JP4237058B2 - 両心室融合ペーシングのためのシステムおよび方法 - Google Patents
両心室融合ペーシングのためのシステムおよび方法 Download PDFInfo
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- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/362—Heart stimulators
- A61N1/3627—Heart stimulators for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
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- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—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
- A61N1/368—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions
- A61N1/3684—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions for stimulating the heart at multiple sites of the ventricle or the atrium
- A61N1/36842—Multi-site stimulation in the same chamber
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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
- A61N1/368—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions
- A61N1/3684—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions for stimulating the heart at multiple sites of the ventricle or the atrium
- A61N1/36843—Bi-ventricular stimulation
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—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
- A61N1/368—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions
- A61N1/3682—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions with a variable atrioventricular delay
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—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
- A61N1/368—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions
- A61N1/3684—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions for stimulating the heart at multiple sites of the ventricle or the atrium
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Description
[発明の概要]
本発明者は、CHFを呈する特定の心臓において、LVの誘発脱分極がRVの内因性脱分極と融合して行われるように、LV−PACEパルスをタイミングをとって送出することによって、心拍出量が向上することを見いだした。先行する内因性または誘発心房脱分極波面の完全なA−V伝導によりRVがまず脱分極するが、LVのA−V伝導脱分極が過度に遅延しているような心臓において、融合脱分極は心拍出量を向上させる。LVの融合脱分極は、時間的にRVの内因性脱分極の後であるが、時間的にLVの内因性脱分極の前になるように、LV−PACEパルスをタイミングをとって送出することによって達成される。有利には、RV−PACEパルスは、RV−EVENTの際にRV−PACEの阻止により送出されず、それにより波面の自然伝播および中隔の脱分極を可能にする一方で、LV−PACEパルスが、RV脱分極と融合して早期に送出される。
ステップS420の条件が満たされない場合、両心室ペーシングに転換する必要がある。その場合、RV−PACEがまず送出された後、LV−PACEが送出される。ステップS424で、公式 A−RVp=A−RVs−Δms によって、現在測定されている内因性A−RVs遅延を反映するように、A−RVp遅延を調整する。ここでΔmsは、プログラムされた値(例えば、10ミリ秒)、または測定された内因性A−LVs伝導遅延もしくはA−LVs/測定された内因性A−A周期長の適応値(例えば、百分率、例えば10%)である。
好ましい実施形態のペーシングシステムの上記の構成、機能および動作のいくつかは、本発明を実施するために必要ではなく、単に例示的実施形態を完全にするためにのみ説明に含まれていることが理解されよう。また、AV同期三腔または四腔ペースメーカの典型的動作にとって副次的な他の構成、機能および動作であって、開示されていないもの、および本発明の実施に必要でないものもあり得ることが理解されよう。
Claims (15)
- 先行する心房事象、即ちA事象以降で、かつ時間的に右心室の脱分極の後に同時にタイミングをとった心室ペーシングパルスを心臓の左心室部位に送出する複数部位心臓ペーシングシステムであって、
左心室の心室脱分極を、左心室検知事象、即ちLVs事象として検知する左心室検知手段と、
心房事象と前記LVs事象の間の内因性心房左心室遅延を、内因性A−LVs遅延として測定する手段と、
右心室の心室脱分極を、右心室検知事象、即ちRVs事象として検知する右心室検知手段と、
心房事象と前記RVs事象の間の内因性心房右心室遅延を、内因性A−RVs遅延として測定する手段と、
前記内因性A−LVs遅延より短く、前記内因性A−RVs遅延より長い左心室A−LVp遅延を決定する手段と、
前記心房事象から前記A−LVp遅延をタイムアウトさせる手段と、
右心室の内因性脱分極との左心室の融合ペーシングを行うために、前記A−LVp遅延のタイムアウト時に左心室に左心室ペーシングパルスを送出する手段と、
