CN101939051A - 用于膈刺激检测的方法和装置 - Google Patents
用于膈刺激检测的方法和装置 Download PDFInfo
- Publication number
- CN101939051A CN101939051A CN2009801046067A CN200980104606A CN101939051A CN 101939051 A CN101939051 A CN 101939051A CN 2009801046067 A CN2009801046067 A CN 2009801046067A CN 200980104606 A CN200980104606 A CN 200980104606A CN 101939051 A CN101939051 A CN 101939051A
- Authority
- CN
- China
- Prior art keywords
- parameter
- cardiac pacing
- diaphragm
- pulse
- threshold
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Granted
Links
- 230000000638 stimulation Effects 0.000 title claims abstract description 43
- 238000000034 method Methods 0.000 title claims description 113
- 230000001830 phrenic effect Effects 0.000 title abstract 3
- 238000001514 detection method Methods 0.000 title description 6
- 230000000747 cardiac effect Effects 0.000 claims abstract description 118
- 210000003105 phrenic nerve Anatomy 0.000 claims abstract description 31
- 210000002216 heart Anatomy 0.000 claims description 107
- 230000000661 pacemaking effect Effects 0.000 claims description 40
- 238000000554 physical therapy Methods 0.000 claims description 30
- 230000008859 change Effects 0.000 claims description 27
- 230000008672 reprogramming Effects 0.000 claims description 12
- 238000013459 approach Methods 0.000 abstract 1
- 238000011156 evaluation Methods 0.000 abstract 1
- 230000008569 process Effects 0.000 description 48
- 238000012360 testing method Methods 0.000 description 33
- 230000004913 activation Effects 0.000 description 21
- 210000005242 cardiac chamber Anatomy 0.000 description 13
- 210000005003 heart tissue Anatomy 0.000 description 12
- 238000005516 engineering process Methods 0.000 description 11
- 206010061592 cardiac fibrillation Diseases 0.000 description 10
- 230000002600 fibrillogenic effect Effects 0.000 description 10
- 230000008602 contraction Effects 0.000 description 9
- 210000005036 nerve Anatomy 0.000 description 9
- 230000004044 response Effects 0.000 description 9
- 230000002085 persistent effect Effects 0.000 description 8
- 230000005611 electricity Effects 0.000 description 7
- 210000002837 heart atrium Anatomy 0.000 description 7
- 230000001965 increasing effect Effects 0.000 description 7
- 230000007794 irritation Effects 0.000 description 7
- 238000005259 measurement Methods 0.000 description 7
- 230000028161 membrane depolarization Effects 0.000 description 7
- 238000012512 characterization method Methods 0.000 description 6
- 230000000694 effects Effects 0.000 description 6
- 230000006870 function Effects 0.000 description 6
- 238000007726 management method Methods 0.000 description 6
- 239000000654 additive Substances 0.000 description 5
- 230000000996 additive effect Effects 0.000 description 5
- 230000008901 benefit Effects 0.000 description 5
- 210000005240 left ventricle Anatomy 0.000 description 5
- 230000037361 pathway Effects 0.000 description 5
- 208000001871 Tachycardia Diseases 0.000 description 4
- 238000006243 chemical reaction Methods 0.000 description 4
- 210000000038 chest Anatomy 0.000 description 4
- 230000007423 decrease Effects 0.000 description 4
- 230000010247 heart contraction Effects 0.000 description 4
- 230000007383 nerve stimulation Effects 0.000 description 4
- 238000005086 pumping Methods 0.000 description 4
- 230000002861 ventricular Effects 0.000 description 4
- 206010019280 Heart failures Diseases 0.000 description 3
- 230000009471 action Effects 0.000 description 3
- 239000012190 activator Substances 0.000 description 3
- 238000013194 cardioversion Methods 0.000 description 3
- 230000004217 heart function Effects 0.000 description 3
- 238000012986 modification Methods 0.000 description 3
- 230000004048 modification Effects 0.000 description 3
- 238000012544 monitoring process Methods 0.000 description 3
- 210000003205 muscle Anatomy 0.000 description 3
- 210000004165 myocardium Anatomy 0.000 description 3
- 230000008520 organization Effects 0.000 description 3
- 230000033764 rhythmic process Effects 0.000 description 3
- 230000006794 tachycardia Effects 0.000 description 3
- 208000031361 Hiccup Diseases 0.000 description 2
- 230000036982 action potential Effects 0.000 description 2
- 210000000481 breast Anatomy 0.000 description 2
- 238000004891 communication Methods 0.000 description 2
- 238000004590 computer program Methods 0.000 description 2
- 230000009989 contractile response Effects 0.000 description 2
- 238000010586 diagram Methods 0.000 description 2
- 230000002708 enhancing effect Effects 0.000 description 2
- 238000013213 extrapolation Methods 0.000 description 2
- 238000002513 implantation Methods 0.000 description 2
- 230000003993 interaction Effects 0.000 description 2
- 210000005246 left atrium Anatomy 0.000 description 2
- 230000004060 metabolic process Effects 0.000 description 2
- 230000005012 migration Effects 0.000 description 2
- 238000013508 migration Methods 0.000 description 2
- 230000002969 morbid Effects 0.000 description 2
- 230000003387 muscular Effects 0.000 description 2
- 230000001537 neural effect Effects 0.000 description 2
- 210000002569 neuron Anatomy 0.000 description 2
- 230000029058 respiratory gaseous exchange Effects 0.000 description 2
- 210000005245 right atrium Anatomy 0.000 description 2
- 210000005241 right ventricle Anatomy 0.000 description 2
- 238000007920 subcutaneous administration Methods 0.000 description 2
- 210000001519 tissue Anatomy 0.000 description 2
- 210000003462 vein Anatomy 0.000 description 2
- 108010022579 ATP dependent 26S protease Proteins 0.000 description 1
- 208000036626 Mental retardation Diseases 0.000 description 1
- 206010034719 Personality change Diseases 0.000 description 1
- 230000001133 acceleration Effects 0.000 description 1
- 206010003119 arrhythmia Diseases 0.000 description 1
- 230000006793 arrhythmia Effects 0.000 description 1
- 210000001992 atrioventricular node Anatomy 0.000 description 1
- 239000008280 blood Substances 0.000 description 1
- 210000004369 blood Anatomy 0.000 description 1
- 210000004204 blood vessel Anatomy 0.000 description 1
- 239000003990 capacitor Substances 0.000 description 1
- 210000003748 coronary sinus Anatomy 0.000 description 1
- 230000003247 decreasing effect Effects 0.000 description 1
- 230000002950 deficient Effects 0.000 description 1
- 230000001627 detrimental effect Effects 0.000 description 1
- 238000004070 electrodeposition Methods 0.000 description 1
- 238000005265 energy consumption Methods 0.000 description 1
- 230000005284 excitation Effects 0.000 description 1
- 230000002349 favourable effect Effects 0.000 description 1
- 230000036541 health Effects 0.000 description 1
- 238000009532 heart rate measurement Methods 0.000 description 1
- 230000000004 hemodynamic effect Effects 0.000 description 1
- 230000036571 hydration Effects 0.000 description 1
- 238000006703 hydration reaction Methods 0.000 description 1
- 239000007943 implant Substances 0.000 description 1
- 238000011835 investigation Methods 0.000 description 1
- 230000000670 limiting effect Effects 0.000 description 1
- 230000007774 longterm Effects 0.000 description 1
- 210000004072 lung Anatomy 0.000 description 1
- 239000011159 matrix material Substances 0.000 description 1
- 230000002107 myocardial effect Effects 0.000 description 1
- 230000007170 pathology Effects 0.000 description 1
- 210000003516 pericardium Anatomy 0.000 description 1
- 230000000737 periodic effect Effects 0.000 description 1
- 230000037081 physical activity Effects 0.000 description 1
- 210000004224 pleura Anatomy 0.000 description 1
- 230000004224 protection Effects 0.000 description 1
- 238000000718 qrs complex Methods 0.000 description 1
- 230000011514 reflex Effects 0.000 description 1
- 238000001228 spectrum Methods 0.000 description 1
- 230000004936 stimulating effect Effects 0.000 description 1
- 210000005094 subcutaneous system Anatomy 0.000 description 1
- 210000000115 thoracic cavity Anatomy 0.000 description 1
- 210000001186 vagus nerve Anatomy 0.000 description 1
Images
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/362—Heart stimulators
- A61N1/37—Monitoring; Protecting
- A61N1/371—Capture, i.e. successful stimulation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/40—Detecting, measuring or recording for evaluating the nervous system
- A61B5/4029—Detecting, measuring or recording for evaluating the nervous system for evaluating the peripheral nervous systems
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/48—Other medical applications
- A61B5/4848—Monitoring or testing the effects of treatment, e.g. of medication
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/3601—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation of respiratory organs
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/362—Heart stimulators
- A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
- A61N1/36585—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by two or more physical parameters
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/362—Heart stimulators
- A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
- A61N1/368—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions
- A61N1/3684—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions for stimulating the heart at multiple sites of the ventricle or the atrium
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/362—Heart stimulators
- A61N1/37—Monitoring; Protecting
- A61N1/3706—Pacemaker parameters
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/362—Heart stimulators
- A61N1/37—Monitoring; Protecting
- A61N1/371—Capture, i.e. successful stimulation
- A61N1/3712—Auto-capture, i.e. automatic adjustment of the stimulation threshold
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2562/00—Details of sensors; Constructional details of sensor housings or probes; Accessories for sensors
- A61B2562/02—Details of sensors specially adapted for in-vivo measurements
- A61B2562/0219—Inertial sensors, e.g. accelerometers, gyroscopes, tilt switches
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/103—Detecting, measuring or recording devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
- A61B5/11—Measuring movement of the entire body or parts thereof, e.g. head or hand tremor, mobility of a limb
- A61B5/1107—Measuring contraction of parts of the body, e.g. organ, muscle
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
- A61B5/25—Bioelectric electrodes therefor
- A61B5/279—Bioelectric electrodes therefor specially adapted for particular uses
- A61B5/28—Bioelectric electrodes therefor specially adapted for particular uses for electrocardiography [ECG]
- A61B5/283—Invasive
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
- A61B5/316—Modalities, i.e. specific diagnostic methods
- A61B5/389—Electromyography [EMG]
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/362—Heart stimulators
- A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
- A61N1/368—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions
- A61N1/3684—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions for stimulating the heart at multiple sites of the ventricle or the atrium
- A61N1/36842—Multi-site stimulation in the same chamber
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/362—Heart stimulators
- A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
- A61N1/368—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions
- A61N1/3684—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions for stimulating the heart at multiple sites of the ventricle or the atrium
- A61N1/36843—Bi-ventricular stimulation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/372—Arrangements in connection with the implantation of stimulators
Abstract
描述了用于表征膈刺激阈值、心脏捕获阈值、最大设备参数和最小设备参数的方法。可以通过使用心脏起搏设备来递送多个心脏起搏脉冲,多个心脏起搏脉冲的起搏参数在至少一些脉冲的递送之间改变。可以评估一个或者多个感测器信号以检测多个心脏起搏脉冲中的一个或者多个心脏起搏脉冲对膈神经的刺激。可以对一个或者多个感测器信号的评估与起搏参数进行比较以确定膈刺激阈值是否是高于最大设备参数和低于最小设备参数中的至少一个。
Description
技术领域
本发明主要地涉及心脏设备和方法,并且具体地涉及捕获和膈刺激阈值以及设备参数的表征。
背景技术
当正常工作时,心脏产生节律收缩并且能够泵送血液遍及身体。心脏在心房和心室中均具有专门传导途径,其实现在整个心肌内迅速传导从窦房(SA)结启动的激励冲击(即去极化)。这些专门传导途径向心房心肌、向房室结和向心室心肌传导来自SA结的去极化以产生两个心房和两个心室的协调收缩。
传导途径同步各室的肌纤维的收缩以及各心房或者心室的收缩与相对心房或者心室的收缩。没有正常工作的专门传导途径所赋予的同步,心脏的泵送效率大为削弱。表现这些传导途径的病理的患者可能遭受所危及的心脏输出。
已经开发向一个或者多个心脏室提供起搏刺激以试图改进心房和/或心室收缩的节律和协调的心率管理(CRM)设备。CRM设备通常包括用于感测来自心脏的信号的电路和用于向心脏提供电刺激的脉冲生成器。延伸到患者的心脏室中和/或心脏的血管中的引线耦合到如下电极,这些电极感测心脏的电信号并且根据用于治疗心律失常和不同步的各种理疗向心脏递送刺激。
起搏器是递送一系列低能起搏脉冲的CRM设备,这些脉冲被定时成辅助心脏产生维持心脏泵送效率的收缩节律。起搏脉冲根据患者的需要可以是间歇或者连续的。存在具有用于对一个或者多个心脏室进行感测和起搏的各种模式的多类起搏器设备。
起搏脉冲必须超过最小能量值或者捕获阈值以“捕获”心脏组织,从而生成如下诱发反应,该反应生成使心脏室收缩的传播去极化波。如果起搏脉冲能量太低,则起搏脉冲可能在心脏室中不可靠地产生收缩反应并且可能造成对心脏功能或者心脏输出无改善的无效起搏。
即使脉冲能量不足以捕获心脏组织,起搏脉冲仍然可能无意地刺激神经或者肌肉。例如,递送的起搏脉冲可能刺激患者的在心脏附近伸展并且使横膈膜活动的膈神经。
本发明提供使用膈刺激算法的方法和系统并且提供优于现有技术的各种优点。
发明内容
本发明涉及到用于将膈刺激算法用于表征捕获和膈刺激阈值和设备参数的方式。本发明的一个实施例涉及一种包括使用心脏起搏设备来递送多个心脏起搏脉冲的方法,多个心脏起搏脉冲的起搏参数在脉冲的递送之间改变。参数可以例如是起搏脉冲幅度或者宽度。该方法实施例还包括评估一个或多个感测器信号以检测多个心脏起搏脉冲中的一个或者多个心脏起搏脉冲对膈神经的激活,并且对一个或者多个感测器信号的评估与起搏参数进行比较以确定膈神经激活阈值是否是高于最大设备参数和低于最小设备参数中的至少一个。心脏捕获阈值可以是检测到的在目标心脏组织中引起去极化的最小起搏脉冲幅度。最大设备参数可以是心脏起搏设备被编程为递送的起搏脉冲的最大宽度。最小设备参数可以是心脏起搏设备被编程为递送的起搏脉冲的最小宽度。
另一实施例涉及一种心率管理系统,该系统包括具有多个电极的可植入心脏起搏设备。该可植入心脏起搏设备可以包括:电路,配置成通过电极输出多个心脏起搏脉冲并且修改多个心脏起搏脉冲的一个或者多个起搏参数;一个或者多个感测器,配置成感测多个起搏脉冲中的一个或者多个起搏脉冲对膈神经的激活,并且基于感测的膈神经激活来提供一个或者多个信号;控制器,配置成执行存储器中存储的程序指令以使系统对一个或者多个信号与一个或者多个起搏参数进行比较以确定膈神经激活阈值是否是高于最大心脏起搏设备参数和低于最小心脏起搏设备参数中的至少一个,并且基于该确定来存储信息。
另一实施例涉及一种心率管理系统,该系统包括具有多个电极的可植入心脏起搏设备。该可植入心脏起搏设备可以包括:电路,配置成通过多个电极输出多个心脏起搏脉冲并且修改多个心脏起搏脉冲的一个或者多个起搏参数;一个或者多个感测器,配置成感测多个起搏脉冲中的一个或者多个起搏脉冲对膈神经的激活,并且基于感测的膈神经激活来提供一个或者多个信号;用于对一个或者多个感测器信号的评估与一个或者多个起搏参数进行比较以确定膈神经激活阈值是否是高于最大编程设备参数和低于最小编程设备参数中的至少一个的装置。
本发明的上述发明内容并非旨在于描述本发明的各实施例或者每种实施方式。通过参照与附图结合的下文具体实施方式和权利要求书,本发明的优点和效果以及更完整的理解将变得清楚和被理解。
附图说明
图1是图示了根据本发明实施例的用于表征设备参数限制、捕获阈值和膈刺激阈值的方法的流程图;
图2是根据本发明实施例的系统电路的框图;
图3是图示了根据本发明实施例的提供用户接口的患者外部设备的图,该用户接口允许人类分析员与信息交互并且对可植入医疗设备进行编程;
图4是根据本发明实施例的包括能够实施电极组合选择技术的电路的理疗设备;
图5是图示了根据本发明实施例的估计阈值的方法的流程图;
图6是图示了根据本发明实施例的强度-持续时间起搏脉冲参数和设备限制曲线的各种方面的曲线图;
图7是图示了根据本发明实施例的使用逐步增加扫描技术来表征设备参数限制、捕获阈值和膈刺激阈值的方法的流程图;
图8是图示了根据本发明实施例的使用逐步减低扫描技术来表征设备参数限制、捕获阈值和膈刺激阈值的方法的流程图;以及
图9是图示了根据本发明实施例的使用逐步减低扫描技术来表征捕获阈值和膈刺激阈值的方法的流程图。
尽管本发明可有各种修改和替代形式,但是已经在附图中通过例子示出并且下文将详细地描述其细节。然而,将理解本意并非使本发明限于描述的具体实施例。恰好相反,本发明旨在于涵盖落入如由所附权利要求书限定的本发明范围内的所有修改、等效和替代实施例。
具体实施方式
在所示实施例的下文描述中参照附图,这些附图形成该描述的一部分并且在附图中通过示例来示出可以对本发明进行实施的各种实施例。将理解可以利用其他实施例并且可以进行结构和功能上的改变而不脱离本发明的范围。
根据本发明的系统、设备或者方法可以包括这里描述的一个或者多个特征、结构、方法或者其组合。例如,设备或者系统可以实施成包括下文描述的一个或者多个有利特征和/或过程。本意在于这样的设备或者系统无需包括这里描述的所有特征,但是可以实施成包括提供有用结构和/或功能的所选特征。这样的设备或者系统可以实施成提供多种治疗或者诊断功能。
种类广泛的可植入心脏监视和/或刺激设备可以配置成实施本发明的膈刺激算法。这样的设备的非限制性的有代表性的列表包括心脏监视器、起搏器、心脏复律器、去心脏纤颤器、再同步器和其他心脏监视和理疗递送设备。这些设备可以配置有多种电极布置,这些电极布置包括经静脉、心脏内和心外膜电极(即,胸廓内电极)和/或皮下、非胸廓内电极(包括罐、头部和无效电极以及皮下阵列或者引线电极(即,非胸廓内电极))。
双心室起搏为遭受心力衰竭的患者提供理疗选项。然而,在双心室起搏系统中经由冠状窦放置左心室引线已经遭受新挑战。由于冠状静脉与膈神经邻近,所以左心室起搏可能造成膈神经刺激。膈神经使横膈膜活动,因而膈神经的刺激可能使患者经历打嗝。膈神经的电刺激可能让患者感觉不适,并且可能干扰呼吸。因此,来自心脏起搏的膈刺激可能使患者表现随着左心室起搏而定时的令人不适的呼吸模式。
可以确定如下膈刺激阈值,在该阈值以上时膈神经将受起搏脉冲刺激。一种用于确定膈刺激阈值的方法包括感测随着起搏脉冲的递送而定时的膈神经激活和/或横膈膜移动。如果使用递送的电能级未感测到膈刺激,则可以针对递送电能并且监视膈刺激的后续试验迭代地增加能级,直至感测到膈刺激。检测到膈刺激时的电能级可以是膈刺激阈值。在一些实施例中,可以减少或者以别的方式调节电能级,直至未检测到膈刺激。在这样的扫描期间递送的能量也可以用来同时进行其他测试,比如搜索捕获阈值。
在各自通过相应整体引用结合于此的第6,772,008号美国专利和于2005年4月26日提交的公开号为20060241711的专利申请中公开了可以结合于本发明实施例中的用于评估膈刺激的方法。
