JP2006288837A - Defibrillator - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To stimulate stopping of ventricular fibrillation by reversibly cooling the heart and to enhance the efficiency of defibrillation by electrification by applying a relatively weak pulse voltage/current to a cooled portion of the heart. <P>SOLUTION: A rectangular substrate 10 is sewn on the surface of epicardium of a left ventricle 38. The substrate 10 is provided with four Peltier elements for cooling in its center and is provided with thermistors for detecting the temperature in a part of their periphery. Energizing electrodes for applying pulse voltage/current to the heart are provided on the surface of the substrate 10. When ventricular fibrillation is detected, the Peltier elements are energized. When the ventricular fibrillation is not stopped after cooling the heart, pulse voltage/current is applied through the energizing electrodes for clearing away the ventricular fibrillation by a low voltage/low current. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

  The present invention relates generally to medical devices, and more specifically to a defibrillator that stops ventricular fibrillation.

  Conventionally, as disclosed in Patent Documents 1 to 6 below, when ventricular tachycardia or ventricular fibrillation of the heart is detected, the capacitor is charged with electric charge and discharged to the heart. Defibrillators that stop tachycardia and fibrillation by applying an electric shock are known.

Special table flat 8-509385 Special table 2002-524218 Special table flat 8-506263 Special table hei 9-502629 Patent 2601762 Patent 312765

  A conventional defibrillator is a device that applies a strong pulse voltage / current to the heart after the detection of ventricular fibrillation to stop the ventricular fibrillation and restore normal heart excitement. However, with this device, ventricular fibrillation may not stop even if a strong current is repeatedly applied at a high voltage, causing a myocardial injury due to the strong current, reducing the heart's pump function, or inducing a new arrhythmia. There was a problem such as.

  The present invention has been made to solve the above-mentioned problems, and its purpose is to promote the stoppage of ventricular fibrillation by applying reversible cooling to the heart. Another object is to increase the efficiency of defibrillation by energization by applying a relatively weak pulse voltage / current to the cooling part of the heart.

  Each of these objects of the present invention is to be achieved by any invention, and each invention should not be construed as achieving all of the plurality of objects simultaneously.

As we will see later, we have discovered the following facts:
(1) The ventricular tachycardia can be stopped by locally cooling a part of the heart to restore normal myocardial contraction.
(2) By locally cooling a part of the heart, it is possible to restrain the spiral reentry wave, which is a potential distribution of the heart, at a high cooling rate at the heart. In other words, the center of rotation (core region) of the spiral reentry wave can be constrained to the cooling location at a high rate.
(3) The spiral reentry wave may disappear by cooling a part of the heart.
(4) A spiral reentry wave can be extinguished by constraining a spiral reentry wave at a cooling part of the heart and applying a pulse voltage / current to the constrained part.
(5) The pulse voltage / current that can constrain the spiral reentry wave at the cooling point and extinguish the wave is the pulse voltage / current that stops the ventricular fibrillation that has occurred without cooling the conventional heart. Can be much lower.
(6) In a computer simulation using a virtual heart, the application timing at which a spiral reentry wave can be constrained at a cooling location and the wave can be extinguished is the same as the conventional pulse voltage / current. Can be much wider than the application timing to stop the ventricular fibrillation that occurs without cooling.

The present invention has been completed based on the above findings, and has very originality.
A first invention for solving the above-mentioned problems is a defibrillator characterized by providing a cooling device for reversibly cooling the heart.

  The apparatus of the present invention is an apparatus that operates to cool the heart when ventricular fibrillation is detected. If cooled, ventricular fibrillation may disappear. The cooling temperature is not limited, but is a temperature range that allows reversible cooling without killing the heart tissue. For example, it is effective at a temperature 3 to 10 ° C. lower than the body temperature.

The second invention is the defibrillator according to claim 1, further comprising a control device that drives and controls the cooling device when ventricular fibrillation is detected.
Ventricular fibrillation may disappear due to the cooling of the heart. When the ventricular fibrillation disappears, a pulse voltage / current that may damage the heart is not applied.

  According to a third aspect of the present invention, there is provided a defibrillator according to claim 1 or 2, further comprising an electrocardiogram signal detection device for detecting an electrocardiogram signal of the heart. There are many devices for detecting this electrocardiographic signal, as will be described later.

According to a fourth aspect of the present invention, the electrocardiographic signal detection device has an atrial lead inserted into the atrium and a ventricular lead inserted into the ventricle.
In this invention, since ventricular fibrillation is detected by the conventional ICD, when the ventricular fibrillation is detected, a cooling device for cooling the heart is added to the conventional ICD.

A fifth aspect of the invention is the defibrillator according to claim 3, wherein the electrocardiogram signal detection apparatus has an electrocardiogram recording electrode adhered to the body surface of the patient.
In this invention, it can be used in an external defibrillator. In other words, the external defibrillator is provided with a cooling device for cooling the heart. The detection of ventricular fibrillation includes detection based on a doctor's judgment based on an electrocardiogram and automatic detection based on an algorithm.

According to a sixth aspect of the invention, ventricular fibrillation is detected from an atrial lead inserted into the atrium and an electrocardiographic signal detected by the ventricular lead inserted into the ventricle. A fibrillator.
In the present invention, the present invention is applied to a conventional ICD, and a cooling device is added to the conventional ICD.

A seventh aspect of the present invention is the defibrillator according to any one of claims 1 to 6, further comprising an energization device that applies a pulse voltage / current to the heart.
The present invention is applicable to implantable defibrillators and external defibrillators. The timing for applying the pulse voltage / current is automatically determined by the controller if it is an implantable defibrillator, or automatically determined by the controller if it is an external defibrillator, or determined by the judgment of the doctor. Is done.

The eighth invention is the defibrillator according to claim 7, wherein after the heart is cooled by the cooling device, the energization device is driven and a pulse voltage / current is applied to the heart. .
By locally cooling the heart, the spiral reentry wave can be constrained to the heart cooling location. By constraining to the cooling portion, irregularity of the spiral reentry wave can be suppressed, and in some cases, the spiral reentry wave can be naturally extinguished. This can eliminate ventricular fibrillation.

