公开(公告)号：US20120157861A1

公开(公告)日：2012-06-21

申请号：US13392395

申请日：2009-08-27

申请人： Karin Jarverud ,  Anders Bjorling ,  Jay Snell

发明人： Karin Jarverud ,  Anders Bjorling ,  Jay Snell

IPC分类号： A61B5/0402 ,  A61B5/0215 ,  A61B5/02

CPC分类号： A61B5/1102 ,  A61B5/02 ,  A61B5/0215 ,  A61B5/02416 ,  A61B5/042 ,  A61B5/0452 ,  A61B5/1118 ,  A61B5/6846 ,  A61B5/7275 ,  A61B5/7278 ,  A61B7/023 ,  A61N1/3627

摘要： The present invention relates to an improved medical device and method for accurately and reliably determining a cardiac status of a patient. An implantable medical device, IMD, comprises a sensor arrangement adapted to sense signals related to mechanical activity of the heart and an activity level sensor arrangement adapted to sense an activity level of the patient. Further, the IMD calculates a percentage of left ventricular diastolic time (PLVDT) for a cardiac cycle corresponding to a relation between a diastolic time interval and a cardiac cycle time interval using the determined systolic and diastolic time intervals or a percentage of left ventricular systolic time (PLVST) for a cardiac cycle corresponding to a relation between a systolic interval time interval and a cardiac cycle time interval. A cardiac status is determined based on the calculated PLVDT (or PLVST) and on an activity level of the patient.

摘要翻译： 本发明涉及用于准确且可靠地确定患者的心脏状态的改进的医疗装置和方法。 可植入医疗装置IMD包括适于感测与心脏的机械活动相关的信号的传感器装置和适于感测患者的活动水平的活动度传感器装置。 此外，IMD使用确定的收缩期和舒张时间间隔或左心室收缩期的百分比来计算对应于舒张时间间隔和心动周期时间间隔之间的关系的心脏周期的左心室舒张时间（PLVDT）的百分比 （PLVST），其对应于收缩期间隔时间间隔和心搏周期时间间隔之间的关系。 基于计算的PLVDT（或PLVST）和患者的活动水平来确定心脏状态。

公开(公告)号：US08998820B2

公开(公告)日：2015-04-07

申请号：US13392395

申请日：2009-08-27

申请人： Karin Jarverud ,  Anders Bjorling ,  Jay Snell

发明人： Karin Jarverud ,  Anders Bjorling ,  Jay Snell

IPC分类号： A61B5/02 ,  A61B5/0452 ,  A61B5/11 ,  A61B5/00 ,  A61N1/362

CPC分类号： A61B5/1102 ,  A61B5/02 ,  A61B5/0215 ,  A61B5/02416 ,  A61B5/042 ,  A61B5/0452 ,  A61B5/1118 ,  A61B5/6846 ,  A61B5/7275 ,  A61B5/7278 ,  A61B7/023 ,  A61N1/3627

摘要： The present invention relates to an improved medical device and method for accurately and reliably determining a cardiac status of a patient. An implantable medical device, IMD, comprises a sensor arrangement adapted to sense signals related to mechanical activity of the heart and an activity level sensor arrangement adapted to sense an activity level of the patient. Further, the IMD calculates a percentage of left ventricular diastolic time (PLVDT) for a cardiac cycle corresponding to a relation between a diastolic time interval and a cardiac cycle time interval using the determined systolic and diastolic time intervals or a percentage of left ventricular systolic time (PLVST) for a cardiac cycle corresponding to a relation between a systolic interval time interval and a cardiac cycle time interval. A cardiac status is determined based on the calculated PLVDT (or PLVST) and on an activity level of the patient.

摘要翻译： 本发明涉及用于准确且可靠地确定患者的心脏状态的改进的医疗装置和方法。 可植入医疗装置IMD包括适于感测与心脏的机械活动相关的信号的传感器装置和适于感测患者的活动水平的活动度传感器装置。 此外，IMD使用确定的收缩期和舒张时间间隔或左心室收缩期的百分比来计算对应于舒张时间间隔和心动周期时间间隔之间的关系的心脏周期的左心室舒张时间（PLVDT）的百分比 （PLVST），其对应于收缩期间隔时间间隔和心搏周期时间间隔之间的关系。 基于计算的PLVDT（或PLVST）和患者的活动水平来确定心脏状态。

公开(公告)号：US07769436B1

公开(公告)日：2010-08-03

申请号：US11757796

申请日：2007-06-04

申请人： Peter Boileau ,  Jay Snell ,  Rupinder Bharmi ,  Laleh Jalali ,  Gene A. Bornzin

