CA2446456A1 - Implantable medical device with dual cell power source - Google Patents

Implantable medical device with dual cell power source Download PDF

Info

Publication number
CA2446456A1
CA2446456A1 CA002446456A CA2446456A CA2446456A1 CA 2446456 A1 CA2446456 A1 CA 2446456A1 CA 002446456 A CA002446456 A CA 002446456A CA 2446456 A CA2446456 A CA 2446456A CA 2446456 A1 CA2446456 A1 CA 2446456A1
Authority
CA
Canada
Prior art keywords
cell
rate
medical device
implantable medical
rate cell
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Abandoned
Application number
CA002446456A
Other languages
English (en)
French (fr)
Inventor
Mary A Farley
George Johnstone
Ronald F. Hoch
Joseph F. Lessar
James Strom
Lynn M. Seifried
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Medtronic Inc
Original Assignee
Individual
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Individual filed Critical Individual
Publication of CA2446456A1 publication Critical patent/CA2446456A1/en
Abandoned legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/372—Arrangements in connection with the implantation of stimulators
    • A61N1/378—Electrical supply
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/372—Arrangements in connection with the implantation of stimulators
    • A61N1/375—Constructional arrangements, e.g. casings
    • A61N1/3752—Details of casing-lead connections
    • A61N1/3754—Feedthroughs
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/372—Arrangements in connection with the implantation of stimulators
    • A61N1/375—Constructional arrangements, e.g. casings
    • A61N1/3756—Casings with electrodes thereon, e.g. leadless stimulators
    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y02—TECHNOLOGIES OR APPLICATIONS FOR MITIGATION OR ADAPTATION AGAINST CLIMATE CHANGE
    • Y02E—REDUCTION OF GREENHOUSE GAS [GHG] EMISSIONS, RELATED TO ENERGY GENERATION, TRANSMISSION OR DISTRIBUTION
    • Y02E60/00—Enabling technologies; Technologies with a potential or indirect contribution to GHG emissions mitigation
    • Y02E60/10—Energy storage using batteries

Landscapes

  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Radiology & Medical Imaging (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Electrotherapy Devices (AREA)
  • Measurement And Recording Of Electrical Phenomena And Electrical Characteristics Of The Living Body (AREA)
  • Primary Cells (AREA)
  • Secondary Cells (AREA)
  • Battery Electrode And Active Subsutance (AREA)
CA002446456A 2001-05-07 2002-03-20 Implantable medical device with dual cell power source Abandoned CA2446456A1 (en)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
US09/850,331 US6622046B2 (en) 2001-05-07 2001-05-07 Subcutaneous sensing feedthrough/electrode assembly
US09/850,331 2001-05-07
PCT/US2002/008889 WO2002089904A2 (en) 2001-05-07 2002-03-20 Implantable medical device with dual cell power source

Publications (1)

Publication Number Publication Date
CA2446456A1 true CA2446456A1 (en) 2002-11-14

Family

ID=25307844

Family Applications (1)

Application Number Title Priority Date Filing Date
CA002446456A Abandoned CA2446456A1 (en) 2001-05-07 2002-03-20 Implantable medical device with dual cell power source

Country Status (6)

Country Link
US (1) US6622046B2 (enExample)
EP (1) EP1406692B1 (enExample)
JP (1) JP2004537347A (enExample)
CA (1) CA2446456A1 (enExample)
DE (1) DE60236086D1 (enExample)
WO (1) WO2002089904A2 (enExample)

