JP4406720B2 - 左心室加速度に基づいて心臓再同期化治療を最適化する方法及び装置 - Google Patents
左心室加速度に基づいて心臓再同期化治療を最適化する方法及び装置 Download PDFInfo
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- JP4406720B2 JP4406720B2 JP2006508768A JP2006508768A JP4406720B2 JP 4406720 B2 JP4406720 B2 JP 4406720B2 JP 2006508768 A JP2006508768 A JP 2006508768A JP 2006508768 A JP2006508768 A JP 2006508768A JP 4406720 B2 JP4406720 B2 JP 4406720B2
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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
- A61N1/3627—Heart stimulators for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
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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
- A61N1/36843—Bi-ventricular stimulation
-
- 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
- A61N1/36514—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by a physiological quantity other than heart potential, e.g. blood pressure
- A61N1/36542—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by a physiological quantity other than heart potential, e.g. blood pressure controlled by body motion, e.g. acceleration
-
- 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
- A61N1/36514—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by a physiological quantity other than heart potential, e.g. blood pressure
- A61N1/36578—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by a physiological quantity other than heart potential, e.g. blood pressure controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone
-
- 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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- Biomedical Technology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Radiology & Medical Imaging (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Veterinary Medicine (AREA)
- Physiology (AREA)
- Biophysics (AREA)
- Hospice & Palliative Care (AREA)
- Electrotherapy Devices (AREA)
- Measurement Of The Respiration, Hearing Ability, Form, And Blood Characteristics Of Living Organisms (AREA)
Description
Claims (13)
- 心室間(V−V)同期性を最適化し、該最適化の結果として、閉ループ心臓再同期化治療を送出する装置であって、
左心室の一部と電気的に接続し、且つパルス発生器のペーシング回路に電気結合する左ペーシング電極(50)と、
右心室の一部と電気的に接続し、且つ前記パルス発生器のペーシング回路に電気結合する右ペーシング電極(38)と、
を備えるものであり、
以下の、
左心室の側壁の心外膜又は心膜の一部の中に、又はその上に、機械的に結合されるように、心外膜リード線に位置して、左心室の側壁の一部の運動を測定し、そのような運動に関連する左心室加速度信号を提供し、パルス発生器に結合される運動測定回路に結合される、加速度トランスデューサ手段(62)、及び、
少なくとも1つの心周期の間に心室間(V−V)間隔を反復して変更し、且つ心周期の等容性収縮部分の間に取得された前記左心室加速度信号の第1ピークに対応するピーク振幅値を、前記心周期中に使用される前記心室間(V−V)間隔について記憶し、また、該記憶したピーク振幅を比較し、その後、前記最大のピーク振幅に対応する心室間(V−V)間隔に基づいて最適化した心室間(V−V)間隔をプログラムするための心室間(V−V)間隔最適化手段(102)と、
を備えることを特徴とする、閉ループ心臓再同期化治療を送出する装置。 - 前記パルス発生器が、埋め込み可能なパルス発生器(14)である、請求項1に記載の装置。
- 前記パルス発生器が、更に、
前記心臓の少なくとも1つの心腔、及び、前記パルス発生器内に配置される高電圧回路と電気的に接続する、少なくとも1つのディフィブリレーション電極と、
を備える、
請求項1又は2に記載の装置。 - 前記側壁の一部が、前記側壁の中間−基底部分である、請求項1ないし3に記載の装置。
- 心房腔と電気的に接続し、前記パルス発生器のペーシング回路に電気結合する、ペーシング電極を更に備える、請求項4に記載の装置。
- 請求項1に記載の装置において、左心室機能を評価し、且つ、心臓ペーシング間隔を最適化するための方法を実行するための命令でプログラミングされた、コンピュータ可読媒体であって、
心臓の左心室腔の側壁の一部の運動を、前記配置された加速度トランスデューサ手段で検知し、前記トランスデューサから当該運動に関連する左心室加速度信号を測定するための命令、
を備え、
以下の、
1つの心室と電気的に接続する第1のペーシンング電極と、他の心室と電気的に接続する第2のペーシング電極との、心室間(V−V)タイミング・パラメータを、心周期の、所定の時間間隔にわたって、又は、所定の数にわたって、反復的に調整するための命令、
心室間(V−V)タイミング・パラメータの少なくとも2つを記憶するための命令、及び、当該心室間(V−V)タイミング・パラメータの少なくとも2つの各々のために、各記憶された心室間(V−V)タイミング・パラメータを、心周期の等容性収縮部分の間に得られた前記左室加速度信号の第1のピークに対応するピーク振幅値に関連付けるための命令、
前記記憶された複数のピーク振幅値の大きさを比較するための命令、及び、
最も大きい、記憶されたピーク振幅値に対応する、心室間(V−V)タイミング・パラメータを用いて、最適化された心室間(V−V)間隔をプログラミングするための命令、
を更に備えることを特徴とするコンピュータ可読媒体。 - 前記トランスデューサ手段が、冠状静脈洞血管の一部、即ち、当該冠状静脈洞に流体結合した血管内に配置されるようにされる、
請求項6に記載のコンピュータ可読媒体。 - 前記加速度トランスデューサ手段が、前記心臓の左心室心尖部に向かって整列した、長手方向検知軸を有する単軸加速度計を備える、
