External defibrillator

Abstract

A wearable external defibrillator with a plurality of ECG sensing electrodes and a first defibrillator pad electrode and a second defibrillator pad electrode. The ECG sensing electrodes and the defibrillator pad electrodes are configured for long term wear.

What is claimed is: 
     
         1 . A wearable external defibrillator comprising:
 one or more sensing electrodes configured to engage with a patient's skin to detect a cardiac signal;   a defibrillator electrode pad configured to engage with the patient's skin and to deliver an electrical therapy to the patient, the defibrillator electrode pad configured to be in continuous electrical communication with the patient's skin;   a patient engagement substrate comprising an adhesive, the one or more sensing electrodes, the defibrillator electrode pad, and a fluid transport element configured to transport fluid away from the skin to allow the wearable external defibrillator to be worn continuously during movement and showering activities;   an energy source; and   a controller configured to detect the cardiac signal with the sensing electrodes and to deliver a therapeutic shock through the defibrillator pad to the patient while the patient engagement substrate is engaged with the patient.   
     
     
         2 . A wearable external defibrillator comprising:
 one or more sensing electrodes configured to engage with a patient's skin to detect a cardiac signal;   a defibrillator electrode pad configured to engage with the patient's skin and to deliver an electrical therapy to the patient, the defibrillator electrode pad configured to be in continuous electrical communication with the patient's skin;   a patient engagement substrate comprising the one or more sensing electrodes, the defibrillator electrode pad, and an elastic element configured to conform to, and stretch with, the patient's skin to allow the wearable external defibrillator to be worn continuously during movement and showering activities;   an electrical energy source; and   a controller configured to detect the cardiac signal with the sensing electrodes and to deliver a therapeutic shock through the defibrillator pad to the patient while the patient engagement substrate is engaged with the patient.   
     
     
         3 . The wearable external defibrillator of  claim 1  or  claim 2 , further comprising:
 a second patient engagement substrate comprising a second defibrillator electrode pad, a second adhesive, and a second plurality of sensing electrodes, the second defibrillator electrode pad configured to engage with the patient's skin and to deliver an electrical therapy to the patient, the second defibrillator electrode pad configured to be in continuous electrical communication with the patient's skin, the second defibrillator electrode in electrical communication with the electrical energy source. 
 
     
     
         4 . The wearable defibrillator of any of  claims 1 - 3 , further comprising: a battery, one or more capacitors, wherein the controller is configured to charge the one or more capacitors with the battery and to discharge the one or more capacitors through the defibrillator electrode pad and the second defibrillator electrode pad, wherein the electrical energy source includes the one or more capacitors. 
     
     
         5 . The wearable defibrillator of  claim 4 , wherein the battery, one or more capacitors, and the controller are enclosed in a housing connected to the patient engagement substrate. 
     
     
         6 . The wearable defibrillator of  claim 4 , wherein the battery, one or more capacitors, and the controller are enclosed in two or more separate housing connected to the patient engagement substrate. 
     
     
         7 . The wearable defibrillator of  claim 5  or  claim 6 , wherein the housing is configured to allow water vapor to pass from an interior surface of the housing through the housing to an exterior surface. 
     
     
         8 . The wearable defibrillator of  claim 7 , wherein the interior surface of the housing is permeable to water vapor such that water vapor can pass from the interior surface to the exterior surface with an average moisture transmission rate of greater than about 250 g/m 2  per day based on a surface area of the patient engagement substrate. 
     
     
         9 . The wearable defibrillator of any of  claims 5 - 8 , wherein the housing is air permeable. 
     
     
         10 . The wearable defibrillator of any of  claims 5 - 9 , wherein the exterior surface of the housing is hydrophobic. 
     
     
         11 . The wearable defibrillator of any of  claims 5 - 10 , wherein the exterior surface of the housing is water resistant. 
     
