公开(公告)号：US06636766B2

公开(公告)日：2003-10-21

申请号：US09849723

申请日：2001-05-03

申请人： Gene A. Bornzin ,  Junyu Mai ,  Euljoon Park ,  Joseph J. Florio

发明人： Gene A. Bornzin ,  Junyu Mai ,  Euljoon Park ,  Joseph J. Florio

IPC分类号： A61N1365

CPC分类号： A61N1/362

摘要： A rate smoothing technique is applied by the pacing device to sensed and paced heart signals so as to prevent a sharp drop in heart rate, particularly for use within patients prone to vasovagal syncope. The rate smoothing technique is applied by the pacing device during the calculation of an escape interval employed by the device in determining whether to pace the heart. The rate smoothing technique has the effect of adjusting the escape interval to ensure the heart is paced for a period of time subsequent to a sharp drop in the natural heart rate of the patient permitting the heart rate to decrease gradually rather than suddenly. The rate smoothing technique however does not interfere with a sharp increase in heart rate as may be required during sudden physical exertion. System and method examples are described herein.

公开(公告)号：US06606517B1

公开(公告)日：2003-08-12

申请号：US09548293

申请日：2000-04-12

申请人： Euljoon Park ,  Gene A. Bornzin ,  Joseph J. Florio ,  John W. Poore ,  Laurence S. Sloman ,  Peter Boileau ,  Douglas T. Kurschinski

发明人： Euljoon Park ,  Gene A. Bornzin ,  Joseph J. Florio ,  John W. Poore ,  Laurence S. Sloman ,  Peter Boileau ,  Douglas T. Kurschinski

IPC分类号： A61N1362

CPC分类号： A61N1/3622

摘要： A method and apparatus for reducing the incidence of atrial arrhythmias by using an overdrive algorithm to determine the application of overdrive stimulation pulses to a patient's heart, e.g., in the atria. In a first aspect of the invention, the apparatus first determines an overdrive pacing rate and then applies pairs of temporally spaced (staggered) pacing pulses, i.e., primary and secondary pacing pulses, at the determined overdrive pacing rate. In a further aspect of the invention, the pairs of pacing pulses are applied at the overdrive pacing rate to multiple spatially spaced electrodes, i.e., electrodes distributed among multiple sites in a patient's heart, e.g., in the atria. In accordance with a first preferred embodiment, the electrodes may be distributed within a single atrium, e.g., the right atrium, of the patient's heart. Alternatively, a first electrode may be placed in the right atrium and a second electrode may be placed in the coronary sinus or the left atrium or multiple electrodes may be placed proximate to the left atrium. Furthermore, the invention relates to techniques for controlling overdrive pacing to multiple sites in a patient's heart so as to achieve and maintain a target degree of pacing and thus suppress tachycardias.

摘要翻译： 一种用于通过使用过驱动算法来确定过度驱动刺激脉冲施加到患者心脏（例如在心房）中来减少心房心律失常发生率的方法和装置。 在本发明的第一方面中，装置首先确定过驱动起搏速率，然后以确定的超速起搏速率施加时间间隔（交错）的起搏脉冲，即初级和次级起搏脉冲。 在本发明的另一方面，以超速起搏速率将多对起搏脉冲施加到多个空间间隔开的电极，即分布在患者心脏中的多个部位之间的电极，例如在心房中。 根据第一优选实施例，电极可以分布在患者心脏的单个心房（例如右心房）内。 或者，第一电极可以放置在右心房中，并且第二电极可以放置在冠状窦或左心房中，或者多个电极可以放置在靠近左心房的位置。 此外，本发明涉及用于控制对患者心脏中的多个部位的超速起搏的技术，以便实现和维持目标起搏程度，从而抑制心动过速。

公开(公告)号：US06510342B1

公开(公告)日：2003-01-21

申请号：US09548116

申请日：2000-04-12

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： A61N1368

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.

摘要翻译： 描述了用于使用起搏器使用超速起搏心脏起搏心脏多个部位的技术，其包括其中在确定的搜索周期内检测到至少两个固有节拍时，超速起搏速率仅增加的技术。 在一种特定技术中，只有在X个心动周期内检测到两个P波时，起搏速率才会增加。 在另一个具体技术中，只有在N个心动周期的块内检测到至少两个P波时，才能增加超速起搏速率。 在两种技术中，如果在最后Z个心动周期中没有发生增加，则超速起搏速率将降低。 通过仅在确定的心跳周期内响应于至少两个P波的检测来增加超速起搏速率，避免了过高的超速起搏速率。 描述了用于自适应地调节过驱动起搏参数的其它技术，以便实现例如95％起搏节拍的确定的目标起搏程度。 通过自适应地调整过驱动参数以保持目标起搏程度，平均超速起搏速度最小化，同时仍然保持大量的起搏节奏，从而降低患者内出现快速性心律失常的风险。

