CN112933411B - Self-adaptive adjusting device for cardiac pacing frequency and cardiac pacing device - Google Patents
Self-adaptive adjusting device for cardiac pacing frequency and cardiac pacing device Download PDFInfo
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Abstract
The invention discloses a self-adaptive adjusting device of cardiac pacing frequency and a cardiac pacing device, comprising: the data acquisition module is used for acquiring triaxial acceleration data corresponding to the physical activity signals by utilizing a triaxial acceleration sensor and preprocessing the triaxial acceleration data; the data processing module is used for calculating the three-axis maximum jerk according to the preprocessed three-axis acceleration data, and synchronously detecting and evaluating the motion amount at the current moment according to the three-axis maximum jerk and multi-level jerk thresholds; and the pacing frequency adjusting module is used for adjusting and controlling the cardiac pacing frequency at the next moment according to the motion amount at the current moment and outputting the cardiac pacing frequency. The three-axis acceleration sensor can acquire complete acceleration information of a patient during movement, and can more accurately evaluate the movement amount of the patient in various daily activities; the jerk is adopted to replace the acceleration to evaluate the amount of exercise, so that most of external environment interference can be eliminated; the multi-threshold synchronous detection method can enable the motion quantity evaluation to be more real-time, rapid and accurate.
Description
Technical Field
The invention belongs to the field of medical instruments, and particularly relates to a self-adaptive adjusting device for cardiac pacing frequency and a cardiac pacing device.
Background
With the wide clinical application of Cardiac Implantable Electronic Devices (Cardiac Implantable Electronic Devices), such as single/dual chamber Cardiac pacemakers (pacemakers) and Cardiac Resynchronization Therapy (CRT), more and more patients with arrhythmia and Cardiac insufficiency benefit from the Cardiac Implantable Electronic Devices, the prognosis of the patients is greatly improved, and the survival period is prolonged.
For a pacemaker patient who is weak, bedridden or sedentary and does not move, the metabolic needs can be met by a single basic pacing frequency; however, for more active patients, even if only daily activity is performed, a single basal pacing rate may not meet their metabolic needs. Rate adaptive pacing is an important function set for meeting the requirement of pacemaker patients to obtain sufficient cardiac output under different metabolic demands. The self-adaptive adjustment of the pacing frequency can make up the symptoms of the cardiac chronotropic dysfunction to a considerable extent, and greatly improves the exercise tolerance of the pacemaker patients. The proportion of the cardiac pacemaker with the self-adaptive adjustment of the implanted pacing frequency in China per year currently exceeds 50 percent of the total implanted amount of the pacemaker.
The pacemaker may use the sensed physiological/non-physiological parameter to adjust the pacing rate in real time. The pacing rate adaptive adjustment scheme currently in clinical use is mainly based on minute ventilation, closed-loop stimulation and acceleration sensors.
Minute Volume (MV) is the product of ventilation frequency and tidal volume, and is a physiological variable that best reflects metabolic demand of exercise, in a linear relationship with aerobic oxygen consumption during exercise. The chest impedance is measured through a standard bipolar lead, the ventilation frequency and amplitude information can be obtained according to the chest impedance, the minute ventilation volume is further calculated, and then the pacing frequency can be calculated by utilizing a specific algorithm. The disadvantages of minute ventilation are: the device can not work normally under the scenes of electrosurgery, radio frequency ablation and the like; cough and hyperventilation increase heart rate; breath holding, speaking during exercise, can reduce the expected paced heart rate; sensitivity is poor and hysteresis exists.
Closed Loop Stimulation (CLS) is obtained by measuring the intracardiac impedance throughout ventricular contraction. The theoretical basis of CLS is the closed-loop control mechanism of the Autonomic Nervous System (ANS) on cardiac output. CLS can perform adaptive pacing under the conditions of movement, mental activity and hemodynamic change, and researches show that CLS can remarkably improve the life quality of patients with chronotropic insufficiency and vasovagal syncope, and patients with atrial fibrillation can also benefit from CLS. However, the disadvantages of CLS are: the adjustment is too sensitive, and the heart rate may be increased inappropriately, so that the patient has uncomfortable symptoms; and the CLS cannot normally operate during mode conversion.
