公开(公告)号：US06622045B2

公开(公告)日：2003-09-16

申请号：US09823374

申请日：2001-03-29

申请人： Jeffery D. Snell ,  John W. Poore ,  Jason A. Sholder

发明人： Jeffery D. Snell ,  John W. Poore ,  Jason A. Sholder

IPC分类号： A61N108

CPC分类号： A61N1/37282

摘要： To permit remote programming of implantable cardiac stimulation devices such as pacemakers, a central device programmer is provided in conjunction with a network of remote telemetry units for use in patient homes or in remote clinics. To reprogram a device implanted within a patient, a physician enters programming commands within the central programmer which relays the programming commands to a remote telemetry unit in proximity to the patient. The remote telemetry unit, in turn, forwards the programming commands to the implanted device. In this manner, the patient need not return to the physician for reprogramming of the device. Remote telemetry units may be provided within patient homes, clinics, hospital emergency rooms, hospital patient rooms, and the like. Depending upon the implementation, different levels of programmability may be permitted depending upon the degree of supervision of the patient. For an unsupervised patient, limited programmability is permitted. For a nurse-supervised patient, a greater degree of programmability is permitted. Finally, for a physician-supervised patient, a full range of programmability is permitted. In a specific example described herein, each remote telemetry unit includes minimal hardware and software components necessary to relay programming commands, diagnostic information, and other signals between the central programmer and the implanted device.

公开(公告)号：US6058328A

公开(公告)日：2000-05-02

申请号：US788152

申请日：1997-01-24

申请人： Paul A. Levine ,  Jason A. Sholder ,  Gene A. Bornzin ,  Joseph J. Florio ,  Kenneth Valikai ,  Lisa P. Weinberg

发明人： Paul A. Levine ,  Jason A. Sholder ,  Gene A. Bornzin ,  Joseph J. Florio ,  Kenneth Valikai ,  Lisa P. Weinberg

IPC分类号： A61N1/362 ,  A61N1/365 ,  A61N1/39

CPC分类号： A61N1/3956 ,  A61N1/3622 ,  A61N1/36585 ,  A61N1/3688

摘要： Preemptive tachyarrhythmia pacing is provided in an implantable cardiac-stimulation device, such as an implantable pacemaker or defibrillator, by modifying the operation of the implantable device in a way that minimizes the likelihood of occurrence of a tachyarrhythmia. The behavior modification is achieved through the use of an appropriate preemptive tachyarrhythmia pacing control routine stored within the memory of the device. Depending upon the needs of the patient, preemptive tachyarrhythmia pacing is invoked continuously or on demand. If invoked on demand, Preemptive tachyarrhythmia pacing is triggered only upon the sensing of one or more conditions suggest that the onset of a tachyarrhythmia is imminent. When thus invoked, preemptive tachyarrhythmia pacing remains invoked only for as long as the onset-of-a-tachyarrhythmia-is-imminent conditions persist. Various preemptive tachyarrhythmia pacing control routines are contemplated, including those based on overdrive pacing, pacing with randomicity, and mode switching. Overdrive pacing, when used, is based on an automatically-determined diurnal rate, an automatic stepped increase over the average atrial rate, or a rate set by a cycle-to-cycle negative hysteresis. Conditions which suggest the imminency of the onset of a tachyarrhythmia include, but are not limited to, a sudden change in the patient's cardiac cycle from a previously-determined normal cardiac cycle.

