JP2006524106A5 - - Google Patents

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JP2006524106A5
JP2006524106A5 JP2006509836A JP2006509836A JP2006524106A5 JP 2006524106 A5 JP2006524106 A5 JP 2006524106A5 JP 2006509836 A JP2006509836 A JP 2006509836A JP 2006509836 A JP2006509836 A JP 2006509836A JP 2006524106 A5 JP2006524106 A5 JP 2006524106A5
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胸腔内ではない皮下に配置されるように構成されたハウジングと、
前記ハウジング内に設けられ、電気生理学的心臓信号を生成するように構成された検出回路と、
前記ハウジング内に設けられるエネルギー送出回路と、
胸腔内ではない皮下に配置されるように構成され、前記検出回路及び前記エネルギー送出回路に接続される少なくとも１つの電極と、
センサ信号を生成するように構成された植え込み型センサと、
前記ハウジング内に設けられ、前記センサ、前記検出回路及び前記エネルギー送出回路に接続されるプロセッサであって、前記センサ信号を用いて前記電気生理学的心臓信号が心臓信号を含むことを確認するように構成され、かつ前記センサ信号と前記心臓信号を含む前記心臓の電気生理学的な信号とを用いて心律動を評価するように構成されるプロセッサと、
を含む植え込み型皮下装置。 A housing configured to be placed subcutaneously not in the thoracic cavity;
A detection circuit provided within the housing and configured to generate an electrophysiological cardiac signal;
An energy delivery circuit provided in the housing;
At least one electrode configured to be placed subcutaneously not in the thoracic cavity and connected to the detection circuit and the energy delivery circuit;
An implantable sensor configured to generate a sensor signal;
A processor provided in the housing and connected to the sensor, the detection circuit, and the energy delivery circuit, wherein the sensor signal is used to verify that the electrophysiological heart signal includes a cardiac signal. A processor configured and configured to evaluate a cardiac rhythm using the sensor signal and the cardiac electrophysiological signal including the cardiac signal;
Implantable subcutaneous device. 前記センサが、胸腔内ではない皮下に配置されるように構成され、前記ハウジングの中又は上に又は前記ハウジングに接続されたリード上に設けられる、請求項１記載の装置。   The apparatus of claim 1, wherein the sensor is configured to be placed subcutaneously rather than in the thoracic cavity and is provided in or on the housing or on a lead connected to the housing. 前記センサが、血液センサを含み、前記血液センサは、胸腔内ではない皮下に配置されるように構成され、前記ハウジングの中又は上に又は前記ハウジングに接続されたリード上に設けられる、請求項１記載の装置。   The sensor includes a blood sensor, wherein the blood sensor is configured to be placed subcutaneously rather than in a thoracic cavity and is provided in or on the housing or on a lead connected to the housing. The apparatus according to 1. 前記センサが、血液センサを含み、光学的血液センサ、血液酸素飽和センサ、パルス酸素濃度計、又は光電脈派回路の少なくとも１つを含む、請求項１記載の装置。   The apparatus of claim 1, wherein the sensor comprises a blood sensor and comprises at least one of an optical blood sensor, a blood oxygen saturation sensor, a pulse oximeter, or a photoelectric pulse circuit. 前記プロセッサが、前記電気生理学的心臓信号と前記センサ信号又は前記センサ信号の相対的変化とを用いて前記心律動を頻拍性不整脈として確認するように構成される、請求項１記載の装置。   The apparatus of claim 1, wherein the processor is configured to identify the cardiac rhythm as a tachyarrhythmia using the electrophysiological heart signal and the sensor signal or a relative change in the sensor signal. 前記プロセッサが、前記センサ信号を用いて頻拍性不整脈を確認するまで頻拍性不整脈治療の送出を禁止すること、及び前記検出された電気生理学的心臓信号が前記心臓信号を含まない場合に心不整脈の治療を保留することの１つ又は両方を行うように構成される、請求項１記載の装置。   The processor prohibits delivery of tachyarrhythmia therapy until the tachyarrhythmia is confirmed using the sensor signal, and a heart when the detected electrophysiological heart signal does not include the heart signal. The apparatus of claim 1, wherein the apparatus is configured to perform one or both of withholding treatment for an arrhythmia. 前記プロセッサが、前記電気生理学的心臓信号及び前記センサ信号を用いて血液動態を判定するように構成される、請求項１記載の装置。   The apparatus of claim 1, wherein the processor is configured to determine hemodynamics using the electrophysiological heart signal and the sensor signal. 