Abstract: An active implantable medical device, in particular a pacemaker, defibrillator, or cardiovertor having an automatic adjustment of the stimulation pulse level. This device delivers to the heart stimulation pulses of low energy for the treatment of the cardiac disorders, which stimulation pulses present a predetermined amplitude and duration (width). The amplitude of the stimulation pulses can be automatically adjusted, a capture threshold is measured at predetermined intervals, and the measured capture threshold value is used as a basis for the adjustment of the stimulation pulse amplitude. The amplitude adjustment includes a validation of the measured capture threshold value, suitable to operate a coherence test between the last capture threshold value measured and at least one of the corresponding capture threshold values previously measured. The adjustment of the stimulation pulse amplitude level is then inhibited in the event of positive result of the coherence test.

Abstract: A probe for the stimulation of the left atrium that is implantable in the coronary venous network for use with an active implantable medial device, in particular a pulse generator of “multisite” type. The probe is a tripolar probe including a cylindrical body provided, in an electrode area located axially and remotely of its distal end, with a stimulation electrode (18) electrically connected to a first probe conductor (24), and two annular reference electrodes (20, 22), one distal (20) and one proximal (22) of the stimulation electrode, electrically connected together and to a second probe conductor (26). The stimulation electrode is axially disposed between the two reference electrodes and is an annular or a sectoral electrode. The probe comprises an electric connection body connecting the two reference electrodes (20, 22) to an internal conductor segment (36, 38) disposed in the area of the stimulation electrode but electrically isolated therefrom.

Abstract: A Holter-type apparatus for the recording of physiological signals indicative of cardiac activity. This apparatus has a base unit formed of a flexible sheet carrying the electrodes collecting the physiological signals and the conductive connection elements connected to the electrodes. The base unit has a central area receiving a recording case and which contains contact areas forming the proximal terminations of the respective conductive connection elements. The recording case is equipped to be fastened to the base unit central area and to have electrode contacts that make electrical contact with contact areas of the base unit. The base unit also can carry a battery to supply power to the recording case. The base unit is advantageously made of a sheet of flexible printed circuit material carrying a conducting pattern forming the aforementioned electrodes, conductive connection elements and contact areas.

Abstract: A rate-responsive active implantable medical device, in particular a cardiac pacemaker, defibrillator or cardiovertor, which is protected from the effects of bradycardia- and/or tachycardia-dependent extrasystoles. The device is able to stimulate at least one cardiac cavity by delivering low-energy pulses to the heart at a frequency determined by the device, and evaluates the activity level of the patient bearing the device and discriminates between phases of rest, normal activity and effort. Further, the device is capable of adjusting the frequency according to the determined activity level, more particularly decreasing the base frequency to a given minimum level during a rest phase. The device also detects the occurrence of brady-dependent extrasystoles, determines a corresponding extrasystole rate, and then increases the base frequency minimum level when the extrasystole rate exceeds a predetermined threshold during the rest phase.

Abstract: An active implantable medical device having an automatic DDD/AAI mode switching. This device includes sensing spontaneous atrial and ventricular events, detecting an atrio-ventricular block and stimulating the ventricle and atrium, the ventricular stimulation being applied on the detection of an atrio-ventricular block (AVB ), after completion of a programmed atrio-ventricular delay begun on an atrial event. The device also includes a control algorithm that discriminates a paroxystic AVB from a chronic AVB. In the event of an established chronic AVB, the device stops the automatic mode switching, switches to the DDD mode, and reprograms the atrio-ventricular delay with a shorter value than that which previously existed. The AVB discrimination can be based on, in a first phase, a suspicion of a chronic AVB, and in a second phase, a confirmed presence of a chronic AVB in the event that consecutive suspicions of chronic AVB persist for a predetermined length of time.

Abstract: A probe for the stimulation of the left heart which is implantable in the coronary venus system. The probe is particularly useful for an active implantable medical device, in particular, pacemakers of the “multisite” type. The probe has a body, including a hollow sheath which elastically deformable and primarily deprived of any rigid element. The probe body has a distal extremity (34) which supports at least one stimulation electrode (54), and a stylet which is removable, and is able to be introduced inside the probe body and moveable in translation and rotation inside the probe body. The stylet is relatively rigid compared to the sheath and plastically deformable locally. The distal extremity (34) of the probe has, in the absence of stress, two curves, comprised in two distinct surfaces. The first surface (62) corresponds to an orientation curve laid down by a preform of the probe body.

