公开(公告)号：US06606517B1

公开(公告)日：2003-08-12

申请号：US09548293

申请日：2000-04-12

申请人： Euljoon Park ,  Gene A. Bornzin ,  Joseph J. Florio ,  John W. Poore ,  Laurence S. Sloman ,  Peter Boileau ,  Douglas T. Kurschinski

发明人： Euljoon Park ,  Gene A. Bornzin ,  Joseph J. Florio ,  John W. Poore ,  Laurence S. Sloman ,  Peter Boileau ,  Douglas T. Kurschinski

IPC分类号： A61N1362

CPC分类号： A61N1/3622

摘要： A method and apparatus for reducing the incidence of atrial arrhythmias by using an overdrive algorithm to determine the application of overdrive stimulation pulses to a patient's heart, e.g., in the atria. In a first aspect of the invention, the apparatus first determines an overdrive pacing rate and then applies pairs of temporally spaced (staggered) pacing pulses, i.e., primary and secondary pacing pulses, at the determined overdrive pacing rate. In a further aspect of the invention, the pairs of pacing pulses are applied at the overdrive pacing rate to multiple spatially spaced electrodes, i.e., electrodes distributed among multiple sites in a patient's heart, e.g., in the atria. In accordance with a first preferred embodiment, the electrodes may be distributed within a single atrium, e.g., the right atrium, of the patient's heart. Alternatively, a first electrode may be placed in the right atrium and a second electrode may be placed in the coronary sinus or the left atrium or multiple electrodes may be placed proximate to the left atrium. Furthermore, the invention relates to techniques for controlling overdrive pacing to multiple sites in a patient's heart so as to achieve and maintain a target degree of pacing and thus suppress tachycardias.

摘要翻译： 一种用于通过使用过驱动算法来确定过度驱动刺激脉冲施加到患者心脏（例如在心房）中来减少心房心律失常发生率的方法和装置。 在本发明的第一方面中，装置首先确定过驱动起搏速率，然后以确定的超速起搏速率施加时间间隔（交错）的起搏脉冲，即初级和次级起搏脉冲。 在本发明的另一方面，以超速起搏速率将多对起搏脉冲施加到多个空间间隔开的电极，即分布在患者心脏中的多个部位之间的电极，例如在心房中。 根据第一优选实施例，电极可以分布在患者心脏的单个心房（例如右心房）内。 或者，第一电极可以放置在右心房中，并且第二电极可以放置在冠状窦或左心房中，或者多个电极可以放置在靠近左心房的位置。 此外，本发明涉及用于控制对患者心脏中的多个部位的超速起搏的技术，以便实现和维持目标起搏程度，从而抑制心动过速。

公开(公告)号：US06731985B2

公开(公告)日：2004-05-04

申请号：US09981555

申请日：2001-10-16

申请人： John W. Poore ,  Kerry Bradley ,  Laurence S. Sloman ,  Gene A. Bornzin ,  Joseph J. Florio

发明人： John W. Poore ,  Kerry Bradley ,  Laurence S. Sloman ,  Gene A. Bornzin ,  Joseph J. Florio

IPC分类号： A61N1362

CPC分类号： A61N1/3712

摘要： An implantable cardiac stimulation device and associated method perform an automatic calibration procedure for evaluating whether automatic capture verification can be recommended. The calibration procedure calculates and displays a number of variables for use by a medical practitioner in programming automatic capture operating parameters. An average paced depolarization integral (PDI) is determined from the cardiac signals following delivery of multiple stimulation pulse below and above capture threshold such that both pure lead polarization signals and evoked response signals may be analyzed. From the paced depolarization integral data, a capture threshold, a stimulation response curve, a minimum evoked response, a maximum lead polarization, an evoked response sensitivity, an evoked response safety margin, and a polarization safety margin are determined. Based on these variables, the calibration procedure determines if automatic capture verification can be recommended. If so, the stimulation device calculates a capture detection threshold. The automatic capture verification recommendation and the estimated calibration variables are displayed.