     
         12 . The wearable defibrillator of any of  claims 5 - 11 , further comprising:
 a fluid transport layer within the housing in fluid communication with the patient engagement substrate, the fluid transport layer configured to improve the flow of fluid across the patient engagement substrate.   
     
     
         13 . The wearable defibrillator of  claim 12 , wherein the fluid transport layer has an absorption capacity of greater than about 500%. 
     
     
         14 . The wearable defibrillator of any of  claims 12 - 13 , wherein the fluid transport element includes the adhesive and the fluid transport layer. 
     
     
         15 . The wearable defibrillator of  claims 12 - 14 , wherein the fluid transport layer is configured to transport fluid across a dominant surface area of the fluid transport layer. 
     
     
         16 . The wearable defibrillator of any of  claims 12 - 15 , further comprising: an absorbent material within the housing. 
     
     
         17 . The wearable defibrillator of  claim 16 , wherein transport element includes the absorbent material. 
     
     
         18 . The wearable defibrillator of  claim 17 , wherein the transport element includes the housing. 
     
     
         19 . The wearable defibrillator of any of  claims 5 - 18 , further comprising one or more waterproof housings surrounding the one or more capacitors, battery, and controller. 
     
     
         20 . The wearable defibrillator of any of  claims 5 - 19 , further comprising a support layer configured to engage with and support the controller, one or more capacitors, and battery. 
     
     
         21 . The wearable defibrillator of any of  claims 5 - 20 , wherein a ratio of a combined weight of the one or more capacitors, battery, and controller to the surface area of the patient engagement substrate is less than about 2 g/cm 2 . 
     
     
         22 . The wearable defibrillator of  claim 4 , wherein the battery, one or more capacitors, and the controller are enclosed in a housing separate from the patient engagement substrate and the second patient engagement substrate. 
     
     
         23 . The wearable defibrillator of any of  claims 1 - 22 , wherein the patient engagement surface has an average moisture transmission rate of greater than about 10 g/m 2  per day based on a surface area of the patient engagement substrate. 
     
     
         24 . The wearable defibrillator of any of  claims 1 - 23 , wherein the patient engagement surface has an average moisture transmission rate of greater than about 50 g/m 2  per day based on a surface area of the patient engagement substrate. 
     
     
         25 . The wearable defibrillator of any of  claims 1 - 24 , wherein the patient engagement surface has an average moisture transmission rate of greater than about 100 g/m 2  per day based on a surface area of the patient engagement substrate. 
     
     
         26 . The wearable defibrillator of any of  claims 1 - 25 , wherein the patient engagement surface has an average moisture transmission rate of greater than about 150 g/m 2  per day based on a surface area of the patient engagement substrate. 
     
     
         27 . The wearable defibrillator of any of  claims 1 - 26 , wherein the patient engagement surface has an average moisture transmission rate of greater than about 200 g/m 2  per day based on a surface area of the patient engagement substrate. 
     
     
         28 . The wearable defibrillator of any of  claims 1 - 27 , wherein the patient engagement surface has an average moisture transmission rate of greater than about 250 g/m 2  per day based on a surface area of the patient engagement substrate. 
     
     
         29 . The wearable defibrillator of any of  claims 2 - 28 , wherein the elastic element has an average modulus of elasticity of about 0.40 MPa to about 0.9 MPa. 
     
     
         30 . The wearable defibrillator of any of  claims 1 - 29 , wherein the patient engagement substrate has an average modulus of elasticity of about 0.40 MPa to about 0.9 MPa. 
     
     
         31 . The wearable defibrillator of any of  claims 1 - 30 , wherein the patient engagement substrate has an average modulus of elasticity of less than about 5.0 MPa. 
     
     
         32 . The wearable defibrillator of any of  claims 1 - 30 , wherein the patient engagement substrate has an average modulus of elasticity of less than about 2.0 MPa. 
     
     
         33 . The wearable defibrillator of any of  claims 4 - 32 , wherein the one or more capacitors have a total nominal capacitance of greater than about 50 μF. 
     
