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1. 发明授权

US07648464B1 Detecting ischemia using an implantable cardiac device based on morphology of cardiac pressure signal 有权
标题翻译：基于心脏压力信号的形态，使用可植入心脏装置检测缺血
公开(公告)号：US07648464B1
公开(公告)日：2010-01-19
申请号：US11458617
申请日：2006-07-19
申请人： Jong Gill , Peter Boileau , Gene A. Bornzin , Joseph J. Florio , Xiaoyi Min
发明人： Jong Gill , Peter Boileau , Gene A. Bornzin , Joseph J. Florio , Xiaoyi Min
IPC分类号： A61B5/021
CPC分类号： A61B5/0215 , A61B5/0031 , A61B5/042 , A61B5/7239 , A61N1/36564
摘要： Methods and systems are presented for using an ICD to detect myocardial ischemia. In one embodiment, a method includes sensing a signal indicative of cardiac pressure, measuring a height of the sensed signal at a peak amplitude of the sensed signal, and measuring a duration of the sensed signal. The method further includes indicating an ischemia based on a comparison of a ratio of the height to the duration with a predetermined value. In another embodiment, a method includes sensing a signal indicative of cardiac pressure, determining a derivative signal that is a first derivative of the sensed signal, measuring a maximum positive value of the derivative signal, and measuring a maximum negative value of the derivative signal. The method further includes indicating an ischemia based on a comparison of a ratio of the maximum positive value to the maximum negative value with a predetermined value.
摘要翻译：提出了使用ICD检测心肌缺血的方法和系统。在一个实施例中，一种方法包括感测指示心脏压力的信号，以感测信号的峰值幅度测量感测信号的高度，以及测量感测信号的持续时间。该方法还包括基于将高度与持续时间的比率与预定值的比较来指示缺血。在另一个实施例中，一种方法包括感测指示心脏压力的信号，确定作为感测信号的一阶导数的导数信号，测量导数信号的最大正值，以及测量导数信号的最大负值。该方法还包括基于将最大正值与最大负值的比率与预定值进行比较来指示缺血。

2. 发明授权

US06944506B1 Stylet feature for resisting perforation of an implantable lead 失效
标题翻译：用于抵抗可植入引线穿孔的探针特征
公开(公告)号：US06944506B1
公开(公告)日：2005-09-13
申请号：US10180789
申请日：2002-06-25
申请人： Kevin L. Morgan , Joseph J. Florio
发明人： Kevin L. Morgan , Joseph J. Florio
IPC分类号： A61N1/05
CPC分类号： A61N1/05 , A61M2025/09175 , A61N1/056
摘要： A stylet unit for implanting a removable lead system for a cardiac stimulation device includes an elongated main body having an enlarged feature at the distal end of the main body with a rounded blunt tip end, a width greater than the width of the distal end of the main body, and a length greater than the width. A finger grip is provided at a proximal extremity of the elongated main body for manipulating the stylet unit. Lead system includes an elongated tubular lead body containing an elongated coil conductor with a plurality of coil windings defining a passageway extending the length of the coil conductor and having inner surfaces facing toward the passageway. The enlarged feature of the stylet is sufficiently long to assure that it advances along the passageway in slidable engagement with the inner surfaces of the coil conductor but without thrusting between adjoining coils.
摘要翻译：用于植入用于心脏刺激装置的可移除引线系统的探针单元包括细长主体，其在主体的远端具有扩大的特征，具有圆钝钝的末端，宽度大于所述主体的远端的宽度主体，长度大于宽度。在细长主体的近端设置有手指握柄，用于操纵探针单元。引线系统包括细长的管状引线体，其包含具有多个线圈绕组的细长线圈导体，所述多个线圈绕组限定延伸线圈导体的长度并具有面向通道的内表面的通道。探针的扩大特征足够长，以确保其沿着通道前进，可与线圈导体的内表面滑动接合，但不会在相邻线圈之间推动。

