Abstract: Adjusting the maximum ventricular stimulation frequency according to the hemodynamic state of the patient in an active implantable medical device. This device provides for limiting ventricular stimulation to a maximum frequency (Fmax), the rate of delivery of the stimulation pulses, measuring an intracardiac bio-impedance (Zn, Zn+1), and adjusting the maximum frequency according to the measured intracardiac bio-impedance. The adjusting process can include evaluating a parameter representative of the cardiac flow (dn, dn+1) utilizing the intracardiac signal of bio-impedance; controlling a predetermined variation (X %) of the frequency (f) of delivery of the stimulation pulses; evaluating the correlative variation (y %) of the cardiac flow; and adjusting the value of the maximum frequency (Fmax) according to the variation of the cardiac flow thus evaluated.

Abstract: An active implantable medical device with biventricular pacing and automatic optimization of pacing configuration. The device collects and analyzes an endocardial acceleration signal (EA), and searches for an optimal pacing configuration based upon a performance index derived from at least one value relating to one and/or the other of the two endocardial acceleration peaks (PEA I, PEA II) over a given heart cycle. Optimization search operates through a scanning of a parameter, e.g., atrio-ventricular delay, and calculation of the surface area underneath the characteristic of the peak amplitude as a function of the scanned parameter (atrioventricular delay).

Abstract: RF telemetry for an active medical device such as active implant or programmer for such implant. The device includes at least one RF antenna (14), and at least one RF telemetry transmitter/receiver (44) with, for coupling to the antenna, an associated band rejection filter (54). The band rejection filter (54) comprises at least one volume acoustic wave BAW resonator (40) of the SMR type with insulation by Bragg acoustic reflector (42). The device can be a multi-band device comprising a plurality of RF transmitters/receivers (12, 44) operating in respective distinct bands of frequencies such as the 402˜405-MHz, 863˜870-MHz, 902˜928-MHz and 2.4-GHz bands or by UWB transmission.

Abstract: An apparatus for non-invasive diagnosis of states of vasovagal syncope in a patient placed on a tilt table and subjected to a tilt-test, the apparatus comprising: circuits for sensing the patient's endocardiac acceleration; circuits for sensing the patient's heart rate; and analyzer circuits receiving as inputs said endocardiac acceleration and said heart rate, and outputting information about the sympthetico-vagal activity of the patient. The circuits for sensing endocardiac acceleration comprise an external accelerator sensor suitable for being held in contact with the patient's rib cage. The analyzer circuits comprise classifier circuits suitable, in the event of a syncope occurring, for determining one type of syncope amongst a plurality of syncope types as a function of the endocardiac acceleration and heart rate values sensed during a plurality of heart cycles preceding the occurrence of the syncope.

Abstract: Improved management of respiratory pauses (apnea) or hypopnea in an active implantable medical device of the cardiac pacemaker, cardiovertor and defibrillator types including multisite devices. This device operates to analyze the patient's respiratory activity, detect the occurrence of respiratory pauses (apnea) or diminutions (hypopnea), analyze the contractility of the myocardium, for example, by measurement of the intracardiac impedance or the endocardial acceleration, and detect the occurrence of a variation of the hemodynamic state. In the event of a significant variation of the hemodynamic state (i.e., contractility) detected in relation to the detection of an apnea or of an hypopnea, the device modifies conditionally and temporarily an operating parameter of the device, for example, the frequency of stimulation, the atrio-ventricular delay or to trigger a multistate stimulation to compensate.

Abstract: A kit for penetrating the cardiac septum and for the placement of a trans-septal device, in particular of a stimulation probe, in a left heart cavity. This kit includes a penetration guide (16), a handling stylet, a piercing stylet (38) and a guiding stylet (46). The penetration guide (16) comprises a probe body with a flexible hollow sheath (22) successively receiving these stylets, and a probe-head (18, 24) having an extendable helicoid screw (20) for anchoring to the wall of the septum (10). The piercing stylet (38) presents a sharp distal extremity (44) emerging from the frontal face, through the anchor (20), over a distance at least equal to the local thickness of the septum (10), so as to traverse through the septum. A guiding stylet will be then introduced into the sheath to form, after withdrawal of the penetration guide (16), an axial guide traversing the septum, for the introduction therethrough of a trans-septal device.

