公开(公告)号：US07363081B1

公开(公告)日：2008-04-22

申请号：US10657840

申请日：2003-09-08

申请人： Mark W. Kroll ,  Eric Falkenberg ,  Paul A. Levine

发明人： Mark W. Kroll ,  Eric Falkenberg ,  Paul A. Levine

IPC分类号： A61N1/362

CPC分类号： A61N1/3712 ,  A61N1/3624 ,  A61N1/3688 ,  A61N1/3714 ,  A61N1/395

摘要： Techniques for enabling both preventive overdrive pacing and antitachycardia pacing (ATP) within an implantable device are provided. The device gains the benefits of overdrive pacing for preventing the onset of a tachycardia and, if one nevertheless occurs, ATP is employed to terminate the tachycardia. In particular, a technique is provided for promptly detecting the onset of atrial tachycardia during preventive overdrive pacing based on loss of capture of atrial pacing pulses. A technique is also provided for using detection of loss of capture of atrial or ventricular pacing pulses to trigger automatic switching from overdrive pacing to ATP. A setup technique determines whether to enable the automatic switching from overdrive pacing to ATP within a particular patient. Also, techniques are provided for verifying loss of capture of atrial or ventricular backup pacing pulses and for detecting low amplitude ventricular fibrillation based on loss of capture of ventricular backup pacing pulses.

摘要翻译： 提供了在植入式装置内实现预防性超速起搏和抗心动过速起搏（ATP）的技术。 该装置获得超速起搏的好处，以防止心动过速的发作，并且如果仍然发生，则使用ATP来终止心动过速。 特别地，提供了一种技术，用于基于心房起搏脉冲的捕获损失，在预防性超速起搏中及时检测心房心动过速的发生。 还提供了一种技术，用于检测心房或心室起搏脉冲的捕获损失，以触发从过速起搏到ATP的自动切换。 设置技术确定是否启用在特定患者内从过速起搏到ATP的自动切换。 此外，提供了用于验证心房或心室起搏脉冲的捕获损失的技术，并且用于基于心室起搏脉冲的捕获损失来检测低振幅心室颤动。

公开(公告)号：US07146213B1

公开(公告)日：2006-12-05

申请号：US10728459

申请日：2003-12-05

申请人： Paul A. Levine

发明人： Paul A. Levine

IPC分类号： A61N1/20

CPC分类号： A61N1/3622 ,  A61N1/365 ,  A61N1/3688 ,  A61N1/3925

摘要： Techniques are provided for allowing Automatic Mode Switching (AMS) to be exploited within dual unipolar systems employing Combipolar sensing. Relative refractory windows are opened within both the atrial and ventricular refractory periods for the purposes of determining the atrial rate using Combipolar sensing logic. In this manner, T-waves occurring during the relative refractory windows are excluded from the atrial rate calculation, whereas any P-waves occurring during the relative refractory windows are counted, thereby achieving a more accurate atrial rate calculation, particularly at high atrial rates, and thus permitting AMS to be enabled along with Combipolar sensing in the dual unipolar lead system. An alternative technique is provided for use in dual unipolar systems not initially set to a Combipolar Sensing mode, which also achieves more accurate atrial rate calculation at high atrial rates. Additional techniques are provided for use in dual bipolar systems. An improved Combipolar sensing logic is also provided.

摘要翻译： 提供了技术，允许在采用组合极性检测的双重单极系统中利用自动模式切换（AMS）。 在心房和心室不应期内开放相对耐火窗，以确定使用联合极检测逻辑的心房率。 以这种方式，在相对耐火窗口期间发生的T波从心房率计算中排除，而在相对耐火窗口期间发生的任何P波被计数，从而实现更精确的心房率计算，特别是在高心房率， 并因此允许AMS在双极性引线系统中与Combipolar感测一起使能。 提供了一种替代技术，用于未初始设置为组合极检测模式的双重单极系统，其也可以在高心房率下实现更准确的心房率计算。 另外提供了用于双极双极系统的技术。 还提供了改进的组合极检测逻辑。

公开(公告)号：US07136703B1

公开(公告)日：2006-11-14

申请号：US10123944

申请日：2002-04-16

申请人： Armando M. Cappa ,  Sergiu Silvian ,  Paul A. Levine

发明人： Armando M. Cappa ,  Sergiu Silvian ,  Paul A. Levine

IPC分类号： A61N1/362

CPC分类号： A61N1/37247 ,  A61N1/37211 ,  A61N1/37252

摘要： A programmer for implantable stimulation devices and surface ECG system in wireless communication with each other. A self-powered ECG monitor with conventional surface electrodes transceives signals from and to a programmer provided with a radio frequency transceiver to eliminate hardwiring between the surface electrodes and the programmer. The system reduces the need for supply line frequency filtering and isolation circuitry to protect against high voltage defibrillation shocks.