3. 发明授权

US06937900B1 AC/DC multi-axis accelerometer for determining patient activity and body position 有权
标题翻译：用于确定患者活动和身体位置的AC / DC多轴加速度计
公开(公告)号：US06937900B1
公开(公告)日：2005-08-30
申请号：US10205188
申请日：2002-07-24
申请人： Anne M. Pianca , Gene A. Bornzin , Euljoon Park , Alan B. Vogel , Joseph J. Florio , Lee Jay Mandell , Junyu Mai
发明人： Anne M. Pianca , Gene A. Bornzin , Euljoon Park , Alan B. Vogel , Joseph J. Florio , Lee Jay Mandell , Junyu Mai
IPC分类号： A61N1/365 , A61N1/372
CPC分类号： A61N1/36542
摘要： An implantable cardiac stimulation device which determines stimulation based upon the patient's body position and activity level while eliminating special implantation or calibration procedures. To eliminate such special implantation and calibration procedures, the stimulation device correlates the patient's body position using a multi-axis DC accelerometer or other sensor during times of high activity and determines a patient's standing position value. During other times, the stimulation device compares the signals from the accelerometer to the standing position value to determine the patient's current body position. Based upon the current body position and the activity level, the stimulation device determines the necessary stimulation to deliver to the patient.
摘要翻译：一种可植入心脏刺激装置，其基于患者的身体位置和活动水平确定刺激，同时消除特殊植入或校准过程。为了消除这种特殊的植入和校准过程，刺激装置在高活动时间期间使用多轴DC加速度计或其他传感器来关联患者的身体位置并且确定患者的站立位置值。在其他时间，刺激装置将来自加速度计的信号与站立位置值进行比较，以确定患者的当前身体位置。基于当前身体位置和活动水平，刺激装置确定必要的刺激以递送给患者。

4. 发明授权

US06804556B1 Methods and apparatus for overdrive pacing heat tissue using an implantable cardiac stimulation device 有权
标题翻译：使用可植入心脏刺激装置的超速起搏热组织的方法和装置
公开(公告)号：US06804556B1
公开(公告)日：2004-10-12
申请号：US10036026
申请日：2001-12-21
申请人： Joseph J. Florio , Gene A. Bornzin , John W. Poore , Douglas T. Kurschinski
发明人： Joseph J. Florio , Gene A. Bornzin , John W. Poore , Douglas T. Kurschinski
IPC分类号： A61N1365
CPC分类号： A61N1/368
摘要： Techniques are described for overdrive pacing the heart using a pacemaker wherein the overdrive pacing rate only increases when at least two intrinsic beats are detected within a determined search period. In one specific technique, an increase in the pacing rate occurs only if two P-waves are detected within X cardiac cycles. In another specific technique, the overdrive pacing rate is increased only if at least two P-waves are detected within a block of N cardiac cycles. In both techniques, the overdrive pacing rate is decreased if no increase has occurred in the last Z cardiac cycles. By increasing the overdrive pacing rate only in response to detection of at least two P-waves within a determined number of cardiac cycles, an excessively high overdrive pacing rate is avoided. Other techniques are described for adaptively adjusting overdrive pacing parameters so as to achieve a determined target degree of pacing of, for example, 95% paced beats. By adaptively adjusting overdrive parameters to maintain a target degree of pacing, the average overdrive pacing rate is minimized while still maintaining a high number of paced beats, thereby reducing the risk of a tachyarrhythmia occurring within the patient.
摘要翻译：描述了使用起搏器超速起搏心脏的技术，其中在确定的搜索周期内检测到至少两个固有节拍时，超速起搏速率仅增加。在一种特定技术中，只有在X个心动周期内检测到两个P波时，起搏速率才会增加。在另一个具体技术中，只有在N个心动周期的块内检测到至少两个P波时，才能增加超速起搏速率。在两种技术中，如果在最后Z个心动周期中没有发生增加，则超速起搏速率将降低。通过仅在确定的心跳周期内响应于至少两个P波的检测来增加超速起搏速率，避免了过高的超速起搏速率。描述了用于自适应地调节过驱动起搏参数的其它技术，以便实现例如95％起搏节拍的确定的目标起搏程度。通过自适应地调整过驱动参数以保持目标起搏程度，平均超速起搏速度最小化，同时仍然保持大量的起搏节奏，从而降低患者内出现快速性心律失常的风险。