Families Citing this family (247)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7283874B2 (en) 2000-10-16 2007-10-16 Remon Medical Technologies Ltd. Acoustically powered implantable stimulating device
KR100751310B1 (ko) * 2001-09-24 2007-08-22 삼성에스디아이 주식회사 캡 조립체 및, 그것을 구비한 각형 2 차 전지
EP2468358B1 (en) * 2002-06-28 2013-08-07 Boston Scientific Neuromodulation Corporation Microstimulator having self-contained power source and bi-directional telemetry system
US7189204B2 (en) 2002-12-04 2007-03-13 Cardiac Pacemakers, Inc. Sleep detection using an adjustable threshold
WO2004052453A1 (en) 2002-12-09 2004-06-24 Medtronic, Inc. Low-profile implantable medical device
US7596408B2 (en) 2002-12-09 2009-09-29 Medtronic, Inc. Implantable medical device with anti-infection agent
WO2004074879A2 (en) * 2003-02-19 2004-09-02 Seagate Technology Llc Internal support member in a hermetically sealed data storage device
US7392081B2 (en) * 2003-02-28 2008-06-24 Cardiac Pacemakers, Inc. Subcutaneous cardiac stimulator employing post-shock transthoracic asystole prevention pacing
US7236819B2 (en) 2003-04-11 2007-06-26 Cardiac Pacemakers, Inc. Separation of a subcutaneous cardiac signal from a plurality of composite signals
US7702399B2 (en) 2003-04-11 2010-04-20 Cardiac Pacemakers, Inc. Subcutaneous electrode and lead with phoresis based pharmacological agent delivery
US7389138B2 (en) 2003-04-11 2008-06-17 Cardiac Pacemakers, Inc. Electrode placement determination for subcutaneous cardiac monitoring and therapy
US20040204734A1 (en) * 2003-04-11 2004-10-14 Wagner Darrell Orvin Tunneling tool with subcutaneous transdermal illumination
US20040220628A1 (en) * 2003-04-11 2004-11-04 Wagner Darrell Orvin Subcutaneous defibrillation timing correlated with induced skeletal muscle contraction
US7218966B2 (en) 2003-04-11 2007-05-15 Cardiac Pacemakers, Inc. Multi-parameter arrhythmia discrimination
US7566318B2 (en) 2003-04-11 2009-07-28 Cardiac Pacemakers, Inc. Ultrasonic subcutaneous dissection tool incorporating fluid delivery
US7047071B2 (en) 2003-04-11 2006-05-16 Cardiac Pacemakers, Inc. Patient stratification for implantable subcutaneous cardiac monitoring and therapy
US7570997B2 (en) 2003-04-11 2009-08-04 Cardiac Pacemakers, Inc. Subcutaneous cardiac rhythm management with asystole prevention therapy
US7499758B2 (en) 2003-04-11 2009-03-03 Cardiac Pacemakers, Inc. Helical fixation elements for subcutaneous electrodes
US8116868B2 (en) 2003-04-11 2012-02-14 Cardiac Pacemakers, Inc. Implantable device with cardiac event audio playback
US7555335B2 (en) 2003-04-11 2009-06-30 Cardiac Pacemakers, Inc. Biopotential signal source separation using source impedances
US20040230272A1 (en) * 2003-04-11 2004-11-18 Cates Adam W. Subcutaneous lead with temporary pharmacological agents
US7117035B2 (en) 2003-04-11 2006-10-03 Cardiac Pacemakers, Inc. Subcutaneous cardiac stimulation system with patient activity sensing
US7302294B2 (en) 2003-04-11 2007-11-27 Cardiac Pacemakers, Inc. Subcutaneous cardiac sensing and stimulation system employing blood sensor
US7979122B2 (en) 2003-04-11 2011-07-12 Cardiac Pacemakers, Inc. Implantable sudden cardiac death prevention device with reduced programmable feature set
US7493175B2 (en) * 2003-04-11 2009-02-17 Cardiac Pacemakers, Inc. Subcutaneous lead with tined fixation
US20040230229A1 (en) * 2003-04-11 2004-11-18 Lovett Eric G. Hybrid transthoracic/intrathoracic cardiac stimulation devices and methods
US20040220626A1 (en) * 2003-04-11 2004-11-04 Wagner Darrell Orvin Distributed subcutaneous defibrillation system
US7865233B2 (en) 2003-04-11 2011-01-04 Cardiac Pacemakers, Inc. Subcutaneous cardiac signal discrimination employing non-electrophysiologic signal
US7529592B2 (en) * 2003-04-11 2009-05-05 Cardiac Pacemakers, Inc. Subcutaneous electrode and lead with temporary pharmacological agents
US7349742B2 (en) * 2003-04-11 2008-03-25 Cardiac Pacemakers, Inc. Expandable fixation elements for subcutaneous electrodes
US7499750B2 (en) 2003-04-11 2009-03-03 Cardiac Pacemakers, Inc. Noise canceling cardiac electrodes
US7317947B2 (en) 2003-05-16 2008-01-08 Medtronic, Inc. Headset recharger for cranially implantable medical devices
US7263401B2 (en) 2003-05-16 2007-08-28 Medtronic, Inc. Implantable medical device with a nonhermetic battery
US20050003268A1 (en) * 2003-05-16 2005-01-06 Scott Erik R. Battery housing configuration
US7239146B2 (en) 2003-07-11 2007-07-03 Cardiac Pacemakers, Inc. Indicator of remaining energy in storage cell of implantable medical device
WO2005028029A2 (en) 2003-08-18 2005-03-31 Cardiac Pacemakers, Inc. Patient monitoring, diagnosis, and/or therapy systems and methods
US7887493B2 (en) 2003-09-18 2011-02-15 Cardiac Pacemakers, Inc. Implantable device employing movement sensing for detecting sleep-related disorders
US7396333B2 (en) 2003-08-18 2008-07-08 Cardiac Pacemakers, Inc. Prediction of disordered breathing
US8606356B2 (en) 2003-09-18 2013-12-10 Cardiac Pacemakers, Inc. Autonomic arousal detection system and method
US8002553B2 (en) 2003-08-18 2011-08-23 Cardiac Pacemakers, Inc. Sleep quality data collection and evaluation