The acceleration sensor is the sensor which is currently most widely applied to pacemakers with adaptive pacing rate adjustment. The acceleration sensor is arranged in the pacemaker shell, and is used for detecting the acceleration signal of human motion, processing the acceleration signal and converting the processed acceleration signal into the estimation of the motion amount of a patient, and then adjusting the pacing frequency through a certain algorithm. The motion sensor has the advantages of good long-term stability and high sensitivity, and has the disadvantages of poor specificity and incapability of directly sensing metabolic changes.
The human body can be regarded as an acceleration time-varying system when moving, the main frequency of the acceleration reflects the step frequency of the movement, and the amplitude reflects the strength of the movement. Only by taking the amplitude and frequency characteristics of the motion together, an accurate assessment of the patient's amount of motion can be obtained. However, because the requirement of the cardiac pacemaker on power consumption is very strict, and a complex method cannot be adopted for estimating the amount of exercise, the conventional pacing frequency adaptive adjustment scheme based on the acceleration sensor usually adopts a single-axis acceleration sensor to acquire the acceleration of the human body in the front and back movement directions, counts by setting a fixed time interval (usually more than 1 second) to circularly adjust a threshold value after preprocessing such as band-pass filtering, and weights the count value to serve as the estimated value of the amount of exercise.
However, the above method has several problems: (1) the single-axis acceleration sensor cannot obtain complete acceleration information of the patient during movement, the forward and backward acceleration can only evaluate the amount of exercise of the patient during walking or running, but cannot effectively evaluate the amount of exercise in movement modes such as rope skipping and swimming, and daily activities of the patient are greatly limited; (2) the motion quantity evaluation directly by adopting the acceleration signal is easily interfered by the external environment, for example, the acceleration can reach 2m/s when the automobile is accelerated/decelerated2-5 m/s2The acceleration can reach 1.5m/s when the elevator is braked or started2If the signals cannot be effectively filtered by band-pass filtering, the heart rate of the patient in the daily life scenes is increased by mistake, the patient may feel uncomfortable, and the life quality is affected; (3) when the threshold value is adjusted circularly at fixed time intervals to evaluate the amount of exercise, the evaluation of the amount of exercise is low no matter whether high-intensity exercise is detected at the time of low threshold value or low-intensity exercise is detected at the time of high threshold value, so that the evaluation of the target heart rate is low, and the heart rate increased by a patient cannot meet the evaluation requirement when the target heart rate is evaluatedThe pre-metabolic requirements, especially when the patient's exercise state changes rapidly, the error in the assessment of exercise amount is further increased.
Disclosure of Invention
In view of the technical problems in the prior art, an object of the present invention is to provide a cardiac pacing frequency adaptive adjustment apparatus and a cardiac pacing apparatus, wherein a triaxial acceleration sensor is used to obtain a complete acceleration signal of a patient during exercise, and jerk is used to replace acceleration to perform exercise amount evaluation, and a multi-threshold synchronous detection method is used to evaluate the exercise intensity of the patient in real time, and can calculate and update a target heart rate in real time, and track and adjust the pacing frequency in real time.
In order to achieve the purpose, the invention provides the following technical scheme:
in a first aspect, an embodiment of the present invention provides an apparatus for adaptively adjusting a cardiac pacing rate, including:
the data acquisition module is used for acquiring triaxial acceleration data corresponding to the physical activity signals by utilizing a triaxial acceleration sensor and preprocessing the triaxial acceleration data;
the data processing module is used for calculating the triaxial maximum jerk at each moment according to the preprocessed triaxial acceleration data, and synchronously detecting and evaluating the motion amount at the current moment according to the triaxial maximum jerk and a multi-level jerk threshold;
and the pacing frequency adjusting module is used for adjusting and controlling the cardiac pacing frequency at the next moment according to the motion amount at the current moment and outputting the cardiac pacing frequency, so that the self-adaptive adjustment of the cardiac pacing frequency is realized.
