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    Cardiac stimulation during a refractory period
    1.
    发明授权
    Cardiac stimulation during a refractory period 失效
    电动高效神经兴奋刺激技术领域

    公开(公告)号：US07292888B2

    公开(公告)日：2007-11-06

    申请号：US10638855

    申请日：2003-08-11

    申请人： D. Curtis Deno ,  David E. Euler ,  Lawrence J. Mulligan ,  Edwin G. Duffin ,  David A. Igel

    发明人： D. Curtis Deno ,  David E. Euler ,  Lawrence J. Mulligan ,  Edwin G. Duffin ,  David A. Igel

    IPC分类号： A61N1/365

    CPC分类号： A61N1/36514 ,  A61N1/3627 ,  A61N1/36564 ,  A61N1/368

    摘要： A medical device, e.g., an implantable medical device, delivers one or more neurally-excitable stimulation pulses to myocardial tissue during a period when the tissue is refractory. The width of the pulses is less than or equal to approximately one half millisecond. In some embodiments, the current amplitude of the pulses is less than or equal to approximately twenty milliamps. In exemplary embodiments, the medical device delivers a pulse train of six or fewer pulses separated from each other by an interval that is greater than or equal to approximately ten milliseconds. In some embodiments, the medical device delivers pulses according to a schedule stored in a memory, or as a function of a monitored physiological parameter of a patient, such as an intracardiac pressure. In some embodiments, the medical device suspends or withholds delivery of neurally-excitable based on detection of cardiac ischemia.

    摘要翻译： 医疗装置，例如可植入的医疗装置，在组织难治的时期期间，向心肌组织递送一个或多个神经可兴奋的刺激脉冲。 脉冲的宽度小于或等于大约一个半毫秒。 在一些实施例中，脉冲的电流幅度小于或等于大约二十毫安。 在示例性实施例中，医疗设备递送彼此间隔大于或等于大约十毫秒的六个或更少个脉冲的脉冲串。 在一些实施例中，医疗装置根据存储在存储器中的计划或者作为患者的被监测的生理参数（例如心脏内压力）递送脉冲。 在一些实施方案中，基于心脏缺血的检测，医疗装置暂停或禁止神经可兴奋的递送。

    Implantable medical device for assessing heart failure state from Mechanical Pulsus Alternans
    5.
    发明授权
    Implantable medical device for assessing heart failure state from Mechanical Pulsus Alternans 有权
    用于评估机械Pulsus Alternans的心力衰竭状态的可植入医疗装置

    公开(公告)号：US06915157B2

    公开(公告)日：2005-07-05

    申请号：US10368278

    申请日：2003-02-18

    申请人： Tommy D. Bennett ,  Lawrence J. Mulligan ,  Edwin G. Duffin ,  Robert C. Hamlen ,  Wael Abo-Auda

    发明人： Tommy D. Bennett ,  Lawrence J. Mulligan ,  Edwin G. Duffin ,  Robert C. Hamlen ,  Wael Abo-Auda

    IPC分类号： A61B5/00 ,  A61B5/0215 ,  A61B5/0245 ,  A61B5/0452 ,  A61B5/04

    CPC分类号： A61B5/02405 ,  A61B5/0031 ,  A61B5/0215 ,  A61B5/0245 ,  A61B5/0452

    摘要： An implantable heart monitor (IHM) implanted in a patient's body having electrogram (EGM) sense electrodes coupled with EGM sense circuitry to generate sense events upon detection of cardiac depolarizations and a blood pressure measurement transducer disposed in a heart chamber and coupled with blood pressure measurement circuitry operates to assess heart failure state as a function of mechanical pulsus alternans (MPA). MPA episodes are detected, and MPA characteristics of the MPA episode are used alone or as a group as a diagnostic marker of HF state. The MPA episode data set can be stored in memory associated with a time and date stamp. The MPA characteristics of each MPA data set in a series of MPA data sets collected over time can be compared or plotted to determine if a trend indicative of change in HF state is discernible.

