CN106068141A - 用于检测心脏心律失常的系统和方法 - Google Patents
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- A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
- A61B5/316—Modalities, i.e. specific diagnostic methods
- A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
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- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/362—Heart stimulators
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- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/362—Heart stimulators
- A61N1/3621—Heart stimulators for treating or preventing abnormally high heart rate
- A61N1/3622—Heart stimulators for treating or preventing abnormally high heart rate comprising two or more electrodes co-operating with different heart regions
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- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/372—Arrangements in connection with the implantation of stimulators
- A61N1/37211—Means for communicating with stimulators
- A61N1/37252—Details of algorithms or data aspects of communication system, e.g. handshaking, transmitting specific data or segmenting data
- A61N1/37288—Communication to several implantable medical devices within one patient
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- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/372—Arrangements in connection with the implantation of stimulators
- A61N1/375—Constructional arrangements, e.g. casings
- A61N1/3756—Casings with electrodes thereon, e.g. leadless stimulators
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- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/38—Applying electric currents by contact electrodes alternating or intermittent currents for producing shock effects
- A61N1/39—Heart defibrillators
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- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/38—Applying electric currents by contact electrodes alternating or intermittent currents for producing shock effects
- A61N1/39—Heart defibrillators
- A61N1/3956—Implantable devices for applying electric shocks to the heart, e.g. for cardioversion
- A61N1/3962—Implantable devices for applying electric shocks to the heart, e.g. for cardioversion in combination with another heart therapy
- A61N1/39622—Pacing therapy
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- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/0002—Remote monitoring of patients using telemetry, e.g. transmission of vital signals via a communication network
- A61B5/0004—Remote monitoring of patients using telemetry, e.g. transmission of vital signals via a communication network characterised by the type of physiological signal transmitted
- A61B5/0006—ECG or EEG signals
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/0002—Remote monitoring of patients using telemetry, e.g. transmission of vital signals via a communication network
- A61B5/0031—Implanted circuitry
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/48—Other medical applications
- A61B5/4836—Diagnosis combined with treatment in closed-loop systems or methods
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/68—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient
- A61B5/6846—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive
- A61B5/6847—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive mounted on an invasive device
- A61B5/686—Permanently implanted devices, e.g. pacemakers, other stimulators, biochips
Abstract
用于使用患者内的多个植入装置来协调异常心脏活动的检测和/或治疗的系统和方法。在一个示例中,可用两个或更多医疗装置包括无引线心脏起搏器来感测心脏活动。由植入装置中的一个感测到的心脏活动可被传送到植入装置中的另一个。然后可基于两个医疗装置的心脏活动来确定异常心脏活动。
Description
技术领域
本公开一般地涉及用于检测心脏心律失常的系统、装置以及方法,并且更具体地涉及用于检测和识别心脏心律失常的多装置系统、方法以及装置。
背景技术
可以使用起搏器械来治疗遭受心脏的能力下降的各种心脏疾病的患者以向患者的身体递送足够量的血液。这些心脏疾病可导致快速、不规则和/或抵消的心脏收缩。为了帮助减轻这些疾病中的某些,可以在患者的身体中植入各种装置(例如,起搏器、除颤器等)。此类装置可监视并向心脏提供电刺激以帮助心脏以更加正常、高效和/或安全的方式操作。在某些情况下,患者可具有多个植入装置。
发明内容
本公开一般地涉及用于使用患者体内的多个植入装置来协调异常心脏活动的检测和/或治疗的系统和方法。可设想的是多个植入装置可根据期望而包括例如起搏器、除颤器、诊断装置和/或任何其它适当的可植入装置。
在一个示例中,可植入无引线心脏起搏器(LCP)以帮助确定和/或治疗快速性心律失常。可以单独地或与一个或多个其它装置相组合地使用一个或多个无引线心脏起搏器(LCP)来感测心脏的心脏活动。可以在心脏的紧密接近区域中植入无引线心脏起搏器(LCP),诸如在心脏中或上面。在某些情况下,用一个或多个无引线心脏起搏器(LCP)来感测心脏活动可以帮助系统确定心脏心律失常的发生。出于治疗的目的,可以用植入装置中的至少一个来递送电刺激治疗,例如防快速性心律失常起搏(ATP)治疗。此类治疗可以帮助治疗检测到的心脏心律失常。
一种识别心脏的快速性心律失常的说明性方法可包括:由医疗装置来感测心脏活动;由第一无引线心脏起搏器来感测心脏活动,其中,第一无引线心脏起搏器与医疗装置间隔开并经由包括患者身体的通信路径而可通信地耦合到医疗装置;以及至少部分地基于由医疗装置感测的心脏活动和由第一无引线心脏起搏器感测的心脏活动两者来确定快速性心律失常是否正在发生。