US7194308B2 (en) 2003-11-12 2007-03-20 Cardiac Pacemakers, Inc. System and method for monitoring or reporting battery status of implantable medical device
US20060247693A1 (en) 2005-04-28 2006-11-02 Yanting Dong Non-captured intrinsic discrimination in cardiac pacing response classification
US8521284B2 (en) 2003-12-12 2013-08-27 Cardiac Pacemakers, Inc. Cardiac response classification using multisite sensing and pacing
US7774064B2 (en) 2003-12-12 2010-08-10 Cardiac Pacemakers, Inc. Cardiac response classification using retriggerable classification windows
US7765005B2 (en) * 2004-02-12 2010-07-27 Greatbatch Ltd. Apparatus and process for reducing the susceptability of active implantable medical devices to medical procedures such as magnetic resonance imaging
US7756581B2 (en) * 2004-02-18 2010-07-13 Medtronic, Inc. Implantable temperature sensor
US7339353B1 (en) 2004-03-10 2008-03-04 Quallion Llc Power system for managing power from multiple power sources
US7596399B2 (en) 2004-04-29 2009-09-29 Medtronic, Inc Implantation of implantable medical device
US20050245984A1 (en) 2004-04-30 2005-11-03 Medtronic, Inc. Implantable medical device with lubricious material
US20080294210A1 (en) * 2004-05-04 2008-11-27 Spencer Rosero Leadless Implantable Cardioverter Defibrillator
WO2005107852A1 (en) * 2004-05-04 2005-11-17 University Of Rochester Leadless implantable intravascular electrophysiologic device for neurologic/cardiovascular sensing and stimulation
US8849416B2 (en) 2004-05-04 2014-09-30 University Of Rochester Implantable bio-electro-physiologic interface matrix
US7706866B2 (en) 2004-06-24 2010-04-27 Cardiac Pacemakers, Inc. Automatic orientation determination for ECG measurements using multiple electrodes
US9192772B1 (en) 2004-06-29 2015-11-24 Quallion Llc Portable medical power system
US7457664B2 (en) 2005-05-09 2008-11-25 Cardiac Pacemakers, Inc. Closed loop cardiac resynchronization therapy using cardiac activation sequence information
US7917196B2 (en) 2005-05-09 2011-03-29 Cardiac Pacemakers, Inc. Arrhythmia discrimination using electrocardiograms sensed from multiple implanted electrodes
US7805185B2 (en) 2005-05-09 2010-09-28 Cardiac Pacemakers, In. Posture monitoring using cardiac activation sequences
US7890159B2 (en) 2004-09-30 2011-02-15 Cardiac Pacemakers, Inc. Cardiac activation sequence monitoring and tracking
US7797036B2 (en) 2004-11-30 2010-09-14 Cardiac Pacemakers, Inc. Cardiac activation sequence monitoring for ischemia detection
US7509170B2 (en) 2005-05-09 2009-03-24 Cardiac Pacemakers, Inc. Automatic capture verification using electrocardiograms sensed from multiple implanted electrodes
US7771838B1 (en) 2004-10-12 2010-08-10 Boston Scientific Neuromodulation Corporation Hermetically bonding ceramic and titanium with a Ti-Pd braze interface
US8329314B1 (en) 2004-10-12 2012-12-11 Boston Scientific Neuromodulation Corporation Hermetically bonding ceramic and titanium with a palladium braze
US7996072B2 (en) 2004-12-21 2011-08-09 Cardiac Pacemakers, Inc. Positionally adaptable implantable cardiac device
US8577455B2 (en) * 2005-01-18 2013-11-05 Medtronic, Inc. Method and apparatus for arrhythmia detection in a medical device
US7145076B2 (en) * 2005-02-08 2006-12-05 Greatbatch, Inc. Method for minimizing stress in feedthrough capacitor filter assemblies
US7680534B2 (en) 2005-02-28 2010-03-16 Cardiac Pacemakers, Inc. Implantable cardiac device with dyspnea measurement
US7920915B2 (en) * 2005-11-16 2011-04-05 Boston Scientific Neuromodulation Corporation Implantable stimulator
US20060217777A1 (en) * 2005-03-22 2006-09-28 James Strom Apparatus and methods of monitoring cardiac activity utilizing implantable shroud-based electrodes
US7392086B2 (en) 2005-04-26 2008-06-24 Cardiac Pacemakers, Inc. Implantable cardiac device and method for reduced phrenic nerve stimulation
US7493166B2 (en) * 2005-04-28 2009-02-17 Medtronic, Inc. Electrical contact for a feedthrough/electrode assembly
US8391990B2 (en) 2005-05-18 2013-03-05 Cardiac Pacemakers, Inc. Modular antitachyarrhythmia therapy system
US20070049975A1 (en) * 2005-09-01 2007-03-01 Cates Adam W Active can with dedicated defibrillation and sensing electrodes
US20070118180A1 (en) 2005-11-18 2007-05-24 Quan Ni Cardiac resynchronization therapy for improved hemodynamics based on disordered breathing detection
US7761158B2 (en) * 2005-12-20 2010-07-20 Cardiac Pacemakers, Inc. Detection of heart failure decompensation based on cumulative changes in sensor signals
US8078278B2 (en) 2006-01-10 2011-12-13 Remon Medical Technologies Ltd. Body attachable unit in wireless communication with implantable devices
US20070179538A1 (en) * 2006-01-30 2007-08-02 Deno D C Implantable subcutaneous medical device providing post-extra-systolic potentiation therapy
US8478399B2 (en) * 2006-01-31 2013-07-02 Paul J. Degroot Method and apparatus for controlling arrhythmia detection and treatment based on patient posture
US7991471B2 (en) * 2006-03-29 2011-08-02 Medtronic, Inc. Method and apparatus for detecting arrhythmias in a subcutaneous medical device
