JP2887757B2 - Defibrillator - Google Patents

Description

Description: TECHNICAL FIELD The present invention relates generally to cardiac defibrillation devices, and more particularly to placing electrodes in or near the heart via a vein, using a bipolar coaxial cable or catheter, and providing a low frequency wave. The present invention relates to a device for performing defibrillation by supplying electrical energy with a single-shot pulse waveform of a type known as Lown wave).

BACKGROUND ART The applicant's U.S. Pat. No. 3,738,370 is coaxial cable.
Via catheter and via vein (transvenous)
It discloses using technology to place electrodes in or near the heart. A sensor is positioned thereon to detect the state of "fibrillation", i.e., the inconsistent activity of the atrial or ventricular myocardial fibers, and to detect such fibrillation or arrhythmia through the coaxial cable. It has been proposed to apply energy to the electrodes to perform defibrillation. The contents of this known patent are referred to in the present application.

Here, the words “defibrillation” and “cardioversion” (cardiac resuscitation) (cardio
version) may be used interchangeably,
Mean the same thing. Both of these terms use electrical signals to remove fibrillation or arrhythmias. The main difference between "defibrillation" (defibrillation) and "cardioversion" is that the latter has a synchronization function, which synchronizes the special signal detected from the heart with the applied electric shock. is there.

Performing defibrillation of the heart using electrical signals has long been known. In addition to the method of using the bipolar coaxial cable catheter disclosed by the above-mentioned patent of the present applicant, it is a conventionally known technique to apply electric energy from outside the patient's body by using, for example, a pair of conductive paddles. . In other known techniques, 1
One electrode is incorporated into the heart and a second electrode is placed in the thoracic cavity outside the heart. In either case, the magnitude of the current or voltage must be of an appropriate value, and the use of electrical energy or electrical input of a particular property capable of defibrillation without damaging the heart or parts of the heart. It is.

One of the drawbacks of the "paddle" technology is that the device is not particularly small and cannot be placed inside the body, and the impedance of the patient's body is relatively high, for example, 1000 ohms. There is also the disadvantage that relatively large electrical energy is required for removal. By using the combination of the conventional intravenous electrode and the surgically embedded electrode,
Defibrillation requires less energy than with the "paddle" technique because the impedance of the exposed heart is reduced to about 50 ohms. However, in this case, the built-in electrode itself by the surgical operation is disadvantageous.

Various types of electrical signals are used for defibrillation. (The term "electrical signal" here refers to the power actually supplied to perform defibrillation, unless otherwise defined). Examples include square waves, trapezoidal waves, waveforms derived from capacitor discharge through resistors, waveforms derived from delay line coupling devices, and the like. George Washington University
Articles published in February 1977 include J. Carr
"Serving Medical and Bioelectronic Equipment," p.148-165,
It describes the use of a LOWN wave pulse signal and its supply circuit. This description is also a reference here.

In addition, various types of sensors are used to detect the state of defibrillation and initiate operation of the defibrillator. The sensors and motion detection circuits used in defibrillators are disclosed in the following U.S. patents.

No. 4,184,495 No. 4,270,549 No. 4,393,877 No. 4,559,546 SUMMARY OF THE INVENTION The present inventor has found that using an electric pulse signal having a specific waveform called a "Lown" wave, the present invention provides a biaxial coaxial catheter fibrillation via a vein according to the present invention. It has been discovered that optimal electrical energy can be transmitted in the removal device. In addition, the present inventors have discovered that the trapezoidal and square waveforms of previously known implantable defibrillators do not work well for good defibrillation. That is, they have found that the catheters of the present invention are not optimal in terms of not damaging or minimizing injury when the catheter according to the invention is placed via a vein with a bipolar cable.

According to the invention, there is provided a bipolar catheter means having a pair of electrical conductors for transmitting electrical energy, and electrode means mounted on an end of the catheter means for transmitting electrical energy for defibrillation, The catheter means is configured to be introduced via the vein to a location at or near the heart such that an electrical shock can be delivered to the heart by the electrodes for defibrillation, and provides an electrical signal having a low pulse waveform to the catheter means. A defibrillation and ablation device comprising a single pulse generator is characterized in that the catheter means can be placed intramuscularly and intravenously in the patient's heart via a vein. Further, the present invention is characterized in that the catheter is a coaxial cable, a low pulse wave is supplied to the electrode through the cable, the low pulse wave waveform is maintained relatively accurately, and the deformation of the waveform can be controlled to a minimum. And

Further, the device is provided with a detector of the status of the defibrillation of the heart, which automatically supplies defibrillation energy in response to such detection.

