CN101668479B - 带姿势评估的心脏刺激装置中的感测矢量选择 - Google Patents
带姿势评估的心脏刺激装置中的感测矢量选择 Download PDFInfo
- Publication number
- CN101668479B CN101668479B CN2008800043264A CN200880004326A CN101668479B CN 101668479 B CN101668479 B CN 101668479B CN 2008800043264 A CN2008800043264 A CN 2008800043264A CN 200880004326 A CN200880004326 A CN 200880004326A CN 101668479 B CN101668479 B CN 101668479B
- Authority
- CN
- China
- Prior art keywords
- programmable device
- vector
- implantable
- sensing
- data
- 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.)
- Active
Links
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
- A61N1/372—Arrangements in connection with the implantation of stimulators
- A61N1/37211—Means for communicating with stimulators
- A61N1/37235—Aspects of the external programmer
- A61N1/37247—User interfaces, e.g. input or presentation means
-
- 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
- A61B5/1116—Determining posture transitions
-
- 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
- A61B5/25—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
- A61B5/29—Invasive for permanent or long-term implantation
-
- 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
- A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
- A61B5/339—Displays specially adapted therefor
- A61B5/341—Vectorcardiography [VCG]
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
- A61B5/7221—Determining signal validity, reliability or quality
-
- 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
-
- 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
-
- 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
- A61N1/3702—Physiological 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
- A61N1/3702—Physiological parameters
- A61N1/3704—Circuits specially adapted therefor, e.g. for sensitivity control
-
- 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
- A61N1/38—Applying electric currents by contact electrodes alternating or intermittent currents for producing shock effects
- A61N1/39—Heart defibrillators
- A61N1/3925—Monitoring; Protecting
-
- 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
- A61N1/38—Applying electric currents by contact electrodes alternating or intermittent currents for producing shock effects
- A61N1/39—Heart defibrillators
- A61N1/3956—Implantable devices for applying electric shocks to the heart, e.g. for cardioversion
-
- 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
- A61N1/36514—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by a physiological quantity other than heart potential, e.g. blood pressure
- A61N1/36535—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by a physiological quantity other than heart potential, e.g. blood pressure controlled by body position or posture
Abstract
方法、可植入医疗装置和系统配置成执行来自己植入电极的所捕获信号的分析,以便识别心律失常。在说明性实施例中,分析从两个或两个以上感测矢量所捕获的信号,其中对处于至少第一和第二体位的患者捕获信号。执行分析以便识别主要或默认感测矢量和/或模板用于事件检测。
Description
相关申请的交叉引用
本申请涉及2007年1月16日提交的标题为《使用多项式方法的可植入医疗装置中的感测矢量选择的系统和方法》(SYSTEMS ANDMETHODS FOR SENSING VECTOR SELECTION IN ANIMPLANTABLE MEDICAL DEVICE USING A POLYNOMIALAPPROACH)的美国申请序号11/623472,通过引用将其公开结合到本文中。本申请还涉及2006年5月26日提交的标题为《可植入医疗装置中的感测矢量选择的系统和方法》(SYSTEMS AND METHODSFOR SENSING VECTOR SELECTION IN AN IMPLANTABLEMEDICAL DEVICE)的美国申请序号11/441522,通过引用将其公开结合到本文中。
技术领域
本发明涉及可植入医疗装置领域。更具体来说,本发明涉及监测和/或刺激心脏的可植入装置。
背景技术
可植入心脏监测和/或刺激装置可向接收它们的患者提供各种好处。这类装置适合在被植入时监测患者的心搏,并且在这样配备时根据需要提供刺激,以便确保足够的心脏功能。需要新的不同方法来在这类装置中配置和执行心脏信号评估。
发明内容
在一个说明性实施例中,本发明包括可植入医疗装置,所述可植入医疗装置包括感测电极和电路,所述感测电极和电路允许所述装置在被植入到患者体内时沿多个感测矢量感测从患者的心脏发出的电活动。在说明性实施例中,可植入医疗装置配置成通过观测沿多个感测矢量的一个或多个的心脏信号特性来选择主要或默认感测矢量。在一个说明性实施例中,心脏信号特性的观测包括患者的体位或姿势方面的初始化。
在另一说明性实施例中,包括作为包括外部编程器的系统的一部分的如上所述的装置,其中编程器和已植入(implanted)装置配置成相互通信。在这个实施例中,对系统进行配置使得可经由编程器指导患者执行某些动作和/或采取所选姿势/姿态/体位,从而允许已植入装置观测患者的姿势变化对所捕获心脏信号的影响。然后,已植入装置(或者编程器,取决于具体配置)可选择主要或默认感测矢量。
另一说明性实施例包括选择矢量供感测心脏事件使用的方法。在说明性方法中,可对处于各种体位(例如站立、坐和/或平躺)的患者考虑沿若干矢量的感测特性。使用所捕获感测特性,可选择默认或主要感测矢量。在一个说明性示例中,该方法包括指导患者采取一组姿势/姿态/体位。
除了选择主要或默认感测矢量之外,在一些实施例中,选择辅助矢量用于各种用途。
附图说明
图1A-1B示出皮下和经静脉的心脏刺激器;
图2是示出说明性植入过程中的步骤的框图;
图3-5示出已植入医疗装置中的姿势评估的说明性方法;
图6A-6B是姿势评估期间分析感测矢量的说明性方法中的变量关系的图表;
图7A-7C是说明性信号分析方法中的变量关系的图表;以及
图8A-8E是姿势评估的说明性方法中的编程器的显示输出的图形表示。
具体实施方式
应当参照附图来阅读以下详细描述。不一定按比例的附图示出说明性实施例,而不是要限制本发明的范围。
本发明涉及2006年5月26日提交的标题为《可植入医疗装置中的感测矢量选择的系统和方法》(SYSTEMS AND METHODS FORSENSING VECTOR SELECTION IN AN IMPLANTABLE MEDICALDEVICE)的美国申请序号11/441522,通过引用将其公开结合到本文中。具体来说,该’522申请示出分析沿给定感测矢量所捕获的心脏信号的说明性方法。其所示的方法说明了也可结合本发明执行的分析方法与“评分”。
图1A-1B分别示出相对于心脏的皮下和经静脉植入的心脏刺激系统。参照图1A,相对于植入的包括罐(canister)12的皮下心脏刺激系统示出患者的心脏10。引线14固定到罐12,并且包括感测电极A16、线圈电极18和感测电极B 20。在罐12上示出罐(can)电极22。因此,用于感测的若干矢量是可用的,其中包括A-can、B-can和A-B。应当注意,线圈电极18用作感测电极也是可能的。在美国专利号6647292和6721597中示出说明性皮下系统,通过引用将这些专利的公开结合到本文中。一些实施例包括具有如’292专利中提出的壳体上的两个或更多电极的单一(unitary)系统,而不是图1A所示的系统。也可使用包括附加引线的单一系统。应当理解,对于本文所述的任何矢量,各矢量的两个可用极性的任一种是可能的,并且可在需要时对其进行分析和/或选择。
现在参照图1B,相对于患者的心脏30示出经静脉系统。静脉心脏刺激系统包括与引线34连接的罐32。引线34进入患者的心脏,并且包括电极A36和B38。说明性示例还包括示出在心脏30的内部和外部的线圈电极42。线圈电极42可用于感测或刺激传递。在说明性示例中,电极A36一般设置在患者的心室中,而电极B38一般设置在患者的心房中。引线34可锚定到患者的心肌。又在罐32上示出罐(can)电极40。用该皮下系统,还可定义多个感测矢量。
在图1A和图1B中,一个或多个感测电极也可用于刺激传递。本发明的一些实施例可用于可包括两个皮下电极之间、皮下电极与经静脉的电极之间或者两个经静脉的电极之间所定义的感测矢量的组合系统。例如,本发明可在具有用于经静脉、心外膜和/或皮下的若干位置中的每个位置的电极的混合系统中实施。
在图1A和图1B的配置中,有多个感测矢量可用。沿这些感测矢量其中之一的心脏功能检测允许植入的心脏刺激系统确定是否因检测和识别到例如室性心动过速(ventricular tachycardia)等恶性疾病而指明了处理(treatment)。植入医师可通过例如经由视觉检查所捕获信号的图形表示确定哪个所捕获矢量最佳来执行矢量选择。但是,这要求根据若干矢量来评估心脏功能,并且可能增加执行植入所需的时间,而且还增加人为错误的风险。此外,矢量的选择可能需要高级或专业训练,因为在那些可用矢量中选择适当的矢量不一定是直观的。
鲁棒(robust)感测矢量选择方法以及适用于执行这类方法的装置是合乎需要的。在说明性实施例中,本发明提供这类方法,并且使用各种标准来进行。一些实施例包括适用于执行这类方法的可植入装置以及可植入装置的编程器。
图1A-1B所示的系统可包括包含在相应罐中的操作电路以及电源。电源可以是例如电池或电池组。操作电路可配置成包括执行本文提出的说明性方法所选、所需或者所希望的这类控制器、微控制器、逻辑装置、存储器等。操作电路可以(但不是必须)还包括用于为采取心律转变(cardioversion)和/或去纤颤(defibrillation)的形式的心脏刺激建立贮存电压的充电子电路和功率存储子电路(例如电容器组)。操作电路还可适用于提供起搏输出。心律转变/去纤颤和起博子电路中的每个及功能可结合到单个装置中。下面所述的方法可通过操作电路中的硬件和/或作为操作该操作电路的指令集和/或采取包含这类指令和指令集的机器可读介质(光、电、磁等)的形式来体现。
装置12、32的每个装置还可包括例如适合与例如编程器的外部装置进行通信(例如RF通信或感应遥测)的这类组件。为此,还示出编程器24(图1A)和42(图1B)。例如,在植入过程中,一旦放置可植入装置12、32和引线(如果包含的话),则可使用编程器24、42来激活和/或指导和/或观测诊断或操作测试。植入之后,编程器24、42可用于非侵入式地确定植入装置的状态和历史。编程器24、42和植入装置12、32可适用于无线通信,从而允许植入的装置以对已植入装置系统的任何适当方式的询问。编程器24、42与已植入装置12、32结合还可允许向用户或医师公布统计、错误、历史和可能的问题。
图2是示出说明性植入过程中的步骤的框图。自开始框100,第一步骤是物理植入本身102,它可包括本领域已知的各种术前准备、对患者切口以及放置例如上文在图1A-1B示出的经静脉或皮下系统的系统。用于物理植入经静脉装置的方法是众所周知的。可按照例如以下共同未决美国申请序号中所提出的植入皮下装置:11/006291,2004年12月6日提交,标题为《用于皮下电极插入的设备和方法》(APPARATUS AND METHOD FOR SUBCUTANEOUS ELECTRODEINSERTION),作为美国专利发布No.2006/0122676发布;和/或11/497203,2006年8月1日提交,标题为《用于放置心脏装置电极的电极插入工具、引线组件、套件和方法》(ELECTRODE INSERSIONTOOLS,LEAD ASSEMBLIES,KITS AND METHODS FORPLACEMENT OF CARDIAC DEVICE ELECTRODES),通过引用将这些公开结合到本文中。
随着系统在患者体内定位,装置被初始化,如104所示。这可包括如106所示的各种功能,例如装置的加电、系统检查、引线连接、检测和阻抗检查。初始化104还可包括矢量选择步骤和模板形成步骤,从而在患者处于手术室时允许装置的初始设置。在2004年11月29日提交的标题为《定义可植入心脏装置中的信号模板的方法》(METHOD FOR DEFINING SIGNAL TEMPLATES IN PLANTABLECARDIAC DEVICES)、作为美国专利发布No.2006/0116595发布的美国申请序号10/999853中论述了模板形成的说明性方法,通过引用将其公开结合到本文中。在以下文献中论述了矢量选择的说明性方法:共同未决美国申请序号11/441522,2006年5月26日提交,标题为《用于可植入医疗装置中的感测矢量选择的系统和方法》(SYSTEMSAND METHODS FOR SENSING VECTOR SELECTION IN ANIMPLANTABLE MEDICAL DEVICE);共同未决美国申请序号10/901258,2004年7月27日提交,标题为《皮下ICD的多个电极矢量》(MULTIPLE ELECTRODE VECTORS ON A SUBCUTANEOUSICD),作为专利申请发布No.2005/0049644发布;以及美国专利No.6988003,标题为《单一皮下可植入心律转变器-去纤颤器的引线的可选使用》(OPTIONAL USE OF A LEAD FOR A UNITARYSUBCUTANEOUS IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR),通过引用将这些公开结合到本文中。功能106的每个功能的包含可根据特定装置而改变。
在104的装置初始化之后,装置被测试,如108所示。例如,对于可植入心律转变器去纤颤器(ICD),可在患者体内引起纤颤,以便确定ICD是否准确感测该纤颤并成功传递使患者回复正常心律的治疗。如果测试不成功,或者如果装置没有初始化,则系统可能被外植了。相反,如果在104的初始化成功完成,并且系统通过在108的装置测试,则用具有包括缝合植入期间进行的切口的适当方法完成植入的手术部分,如110所示。
在说明性方法中,在完成植入方法的手术部分后进行姿势分析112。在姿势分析112期间,在患者已经具有了已插入并激活的装置之后,并且可能在患者已经有时间略微复原之后,观测并可修改已植入装置的操作。具体来说,可要求患者采取一系列位置、如坐下然后站起,同时已植入装置收集数据以便确定其可用感测矢量中的哪一个最适合永久操作。在一个说明性示例中,引导患者通过一系列体位,使得装置可确定始终用作主要或默认感测矢量的单个感测矢量,使得每当患者改变姿势或体位时不是必需出现感测操作的变化。
在另一个说明性示例中,对若干体位中的每个体位确定最佳或最好矢量,并在操作期间监测体位使得已植入装置可为患者的当前体位选择最佳矢量。例如可通过设置参考重力、移动等检测体位的物理传感器来监测体位。例如,可用经胸廓(transthoracic)的阻抗来提供患者体位的测量。可用活动传感器来推断患者是站立还是平躺。备选地,体位可通过观测所捕获电信号来监测。例如,在姿势分析112期间,系统可配置成识别信号标记,以便区分患者处于若干体位中的每个体位时所捕获的心脏信号,并在此后通过观测患者的心脏信号来识别患者的体位。
一旦姿势分析112完成,则可放开(discharge)患者114,因为植入过程和处理已完成。放开114之后,可要求患者返回以便进行进一步诊断,例如,可更新初始化(例如功能106),并且可在以后重复进行姿势分析112。例如,这可在患者的生理情况由于对植入本身的反应而随患者药物治疗的变化而改变时和/或在患者年纪增长时进行。
图3-5示出已植入医疗装置中的姿势评估的说明性方法。图3示出姿势评估的确认方法,其中根据患者处于给定体位时的特性来识别矢量,然后检查所识别矢量以便确认它可用,而与患者的体位无关。该方法在框130开始,其中患者处于给定体位、在本例中为仰卧。在其它实施例中,例如,患者可以例如俯卧、斜躺、站立等不同体位或者患者睡觉时偏好的无论什么位置开始。
患者处于给定位置时选择矢量,如132所示。在132,例如可根据所捕获心脏信号沿矢量的信噪比(SNR)来选择那个矢量。用于在132选择矢量的其它量度可包括信号幅度、噪声幅度等。在一个说明性实施例中,考虑SNR和信号幅度的组合。例如,可采用使用SNR和幅度的公式。在2006年5月26日提交的标题为《用于可植入医疗装置中的感测矢量选择的系统和方法》(SYSTEMS AND METHODSFOR SENSING VECTOR SELECTION IN AN IMPLANTABLEMEDICAL DEVICE)的共同未决美国申请序号11/441522中示出这种分析的一些说明性示例。
在另一个说明性实施例中,采取默认矢量而不是基于任何量度进行选择。例如,如果特定系统和植入具有适用于大多数患者的矢量,则可首先选择那个矢量来开始分析。在另一个示例中,可存在优选矢量,例如在存在两个仅感测电极和一个或多个感测/震动电极的情况下。因为在传递刺激时对于感测/震动电极可能在电极/组织界面发生物理变化,所以两个仅感测电极之间的矢量可以是“优选的”。因此,在开始该方法时,在步骤132可选择“优选”矢量。
可选地,可用在132选择的矢量形成用于分析心脏信号的模板,如134所示。图3的方法的这个可选步骤可包括用所选矢量捕获一组信号,在这组信号中识别可能的心脏事件,以及围绕可能对应于心脏事件的基准点形成所捕获信号的窗口。
模板形成的一个说明性示例可如下所述:首先,可将沿所选矢量所捕获的信号与阈值进行比较,以及当超过阈值时,心脏事件被认为是可能的。将阈值横过(crossing)之后的一组样本(例如在256Hz所捕获的随后40个连续样本)中的峰值确定为基准点,并且计算围绕该基准点的样本的窗口。这个初始捕获被认为是心脏事件。随后结合以后的阈值横过来捕获若干附加“事件”,其中以对应于原始识别的“事件”的方式来选择基准点和/或窗口。
然后,例如使用相关波形分析或者备选地使用例如QRS宽度的另一种量度来将所捕获事件相互比较,所述QRS宽度可确定为其中信号保持为高于最小阈值的持续时间。如果这组事件充分相似,则通过选择有代表性的事件或者通过对这组事件求平均来形成模板。在一些实施例中,模板可通过对在以后捕获的事件求平均来进行动态更新。模板形成的附加示例还可见于2004年11月29日提交的标题为《定义可植入心脏装置中的信号模板的方法》(METHOD FORDEFINING SIGNAL TEMPLATES IN PLANTABLE CARDIACDEVICES)、作为美国专利发布No.2006/0116595发布的美国申请序号10/999853。在一些实施例中,在多组捕获事件之间没有出现相似性的情况下,模板形成可能失败。例如,可使用超时,以及如果在一段时间(例如60-180秒)之后模板无法使用相似性分析来形成,则所考虑的矢量可确定为不适合于检测。
随后,指导患者改变体位,如136所示。可使用原始位置之外的一个或多个附加位置。例如,如果患者仰卧,如130所示,则可要求患者移到俯卧位置、坐起和/或站立。在138所列的位置只是说明性的,并且这类位置的固定数量不是必要的。在一个说明性实施例中,确定患者趋向于以什么位置来休息,例如斜躺和/或患者的睡姿、如侧卧,以便姿势评估考虑患者在大多数情况所处的位置。对于要求患者采取的各位置,已植入装置分析所选矢量,以便确定所选矢量对于心脏事件检测和分析是否充分起作用。在一个说明性示例中,如果所选矢量无法在任何位置充分起作用,则该方法跳过任何其余体位,并且进入步骤140。否则,在至少两个位置中的每个位置分析所选矢量。
