Source: http://www.google.se/patents/US5025786?hl=sv
Timestamp: 2013-05-22 07:06:36
Document Index: 617843901

Matched Legal Cases: ['art.\n9', 'art.\n15', 'art.\n17', 'art.\n20', 'art 2', 'art 2']

Patent US5025786 - Intracardiac catheter and method for detecting and diagnosing myocardial ... - Google PatentS�k Bilder Kartor Play YouTube Nyheter Gmail Drive Mer » Avancerad patents�kning | Webbhistorik | Logga in Avancerad patents�kning PatentAn intracardiac catheter and method for detecting and diagnosing myocardial ischemia. The intracardiac catheter comprises a flexible, elongated body which is insertable into the heart of the subject. The distal portion of the catheter is insertable into the ventricle of the heart while an intermediate...http://www.google.se/patents/US5025786?utm_source=gb-gplus-sharePatent US5025786 - Intracardiac catheter and method for detecting and diagnosing myocardial ischemia PublikationsnummerUS5025786 ATyp av kung�relseBeviljande Ans�kningsnummer07/222,217 Publiceringsdatum25 jun 1991 Registreringsdatum21 jul 1988 Prioritetsdatum21 jul 1988 UppfinnareSharon B. Siegel Ursprunglig innehavareSiegel; Sharon B. USA-klassificering600/375600/486 Internationell klassificeringA61N1/05A61B5/042A61B5/0215 Kooperativ klassningA61N1/056A61B5/02158A61B2562/043A61B2562/0209A61B5/0422A61B5/6853 Europeisk klassificeringA61B5/68D1H1A61B5/0215HA61N1/05NA61B5/042DH�nvisningarCitat fr�n patent (4)Citat fr�n andra k�llor (14) H�nvisningar finns i f�ljande patent (129)Externa l�nkarUSPTO �verl�telse av �gander�tt till patent som har registrerats av USPTO EspacenetIntracardiac catheter and method for detecting and diagnosing myocardial ischemiaUS 5025786 A Sammanfattning An intracardiac catheter and method for detecting and diagnosing myocardial ischemia. The intracardiac catheter comprises a flexible, elongated body which is insertable into the heart of the subject. The distal portion of the catheter is insertable into the ventricle of the heart while an intermediate portion is insertable into an adjacent body chamber, likely the atrium. The catheter includes electrical sensing means having at least one sensing electrode at the distal end portion for measuring the electrical activity in the ventricle and means for preventing the sensing electrode from coming into direct contact with the endocardium. Pressure sensing means is provided on, at least the intermediate portion. The catheter has the capability of providing simultaneous indications of electrical activity within the ventricle and pressure within the adjacent body chamber, thus permitting correlation between indications of pressure and electrical activity.
What is claimed and desired to be secured by Letters Patent of the United States is: 1. An intracardiac catheter for sensing electrical activity and pressure within the heart of a living subject and for transmitting indications of this electrical activity and pressure to an external monitoring source, comprising: a) a flexible elongated body having an outer wall defining a lumen formed therein extending the length of said elongated body, said body having a proximal end portion and a distal end portion; b) electrical activity sensing means for measuring the electrical activity in a ventricle of the heart, including, at least one distally extending electric conductor having a proximal end and a distal end, said electric conductor extending within said lumen from said proximal end portion to said distal end portion, an electrically insulating sheath covering a substantial portion of said electric conductor, sensing electrode means connected to the distal end of the conductor, said sensing electrode means being capable of detecting electric currents from the ventricle, and means connected to the proximal end of the conductor to connect the electric conductor to said external monitoring source; c) means secured to the elongated body for preventing the sensing electrode means from coming into direct contact with the endocardium of the heart plus preventing obscuration of the sensed electrical currents by interference patterns; and d) pressure sensing means for sensing pressure in a body chamber adjacent said ventricle, said pressure sensing means extending within said lumen from an intermediate portion located between the distal portion and the proximal portion to said proximal portion, said pressure sensing means being connectable at a proximal end to said external monitoring source, wherein during utilization of the catheter said intermediate portion is positioned within said body chamber adjacent said ventricle and said distal portion is positioned in a ventricle of the heart, the catheter therefore having the capability of providing simultaneous indications of electrical activity within the ventricle and pressure within the adjacent body chamber, thus permitting correlation between indications of pressure and electrical activity.
2. The intracardiac catheter of claim 1 further including, ventricular pressure sensing means extending within said lumen from said distal portion to said proximal portion, said ventricular pressure sensing means having a distal end in sufficient proximity to said means for preventing contact so as to prevent contact of said distal end with the endocardium of the heart, said ventricular pressure sensing means being connectable at a proximal end thereof to said external monitoring source for providing indications of pressure within said ventricle during operation thereof.
3. The intracardiac catheter of claim 2 wherein: said ventricular pressure sensing means includes a plurality of axially spaced pressure sensors.
4. The intracardiac catheter of claim 1 wherein said adjacent chamber is an atrium, the catheter further including means secured to said elongated body at said intermediate portion for securely positioning the catheter and for preventing said pressure sensing means from coming into direct contact with the atrium, thus preventing distortion of the sensed pressure wave by interference.
5. The intracardiac catheter of claim 4 further including, atrial pacing means extending within said lumen from said proximal end portion and terminating with an atrial pacing electrode located on said means secured to said elongated body at said intermediate portion for securely positioning the catheter, said means for securing positioning including radially extending means which maintains contact with the atrial wall, said atrial pacing electrode being attached to and positioned with respect to said radially extending means so that the atrial pacing electrode is kept in contact with the atrial muscle so as to provide efficient pacing.
