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    Implantable medical device for treating cardiac mechanical dysfunction by electrical stimulation
    5.
    发明授权
    Implantable medical device for treating cardiac mechanical dysfunction by electrical stimulation 有权
    用于通过电刺激治疗心脏机械功能障碍的植入式医疗装置

    公开(公告)号：US06738667B2

    公开(公告)日：2004-05-18

    申请号：US09750631

    申请日：2000-12-28

    申请人： D. Curtis Deno ,  Lawrence J. Mulligan ,  Tom D. Bennett ,  David A. Igel ,  Michael R. S. Hill ,  Richard J. Shaw

    发明人： D. Curtis Deno ,  Lawrence J. Mulligan ,  Tom D. Bennett ,  David A. Igel ,  Michael R. S. Hill ,  Richard J. Shaw

    IPC分类号： A61N118

    CPC分类号： A61N1/3627 ,  A61N1/36564

    摘要： An implantable stimulator and monitor measures a group of heart failure parameters indicative of the state of heart failure employing EGM signals, measures of blood pressure including absolute pressure P, developed pressure (DP=systolic P−diastolic P), and/or dP/dt, and measures of heart chamber volume (V) over one or more cardiac cycles. These parameters include: (1) relaxation or contraction time constant tau (&tgr;); (2) mechanical restitution (MR), i.e., the mechanical response of a heart chamber to premature stimuli applied to the heart chamber; (3) recirculation fraction (RF), i.e., the rate of decay of PESP effects over a series of heart cycles; and (4) end systolic elastance (EES), i.e., the ratios of end systolic blood pressure P to volume V. These heart failure parameters are determined periodically regardless of patient posture and activity level. The physician can determine whether a particular therapy is appropriate, prescribe the therapy for a period of time while again accumulating the stored patient data for a later review and assessment to determine whether the applied therapy is beneficial or not, thereby enabling periodic changes in therapy, if appropriate. Drug therapies and electrical stimulation therapies, including PESP stimulation, and pacing therapies including single chamber, dual chamber and multi-chamber (bi-atrial and/or bi-ventricular) pacing can be delivered. In patient's prone to malignant tachyarrhythmias, the assessment of heart failure state can be taken into account in setting parameters of detection or classification of tachyarrhythmias and the therapies that are delivered.

    摘要翻译： 可植入的刺激器和监测器测量一组指示使用EGM信号的心力衰竭状态的心力衰竭参数，包括绝对压力P的血压测量，开发压力（DP =收缩期舒张压P）和/或dP / dt ，以及一个或多个心动周期的心室容量（V）的测量。 这些参数包括：（1）松弛或收缩时间常数τ（τ）; （2）机械恢复（MR），即心脏室对施加到心脏室的过早刺激的机械响应; （3）循环分数（RF），即一系列心脏循环中PESP效应的衰减速率; 和（4）收缩末期弹性（EES），即收缩末期血压P与体积V的比值。不管患者的姿势和活动水平如何，这些心力衰竭参数是周期性确定的。 医生可以确定特定治疗是否合适，在一段时间内开出治疗，同时再次累积存储的患者数据以供稍后进行检查和评估，以确定所应用的治疗是否有益，从而使治疗周期性变化， 如果合适的话。 可以提供药物治疗和电刺激疗法，包括PESP刺激和起搏治疗，包括单室，双室和多室（双心房和/或双心室）起搏。 在患者易发生恶性快速性心律失常的情况下，可以在设定快速性心律失常检测或分类参数和所传递的治疗方案时考虑心力衰竭状态的评估。

    Method and apparatus for treating diastolic heart failure
    6.
    发明授权
    Method and apparatus for treating diastolic heart failure 有权
    用于治疗舒张性心力衰竭的方法和装置

    公开(公告)号：US07792581B2

    公开(公告)日：2010-09-07

    申请号：US11363729

    申请日：2006-02-28

    申请人： Douglas A. Hettrick ,  Lawrence J. Mulligan ,  David E. Euler

    发明人： Douglas A. Hettrick ,  Lawrence J. Mulligan ,  David E. Euler

    IPC分类号： A61N1/365

    CPC分类号： A61N1/3627

    摘要： Methods and systems for treating patients with diastolic heart failure (DHF) are disclosed which include slowing a patient's heart rate below its intrinsic rate, and controlling the rate using cardiac pacing therapy to improve LV filling and cardiac output. In certain embodiments, a pacing treatment rate may be determined by adjusting an adaptive rate by an amount determined by evaluating one or more patient parameters.

