公开(公告)号：US06876880B2

公开(公告)日：2005-04-05

申请号：US10034060

申请日：2001-12-20

申请人： Michael F. Hess ,  Rahul Mehra ,  Eduardo N. Warman ,  Nirav V. Sheth ,  Mark L. Brown ,  David Ritscher

发明人： Michael F. Hess ,  Rahul Mehra ,  Eduardo N. Warman ,  Nirav V. Sheth ,  Mark L. Brown ,  David Ritscher

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

CPC分类号： A61N1/3622 ,  A61N1/3624

摘要： The invention relates to the use of atrial pacing therapies to treat atrial tachycardia (AT). When an AT episode is detected, an implantable medical device applies an ATP therapy. If the AT episode persists, the ATP therapy may be automatically reapplied at a later time during the course of the same AT episode. In particular, previously used ATP therapies are reapplied when episodic conditions, such as cycle length or cycle regularity, change. Although a particular ATP therapy initially may be unsuccessful in terminating the AT, it may prove successful when the cycle length or regularity of the atrial rhythm changes. As the rhythm slows down, the AT may be more responsive to ATP therapies that were previously unsuccessful. As a result, potentially efficacious ATP therapies can be reapplied to terminate AT episodes, and reduce the number of episodes that require more aggressive termination by painful, atrial shocks.

摘要翻译： 本发明涉及心房起搏疗法用于治疗房性心动过速（AT）的用途。 当检测到AT发作时，可植入医疗装置应用ATP疗法。 如果AT发作持续存在，ATP疗法可能会在相同的AT发作过程中的较晚时间自动重新应用。 特别是，当诸如循环长度或循环规律性等情况时，先前使用的ATP疗法将被重新应用。 尽管特定的ATP疗法最初可能不能终止AT，但是当心房节律的周期长度或规律性发生变化时，可能会成功。 随着节奏减慢，AT可能对以前不成功的ATP疗法更有反应。 因此，可以重新应用潜在有效的ATP疗法来终止AT发作，并通过痛苦的心房休克减少需要更积极终止的发作次数。

公开(公告)号：US07076290B2

公开(公告)日：2006-07-11

申请号：US10682982

申请日：2003-10-10

申请人： Nirav V. Sheth ,  Eduardo N. Warman ,  Michael F. Hess

发明人： Nirav V. Sheth ,  Eduardo N. Warman ,  Michael F. Hess

IPC分类号： A61B5/04

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。

公开(公告)号：US07366570B2

公开(公告)日：2008-04-29

申请号：US10376061

申请日：2003-02-26

申请人： Kenneth M. Riff ,  Patrick M. Mahoney ,  Clifton W. Owens ,  Rahul Mehra ,  Michael F. Hess ,  Nirav V. Sheth ,  Nancy Perry Pool ,  Michael R. Ujhelyi

发明人： Kenneth M. Riff ,  Patrick M. Mahoney ,  Clifton W. Owens ,  Rahul Mehra ,  Michael F. Hess ,  Nirav V. Sheth ,  Nancy Perry Pool ,  Michael R. Ujhelyi

IPC分类号： A61N1/08

CPC分类号： A61N1/37258 ,  A61B5/0031 ,  A61N1/37252 ,  G06F19/00 ,  G06F19/3418 ,  G06F19/3456 ,  G16H10/60 ,  G16H15/00 ,  G16H40/63

摘要： A method and system facilitates the access by a patient of implanted medical device related data for patient participation in their own clinical care and therapy. In an example embodiment, the method includes establishing a communications link between an implanted medical device and a data processor via an implanted medical device interface. Access to a secured database is obtained via the implanted device data processor using a set of patient identification data. A query is then submitted via the data processor to the secured database in response to input patient diagnostic data. Data received from the secured database is then displayed for use in a patient evaluation.

摘要翻译： 一种方法和系统便于患者接触植入的医疗装置相关数据，以使患者参与其自身临床护理和治疗。 在示例实施例中，该方法包括经由植入的医疗设备接口在植入的医疗设备和数据处理器之间建立通信链路。 通过使用一组患者识别数据的植入装置数据处理器获得对安全数据库的访问。 然后，响应于输入的患者诊断数据，通过数据处理器将查询提交到安全数据库。 然后显示从安全数据库接收到的数据以用于患者评估。

