Defibrillation control device

Abstract

To provide information useful for catheter treatment.SOLUTION: A defibrillation control device 14 includes: a power source part 48 that supplies electric energy to an electrode catheter 12; an abnormality detection part 52c that detects an earliest abnormal waveform by using a plurality of electrocardiographic waveforms measured by a plurality of electrodes of the electrode catheter 12 after the supply of the electric energy; and an alarm part 52d that issues an alert in response to detection of the earliest abnormal waveform.SELECTED DRAWING: Figure 1

Description

Technical Field

[0001] The present disclosure relates to a defibrillation control device.

Background Art

[0002] Catheter ablation treatment is generally performed by inserting a catheter into the heart cavity and locally ablating the location considered to be the cause of arrhythmia. In ablation treatment, the intracardiac electrocardiogram is measured using an electrode catheter inserted into the heart cavity, and the location considered to be the cause of arrhythmia is analyzed. In order to remove atrial fibrillation that may occur during the ablation procedure, an intracardiac defibrillation system that directly supplies electrical energy for defibrillation to the heart through an intracardiac electrode catheter is also used.

Prior Art Documents

Patent Documents

[0003]

Patent Document 1

Summary of the Invention

Problems to be Solved by the Invention

[0004] In ablation treatment, identification of the location causing arrhythmia and ablation of the identified location may be carried out concurrently. It would be beneficial for physicians and the like involved in the treatment if information useful for diagnosing the location causing arrhythmia could be provided.

[0005] The present disclosure has been made in view of such circumstances, and an object thereof is to provide information useful for catheter treatment.

Means for Solving the Problems

[0006] A defibrillation control device according to one embodiment of the present disclosure includes a power supply unit that supplies electrical energy to an electrode catheter, an abnormality detection unit that detects the earliest abnormal waveform using multiple electrocardiogram waveforms measured by multiple electrodes of the electrode catheter after the supply of electrical energy, and a warning unit that issues an alert upon detection of the earliest abnormal waveform.

[0007] Any combination of the above components, or any conversion of these components into a method, device, system, recording medium, computer program, or the like, is also encompassed by the present disclosure. Effect of the Invention

[0008] According to the present disclosure, it is possible to provide information useful for catheter treatment. [Brief description of the drawings]

[0009]

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Mode for Carrying Out the Invention

[0010] Hereinafter, with reference to the drawings, embodiments for carrying out the present disclosure (hereinafter also referred to as embodiments) will be described in detail. In the description and / or drawings, the same or equivalent components, members, processes, etc. are denoted by the same reference numerals, and duplicate descriptions are omitted. The scales and shapes of the respective parts shown are set for the sake of simplicity of explanation and are not to be construed in a limited manner unless otherwise specified. The embodiments are examples and do not limit the scope of the present disclosure in any way. All features described in the embodiments and combinations thereof are not necessarily essential to the present disclosure.

[0011] (First Embodiment) FIG. 1 is a diagram schematically showing the configuration of a defibrillation system 10 according to the first embodiment. The defibrillation system 10 includes an electrode catheter 12, a defibrillation control device 14, and a monitoring device 16.

[0012] The electrode catheter 12 is a so-called cardiac catheter. The electrode catheter 12 is inserted into the body of the patient 20 and is used such that the distal end portion 24 of the electrode catheter 12 is positioned at the heart 22 of the patient 20. A plurality of electrodes are provided on the distal end side of the electrode catheter 12 so as to be arranged in the longitudinal direction. The electrode catheter 12 can measure the electrocardiogram potentials at a plurality of locations within the heart cavity with the plurality of electrodes. The electrode catheter 12 can directly supply electrical energy for defibrillation to the heart 22 by applying a voltage to the plurality of electrodes.

[0013] The defibrillation control device 14 is connected to the electrode catheter 12. The defibrillation control device 14 operates in either an electrocardiogram measurement mode or a defibrillation mode. In the electrocardiogram measurement mode, the defibrillation control device 14 acquires the electrocardiogram waveform measured by the plurality of electrodes of the electrode catheter 12 and outputs it to the monitoring device 16. In the defibrillation mode, the defibrillation control device 14 supplies electrical energy for defibrillation to the electrode catheter 12 by applying a voltage to the plurality of electrodes of the electrode catheter 12.

[0014] The monitoring device 16 acquires and monitors the electrocardiogram waveform of the patient 20. The monitoring device 16 acquires the electrocardiogram waveform measured by the electrode catheter 12 via the defibrillation control device 14. The monitoring device 16 acquires the electrocardiogram waveform of the patient 20 via an electrocardiogram potential measurement means such as an electrode pad 18 attached to the body surface of the patient 20. The monitoring device 16 can also acquire the electrocardiogram waveform of the patient 20 obtained from an electrode catheter different from the electrode catheter 12 connected to the defibrillation control device 14. The monitoring device 16 provides at least one of the acquired electrocardiogram waveforms to the defibrillation control device 14. The electrocardiogram waveform provided from the monitoring device 16 to the defibrillation control device 14 is used to determine the timing (trigger point) at which the supply of electrical energy for defibrillation can be started.

[0015] The defibrillation system 10 is used, for example, in catheter ablation surgery for locally cauterizing a location considered to be the cause of arrhythmia. During the ablation surgery, atrial fibrillation, which is a type of arrhythmia, may occur. When atrial fibrillation occurs, electrical energy is supplied via the electrode catheter 12 for defibrillation. When atrial fibrillation is removed by the supply of electrical energy, normal heartbeats often start, but before the start of normal heartbeats, the location of the cause of arrhythmia may be abnormally excited. In the present embodiment, by analyzing the electrocardiogram waveform after defibrillation, the earliest abnormal waveform indicating the occurrence of abnormal excitation is detected. According to the present embodiment, by detecting the earliest abnormal waveform, useful information related to the cause of arrhythmia can be provided to a doctor or the like.

[0016] FIG. 2 is a diagram schematically showing the structure of the electrode catheter 12. The electrode catheter 12 includes a tubular flexible shaft 26 to be inserted into the body, and a handle portion 28 connected to the proximal end side (outside the body) of the shaft 26. A doctor or the like who is a user of the electrode catheter 12 operates the electrode catheter 12 while gripping the handle portion 28. The user can deflect (wag) the distal end portion 24 of the shaft 26 in a predetermined direction by rotating the knob portion 34 while gripping the handle portion 28, through a pull wire (not shown) inserted into the shaft 26. Further, by rotating the handle portion 28 in the circumferential direction, the deflection direction of the distal end portion 24 of the shaft 26 can be adjusted. A cable 30 for connecting to the defibrillation control device 14 is connected to the end of the handle portion 28.

[0017] On the tip side of the shaft 26, a first electrode group 31G, a second electrode group 32G, and a third electrode group 33G are provided. The positions and orders of the first electrode group 31G, the second electrode group 32G, and the third electrode group 33G in the axial direction (longitudinal direction) of the shaft 26 are arbitrary. However, in the example shown in FIG. 2, the first electrode group 31G, the second electrode group 32G, and the third electrode group 33G are arranged in this order from the tip side toward the base end side. When performing defibrillation treatment in the heart cavity with the electrode catheter 12 having such an electrode arrangement, for example, the first electrode group 31G on the tip side is located in the coronary sinus (CS), the second electrode group 32G on the base end side is located in the right atrium (RA), and the third electrode group 33G on the further base end side is located in the superior vena cava (SVC).

[0018] The first electrode group 31G includes a plurality of ring-shaped first electrodes 31 arranged at intervals in the axial direction. The second electrode group 32G includes a plurality of ring-shaped second electrodes 32 arranged at intervals in the axial direction. The third electrode group 33G includes a plurality of ring-shaped third electrodes 33 arranged at intervals in the axial direction. In the example shown in FIG. 2, eight first electrodes 31, eight second electrodes 32, and four third electrodes 33 are provided. However, the number of electrodes included in each of the electrode groups 31G, 32G, 33G is not particularly limited. The plurality of electrodes 31, 32, 33 do not have to be arranged together as the electrode groups 31G, 32G, 33G, and each of them may be dispersed and arranged at arbitrary positions in the axial direction.

[0019] Electrode numbers may be assigned to each of the plurality of electrodes 31, 32, 33 provided on the electrode catheter 12. The electrode numbers are assigned, for example, in order from the tip side toward the base end side of the electrode catheter 12. For example, the numbers "1" to "8" are assigned to the eight first electrodes 31 of the first electrode group 31G, the numbers "9" to "16" are assigned to the eight second electrodes 32 of the second electrode group 32G, and the numbers "17" to "20" are assigned to the four third electrodes 33 of the third electrode group 33G.

[0020] Inside the shaft 26, a first conductor group, a second conductor group, and a third conductor group (not shown) that are electrically connected to each of the electrode groups 31G, 32G, and 33G are inserted. The first conductor group includes a plurality (for example, eight) of first conductors that are connected corresponding to the plurality of first electrodes 31 in the first electrode group 31G. The second conductor group includes a plurality (for example, eight) of second conductors that are connected corresponding to the plurality of second electrodes 32 in the second electrode group 32G. The third conductor group includes a plurality (for example, four) of third conductors that are connected corresponding to the plurality of third electrodes 33 in the third electrode group 33G. Each conductor group is electrically connected to the defibrillation control device 14 via the cable 30. The defibrillation control device 14 can acquire electrocardiogram waveforms measured by each of the plurality of electrodes 31, 32, and 33 that constitute the electrode groups 31G, 32G, and 33G in the electrocardiogram measurement mode.

[0021] The electrocardiogram waveform measured using the first electrode group 31G is also referred to as the first electrocardiogram waveform. The first electrocardiogram waveform is, for example, a CS waveform indicating the electrocardiogram potential of the coronary sinus (CS). When the first electrode group 31G includes eight first electrodes 31, four CS waveforms (CS1, CS2, CS3, CS4) at four locations in the coronary sinus can be measured. Each of the four CS waveforms corresponds to, for example, the time change of the potential difference between two adjacent first electrodes 31 among the first electrode group 31G.

