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1. 发明申请

WO2009114447A1 APPARATUS AND METHODS OF OPTIMIZING ATRIOVENTRICULAR PACING DELAY INTERVALS 审中-公开
标题翻译：优化ATRIOVENTRICULAR PACING DELAY INTERVALS的装置和方法
公开(公告)号：WO2009114447A1
公开(公告)日：2009-09-17
申请号：PCT/US2009/036470
申请日：2009-03-09
申请人： MEDTRONIC, INC. , MULLEN, Thomas, J. , SAMBELASHVILI, Aleksandre, T.
发明人： MULLEN, Thomas, J. , SAMBELASHVILI, Aleksandre, T.
IPC分类号： A61N1/362 , A61B5/0452
CPC分类号： A61N1/3627 , A61B5/0452 , A61N1/3682 , A61N1/375 , A61N1/3752 , A61N1/3756
摘要： Provided herewith are methods and apparatus for optimizing an atrioventricular (AV) pacing delay interval. One manner described involves programming an AV interval in such a way that the time interval between the end of the P-wave (P Wend) and the beginning of the QRS complex (QRSbeg) or ventricular pace stimulus (Vp) is close to or no less than a certain fixed value (e.g. 40 ms). This is defined as an optimized AV interval (AVopt) herein. The foregoing can be dynamically and chronically implemented in an implantable medical device such as a dual- or triple-chamber pacemaker. The PWend value is detected using a novel technique and sensing QRSbeg and/or Vp is achieved with traditional circuitry and components. Then automatic adjustment of an operating AV interval occurs until AVopt is identified. Thereafter, periodic, continuous, or manually- triggered performance of the foregoing can be implemented.
摘要翻译：提供了用于优化房室（AV）起搏延迟间隔的方法和装置。所描述的一种方式涉及对AV间隔进行编程，使得P波（P Wend）的结束与QRS复合物（QRSbeg）或心室起搏刺激（Vp）的开始之间的时间间隔接近或不接近小于某个固定值（例如40 ms）。这被定义为优化的AV间隔（AVopt）。前述可以在诸如双室或三室起搏器的可植入医疗装置中动态地和长期地实现。使用新技术检测PWend值，并且使用传统电路和组件实现QRSbeg和/或Vp感测。然后自动调整操作AV间隔，直到识别AVopt。此后，可以实现上述的周期性，连续的或手动触发的性能。

2. 发明申请

WO2009114359A1 APPARATUS AND METHODS OF OPTIMIZING ATRIOVENTRICULAR PACING DELAY INTERVALS 审中-公开
标题翻译：优化ATRIOVENTRICULAR PACING DELAY INTERVALS的装置和方法
公开(公告)号：WO2009114359A1
公开(公告)日：2009-09-17
申请号：PCT/US2009/036027
申请日：2009-03-04
申请人： MEDTRONIC, INC. , SAMBELASHVILI, Aleksandre, T. , MULLEN, Thomas, J.
发明人： SAMBELASHVILI, Aleksandre, T. , MULLEN, Thomas, J.
IPC分类号： A61N1/365 , A61N1/362 , A61N1/368
CPC分类号： A61N1/36585 , A61N1/3627 , A61N1/3682 , A61N1/3684 , A61N1/375 , A61N1/3752 , A61N1/3756
摘要： Provided herewith are methods and apparatus for optimizing an atrioventricular (AV) pacing delay interval based upon ECG-based optimization is calculated as a linear function of P-wave duration, sensed PR (intrinsic) interval, sensed or paced QRS duration and heart rate. Since the relationship among these parameters is linear, once the coefficients are solved (which can be any value, including null) with reference to a known optimized AV interval (AVopt) such as from an echocardiographic study, an AVopt value can be dynamically adjusted in an ambulatory subject. The various combinations of values can be loaded into a look up table or calculated automatically. And, since some of the parameters do not typically change much over time they can be determined acutely and fed into the equation while the other values can be measured frequently. The parameter values can be measured by an implantable medical device such as a dual- or triple- chamber pacemaker.
摘要翻译：提供了用于优化基于ECG的优化的房室（AV）起搏延迟间隔的方法和装置，其被计算为P波持续时间，感测的PR（固有）间隔，感测或节奏QRS持续时间和心率的线性函数。由于这些参数之间的关系是线性的，所以参考已知的优化AV间隔（AVopt）（例如来自超声心动图研究），一旦系数被解决（其可以是包括空值的任何值）可以动态调整AVopt值一个流动的主题。值的各种组合可以加载到查找表中或自动计算。并且，由于一些参数通常不会随着时间而变化很大，因此它们可以被急剧地确定并且被馈送到方程式中，而可以频繁地测量其它值。参数值可以通过诸如双室或三室起搏器的可植入医疗装置来测量。