在一个说明性示例中,通过考虑SNR、信号幅度和/或噪声幅度中之一或多个,在每个位置分析所选矢量。例如,SNR和信号幅度可通过使用公式来考虑,下面进一步说明。
然后,该方法转到步骤140,其中确定所选矢量是否被检验或者确认为“良好”感测矢量。如果是,则该方法在142结束。如果所选矢量未经检验或确认,则该方法返回到步骤132,并且选择不同的矢量,其中在返回到步骤132时再次要求患者采取第一体位、然后转到如步骤136所示的附加体位。在这种方法中,首先选择矢量,然后在患者改变体位时测试该矢量。
与图3的确认方式相比,图4示出确定性方式。图4中,例如,患者采取给定体位,并且保持那个位置,直至收集到每个可用矢量的数据为止。图4的方法以开始框160开始。要求患者选择体位,如162所示。在164列出了说明性位置;在一个示例中,要求患者仰卧,然后要求患者坐起和/或站立。然后,在患者保持在所选体位时分析各矢量,如166所示。在步骤166期间捕获各矢量的数据之后,确定是否已经测试所有位置,如168所示。如果没有,则该方法返回到步骤162,在那里选择不同的体位,并且要求患者采取不同的体位。一旦测试了每个预期体位,则该方法从168退出循环,并且选择矢量,如170所示。一旦根据162-166-168的循环中捕获的数据识别了矢量,则该方法可执行模板形成,如172所示。在一些实施例中,如果模板形成172失败,则该方法可返回到步骤170,并且选择不同的矢量。然后,该方法结束,如174所示。
在一个备选实施例中,识别第一和第二矢量,其中第二矢量是备用矢量,该备用矢量因为第一主要或默认矢量变为不可用而使用或者备选地在第一矢量提供关于患者是否正经受心律失常的不明确指示时使用。
在一些实施例中,识别单个矢量以供在患者处于任何体位时使用。在其它实施例中,可对患者形成若干模板。例如,患者处于仰卧位置时所捕获的数据的分析可指明与患者处于直立位置时所捕获的数据不同的“最佳”矢量。然后可形成两个模板,而不管第一和第二模板是否使用同一矢量来形成,其中各模板包括用于其感测矢量配置的信息。
作为说明,第一模板可使用感测矢量A-Can(参见图1),并且可在患者仰卧时的姿势评估的时候定义,而第二模板可使用矢量A-B(参见图1A),并且可在患者端坐时的姿势评估的时候定义。然后,在分析期间,任何给定时间的主要模板可以是指明普通心脏功能的任何一个。如果没有模板指明普通心脏功能,则可认为正发生心律失常,并且可传递刺激。这可作为布尔方法的一部分来执行,以便查找心律失常活动:
IF分析(A)失败
AND IF分析(B)失败
THEN事件指明恶性节律
这种分层分析可防止因患者体位的变化引起的心律的误诊。
在另一个说明性示例中,主要和辅助模板可响应来自体位传感器的输出而相互转换。例如,如果主要模板与第一体位关联,而辅助模板与第二体位关联,则可监测体位传感器的输出,并且模板根据体位传感器所指明的体位进行转换。
另外,可实现模板之间的转换,而无需使用专用位置传感器。在一个说明性示例中,仅在基于形态的分析系统中执行分析(A),直到满足第一异常阈值。例如,如果使用X/Y计数器,则分析(A)可单独使用,直到满足第一X/Y阈值。在一个说明性示例中,如果18/24个事件是关于正发生恶性心律的确定的阈值,则8/24阈值可用于激活分析(B)。如果2-3个事件在分析(B)开始起作用之前发生,那么如果患者已经改变位置则可发生平滑过渡,因为到18/24计数器填充分析(A)时,将已经使用分析(B)检测8个或更多事件。在一个说明性示例中,如果发现使用分析(B)的4/8事件满足模板比较参数,则系统可转换到分析(B),从而将与分析(A)不同的模板和/或矢量用于主要分析。在使用主要和辅助模板的一些说明性实施例中,可将刺激传递(或者刺激传递的准备)延迟到确定采用各模板的分析指明恶性心律为止。
图4的方法要求收集比图3的方法更多的数据,而不管一个矢量是否优良。因此,在一些情况下,这种方法可能比图3的方法更慢。但是,采用图3的方法,在姿势评估期间可能要求患者采取并重复若干动作。如果装置被植入到例如因老年充血性心力衰竭而比较虚弱的患者,则反复的动作可能是不合要求的。说明性示例可配置成执行任一种方法。在另一个说明性示例中,系统中的装置(已植入医疗装置和/或编程器)配备成执行任一种方法,其中编程器允许医师选择一种或另一种方法。
图5示出说明性实施例的详细方法。如200所示,该方法以患者(PT)仰卧开始。步骤200可以是从编程器给予医师的使患者采取仰卧位置的指示,或者可从编程器本身直接给予患者。检验了这个位置(例如编程器可请求指明患者处于所要求位置的输入),则选择第一矢量,如202所示。
然后计算VS SCORESUP,如204所示。VS SCORESUP可以是计算来指明感测矢量的质量的“得分”。如上所述,这可包括考虑信号幅度、SNR等。SCORE的计算可利用公式、查找表或者对感测矢量的质量设置量度的任何适当方法。在2006年5月26日提交的标题为《用于可植入医疗装置中的感测矢量选择的系统和方法》(SYSTEMS ANDMETHODS FOR SENSING VECTOR SELECTION IN ANIMPLANTABLE MEDICAL DEVICE)的共同未决美国申请序号11/441522中示出说明性方法。
在204计算得分之后,确定是否已经分析所有矢量,如206所示。如果没有,则选择不同的矢量,如208所示,并在204,该方法计算另一个VS SCORESUP。如果在步骤206已经考虑所有矢量,则该方法继续进行到框210。
在框210,根据系统配置,编程器或可植入装置确定附加患者位置是否是可能的。如果不是,则该方法继续进行到步骤212,在那里选择具有来自初始分析的最大SCORE的矢量以供分析使用,并发起模板形成,如214所示。可提供这个选择输出步骤210以便适应由于身体限制而不能改变体位的患者或者适应植入过程期间的使用。
如果在步骤210,一个或多个附加患者位置是可能的,则该方法继续进行到步骤220。在步骤220,编程器请求用户采用不同的位置,例如站或坐。然后,该方法执行与对于第一体位所执行的相似的步骤。在222选择矢量,在224计算得分VS SCORESTD,并确定是否已经在226考虑了每个矢量。如果没有,则如228所示,该方法随所选的不同矢量返回到224。一旦完成所有矢量,则比较这些矢量,如230所示。在一个说明性实施例中,使用在236所示的公式来计算各矢量的PASSValue。
公式236包含两个大项。图6A-6B是姿势评估期间分析感测矢量的说明性方法中的变量关系的图表,其中图6A示出第一项:
这个第一项的结果随每个SCORE的幅度而增加,并且在SCORE的幅度相似时最大。
图6B示出第二项的关系:
当信号幅度相互最接近时,这项的值接近1,而如果患者处于一个体位时的感测矢量的最大信号幅度与患者处于另一个体位时的感测矢量的最大信号幅度明显不同,则它接近0。
简言之,说明性公式236考虑到SCORE的大小和相似性,即,在第一项中矢量质量是否很高并且沿给定矢量的信号强度是否很高,以及矢量是否提供比较一致的输出,特别是在信号幅度方面,而不管患者的体位。包含第二项的一个原因在于,在说明性实施例中,可植入装置的事件检测系统包括具有两个动态范围的放大输入,其中一个较大而一个较小。采用这种系统,在一些实施例中,可以更好地选择在每个患者体位中捕获比较全面利用所述动态范围中之一的信号的矢量。
例如,给定动态范围0-2.0mV和0-4.0mV,采用其中峰值电压对两个体位均为0.75mV的第一矢量而不采用其中峰值电压对于一个体位为0.75mV而对第二体位为2.5mV的第二矢量,分析可更容易并且更可靠,因为后一个矢量要求更低放大以适应第二体位但使用患者处于第一体位时不良的动态范围。例如,图7C示出SCORE计算,其中幅度以具有第一和第二峰值以及它们之间具有波谷的方式来影响输出SCORE。虽然用两项来说明动态范围是一些说明性实施例的组成部分,但是其它说明性实施例可改为将图7A的公式用于得分计算,下面进一步说明。
说明性公式236假设以某种方式生成SCORE值。一些说明性实施例使用以下方式:
SCORE=SA×SR
式中,例如,SA和SR可使用若干方式中之一来计算。在一个这样的实施例中,使用如下公式:
式中:
GAIN=64.0 N1=-34.7222
N2 =0.2326 N3=-0.6047
D1 =0.3008 D2=-0.7821
应当注意,在该说明性实施例中,对QRSAvg的限制为0<QRSAvg<4.0。示出SA与QRSAvg之间的关系的图表如图7A所示。
说明性评分方法还包括将值SR计算为:
SR=CR *(SNR)2
式中:如果SNR≤3.5,则CR=0.1;
如果3.5<SNR≤10,则CR=1;以及
如果SNR>10,则SR=100
示出SR与SNR之间的关系的图表如图7B所示。
在另一个实施例中,SA和SR可根据如下查找表来计算:
查找表
SA | QRSAvg(mV) | SR | SNR |
0.5 | ≤0.5 | 0.5 | ≤3 |
5 | 0.5-0.65 | 1 | 3-3.5 |
10 | 0.65-0.8 | 25 | 3.5-4 |
18 | 0.8-1.0 | 50 | 4-5 |
30 | 1.0-1.7 | 75 | 5-7.5 |
20 | 1.7-2.0 | 100 | >7.5 |
40 | 2.0-3.0 | ||
15 | 3.0-3.5 | ||
0.5 | 3.5-4.0 |
可以看到,根据适用于多个动态范围的一个实施例,使用查找表的输出得分包括在1.7mV<QRSAvg<2.0mV的范围中的波谷。
在又一实施例中,SA和SR使用另一个多项式公式来计算,例如:
SR=CR *(SNR)2
其中:如果SNR≤3.5,则CR=0.1;
如果3.5<SNR≤10,则CR=1;以及
如果SNR>10,则SR=100
可以看到,SR在这里与如上所示的第一计算方法相同地计算,以及示出该关系的图表如图7B所示。在这个说明性示例中,SA可使用下式来计算:
SA={C1 *(QRSAvg)6+C2 *(QRSAvg)5+C3 *(QRSAvg)4+C4 *(QRSAvg)3+C5 *(QRSAvg)2+C6 *(QRSAvg)+C7}
其中,若QRSAvg≤2.0,则
C1=22.5718 C2=-105.9666 C3=160.2345
C4=-88.9262 C5=29.6019 C6=-1.2859
C7=0.0087
以及,若QRSAvg>2.0,则
C1=56.5544 C2=-1069.9959 C3=8310.0056
C4=-33849.9682 C5=76139.7271 C6=-89551.3405
C7=43035.7880
示出SA与QRSAVG之间的关系的图表如图7C所示。查找表和使用6阶多项式的这种第三方法均通过在对应于输入信号的SCORE中提供在这两个动态范围之间交界的倾斜(dip)来考虑具有第一和第二动态范围的系统。
计算SCORE的这些方法只是说明性的,并且本领域的技术人员会理解,所涉及的值和计算将根据系统的定位、所使用的电子器件和电极、功率等级以及可能的其它变量而改变。
如果两个位置是可能的则在两个或更多体位对患者执行感测矢量的分析,以及这种分析提供指明该矢量是否有用/可使用的结果,对于本发明是充分的。对于一些实施例,分析还可提供若干矢量的结果,使得可将这些矢量相互比较。例如,在图3的方法中,“Yes”/“No”的布尔输出可以是矢量分析的结果,使得在矢量最初被选择并且起作用时,产生“Yes”的输出结果。但是,对于图4-5的方法实施例,示出允许比较分析的矢量分析的输出,因为它允许在分析结束时将这些矢量相互比较。在备选实施例中,如同图4-5中的方法以确定了优先顺序的可用矢量返回布尔结果,使得选择返回有用结果(例如“Yes”输出)的最高优先级矢量。
再参照图5,在230的矢量比较之后,将具有最大PASSValue的矢量选择为默认或主要感测矢量,如232所示。然后可发起模板形成,如214所示,且装置可继续前进到普通功能。如果需要,则还可在步骤232识别辅助感测矢量。例如可因为上述任何原因包括解决不明确性、提供心脏功能的布尔校验或者提供患者改变体位时使用的第二矢量而使用辅助感测矢量。
在利用相似关系的一个更一般实施例中,第一公式可以是如下形式:
其中,n是被测体位的数量,以及SCOREi是患者处于第i体位时的矢量的得分。幅度因子可与上述幅度因子相似。可包括的附加因子采取如下形式:
这一项还强调最小得分值,例如,在姿势评估中使用三个体位时,如果在这些体位的任一个中得到很低得分,则所考虑的矢量可能不适合于检测,而不管其它位置中的高SCORE,并且这个因子将减小输出PASS值。
图8A-8E是姿势评估的说明性方法中的编程器的显示输出的图形表示。在说明性实施例中,编程器包括触摸屏;在其它实施例中,编程器可包括按钮、小键盘或其它控件,并且可采取任何适当的形式。
图8A示出第一屏幕截图(shot)。编程器向医师指明姿势评估过程将要开始。要求医师确保患者平躺(第一体位),然后触摸屏幕上的“continue(继续)”图标300。在编程器屏幕的顶部,指明已植入装置的状态。具体来说,在这些步骤中,装置的治疗可以(可选地)关掉。指明装置状态为“implanted(已植入)”以及患者的心率。在一些实施例中,如果患者的心率不在预定范围、例如50与120bpm之内,则编程器可拒绝执行姿势评估。
在医师按下图8A的屏幕截图的“continue”图标300之后,看到的下一个屏幕是图8B的屏幕截图,在那里编程器指明装置正在收集患者的节律。要求医师使患者保持不动。提供“cancel(取消)”按钮302,以防医师确定该过程应当例如当患者感到不适或痛苦、显示身体异常(例如升高的心率)或者当患者移动时停止。如果需要,则可提供状态栏,以便向医师指明感测矢量分析的进度。
一旦捕获了第一患者体位的数据,则下一个屏幕截图是图8C的屏幕截图。要求医师使患者端坐(第二体位)。患者端坐时,要求医师使患者保持不动,并且按下“continue”按钮304。然后,编程器显示图8D的屏幕截图,它与图8B十分相似,并且又包括可选的“cancel”按钮306,并且可包括状态栏。
如图8E所示,一旦第二体位的数据捕获完成,说明性实施例中的患者适应(tailoring)完成。医师(或其他操作人员)可通过触摸“continue”图标310来继续执行其它任务。在其它实施例中,需要时,可接着进行附加数据捕获。
在一些实施例中,患者的数据捕获可包括医师输入的选项。例如,在数据捕获期间,有可能使人为现象(artifact)(如T波)干扰R波的检测。在一些情况下,可需要或请求医师的输入,以便解决与事件分类相关的任何问题。在2006年5月26日提交的标题为《用于可植入医疗装置中的感测矢量选择的系统和方法》(SYSTEMS ANDMETHODS FOR SENSING VECTOR SELECTION IN ANIMPLANTABLE MEDICAL DEVICE)的共同未决美国申请序号11/441522中论述了一些示例。在一个说明性实施例中,延迟任何这类问题均直到已经捕获所有数据为止,从而允许医师集中于编程器以便回答这类问题,而不是在解决这类问题时还使患者保持在预定位置。在另一个说明性实施例中,在出现这类问题时询问这类问题。
在一些实施例中,上述方法可在植入之后由患者稍后亲自重访。例如,当家庭监测系统可用于具有已植入心脏监测和/或刺激装置的患者时,家庭监测系统可用于与已植入装置进行通信,从而允许稍后按照姿势评估来重新选择感测矢量。在一个说明性示例中,家庭监测系统可包括允许用户指明姿势评估准备就绪的图形用户界面,此后,家庭监测系统可提供图形输出,指明使患者完成对心脏信号的姿势影响的家庭监测自评估要在身体上进行的操作。因此,具有允许其在支持姿势评估方面为患者提供指导的功能性的家庭监测系统也可以是本文所述的方法和系统中的“编程器”。
又一说明性实施例可包括如图1A-1B的任一个所示的装置,所述装置包括用于确定患者体位的传感器或感测系统。例如,传感器可以是重力传感器或者加速计类型的传感器。传感器还可用于测量经胸廓的阻抗,作为患者体位的替代。在一个实施例中,系统不需要使用位置传感器来确定实际位置,而是可识别与特定矢量和/或模板的有效性相关的位置传感器输出范围。例如,当患者从端坐转到站立时,位置传感器输出可指明位置的变化。当位置如位置传感器所示改变时,系统可通过观测各种模板分析独自确定主要感测矢量是否应当改变。为此,从已植入医疗装置系统的角度来看,不需要对位置的了解,而是从可用的若干模板识别最佳模板就已足够。
在操作期间,另一说明性已植入医疗装置可定期(每隔一段时间)或者偶尔(响应于条件或请求)执行姿势评估,而无需要求患者移动。例如,如果位置传感器输出为“X”,则可执行矢量选择。如果位置传感器稍后提供不同的输出“Y”,则可再次执行矢量选择,因为可假设患者处于不同的体位。这个过程可重复进行数次,其中对于各种位置传感器输出识别模板和矢量。在选择过程之后,如果位置传感器输出返回到“X”,则可选择与位置传感器输出“X”关联的矢量和/或模板。在这种方法中,单个矢量可具有各对应于一个位置传感器输出的多个模板。
本领域的技术人员将会知道,本发明可通过除了本文所述和所考虑的具体实施例之外的多种形式来证明。因此,在没有脱离如所附权利要求书所述的本发明的范围和精神的条件下,可进行形式和细节上的脱离。
Claims (25)
1.一种初始化可植入心脏刺激装置的方法,所述可植入心脏刺激装置包括至少两个用于通过使用可植入电极来感测心脏活动的可用感测矢量,通过在植入之后使用编程器与所述可植入心脏刺激装置通信来执行所述方法,所述方法包括:
所述编程器与所述可植入心脏刺激装置进行通信,并且指示所述可植入心脏刺激装置以初始化例程进行操作;
在所述初始化例程期间,所述编程器提供提示使所述可植入心脏刺激装置的接受者采用并保持第一体位,并且所述编程器等待指明正在保持所述第一体位的输入;
在所述第一体位之后,所述编程器提供提示使所述接受者采用并保持第二体位,并且所述编程器等待指明正在保持所述第二体位的输入;以及
所述编程器指示所述初始化例程完成,或者如果初始化没有自动完成,则所述编程器从所述编程器所提供的信号表示请求识别心脏事件的输入;
其中:
所述编程器提供提示并且在所述植入物在所述接受者处于所述体位中的每一个时从所述可用感测矢量捕获数据的同时接收输入;
如果所述编程器指示所述初始化例程完成,则所述可植入心脏刺激装置和/或编程器使用在所述接受者处于所述体位中的每一个时所捕获的数据来选择所述可用感测矢量中的一个作为默认感测矢量供所述可植入心脏刺激装置使用。
2.如权利要求1所述的方法,其中,所述可植入心脏刺激装置执行响应于所述编程器所通信的指示的操作以便捕获与所述感测矢量中至少两个相关的数据并将其传送给所述编程器,所述编程器执行分析所述数据以便选择矢量以供所述可植入心脏刺激装置的心脏事件检测使用的步骤。
3.如权利要求1所述的方法,其中,所述可植入心脏刺激装置执行定向成选择默认感测矢量的数据捕获和分析,其中所述编程器提供:a)开始初始化的指示;b)所述接受者处于所述第一体位的指示;c)所述接受者处于所述第二体位的指示;以及d)在自动矢量选择因不良信号质量而不可能时,所述编程器提供所捕获信号的样本中的心脏R波峰值的标识。
4.如权利要求1所述的方法,还包括:在所述第二体位之后且在所述初始化例程完成之前,响应来自所述编程器的提示使所述接受者采用和保持第三体位,并且向所述编程器提供指明正在保持所述第三体位的输入。
5.一种用于可植入医疗装置系统的操作方法,所述系统包括:
可植入心脏刺激装置,包括密封地包含在壳体中的操作电路,并且包括定义用于检测装置接受者的心脏活动的多个感测矢量的多个感测电极;
编程器,配置用于与所述可植入心脏刺激装置进行遥测通信,并且包括用于与植入操作人员进行通信的输入/输出部件;
所述方法包括,在所述系统的初始化操作期间并且在所述可植入心脏刺激装置在被植入者中的植入之后:
所述编程器提供指导所述操作人员使所述被植入者采取第一体位的输出,并且等待来自所述操作人员的指明所述被植入者准备就绪的输入,一旦接收到所述输入,所述可植入心脏刺激装置就为至少两个感测矢量中的每个捕获数据;
所述编程器提供指导所述操作人员使被植入者采取第二体位的输出,并且等待来自所述操作人员的指明所述被植入者再次准备就绪的输入,一旦接收到所述输入,所述可植入心脏刺激装置就为至少两个感测矢量捕获数据;以及
识别默认心脏事件感测矢量。
6.如权利要求5所述的方法,其中,识别默认心脏事件感测矢量的所述步骤由所述可植入心脏刺激装置通过分析所述所捕获数据并使用幅度和噪声计算选择“最佳”矢量来执行。
7.如权利要求5所述的方法,其中,识别默认心脏事件感测矢量的所述步骤由所述编程器通过使用所述可植入心脏刺激装置所通信的数据来执行。
8.如权利要求5所述的方法,其中,识别默认心脏事件感测矢量的所述步骤通过默认自动执行,除非所述最佳可用感测矢量呈现不明确性;并且,在所述最佳可用感测矢量呈现不明确性时,所述方法还包括所述编程器向所述操作人员呈现所捕获信号的图形表示使得所述操作人员可以向所述编程器提供在所述图形表示中识别一个或多个R波的输入。
9.如权利要求1-8中的任一项所述的方法,其中,所述第一和第二体位为按任何顺序的仰卧和端坐。
10.如权利要求1-8中的任一项所述的方法,其中,所述第一和第二体位为按任何顺序的仰卧和站立。
11.如权利要求1-8中的任一项所述的方法,其中,所述第一和第二体位为按任何顺序的仰卧和俯卧。
12.如权利要求1-8中的任一项所述的方法,其中,所述第一和第二体位为按任何顺序的端坐和站立。
13.如权利要求1-8中的任一项所述的方法,其中,所述第一和第二体位为按任何顺序的端坐和俯卧。
14.如权利要求1-8中的任一项所述的方法,其中,所述第一和第二体位为按任何顺序的站立和俯卧。
15.一种可植入心脏刺激系统,包括:
可植入医疗装置,包括装有与至少三个电极耦合的操作电路的罐;以及
编程器,配置成在所述可植入医疗装置被植入患者体内之后与所述可植入医疗装置进行通信;
其中,所述系统配置成在所述可植入医疗装置被植入患者体内之后执行以下方法,使得所述至少三个电极定义所述操作电路可分析的至少第一和第二感测矢量:
所述编程器指明所述患者将在执行第一分析时保持第一体位;
所述可植入医疗装置使用至少所述第一和第二感测矢量来捕获数据;
所述可植入医疗装置向所述编程器指明所述第一分析已完成;
一旦所述可植入医疗装置指明对感测矢量分析的所述第一数据捕获的完成,所述编程器就指明所述患者将在执行第二分析时保持第二体位;
所述可植入医疗装置再次使用至少所述第一和第二感测矢量来捕获数据;
所述可植入医疗装置向所述编程器指明使用所述第一和第二感测矢量对感测矢量分析的第二数据捕获已完成;以及
所述编程器指明所述第二分析已完成;
其中所述可植入心脏刺激系统被配置成在所述第一和第二分析完成之后使用从所述第一和第二感测矢量中的每一个捕获的数据来选择主要感测矢量供所述可植入医疗装置用在心脏事件检测中。
16.如权利要求15所述的系统,其中,所述可植入医疗装置配置成选择所述主要感测矢量以供心脏事件检测使用。
17.如权利要求15所述的系统,其中,所述可植入医疗装置配置成根据所述第一和第二数据捕获向所述编程器传送数据,以及所述编程器配置成选择所述主要感测矢量以供心脏事件检测使用。
