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61. 发明授权

US5957956A Implantable cardioverter defibrillator having a smaller mass 失效
标题翻译：植入式心律转复除颤器质量较小
公开(公告)号：US5957956A
公开(公告)日：1999-09-28
申请号：US963154
申请日：1997-11-03
申请人： Mark W. Kroll , Theodore P. Adams , Kenneth M. Anderson , Charles U. Smith
发明人： Mark W. Kroll , Theodore P. Adams , Kenneth M. Anderson , Charles U. Smith
IPC分类号： A61N1/375 , A61N1/39 , H01M2/10 , H01M6/50 , H01M16/00 , A61N1/18
CPC分类号： A61N1/375 , A61N1/3956 , A61N1/3758 , H01M16/00 , H01M2/1066 , H01M6/5016
摘要： A capacitor-discharge implantable cardioverter defibrillator (ICD) has a relatively smaller mass of less than about 120 grams. The smaller mass of the ICD is achieved by selecting and arranging the internal components of the ICD to deliver a maximum defibrillation countershock optimized in terms of a minimum physiologically effective current (I.sub.pe), rather than a minimum defibrillation threshold energy (DFT). As a result of the optimization in terms of a minimum effective current I.sub.pe, there is a significant decrease in the maximum electrical charge energy (E.sub.c) that must be stored by the capacitor of the ICD to less than about 30 Joules, even though a higher safety margin is provided for by the device. Due to this decrease in the maximum E.sub.c, as well as corollary decreases in the effective capacitance value required for the capacitor and the net energy storage required of the battery, the overall displacement volume of the ICD is reduced to the point where subcutaneous implantation of the device in the pectoral region of human patients is practical. The size of the capacitor is reduced because the effective capacitance required can be less than about 125 .mu.F. By optimizing both the charging time and the countershock duration for the smaller maximum E.sub.c, the size of the battery is reduced because the total energy storage capacity can be less than about 1.0 Amp-hours. In the preferred embodiment, the charging time for each defibrillation countershock is reduced to less than about 10 seconds and the pulse duration of the countershock is reduced to less than about 6 milliseconds.
摘要翻译：电容放电植入式心律转复除颤器（ICD）的质量相对较小，小于约120克。通过选择和布置ICD的内部部件来实现ICD的较小质量，以提供根据最小生理有效电流（Ipe）而不是最小除颤阈值能量（DFT）优化的最大除颤抗倒伏。作为最小有效电流Ipe优化的结果，ICD的电容器必须存储的最大电荷能量（Ec）显着降低到小于约30焦耳，即使较高的设备提供安全余量。由于最大Ec的这种减小以及电容器所需的有效电容值和电池所需的净能量存储的必然减小，ICD的总位移体积减少到皮下植入在人类胸腔的器官是实用的。电容器的尺寸减小，因为所需的有效电容可以小于约125μF。通过优化较小的最大Ec的充电时间和反冲时间，电池的尺寸减小，因为总能量存储容量可以小于约1.0安培小时。在优选实施例中，每个去纤维颤动反射的充电时间减少到小于约10秒，并且该反冲的脉冲持续时间减小到小于约6毫秒。