3. 发明申请

WO2009114318A3 APPARATUS OF ADJUSTING ATRIOVENTRICULAR PACING DELAY INTERVALS IN A RATE ADAPTIVE PACEMAKER 审中-公开
公开(公告)号：WO2009114318A3
公开(公告)日：2009-09-17
申请号：PCT/US2009/035698
申请日：2009-03-02
申请人： MEDTRONIC, INC. , MULLEN, Thomas, J. , SAMBELASHVILI, Aleksandre, T.
发明人： MULLEN, Thomas, J. , SAMBELASHVILI, Aleksandre, T.
IPC分类号： A61N1/362 , A61N1/368
摘要： Provided herewith are methods and apparatus for optimizing an atrioventricular (AV) pacing delay interval. One manner described involves dynamically programming an AV interval in cardiac resynchronization therapy (CRT) device having a rate-adaptive AV (RAAV) feature in such a way that not less than a minimum AV interval is maintained. That is, the AV interval is not allowed to be reduced so much that the P-wave is truncated by the QRS complex. In this form of the invention, the AV interval is reduced by one millisecond per one bpm increase in heart rate (and vice versa for reducing heart rate) but maintained at a value calculated from the end of the P-wave (P Wend) and the beginning of the QRS complex (QRSbeg) or delivery of a ventricular pacing stimulus or to the end of the end of the QRS complex (QRSend).

4. 发明申请

WO2009120499A1 APPARATUS AND METHODS OF OPTIMIZING VENTRICLE-TO-VENTRICULAR PACING DELAY INTERVALS 审中-公开
标题翻译：优化通风向静电延迟间隔的装置和方法
公开(公告)号：WO2009120499A1
公开(公告)日：2009-10-01
申请号：PCT/US2009/036818
申请日：2009-03-11
申请人： MEDTRONIC, INC. , SAMBELASHVILI, Aleksandre, T. , MULLEN, Thomas, J.
发明人： SAMBELASHVILI, Aleksandre, T. , MULLEN, Thomas, J.
IPC分类号： A61N1/365 , A61N1/362 , A61N1/368
CPC分类号： A61N1/3627 , A61N1/3684 , A61N1/375 , A61N1/3752 , A61N1/3756
摘要： Provided herewith are methods and apparatus for optimizing ventricle-to-ventricle (V-V) pacing delay intervals based upon ECG-based optimization calculated as a linear function of P-wave duration, sensed PR (intrinsic) interval, sensed (or paced) QRS duration and heart rate. Since the relationship among these parameters is linear, once the coefficients are solved (which can be any value, including null) with reference to a known optimized V-V interval such as from an echocardiographic study, an operating V-V interval value can be dynamically adjusted in an ambulatory subject. The various combinations of values can be loaded into a look up table or calculated automatically. And, since some of the parameters do not typically change much over time they can be determined acutely and fed into the equation while the other values can be measured more frequently. The parameter values can be measured by an implantable medical device such as a dual- or triple-chamber pacemaker.
摘要翻译：提供了基于基于ECG的优化的心室至心室（VV）起搏延迟间隔的方法和装置，其计算为P波持续时间，感测的PR（固有）间隔，感测（或起搏）QRS持续时间的线性函数和心率。由于这些参数之间的关系是线性的，所以参考已知优化的VV间隔（例如来自超声心动图研究），一旦系数被解决（其可以是任何值，包括空值），则可以动态地调整操作VV间隔值走路主题值的各种组合可以加载到查找表中或自动计算。并且，由于一些参数通常不会随着时间而变化很大，因此它们可以被急剧地确定并且被馈送到方程式中，而可以更频繁地测量其它值。参数值可以通过诸如双室或三室起搏器的可植入医疗装置来测量。

