|Publication number||USRE38119 E1|
|Application number||US 08/547,691|
|Publication date||May 20, 2003|
|Filing date||Oct 19, 1995|
|Priority date||Jan 23, 1989|
|Also published as||USRE39897|
|Publication number||08547691, 547691, US RE38119 E1, US RE38119E1, US-E1-RE38119, USRE38119 E1, USRE38119E1|
|Inventors||Morton M. Mower|
|Original Assignee||Mirowski Family Ventures, LLC|
|Export Citation||BiBTeX, EndNote, RefMan|
|Patent Citations (8), Non-Patent Citations (11), Referenced by (147), Classifications (7), Legal Events (1)|
|External Links: USPTO, USPTO Assignment, Espacenet|
Application Ser. No. 10/214,474 filed August 8, 2002 is a continuation application of the instant reissue application, Ser. No. 08/547,691, which application is, in turn, a continuation of application Ser. No. 07/890,280, filed May 29, 1992, now abandoned, which is a Reissue of Ser. No. 07/299,895, filed Jan. 23, 1989, now U.S. Pat. No. 4,928,688.
I. Field of the Invention
This invention pertains to medical devices, but more specifically, to a method for increasing the cardiac output of a patient suffering from congestive heart failure by stimulating the heart of the patient at multiple sites simultaneously.
II. Discussion of the Prior Art
Normally, impulses from the SA node affect contraction of the atria and then propagate to the AV node. The AV node, in turn, emits a second nerve impulse which affects contraction of the ventricles. These nerve impulses affect contraction, i.e., depolarization of the tissue of the heart, in a coordinated manner to circulate blood through the body. Cardiac pacers of the type herein described generally are useful for maintaining proper functional operation of a sick heart. Of many cardiac deficiencies which have in the past been diagnosed and treated, conduction difficulties have presented significant problems for which a pacer has been used for treatment. A particular conduction deficiency, known as AV branch block, inhibits the transfer of nerve impulses from the sinoatrial (SA) node to atrial-ventricular (AV) node. When a bundle block occurs, these nerve impulses are not properly transmitted from the SA node to the AV node and ventricles.
When this condition occurs, normal treatment is to employ a pacer which locks onto the rhythmic cycle of the atrial beating signal and supplies to the ventricles a stimulating impulse at a certain time thereafter to effect contraction of the ventricles. The time period between the occurrence of the atrial beat and the normal contraction of the ventricles is known as the A-V delay period. Generally, hemodynamic efficiency is somewhat dependent to the A-V delay period, thus the pacer must emit a stimulating pulse at a time to preserve an optimum A-V delay period.
Other forms of conduction deficiency, such as myocardial scarring and bundle branch block, cause slow conduction of nerve impulses, in which case, nerve impulses are indeed passed from the SA to the AV node, but in a time period which is slower than normal. The Q-R-S complex in this case would manifest itself in being very wide and hemodynamic efficiency also becomes lower than normal.
In each of the above-mentioned cardiac deficiencies, the heart does not contract in coordinated fashion. This uncoordinated movement increases depolarization time and reults in more inefficient pumping rather than a more coordinated and simultaneous ventricular depolarization. In essence, such conduction deficiencies result in asynchrony between the left and right ventricle.
Additionally, arrhythmias of the heart produce uncoordinated ventricular contraction that affects the hemodynamic efficiency of the heart. Specifically, the recent paper “Incomplete Filling and Incoordinate Contraction as Mechanisms of Hypotension During Ventricular Tachycardia in Man”, published in Circulation, Vol. 68, No. 5, in 1983, describes that left ventricular function is severely disturbed by the disorganization of wall motion in hearts undergoing ventricular tachycardias. Moreover, it was found that hearts with impaired functions show profound reductions in pumping ability due to incoordinate contraction of the ventricles. It appears reasonable to believe, therefore, that any abnormal functioning heart that requires pacemaking or which has QRS widening will have a better hemodynamic efficiency if both ventricles are paced to contract in coordination with each other. There have been systems developed in the past employing a plurality of electrodes attached to the heart for effecting stimulation of a plurality of regions of the heart. For example, the Funke U.S. Pat. No. 3,937,226 discloses a cardiac electrical stimulation defibrillation system including a plurality of electrode terminals connected in a spaced relation on the heart. The electrodes, which provide stimulating and sensing, are each connected to amplifiers. The amplifiers are connected to electronic control circuit means configured to cause stimulation of all of the electrode terminals simultaneously in response to a sensed depolrization signal on the heart by at least one electrode terminal. In addition, the electronic control circuit is provided with a multivibrator means to synchronize the stimulation signal with the Q-R-S complex. Although Funke does teach the concept of simultaneous stimulation of a plurality of spaced electrodes, he does not disclose its specific use as a method of improving the cardiac output of patients suffering from congestive heart failure, nor does he discuss the specific placement of the electrodes about the heart.
The Rockland et al U.S. Pat. No. 4,088,140 discloses a similar system to Funke's although a specific use as a pacemaker is stated in the patent. Rockland, et al discloses a demand anti-arrythmia pacemaker including a plurality of sensing electrodes connected to the heart to sense ventricular depolarizations. Electronic circuitry is provided having two paths of operation. A first path provides stimulation to one area of the heart if depolarization of a naturally occurring heart beat fails to occur within a first predetermined time period. In this first path, it is stated that the circuitry acts as a pacemaker in the event of skipped natural heartbeats. A second path provides stimulation to a plurality of locations on the heart if a depolarization signal is sensed on the heart with a second predetermined time period. In this second path, it is stated that the circuitry acts as a synchronous multiple electrode pacemaker or a synchronous multiple electrode defibrillator. Although, one example of an electrode placed in the intraventricular section and others in a spaced relation on the heart ventricles is given, there are no teachings of the specific placement of the electrodes on the heart nor the improvement of cardiac output from a sick heart. In addition, the electrodes perform either stimulating or sensing, not both, therefore a large number of electrodes is required in this system.
