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1. 发明授权

US5735878A Implantable defibrillator having multiple pathways 失效
标题翻译：植入式除颤器具有多个途径
公开(公告)号：US5735878A
公开(公告)日：1998-04-07
申请号：US577949
申请日：1995-12-22
申请人： Mark W. Kroll , Theodore P. Adams , Charles G. Supino
发明人： Mark W. Kroll , Theodore P. Adams , Charles G. Supino
IPC分类号： A61N1/39 , A61N1/36
CPC分类号： A61N1/3925 , A61N1/3956 , A61N1/3906 , A61N1/3912
摘要： An implantable defibrillator derives a rectangular current waveform from a capacitor discharge by using a current limiter. This pulse-shaping method is equally applicable to single-path and multiple-path situations. A rectangular pulse delivers a maximum of energy for a given peak-field value with a particular electrode combination and pulse duration. Peak field is a measure of the tissue-damage potentiality of a particular discharge.
摘要翻译：可植入除颤器通过使用限流器从电容器放电导出矩形电流波形。这种脉冲整形方法同样适用于单路径和多路径情况。矩形脉冲通过特定的电极组合和脉冲持续时间为给定的峰值值提供最大的能量。峰值场是测量特定放电的组织损伤潜能。

2. 发明授权

US5441518A Implantable cardioverter defibrillator system having independently controllable electrode discharge pathway 失效
标题翻译：植入式心律转复除颤器系统具有独立可控的电极放电通路
公开(公告)号：US5441518A
公开(公告)日：1995-08-15
申请号：US96170
申请日：1993-07-22
申请人： Theodore P. Adams , Charles G. Supino , Mark W. Kroll
发明人： Theodore P. Adams , Charles G. Supino , Mark W. Kroll
IPC分类号： A61N1/39
CPC分类号： A61N1/3956 , A61N1/3918 , A61N1/3906
摘要： An implantable multichamber cardioversion and defibrillation system is provided with multiple independently controllable and programmable switched electrode discharge pathways. This independently controlled switching arrangement provides for control over the polarity, phase, direction and timing of all cardioversion and defibrillation countershocks, and allows for the varying of subsequent countershocks after an initial countershock. The switching arrangement is, preferably, both programmable prior to implantation of the system and re-programmable after implantation of the system.
摘要翻译：可植入的多室复律和除颤系统具有多个可独立控制和可编程的切换电极放电通路。这种独立控制的切换装置可以控制所有心脏复律和除颤反射的极性，相位，方向和时间，并允许在初始反冲时间之后改变随后的冲击波。开关布置优选地在植入系统之前可编程，并且在植入系统之后可重新编程。

3. 发明授权

US5376103A Electrode system for implantable defibrillator 失效
标题翻译：用于植入式除颤器的电极系统
公开(公告)号：US5376103A
公开(公告)日：1994-12-27
申请号：US854862
申请日：1992-03-19
申请人： Kenneth M. Anderson , Theodore P. Adams , Charles G. Supino , Mark W. Kroll
发明人： Kenneth M. Anderson , Theodore P. Adams , Charles G. Supino , Mark W. Kroll
IPC分类号： A61N1/04 , A61N1/05 , A61N1/39
CPC分类号： A61N1/3956 , A61N1/0563 , A61N1/3918
摘要： A defibrillator pulse generator for pectoral implant utilizing the metal case as an electrode and operative to supply unique patterns of monophasic, biphasic, or pairs of electrical pulses to the connected electrodes.
摘要翻译：一种用于胸部植入物的除颤器脉冲发生器，其利用金属壳体作为电极并且可操作以向连接的电极提供单相，双相或成对的电脉冲的独特模式。

