公开(公告)号：US5824019A

公开(公告)日：1998-10-20

申请号：US729465

申请日：1996-10-11

申请人： John C. Rueter ,  Catherine R. Condie

发明人： John C. Rueter ,  Catherine R. Condie

IPC分类号： A61N1/365 ,  A61N1/368

CPC分类号： A61N1/368 ,  A61N1/36521

摘要： There is provided an improved pacing system and method which monitors when the ventricle has become appropriately filled with blood and controls the delivery of each ventricular pace pulse to substantially coincide with desired ventricular filling, e.g., when the chamber has substantially filled. By this technique, the desired time for delivering the ventricular pace pulse is determined on a beat-by-beat basis, providing an improved physiologically optimum mode of pacing. The physiologically ventricular pacing technique of this invention is applicable either to a single chamber pacemaker, or to a dual chamber pacemaker, and in either case enables the important improvement of delivering the pace pulse at the most physiologically appropriate time. In a first embodiment, the moment when the ventricle has substantially filled with blood is determined by monitoring impedance variations which vary inversely with ventricular volume, such that filling of the ventricle corresponds to the time when the impedance waveform bottoms out, or reaches a minimum level. Other sensor arrangements which provide information as to the state of or rate of change of ventricular volume can likewise be used. The invention enables a single lead-single chamber pacemaker which achieves effective synchrony with atrial contractions, or a dual chamber pacemaker which does not require programming of an AV interval.

摘要翻译： 提供了一种改进的起搏系统和方法，其监测心室何时已经适当地充满血液，并且控制每个心室起搏脉冲的输送与期望的心室充盈基本一致，例如当腔基本上被填充时。 通过这种技术，用于递送心室起搏脉冲的期望时间是以逐拍为基础确定的，从而提供改善的生理上最佳的起搏模式。 本发明的生理心室起搏技术可应用于单室起搏器或双室心脏起搏器，并且在任一情况下都能够在最生理适当的时间提供步速脉冲的重要改进。 在第一实施例中，通过监测与心室容积成反比变化的阻抗变化来确定心室基本上充满血液的时刻，使得心室的填充对应于阻抗波形底部流出或达到最小水平的时间 。 同样可以使用提供关于心室容积的变化状态或速度变化信息的其它传感器装置。 本发明使得能够实现与心房收缩有效同步的单个单体室起搏器，或者不需要编程AV间隔的双室心脏起搏器。

公开(公告)号：US5601615A

公开(公告)日：1997-02-11

申请号：US291304

申请日：1994-08-16

申请人： H. T. Markowitz ,  John C. Stroebel ,  Ren Zhou ,  John C. Rueter

发明人： H. T. Markowitz ,  John C. Stroebel ,  Ren Zhou ,  John C. Rueter

IPC分类号： A61N1/368 ,  A61N1/37 ,  A61N1/372

CPC分类号： A61N1/3712 ,  A61N1/368 ,  A61N1/3714

摘要： Capture detection and stimulation threshold-measurement methods and apparatus for deriving atrial and ventricular pace pulse (A-pace and V-pace) stimulation energy strength-duration data. In a first atrial and ventricular threshold test regimen for use with patients having intact A-V conduction or first degree AV block, A-pace pulses are delivered at a test escape interval and A-V delay. Atrial loss of capture (ALOC) in response to an A-pace test stimulus is declared by the absence of a detected ventricular depolarization (V-event) in the latter portion of the paced A-V delay interval following the delivery of the A-pace test stimulus. In the ventricular threshold test regimen, a V-pace test stimulus is delivered after a shortened A-V delay. Ventricular loss of capture (VLOC) is declared by the detection of a V-event in the ventricular refractory period of the V-pace test stimulus. In a second algorithm for use in the atrium or ventricle in patients having regular measured sinus rhythm, premature A-pace or V-pace test stimuli are delivered, and the presence of an A-event or V-event at the end of the measured sinus escape interval is declared to be ALOC or VLOC, respectively. A-pace and V-pace test stimuli are repeated to confirm capture declarations at an energy exceeding the LOC test energy. The atrial and ventricular stimulation threshold data derived by varying both pulse amplitude (strength) and width (duration) is stored in memory for telemetry out and analysis and for use in setting the V-pace and A-pace normal pulse width and amplitude used between successive auto-capture tests in order to conserve battery energy.

