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1. 发明授权

US6058328A Implantable stimulation device having means for operating in a preemptive pacing mode to prevent tachyarrhythmias and method thereof 失效
标题翻译：可植入刺激装置具有用于以抢占式起搏模式操作以防止快速性心律失常的装置及其方法
公开(公告)号：US6058328A
公开(公告)日：2000-05-02
申请号：US788152
申请日：1997-01-24
申请人： Paul A. Levine , Jason A. Sholder , Gene A. Bornzin , Joseph J. Florio , Kenneth Valikai , Lisa P. Weinberg
发明人： Paul A. Levine , Jason A. Sholder , Gene A. Bornzin , Joseph J. Florio , Kenneth Valikai , Lisa P. Weinberg
IPC分类号： A61N1/362 , A61N1/365 , A61N1/39
CPC分类号： A61N1/3956 , A61N1/3622 , A61N1/36585 , A61N1/3688
摘要： Preemptive tachyarrhythmia pacing is provided in an implantable cardiac-stimulation device, such as an implantable pacemaker or defibrillator, by modifying the operation of the implantable device in a way that minimizes the likelihood of occurrence of a tachyarrhythmia. The behavior modification is achieved through the use of an appropriate preemptive tachyarrhythmia pacing control routine stored within the memory of the device. Depending upon the needs of the patient, preemptive tachyarrhythmia pacing is invoked continuously or on demand. If invoked on demand, Preemptive tachyarrhythmia pacing is triggered only upon the sensing of one or more conditions suggest that the onset of a tachyarrhythmia is imminent. When thus invoked, preemptive tachyarrhythmia pacing remains invoked only for as long as the onset-of-a-tachyarrhythmia-is-imminent conditions persist. Various preemptive tachyarrhythmia pacing control routines are contemplated, including those based on overdrive pacing, pacing with randomicity, and mode switching. Overdrive pacing, when used, is based on an automatically-determined diurnal rate, an automatic stepped increase over the average atrial rate, or a rate set by a cycle-to-cycle negative hysteresis. Conditions which suggest the imminency of the onset of a tachyarrhythmia include, but are not limited to, a sudden change in the patient's cardiac cycle from a previously-determined normal cardiac cycle.
摘要翻译：通过以最小化发生快速性心律失常的可能性的方式修改可植入装置的操作，在可植入心脏刺激装置（例如可植入起搏器或除颤器）中提供先发性快速性心律失调起搏。通过使用存储在设备的存储器内的适当的先发性快速性心律失常起搏控制程序来实现行为修改。根据患者的需要，可以连续或按需调用抢先式快速性心律失调起搏。如果按需调用，先发性快速性心律失常起搏仅在感觉到一种或多种情况时才触发，表明快速性心律失常的发作即将到来。当这样被援引时，只有在发生急性心律失常即将到来的情况持续存在的情况下，抢救性快速性心律失调起搏仍然被援引。预期各种先发性快速性心律失常起搏控制程序，包括基于超速起搏，起搏随机性和模式切换的那些。超速起搏在使用时，基于自动确定的昼夜速率，比平均心房率自动逐步增加，或由周期到周期的负滞后设定的速率。表明快速性心律失常发作即将发生的情况包括但不限于患者心动周期从先前确定的正常心动周期的突然变化。

