公开(公告)号：US08583230B2

公开(公告)日：2013-11-12

申请号：US13009404

申请日：2011-01-19

申请人： Kyungmoo Ryu ,  Allen Keel ,  Heidi Hellman ,  Tomas Svensson

发明人： Kyungmoo Ryu ,  Allen Keel ,  Heidi Hellman ,  Tomas Svensson

IPC分类号： A61N1/00

CPC分类号： A61N1/3627 ,  A61N1/3684 ,  A61N1/3712

摘要： Techniques are provided for use with implantable cardiac stimulation devices equipped for multi-site left ventricular (MSLV) cardiac pacing. Briefly, intraventricular and interventricular conduction delays are detected for paced cardiac events. Maximum pacing time delays are determined for use with MSLV pacing where the maximum pacing time delays are set based on the conduction delays to values sufficient to avoid capture problems due to wavefront propagation, such as fusion or lack of capture. MSLV pacing delays are then set to values no greater than the maximum pacing delays and cardiac resynchronization therapy (CRT) is delivered using the MSLV pacing delays. In an example where an optimal interventricular pacing delay (VV) is determined in advance using intracardiac electrogram-based or hemodynamic-based optimization techniques, the optimal value for VV can be used as a limiting factor when determining the maximum MSLV pacing time delays.

摘要翻译： 提供技术用于配备用于多部位左心室（MSLV）心脏起搏的可植入心脏刺激装置。 简而言之，对于心跳事件，检测到心室内和室间传导延迟。 确定最大起搏时间延迟用于MSLV起搏，其中最大起搏时间延迟基于导通延迟设置为足以避免由于波前传播引起的捕获问题，例如融合或缺乏捕获。 然后将MSLV起搏延迟设置为不大于最大起搏延迟的值，并使用MSLV起搏延迟传递心脏再同步治疗（CRT）。 在使用基于心脏电图或基于血液动力学的优化技术预先确定最佳心室起搏延迟（VV）的示例中，当确定最大MSLV起搏时间延迟时，可以将VV的最佳值用作限制因素。

公开(公告)号：US20120185012A1

公开(公告)日：2012-07-19

申请号：US13009404

申请日：2011-01-19

申请人： Kyungmoo Ryu ,  Allen Keel ,  Heidi Hellman ,  Tomas Svensson

发明人： Kyungmoo Ryu ,  Allen Keel ,  Heidi Hellman ,  Tomas Svensson

IPC分类号： A61N1/365

CPC分类号： A61N1/3627 ,  A61N1/3684 ,  A61N1/3712

摘要： Techniques are provided for use with implantable cardiac stimulation devices equipped for multi-site left ventricular (MSLV) cardiac pacing. Briefly, intraventricular and interventricular conduction delays are detected for paced cardiac events. Maximum pacing time delays are determined for use with MSLV pacing where the maximum pacing time delays are set based on the conduction delays to values sufficient to avoid capture problems due to wavefront propagation, such as fusion or lack of capture. MSLV pacing delays are then set to values no greater than the maximum pacing delays and cardiac resynchronization therapy (CRT) is delivered using the MSLV pacing delays. In an example where an optimal interventricular pacing delay (VV) is determined in advance using intracardiac electrogram-based or hemodynamic-based optimization techniques, the optimal value for VV can be used as a limiting factor when determining the maximum MSLV pacing time delays.

摘要翻译： 提供技术用于配备用于多部位左心室（MSLV）心脏起搏的可植入心脏刺激装置。 简而言之，对于心跳事件，检测到心室内和室间传导延迟。 确定最大起搏时间延迟用于MSLV起搏，其中最大起搏时间延迟基于导通延迟设置为足以避免由于波前传播引起的捕获问题，例如融合或缺乏捕获。 然后将MSLV起搏延迟设置为不大于最大起搏延迟的值，并使用MSLV起搏延迟传递心脏再同步治疗（CRT）。 在使用基于心脏电图或基于血液动力学的优化技术预先确定最佳心室起搏延迟（VV）的示例中，当确定最大MSLV起搏时间延迟时，可以将VV的最佳值用作限制因素。

公开(公告)号：US09002455B2

公开(公告)日：2015-04-07

申请号：US13351958

申请日：2012-01-17

申请人： Heidi Hellman ,  Kyungmoo Ryu

发明人： Heidi Hellman ,  Kyungmoo Ryu

IPC分类号： A61N1/18 ,  A61B5/0452 ,  A61N1/37 ,  A61B5/042 ,  A61B5/00

CPC分类号： A61N1/3712 ,  A61B5/042 ,  A61B5/0452 ,  A61B5/7242

摘要： Techniques are provided for use by an implantable medical device for assessing and controlling concurrent anodal/cathodal capture. In one example, the device delivers bipolar pacing stimulus while sensing a bipolar intracardiac electrogram (IEGM) and while adjusting a magnitude of the pacing stimulus. The device analyzes the bipolar IEGM signals to detect an indication of activation representative of concurrent anodal and cathodal capture. Preferably, the pulse magnitude is set relative to the anodal/cathodal capture threshold based upon clinician programming in response to the needs of the patient. In this manner, concurrent anodal and cathodal capture can be selectively activated or deactivated based on clinician instructions received from a device programmer or other external programming device. Techniques exploiting both bipolar and unipolar IEGM signals to assess and control concurrent anodal/cathodal capture are also described. Techniques for use with quad-pole leads to achieve dual-site or quad-site capture are also set forth.

