公开(公告)号：US4788980A

公开(公告)日：1988-12-06

申请号：US887297

申请日：1986-07-18

申请人： Brian M. Mann ,  Stuart W. Buchanan

发明人： Brian M. Mann ,  Stuart W. Buchanan

IPC分类号： A61N1/362 ,  A61N1/36

CPC分类号： A61N1/3622

摘要： An atrial tracking dual-chamber pacemaker and method of use for reducing the risk of initiating a pacer mediated tachycardia (PMT), and breaking such a PMT if once started. The pacemaker includes means for sensing a premature ventricular contraction (PVC). The pacemaker operates in a conventional manner unless a PVC is sensed. If a PVC is sensed, in accordance with one embodiment, an extended atrial refractory period is triggered in an attempt to block any retrograde atrial events resulting from the PVC. This is followed by an atrial alert time window. After a prescribed A-V delay subsequent to the timing out or other termination of the atrial alert time window, a ventricular stimulation pulse is generated, unless prior ventricular activity is sensed that inhibits such ventricular stimulation pulse. In accordance with another embodiment, the sensing of a PVC triggers, after a suitable refractory period, a retrograde sense period during which any sensed atrial electrical activity is presumed to be a retrograde event. Appropriate steps are taken in order to deal with the retrograde event to prevent its occurrence from triggering a PMT. If a PMT has started, a prescribed number of cycles of the PMT are counted, after which the same action used in response to a sensed PVC is triggered, which action disrupts the rhythm of the PMT so as to break it. If the PMT is not broken with the first attempt, the PVC response is recurringly generated after a prescribed number of subsequent PMT cycles.

摘要翻译： 心房跟踪双室起搏器和使用方法来降低起搏介导的心动过速（PMT）的风险，如果一旦开始就打破这种PMT。 起搏器包括用于感测早产性心室收缩（PVC）的手段。 起搏器以常规方式操作，除非检测到PVC。 如果检测到PVC，根据一个实施方案，触发延长的心房不应期，以试图阻止由PVC引起的任何逆行心房事件。 之后是心房警报时间窗口。 在心房警报时间窗口的超时或其他终止之后的规定的A-V延迟之后，产生心室刺激脉冲，除非感测到抑制这种心室刺激脉冲的先前的心室活动。 根据另一个实施例，PVC的感测在适当的不应期之后触发逆行感测期，在此期间任何感测到的心房电活动被认为是逆行事件。 采取适当的步骤来处理逆行事件，以防止其发生触发PMT。 如果PMT已经启动，则对PMT的规定数量的周期进行计数，在此之后触发响应于感测到的PVC所使用的相同动作，哪个动作会破坏PMT的节奏，从而破坏PMT的节奏。 如果PMT在第一次尝试中没有破坏，则PVC响应在规定数量的后续PMT周期之后反复生成。

公开(公告)号：US5350410A

公开(公告)日：1994-09-27

申请号：US980941

申请日：1992-11-23

申请人： Jonathan A. Kleks ,  Stuart W. Buchanan ,  Raymond J. Wilson ,  John W. Poore ,  Brian M. Mann

发明人： Jonathan A. Kleks ,  Stuart W. Buchanan ,  Raymond J. Wilson ,  John W. Poore ,  Brian M. Mann

IPC分类号： A61N1/365 ,  A61N1/37 ,  A61N1/362

CPC分类号： A61N1/3712 ,  A61N1/3716

摘要： An autocapture system within an implantable pulse generator automatically maintains the energy of a stimulation pulse at a level just above that which is needed to effectuate capture. The electrical post-stimulus signal of the heart following delivery of a stimulation pulse is compared to a polarization template, determined during a capture verification test. A prescribed difference between the polarization template and the post-stimulus signal indicates capture has occurred. Otherwise, loss of capture is presumed, and a loss-of-capture routine is invoked that increases the energy a prescribed amount to obtain capture. Periodically, and/or at programmed intervals or events, the capture verification test is performed. During the capture verification test, the pulse generator determines a polarization template for a particular stimulation energy and for each of a plurality of sensitivity or threshold settings. A determination is also made as to which sensitivity settings yield capture. An autocapture routine extends the capture verification test data to a wide range of stimulation energies. An autothreshold routine automatically sets the energy of the stimulation pulse a specified level above the energy at which capture is first lost.

