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11. 发明申请

US20120303084A1 SECURE AND EFFICACIOUS THERAPY DELIVERY FOR A PACING ENGINE 审中-公开
标题翻译：安全和有效的治疗发动机
公开(公告)号：US20120303084A1
公开(公告)日：2012-11-29
申请号：US13569523
申请日：2012-08-08
申请人： Karen J. Kleckner , Kathleen A. Prieve , Jeffrey M. Gillberg , Ren Zhou , Kenneth M. Anderson , D. Curtis Deno , Glenn C. Zillmer , Ruth N. Klepfer , Vincent E. Splett , David E. Euler , Lawrence J. Mulligan , Edwin G. Duffin , David A. Igel , John E. Burnes
发明人： Karen J. Kleckner , Kathleen A. Prieve , Jeffrey M. Gillberg , Ren Zhou , Kenneth M. Anderson , D. Curtis Deno , Glenn C. Zillmer , Ruth N. Klepfer , Vincent E. Splett , David E. Euler , Lawrence J. Mulligan , Edwin G. Duffin , David A. Igel , John E. Burnes
IPC分类号： A61N1/365
CPC分类号： A61N1/3627 , A61N1/36114 , A61N1/36521 , A61N1/36564 , A61N1/36578 , A61N1/36585 , A61N1/3684 , A61N1/3962
摘要： The above-described methods and apparatus are believed to be of particular benefit for patients suffering heart failure including cardiac dysfunction, chronic HF, and the like and all variants as described herein and including those known to those of skill in the art to which the invention is directed. It will understood that the present invention offers the possibility of monitoring and therapy of a wide variety of acute and chronic cardiac dysfunctions. The current invention provides systems and methods for delivering therapy for cardiac hemodynamic dysfunction via the innervated myocardial substrate receives one or more discrete pulses of electrical stimulation during the refractory period of said innervated myocardial substrate.
摘要翻译：据信上述方法和装置对于患有心力衰竭，包括心脏功能障碍，慢性HF等的患者以及本文所述的所有变体以及包括本发明的本领域技术人员已知的那些的患者特别有益被指示。应当理解，本发明提供监测和治疗各种急性和慢性心脏功能障碍的可能性。本发明提供了用于通过所述神经支配的心肌底物递送治疗心脏血液动力学功能障碍的系统和方法，在所述神经支配的心肌基质的不应期期间接收电刺激的一个或多个离散脉冲。

12. 发明授权

US07970466B2 Method and apparatus for optimization and assessment of response to extra-systolic stimulation (ESS) therapy 失效
标题翻译：用于优化和评估对收缩期刺激（ESS）治疗的反应的方法和装置
公开(公告)号：US07970466B2
公开(公告)日：2011-06-28
申请号：US10680494
申请日：2003-10-07
申请人： Lawrence J. Mulligan , D. Curtis Deno , John E. Burnes , Nirav V. Sheth
发明人： Lawrence J. Mulligan , D. Curtis Deno , John E. Burnes , Nirav V. Sheth
IPC分类号： A61N1/00 , A61B5/04
CPC分类号： A61N1/3627 , A61N1/36514 , A61N1/36578
摘要： A method and apparatus for optimizing and assessing the response to extra-systolic stimulation (ESS) are provided. An optimization/monitoring parameter is calculated as a function of potentiation ratio, PR, and recirculation fraction, RF, derived from measurements of myocardial contractile function during and after ESS. PR may be computed as the ratio of the contractile function on post-extra-systolic beats during ESS to baseline contractile function. RF may be computed as the slope of a linear regression performed on a plot of the contractile function for a post-extra-systolic beat versus the contractile function for the previous post-extra-systolic beat after ESS is ceased. The ESI resulting in a maximum optimization/monitoring parameter, preferably computed as the product of PR and RF, is determined as the optimal ESI. The operating ESI may be automatically adjusted, and/or PR and RF data may be stored for monitoring purposes.
摘要翻译：提供了一种用于优化和评估对收缩期刺激（ESS）的反应的方法和装置。根据ESS期间和之后的心肌收缩功能测量得出，优化/监测参数作为增强比PR和再循环分数RF的函数计算。 PR可以计算为ESS期间收缩功能对收缩后收缩期与基线收缩功能的比值。 RF可以被计算为在ESS停止之后针对收缩后收缩压的收缩功能图与先前的收缩后节拍后的收缩功能的曲线进行的线性回归的斜率。产生最大优化/监测参数的ESI，优选地计算为PR和RF的乘积，被确定为最佳ESI。可以自动调整操作ESI，并且可以存储和/或PR和RF数据用于监视目的。

