Source: https://patents.google.com/patent/CN105848711A/en
Timestamp: 2018-09-26 07:15:51
Document Index: 668599355

Matched Legal Cases: ['art 115', 'art 115', 'art 115', 'art 115', 'art 115', 'art 115', 'art 115', 'art 115', 'art 170', 'art 115', 'art 115', 'art.\n2']

CN105848711A - Method of facilitating selection of a vector for delivering electrical stimulation to a patient - Google Patents
Method of facilitating selection of a vector for delivering electrical stimulation to a patient Download PDF
CN105848711A
CN105848711A CN 201480069521 CN201480069521A CN105848711A CN 105848711 A CN105848711 A CN 105848711A CN 201480069521 CN201480069521 CN 201480069521 CN 201480069521 A CN201480069521 A CN 201480069521A CN 105848711 A CN105848711 A CN 105848711A
CN 201480069521
喻映红
基思·L·赫尔曼
霍利·E·罗克韦勒
本杰明·J·奈奎斯特
Method of facilitating selection of a vector for delivering electrical stimulation to a patient's heart via an electro-stimulation device having three or more electro-stimulation electrodes, the method comprising displaying a plurality of vectors on a display screen, wherein each vector represents a different combination of the three or more electro-stimulation electrodes. In one example, an intrinsic electrical delay associated with each of two or more left ventricle electrodes may be determined (400). The intrinsic electrical delay associated with each of the two or more left ventricle electrodes may be compared (402) to an electrical delay threshold. A single left ventricle electrode may be selected (404) or two or more of the left ventricle electrodes may be selected (406) for use during subsequent CRT based on the comparison.
促进用于将电刺激输送到病人的矢量的选择的方法 Methods for promoting delivery of electrical stimulation to the patient's vector
[0001] 本公开一般地涉及用于配置植入式医疗设备、并且更具体地用于评估和选择一个或多个矢量以便利用多个电极输送医疗设备的电刺激的系统和方法。 [0001] The present disclosure relates generally to implantable medical devices arranged, and more particularly for evaluating and selecting one or more electrodes using a plurality of vectors to deliver electrical stimulation medical device systems and methods.
[0002] 心脏节律管理设备可以包括一个或多个植入式或移动至设备，诸如起搏器、复律器、除颤器和/或监视一个或多个生理参数和/或提供起搏、除颤以及心脏再同步化治疗中的一个或其组合的设备。 [0002] The cardiac rhythm management device may include one or more implanted or to move equipment, such as a pacemaker, cardioverter, defibrillator, and / or monitor one or more physiological parameters and / or providing pacing, defibrillation and cardiac resynchronization device, or a combination therapy. 此类设备可以被配置成用于多个植入或外部电极，诸如以检测和/ 或治疗心脏疾病。 Such devices may be configured to a plurality of external or implanted electrodes, such as to detect and / or treatment of heart disease. 这些电极被以多个不同的组合配置成用于感测心脏电活动和/或输送电刺激治疗。 The electrodes are arranged in a plurality of different combinations for sensing cardiac electrical activity and / or delivery of electrical stimulation therapy. 将电极的不同组合用于感测心脏电活动可产生相同心脏周期的感测的电活动的不同电极组合。 Different combinations of the electrodes of the electrical activity of different combinations of electrodes for sensing cardiac electrical activity of the cardiac cycle can produce the same sensed. 将电极的不同组合用于输送电刺激治疗到心脏的电极可类似导致治疗的不同有效性。 The different combinations of electrodes for delivering an electrical stimulation therapy to the heart electrodes may similarly lead to different effectiveness of the treatment. 可将这些电极配置中的每一个称为"矢量"。 Each of these electrodes can be arranged is called a "vector." 选择用于感测心脏电活动和/或用于输送电刺激治疗的适当矢量可以帮助改进治疗。 Selecting for sensing cardiac electrical activity and / or a suitable vector for delivery of electrical stimulation therapy can help to improve the treatment.
[0003] 本公开一般地涉及用于评估接近病人的心脏植入的植入式医疗设备系统中的多个矢量且更具体地基于该评估来选择矢量中的一个或多个以便感测心脏电信号和/或输送电刺激治疗的系统和方法。 [0003] The present disclosure relates generally to a plurality of vectors implantable medical device system implanted cardiac assessment for access to the patient in more specifically based on the evaluation to select one or more vectors to sense cardiac electrical systems and methods for treating the signals and / or delivery of electrical stimulation. 基于感测心脏电信号的评估选择矢量中的一个或多个可以帮助植入式医疗设备系统以一致的方式捕捉期望的心脏电信号。 Evaluating the selection based on one or more vectors sensed cardiac electrical signals in the implantable medical device to help the system in a consistent manner to capture a desired cardiac electrical signals. 该心脏电信号对于辅助植入式医疗设备确定适当定时以及用于将电刺激治疗输送到病人的心脏的其他参数是重要的。 The cardiac electrical signal is determined for auxiliary implantable medical device suitable for the timing and delivery of electrical stimulation therapy to patients with other parameters of the heart it is important. 基于用于输送电刺激治疗的评估选择一个或多个矢量可以帮助改进电刺激治疗的有效性。 Evaluation for delivery of electrical stimulation therapy based on the selected one or more vectors can help improve the effectiveness of the electrical stimulation therapy.
[0004] 在一个示例中，一种利用植入式多地点起搏医疗设备为病人提供CRT治疗的方法包括:确定与两个或更多个左心室电极中的每个相关联的固有电延迟，将与所述两个或更多个左心室电极中的每个相关联的固有电延迟与电延迟阈值进行比较，如果与一个或更少的左心室电极相关联的电延迟大于电延迟阈值，则选择左心室电极在后续的CRT治疗期间使用，并且如果与多于一个的左心室电极相关联的电延迟大于电延迟阈值，则选择两个或更多个左心室电极在后续的CRT治疗期间使用。 Determining for each associated intrinsic electrical two or more electrodes in the left ventricle delay: [0004] In one example, the method of the implantable medical device to provide multi-site pacing therapy to a patient comprising a CRT utilizing the inherent delay threshold and the electrical delay of the two or more electrically ventricular electrodes associated with each compared with if a left ventricular electrode electrically or less delay associated electrical delay is greater than the threshold value , the left ventricle electrode is selected for use during the subsequent treatment of CRT, and if the delay left ventricular electrode with more than one associated electrical power is greater than a delay threshold, selecting two or more ventricular electrodes CRT subsequent treatment during use.
[0005] 在另一示例中，一种利用植入式多地步进医疗设备为病人提供CRT治疗的方法包括:感测多个电极对中的每个电极对的一对电极之间的电延迟，将所感测的多个电极对中的每个电极对的电延迟与电延迟阈值进行比较，如果一个或更少的电极对的电延迟大于电延迟阈值，则选择单个电极用作后续的CRT治疗的阴极，并且如果与多于一个的电极对的电延迟大于电延迟阈值，则选择两个或更多个电极都用作后续的CRT治疗期间的阴极。 [0005] In another example, utilizing multi-point implantable medical device into a patient to provide a method for CRT comprising: an electrical connection between a pair of electrodes of each electrode pair of the sensing electrodes of the plurality of delay, a plurality of electrodes electrically sensed on each electrode in electrical delay threshold delay, electrical or less if a pair of electrodes an electrical delay is greater than a delay threshold, a single electrode is selected as the subsequent the cathode of CRT, and if more than one pair of electrodes with an electrical power delay is greater than a delay threshold, selecting two or more electrodes are used as the cathode of the CRT during the subsequent treatment.
[0006] 在另一示例中，一种为病人提供CRT治疗的医疗设备系统可以包括:脉冲发生器、 可操作地联接到脉冲发生器的两个或更多个左心室电极、以及控制器。 [0006] In another example, a method of providing therapy to patients CRT medical device system may comprise: a pulse generator operatively coupled to two or more electrodes ventricular pulse generator, and a controller. 控制器可以被配置成:确定与两个或更多个左心室电极中的每个相关联的固有电延迟，将与所述两个或更多个左心室电极中的每个相关联的固有电延迟与电延迟阈值进行比较，如果与一个或更少的左心室电极相关联的电延迟大于电延迟阈值，则选择单个左心室电极在后续的CRT治疗期间使用，并且如果与多于一个的左心室电极相关联的电延迟大于电延迟阈值，则选择两个或更多个左心室电极在后续的CRT治疗期间使用。 The controller may be configured to: determine two or more electrically intrinsic ventricular electrodes associated with each delay inherent with the left ventricle of the two or more electrodes associated with each of delay and delay electric power threshold value, and if a left ventricular electrode electrically or less delay associated electrical delay is greater than the threshold value, selecting a single ventricular electrode used during the subsequent treatment of CRT, and if with more than one Left ventricular electrode electrically associated electrical delay is greater than a delay threshold, selecting two or more ventricular electrodes CRT used during the subsequent treatment.
[0007] 以上发明内容并不意图描述本公开的每个实施例或每个实施方式。 [0007] The foregoing disclosure is not intended to describe each embodiment or every embodiment of the present disclosure. 通过参考接合附图进行的以下描述和权利要求，本公开的优点和成就以及其更全面理解将变得显而易见并被认识到。 By reference to the following description and the accompanying drawings engaging the claims of the present disclosure and its advantages and achievements fuller understanding will become apparent and appreciated.
[0008] 结合附图而考虑各种说明性实施例的以下描述可更全面地理解本公开，在所述附图中： [0008] The following description of various illustrative embodiments considered in conjunction with the accompanying drawings embodiments may be more fully understood from the present disclosure, in the drawings:
[0009] 图1是可以根据在此描述的各种实施例使用的植入式医疗系统的示意图； [0009] FIG. 1 is a schematic diagram of an implantable medical system embodiments may be used in accordance with various embodiments described herein;
[0010] 图2是包括说明性矢量的植入式医疗系统的示意图； [0010] FIG. 2 is a vector illustrative implantable medical system schematic;
[0011] 图3是植入式医疗设备系统和具有电延迟区域的心脏的示意图； [0011] FIG. 3 is an implantable medical device system delay and a schematic electrical cardiac region having;
[0012] 图4是可以由如图1所示的植入式医疗设备系统实现的方法的流程图； [0012] FIG. 4 is a flowchart of a method may be implemented by an implantable medical device system shown in Figure 1;
[0013] 图5是可以由如图1所示的植入式医疗设备系统实现的方法的流程图。 [0013] FIG. 5 is a flowchart of a method may be implemented by an implantable medical device system shown in Figure 1.
[0014] 虽然本公开可修改为多种改型和替代形式，但是已经在附图中以示例的方式示出其特定细节，并将进行详细描述。 [0014] While the disclosure is amenable to various modifications and alternative forms, the drawings have been shown by way of example the specific details thereof, will be described in detail. 然而，应理解的是并不意图使本公开的各方面局限于所描述的特定说明性实施例。 However, it should be understood that various aspects of the present is not intended that the disclosure be limited to the specific embodiments described illustrative. 相反地，意图涵盖落在本公开的精神和范围内的所有修改、等价物以及替换方案。 On the contrary, it is intended to cover all modifications, equivalents, and alternatives falling within the spirit and scope of the present disclosure.
[0015] 应参考其中将不同图中的类似元件相同地编号的各图来阅读以下描述。 [0015] Reference should be the drawings wherein like elements in different drawings are numbered the same reading the following description. 本描述和不一定按比例的附图描绘说明性实施例，并且并不意图限制本公开的范围。 This description and drawings are not necessarily to scale, depict illustrative embodiments and are not intended to limit the scope of the present disclosure.
