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1. 发明授权

US06564099B2 Implantable cardiac stimulator with electrode-tissue interface characterization 有权
公开(公告)号：US06564099B2
公开(公告)日：2003-05-13
申请号：US09454742
申请日：1999-12-06
申请人： David Prutchi , Patrick J. Paul , Gregory R. Martin
发明人： David Prutchi , Patrick J. Paul , Gregory R. Martin
IPC分类号： A61N1362
CPC分类号： A61N1/36521 , A61M5/142 , A61M5/14244 , A61M5/16854 , A61N1/3706 , A61N2001/083
摘要： A cardiac stimulator capable of measuring pacing impedance includes a tank capacitor for delivering charge to the heart via device leads, a shunt resistor, and high-impedance buffers for measuring pacing current through the shunt resistor. Soon after the leading edge of the stimulation pulse, the voltage across the shunt resistor, as sampled by a high-impedance buffer, indicates lead and cardiac tissue resistance. Just prior to opening the pacing switch to terminate the stimulation pulse, the voltage across the shunt resistor is sampled by a high-impedance buffer and held once again to allow the capacitance of the lead/heart tissue to be calculated. In alternative embodiments, a high-impedance buffer measures the voltage between the tank capacitor and ground immediately following the stimulation pulse to allow estimation of the lead/heart tissue capacitance. In one alternative embodiment, a look-up table is created in main memory and searched to find the closest lead/heart tissue capacitance estimate to any arbitrary degree of accuracy. In another alternative embodiment, the lead/heart tissue capacitance is estimated by successive approximation to any arbitrary degree of accuracy. When the lead/heart tissue capacitance and lead resistance have been determined, a plurality of parameters of importance for analyzing and optimizing a cardiac stimulation system may be calculated, such as the instantaneous current, the average current, the charge, and the energy delivered to the cardiac tissue.

2. 发明授权

US06507759B1 Implantable device with digital waveform telemetry 有权
标题翻译：带数字波形遥测的植入式设备
公开(公告)号：US06507759B1
公开(公告)日：2003-01-14
申请号：US09369068
申请日：1999-08-05
申请人： David Prutchi , Patrick J. Paul
发明人： David Prutchi , Patrick J. Paul
IPC分类号： A61N108
CPC分类号： A61N1/37252 , Y10S128/903
摘要： A technique for acquiring and accessing information from a medical implantable device is provided. Analog waveforms of interest are sensed and processed by signal acquisition circuitry. Analog parameters of interest are applied to selector switches which are controlled by a logic circuit. The logic circuit is also coupled an A/D converter for converting the analog signals to digital values. The digital values are stored in dedicated registers and are available for telemetry to an external device upon receipt of a request or prompt signal. When a digitized value is accessed and telemetered, the control logic circuit changes the conductive state of the selector switches to apply the corresponding analog signal to the A/D converter. The resulting digital value is applied to the corresponding register to refresh the accessed and telemetered value. The technique permits the external device to request and configure the implanted device to send only digitized values of interest. The technique also makes efficient use of the A/D converter, which consumes energy only as needed to refresh the memory when digital values are accessed and telemetered.
摘要翻译：提供了一种用于从医用可植入装置获得和访问信息的技术。感兴趣的模拟波形由信号采集电路感测和处理。感兴趣的模拟参数应用于由逻辑电路控制的选择器开关。逻辑电路还耦合有A / D转换器，用于将模拟信号转换为数字值。数字值存储在专用寄存器中，可在接收到请求或提示信号时向外部设备进行遥测。当访问和遥测数字化值时，控制逻辑电路改变选择器开关的导通状态，以将相应的模拟信号施加到A / D转换器。所得到的数字值被应用于相应的寄存器以刷新访问和遥测值。该技术允许外部设备请求和配置植入的设备以仅发送感兴趣的数字化值。该技术还有效地利用了A / D转换器，仅在需要访问和遥测数字值时根据需要消耗能量来刷新存储器。

