公开(公告)号：US06259948B1

公开(公告)日：2001-07-10

申请号：US09191166

申请日：1998-11-13

申请人： Joseph J. Florio ,  Paul A. Levine ,  Mark R. Myers

发明人： Joseph J. Florio ,  Paul A. Levine ,  Mark R. Myers

IPC分类号： A61N136

CPC分类号： A61N1/36542 ,  A61N1/368

摘要： A device in the form of a cardiac pacemaker for treating a malfunctioning heart, in which the intrinsic heart rate information is combined with secondary sensor variance information to select an appropriate therapy for the patient. The cardiac pacemaker has operational capability in the sleep mode and includes a hysteresis function. The hysteresis function is disabled during operation in the sleep mode and a pacing therapy is selected based upon the intrinsic heart rate and sleep mode operation.

摘要翻译： 心脏起搏器形式的用于治疗故障心脏的装置，其中内在心率信息与次级传感器方差信息组合以选择患者的适当治疗。 心脏起搏器在睡眠模式下具有操作能力，并且包括滞后功能。 滞后功能在睡眠模式下操作期间被禁用，并且基于内在的心率和睡眠模式操作来选择起搏治疗。

公开(公告)号：US6058328A

公开(公告)日：2000-05-02

申请号：US788152

申请日：1997-01-24

申请人： Paul A. Levine ,  Jason A. Sholder ,  Gene A. Bornzin ,  Joseph J. Florio ,  Kenneth Valikai ,  Lisa P. Weinberg

发明人： Paul A. Levine ,  Jason A. Sholder ,  Gene A. Bornzin ,  Joseph J. Florio ,  Kenneth Valikai ,  Lisa P. Weinberg

IPC分类号： A61N1/362 ,  A61N1/365 ,  A61N1/39

CPC分类号： A61N1/3956 ,  A61N1/3622 ,  A61N1/36585 ,  A61N1/3688

摘要： Preemptive tachyarrhythmia pacing is provided in an implantable cardiac-stimulation device, such as an implantable pacemaker or defibrillator, by modifying the operation of the implantable device in a way that minimizes the likelihood of occurrence of a tachyarrhythmia. The behavior modification is achieved through the use of an appropriate preemptive tachyarrhythmia pacing control routine stored within the memory of the device. Depending upon the needs of the patient, preemptive tachyarrhythmia pacing is invoked continuously or on demand. If invoked on demand, Preemptive tachyarrhythmia pacing is triggered only upon the sensing of one or more conditions suggest that the onset of a tachyarrhythmia is imminent. When thus invoked, preemptive tachyarrhythmia pacing remains invoked only for as long as the onset-of-a-tachyarrhythmia-is-imminent conditions persist. Various preemptive tachyarrhythmia pacing control routines are contemplated, including those based on overdrive pacing, pacing with randomicity, and mode switching. Overdrive pacing, when used, is based on an automatically-determined diurnal rate, an automatic stepped increase over the average atrial rate, or a rate set by a cycle-to-cycle negative hysteresis. Conditions which suggest the imminency of the onset of a tachyarrhythmia include, but are not limited to, a sudden change in the patient's cardiac cycle from a previously-determined normal cardiac cycle.

摘要翻译： 通过以最小化发生快速性心律失常的可能性的方式修改可植入装置的操作，在可植入心脏刺激装置（例如可植入起搏器或除颤器）中提供先发性快速性心律失调起搏。 通过使用存储在设备的存储器内的适当的先发性快速性心律失常起搏控制程序来实现行为修改。 根据患者的需要，可以连续或按需调用抢先式快速性心律失调起搏。 如果按需调用，先发性快速性心律失常起搏仅在感觉到一种或多种情况时才触发，表明快速性心律失常的发作即将到来。 当这样被援引时，只有在发生急性心律失常即将到来的情况持续存在的情况下，抢救性快速性心律失调起搏仍然被援引。 预期各种先发性快速性心律失常起搏控制程序，包括基于超速起搏，起搏随机性和模式切换的那些。 超速起搏在使用时，基于自动确定的昼夜速率，比平均心房率自动逐步增加，或由周期到周期的负滞后设定的速率。 表明快速性心律失常发作即将发生的情况包括但不限于患者心动周期从先前确定的正常心动周期的突然变化。