[0022] The electrocardiogram waveform measured using the second electrode group 32G is also referred to as the second electrocardiogram waveform. The second electrocardiogram waveform is, for example, an RA waveform indicating the electrocardiogram potential of the right atrium (RA). When the second electrode group 32G includes eight second electrodes 32, four RA waveforms (RA1, RA2, RA3, RA4) at four locations in the right atrium can be measured. Each of the four RA waveforms corresponds to, for example, the time change of the potential difference between two adjacent second electrodes 32 among the second electrode group 32G.

[0023] The electrocardiogram waveform measured using the third electrode group 33G is also referred to as the third electrocardiogram waveform. The third electrocardiogram waveform is, for example, an SVC waveform indicating the electrocardiogram potential of the superior vena cava (SVC). When the third electrode group 33G includes four third electrodes 33, two SVC waveforms (SVC1, SVC2) at two locations in the superior vena cava can be measured. Each of the two SVC waveforms corresponds to, for example, the time change in the potential difference between two adjacent third electrodes 33.

[0024] In the defibrillation mode, different polarities of voltages are applied to the first electrode group 31G and the second electrode group 32G by the defibrillation control device 14. When a positive voltage is applied to the first electrode group 31G, a negative voltage is applied to the second electrode group 32G. For example, a common positive voltage is applied to the plurality of first electrodes 31 constituting the first electrode group 31G, and a common negative voltage is applied to the plurality of second electrodes 32 constituting the second electrode group 32G. Conversely, when a negative voltage is applied to the first electrode group 31G, a positive voltage is applied to the second electrode group 32G. For example, a common negative voltage is applied to the plurality of first electrodes 31 constituting the first electrode group 31G, and a common positive voltage is applied to the plurality of second electrodes 32 constituting the second electrode group 32G. In this way, electrical energy for defibrillation can be directly supplied between the coronary sinus (CS) where the first electrode group 31G is disposed and the right atrium (RA) where the second electrode group 32G is disposed.

[0025] Returning to FIG. 1, the defibrillation control device 14 will be described. The defibrillation control device 14 includes a catheter connection portion 40, a contact switching portion 42, a waveform output portion 44, a waveform input portion 46, a power supply portion 48, an operation button 50, a control portion 52, a display portion 54, and a speaker 56.

[0026] The catheter connection part 40 has a cable 30 attached thereto which is connected to the electrode catheter 12. The catheter connection part 40 includes a connection terminal group that is electrically connected to each of the plurality of electrodes 31, 32, 33 constituting each electrode group 31G, 32G, 33G of the electrode catheter 12. The catheter connection part 40 includes a first connection terminal group electrically connected to the first electrode group 31G, a second connection terminal group electrically connected to the second electrode group 32G, and a third connection terminal group electrically connected to the third electrode group 33G. The first connection terminal group and the second connection terminal group are connected to the contact switching part 42. The third connection terminal group is connected to the waveform output part 44 and the control part 52, rather than the contact switching part 42, as indicated by the broken line 40a.

[0027] The contact switching part 42 is a one-circuit two-contact switching switch configured to connect the common contact 42c to either the first contact 42a or the second contact 42b. The first connection terminal group and the second connection terminal group of the catheter connection part 40 are connected to the common contact 42c. Accordingly, the common contact 42c is connected to the first electrode group 31G and the second electrode group 32G of the electrode catheter 12. The first contact 42a is connected to the waveform output part 44 and the control part 52. The second contact 42b is electrically connected to the power supply part 48.

[0028] The contact switching part 42 connects the common contact 42c to the first contact 42a, for example, in the electrocardiogram measurement mode. By connecting the common contact 42c to the first contact 42a, the first electrocardiogram waveform measured by the first electrode group 31G and the second electrocardiogram waveform measured by the second electrode group 32G can be output to the monitoring device 16 via the waveform output part 44. By connecting the common contact 42c to the first contact 42a, the first electrocardiogram waveform and the second electrocardiogram waveform can be analyzed by the control part 52. The contact switching part 42 connects the common contact 42c to the second contact 42b, for example, in the defibrillation mode. By connecting the common contact 42c to the second contact 42b, the first electrode group 31G and the second electrode group 32G are connected to the power supply part 48, and electrical energy can be supplied from the power supply part 48.

[0029] The waveform output unit 44 outputs the electrocardiogram waveform measured using the electrode catheter 12 toward the monitoring device 16. The waveform output unit 44 includes, for example, a first output terminal group that outputs a plurality of first electrocardiogram waveforms measured by the first electrode group 31G, a second output terminal group that outputs a plurality of second electrocardiogram waveforms measured by the second electrode group 32G, and a third output terminal group that outputs a plurality of third electrocardiogram waveforms measured by the third electrode group 33G.

[0030] In the electrocardiogram measurement mode, for example, the waveform output unit 44 outputs the first electrocardiogram waveform and the second electrocardiogram waveform. The first electrocardiogram waveform and the second electrocardiogram waveform output from the waveform output unit 44 pass through the contact switching unit 42. When the first contact 42a is separated from the common contact 42c in the defibrillation mode, for example, the waveform output unit 44 does not output the first electrocardiogram waveform and the second electrocardiogram waveform. The waveform output unit 44 outputs the third electrocardiogram waveform in both the electrocardiogram measurement mode and the defibrillation mode. This is because the third electrocardiogram waveform output from the waveform output unit 44 does not pass through the contact switching unit 42.

[0031] The waveform input unit 46 receives the electrocardiogram waveform provided from the monitoring device 16. The waveform input unit 46 includes, for example, an input terminal to which the electrocardiogram waveform provided from the monitoring device 16 is input. The electrocardiogram waveform input to the waveform input unit 46 is, for example, a body surface electrocardiogram waveform measured by the electrode pad 18. The electrocardiogram waveform input to the waveform input unit 46 may be an intracardiac electrocardiogram waveform measured by a different electrode catheter from the electrode catheter 12. The electrocardiogram waveform input to the waveform input unit 46 may be the third electrocardiogram waveform measured by the third electrode group 33G of the electrode catheter 12.

[0032] The power supply unit 48 is connected to the second contact 42b of the contact switching unit 42. The power supply unit 48 is connected to the catheter connection unit 40 in the defibrillation mode and is disconnected from the catheter connection unit 40 in the electrocardiogram measurement mode. The power supply unit 48 is connected to the first electrode group 31G and the second electrode group 32G of the electrode catheter 12 in the defibrillation mode and is disconnected from the first electrode group 31G and the second electrode group 32G of the electrode catheter 12 in the electrocardiogram measurement mode.

[0033] In the defibrillation mode, the power supply unit 48 supplies the electrical energy necessary for the defibrillation treatment to the electrode catheter 12. The power supply unit 48 includes a measurement circuit 48a, a charging circuit 48b, a discharge circuit 48c, and a capacitor 48d.

[0034] The measurement circuit 48a measures the impedance between the first electrode group 31G and the second electrode group 32G. The impedance measured by the measurement circuit 48a is used to determine whether the first electrode group 31G and the second electrode group 32G are in appropriate contact with the tissue in the heart cavity and are in a state suitable for supplying electrical energy for defibrillation. For example, if the impedance measured by the measurement circuit 48a is 21 Ω or more and 99 Ω or less, it is determined that the state is appropriate for defibrillation.

[0035] The charging circuit 48b charges the capacitor 48d with the electrical energy for defibrillation. The charging circuit 48b is constituted by, for example, a boost circuit that generates a high voltage of about 100V to 600V. The amount of energy charged in the capacitor 48d by the charging circuit 48b is configured to be variable by an input operation from the user.

[0036] The discharge circuit 48c supplies the electrical energy charged in the capacitor 48d to the first electrode group 31G and the second electrode group 32G of the electrode catheter 12. The discharge circuit 48c is constituted by, for example, an H-bridge circuit using four switch elements (for example, transistors). The discharge circuit 48c generates a first state in which a positive voltage is applied to the first electrode group 31G and a negative voltage is applied to the second electrode group 32G, and a second state in which a negative voltage is applied to the first electrode group 31G and a positive voltage is applied to the second electrode group 32G by switching the on / off of the four switch elements.

[0037] FIG. 3 is a diagram schematically showing the circuit configuration of the power supply unit 48. The power supply unit 48 includes a first terminal 48e connectable to the first electrode group 31G and a second terminal 48f connectable to the second electrode group 32G. The measurement circuit 48a is connected to the first terminal 48e and the second terminal 48f via a first switch S1 and a second switch S2. The discharge circuit 48c includes a third switch S3, a fourth switch S4, a fifth switch S5, and a sixth switch S6 that form an H-bridge.

[0038] When the measurement circuit 48a measures the impedance between the first terminal 48e and the second terminal 48f, the first switch S1 and the second switch S2 are turned on, and the four switches S3 to S6 of the discharge circuit 48c are turned off. When the capacitor 48d is charged by the charging circuit 48b, all the switches S1 to S6 are turned off. When discharging from the capacitor 48d by the discharge circuit 48c, a first state in which the third switch S3 and the fourth switch S4 are turned on and the fifth switch S5 and the sixth switch S6 are turned off, and a second state in which the third switch S3 and the fourth switch S4 are turned off and the fifth switch S5 and the sixth switch S6 are turned on are used.

