WO1982000415A1 - Systeme et procede de detection d'arythmie - Google Patents

Systeme et procede de detection d'arythmie Download PDF

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Publication number
WO1982000415A1
WO1982000415A1 PCT/US1981/001051 US8101051W WO8200415A1 WO 1982000415 A1 WO1982000415 A1 WO 1982000415A1 US 8101051 W US8101051 W US 8101051W WO 8200415 A1 WO8200415 A1 WO 8200415A1
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WIPO (PCT)
Prior art keywords
circuit
sensing
heart
rate
ecg
Prior art date
Application number
PCT/US1981/001051
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English (en)
Inventor
M Mirowski
A Langer
M Heilman
Original Assignee
M Mirowski
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 M Mirowski filed Critical M Mirowski
Publication of WO1982000415A1 publication Critical patent/WO1982000415A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
    • A61B5/346—Analysis of electrocardiograms
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
    • A61B5/7235—Details of waveform analysis
    • A61B5/7239—Details of waveform analysis using differentiation including higher order derivatives
    • 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
    • A61N1/3987—Heart defibrillators characterised by the timing or triggering of the shock

Definitions

  • the present invention relates to an arrhythmia detection system and method, and more particularly to an improved system and method for defibriHating the heart of a patient when the patient experiences life-threatening fibrillation.
  • an apex electrode is applied to the external intrapericardial or extra- pericardial surface of the heart, and acts against a base electrode which can be either similarly conformal or in the form of an intravascular catheter.
  • Such electrode arrangements of the prior art, as disclosed in the aforementioned patent of Heilman et al- can employ independent pacing tips associated with either a base electrode or an apex electrode, or both.
  • the prior art probability density function ⁇ detector if not optimally adjusted, can be "triggered” not only by actual ventricular fibrillation, but also by some forms of high rate ventricular tachycardia, and low rate ventricular tachycardia as well, particularly in the presence of ventricular conduction abnormalities.
  • the possibility of such triggering in the presence of high rate tachycardia is acceptable because high rate tachycardia can be fatal if present at such a rate that sufficient blood pumping no longer is accomplished.
  • inventive system and method herein disclosed amounts to a "backup" technique by means of which high rate tachycardia is treated by issuance of a defibrillating shock to the patient, while low rate tachycardia is not so treated. Disclosure of Invention
  • an arrhythmia detection system and method and more particularly an improved system and method for defibrillating a heart which is undergoing abnormal cardiac rhythm, the improved system and method employing an additional technique for distinguishing between ventricular fibrillation and high rate tachycardia, on the one hand, and low rate tachycardia, on the other hand- More specifically, the system and method of the present invention, besides utilizing the probability density function technique to determine the presence of abnormal cardiac rhythm, also employs heart rate sensing for the purpose of distinguishing between ventricular fibrillation and high rate tachy ⁇ cardia, on the one hand, the latter being indicated by a heart rate above a predetermined threshold, and low rate tachycardia, on the other hand, the latter being indicated by a heart rate falling below the predetermined threshold.
  • the present invention is implemented by a first preferred embodiment of a system, wherein a superior vena cava (or base) electrode and an apical (or patch) electrode are associated with the heart, and are employed, as is conventional in the art, not only to derive an electrocardiograph (ECG) signal, but also to apply a defibrillating shock to the heart.
  • ECG electrocardiograph
  • the ECG amplifier in the first embodiment essentially provides the derivative of the heart signal as taught in U.S. Patent No.
  • the differentiated ECG signal is, in this first embodiment of the invention, applied to a probability density function circuit, and to a low pass filter and a heart rate circuit, by means of which the probability density function and heart rate, respectively, are obtained.
  • satisfaction of the probability density criteria that is, determination of whether the time-averaged derivative of the ECG remains off the base line for extended periods of time
  • the heart rate is above a predetermined threshold
  • the defibrillating pulse generator to issue a defibrillating shock to the heart.
  • the defibrillating shock will be issued to the heart only upon the occurrence of fibrillation or high rate tachycardia, as contrasted with non-life threatening low rate tachycardia.
  • a sensing button (preferably, associated with the apical or patch electrode) is connected to the heart for use in deriving the heart rate.
  • the base and apical electrodes are utilized initially to derive the ECG signal by means of which the probability density function is examined. If the probability density function indicates abnormal cardiac rhythm, a switching operation takes place, whereby the sensing button is utilized to derive an ECG signal which is further utilized to determine the heart rate. Since a very small area electrode will result in signals in which cardiac depolarizations can still be identified, even during ventricular fibrillation, a conventional R-wave detector can be used so as to provide an R-wave for heart rate sensing.
