WO1995019201A1 - Procede d'electrotherapie cardiaque avec mesure de la sequence de contraction cardiaque - Google Patents

Procede d'electrotherapie cardiaque avec mesure de la sequence de contraction cardiaque Download PDF

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Publication number
WO1995019201A1
WO1995019201A1 PCT/EP1995/000113 EP9500113W WO9519201A1 WO 1995019201 A1 WO1995019201 A1 WO 1995019201A1 EP 9500113 W EP9500113 W EP 9500113W WO 9519201 A1 WO9519201 A1 WO 9519201A1
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WO
WIPO (PCT)
Prior art keywords
cardiac
contraction
leads
heart
electronic circuitry
Prior art date
Application number
PCT/EP1995/000113
Other languages
English (en)
Inventor
Bozidar Ferec-Petric
Original Assignee
Pacesetter Ab
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 Pacesetter Ab filed Critical Pacesetter Ab
Publication of WO1995019201A1 publication Critical patent/WO1995019201A1/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
    • 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

Definitions

  • This invention relates to cardiac pacemakers and implantable cardioverters - defibrillators, in general, and to a cardiac electrotherapy device in particular.
  • a device which has been disclosed in the U.S. Pat.No. 4,790,317 can automatically recognize the pathologic rhythm by means of monitoring of the pulse sequence represent ⁇ ing the ventricular electrical activity.
  • the disclosed device measures the timing sequence of electrical depolarization of the heart. Different ventricular rhythms can be identified by a specific different ventricular depolarization wave spread. Detection of either epicardial or endocardial potential on at least two different points of ventricular muscle provides a specific timing sequence of ventricular depolarization for every kind of ventricular rhythm. Therefore at least two sensing positions on the ventricles are used, but more sensing points will obtain better discrimination between normal and pathologic rhythms as well as between various pathologic rhythms. If the multiple points ventricular sensing is combined with atrial potential sensing, the specific timing sequence may be obtained in order to detect and discriminate various supraventricular arrhythmias.
  • U.S. patent No. 5,261,418, U.S. patent No. 5,271,392 and EP 0 473 070 A2 discloses a device for lead tension measurement comprising so-called tensiometric transducers. These transducers may be produced of either the piezoelectric material or the conductive rubber. Both materials may be used for production of tensiometric stylets. In these patent applica ⁇ tions, there is a possibility to use a standard pacing lead for tensiometric measurement. Normally, the stylet channel of a lead enables the control of the lead implantation by means of a steel wire (stylet) insertion. Manipulating the stylet i.e. rotating, pushing and pulling governs the direction of the lead tip.
  • Every implanted lead comprises an empty stylet channel which may be used for the permanent insertion of a stylet which may be used for lead tension measurement.
  • European Pat.No. 461 539 as well as U.S. Pat.No. 4,291,707 specify a tensiometric patch.
  • U.S. Pat. No. 5,109,842 discloses a motion sensor which may be mounted onto the restricted and relatively small area of a defibrillator patch. None of these systems disclose the use of at least two sensors.
  • the device is incorporated within an implantable electrotherapy apparatus in order to achieve the measuring of the mechanical contractions of the heart muscle. Therefore, the mechanical activity of the heart is used for the purpose of the present invention, instead of the electrical activity as described in the prior art.
  • At least two of the elastic tensiometric strips are mechanically coupled to the heart muscle on the two different positions. Either analysis of the electric signals or measurement of the resistivity variations produced within the multiple tensiometric strips and caused by means of the cardiac muscle contractions, provides monitoring of the mechanical activity of the heart in such a way as to obtain the timing sequence of mechanical contraction of the heart.
  • the disclosed device yields a detection of the mechanical contraction sequence of the heart which is characteristic for a certain type of cardiac rhythm, thus enabling exact detection of the pathologic cardiac rhythm as well as differentiation of various cardiac arrhythmias.
  • the device can monitor the ration of amplitudes of at least two tensiometric transducer signals for the purpose of detection of the pathologic cardiac rhythm as well as differentia- tion of various cardiac arrhythmias.
  • Fig. 1 is a cross-sectional four-chamber view of a human heart having implanted the atrial and the ventricular pacing lead as well as the left ventricular patch.
  • Fig. 2 discloses the input circuits for the cardiac contraction sequence measurement.
  • Fig. 3 shows the electrocardiogram and the corresponding output waveforms of circuits from previous Fig..
  • Fig. 1 there is disclosed a four-chamber cross-section of the human heart having implanted the atrial 150 as well as the ventricular 151 cardiac pacing lead. Both leads enter the right atrium 152 through the superior vena cava 153.
  • the atrial lead is a J-shaped lead comprising an electrode 154 on its tip which is positioned in the right atrial appendage.
  • the ventricular lead has an electrode 155 on its tip which is positioned in the right ventricle 156 in the apical position.
  • Epicardial cardioversion patch 157 is implanted on the left ventricular free wall 158. Though unipolar leads are disclosed, bipolar leads would be also implanted in the same anatomic relation to the heart chambers.
  • the atrial contraction causes the bending of the atrial lead while the ventricular contraction causes the bending of the ventricular lead as well as of the patch.
  • Magnitude of the lead deflection depends on the radial lead stiffness and on the heart muscle contraction forces.