Abstract: A device for the non-invasive detection of apneae or hypopneae in a patient. This apparatus collects the patient's endocardial acceleration using an external acceleration sensor (12) able to be maintained in contact with the patient's thoracic wall (10). An analysis is made to determine at least one parameter that is function of collected endocardial acceleration and to conditionally deliver an apnea or hypopnea alert signal as a function of the value taken by this parameter. This parameter can notably be a function of one and/or the other of the two endocardial acceleration peaks over one given heart cycle, the first peak (PEA I) corresponding to the ventricular isovolumetric contraction phase and the second peak (PEA II) to the ventricular isovolumetric relaxation phase.

Abstract: An active implantable medical device such as a cardiac pacemaker, defibrillator, cardiovertor and/or multisite device that is able to determine and average a hemodynamic index parameter. The intracardiac impedance signal is correlated to the instantaneous blood flow, and is used to determine periodically an average hemodynamic index (Dave) evaluated over several cardiac cycles under certain preset measurement conditions. For example, the preset conditions include checking that the state of the patient and of the device satisfies, the criteria (stages 12-20) defining predetermined measurement conditions, and inhibiting the determination of the aforesaid hemodynamic index if these criteria are not satisfied. A plurality of samples (Zij) of the measured impedance signal are collected over a length of time (Ti) of the systole of one cardiac cycle.

Abstract: A tool for cutting or slitting the tubular sheath of a guide-catheter in the presence of a lead placed in this sheath. The tool (10) has a flattened, substantially planar blade holder body (12) with a cutting area (14) and a prehension area (16). The cutting area has a blade (18) and a tubular guide (22) receiving the lead for isolating it from the guide-catheter. The prehension area (16) has on a first side (30) an area for receiving the thumb and a lead holding pathway (68) spreading in the continuation of the tubular guide following an overall orientation forming an angle with this guide. The thumb reception area has a concave footprint (34) crossed through and through by the lead holding pathway (68), which spreads in the prehension area following an “S” shaped curve having a first curved area (74) and a second counter-curved area (76). The minimal distance between the blade (18) and the contour of the first footprint (34) is to the most equal to 15-20 mm.

Abstract: A toolkit for implanting an intracorporal lead, preferably a cardiac sensing/pacing lead. This toolkit includes a guide-catheter (10), having a sheath (12) with an internal lumen (42) opened at its distal and proximal ends, and cuttable along a generatrix in order to allow extracting of the guide-catheter after use. A hemostatic valve (14) is mounted at the proximal end (40) of the guide-catheter, for selectively filling, or not, the internal lumen of the guide-catheter at its input end. The valve is frangible in at least two parts, each dissociable from the guide-catheter at both sides around a median axial plane. The valve comprising a mobile element sliding on the guide-catheter between two extreme positions, with an opened position where the proximal end (40) of the guide-catheter (10) freely emerges out of the valve so as to allow access to said internal lumen, and a closed position where this proximal end of the guide-catheter is filled in a tight manner.

Abstract: An active implantable medical device including a generator connected to a right ventricular electrode and a left ventricular electrode. The generator includes two output terminals connected to the ventricular electrodes, to deliver joint stimulation impulses with an adjustable inter-ventricular delay. The generator is a generator of the double chamber pacemaker type including an atrial terminal, a ventricular terminal, and circuits for jointly delivering at the atrial and ventricular terminals stimulation impulses with an adjustable atrio-ventricular delay. One of the outputs is the atrial terminal and the other is the ventricular terminal, the atrio-ventricular delay being adjusted with the value of the inter-ventricular delay.

Abstract: An active implantable medical device, such as a double chamber pacemaker or defibrillator or cardiovertor, having an improved adjustment of atrial sensitivity and of atrial stimulation energy. This device includes control algorithms for suspecting a loss of atrial detection and/or atrial capture that operates by analysis of a sequence of detected stimulations and ventricular and atrial detections.

Abstract: A coronary probe for stimulation of the heart having a sophisticated retention structure. The probe is intended to be implanted in a vein of the coronary network for the stimulation of a left cavity of the heart by an active implantable medical device. It includes a flexible hollow sheath (10) including an internal conductor, an intermediate element (12) with a cylindrical body (24) bearing retention structure, and an end forming a probe-head (14) that is equipped with at least one stimulation electrode (20). The retention structure includes at least one relief (28) formed on the cylindrical body (24) and presenting, as seen from the end, an overall circular contour so as to have locally an increased diameter compared to the diameter of the cylindrical body. This contour is eccentric compared to the axis (D) of cylindrical body.

