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11.发明授权Implanatable cardiac stimulation device and method for prolonging atrial refractoriness 有权可手术心脏刺激装置及延长心房不应性的方法公开(公告)号：US06377852B1
公开(公告)日：2002-04-23
申请号：US09488284
申请日：2000-01-20
IPC分类号： A61N1362
CPC分类号： A61N1/3622 , A61N1/3956
摘要： An implantable cardiac stimulation device, e.g., a pacemaker or an implantable cardioverter defibrillator (ICD), is provided which prolongs the atrial refractoriness of a heart. The implantable cardiac stimulation device includes a generator that delivers pacing pulses to an atrium of a heart and a detector that detects atrial activations of the heart. An inhibitor is coupled to the detector that inhibits the generator when an atrial activation is detected within an escape interval. A generator control coupled to the generator causes the generator to deliver a primary pacing pulse to the atrium at the end of the escape interval, absent an atrial activation being detected within the escape interval, and causes the generator to deliver a secondary pacing pulse to the atrium a delay time after an atrial activation is detected within the escape interval or the delivery of a primary pacing pulse to the atrium.
摘要翻译： 提供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（ICD），其延长心脏的心房不应性。 可植入心脏刺激装置包括将起搏脉冲传送到心脏心房的发生器和检测心脏心房激活的检测器。 当在逃避间隔内检测到心房激活时，抑制剂耦合到检测器，该检测器抑制发生器。 耦合到发生器的发生器控制器使得发生器在逃逸间隔结束时将主起搏脉冲递送到心房，没有在逃逸间隔内检测到心房激活，并且使得发生器将辅助起搏脉冲输送到 在转移间隔内检测到心房激活之后的延迟时间或者向心房传送初次起搏脉冲。
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12.发明授权Method and apparatus for detecting natural electrical coherence within the heart and for administering therapy based thereon 有权用于检测心脏内的自然电相干性并用于基于其进行治疗的方法和装置公开(公告)号：US06766195B1
公开(公告)日：2004-07-20
申请号：US09686630
申请日：2000-10-10
IPC分类号： A61N0118
CPC分类号： A61N1/3962 , A61N1/395
摘要： Techniques are provided for detecting natural electrical coherence within the heart and for administering or adjusting therapy based upon whether natural electrical coherence is detected. In one example, an implantable cardioverter defibrillator (ICD), upon detecting atrial fibrillation, delays administering an atrial defibrillation pulse until a period of natural electrical coherence is detected between the left and the right atria of the heart. The ICD may further delay the pulse until the ventricles of the heart are refractory so as to help prevent triggering ventricular fibrillation. The pulses are administered at a time selected based upon the period of electrical coherence to reduce the amount of electrical energy required within the pulse to reliably defibrillate the heart. Other types of therapy besides defibrillation therapy such as anti-tachycardia pacing pulses may also be timed based upon detection periods of natural electrical coherence. Method and apparatus embodiments are described.
摘要翻译： 提供了用于检测心脏内的自然电连贯性的技术，并且用于基于是否检测到自然电连贯来施用或调整治疗。 在一个实例中，在检测心房颤动时，植入式心律转复除颤器（ICD）延迟施用心房除颤脉冲，直到在心脏的左心房和右心房之间检测到自然电相干的时间段。 ICD可以进一步延迟脉冲，直到心脏的心室难以耐受，以便有助于防止触发心室颤动。 在基于电相干周期选择的时间施加脉冲以减少脉冲内所需的电能量以可靠地除颤心脏。 除了除颤疗法之外的其他类型的治疗，如抗心动过速起搏脉冲也可以基于自然电连续性的检测周期来计时。 描述了方法和设备实施例。
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公开(公告)号：US07308306B1
公开(公告)日：2007-12-11
申请号：US10456060
申请日：2003-06-06
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。
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14.发明授权Implantable cardiac stimulation device with automatic evoked response sensing electrode configuration selection and method 有权可植入心脏刺激装置具有自动诱发响应感应电极配置选择和方法公开(公告)号：US06782291B1
公开(公告)日：2004-08-24
申请号：US09655438
申请日：2000-09-05
IPC分类号： A61N1372
CPC分类号： A61N1/3686 , A61N1/36185 , A61N1/371
摘要： An implantable cardiac stimulation device applies pacing stimulation pulses to a heart and senses evoked responses to the pacing stimulation pulses. A pulse generator applies the stimulation pacing pulses to the heart in accordance with a pacing configuration. A sensor control selects an evoked response sensing electrode configuration from among a plurality of evoked response sensing electrode configurations in response to the pacing configuration. A sensor is then programmed to sense the evoked responses with the selected evoked response sensing electrode configuration. In accordance with a preferred embodiment, signal-to-noise ratios obtained with the various electrode configurations are used to select a best electrode configuration for sensing evoked responses.
