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WO1997039798A1 - Dispositif de stimulation cardiaque implantable - Google Patents

Dispositif de stimulation cardiaque implantable Download PDF

Info

Publication number
WO1997039798A1
WO1997039798A1 PCT/EP1997/001989 EP9701989W WO9739798A1 WO 1997039798 A1 WO1997039798 A1 WO 1997039798A1 EP 9701989 W EP9701989 W EP 9701989W WO 9739798 A1 WO9739798 A1 WO 9739798A1
Authority
WO
WIPO (PCT)
Prior art keywords
frequency
cardiac
natural
extrasystole
stimulation device
Prior art date
Application number
PCT/EP1997/001989
Other languages
German (de)
English (en)
Inventor
Dietmar Wietholt
Original Assignee
Dietmar Wietholt
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 Dietmar Wietholt filed Critical Dietmar Wietholt
Priority to US09/171,280 priority Critical patent/US6134469A/en
Publication of WO1997039798A1 publication Critical patent/WO1997039798A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/3621—Heart stimulators for treating or preventing abnormally high heart rate
    • A61N1/3622—Heart stimulators for treating or preventing abnormally high heart rate comprising two or more electrodes co-operating with different heart regions

Definitions

  • Implantable cardiac stimulation device
  • the invention relates to an implantable cardioverter defibrillator and / or pacemaker for stimulating the heart muscle (cardiac stimulation device), with at least one electrode to be connected to the heart muscle, a programmable electrical circuit for generating stimulation pulse sequences with which the electrode can be acted upon, and with an electronic memory connected to the said circuit, with which the electrical processes inherent in the heartbeat, in particular the systoles and their natural frequency f, can be registered and stored over several periods of the heartbeat, the electrical circuit evaluating the stored electrical processes and corresponding sequences of delivers antitachycardial and antibradycardial stimulation pulses.
  • cardiac stimulation devices namely cardioverter-defibrillators and so-called cardiac pacemakers (Pacer), traditionally work with types of stimulation which are used after the occurrence of tachyarrhythmias and cardiac flutter.
  • Such cardiac stimulation devices in the form of cardioverter defibrillators and / or pacers with anti-tachycardial or anti-bradycardial stimulation modes are known, for example according to US Pat. No. 4,052,991 and US Pat. No. 3,857,399.
  • the stimulation devices according to the aforementioned state of the art emits stimulation impulses which start with the antitachycardial function after the occurrence of tachycardia with a time delay (delay) of approx. 1 s.
  • the stimulation pulse sequence is shorter than the period of the
  • Systoles in tachycardia This shortened pulse sequence is intended to "intercept" the extrasystoles 0 that start with tachycardia.
  • the "delay" time is followed by a continuous stimulation with a frequency f that is higher than the natural frequency f.
  • This frequency f is mainly kept constant. 5
  • the task is to specify a cardiac stimulation device that can prevent the occurrence of tachycardia in advance.
  • a cardiac stimulation device namely a cardioverter defibrillator or a cardiac pacemaker of the type mentioned at the outset, which is characterized in that the electrical circuit upon detection of one or the last of 5 several consecutive ones which do not comply with the natural frequency f Extrasystole (n) a sequence of stimulation pulses of the frequency f (t) can be generated, which after the occurrence of the extrasystole compared to the determined previous natural frequency f after a programmable time interval 0, which measures between 50 and 100% of an average time interval t between two natural frequency systoles, starts at a higher frequency f and then decreases continuously in frequency f until frequency f (t) falls below a natural frequency f to a frequency fsub 5 or ends at frequency f.
  • This type of generation of a sequence of stimulation pulses is carried out in a heart stimulation known per se.
  • Device as characterized in the preamble of claim 1.
  • the cardiac stimulation device generates a sequence of stimulation pulses with a higher frequency f than the frequency f (natural frequency), which is initially faster following an extra beat. A slowdown then takes place until the frequency f (t) corresponds to or falls below the natural frequency f.
  • Frequency f preferably ends when the
  • the stimulation device can therefore generate a further stimulation mode which intervenes after each extrasystole or after the last of a sequence of extrasystoles, which is followed by a longer "compensatory" pause without a delay beforehand for the first stimulation pulse of the order of 1 s, as in the prior art.
  • the time interval t between the occurred extrasystole and the first stimulation pulse be programmable with the frequency f, the time interval t between the occurred extrasystole and the first stimulation pulse preferably being between 60 and 90% of the mean time interval t between two natural-frequency systoles is.
  • the percentage can be programmed according to the premature nature of the extrasystole.
  • the frequency reduction can be carried out, for example, in such a way that the time interval of the stimulation pulses increases from pulse to pulse by at least 3%, preferably 6-18%.
  • An average time interval tm ⁇ an between two natural-frequency systoles for determining the frequency is considered to be a sliding one Average determined over several, for example 2-5 heartbeat periods.
  • the frequency determination starts at the last systole corresponding to the natural frequency.
  • the decrease in the initially higher frequency can be linear, for example according to the equation
  • the decrease in the initially higher frequency f can also be exponential, for example according to the equation
  • a further advantageous property of the cardiac stimulation device is if, when a further extrasystole is detected, the currently running stimulation sequence can be broken off and restarted after the extrasystole. This also ensures that normal heart systoles are not contrast-stimulated.
  • the cardiac stimulation device mentioned is further characterized in that it can be stimulated in the cardiac atrium or in the cardiac ventricle.
  • Fig. 1 shows an electrocardiogram of an untreated
  • FIG. 2 shows a stimulation sequence when extrasystoles occur for the prophylaxis of tachycardia.
  • Figure 1 shows a schematic representation with the time t as the X axis, the occurrence of systoles S 1, S2, S3, S ⁇ , SS at natural frequency, normal spacing. Shown in dashed lines is the time at which another own "normal"
  • Systole S is expected. In this case, however, an extrasystole ES occurs. The distance between S and ES is shorter than the normal distance between two systoles.
  • a further systole S occurs, which in turn is followed by an extrasystole ES, which has a shorter time interval from the systole than would be expected if a normal frequency (natural frequency) were maintained.
  • An expected normal systole S fails.
  • the so-called compensatory pause arises until another systole S occurs, which in many cases is followed by a so-called tachycardia (increase in heart rate to over 100 beats per minute).
  • tachycardia has an "unfavorable prognosis" (cf. PSCHYREMBEL, Clinical Dictionary, 255th edition, article "Tachycardia").
  • FIG. 2 shows the same initial situation.
  • the systoles with the normal frequency f S - S occur at the same time and normal intervals.
  • An extrasystole ES then occurs, namely at a shorter time interval than the frequency f.
  • Systole S (dashed) fails.
  • the cardiac stimulation device according to the invention in the cardiac atrium or cardiac ventricle after the extrasystole ES or the last extrasystole causes a sequence of extrasystoles shorter or equal time interval (50 - 100%) than the distance between the two normal systoles S 1, S2, ... S! triggered a stimulation pulse SI, followed by a second stimulation pulse SI and a third SI.
  • the intervals of the stimulation pulses are each drawn 10% larger than the previous one in FIG. In reality, the magnification is only about 3-5%. Stimulation pulses are emitted over such a long period of time until normal self-systole S occurs again.
  • the current stimulation pulse sequence is also terminated and restarted after the occurrence of the extrasystole or a sequence of extrasystoles.
  • tachycardia can obviously be prevented in many cases by the pulse sequences generated by the cardiac stimulation device.

