TW201521823A - Intracardiac defibrillation catheter system - Google Patents

Abstract

An intracardiac defibrillation catheter system used for defibrillation by applying direct voltage synchronously with R waves of an electrocardiogram only when extrasystole and other unusual situations do not occur is provided. The intracardiac defibrillation catheter system is provided with a defibrillation catheter, a power source device, and an electrocardiograph. The power source device is provided with: a DC power source unit (71); an external switch (74) of an energy applying switch 744; and an arithmetic processing unit (75) which controls the DC power source unit. The arithmetic processing unit controls the DC power source unit in the following manner that: events deducing that the electrocardiogram input by the electrocardiograph is an R wave is sensed gradually, and when the polarity of the sensed event (Vn) after the input of the energy applying switch, the polarity of the former sensed event (Vn-1) and the polarity of the antepenultimate event (Vn-2) accord, direct voltage is applied to a number 1 DC electrode group (31G) and a number 2 DC electrode group (32G) synchronously with the event (Vn).

Description

Intracardiac defibrillation catheter system

The present invention relates to an intracardiac catheter defibrillation system, and more particularly to a defibrillation catheter having a heart inserted into a heart chamber, a power supply device for applying a DC voltage to the electrodes of the defibrillation catheter, and a catheter system for the electrocardiograph.

As a defibrillator for removing atrial fibrillation, an external defibrillator (hereinafter referred to as AED) is known. In the defibrillation treatment using the AED, electric power is supplied to the patient's body by mounting an electrode sheet on the body surface of the patient and applying a DC voltage. Here, the electrical energy flowing from the electrode sheet to the patient's body is usually 150 to 200 J, and a part (usually, several to 20% or so) flows to the heart for defibrillation treatment.

However, atrial fibrillation is easily caused in cardiac catheterization, and in this case, defibrillation is also required.

However, it is difficult to efficiently supply electric energy (for example, 10 to 30 J) to the heart where fibrillation is generated by the AED that supplies electric energy from outside the body.

That is, in the case where the proportion of electric energy supplied from the outside of the body to the heart is small (for example, about several %), sufficient defibrillation treatment cannot be performed.

On the other hand, in the case where electric energy supplied from outside the body flows to the heart at a high ratio, there is a concern that the tissue of the heart may be damaged.

Further, in the defibrillation treatment using the AED, burns are likely to occur on the body surface on which the electrode sheets are attached. Further, as described above, when the proportion of electric energy flowing to the heart is small, the supply of electric energy is repeated, and the degree of burns becomes heavier, which is a considerable burden for patients undergoing catheterization.

In view of such a matter, the inventors propose a catheter defibrillation system having a defibrillation catheter that is inserted into a cardiac chamber for defibrillation, and a power supply device that applies an electrode to the defibrillation catheter a DC voltage; and an electrocardiograph, wherein the defibrillation catheter comprises: an insulating tube member; a first DC electrode group consisting of a plurality of annular electrodes mounted in a front end region of the tube member; and a second DC electrode group And consisting of a plurality of annular electrodes mounted on the tube member at a distance from the first DC electrode group to the proximal end side; the first lead group being connected to the electrodes constituting the first DC electrode group by a front end a plurality of lead wires; and a second lead wire group comprising a plurality of lead wires respectively connected to the electrodes constituting the second DC electrode group; the power supply device includes: a DC power source portion; a conduit connection connector, and the defibrillation a first lead set of the catheter and a base end side of the second lead set are connected; an electrocardiograph connection connector is connected to the input terminal of the electrocardiograph; and an arithmetic processing unit that supplies the DC power source according to an input of the external switch unit An output circuit having a DC voltage from the DC power supply unit; and a switching portion formed by a switch of a circuit two contacts, the common contact connecting the conduit connection connector, and the first contact connecting the electrocardiograph The connector is connected, and the second contact is connected to the arithmetic processing unit. When the cardiac potential is measured through the electrode of the defibrillation catheter (the electrode constituting the first DC electrode group and/or the second DC electrode group), the first connection is selected in the switching unit. At the point, the cardiac potential information from the defibrillation catheter is input to the electrocardiograph via the catheter connection connector, the switching portion, and the electrocardiographic connection connector of the power supply device, and the operation of the power supply device is performed when defibrillation is performed through the defibrillation catheter. The processing unit switches the contact of the switching unit to the second contact, and the first DC electrode group and the second DC of the defibrillation catheter are connected from the DC power supply unit via the output circuit of the arithmetic processing unit, the switching unit, and the catheter connection connector. Voltages of mutually different polarities are applied to the electrode group (see Patent Document 1 below).

According to the defibrillation catheter system described in Patent Document 1, it is possible to reliably supply a sufficient amount of electric energy required for defibrillation to a heart such as atrial fibrillation during cardiac catheterization. In addition, it does not cause burns on the body surface of the patient and has less invasiveness.

Further, when the defibrillation treatment is not required, the defibrillation catheter constituting the present invention can be used as an electrode catheter for measuring cardiac potential.

In the catheter system described in Patent Document 1, when an external switch, that is, an energy application switch is input, the communication processing unit transmits the contact of the switching unit from the first contact to the second contact, and connects from the catheter. The path that the device reaches the arithmetic processing unit via the switching unit is secured.

After the contact of the switching unit is switched to the second contact, the DC power supply unit that has received the control signal from the arithmetic processing unit passes through the output circuit of the arithmetic processing unit, the switching unit, and the catheter connection connector, and the defibrillation catheter is A DC electrode group and a second DC electrode group apply DC voltages of mutually different polarities.

Here, the arithmetic processing unit performs arithmetic processing and transmits a control signal to the DC power supply unit to apply a voltage in synchronization with the cardiac potential waveform input through the electrocardiogram input connector.

Specifically, a control signal is transmitted to the DC power supply unit in such a manner that one R wave (maximum peak value) is detected in the cardiac potential waveform (electrocardiogram) sequentially input to the arithmetic processing unit, and the peak height is obtained. The application is started after a certain period of time (for example, an extremely short time of about 1/10 of the peak width of the R wave) from the time when the potential difference reaches a height (trigger level) of 80% of the peak height.

Patent Document 1: Japanese Patent No. 4545216

In order to perform effective defibrillation treatment without causing a bad influence on the ventricle, defibrillation (application of voltage) is usually performed in synchronization with the R wave.

Defibrillation in synchronization with the T wave has a high risk of causing severe ventricular fibrillation, and therefore it is necessary to avoid synchronization with the T wave.

Therefore, in the catheter system described in Patent Document 1, the peak reaching the trigger level shortly after the input of the energy application switch is recognized as an R wave, and a voltage is applied to the first electrode group and the second electrode group in synchronization with the peak.

However, in the case where the heart of the patient who is to receive the defibrillation treatment is contracted outside the contraction, or the drift of the reference line (baseline) swing input to the electrocardiogram of the arithmetic processing unit is generated, it sometimes arrives shortly after the input of the energy application switch. The peak of the potential difference of the trigger level (identified as the peak of the R wave) is actually not the peak of the R wave.

For example, when a single-shot extra-systolic contraction occurs in the heart of the patient, the electrocardiogram (cardiac potential waveform) input to the arithmetic processing unit is as shown in FIG. 19, and the R wave (in the figure, the fourth R-wave from the left) The polarity of the ) is reversed, and the peak of the next T wave tends to increase.

Further, as shown in the figure, if the electric energy application switch is input shortly after the occurrence of the extra-systolic contraction, it is considered that the T-wave missensing (detection) which is increased to reach the trigger level is R wave, and The T wave is synchronously applied with a voltage to perform defibrillation.

Further, when the reference line of the electrocardiogram is swung, it is considered that there is a case where the waveform that is not normally sensed is mistaken for the R wave and sensed. For example, when the rise of the reference line occurs, there is a case where the height of the waveform that is not positive for the R wave is higher than the actual reading. Fig. 20 shows an electrocardiogram in which drift occurs and the reference line is lowered, and then the reference line rises and returns to the original reference line. However, before the reference line rises, the electric energy application switch is input, so that the rise of the reference line is mistaken for the R wave to be sensed (detected), and the voltage is applied in synchronization with the defibrillation.

The present invention has been completed based on the above matters.

A first object of the present invention is to provide an intracardiac defibrillation catheter system capable of applying a voltage to an electrode of a defibrillation catheter without contracting during a cardiac contraction of a patient undergoing defibrillation therapy. At the time of contraction, a DC voltage is applied to the electrodes of the defibrillation catheter in synchronization with the R wave of the electrocardiogram input to the arithmetic processing unit to perform defibrillation.

A second object of the present invention is to provide an intracardiac defibrillation catheter system capable of applying a voltage to an electrode of a defibrillation catheter without being applied to a reference line of an electrocardiogram input to the arithmetic processing unit, but at a reference line When it is stable, a DC voltage is applied to the electrodes of the defibrillation catheter in synchronization with the R wave of the electrocardiogram to perform defibrillation.

In order to achieve the above-mentioned object, the inventors of the present invention have found that the electrocardiogram is generated when the patient's heart is contracted outside the heart, and when the reference line of the electrocardiogram of the arithmetic processing unit input to the power supply device is swung. The polarity change of the event that is sequentially sensed (the waveform that is presumed to be the R wave); when the polarity of the event is generated in the same direction three times in succession, at least at the time of sensing the event of the third time, it becomes non-occurring There is no steady state of drift, and the third event (waveform) is indeed the peak of the R wave; only when the polarity of the event estimated as the R wave is generated three times or more in the same direction (after the power application switch is input) When the polarity of the sensed event coincides with the polarity of the previous two sensed events, the defibrillation synchronized with the R wave can be reliably performed by applying a voltage in synchronization with the event, and based on these findings, this invention.