对起搏设备进行编程以避免非所需刺激如膈刺激不是一维的,因为许多其他因素在设置适当起搏参数时可能是重要的。例如,起搏脉冲必须超过最小能量值或者捕获阈值以产生心脏组织的预计收缩。希望起搏脉冲具有充分能量以刺激心脏的捕获而不消耗明显超过捕获阈值的能量。因此,捕获阈值的准确确定提供高效起搏能量管理。如果起搏脉冲能量过低,则起搏脉冲可能在心脏中不可靠地产生收缩反应并且可能造成无效起搏。
除了其他方法之外还可以使用如下逐步减低技术来确定捕获阈值,在该技术中当在连续起搏循环之后检测到失去捕获时标识捕获阈值。也可以使用如下逐步增加技术,在该技术中当在无捕获的连续起搏循环之后检测到捕获时标识捕获阈值。可以使用心电图的表明预计心脏反应的特性(例如,QRS复合波)来检测捕获。
捕获检测允许心率管理系统调节起搏脉冲的能级以对应于可靠地产生收缩的最优能耗。另外,捕获检测允许心率管理系统无论起搏脉冲何时未产生收缩就在更高能级启动支援脉冲。例如,本发明的实施例可以表征捕获和膈刺激阈值并且递送其能级比设置在捕获阈值或者在捕获阈值以上的标准起搏能级更高的支援脉冲,该支援脉冲的能级在膈刺激阈值以下。
起搏设备可以具有起搏参数限制,比如编程限制和对设备能力的限制。例如,可以对可植入起搏设备进行编程以仅递送不超过指定幅度的起搏脉冲。其他编程限制除了其他参数之外还可以包括最小脉冲幅度、最小脉冲持续时间、最大脉冲持续时间、最小脉冲频率、最大脉冲频率、最小脉冲电流和/或最大脉冲电流。可以出于若干原因用这些和其他参数限制对设备进行编程。例如,编程为自动的选择起搏脉冲幅度的设备可以具有对幅度的编程限制以防止设备选择可能对患者有危险的脉冲幅度(比如在自动捕获模式中)。此外,可以用参数限制对设备进行编程以避免可能有害于设备的操作调节。
在植入起搏设备时,人类分析员如医生可以建立初始捕获和膈神经刺激阈值。基于那些初始阈值确定,分析员可以用如下参数范围限制对设备进行编程,自动化设备特征可以在这些限制内操作。在脉冲幅度的情况下,医生可以设置最小值在捕获阈值以上并且最大值在膈刺激阈值以下的如下电压范围,自动捕获特征可以在该范围内操作。最大值和最小值可以各自具有安全裕度,从而在参数最小值/最大值之间的范围少于在捕获与膈刺激阈值之间的范围。如果捕获阈值和膈刺激阈值这些阈值中的任一阈值随时间改变,则安全裕度提供防止自动捕获过程在捕获阈值以下或者在膈刺激阈值以上起搏的一些保护。
设备也可以具有与设备的硬件关联的能力限制。例如,即使对起搏设备的操作未设定编程限制,设备除了其他参数之外还可以具有关于最小脉冲幅度、最大脉冲幅度、最小脉冲持续时间、最大脉冲持续时间、最小脉冲频率、最大脉冲频率、最小脉冲电流和最大脉冲电流的限制。设备能力限制可以涉及用于构成设备的部件(例如电容器和电池)的性能限制。
在多电极起搏系统中,多个起搏电极可以设置于单个心脏室中、多个心脏室中和/或患者的身体中的别处。用于递送起搏脉冲的电极可以包括一个或者多个阴极电极和一个或者多个阳极电极。经由阴极/阳极电极组合来递送起搏脉冲,其中术语“电极组合”表明使用至少一个阴极电极和至少一个阳极电极。电极组合可以涉及到多于两个电极,比如当电连接的多个电极用作阳极和/或电连接的多个电极用作阴极时。通常,在一个或者多个起搏部位经由一个或者多个阴极电极向心脏组织递送起搏能量,而经由一个或者多个阳极电极提供返回路径。如果出现心脏捕获,则在阴极电极部位注入的能量产生可以与其他去极化波阵面组合以触发心肌收缩的传播去极化波阵面。递送起搏能量的阴极和阳极电极组合限定用于起搏的起搏矢量。
可以在心脏循环期间的定时序列中在单个心脏室中通过多个电极(即,由各种电极组合限定的起搏矢量)施加起搏脉冲以提高收缩性并且增强心脏室的泵送作用。希望经由多个电极组合递送的各起搏脉冲捕获与阴极电极邻近的心脏组织。心脏组织的捕获除了其他因素之外还依赖于用来递送脉冲的矢量和各种脉冲参数,比如脉冲的幅度和持续时间。
起搏理疗的刺激特性依赖于许多因素,这些因素除了其他因素之外还包括电极之间的距离、与目标组织的邻近度、与易受非预计刺激的非目标组织的邻近度、收缩和在电极之间的组织类型、电极之间的阻抗、电极之间的电阻和电极类型。这样的因素可以影响心脏捕获和膈刺激阈值。刺激特性除了其他因素之外还可以随着心理改变、电极迁移、物理活动水平、体液化学性、水合作用和疾病状态而变化。因此,用于各电极组合的刺激特性是唯一的并且可以随时间改变。这样,为各电极组合定期地确定刺激特性(例如,心脏捕获和膈刺激阈值)以求最佳起搏(例如,在心脏捕获阈值或者恰好高于心脏捕获阈值而不引起非所需刺激的起搏)可以是有用的。
在对设备进行编程、重新编程和/或操作时关于各种阈值(例如,膈刺激、心脏捕获)考虑设备参数限制可以是有用的。例如,如果已知膈刺激阈值大于设备脉冲幅度限制,则设备可以在进行扫描以更新心脏捕获阈值时无需考虑膈刺激。此外,如果已知膈刺激阈值高于编程设备限制,则自动捕获过程的逐步增加幅度扫描可以使用更大参数增量以有助于更快确定心脏捕获阈值。在逐步减低扫描模式中,如果确定设备最小参数限制在膈刺激阈值以上(例如设备不能递送脉冲宽度不刺激膈神经的起搏脉冲),则设备可以告警通知医师和/或执行重新配置。
本发明的设备可以有助于使用各种膈刺激算法来表征起搏配置。设备除了其他方面之外还可以确定设备参数限制、捕获阈值和/或膈刺激阈值之间的关系。如果一个或者多个阈值的改变可以改变编程参数限制与一个或者多个阈值之间的关系,则实施例可以通知医生和/或采取一些其他动作。例如,如果膈刺激阈值改变使得阈值低于编程起搏参数限制(其中在膈刺激阈值高于编程范围的最大参数限制之前),则可以通知医生和/或(设备本身或者另一系统)可以对设备自动地重新编程。
图1的流程图图示了用于使用膈刺激算法的过程。该过程包括递送110心脏起搏脉冲同时迭代地改变起搏脉冲的参数。迭代地改变的参数除了其他参数之外还可以是脉冲幅度、宽度、频率和电流中的一个或者多个。参数改变可以是增加或者减少。以这一方式,可以针对一个或者多个参数中的各参数进行扫描以调查在可用参数谱的至少部分内的生理反应(例如,捕获、膈刺激)。
评估120感测器信号以检测递送110的心脏起搏脉冲所致的膈刺激。这里公开的方法可以检测膈刺激。在一个实施例中,如下加速计信号可以检测膈刺激,该信号表明在递送110起搏脉冲之后不久的胸部移动(例如,诱发的打嗝)。也可以通过检测经胸廓的阻抗信号的幅度的短持续时间的偏离来检测膈刺激。
可以对与用于检测膈刺激的评估120和起搏脉冲的递送110有关的信息进行比较130以除了其他方面之外还确定膈刺激阈值是否高于最大编程设备参数、低于最小编程设备参数和/或低于心脏捕获阈值。
例如,如果即使以用于起搏设备的最大编程幅度设置来递送起搏脉冲,但是评估120未检测到与递送110的起搏脉冲中的任何起搏脉冲对应的膈刺激,则可以标识膈刺激阈值大于设备的最大编程幅度参数。此外,还可以确定膈刺激脉冲宽度阈值大于设备的最大编程脉冲宽度参数。也可以针对这里公开的其他参数标识类似关系。
如果使用逐步减低迭代参数改变方式来应用图1的过程,则可以标识膈刺激阈值在设备的编程最小幅度和/或脉冲宽度参数以下。根据图1的过程的逐步减低扫描也可以标识捕获阈值在设备的最小编程幅度和/或脉冲宽度参数以下、膈刺激阈值大于心脏捕获阈值和/或膈刺激和心脏捕获阈值中的一个或者两个在最大编程设备参数以下。
在一些实施例中,设备可以仅在它的如下编程参数范围内扫描,该范围允许操作特定过程,比如自动捕获。这样的实施例使测试最少而同时保证阈值尚未漂移进自动化过程的编程范围中。
在一些实施例中,设备可以在它的如下编程参数范围以外扫描,特定过程在该范围内被允许操作。这样的实施例允许设备和/或医生识别阈值相对于编程参数限制何时已经改变并且采取适当动作。例如,如果标识出捕获阈值已经减少并且从最小编程参数限制进一步漂移,则可以用更低最小参数限制对设备重新编程,这可以节约电池寿命。如果膈刺激阈值已经减少,则可以用更低最大参数限制对设备重新编程以保证安全裕度存在于膈刺激阈值与最大编程参数限制之间。
基于标识的在膈刺激阈值、捕获阈值与各种编程脉冲参数限制之间的关系,可以通知医生需要对设备重新编程。例如,如果确定捕获阈值已经随时间增加,则本发明的实施例可以有助于通知医生捕获阈值已经增加并且正在接近设备的最小编程脉冲幅度参数(其中已经在编程参数限制以外进行扫描)。在这样的情况下,医生可以通过增加最小编程脉冲参数对设备的脉冲参数限制重新编程。医生可以进一步增加最大编程脉冲参数以允许设备的自动化功能,比如自动捕获过程、在改变参数时的充足可变性。取而代之,设备可以对它本身重新编程或者由另一系统进行编程以响应于标识的在膈刺激阈值、捕获阈值与各种编程脉冲参数限制之间的改变的关系来修改编程参数限制。
可以自动地进行图1的各种步骤以及这里公开的其他步骤,从而无需直接人为辅助(例如,医师和/或患者)以启动或者进行各种离散步骤。取而代之,可以半自动地进行本公开内容的各种步骤从而要求一些数量的人类交互以启动或者进行一个或者多个步骤。。
图2是根据本发明实施例的可以并入运用膈刺激算法的电路的CRM设备200的框图。CRM设备200包括向心脏递送起搏脉冲的起搏理疗电路230。CRM设备200可以可选地包括配置成向心脏递送高能去心脏纤颤或者心脏复律刺激以便终止危险的心率过速的去心脏纤颤/心脏复律电路235。
经由除了其他位置之外还可以在心脏内设置于多个位置的多个心脏电极205(电极组合)递送起搏脉冲。两个或者更多电极可以设置于单个心脏室内。电极205耦合到开关矩阵225电路,该电路用来将各种起搏配置的电极205有选择地耦合到信号处理器201和/或CRM设备200的其他部件。
CRM设备也包括膈刺激感测器210。膈刺激感测器210可以向信号处理器201和控制处理器240输出信号和/或其他信息。膈刺激感测器210可以包括加速计、电信号感测器(例如,EMG、阻抗)、压力感测器、声学感测器和/或可以参与检测膈刺激的任何其他感测器。可以使用离散感测器或者经由FRM设备的处理器(例如,控制处理器240)执行的软件来实施膈刺激感测器210。
控制处理器240可以使用从信号处理器201、膈刺激感测器210、存储器245和其他部件接收的信息以实施如这里公开的膈刺激算法。
例如,起搏理疗电路230可以提供与何时递送起搏脉冲和该起搏脉冲的参数有关的信息,膈刺激感测器210可以提供与感测的膈刺激有关的信息,并且信号处理器可以提供与心脏的捕获有关的信息。该信息除了其他方面之外还可以用来确定膈刺激阈值是否高于最大设备参数、低于最小设备参数和/或低于心脏捕获阈值。
递送的脉冲的幅度、峰值定时和/或与膈刺激的相关性(心跳到心跳和/或随时间)可以与时域或者频域中的膈刺激信号一起用来确定一个或者多个起搏脉冲是否引起膈刺激。
CRM设备200通常包括电池电源(未示出)和用于与外部设备编程器260或者其他患者外部设备通信的通信电路250。可以在设备编程器260与患者管理服务器270之间、在CRM设备200与设备编程器260之间和/或在CRM设备200与患者管理服务器270和/或其他外部系统之间传送诸如数据、参数信息、评估、比较、数据和/或程序指令等信息。在一些实施例中,处理器240、存储器245和/或信号处理器201可以是设备编程器260、患者管理服务器270和/或其他患者外部系统的部件。
CRM设备200还包括由和通过控制处理器240存取的用于存储可执行程序指令和/或数据的存储器245。在各种配置中,存储器245可以用来存储与阈值、参数、参数限制、测量值、程序指令等有关的信息。
图2中表示的电路可以用来实现这里讨论的各种方法和技术。存储器245可以是用计算机程序、软件、固件、计算机可执行指令、能够由计算机等执行的指令编码以由电路如控制处理器240执行的计算机可读介质。例如,存储器245可以是存储计算机程序的计算机可读介质,控制处理器240对该计算机程序的执行引起根据本公开内容已知或者引用的各种方法和技术根据本发明的实施例来递送由起搏理疗电路引导的起搏脉冲、从膈刺激感测器210和/或信号处理器201接收一个或者多个信号以识别并且建立在设备参数限制、捕获阈值与膈刺激阈值之间的关系。以类似方式可以使用图2中表示的电路来进行这里讨论的其他方法和技术。
图3图示了提供如下用户接口的患者外部设备300,该用户接口被配置成与允许人类分析员如医师或者患者与植入的医疗设备交互。将患者外部设备300描述为CRM编程器,尽管本发明的方法也可在其他类型的设备(比如便携电话设备、计算机、PDA或者结合远程系统使用的患者信息服务器)上操作。编程器300包括在植入的设备的植入部位附近放置于患者的身体之上以在CRM与编程器300之间建立遥测链路的编程头310。遥测链路允许向编程器300下载由可植入设备收集的数据。下载的数据存储于编程器存储器365中。在一些实施例中,可以经由射频在可植入设备与外部设备之间建立通信链路,从而可植入设备和外部设备无需相对近的邻近度以有助于传送数据、命令、指令和其他信息。
编程器300包括能够显示图形、字母数字符号和/或其他信息的图形显示屏320,例如LCD显示屏。例如,编程器300可以在屏幕320上用图形显示与从CMR下载的起搏参数、设备限制、感测信息和阈值有关的信息。显示屏320可以包括触敏能力,从而用户可以通过用触笔330或者用户的手指触摸显示屏320来输入信息或者命令。取而代之或者除此之外,用户可以经由键盘340或者鼠标350输入信息或者命令。
编程器300包括数据处理器360,该数据处理器包括用于使用编程器300的存储器365中存储的程序指令来实现这里公开的方法的软件和/或硬件。在一种实施方式中,经由编程器300的通信电路366从CMR接收并且在存储器365中存储感测的数据。数据处理器360评估如下感测的数据,该数据可以包括与起搏参数、设备限制和阈值有关的信息。数据处理器360也可以进行这里讨论的其他方法步骤,这些方法步骤除了其他方法步骤之外还包括评估信号、检测膈刺激和对起搏参数、设备限制和阈值进行比较。可以经由显示屏320向用户呈现起搏参数、设备限制、编程参数限制和阈值以及其他信息。可以通过使用显示屏320来显示与设备起搏脉冲参数限制、捕获阈值和膈刺激阈值有关的通知以供人类分析员查看。
图4中所示理疗设备400运用能够实施这里描述的膈刺激算法技术的电路。理疗设备400包括封入可植入壳401内的CRM电路。CRM电路电耦合到心脏内引线系统410。虽然在图4中图示了心脏内引线系统410,但是除此之外或者取而代之还可以部署各种其他类型的引线/电极系统。例如,引线/电极系统可以包括心外膜引线/电极系统,该系统包括在心脏和/或心室以外的电极,比如心脏套、心外膜贴片和/或具有在皮肤表面以下、但是在胸腔以外植入的电极的皮下系统。
示出了心脏内引线系统410的部分插入到患者的心脏中。引线系统410包括定位于一个或者多个心脏室中、上或者周围、用于感测来自患者的心脏的电信号和/或向心脏递送起搏脉冲的心脏起搏/感测电极451-456。比如图4中所示心脏内感测/起搏电极可以用来对心脏的包括左心室、右心室、左心房和/或右心房的一个或者多个室进行感测和/或起搏。CRM电路控制对经由电极451-456递送的电刺激脉冲的递送。电刺激脉冲可以用来保证心脏以血液动力充分的速率跳动、可以用来提高心跳的同步性、可以用来增加心跳的强度和/或可以用于其他理疗目的以支持与指定理疗一致的心脏功能。
引线系统410可以包括用于向心脏递送去心脏纤颤/心脏复律脉冲的去心脏纤颤电极441、442。
左心室引线405并入在与左心室邻近的冠状静脉系统内定位于各种位置的多个电极454a-454d和455。在左心室中的多个位置或在单个所选位置刺激心室可以在例如遭受心力衰竭(HF)的患者中提供增加的心脏输出和/或可以提供其他益处。可以根据增强心脏功能的定时序列和输出配置经由所选电极递送电刺激脉冲。虽然图4图示了多个左心室电极,但是在其他配置中,除此之外或者取而代之还可以在右心房、左心房和右心室中的一个或者多个中提供多个电极。
可植入设备400的壳401的部分可以可选地适于作为一个或者多个罐481或者无效电极482。将壳401图示为并入如下头部489,该头部可以配置成有助于在一个或者多个引线与壳401之间的可卸式附接。理疗设备400的壳401可以包括一个或者多个罐电极481。理疗设备400的头部489可以包括一个或者多个无效电极482。罐481和/或无效电极482可以用来向心脏递送起搏和/或去心脏纤颤刺激和/或以便感测心脏的电心脏信号。
通信电路设置于壳401内以便有助于在CRM电路与患者外部设备如外部编程器或者高级患者管理(APM)系统之间的通信。理疗设备400也可以包括用于感测患者的代谢需要并且调节向心脏递送的起搏脉冲以适应患者的代谢需要的感测器和适当电路。
在一些实施方式中,APM系统可以用来进行这里讨论的一些过程,这些过程除了其他过程之外还包括评估、估计、比较、检测、选择和更新。这里描述的方法、结构和/或技术可以并入各种与APM有关的方法,这些方法包括在各自通过相应整体引用结合于此的以下参考文献的一个或者多个中描述的特征:第6,221,011号、第6,270,457号、第6,277,072号、第6,280,380号、第6,312,378号、第6,336,903号、第6,358,203号、第6,368,284号、第6,398,728号和第6,440,066号美国专利。
在某些实施例中,理疗设备600可以包括用于经由去心脏纤颤理疗和/或防心率过速起搏(ATP)来检测和治疗心脏心率过速的电路。提供去心脏纤颤能力的配置可以利用去心脏纤颤线圈441、442向心脏递送高能脉冲以终止或者缓解心率过速。
使用比如这里所示多个电极的CRM设备能够在心脏循环期间向心房和/或心室的多个部位递送起搏脉冲。某些患者可以受益于在不同时间激活心脏室的部分如心室以便向心室的不同区域分布泵送负荷和/或去极化序列。多电极起搏器具有在不同心脏循环期间在心脏室内在所选电极组合之间切换起搏脉冲输出的能力。
通过引用结合于此的共有美国专利6,772,008描述了关于检测非所需组织刺激可以使用的方法和系统。可以例如通过使用加速计和/或感测表明与刺激脉冲的输出吻合的肌肉移动的加速的其他电路来检测肌肉刺激。
其他测量组织刺激的方法可以例如涉及到使用肌电图感测器(EMG)、麦克风和/或其他感测器。例如,可以使用麦克风以检测患者对由于电膈刺激所致非所需横膈膜激活的呼气反应来自动地检测喉部肌肉的刺激。
可以通过感测直接或者间接响应于刺激的参数来检测非所需神经或者肌肉刺激。可以例如使用神经电图(ENG)电极和电路来直接感测非所需神经刺激如迷走神经或者膈神经的刺激以测量和/或记录神经中的神经峰值和/或动作电位。ENG感测器可以包括位于感兴趣的神经上或者附近的神经卡肤(cuff)和/或其他类型的神经电极。例如,在通过相应整体引用结合于此的第4,573,481号和第5,658,318号美国专利中讨论了用于直接测量神经激活信号的系统和方法。ENG可以包括缠绕于神经(例如,膈神经)周围并且电连接到配置成测量神经活动的电路的螺旋神经电极。神经电极和电路进行操作以在施加电刺激脉冲之后检测神经的电激活(动作电位)。
可以通过感测间接响应于神经刺激的替代参数来检测神经激活。肺压力、胸膜压力、胸压力、气道压力和胸阻抗是响应于膈神经的刺激而改变的参数例子。在一些实施例中,可以在递送电刺激期间和/在紧接递送电刺激之后测量患者的气道压力。检测到的压力改变可以与膈神经的刺激有关。
可能通过迭代地增加、减少或者以一些方式改变一系列测试脉冲之间的电压、电流、持续时间、能级和/或其他理疗参数来进行非所需刺激阈值测量。一个或者多个感测器可以在紧接着递送各测试脉冲之后监视非所需激活。使用这些方法,可以将参数改变引起非所需刺激时的点标识为非所需刺激阈值。
举例而言并且无限制性,可以通过使用初始电极组合递送第一测试脉冲来测量用于特定电极组合的非所需刺激阈值。在递送各测试脉冲期间和/或之后,感测器可以监视非所需刺激。例如,加速计可以监视横膈膜的如下移动,该移动表明测试脉冲刺激膈神经和/或横膈膜肌。如果在递送测试脉冲之后未检测到膈神经和/或横膈膜肌刺激,则将测试脉冲增加预定数量并且递送另一测试脉冲。重复该递送、监视和递增的扫描过程直至检测到膈神经和/或横膈膜肌刺激。检测到第一非所需刺激时的一个或者多个测试脉冲参数可以被视为非所需刺激阈值。
虽然这里公开用于测量心脏捕获和膈刺激阈值的方法,但是设想可以如图5中所示估计而不是直接测量各种阈值。
图5的流程图图示了用于估计阈值如心脏捕获阈值或者膈刺激阈值的过程500。该过程500包括测量510初始电极组合的捕获阈值。可以根据这里公开或者本领域已知的任何捕获阈值测量方法来完成用于测量510用于初始电极组合的捕获阈值的过程。
图5的过程500还包括测量520初始电极组合的阻抗。可以用初始电极组合的捕获阈值测量来测量初始电极组合的阻抗。
可以使用任何用于针对一个或者多个电极组合测量阻抗的方法。在通过整体引用结合于此的第6,076,015号共有美国专利中描述用于确定电极组合阻抗的技术和电路的一个示例例子。
根据这一方法,阻抗的测量涉及到电刺激源,比如激励器。激励器向电极之间的心脏递送电刺激信号,比如电流脉冲或者其他测量刺激的选通序列。响应于由激励器提供的激励信号,响应信号如电压响应值由阻抗检测器电路感测。根据测量的电压响应值和已知电流值,可以计算电极组合的阻抗。
图5的过程500还包括测量530替代电极组合的阻抗。可以针对多个不同替代电极组合重复测量步骤530。
图5的过程500还包括测量540初始电极组合的非所需激活阈值(例如,膈刺激阈值)。用于测量540初始电极组合的非所需激活阈值的过程可以类似于用于测量510初始电极组合的捕获阈值的过程,并且可以与初始电极组合的捕获阈值的测量510同时完成。
图5的过程500还包括估计550替代电极组合的捕获阈值。通过使用初始电极组合的捕获阈值和阻抗以及替代电极组合的阻抗来进行估计550替代电极组合的捕获阈值。
根据这里描述的一些实施例的替代电极组合的捕获阈值估计是基于如下假设:对于给定的脉冲宽度,用于初始电极组合的捕获阈值电压和用于替代电极组合的捕获阈值电压要求等量电流、能量或者电荷。在用于各电极组合的捕获阈值电压与电流之间的关系可以按照欧姆定律限定如下:
Vth=IthZ [1]
其中,Vth是电极组合的捕获阈值电压,Ith是电极组合的捕获阈值电流,并且Z是电极组合的阻抗。
对于初始电极组合,在捕获阈值电压与电流之间的关系可以表达为:
Vth-in=Ith-inZin [2]
其中,Vth-in是初始电极组合的捕获阈值电压,Ith-in是初始电极组合的捕获阈值电流,并且Zin是初始电极组合的阻抗。
对于替代电极组合,在捕获阈值电压与电流之间的关系可以表达为:
Vth-ex=Ith-exZex [3]
其中,Vth-ex是替代电极组合的捕获阈值电压,Ith-ex是替代电极组合的捕获阈值电流,并且Zex是替代电极组合的阻抗。
如先前所言,在一些实施例中,假设具有共同电极的两个电极组合的捕获阈值电流大约相等,或者Ith-in=Ith-ex。
在替代与初始捕获阈值电压之间的关系然后可以表达为:
按照上文概括的过程,Vth-in、Zin和Zex是测量参数,并且可以基于这些测量参数来估计捕获阈值电压。
如果测量的电极组合具有与为其估计捕获阈值的电极组合相同的极性,则可以增加用于特定电极组合的捕获阈值的估计计算准确度。在通过整体引用结合于此、于2006年8月17日提交的第11/505,645号美国专利申请中公开了包括捕获阈值估计的用于参数估计的方法。
图5的过程500还包括估计560替代电极组合的非所需激活阈值。非所需激活阈值可以例如是膈刺激阈值。可以通过使用初始电极组合的非所需激活阈值和阻抗以及替代电极组合的阻抗来进行估计560替代电极组合的非所需激活阈值。可以使用与如这里讨论和引用的估计捕获阈值类似的方法来进行估计550替代电极组合的非所需激活阈值。
估计阈值(比如估计捕获阈值和/或者非所需激活阈值)而不是测量该阈值可以提供若干优点。例如,在一些境况中,可以比为多个电极组合中的各电极组合测量阈值更快地完成为多个电极组合测量和估计一些阈值,因为无需为各电极组合递送一个或者多个测试脉冲。此外,让患者体验测试脉冲还可能令人不适,因此使测试脉冲数目最小可能是优选的。
这里公开的方法和设备可以运用测量或者以别的方式提供的强度-持续时间关系信息。
捕获由如下起搏脉冲产生,这些起搏脉冲具有充分能量以产生造成心脏组织收缩的传播电去极化波阵面。广而言之,起搏脉冲的能量是起搏脉冲的幅度和脉冲的持续时间这两个能量参数的乘积。因此,可以如图6中所示在捕获强度-持续时间标绘610中表达在脉冲宽度范围内的捕获阈值电压。
起搏脉冲所致的非所需激活也依赖于脉冲强度。针对非所需激活的膈刺激强度-持续时间标绘620可以具有来自捕获强度-持续时间的不同特性并且可以具有在起搏脉冲电压与起搏脉冲宽度之间的关系。
CRM设备如起搏器可以具有通过修改脉冲宽度和脉冲幅度中的一个或者两个来调节起搏脉冲能量以产生捕获的能力。起搏脉冲能量的相同改变可以在应用于使用不同电极组合的相同理疗时引起不同改变。确定捕获强度-持续时间标绘610除了其他方面之外还可以辅助表征设备参数限制、捕获阈值和/或膈刺激阈值之间的关系。
图6提供如下曲线图,这些曲线图图示了与非所需横膈膜激活关联的捕获强度-持续时间标绘610和膈刺激强度-持续时间标绘620。具有脉冲宽度W1的起搏脉冲要求脉冲幅度Vc1以产生捕获。具有脉冲宽度W1和脉冲幅度Vc1的起搏脉冲超过用于非所需横膈膜激活的电压阈值Vu1。如果脉冲宽度增加至W2,则捕获所需电压Vc2少于非所需横膈膜激活所需电压Vu2。因此,可以按照与W2关联的起搏能量Vc2来递送起搏脉冲以提供心脏的捕获而不引起膈刺激。
在膈刺激强度-持续时间标绘620与捕获强度-持续时间标绘610之间的、在捕获强度-持续时间标绘610和膈刺激强度-持续时间标绘620的交点651右边的区域限定产生捕获的能量参数值集合同时避免膈刺激。在该区域内的起搏脉冲产生最理想理疗反应(无非所需刺激的捕获)。
可以通过以各种幅度和脉冲宽度递送多个测试脉冲并且评估是否出现心脏捕获和非所需刺激来生成图6的捕获强度-持续时间标绘610和膈刺激强度-持续时间标绘620。然后可以通过例如基于指数拟合的内插和外插来完成捕获强度-持续时间标绘610和膈刺激强度-持续时间标绘620曲线。这样的方法可以使为了完全地表征脉冲参数与刺激之间的关系而需要的测试脉冲数目最小,由此使电池消耗和令人不适的测试最少。
外插和内插也可以允许在设备本身被编程或者能够进行的范围以外表征针对特定设备配置的在脉冲参数与刺激之间的关系。
虚线曲线640和680图示了设备能力起搏参数限制。最大值曲线640图示了设备能够递送的最大能量输出(基于脉冲幅度和宽度参数)。最大值曲线640展示了当尝试递送最大可能数量的能量时针对特定设备的脉冲参数折衷——牺牲脉冲幅度以求更大脉冲宽度。
最小值曲线680图示了设备能够递送的最小能量输出(基于脉冲幅度和宽度参数)。设备可以能够递送其幅度和脉冲宽度参数在曲线640与680之间的区域内的脉冲。
如图6中所示,特定设备可能不能递送具有将捕获目标心脏组织而不引起非所需刺激的任何特定幅度/宽度参数的起搏脉冲。
一般希望在捕获目标心脏组织而不引起非所需刺激的起搏脉冲参数范围与特定设备实际上能够递送的起搏脉冲参数范围之间具有最大量的重叠,因为重叠量反映可以用来实现预计理疗成果的参数的相对变化数量。
这里讨论的方法和设备可以有助于理解在设备参数限制、捕获阈值和/或膈刺激阈值之间的关系并且优化理疗。例如,图6的标绘的生成可以允许针对不同设备配置来比较在捕获目标心脏组织而不引起非所需刺激的脉冲参数范围与特定设备实际上能够递送的脉冲参数范围之间的重叠。医师(或者程序)可以选择使用重叠量最大的设备配置(例如,与矢量对应的电极组合),因为该配置将可能对应于在操作中的灵活度数量最大的配置,因为实现所需理疗成果的可能参数范围最大。
建立在设备参数限制、捕获阈值和/或膈刺激阈值之间的关系也可以辅助选择起搏参数。例如,当选择脉冲宽度参数时,医师可以查看与图6的标绘类似的标绘以选择幅度范围最大的脉冲宽度,该范围由最大设备参数曲线640、最小设备参数曲线680、非所需激活阈值曲线620和/或捕获阈值曲线610限制。类似地,可以基于哪个脉冲幅度与最大设备参数曲线640、最小设备参数曲线680、非所需激活阈值曲线620和/或捕获阈值曲线610内的最大脉冲宽度范围对应来选择脉冲幅度参数。以这一方式的参数选择可以由人类或者自动地由执行程序指令的处理器进行。
在通过整体引用结合于此、于2006年9月14日提交的公开号为2008/0071318的美国专利申请中描述了用于确定和使用强度-持续时间关系的方法和系统。
图6也图示了限定最大和最小脉冲宽度和幅度的编程参数限制690,设备被编程为在这些限制内操作。各种自动化设备特征可以比如利用自动捕获程序自动地改变脉冲参数以调节各种条件。医生可以实施编程参数限制690以保证设备未将参数自动地调节至可能有损于患者护理的水平,比如过早地用完电池或者有引起非所需刺激的风险的水平。
可以基于检测到的阈值水平在设备植入时对编程参数限制690预先编程或者设置。如果本发明的实施例标识在编程参数限制690、捕获强度-持续时间标绘610与膈刺激强度-持续时间标绘620之间的可变关系,则可以例如自动地或者在通知医生有改变之后调节编程参数限制690。编程参数限制690的调节可以增加最大脉冲幅度、减少最大脉冲幅度、增加最小脉冲幅度、减少最小脉冲幅度、增加最大脉冲持续时间、减少最大脉冲持续时间、增加最小脉冲持续时间和/或减少最小脉冲持续时间。以这样的方式,可以通过重新编程在设备能够递送的参数限制640和680内使编程参数限制范围(例如幅度范围)变宽、变窄和/或移位。可以类似地对这里讨论或者以别的方式已知的其他脉冲参数的其他脉冲参数限制重新编程。
在本发明的一些实施例中,在阈值与编程脉冲限制之间的可变关系的标识可以对使用脉冲参数增量和/或扫描技术的自动化过程(例如自动扫描)进行修改。例如,如果膈刺激强度-持续时间标绘620将与检测到的膈刺激阈值减少对应随时间减少,则自动捕获程序可以在编程参数限制690内操作时运用更小参数增量。取而代之,如果膈刺激强度-持续时间标绘620将与检测到的膈刺激阈值增加对应随时间增加,则自动捕获参数增量可以增加。增量增加可以有助于更快标识阈值等同时使测试脉冲递送最少。增量减少可以允许更谨慎和彻底的扫描。响应于在编程参数限制与阈值之间的关系改变而增加或者减少脉冲增量可以快速地优化自动化设备功能,同时平衡安全、功效和电池消耗考虑。参数增量的改变可以由设备在检测到编程参数限制与阈值之间的关系改变时自动地进行和/或由医生在查看与标识的关系改变有关的信息时实施。
在一些实施例中,可以定期地标识和更新捕获阈值和/或膈刺激阈值。如果在编程参数限制与一个或者两个阈值之间存在一些数量的参数间隔,则设备可以不那么频繁地重新测试以标识捕获阈值和/或膈刺激阈值。该间隔可以是在阈值与编程参数限制之间的预编程安全裕度。如果将检测到的阈值标识为在参数间隔内(例如,超过安全裕度),则设备可以增加它测试阈值的频率。基于检测到的阈值与编程参数限制的邻近度来增加和/或减少测试频率可以使电池消耗和令人不适的测试最少,同时平衡安全和功效考虑(即,当阈值可能将进入编程参数限制内更频繁地进行测试时,而当大裕度存在于阈值和编程限制之间时不那么频繁地进行测试)。
图7的流程图图示了用于除了其他方面之外还将膈刺激算法用于标识和表征设备参数限制、捕获阈值和/或膈刺激阈值之间的关系的过程700。过程700包括启动710捕获/阈值测试并且设置初始起搏参数。初始起搏参数设置可以例如是设备最小幅度、设备最小脉冲宽度、设备最小脉冲电流、先前确定的捕获阈值或者其一些组合。过程700还包括使用当前起搏参数设置来递送720至少一个起搏脉冲。如果首次进行步骤720,则当前起搏参数设置可以是初始起搏参数设置。另外,当前起搏参数设置可以是与初始设置值的参数值(例如,脉冲幅度)不同的参数值。
在递送720至少一个起搏脉冲之后,可以获得730膈刺感测器信号。这样的膈感测器信号可以是能够检测膈刺激的任何感测器所产生的任何信号。然后评估740膈感测器信号。评估740可以用来确定递送720的起搏脉冲是否刺激膈神经或者以别的方式引起横膈膜移动。如果检测到750膈刺激,则存储760膈刺激阈值/设备信息。这样的信息可以反映膈刺激阈值(PST)少于设备最大参数值,并且如果已经相应地设置和增加参数设置则可以等于设备参数最小值或者捕获阈值。
如果未检测到750膈刺激,则确定起搏参数设置是否设置于最大值770。在过程700的前数次迭代期间,起搏参数设置不可能设置于最大值770,并且在该情况下过程700递增790当前起搏脉冲参数并且返回到使用当前起搏参数设置来递送720至少一个更多起搏脉冲。以这一方式,过程700可以重复步骤720-730-740-750-770-790,从而以扫描方式在每次迭代时均增加起搏脉冲参数,直至标识750-760膈刺激阈值或者起搏参数设置达到最大值770。
如果起搏参数设置递增790至最大值770,则过程700存储780膈刺激阈值/设备信息。这样的膈刺激阈值/设备信息可以反映PST大于最大设备参数设置。
用于特定电极组合的捕获阈值和/或PST可以由于各种生理效果而随时间改变。可以定期地或者按照要求实施测试用于特定电极组合的捕获阈值和PST,以保证关于设备参数限制、捕获阈值和/或膈刺激阈值之间的关系的信息是当前的。
图8的流程图图示了用于除了其他方面之外还将膈刺激算法用于标识和表征设备参数限制、捕获阈值和/或膈刺激阈值之间的关系的过程800。过程800包括启动810捕获/阈值测试并且设置初始起搏参数。初始起搏参数设置可以例如是设备最大幅度、设备最大脉冲宽度、设备最大脉冲电流、先前确定的阈值或者其一些组合。过程800还包括使用当前起搏参数设置来递送820至少一个起搏脉冲。如果首次进行步骤820,则当前起搏参数设置可以是初始起搏参数设置。否则,当前起搏参数设置可以是与初始设置值的参数值(例如,脉冲宽度)不同的参数值。
在递送820至少一个起搏脉冲之后,可以获得830膈感测器信号。这样的膈感测器信号可以是能够检测膈刺激的任何感测器所产生的任何信号。然后评估840膈感测器信号。评估840可以用来确定递送820的起搏脉冲是否刺激膈神经。如果检测到850膈刺激,则存储860膈刺激阈值/设备信息。这样的信息可以反映PST大于或者等于设备最大参数值。
如果未检测到850膈刺激,则确定起搏参数设置是否设置于最小值和/或捕获阈值870。在过程800的前数次迭代期间,起搏参数设置不可能设置于最小值或者捕获阈值870,并且在该情况下过程800递减890当前起搏脉冲参数并且返回到使用当前起搏参数设置来递送820至少一个更多起搏脉冲。以这一方式,过程800可以重复步骤820-830-840-850-870-890,从而以扫描方式在每次迭代时均减少起搏脉冲参数,直至标识850-860膈刺激阈值或者起搏参数设置达到设备最小和/或捕获阈值870。在一些实施例中,可能希望不扫描在捕获阈值以下的膈刺激阈值,因为在测试期间失去心脏组织捕获可能是危险的。
如果起搏参数设置递减890至设备最小和/或捕获阈值870,则过程800存储880膈刺激阈值/设备信息。这样的膈刺激阈值/设备信息可以反映PST少于最小设备参数设置和/或心脏捕获阈值。如果测试无法对产生捕获的起搏参数进行标识并且避免膈刺激,则可以经由通信电路向外部设备传达报警以向系统或者医师告警。
