公开(公告)号：US08527051B1

公开(公告)日：2013-09-03

申请号：US13545776

申请日：2012-07-10

申请人： Sven-Erik Hedberg ,  Tomas Svensson ,  Kjell Noren ,  Stuart Rosenberg ,  Kyungmoo Ryu ,  Edward Karst

发明人： Sven-Erik Hedberg ,  Tomas Svensson ,  Kjell Noren ,  Stuart Rosenberg ,  Kyungmoo Ryu ,  Edward Karst

IPC分类号： A61N1/37

CPC分类号： A61N1/36521 ,  A61N1/3702

摘要： The present invention provides implantable medical devices for detecting phrenic nerve stimulation. A pacing module is configured to deliver pacing pulses having a predetermined pulse amplitude and/or width within the refractory period of the left ventricle. The pacing pulses are repeatedly delivered during a number of cardiac cycles, and the pacing pulses are delivered at different delays relative to an onset of the refractory period of the left ventricle in different cardiac cycles. An impedance measurement module is configured to measure impedance signals in time windows synchronized with the delivery of pacing pulses in the refractory period of the left ventricle. A phrenic nerve stimulation, PNS, detection module is configured to gather at least one impedance signal from each time window, create aggregated impedance signals using the impedance signals from the different time windows, and analyze the aggregated impedance signals to detect PNS.

摘要翻译： 本发明提供了用于检测膈神经刺激的可植入医疗装置。 起搏模块被配置为在左心室的不应期内输送具有预定脉冲幅度和/或宽度的起搏脉冲。 起搏脉冲在多个心动周期期间重复递送，起搏脉冲相对于不同心脏周期中左心室的不应期的开始以不同的延迟递送。 阻抗测量模块被配置为测量与在左心室的不应期中递送起搏脉冲同步的时间窗内的阻抗信号。 膈神经刺激，PNS检测模块配置为从每个时间窗口收集至少一个阻抗信号，使用来自不同时间窗口的阻抗信号创建聚合阻抗信号，并分析聚合阻抗信号以检测PNS。

公开(公告)号：US08532774B1

公开(公告)日：2013-09-10

申请号：US13545794

申请日：2012-07-10

申请人： Sven-Erik Hedberg ,  Tomas Svensson ,  Kjell Noren ,  Stuart Rosenberg ,  Kyungmoo Ryu ,  Edward Karst

发明人： Sven-Erik Hedberg ,  Tomas Svensson ,  Kjell Noren ,  Stuart Rosenberg ,  Kyungmoo Ryu ,  Edward Karst

IPC分类号： A61N1/37

CPC分类号： A61N1/36521 ,  A61B5/042 ,  A61B5/0538 ,  A61N1/3686 ,  A61N1/3702

摘要： The present invention provides methods for detecting phrenic nerve stimulation. A pacing module is instructed to deliver pacing pulses having a predetermined pulse amplitude and/or width within the refractory period of the left ventricle. The pacing pulses are repeatedly delivered during a number of cardiac cycles and wherein the pacing pulses are delivered at different delays relative to an onset of the refractory period of the left ventricle in different cardiac cycles. Impedance signals are measured in time windows synchronized with the delivery of pacing pulses in the refractory period of the left ventricle using at least one electrode configuration. At least one impedance signal is gathered from each time window, aggregated impedance signals are created using the impedance signals from the different time windows, and the aggregated impedance signals are analyzed to detect PNS.

摘要翻译： 本发明提供了检测膈神经刺激的方法。 指示起搏模块在左心室的不应期内输送具有预定脉搏幅度和/或宽度的起搏脉冲。 起搏脉冲在多个心动周期期间重复递送，并且其中起搏脉冲相对于在不同心脏周期中的左心室的不应期的开始以不同的延迟递送。 使用至少一个电极配置，在与左心室的不应期中的起搏脉冲的递送同步的时间窗口中测量阻抗信号。 从每个时间窗口收集至少一个阻抗信号，使用来自不同时间窗口的阻抗信号创建聚合阻抗信号，并分析聚合阻抗信号以检测PNS。

公开(公告)号：US20130066222A1

公开(公告)日：2013-03-14

申请号：US13230482

申请日：2011-09-12

申请人： Stuart Rosenberg ,  Tomas Svensson ,  Kjell Norén ,  Edward Karst ,  Kyungmoo Ryu

发明人： Stuart Rosenberg ,  Tomas Svensson ,  Kjell Norén ,  Edward Karst ,  Kyungmoo Ryu

