公开(公告)号：US07991467B2

公开(公告)日：2011-08-02

申请号：US11114474

申请日：2005-04-26

申请人： H. Toby Markowitz ,  Douglas A. Hettrick ,  William J. Combs ,  Todd J. Sheldon ,  David L. Thompson ,  Raja N. Ghanem ,  Kevin A. Wanasek

发明人： H. Toby Markowitz ,  Douglas A. Hettrick ,  William J. Combs ,  Todd J. Sheldon ,  David L. Thompson ,  Raja N. Ghanem ,  Kevin A. Wanasek

IPC分类号： A61B5/02 ,  A61N1/362

CPC分类号： A61N1/3962 ,  A61N1/025 ,  A61N1/37211 ,  A61N1/37229 ,  A61N1/37288

摘要： Subcutaneous Implantable cardioverter-defibrillators (SubQ ICDs) are disclosed that are entirely implantable subcutaneously with minimal surgical intrusion into the body of the patient and provide distributed cardioversion-defibrillation sense and stimulation electrodes for delivery of cardioversion-defibrillation shock and pacing therapies across the heart when necessary. The SubQ ICD is implemented with other implantable and external medical devices and communicates to provide drugs and therapy in a coordinated and synergistic manner.

摘要翻译： 皮下植入式心脏复律除颤器（SubQ ICD）被公开，其完全可植入皮下，以最小的外科手术入侵患者体内，并提供分布式心脏复律除颤感和刺激电极，用于在整个心脏中递送心脏复律除颤休克和起搏疗法 必要。 SubQ ICD与其他植入式和外部医疗设备一起实施，并以协调和协同的方式进行通信以提供药物和治疗。

公开(公告)号：US5902325A

公开(公告)日：1999-05-11

申请号：US126469

申请日：1998-07-30

申请人： Catherine R. Condie ,  Daniel J. Baxter ,  William J. Combs ,  Daniel J. Greeninger ,  Karen J. Kleckner ,  H. Toby Markowitz ,  John C. Stroebel ,  John D. Wahlstrand

发明人： Catherine R. Condie ,  Daniel J. Baxter ,  William J. Combs ,  Daniel J. Greeninger ,  Karen J. Kleckner ,  H. Toby Markowitz ,  John C. Stroebel ,  John D. Wahlstrand

IPC分类号： A61N1/365 ,  A61N1/37

CPC分类号： A61N1/36521 ,  A61N1/3712 ,  A61N1/3714

摘要： A method and apparatus for automatic determination of a pacemaker patient's pacing stimulation threshold. Circuitry is provided in a pacemaker for obtaining a signal reflecting cardiac impedance, which is known to reliably reflect certain aspects of cardiac function. Circuitry is also provided for monitoring the cardiac impedance waveform during a predetermined capture detect window following delivery of stimulating pulses. One or more values are derived which characterize the morphology of the impedance waveform during the capture detect window associated with each stimulation pulse delivered. These values are compared to predetermined control values in order to assess whether a stimulation pulse has achieved cardiac capture. The assessment of whether cardiac capture has been achieved is also based partly upon the conventional sensing of atrial and/or ventricular cardiac signals occurring during the capture detect window. In one embodiment of the invention, the control values against which impedance waveform characterization values are compared are obtained by delivering a series of stimulation pulses having sufficient energy to ensure that capture is achieved, and by monitoring the impedance waveform during delivery of these pulses.

摘要翻译： 一种用于自动确定起搏器患者起搏刺激阈值的方法和装置。 在起搏器中提供电路以获得反映心脏阻抗的信号，这已知可靠地反映心脏功能的某些方面。 还提供电路用于在传送刺激脉冲之后的预定捕获检测窗口期间监测心脏阻抗波形。 导出一个或多个值，其表征在与递送的每个刺激脉冲相关联的捕获检测窗口期间阻抗波形的形态。 将这些值与预定的控制值进行比较，以便评估刺激脉冲是否已经实现心脏捕获。 是否已经实现心脏捕获的评估也部分地基于在捕获检测窗口期间发生的心房和/或心室心脏信号的常规感测。 在本发明的一个实施例中，通过递送具有足够能量的一系列刺激脉冲来确定阻抗波形表征值被比较的控制值，以确保实现捕获，并且通过在传送这些脉冲期间监视阻抗波形来获得。

公开(公告)号：US5843137A

公开(公告)日：1998-12-01

申请号：US784687

申请日：1997-01-22

申请人： Catherine R. Condie ,  Daniel J. Baxter ,  William J. Combs ,  Daniel J. Greeninger ,  Karen J. Kleckner ,  H. Toby Markowitz ,  John C. Stroebel ,  John D. Wahlstrand

