JP6951058B2 - Cardiac electrical stimulator - Google Patents

Description

The present invention relates to a cardiac electrical stimulator used in connection with ablation.

Conventionally, in order to treat arrhythmia and the like, myocardial ablation treatment is known in which an electrode catheter (ablation catheter) is percutaneously inserted into the heart and a high-frequency current is applied to cauterize the affected area. Preliminary electrophysiological tests are performed when performing myocardial ablation therapy. In electrophysiological examination, an electrode catheter is placed inside the heart, and the electric potential of each part in the heart is recorded while stimulating the myocardium using an electrical stimulator to examine the conduction system and induce / stop arrhythmia. .. In this way, the ablation position is identified.

In myocardial ablation treatment, a doctor who is an operator operates an electrode catheter and gradually moves the tip of the electrode in the heart. At this time, the position of the tip electrode of the electrode catheter is imaged by an X-ray camera. The doctor confirms the electrode position by looking at the image displayed on the X-ray monitor. Then, the operator operates the high-frequency energization switch to turn on / off the energization to the ablation position according to the instruction of the doctor. If it is found from the various waveforms appearing on the electrocardiogram displayed on a polygraph (cardiac catheter examination device) that there is no effect of energization, the energization to the ablation position is cut off according to the doctor's instruction. This operation is repeated while changing the electrode position until the effect of energization appears. Then, if the effect of energization appears, high-frequency energization is continued and the affected area is cauterized.

By the way, in the conventional myocardial ablation treatment, since the esophagus is located on the back side of the affected area (atria) where ablation is actually performed, when high frequency energization is performed with a strong output or continuously for a long time. May cause unnecessary damage to the esophagus that is not related to treatment such as arrhythmia.

Therefore, when performing myocardial ablation treatment, in order to avoid damage to the esophagus, a method is adopted in which an esophageal temperature catheter is inserted into the transesophagus and the esophageal temperature during ablation is measured with an esophageal temperature monitor (patented). Reference 1).

Japanese Unexamined Patent Publication No. 2013-202264

However, in myocardial ablation treatment using a conventional cardiac electrical stimulator, polygraph, esophageal temperature monitor, etc., medical personnel such as doctors and operators must confirm the condition of the subject while looking at multiple monitors. It was annoying. There is also a drawback that the system configuration becomes complicated.

The present invention has been made in consideration of the above points, and provides a cardiac electrical stimulator that allows a medical worker to confirm the state of a subject at the time of ablation at a glance and simplify the system configuration. ..

One aspect of the cardiac electrical stimulator of the present invention is:
An electrical stimulation output unit that outputs electrical stimulation to the electrode catheter,
An electrocardiogram acquisition unit that obtains an electrocardiogram based on the intracardiac potential from the electrode catheter and the body surface potential from the body surface electrode, and
An esophageal temperature input section that inputs the esophageal temperature obtained by an esophageal temperature catheter inserted into the esophagus,
A display unit that displays the electrical stimulation waveform output from the electrical stimulation output unit, the electrocardiogram acquired by the electrocardiogram acquisition unit, and the esophageal temperature input from the esophageal temperature input unit on the same screen.
Equipped with
While the electrical stimulation waveform and the electrocardiogram are displayed in the form of waveforms traveling in the time axis direction,
The esophageal temperature is displayed in the form of a numerical value in which the esophageal temperatures of a plurality of measurement points are arranged in the direction of the time axis .

According to the present invention, medical personnel such as doctors and operators can view the electrical stimulation waveform and electrocardiogram and the esophageal temperature on the same screen while ablating, so that the condition of the subject can be confirmed at a glance. Will be. Moreover, since it is not necessary to provide an esophageal temperature monitor separately from the cardiac electrical stimulator, the system configuration can be simplified.

Schematic diagram showing the overall configuration of the cardiac electrical stimulation system according to the embodiment Rear view of the stimulator body Plan view of the structure of the control panel Diagram showing the main menu screen Diagram showing how the screen of the sub monitor is switched Diagram showing the waveform screen displayed on the sub monitor Diagram showing the esophageal temperature screen displayed on the sub monitor Diagram showing an example of the waveform screen displayed on the sub monitor Diagram showing the stimulation mode screen Diagram showing stimulus program selection / setting area A diagram showing how the basic stimulation pattern is displayed by selecting the "LEGACY" tab. Diagram showing the trigger setting area Diagram showing the measurement mode screen Diagram showing the waveform screen Diagram showing the esophageal temperature screen Diagram showing the esophageal temperature screen Diagram showing the wave and log mode screen

Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings.