IPC分类号： A61B5/0464 ,  A61N1/39 ,  A61B5/0452 ,  A61N1/365 ,  A61B5/0402 ,  A61B5/0456

CPC分类号： A61N1/3704 ,  A61B5/0464 ,  A61B5/0468 ,  A61B5/686 ,  A61N1/3627 ,  A61N1/3684

摘要： A device senses cardioelectrical signals using a right atrial (RA) lead, which might include far-field R-waves as well as near-field P-waves. The device concurrently senses events using a proximal electrode of an LV lead, which can sense both P-waves and R-waves as substantially near-field events. Suitable templates are then applied to the signals sensed via the proximal LV electrode to identify the origin of the signals (e.g. atrial vs. ventricular) so as to properly classify the corresponding events sensed in the RA as near-field or far-field events. In this manner, far-field oversensing is conveniently detected.

摘要翻译： 一种装置使用右心房（RA）导联感测心电信号，其可能包括远场R波以及近场P波。 该装置使用LV引线的近侧电极同时感测事件，其可以感测P波和R波作为基本近场事件。 然后将合适的模板施加到经由近端LV电极感测的信号以识别信号的来源（例如心房与心室），以便将在RA中感测到的相应事件适当地分类为近场或远场事件​​。 以这种方式，可以方便地检测远场超检测。

公开(公告)号：US08538524B2

公开(公告)日：2013-09-17

申请号：US13230482

申请日：2011-09-12

申请人： Stuart Rosenberg ,  Tomas Svensson ,  Kjell Norén ,  Edward Karst ,  Kyungmoo Ryu

发明人： Stuart Rosenberg ,  Tomas Svensson ,  Kjell Norén ,  Edward Karst ,  Kyungmoo Ryu

IPC分类号： A61N1/368

CPC分类号： A61N1/3704 ,  A61B5/0464 ,  A61B5/0468 ,  A61B5/686 ,  A61N1/3627 ,  A61N1/3684

摘要： A device senses cardioelectrical signals using a right atrial (RA) lead, which might include far-field R-waves as well as near-field P-waves. The device concurrently senses events using a proximal electrode of an LV lead, which can sense both P-waves and R-waves as substantially near-field events. Suitable templates are then applied to the signals sensed via the proximal LV electrode to identify the origin of the signals (e.g. atrial vs. ventricular) so as to properly classify the corresponding events sensed in the RA as near-field or far-field events. In this manner, far-field oversensing is conveniently detected.

摘要翻译： 一种装置使用右心房（RA）导联感测心电信号，其可能包括远场R波以及近场P波。 该装置使用LV引线的近侧电极同时感测事件，其可以感测P波和R波作为基本近场事件。 然后将合适的模板施加到经由近端LV电极感测的信号以识别信号的来源（例如心房与心室），以便将在RA中感测到的相应事件适当地分类为近场或远场事件​​。 以这种方式，可以方便地检测远场超检测。

公开(公告)号：US09327131B2

公开(公告)日：2016-05-03

申请号：US12961065

申请日：2010-12-06

申请人： Kyungmoo Ryu ,  Stuart Rosenberg ,  Edward Karst

发明人： Kyungmoo Ryu ,  Stuart Rosenberg ,  Edward Karst

IPC分类号： A61N1/37 ,  A61B5/0452 ,  A61B5/08 ,  A61B5/11 ,  A61B5/00 ,  A61N1/39 ,  A61N1/08

CPC分类号： A61N1/37 ,  A61B5/04525 ,  A61B5/0816 ,  A61B5/1116 ,  A61B5/7292 ,  A61B2560/0276 ,  A61N1/3956 ,  A61N2001/083

摘要： Evaluation of an implanted electrical lead condition includes comparing electrogram template features with test electrogram features. The evaluating also includes determining the implanted electrical lead condition based solely on the electrogram comparison. The compared test electrogram features and template electrogram features may be atrial amplitudes and ventricular amplitudes. The sensing may be with a quad polar lead. The compared test electrogram features and electrogram template features may account for different patient postures and/or may account for respiration modulation.