公开(公告)号：US5549649A

公开(公告)日：1996-08-27

申请号：US258014

申请日：1994-06-10

申请人： Joseph J. Florio ,  Gene A. Bornzin ,  Paul A. Levine ,  J. Jeffrey Barlow

发明人： Joseph J. Florio ,  Gene A. Bornzin ,  Paul A. Levine ,  J. Jeffrey Barlow

IPC分类号： A61N1/362 ,  A61N1/36

CPC分类号： A61N1/3622

摘要： An implantable dual-chamber pacemaker programmed to operate primarily in an atrial tracking mode is provided, where the pacemaker includes an atrial rate smoothing filter for producing a filtered atrial rate from an intrinsic atrial rate, and where the pacemaker automatically switches its mode of operation from the atrial tracking mode to a non-atrial tracking mode in the event the filtered atrial rate exceeds a prescribed upper rate limit. The pacemaker switches from a primary set of operational parameter settings for the primary mode, to an alternate set of operational parameters for the alternate mode when the mode is switched from the primary mode to the alternate mode. The pacemaker also includes the capability of recording and storing mode switching events and data pertaining to the mode switching events.

摘要翻译： 提供了一种被编程为主要以心房跟踪模式操作的可植入双室心脏起搏器，其中起搏器包括心房速率平滑滤波器，用于从固有心房率产生经滤波的心房率，并且起搏器自动将其操作模式从 在过滤心房率超过规定的上限速率的情况下，将心房跟踪模式转换为非心房跟踪模式。 当模式从主模式切换到备用模式时，起搏器从主模式的主要操作参数设置切换到备用模式的备用操作参数集。 起搏器还包括记录和存储模式切换事件和与模式切换事件有关的数据的能力。

公开(公告)号：US07031773B1

公开(公告)日：2006-04-18

申请号：US10340099

申请日：2003-01-10

申请人： Paul A. Levine ,  Balakrishnan Shankar ,  Kenneth R. McNeil, II ,  Joseph J. Florio

发明人： Paul A. Levine ,  Balakrishnan Shankar ,  Kenneth R. McNeil, II ,  Joseph J. Florio

IPC分类号： A61N1/362

CPC分类号： A61N1/3686 ,  A61N1/3712

摘要： An implantable cardiac stimulation system provides autocapture assessment and lead impedance surveillance. The system includes a pulse generator that provides pacing stimulation pulses and a lead system including a plurality of electrodes that provide a plurality of different electrode configurations. The system further includes a switch that selectively couples the pulse generator to any one of the plurality of pacing electrode configurations and an autocapture circuit that performs autocapture tests with the pulse generator. The autocapture circuit includes a capture detector that detects evoked responses with an evoked response electrode configuration. When there is a failure to detect an evoked response, an impedance measuring circuit measures the lead impedance of the evoked response electrode configuration. If the measured lead impedance is outside of a given range, the switch couples the pulse generator to an electrode configuration other than the evoked response electrode configuration. Thereafter, the autocapture circuit performs a further autocapture and impedance measuring test or sets the pacing output to a level which assures capture.