The Tacker, Jr. et al and McCorkle U.S. Pat. Nos. 4,548,203, 4,458,677 and 4,332,259, respectively, disclose the specific placement of an electrode in or around both left and right ventricles of the heart. The Tacker, Jr. et al patent discloses the placement of a catheter having one electrode in the right ventricle and another outside the heart and a third electrode placed on the left ventricle. The catheter electrodes, each being paired with the left ventricular electrode, are pulsed in sequence with a predetermined time separation resulting in uniform current density delivered to the heart. However, this pulsing scheme and configuration is disclosed for use in a ventricular defibrillation device and not for cardiac pacing to improve cardiac output wherein a more precise synchronization of stimulation signals with the Q-R-S complex is required.
The McCorkle, Jr. patents disclose the specific placement of an electrode in the right ventricle and another electrode in the coronary sinus surrounding the left ventricle for connection to a pacemaker. However, there is no specific technique disclose of providing stimulating signals to the electrodes to perform a pacemaking function.
In light of the above difficulties and shortcomings of the prior art, an objective of the present invention is to provide a cardiac pacer for increasing hemodynamic efficiency of a heart experiencing a conduction deficiency.
Another objective of the invention is to ensure a more coordinated and simultaneous ventricular depolarization of both left and right ventricles of the heart.
A yet further objective of this invention is to provide a cardiac pacer suitable for being implanted in a manner so as to impose a minimal surgical risk during implantation thereof.
A further objective of this invention is to provide a method and apparatus of separately sensing and stimulating each ventricle of the heart in order for effecting simultaneous contraction automatically of both ventricles of the heart to narrow the QRS complex of a failing heart and thereby cause an increase in blood pressure and cardiac output.
The method of the present invention involves a procedure for pacing of the heart in a particular way so as to improve its contraction pattern, and thereby augment the movement of blood through the heart. Patients suffering from severe congestive heart failure, which is found not to respond well to conventional drug therapy and to have a conduction defect in the ventricle resulting in a widen Q-R-S complex have been aided by a pacing regimen in which stimulating pulses are simultaneously applied to both ventricles by way of a demand pacemaker or asynchronous pacemaker.
It is theorized that a considerable part of the hemodynamic impairment in refractory congestive heart failure with conduction defects is due to an incoordinate contraction of the heart, so that a part of the heart muscle contracts and balloons out the part that is not contracting. When the latter area of the heart muscle does finally contract, the former has relaxed, so that a large part of the blood volume is merely shunted back and forth within the heart rather than being ejected as would happen with a more coordinate contraction pattern.
To attain the foregoing and other objectives, the present invention comprises, a bi-ventricular cardiac pacer having detecting and stimulating circuits for effecting substatially simultaneous contraction of both left and right ventricles of the heart. In the preferred embodiment, the bi-ventricular pacer comprises ECG amplifier means for separately processing sensed cardiac signals from each of the right and left ventricles. The amplified sensed signals are used to determined where possible abnormal conduction delays exist on the heart and to activate an electrical stimulator for stimulating the appropriate abnormally functioning part of the heart. More specifically, the stimulator responds to the control circuit to issue stimulating pulses simultaneously to either the left or right ventricle, as appropriate. The stimulator may be of the demand type wherein pacing pulses are only issued in the absence of a normal Q-R-S complex for on or the other of the two ventricles (e.g., occasional bundle branch block or slow conduction), or the nondemand type wherein pacing pulses are always issued (e.g., permanent bundle branch block or slow conduction).
To convey and sense signals to and from the heart, the present invention includes a pacing lead assembly comprising first and second separate electrodes. The first electrode is preferably introduced through the superior vena cava into the right ventricle and the second electrode is introduced through the coronary sinus to the left ventricle. Both lead segments include a sensing and pacing tip electrode which serves to both sense a cardiac depolarization signal or to apply a stimulating pulse from an implanted pulse generator to the ventricle.
Additionally, to preserve a predetermined A-V delay period, additional atrial sensing electrodes may be placed on or around the atrial chambers of the heart and connected to the control circuit. The control circuit responds to the sensed atrial and ventricular depolarization signals to provide simultaneous ventricular contraction signals applied to the left and right ventricles following a preset A-V delay period.
The advantages of the present invention include a more precise and coordinated simultaneous ventricular depolarization of both the right and left ventricular to thereby increase hemodynamic efficiency of a patient experiencing congestive heart failure or weak contractions.
These together with other objects and advantages which will become subsequently apparent reside in the details of construction and operation as more fully hereinafter described and claimed, reference being had to the accompanying drawing forming a part hereof, wherein like numerals refer to like parts throughout.
FIG. 1 depicts a functional block diagram of an apparatus for carrying out the teaching of this invention; and
FIG. 2 is a logic diagram of the “CONTROL” shown in FIG. 1.
FIG. 1 illustrates the overall pacing system which may be employed for carrying out the teachings of the invention. A pair of leads 12 and 14 with corresponding sensing/stimulating tip electrodes 13 and 15 are electrically connected, via conductors 18 and 21, to separate ECG sense amplifiers 16 and 17 (or to a single multiplexed amplifier). The amplifiers 16 and 17 are both connected to a control circuit unit 20. A stimulator circuit 22 is connected to the control unit 20 and has two output conductor lines 24 and 26 which are electrically connected to the conductors 18 and 21, respectively. From this structure, signals my be separately sensed by the electrodes 13 and 15 and stimulating pacing signals may be separately delivered to the electrodes 13 and 15, via lead branches 12 and 14.