(1) That is, the intracardiac defibrillation catheter system of the present invention is a defibrillation catheter having a defibrillation inserted into a cardiac chamber, a power supply device for applying a DC voltage to an electrode of the defibrillation catheter, and an electrocardiograph a catheter system, the defibrillation catheter comprising: an insulating tube member; a first electrode group (first DC electrode group) comprising a plurality of annular electrodes mounted in a front end region of the tube member; and a second electrode group ( a second DC electrode group) comprising a plurality of annular electrodes, the plurality of ring electrodes being attached to the tube member at a distance from the first DC electrode group toward the proximal end side; the first lead group; a front end is formed of a plurality of leads respectively connected to the electrodes constituting the first DC electrode group; and a second lead group is formed by a plurality of leads respectively connected to the electrodes constituting the second DC electrode group, and the power supply device a DC power supply unit; a catheter connection connector connected to a first lead group of the defibrillation catheter and a base end side of the second lead set; an external switch including an electric energy application switch; and an arithmetic processing unit having An output circuit of a DC voltage of the DC power supply unit, and controlling the DC power supply unit based on an input of the external switch; and an electrocardiogram input connector connected to the arithmetic processing unit and an output terminal of the electrocardiograph When the defibrillation catheter performs defibrillation, the first DC electrode group and the second DC electrode group of the defibrillation catheter are different from each other by the DC power supply unit via the output circuit of the arithmetic processing unit and the catheter connection connector ( The voltage of the ± opposite polarity is calculated by the arithmetic processing unit of the power supply device as follows to control the DC power supply unit, that is, the sequential sensing is input from the electrocardiograph according to the input via the electrocardiogram input connector. An electrocardiogram is inferred as an event of an R wave, and the polarity of the event (Vn) sensed after the input of the above-described power application switch (nth time) is at least the polarity of the previous sensed event (Vn-1) And when the polarities of the previous two sensed events (Vn-2) are the same, the first DC electrode group and the second DC electrode group are applied in synchronization with the event (Vn). Voltage.

According to the intracardiac defibrillation catheter system having such a configuration, in the electrocardiogram input to the arithmetic processing unit of the power supply device, if three events (Vn-2), (Vn-1), and the like are continuously sensed, When the polarity of (Vn) does not match, it is determined that there is a possibility that the patient's heart is contracted outside the heart, or the reference line of the electrocardiogram is drifted, and the event (Vn) is not the peak of the R wave. The voltage is not applied in synchronization with the event (Vn). Further, when the polarities of the three events (Vn-2), (Vn-1), and (Vn) match, it is determined that the third event (Vn) is the peak of the R wave, and is synchronized with the event (Vn). The voltage is applied to the ground so that defibrillation synchronized with the R wave can be reliably performed.

(2) In the intracardiac defibrillation catheter system of the present invention, it is preferable that the arithmetic processing unit of the power supply device controls the DC power supply unit so as to be the shortest of 50 m seconds after sensing an event estimated to be an R wave. A voltage is not applied to the first DC electrode group and the second DC electrode group between 500 msec, preferably 260 msec.

According to the intracardiac defibrillation catheter system having such a configuration, after the event estimated to be the R wave is sensed, the voltage is not applied to the first DC electrode group and the second DC electrode group at the shortest time of 50 m seconds. When the sensed event is the peak of the R wave, it is possible to reliably avoid the defibrillation at the time when the next T wave appears, that is, the peak estimated to be the T wave can be masked.

(3) In the intracardiac defibrillation catheter system according to the above (2), preferably, the arithmetic processing unit of the power supply device has a shortest time of 10 m seconds and a maximum length of 150 msec, preferably 100 msec, after sensing an event estimated to be an R wave. No new sensing is estimated to be an R wave event.

According to the intracardiac defibrillation catheter system having such a configuration, after an event estimated to be an R wave is sensed, a new event is not sensed for a minimum of 10 m seconds, so that the sensed event is prevented from being an R wave peak, and then When the peak value of the S wave appearing in the opposite direction increases and reaches the trigger level (the state has no particular problem when defibrillation is performed), the peak of the S wave is sensed and the polarity of the event is affected by the continuity of the event. The case of loss (the count of the same polarity is reset).

(4) In the intracardiac defibrillation catheter system according to (2) or (3) above, preferably, the arithmetic processing unit of the power supply device is between a shortest time of 10 m seconds and a maximum of 500 msec, preferably 260 msec, after the input of the electric energy application switch. The DC power supply unit is controlled so as not to apply a voltage to the first DC electrode group and the second electrode group.

According to the intracardiac defibrillation catheter system thus constructed, since the voltage is not applied to the first DC electrode group and the second DC electrode group for a minimum of 10 m seconds after the input of the electric energy application switch, it is possible to prevent the input due to the input of the application switch. The noise (the noise of the same polarity as the last time and the last time of the previous event) is erroneously sensed as an R wave, and the defibrillation is performed in synchronization with the noise. In addition, it is possible to prevent noise generated by the input of the switch (noise of the same polarity as the last time and the last event), resulting in impaired continuity of the polarity of the event (the count of the same polarity is reset) Happening. Further, it is possible to prevent the fluctuation of the reference line which occurs shortly after the input of the application switch is erroneously sensed as the R wave, and the defibrillation can be performed in synchronization therewith.

According to the intracardiac defibrillation catheter system of the present invention, when a patient undergoing defibrillation treatment is contracted outside the heart, the voltage of the defibrillation catheter is not applied to the electrode of the defibrillation catheter, and when no extravasation occurs, the input is The electrocardiogram R wave of the arithmetic processing unit synchronously applies a DC voltage to the electrodes of the defibrillation catheter to perform defibrillation.

Further, when the reference line of the electrocardiogram input to the arithmetic processing unit is swung (drifted), a voltage is not applied to the electrode of the defibrillation catheter, and when the reference line is stabilized, the defibrillation catheter is placed in synchronization with the R wave of the electrocardiogram. A DC voltage is applied to the electrodes for defibrillation.

As shown in FIG. 1, the intracardiac defibrillation catheter system of the present embodiment includes a defibrillation catheter 100, a power supply device 700, an electrocardiograph 800, and a cardiac potential measuring unit 900.

As shown in FIGS. 2 to 5, the defibrillation catheter 100 constituting the defibrillation catheter system of the present embodiment includes a multi-lumen tube 10, a handle 20, a first DC electrode group 31G, a second DC electrode group 32G, and a proximal end side potential. The electrode group 33G, the first lead group 41G, the second lead group 42G, and the third lead group 43G are measured.

As shown in FIGS. 4 and 5, in the multi-lumen tube 10 (insulating tube member having a multi-chamber structure) constituting the defibrillation catheter 100, four lumens (the first lumen 11 and the second tube) are formed. The cavity 12, the third lumen 13, and the fourth lumen 14).

In Fig. 4 and Fig. 5, 15 is a fluororesin layer dividing the lumen, 16 is a lining (core) portion made of a low-hardness nylon elastomer, and 17 is an outer shell (shell) made of a high-hardness nylon elastomer. In the section, 18 in Fig. 4 is a stainless steel wire forming a braided blade.

The fluororesin layer 15 that divides the lumen is made of, for example, a material having high insulating properties such as tetrafluoroethylene-perfluoroalkoxy vinyl ether copolymer (PFA) or polytetrafluoroethylene (PTFE).

The nylon elastomer constituting the outer portion 17 of the multi-lumen tube 10 uses a material having a hardness different depending on the axial direction. Thereby, the multi-lumen tube 10 is configured to gradually increase in hardness from the distal end side toward the proximal end side.

When a preferred example is shown, in FIG. 3, the hardness of the region indicated by L1 (length 52 mm) (hardness obtained by the D-type durometer) is 40, and the hardness of the region indicated by L2 (length 108 mm) is 55. The hardness of the region indicated by L3 (length 25.7 mm) is 63, and the hardness of the region indicated by L4 (length 10 mm) is 68, and the hardness of L5 (length 500 mm) is 72.

The braided blade composed of a stainless steel wire is formed only in the region shown by L5 in Fig. 3, as shown in Fig. 4, between the inner portion 16 and the outer portion 17.

The outer diameter of the multi-lumen tube 10 is, for example, 1.2 to 3.3 mm.

The method of manufacturing the multi-lumen tube 10 is not particularly limited.

The handle 20 constituting the defibrillation catheter 100 in the present embodiment includes a handle body 21, a stringer 22, and a strain relief 24.

By rotating the stringer 22, the distal end portion of the multi-lumen tube 10 can be deflected (shaking).

The first DC electrode group 31G, the second DC electrode group 32G, and the proximal end side potential measurement electrode group 33G are attached to the outer circumference of the multi-lumen tube 10 (the front end region where the knitting is not formed). Here, the "electrode group" refers to an aggregate of a plurality of electrodes constituting the same pole (having the same polarity) or being mounted at a narrow interval (for example, 5 mm or less) for the same purpose.

The first DC electrode group is formed by mounting a plurality of electrodes constituting the same pole (-pole or + pole) at narrow intervals in the front end region of the multi-lumen tube. Here, the number of electrodes constituting the first DC electrode group differs depending on the width and arrangement interval of the electrodes, but is, for example, 4 to 13, preferably 8 to 10.

In the present embodiment, the first DC electrode group 31G is constituted by eight annular electrodes 31 attached to the front end region of the multi-lumen tube 10.

The electrode 31 constituting the first DC electrode group 31G is connected to the catheter connection connector of the power supply device 700 via a lead wire (a lead wire 41 constituting the first lead wire group 41G) and a connector to be described later.

Here, the width (length in the axial direction) of the electrode 31 is preferably 2 to 5 mm, and a preferred example is 4 mm.

If the width of the electrode 31 is too narrow, the amount of heat generated when the voltage is applied becomes excessively large, which may cause damage to the surrounding tissue. On the other hand, if the width of the electrode 31 is too wide, the flexibility and flexibility of the portion of the multi-lumen tube 10 in which the first DC electrode group 31G is provided may be impaired.

The mounting interval of the electrodes 31 (the distance between adjacent electrodes) is preferably 1 to 5 mm, and is 2 mm if a preferred example is shown.

When the defibrillation catheter 100 is used (when placed in the heart chamber), the first DC electrode group 31G is located, for example, in a coronary vein.

The second DC electrode group is spaced apart from the mounting position of the first DC electrode group of the multi-lumen tube to the base end side, and is installed at a narrow interval to form an opposite pole (+ pole or - pole) to the first DC electrode group. Formed by a plurality of electrodes. Here, the number of electrodes constituting the second DC electrode group also differs depending on the width and arrangement interval of the electrodes, but is, for example, 4 to 13, preferably 8 to 10.

