公开(公告)号：US06975904B1

公开(公告)日：2005-12-13

申请号：US10053462

申请日：2001-11-08

申请人： Laurence S. Sloman

发明人： Laurence S. Sloman

IPC分类号： A61N1/365 ,  A61N1/37

CPC分类号： A61N1/36542 ,  A61N1/3712

摘要： Optimization of evoked response detection in an automatic capture detection system employed by an implantable cardiac stimulation device is presented. Patient state information is used to determine the appropriate settings of variables that are associated with the evoked response signal detection algorithm. The variables used by the evoked response signal detection algorithm are first established for the patient in a variety of positions. During operation of the implantable cardiac stimulation device, the patient state is monitored and the variables used by the evoked response signal detection algorithm are adjusted accordingly.

摘要翻译： 提出了可植入心脏刺激装置采用的自动捕获检测系统中诱发反应检测的优化。 患者状态信息用于确定与诱发反应信号检测算法相关联的变量的适当设置。 首先为各种位置的患者建立了诱发反应信号检测算法使用的变量。 在可植入心脏刺激装置的操作期间，监测患者状态，并且相应地调整由诱发响应信号检测算法使用的变量。

公开(公告)号：US06738669B1

公开(公告)日：2004-05-18

申请号：US10011127

申请日：2001-10-24

申请人： Laurence S. Sloman ,  Kerry Bradley

发明人： Laurence S. Sloman ,  Kerry Bradley

IPC分类号： A61N1368

CPC分类号： A61N1/3712 ,  A61N1/3714

摘要： An implantable cardiac stimulation device and method automatically verify capture of one or both ventricular chambers by sensing a far-field signal in both atrial chambers. A far-field interval window is set following the delivery of the ventricular stimulation, during which a far-field signal is detected and compared to a signal representing a predetermined far-field R-wave that represents successful capture of one or both ventricular chambers. If the far-field signal is approximately equal to the predetermined far-field R-wave signal, then capture is verified. If capture is not verified, a threshold search is performed in the ventricle in which capture was lost.

摘要翻译： 可植入心脏刺激装置和方法通过感测两个心房中的远场信号来自动验证一个或两个心室的捕获。 远场间隔窗口设置在心室刺激传递之后，在此期间，检测到远场信号，并将其与表示成功捕获一个或两个心室的成像捕获的预定远场R波的信号进行比较。 如果远场信号近似等于预定的远场R波信号，则验证捕获。 如果没有验证捕获，则在捕获丢失的心室中执行阈值搜索。

公开(公告)号：US06339723B1

公开(公告)日：2002-01-15

申请号：US09488731

申请日：2000-01-20

申请人： Laurence S. Sloman

发明人： Laurence S. Sloman

IPC分类号： A61N118

CPC分类号： A61N1/056 ,  A61N1/362 ,  A61N1/3712

摘要： An implantable cardiac stimulation device is provided which alters the stimulation regime during determination of a capture threshold level. In order to avoid the potential for fusion beats which would interfere with a capture threshold level determination, a two-fold approach is used. First, the atrial refractoriness of the atrium of the patient's heart is extended by supplying a secondary atrial stimulation pulse during a prescribed time period following delivery of a primary atrial stimulation pulse. Second, the atrium is overdriven by providing an atrial stimulation pulse at a rate in excess of the intrinsic heart rate. Accordingly, the potential for fusion beats is significantly decreased and the reliability of the determined capture threshold level is increased. In a preferred embodiment, two closely placed stimulation pulses, i.e., a first primary atrial stimulation pulse and a secondary atrial stimulation pulse, are provided to an atrium of the patient's heart, and a second primary atrial stimulation pulse set to a test level is delivered faster than the heart's intrinsic rate. During this pacing regime, the potential for fusion beats is decreased and accordingly, sensing the presence or absence of evoked responses can accurately determine the capture threshold level.

