JP2022116051A - Intracardiac defibrillation system and cardiac defibrillator - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an intracardiac defibrillation system capable of executing intracardiac defibrillation of cardioversion without using an ECG signal from polygraph test equipment.

SOLUTION: A cardiac defibrillator 100 acquires an electrocardiogram based on measurement potentials of an RA electrode group and a CS electrode group short-circuited by a catheter short-circuit SW 230, detects a timing corresponding to an R wave from the electrocardiogram, and supplies electric energy for intracardiac defibrillation to the RA electrode group and the CS electrode group short-circuited by the catheter short-circuit SW 230 at a timing synchronized with the detected timing.

SELECTED DRAWING: Figure 7

COPYRIGHT: (C)2022,JPO&INPIT

Description

The present invention relates to an intracardiac defibrillation system and a defibrillator for performing intracardiac defibrillation and intracardiac potential measurement using an electrode catheter.

In ablation therapy for 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 placed in the heart chamber in advance when it is necessary to stop intraoperative atrial fibrillation by electrical cardioversion. It removes fibrillation. Intracardiac defibrillation requires less electrical energy to be given to the patient than external defibrillation 30 J or less in motion), and has the advantage of reducing the burden on the patient.

Prior to the use of intracardiac defibrillation systems, when measuring an intracardiac electrocardiogram, the terminal of an electrode catheter was connected to the terminal of a polygraph examination device, and when performing intracardiac defibrillation, A medical staff such as a doctor had to manually perform work such as connecting the terminal of the electrode catheter to the terminal of the defibrillator. Therefore, when the terminals of the electrode catheter are reconnected, the intracardiac electrocardiogram cannot be measured temporarily.

Patent Literature 1 discloses providing a one-circuit, two-contact switch for switching between a polygraph examination apparatus and a defibrillator and an electrode catheter. According to this configuration, it is thought that the labor of the medical staff can be reduced as compared with the case of manually reinserting the terminal of the electrode catheter. In addition, it is considered possible to eliminate the inconvenience of temporarily being unable to measure an intracardiac electrocardiogram when reinserting the terminal of the electrode catheter.

JP 2010-220778 A

By the way, in arrhythmia ablation treatment in a cardiac catheterization laboratory, when cardioversion intracardiac defibrillation is performed (that is, when the electrode catheter is energized in synchronization with the R wave), it is generally acquired by a polygraph examination device. R-waves are detected from the detected body-surface electrocardiogram, and R-wave synchronous energization is performed based on the detected R-waves.

Such a configuration requires the defibrillator to receive the ECG signal from the polygraph, which requires a cable between the defibrillator and the polygraph.

Here, in the arrhythmia ablation treatment in the cardiac catheterization laboratory, usually two devices, an external defibrillator and an intracardiac defibrillator, are installed and used depending on the case.

In the treatment of atrial fibrillation, a defibrillation catheter (electrode catheter) is connected to an intracardiac defibrillator for examination. In addition, for patients who are expected to develop ventricular fibrillation/ventricular tachycardia, examinations should be performed with defibrillation pads connected to an external defibrillator.

Therefore, each device is connected using a large number of cables. Specifically, the following cables exist.
[1] A relay cable that connects an electrode catheter placed in the subject's body and an intracardiac defibrillator [2] An ECG signal cable that connects an intracardiac defibrillator and a polygraph examination device [ 3] Cable connecting external defibrillator and defibrillation pads

In order to perform arrhythmia ablation treatment, it is necessary to install all of the above cables [1] to [3] within a range that can reach the patient or peripheral devices. There is a drawback that the degree of freedom of Therefore, it is desirable to reduce the number of cables.

SUMMARY OF THE INVENTION It is with these considerations in mind that the present invention enables cardioversion intracardiac defibrillation to be performed without the use of ECG signals from a polygraph, resulting in a reduction in the number of cables. To provide an intracardiac defibrillation system and defibrillator that can also contribute to reduction.

