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41.发明授权System and method for automatic atrial capture detection and atrial pacing threshold determination 失效用于自动心房捕获检测和心房起搏阈值测定的系统和方法公开(公告)号：US06934587B1
公开(公告)日：2005-08-23
申请号：US10160732
申请日：2002-06-03
IPC分类号： A61N1/37
CPC分类号： A61N1/3712 , A61N1/3714
摘要： An implantable dual chamber stimulation device provides a novel detection scheme for automatically detecting atrial capture and performing an atrial pacing threshold assessment. The stimulation device preferably waits until the patient is at or near rest and monitors the patient's P-wave activity to determine a detection window where a next P-wave is expected to occur. The stimulation device then delivers an atrial pulse prior to the next detection window, and monitors the window to determine whether a P-wave occurs therein. If a P-wave does not occur, then atrial capture is present, while occurrence of a P-wave indicates absence of atrial capture. If atrial capture is absent, the stimulation device automatically determines an appropriate atrial pacing threshold by monitoring the detection window while adjusting the stimulation pulse energy level. Advantageously, the present invention further employs a “bottom-up” adjusting scheme which starts at a low energy level, below the expected atrial pacing threshold, and increases the energy level until atrial capture is detected, thus saving energy and further avoiding corruption by large polarization signals. The latter feature is compatible with the present detection scheme and conventional evoked response detection schemes. The new atrial pacing threshold is then set at the atrial pulse level at which atrial capture was effectuated plus a predetermined safety margin.
摘要翻译： 可植入双室刺激装置提供用于自动检测心房捕获并执行心房起搏阈值评估的新型检测方案。 刺激装置优选地等待直到患者处于或接近静止并且监视患者的P波活动以确定期望发生下一个P波的检测窗口。 刺激装置然后在下一个检测窗口之前递送心房脉搏，并监视窗口以确定其中是否发生P波。 如果不发生P波，则存在心房捕获，而P波的发生表明不存在心房捕获。 如果不存在心房捕获，则刺激装置通过在调节刺激脉冲能量水平的同时监测检测窗口自动确定适当的心房起搏阈值。 有利地，本发明还采用从低能量水平开始的“自下而上”调整方案，低于预期的心房起搏阈值，并且增加能量水平直到检测到心房捕获，从而节省能量并进一步避免大的腐败 极化信号。 后一个特征与本发明的检测方案和常规的诱发响应检测方案兼容。 然后将新的心房起搏阈值设置在心房采集的心房脉搏水平加上预定的安全余量。
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42.发明授权System and method for automatic atrial capture detection and atrial pacing threshold determination 失效用于自动心房捕获检测和心房起搏阈值测定的系统和方法公开(公告)号：US06408210B1
公开(公告)日：2002-06-18
申请号：US09481086
申请日：2000-01-11
IPC分类号： A61N137
CPC分类号： A61N1/3712 , A61N1/3714
摘要： An implantable dual chamber stimulation device provides a novel detection scheme for automatically detecting atrial capture and performing an atrial pacing threshold assessment. The stimulation device preferably waits until the patient is at or near rest and monitors the patient's P-wave activity to determine an detection window where a next P-wave is expected to occur. The stimulation device then delivers an atrial pulse prior to the next detection window, and monitors the window to determine whether a P-wave occurs therein. If a P-wave does not occur, then atrial capture is present, while occurrence of a P-wave indicates absence of atrial capture. If atrial capture is absent, the stimulation device automatically determines an appropriate atrial pacing threshold by monitoring the detection window while adjusting the stimulation pulse energy level. Advantageously, the present invention further employs a “bottom-up” adjusting scheme which starts at a low energy level, below the expected atrial pacing threshold, and increases the energy level until atrial capture is detected, thus saving energy and further avoiding corruption by large polarization signals. The latter feature is compatible with the present detection scheme and conventional evoked response detection schemes. The new atrial pacing threshold is then set at the atrial pulse level at which atrial capture was effectuated plus a predetermined safety margin.