5. 发明授权

US06766195B1 Method and apparatus for detecting natural electrical coherence within the heart and for administering therapy based thereon 有权
标题翻译：用于检测心脏内的自然电相干性并用于基于其进行治疗的方法和装置
公开(公告)号：US06766195B1
公开(公告)日：2004-07-20
申请号：US09686630
申请日：2000-10-10
申请人： Gene A. Bornzin , Peter Boileau , Joseph J. Florio , John W. Poore , Kelly H. McClure
发明人： Gene A. Bornzin , Peter Boileau , Joseph J. Florio , John W. Poore , Kelly H. McClure
IPC分类号： A61N0118
CPC分类号： A61N1/3962 , A61N1/395
摘要： Techniques are provided for detecting natural electrical coherence within the heart and for administering or adjusting therapy based upon whether natural electrical coherence is detected. In one example, an implantable cardioverter defibrillator (ICD), upon detecting atrial fibrillation, delays administering an atrial defibrillation pulse until a period of natural electrical coherence is detected between the left and the right atria of the heart. The ICD may further delay the pulse until the ventricles of the heart are refractory so as to help prevent triggering ventricular fibrillation. The pulses are administered at a time selected based upon the period of electrical coherence to reduce the amount of electrical energy required within the pulse to reliably defibrillate the heart. Other types of therapy besides defibrillation therapy such as anti-tachycardia pacing pulses may also be timed based upon detection periods of natural electrical coherence. Method and apparatus embodiments are described.
摘要翻译：提供了用于检测心脏内的自然电连贯性的技术，并且用于基于是否检测到自然电连贯来施用或调整治疗。在一个实例中，在检测心房颤动时，植入式心律转复除颤器（ICD）延迟施用心房除颤脉冲，直到在心脏的左心房和右心房之间检测到自然电相干的时间段。 ICD可以进一步延迟脉冲，直到心脏的心室难以耐受，以便有助于防止触发心室颤动。在基于电相干周期选择的时间施加脉冲以减少脉冲内所需的电能量以可靠地除颤心脏。除了除颤疗法之外的其他类型的治疗，如抗心动过速起搏脉冲也可以基于自然电连续性的检测周期来计时。描述了方法和设备实施例。

6. 发明授权

US06731985B2 Implantable cardiac stimulation system and method for automatic capture verification calibration 有权
标题翻译：植入式心脏刺激系统和自动捕获验证校准方法
公开(公告)号：US06731985B2
公开(公告)日：2004-05-04
申请号：US09981555
申请日：2001-10-16
申请人： John W. Poore , Kerry Bradley , Laurence S. Sloman , Gene A. Bornzin , Joseph J. Florio
发明人： John W. Poore , Kerry Bradley , Laurence S. Sloman , Gene A. Bornzin , Joseph J. Florio
IPC分类号： A61N1362
CPC分类号： A61N1/3712
摘要： An implantable cardiac stimulation device and associated method perform an automatic calibration procedure for evaluating whether automatic capture verification can be recommended. The calibration procedure calculates and displays a number of variables for use by a medical practitioner in programming automatic capture operating parameters. An average paced depolarization integral (PDI) is determined from the cardiac signals following delivery of multiple stimulation pulse below and above capture threshold such that both pure lead polarization signals and evoked response signals may be analyzed. From the paced depolarization integral data, a capture threshold, a stimulation response curve, a minimum evoked response, a maximum lead polarization, an evoked response sensitivity, an evoked response safety margin, and a polarization safety margin are determined. Based on these variables, the calibration procedure determines if automatic capture verification can be recommended. If so, the stimulation device calculates a capture detection threshold. The automatic capture verification recommendation and the estimated calibration variables are displayed.
摘要翻译：可植入心脏刺激装置和相关方法执行自动校准程序，以评估是否可以推荐自动捕获验证。校准程序计算并显示许多变量，供医生在编程自动捕获操作参数时使用。平均节奏去极化积分（PDI）是在多次刺激脉冲传递后低于和高于捕获阈值的心脏信号确定的，以便可以分析纯铅极化信号和诱发响应信号。从起搏去极化积分数据中，确定捕获阈值，刺激响应曲线，最小诱发响应，最大引线极化，诱发响应灵敏度，诱发响应安全裕度和极化安全裕度。基于这些变量，校准过程确定是否可以推荐自动捕获验证。如果是，则刺激装置计算捕获检测阈值。显示自动捕获验证建议和估计的校准变量。

