Intracardiac defibrillation system

Abstract

To provide an intracardiac defibrillation system capable of improving defibrillation efficiency.SOLUTION: An intracardiac defibrillation system 1 comprises: a defibrillation catheter 2A for defibrillating in a cardiac chamber, the defibrillation catheter 2A including a first electrode group including a plurality of first electrodes; a defibrillation catheter 2B for defibrillating in the cardiac chamber, the defibrillation catheter 2B including a second electrode group including a plurality of second electrodes; and a defibrillator 10 including a connector 10a for connecting the defibrillation catheter 2A, a connector 10b for connecting the defibrillation catheter 2B, and a power supply circuit 12 for supplying a voltage. The defibrillator 10 applies the voltage of a same polarity to the plurality of first electrodes and applies the voltage of a same polarity to the plurality of second electrodes.SELECTED DRAWING: Figure 1

Description

Technical Field

[0001] The present disclosure relates to an intracardiac defibrillation system.

Background Art

[0002] During surgery using a cardiac catheter, if fibrillation occurs, it is necessary to perform electrical defibrillation. Patent Document 1 describes an intracardiac defibrillation catheter system including a defibrillation catheter inserted into the heart cavity to perform defibrillation, and a power supply device that applies a DC voltage to the electrodes of the defibrillation catheter. The defibrillation catheter has a first electrode group composed of a plurality of ring-shaped electrodes for applying a voltage of the same polarity, and a second electrode group composed of a plurality of ring-shaped electrodes for applying a voltage of the opposite polarity to the first electrode group.

Prior Art Documents

Patent Documents

[0003]

Patent Document 1

Summary of the Invention

Problems to be Solved by the Invention

[0004] In the intracardiac defibrillation catheter system described in Patent Document 1, the first electrode group and the second electrode group are mounted on the outer periphery of the same tube member while being spaced apart from each other. Therefore, since the distance between the first electrode group and the second electrode group on the tube member is constant, it is difficult to place the first electrode group and the second electrode group at desired positions in the heart cavity. Therefore, there are cases where the first electrode group and the second electrode group cannot be placed at appropriate positions with respect to the portion where the myocardium is in spasm. In such a case, it is necessary to set the defibrillation energy high in order to electrically reset the spastic portion, and there is a risk that the defibrillation efficiency will decrease.

[0005] The present disclosure provides an intracardiac defibrillation system capable of improving defibrillation efficiency. [Means for solving the problem]

[0006] An intracardiac defibrillation system according to one aspect of the present disclosure comprises a defibrillation device having a first defibrillation catheter for performing defibrillation in the cardiac chamber, the first defibrillation catheter having a first electrode group including a plurality of first electrodes; a second defibrillation catheter for performing defibrillation in the cardiac chamber, the second defibrillation catheter having a second electrode group including a plurality of second electrodes; a first connector for connecting the first defibrillation catheter; a second connector for connecting the second defibrillation catheter; and a power supply circuit for supplying voltage. The defibrillation device applies voltages of the same polarity to the plurality of first electrodes and voltages of the same polarity to the plurality of second electrodes.

[0007] In this intracardiac defibrillation system, the first defibrillation catheter has a first electrode group, and the second defibrillation catheter has a second electrode group. Because the first and second electrode groups are contained within different defibrillation catheters, the flexibility in their placement is increased. Therefore, the first and second electrode groups can be placed closer to the area where the myocardium is spasming. This allows for efficient application of defibrillation energy to the area of ​​myocardial spasm. As a result, there is no need to set the defibrillation energy unnecessarily high, thus improving defibrillation efficiency.

[0008] In some embodiments, the defibrillator may apply a voltage to a plurality of second electrodes that has a different polarity from the voltage applied to a plurality of first electrodes. With this configuration, defibrillation energy can be applied between the first electrode group and the second electrode group.

[0009] In some embodiments, the intracardiac defibrillation system may further include a counter electrode plate for performing defibrillation on the body surface. The defibrillator may further include a third connector for connecting the counter electrode plate. The defibrillator may apply a voltage to the counter electrode plate with a polarity different from that of the voltages applied to the plurality of first electrodes or plurality of second electrodes. With this configuration, defibrillation energy can be applied between the first electrode group or the second electrode group and the counter electrode plate.

[0010] In some embodiments, the defibrillator may further include a switching circuit that can selectively switch between a first member connected to the first terminal of the power supply circuit and a second member connected to the second terminal of the power supply circuit, among the first electrode group, the second electrode group, and the counter electrode plate. In this case, defibrillation can be performed using a combination selected from the first electrode group, the second electrode group, and the counter electrode plate. Therefore, it is possible to select an appropriate combination depending on the location where fibrillation occurs, thereby improving defibrillation efficiency.

[0011] In some embodiments, the defibrillator may further include a measuring instrument for measuring the resistance of the voltage supply path. The switching circuit may selectively connect the first and second members to either the power supply circuit or the measuring instrument. With this configuration, a combination selected from the first electrode group, the second electrode group, and the counter electrode plate is selectively connected to the power supply circuit and the measuring instrument. Therefore, the defibrillator can be miniaturized compared to a configuration in which the voltage supply path and the resistance measurement path are provided separately.

[0012] In some embodiments, the intracardiac defibrillation system may further include an electrocardiograph. The first defibrillation catheter may further have a third electrode group including a plurality of third electrodes, and the second defibrillation catheter may further have a fourth electrode group including a plurality of fourth electrodes. The electrocardiograph may measure the potentials of the plurality of third electrodes and the plurality of fourth electrodes. With this configuration, intracardiac potentials can be measured without using an electrophysiological examination catheter.

[0013] In some embodiments, the defibrillator may further include a measuring instrument for measuring the resistance of the voltage supply path and an arithmetic processing unit for controlling the power supply circuit. The arithmetic processing unit may apply voltage to the power supply circuit when the resistance is within an appropriate range. If the resistance of the voltage supply path is outside an appropriate range, it is considered that the electrodes to which the voltage is applied are not properly positioned. In order to perform defibrillation in this state, it is necessary to increase the defibrillation energy. With the above configuration, since voltage is applied when the resistance of the voltage supply path is within an appropriate range, it is not necessary to increase the defibrillation energy excessively. As a result, the defibrillation efficiency can be improved.

[0014] In some embodiments, the processing unit may apply a voltage to the power supply circuit in synchronization with the peak of the intracardiac potential. In this configuration, since the voltage is applied in synchronization with the peak of the intracardiac potential, the induction of ventricular fibrillation can be prevented.

[0015] In some embodiments, the first defibrillator catheter may further include a tubular member. Each of the multiple first electrodes may be provided on the outer surface of the tubular member, and the multiple first electrodes may be arranged in the axial direction of the tubular member. This configuration allows for increased flexibility and suppleness of the first defibrillator catheter compared to a configuration in which the multiple first electrodes are integrated. Therefore, it is possible to improve the operability of the first defibrillator catheter.

[0016] In some embodiments, the first defibrillation catheter may further include a tip provided at the end of a tubular member, a pull wire disposed inside the tubular member and having one end fixed to the tip at a position eccentric with respect to the central axis of the tubular member, and an operating unit for moving the pull wire axially. With this configuration, since one end of the pull wire is fixed to the tip at a position eccentric with respect to the central axis of the tubular member, moving the pull wire forward and backward by the operating unit applies a force to the tip at a position eccentric with respect to the central axis. This makes it possible to deflect the tip of the tubular member. As a result, it is possible to improve the operability of the first defibrillation catheter.

[0017] In some embodiments, the first defibrillator catheter may further include a balloon at the tip of a tubular member that is inflatable and deflated, and a supply tube for supplying fluid to the balloon. With this configuration, when the balloon is inflated by the supply of fluid while the first defibrillator catheter is inserted into a blood vessel, the balloon receives force from the blood flowing within the vessel. As a result, the first defibrillator catheter can advance with the blood flow, thus simplifying the insertion procedure of the first defibrillator catheter.

[0018] In some embodiments, the first defibrillation catheter may further include an insertion tube for inserting a guidewire, which is located within a tubular member and extends from the proximal end to the tip of the tubular member. With this configuration, the first defibrillation catheter can be advanced along the guidewire while the guidewire is inserted into the blood vessel. This simplifies the insertion procedure of the first defibrillation catheter.

[0019] In some embodiments, the first defibrillation catheter may further include an insertion tube for inserting a guidewire, which is located within a tubular member and extends from its outer surface to the tip of the tubular member. With this configuration, the first defibrillation catheter can be advanced along the guidewire while the guidewire is inserted into the blood vessel. This simplifies the insertion procedure of the first defibrillation catheter.

[0020] In some embodiments, each of the multiple first electrodes may have a curved shape that is convex in a direction intersecting the axial direction. The longer the length of the first electrode in the axial direction, the less flexible and pliable the first defibrillator catheter becomes, and the less maneuverable the first defibrillator catheter is. The smaller the contact area between the first electrode and the surrounding tissue, the greater the current density when a voltage is applied to the first electrode, and the higher the likelihood of damaging the surrounding tissue. In the above configuration, the surface area of ​​the first electrode can be increased without increasing its length in the axial direction. Therefore, the likelihood of damaging the surrounding tissue can be reduced without impairing the maneuverability of the first defibrillator catheter.