One aspect of the intracardiac defibrillation system of the present invention comprises:
an electrode catheter having an RA electrode placed in the right atrium and a CS electrode placed in the coronary sinus;
An electrocardiogram is obtained based on the measured potentials of the RA electrode and the CS electrode, and the timing corresponding to the R wave is detected from the electrocardiogram, and the RA electrode and the CS electrode are applied to the heart chamber at a timing synchronized with the detected timing. a defibrillator that provides electrical energy for defibrillation;
Equipped with

One aspect of the defibrillator of the present invention is
A defibrillator connected to an electrode catheter for supplying electrical energy for intracardiac defibrillation to the electrode catheter,
a timing detection unit that obtains an electrocardiogram based on the measured potentials of the RA electrode and the CS electrode of the electrode catheter and detects the timing of R-wave synchronous energization based on the electrocardiogram;
an electrical energy supply unit that supplies electrical energy for intracardiac defibrillation to the RA electrodes and the CS electrodes at timings synchronized with the timings detected by the timing detection unit;
Equipped with

The present invention allows cardioversion intracardiac defibrillation to be performed without the use of ECG signals from a polygraph.

Diagrams for explaining the principle of the embodiment FIG. 3 shows an example of an electrode catheter in which a potential measuring electrode and a voltage applying electrode are provided separately. FIG. 4 is a diagram showing an example of an electrode catheter in which potential measurement electrodes and voltage application electrodes are shared; Schematic diagram showing the overall configuration of an intracardiac defibrillation system according to an embodiment, corresponding to the electrode catheter of FIG. Schematic diagram showing the external configuration of a defibrillator Enlarged view of the output setting dial SW Schematic diagram showing the overall configuration of an intracardiac defibrillation system according to an embodiment, corresponding to the electrode catheter of FIG. Diagram showing the state during intracardiac electrocardiogram measurement Diagram showing the state during intracardiac defibrillation Schematic diagram showing the configuration of an intracardiac defibrillation system as a comparative example

BEST MODE FOR CARRYING OUT THE INVENTION Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings.

<1> Principle of the Embodiment First, the principle of the embodiment will be described before describing the specific configuration of the embodiment.

FIG. 1 shows a patient 10 fitted with an electrode catheter 20 and a defibrillation paddle or pad 30 (hereinafter "paddle/pad"). Defibrillator 40 is capable of performing external defibrillation while connected to terminals A1 and A2 of paddle/pad 30 . In addition, the defibrillator 40 can perform intracardiac defibrillation while being connected to the terminals B1 and B2 of the electrode catheter 20 .

The electrode catheter 20 includes an 8-pole RA electrode group 21 placed in the right atrium, an 8-pole CS electrode group 22 placed in the coronary sinus, and a 4-pole EP electrode placed in the superior vena cava. groups (SVC electrodes, IVC electrodes, etc.); Among these electrodes, the RA electrode group 21 and the CS electrode group 22 are used to perform intracardiac defibrillation, and the RA electrode group 21, the CS electrode group 22 and the EP electrode group are used to measure intracardiac potentials. used for The detailed configuration of these electrodes will be described later with reference to FIGS. 2 and 3. FIG.

In the present embodiment, the defibrillator 40 obtains an electrocardiogram (herein, this electrocardiogram is referred to as an "RA-CS lead electrocardiogram") based on the measured potentials of the RA and CS electrodes, and the electrocardiogram , and supplies electrical energy for intracardiac defibrillation to the RA and CS electrodes in synchronization with the detected timing.

As a result, intracardiac defibrillation synchronized with the R wave can be performed without using the ECG signal of the polygraph examination apparatus.

<2> Configuration of Electrode Catheter Next, the configuration of the electrode catheter 20 assumed to be used in the present embodiment will be described. In this embodiment, it is assumed that two types of electrode catheters, the electrode catheter shown in FIG. 2 and the electrode catheter shown in FIG. 3, are used.

The electrode catheter 20 shown in FIG. 2 has separate electrodes for potential measurement and voltage application. In the following, such an electrode catheter will be referred to as type 1. The electrode catheter 20 shown in FIG. 3 has common electrodes for potential measurement and voltage application. In the following, such an electrode catheter will be referred to as type 2. As a conventional electrode catheter for intracardiac defibrillation, type 2 is often used.

