公开(公告)号：US07130684B2

公开(公告)日：2006-10-31

申请号：US10426730

申请日：2003-04-30

申请人： Lawrence J. Mulligan ,  Michael R. S. Hill ,  John E. Burnes

发明人： Lawrence J. Mulligan ,  Michael R. S. Hill ,  John E. Burnes

IPC分类号： A61N1/362

CPC分类号： A61N1/36514 ,  A61N1/3627

摘要： Methods and devices for improving ventricular contractile status of a patient suitably exploit changes in ventricular pressure and/or dP/dtmax to provide and/or optimize a response to a patient. The ventricular pressure may be appropriately correlated to intracellular calcium regulation, which is indicative of contractile status. To assess ventricular contractile status, the device suitably observes a cardiac perturbation of the patient and measures force interval potentiation following the perturbation. The contractile potentiation can then be stored and/or quantified in the implantable medical device to determine the ventricular contractile status of the patient, and an appropriate response may be provided to the patient as a function of the ventricular contractile status. Examples of responses may include administration of drug or neuro therapies, modification of a pacing rate, or the like. Force interval potentiation may also be used to optimize or improve a parameter for a response provided by the implantable medical device.

摘要翻译： 用于改善患者的心室收缩状态的方法和装置适当地利用心室压力和/或dP / dt最大值的变化来提供和/或优化对患者的反应。 心室压力可以适当地与细胞内钙调节相关，细胞内钙调节指示收缩状态。 为了评估心室收缩状态，该装置适当地观察患者的心脏摄动，并测量扰动后的力间隔增强作用。 收缩增强能随后在可植入的医疗装置中被储存和/或定量，以确定患者的心室收缩状态，并且作为心室收缩状态的函数可以向患者提供适当的响应。 反应的实例可包括药物或神经疗法的施用，起搏速率的改变等。 力间隔增强也可用于优化或改善由可植入医疗装置提供的响应的参数。

公开(公告)号：US07079887B2

公开(公告)日：2006-07-18

申请号：US10394778

申请日：2003-03-20

申请人： John E. Burnes ,  Lawrence J. Mulligan ,  Michael R. S. Hill

发明人： John E. Burnes ,  Lawrence J. Mulligan ,  Michael R. S. Hill

IPC分类号： A61B5/04

CPC分类号： A61B5/02405 ,  A61B5/0245 ,  A61N1/3622 ,  A61N1/3627 ,  A61N1/365 ,  A61N1/3682

摘要： A hemodynamic status of a patient is determined in an implanted medical device (IMD) by observing a perturbation of the patient's heart, measuring heart rate turbulence resulting from the perturbation, and quantifying the heart rate turbulence to determine the hemodynamic status. The perturbation may be naturally-occurring, or may be generated by the implantable medical device. The patient's response to heart rate turbulence may also be used to provide a response to the patient, such as providing an alarm and/or administering a therapy. Heart rate turbulence may also be used to tune and/or optimize a device parameter such as A-V or V—V pacing intervals.

摘要翻译： 通过观察患者心脏的扰动，测量由扰动引起的心率湍流并量化心率湍流以确定血液动力学状态，在植入的医疗装置（IMD）中确定患者的血液动力学状态。 扰动可以是天然存在的，或者可以由可植入医疗装置产生。 患者对心率湍流的反应也可用于向患者提供反应，例如提供警报和/或施用治疗。 心率湍流也可用于调节和/或优化诸如A-V或V-V起搏间隔的装置参数。

公开(公告)号：US06738667B2

公开(公告)日：2004-05-18

申请号：US09750631

申请日：2000-12-28

申请人： D. Curtis Deno ,  Lawrence J. Mulligan ,  Tom D. Bennett ,  David A. Igel ,  Michael R. S. Hill ,  Richard J. Shaw

发明人： D. Curtis Deno ,  Lawrence J. Mulligan ,  Tom D. Bennett ,  David A. Igel ,  Michael R. S. Hill ,  Richard J. Shaw