Abstract: An active implantable medical device, in particular a pacemaker, defibrillator and/or cardiovertor, including a circuit for recording cardiac events. This device records cardiac events or parameters representative of cardiac events, such that the recording of the current cardiac events replaces that of the oldest events previously recorded. The device inhibits the recording operation so as to stop the recording of the cardiac events and/or event markers in response to it being established that the patient has died. The inhibition can be obtained by detecting spontaneous or stimulated cardiac activity, advantageously combined with the detection of a parameter indicative of the patient's metabolic demand, such as the activity or effort of the patient, so that the inhibition occurs only in the event of the detection of an absence of cardiac activity confirmed by an absence of activity and/or effort of the patient.

Abstract: An improved active implantable medical device which detects spontaneous atrial and ventricular events, the presence or the absence of an atrio-ventricular spontaneous conduction, and stimulates the atrium and the ventricle, an automatic mode switching operation as between, e.g., DDD and AAI operating modes, for cardiac pacing, which device also includes an activity sensor to discriminate between phases of effort and rest of the patient, and measures the conduction time separating a spontaneous or stimulated atrial event, and a consecutive corresponding spontaneous ventricular event, and provides for a diagnosis of a good or a bad adaptation of the conduction time during the effort phase of the patient. The diagnosis of a good or bad adaptation is performed by an evaluation, during the effort, of the variation of the conduction time in relation to the variation of the heart rate.

Abstract: An active implantable medical device with a sophisticated management of the refractory periods. Such devices typically include a detection circuit and a stimulation circuit and a circuit which applies a refractory period to the detection circuit, including an absolute refractory period (ARP), which can be fixed or pre-programmed, and a relative refractory period (RRP), which is variable. The relative refractory period includes a succession of elementary periods (X) of a fixed or programmable duration, which elementary period is further subdivided into sub-periods (Y) such that an elementary period X is retriggered or restarted at the end of a sub-period Y if a residual potential of a level higher than a given threshold is detected at output of the detection circuit during that sub-period. In the absence of a detected residual potential being detected during the successive sub-periods comprising the elementary period, then the refractory period ends.

Abstract: An active implantable medical device, notably a cardiac pacemaker, enslaved to at least a physiological parameter which comprises at least one effort sensor (MV) having a plurality of determinable states, for measuring a primarily physiological parameter and delivering a signal which is a function of effort exerted by a patient bearing the device and at least one activity sensor (G) having a plurality of determinable states, for measuring a primarily physical parameter and delivering a signal which is indicative of the activity of the patient bearing the device. The determinable states of the respective sensors are determined and the relative sequence of successive changes in the state of the respective sensors are identified and analyzed periodically according to predetermined criteria. A command escape interval (IECONSIG) controlling the enslaved functioning of the device is determined from the analyzed states of the sensors.

Abstract: The semiconductor device comprises at least one chip arranged on a support. The chip is coated with an electrically insulating and heat-stable material. This electrically insulating and heat-stable material is penetrated by electrical-connection leads connecting sites of the chip to metallized contacts, and leads are substantially perpendicular both to the said sites and to the said metallized contacts.

Abstract: An electronic circuit, particularly for an active implantable medical device such as a cardiac pacemaker or a defibrillator, and a process of realization (manufacture/assembly). This electronic circuit includes at least one chip (12), as well as other associated electronic components (18), placed on a substrate (10). The chip is a bare, exposed chip, that is not one embedded in a case or encapsulated, having on its face electrical contact pads turned to the exterior, such that the chip is buried in the thickness of the substrate, preferably near or at the bottom of a cavity (30). The cavity is filled with an isolating resin (38), up to the surface of the substrate and covering the chip, except for connection threads (34,36) connected to interconnection conductors (24, 26, 28) of the substrate. It is thus possible to place at least some supplementary components superimposed above the chip and, further, to foresee above the chip a plurality of supplementary layers of interconnections.

Abstract: An active implantable medical device, especially a cardiac pacemaker, defibrillator and/or cardiovertor, of the configurable multisite type. In this multisite device, electrodes are placed in at least three distinct myocardial sites for stimulation (12, 14, 20, 22), of which at least one is a site for ventricular stimulation/detection (14, 22), these electrodes being connected to independent outputs (DA, DV, Da1, Dv2) of the multisite device in a manner as to allow the application of stimulation pulses produced by a plurality of distinct stimulation stages (24, 26, 28, 30). The number of stimulation output stages is at most equal to the number of stimulation sites. The device also includes switches (SA, SV, S1, S2) to connect selectively and according to one of various possible stimulation configurations, the stimulation stages, or selected ones of the stimulation stages, to the various sites of stimulation, or to selected ones of the stimulation sites.

