公开(公告)号：WO2013162782A1

公开(公告)日：2013-10-31

申请号：PCT/US2013/032879

申请日：2013-03-19

Applicant: MEDTRONIC, INC.

Inventor： ZHANG, Xusheng ,  GILLBERG, Jeffrey M.

IPC: A61N1/365 ,  A61N1/368

CPC classification number: A61N1/36578 ,  A61N1/3686

Abstract: A system for generating a pacing vector selection table is configured to sense a heart sound signal and to represent sounds generated by the heart of the patient. A processor is configured to control the sequential selection (204) of pacing electrode vectors from electrodes positioned along a heart chamber. The processor is configured to receive (208) the heart sound signal, determine ((210), (212), (214), (216), (218), (220)) a plurality of different pacing responses using the heart sound signal for each of the pacing electrode vectors and generate (224) a pacing vector selection table listing the plurality of different pacing responses for each of the plurality of pacing electrode vectors.

Abstract translation: 用于生成起搏矢量选择表的系统被配置为感测心音信号并且表示由患者心脏产生的声音。 处理器被配置为控制来自沿心室的电极的起搏电极向量的顺序选择（204）。 处理器被配置为接收（208）心音信号，使用心音响应（（210），（212），（214），（216），（218），（220））多个不同的起搏响应 信号，并且生成（224）列出多个起搏电极矢量中的每一个的多个不同的起搏响应的起搏矢量选择表。

公开(公告)号：WO2013123386A1

公开(公告)日：2013-08-22

申请号：PCT/US2013/026425

申请日：2013-02-15

Applicant: MEDTRONIC, INC.

Inventor： GHOSH, Subham

IPC: A61N1/368

CPC classification number: A61N1/3686 ,  A61N1/3622 ,  A61N1/3627 ,  A61N1/368 ,  A61N1/3684 ,  A61N1/371

Abstract: Generally, the disclosure is directed one or more methods or systems of cardiac pacing employing a right ventricular electrode and a plurality of left ventricular electrodes. Pacing using the right ventricular electrode and a first one of the left ventricular electrodes and measuring activation times at other ones of the left ventricular electrodes. Pacing using the right ventricular electrode and a second one of the ventricular electrodes and measuring activation times at other ones of the left ventricular electrodes. Employing sums of the measured activation times to select one of the left ventricular electrodes for delivery of subsequent pacing pulses.

Abstract translation: 通常，本公开内容针对一种或多种使用右心室电极和多个左心室电极的心脏起搏方法或系统。 使用右心室电极和第一个左心室电极进行起搏并测量其他左心室电极的激活时间。 使用右心室电极和第二个心室电​​极进行起搏，并测量其他左心室电极的激活时间。 使用所测量的激活时间的总和来选择一个左心室电极用于递送随后的起搏脉冲。

公开(公告)号：WO2013016388A3

公开(公告)日：2013-07-11

申请号：PCT/US2012048071

申请日：2012-07-25

Applicant: MEDTRONIC INC ,  STADLER ROBERT ,  SHELDON TODD J ,  SPLETT VINCENT E ,  DEMMER WADE M

Inventor： STADLER ROBERT ,  SHELDON TODD J ,  SPLETT VINCENT E ,  DEMMER WADE M

IPC: A61N1/37 ,  A61N1/368

CPC classification number: A61N1/371 ,  A61N1/3684 ,  A61N1/3686 ,  A61N1/3712

Abstract: An implantable device and associated method detect anodal capture during electrical stimulation. A first pacing pulse is delivered using a first cathode and a first anode. A second pacing pulse is delivered using the first cathode and a second anode. A first response to the first pacing pulse and a second response to the second pacing pulse are measured. Anodal capture of the first pacing pulse at the first anode is detected in response to a first difference between the first response and the second response.