13. 发明申请

US20100152804A1 SECURE AND EFFICACIOUS THERAPY DELIVERY FOR A PACING ENGINE 有权
标题翻译：安全和有效的治疗发动机
公开(公告)号：US20100152804A1
公开(公告)日：2010-06-17
申请号：US12633893
申请日：2009-12-09
申请人： Karen J. Kleckner , Kathleen A. Prieve , Jeffrey M. Gillberg , Ren Zhou , Kenneth M. Anderson , D. Curtis Deno , Glenn C. Zillmer , Ruth N. Klepfer , Vincent E. Splett , David E. Euler , Lawrence J. Mulligan , Edwin G. Duffin , David A. Igel , John E. Burnes
发明人： Karen J. Kleckner , Kathleen A. Prieve , Jeffrey M. Gillberg , Ren Zhou , Kenneth M. Anderson , D. Curtis Deno , Glenn C. Zillmer , Ruth N. Klepfer , Vincent E. Splett , David E. Euler , Lawrence J. Mulligan , Edwin G. Duffin , David A. Igel , John E. Burnes
IPC分类号： A61N1/365
CPC分类号： A61N1/3627 , A61N1/36114 , A61N1/36521 , A61N1/36564 , A61N1/36578 , A61N1/36585 , A61N1/3684 , A61N1/3962
摘要： The above-described methods and apparatus are believed to be of particular benefit for patients suffering heart failure including cardiac dysfunction, chronic HF, and the like and all variants as described herein and including those known to those of skill in the art to which the invention is directed. It will understood that the present invention offers the possibility of monitoring and therapy of a wide variety of acute and chronic cardiac dysfunctions. The current invention provides systems and methods for delivering therapy for cardiac hemodynamic dysfunction via the innervated myocardial substrate receives one or more discrete pulses of electrical stimulation during the refractory period of said innervated myocardial substrate.
摘要翻译：据信上述方法和装置对于患有心力衰竭，包括心脏功能障碍，慢性HF等的患者以及本文所述的所有变体以及包括本发明的本领域技术人员已知的那些的患者特别有益被指示。应当理解，本发明提供监测和治疗各种急性和慢性心脏功能障碍的可能性。本发明提供了用于通过所述神经支配的心肌底物递送治疗心脏血液动力学功能障碍的系统和方法，在所述神经支配的心肌基质的不应期期间接收电刺激的一个或多个离散脉冲。