     
         34 . The wearable defibrillator of any of  claims 4 - 33 , wherein the one or more capacitors have a total voltage greater than about 100 V. 
     
     
         35 . The wearable defibrillator of any of  claims 1 - 34 , further comprising a flexible bridge connecting the first and second patient engagement substrates. 
     
     
         36 . The wearable defibrillator of  claim 35 , wherein the flexible bridge includes an electrical conductor configured to provide electrical communication between the second defibrillator pad electrode and the second plurality of ECG sensing electrodes to one or more of the controller and the one or more capacitors. 
     
     
         37 . The wearable defibrillator of any of  claims 1 - 36 , wherein the adhesive comprises an adhesive border along a perimeter of the first patient engagement substrate configured to adhere to the wearable defibrillator and the skin of the patient, wherein the wearable defibrillator has a tapered cross-sectional profile along the adhesive border from a side of the adhesive border towards a center of the wearable defibrillator to an outer edge of the adhesive border. 
     
     
         38 . The wearable defibrillator of any of  claims 1 - 37 , further comprising: a wireless data communication module within the housing. 
     
     
         39 . The wearable defibrillator of any of  claims 1 - 38 , further comprising one or more sensors within the housing. 
     
     
         40 . The wearable defibrillator or  claim 39 , wherein the sensors include one or more of: a GPS sensor, accelerometer, microphone, and a gyroscope. 
     
     
         41 . The wearable defibrillator of any of  claims 1 - 40 , wherein the wearable defibrillator has a moisture transport rate of greater than about 250 g/m 2  per day from the first patient engagement substrate to the exterior of the housing based on a surface area of the first patient engagement substrate. 
     
     
         42 . The wearable defibrillator of any of  claims 1 - 41 , wherein the first defibrillator pad electrode comprises a hydrogel and a woven carbon fiber structure. 
     
     
         43 . The wearable defibrillator of any of  claims 1 - 42 , wherein the wearable defibrillator has a moisture transport rate of greater than about 250 g/m 2  per day from the second patient engagement substrate to an exterior of an outer layer based on a surface area of the second patient engagement substrate. 
     
     
         44 . The wearable defibrillator of any of  claims 1 - 43 , further comprising a user interface. 
     
     
         45 . The wearable defibrillator of any of  claims 1 - 44 , wherein the patient engagement substrate has an average moisture transmission rate of greater than about 500 g/m 2  per day. 
     
     
         46 . The wearable defibrillator of any of  claims 1 - 45 , wherein the fluid transport element has an average moisture transmission rate of greater than about 50 g/m 2  per day based on a surface area of the patient engagement substrate. 
     
     
         47 . The wearable defibrillator of any of  claims 1 - 46 , wherein the fluid transport element has an average moisture transmission rate of greater than about 250 g/m 2  per day based on a surface area of the patient engagement substrate. 
     
     
         48 . The wearable defibrillator of any of  claims 1 - 47 , wherein the adhesive in the patient engagement substrate includes perforations. 
     
     
         49 . The wearable defibrillator of  claim 48 , wherein the perforations have a diameter of about 0.5 mm to about 2 mm. 
     
     
         50 . The wearable defibrillator of  claim 48  or  claim 49 , wherein the perforations in the adhesive have an open area of about 10% to about 25% of an overall surface area of the adhesive. 
     
     
         51 . The wearable defibrillator of any of  claims 2 - 50 , wherein the elastic element includes the adhesive. 
     
     
         52 . The wearable defibrillator of any of  claims 1 - 51 , wherein the wearable external defibrillator is configured to be worn continuously during movement and showering activities for greater than about 24 hours. 
     
     
         53 . The wearable defibrillator of any of  claims 1 - 52 , wherein the wearable external defibrillator is configured to be worn continuously during movement and showering activities for greater than about 5 days. 
     
