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：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：US08798765B2

公开(公告)日：2014-08-05

申请号：US13471167

申请日：2012-05-14

申请人： Kjell Noren ,  Anders Bjorling ,  Tomas Svensson ,  Sven-Erik Hedberg ,  Allen Keel ,  Stuart Rosenberg ,  Kyungmoo Ryu

发明人： Kjell Noren ,  Anders Bjorling ,  Tomas Svensson ,  Sven-Erik Hedberg ,  Allen Keel ,  Stuart Rosenberg ,  Kyungmoo Ryu

IPC分类号： A61N1/365 ,  A61N1/372 ,  A61N1/368

CPC分类号： A61N1/36507 ,  A61N1/3682 ,  A61N1/3684 ,  A61N1/37252

摘要： CRT settings for an implantable medical device are determined by applying pacing pulses to heart chambers of a scheme of different combinations of interchamber delays. A respective width parameter value representing an R or P wave width is determined for each such delay combination based on an ECG representing signal and the width parameter values are employed to estimate a parametric model defining the width parameter as a function of interchamber delays. Candidate interchamber delays that minimize the width parameter are determined from the parametric model and employed to determine optimal CRT settings. The technique provides an efficient way of finding optimal CRT settings when multiple pacing sites are available in a heart chamber.

摘要翻译： 用于可植入医疗装置的CRT设置通过将不同组合的车间延迟的方案应用于心室来进行起搏脉冲来确定。 基于ECG表示信号为每个这样的延迟组合确定表示R或P波宽的相应宽度参数值，并且使用宽度参数值来估计定义作为间歇延迟的函数的宽度参数的参数模型。 从参数模型中确定最小化宽度参数的候选车间延迟，并用于确定最佳CRT设置。 该技术提供了一种在心室中可用多个起搏部位时可以找到最佳CRT设置的有效方式。

公开(公告)号：US20120310296A1

公开(公告)日：2012-12-06

申请号：US13471167

申请日：2012-05-14

申请人： Kjell Noren ,  Anders Bjorling ,  Tomas Svensson ,  Sven-Erik Hedberg ,  Allen Keel ,  Stuart Rosenberg ,  Kyungmoo Ryu

发明人： Kjell Noren ,  Anders Bjorling ,  Tomas Svensson ,  Sven-Erik Hedberg ,  Allen Keel ,  Stuart Rosenberg ,  Kyungmoo Ryu

IPC分类号： A61N1/365

CPC分类号： A61N1/36507 ,  A61N1/3682 ,  A61N1/3684 ,  A61N1/37252

摘要： CRT settings for an implantable medical device are determined by applying pacing pulses to heart chambers of a scheme of different combinations of interchamber delays. A respective width parameter value representing an R or P wave width is determined for each such delay combination based on an ECG representing signal and the width parameter values are employed to estimate a parametric model defining the width parameter as a function of interchamber delays. Candidate interchamber delays that minimize the width parameter are determined from the parametric model and employed to determine optimal CRT settings. The technique provides an efficient way of finding optimal CRT settings when multiple pacing sites are available in a heart chamber.

摘要翻译： 用于可植入医疗装置的CRT设置通过将不同组合的车间延迟的方案应用于心室来进行起搏脉冲来确定。 基于ECG表示信号为每个这样的延迟组合确定表示R或P波宽的相应宽度参数值，并且使用宽度参数值来估计定义作为间歇延迟的函数的宽度参数的参数模型。 从参数模型中确定最小化宽度参数的候选车间延迟，并用于确定最佳CRT设置。 该技术提供了一种在心室中可用多个起搏部位时可以找到最佳CRT设置的有效方式。

公开(公告)号：US09254391B2

公开(公告)日：2016-02-09

申请号：US13196580

申请日：2011-08-02

申请人： Kyungmoo Ryu ,  Tomas Svensson ,  Stuart Rosenberg

发明人： Kyungmoo Ryu ,  Tomas Svensson ,  Stuart Rosenberg

IPC分类号： A61N1/365 ,  A61N1/368 ,  A61N1/37

CPC分类号： A61N1/3682 ,  A61N1/3684 ,  A61N1/371

摘要： Pacing related timing is determined for an implantable medical device (IMD) by pacing at an RV pacing site, a first LV pacing site and a second LV pacing site in accordance with a first site, a second site and a third site pacing order, and further in accordance with a first inter-electrode pacing delay between pacing at the first site and pacing at the second site and a second inter-electrode pacing delay between pacing at the second site and pacing at the third site. At least one of a sensed event or a paced event is detected for at each of the second site and the third site. The first inter-electrode pacing delay and the second inter-electrode pacing delay are adjusted to avoid sensed events in favor of paced events at each of the second site and the third site. An atrio-ventricular delay may also be adjusted to avoid sensed events or lack of capture due to possible fusion at the first site, in favor of paced events at the first site.

