JPWO2020152619A5 - - Google Patents

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JPWO2020152619A5
JPWO2020152619A5 JP2021542190A JP2021542190A JPWO2020152619A5 JP WO2020152619 A5 JPWO2020152619 A5 JP WO2020152619A5 JP 2021542190 A JP2021542190 A JP 2021542190A JP 2021542190 A JP2021542190 A JP 2021542190A JP WO2020152619 A5 JPWO2020152619 A5 JP WO2020152619A5
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wavefront
locations
sensing
icd
electrical
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JP2022523023A (en
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Priority claimed from PCT/IB2020/050534 external-priority patent/WO2020152619A1/en
Publication of JP2022523023A publication Critical patent/JP2022523023A/en
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Claims (14)

少なくとも２つの双極感知電極を含む、植込み型除細動器デバイス（ＩＣＤ）であって、
心臓の心不整脈の間、および心拍の間隔内で、心臓の少なくとも２つの心室位置における電気波面の到達の時間を感知し、
より早い感知電極位置と後の感知電極位置との間を通過する波面の方向に基づいて、心房からまたは心室から開始される波面の送出を判別し、
心房からまたは心室から開始される波面の送出に基づいて、上室性頻拍または心室性頻拍を判別し、前記少なくとも２つの位置における前記感知の相対的タイミングにより示され、および心臓における前記少なくとも２つの位置の間の接合軸の知られた方向に関して計算される波面移動の方向に基づいて、前記上室性頻拍を識別する場合、心不整脈に応じた除細動器による除細動ショックの発生を抑制する、ように構成され、
前記少なくとも２つの双極感知電極は、右心室内の異なる位置で別個のリードにより配置されるように構成される、植込み型除細動器デバイス（ＩＣＤ）。 An implantable cardioverter-defibrillator device (ICD) comprising at least two bipolar sensing electrodes,
sensing the time of arrival of an electrical wavefront at at least two ventricular locations of the heart during a cardiac arrhythmia and within a heart beat interval;
determining delivery of the wavefront originating from the atrium or the ventricle based on the direction of the wavefront passing between the earlier and later sensing electrode locations;
discriminate supraventricular tachycardia or ventricular tachycardia based on the delivery of wavefronts originating from the atria or from the ventricles, indicated by the relative timing of the sensing at the at least two locations, and the at least A defibrillation shock by a defibrillator in response to a cardiac arrhythmia when identifying said supraventricular tachycardia based on the direction of wavefront movement calculated with respect to the known direction of the coaptation axis between two locations. is configured to suppress the occurrence of
An implantable cardioverter-defibrillator device (ICD), wherein the at least two bipolar sensing electrodes are configured to be positioned by separate leads at different locations within the right ventricle. 前記少なくとも２つの双極感知電極は、心室中隔に沿った位置に取り付けられるように構成される、請求項１に記載のデバイス。 2. The device of claim 1, wherein the at least two bipolar sensing electrodes are configured to be attached at locations along the interventricular septum. 前記心室中隔に沿った前記少なくとも２つの位置は、少なくとも１ｃｍ離れている、請求項２に記載のデバイス。 3. The device of claim 2, wherein the at least two locations along the interventricular septum are separated by at least 1 cm. 前記心室中隔に沿った前記２つの位置は、心室中隔に沿って延在する上下軸に沿って配置される、請求項２または３に記載のデバイス。 4. The device of claim 2 or 3, wherein the two locations along the interventricular septum are arranged along a superior-inferior axis extending along the interventricular septum. 前記少なくとも２つの双極感知電極は、別個のリード上にある、請求項１から４のいずれか一項に記載のデバイス。 5. The device of any one of claims 1-4, wherein the at least two bipolar sensing electrodes are on separate leads. さらに、前記別個のリード上にある前記電極を使用して心臓収縮性調節（ＣＣＭ）治療を行うように構成される、請求項５に記載のデバイス。 6. The device of claim 5, further configured to deliver cardiac contractility modulation (CCM) therapy using the electrodes on the separate leads. 前記電極は、ＣＣＭ治療の送出のため、および前記少なくとも２つの位置における電気波面の到着を感知するために使用される、請求項６に記載のデバイス。 