US7941214B2 (en) * 2006-03-29 2011-05-10 Medtronic, Inc. Method and apparatus for detecting arrhythmias in a subcutaneous medical device
US7894894B2 (en) 2006-03-29 2011-02-22 Medtronic, Inc. Method and apparatus for detecting arrhythmias in a subcutaneous medical device
US8435185B2 (en) 2006-03-29 2013-05-07 Medtronic, Inc. Method and apparatus for detecting arrhythmias in a medical device
US7496409B2 (en) * 2006-03-29 2009-02-24 Medtronic, Inc. Implantable medical device system and method with signal quality monitoring and response
US8326425B2 (en) * 2006-03-30 2012-12-04 Cardiac Pacemakers, Inc. Feedthrough connector for implantable device
US7803014B2 (en) * 2006-03-30 2010-09-28 Cardiac Pacemakers, Inc. Implantable medical device assembly and manufacturing method
US7668597B2 (en) * 2006-03-31 2010-02-23 Medtronic, Inc. Feedthrough array for use in implantable medical devices
US7962202B2 (en) * 2006-03-31 2011-06-14 Medtronic, Inc. Method and apparatus for verifying a determined cardiac event in a medical device based on detected variation in hemodynamic status
US20070233217A1 (en) 2006-03-31 2007-10-04 Zhongping Yang Implantable medical electrode
US7647095B2 (en) * 2006-03-31 2010-01-12 Medtronic, Inc. Method and apparatus for verifying a determined cardiac event in a medical device based on detected variation in hemodynamic status
US9084901B2 (en) 2006-04-28 2015-07-21 Medtronic, Inc. Cranial implant
US7498516B1 (en) 2006-06-14 2009-03-03 Boston Scientific Neuromodulation Corporation Feedthru assembly
US8527048B2 (en) 2006-06-29 2013-09-03 Cardiac Pacemakers, Inc. Local and non-local sensing for cardiac pacing
US7801623B2 (en) * 2006-06-29 2010-09-21 Medtronic, Inc. Implantable medical device having a conformal coating
US7580741B2 (en) 2006-08-18 2009-08-25 Cardiac Pacemakers, Inc. Method and device for determination of arrhythmia rate zone thresholds using a probability function
US8209013B2 (en) 2006-09-14 2012-06-26 Cardiac Pacemakers, Inc. Therapeutic electrical stimulation that avoids undesirable activation
US8712507B2 (en) 2006-09-14 2014-04-29 Cardiac Pacemakers, Inc. Systems and methods for arranging and labeling cardiac episodes
US8437837B2 (en) * 2006-09-29 2013-05-07 Medtronic, Inc. Method and apparatus for induced T-wave alternans assessment
US7941208B2 (en) 2006-11-29 2011-05-10 Cardiac Pacemakers, Inc. Therapy delivery for identified tachyarrhythmia episode types
WO2008118908A1 (en) 2007-03-26 2008-10-02 Remon Medical Technologies, Ltd. Biased acoustic switch for implantable medical device
US7904153B2 (en) * 2007-04-27 2011-03-08 Medtronic, Inc. Method and apparatus for subcutaneous ECG vector acceptability and selection
US8095206B2 (en) * 2007-05-01 2012-01-10 Medtronic, Inc. Method and apparatus for detecting arrhythmias in a medical device
US8068901B2 (en) * 2007-05-01 2011-11-29 Medtronic, Inc. Method and apparatus for adjusting a sensing parameter
US7937135B2 (en) * 2007-05-01 2011-05-03 Medtronic, Inc. Method and apparatus for adjusting a sensing parameter
US7774049B2 (en) * 2007-05-01 2010-08-10 Medtronic, Inc. Method and apparatus for determining oversensing in a medical device
US7715906B2 (en) * 2007-06-04 2010-05-11 Medtronic, Inc. Method and apparatus for detecting noise in an implantable medical device
US9037239B2 (en) 2007-08-07 2015-05-19 Cardiac Pacemakers, Inc. Method and apparatus to perform electrode combination selection
US8265736B2 (en) 2007-08-07 2012-09-11 Cardiac Pacemakers, Inc. Method and apparatus to perform electrode combination selection
WO2009102726A1 (en) 2008-02-14 2009-08-20 Cardiac Pacemakers, Inc. Method and apparatus for phrenic stimulation detection
US9545215B2 (en) * 2008-07-31 2017-01-17 Medtronic, Inc. Apparatus and method for detecting cardiac events
US8321014B2 (en) 2008-10-06 2012-11-27 Cardiac Pacemakers, Inc. Dynamic cardiac resynchronization therapy by tracking intrinsic conduction
JP5492903B2 (ja) 2008-10-27 2014-05-14 カーディアック ペースメイカーズ， インコーポレイテッド 植込型装置を充電するための方法およびシステム
US9393432B2 (en) 2008-10-31 2016-07-19 Medtronic, Inc. Non-hermetic direct current interconnect
US8352008B2 (en) * 2009-06-10 2013-01-08 Medtronic, Inc. Active noise cancellation in an optical sensor signal
WO2010144667A1 (en) * 2009-06-10 2010-12-16 Medtronic, Inc. Tissue oxygenation monitoring in heart failure
WO2010144662A1 (en) * 2009-06-10 2010-12-16 Medtronic, Inc. Absolute calibrated tissue oxygen saturation and total hemoglobin volume fraction
US9126049B2 (en) * 2009-06-10 2015-09-08 Medtronic, Inc. Shock reduction using absolute calibrated tissue oxygen saturation and total hemoglobin volume fraction
WO2010144670A1 (en) * 2009-06-10 2010-12-16 Medtronic, Inc. Device and method for monitoring of absolute oxygen saturation and tissue hemoglobin concentration
US9242108B2 (en) 2009-07-31 2016-01-26 Medtronic, Inc. Medical device surface electrode
US10449373B2 (en) 2009-07-31 2019-10-22 Medtronic, Inc. Connector enclosure assemblies of medical devices including an angled lead passageway
US12179028B2 (en) 2009-07-31 2024-12-31 Medtronic, Inc. Implantable medical device