6. The intracardiac catheter of claim 4 wherein said means for securely positioning the catheter at said intermediate portion includes balloon means for such a secure positioning.
7. The intracardiac catheter of claim 4 wherein said means for securing said catheter at said intermediate portion includes first radially extending means locatable at a position proximal to the atrial wall and second radially extending means locatable distal to the atrial wall.
8. The intracardiac catheter of claim 1 further including, second electrical activity sensing means for measuring the electrical activity in said adjacent body chamber, having, at least one intermediate electric conductor extending within said lumen from a first end at said proximal end portion to a second end at said intermediate portion; an intermediate electrically insulating sheath covering a substantial portion of said intermediate electric conductor; intermediate sensing electrode means connected to the second end of the intermediate electric conductor, said intermediate electrode sensing means being capable of detecting electric currents in the adjacent body chamber; means connected to a proximal end of the intermediate electric conductor to connect the intermediate electric conductor to said external monitoring source; and means secured to the intermediate portion of said elongated body for securely positioning the catheter and preventing the intermediate sensing electrode means from coming into direct contact with the endocardium of the heart.
9. The intracardiac catheter of claim 1, wherein, said electrical activity sensing means for measuring the electrical activity in the ventricle of the heart includes, a plurality of distally extending electric conductors having parallel paths from said proximal end portion to said distal end portion, each electric conductor having a respective insulating sheath and a sensing electrode connected to its distal end, each sensing electrode being capable of detecting electric currents from the ventricle, said sensing electrodes being axially spaced apart within said distal end portion, said means for preventing the sensing electrode means from coming into direct contact with the endocardium, including means secured to said elongated body for preventing said sensing electrodes from coming into direct contact with the endocardium of the heart for preventing obscuration of the sensed electrical currents by interference patterns.
10. The intracardiac catheter of claim 1 further including, ventricular pacing means extending within said lumen from said proximal end portion and terminating at said distal end portion for providing electrical impulses to said endocardium in response to said indications of electrical activity and pressure.
11. The intracardiac catheter of claim 1 wherein the means for preventing the sensing means from contacting the endocardium includes electrically conductive balloon means for enclosing the sensing electrode means.
12. The intracardiac catheter of claim 11 wherein said balloon means includes a single balloon.
13. The intracardiac catheter of claim 11 wherein said balloon means includes a plurality of axially-spaced balloons.
14. The intracardiac catheter of claim 1, wherein: said electrical activity sensing means for measuring the electrical activity in the ventricle of the heart includes, a plurality of distally extending electric conductors having parallel paths from said proximal end portion to said distal end portion, each electric conductor having a respective insulating sheath and a sensing electrode connected to its distal end, each sensing electrode being capable of detecting electric currents from the ventricle, said sensing electrodes being axially spaced apart within said distal end portion, and said means for preventing said sensing electrode means from coming into direct contact includes a plurality of axially-spaced balloons being sufficiently spaced so as to form axially alternating balloon enclosed and unenclosed sections on the distal end portion of said elongated body, each said sensing electrode being located at one of said unenclosed sections, the balloon or balloons located adjacent to or being in sufficiently close proximity thereto so as to prevent contact of the sensing electrode with the endocardium of the heart.
15. The intracardiac catheter of claim 14 including a single ventricular pressure sensor.
16. The intracardiac catheter of claim 14 wherein said ventricular pressure sensing means includes a plurality of pressure ports, each being located in an unenclosed section in sufficiently close proximity to a balloon so as to prevent its contact with the endocardium of the heart.
17. The intracardiac catheter of claim 1 wherein said means for preventing the sensing electrode means from coming into direct contact with the endocardium includes radially extending means for urging said distal end portion of said elongated body away from the endocardium.
18. The intracardiac catheter of claim 17 wherein said radially extending means includes balloon means for such a radial extension.
19. The intracardiac catheter of claim 18 wherein: said electrical activity sensing means for measuring the electrical activity in the ventricle of the heart includes, a plurality of distally extending electric conductors having parallel paths from said proximal end portion to said distal end portion, each electric conductor having a respective insulating sheath and a sensing electrode connected to its distal end, each sensing electrode being capable of detecting electric currents from the ventricle, said sensing electrodes being axially spaced apart within said distal end portion, and said means for preventing said sensing electrode means from coming into direct contact includes a plurality of axially-spaced balloons being sufficiently spaced so as to form axially alternating balloon enclosed and unenclosed sections on the distal end portion of said elongated body, each said sensing electrode being located at one of said unenclosed sections, the balloon or balloons located adjacent to or being in sufficiently close proximity thereto so as to prevent contact of the sensing electrode with the endocardium of the heart.
20. The intracardiac catheter of claim 17 wherein said radially extending means includes bead means for such a radial extension.
21. A method for detecting and diagnosing myocardial ischemia in a living subject, comprising: a) inserting a catheter into the heart of the subject intraoperatively or in the laboratory transveneously, transeptally or transarterially, said catheter having sensing electrode means at a distal end portion which is insertable into a ventricle of the heart and pressure sensing means at an intermediate portion of the catheter which is insertable into a body chamber adjacent said ventricle; b) preventing said sensing electrode means from coming into direct contact with the endocardium of the heart thus preventing obscuration of the sensed electrical currents by interference patterns; c) sensing the electrical activity in the ventricle, with the sensing electrode means and pressure within the adjacent body chamber with the pressure sensing means; d) correlating the sensed electrical activity and pressure within the adjacent body chamber for evaluating the status of the heart and thereby permitting a diagnosis and treatment of myocardial ischemia.
This invention generally relates to intracardiac instruments and methods, and more particularly to an intracardiac catheter and a method with the capability for electrical sensing, pressure sensing and cardiac pacing that is especially well suited for detecting, diagnosing, and treating myocardial ischemia.
