WO2004058350A1 - Implantierbarer herzstimulator - Google Patents
Implantierbarer herzstimulator Download PDFInfo
- Publication number
- WO2004058350A1 WO2004058350A1 PCT/EP2003/014429 EP0314429W WO2004058350A1 WO 2004058350 A1 WO2004058350 A1 WO 2004058350A1 EP 0314429 W EP0314429 W EP 0314429W WO 2004058350 A1 WO2004058350 A1 WO 2004058350A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- ventricular
- rate
- stimulation
- control unit
- designed
- Prior art date
Links
- 230000000747 cardiac effect Effects 0.000 title claims abstract description 19
- 230000000638 stimulation Effects 0.000 claims abstract description 61
- 230000002861 ventricular Effects 0.000 claims abstract description 56
- 238000001514 detection method Methods 0.000 claims abstract description 17
- 230000001746 atrial effect Effects 0.000 claims description 21
- 210000002837 heart atrium Anatomy 0.000 claims description 15
- 206010047302 ventricular tachycardia Diseases 0.000 claims description 11
- 230000007704 transition Effects 0.000 claims description 7
- 230000001960 triggered effect Effects 0.000 claims description 4
- 210000001992 atrioventricular node Anatomy 0.000 claims description 2
- 230000008602 contraction Effects 0.000 claims description 2
- 208000001871 Tachycardia Diseases 0.000 description 9
- 230000006794 tachycardia Effects 0.000 description 9
- 238000012546 transfer Methods 0.000 description 3
- 230000006978 adaptation Effects 0.000 description 2
- QVGXLLKOCUKJST-UHFFFAOYSA-N atomic oxygen Chemical compound [O] QVGXLLKOCUKJST-UHFFFAOYSA-N 0.000 description 2
- 206010003668 atrial tachycardia Diseases 0.000 description 2
- 239000008280 blood Substances 0.000 description 2
- 210000004369 blood Anatomy 0.000 description 2
- 238000013194 cardioversion Methods 0.000 description 2
- 238000004891 communication Methods 0.000 description 2
- 238000005259 measurement Methods 0.000 description 2
- 229910052760 oxygen Inorganic materials 0.000 description 2
- 239000001301 oxygen Substances 0.000 description 2
- 230000004044 response Effects 0.000 description 2
- 238000002560 therapeutic procedure Methods 0.000 description 2
- 206010003658 Atrial Fibrillation Diseases 0.000 description 1
- 238000013459 approach Methods 0.000 description 1
- 230000005540 biological transmission Effects 0.000 description 1
- 230000015572 biosynthetic process Effects 0.000 description 1
- 230000001419 dependent effect Effects 0.000 description 1
- 230000002999 depolarising effect Effects 0.000 description 1
- 238000010586 diagram Methods 0.000 description 1
- 230000000694 effects Effects 0.000 description 1
- 238000011156 evaluation Methods 0.000 description 1
- 230000001575 pathological effect Effects 0.000 description 1
- 230000037081 physical activity Effects 0.000 description 1
- 230000000284 resting effect Effects 0.000 description 1
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
- A61N1/368—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions
Definitions
- the heart stimulator comprises a control unit, which is connected to the ventricular detection unit and to the ventricular stimulation unit and is designed to control the ventricular stimulation unit in VVI mode (ventricle-inhibited) in such a way that a ventricular stimulation pulse is given at a point in time predetermined by a stimulation rate is triggered if one is not inhibited by detecting a natural ventricular contraction by means of the ventricular detection unit within a predetermined time window.
- the specified time window is often referred to as the escape interval.
- ventricular tachycardia in the context of cardioversion therapy by stimulation with a stimulation rate that is above the tachycardia rate.
- a number of subraventricular and ventricular tachycardias can be broken through in this way.
- the aim is to interrupt reentry circles in particular by prematurely depolarizing an ectopic stimulus formation center by stimulation before a trinsic stimulus can take effect.
- the pacing rate for overdrive pacing is generally chosen to be ten to fifty pulses per minute higher than the tachycardia to be terminated.
- a response to atrial tachycardia is, for example, mode switching to VVI mode and, as a response to ventricular tachycardia, the triggering of an overdrive stimulation can be provided as cardioversion therapy.
- the aim of the present invention is to provide a cardiac stimulator with which the occurrence of ventricular tachycardias can be prevented as possible from the outset.
- the cardiac pacemaker according to the invention should therefore operate continuously in a type of overdrive mode, and not only in the presence of tachycardia.
- An overdrive rate is usually used to denote a rate which is above a reference rate, namely in known cardioverters above a tachycardia rate.
- the reference rate for the claimed permanent overdrive stimulation is not a pathological rate, but a natural intrinsic rate that corresponds, for example, to a healthy atrial heart rate or in a manner known per se from parameters or measurement values characterizing the physiological needs of a patient is derived.
- the control unit of the implantable pacemaker is designed in an embodiment variant to specify a fixed stimulation rate between 70 and 80 stimulation pulses or beats per minute, in particular a rate of approximately 80 per minute.
- a stimulation rate is approximately ten to twenty beats per minute above a patient's natural resting heart rate.
- control unit In order to achieve the fastest possible adaptation of the overstimulation rate, it is preferably provided to increase the overstimulation rate when only a single conduction or a single conduction stimulus is detected by the control unit.
- the control unit is designed such that it automatically increases the overstimulation rate as soon as a transfer or a transferred stimulus is detected.
