公开(公告)号：US06862476B2

公开(公告)日：2005-03-01

申请号：US10081709

申请日：2002-02-20

申请人： Gabriel A. Mouchawar ,  James D. Causey, III ,  Kelly H. McClure ,  J. Christopher Moulder ,  Paul A. Levine

发明人： Gabriel A. Mouchawar ,  James D. Causey, III ,  Kelly H. McClure ,  J. Christopher Moulder ,  Paul A. Levine

IPC分类号： A61N1/37 ,  A61N1/39

CPC分类号： A61N1/3704 ,  A61N1/3962

摘要： An implantable cardiac stimulation device and method provides reliable sensing of cardiac events to support cardiac pacing or fibrillation detection. The device comprises a sensing circuit that senses the cardiac events in accordance with a plurality of threshold characterizing parameters. A parameter control adjusts the threshold parameters responsive to the rate of the sensed cardiac events in a manner which precludes positive feedback to prevent continued oversensing, undersensing, or noise sensing.

摘要翻译： 可植入心脏刺激装置和方法提供心脏事件的可靠感测以支持心脏起搏或原纤维化检测。 该装置包括感测电路，其根据多个阈值特性参数来感测心脏事件。 参数控制以响应于感测到的心脏事件的速率的方式调整阈值参数，排除正反馈以防止持续的过度感测，欠感测或噪声感测。

公开(公告)号：US08447400B2

公开(公告)日：2013-05-21

申请号：US12822983

申请日：2010-06-24

申请人： Rohan A. More ,  Heidi Hellman ,  Eliot L. Ostrow ,  Paul A. Levine

发明人： Rohan A. More ,  Heidi Hellman ,  Eliot L. Ostrow ,  Paul A. Levine

IPC分类号： A61N1/368

CPC分类号： A61N1/368 ,  A61N1/3624 ,  A61N1/3684 ,  A61N1/3688

摘要： Systems and methods are provided for use by implantable medical devices equipped to deliver multi-site left ventricular (MSLV) pacing. MSLV is associated with a relatively long post-ventricular atrial blanking (PVAB) period that might limit the detection of pathologic rapid organized atrial tachycardias (OAT). In one example, MSLV cardiac resynchronization therapy (CRT) pacing is delivered within a tracking mode. A possible atrial tachycardia is detected based on the atrial rate exceeding an atrial tachycardia assessment rate (ATAR) threshold. The device then switches to single-site LV pacing, thereby effectively shortening the PVAB to detect additional atrial events that might otherwise be obscured, and thereby permitting the device to more reliably distinguish organized atrial tachycardias (such as atrial flutter) from sinus tachycardia. The device may also employ an automatic mode switch (AMS) threshold that is set higher than the ATAR threshold for use in switching from tracking modes to nontracking modes.

摘要翻译： 系统和方法被提供用于装备用于递送多部位左心室（MSLV）起搏的可植入医疗装置的使用。 MSLV与相对较长的心室后空位（PVAB）相关，可能限制病理性快速组织性房性心动过速（OAT）的检测。 在一个示例中，MSLV心脏再同步治疗（CRT）起搏在跟踪模式内递送。 基于心房速率超过心房心动过速评估率（ATAR）阈值，可以检测到心房心动过速。 然后，该装置切换到单位置LV起搏，从而有效地缩短PVAB以检测可能被模糊的额外的心房事件，从而允许该装置更可靠地区分有组织的心房心动过速（例如心房扑动）和窦性心动过速。 设备还可以采用设置为高于ATAR阈值的自动模式切换（AMS）阈值，用于从跟踪模式切换到非跟踪模式。

公开(公告)号：US08147416B2

公开(公告)日：2012-04-03

申请号：US11848586

申请日：2007-08-31

申请人： Timothy A. Fayram ,  Eric S. Fain ,  Paul A. Levine ,  Anders Björling

发明人： Timothy A. Fayram ,  Eric S. Fain ,  Paul A. Levine ,  Anders Björling

IPC分类号： A61B5/02 ,  A61B5/021

CPC分类号： A61B5/0215 ,  A61B5/02108 ,  A61B5/02116 ,  A61B5/02125 ,  A61B5/0285 ,  A61B5/0295 ,  A61B5/0452 ,  A61B5/6846 ,  A61B2562/0219 ,  A61N1/36564 ,  A61N1/36578 ,  A61N1/36585

