公开(公告)号：US07594728B2

公开(公告)日：2009-09-29

申请号：US11640548

申请日：2006-12-18

申请人： Jim Seal ,  Sigrid Kenkel ,  Michelle Boster ,  Patrick J. Paul

发明人： Jim Seal ,  Sigrid Kenkel ,  Michelle Boster ,  Patrick J. Paul

IPC分类号： A61B3/14 ,  A61B3/10

CPC分类号： A61B3/024 ,  A61B3/005 ,  A61B3/0075 ,  A61B3/0083 ,  A61H5/00

摘要： An adjustable and foldable device for visual field testing or treatment includes a computer display mounted on a base and presents visual stimuli to the patient. An associated head support assembly with a chinrest supports and positions the head of the subject with respect to the display. An articulated arm joins the base and the head support assembly. The arm will resist a given downward force supplied by the head, and is foldable toward the display to create a more compact and portable device. Additional articulations may allow the head support assembly to fold upon arm, and the arm to fold upon the base. The device may include a locking mechanism that secures the device in a folded or unfolded configuration.

摘要翻译： 用于视野测试或治疗的可调节和可折叠设备包括安装在基座上并向患者呈现视觉刺激的计算机显示器。 具有下巴的相关联的头部支撑组件相对于显示器支撑并定位被检体的头部。 铰接臂连接基座和头部支撑组件。 手臂将抵抗由头部提供的给定的向下的力，并且可朝向显示器折叠，以创建更紧凑和便携的装置。 附加的关节可以允许头部支撑组件在臂上折叠，并且手臂折叠在基部上。 该装置可以包括将装置固定在折叠或展开构造中的锁定机构。

公开(公告)号：US06564099B2

公开(公告)日：2003-05-13

申请号：US09454742

申请日：1999-12-06

申请人： David Prutchi ,  Patrick J. Paul ,  Gregory R. Martin

发明人： David Prutchi ,  Patrick J. Paul ,  Gregory R. Martin

IPC分类号： A61N1362

CPC分类号： A61N1/36521 ,  A61M5/142 ,  A61M5/14244 ,  A61M5/16854 ,  A61N1/3706 ,  A61N2001/083

摘要： A cardiac stimulator capable of measuring pacing impedance includes a tank capacitor for delivering charge to the heart via device leads, a shunt resistor, and high-impedance buffers for measuring pacing current through the shunt resistor. Soon after the leading edge of the stimulation pulse, the voltage across the shunt resistor, as sampled by a high-impedance buffer, indicates lead and cardiac tissue resistance. Just prior to opening the pacing switch to terminate the stimulation pulse, the voltage across the shunt resistor is sampled by a high-impedance buffer and held once again to allow the capacitance of the lead/heart tissue to be calculated. In alternative embodiments, a high-impedance buffer measures the voltage between the tank capacitor and ground immediately following the stimulation pulse to allow estimation of the lead/heart tissue capacitance. In one alternative embodiment, a look-up table is created in main memory and searched to find the closest lead/heart tissue capacitance estimate to any arbitrary degree of accuracy. In another alternative embodiment, the lead/heart tissue capacitance is estimated by successive approximation to any arbitrary degree of accuracy. When the lead/heart tissue capacitance and lead resistance have been determined, a plurality of parameters of importance for analyzing and optimizing a cardiac stimulation system may be calculated, such as the instantaneous current, the average current, the charge, and the energy delivered to the cardiac tissue.

公开(公告)号：US06507759B1

公开(公告)日：2003-01-14

申请号：US09369068

申请日：1999-08-05

申请人： David Prutchi ,  Patrick J. Paul

发明人： David Prutchi ,  Patrick J. Paul

IPC分类号： A61N108

CPC分类号： A61N1/37252 ,  Y10S128/903

摘要： A technique for acquiring and accessing information from a medical implantable device is provided. Analog waveforms of interest are sensed and processed by signal acquisition circuitry. Analog parameters of interest are applied to selector switches which are controlled by a logic circuit. The logic circuit is also coupled an A/D converter for converting the analog signals to digital values. The digital values are stored in dedicated registers and are available for telemetry to an external device upon receipt of a request or prompt signal. When a digitized value is accessed and telemetered, the control logic circuit changes the conductive state of the selector switches to apply the corresponding analog signal to the A/D converter. The resulting digital value is applied to the corresponding register to refresh the accessed and telemetered value. The technique permits the external device to request and configure the implanted device to send only digitized values of interest. The technique also makes efficient use of the A/D converter, which consumes energy only as needed to refresh the memory when digital values are accessed and telemetered.

