US20230148130A1 - An electric field or electric voltage delivering electrode system for the treatment of internal organ oedema - Google Patents

An electric field or electric voltage delivering electrode system for the treatment of internal organ oedema Download PDF

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US20230148130A1
US20230148130A1 US17/995,098 US202117995098A US2023148130A1 US 20230148130 A1 US20230148130 A1 US 20230148130A1 US 202117995098 A US202117995098 A US 202117995098A US 2023148130 A1 US2023148130 A1 US 2023148130A1
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electrode
electrodes
electric field
internal organ
control unit
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Johannes Müller
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Berlin Heals GmbH
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Berlin Heals GmbH
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/20—Applying electric currents by contact electrodes continuous direct currents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/02—Details
    • A61N1/04—Electrodes
    • A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/02—Details
    • A61N1/04—Electrodes
    • A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
    • A61N1/0507—Electrodes for the digestive system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/02—Details
    • A61N1/04—Electrodes
    • A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
    • A61N1/0507—Electrodes for the digestive system
    • A61N1/0514—Electrodes for the urinary tract
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/02—Details
    • A61N1/04—Electrodes
    • A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
    • A61N1/056—Transvascular endocardial electrode systems
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/02—Details
    • A61N1/04—Electrodes
    • A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
    • A61N1/0587—Epicardial electrode systems; Endocardial electrodes piercing the pericardium
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/02—Details
    • A61N1/04—Electrodes
    • A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
    • A61N1/0587—Epicardial electrode systems; Endocardial electrodes piercing the pericardium
    • A61N1/0597—Surface area electrodes, e.g. cardiac harness
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/20—Applying electric currents by contact electrodes continuous direct currents
    • A61N1/205—Applying electric currents by contact electrodes continuous direct currents for promoting a biological process
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/02—Details
    • A61N1/04—Electrodes
    • A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
    • A61N1/056—Transvascular endocardial electrode systems
    • A61N2001/0585—Coronary sinus electrodes

Definitions

  • the present invention relates to an electric field or electric voltage delivering electrode assembly system for the treatment of internal organ oedema by electrokinetic methods like electro-osmosis and/or electrophoresis by delivering an electric field within a process of treatment of internal organ oedema, wherein the electrode assembly system comprises two electrodes to be positioned at two places on or close to the internal organ or in liquid carrying vessels as part of the organ or in the internal organ.
  • the present invention also relates to the use of such system for inducing an electrokinetic-like effect for treatment of internal organ oedema by means of inducing an electric field.
  • the present invention relates to a process of treatment of internal organ oedema using such system.
  • organs Primary or secondary disease of an organ, acute or chronic infections or a reduced blood supply to organs are often associated with oedema of the affected organ, which can severely impair the function of the organ. In the heart, this is particularly evident in the form of a restriction of the pumping function, which has an effect on all organs of the body.
  • internal organ oedema relate to myocardial oedema as described in the following prior art articles but also to kidney oedema or liver oedema to name specific internal organs.
  • Reduced pumping function of the heart typically leads to a congestion of blood in other dependent organs (e.g. liver, kidney), which impresses as oedema in these organs.
  • Organ oedema in these organs depends on the severity of the heart dysfunction. Organ oedema can also occur independently of a reduced pumping function of the heart in organ-specific diseases (e.g. diseases of the kidney or liver), such as nephrotic syndrome or inflammation of the liver.
  • organ-specific diseases e.g. diseases of the kidney or liver
  • CMR cardiac magnetic resonance
  • WO 2017/021255 A2 describes an implantable direct-current electrode assembly with two implantable electrodes and a control circuit, to which the first and the second electrodes are electrically connected, wherein one of the electrodes is a coil electrode with a maximum length that is pre-determined by the distance between the tricuspid valve and the apex of the right ventricle lying inside the right ventricular cavity between the tricuspid valve and in the right ventricular apex or an area around the apex, whereas the counter-electrode can be a coil electrode for the coronary sinus or a plate electrode that can be attached to the exterior of the left ventricle (epicardium of the left ventricle).
  • the control circuit is particularly designed to establish a potential difference between the two electrodes so that a direct current flows between the two electrodes, wherein the control unit directly sets and feedback controls the desired direct current by means of adjusting the potential difference between the electrodes.
  • US 2008/0195163 A1 describes an electromedical implantable or extracorporeally applicable device for treating and monitoring organs by allowing healing processes to be excited in diseased organs, wherein the device comprises a power supply unit, a programmable generator and receiver unit which generates and receives electrical microcurrents and electromagnetic power and is connected in a conducting manner to electrodes, a telemetry unit integrated into the generator and receiver unit and provided with a transmitter and a receiver for exchanging data with an extracorporeal device. Therein, the desired current form and frequency are selected and the electrical microcurrents and electromagnetic power are directly controlled by the generator and receiver unit.
