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    Cardiac stimulation during a refractory period
    4.
    发明授权
    Cardiac stimulation during a refractory period 失效
    电动高效神经兴奋刺激技术领域

    公开(公告)号：US07292888B2

    公开(公告)日：2007-11-06

    申请号：US10638855

    申请日：2003-08-11

    申请人： D. Curtis Deno ,  David E. Euler ,  Lawrence J. Mulligan ,  Edwin G. Duffin ,  David A. Igel

    发明人： D. Curtis Deno ,  David E. Euler ,  Lawrence J. Mulligan ,  Edwin G. Duffin ,  David A. Igel

    IPC分类号： A61N1/365

    CPC分类号： A61N1/36514 ,  A61N1/3627 ,  A61N1/36564 ,  A61N1/368

    摘要： A medical device, e.g., an implantable medical device, delivers one or more neurally-excitable stimulation pulses to myocardial tissue during a period when the tissue is refractory. The width of the pulses is less than or equal to approximately one half millisecond. In some embodiments, the current amplitude of the pulses is less than or equal to approximately twenty milliamps. In exemplary embodiments, the medical device delivers a pulse train of six or fewer pulses separated from each other by an interval that is greater than or equal to approximately ten milliseconds. In some embodiments, the medical device delivers pulses according to a schedule stored in a memory, or as a function of a monitored physiological parameter of a patient, such as an intracardiac pressure. In some embodiments, the medical device suspends or withholds delivery of neurally-excitable based on detection of cardiac ischemia.

    摘要翻译： 医疗装置，例如可植入的医疗装置，在组织难治的时期期间，向心肌组织递送一个或多个神经可兴奋的刺激脉冲。 脉冲的宽度小于或等于大约一个半毫秒。 在一些实施例中，脉冲的电流幅度小于或等于大约二十毫安。 在示例性实施例中，医疗设备递送彼此间隔大于或等于大约十毫秒的六个或更少个脉冲的脉冲串。 在一些实施例中，医疗装置根据存储在存储器中的计划或者作为患者的被监测的生理参数（例如心脏内压力）递送脉冲。 在一些实施方案中，基于心脏缺血的检测，医疗装置暂停或禁止神经可兴奋的递送。

    Implantable medical device for monitoring congestive heart failure
    5.
    发明授权
    Implantable medical device for monitoring congestive heart failure 失效
    用于监测充血性心力衰竭的植入式医疗装置

    公开(公告)号：US06438408B1

    公开(公告)日：2002-08-20

    申请号：US09751079

    申请日：2000-12-28

    申请人： Lawrence J. Mulligan ,  D. Curtis Deno ,  Tom D. Bennett ,  David A. Igel ,  Michael R. S. Hill

    发明人： Lawrence J. Mulligan ,  D. Curtis Deno ,  Tom D. Bennett ,  David A. Igel ,  Michael R. S. Hill

    IPC分类号： A61B50452

    CPC分类号： A61N1/36564 ,  G06F19/00

    摘要： An implantable stimulator and monitor measures a group of heart failure parameters indicative of the state of heart failure employing EGM signals, measures of blood pressure including absolute pressure P, developed pressure (DP=systolic P−diastolic P), and/or dP/dt, and measures of heart chamber volume (V) over one or more cardiac cycles. These parameters include: (1) relaxation or contraction time constant tau (&tgr;); (2) mechanical restitution (MR), i.e., the mechanical response of a heart chamber to premature stimuli applied to the heart chamber; (3) recirculation fraction (RF), i.e., the rate of decay of PESP effects over a series of heart cycles; and (4) end systolic elastance (EES), i.e., the ratios of end systolic blood pressure P to volume V. These heart failure parameters are determined periodically regardless of patient posture and activity level. However, certain of the parameters are only measured or certain of the data are only stored when the patient heart rate is regular and within a normal sinus range between programmed lower and upper heart rates. The parameter data is associated with a date and time stamp and with other patient data, e.g., patient activity level, and the associated parameter data is stored in IMD memory for retrieval at a later date employing conventional telemetry systems. Incremental changes in the parameter data over time, taking any associated time of day and patient data into account, provide a measure of the degree of change in the heart failure state of the heart.

