RU41243U1 - PACEMAKER - Google Patents

Abstract

Usage: medicine, medical equipment Objective: to expand indications for cardiac pacing, improve the results of its use in clinical practice, increase safety of use. The essence of the utility model: The pacemaker applies an electric pulse generated by the main clock generator and amplified by the output amplifier to the heart through the block of output electrodes. New in the design of the pacemaker is the addition of an input electrode block, an input signal amplifier block, a digitally controlled analogue signal switch block, a digital unit for transesophageal atrial electrocardiogram digital analysis, a surface electrocardiogram digital analysis unit, and an intracardiac electronic time interval adjustment unit, a computer interface control unit, a trigger control unit, while a control input of the input signal amplifier unit s connected to the output of the block of input electrodes, the output of the amplifier of the input signals is connected to the control input of the switch of analog signals with digital control, the outputs of the switch of analog signals with digital control are connected to the control inputs of the digital processing units of the transesophageal and surface electrocardiograms, the outputs of these blocks are connected to the control input of the block adjustment of the electronic interval of intracardiac conduction, the output of the last block is connected to the control input of the trigger unit a circuit whose output is intended to be connected to the control input of the main clock generator unit, the output of the computer interface unit is connected to the information input of the input signal amplifier block, digitally controlled analog signal switch block, digital transesophageal atrial electrocardiogram digital analysis unit, surface electrocardiogram digital analysis unit, the unit for adjusting the electronic interval of time of intracardiac conduction, the trigger control unit, the main clock unit generator, amplifier unit of the output signals, the input of the computer interface unit is connected to the computer.

Description

The utility model relates to medical equipment and can be used to correct central hemodynamics in patients with impaired conduction of excitation through the cardiac conduction system by means of pacing.

As a prototype, a pacemaker for transesophageal electrostimulation of the heart was selected, containing a main clock generator block, an output amplifier block and an output electrode block (Kirkutis A.A., Rimsha E.D., Nyaviarauskas Yu.V. Methods of using transesophageal electrostimulation of the heart: Textbook .-- method, manual. Kaunas, 1990. P. 14-18)

The disadvantages of the existing pacemaker for transesophageal electrostimulation of the heart are the impossibility of physiological sequential multifocal (biatrial, three-chamber) and atrioventricular electrostimulation in patients with impaired atrial and / or atrioventricular conduction of the heart, as well as the lack of sensitivity of cardiac cardiac function creates a risk of asynchronous electrical stimulation of the heart and induction tachyarrhythmias.

The utility model is aimed at solving problems: expanding indications for electrical stimulation of the heart, improving the results of its use in clinical practice, increasing the safety of the method.

These tasks are achieved through the use of an additional electronic circuit in the device designed to detect spontaneous and induced by the implanted pacemaker atrial and ventricular activity, which is the starting factor for determining the time of application of the electrical stimulus synchronized with atrial activity on the patient’s heart by the main clock pace generator after a period of time corresponding to normal intracardiac (atrial wow, atrioventricular) conduction, which allows to ensure the physiological sequence of activation and contraction of the heart chambers, to exclude asynchronous electrical stimulation and the risk of induction of tachyarrhythmias.

This is achieved due to the fact that an input electrode block, an input signal amplifier block, a digitally controlled analog signal switch block, a digital transesophageal atrial electrogram analysis block, a transesophageal atrial electrogram program, are inserted into the pacemaker, which contains the main clock generator block, the output amplifier block and the output electrode block. digital analysis of the surface electrocardiogram, the unit for adjusting the electronic interval of time of intracardiac conduction, the computer interface control unit, the trigger unit wow management.

In this case, the control input of the input signal amplifier block is connected to the output of the input electrode block, which take into account two sources of the patient's electrocardiogram (transesophageal electrocardiogram by means of a mono- or bipolar esophageal electrode installed in the esophagus at the level of the left atrium, surface electrocardiogram

using two cutaneous electrodes placed on the patient’s body in the area of the bed implanted in the subcutaneous tissue of a pacemaker), the output of the input signal amplifier block is connected to the control input of the digital signal analogue switchboard, the digitally controlled analogue signal switch outputs are connected to the control inputs of digital processing units input information (transesophageal and superficial electrocardiograms), the outputs of these blocks are connected to the control input of the adjustment unit electronic interval of intracardiac conduction, the output of the last unit is connected to the control input of the trigger control unit, the output of which is designed to connect to the control input of the main clock generator unit, the output of the computer interface unit is connected to the information input of the input signal amplifier block, the digital signal analogue switch block unit , block of digital analysis of transesophageal atrial electrogram, block of digital analysis of surface electrocardiogram, block of regulation Electronic time interval of the intracardiac application, trigger management unit block of the main clock generator, the output signals of the amplifier unit; the input of the computer interface control unit is designed to be connected to a computer.