  • Magnitude of the patch deflection depends on the patch stiffness and on the heart muscle contraction forces.
  • the bending segment 159 of the lead 150 implanted in the right atrial appendage is shaded gray, as well as it is the bending segment 160 of the ventricular lead 151.
  • the patch 157 is fixed with its entire body to the left ventricular wall 158, the entire patch is bended by the left ventricular wall contraction.
  • the ventricular lead bending forces are mainly caused by the right ventricular contraction. Therefore the timing sequence between the ventricular lead 151 bending and epicardial patch 157 bending corresponds to the timing sequence between the right ventricular and left ventricular contraction. In normal sinus rhythm or in rhythm of ventricular pacing, there will be always some delay of patch 157 bended relatively to the ventricular lead 151 bending.
  • this delay may be changed or even inverted in the manner that patch 157 is bending first and then lead 151 after certain delay. If leads and patch are tensiometric, such as disclosed in U.S. Patent No. 5,261,418, the signals of tensiometric transducers will provide the timing sequence of cardiac mechanical contraction.
  • FIG. 2 there is disclosed a block diagram of the input circuit for cardiac contraction sequence measurement by means of tensiometric leads and tensiometric patch implanted as disclosed in previous Fig. 1.
  • the tensiometric transducers of the atrial lead 170, ventricular lead 171 and ventricular patch 172 are connected to the correspond ⁇ ing amplifiers 173, 174 and 175, respectively.
  • the outputs of the amplifiers 173, 174 and 175 are connected to the voltage comparators 176, 177 and 178, respectively.
  • the outputs of the comparators 176, 177 and 178 are connected to the inputs of retriggerable mono- stable multivibrators 179, 180 and 181, respectively.
  • the output 182 of multivibrator 179 provides a pulse representing the moment of atrial lead tension, i.e. right atrial appendage contraction.
  • the output 183 of multivibrator 180 provides a pulse representing the moment of ventricular lead tension, i.e. right ventricular contraction.
  • the output 184 of multivibrator 181 provides a pulse representing the moment of ventricular patch tension, i.e. left ventricular contraction.
  • Reference voltage for comparators is generated by means of a precise programmable voltage level source 185.
  • Waveform A shows the electrocardiogram having P-wave 190, QRS complex 191 and T-wave 192.
  • Waveform B are the pulses provided at the output 182, designating the occurence 193 of the artrial appendage contraction.
  • Waveform C are the pulses provided at the output 183, designat ⁇ ing the occurrence 194 of the right ventricular contraction.
  • Waveform D are the pulses provided at the output 184, designating the occurrence 195 of the left ventricular contrac ⁇ tion at the site of patch implantation.
  • Pulse 193 occurs after certain delay succeeding the P-wave 190 which is a normal delay of the cardiac muscle contraction after the cardiac muscle depolarization. Because of the same reason, pulses 194 and 195 occur after certain delay succeeding the QRS complex 191. There is a slight delay interval 196 of pulse 195 after the pulse 194 which is the delay of left ventricular patch tension after d e ventricular lead tension. Delay interval 196 usually increases if ventricular tachycardia occurs, but may be also vice versa. Different delay interval durations distinguish different ventricular tachycardias. In certain ventricular tachycardias pulse 195 may occur before the pulse 194. There are two tensiometric atrio-ventricular intervals 197 and 198.
  • every cardiac rhythm either natural of pathologic may be defined by means of three tensiometric intervals 196, 197 and 198. This means that every cardiac rhythm has a distinctive sequence of pulses 193, 194 and 195. Measurement of this sequence is used for tachycardia detection and differentiation between various types of tachycardias.
  • outputs 182, 183 and 184 are connected to the microprocessor of an electrotherapy device.
  • Specific pulses sequence for specific tachycardia is memorized within the microprocessor memory during intentionally provoked episode of tachycardia in electrophysiologic study session. Detection of the specific pulses sequence, within the certain allowed margins of timing accuracy, may initiate a certain antiarrhythmic mode of electrotherapy.
  • Fig. 2 can also illustrate completely another possible embodiment of the present invention.
  • the outputs of amplifiers 173, 174, and 175 could be also connected to sample-and-hold circuits 176, 177 and 178, as well as to the analog to digital convenors 179, 180 and 181.
  • the outputs 182, 183 and 184 would be connected to the digital input ports (not disclosed) in order to supply a micropro ⁇ cessor circuit (not disclosed) with digital form of tensiometric transducers' signals.
  • the voltages produced by transducers 170, 171 and 172 could be measured and compared by means of the appropriate software.
  • Some tachycardias decrease the magnitude of the contraction at the certain region of the cardiac muscle. Some tachycardias change the ratio of magnitudes of contractions of the two different regions.
  • the output voltage amplitude of the piezoelectric transducer is proportional to the magnitude of the cardiac contraction being measured by the transducer. Accordingly, mutual rations of voltage amplitudes generated by the transducers 170, 171 and 172 represent the mutual rations of magnitudes of the tensions of leads 150 and 151 as well as of patch 157. For instance, the ration of voltages generated by the transducers 171 and 172 represents the certain ventricular rhythm. It will be significantly different in ventricu- lar tachycardia, compared with the sinus rhythm.
  • the electrotherapy device having both disclosed measurement systems i.e. contraction sequence and regional contraction magnitude ratio variation would have a powerful means for cardiac arrhythmias recognition and classification.

