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1. 发明授权

US5247930A Dual chamber pacing system with dynamic physiological tracking and method of timing delivered stimulus for optimized synchronous pacing 失效
标题翻译：具有动态生理跟踪的双室PAC系统和用于优化同步PACING的递送STIMULUS的方法
公开(公告)号：US5247930A
公开(公告)日：1993-09-28
申请号：US831115
申请日：1992-02-04
申请人： Malcolm J. S. Begemann , Gustaaf A. P. Stoop , Johannes S. van der Veen
发明人： Malcolm J. S. Begemann , Gustaaf A. P. Stoop , Johannes S. van der Veen
IPC分类号： A61N1/368 , A61N1/362
CPC分类号： A61N1/3622
摘要： A dual chamber pacemaker system is provided having means for determining when sensed atrial signals have a physiological rate, and tracking only such sensed atrial signals as are found to have physiological rates. The pacemaker provides logic means for continuously determining a physiological rate as a function of sensed atrial rate, whereby physiological rate substantially tracks the rate of sensed physiological atrial signals. The pacemaker also determines dynamic decision rates which are coupled to follow the physiological rate. The decision rates comprise a dynamic pacing limit, which sets the pacing escape interval; a dynamic tracking limit, which sets the upper limit of the physiological range of rates which are tracked; and the dynamic Wenckebach limit, which defines the upper rate for a dynamic Wenckebach range. The pacemaker enables time out of an AV delay for synchronizing delivery of ventricular pacing pulses with respect to atrial heartbeats which occur within the range between the dynamic pacing limit and the dynamic tracking limit, i.e., the physiological range. Synchronized ventricular pacing pulses are delivered when both the sensed atrial signal and the scheduled synchronized ventricular signal have rates within the determined physiological range. The pacemaker substantially continuously determines atrial rate, sensing all atrial signals except for a short PVAB which limits atrial sensing only to the extent required to block far field R-waves.
摘要翻译：提供了一种双室起搏器系统，其具有用于确定感测到的心房信号何时具有生理速率的装置，并且仅跟踪被发现具有生理速率的这种感测的心房信号。起搏器提供用于连续地确定作为感测的心房率的函数的生理速率的逻辑手段，由此生理速率基本上跟踪所感测的生理心房信号的速率。起搏器还决定了动态决策速率，这些速率与生理速率相关。决策速率包括动态起搏限制，设置起搏逃生间隔; 一个动态跟踪限制，设定跟踪率的生理范围的上限; 以及动态的Wenckebach限制，它定义了动态Wenckebach范围的较高速率。起搏器使AV时间延迟以使心室起搏脉冲相对于在动态起搏极限和动态跟踪极限即生理范围之间的范围内的心房心跳的同步传送。当感测的心房信号和调度的同步心室信号都在确定的生理范围内时，同步的心室起搏脉冲被递送。心脏起搏器基本上连续地确定心房率，感测所有心房信号，除了短暂的PVAB，其限制心房感应到达阻止远场R波所需的程度。

2. 发明授权

US5247929A Dual chamber pacemaker with AV extension and PMT control 失效
标题翻译：双室心脏起搏器，具有AV延伸和PMT控制
公开(公告)号：US5247929A
公开(公告)日：1993-09-28
申请号：US830656
申请日：1992-02-04
申请人： Gustaaf A. P. Stoop , Johannes S. van der Veen , Malcolm J. S. Begemann
发明人： Gustaaf A. P. Stoop , Johannes S. van der Veen , Malcolm J. S. Begemann
IPC分类号： A61N1/362
CPC分类号： A61N1/3622
摘要： A dual chamber pacemaker is provided having incorporated therein a VA conduction test for concurrently testing for the conditions of retrograde conduction (RC) and far field R wave sensing (FFRS). The pacemaker changes the AV or VV interval to a predetermined interval over a number of pacemaker cycles, and determines whether the VA interval remains substantially unchanged, i.e., the VA intervals are substantially equal. When VA interval equality is determined, the pacemaker checks the measure of VA interval with stored RC and FFRS criteria to determine whether either can be verified. Respective corrective steps are taken if either RC or FFRS is verified.
摘要翻译：提供了一种双室起搏器，其中并入其中用于同时测试逆行传导（RC）和远场R波感测（FFRS）的条件的VA导电测试。起搏器在多个起搏器周期中将AV或VV间隔改变到预定间隔，并且确定VA间隔是否保持基本不变，即VA间隔基本相等。当确定VA间隔相等时，起搏器使用存储的RC和FFRS标准检查VA间隔的测量值，以确定是否可以验证。如果RC或FFRS被验证，则采取相应的校正步骤。

