CN1747764A - Breaking reentry circuits by cooling cardiac tissue - Google Patents
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Abstract
Systems and methods to inhibit the conduction of certain spurious electrical impulses in the heart. Inhibition of spurious electrical impulses in the heart is accomplished by cooling (110) one or more targeted portions of the heart. Optionally, inhibition of spurious electrical impulses may be accomplished by cooling of cardiac tissue in combination with pacing of the heart.
Description
Technical field
Present invention relates in general to the system and method for excite myocardial tissue.Particularly, embodiments of the invention provide a kind of system and method for curing heart tissue, and it suppresses the conduction of specific electrical signal in the heart tissue by the cooling heart tissue and reduces the tachycardic time and increase pace-making and the effect of defibrillation stimulation.
Background technology
The effect of cardiovascular system is vital to surviving.By blood circulation, tissue obtains necessary nutrition and oxygen, and discharges garbage.Do not have blood circulation, cell begins to carry out irreversible variation and causes death.The muscle contraction of heart is the motive force of blood circulation back.
Heart contraction, or heart beating is each time all triggered by electric pulse.These electric pulses are from sinuatrial node (natural pacemaker of heart), and it is positioned at the top or the right atrium in the upper right chamber of heart.Therefrom, electric pulse is communicated to the cavity of resorption of ventricle through the epicoele (atrium) and chamber (AV) knot of heart by " bundle branch ".Like this, electric pulse is communicated to ventricle from sinuatrial node, triggers and regulate heart beating.
The heart beating that arrhythmia is any variation of conducting system of heart, deviation or fault caused is unusual, and described conducting system of heart makes the normal electrical pulse conduction to heart.Under normal conditions, heart contraction, or heart beating is each time all triggered by electric pulse.These electric pulses are from sinuatrial node (natural pacemaker of heart), and it is positioned at the top or the right atrium in the upper right chamber of heart.Therefrom, electric pulse passes the epicoele (atrium) and chamber (AV) knot of heart, is communicated to the cavity of resorption of ventricle by " bundle branch ".Like this, electric pulse is communicated to ventricle from sinuatrial node, triggers and regulate heart beating.
When the electricity " circulation " of heart can not most desirably turn round, arrhythmia took place.Arrhythmia causes the heart beating of undesired fast (tachycardia) or undesired slow (bradycardia).ARR cause may relate to previous heart (for example, because the infringement that causes of previous heart disease) or other factors (for example, medicine, pressure does not have competent sleep).Under most situation, leaking fights does not have medical significance.Yet the most serious arrhythmia in the U.S., according to the statistics of american heart association, causes almost 500,000 people's death in every year.Sudden heart disease (" asystole ") accounts for because almost half of deaths from heart disease number, and is the first lethal reason in the U.S., this be according to North America pace-making and electrophysiology can statistics draw.
Nearly all important clinically tachycardia arrhythmia all is to continue to propagate and remotivate heart tissue (being called " reciprocal excitation ") because marker pulse does not disappear.This tachycardia arrhythmia comprises the sino-atrial node reentry excitement, atrial fibrillation, and the room is pounced on, atrial tachycardia, atrioventricular nodal reentrant tachycardia, chamber reciprocal excitation (Wolff Parkinson White syndrome or invisible additional chamber connect), ventricular tachycardia and bundle branch reentry tachycardia.
To the generation of reciprocal excitation, must in heart tissue, exist a substrate can support reciprocal excitation (" loop of turning back ").The action wavefront must and run into unidirectional retardance along the circulation of retardance center, forces it along direction conduction of center retardance like this.If (the action wavefront allows along the conduction of blocking zone both direction, and the action wavefront will collide and fade away.) conduction velocity of the wavefront that importantly circulates.If conduction velocity is too fast, the circulation wavefront will arrive original point before the excitement once more organizing substantially repolarization to become.Like this, at least slowly Chuan Dao a zone is the part in loop of turning back concerning all clinical rules of turning back in fact.The turn back composition of conduction slowly in loop of elimination has just destroyed the loop.
Atrial fibrillation (AF) is identical ARR prevailing type, and just there is 2,000,000 morbidities every year in single U.S..The danger that has all increased apoplexy is pounced in atrial fibrillation and room.According to the statistics of american heart association, they cause the U.S. annual above 54,000 people's death.Cause the rising and the age significant correlation of atrial fibrillation danger.Its result, almost the age of 70% patients with atrial fibrillation 65 and 85 years old between.Atrial fibrillation is quick, the abnormal heart rhythm (arrhythmia) that have the disappearance signal of telecommunication to cause that is sent by the epicoele (atrium) from heart.The signal of telecommunication that sends from sinuatrial node normally should be the fixing rhythm and pace of moving things: approximately per minute is 60 to 100 times.Heart stands atrial fibrillation and is rendered as two hearts rate: a room rate and a heart rate.Atrial fibrillation has been arranged, and the room rate is per minute 300-400 time and heart rate is per minute 100-175 time.This heart rate is that atrioventricular node has been blocked most atrial pulse, and only allows the sub-fraction pulse to appear at the result of ventricle.
Specific arrhythmia is relevant with the particular electrical problem in the heart.Atrioventricular nodal reentrant tachycardia is to be caused by the exterior conductive path in atrioventricular node.This allows cardiac electrical activity to " short loop " or in the circulation of sinuatrial node zone.
Atrioventricular nodal reentrant tachycardia is caused that by the exterior conductive path this exterior conductive path allows cardiac electrical activity to arrive the atrioventricular node of " short loop " and bypass simultaneously.In this pattern, outer " loop " directly connects atrium and ventricle.More often than not, this path " oppositely " conduction only: from the ventricle to the atrium.This is called " invisible additional path ", because it can not be diagnosed from routine electrocardiogram (EKG).These arrhythmia medically are treatable, but also can be treated by the catheter ablation art.Rare, external path is conducted and is embodied on EKG at forward (from the atrium to the ventricle).Wherein there is a kind of situation to be called Wolff Parkinson White syndrome (WPW).The WPW syndrome is cause and potential causing death by express heart rate.Typical WPW syndrome needs the treatment of catheter ablation art usually.
