JP2014023870A - Heart electrostimulator and heart electrostimulation method - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a heart electrostimulator capable of obtaining an accurate electrocardiographic waveform in a short time by excellently controlling an afterpotential.SOLUTION: An inner impedance control part 204 sets a resistance value Ra of a variable resistance 14 to a large value as energy of an electric stimulation signal is larger or biological impedance Rs is larger. This enables a heart electrostimulator to select a minimum resistance value Ra capable of preventing discharge of charge of a charge storage capacitor Ca from being completed until the discharge of charge from a capacitor Cs is completed. As a result, the heart electrostimulator can return measured voltage to a level of a base line in a short time while performing an excellent discharge operation.

Description

  The present invention relates to a cardiac electrical stimulation device and a cardiac stimulation method.

  Conventionally, in order to test whether the heart's stimulation conduction system is normal or not, an electrical stimulation pulse is output to an electrode catheter mounted on a living body, and the biological reaction obtained at that time is obtained via the electrode catheter. Thus, there is a cardiac stimulation test apparatus that obtains an electrocardiogram waveform (intracardiac electrocardiogram). This type of cardiac stimulation inspection apparatus is disclosed in Patent Documents 1 to 3, for example.

  Briefly described, the cardiac stimulation examination apparatus includes a cardiac electrical stimulation apparatus that outputs an electrical stimulation pulse to the electrode catheter, and a cardiac catheter examination apparatus that measures an electrocardiographic waveform based on the voltage of the electrode catheter. The cardiac electrical stimulation device intentionally induces an arrhythmia or stops the arrhythmia by applying an electrical stimulation pulse through an electrode catheter. The cardiac catheter inspection device measures an electrocardiographic waveform by acquiring a response voltage from a living body that appears immediately after a stimulus is applied by the cardiac electrical stimulation device via an electrode catheter.

  Here, as disclosed in Patent Document 1 and Patent Document 2, when an electrical stimulation pulse is applied to a living body by a cardiac electrical stimulation device, a post-potential due to polarization is generated. The post-potential becomes a large value immediately after the electrical stimulation pulse is applied, but gradually decreases due to discharge (discharge). When the posterior potential is very large compared to the electrocardiogram waveform, the electrocardiogram waveform is masked by the posterior potential. Therefore, the electrocardiogram waveform must be measured after the posterior potential is attenuated to a sufficiently small value. is there.

U.S. Pat. No. 4,498,478 JP 2002-516732 A JP-A-6-154182

  By the way, the magnitude of the post-potential is determined by the amplitude and pulse width of the electrical stimulation pulse. That is, as the amplitude increases and the pulse width increases, the rear potential increases. When the post-potential increases, the time until the electrocardiographic waveform can be measured naturally becomes longer.

  At present, the electrical stimulation pulse has a voltage of several volts to several tens of volts and a pulse width of about 10 [msec]. Incidentally, the voltage of the electrocardiographic waveform to be measured is several millivolts.

  At present, for example, the electrocardiographic waveform has a baseline level of 50 [msec] or less within ± 1 [mV] under a stimulation condition where the electrical stimulation pulse has an amplitude of 5 V and a pulse width of 1 [msec]. It is required as the performance of the cardiac stimulation test apparatus to be within the accuracy, and is actually realized.

  By the way, depending on the part of the heart to be inspected, there is a part where the response to the electrical stimulation is dull. In order to inspect such a part, it is effective to increase the amplitude and pulse width of the electrical stimulation pulse. . For example, it is considered to use an electrical stimulation pulse having a large energy such as an amplitude of 30 V and a pulse width of 10 [msec].

  When such a large energy electrical stimulation is applied, naturally the posterior potential is also increased, and therefore the time until the posterior potential is attenuated to such an extent that the electrocardiographic waveform can be measured is increased. On the other hand, usually, the time from application of a certain electrical stimulation pulse to application of the next electrical stimulation pulse (that is, the interval between electrical stimulation pulses) is determined to be 100 [msec], for example. For this reason, the electrocardiogram waveform must be measured within 100 [msec]. However, if the post-potential is large, the electrocardiogram waveform may not be measured within that time.

  A method of extracting the electrocardiogram by removing the posterior potential with a high-pass filter is also conceivable, but even in this case, if the posterior potential is at a much higher level than the electrocardiogram waveform, the accuracy of It takes a long time to obtain a good filtering result.

