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Небесная энциклопедия

Космические корабли и станции, автоматические КА и методы их проектирования, бортовые комплексы управления, системы и средства жизнеобеспечения, особенности технологии производства ракетно-космических систем

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Мониторинг СМИ

Мониторинг СМИ и социальных сетей. Сканирование интернета, новостных сайтов, специализированных контентных площадок на базе мессенджеров. Гибкие настройки фильтров и первоначальных источников.

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Поддерживает ввод нескольких поисковых фраз (по одной на строку). При поиске обеспечивает поддержку морфологии русского и английского языка
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Применить Всего найдено 186. Отображено 100.
05-01-2012 дата публикации

Non-linear dynamic av delay

Номер: US20120004697A1
Автор: David J. Ternes, Donald L. Hopper, Yinghong Yu
Принадлежит: Cardiac Pacemakers Inc

A non-linear dynamic specified AV delay can be used, such as to help maintain cardiac resynchronization therapy, such as in patients with one or more symptoms of congestive heart failure.

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Номер записи: 1
05-01-2012 дата публикации

Physiologic demand driven pacing

Номер: US20120004698A1
Автор: David J. Ternes, Donald L. Hopper, Yinghong Yu
Принадлежит: Cardiac Pacemakers Inc

Physiologic demand driven pacing can be used to maintain cardiac synchrony and improve hemodynamic function in patients with heart failure.

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Номер записи: 2
19-04-2012 дата публикации

Method and apparatus for controlling neurostimulation according to physical state

Номер: US20120095530A1
Автор: Abhi V. Chavan, David J. Ternes, Jason J. Hamann, Juan Gabriel Hincapie Ordonez, Keith R. Maile, Stephen Ruble
Принадлежит: Cardiac Pacemakers Inc

A neurostimulation system senses a signal indicative of a patient's physical state such as posture and/or activity level. In various embodiments, a stored value for each of stimulation parameters controlling delivery of neurostimulation is selected according to the patient's physical state. In various embodiments, values of the stimulation parameters are approximately optimized for each of a number of different physical states, and are stored for later selection.

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Номер записи: 3
07-06-2012 дата публикации

SYSTEMS AND METHODS FOR INCREASING STIMULATION DOSE

Номер: US20120143286A1
Автор: Hahn Stephen J., Hamann Jason J., Ternes David J.
Принадлежит:

According to an embodiment of a method performed by an implantable medical device to deliver a neural stimulation therapy to a patient, a lower dose of the neural stimulation therapy is delivered to the patient. The dose of the neural stimulation therapy is automatically increased from the lower dose to a higher dose, and the higher dose of the neural stimulation therapy is delivered to the patient. A trigger that is controlled by the patient is detected, and the dose of the neural stimulation therapy is automatically returned from the higher dose back to the lower dose in response to detecting the trigger. 1. An implantable neural stimulator for implantation in a patient , comprising:controller circuitry;neural stimulation output circuitry configured to deliver neural stimulation, wherein the controller circuitry is configured to control an intensity of the neural stimulation delivered by the neural stimulation output circuitry;an input configured to receive a trigger from the patient, wherein the controller circuitry is configured to detect the trigger; instructions for delivering neural stimulation using the neural stimulation output circuitry;', 'instructions for implementing an up-titration routine to automatically increase the intensity of the neural stimulation from a lower intensity level to a higher intensity level; and', 'instructions for automatically decreasing the intensity of the neural stimulation from the higher intensity level to the lower intensity level in response to receiving the trigger from the patient, wherein the automatically increased intensity is maintained if the trigger from the patient is not received., 'a memory with instructions operable on by the controller circuitry, wherein the instructions include2. The stimulator of claim 1 , wherein the memory includes a plurality of neural stimulation parameter sets claim 1 , each of the neural stimulation parameter sets correspond to one of a plurality of intensity levels for the neural ...

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Номер записи: 4
22-11-2012 дата публикации

METHOD AND APPARATUS FOR NEUROSTIMULATION WITH PREVENTION OF NEURAL ACCOMMODATION

Номер: US20120296395A1
Автор: Hamann Jason J., Hincapie Ordonez Juan Gabriel, Ruble Stephen, Ternes David J.
Принадлежит:

A neurostimulation system delivers neurostimulation to a patient using one or more primary parameters and one or more secondary parameters. The one or more primary parameters are controlled for maintaining efficacy of the neurostimulation. The one or more secondary parameters are adjusted for preventing the patient from developing neural accommodation. In various embodiments, values for the one or more secondary parameters are varied during the delivery of the neurostimulation for prevention of neural accommodation that may result from a constant or periodic pattern of stimulation pulses. 1. An implantable medical device , comprising:a stimulation output circuit configured to deliver neurostimulation during therapy sessions;a storage device configured to store values of a plurality of stimulation parameters including one or more primary parameters each having a value selected for efficacy of the neurostimulation and one or more secondary parameters each having a value adjustable for preventing neural accommodation while maintaining the efficacy of the neurostimulation, the values including a plurality of value sets for the one or more secondary parameters, the value sets each being a set of one or more values each given to one of the one or more secondary parameters;a control circuit configured to control the delivery of the neurostimulation using the plurality of stimulation parameters, the control circuit including a parameter adjuster configured to adjust one or more parameters of the plurality of parameters, the parameter adjuster including a secondary parameter adjuster configured to select a subset of one or more value sets from the stored plurality of value sets for the one or more secondary parameters for each session of the therapy sessions such that the one or more secondary parameters are adjusted randomly through the therapy sessions; andan implantable housing encapsulating the stimulation output circuit, the storage device, and the control circuit.2. ...

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Номер записи: 5
24-01-2013 дата публикации

REMOTE SENSING IN AN IMPLANTABLE MEDICAL DEVICE

Номер: US20130023956A1
Автор: Hamann Jason J., Ruble Stephen, Siejko Krzysztof Z., Ternes David J.
Принадлежит:

An embodiment uses an accelerometer to sense heart sounds, and determines heart rate information using the sensed heart sounds. An embodiment uses an accelerometer to sense respiratory activity. An embodiment delivers a programmed neural stimulation therapy with a programmed duty cycle, where the programmed duty cycle includes a stimulation ON portion followed by a stimulation OFF portion. An electrode electrically connected to the implanted neural stimulation device is used to remotely detect cardiac activity. The remotely detected cardiac activity is used to detect heart rate information during the stimulation ON portion and to detect heart rate information during the stimulation OFF portion. The detected heart rate information and/or the detected respiration information are used to control a neural stimulation therapy performed by the neural stimulator device and/or are used to provide diagnostic information for the patient's condition. 1. A method for operating an implanted neural stimulation device having an electrode , comprising:implementing a neural stimulation therapy stored in the implanted neural stimulation device, wherein the neural stimulation therapy includes a programmed duty cycle, and the programmed duty cycle includes a stimulation ON portion followed by a stimulation OFF portion;remotely detecting cardiac activity using the electrode to detect heart rate information during at least one of the stimulation ON portion or during the stimulation OFF portion; andcontrolling the neural stimulation therapy using the detected heart rate information.2. The method of claim 1 , further comprising identifying R waves from the remotely detected cardiac activity or identifying PQRS waves from the remotely detected cardiac activity.3. The method of claim 1 , further comprising detecting a change in heart rate during the ON portion of the duty cycle and modifying the neural stimulation therapy using the change in heart rate.4. The method of claim 1 , further ...

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Номер записи: 6
24-01-2013 дата публикации

REMOTE PACE DETECTION IN AN IMPLANTABLE MEDICAL DEVICE

Номер: US20130023957A1
Автор: Baker Kenneth L., Ternes David J.
Принадлежит:

A system embodiment for stimulating a neural target comprises a neural stimulator, a pace detector, and a controller. The neural stimulator is electrically connected to at least one electrode, and is configured to deliver a neural stimulation signal through the at least one electrode to stimulate the neural target. The pace detector is configured to use at least one electrode to sense cardiac activity and distinguish paced cardiac activity in the sensed cardiac activity from non-paced cardiac activity in the sensed cardiac activity. The controller is configured to control a programmed neural stimulation therapy using the neural stimulator and using detected paced cardiac activity as an input for the neural stimulation therapy. 1. A system for stimulating a neural target , comprising:a neural stimulator configured to stimulate the neural target;a pace detector configured to sense cardiac activity and detect when the sensed cardiac activity includes paced cardiac activity; anda controller configured to control a programmed neural stimulation therapy using the neural stimulator and using detected paced cardiac activity as an input for the neural stimulation therapy.2. The system of claim 1 , wherein the controller is configured to synchronize neural stimulation on a remotely detected pace.3. The system of claim 1 , wherein the controller is configured to withhold neural stimulation upon detecting a remotely detected pace.4. The system of claim 1 , wherein the controller is configured to alter neural stimulation upon detecting a remotely detected pace.5. The system of claim 1 , wherein the detected paced cardiac activity includes detected paces claim 1 , the controller is configured to determine a pacing rate of the detected paces claim 1 , and the controller is configured to control the programmed neural stimulation based on whether the pacing rate of the detected paces is above a lower rate limit (LRL).6. The system of claim 1 , wherein the system is configured to ...

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Номер записи: 7
14-02-2013 дата публикации

METHOD AND APPARATUS FOR DETERMINATION OF PHYSIOLOGICAL PARAMETERS USING CERVICAL IMPEDANCE

Номер: US20130041269A1
Автор: Arcot-Krishnamurthy Shantha, Hincapie Ordonez Juan Gabriel, Maskara Barun, Stahmann Jeffrey E., Ternes David J., Vanderlinde Scott
Принадлежит:

Implanted electrodes can be used to deliver electrical stimulation signals to areas near blood vessels, nerves, or other internal body locations. In an example, an electrode can be implanted in a cervical location and can be used to measure dimensional changes in an artery using impedance plethysmography. Measured artery dimensional changes can be used to determine one or more physiological parameters associated with a patient's health status, such as pulse transit time, relative pulse pressure, or aterial compliance, among others. These parameters can be used to monitor a patient health status or to modulate a patient's therapy, among other uses. In some examples, an electrode configured to deliver an electrostimulation signal to nerve tissue can be used to provide non-neurostimulating electrical stimulation plethysmography signals near a blood vessel. 1. An apparatus , comprising:an electrical energy delivery circuit configured to provide an electrical test signal to a location internal to a patient body and near a blood vessel;a detector circuit configured to receive an electrical response signal in response to the electrical test signal; and determine a vessel dimension using the received response signal;', 'compare the determined vessel dimension to a reference vessel dimension to determine a vessel dimension change; and', 'output information about the vessel dimension change., 'a signal processor circuit, coupled to the electrical energy delivery circuit a the detector circuit, the signal processor circuit configured to2. The apparatus of claim 1 , wherein the electrical energy delivery circuit is configured to provide the electrical test signal using an electrode disposed in a cervical region near a carotid artery and a vagus nerve.3. The apparatus of claim 2 , wherein the electrical energy delivery circuit is configured to provide the electrical test signal as a non-neurostimulating electrical test signal.4. The apparatus of claim 2 , wherein the electrical ...

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Номер записи: 8
28-02-2013 дата публикации

Systems to detect vagus capture

Номер: US20130053926A1
Автор: David J. Ternes, Jason J. Hamann, Juan Gabriel Hincapie Ordonez, Shantha Arcot-Krishnamurthy, Stephen J. Hahn
Принадлежит: Cardiac Pacemakers Inc

Some embodiments provide a system for delivering neurostimulation. Some system embodiments comprise a lead configured to be implanted in the body, a stimulation output circuit configured to deliver neurostimulation pulses to the vagus nerve through the lead, an EMG sensing circuit configured to use the lead to sense EMG signals from laryngeal muscle activity, and an evoked muscular response detection circuit configured to use the EMG signals sensed by the EMG sensing circuit to detect evoked laryngeal muscle activity evoked by the neurostimulation pulse.

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Номер записи: 9
21-03-2013 дата публикации

POWER SUPPLY MANAGEMENT FOR IMPLANTABLE NEUROSTIMULATION DEVICES

Номер: US20130073008A1
Автор: Boon Scot C., Ternes David J., Vanderlinde Scott, Vijayagopal Ramprasad
Принадлежит:

An apparatus comprises a therapy circuit that provides a neural stimulation current, an impedance measurement circuit that measures a value of impedance at the output of the therapy circuit, a supply voltage generating circuit that provides an adjustable supply voltage value to the therapy circuit including a first supply voltage value when in a first mode, and a control circuit communicatively coupled to the therapy circuit, the impedance measuring circuit, and the supply voltage generating circuit. The control circuit, upon receiving an indication to exit the first mode, initiates an impedance measurement by the impedance measurement circuit, determines the second supply voltage value using the impedance measurement, and initiates a change from the first supply voltage value to the second supply voltage value. The second supply voltage value is sufficient to operate the therapy circuit and to provide a specified load current value to the measured impedance. 1. An ambulatory medical device comprising:a therapy circuit configured to provide a neural stimulation current at an output of the therapy circuit;an impedance measurement circuit configured to measure a value of impedance at the output of the therapy circuit;a supply voltage generating circuit configured to provide an adjustable supply voltage value to the therapy circuit including a first supply voltage value when in a first mode; initiate an impedance measurement by the impedance measurement circuit;', 'determine a second supply voltage value using the impedance measurement, wherein the second supply voltage value is sufficient to operate the therapy circuit and to provide a specified load current value to the measured impedance; and', 'initiate a change from the first supply voltage value to the second supply voltage value., 'a control circuit communicatively coupled to the therapy circuit, the impedance measuring circuit, and the supply voltage generating circuit, wherein the control circuit, upon ...

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Номер записи: 10
30-05-2013 дата публикации

MANAGING CROSS THERAPY SENSING IN A MULTIPLE THERAPY IMPLANTABLE DEVICE

Номер: US20130138170A1
Автор: Brandner Douglas J., Chavan Abhi V., Linder William J., Maile Keith R., Stessman Nicholas J., Ternes David J., Vijayagopal Ramprasad
Принадлежит:

An apparatus comprises a cardiac signal sensing circuit configured to sense an electrical cardiac signal from at least one of an atrium or ventricle of a heart of a subject, a therapy circuit configured to provide electrical pacing therapy and electrical autonomic neural modulation therapy to the subject, and a control circuit. The control circuit is configured to initiate delivery of the autonomic modulation neural therapy, and the control circuit includes a signal detection circuit configured to detect delivery of the autonomic neural modulation therapy in the sensed cardiac signal. The control circuit is configured to change, in response to detecting the delivery, a sensitivity of the cardiac signal sensing circuit during delivery of the autonomic neural modulation therapy. 1. An apparatus comprising:a cardiac signal sensing circuit configured to sense an electrical cardiac signal from at least one of an atrium or ventricle of a heart of a subject;a therapy circuit configured to provide electrical pacing therapy and electrical autonomic neural modulation therapy to the subject;a control circuit communicatively coupled to the cardiac signal sensing circuit and the therapy circuit and configured to initiate delivery of the autonomic modulation neural therapy;wherein the control circuit includes a signal detection circuit configured to detect delivery of the autonomic neural modulation therapy in the sensed cardiac signal; andwherein the control circuit is configured to change, in response to detecting the delivery of the autonomic neural modulation therapy, a sensitivity of the cardiac signal sensing circuit during delivery of the autonomic neural modulation therapy.2. The apparatus of claim 1 ,wherein the signal detection circuit is configured to detect a signal artifact of the autonomic neural modulation therapy in the sensed cardiac signal,wherein the cardiac signal sensing circuit includes at least one sense amplifier, andwherein the control circuit is ...

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Номер записи: 11
27-06-2013 дата публикации

Managing cross therapy delivery in a multiple therapy implantable device

Номер: US20130165985A1
Автор: David J. Ternes, Jason J. Hamann, Jeffrey E. Stahmann, Stephen Ruble
Принадлежит: Cardiac Pacemakers Inc

An apparatus comprises a cardiac signal sensing circuit configured to sense an electrical cardiac signal from at least one of an atrium or ventricle of a heart of a subject, a therapy circuit configured to provide electrical pacing therapy and electrical neural stimulation therapy to the subject, and a control circuit. The control circuit is configured to initiate delivery of the electrical pacing therapy, initiate a blanking period in a time relationship to the delivery of electrical pacing therapy, and initiate delivery of the electrical neural stimulation therapy to the subject during the blanking period. At least one sense amplifier of the cardiac signal sensing circuit is disabled during the blanking period.

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Номер записи: 12
27-06-2013 дата публикации

MAINTAINING STIMULATION THERAPY EFFICACY

Номер: US20130165994A1
Автор: Hamann Jason J., Ruble Stephen, Ternes David J.
Принадлежит:

An apparatus comprises a therapy circuit configured to provide electrical neural stimulation therapy to a subject using a first set of a plurality of implantable electrodes, a switching circuit communicatively coupled to the therapy circuit and configured to change the delivery of therapy among the plurality of implantable electrodes, and a control circuit. The control circuit is configured to initiate delivery of the neural stimulation therapy to a first subset of the first set of electrodes during a therapy session, change the therapy delivery from the first subset of electrodes to at least a second subset of electrodes of the first set of the plurality of implantable electrodes, and recurrently alternate the therapy delivery between the first and second subsets of electrodes during the same therapy session. 1. An apparatus comprising:a therapy circuit configured to provide electrical neural stimulation therapy to a neural stimulation target of a subject using a first set of a plurality of implantable electrodes, wherein the first set of the plurality of implantable electrodes provides the neural stimulation to a first region of the neural stimulation target;a switching circuit communicatively coupled to the therapy circuit and configured to change the delivery of therapy among the plurality of implantable electrodes; and initiate delivery of the neural stimulation therapy to a first subset of the first set of electrodes during a therapy session;', 'change the therapy delivery from the first subset of electrodes to at least a second subset of electrodes of the first set of the plurality of implantable electrodes; and', 'recurrently alternate the therapy delivery among the first subset and the at least second subsets of electrodes during the same therapy session., 'a control circuit configured to2. The apparatus of claim 1 , wherein the control circuit includes a timer circuit and is configured to:initiate delivery of the neural stimulation therapy using the first ...

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Номер записи: 13
08-08-2013 дата публикации

CONTROL OF NEURAL MODULATION THERAPY USING CERVICAL IMPEDANCE

Номер: US20130204328A1
Автор: Hamann Jason J., Ruble Stephen, Stahmann Jeffrey E., Ternes David J.
Принадлежит: Cardiac Pacemakers, Inc.

An implantable apparatus can comprise an electrical test energy delivery circuit configured to provide an electrical test signal to a cervical location in a patient body. A detector circuit can use the electrical test signal to detect cervical impedance and generate a cervical impedance signal representing fluctuations in the detected cervical impedance. The implantable apparatus can comprise a therapy delivery circuit, such as configured to provide electrical neural modulation therapy using a neural modulation timing parameter, and a processor circuit that can be coupled to the electrical test energy delivery circuit, the detector circuit, and the therapy delivery circuit. The processor circuit can be configured to determine a pulsatile signal or pulse pressure signal, such as using the cervical impedance signal, identify a characteristic of the pulsatile signal or pulse pressure signal, and control a neural modulation therapy using the timing parameter and the identified pulse pressure signal characteristic. 1. An implantable apparatus comprising:an electrical test energy delivery circuit configured to provide an electrical test signal to a cervical location in a patient body;a detector circuit configured to use the electrical test signal to detect cervical impedance and generate a cervical impedance signal representing fluctuations in the detected cervical impedance over time;a therapy delivery circuit configured to provide electrical neural modulation therapy to the patient using a neural modulation timing parameter; and determine a pulsatile signal using the cervical impedance signal;', 'identify at least one characteristic of the pulsatile signal; and', 'control delivery of the neural modulation therapy using the neural modulation timing parameter and the at least one identified characteristic of the pulsatile signal., 'a processor circuit, coupled to the electrical test energy delivery circuit, the detector circuit, and the therapy delivery circuit, the ...

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Номер записи: 14
29-08-2013 дата публикации

METHOD AND APPARATUS FOR CONTROLLING NEUROSTIMULATION ACCORDING TO PHYSICAL STATE

Номер: US20130226264A1
Автор: Chavan Abhi V., Hamann Jason J., Hincapie Ordonez Juan Gabriel, Maile Keith R., Ruble Stephen, Ternes David J.
Принадлежит: Cardiac Pacemakers, Inc.

