EP0249818A1 - A cardiac pacer for pacing a human heart - Google Patents
A cardiac pacer for pacing a human heart Download PDFInfo
- Publication number
- EP0249818A1 EP0249818A1 EP87108101A EP87108101A EP0249818A1 EP 0249818 A1 EP0249818 A1 EP 0249818A1 EP 87108101 A EP87108101 A EP 87108101A EP 87108101 A EP87108101 A EP 87108101A EP 0249818 A1 EP0249818 A1 EP 0249818A1
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- EP
- European Patent Office
- Prior art keywords
- pacing
- signal
- cardiac pacer
- rate
- pulse
- Prior art date
- Legal status (The legal status 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 status listed.)
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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
- A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
- A61N1/36514—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by a physiological quantity other than heart potential, e.g. blood pressure
- A61N1/36521—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by a physiological quantity other than heart potential, e.g. blood pressure the parameter being derived from measurement of an electrical impedance
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- Health & Medical Sciences (AREA)
- Cardiology (AREA)
- Heart & Thoracic Surgery (AREA)
- Life Sciences & Earth Sciences (AREA)
- Biomedical Technology (AREA)
- Biophysics (AREA)
- Physiology (AREA)
- Engineering & Computer Science (AREA)
- Hematology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Radiology & Medical Imaging (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Electrotherapy Devices (AREA)
Abstract
A cardiac pacer, which generates pacing pulses at a predetermined pacing rate comprises a device (7) for processing the pacing pulses according to an impedance measurement in a manner that a respiratory signal is obtained. The predetermined pacing rate is then varied dependent on the respiratory signal.
Description
- This invention relates to a cardiac pacer for pacing a human heart, wherein the pacing rate is controlled by the respiration of the patient.
- Conventional cardiac pacers usually comprise a pacing electrode and an indifferent electrode. The pacing electrode is placed in the human heart by means of a pacing lead. The conductive (metallic) housing of the cardiac pacer defines the indifferent electrode.
- The US Patent 3,593,718 describes such a conventional cardiac pacer which in addition utilizes an impedance pneumograph for obtaining a respiratory signal from thoracic impedance variations. The impedance pneumograph comprises a first and a second impedance measuring electrodes each connected with a separate first and second leads, respectively. Both impedance measuring electrodes of the impedance pneumograph are placed on the surface of the patient's chest.
- The European Patent Application 0 089 014 depicts a conventional cardiac pacer which also employs an impedance pneumograph for obtaining a respiratory signal. Again the impedance pneumograph comprises first and a second impedance measuring electrodes. However, only the first impedance measuring electrode is connected to a lead while the second electrode is defined by the conductive (metallic) housing which contains the cardiac pacer and the impedance pneumograph. Furthermore, the first impedance measuring electrode and, since the conductive (metallic) housing is implanted, the second electrode are subcutaneously placed in the thorax. Under the circumstances the complete pacing and impedance measuring system comprises a pacing electrode on a first lead, a first impedance measuring electrode on a second lead and the metallic housing as both the indifferent electrode of the cardiac pacer and the second electrode of the impedance pneumograph. Finally the current impulses generated and utilized for impedance measurement are at a higher rate than those of the ventilation rate. Under the circumstances the pacer needs an unnecessary high amount of energy.
- It is an object of this invention to provide for an improved cardiac pacer for pacing a human heart wherein the pacing rate is controlled by the respiration rate of the patient, and wherein the number of necessary electrodes and therefore also the number of necessary leads for obtaining a respiratory signal from thoracic impedance variations is reduced to a minimum. Furthermore the amount of energy necessary to activate the respiration rate measuring means should be reduced to a minimum.
- According to this invention an improved cardiac pacer is provided which comprises
- a) means for generating pacing pulses at a predetermined pacing rate;
- b) means for transmitting the pacing pulses to the human heart for pacing;
- c) means for processing the pacing pulses for obtaining a respiratory signal according to an impedance measurement; and
- d) means for varying the predetermined pacing rate dependent on the respiratory signal.