  An object of the present invention is to provide a cardiac electrical stimulation device and a cardiac stimulation method capable of obtaining a highly accurate electrocardiographic waveform in a short time by controlling the post-potential well.

One aspect of the cardiac electrical stimulation device of the present invention is:
A stimulation signal supply unit for supplying an electrical stimulation signal for stimulating the heart to an electrode catheter mounted on a living body;
A bioelectrical impedance calculation unit for calculating the impedance of the biological body;
Based on the energy of the electrical stimulation signal and the bioelectrical impedance, an internal impedance control unit that controls the internal impedance during discharge,
It comprises.

One aspect of the cardiac stimulation method of the present invention is:
A cardiac stimulation method performed by a cardiac electrical stimulation device,
Supplying an electrical stimulation signal for stimulating the heart to an electrode catheter mounted on a living body;
Calculating the impedance of the living body;
Controlling internal impedance at the time of discharge based on the energy of the supplied electrical stimulation signal and the calculated bioelectrical impedance;
including.

  According to the present invention, since the internal impedance at the time of discharge is controlled based on the energy of the electrical stimulation signal and the bioelectrical impedance, the post-potential is controlled well to obtain an accurate electrocardiographic waveform in a short time. Will be able to.

FIG. 1A is an equivalent circuit for explaining the principle configuration of a cardiac electrical stimulation device, FIG. 1A is a diagram showing a state during stimulation, and FIG. 1B is a diagram showing a state during discharge The figure which shows the mode of the measurement voltage V obtained by a cardiac stimulation test | inspection The figure which shows the whole structure of a cardiac stimulation inspection apparatus The figure which shows the basic composition of the cardiac electrical stimulation apparatus The figure which shows the relationship of the return time of the measurement voltage V with respect to internal resistance Ra. The figure which serves for explanation of the table which the internal impedance control section has

  Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings.

(1) Principle Before describing the configuration of the embodiment, the principle of the present invention will be described.

  1A and 1B are equivalent circuits for explaining the principle configuration of the cardiac electrical stimulation device. FIG. 1A shows a state during stimulation, and FIG. 1B shows a state during discharge.

  The equivalent circuit of FIG. 1 is divided into a circuit side and a living body side with electrode catheters (electrode leads) T1 and T2 attached to the living body as a boundary. The circuit side is the cardiac electrical stimulation device 10, and the living body side is the living body model 20.

  The cardiac electrical stimulation device 10 can be represented by using an electrical stimulation pulse generation unit 11, a charge storage capacitor Ca, an internal resistance Ra, and switches 12 and 13. The biological model 20 can be represented using a resistance Rs and a capacitor Cs.

  At the time of stimulation shown in FIG. 1A, after the switch 12 is connected to the terminal a side and the switch 13 is turned OFF, the stimulation pulse generated by the electrical stimulation pulse generation unit 11 is accumulated by the charge storage capacitor Ca. , And supplied to the biological model 20. That is, the electrical stimulation pulse generation unit 11 and the charge storage capacitor Ca function as a stimulation signal supply unit that supplies an electrical stimulation signal for stimulating the heart to the electrode catheters T1 and T2 mounted on the living body.

  On the other hand, at the time of discharging shown in FIG. 1B, the switch 12 is connected to the terminal b side and the switch 13 is turned on, whereby the charge accumulated in the capacitor Cs of the biological model 20 is discharged. At the time of this discharge, the electrocardiographic waveform is measured by measuring the voltage V between the electrode leads T1 and T2 by the cardiac catheter inspection device (FIG. 3).

  FIG. 2 shows the state of the measurement voltage V obtained by the cardiac stimulation test. The period from the time point t1 to the time point t2 is a period in which the cardiac electrical stimulation device 10 is in the state of FIG. 1A, and the period from the time point t3 to the time point t4 is a period in which the cardiac electrical stimulation device 10 is in the state of FIG. There is a period from time t4 to time t5 in which the cardiac electrical stimulation device 10 is in the state of FIG. 1A. The cardiac electrical stimulation device 10 repeats stimulation and discharge in this way. Then, the voltage V between the electrode leads T1 and T2 in the discharge period is measured by the cardiac catheter inspection device (FIG. 3).