In operation, the electrodes 13 and 15 are disposed in or about the right and left ventricles, respectively. A preferred surgical procedure for implanting the lead 12 is to extend it through the superior vena cava 28 so that the sensing stimulating tip 13 thereof lodges in the internal chamber of the right ventricle of the heart 10. A preferred surgical procedure for implanting lead branch 14 is to extend it through the coronary sinus (not shown) of the heart 10 so that the sensing/stimulating tip 15 thereof lodges directly in or about the coronary simus and left ventricle. Although it is described that electrodes 13 and 15 perform both sensing and pacing, it is possible for testing and examination, that separate unipolar or bipolar sensing and stimulating electrodes may be used.
When attached to the heart, the electrodes 13 and 15 sense cardiac signals in the form of well-known Q-R-S complex at separate sites with the left and right ventricles. The ECG amplifiers 16 and 17 feed the amplified versions of these signals to the control circuit 20.
The control circuit 20 analyzes the cardiac signals to determine whether an abnormal conduction exists. Specifically, if a cardiac signal is received from the left ventricle but not from the right ventricle, the control circuit 20 provides a control signal to the stimulator 22 to issue a stimulating pacing pulse over conductors 24 and 18 and lead branch 12 to the right ventricle, via the sensing/stimulating tip electrodes 13. Similarly, the control circuit 20 provides a control signal to the stimulator 22 to issue a stimulating pacing pulse over lead branch 14 to the left ventricle, via sensing/stimulating tip electrode 15, if a cardiac depolarization signal is received from the right ventricle, but not from the left ventricle. It is also possible to sense a depolarization signal from only one ventricular chamber and then unconditionally stimulate both ventricular chambers. This is wasteful of powe which is a concern only if the stimulator is totally implanted and must rely on an implanted battery power source.
The timing of the stimulating pacing pulse from the stimulator 22 is such that both ventricles will contract substantially simultaneously. Where both ventricles are unconditionally stimulated upon the occurrence of a QRS complex on only one side, the fact that ventricular site which had produced a Q-R-S complex is immediately stimulated along with the other ventricle does not cause a problem since the site producing that complex is still refractory at the time it is stimulated.
It is also possible that no cardiac signals are sensed from either ventricle, possibly resulting from complete conduction failure between the sinoatrial node and the atrialventricular node. In this case, the control circuit 20 will again activate the stimulator 22 to provide stimulating signals to both ventricles simultaneously.
In an alternative embodiment of this invention, the issuance of pacing pulses to the ventricles is time-coupled to the rhythmic cycle of the atrial beat of the heart to preserve a preset atrial-ventricular delay period of about 120 to 200 milliseconds. Additional atrial sensing is accomplished, via lead 23 and a sense electrode 25 similar to the ventricular leads 12 and 14, but disposed in or about the right atrial chamber and connected to the control circuit 20, via atrial sense amplifier 27. The control circuit 20 may be configured to respond to the sensed atrial and ventricular signals to activate the stimulator for providing appropriate simultaneous stimulating signals to the ventricles as described above in accordance with the predetermined A-V delay period.
In the case where the conduction of the natural stimulating signal originating at the sinoatrial node of the heart 10 is only partially blocked or slowed, the ventricles may partially or incompletely contract, in which case hemodynanmic efficiency is reduced. Under these circumstances, provision is made in the control circuit 20 for determining whether a Q-R-S cardiac signal, although present, is weak or slow, and if so, to activate the stimulator 22 to stimulate the ventricles of the heart by passing pacing pulses simultaneously thereto.
FIG. 2 shows one embodiment of the control circuitry 20 of FIG. 1 required to perform bi-ventricular pacing. Also shown in the circuit of FIG. 2 are means for interconnecting the bi-ventricular control circuitry with conventional demand pacing circuitry to implement various additional pacing modes. It is understood that in the preferred embodiment, the circuitry shown in FIG. 1 would be preferably incorporated directly into the design of a pacer rather than its adjunctive form shown here for purposes of illustration.
To accomplish bi-ventricular pacing, activity is sensed in both the left and the right ventricle. When a ventricular contraction is sensed in either ventricle, a timer is initiated. If within a time window established by said timer, the contraction is sensed in the other ventricle, all pacing is inhibited because the natural contractions are deemed to be simultaneous. On the other hand, if ventricular contractions are not sensed in both ventricles within a period of coincidence defined by the time delay, at the end of this delay, the pacing pulse will be emitted, but only to the ventricle for which a QRS complex has not been sensed. Generally, ventricular contractions which occur with 5-10 milliseconds of each other result in sufficient hemodynamic efficiency so as to not require treatment. Hence, the delay window may be of this order of magnitude. As used herein, the term “substantially simultaneous contraction” includes the occurence of natural contractions of both ventricles with the window period or an evoked contraction of one or both ventricles immediately following the expiration of the window period.
Operation of the circuit of FIG. 2 will now be described. Electrical activity originating in the left ventricle is sensed by electrode 15 on lead 14 coupled to amplifier 16. It is assumed that amplifier 16 contains all of the thresholding and inhibiting provisions commonly utilized in existing pacing systems to inhibit all electrical activity, save valid ventricular contractions. Similarly, electrical activity in the right ventricle is sensed by electrode 13 on lead 12 and processed by ECG amplifier 17.
Let if first be assumed that a left ventricle contraction procedes that of the right. In this case, an R-wave signal propagates through amplifier 16 to set the Set-Reset type flip-flop 30. a logical “l” signal passes through OR gate 32 to clock D-type of flop 34 to the “set” state which, in turn, initiates the aforementioned delay timing. Window register 36 is loaded with a digital count value which is representative of the desired delay window, e.g., 5-10 ms. This may be either a fixed, hard-wired register or, alternatively, a programmable register which may be set by telemetry means in a known manner. When the preset enable input (PE) in high, counter 38 is held at a digital count corresponding to the value held in window register 36. When flip-flop 34 is set, the PE on counter 38 is removed, allowing the counter to be decremented with each clock pulse provided on clock line 40. At the end of the preporgrammed window delay interval, counter 38 is decremented to zero, causing the zero detect (ZD) line 42 to go high. The leading edge of the zero detect pulse is used to trigger a ventricle pacing pulse from pulse generator 44, via gates 54 and 56, as required. The pulse generator circuitry 44 converts the leading edge trigger to a pulse of the proper amplitube and duration for effective stimulation of the right ventricle. Note that, since under the assumed conditions flip-flop 30 has been set, AND gate 48 is disabled and, therefore, pulse generator 50 is inhibited from generating a left ventricle pacing pulse.