18.如权利要求15所述的系统,其中,所述可植入医疗装置配置成执行定向成在所感测数据流中识别心脏事件的分析,以及,如果在所述所捕获数据中识别心脏事件时出现困难,则所述可植入医疗装置适用于识别这类困难并向所述编程器通信与这类困难相关的数据,以及,如果与在所述所捕获数据中识别心脏事件的困难相关的数据被通信到所述编程器,则所述编程器适合向所述编程器的操作人员呈现一个或多个查询以便解决这类困难作为所述第一分析或所述第二分析中的任何一个的表现的部分。
19.如权利要求15所述的系统,其中,所述可植入心脏刺激系统被配置成识别主要和辅助感测矢量两者。
20.如权利要求15-19中的任一项所述的系统,其中,所述第一和第二体位为按任何顺序的仰卧和端坐。
21.如权利要求15-19中的任一项所述的系统,其中,所述第一和第二体位为按任何顺序的仰卧和站立。
22.如权利要求15-19中的任一项所述的系统,其中,所述第一和第二体位为按任何顺序的仰卧和俯卧。
23.如权利要求15-19中的任一项所述的系统,其中,所述第一和第二体位为按任何顺序的端坐和站立。
24.如权利要求15-19中的任一项所述的系统,其中,所述第一和第二体位为按任何顺序的端坐和俯卧。
25.如权利要求15-19中的任一项所述的系统,其中,所述第一和第二体位为按任何顺序的站立和俯卧。
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US11/672,353 | 2007-02-07 | ||
US11/672,353 US8200341B2 (en) | 2007-02-07 | 2007-02-07 | Sensing vector selection in a cardiac stimulus device with postural assessment |
PCT/US2008/053197 WO2008098062A1 (en) | 2007-02-07 | 2008-02-06 | Sensing vector selection in a cardiac stimulus device with postural assessment |
Publications (2)
Publication Number | Publication Date |
---|---|
CN101668479A CN101668479A (zh) | 2010-03-10 |
CN101668479B true CN101668479B (zh) | 2012-11-14 |
Family
ID=39456441
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
CN2008800043264A Active CN101668479B (zh) | 2007-02-07 | 2008-02-06 | 带姿势评估的心脏刺激装置中的感测矢量选择 |
Country Status (8)
Country | Link |
---|---|
US (8) | US8200341B2 (zh) |
EP (1) | EP2114244B1 (zh) |
JP (1) | JP5102313B2 (zh) |
CN (1) | CN101668479B (zh) |
AU (1) | AU2008213812B2 (zh) |
CA (1) | CA2676425C (zh) |
ES (1) | ES2691249T3 (zh) |
WO (1) | WO2008098062A1 (zh) |
Families Citing this family (92)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US8396565B2 (en) | 2003-09-15 | 2013-03-12 | Medtronic, Inc. | Automatic therapy adjustments |
US7957809B2 (en) | 2005-12-02 | 2011-06-07 | Medtronic, Inc. | Closed-loop therapy adjustment |
US8788023B2 (en) | 2006-05-26 | 2014-07-22 | Cameron Health, Inc. | Systems and methods for sensing vector selection in an implantable medical device |
US7783340B2 (en) * | 2007-01-16 | 2010-08-24 | Cameron Health, Inc. | Systems and methods for sensing vector selection in an implantable medical device using a polynomial approach |
US8200341B2 (en) | 2007-02-07 | 2012-06-12 | Cameron Health, Inc. | Sensing vector selection in a cardiac stimulus device with postural assessment |
CA2695468C (en) | 2007-08-23 | 2016-05-17 | Cameron Health, Inc. | Patient screening tools for implantable cardiac stimulus systems |
US8494630B2 (en) | 2008-01-18 | 2013-07-23 | Cameron Health, Inc. | Data manipulation following delivery of a cardiac stimulus in an implantable cardiac stimulus device |
JP5562260B2 (ja) | 2008-03-07 | 2014-07-30 | キャメロン ヘルス、 インコーポレイテッド | 心臓活動を正確に分類するための方法および装置 |
EP2268358B1 (en) | 2008-03-07 | 2013-05-22 | Cameron Health, Inc. | Accurate cardiac event detection in an implantable cardiac stimulus device |
EP2455132B1 (en) | 2008-05-07 | 2013-06-26 | Cameron Health, Inc. | Devices for accurately classifying cardiac activity |
US8219206B2 (en) | 2008-07-11 | 2012-07-10 | Medtronic, Inc. | Dwell time adjustments for posture state-responsive therapy |
US9050471B2 (en) | 2008-07-11 | 2015-06-09 | Medtronic, Inc. | Posture state display on medical device user interface |
US8708934B2 (en) | 2008-07-11 | 2014-04-29 | Medtronic, Inc. | Reorientation of patient posture states for posture-responsive therapy |
US8249718B2 (en) | 2008-07-11 | 2012-08-21 | Medtronic, Inc. | Programming posture state-responsive therapy with nominal therapy parameters |
US9440084B2 (en) | 2008-07-11 | 2016-09-13 | Medtronic, Inc. | Programming posture responsive therapy |
US9592387B2 (en) | 2008-07-11 | 2017-03-14 | Medtronic, Inc. | Patient-defined posture states for posture responsive therapy |
US8209028B2 (en) | 2008-07-11 | 2012-06-26 | Medtronic, Inc. | Objectification of posture state-responsive therapy based on patient therapy adjustments |
US8886302B2 (en) | 2008-07-11 | 2014-11-11 | Medtronic, Inc. | Adjustment of posture-responsive therapy |
US8504150B2 (en) | 2008-07-11 | 2013-08-06 | Medtronic, Inc. | Associating therapy adjustments with posture states using a stability timer |
US8280517B2 (en) | 2008-09-19 | 2012-10-02 | Medtronic, Inc. | Automatic validation techniques for validating operation of medical devices |
US8483841B2 (en) | 2008-12-12 | 2013-07-09 | Cameron Health, Inc. | Electrode spacing in a subcutaneous implantable cardiac stimulus device |
US8175720B2 (en) | 2009-04-30 | 2012-05-08 | Medtronic, Inc. | Posture-responsive therapy control based on patient input |
US9026223B2 (en) | 2009-04-30 | 2015-05-05 | Medtronic, Inc. | Therapy system including multiple posture sensors |
US9327070B2 (en) | 2009-04-30 | 2016-05-03 | Medtronic, Inc. | Medical device therapy based on posture and timing |
CN102596310B (zh) | 2009-06-29 | 2015-02-25 | 卡梅伦保健公司 | 可植入心脏刺激设备中的可治疗心律失常的自适应确认 |
US8744555B2 (en) | 2009-10-27 | 2014-06-03 | Cameron Health, Inc. | Adaptive waveform appraisal in an implantable cardiac system |
US8265737B2 (en) | 2009-10-27 | 2012-09-11 | Cameron Health, Inc. | Methods and devices for identifying overdetection of cardiac signals |
US8388555B2 (en) | 2010-01-08 | 2013-03-05 | Medtronic, Inc. | Posture state classification for a medical device |
US8579834B2 (en) | 2010-01-08 | 2013-11-12 | Medtronic, Inc. | Display of detected patient posture state |
US9357949B2 (en) | 2010-01-08 | 2016-06-07 | Medtronic, Inc. | User interface that displays medical therapy and posture data |
US9956418B2 (en) | 2010-01-08 | 2018-05-01 | Medtronic, Inc. | Graphical manipulation of posture zones for posture-responsive therapy |
US8548573B2 (en) | 2010-01-18 | 2013-10-01 | Cameron Health, Inc. | Dynamically filtered beat detection in an implantable cardiac device |
US9566441B2 (en) | 2010-04-30 | 2017-02-14 | Medtronic, Inc. | Detecting posture sensor signal shift or drift in medical devices |
US9907959B2 (en) | 2012-04-12 | 2018-03-06 | Medtronic, Inc. | Velocity detection for posture-responsive therapy |
US9737719B2 (en) | 2012-04-26 | 2017-08-22 | Medtronic, Inc. | Adjustment of therapy based on acceleration |
EP2956213B1 (en) | 2013-02-18 | 2017-03-22 | Cardiac Pacemakers, Inc. | Medical device for algorithm adaptation to an external impact on the data |
JP2016512460A (ja) | 2013-03-11 | 2016-04-28 | キャメロン ヘルス、 インコーポレイテッド | 不整脈検出のための二重基準を実現する方法及び装置 |
US9579065B2 (en) | 2013-03-12 | 2017-02-28 | Cameron Health Inc. | Cardiac signal vector selection with monophasic and biphasic shape consideration |
EP3082951B1 (en) * | 2013-12-18 | 2020-12-09 | Cardiac Pacemakers, Inc. | Systems for facilitating selecting of one or more vectors in a medical device |
US9788742B2 (en) | 2014-02-04 | 2017-10-17 | Cameron Health, Inc. | Impedance waveform monitoring for heart beat confirmation |
US9526908B2 (en) | 2014-04-01 | 2016-12-27 | Medtronic, Inc. | Method and apparatus for discriminating tachycardia events in a medical device |
US10376705B2 (en) | 2014-04-01 | 2019-08-13 | Medtronic, Inc. | Method and apparatus for discriminating tachycardia events in a medical device |
US9808640B2 (en) | 2014-04-10 | 2017-11-07 | Medtronic, Inc. | Method and apparatus for discriminating tachycardia events in a medical device using two sensing vectors |
US9352165B2 (en) | 2014-04-17 | 2016-05-31 | Medtronic, Inc. | Method and apparatus for verifying discriminating of tachycardia events in a medical device having dual sensing vectors |
US10252067B2 (en) | 2014-04-24 | 2019-04-09 | Medtronic, Inc. | Method and apparatus for adjusting a blanking period during transitioning between operating states in a medical device |
US9795312B2 (en) | 2014-04-24 | 2017-10-24 | Medtronic, Inc. | Method and apparatus for adjusting a blanking period for selecting a sensing vector configuration in a medical device |
US10244957B2 (en) | 2014-04-24 | 2019-04-02 | Medtronic, Inc. | Method and apparatus for selecting a sensing vector configuration in a medical device |
US10278601B2 (en) | 2014-04-24 | 2019-05-07 | Medtronic, Inc. | Method and apparatus for selecting a sensing vector configuration in a medical device |
US10226197B2 (en) | 2014-04-25 | 2019-03-12 | Medtronic, Inc. | Pace pulse detector for an implantable medical device |
US10448855B2 (en) | 2014-04-25 | 2019-10-22 | Medtronic, Inc. | Implantable medical device (IMD) sensing modifications responsive to detected pacing pulses |
US10154794B2 (en) | 2014-04-25 | 2018-12-18 | Medtronic, Inc. | Implantable cardioverter-defibrillator (ICD) tachyarrhythmia detection modifications responsive to detected pacing |
US9610025B2 (en) | 2014-07-01 | 2017-04-04 | Medtronic, Inc. | Method and apparatus for verifying discriminating of tachycardia events in a medical device having dual sensing vectors |
US9486637B2 (en) | 2014-07-24 | 2016-11-08 | Medtronic, Inc. | Method and apparatus for accurate separation of supraventricular tachycardia from ventricular tachycardia during posture changes |
US9924885B2 (en) | 2014-07-24 | 2018-03-27 | Medtronic, Inc. | Rhythm discriminator with immunity to body posture |
US9554714B2 (en) | 2014-08-14 | 2017-01-31 | Cameron Health Inc. | Use of detection profiles in an implantable medical device |
US9451892B2 (en) | 2014-08-18 | 2016-09-27 | Cameron Health, Inc. | Cardiac rate tracking in an implantable medical device |
US9566012B2 (en) * | 2014-10-27 | 2017-02-14 | Medtronic, Inc. | Method and apparatus for selection and use of virtual sensing vectors |
US9993171B2 (en) | 2015-04-08 | 2018-06-12 | Cameron Health, Inc. | Automated screening methods and apparatuses for implantable medical devices |
US10314502B2 (en) | 2015-07-02 | 2019-06-11 | Cardiac Pacemakers, Inc. | System and methods for sensing vector selection |
US10321834B2 (en) | 2015-10-23 | 2019-06-18 | Cardiac Pacemakers, Inc. | Multi-vector sensing in cardiac devices using a hybrid approach |
