公开(公告)号：US5643328A

公开(公告)日：1997-07-01

申请号：US684429

申请日：1996-07-19

申请人： Daniel J. Cooke ,  David Prutchi ,  Patrick J. Paul

发明人： Daniel J. Cooke ,  David Prutchi ,  Patrick J. Paul

IPC分类号： A61N1/05 ,  A61N1/362 ,  A61N1/37 ,  A61N1/375

CPC分类号： A61N1/3708 ,  A61N1/05 ,  A61N1/375

摘要： An implantable cardiac stimulation system having a patient warning system and an elongated electrode mounted near the can of the system for providing reliable stimulation for warning. The electrode has an extended length and a short width. The length is preferably at least double the width and more preferably at least four times the width. This extended length increases the probability that contact with the surrounding tissue will be achieved. The short width and rounded profile of the width, forming an "edge", on the other hand, increases the probability that a high enough current density will be achieved, causing stimulation to occur. The electrode may also be curved along its length, which tends to promote a "point" or small area contact between the electrode and the patient's tissue. The electrode may be mounted directly on the can or header of the cardiac stimulator or may be part of a separate pin electrode. If a pin electrode is used, a hood configuration can be used to surround at least part of the header, reducing rotation of the pin electrode. By making only a portion of the surface of the pin electrode conductive, and particularly edges or corners, an elongated electrode, as described herein, is formed which produces a higher electric current density and more efficient stimulation.

摘要翻译： 一种植入式心脏刺激系统，其具有患者警告系统和安装在该系统的罐附近的细长电极，用于提供用于警告的可靠刺激。 电极具有延长的长度和短的宽度。 该长度优选为宽度的至少两倍，更优选地为该宽度的至少四倍。 这种延长的长度增加了与周围组织接触的可能性。 另一方面，形成“边缘”的宽度的短宽度和圆形轮廓增加了实现足够高的电流密度，导致刺激发生的可能性。 电极也可以沿其长度弯曲，这倾向于促进电极和患者组织之间的“点”或小面积的接触。 电极可以直接安装在心脏刺激器的容器或头部上，或者可以是单独的针电极的一部分。 如果使用引脚电极，则可以使用发动机罩构造来围绕头部的至少一部分，减少销电极的旋转。 通过仅使引脚电极的表面的一部分导电，特别是边缘或角部，形成如本文所述的细长电极，其产生较高的电流密度和更有效的刺激。

公开(公告)号：US06525986B2

公开(公告)日：2003-02-25

申请号：US09767040

申请日：2001-01-22

申请人： David Prutchi ,  Patrick J. Paul

发明人： David Prutchi ,  Patrick J. Paul

IPC分类号： G11C800

CPC分类号： A61N1/375 ,  H01L24/73 ,  H01L25/0657 ,  H01L2224/05554 ,  H01L2224/32145 ,  H01L2224/32225 ,  H01L2224/48091 ,  H01L2224/48137 ,  H01L2224/48145 ,  H01L2224/48147 ,  H01L2224/48227 ,  H01L2224/49175 ,  H01L2224/73265 ,  H01L2225/06506 ,  H01L2225/0651 ,  H01L2225/06555 ,  H01L2225/06562 ,  H01L2924/01019 ,  H01L2924/14 ,  H01L2924/00 ,  H01L2924/00012 ,  H01L2924/00014

摘要： A memory device particularly useful in size-constrained electronic products, such as cardiac stimulators. To provide additional memory for such size-constrained products, memory chips are stacked one on top of another. The memory chips are configured to facilitate bonding without crossed contacts, using aligned bonding pads, vias, or castellations. Each memory chip also includes an address selection circuit that receives signals from one or more address lines to selectively enable and disable the memory chips in the stack.