The device is shown in the diagram, where Fig. 1 is a structural diagram of a pacemaker.

The pacemaker contains: block 1 of the input electrodes for recognition of spontaneous and induced atrial pacemaker induced by the pacemaker; input amplifier block 2

signals; block 3 switch analog signals with digital control; block 4 of the digital analysis of the transesophageal atrial electrogram; block 5 of digital analysis of the surface electrocardiogram; block 6 adjust the electronic time interval "intracardiac" conducting; a computer control unit 7; block 8 trigger control; block 9 of the main clock; block 10 amplifier input signals; block 11 of the output electrodes for supplying electrical pulses to the myocardium of the patient, communication lines 12, 13, 14, 15, 16, 17, 18, 20, 21, and 22 for connecting the blocks, respectively, 1 with 2, 2 with 3, 3 with 4 3 s 5, 4 s 6, 5 s 6, 6 s 8, 8 s 9, 9 s 10, 10 s 11, connection line 19 of the computer interface control unit 7, information bus 23 for adjustment by the computer interface control unit 7 blocks 2, 3, 4, 5, 6, 8, 9, and 10.

Pacemaker operates in the following modes of cardiac pacing:

1. a combination of (temporary and permanent) biatrial (right and left atria);

2. combined three-chamber (biatrial-ventricular);

3. combined two-chamber (atrioventricular) synchronized with the activity of the left atrium;

4. temporary single-chamber (atrial or ventricular) biocontrolled.

All operating modes of the pacemaker are set by the computer by entering via the interface line 19 into the computer interface control unit 7 (Fig. 1), generated programmatically on a personal computer and further distributed into blocks 2, 3, 4, 5, 6, 8, 9 and 10 by informational

23 tires. Initially, blocks 2, 3, 4, 5, 6, 8, 9, and 10 are set to their initial state by entering the necessary initial information into the information registers of these blocks.

In the mode of combined biatrial electrostimulation of the heart in a patient with interatrial blockade, a surface electrocardiogram is recorded to recognize the atrial activity induced by the implanted single-chamber atrial pacemaker (not shown in Fig. 1) using block 1 of the input electrodes using two cutaneous electrodes located in the bed area. From the output of block 1 through the communication line 12, the registered information is fed to the control input of block 2 of the input signal amplifier. After amplification, filtering and isolated isolation of the moment of applying the atrial impulse by the implanted pacemaker, the information from the output of block 2 is fed through the communication line 13 to the control input of the digital signals analog switch block 3, which, after processing by the computer interface control unit 7, sends information from the 3B output via communication lines 15 to the control input of block 5 of digital analysis of surface electrocardiogram. The recognized information is a starting signal for directing from the output of block 5 via the communication line 17 to the control input of the block for adjusting the electronic interval of intracardiac conduction, which after setting the value of this interval (within 0-100 milliseconds) of time by the computer interface control unit 7 transmits a pulse through the communication line 18 to the control input of the trigger control unit 8, which transmits

information through the communication line 20 to the control input of the block 9 of the main clock generator to generate an electrical pulse. This electric impulse after the input via the communication line 21 to the control input of the amplifier unit 10 of the input signals increases in amplitude and / or duration and is transmitted through the communication line 22 to the control input of the block 11 of the output electrodes and subsequently to the myocardium of the left atrium by means of the esophageal electrode installed in the esophagus at the level of the left atrium, with a value exceeding by 50% the value of the diastolic threshold of excitation.

In this way, a sequence of pulses of combined biatrial sequential electrical stimulation of the heart is formed, including the sequential application of two electrical pulses, first to the right and then to the left atrium, through a given electronic interval of intracardiac conduction, which helps to normalize the spread of excitation in the heart and ensures the physiological sequence of electrical excitation and atrial contraction. In the regime of combined biatrial sequential electrical stimulation of the heart, the intracardiac interval of the pacemaker corresponds to the time of physiological interatrial atrial excitation.

