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1. 发明申请

US20060224197A1 Method of optimizing mechanical heart rate during delivery of coupled or paired pacing 失效
标题翻译：耦合或配对起搏期间机械心率优化的方法
公开(公告)号：US20060224197A1
公开(公告)日：2006-10-05
申请号：US11096388
申请日：2005-03-31
申请人： William Havel , Paul Krause , Karen Kleckner , D. Deno
发明人： William Havel , Paul Krause , Karen Kleckner , D. Deno
IPC分类号： A61N1/362
CPC分类号： A61N1/3627 , A61N1/3682 , A61N1/37
摘要： A method of operating a cardiac pacing device that optimizes the mechanical heart rate using coordinated potentiation therapy while maximizing the opportunity for intrinsic AV conduction to occur. The method may include adjusting the timing of extra stimulus intervals during coupled or paired pacing to promote AV conduction and to effect changes in rate according to certain embodiments of the invention. Other embodiments may include adjusting the atrial pacing rate to achieve a desired target rate consistent with AV conduction. A mode switch to a dual-chamber pacing mode may be provided according to certain embodiments of the invention to ensure a ventricular rate that meets or exceeds a minimum mechanical rate.
摘要翻译：一种操作心脏起搏装置的方法，其使用协同增强疗法优化机械心率，同时最大化发生固有AV传导的机会。该方法可以包括在耦合或配对的起搏期间调整额外刺激间隔的时间，以促进AV传导并且根据本发明的某些实施例来实现速率变化。其他实施例可以包括调整心房起搏速率以实现与AV传导一致的期望目标速率。根据本发明的某些实施例，可以提供到双室起搏模式的模式切换，以确保达到或超过最小机械速率的心室率。

2. 发明申请

US20050090872A1 Cardiac pacing modality having improved blanking, timing, and therapy delivery methods for extra-systolic stimulation pacing therapy 有权
标题翻译：心脏起搏模式具有改善的消隐，时机和治疗收费刺激起搏治疗方法
公开(公告)号：US20050090872A1
公开(公告)日：2005-04-28
申请号：US10692990
申请日：2003-10-24
申请人： D. Deno , Vincent Splett , Jeffrey Gillberg , Glenn Zillmer , Ruth Klepfer , Karen Kleckner
发明人： D. Deno , Vincent Splett , Jeffrey Gillberg , Glenn Zillmer , Ruth Klepfer , Karen Kleckner
IPC分类号： A61N20060101 , A61N1/362 , A61N1/365
CPC分类号： A61N1/365 , A61N1/3627
摘要： The present invention relates to the secure delivery of an extra-systolic stimulation (ESS) therapy to treat cardiac dysfunction that employs atrial and/or ventricular extra-systoles via pacing-like stimulation of the heart. These extra-systoles must be timed correctly to achieve beneficial effects on myocardial mechanics (benefit) while maintaining an extremely low level of risk of arrhythmia induction and excellent ICD-like arrhythmia sensing and detection (security). Further experience with ESS has led to improved implementation methods that depend on better blanking, ESS stimulation timing (of an “extra-systolic interval” or ESI), and ESS therapy delivery options and guidance. These methods may be employed individually or in combinations in an external or implantable ESS therapy delivery device.
摘要翻译：本发明涉及一种收缩期刺激（ESS）疗法的安全递送，以治疗心脏功能障碍，其通过心脏起搏样刺激使用心房和/或心室外的心脏。这些额外的收缩期必须正确定时，以获得对心肌力学（益处）的有益影响，同时保持心律失常诱导和优异的ICD样心律失常感知和检测（安全性）的极低水平的风险。 ESS的进一步经验导致改进的实施方法取决于更好的消隐，ESS刺激时间（“收缩期间期”或ESI）和ESS治疗递送选项和指导。这些方法可以在外部或可植入的ESS治疗递送装置中单独使用或组合使用。

