JP2017176349A - Intracardiac defibrillation system, connecting device in intracardiac defibrillation system, and defibrillator - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an intracardiac defibrillation system capable of measuring an intracardiac electrocardiogram even in intracardiac defibrillation, while protecting an electrocardiograph from energy of the defibrillation.SOLUTION: A connecting device 200 includes: a first connecting line for connecting an electrode catheter 130 and a defibrillator 110; a second connecting line for connecting the electrode catheter 130 and a polygraph testing device 120 (an electrocardiograph) and connected to the first connecting line; an on/off switch 240 provided on the second connecting line; and a protective resistance 250 provided on the second connecting line in parallel with the on/off switch 240.SELECTED DRAWING: Figure 1

Description

  The present invention relates to an intracardiac defibrillation system that performs intracardiac defibrillation and intracardiac potential measurement using an electrode catheter.

  In ablation treatment of atrial fibrillation, atrial fibrillation, atrial flutter or atrial tachycardia may occur when atrial fibrillation is induced to identify the cause site or as a spontaneous attack during surgery. Intracardiac defibrillation is the application of electrical energy to an electrode catheter previously placed in the heart chamber when it is necessary to stop atrial fibrillation that has occurred during surgery by electrical defibrillation. Remove fibrillation. Intracardiac defibrillation requires less electrical energy to the patient compared to external defibrillation (for example, external defibrillation is about 150-200 J, whereas intracardiac defibrillation is There is an advantage that the burden on the patient is small.

  Before the intracardiac defibrillation system is used, when measuring an intracardiac electrocardiogram, when connecting the electrode catheter terminal to the terminal of the polygraph examination device and performing intracardiac defibrillation, Medical staff such as doctors have to manually perform operations such as connecting the electrode catheter terminal to the defibrillator terminal. Therefore, when the electrode catheter terminal is reconnected, the intracardiac electrocardiogram cannot be measured temporarily.

  Patent Document 1 discloses that a switch for switching one circuit and two contacts for switching between a polygraph inspection device, a defibrillator, and an electrode catheter is disclosed. According to this structure, compared with the case where the terminal of an electrode catheter is reinserted manually, it is thought that the effort of a medical staff can be reduced. Moreover, it is considered that the inconvenience that the intracardiac electrocardiogram cannot be temporarily measured when the terminal of the electrode catheter is reinserted can be solved.

JP 2010-220778 A

  By the way, in the configuration in which the polygraph inspection device (electrocardiograph), the defibrillator, and the electrode catheter are switched by the switch of one circuit and two contacts as in Patent Document 1, the intracardiac is performed at the time of defibrillation. An electrocardiogram cannot be measured. Specifically, in Patent Document 1, an electrode catheter is connected to a common contact of one circuit / two-contact changeover switch, an electrocardiograph is connected to the first contact, and a defibrillator is connected to the second contact. Since the contact is selectively connected to either the first or second contact, the electrocardiograph is connected to the electrode when the electrode catheter is connected to the defibrillator, that is, when defibrillation is performed. Since it is not connected to the catheter, it is not possible to obtain an intracardiac electrocardiogram during defibrillation.

  In addition, in order to obtain an intracardiac electrocardiogram during defibrillation, if the electrocardiograph and electrode catheter are simply connected during defibrillation, the electrocardiograph will be damaged by the defibrillation energy. There is a risk that.

  The present invention has been made in consideration of the above points, and protects the electrocardiograph from the energy of defibrillation so that the intracardiac electrocardiogram can be measured even when intracardiac defibrillation is performed. A defibrillation system, a connection device in an intracardiac defibrillation system, and a defibrillator are provided.