识别患者的心脏的快速性心律失常的另一说明性方法可包括:由医疗装置来感测心脏活动;由第一无引线心脏起搏器来感测心脏活动,其中,第一无引线心脏起搏器经由包括患者身体的通信路径而可通信地耦合到医疗装置;由医疗装置和第一无引线心脏起搏器中的一个或多个至少部分地基于由医疗装置感测的心脏活动和/或由第一无引线心脏起搏器感测的心脏活动来确定快速性心律失常是否正在发生;以及在确定快速性心律失常正在发生之后,由医疗装置和第一无引线心脏起搏器中的一个或多个至少部分地基于由医疗装置感测的心脏活动和/或由第一无引线心脏起搏器感测的心脏活动两者来确定快速性心律失常的类型。
以上发明内容并不意图描述本公开的每个实施例或每个实施方式。通过参考接合附图进行的以下描述和权利要求,本公开的优点和成就以及其更全面理解将变得显而易见并被认识到。
附图说明
结合附图而考虑各种说明性实施例的以下描述可更全面地理解本公开,在所述附图中:
图1图示出根据本公开的各种示例的可使用的示例性医疗装置的框图;
图2图示出根据本公开的一个示例的具有电极的示例性无引线心脏起搏器(LCP);
图3是包括与本公开相互通信的多个无引线心脏起搏器(LCP)和/或其它装置的示例性医疗系统的示意图;
图4是根据本公开的另一示例的包括LCP和另一医疗装置的系统的示意图;
图5是根据本公开的另一示例的包括LCP和另一医疗装置的系统的示意图;
图6是图示出根据本公开的另一示例的多无引线心脏起搏器(LCP)系统的示意图;
图7图示出根据本公开的另一示例的多个无引线心脏起搏器(LCP)系统的示意图;
图8是图示出根据本公开的另一示例的其中在心脏的单个室内植入两个LCP的多个无引线心脏起搏器(LCP)系统的示意图;
图9是图示出根据本公开的另一示例的其中在心脏的心外膜表面上植入LCP中的一个的多无引线心脏起搏器(LCP)系统的示意图;
图10是包括主装置和多个从属装置的示例性医疗装置的框图;以及
图11—23是可由医疗装置系统(诸如相对于图3—10所述的那些医疗装置系统)实现的各种说明性方法的流程图。
虽然本公开可修改为多种改型和替代形式,但是已经在附图中以示例的方式示出其特定细节,并将进行详细描述。然而,应理解的是并不意图使本公开的各方面局限于所描述的特定说明性实施例。相反地,意图涵盖落在本公开的精神和范围内的所有修改、等价物以及替换方案。
具体实施方式
应参考其中将不同图中的类似元件相同地编号的各图来阅读以下描述。本描述和不一定按比例的附图描绘说明性实施例,并且并不意图限制本公开的范围。
正常的健康的心脏通过遍及整个心脏传导固有地生成的电信号而引发收缩。这些固有信号促使心脏的肌细胞或组织收缩。此收缩迫使血液从心脏出来和进入心脏,遍及身体的其余部分提供血液的循环。然而,许多病人遭受影响其心脏的此收缩性的心脏疾病。例如,某些心脏可逐渐产生不再生成或传导固有电信号的有病组织。在某些示例中,有病的心脏组织以不同的速率传导电信号,从而引起心脏的不同步和低效收缩。在其它示例中,心脏可以如此低、以致于心率变得有危险地低的速率生成固有信号。在其它示例中,心脏可以异常高的速率生成电信号。在某些情况下,此类异常可以发展成纤维性颤动状态,其中,患者心脏的收缩是几乎完全去同步的,并且心脏几乎不泵送血液。
已经开发了许多医疗系统以帮助经历此类异常的患者。例如,已经开发了用以感测固有心脏电信号并基于感测的电信号确定患者是否正在遭受一个或多个心律失常的系统。此类系统还可包括向患者的心脏递送电刺激以便治疗检测到的心律失常的能力。在一个示例中,某些医疗装置系统包括识别心脏何时在以过低的速率搏动(称为心搏徐缓)的能力。此类系统可递送电刺激治疗或“起搏”脉冲,其促使心脏以更高、更安全的速率收缩。某些医疗装置系统能够缺失心脏何时以过快的速率搏动,称为心率过速。此类系统还可包括一个或多个防心动过速起搏(ATP)治疗。一个此类ATP治疗包括以快于固有生成信号的速率向心脏递送电刺激脉冲。虽然这可临时地促使心脏更快地搏动,此类刺激协议可促使心脏响应于递送的起搏脉冲而收缩,与固有生成信号相反。ATP治疗然后可使递送的起搏脉冲的速率减慢,从而将心率降低至更低、更安全水平。
其它医疗状纸系统可能能够检测纤维性颤动状态和异步收缩。例如,基于感测信号,某些系统可能能够确定心脏何时处于纤维性颤动状态。此类系统可进一步被配置成用电刺激治疗来治疗此类纤维性颤动状态。一个此类治疗包括向心脏递送相对大量的电能“除颤脉冲”,目的是克服任何固有生成信号。此类治疗可使心脏“复位”,从电学观点出发,其可允许正常电过程接管。其它医疗系统可能能够感测到固有生成信号是在不同的时间生成或者心脏以不同的速率传导此类信号。这些异常可导致不同步的低效心脏收缩。系统还可包括管理一个或多个心脏再同步治疗(CRT)的能力。一个此类CRT可包括在心脏上和/或内的不同位置处向心脏递送电刺激。这种方法可帮助心脏的不同部分接近同时地或者以同步方式(如果系统在不同的时间向不同位置递送电刺激的话)收缩。
本公开一般地涉及用于使用患者体内的多个植入装置来协调异常心脏活动的检测和/或治疗的系统和方法。在某些情况下,一种医疗装置系统可包括用于检测心脏心律失常并递送电刺激治疗的多个装置。例如,说明性系统可包括诸如皮下复律除颤器(S-ICD)、外部复律除颤器、植入式心脏起搏器(ICP)、无引线心脏起搏器(LCP)和/或仅诊断装置(可感测心脏电信号和/或确定心律失常但不递送电刺激治疗的装置)。
图1图示出根据本发明的各种示例的可使用的示例性医疗装置100(在下文中称为MD 100)的框图。在某些情况下,MD 100可被用于感测固有心脏活动、确定心律失常的发生并响应于确定心律失常的发生而递送电刺激。在某些情况下,可以在患者体内、在特定位置处(例如,紧密接近于患者的心脏处)植入MD 100,以感测和/或调节心脏的心脏活动。在其它示例中,MD 100可位于患者体外以感测和/或调节心脏的心脏活动。在一个示例中,心脏收缩一般地由心脏固有地生成的电信号引起。这些电信号通过心脏组织传导,促使心脏的肌细胞收缩。MD 100可包括允许MD 100感测心脏的此类电信号和/或其它物理参数(例如,机械收缩、心音、血压、血氧水平等)的特征。可将此类电信号和/或物理性质视为“心脏活动”。MD 100可包括基于感测到的心脏活动来确定心律失常的发生的能力。在某些示例中,MD 100可能能够向心脏递送电刺激以便治疗任何检测到的心律失常。例如,MD 100可被配置成递送电刺激、起搏脉冲、除纤颤脉冲等以便实现一个或多个治疗,诸如心搏徐缓治疗、ATP治疗、CRT、除颤或其它电刺激治疗。
图1是一个示例性医疗装置100的图示。说明性MD 100可包括感测模块102、脉冲发生器模块104、处理模块106、遥测模块108以及电池110,其全部被容纳在外壳120内。MD 100还可包括引线112以及被附着到外壳120且与被容纳在外壳120内的模块102、104、106和108中的一个或多个进行电通信的电极114。
引线112可连接到MD 100的外壳120并远离该外壳120延伸。在某些示例中,在患者的心脏(诸如心脏115)上或内部植入引线112。引线112可包含一个或多个电极114,其位于引线112上的各种位置并距外壳120一个距离。某些引线112可仅包括单个电极114,而其它引线112可包括多个电极114。一般地,电极114位于引线112上,使得当引线112被植入患者体内时,一个或多个电极114与患者的心脏组织接触。因此,电极114可将固有生成电信号传导到引线112。引线112又可将接收到的电信号传导至MD 100的一个或多个模块102、104、106和108。以类似方式,MD 100可生成电刺激,并且引线112可将生成的电刺激传导到电极114。电极114然后可将电信号传导到患者的心脏组织。当讨论感测固有信号并递送电刺激时,本公开可考虑在那些过程中隐含的此类传导。
感测模块102可被配置成感测心脏的心脏电活动。例如,感测模块102可通过引线112连接到引线112和电极114,并且感测模块102可被配置成接收通过电极114和引线112传导的心脏电信号。在某些示例中,引线112可包括测量心脏和/或患者的生理参数的各种传感器,诸如加速度计、血压传感器、心音传感器、血氧传感器及其它传感器。在其它示例中,可将此类传感器直接地连接到感测模块102而不是引线112。在任何情况下,感测模块102可被配置成接收由直接地或通过引线112连接到感测模块102的任何传感器产生的此类信号。感测模块102可另外连接到处理模块106,并且可被配置成将此类接收到的信号传送到处理模块106。
脉冲发生器模块104可连接到电极114。在某些示例中,脉冲发生器模块104可被配置成生成电刺激信号以向心脏提供电刺激治疗。例如,脉冲发生器模块104可通过使用存储在MD 100内的电池110中的能量来生成此类信号。脉冲发生器模块104可被配置成生成电刺激信号以便提供许多不同治疗中的一个或多个。例如,脉冲发生器模块104可被配置成生成电刺激信号以提供心搏徐缓治疗、心动过速治疗、心脏再同步化治疗以及纤维性颤动治疗。心搏徐缓治疗可包括以快于固有生成电信号的速率生成并递送起搏脉冲以便尝试增加心率。心动过速治疗可包括如本文所述的ATP治疗。心脏再同步化治疗可包括也在本文中描述的CRT治疗。纤维性颤动治疗可包括递送纤维性颤动脉冲以尝试压倒心脏并停止纤维性颤动状态。在其它示例中,脉冲发生器104可被配置成生成电刺激信号以提供不同于本文所述那些的电刺激治疗以治疗一个或多个检测到的心律失常。
处理模块106可以被配置成控制MD 100的操作。例如,处理模块106可被配置成从感测模块102接收电信号。基于接收到的信号,处理模块106可能能够确定心律失常的发生。基于任何确定的心律失常,处理模块106可被配置成根据一个或多个治疗控制脉冲发生器模块104生成电刺激以治疗所确定的一个或多个心律失常。处理模块106可进一步从遥测模块108接收信息。在某些示例中,处理模块106可在确定心律失常是否正在发生时使用此类接收到的信息或者响应于该信息而采取特定动作。处理模块106可另外控制遥测模块108向其它装置发送信息。
