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1.发明授权Implantable cardiac stimulation device with automatic evoked response sensing electrode configuration selection and method 有权可植入心脏刺激装置具有自动诱发响应感应电极配置选择和方法公开(公告)号：US06782291B1
公开(公告)日：2004-08-24
申请号：US09655438
申请日：2000-09-05
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。
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2.发明授权Implantable cardiac stimulation device with automatic evoked response sensing electrode configuration selection and method 有权可植入心脏刺激装置具有自动诱发响应感应电极配置选择和方法公开(公告)号：US07233827B1
公开(公告)日：2007-06-19
申请号：US10865124
申请日：2004-06-09
IPC分类号： A61N1/365
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，使用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。
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3.发明授权Atrial rate determination and atrial tachycardia detection in a dual-chamber implantable pacemaker 失效双室植入式起搏器的心房率测定和房性心动过速检测
公开(公告)号：US5788717A
公开(公告)日：1998-08-04
申请号：US500730
申请日：1995-07-11
CPC分类号： A61N1/3962 , A61N1/3622 , A61N1/36514
摘要： An implantable pacemaker accurately senses the regular atrial rhythm even though some portions of the atrial rhythm, e.g., every other P-wave, may potentially be masked or hidden within the ventricular absolute refractory period. Such sensing includes unmasking or uncovering any hidden P-waves, thereby allowing an accurate atrial rate to be determined. The hidden P-waves are uncovered by: changing the PV delay, not tracking a sensed P-wave, or comparing the incoming morphology of the atrial channel signal to a prior stored baseline morphology signal. The accurate atrial rate, once determined, allows the presence of an atrial tachycardia to be reliably confirmed, thereby enabling appropriate atrial anti-tachycardia pacing (ATP) procedures to be invoked, or mode switching from an atrial synchronous mode of operation, e.g., DDD, to a non-atrial synchronous mode, e.g., VVIR.
摘要翻译： 尽管心房节律的一些部分，例如每隔一个P波，可植入式心脏起搏器可以准确地感测正常的心房节律，但是可能潜在地掩盖或隐藏在心室绝对不应期内。 这种感测包括揭露或揭露任何隐藏的P波，从而允许确定准确的心率。 隐藏的P波被覆盖：改变PV延迟，不跟踪感测的P波，或将心房通道信号的进入形态与先前存储的基线形态信号进行比较。 一旦确定，准确的心房率允许可靠地确认房性心动过速的存在，从而使得能够调用适当的心房抗心动过速起搏（ATP）程序或从心房同步操作模式切换，例如DDD ，到非心房同步模式，例如VVIR。
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4.发明授权Implantable cardiac stimulation system and method for automatic capture verification calibration 有权植入式心脏刺激系统和自动捕获验证校准方法公开(公告)号：US06731985B2
公开(公告)日：2004-05-04
申请号：US09981555
申请日：2001-10-16
IPC分类号： A61N1362
CPC分类号： A61N1/3712
摘要： An implantable cardiac stimulation device and associated method perform an automatic calibration procedure for evaluating whether automatic capture verification can be recommended. The calibration procedure calculates and displays a number of variables for use by a medical practitioner in programming automatic capture operating parameters. An average paced depolarization integral (PDI) is determined from the cardiac signals following delivery of multiple stimulation pulse below and above capture threshold such that both pure lead polarization signals and evoked response signals may be analyzed. From the paced depolarization integral data, a capture threshold, a stimulation response curve, a minimum evoked response, a maximum lead polarization, an evoked response sensitivity, an evoked response safety margin, and a polarization safety margin are determined. Based on these variables, the calibration procedure determines if automatic capture verification can be recommended. If so, the stimulation device calculates a capture detection threshold. The automatic capture verification recommendation and the estimated calibration variables are displayed.
摘要翻译： 可植入心脏刺激装置和相关方法执行自动校准程序，以评估是否可以推荐自动捕获验证。 校准程序计算并显示许多变量，供医生在编程自动捕获操作参数时使用。 平均节奏去极化积分（PDI）是在多次刺激脉冲传递后低于和高于捕获阈值的心脏信号确定的，以便可以分析纯铅极化信号和诱发响应信号。 从起搏去极化积分数据中，确定捕获阈值，刺激响应曲线，最小诱发响应，最大引线极化，诱发响应灵敏度，诱发响应安全裕度和极化安全裕度。 基于这些变量，校准过程确定是否可以推荐自动捕获验证。 如果是，则刺激装置计算捕获检测阈值。 显示自动捕获验证建议和估计的校准变量。
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5.发明授权Implantable cardiac stimulation device and method for prolonging atrial refractoriness 失效植入式心脏刺激装置及延长心房不应性的方法公开(公告)号：US06701187B1
公开(公告)日：2004-03-02
申请号：US10061567
申请日：2002-02-01
IPC分类号： A61N1362
CPC分类号： A61N1/3622 , A61N1/3956
摘要： An implantable cardiac stimulation device, e.g., a pacemaker or an implantable cardioverter defibrillator (ICD), is provided which prolongs the atrial refractoriness of a heart. The implantable cardiac stimulation device includes a generator that delivers pacing pulses to an atrium of a heart and a detector that detects atrial activations of the heart. An inhibitor is coupled to the detector that inhibits the generator when an atrial activation is detected within an escape interval. A generator control coupled to the generator causes the generator to deliver a primary pacing pulse to the atrium at the end of the escape interval, absent an atrial activation being detected within the escape interval, and causes the generator to deliver a secondary pacing pulse to the atrium a delay time after an atrial activation is detected within the escape interval or the delivery of a primary pacing pulse to the atrium.
