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1. 发明授权

US5902325A Method and apparatus for detecting cardiac capture 失效
标题翻译：用于检测心脏捕获的方法和装置
公开(公告)号：US5902325A
公开(公告)日：1999-05-11
申请号：US126469
申请日：1998-07-30
申请人： Catherine R. Condie , Daniel J. Baxter , William J. Combs , Daniel J. Greeninger , Karen J. Kleckner , H. Toby Markowitz , John C. Stroebel , John D. Wahlstrand
发明人： Catherine R. Condie , Daniel J. Baxter , William J. Combs , Daniel J. Greeninger , Karen J. Kleckner , H. Toby Markowitz , John C. Stroebel , John D. Wahlstrand
IPC分类号： A61N1/365 , A61N1/37
CPC分类号： A61N1/36521 , A61N1/3712 , A61N1/3714
摘要： A method and apparatus for automatic determination of a pacemaker patient's pacing stimulation threshold. Circuitry is provided in a pacemaker for obtaining a signal reflecting cardiac impedance, which is known to reliably reflect certain aspects of cardiac function. Circuitry is also provided for monitoring the cardiac impedance waveform during a predetermined capture detect window following delivery of stimulating pulses. One or more values are derived which characterize the morphology of the impedance waveform during the capture detect window associated with each stimulation pulse delivered. These values are compared to predetermined control values in order to assess whether a stimulation pulse has achieved cardiac capture. The assessment of whether cardiac capture has been achieved is also based partly upon the conventional sensing of atrial and/or ventricular cardiac signals occurring during the capture detect window. In one embodiment of the invention, the control values against which impedance waveform characterization values are compared are obtained by delivering a series of stimulation pulses having sufficient energy to ensure that capture is achieved, and by monitoring the impedance waveform during delivery of these pulses.
摘要翻译：一种用于自动确定起搏器患者起搏刺激阈值的方法和装置。在起搏器中提供电路以获得反映心脏阻抗的信号，这已知可靠地反映心脏功能的某些方面。还提供电路用于在传送刺激脉冲之后的预定捕获检测窗口期间监测心脏阻抗波形。导出一个或多个值，其表征在与递送的每个刺激脉冲相关联的捕获检测窗口期间阻抗波形的形态。将这些值与预定的控制值进行比较，以便评估刺激脉冲是否已经实现心脏捕获。是否已经实现心脏捕获的评估也部分地基于在捕获检测窗口期间发生的心房和/或心室心脏信号的常规感测。在本发明的一个实施例中，通过递送具有足够能量的一系列刺激脉冲来确定阻抗波形表征值被比较的控制值，以确保实现捕获，并且通过在传送这些脉冲期间监视阻抗波形来获得。

2. 发明授权

US5843137A Capture detection method 失效
标题翻译：捕获检测方法
公开(公告)号：US5843137A
公开(公告)日：1998-12-01
申请号：US784687
申请日：1997-01-22
申请人： Catherine R. Condie , Daniel J. Baxter , William J. Combs , Daniel J. Greeninger , Karen J. Kleckner , H. Toby Markowitz , John C. Stroebel , John D. Wahlstrand
发明人： Catherine R. Condie , Daniel J. Baxter , William J. Combs , Daniel J. Greeninger , Karen J. Kleckner , H. Toby Markowitz , John C. Stroebel , John D. Wahlstrand
IPC分类号： A61N1/365 , A61N1/37
CPC分类号： A61N1/36521 , A61N1/3712 , A61N1/3714
摘要： A method and apparatus for automatic determination of a pacemaker patient's pacing stimulation threshold. Circuitry is provided in a pacemaker for obtaining a signal reflecting cardiac impedance, which is known to reliably reflect certain aspects of cardiac function. Circuitry is also provided for monitoring the cardiac impedance waveform during a predetermined capture detect window following delivery of stimulating pulses. One or more values are derived which characterize the morphology of the impedance waveform during the capture detect window associated with each stimulation pulse delivered. These values are compared to predetermined control values in order to assess whether a stimulation pulse has achieved cardiac capture. The assessment of whether cardiac capture has been achieved is also based partly upon the conventional sensing of atrial and/or ventricular cardiac signals occurring during the capture detect window. In one embodiment of the invention, the control values against which impedance waveform characterization values are compared are obtained by delivering a series of stimulation pulses having sufficient energy to ensure that capture is achieved, and by monitoring the impedance waveform during delivery of these pulses.
摘要翻译：一种用于自动确定起搏器患者起搏刺激阈值的方法和装置。在起搏器中提供电路以获得反映心脏阻抗的信号，这已知可靠地反映心脏功能的某些方面。还提供电路用于在传送刺激脉冲之后的预定捕获检测窗口期间监测心脏阻抗波形。导出一个或多个值，其表征在与递送的每个刺激脉冲相关联的捕获检测窗口期间阻抗波形的形态。将这些值与预定的控制值进行比较，以便评估刺激脉冲是否已经实现心脏捕获。是否已经实现心脏捕获的评估也部分地基于在捕获检测窗口期间发生的心房和/或心室心脏信号的常规感测。在本发明的一个实施例中，通过递送具有足够能量的一系列刺激脉冲来确定阻抗波形表征值被比较的控制值，以确保实现捕获，并且通过在传送这些脉冲期间监视阻抗波形来获得。

