Patent US5174289A successfully refreshed from Google Patents.
US5174289A
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Pacing systems and methods for control of the ventricular activation sequence
Assignee: Individual
•
Filing: 1990-09-07
•
Granted: 1992-12-29
•
Expires: 2010-09-07
Abstract
Abstract Apparatus and methods for improving the ventricular activation sequence of the heart by pacing at an advantageous selected ventricular location to achieve shortening of the QRS complex or pacing at multiple advantageous selected ventricular locations, either simulataneously or with a programmed delay or delays between firings, to achieve shortening of the QRS complex in combination with producing a desirable and efficient ventricular motion. During a cardiac cycle initiated by intrinsic cardiac activity, stimulating impulses may be directed to advantageous selected locations of the ventricles by employing intrinsic cardiac signals to trigger the stimulating impulses, either simultaneously or with a programmed delay or delays between the sensed event or events and firing event or events, to provide improved mechanical and electrical ventricular function.
Inventors
- 👤 Fred M. Cohen
Bibliographic Details
Application Number
—
Jurisdiction
US
Data Source
google_patents
Last Synchronized
2026-11-02 14:23
CPC Classifications
A; A61; A61N; A61N1/00; A61N1/02; A61N1/04; A61N1/05; A61N1/056; A61N1/18; A61N1/32; A61N1/36; A61N1/362; A61N1/365; A61N1/368
Claims Analysis
Total Claims: 66
Claim 1
Independent Claim
301 words
A method for improving the ventricular function of the heart of a patient comprising the steps of: (a) monitoring the electrocardiogram of a patient to determine the duration of the patient's ZRS complex; (b) introducing a lead incorporating at least two electrodes of the same polarity thereon for electrical contact with ventricular muscle, each electrode electrically connected to a different lead terminal; (c) manipulating said lead to position at least two of said electrodes in electrical contact with said ventricular muscle; (d) electrically connecting all said lead terminals to an implantable pulse generator incorporating noninvasive means for selective pacing through each terminal from at least one output pole and electrically connecting at least one electrical group location, or polarity opposite to that of said electrodes, to the other pole of said pulse generator to complete each selected electrical circuit; (e) providing pacing pulses from said pulse generator to at least two selected terminals, one at a time, at a constant rate determined to stimulate said ventricular muscle in the absence of ventricular fusion; (f) noninvasevely positioning the location of the pacing pulse by employing said pulse generator noninvasive means to select the one of said terminals that produces the minimum QRS duration with respect to said electrode locations on said lead; (g) setting said implantable pulse generator at a desired predetermined time interval; sensing intrinsic cardiac signals from at least one said terminal during a cardiac cycle; and employing the first of said cardiac signal sin the electronic control circuit of said pulse generator to inhibit the deliverance of pacing pulses to said selected terminal upon occurrence of said first cardiac signal within said predetermined time interval and cause the deliverance of pacing pulses to said selected terminal upon the absence of any said cardiac signal with said predetermined time interval.
Claim 2
Independent Claim
301 words
A method for improving the ventricular function of the heart of a patient comprising the steps of: (a) monitoring the electrocardiogram of a patient to determine the duration of the patient's ZRS complex; (b) introducing a lead incorporating at least two electrodes of the same polarity thereon for electrical contact with ventricular muscle, each electrode electrically connected to a different lead terminal; (c) manipulating said lead to position at least two of said electrodes in electrical contact with said ventricular muscle; (d) electrically connecting all said lead terminals to an implantable pulse generator incorporating noninvasive means for selective pacing through each terminal from at least one output pole and electrically connecting at least one electrical group location, or polarity opposite to that of said electrodes, to the other pole of said pulse generator to complete each selected electrical circuit; (e) providing pacing pulses from said pulse generator to at least two selected terminals, one at a time, at a constant rate determined to stimulate said ventricular muscle in the absence of ventricular fusion; (f) noninvasevely positioning the location of the pacing pulse by employing said pulse generator noninvasive means to select the one of said terminals that produces the minimum QRS duration with respect to said electrode locations on said lead; (g) setting said implantable pulse generator at a desired predetermined time interval; sensing intrinsic cardiac signals from at least one said terminal during a cardiac cycle; and employing the first of said cardiac signal sin the electronic control circuit of said pulse generator to inhibit the deliverance of pacing pulses to said selected terminal upon occurrence of said first cardiac signal within said predetermined time interval and cause the deliverance of pacing pulses to said selected terminal upon the absence of any said cardiac signal with said predetermined time interval.