摘要翻译： 提供可植入心脏刺激装置，例如起搏器或植入式心律转复除颤器（ICD），其延长心脏的心房不应性。 可植入心脏刺激装置包括将起搏脉冲传送到心脏心房的发生器和检测心脏心房激活的检测器。 当在逃避间隔内检测到心房激活时，抑制剂耦合到检测器，该检测器抑制发生器。 耦合到发生器的发生器控制器使得发生器在逃逸间隔结束时将主起搏脉冲递送到心房，没有在逃逸间隔内检测到心房激活，并且使得发生器将辅助起搏脉冲输送到 在转移间隔内检测到心房激活之后的延迟时间或者向心房传送初级起搏脉冲。
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6.发明授权Implanatable cardiac stimulation device and method for prolonging atrial refractoriness 有权可手术心脏刺激装置及延长心房不应性的方法公开(公告)号：US06377852B1
公开(公告)日：2002-04-23
申请号：US09488284
申请日：2000-01-20
IPC分类号： A61N1362
CPC分类号： A61N1/3622 , A61N1/3956
摘要： An implantable cardiac stimulation device, e.g., a pacemaker or an implantable cardioverter defibrillator (ICD), is provided which prolongs the atrial refractoriness of a heart. The implantable cardiac stimulation device includes a generator that delivers pacing pulses to an atrium of a heart and a detector that detects atrial activations of the heart. An inhibitor is coupled to the detector that inhibits the generator when an atrial activation is detected within an escape interval. A generator control coupled to the generator causes the generator to deliver a primary pacing pulse to the atrium at the end of the escape interval, absent an atrial activation being detected within the escape interval, and causes the generator to deliver a secondary pacing pulse to the atrium a delay time after an atrial activation is detected within the escape interval or the delivery of a primary pacing pulse to the atrium.
摘要翻译： 提供可植入心脏刺激装置，例如起搏器或植入式心律转复除颤器（ICD），其延长心脏的心房不应性。 可植入心脏刺激装置包括将起搏脉冲传送到心脏心房的发生器和检测心脏心房激活的检测器。 当在逃避间隔内检测到心房激活时，抑制剂耦合到检测器，该检测器抑制发生器。 耦合到发生器的发生器控制器使得发生器在逃逸间隔结束时将主起搏脉冲递送到心房，没有在逃逸间隔内检测到心房激活，并且使得发生器将辅助起搏脉冲输送到 在转移间隔内检测到心房激活之后的延迟时间或者向心房传送初次起搏脉冲。
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7.发明授权公开(公告)号：US06978175B1
公开(公告)日：2005-12-20
申请号：US10213489
申请日：2002-08-06
CPC分类号： A61N1/3702 , A61N1/3716
摘要： An implantable stimulation device delivers a stimulation pulse in the ventricular chamber of a patient's heart and automatically adjusts a post-ventricular atrial blanking period. The stimulation device generates a ventricular stimulation pulse to trigger an evoked response, in order to produce a ventricular far-field signal that follows a successfully captured ventricular stimulation pulse. The stimulation device further includes an atrial sense circuit that senses the ventricular far-field signal, and a control system that adaptively segments the post-ventricular atrial blanking period in a post-ventricular atrial blanking period (PVAB) which is fixed in duration, and a variable far-field interval (FFI) window. PVAB is initiated upon the delivery of the ventricular stimulation pulse, such that events sensed outside the segmented post-ventricular atrial blanking (SPVAB) period are presumed to be intrinsic atrial events, and events sensed within the far-field interval window are presumed to be far-field signals. The far-field interval window is preferably centered on a previously sensed far-field R-wave. If an intrinsic ventricular event is sensed, the stimulation device does not initiate the PVAB period but rather sets the FFI window.
