Abstract: An active implantable medical device for cardiac resynchronization therapy with effort based rate-responsive pacing is described. The device calculates a rate-responsive stimulation frequency based on output signal of an effort sensor between a base frequency (fbase) and a maximum frequency (fmax). The device determines a target stimulation frequency based on the difference between a first frequency and the maximum frequency (fmax). The first frequency is the higher frequency of the base frequency (fbase) and the spontaneous frequency of the patient. The device calculates a stimulation frequency that has an immediate increase in the pacing rate from the higher of the initial value of the current stimulation frequency, or the spontaneous frequency to the target stimulation frequency, within a predetermined time, or a predetermined number of cardiac cycles. A plurality of consecutive effort zones (Z1-Z4) is defined over the extent of the dynamic range of the output signal of the effort sensor.

Abstract: An active implantable medical device such as a cardiac prosthesis for the treatment of a heart failure by controlled adjustment of the atrioventricular and interventricular delays. The device provides atrioventricular and/or biventricular stimulation, a sensor delivering at least one hemodynamic parameter correlated with time intervals representative of the succession of the systolic and diastolic phases, and circuits to adjust the AV delay and/or VV delay. The device determines (12) during one cardiac cycle several parameters such as the left ventricular pre-ejection interval LPEI, the left ventricular ejection time LVET, the diastolic filling time FT and the conduction time PR. The device compares (14, 18) these parameters with at least one predetermined criterion. If a condition is met, the device readjusts (16) the AV delay and/or VV delay to maximize the ventricular filling and ejection.

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: An active implantable medical device comprising circuits for right ventricular, left ventricular, right atrial and eventually left atrial detection, as well as circuits for right and left ventricular stimulation. The device can operate in mode of resynchronization of the ventricular contractions, with an adjustable delay of inter-ventricular stimulation. It includes moreover: circuits for atrial stimulation; circuits able to operate the device in AAI mode with right atrial stimulation and right ventricular detection; circuits for detection of ventricular capture, to determine the detection or the loss of capture after a right ventricular stimulation and a left ventricular stimulation; and of the circuits for mode switching, able to control a switching of mode, from the mode of resynchronization towards AAI mode, in response to the detection of a loss of capture after a right ventricular stimulation or a left ventricular stimulation.

Abstract: A device including circuits able to control the switching of a AAI mode in a DDD mode, and conversely the return of DDD mode to AAI mode, according to predetermined criteria of detection of atrio-ventricular block (AVB) of the first, second, or third degree and of ventricular pause. The device includes moreover circuits for detecting state, able to diagnose at least a specific temporary state of the patient, in particular a state of effort or sleep, and the circuits for mode switching operate in response to these circuits for detecting state to modify selectively, for the length of time when the aforementioned state is diagnosed, the criteria of switching from AAI mode towards DDD mode and/or the criteria of return to AAI mode, and/or the criteria of final commutation in DDD mode.

Abstract: Sensing ventricular noise artifacts in an active implantable medical device for pacing, resynchronization and/or defibrillation of the heart. This device concerns sensing heart rhythm through an endocardial electrode collecting the depolarization potentials, and detecting the myocardium contractions through an endocardial acceleration sensor. The device searches for ventricular noise artifacts (X, Y) by correlating the signals representative of successive ventricular and atrial depolarizations (P, R) with the signals representative of successive acceleration peaks (PEA I). In case of a lack of correlation, a signal of suspicion of ventricular noise is delivered, which temporarily modifies the sensing sensitivity (S) of the sensing circuit.

Abstract: A process for managing medical data in an active implantable medical device such as a pacemaker, defibrillator, cardiometer or multisite device for use of the medical data by a specialized follow-up practitioner such as a cardiologist. The process is characterized by reading by telemetry the memory data (12) of the device (10) in a patient by use of a programmer (14), memorizing in a database within the programmer the raw medical data thus read, the database having a memory field (24) containing an identifier of the patient (26), an address (28) of the follow-up practitioner such as a cardiologist or a regular practitioner ensuring the medical follow-up of the patient, as well as the aforementioned raw medical data (30), transmitting by a telematic way (36) to that follow-up practitioner, at the corresponding address, the medical data relating to the identified patient, and collecting, treating and presenting to the follow-up practitioner the medical data thus transmitted.

