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1. 发明申请

US20120185012A1 SYSTEMS AND METHODS FOR SELECTIVELY LIMITING MULTI-SITE VENTRICULAR PACING DELAYS DURING OPTIMIZATION OF CARDIAC RESYNCHRONIZATION THERAPY PARAMETERS 有权
标题翻译：在优化心脏再生治疗参数的过程中，选择性限制多位置静态延迟的系统和方法
公开(公告)号：US20120185012A1
公开(公告)日：2012-07-19
申请号：US13009404
申请日：2011-01-19
申请人： Kyungmoo Ryu , Allen Keel , Heidi Hellman , Tomas Svensson
发明人： Kyungmoo Ryu , Allen Keel , Heidi Hellman , Tomas Svensson
IPC分类号： A61N1/365
CPC分类号： A61N1/3627 , A61N1/3684 , A61N1/3712
摘要： Techniques are provided for use with implantable cardiac stimulation devices equipped for multi-site left ventricular (MSLV) cardiac pacing. Briefly, intraventricular and interventricular conduction delays are detected for paced cardiac events. Maximum pacing time delays are determined for use with MSLV pacing where the maximum pacing time delays are set based on the conduction delays to values sufficient to avoid capture problems due to wavefront propagation, such as fusion or lack of capture. MSLV pacing delays are then set to values no greater than the maximum pacing delays and cardiac resynchronization therapy (CRT) is delivered using the MSLV pacing delays. In an example where an optimal interventricular pacing delay (VV) is determined in advance using intracardiac electrogram-based or hemodynamic-based optimization techniques, the optimal value for VV can be used as a limiting factor when determining the maximum MSLV pacing time delays.
摘要翻译：提供技术用于配备用于多部位左心室（MSLV）心脏起搏的可植入心脏刺激装置。简而言之，对于心跳事件，检测到心室内和室间传导延迟。确定最大起搏时间延迟用于MSLV起搏，其中最大起搏时间延迟基于导通延迟设置为足以避免由于波前传播引起的捕获问题，例如融合或缺乏捕获。然后将MSLV起搏延迟设置为不大于最大起搏延迟的值，并使用MSLV起搏延迟传递心脏再同步治疗（CRT）。在使用基于心脏电图或基于血液动力学的优化技术预先确定最佳心室起搏延迟（VV）的示例中，当确定最大MSLV起搏时间延迟时，可以将VV的最佳值用作限制因素。

2. 发明授权

US08583230B2 Systems and methods for selectively limiting multi-site ventricular pacing delays during optimization of cardiac resynchronization therapy parameters 有权
标题翻译：用于在优化心脏再同步治疗参数期间选择性限制多部位心室起搏延迟的系统和方法
公开(公告)号：US08583230B2
公开(公告)日：2013-11-12
申请号：US13009404
申请日：2011-01-19
申请人： Kyungmoo Ryu , Allen Keel , Heidi Hellman , Tomas Svensson
发明人： Kyungmoo Ryu , Allen Keel , Heidi Hellman , Tomas Svensson
IPC分类号： A61N1/00
CPC分类号： A61N1/3627 , A61N1/3684 , A61N1/3712
摘要： Techniques are provided for use with implantable cardiac stimulation devices equipped for multi-site left ventricular (MSLV) cardiac pacing. Briefly, intraventricular and interventricular conduction delays are detected for paced cardiac events. Maximum pacing time delays are determined for use with MSLV pacing where the maximum pacing time delays are set based on the conduction delays to values sufficient to avoid capture problems due to wavefront propagation, such as fusion or lack of capture. MSLV pacing delays are then set to values no greater than the maximum pacing delays and cardiac resynchronization therapy (CRT) is delivered using the MSLV pacing delays. In an example where an optimal interventricular pacing delay (VV) is determined in advance using intracardiac electrogram-based or hemodynamic-based optimization techniques, the optimal value for VV can be used as a limiting factor when determining the maximum MSLV pacing time delays.
摘要翻译：提供技术用于配备用于多部位左心室（MSLV）心脏起搏的可植入心脏刺激装置。简而言之，对于心跳事件，检测到心室内和室间传导延迟。确定最大起搏时间延迟用于MSLV起搏，其中最大起搏时间延迟基于导通延迟设置为足以避免由于波前传播引起的捕获问题，例如融合或缺乏捕获。然后将MSLV起搏延迟设置为不大于最大起搏延迟的值，并使用MSLV起搏延迟传递心脏再同步治疗（CRT）。在使用基于心脏电图或基于血液动力学的优化技术预先确定最佳心室起搏延迟（VV）的示例中，当确定最大MSLV起搏时间延迟时，可以将VV的最佳值用作限制因素。

