CN114652426A - Pulse ablation device, system, control method, and readable storage medium - Google Patents
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Abstract
Description
技术领域technical field
本发明涉及医疗器械技术领域,尤其涉及一种脉冲消融设备、系统、控制方法及可读存储介质。The present invention relates to the technical field of medical devices, and in particular, to a pulse ablation device, a system, a control method and a readable storage medium.
背景技术Background technique
肾动脉交感神经消融术是治疗顽固性高血压的一个重要研究方向。目前通常使用射频消融或冷冻消融的方式来消融肾动脉交感神经,这两种消融方式都基于热效应,会对消融的靶点和靶点周围的健康组织如血管和脂肪等产生无差别的损伤,因此一旦控制不好消融能量,容易引起各种并发症,如肾动脉穿孔、肾动脉狭窄或闭塞和肾动脉夹层等。另外,肾动脉交感神经是围绕着肾动脉分布的,而肾动脉多有分支,由于导管(如:球囊导管)的体积限制,目前对于肾动脉分支神经的消融治疗尚且不够深入。Renal artery sympathetic nerve ablation is an important research direction in the treatment of resistant hypertension. At present, radiofrequency ablation or cryoablation are usually used to ablate the renal artery sympathetic nerve. Both ablation methods are based on thermal effects, which will cause indiscriminate damage to the ablation target and surrounding healthy tissues such as blood vessels and fat. Therefore, once the ablation energy is not well controlled, various complications, such as renal artery perforation, renal artery stenosis or occlusion, and renal artery dissection, are easily caused. In addition, the renal artery sympathetic nerve is distributed around the renal artery, and the renal artery has many branches. Due to the volume limitation of the catheter (eg, balloon catheter), the current ablation treatment for the renal artery branch nerve is not deep enough.
脉冲消融的方式也可以用来消融肾动脉交感神经。采用脉冲消融的方式进行消融治疗时,脉冲消融系统应用间歇性的高强度、窄脉冲的电场施加到待消融的组织上,会使组织细胞的细胞膜产生微孔隙,增加细胞膜的通透性。当脉冲电场的强度达到一定程度时,细胞膜上会出现不可修复的大穿孔,这个过程被称为不可逆电穿孔,从而导致细胞凋亡。由于不同类型的组织细胞对于脉冲电场的耐受性不同,在将脉冲电场应用于消融治疗时,选择特定的脉冲电场参数可以达到破坏特定的待消融细胞及组织的效果。另外,脉冲消融术的实施时间短,且不是基于热效应,能够进一步减轻对周围健康组织的损伤。因此,脉冲消融也已经在心脏等器官和各种肿瘤的消融治疗中得到了广泛的应用。Pulse ablation can also be used to ablate the renal artery sympathetic nerve. When pulse ablation is used for ablation therapy, the pulse ablation system applies intermittent high-intensity, narrow-pulse electric fields to the tissue to be ablated, which will cause micropores in the cell membrane of tissue cells and increase the permeability of the cell membrane. When the intensity of the pulsed electric field reaches a certain level, large irreparable perforations appear in the cell membrane, a process called irreversible electroporation, which leads to apoptosis. Since different types of tissue cells have different tolerances to the pulsed electric field, when the pulsed electric field is applied to ablation therapy, selecting specific pulsed electric field parameters can achieve the effect of destroying specific cells and tissues to be ablated. Additionally, pulse ablation is performed for a short time and is not based on thermal effects, further reducing damage to surrounding healthy tissue. Therefore, pulse ablation has also been widely used in the ablation treatment of organs such as the heart and various tumors.
虽然脉冲消融具有以上所述优点,但是,脉冲消融时的脉冲电场很容易导致患者的心脏电活动发生异常,容易引发心肌震颤和心率异常。特别是对于顽固性高血压患者来说,根据临床统计,大都伴随有不同程度、不同类型的心律失常,对于这样的患者,心律失常起源部位的心肌细胞功能更容易被外界的刺激所干扰,从而可能导致更加混乱的电活动,极大地影响了脉冲消融手术的安全性。Although pulse ablation has the above-mentioned advantages, the pulse electric field during pulse ablation can easily lead to abnormal cardiac electrical activity of the patient, and it is easy to cause myocardial tremor and abnormal heart rate. Especially for patients with refractory hypertension, according to clinical statistics, most of them are accompanied by different degrees and types of arrhythmias. For such patients, the function of cardiomyocytes at the origin of the arrhythmia is more easily disturbed by external stimuli. May lead to more chaotic electrical activity, greatly affecting the safety of pulse ablation procedures.
发明内容SUMMARY OF THE INVENTION
本发明的目的在于提供一种脉冲消融设备、系统、控制方法及可读存储介质,根据不同患者的心律类型,决定施加脉冲电场的时机,减小脉冲消融对患者正常心律的影响,以提高手术的安全性。The purpose of the present invention is to provide a pulse ablation device, a system, a control method and a readable storage medium, which can determine the timing of applying a pulse electric field according to the heart rhythm types of different patients, reduce the influence of pulse ablation on the normal heart rhythm of patients, and improve the operation efficiency. security.
为了达到上述目的,本发明提供了一种脉冲消融设备,包括:In order to achieve the above object, the present invention provides a pulse ablation device, comprising:
处理器模块,用于根据心律类型输出控制信号;以及a processor module for outputting control signals according to the heart rhythm type; and
脉冲电场发生模块,用于根据所述控制信号输出脉冲信号,所述脉冲电场发生模块用于与介入装置相连,所述介入装置上配置有电极,所述脉冲信号通过所述电极作用于待消融部位以实施脉冲消融。A pulsed electric field generating module, used for outputting a pulsed signal according to the control signal, the pulsed electric field generating module is used for connecting to an interventional device, an electrode is configured on the interventional device, and the pulsed signal acts on the to-be-ablated through the electrode site to perform pulse ablation.
可选的,所述控制信号包括脉冲信号发放时机,其中不同的所述心律类型对应不同的所述脉冲信号发放时机,所述脉冲信号发放时机被设置为位于心电信号的每个心动周期的特定时间段内。Optionally, the control signal includes a pulse signal sending timing, wherein different heart rhythm types correspond to different pulse signal sending timings, and the pulse signal sending timing is set to be located at the position of each cardiac cycle of the ECG signal. within a specific time period.
可选的,所述脉冲消融设备还包括心电信号采集模块,用于采集心电信号,所述处理器模块接收所述心电信号,并根据所述心电信号的特征参数得到所述心律类型,并根据所述心律类型确定所述脉冲信号发放时机。Optionally, the pulse ablation device further includes an ECG signal acquisition module for acquiring ECG signals, the processor module receives the ECG signals, and obtains the cardiac rhythm according to the characteristic parameters of the ECG signals. type, and determine the timing of sending the pulse signal according to the heart rhythm type.
可选的,所述处理器模块用于根据持续接收到的所述心电信号,不断更新所述控制信号并向所述脉冲电场发生模块输出更新的所述控制信号。Optionally, the processor module is configured to continuously update the control signal according to the continuously received ECG signal and output the updated control signal to the pulsed electric field generating module.
可选的,所述脉冲消融设备还包括输入模块,用于输入所述心律类型,所述处理器模块根据所述心律类型确定所述脉冲信号发放时机。Optionally, the pulse ablation device further includes an input module for inputting the heart rhythm type, and the processor module determines the timing of sending the pulse signal according to the heart rhythm type.
可选的,所述控制信号包括脉冲信号参数;当所述处理器模块设定所述脉冲信号发放时机和所述脉冲信号参数后,所述处理器模块向所述脉冲电场发生模块发放所述控制信号,所述控制信号控制所述脉冲电场发生模块在每个心动周期的特定时间段内不断的产生预设参数的脉冲信号。Optionally, the control signal includes a pulse signal parameter; after the processor module sets the pulse signal sending timing and the pulse signal parameter, the processor module sends the pulse electric field generating module the pulse signal. a control signal, the control signal controls the pulse electric field generating module to continuously generate a pulse signal with preset parameters within a specific time period of each cardiac cycle.
可选的,所述心电信号包括P波、QRS波群和T波;所述心电信号的特征参数包括P波、R波和T波的起始时刻、峰值时刻和/或终止时刻,其中,R波为QRS波群中的波,所述P波终点到所述QRS波群起点之间的时间段为所述心动周期的PQ段,所述QRS波群终点到所述T波起点之间的时间段为所述心动周期的ST段,所述特定时间段包括所述PQ段和所述ST段。Optionally, the ECG signal includes a P wave, a QRS complex and a T wave; the characteristic parameters of the ECG signal include the starting moment, the peak moment and/or the ending moment of the P wave, the R wave and the T wave, The R wave is a wave in the QRS complex, the time period between the end of the P wave and the start of the QRS complex is the PQ segment of the cardiac cycle, and the end of the QRS complex to the start of the T wave The time period between is the ST segment of the cardiac cycle, and the specific time period includes the PQ segment and the ST segment.