Claim 3
Independent Claim
427 words
A method for improving the ventricular function of the heart of a patient comprising the steps of: (a) monitoring the electrocardiogram of a patient to determine the duration of the patient's QRS complex: (b) introducing a lead incorporating at least two electrodes of the same polarity thereon for electrical contact with the ventricular muscle, each electrode electrically connected to a different lead terminal; (c) manipulating said lead to position at least two of said electrodes in electrical contact with said ventricular muscle; (d) electrically connecting each terminal to at least one output pole of a pulse generator and electrically connecting at least one electrical group location, of polarity opposite to that of said electrodes, to the other pole of said pulse generator in order to complete each electrical circuit; (e) providing pacing pulses from said pulse generator to at least one selected terminal, one at a time, at a constant rate determined to stimulate said ventricular muscle in the absence of ventricular fusion; (f) analyzing said selected electrode positions to determine their respective resultant QRS durations and, if desired, further manipulating said lead to re-position said electrodes and analyzing such new positions to determine if a shorter resultant QRS duration is obtained; (g) electrically connecting all said lead terminals to an implantable pulse generator incorporating noninvasive means for selective pacing through each terminal from at least one output pole and electrically connecting at least one electrical ground location, of polarity opposite to that of said electrodes, to the other pole of said implantable pulse generator to complete each selected electrical pacing circuit; (h) providing pacing pulses from said implantable pulse generator to at least two selected terminals, one at a time, at a constant rate determined to stimulate said ventricular muscle in the absence of ventricular fusion; (i) noninvasively positioning the location of the pacing pulse by employing said implantable pulse generator noninvasive means to select the one of said terminals that produces the minimum QRS duration with respect to said electrode locations on said lead; (j) setting said implantable pulse generator at a desired predetermined time interval; sensing intrinsic cardiac signals from at least one said terminal during a cardiac cycle; and (l) employing the first of said cardiac signals in the electronic control circuit of said pulse generator to inhibit the deliverance of pacing pulses to said selected terminal upon occurrence of said first cardiac signal within said predetermined time interval and cause the deliverance of pacing pulses to said selected terminal upon the absence of any said cardiac signal within said predetermined time interval.
Claim 4
Independent Claim
427 words
A method for improving the ventricular function of the heart of a patient comprising the steps of: (a) monitoring the electrocardiogram of a patient to determine the duration of the patient's QRS complex: (b) introducing a lead incorporating at least two electrodes of the same polarity thereon for electrical contact with the ventricular muscle, each electrode electrically connected to a different lead terminal; (c) manipulating said lead to position at least two of said electrodes in electrical contact with said ventricular muscle; (d) electrically connecting each terminal to at least one output pole of a pulse generator and electrically connecting at least one electrical group location, of polarity opposite to that of said electrodes, to the other pole of said pulse generator in order to complete each electrical circuit; (e) providing pacing pulses from said pulse generator to at least one selected terminal, one at a time, at a constant rate determined to stimulate said ventricular muscle in the absence of ventricular fusion; (f) analyzing said selected electrode positions to determine their respective resultant QRS durations and, if desired, further manipulating said lead to re-position said electrodes and analyzing such new positions to determine if a shorter resultant QRS duration is obtained; (g) electrically connecting all said lead terminals to an implantable pulse generator incorporating noninvasive means for selective pacing through each terminal from at least one output pole and electrically connecting at least one electrical ground location, of polarity opposite to that of said electrodes, to the other pole of said implantable pulse generator to complete each selected electrical pacing circuit; (h) providing pacing pulses from said implantable pulse generator to at least two selected terminals, one at a time, at a constant rate determined to stimulate said ventricular muscle in the absence of ventricular fusion; (i) noninvasively positioning the location of the pacing pulse by employing said implantable pulse generator noninvasive means to select the one of said terminals that produces the minimum QRS duration with respect to said electrode locations on said lead; (j) setting said implantable pulse generator at a desired predetermined time interval; sensing intrinsic cardiac signals from at least one said terminal during a cardiac cycle; and (l) employing the first of said cardiac signals in the electronic control circuit of said pulse generator to inhibit the deliverance of pacing pulses to said selected terminal upon occurrence of said first cardiac signal within said predetermined time interval and cause the deliverance of pacing pulses to said selected terminal upon the absence of any said cardiac signal within said predetermined time interval.
Claim 5
Dependent Claim
21 words
The method of claim 2 wherein at least two of said electrodes on said lead are connected to one lead terminal.
