Source: http://www.google.com/patents/US6240314?dq=7800613
Timestamp: 2014-03-07 22:46:18
Document Index: 706638560

Matched Legal Cases: ['art.\n3', 'art.\n4', 'art.\n5', 'art.\n6', 'art.\n7', 'art.\n8', 'art.\n9']

Patent US6240314 - Heart stimulation device with electrotonic inhibition - Google PatentsSearch Images Maps Play YouTube News Gmail Drive More »Sign inAdvanced Patent SearchPatentsElectrodes can generate electrical stimulation pulses at least one first intensity level and at least one second intensity level. The first and second intensity levels are above and below a given stimulation threshold, respectively. The synchronous or asynchronous delivery of second-level pulses enables...http://www.google.com/patents/US6240314?utm_source=gb-gplus-sharePatent US6240314 - Heart stimulation device with electrotonic inhibitionAdvanced Patent SearchPublication numberUS6240314 B1Publication typeGrantApplication numberUS 09/301,372Publication dateMay 29, 2001Filing dateApr 26, 1999Priority dateJan 28, 1999Fee statusPaidAlso published asDE69918657D1, EP1023917A1, EP1023917B1, US6493585, US20010018600Publication number09301372, 301372, US 6240314 B1, US 6240314B1, US-B1-6240314, US6240314 B1, US6240314B1InventorsGianni Plicchi, Bruno Garberoglio, Guido Gaggini, Emanuela MarcelliOriginal AssigneeSorin Biomedica Cardio S.P.A.Export CitationBiBTeX, EndNote, RefManPatent Citations (3), Non-Patent Citations (8), Referenced by (70), Classifications (6), Legal Events (4) External Links: USPTO, USPTO Assignment, EspacenetHeart stimulation device with electrotonic inhibitionUS 6240314 B1Abstract Electrodes can generate electrical stimulation pulses at least one first intensity level and at least one second intensity level. The first and second intensity levels are above and below a given stimulation threshold, respectively. The synchronous or asynchronous delivery of second-level pulses enables the conduction of the atrioventricular node to be modulated by electrotonic effect, for example, to reduce ventricular frequency in the event of atrial fibrillation.
What is claimed is: 1. A method of stimulating the heart, comprising:
providing a processing unit in electrical communication with a means for detecting atrial fibrillation and with first and second electrodes; implanting the electrodes in the heart; providing first electrical stimulation pulses to the heart from the first electrode above a stimulation threshold; and providing second electrical stimulation pulses to the heart from the second electrode below a stimulation threshold, wherein the second electrical stimulation pulses are delivered in response to the detection of atrial fibrillation. 2. The method of claim 1 wherein the first electrode is implanted in a location effective to stimulate at least one of an atrium and a ventricle of the heart.
3. The method of claim 1 wherein the second electrode is implanted in the region of the atrioventricular node of the heart.
4. The method of claim 1 wherein the second electrode is implanted in a region effective to inhibit propagation of pulses from an atrium of the heart to a ventricle of the heart.
5. The method of claim 1 further comprising providing a third electrode and providing third electrical stimulation pulses to the heart from the third electrode and wherein the first electrode is implanted in a location effective to stimulate an atrium of the heart, the third electrode is implanted in a location effective to stimulate a ventricle of the heart, and the second electrode is implanted in the region of the atrioventricular node of the heart.
6. The method of claim 1 further comprising providing a third electrode and providing third electrical stimulation pulses to the heart from the third electrode and wherein the first electrode is implanted in a location effective to stimulate an atrium of the heart, the third electrode is implanted in a location effective to stimulate a ventricle of the heart, and the second electrode is implanted in a region effective to inhibit propagation of pulses from an atrium of the heart to a ventricle of the heart.
7. The method of claim 2 wherein the second electrode is implanted in the region of the atrioventricular node of the heart.
8. The method of claim 2 wherein the second electrode is implanted in a region effective to inhibit propagation of pulses from an atrium of the heart to a ventricle of the heart.
9. The method of claim 1 wherein the second electrode further comprises a sensor for sensing the activity of the heart muscle.
10. The method of claim 1 wherein the processing unit is capable of varying at least one intensity parameter selected from the group of pulse amplitude, duration and frequency.
11. The method of claim 1 wherein the second electrode is configured to generate sub-threshold stimulation pulses in the form of individual pulses.
12. The method of claim 1 wherein the second electrode is configured to generate sub-threshold stimulation pulses synchronously according to spontaneous heart activity.
13. The method of claim 1 wherein the second electrode is configured to generate sub-threshold stimulation pulses in the form of repeated pulse trains.
14. The method of claim 1 wherein the second electrode is configured to generate sub-threshold stimulation pulses asynchronously according to spontaneous heart activity.
FIELD OF THE INVENTION The present invention relates to a device and a method for electrical stimulation of the heart.
BACKGROUND OF THE INVENTION Experimental studies on animals and on man (such as those reported, for example, in the work �Electronic inhibition and active facilitation of excitability in ventricular muscle� by J. M. Davidenko, M. Delmar, and J. Beaumont in J. Cardiov. Electrophysiol. Vol. 5, No. 11 November 1994, pages 945-960), have shown the effects of subthreshold electrical stimuli on response to subsequent stimulations. These effects are referred to briefly by the term electrotonic inhibition. According to this research, the introduction of a subthreshold conditioning stimulus between two above-threshold stimulations is followed by a transitory decay in the excitability of the muscle stimulated. In particular, a subthreshold stimulus triggered a certain period of time before the subsequent above-threshold stimulus may delay the response to the subsequent stimulus in question, increasing so-called latency, that is, the interval between the pulse and the respective rapid front of the action potential, and even having an actual inhibition effect. The degree of inhibition is directly proportional to the amplitude and to the duration of the subthreshold conditioning stimulus and is inversely proportional to the post-conditioning period between the electrotonic inhibition pulse and the next stimulation pulse.
