公开(公告)号：EP0988089A1

公开(公告)日：2000-03-29

申请号：EP98926430.4

申请日：1998-06-09

申请人： INTERMEDICS INC.

发明人： ALT, Eckhard ,  STOTTS, Lawrence, J.

IPC分类号： A61N1/39 ,  A61N1/365

CPC分类号： A61N1/3962 ,  A61N1/36585

摘要： An implantable medical interventional device (10) is responsive to detection of any of a plurality of cardiac dysrhythmias in a human patient by performing an appropriate therapy including cardiac pacing, cardioversion or defibrillation according to the nature of the detected dysrhythmia. The device includes a first sensor means (13, 21) for detecting any of the plurality of cardiac dysrhythmias, and a generator (15, 20) for developing pulses and shocks for delivery to the patient's heart according to whether a detected dysrhythmia is bradycardia or a relatively slow pathologic tachycardia on the one hand, or a relatively fast tachycardia or fibrillation on the other hand. An optimizer (22, 24) in the device seeks to maintain at all times a substantial match of the patient's heart rate to the normal rate for a healthy person under like conditions of physical exercise, including relatively minor activity, and rest experienced by the patient. The optimizer includes a second sensor (30) to detect when the patient is engaged in physical exercise or rest as imposing different hemodynamic demands on the patient's cardiovascular system, and to produce a signal representative of the then-current hemodynamic demand. A signal processor (31) of the device enhances the signal to distinguish components thereof representing true physical exercise by the patient and the extent of such exercise from components of the signal constituting false indications of activity by the patient. The enhanced signal is applied to the generator (15) to develop pulses for delivery to the patient's heart to vary the heart rate to conform to the then-current hemodynamic demand on the patient attributable to the conditions of physical exercise or rest. In that way, the device focuses on correction of cardiac pacing problems before they become sufficiently aggravated to require more aggressive cardioversion and defibrillation therapies.

公开(公告)号：EP0988084A1

公开(公告)日：2000-03-29

申请号：EP98926538.4

申请日：1998-06-09

申请人： INTERMEDICS INC.

发明人： ALT, Eckhard, U. ,  STOTTS, Lawrence, J.

IPC分类号： A61N1/05

CPC分类号： A61N1/056

摘要： A device for implanting small diameter conductive leads for an artifical cardiac pacemaker or other body-implantable medical device includes a stylet (22) for guiding the lead along a predetermined path within the patient's body. At least a portion (25, 27) of the stylet which is to traverse the path has an enhanced radiopaque characteristic attributable to the application or addition to the material of which the stylet is composed of a substance having such radiopaque characteristic. When viewed under fluoroscopy external to the patient's body as the lead is maneuvered along the path, although the thin lead itself may be difficult to see, the stylet is readily discernible by virtue of its enhanced radiopacity, thereby enabling the physician to position the lead at a desired location within the patient's body. For various reasons,the thin lead itself may not be amenable to similar enhancement, which makes the stylet a suitable solution. A portion of the distal end of the stylet, such as its distal tip (25) or a plurality of spaced apart points (25, 27) along its distal end, is provided with the enhanced radiopacity, as by application or addition of gold to the stylet material.

公开(公告)号：EP0942771A1

公开(公告)日：1999-09-22

申请号：EP97946478.0

申请日：1997-10-31

申请人： INTERMEDICS INC.

发明人： STOTTS, Lawrence, J. ,  SCHROEPPEL, Edward, A.

IPC分类号： A61N1

CPC分类号： A61N1/36521

摘要： An implantable, rate responsive pacemaker (10), sensitive to impedance changes (42) in the heart, wherein the cardiac pacing rate and maximum cardiac pacing rate, or either of them, are adjusted as a function of an interval between either the administration of a pacing pulse or the detection of the R-wave and the occurrence of a maximum detected impedance, called the intercept interval. Because an intercept point of the derivative (114) of the impedance curve is detected, the apparatus and method are insensitive to electrode characteristics, electrode movement, body posture or other factors which could affect the magnitude of the detected impedance. The information contained in the intercept interval can also be combined with other sensed or calculated information to set the desired rates.

公开(公告)号：EP0906137A1

公开(公告)日：1999-04-07

申请号：EP97926498.0

申请日：1997-05-14

申请人： SULZER INTERMEDICS INC.

发明人： ALT, Eckhard ,  STOTTS, Lawrence, J.