Claim 6
Dependent Claim
24 words
The method of claim 2 wherein said step (c) of manipulating said lead includes positioning the end of said lead at a ventricular apex.
Claim 7
Dependent Claim
52 words
The method of claim 2 wherein said step (f) of analyzing said electrode positions includes manipulating said lead in an endocardial position within a ventricular chamber to position one electrode at a point to yield the minimum QRS duration possible as compared to QRS durations obtained when pacing at any other point.
Claim 8
Independent Claim
332 words
A method for improving the ventricular function of the heat of a patient comprising the steps of: (a) monitoring the electrocardiogram of a patient to determine the duration of the patient's QRS complex: (b) introducing a lead incorporating at least two electrodes of the same polarity thereon for electrical contact with ventricular muscle, each electrode electrically connected to a different lead terminal; (c) manipulating said lead to position at least two of said electrodes in electrical contact with said ventricular muscle; (d) electrically connecting all said lead terminals to an implantable pulse generator incorporating noninvasive means for selective pacing through any combination of said terminals or an individual terminal, from at least one output pole and electrically connecting at least one electrical ground location, of polarity opposite to that of said electrodes, to the other pole of said pulse generator to complete the electrical circuits selected and to provide simultaneous pacing pulses to said selected combinations of terminals; (e) providing pacing pulses from said pulse generator to a selected individual terminal or any selected combination of terminals, one selection at a time, at a constant rate determined to stimulate said ventricular muscle in the absence of ventricular fusion; (f) noninvasively positioning the location of the pacing pulses by employing said pulse generator to select the combination of said terminals or individual terminal that produces the minimum QRS duration with respect to said electrode locations on said lead; (g) setting said implantable pulse generator at a desired predetermined time interval; (h) sensing intrinsic cardiac signals from at least one said terminal during a cardiac cycle; and (i) employing the first of said cardiac signals in the electronic control circuit of said pulse generator to trigger the deliverance of pacing pulses to said selected terminals simultaneous with the occurrence of said first intrinsic signal within a predetermined time interval and cause the deliverance of simultaneous pacing pulses to said selected terminals upon the absence of any said cardiac signal within said predetermined time interval.
Claim 9
Independent Claim
332 words
A method for improving the ventricular function of the heat of a patient comprising the steps of: (a) monitoring the electrocardiogram of a patient to determine the duration of the patient's QRS complex: (b) introducing a lead incorporating at least two electrodes of the same polarity thereon for electrical contact with ventricular muscle, each electrode electrically connected to a different lead terminal; (c) manipulating said lead to position at least two of said electrodes in electrical contact with said ventricular muscle; (d) electrically connecting all said lead terminals to an implantable pulse generator incorporating noninvasive means for selective pacing through any combination of said terminals or an individual terminal, from at least one output pole and electrically connecting at least one electrical ground location, of polarity opposite to that of said electrodes, to the other pole of said pulse generator to complete the electrical circuits selected and to provide simultaneous pacing pulses to said selected combinations of terminals; (e) providing pacing pulses from said pulse generator to a selected individual terminal or any selected combination of terminals, one selection at a time, at a constant rate determined to stimulate said ventricular muscle in the absence of ventricular fusion; (f) noninvasively positioning the location of the pacing pulses by employing said pulse generator to select the combination of said terminals or individual terminal that produces the minimum QRS duration with respect to said electrode locations on said lead; (g) setting said implantable pulse generator at a desired predetermined time interval; (h) sensing intrinsic cardiac signals from at least one said terminal during a cardiac cycle; and (i) employing the first of said cardiac signals in the electronic control circuit of said pulse generator to trigger the deliverance of pacing pulses to said selected terminals simultaneous with the occurrence of said first intrinsic signal within a predetermined time interval and cause the deliverance of simultaneous pacing pulses to said selected terminals upon the absence of any said cardiac signal within said predetermined time interval.
