WO2005018739A1 - 心臓治療装置及び心臓治療方法 - Google Patents
心臓治療装置及び心臓治療方法 Download PDFInfo
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- WO2005018739A1 WO2005018739A1 PCT/JP2004/012248 JP2004012248W WO2005018739A1 WO 2005018739 A1 WO2005018739 A1 WO 2005018739A1 JP 2004012248 W JP2004012248 W JP 2004012248W WO 2005018739 A1 WO2005018739 A1 WO 2005018739A1
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- heart
- interval
- heart rate
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- atrial
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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
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/3605—Implantable neurostimulators for stimulating central or peripheral nerve system
- A61N1/3606—Implantable neurostimulators for stimulating central or peripheral nerve system adapted for a particular treatment
- A61N1/36114—Cardiac control, e.g. by vagal stimulation
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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
- A61N1/32—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
- A61N1/3622—Heart stimulators for treating or preventing abnormally high heart rate comprising two or more electrodes co-operating with different heart regions
Definitions
- the present invention relates to a cardiac treatment apparatus for preventing the occurrence of tachycardia by electrical stimulation of the vagus nerve, and more particularly to a cardiac therapy capable of controlling electrical stimulation of the vagus nerve in response to detection of a sign of tachycardia occurrence.
- the present invention relates to an apparatus and a method for treating a heart. Background art
- the vagus nerve (fat pad) is used when the spontaneous rate of the heart exceeds a predetermined threshold.
- a device for stimulating see, for example, Japanese Patent Application Laid-Open No. 7-5404596 (lower column on page 3)).
- This fat pad is associated with the sinoatrial node or atrioventricular node, and the fat pad associated with the sinoatrial node is located at the curved entrance of the right pulmonary vein and, in most people, It is located along the atrioventricular groove.
- the fat pad associated with the atrioventricular node is located at the bent junction of the inferior vena cava and the lower left atrium, and most people are located along the dorsal atrioventricular groove.
- the device described in Japanese Unexamined Patent Application Publication No. 7-5044596 (lower right column on page 3) is particularly useful for patients with recurrent atrial fibrillation or atrial flutter.
- a combined pacemaker / fat pad stimulator intended to be implanted in patients who are unable to perform satisfactorily, senses rapid ventricular onset and triggers an absolute or relative cardiac prognosis
- a stimulating pulse that stimulates the fat pad associated with the atrioventricular node is generated.
- the stimulation of this atrioventricular node to the fat pad is a heart block Induces increased heart rate, reduces the rate of atrial depolarization transmitted to the ventricles, and slows the ventricular rate. For this reason, the device described in Patent Document 1 has a function of a pacemaker that slows down the heart rate of the heart due to fat pad stimulation.
- ventricular premature contractions Prior to the onset of lethal arrhythmias, it is known that ventricular premature contractions, abnormal ventricular repolarization processes, changes in electrocardiogram ST potential, etc. occur. It is considered an important parameter as a predictor. Premature ventricular contraction is a ventricular contraction that occurs sooner than expected, which is expected as a normal rhythm.This triggers the excitatory circuit formed in the myocardium. Circulates to produce ventricular tachycardia ⁇ ventricular fibrillation. For repolarization abnormalities, early post-depolarization that occurs when the repolarization of the action potential of the myocardium is impaired, and delayed depolarization that causes the depolarization of the membrane potential immediately after the end of repolarization, are known. Depolarization is considered to be a mechanism of ventricular tachycardia / ventricular fibrillation by causing new excitation when its amplitude increases and reaches a threshold value.
- ST changes are manifested by myocardial ischemia-myocardial infarction, and the myocardial oxygen deficiency associated with myocardial ischemia-myocardial infarction promotes electrical instability and facilitates the occurrence of fatal arrhythmias.
- Electrical instability is strongly influenced by functional factors such as the autonomic nervous system and heart rate.
- the accompanying increase in myocardial oxygen consumption and increase in sympathetic tone further increase the electrical instability inherent in patients with organic heart disease such as myocardial infarction and cardiomyopathy, and premature contractions and abnormal repolarization In such a state, lethal arrhythmias can be easily induced by ST changes. Disclosure of the invention
- the heart rate is reduced by controlling vagal nerve stimulation so that the heart rate falls within a predetermined allowable range in response to detection of a sign of lethal arrhythmia.
- the purpose is to suppress the induction of arrhythmias.
- a heart treatment apparatus of the present invention includes a nerve stimulating unit that generates a nerve stimulating signal for stimulating a vagus nerve; a tachycardia sign detecting unit that detects a sign of tachycardia occurrence; Heart activity measuring means for measuring the activity of the heart, means for defining the allowable range of the heart activity, control means connected to these nerve stimulating means, tachycardia sign detecting means, and heart activity measuring means.
- the nerve stimulating means is controlled such that the output of the cardiac activity measuring means is maintained within an allowable range.
- the heart treatment method of the present invention includes the steps of: generating a neural stimulation signal for stimulating the vagus nerve; detecting a sign of tachycardia occurrence; measuring heart activity; In response to the step of defining an allowable range of activity and the detection of the sign of tachycardia occurrence, the neural stimulation is controlled so that the measured output of cardiac activity is maintained within the allowable range.
- Detection of a sign of tachycardia occurrence is performed based on an electrocardiogram, and the sign is characterized by any of extrasystole, ST change, and abnormal repolarization.
- control of the neural stimulation performed in response to the tachycardia sign detection is performed for a predetermined period adjusted based on the tachycardia sign detection output.
- control of the neural stimulation performed in response to the tachycardia sign detection is performed until the number of times of the heart activity adjusted based on the output of the tachycardia sign detection reaches a predetermined number. It is characterized by what is done.
- a nerve stimulation signal is generated.
- Neve stimulation means is generated based on a difference between the heart activity measurement output and the above-mentioned allowable range of the heart activity. It is characterized in that the parameters of the neural stimulation signal are adjusted.
- the parameters of the nerve stimulation signal include at least one of a pulse period, a pulse width, a pulse number, a pulse current, a zero pulse voltage, a delay time, a rest time, and a repetition number. Are multiple combinations selected from these.
- the heart activity is a heartbeat
- the heartbeat measurement by the heart activity measurement is a heartbeat interval or heart rate measurement.
- An acceptable range is defined as a heart rate interval range that is longer than a predetermined lower limit heart rate interval or a heart rate range that is lower than a predetermined upper limit heart rate. It is characterized in that the lower limit heart rate interval or upper limit heart rate is adjusted based on the output of tachycardia sign detection.
- Adjustment of the lower limit interval or the upper limit heart rate is longer or more correct than the normal heart rate interval by a predetermined amount. It is smaller than the normal heart rate, and the predetermined amount can be a fixed value, but it can also be a predetermined percentage of the normal heart rate or the heart rate. .