Next to be considered is the case where a right ventricle contraction has not been sensed within the prescribed window interval. In this case, flip-flop 52 remains reset and AND gate 54 is enabled which allows the zero detect pulse ZD to propagate through OR gate 56 to trigger pulse generator 44, thus stimulating the right ventricle. If, however, a right ventricle contraction has been detected, flip-flop 52 would have been set prior to the generation of the ZD pulse and, in this case, both AND gates 48 and 54 are disabled and no pacing pulse in either ventricle is generated.
It can be seen from the symmetry of the circuit that the operation is identical if the right ventricle contraction precedes the left ventricle contraction by more than the preprogrammed delay interval. In either case, the setting of either flip-flop 30 or 52 causes 52 causes the initiation of the timing window delay interval. When one of these flip-flop sets, the other must set within the window period, otherwise a pacing pulse will be generated in the unsensed ventricle.
The vi-bentriclar pacing control circuitry may be combined with other well-known pacer control circuitry such that the bi-ventriclar mode can be realized in combination with any other pacing mode, such as VVI, DDD, VOO. Line 58 is the logical OR of either of left ventricle event or a right ventricle event. It may be connected to other pacing control circuitry 62 in place of the signal which is normally responsive to only activity in the left ventricle. A sensed ventricle event thus inhibits the generation of a pacing trigger from another pacing circuitry and leaves the control of pacing in the alternate ventricle, as required; to the circuitry of FIG. 1. If line 58 is not activated within the escape interval of the other pacing control circuitry, a paced ventricle trigger signal on line 60 is produced which propagates through both OR gate 62 and OR gate 56 to trigger pacing pulses in both ventricles.
It is also contemplated that when a ventricular depolarization signal is sensed in one or the other of the ventricles, that a stimulating pulse may also be immediately delivered, on an unconditional basis, to both ventricles, via the implanted leads 13 and 15, thus resulting in a coordinated contraction of both ventricles.
The foregoing illustrate preferred arrangements for carrying out the objectives of this invention. Modifications and variations can obviously be made by those skilled in the art without departing from the true spirit and scope of the invention. For instance, the circuit may be employed to simultaneously pace the auricles, instead of ventricles, if such is required to improve pumping efficiency. The arrangement may also be employed as an improvement of conventional pacers thereby to improve their performance. As stated herein, the inventive arrangement can be used in an implanted device or in an external treating, diagnostic or testing device. Accordingly, the invention is limited only by the scope of the appended claims rather than by what is shown and described. Therefore, it is the intent to cover all such modifications and alternate embodiments as may come within the true scope of this invention.
|Cited Patent||Filing date||Publication date||Applicant||Title|
|US3937226 *||Jul 10, 1974||Feb 10, 1976||Medtronic, Inc.||Arrhythmia prevention apparatus|
|US4088140 *||Jun 18, 1976||May 9, 1978||Medtronic, Inc.||Demand anti-arrhythmia pacemaker|
|US4332259 *||Sep 19, 1979||Jun 1, 1982||Mccorkle Jr Charles E||Intravenous channel cardiac electrode and lead assembly and method|
|US4378020 *||Aug 20, 1981||Mar 29, 1983||Telectronics Pty. Ltd.||Dual chamber pacer|
|US4458677 *||Nov 19, 1981||Jul 10, 1984||Mccorkle Jr Charles E||Intravenous channel cardiac electrode and lead assembly and method|
|US4548203 *||Jun 25, 1984||Oct 22, 1985||Purdue Research Foundation||Sequential-pulse, multiple pathway defibrillation method|
|US4624260 *||May 7, 1985||Nov 25, 1986||Intermedics, Inc.||Pacemaker with conditional atrial tracking capability|
|US4774950 *||Oct 6, 1987||Oct 4, 1988||Leonard Bloom||Hemodynamically responsive system for and method of treating a malfunctioning heart|
|1||Aranda, et al., "A New Pacemaker for Simultaneous Biventricular Stimulation . . . ", Clin. Res., 24, 206A.|
|2||Befeler, et al., "Programmed Simultaneous Biventricular Stimulation . . . ", Eur. J. of Cardiology, 1979, pp. 369-378.|
|3||Haas, et al., "Pacemaker-Induced Cardiovascular Failure", Am. J. of Cardiology, 1974, pp. 295-299.|
|4||Haas, et al., "Pacemaker—Induced Cardiovascular Failure", Am. J. of Cardiology, 1974, pp. 295-299.|
|5||*||Incomplete Filling and Incoordinate Contraction as Mechanisms of Hypotension during Ventricular Tachycardia in Man, by Joao A. Lima et al., Circulation, vol. 68, No. 5 (1983).*|
|6||Lister, et al., "Effect of Pacemaker Site in . . . Heart Block", Am. J. of Cardiology, 1964, pp. 494-503.|
