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1.发明授权Method and apparatus for monitoring drug effects on cardiac electrical signals using an implantable cardiac stimulation device 有权使用可植入心脏刺激装置监测对心脏电信号的药物作用的方法和装置公开(公告)号：US07142911B2
公开(公告)日：2006-11-28
申请号：US10608409
申请日：2003-06-26
申请人： Peter Boileau , Janice Barstad , Gene A. Bornzin , Kerry Bradley , Eric Falkenberg , Joseph J. Florio
发明人： Peter Boileau , Janice Barstad , Gene A. Bornzin , Kerry Bradley , Eric Falkenberg , Joseph J. Florio
CPC分类号： A61N1/3622 , A61B5/0031 , A61B5/04525 , A61B5/4839 , A61M5/14276 , A61M5/1723 , A61M2205/3523 , A61M2205/3553 , A61M2230/10 , G06F19/00 , G06F19/3456 , G06F19/3481 , G16H50/20 , Y10S514/821
摘要： An implantable cardiac stimulation device, such as a pacemaker or Implantable Cardioverter Defibrillator, is configured to automatically monitor the effects of antiarrhythmic drugs on cardiac electrical signals within a patient to verify the efficacy of the drugs taken. In one example, an analysis of patient cardiac electrical signals is performed by comparing the cardiac electrical signals with values representative of the effects of different classes of antiarrhythmic drugs. If the implantable device determines that the prescribed antiarrhythmic drugs have not been effective, a warning signal is generated. The warning signal is conveyed directly to the patient via a bedside monitor and to the patient's physician via remote connection to an external programmer device so that both are notified of the drug efficacy problems. Additionally, the implantable device may be configured to automatically adjust pacing and defibrillation control parameters in an attempt to compensate for any lack of efficacy in the drugs. For example, the aggressiveness of overdrive pacing may be increased. Alternatively, a drug pump is controlled to adjust the dosage of antiarrhythmic drugs if an initial dosage is found to be ineffective.
摘要翻译： 可植入心脏刺激装置，例如起搏器或植入式心律转复除颤器，被配置为自动监测抗心律失常药物对患者内心脏电信号的影响，以验证所用药物的功效。 在一个示例中，通过将心脏电信号与代表不同类别的抗心律失常药物的作用的值进行比较来进行对患者心电信号的分析。 如果植入装置确定规定的抗心律不齐药物没有效果，则产生警告信号。 警告信号通过床边监护仪直接传送给患者，并通过与外部编程器设备的远程连接向病人的医生传送，以便两者被通知药物功效问题。 另外，可植入装置可被配置为自动调节起搏和除颤控制参数，以试图补偿药物中的任何功效缺乏。 例如，可能会增加超速起搏的积极性。 或者，如果发现初始剂量无效，则控制药物泵以调节抗心律失常药物的剂量。
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2.发明授权公开(公告)号：US06904317B2
公开(公告)日：2005-06-07
申请号：US10043472
申请日：2002-01-09
CPC分类号： A61N1/3621
摘要： Dynamic overdrive pacing adjustment techniques are described for use in implantable cardiac stimulation devices. In a first technique, an overdrive pacing unit of a microcontroller of the implantable device operates to optimize various control parameters that affect overdrive pacing so as to achieve a desired degree of overdrive pacing for the particular patient in which the stimulation device is implanted. Parameters to be optimized include the number of overdrive beats paced once overdrive pacing is trigged, the overdrive pacing response function, the recovery rate, and various base rates. The control parameters are adjusted in a hierarchical order of priority until the desired degree of overdrive pacing is achieved. Adjustment of the number of overdrive beats, the recovery rate, and various base rates is iteratively performed by using incremental numerical adjustments. Adjustment of the overdrive pacing response function may be performed by selecting among a set of fixed predetermined linear response functions. In a second technique, the overdrive pacing unit operates to optimize the shape of a single non-linear dynamic overdrive pacing response function so as to achieve the desired degree of overdrive pacing for the patient. The second technique may either be employed alone or in combination with the first, hierarchical optimization technique.