  • Astonishingly it has been found that application of an electrical field between two electrodes provided on an internal organ or in liquid carrying vessels in the internal organ over hours immediately starts to reduce the swelling (oedema), e.g. in ten minutes, and further beneficial results appear if the electric field application is maintained up to days, weeks or even long-term (chronically), e.g. three months or a year. Therefore, a bandwidth of treatment period between ten minutes and three months or a year, especially between 12 hours and 7 days is contemplated.
  • a liquid carrying vessel can be a blood vessel or a vessel of the lymphatic system.
  • the electrodes are positioned on or near by or in the heart at positions taken from the group comprising inside the right ventricle, inside the coronary sinus, on the outside of the left ventricle and/or on the outside of the right ventricle. Regardless of where the electrodes are placed (for example even subcutaneously or outside the human body with or without skin contact), it is only relevant that the electric field is maintained with electric field lines through the affected organ. In a preferred embodiment, the electrodes, regardless of their technical design, are positioned so that the electric field they generate leads to a reduction in oedema of the corresponding organ. Such positioning is well within the technical skill of a person skilled in the art and can be monitored by techniques known in the art.
  • these can be flat electrodes (so called patch electrodes); when an outside mounted electrode is combined with an inside mounted electrode these can be realized as a flat electrode and a coil electrode, respectively.
  • patch electrodes when two inside mounted electrodes are used, they usually are coil electrodes or a combination of a coil electrode and a patch electrode, or two patch electrodes. Then the volume of the treated organ, i.e. the region where the electric field is spanned, is usually smaller than if at least one flat electrode is used, but the density of the electric field is stronger around the cylindrical coil electrode.
  • the electrode according to the invention for reducing oedema of internal organs through spanning an electrical field comprises an electrode support and at least one electrically conductive electrode surface which is embedded in the electrode support, wherein the electrode surface is connected to a control and power supply unit by way of electric lines to charge the electrodes comparable to the electrode plates of a capacitor, wherein the internal organ and any further intervening element as blood vessel and its content, skin if a plate electrode is provided outside the body, provide for the dielectric separating the two conductive plates, with at least one of the plates being electrically isolated.
  • the predetermined strength of the electric field can be maintained by controlling/regulating the voltage for any given distance of the electrodes.
  • the strength of the electric field is directly controlled by setting the voltage to a preset value, preferably to a preset value which has been calculated or at least roughly estimated based on the electroosmotic and/or electrophoretic flow velocity to be achieved e.g. according to the Helmholtz-Smoluchowski relation to generate a specific electrical field strength based on the predetermined distance of the two electrodes to each other.
  • the control unit is adapted to directly control a strength of an electric field by causing a voltage of a preset value.
  • the strength of the electric field is directly controlled by setting the electric field strength to a preset value.
  • the control unit is adapted to directly control a strength of an electric field by causing an electric field strength of a preset value.
  • the electric field can be maintained, in particular, for a time period starting from days, i.e. longer than 24 hours, to weeks and months. Subsequently, it is possible but not necessary to provide switch polarity and charging the electrodes in the opposite way, wherein the polarity of the electrodes can be switched in predetermined time intervals. Such as intervals between ten minutes and three months, or between 12 hours and 7 days.
  • the specific value for the current would then cause values for the voltage and the electric field largely depending on specific resistance (impedance) and the electrochemical boundary conditions of the myocardial tissue, of the patient, internal organs, medical equipment used as well as possible dynamic variables influencing the resistance (impedance) and/or the resulting voltage and electrical field.
  • Using the current for regulating the strength of the electric field thus causes additional steps of adjusting the current to reach a specific electric field strength.
  • electrokinetic effects such as electro-osmosis, electrophoresis or an osmotic like or electrophoretic like effect, wherein electroosmotic and/or electrophoretic flow is caused by the Coulomb force induced by the electric field on net mobile electric charge in a solution.
  • electrokinetic effects such as electro-osmosis, electrophoresis or an osmotic like or electrophoretic like effect
  • electroosmotic and/or electrophoretic flow is caused by the Coulomb force induced by the electric field on net mobile electric charge in a solution.
  • the secretion of aqueous solution droplets usually happens at the cathode, however, depending on the composition of the liquid (electrical charge carriers in the liquid) to be removed, the liquid can also be secreted at the anode.
  • such a one-way valve is a diaphragm valve having a valve diaphragm.
