公开(公告)号：US06259948B1

公开(公告)日：2001-07-10

申请号：US09191166

申请日：1998-11-13

申请人： Joseph J. Florio ,  Paul A. Levine ,  Mark R. Myers

发明人： Joseph J. Florio ,  Paul A. Levine ,  Mark R. Myers

IPC分类号： A61N136

CPC分类号： A61N1/36542 ,  A61N1/368

摘要： A device in the form of a cardiac pacemaker for treating a malfunctioning heart, in which the intrinsic heart rate information is combined with secondary sensor variance information to select an appropriate therapy for the patient. The cardiac pacemaker has operational capability in the sleep mode and includes a hysteresis function. The hysteresis function is disabled during operation in the sleep mode and a pacing therapy is selected based upon the intrinsic heart rate and sleep mode operation.

摘要翻译： 心脏起搏器形式的用于治疗故障心脏的装置，其中内在心率信息与次级传感器方差信息组合以选择患者的适当治疗。 心脏起搏器在睡眠模式下具有操作能力，并且包括滞后功能。 滞后功能在睡眠模式下操作期间被禁用，并且基于内在的心率和睡眠模式操作来选择起搏治疗。

公开(公告)号：US06324427B1

公开(公告)日：2001-11-27

申请号：US09237617

申请日：1999-01-26

申请人： Joseph J. Florio

发明人： Joseph J. Florio

IPC分类号： A61N1362

CPC分类号： A61N1/3712

摘要： A system and method for discriminating a fusion beat from an evoked response during the autocapture/autothreshold routines of an implantable stimulation device is provided. The presently disclosed system and method reliably verifies capture in an implantable stimulation device by accurately discriminating a fusion beat from an evoked response based on an analysis and comparison of the morphology, amplitude, polarity, pattern and/or timing intervals of resulting T-waves. The disclosed system for discriminating a fusion beat includes a pulse generator; a means for sensing voltage signals evidencing depolarization and repolarization of cardiac tissue; and a microprocessor based means for determining, based on an analysis of the subsequent T-waves, whether a voltage signal that occurs during the capture detection window is a depolarization voltage signal, which evidences capture, or a fusion beat.

摘要翻译： 提供了一种用于在可植入刺激装置的自动捕获/自动阈值程序期间区分融合搏动与诱发响应的系统和方法。 目前公开的系统和方法基于对所得T波的形态，振幅，极性，模式和/或定时间隔的分析和比较，可靠地通过从诱发响应中精确地区分融合节拍来可靠地验证可植入刺激装置中的捕获。 所公开的用于识别融合节拍的系统包括脉冲发生器; 用于感测证明心脏组织去极化和复极化的电压信号的手段; 以及基于微处理器的装置，用于基于对后续T波的分析来确定在捕获检测窗口期间发生的电压信号是否是捕获的去极化电压信号或融合搏动。

公开(公告)号：US07117036B2

公开(公告)日：2006-10-03

申请号：US10185776

申请日：2002-06-27

申请人： Joseph J. Florio

发明人： Joseph J. Florio

IPC分类号： A61N1/365 ,  A61N1/37 ,  A61B5/11

CPC分类号： A61N1/36542 ,  A61N1/3601

摘要： An implantable cardiac device is programmed to monitor short term activity changes that occur while a patient is at rest to produce a sleep disturbance metric that is useful in analyzing and/or treating sleep apnea. After the implantable cardiac device confirms that a patient is at rest, the device monitors an instantaneous signal from an activity sensor to detect variances from normal rest mode activity. When the variances exceed a preset threshold for a short time period (e.g., less than 30–40 sec.), the patient is presumed to be experiencing a form of sleep disturbance as opposed to conscious or wakeful activity. These short term events are recorded as sleep disturbance events. The sleep disturbance metric are reported to a physician as a diagnostic to help ascertain the severity of sleep apnea or to evaluate the effectiveness of pacing therapies being applied to treat sleep apnea.

摘要翻译： 可植入心脏装置被编程以监测在患者静息时发生的短期活动变化，以产生可用于分析和/或治疗睡眠呼吸暂停的睡眠障碍度量。 在可植入心脏装置确认患者处于静止状态之后，该装置监测来自活动传感器的瞬时信号，以检测与正常休息模式活动的差异。 当方差在短时间内（例如，小于30-40秒）超过预设阈值时，假设患者正在经历与有意识或觉醒活动相反的睡眠障碍的形式。 这些短期事件记录为睡眠障碍事件。 睡眠障碍指标作为诊断报告给医师，以帮助确定睡眠呼吸暂停的严重性或评估应用于治疗睡眠呼吸暂停的起搏治疗的有效性。

公开(公告)号：US06865422B1

公开(公告)日：2005-03-08

申请号：US09964225

申请日：2001-09-25

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

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

IPC分类号： A61N1/08 ,  A61N1/365 ,  A61N1/37

CPC分类号： A61N1/3712 ,  A61N2001/083

摘要： An implantable cardiac stimulation device and method provide a histogram for storing the number of primary and backup stimulation pulses delivered at each amplitude setting, to monitor the performance of the automatic capture verification. The stimulation device delivers cardiac stimulation therapy in which a stimulation histogram advantageously stores the number of primary pulses delivered at each stimulation output, or range of outputs, and separately stores the number of high-energy backup stimulation pulses delivered. Knowing the historical frequency of the applied stimulation amplitudes is useful to a physician in selecting future stimulation pulse output settings and the working margin. This information is also useful in determining the expected remaining battery life. The stimulation histogram further provides a useful diagnostic tool for evaluating the integrity of the stimulation device, lead system and performance of the automatic capture algorithm.