Claim 10
Independent Claim
483 words
A method for improving the ventricular function of the heart of a patient comprising the steps of: (a) monitoring the electrocardiogram of a patient to determine the duration of the patient's QRS complex: (b) introducing a lead incorporating at least two electrodes of the same polarity thereon for electrical contact with ventricular muscle, each electrode electrically connected to a different lead terminal; (c) manipulating said lead to position at least two of said electrodes in electrical contact with said ventricular muscle; (d) electrically connecting selected combinations of said terminals or individual terminals in turn to at least one output pole of a pulse generator and electrically connecting at least one electrical ground location, of polarity opposite to that of said electrodes, to the other pole of said pulse generator in order to complete the electrical circuits selected and to provide simultaneous pacing pulses to said selected combinations of terminals; (e) providing pacing pulses from said pulse generator to a selected individual terminal or any selected combination of terminals, one selection at a time, at a constant rate determined to stimulate said ventricular muscle in the absence of ventricular fusion; (f) analyzing said selected electrode positions to determine their respective resultant QRS durations and, if desired, further manipulating said lead to re-position said electrodes and analyzing such new positions to determine if a shorter resultant QRS duration is obtainable; (g) electrically connecting all said lead terminals to an implantable pulse generator incorporating noninvasive means for selective pacing through any combination of said terminals or an individual terminal, from at least one output pole and electrically connecting at least one electrical ground location, of polarity opposite to that of said electrodes, to the other pole of said implantable pulse generator to complete the electrical circuits selected and to provide simultaneous pacing pulse to said selected combinations of terminals; (h) providing pacing pulses from said implantable pulse generator to a selected terminal or any selected combination of terminals, one selection at a time, at a constant rate determined to stimulate said ventricular muscle in the absence of ventricular fusion; (i) noninvasively positioning the location of the pacing pulses by employing said implantable pulse generator noninvasive means to select the combination of said terminals or an individual terminal that produces a desired QRS duration with respect to said electrode locations on said lead; (j) setting said implantable pulse generator at a desired predetermined time interval; sensing intrinsic cardiac signals from at least one said terminal during a cardiac cycle; and (l) employing the first and said cardiac signals in the electronic control circuit of said pulse generator to trigger the deliverance of pacing pulses to said selected terminals simultaneous with the occurrence of said first intrinsic signal within a predetermined time interval and cause the deliverance of simultaneous pacing pulses to said selected terminals upon the absence of any said cardiac signal within said predetermined time interval.
Claim 11
Independent Claim
483 words
A method for improving the ventricular function of the heart of a patient comprising the steps of: (a) monitoring the electrocardiogram of a patient to determine the duration of the patient's QRS complex: (b) introducing a lead incorporating at least two electrodes of the same polarity thereon for electrical contact with ventricular muscle, each electrode electrically connected to a different lead terminal; (c) manipulating said lead to position at least two of said electrodes in electrical contact with said ventricular muscle; (d) electrically connecting selected combinations of said terminals or individual terminals in turn to at least one output pole of a pulse generator and electrically connecting at least one electrical ground location, of polarity opposite to that of said electrodes, to the other pole of said pulse generator in order to complete the electrical circuits selected and to provide simultaneous pacing pulses to said selected combinations of terminals; (e) providing pacing pulses from said pulse generator to a selected individual terminal or any selected combination of terminals, one selection at a time, at a constant rate determined to stimulate said ventricular muscle in the absence of ventricular fusion; (f) analyzing said selected electrode positions to determine their respective resultant QRS durations and, if desired, further manipulating said lead to re-position said electrodes and analyzing such new positions to determine if a shorter resultant QRS duration is obtainable; (g) electrically connecting all said lead terminals to an implantable pulse generator incorporating noninvasive means for selective pacing through any combination of said terminals or an individual terminal, from at least one output pole and electrically connecting at least one electrical ground location, of polarity opposite to that of said electrodes, to the other pole of said implantable pulse generator to complete the electrical circuits selected and to provide simultaneous pacing pulse to said selected combinations of terminals; (h) providing pacing pulses from said implantable pulse generator to a selected terminal or any selected combination of terminals, one selection at a time, at a constant rate determined to stimulate said ventricular muscle in the absence of ventricular fusion; (i) noninvasively positioning the location of the pacing pulses by employing said implantable pulse generator noninvasive means to select the combination of said terminals or an individual terminal that produces a desired QRS duration with respect to said electrode locations on said lead; (j) setting said implantable pulse generator at a desired predetermined time interval; sensing intrinsic cardiac signals from at least one said terminal during a cardiac cycle; and (l) employing the first and said cardiac signals in the electronic control circuit of said pulse generator to trigger the deliverance of pacing pulses to said selected terminals simultaneous with the occurrence of said first intrinsic signal within a predetermined time interval and cause the deliverance of simultaneous pacing pulses to said selected terminals upon the absence of any said cardiac signal within said predetermined time interval.
