公开(公告)号：US5824019A

公开(公告)日：1998-10-20

申请号：US729465

申请日：1996-10-11

申请人： John C. Rueter ,  Catherine R. Condie

发明人： John C. Rueter ,  Catherine R. Condie

IPC分类号： A61N1/365 ,  A61N1/368

CPC分类号： A61N1/368 ,  A61N1/36521

摘要： There is provided an improved pacing system and method which monitors when the ventricle has become appropriately filled with blood and controls the delivery of each ventricular pace pulse to substantially coincide with desired ventricular filling, e.g., when the chamber has substantially filled. By this technique, the desired time for delivering the ventricular pace pulse is determined on a beat-by-beat basis, providing an improved physiologically optimum mode of pacing. The physiologically ventricular pacing technique of this invention is applicable either to a single chamber pacemaker, or to a dual chamber pacemaker, and in either case enables the important improvement of delivering the pace pulse at the most physiologically appropriate time. In a first embodiment, the moment when the ventricle has substantially filled with blood is determined by monitoring impedance variations which vary inversely with ventricular volume, such that filling of the ventricle corresponds to the time when the impedance waveform bottoms out, or reaches a minimum level. Other sensor arrangements which provide information as to the state of or rate of change of ventricular volume can likewise be used. The invention enables a single lead-single chamber pacemaker which achieves effective synchrony with atrial contractions, or a dual chamber pacemaker which does not require programming of an AV interval.

摘要翻译： 提供了一种改进的起搏系统和方法，其监测心室何时已经适当地充满血液，并且控制每个心室起搏脉冲的输送与期望的心室充盈基本一致，例如当腔基本上被填充时。 通过这种技术，用于递送心室起搏脉冲的期望时间是以逐拍为基础确定的，从而提供改善的生理上最佳的起搏模式。 本发明的生理心室起搏技术可应用于单室起搏器或双室心脏起搏器，并且在任一情况下都能够在最生理适当的时间提供步速脉冲的重要改进。 在第一实施例中，通过监测与心室容积成反比变化的阻抗变化来确定心室基本上充满血液的时刻，使得心室的填充对应于阻抗波形底部流出或达到最小水平的时间 。 同样可以使用提供关于心室容积的变化状态或速度变化信息的其它传感器装置。 本发明使得能够实现与心房收缩有效同步的单个单体室起搏器，或者不需要编程AV间隔的双室心脏起搏器。

公开(公告)号：US5601615A

公开(公告)日：1997-02-11

申请号：US291304

申请日：1994-08-16

申请人： H. T. Markowitz ,  John C. Stroebel ,  Ren Zhou ,  John C. Rueter

发明人： H. T. Markowitz ,  John C. Stroebel ,  Ren Zhou ,  John C. Rueter

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

CPC分类号： A61N1/3712 ,  A61N1/368 ,  A61N1/3714

摘要： Capture detection and stimulation threshold-measurement methods and apparatus for deriving atrial and ventricular pace pulse (A-pace and V-pace) stimulation energy strength-duration data. In a first atrial and ventricular threshold test regimen for use with patients having intact A-V conduction or first degree AV block, A-pace pulses are delivered at a test escape interval and A-V delay. Atrial loss of capture (ALOC) in response to an A-pace test stimulus is declared by the absence of a detected ventricular depolarization (V-event) in the latter portion of the paced A-V delay interval following the delivery of the A-pace test stimulus. In the ventricular threshold test regimen, a V-pace test stimulus is delivered after a shortened A-V delay. Ventricular loss of capture (VLOC) is declared by the detection of a V-event in the ventricular refractory period of the V-pace test stimulus. In a second algorithm for use in the atrium or ventricle in patients having regular measured sinus rhythm, premature A-pace or V-pace test stimuli are delivered, and the presence of an A-event or V-event at the end of the measured sinus escape interval is declared to be ALOC or VLOC, respectively. A-pace and V-pace test stimuli are repeated to confirm capture declarations at an energy exceeding the LOC test energy. The atrial and ventricular stimulation threshold data derived by varying both pulse amplitude (strength) and width (duration) is stored in memory for telemetry out and analysis and for use in setting the V-pace and A-pace normal pulse width and amplitude used between successive auto-capture tests in order to conserve battery energy.