<1> Overall Configuration of Cardiac Electrical Stimulation System FIG. 1 is a schematic view showing an overall configuration of a cardiac electrical stimulation system according to an embodiment of the present invention.

The cardiac electrical stimulation system 100 evaluates the conductivity of the conduction system, evaluates the automatic ability of sinus nodes, etc. by applying electrical stimulation from the electrode catheter 10 placed in the heart chamber, and the nature and generator of arrhythmia. It has become possible to examine the introduction, determine the ablation site of catheter ablation treatment, and confirm the therapeutic effect. In addition, the electrocardiographic stimulation system 100 can measure an intracardiac electrocardiogram, pacing, and impedance by using an electrode catheter 10. Further, the electrocardiographic stimulation system 100 can use the esophageal temperature catheter 20 to measure the esophageal temperature, which is effective for preventing esophageal damage during catheter ablation treatment. The esophageal temperature is measured by measuring the temperature of the electrode of the esophageal temperature catheter 20 placed in the esophagus with a thermocouple as a temperature sensor. In the example of this embodiment, the esophageal temperature is measured at seven points of the esophageal temperature catheter 20.

The cardiac electrical stimulation system 100 includes a control panel unit 200, a stimulation device main body 300, and a sub monitor 400. The control panel unit 200 and the sub monitor 400 are connected to the stimulator main body 300 by a cable. In the case of the present embodiment, the control panel unit 200 is arranged in the operation room, and the stimulator main body 300 and the sub monitor 400 are arranged in the examination room. Although the sub monitor 400 is always arranged in the examination room, the stimulator main body 300 may be arranged in the operation room. Further, when the operator operates in the examination room, the control panel 200 and the stimulator main body 300 are also arranged in the examination room.

Further, in the example of FIG. 1, the control panel unit 200 and the stimulator main body 300 are separately configured, but the control panel unit 200 and the stimulator main body 300 may be integrally configured. Essentially, the control panel unit 200 and the stimulator main body 300 constitute the cardiac electrical stimulator 500. Furthermore, the cardiac electrical stimulator 500 essentially provides a main monitor that displays the main screen of the cardiac electrical stimulator 500, an operating unit, and electrical stimulation that is supplied to the electrode catheter in response to the operation of the operating unit. It suffices to have a stimulator main body to output.

The control panel unit 200 is provided with a monitor unit and an operation unit. In the case of the present embodiment, the monitor unit has a touch panel configuration, and the operator of the stimulator 500 operates the stimulator 500 using the monitor unit and the operation unit.

In addition to the control panel unit 200 and the sub monitor 400, the stimulator main body 300 is connected to a relay cable to which the electrode catheter 10 is connected, a relay cable to which the esophageal temperature catheter 20 is connected, and the like. The stimulator main body 300 includes an amplifier and the like that form an electrical stimulation pulse to be supplied to the electrode catheter 10. The stimulator 500 of the present embodiment can perform stimulus output and measurement using a maximum of four electrode catheters 10.

FIG. 2 is a rear view showing a state of a connector provided on the back surface of the stimulator main body 300.

A power cord is connected to the power connector 301. An electrode connection cable (relay cable) is connected to the stimulus output connector 302. An isolated stimulus pulse is output from the stimulus output connector 302. An electrocardiogram signal for trigger detection is input to the external trigger input connector 303 from an external device. An esophageal temperature connection cable (relay cable) is connected to the esophageal temperature signal input connector 304. The control panel unit 200 is connected to the control panel connection connector 305. The sub monitor 400 is connected to the sub monitor connector 306. The LAN connector 307 is an expansion connector, and for example, a polygraph or the like can be connected to it. A printer is connected to the USB connector 308 for a printer.

<2> Configuration of Control Panel Unit As shown in FIG. 3, the control panel unit 200 is composed of a touch panel 210 and a fixed key 220. Frequently operated keys are assigned to the fixed keys 220. As the fixed key 220, a sub monitor screen switching key 221, a termination key 222, an emergency 223, a numerical setting dial key 224, a +/- key 225, a left / right key 226, a numeric keypad 227, a start key 228, and a stop key 229 are provided. There is.

