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91. 发明申请

US20100234906A1 SYSTEM AND METHOD FOR CONTROLLING RATE-ADAPTIVE PACING BASED ON A CARDIAC FORCE-FREQUENCY RELATION DETECTED BY AN IMPLANTABLE MEDICAL DEVICE 审中-公开
标题翻译：基于由可植入医疗器械检测的心脏频率关系控制速率自适应控制的系统和方法
公开(公告)号：US20100234906A1
公开(公告)日：2010-09-16
申请号：US12405090
申请日：2009-03-16
申请人： Steve Koh
发明人： Steve Koh
IPC分类号： A61N1/365 , A61M1/00
CPC分类号： A61N1/36585 , A61B5/1459 , A61N1/3627 , A61N1/36521 , A61N1/36564
摘要： Techniques are provided for use in controlling rate-adaptive pacing within implantable medical devices such as pacemakers or implantable cardioverter-defibrillators (ICDs). In one example, a force-frequency relationship is determined for the heart of the patient, which is representative of the relationship between cardiac stimulation frequency and myocardial contractile force. To this end, various parameters are detected for use as surrogates for contractile force, including selected systolic pressure parameters and cardiogenic impedance parameters. Rate-adaptive pacing is then controlled based on the detected force-frequency relationship to, for example, deactivate rate-adaptive pacing if the slope and/or abscissa of the force-frequency relationship indicates significant contractility dysfunction within the patient. In other examples, rather than deactivating rate-adaptive pacing, control parameters are adjusted to render the rate-adaptive pacing less aggressive. In still other examples, trends in the slope and/or abscissa of the force-frequency relationship are monitored to detect contractility dysfunction and/or heart failure and titrate medications accordingly.
摘要翻译：提供技术用于控制可植入医疗装置（例如起搏器或植入式心律转复除颤器（ICD））内的速率自适应起搏。在一个示例中，为患者的心脏确定力 - 频率关系，其代表心脏刺激频率与心肌收缩力之间的关系。为此，检测各种参数以用作收缩力的替代物，包括选择的收缩压参数和心源阻抗参数。然后，如果力 - 频率关系的斜率和/或横坐标表示患者内的显着的收缩功能障碍，则基于检测到的力 - 频率关系来控制速率自适应起搏，例如，去激活速率自适应起搏。在其他示例中，不是去激活速率自适应起搏，而是调节控制参数以使速率自适应起搏较不具有侵略性。在另一些实例中，监测力 - 频率关系的斜率和/或横坐标的趋势以检测收缩功能障碍和/或心力衰竭并相应地滴定药物。

92. 发明授权

US07636600B1 Pressure monitoring for apnea prevention and/or therapy 有权
标题翻译：呼吸暂停预防和/或治疗的压力监测
公开(公告)号：US07636600B1
公开(公告)日：2009-12-22
申请号：US11255379
申请日：2005-10-21
申请人： Steve Koh
发明人： Steve Koh
IPC分类号： A61N1/37
CPC分类号： A61N1/36564 , A61N1/3601
摘要： An exemplary method includes determining an intramural pressure based on one or more in vivo pressure measurements, based on the intramural pressure, deciding whether apnea exists and, if apnea exists, calling for one or more types of stimulation selected from a group consisting of autonomic nerve stimulation, phrenic nerve stimulation, diaphragm stimulation and cardiac stimulation. Other exemplary methods, devices, systems, etc., are also disclosed.
摘要翻译：示例性方法包括基于壁内压力确定基于一个或多个体内压力测量的壁内压力，确定是否存在呼吸暂停，并且如果存在呼吸暂停，则呼叫选自自主神经的一种或多种类型的刺激刺激，膈神经刺激，隔膜刺激和心脏刺激。还公开了其它示例性方法，装置，系统等。