- By utilizing the pacing pulses for obtaining a respiratory signal the amount of energy to activate the respiration measuring means is reduced to a minimum. Furthermore it is possible to manage with only two electrodes and one lead for both pacing and measuring the impedance variations, namely the pacing electrode connected to the pacing lead and the metallic housing containing the pacer and the impedance pneumograph. Under the circumstances the invention provides for a minimum number of electrodes and leads for pacing and impedance measurement. Since the pacing pulse itself is processed for obtaining a respiratory signal no additional current for impedance measurement has to be supplied.
- The foregoing and other objects, features and advantages of the invention will be apparent from the following more particular description of a preferred embodiment of the invention, as illustrated in the accompanying drawings.
-
- Fig. 1 shows the invention in a schematic block diagram; and
- Fig. 2 illustrates the invention in a more detailed block diagram.
- In Fig. 1 a human heart which has to be paced is generally designated with 1. A
pacing electrode 2 is inserted in the human heart 1 in a manner and position that the heart can most efficiently be paced. Thepacing electrode 2 is connected through apacing lead 3 with apacing pulse generator 4. Atime base unit 5 controls the pacing rate of thepacing pulse generator 4 throughline 6. Animpedance pneumograph 7 is connected with thepacing pulse generator 4 throughline 8 for processing thepacing pulses 9 in a manner that a respiratory signal is obtained from thepacing pulses 9 when evaluating theamplitude decays 10 ofpacing pulses 10. Theamplitude decay 10 changes according to alternating body impedance during respiration. - Alternatively, the impedance measurement can be done by the simultaneous measurement of voltage and its associated current and an analog or digital division of voltage and current.
- The
impedance pneumograph 7 controls thetime base unit 5 throughline 11 in a manner that a predetermined basic pacing rate of thepacing pulse generator 4 is varied dependent on the respiratory signal. Theline 12 is a control line from thetime base unit 5 to theimpedance pneumograph 7. - In Fig. 1 the
pacing pulse generator 4, thetime base unit 5 and theimpedance pneumograph 7 are all encapsuled in an implantable conductive (metallic)housing 13 which is the housing of the cardiac pacer according this invention. Themetallic housing 13 defines both the indifferent electrode for pacing and the second electrode for impedance measurement as indicated in Fig. 1 withreference numeral 14. Under the circumstances the cardiac pacer according to this invention manages with only two electrodes and one lead, namelyelectrodes lead 3 for both pacing and impedance measurement. Since the pacing pulse itself is processed for obtaining a respiratory signal no additional current for impedance measurement has to be supplied. Therefore the amount of energy necessary for activating impedance measurement is reduced to a miniumum. - Fig. 2 depicts the schematic block diagram of Fig. 1 in more detail. The complete impedance including the heart is designated with Z. The
pacing pulse generator 4 comprises anoutput capacitor 15 which is switchable by means ofswitch 16 between battery 17 (switch position A) and pacing lead 3 (switch position B). In switch position A theoutput capacitor 15 is charged by the battery 17 to a voltage V1. In switch position B theoutput capacitor 15 is discharged throughpacing lead 3 aspacing pulse 9. The amount of discharge depends on the impedance variations of the patient 's thorax during respiration. According to Fig. 2 thepacing pulse 9 discharges from V1 to V2 (amplitude decay 10). - The
impedance pneumograph 7 includes a sample and hold circuitry 18, a difference former 19, a filter 20, a non-linear amplification (e.g. squaring) circuitry 21, an integrator 22 and a voltage topulse rate converter 23. The sample and hold circuitry samples and holds the voltages V1, V2 ofoutput capacitor 15. The difference former 19 supplies the difference V1 - V2 through the filter 20 to the non-linear amplification circuitry 21. The non-linear amplification circuitry 21 amplifies the output signal of filter 20 in a manner that signal portions having higher amplitudes are more amplified than signal portions having lower amplitudes. Under the circumstances interesting signal portions including the respiration signal are enhanced with respect to low amplitude noise for further processing. Non-linear amplification circuitries of this kind are well known in the art. They do not need described in more detail. The output signal of the non-linear amplification circuitry 21 is integrated in integrator 22 over a period of time, e. g. in the range of 5 to 30s. By integrating, high-frequency noise is significantly reduced. The voltage to pulse rate converter converts the integrated signal into a pulse rate according to the breathing rate. - The
time base unit 5 comprises a zerodecoder 24, adown counter 25, atime base register 26 and an analog signal to digitalcontrol word converter 27. The latter one converts the analog pulse rate signal of the voltage topulse rate converter 23 into a digital control word. This digital control word is supplied to thetime base register 26. It controls thetime base register 26 in a manner that a basic pacing rate, e.g. 60 beats/min., is varied dependent on the respiration rate. When the breathing rate increases thetime base register 26 increases the counting speed ofdown counter 25 so that it reaches zero faster than at basic rate. Under the circumstances the zerodecoder 24 generates switching signals at higher rates, so that theoutput capacitor 15 of the pacingpulse generator 4 charges and discharges at higher rates. As a result the pacing rate increases dependent on increasing breathing rate as desired. - Having thus described the invention with particular reference to the preferred forms thereof, it will be obvious to those skilled in the art to which the invention pertains, after understanding the invention, that various changes and modifications may be made therein without departing from the spirit and scope of the invention as defined by the claims apended hereto.