摘要翻译： 可植入双室刺激装置提供用于自动检测心房捕获并执行心房起搏阈值评估的新型检测方案。 刺激装置优选地等待直到患者处于或接近静止，并且监视患者的P波活动以确定期望发生下一个P波的检测窗口。 刺激装置然后在下一个检测窗口之前递送心房脉搏，并监视窗口以确定其中是否发生P波。 如果不发生P波，则存在心房捕获，而P波的发生表明不存在心房捕获。 如果不存在心房捕获，则刺激装置通过在调节刺激脉冲能量水平的同时监测检测窗口自动确定适当的心房起搏阈值。 有利地，本发明还采用从低能量水平开始的“自下而上”调整方案，低于预期的心房起搏阈值，并且增加能量水平直到检测到心房捕获，从而节省能量并进一步避免大的腐败 极化信号。 后一个特征与本发明的检测方案和常规的诱发响应检测方案兼容。 然后将新的心房起搏阈值设置在心房采集的心房脉搏水平加上预定的安全余量。
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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
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。
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公开(公告)号：US5873895A
公开(公告)日：1999-02-23
申请号：US128341
申请日：1998-08-03
CPC分类号： A61N1/36585 , A61N1/3627 , A61N1/3682
摘要： A special type of AV/PV hysteresis is provided in a dual-chamber pacemaker. A long AV delay is initially provided, thereby affording as much opportunity as possible for natural AV conduction to occur. Such long AV delay is automatically shortened should AV block occur. Periodic scanning for the return of AV conduction (absence of AV block) is performed so that the AV delay can be returned to its long value as soon as possible. In one embodiment, the pacemaker "learns" the natural conduction time (AR interval) of the patient and thereafter uses such learned natural conduction time as a reference against which subsequently measured AR intervals are compared to better distinguish conducted ventricular contractions from ectopic, pathologic, or other nonconducted ventricular contractions (e.g., PVC's). If the measured AR interval is approximately the same as the "learned" AR interval, then the R-wave at the conclusion of the measured AR interval is presumed to be a conducted R-wave that signals the return of AV conduction, and the AV delay is lengthened back to its original value. If, on the other hand, the measured AR interval is significantly different than the "learned" natural conduction time, then the R-wave at the conclusion of the measured AR interval is presumed to be a nonconducted R-wave, and the AV delay is kept short. In other embodiments, other techniques are used to distinguish a conducted R-wave from a nonconducted R-wave.
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45.发明授权Programming system having means for recording and analyzing a patient's cardiac signal 失效具有用于记录和分析患者心脏信号的装置的编程系统
公开(公告)号：US5421830A
公开(公告)日：1995-06-06
申请号：US113540
申请日：1993-08-27
CPC分类号： A61N1/37235 , G06F19/3406 , A61N1/37252
摘要： A programming system is provided that allows a physician or medical personnel to optimize the settings of various arrhythmia detection criteria and/or parameters related to hemodynamic performance to be programmed into the implanted cardiac stimulating device. The cardiac stimulating device may be a pacemaker or cardioverter/defibrillator that detects heart arrhythmias by using various arrhythmia detection criteria. The cardiac stimulating device is capable of recording the patient's cardiac signals and/or sensor data. The programming system may play back the recorded signals to test the detection criteria and hemodynamic performance and may simulate the response of the device to the cardiac signal. Alternatively, the programming system may play back an artificially created or previously stored cardiac signal for test purposes. As a result, the recorded signal may be played back repeatedly without unnecessarily stressing the patient's heart. Additionally, the programmer may suggest specific arrhythmia detection criteria and therapies to a physician based on an analysis of a patient's arrhythmia.
摘要翻译： 提供了一种编程系统，其允许医师或医务人员优化各种心律失常检测标准和/或与要编程到植入的心脏刺激装置中的血液动力学性能相关的参数的设置。 心脏刺激装置可以是通过使用各种心律失常检测标准来检测心律失常的起搏器或心律转复/除颤器。 心脏刺激装置能够记录患者的心脏信号和/或传感器数据。 编程系统可以回放记录的信号，以测试检测标准和血液动力学性能，并且可以模拟该装置对心脏信号的响应。 或者，编程系统可以回放用于测试目的的人为创建或预先存储的心脏信号。 结果，记录的信号可以重复播放，而不会不必要地强迫患者的心脏。 此外，程序员可以基于对患者的心律失常的分析来向医师建议具体的心律失常检测标准和疗法。
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46.发明授权Dual-chamber implantable pacemaker having an adaptive AV interval that prevents ventricular fusion beats and method of operating same 失效具有防止心室融合搏动的自适应AV间隔的双室可植入起搏器及其操作方法
公开(公告)号：US5334220A
公开(公告)日：1994-08-02
申请号：US976153
申请日：1992-11-13
申请人： Jason A. Sholder
发明人： Jason A. Sholder
CPC分类号： A61N1/36585 , A61N1/3627 , A61N1/3682
摘要： A dual-chamber implantable pacemaker automatically adjusts its AV interval so that any ventricular stimulation pulses generated by the pacemaker at the conclusion of the pacemaker-defined AV interval occur at a time in the cardiac cycle that avoids fusion with the natural ventricular depolarization of a patient's heart. The AV interval is set using a search sequence that sets the AV interval value to be on one side or the other of the natural conduction time of the heart, and incrementally changes the AV interval value until it crosses over the natural conduction time interval. The cross-over point is manifest by the occurrence of an R-wave, where an R-wave had previously been absent, or the absence of an R-wave, where an R-wave had previously been present. A final AV interval value is then set as the AV interval value at the cross-over point, adjusted by appending an AV margin thereto. The search sequence is automatically invoked whenever a prescribed search time has elapsed, or whenever the sudden presence or absence of a sensed R-wave indicates a sufficient change in the natural conduction time so as to have crossed over with the existing AV interval. If the search sequence is invoked too frequently, it is automatically suspended for a prescribed suspension period.