93. 发明授权

US07628757B1 System and method for impedance-based detection of pulmonary edema and reduced respiration using an implantable medical system 有权
标题翻译：使用植入式医疗系统进行基于阻抗的肺水肿检测和减少呼吸的系统和方法
公开(公告)号：US07628757B1
公开(公告)日：2009-12-08
申请号：US11138229
申请日：2005-05-25
申请人： Steve Koh
发明人： Steve Koh
IPC分类号： A61B5/08
CPC分类号： A61B5/0809 , A61B5/0205 , A61B5/053 , A61N1/3601 , A61N1/36521
摘要： Techniques are provided for detecting pulmonary edema based on a comparison of impedance-based respiratory patterns and impedance-based cardiac patterns, i.e. patterns derived from thoracic impedance signals. In one example, a numerical ratio is calculated between average peak-to-peak amplitudes of the respiratory patterns and average peak-to-peak amplitudes of the cardiac patterns. Pulmonary edema is detected if the amplitude ratio falls below a pulmonary edema detection threshold. Techniques are also provided for controlling operation of an impedance-based reduced respiration detector, i.e. a detector which seeks to detect apnea, hypopnea, or the like, based on analysis of respiratory patterns derived from a thoracic impedance signal. If the numerical ratio falls below a minimum reliability threshold, then the reduced respiration detector is deactivated because episodes of reduced respiration cannot then reliably be derived from an analysis of respiration patterns obtained from the thoracic impedance signals.
摘要翻译：提供了基于基于阻抗的呼吸模式和基于阻抗的心脏模式（即从胸部阻抗信号导出的模式）的比较来检测肺水肿的技术。在一个示例中，在呼吸模式的平均峰 - 峰幅度和心脏图案的平均峰 - 峰幅度之间计算数值比。如果振幅比低于肺水肿检测阈值，则检测肺水肿。还提供了用于控制基于阻抗的减少的呼吸检测器的操作的技术，即基于从胸部阻抗信号导出的呼吸模式的分析来寻求检测呼吸暂停，呼吸不足等的检测器。如果数值比低于最小可靠性阈值，则减少的呼吸检测器被停用，因为不能随后从对胸部阻抗信号获得的呼吸模式的分析中可靠地导出减少呼吸的发作。

94. 发明授权

US07519426B1 Techniques for reducing orthostatic hypotension 有权
标题翻译：降低直立性低血压的技术
公开(公告)号：US07519426B1
公开(公告)日：2009-04-14
申请号：US11245875
申请日：2005-10-07
申请人： Steve Koh , Euljoon Park
发明人： Steve Koh , Euljoon Park
IPC分类号： A61N1/18
CPC分类号： A61N1/36564 , A61N1/36114
摘要： Techniques for reducing orthostatic hypotension are described. One technique detects an incident of orthostatic hypotension in a patient, and in response, increases cardiac stroke volume, at least in part, by stimulating the patient's phrenic nerve.
摘要翻译：描述了减少体位性低血压的技术。一种技术检测患者的直立性低血压的事件，并且作为响应，至少部分地通过刺激患者的膈神经来增加心脏搏动体积。

95. 发明授权

US07440804B1 System and method for measuring ventricular evoked response using an implantable medical device 有权
标题翻译：使用可植入医疗装置测量心室诱发反应的系统和方法
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。

