公开(公告)号：US08583230B2

公开(公告)日：2013-11-12

申请号：US13009404

申请日：2011-01-19

申请人： Kyungmoo Ryu ,  Allen Keel ,  Heidi Hellman ,  Tomas Svensson

发明人： Kyungmoo Ryu ,  Allen Keel ,  Heidi Hellman ,  Tomas Svensson

IPC分类号： A61N1/00

CPC分类号： A61N1/3627 ,  A61N1/3684 ,  A61N1/3712

摘要： Techniques are provided for use with implantable cardiac stimulation devices equipped for multi-site left ventricular (MSLV) cardiac pacing. Briefly, intraventricular and interventricular conduction delays are detected for paced cardiac events. Maximum pacing time delays are determined for use with MSLV pacing where the maximum pacing time delays are set based on the conduction delays to values sufficient to avoid capture problems due to wavefront propagation, such as fusion or lack of capture. MSLV pacing delays are then set to values no greater than the maximum pacing delays and cardiac resynchronization therapy (CRT) is delivered using the MSLV pacing delays. In an example where an optimal interventricular pacing delay (VV) is determined in advance using intracardiac electrogram-based or hemodynamic-based optimization techniques, the optimal value for VV can be used as a limiting factor when determining the maximum MSLV pacing time delays.

摘要翻译： 提供技术用于配备用于多部位左心室（MSLV）心脏起搏的可植入心脏刺激装置。 简而言之，对于心跳事件，检测到心室内和室间传导延迟。 确定最大起搏时间延迟用于MSLV起搏，其中最大起搏时间延迟基于导通延迟设置为足以避免由于波前传播引起的捕获问题，例如融合或缺乏捕获。 然后将MSLV起搏延迟设置为不大于最大起搏延迟的值，并使用MSLV起搏延迟传递心脏再同步治疗（CRT）。 在使用基于心脏电图或基于血液动力学的优化技术预先确定最佳心室起搏延迟（VV）的示例中，当确定最大MSLV起搏时间延迟时，可以将VV的最佳值用作限制因素。

公开(公告)号：US09002455B2

公开(公告)日：2015-04-07

申请号：US13351958

申请日：2012-01-17

申请人： Heidi Hellman ,  Kyungmoo Ryu

发明人： Heidi Hellman ,  Kyungmoo Ryu

IPC分类号： A61N1/18 ,  A61B5/0452 ,  A61N1/37 ,  A61B5/042 ,  A61B5/00

CPC分类号： A61N1/3712 ,  A61B5/042 ,  A61B5/0452 ,  A61B5/7242

摘要： Techniques are provided for use by an implantable medical device for assessing and controlling concurrent anodal/cathodal capture. In one example, the device delivers bipolar pacing stimulus while sensing a bipolar intracardiac electrogram (IEGM) and while adjusting a magnitude of the pacing stimulus. The device analyzes the bipolar IEGM signals to detect an indication of activation representative of concurrent anodal and cathodal capture. Preferably, the pulse magnitude is set relative to the anodal/cathodal capture threshold based upon clinician programming in response to the needs of the patient. In this manner, concurrent anodal and cathodal capture can be selectively activated or deactivated based on clinician instructions received from a device programmer or other external programming device. Techniques exploiting both bipolar and unipolar IEGM signals to assess and control concurrent anodal/cathodal capture are also described. Techniques for use with quad-pole leads to achieve dual-site or quad-site capture are also set forth.