IPC分类号： A61N118

CPC分类号： A61N1/3627 ,  A61N1/36564

摘要： An implantable stimulator and monitor measures a group of heart failure parameters indicative of the state of heart failure employing EGM signals, measures of blood pressure including absolute pressure P, developed pressure (DP=systolic P−diastolic P), and/or dP/dt, and measures of heart chamber volume (V) over one or more cardiac cycles. These parameters include: (1) relaxation or contraction time constant tau (&tgr;); (2) mechanical restitution (MR), i.e., the mechanical response of a heart chamber to premature stimuli applied to the heart chamber; (3) recirculation fraction (RF), i.e., the rate of decay of PESP effects over a series of heart cycles; and (4) end systolic elastance (EES), i.e., the ratios of end systolic blood pressure P to volume V. These heart failure parameters are determined periodically regardless of patient posture and activity level. The physician can determine whether a particular therapy is appropriate, prescribe the therapy for a period of time while again accumulating the stored patient data for a later review and assessment to determine whether the applied therapy is beneficial or not, thereby enabling periodic changes in therapy, if appropriate. Drug therapies and electrical stimulation therapies, including PESP stimulation, and pacing therapies including single chamber, dual chamber and multi-chamber (bi-atrial and/or bi-ventricular) pacing can be delivered. In patient's prone to malignant tachyarrhythmias, the assessment of heart failure state can be taken into account in setting parameters of detection or classification of tachyarrhythmias and the therapies that are delivered.

摘要翻译： 可植入的刺激器和监测器测量一组指示使用EGM信号的心力衰竭状态的心力衰竭参数，包括绝对压力P的血压测量，开发压力（DP =收缩期舒张压P）和/或dP / dt ，以及一个或多个心动周期的心室容量（V）的测量。 这些参数包括：（1）松弛或收缩时间常数τ（τ）; （2）机械恢复（MR），即心脏室对施加到心脏室的过早刺激的机械响应; （3）循环分数（RF），即一系列心脏循环中PESP效应的衰减速率; 和（4）收缩末期弹性（EES），即收缩末期血压P与体积V的比值。不管患者的姿势和活动水平如何，这些心力衰竭参数是周期性确定的。 医生可以确定特定治疗是否合适，在一段时间内开出治疗，同时再次累积存储的患者数据以供稍后进行检查和评估，以确定所应用的治疗是否有益，从而使治疗周期性变化， 如果合适的话。 可以提供药物治疗和电刺激疗法，包括PESP刺激和起搏治疗，包括单室，双室和多室（双心房和/或双心室）起搏。 在患者易发生恶性快速性心律失常的情况下，可以在设定快速性心律失常检测或分类参数和所传递的治疗方案时考虑心力衰竭状态的评估。

公开(公告)号：US06438408B1

公开(公告)日：2002-08-20

申请号：US09751079

申请日：2000-12-28

申请人： Lawrence J. Mulligan ,  D. Curtis Deno ,  Tom D. Bennett ,  David A. Igel ,  Michael R. S. Hill

发明人： Lawrence J. Mulligan ,  D. Curtis Deno ,  Tom D. Bennett ,  David A. Igel ,  Michael R. S. Hill

IPC分类号： A61B50452

CPC分类号： A61N1/36564 ,  G06F19/00

摘要： An implantable stimulator and monitor measures a group of heart failure parameters indicative of the state of heart failure employing EGM signals, measures of blood pressure including absolute pressure P, developed pressure (DP=systolic P−diastolic P), and/or dP/dt, and measures of heart chamber volume (V) over one or more cardiac cycles. These parameters include: (1) relaxation or contraction time constant tau (&tgr;); (2) mechanical restitution (MR), i.e., the mechanical response of a heart chamber to premature stimuli applied to the heart chamber; (3) recirculation fraction (RF), i.e., the rate of decay of PESP effects over a series of heart cycles; and (4) end systolic elastance (EES), i.e., the ratios of end systolic blood pressure P to volume V. These heart failure parameters are determined periodically regardless of patient posture and activity level. However, certain of the parameters are only measured or certain of the data are only stored when the patient heart rate is regular and within a normal sinus range between programmed lower and upper heart rates. The parameter data is associated with a date and time stamp and with other patient data, e.g., patient activity level, and the associated parameter data is stored in IMD memory for retrieval at a later date employing conventional telemetry systems. Incremental changes in the parameter data over time, taking any associated time of day and patient data into account, provide a measure of the degree of change in the heart failure state of the heart.