14. 发明授权

US07289850B2 System for enhanced cardiac function with combined PESP/NES 有权
标题翻译：使用PESP / NES组合增强心脏功能的系统
公开(公告)号：US07289850B2
公开(公告)日：2007-10-30
申请号：US11116941
申请日：2005-04-28
申请人： John E. Burnes , Lawrence J. Mulligan , Randall L. Knoll
发明人： John E. Burnes , Lawrence J. Mulligan , Randall L. Knoll
IPC分类号： A61N1/36
CPC分类号： A61N1/3627 , A61N1/36114 , A61N1/36564
摘要： In some embodiments, a method of applying stimulation pulse therapy to excitable tissue may include one or more of the following steps: (a) delivering a PESP stimulation therapy to the excitable tissue for a cardiac cycle, (b) delivering a NES stimulation therapy to the excitable tissue during certain cardiac cycles, (c) determining physiologic demand of the patient based on at least one physiologic measurement, (d) determining physiologic demand being placed on a heart based on at least one physiologic measurement, and ceasing the delivery of the NES and PESP stimulation therapy when physiologic demand returns to a base level, and (e) determining physiologic demand being placed on a heart based on at least one physiologic measurement, and modulating the ratio of the number of cardiac cycles in which the NES stimulation therapy is delivered to the number of cardiac cycles in which the PESP stimulation therapy is delivered based on physiologic demand.
摘要翻译：在一些实施方案中，将刺激脉冲治疗应用于可兴奋组织的方法可以包括以下步骤中的一个或多个：（a）将PESP刺激疗法递送至心脏周期的可兴奋组织，（b）将NES刺激疗法递送至（c）基于至少一个生理测量来确定患者的生理需求，（d）基于至少一个生理测量来确定置于心脏上的生理需求，并且停止递送 NES和PESP刺激治疗，当生理需求恢复到基础水平时，以及（e）基于至少一个生理测量来确定置于心脏上的生理需求，以及调节NES刺激疗法的心脏周期数基于生理需求被传递到其中递送PESP刺激疗法的心脏周期数。

15. 发明授权

US07130684B2 Method and apparatus for improving ventricular status using the force interval relationship 失效
标题翻译：使用力间隔关系改善心室状态的方法和装置
公开(公告)号：US07130684B2
公开(公告)日：2006-10-31
申请号：US10426730
申请日：2003-04-30
申请人： Lawrence J. Mulligan , Michael R. S. Hill , John E. Burnes
发明人： Lawrence J. Mulligan , Michael R. S. Hill , John E. Burnes
IPC分类号： A61N1/362
CPC分类号： A61N1/36514 , A61N1/3627
摘要： Methods and devices for improving ventricular contractile status of a patient suitably exploit changes in ventricular pressure and/or dP/dtmax to provide and/or optimize a response to a patient. The ventricular pressure may be appropriately correlated to intracellular calcium regulation, which is indicative of contractile status. To assess ventricular contractile status, the device suitably observes a cardiac perturbation of the patient and measures force interval potentiation following the perturbation. The contractile potentiation can then be stored and/or quantified in the implantable medical device to determine the ventricular contractile status of the patient, and an appropriate response may be provided to the patient as a function of the ventricular contractile status. Examples of responses may include administration of drug or neuro therapies, modification of a pacing rate, or the like. Force interval potentiation may also be used to optimize or improve a parameter for a response provided by the implantable medical device.
摘要翻译：用于改善患者的心室收缩状态的方法和装置适当地利用心室压力和/或dP / dt最大值的变化来提供和/或优化对患者的反应。心室压力可以适当地与细胞内钙调节相关，细胞内钙调节指示收缩状态。为了评估心室收缩状态，该装置适当地观察患者的心脏摄动，并测量扰动后的力间隔增强作用。收缩增强能随后在可植入的医疗装置中被储存和/或定量，以确定患者的心室收缩状态，并且作为心室收缩状态的函数可以向患者提供适当的响应。反应的实例可包括药物或神经疗法的施用，起搏速率的改变等。力间隔增强也可用于优化或改善由可植入医疗装置提供的响应的参数。

16. 发明授权

US07079887B2 Method and apparatus for gauging cardiac status using post premature heart rate turbulence 有权
标题翻译：使用过早的心率湍流来测量心脏状态的方法和装置
公开(公告)号：US07079887B2
公开(公告)日：2006-07-18
申请号：US10394778
申请日：2003-03-20
申请人： John E. Burnes , Lawrence J. Mulligan , Michael R. S. Hill
发明人： John E. Burnes , Lawrence J. Mulligan , Michael R. S. Hill
IPC分类号： A61B5/04
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。