摘要翻译： 可植入心脏刺激装置和相关方法执行自动校准程序，以评估是否可以推荐自动捕获验证。 校准程序计算并显示许多变量，供医生在编程自动捕获操作参数时使用。 平均节奏去极化积分（PDI）是在多次刺激脉冲传递后低于和高于捕获阈值的心脏信号确定的，以便可以分析纯铅极化信号和诱发响应信号。 从起搏去极化积分数据中，确定捕获阈值，刺激响应曲线，最小诱发响应，最大引线极化，诱发响应灵敏度，诱发响应安全裕度和极化安全裕度。 基于这些变量，校准过程确定是否可以推荐自动捕获验证。 如果是，则刺激装置计算捕获检测阈值。 显示自动捕获验证建议和估计的校准变量。

公开(公告)号：US06456880B1

公开(公告)日：2002-09-24

申请号：US09712861

申请日：2000-11-14

申请人： Euljoon Park ,  Joseph J. Florio ,  Kerry Bradley ,  Gene A. Bornzin ,  Laurence S. Sloman

发明人： Euljoon Park ,  Joseph J. Florio ,  Kerry Bradley ,  Gene A. Bornzin ,  Laurence S. Sloman

IPC分类号： A61N1365

CPC分类号： A61N1/3702 ,  A61N1/365

摘要： An implantable cardiac stimulation device includes a system that monitors progression or regression of a patient's heart condition. The system includes a plurality of electrode configurations for sensing cardiac activity of the heart. A sensing circuit provides an electrical signal representing electrical activity of the heart from each of the sensing electrode configurations. A processor coupled to the sensing circuit determines, at spaced apart times, and over time, a ventricular repolarization interval in each of the electrical signals and a corresponding ventricular repolarization interval dispersion. A memory stores the ventricular repolarization interval dispersions for transmission by a telemetry circuit to an external receiver for analysis.

摘要翻译： 可植入心脏刺激装置包括监测患者心脏状况的进展或消退的系统。 该系统包括用于感测心脏的心脏活动的多个电极配置。 感测电路从每个感测电极配置提供表示心脏的电活动的电信号。 耦合到感测电路的处理器在间隔开的时间和时间上确定每个电信号中的心室复极间隔和对应的心室复极间隔分散。 存储器存储用于通过遥测电路传输到外部接收器用于分析的心室复极间隔分散体。

公开(公告)号：US06701187B1

公开(公告)日：2004-03-02

申请号：US10061567

申请日：2002-02-01

申请人： Gene A. Bornzin ,  Laurence S. Sloman ,  Peter Boileau ,  Joseph J. Florio

发明人： Gene A. Bornzin ,  Laurence S. Sloman ,  Peter Boileau ,  Joseph J. Florio

IPC分类号： A61N1362

CPC分类号： A61N1/3622 ,  A61N1/3956

摘要： An implantable cardiac stimulation device, e.g., a pacemaker or an implantable cardioverter defibrillator (ICD), is provided which prolongs the atrial refractoriness of a heart. The implantable cardiac stimulation device includes a generator that delivers pacing pulses to an atrium of a heart and a detector that detects atrial activations of the heart. An inhibitor is coupled to the detector that inhibits the generator when an atrial activation is detected within an escape interval. A generator control coupled to the generator causes the generator to deliver a primary pacing pulse to the atrium at the end of the escape interval, absent an atrial activation being detected within the escape interval, and causes the generator to deliver a secondary pacing pulse to the atrium a delay time after an atrial activation is detected within the escape interval or the delivery of a primary pacing pulse to the atrium.

