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111. 发明申请

WO2005011802A3 MECHANICALLY-BASED INTERVAL OPTIMIZATION FOR A BIVENTRICULAR PACING ENGINE 审中-公开
公开(公告)号：WO2005011802A3
公开(公告)日：2005-02-10
申请号：PCT/US2004/024493
申请日：2004-07-29
申请人： MEDTRONIC, INC. , WARKENTIN, Dwight, H.
发明人： WARKENTIN, Dwight, H.
IPC分类号： A61N01/365
摘要： According to the present invention, discrete measurements of fluid pressure development (and derivatives thereof) are used in optimizing hemodynamics for cardiac resynchronization therapy (CRT) delivery and multiple chamber cardiac pacing, and in enhancing hemodynamics in the event of a sub-optimal left-side lead placement. For example, such diverse pressure measurements include: maximum positive or negative dP/dt values, ePAD, RV systolic, RV diastolic, pulse pressure, and the like. According to the present invention, on a periodic basis or upon demand one or more cardiac pacing intervals are iteratively cycled through a predetermined range and the resulting pressure measurements stored for comparison. The cardiac pacing intervals are then adjusted based at least in part upon the most appropriate, or desirable, measured hemodynamics of the patient. The present invention may be implemented as computer readable instructions executed by a microprocessor-based implantable medical device.

112. 发明申请

WO2004101062A2 METHOD AND APPARATUS TO MONITOR PULMONARY EDEMA 审中-公开
标题翻译：监测器脉搏波的方法和装置
公开(公告)号：WO2004101062A2
公开(公告)日：2004-11-25
申请号：PCT/US2004/013152
申请日：2004-04-28
申请人： MEDTRONIC, INC. , BURNES, John, E.
发明人： BURNES, John, E.
IPC分类号： A61N
CPC分类号： A61B5/0472 , A61M5/14276 , A61N1/3627 , A61N1/3702
摘要： In general, the invention is directed to monitoring fluid retention that may accompany congestive heart failure and pulmonary edema. A medical device, such as an implanted pacemaker or an external defibrillator, senses electrical signals associated with the periodic depolarization and re-polarization of a heart. The device processes the electrical signals to obtain one or more "cardiac parameters," which reflect pulmonary edema. By monitoring the cardiac parameters, the device monitors pulmonary edema. Cardiac parameters comprise the amplitude of the QRS complex, the integral of the QRS complex, or the integral of the QRST segment and the like. When the device detects fluid buildup, the device may respond by taking remedial action and/or generating an alert.
摘要翻译：通常，本发明涉及监测可伴随充血性心力衰竭和肺水肿的液体保留。诸如植入式心脏起搏器或外部除颤器之类的医疗装置感测到与心脏的周期性去极化和再极化相关联的电信号。该装置处理电信号以获得反映肺水肿的一个或多个“心脏参数”。通过监测心脏参数，该装置监测肺水肿。心脏参数包括QRS波段的振幅，QRS波段的积分或QRST段的积分等。当设备检测到液体积聚时，设备可以通过采取补救措施和/或产生警报来做出响应。

113. 发明申请

WO2004096345A2 CARDIAC PACING FOR OPTIMAL INTRA-LEFT VENTRICULAR RESYNCHRONIZATION 审中-公开
标题翻译： CARDIAC PACING用于最佳的左心室再生
公开(公告)号：WO2004096345A2
公开(公告)日：2004-11-11
申请号：PCT/US2004/011649
申请日：2004-04-14
申请人： MEDTRONIC, INC. , PRINZEN, Frits, W. , VERBEEK, Marcel A. E.
发明人： PRINZEN, Frits, W. , VERBEEK, Marcel A. E.
IPC分类号： A61N1/00
CPC分类号： A61N1/368
摘要： Cardiac pacing to treat ventricle dysynchrony for improved cardiac function is performed as follows. Early paced inter-ventricular asynchrony is determined during ventricular pacing. Baseline inter-ventricular asynchrony is determined without pacing. Average inter-ventricular asynchrony is calculated by averaging the early paced inter-ventricular asynchrony and the baseline inter-ventricular asynchrony. Atrio-ventricular delay and ventricular-ventricular delay are adjusted during ventricular pacing to yield the average nter-ventricular asynchrony for optimal intra-left ventricular resynchronization and maximal cardiac function. The elements above can be configured in software contained in an implantable medical device or embodied as a computer software product that includes a medium readable by a processor.
摘要翻译：心脏起搏治疗心室异常以改善心脏功能如下进行。在心室起搏期间确定早期起搏心室间不同步。确定基线心室间不同步，无起搏。平均心室间异常是通过对早期起搏心室间不同步和基线心室间不同步进行平均来计算的。在心室起搏期间调节心室延迟和心室 - 心室延迟，以产生最佳左心室再同步和最大心脏功能的平均心室不同步。上述元件可以用包含在可植入医疗设备中的软件来配置，或者被实现为包括可由处理器读取的介质的计算机软件产品。

