公开(公告)号：US09042982B2

公开(公告)日：2015-05-26

申请号：US13400381

申请日：2012-02-20

申请人： John E. Burnes ,  Yong K. Cho ,  David Igel ,  Luc R. Mongeon ,  John C. Rueter ,  Harry Stone ,  Jodi Zilinski

发明人： John E. Burnes ,  Yong K. Cho ,  David Igel ,  Luc R. Mongeon ,  John C. Rueter ,  Harry Stone ,  Jodi Zilinski

IPC分类号： A61N1/00 ,  A61N1/362 ,  A61N1/365 ,  A61N1/368

CPC分类号： A61N1/3627 ,  A61N1/36521 ,  A61N1/3682 ,  A61N1/3684

摘要： Methods and devices for determining optimal Atrial to Ventricular (AV) pacing intervals and Ventricular to Ventricular (VV) delay intervals in order to optimize cardiac output. Impedance, preferably sub-threshold impedance, is measured across the heart at selected cardiac cycle times as a measure of chamber expansion or contraction. One embodiment measures impedance over a long AV interval to obtain the minimum impedance, indicative of maximum ventricular expansion, in order to set the AV interval. Another embodiment measures impedance change over a cycle and varies the AV pace interval in a binary search to converge on the AV interval causing maximum impedance change indicative of maximum ventricular output. Another method varies the right ventricle to left ventricle (VV) interval to converge on an impedance maximum indicative of minimum cardiac volume at end systole. Another embodiment varies the VV interval to maximize impedance change.

公开(公告)号：US20120150253A1

公开(公告)日：2012-06-14

申请号：US13400381

申请日：2012-02-20

申请人： John E. Burnes ,  Yong K. Cho ,  David Igel ,  Luc R. Mongeon ,  John C. Rueter ,  Harry Stone ,  Jodi Zilinski

发明人： John E. Burnes ,  Yong K. Cho ,  David Igel ,  Luc R. Mongeon ,  John C. Rueter ,  Harry Stone ,  Jodi Zilinski

IPC分类号： A61N1/365

CPC分类号： A61N1/3627 ,  A61N1/36521 ,  A61N1/3682 ,  A61N1/3684

摘要： Methods and devices for determining optimal Atrial to Ventricular (AV) pacing intervals and Ventricular to Ventricular (VV) delay intervals in order to optimize cardiac output. Impedance, preferably sub-threshold impedance, is measured across the heart at selected cardiac cycle times as a measure of chamber expansion or contraction. One embodiment measures impedance over a long AV interval to obtain the minimum impedance, indicative of maximum ventricular expansion, in order to set the AV interval. Another embodiment measures impedance change over a cycle and varies the AV pace interval in a binary search to converge on the AV interval causing maximum impedance change indicative of maximum ventricular output. Another method varies the right ventricle to left ventricle (VV) interval to converge on an impedance maximum indicative of minimum cardiac volume at end systole. Another embodiment varies the VV interval to maximize impedance change.

摘要翻译： 用于确定最佳心房与心室（AV）起搏间隔和心室间室（VV）延迟间隔的方法和装置，以优化心输出量。 在选择的心脏周期时间内，跨心脏测量阻抗，优选亚阈值阻抗，作为腔室扩张或收缩的量度。 为了设定AV间隔，一个实施例测量长AV间隔上的阻抗以获得指示最大心室扩张的最小阻抗。 另一个实施例测量一个周期的阻抗变化，并且改变二进制搜索中的AV步速间隔以收敛于AV间隔，从而引起指示最大心室输出的最大阻抗变化。 另一种方法将右心室改变为左心室（VV）间隔，以收敛于指示最终心脏收缩最小心脏容积的阻抗最大值。 另一实施例改变VV间隔以最大化阻抗变化。

公开(公告)号：US08135463B2

公开(公告)日：2012-03-13

申请号：US11751250

申请日：2007-05-21

申请人： John E. Burnes ,  Yong K. Cho ,  David Igel ,  Luc R. Mongeon ,  John C. Rueter ,  Harry Stone ,  Jodi Zilinski

发明人： John E. Burnes ,  Yong K. Cho ,  David Igel ,  Luc R. Mongeon ,  John C. Rueter ,  Harry Stone ,  Jodi Zilinski

IPC分类号： A61N1/00

CPC分类号： A61N1/3627 ,  A61N1/36521 ,  A61N1/3682 ,  A61N1/3684

摘要： Methods and devices for determining optimal Atrial to Ventricular (AV) pacing intervals and Ventricular to Ventricular (VV) delay intervals in order to optimize cardiac output. Impedance, preferably sub-threshold impedance, is measured across the heart at selected cardiac cycle times as a measure of chamber expansion or contraction. One embodiment measures impedance over a long AV interval to obtain the minimum impedance, indicative of maximum ventricular expansion, in order to set the AV interval. Another embodiment measures impedance change over a cycle and varies the AV pace interval in a binary search to converge on the AV interval causing maximum impedance change indicative of maximum ventricular output. Another method varies the right ventricle to left ventricle (VV) interval to converge on an impedance maximum indicative of minimum cardiac volume at end systole. Another embodiment varies the VV interval to maximize impedance change.

