公开(公告)号：US5626620A

公开(公告)日：1997-05-06

申请号：US391883

申请日：1995-02-21

申请人： Robert S. Kieval ,  Michael F. Hess

发明人： Robert S. Kieval ,  Michael F. Hess

IPC分类号： A61N1/368 ,  A61N1/362 ,  A61N1/37 ,  A61N1/36

CPC分类号： A61N1/3712 ,  A61N1/3627 ,  A61N1/3682

摘要： A dual chamber pacemaker is provided having capability for adjusting the AV escape interval so as to optimize the timing of delivered ventricular pace pulses for therapy of patients with cardiomyopathy. The pacemaker system continually monitors to determine when a delivered pace pulse results in a fusion beat, and periodically adjusts the AV escape interval in accordance with the percentage or rate of incidence of such fusion beats. In one specific embodiment, the pacing system determines the percentage of delivered ventricular pace pulses which are followed by fusion beats over a predetermined number of intervals, and decrements AV escape interval when such percentage is not below a predetermined minimum. The pacing system also periodically increments AV escape interval when the rate of fusion beats is acceptable, thereby providing a closed loop system for maintaining the AV interval at an optimally long value consistent with maximizing full capture by delivered ventricular pace pulses. In another embodiment, the V--V escape interval of a non-tracking mode pacemaker is controlled to optimize pre-excitation of the ventricle.

摘要翻译： 提供了一种双室起搏器，具有调整AV逃逸间隔的能力，从而优化用于治疗心肌病患者的输送心室起搏脉冲的时间。 起搏器系统持续监测以确定何时传送的步态脉冲导致融合节拍，并且根据这种融合节拍的百分比或发生率周期性地调整AV逃逸间隔。 在一个具体实施例中，起搏系统确定所提供的心室起搏脉冲的百分比，随后在预定数量的间隔上进行融合搏动，并且当该百分比不低于预定最小值时减小AV逃逸间隔。 当融合搏动速率可接受时，起搏系统还周期性地增加AV逃逸间隔，从而提供闭环系统，用于将AV间隔保持在最佳长度值，与通过传递的心室起搏脉冲最大化完全捕获相一致。 在另一个实施例中，控制非跟踪模式起搏器的V-V逃逸间隔以优化心室的预激发。

公开(公告)号：US08332030B2

公开(公告)日：2012-12-11

申请号：US11115597

申请日：2005-04-27

申请人： Michael F. Hess ,  Eduardo N. Warman

发明人： Michael F. Hess ,  Eduardo N. Warman

IPC分类号： A61N1/00

CPC分类号： A61N1/3622 ,  A61N1/3627 ,  A61N1/3684

摘要： A device for delivering pacing therapy includes an atrial and ventricular leads, sensing circuitry connected to the leads for detecting depolarizations, and pulse generation circuitry for delivering ventricular pacing pulses based on sensed atrial depolarizations. The device includes control circuitry for controlling the pulse generation circuitry in a first mode in which the pulse generation circuitry delivers atrial synchronized pulses to both the right and left ventricular leads in response to each atrial depolarization sensed. In response to a detected atrial arrhythmia, the control circuitry causes the pulse generation circuitry to deliver atrial synchronized ventricular pacing pulses in response only to selected atrial depolarizations.

摘要翻译： 用于输送起搏治疗的装置包括心房和心室引线，连接到用于检测去极化的引线的感测电路以及用于基于感测的心房去极化来输送心室起搏脉冲的脉冲产生电路。 该装置包括用于在第一模式中控制脉冲发生电路的控制电路，其中脉冲发生电路响应于感测到的每个心房去极化而将心房同步脉冲输送到右心室和左心室引线。 响应于检测到的心房心律失常，控制电路使得脉冲发生电路仅响应于所选择的心房去极化来递送心房同步心室起搏脉冲。