114. 发明申请

WO2004096341A2 VENTRICULAR RATE STABILIZATION WITH CARDIAC RESYNCHRONIZATION 审中-公开
标题翻译：心脏再生能力的稳定性稳定性
公开(公告)号：WO2004096341A2
公开(公告)日：2004-11-11
申请号：PCT/US2004/012263
申请日：2004-04-20
申请人： MEDTRONIC, INC. , VAN OORT, Geeske , VAN HOVE, Jos, W.
发明人： VAN OORT, Geeske , VAN HOVE, Jos, W.
IPC分类号： A61N
CPC分类号： A61N1/368 , A61N1/3684
摘要： An implantable medical device (IMD) selectively switches to a more hemodynamically beneficial pacing mode upon detection of ventricular dysynchrony and/or reduced hemodynamic function during delivery of pacing pulses according to a ventricular rate stabilization algorithm. For example, in some embodiments of the invention, an IMD switches from right ventricular pacing according to a ventricular rate stabilization algorithm, to biventricular pacing according to the algorithm. The biventricular pacing can be provided according to a cardiac resynchronization therapy mode, and can involve use of an intraventricular delay between delivery of pacing pulses to the respective ventricles to improve hemodynamic functioning of a heart. The IMD monitors an electrogram signal to detect ventricular dysynchrony and/or decreased hemodynamic performance of the ventricles. The IMD can detect ventricular dysynchrony based on elongated QRS complex widths. The IMD can detect decreased hemodynamic performance based on shortened Q-T intervals and/or decreased ventricular evoked response amplitudes.
摘要翻译：根据心室速率稳定算法，可以在检测到心室异常和/或在递送起搏脉冲期间降低的血液动力学功能时，可植入医疗装置（IMD）选择性地切换到更有效的起搏方式。例如，在本发明的一些实施例中，IMD根据心室速率稳定算法从右心室起搏切换到根据该算法的双心室起搏。可以根据心脏再同步治疗模式提供双心室起搏，并且可以涉及在将起搏脉冲递送到各个心室之间使用室内延迟以改善心脏的血液动力学功能。 IMD监测电描记图信号以检测心室异常和/或降低心室的血液动力学性能。 IMD可以根据延长的QRS复杂宽度来检测心室异常。 IMD可以基于缩短的Q-T间期和/或降低的心室诱发反应幅度来检测血液动力学性能降低。

115. 发明申请

WO2004096041A2 METHOD AND APPARATUS FOR IMPEDANCE SIGNAL LOCALIZATIONS FROM IMPLANTED DEVICES 审中-公开
标题翻译：用于来自植入装置的阻抗信号定位的方法和装置
公开(公告)号：WO2004096041A2
公开(公告)日：2004-11-11
申请号：PCT/US2004/011470
申请日：2004-04-14
申请人： MEDTRONIC, INC. , WANG, Li
发明人： WANG, Li
IPC分类号： A61B5/053
CPC分类号： A61N1/36521 , A61B5/053 , A61B5/0809 , A61B5/7285
摘要： Method and apparatus for monitoring a plurality of physiological factors contributing to physiological conditions of a heart, that determines a first impedance, corresponding to the plurality of physiological factors, across a plurality of vectors, and a second impedance, corresponding to the plurality of physiological factors, across the plurality of vectors subsequent to determining the first impedance. A relative change in impedance corresponding to the plurality of vectors is determined in response to the first impedance and the second impedance, first minimally contributing physiological factors of the plurality of physiological factors associated with a first physiological factor of the plurality of physiological factors are determined, and relative change in tissue resistivity corresponding to the first physiological factor in response to physiological factors of the plurality of physiological factors other than the first minimal contributing physiological factors and the relative change in impedance are determined.
摘要翻译：用于监测对心脏的生理状况有贡献的多个生理因素的方法和装置，所述多个生理因素确定对应于多个生理因素的第一阻抗，跨多个矢量，并且第二阻抗，其对应于所述多个生理因素，在确定所述第一阻抗之后跨越所述多个矢量。响应于第一阻抗和第二阻抗确定与多个矢量相对应的阻抗的相对变化，首先确定与多个生理因素中的第一生理因素相关联的多个生理因素中的最小生理因素，并且响应于除第一最小有助于生理因素之外的多个生理因素的生理因素以及阻抗的相对变化来确定对应于第一生理因素的组织电阻率的相对变化。

