JP2009535170A - 心筋刺激と副交感神経刺激を使用する心筋層コンディショニング - Google Patents
心筋刺激と副交感神経刺激を使用する心筋層コンディショニング Download PDFInfo
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- JP2009535170A JP2009535170A JP2009509914A JP2009509914A JP2009535170A JP 2009535170 A JP2009535170 A JP 2009535170A JP 2009509914 A JP2009509914 A JP 2009509914A JP 2009509914 A JP2009509914 A JP 2009509914A JP 2009535170 A JP2009535170 A JP 2009535170A
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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
- A61N1/3627—Heart stimulators for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
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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
- A61N1/372—Arrangements in connection with the implantation of stimulators
- A61N1/37211—Means for communicating with stimulators
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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
- A61N1/38—Applying electric currents by contact electrodes alternating or intermittent currents for producing shock effects
- A61N1/39—Heart defibrillators
- A61N1/3956—Implantable devices for applying electric shocks to the heart, e.g. for cardioversion
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Abstract
Description
様々な動物モデルによって、虚血障害前の定期的ペーシングが、閉塞面積の縮小や不整脈の発生率の低下などの心臓保護効果をもたらすことが実証された。そのような心臓保護効果を引き出すために、断続的心室ペーシングの提供が提案されてきた。心臓保護の処置の1つの細胞的メカニズムは、Akt介在経路の転形である。このAkt介在経路は、様々な動物モデルにおける予防的プレコンディショニング(ハウセンロイ(Hausenloy)らの「Ischemic Preconditioning Protects By Activating Prosurvival Kinases At Reperfusion」Am J Physiol Heart Circ Physiol, 288: H971-76 (2005)と、治療的ポストコンディショニング(サング(Tsang)らによる「Postconditioning: A Form Of "Modified Reperfusion" Protects The Myocardium By Activating The Phosphatidylinositol 3- Kinase-Akt Pathway」Circ Res, 95:230-32 (2004))の両方に示唆されている。
心筋層ペーシングと副交感神経刺激による心筋層コンディショニングは、様々な実施計画に従って実施することができる。ここでは、そのような実施計画のうちのいくつかを示す。
図5は、本主題の様々な実施形態によるペーシング治療と副交感神経刺激治療を実施して心筋層をコンディショニングする装置の実施形態を示す。図示した装置505は、感知回路506、虚血検出器507、パルス出力回路508、神経刺激器509、制御回路510を含む。感知回路506は、いくつかの電極及び/又は1つ又は複数のセンサを使用して1つ又は複数の信号を検出する。1つ又は複数の信号は、虚血イベントを示す。虚血検出器507は、信号からの虚血イベントを検出する。パルス出力回路508は、心臓に心筋層ペーシングパルスを与え、神経刺激器509は、迷走神経や迷走神経の分岐、心臓脂肪体などの心臓を刺激する副交感神経ニューラルネットに神経パルスを与える。制御回路510は、1つ又は複数の検出信号に基づいて且つ/又はそれぞれの虚血イベントの検出に応じて、ペーシングパルスと神経刺激の実施を制御する。様々な実施形態では、装置505は、実質的に、埋め込み型医療装置の埋め込み型ハウジングに収容される。
図9は、本主題の様々な実施形態による埋め込み型医療装置(IMD)952と外部システム又は装置953を含むシステム951を示す。IMD952の様々な実施形態は、NSとCRM機能の組み合わせを含む。また、IMDは、生物学的薬剤や医薬品を送ることがある。外部システム953とIMD952は、データと命令を無線で通信することができる。様々な実施形態では、例えば、外部システム953とIMD952は、遠隔計測コイルを使用してデータと命令を無線で通信する。従って、プログラム装置を使用して、IMD952によって実施されるプログラムされた治療を調整することができ、また、例えば、IMDは、無線遠隔計測を使用して装置データ(バッテリやリード線抵抗など)と治療データ(センスデータや刺激データなど)をプログラム装置に報告することができる。様々な実施形態によれば、IMD952は、副交感神経標的を刺激して心筋層コンディショニング治療を実施し、また心筋層コンディショニング治療の一部として心筋層をペーシングする。