在某些示例中,处理模块106可包括预编程芯片,诸如超大规模集成(VLSI)芯片或专用集成电路(ASIC)。在此类实施例中,可用控制逻辑对芯片进行预编程以便控制MD 100的操作。通过使用预编程芯片,处理模块106可在能够保持基本功能的同时使用比其它可编程电路少的功率,从而增加MD 100的电池寿命。在其它示例中,处理模块106可包括可编程微处理器。此类可编程微处理器可允许用户调整MD 100的控制逻辑,从而允许有比在使用预编程芯片时更大的MD 100的灵活性。在某些示例中,处理模块106还可包括存储器电路,并且处理模块106可在存储器电路上存储信息和从存储器电路读取信息。在其它示例中,MD100可包括与处理模块106通信的单独存储器电路(未示出),使得处理模块106可向和从单独存储器电路读和写信息。
遥测模块108可被配置成与位于MD 100外部的装置(诸如传感器、其它医疗装置等)通信。此类装置可位于患者的身体外部或内部。无论位置如何,外部装置(即在MD 100外部但不一定在患者身体外部)可以经由遥测模块108与MD 100通信以实现一个或多个期望功能。例如,MD 100可通过遥测模块108将感测到的电信号传送到外部医疗装置。外部医疗装置可在确定心律失常的发生时使用传送的电信号。MD 100可另外通过遥测模块108从外部医疗装置接收感测的电信号,并且MD 100可在确定心律失常的发生时使用接收到的感测电信号。遥测模块108可被配置成使用一个或多个方法以便与外部装置通信。例如,遥测模块108可经由射频(RF)信号、电感耦合、光信号、声信号、传导通信信号或适合于通信的任何其它信号进行通信。下面将参考图3来更详细地讨论MD 100与外部装置之间的通信技术。
电池110可向MD 100提供电源以实现其操作。在一个示例中,电池110可以是可再充电的基于锂的电池。在其它示例中,不可再充电电池可由本领域中已知的其它适当材料制成。由于MD 100是植入式装置的示例中对MD 100的访问可能受到限制,所以必须具有电池的足够容量以在治疗时段(诸如几天、几周、几个月或几年)内递送足够的治疗。在其它示例中,电池110可以是可再充电的基于锂的电池以便促进增加MD 100的可用寿命。
一般地,MD 100可类似于许多现有医疗装置中的一个。例如,MD 100可类似于各种植入式医疗装置。在此类示例中,可在患者的经胸部位中植入MD 100的外壳120。外壳120一般地可包括对于在人体内的植入而言安全的许多已知材料中的任何一个,并且在被植入时针对患者身体的流体和组织将MD 100的各种组件气密密封。
在某些示例中,MD 100可以是植入式心脏起搏器(ICP)。在此类示例中,MD 110可具有一个或多个引线,例如引线112,其在患者的心脏上或内部植入。一个或多个引线112可包括与患者心脏的心脏组织和/或血液接触的一个或多个电极114。MD 100还可被配置成感测固有生成心脏电信号并例如基于感测到的信号的分析来确定一个或多个心脏心律失常。MD 100还可被配置成经由植入在心脏内的引线112来递送CRT、ATP治疗、心搏徐缓治疗、除纤颤治疗和/或其它治疗类型。
在某些情况下,MD 100可以是皮下复律除颤器(S-ICD)。在此类示例中,引线112中的一个可包括皮下植入引线。在某些情况下,MD 100可被配置成感测固有生成心脏电信号,并基于感测到的信号的分析来确定一个或多个心脏心律失常。MD 100可进一步被配置成响应于确定心律失常而递送一个或多个除纤颤脉冲。在其它示例中,MD 100可以是植入式复律除颤器(ICD),其中,可在心脏115内植入引线112中的一个或多个。
在其它示例中,MD 100可以是无引线心脏起搏器(LCP—相对于图2更具体地描述)。在此类示例中,MD 100可不包括远离外壳120延伸的引线112。相反地,MD 100可包括相对于外壳120被耦合的电极114。在这些示例中,可在期望位置处在患者的心脏上或内部植入MD 100,并且其可被配置成经由电极114来递送CRT、ATP治疗、心搏徐缓治疗和/或其它治疗类型。
在某些情况下,MD 100可以是仅诊断装置。在某些情况下,MD 100可被配置成感测或接收心脏电信号和/或物理参数,诸如机械收缩、心音、血压、血氧水平等。MD 100可进一步被配置成基于感测出或接收到的心脏电信号和/或物理参数来确定心律失常的发生。在一个示例中,MD 100可去掉脉冲发生模块104,因为MD 100可未被配置成响应于确定心律失常的发生而递送电刺激。相反地,为了对检测到的心脏心律失常进行响应,MD 100可以是医疗装置的系统的一部分。在此类系统中,MD 100可向系统内的其它装置传送信息,并且其它装置中的一个或多个可响应于来自MD 100的接收信息而采取行动,例如递送电刺激治疗。术语脉冲发生器可用来描述能够向心脏递送电刺激治疗的任何此类装置,诸如ICD、ICP、LCP等。
在某些示例中,MD 100可以不是植入式医疗装置。相反地,MD 100可以是在患者身体外部的装置,并且可包括放置在患者身体上的皮肤电极。在此类示例中,MD 100可能能够感测表面心脏电信号(例如,由心脏或植入患者体内的装置生成的且被通过身体传导至皮肤的电信号)。在此类示例中,MD 100仍可被配置成递送各种类型的电刺激治疗。然而,在其它示例中,MD 100可以是仅诊断装置。
图2是示例性无引线心脏起搏器(LCP)200的图示。在所示的示例中,LCP可包括MD100的所有模块或组件,只是LCP 200可不包括引线112。如在图2中可以看到的,LCP 200可以是紧凑式装置,所有组件都被容纳在LCP 200内或直接地在外壳220上。如图2中所示,LCP200可包括遥测模块202、脉冲发生器模块204、处理模块210以及电池212。此类组件可具有与结合图1的MD 100所讨论的类似命名的模块和组件类似的功能。
在某些示例中,LCP 200可包括电感测模块206和机械感测模块208。电感测模块206可类似于MD 100的感测模块102。例如,电感测模块206可被配置成接收由心脏固有地生成的电信号。电感测模块206可与电极214电连接,其可将固有生成电信号传导至电感测模块206。机械感测模块208可被配置成接收表示心脏的一个或多个生理信号的一个或多个信号。例如,机械感测模块208可包括测量患者的生理参数的一个或多个传感器或与之电通信,所述传感器诸如加速度计、血压传感器、心音传感器、血氧传感器及其它传感器。虽然相对于图2被描述为单独的感测模块,但在某些示例中,电感测模块206和机械感测模块208可被组合成单个模块。
在至少一个示例中,可在单个集成电路芯片上实现图2中所示的模块202、204、206、208和210中的每一个。在其它示例中,可用相互电通信的多个集成电路芯片来实现所示组件。全部的模块202、204、206、208和210及电池212可被包含在外壳220内。外壳220一般地可包括以对于在人体内的植入而言安全著称的任何材料,并且可在LCP 200被植入在患者体内时针对流体和组织将模块202、204、206、208和210及电池212气密密封。
如在图2中描绘的,LCP 200可包括电极214,其可相对于外壳220被固定,但是被暴露于围绕LCP 200的组织和/或血液。同样地,电极214一般地可被设置在LCP 200的末端上,并且可与模块202、204、206、208和210中的一个或多个电通信。在某些示例中,电极214可仅通过短连接导线连接到外壳220,使得电极214未被相对于外壳220直接地固定。在某些示例中,LCP 200可另外包括一个或多个电极214'。电极214'可位于LCP 200的侧面,并增加LCP200可用来感测心脏电活动和/或递送电刺激的电极的数目。电极214和/或214'可由以对于在人体内的植入而言安全著称的一个或多个生物相容导电材料构成,诸如各种金属或合金。在某些情况下,连接到LCP 200的电极214和/或214'可具有将电极214与相邻电极、外壳220和/或其它材料电隔离的绝缘部分。
为了在患者身体内部植入LCP 200,操作员(例如,医生、临床医生等)可能需要将LCP 200固定到患者心脏的心脏组织。为了促进固定,LCP 200可包括一个或多个锚定件216。锚定件216可以是许多固定或锚定机构中的任何一个。例如,锚定件216可包括一个或多个销、卡钉、螺丝、螺钉、螺旋件、尖齿等。在某些示例中,虽然未示出,但锚定件216可在其外表面上包括可沿着锚定件216的至少部分长度行进的螺纹。螺纹可提供心脏组织与锚定件之间的摩擦以帮助将锚定件216固定在心脏组织内。在其它示例中,锚定件216可包括其它结构(诸如倒刺、长钉等以促进与周围心脏组织的卡合)。
可以基于各种因素来选择分别地如图1和2中所示的MD 100和LCP 200的设计和尺寸。例如,如果医疗装置是用于植入在心外膜组织上,诸如有时LCP情况就是如此,可以通过股静脉将医疗装置引入到心脏中。在这种情况下,医疗装置的尺寸可从而被平滑地导航通过静脉的弯曲路径而不对静脉的周围组织造成任何损害。根据一个示例,股静脉的平均直径在宽度方面可在约4mm至约8mm之间。为了通过股静脉导航至心脏,医疗装置可以具有小于8mm的直径。在某些示例中,医疗装置可以具有圆筒形状,该圆筒形状具有圆形横截面。然而,应注意的是医疗装置可以由任何其它适当形状制成,诸如矩形、椭圆形等。当医疗装置被设计成皮下植入时,可能期望具有低剖面的矩形医疗装置。
以上图1和2描述了MD 100的各种示例。在某些示例中,医疗装置系统可包括超过一个医疗装置。例如,多个医疗装置100/200可被互操作地用来检测和治疗心脏心律失常和/或其它心脏异常。下面结合图3—10描述了某些示例性系统。在此类多装置系统中,可能期望具有与另一医疗装置通信的医疗装置或者至少从另一医疗装置接收各种通信信号。
图3图示出医疗装置系统和多个医疗装置可经由其进行通信的通信路径的示例。在所示的示例中,医疗装置系统300可包括LCP 302和304、外部医疗装置306及其它传感器/装置310。外部装置306可以是先前相对于MD 100所述的任何装置。其它传感器/装置310还可以是先前相对于MD 100所描述的任何装置。在其它示例中,其它传感器/装置310可包括传感器,诸如加速度计或血压传感器等。在其它示例中,其它传感器/装置310可包括可用来对系统300的一个或多个装置进行编程的外部编程器装置。