In this connection, the following references may be consulted: �On the mechanism(s) of atrioventricular nodal transmission in atrial fibrillation� by F. L. Meijler and J. Jalife in Cardiology 1997; 42(4); pages 375-384, and
�AV nodal function during atrial fibrillation; the role of electrotonic modulation of propagation� by F. L. Meijler, J. Jalife, J. Beaumont, and D. Vaidya in J. Cardiov. Electrophysiol. Vol. 7, No. 9 September 1996, pages 843-861.
�Subthreshold conditioning stimuli prolong human ventricular refractoriness� by J. R. Windle, W. M. Miles, D. P. Zipes, and E. N. Prystowsky, in Am. J. Cardiol. 1986; 57; pages 381-6, and
�Subthreshold stimulation in the region of the slow pathway during atrioventricular node re-entrant tachycardia: correlation with effect of radio-frequency catheter ablation� by S. Willems, C. Weiis, T. Hofmann, C. Rickers, and T. Meinertz in JACC Vol. 29, No. 2, February 1997, pages 408-15.
SUMMARY OF THE INVENTION The object of the present invention is to provide improved solutions which can take advantage of the above-described phenomenon, known as electrotonic inhibition, to achieve an improvement in the course of the electrical heart-stimulation effect.
BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 shows a block diagram of an electrical heart-stimulator device of the present invention.
DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS It should be noted that, in the current state of the art, only sporadic use of antitachycardia electrical stimulators temporarily programmed to deliver trains of subthreshold pulses in order to terminate re-entrant atrioventricular tachycardia is known; reference should be made in particular to the work �Ultra rapid subthreshold stimulation for termination of atrioventricular node re-entrant tachycardia� by M. Fromer and M. Shenasa, in JACC Vol. 20, No. 4, October 1992, pages 879-83.
In a preferred embodiment, the stimulator has an associated stimulation/sensing channel which can be dedicated independently to bringing about the electrotonic inhibition effect, preferably applied to the atrioventricular node. For this purpose, an electrode located chronically in the vicinity of this node can deliver stimuli of programmable amplitude, duration and frequency when a situation of atrial fibrillation is detected.
In FIG. 1, a device, generally indicated 1, is substantially comparable to a normal electrical atrioventricular stimulator and, according to the invention, has a supplementary module which can perform an electrotonic inhibition function. In particular, the set of circuit components�which can be considered generally known�form the means for bringing about the stimulation effect at the atrial level and at the ventricular level (i.e., generally indicated 2 and 3, respectively).
Each of electrodes 21 and 31 is also connected to processing and timing unit 4 by means of a so-called �sensing� line comprising, in series, filter 24, 34, for rejecting interference and spurious signals, and amplifier 25, 35 the gain of which is determined selectively by processing and timing unit 4 by means of atrial or ventricular gain-control line 250 or 350, respectively. The sensing signal coming from each amplifier 25 and 35 is compared, in a respective threshold comparator, indicated 26 or 36, with a threshold level set by processing and timing unit 4, by means of respective line 27 or 37.
Finally, respective detectors 28 and 38�of known type�can detect the value of the so-called �A� period (atrial period) and of the so-called �V� period (ventricular period) in dependence on the output signal of threshold comparators 26 and 36, generating corresponding�usually digital�signals for transmission to processing and timing unit 4 for processing and for bringing about a feedback effect on the driving of the stimulation.
Power stage 72 is driven by processing and timing unit 4 in substantially the same manner as stages 22 and 32, by means of a set of respective synchronizing (trigger), amplitude-control and duration-control lines 73. In particular, processing and timing unit 4 can impart to power stage 72, by means of lines 73, control and stimulation signals such as to give rise, by means of electrode 71, either to isolated subthreshold signals with a frequency comparable to the heart frequency, or to very rapid and repeated pulse trains. By way of example, one of these pulse trains may comprise, for example, 20 pulses at a frequency corresponding to 400 pulses per minute, these pulse trains possibly even being repeated tens of times.
A threshold comparator in which the output signal of amplifier 75 is compared with a threshold level transmitted by processing and timing unit 4 on line 77 is indicated 76. The result of the comparison is transmitted to detector 78 which identifies the duration of the so-called �AVJ� period, that is, the period of the signal detected by electrode 71 at its implantation site, and which transmits a corresponding signal to processing and timing unit 4.
Since it has been demonstrated in the past that the variability of heart frequency during atrial fibrillation is connected with the vagal tonus, studies have recently been performed (see in particular the work �Post-ganglionic vagal stimulation of the atrioventricular node reduces ventricular rate during atrial fibrillation� by S. Garrigue et al, in Pace, April 1998, Vol. 21, No. 4, Part II, page 878) to evaluate the effect in reducing ventricular frequency during atrial fibrillation (induced in animals�rabbits) of a post-ganglionic vagal stimulation directly in contact with the atrioventricular node. It has been found that post-ganglionic vagal stimulation performed, in particular, with pulse trains in the manner described above, in contact with the atrioventricular node, can achieve an effective reduction in ventricular frequency during atrial fibrillation.
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