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EP0000986B1 - Einrichtung zum Programmieren eines implantierten Schrittmachers - Google Patents

Einrichtung zum Programmieren eines implantierten Schrittmachers Download PDF

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Publication number
EP0000986B1
EP0000986B1 EP78300240A EP78300240A EP0000986B1 EP 0000986 B1 EP0000986 B1 EP 0000986B1 EP 78300240 A EP78300240 A EP 78300240A EP 78300240 A EP78300240 A EP 78300240A EP 0000986 B1 EP0000986 B1 EP 0000986B1
Authority
EP
European Patent Office
Prior art keywords
counter
output
programmer
enabling
disabling
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired
Application number
EP78300240A
Other languages
English (en)
French (fr)
Other versions
EP0000986A1 (de
Inventor
John Walter Keller
Dennis Digby
Alan Coombes
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Biotronik SE and Co KG
Original Assignee
Biotronik Mess und Therapiegeraete GmbH and Co
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from US05/917,139 external-priority patent/US4211235A/en
Application filed by Biotronik Mess und Therapiegeraete GmbH and Co filed Critical Biotronik Mess und Therapiegeraete GmbH and Co
Publication of EP0000986A1 publication Critical patent/EP0000986A1/de
Application granted granted Critical
Publication of EP0000986B1 publication Critical patent/EP0000986B1/de
Expired legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/372—Arrangements in connection with the implantation of stimulators
    • A61N1/37211—Means for communicating with stimulators
    • A61N1/37252—Details of algorithms or data aspects of communication system, e.g. handshaking, transmitting specific data or segmenting data
    • A61N1/3727—Details of algorithms or data aspects of communication system, e.g. handshaking, transmitting specific data or segmenting data characterised by the modulation technique
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/37—Monitoring; Protecting
    • G—PHYSICS
    • G08—SIGNALLING
    • G08C—TRANSMISSION SYSTEMS FOR MEASURED VALUES, CONTROL OR SIMILAR SIGNALS
    • G08C19/00—Electric signal transmission systems
    • G08C19/16—Electric signal transmission systems in which transmission is by pulses
    • G08C19/22—Electric signal transmission systems in which transmission is by pulses by varying the duration of individual pulses