[0016] 正常的健康的心脏通过遍及整个心脏传导固有地生成的电信号而引发收缩。 [0016] normal, healthy heart caused by contraction throughout the cardiac conduction of electrical signals inherently generated. 这些固有信号促使心脏的肌细胞或组织收缩。 These muscle cells or tissue inherent signal causes the contraction of the heart. 此收缩迫使血液从心脏出来和进入心脏，遍及身体的其余部分提供血液的循环。 This contraction forces blood from the heart and out into the heart throughout the rest of the body to provide blood circulation. 然而，许多病人遭受影响其心脏的此收缩性的心脏疾病。 However, many patients suffer from this cardiac contractility their heart disease. 例如，某些心脏可逐渐发展不再传导固有电刺激信号的有病组织。 For example, certain heart can no longer evolved intrinsic electrical conductivity of the diseased tissue stimulation signal. 在其它示例中，该有病组织可能不像健康组织那么快地传导固有信号，从而使心脏的收缩去同步。 In other examples, the healthy tissue, diseased tissue may not be the natural signal transduction so quickly, so that the contraction of the heart to be synchronized. 即，心肌的各部分可由于心脏组织相对于固有电信号的不同传导性而比心脏的其它肌细胞更早或更晚地收缩。 That is, since each part of the heart may be different with respect to heart tissue electrical conductivity of intrinsic muscle cells rather than other earlier or the later contraction of the heart. 此不协调收缩可以导致遍及身体其余部分的血液流动的减少，引起各种健康问题。 This uncoordinated contraction may result in a reduction of blood flow throughout the rest of the body parts, causing various health problems.
[0017]已经开发了许多植入式医疗设备aMD)系统以帮助此类有病心脏。 [0017] have developed a number of implantable medical devices aMD) system to help these sick heart. 这些M)系统可包括在病人的心脏上或内部植入的电极。 These M) system may include an electrode on a patient's heart or internal implanted. 頂D系统可通过这些电极向心脏输送电刺激治疗。 D Systems top electrical stimulation therapy may be delivered to the heart via the electrodes. 输送的电刺激治疗可在引起心脏的收缩方面替换或帮助固有地生成的电信号。 Electrical stimulation therapy delivered Alternatively or assist the electrical signal generated inherently in terms of contraction of the heart. 一种电刺激治疗称为心脏再同步化治疗(CRT)。 An electrical stimulation therapy called cardiac resynchronization therapy (CRT). 一般地，CRT包括向心脏输送电刺激脉冲或治疗，有时称为"起搏"，以便辅助心脏的所有部分以正常的同步方式收缩。 Generally, CRT comprising delivering electrical stimulation pulses to the heart or treatment, sometimes called "pacing", all parts of the heart to aid in the normal manner synchronous contraction.
[0018]用于输送CRT的某些MD系统包括多个电极。 Some MD system [0018] for transporting a plurality of electrodes comprises a CRT. 然而，这些頂D系统可仅将这些电极的子集用于感测心脏电信号或在任何给定时间用于输送电刺激治疗。 However, these systems can only top D subset of electrodes for sensing cardiac electrical signals at any given time or for delivery of electrical stimulation therapy. 例如，一些IMD系统在递送电刺激治疗中可以使用两个电极的配置，其中一个电极用于阴极而一个电极用于阳极。 For example, some systems may use IMD two electrodes arranged to deliver electrical stimulation therapy, one of the electrodes for a cathode electrode for the anode. 当通过这样的电极对将电刺激输送到心脏时，经过心脏组织的电刺激所采取的路径，例如其传播途径，可被称为矢量。 When through such electrode pairs deliver electrical stimulation to the heart, electrical stimulation of cardiac tissue through the path taken by, for example, route of transmission, which may be referred to as a vector. 许多生理和物理因素影响在给定心脏植入的頂D系统中的哪个矢量将适合于将CRT输送到心脏。 Which vector physical factors affect many physiological and D on the top of the given system will heart implant suitable for delivery to the heart CRT. 例如，心脏可以具有患病组织的区域，其不会传导电信号或慢于周围组织地传导电信号。 For example, diseased tissue may have a heart region, which does not conduct electrical signals or slower than surrounding tissue to conduct an electrical signal. 在其它实例中，植入电极和心脏组织之间的连接可以导致输送的CRT的功率、效率或传播速度的变异性。 In other examples, the implant is connected between the electrode and the heart tissue may lead to variability in the CRT power delivered, efficiency or propagation velocity. 因此，具有多个可用的矢量的頂D系统，例如由于IMD系统具有三个以上的电极，可以在选择哪个矢量用于输送电刺激治疗前执行所有潜在矢量的评估。 Thus, a vector having a plurality of top D systems available, for example due to IMD system having three or more electrodes, which vector may be selected for execution before all vectors evaluate the potential delivery of electrical stimulation therapy.
[0019] -些頂D系统可以通过多个矢量进一步输送CRT。 [0019] - Some top CRT D system may further conveyed by a plurality of vectors. 例如，一些系统可以使用多个阴极电极和单个阳极电极用于输送CRT。 For example, some systems may use a plurality of cathode electrode and the anode electrode for delivering a single CRT. 通过多个矢量输送CRT可以例如帮助输送的CRT通过接合被破坏组织周围的多个区域而捕捉更大的心脏的区域。 CRT conveyed by a plurality of vectors may e.g. CRT help delivered by joining a plurality of regions surrounding the damaged tissue and to capture a larger area of ​​the heart. 通过多个矢量输送CRT也可以通过具有输送的刺激更迅速地传播经过心脏而帮助生成更同步的心脏收缩。 CRT conveyed by a plurality of vectors may spread rapidly through the heart and to help generate a more synchronized contraction of the heart by having more stimulation delivered. 然而，通过多个矢量输送CRT治疗(例如，"多地点起搏(multi-site pacing)"）经常使用比通过单个矢量(例如，"单地点起搏(single-site pacing)"）输送CRT治疗更多的功率。 However, by a plurality of conveying CRT therapy vectors (e.g., "multi-site pacing (multi-site pacing)") than the frequently used by a single vector (e.g., "single-site pacing (single-site pacing)") therapy delivery CRT more power. 由于许多頂D系统不容易进行更换电池或充电，延长电池的使用寿命通常是重要的设计考虑。 Since many top D system is not easy to replace or recharge, longer battery life is generally an important design consideration.
[0020] 本发明涉及用于确定何时使用单地点起搏或多地点起搏以提供有效的治疗的系统和技术。 [0020] The present invention relates to determining when using single site or multi-site pacing to provide effective pacing therapy systems and techniques. 本发明还涉及用于在多起搏配置中输送CRT以产生有效的心脏收缩的系统和技术。 The present invention further relates to the CRT for delivering pacing configuration to multiple systems and techniques generate efficient cardiac contraction.
[0021] 图1 一般地图示出可以包括植入式医疗设备101的系统100的示例。 [0021] Figure 1 generally illustrates an exemplary system may include an implantable medical device 101 100. 植入式医疗设备101可以被耦合到一个或多个电刺激电极，其可以由一个或多个植入式引线、诸如植入式引线110、120和130承载。 The implantable medical device 101 may be coupled to one or more electrical stimulation electrode, which may consist of one or more implantable leads, such as leads 110, 120 and 130 implanted carrier. 植入式引线110、120和130可以被配置成接收或感测来自心脏115 的心脏电信号。 Implantable leads 110, 120 and 130 may be configured to receive or sense cardiac electrical signals from the heart 115. 植入式医疗设备101可以包括密封或类似外壳111。 The implantable medical device 101 may include a seal housing 111 or the like. 外壳111可以包括钛或另一生物相容材料，诸如一个或多个其它导电材料。 Housing 111 may include titanium or another biocompatible material, such as one or more other conductive materials.
[0022] 在一个示例中，植入式医疗设备101可包括起搏器、除颤器、植入式监视器、药物输送设备、心脏再同步化治疗(CRT)设备、神经刺激设备和/或被配置成监视人或被配置成向人提供一个或多个治疗的一个或多个其它植入式组件中的一个或多个。 [0022] In one example, the implantable medical device 101 may include pacemakers, defibrillators, implantable monitors, drug delivery devices, cardiac resynchronization therapy (CRT) devices, nerve stimulation devices, and / or It is configured to monitor human or configured to provide one or more of one or more people to treat one or more other implantable assembly. 此类监视或治疗的示例可包括向诸如心脏组织之类的组织输送电刺激治疗，或者肌肉或心脏活动的电监视。 Examples of such may include a monitor or therapy delivery of power to the tissue of the cardiac tissue such as a stimulation treatment, or monitoring the electrical activity of the heart or muscle. 在一个示例中，植入式医疗设备101可以包括外部医疗设备，诸如起搏系统分析仪、编程器记录器监视器或者可以用来配置多极植入式引线的系统的其它外部医疗设备。 In one example, the implantable medical device 101 may comprise an external medical device, such as a pacing system analyzer programmer recorder monitor, or may be used to configure multiple other external medical device system implanted electrode lead. 在某些情况下，植入式医疗设备101可包括皮下植入式复律器一除颤器(s-ι⑶)和/或皮下起搏器。 In some cases, implantable medical device 101 may comprise a subcutaneous implantable cardioverter defibrillator a (s-ι⑶) and / or subcutaneous pacemaker.
[0023] 在一些情况下，可通过无引线起搏器(LCP)(其与其他的LCP和/或与另一个植入式医疗设备101通信)来提供一个或多个电极。 [0023] In some cases, by leadless pacemaker (LCP) (which other LCP and / or communicate with other implanted medical device 101) to provide one or more electrodes. LCP的使用可以减少或消除一个或多个可植入引线110、120和130的需要。 LCP may reduce or eliminate the use of one or more implantable leads 110, 120 and 130 need.
[0024] 在图1的示例中，植入式医疗设备101可以诸如经由电极系统107、心外膜电极或外部(例如，皮肤贴片）电极而耦合到心脏115或其它身体组织。 [0024] In the example of Figure 1, the implantable medical device 101 may be coupled to heart 115, such as other body tissues or systems via the electrodes 107, epicardial or external (e.g., skin patches) electrode. 在图1的系统中，电极系统107 包括至少一个引线和用于每个引线的至少一个电极。 In the system of FIG. 1, system 107 includes at least one electrode lead and the at least one electrode for each lead. 图1示出了其中存在三个植入式引线110、120和130的示例。 FIG 1 shows an example wherein there are three implantable leads 110, 120 and 130. 在图1的示例中，可将植入式引线110配置成与心脏115的左心室相关联地使用。 In the example of Figure 1, the implantable lead 110 may be configured to use the left ventricle of the heart 115 in association. 例如，植入式引线110可以被形成尺寸和形状为允许插入到冠状窦和血管内前进中，从而将至少一个电极置于与心脏115的左心室相关联。 For example, implantable leads 110 may be formed in a size and shape to allow insertion into the coronary sinus and intravascular advance, so as to at least one of the left ventricle of the heart 115 placed on the associated electrode. 植入式引线110可以是多极引线， 包括多个电极和相应导体。 The implantable lead 110 may be a multi-electrode lead, comprising a plurality of electrodes and corresponding conductors. 在示例中，植入式引线110可以包括四个分立电极，诸如尖端电极112、第一环形电极114、第二环形电极116以及第三环形电极118。 In an example, the implantable lead 110 may include four discrete electrodes, such as tip electrode 112, a first ring electrode 114, a second annular electrode 116 and a third annular electrode 118. 在示例中，电极114、116 和118可以位于植入式引线110的远侧部分附近。 In an example, the electrodes 114, 116 and 118 may be located near the distal portion 110 of the implantable lead. 电极114、116和118中的每一个可以被电绝缘材料分离，因此将单独电极电隔离。 Electrodes 114, 116 and 118 may each be isolated electrically insulating material, thus electrically isolating the individual electrodes. 四个左心室电极112、114、116和118中的每一个可以对应于唯一电导体，并且可以被在植入式医疗设备101内包含的感测电路106或电刺激电路105单独地寻址。 Four left ventricular electrodes 112, 114 and 118 may each correspond to a unique electrical conductor, and may be contained within the implantable medical device 101 of the sensing circuit 106 or electrical circuit 105 individually addressable stimulation.
