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1.发明授权Pacemaker system and method with improved capture detection and threshold search 失效起搏器系统和方法具有改进的捕获检测和阈值搜索
公开(公告)号：US5741312A
公开(公告)日：1998-04-21
申请号：US820445
申请日：1997-03-12
CPC分类号： A61N1/3712
摘要： There is provided a pacemaker system with capture verification and threshold testing, in which the pacemaker waits after each change in delivered pace pulses for a stabilization interval, in order to minimize polarization and enhance capture verification. The threshold test utilizes a pace pulse pair, comprising a prior search pulse which is varied during the test, and the regular pacing pulse which is above threshold. When delivery of the pulse pairs is initiated, the search pulse is adjusted to optimize polarization, and the pacemaker waits for predetermined stabilization period of time in order to allow for minimum polarization and to optimize capture detection. The search pulse is increased incrementally in output value toward threshold, and following each such increase the pacemaker waits for a stabilization interval. The pacemaker detects when capture is achieved by the search pulse, thereby providing an indication of threshold.
摘要翻译： 提供了具有捕获验证和阈值测试的起搏器系统，其中起搏器在每次改变传送的起搏脉冲之后等待稳定间隔，以便最小化极化并增强捕获验证。 阈值测试利用了一个起搏脉冲对，其包括在测试期间变化的先前搜索脉冲和高于阈值的规则起搏脉冲。 当开始传送脉冲对时，调整搜索脉冲以优化极化，并且起搏器等待预定的稳定时间段，以便允许最小偏振并且优化捕获检测。 搜索脉冲在输出值向阈值逐渐增加，并且随着每个这样的增加，起搏器等待稳定间隔。 起搏器通过搜索脉冲检测何时捕获，从而提供阈值的指示。
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公开(公告)号：US5713930A
公开(公告)日：1998-02-03
申请号：US744576
申请日：1996-11-06
CPC分类号： A61N1/3627 , A61N1/3682
摘要： A dual chamber pacemaker system and method is provided for adjusting AV delay to provide for an optimal AV setting for a selected pacing application. In the inventive system and method, the basis for determining the AV delay setting is to perform a ventricular fusion test, wherein variations in QT interval are monitored corresponding to variations in AV interval. Based upon the AV-QT data, the pacemaker can determine the ventricular fusion zone where the pacemaker AV interval is substantially the same as the intrinsic conduction interval, as well as the knee where AV intervals just shorter than the ventricular fusion zone result in full capture. The pacemaker selects a routine for adjusting AV interval depending upon a desired application, including the applications of adjusting AV interval for full capture and for treatment of a HOCM patient. There is also provided a routine for determining an appropriate AV hysteresis value for inhibiting ventricular pacing and allowing ventricular sensing as much as possible, for patients with intermittent AV block.
摘要翻译： 提供了一种双室起搏器系统和方法，用于调节AV延迟以为选定的起搏应用提供最佳的AV设置。 在本发明的系统和方法中，用于确定AV延迟设置的基础是执行心室融合测试，其中根据AV间隔的变化监视QT间期的变化。 基于AV-QT数据，起搏器可以确定起搏器AV间隔与内在传导间隔基本相同的心室融合区以及短于心室融合区的AV间隔导致完全捕获的膝盖 。 起搏器根据所期望的应用选择一个用于调节AV间隔的程序，包括调整AV间隔用于完全捕获和用于治疗HOCM患者的应用。 还提供了用于确定用于抑制心室起搏并且允许对间歇性AV阻滞患者尽可能多地进行心室感测的适当AV滞后值的程序。
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3.发明授权Rate adaptive dual chamber pacing system and method with automatic adjustment of operating parameters for minimizing sensor-sinus competition 失效速率自适应双室起搏系统和方法，自动调整操作参数以最小化传感器 - 窦性竞争
公开(公告)号：US5391189A
公开(公告)日：1995-02-21
申请号：US147347
申请日：1993-11-04
CPC分类号： A61N1/368
摘要： There is disclosed a pacemaker, a dual chamber VDD(R) or DDD(R) pacemaker, having improved features for avoiding undesired sensor-sinus competition and providing blended sensor and sinus (atrial) control. The pacemaker employs atrial hysteresis which is used during sensing of natural atrial beats in order to enable tracking the sinus signals that occur at rates below the current pacing limit; and sensor hysteresis which prevents early takeover by sensor control and, in a DDDR pacer, controls when the sensor rate controls over a sensed sinus rate and also enables dropping the pacing rate during sensor control so as to enable finding and tracking of underlying lower rate sinus signals. The sensor hysteresis function is automatically adapted by obtaining and processing scattergram data representative of the sensor rate compared to the average of the natural sinus rate, and adjusting the sensor hysteresis function to optimally match the data. The atrial hysteresis function is also automatically adjusted as a function of rate by obtaining and processing scattergram data representative of sinus jitter, i.e., the difference between the current rate of the last atrial interval and the average sinus rate. In addition, blending of sensor and sinus control is achieved by automatic adjustment of the rate response curve based on accumulated data representative of RR signals as a function of running atrial rate.