摘要翻译： 双腔植入式起搏器自动调整其间隔时间，以便在起搏器定义的AV间期结束时由起搏器产生的任何心室刺激脉冲都发生在心动周期中，避免与患者的自然心室去极化融合 心。 使用将AV间隔值设定为心脏的自然传导时间的一侧或另一侧的搜索序列来设定AV间隔，并且逐渐改变AV间隔值，直到其跨过自然传导时间间隔。 交叉点是由于先前已经不存在R波的R波的发生，或者没有存在R波的R波而出现的。 然后将最终AV间隔值设置为交叉点处的AV间隔值，通过向其附加AV边缘来调整。 每当规定的搜索时间过去时，或每当感测到的R波的突然存在或不存在表明自然传导时间的充分变化，以便与现有的AV间隔交叉时，搜索序列就被自动调用。 如果搜索序列被调用太频繁，则会在规定的暂停期间自动暂停。
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47.发明授权Pacemaker system and method for measuring and monitoring cardiac activity and for determining and maintaining capture 失效起搏器系统和测量和监测心脏活动以及确定和维持捕获的方法
公开(公告)号：US4817605A
公开(公告)日：1989-04-04
申请号：US27715
申请日：1987-03-19
申请人： Jason A. Sholder
发明人： Jason A. Sholder
CPC分类号： A61N1/3712 , A61N1/368 , A61N1/3714
摘要： A system for determining P-wave or R-wave capture in response to pacemaker supplied electrical stimuli. One embodiment includes a conventional bipolar atrial lead having a tip electrode, connected to an atrial pulse generator circuit within an implantable pacemaker, and a ring electrode, spaced apart from the tip electrode, connected to a P-wave sensing EGM amplifier within the pacemaker. The bandpass characteristics of the P-wave sensing EGM amplifier allow detection of all electrical frequencies in the atrium within the bandpass chosen. The output signal from this amplifier is selectively telemetered to an external receiver, as is a signal indicating the generation of an atrial stimulation pulse, where the occurrence of atrial stimulation pulses and P-waves can be monitored. In operation, if constant time intervals between the monitored atrial stimulation pulses and P-wave occurrences are present, P-wave capture has occurred. In the event of variable time intervals, capture has not occurred and the magnitude of the atrial stimulation pulses can be increased until P-wave capture does occur. An alternative embodiment measures this time differential and makes the stimulation pulse adjustment automatically. Other embodiments use the same manual or automatic systems to determin R-wave capture.
摘要翻译： 用于响应于起搏器提供的电刺激来确定P波或R波捕获的系统。 一个实施例包括具有尖端电极的常规双极性心房线，其连接到可植入起搏器内的心房脉冲发生器电路，以及与起搏器内的P波感测EGM放大器连接的与尖端电极间隔开的环形电极。 P波感测EGM放大器的带通特性允许检测所选带通内心房中的所有电频率。 来自该放大器的输出信号被选择性地遥测到外部接收器，以及指示产生心房刺激脉冲的信号，其中可以监测心房刺激脉冲和P波的发生。 在操作中，如果存在监测的心房刺激脉冲和P波发生之间的恒定时间间隔，则发生P波捕获。 在可变时间间隔的情况下，没有发生捕获，并且可以增加心房刺激脉冲的幅度直到P波捕获确实发生。 替代实施例测量该时间差并使得刺激脉冲自动调整。 其他实施例使用相同的手动或自动系统来确定R波捕获。
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