Present applicant has previously demonstrated the efficacy of utilizing a specially designed intracardiac catheter for detecting ischemia induced experimentally by partial coronary artery stenosis in dogs. (See the paper entitled "Intracardiac Electrode Detection of Early or Subendocardial Ischemia" by S. Siegel, et. al, Pace, Vol. 5, December 1982, pages 892-902. Also, the abstracts entitled "Detection of Ischemia with an Intracavitary Electrode" by S. Siegel, et. al, Pace, Vol. 5, March-April 1982, page 307; "Intracardiac Electrode Detection of Early or Subendocardial Ischemia" by S. Siegel et. al, Circulation Vol. 66 Part II, page 367; Onset of Ventricular Fibrillation" by S. Siegel et. al, Pace, Vol. 6, page A-136; and "Detection of Ischemia Presaging Ventricular Arrhythmias in Canines" by R. Brodman, S. Siegel et. al, Chest, Vol. 86, page 324.) The catheter disclosed in the above references included an elongated body having a lumen form therein. Electrical conducting means was contained within the lumen extending from a monitor at the proximal end to an electrical activity sensing electrode at the distal end.
The distal end of the catheter was placed in the ventricle of the heart. Analysis of resulting electrocardiographs demonstrated a correlation between the stenoses produced and the sensed electrogram.
Although potentially useful for detecting ischemia, the intracardiac catheter utilized in those references may have detected a variety of superimposed variables. The proximity of the sensing electrode to the ischemic area may have been variable and was not evaluated. Cardiac function may change drastically within seconds based upon any number of variable factors which are interrelated such as changes in volume status, peripheral vascular resistance, heart rate, rhythm and cardiac output. Cardiac output may significantly affect myocardial function and secondarily result in changes in myocardial perfusion or ischemia.
Proper diagnosis of ischemia as a primary event (e.g. spasm, graft closure, coronary thrombosis causing ischemia) or secondary event (e.g. due to hypovolumia; hypertension; tachycardia; bradycardia; pulmonary edema; loss of atrial kick; drop in cardiac output; etc.) is critical to accurate diagnosis and formulation of an appropriate plan of treatment. Thus, the previously disclosed catheter, although useful in detecting myocardial ischemia, lacked the capacity to diagnose and treat the problem.
OBJECTS AND SUMMARY OF THE INVENTION It is a primary object of the present invention, therefore, to effectively diagnose and treat myocardial ischemia.
It is another object to permit simultaneous, reliable, and instantaneous detection of multiple crucial variables, critical in producing or resulting from myocardial ischemia, including intracavitary pressure, rhythm, rate intracardiac electrogram--thus permitting appropriate evaluation, diagnosis and treatment and improve myocardial salvage.
It is another object to provide a means for pacing the atrium and/or ventricle, thus optimizing oxygen supply and hemodynamics of the heart with continuous feedback.
The invention is an intracardiac catheter and method for diagnosing and treating myocardial ischemia. In its broadest aspects, the intracardiac catheter comprises a flexible, elongated body which is insertable into the heart of the subject. The distal portion of the catheter is insertable into the ventricle of the heart while an intermediate portion is located in an adjacent body chamber, preferably the atrium. The catheter includes electrical sensing means having at least one sensing electrode at the distal end portion for measuring the electrical activity in the ventricle and means for preventing the sensing electrode from coming into direct contact with the endocardium. Pressure sensing means is provided on the intermediate portion. The catheter has the capability of providing simultaneous indications of electrical activity within the ventricle and pressure within the adjacent body chamber, thus permitting correlation between indications of pressure and electrical activity. This correlation is necessary in order to help determine whether the ischemia is a primary event or the result of some other condition, such a determination being critical for formulating an appropriate plan of treatment.
Preferably, the catheter includes balloons for preventing the sensing electrode or electrodes from coming into contact with the endocardium. However, a variety of other means may be utilized such as beads. It is also preferable to have pacing electrodes attached to the end balloon for pacing the heart. With the utilization of a single unit providing the capability of simultaneous input and analysis of various parameters (i.e. electrical activity at different locations, pressures at different locations) extremely effective feedback is provided for optimal pacing, volume, drug administration or other treatment. In this spirit it is contemplated that various combinations of sensing electrodes, pressure sensors, and balloons may be utilized, as described below.
BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a perspective view of a preferred embodiment of the intracardiac catheter of the present invention.
FIG. 2 is a front view, partially in cross-section, of an alternate embodiment of the present invention in which the balloons surround the electrical sensing means.
FIG. 3 is an illustration of a portion of an intracardiac catheter in accordance with an alternate embodiment of the invention in which perforated insulating material encircles the electrical activity sensing means.
FIG. 4 illustrates an alternate embodiment in which beads are utilized.
FIG. 5 is a simplified, cross-sectional view of a heart, with intracardiac catheters built in accordance with the present invention placed in the left and right ventricles by the transvenous, transeptal, transarterial and intraoperative approaches.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS Referring to the drawings and the characters of reference marked thereon the intracardiac catheter of the present invention is designated generally as 10 in FIG. 1. The catheter 10 includes a flexible, elongated body having an outer wall 12 defining a lumen 14 which extends the length of the body. The catheter 10 contains electrical activity sensing means, designated generally as 16 for measuring the electrical activity in a ventricle of the heart. Means 16 includes at least one distally extending electrical conductor 18 extending within the lumen 14 from the proximal end portion to a distal end portion. An electrically insulting sheath 20 covers a substantial portion of the electrical conductor 18. Sensing electrode means 22 are connected to the distal end of the conductor 18 for detecting electric currents from the ventricle. Plugs 24 are connected to the proximal end of the conductor 18 for connection to an external monitoring source (not shown).
