JP6667339B2 - Intracardiac defibrillation system, connection device in intracardiac defibrillation system, and defibrillator - Google Patents

Description

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

  In atrial fibrillation ablation treatment, atrial fibrillation, atrial flutter, or atrial tachycardia may occur when atrial fibrillation is induced to identify the cause site or as an intraoperative spontaneous attack. With intracardiac defibrillation, when it is necessary to stop atrial fibrillation generated during surgery by electrical defibrillation, by applying electrical energy to an electrode catheter that is indwelled in the heart chamber in advance It removes fibrillation. According to the intracardiac defibrillation, less electric energy needs to be given to the patient as compared with the external defibrillation (for example, while the external defibrillation is about 150 to 200 J, the intracardiac defibrillation is performed). (30 J or less in motion), which has the advantage of reducing the burden on the patient.

  Before the intracardiac defibrillation system is used, when measuring the intracardiac electrocardiogram, connect the terminal of the electrode catheter to the terminal of the polygraph inspection device, when performing intracardiac defibrillation, The medical staff such as a doctor had to manually perform the operation of connecting the terminal of the electrode catheter to the terminal of the defibrillator. Therefore, when reconnecting the terminal of the electrode catheter, the intracardiac electrogram cannot be measured temporarily.

  Patent Literature 1 discloses that a one-circuit, two-contact switch for switching between a polygraph inspection apparatus and a defibrillator and an electrode catheter is provided. According to this configuration, it is considered that the labor of medical staff can be reduced as compared with a case where the terminal of the electrode catheter is reinserted manually. In addition, when the terminal of the electrode catheter is reinserted, the inconvenience that the intracardiac electrogram cannot be measured temporarily can be solved.

JP 2010-220778 A

  By the way, in the configuration of switching between a polygraph examination apparatus (electrocardiograph) and a defibrillator and an electrode catheter by a changeover switch having one circuit and two contacts as in Patent Literature 1, an intracardiac during defibrillation is performed. ECG measurements cannot be made. Specifically, in Patent Document 1, an electrode catheter is connected to a common contact of a one-circuit two-contact changeover switch, an electrocardiograph is connected to a first contact, a defibrillator is connected to a second contact, and When the electrode catheter is connected to the defibrillator, that is, when the defibrillation is performed, the electrocardiograph is configured to connect the electrode to the first or second contact. Since it is not connected to a catheter, an intracardiac electrocardiogram during defibrillation cannot be obtained.

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

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

One embodiment of the intracardiac defibrillation system of the present invention,
An electrocardiograph that obtains an electrocardiogram based on the electrocardiogram obtained by the electrode catheter,
A defibrillator that supplies electrical energy for intracardiac defibrillation to the electrode catheter,
A connection device for connecting the electrode catheter, the electrocardiograph and the defibrillator,
Has,
The connection device,
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 protection resistor provided on the second connection line in parallel with the on / off switch;
A control unit for controlling the on / off switch,
Prepared,
When performing intracardiac defibrillation,
The control unit opens the on / off switch, and as a result, the connection device prevents the current from flowing from the defibrillator to the electrocardiograph through the on / off switch, and also controls the protection resistor. The input of an intracardiac potential from the electrode catheter to the electrocardiograph via the electrocardiograph via the electrocardiograph enables the measurement of an intracardiac electrogram with the electrocardiograph .

One embodiment of the connection device in the intracardiac defibrillation system of the present invention,
A first terminal portion to which the electrode catheter is connected;
A second terminal to which the defibrillator is connected;
A third terminal to which the electrocardiograph is connected;
A first connection line connecting the first terminal unit and the second terminal unit;
A second connection line connecting the first terminal unit and the third terminal unit;
An on / off switch provided on the second connection line;
A protection resistor provided on the second connection line in parallel with the on / off switch;
A control unit for controlling the on / off switch,
Has,
When performing intracardiac defibrillation,
The control unit opens the on / off switch, and as a result, prevents the current from flowing from the defibrillator to the electrocardiograph via the on / off switch, while preventing the electrode from passing through the protection resistor. The input of the intracardiac potential from the catheter to the electrocardiograph is maintained, and the electrocardiogram can be measured by the electrocardiograph .