Landscapes

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

Abstract

L'invention concerne un dispositif de stimulation cardiaque dont le circuit électrique permet de produire une séquence d'impulsions de stimulation (SI) de fréquence fs(t) lorsqu'une extrasystole, ou la dernière d'une série d'extrasystoles (ES), ne correspondant pas à la fréquence propre fe, est constatée. Après apparition de cette extrasystole, cette séquence débute avec une fréquence fsi supérieure à la fréquence propre fe constatée auparavant, après un intervalle ti programmable se situant entre 50 et 100 % d'un intervalle moyen tmean entre deux systoles de fréquence propre, puis la fréquence fs diminue constamment jusqu'à ce que la fréquence fs(t) diminue pour passer sous la fréquence fe, à une fréquence fsub, ou se termine lorsque la fréquence fe est atteinte.
PCT/EP1997/001989 1996-04-20 1997-04-19 Dispositif de stimulation cardiaque implantable WO1997039798A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
US09/171,280 US6134469A (en) 1997-04-19 1997-04-19 Implantable heart stimulator

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE1996115844 DE19615844B4 (de) 1996-04-20 1996-04-20 Implantierbare Herz-Stimulationsvorrichtung
DE19615844.3 1996-04-20

Publications (1)

Publication Number Publication Date
WO1997039798A1 true WO1997039798A1 (fr) 1997-10-30