を備える複数部位心臓ペーシングシステム。 - 前記決定する手段は、プログラム可能なファクタによって、前記内因性A−LVs遅延より短くなるように前記A−LVp遅延を設定する手段を備える請求項1に記載の複数部位心臓ペーシングシステム。
- 前記決定する手段は、前記決定されたA−LVp遅延を前記内因性A−RVs遅延と比較し、前記決定されたA−LVp遅延が前記内因性A−RVs遅延より短い場合、前記内因性A−RVs遅延および前記決定されたA−LVp遅延より短い右心室A−RVp遅延を決定する手段を含み、該システムは、
右心室および左心室の両心室ペーシングを行うために、前記心房事象から前記A−RVp遅延をタイムアウトさせ、前記A−RVp遅延のタイムアウト時に右心室に右心室ペーシングパルスを送出する手段、
をさらに備える請求項2に記載の複数部位心臓ペーシングシステム。 - 前記決定する手段は、前記決定されたA−LVp遅延を前記内因性A−RVs遅延と比較し、前記決定されたA−LVp遅延が前記内因性A−RVs遅延より長い場合、前記内因性A−RVs遅延より長い右心室A−RVp遅延を決定する手段をさらに備える請求項2に記載の複数部位心臓ペーシングシステム。
- 前記決定する手段は、前記決定されたA−LVp遅延を前記内因性A−RVs遅延と比較し、前記決定されたA−LVp遅延が前記内因性A−RVs遅延より短い場合、前記内因性A−RVs遅延および前記決定されたA−LVp遅延より短い右心室A−RVp遅延を決定する手段を含み、該システムは、
右心室および左心室の両心室ペーシングを行うために、前記心房事象から前記A−RVp遅延をタイムアウトさせ、前記A−RVp遅延のタイムアウト時に右心室に右心室ペーシングパルスを送出する手段、
をさらに備える請求項4に記載の複数部位心臓ペーシングシステム。 - 前記決定する手段は、前記決定されたA−LVp遅延を前記内因性A−RVs遅延と比較し、前記決定されたA−LVp遅延が前記内因性A−RVs遅延より短い場合、前記内因性A−RVs遅延および前記決定されたA−LVp遅延より短い右心室A−RVp遅延を決定する手段を含み、該システムは、
右心室および左心室の両心室ペーシングを行うために、前記心房事象から前記A−RVp遅延をタイムアウトさせ、前記A−RVp遅延のタイムアウト時に右心室に右心室ペーシングパルスを送出する手段、
をさらに備える請求項1に記載の複数部位心臓ペーシングシステム。 - 心拍出量に対する患者の生理的需要を示すレート制御パラメータを監視する手段と、
前記監視されたレート制御パラメータを反映するように前記決定されたA−LVp遅延を調整する手段と、
をさらに備える請求項1に記載の複数部位心臓ペーシングシステム。 - 前記調整する手段は、
前記監視されたレート制御パラメータが心拍出量に対する需要の増大を示す時に前記A−LVp遅延を減少させ、前記監視されたレート制御パラメータが心拍出量に対する需要の減少を示す時に前記A−LVp遅延を増大させる手段、
をさらに備える請求項7に記載の複数部位心臓ペーシングシステム。 - 患者の心臓の内因性心房レートを監視する手段と、
前記監視された心房レートを反映するように前記決定されたA−LVpを調整する手段と、
をさらに備える請求項1に記載の複数部位心臓ペーシングシステム。 - 前記調整する手段は、
前記監視された心房レートが短くなった時に前記A−LVp遅延を減少させる手段と、
前記監視された心房レートが長くなった時に前記A−LVp遅延を増大させる手段と、をさらに備える請求項9に記載の複数部位心臓ペーシングシステム。 - 前記A−LVp遅延のタイムアウト中に内因性LVs事象を検知する手段と、
検知された内因性LVs事象に応答して前記A−LVp遅延を減少させる手段と、
をさらに備える請求項1に記載の複数部位心臓ペーシングシステム。 - 前記A−RVp遅延のタイムアウト中に内因性RVs事象を検知する手段と、
検知された内因性RVs事象に応答して前記A−RVp遅延を減少させる手段と、
をさらに備える請請求項1に記載の複数部位心臓ペーシングシステム。 - 先行する心房事象以降で、かつ時間的に右心室および左心室の他方V2の脱分極の後にタイミングをとった心室ペーシングパルスを心臓の右心室および左心室の少なくとも一方V1に送出する心臓ペーシングシステムであって、
心房事象、A事象からの房室遅延、A−V1pを確定する手段であって、それによって、心室V1への心室ペーシングパルスV1pをタイミングをとって送出することが、
心室V1の心室脱分極を、心室検知事象、V1s事象として検知すること、
心房事象と前記V1s事象の間の内因性房室遅延を内因性A−V1s遅延として測定すること、
心室V2の心室脱分極を、心室検知事象、V2s事象として検知すること、
心房事象と前記V2s事象の間の内因性房室遅延を内因性A−V2s遅延として測定すること、
前記内因性A−V1s遅延より短く、前記内因性A−V2s遅延より長い房室A−V1p遅延を決定すること、
によって行われる、A−V1pを確定する手段と、
各心房事象から前記A−V1p遅延をタイムアウトさせる手段と、
心室V2の内因性脱分極との心室V1の融合ペーシングを行うために、前記A−V1p遅延のタイムアウト時に心室V1に心室ペーシングパルスV1pを送出する手段と、
を備える心臓ペーシングシステム。 - 心室V1は右心室であり、心室V2は左心室である請求項13に記載の心臓ペーシングシステム。
- 心室V1は左心室であり、心室V2は右心室である請求項13に記載の心臓ペーシングシステム。
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
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US10/000,474 US6871096B2 (en) | 2001-10-26 | 2001-10-26 | System and method for bi-ventricular fusion pacing |
PCT/US2002/031136 WO2003037427A1 (en) | 2001-10-26 | 2002-10-01 | System and method for bi-ventrcular fusion pacing |
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JP2005507720A JP2005507720A (ja) | 2005-03-24 |
JP4237058B2 true JP4237058B2 (ja) | 2009-03-11 |
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EP (1) | EP1446191B1 (ja) |
JP (1) | JP4237058B2 (ja) |
CA (1) | CA2463888A1 (ja) |
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