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71. 发明授权

US06477417B1 System and method for automatically selecting electrode polarity during sensing and stimulation 有权
公开(公告)号：US06477417B1
公开(公告)日：2002-11-05
申请号：US09835006
申请日：2001-04-12
申请人： Paul A. Levine
发明人： Paul A. Levine
IPC分类号： A61N137
CPC分类号： A61N1/3627 , A61N1/368 , A61N1/3684 , A61N1/3918
摘要： An implantable multi-chamber cardiac stimulation device includes flexibly programmable electrode stimulation configurations, and is capable of precisely controlling the stimulation sequence between multiple sites. The stimulation device provides a plurality of connection ports that allow independent connection of each electrical lead associated with a particular stimulation site in the heart. Each connection port further provides a unique terminal for making electrical contact with only one electrode such that no two electrodes are required to be electrically coupled. Furthermore, each electrode, whether residing on a unipolar, bipolar or multipolar lead, may be selectively connected or disconnected through programmable switching circuitry that determines the electrode configurations to be used for sensing and for stimulating at each stimulation site. The stimulation device allows for the programmable selection of each electrode terminal connection to a relatively positive or negative battery potential. In this way, each electrode, when electrically connected, may be programmed to act as the cathode or as the anode during sensing or stimulation delivery. Thus, directionality of the depolarization wave may be controlled by programming the cathode and anode assignments of the stimulation electrodes.

72. 发明授权

US06434428B1 System and method for optimizing far-field R-wave sensing by switching electrode polarity during atrial capture verification 有权
标题翻译：通过在心房捕获验证期间切换电极极性来优化远场R波感测的系统和方法
公开(公告)号：US06434428B1
公开(公告)日：2002-08-13
申请号：US09628753
申请日：2000-07-31
申请人： Laurence S. Sloman , Paul A. Levine
发明人： Laurence S. Sloman , Paul A. Levine
IPC分类号： A61N137
CPC分类号： A61N1/3712 , A61N1/3714
摘要： An implantable stimulator device provides automatic electrode polarity switching during an atrial capture verification mode. In systems using a bipolar sensing configuration in the atrium, polarity switching will be advantageous in detecting far-field R-waves for verification of capture. This automatic polarity switching feature is programmable and enables or disables automatic switching from bipolar to unipolar sensing at the onset of a far-field interval window and switching again back to bipolar pacing at the end of the far-field interval window.
摘要翻译：可植入刺激器装置在心房捕获验证模式期间提供自动电极极性切换。在使用在心房中的双极感测配置的系统中，极性切换在检测远场R波中有利于验证捕获。这种自动极性切换功能是可编程的，并且在远场间隔窗口开始时启用或禁用从双极到单极感测的自动切换，并在远场间隔窗口的末端再次切换回双极起搏。

73. 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.

74. 发明授权

US06311089B1 Implantable stimulation device and method for determining ventricular and atrial sensitivity thresholds 有权
标题翻译：植入式刺激装置和确定心室和心房灵敏度阈值的方法
公开(公告)号：US06311089B1
公开(公告)日：2001-10-30
申请号：US09378149
申请日：1999-08-20
申请人： Brian M. Mann , Melinda Endaya , Paul A. Levine
发明人： Brian M. Mann , Melinda Endaya , Paul A. Levine
IPC分类号： A61N136
CPC分类号： A61N1/3712 , A61N1/368 , A61N1/3682 , A61N1/3714
摘要： A pacemaker programmer and diagnostic system retrieves information stored within a pacemaker and analyzes the retrieved data in real time. The stored information can be retrieved by a telemetry communication link. The programmer includes features for allowing the physician to interactively adjust program parameters while viewing the results of parameter changes in real-time. The programmer performs a ventricular sensitivity threshold test by setting the stimulation device to an atrial tracking mode, and by assessing the ventricular sensing of the pacemaker. If ventricular sensing is confirmed, the processor performs a ventricular sensitivity threshold test to determine the pacemaker ventricular sensitivity threshold, and then automatically adjusts the ventricular sensitivity to within a safety margin from the ventricular sensitivity threshold. The programmer also performs an atrial sensitivity threshold test by setting the stimulation device to the atrial tracking mode, and by assessing the atrial sensing of the pacemaker. If atrial sensing is confirmed, the programmer determines whether the base rate is less than the sensed atrial rate by 20 BPM or more; if so, the processor performs an atrial sensitivity threshold test to determine the pacemaker atrial sensitivity threshold, and automatically adjusts the atrial sensitivity to within a safety margin from the atrial sensitivity threshold.
摘要翻译：起搏器程序员和诊断系统检索存储在起搏器内的信息，并实时分析检索到的数据。存储的信息可以通过遥测通信链路检索。程序员包括允许医师在实时观察参数变化结果时交互式地调整程序参数的功能。程序员通过将刺激装置设置为心房跟踪模式，并通过评估起搏器的心室感应来执行心室灵敏度阈值测试。如果确认心室感应，则处理器执行心室灵敏度阈值测试，以确定起搏器心室灵敏度阈值，然后自动将心室灵敏度调整到距心室灵敏度阈值以内的安全范围内。程序员还通过将刺激装置设置为心房跟踪模式以及通过评估起搏器的心房感测来执行心房敏感性阈值测试。如果确认心房感应，程序员确定基本速率是否小于感测到的心房率20 BPM以上; 如果是这样，处理器执行心房敏感性阈值测试来确定起搏器心房敏感度阈值，并且将心房敏感度自动地调整到从心房敏感度阈值以内的安全边界内。