摘要翻译： 提供技术用于可植入医疗装置用于评估和控制并发阳极/阴极捕获。 在一个示例中，该装置提供双极起搏刺激，同时感测双极性心内电描记图（IEGM），同时调整起搏刺激的幅度。 该器件分析双极性IEGM信号以检测表示并发阳极和阴极捕获的激活指示。 优选地，响应于患者的需要，基于临床医师编程，相对于阳极/阴极俘获阈值设置脉搏幅度。 以这种方式，可以基于从设备编程器或其它外部编程设备接收的临床医生指令来选择性地激活或去激活并发阳极和阴极捕获。 还描述了利用双极和单极IEGM信号来评估和控制并行阳极/阴极俘获的技术。 还阐述了与四极引线一起使用以实现双位点或四点捕获的技术。

公开(公告)号：US20130184777A1

公开(公告)日：2013-07-18

申请号：US13351958

申请日：2012-01-17

申请人： Heidi Hellman ,  Kyungmoo Ryu

发明人： Heidi Hellman ,  Kyungmoo Ryu

IPC分类号： A61N1/37

CPC分类号： A61N1/3712 ,  A61B5/042 ,  A61B5/0452 ,  A61B5/7242

摘要： Techniques are provided for use by an implantable medical device for assessing and controlling concurrent anodal/cathodal capture. In one example, the device delivers bipolar pacing stimulus while sensing a bipolar intracardiac electrogram (IEGM) and while adjusting a magnitude of the pacing stimulus. The device analyzes the bipolar IEGM signals to detect an indication of activation representative of concurrent anodal and cathodal capture. Preferably, the pulse magnitude is set relative to the anodal/cathodal capture threshold based upon clinician programming in response to the needs of the patient. In this manner, concurrent anodal and cathodal capture can be selectively activated or deactivated based on clinician instructions received from a device programmer or other external programming device. Techniques exploiting both bipolar and unipolar IEGM signals to assess and control concurrent anodal/cathodal capture are also described. Techniques for use with quad-pole leads to achieve dual-site or quad-site capture are also set forth.

摘要翻译： 提供技术用于可植入医疗装置用于评估和控制并发阳极/阴极捕获。 在一个示例中，该装置提供双极起搏刺激，同时感测双极性心内电描记图（IEGM），同时调整起搏刺激的幅度。 该器件分析双极性IEGM信号以检测表示并发阳极和阴极捕获的激活指示。 优选地，响应于患者的需要，基于临床医师编程，相对于阳极/阴极俘获阈值设置脉搏幅度。 以这种方式，可以基于从设备编程器或其它外部编程设备接收的临床医生指令来选择性地激活或去激活并发阳极和阴极捕获。 还描述了利用双极和单极IEGM信号来评估和控制并行阳极/阴极俘获的技术。 还阐述了与四极引线一起使用以实现双位点或四点捕获的技术。

公开(公告)号：US20120185012A1

公开(公告)日：2012-07-19

申请号：US13009404

申请日：2011-01-19

申请人： Kyungmoo Ryu ,  Allen Keel ,  Heidi Hellman ,  Tomas Svensson

发明人： Kyungmoo Ryu ,  Allen Keel ,  Heidi Hellman ,  Tomas Svensson

IPC分类号： A61N1/365

CPC分类号： A61N1/3627 ,  A61N1/3684 ,  A61N1/3712

摘要： Techniques are provided for use with implantable cardiac stimulation devices equipped for multi-site left ventricular (MSLV) cardiac pacing. Briefly, intraventricular and interventricular conduction delays are detected for paced cardiac events. Maximum pacing time delays are determined for use with MSLV pacing where the maximum pacing time delays are set based on the conduction delays to values sufficient to avoid capture problems due to wavefront propagation, such as fusion or lack of capture. MSLV pacing delays are then set to values no greater than the maximum pacing delays and cardiac resynchronization therapy (CRT) is delivered using the MSLV pacing delays. In an example where an optimal interventricular pacing delay (VV) is determined in advance using intracardiac electrogram-based or hemodynamic-based optimization techniques, the optimal value for VV can be used as a limiting factor when determining the maximum MSLV pacing time delays.

