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公开(公告)号：US5545205A
公开(公告)日：1996-08-13
申请号：US386210
申请日：1995-02-09
申请人： Theodore J. Schulte , Roger W. Dahl , Stanley M. Bach, Jr. , J. Edward Shapland , Douglas J. Lang
发明人： Theodore J. Schulte , Roger W. Dahl , Stanley M. Bach, Jr. , J. Edward Shapland , Douglas J. Lang
CPC分类号： A61N1/056 , A61N1/3918
摘要： A unitary intravascular defibrillating catheter includes distal and proximal spring electrodes, displaced to such distance from one another that defibrillating shock is effected through a field including the interventricular septum and left ventricular free wall. In one embodiment of this catheter, the proximal electrode is placed in the region of the subclavian vein. Alternatively, it may be placed in the region of the third through seventh intercostal space. A unitary catheter is also described which includes an intermediate electrode, placed between distal and proximal electrodes. Selection of placement of electrodes either in the superior vena cava or in the region of the subclavian vein is medically indicated by physiological conditions of the individual patient. The cardioversion system further includes a unipolar or bipolar sensing circuit with at least one sensing electrode, and a cardioversion/defibrillation circuit with either two or three spaced apart spring electrodes. The sensing electrodes are spaced apart from one another, but they are kept sufficiently close to one another for isolated, localized R-wave sensing. The sensing electrodes further are positioned remotely of the cardioversion/defibrillation electrodes, to avoid post-shock abnormalities which otherwise would interfere with a timely R-wave sensing, and to substantially prevent the discharge of an unnecessary cardioversion pulse after return of the heart to normal cardiac rhythm.
摘要翻译： 单一的血管内除颤导管包括远端和近端的弹簧电极，彼此相距移动，使得去纤维化的休克通过包括室间隔和左心室游离壁的场进行。 在该导管的一个实施例中，近端电极被放置在锁骨下静脉的区域中。 或者，其可以放置在第三至第七肋间空间的区域中。 还描述了包括放置在远端和近端电极之间的中间电极的单一导管。 在上腔静脉或锁骨下静脉区域中放置电极的选择由个体患者的生理条件医学指示。 心脏复律系统还包括具有至少一个感测电极的单极或双极检测电路，以及具有两个或三个间隔开的弹簧电极的心电复律/除颤电路。 感测电极彼此间隔开，但它们彼此保持足够接近以进行隔离的局部R波感测。 感测电极进一步位于心脏复律/除颤电极的远端，以避免冲击后异常，否则将干扰及时的R波感测，并且在将心脏恢复正常后基本上防止不必要的心脏复律脉冲的放电 心律
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2.发明授权
公开(公告)号：US5044375A
公开(公告)日：1991-09-03
申请号：US447908
申请日：1989-12-08
CPC分类号： A61N1/3918 , A61N1/056
摘要： A cardioversion system includes a bipolar sensing circuit with two sensing electrodes, and a cardioversion circuit with two spaced apart spring electrodes. The sensing electrodes are spaced apart from one another but kept sufficiently close to one another for isolated, localized R-wave sensing. The sensing electrodes further are positioned remotely of the cardioversion electrodes, to avoid post-shock abnormalities which otherwise would interfere with a timely R-wave sensing, to substantially prevent the discharge of an unnecessary cardioversion pulse after return of the heart to normal cardiac rhythm. One preferred version of the system is a unitary catheter including a distal tip electrode and ring electrode as the sensing electrodes, and to substantially larger, more proximal spring electrodes for defibrillation. Alternatively, the defibrillation electrodes and the sensing electrodes can be provided on two separate catheters. Yet another alternative involves providing one or more patch electrodes as defibrillation electrodes.
摘要翻译： 复律系统包括具有两个感测电极的双极感测电路和具有两个间隔开的弹簧电极的心电复律电路。 感测电极彼此间隔开，但彼此保持足够接近以进行隔离的局部R波感测。 检测电极进一步位于心复律电极的远端，以避免后期的异常，否则会干扰及时的R波检测，从而基本上防止在心脏恢复正常的心脏节律之后放出不必要的心脏复律脉冲。 系统的一个优选方案是整体导管，其包括作为感测电极的远侧末端电极和环形电极，以及用于除颤的基本上较大的更近的弹簧电极。 或者，除颤电极和感测电极可以设置在两个分开的导管上。 另一替代方案涉及提供一个或多个贴片电极作为除颤电极。
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公开(公告)号：US5269319A
公开(公告)日：1993-12-14
申请号：US753115
申请日：1991-08-30
CPC分类号： A61N1/056 , A61N1/3918
摘要： A unitary intravascular defibrillating catheter includes distal and proximal spring electrodes, displaced to such distance from one another that defibrillating shock is effected through a field including the interventricular septum and left ventricular free wall. In one embodiment of this catheter, the proximal electrode is placed in the region of the subclavian vein. Alternatively, it may be placed in the region of the third through seventh intercostal space. A unitary catheter is also described which includes an intermediate electrode, placed between distal and proximal electrodes. Selection of placement of electrodes either in the superior vena cava or in the region of the subclavian vein is medically indicated by physiological conditions of the individual patient.The cardioversion system further includes a unipolar or bipolar sensing circuit with at least one sensing electrode, and a cardioversion/defibrillation circuit with either two or three spaced apart spring electrodes. The sensing electrodes are spaced apart from one another, but they are kept sufficiently close to one another for isolated, localized R-wave sensing. The sensing electrodes further are positioned remotely of the cardioversion/defibrillation electrodes, to avoid post-shock abnormalities which otherwise would interfere with a timely R-wave sensing, and to substantially prevent the discharge of an unnecessary cardioversion pulse after return of the heart to normal cardiac rhythm.