|7||Mann, et al., "Entrainment of Ventricular Tachycardia", J. Am. College of Cardiology, 1985, pp. 781-787.|
|8||Schlant et al., "Modification of the Law of the Heart: Influence of Early Contracting Areas (P)", Circulation, Supp. III, 1964, pp. III-153 & 154.|
|9||Tyers, "Ventricular Stimulation After A-V Block", J. Thoracic and Cardiovas. Sur., 1970, pp. 211-217.|
|10||William-Olsson, ". . . Pacemaker Electrode Cite . . . ", J. Thoracic and Cardiovas. Surg., 1963, pp. 618-621.|
|11||Zile, et al., "Relaxation and Filling Rates During Asynchrony", J. Am. Coll. Cardiol., 1987, pp. 702-709.|
|Citing Patent||Filing date||Publication date||Applicant||Title|
|US6706059||Nov 21, 2001||Mar 16, 2004||Cardiac Pacemakers, Inc.||Reforming wet-tantalum capacitors in implantable medical devices|
|US6763267||Jan 22, 2002||Jul 13, 2004||Cardiac Pacemakers, Inc.||Ventricular conduction delay trending system and method|
|US6795734||Dec 26, 2000||Sep 21, 2004||Cardiac Pacemakers, Inc.||Method and apparatus for display of ventricular electrograms|
|US6920355||May 17, 2002||Jul 19, 2005||Cardiac Pacemakers, Inc.||Multi-site hybrid hardware-based cardiac pacemaker|
|US7043305||Mar 6, 2002||May 9, 2006||Cardiac Pacemakers, Inc.||Method and apparatus for establishing context among events and optimizing implanted medical device performance|
|US7050849||Jun 15, 2004||May 23, 2006||Ebr Systems, Inc.||Vibrational therapy device used for resynchronization pacing in a treatment for heart failure|
|US7131988||Mar 16, 2004||Nov 7, 2006||Greatbatch Ltd.||Reforming wet-tantalum capacitors in implantable medical devices|
|US7142914||Aug 16, 2002||Nov 28, 2006||Cardiac Pacemakers, Inc.||Mode transition timing for synchronized pacing|
|US7171267||Aug 4, 2003||Jan 30, 2007||Greatbatch, Inc.||Reforming wet-tantalum capacitors in implantable defibrillators and other medical devices|
|US7181285||Dec 26, 2000||Feb 20, 2007||Cardiac Pacemakers, Inc.||Expert system and method|
|US7231249||Jul 24, 2003||Jun 12, 2007||Mirowski Family Ventures, L.L.C.||Methods, apparatus, and systems for multiple stimulation from a single stimulator|
|US7349734||Dec 24, 2003||Mar 25, 2008||Cardiac Pacemakers, Inc.||Method and apparatus for delivering defibrillation shock therapy while reducing electrical dispersion due to ventricular conduction disorder|
|US7383088||Nov 7, 2001||Jun 3, 2008||Cardiac Pacemakers, Inc.||Centralized management system for programmable medical devices|
|US7468032||Dec 18, 2002||Dec 23, 2008||Cardiac Pacemakers, Inc.||Advanced patient management for identifying, displaying and assisting with correlating health-related data|
|US7536223||Aug 17, 2004||May 19, 2009||Cardiac Pacemakers, Inc.||Mode transition timing for synchronized pacing|
|US7558631||Sep 27, 2006||Jul 7, 2009||Ebr Systems, Inc.||Leadless tissue stimulation systems and methods|
|US7561914 *||Dec 20, 2005||Jul 14, 2009||Medtronic, Inc.||Method of continuous capture verification in cardiac resynchronization devices|
|US7606621||Dec 21, 2005||Oct 20, 2009||Ebr Systems, Inc.||Implantable transducer devices|
|US7610092||Dec 21, 2005||Oct 27, 2009||Ebr Systems, Inc.||Leadless tissue stimulation systems and methods|
|US7647102||Nov 18, 2005||Jan 12, 2010||Impulse Dynamics N.V.||Cardiac contractility modulation device having anti-arrhythmic capabilities and method of operating thereof|
|US7662104||Jan 18, 2005||Feb 16, 2010||Cardiac Pacemakers, Inc.||Method for correction of posture dependence on heart sounds|
|US7678573||Apr 11, 2005||Mar 16, 2010||Pluristem Ltd.||Method of preparing a conditioned medium from a confluent stromal cell culture|
|US7680530||May 3, 2006||Mar 16, 2010||Cardiac Pacemakers, Inc.||Method and system for display of cardiac event intervals in a resynchronization pacemaker|
|US7702392||Feb 10, 2006||Apr 20, 2010||Ebr Systems, Inc.||Methods and apparatus for determining cardiac stimulation sites using hemodynamic data|
|US7742814||Apr 25, 2006||Jun 22, 2010||Cardiac Pacemakers, Inc.||Cardiac pacing system for prevention of ventricular fibrillation and ventricular tachycardia episode|
|US7751884||Oct 19, 2006||Jul 6, 2010||Cardiac Pacemakers, Inc.||Flexible neural stimulation engine|
|US7765001||Aug 29, 2006||Jul 27, 2010||Ebr Systems, Inc.||Methods and systems for heart failure prevention and treatments using ultrasound and leadless implantable devices|
|US7769447||Apr 28, 2005||Aug 3, 2010||Cardiac Pacemakers, Inc.||Cardiac pacemaker with table-based pacing mode implementation|
|US7805199||May 1, 2006||Sep 28, 2010||Cardiac Pacemakers, Inc.||Method and apparatus for establishing context among events and optimizing implanted medical device performance|
|US7840262||Mar 10, 2004||Nov 23, 2010||Impulse Dynamics Nv||Apparatus and method for delivering electrical signals to modify gene expression in cardiac tissue|