Claim 12
Dependent Claim
40 words
The method of claim 7 wherein said step (i) of noninvasively positioning includes selecting the combination of terminals that produces the minimum QRS duration with respect to the electrodes' locations on the lead as determined by said monitoring step (a).
Claim 13
Dependent Claim
69 words
The method of claim 7 wherein said step (l) of employing said cardiac signals comprises employing the first of said cardiac signals in the electronic control circuit of said pulse selected electrodes upon occurrence of said first cardiac signal with said predetermined time interval and cause the deliverance of simultaneous pacing pulses to said selected electrodes upon the absence of any said cardiac signal within said predetermined time interval.
Claim 14
Dependent Claim
67 words
The method of claim 7 wherein said step (c) of manipulating said lead includes positioning a first said electrode in an area of said ventricular muscle where early activation is desired and positioning at least one other said electrode in an area or areas of the ventricular muscle where avoidance of late activation is desired, as determined by the QRS interval resulting from said analyzing step (f).
Claim 15
Dependent Claim
26 words
The method of claim 7 wherein said step (c) of manipulating said lead includes positioning certain electrodes at positions to produce a more desirable ventricular motion.
Claim 16
Dependent Claim
21 words
The method of claim 7 wherein said step (c) of manipulating said lead includes positioning said electrodes within a ventricular chamber.
Claim 17
Dependent Claim
48 words
The method of claim 12 wherein said step (f) of analyzing said electrode positions includes positioning two of said electrodes in contact with ventricular muscle to produce a QRS duration that is shorter than the QRS duration obtained by pacing at any individual point in the ventricular muscle.
Claim 18
Dependent Claim
28 words
The method of claim 12 wherein said step (c) of manipulating said lead includes positioning one electrode at the ventricular apex and another electrode at a midseptal position.
Claim 19
Dependent Claim
37 words
The method of claim 14 wherein said step (c) of manipulating said lead includes positioning at least one additional electrode in a septal position between said two previously positioned electrodes, to produce a more desirable ventricular motion.
Claim 20
Dependent Claim
92 words
The method of claim 7 wherein said step (l) of employing the first of said cardiac signals comprises delivering a pacing pulse to a second terminal at a programmed time delay interval from the occurrence of said first cardiac signal at a first terminal within said predetermined time interval and delivering a pacing pulse to said first terminal upon the absence of said first cardiac signal at said first terminal within said predetermined time interval followed by a second pacing pulse delivered to said second terminal at expiration of said delay interval.
Claim 21
Dependent Claim
25 words
The method of claim 16 wherein said delayed pacing pulses are inhibited by intrinsic cardiac activity occurring at the second terminal within the delay interval.
Claim 22
Dependent Claim
23 words
The method of claim 17 wherein the electrical power delivered to each terminal and sensitivity of each terminal are independently and noninvasively adjustable.
Claim 23
Dependent Claim
23 words
The method of claim 17 wherein said implantable pulse generator is simultaneously connected to at least two ground locations of the same polarity.
Claim 24
Dependent Claim
23 words
The method of claim 19 wherein at least one of said ground locations is on the lead and outside of a ventricular chamber.
Claim 25
Dependent Claim
22 words
The method of claim 20 wherein said implantable generator incorporates noninvasive means for selection of said ground locations or location during pacing.
Claim 26
Dependent Claim
22 words
The method of claim 21 wherein said implantable generator incorporates noninvasive means for selection of said ground locations or location during sensing.
Claim 27
Dependent Claim
20 words
The method of claim 17 wherein the programmed time delay interval is adjustable from about 0 to about 75 msec.
Claim 28
Independent Claim
28 words
The method of claim wherein said implantable pulse generator incorporates a rate adaptive sensor to automatically adjust said predetermined interval in response to physiologic indications of cardiac demand.
Claim 29
Dependent Claim
21 words
The method of claim 24 wherein said delay interval is automatically adjusted in response to said physiologic indications of cardiac demand.
Claim 30
Dependent Claim
23 words
The method of claim 17 wherein said lead incorporates at least two of said electrodes electrically connected to one of said lead terminals.
Claim 31
Dependent Claim
20 words
The method of claim 26 wherein said lead incorporates at least two terminals each electrically connected to at least two
Claim 32
Dependent Claim
17 words
The method of claim 16 wherein at least two delays are employed between at least three terminals.
Claim 33
Dependent Claim
25 words
The method of claim 28 wherein the delayed pulse are inhibited by intrinsic cardiac activity occurring at their respective terminals within their respective delay intervals.