62. 发明授权

US5906633A System for delivering rounded low pain therapeutic electrical waveforms to the heart 失效
标题翻译：向心脏传递圆滑的低疼痛治疗电波形的系统
公开(公告)号：US5906633A
公开(公告)日：1999-05-25
申请号：US64422
申请日：1998-04-22
申请人： Gabriel Mouchawar , Robert J. Sweeney , Mark W. Kroll
发明人： Gabriel Mouchawar , Robert J. Sweeney , Mark W. Kroll
IPC分类号： A61N1/39
CPC分类号： A61N1/3956 , A61N1/3906 , A61N1/3912 , Y10S128/908
摘要： A system for delivering low pain cardioversion shocks to the heart wherein the system provides a waveform to the heart that is biphasic and has rounded leading and trailing edges. The rounded leading and trailing edges are believed to decrease the discomfort experienced by the patient. In one embodiment, the circuit has a two capacitors connected in parallel with each other and with an H-bridge. The two capacitors are connected via a switch that can be closed so as to simultaneously charge one capacitor from the other while simultaneously applying voltage to the H-bridge. The circuit also includes a dump resistor that can be connected in parallel with the capacitors so as to increase the rounding of the trailing edges of the waveform. In another embodiment, controllable switches can also be included so as to be able to connect the capacitors in series and apply a sharp peak defibrillation waveform to the heart.
摘要翻译：用于向心脏递送低疼痛心脏复律冲击的系统，其中系统向心脏提供双相并具有圆形前缘和后缘的波形。认为圆形的前缘和后缘减少了患者所遭受的不适。在一个实施例中，该电路具有彼此并联并具有H桥的两个电容器。两个电容器通过可以关闭的开关连接，以便同时向另一个电容器充电，同时向H桥施加电压。该电路还包括可与电容器并联连接的转储电阻器，以增加波形后沿的舍入。在另一个实施例中，还可以包括可控开关，以便能够串联连接电容器，并向心脏施加尖锐的除颤波形。

63. 发明授权

US5833712A Implantable defibrillator system for generating a biphasic waveform 失效
标题翻译：用于产生双相波形的植入式除颤器系统
公开(公告)号：US5833712A
公开(公告)日：1998-11-10
申请号：US426023
申请日：1995-04-21
申请人： Mark W. Kroll , Kai Kroll
发明人： Mark W. Kroll , Kai Kroll
IPC分类号： A61N1/39 , H02M3/07
CPC分类号： H02M3/07 , A61N1/3956 , A61N1/3906 , A61N1/3912
摘要： A method and apparatus for generating biphasic waveforms uses an implantable cardioverter defibrillator having two capacitor systems and a switching network. A first phase of the biphasic waveform is produced by configuring the two capacitor systems to selectively discharge first in a parallel combination, and then in a series combination. The second phase of the biphasic waveform is produced by reconfiguring the two capacitor systems in a parallel combination. By reverting to a parallel configuration for the second phase of the biphasic waveform, the output characteristics of the second phase of a biphasic waveform of the present invention more closely match a new model for understanding the effectiveness of the biphasic.
摘要翻译：用于产生双相波形的方法和装置使用具有两个电容器系统和开关网络的可植入心律转复除颤器。双相波形的第一相通过将两个电容器系统配置为首先以并联组合然后以串联组合的方式选择性地放电来产生。双相波形的第二相通过并联组合重新配置两个电容器系统来产生。通过恢复到双相波形的第二相的并联配置，本发明的双相波形的第二相的输出特性更加匹配用于理解双相的有效性的新模型。

