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1. 发明授权

US09002453B2 Devices, systems and methods to perform arrhythmia discrimination based on R-R interval stability corresponding to a plurality of ventricular regions 有权
标题翻译：基于对应于多个心室区域的R-R间期稳定性执行心律失常鉴别的装置，系统和方法
公开(公告)号：US09002453B2
公开(公告)日：2015-04-07
申请号：US13194732
申请日：2011-07-29
申请人： Allen J. Keel , Kyungmoo Ryu , Stuart Rosenberg
发明人： Allen J. Keel , Kyungmoo Ryu , Stuart Rosenberg
IPC分类号： A61N1/00 , A61B5/04 , A61B5/042 , A61B5/0452 , A61B5/0464 , A61N1/362 , A61N1/368 , A61B5/0456
CPC分类号： A61B5/0422 , A61B5/0452 , A61B5/0456 , A61B5/0464 , A61N1/3627 , A61N1/3684 , A61N1/3686
摘要： Described herein are implantable systems and devices, and methods for use therewith, that can be used to perform arrhythmia discrimination. A plurality of different sensing vectors are used to obtain a plurality of different IEGMs, each of which is indicative of cardiac electrical activity at a different ventricular region. The plurality of different IEGMs can include, e.g., an IEGM indicative of cardiac electrical activity at a first region of the patient's left ventricular (LV) chamber and an IEGM indicative of cardiac electrical activity at a second region of the patient's LV chamber. Additionally, the plurality of different IEGMs can further include an IEGM indicative of cardiac electrical activity at a region of a patient's right ventricular (RV) chamber. For each of the IEGMs, there is a determination of a corresponding localized R-R interval stability metric indicative of the R-R interval stability at the corresponding ventricular region. This can include, e.g., determining, for each of the IEGMs, a plurality of R-R intervals corresponding to a plurality of consecutive cardiac cycles of the IEGM. For each IEGM, a measure of variation (e.g., standard deviation, range or variance, but not limited thereto) can then be determined for the plurality of R-R intervals to thereby determine the localized R-R interval stability metric for the IEGM. Arrhythmia discrimination is then performed using the plurality of determined localized R-R interval stability metrics.
摘要翻译：本文描述了可用于执行心律失常鉴别的可植入系统和装置及其使用方法。使用多个不同的感测向量来获得多个不同的IEGM，每个IEGM指示在不同心室区域处的心脏电活动。多个不同的IEGM可以包括例如指示患者左心室（LV）室的第一区域处的心脏电活动的IEGM和指示患者LV室的第二区域处的心脏电活动的IEGM。另外，多个不同的IEGM还可以包括指示患者右心室（RV）室的区域处的心脏电活动的IEGM。对于每个IEGM，存在确定相应的局部R-R间期稳定性度量，其指示相应心室区域处的R-R间期稳定性。这可以包括例如为每个IEGM确定对应于IEGM的多个连续心脏周期的多个R-R间隔。对于每个IEGM，然后可以为多个R-R间隔确定变化量（例如，标准偏差，范围或方差，但不限于此），从而确定IEGM的局部R-R间隔稳定性度量。然后使用多个确定的局部R-R间期稳定性度量进行心律失常鉴别。

2. 发明授权

US08843197B2 Method and system to correct contractility based on non-heart failure factors 有权
标题翻译：基于非心力衰竭因子校正收缩性的方法和系统
公开(公告)号：US08843197B2
公开(公告)日：2014-09-23
申请号：US13049774
申请日：2011-03-16
申请人： Stuart Rosenberg , Cecilia Qin Xi , Jong Gill , Brian Jeffrey Wenzel , Yelena Nabutovsky , William Hsu
发明人： Stuart Rosenberg , Cecilia Qin Xi , Jong Gill , Brian Jeffrey Wenzel , Yelena Nabutovsky , William Hsu
IPC分类号： A61N1/365 , A61B5/02 , A61B5/042 , A61N1/362
CPC分类号： A61N1/36585 , A61B5/02028 , A61B5/042 , A61N1/3627 , A61N1/36507 , A61N1/36521 , A61N1/36564 , A61N1/36578
摘要： A method for trending heart failure measures cardiogenic impedance (CI) and obtains signals representing estimates for or direct measurements of at least one of cardiac volume and pressure of the heart when the CI measurements were obtained. The method identifies correction factors based on the signals and applies the correction factors to the contractility estimates. A system for trending heart failure includes a contractility module to determine contractility estimates from CI measurements taken along at least a first vector through a heart, and a collection module to receive signals representing estimates for or direct measurements of at least one of cardiac volume and pressure of the heart when the CI measurements were obtained. The system further includes a factor module to identify correction factors based on the signals and a correction module to apply the correction factors to the contractility estimates.
摘要翻译：用于趋势性心力衰竭的方法测量心源性阻抗（CI）并且获得当获得CI测量时表示心脏体积和心脏压力中的至少一个的估计或直接测量的信号。该方法基于信号识别校正因子，并将修正因子应用于收缩率估计。用于趋向心力衰竭的系统包括收缩模块，用于根据通过心脏的至少第一载体进行的CI测量来确定收缩性估计，以及收集模块，用于接收代表心脏体积和压力中的至少一个的估计或直接测量的信号的CI测量值。该系统还包括一个因素模块，用于基于信号识别校正因子，以及一个校正模块，以将校正因子应用于收缩性估计。