  • this second embodiment is provided with a timed reset capability, whereby, once the probability density function indicates abnormal cardiac rhythm, if a heart rate above the predetermined threshold is not indicated within a predetermined time, a return switch operation is automatically executed so as to permit renewed monitoring of the base and apical electrodes and examination of the resulting ECG signal vis-a-vis the probability density function.
  • an object of the present invention to provide an arrhythmia detection system and method, and more particularly an improved system and method for defibrillating a heart experiencing abnormal cardiac rhythm.
  • Figure 1 is a block diagram of a first embodiment of the arrhythmia detection system of the present invention.
  • Figure 2 is a detailed diagram of the heart rate circuit employed for detecting heart rate in the embodiment of Figure 1.
  • Figure 3A and 3B are a series of waveform diagrams utilized in describing the operation of the heart rate circuit of Figure 2.
  • Figure 4 is a block diagram of a second embodiment of the system of the present invention.
  • FIG. 5 is a detailed diagram of the heart rate circuit employed for detecting heart rate in the embodiment of Figure 2.
  • Figure 6 is a series of waveform diagrams utilized in describing the operation of the heart rate circuit of Figure 5.
  • FIG. 1 is a block diagram of a first embodiment of the system.
  • the system of the present invention (generally indicated by reference numeral 10) is connected to a superior vena cava (or base) electrode 12 and an apical (or patch) electrode 14, the latter being disposed in contact with the heart of the patient as is known in the prior art (see, for example, U.S. Patent No. 4,030,509 of Heil an et al mentioned above).
  • electrodes 12 and 14 are connected, via an interface 16, to an ECG amplifier 18 which has inherent filtering so as to provide an approximation of the differentiated ECG.
  • the ECG amplifier 18 is connected both to low pass filter circuit 19 (which itself is connected to heart rate circuit 21) and to probability density function (PDF) circuit 20.
  • PDF probability density function
  • Heart rate circuit 21 is connected via its inhibit output line (INHIBIT) to the PDF circuit 20, by means of which the output line heart rate circuit 21 is able to inhibit output from the PDF circuit 20.
  • the output of the PDF circuit 20 is connected to defibrillation pulse generator 26, the latter being connected via the interface 16 to the electrodes 12 and 14.
  • electrodes 12 and 14 are employed, via the interface 16 (a conventional interface, or isolation circuit), for two purposes: (1) monitoring of heart activity via ECG amplifier 18, which develops a differentiated ECG signal output provided to PDF circuit 20 and low pass filter 21, respectively; and (2) application of a defibrillating shock from defibrillation pulse generator 26, via the interface 16, to the heart.
  • PDF circuit 20 monitors the probability density function of the differentiated ECG output signal of ECG amplifier 18, and, in accordance with conventional techniques (as disclosed, for example, in U.S. Patents No. 4,184,493 and 4,202,340 of Langer et al), determines when abnormal cardiac rhythm of the heart exists.
  • the low pass filtered ECG signal provided as the output of low pass filter 19, is employed by rate circuit 21 to determine when the heart rate exceeds a predetermined threshold, at which time rate circuit 21 removes its inhibiting influence on PDF circuit 20.
  • FIG. 2 is a detailed diagram of the heart rate circuit employed for detecting heart rate in the embodiment of Figure 1, while Figures 3A and 3B are a series of waveform diagrams utilized in describing the operation of the heart rate circuit of Figure 2.
  • the heart rate circuit 21 comprises operational amplifier OP1 (which is used as a comparator), transistors Ql through 4, resistors R3 through R14, capacitors C2 and C3, and diodes Dl and D2.
  • the heart rate circuit 21 of Figure 2 functions in the following manner, with reference to the waveforms shown in Figure 3.
  • the input to ECG amplifier 18 ( Figure 1) comprises an undifferentiated ECG signal, as provided by the electrodes 12 and 14.
  • the undifferentiated ECG signal is represented by the waveform 100 of Figure 3A.
  • the ECG amplifier 18 amplifies and filters (differentiates) the ECG signal, and the amplified and differentiated output of the ECG amplifier 18 is shown as waveform 102 in Figure 3A.
  • the amplified and differentiated ECG signal from amplifier 18 is filtered, in a manner to be discussed in more detail below, by low pass filter 19 (made up of resistor Rl and capacitor Cl).
  • the amplified, differentiated and filtered ECG signal is provided to the negative input of operational amplifier OP1, the positive input of which receives a reference input REF via resistor R3.
  • Operational amplifier OP1 is used as a comparator, and switches between low and high outputs in accordance with the relationship between the ECG input and the reference REF. More specifically, it should be noted that zero crossings in a derivative waveform (such as the output of amplifier 18 of Figure 1) correspond to peaks in the original signal (the original ECG signal).
  • low pass filter 19 of Figure 1 filters the differentiated ECG input provided thereto in such a way that the output of operational amplifier OP1 ( Figure 2), used as a comparator, switches at the zero crossings in the derivative waveform corresponding to major peaks in the ECG input signal.
  • the output of comparator OP1 appears as waveform 104 in Figure 3A, and illustrates the switching action just described.
  • transistor Ql has its emitter connected to one of the offset adjustment terminals of operational amplifier OP1 so as to add hysteresis to the switching threshold of the amplifier OP1.
  • This hysteresis in combination with the characteristics of the low pass filter 19 of Figure 1, has the effect of reducing the sensitivity of the heart rate circuit 21 to smaller peaks in the ECG input signal.
