公开(公告)号：US6016447A

公开(公告)日：2000-01-18

申请号：US181022

申请日：1998-10-27

申请人： Carleen J. Juran ,  Kristin Yakimow ,  Michael B. Shelton ,  John C. Stroebel ,  H. Toby Markowitz ,  Pierce Vatterott ,  Harry A. Strandquist

发明人： Carleen J. Juran ,  Kristin Yakimow ,  Michael B. Shelton ,  John C. Stroebel ,  H. Toby Markowitz ,  Pierce Vatterott ,  Harry A. Strandquist

IPC分类号： A61N1/08 ,  A61N1/37

CPC分类号： A61N1/3706 ,  A61N2001/083

摘要： An automatic, body-implantable medical device having at least two modes of operation is disclosed. The device is provided with circuitry for automatically detecting when the device has been implanted in a patient, so that the device can automatically switch from a first mode to a second mode of operation upon implantation. In one embodiment, the first mode is a power conserving mode in which one or more non-essential sub-systems of the device are disabled. Prior to detection of implant, at least two conditions of the device known to reflect whether the device has been implanted are monitored. After implant has been detected, situations in which power to the device is disrupted and then restored will cause the device to enter a predefined "power-on-reset" mode of operation. Prior to detection of implant, however, such conditions do not result in the device entering the power-on-reset mode, or this mode is reset. An Elective Replacement Indicator mode is also used which is based on measured impedance against a target battery impedance. When the measured battery impedance reaches the target level, the voltage of the battery that precipitates an ERI condition is modified.

摘要翻译： 公开了具有至少两种操作模式的自动植入式医疗装置。 该装置设置有用于自动检测装置何时植入患者的电路，使得装置可以在植入时自动地从第一模式切换到第二模式。 在一个实施例中，第一模式是功率节省模式，其中该设备的一个或多个非必要子系统被禁用。 在检测植入物之前，监测已知反映装置是否植入的装置的至少两个条件。 在检测到植入物之后，设备电源中断然后恢复的情况将导致设备进入预定义的“上电复位”操作模式。 然而，在检测到植入物之前，这种条件不会导致器件进入上电复位模式，或者该模式被复位。 还使用选择性替换指示器模式，其基于针对目标电池阻抗的测量阻抗。 当测得的电池阻抗达到目标水平时，会改变引起ERI条件的电池电压。

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：US5522859A

公开(公告)日：1996-06-04

申请号：US343166

申请日：1994-11-22

申请人： John C. Stroebel ,  H. Toby Markowitz

发明人： John C. Stroebel ,  H. Toby Markowitz

IPC分类号： A61N1/365 ,  A61N1/368

CPC分类号： A61N1/368 ,  A61N1/36585

摘要： A dual chamber, rate-responsive pacemaker for pacing a patient's heart novelly allows tracking of the patient's sinus rate when the sinus rate is slightly less than the sensor rate; i.e., within a predetermined "Sinus Preference Window Maximum Rate Drop." Pacing at the sensor rate occurs when the sensor rate exceeds the sinus rate by more than the Sinus Preference Window Maximum Rate Drop. In the preferred embodiment a Sinus Preference Window, which occurs at the end of the ventricle-to-atrium interval, is decremented with successive heart beats by a programmable delta to increase the pacing rate until the Sinus Preference Window reaches zero, in which case the pacemaker paces at the sensor rate. The Sinus Preference Window is reset to its maximum value upon either the detection of an atrial sensed event, or upon the expiration of a programmable Sinus Check Interval. The pacemaker paces at the sinus rate or the maximum rate drop rate, whichever is faster, for a number of recovery beats, and then increments the pacing rate up to the sensor rate.

摘要翻译： 双室，速率响应的心脏起搏器用于起搏患者的心脏新颖地允许跟踪患者的窦速率，当窦速率略低于传感器速率时; 即在预定的“窦性偏好窗口最大速率下降”内。 当传感器速率超过窦性速率超过窦性偏好窗口最大速率下降时，会以传感器速率进行起搏。 在优选实施例中，在心室至心房间隔的末端发生的窦偏好窗口以连续的心跳递减可编程的增量以增加起搏速率直到窦偏好窗口达到零，在这种情况下 起搏器以传感器速率步进。 当检测到心房感应事件时，或者在可编程窦性检查间隔期满时，窦偏好窗口被重置为最大值。 起搏器以窦速率或最大速率下降速率（以更快者为准）起搏，以进行多次恢复搏动，然后将起搏速率递增至传感器速率。

公开(公告)号：US5273035A

公开(公告)日：1993-12-28

申请号：US829811

申请日：1992-02-03

申请人： H. Toby Markowitz ,  John C. Stroebel ,  Robert A. Betzold

发明人： H. Toby Markowitz ,  John C. Stroebel ,  Robert A. Betzold

IPC分类号： A61N1/362

CPC分类号： A61N1/3622

摘要： A dual chamber pacemaker is provided, preferably either DDDR or DDIR, having logic hardware and/or software for normally carrying out the DDIR or DDDR mode of operation, and further having means for carrying out a safe atrial pace method of operation in circumstances where normal atrial pacing could otherwise be competitive or result in loss of atrial capture. The pacemaker has means for detecting an atrial sense during PVARP, timing out a delay from the time of the early atrial sense, delivering a safe atrial pulse at the end of the delay, and controlling generation of a ventricular pace pulse in synchronous relation to the safe atrial pulse and with at least a minimum AV interval.