摘要翻译： 可植入心脏刺激系统提供自体电位评估和引线阻抗监测。 该系统包括提供起搏刺激脉冲的脉冲发生器和包括提供多个不同电极配置的多个电极的引导系统。 所述系统还包括将所述脉冲发生器选择性地耦合到所述多个起搏电极配置中的任一个的开关和使用所述脉冲发生器进行自动俘获测试的自动俘获电路。 自动俘获电路包括捕获检测器，其通过诱发的响应电极配置来检测诱发的反应。 当无法检测到诱发反应时，阻抗测量电路测量诱发响应电极配置的引线阻抗。 如果测量的引线阻抗在给定范围之外，则开关将脉冲发生器耦合到除了​​诱发响应电极配置之外的电极配置。 此后，自动捕获电路进一步进行自动捕获和阻抗测量测试，或将起搏输出设置为确保捕获的水平。

公开(公告)号：US5814077A

公开(公告)日：1998-09-29

申请号：US854797

申请日：1997-05-12

申请人： Jason A. Sholder ,  Paul A. Levine ,  Joseph J. Florio ,  Gene A. Bornzin

发明人： Jason A. Sholder ,  Paul A. Levine ,  Joseph J. Florio ,  Gene A. Bornzin

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

CPC分类号： A61N1/36585 ,  A61N1/3627 ,  A61N1/3682

摘要： A special type of AV/PV hysteresis is provided in a dual-chamber pacemaker. A long AV delay is initially provided, thereby affording as much opportunity as possible for natural AV conduction to occur. Such long AV delay is automatically shortened should AV block occur. Periodic scanning for the return of AV conduction (absence of AV block) is performed so that the AV delay can be returned to its long value as soon as possible. In one embodiment, the pacemaker "learns" the natural conduction time (AR interval) of the patient and thereafter uses such learned natural conduction time as a reference against which subsequently measured AR intervals are compared to better distinguish conducted ventricular contractions from ectopic, pathologic, or other nonconducted ventricular contractions (e.g., PVC's). If the measured AR interval is approximately the same as the "learned" AR interval, then the R-wave at the conclusion of the measured AR interval is presumed to be a conducted R-wave that signals the return of AV conduction, and the AV delay is lengthened back to its original value. If, on the other hand, the measured AR interval is significantly different than the "learned" natural conduction time, then the R-wave at the conclusion of the measured AR interval is presumed to be a nonconducted R-wave, and the AV delay is kept short. In other embodiments, other techniques are used to distinguish a conducted R-wave from a nonconducted R-wave.

公开(公告)号：US5873895A

公开(公告)日：1999-02-23

申请号：US128341

申请日：1998-08-03

申请人： Jason A. Sholder ,  Paul A. Levine ,  Joseph J. Florio ,  Gene A. Bornzin

发明人： Jason A. Sholder ,  Paul A. Levine ,  Joseph J. Florio ,  Gene A. Bornzin

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

CPC分类号： A61N1/36585 ,  A61N1/3627 ,  A61N1/3682

摘要： A special type of AV/PV hysteresis is provided in a dual-chamber pacemaker. A long AV delay is initially provided, thereby affording as much opportunity as possible for natural AV conduction to occur. Such long AV delay is automatically shortened should AV block occur. Periodic scanning for the return of AV conduction (absence of AV block) is performed so that the AV delay can be returned to its long value as soon as possible. In one embodiment, the pacemaker "learns" the natural conduction time (AR interval) of the patient and thereafter uses such learned natural conduction time as a reference against which subsequently measured AR intervals are compared to better distinguish conducted ventricular contractions from ectopic, pathologic, or other nonconducted ventricular contractions (e.g., PVC's). If the measured AR interval is approximately the same as the "learned" AR interval, then the R-wave at the conclusion of the measured AR interval is presumed to be a conducted R-wave that signals the return of AV conduction, and the AV delay is lengthened back to its original value. If, on the other hand, the measured AR interval is significantly different than the "learned" natural conduction time, then the R-wave at the conclusion of the measured AR interval is presumed to be a nonconducted R-wave, and the AV delay is kept short. In other embodiments, other techniques are used to distinguish a conducted R-wave from a nonconducted R-wave.