公开(公告)号：US06208579B1

公开(公告)日：2001-03-27

申请号：US09347841

申请日：1999-07-02

申请人： David Prutchi ,  Patrick J. Paul

发明人： David Prutchi ,  Patrick J. Paul

IPC分类号： G11C800

CPC分类号： A61N1/375 ,  H01L24/73 ,  H01L25/0657 ,  H01L2224/05554 ,  H01L2224/32145 ,  H01L2224/32225 ,  H01L2224/48091 ,  H01L2224/48137 ,  H01L2224/48145 ,  H01L2224/48147 ,  H01L2224/48227 ,  H01L2224/49175 ,  H01L2224/73265 ,  H01L2225/06506 ,  H01L2225/0651 ,  H01L2225/06555 ,  H01L2225/06562 ,  H01L2924/01019 ,  H01L2924/14 ,  H01L2924/00 ,  H01L2924/00012 ,  H01L2924/00014

摘要： A memory device particularly useful in size-constrained electronic products, such as cardiac stimulators. To provide additional memory for such size-constrained products, memory chips are stacked one on top of another. The memory chips are configured to facilitate bonding without crossed contacts, using aligned bonding pads, vias, or castellations. Each memory chip also includes an address selection circuit that receives signals from one or more address lines to selectively enable and disable the memory chips in the stack.

摘要翻译： 在尺寸受限的电子产品中特别有用的记忆装置，例如心脏刺激器。 为了为这种尺寸受限的产品提供额外的存储器，存储器芯片被堆叠在另一个之上。 存储器芯片被配置为便于使用对准的接合焊盘，通孔或蓖体的无交叉接触的接合。 每个存储器芯片还包括地址选择电路，其接收来自一个或多个地址线的信号以选择性地启用和禁用堆叠中的存储器芯片。

公开(公告)号：US5735883A

公开(公告)日：1998-04-07

申请号：US766870

申请日：1996-12-13

申请人： Patrick J. Paul ,  David Prutchi

发明人： Patrick J. Paul ,  David Prutchi

IPC分类号： A61N1/37

CPC分类号： A61N1/3712

摘要： An implantable pacemaker with apparatus for detecting capture or adjusting the strength or duration of pacing pulses by assessing the mechanical evoked response that may be distinctly sensed through impedance sensing, pressure sensing, plethysmography or other suitable methods. When capture is to be detected or the strength or duration of the pacing pulses is to be adjusted, two pacing pulses are delivered to the heart in each cycle of a series of cardiac cycles. The first pulse is varied in strength or duration or both. The second pulse is maintained at a consistently high strength or duration to assure capture. The impedance of the heart is measured during a time window following the first pulse which is predicted to include a recognizable feature of the impedance waveform of the heart following a stimulating pulse. The magnitude of the first pulse is gradually changed until capture is lost. When the stimulation effect of the first pulse on the heart changes, the impedance measured during the window will change distinctly, indicating that a stimulus threshold has been detected.

摘要翻译： 一种可植入起搏器，其具有用于通过评估可通过阻抗感测，压力感测，体积描记法或其它合适方法明确感测到的机械诱发反应来检测捕获或调整起搏脉冲的强度或持续时间的装置。 当要检测到捕获或要调整起搏脉冲的强度或持续时间时，在一系列心动周期的每个循环中将两个起搏脉冲输送到心脏。 第一个脉冲的强度或持续时间是不同的，或两者都有差异。 第二脉冲保持在一致的高强度或持续时间以确保捕获。 在第一脉冲之后的时间窗中测量心脏的阻抗，该第一脉冲被预测为包括刺激脉冲之后心脏的阻抗波形的可识别特征。 第一个脉冲的幅度逐渐变化，直到捕获丢失为止。 当第一脉冲对心脏的刺激作用发生变化时，窗口内测得的阻抗会明显变化，表明已经检测到刺激阈值。