Claims (7)
1. A cardiac pacer for pacing a human heart comprising
a) means (4) for generating pacing pulses (9) at a predetermined pacing rate;
b) means (2, 3) for transmitting the pacing pulses (9) to the human heart (1) for pacing;
c) means (7) for processing the pacing pulses (9) for obtaining a respiratory signal according to an impedance measurement; and
d) means (5) for varying the predetermined pacing rate dependent on the respiratory signal.
2. The cardiac pacer according to claim 1, further comprising
a) means (21) for non-linearly amplifying the respiratory signal in a manner that signal portions having higher amplitudes are more amplified than signal portions having lower amplitudes;
b) means (22) for integrating the non-lineary amplified respiratory signal over a period of time, e.g. 5 to 30 s; and
c) means (5) for varying the predetermined pacing rate dependent on the integrated signal.
3. The cardiac pacer according to claim 1 or 2, further comprising means (18) for measuring the amplitude (V1) of a pacing pulse (9) at the beginning and the amplitude (V1) of the same pacing pulse (9) at the end of the pacing pulse and means (9) for obtaining a measure for the decay (10) between the two amplitudes (V1, V2) which is a measure for the respiration.
4. The cardiac pacer according to claim 3, wherein said means (18) for measuring the amplitudes (V1, V2) comprises a sample and hold circuitry.
5. The cardiac pacer according to claim 3 or 4, wherein said means (19) for obtaining a measure for the decay (10) comprise a difference former for the amplitudes (V1, V2).
6. The cardiac pacer according to one of the preceding claims 2 to 8, wherein said means (7) for processing the pacing pulses further comprising a voltage to pulse rate converter (23) for the integrated signal.
7. The cardiac pacer according to claim 6, wherein said means (5) for varying the predetermined pacing rate comprises an analog signal to digital control word converter (27) for the output signal of the voltage to pulse rate converter (23), a time register (26) for the output signal of the analog signal to digital control word converter (27), a down counter (25) which is set to higher zero counting speed when the respiration rate increases and a zero decoder (24) at the output of the down counter (25), said zero decoder (24) being connected with and controlling the pacing pulse generator (4) in a manner that a pacing pulse is generated at each zero count.