The intracardiac catheter 10 includes means 26, secured to the elongated body, for preventing the sensing electrode means 22 from coming into direct contact with the endocardium of the heart. The intracardiac catheter 10 further includes pressure sensing means 28 for sensing pressure at an intermediate portion of the intracardiac catheter. Means 28 comprising a pressure port functions to measure pressure in a body chamber adjacent the ventricle, most likely the atrium.
Another electrical activity sensing means, designated generally as 30 may be utilized at the intermediate portion and is particularly useful for rhythm and rate determinations.
In the preferred embodiment illustrated in FIG. 1, the electrical activity sensing means 16 includes several distally extending, parallel pathed electrical conductors 18 terminating with axially spaced-apart sensing electrodes 22. Preventing contact of the sensing electrodes 22 with the endocardium of the heart is required in order to prevent obscuration of the sensed electrical currents by a current of injury or interference patterns. The means 26 for preventing contact may, as illustrated in FIG. 1, include inflatable balloons. Balloons 26 may be inflated or deflated by injection or aspiration by conduit and valve means more fully described below.
Ventricular pressure sensing may be accomplished by at least one pressure port 32. The pressure port 32 is located in close proximity to its adjacent balloons. Thus, the balloons, as well as preventing contact of the electrical sensing electrode means 16 with the endocardium, also prevent contact of the pressure port 32 with the endocardium. This prevents obscuration of the sensed pressure by interference patterns and assures an accurate pressure tracing. There may be a plurality of pressure ports, for example, also between the most distally positioned balloon and the adjacent balloon.
The most distally positioned balloon potentially extends beyond the length of the elongated body, as illustrated in FIG. 1. It may have pacing electrodes 34 attached, as illustrated. Pacing electrodes 34 permit cardiac pacing. Their position on the balloon assures sufficient contact so as to provide an efficient pacing. A commercially available fixation device 36, such as a screw-in device locatable at the catheter tip may also be utilized when deemed necessary.
Another balloon, designated 38, is located on the intermediate portion of the catheter 10. During use, when the catheter is passed through the atrium, the balloon 38 abuts the atrial wall and prevents the catheter from potentially sliding or being pulled out inadvertently. In addition, it prevents the pressure sensing port 28 from coming into contact with the atrial wall, thus preventing distortion of the sensed pressure wave by interference. The balloon is deflated in order to permit removal of the catheter. Pacing electrodes 40 are shown positioned on the balloon 38 so as to assure continuous contact of the electrodes 40 with the atrial wall and thus provide reliable atrial pacing.
Another balloon, designated 42, illustrated in phantom, is locatable on the other side of the atrial wall opposite balloon 38 as a further means for securely positioning the catheter 10. Movement of the catheter within the heart may result in misleading changes of data input into the monitor. Together with the fixation device 36, utilization of balloons 38, 42 maintains a relatively fixed relationship between the catheter 10 and the endocardium.
Referring now to FIG. 2, a portion of a catheter is illustrated in which a plurality of axially-spaced balloons 50 are utilized and sufficiently spaced to form axially-spaced enclosed and unenclosed sections on the distal end portion of the elongated body. The electrical activity sensing means 52 are enclosed by the balloons 50. (Thus this embodiment is distinguished from that described with reference to FIG. 1 in which the electrical activity sensing means lies outside of the balloon enclosed region.) A conduit 44 is included which extends through the lumen 46 adjacent the electrical conductor 48 and in communication with inflatable balloons 50. The conduit 44 may provide a physiologic electrolyte solution such as saline or blood from a reservoir or source located outside a patient for the balloons 50 to inflate the balloons when the electrical sensing means 52 is within the ventricle and to conduct the solution therefrom to collapse the balloons 50 prior to removal of the catheter 10. With a conductive solution in the embodiment of FIG. 2, the electrical sensing means 52 detects electric currents emanating from the blood surrounding conductive balloons 50 via the conductive solution in communication with the interior of the balloons 50.
As will be appreciated, other arrangements may be employed to prevent the electrical activity sensing means and pressure sensing means from coming into direct contact with the heart. For example, as shown in FIG. 3, insulating material 54 having one or a plurality of openings 56, encircles electrical sensing means 58. Or, other radially outward extending means may be utilized. For example, flaps may be utilized (not illustrated) which extend axially against the outer wall of the elongated body in constricted position during insertion and removal of the catheter. Upon positioning within the body chamber, the flaps would extend radially outward.
FIG. 4 illustrates yet another alternative means for preventing contact of the electrical sensing means with the endocardium of the heart. In this embodiment axially spaced beads 60 prevent such a contact.
The catheter of the present invention may be inserted during a surgical procedure or without such a procedure, transvenously, transeptally or transarterially. Referring now to FIG. 5, a simplified illustration of the heart, during a laboratory procedure, the catheter may be positioned from a venipuncture made in an arm vein, the subclavian vein, or femoral vein into the inferior or superior vena cava, and into the right atrium 70. For right-sided catheterization, the catheter, in this case designated generally as 64 can be passed through the tricuspid valve 66 and the distal portion positioned in the right ventricle 68, the intermediate portion being located in the right atrium 70. For left-sided transvenous catheterization, the catheter, in this case designated generally as 72 can be passed transeptally from the right atrium 70 to the left atrium 74 and then across the mitral valve 76 into the left ventricle 78. The intermediate portion of the catheter 72 would be located in the left atrium 74. Alternatively a catheter, designated generally as 80, may be inserted, in the laboratory, via a brachial or femoral artery through the aorta 82 into the left ventricle 78. In this scenario, the intermediate portion transmits data from the aorta 82 simultaneous with transmission of data from the left ventricle 78.