摘要翻译： 通过根据第一部位，第二部位和第三部位起搏顺序，在RV起搏部位，第一LV起搏部位和第二LV起搏部位进行起搏，确定可植入医疗装置（IMD）的起搏相关时间，以及 进一步根据在第一部位的起搏和第二部位的起搏之间的第一电极间起搏延迟和在第二部位起搏和第三部位起搏之间的第二电极间起搏延迟。 在第二站点和第三站点的每个处检测感测事件或起搏事件中的至少一个。 调整第一电极间起搏延迟和第二电极间起搏延迟以避免感测到的事件有利于在第二位置和第三位置的每一个处的起搏事件。 还可以调整心房延迟以避免感染事件或由于第一部位可能融合而导致的捕获不足，有利于在第一部位的起搏事件。

公开(公告)号：US08527051B1

公开(公告)日：2013-09-03

申请号：US13545776

申请日：2012-07-10

申请人： Sven-Erik Hedberg ,  Tomas Svensson ,  Kjell Noren ,  Stuart Rosenberg ,  Kyungmoo Ryu ,  Edward Karst

发明人： Sven-Erik Hedberg ,  Tomas Svensson ,  Kjell Noren ,  Stuart Rosenberg ,  Kyungmoo Ryu ,  Edward Karst

IPC分类号： A61N1/37

CPC分类号： A61N1/36521 ,  A61N1/3702

摘要： The present invention provides implantable medical devices for detecting phrenic nerve stimulation. A pacing module is configured to deliver pacing pulses having a predetermined pulse amplitude and/or width within the refractory period of the left ventricle. The pacing pulses are repeatedly delivered during a number of cardiac cycles, and the pacing pulses are delivered at different delays relative to an onset of the refractory period of the left ventricle in different cardiac cycles. An impedance measurement module is configured to measure impedance signals in time windows synchronized with the delivery of pacing pulses in the refractory period of the left ventricle. A phrenic nerve stimulation, PNS, detection module is configured to gather at least one impedance signal from each time window, create aggregated impedance signals using the impedance signals from the different time windows, and analyze the aggregated impedance signals to detect PNS.

摘要翻译： 本发明提供了用于检测膈神经刺激的可植入医疗装置。 起搏模块被配置为在左心室的不应期内输送具有预定脉冲幅度和/或宽度的起搏脉冲。 起搏脉冲在多个心动周期期间重复递送，起搏脉冲相对于不同心脏周期中左心室的不应期的开始以不同的延迟递送。 阻抗测量模块被配置为测量与在左心室的不应期中递送起搏脉冲同步的时间窗内的阻抗信号。 膈神经刺激，PNS检测模块配置为从每个时间窗口收集至少一个阻抗信号，使用来自不同时间窗口的阻抗信号创建聚合阻抗信号，并分析聚合阻抗信号以检测PNS。

公开(公告)号：US20130035737A1

公开(公告)日：2013-02-07

申请号：US13196580

申请日：2011-08-02

申请人： Kyungmoo Ryu ,  Tomas Svensson ,  Stuart Rosenberg

发明人： Kyungmoo Ryu ,  Tomas Svensson ,  Stuart Rosenberg

IPC分类号： A61N1/365

CPC分类号： A61N1/3682 ,  A61N1/3684 ,  A61N1/371

摘要： Pacing related timing is determined for an implantable medical device (IMD) by pacing at an RV pacing site, a first LV pacing site and a second LV pacing site in accordance with a first site, a second site and a third site pacing order, and further in accordance with a first inter-electrode pacing delay between pacing at the first site and pacing at the second site and a second inter-electrode pacing delay between pacing at the second site and pacing at the third site. At least one of a sensed event or a paced event is detected for at each of the second site and the third site. The first inter-electrode pacing delay and the second inter-electrode pacing delay are adjusted to avoid sensed events in favor of paced events at each of the second site and the third site. An atrio-ventricular delay may also be adjusted to avoid sensed events or lack of capture due to possible fusion at the first site, in favor of paced events at the first site.

摘要翻译： 通过根据第一部位，第二部位和第三部位起搏顺序，在RV起搏部位，第一LV起搏部位和第二LV起搏部位进行起搏，确定可植入医疗装置（IMD）的起搏相关时间，以及 进一步根据在第一部位的起搏和第二部位的起搏之间的第一电极间起搏延迟和在第二部位起搏和第三部位起搏之间的第二电极间起搏延迟。 在第二站点和第三站点的每个处检测感测事件或起搏事件中的至少一个。 调整第一电极间起搏延迟和第二电极间起搏延迟以避免感测到的事件有利于在第二位置和第三位置的每一个处的起搏事件。 还可以调整心房延迟以避免感染事件或由于第一部位可能融合而导致的捕获不足，有利于在第一部位的起搏事件。

公开(公告)号：US08532774B1

公开(公告)日：2013-09-10

申请号：US13545794

申请日：2012-07-10

申请人： Sven-Erik Hedberg ,  Tomas Svensson ,  Kjell Noren ,  Stuart Rosenberg ,  Kyungmoo Ryu ,  Edward Karst

