JP5329669B2 - Mriに誘導される捕捉閾値の変化に応答する植込型医療装置 - Google Patents
Mriに誘導される捕捉閾値の変化に応答する植込型医療装置 Download PDFInfo
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- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
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- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
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- A61N1/3718—Monitoring of or protection against external electromagnetic fields or currents
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- 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
- A61N1/3925—Monitoring; Protecting
- A61N1/3937—Monitoring output parameters
- A61N1/3943—Monitoring output parameters for threshold determination
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Description
別の態様では、本発明は、植込型医療装置から送達される患者内の身体組織の刺激用のエネルギーを制御する方法において、核磁気共鳴映像法(MRI)走査中、組織の刺激用に送達されるエネルギーを第1のエネルギー状態から第2のエネルギー状態に変化させるエネルギー変化工程と、MRI走査後に、前記送達されるエネルギーを第2のエネルギー状態に維持するエネルギー状態維持工程と、前記組織の捕捉閾値を測定する閾値測定工程と、測定された前記組織の捕捉閾値に基づき、送達されるエネルギーを調節するエネルギ
ー調節工程と、を備える方法に関する。前記閾値測定工程およびエネルギー調節工程は、前記送達されるエネルギーが第1のエネルギー状態に復帰するまで反復されてもよく、測定された前記捕捉閾値がプログラムされた回数の捕捉閾値測定について有意に変化しなくなるまで反復されてもよい。前記閾値測定工程は、大きさの変化する複数のペーシングパルスからなるペーシングパルスのシーケンスを前記組織に送達する工程と、前記ペーシングパルスに対する組織の応答を感知する工程と、を含んでもよい。前記閾値測定工程は、継続時間の変化する複数のペーシングパルスからなるペーシングパルスのシーケンスを前記組織に送達する工程と、前記ペーシングパルスに対する組織の応答を感知する工程と、を含んでもよい。前記閾値測定工程およびエネルギー調節工程は植込型医療装置によって実行されてもよく、植込型医療装置と通信状態にある外部装置によって制御されてもよい。第2のエネルギー状態は、大きさおよび継続時間のうちの1つ以上が第1のエネルギー状態よりも大きな信号を有してもよい。
別の態様では、本発明は、植込型医療装置から送達される患者内の身体組織の刺激用のエネルギーを制御する方法において、組織の刺激用の第1のエネルギーレベルを有するエネルギーを送達するエネルギー送達工程と、核磁気共鳴映像法(MRI)走査場を検出する検出工程と、送達されるエネルギーを第1のエネルギーレベルから第2のエネルギーレベルに上昇させるエネルギーレベル上昇工程と、MRI走査場が検出されなくなった後、前記送達されるエネルギーを第2のエネルギーレベルに維持するエネルギーレベル維持工程と、前記組織の捕捉閾値を測定する閾値測定工程と、測定された前記組織の捕捉閾値に基づき、植込型医療装置によって送達されるエネルギーを調節するエネルギー調節工程と、を備える方法に関する。前記閾値測定工程およびエネルギー調節工程は、植込型医療装置によって送達されるエネルギーのレベルが第1のエネルギーレベルに復帰するまで反復されてもよい。前記閾値測定工程は、大きさの変化する複数のペーシングパルスからなるペーシングパルスのシーケンスを前記組織に送達する工程と、前記ペーシングパルスに対する組織の応答を感知する工程と、を含んでもよい。前記閾値測定工程およびエネルギー調節工程は植込型医療装置によって実行されてもよく、植込型医療装置と通信状態にある外部装置によって制御されてもよい。
別の態様では、本発明は、植込型医療装置において、身体組織の電気刺激用に適合された電極を有するリードと、前記リードを通じて組織の電気活動に基づく信号を受信するように動作する感知回路と、前記リードを通じた前記組織への電気刺激送達用の治療回路と、を備える植込型医療装置に関する。感知回路および治療回路は前記組織の捕捉閾値を測定するようにさらに動作し、前記植込型医療装置は、核磁気共鳴映像法(MRI)走査場を検出するように動作する磁場検出回路と、制御回路であって、磁場検出回路がMRI走査場を検出するとき、組織の刺激用に治療回路によって送達されるエネルギーを通常のエネルギー状態からMRIモードのエネルギー状態に設定し、磁場検出回路がMRI走査場を検出しなくなった後、測定された前記組織の捕捉閾値に基づき、送達されるエネルギーを調節するように動作する制御回路と、をさらに備える。制御回路は、磁場検出回路がMRI走査場を検出しなくなった後の一定の期間、治療回路によって送達されるエネルギーをMRIモードのエネルギーレベルに維持してもよく、送達されるエネルギーが通常のエネルギー状態に復帰するまで、測定された前記捕捉閾値に基づき、送達されるエネルギーを反復的に調節してもよい。捕捉閾値を測定するために、治療回路が大きさおよび継続時間のうちの1つ以上の変化する複数のペーシングパルスからなるペーシングパルスのシーケンスを前記組織に送達し、感知回路が前記ペーシングパルスに対する組織の応答を感知してもよい。感知回路が組織の捕捉閾値を測定し、制御回路が外部装置からの制御信号に応じて、送達されるエネルギーを調節してもよい。感知回路、治療回路、磁場検出回路、および制御回路は、パルス発生器に備えられてもよい。植込型医療装置は、測定された前記捕捉閾値に関する情報を通信するように動作する通信回路をさらに備えてもよい。