In the present embodiment, the second DC electrode group 32G is composed of eight annular electrodes 32 that are attached to the multi-lumen tube 10 from the attachment position of the first DC electrode group 31G to the proximal end side.

The electrode 32 constituting the second DC electrode group 32G is connected to the catheter connection connector of the power supply device 700 via a lead wire (a lead wire 42 constituting the second lead group) and a connector to be described later.

Here, the width (length in the axial direction) of the electrode 32 is preferably 2 to 5 mm. If a preferred example is shown, it is 4 mm.

If the width of the electrode 32 is too narrow, the amount of heat generated when the voltage is applied becomes too large, which may damage the surrounding structure. On the other hand, if the width of the electrode 32 is too wide, the flexibility and flexibility of the portion of the multi-lumen tube 10 in which the second DC electrode group 32G is provided may be impaired.

The mounting interval of the electrodes 32 (the distance between adjacent electrodes) is preferably 1 to 5 mm, and is 2 mm if a preferred example is shown.

When the defibrillation catheter 100 is used (when placed in the heart chamber), the second DC electrode group 32G is located, for example, in the right atrium.

In the present embodiment, the proximal end side potential measurement electrode group 33G is composed of four annular electrodes 32 that are attached to the multi-lumen tube 10 at intervals from the attachment position of the second DC electrode group 32G to the proximal end side.

The electrode 33 constituting the proximal end side potential measurement electrode group 33G is connected to the catheter connection connector of the power supply device 700 via a lead wire (a lead wire 43 constituting the third lead wire group 43G) and a connector to be described later.

Here, the width (length in the axial direction) of the electrode 33 is preferably 0.5 to 2.0 mm, and is 1.2 mm if a preferred example is shown.

When the width of the electrode 33 is too wide, the measurement accuracy of the cardiac potential is lowered, and the location of the abnormal potential is difficult to determine.

The mounting interval of the electrodes 33 (the distance between adjacent electrodes) is preferably 1.0 to 10.0 mm. If a preferred example is shown, it is 5 mm.

When the defibrillation catheter 100 is used (when placed in the cardiac chamber), the proximal end side potential measuring electrode group 33G is located, for example, in the upper large vein where an abnormal potential is likely to occur.

A front end wafer 35 is attached to the front end of the defibrillation catheter 100.

The lead wire is not connected to the front end wafer 35, and is not used as an electrode in the present embodiment. However, it is also possible to use the lead wire as an electrode. The constituent material of the front end wafer 35 may be a metal material such as platinum or stainless steel, various resin materials, and the like, and is not particularly limited.

The distance d2 between the first DC electrode group 31G (the electrode on the proximal end side) and the second DC electrode group 32G (the electrode on the distal end side) is preferably 40 to 100 mm, and is 66 mm as a preferred example.

The distance d3 between the second DC electrode group 32G (the electrode on the proximal end side) and the proximal-side potential measurement electrode group 33G (the electrode on the distal end side) is preferably 5 to 50 mm, and a preferred example is shown. 30mm.

The electrodes 31, 32, and 33 constituting the first DC electrode group 31G, the second DC electrode group 32G, and the proximal end side potential measurement electrode group 33G are preferably made of platinum or platinum in order to improve the contrast property against X-rays. Alloy composition.

The first lead 41G shown in FIGS. 4 and 5 is an aggregate of eight leads 41 connected to the eight electrodes (31) constituting the first DC electrode group (31G).

The eight electrodes 31 constituting the first DC electrode group 31G can be electrically connected to the power supply device 700 through the first lead group 41G (lead 41).

The eight electrodes 31 constituting the first DC electrode group 31G are respectively connected to different leads 41. The lead wires 41 are respectively welded to the inner peripheral surface of the electrode 31 at the front end portion thereof, and enter the first lumen 11 from the side holes formed in the tube wall of the multi-lumen tube 10. The eight lead wires 41 entering the first lumen 11 extend as the first lead group 41G in the first lumen 11.

The second lead group 42G shown in FIGS. 4 and 5 is an aggregate of eight leads 42 connected to the eight electrodes (32) constituting the second DC electrode group (32G).

The eight electrodes 32 constituting the second DC electrode group 32G can be electrically connected to the power supply device 700 through the second lead group 42G (lead 42).

The eight electrodes 32 constituting the second electrode group are respectively connected to different leads 42. The lead wires 42 are respectively welded to the inner peripheral surface of the electrode 32 at the front end portion thereof, and enter the second lumen 12 (the first lumen extending from the first lead group 41G) from the side hole formed in the tube wall of the multi-lumen tube 10 11 different lumens). The eight lead wires 42 entering the second lumen 12 extend as a second lead set 42G in the second lumen 12.

As described above, the first lead set 41G extends in the first lumen 11, and the second lead set 42G extends in the second lumen 12 such that both are completely insulated from each other within the multi-lumen tube 10. Therefore, when a voltage required for defibrillation is applied, a short circuit between the first lead group 41G (first DC electrode group 31G) and the second lead group 42G (second DC electrode group 32G) can be reliably prevented.

The third lead group 43G shown in FIG. 4 is an aggregate of four leads 43 connected to the electrodes (33) constituting the proximal end side potential measuring electrode (33G).

The electrodes 33 constituting the proximal end side potential measurement electrode group 33G can be electrically connected to the power supply device 700 through the third lead group 43G (lead 43).

The four electrodes 33 constituting the proximal end side potential measuring electrode 33G are respectively connected to different lead wires 43. The lead wires 43 are respectively welded to the inner peripheral surface of the electrode 33 at the front end portion thereof, and enter the third lumen 13 from the side holes formed in the tube wall of the multi-lumen tube 10. The four leads 43 entering the third lumen 13 extend as a third lead set 43G in the third lumen.

As described above, the third lead group 43G extending in the third lumen 13 is completely insulated from the first lead group 41G and the second lead group 42G. Therefore, when the voltage required for defibrillation is applied, the third lead group 43G (base end side potential measuring electrode group 33G) and the first lead group 41G (first DC electrode group 31G) or the second lead can be reliably prevented. Short circuit between group 42G (second DC electrode group 32G).

Each of the lead 41, the lead 42 and the lead 43 is composed of a resin-coated wire coated with an outer peripheral surface of a metal wire with a resin such as polyimide. Here, the film thickness of the coating resin is about 2 to 30 μm.

In Fig. 4 and Fig. 5, 65 is a pull wire.

The pull wire 65 extends in the fourth lumen 14 and extends eccentrically relative to the central axis of the multi-lumen tube 10.

The front end portion of the pull wire 65 is fixed to the front end wafer 35 by soldering. Further, a large diameter portion (a retaining portion) for preventing the detachment may be formed at the tip end of the wire 65. Thereby, the front end wafer 35 and the pull wire 65 are firmly coupled, and it is possible to reliably prevent the front end wafer 35 from coming off or the like.

On the other hand, the base end portion of the wire 65 is connected to the stringer 22 of the handle 20, and the wire rope 65 is stretched by the operation of the stringer 22, whereby the front end portion of the multi-lumen tube 10 is deflected.

The wire 65 is made of a stainless steel or a Ni-Ti superelastic alloy, but it does not need to be made of a metal. The pull wire 65 may also be composed of, for example, a high-strength non-conductive wire or the like.

Further, the mechanism for deflecting the distal end portion of the multi-lumen tube is not limited thereto, and may be, for example, a mechanism including a leaf spring.

In the fourth lumen 14 of the multi-lumen tube 10, only the pull wire 65 extends without lead (set) extension. Thereby, at the time of the yaw operation of the front end portion of the multi-lumen tube 10, it is possible to prevent the lead wire from being damaged (for example, scratched) due to the wire 65 moving in the axial direction.

In the defibrillation catheter 100 of the present embodiment, even in the inside of the handle 20, the first lead group 41G, the second lead group 42G, and the third lead group 43 are insulated and insulated.

Fig. 6 is a perspective view showing an internal structure of a handle of the defibrillation catheter 100 according to the present embodiment, Fig. 7 is a partially enlarged view of the inside of the handle (front end side), and Fig. 8 is a partially enlarged view of the inside of the handle (base end side).

As shown in FIG. 6, the proximal end portion of the multi-lumen tube 10 is inserted into the front end opening of the handle 20, whereby the multi-lumen tube 10 is coupled to the handle 20.

As shown in FIG. 6 and FIG. 8 , a cylindrical connector 50 is disposed in the proximal end portion of the handle 20, and the cylindrical connector 50 has a plurality of needles that protrude toward the distal end surface of the distal end surface 50A. Formed by terminals (51, 52, 53).

