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81. 发明授权

US6044297A Posture and device orientation and calibration for implantable medical devices 有权
标题翻译：植入式医疗设备的姿势和设备定向和校准
公开(公告)号：US6044297A
公开(公告)日：2000-03-28
申请号：US160647
申请日：1998-09-25
申请人： Todd J. Sheldon , William J. Combs , Mark K. Erickson , Can Cinbis
发明人： Todd J. Sheldon , William J. Combs , Mark K. Erickson , Can Cinbis
IPC分类号： A61N1/365 , A61N1/362
CPC分类号： A61N1/36542 , A61N1/36535
摘要： A method of and apparatus for determining the physical posture of a patient's body, having a superior-inferior body axis, an anterior-posterior body axis and a lateral-medial body axis, in relation to earth's gravitational field. A medical device having first, second and, optionally, third accelerometers having sensitive axes mounted orthogonally within an implantable housing is adapted to be implanted with the sensitive axes nominally aligned with ideal X, Y and Z device axes correlated to patient body axes. Each accelerometer generates DC accelerometer signals having characteristic magnitudes and polarities on alignment of the sensitive axis with, against or normal to earth's gravitational field and DC accelerometer signals of varying magnitudes and polarities when not so aligned. The actual pitch and roll angles of the sensitive axes of the accelerometers in the implanted IMD with respect to the true gravitational axes are determined and the yaw angles are determined or estimated. Corrected DC accelerometer output signals are derived from the pitch, roll and yaw angles and are compared to a set of stored thresholds for each body posture to determine the actual body posture. Storage of these comparisons or the raw signals themselves can be used for histogram data to provide theraputic or research benefits also described.
摘要翻译：一种用于确定患者身体的物理姿势的方法和装置，其具有相对于地球重力场的上下身体轴线，前后身体轴线和侧向内侧身体轴线。具有第一，第二和第三加速度计的医疗设备具有正交安装在可植入的外壳内的敏感轴，适于植入与名义上与理想的与患者体轴相关的X，Y和Z装置轴对准的敏感轴。每个加速度计产生具有特征幅度和极性的特征幅度和极性的直流加速度计信号，当不对准时，敏感轴对准或反对或垂直于地球重力场和具有不同幅度和极性的直流加速度计信号。确定和估计在植入的IMD中相对于真重力轴的加速度计的敏感轴的实际俯仰角和倾斜角，并且确定或估计偏航角。校正的直流加速度计输出信号是从俯仰角，偏转角和偏航角度得出的，并且与每个身体姿势的一组存储的阈值进行比较，以确定实际的身体姿势。这些比较或原始信号本身的存储可用于直方图数据，以提供还描述的治疗或研究益处。

82. 发明授权

US5725562A Rate responsive cardiac pacemaker and method for discriminating stair climbing from other activities 失效
标题翻译：速率响应心脏起搏器和方法来区分爬梯与其他活动
公开(公告)号：US5725562A
公开(公告)日：1998-03-10
申请号：US668524
申请日：1996-06-28
申请人： Todd J. Sheldon
发明人： Todd J. Sheldon
IPC分类号： A61N1/365
CPC分类号： A61N1/36542 , A61N1/36585 , A61N1/36535
摘要： A method of and apparatus for pacing a patient's heart at a pacing rate dependent on patient activity and posture particularly during stair climbing. A dual chamber, rate responsive pacemaker for pacing a patient's heart includes at least one DC accelerometer mounted in the pacemaker pulse generator for implantation such that the sensitive axis of the DC accelerometer is sensitive to the effects of gravity during forward lean of the patient characteristic of stair climbing posture. The DC and AC signal outputs of the accelerometer are processed to develop a tilt signal and an activity signal. A target rate control signal is derived from the activity signal dependent on the level of activity. A stair climbing rate is selected for controlling the physiologic pacing rate between a lower and an upper pacing rate in the presence of an activity signal indicative of a patient walking rate and a tilt signal value falling within a tilt window. The target rate control signal is used to control the pacing rate if the activity signal is indicative of faster patient movement, e.g. running, or if the tilt signal is outside the tilt window indicating that the patient is either upright or prone.
摘要翻译：一种用于根据患者活动和姿势起搏患者心脏的起搏速度的方法和装置，特别是在楼梯攀爬期间。用于起搏患者心脏的双室速率响应起搏器包括安装在起搏器脉冲发生器中用于植入的至少一个DC加速度计，使得DC加速度计的敏感轴对患者特征向前倾斜时的重力影响敏感楼梯攀登姿势。处理加速度计的直流和交流信号输出以产生倾斜信号和活动信号。根据活动水平从活动信号导出目标速率控制信号。在存在指示患者行走速度的活动信号和落在倾斜窗内的倾斜信号值的情况下，选择楼梯攀爬速率来控制较低和较高起搏速率之间的生理起搏速率。如果活动信号表示更快的患者运动，则目标速率控制信号用于控制起搏速率，例如，运行，或者如果倾斜信号在倾斜窗口之外，指示患者直立或倾向。

