Intracardial impedance measuring arrangement

• US 20050049646A1
• Filed: 08/20/2004
• Published: 03/03/2005
• Est. Priority Date: 09/01/2003
• Status: Active Grant

• Current Assignee: Biotronik SE & Company KG
• Original Assignee: Biotronik SE & Company KG
• Inventors: Lippert, Michael, Czygan, Gerald
• Granted Patent: US 7,395,114 B2
• Time in Patent Office: Days
• US Class Current: 607/27
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• CPC Class Codes: A61B 5/02028 Determining haemodynamic parameters not otherwise provided for, e.g. cardiac contractility or left ventricular ejection fraction
• CPC Class Codes: A61B 5/0535 Impedance plethysmography for measuring blood flow A61B5/0295
• CPC Class Codes: A61B 5/0538 invasively, e.g. using a catheter
• CPC Class Codes: A61B 5/7285 for synchronising or triggering a physiological measurement or image acquisition with a physiological event or waveform, e.g. an ECG signal A61B6/5205, A61B6/541, A61B8/5207, A61B8/543 take precedence
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance

Abstract

Certain embodiments of the present invention disclose an implant with electrode line connections for the connection of intracardial and/or epicardial electrode lines, wherein the electrode line connections have together at least three electrical contacts of which at least one is associated with a right-ventricular electrode and another is associated with a left-ventricular electrode, an impedance determining unit (IMP) which has a current or voltage source (I) and a measuring device (U) for a corresponding voltage or current measurement operation, which is connected to the electrical contacts and possibly a housing electrode of the implant, in such a way as to afford a tri- or quadrupolar impedance measuring arrangement which includes exclusively ventricular electrodes and in addition possibly the housing electrode, wherein the impedance measuring arrangement produces impedance measurement values and is connected to an evaluation unit (EVAL) and the evaluation unit (EVAL) is adapted to ascertain a minimum of the impedance measurement values within a first time window (defined relative to a ventricular event) as end-diastolic impedance (EDZ) and a maximum of the impedance measurement values within a second time window as end-systolic impedance (ESZ).

Claims

1. An implant comprising electrode line connections for the connection of intracardial and/or epicardial electrode lines, wherein the electrode line connections have together at least three electrical contacts of which at least one is associated with a right-ventricular electrode and another is associated with a left-ventricular electrode, an impedance determining unit (IMP) which has a current or voltage source (I) and a measuring device (U) for a corresponding voltage or current measurement operation, which is connected to the electrical contacts and possibly a housing electrode of the implant, in such a way as to afford a tri- or quadrupolar impedance measuring arrangement which includes exclusively ventricular electrodes and in addition possibly the housing electrode, wherein the impedance measuring arrangement produces impedance measurement values and is connected to an evaluation unit (EVAL) and the evaluation unit (EVAL) is adapted to ascertain a minimum of the impedance measurement values within a first time window (defined relative to a ventricular event) as end-diastolic impedance (EDZ) and a maximum of the impedance measurement values within a second time window as end-systolic impedance (ESZ) or to form an end-diastolic conductivity (EDC) as the reciprocal of the end-diastolic impedance (EDZ) and an end-systolic conductivity (ESC) as the reciprocal of the end-systolic impedance (ESZ).

2. The implant as set forth in claim 1 wherein the first and the second time windows are shorter than a respective cardiac cycle interval and oriented relative to a ventricular event in a cardiac cycle.

3. The implant as set forth in claim 2 wherein the first time window begins at a first initial time (x1) prior to the respective ventricular event and ends at a first end time (x2) after said ventricular event while the second time interval begins at a second initial time (y1) after said ventricular event and ends at a second end time (y2) after the ventricular event.

4. The implant as set forth in claim 3 wherein the first initial time (x1) and the first end time (x2) of the first time window and also the second initial time (y1) and the second end time (y2) of the second time interval are prior to the ventricular event as a reference time.

5. The implant as set forth in claim 4 wherein the evaluation unit (EVAL) is adapted to ascertain a beat impedance (SZ) representing a beat volume from a difference of the end-diastolic impedance (EDZ) and the end-systolic impedance (ESZ).

6. The implant as set forth in claim 5 wherein the evaluation unit is adapted to ascertain an EF parameter representing an ejection fraction (EF) from the beat impedance (SZ) and the end-diastolic impedance (EDZ).

7. The implant as set forth in claim 6 wherein the evaluation unit is additionally adapted to determine an impedance signal resulting from a time variation in the impedance measurement values and to ascertain from a first or a second derivative of the impedance signal a contractility parameter representing a contractility of a heart.

8. The implant as set forth in claim 7 further comprising a memory (MEM) for values in respect of beat impedance and/or the EF parameter and/or contractility and/or further values including that of impedance values and conductivity values.

9. The implant as set forth in claim 8 wherein the evaluation unit (EVAL) is adapted to store values in respect of beat impedance and/or the EF parameter and/or contractility at regularly recurring storage times.

10. The implant as set forth in claim 9 wherein the evaluation unit (EVAL) is adapted, for a period between two successive storage times, to form mean values in respect of beat impedance and/or EF parameter and/or contractility and to store the mean value or values.

11. The implant as set forth in claim 10 wherein the evaluation unit is adapted to ascertain from a development in respect of time of the beat impedance and/or the EF parameter and/or contractility, a trend value in respect of beat impedance and/or the EF parameter and/or contractility.

12. The implant as set forth in claim 11 wherein the evaluation unit (EVAL) is adapted to store the trend value or values at a respective storage time in the memory.

13. The implant as set forth in claim 12 further comprising a telemetry unit (TEL) which includes at least one telemetry transmitter and is connected to the memory and is adapted in response to an enquiry or at regular transmission times to send values in respect of beat impedance and/or EF parameter and/or contractility and/or one or more mean or trend values to an external unit.

14. The implant as set forth in claim 13 further comprising at least one control unit (CTRL) and stimulation unit (STIM) with which stimulation, cardioversion, and/or defibrillation pulses are produced and delivered to at least one of the electrode line connections.

15. The implant as set forth in claim 14 wherein said quadrupolar impedance measuring arrangement is adapted for connection to two right-ventricular electrodes for a current feed-in and two left-ventricular electrodes arranged in a coronary sinus for measuring a voltage resulting from the current which is fed in.

16. The implant as set forth in claim 7 wherein the evaluation unit (EVAL) is adapted to store values in respect of beat impedance and/or the EF parameter and/or contractility at regularly recurring storage times.

17. The implant as set forth in claim 8 wherein the evaluation unit (EVAL) is adapted, for a period between two successive storage times, to form mean values in respect of beat impedance and/or EF parameter and/or contractility and to store the mean value or values.

18. The implant as set forth in claim 8 further comprising a telemetry unit (TEL) which includes at least one telemetry transmitter and is connected to the memory and is adapted in response to an enquiry or at regular transmission times to send values in respect of beat impedance and/or EF parameter and/or contractility and/or one or more mean or trend values to an external unit.

19. The implant as set forth in claim 1 further comprising at least one control unit (CTRL) and stimulation unit (STIM) with which stimulation, cardioversion, and/or defibrillation pulses are produced and delivered to at least one of the electrode line connections.

20. The implant as set forth in claim 1 wherein said quadrupolar impedance measuring arrangement is adapted for connection to two right-ventricular electrodes for a current feed-in and two left-ventricular electrodes arranged in a coronary sinus for measuring a voltage resulting from the current which is fed in.