CN108367156B (zh) | 2015-12-02 | 2021-08-17 | 心脏起搏器股份公司 | 心律管理设备中的滤波的自动确定和选择 |
US10512784B2 (en) | 2016-06-27 | 2019-12-24 | Cardiac Pacemakers, Inc. | Cardiac therapy system using subcutaneously sensed P-waves for resynchronization pacing management |
US10426962B2 (en) | 2016-07-07 | 2019-10-01 | Cardiac Pacemakers, Inc. | Leadless pacemaker using pressure measurements for pacing capture verification |
US10471250B2 (en) | 2016-08-05 | 2019-11-12 | Cardiac Pacemakers, Inc. | Pacemakers for implant in the internal thoracic vasculature with communication to other implantable devices |
EP3503970B1 (en) | 2016-08-24 | 2023-01-04 | 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 |
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 |
US10463305B2 (en) | 2016-10-27 | 2019-11-05 | Cardiac Pacemakers, Inc. | Multi-device cardiac resynchronization therapy with timing enhancements |
US10765871B2 (en) | 2016-10-27 | 2020-09-08 | Cardiac Pacemakers, Inc. | Implantable medical device with pressure sensor |
US10646720B2 (en) | 2016-11-17 | 2020-05-12 | Cardiac Pacemakers, Inc. | Parasternal placement of an active medical device using the internal thoracic vasculature |
US10537731B2 (en) | 2016-11-17 | 2020-01-21 | Cardiac Pacemakers, Inc. | Transvenous mediastinum access for the placement of cardiac pacing and defibrillation electrodes |
US10894163B2 (en) | 2016-11-21 | 2021-01-19 | Cardiac Pacemakers, Inc. | LCP based predictive timing for cardiac resynchronization |
US10850067B2 (en) | 2016-12-21 | 2020-12-01 | Cardiac Pacemakers, Inc. | Implantation of an active medical device using the intercostal vein |
WO2018118818A1 (en) | 2016-12-21 | 2018-06-28 | Cardiac Pacemakers, Inc. | Lead with integrated electrodes |
US10675476B2 (en) | 2016-12-22 | 2020-06-09 | Cardiac Pacemakers, Inc. | Internal thoracic vein placement of a transmitter electrode for leadless stimulation of the heart |
US10751543B2 (en) | 2016-12-22 | 2020-08-25 | Cardiac Pacemakers, Inc. | Azygos, internal thoracic, and/or intercostal vein implantation and use of medical devices |
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 |
US10980570B2 (en) | 2017-01-12 | 2021-04-20 | Cardiac Pacemakers, Inc. | Implantation of an active medical device using the internal thoracic vasculature |
US10849524B2 (en) | 2017-02-07 | 2020-12-01 | Cardiac Pacemakers, Inc. | Multimode rate and rhythm analysis calculation for cardiac signal quality analysis |
US11077299B2 (en) | 2017-03-07 | 2021-08-03 | Cardiac Pacemakers, Inc. | Implantation of an active medical device |
WO2018175318A1 (en) | 2017-03-20 | 2018-09-27 | Cardiac Pacemakers, Inc. | Implantable medical device |
US11077297B2 (en) | 2017-04-18 | 2021-08-03 | Cardiac Pacemakers, Inc. | Active medical device with attachment features |
US11020075B2 (en) | 2017-05-12 | 2021-06-01 | Cardiac Pacemakers, Inc. | Implantation of an active medical device using the internal thoracic vasculature |
CN107440708A (zh) * | 2017-06-07 | 2017-12-08 | 武汉吉星医疗科技有限公司 | 基于安卓系统的心电图机的导联脱落计算系统及其方法 |
US11065459B2 (en) | 2017-08-18 | 2021-07-20 | Cardiac Pacemakers, Inc. | Implantable medical device with pressure sensor |
US10751526B2 (en) | 2017-10-25 | 2020-08-25 | Cardiac Pacemakers, Inc. | Subcutaneous lead implantation |
WO2020033839A1 (en) | 2018-08-09 | 2020-02-13 | Medtronic, Inc. | Modification of cardiac sensing and therapy |
WO2020033841A1 (en) | 2018-08-09 | 2020-02-13 | Medtronic, Inc. | Cardiac device system |
US11931592B2 (en) | 2020-02-13 | 2024-03-19 | Cardiac Pacemakers, Inc. | Output circuitry for multiple-therapy implantable devices |
US11717695B2 (en) | 2020-02-13 | 2023-08-08 | Cardiac Pacemakers, Inc. | High voltage therapy system with current control |
US11745023B2 (en) | 2020-03-12 | 2023-09-05 | Cardiac Pacemakers, Inc. | High voltage therapy system with low side control |
CN112438735B (zh) * | 2021-01-29 | 2021-06-15 | 深圳市理邦精密仪器股份有限公司 | 一种心电图p波检测方法、分析装置以及存储介质 |
Citations (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5331966A (en) * | 1991-04-05 | 1994-07-26 | Medtronic, Inc. | Subcutaneous multi-electrode sensing system, method and pacer |
US6044297A (en) * | 1998-09-25 | 2000-03-28 | Medtronic, Inc. | Posture and device orientation and calibration for implantable medical devices |
CN1829554A (zh) * | 2003-05-29 | 2006-09-06 | 卡梅伦保健公司 | 用于区别室性和室上性心律失常的方法 |
US7130689B1 (en) * | 2004-02-24 | 2006-10-31 | Pacesetter, Inc. | Methods and systems for optimizing cardiac pacing intervals for various physiologic factors |
Family Cites Families (313)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3710374A (en) | 1970-03-16 | 1973-01-09 | Wester Instr Inc | Dual-slope and analog-to-digital converter wherein two analog input signals are selectively integrated with respect to time |
US3653387A (en) | 1970-05-08 | 1972-04-04 | Cardiac Electronics Inc | Protector circuit for cardiac apparatus |
USRE30387E (en) | 1972-03-17 | 1980-08-26 | Medtronic, Inc. | Automatic cardioverting circuit |
US3911925A (en) | 1974-05-23 | 1975-10-14 | Jr Joe B Tillery | Ear trimming forceps |
US4030509A (en) | 1975-09-30 | 1977-06-21 | Mieczyslaw Mirowski | Implantable electrodes for accomplishing ventricular defibrillation and pacing and method of electrode implantation and utilization |
US4184493A (en) | 1975-09-30 | 1980-01-22 | Mieczyslaw Mirowski | Circuit for monitoring a heart and for effecting cardioversion of a needy heart |
US4137025A (en) * | 1977-03-07 | 1979-01-30 | Graves Kenneth E | Apparatus for measuring and controlling the wall thickness of plastic pipes |
US4164946A (en) | 1977-05-27 | 1979-08-21 | Mieczyslaw Mirowski | Fault detection circuit for permanently implanted cardioverter |
US4157720A (en) | 1977-09-16 | 1979-06-12 | Greatbatch W | Cardiac pacemaker |
US4248237A (en) | 1978-03-07 | 1981-02-03 | Needle Industries Limited | Cardiac pacemakers |
US4210149A (en) | 1978-04-17 | 1980-07-01 | Mieczyslaw Mirowski | Implantable cardioverter with patient communication |
US4223678A (en) | 1978-05-03 | 1980-09-23 | Mieczyslaw Mirowski | Arrhythmia recorder for use with an implantable defibrillator |
US4191942A (en) | 1978-06-08 | 1980-03-04 | National Semiconductor Corporation | Single slope A/D converter with sample and hold |
US4291707A (en) | 1979-04-30 | 1981-09-29 | Mieczyslaw Mirowski | Implantable cardiac defibrillating electrode |
US4314095A (en) | 1979-04-30 | 1982-02-02 | Mieczyslaw Mirowski | Device and method for making electrical contact |
US4254775A (en) | 1979-07-02 | 1981-03-10 | Mieczyslaw Mirowski | Implantable defibrillator and package therefor |
US4375817A (en) | 1979-07-19 | 1983-03-08 | Medtronic, Inc. | Implantable cardioverter |
US4300567A (en) | 1980-02-11 | 1981-11-17 | Mieczyslaw Mirowski | Method and apparatus for effecting automatic ventricular defibrillation and/or demand cardioversion through the means of an implanted automatic defibrillator |
US4407288B1 (en) | 1981-02-18 | 2000-09-19 | Mieczyslaw Mirowski | Implantable heart stimulator and stimulation method |
US4693253A (en) | 1981-03-23 | 1987-09-15 | Medtronic, Inc. | Automatic implantable defibrillator and pacer |
US4402322A (en) | 1981-03-25 | 1983-09-06 | Medtronic, Inc. | Pacer output circuit |
US4750494A (en) | 1981-05-12 | 1988-06-14 | Medtronic, Inc. | Automatic implantable fibrillation preventer |
US4765341A (en) | 1981-06-22 | 1988-08-23 | Mieczyslaw Mirowski | Cardiac electrode with attachment fin |
US4424818A (en) | 1982-02-18 | 1984-01-10 | Medtronic, Inc. | Electrical lead and insertion tool |
EP0095727A1 (en) | 1982-06-01 | 1983-12-07 | Purdue Research Foundation | Method and apparatus for inserting a defibrillator electrode and defibrillator electrode |
US4450527A (en) | 1982-06-29 | 1984-05-22 | Bomed Medical Mfg. Ltd. | Noninvasive continuous cardiac output monitor |
DE3300672A1 (de) | 1983-01-11 | 1984-07-12 | Siemens AG, 1000 Berlin und 8000 München | Herzschrittmachersystem |
US4550502A (en) | 1983-04-15 | 1985-11-05 | Joseph Grayzel | Device for analysis of recorded electrocardiogram |
US4548209A (en) | 1984-02-06 | 1985-10-22 | Medtronic, Inc. | Energy converter for implantable cardioverter |
US4595009A (en) | 1984-02-06 | 1986-06-17 | Medtronic, Inc. | Protection circuit for implantable cardioverter |
US4603705A (en) | 1984-05-04 | 1986-08-05 | Mieczyslaw Mirowski | Intravascular multiple electrode unitary catheter |
US4567900A (en) | 1984-06-04 | 1986-02-04 | Moore J Paul | Internal deployable defibrillator electrode |
US4589420A (en) | 1984-07-13 | 1986-05-20 | Spacelabs Inc. | Method and apparatus for ECG rhythm analysis |
US4727877A (en) | 1984-12-18 | 1988-03-01 | Medtronic, Inc. | Method and apparatus for low energy endocardial defibrillation |
US5291895A (en) | 1985-06-03 | 1994-03-08 | Mcintyre Kevin M | Evaluation of heart mechanical performance |
US4800883A (en) | 1986-04-02 | 1989-01-31 | Intermedics, Inc. | Apparatus for generating multiphasic defibrillation pulse waveform |
US4768512A (en) | 1986-05-13 | 1988-09-06 | Mieczyslaw Mirowski | Cardioverting system and method with high-frequency pulse delivery |
US4779617A (en) | 1986-10-06 | 1988-10-25 | Telectronics N.V. | Pacemaker noise rejection system |
US4944300A (en) | 1987-04-28 | 1990-07-31 | Sanjeev Saksena | Method for high energy defibrillation of ventricular fibrillation in humans without a thoracotomy |
US5044374A (en) | 1987-06-18 | 1991-09-03 | Medtronic, Inc. | Medical electrical lead |
US4830005A (en) | 1987-07-23 | 1989-05-16 | Siemens-Pacesetter, Inc. | Disposable in-package load test element for pacemakers |
ATE120587T1 (de) | 1987-11-19 | 1995-04-15 | Siemens Ag | Analog-digital-umsetzer. |
US4960126A (en) | 1988-01-15 | 1990-10-02 | Criticare Systems, Inc. | ECG synchronized pulse oximeter |
FR2632865A1 (fr) | 1988-06-15 | 1989-12-22 | Atesys Sa | Defibrillateur de hautes performances a plusieurs electrodes exterieures au coeur |