The situation of very different (and having life to threaten) is to quiver in the chamber.Quiver and comprise the vibration in ventricle rather than atrium in the chamber.Unlike atrial fibrillation, it has life to threaten, because consequently per minute 350 times or higher beating.Heart is not adhered to a few minutes at this rhythm and pace of moving things under the situation of not treatment (for example, using defibrillator).
In some cases, but the arrhythmia transition.For example, the pressure that the patient may experience a period, disease, or medicine (proper or other) reaction.In other cases, more invasive treatments are helpful.To slow (bradycardia) aroused in interest, the most frequently used treatment is electricity (manually) pacemaker.This instrument is implanted subcutaneous and is permanently inserted heart, when detecting slow or sending electric pulse during irregular heart rate.For abnormal fast heart rate, the implantable implantable rhythm of the heart changes defibrillator (ICD).If desired, undesired fast heart beating of ICD monitor recoverable.These instruments are to suffering from the chamber and quiver or the patient of ventricular arrhythmia saving somebody's life.Another method is the electrophysiologic study of carrying pipe ablation.This method is that conduit is imported to heart and destroys (melting) very carefully with radio-frequency (RF) energy and cause the undesired position of ARR heart from lower limb and/or cervical region blood vessel.
In cardiac muscle, muscle fiber inside is connected the bundle branch network in all direction issues of heart.When the irriate of any position of this network, depolarization wave pass to it all sites and total as an overall shrinkage.Before the muscle fiber irriate shrank, its film must be polarized.Muscle fiber is in polarized state usually to be stimulated by the variation of surrounding up to it.Film can be by electricity, chemistry, and machinery or variations in temperature stimulate.Cause that the minimal stimulation that contraction needs is called stimulus threshold.Controllablely do not cause that the maximal stimulus amplitude of contraction is maximum subthreshold value amplitude.
The major part that runs through heart is the bulk and the String structure of special cardiac muscular tissue.This tissue comprises conducting system of heart and is responsible for startup and propagates depolarization wave spreading all over cardiac muscle.Any interruption in cardiac pulses conduction or retardance all can cause arrhythmia or in the heart rate of heart or the significant change on the rhythm and pace of moving things.
Two-phase (negative electrode or anode) electric current is used for stimulating cardiac muscle.Yet, till the work that realizes in the United States Patent (USP) 5,871,506 and 6,141,586 for example, think that anode current is useless clinically.Cathode current comprises the electric pulse of negative pole.The discharge depolarization cell membrane of the type of this electric current by membrane capacitance, and the current potential that directly reduces film is to threshold level.Cathode current, the current potential by direct reduction tranquillization film be to threshold value, the diastole of back than anode current be lower than threshold current half to 1/3rd.At present, all basically artificial pacings use the boost pulse of negative pole, though description of test has been used in the utilization of anodic pulse.
Typical implantable cardioverter/defibrillator (ICD) is launched initial countershock in 10 to 20 seconds of arrhythmia episode, saved countless life whereby.Improved instrument has the anti-tachyarrhythmia pacemaker performance to be attached on the rhythm of the heart transformation/defibrillating function.These ICD can have different primary responses to one or more tachycardias, equally to the corresponding agenda of special arrhythmia.
The threshold value setting that the output energy level is born according to the patient by the doctor usually.The reliable minimum pace-making energy that stimulates patient's heart of this threshold value representative.Yet, since with stimulate relevant wound, between implantable heart pacer lead and cardiac muscle, can grow scar tissue at the interface.This scar tissue has improved the threshold value that the patient bears.In order to ensure reliable heart holding capacity, the common minima of output energy level is located at and doubles initial measurement holding capacity threshold value.The shortcoming of this method is that the higher lower irritation level of irritation level causes more wound to cardiac muscular tissue, thereby has promoted the formation of scar tissue, has increased and has born threshold value.Higher irritation level has also shortened the service life of battery.This is undesirable, because short battery needs more continually surgical operation to implant new battery service life.
Another shortcoming is that the patient who gets in touch with higher irritation level is potential uncomfortable.This is because the tic that higher irritation level can stimulate diaphragm or diaphragm clump or cause intercostal muscle.At last, because retardance comprehensively, higher stimulation produces little effect.
Improved result to the pace-making technology improves the electric pulse conduction relevant with effective heart rate of patients with arrhythmia, and those patients with arrhythmia can not be to normal pace-making reaction.For example by the United States Patent (USP) 6,343 of Morton M.Mower M.D. application, 232B1, it themes as " with the contraction of biphase stimulation increase muscle ".This invention has been described by biphase pace-making increases conductivity and contraction, and this biphase pace-making comprises the original anodic pulse of following cathode pulse.This technology has increased the conduction velocity of almost clapping above effective heart of 100% than traditional pacing stimulation device.Yet this technology can not make the not normal patient of all cardiac conduction recover sinus rhythm.
The true conduction that the alternative method of stimulation cardiac muscle usefully is provided and is suppressed at the specific pseudo-electric pulse in the heart, as substituting or reinforcement of traditional pace-making and Drug therapy, and/or,, other method overcomes the cardiac conduction problem so that being provided in conjunction with traditional pace-making and this alternative method of safe drugs treatment use.
Summary of the invention
Embodiments of the invention comprise the implantable cardiac treatment/stimulating apparatus of design, are used to suppress specific pseudo-electric pulse, preferably without pace-making.This technology that is applied in the implantation equipment comprises the cooling element that cools off heart tissue.Optionally, cooling processing can be used in combination with the biphase stimulation of heart tissue.
Therefore an object of the present invention is to suppress the conduction of specific pseudo-electric pulse in heart tissue that cause by the loop of turning back.
The further purpose of the present invention is the way by the cooling heart tissue, suppresses the conduction of specific pseudo-electric pulse in heart that is caused by the loop of turning back.
The further purpose of the present invention be to the heart tissue regioselectivity apply chilling temperature and suppress the conduction of specific pseudo-electric pulse in heart tissue that cause by the loop of turning back.
Another object of the present invention is to apply cooling to suppress the conduction of specific pseudo-electric pulse in heart tissue that caused by the loop of turning back in the bigger zone of heart tissue.
It is to use than the more effective means of traditional cardiac pacing to influence the loop of turning back that the present invention also has another purpose.