摘要翻译： 用于植入式刺激装置和表面ECG系统的编程器，在无线通信中彼此相连。 具有常规表面电极的自供电ECG监测器将信号传送到带有射频收发器的编程器，以消除表面电极和编程器之间的硬连线。 该系统减少了对电源线频率滤波和隔离电路的需求，以防止高压除颤电击。

公开(公告)号：US07062328B1

公开(公告)日：2006-06-13

申请号：US10648080

申请日：2003-08-25

申请人： Paul A. Levine ,  Mark W. Kroll ,  Scott Patrick Simon

发明人： Paul A. Levine ,  Mark W. Kroll ,  Scott Patrick Simon

IPC分类号： A61N1/18

CPC分类号： A61N1/362 ,  A61N1/3621 ,  A61N1/365 ,  A61N1/3688 ,  A61N1/371 ,  A61N1/3714

摘要： Techniques for improving the specificity of automatic mode switching (AMS) are provided to prevent inappropriate mode switching and to ensure that mode switching is performed when needed. In one example, improved techniques for calculating a filtered rate interval (FARI) are provided, which help avoid inappropriate mode switching within devices that employ FARI in connection with the determination of the atrial rate. Also, techniques are provided for detecting atrial tachycardia and for distinguishing between a true tachycardia and a false tachycardia (such as pacemaker mediated tachycardia). The techniques described herein for detecting atrial tachycardia and for distinguishing between true and false tachycardia are advantageously employed in connection with AMS but may be used in other circumstances as well. Techniques employed in conjunction with dynamic atrial overdrive (DAO) pacing are also discussed.

摘要翻译： 提供用于提高自动模式切换（AMS）特异性的技术，以防止不当的模式切换，并确保在需要时执行模式切换。 在一个示例中，提供了用于计算滤波速率间隔（FARI）的改进技术，其有助于避免在与确定心房率相关联的情况下使用FARI的设备内的不适当模式切换。 此外，提供了用于检测心房性心动过速和区分真正的心动过速和假性心动过速（例如起搏器介导的心动过速）的技术。 本文所述的用于检测心房心动过速和用于区分真和假心动过速的技术有利地与AMS结合使用，但也可以在其他情况下使用。 还讨论了与动态心房超速（DAO）起搏结合使用的技术。

公开(公告)号：US07010346B1

公开(公告)日：2006-03-07

申请号：US09931481

申请日：2001-08-15

申请人： Harold C. Schloss ,  Mark W. Kroll ,  Paul A. Levine

发明人： Harold C. Schloss ,  Mark W. Kroll ,  Paul A. Levine

IPC分类号： A61N1/18

CPC分类号： A61N1/3622

摘要： An implantable medical device provides atrial arrhythmia prevention pacing when an interatrial conduction disturbance is detected. The implantable medical device includes a signal processor that detects the interatrial conduction disturbance and a pulse generator circuit coupled to the detector that delivers the atrial arrhythmia prevention pacing pulses to the heart when the processor detects the interatrial conduction disturbance. The interatrial conduction disturbance may be a P-wave duration, a difference between odd and even P-waves, or a predetermined P-wave spectral energy distribution.

摘要翻译： 当检测到房间传导障碍时，植入式医疗装置提供心律失常预防起搏。 可植入医疗装置包括检测院内传导障碍的信号处理器和耦合到检测器的脉冲发生器电路，当处理器检测到房间传导障碍时，其将心律失常预防起搏脉冲传送到心脏。 室间传导障碍可以是P波持续时间，奇数和偶数P波之间的差异或预定的P波频谱能量分布。

公开(公告)号：US06865414B1

公开(公告)日：2005-03-08

申请号：US09961121

申请日：2001-09-20

申请人： Paul A. Levine

发明人： Paul A. Levine

IPC分类号： A61B5/0452 ,  A61N1/37

CPC分类号： A61N1/3704

摘要： An implantable programmable cardiac stimulation device and associated method for differentiating between normal sinus events and ectopic beats. The stimulation device monitors the sensing thresholds of sinus and non-sinus cardiac events, and stores a history of these sensing thresholds along with temporal data for accurate event detection. The stimulation device further provides accurate and appropriate detection of sensed events including P-waves, non-conducted PACs, and conducted PACs and thus verifies correct detection of PVCs and R-waves. Furthermore, the present invention provides a history record of ectopic events, distinguished by sensing thresholds and timing intervals, giving a valuable diagnostic tool to the physician in optimizing rhythm management therapy. In addition, the stimulation device allows the sensitivity threshold to be set based on a single cardiac cycle and past history.