One aspect of the intracardiac defibrillation system of the present invention is:
An electrocardiograph that obtains an electrocardiogram based on the electrocardiogram acquired by the electrode catheter;
A defibrillator for supplying electrical energy for intracardiac defibrillation to the electrode catheter;
A connection device for connecting the electrode catheter, the electrocardiograph and the defibrillator;
Have
The connecting device is
A first connection line connecting the electrode catheter and the defibrillator;
A second connection line connecting between the electrode catheter and the electrocardiograph;
An on / off switch provided on the second connection line;
A protective resistor provided in parallel with the on / off switch on the second connection line;
Have

One aspect of the connection device in the intracardiac defibrillation system of the present invention is:
A first terminal to which an electrode catheter is connected;
A second terminal to which the defibrillator is connected;
A third terminal to which an electrocardiograph is connected;
A first connection line connecting the first terminal portion and the second terminal portion;
A second connection line connecting the first terminal portion and the third terminal portion;
An on / off switch provided on the second connection line;
A protective resistor provided in parallel with the on / off switch on the second connection line;
Have

One aspect of the defibrillator of the present invention is:
A first connection line connected to the electrode catheter for supplying electrical energy for intracardiac defibrillation to the electrode catheter;
A second connection line connecting between the electrode catheter and the electrocardiograph;
An on / off switch provided on the second connection line;
A protective resistor provided in parallel with the on / off switch on the second connection line;
Have

  According to the present invention, the electrocardiograph can be protected from defibrillation energy, and the intracardiac electrocardiogram can be measured even when performing intracardiac defibrillation.

Schematic showing the overall configuration of the intracardiac defibrillation system according to Embodiment 1 The figure which shows the state at the time of intracardiac electrocardiogram measurement A diagram showing the state of performing intracardiac defibrillation The figure which shows the structure of the defibrillator of Embodiment 2. The figure which shows the structure of the defibrillator of Embodiment 2.

  Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings.

<1> Embodiment 1
<1-1> Configuration FIG. 1 is a schematic diagram showing an overall configuration of a defibrillation system according to an embodiment of the present invention.

  The defibrillation system 100 includes a defibrillator 110, a polygraph examination apparatus 120 having a function as an electrocardiograph, an electrode catheter 130, an extracorporeal paddle 140, and a connection apparatus 200. The defibrillator 110, the polygraph inspection device 120, the electrode catheter 130, and the extracorporeal paddle 140 are connected by a connection device 200. In this embodiment, connection device 200 is separate from defibrillator 110, but connection device 200 may be integrated into defibrillator 110 integrally with defibrillator 110. . This configuration will be described in detail in the second embodiment. In the present embodiment, the extracorporeal paddle 140 is exemplified as an apparatus for performing extracorporeal defibrillation. However, an electrode pad or an intracorporeal paddle may be used instead of the extracorporeal paddle 140.

  The defibrillator 110 can generate electrical energy for performing intracardiac defibrillation with the electrode catheter 130 and electrical energy for performing external defibrillation with the extracorporeal paddle 140. The defibrillator 110 can obtain and display a body surface electrocardiogram such as a 12-lead electrocardiogram based on the measured potential acquired by the electrodes attached to the body surface of the patient 10.

  Specifically, the defibrillator 110 includes various operation switches such as a charging operation switch (hereinafter abbreviated as “SW”) 111, an energization operation SW 112, an output dial SW 113, and an LCD (Liquid Crystal Display) 114. And an AC / DC power supply unit 115 that inputs AC power and converts it into DC power, a defibrillation energy output terminal unit 116, and a body surface electrocardiogram input terminal unit 117. Furthermore, although not shown, the defibrillator 110 includes a battery, a booster circuit, an arithmetic circuit, a control circuit, and the like.

  The polygraph inspection device 120 includes an intracardiac potential input terminal portion 121 and a body surface electrocardiogram input terminal portion 122. Further, although not shown, the polygraph inspection apparatus 120 includes a calculation unit that forms an intracardiac electrogram and a body surface electrocardiogram from a measured potential input from the body surface electrocardiogram input terminal unit 122, and a display unit that displays the electrocardiogram. And a control unit.