IPC分类号： G06F21 ,  A61N1 ,  G06F9 ,  G06Q50

CPC分类号： A61N1/37264 ,  A61N1/37211 ,  A61N1/3962 ,  G06F8/64 ,  G06F8/65 ,  G06F19/00 ,  Y10S128/903

摘要： An implantable cardioverter/defibrillator device is implemented to be selectively non-invasively upgraded from time to time after implantation to enable the device to provide additional therapy for arrhythmia treatment as the patient's need for such treatment undergoes change. The device is adapted to provide a plurality of functions corresponding to different levels of therapy for treating arrhythmias, and to respond to each different type of arrhythmia that may be sensed, to supply a function which is designated as being appropriate to relieve that respective arrhythmia. Each function is not necessarily unique to treating a particular arrhythmia, and, in at least some instances, may be used to treat more than one of the plurality of different types of arrhythmias. At the time of its implant, the device is restricted from providing those of the plurality of functions which are deemed as being non-essential to the patient's needs at that time. From time to time thereafter, however, as the patient experiences periodic need for additional therapy, restricted functions of the device are selectively restored by external programming, but only if the programmer is able to supply to the device an enabling code which is substantially unique to that device. In this way, restoration of the restricted functions is locked out except with a prescribed key.

公开(公告)号：EP0988089B1

公开(公告)日：2006-11-29

申请号：EP98926430.4

申请日：1998-06-09

申请人： INTERMEDICS INC.

发明人： ALT, Eckhard ,  STOTTS, Lawrence, J.

IPC分类号： A61N1/39 ,  A61N1/365

CPC分类号： A61N1/3962 ,  A61N1/36585

摘要： An implantable medical interventional device (10) is responsive to detection of any of a plurality of cardiac dysrhythmias in a human patient by performing an appropriate therapy including cardiac pacing, cardioversion or defibrillation according to the nature of the detected dysrhythmia. The device includes a first sensor means (13, 21) for detecting any of the plurality of cardiac dysrhythmias, and a generator (15, 20) for developing pulses and shocks for delivery to the patient's heart according to whether a detected dysrhythmia is bradycardia or a relatively slow pathologic tachycardia on the one hand, or a relatively fast tachycardia or fibrillation on the other hand. An optimizer (22, 24) in the device seeks to maintain at all times a substantial match of the patient's heart rate to the normal rate for a healthy person under like conditions of physical exercise, including relatively minor activity, and rest experienced by the patient. The optimizer includes a second sensor (30) to detect when the patient is engaged in physical exercise or rest as imposing different hemodynamic demands on the patient's cardiovascular system, and to produce a signal representative of the then-current hemodynamic demand. A signal processor (31) of the device enhances the signal to distinguish components thereof representing true physical exercise by the patient and the extent of such exercise from components of the signal constituting false indications of activity by the patient. The enhanced signal is applied to the generator (15) to develop pulses for delivery to the patient's heart to vary the heart rate to conform to the then-current hemodynamic demand on the patient attributable to the conditions of physical exercise or rest. In that way, the device focuses on correction of cardiac pacing problems before they become sufficiently aggravated to require more aggressive cardioversion and defibrillation therapies.

公开(公告)号：EP0730480B1

公开(公告)日：2000-08-09

申请号：EP95933847.6

申请日：1995-09-19

申请人： INTERMEDICS INC.

发明人： GARCIA, John ,  ALT, Eckhard ,  STOTTS, Lawrence, J.

IPC分类号： A61N1/05

CPC分类号： A61N1/05 ,  A61N1/375

摘要： A pulse generator for a cardiac pacemaker is adapted to be implanted beneath the skin and adjacent the musculus with either of its two sides facing the musculus and its other side facing outwardly of the patient's body, at the option of the implanting surgeon, according to the desired orientation of the receptacle of the header for connection of an electrode lead to the pulse generator, and at the same time avoiding the presence of spurious signals attributable to flexation of the adjacent musculus and twitching attributable to stimulation of the adjacent musculus during operation of the pulse generator when implanted. To that end, the entire surface of the case is coated with an electrically insulative, biocompatible film except along a portion of the edge of the case between its two major sides which is to serve as an anodal contact surface for stimulating and sensing cardiac activity of the patient.

公开(公告)号：EP1098675A2

公开(公告)日：2001-05-16

申请号：EP99934177.9

申请日：1999-07-23

申请人： INTERMEDICS INC. ,  Alt, Eckhard, Dr. ,  Sanders, Richard ,  Stotts, Lawrence J.

发明人： ALT, Eckhard ,  SANDERS, Richard ,  STOTTS, Lawrence, J.

IPC分类号： A61N1/368 ,  A61N1/39 ,  A61N1/05

CPC分类号： A61N1/3627 ,  A61N1/0563 ,  A61N1/368 ,  A61N1/395 ,  A61N1/3962

摘要： Device and method are disclosed in which leads with pacing and defibrillating electrodes are implanted into both the right and left ventricles of a patient's heart to enable simultaneous pacing of both ventricles to reduce the width of the QRS complex of the patient's cardiac activity to a more normal duration, and, when appropriate, to apply electrical shock waveforms to both ventricles simultaneously for lower energy defibrillation of the ventricles. In applying the defibrillation therapy, the defibrillating electrode in the left ventricle may be used as the anode and the defibrillating electrode in the right ventricle may be used as the cathode, or both ventricular defibrillating electrodes may be the anode and the metal case in which the shock waveform generator is implanted may be the cathode. Implanting a lead with pacing and defibrillating electrodes in the right atrium enables selective pacing and defibrillation of the atria, in which atrial fibrillation is treated by applying the shock waveform across the right atrial and left ventricular defibrillation electrodes.