When the sub monitor screen switching key 221 is pressed, the screen displayed on the sub monitor 400 is switched. Specifically, each time the sub-monitor screen switching key 221 is pressed, the screens displayed on the sub-monitor 400 are switched in a predetermined order. As a result, the operator can easily switch the screen of the sub monitor 400.

When the termination key 222 is pressed, the stimulator main body 300 calls a stimulus pattern for tachycardia stop, and when the start key 228 is pressed after that, the stimulus output connector 302 outputs a stimulus for tachycardia stop. When the emergency key 223 is pressed, the stimulator main body 300 forcibly outputs a fixed rate stimulus.

The numerical value setting dial key 224 can be rotated clockwise to increase the numerical value, and rotated counterclockwise to decrease the numerical value. Numerical value setting By inputting numerical values using the dial key 224, the numerical values can be gradually increased or decreased compared to the case of inputting numerical values using the numeric keypad 227. It is possible to prevent dangerous operations such as increasing the number of. The +/- key 225 is also used to increase or decrease the value. The left / right key 226 is used to move the setting target displayed on the touch panel 210.

When the start key 228 is pressed, the stimulus is output from the stimulus output connector 302. The start key 228 lights up during stimulation. When the stop key 229 is pressed, the stimulus output is stopped. The stop key 229 lights up while the stimulation is stopped.

<3> Screen configuration <3-1> Main menu and screen transition FIG. 4 shows a main menu screen displayed on the touch panel 210. The main menu screen is displayed, for example, immediately after the power of the stimulator 500 is turned on.

On the main menu screen, four mode selection keys A1 to A4, which are a stimulation mode key A1, a measurement mode key A2, an esophageal temperature mode key A3, and a wave and log (WAVE & LOG) mode key A4, are displayed as mode selection keys. When any of the mode selection keys A1 to A4 is touched by the operator, the stimulator 500 executes the mode corresponding to the touched mode selection keys A1 to A4, and displays the screen corresponding to the selected mode on the touch panel 210. indicate.

Incidentally, the stimulator 500 of the present embodiment has a wave and log (WAVE & LOG) function. This wave-and-log function includes the waveform of the electrical stimulation waveform and the electrocardiogram, and the log of the stimulation device 500 (date and time when the stimulation is output and stimulation conditions (stimulation interval, pulse width, constant voltage / constant current output value, stimulation). It is a function to record and display a channel, etc.) and a description).

In addition, setting keys B1 to B7 for setting each mode are displayed on the main menu screen. As setting keys B1 to B7, stimulation mode setting key B1, measurement mode setting key B2, esophageal temperature mode setting key B3, wave and log (WAVE & LOG) mode setting key B4, emergency setting key B5, termination setting key B6, system setting key B7 is displayed. When any of the setting keys B1 to B7 is selected by the operator by a touch operation, the stimulator 500 displays a setting screen corresponding to the selected setting key on the touch panel 210.

In addition, the taskbar C10 is displayed at the top of the main menu screen. This taskbar C10 is not limited to the main menu screen, but is commonly displayed at the upper part of each screen. The taskbar C10 includes screen transition keys C11 and C12, and a sub-monitor status display area C13.

By touching the screen transition key C11 on the left side and the screen transition key C12 on the right side, the operator can display a desired screen without returning to the main menu.

The stimulator 500 shifts to the esophageal temperature mode when the screen transition key C11 is touched in the stimulus mode. When the screen transition key C11 is touched in the wave and log mode, the mode shifts to the stimulation mode. When the screen transition key C11 is touched in the esophageal temperature mode, the screen shifts to the waveform screen in the stimulation mode. When the screen transition key C11 is touched during the waveform screen of the stimulation mode, the mode shifts to the wave and log mode. When the screen transition key C11 is touched in the measurement mode, the screen shifts to the waveform screen in the measurement mode. When the screen transition key C11 is touched during the waveform screen of the measurement mode, the mode shifts to the measurement mode.

