公开(公告)号：US06128534A

公开(公告)日：2000-10-03

申请号：US97726

申请日：1998-06-16

申请人： Euljoon Park ,  Gene A. Bornzin ,  Joseph J. Florio ,  Kerry Bradley ,  William Gibb

发明人： Euljoon Park ,  Gene A. Bornzin ,  Joseph J. Florio ,  Kerry Bradley ,  William Gibb

IPC分类号： A61N1/365

CPC分类号： A61N1/36542

摘要： Provided herein are methods and apparatus for automatically adjusting pacing parameters in implantable programmable stimulation devices, such as rate-responsive pacemakers and cardioverter defibrillators. The methods and apparatus provide a circadian varying pacing parameter (e.g., pacing rate, AV Delay, etc.) that very closely mimics the natural diurnal fluctuations of a patient's heart. Using physiological parameters that vary diurnally (e.g., minute ventilation and/or activity variance, etc.), a circadian-base value is derived. In the preferred embodiments, the physiological measurements are used to derive a histogram from which certain characteristic values are determined. These physiological characteristic values, along with the predetermined characteristic rates, automatically and periodically determine a transfer function from which the patient's appropriate circadian base rate is derived. Further contemplated herein are the use of more than one physiological parameter to derive a final circadian base rate, and stimulation devices employing these methods.

摘要翻译： 本文提供了用于自动调节可植入可编程刺激装置（例如速率响应式起搏器和心律转复除颤器）中的起搏参数的方法和装置。 所述方法和装置提供非常接近地模仿患者心脏的天然昼夜波动的昼夜节律变化起搏参数（例如，起搏速率，AV延迟等）。 使用日变化的生理参数（例如，每分通气量和/或活动方差等），得出昼夜基值。 在优选实施例中，使用生理测量来导出确定特定特征值的直方图。 这些生理特征值连同预定的特征率自动和周期性地确定导出患者适当的昼夜基础基率的传递函数。 本文进一步考虑的是使用多于一个生理参数来导出最终昼夜节律基础速率，以及采用这些方法的刺激装置。

公开(公告)号：US06512953B2

公开(公告)日：2003-01-28

申请号：US09844189

申请日：2001-04-26

申请人： Joseph J. Florio ,  Euljoon Park ,  Kerry Bradley ,  Gene A. Bornzin

发明人： Joseph J. Florio ,  Euljoon Park ,  Kerry Bradley ,  Gene A. Bornzin

IPC分类号： A61N1365

CPC分类号： A61N1/3712 ,  A61N1/3627

摘要： A system and corresponding method are provided to reliably detect capture during multi-chamber stimulation, and to further monitor the progression of congestive heart failure. The system provides a method by which intracardiac electrogram (IEGM) characteristics representing single-chamber capture and bi-ventricular capture are stored in memory and displayed. The annotation of the displayed waveforms is such that events associated with loss of capture, single-chamber capture, and bi-ventricular capture are clearly marked for ready interpretation by the physician. In a first situation, a stimulation pulse is followed by a time delay window and a subsequent depolarization complex that represents intrinsic responses of the chambers that have not been captured. In a second situation, a stimulation pulse is followed almost immediately by an evoked response that represents capture of one chamber, and a subsequent depolarization complex that represents an intrinsic response of one chamber that has not been captured. In a third situation, a stimulation pulse is almost immediately followed by an evoked response that represents simultaneous capture of two chambers.

摘要翻译： 提供了一种系统和相应的方法来可靠地检测多室刺激期间的捕获，并进一步监测充血性心力衰竭的进展。 该系统提供了一种表示单室捕获和双心室捕获的心内电图（IEGM）特征存储在存储器中并显示的方法。 显示的波形的注释使得与丢失捕获，单室捕获和双心室捕获相关联的事件被清楚地标记以供医师准备解释。 在第一种情况下，刺激脉冲之后是时间延迟窗口和随后的去极化复合体，其表示未被捕获的室的内在响应。 在第二种情况下，刺激脉冲几乎立即被跟随表示一个腔室的捕获的诱发反应，以及后续的去极化复合体，其表示一个未被捕获的腔室的固有响应。 在第三种情况下，刺激脉冲几乎紧随其后，表示同时捕获两个腔室的诱发反应。