Further, in the present invention, a three-conductor or three-coaxial cable catheter, that is, a catheter having three conductors, is used and placed via a vein at the heart as described above.
Two conductors and electrodes may be used for defibrillation or delivery of cardiac resuscitation electrical energy, and one conductor and associated electrodes may be used for pacemaker function. In addition, a pair of conductors and electrodes may be used to detect fibrillation or other heart defects. The run-wave pulse can be used to detect heart fibrillation or paralysis, and this detection and pacemaker function can be performed by known detection and pacemaker devices.

According to the present invention, a defibrillation signal having a low-frequency pulse waveform is transmitted using a coaxial cable catheter or a three-core coaxial cable catheter, and when cardiac function is completely stopped, that is, cardiac arrest, cardiac arrhythmia or complete cardiac occlusion ( Sends pacemaker impulse at block).

In the present invention, three or more conductors can be introduced into the heart via a vein to perform a plurality of electrical input / monitoring functions.

Further, in the present invention, a part of the catheter may be a hollow tube, and a plurality of conductors may be provided in the hollow tube. This hollow tube can be used to deliver drugs directly into the heart from outside the body or to measure central venous pressure.

The present invention comprises bipolar catheter means having a pair of electrical conductors for transmitting electrical energy, and electrode means mounted at the end of the catheter means for supplying electrical energy for defibrillation, wherein the catheter means comprises: Allowing the electrodes to be positioned via veins so that they can be positioned inside and outside the patient's heart to deliver an electrical shock to the heart from the electrodes for defibrillation, and wherein the electrode means is one of The right atrium has a pair of electrodes spaced apart so that the other is located in the superior vena cava, the means for supplying power to the catheter means initially has a relatively large positively curved peak, Subsequent to this, it is characterized in that it is configured to supply electric energy in the form of an electric signal having a waveform having a much smaller negative curved peak portion.

According to the present invention, a bipolar catheter means having a pair of electrical conductors for transmitting electrical energy, and mounted on an end of the catheter means for supplying electrical energy for defibrillation 1
A pair of electrodes, said catheter means allowing said electrodes to be introduced via veins for defibrillation, spaced apart from each other, one in the right atrium and the other in the superior aorta. An electric shock can be directly supplied to the heart for defibrillation, and a power supply means supplies electric energy to the catheter for defibrillation.

Other features of the present invention are as described in the claims, and the present invention is capable of many modifications.

The present invention will be described below with reference to the drawings.

 In each drawing, the same parts are indicated by the same reference numerals.

FIG. 1 shows the heart, which includes the left atrium or atrial appendage 1, the left atrium 2, the right ventricle 3, the right atrium or atrial appendage 4, the aorta 5, the pulmonary artery 6, the superior aorta 7, and the inferior vena cava 8. . The entire heart is indicated at 9.

A defibrillator according to the present invention is indicated generally at 10.
The device 10 has a coaxial cable 11, which is sometimes also referred to as a catheter. The reason is that this cable is inserted via a vein. The device further comprises a pair of electrodes 12, 13 provided at one end of the coaxial cable.
And a low pulse wave signal generation defibrillation unit 14,
And a fibrillation detector 15.

The coaxial cable 11 includes a central conductor 20, an insulator 21 surrounding the conductor 20, a tubular conductor or conductor 22 surrounding the insulator 21, and a covering insulator surrounding the same.
23. The conductors 20 and 22 can be any material with good conductivity. However, the materials of these conductors must be completely resistant to body fluids and must not cause harmful effects, such as irritation. Insulators 21 and 23 can be any with good insulating properties, but should also be fully resistant to body fluids and not cause irritation or other harmful effects. One example of a good insulating material is commercially available under the trade name Teflon, which has both the desired insulating properties and durability.