    摘要翻译： 一种植入式心脏监测器（IHM），其植入患者体内，其具有与EGM感测电路耦合的电描记图（EGM）感测电极，以便在检测到心脏去极化时产生感测事件，以及设置在心室中的血压测量换能器，并与血压测量结合 电路用于评估作为机械脉动交替（MPA）的函数的心力衰竭状态。 检测到MPA发作，MPA发作的MPA特征单独使用或作为HF状态的诊断标记使用。 MPA情节数据集可以存储在与时间和日期戳相关联的存储器中。 可以比较或绘制在一段时间内收集的一系列MPA数据集中的每个MPA数据集的MPA特性，以确定指示HF状态变化的趋势是否可辨别。

    Method and apparatus for identifying lead-related conditions using lead impedance measurements
    6.
    发明授权
    Method and apparatus for identifying lead-related conditions using lead impedance measurements 有权
    使用引线阻抗测量来识别引线相关条件的方法和装置

    公开(公告)号：US07047083B2

    公开(公告)日：2006-05-16

    申请号：US10260676

    申请日：2002-09-30

    申请人： Bruce D. Gunderson ,  Amisha S. Patel ,  Chad A. Bounds ,  Edwin G. Duffin

    发明人： Bruce D. Gunderson ,  Amisha S. Patel ,  Chad A. Bounds ,  Edwin G. Duffin

    IPC分类号： A61N1/05

    CPC分类号： A61N1/3925 ,  A61B5/0424 ,  A61N2001/083

    摘要： A method and apparatus for automatically detecting and diagnosing lead-related conditions is provided. Specifically, relatively short-term and relatively long-term impedance parameters are determined for detecting an impedance trend indicative of a lead-related condition such as an open circuit, which may be due to a conductor fracture or poor connection to an associated implantable medical device, or a short circuit due to an insulation breach. Monitoring of multiple lead impedance parameters is performed to diagnose a lead-related condition based on a number of diagnostic criteria. Supplementary analysis of multiple lead impedance parameter trends may be performed to identify lead-specific conditions, such as metal ion oxidation induced insulation degradation. A lead-related condition diagnosis and supporting data are stored in memory for uplinking to an external device for review by a clinician. A recommended corrective action and/or a patient notification signal for a lead-related condition may optionally be provided.

    摘要翻译： 提供了一种用于自动检测和诊断铅相关条件的方法和装置。 具体地，确定相对短期和相对长期的阻抗参数，用于检测指示诸如开路的引线相关状况的阻抗趋势，其可能是由于导体断裂或与相关联的可植入医疗装置的不良连接 ，或由于绝缘破坏引起的短路。 执行多个引线阻抗参数的监测，以根据多个诊断标准来诊断引线相关状况。 可以进行多个引线阻抗参数趋势的补充分析，以识别铅特异性条件，例如金属离子氧化诱导的绝缘降解。 引导相关状况诊断和支持数据存储在存储器中用于上行链接到外部设备以供临床医生审查。 可以可选地提供用于引线相关状况的推荐的纠正措施和/或患者通知信号。

    Mode switching pacemaker
    7.
    发明授权
    Mode switching pacemaker 失效
    模式切换机

    公开(公告)号：US5133350A

    公开(公告)日：1992-07-28

    申请号：US648469

    申请日：1991-01-31

    申请人： Edwin G. Duffin

    发明人： Edwin G. Duffin

    IPC分类号： A61N1/365 ,  A61N1/362

    CPC分类号： A61N1/3622 ,  A61N1/3688

    摘要： A mode switching bradycardia pacemaker especially adapted for incorporation in an antitachyarrhythmia pacing and/or cardioversion/defibrillation system, provides AAI pacing in the absence of an intrinsic atrial rate exceeding the pacing lower rate and as long as the patient's heart is capable of normal AV conduction. The pacemaker switches to VVI mode any time that the patient's ventricular rate falls below a predetermined value. The mode switching may be implemented in a DDD pacing system or in a pacing system employing an atrial and ventricular sense amplifier and a single pacing output circuit and switching circuitry for switching its output between atrial and ventricular leads. This bimodal operation allows use of AAI pacing for the antiarrhythmic and hemodynamic benefits of maintaining atrial function in patients with sinus node disease, by obviates the risk of ventricular asystole should the AAI mode become ineffective due to transiant or newly evolving permanent impairment of AV conduction in those patients where atrial synchronous tracking is considered undesirable. In the AAI/VVI bimodal operation, only a single chamber of the patient's heart is paced at any given time, AAI pacing occurs in the presence of spontaneous or conducted ventricular depolarization, and VVI pacing is resorted to in AV dissociation or in the absence of a ventricular rhythm exceeding the lower pacing rate.