4. 发明授权

US5514160A Implantable defibrillator for producing a rectangular-shaped defibrillation waveform 失效
标题翻译：用于产生矩形除颤波形的可植入除颤器
公开(公告)号：US5514160A
公开(公告)日：1996-05-07
申请号：US231036
申请日：1994-04-22
申请人： Mark W. Kroll , Theodore P. Adams , Charles G. Supino
发明人： Mark W. Kroll , Theodore P. Adams , Charles G. Supino
IPC分类号： A61N1/39
CPC分类号： A61N1/3925 , A61N1/3956 , A61N1/3906 , A61N1/3912
摘要： An implantable defibrillator derives a rectangular current waveform from a capacitor discharge by using a current limiter. This pulse-shaping method is equally applicable to single-path and multiple-path situations. A rectangular pulse delivers a maximum of energy for a given peak-field value with a particular electrode combination and pulse duration. Peak field is a measure of the tissue-damage potentiality of a particular discharge.
摘要翻译：可植入除颤器通过使用限流器从电容器放电导出矩形电流波形。这种脉冲整形方法同样适用于单路径和多路径情况。矩形脉冲通过特定的电极组合和脉冲持续时间为给定的峰值值提供最大的能量。峰值场是测量特定放电的组织损伤潜能。

5. 发明授权

US5447521A Safety system for an implantable defibrillator 失效
标题翻译：可植入除颤器的安全系统
公开(公告)号：US5447521A
公开(公告)日：1995-09-05
申请号：US321782
申请日：1994-10-12
申请人： Kenneth M. Anderson , Theodore P. Adams , Charles G. Supino , Mark W. Kroll
发明人： Kenneth M. Anderson , Theodore P. Adams , Charles G. Supino , Mark W. Kroll
IPC分类号： A61N1/04 , A61N1/05 , A61N1/39
CPC分类号： A61N1/3956 , A61N1/0563 , A61N1/3918
摘要： A defibrillator pulse generator for pectoral implant utilizing the metal case as an electrode and operative to supply unique patterns of monophasic, biphasic, or pairs of electrical pulses to the connected electrodes.
摘要翻译：一种用于胸部植入物的除颤器脉冲发生器，其利用金属壳体作为电极并且可操作以向连接的电极提供单相，双相或成对的电脉冲的独特模式。

6. 发明授权

US5411526A Improved implantable defibrillator system for producing true-voltage-pulse waveforms 失效
标题翻译：改进的植入式除颤器系统，用于产生真正的电压脉冲波形
公开(公告)号：US5411526A
公开(公告)日：1995-05-02
申请号：US856733
申请日：1992-03-24
申请人： Mark W. Kroll , Charles G. Supino , Theodore P. Adams , Dennis A. Brumwell
发明人： Mark W. Kroll , Charles G. Supino , Theodore P. Adams , Dennis A. Brumwell
IPC分类号： A61N1/39 , A61N1/00
CPC分类号： A61N1/3956 , A61N1/3906 , A61N1/3912
摘要： The first embodiment of the present invention repositions the shunt thyristor used in the monophasic-waveform generator of the prior art so that it discharges the main capacitor through a series thyristor, thus increasing current through it briefly, rather than reducing current through it. The result of this arrangement is that the node between the series thyristor and the heart is pulled rapidly to a low voltage, causing the shunt switch to discharge the cardiac capacitance, as well as the main capacitance. The consequence is that discharging the cardiac capacitance requires a reversal of current in the heart, which enhances the heart-stimulating effect of the defibrillating waveform. The resulting true-voltage-pulse waveform has an efficacy approximating that of a biphasic waveform and is achieved with a circuit no more complex than that used to generate a monophasic waveform. A second and alternative embodiment of the present invention is a defibrillation system comprising a switching-bridge circuit, augmented by a zener diode and a rectifier diode, that is capable of delivering on demand any one of the waveforms known as monophasic, biphasic, and true-voltage-pulse waveforms.
摘要翻译：本发明的第一实施例重新使用现有技术的单相波形发生器中使用的分流晶闸管，使得其通过串联晶闸管放电主电容器，从而短暂地增加电流，而不是减少通过其的电流。这种安排的结果是串联晶闸管和心脏之间的节点被迅速拉到低电压，导致并联开关放电心电容以及主电容。结果是，放电心脏电容需要心脏中的电流反转，这增强了除颤波形的心脏刺激作用。所得到的真实电压脉冲波形的效果近似于双相波形，并且通过不比用于产生单相波形的电路更复杂的电路来实现。本发明的第二和替代实施例是一种除颤系统，其包括由齐纳二极管和整流二极管增强的开关桥式电路，其能够根据需要输送任何一种已知为单相，双相和真实的波形电压脉冲波形。

