JP2014522697A - 心臓再同期療法制御パラメータの自動調整のためのシステム及び方法 - Google Patents
心臓再同期療法制御パラメータの自動調整のためのシステム及び方法 Download PDFInfo
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- A—HUMAN NECESSITIES
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- 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
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- A—HUMAN NECESSITIES
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Abstract
【選択図】図1
Description
本願は、2011年7月14日に出願された「改良患者特有心室興奮融合反応表現型認識を用いた心臓再同期療法制御パラメータの自動最適調整のための動作システム及びハードウェア」と称される米国仮出願番号61/507,760の利益を享受する。
Claims (21)
- 心調律管理(CRM)装置を用いて患者の心臓に心臓再同期療法を施す方法において、
a)前記CRM装置及び外部プログラマのうち一方と電気通信する電極を用いて、前記患者の心臓の心臓電気的活動を示す信号を取得する工程と、
b)前記取得された心臓電気的活動の信号を基礎心臓電気的活動と比較する工程と、
c)前記工程b)の比較に基づいて興奮融合反応表現型を決定する工程と、
d)前記工程c)で決定された興奮融合反応表現型に基づいて一以上のペーシング制御パラメータを設定する工程と、
e)前記一以上のペーシング制御パラメータを用いて前記患者の心臓に心臓再同期療法を施す工程と、を有する
ことを特徴とする方法。 - 前記工程b)が、前記取得された心臓電気的活動の信号における一以上のQRS群グリフを特定することを含むことを特徴とする請求項1に記載の方法。
- 前記工程b)が、前記特定されたQRS群グリフを、前記基礎心臓電気的活動における対応するQRS群グリフと比較することを含むことを特徴とする請求項1に記載の方法。
- 前記工程b)が、前記取得された心臓電気的活動の信号におけるQRS継続時間を、前記基礎心臓電気的活動における対応するQRS継続時間と比較することをさらに含むことを特徴とする請求項1に記載の方法。
- 前記工程c)が、房室間隔と心室−心室間隔のうち少なくとも一つを設定することを含むことを特徴とする請求項1に記載の方法。
- 前記工程a)において取得された信号を、多数の心臓再同期療法刺激サイトからの伝搬波パターンを備える融合波面と特徴付けることをさらに含むことを特徴とする請求項1に記載の方法。
- 前記伝搬波パターンに基づいて前記融合波面における波面干渉のパターンを特徴付けることをさらに含むことを特徴とする請求項6に記載の方法。
- 前記興奮融合反応表現型が、相殺融合反応表現型、傾斜融合反応表現型及び総和融合反応表現型のうち一つを含むことを特徴とする請求項1に記載の方法。
- 前記工程d)が、前記工程c)で総和融合反応表現型が決定されたときに前記興奮反応表現型を変えるために前記一以上のペーシング制御パラメータを設定することを含むことを特徴とする請求項1に記載の方法。
- 前記工程b)における比較と前記工程c)における決定に基づいて、心臓再同期療法中の逆リモデリングの確率を見積もることをさらに含むことを特徴とする請求項1に記載の方法。
- 心臓再同期療法中の逆リモデリングの確率を見積もることが、少なくとも一つの心臓再同期療法刺激サイトに基づくことを特徴とする請求項1に記載の方法。
- 患者の心臓に心臓再同期療法を施すための心臓埋め込み型電気装置において、
前記心臓内の心臓電気的活動を示す信号を受信するインプットと、
前記心臓に心臓再同期療法を施すために前記心臓に電気的インパルスを与えるインパルス供給システムと、
ペーシング制御パラメータと基礎心電図電気的活動を保存するメモリと、
前記メモリと通信するプロセッサと、を有し、
前記プロセッサが、
前記受信された信号を受信し、
前記受信された信号をグローバル心臓電気的活動のサロゲートと特徴付ける形態学的フレームワークを用いて、前記受信された信号と前記基礎心電図電気的活動を比較し、
前期比較に基づいて興奮融合反応表現型を決定し、
前記興奮融合反応表現型と、前記受信された信号と前記基礎心電図電気的活動との比較と、に基づいて調整されたペーシング制御パラメータを生成し、
前記調整されたペーシング制御パラメータに応じて、前記心臓に心臓再同期療法を施すために、前記インパルス供給システムと通信するよう構成された
ことを特徴とする心臓埋め込み型電気装置。 - 前記プロセッサが、前記受信された信号における一以上のQRS群グリフを特定するよう構成されたことを特徴とする請求項12に記載の心臓埋め込み型電気装置。
- 前記プロセッサが、前記特定されたQRS群グリフを、前記基礎心電図電気的活動における対応するQRS群グリフと比較するよう構成されたことを特徴とする請求項13に記載の心臓埋め込み型電気装置。
- 前記プロセッサが、融合波面を取得するために、前記受信された信号を波面伝搬特性と関連付けるよう構成されたことを特徴とする請求項12に記載の心臓埋め込み型電気装置。
- 前記インパルス供給システムが、電気的インパルスを与えるための刺激サイトを変化させるために多電極リードを含むことを特徴とする請求項12に記載の心臓埋め込み型電気装置。
- 前記保存されたペーシング制御パラメータが、前記刺激サイトを含むことを特徴とする請求項16に記載の心臓埋め込み型電気装置。
- 前記保存されたペーシング制御パラメータが、房室間隔及び心室−心室間隔を含むことを特徴とする請求項12に記載の心臓埋め込み型電気装置。
- 前記プロセッサが、外部プログラマと通信するように構成されていることを特徴とする請求項12に記載の心臓埋め込み型電気装置。
- 前記プロセッサが、携帯用及びベッドサイド通信ステーションのうちの一つを介してリンクされたデジタルネットワーク経由でアクセスされた計算リソースと通信するよう構成されていることを特徴とする請求項12に記載の心臓埋め込み型電気装置。
- 心調律管理(CRM)装置を用いて患者の心臓に心臓再同期療法を施すためのシステムにおいて、
前記患者の心臓内の心臓電気的活動を示す信号を取得するために、前記CRM装置と電気通信する電極に接続されるよう構成されたインプットと、
前記CRM装置に動作制御パラメータを通信するよう構成されたアウトプットと、
プロセッサと、を有し、
前記プロセッサが、
心臓電気的活動を示す信号を受信し、
基礎心臓電気的活動情報にアクセスし、
前記心臓電気的活動を示す信号と前記基礎心臓電気的活動を比較し、
前記心臓電気的活動を示す信号と前記基礎心臓電気的活動の比較に基づいて、患者特有興奮融合反応表現型を決定し、
前記興奮融合反応表現型を用いて、ペーシングを制御するための少なくとも一つの調整された動作制御パラメータを決定し、
前記少なくとも一つの調整された動作制御パラメータを用いて心臓再同期療法を行うために、前記少なくとも一つの調整された動作制御パラメータを前記CRM装置に通信するよう構成された
ことを特徴とするシステム。
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US201161507760P | 2011-07-14 | 2011-07-14 | |
US61/507,760 | 2011-07-14 | ||
PCT/US2012/046907 WO2013010165A1 (en) | 2011-07-14 | 2012-07-16 | System and method for automated adjustment of cardiac resynchronization therapy control parameters |
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JP2014522697A5 JP2014522697A5 (ja) | 2015-09-03 |
JP6105576B2 JP6105576B2 (ja) | 2017-03-29 |
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EP (1) | EP2731672B1 (ja) |
JP (1) | JP6105576B2 (ja) |
CN (1) | CN103796714B (ja) |
ES (1) | ES2739812T3 (ja) |
WO (1) | WO2013010165A1 (ja) |
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