摘要翻译： 提供可植入心脏刺激装置，例如起搏器或植入式心律转复除颤器（ICD），其延长心脏的心房不应性。 可植入心脏刺激装置包括将起搏脉冲传送到心脏心房的发生器和检测心脏心房激活的检测器。 当在逃避间隔内检测到心房激活时，抑制剂耦合到检测器，该检测器抑制发生器。 耦合到发生器的发生器控制器使得发生器在逃逸间隔结束时将主起搏脉冲递送到心房，没有在逃逸间隔内检测到心房激活，并且使得发生器将辅助起搏脉冲输送到 在转移间隔内检测到心房激活之后的延迟时间或者向心房传送初级起搏脉冲。

公开(公告)号：US06377852B1

公开(公告)日：2002-04-23

申请号：US09488284

申请日：2000-01-20

申请人： Gene A. Bornzin ,  Laurence S. Sloman ,  Peter Boileau ,  Joseph J. Florio

发明人： Gene A. Bornzin ,  Laurence S. Sloman ,  Peter Boileau ,  Joseph J. Florio

IPC分类号： A61N1362

CPC分类号： A61N1/3622 ,  A61N1/3956

摘要： An implantable cardiac stimulation device, e.g., a pacemaker or an implantable cardioverter defibrillator (ICD), is provided which prolongs the atrial refractoriness of a heart. The implantable cardiac stimulation device includes a generator that delivers pacing pulses to an atrium of a heart and a detector that detects atrial activations of the heart. An inhibitor is coupled to the detector that inhibits the generator when an atrial activation is detected within an escape interval. A generator control coupled to the generator causes the generator to deliver a primary pacing pulse to the atrium at the end of the escape interval, absent an atrial activation being detected within the escape interval, and causes the generator to deliver a secondary pacing pulse to the atrium a delay time after an atrial activation is detected within the escape interval or the delivery of a primary pacing pulse to the atrium.

摘要翻译： 提供可植入心脏刺激装置，例如起搏器或植入式心律转复除颤器（ICD），其延长心脏的心房不应性。 可植入心脏刺激装置包括将起搏脉冲传送到心脏心房的发生器和检测心脏心房激活的检测器。 当在逃避间隔内检测到心房激活时，抑制剂耦合到检测器，该检测器抑制发生器。 耦合到发生器的发生器控制器使得发生器在逃逸间隔结束时将主起搏脉冲递送到心房，没有在逃逸间隔内检测到心房激活，并且使得发生器将辅助起搏脉冲输送到 在转移间隔内检测到心房激活之后的延迟时间或者向心房传送初次起搏脉冲。

公开(公告)号：US06782291B1

公开(公告)日：2004-08-24

申请号：US09655438

申请日：2000-09-05

申请人： Gene A. Bornzin ,  Joseph J. Florio ,  Laurence S. Sloman ,  Brian M. Mann ,  Jason A. Sholder

发明人： Gene A. Bornzin ,  Joseph J. Florio ,  Laurence S. Sloman ,  Brian M. Mann ,  Jason A. Sholder

IPC分类号： A61N1372

CPC分类号： A61N1/3686 ,  A61N1/36185 ,  A61N1/371

摘要： An implantable cardiac stimulation device applies pacing stimulation pulses to a heart and senses evoked responses to the pacing stimulation pulses. A pulse generator applies the stimulation pacing pulses to the heart in accordance with a pacing configuration. A sensor control selects an evoked response sensing electrode configuration from among a plurality of evoked response sensing electrode configurations in response to the pacing configuration. A sensor is then programmed to sense the evoked responses with the selected evoked response sensing electrode configuration. In accordance with a preferred embodiment, signal-to-noise ratios obtained with the various electrode configurations are used to select a best electrode configuration for sensing evoked responses.

