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    Heart monitoring systems, apparatus and methods adapted to detect myocardial ischemia
    1.
    发明授权
    Heart monitoring systems, apparatus and methods adapted to detect myocardial ischemia 有权
    适用于检测心肌缺血的心脏监测系统，装置和方法

    公开(公告)号：US09179852B2

    公开(公告)日：2015-11-10

    申请号：US11684794

    申请日：2007-03-12

    申请人： Sarah A. Audet ,  James K. Carney ,  William J. Combs

    发明人： Sarah A. Audet ,  James K. Carney ,  William J. Combs

    IPC分类号： A61B5/04 ,  A61B5/0452 ,  A61B5/0402 ,  A61B5/00

    CPC分类号： A61B5/0452 ,  A61B5/0006 ,  A61B5/0031 ,  A61B5/0402 ,  A61B5/721 ,  A61B5/7475

    摘要： Embodiments include heart monitoring systems, apparatus, and methods adapted to detect myocardial ischemia. An apparatus includes at least one first-tier sensor/analyzer adapted to sense a first input related to cardiac function, and to produce a first-tier trigger signal when the first input indicates myocardial ischemia. In an embodiment, a first-tier sensor/analyzer includes an ECG sensor/analyzer. In another embodiment, a first-tier sensor/analyzer includes a patient activator. An apparatus further includes at least one second-tier sensor/analyzer adapted to sense a second input related to cardiac function, and to produce a second-tier trigger signal when the second input indicates myocardial ischemia. In an embodiment, a second-tier sensor-analyzer includes a heart sound sensor/analyzer. A triggering element is adapted to produce a response-invoking signal in response to the first-tier trigger signal and the second-tier trigger signal. The response-invoking signal may invoke a patient alert, a message to an external system, and/or a cardiac stimulus.

    摘要翻译： 实施例包括适于检测心肌缺血的心脏监测系统，装置和方法。 一种装置包括适于感测与心脏功能相关的第一输入的至少一个第一层传感器/分析器，以及当第一输入指示心肌缺血时产生第一层触发信号。 在一个实施例中，第一层传感器/分析器包括ECG传感器/分析器。 在另一个实施例中，第一层传感器/分析器包括患者激活器。 装置还包括适于感测与心脏功能相关的第二输入的至少一个第二层传感器/分析器，并且当第二输入指示心肌缺血时产生第二层触发信号。 在一个实施例中，第二层传感器分析仪包括心音传感器/分析器。 触发元件适于响应于第一层触发信号和第二层触发信号产生响应调用信号。 响应调用信号可以调用患者警报，到外部系统的消息和/或心脏刺激。

    Heart Monitoring Systems, Apparatus and Methods Adapted to Detect Myocardial Ischemia
    3.
    发明申请
    Heart Monitoring Systems, Apparatus and Methods Adapted to Detect Myocardial Ischemia 有权
    心脏监测系统，适用于检测心肌缺血的装置和方法

    公开(公告)号：US20080228094A1

    公开(公告)日：2008-09-18

    申请号：US11684794

    申请日：2007-03-12

    申请人： Sarah A. Audet ,  James K. Carney ,  William J. Combs

    发明人： Sarah A. Audet ,  James K. Carney ,  William J. Combs

    IPC分类号： A61B5/04

    CPC分类号： A61B5/0452 ,  A61B5/0006 ,  A61B5/0031 ,  A61B5/0402 ,  A61B5/721 ,  A61B5/7475

    摘要： Embodiments include heart monitoring systems, apparatus, and methods adapted to detect myocardial ischemia. An apparatus includes at least one first-tier sensor/analyzer adapted to sense a first input related to cardiac function, and to produce a first-tier trigger signal when the first input indicates myocardial ischemia. In an embodiment, a first-tier sensor/analyzer includes an ECG sensor/analyzer. In another embodiment, a first-tier sensor/analyzer includes a patient activator. An apparatus further includes at least one second-tier sensor/analyzer adapted to sense a second input related to cardiac function, and to produce a second-tier trigger signal when the second input indicates myocardial ischemia. In an embodiment, a second-tier sensor-analyzer includes a heart sound sensor/analyzer. A triggering element is adapted to produce a response-invoking signal in response to the first-tier trigger signal and the second-tier trigger signal. The response-invoking signal may invoke a patient alert, a message to an external system, and/or a cardiac stimulus.

