Source: http://www.google.co.uk/patents/US8812106
Timestamp: 2017-11-24 14:56:06
Document Index: 779622472

Matched Legal Cases: ['art.\n5', 'art.\n12', '§120', '§120', 'Application No. 20040104782', 'Art. 94', 'art 2', 'Application No. 2010', 'Application No. 2010']

Patent US8812106 - Apparatus for treating the physiological electric conduction of the heart - Google Patents
A new pacemaker apparatus for treating the physiological electric conduction of the heart that includes a conduction abnormality in a ventricle. The pacemaker includes a pulse generator and a pacing electrode located in the heart, the pulse generator providing pacing signals to the pacing electrode....http://www.google.co.uk/patents/US8812106?utm_source=gb-gplus-sharePatent US8812106 - Apparatus for treating the physiological electric conduction of the heart
Publication number US8812106 B2
Application number US 13/875,681
Also published as CA2591121A1, EP1830920A1, EP1830920A4, EP1830920B1, US7512440, US8285376, US8346358, US8428715, US8437848, US8838238, US20060136001, US20060142812, US20090093859, US20090093861, US20090187226, US20130096638, US20130261690, WO2006068880A1
Publication number 13875681, 875681, US 8812106 B2, US 8812106B2, US-B2-8812106, US8812106 B2, US8812106B2
Inventors Daniel Felipe Ortega, Alberto German Giniger
Patent Citations (471), Non-Patent Citations (276), Referenced by (3), Classifications (10), Legal Events (1)
US 8812106 B2
an electrostimulation pulse generator, configured to provide an electrostimulation signal to a first electrode disposed in a subject heart; and
a His capture verification signal generator, configured to generate an electrical His capture verification signal based on information about whether the electrostimulation signal from the first electrode evokes a response that bypasses a ventricular conduction abnormality of the subject heart;
wherein the pulse generator provides the electrostimulation signal to the first electrode in the subject heart as an electrostimulation signal comprising at least partially concurrent opposite polarity signals.
2. The apparatus of claim 1, comprising the first electrode.
3. The apparatus of claim 2, comprising a second electrode, wherein the pulse generator is configured to provide a portion of the electrostimulation signal to the second electrode when the second electrode is disposed in the subject heart;
wherein the electrostimulation signal comprises a first monopolar pulse delivered from the first electrode with respect to a reference and a second monopolar pulse delivered from the second electrode with respect to the reference.
4. The apparatus of claim 3, wherein the pulse generator is configured to provide the electrostimulation using the first electrode being disposed in a first septal location in the right ventricle near a His bundle of the subject heart, and using the second electrode being disposed in a second septal location in the rig ventricle near the His bundle of the subject heart.
5. The apparatus of claim 1, comprising a catheter including the first electrode located on the catheter and the catheter having a deflectable sheath, wherein the deflectable sheath includes a distal electrode that is configured to be electrically coupled to the signal generator.
6. The apparatus of claim 1, comprising a control circuit, configured to determine whether a contraction of a ventricle of the subject heart responsive to the electrostimulation signal exhibits a desired depolarization-repolarization pattern.
7. The apparatus of claim 6, wherein the control circuit is configured to use the pulse generator to provide an electrostimulation signal to a second electrode disposed in the subject heart when the control circuit determines that the contraction responsive to the electrostimulation signal does not exhibit the desired depolarization-repolarization pattern.
8. The apparatus of claim 1, comprising a control circuit, configured to determine whether a contraction of a ventricle of the subject heart responsive to the electrostimulation signal exhibits a narrow QRS width.
9. The apparatus of claim 8, wherein the control circuit is configured to use the pulse generator to provide an electrostimulation signal to a second electrode disposed in the subject heart when the control circuit determines that the contraction responsive to the electrostimulation signal does not exhibit the narrow QRS width.
10. An apparatus for treating a ventricular conduction abnormality of a subject heart, comprising:
first and second electrodes configured to he disposed in the subject heart, at least one of the first and second electrodes being configured to be secured to a septal location of the subject heart;
a pulse generator, configured to provide an electrostimulation signal to the first and second electrodes; and
a His capture verification signal generator, configured to generate an electrical His capture verification signal based on information about whether the electrostimulation signal from the first and second electrodes evokes a response that bypasses the ventricular conduction abnormality of the subject heart;
wherein the pulse generator is configured to provide the electrostimulation signal to the first and second electrodes as respective electrostimulation signal pulses having at least partially concurrent opposite polarity.
11. The apparatus of claim 10, comprising the first and second electrodes configured to be disposed in a septal region of the subject heart.
12. The apparatus of claim 11, wherein the pulse generator is configured to provide the electrostimulation signal comprising electrostimulation pulses comprising a first monopolar pulse to be provided to the first electrode with respect to an electrical reference and a second monopolar pulse to be provided to the second electrode with respect to the electrical reference.
13. The apparatus of claim 10, wherein the His capture verification signal generator is configured to generate the electrical His capture verification signal to indicate a delay between a beginning of a QRS complex and an activation of the left ventricle free wall at a point distal from the apex of the left ventricle.
14. The apparatus of claim 10, comprising a removable guide sheath that comprises the first and second electrodes.
15. The apparatus of claim 14, wherein the removable guide sheath is deflectable to guide the first and second electrodes to a target pacing region in the subject heart at or near the septal wall.