7. 发明授权

US06701187B1 Implantable cardiac stimulation device and method for prolonging atrial refractoriness 失效
$Implantable cardiac stimulation device and method for prolonging atrial refractoriness$
标题翻译：植入式心脏刺激装置及延长心房不应性的方法
公开(公告)号：US06701187B1
公开(公告)日：2004-03-02
申请号：US10061567
申请日：2002-02-01
申请人： Gene A. Bornzin , Laurence S. Sloman , Peter Boileau , Joseph J. Florio
发明人： Gene A. Bornzin , Laurence S. Sloman , Peter Boileau , Joseph J. Florio
IPC分类号： A61N1362
CPC分类号： A61N1/3622 , A61N1/3956
摘要： An implantable cardiac stimulation device, e.g., a pacemaker or an implantable cardioverter defibrillator (ICD), is provided which prolongs the atrial refractoriness of a heart. The implantable cardiac stimulation device includes a generator that delivers pacing pulses to an atrium of a heart and a detector that detects atrial activations of the heart. An inhibitor is coupled to the detector that inhibits the generator when an atrial activation is detected within an escape interval. A generator control coupled to the generator causes the generator to deliver a primary pacing pulse to the atrium at the end of the escape interval, absent an atrial activation being detected within the escape interval, and causes the generator to deliver a secondary pacing pulse to the atrium a delay time after an atrial activation is detected within the escape interval or the delivery of a primary pacing pulse to the atrium.
摘要翻译：提供可植入心脏刺激装置，例如起搏器或植入式心律转复除颤器（ICD），其延长心脏的心房不应性。可植入心脏刺激装置包括将起搏脉冲传送到心脏心房的发生器和检测心脏心房激活的检测器。当在逃避间隔内检测到心房激活时，抑制剂耦合到检测器，该检测器抑制发生器。耦合到发生器的发生器控制器使得发生器在逃逸间隔结束时将主起搏脉冲递送到心房，没有在逃逸间隔内检测到心房激活，并且使得发生器将辅助起搏脉冲输送到在转移间隔内检测到心房激活之后的延迟时间或者向心房传送初级起搏脉冲。

8. 发明授权

US06658283B1 Implantable cardiac stimulation device, system and method which provides an electrogram signal having the appearance of a surface electrocardiogram 有权
标题翻译：可植入的心脏刺激装置，系统和方法，其提供具有表面心电图的外观的电描记图信号
公开(公告)号：US06658283B1
公开(公告)日：2003-12-02
申请号：US09963207
申请日：2001-09-25
申请人： Gene A. Bornzin , Joseph J. Florio , Kerry Bradley
发明人： Gene A. Bornzin , Joseph J. Florio , Kerry Bradley
IPC分类号： A61B50402
CPC分类号： A61N1/3702 , A61N1/368
摘要： An implantable cardiac stimulation system and method provides an external display of a heart activity signal sensed internally by an implantable cardiac stimulation device which has the appearance of a surface EKG. The heart activity signal is sensed by the implanted device and is processed by the device or the external display to have frequency characteristics resembling that of a surface EKG. The heart activity signal to be displayed takes the form of an intracardiac electrogram signal with a low frequency roll-on of no greater than 0.4 Hz and a high frequency cutoff of no less than 20 Hz. This provides a heart activity signal for display which has the appearance and most attributes of a surface EKG.
摘要翻译：可植入心脏刺激系统和方法提供外部显示心脏活动信号，该心脏活动信号由具有表面EKG外观的可植入心脏刺激装置内部感测。心脏活动信号由植入装置感测，并被装置或外部显示器处理以具有类似于表面EKG的频率特性。要显示的心脏活动信号采取心内电图信号的形式，具有不大于0.4Hz的低频滚动和不小于20Hz的高频截止。这提供了用于显示的心脏活动信号，其具有表面EKG的外观和大多数属性。

