Electrical muscle controller

• US 8,301,247 B2
• Filed: 10/31/2007
• Issued: 10/30/2012
• Est. Priority Date: 01/08/1996
• Status: Expired due to Fees

• Current Assignee: Impulse Dynamics NV
• Original Assignee: Impulse Dynamics NV
• Inventors: Ben-Haim, Shlomo, Darvish, Nissim, Fenster, Maier, Yuval, Mika
• Primary Examiner(s): Lavert, Nicole F
• Application Number:
  US11/931,889
• Publication Number:
  US 20080065164A1
• Time in Patent Office: 1,826 Days
• Field of Search: 607/4, 607/9, 607115-116, 600/374
• US Class Current: 607/9
• 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 trocars attached to inner organs or inner body tissue A61B2017/3488
• 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. A heart control apparatus, the apparatus comprising:

circuitry for generating a non-exciting voltage to control heart rate;

elongated electrode adapted to be positioned to deliver the non-exciting voltage generated by the circuitry at or near a self-pacing portion of a heart;

activation determining circuitry, comprising a sensor adapted to sense an activation of a portion of the heart; and

field application circuitry adapted to apply said voltage to the electrodes as a response to activation sensed by said sensor, wherein the elongate electrodes are characterized by a length of at least 1 cm and an area of at least 2 cm^2.

2. Heart control apparatus, according to claim 1, wherein:

said elongate electrodes are adapted to be positioned to deliver the non-exciting voltage generated by the circuitry at or near a sino-atrial (SA) node of a heart.

3. Apparatus according to claim 2, wherein said activation determining circuitry is configured to at least estimate the activation time at the heart or portion thereof and wherein said circuitry for generating a non-excitatory electric field with a timing relative to said determined activation of the heart or of a portion thereof, and of a magnitude, shape, duty, cycle, phase, frequency, and duration which is unable to generate a propagating action potential.

4. Apparatus according to claim 2, wherein the non-exciting voltage increases heart rate.

5. Apparatus according to claim 2, wherein the non-exciting voltage decreases heart rate.

6. Apparatus according to claim 2, wherein the non-exciting voltage is provided as an AC non-excitatory electric field.

7. Apparatus according to claim 6, comprising an envelope module adapted to impart to the non-excitatory electric field a temporal envelope selected from exponential temporal envelope, sinusoidal temporal envelope, square temporal envelope, triangular temporal envelope, ramped temporal envelope, sawtooth temporal envelope, and biphasic temporal envelope.

8. Apparatus according to claim 2, further comprising logic circuitry to calculate one or more application parameters of the electric field from the activation sensed by the sensor.

9. Apparatus according to claim 2, wherein the electrodes are characterized by a length of at least 2 cm.

10. Apparatus according to claim 9, wherein the electrodes are characterized by a length of at least 4 cm.

11. Heart control apparatus, according to claim 2, wherein said circuitry comprises interference circuitry adapted to generate an interference signal which interferes with an inherent cardiac feedback.

12. Apparatus according to claim 11, wherein the interference signal comprises a train of pulses.

13. Apparatus according to claim 11, wherein the interference signal comprises a non-excitatory electric field.

14. Apparatus according to claim 11, wherein the interference signal increases heart rate.

15. Apparatus according to claim 11, wherein the interference signal decreases heart rate.

16. Apparatus according to claim 11, wherein the interference signal extends a duration of an action potential of the region.

17. Apparatus according to claim 11, wherein the interference signal extends a refractory period of a significant portion of a right atrium of the heart.

18. Apparatus according to claim 3, wherein the activation determining circuitry comprises circuitry for determining a timing of artificial pacing.

19. Apparatus according to claim 2, wherein the non-excitatory voltage is applied with an energy too low to be suitable for defibrillation and less than 500 millijoules.

20. Apparatus according to claim 11, wherein the interference signal is applied with an energy too low to be suitable for defibrillation and less than 500millijoules.