3. 发明授权

US08682450B2 Systems and methods for controlling neurostimulation of acupuncture sites using an implantable cardiac rhythm management device 有权
标题翻译：使用植入式心律管理装置控制针刺部位神经刺激的系统和方法
公开(公告)号：US08682450B2
公开(公告)日：2014-03-25
申请号：US13563417
申请日：2012-07-31
申请人： Xiaoyi Min , Stuart Rosenberg , Taraneh Ghaffari Farazi , Timothy A. Fayram
发明人： Xiaoyi Min , Stuart Rosenberg , Taraneh Ghaffari Farazi , Timothy A. Fayram
IPC分类号： A61N1/05
CPC分类号： A61N1/36139 , A61B5/0215 , A61B5/042 , A61B5/0538 , A61B5/14532 , A61B5/4818 , A61B5/4836 , A61F7/00 , A61H39/002 , A61H39/06 , A61H2201/5002 , A61H2230/045 , A61H2230/305 , A61N1/3606 , A61N1/36114 , A61N1/36117 , A61N1/3621 , A61N1/3627 , A61N1/3962 , A61N2/02
摘要： Techniques are provided for use with an implantable cardiac rhythm management (CRMD) system equipped to deliver neurostimulation to acupuncture sites within anterior regions of the neck, thorax or abdomen of the patient. Parameters associated with the health of the patient are detected, such as parameters indicative of arrhythmia, heart failure and hypertension.
摘要翻译：技术提供用于与植入式心律管理（CRMD）系统一起使用，该系统被配备用于向患者的颈部，胸部或腹部前区域内的针灸位置递送神经刺激。检测与患者健康有关的参数，例如指示心律失常，心力衰竭和高血压的参数。

4. 发明申请

US20140005739A1 METHOD AND SYSTEM TO SELECT A NEUROSTIMULATION SYSTEM CONFIGURATION BASED ON CARDIAC RHYTHM FEEDBACK 有权
标题翻译：选择基于心脏反馈反馈的神经元系统配置的方法和系统
公开(公告)号：US20140005739A1
公开(公告)日：2014-01-02
申请号：US13537757
申请日：2012-06-29
申请人： Cecilia Qin Xi , Lanitia Ness , Stuart Rosenberg
发明人： Cecilia Qin Xi , Lanitia Ness , Stuart Rosenberg
IPC分类号： A61N1/365
CPC分类号： A61N1/36592 , A61B5/0452 , A61B5/046 , A61B5/0468 , A61N1/36139 , A61N1/36142 , A61N1/36185 , A61N1/3621 , A61N1/36585
摘要： Methods and systems are provided to control a configuration of a neural stimulation (NS) system having an NS device coupled to an NS lead. The methods and systems change between configurations of the NS system and collect cardiac signals from a patient that are representative of cardiac rhythms experienced by the patient over a period of time and in connection with multiple NS configurations. The methods and systems derive, from the cardiac signals, characteristic values for at least one physiologic characteristic indicative of at least one of normal and abnormal cardiac rhythms in connection with the multiple NS configurations; and select, from the multiple NS configurations, an NS operating configuration to be used by the NS system based on the characteristic values.
摘要翻译：提供了方法和系统来控制具有与NS引线相连的NS器件的神经刺激（NS）系统的配置。所述方法和系统在NS系统的配置之间改变，并且收集来自患者的心脏信号，所述心脏信号代表患者经历一段时间并与多个NS配置相关的心脏节律。所述方法和系统从心脏信号中导出与多个NS构型有关的指示正常和异常心律中的至少一个的至少一个生理特征的特征值; 并从多个NS配置中选择要由NS系统基于特征值使用的NS操作配置。