摘要翻译： 提供技术用于配备用于多部位左心室（MSLV）心脏起搏的可植入心脏刺激装置。 简而言之，对于心跳事件，检测到心室内和室间传导延迟。 确定最大起搏时间延迟用于MSLV起搏，其中最大起搏时间延迟基于导通延迟设置为足以避免由于波前传播引起的捕获问题，例如融合或缺乏捕获。 然后将MSLV起搏延迟设置为不大于最大起搏延迟的值，并使用MSLV起搏延迟传递心脏再同步治疗（CRT）。 在使用基于心脏电图或基于血液动力学的优化技术预先确定最佳心室起搏延迟（VV）的示例中，当确定最大MSLV起搏时间延迟时，可以将VV的最佳值用作限制因素。

公开(公告)号：US10369368B2

公开(公告)日：2019-08-06

申请号：US15172993

申请日：2016-06-03

申请人： Kyungmoo Ryu ,  Xiaoyi Min

发明人： Kyungmoo Ryu ,  Xiaoyi Min

IPC分类号： A61N1/05 ,  A61N1/37 ,  A61N1/362 ,  A61N1/365 ,  A61N1/368 ,  A61N1/372

摘要： An exemplary method for optimizing pacing configuration includes providing distances between electrodes of a series of three or more ventricular electrodes associated with a ventricle; selecting a ventricular electrode from the series; delivering energy to the ventricle via the selected ventricular electrode, the energy sufficient to cause an evoked response; acquiring signals of cardiac electrical activity associated with the evoked response via non-selected ventricular electrodes of the series; based on signals of cardiac electrical activity acquired via the non-selected ventricular electrodes and the distances, determining conduction velocities; based on the conduction velocities, deciding if the selected ventricular electrode is an optimal electrode for delivery of a cardiac pacing therapy; and, if the selected ventricular electrode comprises an optimal electrode for delivery of the cardiac pacing therapy, calling for delivery of the cardiac pacing therapy using the selected ventricular electrode. Various other methods, devices, systems, etc., are also disclosed.

公开(公告)号：US09381363B2

公开(公告)日：2016-07-05

申请号：US12632519

申请日：2009-12-07

申请人： Kyungmoo Ryu ,  Xiaoyi Min

发明人： Kyungmoo Ryu ,  Xiaoyi Min

IPC分类号： A61N1/36 ,  A61N1/37 ,  A61N1/368 ,  A61N1/362 ,  A61N1/372

CPC分类号： A61N1/3684 ,  A61N1/056 ,  A61N1/3627 ,  A61N1/36514 ,  A61N1/368 ,  A61N1/3686 ,  A61N1/371 ,  A61N1/37247

摘要： An exemplary method for optimizing pacing configuration includes providing distances between electrodes of a series of three or more ventricular electrodes associated with a ventricle; selecting a ventricular electrode from the series; delivering energy to the ventricle via the selected ventricular electrode, the energy sufficient to cause an evoked response; acquiring signals of cardiac electrical activity associated with the evoked response via non-selected ventricular electrodes of the series; based on signals of cardiac electrical activity acquired via the non-selected ventricular electrodes and the distances, determining conduction velocities; based on the conduction velocities, deciding if the selected ventricular electrode is an optimal electrode for delivery of a cardiac pacing therapy; and, if the selected ventricular electrode comprises an optimal electrode for delivery of the cardiac pacing therapy, calling for delivery of the cardiac pacing therapy using the selected ventricular electrode. Various other methods, devices, systems, etc., are also disclosed.