公开(公告)号：US5549653A

公开(公告)日：1996-08-27

申请号：US532961

申请日：1995-09-22

申请人： Lawrence J. Stotts ,  Patrick J. Paul ,  David Prutchi

发明人： Lawrence J. Stotts ,  Patrick J. Paul ,  David Prutchi

IPC分类号： A61N1/05 ,  A61N1/36 ,  A61N1/37 ,  A61N1/375 ,  A61N1/38 ,  A61N1/04

CPC分类号： A61N1/375 ,  A61N1/0563 ,  A61N1/362 ,  A61N1/3708

摘要： A cardiac simulation system with a patient warning apparatus, including a pin electrode insertable into a standard female socket in the header of a dual chamber pacer or multi-function cardiac stimulator. The cardiac stimulator has at least two sockets in a header, such as is commonly found in a dual chamber pacemaker. Rather than stimulating both chambers of the heart, the dual chamber pacemaker is programmed to function as a single chamber pacemaker, with a standard lead connecting one socket and its associated circuitry to a selected chamber of the heart, usually the ventricle. The pin electrode is inserted in the other socket, usually used for the sensing and stimulation of the atrium, and additional programming is provided to the pacemaker or stimulator to automatically produce an output stimulus through the atrial socket to the pin electrode whenever a condition exists requiring patient notification or warning. Our invention includes a specialized pin electrode with an orifice for a suture. The suture is anchored to excitable tissue in a secure fashion to assure contact of the electrode with the tissue and thus stimulation of the tissue.

摘要翻译： 一种具有患者警告装置的心脏模拟系统，包括可插入双室起搏器或多功能心脏刺激器的头部中的标准母插座中的针电极。 心脏刺激器在头部中具有至少两个插座，例如通常在双室起搏器中发现。 双室心脏起搏器不是刺激心脏的两个腔室，而是被编程为用作单室起搏器，标准引线将一个插座及其相关联的电路连接到心脏的选定室，通常是心室。 引脚电极插入另一个插座，通常用于感应和刺激心房，并且当存在条件时需要额外的程序设计提供给起搏器或刺激器，以自动产生通过心房插座的输出刺激到针电极 病人通知或警告。 我们的发明包括具有用于缝线的孔的专用针电极。 缝线以安全的方式锚定到可兴奋的组织，以确保电极与组织的接触，从而刺激组织。

公开(公告)号：US06788972B2

公开(公告)日：2004-09-07

申请号：US10371609

申请日：2003-02-21

申请人： David Prutchi ,  Patrick J. Paul ,  Gregory R. Martin

发明人： David Prutchi ,  Patrick J. Paul ,  Gregory R. Martin

IPC分类号： A61N137

CPC分类号： A61N1/36521 ,  A61M5/142 ,  A61M5/14244 ,  A61M5/16854 ,  A61N1/3706 ,  A61N2001/083

摘要： A cardiac stimulator capable of measuring pacing impedance includes a tank capacitor for delivering charge to the heart via device leads, a shunt resistor, and high-impedance buffers for measuring pacing current through the shunt resistor. Soon after the leading edge of the stimulation pulse, the voltage across the shunt resistor, as sampled by a high-impedance buffer, indicates lead and cardiac tissue resistance. Just prior to opening the pacing switch to terminate the stimulation pulse, the voltage across the shunt resistor is sampled by a high-impedance buffer and held once again to allow the capacitance of the lead/heart tissue to be calculated. In alternative embodiments, a high-impedance buffer measures the voltage between the tank capacitor and ground immediately following the stimulation pulse to allow estimation of the lead/heart tissue capacitance. In one alternative embodiment, a look-up table is created in main memory and searched to find the closest lead/heart tissue capacitance estimate to any arbitrary degree of accuracy. In another alternative embodiment, the lead/heart tissue capacitance is estimated by successive approximation to any arbitrary degree of accuracy. When the lead/heart tissue capacitance and lead resistance have been determined, a plurality of parameters of importance for analyzing and optimizing a cardiac stimulation system may be calculated, such as the instantaneous current, the average current, the charge, and the energy delivered to the cardiac tissue.