    摘要翻译： 公开了用于治疗舒张性心力衰竭（DHF）患者的方法和系统，其包括将患者的心率降低到其内在速率以下，并且使用心脏起搏治疗来控制速率以改善LV灌注和心输出量。 在某些实施例中，起搏治疗率可以通过将自适应速率调整到通过评估一个或多个患者参数确定的量来确定。

    Cardiac stimulation during a refractory period
    7.
    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。

    Method and apparatus for measurement of mean pulmonary artery pressure from a ventricle in an ambulatory monitor
    8.
    发明授权
    Method and apparatus for measurement of mean pulmonary artery pressure from a ventricle in an ambulatory monitor 有权
    用于测量行走监测器中心室平均肺动脉压的方法和装置

    公开(公告)号：US06865419B2

    公开(公告)日：2005-03-08

    申请号：US09997753

    申请日：2001-11-30

    申请人： Lawrence J. Mulligan ,  Tom D. Bennett

    发明人： Lawrence J. Mulligan ,  Tom D. Bennett

    IPC分类号： A61B5/00 ,  A61B5/0205 ,  A61B5/0215 ,  A61B5/0402 ,  A61B5/0408 ,  A61B5/0478 ,  A61B5/0492 ,  A61N1/365

    CPC分类号： A61B5/0205 ,  A61B5/0006 ,  A61B5/0215

    摘要： A system and method for determining mean pulmonary arterial pressure (MPAP) using a pressure sensor located within a ventricle of a heart, and a signal indicative of cardiac electrical activity such as an electrocardiogram (EGM) signal. The pressure may be sensed within the right and/or left ventricle using an implanted pressure sensor. The sensed pressure may be used to determine the Ventricular Systolic Pressure (VSP) and an estimated Pulmonary Arterial Diastolic pressure (ePAD). The VSP, ePAD, and time intervals associated with systole and diastole may then be used to obtain an MPAP that closely approximates mean pulmonary arterial pressure measured using a sensor located in the pulmonary artery.

    摘要翻译： 使用位于心脏心室内的压力传感器和指示心脏电活动的信号（例如心电图（EGM））来确定平均肺动脉压（MPAP）的系统和方法。 可以使用植入的压力传感器在右和/或左心室内检测压力。 感测到的压力可用于确定心室收缩压（VSP）和估计的肺动脉舒张压（ePAD）。 然后可以使用与收缩和舒张相关的VSP，ePAD和时间间隔来获得使用位于肺动脉中的传感器测量的接近平均肺动脉压的MPAP。

    Implantable medical device for monitoring congestive heart failure
    9.
    发明授权
    Implantable medical device for monitoring congestive heart failure 失效
    用于监测充血性心力衰竭的植入式医疗装置

    公开(公告)号：US06438408B1

    公开(公告)日：2002-08-20

    申请号：US09751079

    申请日：2000-12-28

    申请人： Lawrence J. Mulligan ,  D. Curtis Deno ,  Tom D. Bennett ,  David A. Igel ,  Michael R. S. Hill

    发明人： Lawrence J. Mulligan ,  D. Curtis Deno ,  Tom D. Bennett ,  David A. Igel ,  Michael R. S. Hill

    IPC分类号： A61B50452

    CPC分类号： A61N1/36564 ,  G06F19/00

    摘要： An implantable stimulator and monitor measures a group of heart failure parameters indicative of the state of heart failure employing EGM signals, measures of blood pressure including absolute pressure P, developed pressure (DP=systolic P−diastolic P), and/or dP/dt, and measures of heart chamber volume (V) over one or more cardiac cycles. These parameters include: (1) relaxation or contraction time constant tau (&tgr;); (2) mechanical restitution (MR), i.e., the mechanical response of a heart chamber to premature stimuli applied to the heart chamber; (3) recirculation fraction (RF), i.e., the rate of decay of PESP effects over a series of heart cycles; and (4) end systolic elastance (EES), i.e., the ratios of end systolic blood pressure P to volume V. These heart failure parameters are determined periodically regardless of patient posture and activity level. However, certain of the parameters are only measured or certain of the data are only stored when the patient heart rate is regular and within a normal sinus range between programmed lower and upper heart rates. The parameter data is associated with a date and time stamp and with other patient data, e.g., patient activity level, and the associated parameter data is stored in IMD memory for retrieval at a later date employing conventional telemetry systems. Incremental changes in the parameter data over time, taking any associated time of day and patient data into account, provide a measure of the degree of change in the heart failure state of the heart.

    摘要翻译： 可植入的刺激器和监测器测量一组指示使用EGM信号的心力衰竭状态的心力衰竭参数，包括绝对压力P的血压测量，开发压力（DP =收缩期舒张压P）和/或dP / dt ，以及一个或多个心动周期的心室容量（V）的测量。 这些参数包括：（1）松弛或收缩时间常数τ（＆tgr;）; （2）机械恢复（MR），即心脏室对施加到心脏室的过早刺激的机械响应; （3）循环分数（RF），即一系列心脏循环中PESP效应的衰减速率; 和（4）收缩末期弹性（EES），即收缩末期血压P与体积V的比值。不管患者的姿势和活动水平如何，这些心力衰竭参数是周期性确定的。 然而，仅测量某些参数，或仅当患者心率为规律且在编程的较低和较高心率之间的正常窦范围内时才存储某些数据。 参数数据与日期和时间戳以及与其他患者数据（例如患者活动水平）相关联，并且相关联的参数数据存储在IMD存储器中，以便以后采用常规遥测系统进行检索。 随着时间的推移，随着时间的推移，随着时间的推移和相关的患者数据的变化，可以提供心脏心力衰竭状态的变化程度。