[0025]在图1的示例中，植入式引线120可以包括尖端电极122、第一线圈电极124以及第二线圈电极126。 [0025] In the example of Figure 1, the implantable lead 120 may include a tip electrode 122, a first coil and a second coil electrode 124 electrode 126. 如一般地在图1中示出的，植入式引线120在一个示例中可以被插入心脏115的右心房和右心室中，使得第一线圈电极124位于右心室中，并且第二线圈电极126位于右心房中。 As generally shown in FIG. 1, the implantable lead 120 in one example may be inserted into the heart 115 right atrium and right ventricle, so that the first coil electrode 124 located in the right ventricle, and the second coil electrode 126 located in the right atrium.
[0026] 在图1的示例中，植入式引线130可以包括尖端电极132和环形电极134。 [0026] In the example of Figure 1, the implantable lead 130 may include a tip electrode 132 and ring electrode 134. 如一般地在图1中所示，植入式引线130可以被配置成用于插入心脏115的右心房中。 As shown generally in FIG. 1, the implantable lead 130 may be configured for insertion into the right atrium 115 of the heart.
[0027]在图1中提供的植入式引线110、120和130的物理图示仅仅是说明性非限制性示例。 [0027] implantable leads 110 and 120 provided in Figure 1 illustrates the physical and 130 are merely illustrative and non-limiting examples. 其它系统可以包括相对于心脏不同地定位的引线。 Other systems may include differently positioned relative to the heart lead. 另外，其它系统可具有不同数目的电极，并且电极上的引线的定位可不同。 In addition, other systems may have different number of electrodes, and is positioned on the electrode lead may be different. 其它系统还可包括一个或多个植入式引线。 Other systems may also include one or more implantable leads. 在严格地使用LCP的系统中，可不要求或者甚至期望引线。 In the system used strictly LCP, the wire may not be required or even desired. 一般地，本公开的系统和技术有责任地包括可被配置成多个矢量的多个电极的任何系统，无论特定植入位置或电极放置或数目如何。 In general, the systems and techniques of the present disclosure include any of the responsibility of the system may be configured as a plurality of electrodes of a plurality of vectors, regardless of the particular implant location or number of electrodes are placed or how.
[0028] 在一个示例中，植入式医疗设备101可以包括通信电路101、处理器电路103、存储器电路104、电刺激电路105以及感测电路106。 [0028] In one example, the implantable medical device 101 may include a communication circuit 101, processor circuit 103, a memory circuit 104, an electrical stimulation circuit 105 and a sensing circuit 106. 处理器电路103和存储器电路104可以被用来控制植入式医疗设备101的操作。 The processor circuit 103 and the memory circuit 104 may be used to control operation of the implantable medical device 101. 例如，处理器电路103可以被配置成诸如通过使用感测电路106或另一生理传感器来检测心脏状况，并且诸如通过促使电刺激电路105经由一个或多个电极来向心脏115输送电刺激来对所检测心脏状况进行响应。 For example, the processor circuit 103 may be configured to be detected by using a sensing circuit 106 or another physiological sensor, such as a heart condition, and be delivered as an electrical stimulation by causing the electrical stimulation circuitry 105 via one or more of the electrodes to the heart 115 the detected heart condition to respond. 存储器电路104可以包括一个或多个参数，例如用于各种起搏和感测模式、测试程序等。 The memory circuit 104 may include one or more parameters, for example, for various pacing and sensing modes, the test procedures. 存储器电路104可以被配置成存储生理数据，诸如关于心脏115的状况的数据。 The memory circuit 104 may be configured to store the physiological data, such as data regarding the condition of the heart 115. 存储器电路104还可以被配置成存储设备数据，诸如关于测试的状态或测试结果的数据。 The memory circuit 104 may also be configured to store device data, such as data about the status of the test or test results. 在一个示例中，植入式医疗设备101可以使用电刺激电路105或感测电路105来与电极系统107对接。 In one example, the implantable medical device 101 can use electrical stimulation or sensing circuit 105 to circuit 105, 107 interface with the electrode system. 电刺激电路105或感测电路106可以被配置成生成电刺激信号以向心脏115提供电刺激治疗，例如通过使用存储在植入式医疗设备101内的电池(未示出）中所存储的能量。 Electrical stimulation or sensing circuit 105 circuit 106 may be configured to generate electrical stimulation signals to provide electrical stimulation therapy to the heart 115, for example, by using a storage battery (not shown) within the implantable medical device 101, the energy stored in the . 电刺激电路105或感测电路106可以被电耦合到电极系统107。 It may be electrically coupled to the electrical stimulation of the electrode system 107 or circuit 105 sense circuit 106. 例如，可以从电刺激电路105向电极系统107发送电刺激。 For example, electrical stimulation circuitry 105 from transmitting electrical stimulation to the electrode system 107. 同样地，感测电路106可从电极系统107接收信号。 Similarly, sensing circuit 106 may receive a signal 107 from the electrode system. 通信电路102可以被配置成建立植入式医疗设备101与例如外部组件140之间的数据通信链路。 The communication circuit 102 may be configured to establish a data communication link between the implantable medical device 101 and 140 such as an external component.
[0029]在某些情况下，植入式医疗设备101可以被配置成执行矢量评估。 [0029] In some circumstances, implantable medical device 101 may be configured to perform vector evaluation. 例如，处理器电路103可以促使电刺激电路105经由被连接到植入式引线110、120和130的成对电极所创建的某些或所有矢量来输送电刺激。 For example, the processor circuit 103 may cause electrical stimulation of some or all of the vector creating circuit 105 via the pair of electrodes is connected to the implantable leads 110, 120 and 130 to deliver electrical stimulation. 感测电路106可在矢量评估期间检测各种参数，并将所检测的参数存储在存储器电路104中。 Sense circuit 106 may detect various parameters during the vector evaluation, and the detected parameter storage 104 in the memory circuit. 在某些情况下，处理器电路103可经由通信电路102将所检测的参数传送到外部组件140。 In some cases, the processor circuit 103 may be detected parameters 102 transmitted via the communication circuit 140 to external components.
[0030] 可以将植入式医疗设备101配置成经由通信电路102与本地或远程设备、诸如外部组件140通信(有线地或无线地）。 [0030] The implantable medical device 101 may be configured to communicate via the circuit 102 with a local or remote devices, such as a 140 communications (wired or wirelessly) external components. 这可以包括使用RF、光学、声学、传导或其它通信链路。 This may include the use of RF, optical, acoustical, conductive or other communication links. 外部组件140可以是病人管理系统的区段或部分。 External component 140 may be a section or portion of the patient management system. 在一个示例中，外部组件140可以与一个或多个远程客户端、诸如基于网络的客户端通信，或者可以被可通信地耦合到一个或多个服务器，其可以包括医疗和病人数据库。 In one example, the external component 140 may be associated with one or more remote clients, such as client-based communications network, or may be communicatively coupled to one or more servers, and which may include a medical patient database.
[0031] 在某些情况下，外部组件140可以包括通信电路142、处理器电路143、存储器电路144或用户接口145。 [0031] In some cases, the external component 140 may include a communication circuit 142, processor circuit 143, a memory circuit 144 or user interface 145. 在一个示例中，通信电路142可以包括电感线圈或射频遥测电路，并且可以被配置成与植入式医疗设备101通信。 In one example, the communication circuitry 142 may comprise an inductive coil or a radio frequency telemetry circuit, and may be configured to communicate with the implantable medical device 101. 处理器电路143和存储器电路144可以用来解释从用户接口145接收到的信息，并且可以用来确定何时使用通信电路142来与植入式医疗设备101交换信息。 The processor circuit 143 and the memory circuit 144 may be used to interpret the information received from the user interface 145 to, and may be used to determine when the use of the communication circuit 142 to exchange information with implantable medical device 101. 在一个示例中，处理器电路143和存储器电路144可以用来发起至少部分地由外部组件140使用电极系统107来控制的矢量评估。 In one example, the processor circuit 143 and the memory circuit 144 may be used to initiate vector evaluating at least in part using an electrode assembly 140 by an external system 107 controls. 外部组件140可以用来使用电极系统107来执行矢量评估，并且可以被配置成诸如由用户接口145来显示结果。 External electrode assembly 140 may be used to use the system 107 to perform vector evaluator, and may be configured to display the results, such as by the user interface 145. 在某些情况下，外部组件140未被使用，并且其是被配置成使用电极系统107来执行矢量评估的植入式医疗设备101〇 In some cases, the external component 140 is not used, and it is configured to use the electrode system 107 to implantable medical device performs vector evaluation 101〇
[0032] 当被使用时，外部组件140可以是附属(例如，非植入式)外部组件。 [0032] When used, the external component 140 may be a subsidiary (e.g., non-implantable) external components. 在一个示例中， 外部组件140可以包括上文和下面描述的植入式医疗设备101的特征，使得外部组件140可以被配置直接地或间接地被耦合到电极系统107。 In one example, the external component 140 may include features above and implantable medical device 101 described below, such that the external component 140 may be configured to be directly or indirectly coupled to the electrode system 107. 例如，外部组件140可以被配置成评估从电刺激电极112、114、116、118、122、124、126、132和134的全部的各种组合得到的每个电势矢量。 For example, external component 140 may be configured to evaluate each potential vectors of all the various combinations of electrical stimulation from electrodes 112,114,116,118,122,124,126,132 and 134 obtained. 外部组件140可能够通过利用电源(未示出）来执行评估以向电极系统107输送电刺激脉冲。 External component 140 can be configured by using a power source (not shown) evaluation is performed to deliver electrical stimulation pulses to the electrode system 107. 外部组件140可装配有自动地选择被评估矢量中的一个或多个的一个或多个算法并用所选矢量来将植入式医疗设备101配置为。 External component 140 may be equipped with automatically select one or more vectors are evaluated in one or more of the algorithms and with a selected vector to be configured as an implantable medical device 101. 在其它示例中，诸如医生或其它医学专业人员之类的用户可观察评估的结果并提供一个或多个矢量的选择。 In other examples, a user such as a physician or other medical professionals such observations may be assessed and selected to provide one or more vectors. 这些所选矢量可经由通信电路142传送到植入式医疗设备101。 The selected vector may be delivered to the implantable medical device 101 via the communication circuit 142. 通过使用外部组件140来执行矢量评估，植入式医疗设备101可保存功率。 By using external components to perform vector evaluator 140, an implantable medical device 101 to save power.
[0033] 外部组件140的用户接口145可以包括但不限于键盘、鼠标、光笔、触摸屏、显示屏、 打印机或音频扬声器。 The user interface 145 [0033] External assembly 140 may include but are not limited to, a keyboard, a mouse, light pen, touch screen, display screen, printer or audio speaker. 在一个示例中，用户接口145可以被配置为纯色、高清晰度图形显示器，诸如使用IXD计算机监视器。 In one example, the user interface 145 may be configured as a solid, high-resolution graphic display, such as a computer monitor using IXD. 在另一示例中，用户接口145可以被配置成用于用作单色显示器，诸如使用CRT监视器来显示文本。 In another example, the user interface 145 may be configured for use as a monochrome display, such as a CRT monitor used to display text. 在某些示例中，用户接口145可以被配置成交互式地向用户呈现矢量评估的图形表示。 In some examples, user interface 145 may be configured to interactively presented to a user a graphical representation of the vector evaluation. 在其他示例中，用户接口145可以被配置成交互式地呈现矢量评估的基于文本的表示。 In other examples, the user interface 145 may be configured to interactively render text-based representation of the vector evaluation.