A neurostimulation system senses a signal indicative of a patient's physical state such as posture and/or activity level. In various embodiments, a stored value for each of stimulation parameters controlling delivery of neurostimulation is selected according to the patient's physical state. In various embodiments, values of the stimulation parameters are approximately optimized for each of a number of different physical states, and are stored for later selection. 120-. (canceled)21. A system for delivering neurostimulation to a patient , the system comprising:a sensor circuit configured to determine a current value of a sensor parameter representing a physical state of the patient;a stimulation output circuit configured to deliver the neurostimulation; anda stimulation control circuit configured to store a plurality of values of a sensor-driven parameter, identify a value of the sensor-driven parameter for the current value of the sensor parameter from the stored plurality of values of the sensor-driven parameter, determine whether the identified value of the sensor-driven parameter is currently optimal, and control the delivery of the neurostimulation using the identified value of the sensor-driven parameter in response to the identified value of the sensor-driven parameter being determined to be currently optimal.22. The system of claim 21 , wherein the sensor circuit comprises:a posture sensor configured to sense a posture signal indicative of a posture of the patient; anda sensor processing circuit configured to determine the current value of the sensor parameter using the sensed posture signal.23. The system of claim 21 , wherein the sensor circuit comprises:an activity sensor configured to sense an activity signal indicative of an activity level of the patient; anda sensor processing circuit configured to determine the current value of the sensor parameter using the sensed activity signal.24. The system of claim 21 , comprising a parameter input device ...

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Номер записи: 15
19-09-2013 дата публикации

SYSTEMS AND METHODS FOR MONITORING NEUROSTIMULATION DOSING

Номер: US20130245718A1
Автор: Birkholz Doug M., Brandner Douglas J., Gifford Douglas J., Linder William J., Ternes David J.
Принадлежит: Cardiac Pacemakers, Inc.

Various implantable device embodiments may comprise a neural stimulator configured to deliver a neurostimulation therapy with stimulation ON times and stimulation OFF times where a dose of the neurostimulation therapy is provided by a number of neurostimulation pulses over a period of time. The neural stimulator may be configured to monitor the dose of the delivered neurostimulation therapy against dosing parameters. The neural stimulator may be configured to declare a fault if the monitored dose does not favorably compare to a desired dose for the neurostimulation therapy, or may be configured to record data for the monitored dose of the delivered neurostimulation therapy, or may be configured to both record data for the monitored dose of the delivered neurostimulation therapy and declare a fault if the monitored dose does not favorably compare to a desired dose for the neurostimulation therapy. 1. A method , comprising:delivering a neurostimulation therapy, wherein a dose of the neurostimulation therapy is provided by a number of neurostimulation pulses over a period of time;monitoring the dose of the delivered neurostimulation therapy; anddeclaring a fault if the monitored dose does not favorably compare to a desired dose or recording data for the monitored dose of the delivered neurostimulation therapy.2. The method of claim 1 , wherein:delivering the neurostimulation therapy includes using a hardware state machine with hardware registers to deliver a train of neurostimulation pulses for each of a plurality of neurostimulation bursts; andmonitoring the dose of the delivered neurostimulation therapy includes providing a Burst Start Interrupt from the state machine at a beginning of the neurostimulation bursts and a Burst Stop Interrupt from the state machine at an end of the neurostimulation burst, starting a stimulation ON timer in response to the Burst Stop Interrupt; anddeclaring the fault if, after a defined number of times, the stimulation ON timer expires ...

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Номер записи: 16
19-09-2013 дата публикации

Systems and methods for monitoring for nerve damage

Номер: US20130245722A1
Автор: David J. Ternes, Jason J. Hamann, Stephen Ruble
Принадлежит: Cardiac Pacemakers Inc

Various device embodiments may comprise an implantable medical device for implantation in a body and for applying neural stimulation to a neural target in the body. The device may comprise a neural stimulation electrode configured for use in stimulating the neural target, a neural stimulator configured to deliver neural stimulation through the electrode to the neural target, a sensor configured to sense a physiological response to stimulation of motor fibers at the neural target, and a controller operatively connected to the neural stimulator to control the neural stimulation and operatively connected to the sensor to receive a signal indicative of the physiological response. The controller may be configured to detect a potential neural injury and perform an action in response to the detected potential neural injury.

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Номер записи: 17
26-09-2013 дата публикации

AUTOMATIC SELECTION OF LEAD CONFIGURATION FOR A NEURAL STIMULATION LEAD

Номер: US20130253615A1
Автор: Arcot-Krishnamurthy Shantha, Hamann Jason, Hincapie Ordonez Juan Gabriel, Ruble Stephen B., Ternes David J.
Принадлежит: Cardiac Pacemakers, Inc.

A neurostimulation system includes a neural stimulation lead having a proximal portion and a distal portion and including a plurality of electrodes along the distal portion. The plurality of electrodes are configured for positioning proximate a portion of the autonomic nervous system. A neural stimulation circuit, coupled to the plurality of electrodes, delivers neural stimulation pulses to the plurality of electrodes. A processor and controller is configured to control the neural stimulation circuit to deliver first neural stimulation pulses to each of a plurality of electrode configurations. Each electrode configuration includes one or more of the plurality of electrodes. The processor and controller is further configured to receive information related to motor fiber activity that is induced in response to delivery of the first neural stimulation pulses to each of the plurality of electrode configurations and to identify the electrode configurations that induce the motor fiber activity. 1. A neurostimulation system comprising:a neural stimulation lead having a plurality of electrodes, the plurality of electrodes configured for positioning proximate a portion of the autonomic nervous system;a neural stimulation circuit, coupled to the plurality of electrodes, to deliver neural stimulation pulses to the plurality of electrodes;a user interface, the user interfacing including a display; and control the neural stimulation circuit to deliver first neural stimulation pulses to each of a plurality of electrode configurations, each electrode configuration comprising one or more of the plurality of electrodes,', 'receive information related to motor fiber activity that is induced in response to delivery of the first neural stimulation pulses to each of the plurality of electrode configurations,', 'prioritize the plurality of electrode configurations based on a first capture threshold of the motor fiber activity,', 'control the neural stimulation circuit to deliver second ...

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Номер записи: 18
12-12-2013 дата публикации

REMOTE PACE DETECTION IN AN IMPLANTABLE MEDICAL DEVICE

Номер: US20130331904A1
Автор: Baker Kenneth L., Ternes David J.
Принадлежит: Cardiac Pacemakers, Inc.

A system embodiment for stimulating a neural target comprises a neural stimulator, a pace detector, and a controller. The neural stimulator is electrically connected to at least one electrode, and is configured to deliver a neural stimulation signal through the at least one electrode to stimulate the neural target. The pace detector is configured to use at least one electrode to sense cardiac activity and distinguish paced cardiac activity in the sensed cardiac activity from non-paced cardiac activity in the sensed cardiac activity. The controller is configured to control a programmed neural stimulation therapy using the neural stimulator and using detected paced cardiac activity as an input for the neural stimulation therapy. 1. (canceled)2. A system , comprising:a neural stimulator configured to generate and deliver a neural stimulation signal to a neural target;a pace detector configured to sense cardiac activity and detect when the sensed cardiac activity includes paced cardiac activity; anda controller configured to control the neural stimulator to provide a programmed neural stimulation therapy, to communicate with the pace detector, and control the programmed neural stimulation using the detected paced cardiac activity.3. The system of claim 2 , wherein the pace detector is further configured to determine a location of the paced cardiac activity.4. The system of claim 3 , wherein the pace detector is further configured to determine whether the paced cardiac activity is occurring in at least two cardiac locations.5. The system of claim 3 , wherein in determining the location of the paced cardiac activity claim 3 , the pace detector is configured to determine which heart chamber is being paced.6. The system of claim 3 , wherein in determining the location of the paced cardiac activity claim 3 , the pace detector is configured to use a characteristic of the paced cardiac activity to determine the location of the paced cardiac activity.7. The system of claim 6 , ...

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Номер записи: 19
26-12-2013 дата публикации

Method for detecting vagus capture

Номер: US20130345591A1
Автор: David J. Ternes, Jason J. Hamann, Juan Gabriel Hincapie Ordonez, Shantha Arcot-Krishnamurthy, Stephen J. Hahn
Принадлежит: Cardiac Pacemakers Inc

Some embodiments provide a system for delivering neurostimulation. Some system embodiments comprise a lead configured to be implanted in the body, a stimulation output circuit configured to deliver neurostimulation pulses to the vagus nerve through the lead, an EMG sensing circuit configured to use the lead to sense EMG signals from laryngeal muscle activity, and an evoked muscular response detection circuit configured to use the EMG signals sensed by the EMG sensing circuit to detect evoked laryngeal muscle activity evoked by the neurostimulation pulse.

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Номер записи: 20
02-01-2014 дата публикации

CONCURRENT THERAPY DETECTION IN IMPLANTABLE MEDICAL DEVICES

Номер: US20140005494A1
Автор: Baker Kenneth L., Hamann Jason J., Ruble Stephen, Ternes David J.
Принадлежит: Cardiac Pacemakers, Inc.

Various method embodiments detect a concurrent therapy, where the concurrent therapy includes a plurality of therapy pulses. Detecting the concurrent therapy includes detecting at least one electrical pulse, extracting at least one characteristic from the at least one electrical pulse, comparing the at least one characteristic of the detected pulse to at least one characteristic of therapy pulses, and detecting that the concurrent therapy is being applied if the at least one characteristic of the detected pulse favorably compares to the at least one characteristic of the therapy pulses. 1. A method , comprising: detecting at least one electrical pulse;', 'extracting at least one characteristic from the at least one electrical pulse;', 'comparing the at least one characteristic of the detected pulse to at least one characteristic of therapy pulses; and', 'detecting that the concurrent therapy is being applied if the at least one characteristic of the detected pulse favorably compares to the at least one characteristic of the therapy pulses., 'detecting a concurrent therapy, wherein the concurrent therapy includes a plurality of therapy pulses, wherein detecting a concurrent therapy includes2. The method of claim 1 , wherein detecting the at least one electrical pulse includes detecting a rising edge or a falling edge of the electrical pulse.3. The method of claim 2 , wherein detecting the rising edge or the falling edge of the electrical pulse includes detecting both the rising edge and the falling edge of the electrical pulse.4. The method of claim 2 , wherein detecting the rising edge or a falling edge of the electrical pulse includes applying a high frequency filter to transform a sensed pulse signal into a transformed signal claim 2 , wherein the transformed signal has spikes corresponding to transitions at the rising and falling edges of the sensed pulse.5. The method of claim 4 , wherein extracting includes extracting a pulse width from the at least one ...

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Номер записи: 21
13-02-2014 дата публикации

APPARATUS FOR TREATING PELVIC FLOOR DISORDERS AND RELATED METHODS OF USE

Номер: US20140046397A1
Автор: Jackson Timothy, ROHRER Mark, STUCKY Michael, Ternes David J.
Принадлежит: BOSTON SCIENTIFIC SCIMED, INC.

A method of optimizing the electrical stimulation of a bladder of a patient including selecting a first subset of electrodes from a set of electrodes positioned adjacent to a set of nerves associated with the bladder. The set of electrodes may include one or more electrodes, each of which may be configured to deliver electrical stimulation pulses generated by a stimulator device to the nerves. The method may further include delivering an electrical stimulation pulse through the selected first subset of electrodes and recording at least one parameter of the electrical stimulation pulse after receiving patient feedback. 1. A method of optimizing the electrical stimulation of a bladder of a patient , the method comprising:selecting a first subset of electrodes from a set of electrodes positioned adjacent to nerves associated with the bladder, the set of electrodes including one or more electrodes, wherein each electrode of the set of electrodes is configured to deliver electrical stimulation pulses generated by a stimulator device to the nerves;delivering at least one electrical stimulation pulse through the first subset of electrodes; andrecording at least one parameter associated with the at least one electrical stimulation pulse after receiving patient feedback.2. The method of claim 1 , wherein receiving patient feedback includes receiving patient feedback in response to a sensation associated with the at least one electrical stimulation pulse.3. The method of claim 1 , wherein recording the at least one parameter of the at least one electrical stimulation pulse includes recording an amplitude of the at least one electrical stimulation pulse.4. The method of claim 1 , further including increasing an amplitude of the at least one electrical stimulation pulse until receiving patient feedback based on patient tolerance.5. The method of claim 1 , further including:selecting a second subset of electrodes different from the first subset of electrodes;delivering at least ...

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Номер записи: 22
20-02-2014 дата публикации

Therapy delivery architecture for implantable medical device

Номер: US20140052207A1
Автор: David J. Ternes, Keith R. Maile, Nicholas J. Stessman, Ramprasad Vijayagopal, Ron A. Balczewski, William J. Linder
Принадлежит: Cardiac Pacemakers Inc

An implantable medical device (IMD) may include multiple power supply circuits and an electrostimulation therapy output circuit configured to, in response to a control signal specifying an electrostimulation therapy, controllably connect any one or more of the first or second power supply circuits to any one or more of a first electrostimulation output node or a second electrostimulation output node to deliver an electrostimulation. In an embodiment, the IMD may include an electrostimulation therapy return circuit configured to establish a return path for the electrostimulation delivered via one or more of the first electrostimulation output node or the second electrostimulation output node.

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Номер записи: 23
20-02-2014 дата публикации

PHYSIOLOGICAL VIBRATION DETECTION IN AN IMPLANTED MEDICAL DEVICE

Номер: US20140052209A1
Автор: Hamann Jason J., Ruble Stephen B., Siejko Krzysztof Z., Ternes David J.
Принадлежит: Cardiac Pacemakers, Inc.

An embodiment of an implantable system configured to be implanted in a patient includes an accelerometer, a neural stimulator, and a controller. The neural stimulator is configured to deliver neural stimulation to a neural target. The controller is configured to use the accelerometer to detect laryngeal vibration or coughing, and is configured to deliver a programmed neural stimulation therapy using the neural stimulator and using detected laryngeal vibration or detected coughing as an input to the programmed neural stimulation therapy. 1. (canceled)2. An implantable system configured to be implanted in a patient , comprising:an accelerometer;a neural stimulator configured to deliver neural stimulation to a neural target; anda controller configured to use the accelerometer to detect laryngeal vibration and to also detect at least one of heart sounds or respiration, and configured to deliver a programmed neural stimulation therapy using the neural stimulator and using at least detected laryngeal vibration as an input to the programmed neural stimulation therapy.3. The system of claim 2 , wherein the controller is configured to use the accelerometer to detect laryngeal vibration claim 2 , to detect heart sounds claim 2 , and to detect respiration.4. The system of claim 3 , wherein the controller is configured to compensate for heart sounds when detecting respiration.5. The system of claim 2 , wherein the controller is configured to use the accelerometer to detect respiration to detect a respiratory event.6. The system of claim 5 , wherein the controller is configured to use the detected respiratory event to control the programmed neural stimulation therapy.7. The system of claim 5 , wherein the controller is configured to use the detected respiratory event to determine respiration diagnostics for the programmed neural stimulation therapy.8. The system of claim 2 , wherein the controller is configured to use the accelerometer to detect respiration detect a respiratory ...

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Номер записи: 24
27-02-2014 дата публикации

IMPLANTABLE MEDICAL DEVICE WITH CONTROL OF NEURAL STIMULATION BASED ON BATTERY STATUS

Номер: US20140058467A1
Автор: Hamann Jason J., Ternes David J., Vanderlinde Scott
Принадлежит: Cardiac Pacemakers, Inc.

An implantable medical device is powered by a battery to deliver one or more therapies including at least one non-life-sustaining therapy such as neural stimulation for enhancing quality of life of a patient. When the battery approaches its end of life, the implantable medical device reduces power consumption of the neural stimulation (e.g., intensity of the neural stimulation) for extending the remaining battery life while maintaining a certain amount of therapeutic benefits for the patient. In one embodiment, the intensity of the neural stimulation is reduced in a tiered manner. In one embodiment in which the implantable medical device also delivers at least one life-sustaining cardiac stimulation therapy, the neural stimulation is disabled or adjusted to reduce its power consumption (e.g., intensity) while the intensity of the cardiac stimulation therapy is maintained when the battery is near its end of life. 1. An implantable medical device for use in a body , comprising:a battery;a battery monitoring circuit coupled to the battery, the battery monitoring circuit configured to monitor an energy level of the battery and produce a battery status parameter indicative of the energy level;a neural stimulation circuit configured to deliver neural stimulation for modulating neural activities; a power controller configured to set a current power mode of the implantable medical device to a first reduced-power operation mode of a plurality of power modes in response to the battery status parameter indicating that the energy level has fallen below a first energy level threshold of a plurality of energy level thresholds; and', 'a neural stimulation controller configured to control the delivery of the neural stimulation using neural stimulation parameters and to adjust one or more parameters of the neural stimulation parameters within the first reduced-power operation mode such that an intensity of the neural stimulation is reduced within the first reduced-power operation ...

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Номер записи: 25
03-04-2014 дата публикации

REMOTE SENSING IN AN IMPLANTABLE MEDICAL DEVICE

Номер: US20140094875A1
Автор: Hamann Jason J., Ruble Stephen B., Siejko Krzysztof Z., Ternes David J.
Принадлежит: Cardiac Pacemakers, Inc.

An embodiment uses an accelerometer to sense heart sounds, and determines heart rate information using the sensed heart sounds. An embodiment uses an accelerometer to sense respiratory activity. An embodiment delivers a programmed neural stimulation therapy with a programmed duty cycle, where the programmed duty cycle includes a stimulation ON portion followed by a stimulation OFF portion. An electrode electrically connected to the implanted neural stimulation device is used to remotely detect cardiac activity. The remotely detected cardiac activity is used to detect heart rate information during the stimulation ON portion and to detect heart rate information during the stimulation OFF portion. The detected heart rate information and/or the detected respiration information are used to control a neural stimulation therapy performed by the neural stimulator device and/or are used to provide diagnostic information for the patient's condition. 1. (canceled)2. A method for operating an implanted neural stimulation device having a neural stimulator led and remote sensing electrodes for sensing cardiac activity from a position remote from a heart , the method comprising:implementing a neural stimulation therapy stored in the implanted neural stimulation device including delivering the neural stimulation therapy through the neural stimulator lead, wherein the neural stimulation therapy does not significantly alter heart rate, and the neural stimulation therapy includes a programmed duty cycle, the programmed duty cycle including a stimulation ON portion followed by a stimulation OFF portion; andmonitoring cardiac activity, including remotely detecting cardiac activity using the remote sensing electrodes to detect heart rate during implementation of the neural stimulation therapy.3. The method of claim 2 , wherein delivering the neural stimulation therapy includes delivering electrical stimulation to a vagus nerve.4. The method of claim 3 , wherein delivering electrical ...

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Номер записи: 26
10-01-2019 дата публикации

SYSTEMS AND METHODS FOR MANAGING PATIENT-TRIGGERED EPISODES

Номер: US20190008384A1
Автор: An Qi, Averina Viktoria A., Brisben Amy Jean, Mahajan Deepa, Saha Sunipa, Siejko Krzysztof Z., Ternes David J., Thakur Pramodsingh Hirasingh, Trapp Simpson JoAnna
Принадлежит:

Systems and methods for managing machine-generated medical events detected from one or more patients are described herein. A medical event management system includes an event analyzer circuit to detect a medical event using physiological data from a patient-triggered episode acquired from a medical device. The event analyzer circuit determines a confidence score of the medical event detection, and generates an alignment indicator indicating a degree of concordance between the detected medical event and the information about the patient-triggered episode. The system assigns priority information to the patient-triggered episode using the generated alignment indicator and the confidence score of the detection. An output circuit can output the received physiological information to a user or a process according to the assigned priority information. 1. A system for prioritizing medical events detected by an ambulatory medical device (AMD) , the system comprising:a receiver circuit configured to receive physiological information from the AMD corresponding to a patient-triggered episode;an event analyzer circuit configured to analyze the received physiological information corresponding to the patient-triggered episode, and to determine a confidence score for the patient-triggered episode; andan event prioritizer circuit configured to assign priority information to the received patient-triggered episode using the confidence score.2. The system of claim 1 , wherein the event analyzer circuit is configured to perform offline analysis of the received physiological information corresponding to the patient-triggered episode.3. The system of claim 1 , wherein the patient-triggered episode includes information about patient-reported sign or symptom claim 1 , and the event analyzer circuit is configured to detect a medical event and generate an alignment indicator indicating a concordance between the information about patient-reported sign or symptom and the detected medical event.4 ...