3. 发明授权

US4917115A Pacing system and method for physiological stimulation of the heart utilizing Doppler means 失效
标题翻译：使用多普勒手段对心脏生理刺激的起搏系统和方法
公开(公告)号：US4917115A
公开(公告)日：1990-04-17
申请号：US217239
申请日：1988-07-11
申请人： David Flammang , Alexis C. M. Renirie , Malcolm J. S. Begemann
发明人： David Flammang , Alexis C. M. Renirie , Malcolm J. S. Begemann
IPC分类号： A61N1/362 , A61N1/365
CPC分类号： A61N1/36528 , A61N1/3622
摘要： A cardiac pacemaker and method of operation of such pacemaker is disclosed comprising a single lead having conventional ventricular pacing and sensing electrode means as well as atrial sensors adapted to be positioned in the patient's atrim without any contact with the atrial wall, for sensing atrial wall movement and for generating information signals representative of the atrial wall movement. The free-floating atrial sensor is utilized in providing information for making a determination of a number of cardiac conditions, including analysis of direction of P waves to determine whether sensed signals are anterograde or retrograde.
摘要翻译：公开了一种心脏起搏器和这种起搏器的操作方法，其包括具有常规心室起搏和感测电极装置的单个引线以及适于定位在患者的手臂内而不与心房壁接触的心房传感器，用于感测心房壁运动并用于产生表示心房壁运动的信息信号。自由浮动心房传感器用于提供用于确定多个心脏状况的信息，包括分析P波的方向以确定感测到的信号是否是前列腺或逆行。

4. 发明授权

US6052621A System and method for inducing tachycardia 失效
标题翻译：用于诱导心动过速的系统和方法
公开(公告)号：US6052621A
公开(公告)日：2000-04-18
申请号：US14378
申请日：1998-01-27
申请人： Malcolm J. S. Begemann , Karel den Dulk , Henny M. Leerssen , Volkert A. Zeijlemaker
发明人： Malcolm J. S. Begemann , Karel den Dulk , Henny M. Leerssen , Volkert A. Zeijlemaker
IPC分类号： A61N1/362 , A61N1/38 , A61N1/39
CPC分类号： A61N1/385 , A61N1/3621
摘要： A system and method are provided for inducing ventricular tachycardia in a patient to enable testing to determine the optimum parameters for anti-tachycardia stimulation. The implantable device provides for overdrive pacing of the heart for a short sequence, followed by delivery of a series of pulse pairs. Each pulse pair has a first stimulus pulse delivered at the same or similar overdrive rate, and an inducing pulse which is delivered in timed relation to the evoked T-wave, preferably during the falling edge portion of the T-wave. In this way, each cycle the inducing pulse is timed for efficaciously inducing tachycardia. The timing of the inducing pulse is enhanced by near field sensing of the T-wave at about the location where the pulses are delivered, preferably using bipolar sensing and/or sense circuitry designed to recover the signal with an optimum time response.
摘要翻译：提供了一种系统和方法，用于诱导患者的室性心动过速以使测试能够确定用于抗心动过速刺激的最佳参数。可植入装置提供用于短序列的心脏超速起搏，随后递送一系列脉冲对。每个脉冲对具有以相同或相似的过驱动速率传送的第一激励脉冲，以及诱导脉冲，优选地在T波的下降沿部分期间以与激发的T波定时关系递送。以这种方式，诱导脉冲的每个周期被定时以有效诱发心动过速。诱导脉冲的定时通过在脉冲被传送的位置处的T波的近场感测来增强，优选地使用设计成以最佳时间响应恢复信号的双极感测和/或感测电路。