3. 发明申请

US20050101998A1 Secure and efficacious therapy delivery for an extra-systolic stimulation pacing engine 有权
标题翻译：安全有效的治疗输精管收缩期刺激起搏引擎
公开(公告)号：US20050101998A1
公开(公告)日：2005-05-12
申请号：US10703956
申请日：2003-11-07
申请人： Karen Kleckner , Kathleen Prieve , Jeffrey Gillberg , Ren Zhou , Kenneth Anderson , D. Deno , Glenn Zillmer , Ruth Klepfer , Vincent Splett
发明人： Karen Kleckner , Kathleen Prieve , Jeffrey Gillberg , Ren Zhou , Kenneth Anderson , D. Deno , Glenn Zillmer , Ruth Klepfer , Vincent Splett
IPC分类号： A61N1/362 , A61N1/368 , A61N1/39
CPC分类号： A61N1/3627 , A61N1/36114 , A61N1/36521 , A61N1/36564 , A61N1/36578 , A61N1/36585 , A61N1/3684 , A61N1/3962
摘要： An extra-systolic stimulation (ESS) therapy addresses cardiac dysfunction including heart failure. ESS therapy employs atrial and/or ventricular extra-systoles via pacing-level stimulation to a heart. These extra-systoles must be timed correctly to achieve beneficial effects on myocardial mechanics (efficacy) while maintaining an extremely low level of risk of arrhythmia induction and excellent ICD-like arrhythmia sensing and detection (security). The present invention relates to therapy delivery guidance and options for improved ESS therapy delivery. These methods may be employed individually or in combinations in an external or implantable ESS therapy delivery device.
摘要翻译：收缩期刺激（ESS）治疗涉及心脏功能障碍，包括心力衰竭。 ESS治疗通过对心脏的起搏水平刺激使用心房和/或心室超心动过速。这些额外的收缩期必须正确定时，以达到对心肌力学（功效）的有益影响，同时保持心律失常诱导和优异的ICD样心律失常感知和检测（安全性）的极低水平的风险。本发明涉及治疗递送指导和改善ESS治疗递送的选择。这些方法可以在外部或可植入的ESS治疗递送装置中单独使用或组合使用。

4. 发明申请

US20070299477A1 Secure and Efficacious Therapy Delivery for a Pacing Engine 审中-公开
标题翻译：安全和有效的治疗发送起搏发动机
公开(公告)号：US20070299477A1
公开(公告)日：2007-12-27
申请号：US11765260
申请日：2007-06-19
申请人： Karen Kleckner , Kathleen Prieve , Jeffrey Gillberg , Ren Zhou , Kenneth Anderson , D. Deno , Glenn Zillmer , Ruth Klepfer , Vincent Splett , David Euler , Lawrence Mulligan , Edwin Duffin , David Igel , John Burnes
发明人： Karen Kleckner , Kathleen Prieve , Jeffrey Gillberg , Ren Zhou , Kenneth Anderson , D. Deno , Glenn Zillmer , Ruth Klepfer , Vincent Splett , David Euler , Lawrence Mulligan , Edwin Duffin , David Igel , John Burnes
IPC分类号： A61N1/36
CPC分类号： A61N1/3627 , A61N1/36114 , A61N1/36521 , A61N1/36564 , A61N1/36578 , A61N1/36585 , A61N1/3684 , A61N1/3962
摘要： The above-described methods and apparatus are believed to be of particular benefit for patients suffering heart failure including cardiac dysfunction, chronic HF, and the like and all variants as described herein and including those known to those of skill in the art to which the invention is directed. It will understood that the present invention offers the possibility of monitoring and therapy of a wide variety of acute and chronic cardiac dysfunctions. The current invention provides systems and methods for delivering therapy for cardiac hemodynamic dysfunction via the innervated myocardial substrate receives one or more discrete pulses of electrical stimulation during the refractory period of said innervated myocardial substrate.
摘要翻译：据信上述方法和装置对患有心力衰竭，包括心脏功能障碍，慢性HF等的患者以及本文所述的所有变体以及包括本发明的本领域技术人员已知的那些的患者特别有益被指示。应当理解，本发明提供监测和治疗各种急性和慢性心脏功能障碍的可能性。本发明提供了用于通过所述神经支配的心肌底物递送治疗心脏血液动力学功能障碍的系统和方法，在所述神经支配的心肌基质的不应期期间接收电刺激的一个或多个离散脉冲。

5. 发明申请

US20070179538A1 Implantable subcutaneous medical device providing post-extra-systolic potentiation therapy 审中-公开
标题翻译：植入式皮下医疗器械提供收缩后增生疗法
公开(公告)号：US20070179538A1
公开(公告)日：2007-08-02
申请号：US11342785
申请日：2006-01-30
申请人： D. Deno , William Havel
发明人： D. Deno , William Havel
IPC分类号： A61N1/00
CPC分类号： A61N1/36514 , A61N1/36528 , A61N1/36542 , A61N1/3702 , A61N1/3962
摘要： A subcutaneous implantable cardioverter-defibrillator provides post-shock post-extra-systolic potentiation therapy.
摘要翻译：皮下植入式心律转复除颤器提供休克后收缩后增强疗法。