5. 发明授权

US08532774B1 Detection and reduction of phrenic nerve stimulation 有权
标题翻译：检测和减少膈神经刺激
公开(公告)号：US08532774B1
公开(公告)日：2013-09-10
申请号：US13545794
申请日：2012-07-10
申请人： Sven-Erik Hedberg , Tomas Svensson , Kjell Noren , Stuart Rosenberg , Kyungmoo Ryu , Edward Karst
发明人： Sven-Erik Hedberg , Tomas Svensson , Kjell Noren , Stuart Rosenberg , Kyungmoo Ryu , Edward Karst
IPC分类号： A61N1/37
CPC分类号： A61N1/36521 , A61B5/042 , A61B5/0538 , A61N1/3686 , A61N1/3702
摘要： The present invention provides methods for detecting phrenic nerve stimulation. A pacing module is instructed to deliver pacing pulses having a predetermined pulse amplitude and/or width within the refractory period of the left ventricle. The pacing pulses are repeatedly delivered during a number of cardiac cycles and wherein the pacing pulses are delivered at different delays relative to an onset of the refractory period of the left ventricle in different cardiac cycles. Impedance signals are measured in time windows synchronized with the delivery of pacing pulses in the refractory period of the left ventricle using at least one electrode configuration. At least one impedance signal is gathered from each time window, aggregated impedance signals are created using the impedance signals from the different time windows, and the aggregated impedance signals are analyzed to detect PNS.
摘要翻译：本发明提供了检测膈神经刺激的方法。指示起搏模块在左心室的不应期内输送具有预定脉搏幅度和/或宽度的起搏脉冲。起搏脉冲在多个心动周期期间重复递送，并且其中起搏脉冲相对于在不同心脏周期中的左心室的不应期的开始以不同的延迟递送。使用至少一个电极配置，在与左心室的不应期中的起搏脉冲的递送同步的时间窗口中测量阻抗信号。从每个时间窗口收集至少一个阻抗信号，使用来自不同时间窗口的阻抗信号创建聚合阻抗信号，并分析聚合阻抗信号以检测PNS。

6. 发明授权

US08412327B2 Cardiac resynchronization therapy optimization using vector measurements obtained from realtime electrode position tracking 有权
标题翻译：使用从实时电极位置跟踪获得的矢量测量的心脏再同步治疗优化
公开(公告)号：US08412327B2
公开(公告)日：2013-04-02
申请号：US12621397
申请日：2009-11-18
申请人： Wenbo Hou , Stuart Rosenberg , Kyungmoo Ryu , Allen Keel , Steve Koh , Thao Thu Nguyen , Kjell Noren , Michael Yang
发明人： Wenbo Hou , Stuart Rosenberg , Kyungmoo Ryu , Allen Keel , Steve Koh , Thao Thu Nguyen , Kjell Noren , Michael Yang
IPC分类号： A61N1/365
CPC分类号： A61N1/3627 , A61B5/0205 , A61B5/04011 , A61B5/0424 , A61B5/053 , A61B5/0538 , A61B5/063 , A61N1/3684 , A61N1/3686
摘要： An exemplary method includes selecting a first pair of electrodes to define a first vector and selecting a second pair of electrodes to define a second vector; acquiring position information during one or more cardiac cycles for the first and second pairs of electrodes wherein the acquiring comprises using each of the electrodes for measuring one or more electrical potentials in an electrical localization field established in the patient; and determining a dyssynchrony index by applying a cross-covariance technique to the position information for the first and the second vectors. Another method includes determining a phase shift based on the acquired position information for the first and the second vectors; and determining an interventricular delay based at least in part on the phase shift.
摘要翻译：一种示例性方法包括选择第一对电极以限定第一矢量并选择第二对电极以限定第二矢量; 在所述第一和第二对电极的一个或多个心动周期期间获取位置信息，其中所述获取包括使用每个所述电极来测量在所述患者中建立的电定位区域中的一个或多个电位; 以及通过将交叉协方差技术应用于所述第一和第二向量的位置信息来确定不同步索引。另一种方法包括基于所获取的第一和第二矢量的位置信息来确定相移; 以及至少部分地基于所述相移来确定心室间延迟。