[0021] In some embodiments, the first defibrillator catheter may further include an insulating member that fills a recess defined by the axial end face and the outer circumferential surface of one of the multiple first electrodes. When a recess is formed by the axial end face of the first electrode and the outer circumferential surface of the tubular member, the current density increases at the periphery of the end face when a voltage is applied to the first electrode. In the above configuration, since the recess is filled with the insulating member, the increase in current density at the periphery of the end face when a voltage is applied to the first electrode can be suppressed. Therefore, the possibility of damaging surrounding tissue can be reduced. [Effects of the Invention]

[0022] According to this disclosure, it is possible to improve defibrillation efficiency. [Brief explanation of the drawing]

[0023] [Figure 1] FIG. 1 is a schematic configuration diagram of an intracardiac defibrillation system according to an embodiment. [Figure 2] FIG. 2 is a schematic configuration diagram of the defibrillation catheter shown in FIG. 1. [Figure 3] FIG. 3 is a cross-sectional view taken along line III-III of FIG. 2. [Figure 4] FIG. 4 is an enlarged view of the electrode shown in FIG. 2. [Figure 5] FIG. 5 is a flowchart showing a series of processes of a defibrillation method performed by the defibrillation device shown in FIG. 1. [Figure 6] FIG. 6 is a diagram showing an example of the connection state of the switching circuit in the map mode. [Figure 7] FIG. 7 is a diagram showing an example of the connection state of the switching circuit during resistance value measurement in the intracardiac defibrillation mode. [Figure 8] FIG. 8 is a diagram showing another example of the connection state of the switching circuit during resistance value measurement in the intracardiac defibrillation mode. [Figure 9] FIG. 9 is a diagram showing yet another example of the connection state of the switching circuit during resistance value measurement in the intracardiac defibrillation mode. [Figure 10] FIG. 10 is a diagram showing yet another example of the connection state of the switching circuit during resistance value measurement in the intracardiac defibrillation mode. [Figure 11] FIG. 11 is a diagram showing the waveform of the voltage applied by the power supply circuit shown in FIG. 1. [Figure 12] FIG. 12 is a diagram showing an example of the connection state of the switching circuit during voltage application in the intracardiac defibrillation mode. [Figure 13] FIG. 13 is a diagram showing another example of the connection state of the switching circuit during voltage application in the intracardiac defibrillation mode. [Figure 14] FIG. 14 is a diagram showing yet another example of the connection state of the switching circuit during voltage application in the intracardiac defibrillation mode. [Figure 15] FIG. 15 is a diagram showing yet another example of the connection state of the switching circuit during voltage application in the intracardiac defibrillation mode. [Figure 16] Figure 16 is a schematic diagram of a modified defibrillation catheter. [Figure 17] Figure 17 is a cross-sectional view along the line XVII-XVII in Figure 16. [Figure 18] Figure 18 is a schematic diagram of a defibrillation catheter in another modified form. [Figure 19] Figure 19 is a schematic diagram of yet another modified defibrillation catheter. [Modes for carrying out the invention]

[0024] Embodiments of this disclosure will be described in detail below with reference to the drawings. In the description of the drawings, the same elements are denoted by the same reference numerals, and redundant descriptions are omitted.

[0025] An intracardiac defibrillation system according to one embodiment will be described with reference to Figures 1 to 4. Figure 1 is a schematic diagram of the intracardiac defibrillation system according to one embodiment. Figure 2 is a schematic diagram of the defibrillation catheter shown in Figure 1. Figure 3 is a cross-sectional view along line III-III in Figure 2. Figure 4 is an enlarged view of the electrode shown in Figure 2.

[0026] The intracardiac defibrillation system 1 shown in Figure 1 is a system for performing defibrillation. Defibrillation is the process of restoring a fibrillated heart to a normal state. Fibrillation is a condition in which the heart muscle spasms. Examples of fibrillation include atrial fibrillation and ventricular fibrillation. The intracardiac defibrillation system 1 performs defibrillation by electrically resetting the areas where the heart muscle is spasming. The intracardiac defibrillation system 1 is used, for example, in the treatment of atrial fibrillation by catheter ablation. The intracardiac defibrillation system 1 includes a defibrillation catheter 2A (first defibrillation catheter), a defibrillation catheter 2B (second defibrillation catheter), a counter electrode 3, an electrocardiograph 4, and a defibrillator 10.

[0027] Defibrillation catheters 2A and 2B are devices used to perform defibrillation in the cardiac chambers of patient P. As shown in Figures 2 and 3, each of the defibrillation catheters 2A and 2B includes a tube 21 (tubular member), an electrode group 22, an electrode group 23, a lead wire group 24, a lead wire group 25, a tip 26, a pull wire 27, and a handle 28.

[0028] Tube 21 is a long, tubular member. Tube 21 is made of, for example, a high-hardness nylon elastomer. An example of a nylon elastomer is PEBAX®. Tube 21 may have different hardnesses in its axial direction. For example, tube 21 may be configured such that its hardness increases in stages from the tip 21a to the base 21b. The hardness of tube 21 (hardness measured by a D-type hardness tester) is, for example, 40 to 75. The outer diameter of tube 21 is, for example, 1.2 mm to 2.4 mm.

[0029] The tube 21 includes a blade 21c. The blade 21c is a reinforcing member of the tube 21. The blade 21c is a braided wire made of a metallic material. For example, the blade 21c is made of stainless steel strands. The blade 21c is provided around the entire circumference of the tube 21, from the base end of the tube 21 to just before the electrode group 22. The blade 21c is not provided in the region of the tube 21 where the electrode group 22 is provided.

[0030] The electrode group 22 includes a plurality of electrodes 22a. Each electrode 22a is a component for applying defibrillation energy to a desired location within the heart chamber. Each electrode 22a is provided on the outer circumferential surface of the tube 21. Specifically, each electrode 22a is provided on the outer circumferential surface of the tube 21 so as to surround the tube 21 around its axis (central axis). Each electrode 22a has a cylindrical shape with both ends open. As shown in Figure 4, in this embodiment, each electrode 22a has an olive-shaped form. In other words, each electrode 22a has a curved shape that is convex in a direction intersecting the axial direction of the tube 21. More specifically, each electrode 22a has a streamlined shape in which the outer diameter is largest at the center of the electrode 22a in the axial direction of the tube 21, and the outer diameter gradually decreases from the center toward both ends of the electrode 22a in the axial direction of the tube 21.

[0031] Since the outer surface of electrode 22a and the outer surface of tube 21 are not located on the same plane, a recess 22s is created defined by the end face of electrode 22a and the outer surface of tube 21. Defibrillation catheters 2A and 2B further include glue G (insulating material) provided to fill the recess 22s. The glue G smoothly connects the outer surface of electrode 22a and the outer surface of tube 21 so that no edge is created between the outer surface of electrode 22a and the outer surface of tube 21.

[0032] If the length of each electrode 22a in the axial direction of the tube 21 is too short, the current density when voltage is applied may become excessive. If the length of each electrode 22a in the axial direction of the tube 21 is too long, the flexibility and pliability of the portion of the tube 21 where the electrode group 22 is provided may be impaired. From these viewpoints, the length of each electrode 22a in the axial direction of the tube 21 is, for example, 4 mm. Each electrode 22a may be made of a platinum-based alloy such as a platinum-iridium alloy from the viewpoint of improving contrastability (X-ray opacity) to X-rays.

[0033] Multiple electrodes 22a are arranged in the axial direction of the tube 21. In this embodiment, the multiple electrodes 22a are provided at the tip of the tube 21 and are arranged at equal intervals in the axial direction of the tube 21. The distance between two adjacent electrodes 22a is about 1 to 5 mm. The number of electrodes 22a in the electrode group 22 may be determined according to the length and spacing of the electrodes 22a in the axial direction of the tube 21, for example, about 6 to 16. In this embodiment, the electrode group 22 includes 8 electrodes 22a.

[0034] Each electrode 22a is electrically connected to the defibrillator 10 by a lead wire 24a, as described later. A voltage of the same polarity is applied to multiple electrodes 22a (first electrodes) of the electrode group 22 (first electrode group) included in the defibrillation catheter 2A. A voltage of the same polarity is applied to multiple electrodes 22a (second electrodes) of the electrode group 22 (second electrode group) included in the defibrillation catheter 2B. The multiple electrodes 22a included in the defibrillation catheter 2B may be subjected to a voltage of a different polarity than the voltage applied to the multiple electrodes 22a included in the defibrillation catheter 2A, or they may be subjected to a voltage of the same polarity.

[0035] When defibrillation catheters 2A and 2B are used to defibrillate atrial fibrillation, the electrode group 22 of the defibrillation catheters 2A and 2B are placed, for example, in the lateral wall of the right atrial, the posterior wall of the right atrial, the anterior wall of the right atrial, the junction between the superior vena cava and the right atrium, the junction between the inferior vena cava and the right atrium, the lateral wall of the left atrial, the posterior wall of the left atrial, the anterior wall of the left atrial, the junction between the superior pulmonary vein and the left atrium, the junction between the right inferior pulmonary vein and the left atrium, the junction between the left superior pulmonary vein and the left atrium, the junction between the left inferior pulmonary vein and the left atrium, the septum between the right and left atrium, the junction between the atrial septum and the ventricular septum, the esophagus, or the coronary sinus.

[0036] The electrode group 23 includes a plurality of electrodes 23a. Each electrode 23a is a component for measuring intracardiac potential. Each electrode 23a is provided on the outer circumferential surface of the tube 21. Specifically, each electrode 23a is provided on the outer circumferential surface of the tube 21 so as to surround the tube 21 around its axis. Each electrode 23a has a cylindrical shape with both ends open. As shown in Figure 4, in this embodiment, each electrode 23a has a cylindrical shape with a substantially uniform outer diameter over the entire length of the electrode 23a in the axial direction of the tube 21. The length of each electrode 23a in the axial direction of the tube 21 is, for example, 0.5 mm to 2.0 mm. Each electrode 23a may be made of a platinum-based alloy such as a platinum-iridium alloy from the viewpoint of improving contrast enhancement for X-rays.

[0037] Multiple electrodes 23a are arranged in the axial direction of the tube 21. In this embodiment, the multiple electrodes 23a are provided in the tube 21 at positions spaced apart from the electrode group 22 toward the base end 21b, and are arranged at equal intervals in the axial direction of the tube 21. The number of electrodes 23a included in the electrode group 23 may be determined according to the length and spacing of the electrodes 23a, for example, 1 to 8. In this embodiment, the electrode group 23 includes 4 electrodes 23a. Note that no voltage for defibrillation is applied to the multiple electrodes 23a.

[0038] The lead wire group 24 includes multiple lead wires 24a. Each lead wire 24a is a component for electrically connecting an electrode 22a to the defibrillator 10. Each of the multiple lead wires 24a is connected to a different electrode 22a. For example, the number of lead wires 24a included in the lead wire group 24 is the same as the number of electrodes 22a included in the electrode group 22. Each lead wire 24a is inserted through the tube 21, with one end of the lead wire 24a connected to an electrode 22a and the other end of the lead wire 24a connected to a connector 28d on the handle 28. More specifically, one end of the lead wire 24a is welded to the inner circumferential surface of the electrode 22a, and the lead wire 24a is inserted into the tube 21 through a through-hole provided in the tube wall of the tube 21 and extends to the connector 28d.

[0039] Each lead wire 24a is a resin-coated wire comprising a metal conductor and a coating resin that covers the outer surface of the metal conductor. Examples of coating resins include polyimide resin, polyamide resin, and polyamideimide resin. The thickness of the coating resin is, for example, about 10 μm to 50 μm.

[0040] The lead wire group 25 includes multiple lead wires 25a. Each lead wire 25a is a component for electrically connecting an electrode 23a to the defibrillator 10. Each of the multiple lead wires 25a is connected to a different electrode 23a. For example, the number of lead wires 25a included in the lead wire group 25 is the same as the number of electrodes 23a included in the electrode group 23. Each lead wire 25a is inserted through the tube 21, one end of the lead wire 25a is connected to an electrode 23a, and the other end of the lead wire 25a is connected to a connector 28d of the handle 28. More specifically, one end of the lead wire 25a is welded to the inner circumferential surface of the electrode 23a, and the lead wire 25a is inserted into the tube 21 through a through hole provided in the tube wall of the tube 21 and extends to the connector 28d.