摘要翻译： 提供可植入心脏刺激装置，其在确定捕获阈值水平期间改变刺激方案。 为了避免会影响捕获阈值水平确定的融合节拍的潜力，使用双重方法。 首先，通过在传递初级心房刺激脉冲之后的规定时间段期间提供辅助心房刺激脉冲来延长患者心脏心房的心房不应性。 其次，通过以超过内在心率的速率提供心房刺激脉冲来过动心房。 因此，融合节拍的潜力显着降低，并且所确定的捕获阈值水平的可靠性增加。 在优选实施例中，将两个紧密放置的刺激脉冲，即第一初级心房刺激脉冲和次级心房刺激脉冲提供给患者心脏的心房，并且传递设置到测试水平的第二初级心房刺激脉冲 比心脏的内在速度快。 在这种起搏方式期间，融合节拍的潜力降低，因此，感测到诱发反应的存在或不存在可以准确地确定捕获阈值水平。

公开(公告)号：US06266565B1

公开(公告)日：2001-07-24

申请号：US09454647

申请日：1999-12-06

申请人： Siew Bee Er ,  Laurence S. Sloman ,  James E. Tyler

发明人： Siew Bee Er ,  Laurence S. Sloman ,  James E. Tyler

IPC分类号： A61N137

CPC分类号： A61N1/37247

摘要： A pacemaker, or other implantable medical device, connected to heart tissue, detects atrial and ventricular electrical signals. The pacemaker analyzes the signals to determine whether the signals are representative of P-waves or R-waves according to atrial and ventricular sensitivity threshold values. Signals determined to be P-waves or R-waves are identified as sensed signals. Otherwise the signals are identified as not-sensed signals. The pacemaker further determines whether the sensed signals were detected during a refractory period or an alert period and its current tracking mode (e.g., VDD, DDD vs. DDI, VVI). Information pertaining to these atrial and ventricular signals is transmitted to an external programmer which generates representative histograms. The histograms present the number of counts detected within each of a set of high pass filtered amplitude ranges and further indicate the relative numbers of sensed vs. not-sensed counts. For the sensed counts, the histogram may further indicate the relative numbers of counts detected during refractory periods and alert periods. The histograms additionally show the applicable atrial or ventricular sensitivity threshold values to visually assist a physician in determining whether the threshold values are set properly. An auto-sensitivity adjustment system is also provided to determine optimal sensitivity threshold values.

摘要翻译： 连接到心脏组织的起搏器或其他可植入医疗器械检测心房和心室电信号。 起搏器分析信号以确定信号是否根据心房和心室灵敏度阈值代表P波或R波。 确定为P波或R波的信号被识别为感测信号。 否则将信号识别为未感测信号。 起搏器进一步确定在不应期或警报期间及其当前跟踪模式（例如，VDD，DDD与DDI，VVI）之间是否检测到感测到的信号。 关于这些心房和心室信号的信息被传送到产生代表性直方图的外部编程器。 直方图呈现在一组高通滤波幅度范围的每一个中检测到的计数数量，并进一步指示感测到未感测计数的相对数。 对于感测的计数，直方图可以进一步指示在不应期和警报期间检测到的计数的相对数。 直方图还显示适用的心房或心室灵敏度阈值，以视觉上协助医师确定是否正确地设置了阈值。 还提供自动灵敏度调节系统以确定最佳灵敏度阈值。

公开(公告)号：US6101416A

公开(公告)日：2000-08-08

申请号：US124811

申请日：1998-07-29

申请人： Laurence S. Sloman

发明人： Laurence S. Sloman

IPC分类号： A61N1/37 ,  A61N1/368

CPC分类号： A61N1/3712 ,  A61N1/3714

摘要： An implantable pacemaker automatically verifies atrial capture and performs atrial stimulation energy assessment when atrial capture is absent. The pacemaker delivers a stimulation pulse in the atrial chamber of the heart and samples the resulting far-field signal from the ventricular chamber during a predetermined far-field interval window. The pacemaker then compares the far-field signal sample to a predetermined far-field signal recognition template. If the far-field signal sample is approximately equal to the far-field signal recognition template, then atrial capture is deemed verified; otherwise, the pacemaker performs an atrial stimulation energy determination. Optionally, the pacemaker automatically determines the timing of the far-field interval window and defines the far-field signal recognition template.

