WO1994002201A1 - Caracterisation de la conduction intraventriculaire - Google Patents

Caracterisation de la conduction intraventriculaire Download PDF

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Publication number
WO1994002201A1
WO1994002201A1 PCT/GB1993/001484 GB9301484W WO9402201A1 WO 1994002201 A1 WO1994002201 A1 WO 1994002201A1 GB 9301484 W GB9301484 W GB 9301484W WO 9402201 A1 WO9402201 A1 WO 9402201A1
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WO
WIPO (PCT)
Prior art keywords
ventricular
electrograms
increase
latency
pacing
Prior art date
Application number
PCT/GB1993/001484
Other languages
English (en)
Inventor
Richard Charles Saumarez
Original Assignee
Cryogenic Technology Limited
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 Cryogenic Technology Limited filed Critical Cryogenic Technology Limited
Priority to EP93916077A priority Critical patent/EP0650381A1/fr
Priority to JP6504256A priority patent/JPH08501952A/ja
Publication of WO1994002201A1 publication Critical patent/WO1994002201A1/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
    • A61N1/3621—Heart stimulators for treating or preventing abnormally high heart rate
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
    • A61B5/346—Analysis of electrocardiograms
    • A61B5/349—Detecting specific parameters of the electrocardiograph cycle
    • A61B5/361—Detecting fibrillation
    • 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
    • A61N1/3627—Heart stimulators for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy

Definitions

  • the invention relates to a method of characterisation of intraventricular conduction, and in particular to the detection and characterisation of electrophysiological effects of myocardial disarray on intraventricular conduction.
  • HCM Hypertrophic cardiomyopathy
  • myofibrillar disarray i.e. changes in the normal structure of the heart muscle, which is often accompanied by variation in cell diameter. This gives rise to scar tissue which causes thickening of the ventricle wall.
  • These changes cause changes in intraventricular conduction behaviour, creating a number of different potential conduction paths between a paced and a recorded site within the ventricle. Conduction may then be dispersed which can indirectly give rise to uncoordinated contraction of the heart muscles in ventricular fibrillation.
  • Myofibrillar disarray may be expected to cause slow conduction between a paced and a recorded site within the ventricle due to an increase in the number of potential conduction paths between the sites, and vary ⁇ ing utilisation of the respective paths. Accordingly the demonstration of slow conduction may be useful in indicating patients at risk of sudden death.
  • a method of characterisation of cardiac electrophysio- logical behaviour by analysis of paced ve tricular elec ⁇ trograms in which method latency values of transitions of the electrograms are used to construct conduction curves, selected parameters of the curves being used to identify and/or characterise physiologically-significant features of myocardial disarray.
  • the pacing electrode may be located at one of the right ventricular apex, the right ventricular outflow tract (RVOT), the right ventricular inferior wall and the right ventricular septum. Electrograms may be recorded at each of the other sites.
  • the pacing sequence may be computer generated.
  • a decremental sequence which may consist of a 480 millisecond drive chain with an extrastimulus applied every third beat, followed by immediate continuation of the drive chain.
  • the extra ⁇ stimulus coupling interval may be reduced in successive 1 ms steps from 479 ms until the ventricular effective refractory period (VERP) is reached.
  • VEP ventricular effective refractory period
  • the selected parameters preferably include the point of onset of a predetermined increase in latency.
  • the parameters preferably further include the value of the increase in electrogram width in a predetermined interval during the pacing sequence.
  • Preferably the upper limit of the interval coincides with the ventricular effective refractory period (VERP).
  • the results may be analysed by linear discriminant analysis.
  • Fig. 1 is a conduction curve obtained from a control patient
  • Fig. 2 is a conduction curve obtained from a patient with ventricular fibrillation
  • Fig. 3 is a scatter diagram of change in electrogram duration against the extrastimulus coupling interval at which latency starts to increase.
  • Multi-electrode pacing catheters are intro ⁇ quizzed, for example by way of the right femoral vein, to the right ventricular apex, the right ventricular out ⁇ flow tract, the right ventricular inferior wall and the right ventricular septum.
  • pacing is carried out at one of these electrodes, and, where necessary in certain patients, simultaneous pacing takes place at an electrode at the high right atrium to prevent fusion beats. Whilst pacing is carried out at one electrode, recordings are made from the remaining electrodes.
  • the pacing sequence is a computer generated decre- mental sequence.
  • the sequence comprises a continuous drive train of beats at constant 480 ms intervals, with an extrastimulus applied after every third beat, with immediate continuation of the drive chain.
  • the extra- stimulus coupling interval is successively reduced by 1 ms on each occasion to give increasing extrastimulus prematurity, from an initial coupling interval of 479 ms until the ventricular effective refractory period (VERP) is reached.
  • VEP ventricular effective refractory period
  • three sets of recordings are obtained, one from each non-paced electrode. Each set contains responses to between 200 and 300 extrastimuli .
  • the run is repeated with each ventricular site in turn being paced.
  • Electrograms recorded from patients with ventricular fibrillation show increasing fragmentation, or fractionation, of the electrogram with increasing stimulus prematurity, i.e. a splitting of the electrogram peaks and an increase in the width of the electrogram. There is also a variation in latency (the time interval from the stimulus to the particular transition) of the peaks.
  • the electrograms are passed through a digital high pass filter, using conventional techniques, in order to emphasise the various transitions. Compensation is also made for noise, and only the transitions exceeding the calculated noise amplitude are used.
  • the latency of each component of the electrogram is calculated, and conduction curves are constructed of latency values as a function of extrastimulus coupling interval.
  • the conduction curves of patients at risk show clearly different patterns from control patients or patients with no family history of sudden death. In particular, control patients typically show short duration, non-fractionated electrograms as shown in Fig. 1. Patients with ventricular fibrillation by comparison show changes in the number of transitions, an increase in electrogram width and an early increase in latency (Fig. 2).
  • Each conduction curve is characterised by an automated method which determines two parameters. Firstly, the extrastimulus coupling interval at which latency shows a predetermined increase is identified. Secondly, there is determined the increase in the width of the electrogram between a given extrastimulus coupling interval, in this case 350 ms, and at the ventricular effective refractory pariod. These parameters are used to construct a scatter diagram of change in electrogram duration (width) against onset of increase in latency, see Fig. 3. The data are subjected to linear discriminant analysis to distinguish various sub-groups of the patients studied.
  • Electrograms from patients with ventricular fibrillation lie in a group with a marked increase in electrogram width and early increase in latency.
  • the controlled and low risk patients lie in a group with a late increase in latency and a small increase in electrogram width.
  • An intermediate group comprises the patients with a family history of sudden death and with non-sustained ventricular tachycardia.
  • the method therefore provides a means of analysing electrograms to obtain information about the rate and pathways of conduction between the pacing site and the recording site. This information can be used to identify patients who may be at risk of sudden death so that appropriate action may be taken preferentially in those cases.

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

Abstract

On décrit une méthode de caractérisation du comportement électrophysiologique cardiaque permettant d'identifier les sujets susceptibles de subir une mort subite due aux arhytmies, notamment celle qui est liée à la myocardiopathie obstructive (HCM). Des ventriculogrammes sont analysés sous stimulation électrique, et les valeurs de latence des transitions des ventriculogrammes sont utilisées pour tracer des courbes de conduction. Certains paramètres des courbes, par exemple le point de départ d'une augmentation prédéterminée de la latence et l'augmentation de la largeur du ventriculogramme pendant un laps de temps donné au cours de la séquence de stimulation électrique, sont utilisés pour identifier et/ou représenter des caractéristiques physiologiquement importantes d'un dysfonctionnement du myocarde.
PCT/GB1993/001484 1992-07-23 1993-07-14 Caracterisation de la conduction intraventriculaire WO1994002201A1 (fr)

Priority Applications (2)

Application Number Priority Date Filing Date Title
EP93916077A EP0650381A1 (fr) 1992-07-23 1993-07-14 Caracterisation de la conduction intraventriculaire
JP6504256A JPH08501952A (ja) 1992-07-23 1993-07-14 心室内伝導の特性決定