64. 发明授权

US5827326A Implantable cardioverter defibrillator having a smaller energy storage capacity 失效
标题翻译：具有较小能量储存能力的植入式心律转复除颤器
公开(公告)号：US5827326A
公开(公告)日：1998-10-27
申请号：US412920
申请日：1995-03-29
申请人： Mark W. Kroll , Theodore P. Adams , Kenneth M. Anderson , Charles U. Smith
发明人： Mark W. Kroll , Theodore P. Adams , Kenneth M. Anderson , Charles U. Smith
IPC分类号： A61N1/375 , A61N1/378 , A61N1/39 , H01M2/10 , H01M6/50 , H01M16/00
CPC分类号： A61N1/375 , A61N1/3787 , A61N1/3931 , A61N1/3956 , A61N1/3975 , H01M16/00 , A61N1/3758 , A61N1/3906 , A61N1/3912 , H01M2/1066 , H01M6/5016
摘要： A capacitor-discharge implantable cardioverter defibrillator (ICD) has a relatively smaller energy storage capacity of less than about 1.0 Amp-hours. The smaller energy storage capacity of the ICD is achieved by selecting and arranging the internal components of the ICD to deliver a maximum defibrillation countershock optimized in terms of a minimum physiologically effective current (I.sub.pe) rather than a minimum defibrillation threshold energy (DFT). As a result of the optimization in terms of a minimum effective current I.sub.pe, there is a significant decrease in the maximum electrical charge energy (E.sub.c) that must be stored by the capacitor of the ICD to less than about 30 Joules, even though a higher safety margin is provided for by the device. Due to this decrease in the maximum E.sub.c, as well as corollary decreases in the effective capacitance value required for the capacitor and the net energy storage required of the battery, the overall displacement volume of the ICD is reduced to the point where subcutaneous implantation of the device in the pectoral region of human patients is practical. The size of the capacitor is reduced because the effective capacitance required can be less than about 125 .mu.F. By optimizing both the charging time and the countershock duration for the smaller maximum E.sub.c, the size of the battery is reduced because the total energy storage capacity can be less than about 1.0 Amp-hours. In the preferred embodiment, the charging time for each defibrillation countershock is reduced to less than about 10 seconds and the pulse duration of the countershock is reduced to less than about 6 milliseconds.
摘要翻译：电容放电植入式心律转复除颤器（ICD）具有小于约1.0安培小时的相对较小的储能能力。通过选择和布置ICD的内部部件来实现ICD的较小的能量存储容量，以提供根据最小生理有效电流（Ipe）而不是最小除颤阈值能量（DFT）优化的最大除颤反相。作为最小有效电流Ipe优化的结果，ICD的电容器必须存储的最大电荷能量（Ec）显着降低到小于约30焦耳，即使较高的设备提供安全余量。由于最大Ec的这种减小以及电容器所需的有效电容值和电池所需的净能量存储的必然减小，ICD的总位移体积减少到皮下植入在人类胸腔的器官是实用的。电容器的尺寸减小，因为所需的有效电容可以小于约125μF。通过优化较小的最大Ec的充电时间和反冲时间，电池的尺寸减小，因为总能量存储容量可以小于约1.0安培小时。在优选实施例中，每个去纤维颤动反射的充电时间减少到小于约10秒，并且该反冲的脉冲持续时间减小到小于约6毫秒。

65. 发明授权

US5814075A Method and apparatus for optimizing source allocation within an implantable cardioverter-defibrillator 失效
标题翻译：用于优化植入式心律转复除颤器内源分配的方法和装置
公开(公告)号：US5814075A
公开(公告)日：1998-09-29
申请号：US877046
申请日：1997-06-17
申请人： Mark W. Kroll
发明人： Mark W. Kroll
IPC分类号： A61N1/39
CPC分类号： A61N1/3937 , A61N1/3962
摘要： A power control system is described for use in an implantable cardioverter-defibrillator (ICD) having a low-power cell and a high-power cell. The power control system includes a fuzzy logic controller for gradually varying the relative amounts of energy drawn from the low- and high-power cells based upon a selected function to be performed by the ICD and upon various operational parameters of the ICD. Example functions include cardioversion therapy, cardiac defibrillation, cardiac pacing, cardiac monitoring and capacitor reformation. Example operational parameters include the remaining capacities of the low- and high-power cells, the amount of time since implant of the ICD, the number of defibrillation shocks already delivered, and the amount of pacing energy previously utilized. In each case, the fuzzy logic controller applies a set of fuzzy logic rules to determine the relative amounts of energy to be drawn from the two power cells to optimize energy source allocation and to extend the overall longevity of the ICD.
摘要翻译：电力控制系统被描述用于具有低功率电池和高功率电池的可植入心律转复除颤器（ICD）。功率控制系统包括模糊逻辑控制器，用于基于由ICD执行的所选择的功能和ICD的各种操作参数逐渐改变从低功率单元和大功率单元获取的能量的相对量。示例功能包括心脏复律治疗，心脏除颤，心脏起搏，心脏监测和电容器重建。示例性操作参数包括低功率电池和大功率电池的剩余容量，ICD植入后的时间量，已经输送的除颤电击的数量以及以前使用的起搏能量。在每种情况下，模糊逻辑控制器应用一组模糊逻辑规则来确定要从两个电力单元抽取的能量的相对量，以优化能源分配并延长ICD的整体寿命。