Preferably, in the data processing module, calculating the triaxial maximum jerk at each time according to the preprocessed triaxial acceleration data includes:
and regarding each single-axis acceleration data, taking the absolute value of the difference between the single-axis acceleration data values at two adjacent moments as the single-axis jerk at the current moment, and taking the maximum value of the three single-axis jerks as the three-axis maximum jerk at the current moment.
Preferably, in the data processing module, the synchronously detecting and evaluating the motion amount at the current moment according to the three-axis maximum jerk and the multi-level jerk threshold includes:
presetting jerk thresholds of n grades, dividing the maximum jerk of the three axes into n +1 jerk intervals, wherein n is a natural number more than or equal to 3;
determining a motion score value corresponding to the three-axis maximum jerk at the current moment according to the mapping relation between the jerk interval and the motion score value; and taking the sum of the motion score values of all sampling moments in a previous period of time with the current moment as an end point as the motion amount of the current moment.
Preferably, in the pacing rate adjusting module, adjusting and controlling the cardiac pacing rate at the next time according to the amount of motion at the current time includes:
after the target heart rate which is required to be reached by the exercise amount at the current moment is determined according to the exercise amount-target heart rate curve, the pacing frequency at each next moment in the time period that the starting point is the current actual heart rate and the finishing point is the target heart rate is determined by utilizing the time-pacing frequency curve, and transition control from the current actual heart rate to the target heart rate is realized.
Preferably, in the pacing rate adjusting module, determining a target heart rate that should be reached by the exercise amount at the current time according to the exercise amount-target heart rate curve includes:
after the body state of the current moment is determined according to the exercise amount-target heart rate curve and the exercise amount of the current moment, the target heart rate which is required to be reached by the exercise amount of the current moment is determined according to the corresponding relation between the body state and the target heart rate.
Preferably, in the pacing frequency adjustment module, when the target heart rate is determined, a motion amount threshold is preset, and when the motion amount at the current time is smaller than the motion amount threshold, it is determined that the current time is in a static state, and the target heart rate corresponding to the static state is a reference heart rate;
when the exercise amount at the current moment is not less than the exercise amount threshold value, the current moment is judged to be in the exercise state, the target heart rate corresponding to the exercise state is obtained through calculation according to the exercise amount, the exercise amount threshold value and the exercise amount-target heart rate curve slope, and the target heart rate is between the reference heart rate and the maximum heart rate.
Preferably, the time-pacing frequency curve comprises a time-pacing frequency rising curve and a time-pacing frequency falling curve, the time-pacing frequency rising curve indicates the process of the heart rate rising from the reference heart rate to the maximum heart rate, the time-pacing frequency falling curve indicates the process of the heart rate falling from the maximum heart rate to the reference heart rate, the required rising time and/or falling time between the reference heart rate and the maximum heart rate can be set, and the pacing frequency corresponding to each moment is determined according to the set rising time and/or falling time.
Preferably, the time-pacing rate curve is a linear function curve or an exponential function curve.
Preferably, the adaptive adjustment device further comprises a parameter setting module, and the parameter setting module is configured to set a jerk threshold, a motion amount threshold, a reference heart rate, a maximum heart rate, a motion amount-target heart rate curve slope, and a rise time and a fall time of a time-pacing frequency curve.
In a second aspect, embodiments of the present invention provide a cardiac pacing apparatus, including:
the self-adaptive adjusting device of the cardiac pacing frequency;
and the pace-making control unit is in communication connection with the adaptive adjusting device and is used for sending a cardiac pace-making event, namely a cardiac pace-making pulse signal, according to the cardiac pace-making frequency output by the adaptive adjusting device.