One of the special advantages of coaxial cables is that the characteristic impedance can be selected and maintained fairly accurately over the length of the cable. Yet another advantage is that the coaxial cable can transmit electrical signals over its length with a known and relatively relatively low power loss that can be specially calculated. In addition to this, the characteristics of the electrical signal can be maintained very accurately during transmission. These properties not only relate to the use of coaxial cables for defibrillation of the heart via veins, but also to the precise maintenance of signal waveforms, power and application time lengths when applying special low pulsed wave signals according to the invention. It is effective for

In using the defibrillator 10 according to the present invention, a coaxial cable 11 is inserted into a blood vessel. That is, it is inserted into the right or left jugular vein or its branch, and is positioned in the superior aorta via the vein. In a preferred embodiment of the present invention, the electrodes 12, 13 are located in the heart or large vessels. For example, it is located in the right atrium (or right atrial appendage) or the right ventricle, and defibrillation is performed by applying electrical signal energy. But these electrodes 12,1
3 can be installed in other rooms of the heart or outside the heart,
Alternatively, each electrode may be located in a different chamber of the heart, or one may be located inside the heart and the other outside the heart, for example, inside a blood vessel, and may supply electrical signals of appropriate values to perform desired functions. It can also be done. In yet another example, the first
As shown, one (13) of the electrodes 12, 13 is located at the top of the ventricle 3 to be a distal electrode as seen from the defibrillation units 14, 15, and the other electrode (12) is located in the superior aorta 7. To provide a proximal electrode.

In a preferred embodiment of the present invention, and in the best mode, a transvenous coaxial cable catheter is inserted and the distal electrode 13 is inserted.
Is placed directly in the right atrium 3 and the proximal electrode 12 is placed in the superior vena cava 7. Research has shown that applying a low pulse wave signal to the electrodes placed in this manner provides the most repeatable results for the purpose of defibrillation.

Before inserting the coaxial cable 11 via the vein,
Electrodes 12 and 13 are formed on or attached to the front end 11L of 11. For this purpose, the parts of insulation 21, 23 are removed,
Each conductor 20, 22 is exposed and the corresponding electrode 1 is exposed by an exposed conductor.
Form 2,13. However, if desired, separate conductive electrodes can be attached to the ends of the conductors 20,22.

The distal end 11L of the coaxial cable 11 may be located in the right ventricle of the heart in a position close to the inner wall of the ventricle. Both electrodes 12, 13
Are spaced apart and insulated from each other as shown, with the proximal electrode 12 located in the superior vena cava 7 and the distal electrode 13 located in the right ventricle 3. Preferably, the electrodes 12, 13 are spaced a maximum distance along the long axis of the heart. The low-wave electrical signal produces the greatest defibrillation effect when applied over substantially the entire length of the myocardium. It has also been found that both of these electrodes can be located closer together than described above. However, when the electrodes are brought close to each other, it is necessary to increase the magnitude of the electric signal by at least one order of magnitude to obtain the desired effect of defibrillation. In order to prevent damage to the heart or other parts of the human body, it is preferable to keep the magnitude or energy of the electric signal as low as possible and at the same time to a level that can obtain a defibrillation effect on the heart. The distance between the electrodes 12, 13 is determined by the size of the ventricle of the heart,
Naturally, it is also determined by arranging both electrodes in one ventricle.

As an example, as shown in FIG. 1, the electrodes 12, 13 are separated from each other by a distance of about 8 to 10 mm. In this example, the voltage generated between the terminals of the unit 14 is about 500 V, that is, equal to the maximum peak value of the round wave signal. The total application time length of this low pulse wave signal is about 10 to 25ms (millisecond)
And the energy for defibrillation of the myocardium is about 10 to 40
Jules.

The rear end 11T of the catheter of the coaxial cable 11 is connected to the low pulse wave generating / defibrillation unit 14. An example of the circuit of this unit is shown in FIG. In particular, each conductor 20,2
2 is connected to the output terminal of this unit 14, and the low pulse wave signal is transmitted by the coaxial cable 11, and the electrodes 12, 13
Supply directly to the heart. Due to the advantageous properties of the coaxial cable as described above, the low pulse wave signal maintains its power, waveform, and other characteristic levels, and has an effective and efficient defibrillation effect at the point of delivery to the heart 9. Such a coaxial cable 11 can detect the occurrence of fibrillation, the occurrence of arrhythmia, and the occurrence of other possible abnormalities to the detector unit 15. In such a case, in order to protect the detector unit 15, this unit 15 is provided with a normal changeover switch, and during defibrillation, the defibrillation unit (heart drive unit) 14 sends a high-level signal to the cable. The middle detector unit 15 is instantaneously or constantly shut off. After the defibrillation operation is completed, the changeover switch is operated again to connect the detector unit 15 to the conductors 20 and 22,
Maintain the detection function. Detectors that can be used as fibrillation detector 15 are disclosed in the above referenced patents. Detectors that can be advantageously used in the present invention include, for example, Ellie
Intec Corporatio, owned by Eli Lilly Company
n) related to manufacturing.