  The electrode catheter 130 is connected to the connection device 200 via the relay cable 131. In practice, the electrode catheter 130 includes an 8-pole RA electrode placed in the right atrium, an 8-pole CS electrode placed in the coronary sinus, and a 4-pole EP electrode (SVC) placed in the superior vena cava. Electrode and IVC electrode). Of these electrodes, the RA electrode and CS electrode are used for performing intracardiac defibrillation, and the RA electrode, CS electrode, and EP electrode are used for measuring intracardiac potential.

  The extracorporeal paddle 140 is composed of a pair of paddles each having an extracorporeal defibrillation electrode. A charging operation SW 141 and an energizing operation SW 142 are provided on the handle portion of the paddle, and the user performs the charging operation SW 141 and the energizing operation SW 142. , The defibrillator 110 can be charged and the defibrillator 110 can be supplied with energy for defibrillation.

  The connection device 200 includes a switching operation SW201 for selecting either external defibrillation or intracardiac defibrillation, a charging operation SW202, and an energization operation SW203, and the user uses these operation SWs. Thus, switching operation between external defibrillation and intracardiac defibrillation, charging operation, and energization operation can be performed. In addition, the connection apparatus 200 includes an AC / DC power supply unit 204 that inputs AC power and converts the power into DC power.

  The connection device 200 includes a defibrillator connection terminal portion 211, an extracorporeal paddle connection terminal portion 212, an electrode catheter connection terminal portion 213, and a polygraph connection terminal portion 214. Electric energy for external defibrillation or intracardiac defibrillation is input from the defibrillator 110, and electric energy for external defibrillation is input to the external paddle 140 via the external paddle connection terminal portion 212. Is output to the electrode catheter 130 via the electrode catheter connection terminal portion 213, and the intracardiac potential is output to the polygraph examination apparatus 120 via the polygraph connection terminal portion 214. To do. In addition, the connection device 200 inputs a charge switch operation signal and an energization switch operation signal from the extracorporeal paddle 140 via the extracorporeal paddle connection terminal portion 212, and inputs them to the defibrillator via the defibrillator connection terminal portion 211. To 110. In addition, the connection device 200 inputs an intracardiac potential via the electrode catheter connection terminal portion 213 and outputs it to the polygraph inspection device 120 via the polygraph connection terminal portion 214.

  Further, the connection device 200 has a switching SW 220. One of the contacts a and b of the switching SW 220 is selected according to the operation of the switching operation SW 201 by the user. That is, when the user selects the external defibrillation by the switching operation SW201, the switching SW is connected to the contact a, whereas when the user selects the intracardiac defibrillation by the switching operation SW201, the switching SW220 is changed to the contact b. Connecting.

  Between the contact b of the switching SW 220 and the electrode catheter connection terminal portion 213, an electrode catheter short SW 230 is provided. The electrode catheter short SW 230 is configured to short-circuit a plurality of electrodes provided on the electrode catheter 130. Thereby, the contact area with the heart wall can be expanded to reduce the impedance, and the defibrillation energy of the set number of joules can be transmitted to the heart wall. Specifically, the electrode catheter short SW 230 shorts the 8-pole RA electrode and shorts the 8-pole CS electrode when performing intracardiac defibrillation. Incidentally, FIG. 1 shows a state in which each of the 8-pole RA electrode and the 8-pole CS electrode is short-circuited. The electrode catheter short SW 230 is in an open state without short-circuiting each electrode of the electrode catheter 130 at the time of intracardiac electrocardiogram measurement. Thereby, the potential of each electrode can be measured at the time of intracardiac electrocardiogram measurement.

  Further, in the connection device 200, the on / off SW 240 and the protective resistor 250 are connected between the contact point b of the switching SW 220 and the connection midpoint of the electrode catheter connection terminal part 213 and the polygraph connection terminal part 214. The protective resistor 250 is connected in parallel with the on / off SW 240. The on / off SW 240 is provided with a total of 16 on / off SWs corresponding to the 8-pole RA electrode and the 8-pole CS electrode, and the protective resistor 250 is provided with an 8-pole RA electrode and an 8-pole CS electrode. A total of 16 corresponding resistors are provided. In FIG. 1, in order to simplify the drawing, one ON / OFF SW and one resistance are shown for each 8-pole RA electrode, and one ON / OFF SW and one resistance are shown for each 8-pole CS electrode.

