公开(公告)号：US08731665B1

公开(公告)日：2014-05-20

申请号：US11923286

申请日：2007-10-24

申请人： Xiaoyi Min ,  Laleh Jalali ,  Steve Koh ,  Gene A. Bornzin ,  Euljoon Park

发明人： Xiaoyi Min ,  Laleh Jalali ,  Steve Koh ,  Gene A. Bornzin ,  Euljoon Park

IPC分类号： A61N1/00

CPC分类号： A61N1/365 ,  A61N1/36535

摘要： Systems and methods are provided for detecting the orientation and/or movement of a patient having an implantable cardiac stimulation device and evaluating whether a change in the patient's cardiac activity can be at least in part due to a change in the patient's orientation. In one particular embodiment, signals from an orientation sensor and/or a pressure sensor are evaluated to determine static positional orientation of the patient and determine based on the static orientation whether the patient's cardiac activity is abnormal.

摘要翻译： 提供了用于检测具有可植入心脏刺激装置的患者的取向和/或运动的系统和方法，并且评估患者的心脏活动的变化是否可以至少部分地由于患者取向的改变而变化。 在一个特定实施例中，评估来自定向传感器和/或压力传感器的信号以确定患者的静态位置取向，并且基于静态取向来确定患者的心脏活动是否异常。

公开(公告)号：US20130053912A1

公开(公告)日：2013-02-28

申请号：US13217554

申请日：2011-08-25

申请人： Gene A. Bornzin ,  Xiaoyi Min ,  Laurence S. Sloman ,  Steve Koh

发明人： Gene A. Bornzin ,  Xiaoyi Min ,  Laurence S. Sloman ,  Steve Koh

IPC分类号： A61N1/368

CPC分类号： A61B5/053 ,  A61B5/0205 ,  A61B5/0538 ,  A61B5/686 ,  A61N1/36185 ,  A61N1/3627 ,  A61N1/3686

摘要： Techniques are provided for use with an implantable medical device for detecting and assessing heart failure and for controlling cardiac resynchronization therapy (CRT) based on impedance signals obtained using hybrid impedance configurations. The hybrid configurations exploit right atrial (RA)-based impedance measurement vectors and/or left ventricular (LV)-based impedance measurement vectors. In one example, current is injected between the device case and a ring electrode in the right ventricle (RV) or RA. RA-based impedance values are measured along vectors between the device case and an RA electrode. LV-based impedance values are measured along vectors between the device case and one or more electrodes of the LV. Heart failure and other cardiac conditions are detected and tracked using the measured impedance values. CRT delay parameters are also optimized based impedance. In this manner, multiple hybrid impedance measurement configurations are exploited whereby different vectors are used to inject current and measure impedance.

摘要翻译： 提供技术用于可植入医疗装置，用于基于使用混合阻抗配置获得的阻抗信号来检测和评估心力衰竭并用于控制心脏再同步治疗（CRT）。 混合配置利用基于右心房（RA）的阻抗测量向量和/或左心室（LV））的阻抗测量向量。 在一个示例中，电流注入到装置壳体和右心室（RV）或RA中的环形电极之间。 基于RA的阻抗值是沿器件壳体和RA电极之间的矢量测量的。 基于LV的阻抗值在器件壳体和LV的一个或多个电极之间的矢量上测量。 使用测量的阻抗值检测和跟踪心力衰竭和其他心脏状况。 CRT延迟参数也是基于阻抗的优化。 以这种方式，利用多个混合阻抗测量配置，由此使用不同的矢量来注入电流并测量阻抗。

公开(公告)号：US08750981B2

公开(公告)日：2014-06-10

申请号：US13217554

申请日：2011-08-25

申请人： Gene A. Bornzin ,  Xiaoyi Min ,  Laurence S. Sloman ,  Steve Koh

发明人： Gene A. Bornzin ,  Xiaoyi Min ,  Laurence S. Sloman ,  Steve Koh

IPC分类号： A61B5/05 ,  A61B5/053 ,  A61N1/36 ,  A61N1/368 ,  A61B5/0205

CPC分类号： A61B5/053 ,  A61B5/0205 ,  A61B5/0538 ,  A61B5/686 ,  A61N1/36185 ,  A61N1/3627 ,  A61N1/3686

摘要： Techniques are provided for use with an implantable medical device for detecting and assessing heart failure and for controlling cardiac resynchronization therapy (CRT) based on impedance signals obtained using hybrid impedance configurations. The hybrid configurations exploit right atrial (RA)-based impedance measurement vectors and/or left ventricular (LV)-based impedance measurement vectors. In one example, current is injected between the device case and a ring electrode in the right ventricle (RV) or RA. RA-based impedance values are measured along vectors between the device case and an RA electrode. LV-based impedance values are measured along vectors between the device case and one or more electrodes of the LV. Heart failure and other cardiac conditions are detected and tracked using the measured impedance values. CRT delay parameters are also optimized based impedance. In this manner, multiple hybrid impedance measurement configurations are exploited whereby different vectors are used to inject current and measure impedance.