Compared with the prior art, the self-adaptive adjusting device for the cardiac pacing frequency and the cardiac pacing device provided by the embodiment of the invention at least have the following beneficial effects:
the three-axis acceleration sensor can acquire complete three-axis acceleration data during exercise, and the amount of exercise in various daily activities can be more accurately evaluated based on the three-axis acceleration data; the jerk is adopted to replace the acceleration to evaluate the amount of exercise, so that the interference of most external environments can be eliminated, the probability of the error increase of the heart rate of the patient is reduced, and the life quality of the patient is improved; the exercise amount is synchronously detected and evaluated by adopting the multi-level jerk threshold, so that the evaluation of the exercise amount is more real-time, rapid and accurate, further, the cardiac pacing frequency regulated and controlled according to the exercise amount is more accurate, and the metabolic requirements of patients during various exercises can be met.
Drawings
In order to more clearly illustrate the embodiments of the present invention or the technical solutions in the prior art, the drawings used in the description of the embodiments or the prior art will be briefly described below, it is obvious that the drawings in the following description are only some embodiments of the present invention, and for those skilled in the art, other drawings can be obtained according to these drawings without creative efforts.
Fig. 1 is a schematic structural diagram of an adaptive cardiac pacing rate adjusting device according to an embodiment of the present invention;
FIG. 2 is a flow chart of the operation of a data processing module provided by an embodiment of the present invention;
FIG. 3 is a flowchart of the operation of a pacing rate adjustment module provided by an embodiment of the present invention;
FIG. 4(a) is a graph illustrating a curve of exercise amount versus target heart rate at different jerk thresholds Tm according to an embodiment of the present invention;
FIG. 4(b) is a graph illustrating a exercise amount-target heart rate curve with different slopes slope according to an embodiment of the present invention;
fig. 5(a) is a graph illustrating a linear time-pacing frequency rise curve at different rise times according to an embodiment of the present invention;
FIG. 5(b) is a graph illustrating an exponential time-pacing frequency rise curve at different rise times according to an embodiment of the present invention;
fig. 6(a) is a graph illustrating a linear time-pacing rate decrease curve at different decrease times according to an embodiment of the present invention;
fig. 6(b) is a diagram illustrating an exponential time-pacing frequency decrease curve at different decrease times according to an embodiment of the present invention;
FIG. 7 is a schematic structural diagram of an apparatus for adaptively adjusting a cardiac pacing rate according to another embodiment of the present invention;
fig. 8 is a schematic structural diagram of a cardiac pacing device according to an embodiment of the present invention.
Detailed Description
In order to make the objects, technical solutions and advantages of the present invention more apparent, the present invention will be further described in detail with reference to the accompanying drawings and examples. It should be understood that the detailed description and specific examples, while indicating the scope of the invention, are intended for purposes of illustration only and are not intended to limit the scope of the invention.
The technical problem that complete acceleration information of a patient during movement cannot be obtained by adopting a single-axis acceleration sensor is solved. Meanwhile, the technical problem that the motion quantity evaluation directly by adopting an acceleration signal is easily interfered by the external environment is solved. Meanwhile, the problem that the motion quantity evaluated by circularly adjusting the threshold value at fixed time intervals is low is solved. The embodiment of the invention provides a self-adaptive adjusting device of cardiac pacing frequency and a cardiac pacing device, belonging to implantable medical equipment applied to the field of medical instruments.
Fig. 1 is a schematic structural diagram of an adaptive cardiac pacing rate adjustment apparatus according to an embodiment of the present invention. As shown in fig. 1, an adaptive adjustment apparatus 100 according to an embodiment includes a data acquisition module 101, a data processing module 102, and a pacing rate adjustment module 103, where the data acquisition module 101 is in communication connection with the data processing module 102, and the data processing module 102 is in communication connection with the pacing rate adjustment module 103, obtains a complete acceleration signal of a patient during exercise through a three-axis acceleration sensor, performs exercise amount evaluation by using jerk instead of acceleration, evaluates exercise intensity of the patient in real time by using a multi-threshold synchronous detection method, and can calculate and update a target heart rate in real time, and track and adjust a pacing rate in real time.