96. 发明授权

US07357775B1 System and method for providing demand-based Cheyne-Stokes Respiration therapy using an implantable medical device 有权
标题翻译：使用可植入医疗设备提供基于需求的Cheyne-Stokes呼吸治疗的系统和方法
公开(公告)号：US07357775B1
公开(公告)日：2008-04-15
申请号：US10844023
申请日：2004-05-11
申请人： Steve Koh
发明人： Steve Koh
IPC分类号： A61B5/08
CPC分类号： A61N1/3956 , A61B5/0816 , A61B5/4818 , A61B5/7239 , A61N1/3601 , A61N1/36514 , A61N1/3702
摘要： Techniques are provided for controlling therapy delivered in response to Cheyne-Stokes Respiration (CSR) or other forms of periodic breathing in an effort to reduce the likelihood of unnecessary therapy directed toward preventing sleep interruption. Following each burst of respiration during CSR, a prediction is made as to whether the amount of respiration achieved during the burst will be sufficient to sustain the patient through a period of apnea until the next respiration burst. If not, aggressive therapy, such as aggressive diaphragmatic pacing, is delivered to improve respiration and prevent the imminent sleep interruption. If, however, the amount of respiration achieved during the burst appears to be sufficient to sustain the patient until the next respiration burst, then relatively mild therapy is instead delivered. Preferably, the prediction is made by comparing respiration achieved during a CSR respiration burst against the minimal respiration demands of the patient, evaluated based on respiration occurring shortly after the onset of sleep.
摘要翻译：提供技术用于控制响应于Cheyne-Stokes呼吸（CSR）或其他形式的周期性呼吸而递送的治疗，以减少针对预防睡眠中断的不必要的治疗的可能性。在CSR期间的每次呼吸爆发之后，预测在爆发期间实现的呼吸量是否足以在一段呼吸暂停直到下一次呼吸爆发之前维持患者。如果没有，积极的治疗，如积极的膈肌起搏，以提高呼吸，并防止即将到来的睡眠中断。然而，如果在爆发期间实现的呼吸量似乎足以维持患者直到下一次呼吸爆发，那么相反地进行相对温和的治疗。优选地，通过将在CSR呼吸爆发期间实现的呼吸与基于睡眠开始后不久发生的呼吸评估的患者的最小呼吸需求进行比较来进行预测。

97. 发明授权

US07336999B1 Means to check the validity of heart failure surrogate parameters from evoked response using 3-D accelerometer queue 失效
标题翻译：使用3-D加速度计队列从诱发反应检查心力衰竭替代参数的有效性的手段
公开(公告)号：US07336999B1
公开(公告)日：2008-02-26
申请号：US11080219
申请日：2005-03-14
申请人： Steve Koh
发明人： Steve Koh
IPC分类号： A61N1/37
CPC分类号： A61N1/3627 , A61N1/3712
摘要： In one implementation, a method is provided for detecting heart failure which includes retrieving a three-dimensional posture template corresponding to a normal evoked response. The method further includes capturing an intracardiac electrogram of an evoked response and detecting a three-dimensional posture corresponding with the intracardiac electrogram. The detected three-dimensional posture and the three-dimensional posture template are compared. The captured intracardiac electrogram is used for heart failure trend analysis if the comparison of the detected three-dimensional posture and the three-dimensional posture template indicates a same posture.
摘要翻译：在一个实施方案中，提供了一种用于检测心力衰竭的方法，其包括检索与正常诱发反应相对应的三维姿态模板。该方法还包括捕获诱发反应的心内电描记图并检测对应于心内电描记图的三维姿势。比较检测到的立体姿势和三维姿态模板。如果检测到的三维姿势与三维姿态模板的比较表示相同的姿势，则采集的心内电描记图被用于心力衰竭趋势分析。

98. 发明申请

US20070156199A1 MULTI-VARIABLE FEEDBACK CONTROL OF STIMULATION FOR INSPIRATORY FACILITATION 失效
标题翻译：多变量反馈控制刺激感染器具
公开(公告)号：US20070156199A1
公开(公告)日：2007-07-05
申请号：US11624106
申请日：2007-01-17
申请人： Steve Koh , Michael Benser
发明人： Steve Koh , Michael Benser
IPC分类号： A61N1/36
CPC分类号： A61N1/3601
摘要： An exemplary method includes delivering stimulation according to one or more stimulation parameters to cause contraction of the diaphragm, monitoring chest activity related to respiration and, in response to the monitoring, adjusting one or more of the one or more stimulation parameters during contraction of the diaphragm and continuing the delivering. Various other exemplary methods, devices, systems, etc., are also disclosed.
摘要翻译：示例性方法包括根据一个或多个刺激参数递送刺激以引起隔膜的收缩，监测与呼吸相关的胸部活动，并且响应于该监测，在隔膜收缩期间调整一个或多个刺激参数中的一个或多个并继续交付。还公开了各种其它示例性方法，装置，系统等。