6. 发明申请

US20050075676A1 Refractory period tracking and arrhythmia detection 有权
$Refractory period tracking and arrhythmia detection$
标题翻译：难治期跟踪和心律失常检测
公开(公告)号：US20050075676A1
公开(公告)日：2005-04-07
申请号：US10680528
申请日：2003-10-07
申请人： D. Deno , Ruth Klepfer , William Havel , David Schneider , Vincent Splett
发明人： D. Deno , Ruth Klepfer , William Havel , David Schneider , Vincent Splett
IPC分类号： A61N1/362 , A61N1/365
CPC分类号： A61N1/365 , A61N1/3622
摘要： Techniques for estimating the temporal refractory period of a heart, for adjusting a parameter for delivery of extra-systolic stimulation (ESS) therapy and for detecting an arrhythmia during delivery of ESS therapy are disclosed. In some embodiments, probe pulses are periodically delivered to estimate the location of the end boundary of the refractory period, and accordingly estimate its length. In some embodiments, the parameter is adjusted based on estimated length of the refractory period. For example, an extra-systolic interval (ESI) for delivery of ESS is adjusted to be a fixed interval longer than estimated lengths of the refractory period. In other embodiments, the parameter is adjusted based on a measured delay (or latency) between delivery of an ESS pulse and detection of an evoked response resulting from the pulse. In some embodiments, delays between delivery of an ESS pulse and detection of a subsequent depolarization are monitored to detect an arrhythmia.
摘要翻译：公开了用于估计心脏的时间不应期的技术，用于调整用于递送收缩期刺激（ESS）治疗的参数和用于在递送ESS治疗期间检测心律失常的技术。在一些实施例中，周期性地递送探针脉冲以估计不应期的末端边界的位置，并因此估计其长度。在一些实施例中，基于估计的不应期的长度来调整参数。例如，用于递送ESS的收缩期间期（ESI）被调整为比不应期的估计长度更长的固定间隔。在其他实施例中，基于在递送ESS脉冲和从脉冲产生的诱发响应的检测之间的测量延迟（或等待时间）来调整参数。在一些实施例中，监测递送ESS脉冲和随后去极化的检测之间的延迟以检测心律失常。

7. 发明申请

US20050075674A1 Extra-systolic stimulation therapy delivery and sensing via different electrode sets 审中-公开
标题翻译：超声心动图刺激治疗通过不同电极组传递和感测
公开(公告)号：US20050075674A1
公开(公告)日：2005-04-07
申请号：US10680493
申请日：2003-10-07
申请人： Glenn Zillmer , D. Deno , Nirav Sheth
发明人： Glenn Zillmer , D. Deno , Nirav Sheth
IPC分类号： A61N1/362 , A61N1/365
CPC分类号： A61N1/365 , A61N1/3622
摘要： Techniques for delivering ESS to a heart of a patient are disclosed. An implantable medical device delivers ESS stimulation, and in some embodiments pacing stimulation, to a chamber of the heart via a first electrode set. The implantable medical device senses electrical activity within the chamber via a second set of electrodes. In some embodiments, the implantable medical device is able to apply a shorter blanking interval than is typical in the pacing art to a sense amplifier coupled to the second set of electrodes, allowing the implantable medical device to better detect arrhythmias and evoked responses. A variety of electrodes may be used in conjunction with the present invention; including without limitation, tip, ring, coil, can-based, endocardial, epicardial, pericardial, cardiac vein-based, subcutaneous, and/or surface electrodes.
摘要翻译：公开了将ESS递送到患者心脏的技术。可植入医疗装置通过第一电极组将ESS刺激，并且在一些实施例中将起搏刺激提供给心脏室。可植入医疗装置经由第二组电极感测室内的电活动。在一些实施例中，可植入医疗装置能够将比起搏技术中典型的更短的消隐间隔应用于耦合到第二组电极的感测放大器，从而允许可植入医疗装置更好地检测心律失常和诱发反应。可以结合本发明使用各种电极; 包括但不限于尖端，环形，线圈，罐基，心内膜，心外膜，心包，心静脉，皮下和/或表面电极。

8. 发明申请

US20060149184A1 Myocardial stimulation 审中-公开
标题翻译：心肌刺激
公开(公告)号：US20060149184A1
公开(公告)日：2006-07-06
申请号：US11030574
申请日：2005-01-06
申请人： Orhan Soykan , D. Deno
发明人： Orhan Soykan , D. Deno
IPC分类号： A61N1/30
CPC分类号： A61N1/3627 , A61N1/36042 , A61N1/3684
摘要： In general, the invention is directed to methods and devices for electrically stimulating heart tissue. The invention includes delivery of stimulation to transplanted biological material, such as transplanted cells, transplanted in a myocardium of a heart during an ejection phase of a cardiac cycle. The invention also includes delivery of cardiac potentiation therapy stimulation, which improves the hemodynamic performance of the heart. Stimulation to transplanted biological material and cardiac potentiation therapy stimulation can improve the performance of a heart damaged by myocardial infarction.
摘要翻译：通常，本发明涉及用于电刺激心脏组织的方法和装置。本发明包括在移植的生物材料（例如移植的细胞）中递送刺激，在心脏周期的射血期期间移植到心脏的心肌中。本发明还包括递送心脏增强疗法刺激，其改善心脏的血液动力学性能。对移植的生物材料和心脏增强疗法刺激的刺激可以改善由心肌梗塞损伤的心脏的表现。

