公开(公告)号：US20120089032A1

公开(公告)日：2012-04-12

申请号：US12901296

申请日：2010-10-08

申请人： Euljoon Park ,  Steve Koh ,  Gene A. Bornzin

发明人： Euljoon Park ,  Steve Koh ,  Gene A. Bornzin

IPC分类号： A61B5/042 ,  A61B5/0205

CPC分类号： A61B5/046 ,  A61B5/0006 ,  A61B5/0031 ,  A61B5/02028 ,  A61B5/0205 ,  A61B5/029 ,  A61B5/0402 ,  A61B5/0422 ,  A61B5/0468 ,  A61B5/0538 ,  A61B5/0816 ,  A61B5/1116 ,  A61B5/1118 ,  A61B5/686 ,  A61B5/6869 ,  A61N1/3624 ,  A61N1/36521 ,  A61N1/36592

摘要： A medical device is provided that comprises a lead assembly. The lead assembly includes at least one intra-cardiac (IC) electrode, an extra-cardiac (EC) electrode and a subcutaneous remote-cardiac (RC) electrode. The IC electrode is configured to be located within the heart. The EC electrode is configured to be positioned proximate to at least one of a superior vena cava (SVC) and a left ventricle (LV) of a heart. The RC electrode is configured to be located remote from the heart. An arrhythmia monitoring module is configured to analyze intra-cardiac electrogram (IEGM) signals from the at least one IC electrode to identify a potential atrial arrhythmia. An extra-cardiac impedance (ECI) module is configured to measure extra-cardiac impedance along an ECI vector between the EC and RC electrodes to obtain ECI measurements. The hemodynamic performance (HDP) assessment module is configured to determine a hemodynamic performance based on the ECI measurements. The arrhythmia monitoring module is configured to declare the potential atrial arrhythmia to be an atrial arrhythmia based on the hemodynamic performance determined from the ECI measurements. The medical device further provides the HDP assessment module that derives a current ECI waveform from current ECI measurements and compares the current ECI pattern with a prior ECI waveform that is derived from prior ECI measurements.

摘要翻译： 提供了包括引线组件的医疗装置。 引线组件包括至少一个心脏内（IC）电极，心外（EC）电极和皮下远心电（RC）电极）。 IC电极被配置为位于心脏内。 EC电极配置成靠近心脏的上腔静脉（SVC）和左心室（LV）中的至少一个定位。 RC电极被配置为远离心脏。 心律失常监测模块被配置为分析来自至少一个IC电极的心脏内电针（IEGM）信号以识别潜在的心房心律失常。 心脏外阻抗（ECI）模块被配置为测量EC和RC电极之间的ECI向量的心外阻抗，以获得ECI测量值。 血液动力学性能（HDP）评估模块被配置为基于ECI测量来确定血液动力学性能。 心律失常监测模块被配置为基于从ECI测量确定的血流动力学性能来将潜在心房心律失常宣告为心房心律失常。 医疗设备还提供HDP评估模块，其从当前ECI测量中导出当前ECI波形，并将当前ECI模式与从先前ECI测量得到的先前ECI波形进行比较。

公开(公告)号：US20110125049A1

公开(公告)日：2011-05-26

申请号：US12649647

申请日：2009-12-30

申请人： Yelena Nabutovsky ,  Fujian Qu ,  Steve Koh ,  Dan E. Gutfinger ,  Alex Soriano

发明人： Yelena Nabutovsky ,  Fujian Qu ,  Steve Koh ,  Dan E. Gutfinger ,  Alex Soriano

IPC分类号： A61B5/05

CPC分类号： A61B5/053 ,  A61B5/021 ,  A61B5/1116 ,  A61B5/4878 ,  A61B5/686 ,  A61B5/7275 ,  A61N1/3627 ,  A61N1/36521 ,  A61N1/36564 ,  A61N1/36585 ,  A61N1/3684 ,  A61N1/3702 ,  A61N1/37258 ,  A61N1/3962

摘要： In specific embodiments, a method to monitor pulmonary edema of a patient, comprises (a) detecting, using an implanted posture sensor, when a posture of the patient changes from a first predetermined posture to a second predetermined posture, (b) determining an amount of time it takes an impedance signal to achieve a steady state after the posture of the patient changes from the first predetermined posture to the second predetermined posture, where the impedance signal is obtained using implanted electrodes and is indicative of left atrial pressure and/or intra-thoracic fluid volume of the patient, and (c) monitoring the pulmonary edema of the patient based on the determined amount of time it takes the impedance signal to achieve the steady state after the posture of the patient changes from the first predetermined posture to the second pre-determined posture.