3. 发明授权

US08798765B2 Determination of cardiac resynchronization therapy settings 有权
标题翻译：心脏再同步治疗设置的测定
公开(公告)号：US08798765B2
公开(公告)日：2014-08-05
申请号：US13471167
申请日：2012-05-14
申请人： Kjell Noren , Anders Bjorling , Tomas Svensson , Sven-Erik Hedberg , Allen Keel , Stuart Rosenberg , Kyungmoo Ryu
发明人： Kjell Noren , Anders Bjorling , Tomas Svensson , Sven-Erik Hedberg , Allen Keel , Stuart Rosenberg , Kyungmoo Ryu
IPC分类号： A61N1/365 , A61N1/372 , A61N1/368
CPC分类号： A61N1/36507 , A61N1/3682 , A61N1/3684 , A61N1/37252
摘要： CRT settings for an implantable medical device are determined by applying pacing pulses to heart chambers of a scheme of different combinations of interchamber delays. A respective width parameter value representing an R or P wave width is determined for each such delay combination based on an ECG representing signal and the width parameter values are employed to estimate a parametric model defining the width parameter as a function of interchamber delays. Candidate interchamber delays that minimize the width parameter are determined from the parametric model and employed to determine optimal CRT settings. The technique provides an efficient way of finding optimal CRT settings when multiple pacing sites are available in a heart chamber.
摘要翻译：用于可植入医疗装置的CRT设置通过将不同组合的车间延迟的方案应用于心室来进行起搏脉冲来确定。基于ECG表示信号为每个这样的延迟组合确定表示R或P波宽的相应宽度参数值，并且使用宽度参数值来估计定义作为间歇延迟的函数的宽度参数的参数模型。从参数模型中确定最小化宽度参数的候选车间延迟，并用于确定最佳CRT设置。该技术提供了一种在心室中可用多个起搏部位时可以找到最佳CRT设置的有效方式。

4. 发明申请

US20120310296A1 DETERMINATION OF CARDIAC RESYNCHRONIZATION THERAPY SETTINGS 有权
标题翻译：心脏康复治疗方法的确定
公开(公告)号：US20120310296A1
公开(公告)日：2012-12-06
申请号：US13471167
申请日：2012-05-14
申请人： Kjell Noren , Anders Bjorling , Tomas Svensson , Sven-Erik Hedberg , Allen Keel , Stuart Rosenberg , Kyungmoo Ryu
发明人： Kjell Noren , Anders Bjorling , Tomas Svensson , Sven-Erik Hedberg , Allen Keel , Stuart Rosenberg , Kyungmoo Ryu
IPC分类号： A61N1/365
CPC分类号： A61N1/36507 , A61N1/3682 , A61N1/3684 , A61N1/37252
摘要： CRT settings for an implantable medical device are determined by applying pacing pulses to heart chambers of a scheme of different combinations of interchamber delays. A respective width parameter value representing an R or P wave width is determined for each such delay combination based on an ECG representing signal and the width parameter values are employed to estimate a parametric model defining the width parameter as a function of interchamber delays. Candidate interchamber delays that minimize the width parameter are determined from the parametric model and employed to determine optimal CRT settings. The technique provides an efficient way of finding optimal CRT settings when multiple pacing sites are available in a heart chamber.
摘要翻译：用于可植入医疗装置的CRT设置通过将不同组合的车间延迟的方案应用于心室来进行起搏脉冲来确定。基于ECG表示信号为每个这样的延迟组合确定表示R或P波宽的相应宽度参数值，并且使用宽度参数值来估计定义作为间歇延迟的函数的宽度参数的参数模型。从参数模型中确定最小化宽度参数的候选车间延迟，并用于确定最佳CRT设置。该技术提供了一种在心室中可用多个起搏部位时可以找到最佳CRT设置的有效方式。