During operation of the device 10, the detector unit 15 detects an arrhythmia, such as a fibrillation condition, and the detector generates appropriate electrical signal energy from the unit 14 in this case, e.g., a low pulse wave signal, in response to such detection. This signal is supplied directly to the electrodes 12 and 13 in the heart via cable leads 20 and 22 to effect defibrillation or other arrhythmia arrest,
Normally, the heart function returns. Alternatively, the arrhythmia may be detected using an external device known in the art, and the unit 14 may be automatically operated to transmit the appropriate electrical energy or signal to the heart 9.

If desired, the catheter (11) can be of a type other than a coaxial cable, such as a pair of parallel conductors or a twisted pair of conductors, similar to the coaxial cable described above. Introduce after passing. In this case, the characteristics of the low-pulse wave signal transmitted at the part of the heart, that is, the magnitude, the waveform, etc., are not as accurate as at the connection point of the unit 14 connected to the conductor, and the repeatability is the same as the above-described preferred embodiment. It is inferior to the coaxial cable.

The present invention may also use coaxial cables as described above or pairs of conductors that are not twisted pairs, which are guided to the heart via a vein and run by a low pulse wave generation circuit.
A defibrillation function can be performed by generating a pulse wave signal. However, this results in inferior results when using a coaxial cable, a three-layer coaxial cable, or a twisted wire.

FIG. 5 shows an example of a simple circuit 30 of such a pulse wave generating defibrillation unit / cardiac resuscitation treatment unit 14. The unit 14 generates a low pulse wave as shown in FIG. 6 according to the present invention, and performs defibrillation according to the present invention. Circuits more complex than the circuit 30 shown can also be used as a low pulse wave generation circuit for a venous catheter defibrillation device according to the present invention.

In this circuit 30, a capacitor 32 is used for storing electric energy. This capacitor is, for example, of 16 μF (microfarad) rating for oil-filled high pressure. To charge the capacitor 32, a push button switch
33 is opened, and the high voltage relay 34 is restored. Thus, the two switch arms 34a, 34b of the relay 34 contact the contacts 35a, 35b as shown, and the contacts 36a, 36b are disconnected from the power receiving circuit. In this state, the circuit 30
The power supplied from (120V, AC) through the variable transformer 37 further charges the capacitor 32 through the transformer 40 and the diode 41. Voltmeter 42 like kilovolt meter
Displays the charge on the capacitor 32 and converts it to units of watt-seconds to indicate to the user whether the capacitor has been charged to a voltage sufficient to perform defibrillation. However, such a portable unit according to the invention does not require the incorporation of a meter in the circuit 30. In the present invention, it is preferable to immediately charge the capacitor 32 to a voltage that can be used to form a pulse wave for defibrillation.

When it is desired to generate a pulse wave output from the circuit 30, that is, when the operator closes the switch 33 or activates the switch 33 effectively automatically by the detector 15, a pulse wave is generated, and the switch arms 34a and 34b are turned on. Contacts 35a, 35b
And the connection with the contacts 36a and 36b is formed. At this time, the capacitor 32 is connected to the inductor 43 and the output terminal.
Discharge occurs in series with 44 and 45, and output terminals 44 and 45 are connected to the coaxial cable catheter 11.