According to a ninth aspect of the present invention, in the defibrillator according to claim 7 or 8, the energization device has an energization electrode for applying a pulse voltage / current to a cooling part of the heart by the cooling device. is there.
In the present invention, when a predetermined time elapses after the start of cooling of the heart, if the spiral reentry wave is constrained to the cooling location, the spiral can be easily applied even if the applied pulse voltage / current is low. It is based on our discovery that the reentry wave can be extinguished. It is desirable that the energized part is a constrained part of the spiral reentry wave, that is, an area including a cooling part. At this time, the spiral reentry wave can be extinguished and ventricular fibrillation can be stopped even at low voltage and low current.

A tenth aspect of the invention is the defibrillator according to claim 9, wherein the energizing electrodes are disposed at a plurality of locations on the surface of the heart.
In an eleventh aspect of the invention, the energization device includes an atrial lead inserted into the atrium and an energization electrode for applying a pulse voltage / current provided at the tip of the ventricular lead inserted into the ventricle. A defibrillator according to claim 7 or claim 8.
The present invention is characterized in that the pulse voltage / current applied to stop ventricular fibrillation is applied using an atrial lead and a ventricular lead of a conventional ICD. According to the features of the present invention, the conventional ICD can be configured by adding only a cooling device for cooling the heart. Since the method of applying the pulse voltage / current is the same as that of the conventional ICD, this device is a device in which a cooling device is added to the conventional ICD.

A twelfth aspect of the invention is the defibrillator according to claim 7 or 8, wherein the energization device has an energization electrode that is provided on a body surface of a patient and applies a pulse voltage / current. .
The present invention is characterized in that a pulse voltage / current for stopping ventricular fibrillation is applied using a current-carrying electrode of a conventional external defibrillator. According to this feature, a cooling device for cooling the heart can be added to a conventional external defibrillator.

A thirteenth aspect of the invention is the defibrillator according to claim 2, wherein ventricular fibrillation is detected from an electrocardiogram signal detected by an electrocardiogram recording electrode adhered to the body surface of the patient. .
The present invention relates to an external defibrillator, and determination of whether or not ventricular fibrillation includes automatic determination by a control device and determination by a doctor.

A fourteenth aspect of the invention is the defibrillator according to claim 2, wherein a pulse voltage / current is applied to the heart when ventricular fibrillation has not disappeared.
If the ventricular fibrillation has disappeared at the timing of applying the pulse voltage / current, there is no need to apply the pulse voltage / current to the heart, so the pulse voltage / current is applied only when ventricular fibrillation is detected. It is trying to apply. As a result, the heart is not damaged unnecessarily, and no shock is given to humans.

A fifteenth aspect of the invention is the defibrillator according to any one of claims 7 to 14, wherein the pulse voltage / current is applied to a portion cooled by the cooling device. .
When the heart is locally cooled, a spiral reentry wave is restrained at the cooling point. When a pulse voltage / current is applied to this location, the spiral reentry wave can be effectively stopped even at a low voltage / low current.

  In the above invention, at the stage when ventricular tachycardia, which is a precursor phenomenon of ventricular fibrillation, is detected, the cooling device may be driven to cool the heart. In the state of ventricular tachycardia, the ventricular tachycardia can be more easily extinguished by cooling the heart, and the voltage and current of the applied pulse voltage / current can be reduced.

The first and second inventions are characterized in that a cooling device for cooling the heart is provided, and there are cases where ventricular fibrillation can be eliminated by driving the cooling device.
In this case, since only the heart is cooled, the burden on the patient is small.

According to a third aspect of the present invention, an electrocardiogram signal detection device for detecting an electrocardiogram signal of the heart is provided, and thereby the presence or absence of occurrence of ventricular fibrillation can be detected.
The fourth, fifth and sixth inventions specify a sensor for detecting an electrocardiogram signal, and can be detected by ICD or detected outside the body.
The seventh, eighth, ninth, tenth, and eleventh inventions include a cooling device that cools the heart and a control device that controls the application of pulse voltage and current to the heart. With this, ventricular fibrillation can be stopped.

  When the heart is cooled, it is possible to prevent the spiral reentry wave from continuing or to fix the center of rotation. In this state, the energy, pulse voltage, and current required for the disappearance of the spiral reentry wave and the stoppage of ventricular fibrillation may be low. Therefore, since a low pulse voltage / current is applied to the heart, there is little or no damage to the heart, and the burden on the patient is small.

The timing of energization is when a predetermined time elapses after cooling and the spiral reentry wave is restrained.
In particular, according to the ninth aspect of the invention, the ventricular fibrillation based on the spiral reentry wave can be efficiently eliminated because the conduction electrode for applying the pulse voltage / current is provided at the cooling part of the heart.
In the tenth aspect of the invention, since the energizing electrodes are arranged at a plurality of locations on the surface of the heart, it is possible to efficiently apply a pulse voltage / current to the heart.

The twelfth and thirteenth inventions can be used as an emergency lifesaving device because it is possible to detect pulse voltage / current application and electrocardiogram signals as an external defibrillator.
In the fourth, sixth, and eleventh inventions, only a cooling device is added to an ICD having a conventional defibrillation function. Therefore, ventricular fibrillation is achieved by cooling without significant improvement of the device. Can be effectively stopped.

  According to a fourteenth aspect of the present invention, when the ventricular fibrillation disappears at the timing of applying the pulse voltage / current, that is, when the ventricular fibrillation stops only by driving the cooling device, the pulse voltage / current is applied to the heart. Is not applied. Therefore, there is no burden on the patient and the quality of life can be improved.

  In the fifteenth aspect of the present invention, a pulse voltage / current is applied to the cooling part of the heart. When a pulse voltage / current is applied to the cooling location, the spiral reentry wave is constrained to the cooling location, so that ventricular fibrillation can be effectively stopped even at a relatively low voltage / current.

  Hereinafter, the present invention will be described based on embodiments. In addition, this invention is not limited to the following embodiment, A various deformation | transformation is possible.

  The major cause of sudden cardiac death is ventricular fibrillation, most of which occurs with ventricular tachycardia. In recent years, the technology of optical mapping experiments for observing the complex excitement of the heart as a fluorescence signal image has advanced, and it has been clarified that the spiral relintory wave plays an important role in the establishment of ventricular tachycardia and ventricular fibrillation.

  We apply mild cooling (3-10 ° C) to a part of the ventricle to localize the central part (core region) of the spiral reentry wave at that site, and the most myocardium in the excitatory swirl path The idea was to eliminate the spiral reentry wave by efficiently applying weak electrical stimulation in the vicinity of the core region, which is easy to excite.

