公开(公告)号：US5312453A

公开(公告)日：1994-05-17

申请号：US880877

申请日：1992-05-11

申请人： Michael B. Shelton ,  William J. Combs ,  Tommy D. Bennett ,  Michael R. Tollinger ,  Kenneth M. Riff

发明人： Michael B. Shelton ,  William J. Combs ,  Tommy D. Bennett ,  Michael R. Tollinger ,  Kenneth M. Riff

IPC分类号： A61N1/365 ,  A61N1/372 ,  A61N1/00

CPC分类号： A61N1/36514

摘要： A rate-responsive cardiac pacemaker in which deceleration of the pacing rate is modulated according to recent patient activity or "work". Based on signals provided from an activity sensor in the pacemaker, the pacemaker maintains and periodically recomputes a work value corresponding to the amount of patient activity detected over time. In response to a decrease in or cessation of detected patient activity, the pacemaker reduces the pacing rate, first at a more rapid deceleration rate, then at a lower deceleration rate, and then once again at a more rapid deceleration rate. The length of time during which the pacing rate is reduced at the lower deceleration rate is modulated according to the work value maintained by the pacemaker. The work-modulated pacing rate deceleration occurs only if certain achievement criteria are met, the achievement criteria being specified in terms of the amount of time the pacemaker's target pacing rate exceeds a predetermines rest value, and the difference between the target rate and the rest rate.

摘要翻译： 根据最近的患者活动或“工作”调节起搏速度的减速的速率响应心脏起搏器。 基于由起搏器中的活动传感器提供的信号，起搏器维持并周期性地重新计算与随时间检测的患者活动量相对应的工作值。 响应于检测到的患者活动的减少或停止，起搏器降低起搏速率，首先以更快的减速率，然后以较低的减速率，然后再次以更快的减速率。 以较低的减速率降低起搏速度的时间长短根据起搏器保持的工作值进行调制。 工作调节的起搏速度减速仅在满足某些成就标准的情况下发生，成就标准是根据起搏器的目标起搏速度超过预定值的时间量指定的，目标速率与休息率之间的差异 。

公开(公告)号：US5441525A

公开(公告)日：1995-08-15

申请号：US246903

申请日：1994-05-20

申请人： Michael B. Shelton ,  Kenneth M. Riff ,  Michael F. Hess

发明人： Michael B. Shelton ,  Kenneth M. Riff ,  Michael F. Hess

IPC分类号： A61N1/365 ,  A61N1/36

CPC分类号： A61N1/36514 ,  A61N1/365

摘要： A rate-responsive cardiac pacemaker implements a novel scheme which detects incipient vasovagal syncope (or other episodes caused by a vasodepressive or cardioinhibitory disorder) when a) the heart rate drops below a programmable minimum size, and b) the rate after said drop is below a programmable maximum drop ending rate. The pacemaker implements a stability and intervention procedure upon the detection of an episode, in which it ignores transient drops in rate, and paces at a predetermined high rate if the drops are stable. The pacemaker then gradually reduces the pacing rate over a predetermined time to the pre-episodic level. A sleep disable feature disables the vasovagal syncope detection and therapy features during the patient's sleeping hours to reduce or eliminate false positive responses.

摘要翻译： 速率响应心脏起搏器实施一种新颖的方案，其检测初期的血管迷走性晕厥（或由血管抑郁或心脏抑制障碍引起的其他发作），当a）心率下降到可编程的最小尺寸以下时，b）所述下降之后的速率低于 可编程的最大下降结束率。 起搏器在检测到发作时实现稳定性和干预程序，其中它忽略了速率的瞬时下降，并且如果液滴是稳定的，起搏器以预定的高速度步进。 然后，起搏器逐渐将起搏速度在预定时间内降低到事件发生前的水平。 睡眠禁用功能在患者睡眠时间内禁用血管迷走性晕厥检测和治疗功能，以减少或消除假阳性反应。

公开(公告)号：US5540728A

公开(公告)日：1996-07-30

申请号：US308910

申请日：1994-09-20

申请人： Michael B. Shelton ,  Kenneth M. Riff

发明人： Michael B. Shelton ,  Kenneth M. Riff

IPC分类号： A61N1/365 ,  A61N1/362

CPC分类号： A61N1/365 ,  A61N1/36514

摘要： A method and apparatus of cardiac pacing, in which pacing at an increased rate is provided in response to a detected rapid drop in detected heart rate, to a stable rate below a defined threshold rate.