7. 发明申请

US20130066222A1 SYSTEMS AND METHODS FOR DETECTING FAR-FIELD OVERSENSING BASED ON SIGNALS SENSED BY THE PROXIMAL ELECTRODE OF A MULTIPOLAR LV LEAD 有权
标题翻译：用于检测基于由多个LV引线的接近电极感测的信号的场地超声波的系统和方法
公开(公告)号：US20130066222A1
公开(公告)日：2013-03-14
申请号：US13230482
申请日：2011-09-12
申请人： Stuart Rosenberg , Tomas Svensson , Kjell Norén , Edward Karst , Kyungmoo Ryu
发明人： Stuart Rosenberg , Tomas Svensson , Kjell Norén , Edward Karst , Kyungmoo Ryu
IPC分类号： A61B5/0464 , A61N1/39 , A61B5/0452 , A61N1/365 , A61B5/0402 , A61B5/0456
CPC分类号： A61N1/3704 , A61B5/0464 , A61B5/0468 , A61B5/686 , A61N1/3627 , A61N1/3684
摘要： A device senses cardioelectrical signals using a right atrial (RA) lead, which might include far-field R-waves as well as near-field P-waves. The device concurrently senses events using a proximal electrode of an LV lead, which can sense both P-waves and R-waves as substantially near-field events. Suitable templates are then applied to the signals sensed via the proximal LV electrode to identify the origin of the signals (e.g. atrial vs. ventricular) so as to properly classify the corresponding events sensed in the RA as near-field or far-field events. In this manner, far-field oversensing is conveniently detected.
摘要翻译：一种装置使用右心房（RA）导联感测心电信号，其可能包括远场R波以及近场P波。该装置使用LV引线的近侧电极同时感测事件，其可以感测P波和R波作为基本近场事件。然后将合适的模板施加到经由近端LV电极感测的信号以识别信号的来源（例如心房与心室），以便将在RA中感测到的相应事件适当地分类为近场或远场事件。以这种方式，可以方便地检测远场超检测。

8. 发明授权

US08380308B2 Systems and methods for optimizing ventricular pacing based on left atrial electromechanical activation detected by an AV groove electrode 有权
标题翻译：基于由AV凹槽电极检测的左心房机电激活来优化心室起搏的系统和方法
公开(公告)号：US08380308B2
公开(公告)日：2013-02-19
申请号：US13074968
申请日：2011-03-29
申请人： Stuart Rosenberg , Kyungmoo Ryu
发明人： Stuart Rosenberg , Kyungmoo Ryu
IPC分类号： A61N1/00 , A61B5/04
CPC分类号： A61N1/3684 , A61B5/0452 , A61B5/0535 , A61N1/3627 , A61N1/36521 , A61N1/36578
摘要： Techniques are provided for use with an implantable cardiac stimulation device equipped with a multi-pole left ventricular (LV) lead having a proximal electrode implanted near an atrioventricular (AV) groove of the heart of the patient. A left atrial (LA) cardioelectrical event is sensed using the proximal electrode of the LV lead and a corresponding LA cardiomechanical event is also detected, either using an implantable sensor or an external detection system. The electromechanical activation delay between the LA cardioelectrical event and the corresponding LA cardiomechanical event is determined and then pacing delays are set based on the electromechanical activation delay for use in controlling pacing. The pacing delays can include, e.g., AV delays for use with biventricular cardiac resynchronization therapy (CRT) pacing. Other techniques described herein are directed to exploiting right atrial (RA) cardioelectrical events detected via an RA lead for the purposes of setting pacing delays.
摘要翻译：提供技术用于配备有多极左心室（LV）引线的可植入心脏刺激装置，其具有植入患者心脏的房室（AV）凹槽附近的近端电极。使用LV引线的近端电极检测左心房（LA）心电事件，并且还使用可植入传感器或外部检测系统检测相应的LA心脏机械事件。确定LA心电事件与对应的LA心肌机械事件之间的机电激活延迟，然后基于用于控制起搏的机电激活延迟来设定起搏延迟。起搏延迟可以包括例如用于双心室心脏再同步治疗（CRT）起搏的AV延迟。本文描述的其它技术旨在利用通过RA引线检测的心房心电图事件，用于设置起搏延迟。

