Electronic synchronizer-monitor system for controlling the timing of mechanical assistance and pacing of the heart

• US 4,016,871 A
• Filed: 03/06/1975
• Issued: 04/12/1977
• Est. Priority Date: 03/06/1975
• Status: Expired due to Term

• Current Assignee: Arrow Interventional, Inc. (Teleflex Incorporated)
• Original Assignee: Peter Schiff
• Inventors: Schiff, Peter
• Primary Examiner(s): Kamm, William E.
• Application Number:
  US05/556,153
• Time in Patent Office: 768 Days
• Field of Search: 128/1 D, 128/2.05 R, 128/2.06 R, 128/64, 128/419 PG, 128/419 D, 3/1.7
• US Class Current: 600/510
• CPC Class Codes: A61B 1/00048 Constructional features of the display
• CPC Class Codes: A61B 1/0005 combining images e.g. side-by-side, superimposed or tiled
• CPC Class Codes: A61B 5/0006 ECG or EEG signals
• CPC Class Codes: A61B 5/742 using visual displays A61B5/339 takes precedence
• CPC Class Codes: A61B 5/7475 User input or interface means, e.g. keyboard, pointing device, joystick
• CPC Class Codes: A61M 2205/054 with electrotherapy
• CPC Class Codes: A61M 2205/33 Controlling, regulating or measuring
• CPC Class Codes: A61M 2205/3303 Using a biosensor
• CPC Class Codes: A61M 60/139 inside the aorta, e.g. intra-aortic balloon pumps
• CPC Class Codes: A61M 60/148 in line with a blood vessel using resection or like techniques, e.g. permanent endovascular heart assist devices
• CPC Class Codes: A61M 60/187 mechanically acting upon the inside of the patient's native heart, e.g. contractile structures placed inside the heart
• CPC Class Codes: A61M 60/274 the inlet and outlet being the same, e.g. para-aortic counter-pulsation blood pumps
• CPC Class Codes: A61M 60/289 Devices for mechanical circulatory actuation assisting the residual heart function by means mechanically acting upon the patient's native heart or blood vessel structure, e.g. direct cardiac compression [DCC] devices
• CPC Class Codes: A61M 60/295 Balloon pumps for circulatory assistance
• CPC Class Codes: A61M 60/468 the force acting on the actuation means being hydraulic or pneumatic
• CPC Class Codes: A61M 60/497 for balloon pumps for circulatory assistance
• CPC Class Codes: A61M 60/515 Regulation using real-time patient data
• CPC Class Codes: A61M 60/585 User interfaces
• CPC Class Codes: A61N 1/365 controlled by a physiological parameter, e.g. heart potential evoked response A61N1/371

Abstract

A system which is capable of simultaneously displaying a plurality of waveforms on the face of a CRT which are representative of ECG, arterial pressures and operating states of the mechanical heart assistance devices, as well as a "timing bar" which sweeps across the CRT face in synchronism with the ECG grace, for example.

Optical pickups are slidably mounted adjacent the CRT face across the path of the "timing bar" sweep for activating photodetectors which in turn initiate inflation and deflation of mechanical assistive devices at any desired point along the ECG or pressure trace. Any one of the pressure or ECG traces may be "frozen" on the display face to facilitate comparison between a trace of the condition of the heart prior to the use of heart assistance and a trace of the augmented condition. All traces may be freely moved to any location upon the display face so as to permit close positioning and even superimposition of two or more traces to still further facilitate visual comparisons. The timing bar may also be utilized to provide an electrical pacing assist for controlling patient heart rate as well as for extending the heart refractory period enabling the assistance devices to operate at reduced rates.

Claims

1. Means for accurately controlling the operation of an assistance device having first and second operating states utilized to assist and augment the beating of the heart of a patent under treatment comprising:

display means including a cathode ray tube and means for generating a timing bar which sweeps across one predetermined portion of the tube face along an imaginary straight line path at a rate related to the patient'"'"'s present heart beat;

first and second photocells positioned remote from said tube face;

first and second optical pick-up means and means for slidably positioning said first and second pick-up means at any location along said path;

first and second fiber optic bundles each being respectively connected between one of said first and second pick-ups and one of said first and second photocells whereby each photocell is activated as the timing bar passes its associated pick-up;

circuit means controlled by activation of said first and second photocells for alternately shifting said assistance device to its first and second operating states wherein the initiation of each operating state is dependent upon the relative positions of said pick-ups along said path.

2. The control means of claim 1 wherein said assistance device comprises an intra-aortic balloon adapted to be inserted into one of the patient'"'"'s arteries;

balloon control means having a first operating state for inflating said balloon and a second operating state for deflating said balloon, said balloon control means being coupled to said circuit means to inflate said balloon when said timing bar passes said first pick-up and to deflate said balloon when said timing bar passes said second pick-up.

3. The control means of claim 1 wherein said assistance device comprises a mechanical ventrical assistance cup assembly adapted to embrace the ventricles of the heart and means coupled to said cup assembly and controlled by said circuit means for inflating the cup assembly to contract the ventricles when said timing bar passes one of said pick-ups and for deflating the cup assembly to allow the ventricles to expand when said timing bar passes the remaining one of said pick-ups.

4. The means of claim 1 wherein said assistance device comprises a bypass pump assembly adapted to bypass the ventricle and atrium on one side of the patient'"'"'s heart and having first and second selectively connected chambers and being adapted to artificially perform the functions of the bypassed atrium and ventricle and means controlled by said circuit means and coupled to said bypass pump assembly for enabling said first chamber to receive blood when said timing bar passes one of said pick-ups and for transferring blood delivered to said first chamber to said second chamber when said timing bar passes the remaining pick-up.

5. The means of claim 1 wherein said assistance device comprises pulse generating means coupled to one of said photocells for applying an electrical signal of a predetermined pulse duration to the patient'"'"'s heart to defibrillate the heart as the timing bar passes the pick-up associated with the photocell coupled to said pulse generating means and thereby cause the R-wave of a ECG signal occurring during the time interval of said electrical signal to be ineffective on the operation of the heart.

6. The means of claim 1 further comprising means for monitoring the patient to generate an electrocardiogram (ECG) signal;

means coupled to said display means for generating a trace on said face representative of said ECG signal;

trigger means adjustably responsive to a predetermined portion of said ECG signal for resetting said timing bar generating means to thereby control the timing bar sweep rate.

7. The means of claim 6 further comprising recirculating memory means for indefinitely storing a predetermined portion of said ECG signal means coupled to said memory means for displaying the contents of said memory means on the face of said CRT whereby the stored ECG signal may be directly compared with the ECG signal presently being obtained from the patient.

8. The means of claim 7 wherein said means for displaying said memory means further comprises means for displaying the stored ECG signal at a brightness level which is different from the brightness level of the display trace representing the ECG signal presently being obtained from the patient.

9. The means of claim 6 wherein said trigger means is adapted to reset said timing bar generating means upon the occurrence of each R-wave portion of the ECG signal.

10. The apparatus of claim 6 wherein said display means further comprises means responsive to the ECG signal derived from a patient for initiating each ECG trace on the display means in synchronism with the initiation of a timing bar trace.

11. The apparatus of claim 10 wherein said timing bar generating means and said ECG trace generating means each including means to cause the timing bar and ECG traces to be initiated only at sustantially one and the same end of said display means.

12. The apparatus of claim 10 wherein said trace initiating means initiates each ECG trace upon the occurrence of the R-wave of the ECG signal.