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1. 发明授权

US5417714A DDI pacing with PVC-protected hysteresis and automatic AV interval adjustment 失效
标题翻译： DDI起搏带有PVC保护滞后和自动AV间隔调整
公开(公告)号：US5417714A
公开(公告)日：1995-05-23
申请号：US60765
申请日：1993-05-11
申请人： Paul A. Levine , Malcolm Clarke , John W. Poore , Jason A. Sholder
发明人： Paul A. Levine , Malcolm Clarke , John W. Poore , Jason A. Sholder
IPC分类号： A61N1/365 , A61N1/362 , A61N1/368 , A61N1/36
CPC分类号： A61N1/368 , A61N1/3622 , A61N1/3682
摘要： A dual-chamber pacemaker provides DDI pacing with PVC-protected hysteresis and automatic AV interval adjustment. An extended hysteresis atrial escape interval (AEI.sub.H) is invoked in response to the occurrence of either an atrial paced event followed by a sensed R-wave (an AR event), or an atrial sensed event followed by a sensed R-wave (a PR event). The occurrence of a premature ventricular contraction (PVC) thus does not trigger AEI.sub.H. In one embodiment, AEI.sub.H is not invoked unless the sensed AR or PR interval exceeds a prescribed reference interval. In a further embodiment, the AV interval (AVI) associated with the DDI operation is automatically shortened following an atrial stimulation pulse (A-pulse) delivered upon the timing-out of the AEI.sub.H. The shortened AVI is maintained for a programmed number of cycles of DDI operation, after which a lengthened AVI is reestablished for one cycle. If AV pacing follows after using the lengthened AVI, then the shortened AVI is reinstated for a second number of programmed cycles of DDI operation. If AR pacing follows after using the lengthened AVI, signifying intact AV nodal conduction, then the AVI is lengthened to the programmed AVI over a prescribed number of cycles.
摘要翻译：双室心脏起搏器为DDI起搏提供PVC保护的滞后和自动AV间隔调整。响应于发生心房起搏事件，随后是感测到的R波（AR事件）或心房感测事件，随后是感测的R波（PR），调节延长的心房逸出间隔时间（AEIH）事件）。因此早期心室收缩（PVC）的发生不会引发AEIH。在一个实施例中，除非感测到的AR或PR间隔超过规定的参考间隔，否则AEIH不被调用。在另一个实施例中，在AEIH超时之后递送的心房刺激脉冲（A脉冲）之后，与DDI操作相关联的AV间隔（AVI）自动缩短。缩短的AVI维持编程的DDI操作周期数，之后延长的AVI重新建立一个周期。如果在使用延长的AVI之后进行AV起搏，则缩短的AVI将恢复DDI操作的第二个编程周期数。如果在使用延长的AVI后进行AR起搏，则表示完整的AV节点传导，则AVI在规定数量的周期内延长到编程的AVI。

2. 发明授权

US06622045B2 System and method for remote programming of implantable cardiac stimulation devices 有权
公开(公告)号：US06622045B2
公开(公告)日：2003-09-16
申请号：US09823374
申请日：2001-03-29
申请人： Jeffery D. Snell , John W. Poore , Jason A. Sholder
发明人： Jeffery D. Snell , John W. Poore , Jason A. Sholder
IPC分类号： A61N108
CPC分类号： A61N1/37282
摘要： To permit remote programming of implantable cardiac stimulation devices such as pacemakers, a central device programmer is provided in conjunction with a network of remote telemetry units for use in patient homes or in remote clinics. To reprogram a device implanted within a patient, a physician enters programming commands within the central programmer which relays the programming commands to a remote telemetry unit in proximity to the patient. The remote telemetry unit, in turn, forwards the programming commands to the implanted device. In this manner, the patient need not return to the physician for reprogramming of the device. Remote telemetry units may be provided within patient homes, clinics, hospital emergency rooms, hospital patient rooms, and the like. Depending upon the implementation, different levels of programmability may be permitted depending upon the degree of supervision of the patient. For an unsupervised patient, limited programmability is permitted. For a nurse-supervised patient, a greater degree of programmability is permitted. Finally, for a physician-supervised patient, a full range of programmability is permitted. In a specific example described herein, each remote telemetry unit includes minimal hardware and software components necessary to relay programming commands, diagnostic information, and other signals between the central programmer and the implanted device.