17. 发明授权

US06994676B2 Method and apparatus for assessing ventricular contractile status 失效
标题翻译：评估心室收缩状态的方法和装置
公开(公告)号：US06994676B2
公开(公告)日：2006-02-07
申请号：US10426425
申请日：2003-04-30
申请人： Lawrence J. Mulligan , Ursula Gebhardt
发明人： Lawrence J. Mulligan , Ursula Gebhardt
IPC分类号： A61B5/04
CPC分类号： A61N1/3627
摘要： Methods and devices for improving ventricular contractile status of a patient suitably exploit changes in ventricular pressure and/or dP/dtmax to provide and/or optimize a response to a patient. The ventricular pressure may be appropriately correlated to intracellular calcium regulation, which is indicative of contractile status. To assess ventricular contractile status, the device suitably observes a cardiac perturbation of the patient and measures force interval potentiation following the perturbation. The contractile potentiation can then be stored and/or quantified in the implantable medical device to determine the ventricular contractile status of the patient, and an appropriate response may be provided to the patient as a function of the ventricular contractile status. Examples of responses may include administration of drug or neuro therapies, modification of a pacing rate, or the like. Force interval potentiation may also be used to optimize or improve a parameter for a response provided by the implantable medical device.
摘要翻译：用于改善患者的心室收缩状态的方法和装置适当地利用心室压力和/或dP / dt最大值的变化来提供和/或优化对患者的反应。心室压力可以适当地与细胞内钙调节相关，细胞内钙调节指示收缩状态。为了评估心室收缩状态，该装置适当地观察患者的心脏摄动，并测量扰动后的力间隔增强作用。收缩增强能随后在可植入的医疗装置中被储存和/或定量，以确定患者的心室收缩状态，并且作为心室收缩状态的函数可以向患者提供适当的响应。反应的实例可包括药物或神经疗法的施用，起搏速率的改变等。力间隔增强也可用于优化或改善由可植入医疗装置提供的响应的参数。

18. 发明授权

US06915157B2 Implantable medical device for assessing heart failure state from Mechanical Pulsus Alternans 有权
标题翻译：用于评估机械Pulsus Alternans的心力衰竭状态的可植入医疗装置
公开(公告)号：US06915157B2
公开(公告)日：2005-07-05
申请号：US10368278
申请日：2003-02-18
申请人： Tommy D. Bennett , Lawrence J. Mulligan , Edwin G. Duffin , Robert C. Hamlen , Wael Abo-Auda
发明人： Tommy D. Bennett , Lawrence J. Mulligan , Edwin G. Duffin , Robert C. Hamlen , Wael Abo-Auda
IPC分类号： A61B5/00 , A61B5/0215 , A61B5/0245 , A61B5/0452 , A61B5/04
CPC分类号： A61B5/02405 , A61B5/0031 , A61B5/0215 , A61B5/0245 , A61B5/0452
摘要： An implantable heart monitor (IHM) implanted in a patient's body having electrogram (EGM) sense electrodes coupled with EGM sense circuitry to generate sense events upon detection of cardiac depolarizations and a blood pressure measurement transducer disposed in a heart chamber and coupled with blood pressure measurement circuitry operates to assess heart failure state as a function of mechanical pulsus alternans (MPA). MPA episodes are detected, and MPA characteristics of the MPA episode are used alone or as a group as a diagnostic marker of HF state. The MPA episode data set can be stored in memory associated with a time and date stamp. The MPA characteristics of each MPA data set in a series of MPA data sets collected over time can be compared or plotted to determine if a trend indicative of change in HF state is discernible.
摘要翻译：一种植入式心脏监测器（IHM），其植入患者体内，其具有与EGM感测电路耦合的电描记图（EGM）感测电极，以便在检测到心脏去极化时产生感测事件，以及设置在心室中的血压测量换能器，并与血压测量结合电路用于评估作为机械脉动交替（MPA）的函数的心力衰竭状态。检测到MPA发作，MPA发作的MPA特征单独使用或作为HF状态的诊断标记使用。 MPA情节数据集可以存储在与时间和日期戳相关联的存储器中。可以比较或绘制在一段时间内收集的一系列MPA数据集中的每个MPA数据集的MPA特性，以确定指示HF状态变化的趋势是否可辨别。

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