摘要翻译： 可植入的刺激器和监测器测量一组指示使用EGM信号的心力衰竭状态的心力衰竭参数，包括绝对压力P的血压测量，开发压力（DP =收缩期舒张压P）和/或dP / dt ，以及一个或多个心动周期的心室容量（V）的测量。 这些参数包括：（1）松弛或收缩时间常数τ（＆tgr;）; （2）机械恢复（MR），即心脏室对施加到心脏室的过早刺激的机械响应; （3）循环分数（RF），即一系列心脏循环中PESP效应的衰减速率; 和（4）收缩末期弹性（EES），即收缩末期血压P与体积V的比值。不管患者的姿势和活动水平如何，这些心力衰竭参数是周期性确定的。 然而，仅测量某些参数，或仅当患者心率为规律且在编程的较低和较高心率之间的正常窦范围内时才存储某些数据。 参数数据与日期和时间戳以及与其他患者数据（例如患者活动水平）相关联，并且相关联的参数数据存储在IMD存储器中，以便以后采用常规遥测系统进行检索。 随着时间的推移，随着时间的推移，随着时间的推移和相关的患者数据的变化，可以提供心脏心力衰竭状态的变化程度。

公开(公告)号：US08315713B2

公开(公告)日：2012-11-20

申请号：US12433768

申请日：2009-04-30

申请人： John E. Burnes ,  Mary M. Morris ,  Michael R. S. Hill ,  Avram Scheiner ,  Ruth N. Klepfer ,  Matthew D. Bonner

发明人： John E. Burnes ,  Mary M. Morris ,  Michael R. S. Hill ,  Avram Scheiner ,  Ruth N. Klepfer ,  Matthew D. Bonner

IPC分类号： A61N1/00

CPC分类号： A61N1/36053 ,  A61M25/09 ,  A61N1/05 ,  A61N1/0551 ,  A61N1/0558 ,  A61N1/057 ,  A61N1/36085 ,  A61N1/36114 ,  A61N1/36125 ,  A61N1/36128

摘要： This disclosure is directed to extra, intra, and transvascular medical lead placement techniques for arranging medical leads and electrical stimulation and/or sensing electrodes proximate nerve tissue within a patient.

摘要翻译： 本公开涉及用于在患者体内靠近神经组织布置医疗引线和电刺激和/或感测电极的额外的，内部的和经血管内的医疗引线放置技术。

公开(公告)号：US07155278B2

公开(公告)日：2006-12-26

申请号：US10419405

申请日：2003-04-21

申请人： Gary W. King ,  Marcus J. Mianulli ,  Michael R. S. Hill ,  Thomas J. Mullen ,  Roy L. Testerman ,  John E. Burnes ,  Xiaohong Zhou

发明人： Gary W. King ,  Marcus J. Mianulli ,  Michael R. S. Hill ,  Thomas J. Mullen ,  Roy L. Testerman ,  John E. Burnes ,  Xiaohong Zhou

IPC分类号： A61N1/36

CPC分类号： A61N1/3601 ,  A61N1/36017 ,  A61N1/36114

摘要： Neurostimulation is delivered to one or more predetermined locations on or within a patient in order to treat effects of sleep apnea by modulating autonomic nervous activity. Delivery of neurostimulation at predetermined locations can decrease sympathetic nervous activity and/or increase parasympathetic nervous activity, countering the increased intrinsic sympathetic activity associated with apnea-arousal cycles. In some embodiments, neurostimulation is delivered to the spinal cord of the patient via an implanted electrode. In other embodiments, neurostimulation is delivered transcutaneously to the spinal cord or other locations via electrodes located on the surface of the patient. In some embodiments, delivery of neurostimulation is initiated or modified in response to detection of apneas.