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Номер записи: 27
14-01-2021 дата публикации

SYSTEMS AND METHODS FOR MONITORING NEUROSTIMULATION DOSING

Номер: US20210008378A1
Автор: Birkholz Doug M., Brandner Douglas J., Gifford Douglas J., Linder William J., Ternes David J.
Принадлежит:

Various implantable device embodiments may comprise a neural stimulator configured to deliver a neurostimulation therapy with stimulation ON times and stimulation OFF times where a dose of the neurostimulation therapy is provided by a number of neurostimulation pulses over a period of time. The neural stimulator may be configured to monitor the dose of the delivered neurostimulation therapy against dosing parameters. The neural stimulator may be configured to declare a fault if the monitored dose does not favorably compare to a desired dose for the neurostimulation therapy, or may be configured to record data for the monitored dose of the delivered neurostimulation therapy, or may be configured to both record data for the monitored dose of the delivered neurostimulation therapy and declare a fault if the monitored dose does not favorably compare to a desired dose for the neurostimulation therapy. 1. (canceled)2. A method for operating an implantable medical device (IMD) , comprising:delivering a neurostimulation therapy using the IMD, wherein a prescribed dose of the neurostimulation therapy corresponds to a lower charge limit over a period of time;monitoring a delivered dose of the neurostimulation therapy with respect to the prescribed dose using the IMD to determine whether the delivered dose is delivering an amount of charge at least equal to the lower charge limit over the period of time; and declaring a fault if the monitored delivered dose does not deliver the amount of charge at least equal to the lower charge limit; or', 'recording data for the monitored delivered dose of the neurostimulation therapy., 'performing an action using the IMD, including3. The method of claim 2 , wherein monitoring the delivered dose of the neurostimulation therapy with respect to the prescribed dose includes monitoring charge depletion for a time period and comparing the monitored charge depletion against a limit corresponding to the prescribed dose.4. The method of claim 2 , ...

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Номер записи: 28
19-01-2017 дата публикации

APPARATUS FOR TREATING PELVIC FLOOR DISORDERS AND RELATED METHODS OF USE

Номер: US20170014624A1
Автор: Jackson Timothy, ROHRER Mark, STUCKY Michael, Ternes David J.
Принадлежит: BOSTON SCIENTIFIC SCIMED, INC.

A method of optimizing the electrical stimulation of a bladder of a patient including selecting a first subset of electrodes from a set of electrodes positioned adjacent to a set of nerves associated with the bladder. The set of electrodes may include one or more electrodes, each of which may be configured to deliver electrical stimulation pulses generated by a stimulator device to the nerves. The method may further include delivering an electrical stimulation pulse through the selected first subset of electrodes and recording at least one parameter of the electrical stimulation pulse after receiving patient feedback. 120-. (canceled)21. A method comprising:delivering, with a controller, an electrical stimulus through a plurality of electrodes positioned adjacent a bladder;receiving, at the controller, electrical signals generated by the bladder responsive to the electrical stimulus;determining, with the controller, a physiological signal based on the electrical signals; andrecording, with the controller, the physiological signal and at least one parameter associated with the electrical stimulus.22. The method of claim 21 , wherein the physiological signal includes at least one of a bladder void claim 21 , a bladder volume claim 21 , a bladder pressure claim 21 , or a bladder muscle contraction.23. The method of claim 21 , wherein the method further comprises determining claim 21 , with the controller claim 21 , a position of each electric signal relative to the bladder.24. The method of claim 21 , further comprising:sensing, with a sensor positioned adjacent the bladder, at least one other physiological signal responsive to the electrical stimulus; andrecording, with the controller, the at least one other physiological signal.25. The method of claim 21 , further comprising prompting and receiving claim 21 , with the controller claim 21 , a user input associated with the electrical stimulus.26. The method of claim 25 , wherein recording at least one parameter ...

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Номер записи: 29
19-01-2017 дата публикации

Systems and methods for monitoring neurostimulation dosing

Номер: US20170014634A1
Автор: David J. Ternes, Doug M. Birkholz, Douglas J. Brandner, Douglas J. Gifford, William J. Linder
Принадлежит: Cardiac Pacemakers Inc

Various implantable device embodiments may comprise a neural stimulator configured to deliver a neurostimulation therapy with stimulation ON times and stimulation OFF times where a dose of the neurostimulation therapy is provided by a number of neurostimulation pulses over a period of time. The neural stimulator may be configured to monitor the dose of the delivered neurostimulation therapy against dosing parameters. The neural stimulator may be configured to declare a fault if the monitored dose does not favorably compare to a desired dose for the neurostimulation therapy, or may be configured to record data for the monitored dose of the delivered neurostimulation therapy, or may be configured to both record data for the monitored dose of the delivered neurostimulation therapy and declare a fault if the monitored dose does not favorably compare to a desired dose for the neurostimulation therapy.

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Номер записи: 30
22-01-2015 дата публикации

APPARATUS FOR TREATING PELVIC FLOOR DISORDERS AND RELATED METHODS OF USE

Номер: US20150025594A1
Автор: Jackson Timothy, ROHRER Mark, STUCKY Michael, Ternes David J.
Принадлежит:

A method of optimizing the electrical stimulation of a bladder of a patient including selecting a first subset of electrodes from a set of electrodes positioned adjacent to a set of nerves associated with the bladder. The set of electrodes may include one or more electrodes, each of which may be configured to deliver electrical stimulation pulses generated by a stimulator device to the nerves. The method may further include delivering an electrical stimulation pulse through the selected first subset of electrodes and recording at least one parameter of the electrical stimulation pulse after receiving patient feedback. 120-. (canceled)21. A method of optimizing the electrical stimulation of a bladder of a patient , the method comprising:selecting a first subset of electrodes from a set of electrodes positioned adjacent to nerves associated with the bladder, wherein each electrode of the set of electrodes is configured to deliver electrical stimulation pulses generated by a stimulator device to the nerves;delivering at least one electrical stimulation pulse through the first subset of electrodes;sensing a physiological response via a sensor positioned on an external bladder wall; andrecording at least one parameter associated with the at least one electrical stimulation pulse delivered through the first subset of electrodes after receiving patient feedback and the physiological response.22. The method of claim 21 , wherein delivering at least one electrical stimulation pulse through the first subset of electrodes includes delivering the at least one electrical stimulation pulse for a predetermined period of time.23. The method of claim 22 , further including:determining a level of efficacy of electrical stimulation through the first subset of electrodes over the predetermined period of time based on patient feedback.24. The method of claim 22 , wherein the predetermined time is one week.25. The method of claim 21 , wherein recording at least one parameter includes ...

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Номер записи: 31
30-01-2020 дата публикации

MANAGED PACE RECHARGE IN A MULTIPOINT PACING SYSTEM

Номер: US20200030607A1
Автор: Linder William J., Ternes David J.
Принадлежит:

An apparatus comprises a stimulus circuit, a recharge circuit, a switch circuit, and a control circuit. The stimulus circuit provides electrical cardiac pacing stimulation to multiple combinations of a plurality of electrodes, and the electrical stimulation is selectively applied at the first electrode of the electrode combinations. The recharge circuit includes a recharge capacitor electrically coupled to the second electrode of the electrode combinations, and the switch circuit selectively enables electrode combinations for electrical coupling to the stimulus circuit and the recharge circuit. The control circuit includes a pacing activation sub-circuit that selectively initiates delivery of the electrical stimulation using multiple electrode combinations, and enables simultaneous delivery of pacing recharge energy from the recharge capacitor to the second electrode of multiple electrode combinations. 1. An apparatus comprising:a stimulus circuit configured to provide electrical cardiac pacing stimulation to multiple electrode combinations of a plurality of electrodes implantable within a single heart chamber, wherein each electrode combination includes at least a first electrode and a second electrode and the electrical stimulation is selectively applied at the first electrodes of the electrode combinations;a recharge circuit including multiple recharge capacitors electrically coupled to the second electrodes of the electrode combinations;a switch circuit configured to selectively couple the electrode combinations to the stimulus circuit and the recharge circuit; anda control circuit including a pacing activation sub-circuit configured to: selectively initiate delivery of the pacing stimulation to the single heart chamber using the electrode combinations; and enable at least partial sequential delivery of pacing recharge energy from the recharge capacitors to the second electrodes of the electrode combinations, wherein the at least partial sequential delivery of ...

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Номер записи: 32
06-02-2020 дата публикации

AMBULATORY MONITORING OF PHYSIOLOGIC RESPONSE TO VALSALVA MANEUVER

Номер: US20200037887A1
Автор: An Qi, Brisben Amy Jean, Jensen Ashley Moriah, Ternes David J., Thakur Pramodsingh Hirasingh
Принадлежит:

Systems and methods for monitoring physiologic response to Valsalva maneuver (VM) are disclosed. An exemplary patient monitor may detect a natural incidence of a VM session occurred in an ambulatory setting using a heart sound (HS) signal sensed from the patient. The patient monitor may include a physiologic response analyzer to sense patient physiologic response during the detected VM session, and generate a cardiovascular or autonomic function indicator based on the sensed physiologic response to the VM. Using the physiologic response to the VM, the system may detect a target physiologic event using the sensed physiologic response to the VM. 1. A system for monitoring a physiologic response to a Valsalva maneuver (VM) in a patient , the system comprising:a VM detector circuit configured to detect a VM session using a heart sound (HS) signal sensed from the patient;a physiologic response analyzer circuit configured to sense a physiologic signal during the detected VM session; anda physiologic event detector configured to detect a target physiologic event using the sensed physiologic signal during the detected VM session.2. The system of claim 1 , wherein the VM detector circuit is configured to recognize one or more VM phases using a HS metric based on one or more of first (S1) claim 1 , second (S2) claim 1 , third (S3) claim 1 , or fourth (S4) heard sound component from the sensed HS signal claim 1 , the VM phase including sequentially arranged first claim 1 , second claim 1 , third claim 1 , or fourth VM phases.3. The system of claim 2 , wherein the VM detector circuit is configured to detect one or more of:the first VM phase using an increase in S1 intensity and a decrease in S2 intensity, or an increase in S3 intensity or an increase in S4 intensity;the second VM phase using a decrease in S1 intensity and an increase in S2 intensity;the third VM phase using a decrease in S3 intensity or a decrease in S4 intensity; orthe fourth VM phase using an increase in S1 ...

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Номер записи: 33
18-02-2016 дата публикации

APPARATUS FOR TREATING PELVIC FLOOR DISORDERS AND RELATED METHODS OF USE

Номер: US20160045729A1
Автор: Jackson Timothy, ROHRER Mark, STUCKY Michael, Ternes David J.
Принадлежит: BOSTON SCIENTIFIC SCIMED, INC.

A method of optimizing the electrical stimulation of a bladder of a patient including selecting a first subset of electrodes from a set of electrodes positioned adjacent to a set of nerves associated with the bladder. The set of electrodes may include one or more electrodes, each of which may be configured to deliver electrical stimulation pulses generated by a stimulator device to the nerves. The method may further include delivering an electrical stimulation pulse through the selected first subset of electrodes and recording at least one parameter of the electrical stimulation pulse after receiving patient feedback. 1. A method of optimizing the electrical stimulation of a bladder of a patient , the method comprising:selecting a first subset of electrodes from a set of electrodes positioned adjacent to nerves associated with the bladder, the set of electrodes including one or more electrodes, wherein each electrode of the set of electrodes is configured to deliver electrical stimulation pulses generated by a stimulator device to the nerves;delivering at least one electrical stimulation pulse through the first subset of electrodes; andrecording at least one parameter associated with the at least one electrical stimulation pulse after receiving patient feedback.2. The method of claim 1 , wherein receiving patient feedback includes receiving patient feedback in response to a sensation associated with the at least one electrical stimulation pulse.3. The method of claim 1 , wherein recording the at least one parameter of the at least one electrical stimulation pulse includes recording an amplitude of the at least one electrical stimulation pulse.4. The method of claim 1 , further including increasing an amplitude of the at least one electrical stimulation pulse until receiving patient feedback based on patient tolerance.5. The method of claim 1 , further including:selecting a second subset of electrodes different from the first subset of electrodes;delivering at least ...

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Номер записи: 34
22-02-2018 дата публикации

METHOD AND APPARATUS FOR NEUROSTIMULATION WITH PREVENTION OF NEURAL ACCOMMODATION

Номер: US20180050207A1
Автор: Hamann Jason J., Hincapie Ordonez Juan Gabriel, Ruble Stephen B., Ternes David J.
Принадлежит:

A neurostimulation system delivers neurostimulation to a patient using one or more primary parameters and one or more secondary parameters. The one or more primary parameters are controlled for maintaining efficacy of the neurostimulation. 1. A system for delivering neurostimulation , comprising:a stimulation output circuit configured to deliver neurostimulation; anda control circuit configured to control the delivery of the neurostimulation using a plurality of stimulation parameters including one or more primary parameters each having a value selected for efficacy of the neurostimulation and one or more secondary parameters each having a value adjustable for preventing neural accommodation while maintaining the efficacy of the neurostimulation, the one or more primary parameters including a duty cycle being a ratio of an on-period to a sum of the on-period and an off-period, the on-period being a time period during which the neurostimulation is delivered, the off-period being a time period during which the neurostimulation is not delivered, the control circuit including a parameter adjuster configured to adjust the one or more secondary parameters without varying the duty cycle.2. The system of claim 1 , wherein the parameter adjuster is configured to adjust the on-period and the off-period without varying the duty cycle claim 1 , the on-period and the off-period each being a parameter of the one or more secondary parameters.3. The system of claim 1 , wherein the parameter adjuster is configured to adjust a duration of a duration of a ramp during which a stimulation intensity gradually increases from zero to its value specified for the on-period when the ramp ends at a beginning of the on-period or gradually decreases from its value specified for the on-period to zero the ramp starting at an end of the on-period claim 1 , the duration of the ramp being a parameter of the one or more secondary parameters.4. The system of claim 1 , wherein the parameter adjuster is ...

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Номер записи: 35
01-03-2018 дата публикации

Solutions For Early Diagnoses, Prevention And Treatment Of Endometriosis

Номер: US20180055563A1
Автор: CLARK Bryan Allen, HARRAH Timothy Paul, Ruble Stephen B., Shetake Jai, Ternes David J.
Принадлежит:

A system for treating abnormal muscle activity via energy application includes a catheter, an electrode assembly including a plurality of electrodes, a processor configured to receive signals associated with intrinsic tissue activity sensed by the plurality of electrodes, the processor determining a location of a target tissue to be treated based on the sensed intrinsic activity, and a stimulator configured to transmit energy to at least one of the plurality of electrode located at the target tissue. 115-. (canceled)16. A catheter system , comprising:an elongated catheter body extending between a proximal end and a distal end;an electrode assembly coupled to the distal end of the catheter body, the electrode assembly comprising a plurality of arms, each of the arms including a plurality of electrodes;a processor configured to receive signals associated with intrinsic tissue activity sensed by the plurality of electrodes, the processor determining a location of a target tissue to be treated based on the sensed intrinsic tissue activity; anda stimulator coupled to the plurality of electrodes to deliver energy to the target tissue.17. The system of claim 16 , wherein the electrode assembly is in the form of a basket structure sized and dimensioned to fit within the uterus to treat endometriosis.18. The system of claim 16 , further comprising:a display coupled to the processor configured to present real-time output of the electrodes.19. The system of claim 16 , further comprising:a delivery sheath extending between a proximal end and a distal end, wherein the catheter and electrode assembly are slidably received within the delivery sheath, the electrode assembly sized and configured to fit in the sheath in a collapsed configuration.20. The system of claim 16 , wherein the electrode assembly includes a shape memory material that biases the arms toward an expanded configuration.21. The system of claim 16 , wherein the stimulator provides energy to the electrodes ...

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Номер записи: 36
08-03-2018 дата публикации

SYSTEM TO DIAGNOSE AND MANAGE ORTHOSTATIC INTOLERANCE

Номер: US20180064350A1
Автор: An Qi, Brisben Amy Jean, Ternes David J., Thakur Pramodsingh Hirasingh
Принадлежит:

An apparatus includes a posture sensing circuit configured to detect a change in posture of a subject; a cardiac signal sensing circuit configured to generate a sensed cardiac signal, wherein the sensed cardiac signal includes heart rate information of the subject; a physiologic sensing circuit configured to generate a sensed physiologic signal, wherein the physiologic signal includes information related to blood pressure of the subject; a storage buffer; and a control circuit operatively coupled to the posture sensing circuit and the storage buffer. The control circuit is configured to initiate storage of the heart rate information and the information related to blood pressure in response to a detected change in posture of the subject. 1. An ambulatory medical device system , the system comprising:a posture sensing circuit configured to detect a change in posture of a subject;a cardiac signal sensing circuit configured to generate a sensed cardiac signal, wherein the sensed cardiac signal includes heart rate information of the subject;a physiologic sensing circuit configured to generate a sensed physiologic signal, wherein the physiologic signal includes information related to blood pressure of the subject;a storage buffer; anda control circuit operatively coupled to the posture sensing circuit and the storage buffer and configured to store the heart rate information and the information related to blood pressure in response to a detected change in posture of the subject.2. The system of claim 1 , wherein the control circuit is configured to determine claim 1 , using the stored heart rate and blood pressure information claim 1 , one of that blood pressure of the subject is less than a specified blood pressure threshold claim 1 , that a change in blood pressure of the subject is greater than a specified blood pressure change threshold claim 1 , or that the heart rate exceeds a heart rate change threshold without a change in blood pressure that exceeds a blood ...

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Номер записи: 37
08-03-2018 дата публикации

DISCRIMINATION OF APNEA TYPE BY MEDICAL DEVICE

Номер: US20180064390A1
Автор: Ruble Stephen B., Ternes David J., Thakur Pramodsingh Hirasingh
Принадлежит:

Disclosed herein, among other things, are methods and apparatus related to identification of apnea type. One aspect of the present subject matter provides a method for real-time apnea discrimination. The method includes sensing an impedance-based tidal volume signal to monitor a respiratory cycle of a patient, and detecting a reduction in tidal swing using the sensed impendence to detect an apnea event. When the apnea event is detected, a shape of the sensed signal is compared to a stored signal shape to determine whether the apnea event is primarily an obstructive sleep apnea (OSA) event or primarily a central sleep apnea (CSA) event, in various embodiments. 1. A system , comprising:a sensor configured to sense an impedance-based tidal volume signal to monitor a respiratory cycle of a patient; andan external system including a device configured to communicate with the sensor, the external system including a processor configured to detect a reduction in tidal swing using the sensed impendence to detect an apnea event and to determine whether the detected apnea event is primarily an obstructive sleep apnea (OSA) event or primarily a central sleep apnea (CSA) event.2. The system of claim 1 , wherein the external system is configured to compare a stored signal shape to the signal to determine whether the detected apnea event is primarily an OSA event or primarily a CSA event.3. The system of claim 2 , wherein the stored signal shape includes a normal tidal swing for the patient.4. The system of claim 2 , wherein the stored signal shape includes a stored prior OSA waveform template.5. The system of claim 2 , wherein the stored signal shape includes an ideal sine wave as a surrogate for a CSA waveform template.6. The system of claim 1 , wherein the device includes a diagnostic device.7. The system of claim 1 , wherein the device includes a stimulator.8. The system of claim 1 , wherein the device includes a wearable device.9. The system of claim 8 , wherein the wearable ...

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Номер записи: 38
07-03-2019 дата публикации

Methods and Apparatus for Adjusting Neurostimulation Intensity Using Evoked Responses

Номер: US20190070418A1
Автор: David J. Ternes, Jason J. Hamann, Juan Gabriel Hincapie Ordonez, Stephen B. RUBLE
Принадлежит: Cardiac Pacemakers Inc

A neurostimulation system provides for capture verification and stimulation intensity adjustment to ensure effectiveness of vagus nerve stimulation in modulating one or more target functions in a patient. In various embodiments, stimulation is applied to the vagus nerve, and evoked responses are detected to verify that the stimulation captures the vagus nerve and to adjust one or more stimulation parameters that control the stimulation intensity.