7. 发明授权

US5312443A Arrhythmia-detection criteria process for a cardioverter/defibrillator 失效
标题翻译：心律失常检测标准过程为心律转复/除颤器
公开(公告)号：US5312443A
公开(公告)日：1994-05-17
申请号：US837952
申请日：1992-02-20
申请人： Theodore P. Adams , Mark W. Kroll , Charles G. Supino
发明人： Theodore P. Adams , Mark W. Kroll , Charles G. Supino
IPC分类号： A61N1/362 , A61N1/39 , A61B5/04
CPC分类号： A61N1/3621 , A61N1/39 , Y10S128/925
摘要： A major shortcoming in the prior art for detecting cardiac arrhythmias for the purpose of making an electrical intervention decision has been that each variable sensed was given in effect a "veto" over intervention on the basis of its own particular predetermined threshold value, and irrespective of the values of companion variables. The present invention overcomes this prior art problem by generating a function of relevant variables, and assigning a threshold value to the function. As a result, an individual variable can range widely for a positive intervention decision, depending upon the values of the companion variables. Thus, the intervention exploits features often described as those associated with fuzzy logic. The functions chosen for this purpose can be as one desires, with the choice depending upon the current state of advancing knowledge. Even further flexibility can be achieved by employing the principles of the neural net, wherein functional values can themselves be combined, with another threshold value assigned to the result of that combination, and so on.
摘要翻译：用于检测心律失常以用于进行电干预决定的现有技术的主要缺点是感测的每个变量实际上基于其自己的特定预定阈值相对于干预被赋予“否决权”，并且不管伴随变量的值。本发明通过产生相关变量的功能以及为该函数分配阈值来克服该现有技术问题。因此，根据伴随变量的值，单个变量可以广泛地用于积极干预决策。因此，干预利用了经常被描述为与模糊逻辑相关联的特征。为此目的选择的功能可以是一个愿望，根据当前的知识状态选择。甚至可以通过采用神经网络的原理来实现进一步的灵活性，其中功能值本身可以被组合，分配给该组合的结果的另一阈值等等。