By cooling a part of the heart, the spiral reentry wave can be extinguished by applying a pulse voltage / current that is far lower than the conventional pulse voltage / current applied to stop ventricular fibrillation. We confirmed this by animal experiments.
In addition, as for animal experiment results, the causal relationship between the local cooling of the heart and the low voltage / low current of cardioversion was theoretically proved by computer simulation experiments using a virtual heart.

Animal experiments were conducted as follows.
The rabbit heart was removed and arterial perfusion was performed. A myocardial tissue on the left ventricular endocardium side was frozen and coagulated to prepare a two-dimensional pericardial muscle two-dimensional perfusion specimen in which only the submyocardial layer (thickness: about 1 mm) remained. In such specimens, spiral reentry waves are always present on the surface of the heart, so the details of their dynamics can be analyzed.

  In some experiments, microbeads were injected into rabbit coronary arteries to produce subendocardial myocardial infarction, and rabbits that had passed 2 weeks after the operation were used. In experiments using this myocardial infarction model, the ventricular muscle was not frozen and coagulated. The heart was stained with a membrane potential sensitive dye (Di-4-ANEPPS), and a myocardial potential fluorescent signal image in front of the left ventricle was taken using a high-speed video camera. Using a stainless steel cooling probe (diameter: 8-10 mm) or a cold water perfusion device (diameter: 10 mm) incorporated in a transparent acrylic plate, the myocardial temperature of the front part of the left ventricle was lowered by 3-5 ° C.

  By applying electrical stimulation (basic stimulation) at 2.5 Hz (400 ms interval) from the apex of the heart, the action potential duration (APD) and excitation conduction velocity of the ventricular muscle were measured. During the period of the basic stimulation action potential, the heart was electrically stimulated from the electrodes placed so as to sandwich the left and right ventricles, and ventricular tachycardia was induced by spiral reentry waves. Furthermore, we tried to stop the spiral reentry wave by applying a biphasic direct current from a monopolar or bipolar electrode placed near the cooling part of the heart.

  A preliminary experiment (using a two-dimensional perfused heart in which the left ventricular endocardium side of a normal rabbit was frozen and solidified) was applied to a rabbit heart 81 with a 10 mm diameter stainless steel cooling probe 80 shown in FIG. In the experiment, when a circular local cooling region (temperature decreased by 3-5 ° C) was created in front of the left ventricle, the action potential duration (APD) of the cooling region was 30-40% as shown in FIG. Prolonged and the change was reversible. There was no significant change in the excitatory conduction velocity.

  When electrical stimulation was applied to a two-dimensional perfused heart of a normal rabbit to induce ventricular tachycardia, a spiral reentry wave was observed in the observation area in front of the left ventricle in 8 of 21 cases (unidirectional in the remaining 13 cases). The excitement wave propagating to the surface was observed, and the center of the spiral reentry wave was thought to exist outside the observation area). Many spiral reentry waves cause a wandering movement with a linear center of rotation. When such a single spiral reentry wave exists, ventricular tachycardia occurs, and if it splits into multiple or causes a large meandering, it becomes easier to transition to ventricular fibrillation (precursor phenomenon) .

  On the other hand, as shown in FIG. 14, the spiral reentry wave induced after applying local cooling to the front surface of the left ventricle using the stainless-steel cooling probe 80 is always fixed at the edge 82 of the cooling region. In 17 out of 20 cases, spiral reentry waves stopped as shown in FIG. This means that by applying local cooling to a part of the heart, it is possible to constrain the spiral reentry wave at the cooling location, and also has an effect of promoting its disappearance.

  Furthermore, by applying local cooling after inducing the spiral reentry wave, 4 out of 11 cases stopped, and even in 7 cases that did not stop, as shown in FIG. By applying a relatively low voltage / current direct current to point b, 4 out of 7 spiral reentry waves could be stopped. This means that local cooling encourages the suspension of spiral reentry waves by energization, which we discovered for the first time in the world.

  In an experiment using a rabbit heart with a subendocardial infarction, ventricular fibrillation was induced by applying electrical stimulation (DC shock). In the two-dimensional phase diagram of the membrane potential fluorescence signal during ventricular fibrillation, as shown in the measurement diagram before cooling in FIG. 18, there are always a plurality of phase singularities (corresponding to the center of spiral reentry wave rotation), Their numbers and locations were constantly changing. This means that when ventricular fibrillation occurs, the spiral reentry wave repeats splitting and is in an unstable state.

  When local cooling (10 mm in diameter) is applied to a part of the left ventricle with a cold water perfusion device, the phase singularity becomes localized at the edge of the cooling region 84 in 8 of 8 cases, Stoppage of movement was observed in 2 cases. Furthermore, when a relatively low voltage / low current direct current was applied in the vicinity of the cooling region, ventricular fibrillation was stopped in 3 of the 6 cases as shown in the local cooling of FIG. The DC energization voltage (defibrillation threshold) that caused defibrillation dropped to about 50% after local cooling. This means that the strength (voltage × current) of electrical stimulation (pulse) that stops ventricular fibrillation can be reduced by applying local cooling.

By cooling the heart by the above animal experiments, the spiral reentry wave is constrained at the center of rotation at the cooling point, and when voltage / current is applied in this state, the spiral reentry wave disappears at low voltage / low current, It was confirmed that ventricular tachycardia and ventricular fibrillation stopped and normal heart excitement was restored. It was also confirmed that spiral reentry waves disappear and ventricular tachycardia and ventricular fibrillation may cease only by local cooling of the heart.
The present invention is a novel and original defibrillation device devised based on this demonstration.

FIG. 1 shows a state where the implantable defibrillator according to the present embodiment is attached to the heart 30.
An atrial lead 32 is provided through the superior vena cava 33 to the right atrium 31. An electrode 321 is provided at the tip of the atrial lead 32, and the cardiac potential of the right atrium 31 is detected. Similarly, a ventricular lead 34 that extends through the superior vena cava 33 to the right ventricle 37 is provided. An electrode 341 is provided at the tip of the ventricular lead 34, and the cardiac potential of the right ventricle 37 is detected. Arrangement positions of these lead electrodes in the heart are arbitrary. The heart potential detection position may be appropriately selected according to the type of heart state information to be obtained and the control method. For example, a lead may be provided in the left atrium or the left ventricle so that the electrode is disposed.

