公开(公告)号：US08718750B2

公开(公告)日：2014-05-06

申请号：US13462134

申请日：2012-05-02

申请人： Jie Lian ,  J. Christopher Moulder ,  Dirk Muessig

发明人： Jie Lian ,  J. Christopher Moulder ,  Dirk Muessig

IPC分类号： A61B5/04

CPC分类号： A61N1/3684 ,  A61N1/3627 ,  A61N1/36521 ,  A61N1/36578 ,  A61N1/36592 ,  A61N1/3682

摘要： Exemplary methods and apparatuses are disclosed that provide for determination of an atrio-ventricular delay on a beat-to-beat basis by determining a P-wave duration from electric signals corresponding to electric potentials in a heart, and determining the atrio-ventricular delay on a beat-to-beat basis such that the atrio-ventricular delay for an individual heart cycle depends on the P-wave duration of a same or an immediately preceding heart cycle.

摘要翻译： 公开了示例性方法和装置，其通过从对应于心脏中的电位的电信号确定P波持续时间来提供基于节拍的心房延迟的确定，并且确定心室上的心室延迟 以心跳为基础，使得个体心脏周期的心室延迟取决于相同或紧接在前的心脏周期的P波持续时间。

公开(公告)号：US08676317B1

公开(公告)日：2014-03-18

申请号：US11186741

申请日：2005-07-20

申请人： Mark W. Kroll ,  Gabriel A. Mouchawar ,  J. Christopher Moulder

发明人： Mark W. Kroll ,  Gabriel A. Mouchawar ,  J. Christopher Moulder

IPC分类号： A61N1/00 ,  G01R27/00 ,  A61B5/02

CPC分类号： A61N1/3937 ,  A61B5/046 ,  A61B5/0538 ,  A61B5/686 ,  A61B5/6869 ,  A61B2560/0276 ,  A61N1/3706

摘要： Techniques are provided for estimating defibrillation impedance of an implantable cardioverter/defibrillator (ICD). Briefly, at least two low-voltage resistance values are measured at different voltages using a pair of stimulation electrodes connected to the ICD. High-voltage defibrillation impedance is then estimated by the ICD based on a weighted combination of the measured resistance values. In one example, a set of weight coefficients, calculated during an initial calibration procedure, are applied to the measured resistance values to produce the estimate of the high-voltage defibrillation impedance. The weight coefficients are updated whenever a defibrillation shock is delivered, based on actual defibrillation impedance values measured during the shock.

摘要翻译： 提供了用于估计植入式心律转复除颤器（ICD）的除颤阻抗的技术。 简言之，使用连接到ICD的一对刺激电极，在不同的电压下测量至少两个低电压电阻值。 然后，基于所测量的电阻值的加权组合，由ICD估计高电压除颤阻抗。 在一个示例中，在初始校准过程期间计算的一​​组权重系数被施加到测量的电阻值，以产生高电压除颤阻抗的估计。 根据在休克期间测量的实际除颤阻抗值，每当递送除颤电击时，权重系数都被更新。

公开(公告)号：US20120179218A1

公开(公告)日：2012-07-12

申请号：US13340038

申请日：2011-12-29

申请人： J. Christopher Moulder

发明人： J. Christopher Moulder

IPC分类号： A61N1/39

CPC分类号： A61N1/3975 ,  A61N1/3906 ,  A61N1/3912 ,  A61N1/3981 ,  H03F3/217

摘要： An output stage for use in a therapeutic defibrillator enables practical use of specialized output waveforms optimized for cardiac defibrillation. A pulse-width modulated (PWM) switching amplifier, connected to a high voltage source capacitor and to one or more output bridges corresponding to different electrode placements, is adapted to operate with high efficiency, demonstrated at about 80%. The amplifier is capable of delivering a defibrillating electric shock to a heart in the form of a time-varying output voltage waveform of arbitrary shape. Efficiency improvement is accomplished through the use of a high voltage reservoir capacitor network configured to minimize a voltage differential between the high voltage reservoir and the output voltage. The switching amplifier features both step-up and step-down amplifier capability. A PWM control unit is positioned within the circuit so as to reduce complexity by eliminating a need for additional isolation circuitry.