摘要翻译： 捕获检测和刺激阈值测量方法和装置，用于导出心房和心室起搏脉冲（A步和V步）刺激能量强度持续时间数据。 在与具有完整的A-V传导或一级AV阻滞的患者一起使用的第一次心房和心室阈值测试方案中，A步脉冲以测试逃逸间隔和A-V延迟递送。 响应于A速度测试刺激的心律失常的捕获（ALOC）是通过在A步测试发送之后的起搏AV延迟间隔的后半部分中没有检测到的心室去极化（V-event）来宣告的 刺激。 在心室阈值测试方案中，V-pace测试刺激在缩短的A-V延迟之后递送。 通过检测V-速度测试刺激的心室不应期中的V-事件来宣告心室收缩损失（VLOC）。 在具有正常测量的窦性心律的患者中用于心房或心室的第二种算法中，递送过早的A步或V步测试刺激，并且在测量结束时存在A事件或V-事件 窦道逃逸间隔分别被宣告为ALOC或VLOC。 重复A步和V步测试刺激，以超过LOC测试能量的能量确认捕获声明。 通过改变脉冲幅度（强度）和宽度（持续时间）而得到的房室和心室刺激阈值数据被存储在用于遥测和分析的存储器中，并且用于设定V-步速和A-速度正常脉冲宽度和幅度 连续自动捕获测试以节省电池能量。

公开(公告)号：US4503858A

公开(公告)日：1985-03-12

申请号：US504699

申请日：1983-06-15

申请人： Harold T. Markowitz ,  John C. Rueter ,  Gary J. Syring

发明人： Harold T. Markowitz ,  John C. Rueter ,  Gary J. Syring

IPC分类号： A61N1/37 ,  A61N1/00

CPC分类号： A61N1/3702

摘要： A pacing system analyzer as connected to an implantable cardiac pacer and if an atrial pacing pulse is detected only, the analyzer sends a simulated P-wave to the pacer and determines the response of the simulated P-wave to determine if the pacing mode is AAI, AAT, or AOO. In the event a ventricular output pulse only is detected by the analyzer, a simulated R-wave is sent to the pacer and if the pacer responds either by a triggered ventricular pulse or by not changing its response, the analyzer determines that the pacer is in a VVT or VOO mode. On the other hand, if the pacer is inhibited a subsequent simulated P-wave is sent to it and the response of this P-wave determines whether or not the pacer is in a VVI or VDD mode. In the event that both atrial and ventricular pacing pulses are detected by the analyzer, the simulated R-wave is first sent to the pacer and an unchanged response determines that the pacer is in a DOO mode. On the other hand, if the pacer is inhibited so that ventricular pulses are not produced, then a simulated P-wave is sent to it. The response of the pacer to the simulated P-wave determines whether it is in a DVI or DDD mode.

摘要翻译： 起搏系统分析仪连接到可植入心脏起搏器，如果只检测到心房起搏脉搏，则分析仪将模拟的P波发送到起搏器，并确定模拟P波的响应，以确定起搏模式是否为AAI ，AAT或AOO。 在分析仪仅检测到心室输出脉冲的情况下，将模拟的R波发送到起搏器，并且如果起搏器通过触发的心室脉搏或不改变其响应来进行响应，则分析仪确定起搏器处于 VVT或VOO模式。 另一方面，如果起搏器被禁止，则向其发送随后的模拟P波，并且该P波的响应确定起搏器是否处于VVI或VDD模式。 在分析仪检测到心房和心室起搏脉冲的情况下，首先将模拟的R波发送到起搏器，并且不变的响应确定起搏器处于DOO模式。 另一方面，如果抑制起搏器使得不产生心室脉冲，则向其发送模拟的P波。 起搏器对模拟P波的响应决定了它是处于DVI还是DDD模式。

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：US07400924B2

公开(公告)日：2008-07-15

申请号：US11114463

申请日：2005-04-26

申请人： John C. Rueter

发明人： John C. Rueter

IPC分类号： A61N1/37

CPC分类号： A61N1/3712 ,  A61N1/3716

摘要： An implantable medical device (IMD) includes both evoked response and algorithmic based threshold testing methodologies. The leads used with the IMD are evaluated to determine whether they are high or low polarization. The evoked response methodology is only utilized if the leads are low polarization.