摘要翻译： 提供技术用于可植入医疗装置，用于基于使用混合阻抗配置获得的阻抗信号来检测和评估心力衰竭并用于控制心脏再同步治疗（CRT）。 混合配置利用基于右心房（RA）的阻抗测量向量和/或左心室（LV））的阻抗测量向量。 在一个示例中，电流注入到装置壳体和右心室（RV）或RA中的环形电极之间。 基于RA的阻抗值是沿器件壳体和RA电极之间的矢量测量的。 基于LV的阻抗值在器件壳体和LV的一个或多个电极之间的矢量上测量。 使用测量的阻抗值检测和跟踪心力衰竭和其他心脏状况。 CRT延迟参数也是基于阻抗的优化。 以这种方式，利用多个混合阻抗测量配置，由此使用不同的矢量来注入电流并测量阻抗。

公开(公告)号：US07440804B1

公开(公告)日：2008-10-21

申请号：US11025220

申请日：2004-12-28

申请人： Xiaoyi Min ,  Steve Koh

发明人： Xiaoyi Min ,  Steve Koh

IPC分类号： A61N1/378

CPC分类号： A61N1/3712 ,  A61N1/3622 ,  A61N1/3627

摘要： Techniques are provided for measuring ventricular evoked response within the heart of a patient during atrial fibrillation. An intrinsic ventricular depolarization (i.e. a QRS complex) is sensed within the right ventricle and then a pacing pulse is applied to the left ventricle prior to intrinsic depolarization thereof. In this manner, the left ventricle contracts solely in response to the pacing pulse and possible fusion between the pacing pulse and a conducted P-wave/A-pulse from the atria is avoided. The evoked response generated in the left ventricle is then measured by the pacemaker. The technique permits reliable detection of left ventricular evoked response, even during atrial fibrillation when atrial contractions are frequent and erratic, but the technique may also be employed during normal sinus rhythm. Features of the evoked response are analyzed to detect heart failure, evaluate its severity and track its progression. Appropriate therapy is then automatically delivered to the patient.

摘要翻译： 提供了用于在心房颤动期间测量患者心脏内心室诱发反应的技术。 在右心室内检测到内部心室去极化（即QRS复合物），然后在其内部去极化之前将起搏脉冲施加到左心室。 以这种方式，左心室仅响应于起搏脉冲而收缩，并避免起搏脉冲与从心房传导的P波/ A脉冲之间的融合。 然后由起搏器测量在左心室产生的诱发反应。 该技术允许可靠地检测左心室诱发反应，即使在心房收缩频繁且不稳定的心房颤动期间，该技术也可在正常窦性心律中使用。 分析诱发反应的特征以检测心力衰竭，评估其严重程度并跟踪其进展。 然后将适当的治疗自动递送给患者。

公开(公告)号：US08478388B2

公开(公告)日：2013-07-02

申请号：US12755359

申请日：2010-04-06

申请人： Thao Thu Nguyen ,  Kjell Norén ,  Allen Keel ,  Kyungmoo Ryu ,  Stuart Rosenberg ,  Wenbo Hou ,  Steve Koh ,  Michael Yang

发明人： Thao Thu Nguyen ,  Kjell Norén ,  Allen Keel ,  Kyungmoo Ryu ,  Stuart Rosenberg ,  Wenbo Hou ,  Steve Koh ,  Michael Yang

IPC分类号： A61N1/00 ,  A61B5/04

CPC分类号： A61B5/042 ,  A61B5/7203 ,  A61N1/3627 ,  A61N1/36521 ,  A61N1/36535 ,  A61N1/36542 ,  A61N1/36578 ,  A61N1/3684 ,  A61N1/37258 ,  A61N1/37264

摘要： An exemplary method includes accessing cardiac information acquired via a catheter located at various positions in a venous network of a heart of a patient wherein the cardiac information comprises position information with respect to time for one or more electrodes of the catheter; performing a principal component analysis on at least some of the position information; and selecting at least one component of the principal component analysis to represent an axis of a cardiac coordinate system. Various other methods, devices, systems, etc., are also disclosed.