8. 发明授权

US5306291A Optimal energy steering for an implantable defibrillator 失效
标题翻译：可植入除颤器的最佳能量转向
公开(公告)号：US5306291A
公开(公告)日：1994-04-26
申请号：US841544
申请日：1992-02-26
申请人： Mark W. Kroll , Theodore P. Adams , Charles G. Supino
发明人： Mark W. Kroll , Theodore P. Adams , Charles G. Supino
IPC分类号： A61N1/39 , A61N1/36
CPC分类号： A61N1/3925 , A61N1/3956 , A61N1/3906 , A61N1/3912
摘要： Epicardial-patch electrodes for defibrillation are efficient in deliverying electrical energy accurately to the necessary tissue and in minimizing electrical losses, but they are risky and costly because their implantation requires major surgery. Intravenous implantation of endocardial-coil electrodes, such as right-ventricular-apex (RVA) and superior-vena-cava (SVC) electrodes, by means of cardiac catheters, on the other hand, involves simpler procedures. Also, implantation of a subcutaneous-patch (SUB) electrode or of a pulse-generator housing (CAN, subject to co-pending application) electrode requires comparatively minor surgery. Using these last four electrodes, however, involves accepting electrical losses in intervening tissue, relatively inefficient current directions in some cases, and unfavorable energy distributions among paralleled paths. The present invention achieves more favorable energy and current distribution by introducing lossy elements in one or more paths, or by capacitor-switching methods, where RVA is given one polarity, and at least two of the other electrodes are given opposite polarity, yielding at least two pathways. The present invention also achieves current and energy steering by means of differing pulse durations in different paths.
摘要翻译：用于除颤的心包膜电极有效地将电能精确地传递到必要的组织并且最小化电损耗，但是由于其植入需要大量手术，它们是有风险且昂贵的。另一方面，通过心脏导管静脉内植入心内膜线圈电极，例如右心室顶端（RVA）和上腔静脉（SVC）电极，涉及更简单的手术。此外，皮下补片（SUB）电极或脉冲发生器壳体（CAN，待共同未决的应用）电极的植入需要较小的手术。然而，使用这些最后四个电极涉及在中间组织中接受电损耗，在一些情况下相对低效的电流方向以及平行路径中的不利能量分布。本发明通过在一个或多个路径中引入有损耗元件或通过电容器切换方法来实现更有利的能量和电流分布，其中RVA被赋予一个极性，并且至少两个其它电极被赋予相反的极性，至少产生两条途径。本发明还通过不同路径中的不同脉冲持续时间来实现电流和能量转向。

9. 发明授权

US5957956A Implantable cardioverter defibrillator having a smaller mass 失效
标题翻译：植入式心律转复除颤器质量较小
公开(公告)号：US5957956A
公开(公告)日：1999-09-28
申请号：US963154
申请日：1997-11-03
申请人： Mark W. Kroll , Theodore P. Adams , Kenneth M. Anderson , Charles U. Smith
发明人： Mark W. Kroll , Theodore P. Adams , Kenneth M. Anderson , Charles U. Smith
IPC分类号： A61N1/375 , A61N1/39 , H01M2/10 , H01M6/50 , H01M16/00 , A61N1/18
CPC分类号： A61N1/375 , A61N1/3956 , A61N1/3758 , H01M16/00 , H01M2/1066 , H01M6/5016
摘要： A capacitor-discharge implantable cardioverter defibrillator (ICD) has a relatively smaller mass of less than about 120 grams. The smaller mass of the ICD is achieved by selecting and arranging the internal components of the ICD to deliver a maximum defibrillation countershock optimized in terms of a minimum physiologically effective current (I.sub.pe), rather than a minimum defibrillation threshold energy (DFT). As a result of the optimization in terms of a minimum effective current I.sub.pe, there is a significant decrease in the maximum electrical charge energy (E.sub.c) that must be stored by the capacitor of the ICD to less than about 30 Joules, even though a higher safety margin is provided for by the device. Due to this decrease in the maximum E.sub.c, as well as corollary decreases in the effective capacitance value required for the capacitor and the net energy storage required of the battery, the overall displacement volume of the ICD is reduced to the point where subcutaneous implantation of the device in the pectoral region of human patients is practical. The size of the capacitor is reduced because the effective capacitance required can be less than about 125 .mu.F. By optimizing both the charging time and the countershock duration for the smaller maximum E.sub.c, the size of the battery is reduced because the total energy storage capacity can be less than about 1.0 Amp-hours. In the preferred embodiment, the charging time for each defibrillation countershock is reduced to less than about 10 seconds and the pulse duration of the countershock is reduced to less than about 6 milliseconds.
摘要翻译：电容放电植入式心律转复除颤器（ICD）的质量相对较小，小于约120克。通过选择和布置ICD的内部部件来实现ICD的较小质量，以提供根据最小生理有效电流（Ipe）而不是最小除颤阈值能量（DFT）优化的最大除颤抗倒伏。作为最小有效电流Ipe优化的结果，ICD的电容器必须存储的最大电荷能量（Ec）显着降低到小于约30焦耳，即使较高的设备提供安全余量。由于最大Ec的这种减小以及电容器所需的有效电容值和电池所需的净能量存储的必然减小，ICD的总位移体积减少到皮下植入在人类胸腔的器官是实用的。电容器的尺寸减小，因为所需的有效电容可以小于约125μF。通过优化较小的最大Ec的充电时间和反冲时间，电池的尺寸减小，因为总能量存储容量可以小于约1.0安培小时。在优选实施例中，每个去纤维颤动反射的充电时间减少到小于约10秒，并且该反冲的脉冲持续时间减小到小于约6毫秒。