可选的,所述心律类型包括异常心律和正常心律,所述异常心律包括室上性心律失常和室性心律失常;Optionally, the heart rhythm type includes abnormal heart rhythm and normal heart rhythm, and the abnormal heart rhythm includes supraventricular arrhythmia and ventricular arrhythmia;
当所述心律类型为室上性心律失常时,所述脉冲信号发放时机被设置为位于每个所述心动周期的PQ段内;和/或When the cardiac rhythm type is supraventricular arrhythmia, the timing of the pulse signal is set to be located within the PQ segment of each cardiac cycle; and/or
当所述心律类型为室性心律失常和正常心律时,所述脉冲信号发放时机被设置为位于每个所述心动周期的ST段内。When the heart rhythm type is ventricular arrhythmia and normal heart rhythm, the timing of the pulse signal is set to be located within the ST segment of each cardiac cycle.
可选的,所述脉冲信号发放时机包括施加脉冲信号的时刻和持续时长;所述施加脉冲信号的时刻由起始延迟时长控制,所述起始延迟时长是指在所述特征参数发生后延迟发放脉冲信号的时间,所述施加脉冲信号的时刻在所述起始延迟时长之后;所述持续时长是指在每个所述心动周期内脉冲信号的持续时间。Optionally, the timing of issuing the pulse signal includes the moment and the duration of applying the pulse signal; the moment of applying the pulse signal is controlled by the initial delay duration, and the initial delay duration refers to the delay after the characteristic parameter occurs. The time at which the pulse signal is emitted, and the moment of applying the pulse signal is after the initial delay time; the duration refers to the duration of the pulse signal in each cardiac cycle.
可选的,所述处理器模块根据对所述待消融部位施加脉冲信号之前的多个所述心动周期内的心电信号,确定所述起始延迟时长和所述持续时长的平均值,以统一设定所述施加脉冲信号的时刻和所述持续时长。Optionally, the processor module determines the average value of the starting delay time and the duration according to the ECG signals in a plurality of the cardiac cycles before the pulse signal is applied to the part to be ablated, so as to: The timing of applying the pulse signal and the duration are uniformly set.
可选的,所述处理器模块根据每个所述心动周期内的心电信号的特征参数,确定每个所述心动周期内的所述起始延迟时长和所述持续时长,以分别设定所述施加脉冲信号的时刻和所述持续时长。Optionally, the processor module determines the start delay duration and the duration duration in each cardiac cycle according to characteristic parameters of the ECG signal in each cardiac cycle, to set the duration respectively. the time of applying the pulse signal and the duration.
可选的,在每个所述心动周期的PQ段内所述施加脉冲信号的时刻为所述P波峰值后的30ms~55ms内,所述持续时长为50ms~75ms;和/或,Optionally, in the PQ segment of each cardiac cycle, the moment of applying the pulse signal is within 30ms to 55ms after the peak value of the P wave, and the duration is 50ms to 75ms; and/or,
在每个所述心动周期的ST段内所述施加脉冲信号的时刻为所述R波峰值后的50ms~75ms内,所述持续时长为80ms~150ms。In the ST segment of each cardiac cycle, the time of applying the pulse signal is within 50ms-75ms after the peak value of the R wave, and the duration is 80ms-150ms.
可选的,所述脉冲消融设备还包括刺激模块,用于产生刺激信号,所述刺激信号通过所述介入装置作用于目标对象,从而确定所述待消融部位。Optionally, the pulse ablation device further includes a stimulation module, configured to generate a stimulation signal, and the stimulation signal acts on the target object through the interventional device, thereby determining the site to be ablated.
可选的,所述处理器模块还包括显示器,用于显示操控界面以及所述中央处理器的分析结果;所述脉冲信号发生模块还包括一控制面板,所述脉冲信号参数能够通过所述操控界面进行远程控制及/或通过所述控制面板进行控制。Optionally, the processor module further includes a display for displaying a manipulation interface and an analysis result of the central processing unit; the pulse signal generating module further includes a control panel, and the parameters of the pulse signal can be controlled by the control panel. The interface is controlled remotely and/or via the control panel.
此外,本发明还提供了一种脉冲消融系统,包括:In addition, the present invention also provides a pulse ablation system, comprising:
所述脉冲消融设备;the pulse ablation device;
介入装置,用于与所述脉冲消融设备相连,所述介入装置的远端设有电极,所述脉冲信号通过所述电极作用于所述待消融部位以实施脉冲消融。An intervention device is used for connecting with the pulse ablation device, an electrode is provided at the distal end of the intervention device, and the pulse signal acts on the to-be-ablated site through the electrode to implement pulse ablation.
此外,本发明还提供了一种控制脉冲消融方法,包括:根据心律类型生成控制信号,所述控制信号包括脉冲信号的发放时机,其中不同的所述心律类型对应不同的所述脉冲信号发放时机。可选的,所述脉冲信号发放时机被设置为位于心电信号的每个心动周期的特定时间段内。In addition, the present invention also provides a method for controlling pulse ablation, comprising: generating a control signal according to a heart rhythm type, where the control signal includes the timing of sending the pulse signal, wherein different heart rhythm types correspond to different sending timings of the pulse signal . Optionally, the timing of sending the pulse signal is set to be within a specific time period of each cardiac cycle of the ECG signal.
可选的,所述脉冲信号发放时机包括施加脉冲信号的时刻和持续时长;所述施加脉冲信号的时刻由起始延迟时长控制,所述起始延迟时长是指在所述特征参数发生后延迟发放脉冲信号的时间,所述施加脉冲信号的时刻在所述起始延迟时长之后;所述持续时长是指在每个所述心动周期内脉冲信号的持续时间。Optionally, the timing of issuing the pulse signal includes the moment and the duration of applying the pulse signal; the moment of applying the pulse signal is controlled by the initial delay duration, and the initial delay duration refers to the delay after the characteristic parameter occurs. The time at which the pulse signal is emitted, and the moment of applying the pulse signal is after the initial delay time; the duration refers to the duration of the pulse signal in each cardiac cycle.
可选的,根据多个所述心动周期内的心电信号,确定所述起始延迟时长和所述持续时长的平均值,以统一设定所述待消融部位的所述施加脉冲信号的时刻和所述持续时长;或,Optionally, according to the ECG signals in a plurality of the cardiac cycles, the average value of the starting delay time and the duration is determined, so as to uniformly set the time of applying the pulse signal to the part to be ablated. and said duration; or,
根据每个所述心动周期内的心电信号的特征参数,确定每个所述心动周期内的所述起始延迟时长和所述持续时长,以分别设定待消融部位的所述施加脉冲信号的时刻和所述持续时长。According to the characteristic parameters of the ECG signal in each cardiac cycle, the initial delay duration and the duration duration in each cardiac cycle are determined, so as to respectively set the applied pulse signal of the part to be ablated time and said duration.
可选的,所述控制信号包括脉冲信号参数,所述心电信号包括P波、QRS波群和T波;所述心电信号的特征参数包括P波、R波和T波的起始时刻、峰值时刻和/或终止时刻,其中,R波为QRS波群中的波,所述P波终点到所述QRS波群起点之间的时间段为所述心动周期的PQ段,所述QRS波群终点到所述T波起点之间的时间段为所述心动周期的ST段,所述特定时间段包括所述PQ段和所述ST段。Optionally, the control signal includes pulse signal parameters, the ECG signal includes P wave, QRS complex and T wave; the characteristic parameters of the ECG signal include the start time of P wave, R wave and T wave , peak time and/or termination time, wherein the R wave is a wave in the QRS complex, the time period between the end of the P wave and the start of the QRS complex is the PQ segment of the cardiac cycle, and the QRS The time period between the end of the complex and the start of the T wave is the ST segment of the cardiac cycle, and the specific time period includes the PQ segment and the ST segment.
可选的,所述心律类型包括异常心律和正常心律,所述异常心律包括室上性心律失常和室性心律失常;Optionally, the heart rhythm type includes abnormal heart rhythm and normal heart rhythm, and the abnormal heart rhythm includes supraventricular arrhythmia and ventricular arrhythmia;
当所述心律类型为室上性心律失常时,所述脉冲信号发放时机位于每个所述心动周期的PQ段内;When the heart rhythm type is supraventricular arrhythmia, the timing of sending the pulse signal is located in the PQ segment of each cardiac cycle;
当所述心律类型为室性心律失常和正常心律时,所述脉冲信号发放时机位于每个所述心动周期的ST段内。When the heart rhythm type is ventricular arrhythmia and normal heart rhythm, the timing of sending the pulse signal is located in the ST segment of each cardiac cycle.
此外,本发明还提供了一种计算机可读存储介质,其上存储有计算机程序,该程序被处理器执行时实现所述的控制脉冲消融方法。In addition, the present invention also provides a computer-readable storage medium on which a computer program is stored, and when the program is executed by a processor, the control pulse ablation method is implemented.