发明人： Catherine R. Condie ,  Daniel J. Baxter ,  William J. Combs ,  Daniel J. Greeninger ,  Karen J. Kleckner ,  H. Toby Markowitz ,  John C. Stroebel ,  John D. Wahlstrand

IPC分类号： A61N1/365 ,  A61N1/37

CPC分类号： A61N1/36521 ,  A61N1/3712 ,  A61N1/3714

摘要： A method and apparatus for automatic determination of a pacemaker patient's pacing stimulation threshold. Circuitry is provided in a pacemaker for obtaining a signal reflecting cardiac impedance, which is known to reliably reflect certain aspects of cardiac function. Circuitry is also provided for monitoring the cardiac impedance waveform during a predetermined capture detect window following delivery of stimulating pulses. One or more values are derived which characterize the morphology of the impedance waveform during the capture detect window associated with each stimulation pulse delivered. These values are compared to predetermined control values in order to assess whether a stimulation pulse has achieved cardiac capture. The assessment of whether cardiac capture has been achieved is also based partly upon the conventional sensing of atrial and/or ventricular cardiac signals occurring during the capture detect window. In one embodiment of the invention, the control values against which impedance waveform characterization values are compared are obtained by delivering a series of stimulation pulses having sufficient energy to ensure that capture is achieved, and by monitoring the impedance waveform during delivery of these pulses.

摘要翻译： 一种用于自动确定起搏器患者起搏刺激阈值的方法和装置。 在起搏器中提供电路以获得反映心脏阻抗的信号，这已知可靠地反映心脏功能的某些方面。 还提供电路用于在传送刺激脉冲之后的预定捕获检测窗口期间监测心脏阻抗波形。 导出一个或多个值，其表征在与递送的每个刺激脉冲相关联的捕获检测窗口期间阻抗波形的形态。 将这些值与预定的控制值进行比较，以便评估刺激脉冲是否已经实现心脏捕获。 是否已经实现心脏捕获的评估也部分地基于在捕获检测窗口期间发生的心房和/或心室心脏信号的常规感测。 在本发明的一个实施例中，通过递送具有足够能量的一系列刺激脉冲来确定阻抗波形表征值被比较的控制值，以确保实现捕获，并且通过在传送这些脉冲期间监视阻抗波形来获得。

公开(公告)号：US5713933A

公开(公告)日：1998-02-03

申请号：US346815

申请日：1994-11-30

申请人： Catherine R. Condie ,  Daniel J. Baxter ,  William J. Combs ,  Daniel J. Greeninger ,  Karen J. Kleckner ,  H. Toby Markowitz ,  John C. Stroebel ,  John D. Wahlstrand

发明人： Catherine R. Condie ,  Daniel J. Baxter ,  William J. Combs ,  Daniel J. Greeninger ,  Karen J. Kleckner ,  H. Toby Markowitz ,  John C. Stroebel ,  John D. Wahlstrand

IPC分类号： A61N1/365 ,  A61N1/37

CPC分类号： A61N1/36521 ,  A61N1/3712 ,  A61N1/3714

摘要： A method and apparatus for automatic determination of a pacemaker patient's pacing stimulation threshold. Circuitry is provided in a pacemaker for obtaining a signal reflecting cardiac impedance, which is known to reliably reflect certain aspects of cardiac function. Circuitry is also provided for monitoring the cardiac impedance waveform during a predetermined capture detect window following delivery of stimulating pulses. One or more values are derived which characterize the morphology of the impedance waveform during the capture detect window associated with each stimulation pulse delivered. These values are compared to predetermined control values in order to assess whether a stimulation pulse has achieved cardiac capture. The assessment of whether cardiac capture has been achieved is also based partly upon the conventional sensing of atrial and/or ventricular cardiac signals occurring during the capture detect window. In one embodiment of the invention, the control values against which impedance waveform characterization values are compared are obtained by delivering a series of stimulation pulses having sufficient energy to ensure that capture is achieved, and by monitoring the impedance waveform during delivery of these pulses.

摘要翻译： 一种用于自动确定起搏器患者起搏刺激阈值的方法和装置。 在起搏器中提供电路以获得反映心脏阻抗的信号，这已知可靠地反映心脏功能的某些方面。 还提供电路用于在传送刺激脉冲之后的预定捕获检测窗口期间监测心脏阻抗波形。 导出一个或多个值，其表征在与递送的每个刺激脉冲相关联的捕获检测窗口期间阻抗波形的形态。 将这些值与预定的控制值进行比较，以便评估刺激脉冲是否已经实现心脏捕获。 是否已经实现心脏捕获的评估也部分地基于在捕获检测窗口期间发生的心房和/或心室心脏信号的常规感测。 在本发明的一个实施例中，通过递送具有足够能量的一系列刺激脉冲来确定阻抗波形表征值被比较的控制值，以确保实现捕获，并且通过在传送这些脉冲期间监视阻抗波形来获得。