During open heart surgery the catheter would be particularly useful. Current available means of monitoring electrical activity of the heart during these long procedures is generally inadequate. The catheter, in this case designated generally as 84, can be inserted through a purse string on the superior pulmonary vein 85, through the left atrium 74, mitral valve 76, and positioned in the left ventricle 78. In less frequent situations, a catheter designated 86 can be inserted through a purse string on the wall of the right atrium 70 through the right atrium 70, the tricuspid valve 66 and into the right ventricle 68. In both cases the catheter traverses the mediastinum and passes out the chest wall through a pull-away introducer needle. The catheter could be removed a few days post operatively when no longer needed by simply deflating the balloons and pulling it out from where it exits from the chest wall. In the scenarios in which the catheter is inserted into the left ventricle by the transeptal or intraoperative approach, the intermediate portion is located in the left atrium (i.e. adjacent body cavity). When the catheter is positioned in the left ventricle by a transarterial approach (only used in particular circumstances) the intermediate portion is located in the aorta. In this instance no balloon would be utilized on the intermediate portion.
When the catheter is utilized, multiple parameters are being simultaneously monitored. If the measured intracardiac electrogram (i.e. data from electrical activity sensing means) exhibits a change pattern characteristic of ischemia, then the physician may immediately evaluate other simultaneously recorded parameters including vital signs, rate, rhythm, and left atrial pressure. If the patient is found to be bradycardic (slow heart rate), tachycardic (fast heart rate), in a junctional or ventricular rhythm then drugs can be administered or pacing instituted to correct the problem. If the patient is found to be hypotensive or hypertensive then fluid or drug manipulations could be instituted. If the patient is found to be hypovolumic (low atrial pressure) then transfusion or fluid administration would be initiated. If the patient is in pulmonary edema (high atrial pressure) then diuresis, vasodilation or isotopic support could be instituted.
The effect and degree of any of these interventions on the ischemic change can be assessed on a moment to moment basis and thus be curtailed or altered accordingly. If treatment of one of the above problems corrects the ischemia then nothing more need be done. If correction of all other parameters leaves persistent ischemia present then diagnosis of primary ischemia may be made and treatment of primary ischemia may be instituted.
Treatment of primary ischemia may include use of nitrates, or calcium blockers for spasm; anticoagulation for thrombosis; or angioplasty or surgery for occlusion. The efficacy of any intervention could be evaluated and titrated by continuous monitoring of all of the parameters as well as the intracardiac electrogram.
The importance of the simultaneous evaluation of all parameters is illustrated by the scenario below:
If ischemic change is detected on the electrogram and the other parameters not evaluated then the patient might be given a calcium blocker or nitrate. If hypovolemia or junctional rhythm are present then these could be made worse resulting in worsening of the ischemia with potential irreversible and disastrous results.
Therefore, as the above example illustrates, it is not only the detection of ischemia that is important but also the diagnosis of whether the ischemia is primary or secondary which is critical to the proper management thereof.
For example, although FIGS. 1 and 2 show a plurality of balloons which form a plurality of balloon enclosed and unenclosed sections along the distal end portion it is clear that a single balloon or other means for preventing contact may be utilized in either embodiment. Furthermore, although a plurality of sensing electrodes are illustrated along the distal end portion a single sensing electrode may be utilized. The particular combination of balloons, pressure sensors, sensing electrodes and pacing electrodes should be arranged according to the intended use.
Citat fr�n patent citerade patent Registreringsdatum Publiceringsdatum S�kande TitelUS399562311 feb 19767 dec 1976American Hospital Supply CorporationMultipurpose flow-directed catheterUS458501318 maj 198329 apr 1986Cordis CorporationLumenless pervenous electrical lead and method of implantationUS468111727 maj 198621 jul 1987Brodman; Richard F.Intracardiac catheter and a method for detecting myocardial ischemiaCA1192263A1 Ingen titel tillg�ngligCitat fr�n andra k�llorH�nvisning1Brodman and Siegel, et al.; "Detection of Ischemia Presaging Ventricular Arrhythmias in Canines"; Chest, vol. 86, p. 324, 1984 (Abstract).2Brodman and Siegel, et al.; Detection of Ischemia Presaging Ventricular Arrhythmias in Canines ; Chest, vol. 86, p. 324, 1984 (Abstract).3Chatterjee et al, "Multipurpose Flotation Electrode Catheter", Am. J. Card., vol. 33, p. 130, Jan. 1974.4Chatterjee et al, Multipurpose Flotation Electrode Catheter , Am. J. Card., vol. 33, p. 130, Jan. 1974.5Ganz et al, "Newer Applications . . . Disease", Med. Inst., vol. 6, #2, Mar.