3. 发明授权

US6112121A Implantable medical device with positive indication of lead connection and connector therefor 有权
标题翻译：可植入医疗器械，具有引线连接和连接器的正面指示
公开(公告)号：US6112121A
公开(公告)日：2000-08-29
申请号：US150124
申请日：1998-09-09
申请人： Patrick J. Paul , David Prutchi
发明人： Patrick J. Paul , David Prutchi
IPC分类号： A61N1/375
CPC分类号： A61N1/3752
摘要： An implantable medical device including an enclosure and a header portion attached to the enclosure. The header includes a lead cavity into which a lead can be inserted. The lead cavity includes a compression device, such as a spring, for aligning a highly visible indicator plunger at least partially hidden from view inside the volume defined by an annular electrode, or other opaque object, partially surrounding the lead cavity. The plunger includes at least a portion that is easily visible to a surgeon during implantation of the medical device. When a lead is inserted into the lead cavity, the end of the lead pushes against the indicator plunger thereby moving the plunger and compressing the spring. When the lead is fully inserted into the lead cavity, the plunger becomes visible as it is pushed away from the volume defined by the annular electrode. In this way, the plunger provides a positive indication that the lead has been fully inserted into the header. The annular electrode may also include a retaining surface that will contact a corresponding surface on the plunger should the plunger break loose from the spring. This feature helps to keep the plunger from migrating from the header into the body should the plunger break away from the spring.
摘要翻译：一种可植入医疗装置，其包括外壳和附接到外壳的头部部分。头部包括引线腔，引线可插入该引线腔中。引导腔包括诸如弹簧的压缩装置，用于将高度可见的指示器柱塞对准，该高度可见的指示器柱塞至少部分地隐藏在由环形电极或部分围绕引线腔的其它不透明物体限定的体积内。柱塞包括至少一部分，其在植入医疗装置期间对外科医生容易看到。当引线插入引线腔时，引线的端部推压指示器柱塞，从而移动柱塞并压缩弹簧。当引线完全插入引线腔中时，柱塞被从远离由环形电极限定的体积推开时可见。以这种方式，柱塞提供铅指示已被完全插入到头部中的肯定指示。环形电极还可以包括保持表面，该保持表面将在活塞从弹簧松开时接触柱塞上的对应表面。如果柱塞远离弹簧，该功能有助于保持柱塞不会从集管移动到主体内。

4. 发明授权

US5978710A Implantable cardiac stimulator with safe noise mode 失效
标题翻译：具有安全噪音模式的可植入心脏刺激器
公开(公告)号：US5978710A
公开(公告)日：1999-11-02
申请号：US12854
申请日：1998-01-23
申请人： David Prutchi , Patrick J. Paul
发明人： David Prutchi , Patrick J. Paul
IPC分类号： A61N1/365 , A61N1/37
CPC分类号： A61N1/37 , A61N1/3718 , Y10S128/901
摘要： An implantable medical device for electrically stimulating the heart to beat generally includes a processor, a plurality of electrodes, a sense amplifier, a pulse generator, and a heart status monitor. The processor can determine when the patient has entered an environment of high electromagnetic interference. When this occurs, the processor forces the implantable device into a safe noise mode. While in the same noise mode (which preferably continues while the patient is experiencing the electromagnetic interference), the implantable device paces the heart on demand and inhibits pacing during the vulnerable period. The processor determines when the vulnerable period is occurring and when the heart needs to be paced by monitoring a status signal from the heart status monitor. The status signal generated by the heart status monitor preferably is not sensitive to the electromagnetic interference, and thus the processor can determine the bio-mechanical state of the heart during a cardiac cycle even in the face of high electromagnetic interference. The heart status monitor preferably includes an impedance measurement circuit, but may include any type of cardiac sensor that can generate a status signal from which the processor can determine the beginning and ending of the vulnerable period. Accordingly, even during a period of high electromagnetic interference, the implantable device can provide on demand pacing support to the patient.
摘要翻译：用于电激励心跳的可植入医疗装置通常包括处理器，多个电极，感测放大器，脉冲发生器和心脏状态监视器。处理器可以确定患者何时进入高电磁干扰的环境。当这种情况发生时，处理器迫使可植入装置进入安全噪声模式。虽然在相同的噪音模式（其优选地在患者经历电磁干扰的情况下继续），但是可植入装置根据需要对心脏起搏并且在脆弱时期期间抑制起搏。处理器确定何时发生脆弱时期，何时需要通过监测来自心脏状态监视器的状态信号来调整心脏。由心脏状态监视器产生的状态信号优选地对电磁干扰不敏感，因此即使面对高电磁干扰，处理器也可以在心动周期期间确定心脏的生物机械状态。心脏状态监视器优选地包括阻抗测量电路，但是可以包括可以生成状态信号的任何类型的心脏传感器，处理器可以从该状态信号确定脆弱周期的开始和结束。因此，即使在高电磁干扰的时段期间，可植入装置也可以向患者提供按需的起搏支持。

