公开(公告)号：US06907287B1

公开(公告)日：2005-06-14

申请号：US10172393

申请日：2002-06-14

申请人： Gregory C. Bevan ,  Richard Lu ,  Harold C. Schloss ,  Joseph J. Florio ,  Janice Barstad

发明人： Gregory C. Bevan ,  Richard Lu ,  Harold C. Schloss ,  Joseph J. Florio ,  Janice Barstad

IPC分类号： A61N1/362 ,  A61N1/372

CPC分类号： A61N1/3621

摘要： Systems and methods are provided for collecting enhanced diagnostic information specifically pertaining to overdrive pacing within an implantable cardiac stimulation device and for processing and displaying the enhanced diagnostic information using an external programmer. The enhanced diagnostic information includes one or more of overdrive pacing efficacy, overdrive pacing percentage, overdrive pacing/heart rate histogram data, longest recovery duration, atrial event data, minimum/maximum/average of the overdrive pacing rate, number of paced beats at maximum rate, duration of recovery time from maximum rate, intrinsic rate breakthrough histogram data, and number of rate increases. By tracking and displaying the enhanced diagnostic information, a physician can thereby more effectively and reliably program overdrive pacing control parameters to achieve optimal overdrive pacing performance.

摘要翻译： 系统和方法被提供用于收集专门涉及可植入心脏刺激装置内的超速起搏的增强诊断信息，并且使用外部编程器来处理和显示增强的诊断信息。 增强的诊断信息包括超速起搏功效，超速起搏百分比，超速起搏/心率直方图数据，最长恢复持续时间，心房事件数据，超速起搏速率的最小/最大/平均值，最大起搏节拍数 速率，恢复时间从最大速率，内在速率突破直方图数据和速率增加数。 通过跟踪和显示增强的诊断信息，医师可以由此更有效和可靠地编程超速起搏控制参数，以实现最佳超速起搏性能。

公开(公告)号：US06904317B2

公开(公告)日：2005-06-07

申请号：US10043472

申请日：2002-01-09

申请人： Joseph J. Florio ,  Gene A. Bornzin ,  Peter Boileau ,  Eric Falkenberg ,  Janice Barstad

发明人： Joseph J. Florio ,  Gene A. Bornzin ,  Peter Boileau ,  Eric Falkenberg ,  Janice Barstad

IPC分类号： A61N1/362 ,  A61N1/36

CPC分类号： A61N1/3621

摘要： Dynamic overdrive pacing adjustment techniques are described for use in implantable cardiac stimulation devices. In a first technique, an overdrive pacing unit of a microcontroller of the implantable device operates to optimize various control parameters that affect overdrive pacing so as to achieve a desired degree of overdrive pacing for the particular patient in which the stimulation device is implanted. Parameters to be optimized include the number of overdrive beats paced once overdrive pacing is trigged, the overdrive pacing response function, the recovery rate, and various base rates. The control parameters are adjusted in a hierarchical order of priority until the desired degree of overdrive pacing is achieved. Adjustment of the number of overdrive beats, the recovery rate, and various base rates is iteratively performed by using incremental numerical adjustments. Adjustment of the overdrive pacing response function may be performed by selecting among a set of fixed predetermined linear response functions. In a second technique, the overdrive pacing unit operates to optimize the shape of a single non-linear dynamic overdrive pacing response function so as to achieve the desired degree of overdrive pacing for the patient. The second technique may either be employed alone or in combination with the first, hierarchical optimization technique.