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US874591 | 1978-02-02 | ||
US06/874,591 US4697591A (en) | 1986-06-16 | 1986-06-16 | Cardiac pacer for pacing a human heart and pacing method |
Publications (1)
Publication Number | Publication Date |
---|---|
EP0249818A1 true EP0249818A1 (en) | 1987-12-23 |
Family
ID=25364131
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
EP87108101A Withdrawn EP0249818A1 (en) | 1986-06-16 | 1987-06-04 | A cardiac pacer for pacing a human heart |
Country Status (3)
Country | Link |
---|---|
US (1) | US4697591A (en) |
EP (1) | EP0249818A1 (en) |
JP (1) | JP2708420B2 (en) |
Cited By (7)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
EP0249824A1 (en) | 1986-06-16 | 1987-12-23 | Pacesetter AB | A cardiac pacer for pacing a heart |
EP0249819A1 (en) | 1986-06-16 | 1987-12-23 | Pacesetter AB | Cardiac pacer for pacing a human heart |
US4966146A (en) * | 1988-01-14 | 1990-10-30 | Webb Stuart C | Rate-responsive pacemaker |
US5044365A (en) * | 1988-02-17 | 1991-09-03 | Webb Stuart C | Rate-responsive pacemaker |
DE4111505A1 (en) * | 1991-04-09 | 1992-10-15 | Roland Heinze | Appts. determining non-pulse-related information part in cardiac data signal - filters impedance or pressure signal during measurement time when pulse period is constant producing intermediate signal |
EP0933095A2 (en) | 1998-01-29 | 1999-08-04 | BIOTRONIK Mess- und Therapiegeräte GmbH & Co Ingenieurbüro Berlin | Auto-calibrating rate adaptive pacemaker |
US6519494B1 (en) | 1999-08-20 | 2003-02-11 | Biotronik Mess-Und Therapiegeraete Gmbh & Co. Ingenieurbuero Berlin | Rate-adaptive cardiac pacemaker |
Families Citing this family (21)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
DE3774332D1 (en) * | 1986-06-16 | 1991-12-12 | Siemens Ag | DEVICE FOR IMPEDANCE MEASUREMENT ON BODY TISSUES. |
DE3631155A1 (en) * | 1986-09-12 | 1988-03-24 | Alt Eckhard | FREQUENCY VARIABLE HEART PACEMAKER WITH STRESS-ADEQUATE FREQUENCY BEHAVIOR |
DE3732640C1 (en) * | 1987-09-28 | 1989-05-18 | Alt Eckhard | Medical device for determining physiological functional parameters |
US4899750A (en) * | 1988-04-19 | 1990-02-13 | Siemens-Pacesetter, Inc. | Lead impedance scanning system for pacemakers |
US4949720A (en) * | 1988-09-20 | 1990-08-21 | Medtronic, Inc. | Apparatus for measuring the lead current in a pacemaker |
DE3914680A1 (en) * | 1989-05-03 | 1990-11-08 | Alt Eckhard | HEART PACEMAKER |
US5215081A (en) * | 1989-12-28 | 1993-06-01 | Telectronics Pacing Systems, Inc. | Method and device for measuring subthreshold defibrillation electrode resistance and providing a constant energy shock delivery |
US5058583A (en) * | 1990-07-13 | 1991-10-22 | Geddes Leslie A | Multiple monopolar system and method of measuring stroke volume of the heart |
US5174286A (en) * | 1990-12-07 | 1992-12-29 | Raul Chirife | Sensor for right ventricular and thoracic volumes using the trailing edge value of a generated pulse |
US5201808A (en) * | 1992-02-10 | 1993-04-13 | Telectronics Pacing Systems, Inc. | Minute volume rate-responsive pacemaker employing impedance sensing on a unipolar lead |
EP0583499B1 (en) * | 1992-08-18 | 1996-03-06 | Pacesetter AB | Method for detecting cardial ventricular fibrillation and means for detection and treating of cardial ventricular fibrillation |
US5524632A (en) * | 1994-01-07 | 1996-06-11 | Medtronic, Inc. | Method for implanting electromyographic sensing electrodes |
US5800470A (en) * | 1994-01-07 | 1998-09-01 | Medtronic, Inc. | Respiratory muscle electromyographic rate responsive pacemaker |
US7775983B2 (en) * | 2005-09-16 | 2010-08-17 | Cardiac Pacemakers, Inc. | Rapid shallow breathing detection for use in congestive heart failure status determination |
US7766840B2 (en) * | 2005-12-01 | 2010-08-03 | Cardiac Pacemakers, Inc. | Method and system for heart failure status evaluation based on a disordered breathing index |
US7662105B2 (en) | 2005-12-14 | 2010-02-16 | Cardiac Pacemakers, Inc. | Systems and methods for determining respiration metrics |