Further, the stimulator 500 shifts to the wave-and-log mode when the screen transition key C12 is touched in the stimulus mode. When the screen transition key C12 is touched in the wave and log mode, the screen shifts to the waveform screen in the stimulation mode. When the screen transition key C12 is touched in the esophageal temperature mode, the mode shifts to the stimulation mode. When the screen transition key C12 is touched during the waveform screen of the stimulation mode, the mode shifts to the esophageal temperature mode. When the screen transition key C12 is touched in the measurement mode, the screen shifts to the waveform screen in the measurement mode. When the screen transition key C12 is touched during the waveform screen of the measurement mode, the mode shifts to the measurement mode.

In this way, the stimulator 500 can quickly switch modes by using the screen transition keys C11 and C12 that are always arranged at the upper part of each mode screen without returning to the main menu, whereby the inspection can be performed. It is expected that the time required for the inspection will be shortened and the quality of the inspection will be improved.

In particular, in the screen transition using the screen transition keys C11 and C12 of the present embodiment, the electrical stimulation waveform and the electrocardiogram are included from the stimulation control screen (that is, the stimulation mode screen E0) for controlling the formation of the electrical stimulation pulse. It is possible to directly transition to both the waveform screen (that is, the waveform screen D1) and the esophageal temperature screen (that is, the esophageal temperature screens G0 and D2) where the waveform is displayed, and from the waveform screen and the esophageal temperature screen. It is possible to directly transition to the stimulus control screen.

As a result, the operator can quickly switch the screen between the stimulus control screen and the waveform screen, and switch between the stimulus control screen and the esophageal temperature screen. As a result, screen switching can be performed centering on the stimulus control screen that the operator most often sees, and as the switching destination, the waveform screen and the esophageal temperature screen that are often seen as a reference for stimulus control are selected. Therefore, it is possible to quickly shift to the mode required by the operator, and it is possible to reduce the operational burden on the operator.

In the sub-monitor status display area C13, information indicating the type of screen currently displayed on the sub-monitor 400 is displayed. When "SUB: 1" is displayed in the sub-monitor status display area C13, the body surface electrocardiogram, the intracardiac electrocardiogram, and the electrical stimulation waveform (that is, the waveform screen) are displayed on the sub-monitor 400, and "SUB: 2". Is displayed on the sub monitor 400, and the esophageal temperature screen is displayed on the sub monitor 400. When "SUB: 3" is displayed, the screen is the same as the screen displayed on the touch panel 210 on the sub monitor 400. Is displayed. As a result, the operator can easily grasp which screen is displayed on the sub monitor 400 by looking at the sub monitor status display area C13.

That is, on the screen of the sub monitor 400, when the operator presses the sub monitor screen switching key 221, as shown in FIG. 5, the waveform screen D1 → the esophageal temperature screen D2 → the same screen as the touch panel D3 → the waveform screen D1 , However, in the sub-monitor status display area C13 of the touch panel 210, which screens D1 to D3 are currently displayed on the sub-monitor 400 can be identifiable.

In the present embodiment, numbers such as 1, 2, and 3 are displayed in the sub-monitor status display area C13 to indicate the type of screen currently displayed on the sub-monitor 400. The screen type may be indicated by, for example, characters or symbols. For example, "SUB: W" or "SUB: waveform" may be displayed instead of "SUB: 1", and "SUB: T" or "SUB: esophageal temperature" may be displayed instead of "SUB: 2". It may be displayed, and instead of "SUB: 3", "SUB: S" or "SUB: same" may be displayed.

<3-2> Screen displayed on the sub monitor FIG. 6 shows a waveform screen D1 displayed on the sub monitor 400, and FIG. 7 shows an esophageal temperature screen D2 displayed on the sub monitor 400.

A body surface electrocardiogram (ECG), an intracardiac electrocardiogram, an electrical stimulation waveform, and the like are displayed in the central portion of the waveform screen D1. In addition, numerical values such as heart rate (HR), basic stimulation cycle (CL), and esophageal temperature (TEMP) are displayed at the upper part of the waveform screen D1. As described above, by including the esophageal temperature in addition to the electrocardiogram and the electrical stimulation waveform on the waveform screen D1, the doctor can grasp the condition of the subject more comprehensively.

