公开(公告)号：US06587723B1

公开(公告)日：2003-07-01

申请号：US09690565

申请日：2000-10-17

申请人： Laurence S. Sloman ,  Kerry A. Bradley ,  Joseph J. Florio

发明人： Laurence S. Sloman ,  Kerry A. Bradley ,  Joseph J. Florio

IPC分类号： A61N1368

CPC分类号： A61N1/3712

摘要： An implantable cardiac stimulation device with automatic threshold testing capabilities. The device utilizes an algorithm for measuring a first and a second threshold settings. The first threshold setting is determined by decreasing the stimulation energy from an initially high, supra-threshold value until loss of capture is detected, and is set as the pulse energy at which capture is still detected. The second threshold setting is determined by increasing the stimulation energy from an initially low, sub-threshold value until capture is detected, and is set as the stimulation energy at which capture is regained. The algorithm further determines if the threshold test results are reliable by comparing the difference between the first and second threshold settings to an expected difference, known as the Wedensky Effect value. A deviation from the Wedensky Effect value which is known for a given patient, indicates a discrepancy in the threshold test result. Such a deviation could be used to indicate when a threshold test is suspected of being erroneous, for example, due to fusion. During a subsequent threshold test, the stimulation parameters are adjusted so that the likelihood of fusion is minimized. Once a threshold test result is evaluated and found to be consistent with the expected Wedensky Effect value, the stimulation energy is automatically adjusted to a level safely above the threshold value.

摘要翻译： 具有自动阈值测试功能的可植入式心脏刺激装置。 该装置利用用于测量第一和第二阈值设置的算法。 通过从初始高的超阈值减小刺激能量直到检测到捕获的丢失来确定第一阈值设置，并将其设置为仍被检测到捕获的脉冲能量。 通过从初始低的亚阈值增加刺激能量直到检测到捕获来确定第二阈值设置，并将其设置为恢复捕获的刺激能量。 该算法进一步通过将第一和第二阈值设置之间的差值与预期的差值进行比较来确定阈值测试结果是否可靠，称之为威灵斯基效应值。 与给定患者已知的Wedensky Effect值的偏差表示阈值测试结果的差异。 这种偏差可以用于指示阈值测试何时被怀疑是错误的，例如由于融合。 在随后的阈值测试期间，调整刺激参数，使得融合的可能性最小化。 一旦对阈值测试结果进行评估并发现与预期的温斯基效应值一致，则刺激能量被自动调整到安全高于阈值的水平。

公开(公告)号：US06516225B1

公开(公告)日：2003-02-04

申请号：US09662440

申请日：2000-09-15

申请人： Joseph J. Florio

发明人： Joseph J. Florio

IPC分类号： A61N1368

CPC分类号： A61B5/04525 ,  A61N1/3622 ,  A61N1/3956 ,  A61N1/3962

摘要： The system and method discriminates P-waves or other electrical events originating in the atria from R-waves or other electrical events originating in the ventricles. In one example, far-field R-waves in the atria are distinguished from true P-waves using both a post-ventricular atrial blanking (PVAB) interval and a separate pre-ventricular blanking interval (pre-VAB) interval. Insofar as the pre-VAB interval is concerned, upon detection of a P-wave in the atria, the implantable medical device begins tracking a pre-VAB interval. If an R-wave is then detected in the ventricles during the pre-VAB interval, the P-wave is rejected as being a far-field R-wave. A PVAB interval may also be employed to filter out any P-waves detected in the atria immediately following detection of an R-wave in the ventricles. In another example, far-field R-waves are distinguished from true P-waves using template matching. P-waves detected in the atria are compared against a template representative of true P-waves. If the P-wave substantially matches the template, the P-wave is deemed to be a true P-wave; otherwise, the P-wave is rejected as being a far-field R-wave or other anomalous electrical event. In both examples, the techniques are applicable to other types of electrical events detected within the heart besides P-waves and R-waves, such as electrical events occurring during fibrillation or flutter when discrete P-waves and R-waves may not be detectable.

摘要翻译： 该系统和方法鉴别来自R波的起搏于心房的P波或其他电气事件或源自心室的其他电气事件。 在一个示例中，心房中的远场R波与使用心室后空白（PVAB）间隔和单独的心室前消隐间隔（pre-VAB）间隔的真实P波区分开。 就VVA间隔而言，在检测到心房中的P波时，可植入医疗装置开始跟踪VAB之前的间隔。 如果在VAB间隔期间在心室中检测到R波，则P波被拒绝为远场R波。 也可以使用PVAB间隔来在心室中检测到R波之后立即滤除在心房中检测到的任何P波。 在另一个例子中，使用模板匹配将远场R波与真实P波区分开。 将在心房中检测到的P波与代表真实P波的模板进行比较。 如果P波基本上与模板匹配，则P波被认为是真正的P波; 否则，P波被拒绝为远场R波或其他异常电气事件。 在这两个例子中，这些技术适用于除P波和R波之外在心脏中检测到的其他类型的电事件，例如当不可检测到离散的P波和R波时，在颤动期间发生的电气事件或颤动。