图9的流程图图示了用于除了其他方面之外还将膈刺激算法用于标识和表征设备参数限制、捕获阈值和/或膈刺激阈值之间的关系的过程900。过程900包括启动910捕获/阈值测试并且设置初始起搏参数。初始起搏参数设置可以例如是设备最大幅度、设备最大脉冲宽度、设备最大脉冲电流、先前确定的阈值或者其一些组合。过程900还包括使用当前起搏参数设置来递送920至少一个起搏脉冲。如果首次进行步骤920,则当前起搏参数设置可以是初始起搏参数设置。否则,当前起搏参数设置可以是与初始设置值的参数值(例如,脉冲幅度)不同的参数值。
在递送920至少一个起搏脉冲之后,可以获得930膈感测器信号和心脏感测器信号。这样的膈和心脏感测器信号可以是能够检测膈刺激或者检测心脏捕获的感测器所产生的任何信号。然后评估940膈感测器信号和心脏感测器信号。评估940可以用来确定945递送920的起搏脉冲是否刺激膈神经。如果检测到945膈刺激,则过程900确定在递送920一个或者多个起搏脉冲期间是否失去捕获946。
如果检测到膈刺激945和失去心脏捕获946,则可以存储970心脏捕获和膈刺激阈值/设备信息。这样的信息可以反映膈刺激阈值PST少于捕获阈值。
如果检测到945膈刺激而未检测到失去捕获946,则递减980当前起搏脉冲参数。例如,如果起搏脉冲参数是脉冲宽度,则当前脉冲宽度可以递减980成更短脉冲宽度。可以类似地递减(或者在逐步增加实施例中为递增)脉冲幅度、频率和/或当前脉冲参数。
如果未检测到945膈刺激,过程900确定是否检测到950失去捕获。如果未检测到945膈刺激并且检测到950失去捕获,则存储960捕获和膈刺激阈值/设备信息。这样的信息可以表明膈刺激阈值大于或者等于捕获阈值。
以这一方式,过程900可以重复步骤920-930-940-945-946-980或者步骤920-930-940-945-950,从而以扫描方式在每次迭代时减少起搏脉冲参数,直至标识膈刺激阈值与捕获阈值之间的关系(例如,PST≥捕获阈值或者PST<捕获阈值)。这样的过程允许同时扫描膈刺激阈值和心脏捕获阈值。将这些参数一起搜索与单独地完成测试相比使需要递送的脉冲数目最小,从而节约电池能量并且使患者不适感最少。以这一方式的同时扫描也使设备为了测试以建立这些阈值而必需的总时间最少。
过程700、800和900以及这里讨论的其他方法可以在植入时由医师、在检测到条件改变时和/或定期地启动。可以启动过程的条件改变例如包括失去捕获、姿态改变、疾病状态改变、检测到非理疗激活和/或患者活动状态的短期或者长期改变。
图示的700、800和900的设备参数限制以及这里讨论的其他设备参数限制可以是编程参数限制或者与起搏系统能够递送的最大/最小脉冲参数值对应的参数限制。
用于更新捕获阈值、膈刺激阈值与设备关系信息的定期和/或按条件启动的测试可以用于监视否则会不显而易见、但是证实需要注意和/或理疗改变的某些条件。设备和/或生理改变可以改变起搏脉冲的效果。例如,设备部件缺陷、引线迁移、电极封装和/或生理改变可能增加为了可靠地产生捕获而需要的起搏脉冲幅度和/或减少为了刺激膈神经而需要的起搏脉冲幅度,从而造成令人不适和无效的起搏理疗。更新的捕获阈值、膈刺激阈值和设备关系信息可以用来自动地对理疗设备重新编程和/或警告医师重新配置理疗设备。
可以使用配置成进行这里讨论的各过程的单个设备实施例(例如,图2和图4的设备)来进行这里图示和/或描述的各种过程(例如,图1、图5、图7、图8和图9的过程和与图6关联的过程)。
这里描绘的部件、功能和结构配置旨在于提供对可以并入于可植入起搏器/去心脏纤颤器中的各种特征和特征组合的理解。理解到设想从相对复杂到相对简单设计的广泛多种心脏监视和/或刺激设备配置。这样,特定心脏设备配置可以包括如这里描述的特定特征,而其他这样的设备配置可以排除这里描述的特定特征。
可以对上文讨论的优选实施例进行各种修改和添加而不脱离本发明的范围。因而,本发明的范围不应受上述具体实施例限制,但是应当仅由所附权利要求书及其等效含义限定。
Claims (25)
1.一种方法,包括:
使用心脏起搏设备来递送多个心脏起搏脉冲,所述多个心脏起搏脉冲的起搏参数在所述脉冲中的至少一些脉冲的递送之间改变;
评估一个或者多个感测器信号以检测所述多个心脏起搏脉冲中的一个或者多个心脏起搏脉冲对膈神经的刺激;以及
对所述一个或者多个感测器信号的评估与所述多个心脏起搏脉冲中的一个或者多个心脏起搏脉冲的所述起搏参数进行比较以确定膈刺激阈值是否是高于最大设备参数和低于最小设备参数中的至少一个。
2.根据权利要求1所述的方法,其中所述最大设备参数是所述心脏起搏设备被编程为递送的起搏脉冲的最大幅度或者宽度,并且所述最小设备参数是所述心脏起搏设备被编程为递送的起搏脉冲的最小幅度或者宽度。
3.根据权利要求1所述的方法,其中递送所述多个心脏起搏脉冲包括在所述至少一些脉冲的递送之间增加用于所述多个心脏起搏脉冲中的一个或者多个心脏起搏脉冲的起搏脉冲幅度或者宽度参数,直至检测到所述膈刺激阈值中的至少一个膈刺激阈值并且以所述设备被编程为递送的最大幅度或者宽度递送心脏起搏脉冲。
4.根据权利要求1所述的方法,其中递送所述多个心脏起搏脉冲包括递送其幅度或者宽度参数在所述心脏捕获阈值或者在所述心脏捕获阈值之上的初始起搏脉冲,并且在所述至少一些脉冲的递送之间增加用于所述多个心脏起搏脉冲中的一个或者多个心脏起搏脉冲的所述起搏脉冲幅度或者宽度,直至检测到所述膈刺激阈值中的至少一个膈刺激阈值并且以所述设备被编程为递送的最大幅度或者宽度递送心脏起搏脉冲。
5.根据权利要求1所述的方法,其中递送所述多个心脏起搏脉冲包括递送其幅度或者宽度为编程设备最小值的初始起搏脉冲,并且在所述至少一些脉冲的递送之间增加用于所述多个心脏起搏脉冲中的一个或者多个心脏起搏脉冲的所述起搏脉冲幅度或者宽度,直至检测到所述膈刺激阈值中的至少一个膈刺激阈值并且以所述设备被编程为递送的最大幅度或者宽度递送心脏起搏脉冲。
6.根据权利要求1所述的方法,其中递送所述多个心脏起搏脉冲包括在所述至少一些脉冲的递送之间减少用于所述多个心脏起搏脉冲中的一个或者多个心脏起搏脉冲的起搏脉冲幅度或者宽度参数,直至所述起搏脉冲幅度或者宽度参数减少至所述设备被编程为递送的所述心脏捕获阈值和所述最小设备幅度或者宽度中的至少一个。
7.根据权利要求1所述的方法,还包括基于确定所述膈刺激阈值是高于所述最大设备参数和低于所述最小设备参数中的至少一个,对所述最大设备参数和所述最小设备参数中的一个或者两个重新编程。
8.根据权利要求1所述的方法,还包括建立包括所述最大设备参数和所述最小设备参数的参数范围限制,其中递送其起搏参数在所述参数范围限制以外的所述多个心脏起搏脉冲中的至少一个心脏起搏脉冲。
9.根据权利要求8所述的方法,还包括基于对所述一个或者多个感测器信号的评估与所述起搏参数在所述参数范围限制以外的所述至少一个心脏起搏脉冲的所述起搏参数进行的比较,改变所述参数范围限制。
10.根据权利要求1所述的方法,还包括基于对所述一个或者多个感测器信号的评估与所述多个心脏起搏脉冲中的一个或者多个心脏起搏脉冲的所述起搏参数进行的比较,针对在所述脉冲中的所述至少一些脉冲的递送之间改变的所述多个心脏起搏脉冲的所述起搏参数改变递增值和递减值中的一个或者两个。
11.根据权利要求1所述的方法,还包括基于对所述一个或者多个感测器信号的评估与所述多个心脏起搏脉冲中的一个或者多个心脏起搏脉冲的所述起搏参数进行的比较,标识在各所述膈刺激阈值、所述最大设备参数、所述最小设备参数和所述心脏捕获阈值之间的相对关系。
12.根据权利要求9所述的方法,还包括选择用于递送与理疗关联的起搏脉冲的脉冲幅度或者宽度参数范围,所述脉冲幅度或者宽度参数范围的选择基于所述标识的在所述膈刺激阈值、所述最大设备参数、所述最小设备参数和所述心脏捕获阈值之间的关系。
13.一种心率管理系统,包括:
可植入心脏起搏设备,具有多个电极;
电路,配置成通过所述电极输出多个心脏起搏脉冲并且修改所述多个心脏起搏脉冲的一个或者多个起搏参数;
一个或者多个感测器,配置成感测所述多个起搏脉冲中的一个或者多个起搏脉冲对膈神经的刺激并且基于所述感测的膈刺激来提供一个或者多个信号;以及
控制器,配置成执行存储器中存储的程序指令以使所述系统对所述一个或者多个信号与所述一个或者多个起搏参数进行比较以确定膈刺激阈值是否是高于最大心脏起搏参数和低于最小心脏起搏参数中的至少一个,并且基于所述确定来存储信息。
14.根据权利要求13所述的心率管理系统,其中所述最大心脏起搏参数是所述心脏起搏设备被编程为递送的最大起搏脉冲幅度或者宽度,并且所述最小心脏起搏参数是所述心脏起搏设备被编程为递送的最小起搏脉冲幅度或者宽度。
15.根据权利要求13所述的心率管理系统,其中所述控制器还被配置成执行存储的程序指令以使所述系统在所述多个心脏起搏脉冲中的至少一些心脏起搏脉冲的递送之间增加用于所述多个心脏起搏脉冲中的一个或者多个心脏起搏脉冲的起搏脉冲幅度或者宽度参数,直至检测到所述膈刺激阈值中的至少一个膈刺激阈值并且以所述心脏起搏设备被编程为递送的最大幅度或者宽度递送心脏起搏脉冲。
16.根据权利要求13所述的心率管理系统,其中所述控制器还被配置成执行存储的程序指令以使所述系统通过所述电极递送幅度或者宽度在所述心脏捕获阈值或者在所述心脏捕获阈值以上的初始起搏脉冲,并且在所述多个心脏起搏脉冲中的至少一些心脏起搏脉冲的递送之间增加用于所述多个心脏起搏脉冲中的一个或者多个心脏起搏脉冲的所述起搏脉冲幅度或者宽度,直至检测到所述膈刺激阈值中的至少一个膈刺激阈值并且以所述心脏起搏设备被编程为递送的最大幅度或者宽度递送心脏起搏脉冲。
17.根据权利要求13所述的心率管理系统,其中所述控制器还被配置成执行存储的程序指令以使所述系统递送幅度或者宽度为编程最小水平的初始起搏脉冲,并且在所述多个心脏起搏脉冲中的至少一些心脏起搏脉冲的递送之间增加用于所述多个心脏起搏脉冲中的一个或者多个心脏起搏脉冲的所述起搏脉冲幅度或者宽度,直至检测到所述膈刺激阈值中的至少一个膈刺激阈值并且以所述心脏起搏设备被编程为递送的最大幅度或者宽度递送心脏起搏脉冲。
18.根据权利要求13所述的心率管理系统,其中所述控制器还被配置成执行存储的程序指令以使所述系统在所述多个心脏起搏脉冲中的至少一些心脏起搏脉冲的递送之间减少用于所述多个心脏起搏脉冲中的一个或者多个心脏起搏脉冲的起搏脉冲幅度或者宽度参数,直至所述起搏脉冲幅度或者宽度参数减少至所述心脏起搏设备被编程为递送的所述心脏捕获阈值和所述最小心脏起搏幅度或者宽度参数中的至少一个。
19.根据权利要求13所述的心率管理系统,其中所述控制器还被配置成执行存储的程序指令以使所述系统标识在各所述膈刺激阈值、所述最大心脏起搏参数、所述最小心脏起搏参数和所述心脏捕获阈值之间的相对关系。
20.根据权利要求19所述的心率管理系统,其中所述控制器还被配置成执行存储的程序指令以使所述系统选择用于递送与理疗关联的心脏起搏脉冲的脉冲幅度或者宽度参数范围,所述脉冲幅度或者宽度参数范围的选择基于所述标识的在所述膈刺激阈值、所述最大心脏起搏参数、所述最小心脏起搏参数和所述心脏捕获阈值之间的关系。
21.根据权利要求13所述的心率管理系统,其中所述控制器还被配置成执行存储的程序指令以使所述系统基于确定所述膈刺激阈值是高于所述最大心脏起搏参数和低于所述最小心脏起搏参数中的至少一个,对所述最大心脏起搏参数和所述最小心脏起搏参数中的一个或者两个重新编程。
22.根据权利要求13所述的心率管理系统,其中所述控制器还被配置成执行存储的程序指令以使所述系统选择包括所述最大心脏起搏参数和所述最小心脏起搏参数的参数范围限制,并且递送其起搏参数在所述参数范围限制以外的所述多个心脏起搏脉冲中的至少一个心脏起搏脉冲。
23.根据权利要求22所述的心率管理系统,其中所述控制器还被配置成执行存储的程序指令以使所述系统基于对所述一个或者多个感测器信号与所述起搏参数在所述参数范围限制以外的所述至少一个心脏起搏脉冲的所述起搏参数进行的比较,改变所述参数范围限制。
24.根据权利要求13所述的心率管理系统,其中所述控制器还被配置成执行存储的程序指令以使所述系统基于对所述一个或者多个感测器信号的评估与所述多个心脏起搏脉冲中的一个或者多个心脏起搏脉冲的所述起搏参数进行的比较,针对在所述脉冲中的至少一些脉冲的递送之间改变的所述多个心脏起搏脉冲的所述起搏参数改变递增值和递减值中的一个或者两个。
25.一种心率管理系统,包括:
可植入心脏起搏设备,具有多个电极;
用于通过所述多个电极递送多个心脏起搏脉冲并且修改所述多个心脏起搏脉冲的一个或者多个起搏参数的装置;
用于感测所述多个起搏脉冲中的一个或者多个起搏脉冲对膈神经的刺激并且基于所述感测的膈刺激来提供一个或者多个信号的装置;以及
用于对所述一个或者多个感测器信号的评估与所述一个或者多个起搏参数进行比较以确定膈刺激阈值是否是高于最大编程设备参数和低于最小编程设备参数中的至少一个的装置。
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US6574308P | 2008-02-14 | 2008-02-14 | |
US61/065,743 | 2008-02-14 | ||
PCT/US2009/033687 WO2009102726A1 (en) | 2008-02-14 | 2009-02-10 | Method and apparatus for phrenic stimulation detection |
Publications (2)
Publication Number | Publication Date |
---|---|
CN101939051A true CN101939051A (zh) | 2011-01-05 |
CN101939051B CN101939051B (zh) | 2013-07-10 |
Family
ID=40409905
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
CN2009801046067A Expired - Fee Related CN101939051B (zh) | 2008-02-14 | 2009-02-10 | 用于膈刺激检测的方法和装置 |
Country Status (6)
Country | Link |
---|---|
US (4) | US8649866B2 (zh) |
EP (1) | EP2254661B1 (zh) |
JP (1) | JP5276119B2 (zh) |
CN (1) | CN101939051B (zh) |
AU (1) | AU2009214920B2 (zh) |
WO (1) | WO2009102726A1 (zh) |
Cited By (10)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
CN102908146A (zh) * | 2011-08-04 | 2013-02-06 | 罗远明 | 刺激膈神经对膈肌功能检测管进行定位的方法 |
CN104968393A (zh) * | 2012-12-06 | 2015-10-07 | 美敦力公司 | 用于基于所感测的信号的正偏转是否在该信号的负偏转之前的判定而确定捕获的装置 |
CN105873635A (zh) * | 2013-10-25 | 2016-08-17 | 美敦力公司 | 用于自动化膈神经刺激和起搏夺获阈值测试的装置 |
CN106232178A (zh) * | 2014-02-20 | 2016-12-14 | 美敦力公司 | 自动化膈神经刺激和起搏夺获阈值测试 |
CN109745619A (zh) * | 2019-01-23 | 2019-05-14 | 深圳大学 | 心脏起搏器控制系统和控制方法 |
CN109805911A (zh) * | 2014-01-21 | 2019-05-28 | 隆佩瑟尔医疗公司 | 用于优化多电极神经起搏的系统及相关方法 |
CN110072449A (zh) * | 2016-11-16 | 2019-07-30 | 纳维斯国际有限公司 | 通过电标测进行的食道位置检测 |
CN110740780A (zh) * | 2017-06-16 | 2020-01-31 | 心脏起搏器股份公司 | 心力衰竭治疗的动态控制 |
CN111526797A (zh) * | 2017-12-07 | 2020-08-11 | 美敦力公司 | 基于传感器的膈神经刺激检测 |
CN113398475A (zh) * | 2014-03-20 | 2021-09-17 | 美敦力公司 | 膈神经刺激的非侵入式检测 |
Families Citing this family (125)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20060247693A1 (en) | 2005-04-28 | 2006-11-02 | Yanting Dong | Non-captured intrinsic discrimination in cardiac pacing response classification |
US8265736B2 (en) | 2007-08-07 | 2012-09-11 | Cardiac Pacemakers, Inc. | Method and apparatus to perform electrode combination selection |
US9037239B2 (en) | 2007-08-07 | 2015-05-19 | Cardiac Pacemakers, Inc. | Method and apparatus to perform electrode combination selection |
EP2254661B1 (en) | 2008-02-14 | 2015-10-07 | Cardiac Pacemakers, Inc. | Apparatus for phrenic stimulation detection |
US8886313B2 (en) | 2009-07-02 | 2014-11-11 | Cardiac Pacemakers Inc. | Systems and methods for ranking and selection of pacing vectors |
JP5745617B2 (ja) * | 2010-04-29 | 2015-07-08 | カーディアック ペースメイカーズ, インコーポレイテッド | ポート使用状況に基づく植込み型医療機器の構成 |
EP2575961B1 (en) * | 2010-06-03 | 2018-08-29 | Cardiac Pacemakers, Inc. | System for spatially selective vagus nerve stimulation |
US8876727B2 (en) * | 2011-05-19 | 2014-11-04 | Medtronic, Inc. | Phrenic nerve stimulation detection using heart sounds |
US8954160B2 (en) | 2011-09-02 | 2015-02-10 | Medtronic, Inc. | Detection of extracardiac stimulation by a cardiac rhythm management device |
US9724018B2 (en) | 2011-10-27 | 2017-08-08 | Medtronic Cryocath Lp | Method for monitoring phrenic nerve function |
US9199087B2 (en) | 2011-11-21 | 2015-12-01 | Medtronic, Inc. | Apparatus and method for selecting a preferred pacing vector in a cardiac resynchronization device |
US9031651B2 (en) | 2012-03-27 | 2015-05-12 | Cardiac Pacemakers, Inc. | Phrenic nerve stimulation detection |
EP2830705B1 (en) * | 2012-03-27 | 2016-05-11 | Cardiac Pacemakers, Inc. | Determination of phrenic nerve stimulation threshold |
US8958876B2 (en) | 2012-03-27 | 2015-02-17 | Cardiac Pacemakers, Inc. | Determination of phrenic nerve stimulation threshold |
US10413203B2 (en) | 2012-03-27 | 2019-09-17 | Cardiac Pacemakers, Inc. | Baseline determination for phrenic nerve stimulation detection |
US9295843B2 (en) | 2012-05-18 | 2016-03-29 | Cardiac Pacemakers, Inc. | Automatic pacing configuration switcher |
US8965507B2 (en) | 2012-07-02 | 2015-02-24 | Cardiac Pacemakers, Inc. | System and method for selection of pacing vectors |
US9272151B2 (en) | 2012-07-12 | 2016-03-01 | Cardiac Pacemakers, Inc. | Adaptive phrenic nerve stimulation detection |
US9421383B2 (en) | 2013-03-13 | 2016-08-23 | Cardiac Pacemakers, Inc. | Ambulatory phrenic nerve stimulation detection |
US9211415B2 (en) | 2013-03-13 | 2015-12-15 | Cardiac Pacemakers, Inc. | Phrenic nerve stimulation detection with posture sensing |
US20140277279A1 (en) * | 2013-03-15 | 2014-09-18 | Cvrx, Inc. | Methods And Associated Algorithms For Programming A Baroreflex Activation Therapy Device |
US20140309538A1 (en) * | 2013-04-10 | 2014-10-16 | Pacesetter, Inc. | Apparatus and method for detecting phrenic nerve stimulation |
US10064564B2 (en) | 2013-08-23 | 2018-09-04 | Medtronic Cryocath Lp | Method of CMAP monitoring |
US9604065B2 (en) | 2013-08-30 | 2017-03-28 | Cardiac Pacemakers, Inc. | Unwanted stimulation detection during cardiac pacing |
US9533159B2 (en) | 2013-08-30 | 2017-01-03 | Cardiac Pacemakers, Inc. | Unwanted stimulation detection during cardiac pacing |
WO2015095581A1 (en) | 2013-12-18 | 2015-06-25 | Cardiac Pacemakers, Inc. | Systems and methods for facilitating selecting of one or more vectors in a medical device |
CN105848711A (zh) | 2013-12-18 | 2016-08-10 | 心脏起搏器股份公司 | 促进用于将电刺激输送到病人的矢量的选择的方法 |
US9750942B2 (en) | 2013-12-18 | 2017-09-05 | Cardiac Pacemakers, Inc. | Systems and methods for determining parameters for each of a plurality of vectors |
EP3308833B1 (en) | 2014-01-10 | 2019-06-26 | Cardiac Pacemakers, Inc. | Methods and systems for improved communication between medical devices |
WO2015106015A1 (en) | 2014-01-10 | 2015-07-16 | Cardiac Pacemakers, Inc. | Systems and methods for detecting cardiac arrhythmias |
US9555250B2 (en) | 2014-02-20 | 2017-01-31 | Medtronic, Inc. | Automated phrenic nerve stimulation and pacing capture threshold test |
US9498631B2 (en) * | 2014-02-20 | 2016-11-22 | Medtronic, Inc. | Automated phrenic nerve stimulation and pacing capture threshold test |
US9707401B2 (en) | 2014-07-30 | 2017-07-18 | Cardiac Pacemakers, Inc. | Pacing site and configuration optimization using a combination of electrical and mechanical information |
US9707400B2 (en) * | 2014-08-15 | 2017-07-18 | Medtronic, Inc. | Systems, methods, and interfaces for configuring cardiac therapy |
WO2016033177A1 (en) | 2014-08-28 | 2016-03-03 | Cardiac Pacemakers, Inc. | Energy adaptive communication for medical devices |
EP3185952B1 (en) | 2014-08-28 | 2018-07-25 | Cardiac Pacemakers, Inc. | Implantable cardiac rhythm system and an associated method for triggering a blanking period through a second device |
WO2016126613A1 (en) | 2015-02-06 | 2016-08-11 | Cardiac Pacemakers, Inc. | Systems and methods for treating cardiac arrhythmias |
WO2016126968A1 (en) | 2015-02-06 | 2016-08-11 | Cardiac Pacemakers, Inc. | Systems and methods for safe delivery of electrical stimulation therapy |
US10046167B2 (en) | 2015-02-09 | 2018-08-14 | Cardiac Pacemakers, Inc. | Implantable medical device with radiopaque ID tag |
CN107530002B (zh) | 2015-03-04 | 2021-04-30 | 心脏起搏器股份公司 | 用于治疗心律失常的系统和方法 |
CN107427222B (zh) | 2015-03-18 | 2021-02-09 | 心脏起搏器股份公司 | 使用链路质量评估的医疗设备系统中的通信 |
US10050700B2 (en) | 2015-03-18 | 2018-08-14 | Cardiac Pacemakers, Inc. | Communications in a medical device system with temporal optimization |
CN108136186B (zh) | 2015-08-20 | 2021-09-17 | 心脏起搏器股份公司 | 用于医疗装置之间的通信的系统和方法 |
EP3337559B1 (en) | 2015-08-20 | 2019-10-16 | Cardiac Pacemakers, Inc. | Systems and methods for communication between medical devices |
US9968787B2 (en) | 2015-08-27 | 2018-05-15 | Cardiac Pacemakers, Inc. | Spatial configuration of a motion sensor in an implantable medical device |
US9956414B2 (en) | 2015-08-27 | 2018-05-01 | Cardiac Pacemakers, Inc. | Temporal configuration of a motion sensor in an implantable medical device |
EP3341076B1 (en) | 2015-08-28 | 2022-05-11 | Cardiac Pacemakers, Inc. | Systems and methods for behaviorally responsive signal detection and therapy delivery |
WO2017040115A1 (en) | 2015-08-28 | 2017-03-09 | Cardiac Pacemakers, Inc. | System for detecting tamponade |
US10226631B2 (en) | 2015-08-28 | 2019-03-12 | Cardiac Pacemakers, Inc. | Systems and methods for infarct detection |
WO2017044389A1 (en) | 2015-09-11 | 2017-03-16 | Cardiac Pacemakers, Inc. | Arrhythmia detection and confirmation |
EP3359251B1 (en) | 2015-10-08 | 2019-08-07 | Cardiac Pacemakers, Inc. | Adjusting pacing rates in an implantable medical device |
US10183170B2 (en) | 2015-12-17 | 2019-01-22 | Cardiac Pacemakers, Inc. | Conducted communication in a medical device system |
US10905886B2 (en) | 2015-12-28 | 2021-02-02 | Cardiac Pacemakers, Inc. | Implantable medical device for deployment across the atrioventricular septum |
WO2017127548A1 (en) | 2016-01-19 | 2017-07-27 | Cardiac Pacemakers, Inc. | Devices for wirelessly recharging a rechargeable battery of an implantable medical device |
EP3411113B1 (en) | 2016-02-04 | 2019-11-27 | Cardiac Pacemakers, Inc. | Delivery system with force sensor for leadless cardiac device |
CN108883286B (zh) | 2016-03-31 | 2021-12-07 | 心脏起搏器股份公司 | 具有可充电电池的可植入医疗设备 |
US10328272B2 (en) | 2016-05-10 | 2019-06-25 | Cardiac Pacemakers, Inc. | Retrievability for implantable medical devices |
US10668294B2 (en) | 2016-05-10 | 2020-06-02 | Cardiac Pacemakers, Inc. | Leadless cardiac pacemaker configured for over the wire delivery |
US10512784B2 (en) | 2016-06-27 | 2019-12-24 | Cardiac Pacemakers, Inc. | Cardiac therapy system using subcutaneously sensed P-waves for resynchronization pacing management |
US11207527B2 (en) | 2016-07-06 | 2021-12-28 | Cardiac Pacemakers, Inc. | Method and system for determining an atrial contraction timing fiducial in a leadless cardiac pacemaker system |
US10426962B2 (en) | 2016-07-07 | 2019-10-01 | Cardiac Pacemakers, Inc. | Leadless pacemaker using pressure measurements for pacing capture verification |