- an allowable range of heart activity is set in response to detection of a sign of occurrence of tachycardia, and the heart activity is maintained in this allowable range.
- the ability to stimulate nerves optimizes ventricular electrical instability after prediction and reduces the occurrence of fatal arrhythmias in patients with organic heart disease such as myocardial infarction and cardiomyopathy .
- FIG. 1 is a block diagram showing a first embodiment of the heart treatment apparatus of the present invention.
- FIG. 2 is a diagram showing the arrangement of ventricular and atrial electrode leads used in the cardiac treatment apparatus of the present invention and respective stimulation electrodes on the heart.
- FIG. 3 is a part of a flowchart for explaining the operation of the first embodiment of the heart treatment apparatus of the present invention.
- FIG. 4 is a part of a flowchart for explaining the operation of the first embodiment of the heart treatment apparatus of the present invention.
- FIG. 5 is a part of a flowchart for explaining the operation of the first embodiment of the heart treatment apparatus of the present invention.
- FIG. 6 is a part of a flowchart for explaining the operation of the first embodiment of the heart treatment apparatus of the present invention.
- FIG. 7 is a block diagram showing a second embodiment of the heart treatment apparatus of the present invention.
- FIG. 8 is a part of a flowchart for explaining the operation of the second embodiment of the heart treatment apparatus of the present invention.
- FIG. 9 is a part of a flowchart for explaining the operation of the second embodiment of the heart treatment apparatus of the present invention.
- FIG. 10 is a part of a flowchart for explaining the operation of the second embodiment of the heart treatment apparatus of the present invention.
- FIG. 11 is a part of a flowchart for explaining the operation of the second embodiment of the heart treatment apparatus of the present invention.
- FIG. 12 is a block diagram showing a third embodiment of the heart treatment apparatus of the present invention.
- FIG. 13 is a block diagram showing an example of the configuration of the lower atrial interval calculating means in the third embodiment of the heart treatment apparatus of the present invention.
- FIG. 14 is a block diagram of the heart treatment apparatus of the present invention.
- FIG. 15 is a block diagram illustrating another configuration example of the lower atrial interval calculating unit in the third embodiment.
- FIG. 15 illustrates an operation of the third embodiment of the heart treatment apparatus of the present invention. Is a part of a flowchart for the operation.
- FIG. 16 is a part of a flowchart for explaining the operation of the third embodiment of the heart treatment apparatus of the present invention.
- FIG. 17 is a part of a flowchart for explaining the operation of the third embodiment of the heart treatment apparatus of the present invention.
- FIG. 18 is a part of a flowchart for explaining the operation of the third embodiment of the heart treatment apparatus of the present invention.
- FIG. 19 is a waveform diagram showing nerve stimulation signal parameters. BEST MODE FOR CARRYING OUT THE INVENTION
- the heart treatment device 1 of the present invention includes a ventricle stimulating unit 2 for generating a ventricular stimulation pulse for stimulating a right ventricle 29 of a heart 28, a ventricular contraction detecting unit 3 for detecting a contraction of the right ventricle 29, and a heart 2.
- Atrial stimulating unit 4 that generates atrial stimulation pulse that stimulates right atrium 32
- Atrial contraction detecting unit 5 that detects contraction of right atrium 32
- neural stimulation signal that stimulates vagus nerve 3 5
- Electrocardiogram information from the nerve stimulating unit 6 and ventricular contraction detection or ventricular detection electrode 27, or atrial stimulation and atrial contraction detection hereinafter referred to as “atrial event”.
- ventricular stimulation and ventricular contraction detection are referred to as “ventricular Event).
- the ventricular tachycardia sign detection unit 7 that detects a sign of ventricular tachycardia such as ventricular premature contraction, and a sign of ventricular extrasystole is detected Output of ventricular tachycardia sign detection unit 7 or atrial event
- the threshold value of the atrial stimulation interval timer 8 is switched by the output of the atrial stimulation interval timer 8 which starts timekeeping upon detection of the event, and the output of the ventricular tachycardia sign detection unit 7 when a sign of ventricular premature contraction is also detected.
- An interval threshold selection unit 9 a V—A interval storage unit 10 for storing a time period from the detection of the ventricular premature contraction to the atrial stimulation selected when the ventricular premature contraction is detected; A_A interval storage unit 11 that stores the time from the detection of an atrial event to the next atrial stimulation, which is selected when no extra-systolic contraction is detected, and the time measurement and time of the atrial stimulation interval timer 8
- the comparison section 12 compares the V-A interval or the A_A interval selected by the interval threshold selection section 9 with the ventricular tachycardia sign detection.
- Nerve stimulation according to the sign detected by the section 7 The nerve stimulation treatment time table storage unit 13 for selecting the treatment time and the nerve treatment time output selected in the nerve stimulation treatment time table storage unit 13 are loaded and the nerve stimulation operates as a down counter.
- Atrioventricular delay timer 18 that starts timekeeping with output and stops timekeeping with output of ventricular contraction detection unit 3, and atrioventricular delay time set value storage unit 1 that stores reference atrioventricular delay time 9 and a comparison unit 20 that issues an output when the time counted by the atrioventricular delay timer 18 exceeds the set value stored in the atrioventricular delay time set value storage unit 19.
- control unit 15 is supplied with a predictive signal from the ventricular tachycardia predictive sign detection unit 7 and selects a lower limit atrial interval for stimulating the vagus nerve 35 according to the predictive signal. It is activated by the output of the storage unit 21 and the nerve stimulation treatment time timer 14, and is selected by the atrial interval measured by the atrial interval measuring unit 17 and the lower limit atrial interval table storage unit 21.
- a comparison unit 22 that compares the lower limit atrial interval, a difference calculator 23 that calculates a difference between the measured atrial interval and the selected lower limit atrial interval, a comparison unit 22 and an atrial contraction detector
- the neural stimulation controller 24 which receives the output of 5 and outputs it to the neural stimulating unit 6 at the timing of atrial contraction detection, and the neural stimulation signal according to the calculated difference from the difference calculating unit 23 From the nerve stimulation signal control unit 2 5 for selecting a neural stimulation parameters for adjusting the degree of irritation, that is configured.
- the ventricular stimulating unit 2 and the ventricular contraction detecting unit 3 are connected to the ventricular stimulation Z detecting electrode 27 by the common ventricular electrode lead 26. .
- the atrial stimulation unit 4 and the atrial contraction detection unit 5 are also connected to the atrial stimulation Z detection electrode 31 via the common atrial electrode lead 30.
