Electrical Muscle Controller

• US 20080065159A1
• Filed: 10/31/2007
• Published: 03/13/2008
• Est. Priority Date: 01/08/1996
• Status: Active Grant

• Current Assignee: Impulse Dynamics NV
• Original Assignee: Impulse Dynamics NV
• Inventors: Ben-Haim, Mika, Ben-Haim, Shlomo, Darvish, Nissim, Fenster, Maier
• Granted Patent: US 8,260,416 B2
• Time in Patent Office: Days
• US Class Current: 607/2
• CPC Class Codes: A61B 18/20 using laser
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2017/0243 for immobilizing local areas of the heart, e.g. while it beats
• CPC Class Codes: A61B 2018/00392 Transmyocardial revascularisation
• CPC Class Codes: A61B 5/0215 by means inserted into the body catheters A61M25/00
• CPC Class Codes: A61B 5/029 Measuring or recording blood output from the heart, e.g. minute volume A61B8/065 takes precedence
• CPC Class Codes: A61B 5/06 Devices, other than using radiation, for detecting or locating foreign bodies for removing same A61B17/50 ; determining position of probes within or on the body of the patient
• CPC Class Codes: A61B 5/14503 invasive, e.g. introduced into the body by a catheter or needle or using implanted sensors A61B5/1459, A61B5/1464, A61B5/1473, A61B5/1482, A61B5/14865 take precedence
• CPC Class Codes: A61B 5/14539 for measuring pH
• CPC Class Codes: A61B 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 5/4519 Muscles A61B5/389, A61B5/224 take precedence
• CPC Class Codes: A61B 5/6843 Monitoring or controlling sensor contact pressure
• CPC Class Codes: A61B 5/6852 Catheters
• CPC Class Codes: A61B 5/6853 with a balloon
• CPC Class Codes: A61B 5/6856 with a distal loop
• CPC Class Codes: A61B 5/6858 with a distal basket, e.g. expandable basket
• CPC Class Codes: A61B 5/6859 with multiple distal splines
• CPC Class Codes: A61M 2025/0166 Sensors, electrodes or the like for guiding the catheter to a target zone, e.g. image guided or magnetically guided
• CPC Class Codes: A61N 1/32 alternating or intermittent currents applying electric fields by inductive or capacitive coupling A61N1/40; microwave apparatus A61N5/02
• CPC Class Codes: A61N 1/326 : for promoting growth of cells, e.g. bone cells
• CPC Class Codes: A61N 1/36146 : specified by the stimulation parameters
• CPC Class Codes: A61N 1/3621 : for treating or preventing abnormally high heart rate
• CPC Class Codes: A61N 1/3627 : for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/365 : controlled by a physiological parameter, e.g. heart potential evoked response A61N1/371
• CPC Class Codes: A61N 1/36514 : controlled by a physiological quantity other than heart potential, e.g. blood pressure controlled by two or more physical parameters A61N1/36585
• CPC Class Codes: A61N 1/36557 : controlled by chemical substances in blood
• CPC Class Codes: A61N 1/36564 : controlled by blood pressure
• CPC Class Codes: A61N 1/368 : comprising more than one electrode co-operating with different heart regions A61N1/3622, A61N1/3627 take precedence

Abstract

A method of modifying the force of contraction of at least a portion of a heart chamber, including providing a subject having a heart, comprising at least a portion having an activation, and applying a non-excitatory electric field having a given duration, at a delay after the activation, to the portion, which causes the force of contraction to be increased by a least 5%.

Claims

1. Apparatus for treatment of congestive heart failure, the apparatus comprising:

(a) a signal generator adapted to apply an electric signal to a cardiac tissue a;

(b) a controller adapted to operate the signal generator;

wherein the electric signal increases a contractility of cardiac muscle.

2. Apparatus according to claim 1, wherein the contractility of cardiac muscle comprises cellular contractility.

3. Apparatus according to claim 1, wherein contractility of cardiac muscle comprises increased local contractility.

4. Apparatus according to claim 1, wherein the increased contractility has a residual effect on at least one subsequent heartbeat.

5. Apparatus according to claim 4, wherein the residual effect persists through subsequent heart beats in the absence of the electric signal.

6. Apparatus according to claim 1, wherein the signal comprises a pacing pulse and at least one additional pulse applied during a refractory period.

7. Apparatus according to claim 1, wherein a control sequence specifies a first number of beats in which a first control logic is applied and a second number of beats in which a second control logic is applied.