本发明提供的脉冲消融设备,用于对患者的待消融部位实施脉冲消融,所述脉冲消融设备包括处理器模块和脉冲电场发生模块。所述处理器模块用于根据患者心律类型输出控制信号,脉冲电场发生模块,用于根据所述控制信号输出脉冲信号,所述脉冲电场发生模块用于与介入装置相连,所述介入装置上配置有电极,所述脉冲信号通过所述电极作用于待消融部位实施脉冲消融。所述脉冲消融设备能够根据不同患者的心律类型,决定施加脉冲电场的时机,以减小对患者正常心律的影响,从而提高手术的安全性The pulse ablation device provided by the present invention is used for performing pulse ablation on a patient's site to be ablated, and the pulse ablation device includes a processor module and a pulse electric field generating module. The processor module is used for outputting a control signal according to the type of the patient's heart rhythm, the pulsed electric field generating module is used for outputting a pulsed signal according to the control signal, the pulsed electric field generating module is used for connecting with an interventional device, and the interventional device is configured with There are electrodes, through which the pulse signal acts on the site to be ablated to implement pulse ablation. The pulse ablation device can determine the timing of applying the pulse electric field according to the heart rhythm types of different patients, so as to reduce the influence on the normal heart rhythm of the patient, thereby improving the safety of the operation
所述脉冲消融设备还包括心电信号采集模块,用于采集患者的心电信号,所述处理器模块接收所述心电信号,并根据所述心电信号的特征参数得到所述患者的心律类型,并根据所述心律类型输出控制信号。The pulse ablation device further includes an ECG signal acquisition module for acquiring the patient's ECG signal, the processor module receives the ECG signal, and obtains the patient's heart rhythm according to the characteristic parameters of the ECG signal type, and output a control signal according to the heart rhythm type.
相应的,本发明提供了一种脉冲消融系统,采用所述的脉冲消融设备,还包括介入装置,所述介入装置的近端与所述脉冲消融设备相连,远端设有电极,所述电极根据所述脉冲信号向所述待消融部位施加脉冲电场。所述脉冲信号通过所述电极向患者的待消融部位施加脉冲电场,从而引起患者的待消融部位发生不可逆电穿孔效应。由于处理器模块可以根据不同患者的心律类型,决定施加脉冲电场的时机,能够尽量减小脉冲电场对患者正常心律的影响。Correspondingly, the present invention provides a pulse ablation system, which adopts the pulse ablation device and further includes an intervention device, the proximal end of the intervention device is connected to the pulse ablation device, and the distal end is provided with an electrode, and the electrode A pulsed electric field is applied to the site to be ablated according to the pulse signal. The pulse signal applies a pulsed electric field to the part to be ablated of the patient through the electrode, thereby causing an irreversible electroporation effect in the part to be ablated of the patient. Since the processor module can determine the timing of applying the pulsed electric field according to the heart rhythm types of different patients, the influence of the pulsed electric field on the normal heart rhythm of the patient can be minimized.
附图说明Description of drawings
图1为本发明实施例中的脉冲消融系统应用于肾动脉治疗的结构框图;FIG. 1 is a structural block diagram of the pulse ablation system in an embodiment of the present invention applied to renal artery treatment;
图2为本发明实施例中的肾脏结构及介入装置在肾动脉中的位置示意图;2 is a schematic diagram of the renal structure and the position of the interventional device in the renal artery according to the embodiment of the present invention;
图3为本发明实施例中的单相脉冲信号波形示意图;3 is a schematic diagram of a single-phase pulse signal waveform in an embodiment of the present invention;
图4为本发明实施例中的双相脉冲信号波形示意图;4 is a schematic diagram of a biphasic pulse signal waveform in an embodiment of the present invention;
图5为本发明实施例中的体表心电信号在一个心动周期内的典型波形示意图;5 is a schematic diagram of a typical waveform of a body surface electrocardiogram signal in one cardiac cycle in an embodiment of the present invention;
图6为本发明实施例中的处理器模块工作的流程图;6 is a flowchart of the operation of the processor module in the embodiment of the present invention;
图7为本发明实施例中的ST段施加脉冲电场的示意图;7 is a schematic diagram of applying a pulsed electric field to the ST segment in an embodiment of the present invention;
图8为本发明实施例中的一种图形用户界面;Fig. 8 is a kind of graphical user interface in the embodiment of the present invention;
图9为本发明实施例中的脉冲消融系统的使用流程图;FIG. 9 is a flow chart of the use of the pulse ablation system in the embodiment of the present invention;
其中,附图标记如下:Among them, the reference numerals are as follows:
100-脉冲消融设备;110-介入装置;111-电极;120-脉冲电场发生模块;130-处理器模块;131-存储器;132-中央处理器;133-显示器;134-控制电路;140-心电信号采集模块;100-pulse ablation equipment; 110-interventional device; 111-electrode; 120-pulse electric field generating module; 130-processor module; 131-memory; 132-central processing unit; 133-display; 134-control circuit; 140-heart Electrical signal acquisition module;
200-心动周期;200a-第一心动周期;200b-第二心动周期;201-PQ段;202-ST段;202a-第一ST段;202b-第二ST段;200-cardiac cycle; 200a-first cardiac cycle; 200b-second cardiac cycle; 201-PQ segment; 202-ST segment; 202a-first ST segment; 202b-second ST segment;
300-手术对象;310-肾动脉;320-腹主动脉;330-肾脏;300-operation object; 310-renal artery; 320-abdominal aorta; 330-kidney;
a1-第一信息流;a2-第二信息流;a3-第三信息流;a4-第四信息流;a5-第五信息流。a1 - the first information flow; a2 - the second information flow; a3 - the third information flow; a4 - the fourth information flow; a5 - the fifth information flow.
具体实施方式Detailed ways
下面将结合示意图对本发明的具体实施方式进行更详细的描述。根据下列描述,本发明的优点和特征将更清楚。需说明的是,附图均采用非常简化的形式且均使用非精准的比例,仅用以方便、明晰地辅助说明本发明实施例的目的。The specific embodiments of the present invention will be described in more detail below with reference to the schematic diagrams. The advantages and features of the present invention will become more apparent from the following description. It should be noted that, the accompanying drawings are all in a very simplified form and in inaccurate scales, and are only used to facilitate and clearly assist the purpose of explaining the embodiments of the present invention.
在本文中,术语“近端”、“远端”是从使用该医疗器械的医生角度来看相对于彼此的元件或动作的相对方位、相对位置、方向,尽管“近端”、“远端”并非是限制性的,但是“近端”通常指该医疗器械在正常操作过程中靠近医生的一端,而“远端”通常是指首先进入患者体内的一端。As used herein, the terms "proximal", "distal" are the relative orientation, relative position, orientation of elements or actions relative to each other from the perspective of the physician using the medical device, although "proximal", "distal" " is not limiting, but "proximal" generally refers to the end of the medical device that is closest to the physician during normal operation, and "distal" generally refers to the end that first enters the patient.
在脉冲消融手术过程中,高强度(高电压)的脉冲电场在作用于待消融组织的细胞后会改变细胞膜电位,使细胞膜处于极化状态,极化的趋势沿着相邻细胞迅速传导至心脏后,会对心肌细胞的除极化和复极化产生极大的干扰,导致心脏电活动发生异常。During the pulse ablation procedure, the high-intensity (high-voltage) pulsed electric field acts on the cells of the tissue to be ablated, which will change the cell membrane potential and make the cell membrane in a polarized state, and the polarization trend is rapidly transmitted to the heart along the adjacent cells. After that, it will greatly interfere with the depolarization and repolarization of cardiomyocytes, resulting in abnormal cardiac electrical activity.
心脏电活动是指心肌细胞产生和传导动作电位的现象,在此过程中,沿着兴奋传播方向的心肌细胞会依次经历除极化和复极化两个过程。而当某些部位心肌细胞的除极化和复极化功能发生异常,导致正常的心脏电活动发生紊乱时,即认为该患者发生了心律失常。另外,在心肌细胞的动作电位时程中,从零期除极化开始后至膜电位复极到一定程度的一段时间内,即使给予很强的刺激也不能产生动作电位,这段时间被称为心肌细胞的有效不应期。目前临床中一般选择在心室肌的有效不应期内施加脉冲电场。Cardiac electrical activity refers to the phenomenon that cardiomyocytes generate and conduct action potentials. During this process, cardiomyocytes along the direction of excitation propagation undergo depolarization and repolarization in turn. When the depolarization and repolarization functions of myocardial cells in some parts are abnormal, resulting in disturbance of normal cardiac electrical activity, the patient is considered to have arrhythmia. In addition, in the action potential time course of cardiomyocytes, from the start of phase zero depolarization to the repolarization of the membrane potential to a certain degree, the action potential cannot be generated even if a strong stimulus is given. This period is called The effective refractory period for cardiomyocytes. At present, it is generally chosen to apply a pulsed electric field during the effective refractory period of the ventricular myocardium in clinical practice.
但是,根据临床统计,高血压患者的心律失常发生率有明显升高。顽固性高血压患者大都伴随有不同程度、不同类型的心律失常。因此,在高血压患者的脉冲消融手术过程中,更加容易引发心肌震颤和心率异常。However, according to clinical statistics, the incidence of arrhythmia in hypertensive patients has increased significantly. Most patients with resistant hypertension are accompanied by different degrees and types of arrhythmias. Therefore, myocardial tremor and abnormal heart rate are more likely to occur during pulse ablation surgery in hypertensive patients.