Definitions

  • This invention relates to an apparatus for transmitting a preselected signal comprising a sequence of signal bits of different values.
  • Such an apparatus can be termed a programmable transmitter where the signal it is desired to transmit to a receiver may be selected, or set, prior to transmission.
  • the invention is especially concerned with programmable transmitters for enabling programming signals to be transmitted to, and received by, implanted, programmable body function control apparatus such as cardiac pacemakers.
  • Pacemakers for generating artificial stimulating pulses for the heart, and which may be implanted in the body, are well known.
  • the electrical circuitry for such pacemakers was of analog design, but in recent years digital circuitry has been also employed.
  • a digital approach to pacemakers has led to the evolution of programmable pacemakers- pacemakers having parameters such as pulse rates which are adjustable (programmable) once the pacemaker has been implanted.
  • Programmable pacemakers are described in, for instance, British Specifications 1,385,954 and 1,398,875.
  • Such pacemakers have circuitry to detect and decode signals transmitted outside the body and alter the program accordingly.
  • British Specification 1,385,954 (claiming priority based on U.S.S.N. 141694, in turn a parent of U.S.P.N.
  • an external programmer for supplying a fixed number of signal bits as a program for varying given operational functions of an implanted, programmable body function apparatus comprising:
  • the illustrated programmer is designed to transmit an 8-bit tone burst modulated program, that is, an 8-bit pulse width modulated signal where a sine wave carrier frequency is pulse width modulated by each of the 8 data bits.
  • the programmer comprises a "press-to-program” switch 1 tied between the positive supply rail and earth.
  • the switch output drives a monostable 2.
  • the monostable 2 is employed to reset a 13 stage counter 3, and to control an oscillator 4.
  • the oscillator 4 includes an "oscillator disable" NOR gate 16 on its input side which, when supplied with a high input from monostable 2, provides a low output which disables the oscillator output to a clock input of counter 3.
  • stage Q9 is employed to clock a parallel in/serial out eight bit shift register 5 via an inverter 6.
  • the eight parallel inputs for shift register 5 (PI 1 to 8) are labelled A to H and the values of such inputs are set by eight switches which individually can be connected to the positive supply rail or to earth.
  • the Q9 stage of counter 3 also clocks a D-type flip-flop 11 whose D-input is tied to the positive supply rail.
  • the Q output of flip-flop 11 is supplied to one input of a NAND gate 12, whose second input is supplied by the Q1 stage of counter 3.
  • NAND gate 12 drives an amplifier/transmitter 13, outputs from which are transmitted into the body for receipt by an implanted cardiac pacemaker where the received pulses are decoded and employed for changing the program stored in the pacemaker.
  • NOR gate 10 clocks a further D-type flip-flop 14, whose D-input and reset are driven by the Q and Q outputs, respectively, of flip-flop 11.
  • the Q output of flip-flop 14 is employed to reset flip-flop 11.
  • the pacemaker program transmitted by amplifier/transmitter 13 consists of an eight bit pulse-width modulated signal wherein each pulse is itself several cycles of a sine wave carrier frequency.
  • the pulses of short bit length (which might represent "0" in the pacemaker program) and long bit length ("1") are determined by the signal supplied to NAND gate 12 from flip-flop 11 and are initially generated by the values selected by the settings of the eight switches on the inputs A to H of shift register 5.
  • the carrier frequency present in each pulse is derived from the rapid transitions made by the Q1 stage of counter 3, as supplied to the second input of NAND gate 12.
  • the output of NAND gate 12 is thus the square wave carrier frequency from Q1 modulated by the long or short bit lengths determined by the switching times of flip-flop 11. After passage through amplifier/transmitter 13, this output becomes the tone burst modulated signal described above.
  • the monostable 2 output remains high maintaining a reset on counter 3 and disabling oscillator 4.
  • the values of the 8-bits are selected by providing an appropriate combination of values through opening or closing each of the eight switches on the inputs to shift register 5.
  • the inputs H, G, D, and B are tied to the positive supply rail whereas inputs F, E, C, and A are earthed.
  • This will provide, as to be described, for transmission by amplifier/transmitter 13, the program 00110101 where "0" represents a pulse of short length (and "1" of long length), it being appreciated that the values are transmitted in the sequence HGFEDCBA. This arises since the first value appearing at the Q8 output of shift register 5 is the value of the PI 8 input (H).
  • the press-to-program switch 1 is depressed. This causes monostable 2 to fire (i.e. causing its output to go low), thus removing the reset from counter 3 and allowing oscillator 4 to commence running at a period To determined by its timing components. Counter 3 will increment by 1 count on every negative clock edge provided by oscillator 4.
  • flip-flop 11 clocks the level of its D-input to its Q output, putting Q “high” and Q “low”. This removes the reset on flip-flop 14 and places its D-input "high”.
  • the "high” output of Q is also applied to NAND gate 12 to commence transmission of the first bit in the 8- bit sequence of data.
  • the next positive edge on the clock input of flip-flop 14 will clock its Q output to "high” thus resetting flip-flop 11.