5. 发明授权

US06525986B2 Stackable microelectronic components with self-addressing scheme 失效
公开(公告)号：US06525986B2
公开(公告)日：2003-02-25
申请号：US09767040
申请日：2001-01-22
申请人： David Prutchi , Patrick J. Paul
发明人： David Prutchi , Patrick J. Paul
IPC分类号： G11C800
CPC分类号： A61N1/375 , H01L24/73 , H01L25/0657 , H01L2224/05554 , H01L2224/32145 , H01L2224/32225 , H01L2224/48091 , H01L2224/48137 , H01L2224/48145 , H01L2224/48147 , H01L2224/48227 , H01L2224/49175 , H01L2224/73265 , H01L2225/06506 , H01L2225/0651 , H01L2225/06555 , H01L2225/06562 , H01L2924/01019 , H01L2924/14 , H01L2924/00 , H01L2924/00012 , H01L2924/00014
摘要： A memory device particularly useful in size-constrained electronic products, such as cardiac stimulators. To provide additional memory for such size-constrained products, memory chips are stacked one on top of another. The memory chips are configured to facilitate bonding without crossed contacts, using aligned bonding pads, vias, or castellations. Each memory chip also includes an address selection circuit that receives signals from one or more address lines to selectively enable and disable the memory chips in the stack.

6. 发明授权

US06208579B1 Stackable microelectronic components with self-addressing scheme 有权
标题翻译：具有自寻址方案的可堆叠微电子元件
公开(公告)号：US06208579B1
公开(公告)日：2001-03-27
申请号：US09347841
申请日：1999-07-02
申请人： David Prutchi , Patrick J. Paul
发明人： David Prutchi , Patrick J. Paul
IPC分类号： G11C800
CPC分类号： A61N1/375 , H01L24/73 , H01L25/0657 , H01L2224/05554 , H01L2224/32145 , H01L2224/32225 , H01L2224/48091 , H01L2224/48137 , H01L2224/48145 , H01L2224/48147 , H01L2224/48227 , H01L2224/49175 , H01L2224/73265 , H01L2225/06506 , H01L2225/0651 , H01L2225/06555 , H01L2225/06562 , H01L2924/01019 , H01L2924/14 , H01L2924/00 , H01L2924/00012 , H01L2924/00014
摘要： A memory device particularly useful in size-constrained electronic products, such as cardiac stimulators. To provide additional memory for such size-constrained products, memory chips are stacked one on top of another. The memory chips are configured to facilitate bonding without crossed contacts, using aligned bonding pads, vias, or castellations. Each memory chip also includes an address selection circuit that receives signals from one or more address lines to selectively enable and disable the memory chips in the stack.
摘要翻译：在尺寸受限的电子产品中特别有用的记忆装置，例如心脏刺激器。为了为这种尺寸受限的产品提供额外的存储器，存储器芯片被堆叠在另一个之上。存储器芯片被配置为便于使用对准的接合焊盘，通孔或蓖体的无交叉接触的接合。每个存储器芯片还包括地址选择电路，其接收来自一个或多个地址线的信号以选择性地启用和禁用堆叠中的存储器芯片。