US20110066017A1 (en) * 2009-09-11 2011-03-17 Medtronic, Inc. Method and apparatus for post-shock evaluation using tissue oxygenation measurements
US9123470B2 (en) 2009-12-18 2015-09-01 Cardiac Pacemakers, Inc. Implantable energy storage device including a connection post to connect multiple electrodes
JP5555331B2 (ja) 2009-12-18 2014-07-23 カーディアック ペースメイカーズ， インコーポレイテッド 植込み型医療デバイスにエネルギーを貯蔵する焼結電極を備えた装置
US8873220B2 (en) 2009-12-18 2014-10-28 Cardiac Pacemakers, Inc. Systems and methods to connect sintered aluminum electrodes of an energy storage device
WO2011075511A2 (en) * 2009-12-18 2011-06-23 Cardiac Pacemakers, Inc. Sintered capacitor electrode including multiple thicknesses
WO2012091989A2 (en) 2010-12-28 2012-07-05 Medtronic, Inc. Medical devices including metallic connector enclosures
US9572993B2 (en) 2011-01-26 2017-02-21 Medtronic, Inc. Implantable medical devices and related connector enclosure assemblies utilizing conductors electrically coupled to feedthrough pins
US9560980B2 (en) 2012-01-31 2017-02-07 Medtronic, Inc. Automatic selection of electrode vectors for assessing risk of heart failure decompensation events
WO2013122947A2 (en) 2012-02-15 2013-08-22 Cardiac Pacemakers, Inc. Ferrule for implantable medical device
US9351648B2 (en) 2012-08-24 2016-05-31 Medtronic, Inc. Implantable medical device electrode assembly
US8886314B2 (en) 2012-09-26 2014-11-11 Medtronic, Inc. Therapy delivery method and system for implantable medical devices
US8532785B1 (en) 2012-09-26 2013-09-10 Medtronic, Inc. Therapy delivery method and system for implantable medical devices
US9168379B2 (en) 2012-09-26 2015-10-27 Medtronic, Inc. Therapy delivery method and system for implantable medical devices
CN104661702B (zh) 2012-09-26 2016-12-21 美敦力公司 可植入医疗设备的治疗递送方法和系统
US8744572B1 (en) 2013-01-31 2014-06-03 Medronic, Inc. Systems and methods for leadless pacing and shock therapy
US8972005B2 (en) 2013-03-12 2015-03-03 Medtronic, Inc. Subthreshold lead impedance measurement for subcutaneous device
US9782598B2 (en) * 2013-08-28 2017-10-10 Heartware, Inc. Pass-through assembly
US9002470B2 (en) 2013-09-11 2015-04-07 Medtronic, Inc. Supply noise rejection in implantable medical devices
US9511233B2 (en) 2013-11-21 2016-12-06 Medtronic, Inc. Systems and methods for leadless cardiac resynchronization therapy
CN106068141B (zh) 2014-01-10 2019-05-14 心脏起搏器股份公司 用于检测心脏心律失常的系统和方法
JP2017501839A (ja) 2014-01-10 2017-01-19 カーディアック ペースメイカーズ， インコーポレイテッド 医療装置間の優れた通信のための方法およびシステム
US10449361B2 (en) 2014-01-10 2019-10-22 Cardiac Pacemakers, Inc. Systems and methods for treating cardiac arrhythmias
US9138821B2 (en) * 2014-01-17 2015-09-22 Medtronic, Inc. Methods for simultaneously brazing a ferrule and lead pins
US9492671B2 (en) 2014-05-06 2016-11-15 Medtronic, Inc. Acoustically triggered therapy delivery
US9669224B2 (en) 2014-05-06 2017-06-06 Medtronic, Inc. Triggered pacing system
US10463866B2 (en) 2014-07-11 2019-11-05 Cardiac Pacemakers, Inc. Systems and methods for treating cardiac arrhythmias
WO2016033197A2 (en) 2014-08-28 2016-03-03 Cardiac Pacemakers, Inc. Medical device with triggered blanking period
EP3253450B1 (en) 2015-02-06 2021-03-24 Cardiac Pacemakers, Inc. System for treating cardiac arrhythmias
US10220213B2 (en) 2015-02-06 2019-03-05 Cardiac Pacemakers, Inc. Systems and methods for safe delivery of electrical stimulation therapy
US10046167B2 (en) 2015-02-09 2018-08-14 Cardiac Pacemakers, Inc. Implantable medical device with radiopaque ID tag
WO2016141046A1 (en) 2015-03-04 2016-09-09 Cardiac Pacemakers, Inc. Systems and methods for treating cardiac arrhythmias
JP6515195B2 (ja) 2015-03-18 2019-05-15 カーディアック ペースメイカーズ， インコーポレイテッド 植込み型医療装置及び医療システム
US10050700B2 (en) 2015-03-18 2018-08-14 Cardiac Pacemakers, Inc. Communications in a medical device system with temporal optimization
US10004906B2 (en) 2015-07-16 2018-06-26 Medtronic, Inc. Confirming sensed atrial events for pacing during resynchronization therapy in a cardiac medical device and medical device system
WO2017031221A1 (en) 2015-08-20 2017-02-23 Cardiac Pacemakers, Inc. Systems and methods for communication between medical devices
EP3337559B1 (en) 2015-08-20 2019-10-16 Cardiac Pacemakers, Inc. Systems and methods for communication between medical devices
US9968787B2 (en) 2015-08-27 2018-05-15 Cardiac Pacemakers, Inc. Spatial configuration of a motion sensor in an implantable medical device
US9956414B2 (en) 2015-08-27 2018-05-01 Cardiac Pacemakers, Inc. Temporal configuration of a motion sensor in an implantable medical device
US10159842B2 (en) 2015-08-28 2018-12-25 Cardiac Pacemakers, Inc. System and method for detecting tamponade
US10226631B2 (en) 2015-08-28 2019-03-12 Cardiac Pacemakers, Inc. Systems and methods for infarct detection
CN108136189B (zh) 2015-08-28 2021-10-15 心脏起搏器股份公司 用于行为响应信号检测和治疗递送的系统
US10092760B2 (en) 2015-09-11 2018-10-09 Cardiac Pacemakers, Inc. Arrhythmia detection and confirmation
EP3359251B1 (en) 2015-10-08 2019-08-07 Cardiac Pacemakers, Inc. Adjusting pacing rates in an implantable medical device