Further, as shown in FIGS. 6 to 8, three insulating tubes (first insulating tubes 26) that are respectively inserted by the three lead groups (the first lead group 41G, the second lead group 42G, and the third lead group 43G) are inserted. The second insulating tube 27 and the third insulating tube 28) extend inside the handle 20. [00100] As shown in FIGS. 6 and 7, the distal end portion of the first insulating tube 26 (about 10 mm from the front end) is inserted into the first lumen 11 of the multi-lumen tube 10, whereby the first insulating tube 26 is coupled to the first lumen 11 extending from the first lead set 41G. [00101] The first insulating tube 26 coupled to the first lumen 11 extends through the inner hole of the first protective tube 61 extending inside the handle 20 to the connector 50 (the front end face 50A of the needle terminal is disposed) In the vicinity of the connector, an insertion passage for guiding the proximal end portion of the first lead group 41G to the vicinity of the connector 50 is formed. Thereby, the first lead group 41G extending from the multi-lumen tube 10 (the first lumen 11) can be extended inside the handle 20 (the inner hole of the first insulating tube 26) without being twisted. [00102] The first lead group 41G extending from the proximal end opening of the first insulating tube 26 is detached into eight lead wires 41 constituting the first lead group 41G, and these leads 41 are connected and fixed by soldering, respectively. Each of the needle terminals of the front end face 50A of the connector 50. Here, a region in which the needle terminals (needle terminals 51) constituting the lead wires 41 of the first lead group 41G are connected is referred to as a "first terminal group region". The front end portion of the second insulating tube 27 (about 10 mm from the front end) is inserted into the second lumen 12 of the multi-lumen tube 10, whereby the second insulating tube 27 is joined to the second lead group 42G. The second lumen 12. [00104] The second insulating tube 27 coupled to the second lumen 12 extends through the inner hole of the second protective tube 62 extending inside the handle 20 to the connector 50 (the front end face 50A of the needle terminal is disposed) In the vicinity of the connector, an insertion passage for guiding the proximal end portion of the second lead group 42G to the vicinity of the connector 50 is formed. Thereby, the second lead group 42G extending from the multi-lumen tube 10 (the second lumen 12) can be extended inside the handle 20 (the inner hole of the second insulating tube 27) without being twisted. [00105] The second lead group 42G extending from the base end opening of the second insulating tube 27 is detached into eight lead wires 42 constituting the second lead group 42G, and these leads 42 are connected and fixed by soldering, respectively. Each of the needle terminals of the front end face 50A of the connector 50. Here, a region in which the needle terminals (needle terminals 52) constituting the lead wires 42 of the second lead group 42G are connected and fixed is referred to as a "second terminal group region". The front end portion of the third insulating tube 28 (about 10 mm from the front end) is inserted into the third lumen 13 of the multi-lumen tube 10, whereby the third insulating tube 28 is joined to the third lead group 43G. The third lumen 13. [00107] The third insulating tube 28 coupled to the third lumen 13 extends through the inner hole of the second protective tube 62 extending inside the handle 20 to the connector 50 (the front end face 50A of the needle terminal is disposed) In the vicinity of the connector, an insertion passage for guiding the proximal end portion of the third lead group 43G to the vicinity of the connector 50 is formed. Thereby, the third lead group 43G extending from the multi-lumen tube 10 (the third lumen 13) can be extended inside the handle 20 (the inner hole of the third insulating tube 28) without being twisted. [00108] The third lead group 43G extending from the base end opening of the third insulating tube 28 is detached into four lead wires 43 constituting the third lead group 43G, and these lead wires 43 are connected and fixed by soldering, respectively. Each of the needle terminals of the front end face 50A of the connector 50. Here, a region in which the needle terminals (needle terminals 53) constituting the lead wires 43 constituting the third lead group 43G are connected is referred to as a "third terminal group region". [00109] Here, as a constituent material of the insulating tube (the first insulating tube 26, the second insulating tube 27, and the third insulating tube 28), a polyimide resin, a polyamide resin, and the like can be exemplified. Polyamine-quinone imine resin and the like. Among them, a polyimide film having a high hardness and easily inserted into a lead group and capable of achieving thin-wall molding is particularly preferable. [00110] The thickness of the insulating tube is preferably 20 to 40 μm, and is preferably 30 μm as a preferred example. [00111] In addition, as a constituent material of the protective tube (the first protective tube 61 and the second protective tube 62) in which the insulating tube is inserted, a nylon-based elastomer such as "Pebax" (registered trademark of ARKEMA) can be exemplified. . According to the defibrillation catheter 100 of the present embodiment having the above-described configuration, the first lead group 41G extends in the first insulating tube 26, and the second lead group 42G extends in the second insulating tube 27. The third lead group 43G extends inside the third insulating tube 28, so that the first lead group 41G, the second lead group 42G, and the third lead group 43G can be completely insulated from each other even in the inside of the handle 20. As a result, when the voltage required for defibrillation is applied, the short circuit between the first lead group 41G, the second lead group 42G, and the third lead group 43G in the inside of the handle 20 can be reliably prevented (especially in the tube A short circuit between the lead sets extending near the opening of the cavity). [00113] Further, in the inside of the handle 20, the first insulating tube 26 is protected by the first protective tube 61, and the second insulating tube 27 and the third insulating tube 28 are protected by the second protective tube 62, thereby being able to prevent For example, at the time of the yaw operation of the distal end portion of the multi-lumen tube 10, the insulating tube is damaged due to contact or friction of constituent members (movable parts) of the cord plug 22. [00114] The defibrillation tube 100 in the present embodiment includes a partition plate 55 that partitions the front end surface 50A of the connector 50 in which a plurality of needle terminals are disposed as a first terminal group region and a second terminal group The region and the third terminal group region separate the lead 41, the lead 42 and the lead 43 from each other. [0015] The separator 55 that partitions the first terminal group region, the second terminal group region, and the third terminal group region is formed by processing an insulating resin into a water-conducting tube having a flat surface on both sides. The insulating resin constituting the separator 55 is not particularly limited, and a general-purpose resin such as polyethylene can be used. [00116] The thickness of the partition 55 is, for example, 0. 1~0. 5mm, if a preferred example is shown, it is 0. 2mm. [00117] The height of the partition 55 (the distance from the base end edge to the front end edge) needs to be longer than the distance between the front end face 50A of the connector 50 and the insulating tubes (the first insulating tube 26 and the second insulating tube 27). High, in the case where the distance is 7 mm, the height of the partition 55 is, for example, 8 mm. If a separator having a height of less than 7 mm is used, the leading edge cannot be positioned closer to the front end than the base end of the insulating tube. According to such a configuration, the lead 41 constituting the first lead group 41G (the base end portion of the lead 41 extending from the base end opening of the first insulating tube 26) and the second lead can be reliably and neatly separated. A lead 42 of the group 42G (a base end portion of the lead 42 extending from the base end opening of the second insulating tube 27). [00119] Without the spacer 55, the leads 41 and the leads 42 cannot be neatly separated (separated), and they are likely to be mixed. Further, the lead 41 constituting the first lead group 41G and the lead 42 constituting the second lead group 42G to which voltages of mutually different polarities are applied are separated from each other by the spacer 55 without contact, so defibrillation is used. At the time of the catheter 100, even if the voltage required for defibrillation in the cardiac chamber is applied, the lead 41 constituting the first lead group 41G (the base end portion of the lead 41 extending from the proximal end opening of the first insulating tube 26) is not present. A short circuit occurs between the lead 42 constituting the second lead group 42G (the base end portion of the lead 42 extending from the proximal end opening of the second insulating tube 27). Further, in the case of manufacturing a defibrillation catheter, when an error occurs in fixing the lead wire to the pin terminal, for example, the lead wire 41 constituting the first lead wire group 42G is connected and fixed to the second terminal group region. In the case of the needle terminal in the middle, the lead 41 crosses the partition 55, so that the connection error can be easily found. [00122] Further, the lead 43 (needle terminal 53) constituting the third lead group 43G and the lead 42 (needle terminal 52) are separated together by the spacers 55 and 41 (the pin terminal 51), but are not limited thereto. It is also possible to be separated from the lead 42 (needle terminal 52) by the spacer 55 together with the lead 41 (the pin terminal 51). [00123] In the defibrillation catheter 100, the front end edge of the partition plate 55 is located closer to the front end side than the base end of the first insulating tube 26 and the proximal end of the second insulating tube 27. Thereby, the lead wire extending from the base end opening of the first insulating tube 26 (the lead wire 41 constituting the first lead group 41G) and the lead wire extending from the base end opening of the second insulating tube 27 ( The separator 55 is always present between the leads 42) constituting the second lead group 42G, so that the short circuit caused by the contact of the lead 41 and the lead 42 can be reliably prevented. As shown in FIG. 8, the eight lead wires 41 extending from the proximal end opening of the first insulating tube 26 and fixed to the pin terminals 51 of the connector 50, and the base from the second insulating tube 27 The eight lead wires 42 that are extended and connected to the pin terminals 52 of the connector 50 and the pin terminals 53 that are extended from the base end opening of the third insulating tube 28 and are connected and fixed to the connector 50 The four lead wires 43 are fixed to their respective shapes by fixing their circumference with the resin 58. The resin 58 that retains the shape of the lead is formed into a cylindrical shape having the same diameter as the connector 50, and a needle terminal, a lead, a base end portion of the insulating tube, and a spacer are embedded in the resin molded body. The state of 55. Further, according to the configuration in which the base end portion of the insulating tube is embedded in the resin molded body, the resin 58 can be completely covered and extended from the base end opening of the insulating tube to be connected and fixed to the needle terminal. The entire circumference of the lead (base end portion) can completely maintain the shape of the fixed lead (base end portion). Further, the height of the resin molded body (distance from the base end surface to the front end surface) is preferably higher than the height of the separator 55, and when the height of the separator 55 is 8 mm, for example, it is set to 9 mm. Here, the resin 58 constituting the resin molded body is not particularly limited, but a thermosetting resin or a photocurable resin is preferably used. Specifically, a curable resin such as a urethane type, an epoxy resin, or a urethane-epoxy resin can be exemplified. According to the configuration described above, since the transmission resin 58 holds the shape of the fixed lead, when the defibrillation catheter 100 is manufactured (when the connector 50 is mounted inside the handle 20), the opening from the base end of the insulating tube can be prevented. The extended lead is twisted or damaged by contact with the edge of the pin terminal (for example, cracking occurs in the coating resin of the lead). As shown in FIG. 1, the power supply device 700 constituting the defibrillation catheter system of the present embodiment includes a DC power supply unit 71, a catheter connection connector 72, an electrocardiographic connection connector 73, an external switch (input unit) 74, The arithmetic processing unit 75, the switching unit 76, the electrocardiogram input connector 77, and the display unit 78. [00132] A capacitor is built in the DC power supply unit 71, and the built-in capacitor is charged by the input of the external switch 74 (charging switch 743). [00133] The catheter connection connector 72 is connected to the connector 50 of the defibrillation catheter 100, and is electrically connected to the proximal end sides of the first lead set (41G), the second lead set (42G), and the third lead set (43G). [00134] As shown in FIG. 9, the connector 50 of the defibrillation catheter 100 and the catheter connection connector 72 of the power supply device 700 are coupled through the connector cable C1, thereby connecting and fixing the needles of the eight lead wires 41 constituting the first lead group. The terminals 51 (actually eight) and the terminals 721 (actually eight) of the conduit connection connector 72 are connected to the pin terminals 52 of the eight lead wires 42 constituting the second lead group (actually eight) And a terminal 722 (actually eight) of the conduit connection connector 72, a pin terminal 53 (actually four) that connects and fixes the four leads 43 of the third lead group, and a conduit connection connector 72 The terminals 723 (actually four) are connected separately. Here, the terminal 721 and the terminal 722 of the catheter connection connector 72 are connected to the switching unit 76, and the terminal 723 is directly connected to the electrocardiographic connection connector 73 without passing through the switching unit 76. By this, the cardiac potential information measured by the first DC electrode group 31G and the second DC electrode group 32G reaches the electrocardiographic connection connector 73 via the switching unit 76, and is measured by the proximal end side potential measurement electrode group 33G. The cardiac potential information does not reach the electrocardiographic connection connector 73 via the switching portion 76. [00137] The electrocardiographic connection connector 73 is connected to the input terminal of the electrocardiograph 800. [00138] The external switch 74 as an input unit includes a mode changeover switch 741 for switching the cardiac potential measurement mode and the defibrillation mode, an applied energy setting switch 742 for setting electric energy applied during defibrillation, and a pair of DC power supply sections 71. A charging switch 743 for charging and an energy application switch (discharging switch) 744 for applying electric energy for defibrillation are provided. All of the input signals from these external switches 74 are sent to the arithmetic processing unit 75. The arithmetic processing unit 75 controls the DC power supply unit 71, the switching unit 76, and the display unit 78 based on the input of the external switch 74. The arithmetic processing unit 75 has an output circuit 751 for outputting a DC voltage from the DC power supply unit 71 to the electrode of the defibrillation catheter 100 via the switching unit 76. [00141] A DC voltage is applied through the output circuit 751 such that the terminal 721 of the catheter connection connector 72 shown in FIG. 9 (finally the first DC electrode group 31G of the defibrillation catheter 100), and the catheter connection connector 72 The terminal 722 (finally, the second DC electrode group 33G of the defibrillation catheter 100) has different polarities (when one electrode group is a -pole, the other electrode group is a + pole). [00142] The switching unit 76 is composed of a switch of a single pole double throw (Single Pole Double Throw), and the common contact of the switch of the two contacts of the circuit is connected with the conduit connecting connector 72 (terminal 721 and The terminal 722), the first contact are connected to the electrocardiographic connector 73, and the second contact is connected to the arithmetic processing unit 75. [00143] That is, when the first contact is selected (when the first contact is connected to the common contact), the path connecting the conduit connection connector 72 and the electrocardiographic connection connector 73 is ensured, and the second is selected. At the time of the contact (when the second contact is connected to the common contact), the path connecting the conduit connection connector 72 and the arithmetic processing unit 75 is secured. [00144] The arithmetic processing unit 75 controls the switching operation of the switching unit 76 based on the input of the external switch 74 (the mode switching switch 741 and the energy application switch 744). [00145] The electrocardiogram input connector 77 is connected to the arithmetic processing unit 75, and is also connected to the output terminal of the electrocardiograph 800. [00146] The electrocardiogram input connector 77 can be used to input the cardiac potential information (usually a part of the cardiac potential information input to the electrocardiograph 800) output from the electrocardiograph 800 to the arithmetic processing unit 75, and perform arithmetic processing. In the unit 75, the DC power supply unit 71 and the switching unit 76 can be controlled based on the cardiac potential information. The display unit 78 is connected to the arithmetic processing unit 75, and the display unit 78 displays the heart potential information (mainly an electrocardiogram (cardiac potential waveform)) input from the electrocardiogram input connector 77 to the arithmetic processing unit 75, and the operator can monitor Defibrillation therapy (input of an external switch, etc.) is performed while being input to the cardiac potential information (electrocardiogram) of the arithmetic processing unit 75. [00148] The electrocardiograph 800 (input terminal) constituting the defibrillation catheter system of the present embodiment is connected to the electrocardiograph connection connector 73 of the power supply device 700, and is provided by the defibrillation catheter 100 (first DC electrode group 31G, second) The cardiac potential information measured by the DC electrode group 32G and the constituent electrode of the proximal end side potential measurement electrode group 33G is input to the electrocardiograph 800 from the electrocardiographic connection connector 73. [00149] Further, the electrocardiograph 800 (other input terminal) is also connected to the potential measuring unit 900, and the cardiac potential information measured by the cardiac potential measuring unit 900 is also input to the electrocardiograph 800. Here, as the cardiac potential measuring unit 900, an electrode sheet attached to the body surface of the patient for measuring the 12-induction electrocardiogram, and an electrode catheter mounted in the heart of the patient (an electrode different from the defibrillation catheter 100) catheter). [00151] The electrocardiograph 800 (output terminal) is connected to the electrocardiogram input connector 77 of the power supply device 700, and can input the heart potential information (the cardiac potential information from the defibrillation catheter 100 and the cardiac potential measurement) input to the electrocardiograph 800. A part of the cardiac potential information of the unit 900 is transmitted to the arithmetic processing unit 75 via the electrocardiogram input connector 77. [00152] The defibrillation catheter 100 of the present embodiment can be used as an electrode catheter for measuring cardiac potential when the defibrillation treatment is not required. [00153] FIG. 10 shows the flow of cardiac potential information when the cardiac electric potential is measured by the defibrillation catheter 100 of the present embodiment when cardiac catheterization (for example, high-frequency treatment) is performed. At this time, the switching unit 76 of the power supply device 700 selects the first contact to which the electrocardiographic connection connector 73 is connected. [00154] The cardiac potential measured by the first DC electrode group 31G constituting the defibrillation catheter 100 and the electrode of the DC or the second DC electrode group 32G is connected via the catheter connection connector 72, the switching portion 76, and the electrocardiographic connection connector 73. It is input to the electrocardiometer 800. In addition, the cardiac potential measured by the electrode constituting the proximal end side potential measurement electrode group 33G of the defibrillation catheter 100 is directly input from the catheter connection connector 72 through the electrocardiographic connection connector 73 without passing through the switching unit 76. To the electrocardiometer 800. [00156] The cardiac potential information (electrocardiogram) from the defibrillation catheter 100 is displayed on a display (not shown) of the electrocardiograph 800. [00157] In addition, a part of the cardiac potential information from the defibrillation catheter 100 (for example, a potential difference between the electrodes 31 (the first pole and the second pole) constituting the first DC electrode group 31G) can be obtained from the electrocardiograph 800 The display is performed by inputting to the display unit 78 via the electrocardiogram input connector 77 and the arithmetic processing unit 75. As described above, when the defibrillation treatment is not required in cardiac catheterization, the defibrillation catheter 100 can be used as an electrode catheter for measuring cardiac potential. [00159] Moreover, when atrial fibrillation occurs during cardiac catheterization, defibrillation treatment can be performed immediately using the defibrillation catheter 100 used as an electrode catheter. As a result, when atrial fibrillation occurs, it is possible to omit troubles such as newly inserting a catheter for defibrillation. The arithmetic processing unit 75 sequentially senses an event (waveform) of the electrocardiogram estimated to be an R wave based on a part (electrocardiogram) of the heart potential information transmitted from the electrocardiograph 800 via the electrocardiogram input connector 77. [00161] The sensing of the event estimated as the R wave is performed, for example, by detecting the waveform of the maximum peak in the previous period of the period (jitter) to be sensed and the maximum peak in the first two periods. The waveform calculates the average height of these maximum peak waveforms, and detects that the potential difference has reached a height (trigger level) of 80% of the average height. Further, the arithmetic processing unit 75 performs arithmetic processing to control the DC power supply unit 71 such that the polarity of the sensed event (the direction of the peak indicated by the ± symbol) is applied to the input energy, and the input energy is applied. After the switch 744, the polarity of the event (Vn) sensed in the nth cycle is the same as the polarity of the event (Vn-1) sensed in the previous cycle and the event sensed in the previous two cycles ( When the polarity of Vn-2) is the same, the terminal 721 (first DC electrode group 31G) of the conduit connection connector 72 and the terminal 722 of the conduit connection connector 72 (second DC electrode group) are synchronized with the event (Vn). 