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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。
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2.发明授权Implantable stimulation device having means for operating in a preemptive pacing mode to prevent tachyarrhythmias and method thereof 失效可植入刺激装置具有用于以抢占式起搏模式操作以防止快速性心律失常的装置及其方法
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
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。
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3.发明授权Programmable pacemaker including an atrial rate filter for deriving a filtered atrial rate used for switching pacing modes 失效可编程起搏器，包括用于导出用于切换起搏模式的滤波心房率的心房速率滤波器
公开(公告)号：US5549649A
公开(公告)日：1996-08-27
申请号：US258014
申请日：1994-06-10
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。
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公开(公告)号：US5873895A
公开(公告)日：1999-02-23
申请号：US128341
申请日：1998-08-03
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.
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5.发明授权Pacemaker and method of operating same that provides functional atrial cardiac pacing with ventricular support 失效起搏器和操作方法，提供功能性心房心脏起搏与心室支持
公开(公告)号：US6122546A
公开(公告)日：2000-09-19
申请号：US128284
申请日：1998-08-03
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。
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6.发明授权Implantable cardiac stimulation system providing autocapture and lead impedance assessment and method 失效可植入式心脏刺激系统，提供自体电位和引线阻抗评估及方法公开(公告)号：US07031773B1
公开(公告)日：2006-04-18
申请号：US10340099
申请日：2003-01-10
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。
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公开(公告)号：US5814077A
公开(公告)日：1998-09-29
申请号：US854797
申请日：1997-05-12
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.
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8.发明授权Systems and methods for use by an implantable medical device for controlling multi-site CRT pacing in the presence of atrial tachycardia 有权用于在存在心房性心动过速时用于控制多部位CRT起搏的可植入医疗装置的系统和方法公开(公告)号：US08447400B2
公开(公告)日：2013-05-21
申请号：US12822983
申请日：2010-06-24
申请人： Rohan A. More , Heidi Hellman , Eliot L. Ostrow , Paul A. Levine
发明人： Rohan A. More , Heidi Hellman , Eliot L. Ostrow , Paul A. Levine
IPC分类号： A61N1/368
CPC分类号： A61N1/368 , A61N1/3624 , A61N1/3684 , A61N1/3688
摘要： Systems and methods are provided for use by implantable medical devices equipped to deliver multi-site left ventricular (MSLV) pacing. MSLV is associated with a relatively long post-ventricular atrial blanking (PVAB) period that might limit the detection of pathologic rapid organized atrial tachycardias (OAT). In one example, MSLV cardiac resynchronization therapy (CRT) pacing is delivered within a tracking mode. A possible atrial tachycardia is detected based on the atrial rate exceeding an atrial tachycardia assessment rate (ATAR) threshold. The device then switches to single-site LV pacing, thereby effectively shortening the PVAB to detect additional atrial events that might otherwise be obscured, and thereby permitting the device to more reliably distinguish organized atrial tachycardias (such as atrial flutter) from sinus tachycardia. The device may also employ an automatic mode switch (AMS) threshold that is set higher than the ATAR threshold for use in switching from tracking modes to nontracking modes.