Family

ID=7791983

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/EP1997/001989 WO1997039798A1 (fr) 1996-04-20 1997-04-19 Dispositif de stimulation cardiaque implantable

Country Status (2)

Country Link
DE (1) DE19615844B4 (fr)
WO (1) WO1997039798A1 (fr)

Cited By (9)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7039461B1 (en) 2000-05-13 2006-05-02 Cardiac Pacemakers, Inc. Cardiac pacing system for prevention of ventricular fibrillation and ventricular tachycardia episode
US7181278B2 (en) 1999-05-21 2007-02-20 Cardiac Pacemakers, Inc. Apparatus and method for ventricular rate regularization
US7212860B2 (en) 1999-05-21 2007-05-01 Cardiac Pacemakers, Inc. Apparatus and method for pacing mode switching during atrial tachyarrhythmias
US7239914B2 (en) 2000-05-13 2007-07-03 Cardiac Pacemakers, Inc. Rate smoothing control
US7383086B2 (en) 2000-07-13 2008-06-03 Cardiac Pacemakers, Inc. Ventricular conduction delay trending system and method
US7460908B2 (en) 1999-05-21 2008-12-02 Cardiac Pacemakers, Inc. System providing ventricular pacing and biventricular coordination
US7606620B2 (en) 2000-05-13 2009-10-20 Cardiac Pacemakers, Inc. System and method for detection enhancement programming
US8135465B2 (en) 1999-05-21 2012-03-13 Cardiac Pacemakers, Inc. System providing ventricular pacing and biventricular coordination
US10350419B2 (en) 2007-12-13 2019-07-16 Cardiac Pacemakers, Inc. Supraventricular tachy sensing vector

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0488840A1 (fr) * 1990-11-30 1992-06-03 ELA-MEDICAL (Société Anonyme) Procédé de contrôle du rythme cardiaque d'un porteur de stimulateur cardiaque double chambre
EP0550342A1 (fr) * 1991-12-31 1993-07-07 ELA MEDICAL (Société anonyme) Procédé de commande d'un stimulateur cardiaque en cas d'extra-systole ventriculaire

Family Cites Families (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DD221372A1 (de) * 1983-10-24 1985-04-24 Tur Dresden Betr Ultraschallte Verfahren und vorrichtung zur optimierung der stimulation des herzens

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0488840A1 (fr) * 1990-11-30 1992-06-03 ELA-MEDICAL (Société Anonyme) Procédé de contrôle du rythme cardiaque d'un porteur de stimulateur cardiaque double chambre
EP0550342A1 (fr) * 1991-12-31 1993-07-07 ELA MEDICAL (Société anonyme) Procédé de commande d'un stimulateur cardiaque en cas d'extra-systole ventriculaire

Cited By (11)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7181278B2 (en) 1999-05-21 2007-02-20 Cardiac Pacemakers, Inc. Apparatus and method for ventricular rate regularization
US7212860B2 (en) 1999-05-21 2007-05-01 Cardiac Pacemakers, Inc. Apparatus and method for pacing mode switching during atrial tachyarrhythmias
US7460908B2 (en) 1999-05-21 2008-12-02 Cardiac Pacemakers, Inc. System providing ventricular pacing and biventricular coordination
US8135465B2 (en) 1999-05-21 2012-03-13 Cardiac Pacemakers, Inc. System providing ventricular pacing and biventricular coordination
US7039461B1 (en) 2000-05-13 2006-05-02 Cardiac Pacemakers, Inc. Cardiac pacing system for prevention of ventricular fibrillation and ventricular tachycardia episode
US7239914B2 (en) 2000-05-13 2007-07-03 Cardiac Pacemakers, Inc. Rate smoothing control
US7606620B2 (en) 2000-05-13 2009-10-20 Cardiac Pacemakers, Inc. System and method for detection enhancement programming
US7908007B2 (en) 2000-05-13 2011-03-15 Cardiac Pacemakers, Inc. System and method for detection enhancement programming
US7383086B2 (en) 2000-07-13 2008-06-03 Cardiac Pacemakers, Inc. Ventricular conduction delay trending system and method
US10350419B2 (en) 2007-12-13 2019-07-16 Cardiac Pacemakers, Inc. Supraventricular tachy sensing vector
US11504538B2 (en) 2007-12-13 2022-11-22 Cardiac Pacemakers, Inc. Supraventricular tachy sensing vector

Also Published As

Publication number Publication date
DE19615844B4 (de) 2005-07-21
DE19615844A1 (de) 1997-10-23

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