Hemodynamically responsive system for and method of treating a malfunctioning heart
First Claim
1. In a system for treating a malfunctioning heart of the type which includes storage means for storing electrical energy, electrode means for electrically coupling the storage means to the heart, determining means for determining right atrial pressure or central venous pressure and right ventricular pressure, means responsive to an output from the determining means for providing a first signal representative of an increase of at least a predetermined amount in the right atrial pressure or central venous pressure, means responsive to an output from the determining means for developing a second signal representative of a decrease of at least a given amount in right ventricular pressure, and means responsive to the first signal and the second signal for charging and enabling discharge of the electrical energy stored by the storage means across the electrode means upon presence of both the first and the second signals.
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Accused Products
Abstract
A system for a method of treating a malfunctioning heart is based on hemodynamics, the pressure in the right side of a patient'"'"'s circulatory system being sensed. A first signal is developed representative of mean right atrial pressure (MRAP) and a second signal is developed representing right ventricular systolic pressure (RVSP). When the MRAP increases by at least a predetermined amount and the RVSP decreases at least a given amount, the combination being an indication of hemodynamic compromise, cardioversion/defibrillation is effected. In these cases, a heart rate criterion, for example a rate over 150 bpm, may also have to be met before cardioverting/defibrillation is initiated. Fixed or variable baselines against which the changes in pressure are measured may be provided.
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Citations
39 Claims
- 1. In a system for treating a malfunctioning heart of the type which includes storage means for storing electrical energy, electrode means for electrically coupling the storage means to the heart, determining means for determining right atrial pressure or central venous pressure and right ventricular pressure, means responsive to an output from the determining means for providing a first signal representative of an increase of at least a predetermined amount in the right atrial pressure or central venous pressure, means responsive to an output from the determining means for developing a second signal representative of a decrease of at least a given amount in right ventricular pressure, and means responsive to the first signal and the second signal for charging and enabling discharge of the electrical energy stored by the storage means across the electrode means upon presence of both the first and the second signals.
- 13. In a system for treating a malfunctioning heart of the type which includes storage means for storing electrical energy, electrode means for electrically coupling the storage means to the heart, determining means for determining a first pressure parameter at one site in a circulatory system and a second pressure parameter at another site in the circulatory system, means responsive to an output from the determining means for providing a first signal representative of a change of at least a predetermined amount in the first pressure parameter indicative of possible hemodynamic compromise, means responsive to an output from the determining means for developing a second signal representative of a change of at least a given amount in the second pressure parameter indicative of possible hemodynamic compromise, and, charging and enabling discharge of the electrical energy stored by the storage means across the electrode means as at least one cardioverting/defibrillation pulse upon contemporaneous presence of both the first and the second signals.
- 22. A method of treating a malfunctioning heart comprising monitoring right atrial pressure or central venous pressure, monitoring right ventricular pressure, determining if the right atrial pressure increases by at least a predetermining amount, determining if the right ventricular pressure decreases by at least a given amount, and delivering cardioverting/defibrillating electrical energy to the heart upon to determining that the right atrial pressure has increased by at least the predetermined amount and the right ventricular pressure has decreased by at least the given amount.
- 30. A method of treating a malfunctioning heart comprising monitoring a first pressure parameter at one site in a circulatory system, monitoring a second presume parameter at another site int he circulatory system, determining if the first pressure parameter changes by at least a predetermining amount indicative of possible hemodynamic compromise, determining if the second pressure parameter changes by at least a given amount indicative of possible hemodynamic compromise, and delivering at least one pulse of cardioverting/defibrillating electrical energy to the heart upon determining that the first pressure parameter has changed by at least the predetermined amount and the second pressure parameter has also changed by at least the given amount.
- 34. In a system for treating a malfunctioning heart of the type which includes storage means for storing electrical energy and electrode means for electrically coupling the storage means to the heart, an improvement comprising determining means for determining a first hemodynamic parameter and a second hemodynamic parameter in a circulatory system, and means for enabling discharge of at least one pulse of cardioverting/defibrillating electrical energy from the electrical energy stored by the storage means across the electrode means upon output from the determining means indicating that the first hemodynamic parameter has changed by at least a predetermined amount indicative of possible hemodynamic compromise and the second hemodynamic parameter has also changed by at least a predetermined amount indicative of possible hemodynamic compromise.
- 37. A method of treating a malfunctioning heart comprising monitoring at least two hemodynamic parameters in a circulatory system, determining if the first hemodynamic parameter and the second hemodynamic parameter charge by at least respective predetermined amounts indicative in each case of possible hemodynamic compromise, and delivering at least one pulse of cardioverting/defibrillating electrical energy to the heart upon determining that each of the hemodynamic parameters have changed in the respective predetermined amounts.
Specification