  The resistance value of each resistor constituting the protective resistor 250 is, for example, several hundred kΩ. This resistance value may be a value that can protect the polygraph inspection apparatus 120 when energy for defibrillation in the heart chamber is supplied from the defibrillator 110.

  The operations of the electrode catheter short SW 230 and the on / off SW 240 are controlled by the control unit 260. Specifically, in the case of intracardiac electrocardiogram measurement, the control unit 260 sets the electrode catheter short SW 230 to an open state and sets the on / off SW 240 to an on state (that is, a closed state). On the other hand, when performing intracardiac defibrillation, the control unit 260 sets the electrode catheter short SW 230 to a short state and turns the on / off SW 240 to an off state (that is, an open state). The control unit 260 determines whether it is the intracardiac electrocardiogram measurement mode or the intracardiac defibrillation mode based on, for example, the state of the switching SW 220 and the operation states of the charging operation SW 202 and the energization operation SW 203. Can be determined.

<1-2> Intracardiac electrocardiogram measurement mode FIG. 2 is a diagram illustrating a state during intracardiac electrocardiogram measurement.

  At the time of intracardiac electrogram measurement, the electrode catheter short SW 230 is in an open state, and the on / off SW 240 is in an on state (that is, a closed state). As a result, as indicated by the arrow X, the measurement potential obtained by the 8-pole RA electrode and the 8-pole CS electrode of the electrode catheter 130 is input to the polygraph inspection apparatus 120 via the on / off SW 240. Note that the measured potential obtained with the four-pole EP electrode is directly input to the polygraph inspection apparatus 120. As a result, the polygraph inspection apparatus 120 can obtain an intracardiac electrogram based on the measured potential from each electrode.

<1-3> Intracardiac Defibrillation Execution FIG. 3 is a diagram illustrating a state in which intracardiac defibrillation is performed.

  At the time of executing intracardiac defibrillation, the electrode catheter short SW 230 is in a short state, and the on / off SW 240 is in an off state (that is, an open state). As a result, the electrical energy for performing intracardiac defibrillation generated by the defibrillator 110 is supplied to the electrode catheter 130 via the switching SW 220 and the electrode catheter short SW 230 as indicated by the arrow Y. The Further, the measured potential obtained by the electrode catheter 130 is input to the polygraph inspection apparatus 120 via the protective resistance 250 as indicated by an arrow Z. Note that the measured potential obtained with the four-pole EP electrode is directly input to the polygraph inspection apparatus 120 without passing through the protective resistor 250. Incidentally, almost no electric energy for performing intracardiac defibrillation is input to the polygraph examination apparatus 120 by the protective resistance 250, and thereby, predetermined electric energy for performing intracardiac defibrillation is supplied to the heart chamber. Can be supplied within.

  As described above, in the present embodiment, the connection between the polygraph examination apparatus 120 (electrocardiograph) and the electrode catheter 130 is not completely interrupted at the time of defibrillation in the heart chamber, but the heart chamber is removed. Even during fibrillation, by maintaining the connection between the polygraph examination apparatus 120 (electrocardiograph) and the electrode catheter 130 via the protective resistor 250, defibrillation to the polygraph examination apparatus 120 (electrocardiograph) is prevented. A rough intracardiac potential can be measured by the polygraph inspection apparatus 120 (electrocardiograph) while blocking the input of energy to protect the polygraph inspection apparatus 120 (electrocardiograph).