Claim 34
Dependent Claim
23 words
The method of claim 29 wherein the electrical power delivered to each terminal and sensitivity of each terminal are independently and noninvasevely adjustable.
Claim 35
Dependent Claim
27 words
The method of claim 30 wherein each delay interval is independently adjustable and the sum of the multiple delays is from about 0 to about 75 msec.
Claim 36
Dependent Claim
29 words
The method of claim 31 wherein said implantable pulse generator incorporates a rate adaptive sensor to automatically adjust said predetermined interval in response to physiologic indications of cardiac demand.
Claim 37
Dependent Claim
20 words
The method of claim 32 wherein said delay intervals are automatically adjusted in response to physiologic indications of cardiac demand.
Claim 38
Dependent Claim
21 words
The method of claim 31 wherein said lead incorporates at least two electrodes electrically connected to one of said lead terminals.
Claim 39
Dependent Claim
21 words
The method of claim 34 wherein said lead incorporates at least two terminals each electrically connected to at least two electrodes.
Claim 40
Dependent Claim
82 words
A lead adapted for connection to a pulse generator comprising at least two electrodes thereon for electrical contact with the endocardial surface of a ventricular chamber and a preformed curvature within the ventricular chamber, said preformed curvature beginning at the distal end of said lead, extending through an approximate arc of forth five degrees and having a radius of curvature of approximately one inch, for the purpose of facilitating the placement of said electrodes in desired locations by manipulation of said lead.
Claim 41
Dependent Claim
82 words
A lead adapted for connection to a pulse generator comprising at least two electrodes thereon for electrical contact with the endocardial surface of a ventricular chamber and a preformed curvature within the ventricular chamber, said preformed curvature beginning at the distal end of said lead, extending through an approximate arc of forth five degrees and having a radius of curvature of approximately one inch, for the purpose of facilitating the placement of said electrodes in desired locations by manipulation of said lead.
Claim 42
Dependent Claim
20 words
The apparatus of claim 36 further comprising a second preformed curvature proximal to said preformed curvature within the ventricular chamber.
Claim 43
Dependent Claim
38 words
An electrode for location on a cylindrical portion of a pacing lead in electrical contact with a ventricular chamber incorporating an outwardly curved contacting surface to improve said electrode's pacing threshold and capability of sensing intrinsic cardiac signals.
Claim 44
Dependent Claim
38 words
An electrode for location on a cylindrical portion of a pacing lead in electrical contact with a ventricular chamber incorporating an outwardly curved contacting surface to improve said electrode's pacing threshold and capability of sensing intrinsic cardiac signals.
Claim 45
Dependent Claim
103 words
Cardiac electrical stimulation apparatus comprising: first means for sensing a first ventricular depolarization at a first ventricular location; second means having output means and responsive to said first sensing means for providing a stimulating impulse to said first ventricular location upon the absence of said first depolarization within a predetermined time interval; third means for sensing a second ventricular depolarization at a second ventricular location; and fourth means having output means and responsive to said third means for providing a stimulating impulse to said second ventricular location upon the absence of said second ventricular depolarization within said predetermined interval and a delay interval.
Claim 46
Dependent Claim
103 words
Cardiac electrical stimulation apparatus comprising: first means for sensing a first ventricular depolarization at a first ventricular location; second means having output means and responsive to said first sensing means for providing a stimulating impulse to said first ventricular location upon the absence of said first depolarization within a predetermined time interval; third means for sensing a second ventricular depolarization at a second ventricular location; and fourth means having output means and responsive to said third means for providing a stimulating impulse to said second ventricular location upon the absence of said second ventricular depolarization within said predetermined interval and a delay interval.
Claim 47
Dependent Claim
21 words
Apparatus according to claim 39 wherein said first and second ventricular locations are on the endocardial surface of a ventricular chamber.
Claim 48
Dependent Claim
33 words
Apparatus according to claim 39 wherein said first ventricular location is on the endocardial surface of the ventricular chamber and said second ventricular location is on the epicardial surface of a ventricular chamber.
Claim 49
Dependent Claim
59 words
Apparatus according to claim 39 additionally comprising: fifth means for sensing a third ventricular depolarization at a third ventricular location; and sixth means having output means and responsive to said fifth means for providing a stimulating impulse to said third ventricular location upon the absence of said third ventricular depolarization within said predetermined interval and a second delay interval.
Claim 50
Dependent Claim
59 words
Apparatus according to claim 42 additionally comprising: seventh means for sensing a fourth ventricular depolarization at a fourth ventricular location; and eighth means having output means and responsive to said seventh means for providing a stimulating impulse to said fourth ventricular location upon the absence of said fourth ventricular depolarization within said predetermined interval and a third delay interval.