5. 发明授权

US5312447A Pacemaker with improved inhibit and trigger control 失效
标题翻译：起搏器具有改善的抑制和触发控制
公开(公告)号：US5312447A
公开(公告)日：1994-05-17
申请号：US950479
申请日：1992-09-24
申请人： Malcolm J. S. Begemann
发明人： Malcolm J. S. Begemann
IPC分类号： A61N1/362 , A61N1/37
CPC分类号： A61N1/362 , A61N1/3706
摘要： A pacemaker for providing optimized inhibit and trigger responses, operating in a VVD or AAD mode. For each pacemaker cycle, the pacemaker is controlled to time out a refractory interval, an inhibit interval or range following a refractory interval, and a trigger interval or range which follows the inhibit interval and ends at the time out of the scheduled escape interval. A signal sensed during the inhibit range results in no pace pulse delivery, the pacemaker goes to the trigger mode and extends the escape interval. Any signal thereafter sensed before the time out of the extended escape interval results in delivery of a trigger pulse and restarting of a new pacemaker cycle. If no signal is sensed during the inhibit range, any signal sensed during the trigger range results in generation of a trigger pulse and the start of a new pacemaker cycle. The overall result is that noise or other signals which occur within the inhibit range are inhibited without a trigger, with only a small extension of the escape interval so that pacing rate is not greatly affected. Any signal sensed in the trigger range results in delivery of a trigger pulse. The result is an optimized combination of inhibition and triggering which ensures pacing in the presence of any noise that is sensed with relatively minimized sacrifice in rate change and battery energy depletion.
摘要翻译：用于提供优化的抑制和触发响应的起搏器，在VVD或AAD模式下工作。对于每个起搏器周期，起搏器被控制以超出难治性时间间隔，在难治性时间间隔之后的抑制间隔或范围，以及跟随禁用间隔的触发间隔或范围，并且在排除的排程间隔之外结束。在禁止范围内感测到的信号不会产生步速脉冲传递，起搏器进入触发模式并延长逃逸间隔。此后在延长的逃逸间隔之前的时间之后感测到的任何信号导致触发脉冲的传递并重新启动新的起搏器循环。如果在禁止范围内没有感测到信号，则在触发范围内检测到的任何信号都会导致产生触发脉冲并启动新的起搏器周期。总体结果是抑制范围内发生的噪声或其他信号被禁止而没有触发，只有较小的延伸间隔，以便起搏速率不会受到很大的影响。在触发范围内感测到的任何信号导致触发脉冲的传送。结果是禁止和触发的优化组合，其确保在存在以任何噪音的情况下的起搏，所述任何噪声以相对最小的速率变化和电池能量消耗的牺牲被感测。