  • the remainder of heart rate circuit 21 of Figure 2 acts as a precision timer which is responsive to the ECG peaks, as detected by and indicated by switching of the operational amplifier OP1.
  • a programmable uni-junction transistor Q2 is connected in series with resistor R5, the latter series combination being connected between the output of amplifier OP1 and the collector of transistor Ql.
  • programmable uni-junction transistor Q2 is connected in such a way as to provide a narrow pulse to the base of a further transistor Q3 having its base connected via resistors R7 and R8 to the uni-junction transistor Q2, as shown.
  • the narrow pulse thus provided to the base of transistor Q3 corresponds to the rising edge of the output of amplifier OP1 (waveform 104 of Figure 3A), and this narrow pulse is indicated by waveform 106 of Figure 3A.
  • the operation of programmable uni-junction transistor Q2, which thus provides the pulse output shown in waveform 106, will be evident to those of skill in the art with respect to the utilization of such devices.
  • the narrow pulse shown in waveform 106 of Figure 3A is also shown in Figure 3B.
  • This narrow pulse is applied to the base of transistor Q3, and turns on transistor Q3 at a frequency determined by the frequency of occurrence of the rising edges of the output of amplifier OP1, that is, in accordance with a frequency related to heart rate.
  • capacitor C2 will experience a voltage build-up as shown in waveform 108 of Figure 3B. That is to say, capacitor C2 will experience a build-up of voltage under the influence of power supply V ⁇ _3
  • firing of transistor Q4 results in the occurrence of a negative-going pulse (waveform 114 of Figure 3A) at the aforementioned junction between resistors Rll and R12, diode D2 and transistor Q4.
  • Such negative-going pulses are utilized to inhibit operation of the PDF circuit 20 of Figure 1 (via the control line INHIBIT).
  • these negative- going pulses are utilized to remove charge from the integrating capacitor in the PDF circuit 20, as taught in U.S. Patent No. 4,184,493 of Langer et al.
  • interface 16 is a conventional interface. More specifically, interface 16 protects the ECG amplifier 18 from the defibrillation pulses issued by generator 26, while at the same time permitting the monitoring of heart activity by ECG amplifier 18. Interface 16 is, for example, disclosed in more detail in copending application U.S. Serial No. of Langer et al, entitled “Method and Apparatus for Combining Defibrilla ⁇ tion and Pacing Functions in a Single Implanted Device.” Moreover, the PDF circuit 20 is a conventional circuit for performing the probability density function, and is, for example, disclosed in more detail in the aforementioned U.S. Patents No. 4,184,493 and 4,202,340 of Langer et al.
  • Figure 4 is a block diagram of a second embodiment of the system of the present invention. Elements common to both Figures 1 and 4 have been identified by identical reference numerals.
  • the system 30 is shown connected to base and apical electrodes 12 and 14, and to a sensing button 32 (associated with apical electrode 14). More specifically, the electrodes 12 and 14 and sensing button 32 are connected, via a switch 34 and interface 16, both to the ECG amplifier 18 and the defibrillation pulse generator 26.
  • ECG amplifier 18 is connected, as was the case in Figure 1, to the PDF circuit 20, but is also connected to R-wave detector 22 which is of conventional design and provides a pulse with each R-wave.
  • R-wave detector 22 is subsequently connected to rate circuit 23, which is shown in detail in Figure 5 (to be discussed below).
  • the output of PDF circuit 20 is connected, via flip-flop 36, to one input of the AND gate 24, the other input of which is connected to the output of rate circuit 23.
  • the output of flip-flop 36 is connected to rate circuit 23, the input of a timed reset circuit 38 (the output of which is connected to the "reset” input of flip-flop 36), and to switch 34.
  • the output of AND gate 24 is connected not only to defibrillation pulse generator 26, but also to the "reset" input of flip-flop 36 and to switch 34.
  • switch 34 In operation, switch 34 is initially in the position indicated by reference numeral 40. Therefore, * in this mode (subsequently referred to as the "patch” mode), the base and apical electrodes are utilized by ECG amplifier 18 which monitors heart activity via interface 16, switch 34, and aforementioned electrodes 12 and 14. The resulting ECG signal output from amplifier 18 is provided to PDF circuit 20 (rate circuit 23 is initially in the "off” state). Detection of abnormal cardiac rhythm by PDF circuit 20 results in generation of an output, which is applied to the "set" input of flip-flop 36. When flip-flop 36 is set, existence of abnormal cardiac rhythm is "memorized", and a Q output is generated.
  • the Q output of flip-flop 36 is applied as an "enabling input” to AND gate 24. It is also applied as a START command to both rate circuit 23 and timed reset circuit 38. Moreover, the Q output of flip-flop 36 is provided as signal SENSE to the switch 34,
  • switch 34 to the position indicated by reference numeral 42.
  • rate circuit 23 If and when rate circuit 23 detects a heart rate which exceeds a predetermined threshold, it issues an output to AND gate 24 which, as enabled by the Q output of flip-flop 36, provides this output as an enabling input to defibrillation pulse generator 26. Moreover, AND gate 24 provides this output to the "reset" input of flip-flop 36 (thus, resetting flip-flop 36), and as an input signal PATCH to switch 34, actuating switch 34 to the position indicated by reference numeral 40, thus reestablishing the "patch" mode of operation of the system 30.