[0034] 图2是包括示例性矢量的图1的植入式医疗系统的示意图。 [0034] FIG. 2 is a schematic diagram of an implantable medical system in FIG 1 an exemplary vectors include. 如相对于图1所述，可将植入式医疗设备101的每对电极视为"矢量"。 As described with respect to FIG 1, each pair of electrodes may be an implantable medical device 101 is regarded as a "vector." 针对每对电极，电极中的第一个是阴极电极， 并且电极中的第二个是阳极电极。 For each pair of electrodes, the first electrode is a cathode electrode, and the second electrode is an anode electrode. 在每个所示示例性矢量中，每个矢量的箭头指向阳极电极，并且每个箭头的基点指向阴极电极。 In each of the illustrated exemplary vector, each vector arrow pointing to the anode electrode, and each point of the arrow points to the cathode electrode. 虽然此类矢量被描绘为指示路径的箭头，但矢量仅仅表示当经由特定矢量来输送电刺激时的电刺激传播的一般流动。 Although such vector is depicted as the arrows indicate the path, but is merely representative of the general flow of the vector when the electrical stimulation to deliver electrical stimulation via a specific vector when propagated. 电刺激传播的精确路径将取决于包括生理和物理系统因素的许多因素。 Propagated electrical stimulation exact path will depend on many factors, including physical and physiological factors of the system.
[0035] 在某些示例中，植入式医疗设备101还包括"罐状"电极150,如图2中所示。 [0035] In some examples, the implantable medical device 101 further comprises a "cup-shaped" electrode 150, as shown in FIG. 图2还图示出示例性矢量160、162、164、166和168。 FIG 2 further illustrates an exemplary vector 160,162,164,166 and 168. 在图2中，电极112、114、116、118、122、124和150还被分别地标记为1^1、1^2、1^3、1^4、1^、1?1如和04~(有时在本领域中称为〇)，其是在本领域中有时使用的术语。 In FIG. 2, electrode 112,114,116,118,122,124 and 150 are also respectively labeled 1 ^ 1,1 ^ 2,1 ^ 3,1 ^ 4,1 ^ 1? 1 and 04 as ~ (sometimes referred to in the art square), which is a term sometimes used in the art. 矢量160表示成对的CAN电极和LV2电极，其中，CAN电极是阳极电极且LV2电极是阴极电极。 And a vector 160 represents the CAN electrode LV2 pair of electrodes, wherein, CAN electrode is an anode electrode and a cathode electrode LV2 electrode. 其它矢量162、164、166和168全部表示植入式医疗设备101的矢量的示例。 Other vectors 162, 164, and 168 all represent examples of vectors of an implantable medical device 101. 应理解的是电极的任何组合可表示唯一矢量。 It should be understood that any combination of electrodes may represent a unique vector. 另外，每对电极可以实际上产生两个矢量，这是因为成对电极中的任一个可以是阴极电极或阳极电极。 Further, each pair of electrodes may actually generate two vectors, since any pair of electrodes may be a cathode electrode or anode electrode. 下表1列出了包括RV、LV1、 LV2、LV3、LV4和CAN电极的植入式医疗设备101的所有可能矢量。 Table 1 below lists all the possible vectors include RV, LV1, LV2, LV3, LV4 and the CAN electrode 101 of implantable medical devices. 植入式医疗设备101的全体可能矢量还将包括包含电极126、132、134和RING的组合。 All possible vector implantable medical device 101 will also include a combination of an electrode and RING 126,132,134. 然而，应理解的是在其它植入式医疗设备系统中，特别是具有不同量的电极的那些，系统的矢量的数目可以是不同的。 However, it should be appreciated that in other implantable medical device systems, particularly those having a number of vectors, the system of electrodes of different amounts may be different. 本文所述的示例性技术可适用于包括多个电极的任何此类系统。 The exemplary technique described herein is applicable to any such system comprises a plurality of electrodes.
[0038] 表1 [0038] TABLE 1
[0039] 如上述讨论的，在一些实例中，植入式医疗设备101可经由多个矢量输送CRT。 [0039] For example, in some instances, implantable medical device 101 may be delivered via a plurality of CRT vectors discussed above. 例如，植入式医疗设备101可被配置成经由矢量6和经由矢量16输送CRT。 For example, implantable medical device 101 may be configured via the vector 6 and 16 via vector delivery CRT. 一般，植入式医疗设备101可被配置成经由可用于植入式医疗设备101的矢量的任意组合来输送CRT。 In general, the implantable medical device 101 may be configured to be delivered via a combination of vectors may be used for any implantable medical device 101 of CRT. 确定何时通过单个矢量（"单地点起搏"）或多个矢量（"多地点起搏"）来输送CRT，以及在多地点起搏配置中使用多个矢量中的哪个，在下面进一步讨论。 Determining when a single vector ( "single-site pacing") or a plurality of vectors ( "multi-site pacing") to deliver the CRT, as well as multi-site pacing configuration in which using a plurality of vectors, discussed further below .
[0040] 图3是植入式医疗设备系统的示意图，以及包括电延迟区170的心脏。 [0040] FIG. 3 is a schematic diagram of an implantable medical device system, including the heart and the electrical delay zone 170. 图3还示出了矢量162、164、182和184,其中的矢量182和184可在电延迟区170内发起或穿过电延迟区170。 FIG 3 also shows the vector 162,164,182 and 184, 182 and 184 in which the vector can initiate or delay region 170 through the electrical delay in the region 170 electrically. 电延迟区170可表示患病心脏组织。 Electrical delay area 170 may represent diseased heart tissue. 如上所述，这样的患病心脏组织可以不传导电信号，或者可以比周围的心脏组织更慢地传导电信号。 As described above, such a diseased heart tissue may not conduct electrical signals, or may conduct electrical signals more slowly than the surrounding heart tissue. 因此，通过矢量182或184输送CRT可能导致心脏115的非同步收缩。 Thus, delivery by a vector 182 or 184 may cause CRT 115 to asynchronous contraction of the heart. 例如，通过矢量164输送CRT可能导致相对于电延迟区170电刺激更快地传播经过健康的心脏组织。 For example, CRT 164 conveyed by the vector may result in retardation region 170 relative to the electrical stimulation quickly propagate through healthy heart tissue. 在这种实例中，接收到相对快速地传播电刺激的健康的心脏组织可以以近同步方式收缩。 In this example, the received spread relatively quickly electrical stimulation of healthy cardiac tissue may contract nearly synchronized manner. 然而，电延迟区170的心脏组织可能比健康的心脏组织相对较晚收缩，这造成了非同步收缩。 However, the area of ​​heart tissue electrical delay 170 may be relatively late contraction than healthy heart tissue, which resulted in a non-synchronous contraction. 此外，电延迟区170的心脏组织甚至可能相对于电延迟区域170中的其它心脏组织不同步地收缩，因为在电延迟区170内电刺激传播得更慢。 Furthermore, the electrical delay cardiac tissue region 170 may even be delayed with respect to other electrical cardiac tissue does not shrink region 170 in synchronization, since the region 170 within the electrical stimulation delay spread more slowly. 而且，取决于电延迟区170的尺寸和形状，需要前往到与电延迟区170相邻的地区的电信号可能被堵塞或需要在电延迟区170周围重新路由，导致延迟和非同步收缩。 Moreover, depending on size and shape of electrical delay region 170, it is necessary to delay the electrical signal to the electrical region 170 adjacent to the area may be blocked or rerouted around require electrical delay region 170, resulting in delays and unsynchronized contraction. 这些非同步收缩产生相对低效的心脏收缩，其可以是许多不同的健康问题的原因。 These non-synchronous contraction relatively inefficient cardiac contraction, which may be the cause of many different health problems.
[0041] 因此，在许多情况下，它可以是利于植入式医疗设备101经由在电延迟区170内发起或通过电延迟区170的矢量输送CRT。 [0041] Thus, in many cases, it may be beneficial to implantable medical device 101 via a CRT or delivery by a vector originating electrically retardation region 170 in the region of 170 electrical delay. 例如，如果植入式医疗设备101经由矢量182或184输送CRT，则CRT可以导致心脏以比通过矢量162或164输送CRT更同步的方式收缩。 For example, if the implantable medical device 101 via a delivery vector CRT 182 or 184, the CRT can cause the heart more than the contraction mode synchronization CRT 162 or 164 conveyed by the vector. 在这些实例中，当电刺激在电延迟区170内发起时，电刺激可能在到达周围的健康心脏组织之前传播通过电延迟区170的一部分。 In these instances, when the electrical stimulation in the area 170 launch delayed, electrical stimulation may before reaching the surrounding healthy heart tissue propagation delay part 170 through the electrical area. 当CRT的电刺激传播经过电延迟区170时，患病的心脏组织将开始收缩。 When the CRT electrical stimulation propagation delay through the power zone 170, diseased heart tissue will begin to shrink. 一旦电刺激传播通过电延迟区域170到周围健康心脏组织，电刺激将传播比较快，从而使健康的心脏组织也收缩。 Once the electrical stimulation to the propagation delay through the electrical zone 170 surrounding healthy heart tissue, the electrical stimulation propagate faster, allowing healthy cardiac tissue also contract. 该顺序可导致比通过不在患病心脏组织内发起或穿过患病心脏组织(诸如电延迟区170)的矢量来输送CRT更加同步的收缩心脏。 This sequence can lead to the heart than the diseased tissue by not initiating or through diseased heart tissue (such as an electrical delay region 170) vector to deliver a more CRT synchronous contraction of the heart. 此外，被输送到所述电延迟区170的电刺激可以在时间上提前以帮助弥补电延迟区170中的预期延迟。 Further, the power delivered to the electrical stimulation retardation region 170 may be advanced to help compensate for electrical delay in the time zone 170 of the expected delay.
[0042] 在某些情况下，它可以是利于植入式医疗设备101经由多个矢量，例如经由矢量182和矢量184,以输送CRT。 [0042] In some cases, it may be beneficial to implantable medical device 101 via a plurality of vectors, for example vectors 184 and 182, via vector for delivery CRT. 在所示的实例中，这两个矢量182和184驻留在电延迟区170中。 In the example illustrated, these two vectors 182 and 184 reside in the region of 170 electrical delay. 因此，经由两个矢量182和184输送CRT可以增加该电刺激传播通过并充分饱和电延迟区域170和周围区域所处的速度，因为经由两个矢量182和184输送CRT在其中电刺激发起的电延迟区170内产生两个分开的位置。 Thus, two vectors 182 and 184 may be increased via CRT delivery of the electrical stimulation propagate through the surrounding area and the speed at which the full region 170 and saturation delay, because the electrical stimulation in which initiates transport CRT 182 and 184 via two electrical vector generating two separate locations within the retardation region 170. 可替代地，在一些实例中，可以有益的是，经由多个矢量(其中矢量中的至少一个(或所有的矢量)不在电延迟区170内发起)例如经由矢量162和矢量184或矢量118和矢量162,来输送CRT。 Alternatively, in some instances, may be beneficial, (wherein initiating the at least one vector (or vectors all) is not electrically retardation region 170) via a plurality of vectors for example via a vector or vector 162 and vector 184, and 118 vector 162, conveyed CRT.