摘要翻译： 心脏起搏的方法和装置，其中响应于检测到的心率的快速下降而以增加的速率起搏提供到低于定义的阈值速率的稳定速率。

公开(公告)号：US06236889B1

公开(公告)日：2001-05-22

申请号：US09235444

申请日：1999-01-22

申请人： Orhan Soykan ,  William J. Combs ,  Michael B. Shelton

发明人： Orhan Soykan ,  William J. Combs ,  Michael B. Shelton

IPC分类号： A61N108

CPC分类号： A61N1/37217 ,  A61N1/08 ,  A61N1/3727 ,  H04B11/00 ,  H04B13/005 ,  Y10S128/904

摘要： An apparatus and method for communicating acoustic telemetry data produced by an implantable medical device over a communication channel includes a signal generator, a modulator, and an acoustic transmitter each provided in the implantable medical device. The modulator modulates a carrier signal with an information signal representative of information acquired or produced by the implantable medical device so as to produce a modulated information signal. The modulated information signal may have a frequency content that is readily accommodated by a public exchange communication channel. The transmitter transmits the modulated information signal as an acoustic information signal in a form communicable over the communication channel. The acoustic information signal may constitute telephonic tones which are directly communicable over a conventional telephone connection. The acoustic information signal may constitute digital telephonic tones each having a frequency and format that conforms to one or more telephony standards. In an embodiment in which the communication channel constitutes a public exchange communication channel, the acoustic information signal preferably has a frequency content that is band limited by an audio bandwidth of the public exchange communication channel. A number of different modulation techniques may be employed, including phase modulation, amplitude modulation or frequency modulation. Implantable medical devices which may incorporate telemetry circuitry of the present invention include a pacemaker, a pacemaker/cardioverter/defibrillator (PCD), an oxygen sensing device, an implantable hemodynamic monitor, a muscle stimulator device or a nerve stimulator device.

摘要翻译： 用于通过通信信道传送由可植入医疗装置产生的声学遥测数据的装置和方法包括每个设置在可植入医疗装置中的信号发生器，调制器和声发射器。 调制器利用表示由可植入医疗装置获取或产生的信息的信息信号来调制载波信号，以产生调制信息信号。 调制信息信号可以具有容易由公共交换通信信道容纳的频率内容。 发射机将调制信息信号作为在通信信道上可通信的形式的声信息信号发送。 声信息信号可以构成通过常规电话连接直接通信的电话音。 声信息信号可以构成每个具有符合一个或多个电话标准的频率和格式的数字电话音。 在通信信道构成公共交换通信信道的实施例中，声信息信号优选地具有由公共交换通信信道的音频带宽限制的频带内容。 可以采用多种不同的调制技术，包括相位调制，幅度调制或频率调制。 可包含本发明的遥测电路的可植入医疗装置包括起搏器，起搏器/心律转复器/除颤器（PCD），氧气感测装置，可植入血液动力学监测器，肌肉刺激器装置或神经刺激装置。

公开(公告)号：US06904315B2

公开(公告)日：2005-06-07

申请号：US09736640

申请日：2000-12-14

申请人： Eric J. Panken ,  William J. Combs ,  Michael B. Shelton

发明人： Eric J. Panken ,  William J. Combs ,  Michael B. Shelton

IPC分类号： A61B5/0402 ,  A61B5/0472 ,  A61N1/05 ,  A61N1/365 ,  A61N1/368 ,  A61N1/18 ,  A61B5/04

CPC分类号： A61N1/368

摘要： An algorithm is implemented in a circuit for sensing P-waves in a pacemaker to ensure ventricular pacing synchronization with sensed atrial depolarization waves. VDD and VDDR pacing (atrial synchronized, ventricular inhibited pacing) are implemented via a single standard ventricular pacing lead (unipolar or bipolar) and preferably a subcutaneous electrode array (SEA). Specifically, an implanted ventricular lead provides ventricular pacing and ventricular sensing while the SEA enable atrial sensing, thus eliminating the need for an implanted atrial lead or a specialized single pass VDD lead. The algorithm manages the sensed cardiac waves to effect a desired pacing regimen based on the input from the single lead and SEA.