摘要翻译： 植入性起搏器自动验证心房采集，并且在不存在心房捕获时进行心房刺激能量评估。 心脏起搏器在心脏房室内传送刺激脉冲，并在预定的远场间隔窗口期间从心室收集所得到的远场信号。 起搏器然后将远场信号样本与预定的远场信号识别模板进行比较。 如果远场信号样本近似等于远场信号识别模板，则认为心房捕获被验证; 否则，起搏器执行心房刺激能量测定。 可选地，起搏器自动确定远场间隔窗口的定时并定义远场信号识别模板。

公开(公告)号：US20140052012A1

公开(公告)日：2014-02-20

申请号：US13587807

申请日：2012-08-16

申请人： Jeffery D. Snell ,  Laurence S. Sloman ,  Bruce A. Morley

发明人： Jeffery D. Snell ,  Laurence S. Sloman ,  Bruce A. Morley

IPC分类号： A61B5/0464

CPC分类号： A61B5/0464 ,  A61N1/3925

摘要： Techniques are provided for updating a morphology template used to discriminate abnormal cardiac rhythms. In one example, a non-weighted candidate morphology template is generated based on far-field R-wave morphology. A weighted candidate morphology template is generated based on an ensemble average of the non-weighted candidate morphology template and a previous (i.e. active) morphology template. The previous morphology template is then selectively updated based on a comparison of additional R-waves against both the non-weighted and the weighted candidate templates. Thereafter, abnormal cardiac rhythms such as ventricular tachycardia and supraventricular tachycardia are discriminated using the updated morphology template based on newly-detected far-field R-waves. These techniques provide a method for updating the morphology discrimination template in response to long-term changes in morphology due to cardiac remodeling or cardiac disease progression.

摘要翻译： 提供了用于更新用于区分异常心律的形态学模板的技术。 在一个示例中，基于远场R波形态产生非加权候选形态模板。 基于非加权候选形态模板和先前（即主动）形态模板的整体平均值生成加权候选形态模板。 然后基于对另外的R波与非加权和加权的候选模板的比较来选择性地更新先前的形态学模板。 此后，使用基于新检测的远场R波的更新的形态学模板来区分异常心律，如室性心动过速和室上性心动过速。 这些技术提供了一种用于根据心脏重塑或心脏疾病进展的形态学长期变化来更新形态学鉴别模板的方法。

公开(公告)号：US20110098764A1

公开(公告)日：2011-04-28

申请号：US12607847

申请日：2009-10-28

申请人： Laurence S. Sloman ,  Stuart Rosenberg

发明人： Laurence S. Sloman ,  Stuart Rosenberg

IPC分类号： A61N1/39

CPC分类号： A61N1/3702 ,  A61B5/0452 ,  A61B5/7257 ,  A61B5/726 ,  A61N1/37

摘要： Detection of T wave oversensing in an ICD is accomplished in order to prevent improper application of treatment to a patient. The ICD device senses for electrical impulses representing the R waves of a beating heart. In some instances the ICD device will sense T waves that it will assume to be R waves, because the ICD device expects or assumes that such sensed signals are R waves. Time intervals between each detected, assumed R waves are measured and a list of intervals is generated. The list is transformed into its frequency domain equivalent and analyzed for peaks and randomness criteria to determine whether T wave oversensing has occurred.

摘要翻译： 为了防止对患者的不适当的治疗应用，ICD中的T波超检测的检测是完成的。 ICD装置感测表示跳动心脏的R波的电脉冲。 在某些情况下，由于ICD设备预期或假设这些感测信号是R波，因此ICD设备将感测T波将被认为是R波。 测量每个检测到的假定R波之间的时间间隔，并产生间隔列表。 将该列表转换为其等效频域，并分析峰值和随机性标准，以确定是否发生了T波超检测。

公开(公告)号：US07856271B2

公开(公告)日：2010-12-21

申请号：US11948671

申请日：2007-11-30

申请人： Kerry Bradley ,  Laurence S. Sloman

发明人： Kerry Bradley ,  Laurence S. Sloman

IPC分类号： A61N1/362

CPC分类号： A61N1/371 ,  A61N1/3716

摘要： A method for sensing cardiac activity in an atrium of a patient's heart includes delivering a pulse to the atrium using an electrode configuration that includes at least a cathode electrode; sensing cardiac activity in the atrium using a unipolar electrode configuration to provide a sensed signal wherein the unipolar electrode configuration does not include the cathode electrode; determining the duration during which the voltage of the sensed signal falls below a threshold voltage; and comparing the determined duration to a parameter to determine whether the pulse caused an atrial evoked response.