32G) Apply voltage. [00163] In the electrocardiogram shown in FIGS. 16A to 16D, among the six events sensed as R waves, the polarity of the third event from the left is (-) (the peak waveform thereof faces downward) ), the other five events have a polarity of (+) (the peak waveform is facing up). [00164] As shown in FIG. 16A, in the case where the energy application switch 744 is input after sensing the second event (V0) from the left side, the polarity (-) of the third event (V1) is the same as the previous one. The polarity (+) of the second event (V0) sensed in the cycle is different, so the voltage is not applied in synchronization with the event (V1). [00165] In addition, the polarity (+) of the fourth event (V2) is different from the polarity (-) of the third event (V1) sensed in the previous cycle, so it is not synchronized with the event (V2). Apply voltage. [00166] In addition, the polarity (+) of the fifth event (V3) is different from the polarity (-) of the third event (V1) sensed in the first two cycles, so it is not synchronized with the event (V3). Ground voltage is applied. [00167] The polarity (+) of the sixth event (V4) and the polarity (+) of the fifth event (V3) sensed in the previous cycle and the fourth event sensed in the first two cycles Since the polarity (+) of (V2) is the same, a voltage is applied to the first DC electrode group 31G and the second DC electrode group 32G in synchronization with the event (V4). [00168] As shown in FIG. 16B, in the case where the energy application switch 744 is input after sensing the third event (V0) from the left side, the polarity (+) of the fourth event (V1) is the same as the previous one. The polarity (-) of the third event (V0) sensed in the cycle is different, so the voltage is not applied in synchronization with the event (V1). [00169] In addition, the polarity (+) of the fifth event (V2) is different from the polarity (-) of the third event (V0) sensed in the first two cycles, so the event (V2) is not associated with this event. The voltage is applied synchronously. [00170] The polarity (+) of the sixth event (V3) is opposite to the polarity (+) of the fifth event (V2) sensed in the previous cycle and the fourth sensed in the first two cycles The polarity (+) of the events (V1) is the same, so a voltage is applied to the first DC electrode group 31G and the second DC electrode group 32G in synchronization with the event (V3). [00171] As shown in FIG. 16C, in the case where the energy application switch 744 is input after sensing the fourth event (V0) from the left side, the polarity (+) of the fifth event (V1) is the same as the first two. The polarity (-) of the third event (V-1) sensed in one cycle is different, so the voltage is not applied in synchronization with the event (V1). [00172] The polarity (+) of the sixth event (V2) is opposite to the polarity (+) of the fifth event (V1) sensed in the previous cycle and the fourth sensed in the first two cycles The polarity (+) of the events (V0) is the same, so a voltage is applied to the first DC electrode group 31G and the second DC electrode group 32G in synchronization with the event (V2). [00173] As shown in FIG. 16D, in the case where the energy application switch 744 is input after sensing the fifth event (V0) from the left side, the polarity (+) of the sixth event (V1) is the same as the previous one. The polarity (+) of the fifth event (V0) sensed during the cycle and the polarity (+) of the fourth event (V-1) sensed during the first two cycles are the same, so with the event ( V1) A voltage is applied to the first DC electrode group 31G and the second DC electrode group 32G in synchronization. [00174] As described above, even in the case where the energy application switch 744 is input at any time shown in FIGS. 16A to 16D, the third event is the same as the same polarity (+) three times (from the left side) Six events) apply voltage synchronously. In addition, the arithmetic processing unit 75 controls the DC power supply unit 71 within 260 m seconds after the event estimated to be the R wave is sensed in the input electrocardiogram, so that the first DC electrode group 31G and the second DC are not aligned. The electrode group 32G applies a voltage. [00176] Thus, when the sensed event is the peak of the R wave, it is possible to reliably avoid defibrillation at the time when the next T wave appears. That is, the peak that is estimated to be a T wave is masked so that it cannot be defibrillated. [00177] Further, after sensing the event, the period in which the DC voltage is not applied is not limited to 260 msec, the shortest is 50 msec, and the longest is 500 msec. When the period is shorter than 50 m seconds, the peak estimated to be a T wave may not be masked. On the other hand, when the period is longer than 500 msec, the R wave in the next cycle (jump) may not be sensed. In addition, the arithmetic processing unit 75 performs programming so as not to newly sense an event estimated to be an R wave within 100 m seconds after the event estimated as the R wave is sensed. [00179] Thereby, the R wave, in the opposite direction (the opposite polarity) of the R wave, increases the peak value of the S wave and reaches the trigger level (even if defibrillation is performed in this state) In particular, it is possible to prevent the case where the peak of the S wave is sensed and the continuity of the polarity of the event is impaired (the count of the same polarity is reset). Further, after the event is sensed, the period (inhibition period) of the event estimated as the R wave as the non-new sensing is not limited to 100 msec, the shortest is 10 msec, and the longest is 150 msec. Further, the arithmetic processing unit 75 controls the DC power supply unit 71 260 m seconds after the input of the energy application switch 744 so that voltage is not applied to the first DC electrode group 31G and the second DC electrode group 32G. [00182] Thereby, it is possible to prevent the noise generated by the input of the energy application switch 744 (the noise of a polarity different from the previous and previous two events) from being erroneously sensed as the R wave, and the noise The case of defibrillation is performed synchronously. [00183] In addition, it is possible to prevent the continuity of the polarity of the event (the same polarity) from being transmitted through the noise generated by the input of the energy application switch 744 (the noise of a polarity different from the previous and/or the previous two events). The count is reset). Further, it is possible to prevent the fluctuation of the reference line generated after the input of the energy application switch 744 from being erroneously sensed as the R wave, and to perform defibrillation in synchronization with this. [00185] Further, after the input of the energy application switch 744, the period in which the DC voltage is not applied is not limited to 260 msec, and the shortest is 10 msec, and the longest is 500 msec. [00186] Hereinafter, an example of defibrillation treatment of the intracardiac defibrillation catheter system of the present embodiment will be described with reference to the flowchart shown in FIG. (1) First, the position of the electrodes (the first DC electrode group 31G, the second DC electrode group 32G, and the constituent electrode of the proximal end side potential measurement electrode group 33G) of the defibrillation catheter 100 is confirmed by the X-ray image. And a part of the cardiac potential information (12-induction electrocardiogram) input from the cardiac potential measuring unit 900 (the electrode sheet pasted on the body surface) to the electrocardiograph input connector 77 is input to the power supply device 700. Processing unit 75 (step 1 of FIG. 11A). At this time, a part of the heart potential information input to the arithmetic processing unit 75 is displayed on the display unit 78 (see FIG. 12). Further, the constituent electrodes of the first DC electrode group 31G and/or the second DC electrode group 32G of the defibrillation catheter 100 are input to the electrocardiograph 800 via the catheter connection connector 72, the switching portion 76, and the electrocardiographic connection connector 73. The cardiac potential information and the cardiac potential information input from the constituent electrode of the base end side potential measuring electrode group 33G of the defibrillation catheter 100 to the electrocardiograph 800 via the catheter connection connector 72 and the electrocardiographic connection connector 73 are displayed in the heart. A display (not shown) of the electric meter 800. [00188] (2) Next, the mode switching switch 741 as the external switch 74 is input. The power supply device 700 in the present embodiment is the "cardiac potential measurement mode" in the initial state, the switching unit 76 selects the first contact point, and the path from the catheter connection connector 72 to the electrocardiographic connection connector 73 via the switching portion 76 is make sure. The input through the mode changeover switch 741 becomes the "defibrillation mode" (step 2). (3) As shown in FIG. 13, when the mode switching switch 741 is input and switched to the defibrillation mode, the contact of the switching unit 76 is switched to the second contact by the control signal of the arithmetic processing unit 75. The path from the catheter connection connector 72 to the arithmetic processing unit 75 via the switching unit 76 is secured, and the path from the catheter connection connector 72 to the electrocardiographic connection connector 73 via the switching unit 76 is cut off (step 3). When the second contact is selected by the switching unit 76, the cardiac potential information of the constituent electrodes of the first DC electrode group 31G and the second DC electrode group 32G from the defibrillation catheter 100 cannot be input to the electrocardiometer 800 (thus, This cardiac potential information is sent to the arithmetic processing unit 75.). However, the heart potential information of the constituent electrode from the proximal end side potential measuring electrode group 33G that does not pass through the switching portion 76 is input to the electrocardiograph 800. [00190] (4) When the contact of the switching portion 76 is switched to the second contact, the resistance between the first DC electrode group (31G) and the second electrode group (32G) of the defibrillation catheter 100 is measured (step 4). The resistance value input from the catheter connection connector 72 to the arithmetic processing unit 75 via the switching unit 76 is displayed on the display unit 78 together with a part of the cardiac potential information from the cardiac potential measurement unit 900 input to the arithmetic processing unit 75 (refer to FIG. 13). ). [00191] (5) The contact of the switching unit 76 is switched to the first contact, and the path from the catheter connection connector 72 to the electrocardiographic connection connector 73 via the switching unit 76 is restored (step 5). Further, the time at which the contact of the switching unit 76 selects the second contact (steps 3 to 5 described above) is, for example, 1 second. (6) The arithmetic processing unit 75 determines whether or not the resistance measured in step 4 exceeds a certain value, and if it does not exceed, proceeds to the next step 7 (preparation for applying a DC voltage). If it is over, return to step 1 (the position of the electrode of the defibrillation catheter 100 is confirmed) (step 6). [00193] Here, in the case where the resistance exceeds a certain value, it means that the first DC electrode group and/or the second electrode group are not reliably abutted to a predetermined portion (for example, the wall of the coronary vein, right) The inner wall of the atrium), so you need to go back to step 1 and re-adjust the position of the electrodes. [00194] Thus, it is possible to apply only when the first DC electrode group and the second DC electrode group of the defibrillation catheter 100 reliably abut against a prescribed portion (for example, the wall of the coronary vein, the inner wall of the right atrium). The voltage is so efficient for defibrillation treatment. (7) The applied energy setting switch 742 as the external switch 74 is input to set the applied energy at the time of defibrillation (step 7 of FIG. 11B). According to the power supply device 700 of the present embodiment, the applied energy can be set from 1 J to 30 J on a scale of 1 J. (8) The charging switch 743 as the external switch 74 is input, and the built-in capacitor of the DC power supply unit 71 is energized (step 8). [00197] (9) After the charging is completed, the energy application switch 744 as the external switch 74 is input (step 9). (10) The event (Vn) that is sensed in step 12, which will be described later, is the number (n) of events that are sensed a few times after the energy application switch 744 is input, and "1" is generated (step 10). ). (11) The arithmetic processing unit 75 waits for 100 m seconds as the suppression period after sensing the previous event (Vn-1) (the event sensed immediately before the input of the energy application switch 744), and does not perform new operation. Sensing (step 11). (12) After the suppression period elapses, the arithmetic processing unit 75 senses the event (Vn) (step 12). (13) The arithmetic processing unit 75 determines whether or not the polarity of the event (Vn) sensed in step 12 matches the polarity of the last (previously sensed) event (Vn-1), and is consistent. In this case, the process proceeds to step 14, and if there is no match, in step 10', the above number (n) is incremented by one and the process returns to step 11 (step 13). [00202] (14) The arithmetic processing unit 75 determines whether or not the polarity of the event (Vn) sensed in step 12 coincides with the polarity of the event (Vn-2) of the last time (the last two sensed), If they match, the process proceeds to step 15. If there is no match, in step 10', the above number (n) is incremented by one and the process returns to step 11 (step 14). (15) The arithmetic processing unit 75 determines whether or not the time from the sense of the last event (Vn-1) to the sensing event (Vn) exceeds 260 msec, and if it exceeds, the process proceeds to step 16, where If it is not exceeded, in step 10', the above number (n) is incremented by one and the process returns to step 11 (step 15 of Fig. 11). (16) The arithmetic processing unit 75 determines whether the time from the input of the energy application switch 744 to the sensing event (Vn) exceeds 260 seconds, and if it is exceeded, the process proceeds to step 17, and if it is not exceeded, In step 10', 1 is added to the above number (n) and the process returns to step 11 (step 16). (17) The transmission processing unit 75 switches the contact of the switching unit 76 to the second contact, and the path from the catheter connection connector 72 to the arithmetic processing unit 75 via the switching unit 76 is secured, and the connection is made from the catheter. The path of the device 72 to the electrocardiographic connection connector 73 via the switching unit 76 is cut off (step 17). (18) After the contact of the switching unit 76 is switched to the second contact, the DC power supply unit 71 that has received the control signal from the arithmetic processing unit 75 passes through the output circuit 751 of the arithmetic processing unit 75 and the switching unit. 76 and the catheter connection connector 72 apply DC voltages of mutually different polarities to the first DC electrode group and the second DC electrode group of the defibrillation catheter 100 (step 18, see FIG. 14). Here, the arithmetic processing unit 75 performs arithmetic processing to transmit a control signal to the DC power supply unit 71 to pair the first DC electrode group and the second DC electrode group in synchronization with the event (Vn) sensed in step S12. Apply a DC voltage. [00208] Specifically, a very short time elapses from a time when the event (Vn) is sensed (when the next R wave rises) (for example, about 1/10 of the peak width of the R wave of the event (Vn)) After the time) began to apply. [00209] FIG. 15 is a view showing a potential waveform measured when a predetermined electric energy (for example, setting output = 10 J) is applied to the defibrillation catheter 100 according to the present embodiment. In the figure, the horizontal axis represents time and the vertical axis represents potential. First, after the predetermined time (t0) has elapsed since the arithmetic processing unit 75 senses the event (Vn), the first DC electrode group 31G is set to the − pole and the second DC electrode group 32G is set to the + pole. A DC voltage is applied between the two, and electric energy is supplied to measure the potential rise (E1 is the peak voltage at this time). After a certain period of time (t1), a DC voltage in which ± is reversed is applied between the first DC electrode group 31G and the second DC electrode group 32G to become a -pole, and electric energy is supplied thereto. The potential rise is measured (E2 is the peak voltage at this time). [00211] Here, the time (t0) from the sensing event (Vn) to the start of application is, for example, 0. 01~0. 05 seconds, if a preferred example is shown, it is 0. 01 seconds, time (t = t1 + t2) is for example 0. 006~0. 03 seconds, if a preferred example is shown, it is 0. 02 seconds. Thereby, a voltage can be applied in synchronization with an event (Vn) which is an R wave, and efficient defibrillation therapy can be performed. [00212] The measured peak voltage (E1) is, for example, 300 to 600V. (19) After a predetermined time (t0+t) elapses from the sensing event (Vn), the control signal from the arithmetic processing unit 75 is received to stop the application of the voltage from the DC power supply unit 71 (step 19). (20) After the application of the voltage is stopped, the application recording (the heart potential waveform at the time of application as shown in FIG. 15) is displayed on the display unit 78 (step 20). The display time is, for example, 5 seconds. [00215] (21) The contact of the switching portion 76 is switched to the first contact, and the path from the catheter connection connector 72 to the electrocardiographic connection connector 73 via the switching portion 76 is restored, the first from the defibrillation catheter 100 The cardiac potential information of the constituent electrodes of the DC electrode group 31G and the second DC electrode group 32G is input to the electrocardiograph 800 (step 21). (22) Observing the constituent electrodes (the first DC electrode group 31G, the second DC electrode group 32G, and the proximal end side potential measuring electrode group 33G) from the defibrillation catheter 100 displayed on the display of the electrocardiograph 800 The cardiac potential information (electrocardiogram) of the electrode) and the cardiac potential information (12-induction electrocardiogram) from the cardiac potential measuring unit 900 are ended if "normal", in the case of "abnormal (atrial fibrillation is not cured)" Go back to step 2 (step 22). According to the catheter system of the present embodiment, the first DC electrode group 31G and the second DC electrode group 32G that pass through the defibrillation catheter 100 can directly supply electric energy to the fibrillated heart, and can reliably provide only the heart. The electrical stimulation (electric shock) required for the treatment of the tremor. [00218] Moreover, since electric energy can be directly supplied to the heart, burns are not generated on the body surface of the patient. In addition, the cardiac potential information measured by the constituent electrode 33 of the proximal end side potential measurement electrode group 33G is input from the catheter connection connector 72 to the electrocardiograph via the electrocardiographic connection connector 73 without passing through the switching unit 76. 800, and the electrocardiograph 800 is connected to the cardiac potential measuring unit 900, and thus the defibrillation treatment of the cardiac potential of the first DC electrode group 31G and the second DC electrode group 32G from the defibrillation catheter 100 cannot be obtained even if the electrocardiograph 800 cannot acquire. When the switching unit 76 is switched to the contact 2 and the path from the conduit connection connector 72 to the electrocardiographic connection connector 73 via the switching unit 76 is cut, the electrocardiograph 800 can also acquire the potential from the proximal end side. The cardiac potential information measured by the electrode group 33G and the cardiac potential measuring unit 900 is measured, and the defibrillation treatment can be performed while monitoring (monitoring) the cardiac potential in the electrocardiograph 800. Further, the arithmetic processing unit 75 of the power supply device 700 performs arithmetic processing on the voltage application in synchronization with the cardiac potential waveform input through the electrocardiogram input connector 77, and controls the DC power supply unit 71 (from the cardiac potential waveform). The potential difference reaches a trigger level for a certain period of time (for example, 0. Since the application is started after 01 seconds), it is possible to apply a voltage to the first DC electrode group 31G and the second DC electrode group 32G of the defibrillation catheter 100 in synchronization with the cardiac potential waveform, and it is possible to perform efficient defibrillation treatment. Further, when the resistance between the electrode groups of the defibrillation catheter 100 does not exceed a certain value, the arithmetic processing unit 75 reliably abuts only the first DC electrode group 31G and the second DC electrode group 32G. When a predetermined portion (for example, the wall of the coronary vein or the inner wall of the right atrium) is controlled, it is possible to control the preparation for applying a DC voltage, so that effective defibrillation treatment can be performed. Further, the arithmetic processing unit 75 performs calculation to control the DC power supply unit 71 such that the electro-acoustic input from the electrocardiograph 800 via the electrocardiogram input connector 77 is sequentially estimated to be estimated as R. The event of the wave, after the input of the energy application switch 744, the polarity of the nth sensed event (Vn) and the polarity of the previous sensed event (Vn-1) and the previous second sensed event When the polarities of (Vn-2) are the same, voltages are applied to the first DC electrode group 31G and the second DC electrode group 32 in synchronization with the event (Vn), so that if three events (Vn-2) are continuously sensed, When the polarities of (Vn-1) and (Vn) do not match, the voltage is not applied in synchronization with the event (Vn), but only the polarity of the three events (Vn-2), (Vn-1), and (Vn) is the same. At the time, the voltage is applied in synchronization with the third event (Vn), so that defibrillation synchronized with the R wave can be reliably performed. 17A is an electrocardiogram (the same cardiac potential waveform as that shown in FIG. 19) that is input to the arithmetic processing unit 75 when a single contraction of the heart of the patient occurs. In FIG. 17A, the polarity of the fourth R wave (event (V0)) from the left is (-), and the peak of the subsequent T wave is increased, and the T wave is sensed as an event (V1). [00224] As shown in the figure, in the case where the energy application switch 744 is input after the event (V0) is sensed, the polarity (+) of the event (V1) sensed shortly thereafter is sensed from the previous one. The polarity (-) of the event (V0) is different, so the voltage is not applied in synchronization with the event (V1). Thereby, it is possible to avoid the application of a voltage in synchronization with the T wave which is mistaken as the R wave due to the increase in the peak value. [00225] In addition, the next sensed event (V2) of the event (V1) is the peak of the R wave, but its polarity (+) is different from the polarity (-) of the first two sensed events (V0). Therefore, the voltage is not applied in synchronization with the event (V2). [00226] Moreover, due to the polarity (+) of the next sensed event (V3) of the event (V2) and the polarity (+) of the previous sensed event (V2) and the first two sensed Since the polarity (+) of the event (V1) is the same, a voltage is applied to the first DC electrode group 31G and the second DC electrode group 32G in synchronization with the event (V3) which can be surely the peak of the R wave. 17B is an electrocardiogram input to the arithmetic processing unit 75 when the contraction of the patient's heart continuously occurs. [00228] As shown in the figure, in the case where the energy application switch 744 is input after the event (V0) in which the polarity is reversed to (-) due to the out-of-phase contraction is sensed, the event sensed shortly thereafter ( The polarity of V1) is (+), the polarity of the next sensed event (V2) is (-), and the polarity of the next sensed event (V3) is (+), the next sensed event The polarity of (V4) is (-), and the polarity of the next sensed event (V5) is (+), and the polarity of the event alternates. Therefore, in this state, in a state where the polarities of the three events that are continuously sensed are inconsistent, it is determined that each of these events may not be the peak of the R wave, and thus the voltage is not applied in synchronization with the event. [00229] In addition, the polarity (+) of the next sensed event (V6) of the event (V5) is the peak of the R wave, but its polarity (+) and the first two sensed events (V4) The polarity (-) is different, so the voltage is not applied in synchronization with the event (V6). [00230] Moreover, since the polarity (+) of the next sensed event (V7) of the event (V6) is the same as the polarity (+) of the event (V6) and the polarity (+) of the event (V5), it is judged In order to reliably heal the contraction outside the sensing period of the event (V7), a voltage is applied to the first DC electrode group 31G and the second DC electrode group 32G in synchronization with the event (V7) which can be surely the peak of the R wave. [00231] FIG. 18 is an electrocardiogram (the same cardiac potential waveform as shown in FIG. 20) in which the reference line is lowered and the reference line is lowered to the original level, and the drop and rise of the reference line are mistaken. The R waves are sensed as events (V-1) and events (V1), respectively. [00232] As shown in FIG. 18, in the case where the energy application switch 744 is input before the reference line rises, the polarity (+) of the event (V1) sensed shortly after it is compared with the previous sensed event (V0) The polarity (+) is the same, but different from the polarity (-) of the first two sensed events (V-1), so the voltage is not applied in synchronization with the event (V1), thereby avoiding The voltage is applied synchronously when the rise of the reference line of the R wave is mistaken. [00233] Moreover, due to the polarity (+) of the next sensed event (V2) of the event (V1) and the polarity (+) of the previous sensed event (V1) and the first two sensed Since the polarity (+) of the event (V0) is the same, it is determined that the reference line is stable at the time of sensing of the event (V2), and the first DC electrode group 31G and the event (V2) which can be surely the peak of the R wave are synchronized. The second DC electrode group 32G applies a voltage. Further, the arithmetic processing unit 75 controls the DC power supply unit 71 to apply DC voltage to the first DC electrode group 31G and the second DC electrode group 32G within 260 m seconds after sensing the event estimated as the R wave, so that the DC voltage is not applied to the first DC electrode group 31G and the second DC electrode group 32G. In the case where the sensed event is the peak of the R wave, it is possible to reliably avoid defibrillation at the time when the next T wave appears. Further, the arithmetic processing unit 75 performs programming for 100 m seconds after sensing the event estimated as the R wave so that the event estimated to be R wave is not newly sensed, and therefore the sensed event is R. When the peak value of the S wave increases in the opposite direction and the peak value of the S wave appears in the opposite direction to reach the trigger level, it is possible to prevent the peak of the S wave from being sensed and the count of the same polarity being reset. Further, since the arithmetic processing unit 75 controls the DC power supply unit 71 within 260 m seconds after the input of the energy application switch 744 so as not to apply a DC voltage to the first DC electrode group 31G and the second DC electrode group 32G, it is possible to prevent The noise generated by the input of the energy application switch 744 is erroneously sensed as an R wave, and defibrillation is performed in synchronization with the noise, or the count of the same polarity is reset due to the noise. [00237] Although an embodiment of the present invention has been described above, the defibrillation catheter system of the present invention is not limited thereto, and various modifications can be made. [00238] For example, the arithmetic processing unit of the power supply device may perform arithmetic processing to control the DC power supply unit, that is, the polarity of the event (Vn) sensed after the input of the energy application switch and the previous sensing. When the polarity of the event (Vn-1), the polarity of the previous two sensed events (Vn-2), and the polarity of the previous three sensed events (Vn-3) are the same (the same polarity is continuous four) The second time), a voltage is applied to the first DC electrode group and the second DC electrode group in synchronization with the fourth event (Vn).