公开(公告)号：US07515959B2

公开(公告)日：2009-04-07

申请号：US11096511

申请日：2005-03-31

申请人： Michael F. Hess

发明人： Michael F. Hess

IPC分类号： A61N1/362

CPC分类号： A61N1/3627 ,  A61N1/3622 ,  A61N1/3925 ,  A61N1/3956 ,  A61N1/3962

摘要： In some embodiments, a method for operating a cardiac rhythm management device may include one or more of the following steps: (a) sensing atrial depolarizations through an implanted atrial electrode, (b) administering a sequential CRT pacing therapy in a sequential CRT pacing mode to a left and right ventricle of a heart of a patient via implanted ventricular electrodes in a sequential bi-ventricular fashion, (c) switching from the sequential CRT pacing mode to a simultaneous CRT pacing mode, (d) administering a simultaneous CRT pacing therapy in the simultaneous CRT pacing mode to the left and right ventricle in a simultaneous bi-ventricular fashion, (e) analyzing the sensed atrial depolarizations to detect the presence of an atrial arrhythmia, (f) analyzing the sensed atrial depolarizations while in the sequential CRT pacing mode to detect the presence of atrial arrhythmia, and (g) sensing ventricular depolarizations of the left and the right ventricle.

摘要翻译： 在一些实施例中，用于操作心律管理装置的方法可以包括以下步骤中的一个或多个：（a）通过植入的心房电极感测心房去极化，（b）以连续的CRT起搏模式施用连续的CRT起搏治疗 （c）从连续的CRT起搏模式切换到同步的CRT起搏模式，（d）同时进行CRT起搏治疗，其中， （e）分析感测到的心房去极化以检测心房心律失常的存在，（f）分析感染的心房去极化，同时在顺序CRT中 起搏模式来检测心律失常的存在，（g）感测左心室和右心室的心室去极化。

公开(公告)号：US20080269825A1

公开(公告)日：2008-10-30

申请号：US11742210

申请日：2007-04-30

申请人： Edward Chinchoy ,  Michael F. Hess

发明人： Edward Chinchoy ,  Michael F. Hess

IPC分类号： A61N1/37

CPC分类号： A61N1/3627 ,  A61N1/3712

摘要： A system and method for monitoring at least one chamber of a heart (e.g., a left ventricular chamber) during delivery of a refractory period stimulation (RPS) therapy to determine if the desired non-capture (i.e., lack of ventricular mechanical capture due to refractory period stimulation) occurs. The system includes an implantable or external cardiac stimulation device in association with a set of leads such as epicardial, endocardial, and/or coronary sinus leads equipped with motion sensor(s). The device receives and processes acceleration sensor signals to determine a signal characteristic indicative of chamber capture due to pacing stimulus delivery, non-capture due to RPS therapy delivery, and/or contractile status based on the qualities of evoked response to pacing stimulation.

摘要翻译： 一种用于在递送不期期刺激（RPS）治疗期间监测心脏（例如，左心室）的至少一个腔室的系统和方法，以确定是否期望的非捕获（即，由于缺乏心室机械捕获 难治期刺激）发生。 该系统包括与一组引线相关联的可植入或外部心脏刺激装置，例如配备有运动传感器的心外膜，心内膜和/或冠状窦导联。 该装置接收并处理加速度传感器信号以确定指示由于起搏刺激递送，由于RPS治疗递送而导致的非捕获和/或基于对起搏刺激的诱发响应的质量的收缩状态的室捕获的信号特征。

公开(公告)号：US06442429B1

公开(公告)日：2002-08-27

申请号：US09593200

申请日：2000-06-14

申请人： Michael R. S. Hill ,  Michael F. Hess

发明人： Michael R. S. Hill ,  Michael F. Hess

IPC分类号： A61N1362

CPC分类号： A61N1/3622

摘要： A medical device selects the most appropriate among various calculated escape intervals for use in the next cardiac cycle. This is particularly implemented in cardiac event in which a pacemaker is used to prevent multiple tachyarrhythmias. The prevention pacing modes may be simultaneously active, with the escape interval for each mode calculated and updated on a beat-by-beat basis. The medical device selects tachyarrhythmia prevention pacing modality to control the escape interval of the current cardiac cycle in order that a more appropriate method for calculating the escape interval based on the present condition of the patient, may be selected.

