sensing unit and electrodes are used to measure at least one physiological parameter of a patient in which a defibrillator is implanted.

[0047] At least one physiological parameter is then used to determine whether the connected electrode is implanted via a percutaneous intravenous technique or substernal implantation.

[0048] Finally, the ICD is operated in a first operating mode if the electrode is a percutaneous intravenous implanted electrode and in a second operating mode if the electrode is substernal implanted, thus allowing automatic and reliable detection of the type of electrode used and automatic configuration of the ICD's operating mode to ensure safe and reliable operation of the ICD depending on the type of electrode connected.

[0049] In one aspect, the invention relates to a second method of operating a defibrillator according to the above description, the method comprising the steps described below.

[0050] First, an electronic identifier on or in the electrode is read by the ICD.

[0051] The identifier readout is then used to determine whether the connected electrode is implanted via a percutaneous intravenous technique or substernal implantation.

[0052] Finally, the ICD is operated in a first operating mode if the electrode is a percutaneous intravenous implanted electrode and in a second operating mode if the electrode is substernal implanted. Thus, this method also allows automatic and reliable detection of the type of electrode used and ensures a safe and reliable operation of the ICD depending on the type of electrode connected, by automatic configuration of the ICD's operating mode. It functions independently of the patient's physiological parameters, but requires electrodes equipped with electronic identifiers.

[0053] All of the embodiments of the implantable cardioverter-defibrillator may be combined in any desired manner and may be followed, either individually or in any optional combination, with the defibrillation devices and methods described. Similarly, all of the embodiments of the implantable cardioverter-defibrillator may be combined in any desired manner and may be followed, either individually or in any optional combination, with the implantable cardioverter-defibrillator and methods described. Finally, all of the embodiments of the methods may be combined in any desired manner and may be followed, either individually or in any optional combination, with the implantable cardioverter-defibrillator, defibrillator, and each of the other methods described.

[0054] Further details of aspects of the invention are explained below with reference to exemplary embodiments and the accompanying drawings. [Brief description of the drawings]

[0055] [Figure 1A] 1 is a schematic diagram of a first embodiment of a defibrillator; [Figure 1B] FIG. 2 is a schematic diagram of a second embodiment of a defibrillator; [Figure 2A] FIG. 2 is a diagram showing a first embodiment of a connection configuration. [Figure 2B] FIG. 11 is a diagram showing a second embodiment of a connection configuration. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0056] FIG 1A shows an implantable cardioverter defibrillator (ICD) having a housing 2 and an electrode connection port 3. A percutaneously implanted electrode 4 is connected to the electrode connection port 3. The percutaneously implanted electrode 4 is implanted in a human heart 5 via a vena cava. The electrode 4 includes a shock coil 6, a ring electrode pole 7, and a tip electrode pole 8.

[0057] By measuring the impedance between the ring electrode 7 or tip electrode 8 on the one hand and the housing 2 on the other hand, the ICD 1 determines whether the electrode 4 is truly a percutaneous intravenous implanted electrode. If the impedance is too low, a substernal implanted electrode is instead connected to the electrode connection port 3. Such a situation is illustrated in Figure 1B. In this and all following figures, similar elements are denoted with the same numerical references.

[0058] In Fig. 1B, a substernal implanted electrode 14 is connected to the connection port 3 of the housing 2 of the ICD 1 already shown in Fig. 1A. The substernal implanted electrode 14 is placed diagonally from the human heart 5. It also comprises a shock coil 6, a ring electrode 7 and a tip electrode 8. Whereas in the case of the percutaneous intravenous implanted electrode 4 (see Fig. 1A) the ring electrode 7 is placed between the shock coil 6 and the tip electrode 8, in the case of the substernal implanted electrode 14 the ring electrode 7 is placed proximal to the shock coil 6. However, other electrode polar arrangements are also possible.

[0059] Upon determining the impedance between the ring electrode 7 of a substernal implanted electrode 14 and the housing 2 of the ICD 1, the resulting value unambiguously identifies the electrode 14 as truly a substernal implanted electrode and not an electrode implanted by a percutaneous intravenous technique, and the ICD 1 then goes into a mode of operation designed and specifically suited for such a substernal implanted electrode 14.

[0060] FIG. 2A shows a first connection configuration between one connector pole and the pole of the other electrode. This first connection configuration applies in the case of a percutaneously implanted electrode. The first connector pole 21 is electrically connected to the tip electrode 8 of the percutaneously implanted electrode (see FIG. 1A for more details). The first connector pole 21 is the most proximal connector pole of all the connector poles. The second connector pole 22 is adjacent to and distal to the first connector pole 21 and is connected to the ring electrode 7 of the percutaneously implanted electrode. The third connector pole 23 is not connected to any pole of the electrode. However, the fourth connector pole 24 is connected to one end of the shock coil 6 of the percutaneously implanted electrode. Thus, the single electrical connection of the shock coil 6 allows an electrical gradient to build up when an electrical pulse is delivered to the shock coil 6 from the fourth connector pole 24. The counter electrode is in each case the housing 2 of the ICD 1 (see FIG. 1A for more details).

[0061] FIG. 2B shows a second connection configuration that is typically applied when a substernal implanted electrode 14 is connected to the electrode connector 3 of the housing 2 of the ICD 1 (see FIG. 1B for more details). Here, the first connector pole 21 (i.e., the most proximal connector pole) is connected to the tip electrode pole 8 of the substernal implanted electrode. Furthermore, the second connector pole 22 is connected to the ring electrode 7. The third connector pole 23 is located between the second connector pole 22 and the fourth connector pole 24 and is connected to a first end of the shock coil 6. The fourth connector pole 24 (the most distal connector pole) is connected to the opposite end of the shock coil 6. When applying a high voltage to the shock coil 6 via the third connector pole 23 and the fourth connector pole 24, this voltage is delivered to the shock coil 6 at both ends simultaneously. This results in a very uniform electric field between the shock coil 6 and the housing 2 of the ICD, which serves as a counter electrode for the shock coil 6 (see FIG. 1B for more details).