摘要翻译： 在具体实施例中，一种监测患者肺水肿的方法包括：（a）使用植入式姿势传感器时，当患者的姿势从第一预定姿势变化到第二预定姿势时，（b）确定量 的时间，在患者的姿势从第一预定姿势变化到第二预定姿势之后，阻抗信号获得稳定状态，其中使用植入电极获得阻抗信号，并且指示左心房压力和/或内部 - （c）基于在患者的姿势从第一预定姿势改变到第二预定姿势之后所确定的阻抗信号达到稳定状态的所确定的时间量来监测患者的肺水肿 第二预定姿势。

公开(公告)号：US07899522B1

公开(公告)日：2011-03-01

申请号：US11549569

申请日：2006-10-13

申请人： Steve Koh ,  Gene A. Bornzin ,  Euljoon Park

发明人： Steve Koh ,  Gene A. Bornzin ,  Euljoon Park

IPC分类号： A61B5/04

CPC分类号： A61B5/0452 ,  A61B5/0472 ,  A61N1/3627 ,  A61N1/36521 ,  A61N1/36585 ,  A61N1/37258 ,  A61N1/37282

摘要： Techniques are provided for evaluating heart failure within a patient. In one example, the implantable device detects a decrease, if any, in selected morphological parameters derived from the intracardiac electrogram (IEGM) that are indicative of possible heart failure, such as paced depolarization integrals (PDI) or peak-to-peak amplitudes of QRS-complexes. The device also detects a decrease, if any, in transthoracic impedance, which is also indicative of possible heart failure. Acute heart failure is indicated if there is a decrease in the morphological IEGM parameters but no significant decrease in transthoracic impedance. Chronic heart failure is indicated if there is a decrease in transthoracic impedance but no significant decrease in the morphological IEGM parameters. If both transthoracic impedance and the morphological IEGM parameters are found to be decreasing significantly, the device issues a warning of severe heart failure.

摘要翻译： 提供了用于评估患者心脏衰竭的技术。 在一个示例中，可植入装置检测出来自指示可能的心力衰竭的心内电描记图（IEGM）的选定形态学参数中的减少（如果有的话），例如节奏去极化积分（PDI）或峰 - 峰幅度 QRS复合物。 该器件还检测经胸阻抗的减少（如果有的话），这也表示可能的心力衰竭。 如果形态学IEGM参数有降低但经胸阻抗无显着降低，则表示急性心力衰竭。 如果经胸阻抗降低但形态学IEGM参数无明显降低，则表示慢性心力衰竭。 如果发现经胸阻抗和形态学IEGM参数均明显下降，则该装置发出严重心力衰竭的警告。

公开(公告)号：US07896808B1

公开(公告)日：2011-03-01

申请号：US11301452

申请日：2005-12-13

申请人： Steve Koh

发明人： Steve Koh

IPC分类号： A61B5/00 ,  A61B5/04 ,  A61B5/08 ,  A61N1/00

CPC分类号： A61B5/04001 ,  A61B5/486 ,  A61N1/3702

摘要： A system and method of sensing relatively low magnitude signals of interest in a sensing environment with at least intervals of relatively high magnitude noise of comparable or overlapping frequency spectra as the signals of interest. The systems and methods can be implemented in an efficient, low-power manner to facilitate long term monitoring of low magnitude physiologic signals, for example in an in vivo or implantable manner. An amplifier can be arranged with a threshold detector driving a normally closed switch such that the input to or output from the amplifier can be opened when the noise exceeds a threshold. A filter, such as a moving average filter, can be included to smooth the amplified output and compensate for the amplified signal lost when the threshold is exceeded. The systems and method facilitate implantable nerve sensing in high noise environments, such as from myopotentials.

摘要翻译： 在感测环境中感测感兴趣的相对低幅度的信号的系统和方法，其具有与感兴趣的信号相当或重叠的频谱的相对高幅度噪声的至少间隔。 系统和方法可以以有效的低功率方式实现，以便于例如以体内或可植入的方式长期监测低度生理信号。 放大器可以布置有阈值检测器驱动常闭开关，使得当噪声超过阈值时，可以打开放大器的输入或输出。 可以包括诸如移动平均滤波器的滤波器以平滑放大的输出并补偿当超过阈值时丢失的放大信号。 该系统和方法便于在高噪声环境中进行植入式神经感测，例如来自神经根的神经。

公开(公告)号：US07869878B1

公开(公告)日：2011-01-11

申请号：US11245961

申请日：2005-10-06

申请人： Steve Koh

发明人： Steve Koh

IPC分类号： A61N1/365

CPC分类号： A61N1/365

摘要： An implantable cardiac stimulation device provides an intracardiac electrogram with reduced respiratory modulation effect. The device includes a sensing circuit that senses cardiac activity and provides an intracardiac electrogram signal extending over a plurality of cardiac cycles, a respiration monitor that monitors respiration associated with the sensed cardiac activity, and a cardiac cycle selector that selects a set of intracardiac electrogram cardiac cycles of the plurality of cardiac cycles in response to the monitored respiration. A processing circuit processes the selected set of intracardiac electrogram cardiac cycles to provide the intracardiac electrogram with reduced respiratory modulation effect.