[0041] Each lead wire 25a is a resin-coated wire comprising a metal conductor and a coating resin that covers the outer surface of the metal conductor. Examples of coating resins include polyimide resin, polyamide resin, and polyamideimide resin. The thickness of the coating resin is, for example, about 10 μm to 50 μm.

[0042] The tip 26 is a component for sealing the tip 21a of the tube 21. The tip 26 is attached to the tip 21a of the tube 21. The tip of the tip 26 has a hemispherical shape. The length of the tip 26 in the axial direction of the tube 21 is, for example, 0.5 mm to 2.0 mm. In this embodiment, one end of the pull wire 27 is fixed to the inner surface of the tip 26.

[0043] The tip 26 is made of, for example, a metal material. From the viewpoint of improving contrast-enhancing properties for X-rays, the tip 26 may be made of platinum, platinum alloy, tungsten, tungsten alloy, silver, and silver alloy. The tip 26 may also be made of resin. As the resin, a resin with a certain degree of flexibility can be used. Examples of such resins include polyolefins such as polyethylene, polypropylene, ethylene-propylene copolymer, and ethylene-vinyl acetate copolymer, thermoplastic resins such as flexible polyvinyl chloride, polyamide, polyamide elastomer, and polyurethane, silicone rubber, and latex rubber.

[0044] The pull wire 27 is a component for deflecting the tip of the tube 21. The pull wire 27 is inserted through the tube 21 and is positioned eccentrically with respect to the central axis of the tube 21. One end of the pull wire 27 is fixed to the tip 26 at a position eccentric with respect to the central axis of the tube 21. One end of the pull wire 27 is fixed to the tip 26 by, for example, solder. A large-diameter portion for preventing detachment may be provided at one end of the pull wire 27. With this configuration, the tip 26 and one end of the pull wire 27 can be firmly connected, so that the tip 26 does not fall off. The other end of the pull wire 27 is connected to the operating lever 28b (operating part) of the handle 28.

[0045] The pull wire 27 is made of, for example, a metallic material. Examples of metallic materials include stainless steel and nickel-titanium superelastic alloys. The pull wire 27 does not have to be made of a metallic material; for example, it may be made of a high-strength non-conductive wire.

[0046] The defibrillation catheters 2A and 2B may include multiple pull wires 27. For example, if two pull wires 27 are arranged symmetrically with respect to the central axis of the tube 21, the tip of the tube 21 can be deflected in two directions.

[0047] The handle 28 is used to operate the defibrillation catheters 2A and 2B. The handle 28 is located at the proximal end 21b of the tube 21. The handle 28 includes a main body 28a, an operating lever 28b, a strain relief 28c, and a connector 28d.

[0048] The main body 28a is the part that is grasped by the user operating the defibrillation catheters 2A and 2B. The main body 28a is connected to the proximal end 21b of the tube 21. The main body 28a is a cylindrical member through which lead wires 24a, 25a, and pull wire 27 extending from the tube 21 are inserted in an electrically insulated manner.

[0049] The operating lever 28b is a component for moving the pull wire 27 forward and backward in the axial direction of the tube 21. The operating lever 28b may be rotary or sliding. When the user operates the operating lever 28b, the pull wire 27 is pulled, which causes the tip of the tube 21 to deflect. The deflected shape of the tip of the tube 21 is equivalent to that of a standard electrophysiological examination catheter already on the market.

[0050] The strain relief 28c is a member for reinforcing the connection between the tube 21 and the main body 28a. The strain relief 28c is provided so as to cover the connection around the axis of the tube 21 and has a conical shape that tapers towards the tip 21a of the tube 21.

[0051] The connector 28d is a component located at the ends of the multiple lead wires 24a and multiple lead wires 25a. Each lead wire 24a and each lead wire 25a is connected to the connector pin of the connector 28d. The connector 28d of the defibrillation catheter 2A is connected via a cable to the connector 10a (first connector) of the defibrillator 10 described later. The connector 28d of the defibrillation catheter 2B is connected via a cable to the connector 10b (second connector) of the defibrillator 10 described later.

[0052] The counter electrode plate 3 is a device (electrode) used to perform defibrillation on the body surface of patient P. The counter electrode plate 3 is attached to the body surface and applies defibrillation energy from the body surface. The counter electrode plate 3 is, for example, a conductive counter electrode plate. In this embodiment, the counter electrode plate 3 is a rectangular plate material. The counter electrode plate 3 is attached to the body surface, for example, so that its long side faces the defibrillation catheters 2A and 2B. The counter electrode plate 3 may also be a circular plate material. A voltage with a polarity different from the polarity of the voltage applied to at least one of the multiple electrodes 22a of the defibrillation catheters 2A and 2B is applied to the counter electrode plate 3.

[0053] The electrocardiograph 4 is a device for measuring the intracardiac potential of patient P. The electrocardiograph 4 measures the potentials of multiple electrodes 23a (third electrode) of electrode group 23 (third electrode group) included in defibrillation catheter 2A and the potentials of multiple electrodes 23a (fourth electrode) of electrode group 23 (fourth electrode group) included in defibrillation catheter 2B. If no voltage is applied to multiple electrodes 22a of electrode group 22 included in defibrillation catheters 2A and 2B, the electrocardiograph 4 may measure the potentials of these electrodes 22a. The electrocardiograph 4 outputs the intracardiac potential to the defibrillator 10.

[0054] The defibrillator 10 is a device that supplies defibrillation energy for performing defibrillation. The defibrillator 10 is sometimes referred to as a console. The defibrillator 10 supplies defibrillation energy between components by applying voltages of different polarities to one or more components selected from three components: the electrode group 22 included in the defibrillation catheter 2A, the electrode group 22 included in the defibrillation catheter 2B, and the counter electrode plate 3, and to one or more components from the remaining components. The defibrillator 10 applies voltages of the same polarity to multiple electrodes 22a included in the electrode group 22 of the defibrillation catheter 2A, and applies voltages of the same polarity to multiple electrodes 22a included in the electrode group 22 of the defibrillation catheter 2B.

[0055] For example, the defibrillator 10 supplies defibrillation energy between the electrode group 22 of defibrillation catheter 2A and the electrode group 22 of defibrillation catheter 2B by applying a voltage with a different polarity to the electrode group 22 of defibrillation catheter 2B than the polarity of the voltage applied to the electrode group 22 of defibrillation catheter 2A. The defibrillator 10 supplies defibrillation energy between the electrode group 22 of defibrillation catheter 2A and the counter electrode plate 3 by applying a voltage with a different polarity to the counter electrode plate 3 than the polarity of the voltage applied to the electrode group 22 of defibrillation catheter 2A. The defibrillator 10 does not apply voltage to the multiple electrodes 23a included in the electrode group 23.

[0056] The defibrillator 10 includes connectors 10a, 10b, 10c (third connector), 10d, 10e, 10f, and 10g.

[0057] Connector 10a is a connector for connecting the defibrillation catheter 2A. Connector 10a is connected to connector 28d of the defibrillation catheter 2A by a cable. Connector 10b is a connector for connecting the defibrillation catheter 2B. Connector 10b is connected to connector 28d of the defibrillation catheter 2B by a cable. Note that connectors 10a and 10b may be divided into connectors for connecting electrode group 22 and connectors for connecting electrode group 23. Connector 10c is a connector for connecting the counter electrode plate 3. Connector 10c is connected to the counter electrode plate 3 by a cable.

[0058] Connectors 10d, 10e, and 10f are connectors for connecting the electrocardiograph 4. The intracardiac potential measured by the defibrillation catheter 2A is output to the electrocardiograph 4 from connector 10d. The intracardiac potential measured by the defibrillation catheter 2B is output to the electrocardiograph 4 from connector 10e. The intracardiac potential from the electrocardiograph 4 is input to connector 10f and supplied to the arithmetic processing unit 15.

[0059] Connector 10g is a connector for connecting lead electrodes attached to the body surface of patient P. The surface electrocardiogram waveform measured by the lead electrodes is input to connector 10g and supplied to the arithmetic processing unit 15.

[0060] The defibrillator 10 includes an operating device 11, a power supply circuit 12, a measuring instrument 13, a switching circuit 14, and a calculation processing unit 15.

[0061] The operating device 11 is the part for the user to operate the defibrillator 10. The operating device 11 includes a display unit 11a and an input unit 11b. The display unit 11a is the part that displays various information. The display unit 11a is a display such as an LCD (Liquid Crystal Display). The input unit 11b is the part for the user to perform various operations. The input unit 11b is composed of, for example, physical button switches. Examples of button switches include a changeover switch for switching the operating mode of the defibrillator 10, a setting switch for setting the defibrillation energy, a charging switch for charging the capacitor included in the power supply circuit 12, and an application switch (discharge switch) for applying defibrillation energy. The input unit 11b outputs various signals indicating user operations to the arithmetic processing unit 15.

[0062] The display unit 11a and the input unit 11b may be integrated, such as a touch panel. In this case, the input unit 11b may be composed of button icons displayed on the touch panel.

[0063] The power supply circuit 12 is a device that supplies DC voltage. The power supply circuit 12 applies DC voltage to multiple electrodes 22a and counter electrode plates 3 included in the defibrillation catheters 2A and 2B. The power supply circuit 12 has output terminals 12a (first terminal) and output terminal 12b (second terminal). The power supply circuit 12 supplies defibrillation energy by applying voltage to the electrode 22a or counter electrode plate 3 connected to output terminal 12a and to the electrode 22a connected to output terminal 12b. The target to which the voltage is applied connected to output terminals 12a and 12b is selectively switched by the switching circuit 14. The power supply circuit 12 has a built-in capacitor. When a charging command is output to the arithmetic processing unit 15 by the user operating the charging switch, the arithmetic processing unit 15 performs a charging process, thereby charging the capacitor of the power supply circuit 12.

[0064] The measuring instrument 13 is a resistivity meter that measures the resistance of a voltage-supplied path. The measuring instrument 13 has measuring terminals 13a and 13b, and measures the resistance between measuring terminals 13a and 13b. The objects to be measured connected to measuring terminals 13a and 13b are selectively switched by the switching circuit 14. The resistance between measuring terminal 13a or measuring terminal 13b and the electrode group 22 of the defibrillation catheter 2A, the resistance between measuring terminal 13a or measuring terminal 13b and the electrode group 22 of the defibrillation catheter 2B, and the resistance between measuring terminal 13a and the counter electrode plate 3 are negligibly small. Therefore, the measuring instrument 13 substantially measures the resistance between the electrode connected to measuring terminal 13a and the electrode connected to measuring terminal 13b, among the multiple electrodes 22a and counter electrode plate 3 included in the defibrillation catheters 2A and 2B.

