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    Closed-loop systems and methods for controlling neurostimulation based on far-field cardiac signals sensed by a spinal cord stimulation device
    42.
    发明授权
    Closed-loop systems and methods for controlling neurostimulation based on far-field cardiac signals sensed by a spinal cord stimulation device 有权
    基于由脊髓刺激装置感测到的远场心脏信号的闭环系统和用于控制神经刺激的方法

    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。

    Systems and methods for selectively limiting multi-site ventricular pacing delays during optimization of cardiac resynchronization therapy parameters
    43.
    发明授权
    Systems and methods for selectively limiting multi-site ventricular pacing delays during optimization of cardiac resynchronization therapy parameters 有权
    用于在优化心脏再同步治疗参数期间选择性限制多部位心室起搏延迟的系统和方法

    公开(公告)号：US08583230B2

    公开(公告)日：2013-11-12

    申请号：US13009404

    申请日：2011-01-19

    申请人： Kyungmoo Ryu ,  Allen Keel ,  Heidi Hellman ,  Tomas Svensson

    发明人： Kyungmoo Ryu ,  Allen Keel ,  Heidi Hellman ,  Tomas Svensson

    IPC分类号： A61N1/00

    CPC分类号： A61N1/3627 ,  A61N1/3684 ,  A61N1/3712

    摘要： Techniques are provided for use with implantable cardiac stimulation devices equipped for multi-site left ventricular (MSLV) cardiac pacing. Briefly, intraventricular and interventricular conduction delays are detected for paced cardiac events. Maximum pacing time delays are determined for use with MSLV pacing where the maximum pacing time delays are set based on the conduction delays to values sufficient to avoid capture problems due to wavefront propagation, such as fusion or lack of capture. MSLV pacing delays are then set to values no greater than the maximum pacing delays and cardiac resynchronization therapy (CRT) is delivered using the MSLV pacing delays. In an example where an optimal interventricular pacing delay (VV) is determined in advance using intracardiac electrogram-based or hemodynamic-based optimization techniques, the optimal value for VV can be used as a limiting factor when determining the maximum MSLV pacing time delays.

    摘要翻译： 提供技术用于配备用于多部位左心室（MSLV）心脏起搏的可植入心脏刺激装置。 简而言之，对于心跳事件，检测到心室内和室间传导延迟。 确定最大起搏时间延迟用于MSLV起搏，其中最大起搏时间延迟基于导通延迟设置为足以避免由于波前传播引起的捕获问题，例如融合或缺乏捕获。 然后将MSLV起搏延迟设置为不大于最大起搏延迟的值，并使用MSLV起搏延迟传递心脏再同步治疗（CRT）。 在使用基于心脏电图或基于血液动力学的优化技术预先确定最佳心室起搏延迟（VV）的示例中，当确定最大MSLV起搏时间延迟时，可以将VV的最佳值用作限制因素。

    Cardiac resynchronization therapy optimization using vector measurements obtained from realtime electrode position tracking
    44.
    发明授权
    Cardiac resynchronization therapy optimization using vector measurements obtained from realtime electrode position tracking 有权
    使用从实时电极位置跟踪获得的矢量测量的心脏再同步治疗优化

    公开(公告)号：US08527049B2

    公开(公告)日：2013-09-03

    申请号：US12621373

    申请日：2009-11-18

    申请人： Steve Koh ,  Stuart Rosenberg ,  Kyungmoo Ryu ,  Michael Yang ,  Allen Keel

    发明人： Steve Koh ,  Stuart Rosenberg ,  Kyungmoo Ryu ,  Michael Yang ,  Allen Keel

    IPC分类号： A61N1/365 ,  A61B5/05

    CPC分类号： A61N1/3627 ,  A61B5/0422 ,  A61B5/0452 ,  A61N1/36585 ,  A61N1/3682 ,  A61N1/3684 ,  A61N1/3686

    摘要： An exemplary method includes selecting multiple electrodes located in a patient; acquiring position information during one or more cardiac cycles for the multiple electrodes where the acquiring includes using each of the electrodes for measuring one or more electrical potentials in an electrical localization field established in the patient; calculating one or more vector metrics based on the acquired position information for one or more vectors, each vector defined by two of the multiple electrodes; and analyzing the one or more vector metrics to assess cardiac performance during the one or more cardiac cycles. Various other methods, devices, systems, etc., are also disclosed.