The data acquisition module 101 is configured to acquire three-axis acceleration data corresponding to the physical activity signal by using a three-axis acceleration sensor and perform preprocessing. The method specifically comprises the following steps: the method comprises the steps of collecting body activity signals by using a triaxial acceleration sensor, converting the body activity signals into triaxial acceleration analog signals, carrying out pretreatment such as modulation, amplification, phase-sensitive demodulation, anti-aliasing filtering on the triaxial acceleration analog signals, and converting the pretreated triaxial acceleration analog signals into triaxial acceleration digital signals through an analog-to-digital converter. In this embodiment, the three-axis acceleration sensor adopts a 3-axis capacitive MEMS acceleration sensor, and the amplitude detection range of the acceleration is set to ± 2g in consideration of the characteristics of the acceleration of the human motion. The resolution of the analog-to-digital converter is 10 bits, the main frequency of acceleration in daily activities of a human body is considered to be generally lower than 4Hz, and the sampling rate is fixed to be 10 Hz.
The data processing module 102 is configured to calculate a triaxial maximum jerk at each time according to the preprocessed triaxial acceleration data, and synchronously detect and evaluate an amount of exercise at a current time according to the triaxial maximum jerk and a multi-level jerk threshold. Specifically, as shown in fig. 2, when calculating the three-axis maximum jerk, for each single-axis acceleration data, the absolute value of the difference between the single-axis acceleration data values at two adjacent sampling times is used as the single-axis jerk ji (n) at the current time n, that is, ji (n) ═ Ai (n) -Ai (n-1) |, where i ═ x, y, z respectively represent three single axes of x, y, z, Ai (n) represents the single-axis acceleration value at the current sampling time n, Ai (n-1) represents the single-axis acceleration value at the previous time n-1, and then the maximum value of the three single-axis jerks is used as the three-axis maximum jerk j (n), that is, j (n) ═ max (ji (n)). When the amount of exercise at the current time is evaluated, n levels of jerk thresholds Tj are preset, in the embodiment, n takes the value of 3, that is, 3 levels of jerk thresholds Tja, Tjb, Tjc are preset, and Tja<Tjb<Tjc, the three 3 jerk thresholds divide the three-axis maximum jerk J (n) into 4 intervals, which are [0, Tja), [ Tja, Tjb), [ Tjb, Tjc), [ Tjc, (+ ∞)]Judging the section to which the three-axis maximum jerk J (n) belongs according to the jerk threshold, when the three-axis maximum jerk J (n) belongs to the section [0, Tja), the corresponding motion score value S (n) is s1, when the three-axis maximum jerk J (n) belongs to the section [ Tja, Tjb), the corresponding motion score value S (n) is s2, when the three-axis maximum jerk J (n) belongs to the section [ Tjb, Tjc), the corresponding motion score value S (n) is s3, and when the three-axis maximum jerk J (n) belongs to the section [ Tjc, infinity [ (/ n) ])]Then, the corresponding exercise score value s (n) s 4. Then summing up the motion score values S (k) of all sampling moments in the time range of the previous t1 with the current moment as the terminal point to obtain the motion amount M (n) of the current moment, namely
And finishing the evaluation process of the motion quantity once, and waiting for the arrival of the next sampling moment. The jerk threshold may be set to different gears according to the motion characteristics of the patient, in this embodiment, 150mg of Tja, 300mg of Tjb, and 600mg of Tjc are taken as the jerk threshold; taking s 1-0, s 2-1, s 3-2 and s 4-4 as the exercise score values; the motion amount evaluation period t1 is taken to be 6 seconds, and since the sampling rate is 10Hz, m (n) is the sum of the motion score values at 60 sampling times before the current time.