[0039] FIG. 4 is a graph showing an example of the voltage waveform output from the power supply unit 48, and shows the time change of the voltage applied between the first electrode group 31G and the second electrode group 32G. First, voltage application is started after the elapse of a standby period T0 from the start timing (trigger point) of defibrillation. The standby period T0 is, for example, about 10 to 50 ms (milliseconds), and in one example, it is 10 ms. The first period T1 is a first state in which a positive voltage is applied to the first terminal 48e and a negative voltage is applied to the second terminal 48f. In the first period T1, the magnitude of the applied voltage decreases with the passage of time from the first peak voltage V A The magnitude of the first peak voltage V A corresponds to the charging voltage of the capacitor 48d and is about 100 V to 600 V. The second period T2 is a second state in which a negative voltage is applied to the first terminal 48e and a positive voltage is applied to the second terminal 48f. In the second period T2, the second peak voltage V BFrom this point, the magnitude of the applied voltage decreases with the passage of time. The magnitude of the second peak voltage V B is approximately the same as the magnitude of the voltage V C at the end of the first period T1. The interval period ΔT between the first period T1 and the second period T2 is a short time required for switching the on / off states of the switches S3 to S6 of the discharge circuit 48c. The discharge period T including the first period T1 and the second period T2 is, for example, about 6 to 30 ms, and in one example, it is 20 ms.

[0040] Returning to FIG. 1, the operation button 50 is a switch such as a push button that receives an input operation by the user. The operation button 50 includes a mode switching button 50a, a charging button 50b, and a discharge button 50c. The mode switching button 50a is used to switch the operation mode between the electrocardiogram measurement mode and the defibrillation mode. The charging button 50b is used to start charging the capacitor 48d by the charging circuit 48b in the defibrillation mode. The discharge button 50c is used to start discharging from the capacitor 48d by the discharge circuit 48c in the defibrillation mode.

[0041] The control unit 52 controls the overall operation of the defibrillation control device 14. The control unit 52 includes a mode control unit 52a, a trigger detection unit 52b, an abnormality detection unit 52c, and a warning unit 52d.

[0042] The mode control unit 52a switches the operation mode of the defibrillation control device 14 according to the operation of the operation button 50 by the user. The trigger detection unit 52b detects a trigger point for starting a discharge for defibrillation based on the electrocardiogram waveform provided from the monitoring device 16. The abnormality detection unit 52c analyzes the electrocardiogram waveform after the completion of the discharge for defibrillation and detects an abnormality in the electrocardiogram waveform. The warning unit 52d activates an alert by a warning display on the display unit 54 or a warning sound by the speaker 56 when an event that should alert the user occurs.

[0043] FIG. 5 is a diagram schematically showing the transition of the operation modes of the defibrillation control device 14. As described above, the defibrillation control device 14 includes, as operation modes, an electrocardiogram measurement mode 70 and a defibrillation mode 72. The electrocardiogram measurement mode 70 has a normal mode 70a and an abnormality detection mode 70b. The defibrillation mode 72 has a measurement mode 72a, a charging mode 72b, and a discharging mode 72c.

[0044] When the mode switching button 50a is pressed in the normal mode 70a, the mode control unit 52a switches to the defibrillation mode 72 and shifts to the measurement mode 72a. In the measurement mode 72a, the impedance between the first electrode group 31G and the second electrode group 32G is measured by the measurement circuit 48a. When shifting to the measurement mode 72a, the mode control unit 52a switches the contact of the contact switching unit 42 and connects the common contact 42c to the second contact 42b. When the impedance measurement by the measurement circuit 48a is completed, the mode control unit 52a switches the contact of the contact switching unit 42 and returns the common contact 42c to the first contact 42a. When the measured impedance value is within a predetermined range (for example, 21 Ω or more and 99 Ω or less), the mode control unit 52a shifts to the charging mode 72b. When the measured impedance value is outside the predetermined range, the mode control unit 52a shifts to the normal mode 70a. When the impedance value is outside the predetermined range, for example, the position of the electrode catheter 12 in the heart cavity is adjusted by the user so that the first electrode group 31G and the second electrode group 32G appropriately contact the tissue in the heart cavity.

[0045] In the charging mode 72b, the charging circuit 48b charges the capacitor 48d. When the charging button 50b is pressed in the charging mode 72b, the mode control unit 52a causes the charging circuit 48b to start charging the capacitor 48d. When the charging button 50b is not pressed in the charging mode 72b, the mode control unit 52a does not cause the charging circuit 48b to start charging the capacitor 48d. The mode control unit 52a does not switch the contacts of the contact switching unit 42 in the charging mode 72b, and the common contact 42c remains connected to the first contact 42a. When the charging of the capacitor 48d is completed, the mode control unit 52a shifts to the discharging mode 72c.

[0046] In the discharging mode 72c, the discharging circuit 48c discharges the capacitor 48d to the electrode catheter 12. When the discharging button 50c is pressed in the discharging mode 72c, the mode control unit 52a enters a state of waiting for the trigger point to be detected by the trigger detection unit 52b. After the trigger point is detected by the trigger detection unit 52b, the mode control unit 52a switches the contacts of the contact switching unit 42 to connect the common contact 42c to the second contact 42b, and then operates the discharging circuit 48c to supply electrical energy to the electrode catheter 12. After the discharging by the discharging circuit 48c is completed, the mode control unit 52a switches the contacts of the contact switching unit 42 to return the common contact 42c to the first contact 42a and shifts to the abnormal detection mode 70b.

[0047] In the abnormal detection mode 70b, the presence or absence of waveform abnormality is detected based on the electrocardiogram waveform measured by the electrode catheter 12. The abnormal detection unit 52c detects the presence or absence of the earliest abnormal waveform and cardiac arrest in the abnormal detection mode 70b. When the earliest abnormal waveform or cardiac arrest is detected, the warning unit 52d alerts the user. When a predetermined button operation is performed by the user to stop the alert, the mode control unit 52a shifts to the normal mode 70a. When the earliest abnormal waveform or cardiac arrest is not detected, the mode control unit 52a shifts to the normal mode 70a.

[0048] The trigger detection unit 52b detects a trigger point based on the electrocardiogram waveform input to the waveform input unit 46. For example, the trigger detection unit 52b detects the position of the peak of the R wave in the electrocardiogram waveform as the trigger point. For example, the trigger detection unit 52b measures the peak height of the R wave in the electrocardiogram waveform, and when the potential reaches 80% of the measured peak height, it detects the peak position of the next R wave. The trigger detection unit 52b may generate a filtered waveform by extracting the high-frequency component of the electrocardiogram waveform using a band-pass filter, and detect the trigger point based on the peak position of the filtered waveform. The trigger detection unit 52b may exclude the peak positions considered to be caused by arrhythmia from the trigger points based on the intervals between the peak positions of the R waves.

[0049] FIG. 6 is a diagram showing an example of the display screen of the defibrillation control device 14, which is an example of the screen displayed on the display unit 54. In the example shown in FIG. 6, the display unit 54 displays the input electrocardiogram waveform 74, the filtered waveform 76, the heartbeat 78a, the impedance b, the joule 78c, the input type 80a, and the mode 80b. The display unit 54 is constituted by a liquid crystal display, an organic display, or the like.

[0050] The input electrocardiogram waveform 74 is the electrocardiogram waveform input to the waveform input unit 46. The filtered waveform 76 is the waveform of the high-frequency component of the input electrocardiogram waveform 74 and is displayed below the input electrocardiogram waveform 74. Trigger markers 74a, 74b, 74c, 74d, 74e indicating the positions of the trigger points detected by the trigger detection unit 52b are superimposed on the input electrocardiogram waveform 74. The positions of the trigger markers 74a to 74e correspond to the peak positions of the R waves of the input electrocardiogram waveform 74. In the example of FIG. 6, a skip marker 74s indicating the peak position of the R wave that was not detected as a trigger point is displayed. In the example of FIG. 6, since the time interval from the position of the previous trigger marker 74b to the skip marker 74s is shorter than the heartbeat, the peak waveform corresponding to the skip marker 74s is excluded from the trigger points.

[0051] Heartbeat 78a indicates the heart rate calculated from the input electrocardiogram waveform 74. Impedance 78b indicates the impedance value measured by the measurement circuit 48a. Joule 78c indicates the value of the electrical energy charged in the capacitor 48d. Input type 80a indicates the type of the input electrocardiogram waveform 74. In the example shown in FIG. 6, it is displayed as "PAD", indicating that it is an electrocardiogram waveform from the electrode pad 18. Mode 80b indicates the current operation mode of the defibrillation control device 14. In the example shown in FIG. 6, it is displayed as "ECG", indicating that it is an electrocardiogram measurement mode. Note that when it is in the defibrillation mode, it is displayed as "DC".

[0052] The abnormality detection unit 52c detects the earliest abnormal waveform in the abnormality detection mode 70b. The abnormality detection unit 52c detects the earliest waveform using a plurality of electrocardiogram waveforms measured by a plurality of electrodes of the electrode catheter 12. More specifically, the abnormality detection unit 52c detects the earliest waveform among the first electrocardiogram waveform, the second electrocardiogram waveform, and the third electrocardiogram waveform measured by the first electrode group 31G, the second electrode group 32G, and the third electrode group 33G, respectively, at the timing when a significant waveform occurs earliest. The abnormality detection unit 52c detects the earliest abnormal waveform based on the detected earliest waveform.

[0053] FIG. 7 is a diagram schematically showing an example of a plurality of electrocardiogram waveforms in a normal state. In the example of FIG. 7, the electrocardiogram waveforms (PAD1, PAD2) measured by the electrode pad 18, two third electrocardiogram waveforms (SVC1, SVC2) measured by the third electrode group 33G, four second electrocardiogram waveforms (RA1 to RA4) measured by the second electrode group 32G, and four first electrocardiogram waveforms (CS1 to CS4) measured by the first electrode group 31G are shown. At the left end of FIG. 7, there is a defibrillation waveform 82 with a large amplitude corresponding to the applied voltage of defibrillation. After the defibrillation waveform 82, the earliest waveform 84 occurs at RA1, and then the waveforms occur in the order of RA2, RA3, RA4, SVC1, SVC2, CS4, CS3, CS2, CS1. This corresponds to the order of the normal electrical signal transmission path in the heart cavity.