WO2018017226A1 (en) | 2016-07-20 | 2018-01-25 | Cardiac Pacemakers, Inc. | System for utilizing an atrial contraction timing fiducial in a leadless cardiac pacemaker system |
EP3500342B1 (en) | 2016-08-19 | 2020-05-13 | Cardiac Pacemakers, Inc. | Trans-septal implantable medical device |
WO2018039322A1 (en) | 2016-08-24 | 2018-03-01 | Cardiac Pacemakers, Inc. | Cardiac resynchronization using fusion promotion for timing management |
CN109640809B (zh) | 2016-08-24 | 2021-08-17 | 心脏起搏器股份公司 | 使用p波到起搏定时的集成式多装置心脏再同步治疗 |
CN109803720B (zh) | 2016-09-21 | 2023-08-15 | 心脏起搏器股份公司 | 具有容纳其内部部件并充当电池壳和内部电池的端子的壳体的无引线刺激设备 |
WO2018057626A1 (en) | 2016-09-21 | 2018-03-29 | Cardiac Pacemakers, Inc. | Implantable cardiac monitor |
US10758737B2 (en) | 2016-09-21 | 2020-09-01 | Cardiac Pacemakers, Inc. | Using sensor data from an intracardially implanted medical device to influence operation of an extracardially implantable cardioverter |
US10413733B2 (en) | 2016-10-27 | 2019-09-17 | Cardiac Pacemakers, Inc. | Implantable medical device with gyroscope |
US10463305B2 (en) | 2016-10-27 | 2019-11-05 | Cardiac Pacemakers, Inc. | Multi-device cardiac resynchronization therapy with timing enhancements |
WO2018081225A1 (en) | 2016-10-27 | 2018-05-03 | Cardiac Pacemakers, Inc. | Implantable medical device delivery system with integrated sensor |
US10434314B2 (en) | 2016-10-27 | 2019-10-08 | Cardiac Pacemakers, Inc. | Use of a separate device in managing the pace pulse energy of a cardiac pacemaker |
JP7038115B2 (ja) | 2016-10-27 | 2022-03-17 | カーディアック ペースメイカーズ, インコーポレイテッド | 圧力センサを備えた植込み型医療装置 |
US10561330B2 (en) | 2016-10-27 | 2020-02-18 | Cardiac Pacemakers, Inc. | Implantable medical device having a sense channel with performance adjustment |
US10434317B2 (en) | 2016-10-31 | 2019-10-08 | Cardiac Pacemakers, Inc. | Systems and methods for activity level pacing |
US10617874B2 (en) | 2016-10-31 | 2020-04-14 | Cardiac Pacemakers, Inc. | Systems and methods for activity level pacing |
WO2018089311A1 (en) | 2016-11-08 | 2018-05-17 | Cardiac Pacemakers, Inc | Implantable medical device for atrial deployment |
EP3538213B1 (en) | 2016-11-09 | 2023-04-12 | Cardiac Pacemakers, Inc. | Systems and devices for setting cardiac pacing pulse parameters for a cardiac pacing device |
US10639479B2 (en) * | 2016-11-11 | 2020-05-05 | Medtronic, Inc. | Stimulation vector selection using pulse width data |
US10881863B2 (en) | 2016-11-21 | 2021-01-05 | Cardiac Pacemakers, Inc. | Leadless cardiac pacemaker with multimode communication |
US11147979B2 (en) | 2016-11-21 | 2021-10-19 | Cardiac Pacemakers, Inc. | Implantable medical device with a magnetically permeable housing and an inductive coil disposed about the housing |
US10639486B2 (en) | 2016-11-21 | 2020-05-05 | Cardiac Pacemakers, Inc. | Implantable medical device with recharge coil |
US10881869B2 (en) | 2016-11-21 | 2021-01-05 | Cardiac Pacemakers, Inc. | Wireless re-charge of an implantable medical device |
US10894163B2 (en) | 2016-11-21 | 2021-01-19 | Cardiac Pacemakers, Inc. | LCP based predictive timing for cardiac resynchronization |
US11207532B2 (en) | 2017-01-04 | 2021-12-28 | Cardiac Pacemakers, Inc. | Dynamic sensing updates using postural input in a multiple device cardiac rhythm management system |
EP3573706A1 (en) | 2017-01-26 | 2019-12-04 | Cardiac Pacemakers, Inc. | Intra-body device communication with redundant message transmission |
WO2018140623A1 (en) | 2017-01-26 | 2018-08-02 | Cardiac Pacemakers, Inc. | Leadless device with overmolded components |
US10737102B2 (en) | 2017-01-26 | 2020-08-11 | Cardiac Pacemakers, Inc. | Leadless implantable device with detachable fixation |
US10905872B2 (en) | 2017-04-03 | 2021-02-02 | Cardiac Pacemakers, Inc. | Implantable medical device with a movable electrode biased toward an extended position |
US10821288B2 (en) | 2017-04-03 | 2020-11-03 | Cardiac Pacemakers, Inc. | Cardiac pacemaker with pacing pulse energy adjustment based on sensed heart rate |
US10993659B2 (en) * | 2017-06-01 | 2021-05-04 | Biosense Webster (Israel) Ltd. | Automatic detection of phrenic nerve stimulation |
US10918875B2 (en) | 2017-08-18 | 2021-02-16 | Cardiac Pacemakers, Inc. | Implantable medical device with a flux concentrator and a receiving coil disposed about the flux concentrator |
WO2019036600A1 (en) | 2017-08-18 | 2019-02-21 | Cardiac Pacemakers, Inc. | IMPLANTABLE MEDICAL DEVICE WITH PRESSURE SENSOR |
US20190076660A1 (en) * | 2017-09-11 | 2019-03-14 | Pacesetter, Inc. | Systems and methods for normalizing cardiac electrical conditions of measured hemodynamic variations for use in cardiac pacing device optimization processes |
US11723579B2 (en) | 2017-09-19 | 2023-08-15 | Neuroenhancement Lab, LLC | Method and apparatus for neuroenhancement |
CN111107899B (zh) | 2017-09-20 | 2024-04-02 | 心脏起搏器股份公司 | 具有多种操作模式的可植入医疗装置 |
US11185703B2 (en) | 2017-11-07 | 2021-11-30 | Cardiac Pacemakers, Inc. | Leadless cardiac pacemaker for bundle of his pacing |
WO2019108830A1 (en) | 2017-12-01 | 2019-06-06 | Cardiac Pacemakers, Inc. | Leadless cardiac pacemaker with reversionary behavior |
EP3717059A1 (en) | 2017-12-01 | 2020-10-07 | Cardiac Pacemakers, Inc. | Methods and systems for detecting atrial contraction timing fiducials within a search window from a ventricularly implanted leadless cardiac pacemaker |
US11260216B2 (en) | 2017-12-01 | 2022-03-01 | Cardiac Pacemakers, Inc. | Methods and systems for detecting atrial contraction timing fiducials during ventricular filling from a ventricularly implanted leadless cardiac pacemaker |
EP3717063B1 (en) | 2017-12-01 | 2023-12-27 | Cardiac Pacemakers, Inc. | Systems for detecting atrial contraction timing fiducials and determining a cardiac interval from a ventricularly implanted leadless cardiac pacemaker |
US11717686B2 (en) | 2017-12-04 | 2023-08-08 | Neuroenhancement Lab, LLC | Method and apparatus for neuroenhancement to facilitate learning and performance |
US11478603B2 (en) | 2017-12-31 | 2022-10-25 | Neuroenhancement Lab, LLC | Method and apparatus for neuroenhancement to enhance emotional response |
US10874861B2 (en) | 2018-01-04 | 2020-12-29 | Cardiac Pacemakers, Inc. | Dual chamber pacing without beat-to-beat communication |
US11529523B2 (en) | 2018-01-04 | 2022-12-20 | Cardiac Pacemakers, Inc. | Handheld bridge device for providing a communication bridge between an implanted medical device and a smartphone |
US10881861B2 (en) | 2018-01-10 | 2021-01-05 | Medtronic, Inc. | Adaptive cardiac resynchronization therapy |
US11123566B2 (en) | 2018-01-10 | 2021-09-21 | Medtronic, Inc. | Cardiac resynchronization therapy diagnostics |
US10668291B2 (en) | 2018-03-06 | 2020-06-02 | Medtronic, Inc. | Impingement detection for implantable medical devices |
EP3768369A1 (en) | 2018-03-23 | 2021-01-27 | Medtronic, Inc. | Av synchronous vfa cardiac therapy |
CN111902187A (zh) | 2018-03-23 | 2020-11-06 | 美敦力公司 | Vfa心脏再同步治疗 |
WO2019183514A1 (en) | 2018-03-23 | 2019-09-26 | Medtronic, Inc. | Vfa cardiac therapy for tachycardia |
US11364361B2 (en) | 2018-04-20 | 2022-06-21 | Neuroenhancement Lab, LLC | System and method for inducing sleep by transplanting mental states |
EP3849410A4 (en) | 2018-09-14 | 2022-11-02 | Neuroenhancement Lab, LLC | SLEEP ENHANCEMENT SYSTEM AND METHOD |
EP3856331A1 (en) | 2018-09-26 | 2021-08-04 | Medtronic, Inc. | Capture in ventricle-from-atrium cardiac therapy |
US11679265B2 (en) | 2019-02-14 | 2023-06-20 | Medtronic, Inc. | Lead-in-lead systems and methods for cardiac therapy |
US11697025B2 (en) | 2019-03-29 | 2023-07-11 | Medtronic, Inc. | Cardiac conduction system capture |
US11213676B2 (en) | 2019-04-01 | 2022-01-04 | Medtronic, Inc. | Delivery systems for VfA cardiac therapy |
US11712188B2 (en) | 2019-05-07 | 2023-08-01 | Medtronic, Inc. | Posterior left bundle branch engagement |
US11786694B2 (en) | 2019-05-24 | 2023-10-17 | NeuroLight, Inc. | Device, method, and app for facilitating sleep |
US11239928B2 (en) | 2019-06-21 | 2022-02-01 | Pacesetter, Inc. | Dynamic sensitivity and strength control of communication signals between implantable medical devices |
US11305127B2 (en) | 2019-08-26 | 2022-04-19 | Medtronic Inc. | VfA delivery and implant region detection |
US11813466B2 (en) | 2020-01-27 | 2023-11-14 | Medtronic, Inc. | Atrioventricular nodal stimulation |
US11628304B2 (en) * | 2020-03-31 | 2023-04-18 | Biosense Webster (Israel) Ltd. | Detection and mapping of phrenic nerve by pacing |
US11911168B2 (en) | 2020-04-03 | 2024-02-27 | Medtronic, Inc. | Cardiac conduction system therapy benefit determination |
US11813464B2 (en) | 2020-07-31 | 2023-11-14 | Medtronic, Inc. | Cardiac conduction system evaluation |
Citations (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20030065365A1 (en) * | 2001-09-28 | 2003-04-03 | Qingsheng Zhu | Method and apparatus for avoidance of phrenic nerve stimulation during cardiac pacing |
US20060241711A1 (en) * | 2005-04-26 | 2006-10-26 | Sathaye Alok S | Implantable cardiac device and method for reduced phrenic nerve stimulation |
Family Cites Families (439)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3920005A (en) | 1972-03-16 | 1975-11-18 | Medtronic Inc | Evaluation system for cardiac stimulators |
US4023564A (en) | 1976-01-26 | 1977-05-17 | Spacelabs, Inc. | Arrhythmia detector |
US4686332A (en) | 1986-06-26 | 1987-08-11 | International Business Machines Corporation | Combined finger touch and stylus detection system for use on the viewing surface of a visual display device |
US4340063A (en) * | 1980-01-02 | 1982-07-20 | Empi, Inc. | Stimulation device |
US4476869A (en) * | 1980-06-05 | 1984-10-16 | Intermedics, Inc. | Pacer analyzer |
US4364396A (en) | 1981-06-15 | 1982-12-21 | Medtronic, Inc. | Circuit and method for measuring PSA output and energy |
US4365636A (en) | 1981-06-19 | 1982-12-28 | Medicon, Inc. | Method of monitoring patient respiration and predicting apnea therefrom |
US4458692A (en) | 1982-02-11 | 1984-07-10 | Arrhythmia Research Technology, Inc. | System and method for predicting ventricular tachycardia with a gain controlled high pass filter |
US4562841A (en) | 1982-08-05 | 1986-01-07 | Cardiac Pacemakers, Inc. | Programmable multi-mode cardiac pacemaker |
US4550221A (en) | 1983-10-07 | 1985-10-29 | Scott Mabusth | Touch sensitive control device |
US4860766A (en) | 1983-11-18 | 1989-08-29 | Respitrace Corp. | Noninvasive method for measuring and monitoring intrapleural pressure in newborns |
US4552154A (en) | 1984-03-12 | 1985-11-12 | Medtronic, Inc. | Waveform morphology discriminator and method |
US4680708A (en) | 1984-03-20 | 1987-07-14 | Washington University | Method and apparatus for analyzing electrocardiographic signals |
US4573481A (en) * | 1984-06-25 | 1986-03-04 | Huntington Institute Of Applied Research | Implantable electrode array |
US4648407A (en) | 1985-07-08 | 1987-03-10 | Respitrace Corporation | Method for detecting and differentiating central and obstructive apneas in newborns |
US4827935A (en) | 1986-04-24 | 1989-05-09 | Purdue Research Foundation | Demand electroventilator |
US4953551A (en) | 1987-01-14 | 1990-09-04 | Medtronic, Inc. | Method of defibrillating a heart |
US6375621B1 (en) | 1987-03-06 | 2002-04-23 | Ocean Laboratories, Inc. | Passive apnea monitor |
US4878497A (en) | 1988-03-25 | 1989-11-07 | Telectronics N.V. | Pacemaker with improved automatic output regulation |
DE3816042A1 (de) | 1988-05-10 | 1989-11-23 | Alt Eckhard | Energiesparender herzschrittmacher |
US5105354A (en) | 1989-01-23 | 1992-04-14 | Nippon Kayaku Kabushiki Kaisha | Method and apparatus for correlating respiration and heartbeat variability |
US4928688A (en) | 1989-01-23 | 1990-05-29 | Mieczyslaw Mirowski | Method and apparatus for treating hemodynamic disfunction |
JP2794196B2 (ja) | 1989-06-20 | 1998-09-03 | チェスト株式会社 | 無呼吸防止刺激装置 |
JPH0341926A (ja) | 1989-07-07 | 1991-02-22 | Matsushita Electric Works Ltd | 睡眠の状態変化検出装置および睡眠状態制御装置 |
US5033467A (en) * | 1989-08-16 | 1991-07-23 | Cardiac Pacemakers, Inc. | Combined defibrillator pacer system utilizing pacer tip lead switch |
US5000189A (en) | 1989-11-15 | 1991-03-19 | Regents Of The University Of Michigan | Method and system for monitoring electrocardiographic signals and detecting a pathological cardiac arrhythmia such as ventricular tachycardia |
US5111812A (en) | 1990-01-23 | 1992-05-12 | Cardiac Pacemakers, Inc. | Defilbrillation electrode having smooth current distribution |
US5284136A (en) | 1990-04-04 | 1994-02-08 | Cardiac Pacemakers, Inc. | Dual indifferent electrode pacemaker |
US5036849A (en) | 1990-04-04 | 1991-08-06 | Cardiac Pacemakers, Inc. | Variable rate cardiac pacer |
US5187657A (en) | 1990-04-05 | 1993-02-16 | Hewlett-Packard Company | Cardiac analyzer with rem sleep detection |
US5133353A (en) | 1990-04-25 | 1992-07-28 | Cardiac Pacemakers, Inc. | Implantable intravenous cardiac stimulation system with pulse generator housing serving as optional additional electrode |
US5713926A (en) | 1990-04-25 | 1998-02-03 | Cardiac Pacemakers, Inc. | Implantable intravenous cardiac stimulation system with pulse generator housing serving as optional additional electrode |
US5203348A (en) * | 1990-06-06 | 1993-04-20 | Cardiac Pacemakers, Inc. | Subcutaneous defibrillation electrodes |
US5230337A (en) * | 1990-06-06 | 1993-07-27 | Cardiac Pacemakers, Inc. | Process for implanting subcutaneous defibrillation electrodes |
US5105810A (en) | 1990-07-24 | 1992-04-21 | Telectronics Pacing Systems, Inc. | Implantable automatic and haemodynamically responsive cardioverting/defibrillating pacemaker with means for minimizing bradycardia support pacing voltages |
US5411529A (en) | 1990-08-10 | 1995-05-02 | Medtronic, Inc. | Waveform discriminator for cardiac stimulation devices |
US5271411A (en) | 1990-09-21 | 1993-12-21 | Colin Electronics Co., Ltd. | Method and apparatus for ECG signal analysis and cardiac arrhythmia detection |
US5222493A (en) | 1990-10-01 | 1993-06-29 | Siemens Pacesetter, Inc. | Verification of capture using an indifferent electrode mounted on the pacemaker connector top |
US5170784A (en) | 1990-11-27 | 1992-12-15 | Ceon Ramon | Leadless magnetic cardiac pacemaker |
US5179945A (en) | 1991-01-17 | 1993-01-19 | Cardiac Pacemakers, Inc. | Defibrillation/cardioversion system with multiple evaluation of heart condition prior to shock delivery |
US5184615A (en) | 1991-03-08 | 1993-02-09 | Telectronics Pacing Systems, Inc. | Apparatus and method for detecting abnormal cardiac rhythms using evoked potential measurements in an arrhythmia control system |
US5405363A (en) | 1991-03-15 | 1995-04-11 | Angelon Corporation | Implantable cardioverter defibrillator having a smaller displacement volume |
US5146918A (en) | 1991-03-19 | 1992-09-15 | Medtronic, Inc. | Demand apnea control of central and obstructive sleep apnea |
AU654552B2 (en) | 1991-04-05 | 1994-11-10 | Medtronic, Inc. | Subcutaneous multi-electrode sensing system |
US5335657A (en) | 1991-05-03 | 1994-08-09 | Cyberonics, Inc. | Therapeutic treatment of sleep disorder by nerve stimulation |
WO1992020402A1 (en) | 1991-05-17 | 1992-11-26 | Noel Desmond Gray | A pacemaker for a heart |