摘要翻译： 在用于感测起搏器中的P波的电路中实现算法以确保与感测的心房去极化波的心室起搏同步。 通过单个标准心室起搏引线（单极或双极），优选皮下电极阵列（SEA）来实现VDD和VDDR起搏（心房同步，心室抑制起搏）。 具体来说，植入式心室引线可提供心室起搏和心室感应，而SEA能够进行心房感应，从而无需植入心房线或专用单通道VDD引线。 该算法基于来自单个引线和SEA的输入来管理所感测的心脏波以实现期望的起搏方案。

公开(公告)号：US5527347A

公开(公告)日：1996-06-18

申请号：US391884

申请日：1995-02-21

申请人： Michael B. Shelton ,  Dwight H. Warkentin

发明人： Michael B. Shelton ,  Dwight H. Warkentin

IPC分类号： A61N1/368 ,  A61N1/362

CPC分类号： A61N1/3627 ,  A61N1/3682

摘要： There is provided a dual chamber pacemaker system and method for ventricular pacing to provide therapy for a patient with cardiomyopathy, this system being characterized by automatically adjusting the AV escape interval so that ventricular pace pulses are delivered at an AV delay which is optimized for HOCM and/or dialated cardiomyopathy therapy. The pacemaker system continually obtains and stores representations of a QRS wave characteristic such as duration, derived either directly from the QRS signal or from an FFRS signal, and compares duration data from one or more cycles to prior stored duration data. The system then adjusts the AV interval as a function of the duration comparison, and the direction of the last adjustment of AV escape interval. By this means, the AV escape interval is maintained at or just short of the onset of fusion, thereby automatically providing for optimally lengthened AV escape intervals consistent with full capture by the delivered ventricular pace pulse.

摘要翻译： 提供了一种用于心室起搏的双室心脏起搏器系统和方法，用于为患有心肌病的患者提供治疗，该系统的特征在于自动调节AV逃逸间隔，使得心室起搏脉冲在AV延迟下被传递，该AV延迟被优化用于HOCM， /或拨号心肌病治疗。 起搏器系统连续地获得并存储QRS波特征的表示，例如持续时间，直接从QRS信号或从FFRS信号导出，并将来自一个或多个周期的持续时间数据与先前存储的持续时间数据进行比较。 然后，系统根据持续时间比较调整AV间隔，并调整AV转义间隔的最后调整方向。 通过这种方式，AV逃逸间隔保持在融合开始或短于融合开始，从而自动提供与被传递的心室起搏脉冲的完全捕获相一致的最佳延长的AV逃逸间隔。

公开(公告)号：US5402070A

公开(公告)日：1995-03-28

申请号：US275863

申请日：1994-07-15

申请人： Michael B. Shelton ,  Ross O. Starkson ,  Craig L. Schmidt ,  H. Toby Markowitz

发明人： Michael B. Shelton ,  Ross O. Starkson ,  Craig L. Schmidt ,  H. Toby Markowitz

IPC分类号： A61N1/37 ,  A61N1/378 ,  G01R31/36

CPC分类号： G01R31/3662 ,  A61N1/3708 ,  A61N1/378

摘要： A pacemaker having a fault-tolerant elective replacement indicator (ERI) triggering scheme in which transient excursions of parameters used as criteria for triggering ERI are rejected as triggering events. Periodic assessments of certain indicia of battery depletion are made, and subjected to a long-term low-pass filtering operation in order to reduce the effects of transient excursions of the indicia which result from non-ERI conditions. Over a long period of time (e.g., a day) predetermined threshold values of the indicia of interest must be exceeded a predetermined number of times in order for the device to issue an ERI. In one disclosed embodiment of the invention, the battery's loaded terminal voltage and internal impedance are used as indicators of the battery's depletion level. Periodically, these values are measured and converted to digital values. The digital values are subjected to a low-pass filtering operation to prevent temporary or transient excursions of the impedance and voltage curves from causing ERI to be triggered. In another disclosed embodiment of the invention, a long term fading average of periodically measured values is maintained. When the measured values are found to fulfill the ERI criteria, assessment of the parameters of interest is performed at an increased rate. While assessments are performed at the increased rate, the continuously updated fading average value must fulfill the ERI triggering criteria at least a predetermined number of times before ERI is triggered. If the fading average fails to fulfill the ERI triggering criteria the required number of times, assessments are resumed at the first, slower periodic rate.