     
         54 . The wearable defibrillator of any of  claims 1 - 53 , wherein the wearable external defibrillator is configured to be worn continuously during movement and showering activities for greater than about 7 days. 
     
     
         55 . The wearable defibrillator of any of  claims 1 - 54 , wherein the wearable external defibrillator is configured to be worn continuously during movement and showering activities for greater than about 10 days. 
     
     
         56 . A wearable external defibrillator comprising:
 a patient engagement substrate comprising an adhesive, one or more sensing electrodes, and a defibrillator electrode pad;   a fluid communication layer in fluid communication with the patient engagement substrate;   a battery, one or more capacitors, and a controller within one or more electronics housings;   a support layer connected to the electronics housing and the patient engagement substrate; and   an exterior housing connected to a portion of the patient engagement substrate such that the one or more electronics housings are between the exterior housing and the patient engagement substrate.   
     
     
         57 . The wearable defibrillator of  claim 56 , further comprising an absorption layer in fluid communication with the fluid communication layer. 
     
     
         58 . The wearable defibrillator of  claim 56 , wherein the patient engagement substrate has an average moisture transmission rate of greater than about 250 g/m 2  per day based on a surface area of the patient engagement substrate. 
     
     
         59 . The wearable defibrillator of  claim 56 , further comprising: a second patient engagement substrate comprising a second defibrillator electrode pad, a second adhesive, and a second plurality of sensing electrodes and a second fluid communication layer in fluid communication with the second patient engagement substrate, the second defibrillator electrode pad configured to engage with the patient's skin and to deliver an electrical therapy to the patient, the second defibrillator electrode pad configured to be in continuous electrical communication with the patient's skin. 
     
     
         60 . The wearable defibrillator of  claim 59 , wherein the second patient engagement substrate has an average moisture transmission rate of greater than about 250 g/m 2  per day based on a surface area of the second patient engagement substrate. 
     
     
         61 . The wearable defibrillator of any of  claims 56 - 60 , wherein the exterior housing is air permeable. 
     
     
         62 . The wearable defibrillator of any of  claims 56 - 61 , wherein an outer surface of the exterior housing is hydrophobic. 
     
     
         63 . The wearable defibrillator of any of  claims 56 - 62 , wherein an outer surface of the exterior housing is water resistant. 
     
     
         64 . The wearable defibrillator of any of  claim 56 - 63 , wherein the fluid communication layer has an absorption capacity of greater than about 500%. 
     
     
         65 . The wearable defibrillator of any of  claims 56 - 64 , further comprising a waterproof housing surrounding the one or more capacitors, battery, and controller. 
     
     
         66 . The wearable defibrillator of any of  claims 56 - 65 , wherein the patient engagement substrate has an average modulus of elasticity of about 0.40 MPa to about 0.9 MPa. 
     
     
         67 . The wearable defibrillator of any of  claims 56 - 66 , wherein the one or more capacitors have a total nominal capacitance of greater than about 50 μF. 
     
     
         68 . The wearable defibrillator of any of  claims 56 - 67 , wherein the one or more capacitors have a total voltage greater than about 100 V. 
     
     
         69 . The wearable defibrillator of any of  claims 56 - 68 , further comprising: a wireless data communication module within the housing. 
     
     
         70 . The wearable defibrillator of any of  claims 56 - 69 , further comprising one or more sensors within the housing. 
     
     
         71 . The wearable defibrillator of  claim 70 , wherein the sensors include one or more of: a GPS sensor, accelerometer, microphone, and a gyroscope. 
     
     
         72 . The wearable defibrillator of any of  claims 56 - 71 , wherein the adhesive in the patient engagement substrate includes perforations. 
     
     
         73 . The wearable defibrillator of  claim 72 , wherein the perforations have a diameter of about 0.5 mm to about 2 mm. 
     
     
         74 . The wearable defibrillator of  claim 72 , wherein the perforations in the adhesive have an open area of about 10% to about 25% of an overall surface area of the adhesive. 
     