The type 1 electrode catheter 20 shown in FIG. 2 is provided with 8 potential measuring electrodes 21X and 4 voltage applying electrodes 21Y as the RA electrode group 21 . Conductive wires insulated from each other are connected to the eight potential measuring electrodes 21X, so that the potential of each of the eight potential measuring electrodes 21X is measured on the measuring side to which these conducting wires are connected. It is possible. On the other hand, a common conducting wire is connected to the four voltage applying electrodes 21Y, whereby the defibrillator to which this conducting wire is connected is connected to the four voltage applying electrodes 21Y through the conducting wire. of defibrillation electrical energy is supplied.

Similarly, the type 1 electrode catheter 20 is provided with eight potential measuring electrodes 22X and four voltage applying electrodes 22Y as the CS electrode group 22 . Conductive wires insulated from each other are connected to the eight potential measuring electrodes 22X, so that the potential of each of the eight potential measuring electrodes 22X is measured on the measuring side to which these conducting wires are connected. It is possible. On the other hand, a common conducting wire is connected to the four voltage applying electrodes 22Y, whereby the defibrillator to which this conducting wire is connected is connected to the four voltage applying electrodes 22Y through the conducting wire. of defibrillation electrical energy is supplied.

The number, arrangement pattern, and size of the potential measuring electrodes 21X and 22X and the voltage applying electrodes 21Y and 22Y are not limited to the example in FIG. For example, the number of voltage applying electrodes 21Y and 22Y may be one each.

The type 2 electrode catheter 20 shown in FIG. 3 is provided with eight electrodes 21Z as the RA electrode group 21, which are used for both potential measurement and voltage application. Specifically, conductive wires insulated from each other are connected to the eight electrodes 21Z, so that the potential of each of the eight electrodes 21Z can be measured. On the other hand, when the defibrillating electrical energy is supplied to the eight electrodes 21Z, the eight electrodes 21Z are short-circuited to supply the defibrillating electrical energy so that the same voltage is applied to all of the eight electrodes 21Z. can be supplied.

<3> Configuration of defibrillation system Next, the configuration of the defibrillation system of the embodiment will be described. Below, the configuration corresponding to the type 1 electrode catheter 20 (FIG. 2) and the configuration corresponding to the type 2 electrode catheter 20 (FIG. 3) will be described separately.

<3-1> Configuration of Defibrillation System Compatible with Type 1 Electrode Catheter FIG. 4 is a schematic diagram showing the overall configuration of a defibrillation system compatible with the type 1 electrode catheter 20 (FIG. 2).

The defibrillation system 1000 includes a defibrillator 100 (corresponding to the defibrillator 40 in FIG. 1), a polygraph examination apparatus 300 having a function as an electrocardiograph, and an electrode catheter 20 (as shown in FIG. 2). an electrode catheter 20 in which separate potential measuring electrodes 21X, 22X and voltage applying electrodes 21Y, 22Y are separately provided; an extracorporeal paddle 500 (corresponding to the paddle/pad 30 in FIG. 1); , has The defibrillator 100 , the polygraph examination device 300 , the electrode catheter 20 and the extracorporeal paddle 500 are connected by a connecting device 200 . In addition, in the present embodiment, the connection device 200 is separate from the defibrillator 100, but the connection device 200 may be incorporated in the defibrillator 100 integrally with the defibrillator 100. . Also, in the present embodiment, the external paddle 500 is taken as an example of a device for performing external defibrillation, but instead of the external paddle 500, an electrode pad, an internal paddle, or the like may be used.

The defibrillator 100 can generate electrical energy for intracardiac defibrillation with the electrode catheter 20 and electrical energy for external defibrillation with the external paddles 500 .

Specifically, as shown in FIG. 5, the defibrillator 100 has various operations such as a charging operation switch (hereinafter the switch is abbreviated as “SW”) 111, an energization operation SW 112, an output setting dial SW 113, and the like. It has a switch, an LCD (Liquid Crystal Display) 114 , an AC/DC power supply unit 115 for inputting AC power and converting it into DC power, and an input/output terminal unit 116 . Furthermore, the defibrillator 100 has a battery, a booster circuit, an arithmetic circuit, a control circuit, etc., although they are not shown.

The output setting dial SW113 has a function of setting an energization level and a function of switching the energization destination. The output setting dial SW113 also has a function of selecting a monitor mode and an AED (Automated External Defibrillator) mode.