摘要翻译： 可植入心脏刺激装置将起搏刺激脉冲应用于心脏并感测对起搏刺激脉冲的诱发反应。 脉冲发生器根据起搏配置将刺激起搏脉冲施加到心脏。 传感器控制器响应于起搏配置从多个诱发响应感测电极配置中选择诱发响应感测电极配置。 然后将传感器编程为用所选择的诱发响应感测电极配置感测诱发的反应。 根据优选实施例，用各种电极配置获得的信噪比用于选择用于感测诱发响应的最佳电极配置。

公开(公告)号：US06904321B1

公开(公告)日：2005-06-07

申请号：US10208169

申请日：2002-07-29

申请人： Gene A. Bornzin ,  Joseph J. Florio ,  Laurence S. Sloman

发明人： Gene A. Bornzin ,  Joseph J. Florio ,  Laurence S. Sloman

IPC分类号： A61N1/37 ,  A61N1/36

CPC分类号： A61N1/3712

摘要： A multi-chamber stimulation device and associated method reliably and automatically distinguish fusion from loss of capture during ventricular stimulation. The stimulation device provides immediate and accurate fusion detection when a loss of capture is suspected in the ventricles without delivering back-up stimulation pulses. To achieve this objective, the far-field signal present in the atrial channel is examined for evidence of a far-field R-wave whenever the ventricular channel detects a loss of capture. If a far-field R-wave is present, fusion is confirmed, and a far-field R-wave is absent, loss of capture is confirmed. Additionally, the stimulation device inhibits unnecessary back-up stimulation and threshold tests when fusion occurs, and provides appropriate adjustment of stimulation parameters based on confirmed fusion detection such that fusion re-occurrence is minimized.

摘要翻译： 多室刺激装置和相关方法可靠和自动地将融合与心室刺激期间的捕获损失区分开来。 刺激装置提供即时和准确的融合检测，当脑袋怀疑丢失而不输送备用刺激脉冲时。 为了达到这个目的，每当心室通道检测到捕获的丢失时，都会检查存在于心房通道中的远场信号以获得远场R波的证据。 如果存在远场R波，则确认融合，并且不存在远场R波，确认捕获损失。 此外，当融合发生时，刺激装置抑制不必要的后备刺激和阈值测试，并且基于确认的融合检测提供刺激参数的适当调整，使得融合再现最小化。

公开(公告)号：US07233827B1

公开(公告)日：2007-06-19

申请号：US10865124

申请日：2004-06-09

申请人： Gene A. Bornzin ,  Joseph J. Florio ,  Laurence S. Sloman ,  Brian M. Mann ,  Jason A. Sholder

发明人： Gene A. Bornzin ,  Joseph J. Florio ,  Laurence S. Sloman ,  Brian M. Mann ,  Jason A. Sholder

IPC分类号： A61N1/365

CPC分类号： A61N1/3686 ,  A61N1/36185 ,  A61N1/371

摘要： An implantable cardiac stimulation device applies pacing stimulation pulses to a heart and senses evoked responses to the pacing stimulation pulses. A pulse generator applies the stimulation pacing pulses to the heart in accordance with a pacing configuration. A sensor control selects an evoked response sensing electrode configuration from among a plurality of evoked response sensing electrode configurations in response to the pacing configuration. A sensor is then programmed to sense the evoked responses with the selected evoked response sensing electrode configuration. In accordance with a preferred embodiment, signal-to-noise ratios obtained with the various electrode configurations are used to select a best electrode configuration for sensing evoked responses.

摘要翻译： 可植入心脏刺激装置将起搏刺激脉冲应用于心脏并感测对起搏刺激脉冲的诱发反应。 脉冲发生器根据起搏配置将刺激起搏脉冲施加到心脏。 传感器控制器响应于起搏配置从多个诱发响应感测电极配置中选择诱发响应感测电极配置。 然后将传感器编程为用所选择的诱发响应感测电极配置感测诱发的反应。 根据优选实施例，使用用各种电极配置获得的信噪比用于选择用于感测诱发响应的最佳电极配置。