基于此,本实施例中提供了一种脉冲消融设备及系统,用于对患者的待消融部位实施脉冲消融,并且根据患者的心律类型,决定施加脉冲电场的时机,能够尽量减小脉冲电场对患者心律的影响,提高手术的安全性。Based on this, a pulse ablation device and system are provided in this embodiment, which are used to perform pulse ablation on the part to be ablated of the patient, and determine the timing of applying the pulse electric field according to the heart rhythm type of the patient, so as to minimize the impact of the pulse electric field on the The impact of the patient's heart rhythm and improve the safety of surgery.
本发明以肾动脉交感神经脉冲消融为例进行说明,但是本发明的脉冲消融设备及系统不限于肾动脉交感神经的消融,还可用于其他部位或者其他医疗领域的消融手术,比如肺静脉消融等等,本发明对此不做限制。The present invention is described by taking renal artery sympathetic nerve pulse ablation as an example, but the pulse ablation device and system of the present invention is not limited to the ablation of renal artery sympathetic nerve, and can also be used for ablation operations in other parts or other medical fields, such as pulmonary vein ablation, etc. , which is not limited in the present invention.
请参考图1和图2,图1为本实施例中的脉冲消融系统应用于肾动脉治疗的结构框图,图2为本实施例中的肾脏结构及介入装置110在肾动脉中的位置示意图。如图1所示,脉冲消融系统包括:介入装置110和脉冲消融设备100,所述介入装置110可以包括一个或多个导管,所述介入装置110的远端设置有电极111,所述介入装置110的近端与所述脉冲消融设备100相连。所述电极111用于向待消融部位施加脉冲电场。如图2所示,手术对象300为肾脏结构,左右肾动脉310是腹主动脉320的一对分支,经肾门分别进入左右肾脏330。肾动脉交感神经围绕肾动脉310分布,其在血压的调节方面有着重要的作用。在进行肾动脉交感神经脉冲消融过程中,将介入装置110经股动脉或桡(肱)动脉(未画出)穿刺进入体内,而后通过血管通路到达肾动脉310,所述脉冲消融设备100产生的脉冲信号通过介入装置110上的电极111作用于肾动脉310,使肾动脉310周围的交感神经发生细胞凋亡,从而达到阻断肾动脉310的交感神经,继而实现治疗高血压的目的。Please refer to FIG. 1 and FIG. 2 . FIG. 1 is a structural block diagram of the pulse ablation system in this embodiment applied to renal artery treatment, and FIG. 2 is a schematic diagram of the renal structure and the position of the
在本实施例中,所述介入装置110配置有至少一对电极111,可用于向组织施加能量以及测量电生理信号,所述电极111为凸台环电极,其外形呈凸台环状。所述电极111通常会选用生物相容性较好的金属制造,例如铂铱合金或黄金。较优的,所述电极111的直径为3F~7F,所述电极111的长度为1.5mm~5mm。当然,本申请对电极111的数量、具体形状、材质、直径和长度不做限制,只要能满足本申请中释放脉冲消融能量的作用即可。In this embodiment, the
可选的,所述电极111还设置有灌注孔,所述介入装置110内设置有与所述灌注孔连通的灌注腔,在消融过程中,系统使用者可以通过所述灌注腔及所述灌注孔向所述待消融部位灌注生理盐水。所述电极111除了用于施加脉冲电场,还可用于向肾动脉310施加电刺激以及测量肾动脉310内的电信号。Optionally, the
所述介入装置110远端还可以设置有若干传感器,所述传感器可以是温度传感器、压力传感器和磁场传感器等中的一种或多种。这些传感器测量到的数据一般会通过介入装置110内部的导线传入所述脉冲消融设备100后用于辅助消融手术的实施。在一个实施方式中,所述传感器包括温度传感器,所述温度传感器可用于监测消融过程中的温度变化,避免由于过长时间的施加脉冲电场而导致温度过高从而导致血管损伤或血块凝结;在另一个实施方式中,所述传感器包括压力传感器,所述压力传感器可用于检测介入装置110同肾动脉310血管壁的接触程度;在又一个实施方式中,所述传感器包括磁场传感器,所述磁场传感器可用于确定介入装置110在患者体内的三维空间位置和方向。The distal end of the
所述介入装置110的近端还设置有操作手柄(未画出),系统使用者通过调节操作手柄可以调节所述介入装置110远端在肾动脉310内的位置和形态。就形态而言,介入装置110在肾动脉310内可以呈直线状,也可以呈螺旋状或环状,或其他可能的方便实施消融的形状(如球囊状或篮状等)。The proximal end of the
在一个实施方式中,脉冲消融设备100还包括刺激模块(图中未示出),用于产生刺激信号,所述刺激信号通过所述介入装置上的所述电极作用于患者体内潜在的待消融部位,以达到确认所述患者的所述待消融部位的目的。以图1中所示的肾动脉交感神经脉冲消融系统为例,若待消融部位需要消融,此时在电极111传送刺激信号时血压和心率等参数会随时间变化呈现上升的趋势;若待消融部位无需消融,此时在电极传送刺激信号时血压和心率等参数随时间变化没有明显变化。In one embodiment, the
继续参考图1,所述脉冲消融设备100包括:处理器模块130和脉冲电场发生模块120,所述处理器模块130用于根据患者的心律类型输出一个控制信号,所述脉冲电场发生模块120根据所述控制信号输出相应的脉冲信号。所述脉冲电场发生模块与介入装置110相连,所述脉冲信号通过所述介入装置110上的电极111作用于所述待消融部位以实现脉冲消融。所述控制信号包括脉冲信号发放时机和脉冲信号参数,其中不同的所述心律类型对应不同的所述脉冲信号发放时机,所述脉冲信号发放时机被设置为位于心电信号的每个心动周期的特定时间段内。所述脉冲信号参数包括电极111编号、脉冲极性、脉冲电压、脉冲宽度、脉冲占空比以及脉冲时长。应理解,电极111用于对所述待消融部位以实现脉冲消融是基于脉冲电场实现的,所述电极111将脉冲信号转换成所述脉冲电场。脉冲消融是应用高强度的脉冲电场施加于待消融组织,从而导致待消融组织产生不可逆电穿孔效应以达到破坏效果。不同类型的组织细胞对于脉冲电场的耐受性不同,选择特定参数的脉冲信号实施脉冲消融,可以达到破坏特定的待消融组织的效果。应知道,本实施例中,所述待消融部位为围绕肾动脉310分布的交感神经。Continuing to refer to FIG. 1 , the
下面对所述脉冲消融设备100的各个模块进行详细介绍。Each module of the
脉冲消融设备100还可以设置心电信号采集模块140,用于采集患者的心电信号。处理器模块130与心电信号采集模块140电性连接,所述处理器模块130接收所述心电信号并进行处理,所述处理器模块130根据所述心电信号的特征参数得到所述患者的心律类型,并根据所述心律类型确定所述脉冲信号发放时机。The
更优的,所述处理器模块130持续接收所述心电信号,不断更新所述控制信号并向所述脉冲电场发生模块120输出更新的所述控制信号。More preferably, the
作为一种可选的实施方式,所述心电信号采集模块140不与所述处理器模块130电性连接,所述心电信号采集模块140采集患者的心电信号后以心电图的形式呈现给系统使用者,系统使用者根据所述心电信号的特征参数判定所述患者的心律类型。所述脉冲消融设备100还包括输入模块(图中未示出),用于供系统使用者输入患者的心律类型,所述处理器模块130根据所述心律类型确定所述脉冲信号发放时机。As an optional implementation manner, the ECG
在本发明中的脉冲消融设备100中,处理器模块130会对所述心电信号进行处理后发出控制信号来控制脉冲电场发生模块120产生脉冲信号的时机,脉冲电场发生模块120通过所述介入装置110上的电极111向肾动脉310施加脉冲电场,从而导致围绕肾动脉310的交感神经发生不可逆电穿孔效应。由于处理器模块130可以根据不同患者的心律类型,决定施加脉冲电场的时机,能够尽量减小脉冲电场对患者正常心律的影响,以提高手术的安全性。In the
继续参照图1,所述处理器模块130包括存储器131、中央处理器132、控制电路134。所述存储器131用于存储所述脉冲消融设备100工作过程中需要或产生的各种数据。所述中央处理器132用于分析和处理所述脉冲消融设备100的数据。所述控制电路134与所述心电信号采集模块140和所述脉冲电场发生模块120进行数据交互。关于所述处理器模块130与心电信号采集模块140和脉冲电场发生模块120之间进行数据交互的信息流,后文会详细介绍。Continuing to refer to FIG. 1 , the
处理器模块130通常为计算机系统,所述处理器模块130还包括显示器133,所述显示器133用于显示操控界面以及所述中央处理器132的分析结果。所述处理器模块130一般还包括外设,例如键盘、鼠标或者触摸屏等部件,用于操控所述处理器模块130。The
继续参照图1,所述脉冲电场发生模块120用于产生参数可调的脉冲信号。所述脉冲电场发生模块120产生的脉冲信号会通过装配在介入装置110上的电极111施加于肾动脉310以实施脉冲消融。所述脉冲电场发生模块120产生的脉冲信号通过介入装置110上的电极111释放脉冲消融能量以破坏肾动脉310周围的交感神经,从而达到阻断肾动脉310的交感神经的目的。Continuing to refer to FIG. 1 , the pulsed electric
脉冲信号参数包括电极111编号、脉冲极性、脉冲电压、脉冲宽度、脉冲占空比以及脉冲时长。脉冲消融是应用高强度的脉冲电场施加于待消融组织,从而导致待消融组织产生不可逆电穿孔效应以达到破坏效果。不同类型的组织细胞对于脉冲电场的耐受性不同,选择特定参数的脉冲信号实施脉冲消融,可以达到破坏特定的待消融组织的效果。Pulse signal parameters include
应知道,脉冲信号参数可以预先设定在处理器模块130中,所述脉冲电场发生模块120可以根据控制信号在每个心动周期的特定时间段内不断的产生预设参数的脉冲信号。应知道,所述脉冲信号参数也可以由系统使用者根据经验来手动调整。在本实施例的另一种实施方式中,所述脉冲电场发生模块120还包括一控制面板,脉冲信号参数通过所述控制面板进行控制。在本实施例的另一种实施方式中,所述脉冲信号参数通过所述处理器模块130的操控界面来实现远程控制。It should be known that the pulse signal parameters can be preset in the
进一步的,脉冲极性为单相脉冲或双相脉冲两种方式。下面结合附图对不同脉冲极性的脉冲信号作进一步的说明。Further, the pulse polarity is either monophasic or biphasic. The pulse signals with different pulse polarities will be further described below with reference to the accompanying drawings.