摘要翻译： 单一的血管内除颤导管包括远端和近端的弹簧电极，彼此相距移动，使得去纤维化的休克通过包括室间隔和左心室游离壁的场进行。 在该导管的一个实施例中，近端电极被放置在锁骨下静脉的区域中。 或者，其可以放置在第三至第七肋间空间的区域中。 还描述了包括放置在远端和近端电极之间的中间电极的单一导管。 在上腔静脉或锁骨下静脉区域中放置电极的选择由个体患者的生理条件医学指示。 心脏复律系统还包括具有至少一个感测电极的单极或双极检测电路，以及具有两个或三个间隔开的弹簧电极的心电复律/除颤电路。 感测电极彼此间隔开，但它们彼此保持足够接近以进行隔离的局部R波感测。 感测电极进一步位于心脏复律/除颤电极的远端，以避免冲击后异常，否则将干扰及时的R波感测，并且在将心脏恢复正常后基本上防止不必要的心脏复律脉冲的放电 心律
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公开(公告)号：US5018523A
公开(公告)日：1991-05-28
申请号：US512363
申请日：1990-04-23
IPC分类号： A61N1/365
CPC分类号： A61N1/36507 , Y10S128/902
摘要： An apparatus for stimulating and sensing evoked response to stimulus in the heart. First and second electrodes are in electrical contact with the heart, a third indifferent electrode is also in electrical contact with the heart. A pacemaker provides stimulus signals through the electrodes in the stimulating mode of operation. The first and second electrodes are switched through switching apparatus wherein in the first mode the first and second electrodes are maintained at equal electrical potentials, and in a second, sensing mode, the switch operates between the first and second electrodes so as to allow the first and second electrodes to act as bipolar sensing leads. Evoked response is sensed by a differential amplifier having a first differential input connected to the first electrode and a second differential input connected to the second electrode. The differential amplifier provides a differential signal which is proportional to the evoked cardiac response.
摘要翻译： 一种用于刺激和感测对心脏刺激的诱发反应的装置。 第一和第二电极与心脏电接触，第三无电极也与心脏电接触。 起搏器在刺激操作模式下通过电极提供刺激信号。 第一和第二电极通过开关装置切换，其中在第一模式中，第一和第二电极保持在相等的电位，并且在第二感测模式中，开关在第一和第二电极之间操作，以便允许第一和第二电极 以及用作双极感测引线的第二电极。 诱发响应由具有连接到第一电极的第一差分输入和连接到第二电极的第二差分输入的差分放大器感测。 差分放大器提供与诱发心脏反应成正比的差分信号。
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5.发明授权Defibrillation electrode and method for employing gatling discharge defibrillation 失效除颤电极及采用格特林放电除颤的方法
公开(公告)号：US4969463A
公开(公告)日：1990-11-13
申请号：US361978
申请日：1989-06-06
CPC分类号： A61B5/6852 , A61B5/0422 , A61N1/0587 , A61N1/3956 , A61B2562/0209 , A61B2562/043 , A61B2562/046
摘要： An implantable defibrillation/cardioversion system and method comprising an electrode having a plurality of discrete electrically conductive segments. The conductive segments are electrically isolated from each other and electrically connected to a defibrillation/cardioversion unit. An electrical pulse block is generated and chopped into a plurality of discrete pulse segments by the defibrillation/cardioversion unit and applied to the electrode so that each conductive segment receives a particular electrical pulse assigned from the series of pulses. In this way, the concentration of gas generated from ionic current produced by a high energy defibrillation pulse is reduces and more energy is delivered to the heart, thus reducing the required energy input to the electrode. The electrode may be planar or in a catheter electrode configuration.