3. 发明授权

US5713933A Method and apparatus for automatic pacing threshold determination 失效
标题翻译：用于自动起搏阈值确定的方法和装置
公开(公告)号：US5713933A
公开(公告)日：1998-02-03
申请号：US346815
申请日：1994-11-30
申请人： Catherine R. Condie , Daniel J. Baxter , William J. Combs , Daniel J. Greeninger , Karen J. Kleckner , H. Toby Markowitz , John C. Stroebel , John D. Wahlstrand
发明人： Catherine R. Condie , Daniel J. Baxter , William J. Combs , Daniel J. Greeninger , Karen J. Kleckner , H. Toby Markowitz , John C. Stroebel , John D. Wahlstrand
IPC分类号： A61N1/365 , A61N1/37
CPC分类号： A61N1/36521 , A61N1/3712 , A61N1/3714
摘要： A method and apparatus for automatic determination of a pacemaker patient's pacing stimulation threshold. Circuitry is provided in a pacemaker for obtaining a signal reflecting cardiac impedance, which is known to reliably reflect certain aspects of cardiac function. Circuitry is also provided for monitoring the cardiac impedance waveform during a predetermined capture detect window following delivery of stimulating pulses. One or more values are derived which characterize the morphology of the impedance waveform during the capture detect window associated with each stimulation pulse delivered. These values are compared to predetermined control values in order to assess whether a stimulation pulse has achieved cardiac capture. The assessment of whether cardiac capture has been achieved is also based partly upon the conventional sensing of atrial and/or ventricular cardiac signals occurring during the capture detect window. In one embodiment of the invention, the control values against which impedance waveform characterization values are compared are obtained by delivering a series of stimulation pulses having sufficient energy to ensure that capture is achieved, and by monitoring the impedance waveform during delivery of these pulses.
摘要翻译：一种用于自动确定起搏器患者起搏刺激阈值的方法和装置。在起搏器中提供电路以获得反映心脏阻抗的信号，这已知可靠地反映心脏功能的某些方面。还提供电路用于在传送刺激脉冲之后的预定捕获检测窗口期间监测心脏阻抗波形。导出一个或多个值，其表征在与递送的每个刺激脉冲相关联的捕获检测窗口期间阻抗波形的形态。将这些值与预定的控制值进行比较，以便评估刺激脉冲是否已经实现心脏捕获。是否已经实现心脏捕获的评估也部分地基于在捕获检测窗口期间发生的心房和/或心室心脏信号的常规感测。在本发明的一个实施例中，通过递送具有足够能量的一系列刺激脉冲来确定阻抗波形表征值被比较的控制值，以确保实现捕获，并且通过在传送这些脉冲期间监视阻抗波形来获得。