摘要翻译： 通过以最小化发生快速性心律失常的可能性的方式修改可植入装置的操作，在可植入心脏刺激装置（例如可植入起搏器或除颤器）中提供先发性快速性心律失调起搏。 通过使用存储在设备的存储器内的适当的先发性快速性心律失常起搏控制程序来实现行为修改。 根据患者的需要，可以连续或按需调用抢先式快速性心律失调起搏。 如果按需调用，先发性快速性心律失常起搏仅在感觉到一种或多种情况时才触发，表明快速性心律失常的发作即将到来。 当这样被援引时，只有在发生急性心律失常即将到来的情况持续存在的情况下，抢救性快速性心律失调起搏仍然被援引。 预期各种先发性快速性心律失常起搏控制程序，包括基于超速起搏，起搏随机性和模式切换的那些。 超速起搏在使用时，基于自动确定的昼夜速率，比平均心房率自动逐步增加，或由周期到周期的负滞后设定的速率。 表明快速性心律失常发作即将发生的情况包括但不限于患者心动周期从先前确定的正常心动周期的突然变化。

公开(公告)号：US5509927A

公开(公告)日：1996-04-23

申请号：US381799

申请日：1995-02-01

申请人： Andrew E. Epstein ,  James L. Duncan ,  Paul A. Levine ,  Jason A. Sholder

发明人： Andrew E. Epstein ,  James L. Duncan ,  Paul A. Levine ,  Jason A. Sholder

IPC分类号： A61N1/365 ,  A61N1/372 ,  A61N1/37

CPC分类号： A61N1/37235 ,  G06F19/3406 ,  A61N1/37252

摘要： A programming system is provided that allows a physician or medical personnel to optimize the settings of various arrhythmia detection criteria and/or parameters related to hemodynamic performance to be programmed into the implanted cardiac stimulating device. The cardiac stimulating device may be a pacemaker or cardioverter/defibrillator that detects heart arrhythmias by using various arrhythmia detection criteria. The cardiac stimulating device is capable of recording the patient's cardiac signals and/or sensor data. The programming system may play back the recorded signals to test the detection criteria and hemodynamic performance and may simulate the response of the device to the cardiac signal. Alternatively, the programming system may play back an artificially created or previously stored cardiac signal for test purposes. As a result, the recorded signal may be played back repeatedly without unnecessarily stressing the patient's heart. Additionally, the programmer may suggest specific arrhythmia detection criteria and therapies to a physician based on an analysis of a patient's arrhythmia.

公开(公告)号：US5476487A

公开(公告)日：1995-12-19

申请号：US365278

申请日：1994-12-28

申请人： Jason A. Sholder

发明人： Jason A. Sholder

IPC分类号： A61N1/37

CPC分类号： A61N1/3712

摘要： Capture is assessed in an implantable pacemaker by issuing a pair of stimulation pulses, separated by about 60-100 milliseconds. The second pulse of the stimulation pair is set to an energy level that assures capture, and remains at that level. The first pulse of the stimulation pair is initially set to an energy level that assures capture, and its energy level is thereafter systematically decreased, e.g., its amplitude is decreased, by a set amount each time the pair of stimulation pulses is issued. One of the stimulation pulses of the stimulation pair will always cause capture: the first pulse when its energy level is greater than the capture threshold (in which case the second pulse is issued into refractory cardiac tissue and has no effect); or the second pulse, when the energy of the first pulse drops below the capture threshold. In either event, a T-wave follows the capturing pulse, whether the first or the second, evidencing repolarization of the cardiac tissue. Capture is assessed by measuring the time interval between a fixed reference point associated with the stimulation pair, e.g., the first pulse, and the T-wave. A significant change in this time interval, e.g., of approximately 60- 100 milliseconds, indicates that the first pulse has dropped below the capture threshold.