摘要翻译： 可植入的心脏刺激装置提供具有降低的呼吸调节作用的心内电描记图。 该装置包括感测心脏活动并提供在多个心动周期上延伸的心内电描记图信号的感测电路，监测与感测到的心脏活动相关联的呼吸的呼吸监测器，以及选择一组心内电描记图心脏的心动周期选择器 响应于所监测的呼吸，多个心动周期的周期。 处理电路处理所选择的一组心脏心电图心脏周期，以提供具有降低的呼吸调节作用的心内电描记图。

公开(公告)号：US20100249756A1

公开(公告)日：2010-09-30

申请号：US12411262

申请日：2009-03-25

申请人： Steve Koh

发明人： Steve Koh

IPC分类号： A61M5/00 ,  A61B5/0205

CPC分类号： A61B5/0537 ,  A61B5/0538 ,  A61B5/418 ,  A61B5/4878 ,  A61N1/3621 ,  A61N1/3627 ,  A61N1/36521 ,  A61N1/3962

摘要： Techniques are provided for use by a pacemaker or other implantable medical device for detecting and tracking trends in cardiopulmonary fluid transfer rates—such as heart-to-lung fluid perfusion rates and lung-to-lymphatic system fluid excretion rates—and for detecting heart failure, dyspnea or other cardiopulmonary conditions. In one example, the device periodically measures transthoracic admittance values. A first exponential time-constant (k1) is determined using curve-fitting from admittance values obtained while the patient is in a sleep posture. Time-constant k1 is representative of the fluid perfusion rate. A second exponential time-constant (k2) is determined based on admittance values obtained while the patient is standing/walking/sitting. The second exponential time-constant (k2) is representative of the fluid excretion rate from the lungs. The device then detects trends, if any, in the time-constants (or in “DC” baseline values) to detect or predict medical conditions such as an imminent heart failure exacerbation.

摘要翻译： 技术被提供供起搏器或其他可植入医疗装置用于检测和跟踪心肺流体转移速率的趋势，例如心脏 - 肺液体灌注速率和肺对淋巴系统的流体排泄速率，并用于检测心力衰竭 ，呼吸困难或其他心肺病。 在一个示例中，设备周期性地测量经胸导管值。 使用在患者处于睡眠姿势时获得的导纳值的曲线拟合来确定第一指数时间常数（k1）。 时间常数k1代表流体灌注速率。 第二指数时间常数（k2）基于患者站立/行走/坐着时获得的导纳值来确定。 第二指数时间常数（k2）代表来自肺的流体排泄率。 然后，该装置检测时间常数（或“DC”基线值）中的趋势（如果有的话），以检测或预测诸如即将发生的心力衰竭恶化的医学状况。

公开(公告)号：US07778708B1

公开(公告)日：2010-08-17

申请号：US11107221

申请日：2005-04-14

申请人： Steve Koh ,  Rose Province

发明人： Steve Koh ,  Rose Province

IPC分类号： A61N1/00 ,  A61B5/04

CPC分类号： A61B5/0537 ,  A61B5/4878 ,  A61B5/7275 ,  A61N1/36521 ,  A61N1/37247 ,  A61N1/37252 ,  G06F19/00

摘要： Diagnosing a patient's cardiac health through histogram analysis of thoracic impedance is described. Data values indicative of thoracic impedance are measured from a patient over a sample period that includes multiple respiratory cycles. The values are distributed across multiple bins of a histogram. A diagnostic value for use in diagnosing a patient's cardiac health is derived from values in one or more of the bins. As one example, a diagnostic value representing minimum thoracic impedance during the sample period can be derived from values in the lowest-valued bins. Diagnostic values can be computed for multiple sample periods in the same fashion. A trend analysis is performed on the diagnostic values to determine whether the patient's cardiac condition is improving or worsening. The trend may be presented in a graphical form to provide a visual tool for assessing the patient's condition over time.