摘要翻译： 用于优化起搏配置的示例性方法包括提供与心室相关联的一系列三个或更多个心室电极的电极之间的距离; 从该系列中选择一个心室电极; 通过选择的心室电极向心室输送能量，足以引起诱发反应的能量; 通过该系列的非选择性心室电极获取与诱发反应相关的心脏电活动的信号; 基于通过未选择的心室电极获取的心脏电活动的信号和距离，确定传导速度; 基于传导速度，确定所选择的心室电极是否是用于递送心脏起搏疗法的最佳电极; 并且如果所选择的心室电极包括用于递送心脏起搏治疗的最佳电极，则要求使用所选择的心室电极递送心脏起搏治疗。 还公开了各种其它方法，装置，系统等。

公开(公告)号：US09327131B2

公开(公告)日：2016-05-03

申请号：US12961065

申请日：2010-12-06

申请人： Kyungmoo Ryu ,  Stuart Rosenberg ,  Edward Karst

发明人： Kyungmoo Ryu ,  Stuart Rosenberg ,  Edward Karst

IPC分类号： A61N1/37 ,  A61B5/0452 ,  A61B5/08 ,  A61B5/11 ,  A61B5/00 ,  A61N1/39 ,  A61N1/08

CPC分类号： A61N1/37 ,  A61B5/04525 ,  A61B5/0816 ,  A61B5/1116 ,  A61B5/7292 ,  A61B2560/0276 ,  A61N1/3956 ,  A61N2001/083

摘要： Evaluation of an implanted electrical lead condition includes comparing electrogram template features with test electrogram features. The evaluating also includes determining the implanted electrical lead condition based solely on the electrogram comparison. The compared test electrogram features and template electrogram features may be atrial amplitudes and ventricular amplitudes. The sensing may be with a quad polar lead. The compared test electrogram features and electrogram template features may account for different patient postures and/or may account for respiration modulation.

摘要翻译： 植入电引线条件的评估包括将电描记图模板特征与测试电描记图特征进行比较。 评估还包括仅基于电图比较来确定植入的电引线条件。 比较的测试电描图特征和模板电描记图特征可以是心房幅度和心室幅度。 传感可以是四极引线。 比较的测试电描图特征和电描记图模板特征可以解释不同的患者姿势和/或可以解释呼吸调节。

公开(公告)号：US09254391B2

公开(公告)日：2016-02-09

申请号：US13196580

申请日：2011-08-02

申请人： Kyungmoo Ryu ,  Tomas Svensson ,  Stuart Rosenberg

发明人： Kyungmoo Ryu ,  Tomas Svensson ,  Stuart Rosenberg

IPC分类号： A61N1/365 ,  A61N1/368 ,  A61N1/37

CPC分类号： A61N1/3682 ,  A61N1/3684 ,  A61N1/371

摘要： Pacing related timing is determined for an implantable medical device (IMD) by pacing at an RV pacing site, a first LV pacing site and a second LV pacing site in accordance with a first site, a second site and a third site pacing order, and further in accordance with a first inter-electrode pacing delay between pacing at the first site and pacing at the second site and a second inter-electrode pacing delay between pacing at the second site and pacing at the third site. At least one of a sensed event or a paced event is detected for at each of the second site and the third site. The first inter-electrode pacing delay and the second inter-electrode pacing delay are adjusted to avoid sensed events in favor of paced events at each of the second site and the third site. An atrio-ventricular delay may also be adjusted to avoid sensed events or lack of capture due to possible fusion at the first site, in favor of paced events at the first site.

摘要翻译： 通过根据第一部位，第二部位和第三部位起搏顺序，在RV起搏部位，第一LV起搏部位和第二LV起搏部位进行起搏，确定可植入医疗装置（IMD）的起搏相关时间，以及 进一步根据在第一部位的起搏和第二部位的起搏之间的第一电极间起搏延迟和在第二部位起搏和第三部位起搏之间的第二电极间起搏延迟。 在第二站点和第三站点的每个处检测感测事件或起搏事件中的至少一个。 调整第一电极间起搏延迟和第二电极间起搏延迟以避免感测到的事件有利于在第二位置和第三位置的每一个处的起搏事件。 还可以调整心房延迟以避免感染事件或由于第一部位可能融合而导致的捕获不足，有利于在第一部位的起搏事件。