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Номер записи: 39
22-03-2018 дата публикации

SYSTEM, DEVICE AND METHOD FOR TREATMENT OF ENDOMETRIOSIS

Номер: US20180078407A1
Автор: CLARK Bryan Allen, HARRAH Timothy Paul, Ruble Stephen B., Shetake Jai, Ternes David J.
Принадлежит:

A system for preventing retrograde flow in the fallopian tubes including a closure device comprising an elongated body, a channel extending therethrough, and a valve coupled to a proximal end of the body and open to the channel, the valve configured to only allow fluid to flow proximally therethrough from the channel. The system also includes a grasping element to secure the closure device within the fallopian tube comprising a plurality of tines, the tines including sharpened ends configured to penetrate the wall of the fallopian tube. 115-. (canceled)16. A fallopian tube closure device , comprising:an elongated body extending from a proximal end to a distal end and including a channel extending therethrough; anda valve coupled to a proximal end of the body and open to the channel, the valve configured to only allow fluid to flow proximally therethrough from the channel.17. The device of claim 16 , wherein the valve is a slit valve.18. The device of claim 16 , further comprising:a tissue grasping element coupled to a distal end of the body.19. The device of claim 18 , wherein the grasping element comprises a plurality of tines claim 18 , the tines including sharpened ends configured to penetrate the wall of the fallopian tube.20. The device of claim 16 , further comprising:a snare element extending proximally from the body and configured to allow easy removal of the closure device.21. The device of claim 20 , wherein the snare element is configured as a cage extending about the length of the body.22. The device of claim 19 , wherein the grasping element is formed of Nitinol or another shape memory material.23. The device of claim 20 , wherein the elongated body is expandable from a low-profile insertion configuration to an expanded deployed configuration.24. The device of claim 16 , further comprising:a delivery sheath extending between a proximal end and a distal end, wherein the body is slidably received within the delivery sheath, the elongated body sized and ...

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Номер записи: 40
22-03-2018 дата публикации

Method and apparatus for pain management using heart sounds

Номер: US20180078768A1
Автор: Bryan Allen CLARK, David J. Ternes, David L. Perschbacher, James John Kleinedler, Jianwen GU, Pramodsingh Hirasingh Thakur
Принадлежит: Boston Scientific Neuromodulation Corp

An example of a pain management system may include a heart sound sensor, a heart sound sensing circuit, a heart sound detector, a parameter generator, and a pain analyzer. The heart sound sensor may be configured to sense a heart sound signal. The heart sound sensing circuit may be configured to process the heart sound signal. The heart sound detector may be configured to detect heart sounds using the processed heart sound signal. The parameter generator may be configured to generate parameter(s) using the detected heart sounds. The pain analyzer may be configured to analyze the parameter(s) for a quantitative indication of pain, and include a signal metric generator that may be configured to generate a signal metric using the one or more parameters and a pain score generator that may be configured to generate a pain score indicative of a degree of pain using the signal metric.

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Номер записи: 41
22-03-2018 дата публикации

EXTERNAL AUDIT OF IMPLANTABLE MEDICAL DEVICE

Номер: US20180078778A1
Автор: Ruble Stephen B., Ternes David J., Thakur Pramodsingh Hirasingh
Принадлежит:

Systems and methods for auditing an operation of an ambulatory medical device (AMD) are described. A system may include an auditor device and an analyzer circuit communicatively coupled to each other. The auditor device can sense from the patient, independently of and during the operation of the AMD, information about the operation of the AMD including sensed electrostimulation and a physiological signal in response to the electrostimulation. The analyzer unit may generate a device audit indicator indicating the functionality and performance of the AMD using the sensed physiological signal and the sensed AMD operation information. The system may output the device audit indicator to a user or a process, or to program device therapy for the AMD based on the device audit indicator. 1. A system for automatically auditing an operation of an ambulatory medical device (AMD) associated with a patient , the system comprising:an auditor device configured to sense from the patient, independently of and during the operation of the AMD, a physiological signal and information about AMD operation; and receive from the auditor device the sensed physiological signal and the sensed AMD operation information;', 'generate a device audit indicator indicating a performance of the AMD using the sensed physiological signal and the sensed AMD operation information; and', 'output the device audit indicator to a user or a process., 'an analyzer unit communicatively coupled to the auditor device, the analyzer unit configured to2. The system of claim 1 , further comprising the AMD communicatively coupled to the analyzer unit claim 1 , wherein:the AMD is configured to generate information about the operation of AMD; andthe analyzer unit is configured to receive the AMD operation information generated by the AMD, and generate the device audit indicator further using the AMD operation information generated by the AMD.3. The system of claim 2 , wherein the analyzer unit further includes a ...

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Номер записи: 42
23-03-2017 дата публикации

DOSED DELIVERY OF AUTONOMIC MODULATION THERAPY

Номер: US20170080238A1
Автор: Hamann Jason J., Hincapie Ordonez Juan Gabriel, Ruble Stephen B., Ternes David J.
Принадлежит:

An example of a method embodiment may include receiving a user programmable neural stimulation (NS) dose for an intermittent neural stimulation (INS) therapy, and delivering the INS therapy with the user programmable NS dose to an autonomic neural target of a patient. Delivering the INS therapy may include delivering NS bursts, and delivering the NS bursts may include delivering a number of NS pulses per cardiac cycle during a portion of the cardiac cycles and not delivering NS pulses during a remaining portion of the cardiac cycles. The method may further include sensing cardiac events within the cardiac cycles, and controlling delivery of the user programmable NS dose of INS therapy using the sensed cardiac events to time delivery of the number of NS pulses per cardiac cycle to provide the user programmable NS dose. The user programmable NS dose may determine the number of NS pulses per cardiac cycle. 1. A method , comprising:receiving a signal indicative of a user programmable neural stimulation dose;delivering a neural stimulation therapy to a target of a patient;controlling delivery of the neural stimulation therapy to provide the user programmable neural stimulation dose; anddisplaying a dose meter on a display to provide an indicator of a total charge delivered over a period of time, and the indicator of the total charge is for a current user programmable neural stimulation dose, or for a user proposed neural stimulation dose, or for both the current user programmable neural stimulation dose and the user proposed neural stimulation dose.2. The method of claim 1 , wherein the user programmable neural stimulation dose is delivered during a neural stimulation ON window of time claim 1 , and controlling delivery of the user programmable neural stimulation dose of intermittent neural stimulation (INS) therapy includes controlling the delivery of the total charge delivered over the period of time3. The method of claim 1 , wherein:the user programmable neural ...

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Номер записи: 43
29-03-2018 дата публикации

METHOD AND APPARATUS FOR PAIN MANAGEMENT USING OBJECTIVE PAIN MEASURE

Номер: US20180085055A1
Автор: Annoni Elizabeth M., CLARK Bryan Allen, Esteller Rosana, Gu Jianwen, Kleinedler James John, Perschbacher David L., Srivastava Kyle Harish, Ternes David J., Thakur Pramodsingh Hirasingh
Принадлежит:

An example of a system for managing pain may include a pain monitoring circuit, a pain relief device, and a control circuit. The pain monitoring circuit may include a parameter analyzer and a pain score generator. The parameter analyzer may be configured to receive and analyze at least two parameters selected from a physiological parameter indicative of a physiological function or state of a patient, a functional parameter indicative of a physical activity or state of the patient, or a patient parameter including subjective information provided by the patient. The pain score generator may be configured to compute a composite pain score using an outcome of the analysis. The composite pain score may indicate a degree of the pain. The pain relief device may be configured to deliver a pain-relief therapy. The control circuit may be configured to control the delivery of the pain-relief therapy using the composite pain score. 1. A system for managing pain of a patient , comprising: a parameter analyzer configured to receive and analyze at least two parameter of a physiological parameter indicative of a physiological function or state of the patient, a functional parameter indicative of a physical activity or state of the patient, and a patient parameter including subjective information provided by the patient; and', 'a pain score generator configured to compute a composite pain score using an outcome of the analysis, the composite pain score indicating a degree of the pain;, 'a pain monitoring circuit includinga pain relief device configured to deliver one or more pain-relief therapies; anda control circuit configured to control the delivery of the one or more pain-relief therapies using the composite pain score and therapy parameters.2. The system of claim 1 , wherein the parameter analyzer is configured to generate one or more weighting factors claim 1 , and is configured to produce a signal metric using the at least two parameters with the one or more weighting factors ...

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Номер записи: 44
29-03-2018 дата публикации

Systems and methods for closed-loop pain management

Номер: US20180085584A1
Автор: Bryan Allen CLARK, David J. Ternes, David L. Perschbacher, Elizabeth M. Annoni, James John Kleinedler, Jianwen GU, Pramodsingh Hirasingh Thakur
Принадлежит: Boston Scientific Neuromodulation Corp

Systems and methods for managing pain in patient are described. A system may include sensors configured to sense physiological or functional signals, and a pain analyzer to generate signal metrics from the physiological or functional signals. The pain analyzer also generates weight factors corresponding to the signal metrics. The weight factors may indicate the signal metrics reliability in representing an intensity of the pain. The pain analyzer generates a pain score using a plurality of signal metrics and a plurality of weight factors. The pain score may be output to a user or a process. The system may additionally include an electrostimulator to generate and deliver closed-loop pain therapy according to the pain score.

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Номер записи: 45
21-03-2019 дата публикации

SYSTEMS AND METHODS FOR HEART FAILURE MANAGEMENT

Номер: US20190083789A1
Автор: An Qi, Dufresne Michael James, Humphrey Jason, Siejko Krzysztof Z., Ternes David J., Thakur Pramodsingh Hirasingh, Yu Yinghong
Принадлежит:

Systems and methods for managing heart failure are described. The system receives physiological information including a first HS signal corresponding to paced ventricular contractions and a second HS signal corresponding to intrinsic ventricular contractions. The system detects worsening heart failure (WHF) using the received physiological information. A signal analyzer circuit can generate a paced HS metric from the first HS signal and a sensed HS metric from the second HS signal, and determine a concordance indicator between the paced and the sensed HS metrics. In response to the detected WHF, the system can use the concordance indicator to generate a therapy adjustment indicator for adjusting electrostimulation therapy, or a worsening cardiac contractility indicator indicating the detected WHF is attributed to degrading myocardial contractility. 1. A system , comprising:a receiver circuit configured to receive physiological information including a first heart sound (HS) signal corresponding to paced ventricular contractions and a second HS signal corresponding to intrinsic ventricular contractions; and generate (1) a paced HS metric from the first HS signal and (2) a sensed HS metric from the second HS signal, the paced HS metric indicating cardiac contractility in response to paced ventricular contractions, the sensed HS metric indicating cardiac contractility in response to intrinsic ventricular contractions; and', 'determine a worsening heart failure indicator based on the paced HS metric and the sensed HS metric., 'a heart failure detector and analyzer circuit configured to2. The system of claim 1 , comprising an output circuit configured to generate a worsening cardiac contractility indicator using a concordance between the paced and the sensed HS metrics.3. The system of claim 2 , wherein:the heart failure detector and analyzer circuit is configured to trend the paced HS metric and to trend the sensed HS metric over time, and to determine the concordance ...

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Номер записи: 46
19-03-2020 дата публикации

METHOD AND APPARATUS FOR DIRECTED PROPAGATION OF NEURAL STIMULATION

Номер: US20200086113A1
Автор: FRANKE Manfred, Gordon Jack, Hamann Jason J., Hincapie Ordonez Juan Gabriel, Mohsenian Kevin J., Ruble Stephen B., Ternes David J.
Принадлежит:

A neural stimulation system delivers neural stimulation to a target nerve with control of direction of propagation of evoked neural signals in one or more fiber types of the target nerve using electrode configuration, thereby providing effective therapy while minimizing unintended effects. In various embodiments, mechanical parameters of a multi-polar electrode are determined to provide directed propagation of the neural stimulation by effecting neural conduction block in or near the stimulation site. In various embodiments, the electrode includes a cathode for evoking action potentials and a plurality of anodes for blocking the propagation of the evoked action potentials in specified direction(s) and fiber type(s) while minimizing the formation of virtual cathodes. 1. A method for delivering stimulation pulses to a nerve using an electrode having multiple conductive contacts , the method comprising:directing an electrical current of the stimulation pulses to the electrode such that the multiple conductive contacts operate as at least a cathode, a first anode, and a second anode, the cathode positioned to allow the stimulation pulses to evoke action potentials in the nerve, the first anode positioned adjacent to the cathode, the second anode including an array of contacts of the multiple conductive contacts and positioned adjacent to the first anode such that the first anode is positioned between the cathode and the second anode.2. The method of claim 1 , further comprising using sizes of the first anode and the second anode to control a distribution of the electrical current in the first anode and the second anode.3. The method of claim 2 , further comprising determining the sizes of the first anode and the second anode to result in uni-directional blocking of propagation of the evoked action potentials in the nerve using the first anode and minimization of formation of a virtual cathode using the second anode.4. The method of claim 3 , wherein delivering the ...

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Номер записи: 47
29-04-2021 дата публикации

IMPLANTABLE DEVICES AND METHODS FOR CONTROL OF BACTERIAL INFECTIONS

Номер: US20210121683A1
Автор: Frankson Danielle, Maile Keith R., Stahmann Jeffrey E., Stolen Craig M., Ternes David J.
Принадлежит:

An implantable antibacterial barrier device for an elongated medical device, the elongated medical device configured to extend from a first site, through a second site, to a third site. The implantable antibacterial barrier device includes a housing configured to be disposed at the first site, a working electrode configured to be disposed at the second site, and a reference electrode configured to be disposed at the first site. The housing includes barrier circuitry. The working electrode electrically is coupled to the barrier circuitry. The reference electrode is electrically coupled to the barrier circuitry. The barrier circuitry is configured to selectively maintain the working electrode at a negative electrical potential relative to the reference electrode to form an antibacterial barrier. 1. An implantable antibacterial barrier device for an elongated medical device , the elongated medical device configured to extend from a first site , through a second site , to a third site , the implantable antibacterial barrier device comprising:a housing configured to be disposed at the first site, the housing comprising barrier circuitry;a working electrode configured to be disposed at the second site, the working electrode electrically coupled to the barrier circuitry; anda reference electrode configured to be disposed at the first site and spaced apart from the working electrode, the reference electrode electrically coupled to the barrier circuitry, the barrier circuitry configured to selectively maintain the working electrode at a negative electrical potential relative to the reference electrode to form an antibacterial barrier.2. The implantable antibacterial barrier device of claim 1 , wherein the first sited is a subcutaneous pocket.3. The implantable antibacterial barrier device of claim 1 , wherein the second site is adjacent to a vascular entry site and the elongated medical device extends through the vascular entry site and through a portion of a vascular system ...

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Номер записи: 48
26-04-2018 дата публикации

METHOD AND APPARATUS FOR PAIN CONTROL USING BAROREFLEX SENSITIVITY DURING POSTURE CHANGE

Номер: US20180110464A1
Автор: Annoni Elizabeth Mary, CLARK Bryan Allen, Gu Jianwen, Kleinedler James John, Perschbacher David L., Srivastava Kyle Harish, Ternes David J., Thakur Pramodsingh Hirasingh
Принадлежит:

An example of a system for providing a patient with pain management includes a pain monitoring circuit. The pain monitoring circuit may include parameter analyzer circuitry and pain score generator circuitry. The parameter analyzer circuitry may be configured to receive and analyze one or more timing parameters and one or more baroreflex parameters allowing for determination of baroreflex sensitivity (BRS) of the patient. The one or more timing parameters are indicative of time intervals during which values of the one or more baroreflex parameters are used to determine the BRS. The pain score generator circuitry may be configured to compute a pain score using an outcome of the analysis. The pain score is a function of the BRS during the time intervals and indicative of a degree of pain of the patient. 1. A system for providing a patient with pain management , the system comprising: parameter analyzer circuitry configured to receive and analyze one or more timing parameters and one or more baroreflex parameters allowing for determination of baroreflex sensitivity (BRS) of the patient, the one or more timing parameters indicative of time intervals during which values of the one or more baroreflex parameters are used to determine the BRS; and', 'pain score generator circuitry configured to compute a pain score using an outcome of the analysis, the pain score being a function of the BRS during the time intervals and indicative of a degree of pain of the patient., 'a pain monitoring circuit including2. The system of claim 1 , further comprising:a pain relief device configured to deliver one or more pain-relief therapies to the patient; anda control circuit configured to control the delivery of the one or more pain-relief therapies using the computed pain score.3. The system of claim 1 , wherein the parameter analyzer circuitry is further configured to generate a BRS signal metric using the one or more timing parameters and the one or more baroreflex parameters claim 1 , ...

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Номер записи: 49
07-05-2015 дата публикации

SYSTEMS AND METHODS FOR AVOIDING ASPIRATION DURING AUTONOMIC MODULATION THERAPY

Номер: US20150127061A1
Автор: Arcot-Krishnamurthy Shantha, Ternes David J.
Принадлежит:

Some embodiments provide a method comprising delivering neural stimulation for a neural stimulation therapy according to a programmed schedule, detecting a swallow event, and responding to the detected swallow event by overriding the programmed schedule. 1. A method , comprising:delivering neural stimulation for a neural stimulation therapy according to a programmed schedule;detecting a swallow event; andresponding to the detected swallow event by overriding the programmed schedule.2. The method of claim 1 , wherein delivering neural stimulation for the neural stimulation therapy includes delivering intermittent neural stimulation with programmed bursts of neural stimulation pulses claim 1 , wherein each programmed burst is a stimulation ON time separated from adjacent bursts in the programmed schedule by a stimulation OFF time.3. The method of claim 2 , wherein overriding the programmed schedule in response to the detected swallow event includes delaying a subsequent burst of neural stimulation pulses.4. The method of claim 2 , wherein detecting a swallow event includes detecting the swallow event during a programmed burst of neural stimulation pulses claim 2 , and overriding the programmed schedule in response to the detected swallow event includes delaying a neural stimulation pulse in the programmed burst.5. The method of claim 2 , wherein overriding the programmed schedule in response to the detected swallow event includes skipping a subsequent programmed burst of neural stimulation pulses if the swallow event occurs in a detect window of time within the stimulation OFF time.6. The method of claim 2 , wherein detecting a swallow event include detecting the swallow event during a programmed burst of neural stimulation pulses claim 2 , and overriding the programmed schedule in response to the detected swallow event includes interrupting the burst for an override time period claim 2 , and resuming the burst after the override time period.7. The method of claim 2 , ...

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Номер записи: 50
07-05-2015 дата публикации

REMOTE PACE DETECTION IN AN IMPLANTABLE MEDICAL DEVICE

Номер: US20150127067A1
Автор: Baker Kenneth L., Ternes David J.
Принадлежит:

A system embodiment for stimulating a neural target comprises a neural stimulator, a pace detector, and a controller. The neural stimulator is electrically connected to at least one electrode, and is configured to deliver a neural stimulation signal through the at least one electrode to stimulate the neural target. The pace detector is configured to use at least one electrode to sense cardiac activity and distinguish paced cardiac activity in the sensed cardiac activity from non-paced cardiac activity in the sensed cardiac activity. The controller is configured to control a programmed neural stimulation therapy using the neural stimulator and using detected paced cardiac activity as an input for the neural stimulation therapy. 1. (canceled)2. A method for operating an implanted neural stimulation device having a neural stimulator lead and remote sensing electrodes for sensing cardiac activity from a position remote from a heart , the method comprising:implementing a neural stimulation therapy stored in the implanted neural stimulation device including delivering the neural stimulation therapy through the neural stimulator lead, wherein the neural stimulation therapy includes a programmed duty cycle, the programmed duty cycle including a stimulation ON portion followed by a stimulation OFF portion; andmonitoring cardiac activity, including remotely detecting cardiac activity using the remote sensing electrodes to detect heart rate during implementation of the neural stimulation therapy.3. The method of claim 2 , wherein delivering the neural stimulation therapy includes delivering electrical stimulation to a vagus nerve.4. The method of claim 3 , wherein delivering electrical stimulation to a vagus nerve includes using a structure configured to be positioned around the vagus nerve to operably position stimulation electrodes for use to electrically stimulate the vagus nerve.5. The method of claim 2 , wherein monitoring cardiac activity includes averaging heart rate ...