For example, a 16μF capacitor 32 and a 100mH inductor 4
3 and a circuit resistance mainly composed of the resistance of the inductor 43 and the contact resistance of the relay 34, and the characteristic impedance of the coaxial cable 11 and the resistance of the patient.
30 produces a pulse waveform as shown in FIG. This pulse waveform has an energy or power of about 400 WS (watt-seconds). The effective positive portion of this pulse wave has a rise time of about 500 μs (microsecond) or less and a peak amplitude of about 3000 V. This main positive pulse lasts for about 5 ms (milliseconds). The magnetic field in the inductor 43 causes a discharge or loss of energy following the main positive pulse, producing a negative tail pulse for about 5 ms. As shown in FIG. 6, this pulse waveform is a waveform with a high degree of attenuation.

The circuit 30 and pulse waveform 31 shown here are merely examples. For the purpose of defibrillation according to the present invention, other circuits that generate highly attenuated pulse waves with appropriate amplitude and time characteristics can be used.

Defibrillation unit 14 that generates pulse waves is about 10 to 400 W
Electrical energy of the order of S (watt-seconds ... joules) shall be allowed. This unit is about 3 more
It is assumed that such electrical energy can be generated for a controllable time length of 100100 ms. It is particularly advantageous if the time length of the pulse wave signal is about 3 to 50 ms, but this time length may be longer depending on the characteristic impedance of the cable 11 and / or the gap between the electrodes 12 and 13 or the impedance of its environment. It can be. However, the duration of application of the pulse wave needs to be such that a defibrillation effect can be suitably obtained without damaging the heart 9 or other parts of the patient.

The pulse-wave generating / defibrillation unit 14 can be made portable, and it is particularly advantageous that it can be implanted in a patient's body or can be always worn. In order to make such a portable type, the unit 14 may be of a battery supply type.

The reduction in insulation requirements due to the use of coaxial cables allows a permanent embedded unit to be implemented permanently with a built-in electrical unit, enabling the detection of premature or irregular heart beats and delivering appropriate synchronization shocks. It can be done as follows. The energy required for such a unit can be provided by an inductively rechargeable battery connected in series with a series of capacitors for charge storage.

Although the invention has been described with reference to a dipolar coaxial cable, any cable having two parallel, completely isolated and insulated conductors may be used, or two completely separate insulated wires may be used. What is necessary is the arrangement of these wires or electrodes, such as in the atrium, the ventricle, the vein, the upper vena cava, etc. according to the optimal mode of the invention. However, considering the above-mentioned reason, that is, from the viewpoint of minimizing signal distortion and minimizing power loss, when a two-pole or two-conductor coaxial cable is required, or when two or more wires are required, three or three or more wires are required. A coaxial cable is most preferred.

Although the first illustrated device 10 of the present invention has been described for use as a defibrillation situation detection and defibrillation device, the units 14 and 15 can be configured for supplying a pacemaker and an electrical signal having a defibrillation function, The necessity and time of the pacemaker function can be detected as necessary, and the necessity of defibrillation can be detected. In such a case, a conventional pacemaker circuit can be incorporated in the circuit of the unit 14 and combined with the above-described pulse wave generation circuit. The detection circuit (15) is modified to detect the need and time of the pacemaker and defibrillation functions. In addition, the electrodes 12, 13 are located at the best possible positions to properly supply the pacemaker signal and the defibrillation signal as much as possible.

FIG. 7 shows a modification 10 'of the defibrillator according to the present invention. The device 10 'is similar in structure and function to many of the components of the device 10 described with reference to FIG. 1, and these portions are indicated by the same reference numerals with a dash (').
In the device 10 ', the cable catheter 11' is a three-core coaxial cable having a conductor 20 ', 22' and a third conductor 50. These wires are connected to a conventionally known 3
A coaxial structure is adopted. That is, one conductor is centered, the second conductor is concentric and isolated by an electrically insulating material, and the third conductor is concentric with the first and second conductors and the second conductor is an electrical insulator. Separate via The ends of these wires are terminated on the one hand with the device 14 'and on the other hand with the electrodes
Terminate at 12 ', 13' and 52.