2. 发明授权

US06389316B1 System and method for automatic atrial capture detection and atrial pacing threshold determination 有权
公开(公告)号：US06389316B1
公开(公告)日：2002-05-14
申请号：US09481085
申请日：2000-01-11
申请人： Gene A. Bornzin , Paul A. Levine , Kenneth Valikai , Jason A. Sholder
发明人： Gene A. Bornzin , Paul A. Levine , Kenneth Valikai , Jason A. Sholder
IPC分类号： A61N1368
CPC分类号： A61N1/3712 , A61N1/3714
摘要： An implantable dual chamber stimulation device provides a novel detection scheme for automatically detecting atrial capture and performing an atrial pacing threshold assessment. The stimulation device preferably waits until the patient is at or near rest and monitors the patient's P-wave activity to determine an detection window where a next P-wave is expected to occur. The stimulation device then delivers an atrial pulse prior to the next detection window, and monitors the window to determine whether a P-wave occurs therein. If a P-wave does not occur, then atrial capture is present, while occurrence of a P-wave indicates absence of atrial capture. If atrial capture is absent, the stimulation device automatically determines an appropriate atrial pacing threshold by monitoring the detection window while adjusting the stimulation pulse energy level. Advantageously, the present invention further employs a “bottom-up” adjusting scheme which starts at a low energy level, below the expected atrial pacing threshold, and increases the energy level until atrial capture is detected, thus saving energy and further avoiding corruption by large polarization signals. The latter feature is compatible with the present detection scheme and conventional evoked response detection schemes. The new atrial pacing threshold is then set at the atrial pulse level at which atrial capture was effectuated plus a predetermined safety margin.

3. 发明授权

US6122546A Pacemaker and method of operating same that provides functional atrial cardiac pacing with ventricular support 失效
标题翻译：起搏器和操作方法，提供功能性心房心脏起搏与心室支持
公开(公告)号：US6122546A
公开(公告)日：2000-09-19
申请号：US128284
申请日：1998-08-03
申请人： Jason A. Sholder , Paul A. Levine , Joseph J. Florio , Gene A. Bornzin
发明人： Jason A. Sholder , Paul A. Levine , Joseph J. Florio , Gene A. Bornzin
IPC分类号： A61N1/362 , A61N1/365 , A61N1/368
CPC分类号： A61N1/36585 , A61N1/3627 , A61N1/3682
摘要： A special type of AV/PV hysteresis is provided in a dual-chamber pacemaker. A long AV delay is initially provided, thereby affording as much opportunity as possible for natural AV conduction to occur. Such long AV delay is automatically shortened should AV block occur. Periodic scanning for the return of AV conduction (absence of AV block) is performed so that the AV delay can be returned to its long value as soon as possible. In one embodiment, the pacemaker "learns" the natural conduction time (AR interval) of the patient and thereafter uses such learned natural conduction time as a reference against which subsequently measured AR intervals are compared to better distinguish conducted ventricular contractions from ectopic, pathologic, or other nonconducted ventricular contractions (e.g., PVC's). If the measured AR interval is approximately the same as the "learned" AR interval, then the R-wave at the conclusion of the measured AR interval is presumed to be a conducted R-wave that signals the return of AV conduction, and the AV delay is lengthened back to its original value. If, on the other hand, the measured AR interval is significantly different than the "learned" natural conduction time, then the R-wave at the conclusion of the measured AR interval is presumed to be a nonconducted R-wave, and the AV delay is kept short. In other embodiments, other techniques are used to distinguish a conducted R-wave from a nonconducted R-wave.
摘要翻译：在双室起搏器中提供特殊类型的AV / PV滞后。最初提供长的AV延迟，从而为自然AV传导提供尽可能多的机会。如果发生AV块，这样长的AV延迟会自动缩短。进行AV导通（AV区域不存在）的返回的周期性扫描，使得AV延迟可以尽可能快地返回到其长值。在一个实施例中，起搏器“学习”患者的自然传导时间（AR间隔），此后使用这种学习的自然传导时间作为参考，随后比较随后测量的AR间隔以更好地区分进行的心室收缩与异位，病理，或其他非导管性心室收缩（例如PVC）。如果测量的AR间隔与“学习”的AR间隔大致相同，则在测量的AR间隔结束时的R波被推定为用于表示AV传导返回的传导R波，AV 延迟延长到原来的价值。另一方面，如果测量的AR间隔与“学习”的自然传导时间显着不同，则在测量的AR间隔结束时的R波被推定为非导通的R波，并且AV延迟保持短暂。在其他实施例中，使用其它技术来区分传导的R波和非导通的R波。

