Patent Grant
8460189
1. Field of the Invention
The present invention relates to patient monitoring. Although embodiments make specific reference to monitoring impedance and electrocardiogram signals with an adherent patch, the system methods and device described herein may be applicable to many applications in which physiological monitoring is used, for example wireless physiological monitoring for extended periods.
Patients are often treated for diseases and/or conditions associated with a compromised status of the patient, for example a compromised physiologic status. In some instances, a patient may report symptoms that require diagnosis to determine the underlying cause. For example, a patient may report fainting or dizziness that requires diagnosis, in which long term monitoring of the patient can provide useful information as to the physiologic status of the patient. In some instances a patient may have suffered a heart attack and require care and/or monitoring after release from the hospital. One example of a device to provide long term monitoring of a patient is the Holter monitor, or ambulatory electrocardiography device.
In addition to measuring heart signals with electrocardiograms, known physiologic measurements include impedance measurements. For example, transthoracic impedance measurements can be used to measure hydration and respiration.
Work in relation to embodiments of the present invention suggests that known methods and apparatus for long term monitoring of patients may be less than ideal. Although transthoracic measurements can be useful, such measurements may use electrodes that may be somewhat uncomfortable and/or cumbersome for the patient to wear. Also, it would be helpful to detect subtle changes in patient physiology, for example based on subtle changes in electrocardiogram signals and/or patient hydration signals. In at least some instances, electrodes that are held against the skin of the patient can become detached and/or dehydrated, such that the electrodes must be replaced. Replacement of electrodes can result in a change in the orientation of the electrodes that may affect the measured signal in at least some instances. Examples of physiological measurements that may be affected by electrode placement include electrocardiogram signals and tissue impedance signals to measure hydration and/or respiration of a patient. Therefore, a need exists to improve the quality of long term patient measurements with external devices, for example those worn by the patient.
Although implantable devices may be used in some instances, many of these devices can be invasive and/or costly, and may suffer at least some of the shortcomings of known wearable devices.
Therefore, a need exists for improved patient monitoring. Ideally, such improved patient monitoring would avoid at least some of the short-comings of the present methods and devices.
2. Description of the Background Art
The following US patents and Publications may describe relevant background art: U.S. Pat. Nos. 4,121,573; 4,478,223; 4,850,370; 4,955,381; 4,981,139; 5,080,099; 5,125,412; 5,331,966; 5,353,793; 5,511,553; 5,544,661; 5,558,638; 5,724,025; 5,772,586; 5,862,802; 5,970,986; 5,987,352; 6,047,203; 6,052,615; 6,117,077; 6,129,744; 6,225,901; 6,385,473; 6,416,471; 6,454,707; 6,480,733; 6,496,715; 6,527,711; 6,527,729; 6,551,252; 6,595,927; 6,595,929; 6,605,038; 6,611,705; 6,645,153; 6,699,200; 6,821,249; 6,912,414; 6,881,191; 6,980,851; 7,020,508; 7,054,679; 7,153,262; 7,206,630; 2002/0045836; 2003/0092975; 2003/0149349; 2005/0065445; 2005/0113703; 2005/0131288; 2005/0267381; 2006/0010090; 2006/0031102; 2006/0089679; 2006/0116592; 2006/0122474; 2006/0155183; 2006/0253044; 2006/0224051; 2006/0264730; 2007/0016089; 2007/0021678; 2007/0038038; 2007/0073132; 2007/0142715; 2007/0167849; 2007/0167850; and 2007/0208233.
The present invention relates to patient monitoring. Although embodiments make specific reference to monitoring impedance and electrocardiogram signals with an adherent patch, the system methods and device described herein may be applicable to any application in which physiological monitoring is used, for example wireless physiological monitoring for extended periods.
In many embodiments, an adherent device comprises an adhesive patch with at least two electrodes and an accelerometer. The accelerometer can be used to determine an orientation of the at least two measurement electrodes on a patient, for example a measurement axis defined by the at least two electrodes. This use of the accelerometer and the at least two measurement electrodes can be particularly advantageous with patient monitoring for an extended period, for example when it is desirable to detect subtle changes in patient physiology and the adherent patch with electrodes is replaced. By determining the orientation of the electrodes of the patch on the patient, physiologic measurements with the at least two electrodes can be adjusted and/or corrected in response to the orientation of the patch on the patient. In many embodiments, the accelerometer may be oriented with respect to an electrode measurement axis in a predetermined configuration, which can facilitate determination of the electrode measurement axis in response to the accelerometer signal. In many embodiments, the adherent patch and/or electrodes are replaced with a second adherent patch and/or electrodes, and the orientation of the second adherent patch and/or electrodes determined with the accelerometer or a second accelerometer. The determined orientation of the second patch and/or electrodes on the patient can be used to correct measurements made with the second adherent patch and/or electrodes, such that errors associated with the alignment of the first and second patch on the patient can be minimized, even inhibited.
In a first aspect, embodiments of the present invention provide a method of monitoring a patient. An adherent device is adhered to a skin of the patient. The adherent device comprises an accelerometer and at least two measurement electrodes. The at least two measurement electrodes can be separated by a distance to define an electrode measurement axis. An accelerometer signal is measured when the device is adhered to the patient. An orientation of the electrode measurement axis on the patient is determined in response to the accelerometer signal.
In many embodiments, the accelerometer comprises at least one measurement axis sensitive to gravity aligned with the electrode measurement axis. The at least one accelerometer measurement axis can be configured to extend substantially horizontally on the patient when the device is adhered to the patient. The accelerometer signal may correspond to at least one accelerometer measurement vector in a direction along the at least one accelerometer measurement axis.
In many embodiments, the accelerometer comprises at least one accelerometer measurement axis sensitive to gravity, and the at least one accelerometer measurement axis is oriented with respect to the electrode measurement axis in a predetermined configuration.
The at least two electrodes may comprise a positive electrode and a negative electrode that define an orientation of an electrode measurement vector along the electrode measurement axis. The accelerometer signal may correspond to at least one accelerometer measurement vector that extends away from the electrode measurement axis. The at least one accelerometer measurement vector can be sensitive to gravity such that the accelerometer signal indicates when the patch adhered to the patient is upside down.
In many embodiments, the adherent device comprises an adherent surface to adhere to a skin of the patient, and electrode measurement axis extends along the adherent surface. The accelerometer may comprise three axes, and a first axis and a second axis of the three axes may extend along the measurement surface. A third axis of the three axes may extend away from the measurement surface.
In a specific embodiment, the accelerometer measurement signal may correspond to three orthogonal measurement vectors and each of the three orthogonal measurement vectors can extends along one of the accelerometer measurement axes.
In many embodiments, an electrocardiogram signal is measured with the at least two measurement electrodes, and the electrocardiogram signal is modified in response to the accelerometer signal. For example, the electrocardiogram vector can be rotated in response to the accelerometer signal to obtain a standard electrocardiogram vector. As a result of the rotation, the amplitude and direction of electrocardiogram features can be modified so as to approximate those of a standard electrocardiogram vector.
In another aspect, embodiments of the present invention provide a method of monitoring a patient. A first adherent patch is adhered to a skin of the patient, and the first patch comprises an adhesive and electrodes. A first accelerometer signal is measured when the first adherent patch is adhered to the patient. A second adherent patch is adhered to the skin of the patient, and the second patch comprises an adhesive and electrodes. A second accelerometer signal is measured when the second adherent patch is adhered to the patient. An orientation on the patient of at least one of the first patch or the second patch is determined in response to at lest one of the first accelerometer signal or the second accelerometer signal.
In many embodiments, a first electrocardiogram signal is measured when the first adherent patch is adhered to the patient. A second electrocardiogram signal is measured when the second adherent patch is adhered to the patient. At least one of the first electrocardiogram signal or the second electrocardiogram signal is adjusted in response to at least one of the first accelerometer signal or the second accelerometer signal.
In another aspect, embodiments of the present invention provide a method of monitoring a patient. A first adherent measurement device is adhered to a skin of the patient. The first adherent measurement device comprises a first accelerometer and a first at least two measurement electrodes. A second adherent measurement device is adhered to a skin of the patient. The second adherent measurement device comprises a second accelerometer and a second at least two measurement electrodes. A first accelerometer signal is measured and a first electrocardiogram signal is measured with the first at least two measurement electrodes. The first accelerometer signal and the first electrocardiogram signal are measured when the first adherent measurement device is adhered to the skin of the patient. A second accelerometer signal is measured and a second electrocardiogram signal is measured with the second at least two measurement electrodes. The second accelerometer signal and the second electrocardiogram signal are measured when the second adherent measurement device is adhered to the skin of the patient. The first electrocardiogram signal is combined with the second electrocardiogram signal in response to the first accelerometer signal and the second accelerometer signal. The electrocardiogram signals can be combined by summing a scaled version of each signal.
In many embodiments, the first accelerometer comprises a first accelerometer measurement axis and the first at least two electrodes are separated by a first distance to define a first electrode measurement axis. The first accelerometer measurement axis can be aligned with the first electrode measurement axis. The second accelerometer may comprise a second accelerometer measurement axis and the second at least two electrodes can be separated by a second distance to define a second electrode measurement axis. The second accelerometer measurement axis may be aligned with the second electrode measurement axis.
In many embodiments, an orientation of the first electrode measurement axis is determined in response to the first accelerometer signal. An orientation of the second electrode measurement axis is determined in response to the to the accelerometer signal.
In many embodiments, the first electrocardiogram signal is combined with the second electrocardiogram signal when the second adherent measurement device is adhered to the skin of the patient.
In another aspect, embodiments of the present invention provide a device for monitoring a patient. The device comprises a support with an adhesive to adhere to a skin of the patient, and an accelerometer to generate an accelerometer signal with the accelerometer supported with the support. At least two measurement electrodes are supported with the support, and the at least two measurement electrodes are separated by a distance to define an electrode measurement axis. The device comprises circuitry to measure the accelerometer signal when the device is adhered to the patient. A processor comprises a tangible medium configured to determine an orientation of the electrode measurement axis on the patient in response to the accelerometer signal.
In many embodiments, the support comprises an adhesive patch with an adhesive to adhere the support to the patient. The adhesive patch may comprise a breathable tape with adhesive to adhere the support to the patient.
In many embodiments, the accelerometer comprises at least one measurement axis sensitive to gravity aligned with the electrode measurement axis. The accelerometer may comprise at least one accelerometer measurement axis sensitive to gravity, and the accelerometer may be positioned and supported with the support such that the measurement axis extends substantially horizontally on the patient when the support is adhered to the patient.
In many embodiments, the accelerometer signal corresponds to at least one accelerometer measurement vector along the at least one accelerometer measurement axis.
In many embodiments, the accelerometer comprises at least one accelerometer measurement axis sensitive to gravity, and the at least one accelerometer measurement axis is oriented with respect to the electrode measurement axis in a predetermined configuration. The at least two electrodes may comprise a positive electrode and a negative electrode that define an orientation of an electrode measurement vector along the electrode measurement axis.
In many embodiments, the accelerometer signal corresponds to at least one measurement vector that extends away from the electrode measurement axis such that the accelerometer signal indicates when the patch adhered to the patient is upside down.
In many embodiments, the adherent device comprises an adherent surface to adhere to a skin of the patient, and the electrode measurement axis extends along the adherent surface. The accelerometer may comprise three axes, and a first axis and a second axis of the three axes can extend along the adherent surface. A third axis of the three axes can extend away from the adherent surface.
In many embodiments, the accelerometer signal corresponds to three orthogonal measurement vectors, and each of the three orthogonal measurement vectors extends along one of the accelerometer measurement axes.
In many embodiments, measurement circuitry is coupled to the at least two measurement electrode to measure an electrocardiogram signal. A processor is coupled to the measurement circuitry and comprises a tangible medium configured to modify the electrocardiogram signal in response to the accelerometer signal.
In another aspect, embodiments of the present invention provide a system for monitoring a patient. The system comprises a first support with a first adhesive to adhere to a skin of the patient. First electrodes are supported with the support to couple to the skin of the patient. The system comprises a second support with a second adhesive to adhere to the skin of the patient. Second electrodes are supported with the second support to couple to the skin of the patient. At least one accelerometer is coupled to at least one of the first support or the second support to determine an orientation of at least one of the first electrodes or the second electrodes when the at least one of the first electrodes or the second electrodes are coupled to the patient.
In many embodiments, the at least one accelerometer comprises a first accelerometer removably coupled to the first support in a first predetermined orientation and a second accelerometer removably coupled to the second support in a second predetermined orientation.
In many embodiments, the at least one accelerometer comprises an accelerometer removably coupled to the first support in a first predetermined orientation and wherein the accelerometer is removably coupled to the second support in a second predetermined orientation such that the accelerometer can be reused.
In many embodiments, the first support with the first adhesive comprises a first breathable tape and the second support with the second adhesive comprises a second breathable tape.
In another aspect, embodiments of the present invention provide a system for monitoring a patient. The system comprises a first adherent measurement device comprising a first support with a first adhesive to adhere the first support to a skin of the patient. The first adherent measurement device comprises a first accelerometer and a first at least two measurement electrodes. The first adherent device comprises first measurement circuitry to measure a first accelerometer signal with the accelerometer and a first electrocardiogram signal with the first at least two measurement electrodes. A second adherent measurement device comprises a second support with a second adhesive to adhere the second support to a skin of the patient. The second adherent measurement device comprises a second accelerometer and a second at least two measurement electrodes. The second accelerometer comprises second circuitry to measure a second accelerometer signal with the second accelerometer and a second electrocardiogram signal with the second at least two measurement electrodes. A processor system comprises a tangible medium configured to combine the first electrocardiogram signal with the second electrocardiogram signal in response to the first accelerometer signal and the second accelerometer signal.
In many embodiments, the first accelerometer comprises a first accelerometer measurement axis and the first at least two electrodes are separated by a first distance to define a first electrode measurement axis. The first accelerometer measurement axis is aligned with the first electrode measurement axis. The second accelerometer comprises a second accelerometer measurement axis and the second at least two electrodes are separated by a second distance to define a second electrode measurement axis. The second accelerometer measurement axis may be aligned with the second electrode measurement axis. The processor system can be configured to determine an orientation of the first electrode measurement axis in response to the first accelerometer signal and determine an orientation of the second electrode measurement axis in response to the to the accelerometer signal.
The processor system may comprise at least one processor supported with at least one of the first support or the second support, and the at least one processor can be configured to combine the first electrocardiogram signal with the second electrocardiogram signal in response to the first accelerometer signal and the second accelerometer signal. Combining may include scaling each signal and summing the signals together.
FIG. 1D1 shows an equivalent circuit that can be used to determine optimal frequencies for determining patient hydration, according to embodiments of the present invention;
FIG. 1D2 shows an adherent devices as in
FIG. 1D3 shows vectors from a 3D accelerometer to determine orientation of the measurement axis of the patch adhered on the patient, according to embodiments of the present invention;
Embodiments of the present invention relate to patient monitoring. Although embodiments make specific reference to monitoring impedance and electrocardiogram signals with an adherent patch, the system methods and device described herein may be applicable to any application in which physiological monitoring is used, for example wireless physiological monitoring for extended periods.
In many embodiments, an adherent device comprises an adhesive patch with at least two electrodes and an accelerometer. The accelerometer can be used to determine an orientation of the at least two measurement electrodes on a patient, for example a measurement axis defined by the at least two electrodes. This use of the accelerometer and the at least two measurement electrodes can be particularly advantageous with patient monitoring for an extended period, for example when it is desirable to detect subtle changes in patient physiology and the adherent patch with electrodes is replaced. By determining the orientation of the electrodes of the patch on the patient, physiologic measurements with the at least two electrodes can be adjusted and/or corrected in response to the orientation of the patch on the patient. In many embodiments, the accelerometer may be oriented with respect to an electrode measurement axis in a predetermined configuration, which can facilitate determination of the electrode measurement axis in response to the accelerometer signal. In many embodiments, the adherent patch and/or electrodes are replaced with a second adherent patch and/or electrodes, and the orientation of the second adherent patch and/or electrodes determined with the accelerometer or a second accelerometer. The determined orientation of the second patch and/or electrodes on the patient can be used to correct measurements made with the second adherent patch and/or electrodes, such that errors associated with the alignment of the first and second patch on the patient can be minimized, even inhibited.
As used herein, an adhesive patch encompasses a piece of soft material with an adhesive that can cover a part of the body.
In many embodiments, the adherent devices described herein may be used for 90 day monitoring, or more, and may comprise completely disposable components and/or reusable components, and can provide reliable data acquisition and transfer. In many embodiments, the patch is configured for patient comfort, such that the patch can be worn and/or tolerated by the patient for extended periods, for example 90 days or more. In many embodiments, the adherent patch comprises a tape, which comprises a material, preferably breathable, with an adhesive, such that trauma to the patient skin can be minimized while the patch is worn for the extended period. In many embodiments, the printed circuit board comprises a flex printed circuit board that can flex with the patient to provide improved patient comfort.
Adherent device 100 can be aligned and/or oriented with respect to axes of patient P. Orientation of adherent device 100 can comprise orientation of device 100 with a patient coordinate system 100P aligned with axes of the patient. Patient P comprises a horizontal axis Px that extends laterally from one side of the patient to the other, for example from side S1 to side S1 across midline M. Patient P comprises an anterior posterior axis Py that extends from the front, or anterior, of the patient to the back, or posterior of the patient. Patient P comprises a vertical axis Pz that extends vertically along the patient, for example vertically along the midline of the patient from the feet of the patient toward the head of the patient. In many embodiments, horizontal axis Px, anterior posterior axis Py and vertical axis Pz may comprise a right handed triple of orthogonal coordinate references.
