公开(公告)号：US07212855B1

公开(公告)日：2007-05-01

申请号：US10657878

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： A61N1/05

CPC分类号： A61N1/3622 ,  A61N1/3712 ,  A61N1/3714

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.

公开(公告)号：US07164944B1

公开(公告)日：2007-01-16

申请号：US10417477

申请日：2003-04-15

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： A61N1/00

CPC分类号： A61N1/3962 ,  A61N1/36071

摘要： An exemplary method includes delivering a therapy selected from tiered therapies that include cardioversion and/or defibrillation therapies wherein the delivered therapy aims to treat a cardiac condition, delivering analgesic stimulation, determining whether the delivered therapy successfully treated the cardiac condition, and responsive to the determining, changing one or more analgesic stimulation parameters. Various other exemplary methods and/or devices capable of performing such methods are also disclosed.

摘要翻译： 示例性方法包括递送选自包括心脏复律和/或除颤疗法的分层治疗的治疗，其中递送的治疗旨在治疗心脏病症，递送镇痛刺激，确定递送的治疗是否成功治疗了心脏病症，并且响应于确定 改变一个或多个镇痛刺激参数。 还公开了能够执行这些方法的各种其它示例性方法和/或装置。

公开(公告)号：US07158829B1

公开(公告)日：2007-01-02

申请号：US10728511

申请日：2003-12-05

申请人： Paul A. Levine

发明人： Paul A. Levine

IPC分类号： A61N1/368 ,  A61B5/04

CPC分类号： A61B5/0452 ,  A61B5/0464 ,  A61N1/368 ,  A61N1/37

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.

公开(公告)号：US06928326B1

公开(公告)日：2005-08-09

申请号：US10405212

申请日：2003-03-31

申请人： Paul A. Levine

发明人： Paul A. Levine

IPC分类号： A61N1/05 ,  A61N1/37

CPC分类号： A61N1/371

摘要： Exemplary methods and devices for determining whether fusion or pseudofusion have occurred. An exemplary method includes delivering a stimulus, sensing cardiac activity, determining whether the stimulus resulted in capture, and if the determining indicates that the stimulus did not result in capture, then, determining whether the sensed cardiac activity includes characteristics of native cardiac activity by comparing at least some of the sensed cardiac activity to a template. Accordingly, if the sensed activity includes native activity, then a diagnosis is made that the stimulus resulted in fusion or pseudofusion. Another exemplary method includes determining whether a stimulus resulted in capture, and if the determining indicates that the stimulus did not result in capture, then, adjusting sensitivity of a sensor and sensing cardiac activity using the sensor. According to this method, if cardiac activity is sensed, then a diagnosis is made that the stimulus resulted in fusion or pseudofusion. Various methods and/or devices are suitable for use with autocapture. Other methods, devices and/or systems are also disclosed.

摘要翻译： 用于确定是否发生融合或伪融合的示例性方法和装置。 示例性方法包括递送刺激，感测心脏活动，确定刺激是否导致捕获，以及如果确定指示刺激不导致捕获，则确定所感测的心脏活动是否包括天然心脏活动的特征，通过比较 感测到的至少一些对模板的心脏活动。 因此，如果感测到的活动包括天然活动，则进行诊断，使得刺激导致融合或假融合。 另一示例性方法包括确定刺激是否导致捕获，以及如果确定指示刺激不导致捕获，则调整传感器的灵敏度并使用传感器感测心脏活动。 根据该方法，如果感测到心脏活动，则进行诊断，使得刺激导致融合或假融合。 各种方法和/或装置适用于自动捕获。 还公开了其它方法，装置和/或系统。

公开(公告)号：US06925326B1

公开(公告)日：2005-08-02

申请号：US10039414

申请日：2002-01-04

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

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

IPC分类号： A61N1/368 ,  A61B5/04

CPC分类号： A61N1/368

摘要： An implantable cardiac stimulation device and method measure atrioventricular conduction times and automatically adjust an atrioventricular delay time based on the measured conduction time values.