    摘要翻译： 可植入的刺激器和监测器测量一组指示使用EGM信号的心力衰竭状态的心力衰竭参数，包括绝对压力P的血压测量，开发压力（DP =收缩期舒张压P）和/或dP / dt ，以及一个或多个心动周期的心室容量（V）的测量。 这些参数包括：（1）松弛或收缩时间常数τ（＆tgr;）; （2）机械恢复（MR），即心脏室对施加到心脏室的过早刺激的机械响应; （3）循环分数（RF），即一系列心脏循环中PESP效应的衰减速率; 和（4）收缩末期弹性（EES），即收缩末期血压P与体积V的比值。不管患者的姿势和活动水平如何，这些心力衰竭参数是周期性确定的。 然而，仅测量某些参数，或仅当患者心率为规律且在编程的较低和较高心率之间的正常窦范围内时才存储某些数据。 参数数据与日期和时间戳以及与其他患者数据（例如患者活动水平）相关联，并且相关联的参数数据存储在IMD存储器中，以便以后采用常规遥测系统进行检索。 随着时间的推移，随着时间的推移，随着时间的推移和相关的患者数据的变化，可以提供心脏心力衰竭状态的变化程度。

    Implantable medical device for treating cardiac mechanical dysfunction by electrical stimulation
    6.
    发明授权
    Implantable medical device for treating cardiac mechanical dysfunction by electrical stimulation 有权
    用于通过电刺激治疗心脏机械功能障碍的植入式医疗装置

    公开(公告)号：US06738667B2

    公开(公告)日：2004-05-18

    申请号：US09750631

    申请日：2000-12-28

    申请人： D. Curtis Deno ,  Lawrence J. Mulligan ,  Tom D. Bennett ,  David A. Igel ,  Michael R. S. Hill ,  Richard J. Shaw

    发明人： D. Curtis Deno ,  Lawrence J. Mulligan ,  Tom D. Bennett ,  David A. Igel ,  Michael R. S. Hill ,  Richard J. Shaw

    IPC分类号： A61N118

    CPC分类号： A61N1/3627 ,  A61N1/36564

    摘要： An implantable stimulator and monitor measures a group of heart failure parameters indicative of the state of heart failure employing EGM signals, measures of blood pressure including absolute pressure P, developed pressure (DP=systolic P−diastolic P), and/or dP/dt, and measures of heart chamber volume (V) over one or more cardiac cycles. These parameters include: (1) relaxation or contraction time constant tau (&tgr;); (2) mechanical restitution (MR), i.e., the mechanical response of a heart chamber to premature stimuli applied to the heart chamber; (3) recirculation fraction (RF), i.e., the rate of decay of PESP effects over a series of heart cycles; and (4) end systolic elastance (EES), i.e., the ratios of end systolic blood pressure P to volume V. These heart failure parameters are determined periodically regardless of patient posture and activity level. The physician can determine whether a particular therapy is appropriate, prescribe the therapy for a period of time while again accumulating the stored patient data for a later review and assessment to determine whether the applied therapy is beneficial or not, thereby enabling periodic changes in therapy, if appropriate. Drug therapies and electrical stimulation therapies, including PESP stimulation, and pacing therapies including single chamber, dual chamber and multi-chamber (bi-atrial and/or bi-ventricular) pacing can be delivered. In patient's prone to malignant tachyarrhythmias, the assessment of heart failure state can be taken into account in setting parameters of detection or classification of tachyarrhythmias and the therapies that are delivered.

    摘要翻译： 可植入的刺激器和监测器测量一组指示使用EGM信号的心力衰竭状态的心力衰竭参数，包括绝对压力P的血压测量，开发压力（DP =收缩期舒张压P）和/或dP / dt ，以及一个或多个心动周期的心室容量（V）的测量。 这些参数包括：（1）松弛或收缩时间常数τ（τ）; （2）机械恢复（MR），即心脏室对施加到心脏室的过早刺激的机械响应; （3）循环分数（RF），即一系列心脏循环中PESP效应的衰减速率; 和（4）收缩末期弹性（EES），即收缩末期血压P与体积V的比值。不管患者的姿势和活动水平如何，这些心力衰竭参数是周期性确定的。 医生可以确定特定治疗是否合适，在一段时间内开出治疗，同时再次累积存储的患者数据以供稍后进行检查和评估，以确定所应用的治疗是否有益，从而使治疗周期性变化， 如果合适的话。 可以提供药物治疗和电刺激疗法，包括PESP刺激和起搏治疗，包括单室，双室和多室（双心房和/或双心室）起搏。 在患者易发生恶性快速性心律失常的情况下，可以在设定快速性心律失常检测或分类参数和所传递的治疗方案时考虑心力衰竭状态的评估。

    Regularization of ventricular rate during atrial tachyarrhythmia
    7.
    发明授权
    Regularization of ventricular rate during atrial tachyarrhythmia 有权
    房性心律失常期心室率正常化

    公开(公告)号：US06434424B1

    公开(公告)日：2002-08-13

    申请号：US09470120

    申请日：1999-12-22

    申请人： David A. Igel ,  H. Toby Markowitz ,  Robert A. Betzold ,  Karen J. Kleckner ,  Jeremy A. Schroetter

    发明人： David A. Igel ,  H. Toby Markowitz ,  Robert A. Betzold ,  Karen J. Kleckner ,  Jeremy A. Schroetter