    摘要翻译： 特别适用于并入抗心律失常起搏和/或心脏复律/除颤系统的模式切换心动过缓起搏器在没有内在心房率超过起搏较低速率的情况下提供AAI起搏，并且只要患者的心脏能够正常的AV传导 。 每当病人的心室率低于预定值时，起搏器就切换到VVI模式。 模式切换可以在DDD起搏系统中或在采用心房和心室感应放大器和单起搏输出电路和用于在心房和心室导联之间切换其输出的开关电路的起搏系统中实现。 这种双峰操作允许使用AAI起搏来维持窦房结疾病患者心房功能的抗心律失常和血液动力学优势，如果AAI模式由于横断面或新发生的AV传导永久性损伤而无效，则可消除室性心律失常的风险 那些心房同步跟踪的患者被认为是不合需要的。 在AAI / VVI双模式手术中，只有患者心脏的单个室在任何给定的时间进行起搏，AAI起搏发生在存在自发或进行性心室去极化的情况下，VVI起搏在AV解离或不存在 心室节律超过起搏速率较低。

    World wide patient location and data telemetry system for implantable medical devices
    8.
    发明授权
    World wide patient location and data telemetry system for implantable medical devices 失效
    世界范围的可植入医疗器械的患者位置和数据遥测系统

    公开(公告)号：US06292698B1

    公开(公告)日：2001-09-18

    申请号：US09045275

    申请日：1998-03-20

    申请人： Edwin G. Duffin ,  David L. Thompson ,  Steven D. Goedeke ,  Gregory J. Haubrich

    发明人： Edwin G. Duffin ,  David L. Thompson ,  Steven D. Goedeke ,  Gregory J. Haubrich

    IPC分类号： A61N137

    CPC分类号： A61N1/37282 ,  A61B5/1112 ,  G06F19/00 ,  G06F19/3418

    摘要： A system for communicating with a medical device implanted in an ambulatory patient and for locating the patient in order to selectively monitor device function, alter device operating parameters and modes and provide emergency assistance to and communications with a patient. The implanted device includes a telemetry transceiver for communicating data and operating instructions between the implanted device and an external patient communications control device that is either worn by or located in proximity to the patient within the implanted device transceiving range. The control device preferably includes a communication link with a remote medical support network, a global positioning satellite receiver for receiving positioning data identifying the global position of the control device, and a patient activated link for permitting patient initiated personal communication with the medical support network. A system controller in the control device controls data and voice communications for selectively transmitting patient initiated personal communications and global positioning data to the medical support network, for initiating telemetry out of data and operating commands from the implanted device and transmission of the same to the medical support network, and for receiving and initiating re-programming of the implanted device operating modes and parameters in response to instructions received from the medical support network. The communications link between the medical support network and the patient communications control device may comprise a world wide satellite network, hard-wired telephone network, a cellular telephone network or other personal communications system.

    摘要翻译： 一种用于与植入在步行病人中的医疗设备进行通信并用于定位患者的系统，以便选择性地监测设备功能，改变设备操作参数和模式，并向患者提供紧急援助并与患者通信。 植入装置包括遥测收发器，用于在植入的装置和外部患者通信控制装置之间传送数据和操作指令，所述外部患者通信控制装置在植入装置收发范围内由患者佩戴或位于患者附近。 控制装置优选地包括与远程医疗支持网络的通信链路，用于接收标识控制装置的全局位置的定位数据的全球定位卫星接收机，以及用于允许患者发起与医疗支持网络的个人通信的患者激活的链路。 控制装置中的系统控制器控制数据和语音通信，用于选择性地将患者发起的个人通信和全球定位数据发送到医疗支持网络，用于发起远程数据和从植入设备的操作命令并将其传输到医疗 支持网络，以及响应于从医疗支持网络接收到的指令，接收和启动植入设备操作模式和参数的重新编程。 医疗支持网络和患者通信控制设备之间的通信链路可以包括全球卫星网络，硬连线电话网络，蜂窝电话网络或其他个人通信系统。