发明人： Peter Boileau ,  Jay Snell ,  Rupinder Bharmi ,  Laleh Jalali ,  Gene A. Bornzin

IPC分类号： A61B5/04 ,  A61B5/0402 ,  A61B5/0452

CPC分类号： A61B5/0452 ,  A61B5/0422 ,  A61B5/053 ,  A61N1/36585

摘要： Techniques are described for adaptively adjusting detection thresholds for use in detecting cardiac ischemia and other abnormal physiological conditions based on morphological parameters derived from intracardiac electrogram (IEGM) signals, impedance measurements, or other signals. In one example, where ST segment elevation is used to detect cardiac ischemia, default detection thresholds are determined in advance from an examination of variations in ST segment elevations occurring within a population of patients. Thereafter, an individual pacemaker or other implantable medical device uses the default thresholds during an initial learning period to detect ischemia within the patient in which the device is implanted. During the initial learning period, the pacemaker also collects data representative of the range of variation in ST segment elevations occurring within the patient. The pacemaker then adaptively adjusts the thresholds based on the range of variation so as to improve detection specificity within the patient.

摘要翻译： 描述了基于从心脏电图（IEGM）信号，阻抗测量或其它信号得出的形态学参数自适应地调整检测阈值用于检测心脏缺血和其他异常生理状况的技术。 在一个例子中，使用ST段抬高来检测心脏缺血，默认检测阈值是从对患者群体内发生的ST段抬高的变化的检查预先确定的。 此后，单个起搏器或其它可植入医疗装置在初始学习期间使用默认阈值来检测装置植入的患者内的局部缺血。 在初始学习期间，起搏器还收集代表病人ST段抬高范围变化的数据。 起搏器然后根据变异范围自适应地调整阈值，以提高患者内的检测特异性。

公开(公告)号：US07756572B1

公开(公告)日：2010-07-13

申请号：US11740175

申请日：2007-04-25

申请人： Mohssen Fard ,  Xiaoyi Min ,  Peter Boileau ,  Jong Gill ,  Bing Zhu ,  Jay Snell ,  Laleh Jalali ,  Josh Reiss ,  Gene Bornzin

发明人： Mohssen Fard ,  Xiaoyi Min ,  Peter Boileau ,  Jong Gill ,  Bing Zhu ,  Jay Snell ,  Laleh Jalali ,  Josh Reiss ,  Gene Bornzin

IPC分类号： A61B5/0468

CPC分类号： A61N1/36585 ,  A61B5/0452 ,  A61B5/0468 ,  A61B5/14532 ,  A61N1/36557

摘要： Techniques are described for efficiently detecting and distinguishing among cardiac ischemia, hypoglycemia or hyperglycemia based on intracardiac electrogram (IEGM) signals. In one example, a preliminary indication of an episode of cardiac ischemia is detected based on shifts in ST segment elevation within the IEGM. In response, the implanted device then records additional IEGM data for transmission to an external system. The external system analyzes the additional IEGM data to confirm the detection of cardiac ischemia using a more sophisticated analysis procedure exploiting additional detection parameters. In particular, the external system uses detection parameters capable of distinguishing hypoglycemia, hyperglycemia and hyperkalemia from cardiac ischemia, such as QTmax and QTend intervals. Alternatively, the more sophisticated analysis procedure may be performed by the device itself, if it is so equipped. Other examples described herein pertain instead to the detection of atrial fibrillation.

摘要翻译： 描述了基于心脏电图（IEGM）信号来有效检测和区分心脏缺血，低血糖或高血糖的技术。 在一个实例中，基于IEGM内的ST段抬高的移动来检测心脏缺血发作的初步指示。 作为响应，植入的装置然后记录附加的IEGM数据以传输到外部系统。 外部系统使用更复杂的分析程序利用额外的检测参数来分析额外的IEGM数据，以确认心脏缺血的检测。 特别地，外部系统使用能够区分低血糖，高血糖和高血钾从心脏缺血的检测参数，例如QTmax和QTend间期。 或者，如果装置如此装备，则可以由装置本身执行更复杂的分析程序。 本文描述的其它实例代替心房颤动的检测。

公开(公告)号：US20100069768A1

公开(公告)日：2010-03-18

申请号：US12211760

申请日：2008-09-16

申请人： Xiaoyi Min ,  Gene A. Bornzin ,  Jay Snell ,  Josh Reiss

发明人： Xiaoyi Min ,  Gene A. Bornzin ,  Jay Snell ,  Josh Reiss

IPC分类号： A61B5/02

CPC分类号： A61N1/365 ,  A61B5/0215 ,  A61B5/026 ,  A61B7/023 ,  A61B8/08 ,  A61B2562/0219 ,  A61N1/3627 ,  A61N1/36578

摘要： An exemplary method includes receiving a signal from an intrathoracic vibration sensor, analyzing the signal for vibration associated with deceleration of blood flow into the left ventricle, based at least in part on the analyzing, deciding whether to call for adjustment to one or more parameters of a bi-ventricular pacing therapy. Other exemplary methods, devices, systems, etc., are also disclosed.

