WO1991008017A1 - Stimulateur cardiaque - Google Patents

Stimulateur cardiaque Download PDF

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Publication number
WO1991008017A1
WO1991008017A1 PCT/DE1990/000926 DE9000926W WO9108017A1 WO 1991008017 A1 WO1991008017 A1 WO 1991008017A1 DE 9000926 W DE9000926 W DE 9000926W WO 9108017 A1 WO9108017 A1 WO 9108017A1
Authority
WO
WIPO (PCT)
Prior art keywords
pacemaker
patient
physical
signal
measure
Prior art date
Application number
PCT/DE1990/000926
Other languages
German (de)
English (en)
Inventor
Max Schaldach
Original Assignee
BIOTRONIK MESS- UND THERAPIEGERäTE GMBH & CO. INGENIEURBüRO BERLIN
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by BIOTRONIK MESS- UND THERAPIEGERäTE GMBH & CO. INGENIEURBüRO BERLIN filed Critical BIOTRONIK MESS- UND THERAPIEGERäTE GMBH & CO. INGENIEURBüRO BERLIN
Publication of WO1991008017A1 publication Critical patent/WO1991008017A1/fr

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Classifications

    • 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
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
    • A61N1/36585—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by two or more physical parameters
    • 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
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
    • A61N1/36514—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by a physiological quantity other than heart potential, e.g. blood pressure
    • A61N1/36542—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by a physiological quantity other than heart potential, e.g. blood pressure controlled by body motion, e.g. acceleration

Definitions

  • the invention relates to a pacemaker according to the preamble of claim 1.
  • a PEP-controlled pacemaker is described in "Biomed.technik, 34 (1989), 177-184". Under PEP is understand the interval from the beginning of chamber depolarization to the beginning of the expulsion phase.
  • the implantable stimulation system with PEP-controlled physiological frequency control presented there is based on the relationship between PEP and chronotropic heart rate. The shortening of PEP can be converted into an increase in frequency. If the adrenergic effects decrease, both intervals are extended.
  • the solution described there is based on the right ventricular intracardinal detection of a time interval from the impedance profile, which is obtained between the electrode tip and the pacemaker housing and which corresponds well with the left ventricular PEP.
  • the "ideal" physiological parameter for the controlled adaptation of the stimulation frequency of an artificial pacemaker reflects the physical or psychological stress, but is independent of the heart rate.
  • the frequency can be determined from the current measured value of the physiological parameter using a value table or as a functional relationship.
  • the tension time, PEP has these "ideal" properties. With a constant load situation, PEP is an unambiguous function of the load with a constant stimulation frequency.
  • the invention has for its object to provide a pacemaker that takes into account the actual load in the PEP control.
  • the actual stress caused by different stress / stimulation rate relationships is taken into account in a PEP-controlled cardiac pacemaker.
  • a processor-controlled pacemaker this can advantageously be carried out by switching tables stored in a memory.
  • a position sensor is used as the detection device for the position of the patient and for generating a switchover signal.
  • This can be a gravity-controlled switch, for example.
  • it is proposed to adapt the relationship between stress and stimulation rate, which is essentially proportional, to the actual stress by changing a factor.
  • the heart rate is advantageously reduced when lying down in accordance with the physiological requirements set. Without switching, the heart rate would increase due to the elimination of the static preload.
  • FIG. 1 shows a first exemplary embodiment of a cardiac pacemaker having the measures according to the invention
  • FIG. 2 is a complete block diagram of a rate controlled pacemaker.
  • the first exemplary embodiment of a pacemaker 19 according to the invention shown in FIG. 1 has an evaluation circuit 16 for using the PEP as a physiological parameter for the controlled adaptation of the stimulation frequency.
  • the evaluation circuit 16 is supplied with a switchover signal for tables 17, 18 from a signal evaluation circuit 15 to a detection device 10.
  • the detection device 10 can, for example, be a heavy power controlled switch.
  • a mercury switch 11 with switch contacts 12, 13 and a mercury bead 14 is shown as an example.
  • a contact 13 of the contact pair 12, 13 is connected to the supply voltage V, the other contact 12 leads to an input of the signal evaluation circuit 15.
  • the signal evaluation circuit 15 detects whether the patient is in a horizontal or vertical position finds.
  • the signal evaluation circuit 15 generates a switchover signal to adapt the load / stimulation rate relationships to the position of the patient.
  • this is done by using the corresponding table 17, 18 for evaluating the load / stimulation rate relationships.
  • a rate-controlled pacemaker 100 is shown in the block diagram in FIG.
  • This pacemaker stimulates atrium 105 or ventricle 106 of heart 107 via control stages 101 and 102 and output stages 103 and 104, respectively, by means of corresponding electrodes connected to the output circuits. These electrodes also pick up characteristic signals from the heart for cardiac actions and feed them to an input amplifier circuit 108 and 109, respectively. These signals are processed via downstream detection stages 110 and 111 - each separately for the atrium and ventricle.
  • This data is passed to a processor system 112.
  • This processor system is with the control logic over one Data, a control and an additional bus are connected so that the digitized signals received by the processor unit in the atrium and ventricle can be queried and digital control signals can also be emitted to trigger stimulation pulses in the atrium and ventricle.
  • the control logic 112 relates to the processor part 113 like a control part for a peripheral unit, for example as an interface for receiving and outputting external analog signals with an AD-DA converter, often also referred to as an input-output unit.
  • control logic is connected to a bidirectional transmission channel 114, 115 which, by means of an inductor 116, can transmit signals received outside the patient to the heart or control signals for programming the pacemaker from outside the patient to the pacemaker .
  • a battery 117 is also provided for supplying the entire pacemaker, a quartz 118 and an oscillating circuit 119 as a timer or reserve timer.
  • a signal recording part 120 is used to determine a physiological parameter within the patient's body which forms a measure of the physical stress.
  • this is a pulse generator for delivering measuring pulses (current pulses i) in the right ventricle, from which the current electrical resistance within the ventricle can be determined at predetermined times via the electrode located in the ventricle.
  • the circuit 120 is provided with a line for switching off this module, so that in particular the delivery of current pulses is prevented.
  • Block 121 can be switched off by control logic 112 by means of a signal "off”. This shutdown takes place from processor part 113.
  • a position sensor 121 is also provided, the physical situation of the patient and in particular changes in position, i.e. which is captured in transition from a lying to a standing position.
  • the position sensor is connected to the processor system 112 for direct data exchange.
  • the processor unit 113 can be set into a predetermined state by means of an external magnet, in which the stimulation is preferably carried out at a fixed rate.
  • the memory addressing within the processor unit 113 is changed in response to a signal emitted by the position sensor, so that the information corresponding to the corresponding body position is read from the addressable memories of this unit.
  • control values for the basic stimulation rate are output, which compensate for the different measured values with the same physical exertion but different body positions.
  • repeated output signals of the position sensor 121 indicating a change in position of the patient are used as (further) a measure of the physical activity of the patient input parameter used.
  • the evaluation corresponds to that for the quantity PEP which is a measure of the physical stress.
  • the embodiment of the invention is not limited to the preferred exemplary embodiment specified above. Rather, a number of variants are conceivable which make use of the solution shown, even in the case of fundamentally different types. For example, instead of using corresponding tables, corresponding functions can also be used. Evaluation using discrete components is also possible.