摘要翻译： 动态超速起搏调节技术被描述用于可植入心脏刺激装置。 在第一技术中，可植入装置的微控制器的过驱动起搏单元操作以优化影响过驱动起搏的各种控制参数，以便为其中植入刺激装置的特定患者达到期望程度的过速起搏。 要优化的参数包括一旦超速起搏起搏起搏，超速起搏响应功能，恢复速率和各种基准速率起搏的过载跳动次数。 控制参数以优先级的等级顺序进行调整，直到达到期望的过速起搏程度。 通过使用增量数值调整迭代地执行过载跳动次数的调整，恢复率和各种基本速率。 可以通过在一组固定的预定线性响应函数中进行选择来执行过速起搏响应功能的调整。 在第二种技术中，超速起搏单元操作以优化单个非线性动态超速起搏响应功能的形状，以便达到病人期望程度的超速起搏起搏。 第二种技术可以单独使用，也可以与第一层级优化技术结合使用。

公开(公告)号：US06711438B1

公开(公告)日：2004-03-23

申请号：US10033410

申请日：2001-10-25

申请人： Kelly H. McClure ,  Joseph J. Florio ,  Gene A. Bornzin

发明人： Kelly H. McClure ,  Joseph J. Florio ,  Gene A. Bornzin

IPC分类号： A61N1362

CPC分类号： A61N1/368 ,  A61N1/3704

摘要： The stimulation device blanks T-waves from the atrial channel of an electrical cardiac signal by employing a T-wave blanking interval localized to the expected location and duration of the T-wave. To this end, the stimulation device determines the average interval between an R-wave and a T-wave in the patient in which the device is implanted and also determines the average duration of a T-wave within the patient. A T-wave blanking interval is initiated following the average R-T interval subsequent to detection of an R-wave and lasts for a period of time equal to the average T-wave duration. In this manner, highly localized T-wave blanking is achieved permitting P-waves or other atrial signals to be detected during remaining non-blanked portions of the atrial channel of the cardiac signal at least for the purposes of atrial rate detection. The relatively short T-wave blanking interval of the invention is particularly well suited for use in combipolar sensing systems. Method and apparatus implementations are described.

摘要翻译： 刺激装置通过采用局限于T波的预期位置和持续时间的T波消隐间隔来消除来自心电信号心房通道的T波。 为此，刺激装置确定在其中植入装置的患者中的R波和T波之间的平均间隔，并且还确定患者内的T波的平均持续时间。 在检测到R波之后的平均R-T间隔之后开始T波消隐间隔，并且持续一段时间等于平均T波持续时间。 以这种方式，实现高度局部化的T波消隐，允许在心脏信号的心房通道的剩余非消隐部分期间检测P波或其他心房信号，至少用于心房率检测。 本发明的相对较短的T波消隐间隔特别适用于组合极检测系统。 描述了方法和装置实现。

公开(公告)号：US06636766B2

公开(公告)日：2003-10-21

申请号：US09849723

申请日：2001-05-03

申请人： Gene A. Bornzin ,  Junyu Mai ,  Euljoon Park ,  Joseph J. Florio

发明人： Gene A. Bornzin ,  Junyu Mai ,  Euljoon Park ,  Joseph J. Florio

IPC分类号： A61N1365

CPC分类号： A61N1/362

摘要： A rate smoothing technique is applied by the pacing device to sensed and paced heart signals so as to prevent a sharp drop in heart rate, particularly for use within patients prone to vasovagal syncope. The rate smoothing technique is applied by the pacing device during the calculation of an escape interval employed by the device in determining whether to pace the heart. The rate smoothing technique has the effect of adjusting the escape interval to ensure the heart is paced for a period of time subsequent to a sharp drop in the natural heart rate of the patient permitting the heart rate to decrease gradually rather than suddenly. The rate smoothing technique however does not interfere with a sharp increase in heart rate as may be required during sudden physical exertion. System and method examples are described herein.