[0054] FIG. 8 is a diagram schematically showing an example of a plurality of electrocardiogram waveforms at the earliest stage of an abnormality. In the example of FIG. 8, after the defibrillation waveform 82, the earliest waveform 86 occurs at CS4, and then waveforms occur in the order of CS3, CS2, CS1, RA1, RA2, RA3, RA4, SVC1, and SVC2. Therefore, in the example of FIG. 8, waveforms occur in an order different from that in the normal state shown in FIG. 7. This is considered to be because abnormal excitation occurs near the first electrode 31 corresponding to CS4, and the electrical signal generated at the abnormal excitation site is transmitted to the surroundings. Further, the earliest waveform 86 shown in FIG. 8 has a different shape from the earliest waveform 84 shown in FIG. 7 due to the abnormal excitation. The earliest waveform 84 in FIG. 7 can be referred to as the earliest normal waveform, and the earliest waveform 86 in FIG. 8 can be referred to as the earliest abnormal waveform.

[0055] The abnormality detection unit 52c detects the earliest waveform 84 or 86 that occurs after the defibrillation waveform 82. The abnormality detection unit 52c detects, as the earliest waveform, the waveform with the earliest start timing at which the amplitude becomes equal to or greater than a first threshold value (for example, 0.5 mV) after the supply of electrical energy among the plurality of electrocardiogram waveforms. When the detected earliest waveform is not measured by a predetermined electrode (for example, the second electrode 32 corresponding to RA1) or a predetermined electrode group (for example, the second electrode group 32G), the abnormality detection unit 52c detects the earliest abnormal waveform.

[0056] The abnormality detection unit 52c may detect the start timing at which the amplitude becomes equal to or greater than the first threshold value (for example, 0.5 mV) after the supply of electrical energy for two or more of the plurality of electrocardiogram waveforms, and detect the earliest abnormality using the detection order of the start timing. When the detection order of the start timing does not match the order of a predetermined electrode (for example, RA1, RA2, RA3, RA4, SVC1, SVC2, CS4, CS3, CS2, CS1) for two or more of the plurality of electrocardiogram waveforms, the abnormality detection unit 52c may detect the earliest abnormal waveform. When the detection order of the start timing does not match the order of a predetermined electrode group (for example, the second electrode group 32G, the third electrode group 33G, the first electrode group 31G) for two or more of the plurality of electrocardiogram waveforms, the abnormality detection unit 52c may detect the earliest abnormal waveform.

[0057] When the shape of the detected earliest waveform matches a predetermined abnormal shape, the abnormality detection unit 52c detects the earliest abnormal waveform. FIGS. 9 to 11 are diagrams schematically showing an example of the earliest abnormal waveforms 88, 90, and 92. FIG. 9 shows the earliest abnormal waveform 88 that matches the first abnormal shape. The first abnormal shape is such that, from the start timing of the earliest waveform until the first reference time Ta (for example, 150 ms) has elapsed, the number of detected waveform portions 88a, 88b where the amplitude of the waveform is equal to or greater than the first threshold value V1 (for example, 0.5 mV) is equal to or greater than a predetermined first number (for example, 8). The starting point of the first reference time Ta is the timing when the amplitude of the earliest waveform first becomes the first threshold value V1. The starting point of the first reference time Ta may be the timing when the amplitude of the waveform is upward and becomes the first threshold value V1, or the timing when the amplitude of the waveform is downward and becomes the first threshold value V1. The number of detected waveform portions equal to or greater than the first threshold value V1 is the sum of the number of upward waveform portions 88a equal to or greater than the first threshold value V1 and the number of downward waveform portions 88b equal to or greater than the first threshold value V1. In the example shown in FIG. 9, there are 5 upward waveform portions 88a and 4 downward waveform portions 88b, and the total number of detections is 9, which is equal to or greater than the predetermined number (for example, 8), so it matches the first abnormal shape.

[0058] FIG. 10 shows the earliest abnormal waveform 90 that matches the second abnormal shape. The second abnormal shape is such that, from the start timing of the earliest waveform until the first reference time Ta (for example, 150 ms) has elapsed, the number of detected downward waveform portions 90b where the amplitude of the waveform is equal to or greater than the first threshold value V1 (for example, 0.5 mV) is equal to or greater than a predetermined second number (for example, 5). Here, the second number (for example, 5) related to the second abnormal shape is less than the first number (for example, 8) related to the first abnormal shape. The starting point of the first reference time Ta is the same as that of the first abnormal shape in FIG. 9, and may be the timing when the amplitude of the waveform is upward and becomes the first threshold value V1, or the timing when the amplitude of the waveform is downward and becomes the first threshold value V1. In the example shown in FIG. 10, there is 1 upward waveform portion 90a and 5 downward waveform portions 88b, and since the total number of detections is 6, which is less than the first number (for example, 8), it does not match the first abnormal shape. However, since the number of downward waveform portions 88b is equal to or greater than the predetermined number (for example, 5), it matches the second abnormal shape.

[0059] FIG. 11 shows the earliest abnormal waveform 92 that conforms to the third abnormal shape. The third abnormal shape is such that, until the second reference time Tb (e.g., 90 ms) has elapsed from the start timing of the earliest waveform, the continuous time Tc of the flat portion 92c where the amplitude of the waveform is equal to or less than the second threshold value V2 (e.g., 0.2 mV) that is smaller than the first threshold value V1 does not exceed a predetermined value (e.g., 20 ms). It can also be said that the third abnormal waveform is conditional on the time length of one waveform range that constitutes the earliest waveform being equal to or greater than the second reference time Tb (e.g., 90 ms). Here, one waveform range ends when the continuous time Tc of the flat portion 92c exceeds a predetermined value (e.g., 20 ms). In other words, if the continuous time Tc of the flat portion 92c is equal to or less than a predetermined value (e.g., 20 ms), the waveforms before and after it are regarded as one waveform range. In the example shown in FIG. 11, since the continuous time Tc of the flat portion 92c does not become equal to or greater than the predetermined value (e.g., 20 ms) until the second reference time Tb (e.g., 90 ms) has elapsed from the start timing of the earliest waveform, it conforms to the third abnormal shape. In the example shown in FIG. 11, since there are two upward waveform portions 92a and two downward waveform portions 92b, it does not conform to the first abnormal shape and also does not conform to the second abnormal shape.

[0060] The abnormality detection unit 52c may further detect cardiac arrest in the abnormality detection mode 70b. The abnormality detection unit 52c detects cardiac arrest if, after the discharge for defibrillation is completed and until the second time (e.g., 10 seconds) has elapsed after the first time (e.g., 5 seconds) has elapsed, the number of heartbeats with a waveform amplitude equal to or greater than the third threshold value V3 (e.g., 2.8 mV) is less than 5. The abnormality detection unit 52c ends the cardiac arrest detection process if, before the second time (e.g., 10 seconds) has elapsed after the first time (e.g., 5 seconds) has elapsed after the discharge for defibrillation is completed, the number of heartbeats with a waveform amplitude equal to or greater than the third threshold value V3 (e.g., 2.8 mV) is 5 or more.

[0061] When an abnormality is detected by the abnormality detection unit 52c, the warning unit 52d activates an alert. When the earliest abnormal waveform or cardiac arrest is detected by the abnormality detection unit 52c, the warning unit 52d causes the alert to be displayed on the display unit 54 and outputs a warning sound from the speaker 56. The warning unit 52d may cause the display unit 54 to display information indicating which of the electrocardiogram waveform, electrode group, or electrode in which the earliest abnormal waveform was detected. For example, in the example of FIG. 8, "CS4" indicating the electrocardiogram waveform in which the earliest abnormal waveform 86 was detected may be displayed, or "CS" indicating the electrode group may be displayed, or "7" and "8" indicating the electrode numbers may be displayed. When a predetermined button on the operation button 50 for stopping the alert is operated, the warning unit 52d stops the warning display and the warning sound.

[0062] Returning to FIG. 1, the monitoring device 16 will be described. The monitoring device 16 includes a waveform acquisition unit 60, a waveform providing unit 62, and a waveform selection unit 64.

[0063] The waveform acquisition unit 60 acquires the electrocardiogram waveform of the patient 20. The waveform acquisition unit 60 acquires the first electrocardiogram waveform, the second electrocardiogram waveform, and the third electrocardiogram waveform output from the waveform output unit 44 of the defibrillation control device 14. The waveform acquisition unit 60 acquires the body surface electrocardiogram waveform of the patient 20 measured using the electrode pad 18. When a different electrode catheter than the electrode catheter 12 is used for the patient 20, the waveform acquisition unit 60 acquires an electrocardiogram waveform (also referred to as a fourth electrocardiogram waveform) measured using the different electrode catheter.

[0064] The waveform providing unit 62 provides at least one of the electrocardiogram waveforms acquired by the waveform acquisition unit 60 to the waveform input unit 46 of the defibrillation control device 14. The waveform selection unit 64 selects the electrocardiogram waveform provided by the waveform providing unit 62 according to the user's operation. For example, when the waveform selection unit 64 selects the body surface electrocardiogram waveform from the electrode pad 18, the waveform providing unit 62 provides the selected body surface electrocardiogram waveform to the defibrillation control device 14.

[0065] FIG. 12 is a flowchart schematically showing a defibrillation method according to the first embodiment. First, in the electrocardiogram measurement mode, when the mode switch button 50a is pressed, the mode is switched to the defibrillation mode (step S10). Next, the impedance between the electrodes of the electrode catheter 12 is measured (step S12). If the impedance is within a predetermined range (Y in step S14), electrical energy is charged upon pressing the charge button 50b (step S16). After the charging of the electrical energy is completed, upon pressing the discharge button 50c, electrical energy is supplied to the electrode catheter 12 in synchronization with the trigger point (step S18). After the supply of the electrical energy is completed, the mode shifts to the abnormality detection mode (step S20).