4. 发明授权

US06512949B1 Implantable medical device for measuring time varying physiologic conditions especially edema and for responding thereto 有权
标题翻译：用于测量时变生理条件的植入式医疗装置，特别是水肿并对其进行响应
公开(公告)号：US06512949B1
公开(公告)日：2003-01-28
申请号：US09352179
申请日：1999-07-12
申请人： William J. Combs , Catherine R. Condie , Roy Martin , Dwight H. Warkentin , John D. Wahlstrand , David L. Thompson , Li Wang
发明人： William J. Combs , Catherine R. Condie , Roy Martin , Dwight H. Warkentin , John D. Wahlstrand , David L. Thompson , Li Wang
IPC分类号： A61B500
CPC分类号： A61N1/36521 , A61B5/0535 , A61B5/7207 , A61N1/3627
摘要： An impedance monitor for discerning edema through evaluation of respiratory rate. Preferred embodiment includes edema monitor and trigger to initiate diagnostic reporting or corrective action when activated. Recording of Long Term Average and Short Term Average values for secondary edema measure based on DC signal level are described as are methods and apparatus for removing unwanted recurring noise.
摘要翻译：通过评估呼吸频率来辨别水肿的阻抗监测仪。优选实施例包括水肿监测和触发以在被激活时启动诊断报告或纠正动作。长期平均和短期记录基于直流信号电平的次级水肿测量的平均值被描述为用于消除不期望的重复噪声的方法和装置。

5. 发明授权

US5562711A Method and apparatus for rate-responsive cardiac pacing 失效
标题翻译：速率响应心脏起搏方法和装置
公开(公告)号：US5562711A
公开(公告)日：1996-10-08
申请号：US346813
申请日：1994-11-30
申请人： Charles G. Yerich , William J. Combs , Karen J. Kleckner , Eric J. Panken , Richard S. Schallhorn , John D. Wahlstrand
发明人： Charles G. Yerich , William J. Combs , Karen J. Kleckner , Eric J. Panken , Richard S. Schallhorn , John D. Wahlstrand
IPC分类号： A61N1/365
CPC分类号： A61N1/36585
摘要： A body-implantable rate-responsive cardiac pacemaker is provided with circuitry for sensing a plurality of physiologic parameters known to be indicative of a patient's metabolic demand for increased cardiac output. In one embodiment, a rate-responsive pacemaker is provided with an activity sensor for detecting the patient's level of physical activity, and is further provided with an impedance sensing circuit for detecting the patient's level of minute ventilation by monitoring cardiac impedance. A rate-response transfer function, implemented by the pacemaker's control circuitry, periodically computes a rate-responsive pacing rate as a function of the outputs from both physiologic sensing circuits. The pacemaker's pacing rate is variable within a rate range defined by predetermined (programmable) upper and lower limits. In the preferred embodiment, the influence of activity sensing and minute ventilation parameters varies in accordance with the current pacing rate. In particular, the influence of activity sensing in rate determination in accordance with the rate-response function is greater than that of minute ventilation, for slower pacing rates, while the influence of minute ventilation sensing dominates over that of activity sensing for higher pacing rates. Rate response operation of the disclosed system is recorded in the form of histogram data stored over a predetermined history time. The relative influence of the activity sensing and minute ventilation sensing on rate determination is periodically scaled or balanced based upon comparison of the histogram data with predetermined desired response data.
摘要翻译：身体植入式速率响应心脏起搏器被提供有用于感测已知指示患者对增加的心输出量的代谢需求的多个生理参数的电路。在一个实施例中，速率响应起搏器设置有用于检测患者的身体活动水平的活动传感器，并且还设置有阻抗感测电路，用于通过监测心脏阻抗来检测患者的分钟通气水平。由起搏器的控制电路实现的速率响应传递函数周期性地计算速率响应起搏速率作为来自生理感测电路的输出的函数。起搏器的起搏速率在由预定（可编程）上限和下限限定的速率范围内是可变的。在优选实施例中，活动感测和分钟通气参数的影响根据当前起搏速率而变化。特别是，根据速率响应函数的速率测定中的活动检测的影响大于分钟通气量，对于较慢的起搏速率，而微动通气检测的影响比活动检测的影响高于起搏率。以预定历史时间存储的直方图数据的形式记录所公开的系统的速率响应操作。基于直方图数据与预定的期望响应数据的比较，活动感测和分钟通气感测对速率确定的相对影响被周期地缩放或平衡。