[0065] The switching circuit 14 is a circuit that switches the electrically connected paths. The switching circuit 14 is configured to selectively switch between the component connected to the output terminal 12a of the power supply circuit 12 (first component) and the component connected to the output terminal 12b of the power supply circuit 12 (second component), among the electrode group 22 of the defibrillation catheter 2A, the electrode group 22 of the defibrillation catheter 2B, and the counter electrode plate 3. The switching circuit 14 is configured to selectively switch between the component connected to the measurement terminal 13a of the measuring instrument 13 and the component connected to the measurement terminal 13b of the measuring instrument 13, among the electrode group 22 of the defibrillation catheter 2A, the electrode group 22 of the defibrillation catheter 2B, and the counter electrode plate 3. The switching circuit 14 includes switches 41 to 47.

[0066] Switches 41 and 42 are circuit elements that selectively switch between the power supply circuit 12 and the measuring instrument 13. Switch 41 has contacts 41a, 41b, and 41c. Contact 41a is connected to contact 43b of switch 43, contact 44b of switch 44, and contact 45b of switch 45, which will be described later. Contact 41b is connected to the output terminal 12a of the power supply circuit 12. Contact 41c is connected to the measurement terminal 13a of the measuring instrument 13. Switch 41 selectively switches between a state in which contacts 41a and 41b are connected and a state in which contacts 41a and 41c are connected, in response to a switching signal from the arithmetic processing unit 15.

[0067] Switch 42 has contacts 42a, 42b, and 42c. Contact 42a is connected to contact 43c of switch 43 and contact 44c of switch 44. Contact 42b is connected to output terminal 12b of power supply circuit 12. Contact 42c is connected to measurement terminal 13b of measuring instrument 13. Switch 42 selectively switches between a state where contacts 42a and 42b are connected and a state where contacts 42a and 42c are connected, in response to a switching signal from the arithmetic processing unit 15.

[0068] Switches 41 and 42 operate in conjunction to switch each other. When contacts 41a and 41b are connected in switch 41, contacts 42a and 42b are connected in switch 42. When contacts 41a and 41c are connected in switch 41, contacts 42a and 42c are connected in switch 42.

[0069] Switch 43 is a circuit element that selectively switches the connection destination of the electrode group 22 of the defibrillation catheter 2A. Switch 43 has contacts 43a, 43b, 43c, and 43d. Contact 43a is connected to connector 10a. Specifically, contact 43a is connected to the electrode group 22 of the defibrillation catheter 2A via connector 10a. Contact 43b is connected to contact 41a. Contact 43c is connected to contact 42a. Contact 43d is connected to connector 10d. Switch 43 selectively switches between a state where contacts 43a and 43b are connected, a state where contacts 43a and 43c are connected, and a state where contacts 43a and 43d are connected, in response to a switching signal from the arithmetic processing unit 15.

[0070] Switch 44 is a circuit element that selectively switches the connection destination of the electrode group 22 of the defibrillation catheter 2B. Switch 44 has contacts 44a, 44b, 44c, and 44d. Contact 44a is connected to connector 10b. Specifically, contact 44a is connected to the electrode group 22 of the defibrillation catheter 2B via connector 10b. Contact 44b is connected to contact 41a. Contact 44c is connected to contact 42a. Contact 44d is connected to connector 10e. Switch 44 selectively switches between a state where contacts 44a and 44b are connected, a state where contacts 44a and 44c are connected, and a state where contacts 44a and 44d are connected, in response to a switching signal from the arithmetic processing unit 15.

[0071] Switch 45 is a circuit element that switches the connection state of the counter electrode plate 3. Switch 45 has contacts 45a and 45b. Contact 45a is connected to connector 10c. Specifically, contact 45a is connected to the counter electrode plate 3 via connector 10c. Contact 45b is connected to contact 41a. Switch 45 selectively switches between a conductive state (on state) in which contacts 45a and 45b are connected and a disconnected state (off state) in which contacts 45a and 45b are disconnected, in response to a switching signal from the arithmetic processing unit 15.

[0072] Switch 46 is a circuit element that selectively switches the connection destination of the electrode group 23 of the defibrillation catheter 2A. Switch 46 has contacts 46a, 46b, and 46c. Contact 46a is connected to connector 10a. Specifically, contact 46a is connected to the electrode group 23 of the defibrillation catheter 2A via connector 10a. Contact 46b is connected to connector 10d. Contact 46c is connected to the arithmetic processing unit 15. Switch 46 selectively switches between a state in which contacts 46a and 46b are connected and a state in which contacts 46a and 46c are connected, in response to a switching signal from the arithmetic processing unit 15.

[0073] Switch 47 is a circuit element that selectively switches the connection destination of the electrode group 23 of the defibrillation catheter 2B. Switch 47 has contacts 47a, 47b, and 47c. Contact 47a is connected to connector 10b. Specifically, contact 47a is connected to the electrode group 23 of the defibrillation catheter 2B via connector 10b. Contact 47b is connected to connector 10e. Contact 47c is connected to the arithmetic processing unit 15. Switch 47 selectively switches between a state in which contacts 47a and 47b are connected and a state in which contacts 47a and 47c are connected, in response to a switching signal from the arithmetic processing unit 15.

[0074] The arithmetic processing unit 15 is a controller that provides overall control of the defibrillator 10. The arithmetic processing unit 15 controls, for example, the operating device 11, the power supply circuit 12, the measuring instrument 13, and the switching circuit 14. The arithmetic processing unit 15 performs various controls based on various signals output from the input unit 11b. When a user operates the charging switch and a charging command is output from the input unit 11b to the arithmetic processing unit 15, the arithmetic processing unit 15 controls the power supply circuit 12 so that the defibrillation energy (voltage) set by the setting switch charges the capacitor in the power supply circuit 12.

[0075] When a discharge command is output from the input unit 11b to the arithmetic processing unit 15 by the user operating the discharge switch, the arithmetic processing unit 15 controls the power supply circuit 12 to release the defibrillation energy (voltage) stored in the capacitor of the power supply circuit 12. In this embodiment, the arithmetic processing unit 15 applies a voltage to the power supply circuit 12 in synchronization with the peak of the R wave when the resistance value measured by the measuring instrument 13 is within an appropriate range.

[0076] When the user operates a toggle switch to select an operating mode, the arithmetic processing unit 15 operates the defibrillator 10 in the selected operating mode. The operating modes include MAP mode (potential measurement mode) and intracardiac defibrillation mode. The operating mode of the defibrillator 10 is initially set to MAP mode when the defibrillator 10 is started.

[0077] Next, the defibrillation method performed by the defibrillator 10 will be explained with reference to Figures 5 to 15. Figure 5 is a flowchart showing a series of processes in the defibrillation method performed by the defibrillator shown in Figure 1. Figure 6 is a diagram showing an example of the connection state of the switching circuit in map mode. Figures 7 to 10 are diagrams showing an example of the connection state of the switching circuit when measuring resistance in intracardiac defibrillation mode. Figure 11 is a diagram showing the waveform of the voltage applied by the power supply circuit shown in Figure 1. Figures 12 to 15 are diagrams showing an example of the connection state of the switching circuit when voltage is applied in intracardiac defibrillation mode. Note that in Figures 6 to 10 and Figures 12 to 15, for the sake of explanation, the connectors are not shown, and the paths to which electrode group 22 is connected and the paths to which electrode group 23 is connected are shown separately.

[0078] When defibrillation treatment is performed, first, defibrillation catheters 2A and 2B are inserted into the heart chambers of patient P, and the electrode groups 22 of each defibrillation catheter are positioned as desired. A counter electrode plate 3 is attached to a desired position on the body surface of patient P. Then, the power to the defibrillator 10 is turned on, and the defibrillator 10 starts up. Defibrillation catheter 2A is connected to connector 10a of the defibrillator 10, defibrillation catheter 2B is connected to connector 10b of the defibrillator 10, and the counter electrode plate 3 is connected to connector 10c of the defibrillator 10. When the defibrillator 10 starts up, it is operating in map mode.

[0079] As shown in Figure 6, when the defibrillator 10 operates in map mode, contacts 43a and 43d of switch 43 are connected, contacts 44a and 44d of switch 44 are connected, contacts 46a and 46b of switch 46 are connected, and contacts 47a and 47b of switch 47 are connected. This connects electrode groups 22 and 23 of defibrillation catheter 2A and electrode groups 22 and 23 of defibrillation catheter 2B to the electrocardiograph 4. Switch 45 may be set to either a conduction state or an interruption state. Switch 41 is set so that contact 41a is not connected to any contact. Similarly, switch 42 is set so that contact 42a is not connected to any contact.

[0080] In this configuration, the intracardiac potentials measured by electrode groups 22 and 23 of the defibrillation catheter 2A, and electrode groups 22 and 23 of the defibrillation catheter 2B, are output to the electrocardiograph 4. The intracardiac potentials are then output from the electrocardiograph 4 to the defibrillator 10, and the calculation processing unit 15 receives the intracardiac potentials. The calculation processing unit 15 then outputs the intracardiac potentials to the display unit 11a, which displays them. In this state, if the user operates a toggle switch to select the intracardiac defibrillation mode, the series of processes shown in Figure 5 are initiated.

[0081] As shown in Figure 5, first, the calculation processing unit 15 determines whether a combination used for intracardiac defibrillation mode has been selected from among the defibrillation catheters 2A, 2B and the counter electrode plate 3 (step S1). If the intracardiac defibrillation mode is selected, for example, candidate combinations of selectable combinations are displayed on the display unit 11a. The candidate combinations of selectable combinations are combinations of members to which voltages of different polarities are applied, and include combinations of defibrillation catheter 2A and defibrillation catheter 2B, combinations of defibrillation catheter 2A and the counter electrode plate 3 and defibrillation catheter 2B, combinations of defibrillation catheter 2B and the counter electrode plate 3 and defibrillation catheter 2A, and combinations of the counter electrode plate 3 and defibrillation catheters 2A and 2B.

[0082] If the arithmetic processing unit 15 determines that no combination has been selected (step S1: NO), it repeats step S1 until a combination is selected. On the other hand, if the user selects a desired combination to be used for defibrillation from the combination candidates, the arithmetic processing unit 15 determines that a combination has been selected (step S1: YES) and performs resistance value measurement processing (step S2).

[0083] In step S2, the arithmetic processing unit 15 first sets the connection state of the switching circuit 14 to a connection state corresponding to the selected combination in order to measure the resistance value between two electrodes (components) to which voltages of different polarities are supplied, which are included in the selected combination. At this time, the display unit 11a no longer displays the intracardiac potential (intracardiac electrocardiogram) from electrode group 22, but it does display the intracardiac potential (intracardiac electrocardiogram) from electrode group 23. Then, the arithmetic processing unit 15 causes the measuring instrument 13 to measure the resistance value between measuring terminal 13a and measuring terminal 13b.