9. 发明申请

US20050038481A1 Evaluating ventricular synchrony based on phase angle between sensor signals 审中-公开
标题翻译：基于传感器信号之间的相位角评估心室同步
公开(公告)号：US20050038481A1
公开(公告)日：2005-02-17
申请号：US10638883
申请日：2003-08-11
申请人： Edward Chinchoy , D. Deno , Yong Cho
发明人： Edward Chinchoy , D. Deno , Yong Cho
IPC分类号： A61N1/362 , A61N1/368 , A61N1/365
CPC分类号： A61N1/368 , A61N1/3627
摘要： An implantable medical device evaluates ventricular synchrony by determining a phase angle between at least two sensor signals that reflect mechanical contraction of the ventricles. In exemplary embodiments, two intracardiac impedance signals associated with the right and left ventricles, respectively, with two points within either of the left and right ventricles, or with both the left and right ventricles relative to a reference point, are processed. In such embodiments, fundamental frequency phases of each of the impedance signals may be compared to determine the phase angle between the signals. In some embodiments, the signals are used to dynamically adjust one or more timing intervals, such as a V-V timing interval, for delivery of cardiac resynchronization therapy (CRT) pacing. In such embodiments, the one or more timing intervals are periodically adjusted to reduce or possibly eliminate ventricular dysynchrony as indicated by the phase angle between the sensor signals.
摘要翻译：可植入医疗装置通过确定反映心室的机械收缩的至少两个传感器信号之间的相位角来评估心室同步。在示例性实施例中，处理与左心室和左心室相关联的两个心内阻抗信号，其中左心室和右心室内的两个点，或者与左心室和右心室相对于参考点两者。在这样的实施例中，可以比较每个阻抗信号的基频相位以确定信号之间的相位角。在一些实施例中，信号用于动态调整一个或多个定时间隔，例如V-V定时间隔，用于递送心脏再同步治疗（CRT）起搏。在这样的实施例中，周期性地调整一个或多个定时间隔以减少或可能消除如传感器信号之间的相位角所指示的心室异常。

10. 发明申请

US20050038479A1 Electrically efficient neurally-excitable stimulation technical field 失效
标题翻译：电动高效神经兴奋刺激技术领域
公开(公告)号：US20050038479A1
公开(公告)日：2005-02-17
申请号：US10638855
申请日：2003-08-11
申请人： D. Deno , David Euler , Lawrence Mulligan , Edwin Duffin , David Igel
发明人： D. Deno , David Euler , Lawrence Mulligan , Edwin Duffin , David Igel
IPC分类号： A61N1/362 , A61N1/365 , A61N1/368
CPC分类号： A61N1/36514 , A61N1/3627 , A61N1/36564 , A61N1/368
摘要： A medical device, e.g., an implantable medical device, delivers one or more neurally-excitable stimulation pulses to myocardial tissue during a period when the tissue is refractory. The width of the pulses is less than or equal to approximately one half millisecond. In some embodiments, the current amplitude of the pulses is less than or equal to approximately twenty milliamps. In exemplary embodiments, the medical device delivers a pulse train of six or fewer pulses separated from each other by an interval that is greater than or equal to approximately ten milliseconds. In some embodiments, the medical device delivers pulses according to a schedule stored in a memory, or as a function of a monitored physiological parameter of a patient, such as an intracardiac pressure. In some embodiments, the medical device suspends or withholds delivery of neurally-excitable based on detection of cardiac ischemia.
摘要翻译：医疗装置，例如可植入的医疗装置，在组织难治的时期期间，向心肌组织递送一个或多个神经可兴奋的刺激脉冲。脉冲的宽度小于或等于大约一个半毫秒。在一些实施例中，脉冲的电流幅度小于或等于大约二十毫安。在示例性实施例中，医疗设备递送彼此间隔大于或等于大约十毫秒的六个或更少个脉冲的脉冲串。在一些实施例中，医疗装置根据存储在存储器中的计划或者作为患者的被监测的生理参数（例如心脏内压力）递送脉冲。在一些实施方案中，基于心脏缺血的检测，医疗装置暂停或禁止神经可兴奋的递送。

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