Adherent device 100 may comprise a 3D coordinate reference system 112XYZ. Device 100 may comprise an X-axis 112X for alignment with horizontal axis Px of the patient, a Y-axis for alignment with anterior posterior axis Py of the patient and a Z axis for alignment with vertical axis Pz of the patient. Coordinate reference system 112XYZ may comprise X-axis 112X, Y-axis 112Y and Z-axis 112Z. Coordinate reference system 112XYZ may comprise a right handed triple, although other non-orthogonal and orthogonal reference systems may be used.
Adherent device 100 may comprise indicia for alignment with an axis of the patient. The indicia can be used to align at least one axis of device 100 with at least one axis of the patient. The indicia can be positioned on at least one of the adherent patch, a cover, or an electronics module. The indicia can be visible to the patient and/or a care provider to adhere device 100 to the patient in alignment with at least one axis of the patient. A vertical line along Z-axis 112Z can indicate vertical axis 112Z to the patient and/or care provider, and a horizontal line along X-axis 112X can indicate horizontal X-axis 112X to the patient and/or care provider. A name, logo and/or trademark can be visible the outside of device 100 to indicate that device 100 correctly oriented, and arrows can also be used, for example a vertical arrow pointing up and a horizontal arrow pointing to the right.
Monitoring system 10 includes components to transmit data to a remote center 106. Remote center 106 can be located in a different building from the patient, for example in the same town as the patient, and can be located as far from the patient as a separate continent from the patient, for example the patient located on a first continent and the remote center located on a second continent. Adherent device 100 can communicate wirelessly to an intermediate device 102, for example with a single wireless hop from the adherent device on the patient to the intermediate device. Intermediate device 102 can communicate with remote center 106 in many ways, for example with an internet connection and/or with a cellular connection. In many embodiments, monitoring system 10 comprises a distributed processing system with at least one processor comprising a tangible medium of device 100, at least one processor 102P of intermediate device 102, and at least one processor 106P at remote center 106, each of which processors can be in electronic communication with the other processors. At least one processor 102P comprises a tangible medium 102T, and at least one processor 106P comprises a tangible medium 106T. Remote processor 106P may comprise a backend server located at the remote center. Remote center 106 can be in communication with a health care provider 108A with a communication system 107A, such as the Internet, an intranet, phone lines, wireless and/or satellite phone. Health care provider 108A, for example a family member, can be in communication with patient P with a communication, for example with a two way communication system, as indicated by arrow 109A, for example by cell phone, email, landline. Remote center 106 can be in communication with a health care professional, for example a physician 108B, with a communication system 107B, such as the Internet, an intranet, phone lines, wireless and/or satellite phone. Physician 108B can be in communication with patient P with a communication, for example with a two way communication system, as indicated by arrow 109B, for example by cell phone, email, landline. Remote center 106 can be in communication with an emergency responder 108C, for example a 911 operator and/or paramedic, with a communication system 107C, such as the Internet, an intranet, phone lines, wireless and/or satellite phone. Emergency responder 108C can travel to the patient as indicated by arrow 109C. Thus, in many embodiments, monitoring system 10 comprises a closed loop system in which patient care can be monitored and implemented from the remote center in response to signals from the adherent device.
In many embodiments, the adherent device may continuously monitor physiological parameters, communicate wirelessly with a remote center, and provide alerts when necessary. The system may comprise an adherent patch, which attaches to the patient's thorax and contains sensing electrodes, battery, memory, logic, and wireless communication capabilities. In some embodiments, the patch can communicate with the remote center, via the intermediate device in the patient's home. In some embodiments, remote center 106 receives the patient data and applies a patient evaluation algorithm, for example an algorithm to calculate the apnea hypopnea index. When a flag is raised, the center may communicate with the patient, hospital, nurse, and/or physician to allow for therapeutic intervention.
The adherent device may be affixed and/or adhered to the body in many ways. For example, with at least one of the following: an adhesive tape, a constant-force spring, suspenders around shoulders, a screw-in microneedle electrode, a pre-shaped electronics module to shape fabric to a thorax, a pinch onto roll of skin, or transcutaneous anchoring. Patch and/or device replacement may occur with a keyed patch (e.g. two-part patch), an outline or anatomical mark, a low-adhesive guide (place guide|remove old patch|place new patch|remove guide), or a keyed attachment for chatter reduction. The patch and/or device may comprise an adhesiveless embodiment (e.g. chest strap), and/or a low-irritation adhesive for sensitive skin. The adherent patch and/or device can comprise many shapes, for example at least one of a dogbone, an hourglass, an oblong, a circular or an oval shape.
In many embodiments, the adherent device may comprise a reusable electronics module with replaceable patches, and each of the replaceable patches may include a battery. The module may collect cumulative data for approximately 90 days and/or the entire adherent component (electronics+patch) may be disposable. In a completely disposable embodiment, a “baton” mechanism may be used for data transfer and retention, for example baton transfer may include baseline information. In some embodiments, the device may have a rechargeable module, and may use dual battery and/or electronics modules, wherein one module 101A can be recharged using a charging station 103 while the other module 101B is placed on the adherent patch with connectors. In some embodiments, the intermediate device 102 may comprise the charging module, data transfer, storage and/or transmission, such that one of the electronics modules can be placed in the intermediate device for charging and/or data transfer while the other electronics module is worn by the patient.
System 10 can perform the following functions: initiation, programming, measuring, storing, analyzing, communicating, predicting, and displaying. The adherent device may contain a subset of the following physiological sensors: bioimpedance, respiration, respiration rate variability, heart rate (ave, min, max), heart rhythm, hear rate variability (HRV), heart rate turbulence (HRT), heart sounds (e.g. S3), respiratory sounds, blood pressure, activity, posture, wake/sleep, orthopnea, temperature/heat flux, and weight. The activity sensor may comprise one or more of the following: ball switch, accelerometer, minute ventilation, HR, bioimpedance noise, skin temperature/heat flux, BP, muscle noise, posture.
The adherent device can wirelessly communicate with remote center 106. The communication may occur directly (via a cellular or Wi-Fi network), or indirectly through intermediate device 102. Intermediate device 102 may consist of multiple devices, which can communicate wired or wirelessly to relay data to remote center 106.
In many embodiments, instructions are transmitted from remote site 106 to a processor supported with the adherent patch on the patient, and the processor supported with the patient can receive updated instructions for the patient treatment and/or monitoring, for example while worn by the patient.
Electrodes 112A, 112B, 112C and 112D extend substantially along a horizontal measurement axis that corresponds to X axis-112X of the measurement device. Electrodes 112, 112B, 112C and 112D can be affixed to adherent patch 110A, such that the positions of electrodes 112A, 112B, 112C and 112D comprise predetermined positions on adherent patch 110A. Z-axis 112Z can extend perpendicular to the electrode measurement axis, for example vertically and perpendicular to X-axis 112 when adhered on the patient. X-axis 112X and Z-axis 112Z can extend along an adhesive surface of adherent patch 110A, and a Y-axis 112Y can extend away from the adhesive surface of adherent device 110A.
Electronic components 130 comprise components to take physiologic measurements, transmit data to remote center 106 and receive commands from remote center 106. In many embodiments, electronics components 130 may comprise known low power circuitry, for example complementary metal oxide semiconductor (CMOS) circuitry components. Electronics components 130 comprise an activity sensor and activity circuitry 134, impedance circuitry 136 and electrocardiogram circuitry, for example ECG circuitry 136. In some embodiments, electronics circuitry 130 may comprise a microphone and microphone circuitry 142 to detect an audio signal from within the patient, and the audio signal may comprise a heart sound and/or a respiratory sound, for example an S3 heart sound and a respiratory sound with rales and/or crackles.
Electronics circuitry 130 may comprise a temperature sensor, for example a thermistor in contact with the skin of the patient, and temperature sensor circuitry 144 to measure a temperature of the patient, for example a temperature of the skin of the patient. A temperature sensor may be used to determine the sleep and wake state of the patient. The temperature of the patient can decrease as the patient goes to sleep and increase when the patient wakes up.
Work in relation to embodiments of the present invention suggests that skin temperature may effect impedance and/or hydration measurements, and that skin temperature measurements may be used to correct impedance and/or hydration measurements. In some embodiments, increase in skin temperature or heat flux can be associated with increased vaso-dilation near the skin surface, such that measured impedance measurement decreased, even through the hydration of the patient in deeper tissues under the skin remains substantially unchanged. Thus, use of the temperature sensor can allow for correction of the hydration signals to more accurately assess the hydration, for example extra cellular hydration, of deeper tissues of the patient, for example deeper tissues in the thorax.
Electronics circuitry 130 may comprise a processor 146. Processor 146 comprises a tangible medium, for example read only memory (ROM), electrically erasable programmable read only memory (EEPROM) and/or random access memory (RAM). Processor 146 may comprise many known processors with real time clock and frequency generator circuitry, for example the PIC series of processors available from Microchip, of Chandler Ariz. In some embodiments, processor 136 may comprise the frequency generator and real time clock. The processor can be configured to control a collection and transmission of data from the impedance circuitry electrocardiogram circuitry and the accelerometer. In many embodiments, device 100 comprise a distributed processor system, for example with multiple processors on device 100.
In many embodiments, electronics components 130 comprise wireless communications circuitry 132 to communicate with remote center 106. The wireless communication circuitry can be coupled to the impedance circuitry, the electrocardiogram circuitry and the accelerometer to transmit to a remote center with a communication protocol at least one of the hydration signal, the electrocardiogram signal or the inclination signal. In specific embodiments, wireless communication circuitry is configured to transmit the hydration signal, the electrocardiogram signal and the inclination signal to the remote center with a single wireless hop, for example from wireless communication circuitry 132 to intermediate device 102. The communication protocol comprises at least one of Bluetooth, Zigbee, WiFi, WiMax, IR, amplitude modulation or frequency modulation. In many embodiments, the communications protocol comprises a two way protocol such that the remote center is capable of issuing commands to control data collection.
Intermediate device 102 may comprise a data collection system to collect and store data from the wireless transmitter. The data collection system can be configured to communicate periodically with the remote center. The data collection system can transmit data in response to commands from remote center 106 and/or in response to commands from the adherent device.
Activity sensor and activity circuitry 134 can comprise many known activity sensors and circuitry. In many embodiments, the accelerometer comprises at least one of a piezoelectric accelerometer, capacitive accelerometer or electromechanical accelerometer. The accelerometer may comprise a 3-axis accelerometer to measure at least one of an inclination, a position, an orientation or acceleration of the patient in three dimensions. Work in relation to embodiments of the present invention suggests that three dimensional orientation of the patient and associated positions, for example sitting, standing, lying down, can be very useful when combined with data from other sensors, for example ECG data and/or bioimpedance data, for example a respiration rate of the patient.
Activity sensor 134 may comprise an accelerometer with at least one measurement axis, for example two or more measurement axes. In some embodiments, activity sensor 134 comprises three axis accelerometer 134A. Three axis accelerometer 134A may comprise an X-axis 134X, a Y-axis 134Y and a Z-axis 134Z with each axis sensitive to gravity such that the orientation of the accelerometer can be determined in relation to gravity. Three axis accelerometer 134A can be aligned with electrodes of adherent patch 110A. X-axis 134X can be aligned with X-axis 112X of adherent patch 110. Y-axis 134Y can be aligned with Y-axis 112Y of adherent patch 110. Z-axis 134Z can be aligned with Z-axis 112Z of adherent patch 110. Axes of accelerometer 134A can be aligned with axes of patch 110A, for example with connectors 122A, 122B, 122C and 122D, such that the axes of the accelerometer are aligned with adherent patch and/or the electrodes in a predetermined configuration. Although the axes of the patch and accelerometer are shown substantially parallel, the axes of the patch can be aligned with the axes of the accelerometer in a non-parallel configuration, for example an oblique configuration with oblique angles between axes of the accelerometer and axes of the adherent patch and/or electrodes.
Impedance circuitry 136 can generate both hydration data and respiration data. In many embodiments, impedance circuitry 136 is electrically connected to electrodes 112A, 112B, 112C and 112D in a four pole configuration, such that electrodes 112A and 112D comprise outer electrodes that are driven with a current and comprise force electrodes that force the current through the tissue. The current delivered between electrodes 112A and 112D generates a measurable voltage between electrodes 112B and 112C, such that electrodes 112B and 112C comprise inner, sense, electrodes that sense and/or measure the voltage in response to the current from the force electrodes. In some embodiments, electrodes 112B and 112C may comprise force electrodes and electrodes 112A and 112B may comprise sense electrodes. The voltage measured by the sense electrodes can be used to measure the impedance of the patient and determine the respiration rate and/or hydration of the patient.
FIG. 1D1 shows an equivalent circuit 152 that can be used to determine optimal frequencies for measuring patient hydration. Work in relation to embodiments of the present invention indicates that the frequency of the current and/or voltage at the force electrodes can be selected so as to provide impedance signals related to the extracellular and/or intracellular hydration of the patient tissue. Equivalent circuit 152 comprises an intracellular resistance 156, or R(ICW) in series with a capacitor 154, and an extracellular resistance 158, or R(ECW). Extracellular resistance 158 is in parallel with intracellular resistance 156 and capacitor 154 related to capacitance of cell membranes. In many embodiments, impedances can be measured and provide useful information over a wide range of frequencies, for example from about 0.5 kHz to about 200 KHz. Work in relation to embodiments of the present invention suggests that extracellular resistance 158 can be significantly related extracellular fluid and to cardiac decompensation, and that extracellular resistance 158 and extracellular fluid can be effectively measured with frequencies in a range from about 0.5 kHz to about 20 kHz, for example from about 1 kHz to about 10 kHz. In some embodiments, a single frequency can be used to determine the extracellular resistance and/or fluid. As sample frequencies increase from about 10 kHz to about 20 kHz, capacitance related to cell membranes decrease the impedance, such that the intracellular fluid contributes to the impedance and/or hydration measurements. Thus, many embodiments of the present invention measure hydration with frequencies from about 0.5 kHz to about 20 kHz to determine patient hydration.
In many embodiments, impedance circuitry 136 can be configured to determine respiration of the patient. In specific embodiments, the impedance circuitry can measure the hydration at 25 Hz intervals, for example at 25 Hz intervals using impedance measurements with a frequency from about 0.5 kHz to about 20 kHz.
ECG circuitry 138 can generate electrocardiogram signals and data from two or more of electrodes 112A, 112B, 112C and 112D in many ways. In some embodiments, ECG circuitry 138 is connected to inner electrodes 112B and 122C, which may comprise sense electrodes of the impedance circuitry as described above. In some embodiments, ECG circuitry 138 can be connected to electrodes 112A and 112D so as to increase spacing of the electrodes. The inner electrodes may be positioned near the outer electrodes to increase the voltage of the ECG signal measured by ECG circuitry 138. In many embodiments, the ECG circuitry may measure the ECG signal from electrodes 112A and 112D when current is not passed through electrodes 112A and 112D.
ECG circuitry 138 can be coupled to the electrodes in many ways to define an electrocardiogram vector. For example electrode 112A can be coupled to a positive amplifier terminal of ECG circuitry 138 and electrode 112D can be coupled to a negative amplifier terminal of ECG circuitry 138 to define an orientation of an electrocardiogram vector along the electrode measurement axis. To define an electrocardiogram vector with an opposite orientation electrode 112D can be couple to the positive amplifier terminal of ECG circuitry 138 and electrode 112A can be coupled to the negative amplifier terminal of ECG circuitry 138. The ECG circuitry may be coupled to the inner electrodes so as to define an ECG vector along a measurement axis of the inner electrodes.
FIG. 1D2 shows adherent device 100 positioned on patient P to determine orientation of the adherent patch. X-axis 112X of device 100 is inclined at an angle α to horizontal axis Px of patient P. Z-axis 112Z of device 100 is inclined at angle α to vertical axis Pz of patient P. Y-axis 112Y may be inclined at a second angle, for example β, to anterior posterior axis Py and vertical axis Pz. As the accelerometer of adherent device 100 can be sensitive to gravity, inclination of the patch relative to axis of the patient can be measured, for example when the patient stands.
FIG. 1D3 shows vectors from a 3D accelerometer to determine orientation of the measurement axis of the patch adhered on the patient. A Z-axis vector 112ZV can be measured along vertical axis 112Z with an accelerometer signal from axis 134Z of accelerometer 134A. An X-axis vector 112XV can be measured along horizontal axis 112X with an accelerometer signal from axis 134X of accelerometer 134A. Inclination angle α can be determined in response to X-axis vector 112XV and Z-axis vector 112ZV, for example with vector addition of X-axis vector 112XV and Z-axis vector 112ZV. An inclination angle β for the patch along the Y and Z axes can be similarly obtained an accelerometer signal from axis 134Y of accelerometer 134A and vector 112ZV.
Cover 162 may comprise many known biocompatible cover, casing and/or housing materials, such as elastomers, for example silicone. The elastomer may be fenestrated to improve breathability. In some embodiments, cover 162 may comprise many known breathable materials, for example polyester, polyamide, and/or elastane (Spandex). The breathable fabric may be coated to make it water resistant, waterproof, and/or to aid in wicking moisture away from the patch.
