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    • 7. 发明授权
    • Method of determining a ventilatory threshold breakpoint for an adaptive rate pacemaker
    • 确定适应性起搏器通气阈值断点的方法
    • US06411850B1
    • 2002-06-25
    • US09408623
    • 1999-09-30
    • G. Neal KayDonald L. HopperJan-Pieter HeemellsJeff Hall
    • G. Neal KayDonald L. HopperJan-Pieter HeemellsJeff Hall
    • A61N136
    • A61N1/36521
    • A method for automatically determining the ventilatory (or “anaerobic”) threshold breakpoint for adaptive rate pacing without the need for directly measuring anaerobic threshold or ventilatory threshold comprises: (a) positioning a first sensing electrode in the heart or superior vena cava of a patient carrying an implanted pacemaker, the first sensing electrode connected to the implanted pacemaker; (b) positioning a second sensing electrode in the thoracic region of the patient and spaced apart from the first sensing electrode; (c) determining the chest wall impedance of the patient between the first sensing electrode and the second sensing electrode; (d) measuring the ventilation (e.g., the minute ventilation) of the subject from the chest wall impedance during submaximal exercise by the patient; and then (e) determining the ventilatory threshold breakpoint of the patient from the measured ventilation. In the pacemaker, the adaptive rate pacing is preferably based on measured chest wall impedance, with pacing rate increasing as exercise or metabolic activity sensed thereby increases. The implanted pacemaker is then preferably programmed, preferably automatically, so that the rate of increase in pacing rate in response to increasing ventilation by the pacemaker is attenuated after the breakpoint is reached. Peak ventilation is preferably also determined so that the maximum pacing rate of the pacemaker output is matched to the peak ventilation during adaptive rate pacing from the pacemaker. Apparatus implementing the method is also disclosed.
    • 用于自动确定用于自适应速率起搏的通气(或“厌氧”)阈值断点而不需要直接测量厌氧阈值或通气阈值的方法包括:(a)将第一感测电极定位在患者的心脏或上腔静脉中 携带植入式心脏起搏器,第一感测电极连接到植入式起搏器; (b)将第二感测电极定位在患者的胸部区域并与第一感测电极间隔开; (c)确定患者在第一感测电极和第二感测电极之间的胸壁阻抗; (d)在患者的次最大运动期间测量受试者从胸壁阻抗的通气(例如,每分通气量); 然后(e)从所测量的通气中确定患者的通气阈值断点。 在起搏器中,自适应速率起搏优选地基于测量的胸壁阻抗,起搏速率随着运动或感知的代谢活动而增加。 然后,植入式起搏器优选地被自动地编程,使得响应于由起搏器增加的通气而增加的起搏速率的增加在达到断点之后减弱。 优选还确定峰值通气,使得起搏器输出的最大起搏速率与起搏器的适应性起搏期间的峰值通气量匹配。 还公开了实现该方法的装置。