摘要翻译： 一种可植入式可编程心脏刺激装置及其相关方法，用于区分正常窦事件和异位搏动。 刺激装置监测窦和非窦性心脏事件的感测阈值，并且存储这些感测阈值的历史以及用于准确事件检测的时间数据。 刺激装置还提供对包括P波，非导电PAC和传导PAC的感测事件的精确和适当的检测，从而验证PVC和R波的正确检测。 此外，本发明提供了异位事件的历史记录，其特征在于感测阈值和时间间隔，为医师优化节律管理治疗提供了有价值的诊断工具。 此外，刺激装置允许基于单个心动周期和过去历史来设置灵敏度阈值。

公开(公告)号：US06766197B1

公开(公告)日：2004-07-20

申请号：US10043718

申请日：2002-01-11

申请人： Paul A. Levine

发明人： Paul A. Levine

IPC分类号： A61N1362

CPC分类号： A61N1/3712 ,  A61N1/3716

摘要： An implantable cardiac stimulation system capable of automatic capture verification is provided with an associated method for performing automatic testing functions using programmable, or automatically determined, atrioventricular delays. Automatic threshold testing and evoked response sensitivity testing performed at a user-specified delay setting, rather than a preset setting, allows assessment of automatic capture verification based on an atrioventricular delay relevant to daily system function. Further features of the present invention are an adjustable frequency with which automatic threshold tests are performed and an adjustable frequency with which threshold test results are stored in memory in a threshold record for better monitoring of lead stability or impending clinical problems. The frequency of performing threshold tests and the frequency of storing threshold test results may be varied according to the threshold stability. Stored threshold test results are advantageously displayed with respect to a fixed or variable time scale.

摘要翻译： 提供了能够自动捕获验证的可植入心脏刺激系统，其具有使用可编程或自动确定的房室延迟执行自动测试功能的相关方法。 以用户指定的延迟设置而不是预设设置进行的自动阈值测试和诱发响应灵敏度测试允许基于与日常系统功能相关的房室延迟来评估自动捕获验证。 本发明的另外的特征是进行自动阈值测试的可调频率和阈值记录中的阈值测试结果存储在存储器中的可调节频率，用于更好地监测引线稳定性或即将发生的临床问题。 执行阈值测试的频率和存储阈值测试结果的频率可以根据阈值稳定性而变化。 相对于固定或可变时间尺度有利地显示存储的阈值测试结果。

公开(公告)号：US06748274B2

公开(公告)日：2004-06-08

申请号：US09885677

申请日：2001-06-19

申请人： Paul A. Levine ,  Gregory C. Bevan

发明人： Paul A. Levine ,  Gregory C. Bevan

IPC分类号： A61N118

CPC分类号： A61N1/37247 ,  A61B5/044 ,  A61N1/37 ,  A61N1/37252

摘要： Location-specific diagnostic information is detected and recorded by the cardiac stimulation device for subsequent display using the external programmer device. The diagnostic information includes location-specific event records, counters and IEGM signals. The event records include event codes that distinguish among events occurring in the four chambers of the heart, such as sensed or paced events occurring within the left or right atria or the left or right ventricles. The counters separately count events occurring within the chambers of the heart. The IEGM signals are separately detected within the four chambers of the heart using a multiple sensing lead arrangement. The location-specific event records, counters and IEGM signals are ultimately transmitted to the external programmer, which displays graphic representations of the diagnostic information. The event records are displayed using distinct event marker icons which distinguish among the four chambers of the heart. The distinct event marker icons are displayed along with location-specific IEGM displays or surface ECG displays to permit a physician operating the programmer to easily identify the specific chambers of the heart in which events the occurred. Additionally, the programmer displays the values of the various counters to provide, for example, a set of location-specific histograms. The diagnostic information detected and recorded by the stimulation device and displayed by the external programmer device may further distinguish among events detected at multiple locations within each chamber of the heart. Method and apparatus embodiments are described.