摘要翻译： 用于治疗除颤器的输出级使得实际使用针对心脏除颤优化的专用输出波形。 连接到高电压源电容器和对应于不同电极放置的一个或多个输出电桥的脉冲宽度调制（PWM）开关放大器适于以高效率运行，以大约80％的速度表现。 该放大器能够以任意形状的时变输出电压波形的形式向心脏递送除颤电击。 通过使用高压储层电容器网络来实现效率提高，该电容器网络被配置为使高压储层和输出电压之间的电压差最小化。 开关放大器具有升压和降压放大器功能。 PWM控制单元位于电路内，以便通过消除对附加隔离电路的需要来降低复杂度。

公开(公告)号：US08099173B2

公开(公告)日：2012-01-17

申请号：US12393972

申请日：2009-02-26

申请人： J. Christopher Moulder ,  Martin Cholette

发明人： J. Christopher Moulder ,  Martin Cholette

IPC分类号： A61N1/00

CPC分类号： A61N1/37 ,  A61N1/3718

摘要： An implantable medical lead for coupling to an implantable pulse generator may be configured for improved safety. The lead may include: a first electrode; a second electrode in electrical communication with the first electrode; and an active circuit element in electrical communication with the first electrode and the second electrode. The active circuit element may be configured to change an impedance of the lead. The active circuit element may be configured to change the impedance of the lead in response to a pacing signal or a signal having opposite polarity to a pacing signal. A method of using an implantable medical lead for improved safety may include changing an impedance of an implantable medical lead from a relatively high impedance to a relatively low impedance and/or changing an impedance of an implantable medical lead from a relatively low impedance to a relatively high impedance.

摘要翻译： 用于耦合到可植入脉冲发生器的可植入医疗引线可以被配置为提高安全性。 引线可以包括：第一电极; 与所述第一电极电连通的第二电极; 以及与第一电极和第二电极电连通的有源电路元件。 有源电路元件可以被配置为改变引线的阻抗。 有源电路元件可以被配置为响应于起搏信号或与起搏信号具有相反极性的信号来改变引线的阻抗。 使用可植入医疗引线以改善安全性的方法可包括将可植入医疗引线的阻抗从相对高的阻抗改变为相对较低的阻抗和/或将可植入医疗引线的阻抗从相对较低的阻抗改变为相对较低的阻抗 高阻抗。

公开(公告)号：US20100106227A1

公开(公告)日：2010-04-29

申请号：US12257245

申请日：2008-10-23

申请人： Xiaoyi Min ,  Martin Cholette ,  J. Christopher Moulder

发明人： Xiaoyi Min ,  Martin Cholette ,  J. Christopher Moulder

IPC分类号： A61N1/05 ,  A61N1/372 ,  A61N1/36

CPC分类号： A61N1/3718 ,  A61N1/086

摘要： Systems and methods are provided for reducing heating within pacing/sensing leads of a pacemaker or implantable cardioverter-defibrillator that occurs due to induced loop currents during a magnetic resonance imaging (MRI) procedure, or in the presence of other sources of strong radio frequency (RF) fields. For example, bipolar coaxial leads are described herein wherein the ring conductor of the lead is disconnected from the ring electrode in response to detection of MRI fields so as to convert the ring conductor into an RF shield for shielding the inner tip conductor of the lead so as to reduce the strength of loop currents induced therein and hence reduce tip heating. Techniques are also described herein for selectively disconnecting the tip electrode of the lead during an MRI procedure, except during actual delivery of pacing pulses, so as to permit delivery of individual pacing pulses to pacemaker dependent patients during the MRI. Still other techniques describe the use of both RF shielding and tip switching.