图3为本实施例中的单相脉冲信号波形示意图。如图3所示,U代表脉冲电压大小,ts代表施加脉冲电场的总时长(即脉冲时长),tc代表一个完整脉冲周期的总时长(即脉冲宽度),t1代表一个脉冲周期内的通电时间,此时的脉冲占空比即为t1/tc。FIG. 3 is a schematic diagram of a single-phase pulse signal waveform in this embodiment. As shown in Figure 3, U represents the magnitude of the pulse voltage, t s represents the total duration of the applied pulse electric field (ie pulse duration), t c represents the total duration of a complete pulse cycle (ie pulse width), and t 1 represents the duration of a pulse cycle The power-on time of , the pulse duty ratio at this time is t 1 /t c .
图4为本实施例中的双相脉冲信号波形示意图。如图4所示,U代表脉冲电压大小,ts代表施加脉冲电场的总时长(即脉冲时长),tc代表一个完整脉冲周期的总时长(即脉冲宽度),t1为正相脉冲宽度,t2为负相脉冲宽度,此时的占空比即为(t1+t2)/tc,通常t1等于t2。FIG. 4 is a schematic diagram of the waveform of the biphasic pulse signal in this embodiment. As shown in Figure 4, U represents the magnitude of the pulse voltage, t s represents the total duration of the applied pulse electric field (ie pulse duration), t c represents the total duration of a complete pulse cycle (ie pulse width), and t 1 is the positive-phase pulse width , t 2 is the negative-phase pulse width, and the duty ratio at this time is (t 1 +t 2 )/t c , usually t 1 is equal to t 2 .
进一步的,所述脉冲极性优选为双相脉冲,所述脉冲电压优选的调节范围为0.4kV~15kV,所述脉冲宽度的优选调节范围为0.1us~100us。也即t1或t2的宽度调节范围为0.1us~100us。Further, the pulse polarity is preferably a biphasic pulse, the pulse voltage is preferably adjusted within a range of 0.4kV to 15kV, and the pulse width is preferably adjusted within a range of 0.1us to 100us. That is, the width adjustment range of t 1 or t 2 is 0.1us to 100us.
进一步的,所述脉冲占空比的优选调节范围为1%~99%。Further, the preferred adjustment range of the pulse duty ratio is 1% to 99%.
继续参照图1,所述心电信号采集模块140用于采集患者的心电信号。在一个优选的实施方式中,心电信号采集模块140用于采集患者体表的心电信号。此时使用导电性良好的电极贴片贴附于患者体表的特定部位进行采集与记录。在常规的体表心电图检查中,通常会在四肢各放置一个肢体导联电极,并在胸前放置6个胸导联电极。Continuing to refer to FIG. 1 , the ECG
在另一个可选的实施方式中,心电信号采集模块140用于采集患者心脏内表面的电信号。此时一般使用带有感应电极的介入装置110通过血管通路进入心腔内部进行采集与记录。此处的介入装置110主要起到标测的作用,该步骤对于本领域的普通技术人员而言是易于理解的,在此不做过多赘述。另外,心电信号采集模块140会对采集的心电信号做各种预处理,如陷波、滤波和模数转换等。该步骤对于本领域的普通技术人员而言是易于理解的,在此不做过多赘述。In another optional embodiment, the ECG
通过所述心电信号采集模块140可以记录到心电信号在心脏内传导的过程,从而通过处理器模块130分辨出不同部位的心肌细胞除极和复极的各自时间。The ECG
图5为本实施例中的体表心电信号在一个心动周期内的典型波形示意图。如图5所示,心电信号包括P波、QRS波群和T波,P波反映了心房的除极化过程,QRS波群反映了心室的除极化过程,T波反映了心室的复极化过程,而心房的复极波一般被QRS波群所掩盖。在一个心动周期200中,PQ段201代表从P波终止到QRS波群起始的这段时间;ST段202代表从QRS波群终止到T波起始的这段时间。由前文可知,所述脉冲信号发放时机被设置为位于心电信号的每个心动周期的特定时间段内,所述特定时间段包括所述PQ段和所述ST段。FIG. 5 is a schematic diagram of a typical waveform of the body surface electrocardiographic signal in one cardiac cycle in this embodiment. As shown in Figure 5, the ECG signal includes P wave, QRS complex and T wave. The P wave reflects the depolarization process of the atrium, the QRS complex reflects the depolarization process of the ventricle, and the T wave reflects the repolarization process of the ventricle. Polarization process, and the repolarization wave of the atrium is generally masked by the QRS complex. In a
继续参照图1,处理器模块130是脉冲消融设备100控制和数据处理的核心,接下来对处理器模块130与心电信号采集模块140和脉冲电场发生模块120之间存在数据交互的信息流进行介绍,各信息流的箭头代表了数据传输的方向。Continuing to refer to FIG. 1 , the
继续参照图1,第一信息流a1代表从患者体表采集的心电信号,会被送入心电信号采集模块140。第二信息流a2代表经过心电信号采集模块140预处理(如陷波、滤波和模数转换等处理方式)过后的心电信号,会通过控制电路134进入处理器模块130。第三信息流a3代表脉冲电场发生模块120产生的脉冲信号,所述脉冲信号会通过介入装置110上的电极111施加于围绕肾动脉310分布的交感神经。第四信息流a4代表处理器模块130对于脉冲电场发生模块120发出的控制信号。所述控制信号包括两种:一种是指脉冲信号的发放时机,可以理解为应该在心动周期200内的哪些时间点开始或停止发放脉冲信号。另一种是施加的脉冲信号参数,包括用于施加脉冲电场的电极111编号、脉冲极性、脉冲电压、脉冲宽度、脉冲占空比以及脉冲时长等。第五信息流a5代表介入装置110上的电极111或传感器采集到的信号,如电压信号、温度信号或压力信号等,这些信号会通过控制电路134传入处理器模块130以进行后续分析处理。Continuing to refer to FIG. 1 , the first information flow a1 represents the ECG signal collected from the patient's body surface, and will be sent to the ECG
下面对所述处理器模块130的工作流程进行详细描述。The workflow of the
图6为本实施例中的处理器模块130工作的流程图。如图6所示,处理器模块130工作的流程包括以下步骤:FIG. 6 is a flowchart of the operation of the
步骤S01:处理器模块130接收由心电信号采集模块140采集的患者的心电信号。Step S01 : the
步骤S02:处理器模块130对采集的心电信号进行检测,实时分析采集的心电信号的特征参数。Step S02: The
所述心电信号的特征参数包括P波、R波和T波的起始时刻、峰值时刻和/或终止时刻。处理器模块130对心电信号的特征参数执行分析的方式有多种,在一个实施方式中,使用体表标准Ⅰ导联的心电信号执行分析。在另一个实施方式中,使用体表标准Ⅱ导联的心电信号执行分析。在其他实施方式中,使用动态差分阈值方法对心电信号特征参数进行检测或者使用基于小波变换的方法对心电信号特征参数进行检测。The characteristic parameters of the ECG signal include the start time, the peak time and/or the end time of the P wave, the R wave and the T wave. There are various ways for the
步骤S03:处理器模块130根据心电信号的特征参数的分析结果,得到患者的心律类型。Step S03: The
所述心律类型包括:异常心律和正常心律,所述异常心律包括室上性心律失常和室性心律失常。所述处理器模块130可以根据心电信号的特征参数的分析结果来得到患者的心律类型。在本实施例的一个实施方案中,处理器模块130使用机器学习的方法,通过分析心电信号的特征参数来得到患者的心律类型。可选的,在其他实施方式中,系统使用者可以通过自己的经验在操控界面上手动设置患者的心律失常类型。可选的,使用处理器模块130来得到患者的心律类型,因为处理器模块130可以实时显示出患者的心律类型,提示系统使用者患者的心律类型情况,避免患者在手术过程中的心律类型的变化被忽略,造成手术安全隐患。The heart rhythm types include abnormal heart rhythms and normal heart rhythms, the abnormal heart rhythms including supraventricular arrhythmias and ventricular arrhythmias. The
步骤S04:根据患者的心律类型,处理器模块130会给出一个建议性的脉冲信号发放时机,所述脉冲信号发放时机包括施加脉冲信号的时刻和持续时长。所述处理器模块130能够自行确定脉冲信号发放时机,系统使用者也可以根据经验来设置脉冲信号发放时机。Step S04: According to the heart rhythm type of the patient, the