     
         75 . The wearable defibrillator of any of  claims 56 - 74 , wherein the fluid communication layer has an average moisture transmission rate of greater than about 50 g/m 2  per day based on a surface area of the patient engagement substrate. 
     
     
         76 . The wearable defibrillator of  claim 75 , wherein the fluid communication layer has an average moisture transmission rate of greater than about 250 g/m 2  per day based on a surface area of the patient engagement substrate. 
     
     
         77 . A wearable external defibrillator comprising:
 a first patient engagement substrate comprising an adhesive, one or more sensing electrodes, and a first defibrillator electrode pad, the one or more sensing electrodes configured to engage with a patient's skin to detect a cardiac signal, the first defibrillator electrode pad configured to engage with the patient's skin and to deliver an electrical therapy to the patient, the first defibrillator electrode pad configured to be in continuous electrical communication with the patient's skin;   a housing connected to the first patient engagement substrate to form an interior space between the housing and the first patient engagement substrate, the interior portion comprising a battery, one or more capacitors, and a controller, wherein the first defibrillator electrode pad is in electrical communication with the one or more capacitors;   a second patient engagement substrate comprising a second defibrillator electrode pad, second adhesive, and second plurality of sensing electrodes, the second defibrillator electrode pad configured to engage with the patient's skin and to deliver an electrical therapy to the patient, the second defibrillator electrode pad configured to be in continuous electrical communication with the patient's skin, the second defibrillator electrode in electrical communication with the one or more capacitors; and   a fluid transport element configured to transport fluid away from the skin to allow the wearable external defibrillator to be worn continuously for greater than 24 hours,   wherein the controller is configured to charge the one or more capacitors with the battery and to discharge the one or more capacitors through the first defibrillator electrode pad and the second defibrillator electrode pad.   
     
     
         78 . The wearable defibrillator of any of  claim 77 , wherein the wearable external defibrillator is configured to be worn continuously during movement and showering activities for greater than about 5 days. 
     
     
         79 . The wearable defibrillator of any of  claim 77 , wherein the wearable external defibrillator is configured to be worn continuously during movement and showering activities for greater than about 7 days. 
     
     
         80 . The wearable defibrillator of any of  claim 77 , wherein the wearable external defibrillator is configured to be worn continuously during movement and showering activities for greater than about 10 days. 
     
     
         81 . The wearable defibrillator of  claim 77 , the wearable defibrillator has an average moisture transmission rate of greater than about 250 g/m 2  per day from the first patient engagement substrate through the housing connected to the first patient engagement substrate based on a surface area of the first patient engagement substrate. 
     
     
         82 . The wearable defibrillator of  claim 77 , wherein the first patient engagement substrate has an average moisture transmission rate of greater than about 500 g/m 2  per day. 
     
     
         83 . The wearable defibrillator of any of  claims 77 - 82 , wherein the first and second patient engagement substrates have an average modulus of elasticity of about 0.40 MPa to about 0.9 MPa. 
     
     
         84 . The wearable defibrillator of any of  claims 77 - 83 , wherein the housing is air permeable. 
     
     
         85 . The wearable defibrillator of any of  claims 77 - 84 , wherein an outer surface of the housing is hydrophobic. 
     
     
         86 . The wearable defibrillator of any of  claims 77 - 85 , wherein the outer surface of the housing is water resistant. 
     
     
         87 . The wearable defibrillator of any of  claims 77 - 86 , the fluid transport element further comprising:
 a fluid transport layer within the housing in fluid communication with the first patient engagement substrate, the fluid transport layer configured to improve the flow of water across the first patient engagement substrate.   
     
     
         88 . The wearable defibrillator of  claim 87 , wherein the fluid transport layer has an absorption capacity of greater than about 500%. 
     
     
         89 . The wearable defibrillator of  claim 87 , further comprising: an absorbent material within the housing. 
     
