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公开(公告)号：US5735881A
公开(公告)日：1998-04-07
申请号：US843225
申请日：1997-04-14
CPC分类号： A61N1/368 , A61N1/3704
摘要： An implantable medical device for electrically stimulating the heart to beat including a pulse generator, a logic and control unit, and an atrial sense circuit. The atrial sense circuit processes signals from electrodes implanted in an atrial chamber of the heart. The atrial sense circuit provides an atrial sense signal to the logic and control unit when the magnitude of electrical activity in the atria exceeds a threshold. The medical device preferably paces the ventricles in response to detected electrical activity in the atria indicative of atrial contraction. Immediately following ventricular pacing, the medical device initiates an absolute atrial blanking period followed by an atrial sensing period and a programmable blanking period. During both the absolute atrial blanking period and the programmable blanking period, atrial sensing is disabled, while during the atrial sense period, atrial sensing is enabled. The time durations of the atrial sensing period and the programmable blanking period are programmable and may be programmed noninvasively while the medical device is implanted. The time durations of the atrial sense period and the programmable blanking period are adjusted so that paced far field R-waves resulting from a ventricular pace preferably occur during the programmable blanking period when atrial sensing is disabled. Atrial sensing during the atrial sensing period advantageously allows the medical device to monitor the atrial sense signal for normal atrial contractions.
摘要翻译： 一种用于电激励心脏拍击的可植入医疗装置，包括脉冲发生器，逻辑和控制单元以及心房感测电路。 心房感觉电路处理来自植入心脏心房的电极的信号。 当心房中的电活动量超过阈值时，心房感觉电路向逻辑和控制单元提供心房感测信号。 医疗装置优选地响应于指示心房收缩的心房中检测到的电活动来起搏心室。 紧随心室起搏后，医疗器械启动绝对心房消隐期，随后是心房感应期和可编程的消隐期。 在绝对心房消隐期和可编程消隐期间，心房感知被禁用，而在心房感觉期间，能够进行心房感知。 心房感应期和可编程消隐期的持续时间是可编程的，并且可以在植入医疗器械时非侵入性地编程。 调整心房感觉期和可编程消隐期的持续时间，使得在心房感知被禁用的可编程消隐期间优选地发生由心室起搏引起的起搏远场R波。 心房感知期间的心房感应有利地允许医疗装置监测心房感觉信号以用于正常的心房收缩。
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2.发明授权
公开(公告)号：US5843133A
公开(公告)日：1998-12-01
申请号：US843236
申请日：1997-04-14
CPC分类号： A61N1/3622 , A61N1/3704 , A61N1/385 , A61N1/3962 , A61N1/395
摘要： An implantable medical device for electrically stimulating the heart to beat includes a sense circuit for detecting cardiac electrical activity. The sense circuit includes a band pass filter with an adjustable frequency response. The frequency response can be repeatedly adjusted after implantation of the medical device and preferably is adjusted upon detection of the loss of normal sinus rhythm (NSR) in the heart's atria. The loss of NSR often indicates atrial fibrillation (AF), and the filter's frequency response is adjusted to increase the sensitivity of the sense circuit to the cardiac electrical activity typical during AF. The medical device is calibrated during implantation or at subsequent doctor visits with the aid of a calibration device external to the body. Cardiac electrical activity in the form of an electrogram is transmitted from the medical device to the external calibration device. The transmitted electrogram preferably includes both NSR and AF rhythms. The calibration device computes two sets of filter coefficients; one set for increased filter sensitivity during NSR and another set for increased sensitivity during AF. The coefficients are transmitted to the medical device which uses the appropriate set of coefficients to increase the filter's frequency response during both NSR and AF.