公开(公告)号：US06804554B2

公开(公告)日：2004-10-12

申请号：US10053035

申请日：2001-10-19

申请人： Michael R. Ujhelyi ,  Rahul Mehra ,  Nirav V. Sheth ,  Nancy Perry Pool

发明人： Michael R. Ujhelyi ,  Rahul Mehra ,  Nirav V. Sheth ,  Nancy Perry Pool

IPC分类号： A61N130

CPC分类号： A61N1/3956 ,  A61N1/37247 ,  A61N1/37258 ,  A61N1/3987

摘要： A patient-controlled system for temporarily disabling an electrical cardioverting therapy in order to prepare the patient psychologically and physiologically for the pain associated with electrical cardioversion therapy. In an example embodiment, the system includes a capacitive circuit capable of charging and discharging in order to apply the electrical therapy. The implanted medical device automatically causes the capacitive circuit to charge and discharge at least once within a selected period. The system includes a patient activator device that communicates with the implanted device. A disabling circuit is also included within the implanted medical device that temporarily disables the electrical therapy application in response to the patient activator device. The system further includes an alerting arrangement that alerts the patient activator device in response to the disabling circuit. An override circuit overrides the temporary disabling of the electrical therapy application in response to the patient being in a relaxed mode.

摘要翻译： 一种患者控制的系统，用于临时禁用电复律治疗，以便心理和生理地为患者提供与电复律治疗相关的疼痛。 在示例性实施例中，系统包括能够进行充电和放电以便施加电疗法的电容电路。 植入的医疗装置自动使电容电路在选定的时间内至少进行一次充电和放电。 该系统包括与植入装置通信的患者激活装置。 在植入式医疗装置中还包括禁用电路，其暂时禁用响应于患者激活装置的电疗应用。 该系统还包括警报装置，其响应于禁用电路来警告患者激活装置。 覆盖电路覆盖响应于患者处于放松模式的电疗治疗应用的暂时禁用。

公开(公告)号：US07715917B2

公开(公告)日：2010-05-11

申请号：US11004543

申请日：2004-12-03

申请人： Edward Chinchoy ,  Nirav V. Sheth ,  Kathryn E. Hilpisch ,  Thomas J. Mullen ,  John E. Burnes

发明人： Edward Chinchoy ,  Nirav V. Sheth ,  Kathryn E. Hilpisch ,  Thomas J. Mullen ,  John E. Burnes

IPC分类号： A61N1/00

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：US07555336B2

公开(公告)日：2009-06-30

申请号：US11312163

申请日：2005-12-20

申请人： Nirav V. Sheth ,  Karen J. Kleckner ,  John E. Burnes

发明人： Nirav V. Sheth ,  Karen J. Kleckner ,  John E. Burnes

IPC分类号： A61B5/0402

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：US08428717B2

公开(公告)日：2013-04-23

申请号：US10684759

申请日：2003-10-14

申请人： Li Wang ,  Yong K. Cho ,  Kevin Kuehn ,  Glenn C. Zillmer ,  Nirav V. Sheth

发明人： Li Wang ,  Yong K. Cho ,  Kevin Kuehn ,  Glenn C. Zillmer ,  Nirav V. Sheth

IPC分类号： A61N1/365

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：US07970466B2

公开(公告)日：2011-06-28

申请号：US10680494

申请日：2003-10-07

申请人： Lawrence J. Mulligan ,  D. Curtis Deno ,  John E. Burnes ,  Nirav V. Sheth

发明人： Lawrence J. Mulligan ,  D. Curtis Deno ,  John E. Burnes ,  Nirav V. Sheth

IPC分类号： A61N1/00 ,  A61B5/04

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：US06813516B2

公开(公告)日：2004-11-02

申请号：US10062126

申请日：2002-01-31

申请人： Michael R. Ujhelyi ,  David E. Euler ,  David A. Casavant ,  Nirav V. Sheth

发明人： Michael R. Ujhelyi ,  David E. Euler ,  David A. Casavant ,  Nirav V. Sheth

IPC分类号： A61N139

CPC分类号： A61N1/3962 ,  A61N1/395

摘要： A method for preventing early recurrence of atrial fibrillation by pacing a heart in AAI mode at a rate faster than the intrinsic rate for a selected period of time immediately after delivering therapy to terminate the fibrillation. Ventricular backup pacing in VVI mode may also be provided during the atrial pacing.

摘要翻译： 一种通过在递送治疗之后立即在选择的时间段内的速率快于AAI模式的心脏起搏以预防心房颤动的早期复发的方法来终止原纤维颤动。 在心房起搏期间也可以提供VVI模式的心室起搏。