  • the process of reduction of the internal oedema applies steps for controlling the electric field between the electrodes according to the present invention wherein the strength of the electric field generated by the electrodes is regulated in such a way that an electric flux (as measure of the electric field through a given surface) is maintained within a predetermined interval for a predetermined surface near the electrode surface.
  • a treatment-specific electric flux can be set, which is particularly advantageous since providing a predetermined electroosmotic and/or electrophoretic effect.
  • the electroosmotic and/or electrophoretic flow is directly related to and depending on the applied voltage and/or electrical field strength.
  • it is thus advantageous to control the voltage and/or electrical field directly. This will make it possible to determine and calculate a desired and adequate value for each individual patient and apply said value from the start of the treatment in a defined way.
  • Indirect means to control the electroosmotic and/or electrophoretic flow e.g. via setting a specific value for the current is disadvantageous due to the time and additional adaptations necessary to reach a desired voltage and/or field strength.
  • a device which is only adapted to directly control the current, would have to be adapted to external factors such as medical equipment used as well as factors relating to the patient's status such as weight, water retention or water content within the tissue and others in order to reach a defined electroosmotic and/or electrophoretic flow.
  • Such adaptations will take additional time and are cumbersome and laborious to carry out before the defined treatment can take place.
  • the system of the present invention which allows direct control of the voltage and/or the electric field, thus makes direct control of the electroosmotic and/or electrophoretic flow possible. Therefore, the present invention provides an advantageous system, which makes use of the recognition of the present inventors.
  • the inventive electrode assembly system for treatment of internal organ oedema by electrokinetic effects, and in further detail electro-osmosis and/or electrophoresis, by delivering an electric field comprises a first electrode, a second electrode and a control unit, wherein the first electrode and second electrode are electrically connected to the control unit, the control unit is adapted to charge the first electrode negatively and the second electrode positively, and the control unit is adapted to directly control a strength of an electric field induced by the first electrode and the second electrode to a preset value for generating a treatment-specific electric flux.
  • control unit can be configured to (a) allow the preset value of the strength of the electric field to be set and/or entered into the control unit by a user, (b) to automatically control the strength of the electric field to the preset value for the strength of the electric field, and/or (c) to cause and maintain the strength of the electric field at the preset value for the strength of the electric field independently of external influences.
  • the already mentioned use of such electrode assembly system is for inducing an electrokinetic-like effect for treatment of internal organ oedema by means of inducing an electric field, wherein the control unit of the electrode assembly is set to a value for the strength of the electric field by a user to directly control an electric field induced by the first electrode and the second electrode to the preset value for generating a treatment-specific electric flux, wherein the preset value of strength of the electric field is preferably caused and maintained by the control unit independent of external influences.
  • a control unit can achieve that the electric flux can be concentrated in the adjacent areas of the internal organ to have the necessary electric field maintained in the oedema area of the organ.
  • Each electrode according to the invention can be used as a positive or negative charge receiving electrode, wherein the cathode is the electrode where the maximum amount of aqueous solution is gathered and conducted away. Therefore, an important reduction effect of the internal oedema happens where the anode provides the liquid-reduced area.
  • the process of treatment of internal organ oedema can comprise different electrode systems. They always comprise two electrodes and a control unit, wherein the two electrodes can be two patch electrodes, a combination of one patch electrode and one coil electrode, or two coil electrodes.
  • the two electrodes are to be positioned at two places in relation to the internal organ to be treated and the electrodes are connected to the control unit.
  • the control unit is then adapted to provide a voltage generating the electric field with a predetermined electric flux to induce electro-osmosis and/or electrophoresis.
  • two patch electrodes which can be one-surface electrodes or comprises a plurality of separated segments. Then the patch electrodes are mounted on the outer surface of the internal organ, which can be heart, kidney or liver. Mounted can comprise positioning or attaching. It is also possible to position the patch electrodes just subcutaneously or on the outside touching the skin of the patient.
  • a patch electrode is combined with a coil electrode, wherein the patch electrode is positioned on the outer surface of the internal organ, wherein the coil electrode is positioned in a liquid carrying vessel of the internal organ. Then the field lines of the electric field are positioned through the organ.
  • the patch electrode is preferably positioned for the heart on the epicardial side of the heart, wherein the coil electrode is positioned for the heart inside the right ventricular cavity. It is only paramount that the electric field lines are extending through the oedemic parts of the heart. The advantage of the pure electric field application is the more flexible positioning of the electrodes. In order to force the field lines cross the myocard, it is preferred to place a coil electrode in one of the ventricles (left or right).
