EP0806973A1 - Dispositif pour stimuler des tissus corporels excitables - Google Patents

Dispositif pour stimuler des tissus corporels excitables

Info

Publication number
EP0806973A1
EP0806973A1 EP96946169A EP96946169A EP0806973A1 EP 0806973 A1 EP0806973 A1 EP 0806973A1 EP 96946169 A EP96946169 A EP 96946169A EP 96946169 A EP96946169 A EP 96946169A EP 0806973 A1 EP0806973 A1 EP 0806973A1
Authority
EP
European Patent Office
Prior art keywords
electrodes
electrode
probe
arrangement according
stimulation
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Withdrawn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
EP96946169A
Other languages
German (de)
English (en)
Inventor
Dagmar Hartung
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.)
Cardiac Pacemakers Inc
Original Assignee
Cardiac Pacemakers Inc
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 Cardiac Pacemakers Inc filed Critical Cardiac Pacemakers Inc
Publication of EP0806973A1 publication Critical patent/EP0806973A1/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • 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
    • A61N1/38—Applying electric currents by contact electrodes alternating or intermittent currents for producing shock effects
    • A61N1/39—Heart defibrillators
    • A61N1/3918—Heart defibrillators characterised by shock pathway, e.g. by electrode configuration
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/02—Details
    • A61N1/04—Electrodes
    • A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
    • A61N1/056—Transvascular endocardial electrode systems