摘要翻译： 动态超速起搏调节技术被描述用于可植入心脏刺激装置。 在第一技术中，可植入装置的微控制器的过驱动起搏单元操作以优化影响过驱动起搏的各种控制参数，以便为其中植入刺激装置的特定患者达到期望程度的过速起搏。 要优化的参数包括一旦超速起搏起搏起搏，超速起搏响应功能，恢复速率和各种基准速率起搏的过载跳动次数。 控制参数以优先级的等级顺序进行调整，直到达到期望的过速起搏程度。 通过使用增量数值调整迭代地执行过载跳动次数的调整，恢复率和各种基本速率。 可以通过在一组固定的预定线性响应函数中进行选择来执行过速起搏响应功能的调整。 在第二种技术中，超速起搏单元操作以优化单个非线性动态超速起搏响应功能的形状，以便达到病人期望程度的超速起搏起搏。 第二种技术可以单独使用，也可以与第一层级优化技术结合使用。
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公开(公告)号：US07006868B2
公开(公告)日：2006-02-28
申请号：US10092695
申请日：2002-03-06
IPC分类号： A61N1/365
CPC分类号： A61N1/3622 , A61N1/37211
摘要： An implantable cardiac stimulation device is described wherein a controller of the cardiac stimulation device controls selected functions of the device based on whether the patient is at rest and further based on whether the patient is prone to vagally-mediated arrhythmias. Functions of the device that may be controlled include, for example, a pacing base rate, an AV/PV delay, and a refractory period as well as overdrive pacing parameters and diagnostic data gathering parameters. In one example, if the patient is not prone to vagally-mediated arrhythmias, the base rate is lowered while the patient is at rest. Also, overdrive pacing parameters are set to be less aggressive. As such, the operation of the cardiac stimulation device is controlled to make it easier for the patient to rest while also reducing power consumption. However, if the patient is prone to vagally-mediated arrhythmias, the base rate is not lowered while the patient is at rest. Overdrive pacing parameters are instead set to be more aggressive, rather than less aggressive. In this manner, the cardiac stimulation device attempts to compensate for any increased risk of arrhythmia that may occur while the patient, who is prone to vagally-mediated arrhythmias, is at rest. Numerous other parameters may be adjusted dependent upon whether the patient is at rest or dependent upon whether the patient is prone to vagally-mediated arrhythmias.
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4.发明授权Method and apparatus for using a rest mode indicator to automatically adjust control parameters of an implantable cardiac stimulation device 失效用于使用静止模式指示器自动调节可植入心脏刺激装置的控制参数的方法和装置公开(公告)号：US06968232B2
公开(公告)日：2005-11-22
申请号：US10093225
申请日：2002-03-06
CPC分类号： A61N1/3622 , A61N1/3682
摘要： An implantable cardiac stimulation device is described wherein a controller of the cardiac stimulation device controls selected functions of the device based on whether the patient is at rest and further based on whether the patient is prone to vagally-mediated arrhythmias. Functions of the device that may be controlled include, for example, a pacing base rate, an AV/PV delay, and a refractory period as well as overdrive pacing parameters and diagnostic data gathering parameters. In one example, if the patient is not prone to vagally-mediated arrhythmias, the base rate is lowered while the patient is at rest. Also, overdrive pacing parameters are set to be less aggressive. As such, the operation of the cardiac stimulation device is controlled to make it easier for the patient to rest while also reducing power consumption. However, if the patient is prone to vagally-mediated arrhythmias, the base rate is not lowered while the patient is at rest. Overdrive pacing parameters are instead set to be more aggressive, rather than less aggressive. In this manner, the cardiac stimulation device attempts to compensate for any increased risk of arrhythmia that may occur while the patient, who is prone to vagally-mediated arrhythmias, is at rest. Numerous other parameters may be adjusted dependent upon whether the patient is at rest or dependent upon whether the patient is prone to vagally-mediated arrhythmias.