  A flexible rectangular base material 10 according to the feature of the present invention is sewn on the epicardial surface of the left ventricle 38. As shown in FIG. 2, four Peltier elements 12 (cooling devices) for cooling are provided at the center of the base material 10. Further, a thermistor 18 (temperature detector) for detecting temperature is provided in a part of the periphery of each Peltier element 12. On the surface of the base material 10, an energization electrode 16 is provided for applying a pulse voltage / current to the cooling portion. The Peltier element 12, the thermistor 18, and the plurality of energizing electrodes 16 are fixed so as to be in close contact with the epicardial surface of the left ventricle of the heart.

  Further, energization of the energization electrode 16 installed on the base material 10 is controlled, an electrocardiogram signal from the atrial lead 32 and the ventricular lead 34 is input, and a pulse voltage / current is output through these electrodes and leads. A main body 20 for performing control to be performed is implanted under the chest of a human body.

  The electrical configuration of the defibrillator of this embodiment is shown in FIG. The control device mainly includes an MPU (microprocessor unit) 50 that detects an electrocardiogram signal, processes the detection signal, and controls energization, and an A / D converter 52.

  The energizing device 60 mainly includes a battery 62, a booster circuit 64 that boosts the voltage of the battery 62 in accordance with a command from the MPU 50, a capacitor 66 that stores electric charges by the voltage boosted by the booster circuit 64, and an input / output terminal A switch 68 for controlling continuity and switching input / output terminals, a current control device 70 for controlling an energization current to the Peltier element 12 according to a command from the MPU 50, and an energization electrode 16 for applying a pulse voltage / current to the heart Consists of. The main body 20 incorporates the control device and the energization device.

  The switch 68 controls to switch the transmission system of the next circuit. The switch 68 receives a command from the MPU 50, and sends an electrocardiogram signal from the electrode 321 at the tip of the atrial lead 32 and an electrocardiogram signal from the electrode 341 at the tip of the ventricular lead 34 to the A / D converter 52. It can be switched to output. Further, the switch 68 is switched so as to output the voltage from the capacitor 66 to the electrodes 321 and 341 in accordance with a command from the MPU 50.

  Further, the switch 56 is switched so as to output the voltage from the capacitor 66 to the energizing electrode 16 provided on the base material 10 according to a command from the MPU 50.

  The output signal of the thermistor 18 is read by the MPU 50 via the A / D converter 52. The current control device 70 operated by the control of the MPU 50 controls the heart temperature so that the Peltier element 12 is energized to change the cooling capacity of the Peltier element 12 and the temperature detected by the thermistor 18 becomes equal to the target temperature. Yes.

  In this embodiment, the electrocardiogram signal detection apparatus is mainly composed of an atrial lead 32 and an electrode 321 at the tip of the lead, a ventricular lead 34 and an electrode 341 at the tip of the lead. The control device mainly includes an MPU 50, A / D converters 52 and 54, and the thermistor 18. The cooling device includes a Peltier element 12. The energizing device mainly includes a battery 62, a booster circuit 64, a capacitor 66, a switch 68, an energizing electrode 16, and a current control device 70.

Next, the operation of the defibrillator of the present embodiment will be described with reference to FIG. 4 showing the processing procedure of the MPU 50.
First, in step 100, the switch 68 is switched to the side for inputting signals from the atrial lead 32 and the ventricular lead 34. Thereby, the potential of the myocardium of the right atrium 31 and the right ventricle 37 is detected. This signal is an electrocardiographic signal indicating myocardial excitation. Next, in step 102, the electrocardiogram signal is analyzed to determine whether ventricular fibrillation has occurred. Whether or not ventricular fibrillation is possible is basically determined by the excitement cycle (rate) and its duration (beat rate). In this case, it is important not to misidentify supraventricular arrhythmia such as sinus tachycardia or atrial fibrillation as ventricular fibrillation.

    Here, the presence or absence of ventricular fibrillation is determined from the period of the electrocardiogram signal obtained from the tip electrode 341 of the right ventricular lead 34 and its duration. The presence or absence of supraventricular arrhythmia such as sinus tachycardia, atrial fibrillation, or coarse movement is determined from the electrocardiographic signal obtained from the tip electrode 321 of the right atrial lead 32. Such an arrhythmia is distinguished from ventricular fibrillation and does not drive the device. In addition, a detection algorithm for ventricular fibrillation in an arrhythmia detection algorithm adopted in a known ICD can be adopted.

  If ventricular fibrillation is not detected, the apparatus is not driven, so the routine proceeds to step 104, waits for a predetermined time, returns to step 100, and the heart's electrocardiogram is executed by the loop of step 100-102-104. Monitoring of the issue continues.

  If ventricular fibrillation is detected in step 102, a control signal is output to the booster circuit 64, and the storage battery 66 is charged to a predetermined voltage. That is, preparation for applying the pulse voltage / current to the heart is performed in advance. This voltage is lower voltage and lower current than the conventional ICD.

  Next, the process proceeds to step 108, in which the Peltier element 12 as a cooling device is energized, and the control signal for cooling the temperature of the local portion of the epicardial surface of the left ventricle 38 to about −5 ° C. with respect to the body temperature. Is output to the current controller 70. In another temperature control program that operates in parallel in real time, the temperature detection signal from the thermistor 18 is input, and the supply current by the current controller 70 is feedback-controlled so that the detected temperature becomes the target temperature. As a result, the temperature of the local portion of the epicardial surface of the left ventricle 38 becomes the commanded target temperature.

  Next, in step 110, the process waits until the epicardial surface temperature reaches the target set temperature. After the voltage increase variable n is initially set to 1, the process proceeds to step 112, where In exactly the same manner, the electrocardiogram is detected from each sensor. Next, the routine proceeds to step 114, where it is determined whether or not ventricular fibrillation has disappeared. If it has disappeared, the routine proceeds to step 116 where energization of the Peltier element 12, which is a cooling device, is performed. Cut off. In this way, the processing of the MPU 50 returns to step 100, and the above-described cardiac monitoring loop 100-102-104 is executed.

  Next, when it is determined in step 114 that ventricular fibrillation has not disappeared, the process proceeds to step 118 so that the energizing electrode 16 is connected to the energizing device 60 so that a pulse voltage / current can be applied. , Switch 68 is switched. Then, the energization device 60 is operated to apply a pulse voltage / current to the energization electrode 16. The pulse voltage / current uses a biphasic voltage waveform as shown in FIG. This voltage is applied between the two energizing electrodes 16. That is, a pulse voltage / current is applied so as to energize the cooling part. In this manner, in step 118, a pulse voltage / current is applied between the two energizing electrodes 16, and the pulse current flows to the cooling portion of the left ventricle.