One embodiment of the defibrillator of the present invention,
A defibrillation module that generates electrical energy for intracardiac defibrillation;
A first connection line for supply feeding the electric energy generated by the defibrillation module 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 protection resistor provided on the second connection line in parallel with the on / off switch;
With
When performing intracardiac defibrillation,
The on / off switch is in an open state, and as a result, while preventing current from flowing from the defibrillation module to the electrocardiograph via the on / off switch, the electrode catheter from the electrode catheter via the protective resistor. The input of the intracardiac potential to the electrocardiograph is maintained, and the electrocardiogram can be measured by the electrocardiograph .

  According to the present invention, the electrocardiograph can be protected from the energy of defibrillation, and the intracardiac electrocardiogram can be measured even during the execution of intracardiac defibrillation.

FIG. 1 is a schematic diagram showing an overall configuration of an intracardiac defibrillation system according to Embodiment 1. Diagram showing the state during intracardiac electrogram measurement Diagram showing the state during execution of 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> First embodiment
<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 inspection device 120 having a function as an electrocardiograph, an electrode catheter 130, an extracorporeal paddle 140, and a connection device 200. The defibrillator 110, the polygraph examination device 120, the electrode catheter 130, and the extracorporeal paddle 140 are connected by the connection device 200. In the present embodiment, connection device 200 is separate from defibrillator 110, but connection device 200 may be integrated with defibrillator 110 and integrated into defibrillator 110. . This configuration will be described in detail in Embodiment 2. Further, in the present embodiment, an extracorporeal paddle 140 is taken as an example of a device for performing extracorporeal defibrillation, but an electrode pad or an intracorporeal paddle may be used instead of extracorporeal paddle 140.

  The defibrillator 110 can generate electrical energy for performing intracardiac defibrillation by the electrode catheter 130 and electrical energy for performing external defibrillation by the extracorporeal paddle 140. In addition, 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 electrode attached to the body surface of the patient 10.

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

  The polygraph inspection apparatus 120 has an intracardiac potential input terminal 121 and a body surface electrocardiogram input terminal 122. Although not shown, the polygraph inspection apparatus 120 includes a calculation unit that forms an intracardiac electrocardiogram and a body surface electrocardiogram from the measured potential input from the body surface electrocardiogram input terminal unit 122, and a display unit that displays the electrocardiogram. , A control unit and the like.

  The electrode catheter 130 is connected to the connection device 200 via the relay cable 131. In practice, the electrode catheter 130 comprises eight RA electrodes placed in the right atrium, eight CS electrodes placed in the coronary sinus, and four EP electrodes (SVC) placed in the superior vena cava. Electrodes, IVC electrodes, etc.). Among these electrodes, the RA electrode and the CS electrode are used for performing intracardiac defibrillation, and the RA electrode, the CS electrode, and the EP electrode are used for measuring an intracardiac potential.

  The extracorporeal paddle 140 is composed of a pair of paddles each having an extracorporeal defibrillation electrode. A charging operation switch 141 and an energizing operation switch 142 are provided on a handle portion of the paddle, and the user operates the charging operation switch 141 and the energizing operation switch 142. By operating, the defibrillator 110 can perform a charging operation and can receive the supply of energy for defibrillation from the defibrillator 110.

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

  In addition, the connection device 200 has a defibrillator connection terminal 211, an extracorporeal paddle connection terminal 212, an electrode catheter connection terminal 213, and a polygraph connection terminal 214, and via the defibrillator connection terminal 211. The electrical energy for external defibrillation or intracardiac defibrillation is input from the defibrillator 110 and the electrical energy for external defibrillation is supplied to the external paddle 140 via the external paddle connection terminal 212. And outputs electrical energy for intracardiac defibrillation to the electrode catheter 130 via the electrode catheter connection terminal 213, and outputs intracardiac potential to the polygraph inspection apparatus 120 via the polygraph connection terminal 214. I do. The connection device 200 also receives a charge switch operation signal and an energization switch operation signal from the extracorporeal paddle 140 via the extracorporeal paddle connection terminal 212, and inputs these signals to the defibrillator via the defibrillator connection terminal 211. Output to 110. In addition, the connection device 200 inputs an intracardiac potential via the electrode catheter connection terminal portion 213 and outputs this 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 switch SW220 is selected according to the operation of the switch SW201 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, and when the user selects the intracardiac defibrillation by the switching operation SW201, the switching SW220 is connected to the contact b. Connecting.