  • the reset of the latter will, in turn, reset flip-flop 14, causing its Q output to go “low” and terminate transmission of the first bit in the 8-bit sequence.
  • the time at which flip-flop 14 clocks a "high" to its Q output determines the width of the flip-flop 11 Q output and hence the pulse width of the modulation at point C in Figure 1. It is dependent upon the state of the steering network comprising components 7, 8, 9, and 10.
  • the level on the Q8 output of shift register 5 determines whether the clock pulse for flip-flop 14 arises via NOR gate 7 or 9 and is derived from either the Q6 or Q9 stage of counter 3.
  • gate 7 enabled the first positive edge on the flip-flop 14 clock input occurs at 32T o from the time the flip-flop 11 Q output went "high".
  • gate 9 enabled this first positive edge occurs at 256To from the time the flip-flop 11 Q output went "high".
  • the Q8 output of shift register 5 represents the value at its H input ("high") and this causes the pulse supplied by flip-flop 11 to NAND gate 12 to be cut off after 32To (i.e. causing a short pulse representing "0" to be transmitted).
  • T was set to 0.05 ms: this provided short pulses of 1.6 ms in width and long pulses of 12.8 ms in width. These pulses were modulated via the Q1 stage of counter 3 at 10 KHz.
  • the programmer again comprises a "press-to-program” switch 1 tied between the electrical supply rails.
  • the switch output drives a monostable 2.
  • the monostable 2 is employed to reset a 13 stage counter 3 to control an oscillator 4, and to reset a decade counter 15.
  • the oscillator 4 includes an "oscillator disable" NOR gate 16 which, when supplied with a high input from monostable 2, provides a low output which disables the oscillator output to a clock input of counter 3.
  • the Q7, 8 and 9 output stages of counter 3 are combined through a NAND gate 17 and a NOR gate 18 to provide a "short" output pulse to a transmission gate 19.
  • the Q9 output stage of counter 3 provides a "long” output pulse to a transmission gate 20 and, through inverter 21, to the clock input of the decade counter 15.
  • a NAND gate 22 receives the Q1 output of counter 3 and also the outputs of transmission gates 19 and 20.
  • the output of NAND gate 22 drives an amplifier/transmitter 23, output pulses from which are transmitted into the body for receipt by an implanted programmable cardiac pacemaker where the received pulses are decoded and employed for changing the program stored in the pacemaker.
  • the Q13 output of counter 3 is supplied to a disable input of monostable 2.
  • the decade counter 15 has eight output stages (0 to 7) which are successively employed to control (turn on and off) eight transmission gates which, in this embodiment, take the form of two quad/bilateral switches 24.
  • the eight gates formed by the switches 24 each receive an input from a selected switch 25.
  • the switches 25 (“A" to "H") can be individually connected to the positive supply rail or to earth.
  • the eight outputs of the switches 24 are coupled together to provide a common bus 26 which is employed to control transmission gate 20 and (via inverter 27) transmission gate 19.
  • the counts which are supplied by counter 3 to transmission gates 19 and 20 supply pulses representative of short bit lengths (e.g. "0") and long bit lengths (e.g. "1").
  • the eight bit program desired is selected by setting the switches 25 appropriately and these values are sequentially clocked onto the common bus 26 to open either transmission gate 19 or 20 depending upon the logic value supplied on bus 26.
  • the short or long pulse supplied to the amplifier/transmitter 23 from the opened transmission gate 19 or 20 is employed to modulate the higher frequency count supplied to NAND gate 22 from the Q1 stage of counter 3 so that the output of the amplifier/transmitter is an eight-bit tone burst signal.
  • the press to program switch 1 normally open, the monostable 2 output remains high, maintaining a reset on counters 3 and 15 and disabling oscillator 4. No output is provided to amplifier/transmitter 23.
  • the values of the 8-bits are selected by providing an appropriate combination of values through opening or closing each of the switches 25.
  • the press to program switch 1 is then pressed. Pressing, i.e. closing, switch 1 causes monostable 2 to fire (i.e. causing its output to go low), thus removing the reset from counters 3 and 15 and allowing oscillator 4 to commence running.
  • decade counter 15 is incremented by one so that the count, now at its "one" stage, causes the output value supplied by switch 25 "B” rather than 25 "A” to control which of the transmission gates 19 and 20 is opened.
  • the short or long pulse (modulating the Q1 high frequency output as before) is again transmitted by amplifier/transmitter 23.
  • This cycle repeats for each of the eight switches 25 so that a total of eight tone burst modulated pulses, of either short or long width, is transmitted.
  • the Q13 stage of counter 3 is then reacted to disable monostable 2. This causes the latter to revert to its stable state, which reintroduces a reset to counters 3 and 15 and disables oscillator 4. No further information is hence transmitted until the press to program switch 1 is once again depressed, when the whole cycle would then repeat.
  • the oscillator has a 20 KHz frequency.
  • This provides a 10 KHz output at the Q1 stage of counter 3, a pulse length of 3.2 ms to transmission gate 19 (a "short” pulse), a pulse length of 12.8 ms to transmission gate 20 (a “long” pulse), and a data rate for clocking decade counter 15 of 25.6 ms.
  • the NAND gate 22 thus transmits to amplifier/transmitter 23 eight bits, either of 3.2 ms or 12.8 ms in width and each including a 10 KHz square wave carrier.