- the ventricular stimulation detection electrode 27 and the atrial stimulation / detection electrode 31 are connected to the right ventricle 2 of the heart 28 respectively. 9 and right atrium 32 are placed.
- Electrodes for the heart include a myocardial electrode that is implanted in the heart muscle, the so-called myocardium, and a catheter electrode that inserts the electrode through the vena cava to the heart.
- a catheter electrode is used.
- Both the ventricular electrode lead 26 and the atrial electrode lead 30 are initially guided from the vena cava to the right atrium 32 of the heart 28.
- the atrial electrode lead 30 inserted into the right atrium 32 from the vena cava is inserted so that the tip bent in a J shape is hooked into the bag-shaped right atrial appendage protruding from the right atrial wall.
- the atrial stimulation detection electrode 31 is arranged so as to contact the inner wall of the right atrial appendage.
- a ventricular electrode lead 26, also inserted into the right atrium 32 from the vena cava passes through the atrioventricular valve to the right ventricle.
- the ventricular stimulation / detection electrode 27 provided at the tip of the ventricle electrode lead 26 is arranged so as to contact the lowermost part of the right ventricle 29.
- the nerve stimulating section 6 is connected to the nerve stimulating electrode 34 via the nerve electrode lead 33, and
- the nerve stimulation electrode 34 is wound around the vagus nerve 35 and fixed.
- the region around which the nerve stimulation electrode 34 is wound is preferably the neck region or the right central position of the lateral carotid artery.
- the nerve stimulation electrode 34 can also be arranged so as to stimulate the vagus nerve 35 adjacent to the blood vessel wall by placing a catheter electrode in the blood vessel. In this case, the placement region is preferably in the subclavian vein.
- the ventricular tachycardia sign detection unit 7 is supplied with various data necessary for judging the content of the sign from the ventricle detection electrode 27, including electrocardiogram information.
- a ventricular contraction detection signal from the ventricle contraction detection unit 3 and atrial event information are supplied from the OR circuit 16.
- the signs detected by the ventricular tachycardia sign detection unit 7 include various signs related to the degree of tachycardia abnormality.
- a typical sign of ventricle is ventricular extrasystole (PVC), which is excited earlier than scheduled from ventricular sites that differ from normal rhythm.
- Premature contraction can be detected by using a ventricular contraction detection signal and atrial event information without an atrial event prior to detecting ventricular contraction.
- ECG waveforms of extrasystole are accompanied by large and wide QRS waves, and can be detected from ECG information.
- Table 1 (Example of control of treatment time for stimulating stimulus T1 ⁇ T2 ⁇ T3 ⁇ T4) Relationship between ventricular tachycardia sign, neurostimulation treatment time, and lower atrial interval Table 1 classifies signs according to the risk of tachycardia occurrence. It is associated with the sign number ⁇ , and the larger the sign number, the higher the risk of tachycardia occurrence.
- the sign No. is assigned to the case where there is no sign
- the sign No. 1 is the case where extraordinary contraction occurs only once
- the sign No. 2 is the case where the contraction occurs twice in succession (two consecutive PVCs: Couplet).
- PVC PVC
- ST changes Elevation
- the type of the sign to be detected, the number of the sign number, and the association between the sign and the sign number are set by the doctor based on the patient's condition, medical history, or the results of electrophysiological tests. .
- extrasystole may trigger ventricular tachycardia or ventricular fibrillation. This is because the risk increases as the number of fires increases.
- the vicinity of the top of the ⁇ wave on the electrocardiogram is called the vulnerable period, and if an extrasystolic wave overlaps during this period, it is easy to shift to ventricular fibrillation, so the R on T type sign is a risk of lethal arrhythmia Is particularly high.
- the risk is high if there is a short interval between the R wave of premature contraction and the immediately preceding R wave (conjunction period), or if there is instability such that the connection period changes with each onset.
- the shape of the electrocardiogram changes each time an extrasystole occurs. Therefore, it is also possible to add these factors to the detection of signs.
- ST depression increases the likelihood of lethal arrhythmias if it changes rapidly.
- amplitude of repolarization abnormalities such as early post-depolarization that occurs when the repolarization of the action potential of the heart muscle is impaired, and delayed depolarization that occurs when the membrane potential depolarizes immediately after repolarization is completed, has a large amplitude. It is thought to be a mechanism of ventricular tachycardia and ventricular fibrillation by causing new excitement when it increases and reaches a threshold.
- the ventricular tachycardia sign detection unit 7 detects a sign of ventricular tachycardia, the ventricular tachycardia sign detection unit 7 sends a signal corresponding to the sign number N to the nerve stimulation treatment time table storage unit 13 and the nerve stimulation treatment time. It is supplied to the timer 14 and the lower limit atrial interval table storage unit 21 of the control unit 15.
- the nerve stimulation treatment time table storage unit 13 selects a nerve stimulation treatment time corresponding to the sign number ⁇ from the nerve stimulation treatment times T1 to T4 shown in Table 1, and this time Is loaded into the neural stimulation treatment time timer 14.
- the nerve stimulation treatment time timer 14 outputs an output to the comparison unit 22 according to the load of the selected time, and activates the comparison unit 22. Then, the nerve stimulation treatment time timer 14 operates as a down counter, and when the count content becomes “0”, the comparison unit 22 is set to the inactive state. Therefore, the comparison section 22 is activated during the nerve stimulation treatment time corresponding to the selected sign number 2.
- the value of the neurostimulation treatment time ⁇ 1 to ⁇ 4 is set by the doctor based on the patient's condition or medical history, or the results of electrophysiological tests, etc., but usually the sign number ⁇ ⁇ is large.
- the length is set to be longer as the risk increases, that is, as the risk of tachycardia occurrence increases.
- the lower limit atrial interval table storage unit 21 receives a sign detection signal from the ventricular tachycardia sign detection unit 7, the lower limit atrial interval according to the sign number ⁇ is selected, and the lower limit atrial interval is compared with the comparison unit 22. It is supplied to the difference calculator 23.
- the selected lower atrial interval defines the lower limit of the allowable atrial interval range.
- the output of the atrial interval measuring unit 17 is supplied to the comparing unit 22.
- the comparing unit 22 When the comparing unit 22 is activated, the atrial interval measured by the atrial interval measuring unit 17 is supplied.
- Lower limit atrial interval When the measured heart rate is lower than the lower limit atrial interval selected in the table storage unit 2 1, that is, when the measured heart rate is higher than the upper limit heart rate, in other words, the comparison unit 2 2 outputs an output to the nerve stimulation controller 24.
- the comparison section 22 is inactive, no output is output to the nerve stimulation control section 24.