  An electrode catheter short SW 230 is provided between the contact b of the switching SW 220 and the electrode catheter connection terminal 213. The electrode catheter short SW 230 shorts a plurality of electrodes provided on the electrode catheter 130. Thus, the contact area with the heart wall can be increased to lower the impedance, and the defibrillation energy of the set Joule number can be transmitted to the heart wall. Specifically, the electrode catheter short SW 230 shorts the eight RA electrodes and the eight CS electrodes during intracardiac defibrillation. FIG. 1 shows a state in which each of the eight RA electrodes and the eight CS electrodes is short-circuited. The electrode catheter short SW 230 opens the electrodes of the electrode catheter 130 without short-circuiting during intracardiac electrocardiogram measurement. Thus, the potential of each electrode can be measured at the time of measuring the intracardiac electrogram.

  Further, in the connection device 200, an on / off SW 240 and a protective resistor 250 are connected between the contact b of the switching SW 220 and the connection middle point between the electrode catheter connection terminal 213 and the polygraph connection terminal 214. The protection resistor 250 is connected in parallel with the on / off switch 240. The on / off SW 240 is provided with a total of 16 on / off switches corresponding to the eight RA electrodes and the eight CS electrodes, and the protection resistor 250 is provided with eight RA electrodes and eight CS electrodes. A total of 16 corresponding resistors are provided. In FIG. 1, for simplification of the drawing, one on / off SW and one resistor are shown for eight RA electrodes, and one on / off SW and one resistor are shown for eight CS electrodes.

  The resistance value of each resistor constituting the protection resistor 250 is, for example, several hundred kΩ. This resistance value may be any value that can protect the polygraph inspection apparatus 120 when energy for intracardiac defibrillation 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, the control unit 260 sets the electrode catheter short SW 230 to the open state and sets the on / off SW 240 to the on state (that is, the closed state) when measuring the intracardiac electrocardiogram. On the other hand, when executing intracardiac defibrillation, the control unit 260 sets the electrode catheter short SW 230 to the short state and sets the ON / OFF SW 240 to the OFF state (that is, the open state). The control unit 260 determines whether the mode is the intracardiac electrocardiogram measurement mode or the intracardiac defibrillation mode based on, for example, the state of the switch SW220 and the operation states of the charging operation SW202 and the energizing operation SW203. Can be determined.

<1-2> Intracardiac electrocardiogram measurement mode FIG. 2 is a diagram showing a state at the time of intracardiac electrocardiogram measurement.

  At the time of 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, a closed state). As a result, as shown by the arrow X, measured potentials obtained from the eight RA electrodes and eight CS electrodes of the electrode catheter 130 are input to the polygraph inspection apparatus 120 via the on / off SW 240. The measured potential obtained from the four EP electrodes 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> At the time of performing intracardiac defibrillation FIG. 3 is a diagram illustrating a state at the time of performing intracardiac defibrillation.

  During intracardiac defibrillation, the electrode catheter short SW 230 is in a short state, and the on / off SW 240 is in an off state (ie, an open state). Thereby, the electric 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 shown by the arrow Y. You. Further, the measurement potential obtained by the electrode catheter 130 is input to the polygraph inspection apparatus 120 via the protection resistor 250 as shown by the arrow Z. The measured potential obtained from the four EP electrodes is directly input to the polygraph inspection apparatus 120 without passing through the protective resistor 250. Incidentally, the electrical energy for performing the intracardiac defibrillation is hardly input to the polygraph inspection apparatus 120 by the protection resistor 250, and thus, the predetermined electric energy for performing the intracardiac defibrillation is transmitted to the heart chamber. Can be supplied within.