    摘要翻译： 实施例包括适于检测心肌缺血的心脏监测系统，装置和方法。 一种装置包括适于感测与心脏功能相关的第一输入的至少一个第一层传感器/分析器，以及当第一输入指示心肌缺血时产生第一层触发信号。 在一个实施例中，第一层传感器/分析器包括ECG传感器/分析器。 在另一个实施例中，第一层传感器/分析器包括患者激活器。 装置还包括适于感测与心脏功能相关的第二输入的至少一个第二层传感器/分析器，并且当第二输入指示心肌缺血时产生第二层触发信号。 在一个实施例中，第二层传感器分析仪包括心音传感器/分析器。 触发元件适于响应于第一层触发信号和第二层触发信号产生响应调用信号。 响应调用信号可以调用患者警报，到外部系统的消息和/或心脏刺激。

    Organ rejection monitoring
    5.
    发明授权
    Organ rejection monitoring 有权
    器官排斥监测

    公开(公告)号：US07130679B2

    公开(公告)日：2006-10-31

    申请号：US10299397

    申请日：2002-11-20

    申请人： Victor Parsonnet ,  William J. Combs

    发明人： Victor Parsonnet ,  William J. Combs

    IPC分类号： A61B5/05

    CPC分类号： A61B5/413 ,  A61B5/0537

    摘要： The invention is directed to techniques for monitoring organ rejection. An implanted device monitors the impedance of the transplanted organ. When the impedance measurements indicate that the organ is being rejected, the device provides early warning of rejection.

    摘要翻译： 本发明涉及用于监测器官排斥的技术。 植入装置监测移植器官的阻抗。 当阻抗测量表明器官被拒绝时，器件提供拒收的早期警告。

    Leadless fully automatic pacemaker follow-up
    6.
    发明授权
    Leadless fully automatic pacemaker follow-up 有权

    公开(公告)号：US06584352B2

    公开(公告)日：2003-06-24

    申请号：US09749169

    申请日：2000-12-27

    申请人： William J. Combs ,  Gary Berg

    发明人： William J. Combs ,  Gary Berg

    IPC分类号： A61N1362

    CPC分类号： A61N1/37252 ,  A61N1/3702 ,  A61N1/37288

    摘要： A leadless fully automatic follow-up (LFAPF) device that is triggered into operation either locally or remotely is implemented extra-corporeally to access cardiac data such as ECGs stored in one or more implantable medical device (IMDs) implanted in one or more patients. A telemetry unit is used in the LFAPF to transmit and test stored data in the IMDs. The telemetry unit implements a series of adjustable commands depending on the desired level of detail of the follow-up. An alternate embodiment representing intra-corporeal use of an additional device includes cardiac data monitoring and cardioversion pulse synchronization in cooperation with another IMD such as a pacer.

    Method and apparatus for detecting cardiac capture
    7.
    发明授权
    Method and apparatus for detecting cardiac capture 失效
    用于检测心脏捕获的方法和装置

    公开(公告)号：US5902325A

    公开(公告)日：1999-05-11

    申请号：US126469

    申请日：1998-07-30

    申请人： Catherine R. Condie ,  Daniel J. Baxter ,  William J. Combs ,  Daniel J. Greeninger ,  Karen J. Kleckner ,  H. Toby Markowitz ,  John C. Stroebel ,  John D. Wahlstrand

    发明人： Catherine R. Condie ,  Daniel J. Baxter ,  William J. Combs ,  Daniel J. Greeninger ,  Karen J. Kleckner ,  H. Toby Markowitz ,  John C. Stroebel ,  John D. Wahlstrand