摘要翻译： 一种可植入除颤/心脏复律系统和方法，其包括具有多个离散导电段的电极。 导电段彼此电隔离并电连接到除颤/心脏复律单元。 产生电脉冲块并通过除颤/心律转换单元将其切成多个离散脉冲段并施加到电极，使得每个导电段接收从该系列脉冲分配的特定电脉冲。 以这种方式，由高能除颤脉冲产生的离子电流产生的气体的浓度降低，并且更多的能量传递到心脏，从而减少对电极的所需能量输入。 电极可以是平面的或者在导管电极配置中。
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公开(公告)号：US5342407A
公开(公告)日：1994-08-30
申请号：US912924
申请日：1992-07-13
CPC分类号： A61N1/05
摘要： Implantable electrodes for defibrillation are formed of pluralities of electrode segments. Each of the segments is relatively long and narrow. The electrode segments can be parallel and spaced apart from one another a distance at least ten times the nominal width, with one end of each segment mounted to a transverse distal portion of an electrically conductive lead coupling the electrode to a defibrillation pulse generator. Alternatively, segments can branch or radiate outwardly from a common junction. In yet another arrangement, electrode segments are portions of a single conductive path at the distal end of a lead from a pulse generator, arranged in either a spiral configuration or a serpentine configuration which can align electrode segments side by side, parallel and spaced apart. The electrode segments can be formed of composite conductors in the form of titanium ribbons or wires with a sputtered outer layer of platinum, or a silver core in a stainless steel tube, with a platinum layer formed onto the tube. The electrodes are highly compliant yet can provide large effective areas for defibrillation, enabling a transthoracic pulsing arrangement of two electrodes on opposite sides of the heart, implanted subcutaneously outside of the thoracic region.
摘要翻译： 用于除颤的可植入电极由多个电极段形成。 每个段都相对长而窄。 电极段可以彼此平行和间隔至少十倍于标称宽度的距离，每个段的一端安装到将电极耦合到除颤脉冲发生器的导电引线的横向远端部分。 或者，片段可以从公共接头向外分支或辐射。 在另一种布置中，电极段是在来自脉冲发生器的引线的远端处的单个导电路径的部分，其布置成螺旋构造或蛇形结构，其可以并排并排隔离电极段。 电极段可以由具有溅射的铂外层或不锈钢管中的银芯的钛带或电线形式的复合导体形成，铂层形成在管上。 电极是高度依从性的，但可以为除颤提供大的有效区域，使得能够在心脏外侧皮下植入心脏两侧的两个电极的经胸部脉冲排列。
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公开(公告)号：US5203348A
公开(公告)日：1993-04-20
申请号：US533886
申请日：1990-06-06
CPC分类号： A61N1/05
摘要： Implantable electrodes for defibrillation are formed of pluralities of electrode segments. Each of the segments is relatively long and narrow. The electrode segments can be parallel and spaced apart from one another a distance at least ten times the nominal width, with one end of each segment mounted to a transverse distal portion of an electrically conductive lead coupling the electrode to a defibrillation pulse generator. Alternatively, segments can branch or radiate outwardly from a common junction. In yet another arrangement, electrode segments are portions of a single conductive path at the distal end of a lead from a pulse generator, arranged in either a spiral configuration or a serpentine configuration which can align electrode segments side by side, parallel and spaced apart. The electrode segments can be formed of composite conductors in the form of titanium ribbons or wires with a sputtered outer layer of platinum, or a silver core in a stainless steel tube, with a platinum layer formed onto the tube. The electrodes are highly compliant yet can provide large effective areas for defibrillation, enabling a transthoracic pulsing arrangement of two electrodes on opposite sides of the heart, implanted subcutaneously outside of the thoracic region.
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公开(公告)号：US5603732A
公开(公告)日：1997-02-18
申请号：US554577
申请日：1995-11-06
CPC分类号： A61N1/05
摘要： Implantable electrodes for defibrillation are formed of pluralities of electrode segments. Each of the segments is relatively long and narrow. The electrode segments can be parallel and spaced apart from one another a distance at least ten times the nominal width, with one end of each segment mounted to a transverse distal portion of an electrically conductive lead coupling the electrode to a defibrillation pulse generator. Alternatively, segments can branch or radiate outwardly from a common junction. In yet another arrangement, electrode segments are portions of a single conductive path at the distal end of a lead from a pulse generator, arranged in either a spiral configuration or a serpentine configuration which can align electrode segments side by side, parallel and spaced apart. The electrode segments can be formed of composite conductors in the form of titanium ribbons or wires with a sputtered outer layer of platinum, or a silver core in a stainless steel tube, with a platinum layer formed onto the tube. The electrodes are highly compliant yet can provide large effective areas for defibrillation, enabling a transthoracic pulsing arrangement of two electrodes on opposite sides of the heart, implanted subcutaneously outside of the thoracic region.