摘要翻译： 描述了可植入心脏刺激装置，其中心脏刺激装置的控制器基于患者是否处于静止状态并且还基于患者是否易于经历迷走神经介导的心律失常来控制装置的选定功能。 可以被控制的设备的功能包括例如起搏基准速率，AV / PV延迟和不应期，以及过速起搏参数和诊断数据采集参数。 在一个示例中，如果患者不易于经历迷走神经介导的心律失常，则在患者静止时基础速率降低。 此外，过度起搏参数设置为较不积极。 因此，控制心脏刺激装置的操作以使患者更容易休息，同时也降低功率消耗。 然而，如果患者容易出现迷走神经介导的心律失常，则在患者休息时基础速率不降低。 相反，超速起搏参数设置为更具侵略性，而不是较不积极。 以这种方式，心脏刺激装置试图补偿在容易发生迷走神经介导的心律失常的患者处于静止状态时可能出现的任何增加的心律失常风险。 可以根据患者是否休息或依赖于患者是否易于经历迷走神经介导的心律失常而调整许多其他参数。
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公开(公告)号：US07308306B1
公开(公告)日：2007-12-11
申请号：US10456060
申请日：2003-06-06
IPC分类号： A61N1/368
CPC分类号： A61N1/3621 , A61N1/365
摘要： Techniques are provided for overdrive pacing the ventricles using a pacemaker wherein an increase in an overdrive pacing rate is performed primarily to achieve a high degree of rate smoothing. The ventricles are paced at an overdrive pacing rate selected to permit the detection of the least some intrinsic ventricular pulses and then the overdrive pacing rate is dynamically adjusted based on the detected intrinsic ventricular pulses. In one example, an increase in the ventricular overdrive rate is performed only in response to detection of at least two intrinsic ventricular beats within a predetermined search period. If at least two intrinsic ventricular beats are not detected within the search period, the overdrive pacing rate is decreased. Various techniques are also provided for determining when to activate ventricular overdrive pacing depending, in part, on the capabilities of the particular pacemaker, the current mode of operation, the density of premature ventricular contractions, the degree of heart rate stability, and the presence of atrial fibrillation. Adaptive techniques for automatically adjusting ventricular overdrive pacing control parameters are also described.
摘要翻译： 提供技术用于使用起搏器超速起搏心室，其中主要执行超速起搏速率的增加以实现高程度的速率平滑。 心室以选择的超速起搏速度进行起搏，以允许检测至少一些内在的心室脉冲，然后基于检测到的内在心室脉冲来动态地调整超速起搏速率。 在一个示例中，仅在响应于在预定搜索周期内检测到至少两个本征心室搏动来执行心室超速率的增加。 如果在搜索期内未检测到至少两个内在心室搏动，则超速起搏速率降低。 还提供了各种技术来确定何时激活心室过度起搏起搏，其部分取决于特定起搏器的能力，当前的手术方式，早期心室收缩的密度，心率稳定程度以及是否存在 心房颤动。 还描述了用于自动调节心室超速起搏控制参数的自适应技术。
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公开(公告)号：US07056314B1
公开(公告)日：2006-06-06
申请号：US10452244
申请日：2003-05-30
IPC分类号： A61M25/01
CPC分类号： A61M25/0152 , A61B17/3478 , A61B2017/003 , A61M25/0136 , A61M25/0141 , A61M25/0147 , A61M2025/015 , A61M2025/0161
摘要： An omnidirectionally steerable obturator facilitates the delivery of the distal tip of an introducer sheath into the coronary sinus of a heart. The steerable obturator comprises an obturator body extending longitudinally along a central axis, the obturator body being configured to be received by the introducer sheath. The obturator body further has a flexible, deflectable distal end section terminating in a rounded distal tip. An actuator, controllable from a proximal end of the obturator body, is operatively associated with the flexible distal end section of the obturator body to cause deflection of the flexible distal end section of the obturator body in at least one selected direction to facilitate passage of the distal end section of the obturator body and the distal tip of the introducer sheath into the coronary sinus of the heart.The obturator body is preferably configured to be received in a close fit within at least the tip of the introducer sheath. More preferably, the distal end of the obturator body has an outer surface and the fit between the outer surface of the obturator and at least the tip of the introducer sheath comprises substantially a line-to-line fit.