-Apr. 1972, p. 167.6Ganz et al, Newer Applications . . . Disease , Med. Inst., vol. 6, 2, Mar. Apr. 1972, p. 167.7Siegel, et al.; "Detection of Ischemia with an Intracavitary Electrode", Pace, vol. 5, Mar.-Apr. 1982, p. 307 (Abstract).8Siegel, et al.; "Intracardiac Electrode Detection of Early Ischemia Prior to the Onset of Ventricular Fibrillation"; Pace, vol. 6, p. A-136 (Abstract).9Siegel, et al.; "Intracardiac Electrode Detection of Early or Subendocardial Ischemia"; Circulation vol. 66, Part 2, p. 367, Oct. 1982 (Abstract).10Siegel, et al.; "Intracardiac Electrode Detection of Early or Subendocardial Ischemia"; Nov.-Dec. 1982, pp. 892-902.11Siegel, et al.; Detection of Ischemia with an Intracavitary Electrode , Pace, vol. 5, Mar. Apr. 1982, p. 307 (Abstract).12Siegel, et al.; Intracardiac Electrode Detection of Early Ischemia Prior to the Onset of Ventricular Fibrillation ; Pace, vol. 6, p. A 136 (Abstract).13Siegel, et al.; Intracardiac Electrode Detection of Early or Subendocardial Ischemia ; Circulation vol. 66, Part 2, p. 367, Oct. 1982 (Abstract).14Siegel, et al.; Intracardiac Electrode Detection of Early or Subendocardial Ischemia ; Nov. Dec. 1982, pp. 892 902. H�nvisningar finns i f�ljande patent citeras i Registreringsdatum Publiceringsdatum S�kande TitelUS510987026 okt 19905 maj 1992Forschungsgesellschaft Fur Biomedizinische Technik E.V.Apparatus for and method of motility and peristalsis monitoringUS529386925 sep 199215 mar 1994Ep Technologies, Inc.Cardiac probe with dynamic support for maintaining constant surface contact during heart systole and diastoleUS529754923 sep 199229 mar 1994Endocardial Therapeutics, Inc.Endocardial mapping systemUS530991025 sep 199210 maj 1994Ep Technologies, Inc.Cardiac mapping and ablation systemsUS531186623 sep 199217 maj 1994Endocardial Therapeutics, Inc.Heart mapping catheterUS531394325 sep 199224 maj 1994Ep Technologies, Inc.Catheters and methods for performing cardiac diagnosis and treatmentUS53797654 dec 199210 jan 1995Kajiwara; NagaoMonitoring apparatus for use in obtaining bronchial electrocardiogramUS539868718 maj 199221 mar 1995Wilson-Cook Medical Inc.Methods for measuring motility within the biliary tract and instrumentation useful thereforUS543898525 jan 19938 aug 1995Synectics Medical, IncorporatedAmbulatory recording of the presence and activity of substances in gastro-intestinal compartmentsUS544348923 sep 199422 aug 1995Biosense, Inc.Apparatus and method for ablationUS547198229 sep 19925 dec 1995Ep Technologies, Inc.Cardiac mapping and ablation systemsUS547785416 sep 199326 dec 1995Synectics Medical, Inc.System and method to monitor gastrointestinal Helicobacter pylori infectionUS54778605 nov 199226 dec 1995Synectics Medical, Inc.Catheter for measuring respiration and respiratory effortUS547993521 okt 19932 jan 1996Synectics Medical, Inc.Ambulatory reflux monitoring systemUS548042223 sep 19942 jan 1996Biosense, Inc.Apparatus for treating cardiac arrhythmiasUS549778030 mar 199412 mar 1996Biotronik Mess-Und Therapiegerate Gmbh & Co. Ingenieurburo BerlinApparatus for signal analysis of the electrical potential curve of heart excitationUS550728923 mar 199416 apr 1996Synectics Medical, Inc.System and method to diagnose bacterial growthUS550941916 dec 199323 apr 1996Ep Technologies, Inc.Cardiac mapping and ablation systemsUS553624728 apr 199516 jul 1996Scimed Life Systems, Inc.Method of treating cardiac conduction defectsUS554695123 sep 199420 aug 1996Biosense, Inc.Method and apparatus for studying cardiac arrhythmiasUS55491081 jun 199427 aug 1996Ep Technologies, Inc.Cardiac mapping and ablation systemsUS555142518 jan 19953 sep 1996Synectics Medical, Inc.Potential difference and perfusion pressure catheterUS555142614 jul 19933 sep 1996Berger; Ronald D.Intracardiac ablation and mapping catheterUS556880912 jul 199529 okt 1996Biosense, Inc.Apparatus and method for intrabody mappingUS56577596 jan 199519 aug 1997Synectics Medical, IncorporatedMeasurement of gastric emptying and gastrointestinal outputUS56651037 mar 19969 sep 1997Scimed Life Systems, Inc.Stent locating deviceUS570190513 nov 199530 dec 1997Localmed, Inc.Guide catheter with sensing elementUS571394628 okt 19963 feb 1998Biosense, Inc.Apparatus and method for intrabody mappingUS57182417 jun 199517 feb 1998Biosense, Inc.Apparatus and method for treating cardiac arrhythmias with no discrete targetUS57380961 feb 199614 apr 1998Biosense, Inc.Cardiac electromechanicsUS57952987 mar 199718 aug 1998Sonometrics CorporationSystem for sharing electrocardiogram electrodes and transducersUS57978497 mar 199725 aug 1998Sonometrics CorporationMethod for carrying out a medical procedure using a three-dimensional tracking and imaging systemUS581074121 dec 199522 sep 1998Synectics Medical AbMethod of measuring respiration and respiratory effort using plural cathetersUS581702211 mar 19976 okt 1998Sonometrics CorporationSystem for displaying a 2-D ultrasound image within a 3-D viewing environmentUS58301446 mar 19973 nov 1998Sonometrics CorporationTracking data sheathUS583362519 dec 199510 nov 1998Synectics Medical AbAmbulatory reflux monitoring systemUS584002521 nov 199724 nov 1998Biosense, Inc.Apparatus and method for treating cardiac arrhythmiasUS586867311 mar 19979 feb 1999Sonometrics CorporationSystem for carrying out surgery, biopsy and ablation of a tumor or other physical