DE102015121818A1 (de) 2015-12-15 2017-06-22 Biotronik Se & Co. Kg Durchführung eines medizinelektronischen Geräts, Verfahren zur Herstellung einer solchen und medizinelektronisches Gerät
JP6608063B2 (ja) 2015-12-17 2019-11-20 カーディアック ペースメイカーズ， インコーポレイテッド 植込み型医療装置
US10905886B2 (en) 2015-12-28 2021-02-02 Cardiac Pacemakers, Inc. Implantable medical device for deployment across the atrioventricular septum
US10583303B2 (en) 2016-01-19 2020-03-10 Cardiac Pacemakers, Inc. Devices and methods for wirelessly recharging a rechargeable battery of an implantable medical device
EP3411113B1 (en) 2016-02-04 2019-11-27 Cardiac Pacemakers, Inc. Delivery system with force sensor for leadless cardiac device
US9731138B1 (en) 2016-02-17 2017-08-15 Medtronic, Inc. System and method for cardiac pacing
CN108883286B (zh) 2016-03-31 2021-12-07 心脏起搏器股份公司 具有可充电电池的可植入医疗设备
US9802055B2 (en) 2016-04-04 2017-10-31 Medtronic, Inc. Ultrasound powered pulse delivery device
US10328272B2 (en) 2016-05-10 2019-06-25 Cardiac Pacemakers, Inc. Retrievability for implantable medical devices
US10668294B2 (en) 2016-05-10 2020-06-02 Cardiac Pacemakers, Inc. Leadless cardiac pacemaker configured for over the wire delivery
WO2018005373A1 (en) 2016-06-27 2018-01-04 Cardiac Pacemakers, Inc. Cardiac therapy system using subcutaneously sensed p-waves for resynchronization pacing management
US11207527B2 (en) 2016-07-06 2021-12-28 Cardiac Pacemakers, Inc. Method and system for determining an atrial contraction timing fiducial in a leadless cardiac pacemaker system
WO2018009392A1 (en) 2016-07-07 2018-01-11 Cardiac Pacemakers, Inc. Leadless pacemaker using pressure measurements for pacing capture verification
CN109475743B (zh) 2016-07-20 2022-09-02 心脏起搏器股份公司 在无引线心脏起搏器系统中利用心房收缩定时基准的系统
US12478285B2 (en) 2016-08-02 2025-11-25 Medtronic, Inc. Accelerometer signal change as a measure of patient functional status
US10952686B2 (en) 2016-08-02 2021-03-23 Medtronic, Inc. Mobile application to prompt physical action to measure physiologic response in implantable device
EP3500342B1 (en) 2016-08-19 2020-05-13 Cardiac Pacemakers, Inc. Trans-septal implantable medical device
CN109641129B (zh) 2016-08-24 2023-06-30 心脏起搏器股份公司 使用融合促进进行定时管理的心脏再同步
WO2018039335A1 (en) 2016-08-24 2018-03-01 Cardiac Pacemakers, Inc. Integrated multi-device cardiac resynchronization therapy using p-wave to pace timing
US10905889B2 (en) 2016-09-21 2021-02-02 Cardiac Pacemakers, Inc. Leadless stimulation device with a housing that houses internal components of the leadless stimulation device and functions as the battery case and a terminal of an internal battery
WO2018057626A1 (en) 2016-09-21 2018-03-29 Cardiac Pacemakers, Inc. Implantable cardiac monitor
US10758737B2 (en) 2016-09-21 2020-09-01 Cardiac Pacemakers, Inc. Using sensor data from an intracardially implanted medical device to influence operation of an extracardially implantable cardioverter
US10463305B2 (en) 2016-10-27 2019-11-05 Cardiac Pacemakers, Inc. Multi-device cardiac resynchronization therapy with timing enhancements
US10413733B2 (en) 2016-10-27 2019-09-17 Cardiac Pacemakers, Inc. Implantable medical device with gyroscope
US10561330B2 (en) 2016-10-27 2020-02-18 Cardiac Pacemakers, Inc. Implantable medical device having a sense channel with performance adjustment
EP3532160B1 (en) 2016-10-27 2023-01-25 Cardiac Pacemakers, Inc. Separate device in managing the pace pulse energy of a cardiac pacemaker
EP3532159B1 (en) 2016-10-27 2021-12-22 Cardiac Pacemakers, Inc. Implantable medical device delivery system with integrated sensor
EP3532161B1 (en) 2016-10-27 2023-08-30 Cardiac Pacemakers, Inc. Implantable medical device with pressure sensor
JP6843235B2 (ja) 2016-10-31 2021-03-17 カーディアック ペースメイカーズ， インコーポレイテッド 活動レベル・ペーシングのためのシステムおよび方法
EP3532157B1 (en) 2016-10-31 2020-08-26 Cardiac Pacemakers, Inc. Systems for activity level pacing
WO2018089311A1 (en) 2016-11-08 2018-05-17 Cardiac Pacemakers, Inc Implantable medical device for atrial deployment
WO2018089308A1 (en) 2016-11-09 2018-05-17 Cardiac Pacemakers, Inc. Systems, devices, and methods for setting cardiac pacing pulse parameters for a cardiac pacing device
US10881863B2 (en) 2016-11-21 2021-01-05 Cardiac Pacemakers, Inc. Leadless cardiac pacemaker with multimode communication
US10639486B2 (en) 2016-11-21 2020-05-05 Cardiac Pacemakers, Inc. Implantable medical device with recharge coil
US10881869B2 (en) 2016-11-21 2021-01-05 Cardiac Pacemakers, Inc. Wireless re-charge of an implantable medical device
JP6843240B2 (ja) 2016-11-21 2021-03-17 カーディアック ペースメイカーズ， インコーポレイテッド 透磁性ハウジング及びハウジングの周りに配置された誘導コイルを備える植込み型医療装置
US10894163B2 (en) 2016-11-21 2021-01-19 Cardiac Pacemakers, Inc. LCP based predictive timing for cardiac resynchronization
US11207532B2 (en) 2017-01-04 2021-12-28 Cardiac Pacemakers, Inc. Dynamic sensing updates using postural input in a multiple device cardiac rhythm management system
CN110198759B (zh) 2017-01-26 2023-08-11 心脏起搏器股份公司 具有可拆卸固定件的无引线可植入装置
AU2018213326B2 (en) 2017-01-26 2020-09-10 Cardiac Pacemakers, Inc. Intra-body device communication with redundant message transmission
WO2018140623A1 (en) 2017-01-26 2018-08-02 Cardiac Pacemakers, Inc. Leadless device with overmolded components