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  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Radiology & Medical Imaging (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Physics & Mathematics (AREA)
  • General Physics & Mathematics (AREA)
  • Cardiology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Transmitters (AREA)
  • Electrotherapy Devices (AREA)

Claims (6)

1. Externe Programmiervorrichtung zur Abgabe einer vorgebenen Anzahl von Signal-Bits als Programm zur Veränderung der Betriebsfunktionen einer implantierten programmierbaren Körperfunktionsvorrichtung mit
Registriermitteln (5, 25) zum Auswählen und Speichern einer vorgegebenen Anzahl von Signal-Bits, wobei diese Bits eine codierte Darstellung des Programms bilden, welches der implantierten Vorrichtung seriell zugeführt werden soll,
Signalerzeugungsmitteln (4) zum Erzeugen von Impulsen mit einer vorgegebenen Frequenz und
Ausgangsmitteln (13, 23) zur Übertragung von Signalen von den Signalerzeugungsmitteln (4) zur implantierten Vorrichtung in Abhängigkeit von den ausgewählten und gespeicherten Signal-Bits, dadurch gekennzeichnet, daß die Programmiervorrichtung weiterhin enthält:
Zählmittel (3), welche von den Signalerzeugungsmitteln (4) angesteuert werden, um digitale Kontrollzustände bei drei Unterintervallen eines Bezugzählerstandes zu erzeugen, und
Mittel (11, 19, 10), welche auf die Zählmittel (3) ansprechen, um die Ausgangsmittel (13, 23) zum Aussenden von Signalen, mit der Rate des kleinsten der Unterintervalle zu aktivieren, wobei die Periodizität der Aktiviermittel einem festen Bruchteil der Bezugszählerstände entspricht, und zum Deaktivieren der Ausgangsmittel (13, 23) jeweils einmal nach dem periodischen Aktivieren zu einer Zeit nach der Aktivierung, wobei jede der aufeinanderfolgenden Zeiten dem logischen Zustand eines zugeordneten, folgenden Signal-Bits entspricht.
2. Programmiervorrichtung nach Anspruch 1, dadurch gekennzeichnet, daß die Deaktivierungsmittel weitere Mittel (7 bis 10, 19, 20) enthalten, welche auf das Auftreten eines vorgebenen Signal-Bits in den Registermitteln (5, 25) hin ansprechen, um die Ausgangsmittel (13, 23) auf das Auftreten eines mittleren der Unterintervalle zu deaktivieren und auf das Auftreten von Signal-Bits entgegengesetzter Logik in den Registermitteln (5, 25) reagieren, um die Ausgangsmittel (13, 23) beim Auftreten des dritten der genannten Unterintervalle zu deaktivieren.
3. Programmiervorrichtung nach einem der Ansprüche 1 oder 2, dadurch gekennzeichnet, daß die Aktivierungs- und Deaktivierungsmittel zwei Übertragungsgatter (19, 20) enthalten, wobei der Zähler (3) Eingangssignalle für diese Gatter liefert und die Ausgangssignale, welche von diesen Gattern zu den Ausgangsmitteln (23) gelangen, durch die ausgewählten und gespeicherten Signal-Bits gesteuert werden.
4. Programmiervorrichtung nach einem der Ansprüche 1 oder 2, dadurch gekennzeichnet, daß die Aktivier- und Deaktiviermittel ein erstes Flip-Flop (11) enthalten, zum Steuern der Zeit der Fortsetzung der Übertragung eines Signal-Bits durch die Ausgangsmittel (23) und ein zweites Flip-Flop (14) zur Steuerung der Zeit der Beendigung der Übertragung irgendeines Signal-Bits durch die Ausgangsmittel (23).
5. Programmiervorrichtung nach einem der Ansprüche 1 bis 4, dadurch gekennzeichnet, daß die Signalerzeugungsmittel aufweisen:
Schaltmittel (1) zur Programmier-Aktivierung,
monostabile Mittel (2) welche durch die Schaltmittel angesteuert werden, zum Zurücksetzen des Zählers (3) sowie
Oszcillatormittel (4) welche durch die monostabilen Mittel (2) zum Takten des Zählers (3) angesteuert werden.
6. Programmiervorrichtung nach einem der Ansprüche 1 bis 5, dadurch gekennzeichnet, daß die Zählmittel (3) nach Erreichen des vorgegebenen Zählerstandes (Q 13) die Signalerzeugungsmittel (4) sperren.
EP78300240A 1977-08-19 1978-08-03 Einrichtung zum Programmieren eines implantierten Schrittmachers Expired EP0000986B1 (de)

