公开(公告)号：US07248925B2

公开(公告)日：2007-07-24

申请号：US10928586

申请日：2004-08-27

申请人： Ken Bruhns ,  Xiaoyi Min ,  Paul A. Levine ,  Euljoon Park

发明人： Ken Bruhns ,  Xiaoyi Min ,  Paul A. Levine ,  Euljoon Park

IPC分类号： A61N1/36

CPC分类号： A61N1/3627 ,  A61N1/3682

摘要： A system and method for estimating optimal atrioventricular delay values for use in pacing the ventricles. Both the intrinsic inter-atrial conduction delay and the intrinsic atrioventricular conduction delay are determined for the patient and then the preferred atrioventricular pacing delay is derived therefrom. By taking into account intrinsic inter-atrial delay along with intrinsic atrioventricular delay, a more reliable estimate of the true optimal atrioventricular delay values for the patient can be achieved than with techniques that only take into account intrinsic atrioventricular delay values. In one example, the technique uses intracardiac electrogram (IEGM) signals and surface electrocardiogram (EKG) signals and hence can be performed by an external programmer without requiring Doppler echocardiography or other cardiac performance monitoring techniques. In another example, wherein the implanted device is equipped with a coronary sinus lead, the technique uses only IEGM signals and hence can be performed by the device itself.

摘要翻译： 用于估计用于起搏心室的最佳房室延迟值的系统和方法。 对于患者确定内在的心房传导延迟和内在的房室传导延迟，然后从其导出优选的房室起搏延迟。 通过考虑内在的心房延迟以及内在的房室延迟，可以实现比仅考虑内在房室延迟值的技术更可靠的估计患者的真正最佳房室延迟值。 在一个示例中，该技术使用心内电描记图（IEGM）信号和表面心电图（EKG）信号，因此可以由外部编程器执行，而不需要多普勒超声心动图或其他心脏监测技术。 在另一示例中，其中植入的装置配备有冠状窦引线，该技术仅使用IEGM信号，因此可以由装置本身执行。

公开(公告)号：US07139609B1

公开(公告)日：2006-11-21

申请号：US10346809

申请日：2003-01-17

申请人： Xiaoyi Min ,  Paul A. Levine ,  Euljoon Park

发明人： Xiaoyi Min ,  Paul A. Levine ,  Euljoon Park

IPC分类号： A61B5/02 ,  A61N1/365

CPC分类号： A61N1/36585 ,  A61B5/02 ,  A61B5/04004 ,  A61B5/0402 ,  A61B5/7239 ,  A61B7/04 ,  A61N1/3627

摘要： Techniques are provided for performing internal measurement of heart sounds to estimate patient cardiac function in terms of stroke volume, cardiac output, or a maximum rate of change of aortic pressure with time (max dP/dt). Control parameters of the medical device are then automatically adjusted so as to optimize overall cardiac function or to provide for ventricular resynchronization therapy. In one example, heart sound signals are derived from acceleration signals received from an accelerometer. The heart sound signals are analyzed to identify S1 and S2 heart sounds as well as ejection period and isovolumic interval (ISOV). Proxies for max dP/dt, stroke volume and cardiac output are then derived from the S1 and S2 heart sounds, the ejection period and the ISOV. Alternative techniques, not requiring detection of ISOV, are employed for use if the patient has heart value regurgitation.

摘要翻译： 提供技术用于进行心脏声音的内部测量，以根据中风量，心输出量或主动脉压随时间的最大变化率（最大dP / dt）来估计患者心脏功能。 然后自动调节医疗装置的控制参数，以便优化整体心脏功能或提供心室再同步治疗。 在一个示例中，从加速度计接收的加速度信号导出心音信号。 分析心音信号以识别S1和S2心音，以及射血期和等容间隔（ISOV）。 然后从S1和S2心脏声音，射血期和ISOV导出最大dP / dt，搏出量和心输出量的代理。 如果患者有心脏反流，则采用不需要检测ISOV的替代技术。