100‧‧‧Defibrillation catheter
10‧‧‧Multi-lumen tube
11‧‧‧First lumen
12‧‧‧Second lumen
13‧‧‧ Third lumen
14‧‧‧four lumen
15‧‧‧Fluorin layer
16‧‧‧Li (core)
17‧‧‧ outside (shell)
18‧‧‧Stainless steel wire
20‧‧‧Hands
21‧‧‧Handle body
22‧‧‧ rope bolt
24‧‧‧ strain relief
26‧‧‧First insulating tube
27‧‧‧Second insulating tube
28‧‧‧ Third insulating tube
31G‧‧‧First DC electrode group
31‧‧‧Ring electrode
32G‧‧‧second DC electrode set
32‧‧‧Ring electrode
33G‧‧‧ base-side potential measuring electrode group
33‧‧‧Ring electrode
35‧‧‧ Front-end wafer
41G‧‧‧First lead set
41‧‧‧ lead
42G‧‧‧second lead set
42‧‧‧ lead
43G‧‧‧third lead set
43‧‧‧ leads
50‧‧‧Defibrillator catheter connector
51, 52, 53‧‧ needle terminals
55‧‧‧Baffle
58‧‧‧Resin
61‧‧‧First protection tube
62‧‧‧Second protective tube
65‧‧‧ Pull wire
700‧‧‧Power supply unit
71‧‧‧DC Power Supply Department
72‧‧‧Tube connector
721, 722, 723‧‧‧ terminals
73‧‧‧Electrometer connection connector
74‧‧‧External switch (input unit)
741‧‧‧ mode switch
742‧‧‧Energy setting switch
743‧‧‧Charge switch
744‧‧‧Energy application switch (discharge switch)
75‧‧‧Operation Processing Department
76‧‧‧Switching Department
77‧‧‧ECG input connector
78‧‧‧Display unit
800‧‧‧electrocardiograph
900‧‧‧cardiac potential measurement unit