5. 发明申请

WO2011014311A1 ALGORITHM TO MODULATE ATRIAL-VENTRICULAR DELAY AND RATE RESPONSE BASED ON AUTONOMIC FUNCTION 审中-公开
标题翻译：基于自动功能调节心律延迟和速率响应的算法
公开(公告)号：WO2011014311A1
公开(公告)日：2011-02-03
申请号：PCT/US2010/039202
申请日：2010-06-18
申请人： MEDTRONIC, INC. , FISCHER, Trent, M. , HETTRICK, Douglas, A. , SHELDON, Todd, J. , BELK, Paul, A. , MULLEN, Thomas, J. , RUETER, John, C. , KAISER, Daniel, R.
发明人： FISCHER, Trent, M. , HETTRICK, Douglas, A. , SHELDON, Todd, J. , MULLEN, Thomas, J. , RUETER, John, C. , KAISER, Daniel, R.
IPC分类号： A61N1/362 , A61N1/368 , A61N1/365 , A61B5/0205
CPC分类号： A61N1/3627 , A61B5/0456 , A61N1/36514 , A61N1/36542 , A61N1/36557 , A61N1/36564 , A61N1/36571 , A61N1/36578 , A61N1/36585 , A61N1/368 , A61N1/3682 , A61N1/3688
摘要： An implantable medical device and associated method provide atrial pacing and measure an atrial ventricular (AV) delay. An autonomic function index is computed using the AV delay. The autonomic function index may be compiled in a medical report. In some embodiments, the autonomic function index is used to adjust atrial pacing control parameters.
摘要翻译：可植入医疗器械和相关方法提供心房起搏并测量心房（AV）延迟。使用AV延迟计算自主功能指数。自主功能指数可以在医疗报告中编制。在一些实施例中，自主功能指数用于调节心房起搏控制参数。

6. 发明申请

WO2006060587A1 METHOD AND APPARATUS FOR DETECTION AND MONITORING OF T-WAVE ALTERNANS 审中-公开
标题翻译：用于检测和监测T波形变换器的方法和装置
公开(公告)号：WO2006060587A1
公开(公告)日：2006-06-08
申请号：PCT/US2005/043490
申请日：2005-12-01
申请人： MEDTRONIC, INC. , STADLER, Robert, W. , GILLBERG, Jeffrey, M. , MULLEN, Thomas, J. , ZHOU, Xiaohong
发明人： STADLER, Robert, W. , GILLBERG, Jeffrey, M. , MULLEN, Thomas, J. , ZHOU, Xiaohong
IPC分类号： A61B5/0452
CPC分类号： A61N1/3702 , A61B5/0422 , A61B5/0452
摘要： A system and method are provided for assessing T-wave alternans (TWA) using cardiac EGM signals received from implanted electrodes. A T-wave signal parameter is measured from signals received by an automatic gain control sense amplifier. A TWA measurement is computed from a beat-by-beat comparison of T-wave parameter measurements or using frequency spectrum techniques. The TWA measurement magnitude and measurement conditions are used in detecting a clinically important TWA. TWA assessment further includes discriminating concordant and discordant TWA in a multi-vector TWA assessment, and determining the association of a TWA measurement with QRS alternans, mechanical alternans, and other physiological events. A prediction of a pathological cardiac event is made in response to a TWA assessment. A response to a cardiac event prediction is provided.
摘要翻译：提供了一种使用从植入电极接收的心脏EGM信号评估T波交替（TWA）的系统和方法。从由自动增益控制读出放大器接收的信号测量T波信号参数。通过T波参数测量或使用频谱技术的逐拍比较来计算TWA测量。 TWA测量值和测量条件用于检测临床重要的TWA。 TWA评估还包括在多向量TWA评估中区分一致和不一致的TWA，以及确定TWA测量与QRS交替，机械交替和其他生理事件的关联。病理性心脏事件的预测是针对TWA评估做出的。提供对心脏事件预测的响应。