6. 发明授权

US07031772B2 Method and apparatus for rate responsive adjustments in an implantable medical device 有权
公开(公告)号：US07031772B2
公开(公告)日：2006-04-18
申请号：US10134560
申请日：2002-04-29
申请人： Catherine R. Condie , John D. Wahlstrand , Gerald A. Portzline , Yong Kyun Cho , John S. Brandstetter , Luc R. Mongeon
发明人： Catherine R. Condie , John D. Wahlstrand , Gerald A. Portzline , Yong Kyun Cho , John S. Brandstetter , Luc R. Mongeon
IPC分类号： A61N1/365
CPC分类号： A61N1/36542 , A61N1/36521 , G06F19/00 , G06F19/3456 , G16H40/63
摘要： A method and an apparatus for performing rate responsive control in an implantable medical device using a scaling factor. Sensor data is acquired using a sensor operatively coupled with the implantable medical device. At least one setpoint for controlling a rate of therapy is generated, the setpoint being based upon the sensor data. A scaling factor adjustment process is performed for scaling the internal sensor data to correlate the sensor data to the setpoint. The rate of therapy is adjusted based upon the scaling factor adjustment.

7. 发明授权

US5271395A Method and apparatus for rate-responsive cardiac pacing 失效
标题翻译：速率响应心脏起搏方法和装置
公开(公告)号：US5271395A
公开(公告)日：1993-12-21
申请号：US870062
申请日：1992-04-17
申请人： John D. Wahlstrand , Girard B. Borgerding , Daniel R. Greeninger , Daniel J. Baxter
发明人： John D. Wahlstrand , Girard B. Borgerding , Daniel R. Greeninger , Daniel J. Baxter
IPC分类号： A61N1/365 , A61N1/362
CPC分类号： A61N1/36585
摘要： A rate-responsive cardiac pacemaker comprising a minute ventilation circuit and an activity circuit. The minute ventilation circuit computes a first target pacing rate as a function of measurements of the patient's pleural blood impedance, and the activity circuit computes a second target pacing rate as a function of measured levels of patient activity. A rate control function establishes a rate-responsive pacing rate based on the first and second target pacing rates. The minute ventilation circuit delta-modulates an analog impedance waveform and maintains short-term and long-term weighted averages of delta-modulator output counts. Variations in the difference between the short-term and long-term weighted average values are determinative of the first target pacing rate. Variations in an activity sensor output signal are determinative of the second target pacing rate. Physician-programmable parameters for the pacemaker include selection of a rate-response setting, upper and lower pacing rate limits, and rate-smoothing attack and decay settings.
摘要翻译：一种速率响应心脏起搏器，包括微通风回路和活动电路。分钟通气电路根据患者胸膜血阻抗的测量值来计算第一目标起搏速率，并且活动电路根据测量的患者活动水平计算第二目标起搏速率。速率控制功能基于第一和第二目标起搏速率建立速率响应起搏速率。分钟通风电路对模拟阻抗波形进行delta调制，并维持Δ调制器输出计数的短期和长期加权平均值。短期和长期加权平均值差异的变化是第一个目标起搏率的决定因素。活动传感器输出信号的变化是第二目标起搏速率的决定因素。心脏起搏器的医师可编程参数包括选择速率响应设置，上限和下限起搏速率限制以及速率平滑攻击和衰减设置。

8. 发明授权

US5534018A Automatic lead recognition for implantable medical device 失效
标题翻译：可植入医疗器械的自动引线识别
公开(公告)号：US5534018A
公开(公告)日：1996-07-09
申请号：US346661
申请日：1994-11-30
申请人： John D. Wahlstrand , Daniel J. Baxter , R. Michael Ecker , Daniel R. Greeninger , Charles G. Yerich
发明人： John D. Wahlstrand , Daniel J. Baxter , R. Michael Ecker , Daniel R. Greeninger , Charles G. Yerich
IPC分类号： A61N1/08 , A61N1/37 , A61N1/00 , A61N1/362
CPC分类号： A61N1/3706 , A61N2001/083
摘要： A method and apparatus for determining the availability of unipolar and/or bipolar pacing/sensing paths in a body-implantable cardiac pacing system. In one embodiment, a pacemaker system includes impedance monitoring circuitry for periodically measuring impedance between pairs of electrodes that are potentially available for pacing and/or sensing. This impedance monitoring circuitry includes circuitry for delivering excitation pulses between pairs of potentially available electrodes (including the pacemaker canister in the case of unipolar pacing or sensing), and for monitoring the current and voltage between those pairs of electrodes during delivery of an excitation pulse. Availability of a pair of electrodes for pacing and/or sensing is indicated if the impedance between a pair of electrodes is found to lie within a predetermined range. Detection of availability of a particular pair of electrodes is used initially as an indication that the pacing system has been implanted, and is also used to distinguish between unipolar and bipolar leads in the pacing system.
摘要翻译：一种用于确定体内植入式心脏起搏系统中单极和/或双极起搏/感测路径的可用性的方法和装置。在一个实施例中，起搏器系统包括用于周期性地测量潜在可用于起搏和/或感测的电极对之间的阻抗的阻抗监测电路。该阻抗监测电路包括用于在潜在可用电极对（包括单极起搏或感测的情况下包括起搏器罐）之间传递激励脉冲的电路，以及用于在激励脉冲传送期间监测这些电极对之间的电流和电压。如果发现一对电极之间的阻抗位于预定范围内，则指示用于起搏和/或感测的一对电极的可用性。最初使用特定对电极的可用性的检测作为起搏系统已植入的指示，并且还用于区分起搏系统中的单极和双极引线。