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  • Health & Medical Sciences (AREA)
  • Cardiology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Biophysics (AREA)
  • Physiology (AREA)
  • Engineering & Computer Science (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (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)
  • Measurement And Recording Of Electrical Phenomena And Electrical Characteristics Of The Living Body (AREA)

Abstract

Un dispositif d'électrothérapie cardiaque comprend au moins deux électrodes (151, 157) d'électrothérapie cardiaque comportant une partie capteur (160, 157) conçue pour détecter les contractions cardiaques dans deux régions différentes (156, 158) du coeur à travers le fléchissement desdites électrodes (151, 157), un circuit électronique (173-181, 185) relié aux électrodes ou susceptible de leur être relié et conçu pour générer des signaux de données (B, C, D) de contractions cardiaques correspondant à une détection par les parties capteurs, ainsi que des moyens de détection de l'arythmie cardiaque fonctionnant en réponse aux signaux de données des contractions cardiaques et aptes à détecter à partir de ceux-ci l'arythmie cardiaque.
PCT/EP1995/000113 1994-01-12 1995-01-12 Procede d'electrotherapie cardiaque avec mesure de la sequence de contraction cardiaque WO1995019201A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
HRP940023 HRP940023A2 (en) 1994-01-12 1994-01-12 Apparatus for cardial electrotherapy with a system for measuring a sequence of cardial contractions
HRP940023A 1994-01-12

Publications (1)

Publication Number Publication Date
WO1995019201A1 true WO1995019201A1 (fr) 1995-07-20

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Cited By (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2000002612A2 (fr) 1998-07-10 2000-01-20 Medtronic, Inc. Dispositif a usage medical pour revascularisation transmyocardique et methode afferente
EP2189182A1 (fr) * 2008-11-19 2010-05-26 Ela Medical Dispositif médical actif implantable comprenant des moyens de test de capture auriculaire
WO2011008748A3 (fr) * 2009-07-15 2011-11-17 Cardiac Pacemakers, Inc. Télédétection du rythme cardiaque dans un dispositif médical implantable
US8285373B2 (en) 2009-07-15 2012-10-09 Cardiac Pacemakers, Inc. Remote sensing in an implantable medical device
US8588906B2 (en) 2009-07-15 2013-11-19 Cardiac Pacemakers, Inc. Physiological vibration detection in an implanted medical device

Citations (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
FR2166812A5 (fr) * 1971-11-26 1973-08-17 Medtronic Inc
US4291707A (en) * 1979-04-30 1981-09-29 Mieczyslaw Mirowski Implantable cardiac defibrillating electrode
WO1987001947A1 (fr) * 1985-10-07 1987-04-09 Thomas Jefferson University Stimulateur myocardiaque sensible a la contractivite et procede
EP0264666A1 (fr) * 1986-09-30 1988-04-27 Pacesetter AB Détecteur d'activité pour un stimulateur cardiaque
US4790317A (en) * 1985-10-25 1988-12-13 Davies David W Apparatus for recognition and termination of ventricular tachycardia and ventricular fibrillation
EP0461539A2 (fr) * 1990-06-13 1991-12-18 Pacesetter AB Ensemble d'électrodes pour défibrillateur
EP0473070A2 (fr) * 1990-08-24 1992-03-04 Bozidar Ferek-Petric Systèmes de stimulation cardiaque avec mesure de la force de contraction du coeur
EP0474957A2 (fr) * 1990-09-11 1992-03-18 Bozidar Ferek-Petric Appareil synchronisé par effet Doppler à ultrasons pour électrothérapie cardiaque
US5109842A (en) * 1990-09-24 1992-05-05 Siemens Pacesetter, Inc. Implantable tachyarrhythmia control system having a patch electrode with an integrated cardiac activity system
US5271392A (en) * 1990-08-24 1993-12-21 Siemens-Elema Ab Method and apparatus for administering cardiac electrotherapy dependent on mechanical and electrical cardiac activity

