公开(公告)号：US07130679B2

公开(公告)日：2006-10-31

申请号：US10299397

申请日：2002-11-20

申请人： Victor Parsonnet ,  William J. Combs

发明人： Victor Parsonnet ,  William J. Combs

IPC分类号： A61B5/05

CPC分类号： A61B5/413 ,  A61B5/0537

摘要： The invention is directed to techniques for monitoring organ rejection. An implanted device monitors the impedance of the transplanted organ. When the impedance measurements indicate that the organ is being rejected, the device provides early warning of rejection.

摘要翻译： 本发明涉及用于监测器官排斥的技术。 植入装置监测移植器官的阻抗。 当阻抗测量表明器官被拒绝时，器件提供拒收的早期警告。

公开(公告)号：US06584352B2

公开(公告)日：2003-06-24

申请号：US09749169

申请日：2000-12-27

申请人： William J. Combs ,  Gary Berg

发明人： William J. Combs ,  Gary Berg

IPC分类号： A61N1362

CPC分类号： A61N1/37252 ,  A61N1/3702 ,  A61N1/37288

摘要： A leadless fully automatic follow-up (LFAPF) device that is triggered into operation either locally or remotely is implemented extra-corporeally to access cardiac data such as ECGs stored in one or more implantable medical device (IMDs) implanted in one or more patients. A telemetry unit is used in the LFAPF to transmit and test stored data in the IMDs. The telemetry unit implements a series of adjustable commands depending on the desired level of detail of the follow-up. An alternate embodiment representing intra-corporeal use of an additional device includes cardiac data monitoring and cardioversion pulse synchronization in cooperation with another IMD such as a pacer.

公开(公告)号：US5902325A

公开(公告)日：1999-05-11

申请号：US126469

申请日：1998-07-30

申请人： Catherine R. Condie ,  Daniel J. Baxter ,  William J. Combs ,  Daniel J. Greeninger ,  Karen J. Kleckner ,  H. Toby Markowitz ,  John C. Stroebel ,  John D. Wahlstrand

发明人： Catherine R. Condie ,  Daniel J. Baxter ,  William J. Combs ,  Daniel J. Greeninger ,  Karen J. Kleckner ,  H. Toby Markowitz ,  John C. Stroebel ,  John D. Wahlstrand

IPC分类号： A61N1/365 ,  A61N1/37

CPC分类号： A61N1/36521 ,  A61N1/3712 ,  A61N1/3714

摘要： A method and apparatus for automatic determination of a pacemaker patient's pacing stimulation threshold. Circuitry is provided in a pacemaker for obtaining a signal reflecting cardiac impedance, which is known to reliably reflect certain aspects of cardiac function. Circuitry is also provided for monitoring the cardiac impedance waveform during a predetermined capture detect window following delivery of stimulating pulses. One or more values are derived which characterize the morphology of the impedance waveform during the capture detect window associated with each stimulation pulse delivered. These values are compared to predetermined control values in order to assess whether a stimulation pulse has achieved cardiac capture. The assessment of whether cardiac capture has been achieved is also based partly upon the conventional sensing of atrial and/or ventricular cardiac signals occurring during the capture detect window. In one embodiment of the invention, the control values against which impedance waveform characterization values are compared are obtained by delivering a series of stimulation pulses having sufficient energy to ensure that capture is achieved, and by monitoring the impedance waveform during delivery of these pulses.

摘要翻译： 一种用于自动确定起搏器患者起搏刺激阈值的方法和装置。 在起搏器中提供电路以获得反映心脏阻抗的信号，这已知可靠地反映心脏功能的某些方面。 还提供电路用于在传送刺激脉冲之后的预定捕获检测窗口期间监测心脏阻抗波形。 导出一个或多个值，其表征在与递送的每个刺激脉冲相关联的捕获检测窗口期间阻抗波形的形态。 将这些值与预定的控制值进行比较，以便评估刺激脉冲是否已经实现心脏捕获。 是否已经实现心脏捕获的评估也部分地基于在捕获检测窗口期间发生的心房和/或心室心脏信号的常规感测。 在本发明的一个实施例中，通过递送具有足够能量的一系列刺激脉冲来确定阻抗波形表征值被比较的控制值，以确保实现捕获，并且通过在传送这些脉冲期间监视阻抗波形来获得。