7. 发明申请

WO2005089865A1 APPARATUS AND METHODS OF ENERGY EFFICIENT, ATRIAL-BASED BI-VENTRICULAR FUSION-PACING 审中-公开
标题翻译：能量效率，基于ATRIAL的双向融合膜的设备和方法
公开(公告)号：WO2005089865A1
公开(公告)日：2005-09-29
申请号：PCT/US2005/008714
申请日：2005-03-15
申请人： MEDTRONIC, INC. , BURNES, John, E. , MULLEN, Thomas, J.
发明人： BURNES, John, E. , MULLEN, Thomas, J.
IPC分类号： A61N1/362
CPC分类号： A61N1/3627 , A61N1/3682 , A61N1/3684
摘要： The present invention enables hemodynamic efficiencies for patients suffering from intraventricular conduction delays or conduction blockage. The invention effectively overcomes such conduction delay or block (e.g., left bundle branch block, "LBBB," or right bundle branch block, "RBBB") by delivering a novel form of cardiac resynchronization therapy (CRT). Specifically, a single ventricular pre-excitation pacing stimulus is triggered from an atrial event (e.g., intrinsic or evoked depolarization). The triggering event may emanate from the right atrium (RA) or the left atrium (LA). A single ventricular pre-excitation pacing stimulus is delivered prior to the intrinsic depolarization of the other ventricle and thus promotes intraventricular electromechanical synchrony during CRT delivery.
摘要翻译：本发明能够使患有心室内传导延迟或传导阻塞的患者的血液动力学效率。通过递送心脏再同步治疗（CRT）的新形式，本发明有效地克服了这种传导延迟或阻滞（例如，左束支传导阻滞“LBBB”或右束支传导阻滞“RBBB”）。具体地，从心房事件（例如，内在或诱发去极化）触发单个心室预激发起搏刺激。触发事件可能从右心房（RA）或左心房（LA）发出。在另一脑室的内在去极化之前，输送单个心室预激发生起搏刺激，从而在CRT输送期间促进脑室内机电同步。

8. 发明申请

WO2004098698A2 METHODS AND APPARATUS FOR THE REGULATION OF HORMONE RELEASE 审中-公开
标题翻译：用于调节激素释放的方法和装置
公开(公告)号：WO2004098698A2
公开(公告)日：2004-11-18
申请号：PCT/US2004/011736
申请日：2004-04-16
申请人： MEDTRONIC, INC. , ZHOU, xiaohong , KING, Gary, W. , MULLEN, Thomas, J. , HILL, Michael, R. S.
发明人： ZHOU, xiaohong , KING, Gary, W. , MULLEN, Thomas, J. , HILL, Michael, R. S.
IPC分类号： A61N
CPC分类号： A61N1/36071 , A61N1/205 , A61N1/36021
摘要： A method and apparatus for delivering corrective therapy through hormone regulation is provided. Inhibition of sympathetic fibers by spinal cord stimulation is used to regulate the levels of hormones such as catecholamines, renin, and calcitonin gene-related peptide. The invention utilizes a closed or open loop feedback system in which physiological parameters such as the concentrations of hormones and sympathetic indicators such as heart rate and urine production are monitored and used to determine the appropriate level of neurostimulation. The site of electrical stimulation includes, but is not limited to, the spinal cord at levels T7-L2 and the associated neural fibers within a region of the T7-L2 dermatomes.
摘要翻译：提供了通过激素调节进行矫正治疗的方法和装置。脊髓刺激对交感神经纤维的抑制用于调节儿茶酚胺，肾素和降钙素基因相关肽等激素水平。本发明利用封闭或开环反馈系统，其中监测诸如心率和尿液产生之间的激素和交感神经指标的生理参数，并用于确定神经刺激的适当水平。电刺激部位包括但不限于在T7-L2皮层区域内的级别T7-L2的脊髓和相关联的神经纤维。