摘要翻译： 可植入心脏刺激装置和方法提供用于存储在每个幅度设置下传送的主要和备用刺激脉冲的数量的直方图，以监测自动捕获验证的性能。 刺激装置提供心脏刺激治疗，其中刺激直方图有利地存储在每个刺激输出或输出范围处递送的主要脉冲的数量，并且单独存储递送的高能量备用刺激脉冲的数量。 知道施加的刺激振幅的历史频率对于医师选择未来刺激脉冲输出设置和工作余量是有用的。 此信息也可用于确定预期的剩余电池寿命。 刺激直方图还提供了一种有用的诊断工具，用于评估刺激装置的完整性，引导系统和自动捕获算法的性能。

公开(公告)号：US6128533A

公开(公告)日：2000-10-03

申请号：US273403

申请日：1999-03-22

申请人： Joseph J. Florio ,  Gregory Hauck

发明人： Joseph J. Florio ,  Gregory Hauck

IPC分类号： A61N1/362 ,  A61N1/368

CPC分类号： A61N1/368 ,  A61N1/3622

摘要： An implantable dual-chamber pacemaker programmed to operate primarily in an atrial tracking mode includes an atrial rate smoothing filter for producing a filtered atrial rate (FAR) from an intrinsic atrial rate. The pacemaker automatically switches its mode of operation from an atrial tracking mode (i.e., DDD, DDDR, VDD, VDDR, DDT or DDTR) to a non-atrial tracking mode (i.e., DDI, DDIR, VDI, VDIR, DDT or DDTR), in the event the filtered atrial rate exceeds a prescribed upper rate limit. Synchronously with this mode switch, the pacemaker automatically shortens a post ventricular atrial refractory period (PVARP) to a minimum, predefined or programmable value. In one embodiment, the shortened PVARP is set equal to a post ventricular atrial blanking period (PVAB) that ranges between approximately 50 msec and 200 msec. While in the alternate mode of operation, the pacemaker maintains the shortened PVARB refractory period, and continues to monitor the FAR. As soon as FAR drops to a preset value or below, the pacemaker automatically switches back to its primary atrial tracking mode.

摘要翻译： 被编程为主要在心房跟踪模式下操作的可植入双室心脏起搏器包括用于从固有心房率产生过滤心房率（FAR）的心房速率平滑滤波器。 起搏器自动将其操作模式从心房跟踪模式（即DDD，DDDR，VDD，VDDR，DDT或DDTR）切换到非心房跟踪模式（即DDI，DDIR，VDI，VDIR，DDT或DDTR） 在过滤的心率超过规定的上限速率的情况下。 与此模式开关同步，起搏器自动将心室心房不应期（PVARP）缩短至最小预定值或可编程值。 在一个实施方案中，将缩短的PVARP设定为等于约50毫秒和200毫秒之间的心室后消融期（PVAB）。 在替代手术方式下，起搏器维持缩短的PVARB不应期，并继续监测FAR。 一旦FAR下降到预设值或更低，起搏器自动切换回主要心房跟踪模式。

公开(公告)号：US5833623A

公开(公告)日：1998-11-10

申请号：US851059

申请日：1997-05-05

申请人： Brian M. Mann ,  Joseph J. Florio ,  Jason A. Sholder ,  Leslie S. Miller ,  Jeffery D. Snell ,  Kenneth Valikai ,  Gregory Bevan ,  J. Kelly Fox ,  Azita M. Rahbari ,  Allan R. Schwartz

发明人： Brian M. Mann ,  Joseph J. Florio ,  Jason A. Sholder ,  Leslie S. Miller ,  Jeffery D. Snell ,  Kenneth Valikai ,  Gregory Bevan ,  J. Kelly Fox ,  Azita M. Rahbari ,  Allan R. Schwartz

IPC分类号： A61B5/00 ,  A61B5/044 ,  A61N1/37

CPC分类号： G06F19/345 ,  A61B5/0031 ,  A61B5/044 ,  A61N1/3702 ,  G06F19/3406 ,  G06F19/3487

摘要： An implantable device programmer includes a variety of features for allowing a clinician to perform an automated and customized follow-up examination of a patient having an implanted cardiac implantable device, the implantable device being of the type which captures and stores various types of diagnostic data for subsequent retrieval and evaluation. A custom protocol feature of the programmer allows the clinician pre-specify and then semi-automatically follow an ordered sequence of protocol steps, each protocol step involving the interrogation of the implantable device and the display by the programmer of associated implantable device data (such as a heart rate histogram, or the results of a ventricular capture test). When the clinician initiates a custom protocol, the programmer automatically retrieves all of the diagnostic data records of the protocol in the protocol order. This automatic retrieval is performed in the background, allowing the clinician to begin viewing the initial diagnostic data records of the protocol while the other items are being retrieved. Via a user interface of the programmer, the clinician can rapidly and efficiently sequence through the data display screens associated with the protocol, to thereby view the various diagnostic data records and/or perform the various diagnostic tests of the protocol.