The present invention also have another purpose be zone bigger in heart and just pacemaker suppress specific pseudo-electric pulse than small size.
The further purpose of the present invention provides implantable stimulation equipment and is used for automatically to implementing cooling by the heart tissue of the loop influence of turning back.
The present invention also has another purpose to provide movable equipment, can implement the cooling to heart tissue in operating room or wound chamber.
The present invention also has another purpose to provide implantation equipment, the cooling of heart tissue can be combined with using traditional pacing stimulation heart tissue.
The present invention also has another purpose to provide implantation equipment, the cooling of heart tissue can be combined with using biphase stimulation cardiac stimulus tissue.
The further purpose of the present invention provides implantable cardiac stimulation equipment, can respond to outbreak or other bradycardia arrhythmia of fibrillation, and the cooling of optionally using heart tissue, the pace-making of heart tissue, the defibrillation of heart tissue or the combination of above method are arranged as therapeutic state.
In one object of the present invention, cooling and biphase electricity irritation all are that cardiac muscle is operated.Anode composition in the biphase electricity irritation increases the contractility of heart, and it is by the hyperpolarization tissue realization prior to excitement, causes the release of pulse conduction faster, more intracellular Ca2+, and causes good heart contraction.The negative electrode stimulation component has been eliminated the shortcoming of independent anode excitation, and cardiac stimulation need be at lower voltage levvl than independent anode excitation as a result.Thus, prolonged life-span of pacemaker battery and having reduced to disorganization.
In second purpose of the present invention, cooling is applied to heart tissue, and controls biphase electricity irritation to cardiac blood pool, promptly enters and around the blood of heart.Can make cardiac stimulation not need the pace-making electric lead directly to connect heart tissue like this, thereby reduce this disorganization.The stimulus threshold of the biphase stimulation of menses pond control can be the same with the scope of the standard stimulus that directly is put into cardiac muscle.Can strengthen heart contraction by biphase electricity irritation to the use of cardiac blood pool, do not have skeletal muscle contraction, cardiac muscle destruction or to the harmful effect in blood pond.
And another embodiments of the invention comprise the implantation equipment to the automatic treatment of frequent atrial fibrillation that shows effect repeatedly or chronic atrial fibrillation.This embodiment comprises the sensor-based system of a monitoring different parameters, as atrial P DF (probability density function) parameter of induction atrial fibrillation.By detecting the PDF in atrium, can be provided for before not had the detector of advised atrial fibrillation.According to the generation of induction atrial P DF and detection atrial fibrillation, implantation equipment of the present invention begins the heart tissue cooling to the atrium.The zone of striding broad by contact arrangement applies cooling to cover the heart tissue of extensive area.The chilling temperature that applies to heart tissue, cools off heart tissue by contact arrangement, and suppresses the conduction by the glitch of tissue like this.The temperature of this reduction influences the loop of turning back with effective and efficient manner.Because this interference effect is in large tracts of land tissue rather than little pacemaker, the inhibition of glitch can act on than on the big area of the pacemaker of traditional pace-making.
Sensor to cooling apply need the time, in able to programme and adjustable one of short duration time, apply and be cooled to heart tissue.The amount that cooling applies and the bulk temperature of heart are monitored by the thermostat functionality of device.Cooling can be pumped into cooling liquid at the capsule of atrial surface by the mechanical water pressing system and realize.
The monitoring heart rate is if initial failure repeats repeatedly to apply chilling temperature.
Separately heart tissue is reduced under the situation of temperature failure at present embodiment, alternate embodiment comprises that the cooling element of existing contact arrangement form has more traditional cardiac stimulation element again, this stimulation elements applies electric pulse to heart tissue with the form of negative, anodic pulse has been followed the negative pole pulse, or with other stimulating method well known in the art.
This compound mode of heart tissue cooling and cardiac stimulation combination also in another embodiment of the present invention.Processor in implantation equipment detects the beginning of fibrillation, and at first uses chilling temperature to heart tissue.If the not effect of loop of turning back to heart can apply the combination and/or the electricity irritation separately of cooling and electricity irritation.If not effect of road is returned in this compound mode doubling, will use more traditional mode of cardiac pacing separately.Therefore, provide applying of detection and chilling temperature electricity irritation or its combination of stimulation by the circuit in the implantation equipment.
The application of the foregoing description do not need anesthesia and potential effective percentage is higher than traditional cardioversion.
The further embodiment of the present invention is connected to communication terminal with implantation equipment, and is preferably wireless, and suitable like this ward can be noted heart abnormality.Signal can be received by the doctor, is used for the indication situation.The doctor can select control at long-range stimulation strategy to implantation equipment of the present invention.
Another embodiment of the present invention relates to the conductivity that changes heart, and it is should be used for realizing by the pace-making of chilling temperature and other form (as heart rate control, and defibrillation).Pace-making includes, but is not limited to the two poles of the earth, and is biphase, and one pole is single-phase, blasting, atrium, chamber and successive pace-making separately.
Embodiments of the invention are provided in the heart tissue method that suppresses false electric pulse conduction, comprising: the temperature of establishing the electric pulse conduction that helps to suppress the cardiac objects district; The target area is reduced temperature and keeps the temperature of establishment.
Another embodiment of the present invention is provided at the method that suppresses false electric pulse conduction in the heart tissue.This method comprises: detect ARR outbreak, detect the temperature of heart tissue when arrhythmia episode, and the heart tissue Current Temperatures is reduced.
Another embodiment of the present invention is provided at the method that suppresses false electric pulse conduction in the heart tissue.On heat exchange operation device each position in the one or more target areas of heart.In one of the present invention's embodiment, the heat exchange operation device is Pa Er card (Peltier) cooler.In another embodiment of the present invention, the heat exchange operation device is heat sink, and it is thermally coupled in Pa Er card cooler.Detect the symptom relevant with arrhythmia, and, respond ARR detection, by with heat absorption to the heat exchange operation device that is positioned at the target area, optionally heat is shed from the district of relevant cardiac objects with arrhythmia.
In another embodiment of the present invention, provide and suppress the ARR method of patient.The heat exchange operation device is implanted on each position in the one or more target areas of heart.Operate at least one target area that at least one heat exchange operation device cools off heart, suppress arrhythmia with this.