摘要翻译： 已经公开了起搏器，双室VDD（R）或DDD（R）起搏器，具有改进的特征，用于避免不期望的传感器窦性竞争并提供混合传感器和窦（心房）控制。 心脏起搏器使用心房滞后，用于检测自然心房搏动，以便能够跟踪以低于当前起搏极限的速率发生的窦信号; 和传感器滞后，防止传感器控制的早期接管，并且在DDDR起搏器中，当传感器速率控制感测到的窦速率时，还可以控制传感器控制期间的起搏速率，以便能够找到和跟踪潜在的较低速率窦 信号。 传感器滞后功能通过获得和处理表示与自然窦速率的平均值相比的传感器速率的散点图数据自动适应，并调整传感器滞后功能以最佳地匹配数据。 通过获得和处理代表窦性抖动的散点图数据，即最近心房间隔的当前速率与平均窦速率之间的差异，心律滞后功能也作为速率的函数自动调节。 此外，传感器和窦控制的混合是通过基于代表RR信号的累积数据作为运行心率的函数自动调整速率响应曲线来实现的。
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公开(公告)号：US5247929A
公开(公告)日：1993-09-28
申请号：US830656
申请日：1992-02-04
IPC分类号： A61N1/362
CPC分类号： A61N1/3622
摘要： A dual chamber pacemaker is provided having incorporated therein a VA conduction test for concurrently testing for the conditions of retrograde conduction (RC) and far field R wave sensing (FFRS). The pacemaker changes the AV or VV interval to a predetermined interval over a number of pacemaker cycles, and determines whether the VA interval remains substantially unchanged, i.e., the VA intervals are substantially equal. When VA interval equality is determined, the pacemaker checks the measure of VA interval with stored RC and FFRS criteria to determine whether either can be verified. Respective corrective steps are taken if either RC or FFRS is verified.
摘要翻译： 提供了一种双室起搏器，其中并入其中用于同时测试逆行传导（RC）和远场R波感测（FFRS）的条件的VA导电测试。 起搏器在多个起搏器周期中将AV或VV间隔改变到预定间隔，并且确定VA间隔是否保持基本不变，即VA间隔基本相等。 当确定VA间隔相等时，起搏器使用存储的RC和FFRS标准检查VA间隔的测量值，以确定是否可以验证。 如果RC或FFRS被验证，则采取相应的校正步骤。
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公开(公告)号：US5843138A
公开(公告)日：1998-12-01
申请号：US890435
申请日：1997-07-09
CPC分类号： A61N1/37264 , A61N1/37211 , A61N1/37252
摘要： A pacemaker system is provided which provides for more flexibility in re-programming of the control software, or program which is controlling an implanted pacemaker. The system comprises an external programmer device which is capable both of programming the implanted device in a conventional way, and also downloading new control software to the implanted device, subject to predetermined system conditions. All implanted devices, e.g., pacemakers within the system of the invention, share a hardware platform, and are identified as belonging to a given one of a plurality of groups, each group being characterized as providing therapy aimed at a different condition. Each pacemaker also carries type data, indicating the type of pacemaker within the group, and a set of permissions data representative of different types within the group to which it is permitted to be programmed. Upon interrogating the implanted device, the programmer determines whether the device is part of the system, what its group and type is, and whether it is able to modify the device.