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Номер записи: 51
27-05-2021 дата публикации

Methods and Apparatus for Adjusting Neurostimulation Intensity Using Evoked Responses

Номер: US20210154478A1
Автор: Hamann Jason J., Hincapie Ordonez Juan Gabriel, Ruble Stephen B., Ternes David J.
Принадлежит:

A neurostimulation system provides for capture verification and stimulation intensity adjustment to ensure effectiveness of vagus nerve stimulation in modulating one or more target functions in a patient. In various embodiments, stimulation is applied to the vagus nerve, and evoked responses are detected to verify that the stimulation captures the vagus nerve and to adjust one or more stimulation parameters that control the stimulation intensity. 1. A method of delivering neurostimulation to a patient , wherein the patient is implanted with an implantable medical device (IMD) comprising a plurality of electrodes , the method comprising:determining a first posture of the patient,using one or more of the plurality electrodes to deliver electrical stimulation to the patient's neural tissue,using one or more of the plurality of electrodes to sense a neural response evoked in the patient's tissue by the stimulation,adjusting the stimulation to maintain the neural response relative to a first threshold value for the first posture,determining a change from the first posture to a second posture, andadjusting the stimulation to maintain the neural response relative to a second threshold value for the second posture, wherein the first and second threshold values are different.2. The method of claim 1 , further comprising determining one or more characteristic parameters of the evoked neural responses.3. The method of claim 2 , wherein the one or more characteristic parameters comprises an amplitude of the evoked neural response.4. The method of claim 2 , wherein the one or more characteristic parameters comprises a frequency of the evoked neural response.5. The method of claim 2 , wherein the one or more characteristic parameters comprises a width of the evoked neural response.6. The method of claim 2 , wherein the first and second threshold values comprise threshold values for the one or more characteristic parameters of the evoked neural response.7. The method of claim 1 , ...

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Номер записи: 52
24-07-2014 дата публикации

NEURAL STIMULATION SYSTEMS, DEVICES AND METHODS

Номер: US20140207203A1
Автор: Kramer Andrew P., Libbus Imad, Stahmann Jeffrey E., Ternes David J.
Принадлежит: Cardiac Pacemakers, Inc.

Various system embodiments comprise circuitry to determine when an arrhythmia has terminated, and a neural stimulator adapted to temporarily deliver neural stimulation therapy to assist with recovering from the arrhythmia in response to termination of the arrhythmia. 1. (canceled)2. A method , comprising:chronically performing a prophylactic neural stimulation therapy;in response to a therapy trigger, temporarily delivering neural stimulation as part of an arrhythmia therapy, an apnea therapy, or a pain therapy; andupon completion of the arrhythmia therapy, the apnea therapy or the pain therapy, chronically performing the prophylactic neural stimulation therapy.3. The method of claim 2 , wherein the prophylactic neural stimulation therapy includes neural stimulation to discourage cardiac remodeling or ventricular tachyarrhythmias.4. The method of claim 2 , further comprising delivering pre-therapy neural stimulation claim 2 , wherein the pre-therapy neural stimulation is distinct from the prophylactic neural stimulation therapy.5. The method of claim 2 , further comprising delivering post-therapy neural stimulation claim 2 , wherein the post-therapy neural stimulation is distinct from the prophylactic neural stimulation therapy.6. The method of claim 5 , wherein neural stimulation is delivered as part of the arrhythmia therapy claim 5 , the method further comprising determining when an arrhythmia has terminated claim 5 , and responding to termination of the arrhythmia by initiating the post-therapy neural stimulation claim 5 , the post-therapy neural stimulation having a programmed duration.7. The method of claim 2 , wherein temporarily delivering neural stimulation includes temporarily delivering a multi-stage therapy.8. The method of claim 2 , wherein temporarily delivering neural stimulation includes delivering a programmed neural stimulation as a programmed response to the therapy trigger.9. The method of claim 2 , wherein the prophylactic neural stimulation ...

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Номер записи: 53
12-05-2016 дата публикации

METHODS AND APPARATUS FOR ADJUSTING NEUROSTIMULATION INTENSITY USING EVOKED RESPONSES

Номер: US20160129257A1
Автор: Hamann Jason J., Hincapie Ordonez Juan Gabriel, Ruble Stephen B., Ternes David J.
Принадлежит:

A neurostimulation system provides for capture verification and stimulation intensity adjustment to ensure effectiveness of vagus nerve stimulation in modulating one or more target functions in a patient. In various embodiments, stimulation is applied to the vagus nerve, and evoked responses are detected to verify that the stimulation captures the vagus nerve and to adjust one or more stimulation parameters that control the stimulation intensity.

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Номер записи: 54
10-05-2018 дата публикации

CONDUCTION PATHWAY DRIVEN MULTI-SITE PACING MANAGEMENT

Номер: US20180126173A1
Автор: Herrmann Keith L., Ternes David J., Veldman Britta Catherine
Принадлежит:

An apparatus comprises a stimulus circuit, a cardiac signal sensing circuit, and a control circuit. The cardiac signal sensing circuit senses a cardiac activity signal using a sensing channel. The stimulus circuit provides electrical pulse energy to a first pacing channel that includes a first left ventricular (LV) electrode and a second pacing channel that includes a second LV electrode. The control circuit initiates delivery of electrical pulse energy using the first and second pacing channels according to a first multi-site LV pacing mode; determines a cardiac event associated with a change in cardiac conduction path using a sensed cardiac activity signal; and changes to a second LV pacing mode in response to determining the cardiac event. The second LV pacing mode is different from the first multi-site LV pacing mode in one or more of a pacing site location and inter-electrode stimulus timing. 1. An apparatus for electrical coupling to a plurality of implantable electrodes , the apparatus comprising:a cardiac signal sensing circuit configured to sense a cardiac activity signal using a sensing channel that includes implantable electrodes of the plurality of electrodes;a stimulus circuit configured to provide electrical pulse energy using at least a first left ventricular (LV) pacing channel that includes a first LV electrode and a second LV pacing channel that includes a second LV electrode; and initiate delivery of electrical pulse energy using the first and second pacing channels according to a first multi-site LV pacing mode;', 'determine a cardiac event associated with a change in cardiac conduction path using a sensed cardiac activity signal; and', 'change to a second LV pacing mode in response to determining the cardiac event, wherein the second LV pacing mode is different from the first multi-site LV pacing mode in one or more of a pacing site location and inter-electrode stimulus timing., 'a control circuit operatively coupled to the stimulus circuit and ...

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Номер записи: 55
07-08-2014 дата публикации

REMOTE PACE DETECTION IN AN IMPLANTABLE MEDICAL DEVICE

Номер: US20140222115A1
Автор: Baker Kenneth L., Ternes David J.
Принадлежит: Cardiac Pacemakers, Inc.

A system embodiment for stimulating a neural target comprises a neural stimulator, a pace detector, and a controller. The neural stimulator is electrically connected to at least one electrode, and is configured to deliver a neural stimulation signal through the at least one electrode to stimulate the neural target. The pace detector is configured to use at least one electrode to sense cardiac activity and distinguish paced cardiac activity in the sensed cardiac activity from non-paced cardiac activity in the sensed cardiac activity. The controller is configured to control a programmed neural stimulation therapy using the neural stimulator and using detected paced cardiac activity as an input for the neural stimulation therapy. 1. (canceled)2. A system , comprising:an implantable stimulator configured to generate and deliver stimulation;a sensor configured to receive information in a cardiac pacing signal, the cardiac pacing signal being a signal configured to capture myocardial tissue; anda controller operably connected to the stimulator and the sensor, the controller configured to control the stimulator to provide a stimulation therapy, and to control the stimulation therapy using the received information from the cardiac pacing signal.3. The system of claim 2 , wherein the sensor is configured to sense a pulse width of the cardiac pacing signal to receive information from the cardiac pacing signal.4. The system of claim 2 , wherein the received information indicates where the cardiac pacing signal originates.5. The system of claim 4 , wherein the information includes identifying information for a heart chamber being paced by the cardiac pacing signal.6. The system of claim 2 , wherein the implantable stimulator includes an implantable neural stimulator claim 2 , and wherein the controller is configured to control the implantable neural stimulator to provide a neural stimulation therapy.7. The system of claim 2 , further comprising an ECG sensor or a heart sound ...

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Номер записи: 56
28-05-2015 дата публикации

SYSTEMS AND METHODS FOR MONITORING NEUROSTIMULATION DOSING

Номер: US20150148867A1
Автор: Birkholz Doug M., Brandner Douglas J., Gifford Douglas J., Linder William J., Ternes David J.
Принадлежит:

Various implantable device embodiments may comprise a neural stimulator configured to deliver a neurostimulation therapy with stimulation ON times and stimulation OFF times where a dose of the neurostimulation therapy is provided by a number of neurostimulation pulses over a period of time. The neural stimulator may be configured to monitor the dose of the delivered neurostimulation therapy against dosing parameters. The neural stimulator may be configured to declare a fault if the monitored dose does not favorably compare to a desired dose for the neurostimulation therapy, or may be configured to record data for the monitored dose of the delivered neurostimulation therapy, or may be configured to both record data fir the monitored dose of the delivered neurostimulation therapy and declare a fault if the monitored dose does riot favorably compare to a desired dose for the neurostimulation therapy. 1. (canceled)2. An implantable medical device , comprising:a neural stimulator configured to deliver a neurostimulation therapy with a neural stimulation pulse frequency, wherein a dose of the neurostimulation therapy is provided by a number of neurostimulation pulses over a period of time, wherein the neural stimulator includes a clock with an oscillator, a hardware state machine operationally connected to the clock to provide pulse timing control signals, and pulse circuitry configured to receive the timing control signals and deliver neurostimulation pulses with a pulse frequency controlled using the timing control signals, the pulse circuitry including a frequency output limiter configured to avoid excessive charge delivery.3. The device of claim 2 , wherein the output limiter is configured to bloc purse from being issued for a period of time after a preceding pulse.4. The device of claim 2 , wherein the output limiter includes a programmable frequency output limiter configured to block a pulse from being issued for a programmable period of time after a preceding pulse ...

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Номер записи: 57
14-08-2014 дата публикации

PATIENT CONTROL OF THERAPY SUSPENSION

Номер: US20140228912A1
Автор: Carbunaru Rafael, Hamann Jason J., Peterson Les N., Ruble Stephen B., Seim Gary T., Ternes David J., Vanderlinde Scott
Принадлежит: Cardiac Pacemakers, Inc.

An example of a method performed by an implantable medical device (IMD) to deliver a therapy to a patient may include delivering the therapy to the patient, detecting a trigger that is controlled by the patient or a caregiver to the patient, and determining if at least one feature of the IMD for responding to a trigger is enabled. The IMD may be configured to allow the patient or the caregiver to the patient to enable the at least one feature. The method may further include, when the at least one feature is enabled, automatically implementing the at least one enabled feature in response to the detected trigger, including automatically suspending the therapy in response to the detected trigger and automatically restoring the therapy after a defined period after the detected trigger. 1. A method performed by an implantable medical device (IMD) to deliver a therapy to a patient , the method comprising:enabling at least one feature of the IMD for responding to a trigger, wherein enabling includes enabling under control of a patient or a caregiver to the patient;delivering the therapy to the patient;detecting a trigger that is controlled by the patient or the caregiver to the patient; andautomatically implementing the at least one enabled feature in response to the detected trigger, including automatically interrupting the therapy in response to the detected trigger and automatically restoring the therapy after a defined period after the detected trigger.2. The method of claim 1 , wherein delivering the therapy includes delivering vagal nerve stimulation.3. The method of claim 1 , wherein delivering the therapy includes delivering neural stimulation for a cardiovascular therapy.4. The method of claim 1 , wherein automatically interrupting the therapy includes automatically stopping the therapy in response to the detected trigger or automatically adjusting an intensity of the therapy in response to the detected trigger.5. The method of claim 1 , wherein detecting a ...

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Номер записи: 58
11-06-2015 дата публикации

METHOD AND APPARATUS FOR THERAPY ADJUSTMENT IN RESPONSE TO INDUCED CARDIAC CONDUCTION CHANGES

Номер: US20150157863A1
Автор: Ruble Stephen B., Stahmann Jeffrey E., Ternes David J.
Принадлежит:

An implantable system delivers a plurality of electrical stimulation therapies to a patient and controls the delivery such that a physiologic change induced by at least one of the therapies is detected and used to adjust one or more of the therapies. In various embodiments, the implantable system delivers a cardiac rhythm management (CRM) therapy such as a pacing therapy and a neural stimulation (NS) therapy such as an autonomic modulation therapy (AMT). In various embodiments, the physiologic change includes a change in a cardiac conduction interval that may be detected within a detection window following delivery of the pacing or NS therapy.

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Номер записи: 59
11-06-2015 дата публикации

DOSED DELIVERY OF AUTONOMIC MODULATION THERAPY

Номер: US20150157867A1
Автор: Hamann Jason J., Hincapie Ordonez Juan Gabriel, Ruble Stephen B., Ternes David J.
Принадлежит:

An example of a method embodiment may include receiving a user programmable neural stimulation (NS) dose for an intermittent neural stimulation (INS) therapy, and delivering the INS therapy with the user programmable NS dose to an autonomic neural target of a patient. Delivering the INS therapy may include delivering NS bursts, and delivering the NS bursts may include delivering a number of NS pulses per cardiac cycle during a portion of the cardiac cycles and not delivering NS pulses during a remaining portion of the cardiac cycles. The method may further include sensing cardiac events within the cardiac cycles, and controlling delivery of the user programmable NS dose of INS therapy using the sensed cardiac events to time delivery of the number of NS pulses per cardiac cycle to provide the user programmable NS dose. The user programmable NS dose may determine the number of NS pulses per cardiac cycle.

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Номер записи: 60
11-06-2015 дата публикации

INTUITED DELIVERY OF AUTONOMIC MODULATION THERAPY

Номер: US20150157868A1
Автор: FRANKE Manfred, Hamann Jason J., Hincapie Ordonez Juan Gabriel, Ruble Stephen B., Ternes David J.
Принадлежит:

An example of a method embodiment may deliver intermittent neural stimulation (INS) therapy to an autonomic neural target of a patient. The INS therapy includes neural stimulation (NS) ON times alternating with NS OFF times, and includes at least one NS burst of NS pulses during each of the NS ON times. For a given NS OFF time and subsequent NS ON time, delivering INS therapy may include monitoring a plurality of cardiac cycles during the NS OFF time, using the monitored plurality of cardiac cycles to predict cardiac event timing during the subsequent NS ON time, and controlling delivery of the INS therapy using the predicted cardiac event timing to time NS burst delivery of at least one NS burst for the subsequent NS ON time based on the predicted cardiac event timing.

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Номер записи: 61
21-08-2014 дата публикации

METHOD AND SYSTEM FOR INDICATING NEUROSTIMULATION DELIVERY

Номер: US20140236261A1
Автор: Ahmed Rezwan, Kalgren James, Kelly Jonathan H., Sahasrabudhe Rajeev Madhukar, Ternes David J., Vanderlinde Scott, Wika Kevin G.
Принадлежит: Cardiac Pacemakers, Inc.

A method and system for providing an indication of delivery of a neural stimulation therapy is disclosed. In an example, a method may include identifying current timing of an intermittent neural stimulation (INS) programmed in an implantable medical device (IMD) where the programmed INS includes alternating stimulation ON and stimulation OFF times and a timing for delivering stimulation bursts of a plurality of stimulation pulses during the stimulation burst ON times. An indication of the current timing of the INS may be provided using an INS indicator of an external device. 1. A system , comprising: alternating stimulation ON and stimulation OFF times; and', 'timing for delivering stimulation bursts of a plurality of stimulation pulses during the stimulation burst ON times;, 'an implantable medical device (IMD) configured to deliver programmed intermittent neural stimulation (INS) to a vagus nerve, wherein the programmed INS includingan external device configured to identify current timing of the INS delivered by the IMD, the external device including an INS indicator configured to provide a user-perceptible indication of the current timing of the INS.2. The system of claim 1 , wherein to identify the current timing the external device is configured to determine whether the programmed INS is currently in a stimulation ON time or determine whether the programmed INS is currently in a stimulation OFF time claim 1 , and wherein the INS indicator is configured to indicate whether the programmed INS is currently in a stimulation ON time or indicate whether the programmed INS is currently in a stimulation OFF time.3. The system of claim 1 , wherein to identify the current timing the external device is configured to determine when the programmed INS transitions between the stimulation ON and stimulation OFF times claim 1 , and wherein the INS indicator is configured to indicate when the programmed INS transitions between the stimulation ON and stimulation OFF times.4. The ...

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Номер записи: 62
07-06-2018 дата публикации

METHODS AND APPARATUS FOR MONITORING EPILEPSY

Номер: US20180153460A1
Автор: An Qi, Brisben Amy Jean, Maile Keith R., Ruble Stephen B., Ternes David J., Thakur Pramodsingh Hirasingh
Принадлежит:

This document discusses, among other things, systems and methods for monitoring a patient at risk of epilepsy. A system comprises a sensor circuit that senses from the patient at least first and second physiological or functional signals. A wellness detector circuit can detect an epileptic event using the sensed physiological or functional signals, or additionally classify the epileptic event into one of epileptic seizure types. The system can generate a wellness indicator based on a trend of the physiological or functional signal during the detected epileptic event. The wellness indicator indicates an impact of the detected epileptic event on the health status of the patient. The system includes an output unit configured to output the detection of the epileptic event or the wellness indicator to a user or a process. 1. A system for monitoring a patient at risk of epilepsy , the system comprising:a sensor circuit, coupled to a first sensor to sense from the patient a first physiological or functional signal and a second sensor to sense from the patient a different second physiological or functional signal; detect an epileptic event using the sensed first and second physiological or functional signals; and', 'generate a wellness indicator based on a trend of the first or second physiological or functional signal over time during the detected epileptic event, the wellness indicator indicating an impact of the detected epileptic event on the health status of the patient; and, 'a wellness detector circuit communicatively coupled to the sensor circuit, the wellness detector circuit configured toan output unit configured to output the detection of the epileptic event or the wellness indicator to a user or a process.2. The system of claim 1 , comprising a memory configured to store the sensed first and second physiological or functional signals in response to the detection of the epileptic event.3. The method of claim 1 , wherein the wellness indicator includes one or more ...

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Номер записи: 63
07-06-2018 дата публикации

METHODS AND SYSTEMS FOR SELECTING STIMULATION PARAMETERS FOR ELECTRICAL STIMULATION DEVICES

Номер: US20180154156A1
Автор: Blum David, CLARK Bryan Allen, Govea Michael X., Ruble Stephen B., Stoffregen William Conrad, Stolen Craig M., Ternes David J., Thakur Pramodsingh Hirasingh
Принадлежит:

Methods and systems for selecting electrical stimulation parameters for an electrical stimulation device implanted in a patient can use an iterative process for identifying electrodes for stimulation, as well as suitable stimulation parameters. The process begins with an initial set of electrode combinations to identify regions of the nerve or other tissue for stimulation. This leads to selection of other electrode combinations to test, followed by the selection of multiple electrode groups (which can include three or more electrodes) for stimulation. 1. A method of selecting electrical stimulation parameters for an electrical stimulation device implanted in a patient , the electrical stimulation device comprising an electrical stimulation lead comprising a plurality of electrodes , the method comprising:for each of a plurality of first electrode combinations, receiving at least one value indicative of electrical stimulation using the first electrode combination, wherein each of the first electrode combinations comprises at least two electrodes of the electrical stimulation lead;based on the received values indicative of electrode stimulation using the first electrode combinations, selecting one or more of the first electrode combinations;selecting a plurality of second electrode combinations including the selected one or more of the first electrode combinations and one or more additional electrode combinations, wherein at least one of the additional electrode combinations includes at least one electrode from the selected one or more of the first electrode combinations, wherein each of the second electrode combinations comprises at least two electrodes of the electrical stimulation lead;for each of the plurality of second electrode combinations, receiving at least one value indicative of electrical stimulation using the second electrode combination;based on the received values indicative of electrode stimulation using the second electrode combinations, selecting one ...