The breathable cover 162 and adherent patch 110 comprises breathable tape can be configured to couple continuously for at least one week the at least one electrode to the skin so as to measure breathing of the patient. The breathable tape may comprise the stretchable breathable material with the adhesive and the breathable cover may comprises a stretchable water resistant material connected to the breathable tape, as described above, such that both the adherent patch and cover can stretch with the skin of the patient. Arrows 182 show stretching of adherent patch 110, and the stretching of adherent patch can be at least two dimensional along the surface of the skin of the patient. As noted above, connectors 122A, 122B, 122C and 122D between PCB 130 and electrodes 112A, 112B, 112C and 112D may comprise insulated wires that provide strain relief between the PCB and the electrodes, such that the electrodes can move with the adherent patch as the adherent patch comprising breathable tape stretches. Arrows 184 show stretching of cover 162, and the stretching of the cover can be at least two dimensional along the surface of the skin of the patient. Cover 162 can be attached to adherent patch 110 with adhesive 116B such that cover 162 stretches and/or retracts when adherent patch 110 stretches and/or retracts with the skin of the patient. For example, cover 162 and adhesive patch 110 can stretch in two dimensions along length 170 and width 174 with the skin of the patient, and stretching along length 170 can increase spacing between electrodes. Stretching of the cover and adhesive patch 110, for example in two dimensions, can extend the time the patch is adhered to the skin as the patch can move with the skin such that the patch remains adhered to the skin. Cover 162 can be attached to adherent patch 110 with adhesive 116B such that cover 162 stretches and/or retracts when adherent patch 110 stretches and/or retracts with the skin of the patient, for example along two dimensions comprising length 170 and width 174. Electronics housing 160 can be smooth and allow breathable cover 162 to slide over electronics housing 160, such that motion and/or stretching of cover 162 is slidably coupled with housing 160. The printed circuit board can be slidably coupled with adherent patch 110 that comprises breathable tape 110T, such that the breathable tape can stretch with the skin of the patient when the breathable tape is adhered to the skin of the patient. Electronics components 130 can be affixed to printed circuit board 120, for example with solder, and the electronics housing can be affixed over the PCB and electronics components, for example with dip coating, such that electronics components 130, printed circuit board 120 and electronics housing 160 are coupled together. Electronics components 130, printed circuit board 120, and electronics housing 160 are disposed between the stretchable breathable material of adherent patch 110 and the stretchable water resistant material of cover 160 so as to allow the adherent patch 110 and cover 160 to stretch together while electronics components 130, printed circuit board 120, and electronics housing 160 do not stretch substantially, if at all. This decoupling of electronics housing 160, printed circuit board 120 and electronic components 130 can allow the adherent patch 110 comprising breathable tape to move with the skin of the patient, such that the adherent patch can remain adhered to the skin for an extended time of at least one week, for example two or more weeks.
An air gap 169 may extend from adherent patch 110 to the electronics module and/or PCB, so as to provide patient comfort. Air gap 169 allows adherent patch 110 and breathable tape 110T to remain supple and move, for example bend, with the skin of the patient with minimal flexing and/or bending of printed circuit board 120 and electronic components 130, as indicated by arrows 186. Printed circuit board 120 and electronics components 130 that are separated from the breathable tape 110T with air gap 169 can allow the skin to release moisture as water vapor through the breathable tape, gel cover, and breathable cover. This release of moisture from the skin through the air gap can minimize, and even avoid, excess moisture, for example when the patient sweats and/or showers.
The breathable tape of adhesive patch 110 may comprise a first mesh with a first porosity and gel cover 180 may comprise a breathable tape with a second porosity, in which the second porosity is less than the first porosity to minimize, and even inhibit, flow of the gel through the breathable tape. The gel cover may comprise a polyurethane film with the second porosity.
In many embodiments, the adherent device comprises a patch component and at least one electronics module. The patch component may comprise adhesive patch 110 comprising the breathable tape with adhesive coating 116A, at least one electrode, for example electrode 114A and gel 114. The at least one electronics module can be separable from the patch component. In many embodiments, the at least one electronics module comprises the flex printed circuit board 120, electronic components 130, electronics housing 160 and cover 162, such that the flex printed circuit board, electronic components, electronics housing and cover are reusable and/or removable for recharging and data transfer, for example as described above. In many embodiments, adhesive 116B is coated on upper side 110A of adhesive patch 110B, such that the electronics module can be adhered to and/or separated from the adhesive component. In specific embodiments, the electronic module can be adhered to the patch component with a releasable connection, for example with Velcro™, a known hook and loop connection, and/or snap directly to the electrodes. Two electronics modules can be provided, such that one electronics module can be worn by the patient while the other is charged, as described above. Monitoring with multiple adherent patches for an extended period is described in U.S. Pat. App. No. 60/972,537, the full disclosure of which is incorporated herein by reference and may be suitable for combination with some embodiments of the present invention. Many patch components can be provided for monitoring over the extended period. For example, about 12 patches can be used to monitor the patient for at least 90 days with at least one electronics module, for example with two reusable electronics modules.
At least one electrode 112A can extend through at least one aperture 180A in the breathable tape 110 and gel cover 180.
In some embodiments, the adhesive patch may comprise a medicated patch that releases a medicament, such as antibiotic, beta-blocker, ACE inhibitor, diuretic, or steroid to reduce skin irritation. The adhesive patch may comprise a thin, flexible, breathable patch with a polymer grid for stiffening. This grid may be anisotropic, may use electronic components to act as a stiffener, may use electronics-enhanced adhesive elution, and may use an alternating elution of adhesive and steroid.
Reusable electronics module 210 may comprise a connector 219 adapted to connect to each of the disposable patch components, sequentially, for example one disposable patch component at a time. Connector 219 can be formed in many ways, and may comprise known connectors as described above, for example a snap. In some embodiments, the connectors on the electronics module and adhesive component can be disposed at several locations on the reusable electronics module and disposable patch component, for example near each electrode, such that each electrode can couple directly to a corresponding location on the flex PCB of the reusable electronics component.
Reusable electronics module 210 may comprise additional reusable electronics modules, for example two or more rechargeable electronics modules each with a 3D accelerometer, such that the first module comprising a first 3D accelerometer can be recharged while the second module comprising a second 3D accelerometer is worn by the patient. The second module can be recharged and connected to a third adhesive patch when the first adhesive patch is removed from the patient. The second module comprising the second accelerometer can be removably coupled to the adhesive patch such that the second accelerometer can be recharged and connected to a fourth adhesive patch when the second adhesive patch is removed from the patient.
Reusable electronics module 210 may comprises many of the structures described above that may comprise the electronics module. In many embodiments, reusable electronics module 210 comprises a PCB, for example a flex PCB 212, electronics components 214, batteries 216, and a cover 217, for example as described above. In some embodiments, reusable electronics module 210 may comprise an electronics housing over the electronics components and/or PCB as described above. The electronics components may comprise circuitry and/or sensors for measuring ECG signals, hydration impedance signals, respiration impedance signals and accelerometer signals, for example as described above.
Electronics components 214 may comprise an accelerometer 214A. Accelerometer 214A may comprise a three axis accelerometer, for example as described above. Accelerometer 214A may comprise an X-axis 234X, a Y-axis 234Y and a Z-axis 234Z with each axis sensitive to gravity such that the orientation of the accelerometer, for example 3D orientation, can be determined in relation to gravity, as described above. Alignment of the accelerometer, for example the axes of the accelerometer 214A, can be aligned with the axes of the adherent patches using the connectors. For example connector 219 can connect with at least one of connector 229A, connector 229B, connector 229C and connector 229D to align the respective patch with accelerometer 214A.
First disposable patch component 220A comprises a connector 229A to mate with connector 219 on reusable electronics module 210 such that the first disposable patch component 220A is aligned with the reusable electronics module with a predetermined orientation. First disposable patch component 220A comprises a first axis 220AX substantially aligned with electrodes 222A. A second axis 220AZ corresponds to vertical on the patient when first disposable patch component 220A is adhered to the patient. Connector 229A is configured to mate with connector 219 such that axis 234X is aligned with first axis 220AX and axis 234Z is aligned with axis 220AZ.
Second disposable patch component 220B comprises a connector 229B to mate with connector 219 on reusable electronics module 210 such that the second disposable patch component 220B is aligned with the reusable electronics module with the predetermined orientation similar to first disposable patch component 220A. Second disposable patch component 220B comprises a first axis 220BX substantially aligned with electrodes 222B. A second axis 220BZ corresponds to vertical on the patient when second disposable patch component 220B is adhered to the patient. Connector 229B is configured to mate with connector 219 such that axis 234X is aligned with first axis 220BX and axis 234Z is aligned with axis 220BZ.
Third disposable patch component 220C comprises a connector 229C to mate with connector 219 on reusable electronics module 210 such that the third disposable patch component 220C is aligned with the reusable electronics module with the predetermined orientation similar to second disposable patch component 220B. Third disposable patch component 220C comprises a first axis 220CX substantially aligned with electrodes 222C. A second axis 220CZ corresponds to vertical on the patient when second disposable patch component 220C is adhered to the patient. Connector 229C is configured to mate with connector 219 such that axis 234X is aligned with first axis 220CX and axis 234Z is aligned with axis 220CZ.
Fourth disposable patch component 220D comprises a connector 229D to mate with connector 219 on reusable electronics module 210 such that the fourth disposable patch component 220D is aligned with the reusable electronics module with the predetermined orientation similar to third disposable patch component 220C. Fourth disposable patch component 220D comprises a first axis 220DX substantially aligned with electrodes 222D. A second axis 220DZ corresponds to vertical on the patient when second disposable patch component 220D is adhered to the patient. Connector 229D is configured to mate with connector 219 such that axis 234X is aligned with first axis 220DX and axis 234Z is aligned with axis 220DZ.
A step 256 adheres electronics module 210 to second disposable adherent patch component 220B and adheres the second disposable patch component to the skin of the patient, for example with the second adherent patch component adhered to the reusable electronics module. The orientation on the patient of second disposable patch component 220B is determined with the accelerometer, for example as described above, when the second disposable patch component is adhered to the patient. Patient measurements can be taken with the electronics module and/or adjusted in response to the orientation of the second patch on the patient. A step 258 removes the second disposable adherent patch from the patient and separates second disposable adherent patch component 220B from reusable electronics module 210.
A step 260 adheres electronics module 210 to third disposable adherent patch component 220C and adheres the third disposable patch component to the skin of the patient, for example with the third adherent patch component adhered to the reusable electronics module. The orientation on the patient of third disposable patch component 220C is determined with the accelerometer, for example as described above, when the third disposable patch component is adhered to the patient. Patient measurements can be taken with the electronics module and/or adjusted in response to the orientation of the third patch on the patient. A step 262 removes the third disposable adherent patch from the patient and separates third disposable adherent patch component 220C from reusable electronics module 210.
A step 264 adheres electronics module 210 to fourth disposable adherent patch component 220D and adheres the fourth disposable patch component to the skin of the patient, for example with the third adherent patch component adhered to the reusable electronics module. The orientation on the patient of fourth disposable patch component 220D is determined with the accelerometer, for example as described above, when the fourth disposable patch component is adhered to the patient. Patient measurements can be taken with the electronics module and/or adjusted in response to the orientation of the fourth patch on the patient. A step 268 removes the fourth disposable adherent patch from the patient and separates fourth disposable adherent patch component 220D from reusable electronics module 210.
In many embodiments, physiologic signals, for example ECG, hydration impedance, respiration impedance and accelerometer impedance are measured when the adherent patch component is adhered to the patient, for example when any of the first, second, third or fourth disposable adherent patches is adhered to the patient.
In many embodiments each patch comprises at least four electrodes configured to measure an ECG signal and impedance, for example hydration and/or respiration impedance. In many embodiments, the patient comprises a midline 306, with first side, for example right side 302, and second side, for example left side 304, symmetrically disposed about the midline. A step 310 adheres a first adherent patch 312 to at a first location 314 on a first side 302 of the patient for a first period of time, for example about 1 week. When the adherent patch 312 is position at first location 314 on the first side of the patient, the accelerometer signals are measured to determine the orientation of the patch and the electrodes of the patch are coupled to the skin of the patient to measure the ECG signal and impedance signals.
A step 320 removes patch 312 and adheres a second adherent patch 322 at a second location 324 on a second side 206 of the patient for a second period of time, for example about 1 week. In many embodiments, second location 324 can be symmetrically disposed opposite first location 314 across midline 304, for example so as to minimize changes in the sequential impedance signals measured from the second side and first side. When adherent patch 322 is position at second location 324 on the second side of the patient, the orientation of the patch can be measured with the accelerometer and the electrodes of the patch are coupled to the skin of the patient to measure the ECG signal and impedance signals. In many embodiments, while adherent patch 322 is positioned at second location 324, skin at first location 314 can heal and recover from adherent coverage of the first patch. In many embodiments, second location 324 is symmetrically disposed opposite first location 314 across midline 304, for example so as to minimize changes in the impedance signals measured between the first side and second side. In many embodiments, the duration between removal of one patch and placement of the other patch can be short, such that any differences between the signals may be determined to be related to orientation of the patch, and these differences can be corrected in response to the measured orientation of the patch on the patient.
A step 330 removes second patch 322 and adheres a third adherent patch 332 at a third location 334 on the first side, for example right side 302, of the patient for a third period of time, for example about 1 week. In many embodiments, third location 334 can be symmetrically disposed opposite second location 324 across midline 304, for example so as to minimize changes in the sequential impedance signals measured from the third side and second side. In many embodiments, third location 334 substantially overlaps with first location 314, so as to minimize differences in measurements between the first adherent patch and third adherent patch that may be due to patch location. When adherent patch 332 is positioned at third location 334 on the first side of the patient, the orientation of the patch is measured with the accelerometer and the electrodes of the patch are coupled to the skin of the patient to measure the ECG signal and impedance signals. In many embodiments, while adherent patch 332 is positioned at third location 334, skin at second location 324 can heal and recover from adherent coverage of the second patch. In many embodiments, the duration between removal of one patch and placement of the other patch can be short, such that differences between the signals may be determined to be related to orientation of the patch, and these differences can be corrected in response to the measured orientation of the patch on the patient.
A step 340 removes third patch 332 and adheres a fourth adherent patch 342 at a fourth location 344 on the second side, for example left side 306, of the patient for a fourth period of time, for example about 1 week. In many embodiments, fourth location 344 can be symmetrically disposed opposite third location 334 across midline 304, for example so as to minimize changes in the sequential impedance signal measured from the fourth side and third side. In many embodiments, fourth location 344 substantially overlaps with second location 324, so as to minimize differences in measurements between the second adherent patch and fourth adherent patch that may be due to patch location. When adherent patch 342 is positioned at fourth location 344 on the second side of the patient, the orientation of patch is measured with the accelerometer and the electrodes of the patch are coupled to the skin of the patient to measure the ECG signal and impedance signals. In many embodiments, while adherent patch 342 is positioned at fourth location 324, skin at third location 334 can heal and recover from adherent coverage of the third patch. In many embodiments, the duration between removal of one patch and placement of the other patch can be short, such that differences between the signals may be determined to be related to orientation of the patch, and these differences can be corrected in response to the measured orientation of the patch on the patient.
The accelerometer signal measured to determine the orientation on the patient for each of adherent patch 312, adherent patch 322, adherent patch 332 or adherent patch 342 can be measured with a reusable accelerometer of a reusable electronics module, for example as described above, or measured with a disposable accelerometer affixed to each patch and disposed of with the patch after the patch is removed from the patient.
It should be appreciated that the specific steps illustrated in
A step 410A measures a first accelerometer signal along a first axis, for example an X-axis of a 3D accelerometer responsive to gravity as described above. A step 410B measures a first accelerometer signal along a second axis, for example a y-axis of a 3D accelerometer as described above. A step 410C measures a first accelerometer signal along a third axis, for example a Z-axis of a 3D accelerometer as described above. Measurement of the accelerometer signal with step 410A, step 410B and step 41C, which may comprise sub-steps, can be performed with the patient in a known and/or determined position. The patient may be asked to stand and/or sit upright in a chair and the first signal measured. In some embodiments, the 3D accelerometer signal can be analyzed to determine that the patient is standing, walking and the first signal determined from a plurality of measurements to indicate that the patient is upright for the measurement of the first signal.
A step 415 determines an orientation of the first patch on the patient. The accelerometer can be coupled to the patch with a pre-determined orientation, for example with connectors as described above, such that the orientation of the patch can be determined from the accelerometer signal and the orientation of the 3D accelerometer on the adherent patch and the orientation of the patient.
A step 420 measures a first ECG signal. The first ECG signal can be measured with the electrodes attached to the patient when the patch comprises the first orientation. The ECG signal can be measured with electronics components and electrodes, as described above.
A step 425 determines a first orientation of an electrode measurement axis on the patient. The electrode measurement axis may correspond to one of the measurement axes of the 3D accelerometer, for example an X-axis of the accelerometer as described above. However, the orientation of the electrode measurement axis can be aligned in relation to the axes of the accelerometer in many ways, for example at oblique angles, such that the alignment of the accelerometer with the electrode measurement axis is known and the signal from the accelerometer can be used to determine the alignment of the electrode measurement axis.
A step 430 determines a first orientation of the ECG vector. The orientation of the ECG vector can be determined in response to the polarity of the measurement electrodes and orientation of the electrode measurement axis, as described above.
A step 435 rotates a first ECG vector. The first ECG vector orientation of the ECG vector can be used to rotate the ECG vector onto a desired axis, for example an X-axis of the patient in response to the first orientation of the ECG vector and the accelerometer signal. For example, if the first measurement axis of the first ECG vector is rotated five degrees based on the accelerometer signal, the first ECG vector can be rotated by five degrees so as to align the first ECG vector with the patient axis.
A step 440 measures a first patient temperature. The first temperature of the patient can be measured with electronics of the adherent device, as described above.
A step 445 measures a first patient impedance. The first patient impedance may comprise a four pole impedance measurement, as described above. The first patient impedance can be used to determine respiration of the patient and/or hydration of the patient.