摘要翻译： 可植入心脏刺激装置和方法测量房室传导时间，并根据测量的传导时间值自动调节房室延迟时间。

公开(公告)号：US06889077B2

公开(公告)日：2005-05-03

申请号：US10086580

申请日：2002-02-28

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

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

IPC分类号： A61N1/39

CPC分类号： A61N1/3987 ,  A61N1/395

摘要： An implantable cardiac stimulation device applies defibrillating electrical energy to the atria of a heart at a time which avoids inducing ventricular fibrillation of the heart. The device includes an atrial fibrillation detector that detects atrial fibrillation of the heart, a pacing pulse generator that applies a ventricular pacing pulse to the heart responsive to detection of atrial fibrillation, a timer that times a time period through an evoked response and a T-wave caused by the pacing pulse, and a defibrillation pulse generator that applies defibrillating electrical energy to the atria of the heart after the timer completes the timing of the time period.

摘要翻译： 植入式心脏刺激装置在避免引起心脏心室颤动的时间将去纤维化的电能施加到心脏的心房。 该装置包括：心房颤动检测器，其检测心脏的心房颤动;起搏脉冲发生器，响应于心房纤维性颤动的检测而向心脏施加心室起搏脉冲;定时器，其通过诱发反应的时间段和T- 由起搏脉冲引起的波;以及除颤脉冲发生器，其在定时器完成时间段的定时之后，将除颤电能施加到心脏的心房。

公开(公告)号：US06721601B1

公开(公告)日：2004-04-13

申请号：US10102271

申请日：2002-03-19

申请人： Gene A. Bornzin ,  Paul A. Levine ,  Kenneth Valikai ,  Jason A. Sholder

发明人： Gene A. Bornzin ,  Paul A. Levine ,  Kenneth Valikai ,  Jason A. Sholder

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 that 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了一种新的检测方案，其自动检测心房捕获并执行心房起搏阈值评估。 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。

公开(公告)号：US06694184B2

公开(公告)日：2004-02-17

申请号：US09757143

申请日：2001-01-09

申请人： Armando M. Cappa ,  J. Kelly Fox ,  Paul A. Levine ,  Matthew Whitlock ,  James B. Hamilton

发明人： Armando M. Cappa ,  J. Kelly Fox ,  Paul A. Levine ,  Matthew Whitlock ,  James B. Hamilton

IPC分类号： A61B1902

CPC分类号： A61N1/08 ,  Y10S206/818

摘要： A method and assembly for selectively actuating features of implanted medical devices with a magneto-static field. The method includes selectively exposing the implanted device to a static magnetic field source, selectively shielding the magnetic field source, and distancing the shielded magnetic field source from the medical device. One version of the assembly includes a permanent magnet and a displaceable shield assembly that shields the magnetic field generated by the magnet in one configuration and is displaceable to a second configuration wherein the magnetic field is at least partially exposed. In another version, the assembly is an electromagnet that can be selectively activated and deactivated. The electromagnet generates minimal magnet field when it is off.

摘要翻译： 一种用于利用磁静电场选择性地致动植入式医疗装置的特征的方法和组件。 该方法包括将植入的装置选择性地暴露于静态磁场源，选择性地屏蔽磁场源，并将屏蔽的磁场源与医疗装置隔离。 组件的一个版本包括永磁体和可移位的屏蔽组件，其可以以一种构造屏蔽由磁体产生的磁场，并且可移位到第二配置，其中磁场至少部分地暴露。 在另一个版本中，组件是可以选择性地激活和去激活的电磁体。 当电磁铁关闭时，电磁铁产生最小的磁场。