摘要翻译： 提供双室起搏器，优选DDDR或DDIR，具有用于正常执行DDIR或DDDR操作模式的逻辑硬件和/或软件，并且还具有用于在正常情况下执行安全心房步速的操作方法的装置 心房起搏可能会有竞争力或导致心房骤停。 起搏器具有在PVARP期间检测心房感觉的手段，从早期心房感觉时刻延迟，在延迟结束时传送安全的心房脉搏，并且控制与心室起搏脉冲的产生同步关系 安全的心房脉搏和至少最小的AV间隔。

公开(公告)号：US5480414A

公开(公告)日：1996-01-02

申请号：US259048

申请日：1994-06-13

申请人： John C. Stroebel ,  H. Toby Markowitz

发明人： John C. Stroebel ,  H. Toby Markowitz

IPC分类号： A61N1/365 ,  A61N1/37

CPC分类号： A61N1/36514 ,  A61N1/3712

摘要： A cardiac pacemaker improves battery longevity by automatically providing optimized threshold amplitude and pulse width values. During capture verification and threshold searching, the pacemaker delivers a pacing pulse and a rapid, maximum amplitude backup pulse in case the pacing pulse fails to capture a patient's heart. Unlike the prior art, the backup pulse is delivered before a predefined Vulnerable Period (during which time pacing might lead to re-entrant tachycardia or fibrillation). This results in threshold searching which is quick, accurate and with smaller rate drops during loss of capture. In another aspect of the present invention, a diagnostic strength-duration curve is approximated by first setting the pulse width to a maximum value and determining the amplitude threshold (rheobase), and then by doubling the amplitude and determining the pulse width threshold (chronaxie).

摘要翻译： 心脏起搏器通过自动提供优化的阈值幅度和脉冲宽度值来改善电池寿命。 在捕获验证和阈值搜索期间，起搏器可以在起搏脉冲无法捕获患者心脏的情况下提供起搏脉冲和快速，最大振幅的备用脉冲。 与现有技术不同，备用脉冲在预定义的易受伤时段之前（在该时间起搏可能导致进入性心动过速或颤动）期间被递送。 这导致阈值搜索是快速，准确的，并且在捕获丢失期间具有较小的速率下降。 在本发明的另一方面，通过首先将脉冲宽度设置为最大值并确定振幅阈值（rheobase），然后通过将幅度加倍并确定脉冲宽度阈值（chronaxie）近似诊断强度 - 持续时间曲线， 。

公开(公告)号：US5843137A

公开(公告)日：1998-12-01

申请号：US784687

申请日：1997-01-22

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：US5713933A

公开(公告)日：1998-02-03

申请号：US346815

申请日：1994-11-30

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：US5725561A

公开(公告)日：1998-03-10

申请号：US489262

申请日：1995-06-09

申请人： John C. Stroebel ,  Michael F. Hess ,  H. Toby Markowitz

发明人： John C. Stroebel ,  Michael F. Hess ,  H. Toby Markowitz

IPC分类号： A61N1/365 ,  A61N1/362 ,  A61N1/368

CPC分类号： A61N1/3622 ,  A61N1/368

摘要： A method and apparatus for variable rate cardiac stimulation, wherein sudden drops in the rate of delivery of stimulation pulses are avoided by means of rate smoothing and peak rate support functions. In one embodiment, circuitry in a cardiac pulse generator detects atrial events and maintains an updated value of the A-A time intervals between certain atrial events. If a preset ratio or total of these A-A intervals are found to have been shorter than the updated value by at a least a predetermined amount of time, a rate smoothing function is activated wherein the rate of delivery of stimulating pulses is prevented from changing, from cycle to cycle, by more than a predetermined maximum amount. A peak rate support function preferably employs the same updated value in the computation of "escape" intervals. Following the latest A-A interval, if that A-A interval is less than the updated value, then the updated value is used as the new escape interval. If the latest A-A interval is greater than or equal to the updated value but less than the previous updated value, the current escape interval is used as the new escape interval. If the latest A-A interval is less than both the previous updated value and the current updated value, the value updated is used as the new escape interval, and the pulse generator enters a decay mode wherein the escape interval is gradually and incrementally lengthened to prevent sudden changes in the rate of delivery of stimulation pulses.