US5209229A (en) | 1991-05-20 | 1993-05-11 | Telectronics Pacing Systems, Inc. | Apparatus and method employing plural electrode configurations for cardioversion of atrial fibrillation in an arrhythmia control system |
US5300106A (en) | 1991-06-07 | 1994-04-05 | Cardiac Pacemakers, Inc. | Insertion and tunneling tool for a subcutaneous wire patch electrode |
US5217021A (en) | 1991-07-30 | 1993-06-08 | Telectronics Pacing Systems, Inc. | Detection of cardiac arrhythmias using correlation of a cardiac electrical signals and temporal data compression |
FR2680093B1 (fr) | 1991-08-09 | 1993-10-29 | Ela Medical | Procede de controle de l'energie de stimulation dans un stimulateur cardiaque. |
US5233983A (en) | 1991-09-03 | 1993-08-10 | Medtronic, Inc. | Method and apparatus for apnea patient screening |
US5313953A (en) | 1992-01-14 | 1994-05-24 | Incontrol, Inc. | Implantable cardiac patient monitor |
US5411525A (en) * | 1992-01-30 | 1995-05-02 | Cardiac Pacemakers, Inc. | Dual capacitor biphasic defibrillator waveform generator employing selective connection of capacitors for each phase |
EP0553864B1 (en) * | 1992-01-30 | 1999-10-27 | Cardiac Pacemakers, Inc. | Defibrillator waveform generator for generating waveform of long duration |
US5273035A (en) | 1992-02-03 | 1993-12-28 | Medtronic, Inc. | Dual chamber pacemaker with safe airial pacing |
CA2105162A1 (en) | 1992-02-03 | 1993-08-04 | Karel Den Dulk | Dual chamber pacemaker system for delivering atrial sync pulses |
US5301677A (en) * | 1992-02-06 | 1994-04-12 | Cardiac Pacemakers, Inc. | Arrhythmia detector using delta modulated turning point morphology of the ECG wave |
US5261400A (en) | 1992-02-12 | 1993-11-16 | Medtronic, Inc. | Defibrillator employing transvenous and subcutaneous electrodes and method of use |
EP0560569B1 (en) | 1992-03-09 | 1998-07-15 | Angeion Corporation | Fibrillation and tachycardia detection |
US5439482A (en) | 1992-04-07 | 1995-08-08 | Angeion Corporation | Prophylactic implantable cardioverter-defibrillator |
US5490502A (en) | 1992-05-07 | 1996-02-13 | New York University | Method and apparatus for optimizing the continuous positive airway pressure for treating obstructive sleep apnea |
US5324310A (en) | 1992-07-01 | 1994-06-28 | Medtronic, Inc. | Cardiac pacemaker with auto-capture function |
US5292338A (en) | 1992-07-30 | 1994-03-08 | Medtronic, Inc. | Atrial defibrillator employing transvenous and subcutaneous electrodes and method of use |
US7081095B2 (en) | 2001-05-17 | 2006-07-25 | Lynn Lawrence A | Centralized hospital monitoring system for automatically detecting upper airway instability and for preventing and aborting adverse drug reactions |
US5353788A (en) | 1992-09-21 | 1994-10-11 | Miles Laughton E | Cardio-respiratory control and monitoring system for determining CPAP pressure for apnea treatment |
EP0590431B1 (en) * | 1992-09-30 | 1999-02-03 | Cardiac Pacemakers, Inc. | A foldable defibrillation patch electrode with a conductor-free zone which acts as a hinge |
AU5295493A (en) | 1992-10-01 | 1994-04-26 | Cardiac Pacemakers, Inc. | Stent-type defibrillation electrode structures |
US5441518A (en) | 1993-07-22 | 1995-08-15 | Angeion Corporation | Implantable cardioverter defibrillator system having independently controllable electrode discharge pathway |
US5334222A (en) | 1992-11-03 | 1994-08-02 | Cardiac Pacemakers, Inc. | Cardiac stimulating apparatus and method for heart failure therapy |
US5350410A (en) * | 1992-11-23 | 1994-09-27 | Siemens Pacesetter, Inc. | Autocapture system for implantable pulse generator |
US5496362A (en) * | 1992-11-24 | 1996-03-05 | Cardiac Pacemakers, Inc. | Implantable conformal coil patch electrode with multiple conductive elements for cardioversion and defibrillation |
US5517983A (en) | 1992-12-09 | 1996-05-21 | Puritan Bennett Corporation | Compliance meter for respiratory therapy |
US5697953A (en) | 1993-03-13 | 1997-12-16 | Angeion Corporation | Implantable cardioverter defibrillator having a smaller displacement volume |
US5318597A (en) | 1993-03-15 | 1994-06-07 | Cardiac Pacemakers, Inc. | Rate adaptive cardiac rhythm management device control algorithm using trans-thoracic ventilation |
US5366496A (en) * | 1993-04-01 | 1994-11-22 | Cardiac Pacemakers, Inc. | Subcutaneous shunted coil electrode |
US5333095A (en) | 1993-05-03 | 1994-07-26 | Maxwell Laboratories, Inc., Sierra Capacitor Filter Division | Feedthrough filter capacitor assembly for human implant |
US5397342A (en) * | 1993-06-07 | 1995-03-14 | Cardiac Pacemakers, Inc. | Resilient structurally coupled and electrically independent electrodes |
US5314430A (en) | 1993-06-24 | 1994-05-24 | Medtronic, Inc. | Atrial defibrillator employing transvenous and subcutaneous electrodes and method of use |
US5468254A (en) * | 1993-07-26 | 1995-11-21 | Cardiac Pacemakers, Inc. | Method and apparatus for defibrillation using a multiphasic truncated exponential waveform |
US5376476A (en) | 1993-08-02 | 1994-12-27 | Eylon; Dan | Battery orientation-indifferent battery receptor |
US5411539A (en) | 1993-08-31 | 1995-05-02 | Medtronic, Inc. | Active can emulator and method of use |
US5443485A (en) * | 1993-09-08 | 1995-08-22 | Intermedics, Inc. | Apparatus and method for capture detection in a cardiac stimulator |
US5372606A (en) | 1993-10-07 | 1994-12-13 | Cardiac Pacemakers, Inc. | Method and apparatus for generating adaptive n-phasic defibrillation waveforms |
US5331996A (en) | 1993-10-08 | 1994-07-26 | Ziehm Raymond G | Dual mode hot water circulation apparatus |
US5376106A (en) | 1993-10-18 | 1994-12-27 | Cardiac Pacemakers, Inc. | Multi-sensor blending in a rate responsive cardiac pacemaker |
US5411031A (en) | 1993-11-24 | 1995-05-02 | Incontrol, Inc. | Implantable cardiac patient monitor |
US5431693A (en) * | 1993-12-10 | 1995-07-11 | Intermedics, Inc. | Method of verifying capture of the heart by a pacemaker |
US5641326A (en) | 1993-12-13 | 1997-06-24 | Angeion Corporation | Method and apparatus for independent atrial and ventricular defibrillation |
FR2714611B1 (fr) | 1993-12-31 | 1996-03-15 | Ela Medical Sa | Procédé de contrôle d'un dispositif implantable actif. |
US5713367A (en) | 1994-01-26 | 1998-02-03 | Cambridge Heart, Inc. | Measuring and assessing cardiac electrical stability |
US5447519A (en) | 1994-03-19 | 1995-09-05 | Medtronic, Inc. | Method and apparatus for discrimination of monomorphic and polymorphic arrhythmias and for treatment thereof |
US5738102A (en) | 1994-03-31 | 1998-04-14 | Lemelson; Jerome H. | Patient monitoring system |
GB9406702D0 (en) | 1994-04-05 | 1994-05-25 | Binstead Ronald P | Multiple input proximity detector and touchpad system |
US5957956A (en) | 1994-06-21 | 1999-09-28 | Angeion Corp | Implantable cardioverter defibrillator having a smaller mass |
EP0688578B1 (en) * | 1994-06-24 | 1999-11-10 | Pacesetter AB | Arrhythmia detector |
US7027868B2 (en) | 2001-10-30 | 2006-04-11 | Medtronic, Inc. | Capture management improvements |
US5549655A (en) | 1994-09-21 | 1996-08-27 | Medtronic, Inc. | Method and apparatus for synchronized treatment of obstructive sleep apnea |
US5540732A (en) | 1994-09-21 | 1996-07-30 | Medtronic, Inc. | Method and apparatus for impedance detecting and treating obstructive airway disorders |
US5485851A (en) | 1994-09-21 | 1996-01-23 | Medtronic, Inc. | Method and apparatus for arousal detection |
US5520191A (en) | 1994-10-07 | 1996-05-28 | Ortivus Medical Ab | Myocardial ischemia and infarction analysis and monitoring method and apparatus |
US5540727A (en) | 1994-11-15 | 1996-07-30 | Cardiac Pacemakers, Inc. | Method and apparatus to automatically optimize the pacing mode and pacing cycle parameters of a dual chamber pacemaker |
US5713933A (en) | 1994-11-30 | 1998-02-03 | Medtronic, Inc. | Method and apparatus for automatic pacing threshold determination |
US5534017A (en) | 1994-12-02 | 1996-07-09 | Vitatron Medical, B.V. | Dual chamber pacemaker system with improved response to retrograde conduction |
US5724984A (en) | 1995-01-26 | 1998-03-10 | Cambridge Heart, Inc. | Multi-segment ECG electrode and system |
US5626620A (en) | 1995-02-21 | 1997-05-06 | Medtronic, Inc. | Dual chamber pacing system and method with continual adjustment of the AV escape interval so as to maintain optimized ventricular pacing for treating cardiomyopathy |
US5545186A (en) * | 1995-03-30 | 1996-08-13 | Medtronic, Inc. | Prioritized rule based method and apparatus for diagnosis and treatment of arrhythmias |
AUPN236595A0 (en) | 1995-04-11 | 1995-05-11 | Rescare Limited | Monitoring of apneic arousals |
US5591216A (en) * | 1995-05-19 | 1997-01-07 | Medtronic, Inc. | Method for treatment of sleep apnea by electrical stimulation |
US5674254A (en) * | 1995-05-22 | 1997-10-07 | Vitatron Medical, B.V. | Cardiac pacemaker system and method for determining a measure of pacing threshold without incurring loss of capture |
US5697956A (en) | 1995-06-02 | 1997-12-16 | Pacesetter, Inc. | Implantable stimulation device having means for optimizing current drain |
US5620466A (en) | 1995-08-14 | 1997-04-15 | Cardiac Pacemakers, Inc. | Digital AGC using separate gain control and threshold templating |
US5662688A (en) | 1995-08-14 | 1997-09-02 | Cardiac Pacemakers, Inc. | Slow gain control |
US5662696A (en) * | 1995-09-28 | 1997-09-02 | Angeion Corp | One piece disposable threshold test can electrode for use with an implantable cardioverter defibrillator system |
DE19538473A1 (de) | 1995-10-16 | 1997-04-17 | Map Gmbh | Vorrichtung und Verfahren zur quantitativen Analyse von Schlafstörungen |
US5650759A (en) | 1995-11-09 | 1997-07-22 | Hittman Materials & Medical Components, Inc. | Filtered feedthrough assembly having a mounted chip capacitor for medical implantable devices and method of manufacture therefor |
US5836987A (en) | 1995-11-15 | 1998-11-17 | Cardiac Pacemakers, Inc. | Apparatus and method for optimizing cardiac performance by determining the optimal timing interval from an accelerometer signal |
JPH09173310A (ja) | 1995-11-29 | 1997-07-08 | Hewlett Packard Co <Hp> | Ecg波形の心搏を分類する方法および装置 |
US5683431A (en) * | 1996-03-27 | 1997-11-04 | Medtronic, Inc. | Verification of capture by sensing evoked response across cardioversion electrodes |
US5895414A (en) | 1996-04-19 | 1999-04-20 | Sanchez-Zambrano; Sergio | Pacemaker housing |
AU3056397A (en) | 1996-05-14 | 1997-12-05 | Medtronic, Inc. | Prioritized rule based method and apparatus for diagnosis and treatment of arrhythmias |
US6132384A (en) | 1996-06-26 | 2000-10-17 | Medtronic, Inc. | Sensor, method of sensor implant and system for treatment of respiratory disorders |
US5944680A (en) | 1996-06-26 | 1999-08-31 | Medtronic, Inc. | Respiratory effort detection method and apparatus |
EP0944414B1 (en) | 1996-07-11 | 2005-11-09 | Medtronic, Inc. | Minimally invasive implantable device for monitoring physiologic events |
US6496715B1 (en) | 1996-07-11 | 2002-12-17 | Medtronic, Inc. | System and method for non-invasive determination of optimal orientation of an implantable sensing device |
US5857977A (en) | 1996-08-08 | 1999-01-12 | The Regents Of The University Of Michigan | Method and apparatus for separation of ventricular tachycardia from ventricular fibrillation for implantable cardioverter defibrillators |
US6295470B1 (en) | 1996-08-19 | 2001-09-25 | The Mower Family Chf Treatment Irrevocable Trust | Antitachycardial pacing |
US5860918A (en) | 1996-11-22 | 1999-01-19 | Hewlett-Packard Company | Representation of a review of a patent's physiological parameters |
SE9604320D0 (sv) | 1996-11-25 | 1996-11-25 | Pacesetter Ab | Medical device |
US5683434A (en) | 1996-12-06 | 1997-11-04 | Pacesetter, Inc. | Microstrip EMI shunt for an implantable medical device |
US5718720A (en) * | 1996-12-13 | 1998-02-17 | Sulzer Intermedics Inc. | Implantable cardiac stimulator with capture detection and impedance based autotuning of capture detection |
US5735883A (en) * | 1996-12-13 | 1998-04-07 | Sulzer Intermedics Inc. | Implantable cardiac stimulator with impedance based autothreshold |
US5779645A (en) | 1996-12-17 | 1998-07-14 | Pacesetter, Inc. | System and method for waveform morphology comparison |
US5814087A (en) | 1996-12-18 | 1998-09-29 | Medtronic, Inc. | Rate responsive pacemaker adapted to adjust lower rate limit according to monitored patient blood temperature |
US5876353A (en) | 1997-01-31 | 1999-03-02 | Medtronic, Inc. | Impedance monitor for discerning edema through evaluation of respiratory rate |
SE9700396D0 (sv) | 1997-02-05 | 1997-02-05 | Pacesetter Ab | Heart stimulating device |
US6607509B2 (en) | 1997-12-31 | 2003-08-19 | Medtronic Minimed, Inc. | Insertion device for an insertion set and method of using the same |
US5861011A (en) | 1997-02-14 | 1999-01-19 | Vitatron Medical, B.V. | Pacemaker with automatic lower rate limit drop |
US5873898A (en) | 1997-04-29 | 1999-02-23 | Medtronic, Inc. | Microprocessor capture detection circuit and method |
US5974340A (en) | 1997-04-29 | 1999-10-26 | Cardiac Pacemakers, Inc. | Apparatus and method for monitoring respiratory function in heart failure patients to determine efficacy of therapy |
US5861013A (en) | 1997-04-29 | 1999-01-19 | Medtronic Inc. | Peak tracking capture detection circuit and method |
US6147680A (en) | 1997-06-03 | 2000-11-14 | Koa T&T Corporation | Touchpad with interleaved traces |
AU8592898A (en) | 1997-07-25 | 1999-02-16 | Minnesota Innovative Technologies & Instruments Corporation (Miti) | Control device for supplying supplemental respiratory oxygen |
US6076014A (en) | 1997-08-01 | 2000-06-13 | Sulzer Intermedics, Inc. | Cardiac stimulator and defibrillator with means for identifying cardiac rhythm disorder and chamber of origin |
US6128535A (en) | 1997-12-05 | 2000-10-03 | Cardiac Pacemakers, Inc. | Automatic capture verification in multisite cardiac pacing |
IL122875A0 (en) | 1998-01-08 | 1998-08-16 | S L P Ltd | An integrated sleep apnea screening system |
JPH11197248A (ja) | 1998-01-19 | 1999-07-27 | Nippon Sanso Kk | 呼吸用ガス消費量のモニタリング装置及びモニタリング方法 |
US6148230A (en) | 1998-01-30 | 2000-11-14 | Uab Research Foundation | Method for the monitoring and treatment of spontaneous cardiac arrhythmias |
GB9802382D0 (en) | 1998-02-04 | 1998-04-01 | Medtronic Inc | Apparatus for management of sleep apnea |
US6076015A (en) * | 1998-02-27 | 2000-06-13 | Cardiac Pacemakers, Inc. | Rate adaptive cardiac rhythm management device using transthoracic impedance |
US5964778A (en) | 1998-03-17 | 1999-10-12 | Medtronic, Inc. | Balloon attachment at catheter tip |
US6016442A (en) | 1998-03-25 | 2000-01-18 | Cardiac Pacemakers, Inc. | System for displaying cardiac arrhythmia data |
US6251126B1 (en) | 1998-04-23 | 2001-06-26 | Medtronic Inc | Method and apparatus for synchronized treatment of obstructive sleep apnea |
US6144880A (en) * | 1998-05-08 | 2000-11-07 | Cardiac Pacemakers, Inc. | Cardiac pacing using adjustable atrio-ventricular delays |
US6045513A (en) | 1998-05-13 | 2000-04-04 | Medtronic, Inc. | Implantable medical device for tracking patient functional status |
US6026320A (en) | 1998-06-08 | 2000-02-15 | Cardiac Pacemakers, Inc. | Heart rate variability as an indicator of exercise capacity |