摘要翻译： 用于确定最佳心房与心室（AV）起搏间隔和心室间室（VV）延迟间隔的方法和装置，以优化心输出量。 在选择的心脏周期时间内，跨心脏测量阻抗，优选亚阈值阻抗，作为腔室扩张或收缩的量度。 为了设定AV间隔，一个实施例测量长AV间隔上的阻抗以获得指示最大心室扩张的最小阻抗。 另一个实施例测量一个周期的阻抗变化，并且改变二进制搜索中的AV步速间隔以收敛于AV间隔，从而引起指示最大心室输出的最大阻抗变化。 另一种方法将右心室改变为左心室（VV）间隔，以收敛于指示最终心脏收缩最小心脏容积的阻抗最大值。 另一实施例改变VV间隔以最大化阻抗变化。

公开(公告)号：US20060167359A1

公开(公告)日：2006-07-27

申请号：US11044617

申请日：2005-01-27

申请人： Tommy Bennett ,  Mark Choi ,  David Igel ,  Michael Hill ,  Teresa Whitman ,  Douglas Hettrick

发明人： Tommy Bennett ,  Mark Choi ,  David Igel ,  Michael Hill ,  Teresa Whitman ,  Douglas Hettrick

IPC分类号： A61B5/02

CPC分类号： A61B5/0215 ,  A61B5/02028 ,  A61B5/02108 ,  A61B5/042 ,  A61B5/0456 ,  A61N1/36564

摘要： A cardiovascular analysis system and method includes an implantable medical device with a sensor positioned to sense a hemodynamic pressure over time. The implantable medical device generates hemodynamic pressure waveform data based upon the hemodynamic pressure sensed. A processor analyzes the hemodynamic waveform data to provide an indication of cardiovascular health based upon prominent peaks in the hemodynamic waveform data.

摘要翻译： 心血管分析系统和方法包括具有传感器的可植入医疗装置，所述传感器定位成随时间感测血流动力学压力。 可植入医疗装置基于感测的血流动力学压力产生血流动力学压力波形数据。 处理器分析血液动力学波形数据，以基于血流动力学波形数据中突出的峰值提供心血管健康的指示。

公开(公告)号：US20060167360A1

公开(公告)日：2006-07-27

申请号：US11044618

申请日：2005-01-27

申请人： Tommy Bennett ,  Mark Choi ,  David Igel ,  Michael Hill ,  Teresa Whitman

发明人： Tommy Bennett ,  Mark Choi ,  David Igel ,  Michael Hill ,  Teresa Whitman

IPC分类号： A61B5/02

CPC分类号： A61B5/0215 ,  A61B5/02108

摘要： A system and method for cardiovascular analysis includes an implantable medical device capable of generating hemodynamic pressure waveform data based upon sensed pressure. Hemodynamic waveform data is analyzed to identify artifactual data represented in the hemodynamic waveform.

摘要翻译： 用于心血管分析的系统和方法包括能够基于检测到的压力产生血流动力压力波形数据的可植入医疗装置。 分析血流动力学波形数据以识别在血流动力学波形中表示的人为因素数据。

公开(公告)号：US07228174B2

公开(公告)日：2007-06-05

申请号：US10135912

申请日：2002-04-29

申请人： John E. Burnes ,  Yong K. Cho ,  David Igel ,  Luc R. Mongeon ,  John C. Rueter ,  Harry Stone ,  Jodi Zilinski

发明人： John E. Burnes ,  Yong K. Cho ,  David Igel ,  Luc R. Mongeon ,  John C. Rueter ,  Harry Stone ,  Jodi Zilinski

IPC分类号： A61N1/362

CPC分类号： A61N1/3627 ,  A61N1/36521 ,  A61N1/3682 ,  A61N1/3684

摘要： Methods and devices for determining optimal Atrial to Ventricular (AV) pacing intervals and Ventricular to Ventricular (VV) delay intervals in order to optimize cardiac output. Impedance, preferably sub-threshold impedance, is measured across the heart at selected cardiac cycle times as a measure of chamber expansion or contraction. One embodiment measures impedance over a long AV interval to obtain the minimum impedance, indicative of maximum ventricular expansion, in order to set the AV interval. Another embodiment measures impedance change over a cycle and varies the AV pace interval in a binary search to converge on the AV interval causing maximum impedance change indicative of maximum ventricular output. Another method varies the right ventricle to left ventricle (VV) interval to converge on an impedance maximum indicative of minimum cardiac volume at end systole. Another embodiment varies the VV interval to maximize impedance change.