公开(公告)号：US07133718B2

公开(公告)日：2006-11-07

申请号：US10465351

申请日：2003-06-19

申请人： Earl E. Bakken ,  Rebecca M. Bergman ,  William J. Combs ,  H. Toby Markowitz

发明人： Earl E. Bakken ,  Rebecca M. Bergman ,  William J. Combs ,  H. Toby Markowitz

IPC分类号： A61N1/362

CPC分类号： A61N1/365 ,  A61N1/36592

摘要： A method and apparatus for varying a parameter in an implantable medical device that includes a plurality of electrodes stimulating heart tissue and sensing cardiac signals, a timing and control device controlling the stimulation of heart tissue by the plurality of electrodes and measuring intervals between the sensed cardiac signals, a storage device storing the measured intervals, and a microprocessor. The microprocessor determines heart rate variability in response to the stored intervals, compares the determined heart rate variability to a predetermined target rate profile, adjusts the parameter from a first setting to a second setting different from the first setting in response to the comparing of the determined heart rate variability and the predetermined target rate profile, and adjusts the parameter from the second setting to a termination setting in response to a termination event or expiration of a first predetermined time period.

摘要翻译： 一种用于改变可植入医疗装置中的参数的方法和装置，其包括刺激心脏组织和感测心脏信号的多个电极，控制多个电极对心脏组织刺激的定时和控制装置，并且测量感测的心脏 信号，存储测量的间隔的存储装置和微处理器。 微处理器响应于存储的间隔来确定心率变异性，将确定的心率变异性与预定的目标速率分布进行比较，响应于所确定的心率变异性的比较，将参数从第一设置调整到与第一设置不同的第二设置 心率变异性和预定目标速率曲线，并且响应于终止事件或第一预定时间段的期满，将参数从第二设置调整到终止设置。

公开(公告)号：US6044297A

公开(公告)日：2000-03-28

申请号：US160647

申请日：1998-09-25

申请人： Todd J. Sheldon ,  William J. Combs ,  Mark K. Erickson ,  Can Cinbis

发明人： Todd J. Sheldon ,  William J. Combs ,  Mark K. Erickson ,  Can Cinbis

IPC分类号： A61N1/365 ,  A61N1/362

CPC分类号： A61N1/36542 ,  A61N1/36535

摘要： A method of and apparatus for determining the physical posture of a patient's body, having a superior-inferior body axis, an anterior-posterior body axis and a lateral-medial body axis, in relation to earth's gravitational field. A medical device having first, second and, optionally, third accelerometers having sensitive axes mounted orthogonally within an implantable housing is adapted to be implanted with the sensitive axes nominally aligned with ideal X, Y and Z device axes correlated to patient body axes. Each accelerometer generates DC accelerometer signals having characteristic magnitudes and polarities on alignment of the sensitive axis with, against or normal to earth's gravitational field and DC accelerometer signals of varying magnitudes and polarities when not so aligned. The actual pitch and roll angles of the sensitive axes of the accelerometers in the implanted IMD with respect to the true gravitational axes are determined and the yaw angles are determined or estimated. Corrected DC accelerometer output signals are derived from the pitch, roll and yaw angles and are compared to a set of stored thresholds for each body posture to determine the actual body posture. Storage of these comparisons or the raw signals themselves can be used for histogram data to provide theraputic or research benefits also described.

摘要翻译： 一种用于确定患者身体的物理姿势的方法和装置，其具有相对于地球重力场的上下身体轴线，前后身体轴线和侧向内侧身体轴线。 具有第一，第二和第三加速度计的医疗设备具有正交安装在可植入的外壳内的敏感轴，适于植入与名义上与理想的与患者体轴相关的X，Y和Z装置轴对准的敏感轴。 每个加速度计产生具有特征幅度和极性的特征幅度和极性的直流加速度计信号，当不对准时，敏感轴对准或反对或垂直于地球重力场和具有不同幅度和极性的直流加速度计信号。 确定和估计在植入的IMD中相对于真重力轴的加速度计的敏感轴的实际俯仰角和倾斜角，并且确定或估计偏航角。 校正的直流加速度计输出信号是从俯仰角，偏转角和偏航角度得出的，并且与每个身体姿势的一组存储的阈值进行比较，以确定实际的身体姿势。 这些比较或原始信号本身的存储可用于直方图数据，以提供还描述的治疗或研究益处。

公开(公告)号：US07996084B2

公开(公告)日：2011-08-09

申请号：US11379290

申请日：2006-04-19

申请人： Lee Stylos ,  Todd J. Sheldon ,  Steven N. Lu ,  William J. Combs ,  Robert J. Nehls