5. 发明授权

US09002455B2 Systems and methods for assessing and exploiting concurrent cathodal and anodal capture using an implantable medical device 有权
标题翻译：用于评估和利用可植入医疗设备并发阴极和阳极捕获的系统和方法
公开(公告)号：US09002455B2
公开(公告)日：2015-04-07
申请号：US13351958
申请日：2012-01-17
申请人： Heidi Hellman , Kyungmoo Ryu
发明人： Heidi Hellman , Kyungmoo Ryu
IPC分类号： A61N1/18 , A61B5/0452 , A61N1/37 , A61B5/042 , A61B5/00
CPC分类号： A61N1/3712 , A61B5/042 , A61B5/0452 , A61B5/7242
摘要： Techniques are provided for use by an implantable medical device for assessing and controlling concurrent anodal/cathodal capture. In one example, the device delivers bipolar pacing stimulus while sensing a bipolar intracardiac electrogram (IEGM) and while adjusting a magnitude of the pacing stimulus. The device analyzes the bipolar IEGM signals to detect an indication of activation representative of concurrent anodal and cathodal capture. Preferably, the pulse magnitude is set relative to the anodal/cathodal capture threshold based upon clinician programming in response to the needs of the patient. In this manner, concurrent anodal and cathodal capture can be selectively activated or deactivated based on clinician instructions received from a device programmer or other external programming device. Techniques exploiting both bipolar and unipolar IEGM signals to assess and control concurrent anodal/cathodal capture are also described. Techniques for use with quad-pole leads to achieve dual-site or quad-site capture are also set forth.
摘要翻译：提供技术用于可植入医疗装置用于评估和控制并发阳极/阴极捕获。在一个示例中，该装置提供双极起搏刺激，同时感测双极性心内电描记图（IEGM），同时调整起搏刺激的幅度。该器件分析双极性IEGM信号以检测表示并发阳极和阴极捕获的激活指示。优选地，响应于患者的需要，基于临床医师编程，相对于阳极/阴极俘获阈值设置脉搏幅度。以这种方式，可以基于从设备编程器或其它外部编程设备接收的临床医生指令来选择性地激活或去激活并发阳极和阴极捕获。还描述了利用双极和单极IEGM信号来评估和控制并行阳极/阴极俘获的技术。还阐述了与四极引线一起使用以实现双位点或四点捕获的技术。

6. 发明申请

US20130184777A1 SYSTEMS AND METHODS FOR ASSESSING AND EXPLOITING CONCURRENT CATHODAL AND ANODAL CAPTURE USING AN IMPLANTABLE MEDICAL DEVICE 有权
标题翻译：使用可植入医疗器械评估和开发并发阴道和阳极捕获的系统和方法
公开(公告)号：US20130184777A1
公开(公告)日：2013-07-18
申请号：US13351958
申请日：2012-01-17
申请人： Heidi Hellman , Kyungmoo Ryu
发明人： Heidi Hellman , Kyungmoo Ryu
IPC分类号： A61N1/37
CPC分类号： A61N1/3712 , A61B5/042 , A61B5/0452 , A61B5/7242
摘要： Techniques are provided for use by an implantable medical device for assessing and controlling concurrent anodal/cathodal capture. In one example, the device delivers bipolar pacing stimulus while sensing a bipolar intracardiac electrogram (IEGM) and while adjusting a magnitude of the pacing stimulus. The device analyzes the bipolar IEGM signals to detect an indication of activation representative of concurrent anodal and cathodal capture. Preferably, the pulse magnitude is set relative to the anodal/cathodal capture threshold based upon clinician programming in response to the needs of the patient. In this manner, concurrent anodal and cathodal capture can be selectively activated or deactivated based on clinician instructions received from a device programmer or other external programming device. Techniques exploiting both bipolar and unipolar IEGM signals to assess and control concurrent anodal/cathodal capture are also described. Techniques for use with quad-pole leads to achieve dual-site or quad-site capture are also set forth.
摘要翻译：提供技术用于可植入医疗装置用于评估和控制并发阳极/阴极捕获。在一个示例中，该装置提供双极起搏刺激，同时感测双极性心内电描记图（IEGM），同时调整起搏刺激的幅度。该器件分析双极性IEGM信号以检测表示并发阳极和阴极捕获的激活指示。优选地，响应于患者的需要，基于临床医师编程，相对于阳极/阴极俘获阈值设置脉搏幅度。以这种方式，可以基于从设备编程器或其它外部编程设备接收的临床医生指令来选择性地激活或去激活并发阳极和阴极捕获。还描述了利用双极和单极IEGM信号来评估和控制并行阳极/阴极俘获的技术。还阐述了与四极引线一起使用以实现双位点或四点捕获的技术。