9. 发明授权

US08478402B2 Determining intercardiac impedance 有权
标题翻译：确定心脏阻力
公开(公告)号：US08478402B2
公开(公告)日：2013-07-02
申请号：US12263346
申请日：2008-10-31
申请人： John D. Wahlstrand , Timothy J. Denison , Wesley A. Santa
发明人： John D. Wahlstrand , Timothy J. Denison , Wesley A. Santa
IPC分类号： A61N1/00
CPC分类号： A61B5/053 , A61B5/026 , A61B5/0538 , A61B5/6846 , A61B5/7217 , A61N1/36521
摘要： A system and method for determining complex intercardiac impedance to detect various cardiac functions are disclosed involving a signal generator means for providing an adjustable direct current signal, a modulator for modulating the adjustable direct current signal to produce a modulated signal, at least one electrode for propagating the modulated signal across a myocardium, at least one sensor for detecting an outputted modulated signal from the myocardium, and at least one circuit to reduce the influence of process noise (aggressors) in the outputted modulated signal. The at least one circuit comprises an amplifier, a demodulator, and an integrator. The amplitude and phase of the final outputted modulated signal indicate the complex impedance of the myocardium. Changes in the complex impedance patterns of the myocardium provide indication of reduced oxygen and blood flow to the myocardium. The apparatus can be employed in implantable devices, including cardiac pacemakers and implantable cardioverter defibrillators.
摘要翻译：公开了一种用于确定复杂心脏阻抗以检测各种心脏功能的系统和方法，其涉及用于提供可调节直流电流信号的信号发生器装置，用于调制可调直流电信号以产生调制信号的调制器，用于传播的至少一个电极跨越心肌的调制信号，用于检测来自心肌的输出的调制信号的至少一个传感器，以及至少一个电路，以减少输出的调制信号中的过程噪声（侵略者）的影响。所述至少一个电路包括放大器，解调器和积分器。最终输出的调制信号的振幅和相位表示心肌的复阻抗。心肌复合阻抗模式的变化提供氧气和血液流向心肌的指示。该装置可用于可植入装置，包括心脏起搏器和可植入的心律转复除颤器。

10. 发明授权

US08463382B2 Implantable lead functional status monitor and method 有权
公开(公告)号：US08463382B2
公开(公告)日：2013-06-11
申请号：US12868834
申请日：2010-08-26
申请人： David J. Jorgenson , Ross O. Starkson , Rick D. McVenes , Charles D. Trautmann , John D. Wahlstrand , Bradley C. Peck
发明人： David J. Jorgenson , Ross O. Starkson , Rick D. McVenes , Charles D. Trautmann , John D. Wahlstrand , Bradley C. Peck
IPC分类号： A61N1/365
CPC分类号： A61N1/3925 , A61N1/3706 , A61N2001/083
摘要： A system for monitoring trends in lead impedance includes collecting data from various sources in an implantable medical device system. Lead impedance, non-physiologic sensed events percentage of time in mode switch, results of capture management operation, sensed events, adversion pace counts, refractory sense counts and similar data are used to determine the status of a lead. A set of weighted sum rules are implemented by a software system to process the data and provide displayable information to health care professionals via a programmer. The lead monitoring system includes a patient alert system for patients to seek help in the event a serious lead condition is identified.

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