摘要翻译： 示例性方法包括访问经由位于患者心脏的静脉网络中的各个位置的导管获取的心脏信息，其中所述心脏信息包括相对于导管的一个或多个电极的时间的位置信息; 对至少一些所述位置信息进行主成分分析; 以及选择所述主成分分析的至少一个分量来表示心脏坐标系的轴。 还公开了各种其它方法，装置，系统等。

公开(公告)号：US20130035736A1

公开(公告)日：2013-02-07

申请号：US13196763

申请日：2011-08-02

申请人： Steve Koh

发明人： Steve Koh

IPC分类号： A61N1/368

CPC分类号： A61N1/3627 ,  A61N1/3624 ,  A61N1/36571 ,  A61N1/3962

摘要： Techniques are provided for use with implantable medical devices equipped to deliver paired postextrasystolic potentiation (PESP) pacing to control the paired pacing rate based on changes in patient activity. In one example, the current activity level of the patient is detected during paired pacing using an accelerometer. The cardiac output level needed to maintain the current activity level of the patient is determined with reference to pre-stored lookup tables relating activity levels with corresponding minimum necessary cardiac output levels for the particular patient. The minimum paired pacing rate sufficient to achieve the cardiac output level is then determined based, e.g., on stroke volume derived from cardiogenic impedance signals. Paired pacing is then delivered at the minimum paired pacing rate sufficient to achieve the needed cardiac output, thereby assuring that the paired pacing rate is sufficient to meet the current physiological demands of the patient without consuming too much oxygen.

摘要翻译： 提供技术用于与植入式医疗装置配合以递送成对的后收缩期增强（PESP）起搏以基于患者活动的变化来控制配对的起搏速率。 在一个示例中，使用加速度计在配对起搏期间检测患者的当前活动水平。 参考预先存储的查找表来确定维持患者的当前活动水平所需的心输出量水平，其将活动水平与特定患者的相应的最小必要心输出量水平相关联。 然后基于例如来自心源阻抗信号的搏动体积确定足以实现心输出量的最小配对起搏速率。 然后以足以实现所需心输出量的最小配对起搏速率递送配对起搏，从而确保配对的起搏速率足以满足患者的当前生理需求而不消耗太多的氧气。

公开(公告)号：US20120330371A1

公开(公告)日：2012-12-27

申请号：US13601569

申请日：2012-08-31

申请人： Allen Keel ,  Steve Koh ,  Taraneh Ghaffari Farazi

发明人： Allen Keel ,  Steve Koh ,  Taraneh Ghaffari Farazi

IPC分类号： A61N1/365

CPC分类号： A61N1/3702 ,  A61N1/3627 ,  A61N1/36507 ,  A61N1/368 ,  A61N1/3712

摘要： Diastolic function is monitored within a patient using a pacemaker or other implantable medical device. In one example, the implantable device uses morphological parameters derived from the T-wave evoked response waveform as proxies for ventricular relaxation rate and ventricular compliance. In particular, the magnitude of the peak of the T-wave evoked response is employed as a proxy for ventricular compliance. The maximum slew rate of the T-wave evoked response following its peak is employed as a proxy for ventricular relaxation. A metric is derived from these proxy values to represent diastolic function. The metric is tracked over time to evaluate changes in diastolic function. In other examples, specific values for ventricular compliance and ventricular relaxation are derived for the patient based on the T-wave evoked response parameters.

摘要翻译： 使用起搏器或其他可植入医疗器械在患者体内监测舒张功能。 在一个示例中，可植入装置使用从T波诱发反应波形导出的形态参数作为心室松弛率和心室顺应性的代理。 特别地，T波诱发反应的峰值的大小被用作心室顺应性的代表。 其峰值后的T波诱发反应的最大压摆率被用作心室松弛的代用品。 来自这些代理值的度量来表示舒张功能。 随着时间的推移跟踪度量以评估舒张功能的变化。 在其他实例中，基于T波诱发反应参数为患者导出心室顺应性和心室松弛的具体值。