Landscapes

  • Health & Medical Sciences (AREA)
  • Cardiology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Physiology (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Biophysics (AREA)
  • Radiology & Medical Imaging (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Hematology (AREA)
  • Electrotherapy Devices (AREA)

Abstract

Stimulateur cardiaque présentant un circuit d'évaluation pour l'utilisation d'une technique PEP comme paramètre physiologique pour l'adaptation commandée de la fréquence de stimulation. Un dispositif de détection (10, 15) détecte la position du patient et fournit un signal de commutation (20) en vue de l'adaptation des relations charge/vitesse de stimulation à la position du patient. Stimulateur cardiaque pour des patients à fonction circulatoire normale.
PCT/DE1990/000926 1989-11-29 1990-11-29 Stimulateur cardiaque WO1991008017A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DEP3939900.1 1989-11-29
DE3939900 1989-11-29

Publications (1)

Publication Number Publication Date
WO1991008017A1 true WO1991008017A1 (fr) 1991-06-13

Family

ID=6394674

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/DE1990/000926 WO1991008017A1 (fr) 1989-11-29 1990-11-29 Stimulateur cardiaque

Country Status (2)

Country Link
EP (1) EP0502889A1 (fr)
WO (1) WO1991008017A1 (fr)

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0498533A1 (fr) * 1991-02-05 1992-08-12 Cardiac Pacemakers, Inc. Stimulateur cardiaque à fréquence variable avec un fréquence supérieure de coupure qui dépend de l'état hémodynamique
DE19842107A1 (de) * 1998-09-08 2000-03-09 Biotronik Mess & Therapieg Verfahren zur Erkennung der Körperlage eines Menschen

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0225839A1 (fr) * 1985-09-17 1987-06-16 BIOTRONIK Mess- und Therapiegeräte GmbH & Co Ingenieurbüro Berlin Stimulateur cardiaque
EP0259658A2 (fr) * 1986-09-12 1988-03-16 Intermedics Inc. Stimulateur cardiaque commandé par le rythme

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0225839A1 (fr) * 1985-09-17 1987-06-16 BIOTRONIK Mess- und Therapiegeräte GmbH & Co Ingenieurbüro Berlin Stimulateur cardiaque
EP0259658A2 (fr) * 1986-09-12 1988-03-16 Intermedics Inc. Stimulateur cardiaque commandé par le rythme

Non-Patent Citations (2)

* Cited by examiner, † Cited by third party
Title
BIOMEDIZINISCHE TECHNIK. vol. 34, 1989, BERLIN DE Seiten 177 - 184; M. Schaldach: "PEP-gesteuerter Herzschrittmacher" siehe das ganze Dokument (in der Anmeldung erwähnt) *
MEDICAL PROGRESS THROUGH TECHNOLOGY. vol. 13, no. 2, 1987, Dordrecht NL Seiten 85 - 102; M. Schaldach: "Present state and future trends in electrical heart stimulation" siehe das ganze Dokument *

Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0498533A1 (fr) * 1991-02-05 1992-08-12 Cardiac Pacemakers, Inc. Stimulateur cardiaque à fréquence variable avec un fréquence supérieure de coupure qui dépend de l'état hémodynamique
DE19842107A1 (de) * 1998-09-08 2000-03-09 Biotronik Mess & Therapieg Verfahren zur Erkennung der Körperlage eines Menschen
EP0985374A2 (fr) 1998-09-08 2000-03-15 BIOTRONIK Mess- und Therapiegeräte GmbH & Co Ingenieurbüro Berlin Procédé de détection de la posture d'une personne
US6308098B1 (en) 1998-09-08 2001-10-23 Biotronik Mess-Und Therapiegerate Gmbh & Co. Ingenieurburo Berlin Process for detection of physical position of a human being

Also Published As

Publication number Publication date
EP0502889A1 (fr) 1992-09-16

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