[0043] 在其中植入式医疗设备101能够经由多个矢量输送CRT的实施例中，可以期望的是，确定它是否将有利于患者对于植入式医疗设备101经由多个矢量输送CRT(例如使用多地点起搏），特别是因为多地点起搏相对于单地点起搏经常导致植入式医疗设备101的电池的额外消耗。 [0043] in which the implantable medical device 101 can be conveyed via the CRT embodiment a plurality of vectors, it may be desirable to determine whether it will be beneficial for patients with implantable medical device 101 via a plurality of CRT delivery vectors (e.g. using multi-site pacing), particularly as multi-site pacing with respect to the single-site pacing often results in extra consumption of the battery 101 of the implantable medical device. 因此，在植入式医疗设备101植入患者体内的时间，医生或其他医疗专业人员可能导致植入式医疗设备101或外部组件140来执行植入式医疗设备101的矢量的评估。 Thus, at time implantable medical device 101 implanted in the patient, physician or other medical professional may lead to implantable medical device 101 or an external component 140 to perform the evaluation vector of the implantable medical device 101. 例如，医师可以操作植入式医疗设备101，或在一些实例中，操作外部组件140来执行植入式医疗设备101的潜在矢量所有(或所有的子集)的评估。 For example, a physician may operate an implantable medical device 101, or in some examples, an external operating assembly 140 to perform all of the potential vector implantable medical device 101 (or any subset) of the evaluation. 该评估可以测量矢量的许多参数，如阻抗、膈神经刺激、信噪比、捕捉阈值电压以及电延迟等。 The evaluation may be measured a number of parameter vector, such as impedance, phrenic nerve stimulation, signal to noise ratio, the capture threshold voltage and electrical delay. 矢量的阻抗、膈神经刺激、信噪比和/ 或捕捉阈值电压可以被用来确定该特定矢量是否对于输送CRT是可行的。 Impedance vectors, phrenic nerve stimulation, signal to noise ratio and / or capture threshold voltage may be used to determine whether the particular delivery vector is feasible for the CRT. 考虑到植入医疗设备101的电池的额外泄漏，矢量的电延迟可以被用于确定特定患者是否会从多地点起搏受益。 Taking into account the additional leakage implanted medical device battery 101, the electric vector of the delay can be used to determine whether a particular patient will benefit from multi-site pacing. 因此，作为矢量的评估的一部分，植入式医疗设备101可以记录每个可行矢量或电极的电延迟。 Thus, as part of the evaluation of the vector, implantable medical device 101 may record the electric vector of each of the feasible or electrodes delay. 一般地，该电延迟是在对于给定矢量(即，给定的一对电极)下输送电刺激到阴极电极以及检测到阳极电极处的电刺激之间的时间度量。 Generally, the electrical delay is a measure of the time between the delivery of electrical stimulation to the electrical stimulation of a given vector (i.e., a given pair of electrodes) to the cathode electrode and the anode electrode is detected at a. 矢量之间的不同延迟时间可以指示电延迟区或心脏的其他条件的存在。 Different delay times between the vectors may indicate the presence of an electrical retardation region or other conditions of the heart.
[0044] 作为使用图3所示的矢量的一个说明性示例，医师可指示植入式医疗设备101或外部组件140来执行矢量162、164、182和184的评估。 [0044] As an illustrative example of vectors shown in FIG. 3, the physician may indicate that implantable medical device 101 or an external component 140 evaluation is performed 162,164,182 and 184 of the vector. 仅作为示例，评估的结果可以产生电延迟时间，诸如： For example only, result of the evaluation can produce electrical delay time, such as:
[0047] 这些电延迟时间的每一个可以额外地与特定的电极相关联。 [0047] The electrical delay time can additionally each be associated with a particular electrode. 例如，作为将电延迟与矢量相关联替代地或另外地，植入式医疗设备101可将独立电极与电延迟相关联。 For example, the electrical delay associated vector Alternatively or additionally, the implantable medical device 101 may be electrically independent electrodes associated with delay. 在一些实例中，与LV1相关联的电延迟可意味着LV1和RING之间的电延迟，其中LV1是阴极电极。 In some examples, the electrical LV1 associated electrical delay may mean delay between the LV1 and RING, wherein the cathode electrode is LV1. 继续该示例，植入式医疗设备1 〇1或外部组件140可以指示出：电延迟阈值以上的电延迟时间表示电延迟区的存在，诸如表明该患者可能受益于多地点起搏的电延迟区170或其他条件。 Continuing the example, an implantable medical device 〇1 or external component 140 may indicate that: the electrical delay than the delay threshold level indicates the presence of the electrical delay time zone, such indicates that the patient may benefit from multi-site pacing electrical retardation region 170, or other conditions. 因此，植入式医疗设备101或外部组件140可以建议将植入式医疗设备101配置为最初经由多个矢量输送CRT。 Thus, implantable medical device 101 or an external component 140 may be advisable implantable medical device 101 is configured to transport CRT via a plurality of initial vectors.
[0048] 在一些示例中，电延迟阈值可以是，例如70毫秒。 [0048] In some examples, the electrical delay threshold may be, for example, 70 milliseconds. 因此，在该说明性示例中，这两个矢量182和矢量184具有电延迟阈以上的电延迟时间。 Thus, in this illustrative example, these two vectors 182 and the vector 184 has an electrical delay above a threshold electrical delay time. 在一些实例中，其中一个以上的矢量具有电延迟阈值以上的电延迟，植入式医疗设备101或外部组件140可以建议将植入式医疗设备101配置为经由具有大于电延迟阈值的电延迟时间的所有矢量或矢量的一些子集输送CRT。 In some examples, where more than one vector having electrical delay than the threshold delay, implantable medical device 101 or an external component 140 may recommend to configure an implantable medical device 101 is an electrical delay threshold via greater than the electrical delay time All or some subset of the vectors of the vector delivery CRT. 例如，由于矢量182和矢量184都具有大于70毫秒的电延迟时间，所以植入式医疗设备101或外部组件140可以建议将植入式医疗设备101配置为经由两个矢量182和矢量184输送CRT。 For example, since the vector 182 and the vector 184 has an electrical delay time greater than 70 ms, the implantable medical device 101 or an external component 140 may be configured to recommend an implantable medical device 101 to deliver two vectors via the CRT 182 and the vector 184 .
[0049] 在一些实例中，没有矢量或仅单个矢量可具有比电延迟阈值大的电延迟时间。 [0049] In some instances, only a single vector or vector may have a greater delay than the power threshold delay time. 在这些实例中，植入式医疗设备101或外部组件140可以建议将植入式医疗设备101配置为经由单个矢量(例如具有最长延迟的矢量)输送CRT。 In these examples, the implantable medical device 101 or an external component 140 may be advisable implantable medical device 101 configured to communicate via a single vector (e.g., vectors having the longest delay) conveying CRT.
[0050] 在一些情况下，植入式医疗设备101或外部组件140可以在建议输送CRT所经由的矢量中考虑额外因素。 [0050] In some circumstances, implantable medical device 101 or an external component 140 can recommend CRT delivery vectors through which additional factors considered. 例如，每个电极可以另外地与在其引线上的位置相关联。 For example, each electrode may additionally be associated with its position on the lead. 作为仅说明性示例，在图3的实例中，LV4可与位置0相关联，LV3可以与位置15相关联，LV2可以与位置30 相关联，并且LV1可以与位置45相关联，其中每个位置涉及遵循引线的路径110电极离位置0 多少毫米。 As a merely illustrative example, in the example of FIG. 3, the position 0 LV4 is associated with, LV3 may be associated with a location 15, LV2 may be associated with position 30, position 45 and LV1 may be associated, wherein each position It relates to follow the path of the lead electrode 110 mm from the position number 0. 因此，当建议经由哪（些)个矢量输送CRT时，植入式医疗设备101或外部组件140 可考虑阈值电极间距。 Thus, when the recommendation via which (or ones) when the CRT vector delivery, implantable medical device 101 or an external component 140 may be considered the threshold value of the electrode spacing. 例如，如果两个矢量具有比电延迟阈值更大的电延迟，但在两个矢量的阴极电极之间的位置的差小于阈值电极间距，则植入式医疗设备101或外部组件140可以建议将植入式医疗设备101配置为经由具有比电延迟阈值更大的电延迟的两个矢量中的一个而不是两个全部，来输送CRT。 For example, if the two vectors have a larger threshold than the electric delay, but the difference in position between the cathode electrode of the two vectors is smaller than the threshold electrode spacing, the implantable medical device 101 or an external component 140 may be advisable implantable medical device 101 is configured as a two but not all of the delay via the two vectors electrical power than a delay threshold in the larger, conveyed CRT. 在这些实例中，植入式医疗设备101或外部组件140可以建议将植入式医疗设备101配置为经由具有较大电延迟的矢量输送CRT。 In these examples, the implantable medical device 101 or an external component 140 may be configured to recommend an implantable medical device 101 via a vector to deliver a CRT having a large electrical delay. 在其它实例中，植入式医疗设备101或外部组件140可以建议将植入式医疗设备101配置为经由与较小电延迟的矢量输送CRT。 In other examples, the implantable medical device 101 or an external component 140 may be configured to recommend an implantable medical device to deliver a CRT 101 via a vector with a smaller electrical delay.
[0051] 在其中植入式医疗设备101或外部组件140建议将植入式医疗设备101配置为经由多个矢量输送CRT的实例中，植入式医疗设备101或外部组件140可以进一步建议用于输送CRT的各种参数。 [0051] in which the implantable medical device 140 recommendation 101 or an external component 101 to an implantable medical device configured to deliver a plurality of instances of a CRT via a vector, implantable medical device 101 or an external component 140 may be further recommended for transporting various parameters of the CRT. 例如，植入式医疗设备101或外部组件140可以建议将植入式医疗设备101 配置为经由具有起搏偏移的多个矢量输送CRT。 For example, implantable medical device 101 or an external component 140 may be configured to recommend an implantable medical device 101 is conveyed via a plurality of vectors having a CRT pacing offset. 例如，起搏偏移可以是经由第一建议矢量与第二建议矢量输送CRT之间的时间段。 For example, pacing offset may be a first time period between the CRT and the second vector recommendations recommend via vector delivery. 在一些实例中，推荐矢量之间的起搏偏移可以是在矢量之间的电延迟的差。 In some examples, the offset between the pacing vector may be recommended electrical delay difference between vectors. 继续以上图3的实例，植入式医疗设备101或外部组件140可以建议将植入式医疗设备101配置为经由两个矢量182和矢量184输送CRT。 Continuing with the above example of FIG. 3, the implantable medical device 101 or an external component 140 may be configured to recommend an implantable medical device 101 to deliver two vectors via the CRT 182 and the vector 184. 此外，植入式医疗设备101 或外部组件140可以建议将植入式医疗设备101配置为经由相对于经由矢量182输送CRT具有起搏偏移的矢量184输送CRT。 In addition, implantable medical device 101 or an external component 140 may be configured to recommend an implantable medical device 101 via a conveyor 184 having a CRT pacing offset vector with respect to the CRT via a delivery vector 182. 具体地，植入式医疗设备101或外部组件140可以建议将植入式医疗设备101配置为经由相对于经由矢量182输送CRT具有10毫秒的起搏偏移的矢量184输送CRT。 In particular, implantable medical device 101 or an external component 140 may be configured to recommend an implantable medical device 101 with respect to the conveying CRT 10 ms pacing vector offset vector 182 via the CRT 184 via the conveyance. 在本实例中，10毫秒是矢量182和矢量184的电延迟之间的差的一半。 In the present example, 10 ms is half of the difference between the electric vector 182 and the vector 184 of delay. 在其它实例中，所建议的起搏偏移可以是矢量182和矢量184的电延迟之间的差的因子，诸如四分之一、三分之一、二分之一、二、三等。 In other examples, the proposed pacing factor offset may be the difference between the electric vector 182 and the vector of delays 184, such as one-quarter, one third, one half, two, three.