[0062] 2A and 2B, it is clear that the connector poles delivering low voltage to the poles of the electrodes are arranged adjacent to each other (i.e. the first connector pole 21 and the second connector pole 22). Similarly, the two connector poles capable of delivering high voltage to the corresponding poles of the electrodes are also arranged adjacent to each other (i.e. the third connector pole 23 and the fourth connector pole 24).

Claims

1. 1. An implantable cardioverter-defibrillator having a housing (2) with a processor, a memory unit, a single electrode connection port (3), a stimulation unit configured to provide electrical pulses to electrodes (4, 14) connected to said electrode connection port (3) in order to stimulate a human or animal heart (5), and a detection unit configured to receive electrical signals of said same heart (5) from said same electrodes (4, 14), the electrode connection port (3) is configured to receive a percutaneous intravenous implantable electrode (4) or a substernal implantable electrode (14), and the memory unit comprises a computer readable program that causes the processor to operate the stimulation unit and / or the detection unit in a first operating mode when a percutaneous intravenous implantable electrode (4) is connected to the electrode connection port (3), and to operate the stimulation unit and / or the detection unit in a second operating mode when a substernal implantable electrode (14) is connected to the electrode connection port (3).

2. 2. The implantable cardioverter-defibrillator of claim 1, wherein the first operating mode has a first set of parameters and algorithms for generating electrical pulses by the stimulation unit and sensing electrical signals by the detection unit, and the second operating mode has a second set of parameters and algorithms for generating electrical pulses by the stimulation unit and sensing electrical signals by the detection unit, the second set of parameters and algorithms being different from the first set of parameters and algorithms.

3. 3. The implantable cardioverter-defibrillator of claim 2, wherein the first set of parameters and algorithms and the second set of parameters and algorithms include shock energies of the electrical pulses to be generated by the stimulation unit.

4. 4. The implantable cardioverter-defibrillator of claim 1, wherein the first operating mode includes a safety device that prevents the stimulation unit from generating electrical pulses having a voltage and / or energy exceeding a predeterminable threshold.

5. 5. The implantable cardioverter-defibrillator of claim 4, wherein the threshold value is selected from the range of 60 J to 1000 J.

6. A defibrillation device comprising the implantable cardioverter defibrillator (1) according to claim 4 and electrodes (4, 14) connected to the electrode connection ports (3) of the implantable cardioverter defibrillator (1).

7. The memory unit, when executed on the processor, performs the following steps: a) measuring at least one physiological parameter of a patient having the defibrillator implanted therein using the detection unit and the electrodes (4, 14); b) determining, using said at least one physiological parameter, whether said connected electrodes (4, 14) are implanted percutaneously, intravenously or substernally; c) operating the implantable cardioverter-defibrillator (1) in the first operating mode when the electrode (4) is implanted by a percutaneous intravenous method, and in the second operating mode when the electrode (14) is received substernally.

7. The defibrillator of claim 6, further comprising a computer readable program for causing said processor to execute said program.

8. 8. The defibrillator of claim 7, wherein the at least one physiological parameter is selected from the group consisting of impedance and electrocardiogram.

9. 8. The defibrillator of claim 7, wherein the at least one physiological parameter is an electrocardiogram, and the determining step includes analyzing the temporal occurrence of signals detected in the electrocardiogram.

10. 8. The defibrillator of claim 7, wherein the at least one physiological parameter is an electrocardiogram, and the determining step includes a morphological analysis of signals detected in the electrocardiogram.

11. 7. The defibrillator of claim 6, wherein the computer readable program causes the processor to read an electronic identifier of the electrode (4, 14) to determine whether the connected electrode (4, 14) is a percutaneous intravenous implanted electrode (4) or a substernal implanted electrode (14).

12. 7. The defibrillator of claim 6, wherein the defibrillator is configured to deliver electrical pulses having a voltage of at least 60 V between the poles of the electrodes (6, 7, 8) and the poles of the implantable cardioverter-defibrillator (1) in both the first and second operating modes.

13. 7. The defibrillator of claim 6, wherein the connection port (3) comprises a plurality of connector poles (21, 22, 23, 24), and wherein a first connection configuration between the connector poles (21, 22, 23, 24) and the poles (6, 7, 8) of the connected electrode (4, 14) in the first operating mode is different from a second connection configuration between the connector poles (21, 22, 23, 24) and the poles (6, 7, 8) of the electrode in the second operating mode.

14. 7. A method for operating a defibrillator according to claim 6, wherein the defibrillator comprises: 1) an implantable cardioverter-defibrillator (1) having a housing (2) with a processor, a memory unit and a single electrode connection port (3); and 2) electrodes (4, 14) connected to the electrode connection port (3), the housing (2) further comprising a stimulation unit configured to provide electrical pulses to the electrodes (4, 14) to stimulate a human or animal heart (5), and a detection unit configured to receive electrical signals of the same heart (5) from the electrodes (4, 14). The method comprises the steps of: a) measuring at least one physiological parameter of a patient having the defibrillator implanted therein using the detection unit and the electrodes (4, 14); b) determining, using said at least one physiological parameter, whether said connected electrodes (4, 14) are implanted percutaneously, intravenously or substernally; and c) operating the implantable cardioverter-defibrillator (1) in a first operating mode if the electrodes (4) are implanted via a percutaneous intravenous technique, and in a second operating mode if the electrodes (14) are implanted via a substernal technique.

Images