公开(公告)号：US5584868A

公开(公告)日：1996-12-17

申请号：US281476

申请日：1994-07-27

申请人： Rodney W. Salo ,  Julio C. Spinelli ,  Bruce A. Tockman

发明人： Rodney W. Salo ,  Julio C. Spinelli ,  Bruce A. Tockman

IPC分类号： A61N1/362 ,  A61N1/368 ,  A61N1/39

CPC分类号： A61N1/3962 ,  A61N1/3622 ,  A61N1/3627 ,  A61N1/3682

摘要： A cardiac rhythm management device and method includes a dual-chamber pacemaker especially designed for treating congestive heart failure and a defibrillator as a back-up measure. The device incorporates a programmed microcontroller which is operative to adjust the AV delay of the pacemaker to a minimum or maximum length consistent with optimal cardiac function. The cardiac stimulator includes apparatus for sensing cardiac function from cycle-to-cycle and determining whether incremental changes made to the AV delay interval enhances or worsens the measured cardiac function. On each iterative cycle, the AV delay interval is changed, either incremented or decremented, until a cross-over point is reached in which it is noted that the cardiac function ceases to improve and this is followed with a further incremental adjustment in an opposite direction to compensate for any overshoot. By providing a cardiac defibrillator in combination with the pacing device with closed-loop control of the AV interval, incidences of sudden death due to lethal arrhythmias is reduced.

摘要翻译： 心律管理装置和方法包括一个双室心脏起搏器，特别设计用于治疗充血性心力衰竭和除颤器作为后备措施。 该装置包括编程的微控制器，其可操作以将起搏器的AV延迟调整到与最佳心脏功能一致的最小或最大长度。 心脏刺激器包括用于从周期到周期感测心脏功能的装置，以及确定对AV延迟间隔做出的增量变化是否增强或恶化测量的心脏功能。 在每个迭代循环中，AV延迟间隔被改变，递增或递减，直到达到交叉点，其中注意到心脏功能不再改善，并且随后在相反方向上进一步增量调整 以补偿任何过冲。 通过与AV间隔的闭环控制提供与起搏装置组合的心脏除颤器，减少了因致命性心律失常引起的猝死的发生。

公开(公告)号：US5413593A

公开(公告)日：1995-05-09

申请号：US188821

申请日：1994-01-31

申请人： Julio C. Spinelli ,  Jesse Hartley ,  Jan P. Heemels

发明人： Julio C. Spinelli ,  Jesse Hartley ,  Jan P. Heemels

IPC分类号： A61B5/0402 ,  A61N1/362 ,  A61N1/37 ,  A61N1/372

CPC分类号： A61N1/3706 ,  A61N1/37247

摘要： A pacemaker including a marker code generator generating marker codes between an indifferent electrode disposed on the pacemaker housing and the pacemaker can serving as a reference electrode. Marker code signals are generated proximate the pacemaker rather than proximate cardiac tissue, and thus can be generated at a large potential for sensing by surface EKG, and can also be generated simultaneously while pacing the heart and not necessarily in the refractory period. The pacemaker facilitates the interpretation of surface EKG, and can be sensed and recorded by commercially available two-channel holter monitors which can be taken home with the patient. Thus, marker code signals can be sensed and recorded while at home and played back for the physician at a later time for analysis. The marker code generator can be selectively turned on by the external programmer such that battery life depreciation is not appreciable. The pacemaker can be adapted with either a unipolar or bipolar endocardial lead.