摘要翻译： 由心脏刺激装置检测并记录位置特异性诊断信息，以便随后使用外部编程器装置进行显示。 诊断信息包括位置特定事件记录，计数器和IEGM信号。 事件记录包括区分发生在心脏四个腔室中的事件的事件代码，例如发生在左心房或右心房或左心室或右心室内的感觉或起搏事件。 计数器分别计算在心脏室内发生的事件。 使用多感测引线装置在心脏的四个腔室内分别检测IEGM信号。 位置特定事件记录，计数器和IEGM信号最终传输到外部编程器，该程序器显示诊断信息的图形表示。 事件记录使用不同的事件标记图标显示，区分心脏的四个房间。 显示不同的事件标记图标以及位置特异的IEGM显示器或表面ECG显示器，以允许医师操作程序员容易地识别发生事件的心脏的特定腔室。 此外，程序员显示各种计数器的值，以提供例如一组位置特定的直方图。 由刺激装置检测和记录并由外部编程装置显示的诊断信息可以进一步区分在心脏的每个室内的多个位置处检测的事件。 描述了方法和设备实施例。

公开(公告)号：US06477419B2

公开(公告)日：2002-11-05

申请号：US09795409

申请日：2001-02-27

申请人： Paul A. Levine ,  Gene A. Bornzin

发明人： Paul A. Levine ,  Gene A. Bornzin

IPC分类号： A61N1362

CPC分类号： A61N1/3622

摘要： A system and method detects and terminates a repetitive nonreentrant ventriculo-atrial synchronous (RNRVAS) rhythm. The system and method is particularly adapted for use in an implantable cardiac stimulation device that includes a pulse generator that delivers atrial and ventricular pacing stimulation pulses and implements an atrial escape interval and a VA delay interval. This system includes a sensing circuit that senses cardiac activity of a heart and a detector that is responsive to the sensing circuit that determines if an RNRVAS rhythm is present. If an RNRVAS rhythm is present, a therapy control circuit causes the pulse generator to deliver a secondary atrial pacing pulse following a primary atrial pacing pulse delivered at the end of an atrial escape interval. The therapy control circuit may additionally cause the pulse generator to deliver a tertiary atrial pacing pulse following the next ventricular pacing pulse to prevent the occurrence of a retrograde P wave.

摘要翻译： 一种系统和方法检测并终止重复的非心室心房同步（RNRVAS）节律。 该系统和方法特别适用于可植入心脏刺激装置，其包括脉冲发生器，脉冲发生器输送心房和心室起搏刺激脉冲并实现心房逸出间隔和VA延迟间隔。 该系统包括感测心脏的心脏活动的感测电路和响应于感测电路的检测器，该检测电路确定RNRVAS节律是否存在。 如果存在RNRVAS节律，治疗控制电路使得脉搏发生器在心房逸出时间段结束后传递的主要心房起搏脉冲之后递送次级心房起搏脉冲。 治疗控制电路还可以使脉冲发生器在下一个心室起搏脉冲之后递送第三次心房起搏脉冲，以防止出现逆行P波。

公开(公告)号：US06477417B1

公开(公告)日：2002-11-05

申请号：US09835006

申请日：2001-04-12

申请人： Paul A. Levine

发明人： Paul A. Levine

IPC分类号： A61N137

CPC分类号： A61N1/3627 ,  A61N1/368 ,  A61N1/3684 ,  A61N1/3918

摘要： An implantable multi-chamber cardiac stimulation device includes flexibly programmable electrode stimulation configurations, and is capable of precisely controlling the stimulation sequence between multiple sites. The stimulation device provides a plurality of connection ports that allow independent connection of each electrical lead associated with a particular stimulation site in the heart. Each connection port further provides a unique terminal for making electrical contact with only one electrode such that no two electrodes are required to be electrically coupled. Furthermore, each electrode, whether residing on a unipolar, bipolar or multipolar lead, may be selectively connected or disconnected through programmable switching circuitry that determines the electrode configurations to be used for sensing and for stimulating at each stimulation site. The stimulation device allows for the programmable selection of each electrode terminal connection to a relatively positive or negative battery potential. In this way, each electrode, when electrically connected, may be programmed to act as the cathode or as the anode during sensing or stimulation delivery. Thus, directionality of the depolarization wave may be controlled by programming the cathode and anode assignments of the stimulation electrodes.