发明人： Sven-Erik Hedberg ,  Tomas Svensson ,  Kjell Noren ,  Stuart Rosenberg ,  Kyungmoo Ryu ,  Edward Karst

IPC分类号： A61N1/37

CPC分类号： A61N1/36521 ,  A61B5/042 ,  A61B5/0538 ,  A61N1/3686 ,  A61N1/3702

摘要： The present invention provides methods for detecting phrenic nerve stimulation. A pacing module is instructed to deliver pacing pulses having a predetermined pulse amplitude and/or width within the refractory period of the left ventricle. The pacing pulses are repeatedly delivered during a number of cardiac cycles and wherein the pacing pulses are delivered at different delays relative to an onset of the refractory period of the left ventricle in different cardiac cycles. Impedance signals are measured in time windows synchronized with the delivery of pacing pulses in the refractory period of the left ventricle using at least one electrode configuration. At least one impedance signal is gathered from each time window, aggregated impedance signals are created using the impedance signals from the different time windows, and the aggregated impedance signals are analyzed to detect PNS.

摘要翻译： 本发明提供了检测膈神经刺激的方法。 指示起搏模块在左心室的不应期内输送具有预定脉搏幅度和/或宽度的起搏脉冲。 起搏脉冲在多个心动周期期间重复递送，并且其中起搏脉冲相对于在不同心脏周期中的左心室的不应期的开始以不同的延迟递送。 使用至少一个电极配置，在与左心室的不应期中的起搏脉冲的递送同步的时间窗口中测量阻抗信号。 从每个时间窗口收集至少一个阻抗信号，使用来自不同时间窗口的阻抗信号创建聚合阻抗信号，并分析聚合阻抗信号以检测PNS。

公开(公告)号：US20130066222A1

公开(公告)日：2013-03-14

申请号：US13230482

申请日：2011-09-12

申请人： Stuart Rosenberg ,  Tomas Svensson ,  Kjell Norén ,  Edward Karst ,  Kyungmoo Ryu

发明人： Stuart Rosenberg ,  Tomas Svensson ,  Kjell Norén ,  Edward Karst ,  Kyungmoo Ryu

IPC分类号： A61B5/0464 ,  A61N1/39 ,  A61B5/0452 ,  A61N1/365 ,  A61B5/0402 ,  A61B5/0456

CPC分类号： A61N1/3704 ,  A61B5/0464 ,  A61B5/0468 ,  A61B5/686 ,  A61N1/3627 ,  A61N1/3684

摘要： A device senses cardioelectrical signals using a right atrial (RA) lead, which might include far-field R-waves as well as near-field P-waves. The device concurrently senses events using a proximal electrode of an LV lead, which can sense both P-waves and R-waves as substantially near-field events. Suitable templates are then applied to the signals sensed via the proximal LV electrode to identify the origin of the signals (e.g. atrial vs. ventricular) so as to properly classify the corresponding events sensed in the RA as near-field or far-field events. In this manner, far-field oversensing is conveniently detected.

摘要翻译： 一种装置使用右心房（RA）导联感测心电信号，其可能包括远场R波以及近场P波。 该装置使用LV引线的近侧电极同时感测事件，其可以感测P波和R波作为基本近场事件。 然后将合适的模板施加到经由近端LV电极感测的信号以识别信号的来源（例如心房与心室），以便将在RA中感测到的相应事件适当地分类为近场或远场事件​​。 以这种方式，可以方便地检测远场超检测。

公开(公告)号：US08538524B2

公开(公告)日：2013-09-17

申请号：US13230482

申请日：2011-09-12

申请人： Stuart Rosenberg ,  Tomas Svensson ,  Kjell Norén ,  Edward Karst ,  Kyungmoo Ryu

发明人： Stuart Rosenberg ,  Tomas Svensson ,  Kjell Norén ,  Edward Karst ,  Kyungmoo Ryu

IPC分类号： A61N1/368

CPC分类号： A61N1/3704 ,  A61B5/0464 ,  A61B5/0468 ,  A61B5/686 ,  A61N1/3627 ,  A61N1/3684

摘要： A device senses cardioelectrical signals using a right atrial (RA) lead, which might include far-field R-waves as well as near-field P-waves. The device concurrently senses events using a proximal electrode of an LV lead, which can sense both P-waves and R-waves as substantially near-field events. Suitable templates are then applied to the signals sensed via the proximal LV electrode to identify the origin of the signals (e.g. atrial vs. ventricular) so as to properly classify the corresponding events sensed in the RA as near-field or far-field events. In this manner, far-field oversensing is conveniently detected.

摘要翻译： 一种装置使用右心房（RA）导联感测心电信号，其可能包括远场R波以及近场P波。 该装置使用LV引线的近侧电极同时感测事件，其可以感测P波和R波作为基本近场事件。 然后将合适的模板施加到经由近端LV电极感测的信号以识别信号的来源（例如心房与心室），以便将在RA中感测到的相应事件适当地分类为近场或远场事件​​。 以这种方式，可以方便地检测远场超检测。