- the control unit preferably increases the overstimulation rate only for a certain period of time and then lowers it again. In this way it is avoided that an excessively high overstimulation rate is permanently set. On the other hand, the number of possible transitions is effectively reduced.
- the control unit is designed to increase the stimulation rate as soon as 10 to 20 percent conduction or 10 to 20 percent conduction stimuli are detected in relation to a total number of ventricular events in the past period. In other words, the control unit sets an increased stimulation rate as soon as the total number of recorded ventricular events in a retrospective period shows 10% to 20% of events that are based on conduction.
- control unit is preferably designed to increase the variable stimulation rate if the number of episodes of ventricular tachycardia exceeds a predetermined limit value.
- this predetermined limit value is Variant 5 percent episode ventricular tachycardia based on the total number of ventricular events in a retrospective observation period.
Landscapes
- Health & Medical Sciences (AREA)
- Cardiology (AREA)
- Heart & Thoracic Surgery (AREA)
- Life Sciences & Earth Sciences (AREA)
- Biophysics (AREA)
- Physiology (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (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)
- Electrotherapy Devices (AREA)
Abstract
Description
Claims
Priority Applications (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
AU2003294887A AU2003294887A1 (en) | 2002-12-20 | 2003-12-17 | Implantable cardiac stimulator |
EP03785861.0A EP1578491B1 (de) | 2002-12-20 | 2003-12-17 | Implantierbarer herzstimulator |
US10/540,308 US20060149320A1 (en) | 2002-12-20 | 2003-12-17 | Implantable cardiac stimulator |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
DE10261821.6 | 2002-12-20 | ||
DE10261821A DE10261821A1 (de) | 2002-12-20 | 2002-12-20 | Implantierbarer Herzstimulator |
Publications (1)
Publication Number | Publication Date |
---|---|
WO2004058350A1 true WO2004058350A1 (de) | 2004-07-15 |
Family
ID=32404405
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/EP2003/014429 WO2004058350A1 (de) | 2002-12-20 | 2003-12-17 | Implantierbarer herzstimulator |
Country Status (5)
Country | Link |
---|---|
US (1) | US20060149320A1 (de) |
EP (1) | EP1578491B1 (de) |
AU (1) | AU2003294887A1 (de) |
DE (1) | DE10261821A1 (de) |
WO (1) | WO2004058350A1 (de) |
Citations (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5626621A (en) * | 1995-11-07 | 1997-05-06 | Medtronic, Inc. | Dual chamber, multi-mode external pacemaker |
US5713929A (en) * | 1996-05-03 | 1998-02-03 | Medtronic, Inc. | Arrhythmia and fibrillation prevention pacemaker using ratchet up and decay modes of operation |
US6185459B1 (en) * | 1998-08-17 | 2001-02-06 | Medtronic, Inc. | Method and apparatus for prevention of atrial tachyarrhythmias |
US6238422B1 (en) * | 1999-02-25 | 2001-05-29 | Medtronic, Inc. | Pacemaker system with therapy for minimizing risk of morning myocardial infarctions or arrhythmias |
Family Cites Families (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4577633A (en) * | 1984-03-28 | 1986-03-25 | Medtronic, Inc. | Rate scanning demand pacemaker and method for treatment of tachycardia |
US6058328A (en) * | 1996-08-06 | 2000-05-02 | Pacesetter, Inc. | Implantable stimulation device having means for operating in a preemptive pacing mode to prevent tachyarrhythmias and method thereof |
US6611713B2 (en) * | 1999-11-30 | 2003-08-26 | Patrick Schauerte | Implantable device for diagnosing and distinguishing supraventricular and ventricular tachycardias |
US6519493B1 (en) * | 1999-12-23 | 2003-02-11 | Pacesetter, Inc. | Methods and apparatus for overdrive pacing heart tissue using an implantable cardiac stimulation device |
-
2002
- 2002-12-20 DE DE10261821A patent/DE10261821A1/de not_active Withdrawn
-
2003
- 2003-12-17 WO PCT/EP2003/014429 patent/WO2004058350A1/de not_active Application Discontinuation
- 2003-12-17 US US10/540,308 patent/US20060149320A1/en not_active Abandoned
- 2003-12-17 EP EP03785861.0A patent/EP1578491B1/de not_active Expired - Lifetime
- 2003-12-17 AU AU2003294887A patent/AU2003294887A1/en not_active Abandoned
Patent Citations (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5626621A (en) * | 1995-11-07 | 1997-05-06 | Medtronic, Inc. | Dual chamber, multi-mode external pacemaker |
US5713929A (en) * | 1996-05-03 | 1998-02-03 | Medtronic, Inc. | Arrhythmia and fibrillation prevention pacemaker using ratchet up and decay modes of operation |
US6185459B1 (en) * | 1998-08-17 | 2001-02-06 | Medtronic, Inc. | Method and apparatus for prevention of atrial tachyarrhythmias |
US6238422B1 (en) * | 1999-02-25 | 2001-05-29 | Medtronic, Inc. | Pacemaker system with therapy for minimizing risk of morning myocardial infarctions or arrhythmias |
Also Published As
Publication number | Publication date |
---|---|
EP1578491A1 (de) | 2005-09-28 |
US20060149320A1 (en) | 2006-07-06 |
AU2003294887A1 (en) | 2004-07-22 |
DE10261821A1 (de) | 2004-07-01 |
EP1578491B1 (de) | 2016-05-18 |
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