摘要翻译： 全向可操纵的闭孔器有利于将导引鞘的远侧末端递送到心脏的冠状窦。 可操纵的闭孔器包括沿着中心轴线纵向延伸的闭孔器，所述封闭器主体构造成由引导器护套容纳。 闭孔体还具有终止于圆形远端尖端的柔性的，可偏转的远端部分。 从闭塞体的近端可控制的致动器与闭塞体的柔性远端部分可操作地相关联，以使闭塞体的柔性远端部分沿至少一个选定的方向偏转，以便于通过 闭塞体的远端部分和导引鞘的远侧末端插入心脏的冠状窦。 闭孔体优选构造成在至少引导器护套的尖端内紧密配合。 更优选地，闭孔体的远端具有外表面，并且填塞物的外表面与引导器护套的至少末端之间的配合基本上包括线对齐配合。
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7.发明授权Detecting ischemia using an implantable cardiac device based on morphology of cardiac pressure signal 有权基于心脏压力信号的形态，使用可植入心脏装置检测缺血公开(公告)号：US07648464B1
公开(公告)日：2010-01-19
申请号：US11458617
申请日：2006-07-19
申请人： Jong Gill , Peter Boileau , Gene A. Bornzin , Joseph J. Florio , Xiaoyi Min
发明人： Jong Gill , Peter Boileau , Gene A. Bornzin , Joseph J. Florio , Xiaoyi Min
IPC分类号： A61B5/021
CPC分类号： A61B5/0215 , A61B5/0031 , A61B5/042 , A61B5/7239 , A61N1/36564
摘要： Methods and systems are presented for using an ICD to detect myocardial ischemia. In one embodiment, a method includes sensing a signal indicative of cardiac pressure, measuring a height of the sensed signal at a peak amplitude of the sensed signal, and measuring a duration of the sensed signal. The method further includes indicating an ischemia based on a comparison of a ratio of the height to the duration with a predetermined value. In another embodiment, a method includes sensing a signal indicative of cardiac pressure, determining a derivative signal that is a first derivative of the sensed signal, measuring a maximum positive value of the derivative signal, and measuring a maximum negative value of the derivative signal. The method further includes indicating an ischemia based on a comparison of a ratio of the maximum positive value to the maximum negative value with a predetermined value.
摘要翻译： 提出了使用ICD检测心肌缺血的方法和系统。 在一个实施例中，一种方法包括感测指示心脏压力的信号，以感测信号的峰值幅度测量感测信号的高度，以及测量感测信号的持续时间。 该方法还包括基于将高度与持续时间的比率与预定值的比较来指示缺血。 在另一个实施例中，一种方法包括感测指示心脏压力的信号，确定作为感测信号的一阶导数的导数信号，测量导数信号的最大正值，以及测量导数信号的最大负值。 该方法还包括基于将最大正值与最大负值的比率与预定值进行比较来指示缺血。
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8.发明授权Method and apparatus for detecting natural electrical coherence within the heart and for administering therapy based thereon 有权用于检测心脏内的自然电相干性并用于基于其进行治疗的方法和装置公开(公告)号：US06766195B1
公开(公告)日：2004-07-20
申请号：US09686630
申请日：2000-10-10
IPC分类号： A61N0118
CPC分类号： A61N1/3962 , A61N1/395
摘要： Techniques are provided for detecting natural electrical coherence within the heart and for administering or adjusting therapy based upon whether natural electrical coherence is detected. In one example, an implantable cardioverter defibrillator (ICD), upon detecting atrial fibrillation, delays administering an atrial defibrillation pulse until a period of natural electrical coherence is detected between the left and the right atria of the heart. The ICD may further delay the pulse until the ventricles of the heart are refractory so as to help prevent triggering ventricular fibrillation. The pulses are administered at a time selected based upon the period of electrical coherence to reduce the amount of electrical energy required within the pulse to reliably defibrillate the heart. Other types of therapy besides defibrillation therapy such as anti-tachycardia pacing pulses may also be timed based upon detection periods of natural electrical coherence. Method and apparatus embodiments are described.
