JP6700081B2 - Defibrillator - Google Patents

Description

  The present invention relates to a defibrillator used in a defibrillation system that performs intracardiac defibrillation and external defibrillation.

  In the ablation treatment of 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 intraoperative attack. Intracardiac defibrillation is the application of electrical energy to an electrode catheter previously placed in the heart chamber when it is necessary to stop atrial fibrillation during surgery by electrical defibrillation. It removes fibrillation. With intracardiac defibrillation, less electrical energy is given to the patient than with external defibrillation (for example, external defibrillation is about 150 to 200 J, whereas intracardiac defibrillation is about 150 to 200 J). However, there is an advantage that the burden on the patient is small. A configuration for performing intracardiac defibrillation is described in Patent Document 1, for example.

  Here, generally, in the treatment of atrial fibrillation arrhythmia in a cardiac catheterization laboratory, a system for performing intracardiac defibrillation and a system for performing external defibrillation are prepared. External defibrillation is performed when internal defibrillation is performed and atrial fibrillation still cannot be removed or when ventricular fibrillation occurs.

  The defibrillator also has an R-wave synchronous energization mode that gives an electric shock synchronized with the R-wave. In the external defibrillation system, the defibrillation electrode pads attached to the body surface and the measurement potentials obtained by the multiple electrodes for electrocardiogram measurement are input to the external defibrillator for defibrillation, A defibrillator obtains an electrocardiogram, detects an R wave from the electrocardiogram, and produces an R wave synchronous energy output for external defibrillation synchronized with the R wave.

  On the other hand, in the intracardiac defibrillation system, the measured potentials of a plurality of electrodes attached to the body surface are input to a polygraph inspection device, and the polygraph inspection device obtains an electrocardiogram based on the measured potentials. The electrocardiogram obtained by the above is input to a defibrillator for intracardiac defibrillation, and the defibrillator generates an R-wave synchronous energy output for intracardiac defibrillation synchronized with the R wave based on the electrocardiogram. It is like this.

JP, 2010-220778, A

  By the way, for the purpose of preventing the induction of ventricular fibrillation, the R-wave synchronous energization is defined by the standard within 60 msec from the apex of the R-wave. However, as described above, in the case of performing R-wave synchronous energization in the conventional intracardiac defibrillation system, the defibrillator for intracardiac defibrillation passes through a polygraph inspection device (electrocardiograph). Since it is configured to receive an electrocardiogram, a delay is caused by that amount, and as a result, a strict circuit design is required to energize within 60 msec from the apex of the R wave.

  Further, when it is desired to switch the lead that is the basis of the R-wave synchronous energization, in the conventional intracardiac defibrillation system, the switching operation must be performed by the polygraph inspection device, which is a troublesome drawback.

  The present invention has been made in view of the above points, and is a defibrillation device that can realize intracardiac defibrillation energization synchronized with R waves and external defibrillation energization with a simple configuration and with good convenience. Provide motivation.

One aspect of the defibrillator of the present invention is
A first terminal portion to which the electrode catheter is connected,
A second terminal portion to which the external defibrillation electrode is connected,
An electrocardiogram measurement unit for obtaining a body surface electrocardiogram,
A defibrillation energy generation unit that generates electrical energy for defibrillation,
An energization destination switching unit that selectively outputs the electrical energy output from the defibrillation energy generation unit to either one of the first terminal unit or the second terminal unit;
A polygraph connection terminal portion to which the polygraph inspection device is connected,
Equipped with,
Between the polygraph connection terminal portion and the first terminal portion, an on-off switch and a protection resistor connected in parallel to each other are connected,
The electrical energy for intracardiac defibrillation generated by the defibrillation energy generation unit is supplied to a connection line between the first terminal unit and the on/off switch and protection resistor .