摘要翻译： 通过发出一对分开约60-100毫秒的刺激脉冲，在植入式起搏器中评估捕获。 刺激对的第二个脉冲被设置为确保捕获的能量水平，并保持在该水平。 刺激对的第一脉冲最初被设置为确保捕获的能量水平，并且此后其能量水平在每次发出一对刺激脉冲时被系统地减小，例如其幅度减小设定量。 刺激对的刺激脉冲之一将总是引起捕获：第一脉冲当其能量水平大于捕获阈值（在这种情况下，第二脉冲被发射到难治性心脏组织中并且没有作用）; 或第二脉冲，当第一脉冲的能量下降到捕获阈值以下时。 在任一情况下，T波跟随捕获脉冲，无论是第一还是第二，证明心脏组织的复极化。 通过测量与刺激对相关联的固定参考点（例如第一脉冲）和T波之间的时间间隔来评估捕获。 该时间间隔的显着变化，例如大约60-100毫秒，表明第一脉冲已经降到捕获阈值以下。

公开(公告)号：US4989602A

公开(公告)日：1991-02-05

申请号：US336996

申请日：1989-04-12

申请人： Jason A. Sholder ,  Brian M. Mann

发明人： Jason A. Sholder ,  Brian M. Mann

IPC分类号： A61N1/362 ,  A61N1/365 ,  A61N1/39

CPC分类号： A61N1/3962 ,  A61N1/3621 ,  A61N1/365 ,  A61N1/3987

摘要： A non-programmable automatic implantable cardioverter/defibrillator (AICD) capable of providing programmable thresholds for triggering high energy stimulation pulse(s) from the AICD is coupled to an implantable programmable pacemaker which preferably includes bradycardia support and/or tachycardia support using low enery output pulses. When the low energy antitachycardia pulse(s) from the pacemaker fail to terminate a tachycardia, or whenever other various thresholds, as sensed by programmable sensing circuits of the pacemaker, are exceeded, the high enery pulses from the AICD may be selectively invoked by an AICD trigger circuit included within the pacemaker. Coupling between the AICD and pacemaker is by either a direct electrical connection, or by an indirect connection, such as through the use of narrow pulse sequences generated by the pacemaker which are of insufficient energy to invoke a cardiac response but are of sufficient energy to be sensed by the AICD sensing circuits.

摘要翻译： 能够提供用于从AICD触发高能量刺激脉冲的可编程阈值的非可编程自动植入式心律转复除颤器（AICD）被耦合到可植入式可编程起搏器，其优选地包括使用低功率输出的心动过缓支持和/或心动过速支持 脉冲。 当来自起搏器的低能量抗心动过速脉冲不能终止心动过速时，或者当超过起搏器的可编程感测电路所检测到的其它各种阈值时，来自AICD的高功率脉冲可以被选择性地由 AICD触发电路包括起搏器内。 AICD和起搏器之间的耦合是通过直接电连接或通过间接连接，例如通过使用由起搏器产生的窄脉冲序列，其不足以调用心脏反应，但具有足够的能量 由AICD感测电路感测。

公开(公告)号：US20150228176A1

公开(公告)日：2015-08-13

申请号：US14691717

申请日：2015-04-21

申请人： Jason A. Sholder

发明人： Jason A. Sholder

IPC分类号： G08B21/02 ,  A61B5/044 ,  A61B5/0432 ,  A61B5/11 ,  A61B5/0408 ,  A61B5/00

CPC分类号： G08B21/0211 ,  A61B5/0006 ,  A61B5/0022 ,  A61B5/0404 ,  A61B5/04085 ,  A61B5/0432 ,  A61B5/044 ,  A61B5/1112 ,  A61B5/1117 ,  A61B5/6843 ,  A61B5/6898 ,  A61B5/7415 ,  A61B5/746 ,  A61B5/747 ,  A61B5/7475 ,  A61B2560/0468 ,  A61B2562/0219 ,  G06F19/00 ,  G08B21/02 ,  G08B21/0269 ,  G08B21/0283 ,  G08B21/043 ,  G08B21/0446 ,  G08B25/001 ,  G08B25/016 ,  G16H40/67

摘要： The invention provides personal emergency response systems (PERS) with expanded life-saving capabilities. One embodiment of the invention provides a wearable PERS pendant that incorporates a cell phone transmitter or transceiver, a GPS location system, an accelerometer-based fall detector that automatically triggers an alert, and an electrocardiogram (ECG) recorder permitting a remote service center or medical personnel to receive and respond to transmitted alerts and electrocardiographic data.