  Incidentally, since the electrode catheter short SW230 is in a short state at the time of defibrillation in the heart chamber, one measurement potential obtained by averaging the potential of the 8-pole RA electrode is obtained, and the potential of the 8-pole CS electrode is obtained. One measurement potential obtained by averaging is obtained. Therefore, compared with the case where the measurement potential is obtained from each of the 8-pole RA electrode and the 8-pole CS electrode as in the case of the intracardiac electrocardiogram measurement, the electrocardiogram waveforms of the RA electrode and the CS electrode are dull. It becomes. Since the 4-pole EP electrode is not short-circuited by the electrode catheter short SW 230, the measured potential of each of the 4-pole EP electrodes can be obtained for the EP electrode even during the intracardiac defibrillation mode. As described above, the intracardiac electrocardiogram based on the measured potentials of the RA electrode and the CS electrode is distorted. However, compared with the case where no intracardiac electrocardiogram is measured at the time of intracardiac defibrillation, intracardiac defibrillation is performed. It is thought that it can be effectively used for the operation of

  In addition, since the connection between the polygraph examination apparatus 120 and the electrode catheter 130 is maintained even during defibrillation in the heart chamber, the polygraph after the electrical energy for defibrillation in the heart chamber is supplied to the electrode catheter 130. There is also a merit that the measurement potential at the inspection device 120 is quickly returned, in other words, the base line at the polygraph inspection device 120 is stabilized, whereby the display recovery of the intracardiac electrocardiogram at the polygraph inspection device 120 is accelerated.

<1-4> Effects As described above, according to the present embodiment, the connection device 200 includes the first connection line that connects the electrode catheter 130 and the defibrillator 110, the electrode catheter 130, and the polygraph. A second connection line connected to the inspection device 120 (electrocardiograph) and connected to the first connection line, an on / off switch 240 provided on the second connection line, and a second connection line In addition, since the protection resistor 250 provided in parallel with the on / off switch 240 is provided, the polygraph examination apparatus 120 (electrocardiograph) is protected from the energy of defibrillation, and intracardiac defibrillation is executed. Sometimes an intracardiac electrogram can be measured.

<2> Embodiment 2
In the above-described first embodiment, the case where the on / off switch 240 and the protective resistor 250 are provided in the connection device 200 separate from the defibrillator 110 has been described. However, the on / off switch 240 and the protective resistor 250 are defibrillated. It may be built in the vessel.

  4 and 5 are connection diagrams showing a schematic configuration of the defibrillator 300 according to the present embodiment. In FIGS. 4 and 5, to simplify the drawing, only the portion related to the electric energy supply line to the electrode catheter 130 and the potential measurement line from the electrode catheter 130 to the polygraph examination apparatus 120 is shown. FIG. 4 shows a state at the time of intracardiac electrocardiogram measurement, and FIG. 5 shows a state at the time of executing intracardiac defibrillation.

  The electrical energy for performing intracardiac defibrillation generated by the defibrillation module 310 is supplied to the RA electrode group and CS electrode group of the electrode catheter 130 via the first connection line L1. Electrode catheter short SW311 and 312 are provided in the first connection line L1.

  The measured potentials of the RA electrode group and the CS electrode group of the electrode catheter 130 are sent to the polygraph inspection apparatus 120 via the second connection line L2. The second connection line L2 has one end connected to the first connection line L1 and the other end connected to the polygraph inspection apparatus 120. On / off switches 313 and 314 are provided on the second connection line L2. In addition, protective resistors 315 and 316 are provided in parallel with the on / off switches 313 and 314 on the second connection line L2.

  In this configuration, the defibrillator 300 turns off the electrode catheter shorts SW311 and 312 and turns on the on / off switches 313 and 314 during the intracardiac electrocardiogram measurement, as shown in FIG. Thereby, the intracardiac electrocardiogram is measured by the polygraph inspection apparatus 120.

  On the other hand, as shown in FIG. 5, the defibrillator 300 turns on the electrode catheter short SWs 311 and 312 (short state) and turns on / off switches 313 and 314 off when performing intracardiac defibrillation. To. Thereby, the electrical energy of the defibrillation module 310 is supplied to the RA electrode group and the CS electrode group of the electrode catheter 130. At this time, the protective resistors 315 and 316 prevent the electrical energy for intracardiac defibrillation from flowing into the polygraph examination apparatus 120, while the potentials of the RA electrode group and the CS electrode group pass through the protective resistors 315 and 316. Therefore, even when performing intracardiac defibrillation, the potential of the electrode catheter 130 can be measured.