摘要翻译： 提供了系统和方法，用于减少起搏器或植入式心律转复除颤器的起搏/感应引线内的加热，由于在磁共振成像（MRI）程序期间由于感应回路电流而发生，或者存在其他强射频源（ RF）字段。 例如，这里描述了双极同轴引线，其中响应于MRI场的检测，引线的环形导体与环形电极断开，以便将环形导体转换成用于屏蔽引线的内部尖端导体的RF屏蔽 以减少其中引起的环路电流的强度，从而减少尖端加热。 本文还描述了在MRI过程期间选择性地断开引线的尖端电极的技术，除了在实际递送起搏脉冲之前，以便允许在MRI期间将起搏器依赖患者的单个起搏脉冲输送到起搏器依赖患者。 其他技术还描述了使用RF屏蔽和尖端切换。

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：US08892193B2

公开(公告)日：2014-11-18

申请号：US13329363

申请日：2011-12-19

申请人： J. Christopher Moulder ,  Jie Lian

发明人： J. Christopher Moulder ,  Jie Lian

IPC分类号： A61B5/0452 ,  A61N1/37

CPC分类号： A61N1/3704 ,  A61N1/37

摘要： A method for automatic threshold control and detection of lead failure in an implanted medical device obtains three sensing vectors for measurement of an electrocardiogram signal. A dynamic error signal is determined from the vectors, and may be used to set a detection threshold for insufficient ECG signals, and/or to passively monitor the device for indications of lead failure without performing an impedance measurement. Passive mode operation conserves battery power and enables continuous lead integrity checks. A quality factor may also be determined from the error signal, to indicate whether or not signal measurements are valid with respect to noise levels. If the detection threshold is allowed to decay between successive features of the electrocardiogram, the decay rate may be made adaptive such that it automatically adjusts to changes in heart rate or to changes in amplitude of the electrocardiogram features.

摘要翻译： 用于植入医疗装置中的铅缺陷的自动阈值控制和检测的方法获得用于测量心电图信号的三个感测向量。 从向量确定动态误差信号，并且可以用于设置不足的ECG信号的检测阈值，和/或被动地监视器件以获得引线故障的指示，而不进行阻抗测量。 被动模式操作可节省电池电量，并实现连续的导线完整性检查。 质量因子也可以从误差信号确定，以指示信号测量是否对噪声水平有效。 如果允许检测阈值在心电图的连续特征之间衰减，则可以使衰减速率自适应，使得其自动调节心率变化或心电图特征的幅度变化。

公开(公告)号：US08886319B2

公开(公告)日：2014-11-11

申请号：US12617532

申请日：2009-11-12

申请人： Jin Zhang ,  J. Christopher Moulder ,  George I. Isaac ,  Gabriel A. Mouchawar ,  Peter Boileau ,  Ingmar Viohl

发明人： Jin Zhang ,  J. Christopher Moulder ,  George I. Isaac ,  Gabriel A. Mouchawar ,  Peter Boileau ,  Ingmar Viohl

IPC分类号： A61N1/08 ,  G01R33/28 ,  A61N1/37 ,  A61N1/375 ,  A61N1/365 ,  G01R33/36

CPC分类号： G01R33/288 ,  A61N1/36521 ,  A61N1/3718 ,  A61N1/3754 ,  G01R33/3685

摘要： A filtering scheme for an implantable medical device mitigates potentially adverse effects that may be caused by MRI-induced signals. In some aspects filtering is provided to attenuate MRI-induced signals on an implanted cardiac lead that is coupled to an implanted device. In some aspects the filter may be configured to complement a capacitor circuit (e.g., a feedthrough capacitor) that reduces the amount of EMI that enters the implanted device via the cardiac lead. In some implementations the filter consists of a LC tank circuit and a series LC circuit, where the LC tank circuit is in series with the cardiac lead and a cardiac stimulation circuit and the series LC circuit is in a shunt configuration across the cardiac stimulation circuit.