摘要翻译： 可植入装置编程器包括各种特征，用于允许临床医生对具有植入的心脏可植入装置的患者执行自动和定制的随访检查，该可植入装置是捕获和存储各种类型的诊断数据的类型， 后续检索和评估。 编程器的定制协议特征允许临床医生预先指定然后半自动遵循协议步骤的有序序列，每个协议步骤涉及可植入装置的询问以及程序员对相关的可植入装置数据的显示（例如 心率直方图或心室捕获测试的结果）。 当临床医生启动自定义协议时，程序员将以协议顺序自动检索协议的所有诊断数据记录。 这种自动检索在后台执行，允许临床医生在检索其他项目时开始查看协议的初始诊断数据记录。 通过程序员的用户界面，临床医生可以快速有效地顺序通过与协议相关联的数据显示屏幕，从而查看各种诊断数据记录和/或执行协议的各种诊断测试。

公开(公告)号：US4856523A

公开(公告)日：1989-08-15

申请号：US107063

申请日：1987-10-08

申请人： Jason A. Sholder ,  Brian M. Mann ,  Joseph J. Florio

发明人： Jason A. Sholder ,  Brian M. Mann ,  Joseph J. Florio

IPC分类号： A61N1/362 ,  A61N1/365

CPC分类号： A61N1/3622 ,  A61N1/365 ,  A61N1/36514

摘要： In a first embodiment, hysteresis is provided in a rate-responsive pacemaker to allow for natural AV synchrony when possible. In the absence of natural SA node signals, the heart is stimulated at a rate determined by the sensing of physiological need. When a natural heart signal is detected, the hysteresis is activated to extend the escape interval by a predetermined amount which is related to the sensed physiological need. The stimulating pulses are inhibited as long as normal heart activity is sensed. The extension of the escape interval under such conditions eliminates possible competition between normal activity and the paced stimulation. In a second embodiment automatic mode switching is provided in a dual chamber pacemaker to allow for more efficient operation at higher heart rates. When the heart rate (natural or paced) exceeds a prescribed level, such as 90 beats per minute, the pacemaker operates in a single chamber mode, such as VVI.

摘要翻译： 在第一实施例中，在速率响应起搏器中提供迟滞以允许在可能时进行自然AV同步。 在没有自然SA节点信号的情况下，心脏以通过感觉生理需要确定的速率被刺激。 当检测到自然心脏信号时，启动迟滞以将逃逸间隔延长与感测到的生理需要相关的预定量。 只要感测到正常的心脏活动，刺激脉冲就被抑制。 在这种条件下，逃生间隔的延伸消除了正常活动和起搏刺激之间的可能竞争。 在第二实施例中，在双室起搏器中提供自动模式切换以允许在较高心率下更有效的操作。 当心率（自然或起搏）超过规定水平时，例如每分钟90次，心脏起搏器在单室模式下操作，例如VVI。

公开(公告)号：US07092755B2

公开(公告)日：2006-08-15

申请号：US10392128

申请日：2003-03-18

申请人： Joseph J. Florio

发明人： Joseph J. Florio

IPC分类号： A61N1/36

CPC分类号： A61N1/36514 ,  A61N1/3601 ,  A61N1/3682

摘要： An exemplary method for treating sleep apnea is described that includes determining parameters for a cardiac pacing pulse based, at least in part, on information characteristic of sleep apnea, wherein the cardiac pacing pulse aims to create a hemodynamic imbalance. An exemplary implantable cardiac device is programmable to perform such an exemplary method. Other exemplary methods, devices, and/or media are also disclosed.

摘要翻译： 描述了治疗睡眠呼吸暂停的示例性方法，其包括至少部分地基于睡眠呼吸暂停的信息特征确定心脏起搏脉冲的参数，其中心脏起搏脉冲旨在产生血流动力学不平衡。 示例性可植入心脏装置可编程以执行这种示例性方法。 还公开了其它示例性方法，设备和/或介质。

公开(公告)号：US06912418B1

公开(公告)日：2005-06-28

申请号：US10213569

申请日：2002-08-06

申请人： Joseph J. Florio

发明人： Joseph J. Florio

IPC分类号： A61B5/0452 ,  A61N1/362 ,  A61N1/39 ,  A61N1/368

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

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：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。