  • the second electrode is not necessarily directly on the internal organ but can be placed, for example, extrapericardially or subcutaneously, or (theoretically) even on the skin, because the electric field also penetrates the lungs, which the current does not like.
  • the patch electrode is positioned for the kidney on the outer side opposite to the renal artery and renal vein, wherein the coil electrode is positioned inside the renal artery and renal vein or the renal pelvis.
  • the treatment of an oedemic kidney it is also possible for the treatment of an oedemic kidney to place a coil electrode in the renal artery or vein and a patch electrode subcutaneously or even on the skin, since the kidney is directly positioned below the skin.
  • two patch electrodes can be used an each flat side of the kidney. The kidney is then sandwiched by the patch electrodes.
  • the electrodes are positioned extracorporally, preferably in physical contact to the skin of a patient.
  • a place on the outer surface of an internal organ may also include a place on the external skin surface and/or the outer surface of an internal organ may include the external skin surface.
  • myocardial oedema plays a crucial role in the further course of the disease in patients with fresh myocardial infarction or acute myocarditis.
  • a myocardial infarction or myocarditis that cannot be controlled because of myocardial oedema has an increased likelihood of fatal consequences.
  • electrodes are envisaged herein that apply the current with its inherent field or the electric field transdermally (with physical contact to the skin).
  • the electrodes of the present invention and/or the electrode assembly system of the present invention are adapted to allow an extracorporal application thereof.
  • the size of the electrodes of the present invention may be selected depending on the size of the person to be treated.
  • the electrodes to be applied extracorporally are patch electrodes.
  • patch electrodes having a size in the range of from 2 by 2 cm (for babies) up to 30 by 40 cm (for adults), and/or a surface area of from 4 cm 2 to 1200 cm 2 , or any size or surface area in between may be employed.
  • electrodes of different shapes or forms may be used, comprising round, elliptical, square, rectangular and freeform.
  • the electrodes contacting the skin are electrically conductive allowing electrical current to flow. In one embodiment of the present invention, at least one or all electrodes contacting the skin is/are electrically insulated allowing an electrical field to be generated without any current flow.
  • a gel or other liquid with high conductivity may be applied between the extracorporally applied electrode and the skin, similar to substances used for external defibrillation.
  • one embodiment of the present invention features adhesive electrodes which may be reversibly and directly fixed to the skin surface, preferably wherein the adhesive itself has a favorable resistance behavior.
  • the electrically conductive surface of the extracorporal electrode(s) is designed to be deformable so that the electrode(s) can adapt to the body contours.
  • the electrically conductive electrode surface may be connected via an electrical energy conducting cable to a device that can generate and deliver the corresponding currents and voltages.
  • a process of treatment of internal organ oedema can also use two coil electrodes, wherein the two coil electrodes are positioned in different liquid carrying vessels within the same internal organ. Then the electric field is mainly restricted between the core parts of the organ where the coil electrodes are positioned.
  • one of the two coil electrodes can be placed in the coronary sinus and the other of the two electrodes can be positioned in the right or left ventricular cavity.
  • the internal organ oedema to be treated can be a myocardial oedema or an oedema of the kidney or an oedema of the liver.
  • the electro-osmosis and/or electrophoresis is generated for a reduction up to a removal of the internal organ oedema.
  • Myocardial oedema, or oedema in other inner organs the excess accumulation of fluid in the myocardial interstitium, develops when there is an imbalance between filtration from the coronary microvasculature, removal of interstitial fluid via lymphatic vessels and epicardial transudation.
  • the electroosmotic effect comprises an accumulation of oedema fluid at the electrodes to be carried away from the electrodes (transudation).
  • the effect of electroosmosis and/or electrophoresis is to be found in that the lymphatic system can remove the excess fluid more quickly.
  • the control unit can be configured to switch the polarity of the electric field in predetermined time intervals.
  • Such predetermined time intervals can comprise intervals between 10 minutes and three months.
  • the entire process can comprise a treatment time of several days up to several months or even chronically.
  • the therapy with the electric field can be suspended at any intervals. This means that the device switches off at any interval and then switches on again automatically.
  • the intervals can be a few minutes, hours, days, weeks or months.
  • electrolysis generating a pH shift and creation of gas
  • the electrodes with electrically conducting surfaces are positioned as explained, e.g. in a liquid vessel or on the internal organ.
  • electrolysis does not happen or is very reduced, if at least one of the electrodes is isolated, e.g. sheathed with an isolating material, and the isolation and space between the electrodes act as dielectric. Since the field force is small and the possible electrical current is low and the electrodes are preferably made of platinum or a platinum iridium alloy (or made of a different metal with high positive electrochemical voltage), the effects are limited.