摘要翻译： 能够测量起搏阻抗的心脏刺激器包括用于通过器件引线将电荷递送到心脏的储能电容器，分流电阻器和用于测量通过分流电阻器的起搏电流的高阻抗缓冲器。 在刺激脉冲的前沿之后不久，由高阻抗缓冲液取样的分流电阻器两端的电压表示铅和心脏组织的电阻。 在打开起搏开关以终止刺激脉冲之前，分流电阻器两端的电压由高阻抗缓冲器采样，并再次保持以允许计算铅/心脏组织的电容。 在替代实施例中，高阻抗缓冲器在刺激脉冲之后立即测量储能电容器和地之间的电压，以允许对铅/心脏组织电容的估计。 在一个备选实施例中，在主存储器中创建查找表并搜索以找到任何任意精度的最接近的引导/心脏组织电容估计。 在另一替代实施例中，通过逐次逼近任何任意精度来估计引导/心脏组织电容。 当确定了铅/心脏组织电容和引线电阻时，可以计算多个用于分析和优化心脏刺激系统的参数，例如瞬时电流，平均电流，电荷和递送至 心脏组织。

公开(公告)号：US5944744A

公开(公告)日：1999-08-31

申请号：US19751

申请日：1998-02-06

申请人： Patrick J. Paul ,  David Prutchi

发明人： Patrick J. Paul ,  David Prutchi

IPC分类号： A61B5/0402 ,  A61N1/37

CPC分类号： A61N1/3706 ,  A61N1/3704

摘要： An implantable medical device for electrically stimulating the heart to beat generally includes a processor, a plurality of electrodes, a sense amplifier, a pair of comparators, inner and outer target logic units, and pulse generator. The processor controls the magnitudes of inner and outer target reference signals which are generated by the inner and outer target logic units, respectively. The outer target is adjusted to be approximately equal to the peak amplitude of the cardiac signal. The processor stores representations of the outer target reference in memory. Alternatively or additionally, the processor computes a histogram of the relative or absolute number of cardiac cycles that occur over a given period of time for each outer target setting. The processor can be directed to retrieve the outer target representations and/or the histogram from memory and transmit that information to an external programmer for use by a physician.

摘要翻译： 用于电激励心跳的可植入医疗装置通常包括处理器，多个电极，读出放大器，一对比较器，内部和外部目标逻辑单元以及脉冲发生器。 处理器分别控制由内部和外部目标逻辑单元产生的内部和外部目标参考信号的大小。 外部目标被调整为近似等于心脏信号的峰值振幅。 处理器将外部目标参考的表示存储在存储器中。 或者或另外，处理器计算针对每个外部目标设置在给定时间段内发生的心跳周期的相对或绝对数量的直方图。 处理器可以被引导以从存储器检索外部目标表示和/或直方图，并将该信息发送到外部编程器以供医生使用。

公开(公告)号：US5735882A

公开(公告)日：1998-04-07

申请号：US755699

申请日：1996-11-25

申请人： William B. Rottenberg ,  Patrick J. Paul ,  David Prutchi

发明人： William B. Rottenberg ,  Patrick J. Paul ,  David Prutchi

IPC分类号： A61N1/08 ,  A61N1/37 ,  A61N1/39

CPC分类号： A61N1/3706 ,  A61N1/3931 ,  A61N2001/083

摘要： A cardiac stimulator with a method and apparatus for automatically switching the cardiac stimulator to its normal mode from its backup mode. A fault monitor receives fault signals and determines whether a particular fault warrants activation of the backup mode. If so, a number of attempts to reactivate the normal mode are permitted. The normal mode may be reactivated if the stored information is valid and if the circuitry is operational.

摘要翻译： 一种心脏刺激器，具有用于将心脏刺激器从其备用模式自动切换到正常模式的方法和装置。 故障监视器接收故障信号，并确定特定故障是否需要激活备份模式。 如果是这样，许多尝试重新激活正常模式。 如果存储的信息有效并且电路可操作，则可以重新启动正常模式。