4. 发明授权

US5814077A Pacemaker and method of operating same that provides functional atrial cardiac pacing with ventricular support 失效
公开(公告)号：US5814077A
公开(公告)日：1998-09-29
申请号：US854797
申请日：1997-05-12
申请人： Jason A. Sholder , Paul A. Levine , Joseph J. Florio , Gene A. Bornzin
发明人： Jason A. Sholder , Paul A. Levine , Joseph J. Florio , Gene A. Bornzin
IPC分类号： A61N1/362 , A61N1/365 , A61N1/368
CPC分类号： A61N1/36585 , A61N1/3627 , A61N1/3682
摘要： A special type of AV/PV hysteresis is provided in a dual-chamber pacemaker. A long AV delay is initially provided, thereby affording as much opportunity as possible for natural AV conduction to occur. Such long AV delay is automatically shortened should AV block occur. Periodic scanning for the return of AV conduction (absence of AV block) is performed so that the AV delay can be returned to its long value as soon as possible. In one embodiment, the pacemaker "learns" the natural conduction time (AR interval) of the patient and thereafter uses such learned natural conduction time as a reference against which subsequently measured AR intervals are compared to better distinguish conducted ventricular contractions from ectopic, pathologic, or other nonconducted ventricular contractions (e.g., PVC's). If the measured AR interval is approximately the same as the "learned" AR interval, then the R-wave at the conclusion of the measured AR interval is presumed to be a conducted R-wave that signals the return of AV conduction, and the AV delay is lengthened back to its original value. If, on the other hand, the measured AR interval is significantly different than the "learned" natural conduction time, then the R-wave at the conclusion of the measured AR interval is presumed to be a nonconducted R-wave, and the AV delay is kept short. In other embodiments, other techniques are used to distinguish a conducted R-wave from a nonconducted R-wave.

5. 发明授权

US06934587B1 System and method for automatic atrial capture detection and atrial pacing threshold determination 失效
标题翻译：用于自动心房捕获检测和心房起搏阈值测定的系统和方法
公开(公告)号：US06934587B1
公开(公告)日：2005-08-23
申请号：US10160732
申请日：2002-06-03
申请人： Gene A. Bornzin , Paul A. Levine , Kenneth Valikai , Jason A. Sholder
发明人： Gene A. Bornzin , Paul A. Levine , Kenneth Valikai , Jason A. Sholder
IPC分类号： A61N1/37
CPC分类号： A61N1/3712 , A61N1/3714
摘要： An implantable dual chamber stimulation device provides a novel detection scheme for automatically detecting atrial capture and performing an atrial pacing threshold assessment. The stimulation device preferably waits until the patient is at or near rest and monitors the patient's P-wave activity to determine a detection window where a next P-wave is expected to occur. The stimulation device then delivers an atrial pulse prior to the next detection window, and monitors the window to determine whether a P-wave occurs therein. If a P-wave does not occur, then atrial capture is present, while occurrence of a P-wave indicates absence of atrial capture. If atrial capture is absent, the stimulation device automatically determines an appropriate atrial pacing threshold by monitoring the detection window while adjusting the stimulation pulse energy level. Advantageously, the present invention further employs a “bottom-up” adjusting scheme which starts at a low energy level, below the expected atrial pacing threshold, and increases the energy level until atrial capture is detected, thus saving energy and further avoiding corruption by large polarization signals. The latter feature is compatible with the present detection scheme and conventional evoked response detection schemes. The new atrial pacing threshold is then set at the atrial pulse level at which atrial capture was effectuated plus a predetermined safety margin.
摘要翻译：可植入双室刺激装置提供用于自动检测心房捕获并执行心房起搏阈值评估的新型检测方案。刺激装置优选地等待直到患者处于或接近静止并且监视患者的P波活动以确定期望发生下一个P波的检测窗口。刺激装置然后在下一个检测窗口之前递送心房脉搏，并监视窗口以确定其中是否发生P波。如果不发生P波，则存在心房捕获，而P波的发生表明不存在心房捕获。如果不存在心房捕获，则刺激装置通过在调节刺激脉冲能量水平的同时监测检测窗口自动确定适当的心房起搏阈值。有利地，本发明还采用从低能量水平开始的“自下而上”调整方案，低于预期的心房起搏阈值，并且增加能量水平直到检测到心房捕获，从而节省能量并进一步避免大的腐败极化信号。后一个特征与本发明的检测方案和常规的诱发响应检测方案兼容。然后将新的心房起搏阈值设置在心房采集的心房脉搏水平加上预定的安全余量。