  According to the present invention, even when performing intracardiac defibrillation, R-wave synchronous energization can be performed without going through a polygraph inspection device, and as a result, intracardiac defibrillation energization synchronized with the R wave can be performed. Also, it is possible to realize a defibrillator that can externally carry out defibrillation energization with a simple configuration and with good convenience.

The figure which shows the external appearance structure of the defibrillator which concerns on embodiment. Connection diagram showing the main components of the defibrillator Enlarged view of output setting dial Diagram showing the status in monitor mode Diagram showing the state of intracardiac defibrillation mode Figure showing the external defibrillation mode

  Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings.

  FIG. 1 is a diagram showing an external configuration of a defibrillator 100 of the embodiment, and FIG. 2 is a connection diagram showing a main configuration of the defibrillator 100.

  As shown in FIG. 1, the defibrillator 100 has an electrode catheter connection terminal portion 110 to which an electrode catheter 200 is connected and an external defibrillation connection terminal portion 120 to which an electrode pad 300 is connected. Here, the electrode catheter 200 includes an 8-electrode RA electrode placed in the right atrium, an 8-electrode CS electrode placed in the coronary sinus, and a 4-electrode EP electrode (SVC) placed in the superior vena cava. Electrodes, IVC electrodes, etc.), the electrode catheter connection terminal portion 110 has an RA electrode connection portion 110a, a CS electrode connection portion 110b, and an EP electrode connection portion 110c. The RA electrode and CS electrode are used to perform intracardiac defibrillation, and the RA electrode, CS electrode and EP electrode are used to measure intracardiac potential.

  The external defibrillation connection terminal portion 120 is not limited to being connected to the electrode pad 300, but may be an external paddle or an internal paddle. In short, an electrode for performing external defibrillation is provided. Connected.

  In addition, the defibrillator 100 includes the induction electrode connection unit 130 (FIG. 2) to which the induction electrode of the patient 10 (10 electrodes 400 (FIG. 2) in the example of the present embodiment) is connected, and the polygraph inspection device 500 ( 2) to which the polygraph inspection device connecting portion 140 (FIG. 2) is connected.

  In addition, the defibrillator 100 has an LCD (Liquid Crystal Display) 150 and a recording operation button 160, can display the measured electrocardiogram of the patient 10 on the LCD 150, and operates the recording operation button 160 to make a connection (not shown). An electrocardiogram can be output from a printer connected to the section.

  Further, the defibrillator 100 has, as the operation unit 160, an output setting dial 161, a synchronization mode selection button 162, a charge button 163, and an energization button 164.

  The output setting dial 161 has a function of setting the energization level and a function of switching the energization destination. The output setting dial 161 has a function of selecting a monitor mode and an AED (Automated External Defibrillator) mode.

  FIG. 3 is an enlarged view of the output setting dial 161. When the user adjusts the rotating position of the dial to the position of "monitor", the defibrillator 100 enters the electrocardiogram measurement mode, and when the rotating position of the dial matches the position of "AED", the defibrillator 100 enters the AED mode. Become. When the user rotates the dial in the clockwise direction from the “OFF” position, the defibrillator 100 can be set in the intracardiac defibrillation mode. The energization level of any one 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 set to the external defibrillation mode. The energization level of any of 2, 4, 6, 8, 10, 15, 20, 30, 50, 70, 100, 150, 200 [J] can be set.

  As shown in FIG. 2, the defibrillator 100 includes a power source unit 171 including a power cord connected to an external power source and a battery, and a defibrillation energy generating unit 172 including a capacitor. The defibrillation energy generation unit 172 generates energy of the level instructed by the control unit 180 by charging the energy of the power supply unit 171, and outputs this at the timing instructed by the control unit 180. Further, in the R wave synchronization mode, the defibrillation energy generation unit 172 outputs energy immediately after the R wave detection unit 177 detects the R wave.

