Source: http://www.google.com.tw/patents/US7938781
Timestamp: 2013-05-23 16:07:33
Document Index: 71298191

Matched Legal Cases: ['art 105', 'art 105', 'art 105', 'art 105', 'art 105', 'Application No. 2004', 'art 88']

�M�Q US7938781 - Hemodynamic stability assessment based on heart sounds - Google �M�Q�j�M �Ϥ� �a�� Play YouTube �s�D Gmail ���ݵw�� ��h »�i���M�Q�j�M | �������� | �n�J�i���M�Q�j�M�M�QA method comprises detecting at least one episode of ventricular tachyarrhythmia in a subject using an implantable medical device (IMD), sensing at least one heart sound signal for the subject using the IMD, the heart sound signal associated with mechanical vibration of a heart of the subject; initiating,...http://www.google.com.tw/patents/US7938781?utm_source=gb-gplus-share�M�Q US7938781 - Hemodynamic stability assessment based on heart sounds���}��US7938781 B2�X���������v�ӽЮѽs��12/813,073�o�G���2011�~5��10���ӽФ��2010�~6��10�� �u���v���2006�~3��29����L���}�M�Q��EP1998850A2US7780606US20070239218US20100249863WO2007126578A2WO2007126578A3�o��HGerrard M. CarlsonYayun Lin��M�Q�v�HCardiac Pacemakers, Inc. ���M�Q������600/508600/515��ڱM�Q������A61B5/02 �X�@����A61N1/3621A61N1/3962A61N1/36578A61N1/37247A61B5/02028A61N1/3627A61B7/04A61N1/37282A61B5/02405A61N1/36514A61B5/024 �ڬw������A61B 5/024A61N 1/39M2A61N 1/365BA61N 1/362AA61B 7/04A61B 5/024AA61B 5/02F�ѦҤ��m�M�Q�ޥ� (100)�D�M�Q�ޥ� (173)�Q�H�U�M�Q�ޥ� (2)�~���s�����M�Q�ӼЧ� ���M�Q�ӼЧ��M�Q����T�� �ڬw�M�Q��Hemodynamic stability assessment based on heart soundsUS 7938781 B2�K�n A method comprises detecting at least one episode of ventricular tachyarrhythmia in a subject using an implantable medical device (IMD), sensing at least one heart sound signal for the subject using the IMD, the heart sound signal associated with mechanical vibration of a heart of the subject; initiating, in response to and during the detected episode of tachyarrhythmia, a measurement of hemodynamic stability of the ventricular tachyarrhythmia from the heart sound signal, and deeming whether the ventricular tachyarrhythmia is stable according to the measurement of hemodynamic stability. The measurement of hemodynamic stability is determined using linear prediction.
This application may be related to the following, commonly assigned U.S. patent applications: Ser. No. 10/900,570 entitled ��DETERMINING A PATIENT'S POSTURE FROM MECHANICAL VIBRATIONS OF THE HEART,�� filed on Jul. 28, 2004, now issued as U.S. Pat. No. 7,559,901, Ser. No. 10/703,175, entitled ��A DUAL USE SENSOR FOR RATE RESPONSIVE PACING AND HEART SOUND MONITORING,�� filed on Nov. 6, 2003, now issued as U.S. Pat. No. 7,248,923, Ser. No. 10/334,694 entitled ��METHOD AND APPARATUS FOR MONITORING OF DIASTOLIC HEMODYNAMICS,�� filed on Dec. 30, 2002, Ser. No. 10/746,874 entitled ��A THIRD HEART SOUND ACTIVITY INDEX FOR HEART FAILURE MONITORING,�� filed on Dec. 24, 2003, now issued as U.S. Pat. No. 7,115,096, Ser. No. 11/037,275, entitled ��METHOD FOR CORRECTION OF POSTURE DEPENDENCE ON HEART SOUNDS,�� filed on Jan. 18, 2005, now issued as U.S. Pat. No. 7,662,104, Ser. No. 11/129,050, entitled ��METHOD AND APPARATUS FOR CARDIAC PROTECTION PACING,�� filed on May 16, 2005, and Ser. No. 11/148,107, entitled ��ISCHEMIA DETECTION USING HEART SOUND SENSOR,�� filed on Jun. 8, 2005, each of which is hereby incorporated by reference in its entirety.
Cardiac lead 108 includes a proximal end that is coupled to IMD 110 and a distal end, coupled by an electrode or electrodes to one or more portions of a heart 105. The electrodes typically deliver cardioversion, defibrillation, pacing, or resynchronization therapy, or combinations thereof to at least one chamber of the heart 105. The electronics unit of the IMD 110 typically includes components that are enclosed in a hermetically-sealed canister or ��can.�� Other electrodes may be located on the can, or on an insulating header extending from the can, or on other portions of IMD 110, such as for providing pacing energy, defibrillation energy, or both, in conjunction with the electrodes disposed on or around a heart 105. The lead 108 or leads and electrodes may also typically be used for sensing intrinsic or other electrical activity of the heart 105.
Other forms of electrodes include meshes and patches which may be applied to portions of heart 105 or which may be implanted in other areas of the body to help ��steer�� electrical currents produced by IMD 110. The present methods and systems will work in a variety of configurations and with a variety of electrodes.