摘要翻译： 具有容错选择性替换指示符（ERI）触发方案的起搏器，其中用作触发ERI的标准的参数的瞬时偏移作为触发事件被拒绝。 进行电池耗尽的某些标记的定期评估，并进行长期低通滤波操作，以减少由非ERI条件引起的标记的瞬时偏移的影响。 在一段长时间（例如，一天）中，为了使设备发布ERI，必须超过预定次数的预定阈值。 在本发明的一个公开的实施例中，电池的负载端子电压和内部阻抗被用作电池耗尽水平的指标。 定期测量这些值并将其转换为数字值。 对数字值进行低通滤波操作，以防止阻抗和电压曲线的暂时或瞬时偏移导致ERI被触发。 在本发明的另一个公开实施例中，维持周期性测量值的长期衰落平均值。 当发现测量值达到ERI标准时，以增加的速率进行感兴趣参数的评估。 虽然以增加的速率进行评估，但连续更新的衰落平均值必须在触发ERI之前至少达到预定次数的ERI触发标准。 如果衰落平均值不符合所需次数的ERI触发标准，则以第一个较慢的周期速率恢复评估。

公开(公告)号：US5370668A

公开(公告)日：1994-12-06

申请号：US81746

申请日：1993-06-22

申请人： Michael B. Shelton ,  Ross O. Starkson ,  Craig L. Schmidt ,  H. Toby Markowitz

发明人： Michael B. Shelton ,  Ross O. Starkson ,  Craig L. Schmidt ,  H. Toby Markowitz

IPC分类号： A61N1/37 ,  A61N1/378 ,  G01R31/36

CPC分类号： G01R31/3662 ,  A61N1/3708 ,  A61N1/378

摘要： A pacemaker having a fault-tolerant elective replacement indicator (ERI) triggering scheme in which transient excursions of parameters used as criteria for triggering ERI are rejected as triggering events. Periodic assessments of certain indicia of battery depletion are made, and subjected to a long-term low-pass filtering operation in order to reduce the effects of transient excursions of the indicia which result from non-ERI conditions. Over a long period of time (e.g., a day) predetermined threshold values of the indicia of interest must be exceeded a predetermined number of times in order for the device to issue an ERI. In one disclosed embodiment of the invention, the battery's loaded terminal voltage and internal impedance are used as indicators of the battery's depletion level. Periodically, these values are measured and converted to digital values. The digital values are subjected to a low-pass filtering operation to prevent temporary or transient excursions of the impedance and voltage curves from causing ERI to be triggered. In another disclosed embodiment of the invention, a long term fading average of periodically measured values is maintained. When the measured values are found to fulfill the ERI criteria, assessment of the parameters of interest is performed at an increased rate. While assessments are performed at the increased rate, the continuously updated fading average value must fulfill the ERI triggering criteria at least a predetermined number of times before ERI is triggered. If the fading average fails to fulfill the ERI triggering criteria the required number of times, assessments are resumed at the first, slower periodic rate.

摘要翻译： 具有容错选择性替换指示符（ERI）触发方案的起搏器，其中用作触发ERI的标准的参数的瞬时偏移作为触发事件被拒绝。 进行电池耗尽的某些标记的定期评估，并进行长期低通滤波操作，以减少由非ERI条件引起的标记的瞬时偏移的影响。 在一段长时间（例如，一天）中，为了使设备发布ERI，必须超过预定次数的预定阈值。 在本发明的一个公开的实施例中，电池的负载端子电压和内部阻抗被用作电池耗尽水平的指标。 定期测量这些值并将其转换为数字值。 对数字值进行低通滤波操作，以防止阻抗和电压曲线的暂时或瞬时偏移导致ERI被触发。 在本发明的另一个公开实施例中，维持周期性测量值的长期衰落平均值。 当发现测量值达到ERI标准时，以增加的速率进行感兴趣参数的评估。 虽然以增加的速率进行评估，但连续更新的衰落平均值必须在触发ERI之前至少达到预定次数的ERI触发标准。 如果衰落平均值不符合所需次数的ERI触发标准，则以第一个较慢的周期速率恢复评估。