  • the gas generation is effected at the anode, which is preferably in the flowing blood (in the blood vessel) or the flowing lymph fluid (in a lymphatic duct).
  • the liquid is capable to dissolve the gas.
  • the generated gas is especially Cl 2 , which, immediately after its formation, forms bonds that are physiological and therefore harmless.
  • the invention further comprises an electrode assembly comprising two electrodes and a control circuit, wherein the first and second electrodes are electrically connected to the control circuit, wherein the control unit is adapted to charge the first electrode negatively and the second electrode positively, especially by direct current or voltage power.
  • the electrode assembly has preferably a control unit being adapted to switch the polarity of the charged first and second electrodes.
  • the electrode assembly can comprise two patch electrodes to be positioned opposite one the other of the internal organ so that the electric field generated by the negatively and positively charged electrodes is spanned through the internal organ.
  • the electrode assembly can have a mixed lay-out with one coil electrode and a patch electrode, wherein the coil electrode is to be positioned inside a liquid vessel of the internal organ or inside the heart and the patch electrode is to be positioned outside of the internal organ so that the electric field generated by the negatively and positively charged electrodes is spanned through the internal organ oedema part.
  • the electrode assembly can have two coil electrodes to be positioned both inside the heart or in different liquid vessels of the internal organ so that the electric field generated by the negatively and positively charged first and second electrode is spanned through the internal organ oedema part especially between the two liquid vessels.
  • the control unit of the electrode assembly can be adapted to control the charge of the negatively and positively charged first and second electrodes to control the strength of the electric field at the place of the internal organ oedema over time, i.e. adapt the strength of the electric field during the treatment.
  • control unit of the electrode assembly is adapted to directly control the strength of the electric field or the amount of the electric voltage during the treatment according to a value set by a user, preferably the control unit automatically controls the strength of the electric field or voltage caused by the electrode assembly in a way that a specified value can be entered by a user which is then caused and maintained by the control unit independent of external influences.
  • External influences may preferably include differences regarding the inherent resistance (impedance) and the electrochemical boundary conditions of each patient and/or internal organs, equipment used to generate the electric field or voltage or dynamic changes of the resistance (impedance) value during treatment.
  • the electrode assembly can comprise electrodes in the traditional sense that an electrically conductive surface is in contact with the surrounding tissue or in a liquid vessel of the internal organ to be treated.
  • the electrode assembly independent from the fact if it comprises two patch electrodes, two coil electrodes or one coil/one patch electrode can provide a first electrode and a second electrode, wherein one or both can have electrically isolating sheaths.
  • the electrically isolating sheaths are preferably completely encompassing the electrodes until the electric lines leading to the control unit (and also encompassing those).
  • Such electrically isolating sheath can comprise a material taken from the group encompassing silicone, thermoplast, PEEK, PHA and PHB, i.e. use one or more of these and further material but it can also consist of one of these as e.g. silicone or PEEK.
  • the effect within the treatment of an internal organ oedema is based on a voltage (electrical field) and a charge applied on the electrode and the dependency of the internal organ, and further body material between the electrodes as body liquids, vessels, organ tissue and possibly skin, alone.
  • the thus directly controlled electric field between the isolated electrodes nevertheless provides a modified electro-osmotic or electrophoretic effect, i.e. an effect of increase of the lymphatic flow, which reduces the oedema of the internal organ, e.g. heart, liver or kidney.
  • words using the singular or plural number also include the plural and singular number, respectively.
  • words “herein,” “above,”, “previously” and “below” and words of similar import, when used in this application, shall refer to this application as a whole and not to any particular portions of the application.
  • a device in the figures is turned over, elements described as “below” or “beneath” other elements or features would then be “above” or “over” the other elements or features.
  • the exemplary term “below” can encompass both positions and orientations of above and below.
  • the devices may be otherwise oriented (rotated 90 degrees or at other orientations), and the spatially relative descriptors used herein interpreted accordingly.
  • descriptions of movement along and around various axes include various special device positions and orientations.
  • FIG. 1 shows a two internal electrode disposition (two internal coil electrodes) of electrodes in the heart as internal organ
  • FIG. 2 shows a mixed (one internal coil electrode, one external patch electrode) disposition of electrodes in and outside the heart;
  • FIG. 3 shows a two external electrodes (external patches with segmented electrodes) disposition of electrodes on external heart surfaces according to the invention during use;
  • FIG. 4 shows an electrode according to the invention comprising a one-way valve
  • FIG. 5 shows a two external electrodes (external patches with single electrodes) disposition of electrodes on external kidney surfaces according to the invention during use;
  • FIG. 6 shows a mixed (one internal coil electrode, one external patch electrode) disposition of electrodes in and outside the kidney.