摘要： Implantable systems, and methods for use therewith, for monitoring arterial blood pressure on a chronic basis are provided herein. A first signal indicative of electrical activity of a patient's heart, and a second signal indicative of mechanical activity of the patient's heart, are obtained using implanted electrodes and an implanted sensor. By measuring the times between various features of the first signal relative to features of the second signal, values indicative of systolic pressure and diastolic pressure can be determined. In specific embodiments, such features are used to determine a peak pulse arrival time (PPAT), which is used to determine the value indicative of systolic pressure. Additionally, a peak-to-peak amplitude at the maximum peak of the second signal, and the value indicative of systolic pressure, can be used to determine the value indicative of diastolic pressure.

摘要翻译： 本文提供了可植入系统及其使用方法，用于长期监测动脉血压。 使用植入电极和植入的传感器获得指示患者心脏的电活动的第一信号和指示患者心脏的机械活动的第二信号。 通过测量第一信号的各个特征相对于第二信号的特征之间的时间，可以确定指示收缩压和舒张压的值。 在具体实施例中，这些特征用于确定峰值脉冲到达时间（PPAT），其用于确定指示收缩压的值。 此外，可以使用在第二信号的最大峰值处的峰 - 峰幅度和指示收缩压的值来确定指示舒张压的值。

公开(公告)号：US20110319951A1

公开(公告)日：2011-12-29

申请号：US12822983

申请日：2010-06-24

申请人： Rohan A. More ,  Heidi Hellman ,  Eliot L. Ostrow ,  Paul A. Levine

发明人： Rohan A. More ,  Heidi Hellman ,  Eliot L. Ostrow ,  Paul A. Levine

IPC分类号： A61N1/368

CPC分类号： A61N1/368 ,  A61N1/3624 ,  A61N1/3684 ,  A61N1/3688

摘要： Systems and methods are provided for use by implantable medical devices equipped to deliver multi-site left ventricular (MSLV) pacing. MSLV is associated with a relatively long post-ventricular atrial blanking (PVAB) period that might limit the detection of pathologic rapid organized atrial tachycardias (OAT). In one example, MSLV cardiac resynchronization therapy (CRT) pacing is delivered within a tracking mode. A possible atrial tachycardia is detected based on the atrial rate exceeding an atrial tachycardia assessment rate (ATAR) threshold. The device then switches to single-site LV pacing, thereby effectively shortening the PVAB to detect additional atrial events that might otherwise be obscured, and thereby permitting the device to more reliably distinguish organized atrial tachycardias (such as atrial flutter) from sinus tachycardia. The device may also employ an automatic mode switch (AMS) threshold that is set higher than the ATAR threshold for use in switching from tracking modes to nontracking modes.

摘要翻译： 系统和方法被提供用于装备用于递送多部位左心室（MSLV）起搏的可植入医疗装置的使用。 MSLV与相对较长的心室后空泡（PVAB）相关，可能限制病理性快速组织性房性心动过速（OAT）的检测。 在一个示例中，MSLV心脏再同步治疗（CRT）起搏在跟踪模式内递送。 基于心房速率超过心房心动过速评估率（ATAR）阈值，可以检测到心房心动过速。 然后，该装置切换到单位置LV起搏，从而有效地缩短PVAB以检测可能被模糊的额外的心房事件，从而允许该装置更可靠地区分有组织的心房心动过速（例如心房扑动）和窦性心动过速。 设备还可以采用设置为高于ATAR阈值的自动模式切换（AMS）阈值，用于从跟踪模式切换到非跟踪模式。

公开(公告)号：US08082036B2

公开(公告)日：2011-12-20

申请号：US12266441

申请日：2008-11-06

申请人： Paul A. Levine ,  Amdt Godau

发明人： Paul A. Levine ,  Amdt Godau

IPC分类号： A61N1/37

CPC分类号： A61N1/3706

摘要： A system for automatically evaluating the sensing and detection of physiological processes by an implantable medical device, such as an implantable cardiac stimulation device. The system includes an automatic testing algorithm which iteratively adjusts at least one of the threshold and gain settings of the device and evaluates the accuracy of the detection for refining the programming of the device. The algorithm can include sampling the physiological process beginning at a relatively low rate to avoid excessive burden on the processing and battery capacity available and progressively increasing the rate to obtain higher resolution data. The algorithm can also evaluate the observed physiological process for periodicity and can determine repetition of an irregular pattern, such as bigeminy, and use the determined pattern for predictive purposes to refine the programming of the device. The algorithm employs observation of a change in observed pattern as indicia for loss of proper detection.