[0084] Here, with reference to Figures 7 to 10, we will describe some examples of the connection states of the switching circuit 14 when measuring resistance in the intracardiac defibrillation mode.

[0085] For example, when the combination of defibrillation catheter 2A and defibrillation catheter 2B is selected, the connection state of the switching circuit 14 is set to the connection state shown in Figure 7. Specifically, contacts 41a and 41c of switch 41 are connected, contacts 42a and 42c of switch 42 are connected, contacts 43a and 43b of switch 43 are connected, and contacts 44a and 44c of switch 44 are connected. At this time, switch 45 is set to the off state, contacts 46a and 46b of switch 46 are connected, and contacts 47a and 47b of switch 47 are connected. With this configuration, the electrode group 22 of defibrillation catheter 2A is connected to the measurement terminal 13a, and the electrode group 22 of defibrillation catheter 2B is connected to the measurement terminal 13b, so the resistance value between the electrode group 22 of defibrillation catheter 2A and the electrode group 22 of defibrillation catheter 2B is measured.

[0086] When the combination of defibrillation catheter 2A and counter electrode plate 3 with defibrillation catheter 2B is selected, the connection state of the switching circuit 14 is set to the connection state shown in Figure 8. The connection state shown in Figure 8 differs from the connection state in Figure 7 in that the switch 45 is set to the conductive state. With this configuration, the electrode group 22 and counter electrode plate 3 of defibrillation catheter 2A are connected to the measurement terminal 13a, and the electrode group 22 of defibrillation catheter 2B is connected to the measurement terminal 13b, so the resistance value between the electrode group 22 and counter electrode plate 3 of defibrillation catheter 2A and the electrode group 22 of defibrillation catheter 2B is measured. In other words, the combined resistance value of the circuit in which the resistance component between the electrode group 22 of defibrillation catheter 2A and the electrode group 22 of defibrillation catheter 2B and the resistance component between the counter electrode plate 3 and the electrode group 22 of defibrillation catheter 2B are connected in parallel is measured.

[0087] When the combination of defibrillation catheter 2B and counter electrode plate 3 with defibrillation catheter 2A is selected, the connection state of the switching circuit 14 is set to the connection state shown in Figure 9. The connection state shown in Figure 9 differs from the connection state in Figure 8 in the connection state of switches 43 and 44. Specifically, contacts 43a and 43c of switch 43 are connected, and contacts 44a and 44b of switch 44 are connected. With this configuration, the electrode group 22 and counter electrode plate 3 of defibrillation catheter 2B are connected to the measurement terminal 13a, and the electrode group 22 of defibrillation catheter 2A is connected to the measurement terminal 13b, so the resistance value between the electrode group 22 and counter electrode plate 3 of defibrillation catheter 2B and the electrode group 22 of defibrillation catheter 2A is measured. In other words, the combined resistance of a circuit is measured in which the resistance component between the electrode group 22 of defibrillation catheter 2B and the electrode group 22 of defibrillation catheter 2A, and the resistance component between the counter electrode plate 3 and the electrode group 22 of defibrillation catheter 2A are connected in parallel.

[0088] When the combination of the counter electrode plate 3 and the defibrillation catheters 2A and 2B is selected, the connection state of the switching circuit 14 is set to the connection state shown in Figure 10. The connection state shown in Figure 10 differs from the connection state in Figure 9 in the connection state of the switch 44. Specifically, contacts 44a and 44c of the switch 44 are connected. With this configuration, the counter electrode plate 3 is connected to the measurement terminal 13a, and the electrode group 22 of the defibrillation catheters 2A and 2B is connected to the measurement terminal 13b, so the resistance value between the counter electrode plate 3 and the electrode group 22 of the defibrillation catheters 2A and 2B is measured. In other words, the combined resistance value of the circuit in which the resistance component between the counter electrode plate 3 and the electrode group 22 of the defibrillation catheter 2A and the resistance component between the counter electrode plate 3 and the electrode group 22 of the defibrillation catheter 2B are connected in parallel is measured.

[0089] The measuring instrument 13 then outputs the measured resistance value to the calculation processing unit 15.

[0090] Next, the arithmetic processing unit 15 receives the resistance value from the measuring instrument 13 and determines whether the resistance value is within the appropriate range (step S3). The appropriate range is predetermined for each combination. The appropriate range is the range of resistance values ​​that can be measured when the components included in the combination are properly positioned. If it is determined that the resistance value is within the appropriate range (step S3: YES), the arithmetic processing unit 15 sets the charging switch to be operable and determines whether or not a charging command has been received (step S4). If the arithmetic processing unit 15 determines that a charging command has not been received (step S4: NO), it repeats step S4 until a charging command is received. Note that in step S3, the charging switch is set to be inoperable until it is determined that the resistance value is within the appropriate range.

[0091] On the other hand, when a user operates the charging switch and a charging command is output from the input unit 11b to the arithmetic processing unit 15, the arithmetic processing unit 15 receives the charging command (step S4: YES) and performs the charging process (step S5). In step S5, the arithmetic processing unit 15 controls the power supply circuit 12 so that the defibrillation energy (voltage) set by the setting switch charges the capacitor of the power supply circuit 12. The defibrillation energy is set to, for example, 10 J. The time required to charge the capacitor is, for example, about 5 seconds.

[0092] Next, the arithmetic processing unit 15 determines whether or not it has received a discharge command within a predetermined time after the completion of charging (step S6). The predetermined time is set to, for example, about 10 seconds. When a discharge command is output from the input unit 11b to the arithmetic processing unit 15 by the user operating the discharge switch, the arithmetic processing unit 15 receives the discharge command (step S6: YES) and performs the discharge process (step S7). In step S7, first, the arithmetic processing unit 15 sets the connection state of the switching circuit 14 to a connection state corresponding to the selected combination in order to apply voltages of different polarities to the two components (electrodes) included in the selected combination.

[0093] The arithmetic processing unit 15 then measures the peak of the R wave by processing the body surface signal input from the lead electrode via the connector 10g. The arithmetic processing unit 15 then outputs a trigger signal to the power supply circuit 12 in synchronization with the peak of the R wave. Here, the method for calculating the peak of the R wave will be explained in detail. For example, the arithmetic processing unit 15 samples the body surface electrocardiogram at a predetermined period, detects the peak of the R wave, and measures the rise time and fall time of the R wave. The sampling period is set to, for example, 1 millisecond. Since the R wave begins to descend when it reaches its peak, the arithmetic processing unit 15 detects the peak by monitoring the rise and fall of the R wave.

[0094] The arithmetic processing unit 15 then determines whether the R wave is a normal waveform (Narrow) or an abnormal waveform (Wide). For example, the arithmetic processing unit 15 determines that the R wave is a normal waveform if the time from the start of the rising edge of the R wave to the peak of the R wave (rise time) is within 45 milliseconds. The arithmetic processing unit 15 determines that the R wave is an abnormal waveform if the time from the start of the rising edge of the R wave to the peak of the R wave (rise time) is greater than 45 milliseconds.

[0095] The arithmetic processing unit 15 then outputs a trigger signal when it determines that the R wave is a normal waveform, based on the time t0 (see Figure 11) that has elapsed since the peak of the R wave. If voltage is not applied within 60 milliseconds from the peak of the R wave, there is a risk of inducing ventricular fibrillation. For this reason, time t0 is, for example, 10 milliseconds to 50 milliseconds. In this embodiment, time t0 is set to 10 milliseconds. Note that the conditions for determining a normal waveform, the conditions for determining an abnormal waveform, and time t0 are configured to be user-configurable.

[0096] From the intracardiac potentials input to the electrocardiograph 4 via connectors 10d and 10e, one of the intracardiac potentials selected by the user using the operating device 11 is input to the calculation processing unit 15 via connector 10f. The calculation processing unit 15 may output a trigger signal to the power supply circuit 12 in synchronization with the peak of the intracardiac potential input from the electrocardiograph 4 via connector 10f. The method of outputting the trigger signal is the same as when a surface electrocardiogram measured by lead electrodes is used.

[0097] The calculation processing unit 15 may directly use the intracardiac potential measured by the electrode group 23 of the defibrillation catheter 2A and the intracardiac potential measured by the electrode group 23 of the defibrillation catheter 2B. In this case, the calculation processing unit 15 controls the switching circuit 14 so that contacts 46a and 46c of switch 46 are connected and contacts 47a and 47c of switch 47 are connected.

[0098] If both intracardiac potentials and body surface signals are input to the arithmetic processing unit 15, the arithmetic processing unit 15 may prioritize processing the body surface signals and detect the peak of the R wave.

[0099] Then, upon receiving a trigger signal, the power supply circuit 12 releases the defibrillation energy (voltage) stored in its capacitor. As shown in Figure 11, in this embodiment, the power supply circuit 12 applies a two-phase voltage between output terminals 12a and 12b. In the graph of Figure 11, the horizontal axis represents time, and the vertical axis represents potential.

[0100] First, the power supply circuit 12 applies a voltage between output terminals 12a and 12b such that output terminal 12a is the positive terminal and output terminal 12b is the negative terminal. The voltage applied between output terminals 12a and 12b is discharged from the capacitor and therefore decays over time. After time t1 has elapsed since the start of voltage application, the power supply circuit 12 stops applying the voltage and applies a voltage with the polarity reversed between output terminals 12a and 12b such that output terminal 12a is the negative terminal and output terminal 12b is the positive terminal. Then, after time t2 has elapsed since the start of the application of the reversed voltage, the arithmetic processing unit 15 outputs a stop signal to the power supply circuit 12, and upon receiving the stop signal, the power supply circuit 12 stops applying the voltage.

[0101] Time intervals t1 and t2 are, for example, 1.5 milliseconds to 10.0 milliseconds. The magnitude (absolute value) of the peak voltage V1 is, for example, 300V to 500V. The power supply circuit 12 may apply a single-phase voltage between output terminals 12a and 12b. Time interval t is, for example, 1.0 millisecond to 30.0 milliseconds. In this embodiment, time interval t is 20.0 milliseconds. Although there is a time required to switch the voltage polarity, this time is extremely short. Therefore, time interval t is slightly larger than the sum of time intervals t1 and t2, but is substantially equal.

[0102] Here, with reference to Figures 12 to 15, we will describe some examples of the connection states of the switching circuit 14 when voltage is applied in the intracardiac defibrillation mode.