    IPC分类号： A61N1362

    CPC分类号： A61N1/3622

    摘要： A pacing system provided with a mode switching feature and ventricular rate regularization (VRR) function adapted to stabilize or regularize ventricular heart rate during chronic or paroxysmal atrial tachyarrhythmia. In a preferred embodiment, the pacing system nominally operates in an atrial synchronized pacing mode such as DDD or DDDR pacing mode. In response to detection of atrial rhythm characteristics consistent with an atrial tachyarrhythmia, e.g., atrial fibrillation, a mode switch into a non-atrial synchronized, ventricular rate regularization pacing mode, e.g. DDIR or VDIR pacing mode, is made. If the VRR function is programmed on, the ventricular pacing rate based upon a rate responsive sensor derived ventricular pacing rate modulated on a beat by beat basis by preceding intrinsic or paced ventricular events, the stability of the intrinsic ventricular heart rate, and any atrial pace events to regularize the ventricular pacing rate. The pacing system may also be permanently programmed to the DDIR pacing mode with the VRR feature functioning continuously. The pacing system may also be permanently programmed to the VVIR pacing mode with VRR function activated, but without consideration of atrial pace events.

    摘要翻译： 具有模式切换特征和心室率正常化（VRR）功能的起搏系统适于在慢性或阵发性房性快速性心律失常期间稳定或规范心室心率。 在优选实施例中，起搏系统名义地以心房同步起搏模式操作，例如DDD或DDDR起搏模式。 响应于检测与房性快速性心律失常（例如心房颤动）一致的心房节律特征，模式切换到非心房同步的心室速率正则化起搏模式，例如心房颤动。 DDIR或VDIR起搏模式。 如果VRR功能被编程，则基于速率响应传感器导出的心室起搏速率的心室起搏速率通过前进的内在或节奏心室事件，内部心室心率的稳定性和任何心房起搏 事件来规范心室起搏率。 起搏系统也可以永久编程到DDIR起搏模式，VRR功能连续工作。 起搏系统也可以被永久编程到VVIR起搏模式，VRR功能被激活，但不考虑心房速度事件。

    Algorithm for the automatic determination of optimal pacing intervals
    8.
    发明授权
    Algorithm for the automatic determination of optimal pacing intervals 失效
    自动确定最佳起搏间隔的算法

    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。

    Non-programmable automated heart rhythm classifier
    10.
    发明授权
    Non-programmable automated heart rhythm classifier 失效
    不可编程自动心律分类器

    公开(公告)号：US06192273B1

    公开(公告)日：2001-02-20

    申请号：US08982362

    申请日：1997-12-02

    申请人： David A. Igel ,  Bruce L. Wilkoff

    发明人： David A. Igel ,  Bruce L. Wilkoff

    IPC分类号： A61N1365

    CPC分类号： A61B5/0464 ,  A61B5/0428 ,  A61B5/7267

    摘要： A nonprogrammable automated heart rhythm classifier that may be used alone or in conjunction with a therapy system for delivering shock treatment or therapeutic drugs to a patient, a monitoring or recording system, a paging or alarm system, or other rhythm classifying device. The nonprogrammable heart rhythm classifier is used to determine whether a patient's heart rhythm is normal, monomorphic tachycardia or polymorphic tachycardia from extracted features of the cardiac signal of a patent's heart. The extracted features are cycle length and regularity, and preferably with the addition of morphology. Prior to feature extraction, the cardiac electrical signal is conditioned with a signal conditioning system. The classifier may comprise a trained neural network or a trained discriminant function, which has been previously trained by a known set of classified heart rhythm data. Morphology can be estimated by kurtosis or from the probability density function. Regularity can be determined from approximate entropy, information dimension, correlation dimension or from Lyapunov's exponents of the patient's cardiac electrical signal. In yet another embodiment of the invention, adaptive sampling may be utilized to selectively digitize the cardiac electrical signal before classification occurs.

    摘要翻译： 一种不可编程的自动心律分类器，其可以单独使用或与用于向患者，监测或记录系统，寻呼或报警系统或其他节律分类装置递送冲击治疗或治疗药物的治疗系统一起使用。 非编程心律分类器用于确定患者的心律是否正常，单形性心动过速或多形性心动过速从专利心脏的心脏信号的提取特征。 提取的特征是循环长度和规则性，并且优选地加入形态。 在特征提取之前，心电信号用信号调节系统调节。 分类器可以包括经过训练的神经网络或经过训练的判别函数，其已经被先前由已知的一组分类的心律数据训练。 形态可以通过峰度或概率密度函数来估计。 规律性可以从近似熵，信息维度，相关维数或来自患者心电信号的Lyapunov指数来确定。 在本发明的另一个实施例中，可以利用自适应采样来在分类发生之前选择性地数字化心脏电信号。