JP4677411B2 - 副交感神経刺激を用いたマルチサイト心室ペーシング治療 - Google Patents
副交感神経刺激を用いたマルチサイト心室ペーシング治療 Download PDFInfo
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- JP4677411B2 JP4677411B2 JP2006538456A JP2006538456A JP4677411B2 JP 4677411 B2 JP4677411 B2 JP 4677411B2 JP 2006538456 A JP2006538456 A JP 2006538456A JP 2006538456 A JP2006538456 A JP 2006538456A JP 4677411 B2 JP4677411 B2 JP 4677411B2
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- pacing
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- parasympathetic 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
- A61N1/3605—Implantable neurostimulators for stimulating central or peripheral nerve system
- A61N1/3606—Implantable neurostimulators for stimulating central or peripheral nerve system adapted for a particular treatment
- A61N1/36114—Cardiac control, e.g. by vagal 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
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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
- A61N1/3621—Heart stimulators for treating or preventing abnormally high heart rate
- A61N1/3622—Heart stimulators for treating or preventing abnormally high heart rate comprising two or more electrodes co-operating with different heart regions
-
- 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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- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
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- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Veterinary Medicine (AREA)
- Physiology (AREA)
- Biophysics (AREA)
- Neurology (AREA)
- Neurosurgery (AREA)
- Electrotherapy Devices (AREA)
Description
埋め込み型心臓デバイスは、通常、該デバイスとセンシングと刺激に使用される電極とを接続するために、リードが経静脈的に心臓へと通された状態で、患者の胸部に皮下または筋肉下に設置される。また、様々な手段によってリードを心外膜上に位置決めすることもできる。プログラム可能な電子コントローラが、経過時間間隔とセンシングされた電気活動(すなわち、刺激パルスに起因しない固有の心臓の鼓動)に応答して、刺激パルスを出力させる。デバイスは、センシングすべき心腔の近くに配置された内部電極を用いて、固有の心臓電気活動をセンシングする。本デバイスによって検出される心房または心室の固有の収縮に付随した脱分極波は、それぞれ、心房センスまたは心室センスと呼ばれる。固有の鼓動が存在しない状態でそのような収縮を引き起こすために、刺激パルス(特定の律動を強制維持するために供給されるときには、ペースまたはペーシング・パルスとしても知られる)が、特定の閾値を上回るエネルギーで心腔に供給される。
以下で、伝導の欠陥の理由から心拍出量が不十分であり、かつ心室リモデリングの危険がある心不全患者の場合に適用できる、例示的なアルゴリズムについて説明する。心室壁応力を低減させるために単に副交感神経刺激を与えると、リモデリングの危険が小さくなるが、また、既に不十分な患者の心拍出量がさらに減少する虞もある。しかし、副交感神経刺激とマルチサイト心室再同期ペーシング(例えば、両心室ペーシング)とを組み合わせることによって、心拍出量に悪影響を及ぼすことなく副交感神経刺激が可能になるように患者の心室機能を改善することができる。患者の心拍出量が適切なままであることをさらに保証するために、そのときに適切なマッピング関数から決定された心拍出量の適切性を用いて、埋め込み型デバイスによって心拍出量と活動レベルの測定を実施することができる。次いで、副交感神経刺激を行うことができ、また上記決定に基づかずに行うことができる。
Claims (20)
- 患者に心機能治療を行う埋め込み型デバイスであって、
多数の心室部位にペーシング・チャネルを介してペーシング・パルスを供給する複数のパルス発生器と、
副交感神経刺激チャネルを介して刺激パルスを供給して、心臓を神経支配する副交感神経を刺激するパルス発生器と、
プログラムされたペーシング・モードに従って、心周期の間、多数の心室部位へのペーシング・パルスの供給を制御するコントローラとを含んでおり、
前記コントローラが、心室壁応力を低減する副交感神経刺激と併せてマルチサイト心室ペーシング治療を行うようにプログラムされ、