[0103] For example, when the combination of defibrillation catheter 2A and defibrillation catheter 2B is selected, the connection state of the switching circuit 14 is set to the connection state shown in Figure 12. The connection state shown in Figure 12 differs from the connection state in Figure 7 in the connection state of switches 41 and 42. Specifically, contacts 41a and 41b of switch 41 are connected, and contacts 42a and 42b of switch 42 are connected. With this configuration, the electrode group 22 of defibrillation catheter 2A is connected to output terminal 12a, and the electrode group 22 of defibrillation catheter 2B is connected to output terminal 12b. Therefore, a voltage is applied to the electrode group 22 of defibrillation catheter 2A from output terminal 12a, and a voltage is applied to the electrode group 22 of defibrillation catheter 2B from output terminal 12b. Consequently, defibrillation energy is applied between the electrode group 22 of defibrillation catheter 2A and the electrode group 22 of defibrillation catheter 2B.

[0104] When the combination of defibrillation catheter 2A and counter electrode plate 3 with defibrillation catheter 2B is selected, the connection state of the switching circuit 14 is set to the connection state shown in Figure 13. The connection state shown in Figure 13 differs from the connection state in Figure 8 in the connection state of switches 41 and 42. Specifically, contacts 41a and 41b of switch 41 are connected, and contacts 42a and 42b of switch 42 are connected. With this configuration, the electrode group 22 and counter electrode plate 3 of defibrillation catheter 2A are connected to output terminal 12a, and the electrode group 22 of defibrillation catheter 2B is connected to output terminal 12b. Therefore, voltage is applied from output terminal 12a to the electrode group 22 and counter electrode plate 3 of defibrillation catheter 2A, and voltage is applied from output terminal 12b to the electrode group 22 of defibrillation catheter 2B. Therefore, defibrillation energy is applied between the electrode group 22 of defibrillation catheter 2A and the electrode group 22 of defibrillation catheter 2B, and between the counter electrode plate 3 and the electrode group 22 of defibrillation catheter 2B.

[0105] When the combination of defibrillation catheter 2B and counter electrode plate 3 with defibrillation catheter 2A is selected, the connection state of the switching circuit 14 is set to the connection state shown in Figure 14. The connection state shown in Figure 14 differs from the connection state in Figure 9 in the connection state of switches 41 and 42. Specifically, contacts 41a and 41b of switch 41 are connected, and contacts 42a and 42b of switch 42 are connected. With this configuration, the electrode group 22 and counter electrode plate 3 of defibrillation catheter 2B are connected to output terminal 12a, and the electrode group 22 of defibrillation catheter 2A is connected to output terminal 12b. Therefore, voltage is applied from output terminal 12a to the electrode group 22 and counter electrode plate 3 of defibrillation catheter 2B, and voltage is applied from output terminal 12b to the electrode group 22 of defibrillation catheter 2A. Therefore, defibrillation energy is applied between the electrode group 22 of the defibrillation catheter 2B and the electrode group 22 of the defibrillation catheter 2A, and between the counter electrode plate 3 and the electrode group 22 of the defibrillation catheter 2A.

[0106] When the combination of the counter electrode plate 3 and defibrillation catheters 2A and 2B is selected, the connection state of the switching circuit 14 is set to the connection state shown in Figure 15. The connection state shown in Figure 15 differs from the connection state in Figure 10 in the connection state of switches 41 and 42. Specifically, contacts 41a and 41b of switch 41 are connected, and contacts 42a and 42b of switch 42 are connected. With this configuration, the counter electrode plate 3 is connected to output terminal 12a, and the electrode groups 22 of defibrillation catheters 2A and 2B are connected to output terminal 12b. Therefore, voltage is applied to the counter electrode plate 3 from output terminal 12a, and voltage is applied to the electrode groups 22 of defibrillation catheter 2A and defibrillation catheter 2B from output terminal 12b. Consequently, defibrillation energy is applied between the counter electrode plate 3 and the electrode group 22 of defibrillation catheter 2A, and between the counter electrode plate 3 and the electrode group 22 of defibrillation catheter 2B.

[0107] Once the discharge process in step S7 is complete, the arithmetic processing unit 15 switches the operating mode of the defibrillator 10 to map mode (step S9). In step S9, the arithmetic processing unit 15 sets the connection state of the switching circuit 14 to the connection state shown in Figure 6. With this, the series of processes shown in Figure 5 is completed.

[0108] On the other hand, in step S6, if the arithmetic processing unit 15 does not receive a discharge command within a predetermined time after the completion of charging (step S6: NO), it causes the capacitor of the power supply circuit 12 to discharge internally (step S8). Then, the arithmetic processing unit 15 switches the operating mode of the defibrillator 10 to map mode (step S9). With this, the series of processes shown in Figure 5 is completed.

[0109] In step S3, if it is determined that the resistance value is outside the appropriate range (step S3: NO), the calculation processing unit 15 switches the operating mode of the defibrillator 10 to map mode (step S9). This completes the series of processes shown in Figure 5. If the resistance value is outside the appropriate range, it is considered that the electrode group 22 or the counter electrode plate 3 is not properly positioned. Therefore, the user checks the intracardiac potential and readjusts the components used for defibrillation, such as the defibrillation catheters 2A and 2B and the counter electrode plate 3, to the appropriate positions. After that, the user selects the intracardiac defibrillation mode by operating the changeover switch, and the series of processes shown in Figure 5 is restarted.

[0110] In the intracardiac defibrillation system 1 described above, defibrillation catheter 2A has an electrode group 22, and defibrillation catheter 2B also has an electrode group 22. Since the two electrode groups 22 are contained in different defibrillation catheters, the degree of freedom in placing the two electrode groups 22 is improved. Therefore, the electrode groups 22 of defibrillation catheter 2A and defibrillation catheter 2B can be placed in a position close to the area where the myocardium is spasming. This allows defibrillation energy to be efficiently applied to the area where the myocardium is spasming. As a result, it is not necessary to set the defibrillation energy higher than necessary, making it possible to improve defibrillation efficiency.

[0111] The defibrillator 10 may apply a voltage to the electrode group 22 of the defibrillator catheter 2B that has a different polarity from the voltage applied to the electrode group 22 of the defibrillator catheter 2A. With this configuration, defibrillation energy can be applied between the electrode group 22 of the defibrillator catheter 2A and the electrode group 22 of the defibrillator catheter 2B.

[0112] The defibrillator 10 may apply a voltage to the counter electrode plate 3 with a polarity different from that of the voltage applied to the electrode group 22 of the defibrillation catheter 2A. With this configuration, defibrillation energy can be applied between the electrode group 22 of the defibrillation catheter 2A and the counter electrode plate 3. Similarly, the defibrillator 10 may apply a voltage to the counter electrode plate 3 with a polarity different from that of the voltage applied to the electrode group 22 of the defibrillation catheter 2B. With this configuration, defibrillation energy can be applied between the electrode group 22 of the defibrillation catheter 2B and the counter electrode plate 3.

[0113] The switching circuit 14 is configured to selectively switch between the component connected to the output terminal 12a of the power supply circuit 12 and the component connected to the output terminal 12b of the power supply circuit 12, from among the electrode group 22 of the defibrillation catheter 2A, the electrode group 22 of the defibrillation catheter 2B, and the counter electrode plate 3. Specifically, the combination of the component connected to output terminal 12a and the component connected to output terminal 12b is selected according to the connection status of switches 41 to 45. With this configuration, defibrillation can be performed using a combination selected from the electrode group 22 of the defibrillation catheter 2A, the electrode group 22 of the defibrillation catheter 2B, and the counter electrode plate 3. Therefore, it is possible to select an appropriate combination according to the location where fibrillation occurs, thereby improving the efficiency of defibrillation.

[0114] The switching circuit 14 selectively connects a combination selected from the electrode group 22 of the defibrillation catheter 2A, the electrode group 22 of the defibrillation catheter 2B, and the counter electrode plate to either the power supply circuit 12 or the measuring instrument 13. With this configuration, the defibrillator 10 can be made smaller compared to a configuration in which separate paths are provided for supplying voltage and for measuring resistance.

[0115] The defibrillation catheters 2A and 2B have electrode groups 23, which include multiple electrodes 23a. The electrocardiograph 4 measures the potentials of the electrode groups 23 of defibrillation catheter 2A and defibrillation catheter 2B. Therefore, intracardiac potentials can be measured without using an electrophysiological examination catheter.

[0116] If the resistance value of the voltage supply path is outside the appropriate range, it is considered that the electrode to which the voltage is applied (electrode group 22 or counter electrode plate 3) is not properly positioned. In order to perform defibrillation in this state, the defibrillation energy needs to be increased. In the intracardiac defibrillation system 1, voltage is applied only when the resistance value of the voltage supply path is within the appropriate range, so there is no need to excessively increase the defibrillation energy. As a result, the defibrillation efficiency can be improved.

[0117] As described above, if voltage is not applied within 60 milliseconds of the peak of the R wave or intracardiac potential, there is a risk of inducing ventricular fibrillation. The arithmetic processing unit 15 causes the power supply circuit 12 to apply voltage in synchronization with the peak of the R wave or intracardiac potential. Therefore, by applying voltage before 60 milliseconds have elapsed from the peak of the R wave or intracardiac potential, the induction of ventricular fibrillation can be prevented.

[0118] In configurations using a long electrode with multiple electrodes 22a integrated into one unit, the electrode extends in the axial direction of the tube 21, reducing the flexibility and suppleness of the defibrillation catheter. On the other hand, in defibrillation catheters 2A and 2B, the multiple electrodes 22a are provided on the outer surface of the tube 21 and are arranged in the axial direction of the tube 21. Therefore, compared to configurations using a long electrode, the flexibility and suppleness of defibrillation catheters 2A and 2B can be increased. Consequently, the operability of defibrillation catheters 2A and 2B can be improved.

[0119] In defibrillation catheters 2A and 2B, the tip 26 is located at the tip 21a of the tube 21, and one end of the pull wire 27 is fixed to the tip 26 at a position eccentric with respect to the central axis of the tube 21. Therefore, by moving the pull wire 27 forward and backward using the operating lever 28b, a force is applied to the tip 26 at a position eccentric with respect to the central axis. Consequently, the tip of the tube 21 (defibrillation catheters 2A and 2B) can be deflected. As a result, the operability of defibrillation catheters 2A and 2B can be improved.

[0120] The longer the length of the electrode 22a in the axial direction of the tube 21, the less flexible and pliable the defibrillation catheters 2A and 2B become, impairing their maneuverability. The smaller the surface area of ​​the electrode 22a, the greater the current density when voltage is applied, increasing the likelihood of damaging surrounding tissue. Each electrode 22a has a curved shape that is convex in a direction intersecting the axial direction of the tube 21. With this configuration, the surface area of ​​the electrode 22a can be increased without increasing the length of the electrode 22a in the axial direction of the tube 21. Therefore, the likelihood of damaging surrounding tissue can be reduced without impairing the maneuverability of the defibrillation catheters 2A and 2B.