In another embodiment of the present invention, provide the method that is suppressed at false electric pulse conduction in the heart tissue.Detect ARR outbreak and arrhythmia estimation to detecting.Also detect the temperature of heart tissue when arrhythmia episode.Based on to the arrhythmia that detects and the estimation of heart tissue Current Temperatures, be reduced to heart tissue and apply the pace-making pulse and to heart tissue, select one or more treatment measures from applying temperature.Use selected treatment measure.
In another embodiment of the present invention, be included in the device that suppresses the spurious pulse conduction in the heart tissue.The ARR outbreak of sensing element senses; Cooling element response sensing element is implemented cooling to heart tissue to stimulate.In another embodiment of the present invention, generator or be suppressed at false electric pulse conduction in the heart tissue.The symptom that sensor is relevant with arrhythmia.The heat exchange operation device is arranged on each position of the one or more target areas of heart.In another embodiment of the present invention, the heat exchange operation device is a Pa Er card cooler.In another embodiment of the present invention, the heat exchange operation device is heat sink, and it is thermally coupled in plants in the Pa Er of patient's trunk card cooler.The locational heat exchange operation device of in the one or more target areas of heart each all is fit to response sensor, is used for heat is shed from the target area of being responsible for by this heat exchange operation device.
In another embodiment of the present invention, provide to be used for suppressing the ARR device of patient.The heat exchange operation device is implanted on each position in the one or more target areas of patient's heart.Respond ARR detection, the locational heat exchange operation device of in the one or more target areas of heart each all is fit to heat is shed from the target area of being responsible for by this heat exchange operation device, and each position in one or more whereby target areas all is cooled and arrhythmia is suppressed.
Description of drawings
Fig. 1 shows a kind of method that stops pseudo-electric pulse conduction in heart tissue according to the embodiment of the invention.
Fig. 2 shows according to a kind of of the embodiment of the invention and is used for suppressing the method that pseudo-electric pulse conducts in heart tissue by the heart tissue that is reduced to that applies a temperature.
Fig. 3 shows according to a kind of of the embodiment of the invention and reduces the method that is used for suppressing in heart tissue pseudo-electric pulse conduction with at least one pacemaker impulse to heart tissue by applying temperature.
Fig. 4 shows according to a kind of of the embodiment of the invention and is reduced to the target area of heart and applies pacemaker impulse and suppress ARR method to heart tissue by selectively applying temperature.
Fig. 5 shows a kind of by applying the device that target area that temperature is reduced to heart is used for suppressing in heart tissue the electric pulse conduction according to the embodiment of the invention.
The specific embodiment
One embodiment of the present of invention comprise an implantable cardiac treatment/stimulation apparatus, are used for suppressing the conduction of the false signal of telecommunication of heart tissue and pace-making not.The technology that is applied in implantable equipment comprises the cooling element that is used to cool off heart tissue.Selectable, one or two cooling that combines with the single negative electrode or the biphase stimulation of heart tissue embodiment is provided.
One embodiment of the present of invention provide the method that suppresses the conduction of false signal of telecommunication pulse in heart tissue.This method comprises that the temperature of determining conduction is used for the target area of heart is carried out the inhibition of electric pulse conduction; With apply temperature and be reduced to this target area and keep determined temperature.Detect the temperature of target area.If the target area has reached the temperature of determining, just applying that temperature reduces stops.If the target area does not reach definite temperature, to applying that the target area temperature reduces with regard to continuation.
The temperature of heart tissue reduces and can obtain by different means, comprises non-limiting giving an example: apply liquid coolant to heart tissue, and electricity cooling heart tissue, machinery cools off heart tissue.
An alternative embodiment of the invention provides the method that suppresses the conduction of pseudo-electric pulse in heart tissue.This method comprises the ARR outbreak of detection, determines the temperature of heart tissue when arrhythmia episode and apply temperature to heart tissue to reduce.In another method, detect the function of heart tissue.If heart tissue returns to sinus rhythm, just applying that temperature reduces stops.If heart tissue does not return to sinus rhythm, the temperature that is applied to heart tissue just reduces and continues.
The temperature of heart tissue reduces and can obtain by different means, comprises non-limiting giving an example: apply liquid coolant to heart tissue, electricity cooling heart tissue, machinery cooling heart tissue and cool off heart tissue by endothermic chemical reaction.Be suitable for realizing that the example of cooling device of the present invention has: vapotron, radiant coolers, cryoprobe, heat is prolonged (thermal holdover) equipment (as thermal storage unit, utilizing or do not utilize phase transition phenomena) and gas expansion cooler.Can be by heat exchange structure or by directly contact realization cooling.
In another embodiment of the present invention, detect ARR outbreak and comprise the ARR symptom of detection expression.Detect the ARR different symptoms of expression, comprise non-limiting giving an example: electricity changes and the variation of cardiac function in measurement in the heart.
In another embodiment of the present invention, be used for further comprising and apply pacemaker impulse to heart tissue in the method that heart tissue suppresses the conduction of pseudo-electric pulse.Pace-making can be by one or more electrodes of contact heart tissue, or place the electrode in the blood pond of one or more ventricles to realize.In any method, pacemaker impulse is applied to one or more electrodes.Pacemaker impulse can be the cathodic electricity waveform or comprise negative electrode and the biphase electrical waveform of anode composition.
An alternative embodiment of the invention provides the method that is used for suppressing in heart tissue the conduction of pseudo-electric pulse.With one or more districts of the heart of one or more loops influences of turning back as target.In one embodiment of the invention, each in these one or more target areas is selected from right front-side (lateral) atrial surface, one of left front-the side atrial surface, right back-side atrial surface and left back-side atrial surface.The heat exchange operation device is arranged in each of one or more target areas of heart.In one embodiment of the invention, the heat exchange operation device is a Pa Er card cooler.Pa Er card cooler can be electrically connected to the power supply of implanting patient's trunk.In another embodiment of the present invention, the heat exchange operation device is heat sink, and this is heat sink to be thermally coupled to the Pa Er card cooler of implanting patient's trunk.Selectable, heat sink is the thermocouple that adopts Mechanical Contact or heat passage liquid.