Abstract translation: 可植入装置和相关方法在电刺激期间检测阳极捕获。 使用第一阴极和第一阳极传送第一起搏脉冲。 使用第一阴极和第二阳极传送第二起搏脉冲。 测量对第一起搏脉冲的第一响应和对第二起搏脉冲的第二响应。 响应于第一响应和第二响应之间的第一差异来检测在第一阳极处的第一起搏脉冲的阳极捕获。

公开(公告)号：WO2010051406A1

公开(公告)日：2010-05-06

申请号：PCT/US2009/062683

申请日：2009-10-30

Applicant: MEDTRONIC, INC. ,  BURNES, John, E. ,  KRAUSE, Paul, G. ,  DONOFRIO, William, T. ,  ARNE, Gerald, P. ,  PEICHEL, David, J. ,  ZHOU, Xiaohong ,  REINKE, James, D.

Inventor： BURNES, John, E. ,  KRAUSE, Paul, G. ,  DONOFRIO, William, T. ,  ARNE, Gerald, P. ,  PEICHEL, David, J. ,  ZHOU, Xiaohong ,  REINKE, James, D.

IPC: A61N1/36 ,  A61N1/365 ,  A61N1/39 ,  A61N1/362 ,  A61N1/372 ,  A61B5/0452 ,  A61B5/046 ,  A61B5/0464 ,  A61N1/08

CPC classification number: A61N1/36114 ,  A61B5/0424 ,  A61B5/0452 ,  A61B5/046 ,  A61B5/0464 ,  A61B5/7217 ,  A61B2560/0271 ,  A61N1/36185 ,  A61N1/3622 ,  A61N1/365 ,  A61N1/3686 ,  A61N1/37247 ,  A61N1/37288 ,  A61N1/3962 ,  A61N2001/083

Abstract: Electrical crosstalk between two implantable medical devices or two different therapy modules of a common implantable medical device may be evaluated, and, in some examples, mitigated. In some examples, one of the implantable medical devices or therapy modules delivers electrical stimulation to a nonmyocardial tissue site or a nonvascular cardiac tissue site, and the other implantable medical device or therapy module delivers cardiac rhythm management therapy to a heart of the patient.

公开(公告)号：WO2009097597A2

公开(公告)日：2009-08-06

申请号：PCT/US2009/032783

申请日：2009-01-31

Applicant: CAMERON HEALTH, INC. ,  SANGHERA, Rick ,  WARREN, Jay, A.

Inventor： SANGHERA, Rick ,  WARREN, Jay, A.

IPC: A61N1/39

CPC classification number: A61N1/3956 ,  A61N1/3686

Abstract: Methods and devices that are configured to deliver cardiac stimuli in a particular fashion. In an illustrative embodiment, a method is used wherein a first stimulus is delivered using a first polarity, and, if the first stimulus fails to successfully convert an arrhythmia, a second stimulus having a second polarity that is different from or opposite of the first polarity is then delivered. Subsequent stimuli, if needed, are delivered in a continuing alternating-polarity manner. The first polarity may be determined by observing whether successfully-converting stimulus has been delivered previously and, if so, the polarity of the most recent stimulus that resulted in successful conversion is used as the first polarity. In additional embodiments, electrode configuration may be changed instead of or in addition to polarity, following unsuccessful stimulus delivery. Devices configured to perform such methods are included in additional illustrative embodiments.

Abstract translation: 被配置为以特定方式递送心脏刺激的方法和装置。 在说明性实施例中，使用其中使用第一极性传送第一刺激的方法，并且如果第一刺激不能成功转换心律失常，则具有与第一极性不同或相反的第二极性的第二刺激 然后交付。 如果需要，随后的刺激以连续的交替极性方式递送。 第一极性可以通过观察成功转换刺激是否已经被传递来确定，如果是，则将导致成功转换的最近的刺激的极性用作第一极性。 在另外的实施例中，在不成功的刺激递送之后，可以改变电极配置而不是极性或除了极性之外。 被配置为执行这些方法的装置包括在另外的说明性实施例中。

公开(公告)号：WO2009025817A3

公开(公告)日：2009-07-23

申请号：PCT/US2008009906

申请日：2008-08-20

Applicant: MEDTRONIC INC ,  SOMMER JOHN L ,  BOURN DAVID WAYNE ,  MARSHALL MARK T ,  EGGEN MICHAEL D ,  MIYAZAWA GABRIELA C