摘要翻译： 捕获检测和刺激阈值测量方法和装置，用于导出心房和心室起搏脉冲（A步和V步）刺激能量强度持续时间数据。 在与具有完整的A-V传导或一级AV阻滞的患者一起使用的第一次心房和心室阈值测试方案中，A步脉冲以测试逃逸间隔和A-V延迟递送。 响应于A速度测试刺激的心律失常的捕获（ALOC）是通过在A步测试发送之后的起搏AV延迟间隔的后半部分中没有检测到的心室去极化（V-event）来宣告的 刺激。 在心室阈值测试方案中，V-pace测试刺激在缩短的A-V延迟之后递送。 通过检测V-速度测试刺激的心室不应期中的V-事件来宣告心室收缩损失（VLOC）。 在具有正常测量的窦性心律的患者中用于心房或心室的第二种算法中，递送过早的A步或V步测试刺激，并且在测量结束时存在A事件或V-事件 窦道逃逸间隔分别被宣告为ALOC或VLOC。 重复A步和V步测试刺激，以超过LOC测试能量的能量确认捕获声明。 通过改变脉冲幅度（强度）和宽度（持续时间）而得到的房室和心室刺激阈值数据被存储在用于遥测和分析的存储器中，并且用于设定V-步速和A-速度正常脉冲宽度和幅度 连续自动捕获测试以节省电池能量。

公开(公告)号：US4503858A

公开(公告)日：1985-03-12

申请号：US504699

申请日：1983-06-15

申请人： Harold T. Markowitz ,  John C. Rueter ,  Gary J. Syring

发明人： Harold T. Markowitz ,  John C. Rueter ,  Gary J. Syring

IPC分类号： A61N1/37 ,  A61N1/00

CPC分类号： A61N1/3702

摘要： A pacing system analyzer as connected to an implantable cardiac pacer and if an atrial pacing pulse is detected only, the analyzer sends a simulated P-wave to the pacer and determines the response of the simulated P-wave to determine if the pacing mode is AAI, AAT, or AOO. In the event a ventricular output pulse only is detected by the analyzer, a simulated R-wave is sent to the pacer and if the pacer responds either by a triggered ventricular pulse or by not changing its response, the analyzer determines that the pacer is in a VVT or VOO mode. On the other hand, if the pacer is inhibited a subsequent simulated P-wave is sent to it and the response of this P-wave determines whether or not the pacer is in a VVI or VDD mode. In the event that both atrial and ventricular pacing pulses are detected by the analyzer, the simulated R-wave is first sent to the pacer and an unchanged response determines that the pacer is in a DOO mode. On the other hand, if the pacer is inhibited so that ventricular pulses are not produced, then a simulated P-wave is sent to it. The response of the pacer to the simulated P-wave determines whether it is in a DVI or DDD mode.

摘要翻译： 起搏系统分析仪连接到可植入心脏起搏器，如果只检测到心房起搏脉搏，则分析仪将模拟的P波发送到起搏器，并确定模拟P波的响应，以确定起搏模式是否为AAI ，AAT或AOO。 在分析仪仅检测到心室输出脉冲的情况下，将模拟的R波发送到起搏器，并且如果起搏器通过触发的心室脉搏或不改变其响应来进行响应，则分析仪确定起搏器处于 VVT或VOO模式。 另一方面，如果起搏器被禁止，则向其发送随后的模拟P波，并且该P波的响应确定起搏器是否处于VVI或VDD模式。 在分析仪检测到心房和心室起搏脉冲的情况下，首先将模拟的R波发送到起搏器，并且不变的响应确定起搏器处于DOO模式。 另一方面，如果抑制起搏器使得不产生心室脉冲，则向其发送模拟的P波。 起搏器对模拟P波的响应决定了它是处于DVI还是DDD模式。