  The output terminal of the defibrillation energy generation unit 172 is connected to the switching circuit 173. The switching circuit 173 has two switching contacts a and b, and the controller 180 controls which of the two switching contacts a and b the connector is connected to. In the switching circuit 173, the connector is connected to the switching contact a during defibrillation, and the connector is connected to the switching contact b during electrocardiogram measurement.

  The switching circuit 174 is connected to the switching circuit 173. The switching circuit 174 has two connectors C1 and C2 and two switching contacts a and b. The switching contact a is connected to the electrode catheter connection terminal portion 110, and the switching contact b is connected to the external defibrillation connection terminal portion 120. Further, the connector C2 is connected to the electrocardiogram measurement unit 176. The controller 180 controls which connector C1, C2 of the switching circuit 173 is connected to which switching contact a, b.

  In the defibrillator 100, intracardiac defibrillation can be realized by connecting the connector C1 of the switching circuit 174 to the switching contact a while the connector of the switching circuit 173 is connected to the switching contact a. .. On the other hand, external defibrillation can be realized by connecting the connector C1 of the switching circuit 174 to the switching contact b while the connector of the switching circuit 173 is connected to the switching contact a.

  Further, the intracardiac electrogram can be measured by connecting the connector C1 of the switching circuit 174 to the switching contact a while the connector of the switching circuit 173 is connected to the switching contact b. On the other hand, the body surface electrocardiogram can be measured by connecting the connector C1 of the switching circuit 174 to the switching contact b while the connector of the switching circuit 173 is connected to the switching contact b.

  The electrocardiogram measuring unit 176 has an amplifier and an arithmetic unit, amplifies the input measurement potential, and further performs a predetermined calculation using the amplified measurement potential to obtain an electrocardiogram. The electrocardiogram obtained by the electrocardiogram measurement unit 176 is displayed on the LCD 150. The electrocardiogram obtained by the electrocardiogram measurement unit 176 is sent by the R wave detection unit 177, and the R wave detection unit 177 detects the R wave in the electrocardiogram. Of course, the electrocardiogram measurement unit 176 may have the function of the R wave detection unit 177.

  Further, in the defibrillator 100, since the induction electrode 400 is connected to the electrocardiogram measurement unit 176 via the induction electrode connection unit 130, various induction electrocardiograms such as limb lead, chest lead, and 12-lead electrocardiogram can be measured. .. In practice, the defibrillator 100 uses the body surface electrocardiogram obtained by the potential of the induction electrode 400 when a clear R wave cannot be detected from the body surface electrocardiogram obtained by the potential of the electrode pad 300. It is designed to detect R waves. As described above, in the defibrillator 100, the R wave can be detected by the induction electrode 400 even when the R wave cannot be detected by the electrode pad 300, and thus the reliability is high without depending on the polygraph inspection apparatus 500. R-wave synchronous energization can be performed.

  Further, in the defibrillator 100, an on/off switch 191 and a protection resistor 192 connected in parallel to each other are connected between the electrode catheter connection terminal portion 110 and the polygraph inspection apparatus connection portion 140. The on/off switch 191 and the protective resistor 192 are connected to the polygraph inspection apparatus 500 side from the connection point P1 to which the electrical energy for intracardiac defibrillation is supplied.

  An electrode catheter short switch 193 is provided between the connection point P1 and the electrode catheter connection terminal portion 110. The electrode catheter short switch 193 is configured to short-circuit a plurality of electrodes provided on the electrode catheter 200. As a result, the contact area with the heart wall can be expanded to lower the impedance, and the defibrillation energy with the set number of Joules can be transmitted to the heart wall. Specifically, the electrode catheter short switch 193 short-circuits the 8-pole RA electrode and the 8-pole CS electrode when performing intracardiac defibrillation. The electrode catheter short switch 193 puts each electrode of the electrode catheter 200 into a non-short-circuited state at the time of measuring the intracardiac electrogram. As a result, the potential of each electrode can be measured during the intracardiac electrocardiogram measurement.