公开(公告)号：US5991661A

公开(公告)日：1999-11-23

申请号：US954326

申请日：1997-10-17

申请人： Euljoon Park ,  Gene A. Bornzin ,  Joseph J. Florio ,  Kerry Bradley

发明人： Euljoon Park ,  Gene A. Bornzin ,  Joseph J. Florio ,  Kerry Bradley

IPC分类号： A61N1/365

CPC分类号： A61N1/36542

摘要： An implantable cardiac stimulation device, such as a pacemaker or an implantable cardioverter-defibrillator, that includes an accelerometer-based activity sensor that processes one or more signals from the activity sensor to obtain parameters that are indicative of the heartbeat of the patient. The implantable cardiac stimulation device determines when the patient is at rest and the activity sensor provides a signal that corresponds to the acceleration of the sensor due to the heartbeat of the patient. This acceleration signal is integrated over time once to provide a contractility parameter, which is indicative of the contractility of the heart and is integrated over time twice to provide a displacement parameter, which is indicative of the displacement of the heart wall during the heartbeat. This displacement parameter is thereby indicative of the volume of blood pumped by the heart. A microprocessor uses either the contractility parameter, the displacement parameter or both to modify the delivery of therapeutic stimulation pulses to the heart.

摘要翻译： 可植入心脏刺激装置，例如起搏器或植入式心律转复除颤器，其包括基于加速度计的活动传感器，其处理来自活动传感器的一个或多个信号以获得指示患者心跳的参数。 可植入心脏刺激装置确定患者何时休息，并且活动传感器提供对应于由于患者心跳引起的传感器的加速度的信号。 该加速度信号随着时间一度被积分以提供收缩性参数，其表示心脏的收缩性并且随时间积分两次以提供位移参数，其指示在心跳期间心脏壁的位移。 因此，该位移参数指示由心脏泵送的血液的体积。 微处理器使用收缩性参数，位移参数或两者来修改对心脏的治疗刺激脉冲的递送。

公开(公告)号：US06456880B1

公开(公告)日：2002-09-24

申请号：US09712861

申请日：2000-11-14

申请人： Euljoon Park ,  Joseph J. Florio ,  Kerry Bradley ,  Gene A. Bornzin ,  Laurence S. Sloman

发明人： Euljoon Park ,  Joseph J. Florio ,  Kerry Bradley ,  Gene A. Bornzin ,  Laurence S. Sloman

IPC分类号： A61N1365

CPC分类号： A61N1/3702 ,  A61N1/365

摘要： An implantable cardiac stimulation device includes a system that monitors progression or regression of a patient's heart condition. The system includes a plurality of electrode configurations for sensing cardiac activity of the heart. A sensing circuit provides an electrical signal representing electrical activity of the heart from each of the sensing electrode configurations. A processor coupled to the sensing circuit determines, at spaced apart times, and over time, a ventricular repolarization interval in each of the electrical signals and a corresponding ventricular repolarization interval dispersion. A memory stores the ventricular repolarization interval dispersions for transmission by a telemetry circuit to an external receiver for analysis.

摘要翻译： 可植入心脏刺激装置包括监测患者心脏状况的进展或消退的系统。 该系统包括用于感测心脏的心脏活动的多个电极配置。 感测电路从每个感测电极配置提供表示心脏的电活动的电信号。 耦合到感测电路的处理器在间隔开的时间和时间上确定每个电信号中的心室复极间隔和对应的心室复极间隔分散。 存储器存储用于通过遥测电路传输到外部接收器用于分析的心室复极间隔分散体。

公开(公告)号：US07085603B1

公开(公告)日：2006-08-01

申请号：US10353104

申请日：2003-01-27

申请人： Joseph J. Florio ,  Euljoon Park ,  Kerry Bradley ,  Gene A. Bornzin

发明人： Joseph J. Florio ,  Euljoon Park ,  Kerry Bradley ,  Gene A. Bornzin

IPC分类号： A61N1/365

CPC分类号： A61N1/3712 ,  A61N1/3627

摘要： A system and corresponding method are provided to reliably detect capture during multi-chamber stimulation, and to further monitor the progression of congestive heart failure. The system provides a method by which intracardiac electrogram (IEGM) characteristics representing single-chamber capture and bi-ventricular capture are stored in memory and displayed. The annotation of the displayed waveforms is such that events associated with loss of capture, single-chamber capture, and bi-ventricular capture are clearly marked for ready interpretation by the physician. In a first situation, a stimulation pulse is followed by a time delay window and a subsequent depolarization complex that represents intrinsic responses of the chambers that have not been captured. In a second situation, a stimulation pulse is followed almost immediately by an evoked response that represents capture of one chamber, and a subsequent depolarization complex that represents an intrinsic response of one chamber that has not been captured. In a third situation, a stimulation pulse is almost immediately followed by an evoked response that represents simultaneous capture of two chambers.