6. 发明授权

US5282465A Pacemaker with Wenckebach operation 失效
标题翻译：起搏器与Wenckebach手术
公开(公告)号：US5282465A
公开(公告)日：1994-02-01
申请号：US830651
申请日：1992-02-04
申请人： Johannes S. van der Veen , Malcolm J. S. Begemann , Gustaaf A. P. Stoop
发明人： Johannes S. van der Veen , Malcolm J. S. Begemann , Gustaaf A. P. Stoop
IPC分类号： A61N1/362 , A61N1/365
CPC分类号： A61N1/3622
摘要： A dual chamber pacemaker system is provided having an improved Wenckebach response for optimizing tracking of atrial signals having rates within a rate range above the normal tracking range, i.e., in a designated Wenckebach range. When an atrial sense occurs in the Wenckebach range, the AV delay is extended up to a predetermined maximum extension to enable delivery of a ventricular pulse at the ventricular upper rate limit (dynamic tracking limit). When the AV delay would have to be extended beyond the maximum extension in order to pace the ventricle at the dynamic tracking limit, the next ventricular stimulus is delivered asynchronously at an escape interval greater than the escape interval corresponding to the dynamic tracking limit, e.g., at a predetermined lower pacing limit.
摘要翻译：提供双室起搏器系统，其具有改进的Wenckebach响应，用于优化具有高于正常跟踪范围的速率范围内的速率的心房信号的跟踪，即在指定的Wenckebach范围内。当在Wenckebach范围发生心房感觉时，AV延迟被延长到预定的最大延伸，以使得能够以心室上限速度（动态跟踪极限）递送心室脉搏。当AV延迟必须延伸超出最大延长时间以便在动态跟踪极限下对心室进行调节时，下一个心室刺激以大于对应于动态跟踪极限的逃生间隔的逃生间隔异步传递，例如，在预定的较低起搏极限。

7. 发明授权

US5065759A Pacemaker with optimized rate responsiveness and method of rate control 失效
标题翻译：起搏器具有优化的速率响应和速率控制方法
公开(公告)号：US5065759A
公开(公告)日：1991-11-19
申请号：US575289
申请日：1990-08-30
申请人： Malcolm J. S. Begemann , Bernhard de Vries , Johannes S. van der Veen
发明人： Malcolm J. S. Begemann , Bernhard de Vries , Johannes S. van der Veen
IPC分类号： A61N1/365
CPC分类号： A61N1/36585
摘要： A pacemaker system is provided for rate responsive pacing, wherein rate is controlled as a function of two or more sensor inputs, each sensor providing a signal representing a respective different control parameter. Preferably a first sensor signal represents a physiologically accurate although slow response signal such as OT interval, and a second sensor represents a relatively fast response such as activity. The two parameter signals are processed so that they are directly comparable and can be compared as indicators of pacing rate throughout the desired pacing range. The algorithm utilizes a parameter control reference curve for each respective parameter, such reference curve representing the desired correlation between pacing rate and the parameter signal. Rate control is accomplished by determining the difference between each processed parameter signal and its corresponding reference point for the current pacing interval, and logically analyzing the two differences to determine which is used to indicate change in pacing rate. Each parameter reference curve is automatically adjustable to correspond to patient conditions. Automatic drift correction of the fast response parameter, such as activity, is used to compensate for conditions where the fast response signal is not likely to be physiologically reflective of the patient condition.
摘要翻译：提供了一种用于速率响应起搏的起搏器系统，其中速率被控制为两个或更多个传感器输入的函数，每个传感器提供表示相应不同控制参数的信号。优选地，第一传感器信号表示生理上准确的但是响应速度慢的信号，例如OT间隔，第二传感器表示诸如活动的相对快速的响应。两个参数信号被处理，使得它们是直接可比较的，并且可以作为整个期望起搏范围的起搏速度的指标进行比较。该算法对每个相应的参数使用参数控制参考曲线，这种参考曲线表示起搏速率和参数信号之间的期望相关性。速率控制通过确定每个处理的参数信号与其当前起搏间隔的对应参考点之间的差异来完成，并且逻辑分析两个差异以确定哪个用于指示起搏速率的改变。每个参数参考曲线可自动调节，以对应于患者状况。快速响应参数（如活动）的自动漂移校正被用于补偿快速响应信号不太可能在生理上反映患者状况的情况。

8. 发明授权

US4972834A Pacemaker with improved dynamic rate responsiveness 失效
标题翻译：起搏器具有改善的动态响应速度
公开(公告)号：US4972834A
公开(公告)日：1990-11-27
申请号：US252643
申请日：1988-09-30
申请人： Malcolm J. S. Begemann , Willem Boute , Marijn van Gemert
发明人： Malcolm J. S. Begemann , Willem Boute , Marijn van Gemert
IPC分类号： A61N1/365
CPC分类号： A61N1/36585
摘要： A rate adaptive pacemaker system, and method of operation, is provided which has a pacemaker which generates pacing pulses at a controlled pacing rate as a function of at least one monitored patient variable. The correlation of pacing rate with the patient variable is nonlinear, or dynamic, and is adapted to actual patient conditions. The value of the relationship between the pacing rate and the monitoring variable is determined at the lower rate limit and the upper rate limit, and the dynamic characteristic between these limits is automatically adjusted.