前記プロッセサが、心臓機能を評価すること、酸素飽和を評価すること、及び後負荷を評価することの１つ以上のために前記センサ信号を用いるように構成される、請求項１記載の装置。   The apparatus of claim 1, wherein the processor is configured to use the sensor signal for one or more of assessing cardiac function, assessing oxygen saturation, and assessing afterload. 前記エネルギー送出回路が、ペーシング治療回路及び除細動治療回路の１つ又は両方を含む、請求項１記載の装置。   The apparatus of claim 1, wherein the energy delivery circuit comprises one or both of a pacing therapy circuit and a defibrillation therapy circuit. 前記センサが、非電気生理学的な心臓ソースと関連付けられた信号を感知するように構成され、前記プロセッサが、前記検出された前記非電気生理学的心臓信号が前記心臓信号を含むことを確認するために前記非電気生理学的心臓信号を用いるように構成される、
請求項１記載の装置。 The sensor is configured to sense a signal associated with a non-electrophysiological cardiac source, and the processor confirms that the detected non-electrophysiological cardiac signal includes the cardiac signal. Configured to use the non-electrophysiological cardiac signal
The apparatus of claim 1. 前記センサが、アクセロメータ、マイクロホン、音響トランスデユーサ、血流量トランスデユーサ、パルス酸素濃度計、及び光電脈波回路の１つ以上を含む、請求項１０記載の装置。   The apparatus of claim 10, wherein the sensor comprises one or more of an accelerometer, a microphone, an acoustic transducer, a blood flow transducer, a pulse oximeter, and a photoelectric pulse wave circuit. 胸腔内ではない皮下位置で心電図信号を感知する手段と、
胸腔内ではない皮下の感知位置から心電図信号以外の感知信号を取得する手段と、
前記心電図信号が心臓信号を含むことを確認する手段と、
前記感知信号と前記心臓信号を含む前記心電図信号とを用いて心律動を評価する手段と、
を含む植え込み型皮下装置。 Means for sensing an electrocardiogram signal in a subcutaneous position that is not within the thoracic cavity;
Means for acquiring a sensing signal other than an electrocardiogram signal from a subcutaneous sensing position that is not in the thoracic cavity;
Means for verifying that the electrocardiogram signal comprises a cardiac signal;
Means for evaluating cardiac rhythm using the sensing signal and the electrocardiogram signal including the cardiac signal;
An implantable subcutaneous device. 前記心律動を評価する手段が、前記心電図信号及び前記感知信号の１つ又は両方を用いて頻拍性不整脈を検出する手段を含む、請求項１２記載の装置。   13. The apparatus of claim 12, wherein the means for assessing cardiac rhythm includes means for detecting tachyarrhythmia using one or both of the electrocardiogram signal and the sensed signal. 前記頻拍性不整脈を検出する手段が、前記心電図信号の心拍数に基づく解析を行う手段、前記心電図信号のモルフォロジーに基づく解析を行う手段、複数の電極を用いて前記心電図信号の活性化パターンを解析する手段の１つ以上を含む、請求項１３記載の装置。   The means for detecting tachyarrhythmia is a means for performing analysis based on a heart rate of the electrocardiogram signal, a means for performing analysis based on a morphology of the electrocardiogram signal, and an activation pattern of the electrocardiogram signal using a plurality of electrodes. 14. The apparatus of claim 13, comprising one or more means for analyzing. 前記頻拍性不整脈を治療する手段を更に含む、請求項１３記載の装置。   14. The apparatus of claim 13, further comprising means for treating the tachyarrhythmia. 前記心律動を評価する手段が、前記心電図信号を用いて頻拍性不整脈を検出する手段と、前記感知信号を用いて前記頻拍性不整脈の存在を確認する手段を含む、請求項１２記載の装置。   The means for evaluating the cardiac rhythm includes means for detecting tachyarrhythmia using the electrocardiogram signal and means for confirming the presence of the tachyarrhythmia using the sensing signal. apparatus. 前記心律動を評価する手段が、心臓の頻拍性不整脈を検出する手段と、前記感知信号を用いて前記頻拍性不整脈の存在が確認されるまで頻拍性不整脈治療の送出を禁止する手段を含む、請求項１２記載の装置。   The means for evaluating the cardiac rhythm includes means for detecting a tachyarrhythmia in the heart, and means for prohibiting transmission of a tachyarrhythmia therapy until the presence of the tachyarrhythmia is confirmed using the sense signal. The apparatus of claim 12, comprising: 前記センサが血液センサを含み、前記感知信号が、血液灌流情報、血中酸素飽和情報、光電脈波情報、及びパルス酸素測定情報の１つ以上を含む、請求項１２記載の装置。   