Abstract: An implantable pacemaker provides a paced AV delay that is automatically adjusted to include patient variations in latency conduction, that is, the time interval between a stimulus to the heart and an evoked potential, time due to lead position and specific patient latency. An AV timer, designed to provide a programmed AV interval, starts its timing operation at the generation of an atrial pulse, and restarts the timing operation again at the occurrence of the evoked atrial potential. The evoked atrial potential is typically monitored from a ring electrode of a bipolar lead relative to the pacemaker can (case), although other monitoring configurations are also possible. The length of the AV intrval is programmed to a desired value using conventional programming techniques.

Abstract: A multi-contact connector system for electrically and mechanically connecting a lead for the delivery of electrical energy at a body site to an implantable source of the electrical energy includes a plug connector element carried at a proximal end of the lead which is received in a socket connector element carried on the source of electrical energy. The plug connector element is a radially expandable sleeve with a number of exteriorly exposed contacts respectively connected to conductors contained within the lead. Corresponding contacts are mounted in the interior of the socket connector element. The plug connector sleeve fits over a flexible expansion element contained in the socket connector element. The expansion element is operated by a toggle switch after the connector elements are engaged so as to radially expand.

Abstract: A multi-part molded pacemaker connector that meets the precise requirements imposed by the VS-1 standard, yet does not require complex or expensive machining of individual parts. Advantageously, the pacemaker connector is made from a plurality of individually molded parts, with each individual part being designed to readily allow the insertion of seals and other connector components, prior to joining the parts together. The connector includes three molded pieces: a body tip, a body ring, and an entrance connector which are adapted to be joined during assembly. The connector further includes a garter spring, and preferably, two annular sealing rings. A tip connector block is insert-molded into the body tip. A conductive tube, which forms the ring connector, is insert-molded within the entrance connector. The body ring provides appropriate spacing between the tip connector block and the ring connector.

Abstract: A rate-responsive pacing method and system senses the minimum blood oxygen saturation in the right atrium of a patient's heart and uses such minimum blood oxygen saturation as a control parameter for indicating the muscular activity of a patient. Because the oxygen content of the venous blood in the right atrium varies significantly as venous blood from all parts of the body is introduced therein, evidencing differing levels of oxygen demand throughout the patient's body, the minimum oxygen content of the venous blood provides an accurate and reliable measure of those portions of the patient's body experiencing the greatest oxygen demand, i.e., experiencing muscular activity. A rate-responsive pacing system includes means for sensing the minimum oxygen content in the right atrium over a prescribed time interval, and using such minimum oxygen content as a control parameter for adjusting the rate of the pacemaker.

Abstract: A self-adjusting rate-responsive pacemaker includes a conventional programmable pulse generator, a physiological sensor, and a processor, all packaged within an implantable case. The pulse generator generates heart stimulation pulses on demand, or as otherwise programmed, as controlled by a sensor-indicated rate signal. The sensor-indicated rate signal is derived from a raw signal obtained from the physiological sensor, and provides some indication of whether the heart rate should increase or decrease. The processor converts the raw signal to the sensor-indicated rate signal in accordance with a desired relationship (FIGS. 2, 3, 7A, 8). A minimum sensor signal value sets the minimum rate at which the pacemaker generates stimulation pulses, and a maximum sensor signal value sets the maximum rate at which the pacemaker generates stimulation pulses.

Abstract: A pacemaker mediated tachycardia (PMT) is detected by circuitry within an implantable pacemaker. The PMT is detected by first detecting a tachycardia condition that includes a prescribed number of consecutive cardiac cycles having a rate faster than a prescribed rate. Each cardiac cycle of the tachycardia condition includes a natural atrial event, i.e., a P-wave, and a paced ventricular event, i.e., a V-pulse generated by a pacemaker. After the prescribed number of such cardiac cycles, e.g., two to ten, a P-V delay in a single cardiac cycle is modified by a first prescribed amount, e.g., 50 milliseconds. The time interval of a V-P interval associated with at least one cardiac cycle preceding the modified P-V delay is then compared to a V-P interval immediately following the modified P-V delay. Only if the difference between the V-P intervals thus measured is less than a second prescribed amount, e.g., 25 milliseconds, is a PMT indicated. If a PMT is indicated, a PMT termination regimen, e.g.