99. 发明授权

US07225016B1 Implantable medical device with nerve signal sensing 有权
标题翻译：具有神经信号感知的植入式医疗器械
公开(公告)号：US07225016B1
公开(公告)日：2007-05-29
申请号：US10870367
申请日：2004-06-16
申请人： Steve Koh
发明人： Steve Koh
IPC分类号： A61N1/04 , A61N1/37 , A61B5/04
CPC分类号： A61B5/04001 , A61B5/046 , A61B5/0464 , A61B5/4041 , A61N1/0551 , A61N1/0556 , A61N1/3601 , A61N1/3605 , A61N1/36114 , A61N1/365 , A61N1/3962
摘要： An implantable medical device which has a sensor that provides a waveform to an energy accumulator, such as a capacitor. The waveform is representative of electrical activity from a nerve. The implantable medical device further includes a threshold detector which provides a discrete output signal when the energy in the signal energy accumulator exceeds a threshold. The signal energy accumulator can be periodically discharged and then recharged during the time period that electrical activity is being sensed from the nerve thereby generating a number of discrete output signals each time the recharged energy accumulator exceeds the threshold. The frequency and number of pulsed outputs is indicative of the sensed electrical activity.
摘要翻译：一种可植入医疗装置，其具有向诸如电容器的能量累加器提供波形的传感器。波形代表神经的电活动。可植入医疗装置还包括阈值检测器，当信号能量累加器中的能量超过阈值时提供离散的输出信号。信号能量累加器可以在从神经感测到电活动的时间段期间被周期性地放电，然后再充电，从而在每次再充电的能量累加器超过阈值时产生多个离散的输出信号。脉冲输出的频率和数量表示感测到的电活动。

100. 发明授权

US07212862B2 Cardiac stimulation device including sleep apnea prevention and treatment 有权
标题翻译：心脏刺激装置包括睡眠呼吸暂停预防和治疗
公开(公告)号：US07212862B2
公开(公告)日：2007-05-01
申请号：US10247137
申请日：2002-09-18
申请人： Euljoon Park , Steve Koh , Gene A. Bornzin
发明人： Euljoon Park , Steve Koh , Gene A. Bornzin
IPC分类号： A61N1/365
CPC分类号： A61N1/36585 , A61N1/3601 , A61N1/36542 , A61N1/36557
摘要： An implantable cardiac stimulation device comprises a physiologic sensor and one or more pulse generators. The physiologic sensor is capable of sensing a physiologic parameter. The pulse generators can generate cardiac pacing pulses with a timing based on the physiologic parameter. The timed cardiac pacing pulses can prevent a sleep apnea condition. In one example, a cardiac stimulation device has a physiologic sensor and can be configured to pace a patient's heart according to a rest mode of operation. The cardiac stimulation device uses measurements from the physiologic sensor to prevent and treat sleep apnea using a revised rest mode of operation. The revised rest mode operates under a presumption that sleep apnea is primary to a reduced heart rate, rather than secondary, so that pacing at a rate higher than the natural cardiac rate during sleep will prevent sleep apnea.
摘要翻译：植入式心脏刺激装置包括生理传感器和一个或多个脉冲发生器。生理传感器能感测生理参数。脉冲发生器可以产生基于生理参数的定时的心脏起搏脉冲。定时的心脏起搏脉冲可以防止睡眠呼吸暂停状态。在一个示例中，心脏刺激装置具有生理传感器，并且可以被配置为根据休息的操作模式来对患者的心脏进行加速。心脏刺激装置使用来自生理传感器的测量来使用修改的休息模式来预防和治疗睡眠呼吸暂停。修改后的休息模式的作用是假设睡眠呼吸暂停是降低心率而不是继发性睡眠呼吸暂停的原因，因此在睡眠期间以高于自然心率的速率起搏将防止睡眠呼吸暂停。

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