Definitions

  • the invention relates to an arrangement according to the preamble of claim 1
  • stimulation is distinguished from the term “defibrillation”.
  • irritable cells are selectively excited at a point from which the subsequent spread of excitation takes place.
  • defibrillation the largest possible and simultaneous area takes place Influencing cells in order to depolarize them and then to let them resume their natural stimulus conduction in an orderly manner
  • an antistatic electrode should have a small geometric area, so that a high field strength results and the selective excitation desired for the stimulation is achieved
  • Electrodes serve to stimulate the heart tissue, that is, they are intended to cause a directed spread of the excitation from the electrodes by the pulse
  • Non-generic are known for example from EP 559 933 A1 arrangements for defibrillation, in which a synchronous discharge of cardiac cells is to be effected in the hope that normal activity of excitation can then be resumed or that excitation of the pacemaker is stimulated by a pacemaker Cardiac cells can take place undisturbed
  • Defibrillation will use three electrodes, two of which are arranged inside or outside the heart, while a third electrode is implanted under the patient's skin
  • the electrodes are arranged in the heart as wall-mounted electrodes, that is to say they have direct contact with the cells to be stimulated
  • the invention has for its object to further develop a generic arrangement in such a way that when used using conventional impulses for stimulation, the use of wall-standing or floating electrodes is made possible
  • the invention proposes, using the electrode probes known per se, to change the connection between the pulse generator and the probe in such a way that the plurality of electrodes provided on one probe when a single one is dispensed
  • the stimulus threshold can be reduced in such a way that both wall-standing and floating electrodes can be used.
  • Local concentrations of field lines are brought about by superimposing the electric fields or the dipole fields, with an increase, as is known
  • the number of fields causes an increased irritation of the cells, so that even the electrodes which are remote from the wall, namely floating, can cause sufficient stimulation of the heart cells for stimulation
  • the application can be used, for example, for muscular / neuronal stimulation, for example for cardiomuoplasties cardiomy, for stimulating the urinary bladder, for skeletal muscle stimulation or for central or peripheral nerve stimulation
  • implantable pacemakers When used in the field of cardiac pacemaker therapy, implantable pacemakers, external temporary pacemakers or implantable AICD can be designed according to the invention both when using floating electrodes in the heart and when using wall-mounted electrodes in the heart
  • FIG. 1 schematically shows a heart silhouette with H, the left ventricle being indicated at the bottom right by V, while the atrium, ie the atrium, is indicated schematically further above by A_
  • a probe S_ is indicated within the heart silhouette H, which has three electrodes. The two floating electrodes 1 and
  • the probe S combines supply lines to the individual electrodes 1, 2 and 3, it being apparent from FIG. 1 that these supply lines branch out, each of the respective electrodes 1, 2 and
  • the 3 assigned supply line is designated with the same number as the respective electrode and these supply lines are connected to the electrical contacts 4a and 4v of an energy source 5, for example a battery of a pacemaker.
  • the electrical contacts 4a serve to control the atrium electrodes 1 and 2, while the contacts 4v serve to control the ventricular electrode 3.
  • the ventricular electrode 3 serves primarily as a fastening means for the probe S, however, it can also be used for unipolar stimulation of the heart cells, as is known from the circuitry with the minus pole of the energy source 5 can be seen, the plus pole being connected to an additional electrode
  • This additional electrode is referred to as "ground”, wherein this electrode can be formed by the housing of the pacemaker or also by a third separate electrode on the actual pacemaker probe S or on an independent probe
  • ground This additional electrode is referred to as "ground”, wherein this electrode can be formed by the housing of the pacemaker or also by a third separate electrode on the actual pacemaker probe S or on an independent probe
  • four different interconnections of the electrodes are identified with the capital letters A, B, C and P_ in FIG. 1, and the field line course of the electrical fields is shown schematically above them. The overlap region of two electrical fields is shown with dashed lines
  • Circuit diagram B shows the fundamentally the same structure, but with an exactly opposite electrical view of the individual electrodes.
  • the electrode "Ground” is positive. switched, the electrode 1 likewise, the electrode 2 negative in contrast.
  • the course of the electrical field lines remains basically the same, so that the same point of a field concentration in the region of the electrode 2 results.
  • the polarity changes, which the stimulus threshold Is known to influence and be able to influence behavior
  • connection option C the two electrodes 1 and 2 are both connected negatively, while the electrode “Ground” is positive
  • a fundamentally identical field line profile results from a negated connection of the electrodes, in which electrodes 1 and 2 are switched on positively, but the electrode “Ground” is negative, that is, through a change in polarity.
  • the same field line profile results if - As indicated in the bottom right in FIG. 1, the electrodes 1 and “ground” are switched in the opposite direction to the electrode 2 than indicated in the circuit diagrams C and D.
  • the energy source 5 can either have a longer lifespan or be structurally smaller