75. 发明授权

US06292694B1 Implantable medical device having atrial tachyarrhythmia prevention therapy 有权
标题翻译：具有房性心律失常预防治疗的植入式医疗器械
公开(公告)号：US06292694B1
公开(公告)日：2001-09-18
申请号：US09338216
申请日：1999-06-22
申请人： Harold C. Schloss , Mark W. Kroll , Paul A. Levine
发明人： Harold C. Schloss , Mark W. Kroll , Paul A. Levine
IPC分类号： A61N1362
CPC分类号： A61N1/3622
摘要： An implantable medical device provides atrial arrhythmia prevention pacing when an interatrial conduction disturbance is detected. The implantable medical device includes a signal processor that detects the interatrial conduction disturbance and a pulse generator circuit coupled to the detector that delivers the atrial arrhythmia prevention pacing pulses to the heart when the processor detects the interatrial conduction disturbance. The interatrial conduction disturbance may be a P-wave duration, a difference between odd and even P-waves, or a predetermined P-wave spectral energy distribution.
摘要翻译：当检测到房间传导障碍时，植入式医疗装置提供心律失常预防起搏。可植入医疗装置包括检测院内传导障碍的信号处理器和耦合到检测器的脉冲发生器电路，当处理器检测到房间传导障碍时，其将心律失常预防起搏脉冲传送到心脏。室间传导障碍可以是P波持续时间，奇数和偶数P波之间的差异或预定的P波频谱能量分布。

76. 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。

77. 发明授权

US5417714A DDI pacing with PVC-protected hysteresis and automatic AV interval adjustment 失效
标题翻译： DDI起搏带有PVC保护滞后和自动AV间隔调整
公开(公告)号：US5417714A
公开(公告)日：1995-05-23
申请号：US60765
申请日：1993-05-11
申请人： Paul A. Levine , Malcolm Clarke , John W. Poore , Jason A. Sholder
发明人： Paul A. Levine , Malcolm Clarke , John W. Poore , Jason A. Sholder
IPC分类号： A61N1/365 , A61N1/362 , A61N1/368 , A61N1/36
CPC分类号： A61N1/368 , A61N1/3622 , A61N1/3682
摘要： A dual-chamber pacemaker provides DDI pacing with PVC-protected hysteresis and automatic AV interval adjustment. An extended hysteresis atrial escape interval (AEI.sub.H) is invoked in response to the occurrence of either an atrial paced event followed by a sensed R-wave (an AR event), or an atrial sensed event followed by a sensed R-wave (a PR event). The occurrence of a premature ventricular contraction (PVC) thus does not trigger AEI.sub.H. In one embodiment, AEI.sub.H is not invoked unless the sensed AR or PR interval exceeds a prescribed reference interval. In a further embodiment, the AV interval (AVI) associated with the DDI operation is automatically shortened following an atrial stimulation pulse (A-pulse) delivered upon the timing-out of the AEI.sub.H. The shortened AVI is maintained for a programmed number of cycles of DDI operation, after which a lengthened AVI is reestablished for one cycle. If AV pacing follows after using the lengthened AVI, then the shortened AVI is reinstated for a second number of programmed cycles of DDI operation. If AR pacing follows after using the lengthened AVI, signifying intact AV nodal conduction, then the AVI is lengthened to the programmed AVI over a prescribed number of cycles.
摘要翻译：双室心脏起搏器为DDI起搏提供PVC保护的滞后和自动AV间隔调整。响应于发生心房起搏事件，随后是感测到的R波（AR事件）或心房感测事件，随后是感测的R波（PR），调节延长的心房逸出间隔时间（AEIH）事件）。因此早期心室收缩（PVC）的发生不会引发AEIH。在一个实施例中，除非感测到的AR或PR间隔超过规定的参考间隔，否则AEIH不被调用。在另一个实施例中，在AEIH超时之后递送的心房刺激脉冲（A脉冲）之后，与DDI操作相关联的AV间隔（AVI）自动缩短。缩短的AVI维持编程的DDI操作周期数，之后延长的AVI重新建立一个周期。如果在使用延长的AVI之后进行AV起搏，则缩短的AVI将恢复DDI操作的第二个编程周期数。如果在使用延长的AVI后进行AR起搏，则表示完整的AV节点传导，则AVI在规定数量的周期内延长到编程的AVI。