Abstract: A ribbon conductor set and related method of production and installation are provided for electrically interconnecting components in an implantable medical device, such as a heart pacemaker unit or the like. The ribbon conductor set is formed by die cutting and/or stamping a thin plate of conductive material to define a plurality of conductor ribbons supported from a frame. The ribbon set and supporting frame are shaped for seated placement into a fixture to orient the conductor ribbons in predetermined array to extend between electrical components on the fixture, such as between connector blocks and feedthrough terminals of a heart pacemaker unit. The fixture thus supports the conductor ribbons for facilitated connection to the electrical components, such as by welding, after which the resultant subassembly may be further processed as by encapsulation within a cast epoxy head or the like.

Abstract: An improved telemetry system for telemetering digital data from an implantable tissue stimulator such as a heart pacemaker. A carrier signal is pulse modulated in accordance with either or both of stored digital data and a digitized electrocardiogram signal, for coupling onto an electrical lead connected directly to the heart. This arrangement facilitates the transmission of substantially higher data rates than previously could be achieved.

Abstract: A flexible, planar patch electrode for cardiac defibrillation is fabricated from conductive wire mesh covered on an insulation side by a flexible layer of insulation. The electrode provides a substantial electrical contact area of 2-4 square inches and is shaped to provide an essentially rectangular base region with a plurality of protrusions extending longitudinally therefrom. he protrusions may be readily flexed to follow natural heart contours and slots between protrusions may be positioned to avoid features such as arteries near the surface of the heart. Central attachment of a lead within the base region minimizes current density and corresponding I.sup.2 R energy losses.

Abstract: A sensor for use with a rate-responsive pacemaker is disclosed which is responsive to blood oxygen content, thereby allowing the cardiac rate of the pacemaker to closely mimic the natural response pattern of the heart to changing physiological need. The sensor integrates the output from a photosensor driven by blood-reflected light from an LED, and when the integrated output reached a predetermined threshold latches the circuit, enabling the use of time to indicate the level of blood oxygen content. The sensor thus advantageously requires neither a voltage doubler in the driving circuitry, or an analog-to-digital converter in the output circuitry, reducing both complexity and power consumption of the blood oxygen sensor.

Abstract: A rate-responsive pacemaker which includes a conventional programmable pulse generator, a physiological sensor, and a processor is disclosed which generates heart stimulation pulses on demand, or as otherwise programmed, as controlled by a rate control signal which is derived from the physiological sensor. The physiological sensor generates a raw signal which varies as a function of some physiological parameter, such as activity level to provide some indication of whether the heart rate should increase or decrease, and hence whether the pacemaker should change the rate at which pacing pulses are provided. The processor converts the raw signal to the sensor-indicated rate signal in accordance with a selectable transfer relationship which defines the sensor-indicated rate signal as a function of a set of discrete sensor level index signals.

Abstract: A device for use as a rate-responsive pacemaker is disclosed in which the pacing interval is controlled by the average amplitude of a raw signal generated by a suitable physiological sensor and processed by an average amplitude converter to generate an output average amplitude signal coupled to the pacemaker control circuits to adjust the pacing interval. The average amplitude converter may be a rectifying amplifier and an integrating circuit, a voltage controlled oscillator whose frequency is measured over a suitable time interval using a time interval generator and a counter with the output of the counter being used by the control circuits of the pacemaker to vary its pacing interval, or means for measuring average amplitude of the raw signal and storing that measurement in memory and periodically processing it to alter the transfer characteristics of the rate-responsive pacemaker.

Abstract: A system within an implantable stimulation device and a method for limiting the extent to which any high power consumption modes, such as a rate response mode, can be utilized during low battery periods. A battery threshold detector is utilized to detect when the battery is below a predetermined threshold. The implantable stimulation device then switches from a high current drain mode of operation to progressively lower current drain modes of operation. This configuration allows a significant reduction in current drain at RRT and further prevents the output amplitude from dropping below the capture level and prevents the remaining battery capacity from being rapidly used up.

Abstract: In a rate responsive pacemaker, a physiological sensor is used to sense the physiological needs of the patient's heart and to control both the pacing rate and the A-V interval accordingly. A first adjustment means triggers the timing circuitry to adjust the stimulation rate to a slightly sub-optimal value of cardiac output. A second adjustment means adjusts the A-V interval until hemodynamics are optimized according to the physiological sensor. The improvement in hemodynamics due to the A-V adjustment allows a further decrease in the stimulation rate by the first adjustment means, thereby conserving the limited battery supply.