9. 发明申请

WO2007013911A2 METHOD AND APPARATUS FOR DETECTION AND MONITORING OF T-WAVE ALTERNANS 审中-公开
标题翻译：用于检测和监测T波形变换器的方法和装置
公开(公告)号：WO2007013911A2
公开(公告)日：2007-02-01
申请号：PCT/US2006/027995
申请日：2006-07-19
申请人： MEDTRONIC, INC. , ZHOU, Xiaohong , MULLEN, Thomas, J. , GILLBERG, Jeffrey, M. , STADLER, Robert, W.
发明人： ZHOU, Xiaohong , MULLEN, Thomas, J. , GILLBERG, Jeffrey, M. , STADLER, Robert, W.
IPC分类号： A61N1/00 , A61B5/00
CPC分类号： A61B5/0452 , A61B5/0422 , A61N1/365 , A61N1/3702 , A61N1/37258
摘要： A system and method are provided for assessing T-wave alternans (TWA) using cardiac EGM signals received from implanted electrodes. A T-wave signal parameter is measured from signals received by an automatic gain control sense amplifier. A TWA measurement is computed from a beat-by-beat comparison of T-wave parameter measurements or using frequency spectrum techniques. The TWA measurement magnitude and measurement conditions are used in detecting a clinically important TWA. TWA assessment further includes discriminating concordant and discordant TWA in a multi-vector TWA assessment, and determining the association of a TWA measurement with QRS alternans, mechanical alternans, and other physiological events. A prediction of a pathological cardiac event is made in response to a TWA assessment. A response to a cardiac event prediction is provided.
摘要翻译：提供了一种使用从植入电极接收的心脏EGM信号评估T波交替（TWA）的系统和方法。从由自动增益控制读出放大器接收的信号测量T波信号参数。通过T波参数测量或使用频谱技术的逐拍比较来计算TWA测量。 TWA测量值和测量条件用于检测临床重要的TWA。 TWA评估还包括在多向量TWA评估中区分一致和不一致的TWA，并确定TWA测量与QRS交替，机械交替和其他生理事件的关联。病理性心脏事件的预测是针对TWA评估做出的。提供对心脏事件预测的响应。

10. 发明申请

WO2004093982A1 NEUROSTIMULATION FOR TREATMENT OF SLEEP APNEA 审中-公开
标题翻译：用于治疗睡眠APNEA的神经病学
公开(公告)号：WO2004093982A1
公开(公告)日：2004-11-04
申请号：PCT/US2004/011389
申请日：2004-04-14
申请人： MEDTRONIC, INC. , KING, Gary, W. , MIANULLI, Marcus, J. , HILL, Michael, R. S. , MULLEN, Thomas, J. , TESTERMAN, Roy, L. , BURNES, John, E. , ZHOU, Xiaohong
发明人： KING, Gary, W. , MIANULLI, Marcus, J. , HILL, Michael, R. S. , MULLEN, Thomas, J. , TESTERMAN, Roy, L. , BURNES, John, E. , ZHOU, Xiaohong
IPC分类号： A61N1/34
CPC分类号： A61N1/3601 , A61N1/36017 , A61N1/36114
摘要： Neurostimulation is delivered to one or more predetermined locations on or within a patient in order to treat effects of sleep apnea by modulating autonomic nervous activity. Delivery of neurostimulation at predetermined locations can decrease sympathetic nervous activity and/or increase parasympathetic nervous activity, countering the increased intrinsic sympathetic activity associated with apnea-arousal cycles. In some embodiments, neurostimulation is delivered to the spinal cord of the patient via an implanted electrode. In other embodiments, neurostimulation is delivered transcutaneously to the spinal cord or other locations via electrodes located on the surface of the patient. In some embodiments, delivery of neurostimulation is initiated or modified in response to detection of apneas.
摘要翻译：神经刺激被递送到患者身上或内部的一个或多个预定位置，以便通过调节自主神经活动来治疗睡眠呼吸暂停的影响。在预定位置递送神经刺激可降低交感神经活动和/或增加副交感神经活动，抵抗与呼吸暂停 - 觉醒周期相关的增加的内在交感神经活动。在一些实施方案中，神经刺激通过植入电极递送至患者的脊髓。在其他实施方案中，神经刺激通过位于患者表面上的电极经皮递送至脊髓或其它位置。在一些实施方案中，响应于呼吸暂停的检测而启动或修饰神经刺激的递送。

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