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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

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。

5. 发明授权

US06434424B1 Regularization of ventricular rate during atrial tachyarrhythmia 有权
标题翻译：房性心律失常期心室率正常化
公开(公告)号：US06434424B1
公开(公告)日：2002-08-13
申请号：US09470120
申请日：1999-12-22
申请人： David A. Igel , H. Toby Markowitz , Robert A. Betzold , Karen J. Kleckner , Jeremy A. Schroetter
发明人： David A. Igel , H. Toby Markowitz , Robert A. Betzold , Karen J. Kleckner , Jeremy A. Schroetter
IPC分类号： A61N1362
CPC分类号： A61N1/3622
摘要： A pacing system provided with a mode switching feature and ventricular rate regularization (VRR) function adapted to stabilize or regularize ventricular heart rate during chronic or paroxysmal atrial tachyarrhythmia. In a preferred embodiment, the pacing system nominally operates in an atrial synchronized pacing mode such as DDD or DDDR pacing mode. In response to detection of atrial rhythm characteristics consistent with an atrial tachyarrhythmia, e.g., atrial fibrillation, a mode switch into a non-atrial synchronized, ventricular rate regularization pacing mode, e.g. DDIR or VDIR pacing mode, is made. If the VRR function is programmed on, the ventricular pacing rate based upon a rate responsive sensor derived ventricular pacing rate modulated on a beat by beat basis by preceding intrinsic or paced ventricular events, the stability of the intrinsic ventricular heart rate, and any atrial pace events to regularize the ventricular pacing rate. The pacing system may also be permanently programmed to the DDIR pacing mode with the VRR feature functioning continuously. The pacing system may also be permanently programmed to the VVIR pacing mode with VRR function activated, but without consideration of atrial pace events.
摘要翻译：具有模式切换特征和心室率正常化（VRR）功能的起搏系统适于在慢性或阵发性房性快速性心律失常期间稳定或规范心室心率。在优选实施例中，起搏系统名义地以心房同步起搏模式操作，例如DDD或DDDR起搏模式。响应于检测与房性快速性心律失常（例如心房颤动）一致的心房节律特征，模式切换到非心房同步的心室速率正则化起搏模式，例如心房颤动。 DDIR或VDIR起搏模式。如果VRR功能被编程，则基于速率响应传感器导出的心室起搏速率的心室起搏速率通过前进的内在或节奏心室事件，内部心室心率的稳定性和任何心房起搏事件来规范心室起搏率。起搏系统也可以永久编程到DDIR起搏模式，VRR功能连续工作。起搏系统也可以被永久编程到VVIR起搏模式，VRR功能被激活，但不考虑心房速度事件。

6. 发明授权

US08200322B2 Electrogram storage for suspected non-physiological episodes 有权
标题翻译：怀疑非生理发作的电图存储
公开(公告)号：US08200322B2
公开(公告)日：2012-06-12
申请号：US12182687
申请日：2008-07-30
申请人： Kevin T. Ousdigian , Catherine R. Condie , Karen J. Kleckner , Bruce D. Gunderson
发明人： Kevin T. Ousdigian , Catherine R. Condie , Karen J. Kleckner , Bruce D. Gunderson
IPC分类号： A61B5/0468
CPC分类号： A61N1/3702 , A61B5/042 , A61B5/046 , A61B5/0464 , A61B5/053 , A61B5/0538 , A61B5/7264 , A61B2560/0276 , A61N1/3704 , A61N2001/083
摘要： Techniques for storing electrograms (EGMS) that are associated with sensed episodes or events that may be non-physiological and, instead, associated with a sensing integrity condition are described. In some examples, a device or system identifies suspected non-physiological NSTs, and stores an EGM for the suspected non-physiological NSTs within an episode log. In some examples, a device or system determines whether to store an EGM for a suspected non-physiological episode or event based on whether an impedance integrity criterion has been satisfied. For example, a device or system may store an EGM for a detected short interval if the impedance integrity criterion has been met. In some examples, a device or system determines whether to buffer EGM data based on whether an impedance integrity criterion or other sensing integrity criterion has been met.
摘要翻译：描述了用于存储与可能是非生理感知的事件相关联的电摄影（EGMS）的技术，并且相反地与感测完整性条件相关联的技术。在一些示例中，设备或系统识别疑似非生理NST，并且在发作日志中存储用于可疑非生理NST的EGM。在一些示例中，设备或系统基于是否已经满足阻抗完整性标准来确定是否存储用于可疑非生理事件或事件的EGM。例如，如果已经满足了阻抗完整性标准，则设备或系统可以存储用于检测到的短间隔的EGM。在一些示例中，设备或系统基于是否已经满足阻抗完整性标准或其他感测完整性标准来确定是否缓冲EGM数据。