21. Apparatus according to claim 2, wherein the circuitry is configured for reducing of heart rate and includes a memory having stored therein at least an indication of a desired heart rate and wherein said circuitry generates said non-exciting voltage in response to said indication.

22. Apparatus according to claim 11, wherein the circuitry includes a memory having stored therein at least an indication of a desired atrial activation profile and wherein said circuitry generates said interference signal in response to said indication.

23. Apparatus according to claim 2, wherein the circuitry is configured for control of heart rate over a period of at least a week.

24. Apparatus according to claim 2, wherein the circuitry is configured for detecting arrhythmia in an atria as an increased atrial heart rate and configured to reduce said arrhythmia by electrification of said elongate electrodes.

25. Apparatus according to claim 2, wherein at least one of the elongate electrodes is characterized by including a plurality of spaced apart electrode sections which together form an elongate electrification area.

26. Apparatus according to claim 2, wherein the circuitry is configured for control of heart rate and includes a memory having stored therein at least an indication of an elevated heart rate and wherein said circuitry generates said non-exciting voltage in response to a determination that a heart rate of said heart is above said elevated heart rate.

27. Apparatus according to claim 2, wherein the circuitry is configured to apply said non-exciting voltage at least 100 out of 5,000 consecutive cardiac cycles.

28. Apparatus according to claim 2, wherein the circuitry is configured to apply said non-exciting voltage as a DC field longer than one heart beat.

29. Apparatus according to claim 2, wherein the elongate electrodes are adapted for electrifying and attachment to cardiac muscle tissue.

30. Apparatus according to claim 2, wherein the circuitry is configured to apply said non-exciting voltage in a non-arrhythmic heart.

31. Apparatus according to claim 1, wherein said circuitries are adapted for applying said voltage in an atrium.

32. Apparatus according to claim 1, wherein said circuitries are adapted for applying said voltage at or near an SA node.

33. Apparatus according to claim 32, wherein said circuitries are adapted for channeling activation from said SA node to an AV node.

34. Apparatus according to claim 1, comprising rate control circuitry which modifies said application in response to a measured activation rate and a desired activation rate.

35. Apparatus according to claim 1, wherein said field application circuitry is adapted to detect and acts in response to the arrhythmia in the heart.

36. Apparatus according to claim 1, wherein said field application circuitry is adapted to apply said voltage during an absolute refractory period of tissue to which it is applied.

37. Apparatus according to claim 1, comprising a pacing circuit.

38. Apparatus according to claim 1, wherein said circuitry for generating is adapted to generate a contractility enhancing voltage.

39. Apparatus according to claim 1, wherein at least one of said elongate electrodes is adapted for implantation in a blood vessel.

40. Apparatus according to claim 1, wherein at least one of said elongate electrodes is adapted for epicardial attachment.

41. Apparatus according to claim 1, wherein at least one of said elongate electrodes includes a plurality of spaced apart conducting portions separated by isolating portions.

42. Apparatus according to claim 1, wherein at least one of said elongate electrodes includes a plurality of spaced apart conducting electrodes on a lead.

43. Apparatus according to claim 1, wherein said electrodes are configured to be arranged on either side of a wall of the heart chamber.

44. Apparatus according to claim 1, wherein said electrodes are configured to be arranged in different chambers and controlled, by said circuitries, according to local activation times in said chambers.

45. A method of modifying heart rate of a heart, the method comprising:

providing a subject having a heart with an active natural pacemaker region; and

applying a non-excitatory electric field to the region using the apparatus of claim 1.

46. A method according to claim 45, wherein the active natural pacemaker region comprises a sino-atrial (SA) node.

47. A method according to claim 45, wherein the non-excitatory electric field increases heart rate.

48. A method according to claim 45, wherein the non-excitatory electric field decreases heart rate.

49. A method according to claim 45, wherein the non-excitatory electric field extends a duration of an action potential of the region.

50. A method according to claim 45, comprising extending a refractory period of a significant portion of a right atrium of the heart.