公开(公告)号：US20070299477A1

公开(公告)日：2007-12-27

申请号：US11765260

申请日：2007-06-19

申请人： Karen Kleckner ,  Kathleen Prieve ,  Jeffrey Gillberg ,  Ren Zhou ,  Kenneth Anderson ,  D. Deno ,  Glenn Zillmer ,  Ruth Klepfer ,  Vincent Splett ,  David Euler ,  Lawrence Mulligan ,  Edwin Duffin ,  David Igel ,  John Burnes

发明人： Karen Kleckner ,  Kathleen Prieve ,  Jeffrey Gillberg ,  Ren Zhou ,  Kenneth Anderson ,  D. Deno ,  Glenn Zillmer ,  Ruth Klepfer ,  Vincent Splett ,  David Euler ,  Lawrence Mulligan ,  Edwin Duffin ,  David Igel ,  John Burnes

IPC分类号： A61N1/36

CPC分类号： A61N1/3627 ,  A61N1/36114 ,  A61N1/36521 ,  A61N1/36564 ,  A61N1/36578 ,  A61N1/36585 ,  A61N1/3684 ,  A61N1/3962

摘要： The above-described methods and apparatus are believed to be of particular benefit for patients suffering heart failure including cardiac dysfunction, chronic HF, and the like and all variants as described herein and including those known to those of skill in the art to which the invention is directed. It will understood that the present invention offers the possibility of monitoring and therapy of a wide variety of acute and chronic cardiac dysfunctions. The current invention provides systems and methods for delivering therapy for cardiac hemodynamic dysfunction via the innervated myocardial substrate receives one or more discrete pulses of electrical stimulation during the refractory period of said innervated myocardial substrate.

摘要翻译： 据信上述方法和装置对患有心力衰竭，包括心脏功能障碍，慢性HF等的患者以及本文所述的所有变体以及包括本发明的本领域技术人员已知的那些的患者特别有益 被指示。 应当理解，本发明提供监测和治疗各种急性和慢性心脏功能障碍的可能性。 本发明提供了用于通过所述神经支配的心肌底物递送治疗心脏血液动力学功能障碍的系统和方法，在所述神经支配的心肌基质的不应期期间接收电刺激的一个或多个离散脉冲。

公开(公告)号：US20050038479A1

公开(公告)日：2005-02-17

申请号：US10638855

申请日：2003-08-11

申请人： D. Deno ,  David Euler ,  Lawrence Mulligan ,  Edwin Duffin ,  David Igel

发明人： D. Deno ,  David Euler ,  Lawrence Mulligan ,  Edwin Duffin ,  David Igel

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

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。

公开(公告)号：US20050075675A1

公开(公告)日：2005-04-07

申请号：US10680494

申请日：2003-10-07

申请人： Lawrence Mulligan ,  D. Deno ,  John Burnes ,  Nirav Sheth

发明人： Lawrence Mulligan ,  D. Deno ,  John Burnes ,  Nirav Sheth

IPC分类号： A61N1/362 ,  A61N1/365

CPC分类号： A61N1/3627 ,  A61N1/36514 ,  A61N1/36578

摘要： A method and apparatus for optimizing and assessing the response to extra-systolic stimulation (ESS) are provided. An optimization/monitoring parameter is calculated as a function of potentiation ratio, PR, and recirculation fraction, RF, derived from measurements of myocardial contractile function during and after ESS. PR may be computed as the ratio of the contractile function on post-extra-systolic beats during ESS to baseline contractile function. RF may be computed as the slope of a linear regression performed on a plot of the contractile function for a post-extra-systolic beat versus the contractile function for the previous post-extra-systolic beat after ESS is ceased. The ESI resulting in a maximum optimization/monitoring parameter, preferably computed as the product of PR and RF, is determined as the optimal ESI. The operating ESI may be automatically adjusted, and/or PR and RF data may be stored for monitoring purposes.

摘要翻译： 提供了一种用于优化和评估对收缩期刺激（ESS）的反应的方法和装置。 根据ESS期间和之后的心肌收缩功能测量得出，优化/监测参数作为增强比PR和再循环分数RF的函数计算。 PR可以计算为ESS期间收缩功能对收缩后收缩期与基线收缩功能的比值。 RF可以被计算为在ESS停止之后针对收缩后收缩压的收缩功能图与先前的收缩后节拍后的收缩功能的曲线进行的线性回归的斜率。 产生最大优化/监测参数的ESI，优选地计算为PR和RF的乘积，被确定为最佳ESI。 可以自动调整操作ESI，并且可以存储和/或PR和RF数据用于监视目的。

公开(公告)号：US20060247699A1

公开(公告)日：2006-11-02

申请号：US11116941

申请日：2005-04-28

申请人： John Burnes ,  Lawrence Mulligan ,  Randall Knoll

发明人： John Burnes ,  Lawrence Mulligan ,  Randall Knoll

IPC分类号： A61N1/36

CPC分类号： A61N1/3627 ,  A61N1/36114 ,  A61N1/36564

摘要： In some embodiments, a method of applying stimulation pulse therapy to excitable tissue may include one or more of the following steps: (a) delivering a PESP stimulation therapy to the excitable tissue for a cardiac cycle, (b) delivering a NES stimulation therapy to the excitable tissue during certain cardiac cycles, (c) determining physiologic demand of the patient based on at least one physiologic measurement, (d) determining physiologic demand being placed on a heart based on at least one physiologic measurement, and ceasing the delivery of the NES and PESP stimulation therapy when physiologic demand returns to a base level, and (e) determining physiologic demand being placed on a heart based on at least one physiologic measurement, and modulating the ratio of the number of cardiac cycles in which the NES stimulation therapy is delivered to the number of cardiac cycles in which the PESP stimulation therapy is delivered based on physiologic demand.