US7819816B2 (en) * | 2006-03-29 | 2010-10-26 | Cardiac Pacemakers, Inc. | Periodic disordered breathing detection |
US8052611B2 (en) | 2007-03-14 | 2011-11-08 | Cardiac Pacemakers, Inc. | Method and apparatus for management of heart failure hospitalization |
US8135471B2 (en) | 2007-08-28 | 2012-03-13 | Cardiac Pacemakers, Inc. | Method and apparatus for inspiratory muscle stimulation using implantable device |
US9079033B2 (en) | 2008-01-22 | 2015-07-14 | Cardiac Pacemakers, Inc. | Respiration as a trigger for therapy optimization |
CN105451648A (en) | 2013-08-05 | 2016-03-30 | 心脏起搏器股份公司 | System and method for detecting worsening of heart failure based on rapid shallow breathing index |
Citations (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
EP0074126A2 (en) * | 1978-09-21 | 1983-03-16 | Purdue Research Foundation | A method of cardiac ventricular defibrillation |
EP0135911A2 (en) * | 1983-09-21 | 1985-04-03 | Gianni Plicchi | Electronic circuit detecting respiratory parameters in implantable devices, such as implantable and physiologic pacemakers |
Family Cites Families (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3593718A (en) * | 1967-07-13 | 1971-07-20 | Biocybernetics Inc | Physiologically controlled cardiac pacer |
US4303075A (en) * | 1980-02-11 | 1981-12-01 | Mieczyslaw Mirowski | Method and apparatus for maximizing stroke volume through atrioventricular pacing using implanted cardioverter/pacer |
US4428378A (en) * | 1981-11-19 | 1984-01-31 | Medtronic, Inc. | Rate adaptive pacer |
IT1156564B (en) * | 1982-03-16 | 1987-02-04 | Gianni Plicchi | IMPLANTABLE CARDIAC ELECTROSTIMULATOR, OF A PHYSIOLOGICAL TYPE, IN WHICH THE STIMULATION FREQUENCY IS REGULATED BY THE PATIENT'S RESPIRATORY FREQUENCY |
JPH034289U (en) * | 1989-06-02 | 1991-01-17 |
-
1986
- 1986-06-16 US US06/874,591 patent/US4697591A/en not_active Expired - Lifetime
-
1987
- 1987-06-04 EP EP87108101A patent/EP0249818A1/en not_active Withdrawn
- 1987-06-12 JP JP62147803A patent/JP2708420B2/en not_active Expired - Lifetime
Patent Citations (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
EP0074126A2 (en) * | 1978-09-21 | 1983-03-16 | Purdue Research Foundation | A method of cardiac ventricular defibrillation |
EP0135911A2 (en) * | 1983-09-21 | 1985-04-03 | Gianni Plicchi | Electronic circuit detecting respiratory parameters in implantable devices, such as implantable and physiologic pacemakers |
Cited By (9)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
EP0249824A1 (en) | 1986-06-16 | 1987-12-23 | Pacesetter AB | A cardiac pacer for pacing a heart |
EP0249819A1 (en) | 1986-06-16 | 1987-12-23 | Pacesetter AB | Cardiac pacer for pacing a human heart |
US4966146A (en) * | 1988-01-14 | 1990-10-30 | Webb Stuart C | Rate-responsive pacemaker |
US5044365A (en) * | 1988-02-17 | 1991-09-03 | Webb Stuart C | Rate-responsive pacemaker |
US5063927A (en) * | 1988-02-17 | 1991-11-12 | Webb Stuart C | Rate-responsive pacemaker |
DE4111505A1 (en) * | 1991-04-09 | 1992-10-15 | Roland Heinze | Appts. determining non-pulse-related information part in cardiac data signal - filters impedance or pressure signal during measurement time when pulse period is constant producing intermediate signal |
EP0933095A2 (en) | 1998-01-29 | 1999-08-04 | BIOTRONIK Mess- und Therapiegeräte GmbH & Co Ingenieurbüro Berlin | Auto-calibrating rate adaptive pacemaker |
US6154674A (en) * | 1998-01-29 | 2000-11-28 | Biotronik Mess-Und Therapiegeraete Gmbh & Co. Ingenieurbuero Berlin | Self-calibrating adaptive-rate cardiac pacemaker |
US6519494B1 (en) | 1999-08-20 | 2003-02-11 | Biotronik Mess-Und Therapiegeraete Gmbh & Co. Ingenieurbuero Berlin | Rate-adaptive cardiac pacemaker |
Also Published As
Publication number | Publication date |
---|---|
JPS6311172A (en) | 1988-01-18 |
JP2708420B2 (en) | 1998-02-04 |
US4697591A (en) | 1987-10-06 |
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Inventor name: LEKHOLM, ANDERS Inventor name: AMUNDSON, DAVID C. |