The apparatus of claim 12, wherein the sensor comprises a blood sensor, and the sensing signal comprises one or more of blood perfusion information, blood oxygen saturation information, photoelectric pulse wave information, and pulse oximetry information. 前記感知信号を取得する手段が、非電気生理学的な心臓ソースと関連付けられた信号を受け取る手段を含む、請求項１２記載の装置。   The apparatus of claim 12, wherein the means for obtaining the sensing signal includes means for receiving a signal associated with a non-electrophysiological cardiac source. 前記非電気生理学的心臓信号が、心音信号、心臓活動を表す亜音速音響信号、脈拍圧信号、心臓活動を表すインピーダンス信号、パルス酸素測定信号、血流信号、心拍信号の１つ以上を含む、請求項１９記載の装置。   The non-electrophysiological heart signal comprises one or more of a heart sound signal, a subsonic acoustic signal representing cardiac activity, a pulse pressure signal, an impedance signal representing cardiac activity, a pulse oximetry signal, a blood flow signal, a heart rate signal; The apparatus of claim 19. 前記心律動を評価する手段が、心電図信号及び非電気生理学的信号を用いて、正常洞律動と心臓不整脈とを識別する手段を含む、請求項１９記載の装置。   20. The apparatus of claim 19, wherein the means for assessing cardiac rhythm includes means for distinguishing between normal sinus rhythm and cardiac arrhythmia using electrocardiogram signals and non-electrophysiological signals. 前記識別する手段が、前記心電図信号を用いて不整脈の存在を判定する手段と、非電気生理学的信号を用いて不整脈の存在を確認する手段を含む、請求項２１記載の装置。   The apparatus of claim 21, wherein the means for identifying includes means for determining the presence of an arrhythmia using the electrocardiogram signal and means for determining the presence of an arrhythmia using a non-electrophysiological signal. 前記心電図信号が前記心臓信号を含まない場合には、 胸腔内ではない皮下心臓刺激療法の送出を保留する手段を含む、請求項１９記載の装置。   20. The apparatus of claim 19, comprising means for deferring delivery of subcutaneous cardiac stimulation therapy that is not intrathoracic when the electrocardiogram signal does not include the cardiac signal. 患者の 胸腔内ではない皮下に配置されるように構成されたハウジングと、
前記ハウジング内に設けられるエネルギー送出回路と、
前記ハウジング内に設けられる検出回路と、
前記エネルギー送出及び検出回路に接続され、患者の胸腔内ではない皮下に配置されるように構成された１つ以上の電極であって、心臓及び筋活動を感知する１つ以上の電極と、
前記ハウジング内に設けられ、前記エネルギー送出及び検出回路に接続されるプロセッサであって、前記感知された心臓活動から発生された心臓信号を用いて不整脈を検出し、前記感知された筋活動から発生された活動信号を用いて患者の活動状態を検出するように構成され、前記活動信号に応じて前記不整脈を治療する治療の送出を修正するように区政されたプロセッサと、
含む、植え込み型心臓刺激装置。 A housing configured to be placed subcutaneously not within the patient's chest cavity;
An energy delivery circuit provided in the housing;
A detection circuit provided in the housing;
One or more electrodes connected to the energy delivery and detection circuit and configured to be placed subcutaneously not within the patient's thoracic cavity, wherein the one or more electrodes sense heart and muscle activity;
A processor provided in the housing and connected to the energy delivery and detection circuit for detecting an arrhythmia using a cardiac signal generated from the sensed cardiac activity and generating from the sensed muscle activity A processor configured to detect a patient activity state using the generated activity signal and configured to modify the delivery of therapy to treat the arrhythmia in response to the activity signal;
