Apparatus and method for detecting heart characteristics by way of electrical stimulation

• US 4,870,974 A
• Filed: 03/31/1988
• Issued: 10/03/1989
• Est. Priority Date: 09/30/1987
• Status: Expired due to Fees

• Current Assignee: Chinese PLA General Hospital, Citic Technology Incorporated
• Original Assignee: Chinese PLA General Hospital, Citic Technology Incorporated
• Inventors: Wang, Xiangsheng
• Primary Examiner(s): Jaworski, Francis
• Application Number:
  US07/175,514
• Time in Patent Office: 551 Days
• Field of Search: 128/419 P, 128/419PG, 128/419 PT, 128/696-697, 128/700, 128/702-705
• US Class Current: 600/513
• CPC Class Codes: A61N 1/3621 for treating or preventing abnormally high heart rate
• CPC Class Codes: A61N 1/385 Devices for inducing an abnormal cardiac function, e.g. fibrillation
• CPC Class Codes: A61N 1/3943 for threshold determination

Abstract

The apparatus and method of the present invention are used to detect the ECG and/or blood pressure (BP) waveforms and measure the R-R and Q-T intervals from the detected ECG signals, so as to determine the pulse structure of the heart stimulating signals, and to stimulate the heart. The heart is stimulated by the stimulating signals which includes a pacing pulse train applied to atrium for forming an artificial heart rhythm, and an inducing pulse train applied to ventricle for introducing ME or VT waveforms. By adjusting the time location and amplitude of the inducing pulses relative to the pacing pulses, the ME or VT waveforms are induced in the ECG signals. By detecting the ECG and/or BP waveforms, the ME or VT is identified and at the same time the heart stimulation is stopped. Then the induced ME or VT waveforms and the amplitude of the inducing pulse which induces the ME or VT waveforms are displayed and the ventricular fibrillation threshold is derived according to this amplitude.

Claims

1. An apparatus for detecting heart characteristics, comprising:

a plurality of ECG detecting electrodes;

a blood pressure (BP) sensor;

a preamplifier circuit, whose inputs are connected respectively to said ECG detecting electrodes and said BP sensor, for providing parallel multiplex outputs of ECG and BP signals;

an A/D convertor, whose inputs are connected to said parallel multiplex outputs of said preamplifier circuit, for converting said analog ECG and BP signals into digital data;

a data processing unit, whose inputs are connected to the digital output of said A/D convertor, for processing said digital data to generate stimulating instructions and to identify waveforms of said ECG and BP signals;

a stimulating signal generating unit for generating heart stimulation signals under the control of said stimulating instructions issued by said data processing unit;

two pairs of intracardiac electrodes, which are connected to the outputs of said stimulating signal generating unit, for applying said heart stimulation signals to atrium and ventricle, respectively; and

an input-output device, which is connected to said data processing unit for inputting operating instructions therein and providing its processed results and identified waveforms as output;

wherein said data processing unit includes means for processing the ECG and BP signals detected by said ECG detecting electrodes and BP sensor, and for issuing instructions for heart stimulation to said stimulating signal generating unit according to said processed results, said stimulating signal generating unit generating stimulating signals of specific waveforms according to said instructions and applying said stimulating signals to atrium and ventricle, respectively, via said intracardiac electrodes, said data processing unit including means for identifying the change of ECG and BP waveforms under the effects of the stimulating signals, for issuing instructions for stopping stimulation to said stimulating signal generating unit upon the identification of ME (NST) or VT waveforms, and for providing the identified waveforms and the amplitude of the stimulating signal which induces said waveforms to said input-output device.

2. An apparatus for detecting heart characteristics as claimed by claim 1, wherein said data processing unit comprises:

a memory unit, whose input is connected to the output of said A/D convertor, for storing digital ECG and BP waveform signals;

an ECG measuring unit which fetches selectively the ECG signals from said memory unit and measures the characteristics of the ECG signals;

a BP measuring unit which fetches selectively the BP signals from said memory unit and measures the waveform and the diastolic BP value of the BP signals;

an identification unit which inputs said ECG characteristics from said ECG measuring unit and said BP waveform and diastolic value from said BP measuring unit; and

a calculating unit which inputs as its initial values said ECG characteristics from said ECG measuring unit and said BP waveform and diastolic value from said BP measuring unit, generates heart stimulating control signals under the control of said identification unit and provides said control signals to said stimulating signal generating unit;

wherein said identification unit causes said calculating unit to issue said heart stimulating control signals according to identified ECG and BP waveforms, identifies the change of ECG and BP waveforms in response to the stimulating signals, so as to identify ME or VT waveforms, issues instructions for stopping stimulation to said calculating unit upon the identification of ME or VT waveforms and provides the identified waveforms and the amplitude of the stimulating pulse which induces said waveforms to said input-output device for displaying.