摘要翻译： 可植入脉冲发生器内的自动捕获系统自动将刺激脉冲的能量维持在刚好高于实现捕获所需的水平的水平。 输送刺激脉冲后心脏的电刺激后信号与在捕获验证测试期间确定的极化模板进行比较。 偏振模板和后刺激信号之间的规定的差异表明已经发生捕获。 否则，假设捕获的丢失，并且调用丢失捕获程序，将能量增加到规定的量以获得捕获。 周期性地和/或以编程间隔或事件进行捕获验证测试。 在捕获验证测试期间，脉冲发生器确定用于特定刺激能量和多个灵敏度或阈值设置中的每一个的偏振模板。 还决定哪个灵敏度设置产生捕获。 自动捕获程序将捕获验证测试数据扩展到广泛的刺激能量。 自动阈值程序自动将刺激脉冲的能量设置在高于捕获首次丢失的能量的指定水平。

公开(公告)号：US5417718A

公开(公告)日：1995-05-23

申请号：US240042

申请日：1994-05-09

申请人： Jonathan A. Kleks ,  Stuart W. Buchanan ,  Raymond J. Wilson ,  John W. Poore ,  Brian M. Mann

发明人： Jonathan A. Kleks ,  Stuart W. Buchanan ,  Raymond J. Wilson ,  John W. Poore ,  Brian M. Mann

IPC分类号： A61N1/365 ,  A61N1/37

CPC分类号： A61N1/3712 ,  A61N1/3716

摘要： An autocapture system within an implantable pulse generator automatically maintains the energy of a stimulation pulse at a level just above that which is needed to effectuate capture. The electrical post-stimulus signal of the heart following delivery of a stimulation pulse is compared to a polarization template, determined during a capture verification test. A prescribed difference between the polarization template and the post-stimulus signal indicates capture has occurred. Otherwise, loss of capture is presumed, and a loss-of-capture routine is invoked that increases the energy a prescribed amount to obtain capture. Periodically, and/or at programmed intervals or events, the capture verification test is performed. During the capture verification test, the pulse generator determines a polarization template for a particular stimulation energy and for each of a plurality of sensitivity or threshold settings. A determination is also made as to which sensitivity settings yield capture. An autocapture routine extends the capture verification test data to a wide range of stimulation energies. An autothreshold routine automatically sets the energy of the stimulation pulse a specified level above the energy at which capture is first lost.

摘要翻译： 可植入脉冲发生器内的自动捕获系统自动将刺激脉冲的能量维持在刚好高于实现捕获所需的水平的水平。 输送刺激脉冲后心脏的电刺激后信号与在捕获验证测试期间确定的极化模板进行比较。 偏振模板和后刺激信号之间的规定的差异表明已经发生捕获。 否则，假设捕获的丢失，并且调用丢失捕获程序，将能量增加到规定的量以获得捕获。 周期性地和/或以编程间隔或事件进行捕获验证测试。 在捕获验证测试期间，脉冲发生器确定用于特定刺激能量和多个灵敏度或阈值设置中的每一个的偏振模板。 还决定哪个灵敏度设置产生捕获。 自动捕获程序将捕获验证测试数据扩展到广泛的刺激能量。 自动阈值程序自动将刺激脉冲的能量设置在高于捕获首次丢失的能量的指定水平。

公开(公告)号：US4825870A

公开(公告)日：1989-05-02

申请号：US064899

申请日：1987-06-19

申请人： Brian M. Mann ,  Stuart W. Buchanan

发明人： Brian M. Mann ,  Stuart W. Buchanan

IPC分类号： A61N1/368 ,  A61N1/00

CPC分类号： A61N1/368 ,  A61N1/3682

摘要： Programmable timing and logic circuitry is provided to detect crosstalk between paced chambers of the heart and to provide compensation in the event crosstalk is detected. Signals sensed during a prescribed time window early in the cardiac cycle following an atrial pulse are presumed to be crosstalk. If crosstalk occurs, a shortened AV delay is triggered. If crosstalk does not occur, a programmed AV delay is maintained. Absent the occurrence of a ventricular event after the prescribed time window up to the end of the AV delay, a ventricular stimulation pulse is provided. If a ventricular event is sensed during this time, the ventricular stimulation pulse is inhibited.

摘要翻译： 可编程时序和逻辑电路用于检测心脏节奏室之间的串扰，并在发现串扰被检测的情况下提供补偿。 在心房脉搏之后心脏周期早期的规定时间窗内感测到的信号被认为是串扰。 如果发生串扰，则会触发缩短的AV延迟。 如果不发生串扰，则维持编程的AV延迟。 在规定的时间窗口到AV延迟结束之后没有发生心室事件，提供了心室刺激脉冲。 如果在此期间感测到心室事件，则抑制心室刺激脉冲。

公开(公告)号：US5074308A

公开(公告)日：1991-12-24

申请号：US588226

申请日：1990-09-26

申请人： Jason A. Sholder ,  Stuart W. Buchanan ,  Brian M. Mann

发明人： Jason A. Sholder ,  Stuart W. Buchanan ,  Brian M. Mann

IPC分类号： A61N1/365 ,  A61N1/362

CPC分类号： A61N1/3622

摘要： A pacemaker mediated tachycardia (PMT) is detected by circuitry within an implantable pacemaker. The PMT is detected by first detecting a tachycardia condition that includes a prescribed number of consecutive cardiac cycles having a rate faster than a prescribed rate. Each cardiac cycle of the tachycardia condition includes a natural atrial event, i.e., a P-wave, and a paced ventricular event, i.e., a V-pulse generated by a pacemaker. After the prescribed number of such cardiac cycles, e.g., two to ten, a P-V delay in a single cardiac cycle is modified by a first prescribed amount, e.g., 50 milliseconds. The time interval of a V-P interval associated with at least one cardiac cycle preceding the modified P-V delay is then compared to a V-P interval immediately following the modified P-V delay. Only if the difference between the V-P intervals thus measured is less than a second prescribed amount, e.g., 25 milliseconds, is a PMT indicated. If a PMT is indicated, a PMT termination regimen, e.g., extending PVARP, is automatically invoked by the pacemaker for a prescribed number of cardiac cycles, such as one or two cardiac cycles.

