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    • 38. 发明授权
    • Method and apparatus to automatically optimize the pacing mode and
pacing cycle parameters of a dual chamber pacemaker
    • 自动优化双室心脏起搏器的起搏模式和起搏循环参数的方法和装置
    • US5540727A
    • 1996-07-30
    • US339813
    • 1994-11-15
    • Bruce A. TockmanJulio C. SpinelliRodney W. Salo
    • Bruce A. TockmanJulio C. SpinelliRodney W. Salo
    • A61N1/362A61N1/365A61N1/368
    • A61N1/36585A61N1/3627A61N1/3682A61N1/3688
    • A cardiac stimulating system incorporating a microprocessor-based controller is designed to automatically optimize both the pacing mode and one or more pacing cycle parameters in a way that results in optimization of a cardiac performance parameter, such as cardiac output. For each of a plurality of modes in which a DDD cardiac pacer can operate, a pacing parameter such as the AV interval of the pacer is incrementally adjusted and following that, an observation is made as to the effect of the adjustment on cardiac output. After the process has been repeated for all possible pacing modes, a determination is made to find the pacing mode and the AV interval or other pacing parameter that results in the maximum cardiac output or other optimal cardiac performance parameter. It is these pacing parameters that are then programmed into the microcontroller for causing the pacemaker to function in the desired mode and at the desired parameter values.
    • 设计包含基于微处理器的控制器的心脏刺激系统被设计为以导致心脏性能参数(例如心输出量)的优化的方式自动优化起搏模式和一个或多个起搏周期参数。 对于DDD心脏起搏器可以操作的多种模式中的每种,逐步调整起搏参数,例如起搏器的AV间隔,并且随后观察调节对心输出量的影响。 在针对所有可能的起搏模式重复该过程之后,确定找到导致最大心输出量或其他最佳心脏性能参数的起搏模式和AV间隔或其他起搏参数。 正是这些起搏参数然后被编程到微控制器中,以使起搏器在期望的模式和期望的参数值下起作用。
    • 39. 发明授权
    • Automated programmable stimulating device to optimize pacing parameters
and method
    • 自动可编程刺激装置优化起搏参数和方法
    • US5487752A
    • 1996-01-30
    • US339567
    • 1994-11-15
    • Rodney W. SaloJulio C. SpinelliBruce A. Tockman
    • Rodney W. SaloJulio C. SpinelliBruce A. Tockman
    • A61N1/362A61N1/365A61N1/368
    • A61N1/3625A61N1/3627A61N1/36514A61N1/3682
    • A method and apparatus for automatically optimizing a cardiac performance parameter of the heart, such as its cardiac output mean arterial pressure pO.sub.2 or pCO.sub.2. The performance parameter is optimized by periodically pacing the heart for a short period of time with stimulating pulses having a modified pacing parameter value. The intrinsic operation of the heart is monitored a majority of the time and establishes a baseline value for the cardiac performance parameter. The heart is then paced with the modified pacing parameter value during an interval that is approximately a 1:4 ratio with respect to the baseline monitoring interval. The method of the present invention can be achieved using a totally implanted pacemaker, an implanted pulse generator in combination with external equipment communicating with the pacemaker via telemetry, or by using equipment located external the patient.
    • 用于自动优化心脏的心脏性能参数的方法和装置,例如其心输出量平均动脉压pO2或pCO2。 性能参数通过在具有改变的起搏参数值的刺激脉冲中周期性地对心脏起搏一段时间进行优化。 在大多数时间内监测心脏的固有操作,并建立心脏性能参数的基线值。 然后在相对于基线监测间隔约为1:4的间隔的间隔内,使用修改的起搏参数值对心脏进行起搏。 本发明的方法可以使用完全植入的起搏器,植入式脉冲发生器与通过遥测与起搏器通信的外部设备,或通过使用位于病人外部的设备来实现。
    • 40. 发明授权
    • Cardiac stimulating apparatus and method for heart failure therapy
    • 心脏刺激装置及心力衰竭治疗方法
    • US5334222A
    • 1994-08-02
    • US970893
    • 1992-11-03
    • Rodney W. SaloJulio C. SpinelliBruce A. Tockman
    • Rodney W. SaloJulio C. SpinelliBruce A. Tockman
    • A61N1/362A61N1/368A61N1/39
    • A61N1/3962A61N1/3622A61N1/3627A61N1/3682
    • A cardiac rhythm management device includes a dual-chamber pacemaker especially designed for treating congestive heart failure and a defibrillator as a back-up measure. The device incorporates a programmed microcontroller which is operative to adjust the AV delay of the pacemaker to a minimum or maximum length consistent with optimal cardiac function. The cardiac stimulator includes apparatus for sensing cardiac function from cycle-to-cycle and determining whether incremental changes made to the AV delay interval enhances or worsens the measured cardiac function. On each iterative cycle, the AV delay interval is changed, either incremented or decremented, until a cross-over point is reached in which it is noted that the cardiac function ceases to improve and this is followed with a further incremental adjustment in an opposite direction to compensate for any overshoot. By providing a cardiac defibrillator in combination with the pacing device with closed-loop control of the AV interval, incidences of sudden death due to lethal arrhythmias is reduced.
    • 心律管理装置包括专门设计用于治疗充血性心力衰竭的双腔心脏起搏器和除颤器作为后备措施。 该装置包括编程的微控制器,其可操作以将起搏器的AV延迟调整到与最佳心脏功能一致的最小或最大长度。 心脏刺激器包括用于从周期到周期感测心脏功能的装置,以及确定对AV延迟间隔做出的增量变化是否增强或恶化测量的心脏功能。 在每个迭代循环中,AV延迟间隔被改变,递增或递减,直到达到交叉点,其中注意到心脏功能不再改善,并且随后在相反方向上进一步增量调整 以补偿任何过冲。 通过与AV间隔的闭环控制提供与起搏装置组合的心脏除颤器,减少了因致命性心律失常引起的猝死的发生。