EP0249818A1 - Herzschrittmacher zur Stimulierung des menschlichen Herzens - Google Patents

Herzschrittmacher zur Stimulierung des menschlichen Herzens Download PDF

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Publication number
EP0249818A1
EP0249818A1 EP87108101A EP87108101A EP0249818A1 EP 0249818 A1 EP0249818 A1 EP 0249818A1 EP 87108101 A EP87108101 A EP 87108101A EP 87108101 A EP87108101 A EP 87108101A EP 0249818 A1 EP0249818 A1 EP 0249818A1
Authority
EP
European Patent Office
Prior art keywords
pacing
signal
cardiac pacer
rate
pulse
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP87108101A
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English (en)
French (fr)
Inventor
Anders Lekholm
David C. Amundson
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Siemens AG
Siemens Corp
Original Assignee
Siemens AG
Siemens Corp
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Siemens AG, Siemens Corp filed Critical Siemens AG
Publication of EP0249818A1 publication Critical patent/EP0249818A1/de
Withdrawn legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
    • A61N1/36514—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by a physiological quantity other than heart potential, e.g. blood pressure
    • A61N1/36521—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by a physiological quantity other than heart potential, e.g. blood pressure the parameter being derived from measurement of an electrical impedance

Definitions

  • This invention relates to a cardiac pacer for pacing a human heart, wherein the pacing rate is controlled by the respiration of the patient.
  • Conventional cardiac pacers usually comprise a pacing electrode and an indifferent electrode.
  • the pacing electrode is placed in the human heart by means of a pacing lead.
  • the conductive (metallic) housing of the cardiac pacer defines the indifferent electrode.
  • the US Patent 3,593,718 describes such a conventional cardiac pacer which in addition utilizes an impedance pneumograph for obtaining a respiratory signal from thoracic impedance variations.
  • the impedance pneumograph comprises a first and a second impedance measuring electrodes each connected with a separate first and second leads, respectively. Both impedance measuring electrodes of the impedance pneumograph are placed on the surface of the patient's chest.
  • the European Patent Application 0 089 014 depicts a conventional cardiac pacer which also employs an impedance pneumograph for obtaining a respiratory signal.
  • the impedance pneumograph comprises first and a second impedance measuring electrodes.
  • the first impedance measuring electrode is connected to a lead while the second electrode is defined by the conductive (metallic) housing which contains the cardiac pacer and the impedance pneumograph.
  • the first impedance measuring electrode and, since the conductive (metallic) housing is implanted, the second electrode are subcutaneously placed in the thorax.
  • the complete pacing and impedance measuring system comprises a pacing electrode on a first lead, a first impedance measuring electrode on a second lead and the metallic housing as both the indifferent electrode of the cardiac pacer and the second electrode of the impedance pneumograph.
  • the current impulses generated and utilized for impedance measurement are at a higher rate than those of the ventilation rate.
  • the pacer needs an unnecessary high amount of energy.
  • an improved cardiac pacer which comprises
  • the amount of energy to activate the respiration measuring means is reduced to a minimum. Furthermore it is possible to manage with only two electrodes and one lead for both pacing and measuring the impedance varia­tions, namely the pacing electrode connected to the pacing lead and the metallic housing containing the pacer and the impedance pneumograph. Under the circumstances the invention provides for a minimum number of electrodes and leads for pacing and impedance measurement. Since the pacing pulse itself is processed for obtaining a respiratory signal no additional current for impedance measurement has to be supplied.
  • a human heart which has to be paced is generally designated with 1.
  • a pacing electrode 2 is inserted in the human heart 1 in a manner and position that the heart can most efficiently be paced.
  • the pacing elec­trode 2 is connected through a pacing lead 3 with a pacing pulse generator 4.
  • a time base unit 5 controls the pacing rate of the pacing pulse generator 4 through line 6.
  • An impedance pneumograph 7 is connected with the pacing pulse generator 4 through line 8 for processing the pacing pulses 9 in a manner that a respiratory signal is obtained from the pacing pulses 9 when evaluating the amplitude decays 10 of pacing pulses 10.