- the output of the atrial contraction detection unit 5 is also supplied to the nerve stimulation control unit 24, and the nerve stimulation control unit 24 outputs an output to the nerve stimulation unit 6 at the timing of the atrial contraction detection, and outputs the nerve stimulation electrode.
- the vagus nerve 3 5 is stimulated by 3 4. Since the stimulation of the vagus nerve 35 suppresses the heart activity and prolongs the atrial interval, when the measured atrial interval becomes smaller than the lower limit atrial interval, the stimulation of the vagus nerve 35 causes The atrial interval is controlled to be within the allowable range of the lower atrial interval.
- the lower-limit atrial interval is set to a constant value AAI 1 irrespective of the sign number N, but as shown in Table 2, the nerve selected in the nerve stimulation treatment time table storage unit 13
- the stimulation treatment time can be set to a fixed value (T 1), and the lower limit atrial interval AAI 1 to AAI 4 can be selected according to the sign number N.
- Table 2
- Lower limit atrial interval control example ⁇ 1 ⁇ 2 ⁇ 3 ⁇ 4 Relationship between ventricular tachycardia sign, nerve stimulation treatment time, and lower limit atrial interval Similarly, it is set by a physician based on the patient's condition, medical history, or results of electrophysiological tests.
- the lower atrial interval is usually set to be longer as the predictor number ⁇ ⁇ becomes larger, that is, as the risk of tachycardia rises.
- the difference calculator 23 calculates a difference between the atrial interval measured by the atrial interval measuring unit 17 and the lower limit atrial interval selected by the lower limit atrial interval table storage unit 21. Then, the calculated difference is supplied to the nerve stimulation signal control unit 25, and the nerve stimulation signal parameter corresponding to the difference is selected from the nerve stimulation parameters stored in the nerve stimulation signal control unit 25 here. It is selected and supplied to the nerve stimulating unit 6. The degree of stimulation of the vagus nerve 35 by the nerve stimulation unit 6 is adjusted by the nerve stimulation signal parameter.
- the lower limit atrial interval selected by the lower limit atrial interval table storage unit 21 and the atrial interval The comparison unit 22 and the difference calculation unit 23 compare the atrial interval measured by the single-valve measurement unit 17 with the nerve calculation signal parameter, and select the nerve stimulation signal parameter to control the stimulation of the vagus nerve 35. These atrial intervals are temporarily converted to a heart rate to calculate a heart rate difference, and the heart rate difference is used to calculate the heart rate difference and the nerve stimulation signal parameter stored in the nerve stimulation signal control unit 25 in advance. From the relationship, it is also possible to adjust the parameters of the nerve stimulation signal generated by the nerve stimulation unit 6.
- Nono 0 pulse period between the nerve stimulation pulse is a neural stimulation signal parameter, Nono 0 pulse period between the nerve stimulation pulse, pulse width, number of pulses, Nono 0 Luz current, pulse pressure, Delay time, rest time, considered like repeat count
- the control of the nerve stimulation signal parameters one of these parameters can be selected and adjusted, but the combination of two or more selected from these parameters is adjusted and controlled. This is also possible.
- Fig. 19 shows a waveform diagram showing the relationship between these nerve stimulation signal parameters and the electrocardiogram.
- the detection signal is supplied to the atrial stimulation interval timer 8 and the interval threshold value selection unit 9.
- the atrial stimulation interval timer 8 is reset by detecting an extrasystole and starts timing.
- the interval threshold selection unit 9 selects the VA interval storage unit 10 when receiving the detection signal of the extrasystole from the ventricular tachycardia sign detection unit 7. If no extra systole is detected, the A—A interval storage unit 11 is selected.
- the A-A interval is a value obtained by adding the set value stored in the atrioventricular delay time set value storage unit 19 to the V-A interval.
- the comparison unit 12 When the time measured by the atrial stimulation interval timer 8 reaches the VA interval selected by the interval threshold selection unit 9, the comparison unit 12 generates an output to the atrial stimulation unit 4 and outputs the output to the atrial stimulation unit 4. By the atria The right atrium 3 2 is stimulated via the stimulation electrode 31. At this time, the interval threshold selection unit 9 switches to the selection of the A-A interval storage unit 11.
- the V—A interval is smaller than the A—A interval by the atrioventricular delay time set value
- the ventricular event interval after the detection of extrasystole is V—A interval + atrioventricular delay time set value. Thus, it is equal to the atrial event interval specified in the A—A interval.
- the output of the OR circuit 16 to which the output of the atrial contraction detection unit 5 and the output of the comparison unit 12 are added is supplied to the atrioventricular delay timer 18 to start it.
- the atrioventricular delay timer 18 stops the timing when the output of the ventricular contraction detection unit 3 is received, but the time measured during that time is stored in the atrioventricular delay time set value storage unit 19.
- an output is issued from the comparing section 20 and sent to the ventricular stimulating section 2.
- the ventricular stimulating unit 2 stimulates the right ventricle 29 of the heart 28 via the ventricular electrode lead 26 and the ventricular stimulating electrode 27.
- the ventricular tachycardia sign detection unit 7 can hold the maximum value M N of the sign number N.
- MN is the maximum sign number at which the value of the sign number N is stored upon detection of the sign, and the content is reset when the nerve stimulation treatment associated with the sign is completed. If a new sign is detected before the content of the MN is reset, that is, while the nerve stimulation treatment is continued, the newly detected sign number is compared with the currently stored sign number. Is done. If the new sign number is greater than or equal to the currently stored sign number, the content of the MN is updated to the new sign number, and the new sign number is associated with the new sign number. The nerve stimulation treatment is started. Meanwhile, a new
- the ventricular tachycardia sign detection unit 7 resets the maximum value M N of the sign number N to “0” (step S 1).
- the timer value of the nerve stimulation treatment time timer 14 is set to “0” (step S 2), and the interval threshold value selection unit 9 sets the threshold value of the atrial stimulation interval timer 8 to Then, the A_A interval stored in the A—A interval storage unit 11 is selected (step S3). Then, the atrial stimulation interval timer 8 is reset (step S4).
- step S5 it is determined whether or not the atrial stimulation interval timer 8 has timed out. If the atrial stimulation interval timer 8 has timed out, the comparing unit 12 outputs an output and the atrial stimulation unit 4 performs atrial stimulation (step S 6), but the atrial stimulation interval timer 8 If not, the ventricular tachycardia sign detecting unit 7 determines whether or not the premature contraction has been detected (step S7).