公开(公告)号：US06606517B1

公开(公告)日：2003-08-12

申请号：US09548293

申请日：2000-04-12

申请人： Euljoon Park ,  Gene A. Bornzin ,  Joseph J. Florio ,  John W. Poore ,  Laurence S. Sloman ,  Peter Boileau ,  Douglas T. Kurschinski

发明人： Euljoon Park ,  Gene A. Bornzin ,  Joseph J. Florio ,  John W. Poore ,  Laurence S. Sloman ,  Peter Boileau ,  Douglas T. Kurschinski

IPC分类号： A61N1362

CPC分类号： A61N1/3622

摘要： A method and apparatus for reducing the incidence of atrial arrhythmias by using an overdrive algorithm to determine the application of overdrive stimulation pulses to a patient's heart, e.g., in the atria. In a first aspect of the invention, the apparatus first determines an overdrive pacing rate and then applies pairs of temporally spaced (staggered) pacing pulses, i.e., primary and secondary pacing pulses, at the determined overdrive pacing rate. In a further aspect of the invention, the pairs of pacing pulses are applied at the overdrive pacing rate to multiple spatially spaced electrodes, i.e., electrodes distributed among multiple sites in a patient's heart, e.g., in the atria. In accordance with a first preferred embodiment, the electrodes may be distributed within a single atrium, e.g., the right atrium, of the patient's heart. Alternatively, a first electrode may be placed in the right atrium and a second electrode may be placed in the coronary sinus or the left atrium or multiple electrodes may be placed proximate to the left atrium. Furthermore, the invention relates to techniques for controlling overdrive pacing to multiple sites in a patient's heart so as to achieve and maintain a target degree of pacing and thus suppress tachycardias.

摘要翻译： 一种用于通过使用过驱动算法来确定过度驱动刺激脉冲施加到患者心脏（例如在心房）中来减少心房心律失常发生率的方法和装置。 在本发明的第一方面中，装置首先确定过驱动起搏速率，然后以确定的超速起搏速率施加时间间隔（交错）的起搏脉冲，即初级和次级起搏脉冲。 在本发明的另一方面，以超速起搏速率将多对起搏脉冲施加到多个空间间隔开的电极，即分布在患者心脏中的多个部位之间的电极，例如在心房中。 根据第一优选实施例，电极可以分布在患者心脏的单个心房（例如右心房）内。 或者，第一电极可以放置在右心房中，并且第二电极可以放置在冠状窦或左心房中，或者多个电极可以放置在靠近左心房的位置。 此外，本发明涉及用于控制对患者心脏中的多个部位的超速起搏的技术，以便实现和维持目标起搏程度，从而抑制心动过速。

公开(公告)号：US06587723B1

公开(公告)日：2003-07-01

申请号：US09690565

申请日：2000-10-17

申请人： Laurence S. Sloman ,  Kerry A. Bradley ,  Joseph J. Florio

发明人： Laurence S. Sloman ,  Kerry A. Bradley ,  Joseph J. Florio

IPC分类号： A61N1368

CPC分类号： A61N1/3712

摘要： An implantable cardiac stimulation device with automatic threshold testing capabilities. The device utilizes an algorithm for measuring a first and a second threshold settings. The first threshold setting is determined by decreasing the stimulation energy from an initially high, supra-threshold value until loss of capture is detected, and is set as the pulse energy at which capture is still detected. The second threshold setting is determined by increasing the stimulation energy from an initially low, sub-threshold value until capture is detected, and is set as the stimulation energy at which capture is regained. The algorithm further determines if the threshold test results are reliable by comparing the difference between the first and second threshold settings to an expected difference, known as the Wedensky Effect value. A deviation from the Wedensky Effect value which is known for a given patient, indicates a discrepancy in the threshold test result. Such a deviation could be used to indicate when a threshold test is suspected of being erroneous, for example, due to fusion. During a subsequent threshold test, the stimulation parameters are adjusted so that the likelihood of fusion is minimized. Once a threshold test result is evaluated and found to be consistent with the expected Wedensky Effect value, the stimulation energy is automatically adjusted to a level safely above the threshold value.