  • the probe S shown in FIG. 1 represents a commercially available probe in which the electrodes 1 and 2 are used as sensors which merely register an atrial impulse in the case of commercially available cardiac stimulator arrangements
  • the cardiac pacemaker generates the output pulse with the help of the ventricle electrode 3, which is connected as a unipolar electrode, ie the opposite pole to the electrode 3 is not in the heart but outside, for example in the form of the “ground” electrode
  • FIG. 2 is fundamentally similar to FIG. 1 and shows schematically the arrangement according to the invention in the upper region, but when using electrodes 1 and 2 with a wall, without a ventricular electrode, an energy source with only two electrical contacts 4 is used.
  • the one shown in FIG The probe is a commercially available wall-mounted atrial probe that does not have to be modified according to the invention, but only has to be connected to the actual pacemaker in another way in order to achieve the advantages according to the invention.
  • the configuration of the pulses with regard to pulse duration, pulse duration and pulse intensity can remain unchanged, nevertheless an improved stimulation of the tissue is effected. If necessary, the pacemakers can even be carried out more easily than hitherto. While for some applications the increase in tension was required compared to the tension that
  • the battery of the pacemaker supplies (with the aid of a so-called voltage doubler), in many cases, such an increase in voltage is dispensed with when the electrodes are connected according to the invention, so that energy-consuming circuit components of the stimulation arrangement can be dispensed with 3 shows an arrangement similar to FIG. 2, but using floating atrium electrodes.
  • the use of floating electrodes is gentle on the patient, since the noting electrodes do not have to be implanted.
  • the implantation of electrodes in the heart tissue contains the risk of infection and puncturing, so that it is fundamentally desirable to keep the number of implanted electrodes as low as possible Disadvantageous that they require a lot of energy in order to ensure adequate stimulation despite the distance to the cells to be stimulated. This could lead to irritation of the threnic nerve, so that the stimulation could at the same time trigger dwarf jerks in the case of the invention External connections of the electrodes are excluded
  • FIG. 5 shows that the ground electrode can be replaced if an additional atrium electrode 4 is used.
  • FIG. 6 shows that the ground electrode can be replaced if an additional atrium electrode 4 is used.
  • FIG. 6 shows that the ground electrode can be replaced if an additional atrium electrode 4 is used.
  • FIG. 6 shows that the ground electrode can be replaced if an additional atrium electrode 4 is used.
  • FIG. 6 shows that the same arrangement shown on the right in FIG. 5 is shown in FIG. 6 together with the course of the electric fields and dipole fields that can be achieved with it, and with the circuitry possibilities A B, C and D are shown, similar to that in FIG. 1 also indicated at the bottom right in FIG. 6 that the two other electrodes, here the other two atrium electrodes 1 and 4, are each reversed relative to the second atrium electrode 2 can be switched, whereby in principle the same course of the electrical and the dipole fields can be achieved
  • FIG. 7 shows an arrangement similar to that of FIG. 6 with an atomic electrode 2 which is enlarged in comparison therewith, so that even
  • FIG. 8 shows an arrangement in which the ventricular electrode 3 is arranged in a wall-like manner as in the preceding examples, but in the vicinity of which the third atom electrode 4 is arranged.
  • the resultant field rhinoceros are as shown in the previous illustrations, wherein here, too, the area of an increased field line concentration and thus an improved irritating effect for the adjacent body tissue results within the framework of the lines shown in broken lines
  • a commercially available probe according to the prior art is also used in the arrangement according to FIG. 8.
  • the electrodes 1 and 2 serve as sensors which record the paging signals, so that the electrodes 3 and 4 then move the electrodes with a time delay Stimulation can take place.
  • FIG. 9 shows a comparison of two different connection possibilities according to the invention, including a third electrode in the stimulation according to the invention.
  • the illustration labeled “Bimos 1” shows two electrodes attached to a common probe, which are indicated in a rectangular manner, while those indicated oval and according to the invention required third electrode is formed by the circuit maker housing, as is known in a conventional unipolar stimulation configuration.
  • the electrode spacing between the first and the second ring electrode (E1 and E2) is significantly smaller than that
  • the representation "Bimos 2" shows three ring electrodes arranged on the common probe, the distance between the first and second ring electrodes E1 and E2 being either identical or different to the distance between the second and third ring electrodes E2 and E3
  • the third ring electrode E3 is always arranged intracardially or in the lower part of the vena karva supe ⁇ o
  • FIG. 10 shows the two circuit vanants “Bimos 1” and “Bimos 2”, a probe with three electrodes being shown in both cases, which are indicated as rectangular fields.
  • the circuit breaker housing is oval
  • the three electrodes interconnected according to the invention are formed by two of the electrodes arranged on the probe and by the circuit breaker housing.
  • the circuit breaker housing in the electrode connection according to“ Bimos 2 ” is not in the electrode circuit involved
  • bipolar circuit variants 2, 3, 5 and 6 and the unipolar circuit variants 3 and 4 cannot be implemented in an electrode arrangement according to "Bimos 1", so that the corresponding circuit variants are also blackened under the representation "Bimos 1"