    Method and apparatus for discriminating among normal and pathological tachyarrhythmias
    9.
    发明授权
    Method and apparatus for discriminating among normal and pathological tachyarrhythmias 失效
    用于诊断正常和病理性TACHYARRHYTHMIAS的方法和装置

    公开(公告)号：US5193550A

    公开(公告)日：1993-03-16

    申请号：US621133

    申请日：1990-11-30

    申请人： Edwin G. Duffin

    发明人： Edwin G. Duffin

    IPC分类号： A61N1/362

    CPC分类号： A61N1/3622

    摘要： A method and apparatus for discriminating among the various normal and pathologic tachycardias. In response to the detection of tachycardia, far-field ventricular electrograms sensed using atrial electrodes and far-field atrial electrograms sensed using ventricular electrodes are analyzed in order to categorize the source and type of tachyarrhythmia detected. The detection method and apparatus may be employed in conjunction with dual chamber anti-bradycardia pacemakers to avoid pacemaker mediated tachycardias or may be employed to mediate the delivery of pacing energy or cardioversion/defibrillation shock energy to a malfunctioning heart, in the context of an implantable antitachycardia device.

    摘要翻译： 用于区分各种正常和病理性心动过速的方法和装置。 为了响应心动过速的检测，分析使用心房电极感测的远场心室电图和使用心室电极感测的远场心房电描记图，以便对所检测到的快速性心律失常的来源和类型进行分类。 检测方法和装置可以与双室抗心动过缓起搏器结合使用，以避免起搏器介导的心动过速，或者可以用于在可植入物的情况下介导起搏能量或心脏复律/除颤休克能量传递到故障心脏 抗心律失常装置

    Method and apparatus to provide diagnostic index and therapy regulated by subject's autonomic nervous system
    10.
    发明授权
    Method and apparatus to provide diagnostic index and therapy regulated by subject's autonomic nervous system 有权
    提供受试者自主神经系统调节的诊断指标和治疗的方法和装置

    公开(公告)号：US08244355B2

    公开(公告)日：2012-08-14

    申请号：US10977073

    申请日：2004-10-29

    申请人： Tommy D. Bennett ,  Edwin G. Duffin ,  Barbro Kjellstrom

    发明人： Tommy D. Bennett ,  Edwin G. Duffin ,  Barbro Kjellstrom

    IPC分类号： A61N1/00

    CPC分类号： A61B5/0205 ,  A61B5/4035 ,  A61B5/7239 ,  A61N1/36535 ,  A61N1/36578 ,  A61N1/36585 ,  A61N1/36592 ,  A61N1/3702

    摘要： A system and method are provided for determining an index of autonomic nervous system (ANS) or sympathetic nervous system (SNS) activity for use in patient monitoring or therapy delivery control. An ANS or SNS index is calculated as a function of multiple monitored physiological variables that strongly correlate to changes in autonomic or sympathetic tone. These ANS-influenced variables are derived from selected hemodynamic and/or electrical signals and may include variables relating to any of: the maximum rate of pressure rise (dP/dtmax), the maximum rate of pressure decline (dP/dtmin), pulse pressure (PP), pre-ejection time interval (PEI) and/or systolic time interval (STI), heart rate (HR), heart rate variability (HRV), and baro-reflex gain. Changes in the ANS or SNS index may be used to automatically adjust a device delivered therapy.

    摘要翻译： 提供了一种用于确定用于患者监测或治疗递送控制的自主神经系统（ANS）或交感神经系统（SNS）活动指数的系统和方法。 ANS或SNS指数被计算为与自主神经或交感神经紧张度变化密切相关的多个被监测的生理变量的函数。 这些受ANS影响的变量来源于选定的血液动力学和/或电信号，并且可以包括与以下任何相关的变量：压力升高的最大速率（dP / dtmax），压力下降的最大速率（dP / dtmin），脉压 （PP），预喷射时间间隔（PEI）和/或收缩期间隔（STI），心率（HR），心率变异性（HRV）和压力反射增益。 可以使用ANS或SNS指数的变化来自动调整设备传递的治疗。