[0052]可替换地，植入式医疗设备101或外部组件140可以不进行将植入式医疗设备101 进行配置的任何建议。 [0052] Alternatively, the implantable medical device 101 or an external component 140 may not be recommended to any implantable medical device 101 is configured. 相反，植入式医疗设备101或外部组件140可自动地将植入式医疗设备101配置为经由根据上述方法确定的矢量输送CRT。 In contrast, the implantable medical device 101 or an external component 140 may automatically configure the implantable medical device 101 via a vector determined by the above method delivery CRT. 在其它实例中，植入式医疗设备101或外部组件140可以简单地导致在诸如用户界面145的用户界面上要显示矢量评估的结果。 In other examples, the implantable medical device 101 or an external component 140 may simply cause the vector to display the results of evaluation on a user interface such as the user interface 145. 医师或其他医疗专业人员可以观看矢量评估的结果。 Physician or other medical professional can view the results of vector assessment. 然后，医生可能会作出确定植入式医疗设备101应该经由哪个矢量输送CRT。 Then, your doctor may make a determination implantable medical device 101 to be transported via CRT which vector. 然后医师可以将植入式医疗设备101配置为经由所确定的矢量输送CRT。 The physician may then be implanted medical device 101 is configured to transport vector via a CRT determined. 在一些实例中，医师可以遵循与上述方法类似的决定过程。 In some instances, the physician may follow the above-described methods similar decision process.
[0053] 虽然上述过程主要是相对于具有比电延迟阈值更大的电延迟的任一单个矢量或两个矢量示出，但是该描述可以外推到具有比阈值电延迟更大的电延迟的三个或四个或任何数量的矢量。 [0053] While the above process is mainly with respect to a threshold having a greater electrical delay of any single vector or two vectors than the electrical delay is shown, but this description can be extrapolated to the electrical delay having a delay greater than the threshold level three or four, or any number of vectors. 例如，在其中三个矢量具有比电延迟阈值更大的电延迟的情况下，植入式医疗设备101或外部组件140可以建议将植入式医疗设备101配置为经由所有三个矢量输送CRT。 For example, in the case where the electrical delay greater than the threshold level of the three delay vector, implantable medical device 101 or an external component 140 may be configured to recommend an implantable medical device to deliver a CRT 101 through all three vectors. 然而，在一些实例中，植入式医疗设备101或外部组件140可以建议将植入式医疗设备101配置为经由两个矢量的最大来输送CRT，而不管具有比电延迟阈值更大的电延迟的矢量的数量。 However, in some instances, implantable medical device 101 or an external component 140 may be configured to recommend an implantable medical device 101 to deliver two vectors to the CRT via a maximum, regardless of the electrical delay greater than the delay threshold number of vectors. 在这些实例中，植入式医疗设备101或外部组件140可以建议将植入式医疗设备101 配置为经由具有最大电延迟的两个矢量输送CRT。 In these examples, the implantable medical device 101 or an external component 140 may be configured to recommend an implantable medical device to deliver a CRT 101 via two electrical vector having the maximum delay. 植入式医疗设备101或外部组件140可以另外考虑矢量的阴极电极相对于彼此的位置。 Implantable medical device 101 or an external component 140 may additionally consider the cathode electrode vector position relative to each other. 如果建议的矢量中的任何两个阴极电极被放置为小于彼此间隔的阈值间距，则植入式医疗设备101或外部组件140可以建议将植入式医疗设备101配置为仅经由建议的矢量对中的一个输送CRT。 If any two of the cathode electrode vectors proposed are placed spaced from each other less than the threshold distance, the implantable medical device 101 or an external component 140 may be advisable implantable medical device 101 is configured as a vector only via the recommendations of the delivery of a CRT. 以这种方式，可植入的医疗设备101或外部组件140可以在其中任何数量的矢量具有比电延迟阈值更大的电延迟的实例中建议经由哪个矢量输送CRT。 In this manner, the implantable medical device 101 or an external component 140 which may suggest via vector delivery CRT any number of instances in which a vector having a value greater than the electrical delay threshold of electrical delay.
[0054]上面的描述集中在初始将植入式医疗设备101配置为经由哪个矢量来在患者体内植入植入式医疗设备101的时间处输送CRT。 [0054] The above description focuses on the initial implantable medical device 101 is configured to be implanted at a time 101 of an implantable medical device in a patient via a delivery vector which CRT. 然而，在最初被配置为经由一个或多个矢量输送CRT之后，植入式医疗设备101可周期性地执行矢量评估，以检测在矢量的电延迟中的任何变化。 However, after being configured via one or more of the CRT vector delivery, implantable medical device 101 may be performed periodically assess the initial vector, to detect any change in the electrical delay in the vector. 例如，作为生理系统，例如心脏的电系统，趋于随时间改变，周期性地重新评估是否将利于经由单个或多个矢量和经由哪个特定矢量输送CRT是重要的。 For example, a physiological system, such as the heart's electrical system tend to change over time, periodically re-evaluate whether a single or multiple vectors facilitate and via which a specific transport vector via a CRT is important. 因此，植入式医疗设备101可以以上述方式执行矢量的评估。 Thus, implantable medical device 101 may perform vector assess the manner described above. 在一些实例中，植入式医疗设备101可以仅对存储在存储器电路104中的特定矢量执行评估。 In some examples, a particular vector implantable medical device 101 may only be stored in the memory circuit 104 evaluation is performed. 例如，在植入时间处的评估期间，植入式医疗设备101、外部组件140或医师可将潜在矢量的列表存储在存储器电路104内。 For example, during the evaluation time at implantation, implantable medical device 101, external component 140 may be a physician or a list of potential vectors stored in the memory circuit 104. 基于评估的其他参数，诸如阻抗、膈神经刺激、LV捕捉阈值或者信噪比可以已经确定这些矢量。 Based on evaluation of other parameters, such as impedance, phrenic nerve stimulation, LV capture threshold or signal to noise ratio has been determined that these vectors can. 以这种方式，植入式医疗设备101可以仅对所有在植入式医疗设备101中的所有可能矢量的子集进行评估。 In this manner, an implantable medical device 101 may be only a subset of all in all implantable medical device 101 may be assessed vector. 另外在一些实例中，植入式医疗设备101可以仅执行存储矢量的电延迟时间的评估。 Further, in some examples, the implantable medical device 101 may be performed only evaluate the electrical delay time stored vectors.
[0055]在其它实例中，植入式医疗设备101被配置为周期性地测量仅仅该植入式医疗设备101被配置为输送CRT所经由的矢量的电延迟。 [0055] In other examples, the implantable medical device 101 is configured to periodically measure only the implantable medical device 101 is configured to deliver power via the CRT delay vector. 植入式医疗设备101可以另外将用于这些矢量的确定出的电延迟存储在存储器电路104中。 Implantable medical device 101 may additionally be used to determine these vectors stored in the memory of the electrical delay circuit 104. 植入式医疗设备101还可以确定新确定出的一个或多个矢量的电延迟与一个或多个存储的电延迟之间的差。 Implantable medical device 101 may also determine a new determined electrical one or more delay difference between the vector and the one or more stored electrical delay. 如果任何这些延迟之间的差大于预定阈值，则植入式医疗设备101可以被配置成执行所有潜在矢量的全面评估，如在任何上述各部分所述的。 If the difference between any of these delay is greater than a predetermined threshold, the implantable medical device 101 may be configured to perform a comprehensive assessment of all potential vectors, as described in any of the respective portions. 例如，完整的评估可以包括确定植入式医疗设备101的所有潜在矢量的阻抗、膈神经刺激、信噪比、LV捕获阈值以及电延迟。 For example, a complete assessment of all potential may include determining an impedance vector of the implantable medical device 101, phrenic nerve stimulation, SNR, LV capture threshold, and an electrical delay. 可替换地，植入式医疗设备101 可以仅对这些存储在存储器电路104中的矢量执行评估。 Alternatively, implantable medical device 101 may be performed only for those evaluation vectors stored in the memory circuit 104. 在其它实例中，完整的评估可仅包括确定用于所有潜在矢量或仅用于存储在存储电路104中的那些矢量的新的电延迟。 In other examples, it may include complete evaluation of potential vectors determined only for all or just for those new electrical vectors stored in the memory circuit 104 delay. 基于这样的评估结果，根据上述技术，植入式医疗设备101可被配置成，诸如通过处理器电路103，调整该植入式医疗设备101输送CRT所经由的特定矢量和/或数量。 Based on this assessment, in accordance with the techniques described above, implantable medical device 101 may be configured, such as by the processor circuit 103 to adjust the specific vector of the implantable medical device 101 via the CRT delivery and / or quantity.
[0056]在一些实例中，植入式医疗设备101被配置为每天一次执行评估或确定电延迟。 [0056] In some examples, the implantable medical device 101 is configured to perform once a day assessing or determining an electrical delay. 在其它实例中，植入式医疗设备101被配置为每周一次、每月一次、每两个月一次或在任何特定的时间周期中一次执行评估或确定电延迟。 In other examples, the implantable medical device 101 is configured to once a week, once a month, once every two months or evaluation is performed one time in any particular time period or to determine the electrical delay. 在其它实例中，除了当来自外部传感器的输入在阈值之上时，植入式医疗设备101可以被配置为周期性地执行评估或确定电延迟。 In other examples, except when the input from an external sensor when above the threshold, the implantable medical device 101 may be configured to periodically perform assessing or determining an electrical delay. 例如，身体活动可以导致心脏的增加心脏速率和灌注。 For example, physical activity can lead to an increase in heart rate and cardiac perfusion. 这种增加心脏速率或血液流动可以暂时改变矢量的电延迟。 This increase in heart rate or blood flow may temporarily change the electric vector of the delay. 因此，在增加的体力活动的时间期间执行评估或确定电延迟以及改变哪（些)个矢量输送CRT的确定可能是有害的。 Thus, evaluation is performed during a time of increased physical activity or to determine which changes the electrical delay and determining a CRT (s) delivery vectors may be harmful. 在这些实例中，植入式医疗设备101可以进一步被配置成从活动传感器(例如经由通信电路102)接收活动水平信息。 In these examples, the implantable medical device 101 may further be configured to receive the level of activity from the activity sensor (e.g., via the communication circuit 102) information. 当周期来到植入式医疗设备101执行评估或确定电延迟时，植入式医疗设备101可以将来自活动传感器的活动水平信息与活动阈值进行比较。 Activity level information and activity threshold evaluation is performed when the period to an implantable medical device 101 determines or electrical delay, an implantable medical device from the activity sensor 101 can be compared. 如果活动水平高于活动阈值，则植入式医疗设备101可以延迟电延迟的评估或确定。 If the activity level is above the activity threshold, the implantable medical device 101 may delay the evaluation or determination of the electrical delay. 例如，植入式医疗设备101可以跳过当前时间段的评估并且简单地等待直到下一个时间周期发生。 For example, implantable medical device 101 may skip the current evaluation period and simply waits until the next period of time occurs. 在其它实例中，植入式医疗设备101可以延迟评估或确定在一段时间内的电延迟，诸如数分钟或数小时。 In other examples, the implantable medical device 101 may be an electrical delay assessing or determining the delay period of time, such as minutes or hours. 在延迟时间已经过去之后，植入式医疗设备101可以从活动传感器接收新的活动水平信息，并将新的活动水平与活动水平阈值进行比较。 After the delay time has elapsed, the implantable medical device 101 may receive information from the new event activity level sensor, and a new activity level is compared with a threshold level of activity. 植入式医疗设备101可以继续该循环直到时间段发生在其中活动水平小于或等于活动水平处。 Implantable medical device 101 may continue the cycle until a time period in which the level of the activity occurs at the level of activity is less than or equal to. 植入式医疗设备101然后可以进行评估或确定电延迟。 Implantable medical device 101 may then be evaluated or determined electrical delay. 在其它实例中，植入式医疗设备101可以被配置成在一天的特定时间执行评估或确定电延迟，其中心脏处于正常、休息状态的概率高，诸如夜间或清晨时期。 In other examples, the implantable medical device 101 may be configured to perform an electrical evaluation or determination of the day at a particular time delay, in which the heart is in a normal, resting state of high probability, such as during the night or early morning.