3. An apparatus for detecting heart characteristics as claimed in claim 2, wherein said stimulating signal generating unit generates, under the control of said calculating unit, said heart stimulating signals which comprises:

a pacing pulse train to be applied to atrium with a period equal to 50-80% of the R--R interval measured by said ECG measuring unit, and an amplitude in the range of 1-20 mA; and

an inducing pulse train to be applied to ventricle which is made up of a plurality of bursts of n pulses generated at such times that, after each group of N pacing pulses, a burst of inducing pulses is applied to the ventricle in the range between the start point and peak point of T wave, N being in the range of 1-10, the pulse period within each burst being in the range 4-10 ms, and n being determined according to said pulse period and the time from the start point of T wave to its peak point;

wherein the amplitude of the inducing pulse burst is substantially 0.1 mA at beginning and is increased by about 0.1 mA for each burst until ME or VT is induced.

4. An apparatus for detecting heart characteristics as claimed in claim 2, wherein said stimulating signal generating unit generates, under the control of said calculating unit, said heart stimulating signals which comprises:

a pacing pulse train to be applied to atrium with a period equal to 50-80% of the R--R interval measured by said ECG measuring unit, and an amplitude in the range of 1-20 mA; and

an inducing pulse train to be applied to ventricle in a way that each inducing pulse is applied after N pacing pulses, wherein N is selected in the range of 1-10, the first inducing pulse is applied at the start point of T wave, and the following inducing pulses are each delayed 4-10 mS after each group of N pacing pulses, the amplitude of the inducing pulses is substantially 0.1 mA at first, wherein each inducing pulse is delayed relative to the preceding group of N pacing pulses by an amount greater than the amount of delay for the preceding inducing pulse until reaching the peak point of T wave, wherein the amplitude is increased by an increment of about 0.1 mA, and wherein the pulse is again applied at the start point of T wave for another cycle until ME or VT is induced.

5. An apparatus for detecting heart characteristics as claimed by claim 2, wherein said stimulating signal generating unit generates, under the control of said calculating unit, said heart stimulating signals which comprises:

a pacing pulse train to be applied to atrium with a period equal to 50-80% of the R--R interval measured by said ECG measuring unit and an amplitude in the range of 1-20 mA; and

an inducing pulse train to be applied to ventricle in a way that each inducing pulse is applied after N pacing pulses, wherein N is selected in the range of 1-10, the first inducing pulse is applied at the peak point of T wave and the following pulses are each delayed by about 4-10 mS after each group of N pacing pulses, the amplitude of the inducing pulses is about 0.1 mA at first, wherein each pulse is delayed relative to the preceding group of N pacing pulses by an amount less than the amount of delay for the preceding inducing pulse until reaching the start point of T wave, wherein the amplitude is increased by an increment of about 0.1 mA and wherein the pulse is again applied at the peak point of T wave for another cycle until ME or VT is induced.

6. An apparatus for detecting heart characteristics as claimed by claim 2, wherein said identification unit receives as inputs from said ECG measuring unit and BP measuring unit the ECG and BP waveform data measured when the heart is stimulated, compares the BP waveform data detected at the time when an inducing pulse is applied to ventricle with the diastolic BP value detected at the time when pacing pulses are applied to atrium, so as to find out the time duration when said BP waveform is lower than said diastolic BP value;

identifies the anomalous ECG waveform as ME or VT from the length of said duration, and then issues instruction for stopping stimulation, wherein said calculating unit, upon the identification of said ME or VT, fetches from said calculating unit the ampliitude of the inducing pulse which induces said waveform, so as to display the identified anamalous waveform and said inducing pulse amplitude via said input-output device.

