公开(公告)号：US06456880B1

公开(公告)日：2002-09-24

申请号：US09712861

申请日：2000-11-14

申请人： Euljoon Park ,  Joseph J. Florio ,  Kerry Bradley ,  Gene A. Bornzin ,  Laurence S. Sloman

发明人： Euljoon Park ,  Joseph J. Florio ,  Kerry Bradley ,  Gene A. Bornzin ,  Laurence S. Sloman

IPC分类号： A61N1365

CPC分类号： A61N1/3702 ,  A61N1/365

摘要： An implantable cardiac stimulation device includes a system that monitors progression or regression of a patient's heart condition. The system includes a plurality of electrode configurations for sensing cardiac activity of the heart. A sensing circuit provides an electrical signal representing electrical activity of the heart from each of the sensing electrode configurations. A processor coupled to the sensing circuit determines, at spaced apart times, and over time, a ventricular repolarization interval in each of the electrical signals and a corresponding ventricular repolarization interval dispersion. A memory stores the ventricular repolarization interval dispersions for transmission by a telemetry circuit to an external receiver for analysis.

摘要翻译： 可植入心脏刺激装置包括监测患者心脏状况的进展或消退的系统。 该系统包括用于感测心脏的心脏活动的多个电极配置。 感测电路从每个感测电极配置提供表示心脏的电活动的电信号。 耦合到感测电路的处理器在间隔开的时间和时间上确定每个电信号中的心室复极间隔和对应的心室复极间隔分散。 存储器存储用于通过遥测电路传输到外部接收器用于分析的心室复极间隔分散体。

公开(公告)号：US06711439B1

公开(公告)日：2004-03-23

申请号：US10077663

申请日：2002-02-14

申请人： Kerry Bradley ,  Euljoon Park ,  Laurence S. Sloman

发明人： Kerry Bradley ,  Euljoon Park ,  Laurence S. Sloman

IPC分类号： A61N1362

CPC分类号： A61N1/371 ,  A61B5/4035

摘要： Modern implantable cardiac stimulation devices include processing and data storage capabilities that may be exploited to track myocardial condition and autonomic tone. Implantable devices have a capability to measure and store electrogram information over a period of time in a relatively large capacity memory, with advances in technology allowing increases in memory size. The evoked response varies in amplitude and morphology with changes in autonomic tone, ventricular filling, paced rate, and other parameters. The implantable cardiac device can be configured to sense and accurately quantify the evoked response, derive parameters from the quantified evoked response, store the parameters over long time periods, and derive variability statistics from the parameters to assist in tracking the patient's condition over time, and guiding the patient's therapy.

摘要翻译： 现代可植入心脏刺激装置包括可被利用来追踪心肌状况和自主神经紧张的处理和数据存储能力。 可移植设备具有在相对大容量存储器中在一段时间内测量和存储电描记图信息的能力，技术的进步允许存储器大小增加。 诱发反应的幅度和形态随着自主神经调节，心室充盈，起搏率和其他参数的变化而变化。 可植入心脏装置可被配置为感测并准确量化诱发反应，从量化的诱发反应导出参数，在长时间段内存储参数，并从参数中导出可变性统计数据，以帮助随时间跟踪患者的状况，以及 指导患者的治疗。

公开(公告)号：US06738669B1

公开(公告)日：2004-05-18

申请号：US10011127

申请日：2001-10-24

申请人： Laurence S. Sloman ,  Kerry Bradley

发明人： Laurence S. Sloman ,  Kerry Bradley

IPC分类号： A61N1368

CPC分类号： A61N1/3712 ,  A61N1/3714

摘要： An implantable cardiac stimulation device and method automatically verify capture of one or both ventricular chambers by sensing a far-field signal in both atrial chambers. A far-field interval window is set following the delivery of the ventricular stimulation, during which a far-field signal is detected and compared to a signal representing a predetermined far-field R-wave that represents successful capture of one or both ventricular chambers. If the far-field signal is approximately equal to the predetermined far-field R-wave signal, then capture is verified. If capture is not verified, a threshold search is performed in the ventricle in which capture was lost.