摘要翻译： 植入电引线条件的评估包括将电描记图模板特征与测试电描记图特征进行比较。 评估还包括仅基于电图比较来确定植入的电引线条件。 比较的测试电描图特征和模板电描记图特征可以是心房幅度和心室幅度。 传感可以是四极引线。 比较的测试电描图特征和电描记图模板特征可以解释不同的患者姿势和/或可以解释呼吸调节。

公开(公告)号：US20120143278A1

公开(公告)日：2012-06-07

申请号：US12961065

申请日：2010-12-06

申请人： Kyungmoo Ryu ,  Stuart Rosenberg ,  Edward Karst

发明人： Kyungmoo Ryu ,  Stuart Rosenberg ,  Edward Karst

IPC分类号： A61N1/37

CPC分类号： A61N1/37 ,  A61B5/04525 ,  A61B5/0816 ,  A61B5/1116 ,  A61B5/7292 ,  A61B2560/0276 ,  A61N1/3956 ,  A61N2001/083

摘要： Evaluation of an implanted electrical lead condition includes comparing electrogram template features with test electrogram features. The evaluating also includes determining the implanted electrical lead condition based solely on the electrogram comparison. The compared test electrogram features and template electrogram features may be atrial amplitudes and ventricular amplitudes. The sensing may be with a quad polar lead. The compared test electrogram features and electrogram template features may account for different patient postures and/or may account for respiration modulation.

摘要翻译： 植入电引线条件的评估包括将电描记图模板特征与测试电描记图特征进行比较。 评估还包括仅基于电图比较来确定植入的电引线条件。 比较的测试电描图特征和模板电描记图特征可以是心房幅度和心室幅度。 传感可以是四极引线。 比较的测试电描图特征和电描记图模板特征可以解释不同的患者姿势和/或可以解释呼吸调节。

公开(公告)号：US08983604B2

公开(公告)日：2015-03-17

申请号：US13838305

申请日：2013-03-15

申请人： Allen Keel ,  Stuart Rosenberg ,  Rupinder Bharmi ,  Kyungmoo Ryu ,  Edward Karst ,  Fujian Qu ,  Xiaoyi Min ,  Yelena Nabutovsky

发明人： Allen Keel ,  Stuart Rosenberg ,  Rupinder Bharmi ,  Kyungmoo Ryu ,  Edward Karst ,  Fujian Qu ,  Xiaoyi Min ,  Yelena Nabutovsky

IPC分类号： A61N1/365 ,  A61N1/36

CPC分类号： A61N1/36114 ,  A61N1/36139

摘要： Techniques are provided for controlling spinal cord stimulation (SCS) or other forms of neurostimulation. Far-field cardiac electrical signals are sensed using a lead of the SCS device and neurostimulation is selectively delivering using a set of adjustable SCS control parameters. Parameters representative of cardiac rhythm are derived from the far-field cardiac electrical signals. The parameters representative of cardiac rhythm are correlated with SCS control parameters to thereby map neurostimulation control settings to cardiac rhythm parameters. The delivery of further neurostimulation is then controlled based on the mapping of neurostimulation control settings to cardiac rhythm parameters to, for example, address any cardiovascular disorders detected based on the far-field cardiac signals. In this manner, a closed loop control system is provided to automatically adjust SCS control parameters to respond to changes in cardiac rhythm such as changes associated with ischemia, arrhythmia or heart failure.

摘要翻译： 提供了用于控制脊髓刺激（SCS）或其他形式的神经刺激的技术。 使用SCS装置的引线感测远场心电信号，并且神经刺激使用一组可调节的SCS控制参数选择性地递送。 代表心律的参数来源于远场心电信号。 代表心律的参数与SCS控制参数相关，从而将神经刺激控制设置映射到心律参数。 然后基于神经刺激控制设置对心律参数的映射来控制进一步的神经刺激的传递，以例如解决基于远场心脏信号检测的任何心血管疾病。 以这种方式，提供闭环控制系统以自动调整SCS控制参数以响应心律的变化，例如与缺血，心律失常或心力衰竭相关的变化。

公开(公告)号：US20130035738A1

公开(公告)日：2013-02-07

申请号：US13197665

申请日：2011-08-03

申请人： Edward Karst ,  Kyungmoo Ryu ,  Stuart Rosenberg ,  Allen Keel

发明人： Edward Karst ,  Kyungmoo Ryu ,  Stuart Rosenberg ,  Allen Keel

IPC分类号： A61N1/368

CPC分类号： A61N1/3684 ,  A61N1/36507

摘要： Methods and systems are provided for determining pacing parameters for an implantable medical device (IMD). The methods and systems provide electrodes in the right atrium (RA), right ventricle (RV) and left ventricle (LV). The methods and systems sense RV cardiac signals and LV cardiac signals at an RV electrode and an LV electrode, respectively, over multiple cardiac cycles, to collect global activation information. The methods and systems identify a T-wave in the LV cardiac signal. The methods and systems calculate a repolarization index based at least in part on a timing of the T-wave identified in the LV cardiac signal. The methods and systems set at least one pacing parameter based on the repolarization index, wherein the at least one pacing parameter that is set represents at least one of an AV delay, an inter-ventricular interval and an intra-ventricular interval. Optionally, the methods and systems may deliver an RV pacing stimulus at the RV electrode such that the LV cardiac signal sensed thereafter includes the RV pacing stimulus followed by a T-wave. The methods and systems determine a waveform metric such as at least one of a QT interval, T-wave duration, and T-wave amplitude, and utilize the waveform metric to determine as the repolarization index.