公开(公告)号：US06915164B2

公开(公告)日：2005-07-05

申请号：US10124164

申请日：2002-04-16

申请人： Kerry Bradley ,  Joseph J. Florio ,  Gene A. Bornzin ,  Euljoon Park

发明人： Kerry Bradley ,  Joseph J. Florio ,  Gene A. Bornzin ,  Euljoon Park

IPC分类号： A61N1/368 ,  A61N1/37

CPC分类号： A61N1/371 ,  A61N1/3684

摘要： A cardiac stimulation device and method deliver independent stimulation pulses to right and left cardiac chambers, based on the capture thresholds of each chamber, and confirm capture in each chamber. A threshold test is performed in one chamber while stimulating the opposite chamber at increased pulse energy and adjusted interchamber delay.

摘要翻译： 基于每个室的捕获阈值，心脏刺激装置和方法将独立的刺激脉冲输送到左心室和左心室，并确认每个腔室中的捕获。 在一个腔室中执行阈值测试，同时以增加的脉冲能量和调节的车间延迟刺激相反的腔室。

公开(公告)号：US5800467A

公开(公告)日：1998-09-01

申请号：US766641

申请日：1996-12-13

申请人： Euljoon Park ,  Kerry Bradley ,  Gene A. Bornzin ,  Joseph J. Florio

发明人： Euljoon Park ,  Kerry Bradley ,  Gene A. Bornzin ,  Joseph J. Florio

IPC分类号： A61N1/365 ,  A61N1/368

CPC分类号： A61N1/36521 ,  A61N1/3682

摘要： In a pacing system, the pacing controller induces the leads to deliver an impedance measurement pulse to the right ventricle of the heart at at least a 15 ms interval during a window of time following detection of the R-wave or the delivery of a pacing pulse. The window of time corresponds to a period of ventricular ejection. The two or three measured impedance values are then used to determine an impedance slope that has a strong biological correlation to the contractility of the heart. The impedance slope is then used by the controller of the pacing system to adjust the delivery of pacing pulses for purposes such as maximizing contractility for a given AV delay, PV delay and pacing rate of pacing pulses.

摘要翻译： 在起搏系统中，起搏控制器引导引线在检测到R波或递送起搏脉冲之后的窗口期间以至少15ms的间隔向心脏的右心室递送阻抗测量脉冲 。 时间窗口对应于心室射血期。 然后使用两个或三个测量的阻抗值来确定与心脏的收缩力具有强烈生物相关性的阻抗斜率。 因此，起搏系统的控制器使用阻抗斜率来调整起搏脉冲的传递，以便为给定的AV延迟最大化收缩性，起搏脉冲的PV延迟和起搏速率。

公开(公告)号：US06937900B1

公开(公告)日：2005-08-30

申请号：US10205188

申请日：2002-07-24

申请人： Anne M. Pianca ,  Gene A. Bornzin ,  Euljoon Park ,  Alan B. Vogel ,  Joseph J. Florio ,  Lee Jay Mandell ,  Junyu Mai

发明人： Anne M. Pianca ,  Gene A. Bornzin ,  Euljoon Park ,  Alan B. Vogel ,  Joseph J. Florio ,  Lee Jay Mandell ,  Junyu Mai

IPC分类号： A61N1/365 ,  A61N1/372

CPC分类号： A61N1/36542

摘要： An implantable cardiac stimulation device which determines stimulation based upon the patient's body position and activity level while eliminating special implantation or calibration procedures. To eliminate such special implantation and calibration procedures, the stimulation device correlates the patient's body position using a multi-axis DC accelerometer or other sensor during times of high activity and determines a patient's standing position value. During other times, the stimulation device compares the signals from the accelerometer to the standing position value to determine the patient's current body position. Based upon the current body position and the activity level, the stimulation device determines the necessary stimulation to deliver to the patient.