摘要翻译： 可植入心脏刺激装置和方法通过感测两个心房中的远场信号来自动验证一个或两个心室的捕获。 远场间隔窗口设置在心室刺激传递之后，在此期间，检测到远场信号，并将其与表示成功捕获一个或两个心室的成像捕获的预定远场R波的信号进行比较。 如果远场信号近似等于预定的远场R波信号，则验证捕获。 如果没有验证捕获，则在捕获丢失的心室中执行阈值搜索。

公开(公告)号：US07062327B2

公开(公告)日：2006-06-13

申请号：US10138438

申请日：2002-05-02

申请人： Kerry Bradley ,  Laurence S. Sloman

发明人： Kerry Bradley ,  Laurence S. Sloman

IPC分类号： A61N1/36

CPC分类号： A61N1/3712 ,  A61N1/3622

摘要： Techniques for providing capture verification during overdrive pacing are described. If an overdrive pacing pulse fails to evoke capture (i.e. a loss of capture occurs), a high voltage backup pulse is automatically delivered. Once a second loss of capture occurs during a single sequence of overdrive pacing pulses, an overdrive pulse capture threshold detection search, described herein, is performed while overdrive pacing continues. Various techniques for providing rate recovery are also described herein. The rate recovery techniques are designed to avoid problems that might arise from possible fusion of intrinsic beats and overdrive pacing pulses that fail to evoke capture. In a first rate recovery technique, capture detection is suspended during rate recovery due to the possibility of fusion. Instead, an extra safety margin is added to the overdrive pulses. Once two intrinsic beats are detected, automatic capture verification is reactivated for the next two beats to verify capture before the new overdrive rate is finally established. In a second rate recovery technique, capture verification is maintained throughout rate recovery but the pulse magnitude is increased to a high output mode voltage to avoid any risks of fusion. After the output is increased to the high output mode voltage, a subsequent loss of capture is considered to be an intrinsic event for the purposes of terminating rate recovery. In a third rate recovery technique, capture verification is maintained during rate recovery and the output energy is not increased to the high output mode voltage unless loss of capture is first detected. Subsequent loss of capture events are then counted as P-waves.

公开(公告)号：US06731985B2

公开(公告)日：2004-05-04

申请号：US09981555

申请日：2001-10-16

申请人： John W. Poore ,  Kerry Bradley ,  Laurence S. Sloman ,  Gene A. Bornzin ,  Joseph J. Florio

发明人： John W. Poore ,  Kerry Bradley ,  Laurence S. Sloman ,  Gene A. Bornzin ,  Joseph J. Florio

IPC分类号： A61N1362

CPC分类号： A61N1/3712

摘要： An implantable cardiac stimulation device and associated method perform an automatic calibration procedure for evaluating whether automatic capture verification can be recommended. The calibration procedure calculates and displays a number of variables for use by a medical practitioner in programming automatic capture operating parameters. An average paced depolarization integral (PDI) is determined from the cardiac signals following delivery of multiple stimulation pulse below and above capture threshold such that both pure lead polarization signals and evoked response signals may be analyzed. From the paced depolarization integral data, a capture threshold, a stimulation response curve, a minimum evoked response, a maximum lead polarization, an evoked response sensitivity, an evoked response safety margin, and a polarization safety margin are determined. Based on these variables, the calibration procedure determines if automatic capture verification can be recommended. If so, the stimulation device calculates a capture detection threshold. The automatic capture verification recommendation and the estimated calibration variables are displayed.