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
GB929215680A GB9215680D0 (en) 1992-07-23 1992-07-23 Characterisation of intraventricular conduction
GB9215680.1 1992-07-23

Publications (1)

Publication Number Publication Date
WO1994002201A1 true WO1994002201A1 (fr) 1994-02-03

Family

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Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/GB1993/001484 WO1994002201A1 (fr) 1992-07-23 1993-07-14 Caracterisation de la conduction intraventriculaire

Country Status (4)

Country Link
EP (1) EP0650381A1 (fr)
JP (1) JPH08501952A (fr)
GB (1) GB9215680D0 (fr)
WO (1) WO1994002201A1 (fr)

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0653224A2 (fr) * 1993-10-22 1995-05-17 Telectronics N.V. Méthode de classification des rythmes cardiaques d'après la forme des électrogrammes
GB2439562A (en) * 2006-06-29 2008-01-02 Medilec Ltd Analysing electrograms
EP1911492A1 (fr) 2006-10-09 2008-04-16 Pacesetter, Inc. Système et procédés correspondants pour la surveillance d'une maladie cardiaque à l'aide de mesures de latence de régulation

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0310216A2 (fr) * 1987-09-30 1989-04-05 Chinese Pla General Hospital Appareil de détection de caractéristiques cardiaques au moyen d'une stimulation électrique
SU1595525A1 (ru) * 1988-04-15 1990-09-30 Каунасский Медицинский Институт Способ определени активности антиаритмиков

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0310216A2 (fr) * 1987-09-30 1989-04-05 Chinese Pla General Hospital Appareil de détection de caractéristiques cardiaques au moyen d'une stimulation électrique
SU1595525A1 (ru) * 1988-04-15 1990-09-30 Каунасский Медицинский Институт Способ определени активности антиаритмиков

Non-Patent Citations (4)

* Cited by examiner, † Cited by third party
Title
A.R.S. BUKHARI ET AL.: "Cardiac arrival time analyzer", IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, vol. 29, no. 5, May 1982 (1982-05-01), NEW YORK US, pages 359 - 361 *
DATABASE WPI Week 9134, Derwent World Patents Index; AN 91-250484 *
J. M. T. DE BAKKER ET AL.: "Endocardial Mapping by Simultaneous Recording of Endocardial Electrograms during Cardiac Surgery for Ventricular Aneurism", JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, vol. 2, no. 5, November 1983 (1983-11-01), US, pages 947 - 953 *
S.L. CATANIA ET AL.: "AV Delay Latency Compensation", JOURNAL OF ELECTROPHYSIOLOGY, vol. 1, no. 3, 1987, pages 242 - 249 *

Cited By (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0653224A2 (fr) * 1993-10-22 1995-05-17 Telectronics N.V. Méthode de classification des rythmes cardiaques d'après la forme des électrogrammes
EP0653224A3 (fr) * 1993-10-22 1996-12-27 Telectronics Nv Méthode de classification des rythmes cardiaques d'après la forme des électrogrammes.
GB2439562A (en) * 2006-06-29 2008-01-02 Medilec Ltd Analysing electrograms
WO2008000821A2 (fr) * 2006-06-29 2008-01-03 Medilec Limited Système d'analyse d'électrogrammes
WO2008000821A3 (fr) * 2006-06-29 2008-06-26 Medilec Ltd Système d'analyse d'électrogrammes
GB2439562B (en) * 2006-06-29 2011-05-04 Medilec Ltd System for analysis of electrograms
US7945315B2 (en) 2006-06-29 2011-05-17 Medilec Limited System for analysis of electrograms
EP1911492A1 (fr) 2006-10-09 2008-04-16 Pacesetter, Inc. Système et procédés correspondants pour la surveillance d'une maladie cardiaque à l'aide de mesures de latence de régulation

Also Published As

Publication number Publication date
EP0650381A1 (fr) 1995-05-03
GB9215680D0 (en) 1992-09-09
JPH08501952A (ja) 1996-03-05

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