公开(公告)号：US5782888A

公开(公告)日：1998-07-21

申请号：US823006

申请日：1997-03-21

申请人： Weimin Sun ,  Eric J. Panken ,  William J. Combs

发明人： Weimin Sun ,  Eric J. Panken ,  William J. Combs

IPC分类号： A61B5/042 ,  A61B5/0464 ,  A61N1/37

CPC分类号： A61B5/726 ,  A61B5/0422 ,  A61B5/0464 ,  A61B5/7203 ,  A61B5/7267 ,  A61B5/7225

摘要： This is a method and apparatus for the automated discrimination of cardiac events of interest, including P-waves, R-waves, T-waves and specific arrhythmic sequences, in EGM signals for data storage in an implantable monitor or to control operations of an implantable cardiac stimulator through the use of Hidden Markov Modeling techniques and a reduced set of observations.

摘要翻译： 这是用于自动辨别感兴趣的心脏事件（包括P波，R波，T波和特定心律失常序列）的方法和装置，用于在可植入监测器中进行数据存储的EGM信号中，或用于控制可植入的 心脏刺激器通过使用隐马尔可夫建模技术和一组减少的观察结果。

公开(公告)号：US5755739A

公开(公告)日：1998-05-26

申请号：US759902

申请日：1996-12-04

申请人： Weimin Sun ,  Pamela A. Abshire ,  Eric J. Panken ,  William J. Combs

发明人： Weimin Sun ,  Pamela A. Abshire ,  Eric J. Panken ,  William J. Combs

IPC分类号： A61B5/0452 ,  A61N1/368 ,  A61N1/37 ,  A61N1/362 ,  A61B5/0464

CPC分类号： A61N1/3704 ,  A61B5/04525 ,  A61N1/368

摘要： The present invention is a method and apparatus for processing a sensed atrial electrogram in conjunction with a sensed ventricular electrogram. The present invention permits accurate discrimination of atrial P-waves from far field ventricular events such as far field R-waves and avoids oversensing such far field ventricular events as atrial sense events and undersensing atrial events occurring within a fusion beat masked by a far field ventricular event in the atrial electrogram. Atrial channel trigger signals are generated in response to sensed P-waves and far field R-waves in the atrial electrogram, and ventricular trigger signals are generated in response to sensed R-waves in the ventricular electrogram. In response to each ventricular channel trigger signal, the sensed atrial electrogram signal is adaptively filtered for an adaptive filter time window only to remove the far field R-wave signal from the sensed atrial electrogram signal while avoiding adaptive filtering of the sensed atrial electrogram signal at other times. In response to each atrial channel trigger signal, the adaptively filtered, sensed atrial electrogram signal is subjected to morphological analysis in respect of a morphological model of a P-wave only during a morphology time window. In this manner, P-waves in the sensed atrial electrogram signal are detected and far field R-waves in the sensed atrial electrogram signal are not mistakenly detected as P-waves, while morphological analysis of the sensed atrial electrogram at other times is avoided.

摘要翻译： 本发明是一种结合感测的心室电描记图处理感测的心房电描记图的方法和装置。 本发明允许从远场心室事件（例如远场R波）中准确地辨别心房P波，并避免过度监测诸如心房感觉事件的远场心室事件以及在由远场心室掩蔽的融合搏动内发生的低度心房事件 心房电图中的事件。 响应于心房电描记图中的感测到的P波和远场R波产生心房通道触发信号，并且响应于心室电图中的感测到的R波而产生心室触发信号。 响应于每个心室通道触发信号，感测的心房电描记信号被自适应滤波以用于自适应滤波器时间窗口，仅从感测的心房电描记图信号中去除远场R波信号，同时避免对感测的心房电描记图信号的自适应滤波 其他时候。 响应于每个心房通道触发信号，仅在形态学时间窗口期间，自适应滤波感应的心房电描记信号就P波的形态学模型进行形态学分析。 以这种方式，检测到感测的心房电描记信号中的P波，并且将感测到的心房电描记信号中的远场R波未被错误地检测为P波，同时避免了其他时间的感测的心房电描记图的形态学分析。

公开(公告)号：US5562711A

公开(公告)日：1996-10-08

申请号：US346813

申请日：1994-11-30

申请人： Charles G. Yerich ,  William J. Combs ,  Karen J. Kleckner ,  Eric J. Panken ,  Richard S. Schallhorn ,  John D. Wahlstrand

发明人： Charles G. Yerich ,  William J. Combs ,  Karen J. Kleckner ,  Eric J. Panken ,  Richard S. Schallhorn ,  John D. Wahlstrand