摘要翻译： 神经刺激被递送到患者体内或患者内的一个或多个预定位置，以通过调节自主神经活动来治疗睡眠呼吸暂停的影响。 在预定位置递送神经刺激可降低交感神经活动和/或增加副交感神经活动，抵抗与呼吸暂停 - 觉醒周期相关的增加的内在交感神经活动。 在一些实施方案中，神经刺激经由植入的电极递送至患者的脊髓。 在其他实施方案中，神经刺激通过位于患者表面上的电极经皮递送至脊髓或其它位置。 在一些实施方案中，响应于呼吸暂停的检测开始或修饰神经刺激的递送。

公开(公告)号：US07697984B2

公开(公告)日：2010-04-13

申请号：US11112730

申请日：2005-04-22

申请人： Michael R. S. Hill ,  Kenneth R. Jonkman

发明人： Michael R. S. Hill ,  Kenneth R. Jonkman

IPC分类号： A61N1/372

CPC分类号： A61N1/36114 ,  A61B17/3417 ,  A61B2017/00243 ,  A61B2017/00969 ,  A61B2017/0243 ,  A61B2017/3445 ,  A61B2017/3449 ,  A61N1/056 ,  A61N1/362 ,  A61N1/385 ,  A61N1/3962

摘要： An electro-stimulation device includes a pair of electrodes for connection to at least one location in the body that affects or regulates the heartbeat. The electro-stimulation device both electrically arrests the heartbeat and stimulates the heartbeat. A pair of electrodes are provided for connection to at least one location in the body that affects or regulates the heartbeat. The pair of electrodes may be connected to an intravenous catheter for transvenous stimulation of the appropriate nerve. In another aspect, the invention is directed to a method for arresting the beat of a heart in a living body comprising the steps of connecting the pair of electrodes to at least one location in the body that affects or regulates the heartbeat and supplying an electrical current to the electrodes of sufficient amplitude and duration to arrest the heartbeat.

摘要翻译： 电刺激装置包括一对电极，用于连接到体内至少一个影响或调节心跳的位置。 电刺激装置既电气阻止心跳并刺激心跳。 提供一对电极用于连接到体内至少一个影响或调节心跳的位置。 该对电极可以连接到静脉导管，用于适当神经的经静脉刺激。 另一方面，本发明涉及一种用于在生物体中阻止心脏的搏动的方法，包括以下步骤：将一对电极连接到体内至少一个位置，其影响或调节心跳并提供电流 到足够的幅度和持续时间的电极以阻止心跳。

公开(公告)号：US07367951B2

公开(公告)日：2008-05-06

申请号：US11044617

申请日：2005-01-27

申请人： Tommy D. Bennett ,  Mark Choi ,  David A. Igel ,  Michael R. S. Hill ,  Teresa A. Whitman ,  Douglas A. Hettrick

发明人： Tommy D. Bennett ,  Mark Choi ,  David A. Igel ,  Michael R. S. Hill ,  Teresa A. Whitman ,  Douglas A. Hettrick

IPC分类号： A61B5/02

CPC分类号： A61B5/0215 ,  A61B5/02028 ,  A61B5/02108 ,  A61B5/042 ,  A61B5/0456 ,  A61N1/36564

摘要： A cardiovascular analysis system and method includes an implantable medical device with a sensor positioned to sense a hemodynamic pressure over time. The implantable medical device generates hemodynamic pressure waveform data based upon the hemodynamic pressure sensed. A processor analyzes the hemodynamic waveform data to provide an indication of cardiovascular health based upon prominent peaks in the hemodynamic waveform data.