  The resistance value of each resistor forming the protection resistor 192 is, for example, several hundreds kΩ. The resistance value may be a value that can protect the polygraph apparatus 500 when the defibrillator 100 supplies the connection point P1 with energy for intracardiac defibrillation.

  The operations of the electrode catheter short switch 193 and the on/off switch 191 are controlled by the control unit 180. Specifically, the control unit 180 sets the electrode catheter short switch 193 to the non-short state and the on/off switch 191 to the on state (that is, the closed state) at the time of measuring the intracardiac electrogram. On the other hand, the control unit 180 sets the electrode catheter short switch 193 to a short state and the on/off switch 191 to an off state (that is, an open state) when performing intracardiac defibrillation.

  The polygraph device 500 can obtain an intracardiac electrogram from the measurement potential input via the polygraph inspection device connection portion 140, and can obtain a body surface electrocardiogram from the measurement potential input from the induction electrode 400.

  Next, the operation of the defibrillator 100 will be described.

<Monitor mode>
FIG. 4 is a diagram showing a state in the monitor mode (may be referred to as an electrocardiogram measurement mode).

  When the rotation position of the output setting dial 161 is set to the “monitor” position, the defibrillator 100 enters the monitor mode. At this time, the connector of the switching circuit 173 is connected to the switching contact b, and the connector C1 of the switching circuit 174 is connected to the switching contact b, so that the measurement potential from the electrode pad 300 is input to the electrocardiogram measurement unit 176. A body surface electrocardiogram based on the measured potential of the electrode pad 300 can be obtained. If the connector C1 of the switching circuit 174 is connected to the switching contact a, the measurement potential from the electrode catheter 200 is input to the electrocardiogram measurement unit 176, and an intracardiac electrocardiogram based on the measurement potential of the electrode catheter 200 can be obtained. it can. In the monitor mode, the electrode catheter short switch 193 is not short-circuited and the on/off switch 191 is in the on state (that is, the closed state), so that the intracardiac electrogram can be obtained in the polygraph inspection apparatus 500.

<Intracardiac defibrillation mode>
FIG. 5 is a diagram showing a state in the intracardiac defibrillation mode.

  When the rotational position of the output setting dial 161 is set to the intracardiac defibrillation position, the defibrillator 100 enters the intracardiac defibrillation mode. When performing intracardiac defibrillation, the connector of the switching circuit 173 is connected to the switching contact a, and the connector C1 of the switching circuit 174 is connected to the switching contact a. Further, the connector C2 of the switching circuit 174 is connected to the switching contact b. Further, the electrode catheter short switch 193 is set to the short state and the on/off switch 191 is set to the off state (that is, open state).

  As a result, the defibrillation energy generated by the defibrillation energy generation unit 172 is supplied to the electrode catheter 200 via the switching circuits 173 and 174, the electrode catheter short switch 193, and the electrode catheter connection terminal unit 110. Intracardiac defibrillation is performed. At this time, the measured potential from the electrode pad 300 is input to the electrocardiogram measurement unit 176 via the switching circuit 174, and the electrocardiogram measurement unit 176 can obtain a body surface electrocardiogram. Therefore, an R wave is generated based on the body surface electrocardiogram. Synchronous intracardiac defibrillation can be performed. Further, when a clear R wave cannot be detected from the body surface electrocardiogram obtained by the potential of the electrode pad 300, the electrocardiogram measurement unit 176 obtains the body surface electrocardiogram based on the induction electrode 400, and the R wave detection unit 177 determines The R wave is detected from the body surface electrocardiogram.