摘要翻译： 用于可植入医疗装置的过滤方案减轻了可能由MRI诱导的信号引起的潜在的不利影响。 在一些方面，提供过滤以减少与植入装置耦合的植入心脏引线上的MRI诱导信号。 在一些方面，滤波器可以被配置为补充通过心脏引线减少进入植入装置的EMI量的电容器电路（例如，馈通电容器）。 在一些实施方式中，滤波器由LC谐振电路和串联LC电路组成，其中LC谐振电路与心脏引线和心脏刺激电路串联，并且串联LC电路处于穿过心脏刺激电路的分流配置。

公开(公告)号：US08868166B2

公开(公告)日：2014-10-21

申请号：US13455131

申请日：2012-04-25

申请人： Dirk Muessig ,  J. Christopher Moulder ,  Hannes Kraetschmer ,  Jeffrey A. Von Arx ,  Larry Stotts

发明人： Dirk Muessig ,  J. Christopher Moulder ,  Hannes Kraetschmer ,  Jeffrey A. Von Arx ,  Larry Stotts

IPC分类号： A61N5/04 ,  A61B5/00 ,  A61B5/0452 ,  A61N1/05 ,  A61B5/0464 ,  A61B5/046

CPC分类号： A61N1/05 ,  A61B5/0452 ,  A61B5/046 ,  A61B5/0464 ,  A61B5/721

摘要： Implantable electromedical device or loop recorders or ILRs that solve the problem of very low arrhythmia detection specificities in, i.e., high number of false positives, based on detection and analysis of external noise, specifically muscle noise surrounding the electromedical device. Embodiments generally employ active detection of lead or device movement that induces signal artifacts indicative of external noise. One or more embodiments may detect lead or device movement through use of a piezoelectric transducer, for example located proximally to the device or in the lead of the electromedical.

摘要翻译： 基于外部噪声的检测和分析，特别是电动医疗装置周围的肌肉噪声，可植入的电疗装置或回路记录器或ILR，其解决非常低的心律失常检测特性（即，高数量的假阳性）的问题。 实施例通常采用引导或器件移动的主动检测，其引起指示外部噪声的信号伪影。 一个或多个实施例可以通过使用压电换能器来检测引线或器件的移动，例如位于设备的近侧或电子医疗的引线。

公开(公告)号：US08725256B2

公开(公告)日：2014-05-13

申请号：US12968563

申请日：2010-12-15

申请人： J. Christopher Moulder ,  Peter Boileau

发明人： J. Christopher Moulder ,  Peter Boileau

IPC分类号： A61N1/08 ,  A61N1/36

CPC分类号： A61N1/36125 ,  A61N1/36142 ,  A61N1/362 ,  A61N1/37 ,  A61N1/3718

摘要： An RF protection circuit mitigates potentially adverse effects that may otherwise result from electromagnetic interference (e.g., due to MRI scanning of a patient having an implanted medical device). The RF protection circuit may comprise a voltage divider that is deployed across a pair of cardiac electrodes that are coupled to internal circuitry of the implantable medical device. Each leg of the voltage divider may be referenced to a ground of the internal circuit, whereby the different legs are deployed in parallel across different circuits of the internal circuitry. In this way, when an EMI-induced (e.g., MRI-induced) signal appears across the cardiac electrodes, the voltages appearing across these circuits and the currents flowing through these circuits may be reduced. The RF protection circuit may be used in an implantable medical device that employs a relatively low capacitance feedthrough to reduce EMI-induced (e.g., MRI-induced) current flow in a cardiac lead.

摘要翻译： RF保护电路减轻了可能由电磁干扰引起的潜在不利影响（例如，由于具有植入的医疗装置的患者的MRI扫描）。 RF保护电路可以包括分压器，其分布在耦合到可植入医疗装置的内部电路的一对心脏电极上。 分压器的每个支路可以参考内部电路的接地，由此不同的支路并联地布置在内部电路的不同电路上。 以这种方式，当在心电极上出现EMI诱发（例如，MRI诱发的）信​​号时，可以减少跨越这些电路的电压和流过这些电路的电流。 RF保护电路可以用在可植入医疗装置中，其采用相对低电容的馈通以减少心脏导联中的EMI诱发（例如，MRI诱发的）电流。