In the mode of combined three-chamber (biatrial-ventricular) cardiac stimulation in a patient with the presence of both atrial and atrioventricular blockade of the heart, a surface electrocardiogram is recorded to recognize an implanted two-chamber (atrioventricular) pacemaker (not shown in FIG. 1)

by means of a unit 1 of input electrodes using two cutaneous electrodes located in the area of the bed of the implanted pacemaker. From the output of block 1 through the communication line 12, the registered information is fed to the control input of block 2 of the input signal amplifier. After amplification, filtering and isolated isolation of the moment of applying the atrial impulse by the implanted pacemaker, the information from the output of block 2 is fed through the communication line 13 to the control input of the digital signals analog switch block 3, which, after processing by the computer interface control unit 7, sends information from the 3B output via communication lines 15 to the control input of block 5 of digital analysis of surface electrocardiogram. Block 5 carries out further allocation of the atrial impulse of the implanted pacemaker and eliminates after analysis of the computer through block 7 by the computer interface control unit information on the right ventricular pulse of the implanted pacemaker to eliminate the case of erroneous generation of the stimulus by block 9 in response to the right ventricular pulse. Recognized information is a starting signal for directing from the output of block 5 via the communication line 17 to the control input of block 6 for adjusting the electronic interval of intracardiac conduction, which after setting the value of this interval (within 0-100 milliseconds) of time by the computer control unit 7 transmits a pulse through the communication line 18 to the control input of the trigger control unit 8, which transmits information through the communication line 20 to the control input of the main clock generator unit 9 to generate electric pulse-parameter. This electric

the pulse after receipt through the communication line 21 to the control input of the amplifier unit 10 of the input signals increases in amplitude and / or duration and is transmitted through the communication line 22 to the control input of the block 11 of the output electrodes and subsequently to the myocardium of the left atrium through the esophagus electrode installed in the esophagus on the level of the left atrium, with a value exceeding by 50% the value of the diastolic threshold of excitation. Then, after a predetermined value (in the range of 150-250 milliseconds) of the electronic interval of the atrioventricular delay, the implanted pacemaker (not shown in FIG. 1) applies a pulse to the ventricles of the heart.

In this way, a sequence of pulses of combined three-chamber sequential electrical stimulation of the heart is formed, including the sequential application of three electrical pulses first to the right, then through a predetermined electronic interval of intracardiac conduction to the left atrium, and subsequently to the ventricles of the heart, which helps to normalize the spread of excitation in the heart and ensures a physiological sequence electrical excitation and contraction of the atria and ventricles of the heart. In the regime of combined three-chamber sequential electrical stimulation of the heart, the intracardiac interval of the pacemaker corresponds to the time of physiological interatrial atrial excitation.

In the regime of combined two-chamber (atrioventricular) electrical stimulation of the heart, synchronized with the activity of the left atrium in a patient with atrioventricular block and a preserved sinus rhythm in the atria, the patient's electrogram is recorded

transesophageal by using the unit 1 of the input electrodes using two configurations of the poles of the electrodes (bipolar, in which a pair of poles is located on the multipolar electrode installed in the esophagus at the level of the left atrium, or monopolar, in which the only pole of this esophagus electrode is used). From the output of block 1 of the input electrodes, the registered information on the communication line 12 is fed to the control input of block 2 of the input signal amplifier. After amplification, filtering and allocation of the maximum amplitude of spontaneous atrial activity, information from the output of block 2 is transmitted via communication line 13 to the control input of block 3 of digitally controlled analog signals, which, after processing by computer interface control unit 7, sends information from output 3A via line 14 communication to the control input of block 4 of the digital analysis of the transesophageal electrocardiogram. Block 4 carries out further allocation of the maximum amplitude of spontaneous atrial activity and eliminates ventricular activity induced by implanted cardiac pacemaker by block 7 through the control unit of the computer interface unit to block the erroneous production of stimulus by block 9 during detection of ventricular activity. The recognized information is a starting signal for directing from the output of the digital block of digital analysis of the transesophageal atrial electrogram via the communication line 16 to the control input of the adjustment unit 6 of the electronic interval of intracardiac conduction, which, after determining the value of this interval (within 50-250 milliseconds), by the conjugation control unit 7 with a computer transmits a pulse through a predetermined interval in

the communication line 18 to the control input of the trigger control unit 8, which, through the communication line 20, transmits information to the control input of the main clock generator unit 9 to generate an electric pulse. This electric impulse, after receiving via the communication line 22 to the control input of the amplifier unit 10 the input signals increases in amplitude and / or duration and is transmitted through the output of the block 11 of the output electrodes to the ventricles of the heart in three ways:

1. directly to the ventricles of the heart through endo (myo-, epi-) cardiac electrodes;

2. through the esophagus electrode, installed at the level of the ventricles of the heart (in the area of the cardioesophageal junction and the bottom of the stomach);

3. using cutaneous electrodes fixed in the area of the bed of the implanted ventricular trigger pacemaker. This induces the generation of an impulse to the myocardium of the ventricles of the heart by a trigger ventricular pacemaker (not shown in FIG. 1).

In this way, a sequence of combined two-chamber (atrioventricular) electrical stimulation of the heart is synchronized with the activity of the left atrium, including the recognition of left atrial activity and the transmission of an impulse through a given interval of intracardiac conduction to the ventricles of the heart. This helps to normalize the spread of excitation in the heart and provides a physiological sequence of electrical excitation and contraction of the atria and ventricles of the heart. In dual camera mode

(atrioventricular) electrical stimulation of the heart, synchronized with the activity of the left atrium, the intracardiac interval of the pacemaker corresponds to the time of physiological atrioventricular conduction.

In the single-chamber biocontrolled (atrial or ventricular) cardiac stimulation mode, the pulse is applied to the corresponding chamber of the heart and recognition of spontaneous cardiopotentials of the heart is performed using the block 11 of the output electrodes, then, through the communication line 22, the recognized electrical activity of the heart is transmitted to the block 10 of the output signal amplifier, where signal amplification occurs in amplitude and transmission on the communication line 21 to block 9 of the main clock generator. The latter compares the frequency of spontaneous activity of the heart with the base frequency of its functioning, given by block 7 of the interface with the computer via the information bus 23. If the frequency of spontaneous activity of the heart exceeds the base frequency of functioning of block 9 of the main clock, the latter temporarily stops the production of electrical impulses. This will continue until the frequency of spontaneous activity of the heart does not fall below the level of the basic frequency of functioning of block 9 of the main clock generator, this leads to the generation by block 9 of an electric pulse with a basic frequency of functioning, its subsequent amplification by block 10 of the output amplifier and transmission to the myocardium through block 11 of the output electrodes.

A useful model of a multifunctional pacemaker can be used for physiological multifocal (bi-atrial, three-chamber and ventricular, synchronized with activity

of the left atrium) of a biocontrolled combined and temporary electrostimulation of the heart, for choosing the optimal mode and parameters of pace with simultaneous assessment of central hemodynamics without surgery, for correcting cardiac output by optimizing the hemodynamic contribution of the atria to the blood supply to the ventricles of the heart, improving the diagnosis and treatment of “pacemaker syndrome”, improving prophylactic antiarrhythmic effect of atrial and atrioventricular electrical stimulation of the heart.

Claims (1)

An pacemaker comprising a main clock unit, an output amplifier unit and an output electrode unit, characterized in that it further includes an input electrode unit, an input signal amplifier unit, a digitally controlled analog signal switch unit, a digital transesophageal atrial electrocardiogram digital analysis unit, a digital unit analysis of surface electrocardiograms, unit for adjusting the electronic time interval of intracardiac conduction, control unit for computer interface , a trigger control unit, wherein the control input of the input signal amplifier block is connected to the output of the input electrode block, the output of the input signal amplifier is connected to the control input of the digitally controlled analog signal switch, the outputs of the digitally controlled analog signal switch are connected to the control inputs of the transesophageal digital processing units and surface electrocardiograms, the outputs of these blocks are connected to the control input of the intracardiac electronic interval adjustment unit about conducting, the output of the last unit is connected to the control input of the trigger control unit, the output of which is designed to connect to the control input of the main clock generator unit, the output of the computer interface unit is connected to the information input of the input signal amplifier block, the digital signal analogue signal switch block, the block of digital analysis of transesophageal atrial electrocardiogram, block of digital analysis of surface electrocardiogram, electronic time interval adjustment unit no intracardiac conduction, trigger control unit, main clock generator unit, output signal amplifier unit, input of the computer interface unit is connected to the computer.