  • defibrillation pulse generator 26 issues a defibrillation pulse, via interface 16 and switch 34 (in position 40), to the base and apical electrodes 12 and 14, respectively, so as to defibrillate the heart of the patient.
  • timed reset circuit 38 starts the timed reset circuit 38 upon detection of abnormal cardiac rhythm by the PDF circuit 20. If, after a predetermined period of time, rate circuit 23 has not detected a heart rate above the predetermined threshold, timed reset circuit 38 automatically issues a "reset” input to flip-flop 36, and provides a further input PATCH to the switch 34, so as to actuate switch 34 to the position indicated by reference numeral 40, thus reestablishing the "patch" mode of operation.
  • the system 30 is provided with the beneficial feature whereby if, within a predetermined time after detection of abnormal cardiac rhythm by PDF circuit 20, heart rate is not detected as exceeding the predetermined threshold, the system 30 is returned to the "patch" mode of operation so as to permit further monitoring of the ECG signal by the PDF circuit 20. That is to say, the timed reset circuit 38 removes the enabling input from AND gate 24, turns off the rate circuit 23, and returns the switch 34 to the "patch" position (indicated by reference numeral 40). Then the PDF circuit 20 monitors the base and apical electrodes 12 and 14, respectively, via switch 34, interface 16 and ECG amplifier 18, to once again detect existence of any abnormal cardiac rhythm.
  • FIG. 5 is a detailed diagram of the heart rate circuit 23 of Figures 4, while Figure 6 is a series of waveform diagrams describing the operation of the heart rate circuit 23 of Figure 4.
  • rate circuit 23 comprises input resistor 50, NPN transistor 52, current source 54, capacitor 56, differential amplifier or comparison circuit 58, peak detector 60, shift register 62 and AND gate 64.
  • ECG signals (generally indicated by reference numeral 70 of Figure 6) are provided to R-wave detector 22 ( Figure 4), the latter generating a pulse train (generally indicated by reference numeral 75 of Figure 6) corresponding thereto.
  • this pulse train output of the R-wave detector 22 is provided, via input resistor 50 ( Figure 5), to the base of NPN transistor 52.
  • Transistor 52 is turned on as a result of receipt of each individual pulse in pulse train 75, and is thus turned on in correspondence to detection of individual R-waves 72, 74.
  • transistor 52 is non-conductive, and current source 54 builds up a voltage on capacitor 56. This build-up of voltage on capacitor 56 is generally indicated by waveform 76 of Figure 6.
  • NPN transistor 52 ( Figure 5) becomes conductive, and capacitor 56 discharges therethrough (see individual waveforms 78 and 80 of Figure 6).
  • current source 54 is able to build the voltage across capacitor 56 to a relatively high level, exceeding a predetermined reference REF (indicated by reference numeral 86 in Figure 6) .
  • differential amplifier 58 is provided, at its negative input, with a voltage corresponding to the voltage built up on capacitor 56, and, at its positive input, with a voltage REF corresponding to the predetermined reference level 86 of Figure 6.
  • differential amplifier 58 issues an output X equal to 0, as indicated by inverted square waves 84 of Figure 6, to the shift register 62.
  • differential amplifier 58 issues an output X equal to 1 to the shift register 62.
  • Rate circuit 23 of Figure 5 is further provided with a peak detector 60, which is a conventional circuit for detecting the existence of peaks in the R-waves 70 of Figure 6. Upon detection of each peak, detector 60 issues an input SHIFT to shift register 62. As a result, the output X, at that time, of differential amplifier 58 is shifted into an end stage of shift register 62, the contents of register 62 being accordingly shifted by one place to the right.
  • a peak detector 60 is a conventional circuit for detecting the existence of peaks in the R-waves 70 of Figure 6.
  • AND gate 64 the output of shift register 62 (corresponding to the contents of each bit or stage thereof) is provided to AND gate 64. Only detection of all 1's in shift register 62 will result in an output from AND gate 64.
  • This output of AND gate 64 is provided to one input of AND gate 24 ( Figure 4), the other input of which receives the Q output of flip-flop 36, indicating satisfaction of the probability density function criteria, as determined by PDF circuit 20.
  • AND gate 24 enables defibrillation pulse generator 26, so as to issue a defibrillation pulse to the heart of the patient.
  • shift register 62 provides a means of remembering the rates of previous beats. (It should be evident that the greater the number of bits in the shift register, the higher is the number of R-waves which must exceed a given rate before a high rate is indicated.) Thus, defibrillation does not take place, even if the probability density function is satisfied. While preferred forms and arrangements have been shown in illustrating the invention, it is to be clearly understood that various changes in detail and arrangement may be made without departing from the spirit and scope of this disclosure.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Cardiology (AREA)
  • Engineering & Computer Science (AREA)
  • Animal Behavior & Ethology (AREA)
  • Veterinary Medicine (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
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  • General Health & Medical Sciences (AREA)
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  • Surgery (AREA)
  • Molecular Biology (AREA)
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  • Physics & Mathematics (AREA)
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  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Radiology & Medical Imaging (AREA)
  • Electrotherapy Devices (AREA)
  • Measurement And Recording Of Electrical Phenomena And Electrical Characteristics Of The Living Body (AREA)