FIG. 6 is an enlarged view of the output setting dial SW113. When the user sets the rotational position of the dial to the "monitor" position, the defibrillator 100 enters the electrocardiogram measurement mode (monitor mode), and when the user sets the rotational position of the dial to the "AED" position, the defibrillator 100 becomes external defibrillation mode (AED mode). Further, when the user rotates the dial clockwise from the "off" position, the defibrillator 100 can be put into the intracardiac defibrillation mode. Any energization level of 2, 4, 6, 8, 10, 15, 20, 30 [J] can be set. On the other hand, when the user rotates the dial counterclockwise from the "off" position, the defibrillator 100 can be put into the external defibrillation mode. Any energization level of 2, 4, 6, 8, 10, 15, 20, 30, 50, 70, 100, 150, 200 [J] can be set.

Returning to FIG. 4, the description continues. The polygraph examination apparatus 300 has an intracardiac potential input terminal section 301 . Although not shown, the polygraph examination apparatus 300 includes a computing unit for forming an intracardiac electrocardiogram from the measured potential input from the intracardiac potential input terminal unit 301, a display unit for displaying the electrocardiogram, a control unit, and the like. have.

The electrode catheter 20 is connected to the connecting device 200 via the relay cable K1. In practice, the electrode catheter 20 consists of an RA electrode group 21 placed in the right atrium, a CS electrode group 22 placed in the coronary sinus, and a quadrupolar EP electrode group (SVC electrode group) placed in the superior vena cava. and IVC electrodes) (not shown). Among these electrodes, the RA electrode group 21 and the CS electrode group 22 are used to perform intracardiac defibrillation, and the RA electrode group 21, the CS electrode group 22 and the EP electrode group are used to measure intracardiac potentials. used for

The external paddle 500 is composed of a pair of paddles each having an external defibrillation electrode, and a charging operation SW 501 and an energization operation SW 502 are provided on the handle of the paddle. By operating , the defibrillator 100 can be caused to perform a charging operation, and energy for defibrillation can be supplied from the defibrillator 100 .

The connection device 200 is connected to the defibrillator 100 by a cable K0. The connecting device 200 receives electrical energy for external defibrillation or intracardiac defibrillation from the defibrillator 100 via the cable K0, and externally to the external paddle 500 via the terminal T4 and the cable K4. It outputs electrical energy for defibrillation, and outputs electrical energy for intracardiac defibrillation to the electrode catheter 400 via the terminal T1 and the relay cable K1.

Also, the connection device 200 receives a charge switch operation signal and an energization switch operation signal from the extracorporeal paddle 500 via the cable K4 and the terminal T4, and outputs them to the defibrillator 100 via the cable K0.

The connection device 200 also receives an intracardiac potential input from the electrode catheter 20 via the relay cable K1 and the terminal T1, and outputs this to the polygraph examination apparatus 300 via the terminal T2 and the cardiac potential output cable K2.

Also, the connection device 200 has a switching SW 220 . Either contact a or b of switch SW220 is selected according to the operation of output setting dial SW113 of defibrillator 100 by the user. That is, when the user selects external defibrillation with the output setting dial SW113, the switching SW is connected to the contact a. b.

A conductor K11 and a conductor K12 are connected to the contact b. The conducting wire K11 is connected to the potential applying electrode 21Y (FIG. 2) of the electrode catheter 20. As shown in FIG. The conducting wire K12 is connected to the voltage applying electrode 22Y (FIG. 2) of the electrode catheter 20. As shown in FIG.

With this configuration, in the defibrillation system 1000, the defibrillator 100, when performing intracardiac defibrillation using the electrode catheter 20, outputs an intracardiac electrocardiogram based on the RA electrodes and the CS electrodes from the electrode catheter 20. Obtainable.

The connection device 200 also has an on/off switch 240 and a protection resistor 250 . The protective resistor 250 is connected in parallel with the ON/OFF SW 240 . The on/off switch 240 and the protection resistor 250 are connected to a lead wire K13 connected to the potential measuring electrode 21X of the electrode catheter 20 and a lead wire K14 connected to the potential measuring electrode 22X of the electrode catheter 20. The ON/OFF switch 240 is provided with a total of 16 ON/OFF switches corresponding to the 8-pole RA electrode group 21X and the 8-pole CS electrode group 22X. A total of 16 resistors are provided corresponding to the 8-pole CS electrode group 22X.