|US7843439||Mar 26, 2007||Nov 30, 2010||N-Trig Ltd.||Touch detection for a digitizer|
|US7848815||Sep 4, 2009||Dec 7, 2010||Ebr Systems, Inc.||Implantable transducer devices|
|US7856267||Apr 10, 2007||Dec 21, 2010||Cardiac Pacemakers, Inc.||Apparatus and method for pacing mode switching during atrial tachyarrhythmias|
|US7890173||Sep 4, 2009||Feb 15, 2011||Ebr Systems, Inc.||Implantable transducer devices|
|US7899534||Jan 17, 2007||Mar 1, 2011||Cardiac Pacemakers, Inc.||Expert system and method|
|US7951087||Dec 23, 2009||May 31, 2011||Cardiac Pacemakers, Inc.||Method for correction of posture dependence on heart sounds|
|US7953481||Oct 25, 2000||May 31, 2011||Impulse Dynamics N.V.||Anti-arrhythmic device and a method of delivering anti-arrhythmic cardiac therapy|
|US7953493||Dec 19, 2008||May 31, 2011||Ebr Systems, Inc.||Optimizing size of implantable medical devices by isolating the power source|
|US7959568||Dec 22, 2008||Jun 14, 2011||Cardiac Pacemakers, Inc.||Advanced patient management for identifying, displaying and assisting with correlating health-related data|
|US7983745||Jan 8, 2009||Jul 19, 2011||Cardiac Pacemakers, Inc.||Advanced patient management with environmental data|
|US7983759||Dec 18, 2002||Jul 19, 2011||Cardiac Pacemakers, Inc.||Advanced patient management for reporting multiple health-related parameters|
|US7996087||Sep 4, 2009||Aug 9, 2011||Ebr Systems, Inc.||Leadless tissue stimulation systems and methods|
|US8019421||Sep 5, 2002||Sep 13, 2011||Metacure Limited||Blood glucose level control|
|US8027719||Mar 20, 2008||Sep 27, 2011||Cardiac Pacemakers, Inc.||Method and apparatus for delivering defibrillation shock therapy while reducing electrical dispersion due to ventricular conduction disorder|
|US8027721||Mar 24, 2003||Sep 27, 2011||Physio-Control, Inc.||Balanced charge waveform for transcutaneous pacing|
|US8034000||Jul 28, 2009||Oct 11, 2011||Cardiac Pacemakers, Inc.||Ischemia detection using a heart sound sensor|
|US8043213||Dec 18, 2002||Oct 25, 2011||Cardiac Pacemakers, Inc.||Advanced patient management for triaging health-related data using color codes|
|US8064997||Jun 12, 2006||Nov 22, 2011||Cardiac Pacemakers, Inc.||Method and apparatus for treating irregular ventricular contractions such as during atrial arrhythmia|
|US8099165||Feb 15, 2011||Jan 17, 2012||Cardiac Pacemakers, Inc.||Expert system and method|
|US8103334||Feb 17, 2010||Jan 24, 2012||Cardiac Pacemakers, Inc.||Method and system for display of cardiac event intervals in a resynchronization pacemaker|
|US8108034||Nov 28, 2005||Jan 31, 2012||Cardiac Pacemakers, Inc.||Systems and methods for valvular regurgitation detection|
|US8135465||Dec 1, 2008||Mar 13, 2012||Cardiac Pacemakers, Inc.||System providing ventricular pacing and biventricular coordination|
|US8160716||Sep 27, 2010||Apr 17, 2012||Cardiac Pacemakers, Inc.||Method and apparatus for establishing context among events and optimizing implanted medical device performance|
|US8228311||May 16, 2008||Jul 24, 2012||N-Trig Ltd.||Touch detection for a digitizer|
|US8239021||Jun 15, 2010||Aug 7, 2012||Cardiac Pacemakers, Inc.||Cardiac pacing system for prevention of ventricular fibrillation and ventricular tachycardia episode|
|US8244371||Mar 16, 2006||Aug 14, 2012||Metacure Limited||Pancreas lead|
|US8249703||Feb 9, 2007||Aug 21, 2012||Cardiac Pacemakers, Inc.||Apparatus and method for ventricular rate regularization|
|US8249725||May 8, 2007||Aug 21, 2012||Mirowski Family Ventures, L.L.C.||Methods, apparatus, and systems for multiple stimulation from a single stimulator|
|US8260416||Oct 31, 2007||Sep 4, 2012||Impulse Dynamics, N.V.||Electrical muscle controller|
|US8280518||Aug 25, 2006||Oct 2, 2012||Cardiac Pacemakers, Inc.||Recordable macros for pacemaker follow-up|
|US8301247||Oct 31, 2007||Oct 30, 2012||Impulse Dynamics, N.V.||Electrical muscle controller|
|US8301252||Jun 16, 2011||Oct 30, 2012||Cardiac Pacemakers, Inc.||Advanced patient management with composite parameter indices|
|US8311629||Oct 18, 2006||Nov 13, 2012||Impulse Dynamics, N.V.||Electrical muscle controller|
|US8315701||Sep 4, 2009||Nov 20, 2012||Ebr Systems, Inc.||Leadless tissue stimulation systems and methods|
|US8321013||Oct 31, 2007||Nov 27, 2012||Impulse Dynamics, N.V.||Electrical muscle controller and pacing with hemodynamic enhancement|
|US8326416||Oct 25, 2010||Dec 4, 2012||Impulse Dynamics Nv||Apparatus and method for delivering electrical signals to modify gene expression in cardiac tissue|
|US8346363||Dec 27, 2005||Jan 1, 2013||Metacure Limited||Blood glucose level control|
|US8352029||May 24, 2010||Jan 8, 2013||Cardiac Pacemakers, Inc.||Flexible neural stimulation engine|
|US8352031||May 24, 2007||Jan 8, 2013||Impulse Dynamics Nv||Protein activity modification|
|US8386036||Dec 15, 2011||Feb 26, 2013||Cardiac Pacemakers, Inc.||Expert system and method|
