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51.发明授权System and method of identifying fusion for dual-chamber automatic capture stimulation device 有权识别双室自动捕获刺激装置融合的系统和方法公开(公告)号：US06456881B1
公开(公告)日：2002-09-24
申请号：US09630771
申请日：2000-08-02
IPC分类号： A61N136
CPC分类号： A61N1/3712
摘要： A multi-chamber stimulation device and associated method reliably and automatically distinguish fusion from loss of capture during ventricular stimulation. The stimulation device provides immediate and accurate fusion detection when a loss of capture is suspected in the ventricles without delivering back-up stimulation pulses. To achieve this objective, the far-field signal present in the atrial channel is examined for evidence of a far-field R-wave whenever the ventricular channel detects a loss of capture. If a far-field R-wave is present, fusion is confirmed, and a far-field R-wave is absent, loss of capture is confirmed. Additionally, the stimulation device inhibits unnecessary back-up stimulation and threshold tests when fusion occurs, and provides appropriate adjustment of stimulation parameters based on confirmed fusion detection such that fusion re-occurrence is minimized.
摘要翻译： 多室刺激装置和相关方法可靠和自动地将融合与心室刺激期间的捕获损失区分开来。 刺激装置提供即时和准确的融合检测，当脑袋怀疑丢失而不输送备用刺激脉冲时。 为了达到这个目的，每当心室通道检测到捕获的丢失时，都会检查存在于心房通道中的远场信号以获得远场R波的证据。 如果存在远场R波，则确认融合，并且不存在远场R波，确认捕获损失。 此外，当融合发生时，刺激装置抑制不必要的后备刺激和阈值测试，并且基于确认的融合检测提供刺激参数的适当调整，使得融合再现最小化。
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52.发明授权Pacemaker and method of operating same that provides functional atrial cardiac pacing with ventricular support 失效起搏器和操作方法，提供功能性心房心脏起搏与心室支持
公开(公告)号：US6122546A
公开(公告)日：2000-09-19
申请号：US128284
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.
摘要翻译： 在双室起搏器中提供特殊类型的AV / PV滞后。 最初提供长的AV延迟，从而为自然AV传导提供尽可能多的机会。 如果发生AV块，这样长的AV延迟会自动缩短。 进行AV导通（AV区域不存在）的返回的周期性扫描，使得AV延迟可以尽可能快地返回到其长值。 在一个实施例中，起搏器“学习”患者的自然传导时间（AR间隔），此后使用这种学习的自然传导时间作为参考，随后比较随后测量的AR间隔以更好地区分进行的心室收缩与异位，病理， 或其他非导管性心室收缩（例如PVC）。 如果测量的AR间隔与“学习”的AR间隔大致相同，则在测量的AR间隔结束时的R波被推定为用于表示AV传导返回的传导R波，AV 延迟延长到原来的价值。 另一方面，如果测量的AR间隔与“学习”的自然传导时间显着不同，则在测量的AR间隔结束时的R波被推定为非导通的R波，并且AV延迟 保持短暂。 在其他实施例中，使用其它技术来区分传导的R波和非导通的R波。
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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。
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公开(公告)号：US07103411B1
公开(公告)日：2006-09-05
申请号：US10206483
申请日：2002-07-26
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.
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55.发明授权Methods and apparatus for overdrive pacing heart tissue using an implantable cardiac stimulation device 有权使用可植入心脏刺激装置的超速起搏心脏组织的方法和装置公开(公告)号：US06990374B1
公开(公告)日：2006-01-24
申请号：US10117757
申请日：2002-04-04
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。
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公开(公告)号：US06758854B1
公开(公告)日：2004-07-06
申请号：US09344535
申请日：1999-06-25
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。
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57.发明授权公开(公告)号：US06748261B1
公开(公告)日：2004-06-08
申请号：US09675462
申请日：2000-09-28
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。
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58.发明授权公开(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.
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59.发明授权Implantable stimulation device having synchronous sampling for a respiration sensor 有权具有用于呼吸传感器的同步采样的可植入刺激装置公开(公告)号：US06449509B1
公开(公告)日：2002-09-10
申请号：US09651623
申请日：2000-08-30
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。
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公开(公告)号：US5814077A
公开(公告)日：1998-09-29
申请号：US854797
申请日：1997-05-12
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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