摘要翻译： 提供技术用于可植入医疗装置用于评估和控制并发阳极/阴极捕获。 在一个示例中，该装置提供双极起搏刺激，同时感测双极性心内电描记图（IEGM），同时调整起搏刺激的幅度。 该器件分析双极性IEGM信号以检测表示并发阳极和阴极捕获的激活指示。 优选地，响应于患者的需要，基于临床医师编程，相对于阳极/阴极俘获阈值设置脉搏幅度。 以这种方式，可以基于从设备编程器或其它外部编程设备接收的临床医生指令来选择性地激活或去激活并发阳极和阴极捕获。 还描述了利用双极和单极IEGM信号来评估和控制并行阳极/阴极俘获的技术。 还阐述了与四极引线一起使用以实现双位点或四点捕获的技术。

公开(公告)号：US20130184777A1

公开(公告)日：2013-07-18

申请号：US13351958

申请日：2012-01-17

申请人： Heidi Hellman ,  Kyungmoo Ryu

发明人： Heidi Hellman ,  Kyungmoo Ryu

IPC分类号： A61N1/37

CPC分类号： A61N1/3712 ,  A61B5/042 ,  A61B5/0452 ,  A61B5/7242

摘要： Techniques are provided for use by an implantable medical device for assessing and controlling concurrent anodal/cathodal capture. In one example, the device delivers bipolar pacing stimulus while sensing a bipolar intracardiac electrogram (IEGM) and while adjusting a magnitude of the pacing stimulus. The device analyzes the bipolar IEGM signals to detect an indication of activation representative of concurrent anodal and cathodal capture. Preferably, the pulse magnitude is set relative to the anodal/cathodal capture threshold based upon clinician programming in response to the needs of the patient. In this manner, concurrent anodal and cathodal capture can be selectively activated or deactivated based on clinician instructions received from a device programmer or other external programming device. Techniques exploiting both bipolar and unipolar IEGM signals to assess and control concurrent anodal/cathodal capture are also described. Techniques for use with quad-pole leads to achieve dual-site or quad-site capture are also set forth.

摘要翻译： 提供技术用于可植入医疗装置用于评估和控制并发阳极/阴极捕获。 在一个示例中，该装置提供双极起搏刺激，同时感测双极性心内电描记图（IEGM），同时调整起搏刺激的幅度。 该器件分析双极性IEGM信号以检测表示并发阳极和阴极捕获的激活指示。 优选地，响应于患者的需要，基于临床医师编程，相对于阳极/阴极俘获阈值设置脉搏幅度。 以这种方式，可以基于从设备编程器或其它外部编程设备接收的临床医生指令来选择性地激活或去激活并发阳极和阴极捕获。 还描述了利用双极和单极IEGM信号来评估和控制并行阳极/阴极俘获的技术。 还阐述了与四极引线一起使用以实现双位点或四点捕获的技术。

公开(公告)号：US20130261687A1

公开(公告)日：2013-10-03

申请号：US13436578

申请日：2012-03-30

申请人： Cecilia Qin Xi ,  Diana Gavales ,  Andrew Miller ,  Andrew W. McGarvey ,  Zachary Briggs ,  David Bishop ,  Sharon Standage ,  Anil Keni ,  Richard Block ,  Heidi Hellman ,  Taryn Smith

发明人： Cecilia Qin Xi ,  Diana Gavales ,  Andrew Miller ,  Andrew W. McGarvey ,  Zachary Briggs ,  David Bishop ,  Sharon Standage ,  Anil Keni ,  Richard Block ,  Heidi Hellman ,  Taryn Smith

IPC分类号： A61N1/368

CPC分类号： A61N1/3686

摘要： Techniques are provided for use with an implantable cardiac stimulation device equipped with a multi-pole left ventricular (LV) lead and a right ventricular (RV) lead for identifying suitable pacing vectors. In one example, RV-LV delay times are measured while using different electrodes of the LV lead as cathodes for sensing. The LV electrode having the longest RV-LV delay time is identified and LV capture thresholds and diaphragmatic stimulation thresholds are measured for pacing vectors that employ that LV electrode as a cathode. Assuming at least one vector employing the selected LV electrode is found to have acceptable thresholds, the vector is selected for use in delivering pacing therapy with the selected LV electrode. If none of the pacing vectors employing the selected LV electrode has acceptable thresholds, another LV electrode is selected and the procedure is repeated. Examples with a multi-pole RV lead are also described.