Inventor： SOMMER JOHN L ,  BOURN DAVID WAYNE ,  MARSHALL MARK T ,  EGGEN MICHAEL D ,  MIYAZAWA GABRIELA C

IPC: A61N1/362

CPC classification number: A61N1/36514 ,  A61N1/056 ,  A61N1/36114 ,  A61N1/36185 ,  A61N1/3684 ,  A61N1/3686 ,  A61N2001/0585

Abstract: A medical system comprises a plurality of electrodes; at least one sensor configured to output at least one signal based on at least one physiological parameter of a patient; and a processor. The processor is configured to control delivery of stimulation to the patient using a plurality of electrode configurations. Each of the electrode configurations comprises at least one of the plurality of electrodes. For each of the electrode configurations, the processor is configured to determine a first response of target tissue to the stimulation based on the signals, and a second response of non-target tissue to the stimulation based on the signals. The processor is also configured to select at least one of the electrode configurations for delivery of stimulation to the patient based on the first and second responses for the electrode configurations. As examples, the target tissue may be a left ventricle or vagus nerve.

Abstract translation: 医疗系统包括多个电极; 至少一个传感器，被配置为基于患者的至少一个生理参数输出至少一个信号; 和一个处理器。 处理器被配置为使用多个电极配置来控制向患者的刺激的递送。 每个电极配置包括多个电极中的至少一个。 对于每个电极配置，处理器被配置为基于信号确定目标组织对刺激的第一响应，以及基于信号确定非目标组织对刺激的第二响应。 处理器还被配置为基于电极配置的第一和第二响应来选择电极配置中的至少一个以向患者传递刺激。 作为例子，目标组织可以是左心室或迷走神经。

公开(公告)号：WO2009046360A2

公开(公告)日：2009-04-09

申请号：PCT/US2008/078830

申请日：2008-10-03

Applicant: MEDTRONIC, INC. ,  KAISER, Daniel, R. ,  NEIDERT, Michael, R. ,  SKADSBERG, Nicholas, David ,  GARDESKI, Kenneth, C. ,  MULLIGAN, Lawrence, J. ,  KELLEY, James, F. ,  SHELTON, Michael, B. ,  FISCHER, Trent, Markham

Inventor： KAISER, Daniel, R. ,  NEIDERT, Michael, R. ,  SKADSBERG, Nicholas, David ,  GARDESKI, Kenneth, C. ,  MULLIGAN, Lawrence, J. ,  KELLEY, James, F. ,  SHELTON, Michael, B. ,  FISCHER, Trent, Markham

IPC: A61B5/11

CPC classification number: A61N1/368 ,  A61B5/042 ,  A61B5/062 ,  A61B5/1104 ,  A61B5/1107 ,  A61B5/686 ,  A61B5/6882 ,  A61B2562/0209 ,  A61N1/0573 ,  A61N1/3627 ,  A61N1/36578 ,  A61N1/3684 ,  A61N1/3686

公开(公告)号：WO2006118793A2

公开(公告)日：2006-11-09

申请号：PCT/US2006/014690

申请日：2006-04-18

Applicant: CYBERONICS, INC. ,  MASCHINO, Steven, E. ,  PARNIS, Steven, M. ,  ARMSTRONG, Scott, A.

Inventor： MASCHINO, Steven, E. ,  PARNIS, Steven, M. ,  ARMSTRONG, Scott, A.

IPC: A61N1/36 ,  A61F5/00

CPC classification number: A61F5/0026 ,  A61F5/005 ,  A61N1/36007 ,  A61N1/36082 ,  A61N1/36185 ,  A61N1/3686

Abstract: A method and apparatus for treatment of an eating disorder includes electrically, mechanically and/or pharmaceutically/chemically stimulating a of the vagus nerve of the lower esophagus, cardia, esophageal/cardia junction, cardia/fundus junction or upper stomach so as to induce afferent action potentials on the vagus nerve. The device may be noninvasively adjusted after implantation to provide increased or decreased restriction on the patient's gastrointestinal tract. Each stimulus may be administered as a series of programmed pulses of defined amplitude, duration and period, to evoke a responsive signal to the brain by the target nerve, effective for producing a temporary feeling of satiety in the person. An implantable stimulus generator may be operatively coupled to a nerve electrode, pressure device or chemical outlet to apply a defined signal to a selected nerve branch. The implantable stimulus generator is programmable to allow clinician programming of defined signal parameters effective to treat the eating disorder of the patient. Methods are also provided to identify electrodes nearest to a branch of the vagus nerve to apply an electrical stimulation signal with improved efficiency.