Detect the symptom that interrelates with arrhythmia, and respond the detection of this symptom, by with the heat exchange operation device of heat absorption carry in the target area, heat is selectable to pass from relating to ARR cardiac objects district.
Symptom can detect in heart.The heat exchange operation device responds ARR detection and starts.Can detect different symptoms, comprise non-limiting giving an example: the electricity in the heart changes and and the variation of cardiac function in measurement.
Another method comprises the function that detects heart, and when the symptom relevant with arrhythmia do not detect, stops from least one target area heat radiation.
In another embodiment of the present invention, be used for further comprising and apply pacemaker impulse to heart tissue in the method that heart tissue suppresses the conduction of pseudo-electric pulse.Pace-making can be by one or more electrodes of contact heart tissue, or place the electrode in the blood pond of one or more ventricles to realize.In any method, pacemaker impulse is applied to one or more electrodes.Pacemaker impulse can be the cathodic electricity waveform or comprise negative electrode and the biphase electrical waveform of anode composition.
In another embodiment of the present invention, be used for comprising and apply pacemaker impulse to heart tissue in the method that heart tissue suppresses the conduction of pseudo-electric pulse.Pace-making can be by one or more electrodes of contact heart tissue, or place the electrode in the blood pond of one or more ventricles to realize.In any method, pacemaker impulse is applied to one or more electrodes.Pacemaker impulse can be the cathodic electricity waveform or comprise negative electrode and the biphase electrical waveform of anode composition.
In another typical embodiment of the present invention, provide and suppressed the not normal method of patient's heart rhythm.The heat exchange operation device is implanted in one of patient's heart and a plurality of target areas each.At least one heat exchange operation device is used to cool off at least one target area of heart, has therefore suppressed arrhythmia.In one embodiment of the invention, the heat exchange operation device is a Pa Er card cooler of implanting one or more target areas, and each this target area is selected from right front-side atrial surface, and is left front-the side atrial surface, one of right back-side atrial surface and left back-side atrial surface.Pa Er card cooler can be electrically connected to the power supply of implanting patient's trunk.In another embodiment of the present invention, hot conversion operations device is implant one or more target areas heat sink, each this target area is selected from right front-side atrial surface, left front-the side atrial surface, right back-the side atrial surface, with one of left back-side atrial surface, this is heat sink to be thermally coupled to the Pa Er card cooler of implanting patient's trunk.Selectable, heat sink is the thermocouple that adopts Mechanical Contact or heat passage liquid.
The ARR method of another inhibition patient comprises the implantation patient's heart, and at least one is used to detect the detection contact (sensing-contact) of symptom, with be connected this detection contact (sensing-contact) to power supply, this power supply provides electric energy for the operation of heat exchange operation device when detecting symptom.Can detect different symptoms, comprise non-limiting giving an example: electricity changes and the variation of cardiac function in measurement in the heart.
In another embodiment of the present invention, suppressing the ARR method of patient further comprises to heart tissue and applies pacemaker impulse.Pace-making can be by one or more electrodes of contact heart tissue, or place the electrode in the blood pond of one or more ventricles to realize.In any method, pacemaker impulse is applied to one or more electrodes.Pacemaker impulse can be the cathodic electricity waveform or comprise negative electrode and the biphase electrical waveform of anode composition.
In another embodiment of the present invention, provide the method that in heart tissue, suppresses the conduction of pseudo-electric pulse.Detect ARR outbreak and this detected arrhythmia of assessment.Also determine the temperature of heart tissue when arrhythmia episode.Based on to the ARR assessment that detects and the temperature of heart tissue, reduce and apply the one or more treatment measure of selection the pacemaker impulse to heart tissue from apply temperature to heart tissue.Apply selected treatment measure.Selectable, detect the heart tissue function, if heart returns to sinus rhythm, just applying of measure of treatment stops.Similarly, if heart tissue does not return to sinus rhythm, just applying of treatment measure continues.
In other embodiments of the invention, provide the device that is used for suppressing the conduction of pseudo-electric pulse in heart tissue.Device comprises that the checkout equipment that is used to detect ARR outbreak and response checkout equipment apply cooling and stimulate cooling device to heart tissue.Device further comprises the logical device that is used to detect and end the cooling stimulation when sinus rhythm rebulids in the heart tissue when sinus rhythm rebulids.Providing supplementary equipment therefore to be used for continuing cooling when sinus rhythm does not rebulid stimulates.
Cooling device comprises non-limiting giving an example: be used to apply equipment, electric cooling device and the mechanical chiller of cooling liquid to heart tissue.In addition, checkout equipment can be suitable for detecting the symptom of getting in touch with arrhythmia.Non-limiting giving an example, this symptom can be that electricity changes and the measurement of cardiac function in the heart.
Another device of the present invention further comprises cardiac stimulation generator and one or more and heart tissue electrodes in contact.Electrode is connected to the cardiac stimulation generator, is suitable for applying the pacemaker impulse of cathodic electricity waveform or two phase waveform to heart tissue.In alternate embodiment of the present invention, electrode contacts with cardiac blood pool.Selectable, cardiac stimulation generator response checkout equipment.
The device that another is used for suppressing in heart tissue the conduction of pseudo-electric pulse of the present invention comprises the pick off that detects the symptom of getting in touch with arrhythmia.Non-limiting giving an example, this symptom can be that electricity changes in the heart, the measurement of cardiac function and represent ARR change.The heat exchange operation device is arranged in each of one or more target areas of heart.In one embodiment of the invention, the heat exchange operation device is a Pa Er card cooler.Pa Er card cooler can be electrically connected to the power supply of implanting patient's trunk.In another embodiment of the present invention, hot conversion operations device is heat sink, and this is heat sink to be thermally coupled to the Pa Er card cooler of implanting patient's trunk.Selectable, heat sink is the thermocouple that adopts Mechanical Contact or heat passage liquid.
Be arranged in each heat exchange operation device of one or more target areas and be fit to response sensor, the target area of being responsible for from the heat exchange operation device removes heat.Pick off places on the heat exchange operation device.
A kind of device further comprises logical device, is used for detecting when sinus rhythm rebulids and be used for suspending the cooling stimulation when sinus rhythm rebulids in heart tissue.Providing supplementary equipment therefore to be used for continuing cooling when sinus rhythm does not rebulid stimulates.