6. 发明授权

US06408210B1 System and method for automatic atrial capture detection and atrial pacing threshold determination 失效
标题翻译：用于自动心房捕获检测和心房起搏阈值测定的系统和方法
公开(公告)号：US06408210B1
公开(公告)日：2002-06-18
申请号：US09481086
申请日：2000-01-11
申请人： Gene A. Bornzin , Paul A. Levine , Kenneth Valikai , Jason A. Sholder
发明人： Gene A. Bornzin , Paul A. Levine , Kenneth Valikai , Jason A. Sholder
IPC分类号： A61N137
CPC分类号： A61N1/3712 , A61N1/3714
摘要： An implantable dual chamber stimulation device provides a novel detection scheme for automatically detecting atrial capture and performing an atrial pacing threshold assessment. The stimulation device preferably waits until the patient is at or near rest and monitors the patient's P-wave activity to determine an detection window where a next P-wave is expected to occur. The stimulation device then delivers an atrial pulse prior to the next detection window, and monitors the window to determine whether a P-wave occurs therein. If a P-wave does not occur, then atrial capture is present, while occurrence of a P-wave indicates absence of atrial capture. If atrial capture is absent, the stimulation device automatically determines an appropriate atrial pacing threshold by monitoring the detection window while adjusting the stimulation pulse energy level. Advantageously, the present invention further employs a “bottom-up” adjusting scheme which starts at a low energy level, below the expected atrial pacing threshold, and increases the energy level until atrial capture is detected, thus saving energy and further avoiding corruption by large polarization signals. The latter feature is compatible with the present detection scheme and conventional evoked response detection schemes. The new atrial pacing threshold is then set at the atrial pulse level at which atrial capture was effectuated plus a predetermined safety margin.
摘要翻译：可植入双室刺激装置提供用于自动检测心房捕获并执行心房起搏阈值评估的新型检测方案。刺激装置优选地等待直到患者处于或接近静止，并且监视患者的P波活动以确定期望发生下一个P波的检测窗口。刺激装置然后在下一个检测窗口之前递送心房脉搏，并监视窗口以确定其中是否发生P波。如果不发生P波，则存在心房捕获，而P波的发生表明不存在心房捕获。如果不存在心房捕获，则刺激装置通过在调节刺激脉冲能量水平的同时监测检测窗口自动确定适当的心房起搏阈值。有利地，本发明还采用从低能量水平开始的“自下而上”调整方案，低于预期的心房起搏阈值，并且增加能量水平直到检测到心房捕获，从而节省能量并进一步避免大的腐败极化信号。后一个特征与本发明的检测方案和常规的诱发响应检测方案兼容。然后将新的心房起搏阈值设置在心房采集的心房脉搏水平加上预定的安全余量。

7. 发明授权

US5873895A Pacemaker and method of operating same that provides functional atrial cardiac pacing with ventricular support 有权
公开(公告)号：US5873895A
公开(公告)日：1999-02-23
申请号：US128341
申请日：1998-08-03
申请人： Jason A. Sholder , Paul A. Levine , Joseph J. Florio , Gene A. Bornzin
发明人： Jason A. Sholder , Paul A. Levine , Joseph J. Florio , Gene A. Bornzin
IPC分类号： A61N1/362 , A61N1/365 , A61N1/368
CPC分类号： A61N1/36585 , A61N1/3627 , A61N1/3682
摘要： A special type of AV/PV hysteresis is provided in a dual-chamber pacemaker. A long AV delay is initially provided, thereby affording as much opportunity as possible for natural AV conduction to occur. Such long AV delay is automatically shortened should AV block occur. Periodic scanning for the return of AV conduction (absence of AV block) is performed so that the AV delay can be returned to its long value as soon as possible. In one embodiment, the pacemaker "learns" the natural conduction time (AR interval) of the patient and thereafter uses such learned natural conduction time as a reference against which subsequently measured AR intervals are compared to better distinguish conducted ventricular contractions from ectopic, pathologic, or other nonconducted ventricular contractions (e.g., PVC's). If the measured AR interval is approximately the same as the "learned" AR interval, then the R-wave at the conclusion of the measured AR interval is presumed to be a conducted R-wave that signals the return of AV conduction, and the AV delay is lengthened back to its original value. If, on the other hand, the measured AR interval is significantly different than the "learned" natural conduction time, then the R-wave at the conclusion of the measured AR interval is presumed to be a nonconducted R-wave, and the AV delay is kept short. In other embodiments, other techniques are used to distinguish a conducted R-wave from a nonconducted R-wave.