US5299119A (en) * | 1989-07-06 | 1994-03-29 | Qmed, Inc. | Autonomic neuropathy detection and method of analysis |
US5509923A (en) | 1989-08-16 | 1996-04-23 | Raychem Corporation | Device for dissecting, grasping, or cutting an object |
US5215081A (en) | 1989-12-28 | 1993-06-01 | Telectronics Pacing Systems, Inc. | Method and device for measuring subthreshold defibrillation electrode resistance and providing a constant energy shock delivery |
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 |
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 |
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 |
US5271411A (en) | 1990-09-21 | 1993-12-21 | Colin Electronics Co., Ltd. | Method and apparatus for ECG signal analysis and cardiac arrhythmia detection |
US5109842A (en) | 1990-09-24 | 1992-05-05 | Siemens Pacesetter, Inc. | Implantable tachyarrhythmia control system having a patch electrode with an integrated cardiac activity system |
US5105826A (en) | 1990-10-26 | 1992-04-21 | Medtronic, Inc. | Implantable defibrillation electrode and method of manufacture |
US5137025A (en) | 1990-12-17 | 1992-08-11 | Turner Ii Henry H | Nomogram for electrocardiographic interpretation and method of use |
US5531765A (en) | 1990-12-18 | 1996-07-02 | Ventritex, Inc. | Method and apparatus for producing configurable biphasic defibrillation waveforms |
US5129392A (en) | 1990-12-20 | 1992-07-14 | Medtronic, Inc. | Apparatus for automatically inducing fibrillation |
US5405363A (en) | 1991-03-15 | 1995-04-11 | Angelon Corporation | Implantable cardioverter defibrillator having a smaller displacement volume |
US5490862A (en) | 1991-04-12 | 1996-02-13 | Adams; John M. | Atrial defibrillator having patient activated modality |
US6144879A (en) | 1991-05-17 | 2000-11-07 | Gray; Noel Desmond | Heart pacemaker |
US5300106A (en) | 1991-06-07 | 1994-04-05 | Cardiac Pacemakers, Inc. | Insertion and tunneling tool for a subcutaneous wire patch electrode |
US5292339A (en) | 1991-06-14 | 1994-03-08 | Telectronics Pacing Systems, Inc. | Implantable pacemaker/cardioverter/defibrillator device and method incorporating multiple bradycardia support pacing rates |
US5243977A (en) | 1991-06-26 | 1993-09-14 | Trabucco Hector O | Pacemaker |
US5144946A (en) | 1991-08-05 | 1992-09-08 | Siemens Pacesetter, Inc. | Combined pacemaker substrate and electrical interconnect and method of assembly |
US5191901A (en) | 1991-08-29 | 1993-03-09 | Mieczyslaw Mirowski | Controlled discharge defibrillation electrode |
US5423326A (en) | 1991-09-12 | 1995-06-13 | Drexel University | Apparatus and method for measuring cardiac output |
US5215083A (en) | 1991-10-07 | 1993-06-01 | Telectronics Pacing Systems, Inc. | Apparatus and method for arrhythmia induction in arrhythmia control system |
US5184616A (en) | 1991-10-21 | 1993-02-09 | Telectronics Pacing Systems, Inc. | Apparatus and method for generation of varying waveforms in arrhythmia control system |
US5313953A (en) | 1992-01-14 | 1994-05-24 | Incontrol, Inc. | Implantable cardiac patient monitor |
JPH0621492Y2 (ja) | 1992-02-07 | 1994-06-08 | 日本光電工業株式会社 | 心電図モニタ付除細動器 |
US5261400A (en) | 1992-02-12 | 1993-11-16 | Medtronic, Inc. | Defibrillator employing transvenous and subcutaneous electrodes and method of use |
US5306291A (en) | 1992-02-26 | 1994-04-26 | Angeion Corporation | Optimal energy steering for an implantable defibrillator |
US5376103A (en) | 1992-03-19 | 1994-12-27 | Angeion Corporation | Electrode system for implantable defibrillator |
US5601607A (en) | 1992-03-19 | 1997-02-11 | Angeion Corporation | Implantable cardioverter defibrillator housing plated electrode |
US5370667A (en) | 1992-04-03 | 1994-12-06 | Intermedics, Inc. | Device and method for automatically adjusting tachycardia recognition criteria based on detected parameter |
WO1993019809A1 (en) | 1992-04-06 | 1993-10-14 | Angemed, Inc. | System for treatment of ventricular tachycardia using a far-field pulse series |
US5255692A (en) | 1992-09-04 | 1993-10-26 | Siemens Aktiengesellschaft | Subcostal patch electrode |
DE69323374T2 (de) | 1992-09-30 | 1999-06-10 | Cardiac Pacemakers Inc | Klappbare Kissenelektrode zur Herzentflimmerung mit einem Gebiet ohne Leitern, welches als ein Scharnier dient |
US5441518A (en) | 1993-07-22 | 1995-08-15 | Angeion Corporation | Implantable cardioverter defibrillator system having independently controllable electrode discharge pathway |
US5697953A (en) | 1993-03-13 | 1997-12-16 | Angeion Corporation | Implantable cardioverter defibrillator having a smaller displacement volume |
US5366496A (en) | 1993-04-01 | 1994-11-22 | Cardiac Pacemakers, Inc. | Subcutaneous shunted coil electrode |
US5411547A (en) | 1993-08-09 | 1995-05-02 | Pacesetter, Inc. | Implantable cardioversion-defibrillation patch electrodes having means for passive multiplexing of discharge pulses |
US5447518A (en) | 1993-08-31 | 1995-09-05 | Ventritex, Inc. | Method and apparatus for phase related cardiac defibrillation |
US5411539A (en) | 1993-08-31 | 1995-05-02 | Medtronic, Inc. | Active can emulator and method of use |
US5439485A (en) | 1993-09-24 | 1995-08-08 | Ventritex, Inc. | Flexible defibrillation electrode of improved construction |
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 |
US5527346A (en) | 1993-12-13 | 1996-06-18 | Angeion Corporation | Implantable cardioverter defibrillator employing polymer thin film capacitors |
US5464447A (en) | 1994-01-28 | 1995-11-07 | Sony Corporation | Implantable defibrillator electrodes |
US5441185A (en) | 1994-03-14 | 1995-08-15 | Dragos; Michael R. | Wallpaper work belt and accessories |
US5476503A (en) | 1994-03-28 | 1995-12-19 | Pacesetter, Inc. | Sense array intelligent patch lead for an implantable defibrillator and method |
US5620477A (en) | 1994-03-31 | 1997-04-15 | Ventritex, Inc. | Pulse generator with case that can be active or inactive |
SE9401267D0 (sv) | 1994-04-14 | 1994-04-14 | Siemens Elema Ab | Elektrodanordning |
IT1272265B (it) | 1994-06-06 | 1997-06-16 | Medtronic Inc Societa Del Minn | Perfezionamento nei sistemi stimolatori cardiaci |
US5957956A (en) | 1994-06-21 | 1999-09-28 | Angeion Corp | Implantable cardioverter defibrillator having a smaller mass |
US5645586A (en) | 1994-07-08 | 1997-07-08 | Ventritex, Inc. | Conforming implantable defibrillator |
JP3139305B2 (ja) | 1994-08-24 | 2001-02-26 | 株式会社村田製作所 | 容量型加速度センサ |
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 |
US5534022A (en) | 1994-11-22 | 1996-07-09 | Ventritex, Inc. | Lead having an integrated defibrillation/sensing electrode |
US5534019A (en) | 1994-12-09 | 1996-07-09 | Ventritex, Inc. | Cardiac defibrillator with case that can be electrically active or inactive |
US5531766A (en) | 1995-01-23 | 1996-07-02 | Angeion Corporation | Implantable cardioverter defibrillator pulse generator kite-tail electrode system |
US5509928A (en) | 1995-03-02 | 1996-04-23 | Pacesetter, Inc. | Internally supported self-sealing septum |
US5545186A (en) | 1995-03-30 | 1996-08-13 | Medtronic, Inc. | Prioritized rule based method and apparatus for diagnosis and treatment of arrhythmias |
US5607455A (en) | 1995-05-25 | 1997-03-04 | Intermedics, Inc. | Method and apparatus for automatic shock electrode enabling |
US5814090A (en) | 1995-06-07 | 1998-09-29 | Angeion Corporation | Implantable medical device having heat-shrink conforming shield |
US5658321A (en) | 1995-06-09 | 1997-08-19 | Ventritex, Inc. | Conductive housing for implantable cardiac device |
US5690683A (en) | 1995-06-19 | 1997-11-25 | Cardiac Pacemakers, Inc. | After potential removal in cardiac rhythm management device |
US5658317A (en) | 1995-08-14 | 1997-08-19 | Cardiac Pacemakers, Inc. | Threshold templating for digital AGC |
US5690685A (en) | 1995-10-27 | 1997-11-25 | Angeion Corporation | Automatic battery-maintaining implantable cardioverter defibrillator and method for use |
US5558098A (en) | 1995-11-02 | 1996-09-24 | Ventritex, Inc. | Method and apparatus for detecting lead sensing artifacts in cardiac electrograms |
US6014586A (en) | 1995-11-20 | 2000-01-11 | Pacesetter, Inc. | Vertically integrated semiconductor package for an implantable medical device |
US6051017A (en) | 1996-02-20 | 2000-04-18 | Advanced Bionics Corporation | Implantable microstimulator and systems employing the same |
US5674260A (en) | 1996-02-23 | 1997-10-07 | Pacesetter, Inc. | Apparatus and method for mounting an activity sensor or other component within a pacemaker using a contoured hybrid lid |
US5782774A (en) | 1996-04-17 | 1998-07-21 | Imagyn Medical Technologies California, Inc. | Apparatus and method of bioelectrical impedance analysis of blood flow |
US5895414A (en) | 1996-04-19 | 1999-04-20 | Sanchez-Zambrano; Sergio | Pacemaker housing |
US5800465A (en) | 1996-06-18 | 1998-09-01 | Medtronic, Inc. | System and method for multisite steering of cardiac stimuli |
US5919211A (en) | 1996-06-27 | 1999-07-06 | Adams; Theodore P. | ICD power source using multiple single use batteries |
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 |
DE69734599T2 (de) * | 1996-07-11 | 2007-02-08 | Medtronic, Inc., Minneapolis | Minimalinvasive implantierbare vorrichtung zur überwachung physiologischer vorgänge |
AU2437397A (en) | 1996-07-17 | 1998-02-09 | Medtronic, Inc. | System for enhancing cardiac signal sensing by cardiac pacemakers through genetic treatment |
US5643328A (en) | 1996-07-19 | 1997-07-01 | Sulzer Intermedics Inc. | Implantable cardiac stimulation device with warning system having elongated stimulation electrode |
US6058328A (en) | 1996-08-06 | 2000-05-02 | Pacesetter, Inc. | Implantable stimulation device having means for operating in a preemptive pacing mode to prevent tachyarrhythmias and method thereof |
US6295470B1 (en) | 1996-08-19 | 2001-09-25 | The Mower Family Chf Treatment Irrevocable Trust | Antitachycardial pacing |
US5843132A (en) | 1996-10-07 | 1998-12-01 | Ilvento; Joseph P. | Self-contained, self-powered temporary intravenous pacing catheter assembly |