Patent Citations (11)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
FR2166812A5 (fr) * 1971-11-26 1973-08-17 Medtronic Inc
US4291707A (en) * 1979-04-30 1981-09-29 Mieczyslaw Mirowski Implantable cardiac defibrillating electrode
WO1987001947A1 (fr) * 1985-10-07 1987-04-09 Thomas Jefferson University Stimulateur myocardiaque sensible a la contractivite et procede
US4790317A (en) * 1985-10-25 1988-12-13 Davies David W Apparatus for recognition and termination of ventricular tachycardia and ventricular fibrillation
EP0264666A1 (fr) * 1986-09-30 1988-04-27 Pacesetter AB Détecteur d'activité pour un stimulateur cardiaque
EP0461539A2 (fr) * 1990-06-13 1991-12-18 Pacesetter AB Ensemble d'électrodes pour défibrillateur
EP0473070A2 (fr) * 1990-08-24 1992-03-04 Bozidar Ferek-Petric Systèmes de stimulation cardiaque avec mesure de la force de contraction du coeur
US5261418A (en) * 1990-08-24 1993-11-16 Siemens Aktiengesellschaft Cardiac lead with tensiometric element for providing signals corresponding to heart contractions
US5271392A (en) * 1990-08-24 1993-12-21 Siemens-Elema Ab Method and apparatus for administering cardiac electrotherapy dependent on mechanical and electrical cardiac activity
EP0474957A2 (fr) * 1990-09-11 1992-03-18 Bozidar Ferek-Petric Appareil synchronisé par effet Doppler à ultrasons pour électrothérapie cardiaque
US5109842A (en) * 1990-09-24 1992-05-05 Siemens Pacesetter, Inc. Implantable tachyarrhythmia control system having a patch electrode with an integrated cardiac activity system

Cited By (17)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP1020202A2 (fr) 1998-07-10 2000-07-19 Medtronic, Inc. Dispositif à usage médical pour revascularisation transmyocardique
EP1029511A1 (fr) 1998-07-10 2000-08-23 Medtronic, Inc. Appareil médical pour la revascularistion transmyocardique
WO2000002612A2 (fr) 1998-07-10 2000-01-20 Medtronic, Inc. Dispositif a usage medical pour revascularisation transmyocardique et methode afferente
US8214036B2 (en) 2008-11-19 2012-07-03 Sorin Crm S.A.S. Atrial capture test for an active implantable medical device
EP2189182A1 (fr) * 2008-11-19 2010-05-26 Ela Medical Dispositif médical actif implantable comprenant des moyens de test de capture auriculaire
US8515534B2 (en) 2009-07-15 2013-08-20 Cardiac Pacemakers, Inc. Remote pace detection in an implantable medical device
US8285373B2 (en) 2009-07-15 2012-10-09 Cardiac Pacemakers, Inc. Remote sensing in an implantable medical device
US8301241B2 (en) 2009-07-15 2012-10-30 Cardiac Pacemakers, Inc. Remote pace detection in an implantable medical device
WO2011008748A3 (fr) * 2009-07-15 2011-11-17 Cardiac Pacemakers, Inc. Télédétection du rythme cardiaque dans un dispositif médical implantable
US8588906B2 (en) 2009-07-15 2013-11-19 Cardiac Pacemakers, Inc. Physiological vibration detection in an implanted medical device
US8626281B2 (en) 2009-07-15 2014-01-07 Cardiac Pacemakers, Inc. Remote sensing in an implantable medical device
US8700146B2 (en) 2009-07-15 2014-04-15 Cardiac Pacemakers, Inc. Remote pace detection in an implantable medical device
US8862226B2 (en) 2009-07-15 2014-10-14 Cardiac Pacemakers, Inc. Remote sensing in an implantable medical device
US8934970B2 (en) 2009-07-15 2015-01-13 Cardiac Pacemakers, Inc. Physiological vibration detection in an implanted medical device
US8942799B2 (en) 2009-07-15 2015-01-27 Cardiac Pacemakers, Inc. Remote pace detection in an implantable medical device
US9381358B2 (en) 2009-07-15 2016-07-05 Cardiac Pacemakers, Inc. Remote detection of physiological parameter using an implantable medical device
US9867987B2 (en) 2009-07-15 2018-01-16 Cardiac Pacemakers, Inc. Remote detection of physiological parameter using an implantable medical device

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