摘要翻译： 具有自动阈值测试功能的可植入式心脏刺激装置。 该装置利用用于测量第一和第二阈值设置的算法。 通过从初始高的超阈值减小刺激能量直到检测到捕获的丢失来确定第一阈值设置，并将其设置为仍被检测到捕获的脉冲能量。 通过从初始低的亚阈值增加刺激能量直到检测到捕获来确定第二阈值设置，并将其设置为恢复捕获的刺激能量。 该算法进一步通过将第一和第二阈值设置之间的差值与预期的差值进行比较来确定阈值测试结果是否可靠，称之为威灵斯基效应值。 与给定患者已知的Wedensky Effect值的偏差表示阈值测试结果的差异。 这种偏差可以用于指示阈值测试何时被怀疑是错误的，例如由于融合。 在随后的阈值测试期间，调整刺激参数，使得融合的可能性最小化。 一旦对阈值测试结果进行评估并发现与预期的温斯基效应值一致，则刺激能量被自动调整到安全高于阈值的水平。

公开(公告)号：US06519493B1

公开(公告)日：2003-02-11

申请号：US09471788

申请日：1999-12-23

申请人： Joseph J. Florio ,  Gene A. Bornzin ,  John W. Poore ,  Douglas T. Kurschinski

发明人： Joseph J. Florio ,  Gene A. Bornzin ,  John W. Poore ,  Douglas T. Kurschinski

IPC分类号： A61N136

CPC分类号： A61N1/368

摘要： Techniques are described for overdrive pacing the heart using a pacemaker wherein 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.

摘要翻译： 描述了使用起搏器超速起搏心脏的技术，其中在确定的搜索周期内检测到至少两个固有节拍时，超速起搏速率仅增加。 在一种特定技术中，只有在X个心动周期内检测到两个P波时，起搏速率才会增加。 在另一个具体技术中，只有在N个心动周期的块内检测到至少两个P波时，才能增加超速起搏速率。 在两种技术中，如果在最后Z个心动周期中没有发生增加，则超速起搏速率将降低。 通过仅在确定的心跳周期内响应于至少两个P波的检测来增加超速起搏速率，避免了过高的超速起搏速率。 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。

公开(公告)号：US06516225B1

公开(公告)日：2003-02-04

申请号：US09662440

申请日：2000-09-15

申请人： Joseph J. Florio

发明人： Joseph J. Florio

IPC分类号： A61N1368

CPC分类号： A61B5/04525 ,  A61N1/3622 ,  A61N1/3956 ,  A61N1/3962

摘要： The system and method discriminates P-waves or other electrical events originating in the atria from R-waves or other electrical events originating in the ventricles. In one example, far-field R-waves in the atria are distinguished from true P-waves using both a post-ventricular atrial blanking (PVAB) interval and a separate pre-ventricular blanking interval (pre-VAB) interval. Insofar as the pre-VAB interval is concerned, upon detection of a P-wave in the atria, the implantable medical device begins tracking a pre-VAB interval. If an R-wave is then detected in the ventricles during the pre-VAB interval, the P-wave is rejected as being a far-field R-wave. A PVAB interval may also be employed to filter out any P-waves detected in the atria immediately following detection of an R-wave in the ventricles. In another example, far-field R-waves are distinguished from true P-waves using template matching. P-waves detected in the atria are compared against a template representative of true P-waves. If the P-wave substantially matches the template, the P-wave is deemed to be a true P-wave; otherwise, the P-wave is rejected as being a far-field R-wave or other anomalous electrical event. In both examples, the techniques are applicable to other types of electrical events detected within the heart besides P-waves and R-waves, such as electrical events occurring during fibrillation or flutter when discrete P-waves and R-waves may not be detectable.