The esophageal temperature screen D2 includes a trend graph, real-time measured values, and real-time bar graphs for each esophageal temperature measurement points T1 to T7. The trend graph and the bar graph are color-coded for each measurement point, so that it is possible to easily recognize which measurement point the graph is. The esophageal temperature screen D2 is basically the same as the esophageal temperature screen described in detail later with reference to FIGS. 15 and 16.

Here, an example simulating the waveform screen D1 displayed on the sub monitor 400 is shown in FIG. In the figure, period a is a period during which arrhythmia is induced by electrical stimulation, period b is a period during which ablation treatment is being performed, and period c is a period during which a normal electrocardiogram is obtained by ablation treatment. .. The esophageal temperature shown in the example of FIG. 8 is the esophageal temperature at the time when the ablation treatment is completed and a normal electrocardiogram is obtained (the time at the right end in the figure). Since the temperature of the temperature also changes, the esophageal temperature that reflects it is displayed.

<3-3> Stimulation mode screen The stimulation device 500 enters the stimulation mode by touching the stimulation mode key A1 on the main menu screen of FIG. 4 or by touching the task bar C10. When the stimulation mode is entered, the stimulation mode screen E0 as shown in FIG. 9 is displayed on the touch panel 210. The operator uses the stimulation mode screen E0 to select a stimulation program, set various stimulation conditions, and start the stimulation output.

The stimulation mode screen E0 includes a stimulation program selection / setting area E1, a trigger setting area E2, and an output setting area E3. The stimulus program selection / setting area E1 is used to select and set the stimulus program output by the operator. The trigger setting area E2 is used by the operator to set the trigger relationship. The output setting area E3 is used by the operator to set the output value of the stimulus and the output channel.

FIG. 10 is an enlarged view of the stimulus program selection / setting area E1 of FIG. The stimulus program selection / setting area E1 includes a program selection key area E11, a program tab E12, and a program display change area E13.

A plurality of program selection keys (12 in the case of the example of FIG. 10) are provided in the program selection key area E11. A preset stimulus program is associated with each program selection key, and when the operator touches any of the program selection keys, the program corresponding to the selection key is called, and each stimulus time, output, and trigger. The contents of the program are reflected in the above.

Here, the content of the called program is displayed in, for example, the program display change area E13, and the operator can perform a stimulus setting in which the content of the program is changed by operating the touch panel 210 or the fixed key 220. can. In the program display change area E13, various stimulation parameters can be changed.

The program display change area E13 is provided with a return key E131 and a forward key E132. The stimulation device 500 of the present embodiment stores the setting changed after the program key is selected at the timing of starting stimulation, that is, at the timing when the start key 228 is pressed. For example, the set value can be set at the timing when the start key 228 for the past five times is pressed. Then, by touching the back key E131 and the forward key E132, the change program settings one before and one after are called and displayed. As a result, the previously set value of the stimulus output can be easily recalled and displayed, so that the same stimulus can be output again easily and quickly.

Further, even during the period after the start key 228 is pressed, if the set value of the stimulus output is changed, the changed set value may be stored. For example, if the set value is changed manually or automatically after the start key 228 is pressed, the changed set value is automatically stored. By doing so, not only at the start of the stimulus output but also a plurality of stimulus outputs actually output are stored, so that the set value that can be selected by the operator can be made more realistic.

As the program tab E12, five program tabs are always displayed, and the operator can immediately call the program according to the case by touching the program tab according to the case. Incidentally, the program tab E12 includes a "LEGACY" tab, and when the operator selects the "LEGACY" tab, the basic stimulation patterns as shown in FIG. 11 are displayed, and the operator can select from these stimulation patterns. The desired stimulation pattern can be selected.

FIG. 12 is an enlarged view of the trigger setting area E2 of FIG. The trigger channel selection key E21 is provided in the trigger setting area E2, and the operator touches the trigger channel selection key E21 to derive the intracardiac electrocardiogram signals Ch.A, Ch.B, Ch. One can be selected from five types: .C, Ch.D, body surface electrocardiogram signal INT. Derived from body surface electrodes, and EXT. Signal input from an external device. The set trigger level and the signal to be triggered are displayed in the trigger waveform display area E22, and the operator can confirm whether the signal to be triggered is surely triggered based on them.

Further, a backup channel setting key E23 is provided in the trigger setting area E2, and the operator can select a channel to be backed up by touching the backup channel setting key E23. The backup channel that can be selected is one of Ch.A to Ch.D. Next, when the operator touches the start key E24, the preparation for backup pacing on the selected channel is turned on.