  • the amplitude decay 10 changes according to alternating body impedance during respiration.
  • the impedance measurement can be done by the simultaneous measurement of voltage and its associated current and an analog or digital division of voltage and current.
  • the impedance pneumograph 7 controls the time base unit 5 through line 11 in a manner that a predetermined basic pacing rate of the pacing pulse generator 4 is varied dependent on the respiratory signal.
  • the line 12 is a control line from the time base unit 5 to the impedance pneumograph 7.
  • the pacing pulse generator 4, the time base unit 5 and the impedance pneumograph 7 are all encapsuled in an implantable conductive (metallic) housing 13 which is the housing of the cardiac pacer according this invention.
  • the metallic housing 13 defines both the indifferent electrode for pacing and the second electrode for impedance measurement as indicated in Fig. 1 with reference numeral 14.
  • the cardiac pacer according to this invention manages with only two electrodes and one lead, namely electrodes 2 and 14 and lead 3 for both pacing and impedance measurement. Since the pacing pulse itself is processed for obtaining a respiratory signal no additional current for impedance measurement has to be supplied. Therefore the amount of energy necessary for activating impedance measurement is reduced to a miniumum.
  • Fig. 2 depicts the schematic block diagram of Fig. 1 in more detail.
  • the complete impedance including the heart is designated with Z.
  • the pacing pulse generator 4 comprises an output capacitor 15 which is switchable by means of switch 16 between battery 17 (switch position A) and pacing lead 3 (switch position B).
  • switch position A the output capacitor 15 is charged by the battery 17 to a voltage V1.
  • switch position B the output capacitor 15 is discharged through pacing lead 3 as pacing pulse 9.
  • the amount of discharge depends on the impedance variations of the patient 's thorax during respiration.
  • the pacing pulse 9 discharges from V1 to V2 (amplitude decay 10).
  • the impedance pneumograph 7 includes a sample and hold circuitry 18, a difference former 19, a filter 20, a non-linear amplification (e.g. squaring) circuitry 21, an integrator 22 and a voltage to pulse rate converter 23.
  • the sample and hold circuitry samples and holds the voltages V1, V2 of output capacitor 15.
  • the difference former 19 supplies the difference V1 - V2 through the filter 20 to the non-linear amplification circuitry 21.
  • the non-linear amplification circuitry 21 amplifies the output signal of filter 20 in a manner that signal portions having higher amplitudes are more amplified than signal portions having lower amplitudes. Under the circumstances interesting signal portions including the respiration signal are enhanced with respect to low amplitude noise for further processing.
  • Non-linear amplification circuitries of this kind are well known in the art. They do not need described in more detail.
  • the output signal of the non-linear amplification circuitry 21 is integrated in integrator 22 over a period of time, e. g. in the range of 5 to 30s. By integrating, high-frequency noise is significantly reduced.
  • the voltage to pulse rate converter converts the integrated signal into a pulse rate according to the breathing rate.
  • the time base unit 5 comprises a zero decoder 24, a down counter 25, a time base register 26 and an analog signal to digital control word converter 27.
  • the latter one converts the analog pulse rate signal of the voltage to pulse rate converter 23 into a digital control word.
  • This digital control word is supplied to the time base register 26. It controls the time base register 26 in a manner that a basic pacing rate, e.g. 60 beats/min., is varied dependent on the respiration rate.
  • a basic pacing rate e.g. 60 beats/min.

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  • Health & Medical Sciences (AREA)
  • Cardiology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Biophysics (AREA)
  • Physiology (AREA)
  • Engineering & Computer Science (AREA)
  • Hematology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Radiology & Medical Imaging (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Electrotherapy Devices (AREA)
EP87108101A 1986-06-16 1987-06-04 Herzschrittmacher zur Stimulierung des menschlichen Herzens Withdrawn EP0249818A1 (de)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US06/874,591 US4697591A (en) 1986-06-16 1986-06-16 Cardiac pacer for pacing a human heart and pacing method
US874591 1986-06-16

Publications (1)

Publication Number Publication Date
EP0249818A1 true EP0249818A1 (de) 1987-12-23

Family

ID=25364131

Family Applications (1)