The pacing frequency adjusting module 103 is configured to adjust and control a cardiac pacing frequency at a next time according to the amount of motion at the current time and output the cardiac pacing frequency, so as to implement adaptive adjustment of the cardiac pacing frequency. In specific implementation, as shown in fig. 3, at a time N after a fixed time interval t2, the current exercise amount m (N) of the patient is acquired; after the target heart rate TR (N) which is required to be reached by the exercise amount at the current moment is determined according to the exercise amount-target heart rate curve, the pacing frequency at each next moment in the time period of taking the current actual heart rate as the starting point and taking the target heart rate as the finishing point is determined by utilizing the time-pacing frequency curve, and transition control from the current actual heart rate to the target heart rate is realized. Wherein the time-to-pacing rate curve comprises an ascending curve and a descending curve. The process of determining pacing rate using the time-pacing rate curve is: comparing the current actual heart rate HR (N) with the target heart rate TR (N), if HR (N) is less than TR (N), determining the pacing pulse frequency PR (N) at the next moment through a time-pacing frequency rising curve, and if HR (N) is more than or equal to TR (N), determining PR (N) through a time-pacing frequency falling curve; thus, one pacing frequency adjustment is completed, and the next pacing frequency updating moment is waited. In this embodiment, interval t2 is taken to be 2 seconds, i.e., the pacing pulse rate is updated every 2 seconds.
In an embodiment, the motion amount-target heart rate curve indicates a correspondence between the motion amount m (n) and the target heart rate tr (n) at the current time. When the target heart rate is determined, after the body state of the current moment is determined according to the exercise amount-target heart rate curve and the exercise amount of the current moment, the target heart rate which is required to be reached by the exercise amount of the current moment is determined according to the corresponding relation between the body state and the target heart rate. The specific process is as follows: a motion amount threshold value Tm is preset, when the motion amount at the current moment is smaller than the motion amount threshold value, namely M (N) < Tm, the current moment is judged to be in a static state, and a target heart rate TR (N) corresponding to the static state is a reference heart rate in a static state; when the exercise amount at the current time is not less than the exercise amount threshold, that is, m (n) is not less than Tm, it is determined that the current time is in the exercise state, and the target heart rate corresponding to the exercise state is calculated according to the exercise amount m (n), the exercise amount threshold Tm, and the exercise amount-target heart rate curve slope, that is, the target heart rate tr (n) ═ slope x (m (n)) (Tm), and the target heart rate tr (n) is between the reference heart rate HRbase and the maximum heart rate HRmax, that is, the value range of tr (n) is [ HRbase, HRmax ]. In an embodiment, Tm, slope, HRmax, and HRbase are programmable parameters, set during implantation or follow-up. The Tm can be set to be at least three stages of low (Tm1), medium (Tm2) and high (Tm3) according to the value, as shown in figure 4(a), the Tm can be shifted left and right along the exercise-target heart rate curve due to different values; the slope is set to be at least three stages of fast (slope1), medium (slope2) and slow (slope3) according to different values, as shown in fig. 4(b), the slope of the motion amount-target heart rate curve changes due to different values of the slope, the relationship between HRmax and HRbase is that HRbase < HRmax, in this embodiment, HRmax is 120bpm, and HRbase is 60 bpm.
In an embodiment, the time-pacing rate curve comprises a time-pacing rate increase curve indicating the progress of the heart rate increasing from HRbase to HRmax and a time-pacing rate decrease curve, wherein the pacing rate may increase over time as a linear function as shown in fig. 5(a) or as an exponential function as shown in fig. 5(b), wherein the exponential function is more physiological. The total time required to rise from HRbase to HRmax is a programmable parameter set during implantation or follow-up, taking three steps, 15s, 30s and 60s in this example. The time-pacing rate decrease curve indicates the progression of the heart rate from HRmax to HRbase, and the pacing rate may decrease over time as a linear function as shown in fig. 6(a) or as an exponential function as shown in fig. 6(b), where the exponential function is more physiological. The total time required to drop from HRmax to HRbase is a programmable parameter set during implantation or follow-up, in this example, three steps of 2.5min, 5min and 10min were taken.
As shown in fig. 7, the adaptive cardiac pacing rate adjustment apparatus 100 according to an embodiment further includes a parameter setting module 701, which may be a program controller, and sets or adjusts programmable parameters through the program controller during implantation or follow-up, where the programmable parameters are all adjustable parameters in the automatic adjustment apparatus, including a jerk threshold Tj, a motion amount threshold Tm, a reference heart rate HRbase, a maximum heart rate HRmax, a motion amount-target heart rate curve slope, and a rise time and a fall time of a time-pacing rate curve.