8. 发明授权

US06721601B1 System and method for automatic atrial capture detection and atrial pacing threshold determination 有权
标题翻译：用于自动心房捕获检测和心房起搏阈值测定的系统和方法
公开(公告)号：US06721601B1
公开(公告)日：2004-04-13
申请号：US10102271
申请日：2002-03-19
申请人： Gene A. Bornzin , Paul A. Levine , Kenneth Valikai , Jason A. Sholder
发明人： Gene A. Bornzin , Paul A. Levine , Kenneth Valikai , Jason A. Sholder
IPC分类号： A61N137
CPC分类号： A61N1/3712 , A61N1/3714
摘要： An implantable dual chamber stimulation device provides a novel detection scheme that automatically detecting atrial capture and performing an atrial pacing threshold assessment. The stimulation device preferably waits until the patient is at or near rest and monitors the patient's P-wave activity to determine a detection window where a next P-wave is expected to occur. The stimulation device then delivers an atrial pulse prior to the next detection window, and monitors the window to determine whether a P-wave occurs therein. If a P-wave does not occur, then atrial capture is present, while occurrence of a P-wave indicates absence of atrial capture. If atrial capture is absent, the stimulation device automatically determines an appropriate atrial pacing threshold by monitoring the detection window while adjusting the stimulation pulse energy level. Advantageously, the present invention further employs a “bottom-up” adjusting scheme which starts at a low energy level, below the expected atrial pacing threshold, and increases the energy level until atrial capture is detected, thus saving energy and further avoiding corruption by large polarization signals. The latter feature is compatible with the present detection scheme and conventional evoked response detection schemes. The new atrial pacing threshold is then set at the atrial pulse level at which atrial capture was effectuated plus a predetermined safety margin.
摘要翻译：可植入双室刺激装置提供了一种新的检测方案，其自动检测心房捕获并执行心房起搏阈值评估。刺激装置优选地等待直到患者处于或接近静止并且监视患者的P波活动以确定期望发生下一个P波的检测窗口。刺激装置然后在下一个检测窗口之前递送心房脉搏，并监视窗口以确定其中是否发生P波。如果不发生P波，则存在心房捕获，而P波的发生表明不存在心房捕获。如果不存在心房捕获，则刺激装置通过在调节刺激脉冲能量水平的同时监测检测窗口自动确定适当的心房起搏阈值。有利地，本发明还采用从低能量水平开始的“自下而上”调整方案，低于预期的心房起搏阈值，并且增加能量水平直到检测到心房捕获，从而节省能量并进一步避免大的腐败极化信号。后一个特征与本发明的检测方案和常规的诱发响应检测方案兼容。然后将新的心房起搏阈值设置在心房采集的心房脉搏水平加上预定的安全余量。