anomalyUS587144314 nov 199616 feb 1999Ep Technologies, Inc.Cardiac mapping and ablation systemsUS595466523 okt 199721 sep 1999Biosense, Inc.Cardiac ablation catheter using correlation measureUS601644326 mar 199818 jan 2000Pacesetter AbImplantable ischemia detector and implantable stimulator employing sameUS60197257 mar 19971 feb 2000Sonometrics CorporationThree-dimensional tracking and imaging systemUS60660949 jan 199823 maj 2000Biosense, Inc.Cardiac electromechanicsUS608658130 jul 199311 jul 2000Ep Technologies, Inc.Large surface cardiac ablation catheter that assumes a low profile during introduction into the heartUS611562829 mar 19995 sep 2000Medtronic, Inc.Method and apparatus for filtering electrocardiogram (ECG) signals to remove bad cycle information and for use of physiologic signals determined from said filtered ECG signalsUS611563029 mar 19995 sep 2000Medtronic, Inc.Determination of orientation of electrocardiogram signal in implantable medical devicesUS612852629 mar 19993 okt 2000Medtronic, Inc.Method for ischemia detection and apparatus for using sameUS61323721 apr 199717 okt 2000Synectics Medical, IncorporatedMeasurement of gastric emptying and gastrointestinal outputUS621602716 dec 199710 apr 2001Cardiac Pathways CorporationSystem for electrode localization using ultrasoundUS623348613 jan 199815 maj 2001Pacesetter AbIschemia detector and heart stimulator provided with such an ischemia detectorUS624030723 sep 199329 maj 2001Endocardial Solutions, Inc.Endocardial mapping systemUS62468988 maj 199812 jun 2001Sonometrics CorporationMethod for carrying out a medical procedure using a three-dimensional tracking and imaging systemUS625653813 jan 19983 jul 2001Pacesetter AbImplantable heart stimulatorUS62646065 feb 199824 jul 2001Pacesetter AbIschemia detectorUS626465427 jul 199924 jul 2001Daig CorporationAblation catheterUS626654822 jun 199824 jul 2001Lamade WolframIndotracheal tubeUS63080937 okt 199923 okt 2001Massachusetts Institute Of TechnologyMethod and apparatus for guiding ablative therapy of abnormal biological electrical excitationUS632442129 mar 199927 nov 2001Medtronic, Inc.Axis shift analysis of electrocardiogram signal parameters especially applicable for multivector analysis by implantable medical devices, and use of sameUS637041228 mar 20009 apr 2002Massachusetts Institute Of TechnologyMethod and apparatus for guiding ablative therapy of abnormal biological electrical excitationUS637935222 mar 200030 apr 2002Ep Technologies, Inc.Large surface cardiac ablation catherter that assumes a low profile during introduction into the heartUS638149328 sep 199930 apr 2002Medtronic, Inc.Ischemia detection during non-standard cardiac excitation patternsUS63971001 okt 200128 maj 2002Medtronic, Inc.Axis shift analysis of electrocardiogram signal parameters especially applicable for multivector analysis by implantable medical devices, and use of sameUS647521327 jan 20005 nov 2002Ep Technologies, Inc.Method of ablating body tissueUS64904741 aug 19973 dec 2002Cardiac Pathways CorporationSystem and method for electrode localization using ultrasoundUS651294912 jul 199928 jan 2003Medtronic, Inc.Implantable medical device for measuring time varying physiologic conditions especially edema and for responding theretoUS660508717 jul 200112 aug 2003St. Jude Medical, Daig DivisionAblation catheterUS66476177 jun 200018 nov 2003St. Jude Medical, Atrial Fibrillation Division, Inc.Method of construction an endocardial mapping catheterUS68264217 jun 200030 nov 2004St. Jude Medical, Atrial Fibrillation Division, Inc.Endocardial mapping catheterUS691242010 apr 200128 jun 2005Cardiac Pacemakers, Inc.Cardiac rhythm management system for hypotensionUS69506893 aug 199827 sep 2005Boston Scientific Scimed, Inc.Dynamically alterable three-dimensional graphical model of a body regionUS697073321 okt 200229 nov 2005Scimed Life Systems, Inc.System and method for electrode localization using ultrasoundUS701317825 sep 200214 mar 2006Medtronic, Inc.Implantable medical device communication systemUS713961311 dec 200321 nov 2006Medtronic, Inc.Implantable medical device communication system with pulsed power biasingUS717768111 apr 200313 feb 2007Cardiac Pacemakers, Inc.Cardiac rhythm management system for edemaUS718920812 apr 200013 mar 2007Endocardial Solutions, Inc.Method for measuring heart electrophysiologyUS719100031 jul 200113 mar 2007Cardiac Pacemakers, Inc.Cardiac rhythm management system for edemaUS721599223 sep 20038 maj 2007Cardiac Pacemakers, Inc.Method for ischemia detection by implantable cardiac deviceUS72264229 okt 20025 jun 2007Cardiac Pacemakers, Inc.Detection of congestion from monitoring patient response to a recumbent positionUS72633976 apr 200428 aug 2007St. Jude Medical, Atrial Fibrillation Division, Inc.Method and apparatus for catheter navigation and location and mapping in the heartUS72749657 feb 200525 sep 2007Pacesetter, Inc.Trans-septal intra-cardiac lead systemUS727774515 sep 20022 okt 2007Infinite Biomedical Technologies, LlcImplantable myocardial ischemia detection, indication and action technologyUS72898433 dec 200430 okt 2007St. Jude Medical, Atrial Fibrillation Division, Inc.Software for mapping potential distribution of a heart chamberUS73402887 feb 20054 mar 2008Pacesetter, Inc.Trans-septal intra-cardiac lead systemUS734029618 maj 20054 mar 