摘要翻译： 提供了一种起搏器系统，其提供了对控制软件或正在控制植入式心脏起搏器的程序的重新编程的更大灵活性。 该系统包括外部编程器装置，其能够以常规方式编程植入的装置，并且还可以在预定的系统条件下将新的控制软件下载到植入装置。 所有植入的装置，例如本发明的系统内的起搏器，共享一个硬件平台，并且被识别为属于多个组中给定的一组，每个组的特征在于提供针对不同状况的治疗。 每个起搏器还携带类型数据，指示组内起搏器的类型，以及一组表示允许编程的组内不同类型的许可数据。 在询问植入设备时，程序员确定设备是系统的一部分，其组和类型是什么，以及是否能够修改设备。
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公开(公告)号：US5782887A
公开(公告)日：1998-07-21
申请号：US824765
申请日：1997-03-26
IPC分类号： A61N1/362
CPC分类号： A61N1/3622
摘要： A dual chamber pacemaker system and method provide for safe tracking of PACs. The pacemaker obtains an indication of when the T-wave has occurred within the cycle when the PAC occurs, either by measuring the T wave during the cycle, or by getting a QT interval measure from one or more prior cycles. The pacemaker determines a safe V--V interval as the QT interval measure plus a safety factor, the safety factor being selected so as to insure that a pulse that tracks the PAC does not get delivered during the vulnerable period. A PAC is tracked if and only if the VA interval plus the AV delay is as great as the safe V--V interval.
摘要翻译： 双室起搏器系统和方法提供PAC的安全跟踪。 起搏器通过在周期中测量T波，或通过从一个或多个先前循环获得QT间隔测量值，获得当PAC发生时在T周期内何时发生T指示。 起搏器确定一个安全的V-V间隔，因为QT间隔测量加上安全系数，选择安全系数，以确保跟踪PAC的脉冲在脆弱的时期内不会传递。 当且仅当VA间隔加上AV延迟与安全V-V间隔一样大时才跟踪PAC。
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公开(公告)号：US5454836A
公开(公告)日：1995-10-03
申请号：US184218
申请日：1994-01-18
CPC分类号： A61N1/36514 , A61N1/368
摘要： A VDD-type pacing system which may have a floating atrial electrode analyzes P-wave events and absences of P-waves to determine data indicative of the likelihood of P-wave undersensing. The pacemaker logic chooses a reaction algorithm to respond to atrial events in accordance with whether an absence of a P-wave is more likely to have been an undersense or an incidence of bradycardia. Specific algorithms are presented which illustrate pacemaker reactions to probable undersense and brady occurrences. The pacemaker also incorporates a subsystem for detection of undersense events.
摘要翻译： 可以具有浮动心房电极的VDD型起搏系统分析P波事件和P波的缺失以确定指示P波欠感觉的可能性的数据。 起搏器逻辑选择反应算法来响应心房事件，根据是否缺少P波更有可能是心律失常或心动过缓的发生。 提出了具体的算法，说明起搏器对可能的不足和发生的事件的反应。 起搏器还包含一个用于检测不足事件的子系统。
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公开(公告)号：US5282465A
公开(公告)日：1994-02-01
申请号：US830651
申请日：1992-02-04
CPC分类号： A61N1/3622
摘要： A dual chamber pacemaker system is provided having an improved Wenckebach response for optimizing tracking of atrial signals having rates within a rate range above the normal tracking range, i.e., in a designated Wenckebach range. When an atrial sense occurs in the Wenckebach range, the AV delay is extended up to a predetermined maximum extension to enable delivery of a ventricular pulse at the ventricular upper rate limit (dynamic tracking limit). When the AV delay would have to be extended beyond the maximum extension in order to pace the ventricle at the dynamic tracking limit, the next ventricular stimulus is delivered asynchronously at an escape interval greater than the escape interval corresponding to the dynamic tracking limit, e.g., at a predetermined lower pacing limit.