系统300的各种装置可经由通信路径308进行通信。例如,LCP 302和/或304可感测固有心脏电信号,并且可经由通信路径308将此类信号传送到系统300的一个或多个其它装置302/304、306以及301。在一个示例中,外部装置306可接收此类信号,并且基于接收到的信号来确定心律失常的发生。在某些情况下,外部装置306可将此类确定传送到系统300的一个或多个其它装置302/304、306以及310。另外,系统300的一个或多个其它装置302/304、306以及310可诸如通过递送适当的电刺激基于传送的心律失常的确定而采取动作。本描述仅仅是用于系统300的各种装置之间的通信的许多原因中的一个。
通信路径308可表示各种通信方法中的一个或多个。例如,系统300的装置可经由RF信号、电感耦合、光信号、声信号或适合于通信的任何其它信号而相互通信,并且通信路径308可表示此类信号。
在至少一个示例中,通信路径308可表示传导的通信信号。因此,系统300的装置可具有允许进行所执行的通信的组件。在通信路径308包括传导的通信信号的示例中,系统300的装置可通过感测由另一装置递送到患者身体内的电通信脉冲而相互通信。患者的身体可将这些电通信脉冲传导至系统300的其它装置。在此类示例中,递送的电通信脉冲可不同于任何上述电刺激治疗的电刺激脉冲。例如,系统300的装置可以处于亚阈值的电压水平而递送此类电通信脉冲。也就是说,递送的电通信脉冲的电压振幅可足够低从而不捕捉心脏(例如不引起收缩)。虽然在某些情况下一个或多个递送的电通信脉冲可捕捉心脏,并且在其它情况下,递送的电刺激脉冲可不捕捉心脏。在某些情况下,可对递送的电通信脉冲进行调制(例如脉宽调制),或者可调制通信脉冲的递送的时序,以对传送的信息进行编码。这些仅仅是某些示例。
如上所述,某些示例性系统可采用多个装置以便确定心律失常的发生和/或以便响应于确定一个或多个心律失常而递送电刺激治疗。图3—10描述了可使用多个装置以便确定心律失常的发生和/或递送电刺激治疗的各种示例性系统。然而,不应将图3—10视为限制性示例。例如,图3—10描述了各种多装置系统可如何协调以检测各种心律失常。然而,可与用于检测心律失常的下述技术相协调地使用相对于MD 100和LCP 200所述的装置的任何组合。另外,虽然以下描述集中于各种系统的装置可如何操作以检测心律失常,但此类装置可另外进行操作以根据一个或多个技术递送电刺激治疗,诸如在2014年1月10日提交的题为“SYSTEMS AND METHODS FOR TREATING CARDIAC ARRHYTHMIAS”和2014年1月10日提交的“COMMUNICATION OF THERAPY ACTIVITY OF A FIRST IMPLANTABLE MEDICAL DEVICE TOANOTHER IMPLANTABLE MEDICAL DEVICE”的共同待决和共同所有临时申请中所述,该申请两者都被整体地通过引用结合到本文中。
图4图示出包括LCP 402和脉冲发生器406的示例医疗装置系统400。在某些示例中,脉冲发生器406可以是外部复律除颤器或ICD。例如,脉冲发生器406可以是如先前相对于MD 100所描述的此类装置。在某些示例中,脉冲发生器406可以是S—ICD。在脉冲发生器406是外部复律除颤器的示例中,电极408a、408b以及408c可以是常驻于患者身体上的皮肤电极。在脉冲发生器406是S—ICD的示例中,可将电极408a、408b和408c附着到接近于心脏410但不是在心脏410上或内的患者身体内植入的皮下引线。
如所示,可将LCP 402植入在心脏410内。虽然LCP 402被描述为被植入在心脏410的左心室(LV)内,但在其它示例中,可将LCP 402植入在心脏410的不同心室内。例如,可将LCP 402植入在心脏410的左心房(LA)或心脏410的右心房(RA)内。在其它示例中,可将LCP402植入在心脏410的右心室(RV)。
在任何情况下,LCP 402和脉冲发生器406可一起操作以确定心脏410的心脏心律失常的发生。在某些情况下,装置402和406可独立地操作以感测心脏410的心脏活动。如上所述,心脏活动可包括感测到的心脏电信号和/或感测到的生理参数。在此类示例中,LCP402和脉冲发生器406中的每一个可进行操作以基于独立感测的心脏活动来相互独立地确定心律失常的发生。当LCP 402或脉冲发生器406中的第一个进行心律失常的第一确定时,该第一装置可将第一确定传送到第二装置。如果系统400的第二装置还基于其自己感测到的心脏活动而进行心律失常的确定,例如心律失常的第二确定,则可确认心律失常,并且系统400可开始向心脏410递送适当的电刺激治疗。以这种方式,可使用系统400的装置402和406两者来确定心律失常的发生。在某些示例中,当装置402或406中的仅一个确定心律失常的发生且另一个没有时,系统400仍可开始向心脏410递送适当的电刺激治疗。
在其它示例中,装置402和406中的仅一个主动地感测心脏活动并确定心律失常的发生。例如,当主动感测装置(例如LCP 402)确定心律失常的发生时,主动感测装置可将该确定传送到系统400的另一装置(例如,脉冲发生器406)。系统400然后可开始向心脏410递送适当的电刺激治疗。在另一示例中,主动地感测心脏活动的装置可将感测到的心脏活动传送到另一装置。然后,基于接收到的心脏活动,另一装置可确定心律失常的发生。系统400然后可开始向心脏410递送适当的电刺激治疗。在这些示例中的某些中,另一装置可另外将心律失常的确定传送到主动感测装置。
在其它示例中,装置402或406中的仅第一个连续地主动地感测心脏。第一装置(例如脉冲发生器406)可不断地基于感测到的心脏活动而确定心律失常的发生。在此类示例中,当第一装置确定心律失常的发生时,第一装置可将该确定传送到第二装置(例如LCP402)。在接收到心律失常的发生的确定时,第二装置可开始感测心脏活动。基于其感测到的心脏活动,第二装置还可确定心律失常的发生。在此类示例中,只有当第二装置也确定心律失常的发生之后,系统400才可开始向心脏410递送适当的电刺激治疗。
在某些示例中,确定心律失常的发生可包括确定心律失常的开始,并且系统400可被配置成确定何时开始递送电刺激治疗。在某些示例中,确定心律失常的发生可包括确定心律失常的结束。在此类示例中,系统400可被配置成还确定何时停止递送电刺激治疗。
在系统400进行操作以向心脏410递送适当的电刺激治疗的示例中,如果所确定的心律失常是纤维性颤动,则脉冲发生器406可操作以向心脏410递送除纤颤脉冲。在所确定的心律失常是心动过速的示例中,LCP 402可向心脏410递送ATP治疗。在所确定的心律失常是心搏徐缓的示例中,LCP 402可向心脏410递送心搏徐缓治疗。在所确定的心律失常是非同步收缩的示例中,LCP 402可向心脏410递送CRT。
图5图示出包括LCP 502和脉冲发生器506的示例性医疗装置系统500。在本示例中,脉冲发生器506可以是植入式心脏起搏器(ICP)。例如,脉冲发生器506可以是诸如先前相对于MD 100所描述的ICP。在脉冲发生器506是ICP的示例中,可经由一个或多个引线在心脏510的右心室和/或右心房上或内部植入电极504a、504b和504c。
可在心脏510内植入LCP 502。虽然LCP 502被描述为被植入在心脏510的左心室(LV)内,但在某些情况下,可将LCP 502植入在心脏510的不同心室内。例如,可将LCP 502植入在心脏510的左心房(LA)或心脏510的右心房(RA)内。在其它示例中,可将LCP 502植入在心脏510的右心室(RV)。
在任何情况下,LCP 502和脉冲发生器506可一起操作以确定心脏510的心脏心律失常的发生。在某些情况下,装置502和506可独立地操作以感测心脏510的心脏活动。如上所述,心脏活动可包括感测到的心脏电信号和/或感测到的生理参数。在某些情况下,LCP502和脉冲发生器506中的每一个可进行操作以基于独立感测到的心脏活动来相互独立地确定心律失常的发生。当LCP 502或脉冲发生器506中的第一个进行心律失常的第一确定时,该第一装置可将第一确定传送到第二装置。如果系统500的第二装置还基于其自己感测到的心脏活动而进行心律失常的确定,例如心律失常的第二确定,则系统500可确认心律失常,并且可开始向心脏510递送适当的电刺激治疗。以这种方式,可使用系统500的装置502和506两者来确定心律失常的发生。在某些情况下,当装置502或506中的仅一个确定心律失常的发生时,系统500也可开始向心脏510递送适当的电刺激治疗。
在某些示例中,装置502和506中的仅一个可主动地感测心脏活动并确定心律失常的发生。例如,当主动感测装置(例如脉冲发生器506)确定心律失常的发生时,主动感测装置可将该确定传送到系统500的另一装置(例如LCP 502)。系统500然后可开始向心脏510递送适当的电刺激治疗。在某些示例中,主动地感测心脏活动的装置可将感测到的心脏活动传送到另一装置。然后,基于接收到的心脏活动,另一装置可感测并确定心律失常的发生。系统500然后可开始向心脏510递送适当的电刺激治疗。在某些情况下,另一装置可另外将心律失常的确定传送到主动感测装置。
在其它示例性中,装置502或506中的仅第一个可连续地主动地感测心脏。第一装置可另外不断地基于感测到的心脏活动确定心律失常的发生。在某些示例中,当第一装置确定心律失常的发生时,第一装置可将该确定传送到第二装置。在接收到心律失常的发生的确定时,第二装置可开始感测心脏活动。基于其感测的心脏活动,第二装置还可确定心律失常的发生。在此类示例中,只有当第二装置也确定心律失常的发生之后,系统500才可开始向心脏510递送适当的电刺激治疗。
在某些示例中,确定心律失常的发生可包括确定心律失常的开始,并且系统500可被配置成确定何时开始递送电刺激治疗。在某些示例中,确定心律失常的发生可包括确定心律失常的结束。在此类示例中,系统500可被配置成还确定何时停止递送电刺激治疗。在系统500并未开始向心脏510递送适当的电刺激治疗直至多个装置确定心脏心律失常的发生为止的示例中,可将并未触发电刺激治疗的递送的每个确定称为临时确定(provisionaldetermination)。