US6128534A (en) | 1998-06-16 | 2000-10-03 | Pacesetter, Inc. | Implantable cardiac stimulation device and method for varying pacing parameters to mimic circadian cycles |
FR2780654B1 (fr) | 1998-07-06 | 2000-12-01 | Ela Medical Sa | Dispositif medical implantable actif permettant le traitement par electrostimulation du syndrome de l'apnee du sommeil |
US6055454A (en) | 1998-07-27 | 2000-04-25 | Cardiac Pacemakers, Inc. | Cardiac pacemaker with automatic response optimization of a physiologic sensor based on a second sensor |
US6345201B1 (en) | 1998-07-29 | 2002-02-05 | Pacesetter, Inc. | System and method for ventricular capture using far-field evoked response |
US6101416A (en) | 1998-07-29 | 2000-08-08 | Pacesetter, Inc. | System and method for atrial autocapture in single-chamber pacemaker modes using far-field detection |
US6434428B1 (en) * | 1998-07-29 | 2002-08-13 | Pacesetter, Inc. | System and method for optimizing far-field R-wave sensing by switching electrode polarity during atrial capture verification |
US6424234B1 (en) | 1998-09-18 | 2002-07-23 | Greatbatch-Sierra, Inc. | Electromagnetic interference (emi) filter and process for providing electromagnetic compatibility of an electronic device while in the presence of an electromagnetic emitter operating at the same frequency |
US6163724A (en) | 1998-09-18 | 2000-12-19 | Medtronic, Inc. | Microprocessor capture detection circuit and method |
AU1198100A (en) | 1998-09-23 | 2000-04-10 | Keith Bridger | Physiological sensing device |
US6148234A (en) * | 1998-09-28 | 2000-11-14 | Medtronic Inc. | Dual site pacing system with automatic pulse output adjustment |
US6227072B1 (en) | 1998-10-02 | 2001-05-08 | Ritchey Designs, Inc. | Light weight bicycle pedal |
US6044298A (en) | 1998-10-13 | 2000-03-28 | Cardiac Pacemakers, Inc. | Optimization of pacing parameters based on measurement of integrated acoustic noise |
US6415174B1 (en) | 1998-11-09 | 2002-07-02 | Board Of Regents The University Of Texas System | ECG derived respiratory rhythms for improved diagnosis of sleep apnea |
MXPA01005267A (es) | 1998-11-27 | 2002-04-24 | Synaptics Uk Ltd | Sensor de posicion. |
US6169921B1 (en) | 1998-12-08 | 2001-01-02 | Cardiac Pacemakers, Inc. | Autocapture determination for an implantable cardioverter defibrillator |
US6049730A (en) | 1998-12-28 | 2000-04-11 | Flaga Hf | Method and apparatus for improving the accuracy of interpretation of ECG-signals |
US6466820B1 (en) | 1998-12-29 | 2002-10-15 | Medtronic, Inc. | Multi-site cardiac pacing system having trigger pace window |
US6324427B1 (en) | 1999-01-26 | 2001-11-27 | Pacesetter, Inc. | Implantable cardiac stimulation device having T-wave discrimination of fusion events during autocapture/autothreshold assessment |
US6266554B1 (en) | 1999-02-12 | 2001-07-24 | Cardiac Pacemakers, Inc. | System and method for classifying cardiac complexes |
US6084253A (en) | 1999-03-01 | 2000-07-04 | Teccor Electronics, Lp | Low voltage four-layer device with offset buried region |
US6038474A (en) | 1999-03-02 | 2000-03-14 | Cardiac Pacemakers, Inc. | Pseudo-fusion management during automatic capture verification |
US6312388B1 (en) | 1999-03-12 | 2001-11-06 | Cardiac Pacemakers, Inc. | Method and system for verifying the integrity of normal sinus rhythm templates |
US6438409B1 (en) | 1999-03-25 | 2002-08-20 | Medtronic, Inc. | Methods of characterizing ventricular operations and applications thereof |
US6115628A (en) | 1999-03-29 | 2000-09-05 | Medtronic, Inc. | Method and apparatus for filtering electrocardiogram (ECG) signals to remove bad cycle information and for use of physiologic signals determined from said filtered ECG signals |
US6324421B1 (en) | 1999-03-29 | 2001-11-27 | Medtronic, Inc. | Axis shift analysis of electrocardiogram signal parameters especially applicable for multivector analysis by implantable medical devices, and use of same |
US6175766B1 (en) | 1999-03-30 | 2001-01-16 | Pacesetter, Inc. | Cardiac pacemaker autothreshold arrangement and method with reliable capture |
US6190326B1 (en) | 1999-04-23 | 2001-02-20 | Medtrac Technologies, Inc. | Method and apparatus for obtaining patient respiratory data |
US6226551B1 (en) | 1999-05-11 | 2001-05-01 | Cardiac Pacemakers, Inc. | Wide-band evoked response sensing for capture verification |
US6192275B1 (en) | 1999-05-11 | 2001-02-20 | Cardiac Pacemakers, Inc. | Adaptive evoked response sensing for automatic capture verification |
EP1178855B1 (en) | 1999-05-12 | 2006-08-02 | Medtronic, Inc. | Monitoring apparatus using wavelet transforms for the analysis of heart rhythms |
US6351669B1 (en) | 1999-05-21 | 2002-02-26 | Cardiac Pacemakers, Inc. | Cardiac rhythm management system promoting atrial pacing |
US6285907B1 (en) | 1999-05-21 | 2001-09-04 | Cardiac Pacemakers, Inc. | System providing ventricular pacing and biventricular coordination |
US6312378B1 (en) * | 1999-06-03 | 2001-11-06 | Cardiac Intelligence Corporation | System and method for automated collection and analysis of patient information retrieved from an implantable medical device for remote patient care |
US6270457B1 (en) * | 1999-06-03 | 2001-08-07 | Cardiac Intelligence Corp. | System and method for automated collection and analysis of regularly retrieved patient information for remote patient care |
US6449503B1 (en) | 1999-07-14 | 2002-09-10 | Cardiac Pacemakers, Inc. | Classification of supraventricular and ventricular cardiac rhythms using cross channel timing algorithm |
US6221011B1 (en) * | 1999-07-26 | 2001-04-24 | Cardiac Intelligence Corporation | System and method for determining a reference baseline of individual patient status for use in an automated collection and analysis patient care system |
US6418340B1 (en) | 1999-08-20 | 2002-07-09 | Cardiac Pacemakers, Inc. | Method and system for identifying and displaying groups of cardiac arrhythmic episodes |
US6418343B1 (en) | 1999-10-01 | 2002-07-09 | Cardiac Pacemakers, Inc. | Method and apparatus for adjusting the sensing threshold of a cardiac rhythm management device |
US7127290B2 (en) | 1999-10-01 | 2006-10-24 | Cardiac Pacemakers, Inc. | Cardiac rhythm management systems and methods predicting congestive heart failure status |
US6272377B1 (en) | 1999-10-01 | 2001-08-07 | Cardiac Pacemakers, Inc. | Cardiac rhythm management system with arrhythmia prediction and prevention |
US6459929B1 (en) | 1999-11-04 | 2002-10-01 | Cardiac Pacemakers, Inc. | Implantable cardiac rhythm management device for assessing status of CHF patients |
US6480733B1 (en) | 1999-11-10 | 2002-11-12 | Pacesetter, Inc. | Method for monitoring heart failure |
US6409675B1 (en) | 1999-11-10 | 2002-06-25 | Pacesetter, Inc. | Extravascular hemodynamic monitor |
US6600949B1 (en) | 1999-11-10 | 2003-07-29 | Pacesetter, Inc. | Method for monitoring heart failure via respiratory patterns |
US6491639B1 (en) | 1999-11-10 | 2002-12-10 | Pacesetter, Inc. | Extravascular hemodynamic sensor |
US6398728B1 (en) * | 1999-11-16 | 2002-06-04 | Cardiac Intelligence Corporation | Automated collection and analysis patient care system and method for diagnosing and monitoring respiratory insufficiency and outcomes thereof |
US6336903B1 (en) * | 1999-11-16 | 2002-01-08 | Cardiac Intelligence Corp. | Automated collection and analysis patient care system and method for diagnosing and monitoring congestive heart failure and outcomes thereof |
US6368284B1 (en) * | 1999-11-16 | 2002-04-09 | Cardiac Intelligence Corporation | Automated collection and analysis patient care system and method for diagnosing and monitoring myocardial ischemia and outcomes thereof |
US6440066B1 (en) * | 1999-11-16 | 2002-08-27 | Cardiac Intelligence Corporation | Automated collection and analysis patient care system and method for ordering and prioritizing multiple health disorders to identify an index disorder |
US6415183B1 (en) | 1999-12-09 | 2002-07-02 | Cardiac Pacemakers, Inc. | Method and apparatus for diaphragmatic pacing |
US6505071B1 (en) | 1999-12-15 | 2003-01-07 | Cardiac Pacemakers, Inc. | Cardiac management device with capability of noise detection in automatic capture verification |
US6282440B1 (en) | 1999-12-31 | 2001-08-28 | Ge Marquette Medical Systems, Inc. | Method to identify electrode placement |
US6477422B1 (en) | 2000-03-22 | 2002-11-05 | Medtronic, Inc. | Method and apparatus for capture detection |
US6434417B1 (en) | 2000-03-28 | 2002-08-13 | Cardiac Pacemakers, Inc. | Method and system for detecting cardiac depolarization |
IL135335A (en) | 2000-03-29 | 2013-12-31 | Lycored Natural Prod Ind Ltd | Use of Carotenoids in Preparing Pharmaceuticals to Prevent Adverse Effects from Hormones and Pharmaceuticals Containing Carotenoids |
US6615089B1 (en) * | 2000-03-31 | 2003-09-02 | Cardiac Pacemakers, Inc. | System and method for verifying capture in a multi-site pacemaker |
US6371922B1 (en) | 2000-04-07 | 2002-04-16 | Cardiac Pacemakers, Inc. | Method for measuring baroreflex sensitivity and therapy optimization in heart failure patients |
US20020002327A1 (en) | 2000-04-10 | 2002-01-03 | Grant Brydon J.B. | Method for detecting cheyne-stokes respiration in patients with congestive heart failure |
US6456880B1 (en) | 2000-05-01 | 2002-09-24 | Pacesetter, Inc. | Implantable cardiac stimulation device for and method of monitoring progression or regression of a patient's heart condition by monitoring ventricular repolarization interval dispersion |
US6589188B1 (en) | 2000-05-05 | 2003-07-08 | Pacesetter, Inc. | Method for monitoring heart failure via respiratory patterns |
US6512953B2 (en) * | 2000-05-11 | 2003-01-28 | Pacesetter, Inc. | System and method for automatically verifying capture during multi-chamber stimulation |
US6618619B1 (en) | 2000-05-12 | 2003-09-09 | Pacesetter, Inc. | Method and apparatus for reducing the effect of evoked responses on polarization measurements in an automatic capture pacing system |
US6615082B1 (en) | 2000-05-15 | 2003-09-02 | Pacesetter, Inc. | Method and device for optimally altering stimulation energy to maintain capture of cardiac tissue |
US6363281B1 (en) * | 2000-05-16 | 2002-03-26 | Cardiac Pacemakers, Inc. | Cardiac rhythm management system and method |
US6389308B1 (en) | 2000-05-30 | 2002-05-14 | Vladimir Shusterman | System and device for multi-scale analysis and representation of electrocardiographic data |
EP1292360A2 (en) * | 2000-06-19 | 2003-03-19 | Medtronic Physio-Control Manufacturing Corp. | Method and apparatus using a time measurement to an electrical parameter threshold to determine a defibrillation pulse duration |
US6480734B1 (en) | 2000-06-30 | 2002-11-12 | Cardiac Science Inc. | Cardiac arrhythmia detector using ECG waveform-factor and its irregularity |
US6424865B1 (en) | 2000-07-13 | 2002-07-23 | Cardiac Pacemakers, Inc. | Ventricular conduction delay trending system and method |
US6456881B1 (en) | 2000-08-02 | 2002-09-24 | Pacesetter, Inc. | System and method of identifying fusion for dual-chamber automatic capture stimulation device |
CN1447668A (zh) | 2000-08-03 | 2003-10-08 | 美国西门子医疗解决公司 | 用于合成导联和提供精确性量度的心电图系统 |
GB2370509A (en) | 2000-08-29 | 2002-07-03 | Don Edward Casey | Subcutaneously implanted photovoltaic power supply |
US6493586B1 (en) | 2000-08-30 | 2002-12-10 | Cardiac Pacemakers, Inc. | Site reversion in cardiac rhythm management |
US6782291B1 (en) * | 2000-09-05 | 2004-08-24 | Pacesetter, Inc. | Implantable cardiac stimulation device with automatic evoked response sensing electrode configuration selection and method |
US6834204B2 (en) | 2001-11-05 | 2004-12-21 | Cameron Health, Inc. | Method and apparatus for inducing defibrillation in a patient using a T-shock waveform |
US6952610B2 (en) | 2000-09-18 | 2005-10-04 | Cameron Health, Inc. | Current waveforms for anti-tachycardia pacing for a subcutaneous implantable cardioverter- defibrillator |
US6927721B2 (en) | 2001-11-05 | 2005-08-09 | Cameron Health, Inc. | Low power A/D converter |
US7039465B2 (en) | 2000-09-18 | 2006-05-02 | Cameron Health, Inc. | Ceramics and/or other material insulated shell for active and non-active S-ICD can |
US6788974B2 (en) | 2000-09-18 | 2004-09-07 | Cameron Health, Inc. | Radian curve shaped implantable cardioverter-defibrillator canister |
US6952608B2 (en) | 2001-11-05 | 2005-10-04 | Cameron Health, Inc. | Defibrillation pacing circuitry |
US7146212B2 (en) | 2000-09-18 | 2006-12-05 | Cameron Health, Inc. | Anti-bradycardia pacing for a subcutaneous implantable cardioverter-defibrillator |
US20020095184A1 (en) | 2000-09-18 | 2002-07-18 | Bardy Gust H. | Monophasic waveform for anti-tachycardia pacing for a subcutaneous implantable cardioverter-defibrillator |
US7043299B2 (en) | 2000-09-18 | 2006-05-09 | Cameron Health, Inc. | Subcutaneous implantable cardioverter-defibrillator employing a telescoping lead |
US6865417B2 (en) | 2001-11-05 | 2005-03-08 | Cameron Health, Inc. | H-bridge with sensing circuit |
US6988003B2 (en) | 2000-09-18 | 2006-01-17 | Cameron Health, Inc. | Implantable cardioverter-defibrillator having two spaced apart shocking electrodes on housing |
US6856835B2 (en) | 2000-09-18 | 2005-02-15 | Cameron Health, Inc. | Biphasic waveform for anti-tachycardia pacing for a subcutaneous implantable cardioverter-defibrillator |
US7065407B2 (en) | 2000-09-18 | 2006-06-20 | Cameron Health, Inc. | Duckbill-shaped implantable cardioverter-defibrillator canister and method of use |
US7194309B2 (en) | 2000-09-18 | 2007-03-20 | Cameron Health, Inc. | Packaging technology for non-transvenous cardioverter/defibrillator devices |
US6950705B2 (en) | 2000-09-18 | 2005-09-27 | Cameron Health, Inc. | Canister designs for implantable cardioverter-defibrillators |
US6754528B2 (en) | 2001-11-21 | 2004-06-22 | Cameraon Health, Inc. | Apparatus and method of arrhythmia detection in a subcutaneous implantable cardioverter/defibrillator |
US20020035378A1 (en) | 2000-09-18 | 2002-03-21 | Cameron Health, Inc. | Subcutaneous electrode for transthoracic conduction with highly maneuverable insertion tool |
US20020035381A1 (en) | 2000-09-18 | 2002-03-21 | Cameron Health, Inc. | Subcutaneous electrode with improved contact shape for transthoracic conduction |
US7194302B2 (en) | 2000-09-18 | 2007-03-20 | Cameron Health, Inc. | Subcutaneous cardiac stimulator with small contact surface electrodes |
US7076296B2 (en) | 2000-09-18 | 2006-07-11 | Cameron Health, Inc. | Method of supplying energy to subcutaneous cardioverter-defibrillator and pacer |
US20020035379A1 (en) | 2000-09-18 | 2002-03-21 | Bardy Gust H. | Subcutaneous electrode for transthoracic conduction with improved installation characteristics |
US6866044B2 (en) | 2000-09-18 | 2005-03-15 | Cameron Health, Inc. | Method of insertion and implantation of implantable cardioverter-defibrillator canisters |
US7149575B2 (en) | 2000-09-18 | 2006-12-12 | Cameron Health, Inc. | Subcutaneous cardiac stimulator device having an anteriorly positioned electrode |
US20020107544A1 (en) | 2000-09-18 | 2002-08-08 | Cameron Health, Inc. | Current waveform for anti-bradycardia pacing for a subcutaneous implantable cardioverter-defibrillator |
US6954670B2 (en) | 2001-11-05 | 2005-10-11 | Cameron Health, Inc. | Simplified defibrillator output circuit |