摘要翻译： 提供了一种用于从医用可植入装置获得和访问信息的技术。 感兴趣的模拟波形由信号采集电路感测和处理。 感兴趣的模拟参数应用于由逻辑电路控制的选择器开关。 逻辑电路还耦合有A / D转换器，用于将模拟信号转换为数字值。 数字值存储在专用寄存器中，可在接收到请求或提示信号时向外部设备进行遥测。 当访问和遥测数字化值时，控制逻辑电路改变选择器开关的导通状态，以将相应的模拟信号施加到A / D转换器。 所得到的数字值被应用于相应的寄存器以刷新访问和遥测值。 该技术允许外部设备请求和配置植入的设备以仅发送感兴趣的数字化值。 该技术还有效地利用了A / D转换器，仅在需要访问和遥测数字值时根据需要消耗能量来刷新存储器。

公开(公告)号：US6112121A

公开(公告)日：2000-08-29

申请号：US150124

申请日：1998-09-09

申请人： Patrick J. Paul ,  David Prutchi

发明人： Patrick J. Paul ,  David Prutchi

IPC分类号： A61N1/375

CPC分类号： A61N1/3752

摘要： An implantable medical device including an enclosure and a header portion attached to the enclosure. The header includes a lead cavity into which a lead can be inserted. The lead cavity includes a compression device, such as a spring, for aligning a highly visible indicator plunger at least partially hidden from view inside the volume defined by an annular electrode, or other opaque object, partially surrounding the lead cavity. The plunger includes at least a portion that is easily visible to a surgeon during implantation of the medical device. When a lead is inserted into the lead cavity, the end of the lead pushes against the indicator plunger thereby moving the plunger and compressing the spring. When the lead is fully inserted into the lead cavity, the plunger becomes visible as it is pushed away from the volume defined by the annular electrode. In this way, the plunger provides a positive indication that the lead has been fully inserted into the header. The annular electrode may also include a retaining surface that will contact a corresponding surface on the plunger should the plunger break loose from the spring. This feature helps to keep the plunger from migrating from the header into the body should the plunger break away from the spring.

摘要翻译： 一种可植入医疗装置，其包括外壳和附接到外壳的头部部分。 头部包括引线腔，引线可插入该引线腔中。 引导腔包括诸如弹簧的压缩装置，用于将高度可见的指示器柱塞对准，该高度可见的指示器柱塞至少部分地隐藏在由环形电极或部分围绕引线腔的其它不透明物体限定的体积内。 柱塞包括至少一部分，其在植入医疗装置期间对外科医生容易看到。 当引线插入引线腔时，引线的端部推压指示器柱塞，从而移动柱塞并压缩弹簧。 当引线完全插入引线腔中时，柱塞被从远离由环形电极限定的体积推开时可见。 以这种方式，柱塞提供铅指示已被完全插入到头部中的肯定指示。 环形电极还可以包括保持表面，该保持表面将在活塞从弹簧松开时接触柱塞上的对应表面。 如果柱塞远离弹簧，该功能有助于保持柱塞不会从集管移动到主体内。