摘要翻译： 可植入心脏刺激装置和相关方法执行自动校准程序，以评估是否可以推荐自动捕获验证。 校准程序计算并显示许多变量，供医生在编程自动捕获操作参数时使用。 平均节奏去极化积分（PDI）是在多次刺激脉冲传递后低于和高于捕获阈值的心脏信号确定的，以便可以分析纯铅极化信号和诱发响应信号。 从起搏去极化积分数据中，确定捕获阈值，刺激响应曲线，最小诱发响应，最大引线极化，诱发响应灵敏度，诱发响应安全裕度和极化安全裕度。 基于这些变量，校准过程确定是否可以推荐自动捕获验证。 如果是，则刺激装置计算捕获检测阈值。 显示自动捕获验证建议和估计的校准变量。

公开(公告)号：US06643549B1

公开(公告)日：2003-11-04

申请号：US10003953

申请日：2001-10-30

申请人： Kerry Bradley ,  Laurence S. Sloman

发明人： Kerry Bradley ,  Laurence S. Sloman

IPC分类号： A61N1362

CPC分类号： A61N1/3712 ,  A61N1/37247

摘要： A system and associated method for acquiring, storing, and displaying evoked response signal features for the purposes of monitoring evoked response variability and evaluating the performance of automatic capture. The system further acquires, stores, and displays the number of suspected fusion events for the purpose of improving fusion avoidance through either automatic modification to fusion avoidance mechanisms or by providing a clinician with diagnostic information helpful in selecting programmable operating parameters.

摘要翻译： 用于获取，存储和显示诱发响应信号特征的系统和相关方法，用于监视诱发反应变异性并评估自动捕获的性能。 系统进一步获取，存储和显示可疑融合事件的数量，以便通过对融合避免机制的自动修改来改善融合避免，或者通过向临床医生提供有助于选择可编程操作参数的诊断信息。

公开(公告)号：US07349738B1

公开(公告)日：2008-03-25

申请号：US10370815

申请日：2003-02-19

申请人： Kerry Bradley ,  Laurence S. Sloman

发明人： Kerry Bradley ,  Laurence S. Sloman

IPC分类号： A61N1/08

CPC分类号： A61N1/371 ,  A61N1/3716

摘要： A pulse is delivered to the atrium using an electrode configuration that includes at least a pulse cathode electrode. Cardiac activity in the atrium is sensed using a unipolar electrode configuration to provide a sensed signal wherein the unipolar electrode configuration does not include the pulse cathode electrode. A determination as to whether the pulse caused an atrial evoked response is made based on a maximum derivative value of the sensed signal with respect to time, a comparison of the sensed signal to a parameter or an integral of the sensed signal with respect to time.

摘要翻译： 使用至少包括脉冲阴极的电极配置将脉冲传送到心房。 使用单极电极配置来感测心房中的心脏活动以提供感测信号，其中单极电极配置不包括脉冲阴极电极。 基于感测信号相对于时间的最大导数值，感测信号与感测信号相对于时间的参数或积分的比较，确定脉冲是否引起心房诱发反应。

公开(公告)号：US07856271B2

公开(公告)日：2010-12-21

申请号：US11948671

申请日：2007-11-30

申请人： Kerry Bradley ,  Laurence S. Sloman

发明人： Kerry Bradley ,  Laurence S. Sloman

IPC分类号： A61N1/362

CPC分类号： A61N1/371 ,  A61N1/3716

摘要： A method for sensing cardiac activity in an atrium of a patient's heart includes delivering a pulse to the atrium using an electrode configuration that includes at least a cathode electrode; sensing cardiac activity in the atrium using a unipolar electrode configuration to provide a sensed signal wherein the unipolar electrode configuration does not include the cathode electrode; determining the duration during which the voltage of the sensed signal falls below a threshold voltage; and comparing the determined duration to a parameter to determine whether the pulse caused an atrial evoked response.