請求項6に記載のコンピュータ可読媒体。 - 前記加速度トランスデューサ手段が2軸加速度計を備える、請求項6に記載のコンピュータ可読媒体。
- 前記加速度トランスデューサ手段が3軸加速度計を備える、請求項6に記載のコンピュータ可読媒体。
- 前記装置が、埋め込み可能な医療デバイスを備える、請求項6に記載のコンピュータ可読媒体。
- 前記第1のペーシング電極、又は、前記第2のペーシング電極が、更に、前記装置に接続された検知回路と電気的に接続する検知電極を備え、
更に、
脱分極波活動を測定し、少なくとも部分的に、当該測定された脱分極波活動に関連する、少なくとも一時的に、少なくとも1つのパラメータを記憶するための命令を備える、
請求項11に記載のコンピュータ可読媒体。 - 前記装置に結合され、前記心臓に隣接して配置された少なくとも1つの高電圧電極と電気的に通信状態にある、可変電圧ディフィブリレーション回路を更に備える、
請求項12に記載のコンピュータ可読媒体。
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US10/377,207 US6885889B2 (en) | 2003-02-28 | 2003-02-28 | Method and apparatus for optimizing cardiac resynchronization therapy based on left ventricular acceleration |
PCT/US2004/004902 WO2004078257A1 (en) | 2003-02-28 | 2004-02-19 | Method and appartus for optimizing cardiac resynchronization therapy based on left ventricular acceleration |
Publications (2)
Publication Number | Publication Date |
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JP2006519085A JP2006519085A (ja) | 2006-08-24 |
JP4406720B2 true JP4406720B2 (ja) | 2010-02-03 |
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Application Number | Title | Priority Date | Filing Date |
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JP2006508768A Expired - Fee Related JP4406720B2 (ja) | 2003-02-28 | 2004-02-19 | 左心室加速度に基づいて心臓再同期化治療を最適化する方法及び装置 |
Country Status (7)
Country | Link |
---|---|
US (1) | US6885889B2 (ja) |
EP (1) | EP1599257B1 (ja) |
JP (1) | JP4406720B2 (ja) |
AU (1) | AU2004218488A1 (ja) |
CA (1) | CA2517173A1 (ja) |
DE (1) | DE602004016122D1 (ja) |
WO (1) | WO2004078257A1 (ja) |
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IT1256900B (it) * | 1992-07-27 | 1995-12-27 | Franco Vallana | Procedimento e dispositivo per rilevare la funzionalita` cardiaca. |
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IT1260692B (it) * | 1993-10-05 | 1996-04-22 | Sorin Biomedica Spa | Dispositivo per la determinazione della funzione miocardica e relativoprocedimento. |
US5549652A (en) * | 1993-11-15 | 1996-08-27 | Pacesetter, Inc. | Cardiac wall motion-based automatic capture verification system and method |
US6077236A (en) * | 1994-06-07 | 2000-06-20 | Cunningham; David | Apparatus for monitoring cardiac contractility |
US5549650A (en) * | 1994-06-13 | 1996-08-27 | Pacesetter, Inc. | System and method for providing hemodynamically optimal pacing therapy |
US5540727A (en) * | 1994-11-15 | 1996-07-30 | Cardiac Pacemakers, Inc. | Method and apparatus to automatically optimize the pacing mode and pacing cycle parameters of a dual chamber pacemaker |
US5836987A (en) * | 1995-11-15 | 1998-11-17 | Cardiac Pacemakers, Inc. | Apparatus and method for optimizing cardiac performance by determining the optimal timing interval from an accelerometer signal |
US5941904A (en) * | 1997-09-12 | 1999-08-24 | Sulzer Intermedics Inc. | Electromagnetic acceleration transducer for implantable medical device |
US6070100A (en) * | 1997-12-15 | 2000-05-30 | Medtronic Inc. | Pacing system for optimizing cardiac output and determining heart condition |
US6122545A (en) * | 1998-04-28 | 2000-09-19 | Medtronic, Inc. | Multiple channel sequential cardiac pacing method |
AU3219001A (en) | 2000-02-09 | 2001-08-20 | Impulse Dynamics N.V. | Cardiac control using paired pacing |
US6477417B1 (en) * | 2001-04-12 | 2002-11-05 | Pacesetter, Inc. | System and method for automatically selecting electrode polarity during sensing and stimulation |
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CA2517173A1 (en) | 2004-09-16 |
EP1599257A1 (en) | 2005-11-30 |
JP2006519085A (ja) | 2006-08-24 |
DE602004016122D1 (de) | 2008-10-09 |
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