116. 发明申请

WO2004093985A1 PACEMAKER WITH VASOVAGAL SYNCOPE DETECTION AND THERAPY 审中-公开
标题翻译： PASMAKER与VASOVAGAL SYNCOPE检测和治疗
公开(公告)号：WO2004093985A1
公开(公告)日：2004-11-04
申请号：PCT/US2004/011498
申请日：2004-04-14
申请人： MEDTRONIC, INC. , MARKOWITZ, H. Toby , ERICKSON, Mark, K.
发明人： MARKOWITZ, H. Toby , ERICKSON, Mark, K.
IPC分类号： A61N1/365
CPC分类号： A61N1/365
摘要： A method and apparatus for cardiac pacing are provided in which pacing pulses are delivered at an increased rate (454, 470) in response to a detected intrinsic heart rate drop (505) and a special rate drop response detection scheme is temporarily disabled (510) until an intrinsic heart rate exceeds a predetermined threshold value (450). If the pacing rate reaches the lower pacing rate without sensing intrinsic activity, heart rate drop detection remains disabled and lower rate pacing continues. Rate drop detection is re-enabled (530) whenever sufficient sensed intrinsic activity indicates that a sudden intrinsic rate drop could occur again.
摘要翻译：提供了一种用于心脏起搏的方法和装置，其中响应于检测到的固有心率下降（505）以增加的速率（454,470）递送起搏脉冲，并且暂时禁用特殊速率丢弃响应检测方案（510）直到固有心率超过预定阈值（450）。如果起搏速率达不到较低的起搏速率，而不检测内在活动，心率下降检测仍然被禁用，并且较低的起搏速度继续下去。只要足够的感测固有活动表明可能再次发生突然的内在速率下降，速率下降检测被重新启用（530）。

117. 发明申请

WO2004084989A1 METHOD AND APPARATUS FOR GAUGING CARDIAC STATUS USING POST PREMATURE HEART RATE TURBULENCE 审中-公开
标题翻译：使用后期预测心率妊娠测量心脏状态的方法和装置
公开(公告)号：WO2004084989A1
公开(公告)日：2004-10-07
申请号：PCT/US2004/008592
申请日：2004-03-18
申请人： MEDTRONIC INC. , BURNES, John, E. , MULLIGAN, Lawrence, J. , HILL, Michael, R., S.
发明人： BURNES, John, E. , MULLIGAN, Lawrence, J. , HILL, Michael, R., S.
IPC分类号： A61N1/362
CPC分类号： A61B5/02405 , A61B5/0245 , A61N1/3622 , A61N1/3627 , A61N1/365 , A61N1/3682
摘要： A hemodynamic status of a patient is determined in an implanted medical device (IMD) by observing a perturbation of the patient's heart, measuring heart rate turbulence resulting from the perturbation, and quantifying the heart rate turbulence to determine the hemodynamic status. The perturbation may be naturally-occurring, or may be generated by the implantable medical device. The patient's response to heart rate turbulence may also be used to provide a response to the patient, such as providing an alarm and/or administering a therapy. Heart rate turbulence may also be used to tune and/or optimize a device parameter such as A-V or V-V pacing intervals.
摘要翻译：通过观察患者心脏的扰动，测量由扰动引起的心率湍流并量化心率湍流以确定血液动力学状态，在植入的医疗装置（IMD）中确定患者的血液动力学状态。扰动可以是天然存在的，或者可以由可植入医疗装置产生。患者对心率湍流的反应也可用于向患者提供反应，例如提供警报和/或施用治疗。心率湍流也可用于调节和/或优化诸如A-V或V-V起搏间隔的装置参数。