摘要翻译： 一种用于通过可植入医疗装置（例如可植入心脏刺激装置）自动评估生理过程的感测和检测的系统。 该系统包括自动测试算法，其迭代地调整设备的阈值和增益设置中的至少一个，并评估用于精简设备编程的检测的准确性。 该算法可以包括以相对较低的速率开始生理过程的采样，以避免对可用处理和电池容量的过度负担，并逐渐增加速率以获得更高分辨率的数据。 该算法还可以评估观察到的生理过程的周期性，并且可以确定诸如bigeminy的不规则图案的重复，并且使用确定的图案进行预测目的来改进设备的编程。 该算法使用观察模式的变化观察作为丢失适当检测的标记。

公开(公告)号：US20080312710A1

公开(公告)日：2008-12-18

申请号：US12195284

申请日：2008-08-20

申请人： Jeff Zimmer ,  Diane Crawford ,  Paul A. Levine

发明人： Jeff Zimmer ,  Diane Crawford ,  Paul A. Levine

IPC分类号： A61N1/365

CPC分类号： A61N1/3621 ,  A61N1/3624

摘要： The extended AV interval of an auto intrinsic conduction search of an implantable cardiac stimulation device has premature atrial contraction protection. A timer times a base AV interval and the extended AV interval. If the heart is paced with the extended AV interval and a premature atrial contraction is detected, the extended AV interval is maintained. Once a predetermined number of consecutive premature atrial contractions are detected, the extended AV interval is reset to the base AV interval.

摘要翻译： 可植入心脏刺激装置的自动内在传导搜索的扩展AV间隔具有过早的心房收缩保护。 A定时器乘以基本AV间隔和扩展AV间隔。 如果心脏以延长的AV间隔进行起搏，并且检测到过早的心房收缩，则维持延长的AV间隔。 一旦检测到连续的早期心房收缩的预定数量，则扩展的AV间隔被重新设置为基本AV间隔。

公开(公告)号：US07463926B1

公开(公告)日：2008-12-09

申请号：US11166618

申请日：2005-06-24

申请人： Paul A. Levine ,  Arndt Godau

发明人： Paul A. Levine ,  Arndt Godau

IPC分类号： A61N1/37

CPC分类号： A61N1/3706

摘要： A system for automatically evaluating the sensing and detection of physiological processes by an implantable medical device, such as an implantable cardiac stimulation device. The system includes an automatic testing algorithm which iteratively adjusts at least one of the threshold and gain settings of the device and evaluates the accuracy of the detection for refining the programming of the device. The algorithm can include sampling the physiological process beginning at a relatively low rate to avoid excessive burden on the processing and battery capacity available and progressively increasing the rate to obtain higher resolution data. The algorithm can also evaluate the observed physiological process for periodicity and can determine repetition of an irregular pattern, such as bigeminy, and use the determined pattern for predictive purposes to refine the programming of the device. The algorithm employs observation of a change in observed pattern as indicia for loss of proper detection.

摘要翻译： 一种用于通过可植入医疗装置（例如可植入心脏刺激装置）自动评估生理过程的感测和检测的系统。 该系统包括自动测试算法，其迭代地调整设备的阈值和增益设置中的至少一个，并评估用于精简设备编程的检测的准确性。 该算法可以包括以相对较低的速率开始生理过程的采样，以避免对可用处理和电池容量的过度负担，并逐渐增加速率以获得更高分辨率的数据。 该算法还可以评估观察到的生理过程的周期性，并且可以确定诸如bigeminy的不规则图案的重复，并且使用确定的图案进行预测目的来改进设备的编程。 该算法使用观察模式的变化观察作为丢失适当检测的标记。