如前所述,申请人经过研究发现,心律失常起源部位的心肌细胞功能更容易为外界的刺激所干扰,从而可能导致更加混乱的电活动。因此,本发明选择在心律失常起源部位的有效不应期内施加脉冲信号,以尽量降低脉冲信号对于患者现有心律的影响,从而提高脉冲消融手术的安全性。如图5所示,在一个心动周期200中,PQ段201代表从P波终止到QRS波群起始的这段时间,ST段202代表从QRS波群终止到T波起始的这段时间。P波反映了心房的除极化过程,而心房的复极化过程一般被淹没在QRS波群中,可以认为PQ段201近似反映了心房肌(心室之前的组织)的有效不应期时间。QRS波群反映了心室的除极化过程,T波反映了心室的复极化过程,可以认为ST段202近似反映了心室肌的有效不应期时间。因此,对于患有室上性心律失常的高血压患者,处理器模块130可以设定每个心动周期200的PQ段201为脉冲信号发放时机。对于患有室性心律失常的高血压患者和正常心律的高血压患者,处理器模块130可以设定每个心动周期200的ST段202为脉冲信号发放时机。As mentioned above, the applicant has found through research that the function of cardiomyocytes at the origin of arrhythmia is more likely to be disturbed by external stimuli, which may lead to more chaotic electrical activities. Therefore, the present invention chooses to apply the pulse signal within the effective refractory period of the arrhythmia origin to minimize the influence of the pulse signal on the patient's existing heart rhythm, thereby improving the safety of pulse ablation surgery. As shown in FIG. 5, in a
可选的,对患有室上性心律失常的患者,所述脉冲信号发放时机被设置为位于每个所述心动周期200的PQ段内,在每个心动周期200的PQ段内对所述待消融部位施加脉冲信号时,施加脉冲信号的时刻为P波峰值后的30ms~55ms内,持续时长为50ms~75ms。Optionally, for a patient suffering from supraventricular arrhythmia, the timing of sending the pulse signal is set to be located within the PQ segment of each cardiac cycle When a pulse signal is applied to the site to be ablated, the moment of applying the pulse signal is within 30ms to 55ms after the peak of the P wave, and the duration is 50ms to 75ms.
可选的,对患有室性心律失常或正常心律的患者,所述脉冲信号发放时机被设置为位于每个所述心动周期200的ST段内,在每个心动周期200的ST段内对所述待消融部位施加脉冲信号时,施加脉冲信号的时刻为R波峰值后的50ms~75ms内,持续时长为80ms~150ms。Optionally, for a patient suffering from ventricular arrhythmia or normal heart rhythm, the timing of sending the pulse signal is set to be located in the ST segment of each cardiac cycle When the pulse signal is applied to the part to be ablated, the moment of applying the pulse signal is within 50ms-75ms after the peak value of the R wave, and the duration is 80ms-150ms.
当然,在其他实施方式中,系统使用者可以根据患者的心律类型在控制面板或操控界面上手动设置每个心动周期200内开始施加脉冲信号的时刻以及持续时长。Of course, in other embodiments, the system user can manually set the timing and duration of pulse signal application in each
步骤S05:基于肾动脉310血管内的情况来设定脉冲信号参数。Step S05 : setting pulse signal parameters based on the conditions in the
所述肾动脉310血管内的情况包括围绕肾动脉310分布的交感神经对于脉冲电场的耐受性、肾动脉310血管壁厚度和施加脉冲电场的两个电极111的间距等信息,所述脉冲信号相关参数包括用于施加脉冲电场的电极111编号、脉冲极性、脉冲电压、脉冲宽度、脉冲占空比以及脉冲时长等。使用设定参数的脉冲信号可以使得所选择的两个电极111之间的交感神经发生不可逆电穿孔,同时尽量减轻对周围健康组织如肾动脉310血管壁的损伤。脉冲信号参数可以预先设定在处理器模块130中,也可以由系统使用者根据经验来手动调整。脉冲信号参数设定的方法已申请专利,在此不做赘述。The intravascular condition of the
步骤S06:确认好脉冲信号发放时机和脉冲信号参数后,处理器模块130在对心电信号进行检测的同时,不断向脉冲电场发生模块120发放控制信号,控制脉冲电场发生模块120在每个心动周期200的特定时间段内不断的产生预设参数的脉冲信号。Step S06: After confirming the timing of sending the pulse signal and the parameters of the pulse signal, the
为了进一步说明脉冲信号的发放时机,本实施例选取脉冲消融设备100在ST段202内施加脉冲信号作为示例说明。In order to further illustrate the timing of issuing the pulse signal, in this embodiment, the
图7为本实施例中在ST段内施加脉冲信号的示意图。如图7所示,患者的心电信号包括第一心动周期200a和第二心动周期200b。在每个心动周期(200a,200b)中,于每个R波峰值后的tp ms(以下称为“起始延迟时长”)后开始施加脉冲信号,因此,所述施加脉冲信号的时刻由起始延迟时长控制。持续时间为tq ms(以下称为“持续时长”),第一ST段202a和第二ST段202b的端点代表每个心动周期(200a,200b)中脉冲信号开始和停止发放的时刻。FIG. 7 is a schematic diagram of applying a pulse signal in the ST segment in this embodiment. As shown in FIG. 7 , the ECG signal of the patient includes a first
在一个实施方式中,对于第一心动周期200a或第二心动周期200b而言,tp和tq的值都是相同的,只需根据施加脉冲信号之前数个心动周期的特征参数定一个平均值即可。如此,假设步骤S05中预设的脉冲时长为t ms,那么在t/tq个心动周期后,就完成了当前待消融部位的脉冲消融操作。这种模式下,每个心动周期内只需要检测出R波峰值位置即可。这种模式实现较为简单,但是一旦实施消融期间发生了早搏或者某个心动周期内的心电信号形态发生较大变化,可能会导致脉冲信号落在非心律失常起源部位的心肌细胞的有效不应期外,有一定的手术风险。In one embodiment, for the first
在另一个实施方式中,对于第一心动周期200a或第二心动周期200b而言,tp和tq的值都根据当前心动周期的特征参数的检测结果而定。即,tp的值为从当前心动周期的R波峰值时刻TA到S波波谷恢复至基线电压(图中的203)水平的时刻TB之间的时间差,tq的值为S波波谷恢复至基线电压水平的时刻TB到T波之前电压值越过基线电压水平的时刻TC之间的时间差。如此,假设步骤S05中预设的脉冲时长为t ms,那么当连续多个心动周期内施加脉冲电场的总时间超过t ms时,就完成了当前待消融部位的脉冲消融操作。这种模式下,每个心动周期内需要检测出R波峰值时刻、S波波谷恢复至基线电压水平的时刻和T波之前电压值越过基线电压水平的时刻。这种模式可以根据每个心动周期内心电信号的特征参数来调节脉冲信号发放时机,更加具有特异性。In another embodiment, for the first
在另一个实施例中,TA为R波峰值时刻,TB为S波波谷恢复至基线电压水平一定时间后的时刻,TC为T波之前电压值越过基线电压水平一定时间/一定幅度后的时刻。In another embodiment, T A is the peak time of the R wave, T B is the time after the trough of the S wave returns to the baseline voltage level for a certain period of time, and T C is the time after the voltage value before the T wave crosses the baseline voltage level for a certain period of time/a certain amplitude moment.
更优的,对tp和tq的值设定一定的阈值范围。例如,在每个心动周期内,设置有脉冲电场持续时长的上限阈值tm ms,那么当某个心动周期内脉冲信号的持续时长tq>tm时,即使此时的心电信号电压值尚未达到终止发放标准(T波之前越过基线电压水平),处理器模块130也会控制脉冲电场发生模块120暂时停止发放脉冲信号。More preferably, a certain threshold range is set for the values of t p and t q . For example, in each cardiac cycle, the upper threshold t mm ms of the duration of the pulse electric field is set, then when the duration of the pulse signal in a certain cardiac cycle is t q >t m , even if the voltage value of the ECG signal at this time is The
当然,在其他实施例中,每个心动周期内的心电信号波动较大,此时基线电压水平可以根据现有技术手段进行判定,本发明对此不做限定。Of course, in other embodiments, the ECG signal fluctuates greatly in each cardiac cycle, and at this time, the baseline voltage level can be determined according to the prior art means, which is not limited in the present invention.