US10433737B2 (en) 2017-01-27 2019-10-08 Medtronic, Inc. Medical device including feedthrough assembly
WO2018187121A1 (en) 2017-04-03 2018-10-11 Cardiac Pacemakers, Inc. Cardiac pacemaker with pacing pulse energy adjustment based on sensed heart rate
US10905872B2 (en) 2017-04-03 2021-02-02 Cardiac Pacemakers, Inc. Implantable medical device with a movable electrode biased toward an extended position
US10881862B2 (en) 2017-05-10 2021-01-05 Medtronic, Inc. Estimating RV-timings from left ventricular (LV) sensing times for adaptive cardiac resynchronization therapy using DDD/VDD LV pacing without a right ventricular (RV) lead
WO2019036568A1 (en) 2017-08-18 2019-02-21 Cardiac Pacemakers, Inc. IMPLANTABLE MEDICAL DEVICE COMPRISING A FLOW CONCENTRATOR AND A RECEPTION COIL PROVIDED AROUND THE FLOW CONCENTRATOR
US11065459B2 (en) 2017-08-18 2021-07-20 Cardiac Pacemakers, Inc. Implantable medical device with pressure sensor
EP3684465B1 (en) 2017-09-20 2021-07-14 Cardiac Pacemakers, Inc. Implantable medical device with multiple modes of operation
US10694967B2 (en) 2017-10-18 2020-06-30 Medtronic, Inc. State-based atrial event detection
US11185703B2 (en) 2017-11-07 2021-11-30 Cardiac Pacemakers, Inc. Leadless cardiac pacemaker for bundle of his pacing
EP3717059B1 (en) 2017-12-01 2024-11-20 Cardiac Pacemakers, Inc. Systems for detecting atrial contraction timing fiducials within a search window from a ventricularly implanted leadless cardiac pacemaker
WO2019108482A1 (en) 2017-12-01 2019-06-06 Cardiac Pacemakers, Inc. Methods and systems for detecting atrial contraction timing fiducials and determining a cardiac interval from a ventricularly implanted leadless cardiac pacemaker
CN111417433B (zh) 2017-12-01 2024-04-30 心脏起搏器股份公司 从心室植入的无引线心脏起搏器检测心室充盈期间心房收缩定时基准的方法和系统
CN111417432B (zh) 2017-12-01 2024-04-30 心脏起搏器股份公司 具有复归行为的无引线心脏起搏器
WO2019136148A1 (en) 2018-01-04 2019-07-11 Cardiac Pacemakers, Inc. Dual chamber pacing without beat-to-beat communication
US11529523B2 (en) 2018-01-04 2022-12-20 Cardiac Pacemakers, Inc. Handheld bridge device for providing a communication bridge between an implanted medical device and a smartphone
US10561847B2 (en) 2018-02-27 2020-02-18 Medtronic, Inc. Capture management in leadless cardiac pacing device
JP2021518192A (ja) 2018-03-23 2021-08-02 メドトロニック，インコーポレイテッド ＶｆＡ心臓再同期治療
CN111936046B (zh) 2018-03-23 2024-06-28 美敦力公司 用于心动过速的vfa心脏治疗
JP2021518208A (ja) 2018-03-23 2021-08-02 メドトロニック，インコーポレイテッド ＡＶ同期ＶｆＡ心臓治療
US10596383B2 (en) 2018-04-03 2020-03-24 Medtronic, Inc. Feature based sensing for leadless pacing therapy
US11253708B2 (en) 2018-05-24 2022-02-22 Medtronic, Inc. Machined features of enclosures for implantable medical devices
CN112770807B (zh) 2018-09-26 2025-04-29 美敦力公司 心房至心室心脏疗法中的捕获
WO2020086799A1 (en) 2018-10-25 2020-04-30 Pacesetter, Inc. Biostimulator feedthrough having integrated electrode cup
US20210370053A1 (en) * 2018-10-30 2021-12-02 Newrom Biomedical, Llc Neuro-stimulation and Sensor Devices Comprising Low-Impedance Electrodes, and Methods, Systems And Uses Thereof
US11951313B2 (en) 2018-11-17 2024-04-09 Medtronic, Inc. VFA delivery systems and methods
JP2022513779A (ja) 2018-12-21 2022-02-09 メドトロニック，インコーポレイテッド 左心室ペーシングのための送達システムおよび方法
GB2580918A (en) * 2019-01-29 2020-08-05 Saietta Group Ltd Axial flux electrical machine
US11679265B2 (en) 2019-02-14 2023-06-20 Medtronic, Inc. Lead-in-lead systems and methods for cardiac therapy
US11697025B2 (en) 2019-03-29 2023-07-11 Medtronic, Inc. Cardiac conduction system capture
US11213676B2 (en) 2019-04-01 2022-01-04 Medtronic, Inc. Delivery systems for VfA cardiac therapy
US11712188B2 (en) 2019-05-07 2023-08-01 Medtronic, Inc. Posterior left bundle branch engagement
US11224754B2 (en) * 2019-05-23 2022-01-18 Medtronic, Inc. Feedthrough assembly with feature for controlling component position
CN110244546A (zh) * 2019-05-29 2019-09-17 华为技术有限公司 用于智能手表的一体结构和智能手表
ES2804080B2 (es) * 2019-08-02 2021-08-05 Miralles Raimundo Vicente Sistema de sujeción para generador de estimulación eléctrica
US11305127B2 (en) 2019-08-26 2022-04-19 Medtronic Inc. VfA delivery and implant region detection
US11717186B2 (en) 2019-08-27 2023-08-08 Medtronic, Inc. Body stability measurement
US11147978B2 (en) * 2019-10-30 2021-10-19 Wyss Center For Bio And Neuro Engineering Feedthrough protective cover
US11918820B2 (en) 2020-01-21 2024-03-05 Pacesetter, Inc. Leadless biostimulator having overmolded header assembly
US11813466B2 (en) 2020-01-27 2023-11-14 Medtronic, Inc. Atrioventricular nodal stimulation
WO2021170490A1 (en) * 2020-02-25 2021-09-02 Biotronik Se & Co. Kg Feedthrough with integrated electrode and medical device
US11911168B2 (en) 2020-04-03 2024-02-27 Medtronic, Inc. Cardiac conduction system therapy benefit determination
US11602313B2 (en) 2020-07-28 2023-03-14 Medtronic, Inc. Determining a fall risk responsive to detecting body position movements
US12465770B2 (en) 2020-07-31 2025-11-11 Medtronic, Inc. Coronary sinus conduction system pacing and delivery
US11813464B2 (en) 2020-07-31 2023-11-14 Medtronic, Inc. Cardiac conduction system evaluation