The operation of device 10 'is generally the same as device 10. And two of the three conductors, 20 ', 22' and 50, are electrodes 12 ',
13 'and conductor 50 is a defibrillator
Used for pulse delivery. The two conductors and the corresponding electrodes
Used to couple to detector 15 'for detection of cardiac function or its abnormal operation. Similarly, two wires and corresponding electrodes are used for performing conventional pacemaker functions. In this case, it is preferable that the detector 15 ′ detects the necessity of the pacemaker function, or that the timing is detected by replacing or adding the pacemaker function.
Conveniently, 14 'is used to send a pacemaker function signal to each electrode. For example, by using a multi-core coaxial cable having three cores, the distortion of the pulse during transmission is minimized and the power that can be transmitted is maximized. I want to. The location and spacing of the two electrodes 12 ', 13' for the defibrillation function are as described above. The arrangement and interval between the electrode 52 and the electrode 13 'are generally almost the same as those of a pacemaker electrode,
As shown in FIG. 7, electrode 52 is positioned closer to electrode 13 'as compared to the relatively long spacing between defibrillation electrodes 12' and 13 '.

FIG. 8 shows still another embodiment of the present invention. This device
10 ″, one end terminates in the equipment unit 14 ′, the other end
It has an additional conductor or conductor 50 'that terminates at 52'. That is, in this device 10 ", one electrode 12 'is placed in the superior vena cava 7', one electrode 13 'is placed in the right ventricle 3', and the electrodes 52, 52 'are placed in the right atrium 4'. The actual arrangement of each electrode is determined based on its function, a known technique, or an experimental result, for example, if the distance between the electrodes 12 ', 13' is widened, as described above, a round waveform pulse is generated between them. Significant defibrillation effects can be expected by supplying two of the electrodes for sensing cardiac function and the other two for pacemaker function.Multi-conductor or conductor 20 ' , 22 ', 50, 50' (or more) should be inserted through the vein and not cut through the thoracic cavity for implantation purposes.These conductors should be of the multi-core type and should have the desired electrical properties described above. Achieve and minimize intravenous space and facilitate insertion Doo is preferred. Detector 15 'detects the cardiac function, i.e. normal operation, the detectable conventional circuit arrhythmia, alone or equipment unit 14' can have the timing functions of the pacemaker work with.

FIG. 9 shows a third embodiment of the present invention. This device 10
For example, as shown in FIGS.
Multi-core coaxial cable catheter such as coaxial cable
It has a 23 ', a unit 14', a detector 15 'and several electrodes whose operation has been described so far. The device also has a fluid conducting catheter or tube 60, which is
A composite catheter 62 capable of receiving a bundle of 20 ', 22', 50, 50 ', etc., or being attached thereto and inserted through a vein is constructed.
The front end 60L of the catheter 60 for fluid communication is positioned in the heart. (Or, if desired, it is located in a vein through which the catheter 62 is inserted.) The trailing edge 60T is exposed, for example, outside the heart, and is particularly arranged outside the patient to perform the following operation.

The device 10 has a fluid device 64 associated with a fluid conducting catheter 60. The fluid device 64 has a switch 66 that opens and closes a flow path to the catheter 60 or which part of the fluid device 64 is connected to the fluid device 64.
A transvenous drip (infusion) device 68 which supplies fluid to the heart 9 directly, such as to the right atrium 4 ', and a detector 70 which directly detects the central venous pressure in the right atrium 4' of the heart, for example.
And a regulator 72 for controlling the IV drip pressure (intravenous infusion pressure) as a function of the detected central venous pressure, for example. The fluid conduction catheter 60 has one or several independent parallel flow channels, which allows for the monitoring of central venous pressure while providing IV drip.

Detector 70 can be a known fluid pressure detection device. The regulator 72 and IV drip 68 are devices known in the art. When operating the adjuster 72 in accordance with the output of the detector 70, the detector and the adjuster are electrically coupled, and the detector output generates a predetermined adjustment level to control the IV drip 68;
The rate at which fluid enters the heart is controlled as a function of the monitor pressure.

The leading edge 60L of the fluid communication catheter 60 can be located at a location within the heart or outside the heart, and an IV drip can be applied directly to each location. Further catheter
Numeral 60 can be along the lateral side of the multi-core coaxial cable 11 'or inside it, for example formed as a hollow tube, or arranged as part of an annular cross section. In either case,
Preferably, the fluid and electrical portions of the catheter 62 are integrated and inserted through the heart vein as described above. For this reason, it is desirable to form these parts as an integral catheter device, or as described above, a common coaxial device or a side-by-side arrangement.