摘要翻译： 提供双室起搏器系统，其具有改进的Wenckebach响应，用于优化具有高于正常跟踪范围的速率范围内的速率的心房信号的跟踪，即在指定的Wenckebach范围内。 当在Wenckebach范围发生心房感觉时，AV延迟被延长到预定的最大延伸，以使得能够以心室上限速度（动态跟踪极限）递送心室脉搏。 当AV延迟必须延伸超出最大延长时间以便在动态跟踪极限下对心室进行调节时，下一个心室刺激以大于对应于动态跟踪极限的逃生间隔的逃生间隔异步传递，例如， 在预定的较低起搏极限。
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9.发明授权
公开(公告)号：US5065759A
公开(公告)日：1991-11-19
申请号：US575289
申请日：1990-08-30
IPC分类号： A61N1/365
CPC分类号： A61N1/36585
摘要： A pacemaker system is provided for rate responsive pacing, wherein rate is controlled as a function of two or more sensor inputs, each sensor providing a signal representing a respective different control parameter. Preferably a first sensor signal represents a physiologically accurate although slow response signal such as OT interval, and a second sensor represents a relatively fast response such as activity. The two parameter signals are processed so that they are directly comparable and can be compared as indicators of pacing rate throughout the desired pacing range. The algorithm utilizes a parameter control reference curve for each respective parameter, such reference curve representing the desired correlation between pacing rate and the parameter signal. Rate control is accomplished by determining the difference between each processed parameter signal and its corresponding reference point for the current pacing interval, and logically analyzing the two differences to determine which is used to indicate change in pacing rate. Each parameter reference curve is automatically adjustable to correspond to patient conditions. Automatic drift correction of the fast response parameter, such as activity, is used to compensate for conditions where the fast response signal is not likely to be physiologically reflective of the patient condition.
摘要翻译： 提供了一种用于速率响应起搏的起搏器系统，其中速率被控制为两个或更多个传感器输入的函数，每个传感器提供表示相应不同控制参数的信号。 优选地，第一传感器信号表示生理上准确的但是响应速度慢的信号，例如OT间隔，第二传感器表示诸如活动的相对快速的响应。 两个参数信号被处理，使得它们是直接可比较的，并且可以作为整个期望起搏范围的起搏速度的指标进行比较。 该算法对每个相应的参数使用参数控制参考曲线，这种参考曲线表示起搏速率和参数信号之间的期望相关性。 速率控制通过确定每个处理的参数信号与其当前起搏间隔的对应参考点之间的差异来完成，并且逻辑分析两个差异以确定哪个用于指示起搏速率的改变。 每个参数参考曲线可自动调节，以对应于患者状况。 快速响应参数（如活动）的自动漂移校正被用于补偿快速响应信号不太可能在生理上反映患者状况的情况。
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公开(公告)号：US5782886A
公开(公告)日：1998-07-21
申请号：US808314
申请日：1997-02-28
CPC分类号： A61N1/368
摘要： An implantable pacemaker system is provided with a conditional hysteresis feature, whereby a hysteresis value is added to the pacing escape interval only when the prior spontaneous rate corresponded to a rate below the top of a predetermined hysteresis band. This feature limits the lengthening of the escape interval when there are sudden drops in the natural rate thereby avoiding excessive changes in rate. In a preferred embodiment, the pacemaker defines a hysteresis band around a given pacing rate, e.g., lower rate limit, the band having an upper hysteresis limit and a lower hysteresis limit. No hysteresis lengthening of the escape interval is utilized for spontaneous heartbeats having rates above the upper hysteresis limit; for spontaneous heartbeats having rates between the lower rate limit and the upper hysteresis limit, an escape interval is set to have a value corresponding to a rate between the pacing limit and the lower rate limit of the hysteresis band which is, e.g., 0-30 bpm below the lower rate limit; and for a sensed spontaneous rate below the lower rate limit, a hysteresis escape interval corresponding to the lower hysteresis limit is established. In the preferred embodiment, sensed heartbeats having a prior rate between the lower rate limit and the upper hysteresis limit cause an escape interval which is lengthened beyond the LRL escape interval by an amount which varies linearly with the differential between the upper hysteresis rate limit and the spontaneous rate.
摘要翻译： 可植入起搏器系统具有条件滞后特征，由此仅在先前的自发速率对应于低于预定滞后带的顶部的速率时才将滞后值加到起搏逃逸间隔上。 该特征限制了自然速率突然下降时逃逸间隔的延长，从而避免了速率的过度变化。 在优选实施例中，起搏器定义围绕给定起搏速率的滞后带，例如较低速率极限，具有较高滞后极限和较低磁滞极限的频带。 对于速率高于上限滞后极限的自发性心跳，不利于逃逸间隔的滞后延长; 对于具有较低速率限制和较高滞后限制之间的速率的自发心跳，逃避间隔被设置为具有对应于起搏极限与滞后带的较低速率极限之间的速率的值，例如0-30 bpm低于下限; 并且对于低于较低速率限制的感测自发速率，建立对应于较低滞后极限的滞后逃逸间隔。 在优选实施例中，具有较低速率限制和较高滞后限制之间的先前速率的感测心跳导致延长超过LRL逃逸间隔的逃逸间隔，其量随着上滞后速率限制和 自发率
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