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21. 发明授权

US5514160A Implantable defibrillator for producing a rectangular-shaped defibrillation waveform 失效
标题翻译：用于产生矩形除颤波形的可植入除颤器
公开(公告)号：US5514160A
公开(公告)日：1996-05-07
申请号：US231036
申请日：1994-04-22
申请人： Mark W. Kroll , Theodore P. Adams , Charles G. Supino
发明人： Mark W. Kroll , Theodore P. Adams , Charles G. Supino
IPC分类号： A61N1/39
CPC分类号： A61N1/3925 , A61N1/3956 , A61N1/3906 , A61N1/3912
摘要： An implantable defibrillator derives a rectangular current waveform from a capacitor discharge by using a current limiter. This pulse-shaping method is equally applicable to single-path and multiple-path situations. A rectangular pulse delivers a maximum of energy for a given peak-field value with a particular electrode combination and pulse duration. Peak field is a measure of the tissue-damage potentiality of a particular discharge.
摘要翻译：可植入除颤器通过使用限流器从电容器放电导出矩形电流波形。这种脉冲整形方法同样适用于单路径和多路径情况。矩形脉冲通过特定的电极组合和脉冲持续时间为给定的峰值值提供最大的能量。峰值场是测量特定放电的组织损伤潜能。

22. 发明授权

US5507781A Implantable defibrillator system with capacitor switching circuitry 失效
标题翻译：具有电容开关电路的可植入除颤器系统
公开(公告)号：US5507781A
公开(公告)日：1996-04-16
申请号：US292354
申请日：1994-08-18
申请人： Mark W. Kroll , Theodore P. Adams , Dennis A. Brumwell
发明人： Mark W. Kroll , Theodore P. Adams , Dennis A. Brumwell
IPC分类号： A61N1/39
CPC分类号： A61N1/3956 , A61N1/3906 , A61N1/3912
摘要： The present invention uses switches to set the topology and polarity of a circuit that includes capacitors to deliver an electric pulse to a heart during a defibrillation procedure. The waveform of the electric pulse is biphasic, in that it is a positive portion of the pulse followed by a negative portion of the pulse. The topology and polarity of the circuit are utilized to produce a waveform that approximates the ideal waveform for the specific situation. The circuit provides for combinations of capacitors variously in series and in parallel and changing the topology and polarity of the circuit during discharge of the capacitors.
摘要翻译：本发明使用开关来设置包括电容器的电路的拓扑和极性，以在除颤过程期间将电脉冲输送到心脏。电脉冲的波形是双相的，因为它是脉冲的正部分，后面是脉冲的负部分。电路的拓扑结构和极性被用于产生一个近似于特定情况的理想波形的波形。该电路提供串联和并联的电容器的组合，并且在电容器放电期间改变电路的拓扑和极性。

23. 发明授权

US5449377A Overcharged final countershock for an implantable cardioverter defibrillator and method 失效
标题翻译：用于植入式心律转复除颤器和方法的过度充电最后的反冲
公开(公告)号：US5449377A
公开(公告)日：1995-09-12
申请号：US125288
申请日：1993-09-22
申请人： Theodore P. Adams , Mark W. Kroll
发明人： Theodore P. Adams , Mark W. Kroll
IPC分类号： A61N1/39 , H01M2/10
CPC分类号： A61N1/3956 , A61N1/3906 , H01M2/1066
摘要： An implantable cardioverter defibrillator (ICD) device in operated in an overcharged final countershock condition so as to provide greater efficacy and broader treatment modality for the device. Instead of delivering a repeated series of up to five countershocks at the maximum rated charging voltage in response to a persistent ventricular arrhythmia as is done in existing ICD systems, an overcharged final countershock is delivered for which the electrolytic capacitor charge storage system of the ICD system is charged at a voltage that exceeds a maximum voltage specification. By delivering an overcharged final countershock, the present invention increases the chances of reversing a persistent ventricular arrhythmia which has become increasingly resistant to electrical therapy the longer the arrhythmia persists. As there is little to no risk in overcharging electrolytic capacitors for delivering the overcharged final countershock, and in fact the added electrical energy may overcome the increasing resistance to electrical countershock therapy, the present invention can deliver a more efficacious programmed therapy regimen than is available on existing ICD systems.
摘要翻译：一种植入式心律转复除颤器（ICD）装置，其运行于过充电的最终反冲状态，以便为装置提供更大的功效和更广泛的治疗方式。不像现有的ICD系统那样，以最大的额定充电电压提供多达五个反冲的一系列响应于持续性室性心律失常的一系列重复序列，而是向ICD系统提供电解电容器充电存储系统的过充电最终的反冲以超过最大电压规格的电压充电。通过产生过度充电的最后的褥疮，本发明增加了逆转持续性室性心律失常的机会，该心律失常已经变得越来越耐电疗治疗，心律失常持续时间越长。由于过充电的电解电容器用于递送过充电的最后的反冲，几乎没有风险，事实上，所增加的电能可以克服对电抗冲击治疗的增加的阻力，本发明可以提供比现有的更有效的程序治疗方案现有ICD系统。