因此,所述处理器模块130根据对所述待消融部位施加脉冲信号之前的多个所述心动周期内的心电信号,确定所述起始延迟时长和所述持续时长的平均值,来统一设置所述待消融部位施加脉冲信号的时刻和持续时长。并且,所述处理器模块130也可以根据每个所述心动周期内的心电信号的特征参数,确定每个所述心动周期内的所述起始延迟时长和所述持续时长,对待消融部位施加脉冲信号的时刻和持续时长进行特异性调整。如此,系统使用者可根据对患者心电信号稳定性的判断来选择这两种模式,从而进一步提高手术的效率和安全性。Therefore, the
基于同样的发明构思,本发明还提供一种控制脉冲消融方法,所述方法包括:根据心律类型生成控制信号,所述控制信号包括脉冲信号的发放时机,其中不同的所述心律类型对应不同的所述脉冲信号发放时机。所述脉冲信号通过电极释放脉冲电场,所述脉冲电场作用于待消融部位实施脉冲消融。Based on the same inventive concept, the present invention also provides a method for controlling pulse ablation, the method comprising: generating a control signal according to a heart rhythm type, the control signal including the timing of sending the pulse signal, wherein different heart rhythm types correspond to different timing of sending the pulse signal. The pulse signal releases a pulse electric field through the electrode, and the pulse electric field acts on the site to be ablated to implement pulse ablation.
进一步的,所述脉冲信号发放时机被设置为位于心电信号的每个心动周期的特定时间段内。Further, the timing of sending the pulse signal is set to be within a specific time period of each cardiac cycle of the ECG signal.
进一步的,所述脉冲信号发放时机包括施加脉冲信号的时刻和持续时长;所述施加脉冲信号的时刻由起始延迟时长控制,所述起始延迟时长是指在所述特征参数发生后延迟发放脉冲信号的时间,所述施加脉冲信号的时刻在所述起始延迟时长之后;所述持续时长是指在每个所述心动周期内脉冲信号的持续时间。Further, the timing of issuing the pulse signal includes the moment of applying the pulse signal and the duration; the moment of applying the pulse signal is controlled by the initial delay duration, and the initial delay duration refers to the delay in issuing after the characteristic parameter occurs. The time of the pulse signal, the moment of applying the pulse signal is after the start delay time; the duration refers to the duration of the pulse signal in each cardiac cycle.
可选的,根据多个所述心动周期内的心电信号,确定所述起始延迟时长和所述持续时长的平均值,以统一设定所述待消融部位的所述施加脉冲信号的时刻和所述持续时长。Optionally, according to the ECG signals in a plurality of the cardiac cycles, the average value of the starting delay time and the duration is determined, so as to uniformly set the time of applying the pulse signal to the part to be ablated. and said duration.
可选的,根据每个所述心动周期内的心电信号的特征参数,确定每个所述心动周期内的所述起始延迟时长和所述持续时长,以分别设定待消融部位的所述施加脉冲信号的时刻和所述持续时长。Optionally, according to the characteristic parameters of the ECG signal in each cardiac cycle, the initial delay duration and the duration duration in each cardiac cycle are determined, so as to respectively set all the parts to be ablated. the time of applying the pulse signal and the duration.
进一步的,所述控制信号包括脉冲信号参数,所述心电信号包括P波、QRS波群和T波;所述心电信号的特征参数包括P波、R波和T波的起始时刻、峰值时刻和/或终止时刻,其中,R波为QRS波群中的波,所述P波终点到所述QRS波群起点之间的时间段为所述心动周期的PQ段,所述QRS波群终点到所述T波起点之间的时间段为所述心动周期的ST段,所述特定时间段包括所述PQ段和所述ST段。Further, the control signal includes pulse signal parameters, the ECG signal includes P wave, QRS complex and T wave; the characteristic parameters of the ECG signal include the starting time of P wave, R wave and T wave, The peak time and/or the end time, wherein the R wave is a wave in the QRS complex, the time period between the end of the P wave and the start of the QRS complex is the PQ segment of the cardiac cycle, and the QRS complex The time period between the end of the group and the start of the T wave is the ST segment of the cardiac cycle, and the specific time period includes the PQ segment and the ST segment.
进一步的,所述心律类型包括异常心律和正常心律,所述异常心律包括室上性心律失常和室性心律失常。当所述心律类型为室上性心律失常时,所述脉冲信号发放时机被设置为位于每个所述心动周期的PQ段内;当所述心律类型为室性心律失常和正常心律时,所述脉冲信号发放时机被设置为位于每个所述心动周期的ST段内。Further, the heart rhythm type includes abnormal heart rhythm and normal heart rhythm, and the abnormal heart rhythm includes supraventricular arrhythmia and ventricular arrhythmia. When the heart rhythm type is supraventricular arrhythmia, the timing of the pulse signal is set to be located in the PQ segment of each cardiac cycle; when the heart rhythm type is ventricular arrhythmia and normal heart rhythm, all The timing of the pulse signal delivery is set to be within the ST segment of each of the cardiac cycles.
基于同样的发明构思,本发明还提供一种计算机可读存储介质,其上存储有计算机程序,该程序被处理器执行时实现所述的控制脉冲消融方法。Based on the same inventive concept, the present invention also provides a computer-readable storage medium on which a computer program is stored, which implements the control pulse ablation method when the program is executed by a processor.
应理解,本发明实施例中的存储器可以是易失性存储器或非易失性存储器,或可包括易失性和非易失性存储器两者。其中,非易失性存储器可以是只读存储器(read-onlymemory,简称ROM)、可编程只读存储器(programmable ROM,简称PROM)、可擦除可编程只读存储器(erasable PROM,简称EPROM)、电可擦除可编程只读存储器(electricallyEPROM,简称EEPROM)或闪存。易失性存储器可以是随机存取存储器(random accessmemory,简称RAM),其用作外部高速缓存。通过示例性但不是限制性说明,许多形式的随机存取存储器(random access memory,简称RAM)可用,例如静态随机存取存储器(staticRAM,简称SRAM)、动态随机存取存储器(DRAM)、同步动态随机存取存储器(synchronousDRAM,简称SDRAM)、双倍数据速率同步动态随机存取存储器(double datarate SDRAM,简称DDRSDRAM)、增强型同步动态随机存取存储器(enhanced SDRAM,简称ESDRAM)、同步连接动态随机存取存储器(synchlink DRAM,简称SLDRAM)和直接内存总线随机存取存储器(directrambus RAM,简称DR RAM)。It should be understood that the memory in the embodiments of the present invention may be volatile memory or non-volatile memory, or may include both volatile and non-volatile memory. The non-volatile memory may be read-only memory (ROM for short), programmable read-only memory (PROM for short), erasable programmable read-only memory (EPROM for short), Electrically Erasable Programmable Read-Only Memory (electrically EPROM, EEPROM for short) or flash memory. The volatile memory may be random access memory (RAM for short), which is used as an external cache memory. By way of example and not limitation, many forms of random access memory (RAM) are available, such as static random access memory (SRAM), dynamic random access memory (DRAM), synchronous dynamic Random access memory (synchronousDRAM, referred to as SDRAM), double data rate synchronous dynamic random access memory (double datarate SDRAM, referred to as DDRSDRAM), enhanced synchronous dynamic random access memory (enhanced SDRAM, referred to as ESDRAM), synchronous connection dynamic random access memory Access memory (synchlink DRAM, referred to as SLDRAM) and direct memory bus random access memory (directrambus RAM, referred to as DR RAM).
下面介绍下显示器133显示的图形用户界面(Graphical User Interface,简称GUI)。The following describes the Graphical User Interface (Graphical User Interface, GUI for short) displayed by the
图8为本实施例中的一种图形用户界面。如图8所示,脉冲消融设备100通过显示器133的图形用户界面GUI将操控界面以及所述中央处理器132的分析结果呈现给系统使用者。所述图形用户界面GUI包括第一至第五功能区域。FIG. 8 is a graphical user interface in this embodiment. As shown in FIG. 8 , the
第一功能区域b1用于供系统使用者操作,可以通过下拉列表选择用于施加脉冲电场的电极111编号,所述电极111编号分别包括阳极电极编号和阴极电极编号,为了便于描述,此处阳极电极记为111A,阴极电极记为111C。同时在旁边有显示出当前使用的介入装置110的形状,并在介入装置110上绘制出了其上装配的各个电极111及其各自的编号值。优选方案是,在设置好阳极电极111A和阴极电极111C编号后,会在介入装置110上分别使用不同于其他电极111的颜色标识出设置好的阳极电极111A和阴极电极111C,以示区别。例如,阳极电极111A使用红色标识,阴极电极111C使用蓝色标识,其他电极111使用黑色标识。The first functional area b1 is used for operation by the system user, and the
第二功能区域b2用于设置脉冲信号参数,包括脉冲极性、脉冲电压、脉冲宽度、脉冲占空比和脉冲时长等。这些参数可以通过系统预设好,系统使用者也可以根据自己的经验对这些参数进行编辑和调整。The second functional area b2 is used to set the parameters of the pulse signal, including pulse polarity, pulse voltage, pulse width, pulse duty cycle, and pulse duration. These parameters can be preset by the system, and system users can also edit and adjust these parameters according to their own experience.