16. The apparatus of claim 10, wherein the His capture verification signal generator is configured to generate the electrical His capture verification signal based on information about whether the electrostimulation signal from the first and second electrodes evokes a response that bypasses a bundle branch block.
first and second electrodes disposed in a subject ventricle at or near the septal wall of a subject heart;
a pulse generator, configured to provide an electrostimulation signal to the first and second electrodes;
a His capture verification signal generator, configured to generate an electrical His capture verification signal based on information, received using a third electrode, about whether the electrostimulation signal evokes a response indicating a conduction abnormality of the subject heart is bypassed;
wherein the pulse generator provides the electrostimulation signal to the first and second electrodes as respective electrostimulation signal pulses that are at least partially concurrent and of opposite polarity.
18. The apparatus of claim 17, wherein the pulse generator provides the electrostimulation signal pulses as a first monopolar pulse delivered from the first electrode with respect to a reference and a second monopolar pulse delivered from the second electrode with respect to the reference.
19. The apparatus of claim 17, wherein the His capture verification signal generator is configured to include, in the electrical His capture verification signal, information about whether a subject bundle branch block is bypassed.
20. The apparatus of claim 17, comprising the third electrode, wherein the third electrode is disposed on a sheath that is removable from a catheter, and the catheter includes the first and second electrodes.
This patent document a continuation under 35 U.S.C. §120 of U.S. patent application Ser. No. 12/249,479, filed on Oct. 10, 2008, now issued as U.S. Pat. No. 8,437,848, which is a continuation under 35 U.S.C. §120 of U.S. patent application Ser. No. 11/300,242 filed on Dec. 13, 2005, now issued as U.S. Pat. No. 8,346,358, which claims foreign priority to Argentina Patent Application No. 20040104782 filed on Dec. 20, 2004 by inventors Daniel Felipe Ortega and Alberto German Giniger and entitled “A NEW PACEMAKER WHICH REESTABLISHES OR KEEPS THE PHYSIOLOGICAL ELECTRIC CONDUCTION OF THE HEART AND A METHOD OF APPLICATION.”
Programmable pacemakers are insensitive to the needs of the organism and their functioning is to be changed from the outside, so that their adaptability is relative. There are other kinds of pacemakers which are more physiological, that is to say, more capable of meeting the organic needs at every moment, with its continuos fluctuation. In cases where the formation of the cardiac stimulus in the atria is maintained, and the problem lies on the conduction block between the atria and the ventricles, a kind of pacemaker which senses atrial activity and then stimulates the ventricles can be introduced. These are the “atrial triggered” pacemakers, which constitute a practical reality, once the problems of implanting two catheters, one in the auricle and the other in the ventricle, are solved. In these pacemakers, as the variations in the atrial rhythm depend on organic needs variations, the pacemaker is led by the body needs
Together with the pacing system including the new pacemaker and its method of application, by septal implementation the wavefront penetration to the Hisian mainstream is obtained. The result is a narrow QRS, similar to the one in the normal conduction and with an almost normal hemodynamic efficiency.
This is obtained by the formation of a virtual electrode which generates a stimulation field significantly higher than the one in a traditional electrode for the physiological stimulation. Said higher current field allows to compromise more distant areas than the pacemaker place even overcoming conduction disorders,—electrical bypass (EB)—. The use of said virtual electrode assures an energy saving with regards to the necessary high output and makes the placing in the septum easier avoiding difficult electrophysiological mapping procedures.
Group A (31 patients) was tested with pacing on edge of RV and in septum with high ouput (20 volt).
R- EB- SVD-
QRS BASAL sSEP sAPEX VI VI VI EST
BCRD+
14 HBAI 146 120 165 — — — EB
17 HBAI 120 130 190 — — — EB
18 HBAI 140 100 — 68 70 98 EB
22 HBAI 160 120 190 — — — 20 mA
37 HABI 120 125 170 — — — 20 mA
47 HABI 120 130 180 — — — 20 mA
References: measures are expressed in milliseconds; narrow ANG=QRS lower than 100 msec; sSEP=width of QRS in septal stimulation; sAPEX=width of QRS with stimulation from apex of RV; R-LF=conduction time from R to a record of RV from the coronary cavity; EB-RV=conduction time from septal stimulation EB to a record of RV from the coronary cavity; sRV-LV=conduction time from stimulation on apex of RV to a record of the LV from coronary cavity; EST=features of stimulation; 20 mA=traditional stimulation with output of 20 mAmperes.
In the cases where RV apex was paced, a marked difference in spike-to-LV interval versus spike-to-LV(EB) interval was observed, LV activity being recorded as previously explained from the distal dipole of a multipolar catheter located in the coronary sinus. In average, the conduction time from the apex of RV to LV is increased by 54 msec in respect to the septal stimulation time EB to LV. This significant shortage of left-ventricle to right-ventricle time is also registered because of the presence of complete left branch block in the basal ECG, wherein the QRS significantly narrows (39 msec average) after EB stimulation. It is also accompanied by significant narrowing of the QRS in both cases (61 msec average), which supposes a more effective electric re-synchronization of the left ventricle.
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U.S. Classification 607/9, 607/11, 607/36, 607/15, 607/122
Cooperative Classification A61N1/3962, A61N1/3627, A61N1/371, A61N1/362