7. An apparatus for detecting heart characteristics, comprising:

a plurality of ECG detecting electrodes;

a preamplifier circuit, whose inputs are connected to said ECG detecting electrodes, for providing ECG output;

an A/D convertor for converting said ECG output into digital data;

a data processing unit, whose input is connected to the digital output of said A/D convertor, for processing said digital data;

an input-output device connected to said data processing unit for inputting operating instructions and information thereto and providing the processed results and identified waveforms therefrom as output;

two pairs of dual path intracardiac electrodes for applying said heart stimulation signals to atrium and ventricle, respectively;

a stimulating signal generating unit having outputs connected to the dual-path heart stimulating electrodes; and

an earth-floating circuit connected between said preamplifier circuit and said A/D convertor, for preventing electric interference on the ECG signals detected by said preamplifier circuit when the stimulating pulses are applied to heart by said stimulating signal generating unit;

wherein, said data processing unit includes means for processing ECG signals detected via said ECG detecting electrodes, for issuing heart stimulation instructions to said stimulating signal generating unit according to the processed results, said stimulating signal generating unit generating stimulating signals of specific pulse structure according to the information provided by said instructions and applying said stimulating signals to atrium and ventricle respectively via said heart stimulating electrodes;

said data processing unit including means for identifying the waveform of PVC, ME or VT in ECG signals under the effects of said stimulating signals, for issuing instructions for stopping heart stimulation to said stimulating signal generating unit upon the identification of said waveform, and for providing the identified waveform and the amplitude of the pulse which induces said waveform to said input-output device as output.

8. The apparatus of claim 7, wherein said data processing unit further comprises:

a memory unit, whose input is connected to the output of said A/D convertor, for storing said digitized ECG signals;

an ECG measuring unit for fetching ECG signals from said memory unit and measuring parameters therefrom;

an identification unit for identifying the data inputted from said ECG measuring unit; and

a calculating unit which inputs said parameters from said ECG measuring unit as initial vallues, generates heart stimulating control signals under the control of said identification unit, and issues said control signals to said stimulating signal generating unit;

wherein, said identification unit, according to identified ECG signals, controls said calculating unit to issue said heart stimulating control signals, identifies for ME or VT the ECG waveforms detected when the heart stimulating signals are applied, and upon the identifying of ME or VT waveform, issues instructions to said calculating unit for stopping heart stimulation and at the same time provides the identified ECG waveform and the amplitude of the stimulating pulse which induces said waveform to said input-output device for displaying.

9. The apparatus of claim 8, wherein said heart stimulating signals generated by said stimulating signal generating unit under the control of said calculating unit comprises:

a pacing pulse train to be applied to atrium, with a period Tso less than the R--R interval of the ECG signal detected before heart stimulation; and

an inducing pulse train to be applied to ventricle for inducing ME or VT waveforms in ECG signals by adjusting the time location and amplitude of the inducing pulse relative to said pacing pulse;

wherein said identification unit receives the measured ECG data detected during the heart stimulating process from said ECG measuring unit, counts the number of successive anomalous heart beats having R--R interval less than said pacing period Tso, judges ME or VT according to said counted number and at the same time issues instructions to said calculating unit for stopping heart stimulation.

10. The apparatus of claim 9, wherein said identification unit identifies the number of successive anomalous waveforms caused by heart stimulation, and identifies said waveforms as ME or NST when said number is in the range of 3-9, 3 and 9 included, and wherein the calculating unit calculates the ventricular fibrillation threshold VFT from the amplitude MET of the ME'"'"'s inducing pulse and according to the equation:

VFT=1.7932+1.0816 MET; and

wherein said identification unit identifies the waveforms as VT and VFT when said number is equal to or greater than 10, wherein the calculating unit calculates the amplitude VTT of the VT'"'"'s inducing pulse according to the equation;

VFT=0.1349+1.1608 VTT, and wherein the calculating unit provides the calculated VFT to said input-output device.

11. A method for detecting heart characteristics, comprising the steps of:

a. detecting ECG and BP waveforms via ECG detecting electrodes and a BP sensor;

b. measuring R--R interval, Q-T interval, shift of ST segment from detected ECG signals and calculating the diastolic BP values from detected BP signals;

c. applying via intracardiac electrodes, a pacing pulse train to right atrium, with the period of said pacing pulse being 50-80% of said R--R interval and the amplitude being in the range of 1-20 mA;

d. applying via intracardiac electrodes, an inducing pulse to right ventricle after each group of N pacing pulses with the amplitude of said inducing pulse being less than 0.2 mA and preferably 0.1 mA, and applying said inducing pulse within the range from the start point to the peak point of T wave, wherein N is in the range of 1-10;

e. detecting, when said inducing pulse is applied, whether the BP waveform is lower than said diastolic BP value and the duration of the BP decrease;

wherein step d is repeated when no BP decrease is detected with the location of said inducing pulse being delayed 4-10 mS relative to the start point, within the range from the start point to the peak point of T wave, until the whole range is scanned;

f. increasing the amplitude of said inducing pulse by an increment of about 0.1 mA and repeating the above steps d and e, untl detected BP value is lower than said diastolic BP value for the time duration longer than a predetermined value;

g. stopping the application of said pacing and inducing pulses to the heart and providing via output device the ECG waveforms corresponding to said BP decrease and the amplitude of the inducing pulse which induces said waveform for display.