摘要翻译： 提供了用于检测心脏内的自然电连贯性的技术，并且用于基于是否检测到自然电连贯来施用或调整治疗。 在一个实例中，在检测心房颤动时，植入式心律转复除颤器（ICD）延迟施用心房除颤脉冲，直到在心脏的左心房和右心房之间检测到自然电相干的时间段。 ICD可以进一步延迟脉冲，直到心脏的心室难以耐受，以便有助于防止触发心室颤动。 在基于电相干周期选择的时间施加脉冲以减少脉冲内所需的电能量以可靠地除颤心脏。 除了除颤疗法之外的其他类型的治疗，如抗心动过速起搏脉冲也可以基于自然电连续性的检测周期来计时。 描述了方法和设备实施例。
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9.发明授权Implantable cardiac stimulation device and method for prolonging atrial refractoriness 失效植入式心脏刺激装置及延长心房不应性的方法公开(公告)号：US06701187B1
公开(公告)日：2004-03-02
申请号：US10061567
申请日：2002-02-01
IPC分类号： A61N1362
CPC分类号： A61N1/3622 , A61N1/3956
摘要： An implantable cardiac stimulation device, e.g., a pacemaker or an implantable cardioverter defibrillator (ICD), is provided which prolongs the atrial refractoriness of a heart. The implantable cardiac stimulation device includes a generator that delivers pacing pulses to an atrium of a heart and a detector that detects atrial activations of the heart. An inhibitor is coupled to the detector that inhibits the generator when an atrial activation is detected within an escape interval. A generator control coupled to the generator causes the generator to deliver a primary pacing pulse to the atrium at the end of the escape interval, absent an atrial activation being detected within the escape interval, and causes the generator to deliver a secondary pacing pulse to the atrium a delay time after an atrial activation is detected within the escape interval or the delivery of a primary pacing pulse to the atrium.
摘要翻译： 提供可植入心脏刺激装置，例如起搏器或植入式心律转复除颤器（ICD），其延长心脏的心房不应性。 可植入心脏刺激装置包括将起搏脉冲传送到心脏心房的发生器和检测心脏心房激活的检测器。 当在逃避间隔内检测到心房激活时，抑制剂耦合到检测器，该检测器抑制发生器。 耦合到发生器的发生器控制器使得发生器在逃逸间隔结束时将主起搏脉冲递送到心房，没有在逃逸间隔内检测到心房激活，并且使得发生器将辅助起搏脉冲输送到 在转移间隔内检测到心房激活之后的延迟时间或者向心房传送初级起搏脉冲。
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10.发明授权Implanatable cardiac stimulation device and method for prolonging atrial refractoriness 有权可手术心脏刺激装置及延长心房不应性的方法公开(公告)号：US06377852B1
公开(公告)日：2002-04-23
申请号：US09488284
申请日：2000-01-20
IPC分类号： A61N1362
CPC分类号： A61N1/3622 , A61N1/3956
摘要： An implantable cardiac stimulation device, e.g., a pacemaker or an implantable cardioverter defibrillator (ICD), is provided which prolongs the atrial refractoriness of a heart. The implantable cardiac stimulation device includes a generator that delivers pacing pulses to an atrium of a heart and a detector that detects atrial activations of the heart. An inhibitor is coupled to the detector that inhibits the generator when an atrial activation is detected within an escape interval. A generator control coupled to the generator causes the generator to deliver a primary pacing pulse to the atrium at the end of the escape interval, absent an atrial activation being detected within the escape interval, and causes the generator to deliver a secondary pacing pulse to the atrium a delay time after an atrial activation is detected within the escape interval or the delivery of a primary pacing pulse to the atrium.
摘要翻译： 提供可植入心脏刺激装置，例如起搏器或植入式心律转复除颤器（ICD），其延长心脏的心房不应性。 可植入心脏刺激装置包括将起搏脉冲传送到心脏心房的发生器和检测心脏心房激活的检测器。 当在逃避间隔内检测到心房激活时，抑制剂耦合到检测器，该检测器抑制发生器。 耦合到发生器的发生器控制器使得发生器在逃逸间隔结束时将主起搏脉冲递送到心房，没有在逃逸间隔内检测到心房激活，并且使得发生器将辅助起搏脉冲输送到 在转移间隔内检测到心房激活之后的延迟时间或者向心房传送初次起搏脉冲。
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