在系统500进行操作以向心脏510递送适当电刺激治疗的示例中,如果所确定的心律失常是心动过速,则脉冲发生器506、LCP 502或两者可向心脏510递送ATP治疗。在所确定的心律失常是心搏徐缓的示例中,脉冲发生器506、LCP 502或两者可向心脏510递送心搏徐缓治疗。在所确定的心律失常是不同步收缩的示例中,脉冲发生器506、LCP 502或两者可向心脏510递送CRT。
图6图示出包括LCP 602和LCP 606的示例性医疗装置系统600。示出了在心脏610内植入的LCP 602和LCP 606。虽然LCP 602和606描绘为被分别地植入在心脏610的左心室(LV)和心脏610的右心室内,但可将LCP 602和606植入心脏610的不同心室内。例如,系统600可包括植入心脏610的两个心房内的LCP 602和606。在其它示例中,系统600可包括植入心脏610的一个心房和一个心室内的LCP 602和606。在更多示例中,系统600可包括植入心室和心房的任何组合内的LCP 602和606。在其它示例中,系统600可包括植入心脏610的同一心室内的LCP 602和606。
在任何情况下,并且在某些示例中,CLP 602和LCP 606可一起操作以确定心脏610的心脏心律失常的发生。例如,装置602和606可独立地操作以感测心脏610的心脏活动。如上所述,心脏活动可包括感测到的心脏电信号和/或感测到的生理参数。在此类示例中,LCP602和LCP 606中的每一个可进行操作以基于独立感测到的心脏活动来相互独立地确定心律失常的发生。当LCP 602或LCP 606中的第一个进行心律失常的第一确定时,该第一装置可将第一确定传送到第二装置。如果系统600的第二装置还基于其自己感测到的心脏活动而进行心律失常的确定,例如心律失常的第二确定,则系统600可确认心律失常,并且可开始向心脏610递送适当的电刺激治疗。以这种方式,可使用系统600的装置602和606两者来确定心律失常的发生。在某些示例中,当装置602或606中的仅一个确定心律失常的发生时,系统600可开始向心脏610递送适当的电刺激治疗。
在其它示例中,装置602和606中的仅一个可主动地感测心脏活动并确定心律失常的发生。在这些示例中的某些中,当主动感测装置(例如脉冲发生器606)确定心律失常的发生时,主动感测装置可将该确定传送到系统600的另一装置(例如LCP 602)。系统600然后可开始向心脏610递送适当的电刺激治疗。在某些情况下,主动地感测心脏活动的装置可将感测到的心脏活动传送到另一装置。然后,基于接收到的心脏活动,另一装置可确定心律失常的发生。系统600然后可开始向心脏610递送适当的电刺激治疗。在这些示例中的某些中,另一装置可另外将心律失常的确定传送到主动感测装置和/或另一装置。
在某些示例中,装置602或606中的仅的一个可连续地主动地感测心脏。第一装置可基于感测到的心脏活动不断地确定心律失常的发生。在此类示例中,当第一装置确定心律失常的发生时,第一装置可将该确定传送到第二装置。在接收到心律失常的发生的确定时,第二装置可开始感测心脏活动。基于其感测到的心脏活动,第二装置还可确定心律失常的发生。在此类示例中,只有当第二装置也确定心律失常的发生之后,系统600才开始向心脏610递送适当的电刺激治疗。
在某些示例中,确定心律失常的发生可包括确定心律失常的开始,并且系统600可被配置成确定何时开始递送电刺激治疗。在某些示例中,确定心律失常的发生可包括确定心律失常的结束。在此类示例中,系统600可被配置成还确定何时停止递送电刺激治疗。在系统600并未开始向心脏610递送适当的电刺激治疗直至多个装置确定心脏心律失常的发生为止的示例中,可将并未触发电刺激治疗的递送的每个确定称为临时确定。
在系统600进行操作以向心脏610递送适当电刺激治疗的示例中,如果所确定的心律失常是心动过速,则LCP 602、LCP 606或两者可向心脏610递送ATP治疗。在所确定的心律失常是心搏徐缓的示例中,LCP 602、LCP 606或两者可向心脏610递送心搏徐缓治疗。在所确定的心律失常是非同步收缩的示例中,脉冲LCP 602、LCP 606或两者可向心脏610递送CRT。
虽然不一定在图4—6中描述,但系统400、500或600的两个装置中的一个可以是仅诊断装置。在此类示例中,在装置中的一个或多个确定心律失常的发生之后,仅诊断装置可不递送任何电刺激治疗。相反地,如果期望的话,由可能够递送适当电刺激治疗的系统中的另一装置来递送电刺激治疗。
图7图示出具有包括LCP 702、LCP 704和LCP 706的三个单独LCP的示例性医疗装置系统700。虽然描绘了具有分别地植入LV、RV以及LA内的LCP 702、704和706的系统700,但其它示例可包括植入心脏710的不同心脏内的LCP 702、704和706。例如,系统700可包括植入心脏710的两个心房和一个心室内的LCP。在其它示例中,系统700可包括植入心脏710的一个心室和一个心房内的LCP。更一般地,可设想的是系统700可包括植入心室和心房的任何组合内的LCP。在某些情况下,系统700可包括植入心脏710的同一心室内的LCP 702、704和706中的两个或更多。
在实践中,此类系统700可根据上文相对于图4—6所描述的任何技术进行操作。然而,在某些情况下,系统可至少在一定程度上不同地操作。例如,在系统700开始向心脏710递送适当的电刺激治疗之前,LCP 702、704和706中的仅大多数可能需要确定心律失常的发生。例如,在某些情况下,LCP 702、704和706中的全部可能正在独立地感测心脏活动和确定心律失常的发生。在某些情况下,只有在LCP 702、704和706中的大多数确定心律失常的发生之后,系统700才可向心脏710递送适当的电刺激治疗。在某些情况下,LCP中的一个被指定为主LCP,并且其它从属LCP可向主LCP传达其是否确定心律失常的发生。主LCP然后可确定LCP 702、704和706中的大多数是否已确定心律失常的发生,并且如果是这样的话,可命令向心脏710递送适当的电刺激治疗。在某些情况下,取决于检测到的心律失常的类型和/或位置,主LCP可命令LCP 702、704和706中的特定的一些向心脏710递送电刺激治疗,。
替换地,并且在某些情况下,仅单个LCP需要在系统700可开始向心脏710递送适当的电刺激治疗之前确定心律失常的发生。在其它示例中,在系统700向心脏内710递送适当的电刺激治疗之前,全部的三个LCP 702、704和706可能需要确定心律失常的发生。
在某些情况下,仅一个LCP 702 704和706可主动地感测心脏活动并确定心律失常的发生。在确定心律失常的发生之后,主动感测装置可向其它装置中的一者或两者传送该确定。在某些情况下,其它装置中的一者或两者然后可开始感测和确定心律失常的发生。在某些情况下,当其它装置中的第一个确定心律失常的发生时,系统700可开始向心脏710递送适当的电刺激治疗。在其它示例中,当两个其它装置都确定心律失常的发生时,系统700可开始向心脏710递送适当的电刺激治疗。
在某些情况下,可以菊链配置来设置LCP 702、704和76。例如,主动感测装置可向其它两个装置中的仅一个发送心律失常的确定(替换地,两个接收装置中的仅一个可对接收到的来自主动感测装置的确定起作用。接收装置然后可开始主动地感测并确定心律失常的发生。在确定心律失常的发生时,接收装置可将该确定传送到最后一个装置。该最后装置然后可开始感测并确定心律失常的发生。在某些情况下,只有当最后装置确定心律失常的发生时,系统700才开始向心脏710递送适当的电刺激治疗。
并且根据系统400、500和700的描述,在某些示例中,确定心律失常的发生可包括确定心律失常的开始,并且系统700可被配置成确定何时开始递送电刺激治疗。在某些示例中,确定心律失常的发生可包括确定心律失常的结束。在此类示例中,系统700可被配置成还确定何时停止递送电刺激治疗。在其中系统700并未开始向心脏710递送适当的电刺激治疗直至多个LCP装置确定心律失常的发生为止的示例中,可将并未触发电刺激治疗的递送的每个确定称为临时确定。
在系统700进行操作以向心脏710递送适当电刺激治疗的示例中,如果所确定的心律失常是心动过速,则LCP 702、704和706中的一个或多个可向心脏710递送ATP治疗。在所确定的心律失常是心搏徐缓的示例中,LCP 702、704和706中的一个或多个可向心脏710递送心搏徐缓治疗。在所确定的心律失常是非同步收缩的示例中,LCP 702、704和706中的一个或多个可向心脏710递送CRT。可设想少于全部的LCP 702、704和706可响应于心律失常的检测到而递送电刺激治疗。例如,LCP 702、704和706中的仅一个可递送电刺激治疗。在其它示例中,CLP 702、704和706中的两个可递送电刺激治疗。
根据上述描述,可以看到如何可将此类技术扩展至具有甚至超过三个LCP装置的系统。例如,在四个LCP装置系统中,可使用一个、两个、三个或四个装置中的任意来在系统开始递送适当的电刺激治疗之前确定心律失常的发生。在某些此类示例中,LCP装置中的全部、某些或一个可在最初主动地感测和确定心律失常的发生。在少于全部在最初主动地进行感测的示例中,一旦主动感测装置中的一个确定心律失常的发生并将该确定传送给系统的其它装置,则系统的其它装置中的至少一个可开始主动地感测心脏活动并确定心律失常的发生。再次地,可将上述技术扩展至包括任何数目的LCP装置或其它装置,诸如五个、六个、七个或对于在患者体内的植入而言实际上可行的任何其它数目。
另外,虽然上文相对于三个或更多LCP装置进行描述,但可将该技术应用于相对于图4—5所述的任何系统。例如,任何的系统400和500还可包括第三装置,诸如第二LCP装置。在此类系统中,三个装置可根据系统700的任何上述技术进行操作,脉冲发生器能够感测心律失常和/或递送电刺激治疗。在其它示例中,任何的系统400和500可包括多个附加装置。例如,除脉冲发生器405和506之外,任何的系统400和500可包括对在患者体内的植入实用的三个、四个、五个或任何数目的LCP装置。因此,在此类示例中,装置可根据上述技术中的任何一个一起操作。