IPC分类号： A61N1/365

CPC分类号： A61N1/36585

摘要： A body-implantable rate-responsive cardiac pacemaker is provided with circuitry for sensing a plurality of physiologic parameters known to be indicative of a patient's metabolic demand for increased cardiac output. In one embodiment, a rate-responsive pacemaker is provided with an activity sensor for detecting the patient's level of physical activity, and is further provided with an impedance sensing circuit for detecting the patient's level of minute ventilation by monitoring cardiac impedance. A rate-response transfer function, implemented by the pacemaker's control circuitry, periodically computes a rate-responsive pacing rate as a function of the outputs from both physiologic sensing circuits. The pacemaker's pacing rate is variable within a rate range defined by predetermined (programmable) upper and lower limits. In the preferred embodiment, the influence of activity sensing and minute ventilation parameters varies in accordance with the current pacing rate. In particular, the influence of activity sensing in rate determination in accordance with the rate-response function is greater than that of minute ventilation, for slower pacing rates, while the influence of minute ventilation sensing dominates over that of activity sensing for higher pacing rates. Rate response operation of the disclosed system is recorded in the form of histogram data stored over a predetermined history time. The relative influence of the activity sensing and minute ventilation sensing on rate determination is periodically scaled or balanced based upon comparison of the histogram data with predetermined desired response data.

摘要翻译： 身体植入式速率响应心脏起搏器被提供有用于感测已知指示患者对增加的心输出量的代谢需求的多个生理参数的电路。 在一个实施例中，速率响应起搏器设置有用于检测患者的身体活动水平的活动传感器，并且还设置有阻抗感测电路，用于通过监测心脏阻抗来检测患者的分钟通气水平。 由起搏器的控制电路实现的速率响应传递函数周期性地计算速率响应起搏速率作为来自生理感测电路的输出的函数。 起搏器的起搏速率在由预定（可编程）上限和下限限定的速率范围内是可变的。 在优选实施例中，活动感测和分钟通气参数的影响根据当前起搏速率而变化。 特别是，根据速率响应函数的速率测定中的活动检测的影响大于分钟通气量，对于较慢的起搏速率，而微动通气检测的影响比活动检测的影响高于起搏率。 以预定历史时间存储的直方图数据的形式记录所公开的系统的速率响应操作。 基于直方图数据与预定的期望响应数据的比较，活动感测和分钟通气感测对速率确定的相对影响被周期地缩放或平衡。

公开(公告)号：US5331966A

公开(公告)日：1994-07-26

申请号：US168725

申请日：1993-12-16

申请人： Tom D. Bennett ,  William J. Combs ,  Kallok, Michael J. ,  Brian B. Lee ,  Rahul Mehra ,  George J. Klein

发明人： Tom D. Bennett ,  William J. Combs ,  Kallok, Michael J. ,  Brian B. Lee ,  Rahul Mehra ,  George J. Klein

IPC分类号： A61N1/365 ,  A61B5/0402 ,  A61N1/362 ,  A61N1/375 ,  A61B5/0428

CPC分类号： A61N1/3686 ,  A61N1/36185 ,  A61N1/3622 ,  A61N1/0504 ,  A61N1/3756 ,  Y10S128/903

摘要： A method and apparatus for providing an enhanced capability of detecting and gathering electrical cardiac signals via an array of relatively closely spaced subcutaneous electrodes (located on the body of an implanted device) which may be employed with suitable switching circuits, signal processors, and memory to process the electrical cardiac signals between any selected pair or pairs of the electrode array in order to provide a leadless, orientation insensitive means for receiving the electrical signal from the heart. This far-field EGM may be used to provide storage and analysis of arrhythmic events and to provide control signals for the delivery of various therapies including pacing, cardioversion and defibrillation therapies as well as the delivery of antiarrhythmic drugs, and, in the pacing context, to effect capture detection and automatic stimulation threshold adaption, recording of PMT episodes, measurement of refractory periods in order to set timing windows for antitachy pacing therapies, and as a control signal for use in adjusting pacing rate to physiologic demand.