摘要翻译： 系统和方法被提供用于装备用于递送多部位左心室（MSLV）起搏的可植入医疗装置的使用。 MSLV与相对较长的心室后空位（PVAB）相关，可能限制病理性快速组织性房性心动过速（OAT）的检测。 在一个示例中，MSLV心脏再同步治疗（CRT）起搏在跟踪模式内递送。 基于心房速率超过心房心动过速评估率（ATAR）阈值，可以检测到心房心动过速。 然后，该装置切换到单位置LV起搏，从而有效地缩短PVAB以检测可能被模糊的额外的心房事件，从而允许该装置更可靠地区分有组织的心房心动过速（例如心房扑动）和窦性心动过速。 设备还可以采用设置为高于ATAR阈值的自动模式切换（AMS）阈值，用于从跟踪模式切换到非跟踪模式。
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公开(公告)号：US08147416B2
公开(公告)日：2012-04-03
申请号：US11848586
申请日：2007-08-31
CPC分类号： A61B5/0215 , A61B5/02108 , A61B5/02116 , A61B5/02125 , A61B5/0285 , A61B5/0295 , A61B5/0452 , A61B5/6846 , A61B2562/0219 , A61N1/36564 , A61N1/36578 , A61N1/36585
摘要： Implantable systems, and methods for use therewith, for monitoring arterial blood pressure on a chronic basis are provided herein. A first signal indicative of electrical activity of a patient's heart, and a second signal indicative of mechanical activity of the patient's heart, are obtained using implanted electrodes and an implanted sensor. By measuring the times between various features of the first signal relative to features of the second signal, values indicative of systolic pressure and diastolic pressure can be determined. In specific embodiments, such features are used to determine a peak pulse arrival time (PPAT), which is used to determine the value indicative of systolic pressure. Additionally, a peak-to-peak amplitude at the maximum peak of the second signal, and the value indicative of systolic pressure, can be used to determine the value indicative of diastolic pressure.
摘要翻译： 本文提供了可植入系统及其使用方法，用于长期监测动脉血压。 使用植入电极和植入的传感器获得指示患者心脏的电活动的第一信号和指示患者心脏的机械活动的第二信号。 通过测量第一信号的各个特征相对于第二信号的特征之间的时间，可以确定指示收缩压和舒张压的值。 在具体实施例中，这些特征用于确定峰值脉冲到达时间（PPAT），其用于确定指示收缩压的值。 此外，可以使用在第二信号的最大峰值处的峰 - 峰幅度和指示收缩压的值来确定指示舒张压的值。
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10.发明申请Systems and Methods for Use by an Implantable Medical Device for Controlling Multi-Site CRT Pacing in the Presence of Atrial Tachycardia 有权可植入医疗器械使用的系统和方法用于控制心房心动过速的多站点CRT起搏公开(公告)号：US20110319951A1
公开(公告)日：2011-12-29
申请号：US12822983
申请日：2010-06-24
申请人： Rohan A. More , Heidi Hellman , Eliot L. Ostrow , Paul A. Levine
发明人： Rohan A. More , Heidi Hellman , Eliot L. Ostrow , Paul A. Levine
IPC分类号： A61N1/368
CPC分类号： A61N1/368 , A61N1/3624 , A61N1/3684 , A61N1/3688
摘要： Systems and methods are provided for use by implantable medical devices equipped to deliver multi-site left ventricular (MSLV) pacing. MSLV is associated with a relatively long post-ventricular atrial blanking (PVAB) period that might limit the detection of pathologic rapid organized atrial tachycardias (OAT). In one example, MSLV cardiac resynchronization therapy (CRT) pacing is delivered within a tracking mode. A possible atrial tachycardia is detected based on the atrial rate exceeding an atrial tachycardia assessment rate (ATAR) threshold. The device then switches to single-site LV pacing, thereby effectively shortening the PVAB to detect additional atrial events that might otherwise be obscured, and thereby permitting the device to more reliably distinguish organized atrial tachycardias (such as atrial flutter) from sinus tachycardia. The device may also employ an automatic mode switch (AMS) threshold that is set higher than the ATAR threshold for use in switching from tracking modes to nontracking modes.
摘要翻译： 系统和方法被提供用于装备用于递送多部位左心室（MSLV）起搏的可植入医疗装置的使用。 MSLV与相对较长的心室后空泡（PVAB）相关，可能限制病理性快速组织性房性心动过速（OAT）的检测。 在一个示例中，MSLV心脏再同步治疗（CRT）起搏在跟踪模式内递送。 基于心房速率超过心房心动过速评估率（ATAR）阈值，可以检测到心房心动过速。 然后，该装置切换到单位置LV起搏，从而有效地缩短PVAB以检测可能被模糊的额外的心房事件，从而允许该装置更可靠地区分有组织的心房心动过速（例如心房扑动）和窦性心动过速。 设备还可以采用设置为高于ATAR阈值的自动模式切换（AMS）阈值，用于从跟踪模式切换到非跟踪模式。
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