- step S7 If the extra systole is detected in the determination step S7, the process proceeds to (A) in FIG. 4. If the extra systole is not detected, then the atrial contraction detector 5 determines whether the atrial contraction is detected. Is determined (step S8). When the atrial contraction is detected, the process proceeds to (B) of FIG. 5. When the atrial contraction is not detected, the process returns to the determination step S5 to determine whether or not the atrial stimulation interval timer 8 has timed out. In step S6, after the atrial stimulation is performed, the A--A interval stored in the A--A interval storage unit 11 is again selected as the threshold of the atrial stimulation interval timer 8. (Step S 9), and reset the atrial stimulation interval timer 8 (Step S 9). S10). Further, the timing of the atrioventricular delay timer 18 is started (step S11).
- step S12 it is determined whether or not the ventricle contraction is detected by the ventricle contraction detecting section 3 (step S12).
- the timing of the atrioventricular delay timer 18 is stopped (step S13).
- the ventricular contraction is not detected, whether or not the atrioventricular delay timer 18 has timed out, that is, Then, it is determined whether or not the atrioventricular delay timer 18 has timed beyond the set value stored in the atrioventricular delay time set value storage section 19 (step S14). If the atrioventricular delay timer 18 has not timed out, the routine returns to the decision step S12, and waits for detection of ventricular contraction.
- the comparing section 20 When the atrioventricular delay timer 18 times out, the comparing section 20 outputs an output to the ventricular stimulating section 2, and the right ventricle 29 of the heart 28 is stimulated by the ventricular stimulating electrode 27 (step S). 1 5). Then, returning to the determination step S5, it is determined whether or not the atrial stimulation interval timer 8 has timed out.
- the process proceeds to (A) in FIG. 4, and the ventricular tachycardia sign detection unit 7 acquires the sign number N corresponding to the sign (step S16).
- N 1 is set as shown in Table 1, and this is registered in the ventricular tachycardia sign detection unit 7 as a sign number.
- step S17 the acquired sign number N is compared with the maximum sign number MN (step S17).
- the maximum sign number MN is set to "0".
- MN may not be smaller than N (equal to or larger than N).
- N is not smaller than MN in the judgment step S17, that is, if MNN, the value of MN is replaced with the value of N (step S18).
- the lower limit atrial interval stored in the lower limit atrial interval table storage unit 21 is selected based on the detected predictor number N (step S 19), and further based on the predictor number N.
- the nerve stimulation treatment time stored in the nerve stimulation treatment time table storage unit 13 is selected (step S20).
- the selected nerve stimulation treatment time is loaded into the nerve stimulation treatment time timer 14 (step S21), and the nerve stimulation treatment time timer 14 starts measuring time (step S22).
- This timing continues for the loaded neural stimulation treatment time and stops after the loaded treatment time has elapsed.
- the nerve stimulation treatment time timer 14 activates the comparison unit 22, that is, puts it into the operating state.
- the interval threshold value selecting unit 9 Selects the VA interval stored in the VA interval storage unit 10 as the threshold value of the atrial stimulation interval timer 8 (step S23). At the same time, the atrial stimulation interval timer 8 is reset, and timekeeping is started (step S24). Then, return to (D) in FIG.
- step S25 When atrial contraction is detected in the judgment step S8 of FIG. 3, it is next judged whether or not the nerve stimulation treatment time timer 14 has become "0" (step S25).
- the nerve stimulation treatment time timer 14 is "0"
- Sign Number M N is set to "0" (step S26), and the process returns to (E) in the flowchart of FIG.
- the nerve stimulation treatment time timer 14 is not "0" in the determination step S25, that is, when the nerve stimulation treatment is in the activated state, the time is detected by the atrial interval measuring unit 17 The interpal of the atrial event is measured (step S27).
- Step S 2 8) Their to, whether the atrial Lee or measured value of Ntabaru is smaller Ri by lower atrial Lee Ntapa le that is selected in the lower atrium Lee Ntaba one interval table storage unit 2 1 is determined (Step S 2 8) .
- step S28 when the measured value of the atrial interval measuring unit 17 is larger than or equal to the lower limit atrial interval, the vagus nerve 35 is not stimulated, and as shown in FIG. Return.
- the difference calculator 23 calculates the difference between the measured value and the lower limit atrial interval (step S29). ). Then, the calculated difference is added to the nerve stimulation signal control unit 25, and a nerve stimulation signal parameter is selected, and the degree of nerve stimulation is adjusted (step S30).
- the nerve stimulation signal parameter is sent from the nerve stimulation signal control unit 25 to the nerve stimulation unit 6, and nerve stimulation according to the parameter is performed (step S31). After the nerve stimulation is performed, the process returns to (E) in FIG.
- step S13 in FIG. 3 the operation flow after step S13 in FIG. 3 will be described based on the flow diagram in FIG.
- the process proceeds to (C) of FIG. It is determined whether a sign is detected by the pulse sign detection unit 7 (step S32). Since the detection of extrasystole is performed in the judgment step S7 of FIG. 3, the judgment here is a sign other than extrasystole such as abnormal repolarization or ST change. Is detected.
- a sign number N corresponding to the sign is obtained (step S33), and it is determined whether or not the sign number N is smaller than the maximum sign number MN. (Step S34). If the sign number N is greater than or equal to the maximum sign number M N, the acquired sign number N is set as the maximum sign number M N (step S35). Then, based on the sign number N, the corresponding lower limit atrial interval is selected from the lower limit atrial interval table storage unit 21 (step S36), and the neural stimulation treatment time table storage unit 1 is selected. In step 3, the corresponding nerve stimulation treatment time is selected (step S37).
- the neural stimulation treatment time selected in the nerve stimulation treatment time table storage unit 13 is loaded into the nerve stimulation treatment time timer 14 (step S38), and the nerve stimulation treatment time timer 14 is started. (Step S39).
- FIG. 7 components different from those of the first embodiment of FIG. 1 are different from FIG. 1 in that the nerve stimulation treatment time table storage unit 13 and the nerve stimulation treatment time timer 14 of FIG.
- the atrial event count table storage unit 36 and the atrial event counter 37 of FIG. 7 are provided.
- a sign number N corresponding to the sign is stored in the atrial event frequency table storage unit 36 and the atrial event card. Supplied to counter 37.
- the atrial event frequency table storage unit 36 as shown in Table 3, the atrial event frequency corresponding to the sign number N is selected from the atrial event frequency AEN1 to AEN4. Then, this atrial event count is loaded to the atrial event counter 37.
- the values of AEN 1 to AEN 4 are also set by the physician based on the patient's condition, medical history, or results of electrophysiological tests, as in the case of the nerve stimulation treatment time and the lower limit atrial interval.