摘要翻译： 植入式刺激装置在患者心脏的心室中输送刺激脉冲，并自动调节心室后心室消融期。 刺激装置产生心室刺激脉冲以触发诱发反应，以产生跟随成功捕获的心室刺激脉冲的心室远场信号。 刺激装置还包括感测心室远场信号的心房感知电路，以及在持续时间固定的心房后心房消隐期（PVAB）中自适应地分段心室心房消隐期的控制系统，以及 可变远场间隔（FFI）窗口。 PVAB是在输送心室刺激脉冲时开始的，使得在分段的心室后消融（SPVAB）周期之外感测到的事件被认为是内在心房事件，并且假定在远场间隔窗口内感测到的事件为 远场信号。 远场间隔窗口优选地以先前感测的远场R波为中心。 如果感测到内部心室事件，则刺激装置不会启动PVAB周期，而是设置FFI窗口。
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8.发明授权公开(公告)号：US06456880B1
公开(公告)日：2002-09-24
申请号：US09712861
申请日：2000-11-14
IPC分类号： A61N1365
CPC分类号： A61N1/3702 , A61N1/365
摘要： An implantable cardiac stimulation device includes a system that monitors progression or regression of a patient's heart condition. The system includes a plurality of electrode configurations for sensing cardiac activity of the heart. A sensing circuit provides an electrical signal representing electrical activity of the heart from each of the sensing electrode configurations. A processor coupled to the sensing circuit determines, at spaced apart times, and over time, a ventricular repolarization interval in each of the electrical signals and a corresponding ventricular repolarization interval dispersion. A memory stores the ventricular repolarization interval dispersions for transmission by a telemetry circuit to an external receiver for analysis.
摘要翻译： 可植入心脏刺激装置包括监测患者心脏状况的进展或消退的系统。 该系统包括用于感测心脏的心脏活动的多个电极配置。 感测电路从每个感测电极配置提供表示心脏的电活动的电信号。 耦合到感测电路的处理器在间隔开的时间和时间上确定每个电信号中的心室复极间隔和对应的心室复极间隔分散。 存储器存储用于通过遥测电路传输到外部接收器用于分析的心室复极间隔分散体。
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9.发明授权System and method of identifying fusion for dual-chamber automatic capture stimulation device 有权识别双室自动捕获刺激装置融合的系统和方法公开(公告)号：US06904321B1
公开(公告)日：2005-06-07
申请号：US10208169
申请日：2002-07-29
CPC分类号： A61N1/3712
摘要： A multi-chamber stimulation device and associated method reliably and automatically distinguish fusion from loss of capture during ventricular stimulation. The stimulation device provides immediate and accurate fusion detection when a loss of capture is suspected in the ventricles without delivering back-up stimulation pulses. To achieve this objective, the far-field signal present in the atrial channel is examined for evidence of a far-field R-wave whenever the ventricular channel detects a loss of capture. If a far-field R-wave is present, fusion is confirmed, and a far-field R-wave is absent, loss of capture is confirmed. Additionally, the stimulation device inhibits unnecessary back-up stimulation and threshold tests when fusion occurs, and provides appropriate adjustment of stimulation parameters based on confirmed fusion detection such that fusion re-occurrence is minimized.
摘要翻译： 多室刺激装置和相关方法可靠和自动地将融合与心室刺激期间的捕获损失区分开来。 刺激装置提供即时和准确的融合检测，当脑袋怀疑丢失而不输送备用刺激脉冲时。 为了达到这个目的，每当心室通道检测到捕获的丢失时，都会检查存在于心房通道中的远场信号以获得远场R波的证据。 如果存在远场R波，则确认融合，并且不存在远场R波，确认捕获损失。 此外，当融合发生时，刺激装置抑制不必要的后备刺激和阈值测试，并且基于确认的融合检测提供刺激参数的适当调整，使得融合再现最小化。
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10.发明授权Cardiac stimulation method and associated system using a stimulation histogram as an integrity diagnostic tool to monitor the performance of automatic capture verification 有权心脏刺激方法和相关系统使用刺激直方图作为完整的诊断工具来监控自动捕获验证的性能公开(公告)号：US06865422B1
公开(公告)日：2005-03-08
申请号：US09964225
申请日：2001-09-25
CPC分类号： A61N1/3712 , A61N2001/083
摘要： An implantable cardiac stimulation device and method provide a histogram for storing the number of primary and backup stimulation pulses delivered at each amplitude setting, to monitor the performance of the automatic capture verification. The stimulation device delivers cardiac stimulation therapy in which a stimulation histogram advantageously stores the number of primary pulses delivered at each stimulation output, or range of outputs, and separately stores the number of high-energy backup stimulation pulses delivered. Knowing the historical frequency of the applied stimulation amplitudes is useful to a physician in selecting future stimulation pulse output settings and the working margin. This information is also useful in determining the expected remaining battery life. The stimulation histogram further provides a useful diagnostic tool for evaluating the integrity of the stimulation device, lead system and performance of the automatic capture algorithm.
摘要翻译： 可植入心脏刺激装置和方法提供用于存储在每个幅度设置下传送的主要和备用刺激脉冲的数量的直方图，以监测自动捕获验证的性能。 刺激装置提供心脏刺激治疗，其中刺激直方图有利地存储在每个刺激输出或输出范围处递送的主要脉冲的数量，并且单独存储递送的高能量备用刺激脉冲的数量。 知道施加的刺激振幅的历史频率对于医师选择未来刺激脉冲输出设置和工作余量是有用的。 此信息也可用于确定预期的剩余电池寿命。 刺激直方图还提供了一种有用的诊断工具，用于评估刺激装置的完整性，引导系统和自动捕获算法的性能。
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