Abstract

Un systeme de detection d'arythmie et de defribillation possede une electrode de base (12) et une electrode apicale (14) connectees par un interface (16), un amplificateur (18) et un filtre (19) a un detecteur (21) de rythme cardiaque qui peut distinguer d'une part entre une fibrillation et une tachychardie de taux eleve et d'autre part une tachychardie a faible taux, envoyant dans ce deuxieme cas un signal de blocage au circuit (20) de fonction de densite de probabilite, un deuxieme detecteur de fibrillation, qui est aussi connecte aux electrodes (12, 24) par l'intermediaire des circuits (16, 18). Lorsque le battement cardiaque se produit a une vitesse anormalement elevee en combinaison avec un rythme anormal detecte par le circuit (20), un generateur (26) d'impulsions de defibrillation est actionne. Un deuxieme mode de realisation possede une troisieme electrode de detection a bouton et un commutateur (34) connectant de maniere alternative l'electrode apicale (32) a l'interface (16) pendant la defibrillation et l'electrode de detection (a bouton) pendant la surveillance. Un circuit (38) de remise a zero a temporisation permet le retour du commutateur (34) a la position "surveillance".
PCT/US1981/001051 1980-08-05 1981-08-05 Systeme et procede de detection d'arythmie WO1982000415A1 (fr)

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US17567080A 1980-08-05 1980-08-05
US175670800805 1980-08-05

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WO1982000415A1 true WO1982000415A1 (fr) 1982-02-18

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JP (1) JPH0245462B2 (fr)
CA (1) CA1171912A (fr)
DE (1) DE3131042C2 (fr)
GB (1) GB2083363B (fr)
NL (1) NL190185C (fr)
WO (1) WO1982000415A1 (fr)