Abstract: A microelectronic coated CMS component, in particular for an active implantable medical device, and its method of manufacture. The process is applied to a wafer from which will be formed, after cutting, a plurality of CMS components of the CSP type, i.e., having appreciably the same dimensions as those of the chip. The process includes (a) obtaining a wafer (10) on which are formed the chips (12), each chip having a contact pad (16) on at least one side of the chip; (b) sealing on this wafer a cap (18) having openings (20) authorizing an access to the subjacent contact pads of the chips; (c) forming in the cap distinct trenches (22) according to the periphery of each chip; (d) establishing in the openings an electrical connection to the contact pads, these connections (26) emerging through the upper face of the cap; (e) flowing a coating resin (34) into the openings and the trenches; (f) polishing and metallizing the cap; and (g) cutting the wafer thus prepared into individual components.

Abstract: A rate responsive active implantable medical device having at least one effort sensor, measuring a parameter which is predominantly physiological (VE) and delivering an output signal which is a function of the effort developed by a patient carrying the device, and at least one activity sensor, measuring a parameter which predominantly physical. The devices operates to (a) measure periodically at the two sensors “couples of values” (12, 14, 16; 22, 24, 26) corresponding to a given level of effort developed by the patient; (b) establish a characteristic function of the measured couples of values (10, 20), and (c) evaluate over the course of time this established characteristic, by seeking a possible increase in the signals delivered by the effort sensor as compared to the signals delivered by the activity sensor, indicative of the patient's metabolic demand (cardiac output requirements).

Abstract: A micro-electromechanical component (10) which includes a micro-system in a chip made by deposit, photolithography and micro-manufacturing of successive layers. The micro-system comprises a plurality of contact pads for electrical connection (16). The chip is provided with a localized external coating (20) to allow its transfer onto a substrate (28). This coating has on its surface a plurality of external metallizations (22) connected electrically through the coating material to the underlying contact pads of the chip. The coated component has approximately the same length and width as those of the chip before coating. The coating is formed only in a localized region on a reduced portion of the chip, essentially in the region of the pads and the metallizations, the sensing part of the micro-system not so coated and thus protected from mechanical constraints caused due to the application and hardening of the coating material.

Abstract: An active medical device including protected registers for containing digital adjustment parameter values used for the functioning of functional modules of the device. This device includes at least one module (12) for achieving a predetermined device function, this module including a circuit specific for performing the function and which has an adjustable parameter value in the form of a digital word of N bits. Each such module includes a plurality of volatile storage registers having N bits storing the aforementioned digital words, and circuits for comparing (32, 36), the respective contents of the registers and producing an anomaly signal (IT1, IT2 . . . ITi . . . ITk) in the event of a discordance between the contents of the plurality of registers for a given module. The anomaly signal may be an interrupt signal applied to a microcontroller (10).

Abstract: An active implantable medical device, particularly a pacemaker, defibrillator and/or cardiovertor of the “multisite” type, in which electrodes are placed in at least two neighboring cardiac sites, e.g., right and left ventricular sites, and/or right and left atrial sites. These electrodes are connected to a cardiac signal sensing circuit to detect a potential of depolarization on the corresponding site(s). These electrodes also are connected to a stimulation circuit to apply, if necessary, a stimulation impulse on the same site(s). The device adjusts the amplitude of stimulation in relation with the capture threshold and a total refractory period comprising an absolute refractory period, in which all detection is inhibited, followed by a relative refractory period. The detection of a depolarization during the relative refractory period marks the absence of a capture.

Abstract: An active implantable medical device, particularly a cardiac pacemaker, defibrillator and/or cardiovertor capable of detecting the spontaneous depolarisation of the myocardium and determining the instant of its occurrence, which device detects the spontaneous depolarisation (10) of the myocardium through processing of a cardiac signal (E), delivers an information (t) of occurrence of a depolarisation and conditionally discriminates, preferably during consecutive limited time intervals ([t-50, t+200]), a unique characteristic of the cardiac signal giving a temporal information (T.sub.1, T.sub.2, T.sub.3) on the instant of occurrence of the depolarisation. The unique characteristic can particularly be a predetermined singularity of the cardiac signal such as an extreme, particularly the extreme negative, of the first derivative (dE/dt) of the cardiac signal.

Abstract: Apparatus for mechanically immobilizing a probe connector in a generator connector of an active implantable medical device, especially for a cardiac pacemaker, defibrillator and/or cardiovertor. The active implantable medical device comprises a generator connector (10) with an axial female cavity (26) receiving a probe connector (24), at least one connection output (12, 14) and apparatus for the mechanical immobilisation the probe connector in the cavity. The connection output exerts a radial support pressure of the output conducting element (16, 18) against a corresponding conducting element (20, 22) of the probe connector to achieve an adequate electrical connection. Separate from the electrical contacts at the connection outputs, and at the outlet of the cavity, a locking wedge (38) is inserted and held in place between an external surface (46) of the probe and an internal surface (48) of the cavity to achieve a mechanical immobilization of the probe in the generator connector.