Abstract translation: 用于治疗进食障碍的方法和设备包括电，机械和/或药学/化学刺激下食管，贲门，食道/贲门连接处，贲门/眼底连接处的迷走神经 或上胃，以诱导迷走神经上的传入动作电位。 该装置可以在植入后无创地调节，以对患者的胃肠道提供增加或减少的限制。 每个刺激可以作为一系列具有规定幅度，持续时间和周期的程序化脉冲来施用，以唤起目标神经对大脑的响应信号，从而有效地在人体内产生暂时的饱腹感。 可植入刺激发生器可以可操作地耦合到神经电极，压力装置或化学出口以将限定的信号施加到选定的神经分支。 可植入刺激发生器是可编程的，以允许临床医生编程确定的信号参数以有效治疗患者的进食障碍。 还提供了用于识别最接近迷走神经分支的电极以施加具有提高的效率的电刺激信号的方法。

公开(公告)号：WO1995010226A1

公开(公告)日：1995-04-20

申请号：PCT/US1994011495

申请日：1994-10-12

Applicant: EP TECHNOLOGIES, INC.

Inventor： EP TECHNOLOGIES, INC. ,  McGEE, David, L. ,  HOUSER, Russell, A. ,  SWANSON, David, K.

IPC: A61B05/04

CPC classification number: A61B5/6855 ,  A61B5/0422 ,  A61B5/6857 ,  A61B5/6858 ,  A61B18/1492 ,  A61B2017/003 ,  A61B2018/00107 ,  A61B2018/00148 ,  A61B2018/1407 ,  A61B2018/1435 ,  A61B2018/1861 ,  A61B2562/0209 ,  A61B2562/043 ,  A61N1/056 ,  A61N1/06 ,  A61N1/3686 ,  A61N1/403

Abstract: Systems and methods sense electrical events about a selected annulus region (26, 30) of the heart (10) to identify the location of an accessory pathway. They establish a contact site between heart tissue and a multi-electrode array (E1-E10) conforming to the circumferential geometry of the selected annulus region (26, 30). The system and methods maintain this site, while conveying signals representing electrical events sensed by bipolar pairs of the electrodes (E1-E10). The systems and methods display the signals as graphic information that represents the time differences (T1, T2) between the atrium (A) and ventricular (V) electrogram complexes sensed by the pairs (E1-E10) on the selected annulus region (26, 30). The pairs (E1-E10) displaying the least time separation between the complexes (A, V) identifies the region of the accessory pathway. With this information, energy is conveyed to the electrodes of the selected pair to ablate tissue.

Abstract translation: 系统和方法检测关于心脏（10）的选定环区（26,30）的电事件，以识别附件通路的位置。 它们在心脏组织和符合所选择的环空区域（26,30）的圆周几何形状的多电极阵列（E1-E10）之间建立接触位置。 系统和方法维护该站点，同时传送表示由双极电极对（E1-E10）感测的电气事件的信号。 所述系统和方法将所述信号显示为图形信息，所述图形信息表示由所选择的环面区域（26）上的对（E1-E10）感测的心房（A）和心室（V）电描绘图复合体之间的时间差（T1，T2） 30）。 在复合体（A，V）之间显示最小时间间隔的对（E1-E10）标识附件通路的区域。 利用该信息，将能量传送到所选择的对的电极以烧蚀组织。

公开(公告)号：WO1992017240A1

公开(公告)日：1992-10-15

申请号：PCT/US1992000981

申请日：1992-02-04

Applicant: MEDTRONIC, INC.