IMDs can include sensors to monitor heart sounds. An accelerometer is one type of heart sound sensor. An accelerometer converts an acceleration signal due to acoustic vibrations of a heart sound into an electrical signal. A microphone is another type of heart sound sensor. A strain gauge is yet another type of heart sound sensor. A strain gauge converts deformation of the sensor due to heart sound vibrations into an electrical signal. Heart sounds include the ��first heart sound�� or S1, the ��second heart sound�� or S2, the ��third heart sound�� or S3, the ��fourth heart sound�� or S4, and their various sub-components. S1 is indicative of, among other things, mitral valve closure, tricuspid valve closure, and aortic valve opening. S2 is indicative of, among other things, aortic valve closure and pulmonary valve closure. S3 is a ventricular diastolic filling sound often indicative of certain pathological conditions including heart failure. S4 is a ventricular diastolic filling sound resulted from atrial contraction and is usually indicative of pathological conditions. The term ��heart sound�� refers to any heart sound (e.g., S1) and any components thereof (e.g., M1 component of S1, indicative of mitral valve closure). The term heart sound also includes audible and inaudible mechanical vibrations caused by cardiac activity that can be sensed with an accelerometer.
The energy content in heart sounds is predominantly contained in lower frequencies. In some examples, if the low-pass filter circuit 518 has a sharp roll-off, the heart sound sensor interface circuit 515 includes a pre-emphasis circuit. The pre-emphasis circuit has a transfer function of a high-pass filter circuit, but with a lower order than the low-pass filter circuit. The pre-emphasis circuit adds signal gain to higher frequencies of a low-pass filtered heart sound signal. These frequencies include those near the corner frequency of the low-pass filter for example. If the heart sound signal has been digitized, the pre-emphasis transfer function can be implemented mathematically by the controller circuit 525. The term ��controller circuit�� includes a microcontroller, a microprocessor, a digital signal processor, or application specific integrated circuit (ASIC).
The graph 900 also shows that a threshold value T925 of measured He can be chosen so that if, during tachyarrhythmia, a value of He less than the threshold value 925 is measured, the patient's aortic blood pressure may have become inadequately low. The tachyarrhythmia is deemed to be unstable due to the possibly low blood pressure and shock therapy should be administered to the patient. If during tachyarrhythmia, a value higher than the threshold value 925 is measured, treatment can be delayed or a regimen of ATP can be administered to the patient instead of, or prior to, delivery of a shock. In another example, the tachyarrhythmia is deemed to be unstable if a value of He less than the threshold value 925 is measured in X of Y consecutive cardiac cycles, where X and Y are integers and Y��X. In one example, an appropriate threshold value 925 of measured He can be determined from a database containing sampled heart sound data and pressure data from several tachyarrhythmia patients. In another example, an appropriate threshold value 925 of measured He specific to one patient can be determined from a database containing such data only for that patient.
The graph 900 also shows that a baseline value of measured He can be determined for a patient when the patient is not experiencing tachyarrhythmia (region 905). In an example, the baseline is determined from a central tendency of the measured He, such as mean value or a median value. A patient's aortic blood pressure may have become inadequately low if the measured He changes from the baseline He value by more than a predetermined threshold value. A corresponding detected tachyarrhythmia is then deemed to be unstable. In another example, the tachyarrhythmia is deemed to be unstable if the measured He changes, such as a decrease, from the baseline He value by more than a predetermined threshold value in X of Y consecutive cardiac cycles, where X and Y are integers and Y��X.
Sensors can be included in cardiac function management (CFM) devices, such as to monitor a patient's activity. Indications of a patient's activity level are sometimes used to adjust a rate of pacing therapy of a CFM device. Generally, these CFM devices increase a pacing rate in response to an increased activity level of the patient indicated by the sensor. This is sometimes referred to as rate responsive pacing. An accelerometer is one type of sensor that provides electrical signals representative of patient activity. It is sometimes preferable to monitor heart sound signals while a patient is at rest. Thus, in some examples, the hemodynamic stability assessment module 1030 is configured to obtain the measurement of hemodynamic stability from a heart sound signal in correlation with patient activity. Determining that a patient is at rest can be deduced from a patient's heart rate if the IMD 1005 includes rate responsive pacing therapy�Xi.e. the patient's heart rate is at the resting heart rate when the patient is at rest.
In some examples, a measurement of hemodynamic stability from the heart sound signal includes establishing a baseline measurement for the measurement of hemodynamic stability. In some examples, establishing a baseline measurement includes determining a central tendency of the measurement of hemodynamic stability. In some examples, the method 1100 includes deeming the ventricular tachyarrhythmia to be unstable when a measured change from the baseline measurement of hemodynamic stability exceeds a predetermined threshold value. In some examples, the method 1100 includes deeming the ventricular tachyarrhythmia to be unstable when a measured change from the baseline measurement of hemodynamic stability exceeds a predetermined threshold value in X of Y consecutive cardiac cycles, wherein X and Y are integers and Y��X.
Such embodiments of the inventive subject matter may be referred to herein, individually and/or collectively, by the term ��invention�� merely for convenience and without intending to voluntarily limit the scope of this application to any single invention or inventive concept if more than one is in fact disclosed. Thus, although specific embodiments have been illustrated and described herein, it should be appreciated that any arrangement calculated to achieve the same purpose may be substituted for the specific embodiments shown. This disclosure is intended to cover any and all adaptations, or variations, or combinations of various embodiments. Combinations of the above embodiments, and other embodiments not specifically described herein, will be apparent to those of skill in the art upon reviewing the above description.
The Abstract of the Disclosure is provided to comply with 37 C.F.R. ��1.72 (b), requiring an abstract that will allow the reader to quickly ascertain the nature of the technical disclosure. It is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. In addition, in the foregoing Detailed Description, it can be seen that various features are grouped together in a single embodiment for the purpose of streamlining the disclosure. This method of disclosure is not to be interpreted as reflecting an intention that the claimed embodiments require more features than are expressly recited in each claim. Rather, as the following claims reflect, inventive subject matter lies in less than all features of a single disclosed embodiment. Thus the following claims are hereby incorporated into the Detailed Description, with each claim standing on its own.
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