摘要翻译： 可植入心脏刺激装置将起搏刺激脉冲应用于心脏并感测对起搏刺激脉冲的诱发反应。 脉冲发生器根据起搏配置将刺激起搏脉冲施加到心脏。 传感器控制器响应于起搏配置从多个诱发响应感测电极配置中选择诱发响应感测电极配置。 然后将传感器编程为用所选择的诱发响应感测电极配置感测诱发的反应。 根据优选实施例，用各种电极配置获得的信噪比用于选择用于感测诱发响应的最佳电极配置。
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15.发明授权System and method of identifying fusion for dual-chamber automatic capture stimulation device 有权识别双室自动捕获刺激装置融合的系统和方法公开(公告)号：US06904321B1
公开(公告)日：2005-06-07
申请号：US10208169
申请日：2002-07-29
CPC分类号： A61N1/3712
摘要： A multi-chamber stimulation device and associated method reliably and automatically distinguish fusion from loss of capture during ventricular stimulation. The stimulation device provides immediate and accurate fusion detection when a loss of capture is suspected in the ventricles without delivering back-up stimulation pulses. To achieve this objective, the far-field signal present in the atrial channel is examined for evidence of a far-field R-wave whenever the ventricular channel detects a loss of capture. If a far-field R-wave is present, fusion is confirmed, and a far-field R-wave is absent, loss of capture is confirmed. Additionally, the stimulation device inhibits unnecessary back-up stimulation and threshold tests when fusion occurs, and provides appropriate adjustment of stimulation parameters based on confirmed fusion detection such that fusion re-occurrence is minimized.
摘要翻译： 多室刺激装置和相关方法可靠和自动地将融合与心室刺激期间的捕获损失区分开来。 刺激装置提供即时和准确的融合检测，当脑袋怀疑丢失而不输送备用刺激脉冲时。 为了达到这个目的，每当心室通道检测到捕获的丢失时，都会检查存在于心房通道中的远场信号以获得远场R波的证据。 如果存在远场R波，则确认融合，并且不存在远场R波，确认捕获损失。 此外，当融合发生时，刺激装置抑制不必要的后备刺激和阈值测试，并且基于确认的融合检测提供刺激参数的适当调整，使得融合再现最小化。
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16.发明授权Implantable cardiac stimulation device with automatic evoked response sensing electrode configuration selection and method 有权可植入心脏刺激装置具有自动诱发响应感应电极配置选择和方法公开(公告)号：US07233827B1
公开(公告)日：2007-06-19
申请号：US10865124
申请日：2004-06-09
IPC分类号： A61N1/365
CPC分类号： A61N1/3686 , A61N1/36185 , A61N1/371
摘要： An implantable cardiac stimulation device applies pacing stimulation pulses to a heart and senses evoked responses to the pacing stimulation pulses. A pulse generator applies the stimulation pacing pulses to the heart in accordance with a pacing configuration. A sensor control selects an evoked response sensing electrode configuration from among a plurality of evoked response sensing electrode configurations in response to the pacing configuration. A sensor is then programmed to sense the evoked responses with the selected evoked response sensing electrode configuration. In accordance with a preferred embodiment, signal-to-noise ratios obtained with the various electrode configurations are used to select a best electrode configuration for sensing evoked responses.
摘要翻译： 可植入心脏刺激装置将起搏刺激脉冲应用于心脏并感测对起搏刺激脉冲的诱发反应。 脉冲发生器根据起搏配置将刺激起搏脉冲施加到心脏。 传感器控制器响应于起搏配置从多个诱发响应感测电极配置中选择诱发响应感测电极配置。 然后将传感器编程为用所选择的诱发响应感测电极配置感测诱发的反应。 根据优选实施例，使用用各种电极配置获得的信噪比用于选择用于感测诱发响应的最佳电极配置。
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17.发明授权System and method of identifying fusion for dual-chamber automatic capture stimulation device 有权识别双室自动捕获刺激装置融合的系统和方法公开(公告)号：US06456881B1
公开(公告)日：2002-09-24
申请号：US09630771
申请日：2000-08-02
IPC分类号： A61N136
CPC分类号： A61N1/3712
摘要： A multi-chamber stimulation device and associated method reliably and automatically distinguish fusion from loss of capture during ventricular stimulation. The stimulation device provides immediate and accurate fusion detection when a loss of capture is suspected in the ventricles without delivering back-up stimulation pulses. To achieve this objective, the far-field signal present in the atrial channel is examined for evidence of a far-field R-wave whenever the ventricular channel detects a loss of capture. If a far-field R-wave is present, fusion is confirmed, and a far-field R-wave is absent, loss of capture is confirmed. Additionally, the stimulation device inhibits unnecessary back-up stimulation and threshold tests when fusion occurs, and provides appropriate adjustment of stimulation parameters based on confirmed fusion detection such that fusion re-occurrence is minimized.
摘要翻译： 多室刺激装置和相关方法可靠和自动地将融合与心室刺激期间的捕获损失区分开来。 刺激装置提供即时和准确的融合检测，当脑袋怀疑丢失而不输送备用刺激脉冲时。 为了达到这个目的，每当心室通道检测到捕获的丢失时，都会检查存在于心房通道中的远场信号以获得远场R波的证据。 如果存在远场R波，则确认融合，并且不存在远场R波，确认捕获损失。 此外，当融合发生时，刺激装置抑制不必要的后备刺激和阈值测试，并且基于确认的融合检测提供刺激参数的适当调整，使得融合再现最小化。
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18.发明授权AC/DC multi-axis accelerometer for determining patient activity and body position 有权用于确定患者活动和身体位置的AC / DC多轴加速度计公开(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
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。
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19.发明授权System and method for automatically verifying capture during multi-chamber stimulation 有权在多室刺激下自动验证捕获的系统和方法公开(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。
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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。
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