摘要翻译： 包括标记码发生器的起搏器可以在布置在起搏器外壳上的无关电极与起搏器之间产生标记代码，其可以用作参考电极。 在起搏器附近产生标记代码信号，而不是紧邻心脏组织，因此可以在用于通过表面EKG进行感测的大电位下产生，并且还可以同时产生心脏起搏而不一定在不应期。 起搏器有助于表面EKG的解释，并且可以由可以与患者一起回家的市售双通道保持器监视器来感测和记录。 因此，可以在家中感测和记录标记代码信号，并在以后再次为医师回放分析。 标记码发生器可以被外部编程器选择性地打开，使得电池寿命贬值不明显。 起搏器可以适应单极或双极心内膜导联。

公开(公告)号：US5330512A

公开(公告)日：1994-07-19

申请号：US997442

申请日：1992-12-28

申请人： John A. Hauck ,  Julio C. Spinelli

发明人： John A. Hauck ,  Julio C. Spinelli

IPC分类号： A61N1/365 ,  A61N1/37 ,  A61N1/00

CPC分类号： A61N1/3706

摘要： A cardiac pacemaker signal processing circuit adapted to obtain an evoked ECG signal. The circuit senses the electrical signals of the ring and tip electrodes in the unipolar mode from the bipolar lead after the electrical pacing stimulus has been applied to contract the ventricle of the heart. The residual oppositely polarized potentials at the ring and tip electrode, as well as the sensed evoked ECG signals, are added together to cancel out the opposing residual potentials, but to add the common polarized ECG signal. Thus, a high quality evoked ECG signal is obtained, free of the residual potentials, and subsequently utilized by R-wave detection circuits for sensing the QRS complex. The circuit includes compensating signal processing circuits to provide time domain signal processing weighting functions to match exponential time delay of the tip and ring electrodes, and includes amplitude adjusting compensation as well. Thus, the absolute amplitudes of the opposite polarized residual potentials will be adjusted to be equal, are summed, and canceled or nulled at the appropriate time in the time domain. Both biphasic and tripbasic pace pulse techniques are not required, the pace pulse amplitude can be reduced to extend the battery life of the pacemaker. Further, the post pace re-charging cycle is only interrupted and undertaken-passively to, again, reduce current drain on the battery. Classic R-wave detection circuits are adaptable to the signal processing circuit of the present invention.

摘要翻译： 一种心脏起搏器信号处理电路，其适于获得诱发的ECG信号。 在施加电起搏刺激以收缩心脏心室之后，该电路感测来自双极引线的单极模式的环和尖端电极的电信号。 在环和尖端电极处的残留的相反极化电位以及感测到的诱发ECG信号被加在一起以抵消相对的残留电位，而是添加公共极化ECG信号。 因此，获得高质量的诱发ECG信号，没有剩余电位，并随后被R波检测电路用于感测QRS复合物。 电路包括补偿信号处理电路，以提供时域信号处理加权函数，以匹配尖端和环形电极的指数时间延迟，并且还包括幅度调整补偿。 因此，相反的极化残余电位的绝对幅度将被调整为相等，被相加，并在时域中的适当时间被消除或置零。 不需要双相和三相起搏脉冲技术，可以减小起搏脉冲幅度以延长起搏器的电池寿命。 此外，后续重新充电周期仅被中断，被动地被动地减少电池的电流消耗。 经典R波检测电路适用于本发明的信号处理电路。

公开(公告)号：US5156147A

公开(公告)日：1992-10-20

申请号：US651318

申请日：1991-02-05

申请人： Jay A. Warren ,  Jay O. Millerhagen ,  Julio C. Spinelli

发明人： Jay A. Warren ,  Jay O. Millerhagen ,  Julio C. Spinelli

IPC分类号： A61N1/365

CPC分类号： A61N1/36585

摘要： A rate adaptive pacemaker of the type having a variable rate cardiac stimulating pulse generator and a sensor for monitoring some physiologic parameter whereby the pulse generator stimulating rate can be adjusted to meet physiologic demand is further provided with a hemodynamic sensor which is operative to provide an output signal representing the pumping performance of the heart in response to the pacing stimulation. The signal from the hemodynamic sensor is processed and then used in an algorithm to determine whether further rate increase should be permitted based upon whether the rate increase would be accompanied by a further increase in cardiac output, a plateau or a decrease in cardiac output. Hence, the adaptive rate pacemaker is provided with a real-time, hemodynamic maximum pacing rate instead of a preprogrammed, fixed, maximum rate.