24. 发明授权

US5447521A Safety system for an implantable defibrillator 失效
标题翻译：可植入除颤器的安全系统
公开(公告)号：US5447521A
公开(公告)日：1995-09-05
申请号：US321782
申请日：1994-10-12
申请人： Kenneth M. Anderson , Theodore P. Adams , Charles G. Supino , Mark W. Kroll
发明人： Kenneth M. Anderson , Theodore P. Adams , Charles G. Supino , Mark W. Kroll
IPC分类号： A61N1/04 , A61N1/05 , A61N1/39
CPC分类号： A61N1/3956 , A61N1/0563 , A61N1/3918
摘要： A defibrillator pulse generator for pectoral implant utilizing the metal case as an electrode and operative to supply unique patterns of monophasic, biphasic, or pairs of electrical pulses to the connected electrodes.
摘要翻译：一种用于胸部植入物的除颤器脉冲发生器，其利用金属壳体作为电极并且可操作以向连接的电极提供单相，双相或成对的电脉冲的独特模式。

25. 发明授权

US5411526A Improved implantable defibrillator system for producing true-voltage-pulse waveforms 失效
标题翻译：改进的植入式除颤器系统，用于产生真正的电压脉冲波形
公开(公告)号：US5411526A
公开(公告)日：1995-05-02
申请号：US856733
申请日：1992-03-24
申请人： Mark W. Kroll , Charles G. Supino , Theodore P. Adams , Dennis A. Brumwell
发明人： Mark W. Kroll , Charles G. Supino , Theodore P. Adams , Dennis A. Brumwell
IPC分类号： A61N1/39 , A61N1/00
CPC分类号： A61N1/3956 , A61N1/3906 , A61N1/3912
摘要： The first embodiment of the present invention repositions the shunt thyristor used in the monophasic-waveform generator of the prior art so that it discharges the main capacitor through a series thyristor, thus increasing current through it briefly, rather than reducing current through it. The result of this arrangement is that the node between the series thyristor and the heart is pulled rapidly to a low voltage, causing the shunt switch to discharge the cardiac capacitance, as well as the main capacitance. The consequence is that discharging the cardiac capacitance requires a reversal of current in the heart, which enhances the heart-stimulating effect of the defibrillating waveform. The resulting true-voltage-pulse waveform has an efficacy approximating that of a biphasic waveform and is achieved with a circuit no more complex than that used to generate a monophasic waveform. A second and alternative embodiment of the present invention is a defibrillation system comprising a switching-bridge circuit, augmented by a zener diode and a rectifier diode, that is capable of delivering on demand any one of the waveforms known as monophasic, biphasic, and true-voltage-pulse waveforms.
摘要翻译：本发明的第一实施例重新使用现有技术的单相波形发生器中使用的分流晶闸管，使得其通过串联晶闸管放电主电容器，从而短暂地增加电流，而不是减少通过其的电流。这种安排的结果是串联晶闸管和心脏之间的节点被迅速拉到低电压，导致并联开关放电心电容以及主电容。结果是，放电心脏电容需要心脏中的电流反转，这增强了除颤波形的心脏刺激作用。所得到的真实电压脉冲波形的效果近似于双相波形，并且通过不比用于产生单相波形的电路更复杂的电路来实现。本发明的第二和替代实施例是一种除颤系统，其包括由齐纳二极管和整流二极管增强的开关桥式电路，其能够根据需要输送任何一种已知为单相，双相和真实的波形电压脉冲波形。