多装置系统在某些情况下能够递送比单装置系统更有效的电刺激治疗。例如,在开始递送电刺激治疗之前,示例性系统可确定系统的哪一个装置首先感测心脏的去极化波。在此类示例中,此类系统可指导首先感测到去极化波的装置去递送电刺激治疗。这可允许此类系统在更接近于心律失常的原点的部位处递送电刺激治疗,这可增加电刺激治疗的有效性。
在系统700的示例中,系统700的装置中的仅一个可单独地或由系统700的其它装置根据上文所述的任何技术的进行的临时确定之外地来确定快速性心律失常的发生。系统700的装置中的一个(例如,主装置)可确定向心脏710递送ATP治疗或确定指导系统700的另一装置递送ATP治疗。在递送或指导另一装置递送ATP治疗之前,系统700的装置中的一个可确定系统700的哪个装置首先感测心脏710的固有心脏去极化波。感测此类去极化波的装置然后可首先开始ATP治疗的递送。
以上描述仅仅是系统可如何操作以用首先感测到心脏的固有心脏去极化波的装置来递送电刺激治疗的一个示例。在其它示例中,心律失常和治疗的类型可以是不同的。另外,由于此类特征与装置的任何特定配置或数目不相关,所以本文所述的任何系统还可包括此类特征。任何系统中的唯一限制可以是系统的装置是否能够递送适当的电刺激治疗。
可使用多装置系统来帮助提供房性心律失常与室性心律失常之间的区别。例如,本文所述的示例性系统可根据心律失常是房性心律失常还是室性律不齐而不同地操作以便更有效地治疗此类心律失常。
作为一个说明性示例,系统700的装置中的一个可单独地或者除由系统700的其它装置根据任何的上述技术进行的临时确定之外地来确定快速性心律失常的发生。另外,系统700的装置可确定心动过速是房性心动过速还是室性心动过速。如果心动过速是房性心动过速,则系统700的装置中的一个或多个可确定不递送电刺激治疗。如果心动过速是室性心动过速,则系统700的装置中的一个或多个额外地确定心动过速的速率在是否在阈值以上并且心脏电信号是否是多态信号。如果心动过速速率在阈值以下且心脏电信号不是多态信号,则系统700的装置中的一个或多个可向心脏710递送ATP治疗或指导系统700的不同装置向心脏710递送ATP治疗。如果心动过速速率在阈值以上或心脏电信号是多态信号,则系统700的装置中的一个或多个可向心脏710递送除纤颤脉冲或指导系统700的不同装置向心脏710递送除纤颤脉冲。在此类房性和室性心律失常之间的进行区别以及对不同类型的心律失常不同地进行响应可增加所递送的电刺激治疗的有效性并减少任何递送的电刺激治疗的负面结果。以上描述仅仅是公开系统可如何操作以在各种心律失常之间进行区别并响应于不同的所确定的心律失常而递送电刺激治疗的一个示例。
图8和9图示出用于多装置医疗系统的其它示例性植入位置和配置。例如,图8的医疗装置系统800示出了三个LCP装置,即LCP 802、804和806。CLP装置中的两个、即LCP 802和804被示为在心脏810的单个心室内植入。在其它示例中,全部三个装置可被植入在心脏810的单个心室内。虽然两个LCP 802和804被示为被植入在心脏810的LV内,但在其它示例中,心脏810的任何心室可包括多个植入LCP装置。在单个心室内植入多个装置可增强递送的电刺激的有效性,因为多个装置可增加在作为心律失常引发信号的原点的心脏部位附近递送电刺激治疗的机会。如先前相对于其它系统所述,本文所述的任何其它系统(诸如系统400和500)可根据期望包括植入在心脏的单个心室内的一个或多个装置。
图9的医疗装置系统900包括在心脏910的心外膜表面上植入的LCP 902。LCP 904和906被示为在心脏910的心内膜表面上植入。在某些情况下,可在心外膜表面上植入系统900的一个或多个附加装置。在某些情况下,在心脏的心外膜表面上植入的装置可感测固有心脏电信号和/或向心脏递送适当的电刺激治疗。对应地,本文所述的任何系统可根据期望而包括在心脏的心内膜表面上植入的一个或多个装置。
如上所述,在某些实施例中,医疗系统中的一个装置可充当主装置,并且其它装置可充当从属装置。图10是包括主装置1002和多个从属装置1004、1006和1008的说明性医疗装置系统1000的框图。在所示的示例中,主装置1002可通过患者的身体与从属装置1004、1006和1008进行传导通信。在其它示例中,主和从属装置可根据期望经由不同的通信机构进行通信,诸如通过射频(RF)信号、电感耦合、光信号、声信号或适合于通信机制的任何其它等。
在一个示例中,主装置1002可以是ICD装置,例如ICD或S-ICD,并且可被配置成从一个或多个从属装置1004、1006和1008接收心脏信息。在某些情况下,从属装置可以是LCP。传送的心脏信息可包括例如由从属装置1004、1006和1008感测到的心脏电信号、由从属装置1004、1006和1008进行的初步确定或者由从属装置1004、1006和1008感测或确定的其它信息。在某些示例中,主设备1002还可感测心脏活动。在此类示例中,主装置1002可基于其自己的感测到的心脏活动和/或从从属装置1004、1006和1008接收到的心脏活动来确定心律失常的发生。在某些情况下,主装置1002可确定来自系统1000的一个或多个装置的心脏活动指示心律失常的发生。在某些情况下,虽然系统1000的多个装置每个可能正在感测心脏活动,但仅单个装置(诸如主装置1002)可进行心脏心律失常正在发生且期望适当的电刺激治疗的确定。
响应于确定心律失常的发生,主装置1002可确定递送电刺激治疗。在一个示例中,主装置1002可基于心律失常的类型来确定适当的电刺激治疗。另外,主装置1002可确定哪个或哪些装置应递送电刺激治疗。主装置1002可指导装置中的一个或多个(其可能包括主装置本身)实际地递送期望的电刺激治疗。主装置1002可根据任何先前公开的技术进行操作。例如,主装置1002可在确定心律失常的实际发生之后确定心律失常的发生的一个或多个临时确定。主装置1002可额外地在房性和室性心律失常之间进行区别,并基于所确定的心律失常类型来确定要递送的适当电刺激治疗。在某些示例中,主装置1002可基于哪个装置或哪些装置首先感测到心动周期的心脏去极化波而确定哪个或哪些装置需要递送电刺激治疗。
在某些情况下,系统1000的多个装置可确定心律失常的发生。例如,从属装置1004、1006和1008每个可确定心律失常的发生,并且可将此类确定传送到主装置1002。在某些示例中,可将此类确定视为实际或临时确定。基于此类接收到的确定,主装置1002可根据任何先前公开的技术而确定心律失常的发生。基于心律失常的确定,主装置1002可递送和/或指导从属装置1004、1006和1008中的一个或多个递送适当的电刺激治疗。
在某些情况下,并非全部的主装置1002和从属装置1004、1006和1008都可能在主动地感测心律失常。例如,如先前所述,在某些示例中,仅单个或少于全部的主装置1002和从属装置1004、1006和1008可能在主动地感测心律失常。在至少一个示例中,主动感测装置可能在向主装置1002发送心脏活动。基于接收到的心脏活动,主装置1002可确定心律失常的发生。在确定心律失常的发生之后,主装置1002可指导系统1000的第二装置开始主动地感测心脏活动。此第二装置可额外地将感测到的心脏活动传送到主装置1002。再次地,主装置1002可基于从第二装置接收到的心脏活动来确定心律失常的发生。在进行心律失常的发生的一个或更多确定之后,主装置1002可递送,或指导从属装置1004、1006和1008中的一个或多个递送,适当的电刺激治疗。在其它示例中,作为发送感测心脏数据的替代,该装置可将心律失常的发生的确定发送到主装置1002。在某些情况下,主装置1002可不感测心脏活动。相反地,主装置1002可基于从感测心脏活动的那些从属装置接收到的心脏活动和/或确定来进行心脏心律失常的发生的确定。
在某些情况下,主装置1002可以是LCP装置、外部复律除颤器、ICP或仅诊断装置。在某些示例中,主装置1002和从属装置1004、1006和1008可具有类似的硬件配置;然而,其可安装不同的软件。在某些示例中,可将从属装置1004、1006和1008设置成“从属模式”,同时可将主装置1002设置成“主模式”,即使所有装置都共享相同的硬件和软件特征。另外,在某些示例中,系统1000的装置可在被配置为主装置与从属装置之间切换。例如,外部编程器可连接到此类系统的任何装置并根据期望而改变系统的任何装置的编程。
图11—22是示出了可以由上述示例性医疗系统(例如系统400、500、600、700或本文所述的任何其它示例性医疗系统)实现的各种方法的流程图。此类示例性系统可包括图1和2的MD 100和/或LCP 200的任意或本文所述的任何其它装置。特别地,所示的方法可帮助识别和治疗心律失常和患者的其它疾病。
在图11的所示方法1100中,医疗装置系统的装置可感测心脏的心脏活动,如在1102处所示。医疗装置可以是ICD、S-ICD、LCP、仅诊断装置或根据期望的任何其它装置。说明性方法可包括使用第一无引线心脏起搏器(LCP)来感测心脏的心脏活动,该第一无引线心脏起搏器可在经由通信路径耦合到医疗装置的同时与医疗装置间隔开,如在1104处所示。通信路径可以是例如相对于图3所述的那些中的任何一个。在至少某些示例中,通信路径可通过患者的身体的至少一部分。系统的一个或多个装置可至少部分地基于由医疗装置和第一无引线心脏起搏器(如在1106处所示)感测的心脏活动来确定快速性心律失常的发生。可基于由医疗装置或由第一无引线心脏起搏器感测的单独心脏活动或者两个装置的感测到的心脏活动的组合来进行心动过速的发生的确定。在某些示例中,心脏信息可包括感测到的心脏电信号和来自其它装置(诸如加速度计、心音传感器、血压传感器、血氧传感器等)的信息两者。
在某些情况下,第一LCP可基于由第一LCP感测的心脏活动来进行心动过速的发生的临时确定。第一LCP可将临时确定发送到医疗装置。医疗装置可基于由医疗装置感测的心脏活动来进行心动过速的发生的临时确定。心动过速的发生的确定然后可基于由第一LCP和医疗装置进行的临时确定。