摘要翻译： 本发明提供具有延长救生能力的个人应急系统（PERS）。 本发明的一个实施例提供了一种可佩戴的PERS吊坠，其包括手机发射器或收发器，GPS定位系统，自动触发警报的基于加速度计的跌倒检测器和允许远程服务中心或医疗的心电图（ECG）记录器 人员接收和响应传输的警报和心电图数据。

公开(公告)号：US06782291B1

公开(公告)日：2004-08-24

申请号：US09655438

申请日：2000-09-05

申请人： Gene A. Bornzin ,  Joseph J. Florio ,  Laurence S. Sloman ,  Brian M. Mann ,  Jason A. Sholder

发明人： Gene A. Bornzin ,  Joseph J. Florio ,  Laurence S. Sloman ,  Brian M. Mann ,  Jason A. Sholder

IPC分类号： A61N1372

CPC分类号： A61N1/3686 ,  A61N1/36185 ,  A61N1/371

摘要： An implantable cardiac stimulation device applies pacing stimulation pulses to a heart and senses evoked responses to the pacing stimulation pulses. A pulse generator applies the stimulation pacing pulses to the heart in accordance with a pacing configuration. A sensor control selects an evoked response sensing electrode configuration from among a plurality of evoked response sensing electrode configurations in response to the pacing configuration. A sensor is then programmed to sense the evoked responses with the selected evoked response sensing electrode configuration. In accordance with a preferred embodiment, signal-to-noise ratios obtained with the various electrode configurations are used to select a best electrode configuration for sensing evoked responses.

摘要翻译： 可植入心脏刺激装置将起搏刺激脉冲应用于心脏并感测对起搏刺激脉冲的诱发反应。 脉冲发生器根据起搏配置将刺激起搏脉冲施加到心脏。 传感器控制器响应于起搏配置从多个诱发响应感测电极配置中选择诱发响应感测电极配置。 然后将传感器编程为用所选择的诱发响应感测电极配置感测诱发的反应。 根据优选实施例，用各种电极配置获得的信噪比用于选择用于感测诱发响应的最佳电极配置。

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：US06295471B1

公开(公告)日：2001-09-25

申请号：US09481748

申请日：2000-01-11

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 for 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 an 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用于自动检测心房捕获并执行心房起搏阈值评估的新型检测方案。 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：US06269264B1

公开(公告)日：2001-07-31

申请号：US09325312

申请日：1999-06-03

申请人： Robert R. Weyant ,  Jason A. Sholder ,  Euljoon Park ,  Gene A. Bornzin ,  Joseph J. Florio ,  Said Mortazavi

发明人： Robert R. Weyant ,  Jason A. Sholder ,  Euljoon Park ,  Gene A. Bornzin ,  Joseph J. Florio ,  Said Mortazavi

IPC分类号： A61B505

CPC分类号： A61N1/36521

摘要： Methods and apparatus are provided for measuring the impedance of a patient's body. Pulse generating circuitry within a rate-responsive pacemaker is used to generate an impedance measurement signal that is applied to the body of the patient with conventional pacemaker leads. The impedance measurement signal contains a series of multiphasic impedance measurement waveforms, which have no net DC value and zero value after second integration. The impedance measurement signal allows the impedance of the body to be measured without interfering with external cardiac monitoring equipment such as electrocardiogram machines.

摘要翻译： 提供了用于测量患者身体阻抗的方法和装置。 速率响应起搏器内的脉冲发生电路用于产生用常规起搏器引线施加到患者身体的阻抗测量信号。 阻抗测量信号包含一系列多相阻抗测量波形，其在第二次积分后不具有净DC值和零值。 阻抗测量信号允许测量身体的阻抗，而不会干扰外部心脏监测设备，如心电图仪。