公开(公告)号：US5228438A

公开(公告)日：1993-07-20

申请号：US772822

申请日：1991-10-08

申请人： Stuart W. Buchanan

发明人： Stuart W. Buchanan

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

CPC分类号： A61N1/3622

摘要： An atrial tracking dual-chamber pacemaker and method of use thereof for terminating a pacemaker-mediated tachycardia (PMT). The pacemaker includes means for determining whether the present heart rate exceeds a tachycardia reference rate, and if so, whether a PMT-indicating sequence of a tracked P-wave, including a retrograde P-wave followed by a V-pulse, occurs repetitiously for at least a predetermined number of cardiac cycles. The pacemaker includes means for measuring the interval between a P-wave and a V-pulse (PVI) and sets the PVI to 250 milliseconds when the measured value is less than 250 milliseconds. The pacemaker issues a PMT-terminating timed atrial pulse which is timed from a retrograde P-wave by a time equal to the PVI, plus a delay of about 25-100 milliseconds. In the event the atrial pulse fails to terminate the PMT, the process is repeated after a fixed number of cardiac cycles has occurred. An alternate embodiment includes determining a ventricular escape interval (VEI) which is equal to the AEI plus the PVI. Upon the delivery of the timed atrial pulse, the pacemaker changes to the VDD mode of operation, and immediately upon the occurrence of the following V-pulse which is a VEI displaced from the prior pulse, the pacemaker reverts to the DDD mode of operation.

公开(公告)号：US5097832A

公开(公告)日：1992-03-24

申请号：US491385

申请日：1990-03-09

申请人： Stuart W. Buchanan

发明人： Stuart W. Buchanan

IPC分类号： A61N1/365 ,  A61N1/362

CPC分类号： A61N1/3622

摘要： An implantable pacemaker having means for detecting and responding to a premature ventricular contraction (PVC), also includes circuit means for minimizing the likelihood of sensing a PVC when in fact a PVC has not occurred. The circuit means latches the occurrence of any atrial events sensed during the relative atrial refractory period of the pacemaker, whether such atrial events are noise or an early P-wave; and, in response to such latching, disables the PVC detection circuit until certain prescribed events occur, whereupon the PVC detection circuit is re-enabled. The prescribed events that re-enable the PVC detection circuit after it has been disabled include, e.g., the occurrence of a ventricular pulse or sensed R-wave. Further, in the event a PVC is detected and a desired PVC response is invoked, an additional circuit means automatically terminates the PVC response in the event the PVC response becomes stuck.

公开(公告)号：US5507783A

公开(公告)日：1996-04-16

申请号：US372273

申请日：1995-01-11

申请人： Stuart W. Buchanan

发明人： Stuart W. Buchanan

IPC分类号： A61N1/362 ,  A61N1/36

CPC分类号： A61N1/3622

摘要： A pacemaker mediated tachycardia (PMT) is detected and suppressed in an implantable pacemaker operating in the VDD or VDDR modality. Such suppression is effectuated by extending the post ventricular atrial refractory period (PVARP) of the pacemaker to an extended PVARP that prevents retrograde P-waves from being tracked, thereby suppressing the PMT. The extended PVARP includes a retrograde window portion, following an absolute refractory portion. P-waves that occur during the retrograde window portion of the extended PVARP are deemed to be retrograde P-waves. The extended PVARP is returned to its original value whenever: (1) a P-wave is sensed following the extended PVARP, which P-wave is deemed to be a sinus P-wave, or (2) whenever a sufficient number of cardiac cycles elapse without the occurrence of a retrograde P-wave.

摘要翻译： 在以VDD或VDDR模式工作的可植入起搏器中，起搏器介导的心动过速（PMT）被检测和抑制。 通过将起搏器的心室心房不应期（PVARP）延长到延长的PVARP（其防止逆行P波）被跟踪，从而抑制PMT来实现这种抑制。 延伸的PVARP包括在绝对耐火部分之后的逆行窗口部分。 在延伸的PVARP的逆行窗口部分期间发生的P波被认为是逆行P波。 只要以下情况，扩展的PVARP将恢复到其原始值：（1）在扩展PVARP之后检测到P波，该P波被认为是窦性P波，或（2）每当足够数量的心动周期 经过不发生逆行P波。