A resistance value of each resistor constituting the protection resistor 250 is, for example, several hundred kΩ. This resistance value may be a value that can protect the polygraph examination apparatus 300 when energy for intracardiac defibrillation is supplied from the defibrillator 100 .

The operations of electrode catheter short SW 230 and on/off SW 240 are controlled by control signals from defibrillator 100 input via cable K0. Specifically, when a control signal instructing intracardiac electrocardiogram measurement is input, connection device 200 turns ON/OFF SW 240 to the ON state (that is, to the closed state). On the other hand, when a control signal instructing execution of intracardiac defibrillation is input, connection device 200 turns on/off SW 240 to the off state (that is, to the open state).

As a result, during intracardiac electrocardiogram measurement, the ON/OFF SW 240 is turned on (that is, closed), and the 8-electrode RA electrode group 21X for potential positioning and the 8-pole CS electrode group 22X for potential positioning are obtained. A measured potential is input to the polygraph inspection apparatus 300 via the ON/OFF SW 240 . Incidentally, the measured potentials obtained by the four-electrode EP electrode group are directly input to the polygraph inspection apparatus 300 through the conducting wire K15. As a result, the polygraph examination apparatus 300 can obtain an intracardiac electrocardiogram based on the potentials measured from each electrode.

On the other hand, when intracardiac defibrillation is performed, the ON/OFF switch 240 is turned off (that is, open), and the 8-pole RA electrode group 21X for potential positioning and the 8-pole CS electrode group for potential positioning The measured potential obtained at 22X is input to the polygraph inspection apparatus 300 via the protective resistor 250. FIG. Incidentally, when intracardiac defibrillation is performed, electrical energy for defibrillation is not directly applied to the RA electrode group 21X for potential positioning and the CS electrode group 22X for potential positioning. Since the RA electrode group 21X for electric potential positioning and the CS electrode group 22X for potential positioning are arranged near the voltage applying electrodes 21Y and 22Y, a large electric energy is applied through the human body. If this large amount of electrical energy is input directly to polygraph inspection apparatus 300 via on/off switch 240, polygraph inspection apparatus 300 may be damaged. In consideration of this, in the present embodiment, the RA electrode group 21X and the CS electrode group 22X are electrically connected to the polygraph examination apparatus 300 via the protective resistor 250 when performing intracardiac defibrillation. It has become.

Incidentally, during intracardiac defibrillation, electrical connection between the electrode catheter 20 and the polygraph examination apparatus 300 may be completely cut off in order to prevent damage to the polygraph examination apparatus 300. Then, the connection between the polygraph examination apparatus 300 and the electrode catheter 20 is not completely cut off during intracardiac defibrillation. By maintaining the connection between 300 and electrode catheter 20 , the input of electrical energy for defibrillation to polygraph examination apparatus 300 is suppressed to protect polygraph examination apparatus 300 , while intracardiac Potential can be measured.

In addition, since the connection between the polygraph examination apparatus 300 and the electrode catheter 20 is maintained even during intracardiac defibrillation, the polygraph after the electrical energy for intracardiac defibrillation is supplied to the electrode catheter 20 is maintained. The return of the potential measured by the inspection apparatus 300 is accelerated, in other words, the baseline of the polygraph inspection apparatus 300 is stabilized, which has the advantage of speeding up the display recovery of the intracardiac electrocardiogram on the polygraph inspection apparatus 300 .

According to the present embodiment, the defibrillator 100 obtains an electrocardiogram (RS-CS lead electrocardiogram) based on the measured potentials of the RA electrode group 21Y and the CS electrode group 22Y, and corresponds to the R wave from the electrocardiogram. By detecting the timing and supplying electrical energy for intracardiac defibrillation to the RA electrode 21Y and the CS electrode group 22Y in synchronization with the detected timing, cardioversion intracardiac defibrillation is performed. The movement can now be performed without the ECG signal from the polygraph examination device 300 . As a result, the number of cables can be reduced, and the degree of freedom in the arrangement layout of the devices in the examination room can be increased. It should be noted that the R-wave synchronous energization (cardioversion) itself is a known technique, and therefore description thereof will be omitted here.