发明人： Lee Stylos ,  Todd J. Sheldon ,  Steven N. Lu ,  William J. Combs ,  Robert J. Nehls

IPC分类号： A61N1/08

CPC分类号： A61N1/3702 ,  A61N1/36514 ,  A61N1/36542 ,  A61N1/36557 ,  A61N1/37252

摘要： An implantable medical device (IMD) performs periodic testing of a patient to determine ischemia threshold information. At selected times while the patient is at rest, the IMD increases the pacing rate over time until it receives feedback either from the patient or from an ischemia sensor. The IMD determines the threshold based upon the pacing rate at the time when the feedback was received. The threshold information can be used to adjust the upper pacing rate that can be used during rate adaptive pacing, to determine the effects of drug therapy, and to provide a general indication of the state of coronary artery disease in the patient. The periodic increase of pacing rate to the ischemic zone also provides a preconditioning of the myocardium to allow the patient greater exercise benefit without angina.

摘要翻译： 可植入医疗装置（IMD）执行患者的周期性测试以确定缺血阈值信息。 在患者静止时的选定时间，IMD随着时间的推移增加起搏速率，直到其从患者或缺血传感器接收到反馈。 IMD根据接收到反馈时的起搏速率来确定阈值。 阈值信息可以用于调整速率自适应起搏期间可以使用的上起搏速率，以确定药物治疗的效果，并提供患者冠状动脉疾病状态的一般指示。 对缺血区的起搏速率的周期性增加也提供心肌的预处理，以允许患者在没有心绞痛的情况下更大的运动益处。

公开(公告)号：US07848808B2

公开(公告)日：2010-12-07

申请号：US11364828

申请日：2006-02-28

申请人： Todd J. Sheldon ,  William J. Combs ,  Lee Stylos ,  Steven N. Lu ,  Robert J. Nehls

发明人： Todd J. Sheldon ,  William J. Combs ,  Lee Stylos ,  Steven N. Lu ,  Robert J. Nehls

IPC分类号： A61N1/365

CPC分类号： A61N1/37 ,  A61N1/3627

摘要： An implantable medical device system and method in which the implantable device is adapted to operate in a minimum ventricular pacing mode. The device delivers cardiac pacing pulses in a first pacing mode during a normal mode of operation and upon detecting myocardial ischemia alters the first pacing mode in response to the myocardial ischemia detection.

摘要翻译： 一种植入式医疗装置系统和方法，其中所述可植入装置适于以最小心室起搏模式操作。 该装置在正常操作模式期间以第一起搏模式递送心脏起搏脉冲，并且在检测心肌缺血时，响应于心肌缺血检测改变第一起搏模式。

公开(公告)号：US06512949B1

公开(公告)日：2003-01-28

申请号：US09352179

申请日：1999-07-12

申请人： William J. Combs ,  Catherine R. Condie ,  Roy Martin ,  Dwight H. Warkentin ,  John D. Wahlstrand ,  David L. Thompson ,  Li Wang

发明人： William J. Combs ,  Catherine R. Condie ,  Roy Martin ,  Dwight H. Warkentin ,  John D. Wahlstrand ,  David L. Thompson ,  Li Wang

IPC分类号： A61B500

CPC分类号： A61N1/36521 ,  A61B5/0535 ,  A61B5/7207 ,  A61N1/3627

摘要： An impedance monitor for discerning edema through evaluation of respiratory rate. Preferred embodiment includes edema monitor and trigger to initiate diagnostic reporting or corrective action when activated. Recording of Long Term Average and Short Term Average values for secondary edema measure based on DC signal level are described as are methods and apparatus for removing unwanted recurring noise.

摘要翻译： 通过评估呼吸频率来辨别水肿的阻抗监测仪。 优选实施例包括水肿监测和触发以在被激活时启动诊断报告或纠正动作。 长期平均和短期记录基于直流信号电平的次级水肿测量的平均值被描述为用于消除不期望的重复噪声的方法和装置。

公开(公告)号：US07130679B2

公开(公告)日：2006-10-31

申请号：US10299397

申请日：2002-11-20

申请人： Victor Parsonnet ,  William J. Combs

发明人： Victor Parsonnet ,  William J. Combs

IPC分类号： A61B5/05

CPC分类号： A61B5/413 ,  A61B5/0537

摘要： The invention is directed to techniques for monitoring organ rejection. An implanted device monitors the impedance of the transplanted organ. When the impedance measurements indicate that the organ is being rejected, the device provides early warning of rejection.

摘要翻译： 本发明涉及用于监测器官排斥的技术。 植入装置监测移植器官的阻抗。 当阻抗测量表明器官被拒绝时，器件提供拒收的早期警告。