118. 发明申请

WO2004050183A1 SLOW RISE DEFIBRILLATION WAVEFORMS FOR A PULSE MODULATED CIRCUIT 审中-公开
标题翻译：用于脉冲调制电路的缓慢上升的波形波形
公开(公告)号：WO2004050183A1
公开(公告)日：2004-06-17
申请号：PCT/US2003/038312
申请日：2003-12-03
申请人： MEDTRONIC, INC.
发明人： BELK, Paul, A. , DEGROOT, Paul, J.
IPC分类号： A61N1/39
CPC分类号： A61N1/3906
摘要： The present invention provides structures and methods for delivering a complex slow-rise defibrillation waveform wherein in lieu of the simple truncation of prior art defibrillation waveforms, when a predetermined amplitude is reached for an ascending waveform (e.g., a ramp waveform), the waveform transitions to an exponential decay portion for a period of time and at the expiration of the period of time, a truncation occurs. In the event that a first complex bi-phasic ramp wave form is implemented, a second opposite polarity waveform may be delivered. Said second waveform is preferably of similar shape to the first waveform, but of a less magnitude amplitude, although the second waveform may comprise a traditional waveform. The implementation and feasibility of the waveforms according to the present invention in an ICD or an AED is relatively simple while providing significant advantages not previously known or used in the prior art.
摘要翻译：本发明提供了用于递送复合慢速除颤波形的结构和方法，其中，当对于上升波形（例如，斜坡波形）达到预定幅度时，代替现有技术除颤波形的简单截断，波形转换到指数衰减部分一段时间，并且在该时间段到期时，发生截断。在实现第一复杂的双相斜波波形的情况下，可以传送第二相反极性波形。所述第二波形优选地具有与第一波形相似的形状，但幅度较小的幅度，尽管第二波形可以包括传统波形。根据本发明的波形在ICD或AED中的实现和可行性相对简单，同时提供了现有技术中未曾知道或使用的显着优点。

119. 发明申请

WO2004047917A1 ISCHEMIA DETECTION 审中-公开
标题翻译： ISCHEMIA检测
公开(公告)号：WO2004047917A1
公开(公告)日：2004-06-10
申请号：PCT/US2003/035881
申请日：2003-11-12
申请人： MEDTRONIC, INC.
发明人： SHELDON, Todd, J. , NELSON, Shannon, D. , STYLOS, Lee , STADLER, Robert, W.
IPC分类号： A61N1/365
CPC分类号： A61N1/368 , A61N1/3627 , A61N1/36585
摘要： Techniques for detection and treatment of myocardial ischemia are described that monitor both the electrical and dynamic mechanical activity of the heart to detect and verify the occurrence of myocardial ischemia in a more reliable manner. The occurrence of myocardial ischemia can be detected by monitoring changes in an electrical signal such as an ECG or EGM, and changes in dynamic mechanical activity of the heart that are sensed by an accelerometer sensor. The heart acceleration signal can be obtained from an single- or multiple-axis accelerometer and/or a pressure sensor deployed within or near the heart. The techniques correlate contractility changes detected by an accelerometer or pressure sensor with changes in the ST electrogram segment detected by the electrodes to increase the reliability of ischemia detection.
摘要翻译：描述了用于检测和治疗心肌缺血的技术，其监测心脏的电和动态机械活性以更可靠的方式检测和验证心肌缺血的发生。可以通过监测诸如ECG或EGM的电信号的变化以及由加速度计传感器感测到的心脏的动态机械活动的变化来检测心肌缺血的发生。心脏加速度信号可以从部署在心脏内部或附近的单轴或多轴加速度计和/或压力传感器获得。该技术将由加速度计或压力传感器检测到的收缩性变化与由电极检测到的ST电描绘部分的变化相关联，以增加缺血检测的可靠性。

120. 发明申请

WO2004030749A1 APPARATUS AND METHOD FOR OPTIMIZING CAPACITOR CHARGE IN A MEDICAL DEVICE 审中-公开
标题翻译：在医疗设备中优化电容器充电的装置和方法
公开(公告)号：WO2004030749A1
公开(公告)日：2004-04-15
申请号：PCT/US2003/030568
申请日：2003-09-26
申请人： MEDTRONIC, INC.
发明人： NORTON, John, D. , RORVICK, Anthony, W.
IPC分类号： A61N1/00
CPC分类号： A61N1/3975 , A61N1/3981
摘要： A medical device for electrical termination of an arrhythmic condition of a patient's heart in embodiments of the invention may include one or more of the following features: (a) at least one battery; (b) means for detection of an arrhythmic condition of a patient's heart; (c) at least one high voltage capacitor; (d) converter means for providing charging current from said battery to said capacitor; (e) means for maintenance of a charge on said capacitor between arrhythmia therapies; (f) controller means responsive to detection of an arrhythmic condition of said patient's heart and for providing a discharge control signal; and (g) discharge circuit means for delivering voltage stored on said capacitor to said patient's heart in response to said discharge control signal.
摘要翻译：在本发明的实施例中用于电终止患者心脏的心律失常状态的医疗装置可以包括以下特征中的一个或多个：（a）至少一个电池; （b）检测患者心脏的心律不齐症的手段; （c）至少一个高电压电容器; （d）用于从所述电池向所述电容器提供充电电流的转换器装置; （e）用于在心律失常治疗之间维持所述电容器上的电荷的装置; （f）响应于所述患者心脏的心律失常状态的检测并用于提供放电控制信号的控制器装置; 以及（g）放电电路装置，用于响应于所述放电控制信号将存储在所述电容器上的电压传送到所述患者的心脏。

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