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Номер записи: 64
25-06-2015 дата публикации

SYSTEM AND METHOD FOR LOCATING NEURAL TISSUE

Номер: US20150173636A1
Автор: Cao Hong, Mokelke Eric A., Shuros Allan Charles, Ternes David J.
Принадлежит:

An example of a system comprises a patch of electrodes for placement on tissue containing neural tissue, and a tissue tester configured to measure an electrical characteristic of tissue. The tissue tester may include a test controller and switches. The test controller and the switches may be configured to connect different combinations of the electrodes to create subsets of two or more electrodes to measure the electrical characteristic of tissue using the subsets. The test controller may be configured to measure an electrical characteristic of tissue using the subsets within the set of electrodes placed on the tissue, and compare measurements of the electrical characteristic and identify a neural target for a therapy based on the comparison of the measurements of the electrical characteristic for tissue at the neural target relative to adjacent non-neural tissue. 1. A method for identifying a neural target , comprising:placing a set of electrodes on tissue containing neural tissue, the set of electrodes including subsets of two or more electrodes;measuring an electrical characteristic of tissue using the subsets within the set of electrodes placed on the tissue, the electrical characteristic of tissue quantifying an ability of the tissue to oppose or to conduct an electric current or an ability of the tissue to transmit an electric field; andcomparing measurements and identifying a subset of electrodes that that provides a more desirable measurement of the electrical characteristic than other subsets of electrodes to identify the neural target, wherein the more desirable measurement is a measurement that has a lower ability to oppose the electric current, or a higher ability to conduct the electric current, or a higher ability to transmit an electric field.2. The method of claim 1 , wherein identifying the subset of electrodes that has a more desirable measurement of the electrical characteristic includes identifying the subset of electrodes that has the lowest ...

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Номер записи: 65
11-09-2014 дата публикации

HYPERTENSION THERAPY DEVICE WITH LONGEVITY MANAGEMENT

Номер: US20140257425A1
Автор: Arcot-Krishnamurthy Shantha, Mokelke Eric A., Ternes David J.
Принадлежит: Cardiac Pacemakers, Inc.

System and methods for programming and delivering electrical stimulation to treat hypertension are discussed. In various embodiments, an ambulatory stimulator system, such as an implantable medical device, can receive a power-saving command and deliver the electrical stimulation to a target site in a patient according to one or more simulation parameters including a therapy on-off pattern. In some embodiments, stimulation with therapy on-off pattern can reduce the power consumption while maintaining the anti-hypertension therapy efficacy. In some embodiments, the ambulatory stimulator system can include one or more of a physiologic response detector, a patient status detector, or a battery longevity detector. The power-saving command can be generated using one or more of the detected physiologic signal, the patient status, or the information about the battery longevity.

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Номер записи: 66
11-09-2014 дата публикации

METHOD AND APPARATUS FOR CONTROLLING BLOOD PRESSURE USING RESPIRATION-MEDIATED HEART RATE VARIATION

Номер: US20140257426A1
Автор: Arcot-Krishnamurthy Shantha, Mokelke Eric A., Ternes David J.
Принадлежит: Cardiac Pacemakers, Inc.

System and methods for programming and delivering electrical stimulation to treat hypertension are described. In various embodiments, an ambulatory stimulator system, such as an implantable medical device, can detect a respiration-mediated heart rate variation (RM-HRV), monitor the efficacy of hypertension therapy and adjust the stimulation parameters using the detected RM-HRV to achieve desired therapy outcome. In some embodiments, the system can be configured to synchronize the detected heart rates to one or more respiration cycles or respiration phases within the respiration cycles, and determine the RM-HRV using the heart rates synchronized with the respiration cycles or the respiration phases. The RM-HRV may be presented to the system operator to monitor the efficacy of the AHT therapy. The ambulatory stimulator system can adjust the stimulation parameters using at least the RM-HRV.

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Номер записи: 67
09-07-2015 дата публикации

IMPLANTABLE MEDICAL DEVICE WITH CONTROL OF NEURAL STIMULATION BASED ON BATTERY STATUS

Номер: US20150190641A1
Автор: Hamann Jason J., Ternes David J., Vanderlinde Scott
Принадлежит:

An implantable medical device is powered by a battery to deliver one or more therapies including at least one non-life-sustaining therapy such as neural stimulation for enhancing quality of life of a patient. When the battery approaches its end of life, the implantable medical device reduces power consumption of the neural stimulation (e.g., intensity of the neural stimulation) for extending the remaining battery life while maintaining a certain amount of therapeutic benefits for the patient. In one embodiment, the intensity of the neural stimulation is reduced in a tiered manner. In one embodiment in which the implantable medical device also delivers at least one life-sustaining cardiac stimulation therapy, the neural stimulation is disabled or adjusted to reduce its power consumption (e.g., intensity) while the intensity of the cardiac stimulation therapy is maintained when the battery is near its end of life. 1. (canceled)2. An implantable medical device , comprising:a battery;a battery monitoring circuit coupled to the battery, the battery monitoring circuit configured to measure a battery parameter indicative of an energy level of the battery;a neural stimulation circuit configured to deliver neural stimulation for modulating neural activities;a cardiac stimulation circuit configured to deliver cardiac stimulation including one or more of cardiac pacing or defibrillation; and set a current power mode of the implantable medical device to a reduced-power operation mode of a plurality of power modes in response to the battery parameter indicating that the energy level of the battery has fallen below an energy level threshold; and', 'reduce a power consumption required for delivering the neural stimulation without reducing a power consumption required for delivering the cardiac stimulation during the reduced-power operation mode., 'a control circuit coupled to the battery monitoring circuit, the neural stimulation circuit, and the cardiac stimulation circuit, the ...

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Номер записи: 68
18-09-2014 дата публикации

ELECTRICAL ENERGY DELIVERY TISSUE SITE VALIDATION

Номер: US20140277230A1
Автор: Ternes David J.
Принадлежит: Cardiac Pacemakers, Inc.

Electrical energy delivery tissue site validation systems and methods can determine an indication of a tissue type at a tissue site. This information can be used to enable or inhibit electrical energy delivery to the tissue site. The tissue type at the tissue site can be determined such as by delivering a test electrical energy and sensing a responsive electrical energy. An electrical connectivity to the tissue site can also be determined, such as by using a sensed intrinsic electrical signal at the tissue site. Tissue type information may be communicated externally, such as to allow user confirmation or override of the determined indication of tissue type at the tissue site, such as by a physician, user, or other operator. 1. (canceled)2. A system comprising:an electrical energy delivery circuit configured to deliver neurostimulation energy;a signal sensing circuit configured to sense a physiologic characteristic of at least one tissue site;a validation module, coupled to the electrical energy delivery circuit and the signal sensing circuit, configured to determine an indication of a cardiac tissue type at the at least one tissue site using the sensed physiologic characteristic; anda control circuit configured to inhibit the electrical energy delivery circuit from delivering the neurostimulation energy at least in response to the indication of the cardiac tissue type.3. The system claim 2 , wherein the signal sensing circuit is configured to sense a tissue impedance.4. The system of claim 2 , comprising one or more leads configured to couple the electrical energy delivery circuit and the signal sensing circuit to the at least one tissue site via at least one electrode incorporated onto the one or more leads.5. The system of claim 2 , wherein the validation module is further configured to determine an indication of a neural tissue type claim 2 , and the control circuit is configured to enable the electrical energy delivery circuit to deliver the neurostimulation ...

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Номер записи: 69
05-07-2018 дата публикации

SYSTEMS AND METHODS FOR INCREASING STIMULATION DOSE

Номер: US20180185659A1
Автор: Hahn Stephen J., Hamann Jason J., Ternes David J.
Принадлежит:

According to an embodiment of a method performed by an implantable medical device to deliver a neural stimulation therapy to a patient, a lower dose of the neural stimulation therapy is delivered to the patient. The dose of the neural stimulation therapy is automatically increased from the lower dose to a higher dose, and the higher dose of the neural stimulation therapy is delivered to the patient. A trigger that is controlled by the patient is detected, and the dose of the neural stimulation therapy is automatically returned from the higher dose back to the lower dose in response to detecting the trigger. 1. (canceled)2. An implantable neural stimulator for implantation in a patient , comprising:controller circuitry; a memory with instructions operable on by the controller circuitry, wherein the instructions include: instructions for delivering neural stimulation using the neural stimulation output circuitry; and instructions for implementing a titration routine to automatically progress through a plurality of neurostimulation levels wherein the plurality of neurostimulation levels correspond to a plurality of neurostimulation parameter sets; and', 'wherein the neural stimulator is configured to detect a specific condition, and the neural stimulator is configured to allow the titration routine, implemented by the controller circuitry operating on the instructions in the memory, to progress to a subsequent level in the plurality of neurostimulation levels only after the specific condition is detected., 'neural stimulation output circuitry configured to deliver neural stimulation;'}3. The implantable neural stimulator of claim 2 , wherein the instructions for implementing the titration routine includes instructions for changing a neural stimulation dose.4. The implantable neural stimulator of claim 2 , wherein the instructions for changing the dose of neural stimulation includes instructions for changing a number of times the neural stimulation is delivered over a ...

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Номер записи: 70
11-06-2020 дата публикации

HIS-BUNDLE PACING FOR RATE REGULARIZATION

Номер: US20200179692A1
Автор: Herrmann Keith L., Mahajan Deepa, Ternes David J.
Принадлежит:

Systems and methods for pacing cardiac conductive tissue are described. An exemplary system includes an electrostimulation circuit that may generate HBP pulses to stimulate patient physiologic conduction pathway, such as a His bundle or a bundle branch. The system includes an arrhythmia detector to detect an atrial tachyarrhythmia (AT) with intermittent ventricular conduction. A control circuit may sense ventricular activation and, in response to the detected AT indication, determine or update a His-bundle pacing (HBP) configuration. The HBP may be recursively updated on a beat-by-beat basis using the sensed ventricular activation. The electrostimulation circuit may deliver HBP according to the determined or adjusted HBP configuration to regularize ventricular rate during AT. 1. A medical-device system , comprising:an arrhythmia detector configured to detect an atrial tachyarrhythmia (AT) indication with intermittent ventricular conduction in a patient; and receive information of ventricular activation;', 'in response to a detected AT indication, determine a His-bundle pacing (HBP) configuration using the received information of ventricular activation; and', 'control an electrostimulation circuit configured to generate HBP pulses, and provide a control signal to deliver the generated HBP pulses to stimulate a physiologic conduction pathway of a heart of the patient in accordance with the determined HBP configuration to regularize ventricular activation rate., 'a control circuit configured to2. The system of claim 1 , including the electrostimulation circuit claim 1 , wherein:the control circuit is configured to detect ventricular beats from the received information of ventricular activation, and in response to the detected AT indication, update the HBP configuration on a beat-by-beat basis using the detected ventricular beats; andthe electrostimulation circuit is configured to stimulate the physiologic conduction pathway in accordance with the updated HBP ...

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Номер записи: 71
11-06-2020 дата публикации

ATRIOVENTRICULAR CONDUCTION GUIDED HIS-BUNDLE PACING

Номер: US20200179705A1
Автор: Mahajan Deepa, Ternes David J.
Принадлежит:

Systems and methods for dynamically controlling HBP delivery based on patient AV conduction status are disclosed. An exemplary medical system includes an electrostimulation circuit to generate HBP pulses to stimulate a His bundle or a bundle branch of the heart. An AV conduction monitor circuit continuously or periodically assesses AV conduction status, and detects an indication of presence or absence of AV conduction abnormality. If an AV conduction abnormality is indicated, a control circuit may control the electrostimulation circuit to deliver the HBP pulses. Ventricular backup pacing may be delivered if HBP fails to capture and elicit ventricular activation. When the AV conduction become normal, the control circuit may withhold HBP delivery and promote patient intrinsic ventricular activation. 1. A medical-device system , comprising:an atrioventricular (AV) conduction monitor circuit configured to detect an indication of a presence or absence of AV conduction abnormality of a heart of a subject; and in response to a detected indication of presence of AV conduction abnormality of the heart, deliver HBP pulses to stimulate a physiologic conduction pathway of the heart; and', 'in response to a detected indication of absence of AV conduction abnormality of the heart, withhold delivery of HBP pulses., 'a control circuit configured to control an electrostimulation circuit configured to generate His-bundle pacing (HBP) pulses, and to provide a control signal to2. The system of claim 1 , including the electrostimulation circuit claim 1 , wherein claim 1 , in response to the detected indication of absence of AV conduction abnormality:the control circuit is configured to sense an intrinsic ventricular activation during a first atrioventricular delay (AVD) that begins at the atrial sensed event or the atrial paced event; andthe electrostimulation circuit is configured to deliver ventricular demand pacing (VDP) at expiration of the first AVD if no intrinsic ventricular ...

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Номер записи: 72
23-07-2015 дата публикации

METHOD AND APPARATUS FOR DIRECTED PROPAGATION OF NEURAL STIMULATION

Номер: US20150202433A1
Автор: FRANKE Manfred, Gordon Jack, Hamann Jason J., Hincapie Ordonez Juan Gabriel, Mohsenian Kevin J., Ruble Stephen B., Ternes David J.
Принадлежит:

A neural stimulation system delivers neural stimulation to a target nerve with control of direction of propagation of evoked neural signals in one or more fiber types of the target nerve using electrode configuration, thereby providing effective therapy while minimizing unintended effects. In various embodiments, mechanical parameters of a multi-polar electrode are determined to provide directed propagation of the neural stimulation by effecting neural conduction block in or near the stimulation site. In various embodiments, the electrode includes a cathode for evoking action potentials and a plurality of anodes for blocking the propagation of the evoked action potentials in specified direction(s) and fiber type(s) while minimizing the formation of virtual cathodes. 1. A system for delivering stimulation to a nerve at a stimulation site , comprising: a substrate;', 'a cathode formed on the cuff substrate, the cathode configured to allow the electrical stimulation pulses to evoke action potentials;', 'a plurality of anodes formed on the cuff substrate, the plurality of anodes shaped, sized, and arranged to effect neural conduction block without forming a virtual cathode, the neural conduction block including blocking of propagation of the evoked action potentials from the cathode in one or more fiber types of the nerve., 'an electrode configured to deliver electrical stimulation pulses to the nerve at the stimulation site, the electrode including2. The system of claim 1 , wherein the electrode comprises a nerve cuff electrode claim 1 , the substrate comprises a cuff substrate including a self-curling sheet configured to be wrapped around a portion of the nerve at the stimulation site claim 1 , the cathode and the plurality of anodes comprise one or more ring electrodes each configured to encircle the nerve claim 1 , and the plurality of anodes are shaped claim 1 , sized claim 1 , and arranged to effect the neural conduction block substantially within the portion of ...

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Номер записи: 73
23-07-2015 дата публикации

SYSTEMS AND METHODS FOR DELIVERING PULMONARY THERAPY

Номер: US20150202437A1
Автор: CLARK Bryan Allen, Flanagan Aiden, FRANKE Manfred, Hincapie Ordonez Juan Gabriel, Ternes David J.
Принадлежит:

An example of a system may include an electrode and a pulse generation system. The electrode may be configured to be implanted near a neural target that innervates airways. The pulse generation system may be configured to be operably connected to the electrode to deliver depletion block stimulation through the electrode to alleviate symptoms of pulmonary disease. The pulse generation system and the electrode may be configured to cooperate to capture axons in the neural target. The depletion block stimulation may include a series of pulses at a depletion pulse frequency. 1. A system , comprising:an electrode configured to be implanted near a neural target that innervates airways; anda pulse generation system configured to be operably connected to the electrode to deliver depletion block stimulation through the electrode to alleviate symptoms of pulmonary disease, the pulse generation system and the electrode configured to cooperate to capture axons in the neural target, the depletion block stimulation including a series of pulses at a depletion pulse frequency within a range between about 100 Hz to about 1 kHz.2. The system of claim 1 , further comprising an electrode device claim 1 , the electrode device including the electrode and configured to be implanted in an airway operably proximate to the neural target.3. The system of claim 2 , wherein the pulse generation system includes a pulse generator claim 2 , a controller and a power supply configured to cooperate to deliver the depletion block stimulation through the electrode claim 2 , the electrode device including the pulse generator claim 2 , the controller and the power supply.4. The system of claim 1 , wherein the electrode device includes an expandable structure configured to be expanded within the airway to contact an interior surface of the airway structure claim 1 , the expandable structure including a pacing surface claim 1 , the pacing surface including:a smooth surface configured to abut against an ...

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Номер записи: 74
23-07-2015 дата публикации

DEPLETION BLOCK TO BLOCK NERVE COMMUNICATION

Номер: US20150202441A1
Автор: FRANKE Manfred, Hamann Jason J., Hincapie Ordonez Juan Gabriel, Ruble Stephen B., Sharma Arjun D., Ternes David J.
Принадлежит:

An example of a system may include a depletion block neural stimulator and a depletion block controller. The depletion block neural stimulator may be configured to deliver a depletion block stimulation to a nerve. The depletion block stimulation may include a series of pulses at a pulse frequency within a range between about 100 Hz to about 1000 Hz. The depletion block controller may be configured to communicate with the depletion block neural stimulator and control the depletion block stimulation. The depletion block controller may be configured to receive a start depletion block signal and respond to the received start depletion block signal by initiating the delivery of the depletion block stimulation to the nerve, and the depletion block controller may be configured to receive a stop depletion block signal and respond to the received stop depletion block signal by terminating the delivery of the depletion block stimulation to the nerve. 1. A method , comprising:creating a depletion block at a presynaptic terminal of an axon, creating the depletion block including delivering a series of electrical pulses to the axon at a pulse frequency, the pulse frequency being within a range between about 100 Hz to about 1000 Hz.2. The method of claim 1 , wherein delivering the series of electrical pulses to the axon at the pulse frequency includes delivering the series of electrical pulses at a first pulse frequency to initiate the depletion block claim 1 , the method further comprising subsequently delivering the series of electrical pulses at a second pulse frequency to maintain the depletion block claim 1 , the second pulse frequency being lower than the first pulse frequency claim 1 , and both the first and second pulse frequencies being within the range between about 100 Hz to about 1000 Hz.3. The method of claim 1 , further comprising delivering a therapy during the depletion block.4. The method of claim 3 , wherein the therapy includes an ablation procedure claim 3 , ...

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Номер записи: 75
23-07-2015 дата публикации

SYSTEMS AND METHODS FOR SELECTIVE STIMULATION OF NERVE FIBERS IN CAROTID SINUS

Номер: US20150202444A1
Автор: FRANKE Manfred, Hincapie Ordonez Juan Gabriel, Mokelke Eric A., Shuros Allan Charles, Ternes David J.
Принадлежит:

An example of a system may include at least one electrode for placement on tissue in a carotid sinus region and a stimulator. The stimulator may be configured to use the at least one electrode to deliver neural stimulation to a baroreceptor region or at least one nerve innervating the baroreceptor region in the carotid sinus region to elicit a baroreflex response, and to deliver a blocking stimulation to a carotid body or at least one nerve innervating the carotid body in the carotid sinus region to inhibit a chemoreceptor response, the stimulator configured to simultaneously deliver the neural stimulation and the blocking stimulation. 1. A system , comprising:at least one electrode for placement on tissue in a carotid sinus region;a stimulator configured to use the at least one electrode to deliver neural stimulation to a baroreceptor region or at least one nerve innervating the baroreceptor region in the carotid sinus region to elicit a baroreflex response, and to deliver a blocking stimulation to a carotid body or at least one nerve innervating the carotid body in the carotid sinus region to inhibit a chemoreceptor response, the stimulator configured to simultaneously deliver the neural stimulation and the blocking stimulation.2. The system of wherein the stimulator is configured to use a stimulation vector to deliver the blocking stimulation and to use the stimulation vector to deliver the neural stimulation.3. The system of claim 1 , wherein the at least one electrode includes an electrode for placement on or near a carotid body claim 1 , and the stimulator is configured to use the electrode to both deliver the blocking stimulation and deliver the neural stimulation.4. The system of claim 1 , wherein the at least one electrode includes both a first electrode and a second electrode for placement on tissue in the carotid sinus region claim 1 , and the stimulator is configured to use the first electrode to deliver neural stimulation to a baroreceptor region or a ...