スタムハードウェア部品との任意の組み合わせによって実行されてもよい。
行うように構成される。他の実施形態では、IMD12は、テレメトリ信号を受信するように構成された1つ以上のトランスデューサと、またテレメトリ信号を送信するための1つ以上のトランスデューサとを備える。通信モジュール46は、テレメトリ信号を介して情報の送信および/または受信を行うことが可能な任意の種類の装置であってよく、無線周波数(RF)送信器、音響トランスデューサ、または誘導トランスデューサを含むが、それらに限定されない。
56、および入力部58を備える。一部の実施形態では、外部装置19は、介護者がIMD12と通信を行うために使用するための装置である。外部装置19は、インターネット、携帯電話機、および/または情報、プログラム、デバッグ用データ、および更新のダウンロードまたはアップロードを行うための他の有線または無線の手段に接続するためのインタフェースを備えてもよい。
状態は外部装置19を介してIMD12に対し提供されてもよい。
ギーのレベルが調節される。MRI走査の後に捕捉閾値を監視することによって、植込型医療装置は、組織が依然としてMRI走査による影響を受けているときに組織を刺激するのに十分なレベルのエネルギーを送達する。
Claims (12)
- 植込型医療装置において、
身体組織の電気刺激用に適合された電極を有するリードと、
前記リードを通じて組織の電気活動に基づく信号を受信するように動作する感知回路と、
前記リードを通じた前記組織への電気刺激送達用の治療回路と、を備え、
感知回路および治療回路は前記組織の捕捉閾値を測定するようにさらに動作し、
前記植込型医療装置は、
核磁気共鳴映像法走査場を検出するように動作する磁場検出回路と、
制御回路であって、磁場検出回路が前記核磁気共鳴映像法走査場を検出するとき、組織の刺激用に治療回路によって送達されるエネルギーを通常のエネルギー状態から核磁気共鳴映像法モードのエネルギー状態に設定し、磁場検出回路が前記核磁気共鳴映像法走査場を検出しなくなった後の一定の期間、治療回路によって送達されるエネルギーを前記核磁気共鳴映像法モードのエネルギーレベルに維持し、前記期間の後、測定された前記組織の捕捉閾値に基づき、送達されるエネルギーを調節するように動作する制御回路と、をさらに備える植込型医療装置。 - 制御回路は、送達されるエネルギーが通常のエネルギー状態に復帰するまで、測定された前記捕捉閾値に基づき、送達されるエネルギーを反復的に調節する、請求項1に記載の植込型医療装置。
- 捕捉閾値を測定するために、治療回路は、大きさおよび継続時間のうちの1つ以上の変化する複数のペーシングパルスからなるペーシングパルスのシーケンスを前記組織に送達し、感知回路は前記ペーシングパルスに対する組織の応答を感知する、請求項1に記載の植込型医療装置。
- 感知回路は組織の捕捉閾値を測定し、制御回路は、外部装置からの制御信号に応じて、送達されるエネルギーを調節する、請求項1に記載の植込型医療装置。
- 感知回路、治療回路、磁場検出回路、および制御回路は、パルス発生器に備えられてい
る、請求項1に記載の植込型医療装置。 - 測定された前記捕捉閾値に関する情報を通信するように動作する通信回路をさらに備える、請求項1に記載の植込型医療装置。
- 植込型医療装置から送達されるエネルギーを制御する方法において、
核磁気共鳴映像法走査中、植込型医療装置によって送達されるエネルギーを第1のエネルギー状態から第2のエネルギー状態に変化させるエネルギー変化工程と、
前記核磁気共鳴映像法走査後に、前記送達されるエネルギーを第2のエネルギー状態に維持するエネルギー状態維持工程と、
組織の捕捉閾値を表す捕捉閾値信号を受信する閾値受信工程と、
受信した前記捕捉閾値信号に基づき、送達されるエネルギーを調節するエネルギー調節工程と、を備える方法。 - 前記閾値受信工程およびエネルギー調節工程は、前記送達されるエネルギーが第1のエネルギー状態に復帰するまで反復される、請求項7に記載の方法。
- 前記閾値受信工程およびエネルギー調節工程は、受信した前記捕捉閾値信号がプログラムされた回数の捕捉閾値判定について有意に変化しなくなるまで反復される、請求項7に記載の方法。
- 前記閾値受信工程およびエネルギー調節工程は植込型医療装置によって実行される、請求項7に記載の方法。
- 前記閾値受信工程およびエネルギー調節工程は植込型医療装置と通信状態にある外部装置によって制御される、請求項7に記載の方法。
- 第2のエネルギー状態は、大きさおよび継続時間のうちの1つ以上が第1のエネルギー状態よりも大きな信号を有する、請求項7に記載の方法。
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US12/568,433 US8571661B2 (en) | 2008-10-02 | 2009-09-28 | Implantable medical device responsive to MRI induced capture threshold changes |
PCT/US2009/059093 WO2010039877A1 (en) | 2008-10-02 | 2009-09-30 | Implantable medical device responsive to mri induced capture threshold changes |
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JP2012504468A (ja) | 2012-02-23 |
US20140046392A1 (en) | 2014-02-13 |
WO2010039877A1 (en) | 2010-04-08 |
EP2355895A1 (en) | 2011-08-17 |
US8571661B2 (en) | 2013-10-29 |
US20100087892A1 (en) | 2010-04-08 |
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