Abstract: An active implantable medical device, in particular a pacemaker, defibrillator, cardioverter, or multisite device, having an improved cycle to cycle adjustment of the stimulation amplitude. The device stimulates the ventricle, adjusts the stimulation amplitude, periodically evaluates a capture threshold and defines a safety amplitude (Vs), and determines the detection or the loss of a capture on each cardiac cycle after stimulation with a given stimulation amplitude (V). Preferably, the device defines a capture amplitude (Vc) that is higher or equal to the capture threshold, but lower than the safety amplitude.

Abstract: An active implantable medical device such as a pacemaker, defibrillator or cardioverter, able to detect a fusion situation for improving a capture threshold determination. This device is able to deliver to the patient's heart stimulation pulses presenting a predetermined amplitude and a duration, and adjusting the amplitude of these pulses. The adjustment involves calibrating the pulse amplitude, and delivering a stimulation pulse at null or at a primarily null voltage, and measuring automatically the ventricular capture threshold, including detecting the presence or absence of a capture consecutive to a stimulation. The fusion situation is monitored and, in the event of detected fusion situation, used to invalidate the adjustment of the stimulation pulse amplitude. This operates by delivering a stimulation pulse at null or primarily null voltage, and determining the presence of a fusion situation in the event of a detection of a capture in response to a stimulation at null or at primarily null voltage.

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: 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: 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 mulitsite type. This device includes conventional systems, circuits and control algorthym 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 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 implantable medical device, in particular a pacemaker, defibrillator, cardioverter, or multisite device, having an improved cycle to cycle adjustment of the stimulation amplitude. The device stimulates the ventricle, adjusts the stimulation amplitude, periodically evaluates a capture threshold and defines a safety amplitude (Vs), and determines the detection or the loss of a capture on each cardiac cycle after stimulation with a given stimulation amplitude (V). Preferably, the device defines a capture amplitude (Vc) that is higher or equal to the capture threshold, but lower than the safety amplitude.

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: 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, 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 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 such as a pacemaker, defibrillator or cardioverter, able to detect a fusion situation for improving a capture threshold determination. This device is able to deliver to the patient's heart stimulation pulses presenting a predetermined amplitude and a duration, and adjusting the amplitude of these pulses. The adjustment involves calibrating the pulse amplitude, and delivering a stimulation pulse at null or at a primarily null voltage, and measuring automatically the ventricular capture threshold, including detecting the presence or absence of a capture consecutive to a stimulation. The fusion situation is monitored and, in the event of detected fusion situation, used to invalidate the adjustment of the stimulation pulse amplitude. This operates by delivering a stimulation pulse at null or primarily null voltage, and determining the presence of a fusion situation in the event of a detection of a capture in response to a stimulation at null or at primarily null voltage.

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 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 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: 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, especially of the cardiac pacemaker, defibrillator and/or cardiovertor type, and method for the reduction of episodes of arrhythmia, and especially of atrial arrhythmias. The device operates by detecting events of spontaneous electrical activity in a cardiac cavity, especially the atrium; delivering a stimulation to the aforementioned cardiac cavity, which stimulation is controlled according to an actual escape interval such that, at each cardiac cycle, a stimulation is delivered to the cavity if no spontaneous event is detected by the end of a time corresponding to the end of the period of escape interval since the last spontaneous event or the last stimulation in the cavity; counting of the number of successive stimulated events; and discriminating between events detected in the cavity of an extrasystole origin or a non-extrasystole origin.

Abstract: A multi-site pulse generator for the treatment of cardiac insufficiencies by stimulation. In such a multi-site cardiac pulse generator, electrodes are placed in a plurality of distinct respective sites, including at least two ventricular sites. The electrodes are connected to independent outputs of the pulse generator in a manner that allows the detection of a potential of depolarization as well as the application of a stimulation pulse.

Abstract: A device and process for the processing of troubles of the atrial rhythm for an active implantable medical device. The device detects signals from at least the atrial cardiac activity, and stimulates both the atrial and ventricular cardiac cavities, detects the occurrence of atrial extra-systoles (ESA), and determines and releases an intermediate atrial escape interval (PPinter). The intermediate atrial escape interval is then applied during the detection of an atrial extra-systole for improved processing.

Abstract: An active implantable medical device, particularly of the cardiac pacemaker, defibrillator and/or cardiovertor type, having a function of dual chamber cardiac stimulation and a mode of fallback in which a mode of de-synchronisation of the ventricular stimulation occurs when the atrial rhythm exceeds an acceptable level, and a mode of progressive re-synchronisation occurs in the case of a return of the atrial rhythm to the acceptable level. The re-synchronisation is controlled in a conditional manner to be triggered and maintained only if (a) one detects no trouble of the atrial rhythm. In an alternate embodiment the re-synchronisation is triggered and maintained only if, in addition to condition (a): (b) one detects (20) the presence of an effective sinus rhythm.