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：US20050075674A1

公开(公告)日：2005-04-07

申请号：US10680493

申请日：2003-10-07

申请人： Glenn Zillmer ,  D. Deno ,  Nirav Sheth

发明人： Glenn Zillmer ,  D. Deno ,  Nirav Sheth

IPC分类号： A61N1/362 ,  A61N1/365

CPC分类号： A61N1/365 ,  A61N1/3622

摘要： Techniques for delivering ESS to a heart of a patient are disclosed. An implantable medical device delivers ESS stimulation, and in some embodiments pacing stimulation, to a chamber of the heart via a first electrode set. The implantable medical device senses electrical activity within the chamber via a second set of electrodes. In some embodiments, the implantable medical device is able to apply a shorter blanking interval than is typical in the pacing art to a sense amplifier coupled to the second set of electrodes, allowing the implantable medical device to better detect arrhythmias and evoked responses. A variety of electrodes may be used in conjunction with the present invention; including without limitation, tip, ring, coil, can-based, endocardial, epicardial, pericardial, cardiac vein-based, subcutaneous, and/or surface electrodes.

摘要翻译： 公开了将ESS递送到患者心脏的技术。 可植入医疗装置通过第一电极组将ESS刺激，并且在一些实施例中将起搏刺激提供给心脏室。 可植入医疗装置经由第二组电极感测室内的电活动。 在一些实施例中，可植入医疗装置能够将比起搏技术中典型的更短的消隐间隔应用于耦合到第二组电极的感测放大器，从而允许可植入医疗装置更好地检测心律失常和诱发反应。 可以结合本发明使用各种电极; 包括但不限于尖端，环形，线圈，罐基，心内膜，心外膜，心包，心静脉，皮下和/或表面电极。

公开(公告)号：US20050149137A1

公开(公告)日：2005-07-07

申请号：US11004543

申请日：2004-12-03

申请人： Edward Chinchoy ,  Nirav Sheth ,  Kathryn Hilpisch ,  Thomas Mullen ,  John Burnes

发明人： Edward Chinchoy ,  Nirav Sheth ,  Kathryn Hilpisch ,  Thomas Mullen ,  John Burnes

IPC分类号： A61N1/362 ,  A61N1/368

CPC分类号： A61N1/368 ,  A61N1/3627 ,  A61N1/3682 ,  A61N1/3684

摘要： Determining an optimal atrioventricular interval is of interest for proper delivery of cardiac resynchronization therapy. Although device optimization is gradually and more frequently being performed through a referral process with which the patient undergoes an echocardiographic optimization, the decision of whether to optimize or not is still generally reserved for the implanting physician. Recent abstracts have suggested a formulaic approach for setting A-V interval based on intrinsic electrical sensing, that may possess considerable appeal to clinicians versus a patient average nominal A-V setting of 100 ms. The present invention presents a methods of setting nominal device settings based on entering patient cardiac demographics to determine what A-V setting may be appropriate. The data is based on retrospective analysis of the MIRACLE trial to determine what major factors determined baseline A-V settings.

摘要翻译： 确定最佳房室间隔对于正确递送心脏再同步治疗是有意义的。 尽管通过与患者经历超声心动图优化的转诊过程逐渐且更频繁地进行装置优化，但仍然通常为植入医生保留是否优化的决定。 最近的摘要提出了一种基于固有电学感测设置A-V间隔的公式化方法，这可能对临床医生具有相当大的吸引力，而患者平均标称A-V设置为100 ms。 本发明提供了一种基于输入患者心脏人口统计学来设定标称装置设置以确定什么A-V设置可能适合的方法。 数据基于MIRACLE试验的回顾性分析，以确定确定基线A-V设置的主要因素。

公开(公告)号：US20060136002A1

公开(公告)日：2006-06-22

申请号：US11312163

申请日：2005-12-20

申请人： Nirav Sheth ,  Karen Kleckner ,  John Burnes

发明人： Nirav Sheth ,  Karen Kleckner ,  John Burnes

IPC分类号： A61N1/362

CPC分类号： A61N1/371 ,  A61N1/3712

摘要： The present invention provides a technique for verifying pacing capture of a ventricular chamber, particularly to ensure desired delivery of a ventricular pacing regime (e.g., cardiac resynchronization therapy or “CRT”). The invention also provides for ventricular capture management by delivering a single ventricular pacing stimulus and checking inter-ventricular conduction during a temporal window to determine if the ventricular pacing stimulus captured the chamber. If a loss-of-capture (LOC) signal results from the capture management testing, then the characteristics of the applied pacing pulses are modified and the conduction test repeated. In the event that the LOC signal persists, a pacing mode-switch to an atrial-based pacing therapy and/or non-bi-ventricular pacing regimen can be implemented.