Application Number Title Priority Date Filing Date
EP87108101A Withdrawn EP0249818A1 (de) 1986-06-16 1987-06-04 Herzschrittmacher zur Stimulierung des menschlichen Herzens

Country Status (3)

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US (1) US4697591A (de)
EP (1) EP0249818A1 (de)
JP (1) JP2708420B2 (de)

Cited By (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0249819A1 (de) 1986-06-16 1987-12-23 Pacesetter AB Herzschrittmacher zur Stimulierung des menschlichen Herzens
EP0249824A1 (de) 1986-06-16 1987-12-23 Pacesetter AB Herzschrittmacher zur Stimulierung des menschlichen Herzens
US4966146A (en) * 1988-01-14 1990-10-30 Webb Stuart C Rate-responsive pacemaker
US5044365A (en) * 1988-02-17 1991-09-03 Webb Stuart C Rate-responsive pacemaker
DE4111505A1 (de) * 1991-04-09 1992-10-15 Roland Heinze Anordnung zur ermittlung eines nicht pulsbezogenen informationsanteils in einem kardialen informationssignal
EP0933095A2 (de) 1998-01-29 1999-08-04 BIOTRONIK Mess- und Therapiegeräte GmbH & Co Ingenieurbüro Berlin Selbstkalibrierender ratenadaptiver Herzschrittmacher
US6519494B1 (en) 1999-08-20 2003-02-11 Biotronik Mess-Und Therapiegeraete Gmbh & Co. Ingenieurbuero Berlin Rate-adaptive cardiac pacemaker

Families Citing this family (21)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0249825B1 (de) * 1986-06-16 1991-11-06 Pacesetter AB Vorrichtung zur Impedanzmessung an Körpergeweben
DE3631155A1 (de) * 1986-09-12 1988-03-24 Alt Eckhard Frequenzvariabler herzschrittmacher mit belastungsadaequatem frequenzverhalten
DE3732640C1 (de) * 1987-09-28 1989-05-18 Alt Eckhard Medizinisches Geraet zum Ermitteln von physiologischen Funktionsparametern
US4899750A (en) * 1988-04-19 1990-02-13 Siemens-Pacesetter, Inc. Lead impedance scanning system for pacemakers
US4949720A (en) * 1988-09-20 1990-08-21 Medtronic, Inc. Apparatus for measuring the lead current in a pacemaker
DE3914680A1 (de) * 1989-05-03 1990-11-08 Alt Eckhard Herzschrittmacher
US5215081A (en) * 1989-12-28 1993-06-01 Telectronics Pacing Systems, Inc. Method and device for measuring subthreshold defibrillation electrode resistance and providing a constant energy shock delivery
US5058583A (en) * 1990-07-13 1991-10-22 Geddes Leslie A Multiple monopolar system and method of measuring stroke volume of the heart
US5174286A (en) * 1990-12-07 1992-12-29 Raul Chirife Sensor for right ventricular and thoracic volumes using the trailing edge value of a generated pulse
US5201808A (en) * 1992-02-10 1993-04-13 Telectronics Pacing Systems, Inc. Minute volume rate-responsive pacemaker employing impedance sensing on a unipolar lead
EP0583499B1 (de) * 1992-08-18 1996-03-06 Pacesetter AB Verfahren zum Detektieren von Herzkammerflimmern und Vorrichtung zum Detektieren und Behandeln von Herzkammerflimmern
US5524632A (en) * 1994-01-07 1996-06-11 Medtronic, Inc. Method for implanting electromyographic sensing electrodes
US5800470A (en) * 1994-01-07 1998-09-01 Medtronic, Inc. Respiratory muscle electromyographic rate responsive pacemaker
US7775983B2 (en) * 2005-09-16 2010-08-17 Cardiac Pacemakers, Inc. Rapid shallow breathing detection for use in congestive heart failure status determination
US7766840B2 (en) * 2005-12-01 2010-08-03 Cardiac Pacemakers, Inc. Method and system for heart failure status evaluation based on a disordered breathing index
US7662105B2 (en) 2005-12-14 2010-02-16 Cardiac Pacemakers, Inc. Systems and methods for determining respiration metrics
US7819816B2 (en) * 2006-03-29 2010-10-26 Cardiac Pacemakers, Inc. Periodic disordered breathing detection
US8052611B2 (en) 2007-03-14 2011-11-08 Cardiac Pacemakers, Inc. Method and apparatus for management of heart failure hospitalization
US8135471B2 (en) * 2007-08-28 2012-03-13 Cardiac Pacemakers, Inc. Method and apparatus for inspiratory muscle stimulation using implantable device
WO2009094335A1 (en) 2008-01-22 2009-07-30 Cardiac Pacemakers, Inc. Respiration as a trigger for therapy optimization
US9743889B2 (en) 2013-08-05 2017-08-29 Cardiac Pacemakers, Inc. System and method for detecting worsening of heart failure based on rapid shallow breathing index