摘要翻译： 在一些实施方案中，将刺激脉冲治疗应用于可兴奋组织的方法可以包括以下步骤中的一个或多个：（a）将PESP刺激疗法递送至心脏周期的可兴奋组织，（b）将NES刺激疗法递送至 （c）基于至少一个生理测量来确定患者的生理需求，（d）基于至少一个生理测量来确定置于心脏上的生理需求，并且停止递送 NES和PESP刺激治疗，当生理需求恢复到基础水平时，以及（e）基于至少一个生理测量来确定置于心脏上的生理需求，以及调节NES刺激疗法的心脏周期数 基于生理需求被传递到其中递送PESP刺激疗法的心脏周期数。

公开(公告)号：US20050096701A1

公开(公告)日：2005-05-05

申请号：US10918234

申请日：2004-08-13

申请人： Maura Donovan ,  Orhan Soykan ,  D. Deno ,  Lawrence Mulligan ,  Brian Fernandes

发明人： Maura Donovan ,  Orhan Soykan ,  D. Deno ,  Lawrence Mulligan ,  Brian Fernandes

IPC分类号： A61N1/32 ,  A61N1/00

CPC分类号： A61N1/326

摘要： The present invention provides a novel stimulatory device for the controlled production of angiogenic growth factors. More specifically, the present invention provides a subthreshold pulse generator for the local production of vascular endothelial growth factor.

摘要翻译： 本发明提供了用于受控制造血管生成生长因子的新型刺激装置。 更具体地，本发明提供了用于局部产生血管内皮生长因子的亚阈值脉冲发生器。

公开(公告)号：US20070203522A1

公开(公告)日：2007-08-30

申请号：US11363729

申请日：2006-02-28

申请人： Douglas Hettrick ,  Lawrence Mulligan ,  David Euler

发明人： Douglas Hettrick ,  Lawrence Mulligan ,  David Euler

IPC分类号： A61N1/00

CPC分类号： A61N1/3627

摘要： Methods and systems for treating patients with diastolic heart failure (DHF) are disclosed which include slowing a patient's heart rate below its intrinsic rate, and controlling the rate using cardiac pacing therapy to improve LV filling and cardiac output. In certain embodiments, a pacing treatment rate may be determined by adjusting an adaptive rate by an amount determined by evaluating one or more patient parameters.

摘要翻译： 公开了用于治疗舒张性心力衰竭（DHF）患者的方法和系统，其包括将患者的心率降低到其内在速率以下，并且使用心脏起搏治疗来控制速率以改善LV灌注和心输出量。 在某些实施例中，起搏治疗率可以通过将自适应速率调整到通过评估一个或多个患者参数确定的量来确定。

公开(公告)号：US20050027323A1

公开(公告)日：2005-02-03

申请号：US10000973

申请日：2001-10-30

申请人： Lawrence Mulligan ,  Michael Hill

发明人： Lawrence Mulligan ,  Michael Hill

IPC分类号： A61B5/0215 ,  A61N1/362 ,  A61N1/365 ,  A61N1/368

CPC分类号： A61N1/3627 ,  A61N1/36528 ,  A61N1/36564 ,  A61N1/3684

摘要： Implantable medical devices (IMDs) for monitoring signs of acute or chronic cardiac heart failure by measuring cardiac blood pressure and mechanical dimensions of the heart and providing multi-chamber pacing optimized as a function of measured blood pressure and dimensions are disclosed. The dimension sensor or sensors comprise at least a first sonomicrometer piezoelectric crystal mounted to a first lead body implanted into or in relation to one heart chamber that operates as an ultrasound transmitter when a drive signal is applied to it and at least one second sonomicrometer crystal mounted to a second lead body implanted into or in relation to a second heart chamber that operates as an ultrasound receiver. The ultrasound receiver converts impinging ultrasound energy transmitted from the ultrasound transmitter through blood and heart tissue into an electrical signal. The time delay between the generation of the transmitted ultrasound signal and the reception of the ultrasound wave varies as a function of distance between the ultrasound transmitter and receiver which in turn varies with contraction and expansion of a heart chamber between the first and second sonomicrometer crystals. One or more additional sonomicrometer piezoelectric crystal can be mounted to additional lead bodies such that the distances between the three or more sonomicrometer crystals can be determined. In each case, the sonomicrometer crystals are distributed about a heart chamber such that the distance between the separated ultrasound transmitter and receiver crystal pairs changes with contraction and relaxation of the heart chamber walls.

摘要翻译： 公开了通过测量心脏的心脏血压和机械尺寸并提供作为测量血压和尺寸的函数优化的多室起搏的用于监测急性或慢性心脏心力衰竭迹象的可植入医疗装置（IMD）。 尺寸传感器或传感器至少包括安装到第一引线体的第一经济学压电晶体体，该第一引线体被植入或与一个心室相关联，该心室在作用于其上的驱动信号时作为超声波发射器工作，并且至少一个第二经济测量仪晶体安装 植入到作为超声波接收器操作的第二心室的第二引线体中。 超声波接收器将从超声波发射器传输的冲击超声能量通过血液和心脏组织转换为电信号。 发射超声波信号的产生与超声波的接收之间的时间延迟随着超声发射器和接收器之间的距离的函数而变化，而超声发射器与接收器之间随着第一和第二经济计量晶体之间心室的收缩和膨胀而变化。 一个或多个附加的经济测量压电晶体可以安装到另外的引线体上，使得可以确定三个或更多个经济测量晶体之间的距离。 在每种情况下，经济测量仪晶体分布在心室周围，使得分离的超声波发射器和接收器晶体对之间的距离随着心室壁的收缩和松弛而改变。