An implantable cardiac stimulating device. 前記プロセッサが、活動閾値を越える又は患者の意識又は運動を示す前記活動信号に応答して、前記不整脈治療の送出を阻止するように構成される、請求項２４記載の装置。   25. The apparatus of claim 24, wherein the processor is configured to prevent delivery of the arrhythmia therapy in response to the activity signal exceeding an activity threshold or indicating patient consciousness or movement. 前記プロセッサが、活動閾値を越えた前記活動信号に応答して前記不整脈治療の送出を所定時間だけ阻止するように構成され、更に、前記所定時間が満了し且つ前記不整脈が停止している場合には前記不整脈治療の送出を阻止し又は前記所定時間が満了し且つ前記不整脈が停止していない場合には前記不整脈治療を送出するように構成される、請求項２４記載の装置。   The processor is configured to block delivery of the arrhythmia therapy for a predetermined time in response to the activity signal exceeding an activity threshold, and further when the predetermined time has expired and the arrhythmia has stopped. 25. The apparatus of claim 24, wherein the device is configured to prevent delivery of the arrhythmia therapy or to deliver the arrhythmia therapy if the predetermined time has expired and the arrhythmia has not stopped. 患者の意識又は運動を示す前記活動信号に応答して、前記プロセッサが前記不整脈治療の送出を阻止し、生命を脅かす不整脈の検出に応答して、前記活動信号に関わりなく、前記プロセッサが前記不整脈治療を直ちに送出する、請求項２４記載の装置。   In response to the activity signal indicative of patient consciousness or movement, the processor prevents delivery of the arrhythmia therapy, and in response to detection of a life-threatening arrhythmia, the processor is responsive to detection of the activity signal, regardless of the activity signal. 25. The device of claim 24, wherein the treatment is delivered immediately. 前記プロセッサが、前記検出回路を用いて心電図を受け取り、その心電図から心臓信号と活動信号とを識別する、請求項２４記載の装置。   25. The apparatus of claim 24, wherein the processor receives an electrocardiogram using the detection circuit and identifies a cardiac signal and an activity signal from the electrocardiogram. 前記プロセッサが、信号分離技術を用いて前記心臓信号と前記活動信号とを識別するように構成される、請求項２８記載の装置。   30. The apparatus of claim 28, wherein the processor is configured to distinguish the cardiac signal and the activity signal using signal separation techniques. 前記１つ以上の電極が、
前記心臓活動と関連付けられた心臓信号を優先して感知するよう構成された第１の電極の組合せと、
前記筋活動と関連付けられた雑音信号を優先して感知するように構成された第２の電極の組合せと、
を含む、請求項２８記載の装置。 The one or more electrodes;
A first electrode combination configured to preferentially sense a cardiac signal associated with the cardiac activity;
A second electrode combination configured to preferentially sense a noise signal associated with the muscle activity;
30. The apparatus of claim 28, comprising: 前記１つ以上の電極が複数の電極で構成され、
前記プロセッサが前記複数の電極の組合せを選択するように構成され、
前記プロセッサが、コントローラが選択した前記電極の各組合せによって取得された信号の心臓信号成分及び雑音成分を感知するように構成される、請求項３０記載の装置。 The one or more electrodes are composed of a plurality of electrodes;
The processor is configured to select a combination of the plurality of electrodes;
32. The apparatus of claim 30, wherein the processor is configured to sense a cardiac signal component and a noise component of a signal acquired by each combination of the electrodes selected by a controller. 前記１つ以上の電極が複数の電極で構成され、前記プロセッサが、前記複数の電極にわたる興奮順序を用いて前記不整脈を検出するように構成される、請求項２４記載の装置。   25. The apparatus of claim 24, wherein the one or more electrodes are comprised of a plurality of electrodes, and wherein the processor is configured to detect the arrhythmia using an excitation sequence across the plurality of electrodes.
JP2006509836A 2003-04-11 2004-04-09 Implantable subcutaneous device and cardiac stimulation device Expired - Fee Related JP4521396B2 (en)

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US46227203P 2003-04-11 2003-04-11
US10/804,471 US7218966B2 (en) 2003-04-11 2004-03-19 Multi-parameter arrhythmia discrimination
US10/816,464 US7117035B2 (en) 2003-04-11 2004-04-01 Subcutaneous cardiac stimulation system with patient activity sensing
US10/817,749 US7302294B2 (en) 2003-04-11 2004-04-02 Subcutaneous cardiac sensing and stimulation system employing blood sensor
PCT/US2004/010917 WO2004091719A2 (en) 2003-04-11 2004-04-09 Multi-parameter arrhythmia discrimination

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