A step 450 adheres a second patch to the patient. The second patch may comprise a second patch connected to a reusable electronics module, for example a reusable electronics module connected to the first patch for the first patient measurements above. The second patch may comprise a second patch of a second adherent device comprising a second electronics module in which the second patch and second electronics module comprise a disposable second adherent device and the first adherent patch and first electronics module comprise a first disposable adherent device.
A step 455A measures a second accelerometer signal along a first axis, for example an x-axis of the accelerometer as described above. The first axis may comprise the first axis of the first accelerometer as described above, for example the X-axis of the accelerometer used to measure the X-axis signal with the first measurement. In some embodiments, the second accelerometer signal along the first axis may comprise an X-axis of a second accelerometer, for example a second disposable electronics module, aligned with an electrode measurement axis as described above.
A step 455B measures a second accelerometer signal along a second axis. The second axis may comprise the second axis of the first accelerometer as described above, for example the Y-axis of the accelerometer used to measure the Y-axis signal with the first measurement. In some embodiments, the second accelerometer signal along the second axis may comprise a Y-axis of a second accelerometer, for example a second disposable electronics module, aligned with an electrode measurement axis as described above.
A step 455C measures a second accelerometer signal along a third axis. The third axis may comprise the third axis of the first accelerometer as described above, for example the Z-axis of the accelerometer used to measure the Z-axis signal with the first measurement. In some embodiments, the second accelerometer signal along the third axis may comprise a Z-axis of a second accelerometer, for example a second disposable electronics module, aligned with an electrode measurement axis as described above.
A step 460 determines an orientation of the second patch on the patient. The accelerometer can be coupled to the second patch with a pre-determined orientation, for example with connectors as described above, such that the orientation of the second patch can be determined from the second accelerometer signal and the orientation of the 3D accelerometer on the adherent patch and the orientation of the patient.
A step 465 measures a second ECG signal. The second ECG signal can be measured with the electrodes attached to the patient when the second patch comprises the second orientation, for example after the first patch has been removed and the second patch has been positioned on the patient as described above. The ECG signal can be measured with electronics components and electrodes, as described above.
A step 470 determines a second orientation of the electrode measurement axis on the patient. The second orientation of the electrode measurement axis may comprise orientation of an axis of a second set of electrodes, for example a second set of electrodes disposed along an axis of the second patch. The second orientation of the electrode measurement axis may correspond to one of the measurement axes of the 3D accelerometer, for example an X-axis of the accelerometer as described above. However, the second orientation of the electrode measurement axis can be aligned in relation to the axes of the accelerometer in many ways, for example at oblique angles, such that the alignment of the accelerometer with the second electrode measurement axis is known and the signal from the accelerometer can be used to determine the alignment of the electrode measurement axis.
A step 475 determines a second orientation of the ECG vector. The second orientation of the ECG vector can be determined in response to the polarity of the second measurement electrodes and second orientation of the electrode measurement axis, for example second measurement electrodes on the second adherent patch that extend along the electrode measurement axis of the second adherent patch.
A step 480 rotates a second ECG vector. The second ECG vector orientation of the second ECG vector can be used to rotate the second ECG vector onto the desired axis, for example the X-axis of the patient in response to the first orientation of the ECG vector and the accelerometer signal. For example, if the first measurement axis of the first ECG vector is rotated five degrees from the X-axis based on the accelerometer signal, the first ECG vector can be rotated by five degrees so as to align the first ECG vector with the X-axis of the patient, for example the horizontal axis of the patient.
A step 485 measures a second patient temperature. The second temperature of the patient can be measured with electronics of the adherent device, as described above.
A step 490 measures a second patient impedance. The second patient impedance may comprise a four pole impedance measurement, as described above. The second patient impedance can be used to determine respiration of the patient and/or hydration of the patient. A step 495 repeats the above steps. The above steps can be repeated to provide longitudinal monitoring of the patient with differential measurement of patient status. The monitoring of the patient may comprise a comparison of baseline patient data with subsequent patient date.
Many of the steps of method 400 can be performed with the processor system, as described above.
It should be appreciated that the specific steps illustrated in
While the exemplary embodiments have been described in some detail, by way of example and for clarity of understanding, those of skill in the art will recognize that a variety of modifications, adaptations, and changes may be employed. Hence, the scope of the present invention should be limited solely by the appended claims.
The present application claims the benefit under 35 USC 119(e) of U.S. Provisional Application Nos. 60/972,537 filed Sep. 14, 2007, 61/055,666 and 61/055,662 both of which were filed May 23, 2008; the full disclosures of which are incorporated herein by reference in their entirety. The subject matter of the present application is related to the following applications: 60/972,512; 60/972,329; 60/972,354; 60/972,616; 60/972,363; 60/972,343; 60/972,581; 60/972,629; 60/972,316; 60/972,333; 60/972,359; 60/972,336; 60/972,340 all of which were filed on Sep. 14, 2007; 61/046,196 filed Apr. 18, 2008; 61/047,875 filed Apr. 25, 2008; 61/055,645, 61/055,656 all filed May 23, 2008; and 61/079,746 filed Jul. 10, 2008. The following applications are being filed concurrently with the present application, on Sep. 12, 2008: Ser. No. 12/209,279 entitled “Multi-Sensor Patient Monitor to Detect Impending Cardiac Decompensation Prediction”; Ser. No. 12/209,288 entitled “Adherent Device with Multiple Physiological Sensors”; Ser. No. 12/209,430 entitled “Injectable Device for Physiological Monitoring”; Ser. No. 12/209,479 entitled “Delivery System for Injectable Physiological Monitoring System”; Ser. No. 12/209,262 entitled “Adherent Device for Cardiac Rhythm Management”; Ser. No. 12/209,268 entitled “Adherent Device for Respiratory Monitoring”; Ser. No. 12/209,269 entitled “Adherent Athletic Monitor”; Ser. No. 12/209,259 entitled “Adherent Emergency Monitor”; Ser. No. 12/209,273 entitled “Adherent Device with Physiological Sensors”; Ser. No. 12/209,276 entitled “Medical Device Automatic Start-up upon Contact to Patient Tissue”; Ser. No. 12/210,078 entitled “System and Methods for Wireless Body Fluid Monitoring”; Ser. No. 12/209,292 entitled “Adherent Device for Sleep Disordered Breathing”; Ser. No. 12/209,278 entitled “Dynamic Pairing of Patients to Data Collection Gateways”; Ser. No. 12/209,508 entitled “Adherent Multi-Sensor Device with Implantable Device Communications Capabilities”; Ser. No. 12/209,528 entitled “Data Collection in a Multi-Sensor Patient Monitor”; Ser. No. 12/209,294 entitled “Adherent Multi-Sensor Device with Empathic Monitoring”; Ser. No. 12/209,274 entitled “Energy Management for Adherent Patient Monitor”; and Ser. No. 12/209,294 entitled “Tracking and Security for Adherent Patient Monitor.”
| Number | Name | Date | Kind |
|---|---|---|---|
| 834261 | Chambers | Oct 1906 | A |
| 2087124 | Smith et al. | Jul 1937 | A |
| 2184511 | Bagno et al. | Dec 1939 | A |
| 3170459 | Phipps et al. | Feb 1965 | A |
| 3232291 | Parker | Feb 1966 | A |
| 3370459 | Cescati | Feb 1968 | A |
| 3517999 | Weaver | Jun 1970 | A |
| 3620216 | Szymanski | Nov 1971 | A |
| 3677260 | Funfstuck et al. | Jul 1972 | A |
| 3805769 | Sessions | Apr 1974 | A |
| 3845757 | Weyer | Nov 1974 | A |
| 3874368 | Asrican | Apr 1975 | A |
| 3882853 | Gofman et al. | May 1975 | A |
| 3942517 | Bowles et al. | Mar 1976 | A |
| 3972329 | Kaufman | Aug 1976 | A |
| 4008712 | Nyboer | Feb 1977 | A |
| 4024312 | Korpman | May 1977 | A |
| 4077406 | Sandhage et al. | Mar 1978 | A |
| 4121573 | Crovella et al. | Oct 1978 | A |
| 4141366 | Cross, Jr. et al. | Feb 1979 | A |
| RE30101 | Kubicek et al. | Sep 1979 | E |
| 4185621 | Morrow | Jan 1980 | A |
| 4216462 | McGrath et al. | Aug 1980 | A |
| 4300575 | Wilson | Nov 1981 | A |
| 4308872 | Watson et al. | Jan 1982 | A |
| 4358678 | Lawrence | Nov 1982 | A |
| 4409983 | Albert | Oct 1983 | A |
| 4450527 | Sramek | May 1984 | A |
| 4451254 | Dinius et al. | May 1984 | A |
| 4478223 | Allor | Oct 1984 | A |
| 4498479 | Martio et al. | Feb 1985 | A |
| 4522211 | Bare et al. | Jun 1985 | A |
| 4661103 | Harman | Apr 1987 | A |
| 4664129 | Helzel et al. | May 1987 | A |
| 4669480 | Hoffman | Jun 1987 | A |
| 4673387 | Phillips et al. | Jun 1987 | A |
| 4681118 | Asai et al. | Jul 1987 | A |
| 4692685 | Blaze | Sep 1987 | A |
| 4699146 | Sieverding | Oct 1987 | A |
| 4721110 | Lampadius | Jan 1988 | A |
| 4730611 | Lamb | Mar 1988 | A |
| 4733107 | O'Shaughnessy et al. | Mar 1988 | A |
| 4781200 | Baker | Nov 1988 | A |
| 4793362 | Tedner | Dec 1988 | A |
| 4838273 | Cartmell | Jun 1989 | A |
| 4838279 | Fore | Jun 1989 | A |
| 4850370 | Dower | Jul 1989 | A |
| 4880004 | Baker, Jr. et al. | Nov 1989 | A |
| 4895163 | Libke et al. | Jan 1990 | A |
| 4911175 | Shizgal | Mar 1990 | A |
| 4945916 | Kretschmer et al. | Aug 1990 | A |
| 4955381 | Way et al. | Sep 1990 | A |
| 4966158 | Honma et al. | Oct 1990 | A |
| 4981139 | Pfohl | Jan 1991 | A |
| 4988335 | Prindle et al. | Jan 1991 | A |
| 4989612 | Fore | Feb 1991 | A |
| 5001632 | Hall-Tipping | Mar 1991 | A |
| 5012810 | Strand et al. | May 1991 | A |
| 5025791 | Niwa | Jun 1991 | A |
| 5027824 | Dougherty et al. | Jul 1991 | A |
| 5050612 | Matsumura | Sep 1991 | A |
| 5063937 | Ezenwa et al. | Nov 1991 | A |
| 5080099 | Way et al. | Jan 1992 | A |
| 5083563 | Collins | Jan 1992 | A |
| 5086781 | Bookspan | Feb 1992 | A |
| 5113869 | Nappholz et al. | May 1992 | A |
| 5125412 | Thornton | Jun 1992 | A |
| 5133355 | Strand et al. | Jul 1992 | A |
| 5140985 | Schroeder et al. | Aug 1992 | A |
| 5150708 | Brooks | Sep 1992 | A |
| 5168874 | Segalowitz | Dec 1992 | A |
| 5226417 | Swedlow et al. | Jul 1993 | A |
| 5241300 | Buschmann | Aug 1993 | A |
| 5257627 | Rapoport | Nov 1993 | A |
| 5271411 | Ripley et al. | Dec 1993 | A |
| 5273532 | Niezink et al. | Dec 1993 | A |
| 5282840 | Hudrlik | Feb 1994 | A |
| 5291013 | Nafarrate et al. | Mar 1994 | A |
| 5297556 | Shankar | Mar 1994 | A |
| 5301677 | Hsung | Apr 1994 | A |
| 5319363 | Welch et al. | Jun 1994 | A |
| 5331966 | Bennett et al. | Jul 1994 | A |
| 5335664 | Nagashima | Aug 1994 | A |
| 5343869 | Pross et al. | Sep 1994 | A |
| 5353793 | Bornn | Oct 1994 | A |
| 5362069 | Hall-Tipping | Nov 1994 | A |
| 5375604 | Kelly et al. | Dec 1994 | A |
| 5411530 | Akhtar | May 1995 | A |
| 5437285 | Verrier et al. | Aug 1995 | A |
| 5443073 | Wang et al. | Aug 1995 | A |
| 5450845 | Axelgaard | Sep 1995 | A |
| 5454377 | Dzwonczyk et al. | Oct 1995 | A |
| 5464012 | Falcone | Nov 1995 | A |
| 5469859 | Tsoglin et al. | Nov 1995 | A |
| 5482036 | Diab et al. | Jan 1996 | A |
| 5496361 | Moberg et al. | Mar 1996 | A |
| 5503157 | Sramek | Apr 1996 | A |
| 5511548 | Riazzi et al. | Apr 1996 | A |
| 5511553 | Segalowitz | Apr 1996 | A |
| 5518001 | Snell | May 1996 | A |
| 5523742 | Simkins et al. | Jun 1996 | A |
| 5529072 | Sramek | Jun 1996 | A |
| 5544661 | Davis et al. | Aug 1996 | A |
| 5558638 | Evers et al. | Sep 1996 | A |
| 5560368 | Berger | Oct 1996 | A |
| 5564429 | Bornn et al. | Oct 1996 | A |
| 5564434 | Halperin et al. | Oct 1996 | A |
| 5566671 | Lyons | Oct 1996 | A |
| 5575284 | Athan et al. | Nov 1996 | A |
| 5607454 | Cameron et al. | Mar 1997 | A |
| 5632272 | Diab et al. | May 1997 | A |
| 5634468 | Platt et al. | Jun 1997 | A |
| 5642734 | Ruben et al. | Jul 1997 | A |
| 5673704 | Marchlinski et al. | Oct 1997 | A |
| 5678562 | Sellers | Oct 1997 | A |
| 5687717 | Halpern et al. | Nov 1997 | A |
| 5710376 | Weber, Jr. | Jan 1998 | A |
| 5718234 | Warden et al. | Feb 1998 | A |
| 5724025 | Tavori | Mar 1998 | A |
| 5738107 | Martinsen et al. | Apr 1998 | A |
| 5748103 | Flach et al. | May 1998 | A |
| 5767791 | Stoop et al. | Jun 1998 | A |
| 5769793 | Pincus et al. | Jun 1998 | A |
| 5772508 | Sugita et al. | Jun 1998 | A |
| 5772586 | Heinonen et al. | Jun 1998 | A |
| 5778882 | Raymond et al. | Jul 1998 | A |
| 5788643 | Feldman | Aug 1998 | A |
| 5788682 | Maget | Aug 1998 | A |
| 5803915 | Kremenchugsky et al. | Sep 1998 | A |
| 5807272 | Kun | Sep 1998 | A |
| 5814079 | Kieval | Sep 1998 | A |
| 5817035 | Sullivan | Oct 1998 | A |
| 5833603 | Kovacs et al. | Nov 1998 | A |
| 5836990 | Li | Nov 1998 | A |
| 5855614 | Stevens et al. | Jan 1999 | A |
| 5860860 | Clayman | Jan 1999 | A |
| 5862802 | Bird | Jan 1999 | A |
| 5862803 | Besson et al. | Jan 1999 | A |
| 5865733 | Malinouskas et al. | Feb 1999 | A |
| 5876353 | Riff | Mar 1999 | A |
| 5904708 | Goedeke | May 1999 | A |
| 5935079 | Swanson et al. | Aug 1999 | A |