公开(公告)号：US5978710A

公开(公告)日：1999-11-02

申请号：US12854

申请日：1998-01-23

申请人： David Prutchi ,  Patrick J. Paul

发明人： David Prutchi ,  Patrick J. Paul

IPC分类号： A61N1/365 ,  A61N1/37

CPC分类号： A61N1/37 ,  A61N1/3718 ,  Y10S128/901

摘要： An implantable medical device for electrically stimulating the heart to beat generally includes a processor, a plurality of electrodes, a sense amplifier, a pulse generator, and a heart status monitor. The processor can determine when the patient has entered an environment of high electromagnetic interference. When this occurs, the processor forces the implantable device into a safe noise mode. While in the same noise mode (which preferably continues while the patient is experiencing the electromagnetic interference), the implantable device paces the heart on demand and inhibits pacing during the vulnerable period. The processor determines when the vulnerable period is occurring and when the heart needs to be paced by monitoring a status signal from the heart status monitor. The status signal generated by the heart status monitor preferably is not sensitive to the electromagnetic interference, and thus the processor can determine the bio-mechanical state of the heart during a cardiac cycle even in the face of high electromagnetic interference. The heart status monitor preferably includes an impedance measurement circuit, but may include any type of cardiac sensor that can generate a status signal from which the processor can determine the beginning and ending of the vulnerable period. Accordingly, even during a period of high electromagnetic interference, the implantable device can provide on demand pacing support to the patient.

摘要翻译： 用于电激励心跳的可植入医疗装置通常包括处理器，多个电极，感测放大器，脉冲发生器和心脏状态监视器。 处理器可以确定患者何时进入高电磁干扰的环境。 当这种情况发生时，处理器迫使可植入装置进入安全噪声模式。 虽然在相同的噪音模式（其优选地在患者经历电磁干扰的情况下继续），但是可植入装置根据需要对心脏起搏并且在脆弱时期期间抑制起搏。 处理器确定何时发生脆弱时期，何时需要通过监测来自心脏状态监视器的状态信号来调整心脏。 由心脏状态监视器产生的状态信号优选地对电磁干扰不敏感，因此即使面对高电磁干扰，处理器也可以在心动周期期间确定心脏的生物机械状态。 心脏状态监视器优选地包括阻抗测量电路，但是可以包括可以生成状态信号的任何类型的心脏传感器，处理器可以从该状态信号确定脆弱周期的开始和结束。 因此，即使在高电磁干扰的时段期间，可植入装置也可以向患者提供按需的起搏支持。

公开(公告)号：US06788972B2

公开(公告)日：2004-09-07

申请号：US10371609

申请日：2003-02-21

申请人： David Prutchi ,  Patrick J. Paul ,  Gregory R. Martin

发明人： David Prutchi ,  Patrick J. Paul ,  Gregory R. Martin

IPC分类号： A61N137

CPC分类号： A61N1/36521 ,  A61M5/142 ,  A61M5/14244 ,  A61M5/16854 ,  A61N1/3706 ,  A61N2001/083

摘要： A cardiac stimulator capable of measuring pacing impedance includes a tank capacitor for delivering charge to the heart via device leads, a shunt resistor, and high-impedance buffers for measuring pacing current through the shunt resistor. Soon after the leading edge of the stimulation pulse, the voltage across the shunt resistor, as sampled by a high-impedance buffer, indicates lead and cardiac tissue resistance. Just prior to opening the pacing switch to terminate the stimulation pulse, the voltage across the shunt resistor is sampled by a high-impedance buffer and held once again to allow the capacitance of the lead/heart tissue to be calculated. In alternative embodiments, a high-impedance buffer measures the voltage between the tank capacitor and ground immediately following the stimulation pulse to allow estimation of the lead/heart tissue capacitance. In one alternative embodiment, a look-up table is created in main memory and searched to find the closest lead/heart tissue capacitance estimate to any arbitrary degree of accuracy. In another alternative embodiment, the lead/heart tissue capacitance is estimated by successive approximation to any arbitrary degree of accuracy. When the lead/heart tissue capacitance and lead resistance have been determined, a plurality of parameters of importance for analyzing and optimizing a cardiac stimulation system may be calculated, such as the instantaneous current, the average current, the charge, and the energy delivered to the cardiac tissue.