9. 发明授权

US5978709A Pacemaker system with improved techniques for preventing and suppressing atrial arrhythmias 失效
标题翻译：起搏器系统具有改进的预防和抑制心房心律失常的技术
公开(公告)号：US5978709A
公开(公告)日：1999-11-02
申请号：US98162
申请日：1998-06-16
申请人： Malcolm J. S. Begemann , Johannes S. Van Der Veen , Xander Evers
发明人： Malcolm J. S. Begemann , Johannes S. Van Der Veen , Xander Evers
IPC分类号： A61N1/362
CPC分类号： A61N1/3622
摘要： There is provided a pacing system having special functions for treating the patient's atrium with atrial pacing so as to reduce the probability of occurrence of dangerous atrial arrhythmias. The pacemaker of the system provides for atrial Pace.sub.-- Conditioning, whereby the patient's normal intrinsic atrial rate is overridden by higher rate pacing whenever a predetermined sequence of intrinsic heartbeats is sensed. The pacemaker also provides for special pacing routines following the detection of one or more PACs. The PAC response routines include pacing at an elevated rate for a predetermined time or number of beats, and smoothing out pacing intervals for one or several cycles following the occurrence of a PAC. The pacemaker also includes a post-exercise function, for overtaking the intrinsic rate and pacing the heart following exercise, the pacing being in accordance with a predetermined program which holds a relatively higher rate longer than normal post-exercise, so as to provide enhanced blood flow to the cardiac tissue and prevent the onset of ischemia.
摘要翻译：提供了一种具有特殊功能的起搏系统，用于以心房起搏治疗患者心房，以降低危险心房心律失常的发生概率。系统的起搏器提供心房心律调节，从而每当检测到预定的内在心跳序列时，患者的正常固有心房率被更高的速率起搏所覆盖。起搏器还在检测到一个或多个PAC之后提供特殊的起搏程序。 PAC响应例程包括以提高的速率起搏一段预定时间或次数的节拍，以及在出现PAC之后平滑起搏间隔一个或多个周期。起搏器还包括运动后功能，用于超越内在速度，并且在运动后起搏心脏，起搏是按照预定程序进行的，该程序比运动后正常运行的时间要长得多，从而提供增强的血液流向心脏组织并防止缺血发作。

10. 发明授权

US5470344A Rate responsive pacemake with improved rate change dynamics and pacing method 失效
标题翻译：通过改进速率变化动态和起搏方法来评估反应速度
公开(公告)号：US5470344A
公开(公告)日：1995-11-28
申请号：US132758
申请日：1993-10-06
申请人： Malcolm J. S. Begemann
发明人： Malcolm J. S. Begemann
IPC分类号： A61N1/365
CPC分类号： A61N1/365 , A61N1/36585
摘要： A rate responsive pacemaker and method of pacing, having circuitry for controlling the rate of change of pacing rate in response to varying rate sensor signals. The pacemaker increments or decrements pacing rate each cycle, the change in rate being limited as a function of pacing rate, rate of change of sensor rate; the magnitude of the difference between sensor rate and pacing rate; whether prior cycles ended in sense or pace events; and/or a separate fast response sensor.
摘要翻译：速率响应起搏器和起搏方法，具有响应于不同速率传感器信号来控制起搏速率变化速率的电路。起搏器每个周期增加或减少起搏速率，速率的变化作为起搏速率，传感器速率变化率的函数而受到限制; 传感器速率与起搏速率差异的大小; 前一个周期是否在意义上或速度事件结束; 和/或单独的快速响应传感器。

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