83. 发明授权

US09919158B2 Configuring operating parameters of a medical device based on exposure to a disruptive energy field 有权
公开(公告)号：US09919158B2
公开(公告)日：2018-03-20
申请号：US12648690
申请日：2009-12-29
申请人： Michael L. Ellingson , Hyun J. Yoon , Todd J. Sheldon
发明人： Michael L. Ellingson , Hyun J. Yoon , Todd J. Sheldon
IPC分类号： A61N1/00 , A61N1/37 , A61N1/368
CPC分类号： A61N1/3718 , A61N1/3688 , A61N1/37
摘要： An implantable medical device (IMD) determines an effect of the disruptive energy field and adjusts one or more operating parameters of the IMD based on at least the determined effect. In some instances, the IMD may determine an actual effect of the disruptive energy field, such as a temperature change, impedance change, pacing or sensing threshold change, MRI-induced interference one pacing or sensing, or other actual effect. In other instances, the IMD may determine a predicted effect of the disruptive energy field based on one or more characteristics of the exposure. In any case, the IMD adjusts one or more parameters based on at least the determined effect.

84. 发明授权

US08626294B2 Methods for setting cardiac pacing parameters in relatively high efficiency pacing systems 有权
标题翻译：在较高效率起搏系统中设置心脏起搏参数的方法
公开(公告)号：US08626294B2
公开(公告)日：2014-01-07
申请号：US13193783
申请日：2011-07-29
申请人： Todd J. Sheldon , Wade M. Demmer
发明人： Todd J. Sheldon , Wade M. Demmer
IPC分类号： A61N1/368
CPC分类号： A61N1/3712 , A61N1/3708 , A61N1/37205 , A61N1/3756
摘要： According to some methods, for example, preprogrammed in a microprocessor element of an implantable cardiac pacing system, at least one of a number of periodic pacing threshold searches includes steps to reduce an evoked response amplitude threshold for evoked response signal detection. The reduction may be to a minimum value measurable above zero, for example, as determined by establishing a ‘noise floor’. Alternately, amplitudes of test pacing pulses and corresponding post pulse signals are collected and reviewed to search for a break, to determine a lower value to which the evoked response threshold may be adjusted without detecting noise. Subsequent to reducing the threshold, if no evoked response signal is detected for a test pulse applied at or above a predetermined maximum desirable pulse energy, an operational pacing pulse energy is set to greater than or equal to the maximum desirable in conjunction with a reduction in pacing rate.
摘要翻译：根据一些方法，例如，在可植入心脏起搏系统的微处理器元件中预编程，多个周期性起搏阈值搜索中的至少一个包括减少诱发响应信号检测的诱发响应振幅阈值的步骤。该减小可以是在零以上可测量的最小值，例如通过建立“本底噪声”确定的最小值。或者，收集和检查测试起搏脉冲和对应的后脉冲信号的振幅以搜索中断，以确定可以在不检测噪声的情况下调整诱发响应阈值的较低值。在降低阈值之后，如果对于在预定的最大期望脉冲能量之上或之上施加的测试脉冲没有检测到诱发响应信号，则可以将运行起搏脉冲能量设置为大于或等于期望的最大值，起搏率

85. 发明授权

US08417337B2 Method of continuous capture verification in cardiac resynchronization devices 有权
标题翻译：心脏再同步装置中连续捕获验证的方法
公开(公告)号：US08417337B2
公开(公告)日：2013-04-09
申请号：US12501691
申请日：2009-07-13
申请人： James W. Busacker , Todd J. Sheldon
发明人： James W. Busacker , Todd J. Sheldon
IPC分类号： A61N1/00
CPC分类号： A61N1/3627 , A61N1/3684 , A61N1/371
摘要： In bi-ventricular pacing devices (including CRT devices) analysis of myocardial electrogram signals in one ventricle (e.g., a left ventricle, or “LV”) can be used to infer capture or loss-of-capture (LOC) of an earlier stimulus pulse in the same ventricle, on a continuous (every pacing cycle), triggered, aperiodic and/or periodic basis. Rather than using an evoked-response principle as has been the basis of capture detection in prior art and other systems, a principle employed via the present invention uses evidence of inter-ventricular conduction (i.e., from the opposite chamber) and/or atrio-ventricular conduction as evidence of LOC, since a non-capturing pacing stimulus provided to a first chamber will allow the myocardial tissue of the first chamber to remain non-refractory and thus inter-ventricular and atrio-ventricular wavefront propagation and conduction can commence and be detected thereby revealing whether LOC has occurred.
摘要翻译：在双心室起搏装置（包括CRT装置）中，可以使用一个心室（例如左心室或左心室）心肌电图信号的分析来推断早期刺激脉冲的捕获或丢失（LOC）相同的心室，连续（每个起搏周期），触发，非周期性和/或周期性基础。而不是使用诱发反应原理作为现有技术和其他系统中的捕获检测的基础，通过本发明采用的原理使用心室间传导（即，从相对的室）和/或心室传导的证据，心室传导作为LOC的证据，因为提供给第一腔室的非捕获起搏刺激将允许第一腔室的心肌组织保持不耐受，因此可以开始心室间壁和心房内波前传播和传导检测出来是否显示LOC是否发生。