US6937907B2 (en) | 2000-09-18 | 2005-08-30 | Cameron Health, Inc. | Subcutaneous electrode for transthoracic conduction with low-profile installation appendage and method of doing same |
US6778860B2 (en) | 2001-11-05 | 2004-08-17 | Cameron Health, Inc. | Switched capacitor defibrillation circuit |
US7120495B2 (en) | 2000-09-18 | 2006-10-10 | Cameron Health, Inc. | Flexible subcutaneous implantable cardioverter-defibrillator |
US7069080B2 (en) | 2000-09-18 | 2006-06-27 | Cameron Health, Inc. | Active housing and subcutaneous electrode cardioversion/defibrillating system |
US7090682B2 (en) | 2000-09-18 | 2006-08-15 | Cameron Health, Inc. | Method and apparatus for extraction of a subcutaneous electrode |
US20020035377A1 (en) | 2000-09-18 | 2002-03-21 | Cameron Health, Inc. | Subcutaneous electrode for transthoracic conduction with insertion tool |
US6725085B2 (en) | 2000-09-22 | 2004-04-20 | Armin Schwartzman | Method and apparatus for characterizing cardiac tissue from local electrograms |
US6631290B1 (en) | 2000-10-25 | 2003-10-07 | Medtronic, Inc. | Multilayer ceramic electrodes for sensing cardiac depolarization signals |
US6522915B1 (en) | 2000-10-26 | 2003-02-18 | Medtronic, Inc. | Surround shroud connector and electrode housings for a subcutaneous electrode array and leadless ECGS |
US6512940B1 (en) | 2000-10-31 | 2003-01-28 | Medtronic, Inc. | Subcutaneous spiral electrode for sensing electrical signals of the heart |
US6684100B1 (en) | 2000-10-31 | 2004-01-27 | Cardiac Pacemakers, Inc. | Curvature based method for selecting features from an electrophysiologic signals for purpose of complex identification and classification |
JP4028680B2 (ja) | 2000-11-01 | 2007-12-26 | インターナショナル・ビジネス・マシーンズ・コーポレーション | 観測データから原信号を復元する信号分離方法、信号処理装置、モバイル端末装置、および記憶媒体 |
JP3725418B2 (ja) | 2000-11-01 | 2005-12-14 | インターナショナル・ビジネス・マシーンズ・コーポレーション | 複数信号が混合される画像データから多次元信号を復元する信号分離方法、画像処理装置および記憶媒体 |
US6944495B2 (en) | 2000-11-10 | 2005-09-13 | C.R. Bard, Inc. | Methods for processing electrocardiac signals having superimposed complexes |
SE0004240D0 (sv) | 2000-11-17 | 2000-11-17 | St Jude Medical | A cardiac stimulating device |
US6505067B1 (en) | 2000-11-22 | 2003-01-07 | Medtronic, Inc. | System and method for deriving a virtual ECG or EGM signal |
JP2004513752A (ja) | 2000-11-22 | 2004-05-13 | メドトロニック,インコーポレイテッド | 心室性不整脈を検出しかつ治療するための装置 |
US6754523B2 (en) | 2000-11-28 | 2004-06-22 | J. Gerald Toole | Method of analysis of the electrocardiogram |
US6564106B2 (en) | 2000-12-13 | 2003-05-13 | Medtronic, Inc. | Thin film electrodes for sensing cardiac depolarization signals |
US6904315B2 (en) | 2000-12-14 | 2005-06-07 | Medtronic, Inc. | Atrial aware VVI: a method for atrial synchronous ventricular (VDD/R) pacing using the subcutaneous electrode array and a standard pacing lead |
US6567701B2 (en) | 2000-12-21 | 2003-05-20 | Medtronic, Inc. | Method and system for discriminating captured beats from non-captured beats in a cardiac pacing system |
US7181285B2 (en) | 2000-12-26 | 2007-02-20 | Cardiac Pacemakers, Inc. | Expert system and method |
US6611712B2 (en) * | 2000-12-26 | 2003-08-26 | Cardiac Pacemakers, Inc. | Apparatus and method for testing and adjusting a bipolar stimulation configuration |
DE10128982A1 (de) | 2001-01-17 | 2002-07-18 | Biotronik Mess & Therapieg | Stimulationsvorrichtung mit Stimulationserfolgskontrolle |
US6553259B2 (en) * | 2001-03-14 | 2003-04-22 | Pacesetter, Inc. | System and method of performing automatic capture in an implantable cardiac stimulation device |
US6597951B2 (en) * | 2001-03-16 | 2003-07-22 | Cardiac Pacemakers, Inc. | Automatic selection from multiple cardiac optimization protocols |
US6993389B2 (en) * | 2001-03-30 | 2006-01-31 | Cardiac Pacemakers, Inc. | Identifying heart failure patients suitable for resynchronization therapy using QRS complex width from an intracardiac electrogram |
US6615083B2 (en) | 2001-04-27 | 2003-09-02 | Medtronic, Inc. | Implantable medical device system with sensor for hemodynamic stability and method of use |
US6658293B2 (en) | 2001-04-27 | 2003-12-02 | Medtronic, Inc. | Method and system for atrial capture detection based on far-field R-wave sensing |
US6641542B2 (en) | 2001-04-30 | 2003-11-04 | Medtronic, Inc. | Method and apparatus to detect and treat sleep respiratory events |
US6708058B2 (en) * | 2001-04-30 | 2004-03-16 | Cardiac Pacemakers, Inc. | Normal cardiac rhythm template generation system and method |
US6654637B2 (en) | 2001-04-30 | 2003-11-25 | Medtronic, Inc. | Method and system for ventricular fusion prevention |
DE60214698T2 (de) | 2001-04-30 | 2007-09-13 | Medtronic, Inc., Minneapolis | Implantierbare medizinische vorrichtung und pflastersystem |
US6622046B2 (en) | 2001-05-07 | 2003-09-16 | Medtronic, Inc. | Subcutaneous sensing feedthrough/electrode assembly |
US20030023175A1 (en) | 2001-05-22 | 2003-01-30 | Arzbaecher Robert C. | Implantable cardiac arrest monitor and alarm system |
US6456481B1 (en) | 2001-05-31 | 2002-09-24 | Greatbatch-Sierra, Inc. | Integrated EMI filter-DC blocking capacitor |
US6731984B2 (en) | 2001-06-07 | 2004-05-04 | Medtronic, Inc. | Method for providing a therapy to a patient involving modifying the therapy after detecting an onset of sleep in the patient, and implantable medical device embodying same |
US6731973B2 (en) | 2001-06-12 | 2004-05-04 | Ge Medical Systems Information Technologies, Inc. | Method and apparatus for processing physiological data |
DE10129649A1 (de) | 2001-06-14 | 2002-12-19 | Biotronik Mess & Therapieg | Stimulationsgerät |
US7050851B2 (en) | 2001-06-29 | 2006-05-23 | Medtronic, Inc. | Implantable cardioverter/defibrillator with housing electrode and lead detection and switching circuitry |
AU2002354800A1 (en) | 2001-07-05 | 2003-01-21 | Softmax, Inc. | System and method for separating cardiac signals |
US6595927B2 (en) | 2001-07-23 | 2003-07-22 | Medtronic, Inc. | Method and system for diagnosing and administering therapy of pulmonary congestion |
US6847839B2 (en) | 2001-07-30 | 2005-01-25 | The Trustees Of Columbia University In The City Of New York | System and method for determining reentrant ventricular tachycardia isthmus location and shape for catheter ablation |
IL160654A0 (en) | 2001-08-28 | 2004-07-25 | Medtronic Inc | Implantable medical device for treating cardiac mechanical dysfunction by electrical stimulation |
US7006869B2 (en) | 2001-09-10 | 2006-02-28 | Pacesetter, Inc. | Method and device for enhanced capture tracking by discrimination of fusion beats |
US6640136B1 (en) * | 2001-09-12 | 2003-10-28 | Pacesetters, Inc. | Implantable cardiac stimulation device with automatic electrode selection for avoiding cross-chamber stimulation |
FR2829917B1 (fr) | 2001-09-24 | 2004-06-11 | Ela Medical Sa | Dispositif medical actif comprenant des moyens de diagnostic du profil respiratoire |
GB0123772D0 (en) | 2001-10-03 | 2001-11-21 | Qinetiq Ltd | Apparatus for monitoring fetal heartbeat |
US7027861B2 (en) | 2001-10-09 | 2006-04-11 | Medtronic, Inc. | Method and apparatus for affecting atrial defibrillation with bi-atrial pacing |
US6731985B2 (en) * | 2001-10-16 | 2004-05-04 | Pacesetter, Inc. | Implantable cardiac stimulation system and method for automatic capture verification calibration |
US7177689B2 (en) | 2001-10-26 | 2007-02-13 | Cardiac Pacemakers, Inc. | Method and apparatus for capture verification and threshold determination |
US7113823B2 (en) | 2001-10-26 | 2006-09-26 | Cardiac Pacemakers, Inc. | Morphology-based optimization of cardiac resynchronization therapy |
US7286876B2 (en) | 2001-10-26 | 2007-10-23 | Cardiac Pacemakers, Inc. | Template-based capture verification for multi-site pacing |
US6731983B2 (en) | 2001-10-30 | 2004-05-04 | Medtronic, Inc. | Pacemaker having adaptive arrhythmia detection windows |
US6760615B2 (en) | 2001-10-31 | 2004-07-06 | Medtronic, Inc. | Method and apparatus for discriminating between tachyarrhythmias |
US6766190B2 (en) | 2001-10-31 | 2004-07-20 | Medtronic, Inc. | Method and apparatus for developing a vectorcardiograph in an implantable medical device |
US6738668B1 (en) * | 2001-11-01 | 2004-05-18 | Pacesetter, Inc. | Implantable cardiac stimulation device having a capture assurance system which minimizes battery current drain and method for operating the same |
US6701170B2 (en) | 2001-11-02 | 2004-03-02 | Nellcor Puritan Bennett Incorporated | Blind source separation of pulse oximetry signals |
US6975904B1 (en) | 2001-11-08 | 2005-12-13 | Pacesetter, Inc. | Modification of evoked response detection algorithm based on orientation and activity of patient |
US7248921B2 (en) | 2003-06-02 | 2007-07-24 | Cameron Health, Inc. | Method and devices for performing cardiac waveform appraisal |
US6959214B2 (en) | 2001-11-28 | 2005-10-25 | Medtronic, Inc. | Implantable medical device for measuring mechanical heart function |
US6768923B2 (en) | 2001-12-05 | 2004-07-27 | Cardiac Pacemakers, Inc. | Apparatus and method for ventricular pacing triggered by detection of early ventricular excitation |
FR2833177B1 (fr) | 2001-12-07 | 2004-06-04 | Ela Medical Sa | Dispositif medical actif comprenant des moyens perfectionnes de discrimination des phases d'eveil et de sommeil |
FR2833496B1 (fr) | 2001-12-14 | 2004-02-13 | Ela Medical Sa | Dispositif medical actif comprenant des moyens perfectionnes de diagnostic du syndrome d'apnee du sommeil |
US6950701B2 (en) * | 2001-12-21 | 2005-09-27 | Medtronic, Inc. | Dual-chamber pacemaker system for simultaneous bi-chamber pacing and sensing |
US6768924B2 (en) | 2002-01-03 | 2004-07-27 | Cardiac Pacemakers, Inc. | Method and apparatus for capture verification based on propagated electrical activity |
US7050856B2 (en) * | 2002-01-11 | 2006-05-23 | Medtronic, Inc. | Variation of neural-stimulation parameters |
US6915160B2 (en) * | 2002-02-08 | 2005-07-05 | Cardiac Pacemakers, Inc. | Dynamically optimized multisite cardiac resynchronization device |
US20030199945A1 (en) | 2002-02-11 | 2003-10-23 | James Ciulla | Device and method for treating disordered breathing |
US6999817B2 (en) | 2002-02-14 | 2006-02-14 | Packsetter, Inc. | Cardiac stimulation device including sleep apnea prevention and treatment |
US6904320B2 (en) | 2002-02-14 | 2005-06-07 | Pacesetter, Inc. | Sleep apnea therapy device using dynamic overdrive pacing |
US6928324B2 (en) | 2002-02-14 | 2005-08-09 | Pacesetter, Inc. | Stimulation device for sleep apnea prevention, detection and treatment |
US6885893B1 (en) | 2002-03-25 | 2005-04-26 | Pacesetter, Inc. | Implantable stimulation device and method for performing inter-chamber conduction search and conduction time measurement |
US20030195571A1 (en) | 2002-04-12 | 2003-10-16 | Burnes John E. | Method and apparatus for the treatment of central sleep apnea using biventricular pacing |
US6889079B2 (en) | 2002-04-12 | 2005-05-03 | Cardiac Pacemakers, Inc. | Method and system for characterizing supraventricular rhythm during cardiac pacing |
US6915164B2 (en) * | 2002-04-16 | 2005-07-05 | Pacesetter, Inc. | Automatic capture using independent channels in bi-chamber stimulation |
US7139610B2 (en) | 2002-04-26 | 2006-11-21 | Medtronic, Inc. | Capture management in multi-site pacing |
US7263399B2 (en) | 2002-04-29 | 2007-08-28 | Medtronic, Inc. | Apparatus and methods for analysis of cardiac device stored episodes containing sensed signals and waveforms |
US20030204213A1 (en) | 2002-04-30 | 2003-10-30 | Jensen Donald N. | Method and apparatus to detect and monitor the frequency of obstructive sleep apnea |
US6978178B2 (en) | 2002-04-30 | 2005-12-20 | Medtronic, Inc. | Method and apparatus for selecting an optimal electrode configuration of a medical electrical lead having a multiple electrode array |
US7062327B2 (en) * | 2002-05-02 | 2006-06-13 | Pacesetter, Inc. | Method and apparatus for providing atrial autocapture in a dynamic atrial overdrive pacing system for use in an implantable cardiac stimulation device |
US6881192B1 (en) | 2002-06-12 | 2005-04-19 | Pacesetter, Inc. | Measurement of sleep apnea duration and evaluation of response therapies using duration metrics |
US7117036B2 (en) | 2002-06-27 | 2006-10-03 | Pacesetter, Inc. | Using activity-based rest disturbance as a metric of sleep apnea |
US6925330B2 (en) | 2002-07-10 | 2005-08-02 | Pacesetter, Inc. | Implantable medical device and method for detecting cardiac events without using of refractory or blanking periods |
US6950702B2 (en) | 2002-07-15 | 2005-09-27 | Cardiac Pacemakers, Inc. | Use of curvature based features for beat detection |
US7738959B2 (en) * | 2002-09-30 | 2010-06-15 | Medtronic, Inc. | Method and apparatus for performing stimulation threshold searches |
AU2003301481A1 (en) * | 2002-10-15 | 2004-05-04 | Medtronic Inc. | Channel-selective blanking for a medical device system |
US7203543B2 (en) | 2002-10-23 | 2007-04-10 | Cardiac Pacemakers, Inc. | Method and system for detecting capture using a coronary vein electrode |
US7085599B2 (en) | 2002-10-23 | 2006-08-01 | Cardiac Pacemakers, Inc. | Characterization of supraventricular rhythm using collected cardiac beats |
US7027871B2 (en) | 2002-10-31 | 2006-04-11 | Medtronic, Inc. | Aggregation of data from external data sources within an implantable medical device |
FR2847361B1 (fr) | 2002-11-14 | 2005-01-28 | Ela Medical Sa | Dispositif d'analyse d'un signal, notamment d'un signal physiologique tel qu'un signal ecg |
US7308311B2 (en) | 2002-11-22 | 2007-12-11 | Pacesetter, Inc. | Physician programmer system with telemetered sensor waveform |
DE60331351D1 (de) * | 2002-12-06 | 2010-04-01 | Boston Scient Neuromodulation | Verfahren zur feststellung von stimulationsparametern |
US6884218B2 (en) | 2002-12-09 | 2005-04-26 | Charles W. Olson | Three dimensional vector cardiograph and method for detecting and monitoring ischemic events |
SE0203724D0 (sv) | 2002-12-16 | 2002-12-16 | St Jude Medical | A cardiac stimulating device |
SE0203728D0 (sv) * | 2002-12-16 | 2002-12-16 | St Jude Medical | An Implantable heart stimulating device, a system including such a device and use of the system |
US6993379B1 (en) | 2002-12-30 | 2006-01-31 | Pacesetter, Inc. | System and method for emulating a surface EKG using an implantable cardiac stimulation device |
US7191004B2 (en) | 2002-12-31 | 2007-03-13 | Cardiac Pacemakers, Inc. | Capture verification using an evoked response reference |
US7031773B1 (en) * | 2003-01-10 | 2006-04-18 | Pacesetter, Inc. | Implantable cardiac stimulation system providing autocapture and lead impedance assessment and method |
US7160252B2 (en) | 2003-01-10 | 2007-01-09 | Medtronic, Inc. | Method and apparatus for detecting respiratory disturbances |
US7025730B2 (en) | 2003-01-10 | 2006-04-11 | Medtronic, Inc. | System and method for automatically monitoring and delivering therapy for sleep-related disordered breathing |
US7438686B2 (en) | 2003-01-10 | 2008-10-21 | Medtronic, Inc. | Apparatus and method for monitoring for disordered breathing |
US7103404B2 (en) | 2003-02-27 | 2006-09-05 | Medtronic,Inc. | Detection of tachyarrhythmia termination |
US7702388B2 (en) | 2003-02-28 | 2010-04-20 | Cardiac Pacemakers, Inc. | Cardiac therapy triggered by capture verification |