  • FIG. 1 shows a schematic representation of a heart 10 with an electrode assembly 20 according to a first illustrative embodiment of the invention.
  • the implantable electrode assembly 20 comprises two implantable electrodes 30 and 40 and a control circuit 50 , usually arranged in a separate housing in which the battery for the power supply is likewise provided.
  • the two electrodes 30 and 40 are connected to the control circuit 50 via two single-conductor cables 51 and 52 .
  • the control circuit 50 is designed to establish a potential difference between the two electrodes 30 and 40 , such that an electric field is generated between these electrodes 30 and 40 .
  • One electrode 30 is a ventricular electrode, provided for positioning in the right ventricle, and is designed as a coil electrode. It is therefore designated below as a ventricular coil electrode 30 .
  • the length of the ventricular coil electrode 30 defined by the one conductive metallic sheath surface or coil surface defining a sheath, is ca. 4 to 10 centimeters and is designed to fill as far as possible the entire length of the right ventricle after passage through the right cardiac tricuspid valve.
  • the ventricular coil electrode 30 is placed loosely into the right ventricle, but it can touch the wall of the right ventricle.
  • the electrode To prevent the electrode from falling into the outflow tract of the right ventricle (pulmonary valve), it is anchored actively (by screw) with its tip or passively with barbs in the tip of the right ventricle which hook into the trabecular meshwork of the right ventricle and thus fix the electrode tip.
  • the electrode 30 seems to float freely in the right ventricle. However, this is only apparently the case, because the figures are schematic two-dimensional depictions. Generally, the electrode 30 will nestle on the wall of the ventricle; in the depiction in FIG. 2 , this could be the posterior wall, which is not visible there. The electrode 30 is flexible in order to adopt these gentle curvatures, which amount to less than 30 degrees with respect to the longitudinal axis.
  • the other electrode 40 of FIG. 1 is a coronary sinus electrode, provided for positioning in the coronary sinus, and is likewise designed as a coil electrode.
  • This coronary sinus coil electrode 40 has a smaller diameter than the ventricular coil electrode 30 since it is intended to be advanced far into the coronary sinus in order then to come to lie in the narrowing end region there.
  • This electrode thus lies at a position substantially predefined by the vessel walls, which position the operating surgeon otherwise establishes by advancing it in the longitudinal direction.
  • the electrode 30 can be the cathode for a predetermined time of between a few minutes and up to chronically, whereby the direction of the electric field is predefined.
  • the control circuit can then switch the polarity of the voltage and change the direction of the electric field after a correspondingly predetermined time, whereby the electrode 40 becomes the cathode.
  • the strength of the electric flux can also change, since the dielectric property of the volume between the two electrodes 30 and 40 can be dependent on the direction of the electric field.
  • the control device controls the electric flux at a uniform predetermined value.
  • FIG. 2 shows a schematic representation of a heart 10 with an electrode assembly 120 according to a second illustrative embodiment of the invention.
  • the implantable electrode assembly 120 comprises two implantable electrodes 30 and 140 and also a control circuit 50 .
  • the control circuit 50 can be designed in the same way as described in FIG. 1 .
  • the two electrodes 30 and 140 are also connected to the control circuit 50 via two single-conductor cables 51 and 52 .
  • the control circuit 50 is also designed here to establish an electric field between the two electrodes 30 and 140 , such that an electro-osmotic and/or electrophoretic effect can exist between these electrodes 30 and 140 for a predetermined time of several minutes, e.g. 5 minutes, to several days, e.g. 3 days or even chronically.
  • One electrode 30 is once again a ventricular electrode, provided for positioning in the right ventricle, and is designed as a coil electrode. It is therefore also designated here as a ventricular coil electrode 30 .
  • the length of the ventricular coil electrode 30 defined by the one conductive metallic sheath surface or coil surface defining a sheath, is ca. 4 to 10 centimeters and is designed to fill as far as possible the entire length of the right ventricle in the longitudinal axis after passage through the right cardiac valve (tricuspid valve).
  • the ventricular coil electrode 30 is placed loosely into the right ventricle, is passively anchored at the distal end and can bear on the wall of the ventricle or on the septum. To prevent the electrode from falling into the outflow tract of the right ventricle (pulmonary valve), it is anchored actively (by screw) with its tip or passively with barbs in the tip of the right ventricle.