In practice, the defibrillator 100 of FIG. 4 obtains an electrocardiogram based on the measured potentials of the RA electrode group 21Y and the CS electrode group 22Y of the electrode catheter 20, and detects the timing of R-wave synchronous energization based on the electrocardiogram. and an electric energy supply unit that supplies electric energy for intracardiac defibrillation to the RA electrodes 21Y and the CS electrodes 22Y at timings synchronized with the timings detected by the timing detection unit.

<3-2> Configuration of defibrillation system compatible with type 2 electrode catheter FIG. 7, in which parts corresponding to FIG. 4 are assigned the same reference numerals, corresponds to type 2 electrode catheter 20 (FIG. 3). 1 is a schematic diagram showing the overall configuration of a defibrillation system; FIG.

Defibrillation system 2000 has electrode catheter short SW 230 as compared to defibrillation system 1000 of FIG. The electrode catheter short SW230 is provided between the contact b of the switching SW220 and the terminal T1. The electrode catheter short-circuit SW 230 short-circuits the plurality of RA electrode groups 21Z and CS electrode groups 22Z provided on the electrode catheter 20, respectively. Specifically, a conductor K111 in FIG. 7 indicates a conductor connected to a plurality of RA electrode groups 21Z, a conductor K112 in FIG. 7 indicates a conductor connected to a plurality of CS electrode groups 22Z. During internal defibrillation, the multiple RA electrode groups 21Z are short-circuited and the multiple CS electrode groups 22Z are short-circuited. As a result, the contact area with the heart wall is widened, the impedance is lowered, and the defibrillation energy of the set number of joules can be transmitted to the heart wall.

Specifically, the electrode catheter short SW 230 short-circuits the 8-pole RA electrode group 21Z and the 8-pole CS electrode group 22Z during intracardiac defibrillation. The electrode catheter short switch 230 does not short the electrodes 21Z and 22Z of the electrode catheter 20 but opens them during intracardiac electrocardiogram measurement. As a result, the potentials of the electrodes 21Z and 22Z can be measured during intracardiac electrocardiogram measurement.

Further, in the connection device 200, an ON/OFF switch 240 and a protective resistor 250 are connected between the contact point b of the switching switch 220 and the connection midpoint of the terminal portion T1 and the terminal T2. The protective resistor 250 is connected in parallel with the ON/OFF SW 240 . The ON/OFF switch 240 is provided with a total of 16 ON/OFF switches corresponding to the 8-pole RA electrode group 21Z and the 8-pole CS electrode group 22Z. A total of 16 resistors are provided corresponding to the 8-pole CS electrode group 22Z.

The operations of electrode catheter short SW 230 and on/off SW 240 are controlled by control signals from defibrillator 100 input via cable K0. Specifically, when a control signal instructing intracardiac electrocardiogram measurement is input, connection device 200 opens electrode catheter short SW 230 and turns on/off SW 240 (that is, closes). On the other hand, when a control signal instructing execution of intracardiac defibrillation is input, the connection device 200 shorts the electrode catheter short switch 230 and turns the on/off switch 240 off (that is, open).

FIG. 8 is a diagram showing a state during intracardiac electrocardiogram measurement.

During intracardiac electrocardiogram 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, closed state). As a result, as indicated by the arrow X, the measured potentials obtained from the 8-pole RA electrode group 21Z and the 8-pole CS electrode group 22Z of the electrode catheter 20 are input to the polygraph examination apparatus 300 via the ON/OFF SW 240. be done. Note that the measured potential obtained by the four-electrode EP electrode group is directly input to the polygraph inspection apparatus 300 . As a result, the polygraph examination apparatus 300 can obtain an intracardiac electrocardiogram based on the potentials measured from each electrode.

FIG. 9 is a diagram showing a state when intracardiac defibrillation is executed.

When intracardiac defibrillation is performed, the electrode catheter short switch 230 is set in a short state, and the on/off switch 240 is set in an off state (that is, open state). As a result, the electrical energy for performing intracardiac defibrillation generated by the defibrillator 100 is supplied to the electrode catheter 20 via the switching SW 220 and the electrode catheter short SW 230 as indicated by the arrow Y. be.