7. The device of claim 6, wherein the electrodes are used for delivery of CCM therapy and for sensing arrival of electrical wavefronts at the at least two locations. 前記少なくとも２つの双極感知電極は、前記ＩＣＤの単一のリード上にある、請求項１から７のいずれか一項に記載のデバイス。 8. The device of any one of claims 1-7, wherein the at least two bipolar sensing electrodes are on a single lead of the ICD. 前記ＩＣＤの前記単一のリードは、心室中隔に沿って延在して植込まれるように構成される、請求項８に記載のデバイス。 9. The device of claim 8, wherein the single lead of the ICD is configured to extend along the interventricular septum and be implanted. 前記少なくとも２つの双極感知電極は、心室中隔内の上下軸に沿った異なる位置に配置されるように構成され、前記ＩＣＤは、前記電気波面が、より下位の位置に到達する前に、より上位の位置に到達するように感知されるとき、示された波面移動の方向に基づいて、除細動ショックの生成を抑制する、請求項１から９のいずれか一項に記載のデバイス。 The at least two bipolar sensing electrodes are configured to be positioned at different locations along a superior-inferior axis within the interventricular septum, and the ICD allows the electrical wavefront to be more sensitive before reaching lower locations. 10. The device of any one of claims 1-9, wherein when sensed to reach a superior position, it inhibits the generation of defibrillation shocks based on the indicated direction of wavefront movement. 心室の非中隔位置に配置されるように構成された感知電極を含む、請求項１０に記載のデバイス。 11. The device of claim 10, comprising a sensing electrode configured to be placed at a non-septal location in the ventricle. 心室の非中隔位置に配置されるように構成された前記感知電極が、ＩＣＤが心室中隔位置に電気波面が到達したことを感知する前に、所定の間隔内に電気波面が到達したことを感知する場合、除細動ショックの生成は抑制されないように構成された、請求項１１に記載のデバイス。 the sensing electrode configured to be placed at a non-septal location in the ventricle that the electrical wavefront arrives within a predetermined interval before the ICD senses the arrival of the electrical wavefront at the ventricular septal location; 12. The device of claim 11 , configured such that defibrillation shock generation is not inhibited when sensing . 前記電気波面が、より上位の位置に到達した時点から所定の遅延が経過する前に、より下位の位置に到達した場合、抗不整脈治療の送出は抑制されない、請求項１０から１２のいずれか一項に記載のデバイス。 13. The delivery of anti-arrhythmia therapy is not inhibited if the electrical wavefront reaches the lower position before a predetermined delay has elapsed from the time the electrical wavefront reaches the higher position. device described in section. 心臓の不整脈に応じて植込まれた心臓デバイスへの入力を制御する方法であって、
心臓における心不整脈の間に、心臓の心室領域を通過する電気波面の方向を感知することと、
前記電気波面の前記感知された方向に基づいて、前記植込まれた心臓デバイスに入力を提供することと、を含み、
前記植込まれた心臓デバイスは、抗不整脈治療を適用するように構成され、
提供された前記入力を使用して前記抗不整脈治療を適用するように前記植込まれた心臓デバイスを構成することを含む、方法。 A method of controlling input to an implanted cardiac device in response to a cardiac arrhythmia, comprising:
sensing the direction of an electrical wavefront passing through a ventricular region of the heart during a cardiac arrhythmia in the heart;
providing input to the implanted cardiac device based on the sensed direction of the electrical wavefront;
wherein the implanted cardiac device is configured to apply antiarrhythmic therapy;
A method comprising configuring the implanted cardiac device to apply the antiarrhythmic therapy using the provided input.
JP2021542190A 2019-01-23 2020-01-23 Discrimination of supraventricular tachycardia in combined CCM-ICD devices Pending JP2022523023A (en)

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US201962795612P 2019-01-23 2019-01-23
US62/795,612 2019-01-23
PCT/IB2020/050534 WO2020152619A1 (en) 2019-01-23 2020-01-23 Discrimination of supraventricular tachycardias in combined ccm-icd device

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JP2022523023A JP2022523023A (en) 2022-04-21
JPWO2020152619A5 true JPWO2020152619A5 (en) 2023-01-30

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