摘要翻译： 可植入医疗器械（IMD）包括诱发反应和基于算法的阈值测试方法。 评估与IMD一起使用的引线，以确定它们是高极化还是低极化。 诱发反应方法仅在引线为低极化时才被使用。

公开(公告)号：US07280868B2

公开(公告)日：2007-10-09

申请号：US10434689

申请日：2003-05-09

申请人： John C. Rueter ,  Christopher M. Manrodt ,  James W. Busacker ,  Todd J. Sheldon

发明人： John C. Rueter ,  Christopher M. Manrodt ,  James W. Busacker ,  Todd J. Sheldon

IPC分类号： A61N1/362

CPC分类号： A61N1/368 ,  A61N1/371 ,  A61N1/3712 ,  A61N1/3714 ,  A61N2001/083

摘要： A capture detection algorithm detects and distinguishes atrial capture. Atrial chamber reset (ACR) and AV conduction (AVC) algorithms are implemented to measure an atrial pacing threshold The data that is used to choose between ACR and AVC methods is used to determine the progression of the patient's disease state. Some of the significant aspects of the invention include enablement of accurate threshold measurements, including calculation of stability criteria, precise interval measurements and the use of reference interval to determine capture and loss of capture.

摘要翻译： 捕获检测算法检测并区分心房捕获。 实施房室复位（ACR）和AV传导（AVC）算法来测量心房起搏阈值用于在ACR和AVC方法之间选择的数据用于确定患者疾病状态的进展。 本发明的一些重要方面包括启用准确的阈值测量，包括稳定性标准的计算，精确的间隔测量以及参考间隔的使用以确定捕获和捕获的丢失。

公开(公告)号：US07130690B2

公开(公告)日：2006-10-31

申请号：US10625344

申请日：2003-07-23

申请人： John C. Rueter ,  Todd J. Sheldon

发明人： John C. Rueter ,  Todd J. Sheldon

IPC分类号： A61N1/362

CPC分类号： A61N1/3712 ,  A61N1/362 ,  A61N1/3714

摘要： In an atrial pacing system, the A-PACE pulse energy, defined by the pulse width and pulse amplitude, sufficient to reliably capture the atrium without being wasteful of battery energy is periodically determined in accordance with atrial capture management (ACM) algorithms. The ACM algorithms allow a slow intrinsic atrial heart rate that is suppressed by delivered A-PACE pulses resulting in A-CAPTURE and that occurs when delivered test A-PACE pulses result in ALOC to be detected. ALOC is declared if an A-EVENT of the slow intrinsic atrial heart rate is detected either during an ACM test window timed from the last delivered test A-PACE pulse or during delivery of a sequence of test A-PACE pulses delivered within or defining the ACM test window correlated to the slow intrinsic atrial heart rate.

摘要翻译： 在心房起搏系统中，根据心房捕获管理（ACM）算法周期性地确定由脉冲宽度和脉冲幅度定义的足够可靠地捕获心房而不浪费电池能量的A-PACE脉冲能量。 ACM算法允许由传递的A-PACE脉冲抑制的内在心房心率慢，导致A-CAPTURE，并且当递送的测试A-PACE脉冲导致检测到ALOC时发生。 如果在从最后传送的测试A-PACE脉冲定时的ACM测试窗口期间或在递送在其中传送或定义的测试A-PACE脉冲序列期间检测到慢内在心房心率的A-EVENT，则ALOC被声明 ACM测试窗口与内在心房心率缓慢相关。

公开(公告)号：US6129745A

公开(公告)日：2000-10-10

申请号：US178390

申请日：1998-10-23

申请人： Weimin Sun ,  Eric Olson ,  John C. Rueter ,  Michael F. Hess

发明人： Weimin Sun ,  Eric Olson ,  John C. Rueter ,  Michael F. Hess

IPC分类号： A61N1/362 ,  A61N1/37

CPC分类号： A61N1/362 ,  A61N1/37

摘要： There is provided a system and method applicable for use with a dual chamber pacemaker for determining whether long atrial intervals are due to atrial undersensing or to sick sinus syndrome. The determination of undersensing is based upon an algorithm which statistically analyzes a long atrial interval in terms of the patient's prior atrial rate history, and compares a calculated statistical probability measure with an empirically determined undersense threshold factor. The pacemaker can respond to a determination of undersensing by correcting already collected diagnostic data, adjusting one or more pacemaker operating parameters, adjusting synchronous tracking and/or providing an annotated marker channel for indicating undersense events.