The heart rate response degree of the daily activities of the patient can be set as a jerk threshold Tj of different gears, a motion amount threshold Tm of different gears and a motion amount-target heart rate curve slope of different gears, and the rising time and the falling time of different gears can be set according to the change speed of the heart rate of the daily activities, so that the heart rate response degree of the patient can be adapted to different patients, and the patient can obtain enough heart output under different exercise metabolic demands.
The adaptive cardiac pacing rate adjusting device provided in the embodiment is to describe the adaptive cardiac pacing rate adjusting process by the division of the functional modules, and the function allocation can be completed by different functional modules according to needs, that is, a computer program stored in a storage medium is divided into different functional modules to complete all or part of the functions described above. In an embodiment, the adaptive adjustment device for cardiac pacing rate may be implemented in an application specific integrated circuit chip (ASIC), a digital signal processing chip (DSP), or a Micro Control Unit (MCU).
Fig. 8 is a schematic structural diagram of a cardiac pacing device according to an embodiment of the present invention. As shown in fig. 8, an embodiment provides a cardiac pacing apparatus 800 comprising: adaptive adjustment means 801 for the cardiac pacing rate and a pacing control unit 802. The adaptive adjusting device 801 of the cardiac pacing frequency is the automatic adjusting device 100 of the provided pacing frequency, the adaptive adjusting device 801 is in communication connection with the pacing control unit 802, the adaptive adjusting device 801 outputs the cardiac pacing frequency, and the pacing control unit 802 sends a cardiac pacing event, that is, a cardiac pacing pulse signal, according to the cardiac pacing frequency output by the automatic adjusting device 801.
According to the self-adaptive adjusting device for the cardiac pacing frequency and the cardiac pacing device, complete triaxial acceleration data during movement can be obtained through the triaxial acceleration sensor, and the amount of movement in various daily activities can be more accurately estimated based on the triaxial acceleration data; the jerk is adopted to replace the acceleration to evaluate the amount of exercise, so that the interference of most external environments can be eliminated, the probability of the error increase of the heart rate of the patient is reduced, and the life quality of the patient is improved; the exercise amount is synchronously detected and evaluated by adopting the multi-level jerk threshold, so that the evaluation of the exercise amount is more real-time, rapid and accurate, further, the cardiac pacing frequency regulated and controlled according to the exercise amount is more accurate, and the metabolic requirements of patients during various exercises can be met.
The above-mentioned embodiments are intended to illustrate the technical solutions and advantages of the present invention, and it should be understood that the above-mentioned embodiments are only the most preferred embodiments of the present invention, and are not intended to limit the present invention, and any modifications, additions, equivalents, etc. made within the scope of the principles of the present invention should be included in the scope of the present invention.
Claims (8)
1. An apparatus for adaptive adjustment of cardiac pacing rate, comprising:
the data acquisition module is used for acquiring complete triaxial acceleration data during physical activity by utilizing the triaxial acceleration sensor and preprocessing the complete triaxial acceleration data;
the data processing module is used for calculating the triaxial maximum jerk at each moment according to the preprocessed triaxial acceleration data, and comprises: regarding each single-axis acceleration data, taking an absolute value of a difference between single-axis acceleration data values at two adjacent moments as a single-axis jerk at the current moment, and taking a maximum value of the three single-axis jerks as a three-axis maximum jerk at the current moment;
the method is also used for synchronously detecting and evaluating the motion amount at the current moment according to the three-axis maximum jerk and multi-level jerk thresholds, and comprises the following steps:
presetting jerk thresholds of n grades, dividing the maximum jerk of the three axes into n +1 jerk intervals, wherein n is a natural number more than or equal to 3; determining a motion score value corresponding to the three-axis maximum jerk at the current moment according to the mapping relation between the jerk interval and the motion score value; taking the sum of the motion score values of all sampling moments in a previous period of time with the current moment as a terminal point as the motion amount of the current moment;
and the pacing frequency adjusting module is used for adjusting and controlling the cardiac pacing frequency at the next moment according to the motion amount at the current moment and outputting the cardiac pacing frequency, so that the self-adaptive adjustment of the cardiac pacing frequency is realized.