摘要翻译： 医疗设备选择在下一个心动周期中使用的各种计算的逃逸间隔中最合适的。 这在心脏事件中特别实现，其中使用起搏器来预防多发性快速性心律失常。 预防起搏模式可以同时处于活动状态，每个模式的逃脱间隔以逐个节拍为基础计算和更新。 医疗装置选择快速性心律失常预防起搏模式来控制当前心动周期的逃避间隔，以便可以选择基于患者的当前状况来计算逃逸间隔的更合适的方法。

公开(公告)号：US06195584B1

公开(公告)日：2001-02-27

申请号：US09303279

申请日：1999-04-30

申请人： Michael R. S. Hill ,  Rahul Mehra ,  Michael F. Hess ,  Raylene Pitschneider

发明人： Michael R. S. Hill ,  Rahul Mehra ,  Michael F. Hess ,  Raylene Pitschneider

IPC分类号： A61N137

CPC分类号： A61N1/371 ,  A61N2001/083

摘要： A method and apparatus for determining the occurrence of a mis-location of an atrial electrode in a cardiac stimulation device having an atrial pulse generator coupled with the atrial electrode and a ventricular sense amplifier coupled to a ventricular electrode. The device paces the atrium in a first pacing mode employing atrial pacing pulses at a first energy level and in a test mode employs higher energy atrial pacing pulses. In the test mode the device measures PR intervals between atrial pacing pulses following sensed ventricular depolarizations and determines that the atrial electrode is mis-located responsive to occurrence of a threshold number of short PR intervals or that the atrial electrode is appropriately located responsive to occurrence of a threshold number of long PR intervals. Operation of the device in the test mode may be pre-conditioned on an absence of atrial tachyarrhythmia.

摘要翻译： 一种用于确定在具有与心房电极耦合的心房脉冲发生器和耦合到心室电极的心室感应放大器的心脏刺激装置中心房电极错位的发生的方法和装置。 该装置以第一起搏模式采用心房起搏脉冲在第一能级进行起搏，并且在测试模式中采用更高能量的心房起搏脉冲。 在测试模式中，该装置测量感测到的心室去极化之后的心房起搏脉冲之间的PR间隔，并且确定心房电极响应于出现阈值数量的短PR间期而错位，或者心房电极适当地位于响应于 长PR间隔的阈值数。 在测试模式下的装置的操作可以在没有心房快速性心律失常的情况下进行预处理。

公开(公告)号：US5441525A

公开(公告)日：1995-08-15

申请号：US246903

申请日：1994-05-20

申请人： Michael B. Shelton ,  Kenneth M. Riff ,  Michael F. Hess

发明人： Michael B. Shelton ,  Kenneth M. Riff ,  Michael F. Hess

IPC分类号： A61N1/365 ,  A61N1/36

CPC分类号： A61N1/36514 ,  A61N1/365

摘要： A rate-responsive cardiac pacemaker implements a novel scheme which detects incipient vasovagal syncope (or other episodes caused by a vasodepressive or cardioinhibitory disorder) when a) the heart rate drops below a programmable minimum size, and b) the rate after said drop is below a programmable maximum drop ending rate. The pacemaker implements a stability and intervention procedure upon the detection of an episode, in which it ignores transient drops in rate, and paces at a predetermined high rate if the drops are stable. The pacemaker then gradually reduces the pacing rate over a predetermined time to the pre-episodic level. A sleep disable feature disables the vasovagal syncope detection and therapy features during the patient's sleeping hours to reduce or eliminate false positive responses.

摘要翻译： 速率响应心脏起搏器实施一种新颖的方案，其检测初期的血管迷走性晕厥（或由血管抑郁或心脏抑制障碍引起的其他发作），当a）心率下降到可编程的最小尺寸以下时，b）所述下降之后的速率低于 可编程的最大下降结束率。 起搏器在检测到发作时实现稳定性和干预程序，其中它忽略了速率的瞬时下降，并且如果液滴是稳定的，起搏器以预定的高速度步进。 然后，起搏器逐渐将起搏速度在预定时间内降低到事件发生前的水平。 睡眠禁用功能在患者睡眠时间内禁用血管迷走性晕厥检测和治疗功能，以减少或消除假阳性反应。

公开(公告)号：US08738131B2

公开(公告)日：2014-05-27

申请号：US11688515

申请日：2007-03-20

申请人： Edward Chinchoy ,  Michael F. Hess

发明人： Edward Chinchoy ,  Michael F. Hess

IPC分类号： A61N1/365

CPC分类号： A61N1/3712 ,  A61N1/3627

摘要： A system and method for monitoring at least one chamber of a heart (e.g., a left ventricular chamber) during delivery of extrasystolic stimulation to determine if the desired extra-systole (i.e., ventricular mechanical capture following refractory period expiration) occurs. The system includes an implantable or external cardiac stimulation device in association with a set of leads such as epicardial, endocardial, and/or coronary sinus leads equipped with motion sensor(s). The device receives and processes acceleration sensor signals to determine a signal characteristic indicative of chamber capture resulting from one or more pacing stimulus delivered closely following expiration of the refractory period. A threshold optimization method optionally evaluates capture and at least one of: runs an iterative routine to establish or re-establish chamber capture for the PESP therapy, sets a logical flag relating to chamber capture status and stores parameter(s) relating to successful chamber capture for one or more subsequent cardiac cycles.