公开(公告)号：US07333856B1

公开(公告)日：2008-02-19

申请号：US10847709

申请日：2004-05-17

申请人： Siew Bee Er ,  Qiuju Huang ,  Euljoon Park ,  Paul A. Levine

发明人： Siew Bee Er ,  Qiuju Huang ,  Euljoon Park ,  Paul A. Levine

IPC分类号： A61N1/362

CPC分类号： A61N1/37247

摘要： A method and system for programming an implantable therapeutic stimulation device sensing from and delivering therapeutic stimulations to multiple sites within a patient under a plurality of programmable parameters. The method includes automatically determining which parameters need to be programmed, graphically indicating specific parameters that need to be programmed in a spatial correspondence to the affected sites in the patient and/or displaying a waveform corresponding to expected physiological activity with the programming, and providing control inputs to program the specific parameters. The method can also include automatically evaluating the programmed parameters, and if errors exist in the programming, indicating the errors and awaiting corrective input, else programming the implantable device. The method can also include automatically determining a number of sensing and stimulation electrodes connected to the device.

摘要翻译： 一种用于编程可植入治疗刺激装置的方法和系统，其在多个可编程参数下感测并向患者内的多个部位递送治疗刺激。 该方法包括自动确定哪些参数需要被编程，以图形方式指示需要编程的具体参数与病人的受影响部位的空间对应，和/或显示与编程有关的预期生理活动的波形，以及提供控制 输入来编程具体参数。 该方法还可以包括自动评估编程参数，并且如果编程中存在错误，指示错误并等待校正输入，则编程可植入设​​备。 该方法还可以包括自动确定连接到该装置的感测和刺激电极的数量。

公开(公告)号：US06904320B2

公开(公告)日：2005-06-07

申请号：US10077053

申请日：2002-02-14

申请人： Euljoon Park ,  Gene A. Bornzin ,  Paul A. Levine ,  Eric Falkenberg

发明人： Euljoon Park ,  Gene A. Bornzin ,  Paul A. Levine ,  Eric Falkenberg

IPC分类号： A61N1/365 ,  A61N1/18

CPC分类号： A61N1/365 ,  A61N1/36557

摘要： A cardiac stimulation device uses dynamic overdrive pacing to prevent sleep apnea. In another aspect, the device can use dynamic overdrive pacing to terminate sleep apnea after detection. An implantable cardiac stimulation device comprises a sensor and one or more pulse generators. The sensor senses intrinsic cardiac electrical phenomena. The pulse generators can generate cardiac pacing pulses with timing based on the sensed intrinsic cardiac electrical phenomena to dynamically overdrive the intrinsic cardiac electrical phenomena. The timed cardiac pacing pulses can prevent a sleep apnea condition.

摘要翻译： 心脏刺激装置使用动态超速起搏来预防睡眠呼吸暂停。 另一方面，该设备可以使用动态超速起搏来终止检测后的睡眠呼吸暂停。 可植入心脏刺激装置包括传感器和一个或多个脉冲发生器。 传感器感测内在的心脏电学现象。 脉冲发生器可以基于感测到的固有心脏电现象产生心脏起搏脉冲，以动态地过度驱动固有的心脏电学现象。 定时的心脏起搏脉冲可以防止睡眠呼吸暂停状态。

公开(公告)号：US20080091114A1

公开(公告)日：2008-04-17

申请号：US11618266

申请日：2006-12-29

申请人： Xiaoyi Min ,  Paul A. Levine ,  Eliot L. Ostrow

发明人： Xiaoyi Min ,  Paul A. Levine ,  Eliot L. Ostrow

IPC分类号： A61B5/02

CPC分类号： A61B5/0537 ,  A61B5/08 ,  A61B5/4869 ,  A61N1/36521 ,  A61N1/36535 ,  A61N1/36542 ,  A61N1/36585

摘要： Exemplary techniques for correlating thoracic impedance values with physiological status are described. One technique involves an implantable medical device (IMD) that includes means for correlating thoracic impedance values with a patient's physiological status and means for interpreting the correlated thoracic impedance values utilizing a patient-based threshold to detect a heart failure condition.