2. The adaptive cardiac pacing rate adjusting device according to claim 1, wherein the pacing rate adjusting module adjusts and controls the cardiac pacing rate at the next time according to the amount of motion at the current time includes:
after the target heart rate which is required to be reached by the exercise amount at the current moment is determined according to the exercise amount-target heart rate curve, the pacing frequency at each next moment in the time period that the starting point is the current actual heart rate and the finishing point is the target heart rate is determined by utilizing the time-pacing frequency curve, and transition control from the current actual heart rate to the target heart rate is realized.
3. The adaptive cardiac pacing rate adjusting device according to claim 2, wherein the determining, in the pacing rate adjusting module, the target rate to be reached by the exercise amount at the current time according to the exercise amount-target rate curve includes:
after the body state of the current moment is determined according to the exercise amount-target heart rate curve and the exercise amount of the current moment, the target heart rate which is required to be reached by the exercise amount of the current moment is determined according to the corresponding relation between the body state and the target heart rate.
4. The adaptive cardiac pacing rate adjusting device according to claim 3, wherein in the pacing rate adjusting module, when a target heart rate is determined, a motion amount threshold is preset, and when the motion amount at the current time is smaller than the motion amount threshold, it is determined that the current time is in a static state, and the target heart rate corresponding to the static state is a reference heart rate;
when the exercise amount at the current moment is not less than the exercise amount threshold value, the current moment is judged to be in the exercise state, the target heart rate corresponding to the exercise state is obtained through calculation according to the exercise amount, the exercise amount threshold value and the exercise amount-target heart rate curve slope, and the target heart rate is between the reference heart rate and the maximum heart rate.
5. The adaptive cardiac pacing rate adjusting apparatus according to claim 2, wherein the time-pacing rate curve includes a time-pacing rate rising curve and a time-pacing rate falling curve, the time-pacing rate rising curve indicates a process in which the heart rate rises from a reference heart rate to a maximum heart rate, the time-pacing rate falling curve indicates a process in which the heart rate falls from the maximum heart rate to the reference heart rate, a rising time and/or a falling time required between the reference heart rate and the maximum heart rate is settable, and the pacing rate corresponding to each time is determined according to the set rising time and/or falling time.
6. The adaptive cardiac pacing rate adjusting apparatus according to claim 2, wherein the time-pacing rate curve is a linear function curve or an exponential function curve.
7. The adaptive cardiac pacing rate adjusting device according to any one of claims 1 to 6, further comprising a parameter setting module for setting a jerk threshold, a motion amount threshold, a reference heart rate, a maximum heart rate, a motion amount-target heart rate curve slope, and a rise time and a fall time of a time-pacing rate curve.
8. A cardiac pacing apparatus, comprising:
the adaptive cardiac pacing rate adjusting device according to any one of claims 1 to 7;
and the pace-making control unit is in communication connection with the adaptive adjusting device and is used for sending a cardiac pace-making event according to the cardiac pace-making frequency output by the adaptive adjusting device.
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| CN108136189A (en) * | 2015-08-28 | 2018-06-08 | 心脏起搏器股份公司 | For behavior response signal detection and the system and method for the treatment of delivering |
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| WO2013090118A2 (en) * | 2011-12-12 | 2013-06-20 | Cardiac Pacemakers, Inc. | Heart rate variability and heart rate variation |
| US9737719B2 (en) * | 2012-04-26 | 2017-08-22 | Medtronic, Inc. | Adjustment of therapy based on acceleration |
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| CN108136189A (en) * | 2015-08-28 | 2018-06-08 | 心脏起搏器股份公司 | For behavior response signal detection and the system and method for the treatment of delivering |
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Denomination of invention: An adaptive adjustment device for cardiac pacing frequency and a cardiac pacing device Granted publication date: 20211109 Pledgee: Agricultural Bank of China Limited Hangzhou Yuhang Branch Pledgor: Danyuan medical technology (Hangzhou) Co.,Ltd. Registration number: Y2024980016105 |
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