摘要翻译： 用于电刺激心脏跳动的可植入医疗装置包括用于检测心脏电活动的感测电路。 感测电路包括具有可调频率响应的带通滤波器。 可以在植入医疗装置之后重复地调整频率响应，并且优选地在检测到心脏心房中的正常窦性心律（NSR）的损失时进行调整。 NSR的损失经常表明心房颤动（AF），并且调整滤波器的频率响应以增加感觉电路对AF期间典型的心脏电活动的灵敏度。 借助于身体外部的校准装置，在植入期间或随后的医生访问期间校准医疗装置。 以电图形式的心脏电活动从医疗装置传输到外部校准装置。 传输的电描记图优选地包括NSR和AF节奏。 校准装置计算两组滤波器系数; 一组用于在NSR期间增加滤波器灵敏度，另一组用于在AF期间增加灵敏度。 这些系数被传送到使用适当的系数集合的医疗设备，以在NSR和AF期间增加滤波器的频率响应。
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3.发明授权Dynamic atrial detection sensitivity control in an implantable medical cardiac simulator 失效可植入医疗心脏模拟器中的动态心房检测灵敏度控制
公开(公告)号：US5800466A
公开(公告)日：1998-09-01
申请号：US843234
申请日：1997-04-14
CPC分类号： A61N1/3704 , A61N1/3621
摘要： An implantable medical device for electrically stimulating the heart to beat includes a sense circuit for detecting cardiac electrical activity. The sense circuit includes an amplifier with a dynamically adjustable gain to provide increased sensitivity to the electrogram during atrial fibrillation. Alternatively, sensitivity control is provided by dynamically adjusting threshold limits associated with a threshold detector included in the sense circuit. The sensitivity level of the medical device to the electrogram can be repeatedly adjusted after implantation and preferably is increased upon detection of the loss of normal sinus rhythm (NSR) in the heart's atria. The medical device is calibrated with the aid of a calibration device external to the body to determine appropriate sensitivity levels. A method for calibrating and operating an implanted medical device with dynamically adjustable sensitivity is also disclosed for improving the medical device's sensitivity to atrial fibrillation.
摘要翻译： 用于电刺激心脏跳动的可植入医疗装置包括用于检测心脏电活动的感测电路。 感测电路包括具有动态可调增益的放大器，以在心房颤动期间提供对电描记图的增加的灵敏度。 或者，通过动态地调整与检测电路中包括的阈值检测器相关联的阈值限制来提供灵敏度控制。 医疗装置对电描记图的灵敏度水平可以在植入后重复调整，并且优选地在检测到心脏心房中的正常窦性心律（NSR）的损失时增加。 医疗设备借助于身体外部的校准装置进行校准，以确定适当的灵敏度水平。 还公开了用于校准和操作具有动态可调灵敏度的植入式医疗装置的方法，用于改善医疗装置对心房颤动的敏感性。
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4.发明授权Implantable cardiac stimulator with polarity detection for detecting ectopic beats 失效可植入心脏刺激器，具有极性检测功能，用于检测异位搏动
公开(公告)号：US5772691A
公开(公告)日：1998-06-30
申请号：US843235
申请日：1997-04-14
申请人： Andre Routh , Annette Bruls , Drury Woodson, III , Joseph Vandegriff , Yves Verboven , Parick J. Paul
发明人： Andre Routh , Annette Bruls , Drury Woodson, III , Joseph Vandegriff , Yves Verboven , Parick J. Paul
CPC分类号： A61N1/3622
摘要： An implantable medical device for electrically stimulating the heart to beat including a sense circuit for detecting cardiac electrical activity. The sense circuit includes a sense amplifier, band pass filter, and threshold detector. The threshold detector determines whether sensed cardiac electrical activity resulted from a normal heart beat or an ectopic beat such as a premature ventricular contraction. In a preferred embodiment, latches in the threshold detector are activated by output pulses from a pair of comparators. A positive comparator produces an output pulse upon detection of cardiac electrical activity exceeding a positive threshold voltage and a negative comparator produces an output pulse upon detection of cardiac electrical activity more negative than a negative threshold. Threshold logic produces output signals indicative of which comparator first produced an output pulse. A logic and control unit monitors the output signals from the threshold logic and thus determines whether the associated cardiac electrical activity represented a normal heart beat or resulted from an ectopic beat so that appropriate pacing may be provided by the implantable device.