| 5941831 | Turcott | Aug 1999 | A |
| 5944659 | Flach et al. | Aug 1999 | A |
| 5949636 | Johnson et al. | Sep 1999 | A |
| 5957854 | Besson et al. | Sep 1999 | A |
| 5957861 | Combs et al. | Sep 1999 | A |
| 5964703 | Goodman et al. | Oct 1999 | A |
| 5970986 | Bolz et al. | Oct 1999 | A |
| 5984102 | Tay | Nov 1999 | A |
| 5987352 | Klein et al. | Nov 1999 | A |
| 6007532 | Netherly | Dec 1999 | A |
| 6027523 | Schmieding | Feb 2000 | A |
| 6045513 | Stone et al. | Apr 2000 | A |
| 6047203 | Sackner et al. | Apr 2000 | A |
| 6047259 | Campbell et al. | Apr 2000 | A |
| 6049730 | Kristbjarnarson | Apr 2000 | A |
| 6050267 | Nardella et al. | Apr 2000 | A |
| 6050951 | Friedman et al. | Apr 2000 | A |
| 6052615 | Feild et al. | Apr 2000 | A |
| 6067467 | John | May 2000 | A |
| 6080106 | Lloyd et al. | Jun 2000 | A |
| 6081735 | Diab et al. | Jun 2000 | A |
| 6095991 | Krausman et al. | Aug 2000 | A |
| 6102856 | Groff et al. | Aug 2000 | A |
| 6104949 | Pitts Crick et al. | Aug 2000 | A |
| 6112224 | Peifer et al. | Aug 2000 | A |
| 6117077 | Del Mar et al. | Sep 2000 | A |
| 6125297 | Siconolfi | Sep 2000 | A |
| 6129744 | Boute | Oct 2000 | A |
| 6141575 | Price | Oct 2000 | A |
| 6144878 | Schroeppel et al. | Nov 2000 | A |
| 6164284 | Schulman et al. | Dec 2000 | A |
| 6181963 | Chin et al. | Jan 2001 | B1 |
| 6185452 | Schulman et al. | Feb 2001 | B1 |
| 6190313 | Hinkle | Feb 2001 | B1 |
| 6190324 | Kieval et al. | Feb 2001 | B1 |
| 6198394 | Jacobsen et al. | Mar 2001 | B1 |
| 6198955 | Axelgaard et al. | Mar 2001 | B1 |
| 6208894 | Schulman et al. | Mar 2001 | B1 |
| 6212427 | Hoover | Apr 2001 | B1 |
| 6213942 | Flach et al. | Apr 2001 | B1 |
| 6225901 | Kail, IV | May 2001 | B1 |
| 6245021 | Stampfer | Jun 2001 | B1 |
| 6259939 | Rogel | Jul 2001 | B1 |
| 6267730 | Pacunas | Jul 2001 | B1 |
| 6272377 | Sweeney et al. | Aug 2001 | B1 |
| 6277078 | Porat et al. | Aug 2001 | B1 |
| 6287252 | Lugo | Sep 2001 | B1 |
| 6289238 | Besson et al. | Sep 2001 | B1 |
| 6290646 | Cosentino et al. | Sep 2001 | B1 |
| 6295466 | Ishikawa et al. | Sep 2001 | B1 |
| 6305943 | Pougatchev et al. | Oct 2001 | B1 |
| 6306088 | Krausman et al. | Oct 2001 | B1 |
| 6308094 | Shusterman et al. | Oct 2001 | B1 |
| 6312378 | Bardy | Nov 2001 | B1 |
| 6315721 | Schulman et al. | Nov 2001 | B2 |
| 6327487 | Stratbucker | Dec 2001 | B1 |
| 6330464 | Colvin et al. | Dec 2001 | B1 |
| 6336903 | Bardy | Jan 2002 | B1 |
| 6339722 | Heethaar et al. | Jan 2002 | B1 |
| 6343140 | Brooks | Jan 2002 | B1 |
| 6347245 | Lee et al. | Feb 2002 | B1 |
| 6358208 | Lang et al. | Mar 2002 | B1 |
| 6385473 | Haines et al. | May 2002 | B1 |
| 6398727 | Bui et al. | Jun 2002 | B1 |
| 6400982 | Sweeney et al. | Jun 2002 | B2 |
| 6409674 | Brockway et al. | Jun 2002 | B1 |
| 6411853 | Millot et al. | Jun 2002 | B1 |
| 6416471 | Kumar et al. | Jul 2002 | B1 |
| 6440069 | Raymond et al. | Aug 2002 | B1 |
| 6442422 | Duckert | Aug 2002 | B1 |
| 6450820 | Palsson et al. | Sep 2002 | B1 |
| 6450953 | Place et al. | Sep 2002 | B1 |
| 6453186 | Lovejoy et al. | Sep 2002 | B1 |
| 6454707 | Casscells, III et al. | Sep 2002 | B1 |
| 6454708 | Ferguson et al. | Sep 2002 | B1 |
| 6459930 | Takehara et al. | Oct 2002 | B1 |
| 6463328 | John | Oct 2002 | B1 |
| 6473640 | Erlebacher | Oct 2002 | B1 |
| 6480733 | Turcott | Nov 2002 | B1 |
| 6480734 | Zhang et al. | Nov 2002 | B1 |
| 6485461 | Mason et al. | Nov 2002 | B1 |
| 6490478 | Zhang et al. | Dec 2002 | B1 |
| 6491647 | Bridger et al. | Dec 2002 | B1 |
| 6494829 | New, Jr. et al. | Dec 2002 | B1 |
| 6496715 | Lee et al. | Dec 2002 | B1 |
| 6512949 | Combs et al. | Jan 2003 | B1 |
| 6520967 | Cauthen | Feb 2003 | B1 |
| 6527711 | Stivoric et al. | Mar 2003 | B1 |
| 6527729 | Turcott | Mar 2003 | B1 |
| 6528960 | Roden et al. | Mar 2003 | B1 |
| 6544173 | West et al. | Apr 2003 | B2 |
| 6544174 | West et al. | Apr 2003 | B2 |
| 6551251 | Zuckerwar et al. | Apr 2003 | B2 |
| 6551252 | Sackner et al. | Apr 2003 | B2 |
| 6569160 | Goldin et al. | May 2003 | B1 |
| 6572557 | Tchou et al. | Jun 2003 | B2 |
| 6572636 | Hagen et al. | Jun 2003 | B1 |
| 6577139 | Cooper | Jun 2003 | B2 |
| 6577893 | Besson et al. | Jun 2003 | B1 |
| 6577897 | Shurubura et al. | Jun 2003 | B1 |
| 6579231 | Phipps | Jun 2003 | B1 |
| 6580942 | Willshire | Jun 2003 | B1 |
| 6584343 | Ransbury et al. | Jun 2003 | B1 |
| 6587715 | Singer | Jul 2003 | B2 |
| 6589170 | Flach et al. | Jul 2003 | B1 |
| 6595927 | Pitts-Crick et al. | Jul 2003 | B2 |
| 6595929 | Stivoric et al. | Jul 2003 | B2 |
| 6600949 | Turcott | Jul 2003 | B1 |
| 6602201 | Hepp et al. | Aug 2003 | B1 |
| 6605038 | Teller et al. | Aug 2003 | B1 |
| 6611705 | Hopman et al. | Aug 2003 | B2 |
| 6611783 | Kelly et al. | Aug 2003 | B2 |
| 6616606 | Petersen et al. | Sep 2003 | B1 |
| 6622042 | Thacker | Sep 2003 | B1 |
| 6636754 | Baura et al. | Oct 2003 | B1 |
| 6641542 | Cho et al. | Nov 2003 | B2 |
| 6645153 | Kroll et al. | Nov 2003 | B2 |
| 6649829 | Garber et al. | Nov 2003 | B2 |
| 6650917 | Diab et al. | Nov 2003 | B2 |
| 6658300 | Govari et al. | Dec 2003 | B2 |
| 6659947 | Carter et al. | Dec 2003 | B1 |
| 6659949 | Lang et al. | Dec 2003 | B1 |
| 6687540 | Marcovecchio | Feb 2004 | B2 |
| 6697658 | Al-Ali | Feb 2004 | B2 |
| RE38476 | Diab et al. | Mar 2004 | E |
| 6699200 | Cao et al. | Mar 2004 | B2 |
| 6701271 | Willner et al. | Mar 2004 | B2 |
| 6714813 | Ishigooka et al. | Mar 2004 | B2 |
| RE38492 | Diab et al. | Apr 2004 | E |
| 6721594 | Conley et al. | Apr 2004 | B2 |
| 6728572 | Hsu et al. | Apr 2004 | B2 |
| 6748269 | Thompson et al. | Jun 2004 | B2 |
| 6749566 | Russ | Jun 2004 | B2 |
| 6751498 | Greenberg et al. | Jun 2004 | B1 |
| 6760617 | Ward et al. | Jul 2004 | B2 |
| 6773396 | Flach et al. | Aug 2004 | B2 |
| 6775566 | Nissila | Aug 2004 | B2 |
| 6790178 | Mault et al. | Sep 2004 | B1 |
| 6795722 | Sheraton et al. | Sep 2004 | B2 |
| 6814706 | Barton et al. | Nov 2004 | B2 |
| 6816744 | Garfield et al. | Nov 2004 | B2 |
| 6819956 | DiLorenzo | Nov 2004 | B2 |
| 6821249 | Casscells, III et al. | Nov 2004 | B2 |
| 6824515 | Suorsa et al. | Nov 2004 | B2 |
| 6827690 | Bardy | Dec 2004 | B2 |
| 6829503 | Alt | Dec 2004 | B2 |
| 6858006 | MacCarter et al. | Feb 2005 | B2 |
| 6871211 | Labounty et al. | Mar 2005 | B2 |
| 6878121 | Krausman et al. | Apr 2005 | B2 |
| 6879850 | Kimball | Apr 2005 | B2 |
| 6881191 | Oakley et al. | Apr 2005 | B2 |
| 6887201 | Bardy | May 2005 | B2 |
| 6890096 | Tokita et al. | May 2005 | B2 |
| 6893396 | Schulze et al. | May 2005 | B2 |
| 6894204 | Dunshee | May 2005 | B2 |
| 6906530 | Geisel | Jun 2005 | B2 |
| 6912414 | Tong | Jun 2005 | B2 |
| 6936006 | Sabra | Aug 2005 | B2 |
| 6940403 | Kail, IV | Sep 2005 | B2 |
| 6942622 | Turcott | Sep 2005 | B1 |
| 6952695 | Trinks et al. | Oct 2005 | B1 |
| 6970742 | Mann et al. | Nov 2005 | B2 |
| 6972683 | Lestienne et al. | Dec 2005 | B2 |
| 6978177 | Chen et al. | Dec 2005 | B1 |
| 6980851 | Zhu et al. | Dec 2005 | B2 |
| 6980852 | Jersey-Willuhn et al. | Dec 2005 | B2 |
| 5449000 | Kennedy | Jan 2006 | A1 |
| 6985078 | Suzuki et al. | Jan 2006 | B2 |
| 6987965 | Ng et al. | Jan 2006 | B2 |
| 6988989 | Weiner et al. | Jan 2006 | B2 |
| 6993378 | Wiederhold et al. | Jan 2006 | B2 |
| 6997879 | Turcott | Feb 2006 | B1 |
| 7003346 | Singer | Feb 2006 | B2 |
| 7009362 | Tsukamoto et al. | Mar 2006 | B2 |
| 7010340 | Scarantino et al. | Mar 2006 | B2 |
| 7018338 | Vetter et al. | Mar 2006 | B2 |
| 7020508 | Stivoric et al. | Mar 2006 | B2 |
| 7027862 | Dahl et al. | Apr 2006 | B2 |
| 7041062 | Friedrichs et al. | May 2006 | B2 |
| 7044911 | Drinan et al. | May 2006 | B2 |
| 7047067 | Gray et al. | May 2006 | B2 |
| 7050846 | Sweeney et al. | May 2006 | B2 |
| 7054679 | Hirsh | May 2006 | B2 |
| 7059767 | Tokita et al. | Jun 2006 | B2 |
| 7088242 | Aupperle et al. | Aug 2006 | B2 |
| 7113826 | Henry et al. | Sep 2006 | B2 |
| 7118531 | Krill | Oct 2006 | B2 |
| 7127370 | Kelly, Jr. et al. | Oct 2006 | B2 |
| 7129836 | Lawson et al. | Oct 2006 | B2 |
| 7130396 | Rogers et al. | Oct 2006 | B2 |
| 7130679 | Parsonnet et al. | Oct 2006 | B2 |
| 7133716 | Kraemer et al. | Nov 2006 | B2 |
| 7136697 | Singer | Nov 2006 | B2 |
| 7136703 | Cappa et al. | Nov 2006 | B1 |
| 7142907 | Xue et al. | Nov 2006 | B2 |
| 7149574 | Yun et al. | Dec 2006 | B2 |
| 7149773 | Haller et al. | Dec 2006 | B2 |
| 7153262 | Stivoric et al. | Dec 2006 | B2 |
| 7156807 | Carter et al. | Jan 2007 | B2 |
| 7156808 | Quy | Jan 2007 | B2 |
| 7160252 | Cho et al. | Jan 2007 | B2 |
| 7160253 | Nissila | Jan 2007 | B2 |
| 7166063 | Rahman et al. | Jan 2007 | B2 |
| 7167743 | Heruth et al. | Jan 2007 | B2 |
| 7184821 | Belalcazar et al. | Feb 2007 | B2 |
| 7191000 | Zhu et al. | Mar 2007 | B2 |
| 7194306 | Turcott | Mar 2007 | B1 |
| 7206630 | Tarler | Apr 2007 | B1 |
| 7209787 | DiLorenzo | Apr 2007 | B2 |
| 7212849 | Zhang et al. | May 2007 | B2 |
| 7215984 | Diab et al. | May 2007 | B2 |
| 7215991 | Besson et al. | May 2007 | B2 |
| 7231254 | DiLorenzo | Jun 2007 | B2 |
| 7238159 | Banet et al. | Jul 2007 | B2 |
| 7248916 | Bardy | Jul 2007 | B2 |
| 7251524 | Hepp et al. | Jul 2007 | B1 |
| 7257438 | Kinast | Aug 2007 | B2 |
| 7261690 | Teller et al. | Aug 2007 | B2 |
| 7277741 | Debreczeny et al. | Oct 2007 | B2 |
| 7284904 | Tokita et al. | Oct 2007 | B2 |
| 7285090 | Stivoric et al. | Oct 2007 | B2 |
| 7294105 | Islam | Nov 2007 | B1 |
| 7295879 | Denker et al. | Nov 2007 | B2 |
| 7297119 | Westbrook et al. | Nov 2007 | B2 |
| 7318808 | Tarassenko et al. | Jan 2008 | B2 |
| 7319386 | Collins, Jr. et al. | Jan 2008 | B2 |
| 7324851 | DiLorenzo | Jan 2008 | B1 |
| 7336187 | Hubbard, Jr. et al. | Feb 2008 | B2 |
| 7346380 | Axelgaard et al. | Mar 2008 | B2 |
| 7382247 | Welch et al. | Jun 2008 | B2 |
| 7384398 | Gagnadre et al. | Jun 2008 | B2 |
| 7390299 | Weiner et al. | Jun 2008 | B2 |
| 7395106 | Ryu et al. | Jul 2008 | B2 |
| 7423526 | Despotis | Sep 2008 | B2 |
| 7423537 | Bonnet et al. | Sep 2008 | B2 |
| 7443302 | Reeder et al. | Oct 2008 | B2 |
| 7450024 | Wildman et al. | Nov 2008 | B2 |
| 7468032 | Stahmann et al. | Dec 2008 | B2 |
| 7510699 | Black et al. | Mar 2009 | B2 |
| 7660632 | Kirby et al. | Feb 2010 | B2 |
| 7701227 | Saulnier et al. | Apr 2010 | B2 |
| 7813778 | Benaron et al. | Oct 2010 | B2 |
| 7881763 | Brauker et al. | Feb 2011 | B2 |
| 7942824 | Kayyali et al. | May 2011 | B1 |
| 8249686 | Libbus et al. | Aug 2012 | B2 |
| 8285356 | Bly et al. | Oct 2012 | B2 |
| 20010047127 | New, Jr. et al. | Nov 2001 | A1 |
| 20020004640 | Conn et al. | Jan 2002 | A1 |
| 20020019586 | Teller et al. | Feb 2002 | A1 |
| 20020019588 | Marro et al. | Feb 2002 | A1 |
| 20020022786 | Takehara et al. | Feb 2002 | A1 |
| 20020028989 | Pelletier et al. | Mar 2002 | A1 |
| 20020032581 | Reitberg | Mar 2002 | A1 |
| 20020045836 | Alkawwas | Apr 2002 | A1 |
| 20020088465 | Hill | Jul 2002 | A1 |
| 20020099277 | Harry et al. | Jul 2002 | A1 |
| 20020116009 | Fraser et al. | Aug 2002 | A1 |
| 20020123672 | Christophersom et al. | Sep 2002 | A1 |
| 20020123674 | Plicchi et al. | Sep 2002 | A1 |
| 20020138017 | Bui et al. | Sep 2002 | A1 |
| 20020167389 | Uchikoba et al. | Nov 2002 | A1 |
| 20020182485 | Anderson et al. | Dec 2002 | A1 |
| 20030009092 | Parker | Jan 2003 | A1 |
| 20030023184 | Pitts-Crick et al. | Jan 2003 | A1 |
| 20030028221 | Zhu et al. | Feb 2003 | A1 |
| 20030028327 | Brunner et al. | Feb 2003 | A1 |
| 20030045922 | Northrop | Mar 2003 | A1 |
| 20030051144 | Williams | Mar 2003 | A1 |
| 20030055460 | Owens et al. | Mar 2003 | A1 |
| 20030083581 | Taha et al. | May 2003 | A1 |
| 20030085717 | Cooper | May 2003 | A1 |
| 20030087244 | McCarthy | May 2003 | A1 |
| 20030092975 | Casscells, III et al. | May 2003 | A1 |
| 20030093125 | Zhu et al. | May 2003 | A1 |
| 20030093298 | Hernandez et al. | May 2003 | A1 |
| 20030100367 | Cooke | May 2003 | A1 |
| 20030105411 | Smallwood et al. | Jun 2003 | A1 |
| 20030135127 | Sackner et al. | Jul 2003 | A1 |
| 20030143544 | McCarthy | Jul 2003 | A1 |
| 20030149349 | Jensen | Aug 2003 | A1 |
| 20030181815 | Ebner et al. | Sep 2003 | A1 |
| 20030187370 | Kodama | Oct 2003 | A1 |
| 20030191503 | Zhu et al. | Oct 2003 | A1 |
| 20030212319 | Magill | Nov 2003 | A1 |
| 20030221687 | Kaigler | Dec 2003 | A1 |
| 20030233129 | Matos | Dec 2003 | A1 |
| 20040006279 | Arad (Abboud) | Jan 2004 | A1 |
| 20040010303 | Bolea et al. | Jan 2004 | A1 |
| 20040014422 | Kallio | Jan 2004 | A1 |
| 20040015058 | Besson et al. | Jan 2004 | A1 |
| 20040019292 | Drinan et al. | Jan 2004 | A1 |
| 20040044293 | Burton | Mar 2004 | A1 |
| 20040049132 | Barron et al. | Mar 2004 | A1 |
| 20040064133 | Miller et al. | Apr 2004 | A1 |
| 20040073094 | Baker | Apr 2004 | A1 |
| 20040073126 | Rowlandson | Apr 2004 | A1 |
| 20040077954 | Oakley et al. | Apr 2004 | A1 |
| 20040100376 | Lye et al. | May 2004 | A1 |
| 20040102683 | Khanuja et al. | May 2004 | A1 |
| 20040106951 | Edman et al. | Jun 2004 | A1 |
| 20040122489 | Mazar et al. | Jun 2004 | A1 |
| 20040127790 | Lang et al. | Jul 2004 | A1 |
| 20040133079 | Mazar et al. | Jul 2004 | A1 |
| 20040133081 | Teller et al. | Jul 2004 | A1 |
| 20040134496 | Cho et al. | Jul 2004 | A1 |
| 20040143170 | DuRousseau | Jul 2004 | A1 |
| 20040147969 | Mann et al. | Jul 2004 | A1 |
| 20040152956 | Korman | Aug 2004 | A1 |
| 20040158132 | Zaleski | Aug 2004 | A1 |
| 20040167389 | Brabrand | Aug 2004 | A1 |
| 20040172080 | Stadler et al. | Sep 2004 | A1 |
| 20040199056 | Husemann et al. | Oct 2004 | A1 |
| 20040215240 | Lovett et al. | Oct 2004 | A1 |
| 20040215247 | Bolz | Oct 2004 | A1 |
| 20040220639 | Mulligan et al. | Nov 2004 | A1 |
| 20040225199 | Evanyk et al. | Nov 2004 | A1 |
| 20040225203 | Jemison et al. | Nov 2004 | A1 |
| 20040243018 | Organ et al. | Dec 2004 | A1 |
| 20040267142 | Paul | Dec 2004 | A1 |
| 20050004506 | Gyory | Jan 2005 | A1 |
| 20050015094 | Keller | Jan 2005 | A1 |
| 20050015095 | Keller | Jan 2005 | A1 |
| 20050020935 | Helzel et al. | Jan 2005 | A1 |
| 20050027175 | Yang | Feb 2005 | A1 |
| 20050027204 | Kligfield et al. | Feb 2005 | A1 |