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EP0060117A2 (fr) * 1981-03-06 1982-09-15 Medtronic, Inc. Correcteur intracardiaque du rythme cardiaque synchronisé
FR2559068A1 (fr) * 1984-02-06 1985-08-09 Medtronic Inc Circuit de protection pour un dispositif de retablissement cardiaque implantable
FR2561929A1 (fr) * 1984-03-27 1985-10-04 Atesys Appareillage automatique implante pour la defibrillation ventriculaire
EP0220916A2 (fr) 1985-10-25 1987-05-06 David Wyn Davies Appareil de détection et de correction de tachycardies et de fibrillations ventriculaires
EP0253505A3 (en) * 1986-06-17 1988-11-23 Intermedics, Inc. Cardiac stimulator
WO1993006886A1 (fr) * 1991-10-07 1993-04-15 Medtronic, Inc. Procede et appareil de stimulation anti-tachycardie a grande surface

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US4407288B1 (en) * 1981-02-18 2000-09-19 Mieczyslaw Mirowski Implantable heart stimulator and stimulation method
SE8107269L (sv) * 1981-12-04 1983-06-05 Siemens Elema Ab Anordning for att avsluta en takykardi
US4614192A (en) 1982-04-21 1986-09-30 Mieczyslaw Mirowski Implantable cardiac defibrillator employing bipolar sensing and telemetry means
CA1308170C (fr) * 1987-01-14 1992-09-29 Rahul Mehra Appareil de defibrillation cardiaque
US4953551A (en) * 1987-01-14 1990-09-04 Medtronic, Inc. Method of defibrillating a heart
DE4019002A1 (de) * 1990-06-13 1992-01-02 Siemens Ag Elektrodenanordnung fuer einen defibrillator
US5593427A (en) * 1993-08-06 1997-01-14 Heartstream, Inc. Electrotherapy method
US5607454A (en) * 1993-08-06 1997-03-04 Heartstream, Inc. Electrotherapy method and apparatus
US5391187A (en) * 1994-02-22 1995-02-21 Zmd Corporation Semiautomatic defibrillator with heart rate alarm driven by shock advisory algorithm
US5507778A (en) * 1994-02-22 1996-04-16 Zmd Corporation Semiautomatic defibrillator with synchronized shock delivery
US6148233A (en) 1997-03-07 2000-11-14 Cardiac Science, Inc. Defibrillation system having segmented electrodes
US6405081B1 (en) 1999-04-22 2002-06-11 Koninklijke Philips Electronics N.V. Damped biphasic energy delivery circuit for a defibrillator
JP6498325B2 (ja) * 2015-05-13 2019-04-10 アライヴコア・インコーポレーテッド 不一致モニタリング
JP6667339B2 (ja) * 2016-03-29 2020-03-18 フクダ電子株式会社 心腔内除細動システム、心腔内除細動システムにおける接続装置、及び除細動器

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Cited By (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0060117A2 (fr) * 1981-03-06 1982-09-15 Medtronic, Inc. Correcteur intracardiaque du rythme cardiaque synchronisé
EP0060117A3 (en) * 1981-03-06 1983-03-23 Medtronic, Inc. Synchronized intracardiac cardioverter
FR2559068A1 (fr) * 1984-02-06 1985-08-09 Medtronic Inc Circuit de protection pour un dispositif de retablissement cardiaque implantable
FR2561929A1 (fr) * 1984-03-27 1985-10-04 Atesys Appareillage automatique implante pour la defibrillation ventriculaire
EP0220916A2 (fr) 1985-10-25 1987-05-06 David Wyn Davies Appareil de détection et de correction de tachycardies et de fibrillations ventriculaires
EP0220916A3 (en) * 1985-10-25 1987-12-16 David Wyn Davies Apparatus for recognition of ventricular tachycardia and ventricular fibrillation and for termination thereof
EP0253505A3 (en) * 1986-06-17 1988-11-23 Intermedics, Inc. Cardiac stimulator
WO1993006886A1 (fr) * 1991-10-07 1993-04-15 Medtronic, Inc. Procede et appareil de stimulation anti-tachycardie a grande surface

Also Published As

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GB2083363A (en) 1982-03-24
DE3131042A1 (de) 1982-03-25
GB2083363B (en) 1985-02-27
NL190185C (nl) 1993-12-01
DE3131042C2 (de) 1987-02-19
CA1171912A (fr) 1984-07-31
JPH0245462B2 (fr) 1990-10-09
JPS57501116A (fr) 1982-07-01
NL8103696A (nl) 1982-03-01
NL190185B (nl) 1993-07-01

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