摘要翻译： 提供了用于确定可植入医疗装置（IMD）的起搏参数的方法和系统。 方法和系统在右心房（RA），右心室（RV）和左心室（LV）中提供电极。 方法和系统分别在多个心动周期上检测RV电极和LV电极上的RV心脏信号和LV心脏信号，以收集全局激活信息。 方法和系统识别LV心脏信号中的T波。 所述方法和系统至少部分地基于在LV心脏信号中识别的T波的定时来计算复极化指数。 方法和系统基于复极度指数设置至少一个起搏参数，其中设置的至少一个起搏参数表示AV延迟，心室间间隔和心室间间隔中的至少一个。 任选地，方法和系统可以在RV电极处递送RV起搏刺激，使得之后感测的LV心脏信号包括后跟T波的RV起搏刺激。 方法和系统确定诸如QT间期，T波持续时间和T波幅度中的至少一个的波形度量，并且利用波形度量来确定复极化指数。

公开(公告)号：US08728059B2

公开(公告)日：2014-05-20

申请号：US11541302

申请日：2006-09-29

申请人： Edward Karst ,  Clark R. Baker, Jr.

发明人： Edward Karst ,  Clark R. Baker, Jr.

IPC分类号： A61K9/22

CPC分类号： A61B5/4821 ,  A61B5/024 ,  A61B5/0402 ,  A61B5/145 ,  A61B5/14532 ,  A61M5/1723 ,  A61M2005/14208 ,  A61M2230/201

摘要： The disclosed embodiments relate to a system and method for assuring validity of monitoring parameters in combination with a therapeutic device. An exemplary embodiment of the present technique comprises perturbing a treatment administered to a patient, measuring at least one parameter of the patient reflecting the underlying physiological state and associated with the treatment, and comparing the perturbations of the treatment to measurements of the at least one parameter to determine if the perturbations to the treatment are reflected by the parameter.

摘要翻译： 所公开的实施例涉及用于与治疗装置结合来确保监测参数的有效性的系统和方法。 本技术的示例性实施方案包括扰乱施用于患者的治疗，测量反映潜在生理状态并与治疗相关联的患者的至少一个参数，并将治疗的扰动与至少一个参数的测量值进行比较 以确定治疗的扰动是否反映在参数中。

公开(公告)号：US08634912B2

公开(公告)日：2014-01-21

申请号：US13352136

申请日：2012-01-17

申请人： Gene A. Bornzin ,  Gabriel A. Mouchawar ,  Xiaoyi Min ,  John W. Poore ,  Edward Karst ,  Richard Samade ,  Zoltan Somogyi ,  Didier Theret

发明人： Gene A. Bornzin ,  Gabriel A. Mouchawar ,  Xiaoyi Min ,  John W. Poore ,  Edward Karst ,  Richard Samade ,  Zoltan Somogyi ,  Didier Theret

IPC分类号： A61N1/362

CPC分类号： A61N1/056 ,  A61N1/057 ,  A61N1/0573 ,  A61N1/3622 ,  A61N1/368 ,  A61N1/3684 ,  A61N1/3688 ,  A61N1/3756

摘要： A leadless intra-cardiac medical device includes a housing that is configured to be implanted entirely within a single local chamber of the heart. A first electrode is provided on the housing at a first position such that when the housing is implanted in the local chamber, the first electrode engages the local wall tissue at a local activation site within the conduction network of the local chamber. An intra-cardiac extension is coupled to the housing and configured to extend from the local chamber into an adjacent chamber of the heart. A stabilization arm of the intra-cardiac extension engages the adjacent chamber. A second electrode on the intra-cardiac extension engages distal wall tissue at a distal activation site within the conduction network of the adjacent chamber.

摘要翻译： 无引线心脏内心脏医疗设备包括被配置为完全植入心脏的单个局部腔室内的壳体。 第一电极在第一位置处设置在壳体上，使得当壳体被植入局部腔室时，第一电极在局部腔室的传导网络内的局部激活位置接合局部壁组织。 心脏内延伸部分耦合到壳体并且构造成从局部腔室延伸到心脏的相邻室中。 心脏内延伸部的稳定臂与相邻的腔室相接合。 心脏延伸部分上的第二个电极与相邻腔室的传导网络内的远端活化位点处的远端壁组织接合。