|US8391974||Dec 20, 2010||Mar 5, 2013||Cardiac Pacemakers, Inc.||Apparatus and method for pacing mode switching during atrial tachyarrhythmias|
|US8391989||Dec 18, 2002||Mar 5, 2013||Cardiac Pacemakers, Inc.||Advanced patient management for defining, identifying and using predetermined health-related events|
|US8417337||Jul 13, 2009||Apr 9, 2013||Medtronic, Inc.||Method of continuous capture verification in cardiac resynchronization devices|
|US8417350||Sep 14, 2012||Apr 9, 2013||Cardiac Pacemakers, Inc.||Recordable macros for pacemaker follow-up|
|US8512220||Jun 7, 2007||Aug 20, 2013||Cardiac Pacemakers, Inc.||Rate smoothing control|
|US8543215||Feb 18, 2013||Sep 24, 2013||Cardiac Pacemakers, Inc.||Advanced patient management for defining, identifying and using predetermined health-related events|
|US8548583||May 4, 2006||Oct 1, 2013||Impulse Dynamics Nv||Protein activity modification|
|US8600504||Jun 16, 2011||Dec 3, 2013||Cardiac Pacemakers, Inc.||Physiologic demand driven pacing|
|US8639318||Oct 29, 2012||Jan 28, 2014||Cardiac Pacemakers, Inc.||Advanced patient management with composite parameter indices|
|US8666495||Mar 18, 2005||Mar 4, 2014||Metacure Limited||Gastrointestinal methods and apparatus for use in treating disorders and controlling blood sugar|
|US8694116||Apr 16, 2012||Apr 8, 2014||Cardiac Pacemakers, Inc.|
|US8700161||Sep 4, 2003||Apr 15, 2014||Metacure Limited||Blood glucose level control|
|US8718773||May 23, 2007||May 6, 2014||Ebr Systems, Inc.||Optimizing energy transmission in a leadless tissue stimulation system|
|US8744558||Mar 27, 2007||Jun 3, 2014||Mirowski Family Ventures, L.L.C.||Method and apparatus for providing ipselateral therapy|
|US8755897||Nov 19, 2007||Jun 17, 2014||Cardiac Pacemakers, Inc.||System and method for remote expert-system medical device programming|
|US8758260||Sep 13, 2011||Jun 24, 2014||Cardiac Pacemakers, Inc.||Ischemia detection using a heart sound sensor|
|US8761905||Jun 4, 2012||Jun 24, 2014||Mirowski Family Ventures, L.L.C.||Methods, apparatus, and systems for multiple stimulation from a single stimulator|
|US8792985||Jan 20, 2006||Jul 29, 2014||Metacure Limited||Gastrointestinal methods and apparatus for use in treating disorders and controlling blood sugar|
|US8818511||Jun 8, 2009||Aug 26, 2014||Cardiac Pacemakers, Inc.||Automatic selection of stimulation chamber for ventricular resynchronization therapy|
|US8825152||Apr 3, 2002||Sep 2, 2014||Impulse Dynamics, N.V.||Modulation of intracellular calcium concentration using non-excitatory electrical signals applied to the tissue|
|US8934975||Feb 1, 2011||Jan 13, 2015||Metacure Limited||Gastrointestinal electrical therapy|
|US9008776||Oct 22, 2012||Apr 14, 2015||Ebr Systems, Inc.||Leadless tissue stimulation systems and methods|
|US9061156||Jul 17, 2014||Jun 23, 2015||Cardiac Pacemakers, Inc.||Automatic selection of stimulation chamber for ventricular resynchronization therapy|
|US9101765||Feb 16, 2006||Aug 11, 2015||Metacure Limited||Non-immediate effects of therapy|
|US9283392||Sep 24, 2010||Mar 15, 2016||Ebr Systems, Inc.||Temporary electrode connection for wireless pacing systems|
|US9289618||Oct 23, 2001||Mar 22, 2016||Impulse Dynamics Nv||Electrical muscle controller|
|US9333364||Jul 1, 2010||May 10, 2016||Ebr Systems, Inc.||Methods and systems for heart failure treatments using ultrasound and leadless implantable devices|
|US9375566||Jul 18, 2011||Jun 28, 2016||Cardiac Pacemakers, Inc.||Device for reporting heart failure status|
|US9480848||Jul 18, 2011||Nov 1, 2016||Cardiac Pacemakers, Inc.||Advanced patient management with environmental data|
|US9566440||Sep 2, 2011||Feb 14, 2017||Physio-Control, Inc.||Balanced charge waveform for transcutaneous pacing|
|US9566444||May 8, 2014||Feb 14, 2017||Mirowski Family Ventures, L.L.C.||Methods, apparatus, and systems for multiple stimulation from a single stimulator|
|US20020128687 *||May 17, 2002||Sep 12, 2002||Cardiac Pacemakers, Inc.||Multi-site hybrid hardware-based cardiac pacemaker|
|US20030004550 *||Aug 16, 2002||Jan 2, 2003||Cardiac Pacemakers, Inc.||Mode transition timing for synchronized pacing|
|US20030088290 *||Nov 7, 2001||May 8, 2003||Spinelli Julio C.||Centralized management system for programmable medical devices|
|US20030171791 *||Mar 6, 2002||Sep 11, 2003||Kenknight Bruce H.|
|US20030208240 *||May 3, 2002||Nov 6, 2003||Pastore Joseph M.||Method and apparatus for detecting acoustic oscillations in cardiac rhythm|
|US20040122294 *||Dec 18, 2002||Jun 24, 2004||John Hatlestad||Advanced patient management with environmental data|
|US20040122295 *||Dec 18, 2002||Jun 24, 2004||John Hatlestad||Advanced patient management for triaging health-related data using color codes|
|US20040122485 *||Dec 18, 2002||Jun 24, 2004||Stahmann Jeffrey E.||Advanced patient management for reporting multiple health-related parameters|
|US20040122486 *||Dec 18, 2002||Jun 24, 2004||Stahmann Jeffrey E.||Advanced patient management for acquiring, trending and displaying health-related parameters|
