Electrical muscle controller

• US 8,306,617 B2
• Filed: 10/31/2007
• Issued: 11/06/2012
• Est. Priority Date: 01/08/1996
• Status: Expired due to Fees

• Current Assignee: Impulse Dynamics NV
• Original Assignee: Impulse Dynamics NV
• Inventors: Darvish, Nissim, Fenster, Maier, Yuval, Mike, Ben-Haim, Shiomo
• Primary Examiner(s): Patel, Niketa I
• Assistant Examiner(s): Lavert, Nicole F
• Application Number:
  US11/932,064
• Publication Number:
  US 20080058879A1
• Time in Patent Office: 1,833 Days
• Field of Search: 607/4, 607/9, 607/119
• 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
• 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. Heart control apparatus, the apparatus comprising:

circuitry for generating a non-excitatory electric field adapted to stop fibrillation;

timing circuitry configured to determine an estimated activation time and configured to determine an application time for said field relative to said activation time;

a sensor configured to detect fibrillation;

a controller adapted to operate the circuitry in response to the detected fibrillation to generate a non-excitatory field which is applied at a timing and a magnitude where it does not reset the synchronization of the heart by forcing a significant percentage of the cardiac tissue into a refractory state; and

elongate electrodes for applying said non-excitatory electric field, wherein said field generated is characterized by a timing relative to the 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.

2. Apparatus according to claim 1, wherein the elongate electrodes are characterized by a length of at least 1 cm.

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

4. Apparatus according to claim 3, wherein the electrodes are characterized by a length of at least 4 cm.

5. Apparatus according to claim 1, wherein the circuitry includes an AC non-excitatory electric field generator.

6. Apparatus according to claim 1, wherein the circuitry is 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.

7. Apparatus according to claim 1, further comprising velocity modification circuitry for modifying a conduction velocity in a non-arrhythmic segment of a heart portion,

said velocity modification circuitry electrically coupled to one or both of:

(i) one or more of said elongate electrodes; and

(ii) one or more additional electrodes.

8. Apparatus according to claim 1, wherein the electrodes are suitable to be positioned externally to the body.

9. Apparatus according to claim 1, wherein one or more of said controller, said circuitry, said timing circuitry and any additional circuitry are adapted for controlling an additional parameter selected from the force of contraction, heart rate, stroke volume, chamber or aortic pressure, or output flow.

10. Apparatus according to claim 1, wherein the electrodes comprise at least one unipolar electrode and a housing which functions as a second electrode.

11. Apparatus according to claim 1, wherein said electrodes comprises at least two electrodes, suitable to apply said non-excitatory electric field across at least one predetermined portion of the heart.

12. Apparatus according to claim 1, wherein said electrodes comprise at least three electrodes, wherein each pair of said at least three electrodes is selectively and separately electrifiable.

13. Apparatus according to claim 1, wherein said timing circuitry includes a pacing signal input.

14. Apparatus according to claim 1, wherein said timing circuitry includes a local activation sensing input.

15. Apparatus according to claim 14, wherein said activation sensing input receives a cardiac signal from said sensor.

16. Apparatus according to claim 1, wherein said controller, said circuitry and said timing circuitry are formed as a unitary circuitry.

18. Apparatus according to claim 1, wherein said non-excitatory field is at a magnitude too low for defibrillation.

19. Apparatus according to claim 1, wherein said non-excitatory field has an energy too low for defibrillation.

20. Apparatus according to claim 1, wherein said apparatus is implantable and said controller is designed to apply said non-excitatory field for at least 1000 cardiac cycles.

21. Apparatus according to claim 1, wherein said circuitry is configured to apply said signal at least 100 beats out of 50,000 consecutive beats.

22. Apparatus according to claim 1, wherein said circuitry is configured to apply said signal at least 1000 beats out of 50,000 consecutive beats.

23. Apparatus according to claim 1, wherein said circuitry is configured to apply said signal at least 4000 beats out of 50,000 consecutive beats.

24. Apparatus according to claim 1, wherein said circuitry is configured to apply said signal at least 1000 beats out of 5,000 consecutive beats.

25. Apparatus according to claim 1, wherein said circuitry is configured to apply said signal for between 3 and 5000 consecutive beats.

26. Apparatus according to claim 1, wherein said circuitry stores a therapy schedule and is configured to apply said signal periodically according to said therapy schedule.

27. Apparatus according to claim 26, wherein said circuitry is configured to apply said signal on a daily basis.

28. Apparatus according to claim 1, wherein said elongate electrodes are arranged to define one or more conduction pathways in the heart.

29. Apparatus according to claim 2, wherein said non-excitatory field has an energy of below 500 micro-joules.

17. Heart control apparatus, the apparatus comprising:

circuitry for generating a non-excitatory electric field adapted to stop fibrillation;

timing circuitry configured to determine an estimated activation time and configured to determine an application time for said field relative to said activation time;

a sensor configured to detect fibrillation;

a controller adapted to operate the circuitry in response to the detected fibrillation; and

elongate electrodes for applying said non-excitatory electric field, wherein said field generated is characterized by a timing relative to the 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.

30. A method of heart control, comprising:

providing heart control apparatus, the apparatus comprising;

circuitry for generating a non-excitatory electric field adapted to stop fibrillation;

timing circuitry configured to determine an estimated activation time and configured to determine an application time for said field relative to said activation time;

a sensor configured to detect fibrillation;

a controller adapted to operate the circuitry in response to the detected fibrillation; and

elongate electrodes for applying said non-excitatory electric field, wherein said field generated is characterized by a timing relative to the 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; and

electrifying said elongate electrodes in response to a detection of fibrillation or arrhythmia.

31. A method according to claim 30, wherein electrifying comprises electrifying so as to define at least one conduction pathway in the heart in accordance with a desired cardiac activation profile.

32. A method according to claim 31, wherein said conduction pathway includes a conduction pathway between an SA node and an AV node in the heart.

33. A method according to claim 30, wherein said electrifying comprises continuing said electrifying after the heart stops said arrhythmia or defibrillation.