摘要翻译： 用于感测患者心脏的心脏活动的方法包括：使用至少包括阴极电极的电极配置将脉冲输送到心房; 使用单极电极配置感测心房中的心脏活动以提供感测信号，其中单极电极配置不包括阴极电极; 确定感测信号的电压下降到阈值电压以下的持续时间; 以及将所确定的持续时间与参数进行比较以确定所述脉冲是否引起心房诱发反应。

公开(公告)号：US06512953B2

公开(公告)日：2003-01-28

申请号：US09844189

申请日：2001-04-26

申请人： Joseph J. Florio ,  Euljoon Park ,  Kerry Bradley ,  Gene A. Bornzin

发明人： Joseph J. Florio ,  Euljoon Park ,  Kerry Bradley ,  Gene A. Bornzin

IPC分类号： A61N1365

CPC分类号： A61N1/3712 ,  A61N1/3627

摘要： A system and corresponding method are provided to reliably detect capture during multi-chamber stimulation, and to further monitor the progression of congestive heart failure. The system provides a method by which intracardiac electrogram (IEGM) characteristics representing single-chamber capture and bi-ventricular capture are stored in memory and displayed. The annotation of the displayed waveforms is such that events associated with loss of capture, single-chamber capture, and bi-ventricular capture are clearly marked for ready interpretation by the physician. In a first situation, a stimulation pulse is followed by a time delay window and a subsequent depolarization complex that represents intrinsic responses of the chambers that have not been captured. In a second situation, a stimulation pulse is followed almost immediately by an evoked response that represents capture of one chamber, and a subsequent depolarization complex that represents an intrinsic response of one chamber that has not been captured. In a third situation, a stimulation pulse is almost immediately followed by an evoked response that represents simultaneous capture of two chambers.

摘要翻译： 提供了一种系统和相应的方法来可靠地检测多室刺激期间的捕获，并进一步监测充血性心力衰竭的进展。 该系统提供了一种表示单室捕获和双心室捕获的心内电图（IEGM）特征存储在存储器中并显示的方法。 显示的波形的注释使得与丢失捕获，单室捕获和双心室捕获相关联的事件被清楚地标记以供医师准备解释。 在第一种情况下，刺激脉冲之后是时间延迟窗口和随后的去极化复合体，其表示未被捕获的室的内在响应。 在第二种情况下，刺激脉冲几乎立即被跟随表示一个腔室的捕获的诱发反应，以及后续的去极化复合体，其表示一个未被捕获的腔室的固有响应。 在第三种情况下，刺激脉冲几乎紧随其后，表示同时捕获两个腔室的诱发反应。

公开(公告)号：US5991661A

公开(公告)日：1999-11-23

申请号：US954326

申请日：1997-10-17

申请人： Euljoon Park ,  Gene A. Bornzin ,  Joseph J. Florio ,  Kerry Bradley

发明人： Euljoon Park ,  Gene A. Bornzin ,  Joseph J. Florio ,  Kerry Bradley

IPC分类号： A61N1/365

CPC分类号： A61N1/36542

摘要： An implantable cardiac stimulation device, such as a pacemaker or an implantable cardioverter-defibrillator, that includes an accelerometer-based activity sensor that processes one or more signals from the activity sensor to obtain parameters that are indicative of the heartbeat of the patient. The implantable cardiac stimulation device determines when the patient is at rest and the activity sensor provides a signal that corresponds to the acceleration of the sensor due to the heartbeat of the patient. This acceleration signal is integrated over time once to provide a contractility parameter, which is indicative of the contractility of the heart and is integrated over time twice to provide a displacement parameter, which is indicative of the displacement of the heart wall during the heartbeat. This displacement parameter is thereby indicative of the volume of blood pumped by the heart. A microprocessor uses either the contractility parameter, the displacement parameter or both to modify the delivery of therapeutic stimulation pulses to the heart.

摘要翻译： 可植入心脏刺激装置，例如起搏器或植入式心律转复除颤器，其包括基于加速度计的活动传感器，其处理来自活动传感器的一个或多个信号以获得指示患者心跳的参数。 可植入心脏刺激装置确定患者何时休息，并且活动传感器提供对应于由于患者心跳引起的传感器的加速度的信号。 该加速度信号随着时间一度被积分以提供收缩性参数，其表示心脏的收缩性并且随时间积分两次以提供位移参数，其指示在心跳期间心脏壁的位移。 因此，该位移参数指示由心脏泵送的血液的体积。 微处理器使用收缩性参数，位移参数或两者来修改对心脏的治疗刺激脉冲的递送。