摘要翻译： 描述了将胸廓阻抗值与生理状态相关联的示例性技术。 一种技术涉及可植入医疗装置（IMD），其包括用于使胸部阻抗值与患者的生理状态相关联的装置，以及利用基于患者的阈值来解释相关的胸部阻抗值以检测心力衰竭状况的装置。

公开(公告)号：US20080086177A1

公开(公告)日：2008-04-10

申请号：US11539824

申请日：2006-10-09

申请人： Xiaoyi Min ,  Paul A. Levine ,  Jong Gill

发明人： Xiaoyi Min ,  Paul A. Levine ,  Jong Gill

IPC分类号： A61N1/365

CPC分类号： A61N1/37 ,  A61B5/0452 ,  A61B5/0809 ,  A61B5/091 ,  A61B5/11 ,  A61N1/3621 ,  A61N1/3627

摘要： A system and related methods for monitoring cardiac disease. The system includes an implantable medical device having a microcontroller that is configured to measure a pacing latency value for a region of a heart, compare the measured pacing latency value to a previously measured pacing latency value for the region of the heart, and determine a change in an amount of cardiac disease in the region of the heart based on the comparison of the measured pacing latency values.

摘要翻译： 用于监测心脏病的系统和相关方法。 该系统包括具有微控制器的可植入医疗装置，微控制器被配置为测量心脏区域的起搏延迟值，将测量的起搏延迟值与心脏区域的先前测量的起搏延迟值进行比较，并确定改变 基于测量的起搏延迟值的比较，在心脏区域中的心脏病的量。

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。

公开(公告)号：US08147416B2

公开(公告)日：2012-04-03

申请号：US11848586

申请日：2007-08-31

申请人： Timothy A. Fayram ,  Eric S. Fain ,  Paul A. Levine ,  Anders Björling

发明人： Timothy A. Fayram ,  Eric S. Fain ,  Paul A. Levine ,  Anders Björling

IPC分类号： A61B5/02 ,  A61B5/021

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。

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。

公开(公告)号：US08082036B2

公开(公告)日：2011-12-20

申请号：US12266441

申请日：2008-11-06

申请人： Paul A. Levine ,  Amdt Godau

发明人： Paul A. Levine ,  Amdt Godau

IPC分类号： A61N1/37

CPC分类号： A61N1/3706

摘要： A system for automatically evaluating the sensing and detection of physiological processes by an implantable medical device, such as an implantable cardiac stimulation device. The system includes an automatic testing algorithm which iteratively adjusts at least one of the threshold and gain settings of the device and evaluates the accuracy of the detection for refining the programming of the device. The algorithm can include sampling the physiological process beginning at a relatively low rate to avoid excessive burden on the processing and battery capacity available and progressively increasing the rate to obtain higher resolution data. The algorithm can also evaluate the observed physiological process for periodicity and can determine repetition of an irregular pattern, such as bigeminy, and use the determined pattern for predictive purposes to refine the programming of the device. The algorithm employs observation of a change in observed pattern as indicia for loss of proper detection.

摘要翻译： 一种用于通过可植入医疗装置（例如可植入心脏刺激装置）自动评估生理过程的感测和检测的系统。 该系统包括自动测试算法，其迭代地调整设备的阈值和增益设置中的至少一个，并评估用于精简设备编程的检测的准确性。 该算法可以包括以相对较低的速率开始生理过程的采样，以避免对可用处理和电池容量的过度负担，并逐渐增加速率以获得更高分辨率的数据。 该算法还可以评估观察到的生理过程的周期性，并且可以确定诸如bigeminy的不规则图案的重复，并且使用确定的图案进行预测目的来改进设备的编程。 该算法使用观察模式的变化观察作为丢失适当检测的标记。