1 is a block diagram showing an embodiment of an intracardiac defibrillation catheter system of the present invention. Fig. 2 is a plan view showing the configuration of a fibrillation catheter constituting the catheter system shown in Fig. 1; Fig. 3 is a plan view (for illustration of dimensions and hardness) showing a fibrillation catheter constituting the catheter system shown in Fig. 1; Fig. 4 is a transverse cross-sectional view showing a cross section taken along line A-A of Fig. 2; Fig. 5 is a transverse cross-sectional view showing a B-B cross section, a C-C cross section, and a D-D cross section of Fig. 2; Fig. 6 is a perspective view showing an internal structure of a handle of an embodiment of the defibrillation catheter shown in Fig. 2; Fig. 7 is a partial enlarged view of the inside (front end side) of the handle shown in Fig. 6. Fig. 8 is a partial enlarged view of the inside (base end side) of the handle shown in Fig. 6. Fig. 9 is an explanatory view schematically showing a connection state of a connector of a defibrillation catheter and a catheter connection connector of a power supply device in the catheter system shown in Fig. 1; Fig. 10 is a block diagram showing the flow of cardiac potential information in the case where the electrocardiogram is measured through the defibrillation catheter in the catheter system shown in Fig. 1; Fig. 11A is a part (steps 1 to 6) showing a flowchart of the operation and operation of the power supply device in the catheter system shown in Fig. 1; Fig. 11B is a part (step 7 to step 14) showing a flowchart of the operation and operation of the power supply device in the catheter system shown in Fig. 1; Fig. 11C is a part (steps 15 to 22) showing a flowchart of the operation and operation of the power supply device in the catheter system shown in Fig. 1; Fig. 12 is a block diagram showing the flow of cardiac potential information in the cardiac potential measurement mode in the catheter system shown in Fig. 1; Fig. 13 is a block diagram showing information relating to measured values of electrical resistance between electrode groups and flow of cardiac potential information in the defibrillation mode of the catheter system shown in Fig. 1. Fig. 14 is a block diagram showing a state in which a DC voltage is applied in the defibrillation mode of the catheter system shown in Fig. 1. Fig. 15 is a waveform diagram of potentials measured when a predetermined amount of electric energy is applied to a defibrillation catheter constituting the catheter system shown in Fig. 1; FIG. 16A is an explanatory diagram showing an application time (SW-ON) and a DC voltage (DC) of an energy application switch in an electrocardiogram of an arithmetic processing unit of an input power supply device. FIG. 16B is an explanatory diagram showing an input of the energy application switch and an application time of the DC voltage in the electrocardiogram input to the arithmetic processing unit of the power supply device. 16C is an explanatory diagram showing an input of the energy application switch and an application time of the DC voltage in the electrocardiogram input to the arithmetic processing unit of the power supply device. 16D is an explanatory diagram showing an input of the energy application switch and an application time of the DC voltage in the electrocardiogram input to the arithmetic processing unit of the power supply device. FIG. 17A is an explanatory diagram showing an input of an energy application switch and an application time of a DC voltage in an electrocardiogram (a cardiac potential waveform in a case where a single episode contraction occurs in a heart of a patient) input to an arithmetic processing unit of a power supply device. . 17B is an explanatory diagram showing the time during which the energy application switch and the DC voltage are applied, in the electrocardiogram of the arithmetic processing unit of the input power supply device (the cardiac potential waveform in the case where the patient's heart is continuously contracted outside the heart). FIG. 18 is an explanatory diagram showing an input energy application switch and a time when a DC voltage is applied in an electrocardiogram (cardiac potential waveform) in which a reference line of the arithmetic processing unit of the input power supply device changes. 19 is an electrocardiogram (cardiac waveform in a case where a single-shot extra-systolic contraction occurs in a heart of a patient) in which an arithmetic processing unit of a power supply device constituting a conventional catheter system is input, and an input energy application switch and a DC voltage are applied. An illustration of the time. FIG. 20 is an explanatory diagram showing an input of an energy application switch and a time when a DC voltage is applied, in an electrocardiogram (cardiac potential waveform) in which a reference line fluctuation of a calculation processing unit of a power supply device constituting a conventional catheter system is input.