公开(公告)号：US08818511B2

公开(公告)日：2014-08-26

申请号：US12480485

申请日：2009-06-08

申请人： Jiang Ding ,  Julio C. Spinelli ,  Yinghong Yu ,  Andrew P. Kramer

发明人： Jiang Ding ,  Julio C. Spinelli ,  Yinghong Yu ,  Andrew P. Kramer

IPC分类号： A61N1/362

CPC分类号： A61N1/36592 ,  A61B5/0472 ,  A61N1/3627 ,  A61N1/3684

摘要： A method and apparatus for selection of one or more ventricular chambers to stimulate for ventricular resynchronization therapy. Intrinsic intracardia electrograms that include QRS complexes, are recorded from a left and right ventricle. A timing relationship between the intrinsic intracardia electrograms recorded from the left and right ventricle is then determined. In one embodiment, the timing relationship is determined using a delay between a left ventricular and a right ventricular sensed intrinsic ventricular depolarizations and a duration interval of one or more QRS complexes. In one embodiment, the duration of QRS complexes is determined from either intracardiac electrograms or from surface ECG recordings. One or more ventricular chambers in which to provide pacing pulses are then selected based on the timing relationship between intrinsic intracardia electrograms recorded from the right and left ventricle, and the duration of one or more QRS complexes.

摘要翻译： 用于选择一个或多个心室以刺激心室再同步治疗的方法和装置。 包括QRS复合物在内的心内膜电图从左心室和右心室记录。 然后确定从左心室和右心室记录的内在心内电图之间的时间关系。 在一个实施例中，使用左心室和右心室感测的内心室去极化之间的延迟和一个或多个QRS复合物的持续时间间隔来确定时间关系。 在一个实施方案中，QRS复合物的持续时间由心脏内电刺激图或从表面心电图记录确定。 然后基于从右心室和左心室记录的内在心内电图之间的时间关系和一个或多个QRS复合物的持续时间来选择其中提供起搏脉冲的一个或多个心室。

公开(公告)号：US08554321B2

公开(公告)日：2013-10-08

申请号：US13615281

申请日：2012-09-13

申请人： Jiang Ding ,  Yinghong Yu ,  Julio C. Spinelli

发明人： Jiang Ding ,  Yinghong Yu ,  Julio C. Spinelli

IPC分类号： A61N1/37

CPC分类号： A61B5/053 ,  A61B5/0452 ,  A61B5/0456 ,  A61B5/0472 ,  A61B34/20 ,  A61B2034/2072 ,  A61N1/3627 ,  A61N1/36592 ,  A61N1/3682

摘要： Methods and systems are disclosed for determining whether a patient is a responder to cardiac resynchronization therapy. The beginning and ending of the intrinsic ventricular depolarization are determined through signals measured from one or more electrodes implanted in the patient's heart. An interval between the beginning and ending of the intrinsic ventricular depolarization is computed and is compared to a threshold. The threshold may be determined empirically. The pacing parameters of a heart stimulation device, such as a pacemaker, may then be configured, for example, by setting the paced atrio-ventricular delay based on whether the patient responds positively to cardiac resynchronization therapy.

公开(公告)号：US08532771B2

公开(公告)日：2013-09-10

申请号：US13115825

申请日：2011-05-25

申请人： Douglas R. Daum ,  Geng Zhang ,  Qingsheng Zhu ,  Gerrard M. Carlson ,  Julio C. Spinelli

发明人： Douglas R. Daum ,  Geng Zhang ,  Qingsheng Zhu ,  Gerrard M. Carlson ,  Julio C. Spinelli

IPC分类号： A61N1/365

CPC分类号： A61N1/365

摘要： A maximum pacing rate limiter for use in adaptive rate pacing in conjunction with a cardiac rhythm management system for a heart. The maximum pacing rate limiter may function to measure an interval, termed the ERT interval, between a paced ventricular evoked response and a T-wave. The maximum pacing rate limiter may further function to maintain the ERT interval at less than a certain percentage of the total cardiac cycle. In one disclosed embodiment, a maximum pacing rate limiter calculates an ERT rate based on the detected paced ventricular evoked response and the T-wave, and the pacing rate limiter module further communicates the minimum of the ERT rate and an adaptive-rate sensor indicated rate to a pacemaker.