7. 发明授权

US09254391B2 Systems and methods for determining pacing related parameters 有权
标题翻译：用于确定起搏相关参数的系统和方法
公开(公告)号：US09254391B2
公开(公告)日：2016-02-09
申请号：US13196580
申请日：2011-08-02
申请人： Kyungmoo Ryu , Tomas Svensson , Stuart Rosenberg
发明人： Kyungmoo Ryu , Tomas Svensson , Stuart Rosenberg
IPC分类号： A61N1/365 , A61N1/368 , A61N1/37
CPC分类号： A61N1/3682 , A61N1/3684 , A61N1/371
摘要： Pacing related timing is determined for an implantable medical device (IMD) by pacing at an RV pacing site, a first LV pacing site and a second LV pacing site in accordance with a first site, a second site and a third site pacing order, and further in accordance with a first inter-electrode pacing delay between pacing at the first site and pacing at the second site and a second inter-electrode pacing delay between pacing at the second site and pacing at the third site. At least one of a sensed event or a paced event is detected for at each of the second site and the third site. The first inter-electrode pacing delay and the second inter-electrode pacing delay are adjusted to avoid sensed events in favor of paced events at each of the second site and the third site. An atrio-ventricular delay may also be adjusted to avoid sensed events or lack of capture due to possible fusion at the first site, in favor of paced events at the first site.
摘要翻译：通过根据第一部位，第二部位和第三部位起搏顺序，在RV起搏部位，第一LV起搏部位和第二LV起搏部位进行起搏，确定可植入医疗装置（IMD）的起搏相关时间，以及进一步根据在第一部位的起搏和第二部位的起搏之间的第一电极间起搏延迟和在第二部位起搏和第三部位起搏之间的第二电极间起搏延迟。在第二站点和第三站点的每个处检测感测事件或起搏事件中的至少一个。调整第一电极间起搏延迟和第二电极间起搏延迟以避免感测到的事件有利于在第二位置和第三位置的每一个处的起搏事件。还可以调整心房延迟以避免感染事件或由于第一部位可能融合而导致的捕获不足，有利于在第一部位的起搏事件。

8. 发明授权

US08527051B1 Detection and reduction of phrenic nerve stimulation 有权
标题翻译：检测和减少膈神经刺激
公开(公告)号：US08527051B1
公开(公告)日：2013-09-03
申请号：US13545776
申请日：2012-07-10
申请人： Sven-Erik Hedberg , Tomas Svensson , Kjell Noren , Stuart Rosenberg , Kyungmoo Ryu , Edward Karst
发明人： Sven-Erik Hedberg , Tomas Svensson , Kjell Noren , Stuart Rosenberg , Kyungmoo Ryu , Edward Karst
IPC分类号： A61N1/37
CPC分类号： A61N1/36521 , A61N1/3702
摘要： The present invention provides implantable medical devices for detecting phrenic nerve stimulation. A pacing module is configured to deliver pacing pulses having a predetermined pulse amplitude and/or width within the refractory period of the left ventricle. The pacing pulses are repeatedly delivered during a number of cardiac cycles, and the pacing pulses are delivered at different delays relative to an onset of the refractory period of the left ventricle in different cardiac cycles. An impedance measurement module is configured to measure impedance signals in time windows synchronized with the delivery of pacing pulses in the refractory period of the left ventricle. A phrenic nerve stimulation, PNS, detection module is configured to gather at least one impedance signal from each time window, create aggregated impedance signals using the impedance signals from the different time windows, and analyze the aggregated impedance signals to detect PNS.
摘要翻译：本发明提供了用于检测膈神经刺激的可植入医疗装置。起搏模块被配置为在左心室的不应期内输送具有预定脉冲幅度和/或宽度的起搏脉冲。起搏脉冲在多个心动周期期间重复递送，起搏脉冲相对于不同心脏周期中左心室的不应期的开始以不同的延迟递送。阻抗测量模块被配置为测量与在左心室的不应期中递送起搏脉冲同步的时间窗内的阻抗信号。膈神经刺激，PNS检测模块配置为从每个时间窗口收集至少一个阻抗信号，使用来自不同时间窗口的阻抗信号创建聚合阻抗信号，并分析聚合阻抗信号以检测PNS。