  The voltage during the discharge period decays with time. Here, the voltage in the discharge period includes an afterpotential generated due to polarization due to electrical stimulation and an electrocardiographic waveform that is an evoked reaction of the heart due to electrical stimulation. Of these, the electrocardiogram waveform is the waveform to be measured. Immediately after the stimulation, the value of the posterior potential is very large compared to the electrocardiogram waveform, and the posterior potential masks the electrocardiogram waveform. Therefore, the electrocardiographic waveform is measured after the value of the post-potential becomes sufficiently small. Specifically, the electrocardiographic waveform is measured after time t10 when the measurement voltage V becomes lower than the threshold voltage V1.

(2) Configuration FIG. 3 shows the overall configuration of the cardiac stimulation testing apparatus. The cardiac stimulation examination apparatus 100 includes a cardiac electrical stimulation apparatus 200 and a cardiac catheter examination apparatus 300. The cardiac electrical stimulation device 200 supplies electrical stimulation signals for stimulating the heart to the electrode catheters T1 and T2 mounted on the living body. The cardiac catheter inspection apparatus 300 measures an electrocardiographic waveform based on the voltages of the electrode catheters T1 and T2, and displays the waveform on a monitor or outputs it from a printer. In addition, the cardiac electrical stimulation device 200 and the cardiac catheter test device 300 are connected by a cable so that they can transmit and receive each other's information. In the embodiment, in order to simplify the description, the case where the electrode catheter is configured by two electrode catheters T1 and T2 will be described, but of course, the number of electrode catheters may be three or more. . One electrode catheter may be provided with two electrodes.

  FIG. 4 is a block diagram showing a basic configuration of the cardiac electrical stimulation device 200. FIG. 4 shows only characteristic elements in the present embodiment. 4 include those already described with reference to FIG. 1, and therefore, here, components that are not described in FIG. 1 and components that are different from FIG. 1 will be described.

  The state control unit 201 switches the stimulation state shown in FIG. 1A and the discharge state shown in FIG. 1B by controlling the connection of the switches 12 and 13. Incidentally, FIG. 4 shows a discharge state.

  The stimulation energy control unit 202 controls stimulation energy by controlling the amplitude and pulse width of the stimulation pulse generated by the electrical stimulation pulse generation unit 11.

  The bioelectrical impedance calculation unit 203 calculates the impedance of the living body to which the electrode catheters T1 and T2 are attached, that is, the impedance of the living body model 20. The bioelectrical impedance calculation unit 203 calculates the bioelectrical impedance based on the voltage and current of the electrode catheters T1 and T2. That is, in practice, the cardiac electrical stimulation device 200 or the cardiac catheter examination device 300 includes a voltmeter (not shown) for detecting the voltage of the electrode catheters T1 and T2 and a current for detecting the current flowing through the electrode catheters T1 and T2. The bioimpedance calculation unit 203 calculates bioimpedance based on values detected by the voltmeter and ammeter.

  The internal impedance control unit 204 controls the internal impedance at the time of discharge based on the energy of the electrical stimulation signal and the bioelectrical impedance. In practice, the internal impedance control unit 204 obtains information on the energy of the electrical stimulation signal based on the control signal output from the stimulation energy control unit 202, and obtains information on the bioimpedance from the bioimpedance calculation unit 203.

  In the case of the present embodiment, the internal impedance control unit 204 controls the resistance value Ra of the variable resistor 14. The internal impedance control unit 204 increases the resistance value Ra of the variable resistor 14 as the energy of the electrical stimulation signal increases. Further, the internal impedance control unit 204 increases the resistance value Ra of the variable resistor 14 as the bioelectrical impedance increases.

  Thus, the reason for controlling the resistance value Ra based on the energy of the electrical stimulation signal and the bioelectrical impedance will be described.

  During stimulation, the capacitor Cs of the biological model 20 is charged and a voltage is generated. At the time of discharge, the charge of the capacitor Cs is discharged, and the voltage V in FIG. 4 disappears (that is, the rear potential returns to the baseline level).

  Here, as shown in FIG. 5, as the resistance value Ra of the variable resistor 14 is decreased, the time for the measurement voltage V to return to the baseline level is shortened. However, when the resistance value Ra is excessively small, it is not preferable because the discharge of the charge storage capacitor Ca is finished and the discharge operation is finished when the discharge of the charge from the capacitor Cs is not finished.