WO1998025349A1 (en) | 1996-12-03 | 1998-06-11 | Microchip Technology Incorporated | Slope analog-to-digital converter with ramp initiated prior to counter |
US5766226A (en) | 1996-12-09 | 1998-06-16 | Angeion Corporation | Switched discharge pathways for ICD having multiple output capacitors |
US5749911A (en) | 1997-01-24 | 1998-05-12 | Cardiac Pacemakers, Inc. | Implantable tissue stimulator incorporating deposited multilayer capacitor |
DK9700059U1 (da) | 1997-02-04 | 1998-05-04 | Ralph Mathar | Apparat til brug ved by-pass operationer og anvendelse af sådant apparat |
USH1905H (en) | 1997-03-21 | 2000-10-03 | Medtronic, Inc. | Mechanism for adjusting the exposed surface area and position of an electrode along a lead body |
US5755738A (en) | 1997-04-22 | 1998-05-26 | Cardiac Pacemakers, Inc. | Automatic sensing level adjustment for implantable cardiac rhythm management devices |
US5776169A (en) | 1997-04-28 | 1998-07-07 | Sulzer Intermedics Inc. | Implantable cardiac stimulator for minimally invasive implantation |
US5836976A (en) | 1997-04-30 | 1998-11-17 | Medtronic, Inc. | Cardioversion energy reduction system |
EP0996483A1 (en) | 1997-07-17 | 2000-05-03 | CPR Medical, Inc. | Defibrillator/pacemaker |
US6067471A (en) | 1998-08-07 | 2000-05-23 | Cardiac Pacemakers, Inc. | Atrial and ventricular implantable cardioverter-defibrillator and lead system |
US6144866A (en) | 1998-10-30 | 2000-11-07 | Medtronic, Inc. | Multiple sensor assembly for medical electric lead |
US5941904A (en) | 1997-09-12 | 1999-08-24 | Sulzer Intermedics Inc. | Electromagnetic acceleration transducer for implantable medical device |
US5925069A (en) | 1997-11-07 | 1999-07-20 | Sulzer Intermedics Inc. | Method for preparing a high definition window in a conformally coated medical device |
SE9704311D0 (sv) | 1997-11-24 | 1997-11-24 | Pacesetter Ab | A cardiac event detecting system for a heart stimulator |
FR2772516B1 (fr) | 1997-12-12 | 2003-07-04 | Ela Medical Sa | Circuit electronique, notamment pour un dispositif medical implantable actif tel qu'un stimulateur ou defibrillateur cardiaque, et son procede de realisation |
US5919222A (en) | 1998-01-06 | 1999-07-06 | Medtronic Inc. | Adjustable medical electrode lead |
US6345198B1 (en) | 1998-01-23 | 2002-02-05 | Pacesetter, Inc. | Implantable stimulation system for providing dual bipolar sensing using an electrode positioned in proximity to the tricuspid valve and programmable polarity |
US6185450B1 (en) | 1998-01-26 | 2001-02-06 | Physio-Control Manufacturing Corporation | Digital sliding pole fast-restore for an electrocardiograph display |
CA2318907C (en) | 1998-01-27 | 2004-05-04 | Vitatron Medical, B.V. | System for inducing tachycardia utilizing near field t-wave sensing |
US6148230A (en) | 1998-01-30 | 2000-11-14 | Uab Research Foundation | Method for the monitoring and treatment of spontaneous cardiac arrhythmias |
US5999853A (en) | 1998-03-02 | 1999-12-07 | Vitatron Medical, B.V. | Dual chamber pacemaker with single pass lead and with bipolar and unipolar signal processing capability |
US6556862B2 (en) | 1998-03-19 | 2003-04-29 | Cardiac Pacemakers, Inc. | Method and apparatus for treating supraventricular tachyarrhythmias |
US6016442A (en) | 1998-03-25 | 2000-01-18 | Cardiac Pacemakers, Inc. | System for displaying cardiac arrhythmia data |
US6128531A (en) | 1998-04-01 | 2000-10-03 | Pacesetter, Inc. | Delivery of ICD shock capacitor energy via a controlled current source |
MY128127A (en) | 1998-04-23 | 2007-01-31 | Alza Corp | Trocar for inserting implants |
US6029086A (en) | 1998-06-15 | 2000-02-22 | Cardiac Pacemakers, Inc. | Automatic threshold sensitivity adjustment for cardiac rhythm management devices |
US6026325A (en) | 1998-06-18 | 2000-02-15 | Pacesetter, Inc. | Implantable medical device having an improved packaging system and method for making electrical connections |
US6093173A (en) | 1998-09-09 | 2000-07-25 | Embol-X, Inc. | Introducer/dilator with balloon protection and methods of use |
US6208895B1 (en) | 1998-10-13 | 2001-03-27 | Physio-Control Manufacturing Corporation | Circuit for performing external pacing and biphasic defibrillation |
EP1000634A1 (de) | 1998-11-10 | 2000-05-17 | Sulzer Osypka GmbH | Stimulationselektrode sowohl zur Defibrillation als auch zum Pacen |
US6266554B1 (en) | 1999-02-12 | 2001-07-24 | Cardiac Pacemakers, Inc. | System and method for classifying cardiac complexes |
US6308095B1 (en) | 1999-02-12 | 2001-10-23 | Cardiac Pacemakers, Inc. | System and method for arrhythmia discrimination |
SE9900682D0 (sv) | 1999-02-25 | 1999-02-25 | Pacesetter Ab | Implantable tissue stimulating device |
US6223078B1 (en) | 1999-03-12 | 2001-04-24 | Cardiac Pacemakers, Inc. | Discrimination of supraventricular tachycardia and ventricular tachycardia events |
US6312388B1 (en) | 1999-03-12 | 2001-11-06 | Cardiac Pacemakers, Inc. | Method and system for verifying the integrity of normal sinus rhythm templates |
US6377844B1 (en) | 1999-03-13 | 2002-04-23 | Dave Graen | R-wave detector circuit for sensing cardiac signals |
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 |
US6190324B1 (en) | 1999-04-28 | 2001-02-20 | Medtronic, Inc. | Implantable medical device for tracking patient cardiac status |
US6266567B1 (en) | 1999-06-01 | 2001-07-24 | Ball Semiconductor, Inc. | Implantable epicardial electrode |
US6334071B1 (en) | 1999-06-07 | 2001-12-25 | Pacesetter, Inc. | Minute volume pacemakers that require only a single distal electrode |
US6278894B1 (en) | 1999-06-21 | 2001-08-21 | Cardiac Pacemakers, Inc. | Multi-site impedance sensor using coronary sinus/vein electrodes |
US6236882B1 (en) | 1999-07-14 | 2001-05-22 | Medtronic, Inc. | Noise rejection for monitoring ECG's |
US6493579B1 (en) | 1999-08-20 | 2002-12-10 | Cardiac Pacemakers, Inc. | System and method for detection enhancement programming |
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 |
US6411844B1 (en) | 1999-10-19 | 2002-06-25 | Pacesetter, Inc. | Fast recovery sensor amplifier circuit for implantable medical device |
WO2001043649A1 (en) | 1999-12-17 | 2001-06-21 | Fogarty Thomas J | Method and device for use in minimally invasive approximation of muscle and other tissue |
US6516225B1 (en) | 1999-12-28 | 2003-02-04 | Pacesetter, Inc. | System and method for distinguishing electrical events originating in the atria from far-field electrical events originating in the ventricles as detected by an implantable medical device |
WO2001056166A2 (de) | 2000-01-28 | 2001-08-02 | Infineon Technologies Ag | Verfahren und analog-digital-wandler zur umsetzung einer analogen spannung in einen arithmetischen wert |
US6699200B2 (en) | 2000-03-01 | 2004-03-02 | Medtronic, Inc. | Implantable medical device with multi-vector sensing electrodes |
US6567691B1 (en) | 2000-03-22 | 2003-05-20 | Medtronic, Inc. | Method and apparatus diagnosis and treatment of arrhythias |
US6490486B1 (en) | 2000-04-27 | 2002-12-03 | Pacesetter, Inc. | Implantable cardiac stimulation device and method that monitors displacement of an implanted lead |
US6564079B1 (en) * | 2000-07-27 | 2003-05-13 | Ckm Diagnostics, Inc. | Electrode array and skin attachment system for noninvasive nerve location and imaging device |
US6493584B1 (en) | 2000-09-08 | 2002-12-10 | Pacesetter, Inc. | Implantable cardiac stimulation device and method which discriminates between noise and cardiac activity |
US6778860B2 (en) | 2001-11-05 | 2004-08-17 | Cameron Health, Inc. | Switched capacitor defibrillation circuit |
US7076296B2 (en) | 2000-09-18 | 2006-07-11 | Cameron Health, Inc. | Method of supplying energy to subcutaneous cardioverter-defibrillator and pacer |
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 |
US7065407B2 (en) | 2000-09-18 | 2006-06-20 | Cameron Health, Inc. | Duckbill-shaped implantable cardioverter-defibrillator canister and method of use |
US7120495B2 (en) | 2000-09-18 | 2006-10-10 | Cameron Health, Inc. | Flexible subcutaneous implantable cardioverter-defibrillator |
US7146212B2 (en) | 2000-09-18 | 2006-12-05 | Cameron Health, Inc. | Anti-bradycardia pacing for a subcutaneous implantable cardioverter-defibrillator |
US20020107544A1 (en) | 2000-09-18 | 2002-08-08 | Cameron Health, Inc. | Current waveform for anti-bradycardia pacing for a subcutaneous implantable cardioverter-defibrillator |
US6856835B2 (en) | 2000-09-18 | 2005-02-15 | Cameron Health, Inc. | Biphasic waveform for anti-tachycardia pacing for a subcutaneous implantable cardioverter-defibrillator |
US6865417B2 (en) | 2001-11-05 | 2005-03-08 | Cameron Health, Inc. | H-bridge with sensing circuit |
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 |
US7149575B2 (en) | 2000-09-18 | 2006-12-12 | Cameron Health, Inc. | Subcutaneous cardiac stimulator device having an anteriorly positioned electrode |
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 |
US20020035377A1 (en) | 2000-09-18 | 2002-03-21 | Cameron Health, Inc. | Subcutaneous electrode for transthoracic conduction with insertion tool |
US7092754B2 (en) | 2000-09-18 | 2006-08-15 | Cameron Health, Inc. | Monophasic waveform for anti-bradycardia pacing for a subcutaneous implantable cardioverter-defibrillator |
US20020035381A1 (en) | 2000-09-18 | 2002-03-21 | Cameron Health, Inc. | Subcutaneous electrode with improved contact shape for transthoracic conduction |
US6988003B2 (en) | 2000-09-18 | 2006-01-17 | Cameron Health, Inc. | Implantable cardioverter-defibrillator having two spaced apart shocking electrodes on housing |
US6927721B2 (en) | 2001-11-05 | 2005-08-09 | Cameron Health, Inc. | Low power A/D converter |
US6721597B1 (en) | 2000-09-18 | 2004-04-13 | Cameron Health, Inc. | Subcutaneous only implantable cardioverter defibrillator and optional pacer |
US6950705B2 (en) | 2000-09-18 | 2005-09-27 | Cameron Health, Inc. | Canister designs for implantable cardioverter-defibrillators |