摘要翻译： 一种用于提供通过相对紧密间隔的皮下电极（位于植入装置的主体上）的阵列来检测和收集电心电信号的增强能力的方法和装置，其可以与合适的开关电路，信号处理器和存储器一起使用 处理任何所选择的一对或一对电极阵列之间的电心脏信号，以便提供用于从心脏接收电信号的无引导方向不敏感的装置。 这种远场EGM可用于提供心律失常事件的存储和分析，并提供用于递送各种疗法的控制信号，包括起搏，心脏复律和除颤疗法以及递送抗心律失常药物，并且在起搏背景下， 以实现捕获检测和自动刺激阈值适应，记录PMT发作，测量不良期以设置反向起搏治疗的时间窗口，以及用作调整生理需求起搏速率的控制信号。

公开(公告)号：US09301698B2

公开(公告)日：2016-04-05

申请号：US12263423

申请日：2008-10-31

申请人： Sarah A. Audet ,  James K. Carney ,  William J. Combs ,  Tommy D. Bennett ,  Barbro M. L. Kjellstrom

发明人： Sarah A. Audet ,  James K. Carney ,  William J. Combs ,  Tommy D. Bennett ,  Barbro M. L. Kjellstrom

IPC分类号： A61B5/0215 ,  A61N1/365 ,  A61N1/372 ,  A61B5/00

CPC分类号： A61B5/02055 ,  A61B5/0215 ,  A61B5/4836 ,  A61B5/686 ,  A61B5/7203 ,  A61N1/36514 ,  A61N1/36564 ,  A61N1/37258

摘要： The present disclosure provides an apparatus and method of detecting ischemia with a pressure sensor. The method can include obtaining a pressure signal and determining a pressure rate of change. The method can also include identifying at least one of impaired relaxation and impaired contractility in order to detect ischemia.

摘要翻译： 本公开提供了利用压力传感器检测缺血的装置和方法。 该方法可以包括获得压力信号并确定压力变化率。 该方法还可以包括鉴定减轻的松弛和受损的收缩力中的至少一种以便检测缺血。

公开(公告)号：US07991467B2

公开(公告)日：2011-08-02

申请号：US11114474

申请日：2005-04-26

申请人： H. Toby Markowitz ,  Douglas A. Hettrick ,  William J. Combs ,  Todd J. Sheldon ,  David L. Thompson ,  Raja N. Ghanem ,  Kevin A. Wanasek

发明人： H. Toby Markowitz ,  Douglas A. Hettrick ,  William J. Combs ,  Todd J. Sheldon ,  David L. Thompson ,  Raja N. Ghanem ,  Kevin A. Wanasek

IPC分类号： A61B5/02 ,  A61N1/362

CPC分类号： A61N1/3962 ,  A61N1/025 ,  A61N1/37211 ,  A61N1/37229 ,  A61N1/37288

摘要： Subcutaneous Implantable cardioverter-defibrillators (SubQ ICDs) are disclosed that are entirely implantable subcutaneously with minimal surgical intrusion into the body of the patient and provide distributed cardioversion-defibrillation sense and stimulation electrodes for delivery of cardioversion-defibrillation shock and pacing therapies across the heart when necessary. The SubQ ICD is implemented with other implantable and external medical devices and communicates to provide drugs and therapy in a coordinated and synergistic manner.

摘要翻译： 皮下植入式心脏复律除颤器（SubQ ICD）被公开，其完全可植入皮下，以最小的外科手术入侵患者体内，并提供分布式心脏复律除颤感和刺激电极，用于在整个心脏中递送心脏复律除颤休克和起搏疗法 必要。 SubQ ICD与其他植入式和外部医疗设备一起实施，并以协调和协同的方式进行通信以提供药物和治疗。

公开(公告)号：US07899533B2

公开(公告)日：2011-03-01

申请号：US11257643

申请日：2005-10-25

申请人： Raul Chirife ,  William J. Combs ,  Russell R. Lundstrom

发明人： Raul Chirife ,  William J. Combs ,  Russell R. Lundstrom

IPC分类号： A61N1/08

CPC分类号： A61N1/368 ,  A61N1/3682

摘要： An implantable medical device provides ventricular pacing capabilities and optimizes AV intervals for multiple purposes. In general, intrinsic conduction is promoted by determining when electromechanical systole (EMS) ends and setting an AV interval accordingly. EMS is determined utilizing various data including QT interval, sensor input, and algorithmic calculations.

摘要翻译： 可植入医疗装置提供心室起搏功能并优化AV间隔用于多种目的。 通常，通过确定何时机电收缩（EMS）结束并相应地设置AV间隔来促进固有传导。 使用包括QT间隔，传感器输入和算法计算的各种数据来确定EMS。