摘要翻译： 用于在递送收缩期刺激期间监测心脏（例如，左心室）的至少一个室的系统和方法，以确定是否发生期望的收缩期（即，在不应期内期满后的心室机械捕获）。 该系统包括与一组引线相关联的可植入或外部心脏刺激装置，例如配备有运动传感器的心外膜，心内膜和/或冠状窦导联。 该装置接收和处理加速度传感器信号，以确定指示由不可逆期间期满后紧密递送的一个或多个起搏刺激产生的指示腔室捕获的信号特征。 阈值优化方法可选地评估捕获和至少一个：运行迭代程序以建立或重新建立用于PESP治疗的室捕获，设置与室捕获状态相关的逻辑标志并存储与成功室捕获有关的参数 用于一个或多个随后的心动周期。

公开(公告)号：US20080234771A1

公开(公告)日：2008-09-25

申请号：US11688515

申请日：2007-03-20

申请人： Edward Chinchoy ,  Michael F. Hess

发明人： Edward Chinchoy ,  Michael F. Hess

IPC分类号： A61N1/365 ,  A61B5/02

CPC分类号： A61N1/3712 ,  A61N1/3627

摘要： A system and method for monitoring at least one chamber of a heart (e.g., a left ventricular chamber) during delivery of extrasystolic stimulation to determine if the desired extra-systole (i.e., ventricular mechanical capture following refractory period expiration) occurs. The system includes an implantable or external cardiac stimulation device in association with a set of leads such as epicardial, endocardial, and/or coronary sinus leads equipped with motion sensor(s). The device receives and processes acceleration sensor signals to determine a signal characteristic indicative of chamber capture resulting from one or more pacing stimulus delivered closely following expiration of the refractory period. A threshold optimization method optionally evaluates capture and at least one of: runs an iterative routine to establish or re-establish chamber capture for the PESP therapy, sets a logical flag relating to chamber capture status and stores parameter(s) relating to successful chamber capture for one or more subsequent cardiac cycles.

摘要翻译： 用于在递送收缩期刺激期间监测心脏（例如，左心室）的至少一个室的系统和方法，以确定是否发生期望的收缩期（即，在不应期内期满后的心室机械捕获）。 该系统包括与一组引线相关联的可植入或外部心脏刺激装置，例如配备有运动传感器的心外膜，心内膜和/或冠状窦导联。 该装置接收和处理加速度传感器信号，以确定指示由不可逆期间期满后紧密递送的一个或多个起搏刺激产生的指示腔室捕获的信号特征。 阈值优化方法可选地评估捕获和至少一个：运行迭代程序以建立或重新建立用于PESP治疗的室捕获，设置与室捕获状态相关的逻辑标志并存储与成功室捕获有关的参数 用于一个或多个随后的心动周期。

公开(公告)号：US07313436B2

公开(公告)日：2007-12-25

申请号：US10426495

申请日：2003-04-30

申请人： Michael F. Hess

发明人： Michael F. Hess

IPC分类号： A61N1/39

CPC分类号： A61N1/3622 ,  A61N1/3918 ,  A61N1/3962

摘要： An implantable cardioverter defibrillator system and method are provided having configurable shock therapies selected based on an evaluation of the atrial rhythm status following a ventricular tachycardia or fibrillation detection. A dual chamber shock configuration is selected if the ventricular arrhythmia is co-existing with an atrial arrhythmia of recent onset. A ventricular only shock configuration is selected if the ventricular arrhythmia is co-existing with a sustained atrial arrhythmia.

摘要翻译： 提供了一种植入式心律转复除颤器系统和方法，其具有基于在室性心动过速或原纤维化检测之后的心房节律状态的评估来选择的可配置的休克疗法。 如果室性心律失常与近期发作的心房心律失常共存，则选择双室休克配置。 如果室性心律失常与持续的心房心律失常共存，则选择心室唯一的休克配置。