2008Cardiac Pacemakers, Inc.Detection of pleural effusion using transthoracic impedanceUS73843954 jan 200710 jun 2008Cardiac Pacemakers, Inc.Detection of congestion from monitoring patient response to a recumbent positionUS738761019 aug 200417 jun 2008Cardiac Pacemakers, Inc.Thoracic impedance detection with blood resistivity compensationUS73891347 feb 200517 jun 2008Pacesetter, Inc.Trans-septal intra-cardiac lead systemUS741886821 feb 20062 sep 2008Pacesetter, Inc.Pressure sensor and method of fabricating such a moduleUS742256029 okt 20079 sep 2008Cardiac Pacemakers, Inc.Detection of congestion from monitoring patient response to a recumbent positionUS74489997 feb 200511 nov 2008Pacesetter, Inc.Trans-septal intra-cardiac lead systemUS74509997 feb 200511 nov 2008Pacesetter, Inc.Trans-septal intra-cardiac lead systemUS757222628 okt 200311 aug 2009Cardiac Pacemakers, Inc.System and method for monitoring autonomic balance and physical activityUS764846419 jul 200619 jan 2010Pacesetter, Inc.Detecting ischemia using an implantable cardiac device based on morphology of cardiac pressure signalUS767029730 jun 19982 mar 2010St. Jude Medical, Atrial Fibrillation Division, Inc.Chamber mapping systemUS767271816 jun 20082 mar 2010Cardiac Pacemakers, Inc.Thoracic impedance detection with blood resistivity compensationUS77649957 jun 200427 jul 2010Cardiac Pacemakers, Inc.Method and apparatus to modulate cellular regeneration post myocardial infarctUS776501512 jan 200727 jul 2010Cardiac Pacemakers, Inc.Lead with inflatable fixation mechanismUS77740576 sep 200510 aug 2010Cardiac Pacemakers, Inc.Method and apparatus for device controlled gene expression for cardiac protectionUS780682927 jan 20055 okt 2010St. Jude Medical, Atrial Fibrillation Division, Inc.System and method for navigating an ultrasound catheter to image a beating heartUS78268817 jun 20002 nov 2010St. Jude Medical, Atrial Fibrillation Division, Inc.Endocardial chamber mapping systemUS782871116 aug 20049 nov 2010Cardiac Pacemakers, Inc.Method and apparatus for modulating cellular growth and regeneration using ventricular assist deviceUS78312887 jun 20009 nov 2010St. Jude Medical, Atrial Fibrillation Division, Inc.Method for mapping potential distribution of a heart chamberUS783316410 aug 200916 nov 2010Cardiac Pacemakers, Inc.System and method for monitoring autonomic balance and physical activityUS784026327 feb 200423 nov 2010Cardiac Pacemakers, Inc.Method and apparatus for device controlled gene expressionUS78817811 dec 20091 feb 2011Cardiac Pacemakers, Inc.Thoracic impedance detection with blood resistivity compensationUS793001230 sep 200419 apr 2011St. Jude Medical, Atrial Fibrillation Division, Inc.Chamber location methodUS796220825 apr 200514 jun 2011Cardiac Pacemakers, Inc.Method and apparatus for pacing during revascularizationUS797911510 jan 200812 jul 2011Cardiac Pacemakers, Inc.Detection of pleural effusion using transthoracic impedanceUS798106520 dec 200419 jul 2011Cardiac Pacemakers, Inc.Lead electrode incorporating extracellular matrixUS80240407 jun 200420 sep 2011Cardiac Pacemakers, Inc.Method and system for treatment of neurocardiogenic syncopeUS806021920 dec 200415 nov 2011Cardiac Pacemakers, Inc.Epicardial patch including isolated extracellular matrix with pacing electrodesUS81628427 dec 200924 apr 2012Pacesetter, Inc.Detecting ischemia using an implantable cardiac device based on morphology of cardiac pressure signalUS820032610 sep 200912 jun 2012Cardiac Pacemakers, Inc.Calibration of impedance monitoring of respiratory volumes using thoracic D.C. impedanceUS82089983 nov 200526 jun 2012St. Jude Medical, Atrial Fibrillation Division, Inc.Representing the geometry of a heart chamberUS824435215 jun 200914 aug 2012Cardiac Pacemakers, Inc.Pacing catheter releasing conductive liquidUS83337059 sep 201018 dec 2012St. Jude Medical, Atrial Fibrillation Division, Inc.System and method for navigating an ultrasound catheter to image a beating heartUS834635625 mar 20101 jan 2013Cardiac Pacemakers, Inc.Method for preparing an implantable controlled gene or protein delivery deviceUS839656329 jan 201012 mar 2013Medtronic, Inc.Clock synchronization in an implantable medical device systemUSRE4133423 sep 199311 maj 2010St. Jude Medical, Atrial Fibrillation Division, Inc.Endocardial mapping systemEP0867146A112 mar 199830 sep 1998Pacesetter ABIschemia detector sensing repolarisation of the heartEP1201198A127 okt 20002 maj 2002MicroNet Medical, Inc.Catheter with thin film electrodes and method for making sameEP2269505A12 jul 20105 jan 2011St. Jude Medical, Atrial Fibrillation Division, Inc.Apparatus and methods for contactless electrophysiology studiesWO1994013200A125 okt 199323 jun 1994Medtronic, Inc.Implantable pressure sensor leadWO1998031279A113 jan 199823 jul 1998Ekwall, ChristerIschemia detector and heart stimulator provided with such an ischemia detectorWO1998031421A113 jan 199823 jul 1998Ekwall, ChristerImplantable heart stimulatorWO1998034537A15 feb 199813 aug 1998Ekwall, ChristerIschemia detectorWO2001013789A125 aug 20001 mar 2001Andrews, SimonImprovements relating to catheter positioningWO2003053237A218 dec 20023 jul 2003Scimed Life Systems, Inc.Pressure-sensing guidewire and sheathWO2005107850A112 apr 200517 nov 2005Medtronic, Inc.Trans-septal cardiac 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