公开(公告)号：US08180439B2

公开(公告)日：2012-05-15

申请号：US12846387

申请日：2010-07-29

申请人： Jong Gill ,  Peter Boileau ,  Gene A. Bornzin ,  Joseph J. Florio ,  Mohssen Fard

发明人： Jong Gill ,  Peter Boileau ,  Gene A. Bornzin ,  Joseph J. Florio ,  Mohssen Fard

IPC分类号： A61B5/0452

CPC分类号： A61B5/0452 ,  A61B5/7203 ,  A61B5/7264 ,  Y10S128/92

摘要： An implanted cardiac rhythm management device is disclosed that is operative to detect myocardial ischemia. This is done by evaluating electrogram features to detect an electrocardiographic change; specifically, changes in electrogram segment during the early part of an ST segment. The early part of the ST segment is chosen to avoid the T-wave.

摘要翻译： 公开了可用于检测心肌缺血的植入式心律管理装置。 这通过评估电描记图特征来检测心电图变化来完成; 具体来说，在ST段的早期部分，电描绘片段的变化。 选择ST段的早期部分以避免T波。

公开(公告)号：US20100094371A1

公开(公告)日：2010-04-15

申请号：US12635474

申请日：2009-12-10

申请人： Gene A. Bornzin ,  Joseph J. Florio

发明人： Gene A. Bornzin ,  Joseph J. Florio

IPC分类号： A61N1/365

CPC分类号： A61N1/3712 ,  A61N1/3627 ,  A61N1/36578

摘要： A coupled/paired stimulus pulse is delivered to the heart at an inter-pulse interval following one of i) detection of an intrinsic depolarization or ii) delivery of a primary stimulus pulse. Capture resulting from the coupled/paired stimulus pulse is sensed for. In response to capture by a coupled/paired stimulus pulse, the inter-pulse interval is incrementally decreased by a first amount until there is no capture by a coupled/paired stimulus pulse. In response to no capture by a coupled/paired stimulus pulse, the inter-pulse interval is incrementally increased by a second amount greater than the first amount, until capture by a coupled/paired stimulus pulse is detected. Once capture is again detected, paired/coupled pacing is delivered at the inter-pulse interval which resulted in capture for a predetermined period of time or until loss of capture occurs.

摘要翻译： 耦合/配对的刺激脉冲按照i）检测到内部去极化或ii）主要刺激脉冲的传送之间的脉冲间隔递送到心脏。 感测由耦合/配对刺激脉冲产生的捕获。 响应于通过耦合/配对的刺激脉冲的捕获，脉冲间隔逐渐减小第一量，直到没有被耦合/配对的刺激脉冲捕获。 响应于没有通过耦合/配对刺激脉冲的捕获，脉冲间隔逐渐增加大于第一量的第二量，直到检测到耦合/配对刺激脉冲的捕获。 一旦再次检测到捕获，配对/联合起搏将以脉冲间隔传送，这导致捕获预定时间段或直到发生捕获丢失。

公开(公告)号：US07308306B1

公开(公告)日：2007-12-11

申请号：US10456060

申请日：2003-06-06

申请人： Euljoon Park ,  Peter Boileau ,  Joseph J. Florio ,  Gene A. Bornzin ,  Eric Falkenberg

发明人： Euljoon Park ,  Peter Boileau ,  Joseph J. Florio ,  Gene A. Bornzin ,  Eric Falkenberg

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。

公开(公告)号：US07103411B1

公开(公告)日：2006-09-05

申请号：US10206483

申请日：2002-07-26

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： A61N1/368

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.

公开(公告)号：US07056314B1

公开(公告)日：2006-06-06

申请号：US10452244

申请日：2003-05-30

申请人： Joseph J. Florio ,  Gene A. Bornzin ,  Kevin L. Morgan ,  Sheldon Williams ,  Janice Barstad

发明人： Joseph J. Florio ,  Gene A. Bornzin ,  Kevin L. Morgan ,  Sheldon Williams ,  Janice Barstad

IPC分类号： A61M25/01

CPC分类号： A61M25/0152 ,  A61B17/3478 ,  A61B2017/003 ,  A61M25/0136 ,  A61M25/0141 ,  A61M25/0147 ,  A61M2025/015 ,  A61M2025/0161

摘要： An omnidirectionally steerable obturator facilitates the delivery of the distal tip of an introducer sheath into the coronary sinus of a heart. The steerable obturator comprises an obturator body extending longitudinally along a central axis, the obturator body being configured to be received by the introducer sheath. The obturator body further has a flexible, deflectable distal end section terminating in a rounded distal tip. An actuator, controllable from a proximal end of the obturator body, is operatively associated with the flexible distal end section of the obturator body to cause deflection of the flexible distal end section of the obturator body in at least one selected direction to facilitate passage of the distal end section of the obturator body and the distal tip of the introducer sheath into the coronary sinus of the heart.The obturator body is preferably configured to be received in a close fit within at least the tip of the introducer sheath. More preferably, the distal end of the obturator body has an outer surface and the fit between the outer surface of the obturator and at least the tip of the introducer sheath comprises substantially a line-to-line fit.