     
         90 . The wearable defibrillator of any of  claims 77 - 89 , further comprising one or more waterproof housings surrounding the one or more capacitors, battery, and controller. 
     
     
         91 . The wearable defibrillator of any of  claims 77 - 90 , further comprising a support layer configured to engage with and support the controller, one or more capacitors, and battery. 
     
     
         92 . The wearable defibrillator of any of  claims 77 - 91 , wherein a ratio of a combined weight of the one or more capacitors, battery, and controller to the surface area of the patient engagement substrate is less than about 2 g/cm 2 . 
     
     
         93 . The wearable defibrillator of any of  claims 77 - 92 , wherein the one or more capacitors have a total nominal capacitance of greater than about 50 μF. 
     
     
         94 . The wearable defibrillator of any of  claims 77 - 93 , wherein the one or more capacitors have a total voltage greater than about 100 V. 
     
     
         95 . The wearable defibrillator of any of  claims 77 - 94 , further comprising a flexible bridge connecting the first and second patient engagement substrates. 
     
     
         96 . The wearable defibrillator of  claim 95 , wherein the flexible bridge includes an electrical conductor configured to provide electrical communication between the second defibrillator pad electrode and the second plurality of ECG sensing electrodes to one or more of the controller and the one or more capacitors. 
     
     
         97 . The wearable defibrillator of any of  claims 77 - 96 , wherein the adhesive comprises an adhesive border along a perimeter of the first patient engagement substrate configured to adhere to the wearable defibrillator and the skin of the patient, wherein the wearable defibrillator has a tapered cross-sectional profile along the adhesive border from a side of the adhesive border towards a center of the wearable defibrillator to an outer edge of the adhesive border. 
     
     
         98 . The wearable defibrillator of any of  claims 77 - 97 , further comprising: a wireless data communication module within the housing. 
     
     
         99 . The wearable defibrillator of any of  claims 77 - 98 , further comprising one or more sensors within the housing. 
     
     
         100 . The wearable defibrillator or  claim 99 , wherein the sensors include one or more of: a GPS sensor, accelerometer, microphone, and a gyroscope. 
     
     
         101 . The wearable defibrillator of any of  claims 77 - 100 , wherein the first defibrillator pad electrode comprises a hydrogel and a woven carbon fiber structure. 
     
     
         102 . The wearable defibrillator of any of  claims 77 - 101 , wherein the adhesive in the patient engagement substrate includes perforations. 
     
     
         103 . The wearable defibrillator of  claim 102 , wherein the perforations have a diameter of about 0.5 mm to about 2 mm. 
     
     
         104 . The wearable defibrillator of  claim 102 , wherein the perforations in the adhesive have an open area of about 10% to about 25% of an overall surface area of the adhesive. 
     
     
         105 . A patient engagement surface comprising:
 one or more sensing electrodes configured to engage with a patient's skin to detect a cardiac signal;   a defibrillator electrode pad configured to engage with the patient's skin and to deliver an electrical therapy to the patient, the defibrillator electrode pad configured to be in continuous electrical communication with the patient's skin; and   a patient engagement substrate comprising an adhesive, the one or more sensing electrodes, the defibrillator electrode pad, and a fluid transport element configured to transport fluid away from the skin to allow the wearable external defibrillator to be worn continuously during movement and showering activities.   
     
     
         106 . The patient engagement surface of  claim 105 , further comprising elastic element an elastic element configured to conform to, and stretch with, the patient's skin to allow the wearable external defibrillator to be worn continuously during movement and showering activities for greater than seven days. 
     
     
         107 . The patient engagement surface of any of  claims 105 - 106 , wherein the patient engagement surface is configured to be worn continuously during movement and showering activities for greater than about 24 hours. 
     
     
         108 . The patient engagement surface of any of  claims 105 - 107 , wherein the patient engagement surface is configured to be worn continuously during movement and showering activities for greater than about 5 days. 
     