3. 发明授权

US4712555A Physiologically responsive pacemaker and method of adjusting the pacing interval thereof 失效
标题翻译：生理反应起搏器和调整其起搏间隔的方法
公开(公告)号：US4712555A
公开(公告)日：1987-12-15
申请号：US716831
申请日：1985-03-27
申请人： Hans T. Thornander , John W. Poore , Jason A. Sholder , James R. Thacker , David C. Amundson
发明人： Hans T. Thornander , John W. Poore , Jason A. Sholder , James R. Thacker , David C. Amundson
IPC分类号： A61N1/08 , A61N1/365 , A61N1/368 , A61N1/37 , A61N1/36
CPC分类号： A61N1/365 , A61N1/368 , A61N1/3712 , A61N1/3714 , A61N1/3716
摘要： A pacemaker and physiological sensor for use therewith that allows the rate at which the pacemaker delivers electrical stimulation pulses to the heart, or the escape interval during which a natural heart event must occur before an electrical stimulation pulse is delivered, to be adjusted as needed in order to satisfy the body's physiological needs. The sensor measures the depolarization time interval between an atrial stimulation pulse, A, and the responsive atrial or ventricle depolarization, P or R respectively, as an indication of the physiological demands placed on the heart. The time interval between a ventricular stimulation pulse, V, and the responsive ventricular depolarization, R, may also be measured and used as an indication of physiological need, and hence as an alternative criteria for rate control. Atrial depolarization is sensed by detecting a P-wave, and ventricular depolarization is preferably sensed by detecting an R-wave. A method of measuring A-P, A-R, or V-R intervals is used to ascertain if these intervals are increasing or decreasing. If, over several heart cycles or beats, an increase or decrease in these measurements is detected, the pacing interval set by the pacemaker is adjusted in an appropriate direction in order to adjust the heart stimulation rate accordingly.
摘要翻译：用于其的起搏器和生理传感器允许起搏器向心脏传递电刺激脉冲的速率，或者在传送电刺激脉冲之前必须发生自然心脏事件的逃逸间隔，以根据需要进行调整为了满足身体的生理需要。传感器测量心房刺激脉冲A与反应性心房或心室去极化P或R之间的去极化时间间隔，作为对心脏的生理需求的指示。也可以测量心室刺激脉冲V与响应性心室去极化R之间的时间间隔，并将其用作生理需要的指示，并因此用作速率控制的替代标准。通过检测P波来感测心房去极化，并且优选通过检测R波来感测心室去极化。使用测量A-P，A-R或V-R间隔的方法来确定这些间隔是否增加或减少。如果在几个心脏周期或节拍中检测到这些测量值的增加或减少，起搏器设定的起搏间隔将在适当的方向进行调节，以便相应地调整心脏刺激速率。