- Atrial event frequency control AEN1 ⁇ AEN2 ⁇ AEN3 ⁇ AEN4 Relationship between ventricular tachycardia sign, atrial event frequency, and lower atrial interval
- the atrial event counter 37 is supplied to the comparison unit 22 of the control unit 15 and activates the comparison unit 22 until the number of loaded atrial events becomes “0”. Stimulation is possible. Then, the atrial event counter 37 acts as a down counter and OR The output of circuit 16, the number of atrial events loaded each time an atrial event is delivered, is decremented. As a result, when an atrial event is detected from the OR circuit 16 by the number of loaded atrial events, the output from the atrial event counter 37 to the comparing section 22 is turned off, and the comparing section 22 is disabled. It is activated.
- the ventricular tachycardia sign detection unit 7 resets the maximum value M N of the sign number N to “0” (step S50).
- the count value AEN of the atrial event counter 37 is reset to "0" (step S51), and the interval threshold selection unit 9 causes the atrial stimulation interval 9 to be set.
- the A—A interval stored in the A—A interval storage section 11 is selected as the threshold of the timer 8 (step S52). Then, the atrial stimulation interval timer 8 is reset (step S53).
- step S54 it is determined whether or not the atrial stimulation interval timer 8 is timed out.
- the comparing unit 12 outputs an output and the atrial stimulation unit 4 performs atrial stimulation (step S55), but the atrial stimulation is performed. If the interval timer 8 is not in time, then it is determined whether or not the ventricular tachycardia sign detection unit 7 has detected an extrasystole (step S56).
- step S56 If the extrasystole is detected in the determination step S56, the process proceeds to (A) in FIG. 9; if the extrasystole is not detected, the atrial contraction detector 5 subsequently detects the atrial contraction. Is determined (step S57). If an atrial contraction is detected, If atrial contraction is not detected, the flow returns to decision step S54 to determine whether or not the atrial stimulation interval timer 8 has timed out.
- step S58 After the atrial stimulation has been performed in step S55, it is determined whether or not the count value AEN of the atrial event counter 37 is "0" (step S58). Regarding this AEN, "0" was introduced in step S51, but it is determined again whether or not (D) in Fig. 9 and Fig. 11 was fed back before the decision step S54. It is.
- step S60 the A_A interval stored in the A—A interval storage unit 11 is selected again as the threshold value of the atrial stimulation interval timer 8, and the atrial stimulation interval timer 8 is selected again. Is reset (step S61). Further, the timing of the atrioventricular delay timer 18 is started (step S62).
- step S63 it is determined whether or not the ventricle contraction is detected by the ventricle contraction detection unit 3 (step S63).
- the timing of the atrioventricular delay timer 18 is stopped (step S64), and when the ventricular contraction is not detected, whether the atrioventricular delay timer 18 has timed out, Then, it is determined whether or not the atrioventricular delay timer 18 has timed beyond the set value stored in the atrioventricular delay time set value storage section 19 (step S65). If the atrioventricular delay timer 18 has not timed out, the flow returns to the decision step S63 to wait for the detection of ventricular contraction.
- the comparing section 20 When the atrioventricular delay timer 18 times out, the comparing section 20 outputs an output to the ventricular stimulating section 2, and the heart 2 is output by the ventricular stimulating electrode 27. Eight right ventricles 29 are stimulated (step S66). Subsequently, returning to the judgment step S54, it is judged whether or not the atrial stimulation interval timer 8 has timed out.
- Step S56 the process proceeds to (A) of FIG. 9, and the ventricular tachycardia sign detection unit 7 acquires the sign number N corresponding to the sign (step S5).
- step S68 the acquired sign number N is compared with the maximum sign number MN (step S68).
- the maximum sign number MN is set to "0".
- (D) of FIG. 9 and FIG. May be supplied, so MN may not be smaller than N.
- the value of MN is replaced with the value of N (step S69).
- the lower limit atrial interval stored in the lower limit atrial interval table storage unit 21 is selected based on the detected predictor number N (step S70), and further based on the predictor number N.
- the number of atrial events stored in the atrial event frequency table storage unit 36 is selected (step S71). Then, the selected number of atrial events is loaded to the atrial event counter 37 (step S72).
- the one-valve threshold selection unit 9 sets the threshold of the atrial stimulation interval timer 8 as The V—A interval stored in the V_A interval storage unit 10 is selected (step S73). At the same time, the atrial stimulation interval timer 8 is reset, and the timekeeping is started (step S74). After that, the process returns to (D) in FIG.
- step S57 of FIG. 8 the operation when atrial contraction is detected in the judgment step S57 of FIG. 8 (from (B) in FIG. 8) will be described based on the flow chart of FIG.
- the atrial event counter 37 When the AEN loaded to the atrial event counter 37 in the determination step S75 is not "0", that is, when the nerve stimulation treatment is in the activated state, the atrial event counter 37 is used. Each time an atrial event is detected, "1" is decremented from the stored number of atrial events (step S77). Then, the interval of the atrial event detected by the atrial interval measuring unit 17 is measured (step S78).
- step S79 it is determined whether the measured value of the atrial interval is smaller than the lower limit atrial interval selected in the lower limit atrial interval table storage unit 21 (step S79).
- the difference calculator 23 calculates the difference between the measured value and the lower limit atrial interval (Ste S80).
- the calculated difference is supplied to the nerve stimulation signal controller 25.
- the nerve stimulation signal parameters are selected and the degree of nerve stimulation is adjusted (step S81).
- the nerve stimulation signal parameters are sent from the nerve stimulation signal control unit 25 to the nerve stimulation unit 6, and nerve stimulation according to the parameters is performed (step S82). After the nerve stimulation is performed, the process returns to (E) in FIG.
- step S64 in FIG. 8 the operation flow after step S64 in FIG. 8 will be described based on the flowchart in FIG.
- the process proceeds to (C) of FIG. It is determined whether or not a sign has been detected by the sign detection unit 7 (step S83). Since the detection of extra systole is performed in decision step S56 in FIG. 8, the judgment here is based on whether a sign other than extra systole such as abnormal repolarization or ST change is detected. is there.
- a sign number N corresponding to the sign is obtained (step S84), and it is determined whether or not this sign number N is smaller than the maximum sign number MN. (Step S85). If the sign number N is greater than or equal to the maximum sign number M N, the acquired sign number N is set as the maximum sign number M N (step S86). Then, based on the sign number N, the corresponding lower limit atrial interval is selected from the lower limit atrial interval table storage unit 21 (step S87), and the atrial event frequency table storage unit 3 is selected. In step 6, the corresponding number of atrial events is selected (step S88).
- the atrial event count selected in the atrial event count table storage unit 36 is loaded into the atrial event counter 37 (step S89), and is loaded into this atrial event counter 37.
- the neural stimulation treatment by the control unit 15 is activated.