公开(公告)号：US5718720A

公开(公告)日：1998-02-17

申请号：US766526

申请日：1996-12-13

申请人： David Prutchi ,  Patrick J. Paul

发明人： David Prutchi ,  Patrick J. Paul

IPC分类号： A61N1/37

CPC分类号： A61N1/3712

摘要： An implantable cardiac stimulator for detecting capture or adjusting the strength or duration of pacing pulses by using an evoked response detector and periodically tuning the evoked response detector. When the electric evoked response detector is to be tuned, capture is verified by detecting the mechanical evoked response. As the magnitude of the stimulating pulse is adjusted to isolate the threshold as detected by the mechanical response detector. At the same time, the electrical evoked response is also monitored. The difference between the detected electrical signal following capture as detected by the mechanical response detector and the signal following non-capture is used to tune the electrical evoked response detection apparatus and algorithm. The energy of the pacing pulse can then be optimized by adjusting both strength and duration. A very small safety margin is needed since capture is continuously monitored by the electrical evoked response apparatus and a safety pulse is immediately applied if capture is lost. The safety pulse can be applied in the same cardiac cycle so that the heart beat remains controlled.

摘要翻译： 一种可植入心脏刺激器，用于通过使用诱发响应检测器和周期性地调谐诱发响应检测器来检测捕获或调整起搏脉冲的强度或持续时间。 当电诱发响应检测器被调谐时，通过检测机械诱发响应来验证捕获。 当由机械响应检测器检测到的刺激脉冲的幅度被调整以隔离阈值时。 同时，还监测电诱发响应。 使用机械响应检测器检测到的捕获后检测到的电信号与非捕获后的信号之间的差异用于调谐电诱发响应检测装置和算法。 然后可以通过调整强度和持续时间来优化起搏脉冲的能量。 需要非常小的安全余量，因为捕获被电诱发响应装置连续监测，并且如果捕获丢失，则立即施加安全脉冲。 安全脉冲可以在相同的心脏周期中应用，使心跳保持受控。

公开(公告)号：US5607459A

公开(公告)日：1997-03-04

申请号：US613127

申请日：1996-03-08

申请人： Patrick J. Paul ,  David Prutchi

发明人： Patrick J. Paul ,  David Prutchi

IPC分类号： A61N1/37 ,  A61N1/375

CPC分类号： A61N1/3708 ,  A61N1/375

摘要： A cardiac stimulator including a patient warning apparatus, having a real time-clock for delaying delivery of a warning stimulus until a preselected time of day. The time of day may be selected dynamically with respect to detected patterns of patient activity. The stimulator can adjust the time for delivery of patient warning based on the detected circadian rhythm of the patient. In one embodiment, the cardiac stimulator is an implantable pacemaker or defibrillator or combination which can also be programmed to automatically alter the peak voltage of its output stimulus, in particular, to increase the peak voltage of the output stimulus whenever a condition exists requiring patient notification or warning. A stimulus generator in the stimulator can delivers electrical current to the electrically conductive suture point or warning electrode at a preselected voltage level. A sensor for detecting patient reaction to a warning stimulus may be an accelerometer or motion/vibration transducer or other sensor capable of detecting a reaction to a warning stimulus. The level of the stimulus directed to the patient's skeletal muscle is regulated until a preselected magnitude of reaction has been achieved. The reaction is also maintained below a pre-selected maximum to avoid discomfort to the patient.

摘要翻译： 一种心脏刺激器，其包括患者警告装置，具有用于延迟警告刺激的传送的实时时钟，直到一天的预选时间。 相对于检测到的患者活动模式，可以动态地选择一天中的时间。 刺激器可以根据检测到的昼夜节律来调整患者警报的传送时间。 在一个实施例中，心脏刺激器是可植入起搏器或除颤器或组合，其也可被编程为自动改变其输出刺激的峰值电压，特别是当存在需要患者通知的情况时增加输出刺激的峰值电压 或警告。 刺激器中的刺激发生器可以以预选的电压电平将电流传递到导电缝合点或警告电极。 用于检测患者对警告刺激的反应的传感器可以是能够检测对警告刺激的反应的加速度计或运动/振动换能器或其他传感器。 调节针对患者骨骼肌的刺激水平，直到达到预定的反应程度。 反应也保持在预选的最大值以下，以避免患者的不适。