7. 发明授权

US5735883A Implantable cardiac stimulator with impedance based autothreshold 失效
标题翻译：基于阻抗的自动阈值的可植入心脏刺激器
公开(公告)号：US5735883A
公开(公告)日：1998-04-07
申请号：US766870
申请日：1996-12-13
申请人： Patrick J. Paul , David Prutchi
发明人： Patrick J. Paul , David Prutchi
IPC分类号： A61N1/37
CPC分类号： A61N1/3712
摘要： An implantable pacemaker with apparatus for detecting capture or adjusting the strength or duration of pacing pulses by assessing the mechanical evoked response that may be distinctly sensed through impedance sensing, pressure sensing, plethysmography or other suitable methods. When capture is to be detected or the strength or duration of the pacing pulses is to be adjusted, two pacing pulses are delivered to the heart in each cycle of a series of cardiac cycles. The first pulse is varied in strength or duration or both. The second pulse is maintained at a consistently high strength or duration to assure capture. The impedance of the heart is measured during a time window following the first pulse which is predicted to include a recognizable feature of the impedance waveform of the heart following a stimulating pulse. The magnitude of the first pulse is gradually changed until capture is lost. When the stimulation effect of the first pulse on the heart changes, the impedance measured during the window will change distinctly, indicating that a stimulus threshold has been detected.
摘要翻译：一种可植入起搏器，其具有用于通过评估可通过阻抗感测，压力感测，体积描记法或其它合适方法明确感测到的机械诱发反应来检测捕获或调整起搏脉冲的强度或持续时间的装置。当要检测到捕获或要调整起搏脉冲的强度或持续时间时，在一系列心动周期的每个循环中将两个起搏脉冲输送到心脏。第一个脉冲的强度或持续时间是不同的，或两者都有差异。第二脉冲保持在一致的高强度或持续时间以确保捕获。在第一脉冲之后的时间窗中测量心脏的阻抗，该第一脉冲被预测为包括刺激脉冲之后心脏的阻抗波形的可识别特征。第一个脉冲的幅度逐渐变化，直到捕获丢失为止。当第一脉冲对心脏的刺激作用发生变化时，窗口内测得的阻抗会明显变化，表明已经检测到刺激阈值。

8. 发明授权

US5549653A Muscle stimulation electrode for implantable cardial stimulation device with warning system 失效
标题翻译：用于具有警告系统的可植入心脏刺激装置的肌肉刺激电极
公开(公告)号：US5549653A
公开(公告)日：1996-08-27
申请号：US532961
申请日：1995-09-22
申请人： Lawrence J. Stotts , Patrick J. Paul , David Prutchi
发明人： Lawrence J. Stotts , Patrick J. Paul , David Prutchi
IPC分类号： A61N1/05 , A61N1/36 , A61N1/37 , A61N1/375 , A61N1/38 , A61N1/04
CPC分类号： A61N1/375 , A61N1/0563 , A61N1/362 , A61N1/3708
摘要： A cardiac simulation system with a patient warning apparatus, including a pin electrode insertable into a standard female socket in the header of a dual chamber pacer or multi-function cardiac stimulator. The cardiac stimulator has at least two sockets in a header, such as is commonly found in a dual chamber pacemaker. Rather than stimulating both chambers of the heart, the dual chamber pacemaker is programmed to function as a single chamber pacemaker, with a standard lead connecting one socket and its associated circuitry to a selected chamber of the heart, usually the ventricle. The pin electrode is inserted in the other socket, usually used for the sensing and stimulation of the atrium, and additional programming is provided to the pacemaker or stimulator to automatically produce an output stimulus through the atrial socket to the pin electrode whenever a condition exists requiring patient notification or warning. Our invention includes a specialized pin electrode with an orifice for a suture. The suture is anchored to excitable tissue in a secure fashion to assure contact of the electrode with the tissue and thus stimulation of the tissue.
摘要翻译：一种具有患者警告装置的心脏模拟系统，包括可插入双室起搏器或多功能心脏刺激器的头部中的标准母插座中的针电极。心脏刺激器在头部中具有至少两个插座，例如通常在双室起搏器中发现。双室心脏起搏器不是刺激心脏的两个腔室，而是被编程为用作单室起搏器，标准引线将一个插座及其相关联的电路连接到心脏的选定室，通常是心室。引脚电极插入另一个插座，通常用于感应和刺激心房，并且当存在条件时需要额外的程序设计提供给起搏器或刺激器，以自动产生通过心房插座的输出刺激到针电极病人通知或警告。我们的发明包括具有用于缝线的孔的专用针电极。缝线以安全的方式锚定到可兴奋的组织，以确保电极与组织的接触，从而刺激组织。