摘要翻译： 能够测量起搏阻抗的心脏刺激器包括用于通过器件引线将电荷递送到心脏的储能电容器，分流电阻器和用于测量通过分流电阻器的起搏电流的高阻抗缓冲器。 在刺激脉冲的前沿之后不久，由高阻抗缓冲液取样的分流电阻器两端的电压表示铅和心脏组织的电阻。 在打开起搏开关以终止刺激脉冲之前，分流电阻器两端的电压由高阻抗缓冲器采样，并再次保持以允许计算铅/心脏组织的电容。 在替代实施例中，高阻抗缓冲器在刺激脉冲之后立即测量储能电容器和地之间的电压，以允许对铅/心脏组织电容的估计。 在一个备选实施例中，在主存储器中创建查找表并搜索以找到任何任意精度的最接近的引导/心脏组织电容估计。 在另一替代实施例中，通过逐次逼近任何任意精度来估计引导/心脏组织电容。 当确定了铅/心脏组织电容和引线电阻时，可以计算多个用于分析和优化心脏刺激系统的参数，例如瞬时电流，平均电流，电荷和递送至 心脏组织。

公开(公告)号：US5944744A

公开(公告)日：1999-08-31

申请号：US19751

申请日：1998-02-06

申请人： Patrick J. Paul ,  David Prutchi

发明人： Patrick J. Paul ,  David Prutchi

IPC分类号： A61B5/0402 ,  A61N1/37

CPC分类号： A61N1/3706 ,  A61N1/3704

摘要： An implantable medical device for electrically stimulating the heart to beat generally includes a processor, a plurality of electrodes, a sense amplifier, a pair of comparators, inner and outer target logic units, and pulse generator. The processor controls the magnitudes of inner and outer target reference signals which are generated by the inner and outer target logic units, respectively. The outer target is adjusted to be approximately equal to the peak amplitude of the cardiac signal. The processor stores representations of the outer target reference in memory. Alternatively or additionally, the processor computes a histogram of the relative or absolute number of cardiac cycles that occur over a given period of time for each outer target setting. The processor can be directed to retrieve the outer target representations and/or the histogram from memory and transmit that information to an external programmer for use by a physician.

摘要翻译： 用于电激励心跳的可植入医疗装置通常包括处理器，多个电极，读出放大器，一对比较器，内部和外部目标逻辑单元以及脉冲发生器。 处理器分别控制由内部和外部目标逻辑单元产生的内部和外部目标参考信号的大小。 外部目标被调整为近似等于心脏信号的峰值振幅。 处理器将外部目标参考的表示存储在存储器中。 或者或另外，处理器计算针对每个外部目标设置在给定时间段内发生的心跳周期的相对或绝对数量的直方图。 处理器可以被引导以从存储器检索外部目标表示和/或直方图，并将该信息发送到外部编程器以供医生使用。

公开(公告)号：US5735882A

公开(公告)日：1998-04-07

申请号：US755699

申请日：1996-11-25

申请人： William B. Rottenberg ,  Patrick J. Paul ,  David Prutchi

发明人： William B. Rottenberg ,  Patrick J. Paul ,  David Prutchi

IPC分类号： A61N1/08 ,  A61N1/37 ,  A61N1/39

CPC分类号： A61N1/3706 ,  A61N1/3931 ,  A61N2001/083

摘要： A cardiac stimulator with a method and apparatus for automatically switching the cardiac stimulator to its normal mode from its backup mode. A fault monitor receives fault signals and determines whether a particular fault warrants activation of the backup mode. If so, a number of attempts to reactivate the normal mode are permitted. The normal mode may be reactivated if the stored information is valid and if the circuitry is operational.