摘要翻译： 技术提供用于配备有多极左心室（LV）引线和右心室（RV）引线的可植入心脏刺激装置，用于识别合适的起搏向量。 在一个示例中，测量RV-LV延迟时间，同时使用LV引线的不同电极作为用于感测的阴极。 识别具有最长RV-LV延迟时间的LV电极，并测量采用该LV电极作为阴极的起搏向量的LV捕获阈值和膈肌刺激阈值。 假设使用所选择的LV电极的至少一个载体被发现具有可接受的阈值，则选择该载体用于与选定的LV电极递送起搏治疗。 如果没有采用所选择的LV电极的起搏向导具有可接受的阈值，则选择另一LV电极并重复该过程。 还描述了具有多极RV引线的示例。

公开(公告)号：US08332033B2

公开(公告)日：2012-12-11

申请号：US13108740

申请日：2011-05-16

申请人： Derrick W. Reed ,  Rohan A. More ,  Heidi Hellman ,  Eliot L. Ostrow ,  Paul A. Levine

发明人： Derrick W. Reed ,  Rohan A. More ,  Heidi Hellman ,  Eliot L. Ostrow ,  Paul A. Levine

IPC分类号： A61N1/368

CPC分类号： A61N1/3684 ,  A61N1/3624 ,  A61N1/3688

摘要： Systems and methods are provided for use by implantable medical devices equipped to deliver multi-site left ventricular (MSLV) pacing. Sequential 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, sequential 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 either single-site LV pacing or simultaneous MSLV 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 OATs (such as atrial flutter) from sinus tachycardia. The device may also employ an automatic mode switch (AMS) threshold 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。 顺序MSLV与相对较长的心房后心房消融（PVAB）相关，可能限制了病理性快速组织性房性心动过速（OAT）的检测。 在一个示例中，顺序MSLV心脏再同步治疗（CRT）起搏在跟踪模式中被递送。 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，该装置切换到单点LV起搏或同步MSLV起搏，从而有效地缩短PVAB以检测可能被模糊的另外的心房事件，从而允许装置更可靠地将OAT（例如心房扑动）与窦 心动过速 设备还可以采用高于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：US09610447B2

公开(公告)日：2017-04-04

申请号：US13436578

申请日：2012-03-30

申请人： Cecilia Qin Xi ,  Diana Gavales ,  Andrew Miller ,  Andrew W. McGarvey ,  Zachary Briggs ,  David Bishop ,  Sharon Standage ,  Anil Keni ,  Richard Block ,  Heidi Hellman ,  Taryn Smith

发明人： Cecilia Qin Xi ,  Diana Gavales ,  Andrew Miller ,  Andrew W. McGarvey ,  Zachary Briggs ,  David Bishop ,  Sharon Standage ,  Anil Keni ,  Richard Block ,  Heidi Hellman ,  Taryn Smith

IPC分类号： A61N1/36 ,  A61N1/368

CPC分类号： A61N1/3686

摘要： Techniques are provided for use with an implantable cardiac stimulation device equipped with a multi-pole left ventricular (LV) lead and a right ventricular (RV) lead for identifying suitable pacing vectors. In one example, RV-LV delay times are measured while using different electrodes of the LV lead as cathodes for sensing. The LV electrode having the longest RV-LV delay time is identified and LV capture thresholds and diaphragmatic stimulation thresholds are measured for pacing vectors that employ that LV electrode as a cathode. Assuming at least one vector employing the selected LV electrode is found to have acceptable thresholds, the vector is selected for use in delivering pacing therapy with the selected LV electrode. If none of the pacing vectors employing the selected LV electrode has acceptable thresholds, another LV electrode is selected and the procedure is repeated. Examples with a multi-pole RV lead are also described.

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：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：US20110319953A1

公开(公告)日：2011-12-29

申请号：US13108740

申请日：2011-05-16

申请人： Derrick W. Reed ,  Rohan A. More ,  Heidi Hellman ,  Eliot L. Ostrow ,  Paul A. Levine

发明人： Derrick W. Reed ,  Rohan A. More ,  Heidi Hellman ,  Eliot L. Ostrow ,  Paul A. Levine

IPC分类号： A61N1/365

CPC分类号： A61N1/3684 ,  A61N1/3624 ,  A61N1/3688

摘要： Systems and methods are provided for use by implantable medical devices equipped to deliver multi-site left ventricular (MSLV) pacing. Sequential 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, sequential 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 either single-site LV pacing or simultaneous MSLV 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 OATs (such as atrial flutter) from sinus tachycardia. The device may also employ an automatic mode switch (AMS) threshold 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。 顺序MSLV与相对较长的心房后心房消融（PVAB）相关，可能限制了病理性快速组织性房性心动过速（OAT）的检测。 在一个示例中，顺序MSLV心脏再同步治疗（CRT）起搏在跟踪模式中被递送。 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，该装置切换到单点LV起搏或同步MSLV起搏，从而有效地缩短PVAB以检测可能被模糊的另外的心房事件，从而允许装置更可靠地将OAT（例如心房扑动）与窦 心动过速 设备还可以采用高于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。