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Номер записи: 76
23-07-2015 дата публикации

SELECTIVE NERVE STIMULATION USING PRESYNAPTIC TERMINAL DEPLETION BLOCK

Номер: US20150202446A1
Автор: FRANKE Manfred, Hamann Jason J., Hincapie Ordonez Juan Gabriel, Ruble Stephen B., Ternes David J.
Принадлежит:

An example of a system may include a stimulator and at least one controller. The stimulator may be configured to deliver nerve stimulation to capture a first set of axons in a nerve and to deliver depletion block stimulation to capture a second set of axons in the nerve, where the second set is a subset of the first. The depletion block stimulation may include a series of pulses at a depletion pulse frequency within a range between about 100 Hz to about 1 kHz, and the nerve stimulation may include a series of pulses at a stimulation pulse frequency within a range of about 0.25 Hz to about 50 Hz. At least a portion of the nerve stimulation and at least a portion of the depletion block stimulation may be delivered to be effective in providing a nerve block while delivering nerve stimulation. 1. A system , comprising:a stimulator configured to deliver nerve stimulation to capture a first set of axons in a nerve and to deliver depletion block stimulation to capture a second set of axons in the nerve, the second set of axons being a subset of the first set of axons, the depletion block stimulation including a series of pulses at a depletion pulse frequency within a range between about 100 Hz to about 1 kHz, the nerve stimulation including a series of pulses at a stimulation pulse frequency within a range of 0.25 Hz to 50 Hz; andat least one controller configured to communicate with the stimulator and control the depletion block stimulation and the nerve stimulation, at least a portion of the nerve stimulation and at least a portion of the depletion block stimulation being delivered to be effective in providing a nerve block while delivering nerve stimulation.2. The system of claim 1 , wherein the stimulator is configured to deliver neural stimulation to the nerve using a first electrode and a second electrode claim 1 , and to deliver depletion block stimulation to the nerve using the first electrode and the second electrode.3. The system of claim 1 , wherein the ...

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Номер записи: 77
14-07-2016 дата публикации

SYSTEMS AND METHODS TO ACCOUNT FOR NECK MOVEMENT DURING NERVE STIMULATION

Номер: US20160199653A1
Автор: Arcot-Krishnamurthy Shantha, Hamann Jason J., Hincapie Ordonez Juan Gabriel, Ruble Stephen B., Ternes David J.
Принадлежит:

Some embodiments provide a method, comprising performing a neural stimulation test routine for stimulating a neural target in a cervical region of a patient, wherein for each of a plurality of head positions, performing the neural stimulation test routine includes testing a plurality of electrode configurations. The method further comprises recording threshold data for each of the tested electrode configurations for the plurality of head positions, and recommending an electrode configuration based on the recorded threshold data. 1. (canceled)2. A system for delivering vagal stimulation therapy (VST) to a vagus nerve of a patient , comprising:a plurality of electrodes configured to be implanted in a cervical region of the patient;a neural stimulator configured to deliver the VST using at least one electrode configuration from a plurality of potential electrode configurations for the plurality of electrodes;feedback circuitry configured to receive an indicator of a physiological response to VST, wherein the feedback circuitry includes at least one of a sensor configured to sense at least one physiological parameter or a user input device configured to receive patient-entered or clinician-entered feedback;a controller connected to the neural stimulator and to the feedback circuitry, wherein the controller is configured to:perform a neural stimulation test routine for stimulating a neural target in a cervical region of a patient, wherein for each of a plurality of head positions, performing the neural stimulation test routine includes testing a plurality of electrode configurations;record threshold data for each of the tested electrode configurations for the plurality of head positions; andrecommend an electrode configuration based on the recorded threshold data.3. The system of claim 2 , wherein the plurality of electrodes are configured to be implanted within a blood vessel in the cervical region claim 2 , and the neural stimulator is configured to transvascularly ...

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Номер записи: 78
12-07-2018 дата публикации

PAIN MANAGEMENT BASED ON FUNCTIONAL MEASUREMENTS

Номер: US20180192942A1
Автор: Annoni Elizabeth Mary, CLARK Bryan Allen, Gu Jianwen, Kleinedler James John, Srivastava Kyle Harish, Ternes David J., Thakur Pramodsingh Hirasingh
Принадлежит:

This document discusses, among other things, systems and methods for managing pain of a subject. A system may include a motion sensor configured to sense at least one functional signal indicative a physical state of the subject. The at least one functional signal may include at least one motor activity signal or at least one sleep state signal. A pain analyzer circuit may extract, from the functional signal, signal metrics indicative of subject motor control or kinetics, and generate a pain score using the signal metrics. The pain score may be output to a user or a process. The system may additionally include an electrostimulator to generate and deliver a closed-loop pain therapy according to the pain score. 1. A system for managing pain of a patient , the system comprising:a sensor circuit coupled to a motion sensor and configured to sense from the patient at least one functional signal indicative of a physical state of the patient; generate, from each of the sensed at least one functional signal, one or more signal metrics indicative of patient motor control or kinetics; and', 'generate a pain score using the generated one or more signal metrics; and, 'a pain analyzer circuit coupled to the sensor circuit, the pain analyzer circuit configured toan output unit configured to output the pain score to a user or a process.2. The system of claim 1 , further comprising:an electrostimulator configured to generate electrostimulation energy to treat pain; anda controller circuit coupled to the pain analyzer circuit and the electrostimulator, the controller circuit further configured to control the electrostimulator to deliver a pain therapy and to control the electrostimulation energy generated by the electrostimulator according to the pain score.3. The system of claim 2 , wherein the electrostimulator is further configured to deliver at least one of:a spinal cord stimulation;a brain stimulation; ora peripheral nerve stimulation.4. The system of claim 2 , wherein the ...

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Номер записи: 79
13-07-2017 дата публикации

SYNCING MULTIPLE SOURCES OF PHYSIOLOGICAL DATA

Номер: US20170196457A1
Автор: Emerson Paul F., Maile Keith R., Ruble Stephen B., Shen Zhe, Simms Howard D., Ternes David J., Thakur Pramodsingh H.
Принадлежит:

A system includes an implantable medical device configured to sense a sync signal and sense physiological parameters to obtain a physiological signal. In response to sensing the sync signal, the implantable medical device is configured to generate a sync-stamped physiological signal. In certain embodiments, a method includes receiving a first physiological signal coupled with a sync signal; receiving a second physiological signal coupled with the sync signal; and, using the sync signal, synchronizing in time the first and second physiological signals. 1. A system comprising:a sync signal source configured to direct a sync signal towards a first and second medical device;the first medical device configured to sense the sync signal and a first set of physiological parameter measurements and generate a sync-coupled first physiologic signal;the second medical device configured to sense the sync signal and a second set of physiological parameter measurements and generate a sync-coupled second physiologic signal; andcircuitry configured to align, in time, the first and second sync-coupled physiological signals.2. The system of claim 1 , wherein the sync signal includes a predetermined series of pulses of current.3. The system of claim 2 , further comprising:electrodes configured to generate the sync signal.4. The system of claim 1 , wherein the sync signal includes a series of predetermined vibration pulses.5. The system of claim 1 , wherein at least one of the first and second medical devices is an implantable medical device.6. The system of claim 1 , wherein the first medical device is an implantable medical device claim 1 , and wherein the second medical device is a wearable medical device.7. The system of claim 1 , wherein at least one of the first medical device and an external server includes the circuitry.8. A method for use with a medical device claim 1 , the method comprising:sensing, by the medical device, a sync signal;sensing, by the medical device, a first ...

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Номер записи: 80
13-07-2017 дата публикации

OBTAINING HIGH-RESOLUTION INFORMATION FROM AN IMPLANTABLE MEDICAL DEVICE

Номер: US20170196458A1
Автор: Maile Keith R., Ruble Stephen B., Shen Zhe, Ternes David J., Thakur Pramodsingh H.
Принадлежит:

Embodiments of the disclosure include systems and methods for obtaining high-resolution data from implantable medical devices (IMDs) by triggering a limited-time system behavior change. For example, embodiments include utilizing study prescriptions for batching data obtained by an IMD, communicating the batched data to an external device, and reconstructing the batched data at the external device. Study prescriptions refer to sets of instructions, conditions, protocols, and/or the like, that specify one or more of an information gathering scheme and a communication scheme, and may be configured, for example, to obtain information at a resolution sufficient for performing a certain analysis (e.g., associated with a diagnostic model), while managing the resulting impact to device longevity and/or performance. 1. A system , comprising: a sensing component configured to obtain values of a first physiological parameter;', 'a power source configured to provide power to the IMD; and', 'a first communication component configured to transmit, according to a study prescription, the values of the first physiological parameter, the study prescription comprising a communication scheme that is configured based on an impact on a longevity of at least one component of the IMD; and, "an implantable medical device (IMD) configured to be implanted within a patient's body, the IMD comprising:"}an external monitoring device (EMD) configured to be disposed outside of a patient's body, the EMD comprising a second communication component, configured to receive, from the first communication component, the values of the first physiological parameter.2. The system of claim 6 , wherein the impact on the longevity of the at least one component of the IMD corresponds to an amount of power consumption associated with the information transmission.3. The system of claim 6 , wherein the study prescription further includes instructions configured to cause the sensing component to store the values of ...

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Номер записи: 81
18-06-2020 дата публикации

SYSTEMS AND METHODS FOR CLOSED-LOOP PAIN MANAGEMENT

Номер: US20200188673A1
Автор: Annoni Elizabeth Mary, CLARK Bryan Allen, Gu Jianwen, Kleinedler James John, Perschbacher David L., Ternes David J., Thakur Pramodsingh Hirasingh
Принадлежит:

Systems and methods for managing pain in patient are described. A system may include sensors configured to sense physiological or functional signals, and a pain analyzer to generate signal metrics from the physiological or functional signals. The pain analyzer also generates weight factors corresponding to the signal metrics. The weight factors may indicate the signal metrics reliability in representing an intensity of the pain. The pain analyzer generates a pain score using a plurality of signal metrics and a plurality of weight factors. The pain score may be output to a user or a process. The system may additionally include an electrostimulator to generate and deliver closed-loop pain therapy according to the pain score. 1. A system for managing pain in a patient , the system comprising: generate a plurality of signal metrics using one or more physiological or functional signals sensed from the patient; and', 'generate a score using the plurality of signal metrics weighted by respective weight factors; and, 'an analyzer circuit configured toa controller circuit configured to initiate or adjust a pain therapy based on the generated score.2. The system of claim 1 , comprising a therapy circuit configured to deliver the pain therapy including an electrostimulation therapy.3. The system of claim 2 , wherein the controller circuit is configured to control the therapy circuit to deliver a first electrostimulation therapy if the generated score is above a threshold claim 2 , and to control the therapy circuit to deliver a second electrostimulation therapy if the generated score is below the threshold claim 2 ,wherein the first electrostimulation therapy has higher stimulation energy than the second electrostimulation therapy.4. The system of claim 2 , wherein:the analyzer circuit is configured to assess pain relief in the patient in response to the delivery of the pain therapy; andthe controller circuit is configured to determine or adjust the pain therapy based on the ...

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Номер записи: 82
11-08-2016 дата публикации

MANAGED PACE RECHARGE IN A MULTIPOINT PACING SYSTEM

Номер: US20160228708A1
Автор: Linder William J., Ternes David J.
Принадлежит:

An apparatus comprises a stimulus circuit, a recharge circuit, a switch circuit, and a control circuit. The stimulus circuit provides electrical cardiac pacing stimulation to multiple combinations of a plurality of electrodes, and the electrical stimulation is selectively applied at the first electrode of the electrode combinations. The recharge circuit includes a recharge capacitor electrically coupled to the second electrode of the electrode combinations, and the switch circuit selectively enables electrode combinations for electrical coupling to the stimulus circuit and the recharge circuit. The control circuit includes a pacing activation sub-circuit that selectively initiates delivery of the electrical stimulation using multiple electrode combinations, and enables simultaneous delivery of pacing recharge energy from the recharge capacitor to the second electrode of multiple electrode combinations. 1. An apparatus for coupling to a plurality of electrodes implantable at a plurality of tissue sites of a heart chamber of a subject , the apparatus comprising:a stimulus circuit configured to provide electrical cardiac pacing stimulation to multiple combinations of the plurality of electrodes, wherein an electrode combination includes at least a first electrode and a second electrode and the electrical stimulation is selectively applied at the first electrode of the electrode combinations;a recharge circuit including a recharge capacitor electrically coupled to the second electrode of the electrode combinations;a switch circuit configured to selectively enable electrode combinations for electrical coupling to the stimulus circuit and the recharge circuit; anda control circuit including a pacing activation sub-circuit configured to: selectively initiate delivery of the electrical stimulation using multiple electrode combinations; and enable at least partial simultaneous delivery of pacing recharge energy from the recharge capacitor to the second electrode of multiple ...

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Номер записи: 83
11-08-2016 дата публикации

SENSING WINDOW MANAGEMENT OF MULTIPOINT PACING

Номер: US20160228709A1
Автор: Linder William J., Ternes David J.
Принадлежит:

An apparatus for coupling to a plurality of electrodes implantable at a plurality of tissue sites of a heart chamber of a subject. The apparatus including a stimulus circuit configured to provide an electrical cardiac pacing stimulation to the plurality of electrodes, a switching circuit configured to select electrodes of the plurality of electrodes for electrical coupling to the stimulus circuit, and a control circuit including a heart rate sub-circuit configured to determine heart rate; and a pacing site activation sub-circuit configured to selectively change which electrodes of the plurality of electrodes are used to provide the electrical cardiac pacing stimulation therapy according to the determined heart rate. 1. An apparatus for coupling to a plurality of electrodes implantable at a plurality of tissue sites of a heart chamber of a subject , the apparatus comprising:a stimulus circuit configured to provide an electrical cardiac pacing stimulation to the plurality of electrodes;a switching circuit configured to select electrodes of the plurality of electrodes for electrical coupling to the stimulus circuit; anda control circuit including a heart rate sub-circuit configured to determine heart rate; and a pacing site activation sub-circuit configured to selectively change which electrodes of the plurality of electrodes are used to provide the electrical cardiac pacing stimulation therapy according to the determined heart rate.2. The apparatus of claim 1 , including a plurality of electrodes implantable in a left ventricle of the heart claim 1 , wherein the apparatus further includes a pacing delay sub-circuit configured to determine a time delay between delivery of a pacing stimulus pulse to a first electrode of the plurality of electrodes implantable in the left ventricle and delivery to a second electrode of the plurality of electrodes implantable in the left ventricle claim 1 , wherein the pacing site activation sub-circuit is configured to change the ...

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Номер записи: 84
09-07-2020 дата публикации

METHOD AND APPARATUS FOR PAIN CONTROL USING BAROREFLEX SENSITIVITY DURING POSTURE CHANGE

Номер: US20200214623A1
Автор: Annoni Elizabeth Mary, CLARK Bryan Allen, Gu Jianwen, Kleinedler James John, Perschbacher David L., Srivastava Kyle Harish, Ternes David J., Thakur Pramodsingh Hirasingh
Принадлежит:

An example of a system for providing a patient with pain management includes a pain monitoring circuit. The pain monitoring circuit may include parameter analyzer circuitry and pain score generator circuitry. The parameter analyzer circuitry may be configured to receive and analyze one or more timing parameters and one or more baroreflex parameters allowing for determination of baroreflex sensitivity (BRS) of the patient. The one or more timing parameters are indicative of time intervals during which values of the one or more baroreflex parameters are used to determine the BRS. The pain score generator circuitry may be configured to compute a pain score using an outcome of the analysis. The pain score is a function of the BRS during the time intervals and indicative of a degree of pain of the patient. 1. A system for providing a patient with pain management , the system comprising: a parameter generator configured to receive a blood pressure signal indicative of a blood pressure of the patient and to generate one or more baroreflex parameters using at least the blood pressure signal, the one or more baroreflex parameters allowing for determination of baroreflex sensitivity (BRS) of the patient;', 'a parameter analyzer configured to receive and analyze one or more timing parameters and the one or more baroreflex parameters, the one or more timing parameters indicative of time intervals during which values of the one or more baroreflex parameters are used to determine the BRS; and', 'a pain score generator configured to compute a pain score using an outcome of the analysis, the pain score being a function of the BRS during the time intervals and indicative of a degree of pain of the patient;, 'a pain monitoring circuit includinga pain relief device configured to deliver one or more pain-relief therapies to the patient; anda control circuit configured to control the delivery of the one or more pain-relief therapies using the computed pain score.2. The system of claim 1 ...

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Номер записи: 85
09-07-2020 дата публикации

PAIN MANAGEMENT BASED ON FUNCTIONAL MEASUREMENTS

Номер: US20200214624A1
Автор: Annoni Elizabeth Mary, CLARK Bryan Allen, Gu Jianwen, Kleinedler James John, Srivastava Kyle Harish, Ternes David J., Thakur Pramodsingh Hirasingh
Принадлежит:

This document discusses, among other things, systems and methods for managing pain of a subject. A system may include a motion sensor configured to sense at least one functional signal indicative a physical state of the subject. The at least one functional signal may include at least one motor activity signal or at least one sleep state signal. A pain analyzer circuit may extract, from the functional signal, signal metrics indicative of subject motor control or kinetics, and generate a pain score using the signal metrics. The pain score may be output to a user or a process. The system may additionally include an electrostimulator to generate and deliver a closed-loop pain therapy according to the pain score. 1. A method for managing pain in a patient using a pain relief device , the method comprising:sensing, via a sensor circuit, a first functional signal using a sensor circuit in response to delivery of a pain therapy to the patient from the pain relief device;generating, via a controller circuit, signal metrics from the first functional signal, the signal metrics indicative of patient motor control or kinetics;generate, via the controller circuit, an efficacy indicator of the pain therapy using a weighted combination of the signal metrics; andadjusting, via the controller circuit, the pain therapy based on the efficacy indicator.2. The method of claim 1 , wherein the pain therapy includes an electrostimulation therapy claim 1 , and wherein adjusting the pain therapy includes adjusting one or more stimulation parameter including: stimulation energy; stimulation frequency; stimulation pulse amplitude; stimulation pulse width; stimulation pulse duration; stimulation on-off cycle; stimulation pulse waveform; stimulation electrode configuration; or stimulation current or energy fractionalization.3. The method of claim 1 , wherein the pain therapy includes one or more of:radiofrequency ablation therapy;ultrasound therapy;optogenetic therapy;peripheral tissue ...

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Номер записи: 86
17-09-2015 дата публикации

VISUALIZATION OF BIOLOGICAL ENVIRONMENT IMPACT ON IMPLANTED THERAPY

Номер: US20150258341A1
Автор: Eberle LeAnne M., Soltis Brian D., Ternes David J.
Принадлежит:

An implantable medical device (IMD) system communicates to a user information regarding the surrounding biological environment and the influence of that surrounding biological environment on IMD functionality. This influence can be static or dynamic. Providing information on the biological environment can assist the user in determining therapy parameters for an individual patient with an IMD. 1. A method , comprising:measuring a parameter associated with a biological environment for a system including an implantable medical device (IMD) configured for delivering electrical stimulation therapy;determining a limit of the therapy that can be delivered by the IMD based on the measured parameter; anddisplaying the limit to a user using an interface of an external device, the external device configured to communicate with the IMD.2. The method of claim 1 , wherein measuring a parameter associated with a biological environment includes sensing impedance for at least a portion of a lead system connected to the IMD.3. The method of claim 2 , wherein determining a limit of the therapy includes determining voltage compliance based on the sensed impedance and calculating a limit of electric current level that can be delivered by the IMD based on the determined voltage compliance4. The method of claim 3 , further comprising using a color code to display the calculated limit.5. The method of claim 3 , wherein displaying the limit includes displaying a color palette with selections for programming parameters for delivering therapy.6. The method of claim 2 , further comprising:determining charge density based on the sensed impedance;determining potential for nerve damage from therapy delivery by the IMD based on the determined charge density; anddisplaying the determined potential for nerve damage using the interface.7. The method of claim 2 , further comprising:determining maximum allowable programmed frequency of pulse delivery based on the sensed impedance load and time duration ...