摘要翻译： 一种心脏刺激器，具有用于将心脏刺激器从其备用模式自动切换到正常模式的方法和装置。 故障监视器接收故障信号，并确定特定故障是否需要激活备份模式。 如果是这样，许多尝试重新激活正常模式。 如果存储的信息有效并且电路可操作，则可以重新启动正常模式。

公开(公告)号：US5718720A

公开(公告)日：1998-02-17

申请号：US766526

申请日：1996-12-13

申请人： David Prutchi ,  Patrick J. Paul

发明人： David Prutchi ,  Patrick J. Paul

IPC分类号： A61N1/37

CPC分类号： A61N1/3712

摘要： An implantable cardiac stimulator for detecting capture or adjusting the strength or duration of pacing pulses by using an evoked response detector and periodically tuning the evoked response detector. When the electric evoked response detector is to be tuned, capture is verified by detecting the mechanical evoked response. As the magnitude of the stimulating pulse is adjusted to isolate the threshold as detected by the mechanical response detector. At the same time, the electrical evoked response is also monitored. The difference between the detected electrical signal following capture as detected by the mechanical response detector and the signal following non-capture is used to tune the electrical evoked response detection apparatus and algorithm. The energy of the pacing pulse can then be optimized by adjusting both strength and duration. A very small safety margin is needed since capture is continuously monitored by the electrical evoked response apparatus and a safety pulse is immediately applied if capture is lost. The safety pulse can be applied in the same cardiac cycle so that the heart beat remains controlled.

摘要翻译： 一种可植入心脏刺激器，用于通过使用诱发响应检测器和周期性地调谐诱发响应检测器来检测捕获或调整起搏脉冲的强度或持续时间。 当电诱发响应检测器被调谐时，通过检测机械诱发响应来验证捕获。 当由机械响应检测器检测到的刺激脉冲的幅度被调整以隔离阈值时。 同时，还监测电诱发响应。 使用机械响应检测器检测到的捕获后检测到的电信号与非捕获后的信号之间的差异用于调谐电诱发响应检测装置和算法。 然后可以通过调整强度和持续时间来优化起搏脉冲的能量。 需要非常小的安全余量，因为捕获被电诱发响应装置连续监测，并且如果捕获丢失，则立即施加安全脉冲。 安全脉冲可以在相同的心脏周期中应用，使心跳保持受控。

公开(公告)号：US5607459A

公开(公告)日：1997-03-04

申请号：US613127

申请日：1996-03-08

申请人： Patrick J. Paul ,  David Prutchi

发明人： Patrick J. Paul ,  David Prutchi

IPC分类号： A61N1/37 ,  A61N1/375

CPC分类号： A61N1/3708 ,  A61N1/375

摘要： A cardiac stimulator including a patient warning apparatus, having a real time-clock for delaying delivery of a warning stimulus until a preselected time of day. The time of day may be selected dynamically with respect to detected patterns of patient activity. The stimulator can adjust the time for delivery of patient warning based on the detected circadian rhythm of the patient. In one embodiment, the cardiac stimulator is an implantable pacemaker or defibrillator or combination which can also be programmed to automatically alter the peak voltage of its output stimulus, in particular, to increase the peak voltage of the output stimulus whenever a condition exists requiring patient notification or warning. A stimulus generator in the stimulator can delivers electrical current to the electrically conductive suture point or warning electrode at a preselected voltage level. A sensor for detecting patient reaction to a warning stimulus may be an accelerometer or motion/vibration transducer or other sensor capable of detecting a reaction to a warning stimulus. The level of the stimulus directed to the patient's skeletal muscle is regulated until a preselected magnitude of reaction has been achieved. The reaction is also maintained below a pre-selected maximum to avoid discomfort to the patient.

摘要翻译： 一种心脏刺激器，其包括患者警告装置，具有用于延迟警告刺激的传送的实时时钟，直到一天的预选时间。 相对于检测到的患者活动模式，可以动态地选择一天中的时间。 刺激器可以根据检测到的昼夜节律来调整患者警报的传送时间。 在一个实施例中，心脏刺激器是可植入起搏器或除颤器或组合，其也可被编程为自动改变其输出刺激的峰值电压，特别是当存在需要患者通知的情况时增加输出刺激的峰值电压 或警告。 刺激器中的刺激发生器可以以预选的电压电平将电流传递到导电缝合点或警告电极。 用于检测患者对警告刺激的反应的传感器可以是能够检测对警告刺激的反应的加速度计或运动/振动换能器或其他传感器。 调节针对患者骨骼肌的刺激水平，直到达到预定的反应程度。 反应也保持在预选的最大值以下，以避免患者的不适。