4. 发明授权

US6058328A Implantable stimulation device having means for operating in a preemptive pacing mode to prevent tachyarrhythmias and method thereof 失效
标题翻译：可植入刺激装置具有用于以抢占式起搏模式操作以防止快速性心律失常的装置及其方法
公开(公告)号：US6058328A
公开(公告)日：2000-05-02
申请号：US788152
申请日：1997-01-24
申请人： Paul A. Levine , Jason A. Sholder , Gene A. Bornzin , Joseph J. Florio , Kenneth Valikai , Lisa P. Weinberg
发明人： Paul A. Levine , Jason A. Sholder , Gene A. Bornzin , Joseph J. Florio , Kenneth Valikai , Lisa P. Weinberg
IPC分类号： A61N1/362 , A61N1/365 , A61N1/39
CPC分类号： A61N1/3956 , A61N1/3622 , A61N1/36585 , A61N1/3688
摘要： Preemptive tachyarrhythmia pacing is provided in an implantable cardiac-stimulation device, such as an implantable pacemaker or defibrillator, by modifying the operation of the implantable device in a way that minimizes the likelihood of occurrence of a tachyarrhythmia. The behavior modification is achieved through the use of an appropriate preemptive tachyarrhythmia pacing control routine stored within the memory of the device. Depending upon the needs of the patient, preemptive tachyarrhythmia pacing is invoked continuously or on demand. If invoked on demand, Preemptive tachyarrhythmia pacing is triggered only upon the sensing of one or more conditions suggest that the onset of a tachyarrhythmia is imminent. When thus invoked, preemptive tachyarrhythmia pacing remains invoked only for as long as the onset-of-a-tachyarrhythmia-is-imminent conditions persist. Various preemptive tachyarrhythmia pacing control routines are contemplated, including those based on overdrive pacing, pacing with randomicity, and mode switching. Overdrive pacing, when used, is based on an automatically-determined diurnal rate, an automatic stepped increase over the average atrial rate, or a rate set by a cycle-to-cycle negative hysteresis. Conditions which suggest the imminency of the onset of a tachyarrhythmia include, but are not limited to, a sudden change in the patient's cardiac cycle from a previously-determined normal cardiac cycle.
摘要翻译：通过以最小化发生快速性心律失常的可能性的方式修改可植入装置的操作，在可植入心脏刺激装置（例如可植入起搏器或除颤器）中提供先发性快速性心律失调起搏。通过使用存储在设备的存储器内的适当的先发性快速性心律失常起搏控制程序来实现行为修改。根据患者的需要，可以连续或按需调用抢先式快速性心律失调起搏。如果按需调用，先发性快速性心律失常起搏仅在感觉到一种或多种情况时才触发，表明快速性心律失常的发作即将到来。当这样被援引时，只有在发生急性心律失常即将到来的情况持续存在的情况下，抢救性快速性心律失调起搏仍然被援引。预期各种先发性快速性心律失常起搏控制程序，包括基于超速起搏，起搏随机性和模式切换的那些。超速起搏在使用时，基于自动确定的昼夜速率，比平均心房率自动逐步增加，或由周期到周期的负滞后设定的速率。表明快速性心律失常发作即将发生的情况包括但不限于患者心动周期从先前确定的正常心动周期的突然变化。

5. 发明授权

US5509927A Programming system having means for recording and analyzing a patient's cardiac signal 失效
公开(公告)号：US5509927A
公开(公告)日：1996-04-23
申请号：US381799
申请日：1995-02-01
申请人： Andrew E. Epstein , James L. Duncan , Paul A. Levine , Jason A. Sholder
发明人： Andrew E. Epstein , James L. Duncan , Paul A. Levine , Jason A. Sholder
IPC分类号： A61N1/365 , A61N1/372 , A61N1/37
CPC分类号： A61N1/37235 , G06F19/3406 , A61N1/37252
摘要： A programming system is provided that allows a physician or medical personnel to optimize the settings of various arrhythmia detection criteria and/or parameters related to hemodynamic performance to be programmed into the implanted cardiac stimulating device. The cardiac stimulating device may be a pacemaker or cardioverter/defibrillator that detects heart arrhythmias by using various arrhythmia detection criteria. The cardiac stimulating device is capable of recording the patient's cardiac signals and/or sensor data. The programming system may play back the recorded signals to test the detection criteria and hemodynamic performance and may simulate the response of the device to the cardiac signal. Alternatively, the programming system may play back an artificially created or previously stored cardiac signal for test purposes. As a result, the recorded signal may be played back repeatedly without unnecessarily stressing the patient's heart. Additionally, the programmer may suggest specific arrhythmia detection criteria and therapies to a physician based on an analysis of a patient's arrhythmia.