公开(公告)号：US09037237B2

公开(公告)日：2015-05-19

申请号：US12787058

申请日：2010-05-25

申请人： Trent M. Fischer ,  Douglas A. Hettrick ,  Todd J. Sheldon ,  Paul A. Belk ,  Thomas J. Mullen ,  John C. Rueter ,  Daniel R. Kaiser

发明人： Trent M. Fischer ,  Douglas A. Hettrick ,  Todd J. Sheldon ,  Paul A. Belk ,  Thomas J. Mullen ,  John C. Rueter ,  Daniel R. Kaiser

IPC分类号： A61N1/368 ,  A61N1/362 ,  A61N1/365 ,  A61B5/0456

CPC分类号： A61N1/3627 ,  A61B5/0456 ,  A61N1/36514 ,  A61N1/36542 ,  A61N1/36557 ,  A61N1/36564 ,  A61N1/36571 ,  A61N1/36578 ,  A61N1/36585 ,  A61N1/368 ,  A61N1/3682 ,  A61N1/3688

摘要： An implantable medical device and associated method provide atrial pacing and measure an atrial ventricular (AV) delay. An autonomic function index is computed using the AV delay. The autonomic function index may be compiled in a medical report. In some embodiments, the autonomic function index is used to adjust atrial pacing control parameters.

摘要翻译： 可植入医疗器械和相关方法提供心房起搏并测量心房（AV）延迟。 使用AV延迟计算自主功能指数。 自主功能指数可以在医疗报告中编制。 在一些实施例中，自主功能指数用于调节心房起搏控制参数。

公开(公告)号：US07228174B2

公开(公告)日：2007-06-05

申请号：US10135912

申请日：2002-04-29

申请人： John E. Burnes ,  Yong K. Cho ,  David Igel ,  Luc R. Mongeon ,  John C. Rueter ,  Harry Stone ,  Jodi Zilinski

发明人： John E. Burnes ,  Yong K. Cho ,  David Igel ,  Luc R. Mongeon ,  John C. Rueter ,  Harry Stone ,  Jodi Zilinski

IPC分类号： A61N1/362

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

摘要： Methods and devices for determining optimal Atrial to Ventricular (AV) pacing intervals and Ventricular to Ventricular (VV) delay intervals in order to optimize cardiac output. Impedance, preferably sub-threshold impedance, is measured across the heart at selected cardiac cycle times as a measure of chamber expansion or contraction. One embodiment measures impedance over a long AV interval to obtain the minimum impedance, indicative of maximum ventricular expansion, in order to set the AV interval. Another embodiment measures impedance change over a cycle and varies the AV pace interval in a binary search to converge on the AV interval causing maximum impedance change indicative of maximum ventricular output. Another method varies the right ventricle to left ventricle (VV) interval to converge on an impedance maximum indicative of minimum cardiac volume at end systole. Another embodiment varies the VV interval to maximize impedance change.

摘要翻译： 用于确定最佳心房与心室（AV）起搏间隔和心室间室（VV）延迟间隔的方法和装置，以优化心输出量。 在选择的心脏周期时间内，跨心脏测量阻抗，优选亚阈值阻抗，作为腔室扩张或收缩的量度。 为了设定AV间隔，一个实施例测量长AV间隔上的阻抗以获得指示最大心室扩张的最小阻抗。 另一个实施例测量一个周期的阻抗变化，并且改变二进制搜索中的AV步速间隔以收敛于AV间隔，从而引起指示最大心室输出的最大阻抗变化。 另一种方法将右心室改变为左心室（VV）间隔，以收敛于指示最终心脏收缩最小心脏容积的阻抗最大值。 另一实施例改变VV间隔以最大化阻抗变化。