摘要翻译： 描述了通过胸廓阻抗的直方图分析来诊断患者的心脏健康。 在包括多个呼吸周期的采样周期内，从患者测量指示胸阻抗的数据值。 这些值分布在直方图的多个分区中。 用于诊断患者心脏健康的诊断价值来源于一个或多个分区中的值。 作为一个示例，可以从最低值仓中的值导出在采样周期期间表示最小胸部阻抗的诊断值。 可以以相同的方式计算多个采样周期的诊断值。 对诊断值进行趋势分析，以确定患者的心脏病状是否改善或恶化。 该趋势可以以图形形式呈现，以提供用于随时间评估患者状况的可视化工具。

公开(公告)号：US20100204593A1

公开(公告)日：2010-08-12

申请号：US12368916

申请日：2009-02-10

申请人： Euljoon Park ,  Steve Koh

发明人： Euljoon Park ,  Steve Koh

IPC分类号： A61B5/053

CPC分类号： A61B5/0537 ,  A61B5/4878 ,  A61N1/36521

摘要： A method of identifying a potential cause of pulmonary edema is provided. The method includes obtaining one or more impedance vectors between predetermined combinations of the electrodes positioned proximate the heart. At least one of the impedance vectors is representative of a thoracic fluid level. The method also includes applying a stimulation pulse to the heart and sensing cardiac signals of the heart that are representative of an electrophysiological response to the stimulation pulse. The method further includes monitoring the cardiac signals and at least one of the impedance vectors with respect to time to identify the potential cause of pulmonary edema.

摘要翻译： 提供了鉴定肺水肿潜在原因的方法。 该方法包括在定位在心脏附近的电极的预定组合之间获得一个或多个阻抗矢量。 阻抗向量中的至少一个代表胸水液位。 该方法还包括向心脏施加刺激脉冲并感测代表对刺激脉冲的电生理响应的心脏心脏信号。 该方法还包括相对于时间监测心脏信号和阻抗向量中的至少一个以识别肺水肿的潜在原因。

公开(公告)号：US07704211B1

公开(公告)日：2010-04-27

申请号：US11086612

申请日：2005-03-21

申请人： Steve Koh

发明人： Steve Koh

IPC分类号： A61B5/02 ,  A61B5/08 ,  A61B5/00

CPC分类号： A61B5/4818 ,  A61B5/04001 ,  A61B5/0809 ,  A61B5/091 ,  A61B5/14551 ,  A61B5/686 ,  A61F13/4704 ,  A61F13/47236 ,  A61F13/535

摘要： The invention relates to an apparatus and method to assess the fluid level in lungs. An implantable medical device or external monitor is used to sense or monitor the patient's respiratory patterns to identify the presence of periodic breathing or Cheyne-Stokes Respiration (CSR) which is common in patients with congestive heart failure. A fluid index is used to assess the severity of congestive heart failure in a patient. A ratio of Δ blood gas/Σtotal lung volume can be used to determine the lung fluid index.

摘要翻译： 本发明涉及一种评估肺中液体水平的装置和方法。 使用可植入医疗器械或外部监护器来感测或监测患者的呼吸模式，以确定患有充血性心力衰竭患者常见的定期呼吸或Cheyne-Stokes呼吸（CSR）的存在。 流体指数用于评估患者充血性心力衰竭的严重程度。 比例＆Dgr 血气总量可以用来确定肺液指数。

公开(公告)号：US07676260B1

公开(公告)日：2010-03-09

申请号：US11740733

申请日：2007-04-26

申请人： Steve Koh

发明人： Steve Koh

IPC分类号： A61B5/04

CPC分类号： A61N1/365 ,  A61N1/3627 ,  A61N1/36507 ,  A61N1/371

摘要： An implantable cardiac stimulation device monitors the progression and/or regression of heart disease. The device comprises a sensing circuit that senses activity of a heart and provides an electrogram for each one of a plurality of cardiac cycles, an averaging circuit that averages a number of the plurality of electrograms at spaced apart intervals to provide averaged trend electrograms, and a data generator that provides a metric reflective of progression or regression of heart failure responsive to a difference between a current averaged trend electrogram and a previous averaged trend electrogram.

摘要翻译： 可植入心脏刺激装置监测心脏病的进展和/或消退。 该装置包括感测心脏的活动并为多个心动周期中的每一个循环提供电描记图的感测电路，平均电路以间隔开的间隔对多个电描记图的数量进行平均以提供平均趋势电图，以及 数据发生器，其响应于当前平均趋势电描记图和先前平均趋势电描记图之间的差异，提供反映心衰的进展或回归的度量。