Family Cites Families (37)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE2429953C3 (de) 1974-06-21 1987-10-22 Siemens AG, 1000 Berlin und 8000 München Schaltungsanordnung zur Verarbeitung physiologischer Meßsignale
US3981309A (en) * 1974-12-23 1976-09-21 American Optical Corporation Patient stimulating pacer electrode
US3983867A (en) 1975-09-29 1976-10-05 Robert Case Method and apparatus for providing hexaxial ecg display
US4082086A (en) 1976-12-13 1978-04-04 M I Systems, Inc. Ecg monitoring pad
US4170227A (en) 1976-12-27 1979-10-09 Electronics For Medicine, Inc. Apparatus and method for ECG baseline shift detecting
US4121576A (en) 1977-02-09 1978-10-24 Fred Samuel Greensite Method and apparatus for processing vectorcardiographic signals for enabling quantitative determination of the percentage of heart muscle tissue affected by an intervention
US4476868A (en) 1978-11-06 1984-10-16 Medtronic, Inc. Body stimulator output circuit
US4375817A (en) 1979-07-19 1983-03-08 Medtronic, Inc. Implantable cardioverter
US4263919A (en) 1979-10-12 1981-04-28 Levin Kenneth M Heartbeat detection and artifact discrimination method and apparatus
US4310000A (en) 1980-01-23 1982-01-12 Medtronic, Inc. Implantable pulse generator having separate passive sensing reference electrode
US4313443A (en) 1980-09-11 1982-02-02 Nasa Pocket ECG electrode
PL133646B1 (en) 1981-10-22 1985-06-29 Os Bad Rozwojowy Tech Medyc Non-invasive method of measuring activation of hearth stimuli conducting system between successive stimulations
DE3345990A1 (de) * 1983-12-20 1985-06-27 Siemens AG, 1000 Berlin und 8000 München Verfahren zum herstellen einer implantierbaren elektrode
US4674508A (en) 1985-05-28 1987-06-23 Cordis Corporation Low-power consumption cardiac pacer based on automatic verification of evoked contractions
US4729376A (en) 1985-05-28 1988-03-08 Cordis Corporation Cardiac pacer and method providing means for periodically determining capture threshold and adjusting pulse output level accordingly
US4964877A (en) 1986-01-14 1990-10-23 Wilson Greatbatch Ltd. Non-aqueous lithium battery
US5052388A (en) 1989-12-22 1991-10-01 Medtronic, Inc. Method and apparatus for implementing activity sensing in a pulse generator
DE4112936A1 (de) * 1990-04-17 1991-10-24 Biotronik Mess & Therapieg Elektrode fuer medizinische anwendungen
US5235979B1 (en) 1991-03-15 1994-11-01 Angeion Corp Dual battery system for implantable defibrillator
AU654552B2 (en) 1991-04-05 1994-11-10 Medtronic, Inc. Subcutaneous multi-electrode sensing system
US5250373A (en) 1991-09-10 1993-10-05 Wilson Greatbatch Ltd. Internal electrode and assembly method for electrochemical cells
US5345362A (en) 1993-04-29 1994-09-06 Medtronic, Inc. Portable computer apparatus with articulating display panel
US5333095A (en) * 1993-05-03 1994-07-26 Maxwell Laboratories, Inc., Sierra Capacitor Filter Division Feedthrough filter capacitor assembly for human implant
US5439760A (en) 1993-11-19 1995-08-08 Medtronic, Inc. High reliability electrochemical cell and electrode assembly therefor
US5434017A (en) 1993-11-19 1995-07-18 Medtronic, Inc. Isolated connection for an electrochemical cell
US5431695A (en) * 1993-11-23 1995-07-11 Medtronic, Inc. Pacemaker
US5549717A (en) 1994-03-03 1996-08-27 Wilson Greatbatch Ltd. Method of making prismatic cell
US5782891A (en) * 1994-06-16 1998-07-21 Medtronic, Inc. Implantable ceramic enclosure for pacing, neurological, and other medical applications in the human body
US5735884A (en) * 1994-10-04 1998-04-07 Medtronic, Inc. Filtered feedthrough assembly for implantable medical device
US5650759A (en) * 1995-11-09 1997-07-22 Hittman Materials & Medical Components, Inc. Filtered feedthrough assembly having a mounted chip capacitor for medical implantable devices and method of manufacture therefor
US5614331A (en) 1995-12-22 1997-03-25 Wilson Greatbatch Ltd. Medium and high discharge rate combination battery and method
EP0872261B1 (de) 1997-04-16 2004-05-06 LITRONIK Batterietechnologie GmbH & Co. Implantierbares medizinisches Mehrfunktionsgerät
EP1004148A1 (en) 1997-07-25 2000-05-31 Cardiac Pacemakers, Inc. Battery system for implantable medical device
US6008625A (en) 1998-01-16 1999-12-28 Wilson Greatbatch Ltd. Use of double cells to power an implantable medical device
US6052623A (en) * 1998-11-30 2000-04-18 Medtronic, Inc. Feedthrough assembly for implantable medical devices and methods for providing same
US6498951B1 (en) * 2000-10-13 2002-12-24 Medtronic, Inc. Implantable medical device employing integral housing for a formable flat battery
US6631290B1 (en) * 2000-10-25 2003-10-07 Medtronic, Inc. Multilayer ceramic electrodes for sensing cardiac depolarization signals

Also Published As

Publication number Publication date
WO2002089904A3 (en) 2003-04-17
US20020165588A1 (en) 2002-11-07
DE60236086D1 (de) 2010-06-02
EP1406692A2 (en) 2004-04-14
WO2002089904A2 (en) 2002-11-14
WO2002089904A9 (en) 2004-05-21
JP2004537347A (ja) 2004-12-16
EP1406692B1 (en) 2010-04-21
US6622046B2 (en) 2003-09-16

Similar Documents

Publication Publication Date Title
EP1406695B1 (en) Implantable medical device with dual cell power source
US7191008B2 (en) Implantable medical device with a dual power source
CA2446456A1 (en) Implantable medical device with dual cell power source
JP2004535230A5 (enExample)
US10661089B2 (en) Electrochemical cell with adjacent cathodes
EP2783407B1 (en) Electrochemical cell with adjacent cathodes
CA2651261A1 (en) Implantable medical device with a dual power source
EP1611630B1 (en) High power implantable battery with improved safety and method of manufacture
US8027728B2 (en) High power implantable battery with improved safety and method of manufacture

Legal Events

Date Code Title Description
EEER Examination request
FZDE Discontinued