66. 发明授权

US5741307A Method for determining an ICD replacement time 失效
标题翻译：确定ICD更换时间的方法
公开(公告)号：US5741307A
公开(公告)日：1998-04-21
申请号：US784566
申请日：1997-01-21
申请人： Mark W. Kroll
发明人： Mark W. Kroll
IPC分类号： A61N1/39
CPC分类号： A61N1/3975 , A61N1/3931
摘要： Improved methods of determining the recommended replacement time (RRT), and therefore extending the longevity, of implantable electronic medical devices, especially implantable cardioverter-defibrillators, pacemakers and similar devices, which rely on a battery having at least a minimal charge in order for the device to perform its intended function and devices employing these methods are described. In one embodiment, the improved method entails independent measurement of at least two different indicators of battery strength, at least one of which is affected by the battery's internal impedance. In a preferred embodiment, terminal battery voltage and capacitor charge time are independently monitored. If the terminal battery voltage falls below a predetermined minimum threshold or the capacitor charge time is confirmed to exceed a predetermined maximum charge time, an RRT signal is issued. In an alternative embodiment, an RRT signal is also issued by the medical device when one indicator of battery strength, for example, battery terminal voltage, falls below a predetermined intermediate voltage but is above the minimum threshold voltage and a second indicator of battery strength, for example, capacitor charge time, exceeds its predetermined maximum threshold.
摘要翻译：改进的建议替代时间（RRT）的确定方法，并因此延长了可植入电子医疗设备，特别是植入式心律转复除颤器，起搏器和类似设备的寿命，这些设备依靠具有至少最小电荷的电池，以便于描述了执行其预期功能的装置和采用这些方法的装置。在一个实施例中，改进的方法需要对电池强度的至少两个不同指示器进行独立测量，其中至少一个指示器受到电池的内部阻抗的影响。在优选实施例中，独立地监视端子电池电压和电容器充电时间。如果终端电池电压低于规定的最小阈值或电池充电时间被确认超过预定的最大充电时间，则发出RRT信号。在替代实施例中，当电池强度的一个指示符（例如，电池端子电压）下降到低于预定中间电压但是高于最小阈值电压和电池强度的第二指示符时，医疗装置也发出RRT信号，例如，电容器充电时间超过其预定的最大阈值。

67. 发明授权

US5735878A Implantable defibrillator having multiple pathways 失效
标题翻译：植入式除颤器具有多个途径
公开(公告)号：US5735878A
公开(公告)日：1998-04-07
申请号：US577949
申请日：1995-12-22
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 , A61N1/36
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。

68. 发明授权

US5713944A Cardioversion-defibrillation catheter lead having selectively exposable outer conductors 失效
标题翻译：心脏复律除颤导管具有可选择地暴露的外导体
公开(公告)号：US5713944A
公开(公告)日：1998-02-03
申请号：US600749
申请日：1996-02-13
申请人： Mark W. Kroll
发明人： Mark W. Kroll
IPC分类号： A61N1/04 , A61N1/05
CPC分类号： A61N1/0563
摘要： A cardioversion/defibrillation catheter lead has selectively exposable outer conductors that increase the effective electrode area and that can be used to direct electrical countershock vectors delivered by the catheter lead. The lead includes an elongated catheter body having a proximal end, a distal end and a catheter length. The catheter body includes at least one electrical conductor surrounded by a dielectric tubular sheath and an outermost dielectric tubular sheath. Each electrical conductor is electrically connected to an electrical connector located at the proximal end of the catheter body and to a cardioversion/defibrillation electrode located long the catheter body between the proximal end and the distal end. At least a portion of the outermost dielectric tubular sheath includes structure for selectively removing that portion of the outermost tubular sheath, thereby creating an effective length of at least one of the electrodes which is longer than an original length of that electrode. The selectively removable portion of the catheter lead allows that portion of the catheter body to be utilized as an additional electrode, and also allows for the length and relative distance between a first and second electrode along the catheter body to be optimized for the particular dimensions of a patient.
摘要翻译：心脏复律/除颤导管引线具有可选择地暴露的外部导体，其增加有效电极面积，并且可以用于引导由导管引线递送的电反射向量。引线包括具有近端，远端和导管长度的细长导管体。导管主体包括由介电管状护套和最外层介质管状护套包围的至少一个电导体。每个电导体电连接到位于导管主体的近端处的电连接器和位于近端和远端之间的导管本体长的心电复律/除颤电极。最外面的介质管状护套的至少一部分包括用于选择性地去除最外面的管状护套的那部分的结构，从而产生比该电极的原始长度更长的至少一个电极的有效长度。导管引线的选择性可移除部分允许导管主体的该部分用作附加电极，并且还允许沿着导管主体的第一和第二电极之间的长度和相对距离针对特定尺寸病人。