12. The method of claim 11, wherein:

said step d is performed by applying, via said intracardiac electrodes, an inducing pulse burst of n pulses to right ventricle to scan the range from the start point to the peak point of T wave, the period of the pulse within the burst is 4-10 mS, said number n being determined by the period and the width of said range, and where the amplitude of the pulse is less than 0.2 mA, and wherein in said step e, when no BP decrease is detected, the amplitude of the pulse burst is increased by about 0.1 mA, the stimulating process being repeated until the BP signal detected is at a value less than said diastolic BP value for a time duration greater than a predetermined value.

13. the method of claim 11, further comprising the steps of:

h. measuring the ECG signals provided by step g, and identifying the signals as ME when the number of the wide and distorted QRS complex is 1-9, QRS duration being greater than 0.12S, and identifying the signals as VT when said number of the wide and distorted QRS complex is equal to or greater than 10, and terming the amplitude of the inducing pulse the threshold MET or VTT correspondingly.

14. The method of claim 13, further comprising the step of:

i. calculating threshold VFT when no shift of ST segment is measured by step b, using the equations;

space="preserve" listing-type="equation">VFT=2.4709+0.922 MET

space="preserve" listing-type="equation">VFT=0.3617+1.1137 VTT

and calculating threshold VFT when shift of ST segment is measured by step b, using the equations;

space="preserve" listing-type="equation">VFT=0.0082+1.3995 MET

space="preserve" listing-type="equation">VFT=0.3209+1.0161 VTT

and providing said VFT as output.

15. A method for detecting heart characteristics comprising the steps of:

a. detecting ECG signals by ECG detecting electrodes;

b. measuring the R--R interval and Q-T interval of the detected ECG signals;

c. applying, via stimulating electrodes, a pacing pulse train to atrium with a period Tso being 50-80% of said R--R interval and an amplitude being 1-20 mA;

d. applying, via the other stimulating electrodes, an inducing pulse train to ventricle to induce ME or VT waveforms by adjusting the time location and amplitude of said inducing pulses relative to said pacing pulses;

e. identifying the anomalous heart beats having R--R interval less than said pacing period Tso induced by said inducing pulses and repeating step d until said anomalous heart beats are induced; and

f. stopping the application of said pacing pulse train to atrium and said inducing pulse train to ventricle upon the identification of said anomalous heart beats, and providing the waveforms of said anomalous heart beats and the amplitude of the inducing pulse which induces said waveforms to output device for display.

16. The method of claim 15, further comprising the step of:

g. identifying the ECG waveform as ME or MST when the number of successive anomalous heart beats is 3-9, 3 and 9 included, and the amplitude of the inducing pulse as MET; and

calculating VFT by equation;

space="preserve" listing-type="equation">VFT=1.7932+1.0816 MET;

identifying the ECG waveform as VT when the number of successive anomalous heart beats is equal to or greater than 10, and the amplitude of the inducing pulse as VTT, and calculating VFT by equation;

space="preserve" listing-type="equation">VFT=0.1349+1.1608 VTT; and

i. providing said VFT for output.

17. The method of claim 16, further comprising

terming as PVC the number of the anomalous heart beats when said number measured by step g is 1 or 2, and determining a vulnerable period of about 20 mS in width centered substantially at the location of the inducing pulse of said PVC;

and

returning to step d, and adjusting the location and amplitude of said inducing pulses within said vulnerable period until ME or VT is induced.

18. The method of claim 15, wherein the identification of the anomalous heart beats performed by step e comprises the following steps:

e1. filtering said detected ECG signals to eliminate the waveforms having a width less than about 10 mS;

e2. searching the filtered ECG signals to find the waveforms having a base frequency of 17 Hz, so as to identify each QRS complex; and

e3. measuring the R--R interval of the identified QRS complex to find out the anomalous heart beats having R--R interval less than said pacing period Tso.