摘要翻译： 全向可操纵的闭孔器有利于将导引鞘的远侧末端递送到心脏的冠状窦。 可操纵的闭孔器包括沿着中心轴线纵向延伸的闭孔器，所述封闭器主体构造成由引导器护套容纳。 闭孔体还具有终止于圆形远端尖端的柔性的，可偏转的远端部分。 从闭塞体的近端可控制的致动器与闭塞体的柔性远端部分可操作地相关联，以使闭塞体的柔性远端部分沿至少一个选定的方向偏转，以便于通过 闭塞体的远端部分和导引鞘的远侧末端插入心脏的冠状窦。 闭孔体优选构造成在至少引导器护套的尖端内紧密配合。 更优选地，闭孔体的远端具有外表面，并且填塞物的外表面与引导器护套的至少末端之间的配合基本上包括线对齐配合。

公开(公告)号：US06990374B1

公开(公告)日：2006-01-24

申请号：US10117757

申请日：2002-04-04

申请人： Joseph J. Florio ,  Gene A. Bornzin ,  John W. Poore ,  Douglas T. Kurschinski

发明人： Joseph J. Florio ,  Gene A. Bornzin ,  John W. Poore ,  Douglas T. Kurschinski

IPC分类号： A61N1/362

CPC分类号： A61N1/368

摘要： Techniques are described for overdrive pacing the heart using a pacemaker. 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. Still other techniques are described for increasing an overdrive pacing rate by an amount related to a current overdrive pacing rate.

摘要翻译： 描述了使用起搏器超速起搏心脏的技术。 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。 描述了另外一些技术，用于增加超速起搏速率与当前超速起搏速率相关的量。

公开(公告)号：US06758854B1

公开(公告)日：2004-07-06

申请号：US09344535

申请日：1999-06-25

申请人： William Butler ,  John Ockuly ,  Joseph J. Florio ,  Gene A. Bornzin ,  Steven E. Scott

发明人： William Butler ,  John Ockuly ,  Joseph J. Florio ,  Gene A. Bornzin ,  Steven E. Scott

IPC分类号： A61B2900

CPC分类号： A61M39/06 ,  A61M25/0041 ,  A61M25/0668 ,  A61M2210/125

摘要： A splittable occlusion balloon sheath includes a splittable sheath onto which an occlusion balloon has been secured near the distal end of the splittable sheath. A splittable hemostasis valve or a partitioned hemostasis valve system may also be secured within or to the splittable occlusion balloon sheath. This splittable occlusion balloon sheath is utilized to introduce a medical device, such as electrode leads, into the coronary sinus of the human heart. A dilator may also be used with the splittable occlusion balloon sheath for introduction of the medical devices. The splittable occlusion balloon sheath and/or the dilator may be precurved with a particular shape to assist in the introduction of the splittable occlusion balloon sheath and/or dilator into the coronary sinus. Also disclosed is a process of use of the splittable occlusion balloon system within the coronary sinus.

摘要翻译： 可分开的闭塞气囊护套包括可分开的护套，闭塞气球已经被固定到可分开的护套的远端附近。 可分裂的止血阀或分隔式止血阀系统也可以固定在可分开的闭塞球囊护套内或可分开的闭塞气囊护套内。 这种可裂缝闭塞球囊用于将诸如电极引线的医疗装置引入人心脏的冠状窦。 扩张器还可以与可分离的闭塞球囊一起使用以引入医疗装置。 可分离的闭塞气囊鞘和/或扩张器可以具有特定形状的前体，以有助于将可分离的闭塞气囊鞘和/或扩张器引入冠状窦。 还公开了在冠状窦内使用可分裂闭塞球囊系统的过程。

公开(公告)号：US06748261B1

公开(公告)日：2004-06-08

申请号：US09675462

申请日：2000-09-28

申请人： Mark W. Kroll ,  Joseph J. Florio ,  Gene A. Bornzin ,  Euljoon Park ,  Kerry A. Bradley

发明人： Mark W. Kroll ,  Joseph J. Florio ,  Gene A. Bornzin ,  Euljoon Park ,  Kerry A. Bradley

IPC分类号： A61B504

CPC分类号： A61N1/3627 ,  A61B5/0031 ,  A61B5/0456 ,  A61B5/046 ,  A61N1/3684

摘要： A system and method, for use in an implantable cardiac stimulation device, monitors progression or regression in heart disease such as congestive heart failure. The system includes a sensing circuit that derives an electrogram signal indicative of the electrical activity of the patient's heart. A processor processes the electrogram signal to determine interchamber conduction delays which are then stored in memory. The stored interchamber conduction delays may be later retrieved by way of a telemetry circuit. Relative changes in the interchamber conduction delays, over time, are indicative of progression or regression in the heart disease. The relative changes in the interchamber conduction delays may be further used to automatically adjust pacing parameters of the implantable cardiac stimulation device.