[0121] When a recess 22s is formed by the end face of electrode 22a in the axial direction of tube 21 and the outer surface of tube 21, the current density increases at the periphery of the end face of electrode 22a when a voltage is applied to electrode 22a. In this case, there is a possibility of damaging surrounding tissue or causing dielectric breakdown. In contrast, in defibrillation catheters 2A and 2B, the recess 22s is filled with glue G, so the increase in current density at the periphery of the end face when a voltage is applied to electrode 22a can be suppressed. Therefore, the possibility of damaging surrounding tissue can be reduced.

[0122] Depending on the connection status of switches 41 and 42, the power supply circuit 12 and the measuring instrument 13 are selectively connected to the selected combination. Therefore, when a voltage is applied, the measuring instrument 13 is electrically isolated from the path to which the voltage is applied. On the other hand, when the resistance value of the path to which the voltage is applied is measured, the power supply circuit 12 is electrically isolated from that path. Therefore, the defibrillator 10 can be miniaturized, and interference between the power supply circuit 12 and the measuring instrument 13 can be prevented.

[0123] The intracardiac defibrillation system described herein is not limited to the embodiments described above.

[0124] The intracardiac defibrillation system 1 may further include one or more defibrillation catheters having the same configuration as defibrillation catheters 2A and 2B. The defibrillator 10 may include the same number of connectors for connecting defibrillation catheters as the number of defibrillation catheters.

[0125] The intracardiac defibrillation system 1 does not necessarily have to include a counter electrode plate 3. In this case, the defibrillator 10 does not necessarily have to include a connector 10c. The intracardiac defibrillation system 1 may include two or more counter electrode plates 3. The defibrillator 10 may include the same number of connectors for connecting counter electrode plates as the number of counter electrode plates 3.

[0126] If the intracardiac defibrillation system 1 includes a counter electrode plate 3, it may not include one of the defibrillation catheters 2A or 2B.

[0127] Each electrode 22a, like electrode 23a, may have a cylindrical shape with a substantially uniform outer diameter along its entire length in the axial direction of the tube 21.

[0128] Each electrode 22a may be attached to the outer surface of the tube 21 such that no recess 22s is formed between the outer surface of the tube 21 and the outer surface of the electrode 22a. In this case, the defibrillation catheters 2A and 2B do not need to contain glue G.

[0129] The defibrillation catheters 2A and 2B are configured to allow the tip of the tube 21 to be deflected by a pull wire 27, but the mechanism for deflecting the tip of the tube 21 is not limited to this. For example, the defibrillation catheters 2A and 2B may include a leaf spring to deflect the tip of the tube 21 in a planar manner.

[0130] Defibrillation catheters 2A and 2B do not necessarily have to include the pull wire 27. In this case, the handle 28 does not necessarily have to include the operating lever 28b.

[0131] As shown in Figures 16 and 17, the defibrillation catheters 2A and 2B may further include a lumen tube 29. Figure 16 is a schematic diagram of a modified defibrillation catheter. Figure 17 is a cross-sectional view along line XVII-XVII in Figure 16. The defibrillation catheters 2A and 2B shown in Figures 16 and 17 differ from the defibrillation catheters 2A and 2B shown in Figure 2 mainly in that they further include a lumen tube 29 and in the configuration of the handle 28.

[0132] In this modified example, the lumen tube 29 is used as a through tube for inserting the guide wire 31. The lumen tube 29 is located inside the tube 21 and extends from the base end 21b to the tip end 21a. Specifically, the lumen tube 29 extends linearly in the axial direction of the tube 21. The tip of the lumen tube 29 penetrates the tip end 26 and extends to the tip of the tip end 26. The base end of the lumen tube 29 penetrates the handle 28. The lumen tube 29 is located, for example, coaxially with the tube 21.

[0133] The lumen tube 29 is composed of a highly insulating material such as perfluoroalkyl vinyl ether copolymer (PFA) and polytetrafluoroethylene (PTFE). The lumen tube 29 may also be composed of an antithrombotic material produced by incorporating antithrombotic substances such as heparin, prostaglandins, urokinase, and arginine derivatives into these materials.

[0134] The handle 28 differs primarily from the handle 28 of the defibrillation catheters 2A and 2B shown in Figure 2, in that it does not include the operating lever 28b and in the arrangement of the connector 28d. The main body 28a also functions as a hub located at the end of the lumen tube 29. Examples of materials for the hub include thermoplastic resins such as polycarbonate, polyamide, polysulfone, polyarylate, and methacrylate-styrene copolymer. The connector 28d is positioned alongside the main body 28a. In other words, the connector 28d is located off-center from the central axis of the tube 21.

[0135] In these defibrillation catheters 2A and 2B, a guidewire is inserted into the lumen tube 29 from its proximal end and passes through the defibrillation catheters 2A and 2B. The defibrillation catheters 2A and 2B are then moved along the guidewire to the affected area. These defibrillation catheters 2A and 2B are also referred to as over-the-wire type catheters.

[0136] With this configuration, the defibrillation catheters 2A and 2B can be moved along the guidewire 31 while it is inserted into the blood vessel, thereby reaching the affected area. This simplifies the insertion procedure of the defibrillation catheters 2A and 2B.

[0137] As shown in Figure 18, the lumen tube 29 does not have to extend linearly within the tube 21. Figure 18 is a schematic diagram of another modified defibrillation catheter. The defibrillation catheters 2A and 2B shown in Figure 18 differ from the defibrillation catheters 2A and 2B shown in Figure 16 mainly in the shape of the lumen tube 29 and the configuration of the handle 28.

[0138] In this modified example, the lumen tube 29 is positioned inside the tube 21 and extends from the outer surface of the tube 21 to the tip 21a. Specifically, the lumen tube 29 extends diagonally from the outer surface of the tube 21 to the central axis of the tube 21, and further extends along the central axis to the tip of the tip 26. These defibrillation catheters 2A and 2B are also called rapid exchange type catheters.

[0139] The handle 28 includes a main body 28a and a strain relief 28c. The main body 28a also functions as a connector and includes connector pins. Each lead wire 24a and each lead wire 25a are connected to the connector pins of the main body 28a.

[0140] In this configuration as well, with the guidewire 31 inserted into the blood vessel, the defibrillation catheters 2A and 2B can be moved along the guidewire 31 to reach the affected area. Therefore, the insertion procedure for the defibrillation catheters 2A and 2B can be simplified. Furthermore, in this configuration, when replacing the defibrillation catheters 2A and 2B with spare defibrillation catheters 2A and 2B, the length of the guidewire 31 protruding from the patient P can be shortened compared to the over-the-wire type.

[0141] As shown in Figure 19, the defibrillation catheters 2A and 2B may further include a balloon 30. Figure 19 is a schematic diagram of yet another modified defibrillation catheter. The defibrillation catheters 2A and 2B shown in Figure 19 differ from the defibrillation catheters 2A and 2B shown in Figure 16 mainly in that they further include a balloon 30, the use of the lumen tube 29, and the configuration of the handle 28.

[0142] In this modified example, the lumen tube 29 is used as a supply tube for supplying fluid to the balloon 30. The fluid may be a gas, or a liquid such as physiological saline or contrast agent.

[0143] The lumen tube 29 can be made of any flexible fluororesin. Examples of such materials include highly insulating materials such as perfluoroalkyl vinyl ether copolymer (PFA) and polytetrafluoroethylene (PTFE). The lumen tube 29 may also be made of an antithrombotic material produced by incorporating antithrombotic substances such as heparin, prostaglandins, urokinase, and arginine derivatives into these materials.

[0144] The balloon 30 is an inflatable (expandable) and deflatable component. The balloon 30 can be inflated into a spherical shape, for example. The balloon 30 is provided at the tip 21a of the tube 21. Specifically, the balloon 30 is attached to the tip 26. When fluid is supplied into the balloon 30 via the lumen tube 29, the volume of the balloon 30 increases and the balloon 30 expands. When fluid is discharged from inside the balloon 30 via the lumen tube 29, the volume of the balloon 30 decreases and the balloon 30 deflates.

[0145] The balloon 30 is made of a material that has a certain degree of flexibility. Examples of such materials include polyolefins such as polyethylene, polypropylene, and ethylene-propylene copolymer; polyesters such as polyethylene terephthalate; thermoplastic resins such as polyvinyl chloride, ethylene-vinyl acetate copolymer, cross-linked ethylene-vinyl acetate copolymer, and polyurethane; polyamides; polyamide elastomers; silicone rubber; and latex rubber. The balloon 30 may have a single-layer structure or a laminated structure of two or more layers. The outer surface of the balloon 30 may be coated with an antithrombotic substance.

[0146] The handle 28 differs primarily from the handle 28 of the defibrillation catheters 2A and 2B shown in Figure 16, in that it further includes a hub 28e and in the arrangement of the connector 28d. The hub 28e is a component located at the end of the lumen tube 29. Examples of materials for the hub 28e include thermoplastic resins such as polycarbonate, polyamide, polysulfone, polyarylate, and methacrylate-styrene copolymer. The connector 28d is positioned alongside the hub 28e. In other words, the connector 28d is located off-center from the central axis of the tube 21.

[0147] These defibrillation catheters 2A and 2B are inserted into the blood vessels of patient P with the balloon 30 deflated and wrapped around the outer surface of the tube 21. Once the defibrillation catheters 2A and 2B are inserted into the blood vessels, fluid is supplied to the balloon 30, causing it to inflate. The balloon 30 then receives force from the blood flowing through the blood vessels. This allows the defibrillation catheters 2A and 2B to advance with the blood flow, thus simplifying the insertion procedure.

[0148] In the above embodiment, the defibrillation catheters 2A and 2B are single-lumen catheters, but they may also be multi-lumen catheters. For example, the defibrillation catheters 2A and 2B may further include at least one of the lumen tubes to which the lead wire group 24 extends, the lumen tube to which the lead wire group 25 extends, and the lumen tube to which the pull wire 27 extends. In this case, the defibrillation catheters 2A and 2B may further include a core filled between each lumen tube and the tube 21. The core is made of, for example, a low-hardness nylon elastomer. Furthermore, the defibrillation catheters 2A and 2B may include a blade provided between the tube 21 and the core instead of the blade 21c. Note that the blade does not need to be provided in the region of the tube 21 where the electrode group 22 is provided.

[0149] (Note) [1] A first defibrillator catheter for performing defibrillation in the cardiac chamber, comprising a first electrode group including a plurality of first electrodes, A second defibrillator catheter for performing defibrillation in the cardiac chamber, comprising a second electrode group including a plurality of second electrodes, A defibrillator comprising: a first connector for connecting the first defibrillation catheter; a second connector for connecting the second defibrillation catheter; and a power supply circuit for supplying voltage; Equipped with, The defibrillator is an intracardiac defibrillation system that applies a voltage of the same polarity to the plurality of first electrodes and a voltage of the same polarity to the plurality of second electrodes.