In another embodiment of the present invention, device further comprises and is suitable for to pick off power supply and starts the power supply of heat exchange operation device according to the detection of symptom.Selectable, the competent energy of power storage is so that to suppress patient's heart rhythm in a secular time not normal.In addition, after one or more target areas fully cooled off, power supply stopped to power to the heat exchange operation device automatically.In one embodiment of the invention, when detecting the decay (subsidence of the symptom) of symptom by the detection contact, one or more target areas cool off fully.As an alternative, when being measured each target area by thermocouple when reaching predetermined temperature, one or more target areas fully cool off.In another alternate embodiment, when time of a setting that one or more target areas have been dispelled the heat, one or more target areas fully cool off.
In one embodiment of the invention, each in these one or more target areas is selected from right front-side atrial surface, one of left front-the side atrial surface, right back-side atrial surface and left back-side atrial surface.
In another embodiment of the present invention, this device further comprises cardiac stimulation generator and one or more and heart tissue electrodes in contact.Electrode is connected to the cardiac stimulation generator, and described cardiac stimulation generator is suitable for applying the pacemaker impulse of cathodic electricity waveform or two phase waveform to heart tissue.In alternate embodiment of the present invention, electrode contacts with cardiac blood pool.Selectable, cardiac stimulation generator response checkout equipment.
Of the present invention another is used to suppress the ARR device of patient.This device comprises the pick off that detects the symptom relevant with arrhythmia.Non-limiting giving an example, this symptom can be that electricity changes in the heart, the measurement of cardiac function and represent ARR change.The heat exchange operation device is arranged in each of one or more target areas of heart, in response to ARR detection, be arranged in each heat exchange operation device of one or more target areas and be suitable for heat being passed from the target area that the heat exchange operation device is responsible for.As a result, thus each part cooling in one or more target areas has been suppressed arrhythmia.
In one embodiment of the invention, hot conversion operations device is a Pa Er card cooler.Pa Er card cooler can be electrically connected to the power supply of implanting patient's trunk.Power supply is fit to start the heat exchange operation device to the pick off power supply with according to the detection of symptom.In another embodiment of the present invention, the heat exchange operation device is heat sink, and this is heat sink to be thermally coupled to the Pa Er card cooler of implanting patient's trunk.Selectable, heat sink is the thermocouple that adopts Mechanical Contact or heat passage liquid.
In another embodiment of the present invention, each in these one or more target areas is selected from right front-side atrial surface, one of left front-the side atrial surface, right back-side atrial surface and left back-side atrial surface.
In another embodiment of the present invention, device further comprises power supply, and this power supply is fit to start the heat exchange operation device to the pick off power supply with according to the detection of symptom.
In another embodiment of the present invention, this device further comprises cardiac stimulation generator and one or more and heart tissue electrodes in contact.Electrode is connected to the cardiac stimulation generator, is suitable for applying the pacemaker impulse of cathodic electricity waveform or two phase waveform to heart tissue.In alternate embodiment of the present invention, electrode contacts with cardiac blood pool.Selectable, cardiac stimulation generator response checkout equipment.
Fig. 1 shows a kind of method that stops pseudo-electric pulse conduction in heart tissue according to the embodiment of the invention.With reference to Fig. 1, a temperature 100 that helps to suppress the electric pulse conduction is determined in a target area of heart.The temperature reduction is applied to the temperature 110 that this target area keeps this to determine.Detect the temperature 115 of target area and judge whether the target area has reached the temperature of determining 120.If the target area has reached the temperature of determining, applying that temperature reduces just stops 125.If the target area does not also reach definite temperature, the temperature that is applied to the target area reduces and just continues 130.Though Fig. 1 shows the single target district, the invention is not restricted to this.Without departing from the scope of the invention, one or more target areas also are same, and relevant with the temperature of determining 120.
The temperature of heart tissue reduces and can obtain by different means, comprises non-limiting giving an example: apply liquid coolant to heart tissue, electricity cooling heart tissue and the mechanical heart tissue of cooling off.
Fig. 2 shows according to a kind of of the embodiment of the invention and comes to suppress the method that pseudo-electric pulse conducts by the heart tissue that is reduced to that applies a temperature in heart tissue.With reference to Fig. 2, detect ARR outbreak 200 and temperature and reduce and be applied to heart tissue 210.Detect the function 215 of heart tissue and judge whether that heart tissue returns to sinus rhythm 220.If heart tissue returns to sinus rhythm, the temperature that is applied to heart tissue reduces and just stops 225.If heart tissue does not also return to sinus rhythm, the temperature that is applied to heart tissue reduces and just continues 230.
Fig. 3 shows according to a kind of of the embodiment of the invention and comes to suppress the method that pseudo-electric pulse conducts by reduction and at least one pacemaker impulse that applies a temperature to heart tissue in heart tissue.With reference to Fig. 3, detect ARR outbreak 300.At least one pacemaker impulse and temperature reduction are applied to heart tissue 310.Detect the function 315 of heart tissue and judge whether that heart tissue returns to sinus rhythm 320.If heart tissue returns to sinus rhythm, this at least one pacemaker impulse and the temperature reduction that are applied to heart tissue just stop 325.If heart tissue does not also return to sinus rhythm, this at least one pacemaker impulse and the temperature reduction that are applied to heart tissue just continue 330.As mentioned above, pacemaker impulse can be a negative electrode or biphase, and can by electrode contact heart the blood pond or the contact heart tissue be applied to heart tissue.
Fig. 4 shows according to a kind of of the embodiment of the invention and suppresses ARR method by target area that is reduced to heart and the pacemaker impulse that selectively applies a temperature to heart tissue.With reference to Fig. 4, detect ARR outbreak 400.Assess the temperature 405 of this arrhythmia and definite heart tissue.Based on temperature, from applying the temperature reduction to heart tissue and applying the one or more treatment measure 410 of selection the pacemaker impulse to heart tissue to detected ARR assessment and heart tissue.Selected treatment measure is applied to heart tissue 415.Optionally applying of heart cooling and pacemaker impulse is that logic circuit by incorporating in the computer processor is determined.In one embodiment of the invention, processor is arranged in the device that pacemaker impulse is provided.As an alternative, processor is arranged in the device that refrigerating function is provided.In another embodiment of the present invention, processor is an independent equipment.Detect the function 420 of heart tissue and judge whether that heart tissue returns to sinus rhythm 425.If heart tissue returns to sinus rhythm, applying of selected treatment measure just stops 430.If heart tissue does not return to sinus rhythm, applying of selected treatment measure just continues 435.In an alternate embodiment, the temperature of the heart tissue of reappraising and arrhythmia, and reselect one or more treatment measures.