Abstract: An active implantable medical device for cardiac rhythm management, such as a pacemaker, defibrillator, and/or cardioverter, having an improved DDD/AAI operating mode that automatically switches between operating in an AAI and a DDD pacing mode for cardiac rhythm management. This device includes atrial and ventricular detection and stimulation circuits. It can function in a DDD pacing mode or an AAI pacing mode with ventricular detection.

Abstract: Apparatus for detecting atrial arrhythmias in the treatment of disorders of the heartbeat rate in active implantable medical devices of the pacemaker, cardioverter, defribillator and/or multisite type. This device includes conventional systems, circuits and control algorithm for detecting spontaneous and stimulated ventricular events (R, V) and atrial events (P, A), indicating the delivery of a ventricular and/or atrial event, and inhibiting the detection of atrial events after detection of a ventricular event throughout a post-ventricular atrial absolute refractory period (PVAARP). Detecting atrial events includes protecting against the detection of atrial signals that do not correspond to an atrial event that has actually occurred, in particular protecting against atrial detection of far-field signals caused by a ventricular event.

Abstract: An active implantable medical device, such as a pacemaker, defibrillator and/or cardiovertor having an AAI and/or an AAI/DDD operating mode. This device detects atrial and ventricular events and stimulates the atrium, and calculates an atrial escape interval (AEI). The device defines a critical period preceding or following the end of the AEI and determines, in the event of detection of a ventricular extrasystole (VES), if the moment of occurrence of the VES is in the critical period. The device then recognizes a risk of inappropriate operation and/or false diagnosis related to the temporal proximity of the VES and end of the AEI. In such a case, the device modifies an operating parameter so as to eliminate this risk, for example, by resetting the counting of AEI (AEI*) on detection of the VES. The device can also inhibit a switching of AAI mode to a DDD mode in the event of risk of false diagnosis of atrio-ventricular block.

Abstract: A process for managing data collection for clinical protocols and investigations (registry) relating to the use of active implantable medical devices, such as pacemaker, cardiovertor, defibrillator and multisite devices.

Abstract: An active implantable medical device, such as a pacemaker, defibrillator and/or cardiovertor having an AAI and/or an AAI/DDD operating mode. This device detects atrial and ventricular events and stimulates the atrium, and calculates an atrial escape interval (AEI). The device defines a critical period preceding or following the end of the AEI and determines, in the event of detection of a ventricular extrasystole (VES), if the moment of occurrence of the VES is in the critical period. The device then recognizes a risk of inappropriate operation and/or false diagnosis related to the temporal proximity of the VES and end of the AEI. In such a case, the device modifies an operating parameter so as to eliminate this risk, for example, by resetting the counting of AEI (AEI*) on detection of the VES. The device can also inhibit a switching of AAI mode to a DDD mode in the event of risk of false diagnosis of atrio-ventricular block.

Abstract: An active implantable medical device of the multisite defibrillator/cardioverter type having a sophisticated management of ventricular tachycardias. This device delivers a one of a defibrillation and/or cardioversion and/or ventricular antitachycardia pacing (“ATP”) stimulation therapy mode, as desired and known in the art. The device senses the cardiac activity and detects in the sensed activity a disorder of the ventricular rhythm that is distinct from a ventricular fibrillation condition. The device also includes delivery of biventricular stimulation, connected to at least two ventricular sites, right and left, which is triggered on the detection of the aforesaid disorder of the ventricular rhythm prior to delivering the conventional ATP or shock therapy mode.