86. 发明申请

US20120109235A1 CAPTURE DETECTION IN RESPONSE TO LEAD RELATED CONDITIONS 审中-公开
标题翻译：对领导相关条件的响应能力的检测
公开(公告)号：US20120109235A1
公开(公告)日：2012-05-03
申请号：US12913400
申请日：2010-10-27
申请人： Todd J. Sheldon , Bruce D. Gunderson
发明人： Todd J. Sheldon , Bruce D. Gunderson
IPC分类号： A61N1/37 , A61N1/39
CPC分类号： A61N1/371 , A61N1/3706 , A61N1/3712 , A61N1/3962 , A61N2001/083
摘要： Various techniques for detecting cardiac capture in response to a detected lead related condition are described. One example method described includes delivering a pacing therapy to a heart of a patient, periodically determining whether the pacing therapy captures the heart of the patient, detecting a lead related condition, and, in response to the detected lead related condition, increasing a frequency of determining whether the pacing therapy captures the heart.
摘要翻译：描述了响应于检测到的铅相关状况来检测心脏捕获的各种技术。所描述的一个示例性方法包括将起搏治疗递送到患者的心脏，周期性地确定起搏疗法是否捕获患者的心脏，检测引线相关状况，并且响应于检测到的引线相关状况，增加频率确定起搏治疗是否捕获心脏。

87. 发明申请

US20120101543A1 CAPTURE THRESHOLD MEASUREMENT FOR SELECTION OF PACING VECTOR 有权
标题翻译：捕获阈值测量用于选择PACING矢量
公开(公告)号：US20120101543A1
公开(公告)日：2012-04-26
申请号：US12909057
申请日：2010-10-21
申请人： Wade M. Demmer , Todd J. Sheldon
发明人： Wade M. Demmer , Todd J. Sheldon
IPC分类号： A61N1/08
CPC分类号： A61N1/3712 , A61N1/3686
摘要： Various techniques for selecting a pacing vector based on pacing capture thresholds are described. One example method described includes for each of a plurality of vectors, iteratively delivering at least one pacing stimulus at each of a plurality of magnitudes within a predetermined range of magnitudes to a first chamber, determining if a depolarization occurred in a second chamber of the heart within a predetermined threshold time interval after the pacing stimulus that is less than an interval, identifying a pacing stimulus for which a depolarization in the second chamber does not occur within the predetermined threshold time interval, determining a capture threshold magnitude for the vector based on the magnitude of the pacing pulse for which a depolarization in the second chamber does not occur within the predetermined threshold time interval, and recording the capture threshold magnitudes.
摘要翻译：描述了基于起搏捕获阈值来选择起搏向量的各种技术。所描述的一个示例性方法包括针对多个向量中的每一个，在预定范围内的多个量级中的每一个向第一室迭代递送至少一个起搏刺激，确定是否在心脏的第二腔室中发生去极化在所述起搏刺激小于间隔之后的预定阈值时间间隔内，识别在所述预定阈值时间间隔内不发生所述第二腔室中去极化的起搏刺激，基于所述步骤确定所述矢量的捕获阈值量值在预定的阈值时间间隔内在第二腔室中去极化的起搏脉冲的幅值，并记录捕获阈值量值。

88. 发明授权

US07899538B2 Methods and apparatus for automatically tracking heart failure status 有权
标题翻译：自动跟踪心力衰竭状态的方法和装置
公开(公告)号：US07899538B2
公开(公告)日：2011-03-01
申请号：US11691266
申请日：2007-03-26
申请人： Lynn A. Davenport , Purvee P. Parikh , Todd J. Sheldon
发明人： Lynn A. Davenport , Purvee P. Parikh , Todd J. Sheldon
IPC分类号： A61N1/37
CPC分类号： A61N1/3627
摘要： Assessing symptomatic and asymptomatic physiologic changes due to chronic heart failure involves apparatus and methods for gauging degradation and possible improvement using automated measurement of inter-ventricular conduction time, both alone and in combination with other automated physiologic tests. Conduction times increase due to the greater distance a wavefront must traverse as a heart enlarges. Analysis of conduction time can be used to verify the occurrence of cardiac remodeling due to heart failure as well as beneficial reverse remodeling due to successful heart failure therapy delivery. Patient activity level(s) and presence/increase in pulmonary fluids can also be used to automatically determine changes in heart failure status and/or predict hospitalization. Conduction time is monitored between electrodes positioned in the left and right ventricles of the heart via endocardial or epicardial electrodes.
摘要翻译：评估因慢性心力衰竭引起的症状和无症状的生理变化涉及用于测量降解的设备和方法，并且可以通过自动测量心室间传导时间来单独测量并与其他自动化生理测试结合使用。由于随着心脏的扩大，波前必须穿越的距离越大，传导时间就会增加。传导时间分析可以用于验证由于心力衰竭导致的心脏重构的发生以及由于成功的心力衰竭治疗递送而导致的有益的反向重建。患者活动水平和肺流体的存在/增加也可用于自动确定心力衰竭状态的变化和/或预测住院治疗。通过心内膜或心外膜电极监测位于心脏左心室和右心室的电极之间的传导时间。