Claim 51
Dependent Claim
45 words
Apparatus according to claim 39 wherein said first means senses first ventricular depolarization at least two first ventricular locations and said second means for providing stimulating impulses to said first ventricular locations upon the absence of said first ventricular depolarization within said predetermined time interval.
Claim 52
Dependent Claim
49 words
Apparatus according to claim 44 wherein said third means senses second ventricular depolarizations at least two second ventricular locations and said fourth means for providing stimulating impulses to said second ventricular locations upon the absence of a second ventricular depolarization within said predetermined interval and said time delay interval.
Claim 53
Dependent Claim
154 words
Cardiac electrical stimulation apparatus comprising: first means for sensing a first ventricular depolarization at a first ventricular location; second means having output means and responsive to said first sensing means for providing a stimulating impulse to said first ventricular location upon the absence of said first depolarization within a predetermined time interval; third means for sensing a second ventricular depolarization at a second ventricular location; and fourth means having output means and responsive to said first and third means for providing a stimulating impulse to said second location at a programmed time delay interval from the occurrence of said first depolarization within said predetermined interval in the absence of said second depolarization within said delay interval and providing a stimulating impulse to said second ventricular location at said time delay interval from the absence of said first depolarization within said predetermined interval in the absence of said second ventricular depolarization within said delay interval.
Claim 54
Dependent Claim
154 words
Cardiac electrical stimulation apparatus comprising: first means for sensing a first ventricular depolarization at a first ventricular location; second means having output means and responsive to said first sensing means for providing a stimulating impulse to said first ventricular location upon the absence of said first depolarization within a predetermined time interval; third means for sensing a second ventricular depolarization at a second ventricular location; and fourth means having output means and responsive to said first and third means for providing a stimulating impulse to said second location at a programmed time delay interval from the occurrence of said first depolarization within said predetermined interval in the absence of said second depolarization within said delay interval and providing a stimulating impulse to said second ventricular location at said time delay interval from the absence of said first depolarization within said predetermined interval in the absence of said second ventricular depolarization within said delay interval.
Claim 55
Dependent Claim
46 words
Apparatus according to claim 46 wherein said first means senses first ventricular depolarization at at least two first ventricular locations and said second means for providing stimulating impulses to said first ventricular locations upon the absence of said first ventricular depolarization within said predetermined time interval.
Claim 56
Dependent Claim
23 words
Apparatus according to claim 46 wherein said implantable pulse generator is simultaneously connected to at least two ground locations of the same polarity.
Claim 57
Dependent Claim
115 words
Apparatus according to claim 46 additionally comprising fifth means for sensing a third ventricular depolarization at a third ventricular location; and sixth means having output means and responsive to said first and fifth means for providing a stimulating impulse to said third location at a second programmed time delay interval from the occurrence of said first depolarization within said predetermined interval in the absence of said third polarization within said second time delay interval and providing a stimulating impulse to said third ventricular location at said second time delay interval from the absence of said first depolarization within said predetermined interval in the absence of said third ventricular depolarization within said second time delay interval.
Claim 58
Dependent Claim
22 words
Apparatus according to claim 49 wherein said first, second and third ventricular locations are on the endocardial surface of a ventricular chamber.
Claim 59
Dependent Claim
41 words
Apparatus according to claim 50 wherein said first ventricular location is at a ventricular apex, said second ventricular location is at a midseptal position and said third ventricular location is at a septal position between said first and second ventricular locations.
Claim 60
Dependent Claim
116 words
Apparatus according to claim 49 additionally comprising seventh means means for sensing a fourth ventricular depolarization at a fourth ventricular location; and eighth means having output means and responsive to said first and seventh means for providing a stimulating impulse to said fourth location at a third programmed time delay interval from the occurrence of said first depolarization within said predetermined interval in the absence of said fourth polarization within said third time delay interval and providing a stimulating impulse to said fourth ventricular location at said third time delay interval from the absence of said first depolarization within said predetermined interval in the absence of said fourth ventricular depolarization within said third time delay interval.
Claim 61
Dependent Claim
19 words
Apparatus according to claim 46 wherein said first and second ventricular locations are on the endocardial surface of a
Claim 62
Dependent Claim
25 words
Apparatus according to claim 53 wherein said first ventricular location is at a ventricular apex and said second ventricular location is at a midseptal position.
