公开(公告)号：US5531771A

公开(公告)日：1996-07-02

申请号：US329232

申请日：1994-10-26

申请人： Johannes S. van der Veen

发明人： Johannes S. van der Veen

IPC分类号： A61N1/362 ,  A61N1/368 ,  A61N1/36

CPC分类号： A61N1/3622 ,  A61N1/368

摘要： A dual chamber pacemaker system having a dynamic tracking limit, as well as a dynamic pacing limit (flywheel rate), the two dynamic limits being normally coupled to a measure of the sensed atrial rate as long as such rate is physiological. When the atrial signal is lost, i.e., cannot be tracked, the pacemaker responds with asynchronous pacing and normally decrements both dynamic limits, taking the flywheel rate down toward a lower pacing limit. The pacemaker of this invention provides a freeze function whereby the dynamic pacing limit and dynamic tracking limit are maintained constant for a plurality of cycles following asynchronous operation, to improve the possibility of regaining tracking if an underlying physiological atrial signal reappears at about the rate prior to being lost. The freeze function may be timed out for a predetermined number of cycles, e.g., eight, or may have a reduced duration if a series of consecutive synchronous cycles is detected. In a second embodiment, the dynamic tracking limit is decreased without any freeze when the pacer goes into asynchronous operation, but the dynamic tracking limit which existed just before the switch to asynchronous operation is remembered; if the atrial rate reappears below this remembered dynamic tracking limit, the dynamic tracking limit is ramped upward to achieve quick tracking of the reappeared sinus rate. A further embodiment may incorporate the features of the first two embodiments, i.e., a short freeze followed by a period of remembering the value of DTL when async mode was initiated.

摘要翻译： 具有动态跟踪极限以及动态起搏限制（飞轮速率）的双室起搏器系统，只要这种速率是生理的，两个动态极限通常耦合到感测的心房率的测量。 当心房信号丢失，即不能跟踪时，起搏器以异步起搏进行响应，并通常减小动态极限，将飞轮速率降低到较低的起搏极限。 本发明的起搏器提供了冻结功能，其中动态起搏极限和动态跟踪极限在异步操作之后的多个周期中保持恒定，以改善如果潜在的生理心房信号以大约的速率再次出现的恢复跟踪的可能性 失去了 冻结功能可以超过预定数量的周期，例如八个，或者如果检测到一系列连续的同步周期，则可以具有减少的持续时间。 在第二实施例中，当起搏器进入异步操作时，动态跟踪极限减小而没有任何冻结，但是在切换到异步操作之前存在的动态跟踪限制被记住; 如果心房率再次低于此记忆动态跟踪极限，则动态跟踪极限向上倾斜，以实现快速跟踪重现的窦速率。 进一步的实施例可以包括前两个实施例的特征，即，在启动异步模式时短暂的紧随其后是跟踪DTL的值的周期。

公开(公告)号：US5522858A

公开(公告)日：1996-06-04

申请号：US329291

申请日：1994-10-26

申请人： Johannes S. van der Veen

发明人： Johannes S. van der Veen

IPC分类号： A61N1/368 ,  A61N1/362 ,  A61N1/36

CPC分类号： A61N1/3622 ,  A61N1/3682

摘要： A dual chamber cardiac pacemaker system has logic for detecting high rate as well as normal atrial spontaneous signals, and for tracking atrial signals within a predetermined tracking rate range by delivering ventricular pace pulses at an AV interval following each atrial sense within said tracking range. The pacemaker also has detection circuitry for detecting a sequence of pacemaker cycles characterized by first degree AV block, wherein atrial sense signals occur too early to permit tracking, and ventricular spontaneous signals occur following an extended AV-delay such as is characterized by first degree block. The pacemaker restores tracking following detection of such a sequence by delivering ventricular pace pulses at an extended AV interval to override the spontaneous ventricle signals and gradually decreasing the AV-delay back to a normal value, thereby restoring tracking without pacing the ventricle at an excessive rate.

摘要翻译： 双室心脏起搏器系统具有用于检测高速率以及正常心房自发信号的逻辑，并且用于通过在所述跟踪范围内的每个心房感测之后的AV间隔递送心室起搏脉冲来在预定跟踪速率范围内跟踪心房信号。 心脏起搏器还具有检测电路，用于检测以一级AV阻滞为特征的起搏器周期序列，其中心房感觉信号太早发生，不能进行跟踪，并且在延伸的AV延迟之后发生心室自发信号，例如以一级阻塞 。 起搏器通过以扩展的AV间隔递送心室起搏脉冲来恢复跟踪以下检测这样的序列，以覆盖自发心室信号并逐渐将AV延迟降低回正常值，由此恢复跟踪而不以过高的速度起搏心室 。

公开(公告)号：US5247930A

公开(公告)日：1993-09-28

申请号：US831115

申请日：1992-02-04

申请人： Malcolm J. S. Begemann ,  Gustaaf A. P. Stoop ,  Johannes S. van der Veen

发明人： Malcolm J. S. Begemann ,  Gustaaf A. P. Stoop ,  Johannes S. van der Veen

IPC分类号： A61N1/368 ,  A61N1/362

CPC分类号： A61N1/3622

摘要： A dual chamber pacemaker system is provided having means for determining when sensed atrial signals have a physiological rate, and tracking only such sensed atrial signals as are found to have physiological rates. The pacemaker provides logic means for continuously determining a physiological rate as a function of sensed atrial rate, whereby physiological rate substantially tracks the rate of sensed physiological atrial signals. The pacemaker also determines dynamic decision rates which are coupled to follow the physiological rate. The decision rates comprise a dynamic pacing limit, which sets the pacing escape interval; a dynamic tracking limit, which sets the upper limit of the physiological range of rates which are tracked; and the dynamic Wenckebach limit, which defines the upper rate for a dynamic Wenckebach range. The pacemaker enables time out of an AV delay for synchronizing delivery of ventricular pacing pulses with respect to atrial heartbeats which occur within the range between the dynamic pacing limit and the dynamic tracking limit, i.e., the physiological range. Synchronized ventricular pacing pulses are delivered when both the sensed atrial signal and the scheduled synchronized ventricular signal have rates within the determined physiological range. The pacemaker substantially continuously determines atrial rate, sensing all atrial signals except for a short PVAB which limits atrial sensing only to the extent required to block far field R-waves.

摘要翻译： 提供了一种双室起搏器系统，其具有用于确定感测到的心房信号何时具有生理速率的装置，并且仅跟踪被发现具有生理速率的这种感测的心房信号。 起搏器提供用于连续地确定作为感测的心房率的函数的生理速率的逻辑手段，由此生理速率基本上跟踪所感测的生理心房信号的速率。 起搏器还决定了动态决策速率，这些速率与生理速率相关。 决策速率包括动态起搏限制，设置起搏逃生间隔; 一个动态跟踪限制，设定跟踪率的生理范围的上限; 以及动态的Wenckebach限制，它定义了动态Wenckebach范围的较高速率。 起搏器使AV时间延迟以使心室起搏脉冲相对于在动态起搏极限和动态跟踪极限即生理范围之间的范围内的心房心跳的同步传送。 当感测的心房信号和调度的同步心室信号都在确定的生理范围内时，同步的心室起搏脉冲被递送。 心脏起搏器基本上连续地确定心房率，感测所有心房信号，除了短暂的PVAB，其限制心房感应到达阻止远场R波所需的程度。