89. 发明申请

US20110040346A1 METHOD FOR SCHEDULING ATRIAL-VENTRICULAR CONDUCTION CHECKS IN MINIMUM VENTRICULAR PACING 有权
标题翻译：最小静脉血管内调节心房直肠导管检查方法
公开(公告)号：US20110040346A1
公开(公告)日：2011-02-17
申请号：US12540632
申请日：2009-08-13
申请人： Todd J. Sheldon
发明人： Todd J. Sheldon
IPC分类号： A61N1/37
CPC分类号： A61N1/368 , A61N1/3688
摘要： A medical device and associated method deliver cardiac pacing in a dual chamber pacing mode and schedule an atrial-ventricular (AV) conduction check during the dual chamber pacing mode to detect the presence of AV conduction. If AV conduction is detected during the scheduled AV conduction check, the medical device switches to an atrial pacing mode and switches back to the dual chamber pacing mode in response to an absence of AV conduction during the atrial pacing mode. The detected AV conduction is identified as a false positive detection in response to the pacing mode switch to the dual chamber pacing mode occurring within a predetermined interval of time from detecting the AV conduction.
摘要翻译：医疗设备和相关方法在双室起搏模式下提供心脏起搏，并且在双室起搏模式期间安排心房（AV）导通检查以检测AV传导的存在。如果在预定的AV导通检查期间检测到AV传导，则医疗设备切换到心房起搏模式并且响应于在心房起搏模式期间不存在AV传导而切换回双室起搏模式。检测到的AV导通被识别为响应于从检测AV传导而在预定时间间隔内发生的双室起搏模式的起搏模式切换的假阳性检测。

90. 发明申请

US20100137935A1 LV THRESHOLD MEASUREMENT AND CAPTURE MANAGEMENT 有权
标题翻译： LV阈值测量和捕获管理
公开(公告)号：US20100137935A1
公开(公告)日：2010-06-03
申请号：US12700454
申请日：2010-02-04
申请人： Purvee P. Parikh , John C. Stroebel , Todd J. Sheldon , Karen J. Kleckner
发明人： Purvee P. Parikh , John C. Stroebel , Todd J. Sheldon , Karen J. Kleckner
IPC分类号： A61N1/08 , A61N1/362
CPC分类号： A61N1/3627 , A61N1/3684 , A61N1/371
摘要： The invention provides methods and apparatus for determining in a non-tracking pacing mode (e.g., DDI/R, VVI/R) whether a ventricular pacing stimulus is capturing a paced ventricle, including some or all of the following aspects. For example, increasing a ventricular pacing rate a nominal amount to an overdrive pacing rate higher than a most recent heart rate and evaluating a conduction interval from a first pacing ventricle to a second sensing ventricle and then continuing to monitor the underlying rate to ensure that a threshold testing pacing rate will not exceed a predetermined minimum interval and providing pacing stimulation to the first ventricle and sensing the second ventricle to determine whether the pacing stimulation to the first ventricle was one of sub-threshold and supra-threshold. The methods and apparatus are especially useful in conjunction with ensuring actual delivery of a ventricular pacing regime (e.g., cardiac resynchronization therapy or “CRT”).
摘要翻译：本发明提供了用于在非跟踪起搏模式（例如，DDI / R，VVI / R）中确定心室起搏刺激是否捕获节奏心室的方法和装置，包括以下方面中的一些或全部。例如，将心室起搏速率提高到高于最近心率的超速起搏速率的标称值，并评估从第一起搏心室到第二感测心室的传导间隔，然后继续监测潜在速率，以确保阈值测试起搏速率不会超过预定的最小间隔，并且向第一脑室提供起搏刺激并且感测第二脑室以确定对第一脑室的起搏刺激是否是子阈值和超阈值之一。所述方法和装置与确保心室起搏方案（例如，心脏再同步治疗或“CRT”）的实际递送相结合特别有用。

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