69. 发明授权

US5709709A ICD with rate-responsive pacing 失效
标题翻译： ICD与速率响应起搏
公开(公告)号：US5709709A
公开(公告)日：1998-01-20
申请号：US600750
申请日：1996-02-13
申请人： Mark W. Kroll
发明人： Mark W. Kroll
IPC分类号： A61N1/365 , A61N1/39 , A61N1/362
CPC分类号： A61N1/36521 , A61N1/3937 , A61N1/3962
摘要： An implantable cardioverter defibrillator (ICD) system features rate-responsive pacing capabilities. An electrical pulse generating device having a housing containing pulse generating circuitry is provided. A conductive lead connectable to the housing that has a first electrode, a second electrode and a coil electrode is provided. Switching circuitry is provided contained in the housing that switches the coil electrode between the rate-responsive sensing electrode to a defibrillation electrode. Control circuity is provided within the housing for controlling the delivery of modulating signals to the coil electrode and for sensing changes in resistance between the coil electrode and the housing. The control circuitry also causes an alteration of the pacing signal applied to the pacing electrode depending upon the change in the resistance sensed.
摘要翻译：植入式心律转复除颤器（ICD）系统具有速率响应起搏能力。提供一种具有包含脉冲发生电路的外壳的电脉冲发生装置。提供可连接到具有第一电极，第二电极和线圈电极的壳体的导电引线。壳体中提供开关电路，该开关电路将速率响应感测电极之间的线圈电极切换到除颤电极。控制电路设置在壳体内，用于控制向线圈电极传送调制信号，并用于感测线圈电极与壳体之间的电阻变化。控制电路还引起根据感测电阻的变化而施加到起搏电极的起搏信号的改变。

70. 发明授权

US5662696A One piece disposable threshold test can electrode for use with an implantable cardioverter defibrillator system 失效
标题翻译：一次性一次性阈值测试可用于可植入心律转复除颤器系统的电极
公开(公告)号：US5662696A
公开(公告)日：1997-09-02
申请号：US535666
申请日：1995-09-28
申请人： Mark W. Kroll , Roger W. Dahl , Stephen K. Sundquist , Randall S. Nelson
发明人： Mark W. Kroll , Roger W. Dahl , Stephen K. Sundquist , Randall S. Nelson
IPC分类号： A61N1/375 , A61N1/39
CPC分类号： A61N1/3943 , A61N1/375 , A61N1/37241
摘要： The present invention is a one piece, disposable pulse generator emulator for emulating a subcutaneous implantable cardioverter defibrillator (ICD) having an active housing electrode. The emulator of the present invention is for use with an external test system to screen a patient for candidacy for an ICD by determining the patient's minimum defibrillation threshold voltage. The one piece, disposable emulator has a housing that has substantially the same conductive geometry as the desired implantable pulse generator.
摘要翻译：本发明是用于模拟具有活动外壳电极的皮下植入式心律转复除颤器（ICD）的单件式一次性脉冲发生器模拟器。本发明的仿真器用于外部测试系统，以通过确定患者的最小除颤阈值电压来筛选患者的ICD候选资格。一体式一次性仿真器具有与所需可植入脉冲发生器基本上相同的导电几何形状的壳体。

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