9. 发明授权

US06788972B2 Implantable cardiac stimulator with electrode-tissue interface characterization 有权
标题翻译：具有电极 - 组织界面表征的植入式心脏刺激器
公开(公告)号：US06788972B2
公开(公告)日：2004-09-07
申请号：US10371609
申请日：2003-02-21
申请人： David Prutchi , Patrick J. Paul , Gregory R. Martin
发明人： David Prutchi , Patrick J. Paul , Gregory R. Martin
IPC分类号： A61N137
CPC分类号： A61N1/36521 , A61M5/142 , A61M5/14244 , A61M5/16854 , A61N1/3706 , A61N2001/083
摘要： A cardiac stimulator capable of measuring pacing impedance includes a tank capacitor for delivering charge to the heart via device leads, a shunt resistor, and high-impedance buffers for measuring pacing current through the shunt resistor. Soon after the leading edge of the stimulation pulse, the voltage across the shunt resistor, as sampled by a high-impedance buffer, indicates lead and cardiac tissue resistance. Just prior to opening the pacing switch to terminate the stimulation pulse, the voltage across the shunt resistor is sampled by a high-impedance buffer and held once again to allow the capacitance of the lead/heart tissue to be calculated. In alternative embodiments, a high-impedance buffer measures the voltage between the tank capacitor and ground immediately following the stimulation pulse to allow estimation of the lead/heart tissue capacitance. In one alternative embodiment, a look-up table is created in main memory and searched to find the closest lead/heart tissue capacitance estimate to any arbitrary degree of accuracy. In another alternative embodiment, the lead/heart tissue capacitance is estimated by successive approximation to any arbitrary degree of accuracy. When the lead/heart tissue capacitance and lead resistance have been determined, a plurality of parameters of importance for analyzing and optimizing a cardiac stimulation system may be calculated, such as the instantaneous current, the average current, the charge, and the energy delivered to the cardiac tissue.
摘要翻译：能够测量起搏阻抗的心脏刺激器包括用于通过器件引线将电荷递送到心脏的储能电容器，分流电阻器和用于测量通过分流电阻器的起搏电流的高阻抗缓冲器。在刺激脉冲的前沿之后不久，由高阻抗缓冲液取样的分流电阻器两端的电压表示铅和心脏组织的电阻。在打开起搏开关以终止刺激脉冲之前，分流电阻器两端的电压由高阻抗缓冲器采样，并再次保持以允许计算铅/心脏组织的电容。在替代实施例中，高阻抗缓冲器在刺激脉冲之后立即测量储能电容器和地之间的电压，以允许对铅/心脏组织电容的估计。在一个备选实施例中，在主存储器中创建查找表并搜索以找到任何任意精度的最接近的引导/心脏组织电容估计。在另一替代实施例中，通过逐次逼近任何任意精度来估计引导/心脏组织电容。当确定了铅/心脏组织电容和引线电阻时，可以计算多个用于分析和优化心脏刺激系统的参数，例如瞬时电流，平均电流，电荷和递送至心脏组织。

10. 发明授权

US5944744A Implantable cardiac stimulator with automatic electrogram profiling 失效
标题翻译：可植入心脏刺激器，具有自动电描图分析
公开(公告)号：US5944744A
公开(公告)日：1999-08-31
申请号：US19751
申请日：1998-02-06
申请人： Patrick J. Paul , David Prutchi
发明人： Patrick J. Paul , David Prutchi
IPC分类号： A61B5/0402 , A61N1/37
CPC分类号： A61N1/3706 , A61N1/3704
摘要： An implantable medical device for electrically stimulating the heart to beat generally includes a processor, a plurality of electrodes, a sense amplifier, a pair of comparators, inner and outer target logic units, and pulse generator. The processor controls the magnitudes of inner and outer target reference signals which are generated by the inner and outer target logic units, respectively. The outer target is adjusted to be approximately equal to the peak amplitude of the cardiac signal. The processor stores representations of the outer target reference in memory. Alternatively or additionally, the processor computes a histogram of the relative or absolute number of cardiac cycles that occur over a given period of time for each outer target setting. The processor can be directed to retrieve the outer target representations and/or the histogram from memory and transmit that information to an external programmer for use by a physician.
摘要翻译：用于电激励心跳的可植入医疗装置通常包括处理器，多个电极，读出放大器，一对比较器，内部和外部目标逻辑单元以及脉冲发生器。处理器分别控制由内部和外部目标逻辑单元产生的内部和外部目标参考信号的大小。外部目标被调整为近似等于心脏信号的峰值振幅。处理器将外部目标参考的表示存储在存储器中。或者或另外，处理器计算针对每个外部目标设置在给定时间段内发生的心跳周期的相对或绝对数量的直方图。处理器可以被引导以从存储器检索外部目标表示和/或直方图，并将该信息发送到外部编程器以供医生使用。

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