10. 发明授权

US5827326A Implantable cardioverter defibrillator having a smaller energy storage capacity 失效
标题翻译：具有较小能量储存能力的植入式心律转复除颤器
公开(公告)号：US5827326A
公开(公告)日：1998-10-27
申请号：US412920
申请日：1995-03-29
申请人： Mark W. Kroll , Theodore P. Adams , Kenneth M. Anderson , Charles U. Smith
发明人： Mark W. Kroll , Theodore P. Adams , Kenneth M. Anderson , Charles U. Smith
IPC分类号： A61N1/375 , A61N1/378 , A61N1/39 , H01M2/10 , H01M6/50 , H01M16/00
CPC分类号： A61N1/375 , A61N1/3787 , A61N1/3931 , A61N1/3956 , A61N1/3975 , H01M16/00 , A61N1/3758 , A61N1/3906 , A61N1/3912 , H01M2/1066 , H01M6/5016
摘要： A capacitor-discharge implantable cardioverter defibrillator (ICD) has a relatively smaller energy storage capacity of less than about 1.0 Amp-hours. The smaller energy storage capacity of the ICD is achieved by selecting and arranging the internal components of the ICD to deliver a maximum defibrillation countershock optimized in terms of a minimum physiologically effective current (I.sub.pe) rather than a minimum defibrillation threshold energy (DFT). As a result of the optimization in terms of a minimum effective current I.sub.pe, there is a significant decrease in the maximum electrical charge energy (E.sub.c) that must be stored by the capacitor of the ICD to less than about 30 Joules, even though a higher safety margin is provided for by the device. Due to this decrease in the maximum E.sub.c, as well as corollary decreases in the effective capacitance value required for the capacitor and the net energy storage required of the battery, the overall displacement volume of the ICD is reduced to the point where subcutaneous implantation of the device in the pectoral region of human patients is practical. The size of the capacitor is reduced because the effective capacitance required can be less than about 125 .mu.F. By optimizing both the charging time and the countershock duration for the smaller maximum E.sub.c, the size of the battery is reduced because the total energy storage capacity can be less than about 1.0 Amp-hours. In the preferred embodiment, the charging time for each defibrillation countershock is reduced to less than about 10 seconds and the pulse duration of the countershock is reduced to less than about 6 milliseconds.
摘要翻译：电容放电植入式心律转复除颤器（ICD）具有小于约1.0安培小时的相对较小的储能能力。通过选择和布置ICD的内部部件来实现ICD的较小的能量存储容量，以提供根据最小生理有效电流（Ipe）而不是最小除颤阈值能量（DFT）优化的最大除颤反相。作为最小有效电流Ipe优化的结果，ICD的电容器必须存储的最大电荷能量（Ec）显着降低到小于约30焦耳，即使较高的设备提供安全余量。由于最大Ec的这种减小以及电容器所需的有效电容值和电池所需的净能量存储的必然减小，ICD的总位移体积减少到皮下植入在人类胸腔的器官是实用的。电容器的尺寸减小，因为所需的有效电容可以小于约125μF。通过优化较小的最大Ec的充电时间和反冲时间，电池的尺寸减小，因为总能量存储容量可以小于约1.0安培小时。在优选实施例中，每个去纤维颤动反射的充电时间减少到小于约10秒，并且该反冲的脉冲持续时间减小到小于约6毫秒。

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