在某些情况下,第一LCP可不进行心动过速的发生的临时确定,而是可将由第一LCP感测的心脏活动发送到医疗装置。该医疗装置然后可接收由第一LCP感测的心脏活动,并且可基于由第一LCP感测的心脏活动和由医疗装置感测的心脏活动来确定心动过速的发生。
在另一说明性方法1200中,如图12中所示,两个或更多LCP可自主地识别心动过速急性发作并递送ATP。特别地,示例性系统(诸如本文所述的那些中的任何一个)可使用第一无引线心脏起搏器(LCP)感测心脏的心脏活动,其中,第一无引线心脏起搏器被配置成检测心脏的第一位置处的心脏事件并向第一位置递送ATP治疗,如在1202处所示。另外,第二无引线心脏起搏器(LCP)可被配置成检测心脏的第二位置处的心脏事件并向心脏的第二位置递送ATP治疗,如在1204处所示。第一和第二LCP中的一个或多个可被配置成至少部分地基于由第一无引线心脏起搏器检测到的心脏事件和/或由第二无引线心脏起搏器检测到的心脏事件来确定快速性心律失常的发生,如在1206处所示。一旦LCP中的一个或多个确定快速性心律失常的发生,则第一和第二无引线心脏起搏器中的至少一个可向心脏递送ATP治疗,如在1208处所示。
在至少一个示例中,第一无引线心脏起搏器可充当主件,并且第二无引线心脏起搏器可充当从属件。在此类情形中,第一无引线心脏起搏器可进行快速性心律失常的确定,并且促使第一LCP、第二LCP或两者向心脏递送ATP治疗。在另一示例中,第一和第二无引线心脏起搏器可一起确定快速性心律失常的发生,并且第一和第二无引线心脏起搏器两者可向心脏递送ATP治疗。
在另一说明性方法1300中,如图13中所示,医疗装置系统(诸如本文所述的系统400、500、600或任何其它医疗装置系统)可包括无引线心脏起搏器(LCP),其可被诸如植入式复律除颤器(ICD)或皮下ICD(S—ICD)之类的外部装置(例如在LCP外部的装置)触发以递送ATP治疗。该系统可包括使用第一无引线心脏起搏器(LCP)进行的心脏的心脏活动感测,其中,第一无引线心脏起搏器可被配置成检测在心脏的第一位置处的心脏事件,并且还可被配置成向该位置递送ATP治疗,如在1302处所示。至少部分地基于由第一无引线心脏起搏器检测到的心脏事件,系统的一个或多个装置可确定快速性心律失常的发生,如在1304处所示。一旦装置中的一个或多个确定了快速性心律失常的发生,则系统的ICD或S-ICD可开始针对除纤颤脉冲充电,并且还可命令第一无引线心脏起搏器向心脏递送ATP治疗,如在1306处所示。第一无引线心脏起搏器可至少在ICD或S-ICD针对除纤颤脉冲充电的同时向心脏递送ATP治疗。如果装置中的一个或多个随后确定ATP治疗成功地终止快速性心律失常,则ICD或S-ICD可随后释放已充能量而不递送除纤颤脉冲。否则,一旦ICD或S-ICD充满并准备好递送除纤颤脉冲,则ICD或S-ICD可递送除纤颤脉冲。
一般地,患者体内的心室快速性心律失常的一次或多次急性发作后面可以跟着心室纤颤急性发作。包括一个或多个LCP和ICD的医疗装置可比不包括两个此类装置的系统更有效地在治疗重叠的快速性心律失常和纤维性颤动急性发送的情形中有用。
如图14中所示的说明性方法1400可由本文所述的任何系统实现,其包括LCP装置和植入式复律除颤器装置两者。说明性方法1400可包括递送在无引线心脏起搏器与植入式复律除颤器之间可同步的ATP治疗。作为此说明性方法的第一步骤,心脏的心脏活动可被第一无引线心脏起搏器(LCP)感测到,其可被配置成检测心脏的第一位置处的心脏事件并进一步被配置成向该第一位置递送(ATP)治疗,如在1402处所示。系统的一个或多个装置可进一步部分地或完全地基于由第一无引线心脏起搏器检测到的心脏事件来确定快速性心律失常的发生,如在1404处所示。在某些示例中,这可通过将由第一无引线心脏起搏器检测到的心脏活动与当前患者的阈值心脏活动或当前患者的正常节奏的阈值心脏活动相比较来完成。在确定快速性心律失常的发生之后,系统的一个或多个装置可促使第一无引线心脏起搏器递送ATP治疗,有时与用外部装置(诸如ICD(1406))递送的ATP治疗同步地。
图15包括可由包括LCP和ICD的系统实现的说明性方法1500。此类系统可以包括第一无引线心脏起搏器(LCP),其可以感测心脏活动,并且可被可通信地耦合到ICD,如在1502处所示。在某些情况下,第一无引线心脏起搏器可被配置成检测心脏的第一位置处的心脏事件,并且可被配置成向第一位置递送ATP治疗。系统的一个或多个装置可基于由第一无引线心脏起搏器检测到的心脏事件来确定快速性心律失常的发生,如在1504处所示。一旦系统的装置中的一个或多个确定快速性心律失常的发生,第一无引线心脏起搏器可基于ATP治疗协议向心脏递送ATP治疗,如在1506处所示。在某些示例中,可从ICD向第一无引线心脏起搏器传送特定ATP治疗协议。在某些情况下,ICD可充当可规定要递送到心脏的第一位置的电脉冲的主装置。
图16公开了可由包括LCP装置和ICD装置的系统实现的另一说明性方法1600。此类系统可使用可被配置成部分地或完全基于心脏机械信息来检测的一个或多个心脏事件的第一无引线心脏起搏器(LCP)来感测心脏活动,如在1602处所示。心脏机械信息可包括心肌的收缩或松弛诸如通过使用加速度计、心音传感器、血压传感器、血氧传感器或能够感测心脏的机械信息的任何其它传感器。在某些情况下,第一无引线心脏起搏器可被配置成检测心脏的第一位置处的心脏事件,并且可以向第一位置递送ATP治疗。系统的一个或多个装置可进一步至少部分地基于由第一无引线心脏起搏器检测到的心脏事件来确定快速性心律失常的发生,如在1604处所示。一旦一个或多个装置确定了快速性心律失常的发生,则一个或多个装置可促使第一无引线心脏起搏器向心脏递送ATP治疗,如在1606处所示。
在图17中所示的说明性方法1700中,第一无引线心脏起搏器(LCP)可感测心脏活动,如在1702处所示。第一无引线心脏起搏器可被配置成检测心脏的第一位置处的心脏事件,并且可被配置成向第一位置递送ATP治疗。系统的一个或多个装置可进一步至少部分地基于由第一无引线心脏起搏器检测到的心脏事件来确定快速性心律失常的发生(1704)。一旦识别到快速性心律失常,系统的一个或多个装置可确定快速性心律失常是否对ATP治疗敏感,如在1706处所示。这可至少部分地基于由第一无引线心脏起搏器检测到的心脏事件而确定。例如,系统的一个或多个装置可确定快速性心律失常是房性快速性心律失常还是室性快速性心律失常。另外,系统的一个或多个装置可确定心动过速速率是否在阈值以上。某些系统还可包括确定心动过速信号是否是多态信号的一个或多个装置。基于这些确定,一个或多个装置可确定快速性心律失常是否对ATP治疗敏感。一旦快速性心律失常被确定为对ATP治疗敏感,一个或多个装置可促使第一无引线心脏起搏器向心脏递送ATP治疗,并且在某些情况下,可促使植入式复律除颤器至少在ATP治疗的递送期间暂停递送除纤颤休克治疗,如在1708处所示。
图18描述了另一说明性方法1800。系统的第一无引线心脏起搏器可感测心脏的心脏活动,如在1802处所示。第一无引线心脏起搏器可确定快速性心律失常的发生,如在1804处所示。一旦第一无引线心脏起搏器已确定出快速性心律失常的发生,第一无引线心脏起搏器可确定快速性心律失常是否对ATP治疗敏感,如在1806处所示。步骤1804和1806可至少部分地基于由第一无引线心脏起搏器检测到的心脏事件完成。另外,系统的一个或多个装置(其可以是第一无引线心脏起搏器)可确定心动过速速率是否在阈值以上和心动过速信号是否是多态的。如果除第一无引线心脏起搏器之外的装置确定这些参数中的一个或多个,则装置在某些情况下可将此类参数传送到第一无引线心脏起搏器。如果第一无引线心脏起搏器确定快速性心律失常对ATP治疗敏感,则第一无引线心脏起搏器可向心脏递送ATP治疗,如1808处所示。因此,在此类系统中,LCP装置可自主地确定快速性心律失常的发生并基于该确定采取行动。
图19示出了另一说明性方法1900。在图19中,第一无引线心脏起搏器(LCP)可被可通信地耦合到植入式复律除颤器(ICD),如1902处所示。第一无引线心脏起搏器可被配置成检测心脏的第一位置处的心脏事件,并被进一步配置成递送防心动过速起搏(ATP)治疗。系统的一个或多个装置可进一步至少部分地基于由第一无引线心脏起搏器检测到的心脏事件来确定快速性心律失常的发生,如在1904处所示。一旦系统的一个或多个装置已确定快速性心律失常的发生,则可使得第一无引线心脏起搏器向植入式复律除颤器(ICD)传送关于由第一无引线心脏起搏器进行的ATP治疗递送的状态信息,如在1906处所示。例如,第一无引线心脏起搏器可传达要向植入式复律除颤器(ICD)递送ATP治疗或者第一无引线心脏起搏器当前正在递送ATP治疗的意图。在某些示例中,第一无引线心脏起搏器可传达第一无引线心脏起搏器将不递送ATP治疗。
图20示出了另一说明性方法2000。在图20中,第一无引线心脏起搏器(LCP)可被配置成检测心脏的第一位置处的心脏事件。系统的一个或多个装置可至少部分地基于由第一无引线心脏起搏器检测到的心脏事件来确定快速性心律失常的发生,如在2004处所示。在下一步骤处,第一无引线心脏起搏器可向植入式复律除颤器(ICD)传送关于快速性心律失常的信息,如在2006处所示。例如,第一无引线心脏起搏器可传送关于快速性心律失常的此类信息,诸如心动过速速率、心动过速速率是否在阈值以上和/或心动过速信号是否是多态的。
在图21中示出了另一说明性方法2100。第一无引线心脏起搏器(LCP)可被配置成检测心脏的第一位置处的心脏事件,如在2101处所示。基于检测到的心脏事件,第一无引线心脏起搏器可确定快速性心律失常的发生,如在2104处所示。在确定快速性心律失常的发生之后,第一无引线心脏起搏器可向第二无引线心脏起搏器传送关于快速性心律失常的信息,如在2106处所示。例如,第一无引线心脏起搏器可传送诸如心动过速速率、心动过速速率是否在阈值以上和/或心动过速信号是否是多态的之类的信息。