  As described above, in the present embodiment, the connection between the polygraph inspection apparatus 120 (electrocardiograph) and the electrode catheter 130 is not completely cut off during the intracardiac defibrillation, but the intracardiac defibrillation is performed. By maintaining the connection between the polygraph inspection apparatus 120 (electrocardiograph) and the electrode catheter 130 via the protective resistor 250 even during fibrillation, defibrillation to the polygraph inspection apparatus 120 (electrocardiograph) can be performed. A rough intracardiac potential can be measured by the polygraph inspection device 120 (electrocardiograph) while the input of energy is blocked to protect the polygraph inspection device 120 (electrocardiograph).

  Incidentally, at the time of intracardiac defibrillation, since the electrode catheter short SW 230 is in the short state, one measured potential is obtained by averaging the potentials of the eight RA electrodes, and the potential of the eight CS electrodes is obtained. Are averaged to obtain one measured potential. Therefore, the electrocardiogram waveforms of the RA electrode and the CS electrode are distorted compared to the case where the measurement potential is obtained from each of the eight RA electrodes and the eight CS electrodes as in the case of the intracardiac electrogram measurement. Becomes Since the four EP electrodes are not short-circuited by the electrode catheter short SW 230, even during the intracardiac defibrillation mode, the measured potential of each of the four EP electrodes is obtained. As described above, the intracardiac electrocardiogram based on the measured potentials of the RA electrode and the CS electrode is distorted, but compared with the case where the intracardiac electrocardiogram is not measured at all during the intracardiac defibrillation, the 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 inspection apparatus 120 and the electrode catheter 130 is maintained even during intracardiac defibrillation, the polygraph after the electric energy for intracardiac defibrillation is supplied to the electrode catheter 130. There is also an advantage that the return of the measured potential in the inspection device 120 is quickened, in other words, the baseline in the polygraph inspection device 120 is stabilized, and thereby the display recovery of the intracardiac electrocardiogram in the polygraph inspection device 120 is quickened.

<1-4> Effects As described above, according to the present embodiment, the connection device 200 connects the electrode catheter 130 and the defibrillator 110 with the first connection line, 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 protection resistor 250 provided in parallel with the on / off switch 240 to protect the polygraph inspection apparatus 120 (electrocardiograph) from the energy of defibrillation and execute intracardiac defibrillation. Sometimes an intracardiac electrogram can be measured.

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

  4 and 5 are connection diagrams illustrating a schematic configuration of the defibrillator 300 according to the present embodiment. 4 and 5, for simplification of the drawings, only a portion related to an electric energy supply line to the electrode catheter 130 and a potential measurement line from the electrode catheter 130 to the polygraph inspection apparatus 120 are shown. FIG. 4 shows a state during intracardiac electrocardiogram measurement, and FIG. 5 shows a state during intracardiac defibrillation.

  Electric energy for performing intracardiac defibrillation generated by the defibrillation module 310 is supplied to the RA electrode group and the CS electrode group of the electrode catheter 130 via the first connection line L1. The first connection line L1 is provided with electrode catheter short SWs 311 and 312.

  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. Further, on the second connection line L2, protection resistors 315 and 316 are provided in parallel with the on / off switches 313 and 314.

  In this configuration, the defibrillator 300 turns off the electrode catheter short SWs 311 and 312 and turns on the on / off switches 313 and 314 as shown in FIG. 4 during the measurement of the intracardiac electrocardiogram. Thus, the intracardiac electrogram is measured by the polygraph inspection apparatus 120.

  On the other hand, during execution of intracardiac defibrillation, the defibrillator 300 turns on the electrode catheter short SWs 311 and 312 (short state) and turns off the on / off switches 313 and 314, as shown in FIG. To Thereby, the electric 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, while the protection resistors 315 and 316 prevent electric energy for intracardiac defibrillation from flowing into the polygraph inspection apparatus 120, the potentials of the RA electrode group and the CS electrode group pass through the protection resistors 315 and 316. Thus, the potential of the electrode catheter 130 can be measured even during execution of intracardiac defibrillation.