6. 发明授权

US5814077A Pacemaker and method of operating same that provides functional atrial cardiac pacing with ventricular support 失效
公开(公告)号：US5814077A
公开(公告)日：1998-09-29
申请号：US854797
申请日：1997-05-12
申请人： Jason A. Sholder , Paul A. Levine , Joseph J. Florio , Gene A. Bornzin
发明人： Jason A. Sholder , Paul A. Levine , Joseph J. Florio , Gene A. Bornzin
IPC分类号： A61N1/362 , A61N1/365 , A61N1/368
CPC分类号： A61N1/36585 , A61N1/3627 , A61N1/3682
摘要： A special type of AV/PV hysteresis is provided in a dual-chamber pacemaker. A long AV delay is initially provided, thereby affording as much opportunity as possible for natural AV conduction to occur. Such long AV delay is automatically shortened should AV block occur. Periodic scanning for the return of AV conduction (absence of AV block) is performed so that the AV delay can be returned to its long value as soon as possible. In one embodiment, the pacemaker "learns" the natural conduction time (AR interval) of the patient and thereafter uses such learned natural conduction time as a reference against which subsequently measured AR intervals are compared to better distinguish conducted ventricular contractions from ectopic, pathologic, or other nonconducted ventricular contractions (e.g., PVC's). If the measured AR interval is approximately the same as the "learned" AR interval, then the R-wave at the conclusion of the measured AR interval is presumed to be a conducted R-wave that signals the return of AV conduction, and the AV delay is lengthened back to its original value. If, on the other hand, the measured AR interval is significantly different than the "learned" natural conduction time, then the R-wave at the conclusion of the measured AR interval is presumed to be a nonconducted R-wave, and the AV delay is kept short. In other embodiments, other techniques are used to distinguish a conducted R-wave from a nonconducted R-wave.

7. 发明授权

US06721601B1 System and method for automatic atrial capture detection and atrial pacing threshold determination 有权
标题翻译：用于自动心房捕获检测和心房起搏阈值测定的系统和方法
公开(公告)号：US06721601B1
公开(公告)日：2004-04-13
申请号：US10102271
申请日：2002-03-19
申请人： Gene A. Bornzin , Paul A. Levine , Kenneth Valikai , Jason A. Sholder
发明人： Gene A. Bornzin , Paul A. Levine , Kenneth Valikai , Jason A. Sholder
IPC分类号： A61N137
CPC分类号： A61N1/3712 , A61N1/3714
摘要： An implantable dual chamber stimulation device provides a novel detection scheme that automatically detecting atrial capture and performing an atrial pacing threshold assessment. The stimulation device preferably waits until the patient is at or near rest and monitors the patient's P-wave activity to determine a detection window where a next P-wave is expected to occur. The stimulation device then delivers an atrial pulse prior to the next detection window, and monitors the window to determine whether a P-wave occurs therein. If a P-wave does not occur, then atrial capture is present, while occurrence of a P-wave indicates absence of atrial capture. If atrial capture is absent, the stimulation device automatically determines an appropriate atrial pacing threshold by monitoring the detection window while adjusting the stimulation pulse energy level. Advantageously, the present invention further employs a “bottom-up” adjusting scheme which starts at a low energy level, below the expected atrial pacing threshold, and increases the energy level until atrial capture is detected, thus saving energy and further avoiding corruption by large polarization signals. The latter feature is compatible with the present detection scheme and conventional evoked response detection schemes. The new atrial pacing threshold is then set at the atrial pulse level at which atrial capture was effectuated plus a predetermined safety margin.
摘要翻译：可植入双室刺激装置提供了一种新的检测方案，其自动检测心房捕获并执行心房起搏阈值评估。刺激装置优选地等待直到患者处于或接近静止并且监视患者的P波活动以确定期望发生下一个P波的检测窗口。刺激装置然后在下一个检测窗口之前递送心房脉搏，并监视窗口以确定其中是否发生P波。如果不发生P波，则存在心房捕获，而P波的发生表明不存在心房捕获。如果不存在心房捕获，则刺激装置通过在调节刺激脉冲能量水平的同时监测检测窗口自动确定适当的心房起搏阈值。有利地，本发明还采用从低能量水平开始的“自下而上”调整方案，低于预期的心房起搏阈值，并且增加能量水平直到检测到心房捕获，从而节省能量并进一步避免大的腐败极化信号。后一个特征与本发明的检测方案和常规的诱发响应检测方案兼容。然后将新的心房起搏阈值设置在心房采集的心房脉搏水平加上预定的安全余量。