26. 发明授权

US5366485A Apparatus for defibrillation pretreatment of a heart 失效
标题翻译：心脏除颤预处理装置
公开(公告)号：US5366485A
公开(公告)日：1994-11-22
申请号：US967215
申请日：1992-10-27
申请人： Mark W. Kroll , Theodore P. Adams
发明人： Mark W. Kroll , Theodore P. Adams
IPC分类号： A61N1/39 , A61N1/00
CPC分类号： A61N1/3956 , A61N1/3906
摘要： The present invention is an apparatus to apply an electrical pretreatment of pulses to a fibrillating heart that begins the process of organizing the action of the chaotically contracting myocardial cells, so that the defibrillating waveform applied after the pretreatment can accomplish its task with less energy than would otherwise be required. The same electrodes are employed for both pretreatment and defibrillation. In one preferred embodiment a long-duration, low-voltage pretreatment pulse is generated directly by battery and voltage-conversion circuitry, and is followed by the defibrillation pulse delivered from the previously charged capacitor. In variations on the embodiments, the capacitor is charged during the pretreatment pulse, or between the pretreatment and defibrillation pulses. In other embodiments, pretreatment includes a train of pulses of appreciably lower energy than the defibrillation pulse, and with inter-pulse time adjusted so that necessary capacitor recharging can be accomplished, so that the same capacitor (a component of dominant size) can be used for all pretreatment pulses and for the defibrillation pulse as well. Wide-ranging variations of pulse duration, height spacing and waveform are included, as well as selected polarity inversions.
摘要翻译：本发明是一种将脉冲电预处理应用于原纤化心脏的装置，其开始组织紊乱收缩心肌细胞的作用的过程，使得在预处理之后施加的除颤波形可以以比能量少的能量完成其任务否则需要。同样的电极用于预处理和除颤。在一个优选实施例中，长期，低电压预处理脉冲由电池和电压转换电路直接产生，并且之后是从先前充电的电容器传送的除颤脉冲。在实施例的变型中，电容器在预处理脉冲期间或在预处理和除颤脉冲之间被充电。在其他实施例中，预处理包括比除颤脉冲明显更低能量的脉冲序列，并且调整脉冲间时间以便可以实现必要的电容器充电，使得可以使用相同的电容器（主要尺寸的分量）对于所有预处理脉冲和除颤脉冲。包括脉冲宽度，高度间隔和波形的广泛变化，以及选定的极性反转。

27. 发明授权

US5314448A Process for defibrillation pretreatment of a heart 失效
标题翻译：心脏除颤预处理的过程
公开(公告)号：US5314448A
公开(公告)日：1994-05-24
申请号：US783763
申请日：1991-10-28
申请人： Mark W. Kroll , Theodore P. Adams
发明人： Mark W. Kroll , Theodore P. Adams
IPC分类号： A61N1/39
CPC分类号： A61N1/3956 , A61N1/3906
摘要： The present invention is a process to apply an electrical pretreatment to a fibrillating heart that begins the process of organizing the action of the chaotically contracting myocardial cells, so that the defibrillating waveform applied after the pretreatment can accomplish its task with less energy than would otherwise be required. The same electrodes are employed for both pretreatment and defibrillation. In one preferred embodiment a long-duration, low-voltage pretreatment pulse is generated directly by battery and voltage-conversion circuitry, and is followed by the defibrillation pulse delivered from the previously charged capacitor. In variations on this embodiment, the capacitor is charged during the pretreatment pulse, or between the pretreatment and defibrillation pulses. In other preferred embodiments, pretreatment consists of a train of pulses of appreciably lower energy than the defibrillation pulse, and with inter-pulse time adjusted so that necessary capacitor recharging can be accomplished, so that the same capacitor (a component of dominant size) can be used for all pretreatment pulses and for the defibrillation pulse as well. Wide-ranging variations of pulse duration, height spacing and waveform are included, as well as selected polarity inversions.
摘要翻译：本发明是一种将电预处理应用于起始于组织紊乱心肌细胞的作用的过程的原纤维心脏的方法，使得在预处理之后施加的除颤波形可以以比原来的更少的能量完成其任务需要。同样的电极用于预处理和除颤。在一个优选实施例中，长期，低电压预处理脉冲由电池和电压转换电路直接产生，并且之后是从先前充电的电容器传送的除颤脉冲。在本实施例的变型中，电容器在预处理脉冲期间或在预处理和除颤脉冲之间被充电。在其他优选实施例中，预处理包括比除颤脉冲明显更低能量的脉冲序列，并且调整脉冲间时间以便可以实现必要的电容器充电，使得相同的电容器（主要尺寸的分量）可以用于所有预处理脉冲和除颤脉冲。包括脉冲宽度，高度间隔和波形的广泛变化，以及选定的极性反转。