  Thus, the first connection line L1 for supplying the defibrillator 300 with electric energy for defibrillation in the heart chamber to the electrode catheter 130, and the polygraph examination apparatus connected to the first connection line L1. The second connection line L2 connected to the (electrocardiograph) 120, the on / off switches 313 and 314 provided on the second connection line L2, and the on / off switches 313 and 314 on the second connection line L2. Since the protective resistors 315 and 316 provided in parallel are provided, the polygraph inspection device 120 (electrocardiograph) is protected from the energy of defibrillation as in the first embodiment. Intracardiac ECG can be measured even during fibrillation.

  The above-described embodiments are merely examples of implementation in carrying out the present invention, and the technical scope of the present invention should not be construed as being limited thereto. That is, the present invention can be implemented in various forms without departing from the gist or main features thereof.

  In the above-described embodiment, the case where the present invention is applied to the electrode catheter having the 8-pole RA electrode, the 8-pole CS electrode, and the 4-pole SVC electrode has been described. However, the present invention is applicable. The configuration of the electrode catheter is not limited to this. That is, the present invention can be widely applied to electrode catheters having electrodes capable of performing intracardiac defibrillation and electrodes capable of measuring intracardiac potential.

  The present invention can be applied to an intracardiac defibrillation system that performs intracardiac defibrillation and intracardiac potential measurement using an electrode catheter.

100 Defibrillation system 110, 300 Defibrillator 120 Polygraph inspection device (electrocardiograph)
DESCRIPTION OF SYMBOLS 130 Electrode catheter 140 Extracorporeal paddle 200 Connection apparatus 211 Defibrillator connection terminal part (2nd terminal part)
213 Electrode catheter connection terminal part (first terminal part)
214 Polygraph connection terminal (third terminal)
220 Switching SW
230, 311, 312 Electrode catheter short SW
240, 313, 314 ON / OFF SW
250, 315, 316 Protection resistor 310 Defibrillation module L1 First connection line L2 Second connection line

Claims (6)

An electrocardiograph that obtains an electrocardiogram based on the electrocardiogram acquired by the electrode catheter;
A defibrillator for supplying electrical energy for intracardiac defibrillation to the electrode catheter;
A connection device for connecting the electrode catheter, the electrocardiograph and the defibrillator;
Have
The connecting device is
A first connection line connecting the electrode catheter and the defibrillator;
A second connection line connecting between the electrode catheter and the electrocardiograph;
An on / off switch provided on the second connection line;
A protective resistor provided in parallel with the on / off switch on the second connection line;
An intracardiac defibrillation system. The connection device further includes a short switch provided on the first connection line and short-circuiting the electrodes of the electrode catheter,
The intracardiac defibrillation system according to claim 1. The short switch is in a short state at the time of intracardiac defibrillation, and is in an open state at the time of intracardiac electrocardiogram measurement.
The intracardiac defibrillation system according to claim 2. The second connection line is connected to the first connection line;
The intracardiac defibrillation system according to any one of claims 1 to 3. A first terminal to which an electrode catheter is connected;
A second terminal to which the defibrillator is connected;
A third terminal to which an electrocardiograph is connected;
A first connection line connecting the first terminal portion and the second terminal portion;
A second connection line connecting the first terminal portion and the third terminal portion;
An on / off switch provided on the second connection line;
A protective resistor provided in parallel with the on / off switch on the second connection line;
A connection device in an intracardiac defibrillation system. A first connection line connected to the electrode catheter for supplying electrical energy for intracardiac defibrillation to the electrode catheter;
A second connection line connecting between the electrode catheter and the electrocardiograph;
An on / off switch provided on the second connection line;
A protective resistor provided in parallel with the on / off switch on the second connection line;
A defibrillator.

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