  • the other electrode 140 is a surface electrode (patch electrode), provided for positioning on the epicardium, the pericardium or close to the epicardium (e. g. even subcutaneously). It can be designed, for example, according to the teaching of US 2008/0195163 A1. This surface electrode 140 is applied to the left side of the myocardium, epicardially opposite the right ventricle.
  • an electric field is generated with field lines very schematically in the direction according to the arrows 155 through the myocardium.
  • These electric field lines are symbolized here by two arrows which essentially show the approximate direction of the field lines, since the field lines emerge and fan out from a substantially longitudinally dimensional face of the substantially longitudinally oriented surface of the coil electrode 30 toward the surface electrode 140 and thus sweeps across a fan.
  • the main portion of the electric field lines are inside a prism; that is to say proceeding from an edge (of the prism) to its base on the patch electrode.
  • a prism is by definition a geometric body whose side edges are parallel and of equal length and which has a polygon as base. It arises from parallel displacement of a plane polygon along a straight line not lying in this plane and is therefore a special polyhedron.
  • the straight line is predefined by the longitudinal axis of the coil electrode 30
  • the polygon is a triangle with the apex at the coil electrode 30 and with a base that corresponds to the width of the surface electrode (patch electrode) 140 . If these side edges 141 of the surface electrode 140 do not come to lie parallel to the orientation of the coil electrode, it is a rotated prism.
  • the two electrodes 30 and 140 define a not inconsiderable spatial body, which guarantees that the electric field spans through a likewise not inconsiderable sub region of the left cardiac muscle and to a slightly lesser extent also of the right cardiac muscle.
  • Describing the geometry of the body through which the electric field has a substantive strength as a prism is an approximation, since it can be assumed from this that the electrode does not float freely but is instead passively fixed at its distal tip and then bears on the wall of the ventricle.
  • the boundary lines of the body are then certainly not straight but curved, and the defined body is then obtained only approximately as a prism. Of importance, however, is the narrow “edge” on the one side formed by the coil electrode, and the “broad bottom face” on the other side, which is formed by the patch electrode.
  • FIG. 3 shows two patch electrodes 240 and 340 , which are connected with lines 51 and 52 to a control and power supply unit 50 .
  • each patch electrode 240 and 340 as such is a segmented electrode 240 or 340 .
  • each electrode 240 or 340 is or comprises a plurality of electrode segments 241 or 341 , which are shown as smaller rectangles in FIG. 3 .
  • the organ 10 can be a heart, it is also possible that the organ 10 is a kidney with applied electrodes 240 and 340 . In other embodiments, it could be a liver.
  • the electrode 240 or 340 optionally comprises at least one one-way valve 70 , which essentially comprises an opening 72 and a diaphragm 73 covering the opening 72 on the far side of the internal organ.
  • a schematic sectional view of the one-way valve 70 is depicted in FIG. 4 .
  • the diaphragm is made from silicone, for example.
  • the one-way valve 70 is situated within the electrode surface 75 .
  • the apparatus as described in connection with FIG. 1 , 2 or 3 provides a constant electric field with defined polarity for a given time as hours or days applied to the tissue of an internal organ, here the heart. This electric field acts immediately or at least extremely fast on the internal organ, here the heart.
  • Such drainage of the heart muscle i.e. the reduction of myocardial oedema, might be difficult to monitor in living organisms, but the inventors of the present invention have found that the subsequent improvement of the heart function is substantially based on the effect known as electroosmosis and/or electrophoresis.
  • lymphatic drainage since the lymphatic vessels are one of the transport routes, or the most important transport route, that remove the oedema and are stimulated by electroosmosis.
  • the electric field mainly causes ion movement (electrokinesis), i.e. the migration of negatively charged anions (e.g. Cl ⁇ , CO 2 ⁇ etc) to the anode and of positively charged cations (e.g. Na+. Mg++. etc) to the cathode.
  • Electro-chemical reactions occur on metals (electrodes, but also metallic foreign bodies).
  • the capillaries are lined with a layer called glycocalyx, which controls the permeability of the vessel walls to fluid and other substances and exhibits a strong negative charge when in a healthy state.
  • the permeability of the vessels can increase and more fluid and other substances can leak out of the vessel, which then results in the occurrence of oedema of the myocardium.
  • the charge of the glycocalyx can be restored by the applied electric field, thereby supporting the reduction of the oedema and consequently the improvement of cardiac function.
  • the above described effect is as such independent from the application with two internal coil electrodes, one coil electrode and one patch electrode or two patch electrodes applied on opposite parts of the internal organ like the on the left and the right ventricle.
  • the lymphatic system, as part of the affected organ, is thus simultaneously exposed to the field or current and responds by an increased and accelerated lymphatic flow.