- step S83 No sign other than premature contraction was detected in decision step S83 At this time, when it is determined in the decision step S85 that the sign number N is smaller than the maximum sign number MN, and in step S89, the number of atrial events is reported to the atrial event counter 37. After that, in any case, the process returns to (D) in FIG. 8, and it is determined whether or not the atrial stimulation interval timer 8 has timed out.
- FIG. 7 The same components as those of the first embodiment shown in FIG. 1 and the second embodiment shown in FIG. 7 are denoted by the same reference numerals.
- the components different from those of the second embodiment shown in FIG. 7 are the lower limit atrial interval calculator 38 instead of the lower limit atrial interval table storage 21 of FIG. 7. This is where we established.
- the lower limit of the atrial interval that defines the allowable range of the atrial interval is set to the lower limit of the atrial interval of the patient.
- a value set in advance and associated with the detected sign is selected as the threshold value of the nerve stimulation, but the lower limit atrial interval calculation unit 38 of the third embodiment calculates the threshold value.
- the atrial interval prior to the detection of the sign is held, and a predetermined amount of the interval value is added to the held atrial interval to set the lower atrial interval.
- the range is controlled according to the patient's situation.
- the lower-limit atrial interval calculating unit 38 includes an interval fixed value table storage unit 39 to which the sign number N is supplied from the ventricular tachycardia sign detecting unit 7, An atrial interval holding / processing unit 40 to which the measured value from the interval measuring unit 17 is supplied, and the interval fixed value table storage unit An addition unit 41 that adds the interval fixed value stored in 39 to the atrial interval that is the measurement value stored and held in the atrial interval holding processing unit 40, and an A-A interval storage unit It comprises a limiting section 42 that limits the output of the adding section 41 based on the output of 11.
- the interval fixed value table storage unit 39 stores a sign from a plurality of interval fixed values. Select an interval fixed value according to the number N.
- the atrial interval holding Z processing unit 40 receives the measured value of the atrial interval from the atrial interval measuring unit 17 and holds it. The held measured value and the interval fixed value table are stored.
- the interval fixed value selected in the storage unit 39 is added in the addition unit 41. And the restriction section
- the A—A interval from the A—A interval storage section 11 is compared with the lower-limit atrial interval calculated by the adder section 41, and the lower-limit atrial interval calculated is A—A. Limited to A interval or less and sent to comparator 22.
- the lower limit atrial interval calculator 38 shown in FIG. 14 is replaced with a ratio table memory 43 and an interval increment calculator 4 instead of the fixed interval table storage 39 shown in FIG. 4 are provided.
- the operation of the lower limit atrial interval calculator 38 in FIG. 14 will be described.
- a sign is detected by the ventricular tachycardia sign detection unit 7
- a sign number N corresponding to the sign is supplied to the ratio table storage unit 43.
- the ratio table storage unit 43 sets the ratio to be added to the detected atrial interval according to the sign number N, and calculates the interval increment.
- Part 4 Send to 4
- the atrial interval holding / processing unit 40 receives the measured value of the atrial interval from the atrial interval measuring unit 17 and holds it, and calculates the held measured value as an interval increment calculation. It is sent to output section 4 4 and addition section 4 1.
- the interval segment calculating unit 44 multiplies the ratio (percent) set in the ratio table storage unit 43 by the atrial interval stored in the atrial interval holding Z processing unit 40 and calculates the interval. Calculate the increment and send it to the adder 41.
- the adding unit 41 adds the atrial interval stored in the atrial interval holding processing unit 40 and the interval increment calculated by the interval increment calculating unit 44, and adds this to the limiting unit 42. Supply.
- the operation of the restriction unit 42 is the same as that in FIG.
- the ventricular tachycardia sign detection unit 7 resets the maximum value M N of the sign number N to “0” (step S 100).
- the count value AEN of the atrial event counter 37 is reset to "0" (step S101), and the atrial stimulation interval selection unit 9 sets the atrial stimulation interval.
- the A--A interval stored in the A--A interval storage unit 11 is selected as the threshold value of the timer 8 (step S102). Then, the atrial stimulation interval timer 8 is reset and started (step S103).
- step S104 it is determined whether or not the atrial stimulation interval timer 8 has timed out. Atrial stimulation interval When the timer 8 has timed out, the comparison unit 12 outputs an output and the atrial stimulation is performed by the atrial stimulation unit 4 (step S105). The atrial stimulation interval timer 8 times out. If not, then the ventricular tachycardia sign detection unit 7 determines whether or not an extrasystole has been detected (step S106).
- step S106 If the extrasystole is detected in the determination step S106, the process proceeds to (A) in FIG. 16, and if the extrasystole is not detected, the atrial contraction detection unit 5 subsequently detects the atrial contraction. It is determined whether or not the operation has been performed (step S107). If atrial contraction is detected, proceed to (B) in FIG. 17; if atrial contraction is not detected, return to decision step S104 to determine whether or not the atrial stimulation interval timer 8 has timed out. Is done.
- step S108 After the atrial stimulation is performed in step S105, it is determined whether or not the count value AEN of the atrial event counter 37 is "0" (step S108). Regarding this AEN, “0” was introduced in step S 101, but the decision made here is that (D) in FIGS. 16 and 18 precede decision step S 104. This is because feed knocking has been performed.
- step S111 the A-A interval stored in the A-A interval storage unit 11 as the threshold value of the atrial stimulation interval timer 8 is again selected, and the atrial stimulation interval timer is selected. 8 is reset (step S111).
- atrioventricular delay timer 1 The timing of 8 is started (step S113).
- step S114 it is determined whether or not the ventricle contraction is detected by the ventricle contraction detection unit 3 (step S114).
- the timing of the atrioventricular delay timer 18 is stopped (step S115), and if no ventricular contraction is detected, whether or not the atrioventricular delay timer 18 is timed out. That is, it is determined whether or not the atrioventricular delay timer 18 has counted the time exceeding the set value stored in the atrioventricular delay time set value storage section 19 (step S116). If the atrioventricular delay timer 18 has not timed out, the flow returns to the decision step S114 to wait for the detection of ventricular contraction.
- the comparing section 20 When the atrioventricular delay timer 18 times out, the comparing section 20 outputs an output to the ventricular stimulating section 2 and the right ventricle 29 of the heart 28 is stimulated by the ventricular stimulating electrode 27 (step). S 1 17). Then, returning to the judgment step S104, it is judged whether or not the atrial stimulation interval timer 8 has timed out.
- Step S118 the ventricular tachycardia sign detection unit 7 acquires the sign number N corresponding to the sign.
- N l is set as shown in Table 3, and this is registered in the ventricular tachycardia sign detection unit 7 as a sign number.
- step S119 the acquired sign number N is compared with the maximum sign number MN (step S119).