摘要翻译： 本发明提供了一种用于验证心室的起搏捕获的技术，特别是确保心室起搏方案（例如，心脏再同步治疗或“CRT”）的期望递送。 本发明还通过递送单个心室起搏刺激和在时间窗口期间检查心室间传导来确定心室起搏刺激是否捕获腔室来提供心室捕获管理。 如果捕获管理测试产生捕获损失（LOC）信号，则应用起搏脉冲的特性被修改，并重复传导测试。 在LOC信号持续存在的情况下，可以实现起搏模式切换到基于心房的起搏治疗和/或非双心室起搏方案。

公开(公告)号：US20050080460A1

公开(公告)日：2005-04-14

申请号：US10684759

申请日：2003-10-14

申请人： Li Wang ,  Yong Cho ,  Kevin Kuehn ,  Glenn Zillmer ,  Nirav Sheth

发明人： Li Wang ,  Yong Cho ,  Kevin Kuehn ,  Glenn Zillmer ,  Nirav Sheth

IPC分类号： A61B5/053 ,  A61N1/362 ,  A61N1/365 ,  A61N1/39

CPC分类号： A61B5/4869 ,  A61B5/0537 ,  A61B5/0538 ,  A61B5/7203 ,  A61B5/7285 ,  A61N1/3627 ,  A61N1/36521 ,  A61N1/3962

摘要： A fluid status monitoring system for use in implantable cardiac stimulation or monitoring devices is provided for monitoring changes in thoracic fluid content. A fluid status monitor includes excitation pulse generating and control circuitry, and voltage and current measurement and control circuitry for performing a series of cardiac-gated, intra-thoracic impedance measurements. The cardiac-gated measurements are filtered or time-averaged to provide a fluid status impedance value, with respiratory noise removed. Based on comparative analysis of the fluid status impedance value, a clinically relevant trend in fluid status may be tentatively diagnosed and a fluid status response provided. Cross-check intra-thoracic impedance measurements performed using the same or a different excitation pathway and a different measurement pathway than the primary intra-thoracic impedance measurement configuration may be used to verify a tentative diagnosis.

摘要翻译： 提供用于植入式心脏刺激或监测装置的流体状态监测系统，用于监测胸腔液含量的变化。 流体状态监测器包括激励脉冲发生和控制电路以及用于执行一系列心脏门控胸腔内阻抗测量的电压和电流测量和控制电路。 心脏门控测量被过滤或时间平均以提供流体状态阻抗值，消除呼吸噪声。 基于流体状态阻抗值的比较分析，可以暂时诊断流体状态的临床相关趋势，并提供流体状态响应。 使用与主要的胸内阻抗测量配置相同或不同的激发途径和不同的测量路径进行的交叉检查胸内阻抗测量可用于验证临时诊断。

公开(公告)号：US20050080347A1

公开(公告)日：2005-04-14

申请号：US10682982

申请日：2003-10-10

申请人： Nirav Sheth ,  Eduardo Warman ,  Michael Hess

发明人： Nirav Sheth ,  Eduardo Warman ,  Michael Hess

IPC分类号： A61B5/046 ,  A61B5/0464 ,  A61N1/362 ,  A61N1/368 ,  A61N1/39 ,  G06F17/00 ,  A61B5/0402

CPC分类号： A61B5/046 ,  A61B5/0464 ,  A61B5/7264 ,  A61N1/3622 ,  A61N1/3962

摘要： An apparatus and method for discriminating arrhythmias that includes sensing a heart rate indicative of an arrhythmia associated with a first portion of a heart, determining regularity of the sensed heart rate, determining an event interval variability associated with a second portion of the heart, and classifying the arrhythmia in response to the determined event interval variability.

摘要翻译： 一种用于区分心律失常的装置和方法，包括感测指示与心脏的第一部分相关联的心律失常的心率，确定感测心率的规律性，确定与心脏的第二部分相关联的事件间隔变异性，以及分类 响应于确定的事件间隔变异性的心律失常。