Inventor： MEDTRONIC, INC. ,  BENNETT, Tom, D. ,  COMBS, William, J. ,  KALLOK, Michael, J. ,  LEE, Brian, B. ,  MEHRA, Rahul

IPC: A61N01/365

CPC classification number: A61N1/3686 ,  A61N1/0504 ,  A61N1/36185 ,  A61N1/3622 ,  A61N1/3756 ,  Y10S128/903

Abstract: A method and apparatus for providing an enhanced capability of detecting and gathering electrical cardiac signals via an array of relatively closely spaced subcutaneous electrodes (located on the body of an implanted device) which may be employed with suitable switching circuits, signal processors, and memory to process the electrical cardiac signals between any selected pair or pairs of the electrode array in order to provide a leadless, orientation insensitive means for receiving the electrical signal from the heart. This far-field EGM may be used to provide storage and analysis of arrhythmic events and to provide control signals for the delivery of various therapies including pacing, cardioversion and defibrillation therapies as well as the delivery of antiarrhythmic drugs, and, in the pacing context, to effect capture detection and automatic stimulation threshold adaptation, recording of PMT episodes, measurement of refractory periods in order to set timing windows for antitachy pacing therapies, and as a control signal for use in adjusting pacing rate to physiologic demand. The housing or case of the subcutaneously implanted medical device is modified to provide an array of electrodes which may be selectively or sequentially coupled in one or more pairs to the terminals of one or more sense amplifiers to pick up, amplify and process the electrical cardiac signals across each electrode pair. In one embodiment, the signals from the selected electrode pairs may be stored and compared to one another in order to determine the sensing vector which provides the largest cardiac signal (in a test mode). Following completion of the test mode, the system may employ the selected subcutaneous ECG signal vector for a number of applications. The implanted device possesses analog-to-digital conversion circuitry for sampling and converting the selected subcutaneous ECG signal to digital data which is stored in a recirculating buffer, the contents of which are transferred to RAM for later data retrieval either periodically or upon the occurrence of an event of interest. In another embodiment, the selected subcutaneous ECG signal is used to confirm capture in conjunction with an algorithm for determining the stimulation threshold of the heart and set stimulation pulse energy at a level exceeding the threshold by a desired safety margin. Further embodiments include replacing the switching approach with parallel linear and nonlinear combinational processing of the signals from the orthogonal electrode pairs of the electrode array, to develop and employ continuous signals insensitive to the orientation variations of the electrode array. These linear and nonlinear embodiments would be used for improving the data storage and autocapture embodiments by providing an optimal signal at all times, while avoiding the switching process.

Abstract translation: 一种用于提供通过相对紧密间隔的皮下电极（位于植入装置的主体上）的阵列来检测和收集电心电信号的增强能力的方法和装置，其可以与合适的开关电路，信号处理器和存储器一起使用 处理任何所选择的一对或一对电极阵列之间的电心脏信号，以便提供用于从心脏接收电信号的无引导方向不敏感的装置。 这种远场EGM可用于提供心律失常事件的存储和分析，并提供用于递送各种疗法的控制信号，包括起搏，心脏复律和除颤疗法以及递送抗心律失常药物，并且在起搏背景下， 实现捕获检测和自动刺激阈值适应，记录PMT发作，测量不良期以设置反向起搏治疗的时间窗口，以及用于调整生理需求起搏速度的控制信号。 修改皮下植入的医疗装置的壳体或壳体以提供电极阵列，其可以以一对或多对选择性或顺序耦合到一个或多个感测放大器的端子，以拾取，放大和处理电心脏信号 穿过每个电极对。 在一个实施例中，来自所选择的电极对的信号可以彼此存储和比较，以便确定提供最大心脏信号（在测试模式中）的感测向量。 在完成测试模式之后，系统可以使用选择的皮下ECG信号向量进行多种应用。 植入的装置具有模数转换电路，用于对所选择的皮下ECG信号进行取样并将其转换成存储在再循环缓冲器中的数字数据，其内容被传送到RAM以便稍后数据检索 感兴趣的事件 在另一个实施例中，所选择的皮下ECG信号用于结合用于确定心脏的刺激阈值的算法来确认捕获，并将刺激脉冲能量设置在超过阈值的水平所需安全余量。 另外的实施例包括用来自电极阵列的正交电极对的信号的并行线性和非线性组合处理替换开关方法，以开发和采用对电极阵列的取向变化不敏感的连续信号。 这些线性和非线性实施例将用于通过在避免切换过程的同时始终提供最佳信号来改进数据存储和自动捕获实施例。