[0057] 可替换地，在一些情况下，评估可通过检测患者的活动的增加和/或减小而触发。 [0057] Alternatively, in some cases, the evaluation can be triggered by increasing the activity of the patient is detected and / or reduced. 例如，在一些情况下，患者的生理可以为，希望的是当患者是活动的时执行多地点起搏和当患者不是活动的时执行单地点起搏，或反之亦然。 For example, in some cases, the patient may be physiological, desirable when the patient is performing activities when multi-site pacing is not active and when the patient performs single-site pacing, or vice versa. 执行每个活动状态的评估可以识别每个活动状态的适当矢量。 Assessment may be performed in each active state identify an appropriate vector for each active state. 此后，当检测到活动状态时，植入式医疗设备101可以使用如在评估期间确定的用于检测到的状态的适当矢量。 Thereafter, when detecting active implantable medical device 101 may be used as a suitable vector is determined during the evaluation for the detected status.
[0058] 此外，在一些情况下，电延迟阈值可以随时间改变。 [0058] Further, in some cases, the electrical delay threshold may change over time. 例如，可以设想电延迟阈值可以根据患者活动、心脏速率、睡眠状态、因为植入式医疗设备101的植入物的时间长度和/或任何其它合适的参数来改变。 For example, it is contemplated that electrical delay threshold may be based on the patient activity, heart rate, a sleep state, the length of time since implant of the implantable medical device 101 and / or any other suitable parameters to change.
[0059] 基于任何上述评估或确定电延迟的结果，植入式医疗设备101可以调整矢量的数量以及该植入式医疗设备101输送CRT所经由的哪个特定矢量。 [0059] Based on the results of any of the above evaluation or determination of the electrical delay, implantable medical device 101 can adjust the number of vectors and the implantable medical device 101 which particular delivery vector via the CRT. 以这种方式，植入式医疗设备101能够在单地点起搏和多地点起搏之间进行调整，当评估或确定的电延迟结果表示患者可以从多地点起搏中受益时仅采用这样的多地点起搏。 In this manner, an implantable medical device 101 can be adjusted between pacing and pacing multiple sites in a single location, when assessing or determining the electrical delay results are expressed using only the patient may benefit from such multi-site pacing in multi-site pacing. 通过以这种方式调整矢量，植入式医疗设备101可以操作以节省电池寿命。 By adjusting the vector in this manner, the implantable medical device 101 may be operable to save battery life. 此外，通过具有进行多地点起搏的能力，植入式医疗设备101可在某些情况下产生更同步的，因此，更有效的心脏收缩。 Further, by having the ability to perform multi-site pacing, implantable medical device 101 may generate a more synchronized, thus, more effective in some cases systolic.
[0060] 还在其它实例中，在调整该植入式医疗设备101经由哪个矢量输送CRT之后，植入式医疗设备101可以确认该变化已经导致更好的心脏收缩。 [0060] In still other instances, after the adjustment of the implantable medical device 101 via a CRT which vector delivery, implantable medical device 101 can confirm that the change has led to a better cardiac contraction. 例如，植入式医疗设备101可以被配置为从一个或多个传感器接收信息。 For example, implantable medical device 101 may be configured to receive information from one or more sensors. 在其中传感器是在植入式医疗设备101外部的实例中，植入式医疗设备101可以经由通信电路102接收来自传感器的信息。 In the example in which the sensor is external to the implantable medical device 101, the implantable medical device 101 may receive information from the sensor 102 via the communication circuit. 一些示例传感器包括心音传感器、血压传感器和加速度计。 Some examples of sensors include heart sound sensors, blood pressure sensors and accelerometers. 植入式医疗设备101可以在调整植入式医疗设备101经由哪个矢量输送CRT之后从一个或多个这样的传感器接收信息。 Implantable medical device 101 may receive information from one or more of such sensors in an implantable medical device after adjusting the CRT 101 via a conveyance which vector. 然后植入式医疗设备101可以将新的信息与来自存储在存储器电路104中的一个或多个传感器的信息进行比较。 Then implantable medical device 101 may be a new message from the information stored in the memory circuit 104 are compared or more sensors. 基于信息的比较，植入式医疗设备101可以确定矢量的调整是否已增加心脏的收缩。 Based on the comparison of information, adjusting the implantable medical device 101 may determine whether the vector has increased contraction of the heart. 例如， 植入式医疗设备101可以在调整该植入式医疗设备101经由哪个矢量输送CRT之后，从血压传感器接收血压信息，其指示出相对于在植入式医疗设备101进行矢量的调整之前存储在存储器电路104中的心脏速率或左心室血压信息的增加的心脏速率或左心室血压信息。 For example, implantable medical device 101 may adjust the implantable medical device 101 after delivery of the CRT, the blood pressure information received from the pressure transducer via which vector, which indicates that the previously stored with respect to the adjustment vector in the implantable medical device 101 increased heart rate or blood pressure in the left ventricle of the heart rate information or left ventricular blood pressure information in the memory circuit 104. 在这些实例中，植入式医疗设备101可以确定矢量的调整已经增加了心脏的收缩。 In these examples, the adjustment implantable medical device 101 may determine the vector has increased contraction of the heart. 对于其他类型的信息，例如来自任何心音传感器的信号的强度或来自加速度计的信号的强度，可以做出类似确定。 For other types of information, such as the strength of the signal from any sensor or heart sound intensity of the signal from the accelerometer, and can make a similar determination. 在其中植入式医疗设备101从单地点起搏切换到多地点起搏、但已经基于来自附加传感器的信息确定了如传感器所指示的该调整没有增加心脏的收缩或心脏的其他机械功能的实例中，植入式医疗设备101可以切换回到单地点起搏。 Wherein the implantable medical device 101 is switched from single to multi-site pacing site pacing, but the adjustment has been determined as indicated by the sensor based on information from the additional sensors do not increase the systolic function of the heart or other mechanical Examples , the implantable medical device 101 may be switched back to the single-site pacing. 在其中从单地点起搏切换到多地点起搏不显现增加心脏的收缩或心脏的其他机械功能的实例中，由于单地点起搏使用相对较少的能量，继续单地点起搏可以是有益的。 Wherein the switch from a single pacing site does not appear to multi-site pacing example increased systolic or other mechanical functions of the heart, since the single-site pacing using relatively little energy to continue single-site pacing may be beneficial .
[0061] 图4是可以由诸如图1所示的植入式医疗设备系统实现的方法的流程图。 [0061] FIG. 4 is a flowchart of a method may be implemented by an implantable medical device, such as the system shown in FIG. 虽然图4 的方法相对于图1的医疗设备系统进行说明，但是图4的方法可以通过任何合适的医疗设备系统进行。 Although the method of FIG. 4 with respect to the medical device system of FIG. 1 will be described, but the method of Figure 4 may be performed by any suitable medical device system.
[0062] 医疗设备系统，诸如图1的系统100,可以确定两个或更多个左心室电极之间的电延迟(400)。 [0062] The medical device system, such as system 100 of FIG. 1, may be determined between two or more electrodes ventricular delay (400). 例如，植入式医疗设备101可以输送电刺激脉冲到一个或多个阴极电极并感测在一个或多个阳极电极处的输送的电刺激脉冲。 For example, implantable medical device 101 may deliver electrical stimulation pulses to one or more sensing cathode electrode and measuring at one or more anode electrodes of the stimulation pulses delivered. 在一个实例中，植入式医疗设备1 〇1可以经由在心脏的右心室115中的RV电极输送一个或多个电刺激脉冲。 In one example, an implantable medical device may 〇1 one or more electrical stimulation pulses via the delivery electrodes in the right ventricle RV of the heart of 115. 植入医疗设备101可以另外感测在心脏115的左心室中的一个或多个LV1-LV4电极处的输送的电刺激脉冲。 The implantable medical device 101 may sense additional electrical stimulation pulses delivered to one or more electrodes LV1-LV4 measured in the left ventricle 115. 在输送电刺激到阴极电极以及检测在阳极电极处的电刺激之间的确定出的电延迟可以被称为起搏电延迟(paced electrical delay)。 In the delivery of electrical stimulation to the cathode electrode and detecting electrical stimulation between the anode electrode at the determined power delay it may be called the pacemaker electrical delay (paced electrical delay). 在其它实例中，电延迟可以包括固有电延迟。 In other examples, electrical power delay may include an inherent delay. 例如，植入式医疗设备101可以在心脏115的右心室中的一个或多个电极(诸如RV电极)情况下感测固有去极化波。 For example, implantable medical device 101 may be one or more electrodes in the right ventricle of the heart 115 (such as an RV electrode) sensing intrinsic depolarization wave case. 植入式医疗设备101可以另外地在心脏115的左心室中的一个或多个电极(诸如任何LV1-LV4电极)情况下感测固有去极化波。 Implantable medical device 101 may additionally be in the left ventricle 115 in the one or more electrodes (such as any electrode LV1-LV4) sensing intrinsic depolarization wave case. 在右心室中的电极情况下的感测与在左心室中的电极情况下的感测之间的确定出时间差值可以是与左心室电极相关联的固有电延迟。 Determining the time difference between the sensing electrode and the sensing in the left ventricle in the case of an electrode in the right ventricle may be electrically inherent delay associated with left ventricular electrodes. 还在其它实例中，植入式医疗设备可以确定与电极的任何组合相关联的电延迟(起搏或固有的）。 In still other examples, any combination of electrical implantable medical device may determine the delay associated electrode (paced or intrinsic). 然后植入式医疗设备101可以将确定出的电延迟和电延迟阈值进行比较(402)。 Then implantable medical device 101 may determine the delay and the electrical power threshold delay (402).
[0063] 如果与一个或更少的左心室电极相关联的电延迟大于电延迟阈值，则植入式医疗设备101可以选择左心室电极在后续的CRT治疗期间使用(404)。 [0063] If one or less of the left ventricular electrode electrically associated electrical delay is greater than a delay threshold, the implantable medical device 101 can be selected using the left ventricular electrode (404) during the subsequent treatment of a CRT. 例如，在只确定与左心室电极相关联的单个电延迟大于电延迟阈值之后，植入式医疗设备101可以被诸如处理器电路103配置成经由该特定左心室电极输送CRT治疗。 For example, only a single power associated with the determined left ventricular electrode after a delay greater than a delay threshold power, implantable medical device 101 may be configured as a processor circuit 103 to deliver the particular CRT treatment via the left ventricle electrode. 如果与一个以上的左心室电极相关联的延迟大于延迟阈值，则植入式医疗设备101可以选择两个或更多个左心室电极在后续的CRT治疗期间使用(406)。 If the left ventricle with more than one electrode associated delay is greater than a delay threshold, the implantable medical device 101 may select two or more of the left ventricle using the electrodes (406) during the subsequent treatment of a CRT. 例如，在确定与左心室电极相关联的多于一个的电延迟大于电延迟阈值之后，植入式医疗设备101可以被诸如处理器电路103配置成经由多个左心室电极输送CRT 治疗。 For example, after determining the power associated with the left ventricle electrode is greater than the electrical delay of more than a delay threshold, implantable medical device 101 may be configured to deliver such a processor circuit 103 via a plurality of CRT left ventricular electrodes.
[0064] 图5是可以由诸如图1所示的植入式医疗设备系统实现的方法的流程图。 [0064] FIG. 5 is a flowchart of a method may be implemented by an implantable medical device, such as the system shown in FIG. 虽然将相对于图1的医疗设备系统来对图4的方法进行说明，但是图4的方法可以通过任何合适的医疗设备系统进行。 Although the method will be described with respect to FIG. 4 medical device system of FIG. 1, but the method of Figure 4 may be performed by any suitable medical device system.