78. 发明授权

US08694082B2 Method and system for detecting and treating junctional rhythms 有权
标题翻译：连接节律的检测和处理方法和系统
公开(公告)号：US08694082B2
公开(公告)日：2014-04-08
申请号：US12727130
申请日：2010-03-18
申请人： Xing Pei , Paul A. Levine
发明人： Xing Pei , Paul A. Levine
IPC分类号： A61B5/0452
CPC分类号： A61N1/3621 , A61B5/0422 , A61B5/044 , A61B5/0452 , A61N1/36507 , A61N1/36521 , A61N1/37211
摘要： An implantable medical device is provided for detecting transportless ventricular rhythm of a heart lacking atrial transport and comprises a housing, sensors configured to be located proximate to a heart, a sensing module to sense cardiac signals representative of a rhythm originating from the heart and a rhythm detection module. The rhythm detection module determines a change in AV association and identifies a potential ventricular complex with loss of atrial transport (VCLAT) based on the change in AV association.
摘要翻译：提供了一种可植入医疗装置，用于检测缺乏心房输送的心脏的无运动心室节律，并且包括壳体，被配置为邻近心脏定位的传感器，感测模块，用于感测代表源自心脏的节律的心脏信号和节律检测模块。节律检测模块基于AV关联的变化来确定AV关联的变化并识别具有心房传播丧失（VCLAT）的潜在心室复合体。

79. 发明授权

US07986993B1 Implantable cardiac device providing AV interval hysteresis to promote intrinsic conduction while providing PMT avoidance and method 有权
标题翻译：植入式心脏装置提供AV间隔滞后，以提供内在传导，同时提供PMT回避和方法
公开(公告)号：US07986993B1
公开(公告)日：2011-07-26
申请号：US11769602
申请日：2007-06-27
申请人： Paul A. Levine
发明人： Paul A. Levine
IPC分类号： A61N1/18
CPC分类号： A61N1/37 , A61N1/3622 , A61N1/3682
摘要： An implantable cardiac stimulation device provides AV interval hysteresis to promote intrinsic conduction while providing PMT avoidance. The device comprises a pulse generator that provides atrial and ventricular pacing stimulation pulses on demand separated by an AV interval, an AV hysteresis circuit that extends the AV interval from a base AV interval to an extended AV interval to promote intrinsic heart activity, and a refractory circuit that establishes a PVARP following each provided ventricular pacing pulse including a lengthened PVARP longer in duration than a normal PVARP responsive to the AV hysteresis circuit extending the AV interval from the base AV interval to the extended AV interval.
摘要翻译：植入式心脏刺激装置提供AV间隔滞后以促进固有传导，同时提供PMT避免。所述装置包括：脉冲发生器，其根据需要由AV间隔分开提供心房和心室起搏刺激脉冲; AV滞后电路，其将AV间隔从基本AV间隔延伸到延伸的AV间隔以促进内在的心脏活动;以及耐火材料电路，其在每个提供的心室起搏脉冲之后建立PVARP，其包括延长的PVARP，其持续时间长于正常PVARP，所述PVARP响应于将AV间隔从基本AV间隔延伸到扩展AV间隔的AV滞后电路。

80. 发明授权

US07606618B1 Implantable medical device with notification system 有权
标题翻译：具有通知系统的植入式医疗器械
公开(公告)号：US07606618B1
公开(公告)日：2009-10-20
申请号：US11400114
申请日：2006-04-07
申请人： Gene A. Bornzin , Peter Boileau , Paul A. Levine , Corey L. Brown
发明人： Gene A. Bornzin , Peter Boileau , Paul A. Levine , Corey L. Brown
IPC分类号： A61N1/00
CPC分类号： A61N1/3962 , A61N1/3621 , A61N1/37258
摘要： An implantable medical device with a notification system. The device monitors itself and an implantee for one or more condition indicating notification and delivers the notification at a time the patient is determined to be wakeful and, optionally, at relative rest. The notification can be repeated periodically until acknowledged by the user or the system is evaluated and reprogrammed by the physician. A user input can be included to provide the device confirmation of receipt of the notification as well as to delay delivery of any indicated subsequent notifications. The notification is provided without requiring any additional or special dedicated hardware.
摘要翻译：具有通知系统的可植入医疗设备。该装置监视自身和一个植入物，用于指示通知的一个或多个状况，并且在患者被确定为被唤醒并且可选地处于相对静止状态时递送通知。可以定期重复通知，直到用户确认或者由医师评估系统并对其进行重新编程。可以包括用户输入以提供装置确认通知的接收以及延迟所指示的后续通知的传送。提供通知而不需要任何额外的或特殊的专用硬件。

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