9. 发明申请

US20130035737A1 SYSTEMS AND METHODS FOR DETERMINING PACING RELATED PARAMETERS 有权
标题翻译：用于确定相关参数的系统和方法
公开(公告)号：US20130035737A1
公开(公告)日：2013-02-07
申请号：US13196580
申请日：2011-08-02
申请人： Kyungmoo Ryu , Tomas Svensson , Stuart Rosenberg
发明人： Kyungmoo Ryu , Tomas Svensson , Stuart Rosenberg
IPC分类号： A61N1/365
CPC分类号： A61N1/3682 , A61N1/3684 , A61N1/371
摘要： Pacing related timing is determined for an implantable medical device (IMD) by pacing at an RV pacing site, a first LV pacing site and a second LV pacing site in accordance with a first site, a second site and a third site pacing order, and further in accordance with a first inter-electrode pacing delay between pacing at the first site and pacing at the second site and a second inter-electrode pacing delay between pacing at the second site and pacing at the third site. At least one of a sensed event or a paced event is detected for at each of the second site and the third site. The first inter-electrode pacing delay and the second inter-electrode pacing delay are adjusted to avoid sensed events in favor of paced events at each of the second site and the third site. An atrio-ventricular delay may also be adjusted to avoid sensed events or lack of capture due to possible fusion at the first site, in favor of paced events at the first site.
摘要翻译：通过根据第一部位，第二部位和第三部位起搏顺序，在RV起搏部位，第一LV起搏部位和第二LV起搏部位进行起搏，确定可植入医疗装置（IMD）的起搏相关时间，以及进一步根据在第一部位的起搏和第二部位的起搏之间的第一电极间起搏延迟和在第二部位起搏和第三部位起搏之间的第二电极间起搏延迟。在第二站点和第三站点的每个处检测感测事件或起搏事件中的至少一个。调整第一电极间起搏延迟和第二电极间起搏延迟以避免感测到的事件有利于在第二位置和第三位置的每一个处的起搏事件。还可以调整心房延迟以避免感染事件或由于第一部位可能融合而导致的捕获不足，有利于在第一部位的起搏事件。

10. 发明申请

US20110098770A1 SYSTEMS AND METHODS FOR OPTIMIZING MULTI-SITE LEFT VENTRICULAR PACING BASED ON INTERELECTRODE CONDUCTION DELAYS 有权
标题翻译：基于电介质导通延迟优化多位置左心室的系统和方法
公开(公告)号：US20110098770A1
公开(公告)日：2011-04-28
申请号：US12607817
申请日：2009-10-28
申请人： Kyungmoo Ryu , Stuart Rosenberg , Allen Keel
发明人： Kyungmoo Ryu , Stuart Rosenberg , Allen Keel
IPC分类号： A61N1/368 , A61N1/365
CPC分类号： A61N1/3627 , A61N1/368 , A61N1/3684
摘要： Techniques are provided for use with an implantable cardiac stimulation device equipped for multi-site left ventricular (MSLV) pacing using a multi-pole LV lead. In one example, MSLV interelectrode conduction delays are determined among the electrodes of the multi-pole LV lead. MSLV interelectrode pacing delays are then set based on the MSLV interelectrode conduction delays for use in delivering MSLV pacing. To this end, various criteria are exploited for determining optimal values for the pacing delays based on the interelectrode conduction delays. MSLV pacing is then controlled using the specified MSLV interelectrode pacing delays. In some examples, the optimization procedure is performed by the implantable device itself. In other examples, the procedure is performed by an external programmer device. In such an embodiment, the external device determines optimal MSLV interelectrode pacing delays and then transmits programming commands to the implantable device to program the device to use the pacing delays.
摘要翻译：提供技术用于使用多极LV引线配备用于多位点左心室（MSLV）起搏的可植入心脏刺激装置。在一个示例中，在多极LV引线的电极之间确定MSLV电极间导电延迟。然后根据MSLV电极间传导延迟来设置MSLV电极间起搏延迟，以用于传递MSLV起搏。为此，利用各种标准来确定基于电极间传导延迟的起搏延迟的最佳值。然后使用指定的MSLV电极间起搏延迟来控制MSLV起搏。在一些示例中，优化过程由可植入装置本身执行。在其他示例中，该过程由外部编程器设备执行。在这样的实施例中，外部设备确定最佳MSLV电极间起搏延迟，然后将编程命令发送到可植入设备，以对设备进行编程以使用起搏延迟。

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