| 20050027207 | Westbrook et al. | Feb 2005 | A1 |
| 20050027918 | Govindarajulu et al. | Feb 2005 | A1 |
| 20050043675 | Pastore et al. | Feb 2005 | A1 |
| 20050054944 | Nakada et al. | Mar 2005 | A1 |
| 20050059867 | Chung | Mar 2005 | A1 |
| 20050065445 | Arzbaecher et al. | Mar 2005 | A1 |
| 20050065571 | Imran | Mar 2005 | A1 |
| 20050070768 | Zhu et al. | Mar 2005 | A1 |
| 20050070778 | Lackey et al. | Mar 2005 | A1 |
| 20050080346 | Gianchandani et al. | Apr 2005 | A1 |
| 20050080460 | Wang et al. | Apr 2005 | A1 |
| 20050080463 | Stahmann et al. | Apr 2005 | A1 |
| 20050085734 | Tehrani | Apr 2005 | A1 |
| 20050091338 | de la Huerga | Apr 2005 | A1 |
| 20050096513 | Ozguz et al. | May 2005 | A1 |
| 20050113703 | Farringdon et al. | May 2005 | A1 |
| 20050124878 | Sharony | Jun 2005 | A1 |
| 20050124901 | Misczynski et al. | Jun 2005 | A1 |
| 20050124908 | Belalcazar et al. | Jun 2005 | A1 |
| 20050131288 | Turner et al. | Jun 2005 | A1 |
| 20050137464 | Bomba | Jun 2005 | A1 |
| 20050137626 | Pastore et al. | Jun 2005 | A1 |
| 20050148895 | Misczynski et al. | Jul 2005 | A1 |
| 20050158539 | Murphy et al. | Jul 2005 | A1 |
| 20050177038 | Kolpin et al. | Aug 2005 | A1 |
| 20050187482 | O'Brien et al. | Aug 2005 | A1 |
| 20050187796 | Rosenfeld et al. | Aug 2005 | A1 |
| 20050192488 | Bryenton et al. | Sep 2005 | A1 |
| 20050197654 | Edman et al. | Sep 2005 | A1 |
| 20050203433 | Singer | Sep 2005 | A1 |
| 20050203435 | Nakada | Sep 2005 | A1 |
| 20050203436 | Davies | Sep 2005 | A1 |
| 20050203637 | Edman et al. | Sep 2005 | A1 |
| 20050206518 | Welch et al. | Sep 2005 | A1 |
| 20050215914 | Bornzin et al. | Sep 2005 | A1 |
| 20050215918 | Frantz et al. | Sep 2005 | A1 |
| 20050228234 | Yang | Oct 2005 | A1 |
| 20050228238 | Monitzer | Oct 2005 | A1 |
| 20050228244 | Banet | Oct 2005 | A1 |
| 20050239493 | Batkin et al. | Oct 2005 | A1 |
| 20050240087 | Keenan et al. | Oct 2005 | A1 |
| 20050251044 | Hoctor et al. | Nov 2005 | A1 |
| 20050256418 | Mietus et al. | Nov 2005 | A1 |
| 20050261598 | Banet et al. | Nov 2005 | A1 |
| 20050261743 | Kroll | Nov 2005 | A1 |
| 20050267376 | Marossero et al. | Dec 2005 | A1 |
| 20050267377 | Marossero et al. | Dec 2005 | A1 |
| 20050267381 | Benditt et al. | Dec 2005 | A1 |
| 20050273023 | Bystrom et al. | Dec 2005 | A1 |
| 20050277841 | Shennib | Dec 2005 | A1 |
| 20050277842 | Silva | Dec 2005 | A1 |
| 20050277992 | Koh et al. | Dec 2005 | A1 |
| 20050280531 | Fadem et al. | Dec 2005 | A1 |
| 20050283197 | Daum et al. | Dec 2005 | A1 |
| 20050288601 | Wood et al. | Dec 2005 | A1 |
| 20060004300 | Kennedy | Jan 2006 | A1 |
| 20060004377 | Keller | Jan 2006 | A1 |
| 20060009697 | Banet et al. | Jan 2006 | A1 |
| 20060009701 | Nissila et al. | Jan 2006 | A1 |
| 20060010090 | Brockway et al. | Jan 2006 | A1 |
| 20060020218 | Freeman et al. | Jan 2006 | A1 |
| 20060025661 | Sweeney et al. | Feb 2006 | A1 |
| 20060030781 | Shennib | Feb 2006 | A1 |
| 20060030782 | Shennib | Feb 2006 | A1 |
| 20060031102 | Teller et al. | Feb 2006 | A1 |
| 20060041280 | Stahmann et al. | Feb 2006 | A1 |
| 20060047215 | Newman et al. | Mar 2006 | A1 |
| 20060052678 | Drinan et al. | Mar 2006 | A1 |
| 20060058543 | Walter et al. | Mar 2006 | A1 |
| 20060058593 | Drinan et al. | Mar 2006 | A1 |
| 20060064030 | Cosentino et al. | Mar 2006 | A1 |
| 20060064040 | Berger et al. | Mar 2006 | A1 |
| 20060064142 | Chavan et al. | Mar 2006 | A1 |
| 20060066449 | Johnson | Mar 2006 | A1 |
| 20060074283 | Henderson et al. | Apr 2006 | A1 |
| 20060074462 | Verhoef | Apr 2006 | A1 |
| 20060075257 | Martis et al. | Apr 2006 | A1 |
| 20060084881 | Korzinov et al. | Apr 2006 | A1 |
| 20060085049 | Cory et al. | Apr 2006 | A1 |
| 20060089679 | Zhu et al. | Apr 2006 | A1 |
| 20060094948 | Gough et al. | May 2006 | A1 |
| 20060102476 | Niwa et al. | May 2006 | A1 |
| 20060116592 | Zhou et al. | Jun 2006 | A1 |
| 20060122474 | Teller et al. | Jun 2006 | A1 |
| 20060135858 | Nidd et al. | Jun 2006 | A1 |
| 20060142654 | Rytky | Jun 2006 | A1 |
| 20060142820 | Von Arx et al. | Jun 2006 | A1 |
| 20060149168 | Czarnek | Jul 2006 | A1 |
| 20060155174 | Glukhovsky et al. | Jul 2006 | A1 |
| 20060155183 | Kroecker et al. | Jul 2006 | A1 |
| 20060155200 | Ng | Jul 2006 | A1 |
| 20060157893 | Patel | Jul 2006 | A1 |
| 20060161073 | Singer | Jul 2006 | A1 |
| 20060161205 | Mitrani et al. | Jul 2006 | A1 |
| 20060161459 | Rosenfeld et al. | Jul 2006 | A9 |
| 20060167374 | Takehara et al. | Jul 2006 | A1 |
| 20060173257 | Nagai et al. | Aug 2006 | A1 |
| 20060173269 | Glossop | Aug 2006 | A1 |
| 20060195020 | Martin et al. | Aug 2006 | A1 |
| 20060195039 | Drew et al. | Aug 2006 | A1 |
| 20060195097 | Evans et al. | Aug 2006 | A1 |
| 20060195144 | Giftakis et al. | Aug 2006 | A1 |
| 20060202816 | Crump et al. | Sep 2006 | A1 |
| 20060212097 | Varadan et al. | Sep 2006 | A1 |
| 20060224051 | Teller et al. | Oct 2006 | A1 |
| 20060224072 | Shennib | Oct 2006 | A1 |
| 20060224079 | Washchuk | Oct 2006 | A1 |
| 20060235281 | Tuccillo | Oct 2006 | A1 |
| 20060235316 | Ungless et al. | Oct 2006 | A1 |
| 20060235489 | Drew et al. | Oct 2006 | A1 |
| 20060238333 | Welch et al. | Oct 2006 | A1 |
| 20060241641 | Albans et al. | Oct 2006 | A1 |
| 20060241701 | Markowitz et al. | Oct 2006 | A1 |
| 20060241722 | Thacker et al. | Oct 2006 | A1 |
| 20060247545 | St. Martin | Nov 2006 | A1 |
| 20060252999 | Devaul et al. | Nov 2006 | A1 |
| 20060253005 | Drinan et al. | Nov 2006 | A1 |
| 20060253044 | Zhang et al. | Nov 2006 | A1 |
| 20060258952 | Stahmann et al. | Nov 2006 | A1 |
| 20060264730 | Stivoric et al. | Nov 2006 | A1 |
| 20060264767 | Shennib | Nov 2006 | A1 |
| 20060264776 | Stahmann et al. | Nov 2006 | A1 |
| 20060271116 | Stahmann et al. | Nov 2006 | A1 |
| 20060276714 | Holt et al. | Dec 2006 | A1 |
| 20060281981 | Jang et al. | Dec 2006 | A1 |
| 20060281996 | Kuo et al. | Dec 2006 | A1 |
| 20060293571 | Bao et al. | Dec 2006 | A1 |
| 20060293609 | Stahmann et al. | Dec 2006 | A1 |
| 20070010721 | Chen et al. | Jan 2007 | A1 |
| 20070010750 | Ueno et al. | Jan 2007 | A1 |
| 20070015973 | Nanikashvili | Jan 2007 | A1 |
| 20070015976 | Miesel et al. | Jan 2007 | A1 |
| 20070016089 | Fischell et al. | Jan 2007 | A1 |
| 20070021678 | Beck et al. | Jan 2007 | A1 |
| 20070021790 | Kieval et al. | Jan 2007 | A1 |
| 20070021792 | Kieval et al. | Jan 2007 | A1 |
| 20070021794 | Kieval et al. | Jan 2007 | A1 |
| 20070021796 | Kieval et al. | Jan 2007 | A1 |
| 20070021797 | Kieval et al. | Jan 2007 | A1 |
| 20070021798 | Kieval et al. | Jan 2007 | A1 |
| 20070021799 | Kieval et al. | Jan 2007 | A1 |
| 20070027388 | Chou | Feb 2007 | A1 |
| 20070027497 | Parnis | Feb 2007 | A1 |
| 20070032749 | Overall et al. | Feb 2007 | A1 |
| 20070038038 | Stivoric et al. | Feb 2007 | A1 |
| 20070038078 | Osadchy | Feb 2007 | A1 |
| 20070038255 | Kieval et al. | Feb 2007 | A1 |
| 20070038262 | Kieval et al. | Feb 2007 | A1 |
| 20070043301 | Martinsen et al. | Feb 2007 | A1 |
| 20070043303 | Osypka et al. | Feb 2007 | A1 |
| 20070048224 | Howell et al. | Mar 2007 | A1 |
| 20070060800 | Drinan et al. | Mar 2007 | A1 |
| 20070060802 | Ghevondian et al. | Mar 2007 | A1 |
| 20070069887 | Welch et al. | Mar 2007 | A1 |
| 20070073132 | Vosch | Mar 2007 | A1 |
| 20070073168 | Zhang et al. | Mar 2007 | A1 |
| 20070073181 | Pu et al. | Mar 2007 | A1 |
| 20070073361 | Goren et al. | Mar 2007 | A1 |
| 20070082189 | Gillette | Apr 2007 | A1 |
| 20070083092 | Rippo et al. | Apr 2007 | A1 |
| 20070092862 | Gerber | Apr 2007 | A1 |
| 20070104840 | Singer | May 2007 | A1 |
| 20070106132 | Elhag et al. | May 2007 | A1 |
| 20070106137 | Baker, Jr. et al. | May 2007 | A1 |
| 20070106167 | Kinast | May 2007 | A1 |
| 20070118039 | Bodecker et al. | May 2007 | A1 |
| 20070123756 | Kitajima et al. | May 2007 | A1 |
| 20070123903 | Raymond et al. | May 2007 | A1 |
| 20070123904 | Stad et al. | May 2007 | A1 |
| 20070129622 | Bourget et al. | Jun 2007 | A1 |
| 20070129643 | Kwok et al. | Jun 2007 | A1 |
| 20070129769 | Bourget et al. | Jun 2007 | A1 |
| 20070142715 | Banet et al. | Jun 2007 | A1 |
| 20070142732 | Brockway et al. | Jun 2007 | A1 |
| 20070149282 | Lu et al. | Jun 2007 | A1 |
| 20070150008 | Jones et al. | Jun 2007 | A1 |
| 20070150009 | Kveen et al. | Jun 2007 | A1 |
| 20070150029 | Bourget et al. | Jun 2007 | A1 |
| 20070162089 | Mosesov | Jul 2007 | A1 |
| 20070167753 | Van Wyk et al. | Jul 2007 | A1 |
| 20070167848 | Kuo et al. | Jul 2007 | A1 |
| 20070167849 | Zhang et al. | Jul 2007 | A1 |
| 20070167850 | Russell et al. | Jul 2007 | A1 |
| 20070172424 | Roser | Jul 2007 | A1 |
| 20070173705 | Teller et al. | Jul 2007 | A1 |
| 20070180047 | Dong et al. | Aug 2007 | A1 |
| 20070180140 | Welch et al. | Aug 2007 | A1 |
| 20070191723 | Prystowsky et al. | Aug 2007 | A1 |
| 20070207858 | Breving | Sep 2007 | A1 |
| 20070208233 | Kovacs | Sep 2007 | A1 |
| 20070208235 | Besson et al. | Sep 2007 | A1 |
| 20070208262 | Kovacs | Sep 2007 | A1 |
| 20070232867 | Hansmann | Oct 2007 | A1 |
| 20070244403 | Natarajan et al. | Oct 2007 | A1 |
| 20070249946 | Kumar et al. | Oct 2007 | A1 |
| 20070250121 | Miesel et al. | Oct 2007 | A1 |
| 20070255120 | Rosnov | Nov 2007 | A1 |
| 20070255153 | Kumar et al. | Nov 2007 | A1 |
| 20070255184 | Shennib | Nov 2007 | A1 |
| 20070255531 | Drew | Nov 2007 | A1 |
| 20070260133 | Meyer | Nov 2007 | A1 |
| 20070260155 | Rapoport et al. | Nov 2007 | A1 |
| 20070260289 | Giftakis et al. | Nov 2007 | A1 |
| 20070270678 | Fadem et al. | Nov 2007 | A1 |
| 20070273504 | Tran | Nov 2007 | A1 |
| 20070276273 | Watson, Jr. | Nov 2007 | A1 |
| 20070282173 | Wang et al. | Dec 2007 | A1 |
| 20070299325 | Farrell et al. | Dec 2007 | A1 |
| 20080004499 | Davis | Jan 2008 | A1 |
| 20080004547 | Dinsmoor et al. | Jan 2008 | A1 |
| 20080004904 | Tran | Jan 2008 | A1 |
| 20080021336 | Dobak | Jan 2008 | A1 |
| 20080024293 | Stylos | Jan 2008 | A1 |
| 20080024294 | Mazar | Jan 2008 | A1 |
| 20080033260 | Sheppard et al. | Feb 2008 | A1 |
| 20080039700 | Drinan et al. | Feb 2008 | A1 |
| 20080058614 | Banet et al. | Mar 2008 | A1 |
| 20080058656 | Costello et al. | Mar 2008 | A1 |
| 20080059239 | Gerst et al. | Mar 2008 | A1 |
| 20080091089 | Guillory et al. | Apr 2008 | A1 |
| 20080114220 | Banet et al. | May 2008 | A1 |
| 20080120784 | Warner et al. | May 2008 | A1 |
| 20080139934 | McMorrow et al. | Jun 2008 | A1 |
| 20080146892 | LeBoeuf et al. | Jun 2008 | A1 |
| 20080167538 | Teller et al. | Jul 2008 | A1 |
| 20080171918 | Teller et al. | Jul 2008 | A1 |
| 20080171922 | Teller et al. | Jul 2008 | A1 |
| 20080171929 | Katims | Jul 2008 | A1 |
| 20080183052 | Teller et al. | Jul 2008 | A1 |
| 20080200774 | Luo | Aug 2008 | A1 |
| 20080214903 | Orbach | Sep 2008 | A1 |
| 20080220865 | Hsu | Sep 2008 | A1 |
| 20080221399 | Zhou et al. | Sep 2008 | A1 |
| 20080221402 | Despotis | Sep 2008 | A1 |
| 20080224852 | Dicks et al. | Sep 2008 | A1 |
| 20080228084 | Bedard et al. | Sep 2008 | A1 |
| 20080275465 | Paul et al. | Nov 2008 | A1 |
| 20080287751 | Stivoric et al. | Nov 2008 | A1 |
| 20080287752 | Stroetz et al. | Nov 2008 | A1 |
| 20080293491 | Wu et al. | Nov 2008 | A1 |
| 20080294019 | Tran | Nov 2008 | A1 |
| 20080294020 | Sapounas | Nov 2008 | A1 |
| 20080318681 | Rofougaran et al. | Dec 2008 | A1 |
| 20080319279 | Ramsay et al. | Dec 2008 | A1 |
| 20080319282 | Tran | Dec 2008 | A1 |
| 20080319290 | Mao et al. | Dec 2008 | A1 |
| 20090005016 | Eng et al. | Jan 2009 | A1 |
| 20090018410 | Coene et al. | Jan 2009 | A1 |
| 20090018456 | Hung | Jan 2009 | A1 |
| 20090048526 | Aarts et al. | Feb 2009 | A1 |
| 20090054737 | Magar et al. | Feb 2009 | A1 |
| 20090062670 | Sterling et al. | Mar 2009 | A1 |
| 20090073991 | Landrum et al. | Mar 2009 | A1 |
| 20090076336 | Mazar et al. | Mar 2009 | A1 |
| 20090076341 | James et al. | Mar 2009 | A1 |
| 20090076342 | Amurthur et al. | Mar 2009 | A1 |
| 20090076343 | James et al. | Mar 2009 | A1 |
| 20090076344 | Libbus et al. | Mar 2009 | A1 |
| 20090076345 | Manicka et al. | Mar 2009 | A1 |
| 20090076346 | James et al. | Mar 2009 | A1 |
| 20090076348 | Manicka et al. | Mar 2009 | A1 |
| 20090076349 | Libbus et al. | Mar 2009 | A1 |
| 20090076350 | Bly et al. | Mar 2009 | A1 |
| 20090076363 | Bly et al. | Mar 2009 | A1 |
| 20090076364 | Libbus et al. | Mar 2009 | A1 |
| 20090076397 | Libbus et al. | Mar 2009 | A1 |
| 20090076401 | Mazar et al. | Mar 2009 | A1 |
| 20090076405 | Amurthur et al. | Mar 2009 | A1 |
| 20090076410 | Libbus et al. | Mar 2009 | A1 |
| 20090076559 | Libbus et al. | Mar 2009 | A1 |
| 20090177145 | Ohlander et al. | Jul 2009 | A1 |
| 20090182204 | Semler et al. | Jul 2009 | A1 |
| 20090234410 | Libbus et al. | Sep 2009 | A1 |
| 20090264792 | Mazar | Oct 2009 | A1 |
| 20090292194 | Libbus et al. | Nov 2009 | A1 |
| 20100056881 | Libbus et al. | Mar 2010 | A1 |
| 20100191310 | Bly et al. | Jul 2010 | A1 |
| Number | Date | Country |
|---|---|---|
| 2003-220574 | Oct 2003 | AU |
| 1487535 | Dec 2004 | EP |
| 1579801 | Sep 2005 | EP |
| 2005-521448 | Jul 2005 | JP |
| WO 0079255 | Dec 2000 | WO |
| 0189362 | Nov 2001 | WO |
| WO 02092101 | Nov 2002 | WO |
| WO 03082080 | Oct 2003 | WO |
| WO 2005051164 | Jun 2005 | WO |
| WO 2005104930 | Nov 2005 | WO |
| WO 2006008745 | Jan 2006 | WO |
| WO 2006102476 | Sep 2006 | WO |
| WO 2006111878 | Nov 2006 | WO |
| WO 2007041783 | Apr 2007 | WO |
| 2007106455 | Sep 2007 | WO |
| 2009116906 | Sep 2009 | WO |
| Entry |
|---|
| International Search Report and Written Opinion of PCT Application No. PCT/US08/76217, dated Nov. 10, 2008, 16 pages total. |
| AD5934: 250 kSPS 12-Bit Impedance Converter Network Analyzer, Analog Devices, retrieved from the Internet: <<http://www.analog.com/static/imported-files/data—sheets/AD5934.pdf>>, 40 pages. |
| Something in the way he moves, The Economist, 2007, retrieved from the Internet: <<http://www.economist.com/science/printerFriendly.cfm?story id=9861412>>. |
| Abraham, “New approaches to monitoring heart failure before symptoms appear,” Rev Cardiovasc Med. 2006 ;7 Suppl 1 :33-41. |