<3-4> Measurement waveform screen (measurement mode screen)
The stimulator 500 enters the measurement mode by touching the measurement mode key A2 on the main menu screen of FIG. 4 or by touching the task bar C10. When the measurement mode is entered, the measurement mode screen F0 as shown in FIG. 13 is displayed on the touch panel 210.

The stimulator 500 is capable of performing simple PSA (Pacemaker System Analyzer) measurement in the measurement mode. It is also possible to perform examinations in the currently used pacing modes, waveform measurement using them, and high-rate pacing for the purpose of stopping tachyarrhythmia.

Each measured value is displayed in the measured value display area F1. In the measurement display / setting area F2, display and setting as an analyzer are performed. In the device-related setting area F3, it is possible to set the device, that is, the pacemaker to be applied to the subject and the like.

<3-5> In the waveform screen stimulator 500, for example, when the screen transition key C12 is touched on the measurement mode screen F0 of FIG. 13, the waveform screen W0 as shown in FIG. 14 is displayed on the touch panel 210.

In the waveform display area W1 of the waveform screen W0, a waveform composed of an electrical stimulation waveform and an electrocardiogram (body surface electrocardiogram and intracardiac electrocardiogram) is displayed. In the esophageal temperature display area W2, the esophageal temperature obtained by the esophageal temperature catheter 20 is displayed. In this way, on the waveform screen W0, the electrical stimulation waveform, the electrocardiogram, and the esophageal temperature are displayed on the same screen.

As a result, medical staff such as operators and doctors can see the electrical stimulation waveform and electrocardiogram and the esophageal temperature on the same screen while ablating, so that the condition of the subject can be confirmed at a glance. ..

Incidentally, T1 to T7 of the esophageal temperature display region W2 represent temperature measurement points, and the temperature of each temperature measurement point T1 to T7 is numerically displayed at the temperature measurement points T1 to T7 of the esophageal temperature display region W2. Here, among the temperature measurement points T1 to T7, the colors such as numerical values and frames can be changed at the temperature measurement points T1 to T7 that exceed the temperature threshold value described later. In this way, by highlighting the measurement points that exceed the preset temperature threshold value, the measurement points T1 to T7 that exceed the threshold value are notified. The highlighting may be any as long as the measurement point exceeding the temperature threshold can be known, and for example, blinking display or enlarged display may be performed.

<3-6> Esophageal temperature screen The stimulator 500 enters the esophageal temperature mode by touching the esophageal temperature mode key A3 on the main menu screen of FIG. 4 or by touching the task bar C10. When the esophageal temperature mode is entered, the esophageal temperature screen G0 as shown in FIG. 15 is displayed on the touch panel 210.

The esophageal temperature screen G0 includes a trend graph display area G1, a bar graph display area G2, and a temperature measurement value display area G3. In the trend graph display area G1, the measured values of each channel (that is, temperature measurement points T1 to T7) are displayed in a trend graph. In the bar graph display area G2, real-time measured values of each channel are displayed by a bar graph. In the temperature measurement value display area G3, the real-time measurement value of each channel is displayed.

Here, the esophageal temperature screen G0 of the present embodiment shows the relative difference and temporal difference of the esophageal temperature between the plurality of positions by the trend graph, and the relative esophageal temperature between the plurality of positions by the bar graph. Relative display showing the target difference and absolute display showing the esophageal temperature at multiple positions by numerical values are performed. By making such a display, doctors and operators can make a comprehensive and quick state judgment from the temporal tendency of esophageal temperature, the relative tendency between measurement points, and the temperature value of each measurement point. become able to. For example, doctors and operators can find a attention area by the temperature gradient of the trend graph and see the real-time information of the attention area to accurately and quickly recognize a dangerous state.

Further, the esophageal temperature screen G0 is provided with a channel display area G4, and each channel (that is, temperature measurement points T1 to T7) is color-coded and displayed in the channel display area G4. For example, T1 is displayed in yellow, T2 is displayed in green, and T3 is displayed in blue, and the trend graph and bar graph corresponding to the measurement point are also displayed in the same color. Here, the arrangement of the measurement points T1 to T7 in the channel display area G4 corresponds to the arrangement of the measurement points in the esophageal temperature catheter 20, and the colors of the measurement points are associated with the colors of the trend graph and the bar graph. Therefore, it is possible to intuitively grasp what kind of temperature tends to be in which part of the esophagus.