Abstract: An active implantable medical device, such as a cardiac pacemaker, defibrillator, cardiovertor and/or multisite device, able to discriminate noxious and non noxious ventricular extrasystoles. The device is able to detect a heartbeat rate and detect in the rate an occurrence of a ventricular extrasystole (VES). It also is able to measure an intracardiac impedance (Z), correlated with the instantaneous blood flow, and determine, in response to variations of the impedance signal, the presence or the absence of a significant mechanical activity of the myocardium consecutive to the ventricular extrasystole. In response to such variations, the device provides an indicator of the noxious or non noxious character of the ventricular extrasystole. This indicator allows, inter alia, on the following cycle, to adapt in a differentiated way an operating parameter such as the ventricular escape interval, according to the determined noxious or non noxious character of the ventricular extrasystole.

Abstract: A programmer for cardiac implantable medical devices, including an accelerated test mode of the operating parameters. The programmer includes a user interface (10) that is used to define the tests to be performed on the implant and display the results thereof. These tests includes: ventricular and atrial sensing sensitivity, ventricular and atrial lead impedance, and ventricular and atrial capture threshold. Each test step involves (i) a predetermined setting of the operating mode, pacing rate and atrio-ventricular delay of the implantable device, (ii) collection of the operating data of the implantable device according said predetermined settings, and (iii) processing and display of thus collected data. There further exists one test step of time compression along which at least some of the ventricular and atrial tests for a same parameter are executed simultaneously during a common step, preferably the tests of sensing sensitivity and lead impedance.

Abstract: An active medical device, in particular an implantable device such as a cardiac pacemaker, defibrillator, cardioverter, or multisite device, including a function for determining sleep disorders. This device can collect the heartbeat rhythm in at least one heart cavity, and analyze the collected rhythm so as to evaluate a value of heartbeat rate accordingly. The device can also discriminate within a collected heart rhythm the spontaneous events of sinusal origin, and to evaluate the heart rate according only to these spontaneous sinusal events, and to analyze the time variations of the aforementioned heart rate to determine the presence of a sleep respiratory disorder accordingly. This analysis can be realized through a search for episodes of bradycardia followed by episodes of tachycardia, or by determination of an index of sinusal variability that is a function of the detected variations, and comparison of this index with a predetermined threshold.

Abstract: An implantable cardiac pacemaker with automatic control of the connection of a probe and the implantation of the case. The device includes a generator and its energy source. The generator includes: circuits for scanning battery consumption, able to measure current output by the battery and to deliver a measured value of the output current; comparator circuits, able to compare the current value measured with a pre-programmed value of threshold of current. It includes moreover circuits suited to: detect and count the spontaneous depolarizations collected between the aforementioned terminals of the head of connector; to compare the number of depolarizations thus counted with a pre-programmed threshold of counting; and to deliver a signal of suspicion of implantation in the event of crossing of this threshold of counting.

Abstract: An active implantable medical device having a plurality of connection terminals able to be connected to electrodes placed in at least three distinct respective sites in a myocardium; circuits for measuring an intracardiac bio-impedance, comprising circuits for injecting a current and circuits for collecting a voltage at respective poles of a configuration of said connection terminals, and circuits able to deliver at an output a dynamic impedance signal that is a function of the injected current and the collected voltage; and circuits for evaluating an intracardiac volume, receiving at in input the impedance signal and delivering at an output a dynamic value of volume representing an instantaneous absolute value of intracardiac volume.

Abstract: A process for mechanical assembly and electrical interconnection of the functional components of an active implantable medical device. A first step involves preparing an interconnection flex circuit (20) that is able to be electrically and mechanically linked to an electronic circuit module (14), a supply battery (12) and a series of feedthrough terminals (16) of the device, prior to being placed in a common case. The flex circuit has a series of pads (34) for linking to homologous metallizations (46) of the substrate. The mechanical assembling and electrical linking of these pads (34) to the metallizations (46) is performed without either the use of any activation flux or introduction of fusible brazing, and rather by applying an intermediate anisotropic conductive material (38) placed between the pads (34) and metallizations (46), followed by polymerizing this material. The applying and polymerizing are performed under controlled conditions of pressure, temperature and duration.

Abstract: An active implantable medical device having a function for monitoring the sympathico-vagal activity by an analysis of endocardiac acceleration. The device collects at least one physiological parameter of the patient, analyzes that collected parameter and delivers at an output data representative of the sympathico-vagal activity of the patient. The physiological parameter is an endocardiac acceleration (EA), and the representative data include at least one value function of the endocardiac acceleration, in particular a function of a first peak (PEA I) at the time of the phase of isovolumic ventricular contraction and/or of a second peak (PEA II) at the time of the phase of isovolumic ventricular relieving.