公开(公告)号：US06456881B1

公开(公告)日：2002-09-24

申请号：US09630771

申请日：2000-08-02

申请人： Gene A. Bornzin ,  Joseph J. Florio ,  Laurence S. Sloman

发明人： Gene A. Bornzin ,  Joseph J. Florio ,  Laurence S. Sloman

IPC分类号： A61N136

CPC分类号： A61N1/3712

摘要： A multi-chamber stimulation device and associated method reliably and automatically distinguish fusion from loss of capture during ventricular stimulation. The stimulation device provides immediate and accurate fusion detection when a loss of capture is suspected in the ventricles without delivering back-up stimulation pulses. To achieve this objective, the far-field signal present in the atrial channel is examined for evidence of a far-field R-wave whenever the ventricular channel detects a loss of capture. If a far-field R-wave is present, fusion is confirmed, and a far-field R-wave is absent, loss of capture is confirmed. Additionally, the stimulation device inhibits unnecessary back-up stimulation and threshold tests when fusion occurs, and provides appropriate adjustment of stimulation parameters based on confirmed fusion detection such that fusion re-occurrence is minimized.

摘要翻译： 多室刺激装置和相关方法可靠和自动地将融合与心室刺激期间的捕获损失区分开来。 刺激装置提供即时和准确的融合检测，当脑袋怀疑丢失而不输送备用刺激脉冲时。 为了达到这个目的，每当心室通道检测到捕获的丢失时，都会检查存在于心房通道中的远场信号以获得远场R波的证据。 如果存在远场R波，则确认融合，并且不存在远场R波，确认捕获损失。 此外，当融合发生时，刺激装置抑制不必要的后备刺激和阈值测试，并且基于确认的融合检测提供刺激参数的适当调整，使得融合再现最小化。

公开(公告)号：US20130053912A1

公开(公告)日：2013-02-28

申请号：US13217554

申请日：2011-08-25

申请人： Gene A. Bornzin ,  Xiaoyi Min ,  Laurence S. Sloman ,  Steve Koh

发明人： Gene A. Bornzin ,  Xiaoyi Min ,  Laurence S. Sloman ,  Steve Koh

IPC分类号： A61N1/368

CPC分类号： A61B5/053 ,  A61B5/0205 ,  A61B5/0538 ,  A61B5/686 ,  A61N1/36185 ,  A61N1/3627 ,  A61N1/3686

摘要： Techniques are provided for use with an implantable medical device for detecting and assessing heart failure and for controlling cardiac resynchronization therapy (CRT) based on impedance signals obtained using hybrid impedance configurations. The hybrid configurations exploit right atrial (RA)-based impedance measurement vectors and/or left ventricular (LV)-based impedance measurement vectors. In one example, current is injected between the device case and a ring electrode in the right ventricle (RV) or RA. RA-based impedance values are measured along vectors between the device case and an RA electrode. LV-based impedance values are measured along vectors between the device case and one or more electrodes of the LV. Heart failure and other cardiac conditions are detected and tracked using the measured impedance values. CRT delay parameters are also optimized based impedance. In this manner, multiple hybrid impedance measurement configurations are exploited whereby different vectors are used to inject current and measure impedance.

摘要翻译： 提供技术用于可植入医疗装置，用于基于使用混合阻抗配置获得的阻抗信号来检测和评估心力衰竭并用于控制心脏再同步治疗（CRT）。 混合配置利用基于右心房（RA）的阻抗测量向量和/或左心室（LV））的阻抗测量向量。 在一个示例中，电流注入到装置壳体和右心室（RV）或RA中的环形电极之间。 基于RA的阻抗值是沿器件壳体和RA电极之间的矢量测量的。 基于LV的阻抗值在器件壳体和LV的一个或多个电极之间的矢量上测量。 使用测量的阻抗值检测和跟踪心力衰竭和其他心脏状况。 CRT延迟参数也是基于阻抗的优化。 以这种方式，利用多个混合阻抗测量配置，由此使用不同的矢量来注入电流并测量阻抗。