Claim 63
Dependent Claim
29 words
Apparatus according to claim 46 wherein said implantable pulse generator incorporates a rate adaptive sensor to automatically adjust said predetermined interval in response to physiologic indications or cardiac demand.
Claim 64
Dependent Claim
21 words
Apparatus according to claim 55 wherein said delay interval is automatically adjusted in response to said physiologic indications of cardiac demand.
Claim 65
Independent Claim
328 words
A method for improving the ventricular function of the heart of a patient, presenting with wide QRS complexes of intrinsic origin, comprising the steps of: (a) monitoring the electrocardiogram of a patient to determine the duration of the patient's QRS complex; (b) introducing a lead incorporating at least two electrodes of the same polarity thereon for electrical contact with ventricular muscle, each electrode electrically connected to a different lead terminal; (c) manipulating said lead to position at least two of said electrodes in electrical contact with said ventricular muscle; (d) electrically connecting at least two of said individual terminals to at least one output pole of a pulse generator and electrically connecting at least one electrical ground location, of polarity opposite to that of said electrodes, to the other pole of said pulse generator in order to complete each electrical circuit; (e) sensing intrinsic cardiac signals from at least one said terminal during a cardiac cycle; (f) employing the first of said cardiac signals in the electronic control circuit of said pulse generator to trigger the deliverance of pacing pulses to selected terminals simultaneous with the occurrence of said first intrinsic signal within a predetermined time interval and cause the deliverance of simultaneous pacing pulses to said selected terminals upon the absence of any said cardiac signal within said predetermined time interval; (g) providing pacing pulses from said pulse generator to at least one other selected terminal at a rate determined by intrinsic electrical activity in order to stimulate said ventricular muscle in the presence of ventricular fusion; (h) analyzing said electrode positions to determine their respective resultant QRS duration as compared to the intrinsic QRS duration and, if desired, further manipulating said lead to re-position said electrodes and analyzing such new positions to determine if a shorter resultant QRS is obtained; and (j) providing pacing pulses from said pulse generator to a desired combination of terminals that produces a shorter QRS duration than the patient's intrinsic QRS.
Claim 66
Independent Claim
328 words
A method for improving the ventricular function of the heart of a patient, presenting with wide QRS complexes of intrinsic origin, comprising the steps of: (a) monitoring the electrocardiogram of a patient to determine the duration of the patient's QRS complex; (b) introducing a lead incorporating at least two electrodes of the same polarity thereon for electrical contact with ventricular muscle, each electrode electrically connected to a different lead terminal; (c) manipulating said lead to position at least two of said electrodes in electrical contact with said ventricular muscle; (d) electrically connecting at least two of said individual terminals to at least one output pole of a pulse generator and electrically connecting at least one electrical ground location, of polarity opposite to that of said electrodes, to the other pole of said pulse generator in order to complete each electrical circuit; (e) sensing intrinsic cardiac signals from at least one said terminal during a cardiac cycle; (f) employing the first of said cardiac signals in the electronic control circuit of said pulse generator to trigger the deliverance of pacing pulses to selected terminals simultaneous with the occurrence of said first intrinsic signal within a predetermined time interval and cause the deliverance of simultaneous pacing pulses to said selected terminals upon the absence of any said cardiac signal within said predetermined time interval; (g) providing pacing pulses from said pulse generator to at least one other selected terminal at a rate determined by intrinsic electrical activity in order to stimulate said ventricular muscle in the presence of ventricular fusion; (h) analyzing said electrode positions to determine their respective resultant QRS duration as compared to the intrinsic QRS duration and, if desired, further manipulating said lead to re-position said electrodes and analyzing such new positions to determine if a shorter resultant QRS is obtained; and (j) providing pacing pulses from said pulse generator to a desired combination of terminals that produces a shorter QRS duration than the patient's intrinsic QRS.
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USPTO Annuity & Maintenance Windows
| Annuity Stage | Window Opens | Payment Deadline | Surcharge Period Until | Estimated Fee | Status |
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| 3.5 Years (Year 4) | 1995-12-29 | 1996-06-29 | 1996-12-29 | $2000.00 | Window Closed / Lapsed |
| 7.5 Years (Year 8) | 1999-12-29 | 2000-06-29 | 2000-12-29 | $3760.00 | Window Closed / Lapsed |
| 11.5 Years (Year 12) | 2003-12-29 | 2004-06-29 | 2004-12-29 | $7700.00 | Window Closed / Lapsed |