  Next, in step 122, the power supply to the Peltier element 12 is cut off. Next, in step 124, the cardiac potential is detected again by the atrial lead 32 and the ventricular lead 34. Next, when ventricular fibrillation is detected in step 126, it means that the ventricular fibrillation could not be removed by the application of the low pulse voltage / current described above. Thus, a high pulse voltage / current is applied to remove ventricular fibrillation performed in the conventional ICD. This is performed by applying a high pulse voltage / current to the electrode 341 and the electrode 321 via the ventricular lead 34 and the atrial lead 31. That is, when ventricular fibrillation cannot be eliminated by the method of applying a low pulse voltage / current to the cooling location, a high pulse voltage / current is applied between the ventricle and atrium performed in the conventional ICD and the ICD body. Is applied. Thereafter, in step 134, when the conventional ICD process is executed and the conventional ICD control end condition is satisfied, the control of the apparatus is ended. When the process with the conventional ICD is completed, the process is executed again from step 100.

  In the above embodiment, in step 118, the pulse voltage / current is applied between the two energization electrodes 16, but between the electrode 341 at the tip of the ventricular lead 34 and the two energization electrodes 16. Alternatively, a pulse voltage / current may be applied. Alternatively, a combination of these, that is, one of the energizing electrode 16 and the electrode 341 at the tip of the ventricular lead 34 is set to the same potential, and a pulse voltage / current is applied between these and the other energizing electrode 16. Also good. Further, a pulse voltage / current may be applied between the two energizing electrodes 16 and the main body 20.

  This embodiment is characterized in that only a cooling device is added to a conventional implantable ICD. That is, as shown in FIG. 6, only the Peltier element 12 and the thermistor 18 are disposed on the base material 10. In this case, an electrocardiographic signal is detected by the atrial lead 32 and the ventricular lead 34, and a pulse voltage / current for stopping ventricular fibrillation is applied to the heart via the signal. The electrical configuration of this apparatus is the same as that of FIG. 3 except that the energizing electrode 16 is not present. Also, the control method is the same as the processing procedure shown in FIG. However, in step 118, first, a low pulse voltage / current is applied between the main body 20 including the control device and the energization device, and the electrode 321 at the tip of the atrial lead 32 and the electrode 341 at the tip of the ventricular lead 34. Is done. If ventricular fibrillation cannot be removed even with the low pulse voltage / current, the high pulse voltage / current performed in the conventional ICD is applied to the main body 20 and the tip of the atrial lead 32 in step 128. The electrode 321 and the electrode 341 at the tip of the ventricular lead 34 are applied.

  Thus, in this embodiment, in the conventional ICD, the base material 10 having the cooling device is sewn to the ventricle surface, and the processing procedure of the control device may be changed.

Next, an implantable defibrillator that also serves as a fibrillation prevention device that prevents the occurrence of ventricular fibrillation will be described.
The manner in which the anti-fibrillation device according to this embodiment is attached to the heart 30 is the same as in FIG.

FIG. 1 shows a state in which the anti-fibrillation device according to the present embodiment is attached to the heart 30.
A flexible rectangular base material 10 according to the feature of the present invention is sewn on the epicardial surface of the left ventricle 38. As shown in FIG. 7, four Peltier elements 12 (cooling devices) for cooling are provided at the center of the base material 10. Further, a thermistor 18 (temperature detector) for detecting temperature is provided in a part of the periphery of each Peltier element 12. On the surface of the substrate 10, a plurality of circular plate-shaped potential sensors / energization electrodes 14 for detecting the surface potential of the heart are arranged in a lattice at substantially equal intervals. The potential sensor / energization electrode 14 is also an energization electrode for applying a pulse voltage / current to the heart. The Peltier element 12, the thermistor 18, and the plurality of potential sensors / energization electrodes 14 are fixed so as to be in close contact with the epicardial surface of the left ventricle of the heart.

  Further, signals from a plurality of potential sensors / energization electrodes 14 installed on the substrate 10 and electrocardiographic signals from the atrial lead 32 and the ventricular lead 34 are inputted, and a pulse voltage is passed through these electrodes and leads. -The control apparatus 20 for performing the control which outputs an electric current is implanted in the subcutaneous part of the chest of a human body.

  FIG. 8 shows the electrical configuration of the defibrillation preventing apparatus of this embodiment. 3 different from FIG. 3 showing the configuration of the first embodiment is that an A / D converter 54 for connecting a number of potential sensors / energization electrodes 14 to the MPU 50 is eliminated, and the conduction electrode 16 of FIG. 3 is excluded. The switch 56 is provided. The control device 20 (FIG. 1) mainly detects an electrocardiogram signal, processes the detected signal, and controls energization, an MPU (microprocessor unit) 50, an energization device 60, an A / D converter 52, 54. Electrocardiographic signals from the plurality of potential sensors / energization electrodes 14 are input to the A / D converter 54 via the switch 56, converted into digital signals, read by the MPU 50, and processed.

  The energizing device 60 mainly includes a battery 62, a booster circuit 64 that boosts the voltage of the battery 62 in accordance with a command from the MPU 50, a capacitor 66 that stores electric charges by the voltage boosted by the booster circuit 64, and an input / output terminal The switch 68 includes a switch 68 for controlling conduction and switching input / output terminals, and a current control device 70 for controlling a current supplied to the Peltier element 12 according to a command from the MPU 50.

  The switch 68 controls to switch the transmission system of the next circuit. The switch 68 receives a command from the MPU 50, and sends an electrocardiogram signal from the electrode 321 at the tip of the atrial lead 32 and an electrocardiogram signal from the electrode 341 at the tip of the ventricular lead 34 to the A / D converter 52. It can be switched to output. Further, the switch 68 is switched so as to output the voltage from the capacitor 66 to the electrodes 321 and 341 in accordance with a command from the MPU 50.

  Further, the switch 56 is switched so as to output the voltage from the capacitor 66 to the plurality of potential sensors / energization electrodes 14 provided on the substrate 10 in accordance with a command from the MPU 50.

  The output signal of the thermistor 18 is read by the MPU 50 via the A / D converter 52. The current control device 70 operated by the control of the MPU 50 controls the heart temperature so that the Peltier element 12 is energized to change the cooling capacity of the Peltier element 12 and the temperature detected by the thermistor 18 becomes equal to the target temperature. Yes.