     
         109 . The patient engagement surface of any of  claims 105 - 108 , wherein the patient engagement surface is configured to be worn continuously during movement and showering activities for greater than about 10 days. 
     
     
         110 . The patient engagement surface of any of  claims 105 - 109 , wherein the defibrillator pad comprises a woven carbon fiber structure. 
     
     
         111 . The patient engagement surface of any of  claims 105 - 110 , further comprising: a second defibrillator electrode pad. 
     
     
         112 . The patient engagement surface of any of  claims 105 - 111 , further comprising an electronics module in electrical communication with the defibrillator electrode pad and second defibrillator electrode pad. 
     
     
         113 . A kit comprising:
 the wearable external defibrillator of any of the above claims; and one or more of: an adhesive remover, a skin cleaner, hair removal tool, and instructions for applying the wearable defibrillator.   
     
     
         114 . A method of monitoring and defibrillating a patient's heart, comprising:
 adhering to a first skin surface portion of the patient a first patient engagement substrate comprising a first plurality of sensing electrodes and a first defibrillator pad, the first defibrillator pad in electrical communication with an electrical energy source sufficient to provide a defibrillating shock, the first patient engagement substrate part of a wearable defibrillator comprising a fluid transport element configured to transport fluid away from the first skin surface portion of the patient to allow the wearable external defibrillator to be worn continuously during movement and showering activities;   adhering to a second skin surface portion of the patient a second patient engagement substrate comprising a second plurality of sensing electrodes and a second defibrillator pad, the second defibrillator pad in electrical communication with the electrical energy source sufficient to provide the defibrillating shock, the second patient engagement part of the wearable defibrillator; and   measuring electrical data corresponding to a cardiac signal of the patient with the first plurality of sensing electrodes and the second plurality of sensing electrodes.   
     
     
         115 . The method of  claim 114 , wherein the fluid transport element moves fluid away from the first skin portion and towards an exterior of a housing of the wearable defibrillator. 
     
     
         116 . The method of any of  claims 114 - 115 , wherein the fluid transport element moves fluid across a dominant cross-sectional area of the fluid transport element. 
     
     
         117 . The method of any of  claims 114 - 116 , wherein the fluid transport element provides an average moisture transmission rate of greater than about 50 g/m 2  per day to the first skin surface portion of the patient. 
     
     
         118 . The method of any of  claims 114 - 117 , wherein the fluid transport element provides an average moisture transmission rate of greater than about 250 g/m 2  per day to the first skin surface portion of the patient. 
     
     
         119 . The method of any of  claims 114 - 118 , wherein the fluid transport element includes an adhesive and a wicking material, wherein the adhesive is part of the first patient engagement substrate and the second patient engagement substrate. 
     
     
         120 . The method of any of  claims 114 - 119 , further comprising analyzing the electrical data to determine if the patient has a treatable arrhythmia. 
     
     
         121 . The method of any of  claims 114 - 120 , further comprising: detecting one or more of the pulse, breathing rate, heart sounds, and heart rate of the patient. 
     
     
         122 . The method of  claim 121 , further comprising: analyzing the detected one or more of the pulse, breathing rate, heart sounds, and heart rate of the patient to confirm a treatable arrhythmia. 
     
     
         123 . The method of any of  claims 114 - 122 , further comprising delivering an electrical shock after determining that the patient has a treatable arrhythmia. 
     
     
         124 . The method of  claim 123 , further comprising: measuring a transthoracic impedance of the patient between the first defibrillator pad electrode and the second defibrillator pad electrode prior to delivering the electrical shock. 
     
     
         125 . The method of any of  claims 114 - 124 , further comprising continuously wearing the wearable defibrillator for greater than about 24 hours. 
     
     
         126 . The method of any of  claims 114 - 125 , further comprising continuously wearing the wearable defibrillator for greater than about 5 days. 
     