Claims (4)

An intracardiac defibrillation catheter system comprising: a defibrillation catheter inserted into a cardiac chamber for defibrillation; a power supply device applying a DC voltage to an electrode of the defibrillation catheter; and an electrocardiograph, the defibrillation catheter The invention comprises: an insulating tube member; a first electrode group comprising a plurality of annular electrodes mounted in a front end region of the tube member; and a second electrode group comprising a plurality of annular electrodes, the plurality of rings The electrode is attached to the tube member at a distance from the first electrode group toward the proximal end side; the first lead group is composed of a plurality of leads respectively connected to the electrodes constituting the first electrode group; and a second a lead set comprising a plurality of leads respectively connected to the electrodes constituting the second electrode group, the power supply device comprising: a DC power supply unit; a conduit connection connector, the first lead set and the first lead set of the defibrillation catheter The base end side of the two lead sets is connected; the external switch includes an electric energy application switch; an arithmetic processing unit having an output circuit of a DC voltage from the DC power supply unit, and controlling based on an input of the external switch a DC power supply unit; and an electrocardiogram input connector connected to the arithmetic processing unit and an output terminal of the electrocardiograph, and when defibrillating through the defibrillation catheter, the output circuit of the arithmetic processing unit is passed from the DC power supply unit And the catheter connection connector, wherein the first electrode group and the second electrode group of the defibrillation catheter are applied with voltages having mutually different polarities, and the arithmetic processing unit of the power supply device performs arithmetic processing on the DC power supply as follows. Controls, that is, sequentially sensing an event inferred to be an R wave according to an electrocardiogram input from the electrocardiograph via the electrocardiogram input connector, and an event Vn sensed after the input of the electric energy application switch When the polarity is at least coincident with the polarity of the previous one sensed event Vn-1 and the polarity of the previous two sensed events Vn-2, the first electrode group and the second electrode group are synchronized with the event Vn Apply voltage. The intracardiac defibrillation catheter system according to claim 1, wherein the arithmetic processing unit of the power supply unit controls the DC power supply unit so as to be between a minimum of 50 m seconds and a maximum of 500 m seconds after sensing an event estimated to be an R wave. No voltage is applied to the first DC electrode group and the second DC electrode group. The intracardiac defibrillation catheter system according to claim 2, wherein the arithmetic processing unit of the power supply device senses the shortest of 10 m seconds and the longest time of 150 m after sensing the event estimated to be the R wave, and the new sensing is estimated to be R Wave event. The intracardiac defibrillation catheter system according to claim 2 or 3, wherein the arithmetic processing unit of the power supply device controls the DC power supply unit so as to be shortest between 10 m seconds and a maximum of 500 m seconds after the input of the electric energy application switch, A voltage is applied to the first electrode group and the second electrode group.