In addition, in the present embodiment, when this intracardiac defibrillation is executed, the defibrillator 100 is configured with the RA electrode group 21Z shorted by the electrode catheter short SW230 and the CS electrode group shorted by the electrode catheter short SW230. An electrocardiogram (RA-CS lead electrocardiogram) is obtained based on the potential measured with the group 22Z, the timing corresponding to the R wave is detected from the electrocardiogram, and the short-circuited RA electrode group 21Z is synchronized with the detected timing. and the CS electrode group 22Z with electrical energy for intracardiac defibrillation.

In practice, the defibrillator 100 of FIG. 7 obtains an electrocardiogram (RA-CS lead electrocardiogram) based on the measured potentials of the RA electrode group 21Z and the CS electrode group 22Z of the electrode catheter shorted by the catheter short SW 230, A timing detector that detects the timing of R-wave synchronous energization based on an electrocardiogram, and the RA electrode group 21Z and the CS electrode group 22Z that are shorted by the catheter short SW 230 at timing synchronized with the timing detected by the timing detector. an electrical energy supply for supplying electrical energy for intraluminal defibrillation.

As described above, according to the configuration of FIG. 7, the defibrillator 100 performs an electrocardiogram (RA-CS lead electrocardiogram ), the timing corresponding to the R wave is detected from the electrocardiogram, and intracardiac defibrillation is performed on the RA electrode group 21Z and the CS electrode group 22Z shorted by the catheter short SW 230 at the timing synchronized with the detected timing. Therefore, even when using an electrode catheter 20 (FIG. 3) in which an electrode for potential measurement and an electrode for voltage application are shared, such as type 2, cardioversion can be performed. It becomes possible to perform intracardiac defibrillation without using an ECG signal from the polygraph examination device 300 . As a result, the number of cables can be reduced, and the degree of freedom in the arrangement layout of the devices in the examination room can be increased.

That is, the defibrillation system 2000 of FIG. 7 short-circuits the 8-pole RA electrode group 21Z and the 8-pole CS electrode group 22Z during intracardiac defibrillation. Incidentally, when measuring an intracardiac electrocardiogram, each electrode of the electrode catheter 20 is set in an open state without being short-circuited, so that the potential of each electrode is measured.

In addition, the defibrillator 40 of the defibrillation system 2000 of FIG. 7 short-circuits the RA electrode group 21Z and the CS electrode group 22Z during intracardiac defibrillation, and uses them as electrocardiogram measurement electrodes to generate an electrocardiogram. Then, the timing corresponding to the R wave is detected, and then the R wave synchronous energization is performed using the short-circuited RA electrode group 21Z and CS electrode group 21Z.

Here, FIG. 10, in which parts corresponding to those in FIG. 7 are assigned the same reference numerals, shows a comparative example with respect to the defibrillation systems 1000 and 2000 of the embodiment. The connection device 200 of the defibrillation system 3000 of the comparative example receives the ECG signal from the polygraph examination device 300 via the cable K3 and the terminal T3, and outputs it to the defibrillator 100 via the cable K0. The defibrillator 100 performs R-wave synchronous energization (cardioversion) using the input ECG signal. 10, the defibrillator 100 is attached to the body surface of the patient 10 via the body surface electrocardiogram input terminal 117 in addition to the ECG signal from the polygraph examination apparatus 300 via the cable K0. Although the state in which the measured potential obtained by the electrodes is input is shown, in reality, the R-wave synchronous energization can be performed if either one of the signals is present, so only one of them is connected. All you have to do is

Like the defibrillation system 3000 of the comparative example, the ECG signal is input to the defibrillator 100 from the polygraph examination apparatus 300, or the patient 10 Adopting a configuration in which a measured potential obtained by electrodes attached to the body surface is input increases the number of cables required for performing R-wave synchronous energization (cardioversion).

In contrast, according to the configuration of the above-described embodiment, the cables K0 and K1, which are the same as the cables K0 and K1 for supplying electrical energy for intracardiac defibrillation, are used to perform R-wave synchronous energization. Since an electrocardiogram that serves as a reference for (cardioversion) can be acquired, the cable K3 and the body surface electrocardiogram input cable K5 connected to the body surface electrocardiogram input terminal 117 can be eliminated, and the number of cables can be reduced.