摘要翻译： 提供了一种适用于双室心脏起搏器的系统和方法，用于确定长期心房间隔是由于心房不足还是病态窦综合征。 不足感的确定是基于统计分析患者先前心房率历史的长心房间隔的算法，并将计算的统计概率测量与经验确定的不足阈值因子进行比较。 起搏器可以通过校正已经收集的诊断数据，调整一个或多个起搏器操作参数，调整同步跟踪和/或提供用于指示不足事件的注释标记通道，来响应下限的确定。

公开(公告)号：US5792202A

公开(公告)日：1998-08-11

申请号：US761031

申请日：1996-12-05

申请人： John C. Rueter

发明人： John C. Rueter

IPC分类号： A61N1/372 ,  A61N1/36

CPC分类号： A61N1/37247

摘要： There is provided a system and method for increased data transmission from an implanted pacemaker when the pacemaker is in magnet mode. Pacemaker data including, e.g., pacemaker operating conditions, pacing events and patient events, is outputted by changing the asynchronous pacing rate to selected ones of available rates, and with a predetermined sequence, enabling read out of the data on an EKG strip chart. In a preferred embodiment, data-encoded pace pulses with intervals corresponding to selected rates are delivered in a predetermined sequence with fixed rate non-data intervals. For example, four pulses are delivered at 85 ppm followed by one or more data-encoded pulses, each data-encoded pulse being at 90, 95 or 100 ppm, whereafter the sequence is repeated with additional data-encoded intervals. The combination of rates for each of the data-encoded intervals represents the pacemaker data, and can be decoded by observing an EKG strip taken during the pattern of pace pulses. The invention provides for enhanced data transmission from an implanted pacemaker without the need of a programmer for receiving the data, and is thus particularly useful in environments where only a simple magnet is available for pacemaker follow-up.

摘要翻译： 提供了一种用于当起搏器处于磁体模式时从植入式心脏起搏器增加数据传输的系统和方法。 通过将异步起搏速率改变为所选择的可用速率，并且以预定的顺序，使得能够读取EKG条带图上的数据来输出包括例如起搏器操作条件，起搏事件和患者事件的起搏器数据。 在优选实施例中，具有对应于所选择的速率的间隔的数据编码的起搏脉冲以预定的顺序以固定的速率非数据间隔传送。 例如，以85ppm传送四个脉冲，随后是一个或多个数据编码脉冲，每个数据编码的脉冲为90,95或100ppm，此后，使用附加的数据编码间隔重复该序列。 每个数据编码间隔的速率的组合表示起搏器数据，并且可以通过观察在起搏脉冲模式期间拍摄的EKG条来进行解码。 本发明提供了来自植入式心脏起搏器的增强的数据传输，而不需要用于接收数据的编程器，因此特别适用于只有简单磁体可用于起搏器跟踪的环境中。

公开(公告)号：US20110029034A1

公开(公告)日：2011-02-03

申请号：US12787058

申请日：2010-05-25

申请人： Trent M. Fischer ,  Douglas A. Hettrick ,  Todd J. Sheldon ,  Paul A. Belk ,  Thomas J. Mullen ,  John C. Rueter ,  Daniel R. Kaiser

发明人： Trent M. Fischer ,  Douglas A. Hettrick ,  Todd J. Sheldon ,  Paul A. Belk ,  Thomas J. Mullen ,  John C. Rueter ,  Daniel R. Kaiser

IPC分类号： A61N1/365

CPC分类号： A61N1/3627 ,  A61B5/0456 ,  A61N1/36514 ,  A61N1/36542 ,  A61N1/36557 ,  A61N1/36564 ,  A61N1/36571 ,  A61N1/36578 ,  A61N1/36585 ,  A61N1/368 ,  A61N1/3682 ,  A61N1/3688

摘要： An implantable medical device and associated method provide atrial pacing and measure an atrial ventricular (AV) delay. An autonomic function index is computed using the AV delay. The autonomic function index may be compiled in a medical report. In some embodiments, the autonomic function index is used to adjust atrial pacing control parameters.

摘要翻译： 可植入医疗器械和相关方法提供心房起搏并测量心房（AV）延迟。 使用AV延迟计算自主功能指数。 自主功能指数可以在医疗报告中编制。 在一些实施例中，自主功能指数用于调节心房起搏控制参数。