摘要翻译： 一种可植入心脏刺激装置，其基于患者的身体位置和活动水平确定刺激，同时消​​除特殊植入或校准过程。 为了消除这种特殊的植入和校准过程，刺激装置在高活动时间期间使用多轴DC加速度计或其他传感器来关联患者的身体位置并且确定患者的站立位置值。 在其他时间，刺激装置将来自加速度计的信号与站立位置值进行比较，以确定患者的当前身体位置。 基于当前身体位置和活动水平，刺激装置确定必要的刺激以递送给患者。

公开(公告)号：US07308306B1

公开(公告)日：2007-12-11

申请号：US10456060

申请日：2003-06-06

申请人： Euljoon Park ,  Peter Boileau ,  Joseph J. Florio ,  Gene A. Bornzin ,  Eric Falkenberg

发明人： Euljoon Park ,  Peter Boileau ,  Joseph J. Florio ,  Gene A. Bornzin ,  Eric Falkenberg

IPC分类号： A61N1/368

CPC分类号： A61N1/3621 ,  A61N1/365

摘要： Techniques are provided for overdrive pacing the ventricles using a pacemaker wherein an increase in an overdrive pacing rate is performed primarily to achieve a high degree of rate smoothing. The ventricles are paced at an overdrive pacing rate selected to permit the detection of the least some intrinsic ventricular pulses and then the overdrive pacing rate is dynamically adjusted based on the detected intrinsic ventricular pulses. In one example, an increase in the ventricular overdrive rate is performed only in response to detection of at least two intrinsic ventricular beats within a predetermined search period. If at least two intrinsic ventricular beats are not detected within the search period, the overdrive pacing rate is decreased. Various techniques are also provided for determining when to activate ventricular overdrive pacing depending, in part, on the capabilities of the particular pacemaker, the current mode of operation, the density of premature ventricular contractions, the degree of heart rate stability, and the presence of atrial fibrillation. Adaptive techniques for automatically adjusting ventricular overdrive pacing control parameters are also described.

摘要翻译： 提供技术用于使用起搏器超速起搏心室，其中主要执行超速起搏速率的增加以实现高程度的速率平滑。 心室以选择的超速起搏速度进行起搏，以允许检测至少一些内在的心室脉冲，然后基于检测到的内在心室脉冲来动态地调整超速起搏速率。 在一个示例中，仅在响应于在预定搜索周期内检测到至少两个本征心室搏动来执行心室超速率的增加。 如果在搜索期内未检测到至少两个内在心室搏动，则超速起搏速率降低。 还提供了各种技术来确定何时激活心室过度起搏起搏，其部分取决于特定起搏器的能力，当前的手术方式，早期心室收缩的密度，心率稳定程度以及是否存在 心房颤动。 还描述了用于自动调节心室超速起搏控制参数的自适应技术。

公开(公告)号：US07103411B1

公开(公告)日：2006-09-05

申请号：US10206483

申请日：2002-07-26

申请人： Euljoon Park ,  Gene A. Bornzin ,  Joseph J. Florio ,  John W. Poore ,  Douglas T. Kurschinski

发明人： Euljoon Park ,  Gene A. Bornzin ,  Joseph J. Florio ,  John W. Poore ,  Douglas T. Kurschinski

IPC分类号： A61N1/368

CPC分类号： A61N1/3622 ,  A61N1/3684

摘要： Techniques are described for pacing multiple sites in a patient's heart using overdrive pacing the heart using a pacemaker including techniques where the overdrive pacing rate only increases when at least two intrinsic beats are detected within a determined search period. In one specific technique, an increase in the pacing rate occurs only if two P-waves are detected within X cardiac cycles. In another specific technique, the overdrive pacing rate is increased only if at least two P-waves are detected within a block of N cardiac cycles. In both techniques, the overdrive pacing rate is decreased if no increase has occurred in the last Z cardiac cycles. By increasing the overdrive pacing rate only in response to detection of at least two P-waves within a determined number of cardiac cycles, an excessively high overdrive pacing rate is avoided. Other techniques are described for adaptively adjusting overdrive pacing parameters so as to achieve a determined target degree of pacing of, for example, 95% paced beats. By adaptively adjusting overdrive parameters to maintain a target degree of pacing, the average overdrive pacing rate is minimized while still maintaining a high number of paced beats, thereby reducing the risk of a tachyarrhythmia occurring within the patient.