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Номер записи: 87
20-11-2014 дата публикации

CONTROL OF NEURAL MODULATION THERAPY USING CERVICAL IMPEDANCE

Номер: US20140343637A1
Автор: Hamann Jason J., Ruble Stephen B., Stahmann Jeffrey E., Ternes David J.
Принадлежит:

An implantable apparatus can comprise an electrical test energy delivery circuit configured to provide an electrical test signal to a cervical location in a patient body. A detector circuit can use the electrical test signal to detect cervical impedance and generate a cervical impedance signal representing fluctuations in the detected cervical impedance. The implantable apparatus can comprise a therapy delivery circuit, such as configured to provide electrical neural modulation therapy using a neural modulation timing parameter, and a processor circuit that can be coupled to the electrical test energy delivery circuit, the detector circuit, and the therapy delivery circuit. The processor circuit can be configured to determine a pulsatile signal or pulse pressure signal, such as using the cervical impedance signal, identify a characteristic of the pulsatile signal or pulse pressure signal, and control a neural modulation therapy using the timing parameter and the identified pulse pressure signal characteristic. 1. (canceled)2. A method comprising:detecting fluctuations in a cervical vessel dimension of a patient, wherein detecting the fluctuations includes measuring a cervical impedance of the patient over time;determining pulsatile information using the detected fluctuations in the cervical vessel dimension of the patient; andproviding a neural modulation therapy in coordination with a characteristic of the pulsatile information.3. The method of claim 1 , wherein the providing the neural modulation therapy includes providing an electrical neural modulation therapy in coordination with the characteristic of the pulsatile information.4. The method of claim 3 , wherein the providing the electrical neural modulation therapy includes providing the electrical neural modulation therapy at or near a cervical neural target including at least one of a vagus nerve claim 3 , a carotid sinus nerve claim 3 , a hypoglossal nerve claim 3 , a glossopharyngeal nerve claim 3 , and a ...

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Номер записи: 88
08-10-2015 дата публикации

DISCRIMINATION OF APNEA TYPE BY MEDICAL DEVICE

Номер: US20150282738A1
Автор: Ruble Stephen B., Ternes David J., Thakur Pramodsingh Hirasingh
Принадлежит:

Disclosed herein, among other things, are methods and apparatus related to identification of apnea type. One aspect of the present subject matter provides a method for real-time apnea discrimination. The method includes sensing an impedance-based tidal volume signal to monitor a respiratory cycle of a patient, and detecting a reduction in tidal swing using the sensed impendence to detect an apnea event. When the apnea event is detected, a shape of the sensed signal is compared to a stored signal shape to determine whether the apnea event is primarily an obstructive sleep apnea (OSA) event or primarily a central sleep apnea (CSA) event, in various embodiments. 1. A method for apnea discrimination , the method comprising:sensing an impedance-based tidal volume signal to monitor a respiratory cycle of a patient;detecting a reduction in tidal swing using the sensed impendence to detect an apnea event; andwhen the apnea event is detected, comparing a shape of the sensed signal to a stored signal shape to determine whether the apnea event is primarily an obstructive sleep apnea (OSA) event or primarily a central sleep apnea (CSA) event.2. The method of claim 1 , wherein the stored signal shape includes a normal tidal swing shape for the patient.3. The method of claim 1 , wherein the stored signal shape includes a stored prior OSA waveform template.4. The method of claim 1 , wherein the stored signal shape includes a sine wave.5. The method of claim 1 , wherein the stored signal shape includes a square wave.6. The method of claim 2 , wherein if the shape of the sensed signal is similar to the normal tidal swing shape claim 2 , the apnea event is determined to be primarily a CSA event.7. The method of claim 2 , wherein if the shape of the sensed signal is not similar to the normal tidal swing shape claim 2 , the apnea event is determined to be primarily an OSA event.8. The method of claim 1 , further comprising calculating likelihood for each apnea event based on historical ...

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Номер записи: 89
08-10-2015 дата публикации

METHODS AND APPARATUS FOR APNEA THERAPY STIMULATION

Номер: US20150283383A1
Автор: Ruble Stephen B., Ternes David J., Thakur Pramodsingh Hirasingh
Принадлежит:

Disclosed herein, among other things, are methods and apparatus related to apnea therapy. One aspect of the present subject matter provides a method for apnea directed therapy. The method includes receiving a signal indicative of a real-time determination of type of an apnea event for a patient during the apnea event, and using the signal to select appropriate therapy to be applied to the patient during the apnea event to treat the apnea event, and to withhold inappropriate therapy. The therapy is applied in a closed loop system, in various embodiments. In various embodiments, the signal includes a determination of whether the apnea event is primarily an obstructive sleep apnea (OSA) event or primarily a central sleep apnea (CSA) event. 1. A method for apnea directed therapy , the method comprising:receiving a signal indicative of a real-time or near real-time determination of type of an apnea event for a patient during the apnea event;using the signal to select appropriate electrical stimulation therapy to be applied to the patient during the apnea event to treat the apnea event; andapplying the electrical stimulation therapy in a closed loop system.2. The method of claim 1 , wherein the signal includes a determination of whether the apnea event is primarily an obstructive sleep apnea (OSA) event or primarily a central sleep apnea (CSA) event.3. The method of claim 2 , wherein if the apnea event is determined to be primarily an OSA event claim 2 , applying electrical stimulation therapy includes applying hypoglossal nerve stimulation.4. The method of claim 2 , wherein if the apnea event is determined to be primarily an OSA event claim 2 , applying electrical stimulation therapy includes applying vagal nerve stimulation (VNS).5. The method of claim 4 , wherein applying VNS includes applying laryngeal stimulation.6. The method of claim 4 , wherein applying VNS includes using selective fiber stimulation.7. The method of claim 2 , wherein if the apnea event is ...

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Номер записи: 90
15-10-2015 дата публикации

AUTOMATIC SELECTION OF LEAD CONFIGURATION FOR A NEURAL STIMULATION LEAD

Номер: US20150290462A1
Автор: Arcot-Krishnamurthy Shantha, Hamann Jason J., Hincapie Ordonez Juan Gabriel, Ruble Stephen B., Ternes David J.
Принадлежит:

A neurostimulation system includes a neural stimulation lead having a proximal portion and a distal portion and including a plurality of electrodes along the distal portion. The plurality of electrodes are configured for positioning proximate a portion of the autonomic nervous system. A neural stimulation circuit, coupled to the plurality of electrodes, delivers neural stimulation pulses to the plurality of electrodes. A processor and controller is configured to control the neural stimulation circuit to deliver first neural stimulation pulses to each of a plurality of electrode configurations. Each electrode configuration includes one or more of the plurality of electrodes. The processor and controller is further configured to receive information related to motor fiber activity that is induced in response to delivery of the first neural stimulation pulses to each of the plurality of electrode configurations and to identify the electrode configurations that induce the motor fiber activity. 1. A neurostimulation system comprising:an implantable neural stimulation device having a plurality of electrodes and a neural stimulation circuit, the plurality of electrodes configured for positioning proximate a portion of the autonomic nervous system, the neural stimulation circuit configured to deliver neural stimulation pulses through the plurality of electrodes;a user interface, the user interfacing including a display; and control the neural stimulation circuit to deliver a first plurality of neural stimulation pulses to a neural target through a plurality of electrode combinations of the plurality of electrodes,', 'receive information indicative of physiological activity that is induced in response to the delivery of the first plurality of neural stimulation pulses, and', 'identify on the display a subset of the plurality of electrode combinations associated with a lowest capture threshold at which the physiological activity was induced based on the received information., ...

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Номер записи: 91
12-09-2019 дата публикации

AUTO-THRESHOLD TEST FOR HIS-BUNDLE PACING

Номер: US20190275329A1
Автор: Brisben Amy Jean, Mahajan Deepa, Perschbacher David L., Shuros Allan Charles, Ternes David J.
Принадлежит:

Systems and methods for pacing cardiac conductive tissue are described. A medical system includes an electrostimulation circuit to generate His-bundle pacing (HBP) pulses. A sensing circuit senses a physiologic signal, and detect a local His-bundle activation discrete from a pacing artifact of the HBP pulse. A control circuit verifies capture status in response to the HBP pulses. Based on the capture status, the control circuit determines one or more pacing thresholds including a selective HBP threshold representing a threshold strength to capture only the His bundle but not the local myocardium, and a non-selective HBP threshold representing a threshold strength to capture both the His bundle and the local myocardium. The electrostimulation circuit may deliver HBP pulses based on the selective and non-selective HBP thresholds. 1. A system for pacing a heart , comprising:an electrostimulation circuit configured to generate His-bundle pacing (HBP) pulses having a stimulation strength to stimulate a His bundle of the heart;a sensing circuit configured to sense a physiologic signal and to detect, from the sensed physiologic signal, a local His-bundle activation discrete from a pacing artifact of the delivered HBP pulses; and verify a capture status using the detection of the local His-bundle activation; and', 'determine, using the verified capture status, one or more of (1) a selective HBP threshold (S-threshold) representing a threshold strength for the HBP pulses to capture only the His bundle but not local myocardium, or (2) a non-selective HBP threshold (NS-threshold) representing a threshold strength for the HBP pulses to capture both the His bundle and the local myocardium., 'a control circuit configured to2. The system of claim 1 , wherein the sensing circuit is configured to detect an isoelectric interval that separates the local His-bundle activation from the pacing artifact of the HBP pulse claim 1 , and the control circuit is configured to verify the capture ...

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Номер записи: 92
12-10-2017 дата публикации

Sleep study using an implanted medical device

Номер: US20170290528A1
Автор: Amy Jean Brisben, David J. Ternes, John D. Hatlestad, Keith R. Maile, Pramodsingh H. THAKUR, Stephen B. RUBLE
Принадлежит: Cardiac Pacemakers Inc

A system for performing a sleep study includes an implant able medical device (IMD) having a first sensor configured to obtain a first physiological parameter signal; a second sensor configured to obtain a second physiological parameter signal; and at least one processing device. The at least one processing device is configured to: receive the first physiological parameter signal and the second physiological parameter signal; and identify, based on a set of episode data, an occurrence of an episode during a sleep session, the episode corresponding to a sleep disorder, the set of episode data based on at least one of the first physiological parameter signal and the second physiological parameter signal. The at least one processing device is further configured to generate, based on the first physiological parameter signal and the second physiological parameter signal, a study report, the study report comprising an indication of the episode.

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Номер записи: 93
12-10-2017 дата публикации

MULTI-SITE CRT CAPTURE VERIFICATION

Номер: US20170291022A1
Автор: Kane Michael J., Linder William J., Shuros Allan Charles, Ternes David J., Yu Yinghong
Принадлежит:

An apparatus comprises a cardiac signal sensing circuit configured for coupling electrically to a plurality of electrodes and to sense intrinsic cardiac activation at three or more locations within a subject's body using the electrodes; a stimulus circuit configured for coupling to the plurality of electrodes; a signal processing circuit electrically coupled to the cardiac signal sensing circuit and configured to determine a baseline intrinsic activation vector according to the sensed intrinsic cardiac activation; and a control circuit electrically coupled to the cardiac signal sensing circuit and stimulus circuit and configured to: initiate delivery of electrical pacing therapy using initial pacing parameters determined according to the baseline intrinsic activation vector; initiate sensing of a paced activation vector; and adjust one or more pacing therapy parameters according to the paced activation vector. 1. An apparatus comprising:a cardiac signal sensing circuit configured for coupling electrically to a plurality of electrodes and to sense intrinsic cardiac activation at three or more locations within a subject's body using the electrodes;a stimulus circuit configured for coupling to the plurality of electrodes;a signal processing circuit electrically coupled to the cardiac signal sensing circuit and configured to determine a baseline intrinsic activation vector according to the sensed intrinsic cardiac activation, wherein an intrinsic activation vector includes direction information of propagation of activation of cardiac tissue; anda control circuit electrically coupled to the cardiac signal sensing circuit and stimulus circuit and configured to: initiate delivery of electrical pacing therapy using initial pacing parameters determined according to the baseline intrinsic activation vector; initiate sensing of a paced activation vector; and adjust one or more pacing therapy parameters according to the paced activation vector.2. The apparatus of claim 1 , ...

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Номер записи: 94
19-10-2017 дата публикации

Determining cardiac pacing capture effectiveness of an implantable medical device

Номер: US20170296086A1
Автор: David J. Ternes, Keith R. Maile, Pramodsingh H. THAKUR, Qi AN, Sunipa Saha
Принадлежит: Cardiac Pacemakers Inc

A cardiac rhythm management system includes at least one sensing component configured to obtain a first physiological parameter signal, an indication of a cardiac response to a stimulation therapy, and temporal information corresponding to the first physiological parameter signal and the cardiac response; and at least one processor configured to: receive the first physiological parameter signal, the indication of the cardiac response, and the temporal information; and to classify the cardiac response into a first cardiac response class to generate a classified cardiac response. The at least one processor also is configured to determine a correlation, based on the temporal information, between the first physiological parameter signal and the classified cardiac response.

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Номер записи: 95
20-10-2016 дата публикации

Remote pace detection in an implantable medical device

Номер: US20160303377A1
Автор: David J. Ternes, Kenneth L. Baker
Принадлежит: Cardiac Pacemakers Inc

A system embodiment for stimulating a neural target comprises a neural stimulator, a pace detector, and a controller. The neural stimulator is electrically connected to at least one electrode, and is configured to deliver a neural stimulation signal through the at least one electrode to stimulate the neural target. The pace detector is configured to use at least one electrode to sense cardiac activity and distinguish paced cardiac activity in the sensed cardiac activity from non-paced cardiac activity in the sensed cardiac activity. The controller is configured to control a programmed neural stimulation therapy using the neural stimulator and using detected paced cardiac activity as an input for the neural stimulation therapy.

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Номер записи: 96
19-10-2017 дата публикации

LEAD INTEGRITY MONITORING

Номер: US20170296810A1
Автор: An Qi, Mahajan Deepa, Maile Keith R., Shen Zhe, Ternes David J., Thakur Pramodsingh H.
Принадлежит:

A system for lead integrity monitoring includes an implantable medical device (IMD) having a housing enclosing a control circuit; and a lead, having a first sensor. The lead is coupled to the housing and electrically coupled to the control circuit. The system also includes at least one processing device configured to identify a first lead failure alert based on a first set of information; obtain a second set of information generated by a second sensor; perform an evaluation of the first set of information in the context of the second set of information; and confirm or cancel the first lead failure alert based on the evaluation. 1. A system for monitoring lead integrity , comprising: a housing enclosing a control circuit; and', 'a lead, having a first sensor, wherein the lead is coupled to the housing and electrically coupled to the control circuit; and, "an implantable medical device (IMD) configured to be implanted within a patient's body, the IMD comprising:"} identify a first lead failure alert, the first lead failure alert comprising an indication of a potential lead failure based on a first set of information satisfying an alert criterion;', 'obtain a second set of information generated by a second sensor;', 'perform an evaluation of the first set of information in the context of the second set of information; and', 'confirm or cancel the first lead failure alert based on the evaluation., 'at least one processing device configured to2. The system of claim 1 , the first set of information comprising at least one of a first set of impedance data associated with the lead claim 1 , a set of user input associated with the lead claim 1 , a set of sensed noise information claim 1 , a set of pace capture information claim 1 , a set of sensed intrinsic information claim 1 , a set of non-sustained tachycardia episode information claim 1 , and a set of phrenic nerve stimulation information.3. The system of claim 2 , the first set of information comprising at least one of ...

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Номер записи: 97
16-11-2017 дата публикации

AUTOMATIC SELECTION OF LEAD CONFIGURATION FOR A NEURAL STIMULATION LEAD

Номер: US20170326371A1
Автор: Arcot-Krishnamurthy Shantha, Hamann Jason J., Hincapie Ordonez Juan Gabriel, Ruble Stephen B., Ternes David J.
Принадлежит:

A neurostimulation system includes a neural stimulation lead having a proximal portion and a distal portion and including a plurality of electrodes along the distal portion. The plurality of electrodes are configured for positioning proximate a portion of the autonomic nervous system. A neural stimulation circuit, coupled to the plurality of electrodes, delivers neural stimulation pulses to the plurality of electrodes. A processor and controller is configured to control the neural stimulation circuit to deliver first neural stimulation pulses to each of a plurality of electrode configurations. Each electrode configuration includes one or more of the plurality of electrodes. The processor and controller is further configured to receive information related to motor fiber activity that is induced in response to delivery of the first neural stimulation pulses to each of the plurality of electrode configurations and to identify the electrode configurations that induce the motor fiber activity. 1. (canceled)2. A system for use with a neural stimulation circuit operably connected to a plurality of electrodes configured to be positioned proximate to a neural target , the system comprising:a user interface including a display; and control the neural stimulation circuit to deliver a first plurality of neural stimulation pulses to a neural target through the plurality of potential electrode combinations;', 'receive information indicative of neural tissue capture;', 'use the received information indicative of neural tissue capture to group electrode combinations into the subset of potential electrode combinations; and', 'display the smaller subset of potential electrode combinations on the display., 'a controller configured to operably connect to the neural stimulation circuit and the user interface, wherein the controller is configured to facilitate reducing a plurality of potential electrode combinations from the plurality of electrodes to a smaller subset of potential ...

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Номер записи: 98
15-11-2018 дата публикации

PULSE PRESSURE VARIABILITY

Номер: US20180325402A1
Автор: An Qi, Maskara Barun, Ruble Stephen B., Ternes David J., Thakur Pramodsingh Hirasingh
Принадлежит:

This document discusses, among other things, systems and methods to receive physiologic information of a patient, to receive pulse pressure information from the patient different than the received physiologic information, and to determine an indication of atrial fibrillation (AF) using the received physiologic information and the received pulse pressure information. 1. A system , comprising:a first ambulatory medical device (AMD) configured to detect physiologic information from a patient; anda second AMD, different than the first AMD, configured to detect pulse pressure information from the patient,wherein the first AMD is configured to receive pulse pressure information from the second AMD, and to determine an AF indication using the detected physiologic information and the detected pulse pressure information.2. The system of claim 1 , wherein the second AMD includes at least one of:an optical sensor;a pressure sensor;an acoustic sensor;an impedance sensor;a vibratory sensor; ora strain sensor.3. The system of claim 1 , wherein the first AMD includes an implantable cardiac monitor (ICM) configured to detect physiologic information from the patient claim 1 ,wherein the second AMD includes a wearable medical device configured to detect pulse pressure information from the patient.4. The system of claim 3 , wherein the wearable medical device includes at least one of a wrist-worn medical device or a finger-worn medical device configured to detect a photoplethysmogram (PPG) signal from the patient.5. The system of claim 3 , wherein the ICM is configured to determine the AF indication using the detected physiologic information claim 3 , and to augment the determined AF indication using the received pulse pressure information.6. The system of claim 5 , wherein the ICM is configured to confirm or deny the determined AF indication using the received pulse pressure information from the wearable medical device.7. The system of claim 3 , wherein the first AMD includes an AF ...

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Номер записи: 99
15-11-2018 дата публикации

SYSTEMS AND METHODS FOR SYNCOPE DETECTION AND CLASSIFICATION

Номер: US20180325466A1
Автор: An Qi, Brisben Amy Jean, Stahmann Jeffrey E., Ternes David J., Thakur Pramodsingh Hirasingh
Принадлежит:

Systems and methods for monitoring patient for syncope are discussed. A syncope monitor system can detect a precipitating event associated with a syncope onset, and acquire hemodynamic data in response to the detection of the precipitating event. A syncope analyzer circuit may generate temporal profiles of one or more hemodynamic parameters using the hemodynamic data. The syncope analyzer may use the temporal profiles to detect a syncopal event and to classify the syncopal event into one of a plurality of syncope categories. The detection and classification information may be output to a user or a process. 1. A system for monitoring a patient for syncope , the system comprising:a physiological event detector circuit configured to detect a precipitating event associated with a syncope onset using at least one physiological signal;a hemodynamic sensor circuit configured to sense a hemodynamic signal;a syncope analyzer circuit configured to detect a syncopal event and classify the detected syncopal event into one of a plurality of syncope categories; trigger the hemodynamic sensor circuit to acquire hemodynamic data from the sensed hemodynamic signal; and', 'control the syncope analyzer circuit to detect and classify the syncopal event using the acquired hemodynamic data; and, 'a control circuit configured to, in response to the detection of the precipitating eventan output circuit configured to output the detected and classified syncopal event to a user or a process.2. The system of claim 1 , wherein the syncope analyzer circuit is configured to generate a temporal profile of a hemodynamic parameter using the acquired hemodynamic data claim 1 , and to detect and classify the syncopal event using the temporal profile of the hemodynamic parameter.3. The system of claim 2 , wherein the temporal profile of the hemodynamic parameter includes an initial measurement of the hemodynamic parameter within a first time window subsequent to an onset of the precipitating event and ...

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Номер записи: 100