摘要翻译： 用于可变速率心脏刺激的方法和装置，其中通过速率平滑和峰值速率支持功能来避免刺激脉冲的传送速率的突然下降。 在一个实施例中，心脏脉搏发生器中的电路检测心房事件并维持某些心房事件之间的A-A时间间隔的更新值。 如果这些AA间隔的预设比例或总和被发现至少比预定时间量更新的值短，则激活速率平滑功能，其中防止刺激脉冲的传送速率从 循环到循环，超过预定的最大量。 峰值速率支持功能优选地在计算“逃逸”间隔时使用相同的更新值。 按照最新的A-A间隔，如果A-A间隔小于更新的值，则更新的值将用作新的转义间隔。 如果最新的A-A间隔大于或等于更新值但小于先前更新的值，则将使用当前转义间隔作为新的转义间隔。 如果最近的AA间隔小于先前更新值和当前更新值，则更新的值被用作新的转义间隔，并且脉冲发生器进入衰减模式，其中逃逸间隔逐渐且逐渐地延长以防止突然 刺激脉冲传送速率的变化。

公开(公告)号：US5674257A

公开(公告)日：1997-10-07

申请号：US611357

申请日：1996-03-05

申请人： John C. Stroebel ,  H. Toby Markowitz

发明人： John C. Stroebel ,  H. Toby Markowitz

IPC分类号： A61N1/365 ,  A61N1/368

CPC分类号： A61N1/368 ,  A61N1/36585

摘要： A dual chamber, rate-responsive pacemaker for pacing a patient's heart novelly allows tracking of the patient's sinus rate when the sinus rate is slightly less than the sensor rate; i.e., within a predetermined "Sinus Preference Window Maximum Rate Drop." Pacing at the sensor rate occurs when the sensor rate exceeds the sinus rate by more than the Sinus Preference Window Maximum Rate Drop. In the preferred embodiment a Sinus Preference Window, which occurs at the end of the ventricle-to-atrium interval, is decremented with successive heart beats by a programmable delta to increase the pacing rate until the Sinus Preference Window reaches zero, in which case the pacemaker paces at the sensor rate. The Sinus Preference Window is reset to its maximum value upon either the detection of an atrial sensed event, or upon the expiration of a programmable Sinus Check Interval. The pacemaker paces at the sinus rate or the maximum rate drop rate, whichever is faster, for a number of recovery beats, and then increments the pacing rate up to the sensor rate.

摘要翻译： 双室，速率响应的心脏起搏器用于起搏患者的心脏新颖地允许跟踪患者的窦速率，当窦速率略低于传感器速率时; 即在预定的“窦性偏好窗口最大速率下降”内。 当传感器速率超过窦性速率超过窦性偏好窗口最大速率下降时，会以传感器速率进行起搏。 在优选实施例中，在心室至心房间隔的末端发生的窦偏好窗口以连续的心跳减少可编程的增量以增加起搏速率直到窦偏好窗口达到零，在这种情况下 起搏器以传感器速率步进。 当检测到心房感应事件时，或者在可编程窦性检查间隔期满时，窦偏好窗口被重置为最大值。 起搏器以窦速率或最大速率下降速率（以更快者为准）起搏，以进行多次恢复搏动，然后将起搏速率递增至传感器速率。

公开(公告)号：US08744579B2

公开(公告)日：2014-06-03

申请号：US12700454

申请日：2010-02-04

申请人： Purvee P. Parikh ,  John C. Stroebel ,  Todd J. Sheldon ,  Karen J. Kleckner

发明人： Purvee P. Parikh ,  John C. Stroebel ,  Todd J. Sheldon ,  Karen J. Kleckner

IPC分类号： A61N1/00

CPC分类号： A61N1/3627 ,  A61N1/3684 ,  A61N1/371

摘要： The invention provides methods and apparatus for determining in a non-tracking pacing mode (e.g., DDI/R, VVI/R) whether a ventricular pacing stimulus is capturing a paced ventricle, including some or all of the following aspects. For example, increasing a ventricular pacing rate a nominal amount to an overdrive pacing rate higher than a most recent heart rate and evaluating a conduction interval from a first pacing ventricle to a second sensing ventricle and then continuing to monitor the underlying rate to ensure that a threshold testing pacing rate will not exceed a predetermined minimum interval and providing pacing stimulation to the first ventricle and sensing the second ventricle to determine whether the pacing stimulation to the first ventricle was one of sub-threshold and supra-threshold. The methods and apparatus are especially useful in conjunction with ensuring actual delivery of a ventricular pacing regime (e.g., cardiac resynchronization therapy or “CRT”).

摘要翻译： 本发明提供了用于在非跟踪起搏模式（例如，DDI / R，VVI / R）中确定心室起搏刺激是否捕获节奏心室的方法和装置，包括以下方面中的一些或全部。 例如，将心室起搏速率提高到高于最近心率的超速起搏速率的标称值，并评估从第一起搏心室到第二感测心室的传导间隔，然后继续监测潜在速率，以确保 阈值测试起搏速率不会超过预定的最小间隔，并且向第一脑室提供起搏刺激并且感测第二脑室以确定对第一脑室的起搏刺激是否是子阈值和超阈值之一。 所述方法和装置与确保心室起搏方案（例如，心脏再同步治疗或“CRT”）的实际递送相结合特别有用。