公开(公告)号：US06477416B1

公开(公告)日：2002-11-05

申请号：US09572488

申请日：2000-05-15

申请人： Joseph J. Florio ,  Laurence S. Sloman

发明人： Joseph J. Florio ,  Laurence S. Sloman

IPC分类号： A61N118

CPC分类号： A61N1/3702 ,  A61N1/3716

摘要： An implantable stimulation device delivers a stimulation pulse in the ventricular chamber of a patient's heart and automatically adjusts a post-ventricular atrial blanking period. The stimulation device generates a ventricular stimulation pulse to trigger an evoked response, in order to produce a ventricular far-field signal that follows a successfully captured ventricular stimulation pulse. The stimulation device further includes an atrial sense circuit that senses the ventricular far-field signal, and a control system that adaptively segments the post-ventricular atrial blanking period in a post-ventricular atrial blanking period (PVAB) which is fixed in duration, and a variable far-field interval (FFI) window. PVAB is initiated upon the delivery of the ventricular stimulation pulse, such that events sensed outside the segmented post-ventricular atrial blanking (SPVAB) period are presumed to be intrinsic atrial events, and events sensed within the far-field interval window are presumed to be far-field signals. The far-field interval window is preferably centered on a previously sensed far-field R-wave. If an intrinsic ventricular event is sensed, the stimulation device does not initiate the PVAB period but rather sets the FFI window.

摘要翻译： 植入式刺激装置在患者心脏的心室中输送刺激脉冲，并自动调节心室后心室消融期。 刺激装置产生心室刺激脉冲以触发诱发反应，以产生跟随成功捕获的心室刺激脉冲的心室远场信号。 刺激装置还包括感测心室远场信号的心房感知电路，以及在持续时间固定的心房后心房消隐期（PVAB）中自适应地分段心室心房消隐期的控制系统，以及 可变远场间隔（FFI）窗口。 PVAB是在输送心室刺激脉冲时开始的，使得在分段的心室后消融（SPVAB）周期之外感测到的事件被认为是内在心房事件，并且假定在远场间隔窗口内感测到的事件为 远场信号。 远场间隔窗口优选地以先前感测的远场R波为中心。 如果感测到内部心室事件，则刺激装置不会启动PVAB周期，而是设置FFI窗口。

公开(公告)号：US5788717A

公开(公告)日：1998-08-04

申请号：US500730

申请日：1995-07-11

申请人： Brian M. Mann ,  Joseph J. Florio ,  Laurence S. Sloman

发明人： Brian M. Mann ,  Joseph J. Florio ,  Laurence S. Sloman

IPC分类号： A61N1/368 ,  A61N1/362 ,  A61N1/365 ,  A61N1/39 ,  A61N1/36 ,  A61B5/0464

CPC分类号： A61N1/3962 ,  A61N1/3622 ,  A61N1/36514

摘要： An implantable pacemaker accurately senses the regular atrial rhythm even though some portions of the atrial rhythm, e.g., every other P-wave, may potentially be masked or hidden within the ventricular absolute refractory period. Such sensing includes unmasking or uncovering any hidden P-waves, thereby allowing an accurate atrial rate to be determined. The hidden P-waves are uncovered by: changing the PV delay, not tracking a sensed P-wave, or comparing the incoming morphology of the atrial channel signal to a prior stored baseline morphology signal. The accurate atrial rate, once determined, allows the presence of an atrial tachycardia to be reliably confirmed, thereby enabling appropriate atrial anti-tachycardia pacing (ATP) procedures to be invoked, or mode switching from an atrial synchronous mode of operation, e.g., DDD, to a non-atrial synchronous mode, e.g., VVIR.

摘要翻译： 尽管心房节律的一些部分，例如每隔一个P波，可植入式心脏起搏器可以准确地感测正常的心房节律，但是可能潜在地掩盖或隐藏在心室绝对不应期内。 这种感测包括揭露或揭露任何隐藏的P波，从而允许确定准确的心率。 隐藏的P波被覆盖：改变PV延迟，不跟踪感测的P波，或将心房通道信号的进入形态与先前存储的基线形态信号进行比较。 一旦确定，准确的心房率允许可靠地确认房性心动过速的存在，从而使得能够调用适当的心房抗心动过速起搏（ATP）程序或从心房同步操作模式切换，例如DDD ，到非心房同步模式，例如VVIR。

公开(公告)号：US4590944A

公开(公告)日：1986-05-27

申请号：US574708

申请日：1984-01-27

申请人： Brian M. Mann ,  Joseph J. Florio

发明人： Brian M. Mann ,  Joseph J. Florio

IPC分类号： A61N1/362 ,  A61N1/372 ,  A61N1/36

CPC分类号： A61N1/3621 ,  A61N1/37211

摘要： A programmable cardiac stimulator capable of stimulation in the DDX modality having a first sensing system (46) for sensing electrical activity in the atrium, a second sensing system (48) for sensing electrical activity in the ventricle, a pulse generator (24) connected to the first (46) and second (48) sensing system and responsive to electrical activity sensed by these systems (46, 48) for determining the timing for supplying electrical pulses to the atrium and ventricle, for this depolarization and a circuit with the pulse generator (24) for changing the stimulation modality from DDD to DVI when premature ventricular activity is sensed by the second sensing system (46) prior to sensing electrical activity by the first sensing system (48) during the pacer cycle.

摘要翻译： 一种能够在DDX模式中进行刺激的可编程心脏刺激器，其具有用于感测心房中的电活动的第一感测系统（46），用于感测心室中的电活动的第二感测系统（48），连接到 第一（46）和第二（48）感测系统，并且响应于由这些系统（46,48）感测的电活动，用于确定为了该去极化而向心房和心室提供电脉冲的定时和具有脉冲发生器的电路 （24），用于在由所述第一感测系统（48）在所述起搏器周期期间检测到电活动之前由所述第二感测系统（46）感测到过早心室活动时，将刺激模态从DDD改变为DVI。