公开(公告)号：US20090198298A1

公开(公告)日：2009-08-06

申请号：US12421176

申请日：2009-04-09

申请人： Daniel R. Kaiser ,  Michael R. Neidert ,  Nicholas David Skadsberg ,  Kenneth C. Gardeski ,  Lawrence J. Mulligan ,  James F. Kelley ,  Michael B. Shelton ,  Trent M. Fischer

发明人： Daniel R. Kaiser ,  Michael R. Neidert ,  Nicholas David Skadsberg ,  Kenneth C. Gardeski ,  Lawrence J. Mulligan ,  James F. Kelley ,  Michael B. Shelton ,  Trent M. Fischer

IPC分类号： A61N1/365 ,  A61B5/05

CPC分类号： A61B5/1107 ,  A61B5/1104 ,  A61B5/686 ,  A61B5/6882 ,  A61B2562/0209 ,  A61N1/0573 ,  A61N1/3627 ,  A61N1/36578 ,  A61N1/368 ,  A61N1/3684 ,  A61N1/3686 ,  A61N2001/0585

摘要： A method and system for use in selecting a cardiac pacing site includes sensors for tracking wall motion (e.g., sensors coupled to the right and left ventricular heart wall). The wall motion of one or more non-paced cardiac cycles is compared to the wall motion of one or more paced cardiac cycles to determine the effectiveness of one or more pacing sites. For example, image data may be generated to notify the user as to the effectiveness of the one or more pacing sites.

摘要翻译： 用于选择心脏起搏部位的方法和系统包括用于跟踪壁运动的传感器（例如耦合到右心室壁和左心室心壁的传感器）。 将一个或多个非节奏心脏周期的壁运动与一个或多个节奏心动周期的壁运动进行比较，以确定一个或多个起搏部位的有效性。 例如，可以生成图像数据以通知用户关于一个或多个起搏站点的有效性。

公开(公告)号：US5387228A

公开(公告)日：1995-02-07

申请号：US81911

申请日：1993-06-22

申请人： Michael B. Shelton

发明人： Michael B. Shelton

IPC分类号： A61N1/37 ,  A61N1/378 ,  H02J7/00 ,  A61N1/36

CPC分类号： A61N1/3708 ,  A61N1/378

摘要： An implantable cardiac pacemaker having programmable stimulating pulse amplitudes selectable by means of an external programming unit. The pacemaker includes charge pump circuitry for developing a stimulating pulse voltage on an output capacitor. The output capacitor is charged to a selected level identified by a multiple-bit amplitude value communicated to the implanted device from the external programmer. The pacemaker is also provided with circuitry for monitoring the depletion level of its battery and for generating an indicator signal when the battery has depleted beyond a predetermined level. Associated with the charge pump circuitry is a selectively activated comparator circuit for controlling the charging of the output capacitor. Prior to generation of the indicator signal, the charge pump circuitry remains deactivated for some programmed output amplitudes, the level of output capacitor charging being proportional to the battery voltage. After issuance of the indicator signal, the comparator circuit is activated to control the charging of the output capacitor. When the comparator circuit is activated for charging the capacitor, the resulting voltage established on the capacitor is proportional to a predetermined constant reference voltage. Longevity of the device is optimized by not activating the comparator circuit during early stages of battery depletion when the battery's output voltage is relatively stable.

摘要翻译： 具有可编程刺激脉冲幅度的可植入心脏起搏器，其可通过外部编程单元选择。 起搏器包括用于在输出电容器上产生刺激脉冲电压的电荷泵电路。 输出电容器被充电到由外部编程器传送到植入装置的多位振幅值所识别的选定电平。 起搏器还设置有用于监测其电池的耗尽水平并且当电池已经耗尽超过预定水平时产生指示符信号的电路。 与电荷泵电路相关联的是用于控制输出电容器的充电的选择性激活的比较器电路。 在生成指示器信号之前，电荷泵电路对于某些编程的输出幅度保持停用，输出电容器充电的电平与电池电压成比例。 指示信号发出后，比较电路被激活，以控制输出电容器的充电。 当比较器电路被激活以对电容器充电时，在电容器上建立的所得到的电压与预定的恒定参考电压成比例。 当电池的输出电压相对稳定时，通过在电池耗尽的早期阶段不激活比较器电路来优化器件的寿命。