[0065] 医疗设备系统，诸如图1的系统100,可以确定多个电极对中的每个电极对的一对电极之间的电延迟(500)。 [0065] The medical device system, such as system 100 of FIG. 1, each electrode may be determined in a plurality of electrodes between the electrodes of a pair of delay (500). 例如，植入式医疗设备101可以输送电刺激脉冲到在心脏115的右心室中的阴极电极，例如RV电极。 For example, implantable medical device 101 may deliver electrical stimulation pulses to the cathode electrode in the right ventricle of the heart 115, e.g. RV electrodes. 植入式医疗设备101可以进一步感测在心脏115中的阳极电极(例如任何LV1-LV4电极)处的输送的电刺激。 Implantable medical device 101 may further sense the anode electrode 115 is detected in the heart (e.g., any electrode LV1-LV4) to deliver electrical stimulation at. 输送电刺激到阴极电极和感测在阳极电极处的电刺激之间的延迟是确定出的起搏电延迟。 Supplying electrical stimulation to the cathode electrode and the sensing delay between the anode electrode of the electrical stimulation is determined pacing electrical delay. 植入式医疗设备101可以进一步输送及感测对于每一对阴极电极和阳极电极的电刺激。 The implantable medical device 101 may further conveyed and sense electrical stimulation for each cathode electrode and the anode electrode. 在其它实例中，植入式医疗设备101可以通过在第一电极情况下感测去极化波和在第二电极情况下感测相同的去极化来确定固有电延迟。 In other examples, the implantable medical device 101 can be by sensing a depolarization wave and the second electrode in the case of the same depolarization sensed intrinsic electrical delay is determined in the case of the first electrode. 在第一电极情况下感测去极化波和在第二电极情况下感测波之间的时间差可以是固有电延迟。 Sensing depolarization wave and the second electrode in the case where the time difference between the waves may be sensed intrinsic electrical delay in the case where the first electrode. 在任何情况下，植入式医疗设备101可以确定电极的任意组合之间的电延迟。 In any case, any combination of electrical connection between an implantable medical device 101 may determine the delay electrode. 然后植入式医疗设备101可以将多个电极对中的每个电极对的感测出的电延迟与电延迟阈值进行比较(502)。 Then implantable medical device 101 may be an electrical delay of the inductance of the plurality of electrodes in each electrode measured delay threshold value (502).
[0066] 如果一个或更少的电极对的电延迟大于电延迟阈值，则植入式医疗设备101可以选择单个电极充当用于后续CRT治疗的阴极(504)。 [0066] If a power electrode pairs or less delay is greater than the electrical delay threshold, the implantable medical device 101 may select a single electrode functioning as a cathode (504) for subsequent treatment of the CRT. 例如，在只确定单个电延迟大于电延迟阈值之后，植入式医疗设备101可以被诸如处理器电路103配置成经由该特定电极(其中该电极用作阴极电极)输送CRT治疗。 For example, after determining only a single electrical power delay is greater than a delay threshold, implantable medical device 101 may be configured such that the processor circuit 103 to communicate via a particular electrode (wherein the cathode electrode is used as an electrode) CRT therapy delivery. 如果一个以上的电极对的电延迟大于电延迟阈值，则植入式医疗设备101可以选择两个或更多个电极在后续的CRT治疗期间每个电极充当阴极(506)。 If more than one pair of electrodes electrically in the electric delay is greater than a delay threshold, the implantable medical device 101 may select two or more electrodes in the CRT during each subsequent treatment electrode functions as a cathode (506). 例如，在确定一个以上的电延迟大于电延迟阈值之后，植入式医疗设备101可以被诸如处理器电路103配置成经由多个电极(其中多个电极中的每个用作阴极电极)输送CRT治疗。 For example, after determining one or more electrical power delay is greater than a delay threshold, implantable medical device 101 may be configured as a processor circuit 103 to communicate via a plurality of electrodes (a cathode electrode is used as each of the plurality of electrodes) conveying CRT treatment. 如果在两个或更多个电极中的至少两个之间的间距小于阈值电极间距，则植入式医疗设备101可以进一步被配置为取消选择所述两个或更多个电极中的至少一个(508)。 If the spacing between the at least two electrode spacings less than a threshold at two or more electrodes, the implantable medical device 101 may be further configured to deselect the two or more electrodes at least one of (508). 例如， 每个电极可以与在承载电极的引线上的位置相关联。 For example, each electrode may be associated with the position of the carrier on the lead electrode. 在这样的实例中，如果基于电延迟的比较，植入式医疗设备101选择两个或更多个电极充当用于输送CRT治疗的阴极电极，则如果与两个或更多个所选择的电极相关联的位置之间的差小于阈值，植入式医疗设备101可以附加地取消选择两个或更多个电极中的至少一个。 In such instances, if the selected two or more electrodes acting as a cathode electrode for delivering electrical delay of CRT-based comparison, implantable medical device 101, and if the two or more selected electrodes less than a threshold difference between the position of the associated implantable medical device 101 may additionally deselect two or more electrodes at least one.
[0067] 本领域的技术人员将认识到除在本文中描述和设想的特定实施例之外可用多种形式来表明本公开。 [0067] Those skilled in the art will recognize that the available other than the specific embodiments contemplated and described herein show that several forms of the present disclosure. 因此，在不脱离如在所附权利要求中描述的本公开的范围和精神的情况下可进行形式和细节方面的修改。 Thus, without departing from the scope and spirit of the present disclosure as described in the appended claims modifications in form and detail may be made.
1. 一种用于促进矢量的选择以经由具有三个或更多电刺激电极的电刺激设备向病人的心脏输送电刺激的方法，所述方法包括： 在显示屏上显示多个矢量，其中，每个矢量表示三个或更多电刺激电极的不同组合； 确定所述多个矢量中的每个矢量的电阻抗； 在显示屏上显示确定出的所述多个矢量中的每个矢量的电阻抗； 接收所述多个矢量的集合的选择； 针对所述多个矢量的集合中的每个矢量确定捕捉阈值； 在显示屏上显示所述多个矢量的集合中的每个矢量的捕捉阈值； 接收来自所述多个矢量的集合中的、用于向病人的心脏输送电刺激的矢量的选择；以及将电刺激设备编程为在向病人的心脏输送电刺激时使用所选矢量。 1. A method for facilitating selection vectors via the method have three or more electrical stimulation electrode of the electrical stimulation apparatus conveying electrical stimulation to a patient's heart, the method comprising: displaying a plurality of vectors on a display screen, wherein each vector represents a different combination of three or more stimulation electrodes; determining the electrical impedance of each vector in the plurality of vectors; displaying the plurality of vectors determined in each vector on the display screen electrical impedance; receiving a selection of said plurality of sets of vectors; determining capture threshold for a set of said plurality of vectors each vector; displaying the set of plurality of vectors each vector on a display screen capture threshold; receiving a set of vectors from said plurality of selecting vector for delivering electrical stimulation to a patient's heart; and electrical stimulation device is programmed using the selected vector as when transporting electrical stimulation to the patient's heart.
2. 根据权利要求1的方法， 其中，在显示屏上显示所述多个矢量之后但在接收所述多个矢量的集合的选择之前， 该方法还包括： 确定所述多个矢量中的每个矢量的电延迟；以及在显示屏上显示确定出的所述多个矢量中的每个矢量的电延迟和电阻抗。 2. The method of claim 1, wherein, on a display screen of the plurality of vectors after receiving but before said selected set of a plurality of vectors, the method further comprising: determining a plurality of vectors each of electrical delay vectors; and displaying said electrical delay and a plurality of electrical impedance vectors determined in each vector on the display screen.
3. 根据权利要求2的方法，还包括： 在显示屏上以表格格式显示确定出的所述多个矢量中的每个矢量的电延迟和电阻抗， 其中，所述多个矢量每个被用行表示，并且确定出的电延迟和确定出的电阻抗被用列表不。 Display electrodes each delay vector and said plurality of electrical impedance vectors determined in each vector on the display screen in a tabular format, wherein the plurality of: 3. The method according to claim 2, further comprising He represents a row, and determining the electrical impedance and electrical delay determined not to be a list.
4. 根据权利要求3的方法，还包括： 选择第一列；以及将表格按所选第一列排序。 4. A method according to claim 3, further comprising: selecting a first column; and the table sorted by the first selected column.
5. 根据权利要求4的方法，还包括： 在选择第一列之后选择第二列；以及将表格按第一列排序，并且随后若在第一列中存在重复条目，则将重复条目按第二列排序。 The method according to claim 4, further comprising: selecting a second column after selecting a first column; and the table sorted by the first column, and then if duplicate entries in the first column, the entry will be repeated by the first two sorting.
6. 根据权利要求4的方法，还包括： 从按第一列排序的表格中选择一个或多个行； 选择第二列；以及将所选行按所选第二列排序。 6. The method according to claim 4, further comprising: selecting from the first column of the table sorted by one or more rows; selecting a second column; the selected row and column of the selected second sort.
7. 根据权利要求1-6中的任一项的方法，还包括： 针对所述多个矢量的至少子集确定膈神经刺激的存在或不存在；以及在显示屏上显示确定出的所述矢量的每个的膈神经刺激的存在或不存在。 7. A method according to any one of claims 1 to 6, further comprising: determining for at least a subset of the diaphragm plurality of vectors presence or absence of neural stimulation; and displaying the determined on the display screen the presence or absence of each of the phrenic nerve stimulation vector.
8. 根据权利要求7的方法， 还包括基于膈神经的存在将所述多个矢量排序。 8. A method according to claim 7, further comprising based on the presence of the phrenic nerve plurality of sorting vector.
9. 根据权利要求1-8中的任一项的方法， 其中，所述多个矢量的集合少于所述多个矢量的全部。 9. A method according to any one of claims 1-8, wherein the plurality of vectors of said plurality of less than all of a set of vectors.
10. 根据权利要求1-9中的任一项的方法，还包括： 显示速率下限参数，并且其中，所述速率下限参数是由用户可配置的。 10. The method of any one of claims 1-9, further comprising: a display rate limit parameter, and wherein said rate limit parameter is user-configurable.
11. 根据权利要求1-10中的任一项的方法，还包括： 显示起搏AV延迟参数，并且其中，所述速率下限参数是由用户可配置的。 11. The method according to any one of claims 1 to 10, further comprising: displaying the pacing AV delay parameters, and wherein said rate limit parameter is user-configurable.
12. 根据权利要求1-11中的任一项的方法，还包括： 显示振幅参数，并且其中，所述振幅参数是由用户可配置的。 12. The method of any one of claims 1-11, further comprising: displaying an amplitude parameter, and wherein the amplitude parameter is user-configurable.
13. 根据权利要求1-12中的任一项的方法，还包括： 显示脉冲宽度参数，并且其中，所述脉冲宽度参数是由用户可配置的。 13. The method according to any one of claims 1-12, further comprising: displaying a pulse width parameters, and wherein the pulse width parameter is user-configurable.
14. 根据权利要求1-13中的任一项的方法，还包括： 显示每步周期参数，并且其中，所述每步周期参数是由用户可配置的。 14. The method of any one of claims 1 to 13, further comprising: a display cycle parameter for each step, and wherein each said step period parameter is user-configurable.
15. 根据权利要求1-14中的任一项的方法，还包括： 显示LV保护时段参数，并且其中，所述LV保护时段参数是由用户可配置的。 15. A method according to any one of claims 1-14, further comprising: a display period LV protection parameters, and wherein said LV guard period parameter is user-configurable.
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CN 201480069521 CN105848711A (en) 2013-12-18 2014-12-18 Method of facilitating selection of a vector for delivering electrical stimulation to a patient
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