8. 发明授权

US06295471B1 System and method for automatic atrial capture detection and atrial pacing threshold determination 有权
标题翻译：用于自动心房捕获检测和心房起搏阈值测定的系统和方法
公开(公告)号：US06295471B1
公开(公告)日：2001-09-25
申请号：US09481748
申请日：2000-01-11
申请人： Gene A. Bornzin , Paul A. Levine , Kenneth Valikai , Jason A. Sholder
发明人： Gene A. Bornzin , Paul A. Levine , Kenneth Valikai , Jason A. Sholder
IPC分类号： A61N137
CPC分类号： A61N1/3712 , A61N1/3714
摘要： An implantable dual chamber stimulation device provides a novel detection scheme for automatically detecting atrial capture and performing an atrial pacing threshold assessment. The stimulation device preferably waits until the patient is at or near rest and monitors the patient's P-wave activity to determine an detection window where a next P-wave is expected to occur. The stimulation device then delivers an atrial pulse prior to the next detection window, and monitors the window to determine whether a P-wave occurs therein. If a P-wave does not occur, then atrial capture is present, while occurrence of a P-wave indicates absence of atrial capture. If atrial capture is absent, the stimulation device automatically determines an appropriate atrial pacing threshold by monitoring the detection window while adjusting the stimulation pulse energy level. Advantageously, the present invention further employs a “bottom-up” adjusting scheme which starts at a low energy level, below the expected atrial pacing threshold, and increases the energy level until atrial capture is detected, thus saving energy and further avoiding corruption by large polarization signals. The latter feature is compatible with the present detection scheme and conventional evoked response detection schemes. The new atrial pacing threshold is then set at the atrial pulse level at which atrial capture was effectuated plus a predetermined safety margin.
摘要翻译：可植入双室刺激装置提供用于自动检测心房捕获并执行心房起搏阈值评估的新型检测方案。刺激装置优选地等待直到患者处于或接近静止，并且监视患者的P波活动以确定期望发生下一个P波的检测窗口。刺激装置然后在下一个检测窗口之前递送心房脉搏，并监视窗口以确定其中是否发生P波。如果不发生P波，则存在心房捕获，而P波的发生表明不存在心房捕获。如果不存在心房捕获，则刺激装置通过在调节刺激脉冲能量水平的同时监测检测窗口自动确定适当的心房起搏阈值。有利地，本发明还采用从低能量水平开始的“自下而上”调整方案，低于预期的心房起搏阈值，并且增加能量水平直到检测到心房捕获，从而节省能量并进一步避免大的腐败极化信号。后一个特征与本发明的检测方案和常规的诱发响应检测方案兼容。然后将新的心房起搏阈值设置在心房采集的心房脉搏水平加上预定的安全余量。