| Adams, Jr. “Guiding heart failure care by invasive hemodynamic measurements: possible or useful?”, Journal of Cardiac Failure 2002; 8(2):71-73. |
| Adamson et al., “Continuous autonomic assessment in patients with symptomatic heart failure: prognostic value of heart rate variability measured by an implanted cardiac resynchronization device ,” Circulation. 2004;110:2389-2394. |
| Adamson et al., “Ongoing right ventricular hemodynamics in heart failure,” J Am Coll Cardiol, 2003; 41:565-57. |
| Adamson, “Integrating device monitoring into the infrastructure and workflow of routine practice,” Rev Cardiovasc Med. 2006 ;7 Suppl 1:42-6. |
| ADHERE [presentation], “Insights from thedhere Registry: Data from over 100,000 patient cases,” 70 pages total. |
| ADVAMED White Sheet, “Health Information Technology: Improving Patient Safety and Quality of Care,” Jun. 2005, 23 pages. |
| Aghababian, “Acutely decompensated heart failure: opportunities to improve care and outcomes in the emergency department,” Rev Cardiovasc Med. 2002;3 Suppl 4:S3-9. |
| Albert, “Bioimpedance to prevent heart failure hospitalization,” Curr Heart Fail Rep. Sep. 2006;3(3):136-42. |
| American Heart Association, “Heart Disease and Stroke Statistics—2006 Update,” 2006, 43 pages. |
| American Heart Association, “Heart Disease and Stroke Statistics—2007 Update. A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee,” Circulation 2007; 115;e69-e171. |
| Belalcazar et al., “Monitoring lung edema using the pacemaker pulse and skin electrodes,” Physiol. Meas. 2005; 26:S153-S163. |
| Bennet, “Development of implantable devices for continuous ambulatory monitoring of central hemodynamic values in heart failure patients,” PACE Jun. 2005; 28:573-584. |
| Bourge, “Case studies in advanced monitoring with the chronicle device,” Rev Cardiovasc Med. 2006 ;7 Suppl 1:S56-61. |
| Braunschweig, “Continous haemodynamic monitoring during withdrawal of diuretics in patients with congestive heart failure,” European Heart Journal 2002 23(1):59-69. |
| Braunschweig, “Dynamic changes in right ventricular pressures during haemodialysis recorded with an implantable haemodynamic monitor,” Nephrol Dial Transplant 2006; 21:176-183. |
| Brennan, “Measuring a Grounded Impedance Profile Using the AD5933,” Analog Devices, retrieved from the internet <<http://http://www.analog.com/static/imported-files/application—notes/427095282381510189AN847—0.pdf>>, 12 pages total. |
| Buono et al., “The effect of ambient air temperature on whole-body bioelectrical impedance,” Physiol. Meas. 2004;25:119-123. |
| Burkhoff et al., “Heart failure with a normal ejection fraction: Is it really a disorder of diastolic function?” Circulation 2003; 107:656-658. |
| Burr et al., “Heart rate variability and 24-hour minimum heart rate,” Biological Research for Nursing, 2006; 7(4):256-267. |
| CardioNet, “CardioNet Mobile Cardiac Outpatient Telemetry: Addendum to Patient Education Guide”, CardioNet, Inc., 2007, 2 pages. |
| CardioNet, “Patient Education Guide”, CardioNet, Inc., 2007, 7 pages. Undated. |
| Charach et al., “Transthoracic monitoring of the impedance of the right lung in patients with cardiogenic pulmonary edema,” Crit Care Med Jun. 2001;29(6):1137-1144. |
| Charlson et al., “Can disease management target patients most likely to generate high costs? The Impact of Comorbidity,” Journal of General Internal Medicine, Apr. 2007, 22(4):464-469. |
| Chaudhry et al., “Telemonitoring for patients with chronic heart failure: a systematic review,” J Card Fail. Feb. 2007; 13(1): 56-62. |
| Chung et al., “White coat hypertension: Not so benign after all?,” Journal of Human Hypertension (2003) 17, 807-809. |
| Cleland et al., “The EuroHeart Failure survey programme—a survey on the quality of care among patients with heart failure in Europe—Part 1: patient characteristics and diagnosis,” European Heart Journal 2003 24(5):442-463. |
| Cowie et al., “Hospitalization of patients with heart failure. A population-based study,” European Heart Journal 2002 23(11):877-885. |
| Dimri, Chapter 1: Fractals in geophysics and seimology: an introduction, Fractal Behaviour of the Earth System, Springer Berlin Heidelberg 2005, pp. 1-22. [Summary and 1st page Only]. |
| El-Dawlatly et al., “Impedance cardiography: noninvasive assessment of hemodynamics and thoracic fluid content during bariatric surgery,” Obesity Surgery, May 2005, 15(5):655-658. |
| Erdmann, “Editorials: The value of diuretics in chronic heart failure demonstrated by an implanted haemodynamic monitor,” European Heart Journal 2002 23(1):7-9. |
| FDA—Medtronic Inc., Chronicle 9520B Implantable Hemodynamic Monitor Reference Manual, 2007, 112 pages. |
| FDA Executive Summary Memorandum, prepared for Mar. 1, 2007, meeting of the Circulatory Systems Devices Advisory Panel, P050032 Medtronic, Inc. Chronicle Implantable Hemodynamic Monitor (IHM) System, 23 pages. Retrieved from the Internet: <<http://www.fda.gov/ohrms/dockets/ac/07/briefing/2007-4284b1—02.pdf>>. |
| FDA Executive Summary, Medtronic Chronicle Implantable Hemodynamic Monitoring System P050032: Panel Package Sponsor Executive Summary; vol. 1, section 4: Executive Summary. 12 pages total. Retrieved from the Internet: <<http://www.fda.gov/OHRMS/DOCKETS/AC/07/briefing/2007-4284b1—03.pdf>>. |
| FDA—Medtronic Chronicle Implantable Hemodynamic Monitoring System P050032: Panel Package Section 11: Chronicle IHM Summary of Safety and Effectiveness, 2007; retrieved from the Internet: <http://www.fda.gov/OHRMS/DOCKETS/AC/07/briefing/2007-4284b1—04.pdf>, 77 pages total. |
| FDA, Draft questions for Chronicle Advisory Panel Meeting, 3 pages. Retrieved from the Internet: <<http://www.fda.gov/ohrms/dockets/ac/07/questions/2007-4284q1—draft.pdf>>. |
| FDA, References for Mar. 1 Circulatory System Devices Panel, 1 page total. 2007. Retrieved from the Internet: <<http://www.fda.gov/OHRMS/DOCKETS/AC/07/briefing/2007-4284bib1—01.pdf>>. |
| FDA Panel Recommendation, “Chronicle Analysis,” Mar. 1, 2007, 14 pages total. |
| Fonarow et al., “Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis,” JAMA. Feb. 2, 2005;293(5):572-580. |
| Fonarow, “How well are chronic heart failure patients being managed?”, Rev Cardiovasc Med. 2006;7 Suppl 1:S3-11. |
| Fonarow, “Maximizing Heart Failure Care” [Powerpoint Presentation], downloaded from the Internet <<http://www.medreviews.com/media/MaxHFCore.ppt>>, 130 pages total. |
| Fonarow, “Proactive monitoring and management of the chronic heart failure patient,” Rev Cardiovasc Med. 2006; 7 Suppl 1:S1-2. |
| Fonarow, “The Acute Decompensated Heart Failure National Registry (ADHERE): opportunities to improve care of patients hospitalized with acute decompensated heart failure,” Rev Cardiovasc Med. 2003;4 Suppl 7:S21-S30. |
| Ganion et al., “Intrathoracic impedance to monitor heart failure status: a comparison of two methods in a chronic heart failure dog model,” Congest Heart Fail. Jul.-Aug. 2005;11(4):177-81, 211. |
| Gass et al., “Critical pathways in the management of acute decompensated heart failure: A CME-Accredited monograph,” Mount Sinai School of Medicine, 2004, 32 pages total. |
| Gheorghiade et al., “Congestion is an important diagnostic and therapeutic target in heart failure,” Rev Cardiovasc Med. 2006 ;7 Suppl 1 :12-24. |
| Gilliam, III et al., “Changes in heart rate variability, quality of life, and activity in cardiac resynchronization therapy patients: results of the HF-HRV registry,” Pacing and Clinical Electrophysiology, Jan. 18, 2007; 30(1): 56-64. |
| Gilliam, III et al., “Prognostic value of heart rate variability footprint and standard deviation of average 5-minute intrinsic R-R intervals for mortality in cardiac resynchronization therapy patients.,” J Electrocardiol. Oct. 2007;40(4):336-42. |
| Gniadecka, “Localization of dermal edema in lipodermatosclerosis, lymphedema, and cardiac insufficiency high-frequency ultrasound examination of intradermal echogenicity,” J Am Acad oDermatol, Jul. 1996; 35(1):37-41. |
| Goldberg et al., “Randomized trial of a daily electronic home monitoring system in patients with advanced heart failure: The Weight Monitoring in Heart Failure (WHARF) Trial,” American Heart Journal, Oct. 2003; 416(4):705-712. |
| Grap et al., “Actigraphy in the Critically Ill: Correlation With Activity, Agitation, and Sedation,” American Journal of Critical Care. 2005;14: 52-60. |
| Gudivaka et al., “Single- and multifrequency models for bioelectrical impedance analysis of body water compartments,” J Appl Physiol, 1999;87(3):1087-1096. |
| Guyton et al., Unit V: The Body Fluids and Kidneys, Chapter 25: The Body Fluid Compartments: Extracellular and Intracellular Fluids; Interstitial Fluid and Edema, Guyton & Hall Textbook of Medical Physiology 11th Edition, Saunders 2005; pp. 291-306. |
| Hadase et al., “Very low frequency power of heart rate variability is a powerful predictor of clinical prognosis in patients with congestive heart Failure,” Circ J 2004; 68(4):343-347. |
| Hallstrom et al., “Structural relationships between measures based on heart beat intervals: potential for improved risk assessment,” IEEE Biomedical Engineering 2004, 51(8):1414-1420. |
| HFSA 2006 Comprehensive Heart Failure Practice Guideline—Executive Summary: HFSA 2006 Comprehensive Heart Failure Practice Guideline, Journal of Cardiac Failure 2006;12(1):10-e38. |
| HFSA 2006 Comprehensive Heart Failure Practice Guideline—Section 12: Evaluation and Management of Patients With Acute Decompensated Heart Failure, Journal of Cardiac Failure 2006;12(1):e86-e103. |
| HFSA 2006 Comprehensive Heart Failure Practice Guideline—Section 2: Conceptualization and Working Definition of Heart Failure, Journal of Cardiac Failure 2006;12(1):e10-e11. |
| HFSA 2006 Comprehensive Heart Failure Practice Guideline—Section 3: Prevention of Ventricular Remodeling Cardiac Dysfunction, and Heart Failure Overview, Journal of Cardiac Failure 2006;12(1):e12-e15. |
| HFSA 2006 Comprehensive Heart Failure Practice Guideline—Section 4: Evaluation of Patients for Ventricular Dysfunction and Heart Failure, Journal of Cardiac Failure 2006;12(1):e16-e25. |
| HFSA 2006 Comprehensive Heart Failure Practice Guideline—Section 8: Disease Management in Heart Failure Education and Counseling, Journal of Cardiac Failure 2006;12(1):e58-e68. |
| Hunt et al., “ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): Developed in Collaboration With the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: Endorsed by the Heart Rhythm Society,” Circulation. 2005;112:e154-e235. |
| Hunt et al., ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure), Circulation. 2001;104:2996-3007. |
| Imhoff et al., “Noninvasive whole-body electrical bioimpedance cardiac output and invasive thermodilution cardiac output in high-risk surgical patients,” Critical Care Medicine 2000; 28(8):2812-2818. |
| Jaeger et al., “Evidence for Increased Intrathoracic Fluid Volume in Man at High Altitude,” J Appl Physiol 1979; 47(6): 670-676. |
| Jerant et al., “Reducing the cost of frequent hospital admissions for congestive heart failure: a randomized trial of a home telecare intervention,” Medical Care 2001, 39(11):1234-1245. |
| Jaio et al., “Variance fractal dimension analysis of seismic refraction signals,” WESCANEX 97: Communications, Power and Computing. IEEE Conference Proceedings., May 22-23, 1997, pp. 163-167 [Abstract Only]. |
| Kasper et al., “A randomized trial of the efficacy of multidisciplinary care in heart failure outpatients at high risk of hospital readmission,” J Am Coll Cardiol, 2002; 39:471-480. |
| Kaukinen, “Cardiac output measurement after coronary artery bypass grafting using bolus thermodilution, continuous thermodilution, and whole-body impedance cardiography,” Journal of Cardiothoracic and Vascular Anesthesia 2003; 17(2):199-203. |
| Kawaguchi et al., “Combined ventricular systolic and arterial stiffening in patients with heart failure and preserved ejection fraction: implications for systolic and diastolic reserve limitations,” Circulation. 2003;107:714-720. |
| Kawasaki et al., “Heart rate turbulence and clinical prognosis in hypertrophic cardiomyopathy and myocardial infarction,” Circ J. Jul. 2003;67(7):601-604. |
| Kearney et al., “Predicting death due to progressive heart failure in patients with mild-to-moderate chronic heart failure,” J Am Coll Cardiol, 2002; 40(10):1801-1808. |
| Kitzman et al., “Pathophysiological characterization of isolated diastolic heart failure in comparison to systolic heart failure,” JAMA Nov. 2002; 288(17):2144-2150. |
| Kööbi et al., “Non-invasive measurement of cardiac output : whole-body impedance cardiography in simultaneous comparison with thermodilution and direct oxygen Fick methods,” Intensive Care Medicine 1997; 23(11):1132-1137. |
| Koyama et al., “Evaluation of heart-rate turbulence as a new prognostic marker in patients with chronic heart failure,” Circ J 2002; 66(10):902-907. |
| Krumholz et al., “Predictors of readmission among elderly survivors of admission with heart failure,” American Heart Journal 2000; 139 (1):72-77. |
| Kyle et al., “Bioelectrical Impedance Analysis—part I: review of principles and methods,” Clin Nutr. Oct. 2004;23(5):1226-1243. |
| Kyle et al., “Bioelectrical Impedance Analysis—part II: utilization in clinical practice,” Clin Nutr. Oct. 2004;23(5):1430-1453. |
| Lee et al., “Predicting mortality among patients hospitalized for heart failure: derivation and validation of a clinical model,” JAMA 2003;290(19):2581-2587. |
| Leier “The Physical Examination in Heart Failure—Part I,” Congest Heart Fail. Jan.-Feb. 2007;13(1):41-47. |
| LifeShirt® Model 200 Directions for Use, “Introduction”, VivoMetrics, Inc. 9 page total. |
| Liu et al., “Fractal analysis with applications to seismological pattern recognition of underground nuclear explosions,” Singal Processing, Sep. 2000, 80(9):1849-1861. [Abstract Only]. |
| Lozano-Nieto, “Impedance ratio in bioelectrical impedance measurements for body fluid shift determination,” Proceedings of the IEEE 24th Annual Northeast Bioengineering Conference, Apr. 9-10, 1998, pp. 24-25. |