摘要翻译： 一种用于电激励心脏拍击的可植入医疗装置，包括用于检测心脏电活动的感测电路。 感测电路包括读出放大器，带通滤波器和阈值检测器。 阈值检测器确定感测的心脏电活动是否由正常心跳或异位搏动如早搏心室收缩引起。 在优选实施例中，阈值检测器中的锁存器由来自一对比较器的输出脉冲激活。 检测到超过正阈值电压的心电活动时，正比较器产生输出脉冲，而负比较器在检测到比负阈值更负的心电活动时产生输出脉冲。 阈值逻辑产生指示哪个比较器首先产生输出脉冲的输出信号。 逻辑和控制单元监视来自阈值逻辑的输出信号，从而确定相关的心脏电活动是否表示正常心跳或由异位搏动导致，从而可由可植入装置提供适当的起搏。
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公开(公告)号：US5609613A
公开(公告)日：1997-03-11
申请号：US433788
申请日：1995-05-03
CPC分类号： A61N1/36542 , A61N1/3622 , A61N1/368
摘要： A programmable dual-chamber artificial cardiac pacemaker senses atrial activity and normally tracks the sensed atrial activity in pacing the ventricular activity. An accelerometer located in the case of the pulse generator portion senses physical exercise by a patient when the pacemaker is implanted in the patient, and generates a rate control signal indicative of extent of the sensed physical exercise. The pulse generator is programmed for ventricular pacing rate control in multiple rate zones bounded by rate limits including a ventricular tracking limit (VTL) that varies dynamically with sensed physical exercise and a higher mode switch rate. The ventricular pacing rate tracks the sensed atrial activity on a 1:1 basis for atrial rates below the dynamic VTL (DVTL) during a predetermined interval of time for which the DVTL applies, and tracks the sensed atrial activity in Wenckebach behavior for atrial rates above the DVTL up to the mode switch rate with the ventricular pacing rate limited by the DVTL. The mode switch rate is set to effect a switch from dual-chamber to single-chamber mode when the sensed rate of atrial activity exceeds the mode switch rate for a programmed number of cardiac cycles, in which the ventricular pacing rate is controlled solely by sensed spontaneous ventricular activity without regard to the DVTL or sensed physical exercise. The mode switch rate also effects a reversion to the dual-chamber mode when the sensed rate of atrial activity drops below the mode switch rate for a programmed number of cardiac cycles, in which the ventricular pacing rate is controlled according to the respective one of the multiple rate zones in which the atrial activity rate is present.
摘要翻译： 可编程双室人工心脏起搏器感测心房活动，并通常跟踪感觉到的心房活动起搏心室活动。 位于脉冲发生器部分的情况下的加速度计在起搏器植入患者体内时感测到患者的体育锻炼，并产生指示感测体育运动程度的速率控制信号。 脉冲发生器被编程用于由速率限制限定的多个速率区域中的心室起搏速率控制，包括随感测到的身体运动而动态变化的心室跟踪极限（VTL）和更高的模式切换速率。 在DVTL应用的预定时间间隔内，心室起搏速率以1：1的速度跟踪动态VTL（DVTL）以下的心房率的感觉到的心房活动，并跟踪Wenckebach行为中感觉到的心房活动的心房率 DVTL达到DVTL限制的心室起搏速率的模式切换速率。 当所感测的心房活动速率超过编程的心脏周期数的模式切换速率时，模式切换速率被设置为实现从双室模式到单室模式的切换，其中心室起搏速率仅由感测器控制 自发心室活动，不考虑DVTL或感觉到的身体运动。 当所感测的心房活动速率降低到编程的心脏周期数的模式切换速率时，模式切换速率也影响到双室模式的逆转，其中心室起搏速率根据 存在心房活动率的多个速率区。
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