The electrical usage of the device 10 is substantially the same as described above. Fluid use monitors pressure and provides IV drip control. Because the composite catheter 62 has a larger cross-sectional dimension than the catheter 60 without a fluid passage, and because it may be exposed to the flow path at the trailing edge 60T, the device 10 is a relatively controlled environment. It is preferable to use it in a place that is relatively inaccessible from the outside, such as in a heart treatment device in a hospital, for example. Also, the catheter 62 is typically removed before all medical procedures for the patient are completed. Even with the utmost care, the device 10 may be used outside of a restricted or controlled environment as described above. In addition to the devices 10 ', 10 ", and 10 described above, those which are more portable and can be used by a patient even in the case of an unexpected arrhythmia without being in a special control environment, and particularly capable of being automatically operated This is convenient.

 The present invention is capable of many other variations as described above.

INDUSTRIAL APPLICABILITY The device of the present invention has a remarkable effect on defibrillation of the heart as described above.

[Brief description of the drawings]

FIG. 1 is a schematic view of the device of the present invention shown together with a schematic cross section of the heart for explaining the use of the present invention. FIG. 2 is a cross-sectional view taken along the line 2-2 of FIG. 1, and FIG. FIG. 4 is a cross-sectional view taken along line 4-4 in FIG. 1, FIG. 5 is a circuit diagram of a round wave pulse generator, FIG. 6 is a waveform diagram of a round wave pulse, and FIG. FIG. 8 is a view similar to FIG. 1 showing another embodiment, FIG. 8 is a view similar to FIG. 1 showing still another embodiment of the present invention, and FIG. 9 is a further embodiment of the present invention. FIG. 2 is a view similar to FIG. 1 with a catheter provided with an infusion / monitor structure. 10,10 ', 10 ", 10 ... Defibrillator 11,11', 60 ... Coaxial cable 12,13,12 ', 13' ... Electrode 14 ... Fibrillator unit 15,70 ... Detection Containers 20,22,20 ', 22', 50,50 '...... Conductor 21,23 ... Insulator 62 ... Catheter 68 ... IV drip

Claims (9)

(57) [Claims] A bipolar catheter means having a pair of electrical conductors for transmitting electrical energy, and one of said catheter means.
A pair of electrodes mounted on the end for transmitting electrical energy for defibrillation, the catheter means being capable of delivering an electrical shock directly to the heart by the electrodes for effective defibrillation. The electrodes are respectively arranged at positions of the right ventricle and the superior aorta of the heart via a vein so as to be positioned, and the pair of electrodes are separated from each other by a certain distance in the positioning, and Is located in the right ventricle and the other in the superior aorta, and further comprises power supply means for supplying electrical energy to said catheter means for performing defibrillation, said power supply means comprising electrical energy in the form of said signal. To the catheter means, the waveform of the electrical signal initially having a relatively large amplitude positive peak, followed by a much smaller amplitude. Defibrillator for patient, wherein the peak portion of the negative polarity is followed by shape. 2. The apparatus of claim 1 wherein said catheter means positions the entirety of each of said electrodes within a blood vessel and heart with respect to a patient's heart. 3. The apparatus according to claim 1, wherein said power supply means has a round waveform generating circuit and generates a low waveform electric signal. 4. An arrhythmia detector connected to an electrical conductor of said bipolar catheter means, said arrhythmia detector comprising:
2. A power supply means for supplying electrical energy to said catheter means for defibrillation operation.
The device according to any one of claims 1 to 3. 5. The bipolar catheter means, power supply means,
5. The electrode according to claim 1, wherein said electrode has a pacemaker impulse generating means in preparation for a complete stoppage of cardiac electrical function.
An apparatus according to any one of the preceding claims. 6. The apparatus according to claim 1, further comprising a fluid flowing means for flowing a fluid between the outside of the heart and the heart as a part of the catheter means. 7. The apparatus according to claim 6, wherein said fluid flow means has an end exposed outside the body of the patient, and provides a fluid connection between inside and outside of the body. 8. Intravenous drip means for supplying fluid into said fluid conducting means for supplying fluid directly to the heart; detecting means coupled to said fluid conducting means for detecting intravenous blood pressure; 7. A control means for controlling said intravenous drip means as a function of central venous blood pressure.
Or the apparatus according to 7. 9. Apparatus according to claim 1, wherein the catheter means has a multiaxial catheter having more than two electrical conductors for transmitting electrical energy.