摘要翻译： 用于感测患者心脏的心脏活动的方法包括：使用至少包括阴极电极的电极配置将脉冲输送到心房; 使用单极电极配置感测心房中的心脏活动以提供感测信号，其中单极电极配置不包括阴极电极; 确定感测信号的电压下降到阈值电压以下的持续时间; 以及将所确定的持续时间与参数进行比较以确定所述脉冲是否引起心房诱发反应。

公开(公告)号：US20100063561A1

公开(公告)日：2010-03-11

申请号：US12205662

申请日：2008-09-05

申请人： Laurence S. Sloman ,  Jeffery D. Snell

发明人： Laurence S. Sloman ,  Jeffery D. Snell

IPC分类号： A61N1/37

CPC分类号： A61N1/3706 ,  A61N2001/083

摘要： A plurality of electrodes are implanted in, on or near the patient's heart and initially configured to define first circuits or vectors enabled for at least one of sensing and stimulating and second circuits or vectors which are idle for at least one of sensing and stimulating. Selected first circuits or second circuits are tested for fault indications related to one or both of sensing and stimulating and a status record is updated to indicate corresponding sensing fault indications and stimulating fault indications. If a sensing fault is found in one of the first circuits, the first circuit is redefined when enabled for sensing to include at least one electrode of a second circuit that does not have a record of a sensing fault indication. Likewise, if a stimulating fault is found in one of the first circuits, the first circuit is redefined when enabled for stimulating to include at least one electrode of a second circuit that does not have a record of a stimulating fault indication.

摘要翻译： 多个电极被植入在患者心脏中，上面或附近，并且最初被配置为限定为感测和刺激中的至少一个而启用的第一电路或矢量，以及对于感测和刺激中的至少一个空闲的第二电路或矢量。 对所选择的第一电路或第二电路进行与感测和刺激中的一个或两个相关的故障指示的测试，并且更新状态记录以指示相应的感测故障指示并且刺激故障指示。 如果在第一电路中的一个电路中发现感测故障，则当使能感测到第一电路包括不具有感测故障指示记录的第二电路的至少一个电极时，重新定义第一电路。 类似地，如果在第一电路中的一个电路中发现刺激性故障，则当启用激活以包括不具有刺激故障指示记录的第二电路的至少一个电极时，第一电路被重新定义。

公开(公告)号：US07548783B1

公开(公告)日：2009-06-16

申请号：US11330208

申请日：2006-01-11

申请人： Laurence S. Sloman

发明人： Laurence S. Sloman

IPC分类号： A61N1/362

CPC分类号： A61N1/3621 ,  A61N1/3624 ,  A61N1/3702 ,  A61N1/3925 ,  A61N1/395 ,  A61N1/3962

摘要： An implantable cardiac stimulation device selects an arrhythmia therapy based upon the time of day. The device comprises an arrhythmia detector that detects an accelerated arrhythmia of a heart, and a data circuit that maintains a time record of cardiac cycle lengths developed during detected accelerated arrhythmias. A therapy circuit provides a selected therapy to the heart based upon the maintained time record of cardiac cycle lengths and the time of day.

摘要翻译： 可植入心脏刺激装置基于一天中的时间选择心律失常治疗。 该装置包括检测心脏加速心律失常的心律失常检测器，以及维持在检测到的加速心律失常期间产生心脏周期长度的时间记录的数据电路。 治疗电路基于持续的心脏周期长度和时间的时间记录向心脏提供选择的治疗。