公开(公告)号：EP0930914A1

公开(公告)日：1999-07-28

申请号：EP98926505.0

申请日：1998-06-10

申请人： SULZER INTERMEDICS INC.

发明人： ALT, Eckhard, U. ,  STOTTS, Lawrence, J.

IPC分类号： A61N1

CPC分类号： A61N1/3704 ,  A61N1/3943

摘要： A defibrillator (112) is designed for implantation in a patient and for programming certain of its parameters after implantation, including energy content of a shock waveform and timing of delivery of the shock waveform. A shock waveform generator (59) of the device is responsive to a trigger signal for timed production of a shock waveform having a programmable shape and energy content designed for terminating atrial or ventricular fibrillation (AF or VF) of the patient. A detection circuit (50, 55, 56) processes a sensed cardiac signal of the patient to determine the relative timing of various portions of the cardiac signal, including the P-wave and the T-wave. In a test mode of the device, the energy content of a shock waveform is programmed to a magnitude exceeding the upper limit of vulnerability (ULV) of the patient, and the trigger signal times the delivery of a shock waveform of proper magnitude relative to the occurrence of a selected event in the cardiac signal, such as a cardiac stimulus, the P-wave or QRS complex, for application to the patient's heart coincident with the vulnerable period of a P-wave or a T-wave. The probable ULV of the patient's heart is determined or estimated, the defibrillator is set to deliver a shock of sufficient energy to exceed the probable ULV, and delivery of the shock is initiated into the vulnerable period of the P-wave or T-wave. The defibrillator (12) is selected with the capacity to deliver a shock of maximum energy exceeding the probable ULV by a margin deemed to provide an adequate safety margin for the patient. The occurrence of the vulnerable period of the P-wave or T-wave is precisely timed from a predetermined event in the patient's cardiac signal.

公开(公告)号：EP0730480A1

公开(公告)日：1996-09-11

申请号：EP95933847.0

申请日：1995-09-19

申请人： INTERMEDICS INC.

发明人： GARCIA, John ,  ALT, Eckhard ,  STOTTS, Lawrence, J.

IPC分类号： A61N1

CPC分类号： A61N1/05 ,  A61N1/375

摘要： A pulse generator for a cardiac pacemaker is adapted to be implanted beneath the skin and adjacent the musculus with either of its two sides facing the musculus and its other side facing outwardly of the patient's body, at the option of the implanting surgeon, according to the desired orientation of the receptacle of the header for connection of an electrode lead to the pulse generator, and at the same time avoiding the presence of spurious signals attributable to flexation of the adjacent musculus and twitching attributable to stimulation of the adjacent musculus during operation of the pulse generator when implanted. To that end, the entire surface of the case is coated with an electrically insulative, biocompatible film except along a portion of the edge of the case between its two major sides which is to serve as an anodal contact surface for stimulating and sensing cardiac activity of the patient.

公开(公告)号：EP0906137B1

公开(公告)日：2004-12-29

申请号：EP97926498.3

申请日：1997-05-14

申请人： INTERMEDICS INC.

发明人： ALT, Eckhard ,  STOTTS, Lawrence, J.

IPC分类号： A61N1/372

CPC分类号： A61N1/37264 ,  A61N1/37211 ,  A61N1/3962 ,  G06F8/64 ,  G06F8/65 ,  G06F19/00 ,  Y10S128/903

摘要： An implantable cardioverter/defibrillator device is implemented to be selectively non-invasively upgraded from time to time after implantation to enable the device to provide additional therapy for arrhythmia treatment as the patient's need for such treatment undergoes change. The device is adapted to provide a plurality of functions corresponding to different levels of therapy for treating arrhythmias, and to respond to each different type of arrhythmia that may be sensed, to supply a function which is designated as being appropriate to relieve that respective arrhythmia. Each function is not necessarily unique to treating a particular arrhythmia, and, in at least some instances, may be used to treat more than one of the plurality of different types of arrhythmias. At the time of its implant, the device is restricted from providing those of the plurality of functions which are deemed as being non-essential to the patient's needs at that time. From time to time thereafter, however, as the patient experiences periodic need for additional therapy, restricted functions of the device are selectively restored by external programming, but only if the programmer is able to supply to the device an enabling code which is substantially unique to that device. In this way, restoration of the restricted functions is locked out except with a prescribed key.