公开(公告)号：US06584354B1

公开(公告)日：2003-06-24

申请号：US09906505

申请日：2001-07-17

申请人： Brian M. Mann ,  Melinda Endaya ,  Paul A. Levine

发明人： Brian M. Mann ,  Melinda Endaya ,  Paul A. Levine

IPC分类号： A61N137

CPC分类号： A61N1/3712 ,  A61N1/3714 ,  A61N1/37247

摘要： A pacemaker programmer and diagnostic system retrieves information stored within a pacemaker and analyzes the retrieved data in real time. The stored information can be retrieved by means of a telemetry communication link. The pacemaker automatically lengthens a post-ventricular atrial refractory period (PVARP). The pacemaker determines atrial capture threshold by generating atrial stimulation pulses while maintaining the ventricular stimulation pulse amplitude at a level known to ensure ventricular capture, and by detecting loss of atrial capture. In response to loss of atrial capture, a processor automatically triggers a premature ventricular contraction (PVC) response to prevent a retrograde P-wave from initiating a pacemaker-mediated tachycardia. Also in response to loss of atrial capture, the processor sets the atrial stimulation pulse amplitude to a value above the atrial capture threshold in a subsequent cardiac cycle, and restores the PVARP to its pre-test value.

摘要翻译： 起搏器程序员和诊断系统检索存储在起搏器内的信息，并实时分析检索到的数据。 所存储的信息可以通过遥测通信链路来检索。 心脏起搏器自动延长心室不应期（PVARP）。 起搏器通过产生心房刺激脉冲来确定心房捕获阈值，同时将心室刺激脉冲幅度保持在已知的水平以确保心室捕获，并通过检测心房捕获的损失。 为了应对心房捕获的丧失，处理器自动触发早期心室收缩（PVC）反应，以防止逆行P波起始起搏器介导的心动过速。 另外为了响应于心房捕获的丢失，处理器将心房刺激脉冲幅度设置为高于心房捕获阈值的值，并将PVARP恢复到其预测值。

公开(公告)号：US06430441B1

公开(公告)日：2002-08-06

申请号：US09483908

申请日：2000-01-18

申请人： Paul A. Levine

发明人： Paul A. Levine

IPC分类号： A61N1362

CPC分类号： A61N1/3712

摘要： An improved system and method for performing autocapture/autothreshold detection in an implantable cardiac stimulation device or any device capable of stimulating some organ or tissue in the body. In some existing systems, loss-of-capture and capture decisions are based upon two consecutive cardiac events. However, such systems may be subject to subthreshold stimulation pulses that capture and lose capture on alternating pulses, trigeminy PVC sequences, or the like that require a higher stimulation pulse amplitude but cannot make this determination due to the two consecutive event requirement. Accordingly, in the present invention, the determination of whether there is a loss-of-capture is determined only according to paced events, i.e., ignoring intrinsic and PVC beats. Furthermore, the loss-of-capture determination is based upon X out of the last Y beats, where Y is greater than 2 and X is less than Y. Accordingly, consecutive loss-of-capture events are no longer required in determining the threshold level. In a further aspect, a preferred embodiment monitors cardiac events to detect a sequence of patterns that could indicate a trigeminy pattern and, if detected, the pacing rate is increased to attempt to break the pattern and thus permit the threshold level to be detected.

摘要翻译： 一种用于在可植入心脏刺激装置或能够刺激身体中的一些器官或组织的任何装置中执行自动俘获/自动阈值检测的改进的系统和方法。 在一些现有的系统中，丢失捕获和捕获决定是基于两个连续的心脏事件。 然而，这种系统可能经受亚阈值刺激脉冲，其捕获并丢失需要较高刺激脉冲幅度但不能由于两个连续事件要求而做出该确定的交替脉冲，三线PVC序列等的捕获。 因此，在本发明中，仅根据节奏事件确定是否存在捕获损失，即忽略本征和PVC节拍。 此外，捕获损失确定是基于最后Y次跳跃中的X，其中Y大于2并且X小于Y.因此，在确定阈值时不再需要连续的捕获捕获事件 水平。 在另一方面，优选实施例监视心脏事件以检测可以指示三叉形模式的模式序列，并且如果检测到，则起搏速率增加以尝试中断模式，从而允许检测阈值水平。