9. 发明申请

US20130030312A1 DEVICES, SYSTEMS AND METHODS TO PERFORM ARRHYTHMIA DISCRIMINATION BASED ON R-R INTERVAL STABILITY CORRESPONDING TO A PLURALITY OF VENTRICULAR REGIONS 有权
标题翻译：基于R-R间隔稳定性相对于多个地区的ARRHYTHMIA辨别的设备，系统和方法
公开(公告)号：US20130030312A1
公开(公告)日：2013-01-31
申请号：US13194732
申请日：2011-07-29
申请人： Allen J. Keel , Kyungmoo Ryu , Stuart Rosenberg
发明人： Allen J. Keel , Kyungmoo Ryu , Stuart Rosenberg
IPC分类号： A61B5/046 , A61N1/365 , A61N1/39 , A61B5/0456
CPC分类号： A61B5/0422 , A61B5/0452 , A61B5/0456 , A61B5/0464 , A61N1/3627 , A61N1/3684 , A61N1/3686
摘要： Described herein are implantable systems and devices, and methods for use therewith, that can be used to perform arrhythmia discrimination. A plurality of different sensing vectors are used to obtain a plurality of different IEGMs, each of which is indicative of cardiac electrical activity at a different ventricular region. The plurality of different IEGMs can include, e.g., an IEGM indicative of cardiac electrical activity at a first region of the patient's left ventricular (LV) chamber and an IEGM indicative of cardiac electrical activity at a second region of the patient's LV chamber. Additionally, the plurality of different IEGMs can further include an IEGM indicative of cardiac electrical activity at a region of a patient's right ventricular (RV) chamber. For each of the IEGMs, there is a determination of a corresponding localized R-R interval stability metric indicative of the R-R interval stability at the corresponding ventricular region. This can include, e.g., determining, for each of the IEGMs, a plurality of R-R intervals corresponding to a plurality of consecutive cardiac cycles of the IEGM. For each IEGM, a measure of variation (e.g., standard deviation, range or variance, but not limited thereto) can then be determined for the plurality of R-R intervals to thereby determine the localized R-R interval stability metric for the IEGM. Arrhythmia discrimination is then performed using the plurality of determined localized R-R interval stability metrics.
摘要翻译：本文描述了可用于执行心律失常鉴别的可植入系统和装置及其使用方法。使用多个不同的感测向量来获得多个不同的IEGM，每个IEGM指示在不同心室区域处的心脏电活动。多个不同的IEGM可以包括例如指示患者左心室（LV）室的第一区域处的心脏电活动的IEGM和指示患者LV室的第二区域处的心脏电活动的IEGM。另外，多个不同的IEGM还可以包括指示患者右心室（RV）室的区域处的心脏电活动的IEGM。对于每个IEGM，存在确定相应的局部R-R间期稳定性度量，其指示相应心室区域处的R-R间期稳定性。这可以包括例如为每个IEGM确定对应于IEGM的多个连续心脏周期的多个R-R间隔。对于每个IEGM，然后可以为多个R-R间隔确定变化量（例如，标准偏差，范围或方差，但不限于此），从而确定IEGM的局部R-R间隔稳定性度量。然后使用多个确定的局部R-R间期稳定性度量进行心律失常鉴别。

10. 发明授权

US08295918B2 Systems and methods for activating and controlling impedance-based detection systems of implantable medical devices 有权
标题翻译：用于激活和控制可植入医疗设备的基于阻抗的检测系统的系统和方法
公开(公告)号：US08295918B2
公开(公告)日：2012-10-23
申请号：US13035773
申请日：2011-02-25
申请人： Stuart Rosenberg , Cecilia Q. Xi , Yelena Nabutovsky , Brian J. Wenzel , Jong Gill , William Hsu
发明人： Stuart Rosenberg , Cecilia Q. Xi , Yelena Nabutovsky , Brian J. Wenzel , Jong Gill , William Hsu
IPC分类号： A61B5/04
CPC分类号： A61N1/3627 , A61N1/3702 , A61N1/372
摘要： Techniques are provided for use with implantable medical devices for addressing encapsulation effects, particularly in the detection of cardiac decompensation events such as heart failure (HF) or cardiogenic pulmonary edema (PE.) In one example, during an acute interval following device implant, cardiac decompensation is detected using heart rate variability (HRV), ventricular evoked response (ER) or various other non-impedance-based parameters that are insensitive to component encapsulation effects. During the subsequent chronic interval, decompensation is detected using intracardiac or transthoracic impedance signals. In another example, the degree of maturation of encapsulation of implanted components is assessed using impedance frequency-response measurements or based on the frequency bandwidth of heart sounds or other physiological signals. In this manner, impedance-based HF/PE detection systems can be activated as soon as component encapsulation has matured, without necessarily waiting until completion of a preset post-implant maturation interval, often set to forty-five days or more.
摘要翻译：提供技术用于可植入医疗装置，用于解决封装效应，特别是在心脏代偿失调事件如心力衰竭（HF）或心源性肺水肿（PE）的检测中。在一个实例中，在装置植入后的急性期间，心脏使用心率变异性（HRV），心室诱发反应（ER）或对组件封装效应不敏感的各种其他基于非阻抗的参数来检测代偿失调。在随后的慢性间隔期间，使用心内或经胸阻抗信号检测代偿失调。在另一示例中，使用阻抗频率响应测量值或基于心脏声音或其他生理信号的频率带宽来评估植入部件的封装的成熟程度。以这种方式，一旦组件封装已经成熟，就可以激活基于阻抗的HF / PE检测系统，而不必等待直到完成植入后成熟间隔的预设，通常设置为四十五天或更长时间。

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