公开(公告)号：US08798765B2

公开(公告)日：2014-08-05

申请号：US13471167

申请日：2012-05-14

申请人： Kjell Noren ,  Anders Bjorling ,  Tomas Svensson ,  Sven-Erik Hedberg ,  Allen Keel ,  Stuart Rosenberg ,  Kyungmoo Ryu

发明人： Kjell Noren ,  Anders Bjorling ,  Tomas Svensson ,  Sven-Erik Hedberg ,  Allen Keel ,  Stuart Rosenberg ,  Kyungmoo Ryu

IPC分类号： A61N1/365 ,  A61N1/372 ,  A61N1/368

CPC分类号： A61N1/36507 ,  A61N1/3682 ,  A61N1/3684 ,  A61N1/37252

摘要： CRT settings for an implantable medical device are determined by applying pacing pulses to heart chambers of a scheme of different combinations of interchamber delays. A respective width parameter value representing an R or P wave width is determined for each such delay combination based on an ECG representing signal and the width parameter values are employed to estimate a parametric model defining the width parameter as a function of interchamber delays. Candidate interchamber delays that minimize the width parameter are determined from the parametric model and employed to determine optimal CRT settings. The technique provides an efficient way of finding optimal CRT settings when multiple pacing sites are available in a heart chamber.

摘要翻译： 用于可植入医疗装置的CRT设置通过将不同组合的车间延迟的方案应用于心室来进行起搏脉冲来确定。 基于ECG表示信号为每个这样的延迟组合确定表示R或P波宽的相应宽度参数值，并且使用宽度参数值来估计定义作为间歇延迟的函数的宽度参数的参数模型。 从参数模型中确定最小化宽度参数的候选车间延迟，并用于确定最佳CRT设置。 该技术提供了一种在心室中可用多个起搏部位时可以找到最佳CRT设置的有效方式。

公开(公告)号：US20130204312A1

公开(公告)日：2013-08-08

申请号：US13365061

申请日：2012-02-02

申请人： Jong Gill ,  Kwangdeok Lee ,  Kyungmoo Ryu ,  Gene A. Bornzin

发明人： Jong Gill ,  Kwangdeok Lee ,  Kyungmoo Ryu ,  Gene A. Bornzin

IPC分类号： A61N1/365

CPC分类号： A61N1/3627 ,  A61N1/36557 ,  A61N1/3682 ,  A61N1/3684 ,  A61N1/3686

摘要： Techniques are provided for use by an implantable medical device for optimizing the amount of ventricular dyssynchrony induced within a patient during protective pacing. In one example, the device analyzes intracardiac electrogram signals to detect an ischemic event within the heart. The device then delivers pacing stimulus in accordance with adjustable pacing parameters to induce ventricular dyssynchrony within the heart and adjusts the pacing parameters within a range of permissible values to achieve a preferred degree of ventricular dyssynchrony within the patient, so long as there is no significant reduction in left ventricular pumping functionality. Preferably, the pacing parameters are adjusted to maximize or otherwise optimize the degree of dyssynchrony induced within the patient. If a significant reduction in LV pumping functionality is detected, the dyssynchrony-inducing pacing is preferably suspended to avoid any deterioration in the condition of the heart. Techniques for detecting early onset of ischemia are also disclosed.

摘要翻译： 技术被提供用于由可植入医疗装置用于在保护性起搏期间优化患者内引起的心室不同步的量。 在一个实例中，该装置分析心内电描记信号以检测心脏内的缺血事件。 然后，该装置根据可调整的起搏参数提供起搏刺激，以诱导心脏内的心室不同步，并在允许值的范围内调整起搏参数，以在患者体内达到优选的心室不同步程度，只要没有显着的减少 在左心室泵功能。 优选地，起搏参数被调整以最大化或以其他方式优化患者内诱发的不同步程度。 如果检测到LV泵送功能的显着降低，则优选暂停不同步的起搏，以避免心脏状况的任何恶化。 还公开了用于检测早期发作缺血的技术。