  In the present embodiment, the electrocardiogram signal detection apparatus mainly includes an atrial lead 32 and an electrode 321 at the tip of the lead, a ventricular lead 34 and an electrode 341 at the lead tip, and a plurality of potential sensors / energization electrodes 14. . The control device mainly includes an MPU 50, A / D converters 52 and 54, and the thermistor 18. The cooling device includes a Peltier element 12. The energization device mainly includes a battery 62, a booster circuit 64, a capacitor 66, switches 68 and 56, a potential sensor / energization electrode 14, and a current control device 70.

  Next, the operation of the defibrillator of the present embodiment will be described with reference to FIG. 9 showing the processing procedure of the MPU 50.

  First, in step 200, the switch 68 is switched to the side for inputting signals from the atrial lead 32 and the ventricular lead 34. Thereby, the potential of the myocardium of the right atrium 31 and the right ventricle 37 is detected. Further, the switch 56 is switched to the side where the potential signal is input from the plurality of potential sensors / energization electrodes 14, and these potential signals are input to detect the potential distribution of the epicardial surface of the left ventricle. These signals are electrocardiographic signals indicating myocardial excitation. Next, in step 202, these electrocardiographic signals are analyzed to determine whether ventricular tachycardia or ventricular fibrillation has occurred. Whether or not it is a ventricular tachycardia is basically determined by the excitation cycle (rate) and its duration (beat rate). In this case, it is important not to misidentify supraventricular arrhythmia such as sinus tachycardia or atrial fibrillation as ventricular tachycardia.

    Ventricular tachycardia is detected as a precursor that is likely to lead to ventricular fibrillation. Here, the presence or absence of ventricular tachycardia is determined from the period and duration of the electrocardiographic signal obtained from the tip electrode 341 of the right ventricular lead 34 and the plurality of potential sensors / energization electrodes 14. It is possible to detect a spiral reentry wave from the time / space distribution of an electrocardiogram signal obtained from the potential sensor / energization electrode 14. The presence or absence of supraventricular arrhythmia such as sinus tachycardia, atrial fibrillation, or coarse movement is determined from the electrocardiographic signal obtained from the tip electrode 321 of the right atrial lead 32. In the case of such supraventricular arrhythmia, this apparatus is not driven. The device is also driven when ventricular fibrillation is detected. For detecting ventricular tachycardia and ventricular fibrillation, an arrhythmia detection algorithm employed in a known ICD can be used.

  If ventricular tachycardia or ventricular fibrillation is not detected, this apparatus is not driven. Therefore, the process proceeds to step 204, waits for a predetermined time, returns to step 200, and loops of steps 200-202-204 Monitoring of the heart's electrocardiogram signals continues.

  If ventricular tachycardia or ventricular fibrillation is detected in step 202, a control signal is output to the booster circuit 64, and the storage battery 66 is charged to a predetermined voltage. That is, preparation for applying the pulse voltage / current to the heart is performed in advance. This voltage / current is lower than the conventional ICD.

  Next, the process proceeds to step 208, in which the Peltier element 12, which is a cooling device, is energized to control the local portion of the epicardial surface of the left ventricle 38 to cool the body temperature by about -5 ° C. Is output to the current controller 70. In this case, the temperature detection signal from the thermistor 18 is input, and the supply current by the current control device 70 is feedback-controlled so that the detected temperature becomes the target temperature. As a result, the temperature of the local portion of the epicardial surface of the left ventricle 38 becomes the commanded target temperature.

  Next, in step 210, the process waits until the epicardial surface temperature reaches the target set temperature. After the voltage increase variable n is initially set to 1, the process proceeds to step 212, where In exactly the same manner, the electrocardiogram is detected from each sensor. Next, the process proceeds to step 214, where it is determined whether or not ventricular tachycardia and ventricular fibrillation have disappeared. If they have disappeared, the process proceeds to step 216 and the Peltier element 12 serving as a cooling device. Shut off the power to the. In this way, the processing of the MPU 50 returns to step 200, and the above-described cardiac monitoring loop 200-202-204 is executed.

  Next, when it is determined in step 214 that ventricular tachycardia or ventricular fibrillation has not disappeared, the process proceeds to step 218, and the potential sensor / energization electrode 14 is connected to the energization device 60. The switch 56 is switched so that a pulse voltage / current can be applied. Then, the energization device 60 is operated to apply a pulse voltage / current to the potential sensor / energization electrode 14. The pulse voltage / current uses a biphasic voltage waveform as shown in FIG. In this case, the voltage V1 and the pulse width T1 are changed in proportion to the voltage increase variable n. The voltage / current is applied between the plurality of potential sensors / energization electrodes 14 divided into two groups so as to sandwich the cooling portion.

  In this way, in step 218, a pulse voltage / current is applied between the plurality of potential sensors / energization electrodes 14, and the pulse current flows to the cooled cooling portion of the left ventricle. Next, when the control repetition variable n is less than or equal to the maximum value a in step 220, the repetition variable n is incremented by 1 in step 221, and the process returns to step 212 to detect the electrocardiogram, and the ventricle. The loop in which it is determined whether tachycardia and ventricular fibrillation have disappeared is repeated.

  If ventricular tachycardia or ventricular fibrillation does not disappear, in step 218, the voltage value of the pulse voltage / current is increased by a predetermined amount, the pulse width is widened, the energization power is improved, and energization is executed. The This is performed until ventricular tachycardia or ventricular fibrillation disappears, or until the number of repetitions n exceeds the maximum number of repetitions a. If ventricular tachycardia or ventricular fibrillation does not disappear even after the maximum number of repetitions a is exceeded, in step 222, the power supply to the Peltier element 12 that is a cooling device is cut off. In step 224, the cardiac potential is detected again by each potential sensor / energization electrode 14, atrial lead 32, and ventricular lead 34.

    If a ventricular tachycardia is detected in step 226, the process proceeds to step 228, and a pulse voltage / current for removing the ventricular tachycardia performed in the conventional ICD is applied. Here, a pulse voltage / current is applied to the electrode 341 and the electrode 321 via the ventricular lead 34 and the atrial lead 31. That is, in the method of applying a pulse voltage / current to the cooling point, when the ventricular tachycardia cannot be eliminated, the voltage / current is applied between the ventricle and the atrium performed in the conventional ICD and the ICD main body. The After that, in step 234, the process by the conventional ICD is executed, and when the conventional ICD control end condition is satisfied, the control of the apparatus is ended. Then, the processing is executed again from step 200.