前記コントローラが、さらに、前記副交感神経刺激による心拍数の緩徐化を相殺するデマンド・ペーシング・モードに従ってマルチサイト心室ペーシングを行うようにプログラムされる、デバイス。 - 心拍出量を測定するセンサをさらに含んでおり、前記コントローラが、測定された心拍出量に従って副交感神経刺激の供給を調節するようにプログラムされる請求項1に記載のデバイス。
- 前記心拍出量を測定するセンサが経胸腔インピーダンス測定回路である請求項2に記載のデバイス。
- 前記コントローラが、心拍出量が指定の限界値を上回るときにだけ副交感神経刺激を供給するようにプログラムされる請求項2に記載のデバイス。
- 前記コントローラが、測定された心拍出量に従って副交感神経刺激の供給を調節するようにプログラムされる請求項2に記載のデバイス。
- 患者の活動レベルを測定する活動レベル・センサをさらに含んでおり、前記コントローラが、測定された活動レベルに従って副交感神経刺激の供給を調節するようにプログラムされる請求項1から5のいずれか一項に記載のデバイス。
- 前記コントローラが、測定された活動レベルが指定の限界値を下回るときにだけ副交感神経刺激を供給するようにプログラムされる請求項6に記載のデバイス。
- 患者の活動レベルを測定する活動レベル・センサと、
心拍出量を測定するセンサとをさらに含んでおり、
前記コントローラが、測定された活動レベルと測定された心拍出量に従って副交感神経刺激の供給を調節するようにプログラムされる請求項1に記載のデバイス。 - 前記コントローラが、その時点で測定された心拍出量と活動レベルの、算出された関数によって、心拍出量が適切であることが示されるときにだけ、副交感神経刺激を供給するようにプログラムされる請求項7に記載のデバイス。
- 前記活動レベル・センサが分時換気センサである請求項6から9のいずれか一項に記載のデバイス。
- 前記活動レベル・センサが加速度計である請求項6から9のいずれか一項に記載のデバイス。
- 前記副交感神経刺激チャネルに、経静脈挿入に適合されたリードに組み込まれた双極電極が含まれる請求項1から11のいずれか一項に記載のデバイス。
- 前記副交感神経刺激チャネルに、カルジオバージョン/除細動ショックを心臓に供給するために通常使用されるショック・リード内に組み込まれた双極電極が含まれる請求項1から11のいずれか一項に記載のデバイス。
- 前記副交感神経刺激チャネルが、方形波パルス列の形態で副交感神経刺激を供給する請求項1から13のいずれか一項に記載のデバイス。
- 前記副交感神経刺激チャネルが、切頂指数関数形のパルス列の形態で副交感神経刺激を供給する請求項1から13のいずれか一項に記載のデバイス。
- 前記副交感神経刺激チャネルが、5〜50Hzの間の周波数で副交感神経刺激を供給する請求項1から15のいずれか一項に記載のデバイス。
- 前記マルチサイト心室ペーシング治療が、最低心室レートを強制維持するデマンド・ペーシング・モードに従って供給される請求項1から16のいずれか一項に記載のデバイス。
- 心房ペーシング・チャネルをさらに含んでおり、前記マルチサイト心室ペーシング治療が、心房ペーシングによって最低心房レートを強制維持するデマンド・ペーシング・モードに従って行われる請求項1から17のいずれか一項に記載のデバイス。
- 心房センシング・チャネルをさらに含んでおり、前記マルチサイト心室ペーシング治療が、心房トラッキング・ペーシング・モードに従って供給される請求項1から18のいずれか一項に記載のデバイス。
- 前記マルチサイト心室ペーシング治療が、所定のオフセットをもつ両心室ペーシングである請求項1から19のいずれか一項に記載のデバイス。
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US10/700,368 US7657312B2 (en) | 2003-11-03 | 2003-11-03 | Multi-site ventricular pacing therapy with parasympathetic stimulation |
PCT/US2004/036606 WO2005042091A1 (en) | 2003-11-03 | 2004-11-03 | Multi-site ventricular pacing therapy with parasympathetic stimulation |
Publications (2)
Publication Number | Publication Date |
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JP2007510467A JP2007510467A (ja) | 2007-04-26 |
JP4677411B2 true JP4677411B2 (ja) | 2011-04-27 |
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JP2006538456A Expired - Fee Related JP4677411B2 (ja) | 2003-11-03 | 2004-11-03 | 副交感神経刺激を用いたマルチサイト心室ペーシング治療 |
Country Status (4)
Country | Link |
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US (2) | US7657312B2 (ja) |
EP (2) | EP1684857A1 (ja) |
JP (1) | JP4677411B2 (ja) |
WO (1) | WO2005042091A1 (ja) |
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EP2263748A1 (en) | 2010-12-22 |
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EP1684857A1 (en) | 2006-08-02 |
US8571655B2 (en) | 2013-10-29 |
US20050096705A1 (en) | 2005-05-05 |
EP2263748B1 (en) | 2016-01-06 |
WO2005042091A1 (en) | 2005-05-12 |
JP2007510467A (ja) | 2007-04-26 |
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