公开(公告)号：US4523593A

公开(公告)日：1985-06-18

申请号：US504709

申请日：1983-06-15

申请人： John C. Rueter

发明人： John C. Rueter

IPC分类号： A61N1/365 ,  A61N1/362 ,  A61N1/368 ,  A61N1/36

CPC分类号： A61N1/368

摘要： A physiologic cardiac pacer operable in the DVI or A-V sequential pacing mode or the DDD or fully automatic pacing mode senses for the omission of an R-wave from an implantable cardiac pacer during the A-V interval. If the pacer does not sense a R-wave during the A-V interval the V-A interval is timed out immediately following the A-V interval and an atrial pacing pulse is issued at the end of the V-A interval. In the event, however, that an R-wave is sensed during the A-V interval, a flag is set and then the entire A-V interval is to be timed out, at which time the state of the flag is determined. If an R-wave was previously issued, a ventricular pacing pulse is not issued to the pacer at the end of the A-V interval, whereas if the flag is not set it is transmitted to the pacer.

摘要翻译： 在DVI或A-V顺序起搏模式或DDD或全自动起搏模式下可操作的生理性心脏起搏器感测在A-V间隔期间从可植入心脏起搏器省略R波。 如果起搏器在A-V间隔期间没有感测到R波，则V-A间隔在A-V间隔之后立即超时，并且在V-A间隔结束时发出心房起搏脉冲。 然而，在这种情况下，在A-V间隔期间感测到R波，标志被置位，然后整个A-V间隔被超时，此时标志的状态被确定。 如果以前发出R波，则在A-V间隔结束时不会向起搏器发出心室起搏脉冲，而如果标志未设置，则将其发送到起搏器。

公开(公告)号：US09042982B2

公开(公告)日：2015-05-26

申请号：US13400381

申请日：2012-02-20

申请人： John E. Burnes ,  Yong K. Cho ,  David Igel ,  Luc R. Mongeon ,  John C. Rueter ,  Harry Stone ,  Jodi Zilinski

发明人： John E. Burnes ,  Yong K. Cho ,  David Igel ,  Luc R. Mongeon ,  John C. Rueter ,  Harry Stone ,  Jodi Zilinski

IPC分类号： A61N1/00 ,  A61N1/362 ,  A61N1/365 ,  A61N1/368

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

摘要： Methods and devices for determining optimal Atrial to Ventricular (AV) pacing intervals and Ventricular to Ventricular (VV) delay intervals in order to optimize cardiac output. Impedance, preferably sub-threshold impedance, is measured across the heart at selected cardiac cycle times as a measure of chamber expansion or contraction. One embodiment measures impedance over a long AV interval to obtain the minimum impedance, indicative of maximum ventricular expansion, in order to set the AV interval. Another embodiment measures impedance change over a cycle and varies the AV pace interval in a binary search to converge on the AV interval causing maximum impedance change indicative of maximum ventricular output. Another method varies the right ventricle to left ventricle (VV) interval to converge on an impedance maximum indicative of minimum cardiac volume at end systole. Another embodiment varies the VV interval to maximize impedance change.

公开(公告)号：US20120150253A1

公开(公告)日：2012-06-14

申请号：US13400381

申请日：2012-02-20

申请人： John E. Burnes ,  Yong K. Cho ,  David Igel ,  Luc R. Mongeon ,  John C. Rueter ,  Harry Stone ,  Jodi Zilinski

发明人： John E. Burnes ,  Yong K. Cho ,  David Igel ,  Luc R. Mongeon ,  John C. Rueter ,  Harry Stone ,  Jodi Zilinski

IPC分类号： A61N1/365

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

摘要： Methods and devices for determining optimal Atrial to Ventricular (AV) pacing intervals and Ventricular to Ventricular (VV) delay intervals in order to optimize cardiac output. Impedance, preferably sub-threshold impedance, is measured across the heart at selected cardiac cycle times as a measure of chamber expansion or contraction. One embodiment measures impedance over a long AV interval to obtain the minimum impedance, indicative of maximum ventricular expansion, in order to set the AV interval. Another embodiment measures impedance change over a cycle and varies the AV pace interval in a binary search to converge on the AV interval causing maximum impedance change indicative of maximum ventricular output. Another method varies the right ventricle to left ventricle (VV) interval to converge on an impedance maximum indicative of minimum cardiac volume at end systole. Another embodiment varies the VV interval to maximize impedance change.