[0066] In the abnormality detection mode, when the earliest abnormal waveform is detected (Y in step S22), an alert is activated (step S26). If the earliest abnormal waveform is not detected (N in step S22) and cardiac arrest is detected (Y in step S24), an alert is activated (step S26). The alert continues until a predetermined stop operation is performed by the user (N in step S28). When a predetermined stop operation is performed by the user (Y in step S28), the alert is stopped (step S30), and the mode shifts to the electrocardiogram measurement mode (step S32). In step S14, if the impedance is outside the predetermined range (N in step S14), the mode shifts to the electrocardiogram measurement mode (step S32). In step S24, if cardiac arrest is not detected (N in step S24), steps S26 to S30 are skipped, and the mode shifts to the electrocardiogram measurement mode (step S32).

[0067] According to this embodiment, by shifting to the abnormality detection mode after the completion of defibrillation, the earliest abnormal waveform can be detected using a plurality of electrocardiogram waveforms measured by the electrode catheter. By activating an alert triggered by the detection of the earliest abnormal waveform, useful information can be quickly notified to a user such as a doctor.

[0068] According to this embodiment, various types of earliest abnormal waveforms can be detected by analyzing the shape and electrode position of the detected earliest waveform. For example, by determining whether the shape of the detected earliest waveform matches any of the first abnormal shape, the second abnormal shape, or the third abnormal shape, earliest abnormal waveforms of various shapes can be detected.

[0069] According to this embodiment, by notifying information regarding the electrode position of the detected earliest abnormal waveform, information regarding the abnormal excitation site considered to be the cause of the earliest abnormal waveform can be notified. In ablation treatment, it is required to appropriately identify the abnormal excitation site, so information useful for users such as doctors can be provided.

[0070] (Second Embodiment) FIG. 13 is a diagram schematically showing the configuration of the defibrillation system 110 according to the second embodiment. In the second embodiment, the defibrillation control device 114 further includes a transmission unit 120, and the monitoring device 116 further includes a reception unit 124, a synchronization determination unit 128, and a warning unit 130. Hereinafter, the second embodiment will be described centering on the differences from the first embodiment, and the description of the common points will be omitted as appropriate.

[0071] The defibrillation system 110 includes an electrode catheter 12, a defibrillation control device 114, and a monitoring device 116. The electrode catheter 12 is configured in the same manner as in the first embodiment.

[0072] The defibrillation control device 114 includes a catheter connection unit 40, a contact switching unit 42, a waveform output unit 44, a waveform input unit 46, a power supply unit 48, an operation button 50, a control unit 52, a display unit 54, a speaker 56, and a transmission unit 120.

[0073] The transmitting unit 120 transmits a trigger signal indicating a trigger point detected by the trigger detection unit 52b to the monitoring device 116. When the trigger detection unit 52b cannot detect the trigger point, the transmitting unit 120 transmits a trigger abnormality signal to the monitoring device 116. As a cause for the failure to detect the trigger point, it is conceivable that no electrocardiogram waveform is input to the waveform input unit 46, or that there is an abnormality in the electrocardiogram waveform input to the waveform input unit 46 and the peak of the R wave cannot be detected.

[0074] The monitoring device 116 includes a waveform acquisition unit 60, a waveform providing unit 62, a waveform selection unit 64, a receiving unit 124, a synchronization determination unit 128, and a warning unit 130.

[0075] The receiving unit 124 receives the signal transmitted from the transmitting unit 120 of the defibrillation control device 114. The receiving unit 124 receives the trigger signal. The receiving unit 124 receives the trigger abnormality signal.

[0076] The synchronization determination unit 128 determines whether the trigger signal received by the receiving unit 124 is synchronized with the electrocardiogram waveform provided by the waveform providing unit 62. The trigger detection unit 52b of the defibrillation control device 114 detects the trigger point using the electrocardiogram waveform provided by the waveform providing unit 62. Therefore, by determining the synchronization between the trigger signal and the electrocardiogram waveform, it is possible to confirm whether the trigger detection unit 52b appropriately detects the trigger point.

[0077] The synchronization determination unit 128, for example, uses the same method as the trigger detection unit 52b to detect the peak position of the R wave of the electrocardiogram waveform and determines whether the detection timing is synchronized with the trigger signal. The synchronization determination unit 128 may determine the synchronization between the electrocardiogram waveform and the trigger signal using a method different from that of the trigger detection unit 52b.

[0078] When the receiving unit 124 receives a trigger anomaly signal, the warning unit 130 activates an alert. When the synchronization determination unit 128 determines that the trigger signals are not synchronized, the warning unit 130 activates an alert. The warning unit 130 activates an alert, for example, by a warning display on the display screen of the monitoring device 116 or a warning sound from the speaker of the monitoring device 116. When a predetermined operation for stopping the alert is performed, the warning unit 130 stops the alert by the warning display and the warning sound.

[0079] When an alert is activated by the warning unit 130, after stopping the alert, the user can perform an operation to switch the electrocardiogram waveform selected by the waveform selection unit 64 to another electrocardiogram waveform. The user can select any one of the plurality of electrocardiogram waveforms acquired by the waveform acquisition unit 60. For example, an operation can be performed to switch the electrocardiogram waveform selected by the waveform selection unit 64 from PAD1 to PAD2.

[0080] FIG. 14 is a flowchart schematically showing a trigger detection method according to the second embodiment. The monitoring device 116 acquires a plurality of electrocardiogram waveforms by the waveform acquisition unit 60 (step S40). If there is a waveform selection operation by the user (Y in step S42), in response to the selection operation, any one of the plurality of electrocardiogram waveforms is selected by the waveform selection unit 64 (step S44). If there is no waveform selection operation (N in step S42), the process of step S44 is skipped. The monitoring device 116 provides the electrocardiogram waveform being selected from the waveform providing unit 62 to the defibrillation control device 114 (step S46).

[0081] If an electrocardiogram waveform is input to the defibrillation control device 114 (Y in step S48), and if a trigger point can be detected by the trigger detection unit 52b (Y in step S50), the defibrillation control device 114 transmits a trigger signal from the transmission unit 120 to the monitoring device 116 (step S52). If no electrocardiogram waveform is input to the defibrillation control device 114 (N in step S48), or if a trigger point cannot be detected by the trigger detection unit 52b (N in step S50), the defibrillation control device 114 transmits a trigger abnormality signal from the transmission unit 120 to the monitoring device 116 (step S54).

[0082] When the monitoring device 116 receives a trigger abnormality signal at the receiving unit 124 (Y in step S56), the warning unit 130 activates an alert (step S60). When the monitoring device 116 does not receive a trigger abnormality signal (N in step S56), and when it is determined by the synchronization determination unit 128 that the trigger signal is not synchronized (N in step S58), the warning unit 130 activates an alert (step S60). The monitoring device 116 continues the alert by the warning unit 130 until a predetermined stop operation is performed by the user (N in step S62), and when a predetermined stop operation is performed by the user (Y in step S62), the monitoring device 116 stops the alert by the warning unit 130 (step S64). In step S58, when it is determined by the synchronization determination unit 128 that the trigger signal is synchronized (Y in step S58), the processes in steps S60 to S64 are skipped.

[0083] The flow in FIG. 14 is repeatedly executed. After the alert is stopped in step S64, the user performs a waveform selection operation to select an electrocardiogram waveform different from the currently selected electrocardiogram waveform. In this case, the process in step S42 becomes Y, the currently selected electrocardiogram waveform is switched to another electrocardiogram waveform (step S44), and the switched electrocardiogram waveform is provided to the defibrillation control device 114 (step S46).

[0084] According to this embodiment, when the defibrillation control device 114 cannot detect the trigger point, instead of activating an alert at the defibrillation control device 114, an alert can be activated at the monitoring device 116. If an alert is activated at the defibrillation control device 114, after the user stops the alert at the defibrillation control device 114, the user must switch the electrocardiogram waveform at the monitoring device 116, which involves the trouble of operating each of the two devices. On the other hand, if an alert is activated at the monitoring device 116, after the user stops the alert of the monitoring device 116, the user can execute the electrocardiogram waveform switching operation at the monitoring device 116 and only needs to operate one device. According to this embodiment, the convenience of the user using the defibrillation system 110 can be improved. In particular, in a critical situation where defibrillation treatment is required, reducing the user's burden even a little is very beneficial.

[0085] As a modification of the second embodiment, instead of activating an alert at the monitoring device 116, the electrocardiogram waveform being selected by the waveform selection unit 64 may be automatically switched to another electrocardiogram waveform. The waveform selection unit 64 may record the status of "unselected" or "selected" for each of the plurality of electrocardiogram waveforms acquired by the waveform acquisition unit 60. When the waveform selection unit 64 selects an electrocardiogram waveform, it updates the status of the selected electrocardiogram waveform from "unselected" to "selected". When the waveform selection unit 64 automatically selects an electrocardiogram waveform, it selects any of the unselected electrocardiogram waveforms. The warning unit 130 activates an alert when there is no unselected electrocardiogram waveform and the waveform selection unit 64 cannot automatically select an unselected electrocardiogram waveform.

[0086] FIG. 15 is a flowchart schematically showing the waveform selection method according to the second embodiment. The flow in FIG. 15 shows only the operation of the monitoring device 116. In the flow of FIG. 15, the operation of the defibrillation control device 114 is the same as the flow in FIG. 14. In the flow of FIG. 15, the same processes as those in the flow of FIG. 14 are given the same reference numerals.