Abstract: A device including circuits able to control the switching of a AAI mode in a DDD mode, and conversely the return of DDD mode to AAI mode, according to predetermined criteria of detection of atrio-ventricular block (AVB) of the first, second, or third degree and of ventricular pause. The device includes moreover circuits for detecting state, able to diagnose at least a specific temporary state of the patient, in particular a state of effort or sleep, and the circuits for mode switching operate in response to these circuits for detecting state to modify selectively, for the length of time when the aforementioned state is diagnosed, the criteria of switching from AAI mode towards DDD mode and/or the criteria of return to AAI mode, and/or the criteria of final commutation in DDD mode.

Abstract: An active implantable medical device, in particular a pacemaker, defibrillator, cardiovertor, or a multisite device including detection of a risks of a fusion situation. This device is of the double chamber type, and it detects atrial and ventricular events, provides atrial and ventricular stimulation, and delivers a ventricular stimulation pulse after expiration a programmed atrio-ventricular delay (AVD) following the detection of an atrial event (P, A), and in the absence of detection of a ventricular spontaneous event (R) within the AVD. A fusion situation is detected based on an analysis of a sequence of successive cardiac cycles for which the atrio-ventricular delay is modified from one cycle to the next (AVD, AVD+31, AVD+63).

Abstract: An active implantable medical device comprising circuits for right ventricular, left ventricular, right atrial and eventually left atrial detection, as well as circuits for right and left ventricular stimulation. The device can operate in mode of resynchronization of the ventricular contractions, with an adjustable delay of inter-ventricular stimulation. It includes moreover: circuits for atrial stimulation; circuits able to operate the device in AAI mode with right atrial stimulation and right ventricular detection; circuits for detection of ventricular capture, to determine the detection or the loss of capture after a right ventricular stimulation and a left ventricular stimulation; and of the circuits for mode switching, able to control a switching of mode, from the mode of resynchronization towards AAI mode, in response to the detection of a loss of capture after a right ventricular stimulation or a left ventricular stimulation.

Abstract: An active implantable medical device, in particular a defibrillator/cardioverter, with a sophisticated discrimination of atrial fibrillations. This device is able to deliver therapy for defibrillation, cardioversion, and/or ventricular and/or atrial antitachycardiac pacing stimulation; sense the ventricular and atrial activity; identify a suspicion of and confirm the presence of episodes of tachycardia in the activity thus sensed; analyze the stability of detected RR intervals and the stability of the associated PR intervals; and, in the event of a detection of stable RR intervals and unstable PR intervals, discriminate between atrial fibrillation with fast ventricular rhythm and atrial fibrillation with ventricular tachycardia, and to control delivery of a differentiated therapy according to one case or the other. A bi-tachycardia discrimination also can be made.

Abstract: An active medical device to diagnose a patient respiratory profile. This device is able to measure respiratory activity and deliver a signal (26) representative of the periodicity and amplitude of the successive respiratory cycles of the patient, in particular, a of minute ventilation (MV) signal. The device is able to analyze the aforementioned signal and discriminate between various types of respiratory profiles, in particular, to diagnose a respiratory profile of the Cheyne-Stokes type. This is achieved by detecting an alternation of respiratory cycles of hyperventilation (20) separated by periods of respiratory pause (22) or periods of hypoventilation or normal ventilation (24) and, in the latter case, to discriminate between periods of respiratory pause, corresponding to a profile of the Cheyne-Stokes (CSR) type, and periods of hypoventilation or normal ventilation, corresponding to a profile of the periodic breathing (PB) type.

Abstract: An active medical device having an improved discrimination between an awake phase of a patient and a sleep phase of a patient. This device measures a physiological parameter of a patient, delivers a physiological signal with a slow time response variation, in particular a signal of minute-ventilation (signal MV), and detects whether the patient is in a phase of awakening or sleep. An average (VE) of the signal MV is calculated over a given number of respiratory cycle and compared with a predetermined threshold (Threshold MV), such that a first state of awakening is determined when the average is higher than the threshold, and a first state of sleep is determined in the contrary case. The device also measures patient activity (signal G), using a signal having a short response time.

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.