摘要翻译： 心血管分析系统和方法包括具有传感器的可植入医疗装置，所述传感器定位成随时间感测血流动力学压力。 可植入医疗装置基于感测的血流动力学压力产生血流动力学压力波形数据。 处理器分析血液动力学波形数据，以基于血流动力学波形数据中突出的峰值提供心血管健康的指示。

公开(公告)号：US06628987B1

公开(公告)日：2003-09-30

申请号：US09669355

申请日：2000-09-26

申请人： Michael R. S. Hill ,  Scott E. Jahns ,  James R. Keogh

发明人： Michael R. S. Hill ,  Scott E. Jahns ,  James R. Keogh

IPC分类号： A61N136

CPC分类号： A61N1/36114 ,  A61N1/385

摘要： A system of performing a medical procedure, such as surgery, is provided. The system comprises a sensor to sense a state of cardiac tissue, such as an impending contraction and an indicator to indicate the state of the cardiac tissue. Methods and devices for performing the medical procedure are also provided.

摘要翻译： 提供了一种执行诸如手术的医疗程序的系统。 该系统包括用于感测心脏组织的状态的传感器，例如即将到来的收缩和用于指示心脏组织的状态的指示器。 还提供了用于执行医疗程序的方法和装置。

公开(公告)号：US06266564B1

公开(公告)日：2001-07-24

申请号：US09433323

申请日：1999-11-03

申请人： Michael R. S. Hill ,  Kenneth R. Jonkman

发明人： Michael R. S. Hill ,  Kenneth R. Jonkman

IPC分类号： A61N136

CPC分类号： A61N1/36114 ,  A61B17/3417 ,  A61B2017/00243 ,  A61B2017/00969 ,  A61B2017/0243 ,  A61B2017/3445 ,  A61B2017/3449 ,  A61N1/056 ,  A61N1/362 ,  A61N1/385 ,  A61N1/3962

摘要： An electro-stimulation device includes a pair of electrodes for connection to at least one location in the body that affects or regulates the heartbeat. The electro-stimulation device both electrically arrests the heartbeat and stimulates the heartbeat. A pair of electrodes are provided for connection to at least one location in the body that affects or regulates the heartbeat. The pair of electrodes may be connected to an intravenous catheter for transvenous stimulation of the appropriate nerve. A first switch is connected between a power supply and the electrodes for selectively supplying current from the power supply to the electrodes to augment any natural stimuli to the heart and thereby stop the heart from beating. A second switch is connected between the power supply and the electrodes for selectively supplying current from the power supply to the electrodes to provide an artificial stimulus to initiate heartbeating. In another aspect, the invention is directed to a method for arresting the beat of a heart in a living body comprising the steps of connecting the pair of electrodes to at least one location in the body that affects or regulates the heartbeat and supplying an electrical current to the electrodes of sufficient amplitude and duration to arrest the heartbeat. The device may also serve to still the lungs by input to a respirator or by stimulation of the phrenic nerve during surgical procedures.

摘要翻译： 电刺激装置包括一对电极，用于连接到体内至少一个影响或调节心跳的位置。 电刺激装置既电气阻止心跳并刺激心跳。 提供一对电极用于连接到体内至少一个影响或调节心跳的位置。 该对电极可以连接到静脉导管，用于适当神经的经静脉刺激。 第一开关连接在电源和电极之间，用于选择性地从电源向电极提供电流，以增加对心脏的任何自然刺激，从而阻止心脏跳动。 第二开关连接在电源和电极之间，用于选择性地从电源向电极提供电流以提供人造刺激以启动心跳。 另一方面，本发明涉及一种用于在生物体中阻止心脏的搏动的方法，包括以下步骤：将一对电极连接到体内至少一个位置，其影响或调节心跳并提供电流 到足够的幅度和持续时间的电极以阻止心跳。 该装置还可以通过输入呼吸器或在外科手术期间刺激膈神经而服用于肺。