第三功能区域b3用于设置脉冲电场的发放时机。包括有以下几个设置项:The third functional area b3 is used to set the timing of releasing the pulsed electric field. It includes the following settings:
心律类型:包括室上性心律失常、室性心律失常和正常心律三种;应知道,按之前所述,心律类型可以由中央处理器132对心电信号特征参数的分析结果来得到,也可以由系统使用者进行手动设置;Heart rhythm type: including supraventricular arrhythmia, ventricular arrhythmia and normal heart rhythm; it should be known that, as mentioned above, the heart rhythm type can be obtained from the analysis results of the ECG signal characteristic parameters by the
起始波型:用于设置在每个心动周期中待检测的某个心电信号的特征参数,所述心电信号的特征参数用于控制脉冲信号的开始发放时机,对应于图7中的时刻TA。如图8中显示的“心律类型”为室性心律失常,那么“起始波型”可以设置为“R波”,即检测每个心动周期内的R波峰值时刻。Start waveform: used to set the characteristic parameters of a certain ECG signal to be detected in each cardiac cycle, the characteristic parameters of the ECG signal are used to control the timing of the start of the pulse signal, corresponding to the time T A . As shown in Figure 8, the "heart rhythm type" is ventricular arrhythmia, then the "initial waveform" can be set to "R wave", that is, the peak time of the R wave in each cardiac cycle is detected.
起始延迟时长:设置在起始波型发生后延迟发放脉冲信号的时间长度,对应于图7中的参数tp:即设置在每个心动周期内的R波峰值位置处的tp ms后开始施加脉冲信号。Onset delay time: set the time length of the delayed pulse signal after the onset waveform occurs, corresponding to the parameter t p in Fig. 7 : that is, set after t p ms at the peak position of the R wave in each cardiac cycle Start applying the pulse signal.
持续时间:设置脉冲信号在每个心动周期内的持续时间,对应于图7中的参数tq:即设置每个心动周期内,开始施加脉冲信号后,持续tq ms之后停止发放脉冲信号直至下个心动周期。Duration: Set the duration of the pulse signal in each cardiac cycle, corresponding to the parameter t q in Figure 7: that is, set the pulse signal in each cardiac cycle, after starting to apply the pulse signal, stop sending the pulse signal after t q ms until next cardiac cycle.
已施加时间:用于显示有发放脉冲信号的所有心动周期中的脉冲信号持续时间之和,应知道,该项为只读项,不能进行编辑。Applied time: used to display the sum of pulse signal durations in all cardiac cycles with pulsed signals. It should be known that this item is a read-only item and cannot be edited.
第四功能区域b4用于显示心电信号采集模块140实时传输过来的心电信号。可以是体表标准I导联,也可以是体表标准II导联,也可以同时显示多个导联的心电信号。一般的,会在心电信号波形上标识出处理器模块130的检测结果,如对于起始波型的检测结果(见图中的圆点)。另外一般也会在空白区域显示出患者的心率等统计信息(未画出)。The fourth functional area b4 is used to display the ECG signal transmitted by the ECG
第五功能区域b5是处理器模块130对脉冲电场发生模块120的控制交互区域,主要包括两个控制按钮。The fifth functional area b5 is the control interaction area for the
“开始”按钮的作用为:在系统使用者确认第一功能区域b1中电极111的设置、第二功能区域b2中脉冲信号参数的设置和第三功能区域b3中脉冲信号发放时机的设置无误后,点击“开始”按钮即可控制脉冲电场发生模块120按照预设的模式不断在每个心动周期的特定的时间段内发放脉冲信号,同时第三功能区域b3中的“已施加时间”一栏会在置零后不断计时,显示所有心动周期中的脉冲信号持续时间之和。The function of the "Start" button is: after the system user confirms that the setting of the
“终止”按钮的作用为:一旦手术过程中出现任何意外或错误,可通过点击该按钮来控制脉冲电场发生模块120停止发放脉冲信号。The function of the "terminate" button is: once any accident or error occurs during the operation, the pulse electric
当然,也可以通过直接操作脉冲电场发生模块120的控制面板来控制其启停以及相关参数。另外,除了通过“终止”按钮来停止施加脉冲电场,在其他实施例中,也可以设置当第三功能区域b3中的“已施加时间”高于第二功能区域b2中设置的“脉冲时长”时,自动终止施加脉冲电场。Of course, the on-off and related parameters of the pulsed electric
需要说明的是,图形用户界面的设计排版并不是固定的,图中显示的内容(如介入装置110的形状或电极111的个数等)也不是固定的,可以根据实际需要进行调整,本发明对此不做限定。It should be noted that the design and layout of the graphical user interface is not fixed, and the content displayed in the figure (such as the shape of the
为了更好的理解本发明的脉冲消融系统,下面结合图9阐述本实施例中的脉冲消融系统使用的过程,具体过程如下:In order to better understand the pulse ablation system of the present invention, the following describes the process of using the pulse ablation system in this embodiment with reference to FIG. 9 , and the specific process is as follows:
步骤S1:手术起始,将介入装置110的远端通过血管通路到达肾动脉310。Step S1: At the beginning of the operation, the distal end of the
步骤S2:将介入装置110远端在肾动脉310内来回移动并施加刺激信号以确定肾动脉310内的待消融部位。Step S2 : moving the distal end of the
步骤S3:心电信号采集模块140采集患者的心电信号后发送给处理器模块130。处理器模块130会检测心电信号的特征参数并得到患者的心律类型。而后,处理器模块130会根据患者的心律类型以及其他一些外部条件,向脉冲电场发生模块120发放控制信号。Step S3 : the ECG
步骤S4:脉冲电场发生模块120接收到来自处理器模块130的控制信号后,会根据控制信号不断的开始/停止产生指定参数的脉冲信号,直至达到指定的脉冲总时长。Step S4: After receiving the control signal from the
步骤S5:根据指定脉冲时长施加脉冲电场完毕后,需要确认当前部位是否已完成消融。具体判断方法可以采用类似之前确定待消融部位时的方法。如果消融不够彻底,需要再次施加脉冲电场,如此反复操作直至当前部位消融成功。Step S5: After the application of the pulse electric field according to the specified pulse duration is completed, it is necessary to confirm whether the ablation of the current part has been completed. The specific determination method may be similar to the method used for determining the site to be ablated before. If the ablation is not thorough enough, the pulsed electric field needs to be applied again, and this operation is repeated until the current site is successfully ablated.
步骤S6:接下来,如果还存在其他的待消融部位,只需重复上述手术过程即可,直至所有待消融部位都已完成消融,结束手术。Step S6: Next, if there are other parts to be ablated, just repeat the above operation process until all parts to be ablated have been ablated, and the operation is ended.
应当知道,上面的各步骤并不强求顺序执行,各步骤间可能存在并行操作的情况。例如,步骤S3中采集患者心电信号的操作,可能在手术起始就开始执行了。It should be known that the above steps are not required to be executed sequentially, and there may be parallel operations among the steps. For example, the operation of collecting the patient's ECG signal in step S3 may be performed at the beginning of the operation.
本发明虽然以肾动脉交感神经脉冲消融技术为例,但本领域的技术人员可以理解,本发明同时也可以应用于其他部位或者其他领域的脉冲消融技术,也可以应用于非消融的脉冲治疗技术,只要需要根据心律类型确定脉冲电场发放时机的,就可以应用本发明的技术构思,仅需要进行结构上的适应性调整即可。本发明不仅可以适用于人体,也可以适用于其他动物体,在权利要求中,皆包含在目标对象的范围内,本发明对此不作限制。Although the present invention takes the renal artery sympathetic nerve pulse ablation technique as an example, those skilled in the art can understand that the present invention can also be applied to pulse ablation techniques of other parts or fields, and can also be applied to non-ablation pulse therapy techniques , as long as the pulse electric field release timing needs to be determined according to the heart rhythm type, the technical concept of the present invention can be applied, and only structural adaptive adjustment is required. The present invention can be applied not only to the human body, but also to other animal bodies, all of which are included in the scope of the target object in the claims, which are not limited by the present invention.
上述仅为本发明的优选实施例而已,并不对本发明起到任何限制作用。任何所属技术领域的技术人员,在不脱离本发明的技术方案的范围内,对本发明揭露的技术方案和技术内容做任何形式的等同替换或修改等变动,均属未脱离本发明的技术方案的内容,仍属于本发明的保护范围之内。The above are only preferred embodiments of the present invention, and do not have any limiting effect on the present invention. Any person skilled in the art, within the scope of not departing from the technical solution of the present invention, makes any form of equivalent replacement or modification to the technical solution and technical content disclosed in the present invention, all belong to the technical solution of the present invention. content still falls within the protection scope of the present invention.
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