Landscapes

  • Health & Medical Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Radiology & Medical Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Cardiology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Vascular Medicine (AREA)
  • Electrotherapy Devices (AREA)

Abstract

L'invention concerne un dispositif pour stimuler des tissus corporels excitables. Ce dispositif comporte une source d'énergie électrique, un générateur d'impulsions et des électrodes reliées électriquement à la source d'énergie. Ces électrodes sont communtées pour créer des champs électriques, notamment par une seule et même impulsion provenant du générateur d'impulsions, en vue d'engendrer des champs électriques à recouvrement.
EP96946169A 1995-12-04 1996-12-02 Dispositif pour stimuler des tissus corporels excitables Withdrawn EP0806973A1 (fr)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
DE1995145090 DE19545090A1 (de) 1995-12-04 1995-12-04 Anordnung zur Stimulation reizbaren Körpergewebes
DE19545090 1995-12-04
PCT/DE1996/002323 WO1997020595A2 (fr) 1995-12-04 1996-12-02 Dispositif pour stimuler des tissus corporels excitables

Publications (1)

Publication Number Publication Date
EP0806973A1 true EP0806973A1 (fr) 1997-11-19

Family

ID=7779082

Family Applications (1)

Application Number Title Priority Date Filing Date
EP96946169A Withdrawn EP0806973A1 (fr) 1995-12-04 1996-12-02 Dispositif pour stimuler des tissus corporels excitables

Country Status (5)

Country Link
EP (1) EP0806973A1 (fr)
JP (1) JPH11501852A (fr)
CA (1) CA2212174A1 (fr)
DE (1) DE19545090A1 (fr)
WO (1) WO1997020595A2 (fr)

Families Citing this family (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE10245852B4 (de) * 2002-09-30 2007-04-05 Biotronik Gmbh & Co. Kg Schrittmacher zum atrialen Sensing, zur atrialen Stimulation und zur Terminierung von atrialen Tachykardien und Vorhofflimmern

Family Cites Families (13)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4408604A (en) * 1981-04-06 1983-10-11 Teletronics Pty, Limited Porous pacemaker electrode tip
FR2561929B1 (fr) * 1984-03-27 1989-02-03 Atesys Appareillage automatique implante pour la defibrillation ventriculaire
DE3523226A1 (de) * 1985-06-28 1987-01-08 Osypka Peter Defibrillations-elektrode
FR2616072B1 (fr) * 1987-06-04 1990-12-14 Ela Medical Sa Perfectionnements aux extremites conductrices de sondes de stimulation cardiaque
US5172694A (en) * 1991-05-30 1992-12-22 Vitatron Medical B.V. Single pacing lead and method utilizing two different floating bipoles
EP0559933A1 (fr) * 1992-03-10 1993-09-15 Pacesetter AB Configuration d'électrodes pour un défibrillateur/cardioverteur implantable
US5376103A (en) * 1992-03-19 1994-12-27 Angeion Corporation Electrode system for implantable defibrillator
US5265623A (en) * 1992-07-16 1993-11-30 Angeion Corporation Optimized field defibrillation catheter
DE4231600B4 (de) * 1992-09-17 2004-08-12 Biotronik Meß- und Therapiegeräte GmbH & Co. Ingenieurbüro Berlin Implantierbares Defibrillationssystem
SE9203735D0 (sv) * 1992-12-11 1992-12-11 Siemens Elema Ab Elektrodsystem foer defibrillator
US5431681A (en) * 1993-09-22 1995-07-11 Pacesetter, Inc. Combination pacing and defibrillating lead having sensing capability
DE69434664T2 (de) * 1993-10-14 2006-11-09 Boston Scientific Ltd., Barbados Elektroden zur erzeugung bestimmter muster von pathologisch verändertem gewebe
US5487385A (en) * 1993-12-03 1996-01-30 Avitall; Boaz Atrial mapping and ablation catheter system

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
See references of WO9720595A3 *

Also Published As

Publication number Publication date
CA2212174A1 (fr) 1997-06-12
JPH11501852A (ja) 1999-02-16
WO1997020595A3 (fr) 1997-08-28
WO1997020595A2 (fr) 1997-06-12
DE19545090A1 (de) 1997-06-05

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