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0074126A2 (de) * 1978-09-21 1983-03-16 Purdue Research Foundation Verfahren zur Herzkammer-Rhythmuskorrektur
EP0135911A2 (de) * 1983-09-21 1985-04-03 Gianni Plicchi Elektrische Schaltung zur Bestimmung von Altmungsparametern für implantierbare Geräte wie implantierbare und physiologische Schrittmacher

Family Cites Families (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3593718A (en) * 1967-07-13 1971-07-20 Biocybernetics Inc Physiologically controlled cardiac pacer
US4303075A (en) * 1980-02-11 1981-12-01 Mieczyslaw Mirowski Method and apparatus for maximizing stroke volume through atrioventricular pacing using implanted cardioverter/pacer
US4428378A (en) * 1981-11-19 1984-01-31 Medtronic, Inc. Rate adaptive pacer
IT1156564B (it) * 1982-03-16 1987-02-04 Gianni Plicchi Elettrostimolatore cardiaco impiantabile, di tipo fisiologico, in cui la frequenza di stimolazione e'regolata dalla frequenza respiratoria del paziente
JPH034289U (de) * 1989-06-02 1991-01-17

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0074126A2 (de) * 1978-09-21 1983-03-16 Purdue Research Foundation Verfahren zur Herzkammer-Rhythmuskorrektur
EP0135911A2 (de) * 1983-09-21 1985-04-03 Gianni Plicchi Elektrische Schaltung zur Bestimmung von Altmungsparametern für implantierbare Geräte wie implantierbare und physiologische Schrittmacher

Cited By (9)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0249819A1 (de) 1986-06-16 1987-12-23 Pacesetter AB Herzschrittmacher zur Stimulierung des menschlichen Herzens
EP0249824A1 (de) 1986-06-16 1987-12-23 Pacesetter AB Herzschrittmacher zur Stimulierung des menschlichen Herzens
US4966146A (en) * 1988-01-14 1990-10-30 Webb Stuart C Rate-responsive pacemaker
US5044365A (en) * 1988-02-17 1991-09-03 Webb Stuart C Rate-responsive pacemaker
US5063927A (en) * 1988-02-17 1991-11-12 Webb Stuart C Rate-responsive pacemaker
DE4111505A1 (de) * 1991-04-09 1992-10-15 Roland Heinze Anordnung zur ermittlung eines nicht pulsbezogenen informationsanteils in einem kardialen informationssignal
EP0933095A2 (de) 1998-01-29 1999-08-04 BIOTRONIK Mess- und Therapiegeräte GmbH & Co Ingenieurbüro Berlin Selbstkalibrierender ratenadaptiver Herzschrittmacher
US6154674A (en) * 1998-01-29 2000-11-28 Biotronik Mess-Und Therapiegeraete Gmbh & Co. Ingenieurbuero Berlin Self-calibrating adaptive-rate cardiac pacemaker
US6519494B1 (en) 1999-08-20 2003-02-11 Biotronik Mess-Und Therapiegeraete Gmbh & Co. Ingenieurbuero Berlin Rate-adaptive cardiac pacemaker

Also Published As

Publication number Publication date
US4697591A (en) 1987-10-06
JPS6311172A (ja) 1988-01-18
JP2708420B2 (ja) 1998-02-04

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