7. 发明申请

US20090299422A1 ELECTROGRAM STORAGE FOR SUSPECTED NON-PHYSIOLOGICAL EPISODES 有权
标题翻译：电生物存储用于悬浮的非生理性EPISODES
公开(公告)号：US20090299422A1
公开(公告)日：2009-12-03
申请号：US12182687
申请日：2008-07-30
申请人： Kevin T. Ousdigian , Catherine R. Condie , Karen J. Kleckner , Bruce D. Gunderson
发明人： Kevin T. Ousdigian , Catherine R. Condie , Karen J. Kleckner , Bruce D. Gunderson
IPC分类号： A61N1/08 , A61B5/0432
CPC分类号： A61N1/3702 , A61B5/042 , A61B5/046 , A61B5/0464 , A61B5/053 , A61B5/0538 , A61B5/7264 , A61B2560/0276 , A61N1/3704 , A61N2001/083
摘要： Techniques for storing electrograms (EGMS) that are associated with sensed episodes or events that may be non-physiological and, instead, associated with a sensing integrity condition are described. In some examples, a device or system identifies suspected non-physiological NSTs, and stores an EGM for the suspected non-physiological NSTs within an episode log. In some examples, a device or system determines whether to store an EGM for a suspected non-physiological episode or event based on whether an impedance integrity criterion has been satisfied. For example, a device or system may store an EGM for a detected short interval if the impedance integrity criterion has been met. In some examples, a device or system determines whether to buffer EGM data based on whether an impedance integrity criterion or other sensing integrity criterion has been met.
摘要翻译：描述了用于存储与可能是非生理感知的事件相关联的电摄影（EGMS）的技术，并且相反地与感测完整性条件相关联的技术。在一些示例中，设备或系统识别疑似非生理NST，并且在发作日志中存储用于可疑非生理NST的EGM。在一些示例中，设备或系统基于是否已经满足阻抗完整性标准来确定是否存储用于可疑非生理事件或事件的EGM。例如，如果已经满足了阻抗完整性标准，则设备或系统可以存储用于检测到的短间隔的EGM。在一些示例中，设备或系统基于是否已经满足阻抗完整性标准或其他感测完整性标准来确定是否缓冲EGM数据。

8. 发明申请

US20100137935A1 LV THRESHOLD MEASUREMENT AND CAPTURE MANAGEMENT 有权
标题翻译： LV阈值测量和捕获管理
公开(公告)号：US20100137935A1
公开(公告)日：2010-06-03
申请号：US12700454
申请日：2010-02-04
申请人： Purvee P. Parikh , John C. Stroebel , Todd J. Sheldon , Karen J. Kleckner
发明人： Purvee P. Parikh , John C. Stroebel , Todd J. Sheldon , Karen J. Kleckner
IPC分类号： A61N1/08 , A61N1/362
CPC分类号： A61N1/3627 , A61N1/3684 , A61N1/371
摘要： The invention provides methods and apparatus for determining in a non-tracking pacing mode (e.g., DDI/R, VVI/R) whether a ventricular pacing stimulus is capturing a paced ventricle, including some or all of the following aspects. For example, increasing a ventricular pacing rate a nominal amount to an overdrive pacing rate higher than a most recent heart rate and evaluating a conduction interval from a first pacing ventricle to a second sensing ventricle and then continuing to monitor the underlying rate to ensure that a threshold testing pacing rate will not exceed a predetermined minimum interval and providing pacing stimulation to the first ventricle and sensing the second ventricle to determine whether the pacing stimulation to the first ventricle was one of sub-threshold and supra-threshold. The methods and apparatus are especially useful in conjunction with ensuring actual delivery of a ventricular pacing regime (e.g., cardiac resynchronization therapy or “CRT”).
摘要翻译：本发明提供了用于在非跟踪起搏模式（例如，DDI / R，VVI / R）中确定心室起搏刺激是否捕获节奏心室的方法和装置，包括以下方面中的一些或全部。例如，将心室起搏速率提高到高于最近心率的超速起搏速率的标称值，并评估从第一起搏心室到第二感测心室的传导间隔，然后继续监测潜在速率，以确保阈值测试起搏速率不会超过预定的最小间隔，并且向第一脑室提供起搏刺激并且感测第二脑室以确定对第一脑室的起搏刺激是否是子阈值和超阈值之一。所述方法和装置与确保心室起搏方案（例如，心脏再同步治疗或“CRT”）的实际递送相结合特别有用。