|US20040122487 *||Dec 18, 2002||Jun 24, 2004||John Hatlestad||Advanced patient management with composite parameter indices|
|US20040193222 *||Mar 24, 2003||Sep 30, 2004||Sullivan Joseph L.||Balanced charge waveform for transcutaneous pacing|
|US20040230456 *||May 14, 2003||Nov 18, 2004||Lozier Luke R.||System for identifying candidates for ICD implantation|
|US20040252078 *||Jun 13, 2003||Dec 16, 2004||Fischer Jonathan H.||Bi-directional interface for low data rate application|
|US20050021096 *||Jul 24, 2003||Jan 27, 2005||Mirowski Family Ventures, L.L.C.||Methods, apparatus, and systems for multiple stimulation from a single stimulator|
|US20050055057 *||Sep 5, 2003||Mar 10, 2005||Mirowski Famliy Ventures, L.L.C.||Method and apparatus for providing ipselateral therapy|
|US20050055058 *||Sep 8, 2003||Mar 10, 2005||Mower Morton M.||Method and apparatus for intrachamber resynchronization|
|US20050131468 *||Jun 15, 2004||Jun 16, 2005||Ebr Systems, Inc.||Vibrational therapy device used for resynchronization pacing in a treatment for heart failure|
|US20050180958 *||Apr 11, 2005||Aug 18, 2005||Technion Research & Development Foundation Ltd.||Method and apparatus for maintenance and expansion of hemopoietic stem cells and/or progenitor cells|
|US20050181504 *||Apr 11, 2005||Aug 18, 2005||Technion Research & Development||Method and apparatus for maintenance and expansion of hemopoietic stem cells and/or progenitor cells|
|US20060136004 *||Dec 21, 2005||Jun 22, 2006||Ebr Systems, Inc.||Leadless tissue stimulation systems and methods|
|US20060136005 *||Dec 21, 2005||Jun 22, 2006||Ebr Systems, Inc.||Implantable transducer devices|
|US20060161061 *||Mar 21, 2006||Jul 20, 2006||Ebr Systems, Inc.||Vibrational therapy device used for resynchronization pacing in a treatment for heart failure|
|US20060161207 *||Dec 20, 2005||Jul 20, 2006||Busacker James W||Method of continuous capture verification in cardiac resynchronization devices|
|US20060212079 *||Nov 18, 2005||Sep 21, 2006||Routh Andre G||Cardiac contractility modulation device having anti-arrhythmic capabilities and method of operating thereof|
|US20060247708 *||Apr 28, 2005||Nov 2, 2006||Cardiac Pacemakers, Inc.||Cardiac pacemaker with table-based pacing mode implementation|
|US20070043398 *||Oct 19, 2006||Feb 22, 2007||David Ternes||Flexible neural stimulation engine|
|US20070060961 *||Feb 10, 2006||Mar 15, 2007||Ebr Systems, Inc.||Methods and apparatus for determining cardiac stimulation sites using hemodynamic data|
|US20070078490 *||Sep 27, 2006||Apr 5, 2007||Ebr Systems, Inc.||Leadless tissue stimulation systems and methods|
|US20070088393 *||Oct 18, 2006||Apr 19, 2007||Shlomo Ben-Haim||Electrical Muscle Controller|
|US20070156177 *||Dec 27, 2006||Jul 5, 2007||Impulse Dynamics N.V.||Blood glucose level control|
|US20070171211 *||Mar 26, 2007||Jul 26, 2007||N-Trig Ltd.||Touch detection for a digitizer|
|US20070191893 *||Mar 27, 2007||Aug 16, 2007||Mirowski Family Ventures, L.L.C.||Method and apparatus for providing ipselateral therapy background|
|US20070250125 *||Jan 17, 2007||Oct 25, 2007||Cardiac Pacemakers, Inc.||Expert system and method|
|US20080077031 *||Nov 19, 2007||Mar 27, 2008||Cardiac Pacemakers, Inc.||System and method for remote expert-system medical device programming|
|US20080167692 *||Mar 20, 2008||Jul 10, 2008||Cardiac Pacemakers, Inc.||Method and apparatus for delivering defibrillation shock therapy while reducing electrical dispersion due to ventricular conduction disorder|
|US20080294208 *||May 23, 2007||Nov 27, 2008||Ebr Systems, Inc.||Optimizing energy transmission in a leadless tissue stimulation system|
|US20090131993 *||Feb 16, 2006||May 21, 2009||Benny Rousso||Non-Immediate Effects of Therapy|
|US20090149904 *||Dec 3, 2008||Jun 11, 2009||Cardiac Pacemakers, Inc.||Lv unipolar sensing or pacing vector|
|US20090248104 *||Jun 8, 2009||Oct 1, 2009||Jiang Ding||Automatic selection of stimulation chamber for ventricular resynchronization therapy|
|US20090326601 *||Sep 4, 2009||Dec 31, 2009||Ebr Systems, Inc.||Implantable transducer devices|
|US20100063562 *||Sep 4, 2009||Mar 11, 2010||Ebr Systems, Inc.||Leadless tissue stimulation systems and methods|
|US20100228308 *||Sep 4, 2009||Sep 9, 2010||Ebr Systems, Inc.||Leadless tissue stimulation systems and methods|
|US20100234912 *||May 24, 2010||Sep 16, 2010||Ternes David J||Flexible neural stimulation engine|
|US20100298900 *||Aug 2, 2010||Nov 25, 2010||Yost David W||Cardiac pacemaker with table-based pacing mode implementation|
|US20110137368 *||Feb 15, 2011||Jun 9, 2011||Par Lindh||Expert system and method|
|US20110237967 *||Sep 24, 2010||Sep 29, 2011||Ebr Systems, Inc.||Temporary electrode connection for wireless pacing systems|
|International Classification||A61N1/362, A61N1/368|
|Cooperative Classification||A61N1/3627, A61N1/368, A61N1/3684|