US20020035379A1 (en) | 2000-09-18 | 2002-03-21 | Bardy Gust H. | Subcutaneous electrode for transthoracic conduction with improved installation characteristics |
US6647292B1 (en) | 2000-09-18 | 2003-11-11 | Cameron Health | Unitary subcutaneous only implantable cardioverter-defibrillator and optional pacer |
US20020035378A1 (en) | 2000-09-18 | 2002-03-21 | Cameron Health, Inc. | Subcutaneous electrode for transthoracic conduction with highly maneuverable insertion tool |
US20030088277A1 (en) | 2001-11-05 | 2003-05-08 | Ostroff Alan H. | Switched resistor defibrillation circuit |
US6788974B2 (en) | 2000-09-18 | 2004-09-07 | Cameron Health, Inc. | Radian curve shaped implantable cardioverter-defibrillator canister |
US7043299B2 (en) | 2000-09-18 | 2006-05-09 | Cameron Health, Inc. | Subcutaneous implantable cardioverter-defibrillator employing a telescoping lead |
US6952610B2 (en) | 2000-09-18 | 2005-10-04 | Cameron Health, Inc. | Current waveforms for anti-tachycardia pacing for a subcutaneous implantable cardioverter- defibrillator |
US6754528B2 (en) | 2001-11-21 | 2004-06-22 | Cameraon Health, Inc. | Apparatus and method of arrhythmia detection in a subcutaneous implantable cardioverter/defibrillator |
US6952608B2 (en) | 2001-11-05 | 2005-10-04 | Cameron Health, Inc. | Defibrillation pacing circuitry |
US6866044B2 (en) | 2000-09-18 | 2005-03-15 | Cameron Health, Inc. | Method of insertion and implantation of implantable cardioverter-defibrillator canisters |
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 |
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 |
US6804552B2 (en) | 2000-11-03 | 2004-10-12 | Medtronic, Inc. | MEMs switching circuit and method for an implantable medical device |
US6738667B2 (en) | 2000-12-28 | 2004-05-18 | Medtronic, Inc. | Implantable medical device for treating cardiac mechanical dysfunction by electrical stimulation |
AU2002240363A1 (en) | 2001-02-13 | 2002-08-28 | Quetzal Biomedical, Inc. | Multi-electrode apparatus and method for treatment of congestive heart failure |
US6751502B2 (en) | 2001-03-14 | 2004-06-15 | Cardiac Pacemakers, Inc. | Cardiac rhythm management system with defibrillation threshold prediction |
US7386344B2 (en) | 2004-08-11 | 2008-06-10 | Cardiac Pacemakers, Inc. | Pacer with combined defibrillator tailored for bradycardia patients |
US6658293B2 (en) | 2001-04-27 | 2003-12-02 | Medtronic, Inc. | Method and system for atrial capture detection based on far-field R-wave sensing |
US6636762B2 (en) | 2001-04-30 | 2003-10-21 | Medtronic, Inc. | Method and system for monitoring heart failure using rate change dynamics |
US6721602B2 (en) | 2001-08-21 | 2004-04-13 | Medtronic, Inc. | Implantable medical device assembly and manufacturing method |
US6658292B2 (en) | 2001-08-24 | 2003-12-02 | Pacesetter, Inc. | Detection of patient's position and activity status using 3D accelerometer-based position sensor |
ATE554824T1 (de) | 2001-08-30 | 2012-05-15 | Medtronic Inc | Vorrichtung zur detektion myokardialer ischämie |
US7177689B2 (en) | 2001-10-26 | 2007-02-13 | Cardiac Pacemakers, Inc. | Method and apparatus for capture verification and threshold determination |
US6892092B2 (en) | 2001-10-29 | 2005-05-10 | Cardiac Pacemakers, Inc. | Cardiac rhythm management system with noise detector utilizing a hysteresis providing threshold |
US6708062B2 (en) | 2001-10-30 | 2004-03-16 | Medtronic, Inc. | Pacemaker having adaptive arrhythmia detection windows |
US6766190B2 (en) | 2001-10-31 | 2004-07-20 | Medtronic, Inc. | Method and apparatus for developing a vectorcardiograph in an implantable medical device |
US6760615B2 (en) | 2001-10-31 | 2004-07-06 | Medtronic, Inc. | Method and apparatus for discriminating between tachyarrhythmias |
US6975904B1 (en) | 2001-11-08 | 2005-12-13 | Pacesetter, Inc. | Modification of evoked response detection algorithm based on orientation and activity of patient |
US6625490B1 (en) | 2001-11-14 | 2003-09-23 | Pacesetter, Inc. | System and method of automatically adjusting sensing parameters based on temporal measurement of cardiac events |
US6832113B2 (en) | 2001-11-16 | 2004-12-14 | Cardiac Pacemakers, Inc. | Non-invasive method and apparatus for cardiac pacemaker pacing parameter optimization and monitoring of cardiac dysfunction |
US6745076B2 (en) | 2001-11-16 | 2004-06-01 | Medtronic, Inc. | Implantable medical device with autosensitivity algorithm for controlling sensing of cardiac signals |
US7392085B2 (en) * | 2001-11-21 | 2008-06-24 | Cameron Health, Inc. | Multiple electrode vectors for implantable cardiac treatment devices |
US7248921B2 (en) | 2003-06-02 | 2007-07-24 | Cameron Health, Inc. | Method and devices for performing cardiac waveform appraisal |
US6810284B1 (en) | 2001-11-21 | 2004-10-26 | Pacesetter, Inc. | Implantable cardiac stimulation system and method for monitoring diastolic function |
US6728575B2 (en) | 2001-11-30 | 2004-04-27 | St. Jude Medical Ab | Method and circuit for detecting cardiac rhythm abnormalities using a differential signal from a lead with a multi-electrode tip |
EP1450898B1 (en) | 2001-12-03 | 2009-07-29 | Medtronic, Inc. | Dual chamber method and apparatus for diagnosis and treatment of arrhythmias |
US6909916B2 (en) | 2001-12-20 | 2005-06-21 | Cardiac Pacemakers, Inc. | Cardiac rhythm management system with arrhythmia classification and electrode selection |
US6782059B2 (en) | 2002-01-31 | 2004-08-24 | Qualcomm Incorporated | Discontinuous transmission (DTX) detection |
KR100592838B1 (ko) * | 2002-03-14 | 2006-06-26 | 미쯔이가가꾸가부시끼가이샤 | 실런트용 수지 조성물, 실런트 필름 및 그의 용도 |
US7020523B1 (en) | 2002-04-16 | 2006-03-28 | Pacesetter, Inc. | Methods and systems for automatically switching electrode configurations |
US7283863B2 (en) | 2002-04-29 | 2007-10-16 | Medtronic, Inc. | Method and apparatus for identifying cardiac and non-cardiac oversensing using intracardiac electrograms |
US7027862B2 (en) | 2002-07-25 | 2006-04-11 | Medtronic, Inc. | Apparatus and method for transmitting an electrical signal in an implantable medical device |
US7027858B2 (en) | 2002-09-11 | 2006-04-11 | Medtronic, Inc. | Methods and apparatus for cardiac R-wave sensing in a subcutaneous ECG waveform |
US7062329B2 (en) | 2002-10-04 | 2006-06-13 | Cameron Health, Inc. | Implantable cardiac system with a selectable active housing |
US7123963B2 (en) | 2002-10-31 | 2006-10-17 | Medtronic, Inc. | Method of automatic evoked response sensing vector selection using evoked response waveform analysis |
US7031764B2 (en) | 2002-11-08 | 2006-04-18 | Cardiac Pacemakers, Inc. | Cardiac rhythm management systems and methods using multiple morphology templates for discriminating between rhythms |
US7016730B2 (en) | 2002-11-15 | 2006-03-21 | Cardiac Pacemakers, Inc. | Method of operating implantable medical devices to prolong battery life |
US6993379B1 (en) | 2002-12-30 | 2006-01-31 | Pacesetter, Inc. | System and method for emulating a surface EKG using an implantable cardiac stimulation device |
US7489970B2 (en) | 2003-04-02 | 2009-02-10 | Medtronic, Inc. | Management of neurostimulation therapy using parameter sets |
US20050004615A1 (en) | 2003-04-11 | 2005-01-06 | Sanders Richard S. | Reconfigurable implantable cardiac monitoring and therapy delivery device |
US8116868B2 (en) | 2003-04-11 | 2012-02-14 | Cardiac Pacemakers, Inc. | Implantable device with cardiac event audio playback |
EP1613395A2 (en) | 2003-04-11 | 2006-01-11 | Cardiac Pacemakers, Inc. | Subcutaneous cardiac device |
US7499750B2 (en) | 2003-04-11 | 2009-03-03 | Cardiac Pacemakers, Inc. | Noise canceling cardiac electrodes |
US20040215240A1 (en) | 2003-04-11 | 2004-10-28 | Lovett Eric G. | Reconfigurable subcutaneous cardiac device |
US20040230229A1 (en) | 2003-04-11 | 2004-11-18 | Lovett Eric G. | Hybrid transthoracic/intrathoracic cardiac stimulation devices and methods |
US7167747B2 (en) | 2003-05-13 | 2007-01-23 | Medtronic, Inc. | Identification of oversensing using sinus R-wave template |
US8825157B2 (en) | 2003-07-28 | 2014-09-02 | Cameron Health, Inc. | Vector switching in an implantable cardiac stimulus system |
US8396565B2 (en) | 2003-09-15 | 2013-03-12 | Medtronic, Inc. | Automatic therapy adjustments |
US7181281B1 (en) | 2003-10-08 | 2007-02-20 | Pacesetter, Inc. | ICD using MEMS for optimal therapy |
US7412287B2 (en) | 2003-12-22 | 2008-08-12 | Cardiac Pacemakers, Inc. | Automatic sensing vector selection for morphology-based capture verification |
NO20040355A (no) | 2004-01-26 | 2005-05-30 | Rolls Royce Marine As | Anordning ved en tauepinne for å lede en kabel på et fartøy |
US7805196B2 (en) | 2004-03-16 | 2010-09-28 | Medtronic, Inc. | Collecting activity information to evaluate therapy |
US7395113B2 (en) | 2004-03-16 | 2008-07-01 | Medtronic, Inc. | Collecting activity information to evaluate therapy |
US7792583B2 (en) | 2004-03-16 | 2010-09-07 | Medtronic, Inc. | Collecting posture information to evaluate therapy |
US7491181B2 (en) | 2004-03-16 | 2009-02-17 | Medtronic, Inc. | Collecting activity and sleep quality information via a medical device |
US7330760B2 (en) | 2004-03-16 | 2008-02-12 | Medtronic, Inc. | Collecting posture information to evaluate therapy |
US8135473B2 (en) | 2004-04-14 | 2012-03-13 | Medtronic, Inc. | Collecting posture and activity information to evaluate therapy |
US7236825B2 (en) | 2004-04-30 | 2007-06-26 | Medtronic, Inc. | Cardiac activity sensing during pacing in implantable devices |
US7706866B2 (en) * | 2004-06-24 | 2010-04-27 | Cardiac Pacemakers, Inc. | Automatic orientation determination for ECG measurements using multiple electrodes |
JP5065030B2 (ja) * | 2004-09-30 | 2012-10-31 | 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 | 発生源分別を実行する心臓システム |
US7155275B2 (en) | 2004-10-18 | 2006-12-26 | Cardiac Pacemakers, Inc. | Method and apparatus for adjusting cardiac event detection threshold based on dynamic noise estimation |