     
         127 . The method of any of  claims 114 - 126 , further comprising continuously wearing the wearable defibrillator for greater than about 7 days. 
     
     
         128 . A method for treating a patient with a wearable defibrillator comprising:
 receiving ECG data from a plurality of ECG sensing electrodes configured for long term wear and continuous electrical contact with a skin of the patient, the plurality of ECG sensing electrodes being part of the wearable defibrillator;   analyzing the ECG data to determine whether the patient has a treatable arrhythmia;   upon determination of a treatable arrhythmia, detecting one or more of a pulse, a breathing rate, heart sounds, and a heart rate of the patient;   analyzing the detected one or more of the pulse, breathing rate, heart sounds, and heart rate of the patient to confirm a treatable arrhythmia;   measuring a transthoracic impedance of the patient between a first defibrillator pad electrode and a second defibrillator pad electrode, the first defibrillator pad and second defibrillator pad configured for long term wear and continuous electrical contact with the skin of the patient, the first defibrillator pad and second defibrillator pad being part of the wearable defibrillator;   instructing a controller to charge a plurality of capacitors in the wearable defibrillator; and   delivering a therapeutic electrical shock to the patient through the first defibrillator electrode pad and the second defibrillator electrode pad.   
     
     
         129 . The method of  claim 128 , further comprising: after determination of a treatable arrhythmia wirelessly transmitting data corresponding to a location of the patient to an emergency medical service. 
     
     
         130 . The method of  claim 128 , further comprising: after determination of a treatable arrhythmia wirelessly transmitting data corresponding to a location of the patient to an emergency contact of the patient. 
     
     
         131 . The method of  claim 128 , wherein measuring a transthoracic impedance includes determining if the first defibrillator pad and second defibrillator pad electrode are in electrical contact with the skin of the patient. 
     
     
         132 . The method of  claim 128 , further comprising tailoring the therapeutic electrical shock based on the transthoracic impedance. 
     
     
         133 . The method of  claim 128 , further comprising prior to instructing the controller to charge the plurality capacitors, generating an audible alarm to warn the patient of a possible therapeutic electrical shock. 
     
     
         134 . The method of  claim 133 , further comprising instructing the controller to charge the plurality of capacitors if a shutoff button on the wearable defibrillator is not pushed. 
     
     
         135 . A method of monitoring and defibrillating a patient's heart, comprising:
 engaging a patient engagement substrate with skin of the patient, the patient engagement substrate comprising an adhesive, one or more sensing electrodes, and a defibrillator electrode pad and an elastic element;   measuring a cardiac signal with the one or more sensing electrodes;   supporting in electrical contact with the one or more sensing electrodes and the defibrillator electrode pad, a battery, an electrical energy source, and a controller configured to monitor the one or more sensing electrodes, to charge the one or more capacitors with the battery and to discharge the electrical energy source through the defibrillator electrode pad to deliver an electrical therapy to the patient; and   performing the engaging, measuring and supporting steps continuously for at least 24 hours.   
     
     
         136 . The method of  claim 135 , wherein the elastic element has an average modulus of elasticity of about 0.40 MPa to about 0.9 MPa. 
     
     
         137 . The method of  claim 135 , wherein the engaging, measuring and supporting steps are performed continuously for at least about 48 hours. 
     
     
         138 . The method of  claim 135 , wherein the engaging, measuring and supporting steps are performed continuously for at least about 5 days. 
     
     
         139 . The method of  claim 135 , wherein the engaging, measuring and supporting steps are performed continuously for at least 7 days. 
     
     
         140 . The method of  claim 135 , wherein the engaging, measuring and supporting steps are performed continuously for at least 10 days. 
     
     
         141 . The method of any of  claims 135 - 141 , wherein the engaging, measuring, and supporting steps are performed continuously through movement and showering activities. 
     
     
         142 . The device of any of  claim 1 - 112 , wherein the patient engagement surface has an average elasticity of greater than about 0.40 MPa.