Claims (22)
- 神経刺激信号を生成するようにされた神経刺激器と、
心筋層ペーシングを実施するペーシング信号を生成するようにされたパルス発生器と、
神経刺激器とパルス発生器を制御して心臓保護コンディショニング治療を実施するようにされたコントローラとを含み、コンディショニング治療は、副交感神経応答を引き出す神経刺激と心筋層ペーシングを含むシステム。 - 虚血イベントを検出する虚血検出器を更に含み、コントローラは、虚血イベントを示す虚血検出器からの信号に応じてコンディショニング治療を実施するようにされた請求項1に記載のシステム。
- 神経刺激器とパルス発生器は、単一パルス発生器回路に組み込まれた請求項1に記載のシステム。
- 神経刺激器とパルス発生器は、別個である請求項1に記載のシステム。
- コンディショニング治療は、検出された虚血イベントのための治療ポストコンディショニング治療を含む請求項1に記載のシステム。
- コンディショニング治療は、予想される虚血イベントのための予防的プレコンディショニング治療を含む請求項1に記載のシステム。
- 虚血イベントを検出する虚血検出器を更に含み、コントローラは、検出虚血イベントを示す虚血検出器からの信号に応じて検出虚血イベントのための治療的ポストコンディショニング治療を実施し、次に検出虚血イベントの後で予想される虚血イベントのための予防的プレコンディショニング治療を実施するようにされた請求項1に記載のシステム。
- コントローラは、神経刺激器とパルス発生器を制御して神経刺激と心筋層ペーシングを個々に実施するようにされた請求項1に記載のシステム。
- コントローラは、神経刺激器とパルス発生器を制御して神経刺激の実施と心筋層ペーシングの実施を統合するようにされた請求項1に記載のシステム。
- コントローラは、神経刺激器とパルス発生器を制御して神経刺激と心筋層ペーシングの同時実施を防ぐようにされた請求項9に記載のシステム。
- コントローラは、神経刺激器とパルス発生器を制御して神経刺激と心筋層ペーシングの同時実施を調整するようにされた請求項9に記載のシステム。
- 迷走神経を刺激するようにされた少なくとも1つの電極を更に含む請求項1に記載のシステム。
- 少なくとも1つの電極を神経刺激器に接続する血管内供給リード線を更に有し、リード線と少なくとも1つの電極は、少なくとも1つの電極を内頚静脈内に位置決めして迷走神経を経血管的に刺激するようにされた請求項1に記載のシステム。
- 神経刺激器への少なくとも1つの電極に接続された皮下供給リード線を更に含み、少なくとも1つの電極は、迷走神経を刺激するようにされた神経カフ電極を含む請求項1に記載のシステム。
- 迷走神経分岐を刺激するようにされた少なくとも1つの電極を更に含む請求項1に記載のシステム。
- 臓脂肪体を刺激するようにされた少なくとも1つの電極を更に含む請求項1に記載のシステム。
- コントローラ、神経刺激器、パルス発生器が、単一の埋め込み型医療装置に組み込まれた請求項1に記載のシステム。
- 神経刺激器が埋め込み型神経刺激器に組み込まれ、パルス発生器が心臓リズム管理(CRM)装置に組み込まれた請求項1に記載のシステム。
- コントローラは、パルス発生器を制御して心筋層ペーシングを一定間隔で実施するようにされた請求項1に記載のシステム。
- コントローラは、神経刺激器を制御して神経刺激を1分ごとに約10秒間実施するようにされた請求項1に記載のシステム。
- コントローラは、神経パルスを与える神経刺激器を制御して副交感神経連絡を刺激するようにされた請求項1に記載のシステム。
- コントローラは、神経パルスを与える神経刺激器を制御して交感神経連絡を抑止するようにされた請求項1に記載のシステム。
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US11/381,211 US7689286B2 (en) | 2006-05-02 | 2006-05-02 | Myocardium conditioning using myocardial and parasympathetic stimulation |
US11/381,211 | 2006-05-02 | ||
PCT/US2007/066383 WO2007130774A2 (en) | 2006-05-02 | 2007-04-11 | Myocardium conditioning using myocardial and parasympathetic stimulation |
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JP2009535170A true JP2009535170A (ja) | 2009-10-01 |
JP5170705B2 JP5170705B2 (ja) | 2013-03-27 |
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US (2) | US7689286B2 (ja) |
EP (1) | EP2012874A2 (ja) |
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WO (1) | WO2007130774A2 (ja) |
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US8731677B2 (en) | 2014-05-20 |
EP2012874A2 (en) | 2009-01-14 |
US20100145401A1 (en) | 2010-06-10 |
WO2007130774A2 (en) | 2007-11-15 |
JP5170705B2 (ja) | 2013-03-27 |
US7689286B2 (en) | 2010-03-30 |
US20070260284A1 (en) | 2007-11-08 |
WO2007130774A3 (en) | 2008-01-31 |
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