9. 发明授权

US06618619B1 Method and apparatus for reducing the effect of evoked responses on polarization measurements in an automatic capture pacing system 失效
标题翻译：用于在自动捕获起搏系统中减少诱发反应对偏振测量的影响的方法和装置
公开(公告)号：US06618619B1
公开(公告)日：2003-09-09
申请号：US09670243
申请日：2000-09-26
申请人： Joseph J. Florio , Gene A. Bornzin
发明人： Joseph J. Florio , Gene A. Bornzin
IPC分类号： A61N1365
CPC分类号： A61N1/3712 , A61N1/37 , A61N1/3716
摘要： An initial polarization measurement is made by applying two electrical calibration pulses to the heart separated by a first time period. The first pulse is sufficient to generate an evoked response. The second pulse is applied during a refractory period associated with the first pulse. A polarization measurement is made following the second pulse and compared against a predetermined threshold. If the polarization does not exceed the threshold, the evoked response is adjusted using the measured polarization and an automatic capture function of the pacing system is programmed using the adjusted evoked response. However, if the polarization exceeds the threshold, a second pair of pulses are applied to the heart separated by a second time period, different from the first time period. A second polarization measurement is made after the second pulse and, if the second measured polarization does not exceed the predetermined threshold, the evoked response is adjusted using the newly measured polarization and the automatic capture function is programmed using the adjusted evoked response. If the polarization measurement again exceeds the predetermined threshold, the automatic capture function is disabled. Alternatively, a sequence of three pulses are applied to the heart and polarization is measured after the second and third pulses or calibration pulses may be applied after intrinsic depolarization events such as QRS complexes.
摘要翻译：通过对由第一时间段分离的心脏施加两个电校准脉冲来进行初始极化测量。第一个脉冲足以产生诱发反应。在与第一脉冲相关联的不应期期间施加第二脉冲。在第二脉冲之后进行极化测量，并与预定阈值进行比较。如果极化不超过阈值，则使用测量的极化调整诱发反应，并使用调整的诱发反应编程起搏系统的自动捕获功能。然而，如果极化超过阈值，则将第二对脉冲施加到与第一时间段不同的第二时间段分离的心脏。在第二脉冲之后进行第二偏振测量，并且如果第二测量偏振不超过预定阈值，则使用新测量的偏振来调整诱发响应，并且使用经调整的诱发响应对自动捕获功能进行编程。如果偏振测量值再次超过预定阈值，则禁用自动捕捉功能。或者，将三个脉冲的序列施加到心脏，并且在第二和第三脉冲之后测量极化，或者可以在诸如QRS复合物的内在去极化事件之后施加校准脉冲。

10. 发明授权

US06512953B2 System and method for automatically verifying capture during multi-chamber stimulation 有权
标题翻译：在多室刺激下自动验证捕获的系统和方法
公开(公告)号：US06512953B2
公开(公告)日：2003-01-28
申请号：US09844189
申请日：2001-04-26
申请人： Joseph J. Florio , Euljoon Park , Kerry Bradley , Gene A. Bornzin
发明人： Joseph J. Florio , Euljoon Park , Kerry Bradley , Gene A. Bornzin
IPC分类号： A61N1365
CPC分类号： A61N1/3712 , A61N1/3627
摘要： A system and corresponding method are provided to reliably detect capture during multi-chamber stimulation, and to further monitor the progression of congestive heart failure. The system provides a method by which intracardiac electrogram (IEGM) characteristics representing single-chamber capture and bi-ventricular capture are stored in memory and displayed. The annotation of the displayed waveforms is such that events associated with loss of capture, single-chamber capture, and bi-ventricular capture are clearly marked for ready interpretation by the physician. In a first situation, a stimulation pulse is followed by a time delay window and a subsequent depolarization complex that represents intrinsic responses of the chambers that have not been captured. In a second situation, a stimulation pulse is followed almost immediately by an evoked response that represents capture of one chamber, and a subsequent depolarization complex that represents an intrinsic response of one chamber that has not been captured. In a third situation, a stimulation pulse is almost immediately followed by an evoked response that represents simultaneous capture of two chambers.
摘要翻译：提供了一种系统和相应的方法来可靠地检测多室刺激期间的捕获，并进一步监测充血性心力衰竭的进展。该系统提供了一种表示单室捕获和双心室捕获的心内电图（IEGM）特征存储在存储器中并显示的方法。显示的波形的注释使得与丢失捕获，单室捕获和双心室捕获相关联的事件被清楚地标记以供医师准备解释。在第一种情况下，刺激脉冲之后是时间延迟窗口和随后的去极化复合体，其表示未被捕获的室的内在响应。在第二种情况下，刺激脉冲几乎立即被跟随表示一个腔室的捕获的诱发反应，以及后续的去极化复合体，其表示一个未被捕获的腔室的固有响应。在第三种情况下，刺激脉冲几乎紧随其后，表示同时捕获两个腔室的诱发反应。

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