As mentioned above, pacemaker impulse can be a negative electrode or biphase, and can by electrode contact heart the blood pond or the contact heart tissue be applied to heart tissue.
Fig. 5 shows a kind of device that is used for suppressing in heart tissue the electric pulse conduction by the target area that is reduced to heart that applies a temperature according to the embodiment of the invention.With reference to Fig. 5, heart checkout gear 510 and heart chiller 515 are applied to patient 500 heart 505.In one embodiment of the invention.Heart checkout gear 510 detects ARR outbreak.Respond this heart checkout gear 510, cool off heart by heart chiller 515.Logic circuit 520 detects when sinus rhythm rebulids in heart tissue.If sinus rhythm rebulids in heart tissue, the cooled magnetisation that logic circuit 520 suspends chiller 515.If sinus rhythm does not rebulid in heart tissue, the cooled magnetisation that logic circuit 520 continues chiller 515.
In one embodiment of the invention, heart chiller 515 comprises Pa Er card cooler.This heat exchange operation device makes electric current pass through junction between the different metal.The atom of different metal has different energy levels, causes differential between the energy level of each metal junction.When electric current passed through metal, the metal electron with low-lying level had the more metal of high level by first differential the flowing to.In order to pass through this differential and continuous this circuit, electronics must absorb heat energy, thereby causes the metal cools in first junction.In opposite junction, thereby electronics releases energy to low-lying level migration from high level and causes the temperature in this junction to raise.
As is known to the person skilled in the art, without departing from the scope of the invention, other chillers also can be used for realizing this function of the present invention.By non-limiting diagram, heart chiller 515 can be other equipment or system, and this equipment or system absorb heat and also realize heat passage by the convection current or the conduction of liquid from a specific region.As an alternative, can realize cooling by mechanical Hydraulic Power System, this Hydraulic Power System advances coolant pump in the capsule on the atrial surface.The bulk temperature that applies with heart of amount of cooling water can monitor by " thermostat (thermostat) " function of device.
In another embodiment of the present invention, the heart chiller further comprise one heat sink, this is heat sink to be thermally coupled to the heat exchange operation device, as Pa Er card cooler.The heat exchange operation device is electrically connected to power supply, and this power supply provides and flows through the heat exchange operation device and influence heat passage electric current.When not needing when heat passage, power supply is operated effectively by the power supply of closing the heat exchange operation device.When needs were heat passage, power supply can start provided DC current to arrive the heat exchange operation device, and the cold junction that this heat exchange operation device contacts the heat exchange operation device from the target area by hot joining again starts heat passage.
In another embodiment of the present invention, heat exchange operation device response heart checkout gear 510, this device detects ARR symptom.By detected this symptom of heart checkout gear can be ARR electricity of expression or physiological measurements.
In another embodiment of the present invention, logic circuit 520 is determined the fully time of cooling heart.The time that fully cooling off heart needs can be enrolled in the logic circuit 520 or based on the information that obtains from heart checkout gear 510 and be calculated by logic circuit 520.
Refer again to Fig. 5, in another embodiment of the present invention, cardiac stimulation generator 530 applies pacemaker impulse to heart tissue by electrode 525.Though Fig. 5 shows a single electrode, the present invention is not limited to this.As is known to the person skilled in the art, without departing from the scope of the invention, also can use a plurality of electrodes.In addition, electrode 525 can contact placement with heart tissue or place in the blood pond of heart.Cardiac stimulation generator 530 response heart checkout gears 510.The pacemaker impulse that cardiac stimulation generator 530 produces can be the cathodic electricity waveform or comprise negative electrode and the biphase electrical waveform of anode composition.
Though embodiments of the invention are the conduction that suppress pseudo-electric pulse at the cooling heart tissue, the present invention is not limited to this.Can suppress the false signal of telecommunication and influence the other parts of human body (as brain, skeletal muscle, nociceptor) by cooling off.It will be apparent for a person skilled in the art that embodiments of the invention to can be used for suppressing the false signal of telecommunication of human body other parts and do not break away from this
Scope of invention.
The system and method that is used to suppress the conduction of pseudo-electric pulse in the heart tissue has been described.Should be appreciated that concerning the technical staff in field of the present invention other concrete forms also are fine under the situation that does not break away from scope disclosed by the invention, of the present invention for example and embodiment be non-limiting giving an example.The those of skill in the art in field should know that it also is possible adopting other embodiment of notion described here under the present invention.
Claims (46)
1. one kind is suppressed the device that pseudo-electric pulse conducts in heart tissue, and it comprises:
Detect the pick off of the symptom relevant with arrhythmia; And
Be arranged in each locational heat exchange operation device of the one or more target areas of heart;
Wherein, all be fit to the described pick off of response on described heat exchange operation device each position in described one or more target areas, be used for heat is passed from the target area that the heat exchange operation device is responsible for.
2. device as claimed in claim 1 further comprises:
In order to detect the logic element when sinus rhythm rebulids in heart tissue; And
In order to when sinus rhythm rebulids, to suspend the element that cooling stimulates.
3. device as claimed in claim 2, wherein, described logic element further is included in and continues to implement the logic circuit that cooling stimulates when heart tissue is not recovered sinus rhythm.
4. device as claimed in claim 1, wherein, described symptom is that the electricity in the heart changes.
5. device as claimed in claim 1, wherein, described symptom is the variation of cardiac function in measurement.
6. device as claimed in claim 1, wherein, described symptom is the ARR change of expression.
7. device as claimed in claim 1, wherein, described pick off is positioned on the heat exchange operation device.
8. device as claimed in claim 1, wherein, described device further comprises power supply, wherein power supply is suitable for starting the heat exchange operation device to pick off power supply with according to the detection of symptom.
9. device as claimed in claim 8, wherein, it is not normal that the energy that described power storage is enough suppresses patient's heart rhythm for a long time.