摘要翻译： 用于确定最佳心房与心室（AV）起搏间隔和心室间室（VV）延迟间隔的方法和装置，以优化心输出量。 在选择的心脏周期时间内，跨心脏测量阻抗，优选亚阈值阻抗，作为腔室扩张或收缩的量度。 为了设定AV间隔，一个实施例测量长AV间隔上的阻抗以获得指示最大心室扩张的最小阻抗。 另一个实施例测量一个周期的阻抗变化，并且改变二进制搜索中的AV步速间隔以收敛于AV间隔，从而引起指示最大心室输出的最大阻抗变化。 另一种方法将右心室改变为左心室（VV）间隔，以收敛于指示最终心脏收缩最小心脏容积的阻抗最大值。 另一实施例改变VV间隔以最大化阻抗变化。

公开(公告)号：US07818059B2

公开(公告)日：2010-10-19

申请号：US11115628

申请日：2005-04-27

申请人： John C. Rueter ,  Todd J. Sheldon

发明人： John C. Rueter ,  Todd J. Sheldon

IPC分类号： A61N1/362

CPC分类号： A61N1/371 ,  A61N1/3714

摘要： Embodiments of the invention provide systems and methods for an implantable medical device comprising means for selecting between an atrial chamber reset (ACR) test and an atrioventricular conduction (AVC) test to provide atrial capture management and means for switching between an atrial-based pacing mode and a dual chamber pacing mode based on detecting relatively reliable atrioventricular conduction.

摘要翻译： 本发明的实施例提供了一种用于可植入医疗装置的系统和方法，包括用于在房室复位（ACR）测试和房室传导（AVC）测试之间进行选择以提供心房捕获管理的装置和用于在基于心房的起搏模式之间切换的装置 以及基于检测相对可靠的房室传导的双室起搏模式。

公开(公告)号：US07711423B2

公开(公告)日：2010-05-04

申请号：US11135921

申请日：2005-05-24

申请人： John E. Burnes ,  David A. Igel ,  John C. Rueter ,  Yong K. Cho ,  Luc R. Mongeon ,  Harold E. Stone ,  Jodi Zilinski

发明人： John E. Burnes ,  David A. Igel ,  John C. Rueter ,  Yong K. Cho ,  Luc R. Mongeon ,  Harold E. Stone ,  Jodi Zilinski

IPC分类号： A61N1/362

CPC分类号： A61N1/36521

摘要： Impedance, e.g. sub-threshold impedance, is measured across the heart at selected cardiac cycle times as a measure of chamber expansion or contraction. One embodiment measures impedance over a long AV interval to obtain the minimum impedance, indicative of maximum ventricular expansion, in order to set the AV interval. Another embodiment measures impedance change over a cycle and varies the AV pace interval in a binary search to converge on the AV interval causing maximum impedance change indicative of maximum ventricular output. Another method varies the right ventricle to left ventricle (VV) interval to converge on an impedance maximum indicative of minimum cardiac volume at end systole. Another embodiment varies the VV interval to maximize impedance change. Other methods vary the AA interval to maximize impedance change over the entire cardiac cycle or during the atrial cycle.

摘要翻译： 阻抗，例如 亚阈值阻抗是在选定心脏周期时间内心脏测量的，作为腔室扩张或收缩的量度。 为了设定AV间隔，一个实施例测量长AV间隔上的阻抗以获得指示最大心室扩张的最小阻抗。 另一个实施例测量一个周期的阻抗变化，并且改变二进制搜索中的AV步速间隔以收敛于AV间隔，从而引起指示最大心室输出的最大阻抗变化。 另一种方法将右心室改变为左心室（VV）间隔，以收敛于指示最终心脏收缩最小心脏容积的阻抗最大值。 另一实施例改变VV间隔以最大化阻抗变化。 其他方法改变AA间隔以最大化整个心动周期或心房周期期间的阻抗变化。