    IPC分类号： A61N1/365 ,  A61N1/37

    CPC分类号： A61N1/36521 ,  A61N1/3712 ,  A61N1/3714

    摘要： A method and apparatus for automatic determination of a pacemaker patient's pacing stimulation threshold. Circuitry is provided in a pacemaker for obtaining a signal reflecting cardiac impedance, which is known to reliably reflect certain aspects of cardiac function. Circuitry is also provided for monitoring the cardiac impedance waveform during a predetermined capture detect window following delivery of stimulating pulses. One or more values are derived which characterize the morphology of the impedance waveform during the capture detect window associated with each stimulation pulse delivered. These values are compared to predetermined control values in order to assess whether a stimulation pulse has achieved cardiac capture. The assessment of whether cardiac capture has been achieved is also based partly upon the conventional sensing of atrial and/or ventricular cardiac signals occurring during the capture detect window. In one embodiment of the invention, the control values against which impedance waveform characterization values are compared are obtained by delivering a series of stimulation pulses having sufficient energy to ensure that capture is achieved, and by monitoring the impedance waveform during delivery of these pulses.

    摘要翻译： 一种用于自动确定起搏器患者起搏刺激阈值的方法和装置。 在起搏器中提供电路以获得反映心脏阻抗的信号，这已知可靠地反映心脏功能的某些方面。 还提供电路用于在传送刺激脉冲之后的预定捕获检测窗口期间监测心脏阻抗波形。 导出一个或多个值，其表征在与递送的每个刺激脉冲相关联的捕获检测窗口期间阻抗波形的形态。 将这些值与预定的控制值进行比较，以便评估刺激脉冲是否已经实现心脏捕获。 是否已经实现心脏捕获的评估也部分地基于在捕获检测窗口期间发生的心房和/或心室心脏信号的常规感测。 在本发明的一个实施例中，通过递送具有足够能量的一系列刺激脉冲来确定阻抗波形表征值被比较的控制值，以确保实现捕获，并且通过在传送这些脉冲期间监视阻抗波形来获得。

    Adaptive and morphological system for discriminating P-waves and R-waves inside the human body
    9.
    发明授权
    Adaptive and morphological system for discriminating P-waves and R-waves inside the human body 失效
    用于辨别人体内P波和R波的自适应和形态系统

    公开(公告)号：US5755739A

    公开(公告)日：1998-05-26

    申请号：US759902

    申请日：1996-12-04

    申请人： Weimin Sun ,  Pamela A. Abshire ,  Eric J. Panken ,  William J. Combs

    发明人： Weimin Sun ,  Pamela A. Abshire ,  Eric J. Panken ,  William J. Combs

    IPC分类号： A61B5/0452 ,  A61N1/368 ,  A61N1/37 ,  A61N1/362 ,  A61B5/0464

    CPC分类号： A61N1/3704 ,  A61B5/04525 ,  A61N1/368

    摘要： The present invention is a method and apparatus for processing a sensed atrial electrogram in conjunction with a sensed ventricular electrogram. The present invention permits accurate discrimination of atrial P-waves from far field ventricular events such as far field R-waves and avoids oversensing such far field ventricular events as atrial sense events and undersensing atrial events occurring within a fusion beat masked by a far field ventricular event in the atrial electrogram. Atrial channel trigger signals are generated in response to sensed P-waves and far field R-waves in the atrial electrogram, and ventricular trigger signals are generated in response to sensed R-waves in the ventricular electrogram. In response to each ventricular channel trigger signal, the sensed atrial electrogram signal is adaptively filtered for an adaptive filter time window only to remove the far field R-wave signal from the sensed atrial electrogram signal while avoiding adaptive filtering of the sensed atrial electrogram signal at other times. In response to each atrial channel trigger signal, the adaptively filtered, sensed atrial electrogram signal is subjected to morphological analysis in respect of a morphological model of a P-wave only during a morphology time window. In this manner, P-waves in the sensed atrial electrogram signal are detected and far field R-waves in the sensed atrial electrogram signal are not mistakenly detected as P-waves, while morphological analysis of the sensed atrial electrogram at other times is avoided.