摘要翻译： 用于确定最佳心房与心室（AV）起搏间隔和心室间室（VV）延迟间隔的方法和装置，以优化心输出量。 在选择的心脏周期时间内，跨心脏测量阻抗，优选亚阈值阻抗，作为腔室扩张或收缩的量度。 为了设定AV间隔，一个实施例测量长AV间隔上的阻抗以获得指示最大心室扩张的最小阻抗。 另一个实施例测量一个周期的阻抗变化，并且改变二进制搜索中的AV步速间隔以收敛于AV间隔，从而引起指示最大心室输出的最大阻抗变化。 另一种方法将右心室改变为左心室（VV）间隔，以收敛于指示最终心脏收缩最小心脏容积的阻抗最大值。 另一实施例改变VV间隔以最大化阻抗变化。

公开(公告)号：US20060271117A1

公开(公告)日：2006-11-30

申请号：US11135921

申请日：2005-05-24

申请人： John Burnes ,  David Igel ,  John Rueter ,  Yong Cho ,  Luc Mongeon ,  Harold Stone ,  Jodi Zilinski

发明人： John Burnes ,  David Igel ,  John Rueter ,  Yong Cho ,  Luc Mongeon ,  Harold Stone ,  Jodi Zilinski

IPC分类号： A61N1/362

CPC分类号： A61N1/36521

摘要： Impedance, e.g. sub-threshold impedance, is measured across the heart at selected cardiac cycle times as a measure of chamber expansion or contraction. One embodiment measures impedance over a long AV interval to obtain the minimum impedance, indicative of maximum ventricular expansion, in order to set the AV interval. Another embodiment measures impedance change over a cycle and varies the AV pace interval in a binary search to converge on the AV interval causing maximum impedance change indicative of maximum ventricular output. Another method varies the right ventricle to left ventricle (VV) interval to converge on an impedance maximum indicative of minimum cardiac volume at end systole. Another embodiment varies the VV interval to maximize impedance change. Other methods vary the AA interval to maximize impedance change over the entire cardiac cycle or during the atrial cycle.

摘要翻译： 阻抗，例如 亚阈值阻抗是在选定心脏周期时间内心脏测量的，作为腔室扩张或收缩的量度。 为了设定AV间隔，一个实施例测量长AV间隔上的阻抗以获得指示最大心室扩张的最小阻抗。 另一个实施例测量一个周期的阻抗变化，并且改变二进制搜索中的AV步速间隔以收敛于AV间隔，从而引起指示最大心室输出的最大阻抗变化。 另一种方法将右心室改变为左心室（VV）间隔，以收敛于指示最终心脏收缩最小心脏容积的阻抗最大值。 另一实施例改变VV间隔以最大化阻抗变化。 其他方法改变AA间隔以最大化整个心动周期或心房周期期间的阻抗变化。

公开(公告)号：US20070299477A1

公开(公告)日：2007-12-27

申请号：US11765260

申请日：2007-06-19

申请人： Karen Kleckner ,  Kathleen Prieve ,  Jeffrey Gillberg ,  Ren Zhou ,  Kenneth Anderson ,  D. Deno ,  Glenn Zillmer ,  Ruth Klepfer ,  Vincent Splett ,  David Euler ,  Lawrence Mulligan ,  Edwin Duffin ,  David Igel ,  John Burnes

发明人： Karen Kleckner ,  Kathleen Prieve ,  Jeffrey Gillberg ,  Ren Zhou ,  Kenneth Anderson ,  D. Deno ,  Glenn Zillmer ,  Ruth Klepfer ,  Vincent Splett ,  David Euler ,  Lawrence Mulligan ,  Edwin Duffin ,  David Igel ,  John Burnes

IPC分类号： A61N1/36

CPC分类号： A61N1/3627 ,  A61N1/36114 ,  A61N1/36521 ,  A61N1/36564 ,  A61N1/36578 ,  A61N1/36585 ,  A61N1/3684 ,  A61N1/3962

摘要： The above-described methods and apparatus are believed to be of particular benefit for patients suffering heart failure including cardiac dysfunction, chronic HF, and the like and all variants as described herein and including those known to those of skill in the art to which the invention is directed. It will understood that the present invention offers the possibility of monitoring and therapy of a wide variety of acute and chronic cardiac dysfunctions. The current invention provides systems and methods for delivering therapy for cardiac hemodynamic dysfunction via the innervated myocardial substrate receives one or more discrete pulses of electrical stimulation during the refractory period of said innervated myocardial substrate.