图22示出了另一说明性方法2200。第一无引线心脏起搏器(LCP)可被配置成检测心脏的第一位置处的心脏事件,如在2202处所示。第一无引线心脏起搏器可至少部分地基于由第一无引线心脏起搏器检测到的心脏事件来确定快速性心律失常的发生,如在2204处所示。在确定快速性心律失常的发生之后,第一无引线心脏起搏器可向植入式复律除颤器传送关于快速性心律失常的信息,如在2206处所示。例如,第一无引线心脏起搏器可传送诸如心动过速速率、心动过速速率是否在阈值以上和/或心动过速信号是否是多态的之类的信息。植入式复律除颤器可至少部分地基于关于快速性心律失常的传送的信息根据治疗协议来确定是否要递送治疗,如在2208处所示。
图23示出了另一说明性方法2300。可由医疗装置感测心脏活动,如在2302处所示。还可由第一无引线心脏起搏器感测心脏活动,其中,第一无引线心脏起搏器有时经由包括患者身体的通信路径被可通信地耦合到医疗装置,如在2304处所示。医疗装置和第一无引线心脏起搏器中的一个或多个然后可至少部分地基于由医疗装置感测的心脏活动和/或由第一无引线心脏起搏器感测的心脏活动来确定快速性心律失常是否正在发生,如在2306处所示。在确定快速性心律失常正在发生之后,医疗装置和第一无引线心脏起搏器中的一个或多个可至少部分地基于由医疗装置感测的心脏活动和/或由第一无引线心脏起搏器感测的心脏活动两者来确定快速性心律失常的类型,如在2308处所示。在本示例性方法中,由第一无引线心脏起搏器感测的心脏活动可帮助区别心律失常的类型。在本示例中,本方法装置可包括ICD、SICD、另一无引线心脏起搏器或任何其它适当的装置。
在某些情况下,还可由第二无引线心脏起搏器感测心脏活动。在某些情况下,医疗装置、第一无引线心脏起搏器以及第二无引线心脏起搏器中的一个或多个可至少部分地基于由医疗装置感测的心脏活动,由第一无引线心脏起搏器感测的心脏活动和/或由第一无引线心脏起搏器感测的心脏活动来确定快速性心律失常是否正在发生。在确定快速性心律失常正在发生之后,医疗装置、第一无引线心脏起搏器和第二无引线心脏起搏器中的一个或多个可至少部分地基于由医疗装置、第一无引线心脏起搏器和第二无引线心脏起搏器中的两个或更多感测的心脏活动来确定快速性心律失常的类型。这是另一示例。
本领域的技术人员将认识到除在本文中描述和设想的特定实施例之外可用多种形式来表明本公开。作为一个示例,如本文所述,各种示例包括被描述为执行各种功能的一个或多个模块。然而,其它是可包括将所述功能分布在甚至比本文所述更多模块上的附加模块。另外,其它示例可将所述功能合并成较少的模块。因此,在不脱离如在所附权利要求中描述的本公开的范围和精神的情况下可进行形式和细节方面的修改。
附加示例
在第一示例中,一种识别患者的心脏的快速性心律失常的方法包括用医疗装置来感测心脏活动,用第一无引线心脏起搏器来感测心脏活动,其中,第一无引线心脏起搏器与医疗装置间隔开并经由包括患者身体的通信路径而可通信地耦合到医疗装置;以及至少部分地基于由医疗装置感测的心脏活动和由第一无引线心脏起搏器感测的心脏活动两者来确定快速性心律失常是否正在发生。
另外或替换地,并且在第二示例中,第一示例的医疗装置可包括第二无引线心脏起搏器,并且可在心脏的心房处植入第二无引线心脏起搏器并在心脏的心室处植入第一无引线心脏起搏器。
另外或替换地,并且在第三示例中,第一或第二示例中的任一项的医疗装置可包括第二无引线心脏起搏器,并且可在心脏的左心室处植入第二无引线心脏起搏器,并且可在心室的右心室处植入第一无引线心脏起搏器。
另外或替换地,并且在第四示例中,第一至第三示例中的任一项的医疗装置可包括第二无引线心脏起搏器,并且可在心脏的心内膜表面上植入第二无引线心脏起搏器,并且可在心脏的心外膜表面上植入第一无引线心脏起搏器。
另外或替换地,并且在第五示例中,第一至第四示例中的任一项的医疗装置和第一无引线心脏起搏器中的一个可在经由通信路径从医疗装置和第一无引线心脏起搏器中的另一个接收到心脏信息之后执行确定步骤。
另外或替换地,并且在第六示例中,第一至第五示例中的任一项的心脏信息可包括由医疗装置和第一无引线心脏起搏器中的另一个感测的心脏活动。
另外或替换地,并且在第七示例中,第一至第六示例中的任一项的心脏信息可包括由医疗装置和第一无引线心脏起搏器中的另一个确定的快速性心律失常的临时确定。
另外或替换地,并且在第八示例中,第一至第七示例中的任一项的医疗装置可包括第二无引线心脏起搏器、植入式脉冲发生器以及仅诊断医疗装置中的一个。
另外或替换地,并且在第九示例中,第一至第八示例中的任一项的医疗装置和第一无引线心脏起搏器中的一个是主装置,并且其中,医疗装置和第一无引线心脏起搏器中的另一个是从属装置。
另外或替换地,并且在第十示例中,第一至第九示例中的任一项在确定快速性心律失常的发生时向心脏递送防心动过速起搏(ATP)治疗。
在第十一示例中,一种用于识别患者的心脏中的快速性心律失常的医疗系统包括多个无引线心脏起搏器,其被配置成检测心脏的相应位置处的心脏活动;以及植入式复律除颤器(ICD),其经由包括患者身体的通信路径被可通信地耦合到所述多个无引线心脏起搏器中的每一个,ICD至少部分地基于由所述多个无引线心脏起搏器中的两个或更多检测到的心脏活动来确定快速性心律失常是否正在发生。
另外或替换地,并且在第十二示例中,第十一示例的ICD可以是具有一个或多个皮下电极的皮下ICD。
另外或替换地,并且在第十三示例中,由第十一或第十二示例中的任一项的所述多个无引线心脏起搏器中的两个或更多检测到的心脏活动可包括检测心脏的相应位置处的快速性心律失常。
另外或替换地,并且在第十四示例中,第十一至第十三示例中的任一项的ICD如果所述多个无引线心脏起搏器中的两个或更多的大多数确定快速性心律失常正在发生,则可确定快速性心律失常正在发生。
另外或替换地,并且在第十五示例中,第十一至第十四示例中的任一项的所述多个无引线心脏起搏器中的两个或更多可被设置在心脏中的多个心室部位处。
另外或替换地,并且在第十六示例中,第十一至第十五示例中的任一项的ICD可被配置成检测心脏的心脏活动;并且其中,ICD被配置成至少部分地基于由所述多个无引线心脏起搏器中的两个或更多检测的心脏活动和由ICD检测的心脏活动来确定快速性心律失常是否正在发生。
另外或替换地,并且在第十七示例中,当ICD确定快速性心律失常正在发生时,第十一至第十六示例中的任一项的ICD可确定所述多个无引线心脏起搏器中的哪一个递送ATP治疗。
在第十八示例中,一种识别患者的心脏的快速性心律失常的方法包括用医疗装置来感测心脏活动,用第一无引线心脏起搏器来感测心脏活动,其中,第一无引线心脏起搏器经由包括患者身体的通信路径而可通信地耦合到医疗装置;由医疗装置和第一无引线心脏起搏器中的一个或多个至少部分地基于由医疗装置感测的心脏活动和/或由第一无引线心脏起搏器感测的心脏活动来确定快速性心律失常是否正在发生;以及在确定快速性心律失常正在发生之后,由医疗装置和第一无引线心脏起搏器中的一个或多个至少部分地基于由医疗装置感测的心脏活动和/或由第一无引线心脏起搏器感测的心脏活动两者来确定快速性心律失常的类型。在某些情况下,快速性心律失常的类型包括室性快速性心律失常或房性快速性心律失常中的一个。
另外或替换地,并且在第十九示例中,第十八示例可包括基于所确定的第一类型的快速性心律失常而向心脏递送第一治疗,并且基于所确定的第二类型的快速性心律失常而向心脏递送第二治疗。
Claims (15)
1.一种识别患者的心脏的快速性心律失常的方法,该方法包括:
由医疗装置来感测心脏活动;
由第一无引线心脏起搏器来感测心脏活动;其中,第一无引线心脏起搏器与医疗装置间隔开并经由包括患者身体的通信路径而可通信地耦合到医疗装置;以及
至少部分地基于由医疗装置感测的心脏活动和由第一无引线心脏起搏器感测的心脏活动两者来确定快速性心律失常是否正在发生。
2.权利要求1的方法,
其中,所述医疗装置包括第二无引线心脏起搏器,并且
其中,在心脏的心房处植入第二无引线心脏起搏器并在心脏的心室处植入第一无引线心脏起搏器。
3.权利要求1—2中的任一项的方法,
其中,所述医疗装置和所述第一无引线心脏起搏器中的一个在经由通信路径从所述医疗装置和所述第一无引线心脏起搏器中的另一个接收到心脏信息之后执行确定步骤。
4.权利要求3的方法,
其中,所述心脏信息包括由所述医疗装置和所述第一无引线心脏起搏器中的另一个感测的心脏活动。
5.权利要求3的方法,
其中,所述心脏信息包括由所述医疗装置和所述第一无引线心脏起搏器中的另一个确定的快速性心律失常的临时确定。
6.权利要求1—5中的任一项的方法,
其中,所述医疗装置和所述第一无引线心脏起搏器中的一个是主装置,并且其中,所述医疗装置和所述第一无引线心脏起搏器中的另一个是从属装置。
7.权利要求1—6中的任一项的方法,还包括
在确定了快速性心律失常的发生时,向心脏递送防心动过速起搏(ATP)治疗。
8.权利要求7的方法,还包括
确定所述医疗装置和所述第一无引线心脏起搏器中的哪一个要递送ATP治疗。
9.权利要求1—8中的任一项的方法,
其中,所述医疗装置是植入式复律除颤器(ICD)。
10.权利要求1—8中的任一项的方法,
其中,所述医疗装置是包括一个或多个皮下电极的皮下植入式复律除颤器(SICD)。
11.权利要求1—9中的任一项的方法,还包括
确定心脏心律失常的类型。
12.权利要求11的方法,
其中,心脏心律失常的类型包括室性快速性心律失常和房性快速性心律失常中的一个。
13.权利要求1—12中的任一项的方法,还包括
由第二无引线心脏起搏器来感测心脏活动,其中,所述第二无引线心脏起搏器经由包括患者身体的通信路径而可通信地耦合到医疗装置。
14.权利要求13的方法,
其中,至少部分地基于由医疗装置感测的心脏活动和由第一无引线心脏起搏器感测的心脏活动两者来确定快速性心律失常是否正在发生包括:由所述医疗装置、所述第一无引线心脏起搏器以及所述第二无引线心脏起搏器中的一个或多个而至少部分地基于由所述医疗装置感测的心脏活动、由所述第一无引线心脏起搏器感测的心脏活动和/或由所述第一无引线心脏起搏器感测的心脏活动来确定快速性心律失常是否正在发生。
15.权利要求14的方法,还包括
在确定快速性心律失常正在发生之后,由所述医疗装置、所述第一无引线心脏起搏器和所述第二无引线心脏起搏器中的一个或多个而至少部分地基于由所述医疗装置、所述第一无引线心脏起搏器和所述第二无引线心脏起搏器中的两个或更多个感测的心脏活动来确定所述快速性心律失常的类型。
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