US6973350B1 (en) | 2003-03-31 | 2005-12-06 | Pacesetter, Inc. | Diagnosis of atrial fusion, atrial pseudofusion and/or native atrial activity |
FR2853427B1 (fr) | 2003-04-01 | 2005-06-17 | Thales Sa | Procede d'identification aveugle de melanges de sources aux ordres superieurs |
US7236819B2 (en) | 2003-04-11 | 2007-06-26 | Cardiac Pacemakers, Inc. | Separation of a subcutaneous cardiac signal from a plurality of composite signals |
EP1613395A2 (en) | 2003-04-11 | 2006-01-11 | Cardiac Pacemakers, Inc. | Subcutaneous cardiac device |
US20040230229A1 (en) * | 2003-04-11 | 2004-11-18 | Lovett Eric G. | Hybrid transthoracic/intrathoracic cardiac stimulation devices and methods |
US7155278B2 (en) | 2003-04-21 | 2006-12-26 | Medtronic, Inc. | Neurostimulation to treat effects of sleep apnea |
SE0301201D0 (sv) | 2003-04-24 | 2003-04-24 | St Jude Medical | Apparatus for analysing cardiac events |
US20040215253A1 (en) * | 2003-04-24 | 2004-10-28 | Weinberg Lisa P. | Implantable cardiac stimulation device providing atrial accelerated arrhythmia termination electrode configuration selection and method |
US20040215276A1 (en) | 2003-04-25 | 2004-10-28 | Patrick Scholten | Form analysis to detect evoked response |
US20040215277A1 (en) | 2003-04-25 | 2004-10-28 | Peter Oosterhoff | Dynamic pacing interval extension for detection of intrinsic ventricular activity |
US7107093B2 (en) | 2003-04-29 | 2006-09-12 | Medtronic, Inc. | Use of activation and recovery times and dispersions to monitor heart failure status and arrhythmia risk |
US7477932B2 (en) | 2003-05-28 | 2009-01-13 | Cardiac Pacemakers, Inc. | Cardiac waveform template creation, maintenance and use |
US7129935B2 (en) | 2003-06-02 | 2006-10-31 | Synaptics Incorporated | Sensor patterns for a capacitive sensing apparatus |
SE0301800D0 (sv) | 2003-06-23 | 2003-06-23 | St Jude Medical | Evoked response detector |
US20050038478A1 (en) | 2003-08-11 | 2005-02-17 | Klepfer Ruth N. | Activation recovery interval for classification of cardiac beats in an implanted device |
US7468040B2 (en) | 2003-09-18 | 2008-12-23 | Cardiac Pacemakers, Inc. | Methods and systems for implantably monitoring external breathing therapy |
US7887493B2 (en) | 2003-09-18 | 2011-02-15 | Cardiac Pacemakers, Inc. | Implantable device employing movement sensing for detecting sleep-related disorders |
US8192376B2 (en) | 2003-08-18 | 2012-06-05 | Cardiac Pacemakers, Inc. | Sleep state classification |
US7065400B2 (en) | 2003-08-20 | 2006-06-20 | Pacesetter, Inc. | Method and apparatus for automatically programming CRT devices |
US7617002B2 (en) * | 2003-09-15 | 2009-11-10 | Medtronic, Inc. | Selection of neurostimulator parameter configurations using decision trees |
US20050065587A1 (en) | 2003-09-24 | 2005-03-24 | Mark Gryzwa | Implantable lead with magnetic jacket |
US7115097B2 (en) | 2003-10-09 | 2006-10-03 | Johnson Joseph L | Positive airway pressure notification system for treatment of breathing disorders during sleep |
US8467876B2 (en) | 2003-10-15 | 2013-06-18 | Rmx, Llc | Breathing disorder detection and therapy delivery device and method |
US7684861B2 (en) | 2003-11-13 | 2010-03-23 | Cardiac Pacemakers, Inc. | Implantable cardiac monitor upgradeable to pacemaker or cardiac resynchronization device |
JP4680928B2 (ja) | 2003-11-26 | 2011-05-11 | レスメド・リミテッド | 睡眠呼吸障害のための治療のマクロ制御 |
US7242978B2 (en) | 2003-12-03 | 2007-07-10 | Medtronic, Inc. | Method and apparatus for generating a template for arrhythmia detection and electrogram morphology classification |
US20060247693A1 (en) | 2005-04-28 | 2006-11-02 | Yanting Dong | Non-captured intrinsic discrimination in cardiac pacing response classification |
US7319900B2 (en) | 2003-12-11 | 2008-01-15 | Cardiac Pacemakers, Inc. | Cardiac response classification using multiple classification windows |
US7184835B2 (en) | 2003-12-12 | 2007-02-27 | Cardiac Pacemakers, Inc. | Method and apparatus for adjustable AVD programming using a table |
US8521284B2 (en) | 2003-12-12 | 2013-08-27 | Cardiac Pacemakers, Inc. | Cardiac response classification using multisite sensing and pacing |
US7774064B2 (en) * | 2003-12-12 | 2010-08-10 | Cardiac Pacemakers, Inc. | Cardiac response classification using retriggerable classification windows |
US7123960B2 (en) | 2003-12-22 | 2006-10-17 | Cardiac Pacemakers, Inc. | Method and system for delivering cardiac resynchronization therapy with variable atrio-ventricular delay |
US7203540B2 (en) | 2003-12-22 | 2007-04-10 | Cardiac Pacemakers, Inc. | Method and system for setting cardiac resynchronization therapy parameters |
US7277754B2 (en) | 2003-12-24 | 2007-10-02 | Cardiac Pacemakers, Inc. | Method and system for removing pacing artifacts from subcutaneous electrocardiograms |
US7706884B2 (en) * | 2003-12-24 | 2010-04-27 | Cardiac Pacemakers, Inc. | Baroreflex stimulation synchronized to circadian rhythm |
US7225021B1 (en) | 2004-01-30 | 2007-05-29 | Pacesetter, Inc. | Differentiation of central sleep apnea and obstructive sleep apnea using an implantable cardiac device |
US7094207B1 (en) | 2004-03-02 | 2006-08-22 | Pacesetter, Inc. | System and method for diagnosing and tracking congestive heart failure based on the periodicity of cheyne-stokes respiration using an implantable medical device |
US7299086B2 (en) | 2004-03-05 | 2007-11-20 | Cardiac Pacemakers, Inc. | Wireless ECG in implantable devices |
US7181284B2 (en) | 2004-03-17 | 2007-02-20 | Medtronic, Inc. | Apparatus and methods of energy efficient, atrial-based Bi-ventricular fusion-pacing |
US7179229B1 (en) | 2004-04-07 | 2007-02-20 | Pacesetter, Inc. | System and method for apnea detection using blood pressure detected via an implantable medical system |
US7706866B2 (en) | 2004-06-24 | 2010-04-27 | Cardiac Pacemakers, Inc. | Automatic orientation determination for ECG measurements using multiple electrodes |
US7248925B2 (en) | 2004-08-27 | 2007-07-24 | Pacesetter, Inc. | System and method for determining optimal atrioventricular delay based on intrinsic conduction delays |
US7805185B2 (en) | 2005-05-09 | 2010-09-28 | Cardiac Pacemakers, In. | Posture monitoring using cardiac activation sequences |
US7509170B2 (en) | 2005-05-09 | 2009-03-24 | Cardiac Pacemakers, Inc. | Automatic capture verification using electrocardiograms sensed from multiple implanted electrodes |
US7894893B2 (en) | 2004-09-30 | 2011-02-22 | Cardiac Pacemakers, Inc. | Arrhythmia classification and therapy selection |
US7457664B2 (en) | 2005-05-09 | 2008-11-25 | Cardiac Pacemakers, Inc. | Closed loop cardiac resynchronization therapy using cardiac activation sequence information |
US7890159B2 (en) | 2004-09-30 | 2011-02-15 | Cardiac Pacemakers, Inc. | Cardiac activation sequence monitoring and tracking |
US7797036B2 (en) | 2004-11-30 | 2010-09-14 | Cardiac Pacemakers, Inc. | Cardiac activation sequence monitoring for ischemia detection |
US7917196B2 (en) | 2005-05-09 | 2011-03-29 | Cardiac Pacemakers, Inc. | Arrhythmia discrimination using electrocardiograms sensed from multiple implanted electrodes |
US7228173B2 (en) | 2004-11-23 | 2007-06-05 | Cardiac Pacemakers, Inc. | Cardiac tachyarrhythmia therapy selection based on patient response information |
US7647108B2 (en) * | 2004-09-30 | 2010-01-12 | Cardiac Pacemakers, Inc. | Methods and systems for selection of cardiac pacing electrode configurations |
US7933651B2 (en) | 2004-11-23 | 2011-04-26 | Cardiac Pacemakers, Inc. | Cardiac template generation based on patient response information |
US7426412B1 (en) * | 2004-10-13 | 2008-09-16 | Pacesetter, Inc. | Evoked potential and impedance based determination of diaphragmatic stimulation |
US7761162B2 (en) * | 2004-12-13 | 2010-07-20 | Cardiac Pacemakers, Inc. | Capture verification with intrinsic response discrimination |
JP5220419B2 (ja) | 2004-12-15 | 2013-06-26 | カーディアック ペースメイカーズ, インコーポレイテッド | 心臓捕捉検証および逆行管理システム |
US8229561B2 (en) * | 2004-12-15 | 2012-07-24 | Cardiac Pacemakers, Inc. | Atrial retrograde management |
US7908006B2 (en) * | 2004-12-15 | 2011-03-15 | Cardiac Pacemakers, Inc. | Cardiac pacing response classification using an adaptable classification interval |
US7930029B2 (en) * | 2004-12-15 | 2011-04-19 | Cardiac Pacemakers, Inc. | Template initialization for evoked response detection |
US7587240B2 (en) * | 2004-12-15 | 2009-09-08 | Cardiac Pacemakers, Inc. | Atrial capture verification |
US7734347B2 (en) * | 2004-12-15 | 2010-06-08 | Cardiac Pacemakers, Inc. | Cardiac pacing response classification based on waveform feature variability |
US7330761B2 (en) * | 2004-12-15 | 2008-02-12 | Cardiac Pacemakers, Inc. | Baseline adaptation for cardiac pacing response classification |
US7233821B2 (en) * | 2005-03-31 | 2007-06-19 | Medtronic, Inc. | Method and apparatus for evaluating ventricular performance during isovolumic contraction |
US7765004B2 (en) | 2005-04-28 | 2010-07-27 | Cardiac Pacemakers, Inc. | Methods and systems for managing fusion and noise in cardiac pacing response classification |
US7574260B2 (en) | 2005-04-28 | 2009-08-11 | Cardiac Pacemakers, Inc. | Adaptive windowing for cardiac waveform discrimination |
US7499751B2 (en) * | 2005-04-28 | 2009-03-03 | Cardiac Pacemakers, Inc. | Cardiac signal template generation using waveform clustering |
US7337000B2 (en) * | 2005-04-28 | 2008-02-26 | Cardiac Pacemakers Inc. | Selection of cardiac signal features detected in multiple classification intervals for cardiac pacing response classification |
US7908001B2 (en) | 2005-08-23 | 2011-03-15 | Cardiac Pacemakers, Inc. | Automatic multi-level therapy based on morphologic organization of an arrhythmia |
US20070055124A1 (en) * | 2005-09-01 | 2007-03-08 | Viswanathan Raju R | Method and system for optimizing left-heart lead placement |
US7653431B2 (en) | 2005-12-20 | 2010-01-26 | Cardiac Pacemakers, Inc. | Arrhythmia discrimination based on determination of rate dependency |
US8175703B2 (en) | 2006-01-25 | 2012-05-08 | Cardiac Pacemakers, Inc. | Cardiac resynchronization therapy parameter optimization |
EP1981587A1 (en) * | 2006-01-26 | 2008-10-22 | St. Jude Medical AB | Anodal capture |
US7819816B2 (en) | 2006-03-29 | 2010-10-26 | Cardiac Pacemakers, Inc. | Periodic disordered breathing detection |
US8380300B2 (en) | 2006-04-28 | 2013-02-19 | Medtronic, Inc. | Efficacy visualization |
US8527048B2 (en) | 2006-06-29 | 2013-09-03 | Cardiac Pacemakers, Inc. | Local and non-local sensing for cardiac pacing |
US20080004665A1 (en) | 2006-06-29 | 2008-01-03 | Mccabe Aaron R | Determination of cardiac pacing parameters based on non-localized sensing |
US7680536B2 (en) * | 2006-08-17 | 2010-03-16 | Cardiac Pacemakers, Inc. | Capture threshold estimation for alternate pacing vectors |
US7580741B2 (en) | 2006-08-18 | 2009-08-25 | Cardiac Pacemakers, Inc. | Method and device for determination of arrhythmia rate zone thresholds using a probability function |
US8209013B2 (en) * | 2006-09-14 | 2012-06-26 | Cardiac Pacemakers, Inc. | Therapeutic electrical stimulation that avoids undesirable activation |
US20080234556A1 (en) * | 2007-03-20 | 2008-09-25 | Cardiac Pacemakers, Inc. | Method and apparatus for sensing respiratory activities using sensor in lymphatic system |
US8265736B2 (en) * | 2007-08-07 | 2012-09-11 | Cardiac Pacemakers, Inc. | Method and apparatus to perform electrode combination selection |
US9037239B2 (en) * | 2007-08-07 | 2015-05-19 | Cardiac Pacemakers, Inc. | Method and apparatus to perform electrode combination selection |
EP2254661B1 (en) | 2008-02-14 | 2015-10-07 | Cardiac Pacemakers, Inc. | Apparatus for phrenic stimulation detection |
-
2009
- 2009-02-10 EP EP09709478.3A patent/EP2254661B1/en not_active Not-in-force
- 2009-02-10 AU AU2009214920A patent/AU2009214920B2/en not_active Ceased
- 2009-02-10 US US12/368,828 patent/US8649866B2/en active Active
- 2009-02-10 JP JP2010544490A patent/JP5276119B2/ja not_active Expired - Fee Related
- 2009-02-10 WO PCT/US2009/033687 patent/WO2009102726A1/en active Application Filing
- 2009-02-10 CN CN2009801046067A patent/CN101939051B/zh not_active Expired - Fee Related
-
2014
- 2014-01-17 US US14/157,571 patent/US8996112B2/en active Active
-
2015
- 2015-03-23 US US14/665,690 patent/US9352160B2/en active Active
-
2016
- 2016-05-10 US US15/150,853 patent/US9555253B2/en active Active
Patent Citations (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20030065365A1 (en) * | 2001-09-28 | 2003-04-03 | Qingsheng Zhu | Method and apparatus for avoidance of phrenic nerve stimulation during cardiac pacing |
US20060241711A1 (en) * | 2005-04-26 | 2006-10-26 | Sathaye Alok S | Implantable cardiac device and method for reduced phrenic nerve stimulation |
Cited By (13)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
CN102908146A (zh) * | 2011-08-04 | 2013-02-06 | 罗远明 | 刺激膈神经对膈肌功能检测管进行定位的方法 |
CN104968393A (zh) * | 2012-12-06 | 2015-10-07 | 美敦力公司 | 用于基于所感测的信号的正偏转是否在该信号的负偏转之前的判定而确定捕获的装置 |
CN105873635A (zh) * | 2013-10-25 | 2016-08-17 | 美敦力公司 | 用于自动化膈神经刺激和起搏夺获阈值测试的装置 |
CN109805911A (zh) * | 2014-01-21 | 2019-05-28 | 隆佩瑟尔医疗公司 | 用于优化多电极神经起搏的系统及相关方法 |
CN106232178A (zh) * | 2014-02-20 | 2016-12-14 | 美敦力公司 | 自动化膈神经刺激和起搏夺获阈值测试 |
CN106232178B (zh) * | 2014-02-20 | 2018-12-18 | 美敦力公司 | 自动化膈神经刺激和起搏夺获阈值测试 |
CN113398475A (zh) * | 2014-03-20 | 2021-09-17 | 美敦力公司 | 膈神经刺激的非侵入式检测 |
CN110072449A (zh) * | 2016-11-16 | 2019-07-30 | 纳维斯国际有限公司 | 通过电标测进行的食道位置检测 |
CN110740780A (zh) * | 2017-06-16 | 2020-01-31 | 心脏起搏器股份公司 | 心力衰竭治疗的动态控制 |
CN110740780B (zh) * | 2017-06-16 | 2024-03-22 | 心脏起搏器股份公司 | 心力衰竭治疗的动态控制 |
CN111526797A (zh) * | 2017-12-07 | 2020-08-11 | 美敦力公司 | 基于传感器的膈神经刺激检测 |
CN111526797B (zh) * | 2017-12-07 | 2023-09-22 | 美敦力公司 | 基于传感器的膈神经刺激检测 |
CN109745619A (zh) * | 2019-01-23 | 2019-05-14 | 深圳大学 | 心脏起搏器控制系统和控制方法 |
Also Published As
Publication number | Publication date |
---|---|
US20140128933A1 (en) | 2014-05-08 |
US20150190642A1 (en) | 2015-07-09 |
US8649866B2 (en) | 2014-02-11 |
WO2009102726A1 (en) | 2009-08-20 |
AU2009214920A1 (en) | 2009-08-20 |
EP2254661A1 (en) | 2010-12-01 |
US9555253B2 (en) | 2017-01-31 |
AU2009214920B2 (en) | 2012-02-09 |
CN101939051B (zh) | 2013-07-10 |
JP2011510713A (ja) | 2011-04-07 |
JP5276119B2 (ja) | 2013-08-28 |
US20160250479A1 (en) | 2016-09-01 |
EP2254661B1 (en) | 2015-10-07 |
US8996112B2 (en) | 2015-03-31 |
US9352160B2 (en) | 2016-05-31 |
US20090210024A1 (en) | 2009-08-20 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
CN101939051B (zh) | 用于膈刺激检测的方法和装置 | |
US11857795B2 (en) | Method and apparatus to perform electrode combination selection | |
US10080901B2 (en) | Method and apparatus to perform electrode combination selection | |
AU2012202409B2 (en) | Method and apparatus for phrenic stimulation detection | |
AU2012201930B2 (en) | Method and apparatus to perform electrode combination selection |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
C06 | Publication | ||
PB01 | Publication | ||
C10 | Entry into substantive examination | ||
SE01 | Entry into force of request for substantive examination | ||
C14 | Grant of patent or utility model | ||
GR01 | Patent grant | ||
CF01 | Termination of patent right due to non-payment of annual fee | ||
CF01 | Termination of patent right due to non-payment of annual fee |
Granted publication date: 20130710 |