摘要翻译： 一种示例性方法包括从胸腔内振动传感器接收信号，至少部分地基于分析来分析与进入左心室的血流减速相关的振动信号，决定是否要调整一个或多个参数 双心室起搏治疗。 还公开了其它示例性方法，装置，系统等。

公开(公告)号：US08467862B2

公开(公告)日：2013-06-18

申请号：US13049805

申请日：2011-03-16

申请人： Jay Snell ,  Bing Zhu ,  Katie Hoberman ,  Harish Krishnaswamy

发明人： Jay Snell ,  Bing Zhu ,  Katie Hoberman ,  Harish Krishnaswamy

IPC分类号： A61B5/04

CPC分类号： A61B5/0452 ,  A61B5/7264

摘要： Cardiac activity is sensed over a plurality of heart beats defining a beat set. For each beat in the set, it is determined whether the beat is a non-classified beat (e.g., paced beat, a beat outside of a specified heart rate range or a PVC), or a classified beat. For each classified beat, it is determined whether the beat is a non-detect beat, a minor beat or a major beat. Counts of classified beats, non-classified beats, major beats, minor beats, and non-detect beats are maintained. The beat set is declared to be one of a non-classified set, a major set, a minor set or a non-detect set based on the relative counts of classified beats, non-classified beats, major beats, minor beats, and non-detect beats. Over a period of time, counts of beat-set types are maintained and entry into and exit from ST episodes are determined based on these beat-set counts.

摘要翻译： 在定义拍子组的多个心跳上感测到心脏活动。 对于集合中的每个节拍，确定节拍是否是非分类节拍（例如，节奏拍子，指定心率范围或PVC之外的节拍）或分类节拍。 对于每个分类的节拍，确定节拍是否是非检测节拍，小节奏或主要节拍。 维持分类节拍，非分类节拍，主要节拍，次要节拍和非检测节拍的数量。 基于分类节拍，非分类节拍，主要节拍，次要节拍和非节奏组合的相对计数，节拍组被宣布为非分类集，主要集，未成年集或未检测集之一。 检测节拍 在一段时间内，基于这些节拍设置计算确定节拍类型的计数，并且进入和退出ST剧集。

公开(公告)号：US08204592B1

公开(公告)日：2012-06-19

申请号：US11949532

申请日：2007-12-03

申请人： Eliot L. Ostrow ,  Jay Snell ,  Xiaoyi Min

发明人： Eliot L. Ostrow ,  Jay Snell ,  Xiaoyi Min

IPC分类号： A61N1/36

CPC分类号： A61B5/0464 ,  A61B5/686 ,  A61N1/36585 ,  A61N1/37258 ,  G06F19/00 ,  G06F19/3418 ,  G06F19/3468 ,  G06F19/3481

摘要： Techniques are described for generating diagnostic information to aid in determining whether cardiac ischemia within a patient is clinically actionable. In one example, a pacemaker or implantable cardioverter/defibrillator (ICD) detects information pertaining to arrhythmia precursors and to episodes of sustained arrhythmias, as well as information pertaining to episodes of cardiac ischemia. The implanted device then correlates the arrhythmia precursors and the sustained arrhythmias with the episodes of cardiac ischemia so as to generate diagnostics permitting a physician reviewing the diagnostics to determine whether the ischemia is clinically actionable. In some implementations, the diagnostics are instead generated by an external system based on raw data provided by the implanted device. In some implementations, the device itself determines whether the ischemia is clinically actionable and automatically controls therapy or generates warning signals accordingly.