公开(公告)号：US6122546A

公开(公告)日：2000-09-19

申请号：US128284

申请日：1998-08-03

申请人： Jason A. Sholder ,  Paul A. Levine ,  Joseph J. Florio ,  Gene A. Bornzin

发明人： Jason A. Sholder ,  Paul A. Levine ,  Joseph J. Florio ,  Gene A. Bornzin

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

CPC分类号： A61N1/36585 ,  A61N1/3627 ,  A61N1/3682

摘要： A special type of AV/PV hysteresis is provided in a dual-chamber pacemaker. A long AV delay is initially provided, thereby affording as much opportunity as possible for natural AV conduction to occur. Such long AV delay is automatically shortened should AV block occur. Periodic scanning for the return of AV conduction (absence of AV block) is performed so that the AV delay can be returned to its long value as soon as possible. In one embodiment, the pacemaker "learns" the natural conduction time (AR interval) of the patient and thereafter uses such learned natural conduction time as a reference against which subsequently measured AR intervals are compared to better distinguish conducted ventricular contractions from ectopic, pathologic, or other nonconducted ventricular contractions (e.g., PVC's). If the measured AR interval is approximately the same as the "learned" AR interval, then the R-wave at the conclusion of the measured AR interval is presumed to be a conducted R-wave that signals the return of AV conduction, and the AV delay is lengthened back to its original value. If, on the other hand, the measured AR interval is significantly different than the "learned" natural conduction time, then the R-wave at the conclusion of the measured AR interval is presumed to be a nonconducted R-wave, and the AV delay is kept short. In other embodiments, other techniques are used to distinguish a conducted R-wave from a nonconducted R-wave.

摘要翻译： 在双室起搏器中提供特殊类型的AV / PV滞后。 最初提供长的AV延迟，从而为自然AV传导提供尽可能多的机会。 如果发生AV块，这样长的AV延迟会自动缩短。 进行AV导通（AV区域不存在）的返回的周期性扫描，使得AV延迟可以尽可能快地返回到其长值。 在一个实施例中，起搏器“学习”患者的自然传导时间（AR间隔），此后使用这种学习的自然传导时间作为参考，随后比较随后测量的AR间隔以更好地区分进行的心室收缩与异位，病理， 或其他非导管性心室收缩（例如PVC）。 如果测量的AR间隔与“学习”的AR间隔大致相同，则在测量的AR间隔结束时的R波被推定为用于表示AV传导返回的传导R波，AV 延迟延长到原来的价值。 另一方面，如果测量的AR间隔与“学习”的自然传导时间显着不同，则在测量的AR间隔结束时的R波被推定为非导通的R波，并且AV延迟 保持短暂。 在其他实施例中，使用其它技术来区分传导的R波和非导通的R波。

公开(公告)号：US07648464B1

公开(公告)日：2010-01-19

申请号：US11458617

申请日：2006-07-19

申请人： Jong Gill ,  Peter Boileau ,  Gene A. Bornzin ,  Joseph J. Florio ,  Xiaoyi Min

发明人： Jong Gill ,  Peter Boileau ,  Gene A. Bornzin ,  Joseph J. Florio ,  Xiaoyi Min

IPC分类号： A61B5/021

CPC分类号： A61B5/0215 ,  A61B5/0031 ,  A61B5/042 ,  A61B5/7239 ,  A61N1/36564

摘要： Methods and systems are presented for using an ICD to detect myocardial ischemia. In one embodiment, a method includes sensing a signal indicative of cardiac pressure, measuring a height of the sensed signal at a peak amplitude of the sensed signal, and measuring a duration of the sensed signal. The method further includes indicating an ischemia based on a comparison of a ratio of the height to the duration with a predetermined value. In another embodiment, a method includes sensing a signal indicative of cardiac pressure, determining a derivative signal that is a first derivative of the sensed signal, measuring a maximum positive value of the derivative signal, and measuring a maximum negative value of the derivative signal. The method further includes indicating an ischemia based on a comparison of a ratio of the maximum positive value to the maximum negative value with a predetermined value.