  In consideration of this, in the present embodiment, the resistance value Ra of the variable resistor 14 is increased as the energy of the electrical stimulation signal increases (as the charge of the capacitor Cs increases) and as the bioimpedance Rs increases. Thus, the minimum resistance value Ra can be selected so that the discharge of the charge in the charge storage capacitor Ca is not completed until the discharge of the charge from the capacitor Cs is completed. As a result, the measurement voltage V can be restored to the baseline level in a short time while performing a good discharge operation.

  Next, a specific example for setting the resistance value Ra will be described. In this example, an example in which the resistance value Ra is switched from three values of Ra1 <Ra2 <Ra3 will be described. The internal impedance control unit 204 has a table as shown in FIG. 6, and selects the resistance value Ra1, Ra2 or Ra3 on the condition of stimulation energy and bioelectrical impedance (as a read address).

  As described above, according to the present embodiment, by controlling the internal impedance 14 at the time of discharge based on the energy of the electrical stimulation signal and the bioelectrical impedance, the rear potential is controlled well, and the short An accurate electrocardiographic waveform can be obtained in time.

  In the above-described embodiment, the case where the internal impedance controlled by the internal impedance control unit 204 is the resistance value of the resistor 14 connected in parallel with the biological impedance at the time of discharging has been described. The internal impedance to be controlled is not limited to this. The internal impedance controlled by the internal impedance control unit 204 may be the capacity of the charge storage capacitor 15 that is connected in parallel with the biological impedance during discharge. Specifically, as the energy of the electrical stimulation signal is larger (as the charge of the capacitor Cs is larger), or as the bioelectrical impedance Rs is larger, the capacitance Ca of the charge storage capacitor 15 is increased. An effect can be obtained.

  As mentioned above, the invention made by the present inventor has been specifically described based on the embodiment. However, the present invention is not limited to the above embodiment, and can be changed without departing from the gist thereof.

  The embodiment disclosed this time should be considered as illustrative in all points and not restrictive. The scope of the present invention is defined by the terms of the claims, rather than the description above, and is intended to include any modifications within the scope and meaning equivalent to the terms of the claims.

  The present invention can be applied to, for example, a cardiac electrical stimulation apparatus for obtaining an intracardiac electrogram.

DESCRIPTION OF SYMBOLS 10,200 Cardiac electrical stimulation apparatus 11 Electrical stimulation pulse generation part 12, 13 Switch 14 Variable resistance 15 Charge storage capacitor 20 Biological model 100 Cardiac stimulation test apparatus 201 State control part 202 Stimulus energy control part 203 Bioimpedance calculation part 204 Internal impedance control T1, T2 electrode catheter

Claims (8)

A stimulation signal supply unit for supplying an electrical stimulation signal for stimulating the heart to an electrode catheter mounted on a living body;
A bioelectrical impedance calculation unit for calculating the impedance of the biological body;
Based on the energy of the electrical stimulation signal and the bioelectrical impedance, an internal impedance control unit that controls the internal impedance during discharge,
A cardiac electrical stimulation device comprising: The internal impedance controlled by the internal impedance control unit is a resistance value of a resistor connected in parallel with the biological impedance at the time of discharge.
The cardiac electrical stimulation apparatus according to claim 1. The internal impedance controlled by the internal impedance control unit is a capacity of a capacitor connected in parallel with the biological impedance at the time of discharge.
The cardiac electrical stimulation apparatus according to claim 1. The capacitor is a charge storage capacitor connected in series to the bioimpedance at the time of stimulation.
The cardiac electrical stimulation apparatus according to claim 3. The internal impedance control unit increases the internal impedance as the energy of the electrical stimulation signal increases.
The cardiac electrical stimulation apparatus according to any one of claims 1 to 4. The internal impedance control unit increases the internal impedance as the bioimpedance increases.
The cardiac electrical stimulation device according to any one of claims 1 to 5. The internal impedance controller is
Having a table for selecting the internal impedance to be controlled, with the energy of the electrical stimulation signal and the bioelectrical impedance as read addresses;
The cardiac electrical stimulation device according to any one of claims 1 to 6. A cardiac stimulation method performed by a cardiac electrical stimulation device,
Supplying an electrical stimulation signal for stimulating the heart to an electrode catheter mounted on a living body;
Calculating the impedance of the living body;
Controlling internal impedance at the time of discharge based on the energy of the supplied electrical stimulation signal and the calculated bioelectrical impedance;
A cardiac stimulation method comprising:

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