    摘要翻译： 本发明是一种结合感测的心室电描记图处理感测的心房电描记图的方法和装置。 本发明允许从远场心室事件（例如远场R波）中准确地辨别心房P波，并避免过度监测诸如心房感觉事件的远场心室事件以及在由远场心室掩蔽的融合搏动内发生的低度心房事件 心房电图中的事件。 响应于心房电描记图中的感测到的P波和远场R波产生心房通道触发信号，并且响应于心室电图中的感测到的R波而产生心室触发信号。 响应于每个心室通道触发信号，感测的心房电描记信号被自适应滤波以用于自适应滤波器时间窗口，仅从感测的心房电描记图信号中去除远场R波信号，同时避免对感测的心房电描记图信号的自适应滤波 其他时候。 响应于每个心房通道触发信号，仅在形态学时间窗口期间，自适应滤波感应的心房电描记信号就P波的形态学模型进行形态学分析。 以这种方式，检测到感测的心房电描记信号中的P波，并且将感测到的心房电描记信号中的远场R波未被错误地检测为P波，同时避免了其他时间的感测的心房电描记图的形态学分析。

    Method and apparatus for rate-responsive cardiac pacing
    10.
    发明授权
    Method and apparatus for rate-responsive cardiac pacing 失效
    速率响应心脏起搏方法和装置

    公开(公告)号：US5562711A

    公开(公告)日：1996-10-08

    申请号：US346813

    申请日：1994-11-30

    申请人： Charles G. Yerich ,  William J. Combs ,  Karen J. Kleckner ,  Eric J. Panken ,  Richard S. Schallhorn ,  John D. Wahlstrand

    发明人： Charles G. Yerich ,  William J. Combs ,  Karen J. Kleckner ,  Eric J. Panken ,  Richard S. Schallhorn ,  John D. Wahlstrand

    IPC分类号： A61N1/365

    CPC分类号： A61N1/36585

    摘要： A body-implantable rate-responsive cardiac pacemaker is provided with circuitry for sensing a plurality of physiologic parameters known to be indicative of a patient's metabolic demand for increased cardiac output. In one embodiment, a rate-responsive pacemaker is provided with an activity sensor for detecting the patient's level of physical activity, and is further provided with an impedance sensing circuit for detecting the patient's level of minute ventilation by monitoring cardiac impedance. A rate-response transfer function, implemented by the pacemaker's control circuitry, periodically computes a rate-responsive pacing rate as a function of the outputs from both physiologic sensing circuits. The pacemaker's pacing rate is variable within a rate range defined by predetermined (programmable) upper and lower limits. In the preferred embodiment, the influence of activity sensing and minute ventilation parameters varies in accordance with the current pacing rate. In particular, the influence of activity sensing in rate determination in accordance with the rate-response function is greater than that of minute ventilation, for slower pacing rates, while the influence of minute ventilation sensing dominates over that of activity sensing for higher pacing rates. Rate response operation of the disclosed system is recorded in the form of histogram data stored over a predetermined history time. The relative influence of the activity sensing and minute ventilation sensing on rate determination is periodically scaled or balanced based upon comparison of the histogram data with predetermined desired response data.

    摘要翻译： 身体植入式速率响应心脏起搏器被提供有用于感测已知指示患者对增加的心输出量的代谢需求的多个生理参数的电路。 在一个实施例中，速率响应起搏器设置有用于检测患者的身体活动水平的活动传感器，并且还设置有阻抗感测电路，用于通过监测心脏阻抗来检测患者的分钟通气水平。 由起搏器的控制电路实现的速率响应传递函数周期性地计算速率响应起搏速率作为来自生理感测电路的输出的函数。 起搏器的起搏速率在由预定（可编程）上限和下限限定的速率范围内是可变的。 在优选实施例中，活动感测和分钟通气参数的影响根据当前起搏速率而变化。 特别是，根据速率响应函数的速率测定中的活动检测的影响大于分钟通气量，对于较慢的起搏速率，而微动通气检测的影响比活动检测的影响高于起搏率。 以预定历史时间存储的直方图数据的形式记录所公开的系统的速率响应操作。 基于直方图数据与预定的期望响应数据的比较，活动感测和分钟通气感测对速率确定的相对影响被周期地缩放或平衡。