摘要翻译： 提出了使用ICD检测心肌缺血的方法和系统。 在一个实施例中，一种方法包括感测指示心脏压力的信号，以感测信号的峰值幅度测量感测信号的高度，以及测量感测信号的持续时间。 该方法还包括基于将高度与持续时间的比率与预定值的比较来指示缺血。 在另一个实施例中，一种方法包括感测指示心脏压力的信号，确定作为感测信号的一阶导数的导数信号，测量导数信号的最大正值，以及测量导数信号的最大负值。 该方法还包括基于将最大正值与最大负值的比率与预定值进行比较来指示缺血。

公开(公告)号：US06944506B1

公开(公告)日：2005-09-13

申请号：US10180789

申请日：2002-06-25

申请人： Kevin L. Morgan ,  Joseph J. Florio

发明人： Kevin L. Morgan ,  Joseph J. Florio

IPC分类号： A61N1/05

CPC分类号： A61N1/05 ,  A61M2025/09175 ,  A61N1/056

摘要： A stylet unit for implanting a removable lead system for a cardiac stimulation device includes an elongated main body having an enlarged feature at the distal end of the main body with a rounded blunt tip end, a width greater than the width of the distal end of the main body, and a length greater than the width. A finger grip is provided at a proximal extremity of the elongated main body for manipulating the stylet unit. Lead system includes an elongated tubular lead body containing an elongated coil conductor with a plurality of coil windings defining a passageway extending the length of the coil conductor and having inner surfaces facing toward the passageway. The enlarged feature of the stylet is sufficiently long to assure that it advances along the passageway in slidable engagement with the inner surfaces of the coil conductor but without thrusting between adjoining coils.

摘要翻译： 用于植入用于心脏刺激装置的可移除引线系统的探针单元包括细长主体，其在主体的远端具有扩大的特征，具有圆钝钝的末端，宽度大于所述主体的远端的宽度 主体，长度大于宽度。 在细长主体的近端设置有手指握柄，用于操纵探针单元。 引线系统包括细长的管状引线体，其包含具有多个线圈绕组的细长线圈导体，所述多个线圈绕组限定延伸线圈导体的长度并具有面向通道的内表面的通道。 探针的扩大特征足够长，以确保其沿着通道前进，可与线圈导体的内表面滑动接合，但不会在相邻线圈之间推动。

公开(公告)号：US06937900B1

公开(公告)日：2005-08-30

申请号：US10205188

申请日：2002-07-24

申请人： Anne M. Pianca ,  Gene A. Bornzin ,  Euljoon Park ,  Alan B. Vogel ,  Joseph J. Florio ,  Lee Jay Mandell ,  Junyu Mai

发明人： Anne M. Pianca ,  Gene A. Bornzin ,  Euljoon Park ,  Alan B. Vogel ,  Joseph J. Florio ,  Lee Jay Mandell ,  Junyu Mai

IPC分类号： A61N1/365 ,  A61N1/372

CPC分类号： A61N1/36542

摘要： An implantable cardiac stimulation device which determines stimulation based upon the patient's body position and activity level while eliminating special implantation or calibration procedures. To eliminate such special implantation and calibration procedures, the stimulation device correlates the patient's body position using a multi-axis DC accelerometer or other sensor during times of high activity and determines a patient's standing position value. During other times, the stimulation device compares the signals from the accelerometer to the standing position value to determine the patient's current body position. Based upon the current body position and the activity level, the stimulation device determines the necessary stimulation to deliver to the patient.

摘要翻译： 一种可植入心脏刺激装置，其基于患者的身体位置和活动水平确定刺激，同时消​​除特殊植入或校准过程。 为了消除这种特殊的植入和校准过程，刺激装置在高活动时间期间使用多轴DC加速度计或其他传感器来关联患者的身体位置并且确定患者的站立位置值。 在其他时间，刺激装置将来自加速度计的信号与站立位置值进行比较，以确定患者的当前身体位置。 基于当前身体位置和活动水平，刺激装置确定必要的刺激以递送给患者。