  Further, since the on/off switch 191 is in the off state, almost no electric energy for performing intracardiac defibrillation is input to the polygraph inspection device 120 by the protective resistance 192, which causes intracardiac defibrillation. Predetermined electrical energy to perform movement can be delivered into the heart chamber. On the other hand, in the defibrillator 100, during the intracardiac defibrillation, the intracorporeal defibrillation is performed rather than completely disconnecting the connection between the polygraph inspection apparatus 500 and the electrode catheter 200. Above all, by maintaining the connection between the polygraph inspection device 500 and the electrode catheter 200 via the protection resistor 192, the input of defibrillation energy to the polygraph inspection device 500 is blocked to protect the polygraph inspection device 500. Meanwhile, the polygraph inspection apparatus 500 can measure a rough intracardiac potential.

  Incidentally, during the intracardiac defibrillation mode, since the electrode catheter short switch 193 is in a short state, one measured potential obtained by averaging the RA electrode potentials of 8 poles is obtained, and One measured potential is obtained by averaging the potentials of the CS electrodes. Therefore, the electrocardiographic waveforms of the RA electrode and the CS electrode are distorted as compared with the case where the measurement potential is obtained from the RA electrode of 8 poles and the CS electrode of 8 poles as in the monitor mode described above. Become. Since the 4-pole EP electrode is not short-circuited by the electrode catheter short-circuit switch 193, the RA electrodes can obtain the measurement potentials of the 4-pole RA electrodes even during the intracardiac defibrillation mode. .. In this way, the intracardiac electrocardiogram based on the measured potentials of the RA electrode and the CS electrode becomes blunt, but compared with the case where no intracardiac electrocardiogram is measured during intracardiac defibrillation, intracardiac defibrillation is performed. It is thought that it can be effectively used for the operation of.

  Further, since the connection between the polygraph inspection apparatus 500 and the electrode catheter 200 is maintained even during intracardiac defibrillation, the polygraph after the electrical energy for intracardiac defibrillation is supplied to the electrode catheter 200. There is also an advantage that the return of the measured potential in the inspection device 500 becomes faster, in other words, the baseline in the polygraph inspection device 500 becomes stable, and thereby the display recovery of the intracardiac electrogram in the polygraph inspection device 500 becomes faster.

<External defibrillation mode>
FIG. 6 is a diagram showing a state in the external defibrillation mode.

  When the rotation position of the output setting dial 161 is set to the external defibrillation position, the defibrillator 100 enters the external defibrillation mode. When performing external defibrillation, the connector of the switching circuit 173 is connected to the switching contact a, and the connector C1 of the switching circuit 174 is connected to the switching contact b. When measuring an intracardiac electrocardiogram, the electrode catheter short switch 193 is set to a non-short state and the on/off switch 191 is set to an on state (that is, a closed state).

  As a result, the defibrillation energy generated by the defibrillation energy generation unit 172 is supplied to the electrode pad 300 via the switching circuits 173 and 174 and the external defibrillation connection terminal unit 120, so that the external defibrillation is performed. Fibrillation is performed. At this time, the measured potential from the ten electrodes 400 is input to the electrocardiogram measurement unit 176 via the induction electrode connection unit 130, and the electrocardiogram measurement unit 176 can obtain the body surface electrocardiogram. External defibrillation synchronized with waves can be performed.

<Effects of the embodiment>
As described above, according to the present embodiment, the electrode catheter connection terminal portion (first terminal portion) 110 to which the electrode catheter 200 is connected, and the external defibrillation device to which the external defibrillation electrode is connected. Based on the connection terminal portion (second terminal portion) 120 for exercise, an electrocardiogram measurement unit 176 for obtaining a body surface electrocardiogram, and a body surface electrocardiogram measured by the electrocardiogram measurement unit 176, defibrillation is performed at a timing synchronized with the R wave Defibrillation energy generation unit 172 that outputs electrical energy for electric shock, and the electrical energy generated by the defibrillation energy generation unit 172 is either the electrode catheter connection terminal unit 110 or the external defibrillation connection terminal unit 120. By providing a switching circuit (energization destination switching unit) 174 for selectively outputting to one side, R wave synchronous energization is performed without passing through the polygraph inspection apparatus 500 even when performing intracardiac defibrillation. As a result, it is possible to realize the defibrillator 100 that can realize the intracardiac defibrillation energization and the external defibrillation energization synchronized with the R wave with a simple configuration and with good convenience.