10. device as claimed in claim 8, wherein, described power supply stops the heat exchange operation device is powered after one or more target areas enough cool off automatically.
11. as the device of claim 10, wherein, in the time of sx, described one or more target areas are sufficiently cooled, this alleviating by sensor.
12. as the device of claim 10, wherein, when each in described one or more target areas reached predetermined temperature, described one or more target areas were sufficiently cooled.
13. as the device of claim 12, wherein, with the temperature of thermocouple measurement target area.
14. as the device of claim 10, wherein, when described one or more target areas having been dispelled the heat the time of setting, described one or more target areas are sufficiently cooled.
15. device as claimed in claim 1, wherein, described heat exchange operation device is a Pa Er card cooler.
16. as the device of claim 15, wherein, described Pa Er card cooler is electrically connected to the power supply of implanting patient's trunk.
17. device as claimed in claim 1, wherein, described heat exchange operation device comprises heat sink, and described heat sink being thermally coupled to is installed in the intravital Pa Er card of the shell of implanting patient's trunk cooler.
18., wherein, describedly heat sinkly be coupled to described Pa Er card cooler by Mechanical Contact as the device of claim 17.
19., wherein, describedly heat sinkly be coupled to described Pa Er card cooler by heat-conduction liquid as the device of claim 17.
20. as the device of claim 17, wherein, described Pa Er card cooler is electrically connected to and is positioned at the intravital power supply of shell.
21. device as claimed in claim 1, wherein, each in described one or more target areas is selected from the forward right side atrial surface, front left side atrial surface, right lateral side atrial surface, one of left rear side atrial surface.
22. device as claimed in claim 1 further comprises:
The cardiac stimulation generator;
The one or more electrodes that contact with heart tissue, wherein said electrode are connected to described cardiac stimulation generator; And
Wherein said cardiac stimulation generator is suitable for heart tissue is applied pacemaker impulse.
23. as the device of claim 22, wherein, described cardiac stimulation generator is in response to sensing element.
24. as the device of claim 23, wherein, described pacemaker impulse is the cathodic electricity waveform.
25. as the device of claim 23, wherein, described pacemaker impulse is biphase electrical waveform.
26. device as claimed in claim 1 further comprises:
The cardiac stimulation generator;
The one or more electrodes that contact with cardiac blood pool, wherein said electrode are connected to described cardiac stimulation generator; And
Wherein said cardiac stimulation generator is suitable for cardiac blood pool is applied pacemaker impulse.
27. as the device of claim 26, wherein, described pacemaker impulse is the cathodic electricity waveform.
28. as the device of claim 27, wherein, described pacemaker impulse is biphase electrical waveform.
29. one kind is suppressed the ARR device of patient, it comprises:
Detect pick off with the relevant symptom of arrhythmia; And
Be arranged in each locational heat exchange operation device of the one or more target areas of heart;
Wherein, respond ARR detection, the locational heat exchange operation device of in the one or more target areas of heart each all is suitable for dispelling the heat from the target area that this heat exchange operation device is responsible for, and each position in described whereby one or more target areas all is cooled and arrhythmia is suppressed.
30. as the device of claim 29, wherein, described heat exchange operation device is a Pa Er card cooler.
31. as the device of claim 30, wherein, described Pa Er card cooler is electrically connected to the power supply of implanting patient's trunk, and wherein said power supply is suitable for starting the heat exchange operation device to the pick off power supply with according to the detection of symptom.
32. as the device of claim 29, further wherein said heat exchange operation device comprises heat sink, described heat sink being thermally coupled to is installed in the intravital Pa Er card of the shell of implanting patient's trunk cooler.
33. as the device of claim 32, wherein, described Pa Er card cooler is electrically connected to and is positioned at the intravital power supply of shell.
34., wherein, describedly heat sinkly be coupled to described Pa Er card cooler by Mechanical Contact as the device of claim 32.
35., wherein, describedly heat sinkly be coupled to described Pa Er card cooler by heat-conduction liquid as the device of claim 32.
36. as the device of claim 29, wherein, each is selected from the forward right side atrial surface described one or more target areas, front left side atrial surface, right lateral side atrial surface, one of left rear side atrial surface.
37. as the device of claim 29, wherein, described symptom is that the electricity in the heart changes.
38. as the device of claim 29, wherein, described symptom is the variation of cardiac function in measurement.
39. as the device of claim 29, wherein, described symptom is the ARR change of expression.
40. the device as claim 29 further comprises:
The cardiac stimulation generator;
The one or more electrodes that contact with heart tissue, wherein said electrode are connected to described cardiac stimulation generator; And
Wherein said cardiac stimulation generator is suitable for heart tissue is applied pacemaker impulse.
41. as the device of claim 40, wherein, described cardiac stimulation generator is in response to described pick off.
42. as the device of claim 41, wherein, described pacemaker impulse is the cathodic electricity waveform.
43. as the device of claim 41, wherein, described pacemaker impulse is biphase electrical waveform.
44. the device as claim 29 further comprises:
The cardiac stimulation generator;
The one or more electrodes that contact with cardiac blood pool, wherein said electrode are connected to described cardiac stimulation generator; And
Wherein said cardiac stimulation generator is suitable for cardiac blood pool is applied pacemaker impulse.
45. as the device of claim 44, wherein, described pacemaker impulse is the cathodic electricity waveform.
46. as the device of claim 45, wherein, described pacemaker impulse is biphase electrical waveform.
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| US43920603P | 2003-01-10 | 2003-01-10 | |
| US60/439,206 | 2003-01-10 | ||
| US10/754,887 | 2004-01-10 |
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Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| EP3383300A4 (en) * | 2015-12-03 | 2018-12-12 | Mayo Foundation for Medical Education and Research | Thermal modification to treat cardiac electrical disorders and other disorders |
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| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| EP3383300A4 (en) * | 2015-12-03 | 2018-12-12 | Mayo Foundation for Medical Education and Research | Thermal modification to treat cardiac electrical disorders and other disorders |
| US11179270B2 (en) | 2015-12-03 | 2021-11-23 | Mayo Foundation For Medical Education And Research | Thermal modification to treat cardiac electrical disorders and other disorders |
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