公开(公告)号：US08032212B2

公开(公告)日：2011-10-04

申请号：US12210848

申请日：2008-09-15

申请人： Gene A. Bornzin ,  Steve Koh ,  Euljoon Park

发明人： Gene A. Bornzin ,  Steve Koh ,  Euljoon Park

IPC分类号： A61B5/02 ,  A61B5/08 ,  A61B5/05 ,  A61N1/00

CPC分类号： A61N1/36521 ,  A61B5/0537 ,  A61B5/4869

摘要： Techniques are provided for monitoring thoracic fluid levels based on thoracic impedance (ZT) and cardiogenic impedance (ZC). In one example, the implantable device tracks the maximum time rate of change in cardiogenic impedance (i.e. max(dZC/dt)) to detect trends toward hypervolemic or hypovolemic states within the patient based on changes in heart contractility. The detection of these trends in combination with trends in thoracic impedance allows for a determination of whether the thoracic cavity of the patient is generally “too wet” or “too dry,” and thus allows for the titration of diuretics to avoid such extremes. In particular, a decrease in thoracic impedance (ZT) in combination with a decrease in max (dZC/dt) is indicative of the thorax being “too wet” (i.e. a fluid overload). Conversely, an increase in thoracic impedance (ZT) in combination with a decrease in max (dZC/dt) is indicative of the thorax being “too dry” (i.e. a fluid underload).

摘要翻译： 提供了基于胸部阻抗（ZT）和心源阻抗（ZC）监测胸水水平的技术。 在一个示例中，可植入装置跟踪心源性阻抗的最大时间变化率（即max（dZC / dt）），以基于心脏收缩力的变化来检测患者内的高血容量或低血容量状态的趋势。 这些趋势的检测结合胸部阻抗趋势可以确定患者的胸腔通常是否“太湿”或“太干”，从而允许滴定利尿剂以避免这种极端。 特别地，胸部阻抗（ZT）的降低与最大值（dZC / dt）的降低相结合表明胸部“太湿”（即流体过载）。 相反，胸部阻抗（ZT）的增加与最大（dZC / dt）的降低相结合，表明胸部“太干”（即，流体欠载）。

公开(公告)号：US20110230771A1

公开(公告)日：2011-09-22

申请号：US12728064

申请日：2010-03-19

申请人： Steve Koh ,  Euljoon Park

发明人： Steve Koh ,  Euljoon Park

IPC分类号： A61B5/02 ,  A61B5/01

CPC分类号： A61B5/01 ,  A61B5/0215 ,  A61B5/1118 ,  A61B5/4806 ,  A61B5/6869 ,  A61N1/3937 ,  A61N1/3956

摘要： Left atrial pressure and temperature of a patient are monitored to identify a normal wake state, a normal sleep state, and any deviation from those normal states (e.g., an alarm state). In the event an alarm state is identified, a determination is made as to whether to generate an indication of heart failure exacerbation based on a heart failure score. In addition, congestion and perfusion in a patient may be monitored over time to provide a two-dimensional indication of a trend relating to the heart failure status of the patient.

摘要翻译： 监测患者的左心房压力和温度以识别正常的唤醒状态，正常睡眠状态以及与那些正常状态（例如，报警状态）的任何偏差。 在识别到报警状态的情况下，确定是否基于心力衰竭得分产生心力衰竭恶化的指示。 此外，可以随时间监测患者的充血和灌注以提供与患者的心力衰竭状态相关的趋势的二维指示。

公开(公告)号：US20110213260A1

公开(公告)日：2011-09-01

申请号：US12713417

申请日：2010-02-26

申请人： Allen Keel ,  Kyungmoo Ryu ,  Stuart Rosenberg ,  Wenbo Hou ,  Thao Thu Nguyen ,  Steve Koh ,  Kjell Norén ,  Michael Yang

发明人： Allen Keel ,  Kyungmoo Ryu ,  Stuart Rosenberg ,  Wenbo Hou ,  Thao Thu Nguyen ,  Steve Koh ,  Kjell Norén ,  Michael Yang

IPC分类号： A61B5/0402

CPC分类号： A61B5/04085 ,  A61B5/686 ,  A61B5/6869 ,  A61B5/7271 ,  A61N1/3627 ,  A61N1/3702

摘要： An exemplary method includes accessing cardiac information acquired via a catheter located at various positions in a coronary sinus of a patient where the cardiac information includes electrical information and mechanical information; calculating scores based on the cardiac information where each of the scores corresponds to the coronary sinus or a tributary of the coronary sinus; and based on the scores, selecting a tributary of the coronary sinus as an optimal candidate for placement of a left ventricular lead. Accordingly, the selected tributary may be relied on during an implant procedure for the left ventricular lead. Various other methods, devices, systems, etc., are also disclosed.

摘要翻译： 一种示例性方法包括访问位于患者冠状窦内的各种位置处的导管获得的心脏信息，其中心脏信息包括电信息和机械信息; 基于心脏信息计算得分，其中每个评分对应于冠状窦或冠状窦的支流; 并且基于分数，选择冠状窦的支流作为放置左心室铅的最佳候选者。 因此，在用于左心室引线的植入过程期间可以依赖所选择的支流。 还公开了各种其它方法，装置，系统等。