[0087] The monitoring device 116 executes the same processing as steps S40 to S46 in FIG. 14, but after executing step S44, updates the status of the selected electrocardiogram waveform to "selected" (step S45). When the monitoring device 116 receives a trigger anomaly signal at the receiving unit 124 (Y in step S56), if there is an electrocardiogram waveform whose status is "unselected" (Y in step S68), the waveform selection unit 64 automatically selects any one of the "unselected" electrocardiogram waveforms (step S70). When the monitoring device 116 does not receive a trigger anomaly signal (N in step S56) and the synchronization determination unit 128 determines that the trigger signal is not synchronized (N in step S58), if there is an electrocardiogram waveform whose status is "unselected" (Y in step S58), the processing of step S70 is executed. The status of the electrocardiogram waveform automatically selected by the waveform selection unit 64 is updated to "selected" by the waveform selection unit 64 (step S72). When in step S68, if there is no electrocardiogram waveform whose status is "unselected" (N in step S68), after executing the processing of steps S60 to S64 in FIG. 14, the monitoring device 116 executes an initialization to set the status of all the multiple electrocardiogram waveforms to "unselected" (step S74).

[0088] According to the processing flow of FIG. 15, when the defibrillation control device 114 cannot detect a trigger point, the electrocardiogram waveform being selected by the monitoring device 116 is automatically switched, so that the labor of the selection operation for switching the electrocardiogram waveform can be saved. Thereby, the convenience of the user using the defibrillation system 110 can be improved.

[0089] (Third Embodiment) FIG. 16 is a diagram schematically showing the configuration of a defibrillation system 210 according to the third embodiment. In the third embodiment, an anomaly detection unit 232 for detecting the earliest anomaly waveform or cardiac arrest is provided in the monitoring device 216. Hereinafter, the third embodiment will be described centering on the differences from the above-described embodiments, and the description of the common points will be omitted as appropriate.

[0090] The defibrillation system 210 includes an electrode catheter 12, a defibrillation control device 214, and a monitoring device 216. The electrode catheter 12 is configured in the same manner as in the first embodiment.

[0091] The defibrillation control device 214 includes a catheter connection portion 40, a contact switching portion 42, a waveform output portion 44, a waveform input portion 46, a power supply portion 48, an operation button 50, a control portion 252, a display portion 54, a speaker 56, a first transmission portion 220, and a first reception portion 222.

[0092] The control portion 252 includes a mode control portion 252a, a trigger detection portion 52b, and a warning portion 252d. The control portion 252 is different from the first embodiment in that it does not include an abnormality detection portion 52c.

[0093] The mode control portion 252a is different from the first embodiment in that it does not have the abnormality detection mode 70b of FIG. 5. When the supply of electrical energy is completed in the discharge mode 72c, the mode control portion 252a shifts to the normal mode 70a.

[0094] When the first reception portion 222 receives an abnormality signal from the monitoring device 216, the warning portion 252d activates an alert. When a predetermined button operation for stopping the alert is performed, the warning portion 252d stops the warning display and the warning sound.

[0095] When the supply of electrical energy is completed in the discharge mode 72c, the first transmission portion 220 transmits a supply completion signal (or a defibrillation completion signal) to the monitoring device 216. The supply completion signal is transmitted, for example, when the supply of electrical energy is completed in the discharge mode 72c and upon completion of the recording of the voltage waveform during the discharge period T shown in FIG. 4.

[0096] Similar to the transmitter 120 according to the second embodiment, the first transmitter 220 transmits a trigger signal indicating a trigger point detected by the trigger detection unit 52b to the monitoring device 216. Similar to the transmitter 120 according to the second embodiment, when the trigger detection unit 52b cannot detect a trigger point, the first transmitter 220 transmits a trigger anomaly signal to the monitoring device 216. The first receiver 222 receives an anomaly signal from the monitoring device 216. When the first receiver 222 receives an anomaly signal, an alert by the warning unit 252d is activated.

[0097] The monitoring device 216 includes a waveform acquisition unit 60, a waveform providing unit 62, a waveform selection unit 64, a second receiver 224, a second transmitter 226, an anomaly detection unit 232, a synchronization determination unit 128, and a warning unit 130.

[0098] The second receiver 224 receives a supply completion signal transmitted from the defibrillation control device 214. The second receiver 224 receives a trigger signal and a trigger anomaly signal transmitted from the defibrillation control device 214. When the anomaly detection unit 232 detects an earliest anomaly waveform or cardiac arrest, the second transmitter 226 transmits an anomaly signal to the defibrillation control device 214.

[0099] When the second receiver 224 receives a supply completion signal, the anomaly detection unit 232 uses a plurality of electrocardiogram waveforms acquired by the waveform acquisition unit 60 after receiving the supply completion signal to detect an earliest anomaly waveform or cardiac arrest. The method for detecting an earliest anomaly waveform or cardiac arrest by the anomaly detection unit 232 is the same as the method for detecting an earliest anomaly waveform or cardiac arrest by the anomaly detection unit 52c according to the first embodiment described above. Therefore, the anomaly detection unit 232 uses a plurality of electrocardiogram waveforms (for example, a first electrocardiogram waveform, a second electrocardiogram waveform, and a third electrocardiogram waveform) measured by a plurality of electrodes of the electrode catheter 12 to detect an earliest anomaly waveform or cardiac arrest.

[0100] When the earliest abnormal waveform is detected by the abnormality detection unit 232, the second transmission unit 226 may transmit information indicating whether the electrocardiogram waveform, the electrode group, or the electrode in which the earliest abnormal waveform is detected to the defibrillation control device 214. In this case, the warning unit 252d may cause the display unit 54 to display information indicating whether the electrocardiogram waveform, the electrode group, or the electrode in which the earliest abnormal waveform is detected, using the information received by the first reception unit 222.

[0101] FIG. 17 is a flowchart schematically showing a defibrillation method according to the third embodiment. In the flowchart of FIG. 17, the same reference numerals are given to the processes similar to those in the flowchart of FIG. 12.

[0102] First, processes similar to steps S10 to S18 in FIG. 12 are executed. After the supply of electrical energy in step S18 is completed, a supply completion signal is transmitted from the first transmission unit 220 to the monitoring device 216 (step S80), and the mode control unit 252a shifts to the electrocardiogram measurement mode (S82). In step S14, if the impedance is outside the predetermined range (N in step S14), the processes of steps S16 to S80 are skipped, and the mode shifts to the electrocardiogram measurement mode (step S82).

[0103] When the monitoring device 216 receives the supply completion signal at the second receiving unit 224 (Y in step S84), it starts the abnormality detection process by the abnormality detection unit 232 (step S86). When the monitoring device 216 detects the earliest abnormal waveform at the abnormality detection unit 232 (Y in step S88), it transmits an abnormal signal from the second transmitting unit 226 to the defibrillation control device 214 (step S92). When the monitoring device 216 does not detect the earliest abnormal waveform at the abnormality detection unit 232 (N in step S88) and detects cardiac arrest (Y in step S90), it transmits an abnormal signal from the second transmitting unit 226 to the defibrillation control device 214 (step S92). After the process of step S92, the monitoring device 216 ends the abnormality detection process (step S94). When the monitoring device 216 does not detect cardiac arrest in step S90 (N in step S90), it ends the abnormality detection process (step S94). When the monitoring device 216 does not receive the supply completion signal in step S84 (N in step S84), it skips the processes of steps S86 to S94.

[0104] When the defibrillation control device 214 receives the abnormal signal at the first receiving unit 222 (Y in step S96), it activates an alert by the warning unit 252d (step S98). The defibrillation control device 214 continues the alert by the warning unit 252d until a predetermined stop operation is performed by the user (N in step S100), and when a predetermined stop operation is performed by the user (Y in step S100), it stops the alert by the warning unit 252d (step S102). When the defibrillation control device 214 does not receive the abnormal signal in step S96 (N in step S96), it skips the processes of steps S98 to S102.

[0105] According to this embodiment, even when using the defibrillation control device 214 without the abnormality detection unit 52c, the monitoring device 216 can detect abnormalities such as the earliest abnormal waveform and cardiac arrest. According to this embodiment, when the monitoring device 216 detects the earliest abnormal waveform or cardiac arrest, an abnormal signal is transmitted from the monitoring device 216 to the defibrillation control device 214, so that an alert can be activated by the defibrillation control device 214. If an alert is activated by the defibrillation control device 214, the user can perform an operation for defibrillation again by the defibrillation control device 214 after the stop operation of the alert of the defibrillation control device 214, so that only one device needs to be operated. Therefore, according to this embodiment, the convenience of the user using the defibrillation system 210 can be improved. In particular, reducing the burden on the user as much as possible in a critical situation where defibrillation treatment is required is very beneficial.

[0106] In the third embodiment, the monitoring device 216 may not include the synchronization determination unit 128 and the warning unit 130. In this case, the first transmission unit 220 of the defibrillation control device 214 may not transmit the trigger signal and the trigger point signal to the monitoring device 216.

[0107] (Fourth Embodiment) FIG. 18 is a diagram schematically showing the configuration of the defibrillation system 310 according to the fourth embodiment. In the fourth embodiment, a synchronization determination unit 352e is provided in the defibrillation control device 314, and a trigger detection unit 334 is provided in the monitoring device 316. Hereinafter, the fourth embodiment will be described mainly focusing on the differences from the above-described embodiments, and the common points will be omitted as appropriate.

[0108] The defibrillation system 310 includes an electrode catheter 12, a defibrillation control device 314, and a monitoring device 316. The electrode catheter 12 is configured in the same manner as in the first embodiment.

[0109] The defibrillation control device 314 includes a catheter connection part 40, a contact switching part 42, a waveform output part 44, a waveform input part 46, a power supply part 48, an operation button 50, a control part 352, a display part 54, a speaker 56, a first transmission part 320, and a first reception part 322.

[0110] The control part 352 includes a mode control part 352a, a synchronization determination part 352e, and a warning part 252d. The control part 352 is different from the third embodiment in that it includes the synchronization determination part 352e instead of the trigger detection part 52b.