    摘要翻译： 一种示例性方法包括选择位于患者体内的多个电极; 在所述多个电极的一个或多个心动周期期间获取位置信息，其中所述获取包括使用每个所述电极来测量在所述患者中建立的电定位场中的一个或多个电位; 基于所获取的一个或多个向量的位置信息来计算一个或多个矢量度量，每个矢量由所述多个电极中的两个限定; 以及分析所述一个或多个矢量度量以评估所述一个或多个心动周期期间的心脏性能。 还公开了各种其它方法，装置，系统等。

    Electrode and lead stability indexes and stability maps based on localization system data
    47.
    发明授权
    Electrode and lead stability indexes and stability maps based on localization system data 有权
    基于定位系统数据的电极和铅稳定性指标和稳定性图

    公开(公告)号：US08401645B2

    公开(公告)日：2013-03-19

    申请号：US12562003

    申请日：2009-09-17

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

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

    IPC分类号： A61N1/00 ,  A61B5/04

    CPC分类号： A61N1/3702 ,  A61B5/042 ,  A61B5/0424 ,  A61B2560/0276 ,  A61N1/368 ,  A61N1/371

    摘要： A method includes selecting an electrode located in a patient; acquiring position information with respect to time for the electrode where the acquiring uses the electrode for repeatedly measuring electrical potentials in an electrical localization field established in the patient; calculating a stability metric for the electrode based on the acquired position information with respect to time; and deciding if the selected electrode, as located in the patient, has a stable location for sensing biological electrical activity, for delivering electrical energy or for sensing biological electrical activity and delivering electrical energy. Position information may be acquired during one or both of intrinsic or paced activation of a heart and respective stability indexes calculated for each activation type.

    摘要翻译： 一种方法包括选择位于患者体内的电极; 获取相对于所述电极的时间的位置信息，其中所述电极在所述患者中建立的电定位场中使用所述电极重复测量电位; 基于获取的相对于时间的位置信息计算电极的稳定性度量; 并且确定位于患者体内的所选择的电极是否具有用于感测生物电活动的稳定位置，用于传递电能或用于感测生物电活动和递送电能。 位置信息可以在心脏的固有或起搏激活和对于每种激活类型计算的各个稳定性指标的一个或两个期间获取。

    METHODS AND SYSTEMS FOR DETERMINING PACING PARAMETERS BASED ON REPOLARIZATION INDEX
    48.
    发明申请
    METHODS AND SYSTEMS FOR DETERMINING PACING PARAMETERS BASED ON REPOLARIZATION INDEX 审中-公开
    基于复合指数确定PAC参数的方法和系统

    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。

    DETERMINATION OF CARDIAC RESYNCHRONIZATION THERAPY SETTINGS
    49.
    发明申请
    DETERMINATION OF CARDIAC RESYNCHRONIZATION THERAPY SETTINGS 有权
    心脏康复治疗方法的确定

    公开(公告)号：US20120310296A1

    公开(公告)日：2012-12-06

    申请号：US13471167

    申请日：2012-05-14

    申请人： Kjell Noren ,  Anders Bjorling ,  Tomas Svensson ,  Sven-Erik Hedberg ,  Allen Keel ,  Stuart Rosenberg ,  Kyungmoo Ryu

    发明人： Kjell Noren ,  Anders Bjorling ,  Tomas Svensson ,  Sven-Erik Hedberg ,  Allen Keel ,  Stuart Rosenberg ,  Kyungmoo Ryu

    IPC分类号： A61N1/365

    CPC分类号： A61N1/36507 ,  A61N1/3682 ,  A61N1/3684 ,  A61N1/37252

    摘要： CRT settings for an implantable medical device are determined by applying pacing pulses to heart chambers of a scheme of different combinations of interchamber delays. A respective width parameter value representing an R or P wave width is determined for each such delay combination based on an ECG representing signal and the width parameter values are employed to estimate a parametric model defining the width parameter as a function of interchamber delays. Candidate interchamber delays that minimize the width parameter are determined from the parametric model and employed to determine optimal CRT settings. The technique provides an efficient way of finding optimal CRT settings when multiple pacing sites are available in a heart chamber.

    摘要翻译： 用于可植入医疗装置的CRT设置通过将不同组合的车间延迟的方案应用于心室来进行起搏脉冲来确定。 基于ECG表示信号为每个这样的延迟组合确定表示R或P波宽的相应宽度参数值，并且使用宽度参数值来估计定义作为间歇延迟的函数的宽度参数的参数模型。 从参数模型中确定最小化宽度参数的候选车间延迟，并用于确定最佳CRT设置。 该技术提供了一种在心室中可用多个起搏部位时可以找到最佳CRT设置的有效方式。