摘要翻译： 该系统和方法鉴别来自R波的起搏于心房的P波或其他电气事件或源自心室的其他电气事件。 在一个示例中，心房中的远场R波与使用心室后空白（PVAB）间隔和单独的心室前消隐间隔（pre-VAB）间隔的真实P波区分开。 就VVA间隔而言，在检测到心房中的P波时，可植入医疗装置开始跟踪VAB之前的间隔。 如果在VAB间隔期间在心室中检测到R波，则P波被拒绝为远场R波。 也可以使用PVAB间隔来在心室中检测到R波之后立即滤除在心房中检测到的任何P波。 在另一个例子中，使用模板匹配将远场R波与真实P波区分开。 将在心房中检测到的P波与代表真实P波的模板进行比较。 如果P波基本上与模板匹配，则P波被认为是真正的P波; 否则，P波被拒绝为远场R波或其他异常电气事件。 在这两个例子中，这些技术适用于除P波和R波之外在心脏中检测到的其他类型的电事件，例如当不可检测到离散的P波和R波时，在颤动期间发生的电气事件或颤动。

公开(公告)号：US06510342B1

公开(公告)日：2003-01-21

申请号：US09548116

申请日：2000-04-12

申请人： Euljoon Park ,  Gene A. Bornzin ,  Joseph J. Florio ,  John W. Poore ,  Douglas T. Kurschinski

发明人： Euljoon Park ,  Gene A. Bornzin ,  Joseph J. Florio ,  John W. Poore ,  Douglas T. Kurschinski

IPC分类号： A61N1368

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.

摘要翻译： 描述了用于使用起搏器使用超速起搏心脏起搏心脏多个部位的技术，其包括其中在确定的搜索周期内检测到至少两个固有节拍时，超速起搏速率仅增加的技术。 在一种特定技术中，只有在X个心动周期内检测到两个P波时，起搏速率才会增加。 在另一个具体技术中，只有在N个心动周期的块内检测到至少两个P波时，才能增加超速起搏速率。 在两种技术中，如果在最后Z个心动周期中没有发生增加，则超速起搏速率将降低。 通过仅在确定的心跳周期内响应于至少两个P波的检测来增加超速起搏速率，避免了过高的超速起搏速率。 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。

公开(公告)号：US06477416B1

公开(公告)日：2002-11-05

申请号：US09572488

申请日：2000-05-15

申请人： Joseph J. Florio ,  Laurence S. Sloman

发明人： Joseph J. Florio ,  Laurence S. Sloman

IPC分类号： A61N118

CPC分类号： A61N1/3702 ,  A61N1/3716

摘要： An implantable stimulation device delivers a stimulation pulse in the ventricular chamber of a patient's heart and automatically adjusts a post-ventricular atrial blanking period. The stimulation device generates a ventricular stimulation pulse to trigger an evoked response, in order to produce a ventricular far-field signal that follows a successfully captured ventricular stimulation pulse. The stimulation device further includes an atrial sense circuit that senses the ventricular far-field signal, and a control system that adaptively segments the post-ventricular atrial blanking period in a post-ventricular atrial blanking period (PVAB) which is fixed in duration, and a variable far-field interval (FFI) window. PVAB is initiated upon the delivery of the ventricular stimulation pulse, such that events sensed outside the segmented post-ventricular atrial blanking (SPVAB) period are presumed to be intrinsic atrial events, and events sensed within the far-field interval window are presumed to be far-field signals. The far-field interval window is preferably centered on a previously sensed far-field R-wave. If an intrinsic ventricular event is sensed, the stimulation device does not initiate the PVAB period but rather sets the FFI window.

摘要翻译： 植入式刺激装置在患者心脏的心室中输送刺激脉冲，并自动调节心室后心室消融期。 刺激装置产生心室刺激脉冲以触发诱发反应，以产生跟随成功捕获的心室刺激脉冲的心室远场信号。 刺激装置还包括感测心室远场信号的心房感知电路，以及在持续时间固定的心房后心房消隐期（PVAB）中自适应地分段心室心房消隐期的控制系统，以及 可变远场间隔（FFI）窗口。 PVAB是在输送心室刺激脉冲时开始的，使得在分段的心室后消融（SPVAB）周期之外感测到的事件被认为是内在心房事件，并且假定在远场间隔窗口内感测到的事件为 远场信号。 远场间隔窗口优选地以先前感测的远场R波为中心。 如果感测到内部心室事件，则刺激装置不会启动PVAB周期，而是设置FFI窗口。