Abstract: A switched-capacitor, band-pass, programmable amplifier is used as a sense amplifier in an implantable cardiac pacemaker. Switching means are used to switchably connect various capacitors to the same amplifier circuits. Clock generator means are used to generate clock signals that are used to control the rate at which the switching means operates. By programmably selecting the switching rate to be a desired value, the band-pass characteristics and gain of the sense amplifier may be varied. When a pacemaker stimulation pulse occurs, the band-pass characteristics and/or gain of the sense amplifier, may also be automatically varied to improve amplifier recovery time. The rate at which the capacitors are switchably connected to the amplifier circuits, may be selected remotely, thereby allowing the band-pass characteristics to be programmable.

Abstract: A cardiac lead assembly for use with a heart pacemaker. The assembly has an inner electrode with a corkscrew tip, and an electrode housing which can be comprised of a second electrode. A conductor is connected to the inner electrode for supplying electricity thereto and is comprised of a tubular coil. The inner electrode can be manually moved longitudinally relative to the electrode housing by a stylet. The inner electrode and the housing cooperate to prevent axial rotation of the inner electrode at a first longitudinal position, but allow rotation at a second longitudinal position. The first conductor coil can be suitably twisted such that upon movement of the inner electrode to the second position the coil can automatically axially rotate the inner electrode to screw the corkscrew tip into a patient's heart.

Abstract: A joint assembly which may be used for affixing a helically wound lead conductor coil to an electrode of a pacemaker. The electrode has a longitudinal bore and a coaxial counterbore. One end of the coil is fittingly attached to a reduced diameter end of a press tube. The outer diameter of the extreme outer surface of the coil on the press tube is slightly greater than the inner diameter of the counterbore in the electrode. The reduced diameter end of the press tube with the coil thereon is fittingly inserted into the counterbore. This results in a solid connection between the lead conductor coil and the electrode without causing any visible alteration of the outer surface of the electrode.

Abstract: A multi-part molded pacemaker connector meets the precise requirements imposed by the VS-1 standard, yet does not require complex nor expensive machining of individual parts. The connector includes a molded body tip and a molded body ring, adapted to be joined together during assembly. The body tip is molded to include a conductive connector block attached to a first conductive ribbon as an integral part thereof. The body ring is molded to include a second conductive ribbon, having a looped end exposed therewithin to provide a precise specified diameter against which a garter spring contact is placed. An inner shoulder molded within the body ring holds the spring contact laterally on one side. During assembly, an annular spacer is pressed into the body ring to restrain the spring contact laterally on the other side. Inner and outer annular seals are also inserted into the body tip and body ring during assembly. After assembly, i.e.

Abstract: A motion sensor for use within an implantable medical device provides a digital output signal that can be connected directly to the digital processing and control circuits of a pacemaker or other device. This signal may be used to adjust the basic pacing rate of the pacemaker as a function of the physical motion or activity that is sensed. The motion sensor includes an enclosed housing having conductive element therein that partially fills the space of a cavity within the enclosed housing. The conductive element is free to roll, flow or otherwise move around the inside of the housing in response to external forces. The external forces that cause the conductive element to move include the physical motion of the patient as well as the force of gravity. As the conductive element moves within the enclosed housing, it makes electrical contact with at least two of three electrodes that are selectively spaced around the inside periphery of the housing.

Abstract: A noise discrimination circuit determines if sensed electrocardiographic (ECG) pulsed signals sensed within a pulse generator are valid ECG signals, i.e., valid P-waves or R-waves, or noise. The ECG signal may then be processed. The processed ECG signal is monitored to determine both the amplitude and duration of any signal pulses appearing thereon. If the amplitude of a given ECG signal pulse exceeds a prescribed threshold level for a prescribed time period, the pulse is considered to be a valid ECG signal. The noise discrimination circuit includes: a threshold detector for determining if the amplitude of the ECG signal exceeds the prescribed threshold level; a timer circuit for generating a timed window signal, triggered by the threshold detector whenever the ECG signal amplitude exceeds the prescribed threshold level; and logic circuitry for determining if the amplitude of the ECG signal remains above the threshold level for the duration of the timed window signal.