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
GB3491277 1977-08-19
GB3491277 1977-08-19
US917139 1978-06-19
US05/917,139 US4211235A (en) 1977-08-19 1978-06-19 Programmer for implanted pacer

Publications (2)

Publication Number Publication Date
EP0000986A1 EP0000986A1 (de) 1979-03-07
EP0000986B1 true EP0000986B1 (de) 1982-04-07

Family

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Family Applications (1)

Application Number Title Priority Date Filing Date
EP78300240A Expired EP0000986B1 (de) 1977-08-19 1978-08-03 Einrichtung zum Programmieren eines implantierten Schrittmachers

Country Status (4)

Country Link
EP (1) EP0000986B1 (de)
AU (1) AU517553B2 (de)
CA (1) CA1117217A (de)
DE (1) DE2861717D1 (de)

Families Citing this family (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
IT1118131B (it) * 1978-07-20 1986-02-24 Medtronic Inc Perfezionamento nei pacemaker cardiaci multi-modo adattabili impiantabili
EP0015779B1 (de) * 1979-03-12 1985-06-12 Medtronic, Inc. Apparat zum Programmieren eines Herzschrittmachers

Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4049004A (en) * 1976-02-02 1977-09-20 Arco Medical Products Company Implantable digital cardiac pacer having externally selectible operating parameters and "one shot" digital pulse generator for use therein

Family Cites Families (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3906348A (en) * 1973-08-20 1975-09-16 Chamberlain Mfg Corp Digital radio control
US4024875A (en) * 1975-09-19 1977-05-24 Medtronic, Inc. Device for non-invasive programming of implanted body stimulators
NL7700427A (nl) * 1976-03-03 1977-09-06 Arco Med Prod Co Inplanteerbare digitale hartgangmaker, welke voorzien is van extern kiesbare bedrijfspara- meters.

Patent Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4049004A (en) * 1976-02-02 1977-09-20 Arco Medical Products Company Implantable digital cardiac pacer having externally selectible operating parameters and "one shot" digital pulse generator for use therein

Also Published As

Publication number Publication date
AU517553B2 (en) 1981-08-06
CA1117217A (en) 1982-01-26
DE2861717D1 (en) 1982-05-19
AU3895378A (en) 1980-02-21
EP0000986A1 (de) 1979-03-07

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