  Also, if it is determined in step 230 that ventricular fibrillation cannot be eliminated, the process proceeds to step 232 and, as is done in the conventional ICD, via the ventricular lead 34 and the atrial lead 31, The electrode 341 and the electrode 321 apply a voltage / current between the ventricle and the atrium and the ICD body. In this case, it is carried out at a high voltage and high current. Thereafter, in step 236, when the conventional ICD process is executed and the conventional ICD control end condition is satisfied, the control of the apparatus is ended. Then, the processing is executed again from step 200.

  In the above embodiment, in step 218, a pulse voltage / current is applied between the divided potential sensor / energizing electrode 14, but the electrode 341 at the tip of the ventricular lead 34 and a number of potential sensors / currents are applied. A pulse voltage / current may be applied between the energization electrodes 14. Or a combination of these, that is, between the divided potential sensor / energizing electrode 14 and between one group of the potential sensor / energizing electrode 14 and the electrode 341 at the tip of the ventricular lead 34, A current may be applied. Further, a pulse voltage / current may be applied between the plurality of potential sensors / energization electrodes 14 and the main body 20.

  In the above embodiment, the ventricular tachycardia is a precursor phenomenon that is likely to lead to ventricular fibrillation, and the ventilatory tachycardia is detected as the cooling start condition of the heart. If so, the time when the phenomenon is detected may be set as the start of cooling. Further, if a program for measuring the potential distribution of the entire heart and detecting the spiral reentry wave is possible, the heart may be cooled when the spiral reentry wave is detected. In addition, the pulse voltage / current is applied to the heart when a predetermined time has elapsed after the heart is cooled. The pulse voltage / current may be applied when the spiral reentry wave is constrained by the detection at 14.

  Although the voltage value (crest value) and pulse width of the pulse voltage / current are changed according to the voltage increase variable n which is a repetitive variable, the application of the pulse voltage / current may be completed once. good. When ventricular tachycardia is detected, the voltage value and pulse width of the pulse voltage and current are gradually increased according to the voltage increase variable n. When ventricular fibrillation is detected, the predetermined value is used. The pulse voltage / current having a high voltage value of may be applied only once. In the above-described embodiment, the control device is an implantable fibrillation prevention device that is implanted subcutaneously in the chest of the human body, but may be a device that is controlled from outside the human body without being implanted.

  Further, as shown in FIG. 10, the potential sensor 14 and the energizing electrode 16 may be separated. In this case, the circuit configuration of the apparatus is as shown in FIG. The energization electrode 16 is controlled by a switch 68, and the potential sensor 14 directly inputs to the A / D converter 54. The pulse voltage / current is applied between the two energization electrodes 16.

  Also in this case, a pulse voltage / current may be applied between the electrode 341 at the tip of the ventricular lead 34 and the two energizing electrodes 16, or one of the energizing electrode 16 and the electrode at the tip of the ventricular lead 34 may be applied. 341 may be set to the same potential, and a pulse voltage / current may be applied between these electrodes and the other energizing electrode 16. Further, a pulse voltage / current may be applied between the two energization electrodes 16 and the main body 20 in which the control device and the energization device are incorporated.

  In addition, as shown in FIG. 2, the detection of the electrocardiogram signal is performed by the electrode 341 at the tip of the atrial lead 32 and the ventricular lead 34, and the potential sensor 14 on the substrate 10 is eliminated, and only the energizing electrode 16 is provided. Anyway. In this case, the method described in the first embodiment shown in FIG. 2 can be applied as the pulse voltage / current application method.

  Further, as in the second embodiment, only a device for locally cooling the heart may be attached to the conventional ICD. As shown in FIG. 6, only the Peltier element 12 and the thermistor 18 are disposed on the base material 10. In this case, an electrocardiogram signal is detected by the atrial lead 32 and the ventricular lead 34, and a pulse voltage / current for stopping ventricular tachycardia and ventricular fibrillation is applied to the heart via the signal.

  As described above, in this embodiment, when ventricular fibrillation or ventricular tachycardia is detected, the cooling device is driven, the ventricle is cooled, and a pulse voltage / current is applied to the cooling location, thereby efficiently. Ventricular tachycardia can be stopped by eliminating the spiral reentry wave. This prevents ventricular fibrillation. In this device, since the heart is cooled and the pulse voltage / current is applied, the applied voltage / current may be low, so that the wearer is less anxious and uncomfortable with the energization. Therefore, a patient's QOL can be improved. Further, when a pulse voltage / current is applied to the cooling location after the heart is cooled, the voltage / current may be low, so that damage to the heart can be minimized.

    This embodiment is an external defibrillator provided with a heart cooling device. In addition, the external defibrillator is composed of a normal external defibrillator body (control device and energizer) 400, an energizing electrode 402 constituting a part of the energizer, and a cooling device 401 for cooling the heart. You can also This device has a configuration in which a cooling device is added to a commonly used external defibrillator. An outline of the present embodiment is shown in FIG. As shown in FIG. 19A, an electrocardiogram signal is detected from the body surface using an electrocardiogram signal detection device 404, and after the operator confirms ventricular fibrillation using the electrocardiogram monitor, normal extracorporeal removal is performed. Defibrillation by direct current conduction from the body surface (front chest) is tried several times by the fibrillator body (control device and energization device) 400 and the energizing electrode 402 constituting a part of the energization device. The energizing electrode 402 is brought into contact with the body surface of the front chest so as to sandwich the position of the heart.

    If the defibrillation is not successful, as shown in FIG. 19B, a cooling device 401 using a cooling medium is attached to the back and anterior chest to cool the surface of the heart, and then power is supplied from the anterior chest again. Direct current energization is performed through the electrode 402. As a cause of normal defibrillation by direct current energization, a situation where a plurality of spiral reentry waves are generated one after another in the ventricle is assumed. Here, by adopting a treatment method that applies cooling to the surface of the heart, the myocardial electrical characteristics of that part change (extension of the refractory period), the spiral reentry wave stops, or the spiral reentry wave is constrained to the cooling site Therefore, it can be expected that the efficiency of the fibrillation stop is increased by energization.

    Thus, since the defibrillation effect can be expected by cooling by the cooling device 401, the external defibrillation device of the present invention includes a device composed only of the cooling device used for this purpose. In addition, the external defibrillator of the present invention includes a cooling device 401, a device in which a current-carrying electrode 402 and an external defibrillator main body (control device and current-carrying device) 400 are combined. included.