[0150] [2] The intracardiac defibrillation system according to [1], wherein the defibrillator applies a voltage to the plurality of second electrodes that has a polarity different from the polarity of the voltage applied to the plurality of first electrodes.

[0151] [3] It further includes a counter electrode plate for performing defibrillation on the body surface, The defibrillator further includes a third connector for connecting the counter electrode plate, The intracardiac defibrillation system according to [1] or [2], wherein the defibrillator applies a voltage to the counter electrode plate having a polarity different from the polarity of the voltage applied to the plurality of first electrodes or the plurality of second electrodes.

[0152] [4] The intracardiac defibrillation system according to [3], further comprising a switching circuit that can selectively switch between a first member connected to the first terminal of the power supply circuit and a second member connected to the second terminal of the power supply circuit, among the first electrode group, the second electrode group, and the counter electrode plate.

[0153] [5] The defibrillator further includes a measuring instrument for measuring the resistance value of the path through which the voltage is supplied. The intracardiac defibrillation system according to [4], wherein the switching circuit selectively connects the first member and the second member to either the power supply circuit or the measuring instrument.

[0154] [6] Equipped with an electrocardiograph, The first defibrillator catheter further comprises a group of third electrodes, The second defibrillator catheter further comprises a group of fourth electrodes, The electrocardiograph measures the potentials of the plurality of third electrodes and the potentials of the plurality of fourth electrodes. This is an intracardiac defibrillation system according to any one of [1] to [5].

[0155] [7] The defibrillator further comprises a measuring instrument for measuring the resistance value of the path through which the voltage is supplied, and an arithmetic processing unit for controlling the power supply circuit. The intracardiac defibrillation system according to any one of [1] to [6], wherein the calculation processing unit applies a voltage to the power supply circuit when the resistance value is within an appropriate range.

[0156] [8] The intracardiac defibrillation system according to [7], wherein the calculation processing unit applies a voltage to the power supply circuit in synchronization with the peak of the intracardiac potential.

[0157] [9] The first defibrillator catheter further comprises a tubular member, Each of the plurality of first electrodes is provided on the outer circumferential surface of the tubular member, The intracardiac defibrillation system according to any one of [1] to [8], wherein the plurality of first electrodes are arranged in the axial direction of the tubular member.

[0158]

[10] The first defibrillator catheter is A tip provided at the end of the tubular member, A pull wire having one end that is disposed within the tubular member and fixed to the tip at a position eccentric with respect to the central axis of the tubular member, An operating unit for moving the pull wire forward and backward in the axial direction, The intracardiac defibrillation system according to [9] further comprises:

[0159]

[11] The first defibrillator catheter is A balloon that can be inflated and deflated is provided at the tip of the tubular member, A supply pipe for supplying fluid to the balloon, The intracardiac defibrillation system according to [9] further comprises:

[0160]

[12] The intracardiac defibrillation system according to [9], wherein the first defibrillation catheter further comprises an insertion tube for inserting a guidewire, which is disposed within the tubular member and extends from the proximal end of the tubular member to the tip of the tubular member.

[0161]

[13] The intracardiac defibrillation system according to [9], wherein the first defibrillation catheter further comprises an insertion tube for inserting a guidewire, which is disposed within the tubular member and extends from the outer surface to the tip of the tubular member.

[0162]

[14] An intracardiac defibrillation system according to any one of [9] to

[13] , wherein each of the plurality of first electrodes has a curved shape that is convex in a direction intersecting the axial direction.

[0163]

[15] The intracardiac defibrillation system according to any one of [9] to

[14] , wherein the first defibrillation catheter further comprises an insulating member that fills a recess defined by the axial end face and the outer circumferential surface of one of the plurality of first electrodes. [Explanation of Symbols]

[0164] 1…Intracardiac defibrillation system, 2A…Defibrillation catheter (first defibrillation catheter), 2B…Defibrillation catheter (second defibrillation catheter), 3…Counter electrode plate, 4…Electrocardiograph, 10…Defibrillator, 10a…Connector (first connector), 10b…Connector (second connector), 10c…Connector (third connector), 12…Power supply circuit, 12a…Output terminal (first terminal), 12b…Output terminal (second terminal), 13…Measuring instrument, 14…Switching circuit, 15 ...Calculation processing unit, 21...Tube (tubular member), 22...Electrode group (first electrode group, second electrode group), 22a...Electrode (first electrode, second electrode), 22s...Recess, 23...Electrode group (third electrode group, fourth electrode group), 23a...Electrode (third electrode, fourth electrode), 26...Tip, 27...Pull wire, 28b...Operating lever (operating part), 29...Lumen tube (supply tube, insertion tube), 30...Balloon, 31...Guide wire, G...Glue (insulating member).

Claims

1. An intracardiac defibrillation system that performs electrical defibrillation during surgery, A first defibrillation catheter for performing defibrillation in the cardiac chamber, comprising: a first electrode group including a plurality of first electrodes; a tubular member; and an insertion tube disposed within the tubular member for inserting a guidewire; A second defibrillator catheter for performing defibrillation in the cardiac chamber, comprising a second electrode group including a plurality of second electrodes, A defibrillator having a first connector for connecting the first defibrillation catheter, a second connector for connecting the second defibrillation catheter, and a power supply circuit for supplying voltage, Equipped with, Each of the plurality of first electrodes is provided on the outer circumferential surface of the tubular member, The plurality of first electrodes are arranged in the axial direction of the tubular member, The defibrillator is an intracardiac defibrillation system that applies a voltage of the same polarity to the plurality of first electrodes and a voltage of the same polarity to the plurality of second electrodes.

2. The intracardiac defibrillation system according to claim 1, wherein the insertion tube extends from the base end of the tubular member to the tip of the tubular member.

3. The intracardiac defibrillation system according to claim 1, wherein the insertion tube extends from the outer surface to the tip of the tubular member.

4. An intracardiac defibrillation system that performs electrical defibrillation during surgery, A first defibrillation catheter for performing defibrillation in a cardiac chamber, comprising: a first electrode group including a plurality of first electrodes; a tubular member; a balloon provided on the tubular member that can be inflated and deflated; and a supply tube for supplying fluid to the balloon; A second defibrillator catheter for performing defibrillation in the cardiac chamber, comprising a second electrode group including a plurality of second electrodes, A defibrillator having a first connector for connecting the first defibrillation catheter, a second connector for connecting the second defibrillation catheter, and a power supply circuit for supplying voltage, Equipped with, Each of the plurality of first electrodes is provided on the outer circumferential surface of the tubular member, The plurality of first electrodes are arranged in the axial direction of the tubular member, The defibrillator is an intracardiac defibrillation system that applies a voltage of the same polarity to the plurality of first electrodes and a voltage of the same polarity to the plurality of second electrodes.

5. An intracardiac defibrillation system that performs electrical defibrillation during surgery, A first defibrillation catheter for performing defibrillation in a cardiac chamber, comprising: a first electrode group including a plurality of first electrodes; a tubular member; a pull wire disposed within the tubular member and deflecting the tip of the tubular member; and an operating unit for operating the pull wire. A second defibrillator catheter for performing defibrillation in the cardiac chamber, comprising a second electrode group including a plurality of second electrodes, A defibrillator having a first connector for connecting the first defibrillation catheter, a second connector for connecting the second defibrillation catheter, and a power supply circuit for supplying voltage, Equipped with, Each of the plurality of first electrodes is provided on the outer circumferential surface of the tubular member, The plurality of first electrodes are arranged in the axial direction of the tubular member, The defibrillator is an intracardiac defibrillation system that applies a voltage of the same polarity to the plurality of first electrodes and a voltage of the same polarity to the plurality of second electrodes.

6. The first defibrillator catheter further comprises a lumen tube in which the pull wire extends, The intracardiac defibrillation system according to claim 5, wherein the lumen tube is disposed within the tubular member.

7. The intracardiac defibrillation system according to any one of claims 1 to 6, wherein the defibrillator applies a voltage to the plurality of second electrodes that has a polarity different from the polarity of the voltage applied to the plurality of first electrodes.

8. Electrocardiograph and, A switching circuit that selectively switches the connection destination of the first electrode group and the connection destination of the second electrode group, Furthermore, The switching circuit is capable of selectively switching between a state in which the first electrode group is connected to the power supply circuit and a state in which the first electrode group is connected to the electrocardiograph. The switching circuit is capable of selectively switching between a state in which the second electrode group is connected to the power supply circuit and a state in which the second electrode group is connected to the electrocardiograph. The intracardiac defibrillation system according to any one of claims 1 to 6, wherein the electrocardiograph measures the potentials of the plurality of first electrodes and the potentials of the plurality of second electrodes.

9. Equipped with an electrocardiograph, The first defibrillator catheter further comprises a group of third electrodes, The second defibrillator catheter further comprises a group of fourth electrodes, The intracardiac defibrillation system according to any one of claims 1 to 6, wherein the electrocardiograph measures the potentials of the plurality of third electrodes and the potentials of the plurality of fourth electrodes.

10. It further includes a counter electrode plate for performing defibrillation on the body surface, The defibrillator further includes a third connector for connecting the counter electrode plate, The intracardiac defibrillation system according to any one of claims 1 to 6, wherein the defibrillator applies a voltage to the counter electrode plate having a polarity different from the polarity of the voltage applied to the plurality of first electrodes or the plurality of second electrodes.

11. The intracardiac defibrillation system according to claim 10, further comprising a switching circuit capable of selectively switching between a first member connected to the first terminal of the power supply circuit and a second member connected to the second terminal of the power supply circuit, among the first electrode group, the second electrode group, and the counter electrode plate.

12. The defibrillator further includes a measuring instrument for measuring the resistance value of the path through which the voltage is supplied. The intracardiac defibrillation system according to claim 11, wherein the switching circuit selectively connects the first member and the second member to either the power supply circuit or the measuring instrument.

13. The defibrillator further comprises a measuring instrument for measuring the resistance value of the path through which the voltage is supplied, and an arithmetic processing unit for controlling the power supply circuit. The intracardiac defibrillation system according to any one of claims 1 to 6, wherein the calculation processing unit applies a voltage to the power supply circuit when the resistance value is within an appropriate range.

14. The intracardiac defibrillation system according to claim 13, wherein the calculation processing unit applies a voltage to the power supply circuit in synchronization with the peak of the intracardiac potential.

15. The intracardiac defibrillation system according to any one of claims 1 to 6, wherein each of the plurality of first electrodes has a curved shape that is convex in a direction intersecting the axial direction.

16. The intracardiac defibrillation system according to any one of claims 1 to 6, wherein the first defibrillation catheter further comprises an insulating member that fills a recess defined by the axial end face and the outer circumferential surface of one of the plurality of first electrodes.

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