公开(公告)号：US07430448B1

公开(公告)日：2008-09-30

申请号：US11219063

申请日：2005-09-01

申请人： Jeff Zimmer ,  Diane Crawford ,  Paul A. Levine

发明人： Jeff Zimmer ,  Diane Crawford ,  Paul A. Levine

IPC分类号： A61N1/362

CPC分类号： A61N1/3621 ,  A61N1/3624

摘要： The extended AV interval of an auto intrinsic conduction search of an implantable cardiac stimulation device has premature atrial contraction protection. A timer times a base AV interval and the extended AV interval. If the heart is paced with the extended AV interval and a premature atrial contraction is detected, the extended AV interval is maintained. Once a predetermined number of consecutive premature atrial contractions are detected, the extended AV interval is reset to the base AV interval.

摘要翻译： 可植入心脏刺激装置的自动内在传导搜索的扩展AV间隔具有过早的心房收缩保护。 A定时器乘以基本AV间隔和扩展AV间隔。 如果心脏以延长的AV间隔进行起搏，并且检测到过早的心房收缩，则维持延长的AV间隔。 一旦检测到连续的早期心房收缩的预定数量，则扩展的AV间隔被重新设置为基本AV间隔。

公开(公告)号：US20080234777A1

公开(公告)日：2008-09-25

申请号：US12132555

申请日：2008-06-03

申请人： Paul A. Levine

发明人： Paul A. Levine

IPC分类号： A61N1/37

CPC分类号： A61N1/3712 ,  A61N1/3684

摘要： An implantable cardiac stimulation device and associated method perform a true or blanking period ventricular undersensing detection algorithm in response to ventricular loss of capture not associated with fusion or a change in capture threshold. The test identifies an originating cause of loss of capture, which may be ventricular undersensing of intrinsic R-waves or premature ventricular contractions occurring during a ventricular blanking period or atrial undersensing of P-waves resulting in blanking period ventricular undersensing. A corrective action is taken to reduce the likelihood of blanking period ventricular undersensing by automatically adjusting device operating parameters. The corrective action may include automatic adjustment of atrial sensitivity, shortening of the ventricular blanking period, or adjustment of the base stimulation rate. Minimizing the blanking period ventricular undersensing improves device performance by avoiding back-up stimulation and minimizing the risk of pacemaker competition-induced arrhythmias.

摘要翻译： 可植入心脏刺激装置和相关联的方法执行真实或消隐期间心室不足检测算法以响应与融合无关的捕获的心室丢失或捕获阈值的变化。 该测试确定了捕获丧失的原因，其可能是内部R波的心室不足或在心室消融期间发生的室性早搏或P波的心房不足，导致消隐期心室不足感。 采取纠正措施，通过自动调整装置的工作参数，减少消融期心室不足的可能性。 纠正措施可以包括自动调整心房敏感性，缩短心室消隐期，或调整基础刺激率。 最小化消隐期心室不足可以通过避免备用刺激和最小化起搏器竞争引起的心律失常的风险来改善器械性能。

公开(公告)号：US20080091114A1

公开(公告)日：2008-04-17

申请号：US11618266

申请日：2006-12-29

申请人： Xiaoyi Min ,  Paul A. Levine ,  Eliot L. Ostrow

发明人： Xiaoyi Min ,  Paul A. Levine ,  Eliot L. Ostrow

IPC分类号： A61B5/02

CPC分类号： A61B5/0537 ,  A61B5/08 ,  A61B5/4869 ,  A61N1/36521 ,  A61N1/36535 ,  A61N1/36542 ,  A61N1/36585

摘要： Exemplary techniques for correlating thoracic impedance values with physiological status are described. One technique involves an implantable medical device (IMD) that includes means for correlating thoracic impedance values with a patient's physiological status and means for interpreting the correlated thoracic impedance values utilizing a patient-based threshold to detect a heart failure condition.

摘要翻译： 描述了将胸廓阻抗值与生理状态相关联的示例性技术。 一种技术涉及可植入医疗装置（IMD），其包括用于使胸部阻抗值与患者的生理状态相关联的装置，以及利用基于患者的阈值来解释相关的胸部阻抗值以检测心力衰竭状况的装置。