  • FIGS. 1 to 4 only show the heart in the application, similar coil electrodes can be used for the treatment of a liver and/or a kidney. They can be used in blood vessels or the lymphatic system. Flat electrodes can be positioned on or near the liver or kidney with the flat electrodes on mainly opposite sides of the organ, so that the electric field and its field lines passes through the organ. This can also be done subcutaneously or from the exterior of the human body.
  • the average of patients included in the study reported therein is a New York Heart Association (NYHA) Class III non-ischemic patient in the age group of 29 to 67 years, with a body mass index of 22.5 to 35.9 and a history of heart failure, and in particular with a significantly reduced left ventricular ejection fraction (LVEF) and a 6 minute walk under about 250 m.
  • NYHA New York Heart Association
  • LVEF left ventricular ejection fraction
  • 6 min walk test or “6MWT” has been developed by the American Thoracic Society as a reliable indicator in the form of a sub-maximal exercise test for assessing aerobic capacity and endurance, wherein the walking distance covered over a time of 6 minutes by the patient is used as the outcome by which to compare changes in performance capacity.
  • the average patient achieved between ⁇ 170 and ⁇ 250 m at hospitalization, between ⁇ 350 and ⁇ 450 m after 14 days, and between ⁇ 370 and ⁇ 470 m after 6 months of device use, and, furthermore, the average patient's classification according to the NYHA improved to a significantly less critical class after this time period.
  • FIG. 5 shows a two external electrodes (external patches with single electrodes) disposition of electrodes on external kidney surfaces according to the invention during use.
  • kidneys 11 There are two kidneys 11 with a symbolic central aorta or vena renalis 13 .
  • Ureters 12 connect the kidneys 11 with the bladder of the person.
  • a patch electrode 440 is positioned on the outside of one kidney 11 .
  • a second patch electrode 440 ′ (with an identical outlay to the first patch electrode 440 ) is positioned on the opposite side of the kidney 11 . Therefore, the core part of the kidney with its renal pyramids 17 , renal calix 16 and the renal pelvis 18 is positioned between the two patches 440 and patches 440 ′.
  • the flat electrode patches 440 and 440 ′ are connected with a control unit 50 , not shown in FIG. 5 , via connection lines 51 and 52 , respectively.
  • the supply lines 51 and 52 provide an electric field between the flat electrode patches 440 and 440 ′ wherein the electric flux through the mentioned parts of the kidney then effectively reduces the oedema through electro-osmotic and/or electrophoretic effects.
  • the electrode patches 440 and 440 ′ are shown as single electrodes but can also be segmented electrodes as shown in FIG. 3 .
  • FIG. 6 shows a mixed (one internal coil electrode, one external patch electrode) disposition of electrodes in and outside the kidney.
  • the kidney 11 is shown with its renal pyramids 17 , renal calix 16 and the renal pelvis 18 .
  • the aorta renalis 14 and vena renalis 15 are shown as well.
  • a first external electrode 440 is connected via line 51 to a control unit 50 (not shown).
  • a renal coil electrode 540 is positioned in the vena renalis 15 to allow an electric field between this electrode 540 and said external patch electrode 440 .
  • the connection of the renal coil electrode 540 to the control unit 50 is effected via the catheter line 53 used to position the renal coil electrode 540 .
  • the coil electrode could in other embodiments also positioned in the renal lymphatic system.
  • the lines 51 , 52 and/or 53 are usually electrically isolated, e.g. in a catheter or in an isolating sheath.
  • the two electrodes independent from the fact if they are two patch electrodes 140 , 240 , 340 , 440 , 440 ′ especially non-segmented and having one single electrode surface each, two coil electrodes 30 , 40 or one coil/one 5 patch electrode 30 / 140 , 440 / 540 can provide a first electrode and a second electrode which one or both can have electrically isolating sheaths.
  • the electrically isolating sheaths are preferably completely encompassing the electrodes until the electric lines 51 , 52 or 53 leading to the control unit 50 (and also encompassing these elements).
  • Such electrically isolating sheath can comprise a material taken from the group encompassing silicone, thermoplast, PEEK, 10 PHA and PHB, i.e. use one or more of these and further material but it can also consist of one of these as e.g. silicone or PEEK alone.
  • the effect of treatment of internal organ oedema is based on a voltage and a charge applied on the electrode and the dependency of the internal organ, and further body material between the electrodes as body liquids, vessels, organ tissue, and possibly skin), i.e. presetting and directly controlling the electric field between the isolated electrodes alone provides the desired electro-osmotic and/or electrophoretic effect which reduces the oedema of the internal organ, e.g. heart, liver or kidney.

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