8. Apparatus according to claim 1, wherein the electric signal comprises a non-excitatory signal.

9. Apparatus according to claim 1, wherein controller applies the signal during a refractory period.

10. A method of treating congestive heart failure, the method comprising applying an electric signal to cardiac tissue to increase a contractility of cardiac muscle.

12. A method according to claim 10, wherein the applying is conducted according to a control sequence which specifies a first number of beats in which a first control logic is applied and a second number of beats in which a second control logic is applied.

13. A method according to claim 10, wherein the electric signal comprises a non-excitatory signal.

14. A method according to claim 10, wherein the applying occurs during a refractory period.

11. A method of treating congestive heart failure, the method comprising applying an electric signal adapted to exert positive control to cardiac tissue.

15. Use of electric pulses as a treatment for congestive heart failure.

16. Use according to claim 15, wherein the electric pulses are applied to cardiac tissue.

17. Use according to claim 15, wherein the electric pulses are applied via electrodes contacting cardiac tissue.

18. Use according to claim 15, wherein the electric pulses are applied via electrodes in a single heart chamber.

19. Use according to claim 15, wherein the electric pulses are applied through a vein.

20. Use according to claim 15, wherein the electric pulses increase contractility of cardiac muscle.

21. Apparatus adapted for modifying cardiac activity, the apparatus comprising:

(a) a signal generator adapted to apply a non-excitatory signal to a cardiac tissue according to a programmable control sequence;

(b) a controller adapted to operate the signal generator according to the control sequence;

wherein the control sequence specifies a first number of beats in which a first control logic is applied and a second number of beats in which a second control logic is applied.

22. Apparatus according to claim 21, wherein the controller operates according to a predetermined control sequence.

23. Apparatus according to claim 21, wherein the controller is responsive to a cardiac output parameter.

24. Apparatus according to claim 21, wherein the control sequence specifies application of the signal during 1% to 70% of heartbeats.

25. Apparatus according to claim 21, wherein the control sequence specifies rest periods during which no signal is applied.

26. Apparatus according to claim 21, comprising:

(c) a parametric sensor adapted to provide an output to the controller;

wherein the controller is adapted to modify the control sequence responsive to the output.

27. A method for modifying cardiac activity, the method comprising applying a non-excitatory signal with a defined control sequence for a finite amount of time to a cardiac tissue.

28. A method according to claim 27, wherein the defined control sequence is not responsive to a signal from a sensor.

29. A method according to claim 27, wherein the control sequence is defined in terms of heartbeats.

30. A method according to claim 27, wherein modification of the cardiac activity persists after the finite amount of time is over.

31. A method of ameliorating a clinical severity of congestive heart failure, the method comprising:

applying a non-excitatory electric field to at least a portion of a heart, the electric field characterized by a magnitude, shape, duty cycle, phase, frequency and duration suitable to obtain an increase in stroke volume.

32. A method according to claim 31, wherein the electric field is altered in response to an output from a sensor.

33. A method according to claim 32, wherein the sensor includes at least one sensor type selected from the group consisting of a pH sensor, an oxygen saturation sensor, a carbon dioxide saturation sensor, blood flow sensor, an acceleration sensor, a respiration sensor and a pressure sensor.

34. A method according to claim 31, wherein the electric field is applied at a time at which it is unable to generate a propagating action potential.

35. A method according to claim 31, wherein the electric field is adapted to influence a physiologic property of cardiac cells.

36. A method according to claim 35, wherein the physiologic property comprises calcium ion transport.

37. A method according to claim 31, comprising ceasing the applying when a desired change a distribution of muscle mass in the heart is achieved.

38. A method according to claim 31, performed on an ongoing basis by an implanted apparatus as a therapy for congestive heart failure.

39. A method of cardiac modeling, the method comprising:

(a) applying a non-excitatory electric field to at least a portion of a heart to change a distribution of muscle mass in the heart; and

(b) ceasing to apply the non excitatory electric field after a desired change in distribution of muscle mass is achieved.

40. Use of a non excitatory electric field applied to at least a portion of a heart to produce an inotropic effect.

41. Use according to claim 40, wherein the inotropic effect persists after the electric field is no longer being applied.

42. A method of treating heart failure, the method comprising:

(a) applying a non-excitatory electric inotropic therapy program to a subject;

(b) modifying the therapy program responsive to an assessment of at least one parameter.

43. A method according to claim 42, wherein the modifying is performed by control circuitry in response to data provided by at least one sensor.

44. A method of controlling nervous signals in peripheral nerves, the method comprising:

(a) selecting a nerve; and

(b) applying a non-excitatory electric field to the nerve to attenuate conduction of a signal therein.