The above-described embodiments are merely examples of specific implementations of the present invention, and the technical scope of the present invention should not be construed to be limited by these. That is, the present invention can be embodied in various forms without departing from its spirit or essential characteristics.

In the above embodiment, the case where the present invention is applied to the electrode catheter 20 shown in FIGS. 2 and 3 has been described, but the configuration of the electrode catheter to which the present invention is applicable is not limited to this. The configuration of the electrode catheter 20 may include an electrode capable of performing intracardiac defibrillation and an electrode capable of measuring an intracardiac potential.

Further, in the above-described embodiment, the case where the defibrillator 100 having both the intracardiac defibrillation function and the external defibrillation function is connected to the connection device 200 has been described. A first defibrillator with a defibrillation function and a second defibrillator with an external defibrillation function may be separately connected to the connection device 200 . However, if the defibrillator 100 having both the intracardiac defibrillation function and the external defibrillation function is connected to the connection device 200 as in the above-described embodiment, the connection device 200 and the defibrillator are connected. It is more preferable because only one cable is required to connect the moving device 100 .

In the above-described embodiment, the switching SW 220, the electrode catheter short-circuit SW 230, the ON/OFF switch 240 and the protection resistor 250 are provided in the connection device 200 separate from the defibrillator 100, but these are It may be built in the moving device 100 .

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

10 Patient 20 Electrode Catheter 21 RA Electrode Group 22 CS Electrode Group 30 Paddle/Pad 40, 100 Defibrillator 200 Connection Device 220 Switch SW
230 Catheter Short SW
240 ON/OFF switch
250 Protection resistance 300 Polygraph examination device 500 Extracorporeal paddles K0-K5 Cables K11, K12, K13, K14, K15, K111, K112 Conductors 1000, 2000, 3000 Defibrillation system

Claims (5)

an electrode catheter having an RA electrode placed in the right atrium and a CS electrode placed in the coronary sinus;
An intracardiac electrocardiogram is obtained based on the measured potentials of the RA electrode and the CS electrode input from the electrode catheter, the timing corresponding to the R wave is detected from the intracardiac electrocardiogram, and the timing is synchronized with the detected timing. a defibrillator that supplies electrical energy for intracardiac defibrillation to the RA electrode and the CS electrode;
An intracardiac defibrillation system comprising: Each of the RA electrode and the CS electrode is formed as a potential measuring electrode and a voltage applying electrode as separate electrodes,
The defibrillator obtains an electrocardiogram based on the measured potential obtained by the potential measurement electrodes, and supplies the electrical energy to the voltage application electrodes.
The intracardiac defibrillation system of claim 1 . In the RA electrodes, a plurality of RA electrodes are formed as common electrodes for potential measurement and voltage application, and in the CS electrodes, a plurality of CS electrodes are formed as common electrodes for potential measurement and voltage application. ,
The intracardiac defibrillation system includes a short state in which the plurality of RA electrodes are shorted together and the plurality of CS electrodes are shorted together, and a state in which the plurality of RA electrodes are not shorted together and the plurality of CS electrodes are shorted together. has a catheter short switch that can switch between an open state that does not short each
The defibrillator obtains an intracardiac electrocardiogram based on the measured potentials of the plurality of RA electrodes and the plurality of CS electrodes shorted by the catheter short switch, and obtains a timing corresponding to the R wave from the intracardiac electrocardiogram. is detected, and electrical energy for intracardiac defibrillation is supplied to the plurality of RA electrodes and the plurality of CS electrodes shorted by the catheter short switch at timing synchronized with the detected timing;
The intracardiac defibrillation system of claim 1 . The catheter short switch is in the short state during intracardiac defibrillation, and is in the open state during intracardiac electrocardiogram measurement,
4. The intracardiac defibrillation system of claim 3. A defibrillator connected to an electrode catheter for supplying electrical energy for intracardiac defibrillation to the electrode catheter,
a timing detection unit that obtains an intracardiac electrocardiogram based on the measured potentials of the RA electrode and the CS electrode of the electrode catheter input from the electrode catheter and detects the timing of R-wave synchronous energization based on the intracardiac electrocardiogram;
an electrical energy supply unit that supplies electrical energy for intracardiac defibrillation to the RA electrodes and the CS electrodes at timings synchronized with the timings detected by the timing detection unit;
A defibrillator comprising:

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