摘要翻译： 与心脏心律管理系统结合使用的适应性起搏速度的最大起搏速率限制器。 最大起搏速率限制器可以用于测量在起搏心室诱发反应和T波之间的称为ERT间期的间隔。 最大起搏速率限制器可进一步起作用以将ERT间期维持在小于总心律周期的一定百分比。 在一个公开的实施例中，最大起搏速率限制器基于检测到的起搏心室诱发反应和T波计算ERT率，并且起搏速率限制器模块进一步传达最小ERT率和自适应速率传感器指示率 到起搏器。

公开(公告)号：US08498703B2

公开(公告)日：2013-07-30

申请号：US13235599

申请日：2011-09-19

申请人： Julio C. Spinelli ,  Qingsheng Zhu

发明人： Julio C. Spinelli ,  Qingsheng Zhu

IPC分类号： A61N1/16

CPC分类号： A61N1/3627 ,  A61N1/36564

摘要： A method and apparatus for treating or preventing neurocardiogenic syncope is disclosed. Upon detection of bradycardia or a drop in blood pressure indicating the onset of syncope, electrostimulation pulses are delivered during the heart's refractory period. The pulses are non-excitatory but increase myocardial contractility and thereby increase cardiac output.

公开(公告)号：US20130079838A1

公开(公告)日：2013-03-28

申请号：US13678465

申请日：2012-11-15

申请人： Imad Libbus ,  Julio C. Spinelli

发明人： Imad Libbus ,  Julio C. Spinelli

IPC分类号： A61N1/36

CPC分类号： A61N1/36053 ,  A61N1/3611 ,  A61N1/36114 ,  A61N1/36117 ,  A61N1/36146 ,  A61N1/36564

摘要： An aspect of the present subject matter relates to a baroreflex stimulator. An embodiment of the stimulator includes a pulse generator to provide a baroreflex stimulation signal through an electrode, and a modulator. The modulator modulates the baroreflex stimulation signal to increase the baroreflex stimulation therapy by a predetermined rate of change to lower systemic blood pressure to a target pressure. Other aspects are provided herein.

摘要翻译： 本主题的一个方面涉及一种压力反射刺激器。 刺激器的实施例包括脉冲发生器，以通过电极提供压力反射刺激信号和调制器。 该调节剂调节压力反射刺激信号以增​​加压力反射刺激疗法预定的变化率，从而将全身血压降低到目标压力。 本文提供了其他方面。

公开(公告)号：US08369948B2

公开(公告)日：2013-02-05

申请号：US13279493

申请日：2011-10-24

申请人： Andrew P. Kramer ,  Rodney W. Salo ,  Julio C. Spinelli ,  Bruce H. KenKnight

发明人： Andrew P. Kramer ,  Rodney W. Salo ,  Julio C. Spinelli ,  Bruce H. KenKnight

IPC分类号： A61N1/362

CPC分类号： A61N1/3627 ,  A61N1/365 ,  A61N1/36542 ,  A61N1/36585 ,  A61N1/368

摘要： An apparatus for reversing ventricular remodeling with electro-stimulatory therapy. A ventricle is paced by delivering one or more stimulatory pulses in a manner such that a stressed region of the myocardium is pre-excited relative to other regions in order to subject the stressed region to a lessened preload and afterload during systole. The unloading of the stressed myocardium over time effects reversal of undesirable ventricular remodeling.

摘要翻译： 用电刺激治疗逆转心室重构的装置。 通过递送一个或多个刺激脉冲以使得相对于其它区域预激励心肌的应激区域以使受压区域在收缩期间减轻预负荷和后负荷来起搏心室。 随着时间的推移，应力心肌的卸载会影响不良心室重构的逆转。