28. 发明授权

US5312443A Arrhythmia-detection criteria process for a cardioverter/defibrillator 失效
标题翻译：心律失常检测标准过程为心律转复/除颤器
公开(公告)号：US5312443A
公开(公告)日：1994-05-17
申请号：US837952
申请日：1992-02-20
申请人： Theodore P. Adams , Mark W. Kroll , Charles G. Supino
发明人： Theodore P. Adams , Mark W. Kroll , Charles G. Supino
IPC分类号： A61N1/362 , A61N1/39 , A61B5/04
CPC分类号： A61N1/3621 , A61N1/39 , Y10S128/925
摘要： A major shortcoming in the prior art for detecting cardiac arrhythmias for the purpose of making an electrical intervention decision has been that each variable sensed was given in effect a "veto" over intervention on the basis of its own particular predetermined threshold value, and irrespective of the values of companion variables. The present invention overcomes this prior art problem by generating a function of relevant variables, and assigning a threshold value to the function. As a result, an individual variable can range widely for a positive intervention decision, depending upon the values of the companion variables. Thus, the intervention exploits features often described as those associated with fuzzy logic. The functions chosen for this purpose can be as one desires, with the choice depending upon the current state of advancing knowledge. Even further flexibility can be achieved by employing the principles of the neural net, wherein functional values can themselves be combined, with another threshold value assigned to the result of that combination, and so on.
摘要翻译：用于检测心律失常以用于进行电干预决定的现有技术的主要缺点是感测的每个变量实际上基于其自己的特定预定阈值相对于干预被赋予“否决权”，并且不管伴随变量的值。本发明通过产生相关变量的功能以及为该函数分配阈值来克服该现有技术问题。因此，根据伴随变量的值，单个变量可以广泛地用于积极干预决策。因此，干预利用了经常被描述为与模糊逻辑相关联的特征。为此目的选择的功能可以是一个愿望，根据当前的知识状态选择。甚至可以通过采用神经网络的原理来实现进一步的灵活性，其中功能值本身可以被组合，分配给该组合的结果的另一阈值等等。

29. 发明授权

US5306291A Optimal energy steering for an implantable defibrillator 失效
标题翻译：可植入除颤器的最佳能量转向
公开(公告)号：US5306291A
公开(公告)日：1994-04-26
申请号：US841544
申请日：1992-02-26
申请人： Mark W. Kroll , Theodore P. Adams , Charles G. Supino
发明人： Mark W. Kroll , Theodore P. Adams , Charles G. Supino
IPC分类号： A61N1/39 , A61N1/36
CPC分类号： A61N1/3925 , A61N1/3956 , A61N1/3906 , A61N1/3912
摘要： Epicardial-patch electrodes for defibrillation are efficient in deliverying electrical energy accurately to the necessary tissue and in minimizing electrical losses, but they are risky and costly because their implantation requires major surgery. Intravenous implantation of endocardial-coil electrodes, such as right-ventricular-apex (RVA) and superior-vena-cava (SVC) electrodes, by means of cardiac catheters, on the other hand, involves simpler procedures. Also, implantation of a subcutaneous-patch (SUB) electrode or of a pulse-generator housing (CAN, subject to co-pending application) electrode requires comparatively minor surgery. Using these last four electrodes, however, involves accepting electrical losses in intervening tissue, relatively inefficient current directions in some cases, and unfavorable energy distributions among paralleled paths. The present invention achieves more favorable energy and current distribution by introducing lossy elements in one or more paths, or by capacitor-switching methods, where RVA is given one polarity, and at least two of the other electrodes are given opposite polarity, yielding at least two pathways. The present invention also achieves current and energy steering by means of differing pulse durations in different paths.
摘要翻译：用于除颤的心包膜电极有效地将电能精确地传递到必要的组织并且最小化电损耗，但是由于其植入需要大量手术，它们是有风险且昂贵的。另一方面，通过心脏导管静脉内植入心内膜线圈电极，例如右心室顶端（RVA）和上腔静脉（SVC）电极，涉及更简单的手术。此外，皮下补片（SUB）电极或脉冲发生器壳体（CAN，待共同未决的应用）电极的植入需要较小的手术。然而，使用这些最后四个电极涉及在中间组织中接受电损耗，在一些情况下相对低效的电流方向以及平行路径中的不利能量分布。本发明通过在一个或多个路径中引入有损耗元件或通过电容器切换方法来实现更有利的能量和电流分布，其中RVA被赋予一个极性，并且至少两个其它电极被赋予相反的极性，至少产生两条途径。本发明还通过不同路径中的不同脉冲持续时间来实现电流和能量转向。

30. 发明授权

US5300110A Dirk-based epicardial defibrillation electrode 失效
标题翻译：基于Dirk的心外膜除颤电极
公开(公告)号：US5300110A
公开(公告)日：1994-04-05
申请号：US961463
申请日：1992-10-15
申请人： Scott T. Latterell , Mark W. Kroll , Theodore P. Adams
发明人： Scott T. Latterell , Mark W. Kroll , Theodore P. Adams
IPC分类号： A61N1/05 , A61N1/04
CPC分类号： A61N1/0587
摘要： An epicardial defibrillation electrode device having small conductive dirks extending therefrom to lodge into the myocardium to lower the electrode impedence. The electrode device utilizes a flexible, translucent support member to aid in the positioning of the dirks during electrode implantation. Switchable dirks extending from separate conductive members mounted to the support member are provided for pacing, sensing and defibrillation.
摘要翻译：一种心外膜除颤电极装置，其具有从其延伸的小导电性室，以提供到心肌中以降低电极阻抗。电极装置利用柔性的半透明支撑构件来辅助电极植入期间的气流定位。提供从安装到支撑构件的单独的导电构件延伸的可切换的气流，用于起搏，感测和除颤。

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