- the maximum sign number MN is set to “0”, but in the flow diagram of FIG. Since (D) in Fig. 16 and Fig. 18 is supplied to the former stage, MN may not be smaller than N.
- N is not smaller than MN in decision step S 1 19, That is, when MN ⁇ N, the value of MN is replaced with the value of N (step S120). Subsequently, the lower limit atrial interval calculating unit 38 determines a predetermined amount (the case in FIG. 13) or a predetermined amount for the atrial interval measured by the atrial interval measuring unit 7 based on the detected sign number N. The ratio (the case in Figure 14) is selected (Step S 1 2 1) 0
- the lower-limit atrial interval calculating unit 38 calculates the lower-limit atrial interval from the selected predetermined amount or predetermined ratio and the atrial interval held by the atrial interval holding / processing unit '40. Calculate (Step S122).
- the calculated lower limit atrial interval is compared with the A—A interval stored in the A_A interval storage unit 11 to compare the magnitude. (Step S 1 2 3). If the calculated lower atrial interval is larger than the A—A interval, the calculated lower atrial interval is replaced with the A_A interval (step S 1 2 4), and the calculated lower atrial interval is calculated. If the interval is equal to or smaller than the A-A interval, step S124 is skipped, and the calculated lower atrial interval is set as the lower limit atrial interval threshold supplied to the comparison unit 22 (step Step S 1 2 5).
- the number of atrial events stored in the atrial event frequency table storage unit 36 is selected based on the sign number N (step S122). Then, the selected number of atrial events is loaded to the atrial event counter 37 (step S127).
- the interval threshold selection unit 9 determines the threshold of the atrial stimulation interval timer 8 Then, the V—A interval stored in the V—A interval storage unit 10 is selected (step S128). At the same time, the atrial stimulation interval timer 8 is reset, and the timekeeping is started (step S129). After that, return to (D) in Fig. 15.
- the atrial interval measured by the interval measuring unit 17 is held in the atrial interval holding processing unit 40 (see FIG. 13 or FIG. 14) (step S 13 2), and the flow chart of FIG. Return to (E).
- the atrial event counter 37 in the determination step S130 is not "0"
- the atrial event counter is set.
- "1" is decremented from the stored number of atrial events (step S133).
- the interval of the atrial event detected by the atrial interval measuring unit 17 is measured (step S1334).
- step S135) it is determined whether or not the measured value of the atrial interval is smaller than the lower-limit atrial interval calculated by the lower-limit atrial interval calculator 38 (step S135).
- the measured value of the atrial interval measurement unit 17 is larger than or equal to the lower limit atrial interval, the vagus nerve 35 is not stimulated, and the process returns to (E) in FIG. .
- the measurement value of the atrial interval measurement unit 17 is calculated. If it is smaller than the lower limit atrial interval, the difference between the measured value and the lower limit atrial interval is calculated by the difference calculator 23 (step S136).
- the calculated difference is supplied to the nerve stimulation signal control unit 25 to select nerve stimulation signal parameters and adjust the degree of nerve stimulation (step S1337).
- the nerve stimulation signal parameters are sent from the nerve stimulation signal control unit 25 to the nerve stimulation unit 6, and nerve stimulation according to the parameters is performed (step S138). After the nerve stimulation is performed, the process returns to (E) in Fig. 15.
- step S115 in FIG. 15 the operation flow after step S115 in FIG. 15 will be described based on the flow diagram in FIG.
- the process proceeds to (C) of FIG. It is determined whether the tachycardia sign detection unit 7 has detected the sign (Step S139).
- the detection of extrasystole is performed in decision step S106 in FIG. 15, so it is judged here whether or not a sign other than extrasystole such as repolarization abnormality or ST change is detected. It is.
- a sign number N corresponding to the sign is obtained (step S140), and it is determined whether this sign number N is smaller than the maximum sign number MN. (Step S1 4 1). If the predictor number N is greater than or equal to the maximum predictor number MN, the acquired predictor number N is set as the maximum predictor number MN (step S144). Subsequently, the lower limit atrial interval calculating section 38 determines a predetermined amount for the atrial interval measured by the atrial interval measuring section 7 based on the detected sign number N (the case of FIG. 13). Alternatively, a predetermined ratio (the case in FIG. 14) is selected (step S144).
- the lower limit atrial interval calculator 38 calculates the lower limit atrial interval from the selected predetermined amount or predetermined ratio and the atrial interval held by the atrial interval holding Z processing unit 40. Is calculated (step SI44).
- the calculated lower-limit atrial interval is compared with the A-A interval stored in the A-A interval storage unit 11 in magnitude. (Step S 1 4 5). If the calculated lower atrial interval is larger than the A-A interval, the calculated lower atrial interval is replaced with the A-A interval (step S146), and the calculated lower atrial interval is calculated. If the interval is equal to or smaller than the A—A interval, step S146 is skipped, and the calculated lower atrial interval is set as the lower limit atrial interval threshold value supplied to the comparison unit 22 (step S1 4 7).
- the number of atrial events stored in the atrial event frequency table storage unit 36 is selected based on the predictor number N (step S148).
- the atrial event count is loaded into the atrial event counter 37 (step S1449), and the process returns to (D) in FIG.
- the heart treatment device of the present invention is not limited to the first to third embodiments, but It goes without saying that many other forms are included without departing from the gist of the present invention described in the claims.
- the cardiac treatment apparatus of this invention the sign of a fatal arrhythmia is detected, the allowable range of a heart rate is set according to the severity of the sign, and the heart rate falls within this allowable range by vagal nerve stimulation.
- the heart rate can be reduced and the heart rate variability can be suppressed, so that after the detection of a sign, the myocardial oxygen consumption is reduced due to the reduced heart rate, and the myocardial repolarization unevenness due to the suppressed heart rate variability. Correction, and even vagus nerve stings Suppression of intensely antagonistic sympathetic tone can be achieved, and induction of fatal arrhythmias is suppressed.
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EP04772204A EP1666090A4 (en) | 2003-08-26 | 2004-08-19 | HEART TREATMENT DEVICE AND METHOD FOR HEART TREATMENT |
US10/569,648 US7881788B2 (en) | 2003-08-26 | 2004-08-19 | Heart treatment apparatus and heart treatment method |
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JP2003208896A JP4439215B2 (ja) | 2003-08-26 | 2003-08-26 | 心臓治療装置 |
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Also Published As
Publication number | Publication date |
---|---|
US7881788B2 (en) | 2011-02-01 |
JP4439215B2 (ja) | 2010-03-24 |
EP1666090A4 (en) | 2010-05-12 |
US20070118178A1 (en) | 2007-05-24 |
EP1666090A1 (en) | 2006-06-07 |
JP2005065742A (ja) | 2005-03-17 |
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