Further, the esophageal temperature screen G0 is provided with a temperature threshold value notification setting area G5, and the operator can set the threshold value by using the fixed key 220 after touching the position of the threshold value to be set. The stimulator 500 of the present embodiment can set a threshold value (UPPER LIMIT) when performing high frequency ablation (RF) and a threshold value (LOWER LIMIT) when performing cryoablation (CRYO). In addition, two levels of thresholds (1st threshold and 2nd threshold) can be set as the high frequency ablation threshold (UPPER LIMIT) and the cryoablation threshold (LOWER LIMIT), respectively. The stimulator 500 notifies by sound and display when the measured esophageal temperature rises above the high frequency ablation threshold (UPPER LIMIT) or falls below the cryoablation threshold (LOWER LIMIT). At this time, if the 1st threshold value, which is the preliminary threshold value, is exceeded, a preliminary notification is given, and if the 2nd threshold value is exceeded, further notification is given.

FIG. 15 is an esophageal temperature screen during high frequency ablation (RF), and the 1st threshold value and the 2nd threshold value set for high frequency ablation (RF) are linearly displayed in the trend graph display area G1 and the bar graph display area G2. Has been done. As a result, the relationship between the esophageal temperature at each measurement point T1 to T7 and the threshold value can be grasped at a glance, and the doctor can perform ablation more safely.

FIG. 16 is an esophageal temperature screen during cryoablation (CRYO). Switching from the screen of FIG. 15 to the screen of FIG. 16 or switching from the screen of FIG. 16 to the screen of FIG. 15 can be performed by touching the device switching key G6. In the esophageal temperature screen during cryoablation (CRYO) of FIG. 16, the 1st threshold value and the 2nd threshold value set for cryoablation (CRYO) are displayed by straight lines in the trend graph display area G1 and the bar graph display area G2. There is.

In the present embodiment, the case where the relative display showing the relative difference in esophageal temperature between a plurality of positions is performed by a bar graph has been described, but the relative difference in esophageal temperature between a plurality of positions is other than the bar graph. It may be represented by a graph. Further, in the present embodiment, on the same screen, an absolute display image in which the esophageal temperature at a plurality of positions is numerically represented, a relative display image in which the relative difference in the esophageal temperature between the plurality of positions is represented by a graph, and a plurality of images are displayed. The case of displaying the time-dependent display image showing the relative difference and the time difference of the esophageal temperature between the positions by a trend graph has been described, but the absolute display image, the relative display image, and the time-dependent display image have been described. Either two of the above may be displayed on the same screen. That is, it is most effective to display these three images on the same screen, but two images may be displayed in consideration of the size of the monitor and the like. In this case, the absolute display image and the relative display image, or the absolute display image and the time-dependent display image are displayed on the same screen without omitting the absolute display image representing the esophageal temperature at multiple positions numerically. It is preferable to do so.

<3-7> Wave and log (WAVE & LOG) screen The stimulator 500 enters the wave and log mode by touching the wave and log mode key A4 on the main menu screen of FIG. 4 or by touching the task bar C10. When the wave and log mode is entered, the wave and log mode screen H0 as shown in FIG. 17 is displayed on the touch panel 210.

The wave-and-log mode screen H0 includes a waveform display area H1, a stimulus program selection area H2, a stimulus program setting area H3, a trigger setting area H4, an output setting area H5, and a log display setting area H6. An electrocardiogram and an electrical stimulation waveform are displayed in the waveform display area H1. Further, the waveform to be drawn can be set by using the waveform display area H1. The stimulus program can be selected using the stimulus program selection area H2, the stimulus program can be set using the stimulus program setting area H3, the trigger can be set using the trigger setting area H4, and the stimulus output can be set using the output setting area H5. You can make related settings.

One of the features of the wave-and-log mode screen H0 is a waveform screen (waveform display area H1) composed of an electrocardiogram and an electrical stimulation waveform and a stimulation setting screen (stimulation program selection area H2) for setting a stimulus in the same screen. Both the stimulus program setting area H3, the trigger setting area H4, and the output setting area H5) are included. This makes it possible to set the stimulus while checking biological information such as an electrocardiogram on one screen.