9. 发明授权

US06295471B1 System and method for automatic atrial capture detection and atrial pacing threshold determination 有权
标题翻译：用于自动心房捕获检测和心房起搏阈值测定的系统和方法
公开(公告)号：US06295471B1
公开(公告)日：2001-09-25
申请号：US09481748
申请日：2000-01-11
申请人： Gene A. Bornzin , Paul A. Levine , Kenneth Valikai , Jason A. Sholder
发明人： Gene A. Bornzin , Paul A. Levine , Kenneth Valikai , Jason A. Sholder
IPC分类号： A61N137
CPC分类号： A61N1/3712 , A61N1/3714
摘要： An implantable dual chamber stimulation device provides a novel detection scheme for automatically detecting atrial capture and performing an atrial pacing threshold assessment. The stimulation device preferably waits until the patient is at or near rest and monitors the patient's P-wave activity to determine an detection window where a next P-wave is expected to occur. The stimulation device then delivers an atrial pulse prior to the next detection window, and monitors the window to determine whether a P-wave occurs therein. If a P-wave does not occur, then atrial capture is present, while occurrence of a P-wave indicates absence of atrial capture. If atrial capture is absent, the stimulation device automatically determines an appropriate atrial pacing threshold by monitoring the detection window while adjusting the stimulation pulse energy level. Advantageously, the present invention further employs a “bottom-up” adjusting scheme which starts at a low energy level, below the expected atrial pacing threshold, and increases the energy level until atrial capture is detected, thus saving energy and further avoiding corruption by large polarization signals. The latter feature is compatible with the present detection scheme and conventional evoked response detection schemes. The new atrial pacing threshold is then set at the atrial pulse level at which atrial capture was effectuated plus a predetermined safety margin.
摘要翻译：可植入双室刺激装置提供用于自动检测心房捕获并执行心房起搏阈值评估的新型检测方案。刺激装置优选地等待直到患者处于或接近静止，并且监视患者的P波活动以确定期望发生下一个P波的检测窗口。刺激装置然后在下一个检测窗口之前递送心房脉搏，并监视窗口以确定其中是否发生P波。如果不发生P波，则存在心房捕获，而P波的发生表明不存在心房捕获。如果不存在心房捕获，则刺激装置通过在调节刺激脉冲能量水平的同时监测检测窗口自动确定适当的心房起搏阈值。有利地，本发明还采用从低能量水平开始的“自下而上”调整方案，低于预期的心房起搏阈值，并且增加能量水平直到检测到心房捕获，从而节省能量并进一步避免大的腐败极化信号。后一个特征与本发明的检测方案和常规的诱发响应检测方案兼容。然后将新的心房起搏阈值设置在心房采集的心房脉搏水平加上预定的安全余量。

10. 发明授权

US07233827B1 Implantable cardiac stimulation device with automatic evoked response sensing electrode configuration selection and method 有权
标题翻译：可植入心脏刺激装置具有自动诱发响应感应电极配置选择和方法
公开(公告)号：US07233827B1
公开(公告)日：2007-06-19
申请号：US10865124
申请日：2004-06-09
申请人： Gene A. Bornzin , Joseph J. Florio , Laurence S. Sloman , Brian M. Mann , Jason A. Sholder
发明人： Gene A. Bornzin , Joseph J. Florio , Laurence S. Sloman , Brian M. Mann , Jason A. Sholder
IPC分类号： A61N1/365
CPC分类号： A61N1/3686 , A61N1/36185 , A61N1/371
摘要： An implantable cardiac stimulation device applies pacing stimulation pulses to a heart and senses evoked responses to the pacing stimulation pulses. A pulse generator applies the stimulation pacing pulses to the heart in accordance with a pacing configuration. A sensor control selects an evoked response sensing electrode configuration from among a plurality of evoked response sensing electrode configurations in response to the pacing configuration. A sensor is then programmed to sense the evoked responses with the selected evoked response sensing electrode configuration. In accordance with a preferred embodiment, signal-to-noise ratios obtained with the various electrode configurations are used to select a best electrode configuration for sensing evoked responses.
摘要翻译：可植入心脏刺激装置将起搏刺激脉冲应用于心脏并感测对起搏刺激脉冲的诱发反应。脉冲发生器根据起搏配置将刺激起搏脉冲施加到心脏。传感器控制器响应于起搏配置从多个诱发响应感测电极配置中选择诱发响应感测电极配置。然后将传感器编程为用所选择的诱发响应感测电极配置感测诱发的反应。根据优选实施例，使用用各种电极配置获得的信噪比用于选择用于感测诱发响应的最佳电极配置。

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