摘要翻译： 用于可植入心脏刺激装置的系统和方法监测心脏疾病如充血性心力衰竭的进展或消退。 该系统包括感测电路，其导出指示患者心脏的电活动的电描绘信号。 处理器处理电描记图信号以确定然后存储在存储器中的车间传导延迟。 存储的车间传导延迟可以稍后通过遥测电路检索。 随着时间的推移，间歇传导延迟的相对变化表明心脏病发展或消退。 室间传导延迟的相对变化可以进一步用于自动调整可植入心脏刺激装置的起搏参数。

公开(公告)号：US06625492B2

公开(公告)日：2003-09-23

申请号：US09849867

申请日：2001-05-03

申请人： Joseph J. Florio ,  Gregory Hauck ,  Gene A. Bornzin

发明人： Joseph J. Florio ,  Gregory Hauck ,  Gene A. Bornzin

IPC分类号： A61N1365

CPC分类号： A61N1/36514

摘要： A pacemaker or other implantable cardiac stimulation device is configured with both a rate hysteresis mode and a vasovagal syncope prevention mode. Within the rate hysteresis mode, the pacemaker detects when the intrinsic heart rate of the patient is below an escape rate, then paces the heart at a Base Rate until an intrinsic beat is detected. When programmed in the vasovagal syncope prevention mode, upon detecting the intrinsic rate falling below the Hysteresis Escape Rate, the pacemaker paces the heart at a Vasovagal Syncope Response Rate, which is considerably higher than the Base Rate. The pacemaker is preferably set to the syncope prevention mode for patients prone to recurrent vasovagal syncope. By pacing the heart at the higher Vasovagal Syncope Response Rate, the pacemaker thereby helps prevent a significant drop in blood pressure which might otherwise cause a loss of consciousness in the patient. System and method embodiments are described.

公开(公告)号：US06449509B1

公开(公告)日：2002-09-10

申请号：US09651623

申请日：2000-08-30

申请人： Euljoon Park ,  Gene A. Bornzin ,  Joseph J. Florio ,  Said Mortazavi

发明人： Euljoon Park ,  Gene A. Bornzin ,  Joseph J. Florio ,  Said Mortazavi

IPC分类号： A61N1365

CPC分类号： A61N1/36521

摘要： An implantable cardiac device that is adapted to periodically measure a body parameter, such as transthoracic impedance, at time periods selected so that the body parameter is primarily indicative of the respiration of the patient. In this way, a ventilation parameter, such as minute ventilation, can be reconstructed from the signals without requiring filtering of the sampled signals. In one embodiment, the implantable cardiac device measures transthoracic impedance during each quiescent period of the heart and thereby obtains a plurality of transthoracic impedance data points which are then used to reconstruct a ventilation signal. As the transthoracic impedance data points are obtained during the quiescent period, the contribution of the heart to the resulting transthoracic impedance measurement can be ignored and the resulting measurements are indicative of the action of the heart. In another embodiment, the implantable cardiac device obtains transthoracic impedance signals during the zero crossings of the measured impedance signal. As the transthoracic signal is measured during the zero crossing of the measured impedance signal, the heart component of the signal is filtered out.

摘要翻译： 一种可植入心脏装置，其适于在所选择的时间周期周期性地测量身体参数，例如经胸阻抗，使得身体参数主要指示患者的呼吸。 以这种方式，可以从信号重建诸如分钟通气的通气参数，而不需要对采样信号进行滤波。 在一个实施例中，可植入心脏装置在心脏的每个静止期间测量经胸阻抗，从而获得多个经胸阻抗数据点，然后将其用于重建通气信号。 由于在静止期间获得经胸阻抗数据点，所以可以忽略心脏对所得经胸阻抗测量的贡献，并且所得到的测量值表示心脏的作用。 在另一个实施例中，可植入心脏装置在测量的阻抗信号的过零点期间获得经胸阻抗信号。 由于在测量的阻抗信号的过零点期间测量经胸廓信号，所以信号的心脏分量被滤除。