摘要翻译： 用于除颤的可植入电极由多个电极段形成。 每个段都相对长而窄。 电极段可以彼此平行和间隔至少十倍于标称宽度的距离，每个段的一端安装到将电极耦合到除颤脉冲发生器的导电引线的横向远端部分。 或者，片段可以从公共接头向外分支或辐射。 在另一种布置中，电极段是在来自脉冲发生器的引线的远端处的单个导电路径的部分，其布置成螺旋构造或蛇形结构，其可以并排并排隔离电极段。 电极段可以由具有溅射的铂外层或不锈钢管中的银芯的钛带或电线形式的复合导体形成，铂层形成在管上。 电极是高度依从性的，但可以为除颤提供大的有效区域，使得能够在心脏的相对侧上的两个电极的经胸部脉冲排列皮下植入胸部区域。
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公开(公告)号：US5545202A
公开(公告)日：1996-08-13
申请号：US285802
申请日：1994-08-04
CPC分类号： A61N1/05
摘要： Implantable electrodes for defibrillation are formed of pluralities of electrode segments. Each of the segments is relatively long and narrow. The electrode segments can be parallel and spaced apart from one another a distance at least ten times the nominal width, with one end of each segment mounted to a transverse distal portion of an electrically conductive lead coupling the electrode to a defibrillation pulse generator. Alternatively, segments can branch or radiate outwardly from a common junction. In yet another arrangement, electrode segments are portions of a single conductive path at the distal end of a lead from a pulse generator, arranged in either a spiral configuration or a serpentine configuration which can align electrode segments side by side, parallel and spaced apart. The electrode segments can be formed of composite conductors in the form of titanium ribbons or wires with a sputtered outer layer of platinum, or a silver core in a stainless steel tube, with a platinum layer formed onto the tube. The electrodes are highly compliant yet can provide large effective areas for defibrillation, enabling a transthoracic pulsing arrangement of two electrodes on opposite sides of the heart, implanted subcutaneously outside of the thoracic region.
摘要翻译： 用于除颤的可植入电极由多个电极段形成。 每个段都相对长而窄。 电极段可以彼此平行和间隔至少十倍于标称宽度的距离，每个段的一端安装到将电极耦合到除颤脉冲发生器的导电引线的横向远端部分。 或者，片段可以从公共接头向外分支或辐射。 在另一种布置中，电极段是在来自脉冲发生器的引线的远端处的单个导电路径的部分，其布置成螺旋构造或蛇形结构，其可以并排并排隔离电极段。 电极段可以由具有溅射的铂外层或不锈钢管中的银芯的钛带或电线形式的复合导体形成，铂层形成在管上。 电极是高度依从性的，但可以为除颤提供大的有效区域，使得能够在心脏外侧皮下植入心脏两侧的两个电极的经胸部脉冲排列。
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公开(公告)号：US5111812A
公开(公告)日：1992-05-12
申请号：US468739
申请日：1990-01-23
申请人： David K. Swanson , Roger W. Dahl , Douglas J. Lang
发明人： David K. Swanson , Roger W. Dahl , Douglas J. Lang
CPC分类号： A61N1/0563
摘要： A defibrillation electrode for implantation in the region of the heart and for connection to a defibrillation system. The electrode comprises multiple independent conductive segments spaced apart for defining a discharge surface of the electrode. In one embodiment, the electrode comprises a plurality of concentric conductive rings electrically connected together. To smooth the current distribution, the interface impedance of the inner conductive segments is made lower than that of the outer conductive segments. In one embodiment, the impedance is determined by the choice of the conductive material. In another embodiment, the impedance is determined by texturing the surface of the conductive segments. In yet another embodiment, the impedance is determined by the ratio of conductive edges to surface of the conductive segment. The discharge surface region can also take the form of a portion of a cardiac catheter.Other ways to control the current distribution include the use of a floating conductive segment, and the use of discrete segments which receive defibrillating waveforms of different amplitudes and isolating the conductive segments to deliver higher amplitude waveforms in the inner segments than the outer segments.
摘要翻译： 一种用于植入心脏区域并用于与除颤系统连接的除颤电极。 电极包括间隔开的多个独立导电段，用于限定电极的放电表面。 在一个实施例中，电极包括电连接在一起的多个同心导电环。 为了平滑电流分布，使内部导电段的界面阻抗低于外部导电段的界面阻抗。 在一个实施例中，阻抗由导电材料的选择决定。 在另一个实施例中，通过纹理化导电段的表面来确定阻抗。 在另一个实施例中，阻抗由导电部分的导电边缘与表面之比决定。 放电表面区域也可以采取心脏导管的一部分的形式。 控制电流分布的其他方式包括使用浮动导电部分，以及使用接收不同幅度的去纤颤波形的离散部分，并且隔离导电部分以在内部部分中提供比外部部分更高幅度的波形。
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