[0111] The synchronization determination part 352e determines whether the trigger signal received by the first reception part 322 is synchronized with the electrocardiogram waveform input to the waveform input part 46. For example, the synchronization determination part 352e uses a method similar to that of the trigger detection part 52b to detect the peak position of the R wave of the electrocardiogram waveform and determines whether the detection timing is synchronized with the trigger signal. When it is determined that the trigger signal is synchronized, the trigger points (for example, the trigger markers 74a to 74e in FIG. 6) based on the trigger signal are displayed on the display part 54.

[0112] In the discharge mode 72c, the mode control part 352a supplies electrical energy to the electrode catheter 12 in synchronization with the trigger point based on the trigger signal received by the first reception part 322.

[0113] When no trigger signal is being transmitted to the first reception part 322, the first transmission part 320 transmits a trigger abnormal signal to the monitoring device 316. When it is determined by the synchronization determination part 352e that the trigger signal is not synchronized, the first transmission part 320 transmits a trigger abnormal signal to the monitoring device 316. Similar to the first transmission part 220 according to the third embodiment, when the supply of electrical energy is completed in the discharge mode 72c, the first transmission part 320 transmits a supply completion signal to the monitoring device 316.

[0114] The first receiving unit 322 receives a trigger signal indicating a trigger point from the monitoring device 316. The first receiving unit 322 receives an abnormal signal indicating the detection of the earliest abnormal waveform or cardiac arrest from the monitoring device 316, similar to the first receiving unit 222 according to the third embodiment.

[0115] The monitoring device 216 includes a waveform acquisition unit 60, a waveform providing unit 62, a waveform selection unit 64, a second receiving unit 324, a second transmitting unit 326, an abnormality detection unit 232, a trigger detection unit 334, and a warning unit 330.

[0116] The second receiving unit 324 receives a trigger abnormal signal from the defibrillation control device 314. The second receiving unit 324 receives a supply completion signal from the defibrillation control device 314, similar to the second receiving unit 224 according to the third embodiment.

[0117] The second transmitting unit 326 transmits a trigger signal indicating the trigger point detected by the trigger detection unit 334 to the defibrillation control device 314. The second transmitting unit 326 transmits an abnormal signal indicating that the earliest abnormal waveform or cardiac arrest has been detected by the abnormality detection unit 232 to the defibrillation control device 314, similar to the second transmitting unit 226 according to the third embodiment.

[0118] The trigger detection unit 334 detects a trigger point based on the electrocardiogram waveform being selected by the waveform selection unit 64, that is, the electrocardiogram waveform provided to the defibrillation control device 314 by the waveform providing unit 62. The method for detecting the trigger point by the trigger detection unit 334 may be the same as the method of the trigger detection unit 52b according to the first embodiment, or may be a method different from the trigger detection unit 52b.

[0119] When the trigger detection unit 334 cannot detect a trigger point, the warning unit 330 activates an alert. When the second receiving unit 324 receives a trigger abnormal signal, the warning unit 330 activates an alert. When a predetermined operation for stopping the alert is performed, the warning unit 330 stops the alert by warning display and warning sound.

[0120] FIG. 19 is a flowchart schematically showing a trigger detection method according to the fourth embodiment. In the flowchart of FIG. 19, the same reference numerals are given to the processes similar to those in the flowchart of FIG. 14.

[0121] The monitoring device 316 executes the same processes as steps S40 to S46 in FIG. 14. The trigger detection unit 334 detects a trigger point using the currently selected electrocardiogram waveform, and if the trigger point can be detected (Y in step S110), it transmits a trigger signal from the second transmission unit 326 to the defibrillation control device 314 (step S112).

[0122] The defibrillation control device 314 has received a trigger signal at the first reception unit 322 (Y in step S114), and when it is determined at the synchronization determination unit 352e that the trigger signal is synchronized (Y in step S116), it causes the display unit 54 to display the trigger point (for example, the trigger markers 74a to 74e in FIG. 6) (step S118). When the defibrillation control device 314 has not received a trigger signal at the first reception unit 322 (N in step S114), or when it is determined at the synchronization determination unit 352e that the trigger signal is not synchronized (N in step S116), it transmits a trigger abnormality signal from the second reception unit 324 to the monitoring device 316 (step S120).

[0123] When the monitoring device 316 has received a trigger abnormality signal at the second reception unit 324 (Y in step S122), it executes the same processes as steps S60 to S64 in FIG. 14. When the monitoring device 316 cannot detect a trigger point in step S110 (N in step S110), it executes the processes of steps S60 to S64. In step S122, when it has not received a trigger abnormality signal (N in step S122), it skips the processes of steps S60 to S64.

[0124] According to this embodiment, the monitoring device 316 can detect a trigger point and the defibrillation control device 314 can determine whether the trigger signals are synchronized. When the monitoring device 316 cannot detect the trigger point, the monitoring device 316 can activate an alert. Also, even when the defibrillation control device 314 cannot receive the trigger signal or it is determined that the trigger is not synchronized, the monitoring device 316 can activate an alert. Since the user can execute the operation of switching the electrocardiogram waveform on the monitoring device 316 after the stop operation of the alert of the monitoring device 316, only one device needs to be operated. Also in this embodiment, the convenience of the user using the defibrillation system 310 can be improved.

[0125] As a modification of the fourth embodiment, similar to the modification of the second embodiment, instead of activating an alert by the monitoring device 316, the electrocardiogram waveform being selected by the waveform selection unit 64 may be automatically switched to another electrocardiogram waveform. Instead of the processes of S60 to S64 in FIG. 19, the monitoring device 316 may execute the processes of S68 to S74 in FIG. 15. In this case, instead of the processes of S40 to S46 in FIG. 19, the monitoring device 316 may execute the processes of S40 to S46 in FIG. 15.

[0126] As a modification of the fourth embodiment, instead of providing the abnormality detection unit 232 in the monitoring device 316, an abnormality detection unit 52c may be provided in the control unit 352 of the defibrillation control device 314. Similar to the defibrillation control device 14 according to the first embodiment, the defibrillation control device 314 may detect the earliest abnormal waveform or cardiac arrest after defibrillation and activate an alert.

[0127] The present disclosure has been described based on the embodiments. It is obvious to those skilled in the art that various modifications are possible for the combinations of each component and each process in the embodiments as examples, and such modifications are included in the scope of the present disclosure.

[0128] One aspect of the present disclosure is as follows.

[0129] The first aspect is a defibrillation control device including a power supply unit that supplies electrical energy to an electrode catheter, an abnormality detection unit that detects an earliest abnormal waveform using a plurality of electrocardiogram waveforms measured by a plurality of electrodes of the electrode catheter after the supply of the electrical energy, and a warning unit that activates an alert upon detection of the earliest abnormal waveform. According to this aspect, by detecting the earliest abnormal waveform and activating an alert, information useful for a user such as a doctor performing catheter treatment can be provided quickly.

[0130] The second aspect is the defibrillation control device according to the first aspect, wherein the abnormality detection unit detects an earliest waveform having the earliest start timing at which the amplitude becomes equal to or greater than a first threshold value among the plurality of electrocardiogram waveforms, and detects the earliest abnormal waveform using the earliest waveform. According to this aspect, by detecting the earliest waveform from among the plurality of electrocardiogram waveforms, the earliest abnormal waveform can be appropriately detected.

[0131] The third aspect is the defibrillation control device according to the second aspect, wherein the abnormality detection unit detects a waveform portion where the amplitude of the earliest waveform becomes equal to or greater than the first threshold value, and when the number of detections of the waveform portion from the start timing to after a reference time has elapsed is equal to or greater than a predetermined number, detects the earliest abnormal waveform. According to this aspect, an abnormal waveform having a larger number of significant peak waveform portions compared to a normal waveform can be appropriately detected.

[0132] The fourth aspect is the defibrillation control device according to the second or third aspect, wherein the abnormality detection unit detects a waveform portion where the amplitude of the earliest waveform becomes equal to or greater than the first threshold value and is downward, and when the number of detections of the waveform portion from the start timing to after a reference time has elapsed is equal to or greater than a predetermined number, detects the earliest abnormal waveform. According to this aspect, an abnormal waveform having a larger number of downward waveform portions compared to a normal waveform can be appropriately detected.

[0133] The fifth aspect is that the abnormality detection unit measures the continuous time of a flat portion where the amplitude of the earliest waveform is equal to or less than a second threshold value that is smaller than the first threshold value, and when the continuous time of the flat portion measured from the start timing until the reference time has elapsed does not exceed a predetermined value, the earliest abnormal waveform is detected. This is the defibrillation control device according to any one of the second to fourth aspects. According to this aspect, an abnormal waveform with a longer time length in one waveform range compared to a normal waveform can be appropriately detected. In particular, even when a flat portion is included between adjacent waveform portions, if the flat portion is equal to or less than a predetermined value, it can be regarded as being included in one waveform range, and an abnormal waveform can be appropriately detected.

[0134] The sixth aspect is that the abnormality detection unit is the defibrillation control device according to any one of the second to fifth aspects, where when the electrode for acquiring the earliest waveform is not a predetermined electrode, the earliest abnormal waveform is detected. According to this aspect, an abnormal waveform caused by abnormal excitation different from the normal electrical signal transmission in the heart cavity can be appropriately detected.

[0135] The seventh aspect is that the abnormality detection unit is the defibrillation control device according to any one of the first to sixth aspects, where the start timing when the amplitude becomes equal to or greater than the first threshold value after the supply of the electrical energy is detected for the plurality of electrocardiogram waveforms, and the earliest abnormal waveform is detected using the detection order of the start timing of the plurality of electrocardiogram waveforms. According to this aspect, an abnormal waveform caused by abnormal excitation different from the normal electrical signal transmission in the heart cavity can be appropriately detected.