摘要翻译： 描述了用于产生诊断信息以帮助确定患者心脏缺血是否具有临床可行性的技术。 在一个示例中，起搏器或植入式心律转复除颤器（ICD）检测与心律失常前体有关的信息和持续性心律不齐的发作以及与心脏缺血发作有关的信息。 然后植入的装置将心律失常前体和持续性心律失常与心脏缺血发作相关联，以便产生诊断，允许医师检查诊断以确定缺血是否具有临床可操作性。 在一些实施方式中，诊断代替地由外部系统基于植入设备提供的原始数据生成。 在一些实施方案中，装置本身确定缺血是否具有临床作用并且自动控制治疗或相应地产生警告信号。

公开(公告)号：US07647104B1

公开(公告)日：2010-01-12

申请号：US11549517

申请日：2006-10-13

申请人： Jay Snell ,  Jeffery D. Snell

发明人： Jay Snell ,  Jeffery D. Snell

IPC分类号： A61N1/362

CPC分类号： A61N1/36557

摘要： A method and apparatus for analyzing IEGM waveforms is disclosed. The method includes generating a long term ensemble average of a plurality of baseline IEGM waveforms and generating a short term ensemble average of at least a portion of the plurality of baseline IEGM waveforms. The method further includes determining a short term absolute point value as a function of the absolute value of the difference of the amplitude of the short term ensemble average and a test IEGM waveform and a long term absolute point value as a function of the difference of the amplitude of the long term ensemble average and the test waveform at a plurality of sample points. The disclosed method further includes detecting ischemia if the difference between the short term absolute point value and the long term absolute point value is greater than an ischemia detection threshold.

摘要翻译： 公开了一种用于分析IEGM波形的方法和装置。 该方法包括生成多个基线IEGM波形的长期整体平均值，并且生成多个基线IEGM波形的至少一部分的短期整体平均。 该方法还包括将短期绝对点值确定为短期整体平均值的幅度的差的绝对值和测试IEGM波形和长期绝对点值之间的函数的函数，作为 在多个采样点处的长期整体平均值的振幅和测试波形。 所公开的方法还包括如果短期绝对点值和长期绝对点值之间的差异大于缺血检测阈值，则检测局部缺血。

公开(公告)号：US08521267B1

公开(公告)日：2013-08-27

申请号：US11771660

申请日：2007-06-29

申请人： Laleh Jalali ,  Jay Snell ,  Elizabeth Bacon ,  Katie Hoberman ,  Bing Zhu

发明人： Laleh Jalali ,  Jay Snell ,  Elizabeth Bacon ,  Katie Hoberman ,  Bing Zhu

IPC分类号： A61B5/0472

CPC分类号： A61B5/0472 ,  A61B5/0022 ,  A61B5/0031 ,  A61N1/3622 ,  A61N1/3627 ,  A61N1/36507 ,  A61N1/36585 ,  G06F19/00 ,  G16H40/63

摘要： A method and system are provided for trending a coronary burden such as an ischemic burden or acute myocardial infarction (AMI) for a patient. Trending provides obtaining cardiac data over a period of time, identifying the onset and the termination of coronary episodes based on a ST segment variation within the cardiac data, recording coronary burden information, and presenting the coronary burden information to a user. The coronary burden information may include the number of coronary episodes occurring over a period of time, the time duration of the coronary episodes, and the maximum ST segment variations for the coronary episodes that occur over a period of time.

摘要翻译： 提供了一种方法和系统，用于对患者的冠状动脉负荷如缺血负担或急性心肌梗塞（AMI）进行趋势。 趋势提供在一段时间内获得心脏数据，基于心脏数据内的ST段变化识别冠状动脉发作的发作和终止，记录冠状动脉负荷信息，以及向使用者呈现冠状动脉负荷信息。 冠状动脉负荷信息可以包括在一段时间内发生的冠状动脉发作次数，冠状动脉发作的持续时间以及在一段时间内发生的冠状动脉发作的最大ST段变化。

公开(公告)号：US08214033B2

公开(公告)日：2012-07-03

申请号：US12265579

申请日：2008-11-05

申请人： Jay Snell ,  Mary Elizabeth Bush

发明人： Jay Snell ,  Mary Elizabeth Bush

IPC分类号： A61N1/00

CPC分类号： A61N1/3925 ,  A61N1/3906 ,  A61N1/3918 ,  A61N1/3956

摘要： Exemplary systems, devices, and methods pertaining to cardiac related therapy and particularly to interferential cardiac preconditioning and depolarization are described. A cardiac arrhythmia is detected from electrogram data sensed from a patient's heart and a region of the heart affected by the cardiac arrhythmia is determined. The affected region is interferentially energized by multiple cycles of two concurrently delivered alternating currents which are offset in frequency.

摘要翻译： 描述了与心脏相关治疗有关的示例性系统，装置和方法，特别是涉及干扰性心脏预处理和去极化。 从患者心脏感测的电描记图数据中检测到心律失常，并确定受心律失常影响的心脏区域。 受影响的区域通过两个同时传递的交流电流在频率上偏移的多个周期被周向地激励。