Hemodynamically responsive system for and method of treating a malfunctioning heart
First Claim
1. A system for treating a malfunctioning heart, the system including storage means for storing electrical energy, electrode means for electrically coupling the storage means to the heart, pressure responsive sensing means for sensing pressure at a site in a circulatory system, means for providing a first signal representative of fixed baseline pressure;
- means responsive to output from said sensing means for developing a second signal representing mean current pressure over a period of given length, and means responsive to output from the means for providing the first signal and output from the means for developing the second signal for charging and enabling discharge of the electrical energy stored by said storage means across said electrode means and into the heart upon change in the mean current pressure of at least a predetermined amount from the representative fixed baseline pressure.
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Accused Products
Abstract
A system for and method of treating a malfunctioning heart is based on hemodynamics, the pressure at a site in a patient'"'"'s circulatory system being sensed. A signal is developed representative of short term mean arterial pressure (MAP), mean right atrial pressure (MRAP), mean right ventricle pressure (MRVP), mean left atrial pressure (MLAP), mean left ventrical pressure (MLVP) or mean central venous pressure (MCVP). A signal representative of fixed baseline pressure is provided and if the short term current mean pressure differs therefrom by a predetermined value, an indication of hemodynamic compromise, cardioversion/defibrillation is effected. In a second embodiment, the determination of whether the difference between fixed baseline pressure and mean current pressure is undertaken after a rate criteria (for example a heart rate above 155 b.p.m.) has been met. In a third embodiment, the rate and pressure criteria both must exist at the same time, before cardioverting/difibrillation is initiated. In a fourth embodiment, a microprocessor is used. The system may be integrated with antitachycardia and/or antibradycardia pacemakers.
140 Citations
50 Claims
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1. A system for treating a malfunctioning heart, the system including storage means for storing electrical energy, electrode means for electrically coupling the storage means to the heart, pressure responsive sensing means for sensing pressure at a site in a circulatory system, means for providing a first signal representative of fixed baseline pressure;
- means responsive to output from said sensing means for developing a second signal representing mean current pressure over a period of given length, and means responsive to output from the means for providing the first signal and output from the means for developing the second signal for charging and enabling discharge of the electrical energy stored by said storage means across said electrode means and into the heart upon change in the mean current pressure of at least a predetermined amount from the representative fixed baseline pressure.
- View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15)
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16. A system for treating a malfunctioning heart, the system comprising electrical means for sensing heart rate and producing a first control signal upon the heart rate exceeding a predetermined rate;
- pressure responsive sensing means for sensing pressure at a site in a circulatory system, means for providing a first signal representative of fixed baseline pressure, means responsive to output from said sensing means for developing a pressure-related second signal representing mean current pressure at the site over a period of given length and for producing a second control signal indicative of the mean current pressure at the site departing from fixed baseline pressure by at least a predetermined amount;
controllable antitachycardia pacemaking means for supplying pacing signals to the heart;
controllable cardioverting/defibrillating means including storage means for storing electrical energy and electrode means for applying electrical energy from the storage means to the heart to cardiovert or to defibrillate same;
control circuit means responsive to the first control signal and to the second control signal for enabling said antitachycardia pacemaking means in response to presence of the first control signal and contemporaneous absence of the second control signal and for enabling said cardioverting/defibrillating means in response to contemporaneous presence of both the first control signal and the second control signal; and
means for discharging electrical energy stored by said storage means across said electrode means and into the heart. - View Dependent Claims (17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31)
- pressure responsive sensing means for sensing pressure at a site in a circulatory system, means for providing a first signal representative of fixed baseline pressure, means responsive to output from said sensing means for developing a pressure-related second signal representing mean current pressure at the site over a period of given length and for producing a second control signal indicative of the mean current pressure at the site departing from fixed baseline pressure by at least a predetermined amount;
- 32. In a method of treating a malfunctioning heart, the method including a step of sensing pressure at a site in a circulatory system, an improvement comprising providing a representation of fixed baseline pressure, determining mean current pressure from the sensed pressure at the site over a period of given length, and delivering cardioverting/defibrillating electrical energy to the heart in response to change of at least a predetermined magnitude in the mean current pressure from fixed baseline pressure.
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45. A system for treating a malfunctioning heart, the system including means for providing cardioverting/defibrillating electrical energy, pressure responsive sensing means for sensing pressure at a site in a circulatory system, means for providing a fixed signal representative of fixed baseline pressure, means responsive to output from said pressure responsive sensing means for developing a further signal representing mean pressure over a period of given length, and means responsive to the fixed signal and to the further signal for delivering the cardioverting/defibrillating electrical energy into the heart upon occurrence of departure of the further signal from the fixed signal by at least a predetermined magnitude indicative of hemodynamic compromise.
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46. A system for treating a malfunctioning heart, the system comprising electrical means for sensing heart rate and producing a first control signal whenever the rate exceeds a predetermined rate;
- pressure responsive means for sensing pressure at a site in a circulatory system;
means for providing a fixed signal representative of fixed baseline pressure;
means responsive to output from the pressure responsive means for developing a further signal representing mean pressure over a period of given length;
means responsive to the first signal and to the further signal for developing a second control signal upon departure of the further signal from the first signal by at least a predetermined magnitude;
controllable antitachycardia pacemaking means for supplying pacing signals to the heart;
means for producing controllable cardioverting/defibrillating electrical energy;
control circuit means responsive to the first control signal and to the second control signal for enabling said antitachycardia pacemaking means upon presence of the first control signal and absence of the second control signal and for enabling said means for producing the cardioverting/defibrillating electrical energy upon contemporaneous presence of the first control signal and the second control signal.
- pressure responsive means for sensing pressure at a site in a circulatory system;
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47. In a system for treating a malfunctioning heart of a patient, the system including means for delivering electrical energy to the heart and pressure responsive means for sensing pressure at a site in a circulatory system, an improvement comprising means for providing a first signal representative of fixed baseline pressure;
- means coupled to said pressure responsive means and responsive to output therefrom for producing a second signal representing mean pressure over a period of given length;
means responsive to the first signal and to the second signal for producing a control signal upon occurrence of the second signal departing from the first signal by at least a given magnitude; and
means responsive to the control signal for enabling the means for delivering electrical energy to the heart.
- means coupled to said pressure responsive means and responsive to output therefrom for producing a second signal representing mean pressure over a period of given length;
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48. A system for treating a malfunctioning heart of a patient, the system comprising pressure responsive means for sensing pressure at a site in a circulatory system;
- means for providing a first signal representing fixed baseline pressure;
means coupled to said pressure responsive means and responsive to output therefrom for producing a second signal representing mean pressure over a period of given length;
means responsive to the first signal and to the second signal for producing a first control signal upon occurrence of the second signal departing from the first signal by at least a given magnitude;
means responsive to heart rate for producing a second control signal upon heart rate exceeding a given rate; and
means responsive to at least the first control signal and to the second control signal for delivering electrical energy to the heart.
- means for providing a first signal representing fixed baseline pressure;
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49. In a method of treating a malfunctioning heart of a patient which includes sensing change in pressure at a site in a circulatory system and delivering to the patient electrical energy, an improvement comprising providing a representation of fixed baseline pressure, determining mean current pressure from the sensed pressure over a period of given length, and wherein the step of delivering electrical energy is taken in response to a difference of at least predetermined magnitude between mean current pressure and fixed baseline pressure.
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50. The method of claim 51, including determining heart rate, the step of delivering to the heart electrical energy being taken only upon the heart rate exceeding a given rate and the at least predetermined magnitude between mean current pressure and baseline pressure prevails.
Specification