  As described above, the first connection line L1 that supplies the defibrillator 300 with electric energy for intracardiac defibrillation to the electrode catheter 130, and the polygraph inspection apparatus connected to the first connection line L1. A second connection line L2 connected to the (electrocardiograph) 120, on / off switches 313 and 314 provided on the second connection line L2, and on / off switches 313 and 314 on the second connection line L2. By providing the protection resistors 315 and 316 provided in parallel, the polygraph inspection apparatus 120 (electrocardiograph) is protected from the energy of defibrillation and the intracardiac removal is performed, as in the first embodiment. It becomes possible to measure the intracardiac electrocardiogram even during the execution of fibrillation.

  The above-described embodiment is merely an example of the embodiment of the present invention, and the technical scope of the present invention should not be interpreted in a limited manner. That is, the present invention can be implemented in various forms without departing from the gist or the main features thereof.

  In the above embodiment, the case where the present invention is applied to the electrode catheter having the eight RA electrodes, the eight CS electrodes, and the four SVC electrodes 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 is widely applicable to an electrode catheter having an electrode capable of performing intracardiac defibrillation and an electrode 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.

Reference Signs List 100 defibrillation system 110, 300 defibrillator 120 polygraph examination device (electrocardiograph)
130 electrode catheter 140 extracorporeal paddle 200 connection device 211 defibrillator connection terminal (second terminal)
213 electrode catheter connection terminal part (first terminal part)
214 polygraph connection terminal part (third terminal part)
220 Switch SW
230, 311 and 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 obtained by the electrode catheter,
A defibrillator that supplies electrical energy for intracardiac defibrillation to the electrode catheter,
A connection device for connecting the electrode catheter, the electrocardiograph and the defibrillator,
Has,
The connection device,
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 protection resistor provided on the second connection line in parallel with the on / off switch;
A control unit for controlling the on / off switch,
Prepared,
When performing intracardiac defibrillation,
The control unit opens the on / off switch, and as a result, the connection device prevents the current from flowing from the defibrillator to the electrocardiograph through the on / off switch, and also controls the protection resistor. Maintaining the input of an intracardiac potential from the electrode catheter to the electrocardiograph through to enable the measurement of an intracardiac electrogram with the electrocardiograph,
Intracardiac defibrillation system. The connection device is provided on the first connection line, further comprising a short switch that short-circuits the plurality of electrodes of the electrode catheter,
An intracardiac defibrillation system according to claim 1. The short switch, at the time of intracardiac defibrillation and short state between a plurality of electrodes of the electrode catheter, at the time of intracardiac electrocardiogram measurement shall be the open state between a plurality of electrodes of the electrode catheter,
An 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 portion to which the electrode catheter is connected;
A second terminal to which the defibrillator is connected;
A third terminal to which the electrocardiograph is connected;
A first connection line connecting the first terminal unit and the second terminal unit;
A second connection line connecting the first terminal unit and the third terminal unit;
An on / off switch provided on the second connection line;
A protection resistor provided on the second connection line in parallel with the on / off switch;
A control unit for controlling the on / off switch,
Has,
When performing intracardiac defibrillation,
The control unit opens the on / off switch, and as a result, prevents the current from flowing from the defibrillator to the electrocardiograph via the on / off switch, while preventing the electrode from passing through the protection resistor. Maintaining the input of intracardiac potential from the catheter to the electrocardiograph to enable measurement of the intracardiac electrogram with the electrocardiograph,
A connection device in an intracardiac defibrillation system. A defibrillation module that generates electrical energy for intracardiac defibrillation;
A first connection line for supply feeding the electric energy generated by the defibrillation module 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 protection resistor provided on the second connection line in parallel with the on / off switch;
With
When performing intracardiac defibrillation,
The on / off switch is in an open state, and as a result, while preventing current from flowing from the defibrillation module to the electrocardiograph via the on / off switch, the electrode catheter from the electrode catheter via the protective resistor. Maintaining the input of the intracardiac potential to the electrocardiograph to enable measurement of the intracardiac electrogram with the electrocardiograph,
Defibrillator.

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