9. 发明授权

US06389316B1 System and method for automatic atrial capture detection and atrial pacing threshold determination 有权
公开(公告)号：US06389316B1
公开(公告)日：2002-05-14
申请号：US09481085
申请日：2000-01-11
申请人： Gene A. Bornzin , Paul A. Levine , Kenneth Valikai , Jason A. Sholder
发明人： Gene A. Bornzin , Paul A. Levine , Kenneth Valikai , Jason A. Sholder
IPC分类号： A61N1368
CPC分类号： A61N1/3712 , A61N1/3714
摘要： An implantable dual chamber stimulation device provides a novel detection scheme for automatically detecting atrial capture and performing an atrial pacing threshold assessment. The stimulation device preferably waits until the patient is at or near rest and monitors the patient's P-wave activity to determine an detection window where a next P-wave is expected to occur. The stimulation device then delivers an atrial pulse prior to the next detection window, and monitors the window to determine whether a P-wave occurs therein. If a P-wave does not occur, then atrial capture is present, while occurrence of a P-wave indicates absence of atrial capture. If atrial capture is absent, the stimulation device automatically determines an appropriate atrial pacing threshold by monitoring the detection window while adjusting the stimulation pulse energy level. Advantageously, the present invention further employs a “bottom-up” adjusting scheme which starts at a low energy level, below the expected atrial pacing threshold, and increases the energy level until atrial capture is detected, thus saving energy and further avoiding corruption by large polarization signals. The latter feature is compatible with the present detection scheme and conventional evoked response detection schemes. The new atrial pacing threshold is then set at the atrial pulse level at which atrial capture was effectuated plus a predetermined safety margin.

10. 发明授权

US6122546A Pacemaker and method of operating same that provides functional atrial cardiac pacing with ventricular support 失效
标题翻译：起搏器和操作方法，提供功能性心房心脏起搏与心室支持
公开(公告)号：US6122546A
公开(公告)日：2000-09-19
申请号：US128284
申请日：1998-08-03
申请人： Jason A. Sholder , Paul A. Levine , Joseph J. Florio , Gene A. Bornzin
发明人： Jason A. Sholder , Paul A. Levine , Joseph J. Florio , Gene A. Bornzin
IPC分类号： A61N1/362 , A61N1/365 , A61N1/368
CPC分类号： A61N1/36585 , A61N1/3627 , A61N1/3682
摘要： A special type of AV/PV hysteresis is provided in a dual-chamber pacemaker. A long AV delay is initially provided, thereby affording as much opportunity as possible for natural AV conduction to occur. Such long AV delay is automatically shortened should AV block occur. Periodic scanning for the return of AV conduction (absence of AV block) is performed so that the AV delay can be returned to its long value as soon as possible. In one embodiment, the pacemaker "learns" the natural conduction time (AR interval) of the patient and thereafter uses such learned natural conduction time as a reference against which subsequently measured AR intervals are compared to better distinguish conducted ventricular contractions from ectopic, pathologic, or other nonconducted ventricular contractions (e.g., PVC's). If the measured AR interval is approximately the same as the "learned" AR interval, then the R-wave at the conclusion of the measured AR interval is presumed to be a conducted R-wave that signals the return of AV conduction, and the AV delay is lengthened back to its original value. If, on the other hand, the measured AR interval is significantly different than the "learned" natural conduction time, then the R-wave at the conclusion of the measured AR interval is presumed to be a nonconducted R-wave, and the AV delay is kept short. In other embodiments, other techniques are used to distinguish a conducted R-wave from a nonconducted R-wave.
摘要翻译：在双室起搏器中提供特殊类型的AV / PV滞后。最初提供长的AV延迟，从而为自然AV传导提供尽可能多的机会。如果发生AV块，这样长的AV延迟会自动缩短。进行AV导通（AV区域不存在）的返回的周期性扫描，使得AV延迟可以尽可能快地返回到其长值。在一个实施例中，起搏器“学习”患者的自然传导时间（AR间隔），此后使用这种学习的自然传导时间作为参考，随后比较随后测量的AR间隔以更好地区分进行的心室收缩与异位，病理，或其他非导管性心室收缩（例如PVC）。如果测量的AR间隔与“学习”的AR间隔大致相同，则在测量的AR间隔结束时的R波被推定为用于表示AV传导返回的传导R波，AV 延迟延长到原来的价值。另一方面，如果测量的AR间隔与“学习”的自然传导时间显着不同，则在测量的AR间隔结束时的R波被推定为非导通的R波，并且AV延迟保持短暂。在其他实施例中，使用其它技术来区分传导的R波和非导通的R波。

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