    The device of this embodiment is an external defibrillation device having a function of cooling defibrillation DC current from the heart surface and the heart. An outline of this example is shown in FIG. This extracorporeal defibrillator mainly comprises an energizing paddle electrode 501 including a cooling Peltier element 502 and a temperature measuring thermistor 503, and a cooling / energizing device 500. The cooling / energizing device 500 exerts the cooling function by energizing the cooling Peltier element 502 and monitors the myocardial temperature based on the input signal from the temperature measuring thermistor 503 to adjust the cooling function. The cooling / energizing device 500 also has a function of applying direct current to the heart surface.

    If ventricular fibrillation is observed on the surface ECG and normal external defibrillation is not successful several times, the doctor (surgeon) performs emergency thoracotomy to expose the heart and perform a heart massage However, there is a case where the ventricular fibrillation is stopped by applying a DC current from the power paddle electrode 501 in close contact with the heart surface. If it is difficult to stop fibrillation even if such energization is performed from the heart surface, the heart of the energized part is used using the energizing paddle electrode 501 and the cooling / energizing device 500 having a cooling function. Directly energize with a slight decrease in surface temperature. When the surgeon confirms that the local temperature of the heart surface measured by the thermistor 503 has decreased by about 5 ° C. from the body temperature by energizing the Peltier element 502, the surgeon performs direct current energization. For the reason described in Example 4, it can be expected that the efficiency of stopping fibrillation by energization is increased.

  In addition to the devices described in the several embodiments described above, the present invention can be used to cool the heart or to apply a relatively low pulse voltage / current after cooling when ventricular fibrillation occurs. It is also effective as a treatment method to stop movement.

    Furthermore, when a precursor phenomenon of ventricular fibrillation (ventricular tachycardia, spiral reentry wave) is detected, the heart is cooled completely or locally, and after a predetermined time has elapsed, or the spiral reentry wave is cooled It is also effective as a treatment method for preventing the occurrence of ventricular fibrillation by applying a pulse voltage / current when restrained by.

  The present invention is a device that can effectively stop ventricular fibrillation when it occurs, and can prevent the occurrence of ventricular fibrillation, and is therefore extremely effective as a medical device.

BRIEF DESCRIPTION OF THE DRAWINGS Explanatory drawing which showed the state equipped with the defibrillator which concerns on one specific Example of this invention to the human heart. The top view which showed the structure of the board | substrate of the defibrillator which concerns on the Example apparatus. The block diagram which showed the electrical structure of the defibrillator which concerns on the Example apparatus. The flowchart which showed the process sequence of MPU of the defibrillator which concerns on the Example. The wave form diagram which showed the pulse voltage and electric current waveform of the defibrillator which concerns on the Example. The top view which showed the structure of the board | substrate of the defibrillator which concerns on Example 2 of this invention. The top view which showed the structure of the board | substrate of the defibrillator which concerns on Example 3 of this invention. The block diagram which showed the electrical structure of the defibrillator which concerns on the Example apparatus. The flowchart which showed the process sequence of MPU of the defibrillator which concerns on the Example. FIG. 9 is a plan view showing a configuration of a substrate of a defibrillator according to a modification of Example 3. The block diagram which showed the electrical structure of the defibrillator of the modification. A photograph showing the structure of an animal experiment. The figure which showed the change of the heart potential distribution and action potential duration before and behind cooling by animal experiment. The measurement figure which showed a mode that the spiral reentry wave after cooling was restrained by the cooling location. The waveform figure of the electrocardiogram signal which showed that ventricular fibrillation stopped by cooling. The measurement figure which showed the spiral reentry wave when the heart was cooled. The measurement figure which showed the mode of the change of the electrocardiogram signal when a pulse voltage and an electric current were applied without cooling, and when a pulse voltage and an electric current were applied after cooling. The measurement figure which showed the spiral reentry wave when a pulse voltage and an electric current are applied without cooling, and when a pulse voltage and an electric current are applied after cooling. The block diagram which showed the defibrillator which concerns on Example 4 of this invention. The block diagram which showed the defibrillator which concerns on Example 5 of this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 ... Board | substrate 12,502 ... Peltier element 14 ... Electrode for potential sensor / energization 16a, 16b, 402 ... Electrode for conduction 32 ... Atrial lead 34 ... Ventricular lead 501 ... Paddle electrode for electricity supply

Claims (15)

A defibrillator having a cooling device for reversibly cooling the heart. The defibrillator according to claim 1, further comprising a control device that drives and controls the cooling device when ventricular fibrillation is detected. The defibrillator according to claim 1, further comprising an electrocardiogram signal detection device that detects an electrocardiogram signal of the heart. The defibrillator according to claim 3, wherein the electrocardiographic signal detection device includes an atrial lead inserted into the atrium and a ventricular lead inserted into the ventricle. The defibrillator according to claim 3, wherein the electrocardiogram signal detection device has an electrocardiogram recording electrode adhered to a patient's body surface. 3. The defibrillator according to claim 2, wherein the ventricular fibrillation is detected from an atrial lead inserted into the atrium and an electrocardiogram signal detected by the ventricular lead inserted into the ventricle. The defibrillator according to claim 1, further comprising an energization device that applies a pulse voltage / current to the heart. 8. The defibrillator according to claim 7, wherein after the heart is cooled by the cooling device, the energization device is driven and the pulse voltage / current is applied to the heart. The defibrillator according to claim 7 or 8, wherein the energization device includes an energization electrode that applies the pulse voltage / current to a location where the heart is cooled by the cooling device. The defibrillator according to claim 9, wherein the energizing electrode is disposed at a plurality of locations on the surface of the heart. The said electricity supply apparatus has the electricity supply electrode which applies the said pulse voltage and electric current provided in the front-end | tip of the atrial lead inserted in the atrium and the ventricular lead inserted in the ventricle. The defibrillator according to claim 8. The defibrillator according to claim 7 or 8, wherein the energization device includes an energization electrode that is provided on a body surface of a patient and applies the pulse voltage / current. The defibrillation apparatus according to claim 2, wherein the ventricular fibrillation is detected from an electrocardiogram signal detected by an electrocardiogram recording electrode adhered to a body surface of a patient. 3. The defibrillator according to claim 2, wherein a pulse voltage / current is applied to the heart when the ventricular fibrillation has not disappeared. 15. The defibrillator according to any one of claims 7 to 14, wherein the pulse voltage / current is applied to a portion cooled by a cooling device.