  Further, in addition to the measurement potential of the electrode pad 300, the measurement potential of the induction electrode (10 electrodes in the case of the present embodiment) 400 can be input to the electrocardiogram measurement unit 176, so that reliability can be improved. It becomes possible to obtain a high R wave, and the reliability of R wave synchronous energization is improved.

  In the embodiment described above, the intracardiac defibrillation mode is switched between the intracardiac defibrillation mode and the external defibrillation mode based on the rotational position of the output setting dial 161. The configuration for switching between the external defibrillation mode and the external defibrillation mode is not limited to this. For example, each time the output setting dial 161 is pushed, the intracardiac defibrillation mode and the external defibrillation mode may be switched. In addition to the output setting dial 161, the intracardiac defibrillation mode and external A button may be provided for switching between the defibrillation mode.

  The above-described embodiments are merely examples of specific embodiments for carrying out the present invention, and the technical scope of the present invention should not be limitedly interpreted by these. That is, the present invention can be implemented in various forms without departing from the gist or main features thereof.

  In the above-described embodiment, the case where the present invention is applied to the electrode catheter having the RA electrode with 8 poles, the CS electrode with 8 poles, and the EP electrode with 4 poles has been described, but the present invention is applicable. The configuration of the electrode catheter is not limited to this. The electrode catheter may have any configuration as long as it has an electrode capable of performing intracardiac defibrillation and an electrode capable of measuring an intracardiac potential.

  INDUSTRIAL APPLICABILITY The present invention can be applied to a defibrillator used in a defibrillation system that performs intracardiac defibrillation and external defibrillation.

10 Patient 100 Defibrillator 110 Electrode Catheter Connection Terminal Section 120 External Defibrillation Connection Terminal Section 130 Induction Electrode Connection Section 140 Polygraph Examination Equipment Connection Section 150 LCD
160 Operation unit 161 Output setting dial 162 Synchronous mode selection button 163 Charging button 164 Energizing button 171 Power supply unit 172 Defibrillation energy generation unit 173, 174 Switching circuit 176 Electrocardiogram measurement unit 177 R wave detection unit 180 Control unit 191 On-off switch 192 Protection Resistance 193 Electrode catheter short switch 200 Electrode catheter 300 Electrode pad 400 Induction electrode (10 electrodes)
500 polygraph inspection system

Claims (3)

A first terminal portion to which the electrode catheter is connected,
A second terminal portion to which the external defibrillation electrode is connected,
An electrocardiogram measurement unit for obtaining a body surface electrocardiogram,
A defibrillation energy generation unit that generates electrical energy for defibrillation,
An energization destination switching unit that selectively outputs the electric energy output from the defibrillation energy generation unit to either one of the first terminal unit or the second terminal unit;
A polygraph connection terminal portion to which the polygraph inspection device is connected,
Equipped with,
Between the polygraph connection terminal portion and the first terminal portion, an on-off switch and a protection resistor connected in parallel with each other are connected,
The electrical energy for defibrillation in the heart chamber generated by the defibrillation energy generation unit is supplied to a connection line between the first terminal unit and the on/off switch and the protection resistor.
Defibrillator. Furthermore, it comprises a third terminal portion to which the induction electrode attached to the body surface is connected,
The electrocardiogram measurement unit determines a body potential based on a measurement potential of the external defibrillation electrode input from the second terminal unit or a measurement potential of the induction electrode input from the third terminal unit. Find the surface electrocardiogram,
The defibrillator according to claim 1. The defibrillation energy generation unit outputs the electrical energy at a timing synchronized with the R wave, based on the body surface electrocardiogram measured by the electrocardiogram measurement unit,
The defibrillator according to claim 1 or 2.

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