US7376458B2 (en) | 2004-11-29 | 2008-05-20 | Cameron Health, Inc. | Method for defining signal templates in implantable cardiac devices |
US7266409B2 (en) | 2004-12-01 | 2007-09-04 | Medtronic, Inc. | Method and apparatus for determining oversensing in a medical device |
US7655014B2 (en) | 2004-12-06 | 2010-02-02 | Cameron Health, Inc. | Apparatus and method for subcutaneous electrode insertion |
US7996072B2 (en) | 2004-12-21 | 2011-08-09 | Cardiac Pacemakers, Inc. | Positionally adaptable implantable cardiac device |
US20080243025A1 (en) | 2004-12-23 | 2008-10-02 | Nils Holmstrom | Medical Device |
US8577455B2 (en) | 2005-01-18 | 2013-11-05 | Medtronic, Inc. | Method and apparatus for arrhythmia detection in a medical device |
US20060173498A1 (en) | 2005-01-31 | 2006-08-03 | Isabelle Banville | Communication between an external defibrillator and an implantable medical device |
US20080215128A1 (en) * | 2005-02-01 | 2008-09-04 | Rainey Christopher J | Electrode arrangement for applying electrical signals to the skin of an animal |
US7519431B2 (en) | 2005-04-11 | 2009-04-14 | Medtronic, Inc. | Shifting between electrode combinations in electrical stimulation device |
US7567835B2 (en) | 2005-04-18 | 2009-07-28 | Medtronic, Inc. | Method and apparatus for identifying oversensing using far-field intracardiac electrograms and marker channels |
US7630763B2 (en) | 2005-04-20 | 2009-12-08 | Cardiac Pacemakers, Inc. | Thoracic or intracardiac impedance detection with automatic vector selection |
US7389147B2 (en) | 2005-04-29 | 2008-06-17 | Medtronic, Inc. | Therapy delivery mode selection |
EP1745741A1 (en) | 2005-07-19 | 2007-01-24 | Gabriele Moretti-Prucher | Ruler for evaluation of signals |
US7431365B2 (en) | 2005-09-28 | 2008-10-07 | International Automotive Components Group North America, Inc. | Console assembly for a vehicle |
US20070123947A1 (en) | 2005-11-30 | 2007-05-31 | Wenger William K | Medical device packaging system |
US7957809B2 (en) | 2005-12-02 | 2011-06-07 | Medtronic, Inc. | Closed-loop therapy adjustment |
EP1960046A1 (en) | 2005-12-02 | 2008-08-27 | Medtronic, Inc. | Closed-loop therapy adjustment |
US20070179388A1 (en) | 2006-01-30 | 2007-08-02 | Vincent Larik | Methods and systems of implanting a medical implant for improved signal detection |
US7991471B2 (en) | 2006-03-29 | 2011-08-02 | Medtronic, Inc. | Method and apparatus for detecting arrhythmias in a subcutaneous medical device |
US7894894B2 (en) | 2006-03-29 | 2011-02-22 | Medtronic, Inc. | Method and apparatus for detecting arrhythmias in a subcutaneous medical device |
US7907993B2 (en) | 2006-03-29 | 2011-03-15 | Medtronic, Inc. | Method and apparatus for detecting arrhythmias in a medical device |
US7496409B2 (en) * | 2006-03-29 | 2009-02-24 | Medtronic, Inc. | Implantable medical device system and method with signal quality monitoring and response |
US7941214B2 (en) | 2006-03-29 | 2011-05-10 | Medtronic, Inc. | Method and apparatus for detecting arrhythmias in a subcutaneous medical device |
US7623909B2 (en) | 2006-05-26 | 2009-11-24 | Cameron Health, Inc. | Implantable medical devices and programmers adapted for sensing vector selection |
US20070276452A1 (en) | 2006-05-26 | 2007-11-29 | Cameron Health, Inc. | Implantable medical device systems having initialization functions and methods of operation |
EP2029224B1 (en) | 2006-05-26 | 2020-12-02 | Cameron Health, Inc. | Implantable medical devices and associated methods for sensing vector selection |
US7783340B2 (en) | 2007-01-16 | 2010-08-24 | Cameron Health, Inc. | Systems and methods for sensing vector selection in an implantable medical device using a polynomial approach |
US8200341B2 (en) | 2007-02-07 | 2012-06-12 | Cameron Health, Inc. | Sensing vector selection in a cardiac stimulus device with postural assessment |
US8788023B2 (en) | 2006-05-26 | 2014-07-22 | Cameron Health, Inc. | Systems and methods for sensing vector selection in an implantable medical device |
US8718793B2 (en) | 2006-08-01 | 2014-05-06 | Cameron Health, Inc. | Electrode insertion tools, lead assemblies, kits and methods for placement of cardiac device electrodes |
US7880623B2 (en) | 2006-08-31 | 2011-02-01 | Invetex Corporation | Multiple-link water detection unit and system |
US7904153B2 (en) | 2007-04-27 | 2011-03-08 | Medtronic, Inc. | Method and apparatus for subcutaneous ECG vector acceptability and selection |
JP5451606B2 (ja) * | 2007-07-06 | 2014-03-26 | コーニンクレッカ フィリップス エヌ ヴェ | 遮蔽された生体用電極パッチ |
EP2207590A1 (en) | 2007-09-26 | 2010-07-21 | Medtronic, INC. | Therapy program selection |
US8219206B2 (en) | 2008-07-11 | 2012-07-10 | Medtronic, Inc. | Dwell time adjustments for posture state-responsive therapy |
US8209028B2 (en) | 2008-07-11 | 2012-06-26 | Medtronic, Inc. | Objectification of posture state-responsive therapy based on patient therapy adjustments |
US8249718B2 (en) | 2008-07-11 | 2012-08-21 | Medtronic, Inc. | Programming posture state-responsive therapy with nominal therapy parameters |
US8504150B2 (en) | 2008-07-11 | 2013-08-06 | Medtronic, Inc. | Associating therapy adjustments with posture states using a stability timer |
US8886302B2 (en) | 2008-07-11 | 2014-11-11 | Medtronic, Inc. | Adjustment of posture-responsive therapy |
US8280517B2 (en) | 2008-09-19 | 2012-10-02 | Medtronic, Inc. | Automatic validation techniques for validating operation of medical devices |
US9026223B2 (en) | 2009-04-30 | 2015-05-05 | Medtronic, Inc. | Therapy system including multiple posture sensors |
US8626260B2 (en) * | 2009-08-27 | 2014-01-07 | William Crosby | Expandable electrode pad |
US8388555B2 (en) | 2010-01-08 | 2013-03-05 | Medtronic, Inc. | Posture state classification for a medical device |
-
2007
- 2007-02-07 US US11/672,353 patent/US8200341B2/en active Active
-
2008
- 2008-02-06 AU AU2008213812A patent/AU2008213812B2/en active Active
- 2008-02-06 WO PCT/US2008/053197 patent/WO2008098062A1/en active Application Filing
- 2008-02-06 EP EP08729181.1A patent/EP2114244B1/en active Active
- 2008-02-06 JP JP2009549218A patent/JP5102313B2/ja active Active
- 2008-02-06 CA CA2676425A patent/CA2676425C/en active Active
- 2008-02-06 ES ES08729181.1T patent/ES2691249T3/es active Active
- 2008-02-06 CN CN2008800043264A patent/CN101668479B/zh active Active
-
2012
- 2012-06-07 US US13/491,529 patent/US8483843B2/en active Active
-
2013
- 2013-06-17 US US13/919,147 patent/US8781602B2/en active Active
-
2014
- 2014-06-18 US US14/307,756 patent/US8965530B2/en active Active
-
2015
- 2015-01-21 US US14/601,315 patent/US9119596B2/en active Active
- 2015-07-29 US US14/812,029 patent/US9357969B2/en active Active
-
2016
- 2016-05-10 US US15/150,771 patent/US9744366B2/en active Active
-
2017
- 2017-07-26 US US15/660,489 patent/US10016609B2/en not_active Expired - Fee Related
Patent Citations (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5331966A (en) * | 1991-04-05 | 1994-07-26 | Medtronic, Inc. | Subcutaneous multi-electrode sensing system, method and pacer |
US6044297A (en) * | 1998-09-25 | 2000-03-28 | Medtronic, Inc. | Posture and device orientation and calibration for implantable medical devices |
CN1829554A (zh) * | 2003-05-29 | 2006-09-06 | 卡梅伦保健公司 | 用于区别室性和室上性心律失常的方法 |
US7130689B1 (en) * | 2004-02-24 | 2006-10-31 | Pacesetter, Inc. | Methods and systems for optimizing cardiac pacing intervals for various physiologic factors |
Also Published As
Publication number | Publication date |
---|---|
US9744366B2 (en) | 2017-08-29 |
ES2691249T3 (es) | 2018-11-26 |
US20170333721A1 (en) | 2017-11-23 |
US20120245651A1 (en) | 2012-09-27 |
CN101668479A (zh) | 2010-03-10 |
WO2008098062A1 (en) | 2008-08-14 |
US20080188901A1 (en) | 2008-08-07 |
AU2008213812B2 (en) | 2012-12-13 |
US8200341B2 (en) | 2012-06-12 |
US8483843B2 (en) | 2013-07-09 |
US9119596B2 (en) | 2015-09-01 |
US20130274822A1 (en) | 2013-10-17 |
US20150328470A1 (en) | 2015-11-19 |
US9357969B2 (en) | 2016-06-07 |
JP5102313B2 (ja) | 2012-12-19 |
US20160250488A1 (en) | 2016-09-01 |
US10016609B2 (en) | 2018-07-10 |
US8965530B2 (en) | 2015-02-24 |
AU2008213812A1 (en) | 2008-08-14 |
US20140350631A1 (en) | 2014-11-27 |
CA2676425C (en) | 2016-05-17 |
EP2114244B1 (en) | 2018-08-29 |
EP2114244A1 (en) | 2009-11-11 |
US20150182171A1 (en) | 2015-07-02 |
JP2010517692A (ja) | 2010-05-27 |
US8781602B2 (en) | 2014-07-15 |
CA2676425A1 (en) | 2008-08-14 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
CN101668479B (zh) | 带姿势评估的心脏刺激装置中的感测矢量选择 | |
JP6515195B2 (ja) | 植込み型医療装置及び医療システム | |
US9821156B2 (en) | Apparatus for detecting and localizing insulation failures of implantable device leads | |
CN105358215B (zh) | 用于标识最佳电向量的系统、方法和界面 | |
CN101861122B (zh) | 用于可植入心脏刺激系统的患者筛选工具 | |
CN106456979A (zh) | 膈神经刺激的非侵入式检测 | |
US20140046392A1 (en) | Implantable medical device responsive to mri induced capture threshold changes | |
CN113057643A (zh) | 来自多极引线的起搏识别健康基质与不健康基质 | |
CN105555356A (zh) | 可植入电极位置选择 | |
CN104244809A (zh) | 心音感测来减少不适当的快速性心律失常治疗 | |
CN105451811A (zh) | 可植入电极位置选择 | |
WO2010005804A1 (en) | System and method for the detection of acute myocardial infarction | |
CN105828872B (zh) | 用于促进医疗设备中的一个或多个矢量的选择的系统和方法 | |
US20220143406A1 (en) | Analysis device for supporting the implantation of a system for stimulating the human or animal heart | |
US20230321447A1 (en) | Method and systems for using conductive communication to convey information between an implantable medical device and an external device | |
US20210402190A1 (en) | Device and method for determining a cardiac sensing control parameter | |
US20100114231A1 (en) | Methods and systems to monitor ischemia |
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 | ||
C56 | Change in the name or address of the patentee | ||
CP02 | Change in the address of a patent holder |
Address after: American Minnesota Patentee after: Cameron Health Inc. Address before: American California Patentee before: Cameron Health Inc. |