摘要翻译： 据信上述方法和装置对患有心力衰竭，包括心脏功能障碍，慢性HF等的患者以及本文所述的所有变体以及包括本发明的本领域技术人员已知的那些的患者特别有益 被指示。 应当理解，本发明提供监测和治疗各种急性和慢性心脏功能障碍的可能性。 本发明提供了用于通过所述神经支配的心肌底物递送治疗心脏血液动力学功能障碍的系统和方法，在所述神经支配的心肌基质的不应期期间接收电刺激的一个或多个离散脉冲。

公开(公告)号：US20070213778A1

公开(公告)日：2007-09-13

申请号：US11751250

申请日：2007-05-21

申请人： John Burnes ,  Yong Cho ,  David Igel ,  Luc Mongeon ,  John Rueter ,  Harry Stone ,  Jody Zilinski

发明人： John Burnes ,  Yong Cho ,  David Igel ,  Luc Mongeon ,  John Rueter ,  Harry Stone ,  Jody Zilinski

IPC分类号： A61N1/05

CPC分类号： A61N1/3627 ,  A61N1/36521 ,  A61N1/3682 ,  A61N1/3684

摘要： Methods and devices for determining optimal Atrial to Ventricular (AV) pacing intervals and Ventricular to Ventricular (VV) delay intervals in order to optimize cardiac output. Impedance, preferably sub-threshold impedance, is measured across the heart at selected cardiac cycle times as a measure of chamber expansion or contraction. One embodiment measures impedance over a long AV interval to obtain the minimum impedance, indicative of maximum ventricular expansion, in order to set the AV interval. Another embodiment measures impedance change over a cycle and varies the AV pace interval in a binary search to converge on the AV interval causing maximum impedance change indicative of maximum ventricular output. Another method varies the right ventricle to left ventricle (VV) interval to converge on an impedance maximum indicative of minimum cardiac volume at end systole. Another embodiment varies the VV interval to maximize impedance change.

摘要翻译： 用于确定最佳心房与心室（AV）起搏间隔和心室间室（VV）延迟间隔的方法和装置，以优化心输出量。 在选择的心脏周期时间内，跨心脏测量阻抗，优选亚阈值阻抗，作为腔室扩张或收缩的量度。 为了设定AV间隔，一个实施例测量长AV间隔上的阻抗以获得指示最大心室扩张的最小阻抗。 另一个实施例测量一个周期的阻抗变化，并且改变二进制搜索中的AV步速间隔以收敛于AV间隔，从而引起指示最大心室输出的最大阻抗变化。 另一种方法将右心室改变为左心室（VV）间隔，以收敛于指示最终心脏收缩最小心脏容积的阻抗最大值。 另一实施例改变VV间隔以最大化阻抗变化。

公开(公告)号：US20050038479A1

公开(公告)日：2005-02-17

申请号：US10638855

申请日：2003-08-11

申请人： D. Deno ,  David Euler ,  Lawrence Mulligan ,  Edwin Duffin ,  David Igel

发明人： D. Deno ,  David Euler ,  Lawrence Mulligan ,  Edwin Duffin ,  David Igel

IPC分类号： A61N1/362 ,  A61N1/365 ,  A61N1/368

CPC分类号： A61N1/36514 ,  A61N1/3627 ,  A61N1/36564 ,  A61N1/368

摘要： A medical device, e.g., an implantable medical device, delivers one or more neurally-excitable stimulation pulses to myocardial tissue during a period when the tissue is refractory. The width of the pulses is less than or equal to approximately one half millisecond. In some embodiments, the current amplitude of the pulses is less than or equal to approximately twenty milliamps. In exemplary embodiments, the medical device delivers a pulse train of six or fewer pulses separated from each other by an interval that is greater than or equal to approximately ten milliseconds. In some embodiments, the medical device delivers pulses according to a schedule stored in a memory, or as a function of a monitored physiological parameter of a patient, such as an intracardiac pressure. In some embodiments, the medical device suspends or withholds delivery of neurally-excitable based on detection of cardiac ischemia.

摘要翻译： 医疗装置，例如可植入的医疗装置，在组织难治的时期期间，向心肌组织递送一个或多个神经可兴奋的刺激脉冲。 脉冲的宽度小于或等于大约一个半毫秒。 在一些实施例中，脉冲的电流幅度小于或等于大约二十毫安。 在示例性实施例中，医疗设备递送彼此间隔大于或等于大约十毫秒的六个或更少个脉冲的脉冲串。 在一些实施例中，医疗装置根据存储在存储器中的计划或者作为患者的被监测的生理参数（例如心脏内压力）递送脉冲。 在一些实施方案中，基于心脏缺血的检测，医疗装置暂停或禁止神经可兴奋的递送。