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：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：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：US6044294A

公开(公告)日：2000-03-28

申请号：US766636

申请日：1996-12-13

申请人： Said Mortazavi ,  Euljoon Park ,  Gene A. Bornzin ,  Joseph J. Florio ,  Jason A. Sholder ,  Robert R. Weyant

发明人： Said Mortazavi ,  Euljoon Park ,  Gene A. Bornzin ,  Joseph J. Florio ,  Jason A. Sholder ,  Robert R. Weyant

IPC分类号： A61N1/365 ,  A61B5/05

CPC分类号： A61N1/36521

摘要： Methods and apparatus are provided for measuring the impedance of a patient's body. Pulse generating circuitry within a rate-responsive pacemaker is used to generate an impedance measurement signal that is applied to the body of the patient with conventional pacemaker leads. The impedance measurement signal contains a series of multiphasic impedance measurement waveforms, which have no net DC value and zero value after second integration. The impedance measurement signal allows the impedance of the body to be measured without interfering with external cardiac monitoring equipment such as electrocardiogram machines.

摘要翻译： 提供了用于测量患者身体阻抗的方法和装置。 速率响应起搏器内的脉冲发生电路用于产生用常规起搏器引线施加到患者身体的阻抗测量信号。 阻抗测量信号包含一系列多相阻抗测量波形，其在第二次积分后不具有净DC值和零值。 阻抗测量信号允许测量身体的阻抗，而不会干扰外部心脏监测设备，如心电图仪。

公开(公告)号：US06466821B1

公开(公告)日：2002-10-15

申请号：US09457451

申请日：1999-12-08

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

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

IPC分类号： A61N1362

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：US06269264B1

公开(公告)日：2001-07-31

申请号：US09325312

申请日：1999-06-03

申请人： Robert R. Weyant ,  Jason A. Sholder ,  Euljoon Park ,  Gene A. Bornzin ,  Joseph J. Florio ,  Said Mortazavi

发明人： Robert R. Weyant ,  Jason A. Sholder ,  Euljoon Park ,  Gene A. Bornzin ,  Joseph J. Florio ,  Said Mortazavi

IPC分类号： A61B505

CPC分类号： A61N1/36521

摘要： Methods and apparatus are provided for measuring the impedance of a patient's body. Pulse generating circuitry within a rate-responsive pacemaker is used to generate an impedance measurement signal that is applied to the body of the patient with conventional pacemaker leads. The impedance measurement signal contains a series of multiphasic impedance measurement waveforms, which have no net DC value and zero value after second integration. The impedance measurement signal allows the impedance of the body to be measured without interfering with external cardiac monitoring equipment such as electrocardiogram machines.

摘要翻译： 提供了用于测量患者身体阻抗的方法和装置。 速率响应起搏器内的脉冲发生电路用于产生用常规起搏器引线施加到患者身体的阻抗测量信号。 阻抗测量信号包含一系列多相阻抗测量波形，其在第二次积分后不具有净DC值和零值。 阻抗测量信号允许测量身体的阻抗，而不会干扰外部心脏监测设备，如心电图仪。

公开(公告)号：US08731665B1

公开(公告)日：2014-05-20

申请号：US11923286

申请日：2007-10-24

申请人： Xiaoyi Min ,  Laleh Jalali ,  Steve Koh ,  Gene A. Bornzin ,  Euljoon Park

发明人： Xiaoyi Min ,  Laleh Jalali ,  Steve Koh ,  Gene A. Bornzin ,  Euljoon Park

IPC分类号： A61N1/00

CPC分类号： A61N1/365 ,  A61N1/36535

摘要： Systems and methods are provided for detecting the orientation and/or movement of a patient having an implantable cardiac stimulation device and evaluating whether a change in the patient's cardiac activity can be at least in part due to a change in the patient's orientation. In one particular embodiment, signals from an orientation sensor and/or a pressure sensor are evaluated to determine static positional orientation of the patient and determine based on the static orientation whether the patient's cardiac activity is abnormal.

摘要翻译： 提供了用于检测具有可植入心脏刺激装置的患者的取向和/或运动的系统和方法，并且评估患者的心脏活动的变化是否可以至少部分地由于患者取向的改变而变化。 在一个特定实施例中，评估来自定向传感器和/或压力传感器的信号以确定患者的静态位置取向，并且基于静态取向来确定患者的心脏活动是否异常。