9. 发明授权

US08744579B2 LV threshold measurement and capture management 有权
标题翻译： LV阈值测量和捕获管理
公开(公告)号：US08744579B2
公开(公告)日：2014-06-03
申请号：US12700454
申请日：2010-02-04
申请人： Purvee P. Parikh , John C. Stroebel , Todd J. Sheldon , Karen J. Kleckner
发明人： Purvee P. Parikh , John C. Stroebel , Todd J. Sheldon , Karen J. Kleckner
IPC分类号： A61N1/00
CPC分类号： A61N1/3627 , A61N1/3684 , A61N1/371
摘要： The invention provides methods and apparatus for determining in a non-tracking pacing mode (e.g., DDI/R, VVI/R) whether a ventricular pacing stimulus is capturing a paced ventricle, including some or all of the following aspects. For example, increasing a ventricular pacing rate a nominal amount to an overdrive pacing rate higher than a most recent heart rate and evaluating a conduction interval from a first pacing ventricle to a second sensing ventricle and then continuing to monitor the underlying rate to ensure that a threshold testing pacing rate will not exceed a predetermined minimum interval and providing pacing stimulation to the first ventricle and sensing the second ventricle to determine whether the pacing stimulation to the first ventricle was one of sub-threshold and supra-threshold. The methods and apparatus are especially useful in conjunction with ensuring actual delivery of a ventricular pacing regime (e.g., cardiac resynchronization therapy or “CRT”).
摘要翻译：本发明提供了用于在非跟踪起搏模式（例如，DDI / R，VVI / R）中确定心室起搏刺激是否捕获节奏心室的方法和装置，包括以下方面中的一些或全部。例如，将心室起搏速率提高到高于最近心率的超速起搏速率的标称值，并评估从第一起搏心室到第二感测心室的传导间隔，然后继续监测潜在速率，以确保阈值测试起搏速率不会超过预定的最小间隔，并且向第一脑室提供起搏刺激并且感测第二脑室以确定对第一脑室的起搏刺激是否是子阈值和超阈值之一。所述方法和装置与确保心室起搏方案（例如，心脏再同步治疗或“CRT”）的实际递送相结合特别有用。

10. 发明授权

US07684863B2 LV threshold measurement and capture management 有权
标题翻译： LV阈值测量和捕获管理
公开(公告)号：US07684863B2
公开(公告)日：2010-03-23
申请号：US11311984
申请日：2005-12-20
申请人： Purvee P. Parikh , John C. Stroebel , Todd J. Sheldon , Karen J. Kleckner
发明人： Purvee P. Parikh , John C. Stroebel , Todd J. Sheldon , Karen J. Kleckner
IPC分类号： A61N1/362
CPC分类号： A61N1/3627 , A61N1/3684 , A61N1/371
摘要： The invention provides methods and apparatus for determining in a non-tracking pacing mode (e.g., DDI/R, VVI/R) whether a ventricular pacing stimulus is capturing a paced ventricle, including some or all of the following aspects. For example, increasing a ventricular pacing rate a nominal amount to an overdrive pacing rate higher than a most recent heart rate and evaluating a conduction interval from a first pacing ventricle to a second sensing ventricle and then continuing to monitor the underlying rate to ensure that a threshold testing pacing rate will not exceed a predetermined minimum interval and providing pacing stimulation to the first ventricle and sensing the second ventricle to determine whether the pacing stimulation to the first ventricle was one of sub-threshold and supra-threshold. The methods and apparatus are especially useful in conjunction with ensuring actual delivery of a ventricular pacing regime (e.g., cardiac resynchronization therapy or “CRT”).
摘要翻译：本发明提供了用于在非跟踪起搏模式（例如，DDI / R，VVI / R）中确定心室起搏刺激是否捕获节奏心室的方法和装置，包括以下方面中的一些或全部。例如，将心室起搏速率提高到高于最近心率的超速起搏速率的标称值，并评估从第一起搏心室到第二感测心室的传导间隔，然后继续监测潜在速率，以确保阈值测试起搏速率不会超过预定的最小间隔，并且向第一脑室提供起搏刺激并且感测第二脑室以确定对第一脑室的起搏刺激是否是子阈值和超阈值之一。所述方法和装置与确保心室起搏方案（例如，心脏再同步治疗或“CRT”）的实际递送相结合特别有用。

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