[0136] The eighth aspect is that the defibrillation control device according to any one of the first to seventh aspects further includes a display unit that displays information indicating which of the plurality of electrodes is the electrode for acquiring the earliest abnormal waveform. According to this aspect, information related to the position of the abnormal excitation site can be notified, and the convenience of the user can be improved.

[0137] Aspect 9 is a monitoring device comprising a waveform acquisition unit that acquires an electrocardiogram waveform, a waveform providing unit that provides the electrocardiogram waveform to a defibrillation control device that supplies electrical energy to an electrode catheter, a receiving unit that receives a trigger signal indicating the timing at which the defibrillation control device can start supplying the electrical energy, and a synchronization determination unit that determines whether or not the trigger signal is synchronized with the electrocardiogram waveform. According to this aspect, in a monitoring device that provides an electrocardiogram waveform to a defibrillation control device, it is possible to determine whether or not a trigger point is appropriately detected by the defibrillation control device. As a result, the monitoring device can comprehensively grasp whether or not an appropriate electrocardiogram waveform is being provided to the defibrillation control device, improving user convenience.

[0138] Aspect 10 is the monitoring device according to Aspect 9, further comprising a warning unit that activates an alert when it is determined that the trigger signal is not synchronized. According to this aspect, when the defibrillation control device fails to appropriately detect a trigger point, an alert is activated by the monitoring device. Therefore, after the monitoring device performs a stop operation for the alert, the monitoring device can directly execute an operation to switch the electrocardiogram waveform provided to the defibrillation control device. As a result, since the stop operation for the alert and the operation to switch the electrocardiogram waveform can be completed only by the monitoring device, user convenience can be improved.

[0139] Aspect 11 is the monitoring device according to Aspect 9, further comprising a warning unit that activates an alert when the receiving unit receives an abnormal signal from the defibrillation control device. According to this aspect, when an abnormal signal is received from the defibrillation control device, an alert is activated by the monitoring device. Therefore, after the monitoring device performs a stop operation for the alert, the monitoring device can directly execute an operation to switch the electrocardiogram waveform provided to the defibrillation control device. As a result, since the stop operation for the alert and the operation to switch the electrocardiogram waveform can be completed only by the monitoring device, user convenience can be improved.

[0140] Aspect 12 is the monitoring device according to Aspect 9, wherein the waveform acquisition unit further includes a waveform selection unit that acquires a plurality of electrocardiogram waveforms and selects any one of the plurality of electrocardiogram waveforms; the waveform providing unit provides the electrocardiogram waveform selected by the waveform selection unit; and when it is determined that the trigger signal is not synchronized, the waveform selection unit selects an electrocardiogram waveform different from the currently selected electrocardiogram waveform among the plurality of electrocardiogram waveforms. According to this aspect, when the trigger point cannot be appropriately detected by the defibrillation control device, the electrocardiogram waveform provided to the defibrillation control device is automatically switched, thus reducing the user's effort.

[0141] Aspect 13 is the monitoring device according to Aspect 9, wherein the waveform acquisition unit further includes a waveform selection unit that acquires a plurality of electrocardiogram waveforms and selects any one of the plurality of electrocardiogram waveforms; the waveform providing unit provides the electrocardiogram waveform selected by the waveform selection unit; and when the receiving unit receives an abnormal signal from the defibrillation control device, the waveform selection unit selects an electrocardiogram waveform different from the currently selected electrocardiogram waveform among the plurality of electrocardiogram waveforms. According to this aspect, when an abnormal signal is received from the defibrillation control device, the electrocardiogram waveform provided to the defibrillation control device is automatically switched, thus reducing the user's effort.

[0142] Aspect 14 is the monitoring device according to any one of Aspects 9 to 13, further comprising: a receiving unit that receives a supply completion signal of the electrical energy from the defibrillation control device; an abnormality detection unit that detects an earliest abnormal waveform using a plurality of electrocardiogram waveforms measured by a plurality of electrodes of the electrode catheter after receiving the supply completion signal; and a transmitting unit that transmits an abnormal signal to the defibrillation control device upon detection of the earliest abnormal waveform. According to this aspect, by detecting the earliest abnormal waveform and transmitting an abnormal signal to the defibrillation control device, an alert can be triggered by the defibrillation control device. Thereby, information useful for a user such as a doctor performing catheter treatment can be provided promptly.

[0143] The 15th aspect is a monitoring device including: a receiving unit that receives a supply completion signal of the electrical energy from a defibrillation control device that supplies electrical energy to an electrode catheter; a detecting unit that detects an earliest abnormal waveform using a plurality of electrocardiogram waveforms acquired by a plurality of electrodes of the electrode catheter after the reception of the supply completion signal; and a transmitting unit that transmits an abnormal signal to the defibrillation control device upon detection of the earliest abnormal waveform. According to this aspect, by detecting the earliest abnormal waveform and transmitting an abnormal signal to the defibrillation control device, an alert can be activated by the defibrillation control device. Thereby, information useful for a user such as a doctor who performs catheter treatment can be provided promptly.

[0144] The 16th aspect is a defibrillation control device including: a power supply unit that supplies electrical energy to an electrode catheter; a waveform input unit to which an electrocardiogram waveform provided from a monitoring device is input; a receiving unit that receives a trigger signal indicating a timing at which supply of the electrical energy can be started from the monitoring device; a synchronization determination unit that determines whether or not the trigger signal is synchronized with the electrocardiogram waveform; and a transmitting unit that transmits an abnormal signal to the monitoring device when the trigger signal is not synchronized. According to this aspect, in a monitoring device that provides an electrocardiogram waveform and a trigger signal to a defibrillation control device, the defibrillation control device determines whether or not a trigger point can be appropriately detected, and if there is an abnormality, it can notify the monitoring device. Thereby, the monitoring device can comprehensively grasp whether an appropriate electrocardiogram waveform and trigger signal are being provided to the defibrillation control device, improving the convenience for the user.

[0145] The configurations, operations, and functions of the above-described devices and methods can be realized by hardware resources, software resources, or the cooperation of hardware resources and software resources. As hardware resources, for example, various integrated circuits including a processor such as a CPU (Central Processing Unit), and memories such as a ROM (Read Only Memory) and a RAM (Random Access Memory) can be used. As software resources, for example, programs such as an operating system and an application can be used.

Description of Reference Numerals

[0146] 10, 110, 210, 310… defibrillation system, 12… electrode catheter, 14, 114, 214, 314… defibrillation control device, 16, 116, 216, 316… monitoring device, 48… power supply unit, 52, 252, 352… control unit, 52c… abnormality detection unit, 52d, 252d… warning unit, 54… display unit, 120… transmission unit, 122… reception unit, 124… synchronization determination unit, 130, 330… warning unit, 220, 320… first transmission unit, 222, 322… first reception unit, 224, 324… second reception unit, 226, 326… second transmission unit, 232… abnormality detection unit, 334… trigger detection unit, 352e… synchronization determination unit.

Claims

1. A power supply unit that supplies electrical energy to an electrode catheter, An abnormality detection unit that detects an earliest abnormal waveform using a plurality of electrocardiogram waveforms measured by a plurality of electrodes of the electrode catheter after the supply of the electrical energy, A warning unit that activates an alert upon detection of the earliest abnormal waveform, and comprising, The abnormality detection unit detects an earliest waveform having the earliest start timing at which the amplitude becomes equal to or greater than a first threshold value among the plurality of electrocardiogram waveforms, determines whether the earliest waveform is normal or abnormal using the earliest waveform, and detects the earliest abnormal waveform when the earliest waveform is abnormal. An implantable cardioverter defibrillator control device.

2. The abnormality detection unit detects a waveform portion in which the amplitude of the earliest waveform becomes equal to or greater than the first threshold value, and when the number of detections of the waveform portion from the start timing to after a reference time has elapsed is equal to or greater than a predetermined number, the earliest abnormal waveform is detected. The implantable cardioverter defibrillator control device according to claim 1.

3. The abnormality detection unit detects a waveform portion in which the amplitude of the earliest waveform is equal to or greater than the first threshold value and is downward, and when the number of detections of the waveform portion from the start timing to after a reference time has elapsed is equal to or greater than a predetermined number, the earliest abnormal waveform is detected. The implantable cardioverter defibrillator control device according to claim 1.

4. The abnormality detection unit measures the continuous time of a flat portion in which the amplitude of the earliest waveform is equal to or less than a second threshold value smaller than the first threshold value, and when the continuous time of the flat portion measured from the start timing to after a reference time has elapsed does not exceed a predetermined value, the earliest abnormal waveform is detected. The implantable cardioverter defibrillator control device according to claim 1.

5. The abnormality detection unit detects the earliest abnormal waveform when the electrode for acquiring the earliest waveform is not a predetermined electrode. The implantable cardioverter defibrillator control device according to claim 1.

6. The abnormality detection unit detects a start timing at which the amplitude becomes equal to or greater than a first threshold value after the supply of the electrical energy for the plurality of electrocardiogram waveforms, and detects the earliest abnormal waveform using the detection order of the start timing of the plurality of electrocardiogram waveforms. The implantable cardioverter defibrillator control device according to claim 1.

7. The implantable cardioverter defibrillator control device according to any one of claims 1 to 6, further comprising a display unit that displays information indicating which of the plurality of electrodes is the electrode that acquires the earliest abnormal waveform.

8. A power supply unit that supplies electrical energy to an electrode catheter, an abnormality detection unit that detects an earliest abnormal waveform using a plurality of electrocardiogram waveforms measured by a plurality of electrodes of the electrode catheter after the supply of the electrical energy; a warning unit that issues an alert when the earliest abnormal waveform is detected, A defibrillation control device, wherein the abnormality detection unit terminates the earliest abnormal waveform detection process if it detects the earliest abnormal waveform within 10 seconds after the completion of the supply of electrical energy, or if it detects neither the earliest abnormal waveform nor cardiac arrest.

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