Further, one feature of the wave-and-log mode screen H0 is that the log display setting area H6 is included. As described above, the stimulator 500 of the present embodiment can record and display the electrical stimulation waveform and the ECG waveform and the log of the stimulator 500 by having the wave and log (WAVE & LOG) function. can. In the log display setting area H6, a log related to the stimulus output including the operation log of the past stimulator 500 such as the stimulus start, the stimulus stop, the backup execution, the emergency start, the emergency stop, the termination start, and the termination stop is displayed. When the operator selects one of the logs, the electrical stimulation waveform, the electrocardiogram, and the electrical stimulation setting values stored corresponding to the log are displayed on the waveform screen (waveform display area H1) and the stimulation setting screen (stimulation program setting area H3). , Is displayed in the output setting area H5). As a result, the operator can easily know the causal relationship between the electrical stimulation waveform and the electrical stimulation set value and the biological information when the stimulation output was performed in the past. Further, in the case of the present embodiment, the log is provided with a comment field, and the operator can input and store the characteristics of the biological information caused by the stimulus output in the comment field.

<4> Effect of Embodiment As described above, according to the present embodiment, the electrical stimulation output unit (stimulation output connector 302) that outputs electrical stimulation to the electrode catheter 10 and the intracardiac from the electrode catheter 10 An electrocardiogram acquisition unit that obtains an electrocardiogram based on the electric potential and the body surface potential from the body surface electrodes, and an esophageal temperature input unit (esophageal temperature signal input connector 304) that inputs the esophageal temperature obtained by the esophageal temperature catheter 20 inserted into the esophagus. ), The electrical stimulation waveform output from the electrical stimulation output unit, the electrocardiogram acquired by the electrocardiogram acquisition unit, and the esophageal temperature input from the esophageal temperature input unit are displayed on the same screen W0 (touch panel 210). ), And medical personnel such as doctors and operators can see the electrical stimulation waveform and electrocardiogram and the esophageal temperature on the same screen W0 while ablating, so that the condition of the subject can be checked. You will be able to check at a glance. Moreover, since it is not necessary to provide an esophageal temperature monitor separately from the cardiac electrical stimulator, the system configuration can be simplified.

In the above-described embodiment, the case where the main monitor for displaying the main screen of the stimulator 500 is configured by the touch panel 210 has been described, but the main monitor is not configured by the touch panel but is configured by a monitor that merely displays. Input on the control panel unit may be configured to be performed using, for example, a mouse.

The above-described embodiments are merely examples of embodiment of the present invention, and the technical scope of the present invention should not be construed in a limited manner by these. That is, the present invention can be implemented in various forms without departing from its gist or its main features.

The present invention may be applied to cardiac electrical stimulation systems used in connection with ablation.

10 Electrode catheter 20 Esophageal temperature catheter 100 Cardiac electrical stimulation system 200 Control panel 210 Touch panel 220 Fixed key 221 Sub monitor screen switching key 228 Start key 300 Stimulator body 400 Sub monitor 500 Stimulator C10 Taskbar C11, C12 Screen transition key

Claims (2)

An electrical stimulation output unit that outputs electrical stimulation to the electrode catheter,
An electrocardiogram acquisition unit that obtains an electrocardiogram based on the intracardiac potential from the electrode catheter and the body surface potential from the body surface electrode, and
An esophageal temperature input section that inputs the esophageal temperature obtained by an esophageal temperature catheter inserted into the esophagus,
A display unit that displays the electrical stimulation waveform output from the electrical stimulation output unit, the electrocardiogram acquired by the electrocardiogram acquisition unit, and the esophageal temperature input from the esophageal temperature input unit on the same screen.
Equipped with
While the electrical stimulation waveform and the electrocardiogram are displayed in the form of waveforms traveling in the time axis direction,
The esophageal temperature is displayed in the form of a numerical value in which the esophageal temperatures of a plurality of measurement points are arranged in the direction of the time axis.
Cardiac electrical stimulator. The display unit performs a highlight, such as measurement points esophageal temperature exceeding the predetermined temperature threshold value pre Me is found,
The electrocardiographic stimulation device according to claim 1.

Images