| Lucreziotti et al., “Five-minute recording of heart rate variability in severe chronic heart failure : Correlates with right ventricular function and prognostic implications,” American Heart Journal 2000; 139(6):1088-1095. |
| Lüthje et al., “Detection of heart failure decompensation using intrathoracic impedance monitoring by a triple-chamber implantable defibrillator,” Heart Rhythm Sep. 2005;2(9):997-999. |
| Magalski et al., “Continuous ambulatory right heart pressure measurements with an implantable hemodynamic monitor: a multicenter, 12-Month Follow-up Study of Patients With Chronic Heart Failure,” J Card Fail 2002, 8(2):63-70. |
| Mahlberg et al., “Actigraphy in agitated patients with dementia: Monitoring treatment outcomes,” Zeitschrift für Gerontologie und Geriatrie, Jun. 2007; 40(3)178-184. [Abstract Only]. |
| Matthie et al., “Analytic assessment of the various bioimpedance methods used to estimate body water,” Appl Physiol 1998; 84(5):1801-1816. |
| Matthie, “Second generation mixture theory equation for estimating intracellular water using bioimpedance spectroscopy,” J Appl Physiol 2005; 99:780-781. |
| McMurray et al., “Heart Failure: Epidemiology, Aetiology, and Prognosis of Heart Failure,” Heart 2000;83:596-602. |
| Miller, “Home monitoring for congestive heart failure patients,” Caring Magazine, Aug. 1995: 53-54. |
| Moser et al., “Improving outcomes in heart failure: its not unusual beyond usual Care,” Circulation. 2002;105:2810-2812. |
| Nagels et al., “Actigraphic measurement of agitated behaviour in dementia,” International journal of geriatric psychiatry , 2009; 21(4):388-393. [Abstract Only]. |
| Nakamura et al., “Universal scaling law in human behavioral organization,” Physical Review Letters, Sep. 28, 2007; 99(13):138103 (4 pages). |
| Nakaya, “Fractal properties of seismicity in regions affected by large, shallow earthquakes in western Japan: Implications for fault formation processes based on a binary fractal fracture network model,” Journal of geophysical research, Jan. 2005; 11(B1):B01310.1-B01310.15. [Abstract Only]. |
| Naylor et al., “Comprehensive discharge planning for the hospitalized elderly: a randomized clinical trial ,” Amer. College Physicians 1994; 120(12):999-1006. |
| Nesiritide (Natrecor),, [Presentation] Acutely Decompensated Congestive Heart Failure: Burden of Disease, downloaded from the Internet: <<http://www.huntsvillehospital.org/foundation/events/cardiologyupdate/CHF.ppt.>>, 39 pages. |
| Nieminen et al., “EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population,” European Heart Journal 2006; 27(22):2725-2736. |
| Nijsen et al., “The potential value of three-dimensional accelerometry for detection of motor seizures in severe epilepsy,” Epilepsy Behav. Aug. 2005;7(1):74-84. |
| Noble et al., “Diuretic induced change in lung water assessed by electrical impedance tomography,” Physiol. Meas. 2000; 21(1):155-163. |
| Noble et al., “Monitoring patients with left ventricular failure by electrical impedance tomography,” Eur J Heart Fail. Dec. 1999;1(4):379-84. |
| O'Connell et al., “Economic impact of heart failure in the United States: time for a different approach,” J Heart Lung Transplant., Jul.-Aug. 1994 ; 13(4):S107-S112. |
| Ohlsson et al., “Central hemodynamic responses during serial exercise tests in heart failure patients using implantable hemodynamic monitors,” Eur J Heart Fail. Jun. 2003;5(3):253-259. |
| Ohlsson et al., “Continuous ambulatory monitoring of absolute right ventricular pressure and mixed venous oxygen saturation in patients with heart failure using an implantable haemodynamic monitor,” European Heart Journal 2001 22(11):942-954. |
| Packer et al., “Utility of impedance cardiography for the identification of short-term risk of clinical decompensation in stable patients with chronic heart failure,” J Am Coll Cardiol, 2006; 47(11):2245-2252. |
| Palatini et al., “Predictive value of clinic and ambulatory heart rate for mortality in elderly subjects with systolic hypertension” Arch Intern Med. 2002;162:2313-2321. |
| Piiria et al., “Crackles in patients with fibrosing alveolitis bronchiectasis, COPD, and Heart Failure,” Chest May 1991; 99(5):1076-1083. |
| Pocock et al., “Predictors of mortality in patients with chronic heart failure,” Eur Heart J 2006; (27): 65-75. |
| Poole-Wilson, “Importance of control of fluid volumes in heart failure,” European Heart Journal 2000; 22(11):893-894. |
| Raj et al., ‘Letter Regarding Article by Adamson et al, “Continuous Autonomic Assessment in Patients With Symptomatic Heart Failure: Prognostic Value of Heart Rate Variability Measured by an Implanted Cardiac Resynchronization Device”’, Circulation 2005;112:e37-e38. |
| Ramirez et al., “Prognostic value of hemodynamic findings from impedance cardiography in hypertensive stroke,” AJH 2005; 18(20):65-72. |
| Rich et al., “A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure,” New Engl. J. Med. 1995;333:1190-1195. |
| Roglieri et al., “Disease management interventions to improve outcomes in congestive heart failure,” Am J Manag Care. Dec. 1997;3(12):1831-1839. |
| Sahalos et al., “The Electrical impedance of the human thorax as a guide in evaluation of intrathoracic fluid volume,” Phys. Med. Biol. 1986; 31:425-439. |
| Saxon et al., “Remote active monitoring in patients with heart failure (rapid-rf): design and rationale,” Journal of Cardiac Failure 2007; 13(4):241-246. |
| Scharf et al., “Direct digital capture of pulse oximetry waveforms,” Proceedings of the Twelfth Southern Biomedical Engineering Conference, 1993., pp. 230-232. |
| Shabetai, “Monitoring heart failure hemodynamics with an implanted device: its potential to improve outcome,” J Am Coll Cardiol, 2003; 41:572-573. |
| Small, “Integrating monitoring into the Infrastructure and Workflow of Routine Practice: OptiVol,” Rev Cardiovasc Med. 2006 ;7 Supp 1: S47-S55. |
| Smith et al., “Outcomes in heart failure patients with preserved ejection fraction: mortality, readmission, and functional decline ,” J Am Coll Cardiol, 2003; 41:1510-1518. |
| Someren, “Actigraphic monitoring of movement and rest-activity rhythms inaging, Alzheimer's disease, and Parkinson's disease,” IEEE Transactions on Rehabilitation Engineering, Dec. 1997; 5(4):394-398. [Abstract Only]. |
| Starling, “Improving care of chronic heart failure: advances from drugs to devices,” Cleveland Clinic Journal of Medicine Feb. 2003; 70(2):141-146. |
| Steijaert et al., “The use of multi-frequency impedance to determine total body water and extracellular water in obese and lean female individuals,” International Journal of Obesity Oct. 1997; 21(10):930-934. |
| Stewart et al., “Effects of a home-based intervention among patients with congestive heart failure discharged from acute hospital care,” Arch Intern Med. 1998;158:1067-1072. |
| Stewart et al., “Effects of a multidisciplinary, home-based intervention on planned readmissions and survival among patients with chronic congestive heart failure: a randomised controlled study,” The Lancet Sep. 1999, 354(9184):1077-1083. |
| Stewart et al., “Home-based intervention in congestive heart failure: long-term implications on readmission and survival,” Circulation. 2002;105:2861-2866. |
| Stewart et al., “Prolonged beneficial effects of a home-based intervention on unplanned readmissions and mortality among patients with congestive heart failure,” Arch Intern Med. 1999;159:257-261. |
| Stewart et al., “Trends in Hospitalization for Heart Failure in Scotland, 1990-1996. An Epidemic that has Reached Its Peak?,” European Heart Journal 2001 22(3):209-217. |
| Swedberg et al., “Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology,” Eur Heart J. Jun. 2005; 26(11):1115-1140. |
| Tang, “Case studies in advanced monitoring: OptiVol,” Rev Cardiovasc Med. 2006;7 Suppl 1:S62-S66. |
| The ESCAPE Investigators and ESCAPE Study Coordinators, “Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness,” JAMA 2005;294:1625-1633. |
| Tosi et al., “Seismic signal detection by fractal dimension analysis ,” Bulletin of the Seismological Society of America; Aug. 1999; 89(4):970-977. [Abstract Only]. |
| Van De Water et al., “Monitoring the chest with impedance,” Chest. 1973;64:597-603. |
| Vasan et al., “Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction,” J Am Coll Cardiol, 1999; 33:1948-1955. |
| Verdecchia et al., “Adverse prognostic value of a blunted circadian rhythm of heart rate in essential hypertension,” Journal of Hypertension 1998; 16(9):1335-1343. |
| Verdecchia et al., “Ambulatory pulse pressure: a potent predictor of total cardiovascular risk in hypertension,” Hypertension. 1998;32:983-988. |
| Vollmann et al., “Clinical utility of intrathoracic impedance monitoring to alert patients with an implanted device of deteriorating chronic heart failure,” Euorpean Heart Journal Advance Access published on Feb. 19, 2007, downloaded from the Internet:<<http://eurheartj.oxfordjournals.org/cgi/content/full/ehl506v1>>, 6 pages total. |
| Vuksanovic et al., “Effect of posture on heart rate variability spectral measures in children and young adults with heart disease,” International Journal of Cardiology 2005;101(2): 273-278. |
| Wang et al., “Feasibility of using an implantable system to measure thoracic congestion in an ambulatory chronic heart failure canine model,” PACE 2005;28(5):404-411. |
| Wickemeyer et al., #197—“Association between atrial and ventricular tachyarrhythmias, intrathoracic impedance and heart failure decompensation in CRT-D Patients,” Journal of Cardiac Failure 2007; 13 (6) Suppl.; S131-132. |
| Williams et al, “How do different indicators of cardiac pump function impact upon the long-term prognosis of patients with chronic heart failure,” American Heart Journal, 150(5):983.e1-983.e6. |
| Wonisch et al., “Continuous haemodynamic monitoring during exercise in patients with pulmonary hypertension,” Int J Cardiol. Jun. 8, 2005;101(3):415-420. |
| Wynne et al., “Impedance cardiography: a potential monitor for hemodialysis,” Journal of Surgical Research 2006, 133(1):55-60. |
| Yancy “Current approaches to monitoring and management of heart failure,” Rev Cardiovasc Med 2006; 7 Suppl 1:S25-32. |
| Ypenburg et al., “Intrathoracic Impedance Monitoring to Predict Decompensated Heart Failure,” Am J Cardiol 2007, 99(4):554-557. |
| Yu et al., “Intrathoracic Impedance Monitoring in Patients With Heart Failure: Correlation With Fluid Status and Feasibility of Early Warning Preceding Hospitalization,” Circulation. 2005;112:841-848. |
| Zannad et al., “Incidence, clinical and etiologic features, and outcomes of advanced chronic heart failure: The EPICAL Study,” J Am Coll Cardiol, 1999; 33(3):734-742. |
| Zile, “Heart failure with preserved ejection fraction: is this diastolic heart failure?” J Am Coll Cardiol, 2003; 41(9):1519-1522. |
| U.S. Appl. No. 60/006,600, filed Nov. 13, 1995; inventor: Terry E. Flach. |
| U.S. Appl. No. 60/972,316, filed Sep. 12, 2008; inventor: Imad Libbus et al. |
| U.S. Appl. No. 60/972,329, filed Sep. 14, 2007; inventor: Yatheendhar Manicka et al. |
| U.S. Appl. No. 60/972,333, filed Sep. 14, 2007; inventor: Mark Bly et al. |
| U.S. Appl. No. 60/972,336, filed Sep. 14, 2007; inventor: James Kristofer et al. |
| U.S. Appl. No. 60/972,340, filed Sep. 14, 2007; inventor: James Kristofer et al. |
| U.S. Appl. No. 60/972,343, filed Sep. 14, 2007; inventor: James Kristofer et al. |
| U.S. Appl. No. 60/972,354, filed Sep. 14, 2007; inventor: Scott Thomas Mazar et al. |
| U.S. Appl. No. 60/972,359, filed Sep. 14, 2007; inventor: Badri Amurthur et al. |
| U.S. Appl. No. 60/972,363, filed Sep. 14, 2007; inventor: Badri Amurthur et al. |
| U.S. Appl. No. 60/972,512, filed Sep. 14, 2007; inventor: Imad Libbus et al. |
| U.S. Appl. No. 60/972,537 filed Sep. 14, 2007; inventor: Yatheendhar Manicka et al. |
| U.S. Appl. No. 60/972,581, filed Sep. 14, 2007; inventor: Imad Libbus et al. |
| U.S. Appl. No. 60/972,616, filed Sep. 14, 2007; inventor: Imad Libbus et al. |
| U.S. Appl. No. 60/972,629, filed Sep. 14, 2007; inventor: Mark Bly et al. |
| U.S. Appl. No. 61/035,970, filed Mar. 12, 2008; inventor: Imad Libbus et al. |
| U.S. Appl. No. 61/046,196, filed Apr. 18, 2008; inventor: Scott T. Mazar. |
| U.S. Appl. No. 61/047,875, filed Apr. 25, 2008; inventor: Imad Libbus et al. |
| U.S. Appl. No. 61/055,645, filed May 23, 2008; inventor: Mark Bly et al. |
| U.S. Appl. No. 61/055,656, filed May 23, 2008; inventor: Imad Libbus et al. |
| U.S. Appl. No. 61/055,662, filed May 23, 2008; inventor: Imad Libbus et al. |
| U.S. Appl. No. 61/055,666, filed May 23, 2008; inventor: Yatheendhar Manicka et al. |
| U.S. Appl. No. 61/079,746, filed Jul. 10, 2008; inventor: Brett Landrum. |
| U.S. Appl. No. 61/084,567, filed Jul. 29, 2008; inventor: Mark Bly. |
| “Acute Decompensated Heart Failure”—Wikipedia Entry, downloaded from: <http://en.wikipedia.org/wiki/Acute—decompensated—heart—Failure>, submitted version downloaded Feb. 11, 2011, 6 pages total. |
| “Heart Failure”—Wikipedia Entry, downloaded from the Internet: <http://en.wikipedia.org/wiki/Heart—failure>, submitted version downloaded Feb. 11, 2011, 17 pages total. |
| 3M Corporation, “3M Surgical Tapes—Choose the Correct Tape” quicksheet (2004). |
| Cooley, “The Parameters of Transthoracic Electical Conduction,” Annals of the New York Academy of Sciences, 1970; 170(2):702-713. |
| EM Microelectronic—Marin SA, “Plastic Flexible LCD,” [product brochure]; retrieved from the Internet: <<http://www.emmicroelectronic.com/Line.asp?IdLine=48>>, copyright 2009, 2 pages total. |
| HRV Enterprises, LLC, “Heart Rate Variability Seminars,” downloaded from the Internet: <<http://hrventerprise.com/>> on Apr. 24, 2008, 3 pages total. |
| HRV Enterprises, LLC, “LoggerPro HRV Biosignal Analysis,” downloaded from the Internet: <<http://hrventerprise.com/products.html>> on Apr. 24, 2008, 3 pages total. |
| Number | Date | Country | |
|---|---|---|---|
| 20090076340 A1 | Mar 2009 | US |
| Number | Date | Country | |
|---|---|---|---|
| 60972537 | Sep 2007 | US | |
| 61055666 | May 2008 | US | |
| 61055662 | May 2008 | US |
